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St‐Pierre M, Effatparvar MR, Begon M, Sobczak S. Differentiation of strains in the lateral and medial bands of the iliofemoral ligament: A segmental approach. J Anat 2023; 243:674-683. [PMID: 37248724 PMCID: PMC10485585 DOI: 10.1111/joa.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/13/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
Iliofemoral ligament strains have been assessed in a circumscribed portion, limiting the information regarding the strains in the proximal, mid and distal portions. The purpose of this study is to describe the longitudinal and transversal strain within the proximal, mid and distal portions of the lateral and medial bands of the iliofemoral ligament. Ten fresh cadaveric specimens were assessed. The iliofemoral ligaments were divided into medial and lateral bands. Hemispherical beads (2.6 mm) were placed on the lateral and medial borders of each band. Four positions were assessed: abduction, extension, internal and external rotations combined with extension. The hemispherical beads were scanned at the end range of motion using a laser scanner. The three-dimensional position of each bead was used to estimate longitudinal and transversal strains. A three-factor ANOVA was used to compare movements, borders, and portions within each ligament for longitudinal strains. A one-way ANOVA was used to compare transversal strains between portions. This technique showed mean reliability (ICC: 2, 1) of 0.90 ± 0.06. The external rotation showed the highest strains in both ligaments (p < 0.05). Abduction showed a significant difference between the lateral and medial borders in both bands (p = 0.001). Eight movement-border combinations showed a significant difference between proximal, medial, and lateral portions (p < 0.005). According to our results, there is a clear effect of portions (proximal, mid and distal) within the ligament and movements. Abduction shows the lowest strains longitudinally but the largest strains transversally. Although we do not know the impact of this phenomenon, future studies should assess the strains following hip arthroscopies. The latter might improve the impact of this procedure on hip biomechanics. Lastly, the iliofemoral ligament should be assessed using a segmental approach rather than as a complete unit.
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Affiliation(s)
- Marc‐Olivier St‐Pierre
- Chaire de Recherche en Anatomie FonctionnelleUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
- Département d'anatomieUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
| | - Mohammad Reza Effatparvar
- Chaire de Recherche en Anatomie FonctionnelleUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
- Département d'anatomieUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
| | - Mickaël Begon
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de MédecineUniversité de MontréalLavalCanada
- Centre de recherche du CHU Sainte‐JustineMontrealCanada
| | - Stéphane Sobczak
- Chaire de Recherche en Anatomie FonctionnelleUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
- Département d'anatomieUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
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Campón Chekroun A, Velázquez-Saornil J, Guillén Vicente I, Sánchez Milá Z, Rodríguez-Sanz D, Romero-Morales C, Fernandez-Jaén T, Garrido González JI, Sánchez-Garrido MÁ, Guillén García P. Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children. World J Orthop 2022; 13:777-790. [PMID: 36189335 PMCID: PMC9516626 DOI: 10.5312/wjo.v13.i9.777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/16/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Knee examination guidelines in minors are intended to aid decision-making in the management of knee instability. Clinical question: A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence. A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children. Key findings: there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary. Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed. Clinical application: In the absence of a strong evidence base, these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury.
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Affiliation(s)
| | | | - Isabel Guillén Vicente
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
| | - Zacarías Sánchez Milá
- Department of Physiotherapy, Universidad Católica de Ávila, Ávila 05005, Ávila, Spain
| | - David Rodríguez-Sanz
- Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid 28040, Madrid, Spain
| | - Carlos Romero-Morales
- Department of Physical Therapy, Universidad Europea de Madrid, Madrid 28023, Madrid, Spain
| | - Tomas Fernandez-Jaén
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
| | | | | | - Pedro Guillén García
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
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Qu N, Tian H, De Martino E, Zhang B. Neck Pain: Do We Know Enough About the Sensorimotor Control System? Front Comput Neurosci 2022; 16:946514. [PMID: 35910451 PMCID: PMC9337601 DOI: 10.3389/fncom.2022.946514] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Neck pain is a worldwide health problem. Clarifying the etiology and providing effective interventions are challenging for the multifactorial nature of neck pain. As an essential component of cervical spine function, the sensorimotor control system has been extensively studied in both healthy and pathological conditions. Proprioceptive signals generated from cervical structures are crucial to normal cervical functions, and abnormal proprioception caused by neck pain leads to alterations in neural plasticity, cervical muscle recruitment and cervical kinematics. The long-term sensorimotor disturbance and maladaptive neural plasticity are supposed to contribute to the recurrence and chronicity of neck pain. Therefore, multiple clinical evaluations and treatments aiming at restoring the sensorimotor control system and neural plasticity have been proposed. This paper provides a short review on neck pain from perspectives of proprioception, sensorimotor control system, neural plasticity and potential interventions. Future research may need to clarify the molecular mechanism underlying proprioception and pain. The existing assessment methods of cervical proprioceptive impairment and corresponding treatments may need to be systematically reevaluated and standardized. Additionally, new precise motor parameters reflecting sensorimotor deficit and more effective interventions targeting the sensorimotor control system or neural plasticity are encouraged to be proposed.
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Affiliation(s)
- Ning Qu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - HaoChun Tian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Enrico De Martino
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Aerospace Medicine and Rehabilitation Laboratory, Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Bin Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Bin Zhang,
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Eraktas İ, Ayhan C, Hayran M, Soylu AR. Alterations in forearm muscle activation patterns after scapholunate interosseous ligament injury: A dynamic electromyography study. J Hand Ther 2021; 34:384-395. [PMID: 32620427 DOI: 10.1016/j.jht.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case control. PURPOSE OF THE STUDY This study aimed to investigate the alterations seen in the activation patterns of the forearm muscles and to demonstrate the associated functional outcomes, in patients with scapholunate interosseous ligament (SLIL) injury. METHODS The study involved 15 patients with SLIL injury (instability group) and 11 healthy participants (control group). Both groups were evaluated with regard to their pain, grip strength, and upper extremity functional level (disabilities of the arm, shoulder and hand and patient-rated wrist evaluation questionnaires), and they also underwent a dynamic electromyography analysis of their forearm muscle activity. The activation patterns of the extensor carpi ulnaris (ECU), extensor carpi radialis (ECR), flexor carpi ulnaris, and flexor carpi radialis muscles during wrist extension and flexion were recorded by means of surface electromyography. RESULTS In the instability group, the pain severity was higher and the functional level was worse than in the control group (P < .05). Furthermore, during wrist extension, the ECR activity was lower and the ECU activity was higher in the instability group than in the control group (P < .05). CONCLUSION Dynamic stabilization of the wrist, flexor carpi ulnaris, and flexor carpi radialis muscles have been shown to play an active role with ECU and ECR. Increased ECU and decreased ECR activation may pose a potential risk in terms of enhancing the scapholunate gap. We, therefore, propose that appropriate preventive neuromuscular exercise strategies implemented as part of a physiotherapy program for patients with SLIL lesions might increase the contribution of the dynamic stability effect of the relevant muscles.
