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Illmeier G, Rechberger JS. The Limitations of Anterior Knee Displacement during Different Barbell Squat Techniques: A Comprehensive Review. J Clin Med 2023; 12:jcm12082955. [PMID: 37109294 PMCID: PMC10143703 DOI: 10.3390/jcm12082955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Based on seminal research from the 1970s and 1980s, the myth that the knees should only move as far anterior during the barbell squat until they vertically align with the tips of the feet in the sagittal plane still exists today. However, the role of both the hip joint and the lumbar spine, which are exposed to high peak torques during this deliberate restriction in range of motion, has remained largely unnoticed in the traditional literature. More recent anthropometric and biomechanical studies have found disparate results regarding anterior knee displacement during barbell squatting. For a large number of athletes, it may be favorable or even necessary to allow a certain degree of anterior knee displacement in order to achieve optimal training outcomes and minimize the biomechanical stress imparted on the lumbar spine and hip. Overall, restricting this natural movement is likely not an effective strategy for healthy trained individuals. With the exception of knee rehabilitation patients, the contemporary literature suggests it should not be practiced on a general basis.
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Affiliation(s)
- Gabriel Illmeier
- Department of Strength & Conditioning, Nachwuchsleistungssportzentrum Steiermark, 8010 Graz, Austria
| | - Julian S Rechberger
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN 55905, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
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Kaneguchi A, Ozawa J, Minamimoto K, Yamaoka K. The temporal and spatial effects of reconstructive surgery on the atrophy of hindlimb muscles in anterior cruciate ligament transected rats. Physiol Res 2023; 72:99-109. [PMID: 36545871 PMCID: PMC10069818 DOI: 10.33549/physiolres.934909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
After anterior cruciate ligament (ACL) injury, a decrease in muscle strength associated with muscle atrophy is frequently observed. The temporal and spatial effects of reconstructive surgery on muscle atrophy have not been examined in detail. This study aimed to 1) reveal the short and mid-term effects of reconstructive surgery on muscle atrophy, and 2) investigate the differences in the degree of atrophy after ACL reconstruction in the hindlimb muscles. ACL transection with or without reconstructive surgery was performed unilaterally on the knees of rats. Untreated rats were used as controls. At one or four weeks post-surgery, the relative muscle wet weights (wet weight/body weight) of the hindlimb muscles were calculated to assess atrophy. At one week post-surgery, muscle atrophy was induced by ACL transection and further aggravated by reconstructive surgery. Reconstructive surgery facilitated recovery from muscle atrophy in some muscles compared with those without reconstructive surgery (ACL transection alone) at four weeks post-surgery. Muscle atrophy after ACL reconstruction was greater in the rectus femoris and plantar flexors than in the semitendinosus and plantar extensors at one week post-surgery. These results indicate that reconstructive surgery exacerbates muscle atrophy in the first week post-surgery, while facilitating recovery between the first and fourth week post-surgery. After reconstructive surgery, muscle atrophy was observed not only in the quadriceps and hamstrings, but also in the lower leg muscles, suggesting the need for muscle strengthening interventions for the lower leg muscles as well as the quadriceps and hamstrings.
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Affiliation(s)
- A Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan.
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NAKAMURA M, KIYONO R, SATO S, SUTOH S, YAHATA K, MORISHITA S. Estimating training intensity for low-intensity resistance training using surface electromyography. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.20.04426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Liu X, Imai K, Zhou X, Watanabe E. Influence of Ankle Injury on Subsequent Ankle, Knee, and Shoulder Injuries in Competitive Badminton Players Younger Than 13 Years. Orthop J Sports Med 2022; 10:23259671221097438. [PMID: 35647208 PMCID: PMC9134446 DOI: 10.1177/23259671221097438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/02/2022] [Indexed: 12/26/2022] Open
Abstract
Background: In recent years, there has been a trend in badminton toward more specialized training at an earlier age. Accompanying this trend is the increased frequency of injuries in young players. Ankle injury is the most common injury in pediatric sports; however, its influence on subsequent injuries is rarely considered. Purposes: To evaluate the incidence of ankle, knee, and shoulder injuries in youth badminton and to investigate the influence of ankle injuries on subsequent ankle, knee, and shoulder injuries. Study Design: Descriptive epidemiology study; Level of evidence, 3. Methods: A custom-designed questionnaire was used to survey Japanese players 7 to 12 years of age who attended national elementary school–level badminton tournaments between May and September 2019. Information including the players’ characteristics, training history, injuries in the previous 12 months, and ankle injury histories were collected. Logistic regression was used for analysis. Results: A total of 478 players were included in the study, with 71 ankle injuries, 74 knee injuries, and 48 shoulder injuries reported. The injury incidence rates (per 1000 hours of play) were 0.23 (95% CI, 0.18-0.29) for the ankle, 0.24 (95% CI, 0.19-0.30) for the knee, and 0.16 (95% CI, 0.11-0.20) for the shoulder; 90.1% of ankle injuries, 25.7% of knee injuries, and 33.3% of shoulder injuries were acute. Previous ankle injury was significantly associated with subsequent ankle injury (adjusted Odds Ratio (OR), 3.05; 95% CI, 1.54-6.07; P < .05), knee injury (adjusted OR, 2.03; 95% CI, 1.12-3.69; P < .05), and shoulder injury (adjusted OR, 2.46; 95% CI, 1.26-4.83; P < .05). Conclusion: The study results indicated that previous injury to the ankle significantly increased the occurrence of subsequent ankle, knee, and shoulder injuries. Emphasizing protection and prevention of ankle injuries may help lower future injury risk in young badminton players.
