Fast unilateral isometric knee extension torque development and bilateral jump height

PURPOSE: We hypothesized that the initial rate (first 40 ms) of unilateral knee extensor torque development during a maximally fast isometric contraction would depend on the subjects' ability for fast neural activation and that it would predict bilateral jumping performance. METHODS: Nine males (21.8 +/- 0.9 yr, means +/- SD) performed unilateral fast isometric knee extensions (120 degrees knee angle) without countermovement on a dynamometer and bilateral squat jumps (SJ) and countermovement jumps (CMJ) starting from 90 and 120 degrees knee angles (full extension = 180 degrees ). The dynamometer contractions started either from full relaxation or from an isometric pre-tension (15% maximal isometric torque, Tmax). Torque time integral for the first 40 ms after torque onset (TTI-40, normalized to Tmax) and averaged normalized rectified knee extensor EMG for 40 ms before fast torque onset (EMG-40) were used to quantify initial torque rise and voluntary muscle activation. RESULTS: TTI-40 without pre-tension (range: 0.02-0.19% Tmax per second) was significantly lower than TTI-40 with pre-tension, and both were significantly (r = 0.81 and 0.80) related to EMG-40. During jumping, similar significant positive relations were found between jump height and knee extensor EMG during the first 100 ms of the rise in ground reaction force. There also were significant positive linear relations between dynamometer TTI-40 and jump height (r = 0.75 (SJ 90), 0.84 (SJ 120), 0.76 (CMJ 90), and 0.86 (CMJ 120)) but not between dynamometer Tmax and jump height (-0.16 < r < 0.02). CONCLUSION: One-legged TTI-40 to a large extent explained the variation in jump height. The ability to produce a high efferent neural drive before muscle contraction seemed to dominate performance in both the simple single-joint isometric task and the complex multijoint dynamic task.     

Kinetics,kinematics, and knee muscle activation during sit to stand transition in unilateral and bilateral knee osteoarthritis

BackgroundThe sit to stand transition (STS) is a task performed by those with knee osteoarthritis (KOA) with biomechanical modifications that may influence the lower limb load distribution. As a weight bearing task mainly performed in the sagittal plane, the presence of unilateral or bilateral KOA may lead to asymmetry during its performance.Research questionAre the biomechanical and neuromuscular aspects of the sit to stand transition (STS) different between participants with unilateral and bilateral KOA?MethodsTwenty-eight participants were allocated as follows: unilateral KOA (OA_UNI; n = 12) and bilateral KOA (OA_BI; n = 16). All participants were evaluated by means of kinematics (Qualisys Motion Capture System, Qualisys Medical AB, SUE), kinetics (Bertec Corporation's model 4060−08 Mod., USA), and electromyography (TrignoTM Wireless System, DelSys Inc., USA) during the STS. The variables calculated were the symmetry indices of the total support moment (TSM) and ground reaction force (IS_GRF and IS_TSM, respectively), magnitude of the TSM, individual joint contribution to the TSM, peak trunk flexion, hip, knee, and ankle range of motion, duration in seconds, the magnitudes of activation of the extensor and flexor muscles, knee extensors: flexor co-contraction indices and isometric knee extensor peak torques. Participants also answered the WOMAC questionnaire and performed the 30-second STS test (STS₃₀).ResultsThe OA_BI got up from a chair with a lower TSM magnitude in the most affected limb (p = 0.040), used greater trunk flexion amplitude (p ≤ 0.034), and presented lower isometric KET (p = 0.039) and worse self-reported pain (p = 0.011) and physical function (p = 0.015).SignificanceParticipants with unilateral and bilateral KOA differ regarding lower limb kinetics and trunk kinematics while getting up from a chair, without modification in the lower limb intersegmental coordination or symmetry regarding ground reaction force or TSM distribution.     

