Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial

BACKGROUND: Knee-joint pathologies, such as anterior knee pain (AKP), are associated with strength deficits and reduced activation of the knee extensors, which is referred to as muscle inhibition (MI). MI is thought to prevent full functional recovery, and treatment modalities that help to reduce or eliminate MI appear necessary for successful rehabilitation. Clinical observations suggest that AKP is typically associated with sacroiliac (SI) joint dysfunction. It is unknown whether SI-joint dysfunction contributes to knee-extensor deficits and whether correction of SI-joint dysfunction alleviates MI. OBJECTIVE: The objective of this study was to assess whether conservative low back treatment reduces lower limb MI. STUDY DESIGN: In a randomized, controlled, double-blind study the effects of conservative lower back treatment on knee-extensor strength and MI were evaluated in patients with AKP. METHODS: Twenty-eight patients with AKP were randomly assigned to either a treatment or a control group. After a lower back functional assessment, the treatment group received a conservative treatment in the form of a chiropractic spinal manipulation aimed at correcting SI-joint dysfunction. The control group underwent a lower back functional assessment but received no joint manipulation. Before and after the manipulation or the lower back functional assessment, knee-extensor moments, MI, and muscle activation during full effort, isometric knee extensions were measured. RESULTS: Patients showed substantial MI in both legs. Functional assessment revealed SI-joint dysfunction in all subjects (23 symptomatic and 5 asymptomatic). After the SI-joint manipulation, a significant decrease in MI of 7.5% was observed in the involved legs of the treatment group. MI did not change in the contralateral legs of the treatment group or the involved and contralateral legs of the control group. There were no statistically significant changes in knee-extensor moments and muscle activation in either group. CONCLUSIONS: The results of this study suggest that SI-joint manipulation reduces knee-extensor MI. Spinal manipulation may possibly be an effective treatment of MI in the lower limb musculature.     

半月板切除术后等速肌力测试及评价

目的：研究半月板切除术后影响膝关节功能恢复的因素，膝屈伸肌在保持膝关节稳定性中的作用。方法：采用Ｃｙｂｅｘ３３０等速运动测试仪，对２８例半月板切除术后患者的双膝屈伸肌进行等速肌力测试并结合双膝关节Ｘ线片检查进行评定。结果：半月板切除术后仍有关节功能紊乱的患者双膝屈伸肌力均下降，尤其是患侧伸膝肌减弱更明显，患侧膝与健侧膝比较差异有非常显著性（Ｐ＜０．０１）；Ｘ线片检查患膝有退行性骨关节炎改变。结论：半月板切除术后影响膝关节功能恢复的原因主要有膝屈伸肌力下降，退行性骨关节炎等。提高半月板切除术后膝屈伸肌力，对维持膝关节的稳定性，防止后期继发症有重要作用     

Decrease in elbow flexor inhibition after cervical spine manipulation in patients with chronic neck pain

OBJECTIVE: This study measured functional capacity and subjective pain in patients with chronic neck pain before and after manipulation of the cervical spine. DESIGN: Outcomes study on 16 patients with chronic neck pain. BACKGROUND: Muscle inhibition, i.e., the inability to fully activate a muscle, has been observed following joint pathologies and in low back pain conditions. Although chronic neck pain has been associated with changes in muscle recruitment and coordination in the shoulder and arms, the possibility of muscle inhibition has not been explored. METHODS: Biceps activation during a maximal voluntary elbow flexor contraction was assessed using the interpolated twitch technique and electromyography. Cervical range of motion and pressure pain thresholds were measured using a goniometer and an algometer. Manipulation of the cervical spine was applied at the level of C5/6/7, and functional assessments were repeated. RESULTS: Patients showed significant inhibition in their biceps muscles. Cervical range of motion was restricted laterally, and increased pressure pain sensitivity was evident. After cervical spine manipulation, a significant reduction in biceps inhibition and an increase in biceps force occurred. Cervical range of motion and pressure pain thresholds increased significantly. CONCLUSIONS: Significant dysfunction in biceps activation was evident in patients with chronic neck pain, indicating that this muscle group cannot be used to the full extent. Spinal manipulation decreased muscle inhibition and increased elbow flexor strength at least in the short term. RELEVANCE: Muscle inhibition in the biceps has not been previously documented in patients with chronic neck pain. Further research is needed to establish whether muscle inhibition is related to clinical symptoms and functional outcome. Spinal manipulation improved muscle function, cervical range of motion and pain sensitivity, and might therefore be beneficial for treating patients with chronic neck pain.     

