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Schwartz AL, Norte GE, Bonnette S, Stock MS, Chaput M, Sherman DA. Steadiness, smoothness, and regularity: looking beyond force variability to construct a holistic description of force quality. J Appl Physiol (1985) 2024; 136:1271-1272. [PMID: 38743395 DOI: 10.1152/japplphysiol.00208.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Ava L Schwartz
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States
| | - Grant E Norte
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Matt S Stock
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States
| | - Meredith Chaput
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States
| | - David A Sherman
- Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States
- Live4 Physical Therapy & Wellness, Acton, Massachusetts, United States
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Fernandes CA, Norte GE, Schwab SM, Gokeler A, Murray A, Bazett-Jones DM, Sherman DA. Interpersonal Coordination between Female Soccer Players: Leader-Follower Roles within a Collision-Avoidance Task. Int J Sports Phys Ther 2024; 19:548-560. [PMID: 38707861 PMCID: PMC11065781 DOI: 10.26603/001c.116156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024] Open
Abstract
Background/Purpose Return to sport decision-making may be improved by assessing an athlete's ability to coordinate movement with opponents in sport. The purpose was to investigate whether previous injuries associated with female soccer players' interpersonal coordination during a collision avoidance task. The authors hypothesized that external perturbations would disrupt the strength and stability of coordinated movement, and that individuals with a history of injury would be less likely to recover coordinated movement. Study Design Cross-Sectional. Methods Nine female athletes with a history of lower extremity injuries and nine without injuries were paired into dyads. Each dyad completed twenty trials of an externally paced collision-avoidance agility task with an unanticipated perturbation. Participant trajectories were digitized and analyzed using cross-recurrence quantification analysis (CRQA) to determine the strength and stability of interpersonal coordination dynamics. Trials in which participants with injury history assumed leader or follower roles within each dyad were then used to study how dyadic coordination varied across task stages (early, perturbation, and late) using linear mixed effect models. Cohen's d effect sizes were calculated to demonstrate magnitude of differences. In exploratory analysis, psychological readiness (i.e., self-reported knee functioning, fear of injury, and risk-taking propensity) was evaluated for their association with leader-follower status. Results Perturbation disrupted the strength (R2=0.65, p<0.001, early=49.7±1.7, perturbation=41.1±1.7, d=0.39) and stability (R2=0.71, p < 0.001, early=65.0±1.6, perturbation=58.0±1.7, d=0.38) of interpersonal coordination regardless of leader-follower status. Individuals with injury history failed to restore coordination after the perturbation compared to control participants (injury=44.2.0±2.1, control=50.8±2.6, d=0.39). Neither demographic nor psychological measures were associated with leader-follower roles (B=0.039, p=0.224). Conclusion Individuals with a history of lower extremity injury may have a diminished ability to adapt interpersonal coordination to perturbations, possibly contributing to a higher risk of re-injury. Level of Evidence 3.
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Affiliation(s)
| | - Grant E Norte
- Cognition Neuroplasticity and Sarcopenia LaboratoryUniversity of Central Florida
| | - Sarah M Schwab
- 3. Department of Rehabilitation, Exercise, & Nutrition SciencesUniversity of Cincinnati
| | - Alli Gokeler
- 4. Exercise Science and Neuroscience, Department of Exercise & HealthPaderborn University
| | - Amanda Murray
- College of Health and Human ServicesUniversity of Toledo
| | | | - David A Sherman
- Chobanian & Avedisian School of MedicineBoston University
- Live4 Physical Therapy and Wellness
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Batista NP, de Oliveira Silva D, Mochizuki L, Norte GE, Bazett-Jones DM. Clinic- and laboratory-based measures of postural control in patellofemoral pain: A systematic review with meta-analysis and evidence gap map. Gait Posture 2024; 109:189-200. [PMID: 38341930 DOI: 10.1016/j.gaitpost.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent musculoskeletal disorder associated with functional impairments. Although postural control is commonly assessed in people with PFP, there are inconsistent results regarding potential postural control deficits in this population. RESEARCH QUESTION This review aims to evaluate whether postural control is impaired in people with patellofemoral pain (PFP) and the effectiveness of interventions on postural control measures. METHODS We searched six databases from their inception to May 5, 2023. We included studies assessing clinic- or laboratory-based postural control measures in people with PFP compared to pain-free controls, and intervention studies with PFP populations. We assessed risk of bias using the Joanna Briggs Institute critical appraisal checklists and the Cochrane Risk of Bias 2 tool. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We used random-effects meta-analyses considering subgroups based on type of task, measure, and intervention. RESULTS Fifty-three studies were included. Very low certainty evidence indicated that people with PFP have shorter anterior (SMD = 0.53, 95 %CI:0.16,0.90), posteromedial (SMD = 0.54, 95 %CI:0.04,1.03) and posterolateral (SMD = 0.59, 95 %CI:0.11,1.07) reach distance, and worse composite score (SMD = 0.46, 95 %CI:0.22,0.70). Very low to moderate certainty evidence indicated that people with PFP have worse anterior-posterior and overall stability indexes during single-leg stance (SMD = -0.71, 95 %CI:-1.29,-0.14; SMD = -0.63, 95 %CI:-0.94,-0.32) and overall stability index during double-leg stance (SMD = -0.39, 95 %CI:-0.78,-0.00), but no differences in center of pressure area during stair ascent (SMD = 0.32, 95 %CI:-2.72, 3.36). Low certainty evidence indicated that kinesio taping improved anterior reach distance (SMD = -0.49, 95 %CI:-0.89,-0.09), while no significant differences were observed between pre- and post-intervention outcomes for conventional rehabilitation and rigid taping. SIGNIFICANCE Clinicians should use clinic- (star excursion or Y-balance tests) and laboratory-based (stability indexes) measures to identify impairments of postural control in people with PFP. Low certainty of evidence suggests short-term improvement in postural control with kinesio taping.
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Affiliation(s)
- Natanael P Batista
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
| | - Danilo de Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - Luis Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
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Sadeqi S, Norte GE, Murray A, Erbulut DU, Goel VK. Two-to-three times increase in natural hip and lumbar non-sagittal plane kinematics can lead to anterior cruciate ligament injury and cartilage failure scenarios during single-leg landings. Clin Biomech (Bristol, Avon) 2024; 112:106170. [PMID: 38198907 DOI: 10.1016/j.clinbiomech.2024.106170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/12/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Analyzing sports injuries is essential to mitigate risk for injury, but inherently challenging using in vivo approaches. Computational modeling is a powerful engineering tool used to access biomechanical information on tissue failure that cannot be obtained otherwise using traditional motion capture techniques. METHODS We extrapolated high-risk kinematics associated with ACL strain and cartilage load and stress from a previous motion analysis of 14 uninjured participants. Computational simulations were used to induce ACL failure strain and cartilage failure load, stress, and contact pressure in two age- and BMI-matched participants, one of each biological sex, during single-leg cross drop and single-leg drop tasks. The high-risk kinematics were exaggerated in 20% intervals, within their physiological range of motion, to determine if injury occurred in the models. Where injury occurred, we reported the kinematic profiles that led to tissue failure. FINDINGS Our findings revealed ACL strains up to 9.99%, consistent with reported failure values in existing literature. Cartilage failure was observed in all eight analyzed conditions when increasing each high-risk kinematic parameter by 2.61 ± 0.67 times the participants' natural landing values. The kinematics associated with tissue failure included peak hip internal rotation of 22.48 ± 19.04°, peak hip abduction of 22.51 ± 9.09°, and peak lumbar rotation away from the stance limb of 11.56 ± 9.78°. INTERPRETATION Our results support the ability of previously reported high-risk kinematics in the literature to induce injury and add to the literature by reporting extreme motion limits leading to injurious cases. Therefore, training programs able to modify these motions during single-leg landings may reduce the risk of ACL injury and cartilage trauma.
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Affiliation(s)
- Sara Sadeqi
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Toledo, OH 43606, USA.
| | - Grant E Norte
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL 32816, USA
| | - Amanda Murray
- Doctor of Physical Therapy Program, Department of Exercise & Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH 43606, USA
| | - Deniz U Erbulut
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Toledo, OH 43606, USA
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Toledo, OH 43606, USA
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Riehm CD, Bonnette S, Rush JL, Diekfuss JA, Koohestani M, Myer GD, Norte GE, Sherman DA. Corticomuscular cross-recurrence analysis reveals between-limb differences in motor control among individuals with ACL reconstruction. Exp Brain Res 2024; 242:355-365. [PMID: 38092900 PMCID: PMC10872341 DOI: 10.1007/s00221-023-06751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 01/04/2024]
Abstract
Surgical reconstruction of the anterior cruciate ligament (ACL) and subsequent physical therapy can help athletes return to competition; however, re-injury rates remain disproportionately high due, in part, to lingering biomechanical and neurological factors that are not fully addressed during rehabilitation. Prior reports indicate that individuals exhibit altered electrical activity in both brain and muscle after ACL reconstruction (ACLR). In this investigation, we aimed to extend existing approaches by introducing a novel non-linear analysis of corticomuscular dynamics, which does not assume oscillatory coupling between brain and muscle: Corticomuscular cross-recurrence analysis (CM-cRQA). Our findings indicate that corticomuscular dynamics vary significantly between involved (injured) and uninvolved legs of participants with ACLR during voluntary isometric contractions between the brain and both the vastus medialis and lateralis. This finding points to a potential lingering neural deficit underlying re-injury for athletes after surgical reconstruction, namely the dynamical structure of neuromuscular (brain to quad muscle) coordination, which is significantly asymmetric, between limbs, in those who have ACLR.