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Affiliation(s)
- Xiaoxuan Liu
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kazuhiro Imai
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| | - Xiao Zhou
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| | - Eiji Watanabe
- Institute of Sport, Senshu University, Kawasaki, Kanagawa, Japan
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Chan CK, Azah HN, Yeow CH, Goh SK, Ting HN, Salmah K. Effects of Squatting Speed and Depth on Lower Extremity Kinematics, Kinetics and Energetics. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Squatting has received considerable attention in sports and is commonly utilized in daily activities. Knowledge of the squatting biomechanics in terms of its speed and depth may enhance exercise selection when targeting for sport-specific performance improvement and injury avoidance. Nonetheless, these perspectives have not been consistently reported. Hence, this preliminary study intends to quantify the kinematics, kinetics, and energetics in squat with different depths and speeds among healthy young adults with different physical activity levels; i.e., between active and sedentary groups. Twenty participants were administered to squat at varying depths (deep, normal, and half) and speeds (fast, normal, and slow). Motion-capture system and force plates were employed to acquire motion trajectories and ground reaction force. Joint moment was obtained via inverse dynamics, while power was derived as a product of moment and angular velocity. Higher speeds and deeper squats greatly influence higher joint moments and powers at the hip ([Formula: see text]) and knee ([Formula: see text]) than ankle, signifying these joints as the prime movers with knee as the predominant contributor. These preliminary findings show that the knee-strategy and hip-strategy were employed in compensating speed and depth manipulations during squatting. In certain contexts, appreciating these findings may provide clinically relevant implications, from the performance and injury avoidance viewpoint, which will ameliorate the physical activity level of practitioners.
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Affiliation(s)
- Chow-Khuen Chan
- Department of Biomedical Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Hamzaid Nur Azah
- Department of Biomedical Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chen-Hua Yeow
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Sim-Kuan Goh
- Department of Mechanical Engineering, Nanyang Technological University, Singapore
| | - Hua-Nong Ting
- Department of Biomedical Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Karman Salmah
- Department of Biomedical Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
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van Tittelboom V, Alemdaroglu-Gürbüz I, Hanssen B, Heyrman L, Feys H, Desloovere K, Calders P, Van den Broeck C. Reliability of Isokinetic Strength Assessments of Knee and Hip Using the Biodex System 4 Dynamometer and Associations With Functional Strength in Healthy Children. Front Sports Act Living 2022; 4:817216. [PMID: 35280224 PMCID: PMC8907626 DOI: 10.3389/fspor.2022.817216] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to analyze the reliability of concentric isokinetic strength assessments (knee and hip) using the Biodex System 4 in healthy children and assess the association with functional strength tests (sit-to-stand [STS], lateral-step-up [LSU]). Methods 19 children (6–12 years) were included. Knee and hip flexion and extension, and hip abduction and adduction were tested at 60 and 90°/s. Results Relative and absolute reliability at 60°/s tended to show better results compared to those at 90°/s. Intra class correlations (ICCs) of knee flexion and extension at 60°/s were good (0.79–0.89). For hip flexion, extension, abduction and adduction at 60°/s ICCs were moderate to good (0.53–0.83). The smallest detectable change (SDC) values (expressed in %) were highly variable. The SDC% for knee flexion and extension and hip abduction at 60°/s were around 50%. Positive associations were found between hip extension and abduction isokinetic strength and the STS test. Conclusion Concentric isokinetic strength assessments in healthy children using the Biodex System 4 were found reliable for knee flexion and extension and hip abduction. Limited associations were found between concentric isokinetic strength tests and functional strength tests.
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Affiliation(s)
- Vanessa van Tittelboom
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- *Correspondence: Vanessa van Tittelboom
| | | | - Britta Hanssen
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lieve Heyrman
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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Tamamoto T, Koyanagi K, Kimura Y, Koyanagi M, Inoue A, Murabayashi T, Oshima T, Tsukagoshi T, Noda K. Mechanism and Effect of Tread Swing for Lower Limbs Strength Training Device. JOURNAL OF ROBOTICS AND MECHATRONICS 2022. [DOI: 10.20965/jrm.2022.p0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to propose a tread swing mechanism for lower-limb strength training devices and to confirm its effects. In the standing position and for training the lower limbs, if the tread-surface angle is inappropriate, the posture of the knee joints gets affected, and knee adduction/valgus moments, which result in knee stress, get generated. The target training exercises are the front-back leg scissors and open-close leg triangle exercises. With regard to the swing of the tread, it is necessary to realize a pitch/yaw rotation and a roll/yaw rotation for the former and the latter exercises, respectively. As a result, knee joint stress can be reduced by moving the center of pressure (COP). The proposed mechanism has a further differential mechanism that utilizes the difference between the pulley diameters. The translational movement force of the tread is transmitted as the torque of the swing motion for the pitch, roll, and yaw through the effects of a differential mechanism. The rate of the swing angle can be changed by adjusting the pulley diameter. As a result of evaluating the effect of exercises using a manufactured device, it was confirmed that the tread performed a predetermined swing motion. It was also confirmed that the COP position changed. Therefore, it is expected that knee joint stress will reduce. Rehabilitation and strength training that result in small knee joint stresses and generate large muscle load are in great demand for people experiencing knee joint failure.