膝骨关节炎患者膝关节置换后下肢肌的表面肌电图变化

背景：膝骨关节炎患者膝关节置换后下肢肌功能恢复一直存在着争议。目的：评价膝骨关节炎患者膝关节置换手术后下肢肌肉功能。方法：应用TELEMYO2400RG2表面肌电图遥测仪对25例双膝骨关节炎单膝关节置换后患者在平常自然步态下进行双下肢股直肌、胫前肌、股二头肌和腓肠肌内侧的表面肌电信号测试。在肌电图测试前,对患者双膝关节功能进行美国特种外科医院膝关节评分。结果与结论：患者置换后美国特种外科医院膝关节评置换侧平均分91．44,其优良率达100％;未置换侧平均分54．52。置换侧在疼痛、关节功能方面有明显改善;膝关节置换后置换侧股直肌、胫前肌、股二头肌的肌电振幅、肌电积分、平均频率、中位频率的（平均值、最小值、最大值）与未置换侧相比差异无显著性意义（P〉0．05）;置换侧腓肠肌内侧肌电振幅值及肌电积分值显著大于未置换侧（P〈0．05）;置换侧腓肠肌内侧平均频率、中位频率与未置换侧相比差异无显著性意义（P〉0．05）。提示膝关节置换后置换侧的下肢肌没有恢复到正常的功能活动水平,因此膝关节置换后康复要特别重视患者的肌肉锻炼。     

Rehabilitation after damage to the anterior cruciate ligament for persons actively participating in sport

Background. The goal of our research was to evaluate the effectiveness of rehabilitation in cases of major damage to the anterior cruciate ligament. Material and methods. The research involved a group of 80 persons in rehabilitation who had previously been active in sports, and had incurred damage to the anterior cruciate ligament. The examinations covered the circumference of the knee and hip, the range of flexion and extension, the momentum of strength in the flexor and extensor muscle groups, and the stability of the knee joint. The tests were performed twice, once before and once after rehabilitation, and then compared with the results for the healthy limb. Results. Significant improvement was obtained in the circumference of the knee and hip, the range of flexion and extension, and the momentum of strength in the flexor and extensor muscle groups. However, the improvement in the stability of the knee joint was not statistically significant. Conclusions. Rehabilitation after major damage to the anterior cruciate ligament has a significant impact on the range of movement, reduces exudate, and increases the mass and strength of the muscles that stabilize the knee, thus improving the dynamic stability of the joint. There is no significant impact on impaired passive stability, other than slowing the appearance of degenerative changes. In active individuals participating in sport, the treatment of choice after total ACL damage should be surgery.     

Diagnostic Tests for Mechanical Dysfunction of the Sacroiliac Joints

Abstract

Despite almost a century of management of mechanical dysfunction of the sacroiliac joints, no testing procedures have been satisfactorily validated for diagnosis. This paper presents tests that proved to be the most reliable for the management of 57 patients referred by their GPs for treatment of back and leg pain. The patients all regained normal pain-free function after manipulation of the sacroiliac joint(s) followed by a program of modified living and progressively increased walking. The tests include a version of Gillet's test (alternate hip and knee flexion in support standing) revised by the author, passive hip rotations in supine with 90 degrees of hip and knee flexion, and palpation of the superior ligament of the symphysis pubis. This paper proposes that when performed as described, these four tests are worth validating for the diagnosis of sacroiliac joint dysfunction.     

Hamstring muscle strain treated by mobilizing the sacroiliac joint

The purpose of this study was to compare the effectiveness of two types of treatment of hamstring muscle strains. Twenty patients with hamstring muscle strains were assigned randomly to an Experimental Group (n = 10) or a Control Group (n = 10). Peak torque production of the quadriceps femoris and hamstring muscles and hamstring muscle length were measured before and after treatment. The hamstring muscles of the Experimental and Control groups were treated with moist heat followed by passive stretching. The Experimental Group also received manipulation of the sacroiliac joint. The change in hamstring muscle peak torque was significantly greater for the Experimental Group than for the Control Group (p less than .005). No significant differences existed between the two groups in either quadriceps femoris muscle peak torque or hamstring muscle length. The results of this study suggest a relationship between sacroiliac joint dysfunction and hamstring muscle strain.     

Effect of sacroiliac manipulation on postural sway in quiet standing: a randomized controlled trial

Background

Sacroiliac joint manipulation can alter joint and muscle control mechanisms through local and remote effects. Postural balance is controlled by supraspinal (rambling) and spinal–peripheral (trembling) mechanisms. A manipulation may interfere with postural control in quiet standing.

