Relationship between gait speed and strength parameters in multiple sclerosis]

INTRODUCTION: Recent studies have focused on correlation between strength and gait parameters in hemiplegia, suggesting the interest for strength training in patients with central nervous system lesions. The aim of this study was to evaluate this correlation in multiple sclerosis (MS) patients with special regard to the different clinical forms including proprioceptive loss or cerebellar ataxia. PATIENTS AND METHOD: Gait speed and muscular function were performed in 27 patients with moderate affected gait (EDDS < 6). Gait speed was evaluated with Locometre and peak-torques of quadriceps and hamstrings were evaluated with isokinetic dynamometer. Patients were separated in three groups related to their deficiency: spastic group (8 patients), spastic with proprioceptive loss (12 patients) and spastic with cerebellar ataxia (7 patients). Gait parameters were evaluated in 10 healthy subjects as control group. RESULTS: Gait speeds (spontaneous and maximal) and peak torques of quadriceps and hamstring were similar in the three groups. In the whole patients group, gait speed was reduced and related to hamstring peak torque (r = 0.56 at spontaneous speed and 0.51 at high speed) but not with quadriceps peak torque. Patients with proprioceptive loss exhibited not only a higher correlation between gait speed and hamstring torque (r = 0.76 and 0.65 respectively) than other patients but also with quadriceps torque (r = 0.66 and 0.59 respectively) when patients in other groups did not. CONCLUSION: As it was previously pointed out in hemiplegic patients, MS patients exhibit some correlation between gait speed and muscle strength, mainly with hamstrings. These correlations can change in special sensory conditions suggesting that patients with sensory loss use different muscular strategies to maintain gait speed. Strength training may therefore be discussed in MS including specific modalities as a function of clinical parameters.     

Treatment of Knee Osteoarthritis in Relation to Hamstring and Quadriceps Strength

[Purpose] To assess the effect of hamstring and quadriceps strengthening exercises on pain intensity, gait velocity, maximum isometric strength, and activities of daily living of patients with knee osteoarthritis (OA). [Subjects and Methods] A total of 20 patients with knee OA, 50 to 65 years of age (57.65 ± 4.78 years), received hot packs, strengthening exercises for the quadriceps and the hamstring muscles and stretching exercises for hamstring muscles. Outcome measures included: the Western Ontario and McMaster Universities OA index questionnaire (WOMAC) scores for assessing health status and health outcomes of knee OA; self-reported pain intensity scores, measured using a visual analogue scale; the 50 ft walk test (a measure of gait velocity and function); and handheld dynamometry (a tool used to measure maximum isometric strength of knee extension and flexion). [Results] There was a significant difference between pre- and post-intervention measures of pain intensity, 50 ft walk times, hamstring strength, and quadriceps strength. Significant differences in WOMAC measures were also observed in the subscales of pain, stiffness and physical function, as well as WOMAC total scores. [Conclusion] Strengthening the hamstring muscles in addition to strengthening the quadriceps muscles proved to be beneficial for perceived knee pain, range of motion, and decreasing the limitation of functional performance of patients with knee OA.Key words: Hamstring/quadriceps ratio, Knee pain, Osteoarthritis     

Relationship between muscle echo intensity on ultrasound and isokinetic strength of the three superficial quadriceps femoris muscles in healthy young adults

[Purpose] The purpose of this study was to clarify the relationship between muscle echo intensity measured with ultrasound and the isokinetic strength of each of the three superficial quadriceps femoris muscles in healthy young adults. [Participants and Methods] We measured the echo intensity of the three superficial muscles of the quadriceps femoris in 25 healthy adults (10 males and 15 females; mean age, 22.3 years) using ultrasound. Moreover, we obtained the maximum force during isokinetic knee extension at 60°/s using an isokinetic dynamometer. [Results] In males and females, a significant negative correlation between echo intensity and muscle strength was found in the VM (r=−0.65 and r=−0.63, respectively). [Conclusion] In both males and females, only the muscle echo intensity of the vastus medialis was found to have a negative correlation with the maximum force during isokinetic knee extension at 60°/s. Our data lay the foundation for simplifying and rationally performing the measurement of muscle echo intensity of the quadriceps femoris. And it would therefore be sufficient to only measure the VM to clarify a relationship between EI and maximum isokinetic force in the quadriceps.Key words: Echo intensity, Isokinetic strength, Quadriceps femoris muscle     