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Affiliation(s)
- İrem Eraktas
- Bolu Physical Therapy and Rehabilitation Hospital, Bolu, Turkey
| | - Cigdem Ayhan
- Faculty of Health Science, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Mutlu Hayran
- School of Medicine, Department of Preventive Oncology, Hacettepe University, Ankara, Turkey
| | - Abdullah Ruhi Soylu
- School of Medicine, Department of Biophysics, Hacettepe University, Ankara, Turkey
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Olson MW. Static loading of the knee joint results in modified single leg landing biomechanics. PLoS One 2020; 15:e0219648. [PMID: 32084138 PMCID: PMC7034804 DOI: 10.1371/journal.pone.0219648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background External loading of the ligamentous tissues induces mechanical creep, which modifies neuromuscular response to perturbations. It is not well understood how ligamentous creep affects athletic performance and contributes to modifications of knee biomechanics during functional tasks. Hypothesis/purpose The purpose of this study was to examine the mechanical and neuromuscular responses to single leg drop landing perturbations before and after passive loading of the knee joint. Methods Descriptive laboratory study. Male (n = 7) and female (n = 14) participants’ (21.3 ± 2.1 yrs., 1.69 ± 0.09 m, 69.3 ± 13.0 kg) right hip, knee, and ankle kinematics were assessed during drop landings performed from a 30 cm height onto a force platform before and after a 10 min creep protocol. Electromyography (EMG) signals were recorded from rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), semimembranosus (SM), and biceps femoris (BF) muscles. The creep protocol involved fixing the knee joint at 35° during static loading with perpendicular loads of either 200 N (males) or 150 N (females). Maximum, minimum, range of motion (ROM), and angular velocities were assessed for the hip, knee, and ankle joints, while normalized EMG (NEMG), vertical ground reaction forces (VGRF), and rate of force development (RFD) were assessed at landing using ANOVAs. Alpha was set at 0.05. Results Maximum hip flexion velocity decreased (p < 0.01). Minimum knee flexion velocity increased (p < 0.02). Minimum knee ad/abduction velocity decreased (p < 0.001). Ankle ROM decreased (p < 0.001). aVGRF decreased (p < 0.02). RFD had a non-significant trend (p = 0.076). NAEMG was significant between muscle groups (p < 0.02). Conclusion Distinct changes in velocity parameters are attributed to the altered mechanical behavior of the knee joint tissues and may contribute to changes in the loading of the leg during landing.
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Affiliation(s)
- Michael W. Olson
- Department of Kinesiology, Southern Illinois University Carbondale, Carbondale, IL, United States of America
- Department of Athletic Training and Exercise Physiology, Midwestern State University, Wichita Falls, TX, United States of America
- * E-mail:
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Nuccio S, Labanca L, Rocchi JE, Macaluso A, Sbriccoli P. Neuromechanical response to passive cyclic loading of the ACL in non-professional soccer players: A pilot study. Phys Ther Sport 2018; 32:187-193. [DOI: 10.1016/j.ptsp.2018.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/09/2018] [Indexed: 01/13/2023]
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Tennant LM, Chong HC, Acker SM. The effects of a simulated occupational kneeling exposure on squat mechanics and knee joint load during gait. ERGONOMICS 2018; 61:839-852. [PMID: 29192542 DOI: 10.1080/00140139.2017.1411529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/23/2017] [Indexed: 06/07/2023]
Abstract
Occupational kneeling is associated with an increased risk for tibiofemoral knee osteoarthritis. Forces on the knee in the kneeling posture, as well as the greater incidence of meniscus tears among workers, likely contribute to the increased risk. We hypothesise that an additional mechanism may contribute - altered neuromuscular control due to prolonged high knee flexion. Forty participants (20 male, 20 female) completed an evaluation of gait and squatting before, immediately following, and 30 min following a 30 min simulated occupational kneeling exposure. An increase in the peak external knee adduction moment and a delay in vastus medialis activation onset during walking were observed post-kneeling, as well as increased frontal plane knee motion during squatting. This was the first investigation to find changes in high flexion transitions as a result of kneeling. Greater frontal plane knee motion may increase the risk for meniscal tears, and subsequently, knee osteoarthritis. Practitioner Summary: A 30 min simulated occupational kneeling exposure resulted in small but significant gait changes. The greatest effect was on frontal plane knee movement during squatting, which is especially relevant to occupations requiring frequent kneeling/squatting. This increased motion may indicate an increased risk of injury, which supports a link to knee osteoarthritis.
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Affiliation(s)
- Liana Michele Tennant
- a Faculty of Applied Health Sciences, Department of Kinesiology , University of Waterloo , Waterloo , Canada
| | - Helen Christina Chong
- a Faculty of Applied Health Sciences, Department of Kinesiology , University of Waterloo , Waterloo , Canada
| | - Stacey Marie Acker
- a Faculty of Applied Health Sciences, Department of Kinesiology , University of Waterloo , Waterloo , Canada
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Ayhan C, Tanrıkulu S, Leblebicioglu G. Scapholunate interosseous ligament dysfunction as a source of elbow pain syndromes: Possible mechanisms and implications for hand surgeons and therapists. Med Hypotheses 2018; 110:125-131. [PMID: 29317055 DOI: 10.1016/j.mehy.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/02/2017] [Accepted: 12/03/2017] [Indexed: 12/01/2022]
Abstract
Elbow pain syndromes are common upper extremity musculoskeletal disorders, and they are usually associated with repetitive occupational exposure. Ligaments are often one of the sources of musculoskeletal disorders because of their mechanical and neurological properties. The wrist ligaments are some of the ligaments most vulnerable to occupational exposure. Since most occupational tasks require wrist extension for handling tools and loading, the scapholunate interosseous ligament (SLIL) bears greater strain during loading, which results in creep deformation and hysteresis. Ligamentous creep may result in diminished ability to detect signal changes during joint movements, which impairs neuromuscular control established by ligamentomuscular reflex arcs elicited from mechanoreceptors in the ligaments. Changes in muscle activation patterns of forearm muscles due to diminished ligamentomuscular reflexes may initiate a positive feedback loop, leading to musculoskeletal pain syndromes. The relationship between elbow pain syndromes and SLIL injury will be presented through two hypotheses and relevant pain mechanisms: 1. Repetitive tasks may cause creep deformation of the SLIL, which then impairs ligamentomuscular reflexes, leading to elbow pain disorders. 2. Lateral epicondylalgia may increase the risk of SLIL injury through the compensation of the lower extensor carpi radialis muscle activity by higher extensor carpi ulnaris muscle activity, which may alter carpal kinematics, leading to SLIL degeneration over time. The differential diagnosis is usually complicated in musculoskeletal pain disorders. The failure of treatment methods is one of the issues of concern for many researchers. A key element in developing treatment strategies is to understand the source of the disorder and the nature of the injury. We proposed that the differential diagnosis include SLIL injuries when describing elbow pain syndromes, particularly, lateral epicondylalgia.