骶髂关节紊乱导致青少年非典型性跟痛及其治疗

目的验证手法调整治疗骶髂关节紊乱所致非典型性跟痛的疗效。方法对23例骶髂关节紊乱所致非典型性跟痛患者,采用腰椎斜扳法、过伸扳法或(和)髋关节摇转法纠正骶髂关节紊乱,必要时配合本体促进法和静力拉伸放松肌肉。结果 21例患者经1次治疗后症状消失;1例治疗3d后复发,再次治疗后症状消失;1例患者10d内经3次治疗后反复发作2个月。结论骶髂关节紊乱所致青少年跟痛是一种典型的脊柱相关疾病,经仔细检查,明确髂骨旋转方向并予以恰当整复,可即刻痊愈。     

Function and pathomechanics of the sacroiliac joint. A review

The purpose of this article is to describe the biomechanics and function of the sacroiliac joint, the dysfunction and pathomechanics of the sacroiliac joint as a common cause of low back pain, a simple assessment procedure, associated pain mechanisms, treatment and prevention of the problem, and a discussion of related literature. The sacroiliac joints are essentially nonweight-bearing joints that function to absorb forces from various directions. The common onset of dysfunction is during trunk flexion when a person is standing without adequate support of the anterior pelvis. The anterior shift of the weight of the upper trunk causes the innominates to rotate anteriorly and downward and become fixed on the sacrum. Movement downward of the acetabula in relationship to the sacroiliac joint not only results in biomechanical changes but causes the legs to appear longer than they actually are. Physical therapists can correct the dysfunction by manually rotating the innominates posteriorly on the sacrum while they observe objective changes in apparent leg length. People can prevent this dysfunction through adequate anterior pelvic support when they lean forward. Some possible consequences of untreated sacroiliac dysfunction are also discussed.     

Joint mobilization reduces hyperalgesia associated with chronic muscle and joint inflammation in rats.

Joint mobilization is a common treatment used by healthcare professions for management of a variety of painful conditions, including inflammatory joint and muscle pain. We hypothesized that joint mobilization would reduce the bilateral hyperalgesia induced by muscle and joint inflammation. Mechanical hyperalgesia was measured by examining the mechanical withdrawal threshold of the rat's paw before and after induction of inflammation with 3% carrageenan (gastrocnemius muscle) or 3% kaolin/carrageenan (knee joint), and for 1 hour after knee joint mobilization. The mobilization consisted of rhythmically flexing and extending the knee joint to the end of range of extension while the tibia was simultaneously moved in an anterior to posterior direction. A bilateral decrease in mechanical withdrawal thresholds occurred 1, 2, and 4 weeks after inflammation of the knee joint or muscle. In animals with muscle inflammation, mobilization of the knee joint increased the mechanical withdrawal threshold bilaterally when given 1, 2, or 4 weeks after inflammation. However, in animals with knee joint inflammation, mobilization of the knee joint at 4 weeks increased the mechanical withdrawal threshold but had no effect when administered 1 or 2 weeks after inflammation. Therefore, joint mobilization reduces hyperalgesia induced by chronic inflammation of muscle and joint. PERSPECTIVE: This article shows that unilateral joint mobilization reduces bilateral hyperalgesia induced by chronic muscle or joint inflammation. Understanding the pain conditions in which mobilization produces an analgesic effect should assist the clinician in selecting appropriate treatment techniques. The bilateral effect suggests that central mechanisms could mediate the analgesia.     

Muscle training in chronic anterior cruciate ligament insufficiency--a comparative study.

The aim of the investigation was to study and compare the effect of two basically different training methods on muscle strength and knee function on a consecutive and prospective series of 26 conservatively treated patients with chronic anterior cruciate ligament injury. The two training models were: model Q directed towards specific training of knee extensor muscle strength and model F aiming at training of the lower extremity and trunk muscles in functional weightbearing patterns. The parameters evaluated were: isometric and isokinetic muscle strength, a performance test (one-leg hop test), and a functional score. The results after a three-month training period showed in both groups a significant increase of muscle strength in both knee extensors and knee flexors. No significant difference of isokinetic strength values between the two groups was observed. The isometric gain of knee extension was significantly higher in the Q group. The one-leg hop test value and the functional score were also significantly increased in both groups. However, the hop test indicated a more favourable result in the group who were trained functionally.     

