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Samantha N. Boudreau, Maureen K. Dwyer, Carl G. Mattacola, Christian Lattermann, Tim L. Uhl and Jennifer Medina McKeon

Context:

Functional exercises are often used in strengthening programs after lower extremity injury. Activation levels of the stabilizing hip muscles have not been documented.

Objective:

To document the progression of hip-muscle activation levels during 3 lower extremity functional exercises.

Design:

Cross-sectional.

Setting:

Laboratory.

Participants:

44 healthy individuals, 22 women and 22 men.

Intervention:

Subjects, in 1 testing session, completed 3 trials each of the lunge (LUN), single-leg squat (SLSQ), and step-up-and-over (SUO) exercise.

Main Outcome Measures:

Root-mean-square muscle amplitude (% reference voluntary muscle contraction) was measured for 5 muscles during the 3 exercises: rectus femoris (RF), dominant and nondominant gluteus medius (GMed_D and GMed_ND), adductor longus (ADD), and gluteus maximus (GMX).

Results:

The RF, GMAX, and GMed_D were activated in a progression from least to greatest during the SUO, LUN, and SLSQ. The progression for the GMed_ND activation was from least to greatest during the SLSQ, SUO, and then LUN. Activation levels of the ADD showed no progression.

Conclusion:

Progressive activation levels were documented for muscles acting on the hip joint during 3 functional lower extremity exercises. The authors recommend using this exercise progression when targeting the hip muscles during lower extremity strengthening.

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Wissem Dhahbi, Anis Chaouachi, Anis Ben Dhahbi, Jodie Cochrane, Laurence Chèze, Angus Burnett and Karim Chamari

Purpose:

To examine differences between ground-reaction-force (GRF)-based parameters collected from 5 types of plyometric push-ups. Between-trials reliability and the relationships between parameters were also assessed.

Methods:

Thirty-seven highly active commando soldiers performed 3 trials of 5 variations of the plyometric push-up in a counterbalanced order: standard countermovement push-up (SCPu), standard squat push-up (SSPu), kneeling countermovement push-up (KCPu), kneeling squat push-up (KSPu), and drop-fall push-up (DFPu). Vertical GRF was measured during these exercises using a portable Kistler force plate. The GRF applied by the hands in the starting position (initial force supported), peak GRF and rate of force development during takeoff, flight time, impact force, and rate of force development impact on landing were determined.

Results:

During standard-position exercises (SCPu and SSPu) the initial force supported and impact force were higher (P < .001) than with kneeling exercises (KCPu, KSPu, and DFPu). The peak GRF and rate of force development during takeoff were higher (P < .001) in the countermovement push-up exercises ([CMP] SCPu, KCPu, and DFPu) than squat push-up exercises ([SP] SSPu and KSPu). Furthermore, the flight time was greater (P < .001) during kneeling exercises than during standard-position exercises. A significant relationship (P < .01) between impact force and the rate of force development impact was observed for CMP and SP exercises (r = .83 and r = .62, respectively). The initial force supported was also negatively related (P < .01) to the flight time for both CMP and SP (r = –.74 and r = –.80, respectively). It was revealed that the initial force supported and the peak GRF during takeoff had excellent reliability; however, other parameters had poor absolute reliability.

Conclusions:

It is possible to adjust the intensity of plyometric push-up exercises and train athletes’ muscle power by correctly interpreting GRF-based parameters. However, caution is required as some parameters had marginal absolute reliability.

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Rebecca J. Guthrie, Terry L. Grindstaff, Theodore Croy, Christopher D. Ingersoll and Susan A. Saliba

Context:

Individuals with low back pain (LBP) are thought to benefit from interventions that improve motor control of the lumbopelvic region. It is unknown if therapeutic exercise can acutely facilitate activation of lateral abdominal musculature.

Objective:

To investigate the ability of 2 types of bridging-exercise progressions to facilitate lateral abdominal muscles during an abdominal drawing-in maneuver (ADIM) in individuals with LBP.

Design:

Randomized control trial.

Setting:

University research laboratory.

Participants:

51 adults (mean ± SD age 23.1 ± 6.0 y, height 173.6 ± 10.5 cm, mass 74.7 ± 14.5 kg, and 64.7% female) with LBP. All participants met 3 of 4 criteria for stabilization-classification LBP or at least 6 best-fit criteria for stabilization classification.

Interventions:

Participants were randomly assigned to either traditional-bridge progression or suspension-exercise-bridge progression, each with 4 levels of progressive difficulty. They performed 5 repetitions at each level and were progressed based on specific criteria.

Main Outcome Measures:

Muscle thickness of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) was measured during an ADIM using ultrasound imaging preintervention and postintervention. A contraction ratio (contracted thickness:resting thickness) of the EO, IO, and TrA was used to quantify changes in muscle thickness.

Results:

There was not a significant increase in EO (F 1,47 = 0.44, P = .51) or IO (F 1,47 = .30, P = .59) contraction ratios after the exercise progression. There was a significant (F 1,47 = 4.05, P = .05) group-by-time interaction wherein the traditional-bridge progression (pre = 1.55 ± 0.22; post = 1.65 ± 0.21) resulted in greater (P = .03) TrA contraction ratio after exercise than the suspension-exercise-bridge progression (pre = 1.61 ± 0.31; post = 1.58 ± 0.28).

Conclusion:

A single exercise progression did not acutely improve muscle thickness of the EO and IO. The magnitude of change in TrA muscle thickness after the traditional-bridging progression was less than the minimal detectable change, thus not clinically significant.