Relationship between muscular strength, gait and postural parameters in multiple sclerosis

ObjectiveTo evaluate muscle strength, balance control and gait capacity in patients with multiple sclerosis (MS) and to study the correlations between these parameters.Patients and methodsTwenty MS patients were evaluated in terms of knee muscle strength, gait and balance parameters. These evaluations were performed using an isokinetic dynamometer (the Cybex II^®), a Bessou gait analyzer and a Satel^® force platform, respectively. The patients’ results were compared with those of a healthy control group.ResultsHamstring and quadriceps peak torque values were lower in the MS group than in the control group. The sway area was greater in the MS group under eyes-open and eyes-closed conditions. The MS patients displayed lower gait speed, cadence and stride length. Hamstring and quadriceps strength values were significantly correlated with posture and gait parameters.ConclusionThe present study revealed the value of an overall evaluation of knee muscle strength, gait and posture in MS patients.     

Effect of Isometric Quadriceps Exercise on Muscle Strength,Pain, and Function in Patients with Knee Osteoarthritis: A Randomized Controlled Study

[Purpose] The aim of present study was to investigate the effects of isometric quadriceps exercise on muscle strength, pain, and function in knee osteoarthritis. [Subjects and Methods] Outpatients (N=42, 21 per group; age range 40–65 years; 13 men and 29 women) with osteoarthritis of the knee participated in the study. The experimental group performed isometric exercises including isometric quadriceps, straight leg raising, and isometric hip adduction exercise 5 days a week for 5 weeks, whereas the control group did not performed any exercise program. The outcome measures or dependent variables selected for this study were pain intensity, isometric quadriceps strength, and knee function. These variables were measured using the Numerical Rating Scale (NRS), strength gauge device, and reduced WOMAC index, respectively. All the measurements were taken at baseline (week 0) and at the end of the trial at week 5. [Results] In between-group comparisons, the maximum isometric quadriceps strength, reduction in pain intensity, and improvement in function in the isometric exercise group at the end of the 5th week were significantly greater than those of the control group (p<0.05). [Conclusion] The 5-week isometric quadriceps exercise program showed beneficial effects on quadriceps muscle strength, pain, and functional disability in patients with osteoarthritis of the knee.Key words: Isometric exercise, Osteoarthritis, Rehabilitation     

Conséquences et prédiction des lésions musculaires des ischiojambiers à partir des paramètres isocinétiques concentriques et excentriques du joueur de football professionnelConsequences and prediction of hamstring muscle injury with concentric and eccentric isokinetic parameters in elite soccer players

OBJECTIVE: To know if isokinetic parameters identify previous hamstring (H) injury and predict a new muscle injury in high-level soccer player. METHOD: Concentric (con) and eccentric (ecc) isokinetic torque was measured at the angular speed of 60 degrees /s in 28 elite soccer players (23 years +/- 3.3; 74 kg +/- 7.5; 178 cm +/- 6.5). First, 11 players, victims of 15 moderate or major hamstring injuries in the preceding 2 years, were compared with 17 players without previous hamstring injury. Comparisons were carried out from isokinetic knee flexors-extensors ratios [Hcon/Qcon and Hecc/Qcon] and bilateral knee flexors ratios [Hcon/Hcon and Hecc/Hecc]. Secondly, all the population was followed during 12 months and the isokinetic muscular profile of players who presented a recurrence or a new hamstring muscle injury was analysed. RESULTS: A concentric ratio hamstring-to-quadriceps lower than 0.6 and a hamstring asymmetry of more than 10% do not allow to identify previous hamstring injury. On the other hand, the mixed ratio eccentric hamstring-to-concentric quadriceps lower than 0.6 represents the best indicator (probability: 77.5%). The rate of recurrence is 30% (three cases of 10) and the rate of new hamstring muscle injury is 31% (five cases of 16) (P > 0.05). One of the five injured soccer players presented a concentric ratio hamstring-to-quadriceps lower than 0.6 and no player presented a mixed ratio lower than 0.6. However, four of the five injured players presented a concentric and an eccentric asymmetry. But, it is the strongest side, which presented a new hamstring muscle injury. CONCLUSION:The mixed ratio eccentric hamstring-to-concentric quadriceps lower than 0.6 identify a previous hamstring injury despite the resumption of competitive soccer. However, this ratio and the others isokinetic studied parameters do not predict a recurrence or a new hamstring muscle injury.     