应用缝匠肌治疗伸膝功能障碍

Theusualtreatmentofdislocationorsubluxationofpatella，quadricepsfemorisparalysisafterpoliomyelitisaswellasweakex－tensorofkneeafterquadriceps－plastyonextensionstiffnessofkneeandafterpatellectomyresultedfromcomminutedfractureortuber－culosisofpatellawasfarfromsatisfied．Freeingthedistalone－thirdpartofsartoriusmusclewithoutcuttingitsinsertionfortreatmentoftheoutwardsdisplacementofpatellaandfreeingthedistaltwo－thirdspartofsartoriusmusclewithoutcuttingitsinsertionfortreatmenttheweakextensorofkne…     

髌骨软化症患者膝关节等速肌力测试

目的 分析髌骨软化症患者膝关节周围肌力特征,并比较其与健康人的差异。方法 2021年3月,采用等速肌力测试与训练系统,对70例单膝发病髌骨软化症患者(观察组)和35例健康人(对照组)进行膝关节不同角速度(60°/s和180°/s)的屈、伸等速肌力测试。结果 60°/s和180°/s时,观察组患侧屈、伸肌峰力矩、峰力矩体质量比、总功均显著低于对照组(U > 1097.0, P<0.001);观察组患侧60°/s屈、伸肌和180°/s时伸肌峰力矩、峰力矩体质量比、总功均低于观察组健侧(|Z| > 2.121, P<0.05)。60°/s和180°/s时,观察组患侧屈伸肌力比值均明显大于健侧和对照组(U > 1810.0, |Z| >3.691, P<0.01)。结论 髌骨软化症患者的患膝屈、伸肌肌爆发力和耐力均减弱,膝关节肌力存在失衡现象。     

CT导引下的骶髂关节造影及其临床意义初探

目的探讨ＣＴ导引下的骶髂关节造影术及其临床意义。方法对５例骶髂关节病变患者和１５例腰腿痛的志愿者进行ＣＴ导引下的骶髂关节造影,造影后行ＣＴ扫描、Ｘ线拍片并填写疼痛图。结果骶髂关节ＣＴ扫描显影良好,Ｘ线片影像欠清晰。２例有骶髂关节病变患者的ＣＴ扫描发现有造影剂外溢及隐窝。本组共１４例感造影后穿刺侧臀部及大腿后上方酸痛,５例骶髂关节病变患者诉造影术引发的疼痛与术前疼痛部位相同。结论ＣＴ导引下的骶髂关节造影术与传统的造影方法相比,即避免了过多接触Ｘ线照射引起的伤害,又提高了工作效率,为临床诊断和开展相关研究提供了有意义的影像学信息。     

Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial

Background

Manual therapy and exercise therapy are two common treatments for low back pain. Although their effects have been discussed in several studies, the superiority of one over the other for patients with sacroiliac joint dysfunction is still unclear.

Efficacy of isokinetic exercise on joint position sense and muscle strength in patellofemoral pain syndrome

OBJECTIVE: The objective of this study was to demonstrate the impairment of knee joint position sense in individuals with patellofemoral pain syndrome and investigate the effects of isokinetic exercise on knee joint position sense and muscle strength. DESIGN: A total of 24 male patients complaining of anterior knee pain caused by overexertion and 24 male healthy individuals without symptoms were included for this investigation. Isokinetic exercise protocol was carried out at angular velocities of 60 degrees/sec and 180 degrees/sec. These sessions were repeated three times per week and lasted for 6 wks. At the beginning and after 6 wks of knee passive joint position sense, quadriceps and hamstring muscle strength and pain assessments were performed. RESULTS: After the isokinetic exercise, flexion peak torque (P < 0.05), extension peak torque (P < 0.01), flexion total work (P < 0.001), extension total work (P < 0.001), passive reproduction of knee joint position sense for 40 degrees of flexion (P < 0.05) and 50 degrees of extension (P < 0.01), and pain score (P < 0.001) improved significantly in the patellofemoral pain syndrome group. CONCLUSION: Isokinetic exercises have positive effects on passive position sense of knee joints, increasing the muscular strength and work capacity. These findings show that using the present isokinetic exercise in rehabilitation protocols of patients with patellofemoral pain syndrome not only improves the knee joint stabilization but also the proprioceptive acuity.     

Obturator nerve impingement caused by an osteophyte in the sacroiliac joint: A case report

BACKGROUNDCases of obturator nerve impingement (ONI) caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported. This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARYA 65-year-old Asian man presented with severe pain and numbness in his left lower limb, which became aggravated during walking and showed intermittent claudication. The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive. Computed tomography (CT) and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint. The results of electrophysiological examination showed peripheral neuropathy. A CT-guided obturator nerve block significantly reduced the severity of pain in this patient. According to the above findings, ONI caused by the osteophyte in the sacroiliac joint was diagnosed. This patient underwent an operation to remove the bone spur and symptomatic treatment. After therapy, the patient''s pain and numbness were significantly relieved. The last follow-up was performed 6 mo after the operation, and the patient recovered well without other complications, returned to work, and resumed his normal lifestyle.CONCLUSIONOsteophytes of the sacroiliac joint can cause ONI, which leads to symptoms including severe radiative pain in the lower limb in patients. The diagnosis and differentiation of this disease should attract the attention of clinicians. Surgical excision of osteophytes should be considered when conservative treatment is not effective.     