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Doyglas R. Keskula, Jewell B. Duncan and Virginia L. Davis

This paper describes the rehabilitation of a patient following a medial meniscus transplant. Both preoperative and postoperative history and relevant physical findings are presented. Rehabilitation goals and the corresponding treatment plan are discussed, with an emphasis on functional outcomes. A general framework for treatment addressing impairment and functional goals is outlined. Progression of the rehabilitation program was based on surgical precautions and the patient's tolerance to the exercise progression. This case study demonstrates that appropriate surgical intervention combined with a properly designed rehabilitation program contributed to the improved functional abilities of this patient.

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Lori A. Bolgla, Scott W. Shaffer and Terry R. Malone

Context:

Knee extension exercise is an important part of knee rehabilitation. Clinicians prescribe non-weight bearing exercise initially and progress patients to weight bearing exercise once they can perform a straight leg raise (SLR).

Objective:

Compare VM activation during a SLR and weight bearing exercises.

Design:

One-way repeated measures design.

Setting:

University Laboratory.

Subjects:

Fifteen healthy subjects.

Intervention:

One SLR exercise and 6 weight-bearing knee extension exercises.

Main Outcome Measures:

Electromyographic amplitudes for the VM expressed as a percent maximum voluntary isometric contraction.

Results:

The SLR had greater activation than the single leg stance and bilateral squat exercises. The step-up and unilateral leg press exercises had the greatest activation.

Conclusions:

SLR performance can be an important indicator for exercise progression. These results provide foundational knowledge to assist clinicians with exercise prescription.

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Kelsey Picha and Tim Uhl

Context: What is the correct resistive load to start resistive training with elastic resistance to gain strength? This question is typically answered by the clinician’s best estimate and patient’s level of discomfort without objective evidence. Objective: To determine the average level of resistance to initiate a strengthening routine with elastic resistance following isometric strength testing. Design: Cohort. Setting: Clinical. Participants: 34 subjects (31 ± 13 y, 73 ± 17 kg, 170 ± 12 cm). Interventions: The force produced was measured in Newtons (N) with an isometric dynamometer. The force distance was the distance from center of joint to location of force applied was measured in meters to calculate torque that was called “Test Torque” for the purposes of this report. This torque data was converted to “Exercise Load” in pounds based on the location where the resistance was applied, specifically the distance away from the center of rotation of the exercising limb. The average amount of exercise load as percentage of initial Test Torque for each individual for each exercise was recorded to determine what the average level of resistance that could be used for elastic resistance strengthening program. Main Outcome Measures: The percentage of initial test torque calculated for the exercise was recorded for each exercise and torque produced was normalized to body weight. Results: The average percentage of maximal isometric force that was used to initiate exercises was 30 ± 7% of test torque. Conclusions: This provides clinicians with an objective target load to start elastic resistance training. Individual variations will occur but utilization of a load cell during elastic resistance provides objective documentation of exercise progression.

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Timothy J. Gibbons and Marie-Louise Bird

Background: The training of abdominal muscles has a positive impact on the functional capacity of healthy adults, being applied practically in fields of athletics and fitness through rehabilitation for lower back pain. Objective: The study compares abdominal muscle activity while performing graded isometric exercises on stable and unstable surfaces. The authors also examined perceived stability and comfort for the different surfaces. Methods: A total of 30 young, healthy adults performed 3 graded isometric exercises on a Pilates table, foam roller, and Oov (a newly developed tool). Ultrasound investigation measured transversus abdominis, internal oblique abdominis, and external oblique abdominis thickness during each task, comparing muscle thickness between conditions using general linear modeling. Results: Core abdominal activation was greater on the foam roller than the Oov and Pilates table during crook lying (bilateral leg support). Both Oov and foam roller elicited greater contralateral transversus abdominis and internal oblique abdominis thickness than the Pilates table during tabletop and straight leg raises (unilateral leg exercises). For transversus abdominis only, the foam roller elicited more muscle thickness than the Oov during straight leg raises. The Oov was rated more comfortable than the foam roller. Discussion: Exercises performed on the Oov and foam roller elicit core greater abdominal muscle thickness than those performed on a Pilates table. Unilateral leg exercises in a supine position elicit more contralateral muscle thickness than those with bilateral leg support. Conclusions: These results provide information to support choices in exercise progression from flat stable to more unstable surfaces and from those with bilateral foot support to unilateral foot support. The Oov was more comfortable that the foam roller, and this may help with exercise adherence.

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John J. Fraser and Jay Hertel

participants during the 4-week trial. Participants allocated to the control group did not receive any intervention and were asked to not modify their physical activity during the 4-week trial period. Participants allocated to the intervention group were instructed in an IFM home exercise progression detailed

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Dustin R. Grooms, Adam W. Kiefer, Michael A. Riley, Jonathan D. Ellis, Staci Thomas, Katie Kitchen, Christopher A. DiCesare, Scott Bonnette, Brooke Gadd, Kim D. Barber Foss, Weihong Yuan, Paula Silva, Ryan Galloway, Jed A. Diekfuss, James Leach, Kate Berz and Gregory D. Myer

-sensory integration of spatial information supporting motor cortex efficiency is a key neuroplastic factor driving the success of training, then modifications to the training can be made to target these neural processes. Potential clinical examples include optimization of exercise progression not only on classic

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Tim Henwood, Sharon Hetherington, Madeleine Purss, Kevin Rouse, Julie Morrow and Michele Smith

contraindications, how to correct poor technique, and exercise progressions. In brief, the day consisted of an introduction to ageing, its negative consequences and the evidence for exercise, physical activity, and improved lifestyle behaviors as a countermeasure. This was followed by a detailed project overview