Proprioceptive facilitation of muscle tension during unilateral and bilateral knee extension

The effects of double neuromuscular facilitation (DNF) in unilateral movements and of quadruple neuromuscular facilitation (QNF) in bilateral movements were studied in 42 physically active college-age male subjects. Results showed a 10.4% significant increase of maximal knee extension torque output when unilateral extension was preceded by a knee flexion on an isokinetic exerciser and a 16.7% increase of maximal torque in the bilateral condition of simultaneous alternating flexion-extension when compared to the simultaneous extension movement. Consequently, the increased peak torque observed in the unilateral and bilateral experimental conditions in which knee extension was preceded by a knee flexion appears to be the result of a combination of neuromuscular influences and stored elastic energy.     

Muscle activation strategies at the knee during running and cutting maneuvers

PURPOSE: The purpose of this article was to investigate the activation patterns of muscles surrounding the knee during preplanned (PP) and unanticipated (UN) running and cutting tasks, with respect to the external moments applied to the joint. It was hypothesized that activation strategies during PP tasks would correspond to the magnitude and direction of the external loads applied to the knee joint, and the muscle activation patterns would differ between PP and UN tasks. METHODS: Eleven healthy male subjects performed a series of running and cutting tasks under PP and UN conditions. Activation from 10 knee muscles were determined using full-wave rectified, filtered, and normalized EMG calculated during a precontact phase and two epochs across the stance phase. Knee joint flexor and extensor muscle group ratios indicated the level of co-contraction. Individual muscles were also grouped into medial/lateral and internal/external rotation muscle groups, based upon their ability to counter externally applied varus/valgus and internal/external rotation joint loads, respectively. RESULTS: Selective activation of medial/lateral and internal/external rotation muscles and co-contraction of flexors and extensors were used to stabilize the joint under PP conditions, whereas generalized co-contraction strategies were employed during the UN condition. Net muscle activation during the UN sidestepping tasks increased by 10-20%, compared with an approximately 100% increase in applied varus/valgus and internal/external rotation joint moments. CONCLUSION: In PP conditions, activation patterns appear to be selected to support the external loads experienced at the knee, e.g., medial muscles activated to resist applied valgus moments. Under UN conditions, there was no selective activation of muscles to counter the external knee load, with generalized co-contraction being the activation pattern adopted. These findings have implications for the etiology of noncontact knee ligament injuries.     

Dynamic joint forces during knee isokinetic exercise

This study analyzed forces in the tibiofemoral and patellofemoral joints during isokinetic exercise using an analytical biomechanical model. The results show that isokinetic exercise can produce large loads on these joints, especially during extension exercises. The tibiofemoral compressive force (4.0 body weight) is approximately equal to that obtained during walking but it occurs at 55 degrees of knee flexion. Anterior shear forces (resisting force to anterior drawer) exist during extension exercise at less than 40 degrees of knee flexion, with a maximum of 0.3 body weight. Posterior shear forces (resisting force to posterior drawer) exist during extension exercise at knee joint angles greater than 40 degrees and during the flexion portion of isokinetic exercise. The maximum posterior shear force is 1.7 body weight. The patellofemoral joint can encounter loads as high as 5.1 body weight which are 10 times higher than during straight leg raises. These results suggest that isokinetic exercise should be used cautiously in patients with knee lesions.     

Tibiofemoral joint forces during isokinetic knee extension

Using a Cybex II, eight healthy male subjects performed isokinetic knee extensions at two different speeds (30 and 180 deg/sec) and two different positions of the resistance pad (proximal and distal). A sagittal plane, biomechanical model was used for calculating the magnitude of the tibiofemoral joint compressive and shear forces. The magnitude of isokinetic knee extending moments was found to be significantly lower with the resistance pad placed proximally on the leg instead of distally. The tibiofemoral compressive force was of the same magnitude as the patellar tendon force, with a maximum of 6300 N or close to 9 times body weight (BW). The tibiofemoral shear force changed direction from being negative (tibia tends to move posteriorly in relation to femur) to a positive magnitude of about 700 N or close to 1 BW, indicating that high forces arise in the ACL when the knee is extended more than 60 degrees. The anteriorly directed shear force was lowered considerably by locating the resistance pad to a proximal position on the leg. This model may be used when it is desirable to control stress on the ACL, e.g., in the rehabilitative period after ACL repairs or reconstructions.     