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Affiliation(s)
- Cigdem Ayhan
- Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey.
| | - Seval Tanrıkulu
- Koc University, Faculty of Medicine, Orthopedics and Traumatology Department, Hand Surgery Unit, İstanbul, Turkey
| | - Gursel Leblebicioglu
- Hacettepe University, Faculty of Medicine, Orthopaedics and Traumatology Department, Hand Surgery Unit, Ankara, Turkey
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Wei Y, Shan X. Muscular Activation Pattern of Bilateral Extensors Response to Asymmetric Hand Lifting During Trunk Flexion-extension Performance. J Mot Behav 2016; 49:422-428. [PMID: 27740907 DOI: 10.1080/00222895.2016.1219312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors' purpose was to test the effect of asymmetric hand lifting on muscular activation patterns of 3 bilateral extensors. Eighteen male university students without back pain were volunteered. Each performed flexion-extension randomly with conditions of right lifting, left lifting, and nonlifting. Surface electromyography from bilateral thoracic, lumbar erector spinae, and hamstring was recorded. The cross-correlation and relative intensity in paired muscles of bilateral extensors was calculated in flexion as well as extension period. The results showed that the cross-correlation coefficient was decreased and the phase lag as well as the relative intensity of bilateral extensors was increased significantly in thoracic level. The phase lag as well as the relative intensity of bilateral extensors was increased significantly in lumbar level. It was concluded that asymmetric lifting has a significant effect on muscular activation of bilateral extensors in thorax level, which causes the ipsilateral extensor to activate larger and longer. Asymmetric lifting also has some effect on muscular activation of bilateral extensors in lumbar level but with less extent than in thorax level, which causes contralateral extensor to activate larger and longer. Asymmetric lifting seems to have no significant effect on muscular activation of bilateral hamstring.
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Affiliation(s)
- Ying Wei
- a College of Physical Education, Shandong Normal University , Jinan , China
| | - Xinhai Shan
- a College of Physical Education, Shandong Normal University , Jinan , China
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Kajaks T, Costigan P. The effect of sustained static kneeling on kinetic and kinematic knee joint gait parameters. APPLIED ERGONOMICS 2015; 46 Pt A:224-230. [PMID: 25172306 DOI: 10.1016/j.apergo.2014.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 08/02/2014] [Accepted: 08/07/2014] [Indexed: 06/03/2023]
Abstract
Despite epidemiological evidence for kneeling as an occupational risk factor for knee osteoarthritis, biomechanical evidence is lacking. Gait knee joint mechanics, a common measure used to study knee osteoarthritis initiation, were used in the present study to investigate the effect of sustained static kneeling on the knee. Ten healthy male subjects (24.1 years ± 3.5) performed ten baseline walking trials, followed by a 30-min kneeling protocol and a second set of walking trials. Knee joint moments and angles were calculated during the stance phase. Within-subject root mean squared differences were compared within and between the pre- and post-kneeling gait trials. Differences were observed between the pre-kneeling and post-kneeling walking trails for flexion and adduction knee moments (0.12 Nm/kg ± 0.03, 0.07 Nm/kg ± 0.02) and angles (3.18° ± 1.22 and 1.64° ± 1.15), indicating that sustained static deep-knee flexion kneeling does acutely alter knee joint gait parameters.
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Affiliation(s)
- Tara Kajaks
- Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
| | - Patrick Costigan
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada K7L 3N6.
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Cheng X, Zhang T, Shan X, Wang J. Effect of posterior cruciate ligament creep on muscular co-activation around knee: A pilot study. J Electromyogr Kinesiol 2014; 24:271-6. [DOI: 10.1016/j.jelekin.2014.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 12/15/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022] Open
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Gleeson N, Eston R, Minshull C, Bailey A, Al Kitani AH, Darain H, Yates C, Rees D. Effects of antecedent flexibility conditioning on neuromuscular and sensorimotor performance during exercise-induced muscle damage. J Exerc Sci Fit 2013. [DOI: 10.1016/j.jesf.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Chen CF, Kuo YH, Luh JJ, Chen YJ, Chen SW, Kuo TS, Lai JS. Reducing anterior tibial translation by applying functional electrical stimulation in dynamic knee extension exercises: quantitative results acquired via marker tracking. Clin Biomech (Bristol, Avon) 2013; 28:549-54. [PMID: 23583096 DOI: 10.1016/j.clinbiomech.2013.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/27/2013] [Accepted: 03/21/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pain that accompanies anterior cruciate ligament deficiency during dynamic knee extension exercises is usually caused by excessive anterior tibial translation, which can be restricted if the anterior cruciate ligament was intact. METHODS A functional electrical stimulator is incorporated with a training device to induce hamstring contractions during certain degrees of knee extension to replicate effects similar to those generated by an intact anterior cruciate ligament and to reduce anterior tibial translation. By using a camera that tracks markers placed on bony prominences of the femur and tibia, the anterior tibial translations corresponding to various settings were determined by customized image processing procedures. FINDINGS In the electrical stimulation sessions, the knee extensions with electrical stimulation feedback induced significantly (n=6, P<.05) less anterior tibial translation over the range of 20 to 50° when compared to those using the standard isokinetic shank restraint. Likewise, the knee extensions with an anti-shear device that blocks tibia displacement mechanically also induced significantly (n=6, P<.05) less anterior tibial translation, but over a different range of knee extension (30 to 70°). INTERPRETATION Despite the fact that both the electrical stimulator and the anti-shear device assisted in reducing anterior tibial translation, the tendency of the curves generated with the functional electrical stimulation was generally more similar to those generated when using the standard isokinetic shank restraint.