Skeletal muscle strength following orthotopic heart transplantation]

AIM OF THE STUDY: Strength measurement of thigh muscles of patients after orthotopic heart transplantation (HTX) with a sedentary lifestyle, entering a cardiac rehabilitation program. DESIGN: Cross-sectional study; values are compared to patients with chronic heart failure (CHF) and healthy controls. METHODS: Isometric and isokinetic peak torque of knee extensor and flexor muscles measured on a Cybex 6000. Twenty minutes' muscle fatigue test of knee extensor muscles. Test of motor tasks of daily living. RESULTS: HTX group: n = 18, age 59 +/- 7 years, body mass index (BMI) 29 +/- 5, months after HTX 46 +/- 36 months; CHI group: n = 24, age 55 +/- 8 years, BMI 25 +/- 4, months after CHF 19 +/- 16 months; control group: n = 10, age 55 +/- 6 years, BMI 26 +/- 5. The HTX group differed significantly (p < 0.05) from the CHI group. Peak torque of knee extensor muscles: HTX: 120.3 +/- 8.4; CHI: 127.8 +/- 8.0 Nm; controls: 158.3 +/- 5.5 (ANOVA p < 0.05); peak torque of knee flexor muscles: HTX 65.6 +/- 5.9 Nm; CHI 70.1 +/- 6.2 Nm; controls 84.4 +/- 3.1 Nm(ANOVA p < 0.01). Peak torque of knee extensor muscles related to body weight: HTX: 137.4 +/- 10.0 Nm%, CHI: 162.6 +/- 9.3 Nm%, control group 202.8 +/- 5.7 Nm% (ANOVA p < 0.01). Muscle fatigue test of knee extensor muscles: isometric maximal strength (maximal voluntary contraction, MCV; HTX vs. CHI): 331.6 +/- 14.7 N vs. 335.5 +/- 18.6 N (n.s.), MVC after 5 minutes 296.3 +/- 15.7 N vs. 288.4 +/- 16.7 N; MVC after 10 minutes: 283.5 +/- 15.7 N vs. 282.5 +/- 17.7 N; MVC after 15 minutes 275.7 +/- 13.7 N vs. 280.6 +/- 21.6 N. No significant differences between groups were observed. All values were significantly lower than those of healthy controls (406.2 N; 385.9 N; 373.7 N and 369.6 N). There was a significant decline in MVC after 5 minutes compared to initial values (p < 0.01), in both patients groups but not in the control group. No further decline in MVC was observed beyond the 5th minute of the fatigue test (p > 0.05). CONCLUSION: Peak torque related to body weight and muscle endurance of knee extensor muscles of sedentary patients after orthotopic HTX do not significantly differ from those of comparable patients with CHF but do differ from those of healthy controls. Specific training of muscle strength is needed for patients even several years after orthotopic heart transplantation.     

Clinically-relevant measures associated with altered contact forces in patients with anterior cruciate ligament deficiency

Background

Knee joint contact forces are altered after anterior cruciate ligament injury during walking and may be related to clinically-relevant measures of impairments or self-reported function. The purpose of this study was to investigate the association of several clinically-relevant measures with altered knee contact forces in patients with anterior cruciate ligament injury.

Methods

Data for this study represent a cross-sectional observational analysis of thirty-seven (23 M, 14 F) patients with complete unilateral anterior cruciate ligament injury. Gait analysis with electromyography was used to obtain estimates of tibiofemoral joint contact force using an electromyography-driven musculoskeletal model. Multivariable linear regression was used to identify measures associated with tibiofemoral joint contact force.

Findings

Involved knee extensor muscle strength and patient-reported knee function on the Global Rating Scale of perceived function were significantly associated with peak tibiofemoral contact force for the involved limb. Patients who were stronger and who perceived higher knee function walked with greater contact forces on their involved knees. After controlling for walking speed, involved extensor strength explained 8.9% of the variance in involved peak tibiofemoral contact force and score on the Global Rating Scale explained an additional 9.4% of the variance.

Interpretation

Improvements in involved quadriceps strength and overall function as measured by patient self-report may be important for increasing involved limb contact forces, thereby restoring loading symmetry in these patients who demonstrate decreased involved limb loading after injury. These results highlight the potential value of studying the recovery of strength, self-reported function and joint loading symmetry in patients with anterior cruciate ligament injury.