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Renato Semadeni and Kai-Uwe Schmitt

Objective:

In this study a numerical model of a skier was developed to investigate the effect of different rehabilitation strategies after anterior cruciate ligament (ACL) rupture.

Methods:

A computer model using a combined finite-element and multibody approach was established. The model includes a detailed representation of the knee structures, as well as all major leg muscles. Using this model, different strategies after ACL rupture were analyzed.

Results:

The benefit of muscle training to compensate for a loss of the ACL was shown. The results indicate that an increase of 10% of the physiological cross-sectional area has a positive effect without subjecting other knee structures to critical loads. Simulating the use of a hamstring graft indicated increasing knee loads. A patellar-tendon graft resulted in an increase of the stress on the lateral collateral ligament.

Conclusion:

Muscle training of both extensors and flexors is beneficial in medical rehabilitation of ACL-deficient and ACL-reconstructed knees.

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Geraldine L. Pellecchia, Holly Hamel and Peter Behnke

The purpose of this study was to compare an established protocol of modalities and transverse friction massage (MOD & TFM) with iontophoresis of dexamethasone and lidocaine (IONTO) in the treatment of patients with infrapatellar tendinitis. Thirty cases with infrapatellar tendinitis were randomly assigned to either the MOD & TFM or the IONTO intervention. Subjects still symptomatic after six sessions of intervention received the alternate treatment protocol. Four measures were used to assess patient status: a functional index questionnaire, a visual analog pain scale, a rating of tenderness with palpation of the involved tendon, and the number of step-ups needed to elicit pain. In response to the MOD & TFM intervention, only the number of step-ups performed to elicit pain showed significant improvement. All status measures improved significantly with the IONTO intervention. The results suggest that iontophoresis may be more effective and efficient in decreasing pain, reducing inflammation, and promoting healing in patients with infrapatellar tendinitis.

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Danielle M. DeBruyne, Marina M. Dewhurst, Katelyn M. Fischer, Michael S. Wojtanowski and Chris Durall

Clinical Scenario:

Increasing the length of the muscle–tendon unit may prevent musculotendinous injury. Various methods have been proposed to increase muscle–tendon flexibility, including self-mobilization using foam rollers or roller massagers, although the effectiveness of these devices is uncertain. This review was conducted to determine if the use of foam rollers or roller massagers to improve hamstrings flexibility is supported by moderate- to high-quality evidence.

Clinical Question:

Are foam rollers or roller massagers effective for increasing hamstrings flexibility in asymptomatic physically active adults?

Summary of Key Findings:

The literature was searched for studies on the effects of using foam rollers or roller massagers to increase hamstrings flexibility in asymptomatic physically active adults. Four randomized controlled trials were included; 2 studies provided level 2 or 3 evidence regarding foam rollers and 2 studies provided level 2 or 3 evidence regarding roller massagers. Both roller-massager studies reported increases in hamstrings flexibility after treatment. Data from the foam-roller studies did not demonstrate a statistically significant increase in hamstrings flexibility, but 1 study did demonstrate a strong effect size.

Clinical Bottom Line:

The reviewed moderate-quality studies support the use of roller massagers but provide limited evidence on the effectiveness of foam rolling to increase hamstrings flexibility in asymptomatic physically active adults. Flexibility gains may be improved by a longer duration of treatment and administration by a trained therapist. Gains appear to decline rapidly postrolling. Neither device has been shown to confer a therapeutic benefit superior to static stretching, and the effectiveness of these devices for preventing injury is unknown.

Strength of Recommendation:

Grade B evidence supports the use of roller massagers to increase hamstrings flexibility in asymptomatic physically active adults.

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Vera L. Talis and Irina A Solopova

We investigated the development of postural reactions induced in standing subjects by Achilles tendon vibration. We compared vibratory reactions in 3 different conditions: normal standing, standing near support, and when the solid support being protracted forward changed the initial posture. Additional support for the back was placed at subject's sacral or shoulder level. In the easy standing condition, the postural vibration reaction consists of progressive backward upper body movement. When the body contacted the additional support on the sacral level during the vibratory reaction, the movement of the upper body continued in most of the subjects. This was accompanied by an increase of pressure on the toes. When the support was applied at the shoulder level, the body motion reversed its direction in half of the subjects. In this case, backward-forward oscillations occurred near the support. The initial change of body-support interaction did not influence the ensuing vibration reaction; namely the reaction was similar to that with the support near to the body at the sacral level. Our data demonstrate that the vibration-induced reaction is not a local reaction limited to one joint, but a complex postural synergy that involves both leg and trunk muscles and integrates the information from touch and pressure afferents of the upper body.

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Christopher J. Hasson, Richard E.A. van Emmerik and Graham E. Caldwell

In this study, a comprehensive evaluation of static and dynamic balance abilities was performed in young and older adults and regression analysis was used to test whether age-related variations in individual ankle muscle mechanical properties could explain differences in balance performance. The mechanical properties included estimates of the maximal isometric force capability, force-length, force-velocity, and series elastic properties of the dorsiflexors and individual plantarflexor muscles (gastrocnemius and soleus). As expected, the older adults performed more poorly on most balance tasks. Muscular maximal isometric force, optimal fiber length, tendon slack length, and velocity-dependent force capabilities accounted for up to 60% of the age-related variation in performance on the static and dynamic balance tests. In general, the plantarflexors had a stronger predictive role than the dorsiflexors. Plantarflexor stiffness was strongly related to general balance performance, particularly in quiet stance; but this effect did not depend on age. Together, these results suggest that age-related differences in balance performance are explained in part by alterations in muscular mechanical properties.