Antagonist muscle coactivation during isokinetic knee extension

The aim of the present study was to quantify the amount of antagonist coactivation and the resultant moment of force generated by the hamstring muscles during maximal quadriceps contraction in slow isokinetic knee extension. The net joint moment at the knee joint and electromyographic (EMG) signals of the vastus medialis, vastus lateralis, rectus femoris muscles (quadriceps) and the biceps femoris caput longum and semitendinosus muscles (hamstrings) were obtained in 16 male subjects during maximal isokinetic knee joint extension (KinCom, ROM 90-10 degrees, 30 degrees x s(-1)). Two types of extension were performed: [1] maximal concentric quadriceps contractions and [2] maximal eccentric hamstring contractions Hamstring antagonist EMG in [1] were converted into antagonist moment based on the EMG-moment relationships determined in [2] and vice versa. Since antagonist muscle coactivation was present in both [1] and [2] a set of related equations was constructed to yield the moment/EMG relationships for the hamstring and quadriceps muscles, respectively. The equations were solved separately for every 0.05 degrees knee joint angle in the 90-10 degrees range of excursion (0 degrees = full extension) ensuring that the specificity of muscle length and internal muscle lever arms were incorporated into the moment/EMG relationships established. Substantial hamstring coactivation was observed during quadriceps agonist contraction. This resulted in a constant level of antagonist hamstring moment of about 30 Nm throughout the range of motion. In the range of 30-10 degrees from full knee extension this antagonist hamstring moment corresponded to 30-75% of the measured knee extensor moment. The level of antagonist coactivation was 3-fold higher for the lateral (Bfcl) compared to medial (ST) hamstring muscles The amount of EMG crosstalk between agonist-antagonist muscle pairs was negligible (Rxy2<0.02-0.06). The present data show that substantial antagonist coactivation of the hamstring muscles may be present during slow isokinetic knee extension. In consequence substantial antagonist flexor moments are generated. The antagonist hamstring moments potentially counteract the anterior tibial shear and excessive internal tibial rotation induced by the contractile forces of the quadriceps near full knee extension. In doing so the hamstring coactivation is suggested to assist the mechanical and neurosensory functions of the anterior cruciate ligament (ACL).     

Reliability of isokinetic normalized peak torque assessments for knee muscles in post-stroke hemiparesis

The purpose of this study was to establish test–retest reliability of measurement procedures for quantifying isokinetic concentric peak torque (PT) at the knee using normalization methods post-stroke. A second aim was to estimate the change required to show clinically significant improvements in knee muscles strength. The isokinetic normalized PT (NPT) values for the knee extensors and flexors were measured in each participant at two different angular velocities during two sessions 1 day apart. Thirty participants with mild to moderate hemiparesis after stroke who were able to walk were tested. The normalized PT measures for the knee muscles of the affected lower extremity were highly reliable (intraclass correlation coefficients ranged from 0.85 to 0.98; p < 0.05). Size of relative changes (the percent smallest real difference, SRD%) for extensors NPT (ranged from 22.35% to 25.68%) were lower than flexors NPT (ranged from 74.01% to 76.31%), indicating that the affected isokinetic knee flexors had more random variation than the knee extensors. This study supports the use of isokinetic dynamometers for the assessment of knee muscle strength in participants with chronic mild to moderate post-stroke hemiparesis and to measure clinical improvements. Established measurement error and smallest real differences in normalized PT will aid interpretation of real changes in muscle strength in this clinical population.     