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Affiliation(s)
- Christopher D Riehm
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA.
- Emory Sports Medicine Center, Atlanta, GA, USA.
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin L Rush
- Division of Physical Therapy, School of Rehabilitation Sciences, Ohio University, Athens, OH, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Moein Koohestani
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Grant E Norte
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - David A Sherman
- Live4 Physical Therapy and Wellness, Acton, MA, USA
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
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Sherman DA, Rush J, Stock MS, D. Ingersoll C, E. Norte G. Neural drive and motor unit characteristics after anterior cruciate ligament reconstruction: implications for quadriceps weakness. PeerJ 2023; 11:e16261. [PMID: 37818333 PMCID: PMC10561646 DOI: 10.7717/peerj.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose The purpose of this investigation was to compare the quality of neural drive and recruited quadriceps motor units' (MU) action potential amplitude (MUAPAMP) and discharge rate (mean firing rate (MFR)) relative to recruitment threshold (RT) between individuals with anterior cruciate ligament reconstruction (ACLR) and controls. Methods Fourteen individuals with ACLR and 13 matched controls performed trapezoidal knee extensor contractions at 30%, 50%, 70%, and 100% of their maximal voluntary isometric contraction (MVIC). Decomposition electromyography (dEMG) and torque were recorded concurrently. The Hoffmann reflex (H-reflex) and central activation ratio (CAR) were acquired bilaterally to detail the proportion of MU pool available and volitionally activated. We examined MUAPAMP-RT and MFR-RT relationships with linear regression and extracted the regression line slope, y-intercept, and RT range for each contraction. Linear mixed effect modelling used to analyze the effect of group and limb on regression line slope and RT range. Results Individuals with ACLR demonstrated lower MVIC torque in the involved limb compared to uninvolved limb. There were no differences in H-reflex or CAR between groups or limbs. The ACLR involved limb demonstrated smaller mass-normalized RT range and slower MU firing rates at high contraction intensities (70% and 100% MVIC) compared to uninvolved and control limbs. The ACLR involved limb also demonstrated larger MU action potentials in the VM compared to the contralateral limb. These differences were largely attenuated with relative RT normalization. Conclusions These results suggest that persistent strength deficits following ACLR may be attributable to a diminished quadriceps motor neuron pool and inability to upregulate the firing rate of recruited MUs.
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Affiliation(s)
- David A. Sherman
- Live4 Physical Therapy and Wellness, Acton, Massachusetts, United States of America
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
| | - Justin Rush
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, Ohio, United States of America
| | - Matt S. Stock
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, United States of America
| | - Christopher D. Ingersoll
- College of Health Professions and Sciences, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, Florida, United States of America
| | - Grant E. Norte
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, United States of America
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Sadeqi S, Norte GE, Murray A, Erbulut DU, Goel VK. Effect of Whole Body Parameters on Knee Joint Biomechanics: Implications for ACL Injury Prevention During Single-Leg Landings. Am J Sports Med 2023; 51:2098-2109. [PMID: 37259968 DOI: 10.1177/03635465231174899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Previous studies have examined the effect of whole body (WB) parameters on anterior cruciate ligament (ACL) strain and loads, as well as knee joint kinetics and kinematics. However, articular cartilage damage occurs in relation to ACL failure, and the effect of WB parameters on ACL strain and articular cartilage biomechanics during dynamic tasks is unclear. PURPOSES (1) To investigate the effect of WB parameters on ACL strain, as well as articular cartilage stress and contact force, during a single-leg cross drop (SLCD) and single-leg drop (SLD). (2) To identify WB parameters predictive of high ACL strain during these tasks. STUDY DESIGN Descriptive laboratory study. METHODS Three-dimensional motion analysis data from 14 physically active men and women were recorded during an SLCD and SLD. OpenSim was used to obtain their kinematics, kinetics, and muscle forces for the WB model. Using these data in kinetically driven finite element simulations of the knee joint produced outputs of ACL strains and articular cartilage stresses and contact forces. Spearman correlation coefficients were used to assess relationships between WB parameters and ACL strain and cartilage biomechanics. Moreover, receiver operating characteristic curve analyses and multivariate binary logistic regressions were used to find the WB parameters that could discriminate high from low ACL strain trials. RESULTS Correlations showed that more lumbar rotation away from the stance limb at peak ACL strain had the strongest overall association (ρ = 0.877) with peak ACL strain. Higher knee anterior shear force (ρ = 0.895) and lower gluteus maximus muscle force (ρ = 0.89) at peak ACL strain demonstrated the strongest associations with peak articular cartilage stress or contact force in ≥1 of the analyzed tasks. The regression model that used muscle forces to predict high ACL strain trials during the dominant limb SLD yielded the highest accuracy (93.5%), sensitivity (0.881), and specificity (0.952) among all regression models. CONCLUSION WB parameters that were most consistently associated with and predictive of high ACL strain and poor articular cartilage biomechanics during the SLCD and SLD tasks included greater knee abduction angle at initial contact and higher anterior shear force at peak ACL strain, as well as lower gracilis, gluteus maximus, and medial gastrocnemius muscle forces. CLINICAL RELEVANCE Knowledge of which landing postures create a high risk for ACL or cartilage injury may help reduce injuries in athletes by avoiding those postures and practicing the tasks with reduced high-risk motions, as well as by strengthening the muscles that protect the knee during single-leg landings.
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Affiliation(s)
- Sara Sadeqi
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- Motion Analysis and Integrative Neurophysiology Lab, Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Amanda Murray
- Motion Analysis and Integrative Neurophysiology Lab, Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Deniz U Erbulut
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
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Garcia MC, Heiderscheit BC, Kraus EA, Norte GE, Murray AM, Bazett-Jones DM. Preferred temporal-spatial parameters, physical maturation, and sex are related to vertical and braking forces in adolescent long-distance runners. Sports Biomech 2023:1-11. [PMID: 37246741 DOI: 10.1080/14763141.2023.2218325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
For adults, increasing cadence reduces ground reaction forces, but a lower preferred cadence does not predispose adults to experience higher ground reaction forces. Pubertal growth and motor control changes influence running mechanics, but it is unknown if preferred cadence or step length are associated with ground reaction forces for pre-adolescent and adolescent runners. Pre-adolescent and adolescent runners underwent an overground running analysis at a self-selected speed. Mixed model multiple linear regressions investigated the associations of preferred cadence, step length, physical maturation, and sex on ground reaction forces, while accounting for running speed and leg length. Running with a lower preferred cadence or longer preferred step length was associated with larger peak braking and vertical forces (p ≤ .01), being less physically mature was associated with larger vertical impact peak force and vertical loading rate (p ≤ .01), and being a male was associated with larger loading rates (p ≤ .01). A lower preferred cadence or longer preferred step length were associated with higher braking and vertical forces and being less physically mature or a male were associated with higher loading rates. An intervention to increase cadence/decrease step length could be considered if ground reaction forces are a concern for an adolescent runner.
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Affiliation(s)
- Micah C Garcia
- Motion Analysis and Integrative Neurophysiology Lab, College of Health and Human Services, The University of Toledo, Toledo, OH, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Emily A Kraus
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Grant E Norte
- Motion Analysis and Integrative Neurophysiology Lab, College of Health and Human Services, The University of Toledo, Toledo, OH, USA
| | - Amanda M Murray
- Motion Analysis and Integrative Neurophysiology Lab, College of Health and Human Services, The University of Toledo, Toledo, OH, USA
| | - David M Bazett-Jones
- Motion Analysis and Integrative Neurophysiology Lab, College of Health and Human Services, The University of Toledo, Toledo, OH, USA
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Kuenze C, Weaver A, Grindstaff TL, Ulman S, Norte GE, Roman DP, Giampetruzzi N, Lisee CM, Birchmeier T, Triplett A, Farmer B, Hopper H, Sherman DA, Ness BM, Collins K, Walaszek M, Baez SE, Harkey MS, Tulchin-Francis K, Ellis H, Wilson PL, Chang ES, Wilcox CL, Schorfhaar A, Shingles M, Hart JM. Age-, Sex-, and Graft-Specific Reference Values From 783 Adolescent Patients at 5 to 7 Months After ACL Reconstruction: IKDC, Pedi-IKDC, KOOS, ACL-RSI, Single-Leg Hop, and Thigh Strength. J Orthop Sports Phys Ther 2023; 53:1-8. [PMID: 36688716 DOI: 10.2519/jospt.2023.11389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE: To describe age-, sex-, and graft source-specific reference values for patient-reported, physical function, and strength outcome measures in adolescents at 5 to 7 months after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. METHODS: Data were collected at 3 universities and 2 children's hospitals. The participants completed at least one of the International Knee Documentation Committee (IKDC) Subjective Evaluation Form, Pediatric IKDC (Pedi-IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Participants also completed single-leg hop tests and/or isokinetic quadriceps and hamstrings strength assessments (at 60°/s). Reference values were summarized using descriptive statistics and stratified for age, sex, and graft source. RESULTS: Reference values were reported for common patient-reported outcomes and measures of physical function and strength from 783 participants (56% females, age = 16. 4 ± 2.0 years) who were in early adolescence (12-14 years, N = 183, 52% females), middle adolescence (15-17 years, N = 456, 58% females), or late adolescence (18-20 years, N = 144, 55% females). Three hundred seventy-nine participants (48.4%) received a bone-patellar tendon-bone autograft, 292 participants (37.3%) received hamstring tendon autograft, and 112 participants (14.3%) received autograft or allograft from an alternative source. CONCLUSION: Reference values for common patient-reported outcomes and measures of physical function and strength differed depending on a patient's age, sex, and graft source. Using patient-specific reference values, in addition to previously described age-appropriate cutoff values, may help clinicians monitor and progress patients through rehabilitation and return to physical activity after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2023;53(4):1-8. Epub: 23 January 2023. doi:10.2519/jospt.2023.11389.