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Kim HH, Kim KH. Effects of Kinesio Taping with Squat Exercise on the Muscle Activity, Muscle Strength, Muscle Tension, and Dynamic Stability of Softball Players in the Lower Extremities: A Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:276. [PMID: 35010536 PMCID: PMC8751181 DOI: 10.3390/ijerph19010276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE Knee injuries are common among female softball players, and the stability of the lower extremities and the strength of the knee are essential factors for them. The purpose of this study was to investigate the effect of Kinesio taping with squat exercise (KTSE) on lower extremity muscle activity, muscle strength, muscle tone, and dynamic stability of softball players. METHODS In this study, 40 softball players were randomly assigned to the KTSE group and sham taping with squat exercise (SKTSE) group. All subjects were tested three times a week for 6 weeks, i.e., for a total of 18 times. To evaluate the lower-extremity muscle activity, muscle strength, and muscle tone of the lower extremities, as well as dynamic stability, we used Noraxon Mini DTS, a digital muscular meter from JTech Medical, MyotonPRO, and the side hop test (a clinical evaluation method), respectively. These items were measured before the experiment and 6 weeks after the start of the experiment. RESULTS Both groups showed significant differences in lower-extremity muscle activity, muscle strength, muscle tone, and dynamic stability (p < 0.05). After the experiment, significant effects on lower-extremity muscle activity, muscle strength, muscle tone, and dynamic stability were observed in the KTSE group compared with in the SKTSE group (p < 0.05). CONCLUSIONS KTSE did not have a negative effect on all items of the functional performance test. KTSE improved lower-extremity muscle activity, muscle strength, muscle tone, and dynamic stability.
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Affiliation(s)
- Hyeon-Hee Kim
- Department of Physical Therapy, Gimcheon University, Gimcheon-si 39528, Korea;
- Gimcheon Institute of Rehabilitation Science, Gimcheon University, Gimcheon-si 39528, Korea
| | - Kyung-Hun Kim
- Department of Physical Therapy, Gimcheon University, Gimcheon-si 39528, Korea;
- Gimcheon Institute of Rehabilitation Science, Gimcheon University, Gimcheon-si 39528, Korea
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Sung HR, Oh SJ, Ryu JN, Cha YJ. Muscle activities of lower extremity and erector spinae muscles according to ankle joint position during squat exercise. J Back Musculoskelet Rehabil 2021; 34:671-676. [PMID: 33843662 DOI: 10.3233/bmr-191807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the most effective ankle joint position for squat exercise by comparing muscle activities of lower extremity and erector spinae muscles in different ankle joint positions. METHODS Thirty-seven normal healthy adults in their 20s participated in this study. Muscle activities of dominant vastus medialis oblique, vastus lateralis, biceps femoris, and erect spinae were measured in three ankle joint positions; dorsiflexion, neutral, and plantar flexion. RESULTS Muscle activities of the vastus medialis oblique, vastus lateralis, and erector spinae muscles were statistically different in the three ankle joint positions during squat exercise (p< 0.05). Vastus medialis oblique muscles showed higher muscle activity in ankle plantar flexion than in the dorsiflexion or neutral positions (plantar flexion > neutral position, +3.3% of maximal voluntary isometric contraction (MVIC); plantar flexion > dorsiflexion, +12.2% of MVIC, respectively). Vastus lateralis muscles showed 7.1% of MVIC greater muscle activity in the neutral position than in dorsiflexion, and erector spinae muscles showed higher muscle activity in dorsiflexion than in plantar flexion or in the neutral position (dorsiflexion > neutral position, +4.3% of MVIC; dorsiflexion > plantar flexion, +7.1% of MVIC, respectively). CONCLUSION In squat exercises designed to strengthen the vastus medialis oblique, ankle joint plantar flexion is probably the most effective ankle training position, and the dorsiflexion position might be the most effective exercise for strengthening the erector spinae muscle.
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Affiliation(s)
- Ha-Rim Sung
- Department of Physical Therapy, Graduate School, Daejeon University, Dong-Gu, Daejeon, Korea
| | - Se-Jung Oh
- Department of Physical Therapy, Graduate School, Daejeon University, Dong-Gu, Daejeon, Korea
| | - Jun-Nam Ryu
- Department of Physical Therapy, Yeoju University, Yeoju City, Korea
| | - Yong-Jun Cha
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Dong-Gu, Daejeon, Korea
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Clark NC. Noncontact Knee Ligament Injury Prevention Screening in Netball: A Clinical Commentary with Clinical Practice Suggestions for Community-Level Players. Int J Sports Phys Ther 2021; 16:911-929. [PMID: 34123542 PMCID: PMC8169033 DOI: 10.26603/001c.23553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/22/2021] [Indexed: 12/20/2022] Open
Abstract
Netball is a predominantly female team court-sport which is played worldwide. Netball is becoming more popular in the United States following its countrywide introduction to schools and community centers. A unique characteristic of netball is the footwork rule which restricts players to a one-step landing after catching the ball. Most netball landings are single-leg landings resulting in high vertical ground reaction forces and high skeletal tissue forces. Thus, high-risk landing events that have the biomechanical potential for injury occur frequently. Noncontact knee ligament injuries are common following a knee abduction collapse when landing. Because the consequences of noncontact knee ligament injury are profound, strategies are needed to mitigate the burden of such injury for players, teams, and society. The purpose of this clinical commentary is to demonstrate how theoretical principles, different types of research, and different levels of evidence underpin a rational clinical reasoning process for developing noncontact knee ligament injury prevention screening procedures in netball. The theoretical principles that are discussed in this commentary include injury control, the sequence of prevention, principles of screening in injury prevention, the multifactorial model of injury etiology, complex systems theory, and systems science. The different types of research that are reviewed include descriptive and analytic-observational studies. The different levels of evidence that are discussed include prospective studies, cross-sectional studies, and clinicians' own kinesiological modelling. Subsequently, an integrated approach to the evidence-informed development of noncontact knee ligament injury prevention screening procedures is presented. Clinical practice suggestions include a selection of evidence-informed screening tests that are quickly and easily implemented with netball players in local communities. The need for repeated screening at strategic timepoints across a season/year is explained. Sports physical therapists will find this commentary useful as an example for how to undertake clinical reasoning processes that justify the content of screening procedures contributing to noncontact knee ligament injury prevention in community-level netball. LEVEL OF EVIDENCE 5.
