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     

The Effects of Kinesio Tape on Isokinetic Muscular Function of Horse Racing Jockeys

[Purpose] The purpose of this study was to conduct a scientific analysis of the effectiveness of Kinesio taping at preventing injury and improving horse racing jockey'' performance, by studying the effects on isokinetic muscular function of Kinesio taping applied to the knee joint muscle. [Subjects] Eight horse racing jockeys were selected for this study. [Methods] Measurement of isokinetic muscular function of both flexor and extensor muscles was performed at the angular velocities of 60°/sec and 180°/sec using a Biodex system 3, before and after application of Kinesio taping to the rectus femoris, vastus medialis, vastus lateralis, and hamstring. [Result] At the angular velocities of 60°/sec and 180°/sec, significant differences were observed in both flexor and extensor peak torque, average power, and total work of the knee joint after application of Kinesio taping. [Conclusion] The application of Kinesio taping has a positive effect on the function of both knee flexors and extensors, and also kinetic ability. Therefore, its use would lead to a significant increase in the muscle function of horse racing jockeys.Key words: Horse racing jockeys, Isokinetic, Kinesio taping     

Contralateral limb strength deficits after anterior cruciate ligament reconstruction using a hamstring tendon graft

BACKGROUND: The purpose of this study was to determine whether current post-operative rehabilitation protocols return the strength of the contralateral uninjured limb knee flexors and extensors after an anterior cruciate ligament (ACL) reconstruction to those of an uninjured control group. METHODS: Subjects with a hamstring tendon ACL reconstruction (n=12) were compared to an active control group (n=30). Comprehensive bilateral knee flexor and extensor isovelocity strength testing was performed (five speeds, 5-95 degrees , concentric and eccentric contractions). FINDINGS: After hamstring tendon ACL reconstruction and rehabilitation, bilateral strength normalization (within 10% of the contralateral limb) is achieved by the knee extensors but not the knee flexors. When compared to the uninjured control group, large and statistically significant strength deficits were demonstrated in the knee extensors and knee flexors of both the anterior cruciate ligament reconstructed (extensors 24.8%; flexors 26.8%) and the contralateral uninjured (extensors 21%; flexors 13.5%) limbs. INTERPRETATION: These findings suggest that improvement can be made in knee flexor rehabilitation after ACL reconstruction and limit the validity of the use of a contralateral leg as a rehabilitation endpoint or as a control in the ACL reconstructed population.     

Isokinetic torque levels for high school football players.

One hundred fifteen high school football players were screened isokinetically for the knee extensor and flexor torque generating capabilities and muscle imbalances. Each player was tested on a Cybex II at speeds of 30 degrees/sec and 180 degrees/sec. The subjects were stratified by age (15, 16, 17) and by position (linemen vs receivers and backs). Significant (p less than 0.05) torque differences were observed at both the slow and fast speeds for the knee extensors and flexors across the 3 age groups. However, the flexion to extension ratios did not differ significantly. On the other hand, when considering the positions, flexor torque and flexion to extension ratio at the slow speed were greater (p less than 0.05) for the linemen than the receivers and backs. Partial correlation analyses showed that body weight had the greatest effect on the knee torque values. It was concluded that basic torque measures differed with age and by position in the sport of football. Also, speed of movement altered the force generating capabilities of the muscle and resultant ratios.     

Correlation of the Y-Balance Test with Lower-limb Strength of Adult Women

[Purpose] The purpose of this study was to elucidate the relationship between Y-balance test (YBT) distance and the lower-limb strength of adult women. [Subjects] Forty women aged 45 to 80 years volunteered for this study. [Methods] The participants were tested for maximal muscle strength of the lower limbs (hip extensors, hip flexors, hip abductors, knee extensors, knee flexors, and ankle dorsiflexors) and YBT distances in the anterior, posteromedial, and posterolateral directions. Pearson’s correlation coefficient was used to quantify the linear relationships between YBT distances and lower-limb strength. [Results] Hip extensor and knee flexor strength were positively correlated with YBT anterior distance. Hip extensor, hip abductor, and knee flexor strength were positively correlated with the YBT posteromedial distance. Hip extensor and knee flexor strength were positively correlated with YBT posterolateral distance. [Conclusion] There was a weak correlation between lower-limb strength (hip extensors, hip abductors, and knee flexors) and dynamic postural control as measured by the YBT.Key words: Adult women, Lower-limb strength, Y-balance test     

Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial

OBJECTIVE: To investigate the effects of a late-phase exercise program for patients who underwent total hip arthroplasty (THA) 4 to 12 months earlier. DESIGN: A single-blind, randomized controlled trial. SETTING: Exercises were performed in subjects' homes. Exercise instruction and measurements taken before and after the trial were performed in an outpatient research and treatment center. PARTICIPANTS: Convenience sample of 34 adults 4 to 12 months post-THA randomly allocated to experimental or control groups. Twenty-eight subjects completed the study. INTERVENTION: An 8-week, hip-exercise intervention, during which the control group received basic isometric and active range of motion exercises; the experimental group received strength and postural stability exercises. MAIN OUTCOME MEASURES: Score on the 12-Item Hip Questionnaire; fear of falling; hip flexor, extensor, abductor, and knee extensor muscle torque; and postural stability in single stance. RESULTS: There was a statistically significant improvement in all measures of self-perceived function, muscle strength (hip flexors, 24.4%; hip extensors, 47.8%; hip abductors, 41.2%; knee extensors, 23.4%), and postural stability (36.8%) in the experimental group and no significant change in the control group. Neither group had statistically significant changes in fear of falling measures. CONCLUSIONS: An exercise program emphasizing weight bearing and postural stability significantly improved muscle strength, postural stability, and self-perceived function in patients 4 to 12 months after THA.     

Effects of Mat Pilates on hip and knee isokinetic torque parameters in elderly women

This study aimed to analyze the effects of Mat Pilates on isokinetic torque of the lower limbs in elderly women. Fourteen elderly women (Age 62 ± 3 yr) participated in 12 weeks of Mat Pilates training (60-min sessions, 3 times per week). Repetitions increased every 4 weeks and the difficulty of exercises progressed from beginner to intermediate and advanced. Peak torque was assessed before (week ‐4 and week 0, considered as a control period) and after 6 and 12 weeks of a periodized Mat Pilates intervention. The results showed significant improvements (p < 0.05) in concentric and eccentric peak torque of knee flexors muscles, hip flexor and extensor muscles after 12 weeks. Mechanical work showed significant improvement (p < 0.05) for knee extensor muscles during eccentric contractions after week 12, for hip extensor muscles during concentric contractions week 12, and for flexor muscles during concentric and eccentric contractions after week 12. We conclude that the periodization of Mat Pilates induced significant improvements in multiple isokinetic torque parameters.     

Test-retest reliability of isokinetic dynamometry for the assessment of spasticity of the knee flexors and knee extensors in children with cerebral palsy

OBJECTIVE: To assess test-retest reliability of the peak resistance torque and slope of work methods of spasticity measurement of the knee flexors and extensors in children with cerebral palsy (CP). DESIGN: Test-retest reliability study. SETTING: Pediatric orthopedic hospital. PARTICIPANTS: Fifteen children with CP. INTERVENTION: Knee extensor and flexor spasticity was assessed with an isokinetic dynamometer using passive movements at 15 degrees, 90 degrees, and 180 degrees/s taken 1 hour apart. MAIN OUTCOME MEASURES: Peak resistive torque and work were calculated. The relative and absolute test-retest reliability was calculated by using intraclass correlation coefficients (ICCs) and Bland-Altman plots, respectively. RESULTS: Relative reliability was good (ICC>.75) for slope-of-work and peak resistance torque measurements at a velocity of 180 degrees/s, whereas reliability of peak torque measurements was decreased (ICC<.51) at slower velocities for both muscle groups. The 95% limits of agreement of Bland-Altman plots contained most data points for both methods, but the width of the limits of agreement were wide. CONCLUSIONS: The measurement of spasticity of the knee extensors and flexors in children with CP using peak-resistance torque at 180 degrees/s and the slope of work method has acceptable relative test-retest reliability. However, the absolute reliability of spasticity data should be considered cautiously.     