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Affiliation(s)
- Chiun-Fan Chen
- Department of Electrical Engineering, National Taiwan University, Taiwan
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Schlecht SH. Understanding Entheses: Bridging the Gap Between Clinical and Anthropological Perspectives. Anat Rec (Hoboken) 2012; 295:1239-51. [DOI: 10.1002/ar.22516] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 05/08/2012] [Indexed: 11/08/2022]
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Shan X, Zhang Y, Zhang T, Chen Z, Wei Y. Flexion relaxation of erector spinae response to spinal shrinkage. J Electromyogr Kinesiol 2012; 22:370-5. [DOI: 10.1016/j.jelekin.2011.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/26/2011] [Accepted: 12/16/2011] [Indexed: 11/28/2022] Open
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Olson MW. Passive trunk loading influences muscle activation during dynamic activity. Muscle Nerve 2011; 44:749-56. [DOI: 10.1002/mus.22154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Muscle co-contraction after anterior cruciate ligament reconstruction: Influence of functional level. J Electromyogr Kinesiol 2011; 21:1050-5. [PMID: 21978787 DOI: 10.1016/j.jelekin.2011.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 09/01/2011] [Accepted: 09/01/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND ACL reconstruction is recommended to improve function in subjects with ligament injuries. However, after surgery, some individuals are not able to return to their pre-injury functional level. The mechanisms related to this incapacity are not well understood. STUDY DESIGN Cross-sectional study. METHODS Co-contraction levels were assessed in individuals who returned to their pre-injury functional level and in 10 individuals who were not able to return to full activity after unilateral ACL reconstruction. Electromyography of the vastus lateralis and biceps femoris muscles before and after sudden perturbations applied during the stance phase of walking was used to calculate co-contraction. RESULTS The involved limb had lower co-contraction pre-perturbation than the non-involved limb in both groups (p=0.049). The co-contraction level post-perturbation was significantly higher in the limited return group than in the full return group (p=0.03). CONCLUSION Decreased co-contraction in the involved limb before perturbation may be caused by sensorial changes resulting from surgery or injury. Increased co-contraction levels observed in the limited return group after perturbation may be a compensatory mechanism to make up for possible decreased intrinsic stability of the knee joint. CLINICAL RELEVANCE Increased co-contraction after perturbation does not contribute to knee stability.
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Nayak BP, Goh JCH, Toh SL, Satpathy GR. In vitro study of stem cell communication via gap junctions for fibrocartilage regeneration at entheses. Regen Med 2010; 5:221-9. [PMID: 20210582 DOI: 10.2217/rme.09.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Entheses are fibrocartilaginous organs that bridge ligament with bone at their interface and add significant insertional strength. To replace a severely damaged ligament, a tissue-engineered graft preinstalled with interfacial fibrocartilage, which is being regenerated from stem cells, appears to be more promising than ligament-alone graft. Such a concept can be realized by a biomimetic approach of establishing a dynamic communication of stem cells with bone cells and/or ligament fibroblasts in vitro. AIM The current study has two objectives. The first objective is to demonstrate functional coculture of bone marrow-derived stem cells (BMSCs) with mature bone cells/ligament fibroblasts as evidenced by gap-junctional communication in vitro. The second objective is to investigate the role of BMSCs in the regeneration of fibrocartilage within the coculture. MATERIALS & METHODS Rabbit bone/ligament fibroblasts were dual-stained with DiI-Red and calcein (gap-junction permeable dye), and cocultured with unlabeled BMSCs at fixed ratio (1:10). The functional gap junction was demonstrated by the transfer of calcein from donor to recipient cells that was confirmed and quantified by flow cytometry. Type 2 collagen (cartilage extracellular matrix-specific protein) expressed by the mixed cell lines in the cocultures were estimated by real-time reverse transcription PCR and compared with that of the ligament-bone coculture (control). RESULTS Significant transfer of calcein into BMSCs was observed and flow cytometry analyses showed a gradual increase in the percentage of BMSCs acquiring calcein with time. Cocultures that included BMSCs expressed significantly more type 2 collagen compared with the control. CONCLUSION The current study, for the first time, reported the expression of gap-junctional communication of BMSCs with two adherent cell lines of musculoskeletal system in vitro and also confirmed that incorporation of stem cells augments fibrocartilage regeneration. The results open up a path to envisage a composite graft preinstalled with enthesial fibrocartilage using a stem cell-based coculture system.
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Affiliation(s)
- Bibhukalyan Prasad Nayak
- Department of Biotechnology & Medical Engineering, National Institute of Technology, Rourkela, India.
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20
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Solomonow M. Ligaments: a source of musculoskeletal disorders. J Bodyw Mov Ther 2008; 13:136-54. [PMID: 19329050 DOI: 10.1016/j.jbmt.2008.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 01/31/2008] [Accepted: 02/04/2008] [Indexed: 12/22/2022]
Abstract
The mechanical and neurological properties of ligaments are reviewed and updated with recent development from the perspective which evaluates their role as a source of neuromusculoskeletal disorders resulting from exposure to sports and occupational activities. Creep, tension-relaxation, hysteresis, sensitivity to strain rate and strain/load frequency were shown to result not only in mechanical functional degradation but also in the development of sensory-motor disorders with short- and long-term implication on function and disability. The recently exposed relationships between collagen fibers, applied mechanical stimuli, tissue micro-damage, acute and chronic inflammation and neuromuscular disorders are delineated with special reference to sports and occupational stressors such as load duration, rest duration, work/rest ratio, number of repetitions of activity and velocity of movement.
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Affiliation(s)
- Moshe Solomonow
- Musculoskeletal Disorders Research Laboratory, Bioengineering Division, Department of Orthopaedic Surgery, University of Colorado-Denver Health Sciences Center, 12800 E. 19th Avenue, Aurora, CO 80045, USA.
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21
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Venturini C, Penedo MM, Peixoto GH, Chagas MH, Ferreira ML, de Resende MA. Study of the force applied during anteroposterior articular mobilization of the talus and its effect on the dorsiflexion range of motion. J Manipulative Physiol Ther 2007; 30:593-7. [PMID: 17996551 DOI: 10.1016/j.jmpt.2007.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 07/12/2007] [Accepted: 08/04/2007] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the behavior of the force applied during the Maitland grade III anteroposterior joint mobilization of the talus and its effect on dorsiflexion range of motion (ROM). METHODS Two examiners performed measurements of dorsiflexion ROM on both ankles of healthy volunteers using a universal goniometer. The anteroposterior talus mobilization was first applied by examiner A for 30 seconds. Examiner B then repeated the same procedure. A platform was placed under the volunteer's leg to register the forces obtained during mobilization. After the procedure, examiner A assessed the ankle dorsiflexion. RESULTS The results showed consistency regarding maximal forces applied throughout the 30 seconds of mobilization as well as low consistency upon the minimal forces. A significant increase in dorsiflexion ROM of the ankle was found immediately after joint mobilization. CONCLUSIONS The results of the present study have shown consistent maximal forces applied by one examiner and inconsistent minimal forces during an ankle mobilization in healthy volunteers when the same examiner was compared. Moreover, the applied force was able to increase dorsiflexion ROM after the Maitland grade III anteroposterior mobilization of the talus.
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Affiliation(s)
- Claudia Venturini
- Physiotherapy Department of the Catholic Pontifícia University of Minas Gerais, Brazil.