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Arikan H, Maras G, Akaras E, Citaker S, Kafa N. Development, reliability and validity of the Closed Kinetic Chain Lower Extremity Stability Test (CKCLEST): a new clinical performance test. Res Sports Med 2021; 30:475-490. [PMID: 33759654 DOI: 10.1080/15438627.2021.1906674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to develop and determine the test-retest, intra- and interrater reliability, and validity of the Closed Kinetic Chain Lower Extremity Stability Test (CKCLEST). Three-blinded, cross-sectional, repeated-measures clinical measurement reliability trial. Fifty young adults participated in this study. To assess the reliability of CKCLEST, intraclass correlation coefficient, standard error of measurement, minimal detectable change, and Bland-Altman plot were used. For concurrent validity of CKCLEST was applied Spearman correlation analysis with Vertical Jump Test, Isokinetic Dynamometer Test, Single-Leg Hop Test, and Prone Bridge Test. All analyses were made for both the best score and the average score. CKCLEST showed excellent reliability. ICC for test-retest reliability (0.93; 0.84), intrarater reliability (rater 1: 0.90; 0.83- rater 2: 0.93; 0.85), and interrater reliability (0.90; 0.83) was calculated for average score and best score, respectively. CKCLEST was found to be moderately correlated with each of the tests. CKCLEST is a highly reliable, valid, and new clinical assessment tool.
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Affiliation(s)
- Halime Arikan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Gokhan Maras
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Esedullah Akaras
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Seyit Citaker
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Nihan Kafa
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Mullally EM, Clark NC. Noncontact Knee Soft-Tissue Injury Prevention Considerations and Practical Applications for Netball Players. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kim JS, Lee MY. The effect of short foot exercise using visual feedback on the balance and accuracy of knee joint movement in subjects with flexible flatfoot. Medicine (Baltimore) 2020; 99:e19260. [PMID: 32221061 PMCID: PMC7220527 DOI: 10.1097/md.0000000000019260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Flexible flatfoot is a condition characterized by the deformations of the foot where the calcaneus is pronated by weight support. Flat feet can affect balance and the entire chain of motion, causing indirect problems in adjacent joints. We investigated the effects of short foot exercise (SFE) using visual feedback on the static balance and function of proximal joints in subjects with flexible flat feet. METHOD AND ANALYSIS This study involved 30 participants who were assigned to either of the 2 groups: the flexible flatfoot group (n = 15, 8 men and 7 women, aged 22.00 ± 2.07 years) and normal foot group (n = 15, 7 men and 8 women, aged 22.13 ± 1.55 years). All subjects performed the SFE with visual feedback. SFE programs were performed 20 minutes a day, 5 times a week, for a total of 5 weeks. The static balance and accuracy of knee joint motions were compared before and after training. RESULTS There was a significant difference in static balance pre- and post-exercise in the flatfoot group but not in the normal foot group. Moreover, in the flatfoot group, the accuracy of knee joint motions was significantly different between pre- and post-exercise in the closed chain but not in the open chain. CONCLUSION This study examined the influence of SFE using visual feedback on the balance and accuracy of knee joint movements in subjects with flatfoot and demonstrated that this exercise, using visual feedback, improved the balance and accuracy of knee movement.
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Affiliation(s)
- Ju Sang Kim
- Department of Physical Therapy and Rehabilitation, Yeungnam University Hospital, Daegu
| | - Mi Young Lee
- Department of Physical Therapy, College of Biomedical Science, Daegu Haany University, Gyeongsansi, Republic of Korea
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Bishop EL, Kuntze G, Ronsky JL. Characterizing healthy knee symmetry using the finite helical axis and muscle power during open and closed chain tasks. J Biomech 2020; 99:109580. [PMID: 31898978 DOI: 10.1016/j.jbiomech.2019.109580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 11/16/2022]
Abstract
Understanding healthy joint movement and muscle control, and injurious alterations, is important to determine musculoskeletal contributions to post-injury joint instabilities or altered dynamic joint function. The contralateral limb is often used as a point of reference to determine the effects of knee joint injury. However, it is currently difficult to interpret within subject variability between limbs as this is not well established in the healthy population. There is a continuing need to characterize healthy knee joint mechanics and neuromuscular control to determine the degree of symmetry within healthy individuals. The current study quantified limb symmetry in healthy individuals using the finite helical axis with a unique reference position (rFHA) and electromyography (EMG) approaches, for a closed-chain single leg squat (SLS) and an open-chain seated leg swing. Muscle power and FHA translation, orientation and dispersion were similar between limbs. However, the FHA was located significantly more anterior in the dominant limb relative to the contralateral during both tasks. These between-limb differences in FHA location could be attributed to differences in joint geometry and strength between limbs. This finding provides evidence that healthy knees have asymmetries which have implications for selection of control limbs in studies comparing conditions within and between individuals. Differences identified in dynamic joint function between tasks suggest that the SLS is useful for revealing joint asymmetries due to altered muscular control strategies, while the swing task is expected to highlight asymmetries in joint motion due to altered knee structures following injury.