推拿结合等速肌力训练治疗膝关节骨性关节炎临床疗效研究

目的:观察推拿治疗结合等速肌力训练对膝关节骨性关节炎的治疗效果。方法:从膝关节骨性关节炎(KOA)患者中随机选取60例作为观察对象,60例患者随机分为推拿结合等速治疗组(试验组)和单纯推拿治疗组(对照组)。分别将两组治疗前后的膝关节西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、等速屈伸肌力测试对比分析。结果:两组治疗后膝关节WOMAC评分均较治疗前有显著改善(P0.01),其中推拿结合等速组膝关节WOMAC评分由(62.93±16.17)降为(26.20±12.68),改善较单纯推拿组更为显著(P0.01)。两组治疗干预前等速肌力测试各指标比较没有显著性差异。经过8周治疗后推拿加等速训练组膝关节伸肌峰力矩、峰力矩/体重、达峰时间、平均功率,膝关节屈肌峰力矩、达峰时间与本组治疗前比较明显改善,差异有显著性(P0.01);膝关节伸肌平均功率与本组治疗前比较有改善,差异有显著性(P0.05);推拿加等速训练组膝关节伸肌峰力矩、峰力矩/体重、达峰时间、膝关节屈肌达峰时间、屈肌/伸肌比单纯推拿组治疗后改善明显,差异有显著性(P0.05);推拿加等速训练组膝关节屈肌峰力矩与单纯推拿组治疗后比较提高明显,差异有显著性(P0.01)。结论:推拿结合等速肌力训练可以提高KOA患者膝关节屈伸肌肉力量,对于KOA的治疗具有良好的临床疗效,且明显优于单纯推拿治疗。     

Muscle strength in patients with unicompartmental arthroplasty

OBJECTIVE: The aim of the current study was to evaluate the isokinetic strength of the knee in patients with unicondylar prostheses, to compare these results with healthy control subjects of the same age, and to correlate these results with clinical scores. DESIGN: Seventeen patients were examined an average of 21.5 mos after surgery. Clinical examination was done using the Hospital for Special Surgery, Knee Society, and patellar scores and a visual analog scale for pain. Quality of life was assessed by the Short Form 36 Health Questionnaire. Isokinetic evaluation of knee extensor and flexor muscles was done using a Cybex 6000 dynamometer at angular velocities of 60 and 180 degrees/sec. Eleven healthy subjects of comparable age served as a control group. RESULTS: Clinical results differed significantly in all categories. Quality of life differed only in the items of physical functioning, role limitation because of physical problems, and bodily pain. Isokinetic strength in patients showed a loss of torque of approximately 30% in extension and flexion at 60 and 180 degrees/sec compared with the control group. The flexion and extension ratio and the angles of maximum torque did not differ between the groups. CONCLUSION: In comparison with healthy control subjects, persons with an implanted unilateral sledge prosthesis have strength deficits in extension and flexion. A deficit of the extensor muscles, as it has been described previously for patients with a total knee arthroplasty, could not be found.     