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Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Weaker Quadriceps Corticomuscular Coherence in Individuals after ACL Reconstruction during Force Tracing. Med Sci Sports Exerc 2023; 55:625-632. [PMID: 36730761 DOI: 10.1249/mss.0000000000003080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to compare quadriceps corticomuscular coherence (CMC) and force steadiness between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a force tracing task. METHODS Individuals with ACLR ( n = 20) and controls ( n = 20) performed a knee extension force-control task at 50% of maximal voluntary effort. Electrocortical activity, electromyographic activity, and torque output were recorded concurrently. CMC in beta (13-30 Hz) and gamma (31-80 Hz) frequency bands was assessed using partial directed coherence between the contralateral motor cortex (e.g., C4-C2-Cz electrodes) and the ipsilateral quadriceps muscles (e.g., left vastus medialis and lateralis). Force steadiness was quantified using root-mean-square error and coefficient of variation. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) were assessed using peak knee extension strength and active motor threshold as a priori covariates. RESULTS Participants with ACLR had lower gamma band connectivity bilaterally when compared with controls (vastus medialis: d = 0.8; vastus lateralis: d = 0.7). Further, the ACLR group demonstrated worse quadriceps force steadiness (root-mean-square error, d = 0.5), lower involved limb quadriceps strength ( d = 1.1), and higher active motor threshold ( d = 1.0) compared with controls. CONCLUSIONS Lower quadriceps gamma band CMC in the ACLR group suggests lower cortical drive (e.g., corticomotor decoupling) to the quadriceps compared with matched controls. Further, the ACLR group demonstrated worse quadriceps force steadiness, suggesting impaired ability to modulate quadriceps neuromuscular control. Notably, CMC differences were present only in the gamma frequency band, suggesting impairments may be specific to multisensory integration and force modulation.
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Affiliation(s)
| | - Jochen Baumeister
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, GERMANY
| | - Matt S Stock
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL
| | - Amanda M Murray
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
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Young KM, Rush JL, Lepley AS, Girmann AM, Norte GE. Intersession Reliability of Quadriceps Corticospinal Excitability: A Functional Transcranial Magnetic Stimulation Study. Brain Res 2023; 1808:148348. [PMID: 36972836 DOI: 10.1016/j.brainres.2023.148348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
Recording transcranial magnetic stimulation-derived measures during a closed kinetic chain task can serve as a functional technique to assess corticomotor function, which may have implications for activities of daily living or lower extremity injury in physically active individuals. Given the novelty of TMS use in this way, our purpose was to first determine the intersession reliability of quadriceps corticospinal excitability during a single-leg squat. We used a descriptive laboratory study to assess 20 physically active females (22.1 ± 2.5 years, 1.7 ± 0.7 m, 66.3 ± 13.6 kg, Tegner Activity Scale: 5.90 ± 1.12) over a 14-day period. Two-way mixed effects Intraclass Correlation Coefficients (3,1) (ICC) for absolute agreement were used to assess intersession reliability. The active motor threshold (AMT) and normalized motor evoked potential (MEP) amplitudes were assessed in the vastus medialis of each limb. The dominant limb AMTs demonstrated moderate-to-good reliability (ICC = 0.771, 95% CI = 0.51-0.90; p < 0.001). The non-dominant limb AMTs (ICC = 0.364, 95% CI = 0.00-0.68, p = 0.047), dominant limb MEPs (ICC = 0.192, 95% CI = 0.00-0.71; p = 0.340), and non-dominant limb MEPs (ICC = 0.272, 95% CI = 0.00-0.71; p = 0.235) demonstrated poor-to-moderate reliability. These findings may provide insight into corticomotor function during activities requiring weight-bearing, single-leg movement. However, variability in agreement suggests further work is warranted to improve the standardization of this technique prior to incorporating in clinical outcomes research.
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Affiliation(s)
- Kiana M Young
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States of America
| | - Justin L Rush
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States of America.
| | - Adam S Lepley
- Exercise and Sport Science Initiative, School of Kinesiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Adam M Girmann
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States of America
| | - Grant E Norte
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States of America
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Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Brain activation and single-limb balance following anterior cruciate ligament reconstruction. Clin Neurophysiol 2023; 149:88-99. [PMID: 36933325 DOI: 10.1016/j.clinph.2023.02.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To compare brain activity between individuals with anterior cruciate ligament reconstruction (ACLR) and controls during balance. To determine the influence of neuromodulatory interventions (external focus of attention [EF] and transcutaneous electrical nerve stimulation [TENS]) on cortical activity and balance performance. METHODS Individuals with ACLR (n = 20) and controls (n = 20) performed a single-limb balance task under four conditions: internal focus (IF), object-based-EF, target-based-EF, and TENS. Electroencephalographic signals were decomposed, localized, and clustered to generate power spectral density in theta and alpha-2 frequency bands. RESULTS Participants with ACLR had higher motor-planning (d = 0.5), lower sensory (d = 0.6), and lower motor activity (d = 0.4-0.8), while exhibiting faster sway velocity (d = 0.4) than controls across all conditions. Target-based-EF decreased motor-planning (d = 0.1-0.4) and increased visual (d = 0.2), bilateral sensory (d = 0.3-0.4), and bilateral motor (d = 0.4-0.5) activity in both groups compared to all other conditions. Neither EF conditions nor TENS changed balance performance. CONCLUSIONS Individuals with ACLR exhibit lower sensory and motor processing, higher motor planning demands, and greater motor inhibition compared to controls, suggesting visual-dependence and less automatic balance control. Target-based-EF resulted in favorable reductions in motor-planning and increases in somatosensory and motor activity, transient effects in line with impairments after ACLR. SIGNIFICANCE Sensorimotor neuroplasticity underlies balance deficits in individuals with ACLR. Neuromodulatory interventions such as focus of attention may induce favorable neuroplasticity along with performance benefits.
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Affiliation(s)
- David A Sherman
- Live4 Physical Therapy and Wellness, Acton, MA, USA; Dept. of Physical Therapy & Athletic Training, College of Health & Rehabilitation Science: Sargent College, Boston University, Boston, MA, USA; Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
| | - Jochen Baumeister
- Exercise Science & Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Matt S Stock
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA.
| | - Amanda M Murray
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - David M Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA.
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Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Inhibition of Motor Planning and Response Selection after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2023; 55:440-449. [PMID: 36731010 DOI: 10.1249/mss.0000000000003072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to compare cortical motor planning activity during response selection and motor execution processes between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a reaction time and response selection task. METHODS Individuals with ACLR ( n = 20) and controls ( n = 20) performed a lateralized choice reaction time (e.g., Go/NoGo) task. Electrocortical activity and reaction time were recorded concurrently using electroencephalography and inertial measurement units. Separate stimulus locked and response-locked event-related potentials were computed for each limb. The lateralized readiness potential (LRP) was computed as the interhemispheric differences between waveforms and the mean LRP area and onset latency were recorded. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) and the associations between LRP characteristics and response performance (number of errors) were assessed. RESULTS Participants with ACLR have had smaller LRP area during periods of response selection ( P = 0.043, d = 0.4) and motor execution ( P = 0.015, d = 0.5) and committed more errors in both Go ( P < 0.001, d = 0.8) and NoGo ( P = 0.032, d = 0.5) response conditions. There were no differences in latency of response selection or motor execution. Participants with ACLR had higher active motor thresholds ( P < 0.001, d = 1.3) than controls, which was weakly associated with smaller LRP areas ( r = 0.32-0.42, P < 0.05). CONCLUSIONS The ACLR group demonstrated greater motor planning and response inhibition during a choice reaction time task. More errant performance also suggests poorer decision making in the presence of a "speed-accuracy" trade-off. Key features of the sample, including lower corticospinal excitability, lend support to an interpretation of widespread cortical inhibition contributing to impairments in response selection and motor execution.
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Affiliation(s)
| | - Jochen Baumeister
- Exercise Science & Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, GERMANY
| | - Matt S Stock
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL
| | - Amanda M Murray
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
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Chaltron C, Sherman DA, Pamukoff DN, Bazett-Jones DM, Glaviano NR, Norte GE. Whole-body vibration reduces hamstrings neuromuscular function in uninjured individuals. Phys Ther Sport 2023; 60:17-25. [PMID: 36640639 DOI: 10.1016/j.ptsp.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Despite the growing use of whole-body vibration (WBV) to enhance quadriceps neuromuscular function, the hamstrings-specific response is unclear among those without neuromuscular impairment, which is important to inform performance-based recommendations. Our objective was to determine the immediate and prolonged effects of WBV on hamstrings and quadriceps neuromuscular function in uninjured individuals. DESIGN Crossover. SETTING Laboratory. PARTICIPANTS Nineteen, recreationally active individuals performed WBV and control exercise protocols, consisting of six 1-min repetitions of isometric squats, on separate days in a randomized order. MAIN OUTCOME MEASURES Electromyographic (EMG) amplitude, antagonist-to-agonist co-activation, rate of torque development, and peak torque of the hamstrings and quadriceps were measured pre-, immediately post-, and 20 min post-condition. Percentage change scores were calculated from baseline to each post-measurement. RESULTS A condition main effect indicated that WBV reduced agonist semitendinosus EMG amplitudes more than the control (-12.1% vs. -1.5%, p < .001). Antagonist vastus medialis EMG amplitudes were reduced immediately, but not 20 min following WBV (-7.1% vs. 3.5%, p < .001). CONCLUSIONS WBV induced an inhibitory effect on medial hamstrings activity during knee flexion contraction in a majority of our sample, yet this response was not uniformly observed and its functional relevance remains unclear in an uninjured population.
