facilitatory or inhibitory effects on muscle response varies. 19 – 25 A technique often used to assess central nervous system (CNS) level of activation is to measure the Hoffmann reflex (H-reflex). Studies which found depressed H-reflexes following an acute bout of WBV reported that the values return to
Dana M. Otzel, Chris J. Hass, Erik A. Wikstrom, Mark D. Bishop, Paul A. Borsa, and Mark D. Tillman
Tim McGarry, J. Timothy Inglis, and Ian M. Franks
Reduced surface electromyogram (EMG) onsets, observed in some cases when trying to stop an earlier intended action before it begins, were taken to suggest a control process that remains open to stopping right up to the point of motor discharge. This interpretation argues against a final ballistic (involuntary) process in the control of voluntary action. That a final ballistic process may receive reduced input shortly before its manifestation as reduced output (i.e., motor discharge), however, provides for an alternative interpretation of these same data. In this study we used the Hoffmann (H) reflex to further investigate for stopping effects in the brief interval before voluntary motor discharge. Late stopping effects on the facilitated H-reflex within the time window that a final ballistic process would otherwise be expected (i.e, shortly before EMG onset) were observed in some instances. We conclude from these data good evidence against a final ballistic process in the control of voluntary action.
This study investigated the effect of psychological pressure on spinal reflex excitability. Thirteen participants performed a balancing task by standing on a balance disk with one foot. After six practice trials, they performed one nonpressure and one pressure trial involving a performance-contingent cash reward or punishment. Stress responses were successfully induced; state anxiety, mental effort, and heart rates all increased under pressure. Soleus Hoffmann reflex amplitude in the pressure trial was significantly smaller than in the nonpressure trial. This modification of spinal reflexes may be caused by presynaptic inhibition under the control of higher central nerve excitation under pressure. This change did not prevent 12 of the 13 participants from successfully completing the postural control task under pressure. These results suggest that Hoffmann reflex inhibition would contribute to optimal postural control under stressful situations.
J. Ty Hopkins and Christopher D. Ingersoll
To define the concept of arthrogenic muscle inhibition (AMI), to discuss its implications in the rehabilitation of joint injury, to discuss the neurophysiologic events that lead to AMI, to evaluate the methods available to measure AM1 and the models that might be implemented to examine AMI, and to review therapeutic interventions that might reduce AMI.
The databases MEDLINE, SPORTDiscus, and CIHNAL were searched with the terms reflex inhibition, joint mechanoreceptor, Ib interneuron, Hoffmann reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers.
AMI is a limiting factor in the rehabilitation of joint injury. It results in atrophy and deficiencies in strength and increases the susceptibility to further injury. A therapeutic intervention that results in decreased inhibition, allowing for active exercise, would lead to faster and more complete recovery.
Matthew Harkey, Michelle M. McLeod, Masafumi Terada, Phillip A. Gribble, and Brian G. Pietrosimone
Spinal-reflexive and corticomotor excitability may have a critical role in altering muscle function needed to stabilize the ankle in people with chronic ankle instability (CAI).
To determine the association between self-reported disability and both spinal-reflexive and corticomotor excitability in people with CAI.
Descriptive laboratory study.
30 participants with CAI.
Main Outcome Measures:
Soleus spinal-reflexive excitability was measured with normalized Hoffmann reflexes (H:M ratio), and corticomotor excitability was measured with transcranial magnetic stimulation and quantified by normalized motor-evoked-potential (MEP) amplitudes at 120% of active motor threshold (120%MEP). Self-reported disability was quantified with the activities-of-daily-living and sport subscales of the Foot and Ankle Ability Measure (FAAM-ADL and FAAM-S). Separate linear Pearson product–moment correlations and nonlinear quadratic correlations were used to determine associations between the neural-excitability and disability variables.
Thirty participants were included in the spinal-reflexive-excitability analysis, while only 19 were included in the corticomotor analysis. There was a significant, weak linear association between H:M ratio and FAAM-ADL (R = .39, P = .03) and a nonsignificant, weak linear association between H:M ratio and FAAM-S (R = .36, P = .06). There were significant, moderate quadratic associations between H:M ratio and both FAAM-ADL (R = .48, P = .03) and FAAM-S (R = .50, P = .02). There was a significant, moderate linear association between 120%MEP and FAAM-ADL (R = –.48, P = .04) and a nonsignificant, moderate negative linear association between FAAM-S (R = –.42, P = .07). There was a significant, moderate quadratic association between 120%MEP and FAAM-ADL (R = .57, P = .046) and a significant, strong quadratic correlation between 120%MEP and FAAM-S (R = .71, P = .004).