等速肌力训练对脑卒中患者步行功能的影响

目的:观察患侧髋关节及躯干的屈伸肌等速肌力训练对脑卒中后偏瘫患者步行功能的影响。方法:将脑卒中后偏瘫患者60例随机分为对照组和观察组各30例,对照组采取常规康复训练方案,观察组在此基础上增加患侧下肢髋关节及躯干的屈肌和伸肌的等速肌力训练,治疗前及治疗6周后采用等速肌力测试与训练系统评定患者患侧下肢髋关节及躯干的屈肌和伸肌的峰力矩(PT)、屈伸肌的总功(TW),运用意大利Walkerview数字化跑台步态分析系统评定患侧下肢髋、膝和踝关节的关节活动度(ROM)及步长、触地时长。结果:治疗6周后,2组髋关节及躯干的屈伸肌PT和TW值较治疗前均明显增加(均P<0.05),且观察组均高于对照组(均P<0.05);2组髋、膝和踝关节的屈曲、伸展角度较治疗前均扩大(均P<0.05),步长和触地时长均增加(均P<0.05),且观察组的各项数值均显著优于对照组(均P<0.05)。结论:患侧下肢髋关节及躯干的屈肌和伸肌等速肌力训练对提高脑卒中后偏瘫患者步行功能具有显著的促进作用,值得临床参考应用。     

Isokinetic thigh muscle strength in sports: a review]

There is growing evidence that isokinetic muscle strength, is one of the most common testing method why muscle strength is thought to be a major factor in athletic success and rehabilitation. A lot of publications during the last 20 years concerned the peak torque, the concentric ratio flexor/extensor, with comparison between males and females, sport specialties, young and old people. Isokinetic is also used for evaluation of knee disorders. The results are very useful after knee ligament surgery, less for femoro-patellar disorders and arthrosis. More recently some authors proposed the functional concept (eccentric flexors/concentric extensors ratio) as a predictive method for preventive muscle injuries or ACL lesions. They demonstrated more discomfort after muscle disorders with isokinetic eccentric testing, and proposed rehabilitation programs for prevention. However apart from a few situations, isokinetic testing does not fully predict functional measurements. It must be used with other techniques of evaluation (clinical methods and imagery).     

等速训练联合五禽戏对膝骨关节炎肌力的影响及远期疗效

目的:观察推拿结合等速运动训练配合五禽戏对膝关节骨性关节炎患者屈伸肌力的影响及远期疗效。方法:选取2016年12月-2019年1月在福建省第二人民医院就诊的KOA患者180例,随机分成三组:A组(推拿+等速训练+五禽戏),B组(推拿+等速训练),C组(推拿+五禽戏),每组各60例。三组均隔日治疗1次,连续治疗10次。比较三组治疗前后的VAS评分、Lysholm评分、膝关节屈伸肌力和临床总疗效,以及6个月随访时的VAS评分、Lysholm评分、复发率。结果:三组KOA患者的临床疗效A组最佳(P<0.05),B、C组次之(P>0.05)。治疗后三组的VAS、Lysholm评分与治疗前比较有非常显著差异(P<0.01),VAS评分组间比较没有统计学意义(P>0.05),Lysholm评分组间两两比较A>B=C。膝关节屈伸肌群的峰值力矩治疗前后比较差异有非常显著统计学意义(P<0.01),治疗后组间比较差异有非常显著统计学意义(P<0.01),且A>B>C。6个月随访显示VAS、Lysholm评分组间两两比较A>B=C,复发率比较A>B=C。结论:推拿结合等速运动训练配合五禽戏治疗KOA是一种行之有效的优化方案,可以提高膝关节的屈伸肌力,进而增强关节的稳定性,降低复发率,远期疗效确切,值得临床推广。     

Assessment of muscle strength and motor fatigue with a knee dynamometer in subjects with multiple sclerosis: a new fatigue index

OBJECTIVE: To measure muscle strength and motor fatigue with a knee dynamometer and to assess the intra-rater reliability of measurements for maximal isometric extensor and flexor torques and the reliability of a new fatigue index (FI) in patients with mild to moderate multiple sclerosis (MS). DESIGN: Repeated assessments with one-week intervals. SETTING: The Masku Neurological Rehabilitation Centre, Masku, and the Social Insurance Institution, Research Department, Turku, Finland. SUBJECTS: Twenty-eight MS patients. OUTCOME MEASURES: Maximal isometric torque during 5 s and fatigue of knee flexors and extensors during isometric contractions of 30 s were assessed. A new FI was established and compared with the two previously used indices (FI1 and FI2). All three indices are based on the calculated area under the force versus time curve (AUFC), with FI1 using the 30-s recording time in its entirety and F2 omitting the initial 5 s in the calculation. In the new fatigue index (FI3), the time point of maximum (TPM) torque achieved by the subject is used as the starting point in the calculation. The patient's subjective fatigue was measured by Fatigue Severity Scale (FSS). RESULTS: The intraclass correlation coefficient (ICC) was 0.97 in maximal isometric torque measurements. FI3 showed good intra-rater reliability (ICC =0.68-0.86). None of the fatigue indices correlated with FSS. CONCLUSIONS: Maximal isometric torque and motor fatigue of knee flexor and extensor muscles can be reliably measured using a knee dynamometer in MS patients. The new FI proved to be a reliable model for MS patients.     