Effects of Sex and Age on Quadriceps and Hamstring Strength and Flexibility in High School Basketball Athletes

BackgroundEccentric hamstring strength and hamstring/quadriceps strength ratios have been identified as modifiable risk factors of hamstring strains. Additionally, those strength and flexibility characteristics are commonly used as clinical tests to monitor progress of athletes with acute or chronic hamstring strains. Although hamstring strains are common among basketball athletes, normative values of knee strength and flexibility characteristics are scarce. Normative values for these athletes would be important in prevention and management of hamstring strains.PurposeTo establish quadriceps and hamstring isokinetic strength and flexibility values among high school basketball athletes and examine the effects of sex and age.Study DesignCross-sectional researchMethodsIsokinetic knee muscular strength (concentric quadriceps [QuadC], concentric hamstring [HamC], eccentric hamstring [HamE], and strength ratios ([HamC/QuadC and HamE/Quad]), flexibility of hip flexors and quadriceps during a Modified Thomas test, and flexibility of hip extensors and hamstring during passive straight leg raise (SLR) and passive knee extension (PKE) tests were measured. Effects of sex and age were analyzed using t-tests and analysis of variance, respectively with Bonferroni corrected post hoc tests (p≤0.01).ResultsA total of 172 high school basketball athletes (64 males/108 females; mean age (range): 15.7 (14-18) years old) participated in the study. Male athletes were significantly stronger than female athletes (QuadC: p<0.001; HamC: p<0.001) while no differences were observed in strength ratio (HamC/QuadC: p=0.759-0.816; HamE/QuadC: p=0.022-0.061). Among male athletes, a significant effect of age on quadriceps and hamstring strength was observed: older male athletes were stronger than younger male athletes. Contrarily, there were no effects of age on strength among female athletes. There were significant sex differences in quadriceps flexibility, SLR, and PKE (female athletes were more flexible; p=0.001-0.005) while no sex differences were found in hip flexor flexibility (p=0.105-0.164). There were no effects of age for any flexibility variables within male and female athletes (p=0.151-0.984).ConclusionThe current results provide normative values for hamstring strength and flexibility in high school basketball athletes. These normative values may further assist sports medicine specialists to develop screening tests, interventions, and return-to-sport criteria in this population.Level of Evidence3B     

Comparative Study of Hamstring and Quadriceps Strengthening Treatments in the Management of Knee Osteoarthritis

[Purpose] Osteoarthritis (OA) of the knee is the most common form of joint disease. It is one of the major causes of impaired function that reduces quality of life (QOL) worldwide. The purpose of this study was to compare exercise treatments for hamstring and quadriceps strength in the management of knee osteoarthritis. [Subjects and Methods] Forty patients with OA knee, aged 50–65 years were divided into 2 groups. The first group (57.65±4.78 years) received hot packs and performed strengthening exercises for the quadriceps and hamstring, and stretching exercises for the hamstring. The second group (58.15±5.11 years) received hot packs and performed strengthening exercises for only the quadriceps, and stretching exercise for the hamstring. Outcome measures were the WOMAC (Western Ontario and McMaster Universities OA index questionnaire), Visual Analogue Scale (VAS) assessment of pain, the Fifty-Foot Walk Test (FWS), and Handheld dynamometry. [Results] There was a significant difference between the groups. The first group showed a more significant result than the second group. [Conclusion] Strengthening of the hamstrings in addition to strengthening of the quadriceps was shown to be beneficial for improving subjective knee pain, range of motion and decreasing the limitation of functional performance of patients with knee osteoarthritis.Key words: Strengthening, Stretching, Pain     

Effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with knee osteoarthritis

[Purpose] The aim of this study was to investigate the effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with osteoarthritis of the knee. [Subjects] Thirty women over 65 years of age diagnosed with knee osteoarthritis participated in the present study. The subjects were randomly assigned to a control group (n=10), a progressive resistance training group (n=10), or a Russian electrical stimulation group (n=10). [Methods] Each group was treated 3 times weekly for 8 weeks, and each session lasted 45 minutes. Muscle strength was assessed by measuring the peak torque of the quadriceps femoris muscle. Outcome measurements were performed at baseline and at the fourth and eighth weeks of the treatment period. [Results] All groups showed significant intragroup differences in the quadriceps femoris muscle peak torque after the treatment intervention. There were significant intergroup differences between the Russian electrical stimulation group and the other groups. [Conclusion] The results of this study suggest that combined application of progressive resistance training and Russian electrical stimulation can be effective in strengthening the quadriceps femoris muscle in elderly women with knee osteoarthritis.Key words: Knee osteoarthritis, Progressive resistance training, Russian electrical stimulation     

Differences in onset timing between the vastus medialis and lateralis during concentric knee contraction in individuals with genu varum or valgum

[Purpose] The purpose of this study was to investigate the difference in onset timing between the vastus medialis and lateralis among the different knee alignments, as well as the best isokinetic angular velocity for an isokinetic concentric contraction. [Subjects] Fifty-two adults (20 with genu varum, 12 genu valgum, and 20 controls) were enrolled in this study. Subjects with > 4 cm between the medial epicondyles of the knee were placed in the genu varum group, whereas subjects with > 4 cm between the medial malleolus of the ankle were placed in the genu valgum group. [Methods] Surface electromyography was used to measure the onset times of the vastus medialis and vastus lateralis during concentric contractions at 30, 60, and 90°/sec. [Results] The vastus lateralis showed more delayed firing than the vastus medialis in the genu varum group, whereas vastus medialis firing was delayed more than that of the vastus lateralis in the genu valgum group. No differences in onset timing were observed between the vastus medialis and lateralis according the different angular velocities during concentric contractions in all three groups. [Conclusion] Genu varum and valgum affect quadriceps firing. Therefore, selective rehabilitation training of the quadriceps femoris should be considered to prevent pain or knee malalignment deformities.Key words: Quadriceps muscle, Genu varum, Genu valgum     

The effects of ageing on functional capacity and stretch-shortening cycle muscle power

[Purpose] To examine the effects of age and gender in an ageing population with respect to functional decline and the relationship between muscle power and functional capacity. [Participants and Methods] The cohort (N=154) was subdivided into youngest-old (65–70 years.; n=62), middle-old (71–75 years.; n=46), and oldest-old (76–81 years.; n=46). Measures of mechanical muscle function included countermovement jump height, muscle power, leg strength and grip strength. Functional performance-based measures included heel-rise, postural balance, Timed Up and Go, and gait speed. [Results] The oldest-old performed significantly worse than the middle-old, whereas the youngest-old did not outperform the middle-old to the same extent. Increased contribution of muscle power was observed with increasing age. Males had consistently higher scores in measures of mechanical muscle function, whereas no gender differences were observed for functional capacity. [Conclusion] The age-related decline in functional capacity appears to accelerate when approaching 80 years of age and lower limb muscle power seems to contribute to a greater extent to the preservation of functional balance and gait capacity at that stage. Males outperform females in measures of mechanical muscle function independent of age, while the findings give no support for the existence of gender differences in functional capacity.Key words: Stretch-shortening cycle muscle power, Physical function, Ageing     

The Effects of Isokinetic Eccentric Resistance Exercise for the Hip Joint on Functional Gait of Stroke Patients

