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A Neuromuscular Intervention for Exercise-Related Medial Leg Pain

Katherine R. Newsham, Matthew D. Beekley, and Christine A. Lauber


Exercise-related medial leg pain (ERMLP) is a common complaint among athletes, and efforts toward rehabilitation are often unsuccessful.


To evaluate the efficacy of a therapeutic intervention in ERMLP localized to soft tissue.


A quasi-experimental, nonequivalent control-group study.


Athletic training facility.


20 volunteer male and female athletes (18–22 y old) with ERMLP. Complete data were available for 13 participants.


Treatment group (TRE, n = 7) received therapeutic intervention focused on relieving muscle hypertonicity in the deep compartment of the lower leg and restoring balance of the toe flexors and extensors. Control group (CON, n = 6) received no intervention.

Main Outcome Measures:

Self-reported pain intensity, pain threshold, and extensor hallucis longus to extensor digitorum brevis (EHL:EDB) electromyography ratio.


There were no significant differences in age, duration of symptoms, or pain measures between the 2 groups at baseline. CON demonstrated no significant changes in any of the outcome measures in posttreatment testing, but significant between-groups differences were identified for pain during activity (CON mean = 6.5, 95% CI 5.05, 7.95; TRE mean = 3.5, 95% CI 1.67, 5.33; P = .01), change scores for pain during activity (CON mean = 0.33, 95% CI −1.25, 1.91; TRE mean = −3.43, 95% CI:−4.6, −2.25; P < .001), change scores in pressure threshold (CON mean = −0.25, 95% CI −0.74, 0.23; TRE mean = 0.72, 95% CI 0.22, 1.37; P = .006), and change in EHL:EDB ratios (CON mean = 0.05, 95% CI −0.22, 0.33; TRE mean = 1.07, 95% CI 0.75, 2.07; P < .046).


Therapeutic interventions focused on restoring muscle balance appear to be effective in resolving ERMLP.

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The Importance of Functional Hamstring/Quadriceps Ratios in Knee Osteoarthritis

Özlem Aslan, Elif Balevi Batur, and Jale Meray

proposed than the conventional H/Q ratio (Hcon/Qcon, Hecc/Qecc) to identify the muscle strength and muscle balance of the knee in the literature. 12 – 15 However, there are few studies using the functional H/Q ratios for muscle control of the knee in knee OA. Therefore, we aimed to investigate the

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Assessment of Knee Flexor and Extensor Muscle Balance

Philip Graham-Smith, Paul A. Jones, Paul Comfort, and Allan G. Munro

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Shoulder External- and Internal-Rotation Isokinetic Strength in Master’s Swimmers

Deb West, Gisela Sole, and S. John Sullivan


To establish muscle-strength and -balance profiles for shoulder external rotation (ER) and internal rotation (IR) in master’s swimmers.


Cross-sectional study.




Six male and seven female master’s swimmers and a matched control group.


Concentric and eccentric ER and IR shoulder movements were recorded (Kin-Com™ isokinetic dynamometer). Peak-torque values, concentric ER:IR ratios, eccentric ER:IR (conventional) ratios, and eccentric ER:concentric IR (functional) ratios were examined between groups.


Mean peak-torque values ranged from 21.23 to 37.69 N · m for the swimmers, which, although 15% to 27% greater than those of the controls, were not statistically different. Conventional (0.78:0.86) and functional (1.06:1.17) ratios did not differ between groups.


These data will contribute to the development of guidelines for assessing shoulder-muscle strength in Master’s swimmers.

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Hamstring Activation During Lower Body Resistance Training Exercises

William P. Ebben


The purpose of this study was to evaluate differences in hamstring activation during lower body resistance training exercises. This study also sought to assess differences in hamstring-to-quadriceps muscle activation ratios and gender differences therein.


A randomized repeated measures design was used to compare six resistance training exercises that are commonly believed to train the hamstrings, including the squat, seated leg curl, stiff leg dead lift, single leg stiff leg dead lift, good morning, and Russian curl. Subjects included 34 college athletes. Outcome measures included the biceps femoris (H) and rectus femoris (Q) electromyography (EMG) and the H-to-Q EMG ratio, for each exercise.