Measurement of maximal isometric torque and muscle quality of the knee extensors and flexors in healthy 50‐ to 70‐year‐old women

Muscle quality is defined as strength per unit muscle mass. The aim of this study was to measure the maximal voluntary isometric torque of the knee extensor and flexor muscle groups in healthy older women and to develop an index of muscle quality based on the combined knee extensor and flexor torque per unit lean tissue mass (LTM) of the upper leg. One hundred and thirty‐six healthy 50‐ to 70‐year‐old women completed an initial measurement of isometric peak torque of the knee extensors and flexors (Con‐Trex MJ; CMV AG, Dubendorf, Switzerland) that was repeated 7 days later. Subsequently, 131 women returned for whole‐ and regional‐body composition analysis (iDXA^?; GE Healthcare, Chalfont St Giles, Buckinghamshire, UK). Isometric peak torque demonstrated excellent within‐assessment reliability for both the knee extensors and flexors (ICC range: 0·991–1·000). Test–retest reliability was lower (ICC range: 0·777–0·828) with an observed mean increase of 5% in peak torque [6·2 (17·2) N m] on the second day of assessment (P<0·001). The relative mean decrease in combined isometric peak torque (?12·2%; P = 0·001) was double that of the relative, non‐significant, median difference in upper leg LTM (?5·3%; P = 0·102) between those in the 5th and 6th decade. The majority of difference in peak isometric torque came from the knee extensors (15·1 N m, P<0·001 versus 2·4 N m, P = 0·234). Isometric peak torque normalized for upper leg LTM (muscle quality) was 8% lower between decades (P = 0·029). These findings suggest strength per unit tissue may provide a better indication of age‐related differences in muscle quality prior to change in LTM.     

徒手感觉刺激对脑卒中偏瘫患者手指痉挛效果的表面肌电图观察北大核心CSCD

目的观察脑卒中患者偏瘫侧指部接受徒手感觉刺激前后,手指屈、伸肌表面肌电图(sEMG)的变化规律。方法2020年4月至8月,安徽医科大学第二附属医院康复医学科收治的脑卒中偏瘫患者50例,徒手对患侧各指甲床和末节两侧依次实施感觉刺激,至患侧手指主动伸展。刺激前后,采用改良Ashworth量表(MAS)评估患侧拇短屈肌、指浅屈肌、指伸肌张力;采集双侧拇短屈肌、指浅屈肌、指伸肌sEMG信号,计算均方根值(RMS)。结果刺激后,所有被测肌群MAS等级均明显降低(|Z|>2.699,P<0.01);患侧指伸肌RMS增加(t=-2.069,P<0.05)。患侧拇短屈肌和指伸肌RMS刺激前、后均小于健侧(t>2.450,P<0.05)。结论指部徒手感觉刺激能即时缓解脑卒中患者屈指肌痉挛,可能与促进伸指肌肌力有关。     

Tai Chi Chuan to improve muscular strength and endurance in elderly individuals: a pilot study