There are significant quadratic associations between self-reported disability and both spinal-reflexive and corticomotor excitability of the soleus. CAI participants with low or high neural excitability present with lower function.
Christopher Kuenze, Jay Hertel, and Joseph M. Hart
Persistent quadriceps weakness due to arthrogenic muscle inhibition (AMI) has been reported after anterior cruciate ligament (ACL) reconstruction. Fatiguing exercise has been shown to alter lower extremity muscle function and gait mechanics, which may be related to injury risk. The effects of exercise on lower extremity function in the presence of AMI are not currently understood. The purpose of this study was to compare the effect of 30 min of exercise on quadriceps muscle function and soleus motoneuron-pool excitability in ACL-reconstructed participants and healthy controls.
Twenty-six (13 women, 13 men) healthy and 26 (13 women, 13 men) ACL-reconstructed recreationally active volunteers were recruited for a case-control laboratory study. All participants completed 30 min of continuous exercise including alternating cycles of inclined-treadmill walking and bouts of squats and step-ups. Knee-extension torque, quadriceps central activation ratio (CAR), soleus H:M ratio, and soleus V:M ratio were measured before and after 30 min of exercise.
There was a significant group × time interaction for knee-extension torque (P = .002), quadriceps CAR (P = .03), and soleus V:M ratio (P = .03). The effect of exercise was smaller for the ACL-R group than for matched controls for knee-extension torque (ACL-R: %Δ = −4.2 [−8.7, 0.3]; healthy: %Δ = −14.2 [−18.2, −10.2]), quadriceps CAR (ACL-R: %Δ = −5.1 [−8.0, −2.1]; healthy: %Δ = −10.0 [−13.3, −6.7]), and soleus V:M ratio (ACL-R: %Δ = 37.6 [2.1, 73.0]; healthy: %Δ = −24.9 [−38.6, −11.3]).
Declines in quadriceps and soleus volitional muscle function were of lower magnitude in ACL-R subjects than in healthy matched controls. This response suggests an adaptation experienced by patients with quadriceps AMI that may act to maintain lower extremity function during prolonged exercise.
Bradley T. Hayes, Rod A. Harter, Jeffrey J. Widrick, Daniel P. Williams, Mark A. Hoffman, and Charlie A. Hicks-Little
Static stretching is commonly used during the treatment and rehabilitation of orthopedic injuries to increase joint range of motion (ROM) and muscle flexibility. Understanding the physiological adaptations that occur in the neuromuscular system as a result of long-term stretching may provide insight into the mechanisms responsible for changes in flexibility.
To examine possible neurological origins and adaptations in the Ia-reflex pathway that allow for increases in flexibility in ankle ROM, by evaluating the reduction in the synaptic transmission of Ia afferents to the motoneuron pool.
Repeated-measures, case-controlled study.
Sports medicine research laboratory.
40 healthy volunteers with no history of cognitive impairment, neurological impairment, or lower extremity surgery or injury within the previous 12 mo.
Presynaptic and postsynaptic mechanisms were evaluated with a chronic stretching protocol. Twenty subjects stretched 5 times a wk for 6 wk. All subjects were measured at baseline, 3 wk, and 6 wk.
Main Outcome Measures:
Ankle-dorsiflexion ROM, Hmax:Mmax, presynaptic inhibition, and disynaptic reciprocal inhibition.
Only ROM had a significant interaction between group and time, whereas the other dependent variables did not show significant differences. The experimental group had significantly improved ROM from baseline to 3 wk (mean 6.2 ± 0.9, P < .001), 3 wk to 6 wk (mean 5.0 ± 0.8, P < .001), and baseline to 6 wk (mean 11.2 ±0.9, P < .001).
Ankle dorsiflexion increased by 42.25% after 6 wk of static stretching, but no significant neurological changes resulted at any point of the study, contrasting current literature. Significant neuromuscular origins of adaptation do not exist in the Ia-reflex-pathway components after a long-term stretching program as currently understood. Thus, any increases in flexibility are the result of other factors, potentially mechanical changes or stretch tolerance.