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Affiliation(s)
- Cale Chaltron
- University of Kentucky, Athletics Department, Lexington, KY, 40506, United States.
| | - David A Sherman
- Live4 Physical Therapy and Wellness Advising, 525 Massachusetts Ave, Suite 206B, Acton, MA, 01720, United States; Boston University, Department of Physical Therapy and Athletic Training, 635 Commonwealth Avenue, Boston, MA, 02215, United States.
| | - Derek N Pamukoff
- Western University, School of Kinesiology, 1151 Richmond St, London, ON, N6A 3K7, UK.
| | - David M Bazett-Jones
- University of Toledo (study Site), Department of Exercise and Rehabilitation Sciences, 2801 W. Bancroft St., Health and Human Services, 2505H, Mail Stop 119, Toledo, OH, 43606, United States.
| | - Neal R Glaviano
- University of Connecticut, Department of Kinesiology, 2095 Hillside Rd, U-1110, Storrs, CT, 06269, United States.
| | - Grant E Norte
- University of Toledo (study Site), Department of Exercise and Rehabilitation Sciences, 2801 W. Bancroft St., Health and Human Services, 2505H, Mail Stop 119, Toledo, OH, 43606, United States.
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15
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Norte GE, Cousins M, Hogarth DA, Knaus KR, Slater LV, Blemker SS, Hart JM. Personalized volumetric assessment of lower body muscles in patients with knee injuries: A descriptive case series. Knee 2022; 39:38-49. [PMID: 36126493 DOI: 10.1016/j.knee.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with knee joint pathology present with variable muscular responses across the muscles of the lower limb and pelvis. Conventional approaches to characterizing muscle function are limited to gross strength assessments that may overlook subtle changes both in the thigh, hip and shank musculature. PURPOSE To describe individualized patterns of lower extremity muscle volumes in patients with knee pathologies. METHODS This was a retrospective case series performed in a University medical center. Nine patients diagnosed with meniscus tear recommended to undergo meniscectomy volunteered. Participants underwent 3.0 Tesla magnetic resonance imaging (MRI) of the lower extremities. Thirty-five MRI-derived muscle volumes were compared between limbs and expressed as percentage asymmetry. For additional context, z-scores were also calculated for mass- and height-normalized muscles and pre-determined muscle groupings relative to a normative database. RESULTS There were no consistent patterns observed when considering between-limb asymmetries among all patients. The ankle musculature (dorsiflexors, plantar flexors, and invertors) was the only muscle group to be consistently smaller than normal for all patients, with the psoas major and flexor hallucis longus being the only individual muscles. The severity or chronicity of injury and presence of surgical intervention did not appear to have a clear effect on muscle volumes. CONCLUSION Patients with a history of meniscal pathology demonstrate inconsistent patterns of lower extremity muscle volumes about the hip, knee, and ankle between limbs and in comparison to uninjured individuals. These data support the need for individualized assessment and intervention in this population.
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Affiliation(s)
- Grant E Norte
- Department of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, United States.
| | | | - Danielle A Hogarth
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States
| | - Katherine R Knaus
- Department of Bioengineering, University of California at San Diego, San Diego, CA, United States
| | - Lindsay V Slater
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Silvia S Blemker
- Springbok Analytics, Charlottesville, VA, United States; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States; Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States; Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, United States
| | - Joseph M Hart
- Springbok Analytics, Charlottesville, VA, United States; Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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16
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Garcia MC, Heiderscheit BC, Murray AM, Norte GE, Kraus E, Bazett-Jones DM. One size does not fit all: Influence of sex and maturation on temporal-spatial parameters for adolescent long-distance runners. J Sports Sci 2022; 40:2153-2158. [PMID: 36352559 DOI: 10.1080/02640414.2022.2142743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Runners and coaches are often interested in identifying the "ideal" running form to reduce the risk of injury and improve performance. While differences in pelvis and hip motion have been reported among adolescent female and male long-distance runners of different stages of physical maturation, the influence of sex and/or maturation on temporal-spatial parameters is unknown for adolescent runners. Adolescent runners of different stages of physical maturation (pre-, mid-, post-pubertal) completed an overground running analysis at a self-selected speed. We performed 2 × 3 ANCOVAs (covariate = running speed) to compare temporal-spatial parameters among sex and maturation groups. Pre-adolescents ran with higher cadences and shorter step lengths than mid- (p ≤ .01) and post-pubertal adolescents (p ≤ .01), respectively. Mid-pubertal males and post-pubertal females also ran with higher cadences and shorter step lengths than post-pubertal males (p ≤ .01). When step length was normalized to leg length, less physically mature runners demonstrated longer normalized step lengths (p ≤ .01). Caution is advised when using a "one-size-fits-all" approach for recommending an "ideal" cadence and/or step length for adolescent long-distance runners. A runner's sex, stage of physical maturation and leg length should be considered when assessing and prescribing cadence and/or step length.
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Affiliation(s)
- Micah C Garcia
- Motion Analysis and Integrative Neurophysiology Lab, College of Health and Human Services, the University of Toledo, Toledo, OH, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Amanda M Murray
- Motion Analysis and Integrative Neurophysiology Lab, College of Health and Human Services, the University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- Motion Analysis and Integrative Neurophysiology Lab, College of Health and Human Services, the University of Toledo, Toledo, OH, USA
| | - Emily Kraus
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - David M Bazett-Jones
- Motion Analysis and Integrative Neurophysiology Lab, College of Health and Human Services, the University of Toledo, Toledo, OH, USA
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Takeno K, Ingersoll CD, Glaviano NR, Khuder S, Norte GE. Neuromuscular function of the shoulder girdle and upper extremity musculature in individuals with a history of glenohumeral labral repair. Scand J Med Sci Sports 2022; 32:1377-1388. [PMID: 35612722 DOI: 10.1111/sms.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/10/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to compare neuromuscular function in the upper extremity musculature between individuals with glenohumeral labrum repair and uninjured controls. This cross-sectional study examined 16 individuals with a primary, unilateral glenohumeral labral repair (male/female: 13/3, age: 24.1 ± 5.0 years, time from surgery: 36.7 ± 33.3 months) and 14 uninjured individuals (male/female: 11/3, age: 23.8 ± 2.7 years) matched by age, sex, activity level, and limb dominance participated. Mass-normalized shoulder abduction and wrist flexion maximal voluntary isometric contraction (MVIC) torque, motoneuron pool excitability of the flexor carpi radialis (Hoffmann reflex), and corticospinal excitability of the upper trapezius, middle deltoid, and flexor carpi radialis (active motor threshold [AMT]) were evaluated. Dependent and independent t-tests were used to assess between-limb and between-group comparisons. Cohen's d effect sizes with 95% confidence intervals were used to quantify the magnitude of differences observed. Within the injured group, the involved limb had lesser shoulder abduction MVIC torque (p < 0.001, d = 1.16) and higher AMT for the upper trapezius (p = 0.01, d = 0.81) compared with the contralateral limb. The labral repair group had lesser shoulder abduction MVIC torque (p < 0.001, d = 1.17) and Hoffmann reflex (p = 0.01, d = 0.99), as well as higher AMT for the upper trapezius (p < 0.001, d = 1.23) in their involved limb compared with the control group. Large magnitude neuromuscular impairments are present beyond 6 months from glenohumeral labral repair, suggesting potential origins of impairments to be addressed during post-operative rehabilitation.
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Affiliation(s)
- Katsumi Takeno
- Department of Kinesiology, University of North Georgia, Dahlonega, Georgia, USA
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Sherman DA, Lehmann T, Baumeister J, Grooms DR, Norte GE. Somatosensory perturbations influence cortical activity associated with single-limb balance performance. Exp Brain Res 2022; 240:407-420. [PMID: 34767059 DOI: 10.1007/s00221-021-06260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022]
Abstract
To determine the association between cortical activity and postural control performance changes with differing somatosensory perturbations. Healthy individuals (n = 15) performed a single-limb balance task under four conditions: baseline, unstable surface (foam), transcutaneous electrical nerve stimulation (TENS) applied to the stance-limb knee, and combined foam + TENS. Cortical activity was recorded with electroencephalography (EEG) and postural sway via triaxial force plate. EEG signals were decomposed, localized, and clustered to generate power spectral density in theta (4-7 Hz) and alpha-2 (10-12 Hz) frequency bands in anatomical clusters. Postural sway signals were analyzed with center of pressure (COP) sway metrics (e.g., area, distance, velocity). Foam increased theta power in the frontal and central clusters (d = 0.77 to 1.16), decreased alpha-2 power in bilateral motor, right parietal, and occipital clusters (d = - 0.89 to - 2.35) and increased sway area, distance, and velocity (d = 1.09-2.57) relative to baseline. Conversely, TENS decreased central theta power (d = - 0.60), but increased bilateral motor, left parietal, and occipital alpha-2 power (d = 0.51-1.40), with similar to baseline balance performance. In combination, foam + TENS attenuated sway velocity detriments and cortical activity caused by the foam condition alone. There were weak and moderate associations between percent increased central theta and occipital activity and increased sway velocity. Somatosensory perturbations changed patterns of cortical activity during a single-limb balance task in a manner suggestive of sensory re-weighting to pertinent sensory feedback. Across conditions decreased cortical activity in pre-motor and visual regions were associated with reduced sway velocity.