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22
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Nyland J, Patton CM, Roberts CS. Progressive movement-related valgus knee impairments: clinical examination, classification, and treatment. PHYSICAL THERAPY REVIEWS 2007. [DOI: 10.1179/108331907x223092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Li L, Patel N, Solomonow D, Le P, Hoops H, Gerhardt D, Johnson K, Zhou BH, Lu Y, Solomonow M. Neuromuscular response to cyclic lumbar twisting. HUMAN FACTORS 2007; 49:820-9. [PMID: 17915600 DOI: 10.1518/001872007x230190] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To study the influence of 10 min of cyclic twisting motion on abdominal and back muscle activities. BACKGROUND Repetitive (cyclic) occupational activity was identified by many epidemiological reports to be a risk factor for the development of work-related musculoskeletal disorders. Biomechanical and physiological confirmation, however, is lacking. METHODS Trunk muscle electromyography (EMG) was recorded while participants performed a continuous 10-min maximum lumbar cyclic twisting to the left, and maximum isometric twist to the left and right sides was measured before and after the exercise. RESULTS Abdominal muscles contracted symmetrically, independent of twisting direction. The left posterior muscles' integrated EMG (IEMG) decreased during the exercise, whereas the IEMG of the right posterior muscle increased. Simultaneously with increased antagonist coactivity level of the right posterior muscles after the exercise, decrease in maximal isometric left twisting torque was observed. The abdominal muscles did not exhibit any significant changes during the exercise. After the exercise, the right abdominals demonstrated a significant increase in effort, which was independent of the direction of the maximal effort isometric test. CONCLUSIONS The change in muscle activity is attributed to neuromuscular compensation for the development of laxity and microdamage in the soft tissue (ligaments, discs, facet capsules, etc.) of the lumbar spine. APPLICATION The results of this study increase understanding of the risk factors associated with low back disorder induced by labor-intensive occupations that involve cyclic lateral twisting.
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Affiliation(s)
- Li Li
- Department of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA
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24
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Olson MW, Li L, Solomonow M. Interaction of viscoelastic tissue compliance with lumbar muscles during passive cyclic flexion-extension. J Electromyogr Kinesiol 2007; 19:30-8. [PMID: 17703955 DOI: 10.1016/j.jelekin.2007.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 05/14/2007] [Accepted: 06/16/2007] [Indexed: 11/18/2022] Open
Abstract
Human and animal models using electromyography (EMG) based methods have hypothesized that viscoelastic tissue properties becomes compromised by prolonged repetitive cyclic trunk flexion-extension which in turn influences muscular activation including the flexion-relaxation phenomenon. Empirical evidence to support this hypothesis, especially the development of viscoelastic tension-relaxation and its associated muscular response in passive cyclic activity in humans, is incomplete. The objective of this study was to examine the response of lumbar muscles to tension-relaxation development of the viscoelastic tissue during prolonged passive cyclic trunk flexion-extension. Activity of the lumbar muscles remained low and steady during the passive exercise session. Tension supplied by the posterior viscoelastic tissues decreased over time without corresponding changes in muscular activity. Active flexion, following the passive flexion session, elicited significant increase in paraspinal muscles EMG together with increase in the median frequency. It was concluded that reduction of tension in the lumbar viscoelastic tissues of humans occurs during cyclic flexion-extension and is compensated by increased activity of the musculature in order to maintain stability. It was also concluded that the ligamento-muscular reflex is inhibited during passive activities but becomes hyperactive following active cyclic flexion, indicating that moment requirements are the controlling variable. It is conceived that prolonged routine exposure to cyclic flexion minimizes the function of the viscoelastic tissues and places increasing demands on the neuromuscular system which over time may lead to a disorder and possible exposure to injury.
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Affiliation(s)
- Michael W Olson
- Department of Kinesiology, Southern Illinois University, Carbondale, IL, USA
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25
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Minshull C, Gleeson N, Walters-Edwards M, Eston R, Rees D. Effects of acute fatigue on the volitional and magnetically-evoked electromechanical delay of the knee flexors in males and females. Eur J Appl Physiol 2007; 100:469-78. [PMID: 17468881 DOI: 10.1007/s00421-007-0448-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2007] [Indexed: 10/23/2022]
Abstract
Neuromuscular performance capabilities, including those measured by evoked responses, may be adversely affected by fatigue; however, the capability of the neuromuscular system to initiate muscle force rapidly under these circumstances is yet to be established. Sex-differences in the acute responses of neuromuscular performance to exercise stress may be linked to evidence that females are much more vulnerable to anterior cruciate ligament injury than males. Optimal functioning of the knee flexors is paramount to the dynamic stabilisation of the knee joint, therefore the aim of this investigation was to examine the effects of acute maximal intensity fatiguing exercise on the voluntary and magnetically-evoked electromechanical delay in the knee flexors of males and females. Knee flexor volitional and magnetically-evoked neuromuscular performance was assessed in seven male and nine females prior to and immediately after: (1) an intervention condition comprising a fatigue trial of 30-s maximal static exercise of the knee flexors, (2) a control condition consisting of no exercise. The results showed that the fatigue intervention was associated with a substantive reduction in volitional peak force that was greater in males compared to females (15.0, 10.2%, respectively, P < 0.01) and impairment to volitional electromechanical delay in females exclusively (19.3%, P < 0.05). Similar improvements in magnetically-evoked electromechanical delay in males and females following fatigue (21%, P < 0.001), however, may suggest a vital facilitatory mechanism to overcome the effects of impaired voluntary capabilities, and a faster neuromuscular response that can be deployed during critical times to protect the joint system.
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Affiliation(s)
- Claire Minshull
- School of Biomedical and Natural Sciences, Nottingham Trent University, Clifton Campus, Nottingham, NG11 8NS, UK.
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26
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Le P, Solomonow M, Zhou BH, Lu Y, Patel V. Cyclic Load Magnitude is a Risk Factor for a Cumulative Lower Back Disorder. J Occup Environ Med 2007; 49:375-87. [PMID: 17426521 DOI: 10.1097/jom.0b013e318046eb0b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Epidemiological data suggest that high loads lifted by workers engaged in static and cyclic daily activities may be a risk factor for low back disorder. Our previous research provided physiological and biomechanical validation of the epidemiological data for static load conditions. The objective of this report was to provide physiological and biomechanical experimental validation to the epidemiological data in cyclic (repetitive) load conditions. METHODS Three groups of in vivo feline models were subjected to 3 cyclic load levels in a series of 6 periods of 10 minutes of work spaced by 10 minutes of rest followed by 7 hours of rest. Multifidus electromyography (EMG) and lumbar displacement were statistically analyzed after processing. RESULTS Delayed muscular hyperexcitability was observed only in moderate (40 N) and high (60 N) loads (P<0.0001) but was absent in low (20 N) loads. The magnitude of the delayed hyperexcitability was found to be higher (P<0.0001) in the high (60 N) loads compared with the moderate (40 N) loads. CONCLUSIONS Exposure to moderate and high loads in cyclic (repetitive) work results in an acute neuromuscular disorder indicative of soft tissue inflammation that may become chronic with further exposure.