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George Vagenas and Blaine Hoshizaki

The purpose of this study was to identify the kinematic characteristics of bilateral rearfoot asymmetry during heel–toe running under two experimental conditions: worn (broken-in) running shoes and new (standardized) running shoes. High-speed cinematography (150 fps) was used to film the lower limbs of four male runners in the frontal plane while running on a treadmill at their training pace. Six successive footfalls were analyzed for each subject and selected kinematical variables of the rearfoot function were calculated. Significant asymmetries were found in lower leg angle and Achilles tendon angle at touchdown and at maximum pronation. Total pronation and rearfoot angle were almost symmetric. The angular displacement graphs for the shank and foot revealed a distinct overall asymmetry between the lower limbs in both conditions. The mean values of the kinematical asymmetries were appreciably higher in the new shoe condition. It is proposed that the degree of these asymmetries is subject to changes due to injury, personal running style, and stability of the running shoe. Trends of bilateral dominance specific to rearfoot control in running were identified.

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Annette J. Raynor

The patellar tendon reflex (PTR) and simple visual reaction time (VRT) were fractionated and compared in 40 subjects with developmental coordination disorder (DCD) and normal coordination (NC) in two age groups. Four equal groups of subjects, 6 years DCD (6DCD), 6 years NC (6NC), 9 years DCD (9DCD), and 9 years NC (9NC) were compared using ANOVA for the main effects of coordination and age. PTR and its components of reflex latency and motor time were not significantly affected by the level of coordination; however, a significant coordination by age interaction (p < .05) revealed an increased motor time in the 6DCD group. VRT, premotor time, and motor time were all significantly (p < .05) increased in children with DCD; the increased VRT and premotor time support earlier findings, whereas the increased motor time has not previously been found. These findings suggest that the processing of reflexive and volitional responses by children with DCD differs from that of their NC peers.

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David Diggin, Ross Anderson and Andrew J. Harrison

Evidence suggests reports describing the reliability of leg-spring (kleg) and joint stiffness (kjoint) measures are contaminated by artifacts originating from digital filtering procedures. In addition, the intraday reliability of kleg and kjoint requires investigation. This study examined the effects of experimental procedures on the inter- and intraday reliability of kleg and kjoint. Thirty-two participants completed 2 trials of single-legged hopping at 1.5, 2.2, and 3.0 Hz at the same time of day across 3 days. On the final test day a fourth experimental bout took place 6 hours before or after participants’ typical testing time. Kinematic and kinetic data were collected throughout. Stiffness was calculated using models of kleg and kjoint. Classifications of measurement agreement were established using thresholds for absolute and relative reliability statistics. Results illustrated that kleg and kankle exhibited strong agreement. In contrast, kknee and khip demonstrated weak-to-moderate consistency. Results suggest limits in kjoint reliability persist despite employment of appropriate filtering procedures. Furthermore, diurnal fluctuations in lower-limb muscle-tendon stiffness exhibit little effect on intraday reliability. The present findings support the existence of kleg as an attractor state during hopping, achieved through fluctuations in kjoint variables. Limits to kjoint reliability appear to represent biological function rather than measurement artifact.

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Kurt Manal, Dustyn P. Roberts and Thomas S. Buchanan

Ultrasonography was used to measure the pennation angle of the human tibialis anterior (TA), lateral gastrocnemius (LG), medial gastrocnemius (MG), and soleus (Sol). The right and left legs of 8 male and 8 female subjects were tested at rest and during maximum voluntary contraction (MVC). Joint angles were chosen to control muscle tendon lengths so that the muscles were near their optimal length within the length– tension relationship. No differences in pennation angle were detected between the right and left legs. Another consistent finding was that the pennation angle at MVC was significantly greater than at rest for all muscles tested. Optimal pennation angles for the TA, MG, and Sol were significantly greater for the men than for the women. Optimal pennation angles for the TA, LG, MG, and Sol for the male subjects were 14.3°, 23.7°, 34.6°, and 40.1° respectively, whereas values of 12.1°, 16.3°, 27.3°, and 26.3° were recorded for the female subjects. The results of this study suggest the following: (1) similar values for pennation angle can be used for the right and left TA, LG, MG, and Sol; (2) pennation angle is significantly greater at MVC than at rest for all muscles tested; and (3) sex-specific values for optimal pennation angle should be used when modeling the force-generating potential of the primary muscles responsible for ankle plantar and dorsiflexion.

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Pablo B. Costa, Eric D. Ryan, Trent J. Herda, Ashley A. Walter, Katherine M. Hoge and Joel T. Cramer

This study examined the acute effects of passive stretching on electromechanical delay (EMD), peak twitch force (PTF), rate of force development (RFD), and peak-to-peak M-wave (PPM) for the soleus muscle during evoked isometric plantar flexion muscle actions. Fourteen men (mean age ± SD = 21.2 ± 2.4 years; body mass = 80.0 ± 14.9 kg; height = 176.9 ± 7.2 cm) and 20 women (20.9 ± 2.5 years; 61.3 ± 8.9 kg; 165.3 ± 7.5 cm) volunteered for the study. Five single-square, supramaximal transcutaneous electrical stimuli (each separated by 5 s) were delivered to the tibial nerve before and after passive stretching. A time × gender interaction was observed for EMD, and the post hoc dependent-samples t tests indicated that EMD increased 4% for the women (p = .023), but not for the men (p = .191). There were no other stretching-related changes for PTF, RFD, or p-p M-wave for either the men or women (p > .05). These findings tentatively suggested that mechanical factors related to the stiffness of the muscle-tendon unit may contribute to the explanation for why stretching caused an acute increase in the EMD during evoked twitches in the women, but not in the men.