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Affiliation(s)
- David A Sherman
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, 2801 W. Bancroft St., HH 2505E, Mail Stop 119, Toledo, OH, 43606, USA.
| | - Tim Lehmann
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Jochen Baumeister
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Dustin R Grooms
- Division of Physical Therapy, Division of Athletic Training, Ohio Musculoskeletal and Neurological Institute, College of Health Sciences and Professions, Ohio University, Athens, OH, 45701, USA
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, 2801 W. Bancroft St., HH 2505E, Mail Stop 119, Toledo, OH, 43606, USA
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Sherman DA, Lehmann T, Baumeister J, Gokeler A, Donovan L, Norte GE. External Focus of Attention Influences Cortical Activity Associated With Single Limb Balance Performance. Phys Ther 2021; 101:6374811. [PMID: 34636850 DOI: 10.1093/ptj/pzab223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/24/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE External focus (EF) of attention leads to improved balance performance. Consideration of the neuromodulatory effects of EF may inform its clinical utility in addressing neuroplastic impairments after musculoskeletal injuries. This study aimed to determine whether electrocortical activity and balance performance changed with attentional foci that prioritized differing sensory feedback and whether changes in electrocortical activity and balance were associated. METHODS Individuals who were healthy (n = 15) performed a single-limb balance task under 3 conditions: internal focus (IF), somatosensory focus (EF with a baton [EF-baton]), and visual focus (EF with a laser [EF-laser]). Electrocortical activity and postural sway were recorded concurrently using electroencephalography and a triaxial force plate. Electroencephalographic signals were decomposed, localized, and clustered to generate power spectral density in θ and α-2 frequency bands. Postural sway signals were analyzed with center-of-pressure sway metrics (eg, area, distance, velocity) and knee angle. The relationship between percent change in clustered brain activity and task performance metrics was assessed. RESULTS Both EF conditions resulted in increased cortical activity and improved balance performance compared with IF. EF-laser had the largest effect, demonstrating increased frontal θ power (d = 0.64), decreased central θ power (d = -0.30), and decreased bilateral motor, bilateral parietal, and occipital α-2 power (d = -1.38 to -4.27) as well as a shorter path distance (d = -0.94) and a deeper (d = 0.70) and less variable (d = -1.15) knee angle than IF. Weak to moderate associations exist between increases in cortical activity and improved balance performance (ρ = 0.405-0.584). CONCLUSION EF resulted in increased cortical activity associated with cognitive, motor, somatosensory, and visual processing. EF-laser, which prioritized visual feedback, had the largest and broadest effects. Changes in cortical activity resulting from EF were independently associated with improved balance performance. IMPACT This study demonstrates that goal-oriented attention results in functional increases in brain activity compared with internally directed self-focus. These results suggest EF may target neurophysiologic impairments and improve balance in clinical populations.
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Affiliation(s)
- David A Sherman
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Tim Lehmann
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Jochen Baumeister
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Alli Gokeler
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany.,Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands.,OCON Center of Orthopaedic Surgery and Sports Medicine, Hengelo, the Netherlands
| | - Luke Donovan
- Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
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Rush JL, Murray AM, Sherman DA, Gokeler A, Norte GE. Hop Performance After Anterior Cruciate Ligament Reconstruction: Cleared For Landing, But Ready For Take-off? Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760856.95481.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Duckett TR, Fox C, Hart JM, Norte GE. Rationale for a Parsimonious Measure of Subjective Knee Function after ACL Reconstruction: A Rasch Analysis. J Athl Train 2021; 56:1340-1348. [PMID: 33626140 DOI: 10.4085/490-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation is the most frequently used patient-reported measure of subjective knee function among individuals with ACL reconstruction (ACLR). Yet, limitations with traditional validation approaches leave it unclear whether the IKDC measures knee function as intended. Rasch analysis offers a robust validation approach, which may enhance clinical interpretation of the IKDC. OBJECTIVE 1) To assess the psychometric properties, 2) ability to classify health status, and 3) relationships between the IKDC and objective measures of strength and functional performance relative to a newly proposed reduced-item instrument. DESIGN Cross-sectional. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Seventy-seven individuals with primary, unilateral ACLR (21.9±7.8 years, 6.2±1.0 months post-surgery), and seventy-six age-matched controls. MAIN OUTCOME MEASURE(S) Rasch analysis was used to assess the psychometric properties of the IKDC. Receiver-operator-characteristic curves and logistic regression were used to assess the accuracy of classifying ACLR versus control participants. Correlations (Pearson and Spearman) were used to assess relationships between subjective knee function, quadriceps torque, and single-limb hop performance. RESULTS Rasch analysis aided the development of a reduced 8-item instrument (IKDC-8), which yielded improved psychometric properties in misfit analysis, percent of variance accounted for by one dimension (IKDC-8=71.5%; IKDC=56.7%), and item reliability. The IKDC was an outstanding diagnostic tool and the IKDC-8 was excellent, correctly classifying 87.2% and 82.7% of cases, respectively. The Hanley-McNeil formula found that there was no significant difference in the areas under the respective ROC curves. Equivalent associations between subjective and objective knee function were observed regardless of instrument used. CONCLUSIONS We observed evidence of enhanced reliability and validity for a parsimonious measure of subjective knee function. The proposed instrument reduces the number of items, increases score interpretability as measuring a single construct, and improves the rating scale functioning, while not significantly diminishing its ability to classify ACLR versus control participants or changing existing relationships with objective measures of recovery. We suggest the IKDC-8 may enhance clinical use by reducing administration time, improving the interpretation of the subjective knee function score, and clarifying functional ability.
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Affiliation(s)
- T Ryan Duckett
- University of Toledo, Department of Educational Research and Measurement, Toledo, OH
| | - Christine Fox
- University of Toledo, Department of Educational Research and Measurement, Toledo, OH
| | - Joseph M Hart
- University of Virginia, Kinesiology Department, Sports Medicine Program, Charlottesville, VA
| | - Grant E Norte
- University of Toledo, School of Exercise Science and Rehabilitation, Athletic Training Program, Toledo, OH
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Sherman DA, Glaviano NR, Norte GE. Hamstrings Neuromuscular Function After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Sports Med 2021; 51:1751-1769. [PMID: 33609272 DOI: 10.1007/s40279-021-01433-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hamstrings neuromuscular function is a crucial component of functional movement, and changes after anterior cruciate ligament (ACL) injury contribute to risk factors for secondary injury and long-term sequelae. To effectively treat muscular impairments, an accurate understanding of hamstrings neuromuscular function in patients with ACL reconstruction (ACLR) is needed. OBJECTIVE A systematic review and meta-analysis were undertaken to describe and quantify hamstrings neuromuscular function in individuals with ACLR compared to controls. METHODS We searched PubMed, Web of Science, SPORTDiscus, CINAHL, and EBSCOhost databases in October of 2020 for studies evaluating the difference between hamstrings electromyography (EMG) between individuals with ACLR and controls. Two independent reviewers assessed each paper for inclusion and quality. Means and standard deviations were extracted from each included study to allow random-effect size (ES) meta-analysis calculations for comparison of results. RESULTS Thirty-four studies were included for final review. From these, 5 categories of neuromuscular outcomes were identified, and studies were grouped accordingly: (1) muscle activation levels (EMG amplitude), (2) co-activation, (3) onset timing, (4) electromechanical delay, and (5) time-to-peak activity. Moderate to strong evidence indicates that individuals with ACLR demonstrate higher hamstrings EMG amplitude (normalized to % maximum voluntary isometric contraction) and hamstrings-to-quadriceps co-activation during gait and stair ambulation compared to controls. In addition, there was moderate evidence of longer electromechanical delay during knee flexion and greater hamstrings-to-quadriceps co-activation during knee extension compared to controls. CONCLUSIONS Greater hamstrings EMG amplitude and co-activation during gait and ambulation tasks and longer electromechanical delay of the hamstrings in individuals with ACLR align with clinical impairments following ACLR and have implications for re-injury risk and long-term joint health, thus warranting attention in rehabilitation.
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Affiliation(s)
- David A Sherman
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, 2801 W. Bancroft St., HH 2505E, Mail Stop 119, Toledo, OH, 43606, USA.