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Affiliation(s)
- Peter Le
- Musculoskeletal Disorders Research Laboratory, Bioengineering Division, Department of Orthopaedics, University of Colorado Health Sciences Center, Aurora, CO 80045, USA
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Sbriccoli P, Solomonow M, Zhou BH, Lu Y. Work to rest durations ratios exceeding unity are a risk factor for low back disorder; a feline model. J Electromyogr Kinesiol 2007; 17:142-52. [PMID: 16600636 DOI: 10.1016/j.jelekin.2006.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 01/06/2006] [Accepted: 01/30/2006] [Indexed: 11/28/2022] Open
Abstract
Low back disorders are prominent among the work force engaged in static anterior flexion during the workday. As a continuing part of a long-term research aimed to identify the biomechanical and physiological processes and corresponding risk factors leading to such cumulative trauma disorder (CTD), we ventured to assess the effect of rest and the work-to-rest duration ratios that may prevent CTD. Three groups of the feline model were subjected to three load/rest paradigms: two 30 min loading periods spaced by 10 min rest in Group I, two 30 min loading period spaced by 30 min rest in Group II and one 60 min loading period for Group III. The cumulative loading duration in the three groups was 60 min. Each of the groups were allowed 7h of rest while monitoring EMG and lumbar viscoelastic tissue creep each hour. The results demonstrate that for two 30 min load periods with a 30 min in between rest, an acute neuromuscular disorder was not present whereas for two 30 min loading with a 10 min rest it was. Similarly, for a 60 min loading with long-term rest, the disorder was present. Post hoc Fisher analysis demonstrated significant differences in the delayed hyperexcitability between the first and second group (P<0.0001) and the third and second (P<0.0001) group. Statistical difference in the displacement data of the three groups was not present. ANOVA showed a significant effect of time post-loading (P<0.0001 and different rest durations (P<0.0001) on the EMG data during the 7h recovery. The new data allow us to conclude that a work-to-rest duration ratio of 1:1 can prevent the development of CTD as long as the work periods are not too long (<60 min). Longer static flexion durations do not respond favorably to rest even if it is of equal or longer duration. It is suggested that appropriate durations of rest may be a viable tool to avert CTD in a certain range whereas long static flexion durations should be avoided at all cost.
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Affiliation(s)
- Paola Sbriccoli
- Musculoskeletal Disorders Research Laboratory, Bioengineering Division, Department of Orthopaedic Surgery, University of Colorado at Denver and Health Sciences Center, RC-1 North Tower, Room 2103, 12800 East 19th Avenue, Denver, CO 80045, United States
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28
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Solomonow M. Sensory – Motor control of ligaments and associated neuromuscular disorders. J Electromyogr Kinesiol 2006; 16:549-67. [PMID: 17045488 DOI: 10.1016/j.jelekin.2006.08.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The ligaments were considered, over several centuries, as the major restraints of the joints, keeping the associated bones in position and preventing instability, e.g. their separation from each other and/or mal-alignment. This project, conducted over 25 years, presents the following hypothesis: 1. Ligaments are also major sensory organs, capable of monitoring relevant kinesthetic and proprioceptive data. 2. Excitatory and inhibitory reflex arcs from sensory organs within the ligaments recruit/de-recruit the musculature to participate in maintaining joint stability as needed by the movement type performed. 3. The synergy of the ligament and associated musculature allocates prominent role for muscles in maintaining joint stability. 4. The viscoelastic properties of ligaments and their classical responses to static and cyclic loads or movements such as creep, tension-relaxation, hysteresis and strain rate dependence decreases their effectiveness as joint restraint and stabilizers and as sensory organs and exposes the joint to injury. 5. Long-term exposure of ligaments to static or cyclic loads/movements in a certain dose-duration paradigms consisting of high loads, long loading duration, high number of load repetitions, high frequency or rate of loading and short rest periods develops acute inflammatory responses which require long rest periods to resolve. These inflammatory responses are associated with a temporary (acute) neuromuscular disorder and during such period high exposure to injury is present. 6. Continued exposure of an inflamed ligament to static or cyclic load may result in a chronic inflammation and the associated chronic neuromuscular disorder known as cumulative trauma disorder (CTD). 7. The knowledge gained from basic and applied research on the sensory - motor function of ligaments can be used as infrastructure for translational research; mostly for the development of "smart orthotic" systems for ligament deficient patients. Three such "smart orthosis", for the knee and lumbar spine are described. 8. The knowledge gained from the basic and applied research manifests in new physiotherapy modalities for ligament deficient patients. Ligaments, therefore, are important structures with significant impact on motor control and a strong influence on the quality of movement, safety/stability of the joint and potential disorders that impact the safety and health of workers and athletes.
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Affiliation(s)
- M Solomonow
- Musculoskeletal Disorders Research Laboratory, Bioengineering Section, Department of Orthopaedic Surgery, University of Colorado at Denver and Health Sciences Center, 12800 East 19th Avenue, Aurora, Denver, CO 80045, USA.
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Navar D, Zhou BH, Lu Y, Solomonow M. High-repetition cyclic loading is a risk factor for a lumbar disorder. Muscle Nerve 2006; 34:614-22. [PMID: 16892430 DOI: 10.1002/mus.20629] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Epidemiological data suggest that prolonged exposure to cyclic lumbar flexion elicits a chronic neuromuscular disorder and disability in workers. This study provides a physiological and biomechanical assessment of various repetitions of cyclic lumbar flexion sessions as a risk factor for development of an acute neuromuscular disorder. An in vivo feline model was subjected to 10 minutes of cyclic (0.25-HZ) loading, followed by a 10-minute rest period, repeated three times in one experimental group, six times in a second group, and nine times in the third group, followed by rest for 7 hours. Displacement of the lumbar viscoelastic tissue and reflex electromyographic (EMG) activity from the lumbar multifidus muscle were monitored. Creep developed and accumulated during each load/rest period and partially recovered during the subsequent rest. Loading periods were characterized by a decrease in reflex EMG activity with superimposed spasms. In the 7-hour recovery period, initial hyperexcitability was present in all groups, whereas only the six- and nine-repetition groups displayed significant delayed hyperexcitability, indicating the presence of acute inflammation. The mathematical model developed fit the data reasonably well, as the R2 values were generally near 0.90. It was concluded that the resulting delayed muscular hyperexcitability constitutes an acute neuromuscular disorder associated with exposure to many repetitions of cyclic lumbar flexion. The acute disorder can become chronic if not allowed sufficient rest to resolve itself. Workers engaged in cyclic lumbar flexion (e.g., loading/unloading, assembly workers) should avoid long-term exposure in order to prevent the development of a chronic neuromuscular condition known as cumulative trauma disorder.