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Affiliation(s)
- Emily L Bishop
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada.
| | - Gregor Kuntze
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Janet L Ronsky
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Tsukada Y, Matsuse H, Shinozaki N, Takano Y, Nago T, Shiba N. Combined Application of Electrically Stimulated Antagonist Muscle Contraction and Volitional Muscle Contraction Prevents Muscle Strength Weakness and Promotes Physical Function Recovery After Total Knee Arthroplasty: A Randomized Controlled Trial. Kurume Med J 2020; 65:145-154. [PMID: 31723080 DOI: 10.2739/kurumemedj.ms654007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Osteoarthritis of the knee (KOA) is the most common cause of disability in both the United States and in Japan. The Hybrid training system (HTS) has been developed as a resistance exercise method combining electrical stimulation with voluntary exercise. The purpose of the present study is to compare the effects of a conventional rehabilitation program with or without HTS on knee muscle strength and physical function after Total knee arthroplasty (TKA). METHODS We conducted a 12-week randomized controlled trial, using standard rehabilitation (the control group, n = 27) or standard rehabilitation plus HTS (the HTS group, n= 26), in 53 female patients after TKA. The HTS group underwent HTS three times per week for twelve weeks after TKA. Muscle strength, thigh circumference, physical functional testing, QOL and knee pain were assessed before surgery, 6 and 12 weeks after TKA. RESULTS There was a significant decrease in quadriceps strength and thigh circumference on the operative side in the control group, but not in the HTS group at 6 weeks. Hamstring strength on the operative side in the HTS group significantly increased and thigh circumference was bigger than in the control group at 12 weeks. Physical function improved at 6 weeks in the HTS group, but not in the control group. Knee pain significantly improved in both groups at 6 weeks. CONCLUSIONS HTS was effective in preventing quadriceps weakness and in improving physical function and QOL after TKA.
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Affiliation(s)
- Yuya Tsukada
- Division of Rehabilitation, Kurume University Hospital
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital
| | | | - Yoshio Takano
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University Health and Welfare
| | - Takeshi Nago
- Division of Rehabilitation, Kurume University Hospital
| | - Naoto Shiba
- Division of Rehabilitation, Kurume University Hospital
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Glassbrook DJ, Helms ER, Brown SR, Storey AG. A Review of the Biomechanical Differences Between the High-Bar and Low-Bar Back-Squat. J Strength Cond Res 2018; 31:2618-2634. [PMID: 28570490 DOI: 10.1519/jsc.0000000000002007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Glassbrook, DJ, Helms, ER, Brown, SR, and Storey, AG. A review of the biomechanical differences between the high-bar and low-bar back-squat. J Strength Cond Res 31(9): 2618-2634, 2017-The back-squat is a common exercise in strength and conditioning for a variety of sports. It is widely regarded as a fundamental movement to increase and measure lower-body and trunk function, as well as an effective injury rehabilitation exercise. There are typically 2 different bar positions used when performing the back-squat: the traditional "high-bar" back-squat (HBBS) and the "low-bar" back-squat (LBBS). Different movement strategies are used to ensure that the center of mass remains in the base of support for balance during the execution of these lifts. These movement strategies manifest as differences in (a) joint angles, (b) vertical ground reaction forces, and (c) the activity of key muscles. This review showed that the HBBS is characterized by greater knee flexion, lesser hip flexion, a more upright torso, and a deeper squat. The LBBS is characterized by greater hip flexion and, therefore, a greater forward lean. However, there are limited differences in vertical ground reaction forces between the HBBS and LBBS. The LBBS can also be characterized by a greater muscle activity of the erector spinae, adductors, and gluteal muscles, whereas the HBBS can be characterized by greater quadriceps muscle activity. Practitioners seeking to develop the posterior-chain hip musculature (i.e., gluteal, hamstring, and erector muscle groups) may seek to use the LBBS. In comparison, those seeking to replicate movements with a more upright torso and contribution from the quadriceps may rather seek to use the HBBS in training.