| | - Neal R Glaviano
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT, USA
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, 2801 W. Bancroft St., HH 2505E, Mail Stop 119, Toledo, OH, 43606, USA
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Sherman D, Birchmeier T, Kuenze CM, Garrison C, Hannon J, Bothwell J, Bush C, Norte GE. Thigh-Muscle and Patient-Reported Function Early After Anterior Cruciate Ligament Reconstruction: Clinical Cutoffs Unique to Graft Type and Age. J Athl Train 2021; 55:826-833. [PMID: 32688373 DOI: 10.4085/1062-6050-370-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Patient-reported function is an important outcome in anterior cruciate ligament rehabilitation. Identifying which metrics of thigh-muscle function are indicators of normal patient-reported function can help guide treatment. OBJECTIVE To identify which metrics of thigh-muscle function discriminate between patients who meet and patients who fail to meet age- and sex-matched normative values for patient-reported knee function in the first 9 months after anterior cruciate ligament reconstruction (ACLR) and establish cutoffs for these metrics by covariate subgroups. DESIGN Cross-sectional retrospective study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 256 patients (129 females, 128 males; age = 17.1 ± 3.0 years, height = 1.7 ± 0.1 m, mass = 74.1 ± 17.9 kg, months since surgery = 6.4 ± 1.4), 3 to 9 months after primary unilateral ACLR. MAIN OUTCOME MEASURE(S) We stratified the sample into dichotomous groups by the International Knee Documentation Committee (IKDC) score (IKDCMET, IKDCNOT MET) using sex- and age-matched normative values. We measured quadriceps and hamstrings isokinetic (60°/s) torque and power bilaterally. Normalized quadriceps and hamstrings peak torque (Nm/kg) and power (W/kg), limb symmetry indices (LSI, %), and hamstrings : quadriceps ratios were calculated. Logistic regression indicated which of these metrics could predict IKDC classification while controlling for age, graft type, and sex. Receiver operating characteristic curves established cutoffs for explanatory variables for both total cohort and covariate subgroups. Odds ratios (OR) determined the utility of each cutoff to discriminate IKDC status. RESULTS Quadriceps torque LSI (≥69.4%, OR = 3.6), hamstrings torque (≥1.11 Nm/kg, OR = 2.1), and quadriceps power LSI (≥71.4%, OR = 2.0) discriminated between IKDC classification in the total cohort. Quadriceps torque LSI discriminated between IKDC classification in the patellar-tendon graft (≥61.6%, OR = 5.3), hamstrings-tendon graft (≥71.8%, OR = 10.5), and age <18 years (≥74.3%, OR = 5.2) subgroups. Hamstrings torque discriminated between IKDC classifications in the age <18 years (≥1.10 Nm/kg, OR = 2.6) subgroup. CONCLUSIONS Quadriceps torque LSI, hamstrings torque, and quadriceps power LSI were the most useful metrics for predicting normal patient-reported knee function early after ACLR. Further, cutoff values that best predicted normal patient-reported function differed by graft type and age.
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Norte GE, Frendt TR, Murray AM, Armstrong CW, McLoughlin TJ, Donovan LT. Influence of Anticipation and Motor-Motor Task Performance on Cutting Biomechanics in Healthy Men. J Athl Train 2021; 55:834-842. [PMID: 32688389 DOI: 10.4085/1062-6050-569-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Biomechanical analyses of cutting tasks have demonstrated kinematic differences associated with the noncontact knee-injury risk when the movement direction is unanticipated. Motor-motor dual tasks occur within dynamic environments and change the demand for attentional resources needed to complete athletic maneuvers, which may contribute to injury risk. OBJECTIVE To investigate the influence of anticipation and motor-motor task performance on cutting biomechanics. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 32 healthy, recreationally active men (age = 23.1 ± 3.6 years, height = 180.0 ± 7.0 cm, mass = 81.3 ± 17.3 kg) who self-reported regular participation in cutting sports. INTERVENTION(S) Participants performed a 45° side-step cut on the dominant limb in a random order of conditions: anticipation (anticipated, unanticipated) and task (no ball throw, ball fake, ball throw). MAIN OUTCOME MEASURE(S) Triplanar trunk, hip, and knee angles were assessed throughout the stance phase using 3-dimensional motion capture. Data were analyzed using a time series of means calculated from initial contact to toe-off (0%-100%) with 90% confidence intervals. Mean differences between conditions were identified as regions of nonoverlapping confidence intervals, and those that occurred during the region of peak vertical ground reaction force (0%-25%) are presented. RESULTS Regardless of anticipation, attending to a ball (ball throw) resulted in more trunk extension (range = 2.9°-3.7°) and less lateral trunk flexion toward the cutting direction (range = 5.2°-5.9°). Planning to attend to a ball (ball fake) resulted in less lateral trunk flexion toward the cutting direction (4.7°). During unanticipated cutting, more trunk rotation away from the cutting direction was observed when attending to a ball (range = 5.3°-7.1°). The interaction of anticipation and task had a similar influence on sagittal- and frontal-plane trunk position. CONCLUSIONS Motor-motor task performance and its interaction with anticipation induced an upright, neutral trunk position during side-step cutting, which has been associated with the risk for noncontact knee injury. Promoting task complexity during rehabilitation and injury-prevention programs may better prepare individuals to succeed when performing high-risk athletic maneuvers.
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Affiliation(s)
| | | | | | - Charles W Armstrong
- Exercise Science Program, School of Exercise and Rehabilitation Sciences, University of Toledo, OH
| | - Thomas J McLoughlin
- Exercise Science Program, School of Exercise and Rehabilitation Sciences, University of Toledo, OH
| | - Luke T Donovan
- Department of Kinesiology, University of North Carolina at Charlotte
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Kingston B, Murray A, Norte GE, Glaviano NR. Validity and reliability of 2-dimensional trunk, hip, and knee frontal plane kinematics during single-leg squat, drop jump, and single-leg hop in females with patellofemoral pain. Phys Ther Sport 2020; 45:181-187. [PMID: 32823213 DOI: 10.1016/j.ptsp.2020.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate validity and between-session reliability of frontal plane trunk, hip, and knee kinematics during three functional tasks in females with patellofemoral pain (PFP). DESIGN Observational. SETTING Research Laboratory. PARTICIPANTS 20 females with PFP (22.7 ± 3.2 years, 69.9 ± 9.2 kg, 167.7 ± 9.6 cm). MAIN OUTCOME MEASURES Trunk, hip, and knee frontal plane peak angles during the single leg squat (SLS), drop vertical jump (DVJ), and single leg hop (SLH) kinematics were evaluated using 2-dimensional (2D) and 3-dimensional (3D) motion capture. Participants returned to the lab one week later and competed a second 2D analysis of the functional tasks. Concurrent validity was assessed by evaluating relationship between 2D and 3D frontal plane kinematics with Pearson correlations. Between-session reliability was assessed by evaluating 2D kinematics with intraclass correlation coefficients by a single assessor. RESULTS Moderate to strong correlations (r = 0.55-0.76, p < .05) were found for frontal plane hip kinematics during all three tasks and the trunk during the SLH. Frontal plane kinematics demonstrated good to excellent test-retest reliability for each of the three tasks, (ICC (2,1) = 0.70-0.90). CONCLUSION 2D hip joint angles during the three functional tasks were the only valid frontal plane angles. Trunk, hip, and knee 2D frontal plane kinematics ranged between good-excellent reliability.
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Affiliation(s)
- Brianna Kingston
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA
| | - Amanda Murray
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA
| | - Neal R Glaviano
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
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Norte GE, Solaas H, Saliba SA, Goetschius J, Slater LV, Hart JM. The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement. Phys Ther Sport 2019; 40:1-9. [PMID: 31421282 DOI: 10.1016/j.ptsp.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To investigate whether relationships between kinesiophobia, lower extremity function, and patient-reported function differ by self-reported physical activity engagement after ACL reconstruction (ACLR). DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Seventy-seven patients with a primary, unilateral ACLR. MAIN OUTCOME MEASURES Kinesiophobia (TSK-17) was the primary outcome. Lower extremity function included quadriceps and hamstrings strength, fatigue, and hop performance. Patient-reported function included regional function (IKDC, KOOS subscales) and physical activity engagement (Godin Leisure-Time Exercise). Patients were evaluated together, then stratified by LOW and HIGH physical activity. Correlations and multiple regression analyses identified relationships between kinesiophobia and outcome measures. RESULTS Greater kinesiophobia was associated with lesser hamstrings strength, hop performance, and patient-reported function. Greater hamstrings fatigue and lesser KOOSADL explained greater kinesiophobia in patients reporting LOW physical activity. Lesser triple hop symmetry, crossover hop distance, and IKDC explained greater kinesiophobia in patients reporting HIGH physical activity. CONCLUSIONS Greater kinesiophobia associated with worse outcomes after ACLR. Relationships differed by self-reported physical activity engagement. Interventions that improve the ability to perform knee-related activities of daily living may be appropriate to minimize the impact of fear in less active patients, while those targeting hop performance and knee-related sport activities may be better suited for more active patients.
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Affiliation(s)
- Grant E Norte
- University of Toledo, School of Exercise and Rehabilitation Sciences, Athletic Training Program, 2801 W. Bancroft St.Health and Human Services 2505H, Mail Stop 119, Toledo, OH, 43606, United States.
| | - Haley Solaas
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States.
| | - Susan A Saliba
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States; University of Virginia, Department of Orthopedic Surgery, Sports Medicine Division, 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, United States.
| | - John Goetschius
- Adrian College Exercise Science & Athletic Training Department, 110 S. Madison Street Merillat 209, Adrian, MI, 49221, United States.
| | - Lindsay V Slater
- Shirley Ryan AbilityLab, Neuromechanics of Impaired Locomotion Lab, 355 East Erie, Chicago, IL, 60611, United States.
| | - Joseph M Hart
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States; University of Virginia, Department of Orthopedic Surgery, Sports Medicine Division, 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, United States.