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Affiliation(s)
- Daniel Navar
- Musculoskeletal Disorders Research Laboratory, Bioengineering Division, Department of Orthopaedics, RC-1, North Tower, University of Colorado Health Sciences Center, Aurora, Colorado 80045, USA
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30
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Sbriccoli P, Solomonow M, Zhou BH, Lu Y, Sellards R. Neuromuscular response to cyclic loading of the anterior cruciate ligament. Am J Sports Med 2005; 33:543-51. [PMID: 15722294 DOI: 10.1177/0363546504268408] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cyclic load applied to various joints during occupational and sports activities is epidemiologically linked to higher risk of neuromuscular disorder development. HYPOTHESIS Passive cyclic loading of the knee will develop laxity and creep in the anterior cruciate ligament, and these may elicit a neuromuscular disorder in the quadriceps and hamstrings. Women may be more susceptible to the disorder. STUDY DESIGN Controlled laboratory study. METHODS Male and female groups were subjected to 10 minutes of passive cyclic loading (0.1 Hz) of the knee at a mild load (150-200 N) and at 35 degrees and 90 degrees flexion. Anterior tibial displacement and electromyogram from the quadriceps and hamstrings were monitored during cyclic loading. Maximal voluntary contraction of knee extension and flexion was assessed before and after cyclic loading. The effect of gender and angle on maximal voluntary contraction and quadriceps/hamstrings electromyogram was tested by a 2-way analysis of variance. Differences between the preload and postload data were tested by a paired t test. RESULTS At a knee angle of 90 degrees, after cyclic loading, a decrease in maximal voluntary contraction during extension was present in men and women, with an associated decrease in quadriceps electromyogram activity. At 35 degrees, a decrease in maximal voluntary contraction in extension was noted in women and men. Electromyogram spasms were present in the quadriceps and hamstrings during the 10-minute cyclic loading in 51.7% of subjects. Analysis of variance demonstrated that ligament creep was significantly greater in women than in men at both knee angles. CONCLUSIONS Even a mild cyclic loading of the anterior cruciate ligament, for a relatively short period, can elicit substantial creep, laxity, and a neuromuscular disorder. The disorder is composed of spasms and attenuated muscular function that may together create a condition that exposes the knee to injury. Women seem to be more susceptible than men. CLINICAL RELEVANCE Cyclic actions performed at high frequencies and high-load magnitudes may lead to the occurrence of increased knee laxity and changes in neuromuscular function that, together with fatigue and changes in proprioception, may increase the risk of injury.
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Affiliation(s)
- Paola Sbriccoli
- Occupational Medicine Research Center, Bioengineering Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 2025 Gravier Street, Suite 400, New Orleans, LA 70112, USA
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Courville A, Sbriccoli P, Zhou BH, Solomonow M, Lu Y, Burger EL. Short rest periods after static lumbar flexion are a risk factor for cumulative low back disorder. J Electromyogr Kinesiol 2005; 15:37-52. [PMID: 15642652 DOI: 10.1016/j.jelekin.2004.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of this work was to study the effect of rest periods of various durations applied between six 10-min sessions of static flexion on the development of cumulative low back disorder (CLBD). Three experimental groups of a feline model were used, and the rest duration between sequential static load periods was set to 5, 10, and 20 min, with a corresponding load-to-rest ratio of 2:1, 1:1 and 1:2, respectively. The reflex electromyographic (EMG) activity from the multifidus muscles and supraspinous ligament displacement (creep) were recorded during the flexion periods and over 7 h of rest following the load-rest cycles. It was found that a minor disorder developed in all the groups whereas a severe neuromuscular disorder including a delayed hyperexcitability was observed only in the group subjected to 5 min rest. The two-way ANOVA showed a significant effect of time post loading (p<0.001) and rest duration (p<0.001) on the Normalized Integrated EMG (NIEMG) recovery data; a significant effect of time post loading on the Displacement data (p<0.001) was observed as well. The post hoc Fisher test performed on the NIEMG data during the recovery phase showed a significant difference between the group subjected to 5 min rest and the other two groups (p<0.001). These results suggest that while a short rest period of 2:1 load-to-rest ratio leads to CLBD, longer rest at 1:1 and 1:2 load-to-rest ratio are more favorable for preventing or attenuating the development of CLBD. Short rest periods between sessions of static lumbar flexion, therefore, are a risk factor for the development of CLBD.
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Affiliation(s)
- Amy Courville
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Occupational Medicine Research Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
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Sbriccoli P, Yousuf K, Kupershtein I, Solomonow M, Zhou BH, Zhu MP, Lu Y. Static load repetition is a risk factor in the development of lumbar cumulative musculoskeletal disorder. Spine (Phila Pa 1976) 2004; 29:2643-53. [PMID: 15564913 DOI: 10.1097/01.brs.0000146052.44581.5f] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vivo feline model subjected to variable number of repetitions of a short static lumbar flexion followed by an equally long rest period. OBJECTIVES The purpose of this study was to determine the influence of the number of repetitions as a risk factor in promoting a cumulative low back disorder in the feline model. SUMMARY OF BACKGROUND DATA Epidemiologic data point out that the increased number of repetitions of static lumbar loading is a major risk factor in the development of cumulative low back disorder. Biomechanical and physiologic confirmation of the epidemiology is lacking. Recent work demonstrated that repetitive static loading results in accumulation of creep in the lumbar viscoelastic tissues, resulting in a neuromuscular disorder consisting of spasms during loading and hyperexcitability of lumbar muscles during following rest. It was also shown that the load magnitude is a major risk factor. It is hypothesized that increased number of repetitions of static load periods result in increased severity of the resulting neuromuscular disorder. METHODS Static lumbar flexion of 10 minutes duration followed by 10 minutes rest was repeated three times in one experimental group, six times in the second, and nine times in the third group. In all groups, the creep developing in the lumbar viscoelastic tissues as well as the reflexive EMG from the multifidus were monitored during the flexion/rest periods and throughout a 7-hour recovery period after the repetitions. RESULTS Creep developed and accumulated during each of the flexion/rest periods in the three experimental protocols, with larger residual creep at the end of the nine repetitions. A residual creep was still present at the end of the 7 hours of recovery allowed in each of the three groups. During the flexion/rest sessions, EMG spasms were present, and the presence of an initial hyperexcitability was detected during the 7 hours of recovery in all the preparations. The presence of a delayed hyperexcitability was revealed only in the group subjected to nine flexion/rest periods, while it was not observed in the groups subjected to three and six flexion/rest repetitions. The statistical analysis (post hoc Fisher test) performed on the normalized integrated EMG and displacement data during the recovery phase showed a significant difference between the nine repetitions group and the other two groups (P < 0.0001). The two-way ANOVA analysis revealed a significant effect of time (P < 0.005) and number of repetitions (P < 0.0001) on all considered parameters. CONCLUSIONS It was concluded that a cumulative neuromuscular disorder develops because of repetition of static lumbar flexion, and the severity of the disorder provoked is magnified by the number of repetitions. Despite the highly favorable 1:1 work-to-rest ratio and the 7-hour post loading rest period, a full recovery of creep was not obtained in this study.