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Affiliation(s)
- Daniel J Glassbrook
- 1Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand; and 2High Performance Sport New Zealand (HPSNZ), Auckland, New Zealand
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17
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Iacono AD, Buksbaum C, Padulo J, Hetsroni I, Ben-Sira D, Ayalon M. Isokinetic moment curve abnormalities are associated with articular knee lesions. Biol Sport 2018; 35:83-91. [PMID: 30237665 PMCID: PMC6135969 DOI: 10.5114/biolsport.2018.71486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/27/2017] [Accepted: 06/16/2017] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to test whether lesions of the medial meniscus (MM) and of the anterior cruciate ligament (ACL) are associated with specific abnormalities of isokinetic moment curves (IMCs). Fifty-four young adults (20 active healthy people, and 34 patients with unilateral knee injuries) were assessed through knee extensor and flexor isokinetic tests at 60°/s. Qualitative IMC analysis was performed using a novel classification system which identified three distinct abnormal shapes. The chi-squared (χ2) test was used to determine the inter-individual and intra-individual differences between the groups. Quantitative IMC inter-group comparisons were performed by a one-way analysis of variance (ANOVA). Knees with MM and ACL lesions were consistently associated with IMC shape irregularities (p<0.001) and with abnormal quantitative scores (p<0.001). More specifically, knees with isolated ACL lesions and knees with combined ACL and MM lesions presented similar distribution of knee extensor and flexor IMC irregularities, which was not present in knees with isolated MM lesions. A possible association between specific knee pathologies and IMC irregularities was identified (all p<0.05). In conclusion, different knee pathologies may be associated with different qualitative IMCs, which could be used as an additional presentation tool in clinical settings.
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Affiliation(s)
- Antonio Dello Iacono
- Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
| | - Chen Buksbaum
- Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
| | - Johnny Padulo
- University eCampus, Novedrate, Italy
- University of Split, Faculty of Kinesiology, Split, Croatia
| | - Iftach Hetsroni
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Ben-Sira
- Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
| | - Moshe Ayalon
- Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
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18
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Han D, Nam S, Song J, Lee W, Kang T. The effect of knee flexion angles and ground conditions on the muscle activation of the lower extremity in the squat position. J Phys Ther Sci 2017; 29:1852-1855. [PMID: 29184305 PMCID: PMC5684026 DOI: 10.1589/jpts.29.1852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/22/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study is to research the most effective knee flexion angle and ground condition in the squat position. [Subjects and Methods] The subjects of this study were 15 female college students who were able to perform squat movements and who had never previously experienced surgery, orthopedic disease, or musculoskeletal impairment. This study was conducted to examine changes of muscle activation of low-extremity muscles at different knee flexion angles of 70°, 90°, and 100°. Balance Pad (Aero Step, TOGU, Germany) was used as unstable ground. Surface electromyogram (4D-MT & EMD-11, Relive, Korea) was used for measuring muscle activation. Measured muscles were vastus medialis, biceps femoris, tibialis anterior, and gastrocnemius. Muscle activation was determined by the root mean square (RMS). [Results] There was a difference in muscle activation of the vastus medialis and tibialis anterior according to the change of the knee flexion angle with the stable ground. However, there was no difference in muscle activation of the lower extremity muscles according to the change of the knee flexion angle with the unstable ground. [Conclusion] These results suggest that changes in the angle of the knee flexion with the stable ground affect the muscle activation of the vastus medialis and tibialis anterior. It was found that as the joint angle increases, muscle activation also increases. However, ground condition does not affect muscle activation.
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Affiliation(s)
- Dongwook Han
- Department of Physical Therapy, College of Health and Welfare, Silla University: 700 beon-gil, 140 Baegyang-daero, Sasang-gu, Busan 46958, Republic of Korea
| | - Subin Nam
- Department of Physical Therapy, College of Health and Welfare, Silla University: 700 beon-gil, 140 Baegyang-daero, Sasang-gu, Busan 46958, Republic of Korea
| | - Jihun Song
- Department of Physical Therapy, College of Health and Welfare, Silla University: 700 beon-gil, 140 Baegyang-daero, Sasang-gu, Busan 46958, Republic of Korea
| | - Wongeun Lee
- Department of Physical Therapy, College of Health and Welfare, Silla University: 700 beon-gil, 140 Baegyang-daero, Sasang-gu, Busan 46958, Republic of Korea
| | - Taewook Kang
- Department of Physical Therapy, College of Health and Welfare, Silla University: 700 beon-gil, 140 Baegyang-daero, Sasang-gu, Busan 46958, Republic of Korea
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Schellenberg F, Taylor WR, Lorenzetti S. Towards evidence based strength training: a comparison of muscle forces during deadlifts, goodmornings and split squats. BMC Sports Sci Med Rehabil 2017; 9:13. [PMID: 28725437 PMCID: PMC5513080 DOI: 10.1186/s13102-017-0077-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/06/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND To ensure an efficient and targeted adaptation with low injury risk during strength exercises, knowledge of the participant specific internal loading conditions is essential. The goal of this study was to calculate the lower limb muscles forces during the strength exercises deadlifts, goodmornings and splits squats by means of musculoskeletal simulation. METHODS 11 participants were assessed performing 10 different variations of split squats by varying the step length as well as the maximal frontal tibia angle, and 13 participants were measured performing deadlift and goodmorning exercises. Using individualised musculoskeletal models, forces of the Quadriceps (four parts), Hamstrings (four parts) and m. gluteus maximus (three parts) were computed. RESULTS Deadlifts resulted highest loading for the Quadriceps, especially for the vasti (18-34 N/kg), but not for the rectus femoris (8-10 N/kg), which exhibited its greatest loading during split squats (13-27 N/kg) in the rear limb. Hamstrings were loaded isometrically during goodmornings but dynamically during deadlifts. For the m. gluteus maximus, the highest loading was observed during split squats in the front limb (up to 25 N/kg), while deadlifts produced increasingly, large loading over large ranges of motion in hip and knee. CONCLUSIONS Acting muscle forces vary between exercises, execution form and joint angle. For all examined muscles, deadlifts produced considerable loading over large ranges of motion, while split squats seem to be highly dependent upon exercise variation. This study provides key information to design strength-training programs with respect to loading conditions and ranges of motion of lower extremity muscles.