Relationship between muscle oxygenation kinetics and the rate of decline in peak torque during isokinetic knee extension in acute hypoxia and normoxia

To investigate whether low FiO2 affects muscle oxygenation and the rate of decline in peak torque (DR) during isokinetic knee extension, subjects performed 50 isokinetic knee extensions at 180 degrees /s and at 0.5 Hz while inhaling low O2 gas (12 %O2; H) or air (N). Muscle oxygenation kinetics was assessed by near-infrared spectroscopy, and whole-body V.O2 and HR were measured. We calculated total-, oxy- and deoxy-hemoglobin/myoglobin concentrations (TotalHb/Mb, OxyHb/Mb, DeoxyHb/Mb), and the slopes of the change in OxyHb/Mb during exercise. SpO2 decreased in H while DR and V.O2 did not differ between the conditions. During exercise, OxyHb/Mb was lower in H than in N, and DeoxyHb/Mb was higher in H than in N. TotalHb/Mb began to increase from the resting level earlier in H. HR was higher during the latter half of the exercise in H. The slopes of the change in OxyHb/Mb were the same in the two conditions. Our results show that low FiO2 decreases SpO2 and muscle oxygenation during maximal isokinetic knee extension. However, low SpO2 and muscle oxygenation did not affect the rates of decline of peak torque. These results suggest that the decline in peak torque occurs for reasons other than O2 availability.     

Muscle torque in total knee arthroplasty: comparison of subvastus and midvastus approaches

The subvastus and midvastus approaches are two of the most commonly performed quadriceps preserving approaches for total knee arthroplasty (TKA), which can hasten functional recovery and rehabilitation. However, there has not been sufficient investigation with respect to a quantitative comparison between the two approaches in terms of muscle strength. To compare outcomes with respect to muscle strength between these two approaches, quadriceps and hamstring muscle torques of 20 patients who underwent primary TKA with the subvastus (SV) approach and 10 patients who received the midvastus (MV) approach were measured after surgery. The median age of patients in the SV group (68 years, range 53–77 years) was significantly different that the median age of patients in the MV group (61 years, range 50–73 years) (P = 0.0141). There was no significant difference in patient weight, height, or postoperative duration before muscle testing between the SV and MV groups. There were no significant differences in peak muscle torque or hamstring/quadriceps (H/Q) ratio between the groups. We thus conclude peak muscle torque and H/Q ratios were not statistically different with the SV or MV approach, therefore functional outcome is comparable.     

Muscle strength and fatigue during isokinetic exercise in individuals with multiple sclerosis

PURPOSE: To compare muscle strength and muscle fatigue of the knee extensors and flexors in individuals with multiple sclerosis (MS) and non-MS control subjects and to evaluate the reliability of muscle strength and muscle fatigue testing in these individuals. METHODS: Thirty individuals (13 women and 2 men for both MS and control groups), age (mean +/- SD) 38.8 +/- 10 for MS and 33.1 +/- 7.6 yr for controls, participated in this investigation. Peak torque was measured on two occasions separated by approximately 7 d at 30, 60, 90, 120, 180 degrees.s(-1) with 2 min of recovery between each bout. The nondominant leg was tested followed by the dominant leg after 10 min of recovery. Subjects then performed three bouts of 30 flexions and extensions of the dominant leg at 180 degrees.s(-1) with 1 min of recovery between bouts. RESULTS: The reliability of muscle torque was very high for individuals with MS (only 1 of 20 measurements with an ICC below 0.900). Total work was also highly reliable for MS, but the Fatigue Index (work during the last 15 contractions/work during the first 15 contractions) x 100 was not. Peak torque adjusted for age, body mass, and fat free mass (measured by whole body plethysmography; the Bod Pod; Life Measurement Instruments; Concord, CA) was significantly greater for controls than for MS for three of four lower body muscle groups tested. For the muscle fatigue test (3 bouts of 30 knee extensions and flexions at 180 degrees.s(-1)), the Fatigue Index was greater (less fatigue) for the knee extensors for controls than MS for the third bout. For flexion, the Fatigue Index was greater for controls than MS over the three bouts (group effect). Total work was significantly greater for controls than MS for the flexors (group effect) and approached significance for the extensors. CONCLUSIONS: Individuals with MS were weaker than controls when data were adjusted for age, body mass, and fat free mass. This latter finding (force relative to age and fat free mass) suggests that there is a reduced ability to activate muscle mass in MS and/or the muscle mass of individuals with MS is of lower quality (i.e., reduced force/unit muscle mass) than controls.     