[Purpose] The purpose of this study was to determine the effects of resistance exercise strengthening the hip flexor and extensor muscles on functional gait of stroke patients. [Subjects and Methods] Twenty patients were randomized into two groups. Both groups performed conventional physical therapy for six weeks. The experimental group also performed isokinetic eccentric resistance exercises for the hip flexor and extensor muscles. The hip muscle strength, stair up and down time, TUG time(timed up and go test), and 10 m gait velocity were measured at the baseline, and after 3 weeks, and 6 weeks of treatment. [Results] The experimental showed significant improvements compared to the baseline in hip muscle strength, stair up and down time, TUG time and 10 m gait velocity after 3 and 6 weeks of treatment. After 3 and 6 weeks of treatment, there were gains in hip muscle strength and 10 m gait velocity. The control group showed no significant increase in hip muscle strength, stair up and down time, TUG time or 10 m gait velocity. [Conclusion] We consider that conventional physical therapy contributes to the improvement of functional gait of stroke patients. However, it is more desirable to perform isokinetic eccentric resistance exercises for hip flexor and extensor muscles combined with conventional physical therapy for the improvement of hip muscle strength, stair up and down time, TUG time and 10 m gait velocity.Key words: Functional gait, Isokinetic exercise, Stroke patients     

Association between toe grasping strength and accelerometer-determined physical activity in middle-aged and older women

[Purpose] To test the hypothesis that toe grasping strength is associated with daily physical activity in older adults. [Subjects] Fifty-seven Japanese women, aged 52–78 years, volunteered. [Methods] Toe grasping and knee extension strength were measured. Physical activity was also measured, using an accelerometer, and the total duration of each level of exercise intensity (light, moderate, and vigorous) and average step counts were calculated. Subjects were separated into two groups on the basis of accelerometer-determined step counts: LOW (n=28, <8000 steps/day) and HIGH (n=29, ≥8000 steps/day). [Results] Body mass index and body composition (% fat and fat-free mass) were similar between the two groups. Absolute and relative toe grasping strengths (divided by body weight) were greater in HIGH than in LOW. However, both absolute and relative knee extension strength were similar between the groups. Relative toe grasping and knee extension strength correlated with all 3 intensities of physical activity and average step count. After adjusting for age, the duration of light plus moderate physical activity and average step counts correlated to toe grasping strength but not to knee extension strength. [Conclusion] Our results suggest that toe grasping strength may be associated with the amount of light intensity daily physical activity.Key words: Accelerometer, Isometric contraction, Foot muscle strength     

Decreased passive muscle stiffness of vastus medialis is associated with poorer quadriceps strength and knee function after anterior cruciate ligament reconstruction

BackgroundMuscle deficits of the quadriceps and hamstrings are common after anterior cruciate ligament reconstruction, and increase the risk of knee reinjury. Muscle stiffness is an important factor for dynamic joint stability. However, the changes in quadriceps and hamstring muscle stiffness and its influence after anterior cruciate ligament reconstruction remain unclear.MethodTwenty-five male subjects with anterior cruciate ligament reconstruction and twenty-one matched healthy subjects participated in this study. The passive muscle stiffness of the quadriceps and hamstrings was assessed by shear modulus using ultrasound shear wave elastography. The isokinetic muscle strengths of the quadriceps and hamstrings were tested. Knee function was evaluated by the International Knee Documentation Committee and Lysholm score. Muscle stiffness was compared between limbs via non-parametric tests. Correlation analysis was used to detect the relationship between muscle stiffness, isokinetic muscle strength and knee functional scores.FindingsThe involved limb exhibited significantly decreased shear modulus in the vastus medialis compared to the dominant limbs(z = −3.585;P = 0.001;ES = 1.13) and non-dominant limbs(z = −3.551;P = 0.002;ES = 1.24) of healthy controls. The shear modulus of ST was also significantly lower in the involved limb when compared with the contralateral limbs(z = −3.996;P < 0.001;ES = 1.33), dominant limbs(z = −4.477;P < 0.001;ES = 1.65) and non-dominant limbs(z = −4.234;P = 0.001;ES = 1.43) of healthy controls. The shear modulus of the vastus medialis was associated with quadriceps peak torque at 60°/s(r = 0.470; p < 0.001) and knee functional score(r = 0.459; p = 0.021).InterpretationThe passive muscle stiffness of the vastus medialis decreased after anterior cruciate ligament reconstruction, which is associated with poorer quadriceps strength and knee function. The effect of modulation of muscle stiffness on improving knee function warrants future investigation.     