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Affiliation(s)
- Florian Schellenberg
- Institute for Biomechanics, HCP H 16.3, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland
| | - William R Taylor
- Institute for Biomechanics, HCP H 16.3, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland
| | - Silvio Lorenzetti
- Institute for Biomechanics, HCP H 16.3, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland
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20
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Lee TS, Song MY, Kwon YJ. Activation of back and lower limb muscles during squat exercises with different trunk flexion. J Phys Ther Sci 2017; 28:3407-3410. [PMID: 28174462 PMCID: PMC5276771 DOI: 10.1589/jpts.28.3407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/20/2016] [Indexed: 12/15/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the activation of back and lower
limb muscles in subjects who were performing a squat exercise at different angles of trunk
flexion. [Subjects and Methods] Twenty healthy subjects (age 21.1± 1.8 years, height 168.7
± 8.2 cm, weight 66.1 ± 12.3 kg) volunteered. The activation of the erector spinae muscle,
rectus femoris muscle, gluteus maximus muscle and biceps femoris muscle was observed while
the subjects performed squat exercises with a trunk flexion of 0°, 15°, and 30°. [Results]
The erector spinae muscle, gluteus maximus muscle, and biceps femoris muscle were
activated more during the squat exercise with the trunk flexion at 30° than the exercise
with the trunk flexion at 0°. The rectus femoris muscle showed a tendency to decrease as
the truck flexion increased. [Conclusion] Squat exercise be executed while maintaining an
erect trunk posture if one wishes to strengthen the quadriceps muscle while reducing the
load on the lower back.
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Affiliation(s)
- Tae-Sik Lee
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Min-Young Song
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Yu-Jeong Kwon
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
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21
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Musculoskeletal modeling of human lower limb during normal walking, one-legged forward hopping and side jumping: Comparison of measured EMG and predicted muscle activity patterns. J Biomech 2016; 49:3660-3666. [DOI: 10.1016/j.jbiomech.2016.09.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/22/2016] [Accepted: 09/30/2016] [Indexed: 11/23/2022]
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22
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Kim K, Cha YJ, Fell DW. Differential effects of ankle position on isokinetic knee extensor and flexor strength gains during strength training. ISOKINET EXERC SCI 2016. [DOI: 10.3233/ies-160617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Kyeongbuk, Korea
| | - Yong-Jun Cha
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Korea
| | - Dennis W. Fell
- Department of Physical Therapy, University of South Alabama, Mobile, AL, USA
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23
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Bazyler CD, Abbott HA, Bellon CR, Taber CB, Stone MH. Strength Training for Endurance Athletes. Strength Cond J 2015. [DOI: 10.1519/ssc.0000000000000131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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24
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Werner S. Anterior knee pain: an update of physical therapy. Knee Surg Sports Traumatol Arthrosc 2014; 22:2286-94. [PMID: 24997734 DOI: 10.1007/s00167-014-3150-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/19/2014] [Indexed: 02/07/2023]
Abstract
Anterior knee pain is one of the most common knee problems in physically active individuals. The reason for anterior knee pain has been suggested to be multifactorial with patella abnormalities or extensor mechanism disorder leading to patellar malalignment during flexion and extension of the knee joint. Some patients complain mostly of non-specific knee pain, while others report patellar instability problems. The patients present with a variety of symptoms and clinical findings, meaning that a thorough clinical examination is the key for optimal treatment. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. However, irrespective of whether pain or instability is the major problem, hypotrophy and reduced activity of the vastus medialis are often found, which result in an imbalance between vastus medialis and vastus lateralis. This imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease loading of the patello-femoral joint. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least 3 months before considering other treatment options.
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Affiliation(s)
- Suzanne Werner
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,
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25
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Cha YJ. Isokinetic training effect of ankle positions on knee extensor strength. J Phys Ther Sci 2014; 26:1465-7. [PMID: 25276037 PMCID: PMC4175258 DOI: 10.1589/jpts.26.1465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/31/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine which ankle position most influences
knee extensor strength in training programs for strengthening the knee extensors using
three different active ankle positions. [Subjects] Twenty-one healthy adults (6 males and
15 females) participated in this study. [Methods] Subjects were trained isokinetically in
knee extension and flexion at 70 or 80% of 1RM under three actively and naturally fixed,
contracted ankle conditions: dorsiflexion, plantarflexion, and resting position. After
each group successfully executed the training four times a week for three weeks, mean peak
torque (PT) and total work (TW) variables were measured and compared at 60°/sec and
180°/sec among the three groups. [Results] Significant differences were revealed in knee
extensor TW at 60°/sec, PT and TW at 180°/sec, with the greatest PT and TW observed with
the ankle in active dorsiflexion position. [Conclusion] These results suggest that active
ankle dorsiflexion in a knee strength training program may be more effective at increasing
knee extensor strength than a resting or plantarflexion position.