Grant E. Norte, Jay N. Hertel, Susan A. Saliba, David R. Diduch, and Joseph M. Hart
contraction (MVIC) torque, fatigue index (FI), central activation ratio (CAR), Hoffmann reflex (H-reflex), and active motor threshold (AMT). The International Knee Documentation Committee (IKDC) subjective knee evaluation form, 13 Knee Injury and Osteoarthritis Outcome Score, 14 and Western Ontario and
Matthew Harkey, Michelle McLeod, Ashley Van Scoit, Masafumi Terada, Michael Tevald, Phillip Gribble, and Brian Pietrosimone
Altered neuromuscular function and decreased dorsiflexion range of motion (DFROM) have been observed in patients with chronic ankle instability (CAI). Joint mobilizations are indicated for restoring DFROM and dynamic postural control, yet it remains unknown if a mobilization can alter neuromuscular excitability in muscles surrounding the ankle.
To determine the immediate effects of a Maitland grade III anterior-to-posterior joint mobilization on spinal-reflex and corticospinal excitability in the fibularis longus (FL) and soleus (SOL), DFROM, and dynamic postural control.
Single-blinded randomized control trial.
30 patients with CAI randomized into a mobilization (n = 15) or control (n = 15) group.
Maitland grade III anterior-to-posterior joint mobilization.
Main Outcome Measures:
Spinal-reflex excitability was measured with the Hoffmann reflex, while corticospinal excitability was evaluated with transcranial magnetic stimulation. DFROM was measured seated with the knee extended, and dynamic postural control was quantified with the Star Excursion Balance Test. Separate 2 × 2 repeated-measures ANOVAs were performed for each outcome measure. Dependent t tests were used to evaluate individual differences within groups in the presence of significance.
Spinal-reflex and corticospinal excitability of the SOL and FL were not altered in the mobilization or control group (P > .05). DFROM increased immediately after the mobilization (P = .05) but not in the control group, while dynamic postural control was unchanged in both groups (P > .05).
A single joint-mobilization treatment was efficacious at restoring DFROM in participants with CAI; however, excitability of spinal reflex and corticospinal pathways at the ankle and dynamic postural control were unaffected.
Daniel H. Huffman, Brian G. Pietrosimone, Terry L. Grindstaff, Joseph M. Hart, Susan A. Saliba, and Christopher D. Ingersoll
Motoneuron-pool facilitation after cryotherapy may be mediated by stimulation of thermoreceptors surrounding a joint. It is unknown whether menthol counterirritants, which also stimulate thermoreceptors, have the same effect on motoneuron-pool excitability (MNPE).
To compare quadriceps MNPE after a menthol-counterirritant application to the anterior knee, a sham counterirritant application, and a control treatment in healthy subjects.
A blinded, randomized controlled laboratory study.
Thirty healthy subjects (16 m, 14 f; 24.1 ± 3.9 y, 170.6 ± 11.4 cm, 72.1 ± 15.6 kg) with no history of lower extremity surgery volunteered for this study.
Two milliliters of menthol or sham counterirritant was applied to the anterior knee; control subjects received no intervention.
Main Outcome Measures:
The average vastus medialis normalized Hoffmann reflex (Hmax:Mmax ratio) was used to measure MNPE. Measurements were recorded at 5, 15, 25, and 35 minutes postintervention and compared with baseline measures.
Hmax:Mmax ratios for all groups significantly decreased over time (F 4,108 = 10.52, P < .001; menthol: baseline = .32 ± .20, 5 min = .29 ± .18, 15 min = .27 ± .18, 25 min = .28 ± .19, 35 min = .27 ± .18; sham: baseline = .46 ± .26, 5 min = .36 ± .20, 15 min = .35 ± .19, 25 min = .35 ± .20, 35 min = .34 ± .18; control: baseline = .48 ± .32, 5 min = .37 ± .27, 15 min = .37 ± .27, 25 min = .37 ± .29, 35 min = .35 ± .28). No significant Group × Time interaction or group differences in Hmax:Mmax were found.
Menthol did not affect quadriceps MNPE in healthy subjects.