Gender differences in perceived exertion during fatiguing knee extensions

PURPOSE: To examine gender differences in knee extensor strength, fatigue, and perceived exertion during a single set of continuous dynamic knee extensor contractions. METHODS: Fifteen men and 15 women were evaluated for their one-repetition maximum (1RM) during a single-leg, inertial knee extension with their right leg. All subjects then completed a single set of repeated knee extensions with a load equivalent to 50% of their 1RM to failure. Subjects lifted the weight by performing a knee extension, held the weight with the knee extended for 1-2 s, and then lowered the weight in a slow and controlled manner. Perceived exertion was measured after completion of each repetition, by viewing a modified Borg category-ratio (CR-10) scale. Perceived exertion responses were standardized across subjects via linear interpolation and power function modeling. The linear interpolated perceived exertion estimates were then examined for linear, quadratic, and cubic trends across the repetitions. RESULTS: Men lifted a significantly greater amount of mass than women, when corrected for body mass. Men and women did not differ significantly in the number of repetitions performed to failure. Women displayed significantly higher power function exponents for the perceived exertion response than men (0.72 +/- 0.16 and 0.57 +/- 0.16, respectively) and demonstrated statistically nonsignificant greater increases in perceived exertion than men across the repetitions. CONCLUSIONS: The major findings of this study indicated that: 1) men inherently possessed greater knee extensor strength than women; 2) submaximal fatiguing knee extensor performance did not differ between genders; 3) model selection had a significant impact on standardizing perceived exertion estimates; and 4) subtle gender differences in the perceived exertion response may have existed during submaximal, fatiguing resistance exercise.     

Relationship between peak torque and total work in an isokinetic contraction of the medial collateral ligament insufficient knee

The aim of this study was to assess the relationship between the isometric and isokinetic peak torques (speed of movement 0, 60, and 180 degrees/s) and the total work output of multiple contractions (180 degrees/s) of the quadriceps and hamstrings in 25 subjects having a chronic, complete insufficiency of the medial collateral ligament of the knee. At every test speed the Pearson product moment (r) and the Spearman rank (rs) correlation coefficients between the peak torque and total work were highly significant for both muscle groups in the uninjured (r = 0.75-0.96, rs = 0.72-0.95) as well as in the medially unstable (r = 0.79-0.93, rs = 0.76-0.92) knees. In both knees and in both muscle groups, the correlation coefficients increased toward the highest speed of the isokinetic movement, obviously since the total work was registered at that speed. The author concludes that in the medial collateral ligament insufficient knees the total work analysis offers little additional information to that attained by more simple measurement, the peak torque analysis.     

Interlimb asymmetry during walking following unilateral total knee arthroplasty

Osteoarthritis is the most common disease of the joints, and joint replacement surgery is often performed on the major lower extremity joints to relieve pain and improve function. While total knee arthroplasty is successful in restoring some degree of function, there are concerns in relation to the progression of osteoarthritis in other lower limb joints. The purpose of this study was to determine the symmetry of interlimb loading, knee excursion and knee joint stiffness following unilateral total knee arthroplasty. The null hypotheses that vertical loading peak, loading rates, knee flexion excursion and knee flexion stiffness would be the same in the involved and uninvolved limbs after unilateral total knee arthroplasty were tested. Sixteen subjects (eight male and eight female) with previous total knee arthroplasty participated. Kinematic and kinetic data were collected bilaterally during overground walking using a seven camera motion capture system and two force platforms. Following recovery from unilateral total knee arthroplasty, peak vertical ground reaction force, loading rates, knee flexion stiffness and knee flexion excursion are similar in the involved and uninvolved limbs.