Evaluation of the Combined Application of Neuromuscular Electrical Stimulation and Volitional Contractions on Thigh Muscle Strength,Knee Pain,and Physical Performance in Women at Risk for Knee Osteoarthritis: A Randomized Controlled Trial

BackgroundKnee osteoarthritis (OA) is a leading cause of disability that is associated with quadriceps weakness. However, strengthening in people with or with risk factors for knee OA can be poorly tolerated.ObjectiveTo assess the efficacy of a 12-week low-load exercise program, using a hybrid training system (HTS) that uses the combination of neuromuscular electrical stimulation and volitional contractions, for improving thigh muscle strength, knee pain relief, and physical performance in women with or with risk factors for knee OA.DesignRandomized, single-blinded, controlled trial.SettingExercise training laboratory.ParticipantsForty-two women 44-85 years old with risk factors for knee OA.InterventionsParticipants randomized to 12 weeks of biweekly low-load resistance training with the HTS or on an isokinetic dynamometer (control).OutcomesMaximum isokinetic knee extensor torque. Secondary measures included maximum isokinetic knee flexor torque, knee pain (Knee Injury and Osteoarthritis Outcome Score), and timed 20-m walk and chair stand tests.ResultsThe HTS and control treatments resulted in muscle strengthening, decreased knee pain, and improved physical performance. HTS group quadriceps and hamstring strength increased by 0.06 ± 0.04 Nm/kg (P > .05) and 0.05 ± 0.02 Nm/kg (P = .02), respectively. Control group quadriceps and hamstring strength increased by 0.03 ± 0.04 Nm/kg (P > .05) and 0.06 ± 0.02 Nm/kg (P = .009), respectively. Knee pain decreased by 11.9 ± 11.5 points (P < .001) for the HTS group and 14.1 ± 15.4 points (P = .001) for the control group. The 20-m walk time decreased by 1.60 ± 2.04 seconds (P = .005) and 0.95 ± 1.2 seconds (P = .004), and chair stand time decreased by 4.8 ± 10.0 seconds (P > .05) and 1.9 ± 4.7 seconds (P > .05) in the HTS and control groups, respectively. These results did not differ statistically between the HTS and control groups.ConclusionsThese results suggest the HTS is effective for alleviating pain and improving physical performance in women with risk factors for knee OA. However, the HTS does not appear to be superior to low-load resistance training for improving muscle strength, pain relief, or physical function.Clinical trial registration number: NCT02802878.Level of EvidenceI     

Sex differences in knee strength deficit 1?year after anterior cruciate ligament reconstruction

[Purpose] Little is known about the outcome differences between men and women after anterior cruciate ligament (ACL) reconstruction. Therefore, the present study aimed to compare knee muscle strength between men and women 1 year after ACL reconstruction. [Subjects and Methods] Retrospective and outcome study. Between 2012 and 2015, 35 males (mean age, 29.7 ± 010.7 years) and 35 females (mean age, 28.2 ± 11.3 years) who had undergone primary ACL reconstruction were recruited from Samsung medical centers. We assessed the strength deficit in the quadriceps (extensor) and hamstrings (flexor) at 60°/sec and 180°/sec with isokinetic testing equipment. Statistical analysis was conducted with a t-test to determine if sex differences existed in knee strength deficit. [Results] Significant differences were noted between men and women with respect to extensor muscle strength deficit. Women reported less extensor muscle strength than men did, at the angular velocities 60°/sec and 180°/sec. However, no significant sex differences were found at either velocity with respect to the strength deficit of the knee flexor muscles. [Conclusion] Compared to male patients, female patients reported significantly less extensor muscle strength and less improvement 1 year after reconstruction.Key words: Anterior cruciate ligament, Sex, Female     

Influence of age and physical activity on isokinetic characteristics of hamstring and quadriceps muscles of young gymnasts and soccer players]