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Affiliation(s)
- Paola Sbriccoli
- Occupational Medicine Research Center, Bioengineering Laboratory, Department of Orthopaedic Surgery, LA State University Health Sciences Center, New Orleans, LA 70112, USA
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LaBry R, Sbriccoli P, Zhou BH, Solomonow M. Longer static flexion duration elicits a neuromuscular disorder in the lumbar spine. J Appl Physiol (1985) 2004; 96:2005-15. [PMID: 14742451 DOI: 10.1152/japplphysiol.01190.2003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The objective of this study was to assess the impact of two sequential long, static, anterior lumbar flexions on the development of a neuromuscular disorder and to compare it with previously obtained data from a series of short static flexion periods of the same cumulative time (Sbriccoli P, Solomonow M, Zhou BH, Baratta RV, Lu Y, Zhu MP, and Burger EL, Muscle Nerve 29: 300-308, 2004). Static flexions with loads of 20, 40, and 60 N were applied to the lumbar spine over two 30-min periods with a 10-min rest in between. The reflex EMG activity from the multifidus muscles and supraspinous ligament displacement (creep) was recorded during the flexion periods. Creep and EMG were also monitored over 7 h of rest following the work-rest-work cycle. It was found that the creep that developed in the first 30-min flexion period did not recover completely during the following 10 min of rest, giving rise to a large cumulative creep at the end of the work-rest-work session. Spasms were frequently seen within the EMG during the static flexion. Initial and delayed hyperexcitabilities were observed in all of the preparations at any of the three loads explored during the 7-h rest period. ANOVA revealed a significant effect of time ( P < 0.0001) on the postloading data. Larger loads elicited larger magnitudes of the initial and delayed hyperexcitabilities, yet were not statistically different. It was concluded that the 3:1 work-to-rest duration ratio resulted in a neuromuscular disorder, regardless of the load magnitude. The conclusions are reinforced in view of the results from a previous study using 60 min of flexion overall but at 1:1 work-to-rest ratio in which only the highest load elicited a delayed hyperexcitability (Sbriccoli et al., Muscle Nerve 29: 300-308, 2004). An optimal dose-to-duration ratio needs to be established to limit, attenuate, or prevent the adverse effects of static load on the lumbar spine while considering the loading duration as a major risk factor.
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Affiliation(s)
- Rebecca LaBry
- Occupational Medicine Research Center, Bioengineering Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
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Abstract
The mechanical and neurological properties of ligaments are reviewed and updated with recent development from the perspective which evaluates their role as a source of neuromusculoskeletal disorders resulting from exposure to occupational activities. Creep, tension-relaxation, hysteresis, sensitivity to strain rate and strain/load frequency were shown to result not only in mechanical functional degradation but also in the development of sensory-motor disorders with short- and long-term implication on function and disability. The recently exposed relationships between collagen fibers, applied mechanical stimuli, tissue microdamage, acute and chronic inflammation and neuromuscular disorders is delineated with special reference to occupational stressors.
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Affiliation(s)
- M Solomonow
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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Solomonow M, Baratta RV, Zhou BH, Burger E, Zieske A, Gedalia A. Muscular dysfunction elicited by creep of lumbar viscoelastic tissue. J Electromyogr Kinesiol 2003; 13:381-96. [PMID: 12832168 DOI: 10.1016/s1050-6411(03)00045-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The biomechanics, histology and electromyography of the lumbar viscoelastic tissues and multifidus muscles of the in vivo feline were investigated during 20 min of static as well as cyclic flexion under load control and during 7 h of rest following the flexion. It was shown that the creep developed in the viscoelastic tissues during the 20 min of static or cyclic flexion did not fully recover over the 7 h of following rest. It was further seen that a neuromuscular disorder with five distinct components developed during and after the static and cyclic flexion. The neuromuscular disorder consisted of a decreasing magnitude of reflexive EMG from the multifidus upon flexion as well as of superimposed spasms. The recovery period was characterized by an initial muscle hyperexcitability, a slowly increasing reflexive EMG and a delayed hyperexcitability. Histological data from the supraspinous ligament demonstrate significant increase (x 10) in neutrophil density in the ligament 2 h into the recovery and even larger increase (x 100) 6 h into the recovery from the 20 min flexion, indicating an acute soft tissue inflammation. It was concluded that sustained static or cyclic loading of lumbar viscoelastic tissues may cause micro-damage in the collagen structure, which in turn reflexively elicit spasms in the multifidus as well as hyperexcitability early in the recovery when the majority of the creep recovers. The micro-damage, however, results in the time dependent development of inflammation. In all cases, the spasms, initial and delayed hyperexcitabilities represent increased muscular forces applied across the intervertebral joints in an attempt to limit the range of motion and unload the viscoelastic tissues in order to prevent further damage and to promote healing. It is suggested that a significant insight is gained as to the development and implications of a common idiopathic low back disorder as well as to the development of cumulative trauma disorders.
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Affiliation(s)
- M Solomonow
- Occupational Medicine Research Center, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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Solomonow M, Baratta RV, Banks A, Freudenberger C, Zhou BH. Flexion-relaxation response to static lumbar flexion in males and females. Clin Biomech (Bristol, Avon) 2003; 18:273-9. [PMID: 12689776 DOI: 10.1016/s0268-0033(03)00024-x] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine if creep developed in the lumbar viscoelastic tissues during a period of static flexion elicited changes in the muscular responses of the flexion-relaxation phenomenon. BACKGROUND Static lumbar flexion is a risk factor in workers, yet the physiological biomechanical and histological processes active in the evolution of the consequent low back disorder were not demonstrated experimentally. Controlled animal studies show that static lumbar flexion develops creep in the associated viscoelastic tissues and elicits spasms and modification of muscle function. Such neuromuscular changes are to be investigated in this study while assessing normal human subjects via the flexion-relaxation phenomenon. METHODS Male and female subject groups performed three bouts of lumbar flexion-extension before and after a 10 min period of static lumbar flexion. The surface electromyographic from the erector spinae muscles as well as flexion angle were recorded. The angle in which electromyographic diminished during flexion and initiated during extension was determined and subjected to ANOVA with repeated measures to determine any significant changes in the flexion-relaxation response. RESULTS The erector spinae were active through a significantly larger angle during flexion and initiated activity significantly earlier during extension after static flexion. Females demonstrated more pronounced changes than males. EMG amplitude did not change significantly. Spasms were recorded in more than half of the subjects during the static flexion period. CONCLUSIONS Creep developed during a short static lumbar flexion elicited significant changes in the muscular activity pattern of the flexion-relaxation phenomenon. The muscles seem to compensate for the loss of tension in the lumbar viscoelastic tissues, while spasms suggest that some micro-damage was incurred to the viscoelastic tissues. RELEVANCE Static lumbar flexion is shown experimentally as an activity that constitutes an occupational risk factor for the development of low back disorder.
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Affiliation(s)
- Moshe Solomonow
- Occupational Medicine Research Center, Bioengineering Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 2025 Gravier Street, Suite 400, New Orleans, LA 70112, USA.
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