This study assessed muscle inhibition in patients with chronic anterior cruciate ligament (ACL) deficiency or ACL reconstruction. A series of protocols were tested for their effectiveness in increasing activity of the individual knee extensor muscles and decreasing muscle inhibition of the whole quadriceps group. Quadriceps muscle inhibition was measured by superimposing an electrical twitch onto the quadriceps muscle during a maximal voluntary knee extension. The level of activation of the individual knee extensor and knee flexor muscles was assessed via electromyography (EMG). Patients with ACL pathologies showed strength deficits and muscle inhibition in the knee extensors of the involved leg and the contralateral leg. Muscle inhibition was statistically significantly greater in ACL-deficient patients compared to ACL-reconstructed patients. When a knee extension was performed in combination with a hip extension, there was a significant increase, p < 0.05, in activation of the vastus medialis and vastus lateralis muscles compared to isolated knee extension. The use of an anti-shear device, designed to help stabilize the ACL-deficient knee, resulted in increased inhibition in the quadriceps muscle. Furthermore, a relatively more complete activation of the vasti compared to the rectus femoris was achieved during a fatiguing isometric contraction. Based on the results of this study, it is concluded that performing knee extension in combination with hip extension, or performing fatiguing knee extensor contractions, may be more effective in fully activating the vasti muscles than an isolated knee extensor contraction. Training interventions are needed to establish whether these exercise protocols are more effective than traditional rehabilitation approaches in decreasing muscle inhibition and achieving better functional recovery, including equal muscle strength in the injured and the contralateral leg.
Esther Suter, Walter Herzog, and Robert Bray
Esther Suter, Walter Herzog, Kelly De Souza, and Robert Bray
The present study was aimed at determining muscle inhibition (MI) and knee extensor moments in 42 subjects with unilateral anterior knee pain syndrome. The results were compared to a normal, healthy population with no history of knee injury. Also, the effects of 1 week of a nonsteroidal anti-inflammatory drug (NSAID) on MI and knee extensor moments were tested in a randomized controlled trial. At baseline, the involved leg showed significantly higher MI than the noninvolved leg. In both legs, MI was significantly higher and knee extensor moments lower than the corresponding values of the nonimpaired subjects. There was a direct relationship between knee pain during testing and the extent of MI. Higher MI, in turn, was associated with lower knee extensor moments. The study demonstrated significant MI in the quadriceps muscles of the involved and noninvolved legs of subjects with unilateral anterior knee pain syndrome. The results indicate that the noninvolved leg cannot be considered a normal control for a contralateral injury. NSAIDs did not affect MI or knee extensor moments, despite significantly reducing pain. This finding suggests that factors other than pain are responsible for the MI observed in this specific subject population, or that after removal of pain, more time is required to fully restore muscle function.
Luciana Brondino, Esther Suter, Hae-Dong Lee, and Walter Herzog
Muscle inhibition (MI) in human knee extensors increases with increasing maximal voluntary force as a function of knee angle. It was speculated that this angle-dependent MI was modulated by force-dependent feedback, likely Golgi tendon organ pathways. Such angle-dependent MI is of clinical and theoretical importance. The purpose of this study was to determine MI in human elbow flexors for maximal voluntary contractions. Muscle inhibition, elbow flexor force, and electromyographic (EMG) activity were measured in 31 volunteers at elbow angles between 30º and 120º. MI and elbow flexor EMG were the same at all elbow angles. Maximal isometric forces were greatest at the 70º angle, and never fell below 70% of the peak force at any of the tested angles. From these results it is concluded that force-dependent modulation of MI did not occur in the elbow flexors, possibly because maximal isometric force remained relatively close (within 30%) to the peak force. In contrast, force-dependent modulation of MI occurred in the knee extensors at the most extended angles, when the average knee extensor force had dropped to 50% or less of the maximal knee extensor force. It is likely that human maximal voluntary contractions are not associated with a given activation. Rather, activation appears to be modulated by force-dependent feedback at force levels below 70% of the absolute peak force, which manifests itself in a change of MI that parallels the level of maximal isometric force in voluntary contractions.