OBJECTIVE: The aim of this work is the assessment of age and sport influences on the isokinetic knee muscle characteristics. SUBJECTS AND METHOD: Subjects performed a bilateral knee flexion/extension test on an isokinetic device at 60 and 180 degrees.s(-1) speed in concentric mode. The three parameters studied in this work were the Peak Torque, Average Power and hamstring/quadriceps ratio. Thirty-eight soccer players (16,6 +/- 1.4 years old) and 22 gymnasts (18 +/- 2.8 years old) were tested. The population was separated into three groups : 15 years old, 17 years old, 20 years old. RESULTS: The isokinetic values of soccer players were significantly higher (p < 0.0001) than those of the the gymnasts. The isokinetic values of the oldest soccer players were significantly higher (0.005 < p < 0.05) for hamstrings than those of the younger soccer players. The isokinetic values of the oldest gymnasts were significantly higher (0.005 < p < 0.05) for the quadriceps than those of the younger gymnasts. There were no significant differences between dominant and non dominant limbs in soccer players. CONCLUSION: In the present study, the muscular maturation improves the absolute strength of the older sportsmen in comparison to the younger. Soccer favor most the absolute strength of the inferior member in comparison to the gymnastics.     

Isokinetic exercise system modification for short below-the-knee residual limbs.

The use of isokinetic exercise has been shown to be an effective way of strengthening debilitated muscles. In the below the knee amputee, significant quadriceps and hamstring muscle wasting has been documented. Although isokinetic strengthening of the debilitated knee extensors and flexors in the below the knee amputee would be beneficial, there are no fully described isokinetic equipment modifications in literature that would allow a short below the knee amputee to effectively use isokinetic equipment. This article describes such a modification.     

The Effect of Exercise Using a Sliding Rehabilitation Machine on the Gait Function of Children with Cerebral Palsy

[Purpose] The purpose of the present study was to examine the effect of strength training using a sliding rehabilitation machine (SRM) on the gait function of cerebral palsy children. [Subjects and Methods] Thirteen children aged 6–18 years participated in the SRM training for 8 weeks (30 min/day, 2 times/week). The SRM is designed for the performance of a closed-kinetic chain exercise in which a tilt table is moved up and down using wheels on the table. Participants began in a position of flexion of the 3 lower joints (hips, knees, and ankles) on the SRM. In each exercise session, they extended and flexed the 3 joints. The level of exercise was set by changing the inclination of the tilt table. Functional gait ability was measured with the 6-minute walk test (6MWT), 10-m walk test (10MWT), and timed up-and-go test (TUG) before and after the training. Muscle strength was also measured using an isokinetic dynamometer. [Results] Nine of the thirteen children completed the entire study. The peak torques of the knee extensor and flexor group muscles significantly improved after training with the SRM. The total distance of the 6 MWT significantly increased after training. The times of the 10 MWT and the TUG significantly improved after training. The changes in muscle tone were also investigated using the MAS (Modified Ashworth Scale) and Tardieu scale, but no significant changes were found in muscle tone between the pre- and post-test measurements. [Conclusion] The findings demonstrate the effect of the SRM intervention which resulted in improved muscle strength and functional gait.Key words: Cerebral palsy, Sliding rehabilitation machine, Gait     

Ratio of hamstring to quadriceps femoris muscles' strength in the anterior cruciate ligament insufficient knee. Relationship to long-term recovery

The purposes of this study were 1) to investigate the peak torque and total-work ratios of hamstring to quadriceps femoris muscles' (HQ) in 41 subjects (27 male, 14 female; means age = 35 years) with an anterior cruciate ligament insufficient knee (ACLIK) and 2) to determine the relationship between HQ ratios and long-term subject outcome. Quadriceps femoris and hamstring musculature strengths of both legs were measured at follow-up with an isokinetic dynamometer, and peak torque values were recorded at lower (60 degrees/sec) and higher (180 degrees/sec) speeds. Maximal isometric extension and flexion outputs were measured at a 60-degree knee-flexion angle. Three standardized knee-scoring scales were used to determine the overall outcome of the ACLIK. High intersubject variability of the HQ ratios (range = 23%-205%) was observed in all strength tests, including tests of healthy knees. The injured knee of all subjects had a higher HQ ratio (46%-95%) in every test than the healthy knee (42%-85%). The HQ ratio difference between knees was significant at the isokinetic higher speed (p less than .05) and for the total-work (p less than .05) tests because of the weak quadriceps femoris muscle of the injured knee. Outcome scores did not differ significantly between the groups with low, optimal, or high HQ ratios of the ACLIK but were significantly better in subjects whose HQ ratio of the injured knee was similar to that of their uninjured knee.(ABSTRACT TRUNCATED AT 250 WORDS)