Main effects were found for the H (P < 0.001) and Q (P < 0.001). Post hoc analysis identified the specific differences between exercises. In addition, main effects were found for the H-to-Q ratio when analyzed for all subjects (P < 0.001). Further analysis revealed that women achieved between 53.9 to 89.5% of the H-to-Q activation ratios of men, for the exercises assessed. In a separate analysis of strength matched women and men, women achieved between 35.9 to 76.0% of the H-to-Q ratios of men, for these exercises.


Hamstring resistance training exercises offer differing degrees of H and Q activation and ratios. Women compared with men, are less able to activate the hamstrings and/or more able to activate the quadriceps. Women may require disproportionately greater training for the hamstrings compared with the quadriceps.

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Swing Phase Mechanics of Maximal Velocity Sprints—Does Isokinetic Lower-Limb Muscle Strength Matter?

Tobias Alt, Igor Komnik, Jannik Severin, Yannick T. Nodler, Rita Benker, Axel J. Knicker, Gert-Peter Brüggemann, and Heiko K. Strüder

obtained from isokinetic concentric knee extensor (solid line) and eccentric knee flexor (dashed line) movements at 150°/s. The intersection point of both curves is called the “dynamic control ratio at the equilibrium point” (DCRe) and serves to assess the muscle balance between knee extensor and knee

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Muscle Activity Ratios of Scapular Stabilizers During Closed Kinetic Chain Exercises in Healthy Shoulders: A Systematic Review

Damla Karabay, Yusuf Emük, and Derya Özer Kaya

, restoration of the scapular muscle balance via the selective activation of the weaker muscles together with the minimal activation of the UT has been recommended for the rehabilitation of shoulder function. 4 , 6 , 7 Closed kinetic chain (CKC) exercises are exercises where the distal segment is fixed and more

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Angle-Specific Eccentric Hamstring Fatigue After Simulated Soccer

Daniel D. Cohen, Bingnan Zhao, Brian Okwera, Martyn J. Matthews, and Anne Delextrat


To evaluate the effect of simulated soccer on the hamstrings eccentric torque-angle profile and angle of peak torque (APTeccH), and on the hamstrings:quadriceps torque ratio at specific joint angles (ASHecc:Qcon).


The authors assessed dominant-limb isokinetic concentric and eccentric knee flexion and concentric knee extension at 120°/s in 9 semiprofessional male soccer players immediately before and after they completed the Loughborough Intermittent Shuttle Test (LIST).


The LIST resulted in significant decreases in eccentric hamstrings torque at 60°, 50°, and 10° and a significant (21.8%) decrease in ASHecc:Qcon at 10° (P < .05). APTeccH increased from 7.1° ± 1.0° to 18.8° ± 4.2° (P < .05). Eccentric hamstrings peak torque significantly declined from 185.1 ± 70.4 N·m pre-LIST to 150.9 ± 58.5 N·m post-LIST (P = .002), but there were no significant changes in hamstrings or quadriceps concentric peak torque (P = .312, .169, respectively).


Simulated soccer results in a selective loss of eccentric hamstrings torque and hamstrings-to-quadriceps muscle balance at an extended joint position and a shift in the eccentric hamstrings APT to a shorter length, changes that could increase vulnerability to hamstrings injury. These findings suggest that injury-risk screening could be improved by evaluating the eccentric hamstrings torque-angle profile and hamstrings strength-endurance and that the development of hamstrings fatigue resistance and long-length eccentric strength may reduce injury incidence.

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Efficacy of ReBound Diathermy as a Thermal Heating Agent: A Critically Appraised Topic

Alissa C. Rhode, Lauren M. Lavelle, and David C. Berry

clinicians to stretch the entire muscle group after 1 treatment, rather than doing 2 treatments on each half of the limb. Heating the entire body part also allows clinicians to stretch the agonist and antagonist, which can ensure muscle balance. However, more research needs to be conducted to determine if

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Muscle- and Region-Specific Associations Between Muscle Size and Muscular Strength During Hip Extension and Knee Flexion in the Hamstrings

Raki Kawama, Masamichi Okudaira, Hirohiko Maemura, and Satoru Tanigawa

: 1001 . PubMed ID: 31447693 doi:10.3389/fphys.2019.01001 10.3389/fphys.2019.01001 31447693 13. Evangelidis PE , Massey GJ , Pain MT , Folland JP . Strength and size relationships of the quadriceps and hamstrings with special reference to reciprocal muscle balance . Eur J Appl Physiol