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Takeno K, Glaviano NR, Norte GE, Ingersoll CD. Therapeutic Interventions for Scapular Kinematics and Disability in Patients With Subacromial Impingement: A Systematic Review. J Athl Train 2019; 54:283-295. [PMID: 30829536 DOI: 10.4085/1062-6050-309-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Impaired scapular kinematics are commonly reported in patients with subacromial impingement syndrome (SIS). Various therapeutic interventions designed to improve scapular kinematics and minimize pain and disability have been described in the literature. However, the short- and long-term benefits of these interventions are unclear. OBJECTIVE To determine the effects of specific short- and long-term therapeutic interventions on scapular kinematics and disability in patients with SIS. DATA SOURCES We searched PubMed, CINAHL, and SPORTDiscus databases from their origins to January 2018 using a combination of the key words scapular kinematics AND (shoulder dysfunction OR subacromial impingement) and conducted a manual search by reviewing the references of the identified papers. STUDY SELECTION Studies were included if (1) preintervention and postintervention measures were available; (2) patient-reported outcomes were reported; (3) scapular kinematics measures at 90° of ascending limb elevation in the scapular plane were included; (4) SIS was diagnosed in participants or participants self-reported symptoms of SIS; (5) they were original clinical studies published in English; and (6) the sample sizes, means, and measure of variability for each group were reported. DATA EXTRACTION Seven studies were found. Sample sizes, means, and standard deviations of scapular upward rotation, posterior tilt, and internal rotation at 90° of ascending limb elevation on the scapular plane and the Disabilities of the Arm, Shoulder and Hand scores were extracted. DATA SYNTHESIS Standardized mean differences between preintervention and postintervention measures with 95% confidence intervals (CIs) were calculated. We observed that the Disabilities of the Arm, Shoulder and Hand scores improved (mean difference = 0.85; 95% CI = 0.54, 1.16) but did not observe changes in scapular upward rotation (mean difference = -0.04; 95% CI = -0.31, 0.22), posterior tilt (mean difference = -0.09; 95% CI = -0.32, 0.15), or internal rotation (mean difference = 0.06; 95% CI = -0.19, 0.31). CONCLUSIONS The short- and long-term therapeutic interventions for SIS improved patient-reported outcomes but not scapular kinematics. The identified improvements in shoulder pain and function were not likely explained by changes in scapular kinematics.
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Affiliation(s)
- Katsumi Takeno
- College of Health and Human Services, University of Toledo, OH
| | - Neal R Glaviano
- College of Health and Human Services, University of Toledo, OH
| | - Grant E Norte
- College of Health and Human Services, University of Toledo, OH
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Bodkin SG, Norte GE, Hart JM. Corticospinal excitability can discriminate quadriceps strength indicative of knee function after ACL-reconstruction. Scand J Med Sci Sports 2019; 29:716-724. [PMID: 30672626 DOI: 10.1111/sms.13394] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate relationships between quadriceps strength and neural activity, and to establish a clinical threshold of corticospinal excitability able to discriminate between patients with quadriceps strength indicative of satisfactory and unsatisfactory knee function after ACLR. METHODS A total of 29 patients following primary, unilateral ACL-reconstruction (11 female, 23.2 ± 8.1 years of age, 7.3 ± 2.5 months since surgery) participated. Subjective knee function was quantified using the International Knee Documentation Committee (IKDC) subjective evaluation. Peak isokinetic knee extensor torque was assessed at 90°/s. Quadriceps corticospinal excitability was quantified via active motor threshold (AMT, %2-Tesla) using transcranial magnetic stimulation during a 5% maximal voluntary isometric contraction of the quadriceps. Pearson's r correlations were used to assess the relationship between peak knee extensor torque and AMT. Receiver operating characteristic (ROC) curves were used to establish a threshold of (a) mass-normalized peak knee extensor torque to discriminate satisfactory knee function (IKDC ≥ 75.9%), and (b) AMT to discriminate quadriceps strength indicative of satisfactory knee function. Likelihood ratios (LR) and the magnitude of change in pre-post-test probability were calculated for each threshold. RESULTS Active motor threshold was negatively correlated with mass-normalized peak knee extensor torque (r = -0.503, P = 0.005). Knee extensor torque ≥1.23 Nm/kg was an excellent discriminator of satisfactory knee function (AUC = 0.890, P = 0.002; (+)LR = 9.56). An AMT ≤50.5% was an excellent discriminator of quadriceps strength indicative of satisfactory knee function following ACLR (AUC = 0.839, P = 0.005; (+)LR = 23.75). CONCLUSION Lower corticospinal excitability was associated with lower quadriceps strength. An AMT above 50.5% was found to decrease the probability of having satisfactory knee strength by over 62%.
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Affiliation(s)
- Stephan G Bodkin
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Grant E Norte
- School of Exercise and Rehabilitation, University of Toledo, Toledo, Ohio
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
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Williamson CL, Norte GE, Broshek DK, Hart JM, Resch JE. Return to Learn After Sport-Related Concussion: A Survey of Secondary School and Collegiate Athletic Trainers. J Athl Train 2018; 53:990-1003. [PMID: 30398928 DOI: 10.4085/1062-6050-234-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Recent recommendations have emphasized return-to-learn (RTL) protocols to aid athletes in recovery from sport-related concussion (SRC) but have been based primarily on anecdotal evidence. OBJECTIVE To investigate the RTL practices of certified athletic trainers (ATs) after an SRC. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS A total of 1083 individuals (27%) from a random sample of 4000 ATs in the National Athletic Trainers' Association membership database completed an electronic survey. Participants consisted of 729 self-identified secondary school ATs (SSATs; 67.3%; experience = 14.0 ± 9.7 years) and 354 self-identified collegiate ATs (CATs; 32.7%; experience = 13.4 ± 9.7 years). MAIN OUTCOME MEASURE(S) We used χ2 analyses to assess respondent differences related to current knowledge, current practices, and available resources. Independent t tests were used to compare SSATs and CATs on years of certification and annual number of SRCs evaluated. RESULTS Of our total respondents, 41.2% (n = 446) correctly indicated the absence of evidence-based RTL guidelines. Whereas most (73.9%, n = 800) respondents had an established RTL policy, only 38.1% (n = 413) used such guidelines in their clinical practice. Most (97.1%, n = 708) SSATs and 82.2% (n = 291) of CATs had access to (a) mental health professional(s); however, minorities of SSATs (21.4%, n = 156) and CATs (37.0%, n = 131) never accessed these resources to care for concussed student-athletes. CONCLUSIONS Our results suggested that, despite the absence of empirical evidence, most surveyed ATs incorporated some form of RTL protocol in their SRC management policy. The varying AT knowledge, clinical practices, and resources highlighted by our results should be considered when creating or refining an RTL protocol.
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Affiliation(s)
- Chelsea L Williamson
- Department of Kinesiology, Sports Medicine Program Area, University of Virginia, Charlottesville
| | - Grant E Norte
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville
| | - Donna K Broshek
- School of Exercise and Rehabilitation Sciences, Athletic Training Program, University of Toledo, OH
| | - Joseph M Hart
- Department of Kinesiology, Sports Medicine Program Area, University of Virginia, Charlottesville
| | - Jacob E Resch
- Department of Kinesiology, Sports Medicine Program Area, University of Virginia, Charlottesville
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Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM. Quadriceps Function and Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction in Patients With or Without Knee Osteoarthritis. J Athl Train 2018; 53:965-975. [PMID: 30288991 DOI: 10.4085/1062-6050-170-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Relationships between quadriceps function and patient-reported outcomes after anterior cruciate ligament reconstruction (ACLR) are variable and may be confounded by including patients at widely different time points after surgery. Understanding these relationships during the clinically relevant phases of recovery may improve our knowledge of specific factors that influence clinical outcomes. OBJECTIVE To identify the relationships between quadriceps function and patient-reported outcomes in patients <2 years (early) and >2 years (late) after ACLR, including those with posttraumatic knee osteoarthritis. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 72 patients after ACLR: early (n = 34, time from surgery = 9.0 ± 4.3 months), late (n = 30, time from surgery = 70.5 ± 41.6 months), or osteoarthritis (n = 8, time from surgery = 115.9 ± 110.0 months). MAIN OUTCOME MEASURE(S) The total Knee Injury and Osteoarthritis Outcome Score (KOOS) and Veterans RAND 12-Item Health Survey (VR-12) were used to quantify knee function and global health. Predictors of patient-reported outcomes were involved-limb and symmetry indices of quadriceps function (isokinetic strength [peak torque, total work, average power], maximum voluntary isometric contraction torque, fatigue index, central activation ratio, Hoffmann reflex, active motor threshold) and demographics (age, activity level, pain, kinesiophobia, time since surgery). Multiple linear regression analyses were used to predict KOOS and VR-12 scores in each group. RESULTS In the early patients, knee-extensor work, active motor threshold symmetry, pain, and activity level explained 67.8% of the variance in the KOOS score ( P < .001); knee-extensor work, activity level, and pain explained 53.0% of the variance in the VR-12 score ( P < .001). In the late patients, age and isokinetic torque symmetry explained 28.9% of the variance in the KOOS score ( P = .004). In the osteoarthritis patients, kinesiophobia and isokinetic torque explained 77.8% of the variance in the KOOS score ( P = .010); activity level explained 86.4% of the variance in the VR-12 score ( P = .001). CONCLUSIONS Factors of muscle function and demographics that explain patient-reported outcomes were different in patients early and late after ACLR and in those with knee osteoarthritis.