OBJECTIVE: To evaluate the training effect of a Tai Chi Chuan (TCC) program on knee extensor muscular strength and endurance in elderly individuals. DESIGN: Before-after trial. SETTING: Community setting. PARTICIPANTS: Forty-one community dwelling subjects aged 61.1 +/- 9.8 years undertook a TCC program. Nine dropped out during the study. Pretraining and posttraining measurements were obtained from 15 men and 17 women. INTERVENTION: Subjects participated in a 6-month TCC program. Each session consisted of 20 minutes of warm-up, 24 minutes of structured TCC training, and 10 minutes of cool-down exercises. MAIN OUTCOME MEASURES: Peak torque of dominant and nondominant knee extensors was tested at speeds of 60 degrees , 180 degrees , and 240 degrees/sec concentrically and eccentrically. Muscular endurance of the knee extensor was tested at the speed of 180 degrees /sec. RESULTS: In the group of men, concentric knee extensor peak torque increased by 15.1% to 20.0% and eccentric peak torque increased by 15.1% to 23.7%. The group of women also showed increases, ranging from 13.5% to 21.8% in concentric peak torque, and 18.3% to 23.8% in eccentric peak torque. In addition, the knee extensor endurance ratio increased by 9.6% to 18.8% in the men and 10.1% to 14.6% in the women. CONCLUSION: TCC training may enhance muscular strength and endurance of knee extensors in elderly individuals.     

Benefit of isokinetic evaluations of knee before and after anterior cruciate ligament reconstruction in soccer players]

AIM: The aim of this study was to analyse the evolution of the isokinetic performance of the knee flexor and extensor muscles in soccer players before and after intra-articular anterior cruciate ligament reconstruction (Kennet-Jones). METHODS: Two isokinetic evaluations were carried out before surgery and after rehabilitation (i.e. 4 months later) in 18 soccer players. RESULTS: The initial evaluation showed that the stabilizing muscles of the knee were affected differently after lesion of the external anterior crossed ligament. At the opposite of the flexor muscles, the performance of the knee extensor muscles of the injured leg was significantly reduced as compared with that of the healthy leg (peak torque at 90 degrees /s, -16%; power at 180 degrees /s, -14%; total work at 240 degrees /s, -11%). Even if 4 months after surgery, this deficit was accentuated (peak torque at 90 degrees /s, -26%; power at 180 degrees /s, -23%; total work at 240 degrees /s, -19%), the preoperative results of the knee extensor muscle do not condition the postoperative performance. CONCLUSION: After a rupture of the external anterior crossed ligament, a regular program of isokinetic evaluation of the knee seems to be relevant in the follow-up of the wounded athlete. The evaluation before surgery can be used as reference, and from a psychological point of view, this evaluation can create confidence in the athlete during hospitalization. A second evaluation 4 months after surgery can be used to quantify the muscular deficit to direct the exercises of rehabilitation.     

膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性

目的观察膝关节骨关节炎(KOA)患者膝屈伸肌群等速肌力变化及其与膝关节功能的关系。方法23 例双侧KOA患者及14 名正常人进行膝屈伸肌等速肌力检查、五次坐-起试验(FTSST)、静态平衡测试、步态分析。KOA组还完成疼痛视觉模拟评分(VAS)及WOMAC骨关节炎指数评定。结果KOA组伸肌及屈肌峰力矩、峰力矩均值、平均功率、单次最佳做功及总功主患侧均小于对侧(P<0.05);峰力矩屈肌/伸肌(H/Q)百分比主患侧大于对侧(P<0.05)。组间比较,伸肌所有观察指标、屈肌平均功率KOA组均小于正常对照组(P<0.05);峰力矩H/Q 百分比KOA组大于正常对照组(P<0.05)。KOA组伸肌等速肌力峰力矩与FTSST、步行速度、步行距离、跌倒指数、VAS 评分、WOMAC-疼痛评分之间存在相关性(P<0.05),屈肌等速肌力峰力矩与FTSST、步态参数、跌倒指数、VAS评分、WOMAC评分之间无明显相关性(P>0.05)。结论KOA患者伸肌及屈肌等速肌力主患侧较对侧减弱,伸肌等速肌力较正常人减弱,膝伸屈肌肌力变化不同步。KOA患者伸肌等速肌力峰力矩与膝关节疼痛、功能之间存在相关性。