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Affiliation(s)
- Grant E Norte
- School of Exercise and Rehabilitation Sciences, Athletic Training Program, University of Toledo, OH
| | - Jay Hertel
- Department of Kinesiology, Sports Medicine Program, University of Virginia, Charlottesville
| | - Susan A Saliba
- Department of Kinesiology, Sports Medicine Program, University of Virginia, Charlottesville
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - Joseph M Hart
- Department of Kinesiology, Sports Medicine Program, University of Virginia, Charlottesville
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Lipinski CL, Donovan L, McLoughlin TJ, Armstrong CW, Norte GE. Surface electromyography of the forearm musculature during an overhead throwing rehabilitation progression program. Phys Ther Sport 2018; 33:109-116. [DOI: 10.1016/j.ptsp.2018.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 01/26/2023]
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Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM. Quadriceps Neuromuscular Function in Patients With Anterior Cruciate Ligament Reconstruction With or Without Knee Osteoarthritis: A Cross-Sectional Study. J Athl Train 2018; 53:475-485. [PMID: 29893603 DOI: 10.4085/1062-6050-102-17] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Central and peripheral neural adaptations have been identified after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) and are hypothesized to contribute to posttraumatic muscle dysfunction. Limited evidence exists about the temporal nature of neuromuscular adaptations during early and late-term phases of recovery after ACLR, and no researchers have studied patients with posttraumatic osteoarthritis. OBJECTIVE To compare quadriceps neuromuscular function less than 2 years ( early) and more than 2 years ( late) after ACLR, including in patients who experienced posttraumatic knee osteoarthritis. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 72 patients after ACLR, consisting of 34 early (9.0 ± 4.3 months postsurgery), 30 late (70.5 ± 41.6 months postsurgery), and 8 with osteoarthritis (115.9 ± 110.0 months postsurgery), and 30 healthy control volunteers. MAIN OUTCOME MEASURE(S) Quadriceps function was measured bilaterally during a single visit to determine normalized Hoffmann reflex (H : M ratio), knee-extension maximal voluntary isometric contraction torque (Nm/kg), central activation ratio (%), fatigue index (% decline), and active motor threshold (%). Comparisons were made using 2-way analyses of variance to identify the effect of limb and group on each outcome measure. We calculated Cohen d effect sizes to assess the magnitude of difference between ACLR and matched control limbs for each group. RESULTS Compared with healthy control limbs, involved-limb maximal voluntary isometric contraction was lower among all patients after ACLR ( P < .001, Cohen d values = -1.00 to -1.75). The central activation ratio ( P < .001, Cohen d = -1.74) and fatigue index ( P = .003, Cohen d = -0.95) were lower among patients only early after ACLR. The active motor threshold was higher among all patients after ACLR ( P < .001, Cohen d values = -0.42 to -1.56). CONCLUSIONS Neuromuscular impairments were present in patients early and late after ACLR, regardless of osteoarthritis status. Quadriceps strength and corticospinal excitability were impaired at each time point compared with values in healthy control individuals, suggesting the need to address cortical function early after ACLR.
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Affiliation(s)
- Grant E Norte
- School of Exercise and Rehabilitation Sciences, Athletic Training Program, University of Toledo, OH
| | - Jay Hertel
- Department of Kinesiology, Sports Medicine Program and.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - Susan A Saliba
- Department of Kinesiology, Sports Medicine Program and.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - Joseph M Hart
- Department of Kinesiology, Sports Medicine Program and.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
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Etier BE, Norte GE, Gleason MM, Richter DL, Pugh KF, Thomson KB, Slater LV, Hart JM, Brockmeier SF, Diduch DR. A Comparison of Cervical Spine Motion After Immobilization With a Traditional Spine Board and Full-Body Vacuum-Mattress Splint. Orthop J Sports Med 2017; 5:2325967117744757. [PMID: 29318167 PMCID: PMC5753958 DOI: 10.1177/2325967117744757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: The National Athletic Trainers’ Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility. Purpose: To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulder pads, and (3) evaluate the effect of body mass on cervical spine motion. Study Design: Controlled laboratory study. Methods: Twenty healthy male participants volunteered for this study to examine the influence of immobilization type and presence of equipment on triplanar angular cervical spine motion. Three-dimensional cervical spine kinematics was measured using an electromagnetic motion analysis system. Independent variables included testing condition (static lift and hold, 30° tilt, transfer, equipment removal), immobilization type (rigid, vacuum-mattress), and equipment (on, off). Peak sagittal-, frontal-, and transverse-plane angular motions were the primary outcome measures of interest. Results: Subjective ratings of comfort and security did not differ between immobilization types (P > .05). Motion between the rigid board and vacuum splint did not differ by more than 2° under any testing condition, either with or without equipment. In removing equipment, the mean peak motion ranged from 12.5° to 14.0° for the rigid spine board and from 11.4° to 15.4° for the vacuum-mattress splint, and more transverse-plane motion occurred when using the vacuum-mattress splint compared with the rigid spine board (mean difference, 0.14 deg/s [95% CI, 0.05-0.23 deg/s]; P = .002). In patients weighing more than 250 lb, the rigid board provided less motion in the frontal plane (P = .027) and sagittal plane (P = .030) during the tilt condition and transfer condition, respectively. Conclusion: The current study confirms similar motion in the vacuum-mattress splint compared with the rigid backboard in varying sized equipped or nonequipped athletes. Cervical spine motion occurs when removing a football helmet and shoulder pads, at an unknown risk to the injured athlete. In athletes who weighed more than 250 lb, immobilization with the rigid board helped to reduce cervical spine motion. Clinical Relevance: Athletic trainers and team physicians should consider immobilization of athletes who weigh more than 250 lb with a rigid board.
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Affiliation(s)
- Brian E Etier
- Acadiana Orthopedic Group, Lafayette General Medical Center, Lafayette, Louisiana, USA
| | | | | | | | - Kelli F Pugh
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Joe M Hart
- University of Virginia, Charlottesville, Virginia, USA
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Abstract
CONTEXT The superimposed-burst (SIB) technique is commonly used to quantify central activation failure after knee-joint injury, but its reliability has not been established in pathologic cohorts. OBJECTIVE To assess within-session and between-sessions reliability of the SIB technique in patients with patellofemoral pain. DESIGN Descriptive laboratory study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 10 patients with self-reported patellofemoral pain (1 man, 9 women; age = 24.1 ± 3.8 years, height = 167.8 ± 15.2 cm, mass = 71.6 ± 17.5 kg) and 10 healthy control participants (3 men, 7 women; age = 27.4 ± 5.0 years, height = 173.5 ± 9.9 cm, mass = 78.2 ± 16.5 kg) volunteered. INTERVENTION(S) Participants were assessed at 6 intervals spanning 21 days. Intraclass correlation coefficients (ICCs [3,3]) were used to assess reliability. MAIN OUTCOME MEASURE(S) Quadriceps central activation ratio, knee-extension maximal voluntary isometric contraction force, and SIB force. RESULTS The quadriceps central activation ratio was highly reliable within session (ICC [3,3] = 0.97) and between sessions through day 21 (ICC [3,3] = 0.90-0.95). Acceptable reliability of knee extension (ICC [3,3] = 0.75-0.91) and SIB force (ICC [3,3] = 0.77-0.89) was observed through day 21. CONCLUSIONS The SIB technique was reliable for clinical research up to 21 days in patients with patellofemoral pain.
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Affiliation(s)
- Grant E Norte
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Jamie L Frye
- Department of Health Sciences, James Madison University, Harrisonburg, VA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville
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Norte GE, Kuenze C, Hart JM. Closed chain assessment of quadriceps activation using the superimposed burst technique. J Electromyogr Kinesiol 2014; 24:341-7. [PMID: 24731724 DOI: 10.1016/j.jelekin.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 02/24/2014] [Accepted: 03/16/2014] [Indexed: 01/21/2023] Open
Abstract
UNLABELLED The superimposed burst technique is used to estimate quadriceps central activation ratio during a maximal voluntary isometric contraction, which is calculated from force data during an open-chain knee extension task. Assessing quadriceps activation in a closed-chain position would more closely simulate the action of the quadriceps during activity. Our aim was to determine the test-retest reliability of the quadriceps central activation ratio in the closed chain. METHODS Twenty-two healthy, active volunteers (13M/12F; age=23.8±3; height=72.7±14.5cm; mass=175.3±9.6kg) were recruited to participate. Knee extension MVIC torque and the peak torque during a superimposed electrical stimulus delivered to the quadriceps during an MVIC were measured to estimate quadriceps CAR. Interclass correlation coefficients were used to assess test-retest reliability between sessions, and Bland-Altman plots to graphically assess agreement between sessions. RESULTS Test-retest reliability was fair for CAR (ICC2,k=0.68; P=0.005), with a mean difference of -2.8±10.3%, and limits of agreement ranging -23.1-18.1%. CONCLUSIONS CAR calculated using the superimposed burst technique is moderately reliable in a closed-chain position using technique-based instruction. Although acceptable reliability was demonstrated, wide limits of agreement suggest high variability between sessions.
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Affiliation(s)
- Grant E Norte
- Department of Human Services, Kinesiology Program Area, University of Virginia, United States.
| | - Christopher Kuenze
- Department of Human Services, Kinesiology Program Area, University of Virginia, United States
| | - Joseph M Hart
- Department of Human Services, Kinesiology Program Area, University of Virginia, United States
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Abstract
BACKGROUND Glenohumeral dislocations are prevalent injuries in an athletic population, and proper, acute on-field management remains a topic of debate among health care professionals. OBJECTIVE Firstly, to provide a systematic approach to the on-field management of acute anterior glenohumeral dislocations for on-field health care professionals. Secondly, to present current methods of reduction, including a description of the safest and most efficacious methods. METHODS Based on the current literature, an overview of the relevant anatomy, mechanisms of injury, and associated injuries is provided. In addition, systematic guidelines for on-field management of acute glenohumeral dislocations are provided. RESULTS The glenohumeral joint remains the most commonly dislocated joint in the body. Anterior dislocations comprise 90% to 98% of all glenohumeral dislocations. Despite a variety of described methods of reduction, there remains a lack of high-level evidence reporting the efficacy of each. To date, there is no position statement or consensus regarding the acute management of glenohumeral dislocations, creating discontinuity among health care professionals. CONCLUSION A systematic approach in management of the acute anterior glenohumeral dislocation is paramount. Method of reduction and position of immobilization should be dependent on physician and patient comfort, respectively. Reduction is safest in patients aged < 40 years with no neurovascular compromise, and when minimal attempts are performed.
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Affiliation(s)
- Grant E Norte
- Department of Athletics, State University of New York, New Paltz, NY, USA
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