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Affiliation(s)
- Yong-Jun Cha
- Department of Physical Therapy, College of Natural Science, Daejeon University, Republic of Korea
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26
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Son SM, Park MK, Lee NK. Influence of Resistance Exercise Training to Strengthen Muscles across Multiple Joints of the Lower Limbs on Dynamic Balance Functions of Stroke Patients. J Phys Ther Sci 2014; 26:1267-9. [PMID: 25202193 PMCID: PMC4155232 DOI: 10.1589/jpts.26.1267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/20/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of this study was to evaluate the effects of resistance exercise
training for strengthening muscles across multiple joints on the dynamic balance function
of stroke patients. [Subjects and Methods] Subjects in the training group (n=14) and the
control group (n=14) received conservative physical therapy for 30 minutes per day, five
days per week, for a period of six weeks. The training group additionally performed three
sets (eight to 10 repetitions per set) of resistance exercise at 70% of the 1-repetition
maximum (1RM) to strengthen muscles across multiple joints. The control group did the same
exercises for the same duration but without resistance. To assess dynamic balance
function, before and after the intervention, we measured antero-posterior (A-P) and
medio-lateral (M-L) sway distances, the Berg balance scale (BBS), and the timed up and go
(TUG) times. [Results] Compared to pre-intervention values, the BBS score showed
significant increases in both groups, and A-P and M-L sway distances and TUG times showed
significant decreases in both groups. Changes in A-P and M-L sway distances, BBS scores,
and TUG times were significantly different between the muscle training group and the
control group. [Conclusion] Training involving muscle strength across multiple joints is
an effective intervention for improvement of dynamic balance function of stroke
patients.
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Affiliation(s)
- Sung Min Son
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Myung Kyu Park
- School of Mechanical and Automotive Engineering Technology, Yeungnam University College, Republic of Korea
| | - Na Kyung Lee
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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27
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Cotter JA, Chaudhari AM, Jamison ST, Devor ST. Knee joint kinetics in relation to commonly prescribed squat loads and depths. J Strength Cond Res 2014; 27:1765-74. [PMID: 23085977 DOI: 10.1519/jsc.0b013e3182773319] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Controversy exists regarding the safety and performance benefits of performing the squat exercise to depths beyond 90° of knee flexion. Our aim was to compare the net peak external knee flexion moments (pEKFM) experienced over typical ranges of squat loads and depths. Sixteen recreationally trained men (n = 16; age, 22.7 ± 1.1 years; body mass, 85.4 ± 2.1 kg; height, 177.6 ± 0.96 cm; mean ± SEM) with no previous lower-limb surgeries or other orthopedic issues and at least 1 year of consistent resistance training experience while using the squat exercise performed single-repetition squat trials in a random order at squat depths of above parallel, parallel, and below parallel. Less than 1 week before testing, 1RM values were found for each squat depth. Subsequent testing required the subjects to perform squats at the 3 depths with 3 different loads: unloaded, 50% 1RM, and 85% 1RM (9 total trials). Force platform and kinematic data were collected to calculate pEKFM. To assess the differences among loads and depths, a 2-factor (load and depth) repeated measures analysis of variance with significance set at the p < 0.05 level was used. Squat 1RM significantly decreased 13.6% from the above-parallel to the parallel squat and another 3.6% from the parallel to the below-parallel squat (p < 0.05). Net peak external knee flexion moments significantly increased as both squat depth and load were increased (p ≤ 0.02). Slopes of pEKFM were greater from unloaded to 50% 1RM than when progressing from 50% to 85% 1RM (p < 0.001). The results suggest that typical decreases in squat loads used with increasing depths are not enough to offset increases in pEKFM.
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Affiliation(s)
- Joshua A Cotter
- Department of Orthopedics, University of California, Irvine, California, USA.
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28
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Roos PE, Button K, van Deursen RWM. Motor control strategies during double leg squat following anterior cruciate ligament rupture and reconstruction: an observational study. J Neuroeng Rehabil 2014; 11:19. [PMID: 24581172 PMCID: PMC3941570 DOI: 10.1186/1743-0003-11-19] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 02/20/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injured individuals often show asymmetries between the injured and non-injured leg. A better understanding of the underlying motor control could help to improve rehabilitation. Double leg squat exercises allow for compensation strategies. This study therefore investigated motor control strategies during a double leg squat with the aim to investigate if individuals with ACL rupture (ACLD), ACL reconstruction (ACLR) and healthy control subjects (CONT) used different strategies. METHODS 20 ACLD and 21 ACLR were compared to 21 CONT subjects. Participants performed eight continuous double leg squats to their maximum depth, while kinematic and kinetic data were collected. Outcome measures were calculated to quantify the behavior of the injured and non-injured legs and the asymmetry between these legs. RESULTS Squat depth was significantly reduced in ACLR and ACLD compared to CONT (p < 0.05; 106 ± 17°; 105 ± 21°; 113 ± 21°). Peak knee extensor moments (Mkn(mx)) were significantly reduced in ACLR and ACLD compared to CONT in the injured leg only (p < 0.05; 0.045 ± 0.015; 0.046 ± 0.016; 0.059 ± 0.022 body weight.height respectively). There was no significant correlation between symmetry of the support moment (SYM(Msup)) and of the % support moment by the knee (SYM%supkn) in CONT (R(2) = -0.07). Data distribution average indicated good symmetry. ACLR showed a significant correlation between SYM(Msup) and SYM%sup(kn) (R(2) = 0.561) when two participants who did not recover as well were excluded. ACLR controlled knee moment magnitude using two strategies; 1) transfer of support moment to non-injured leg; 2) transfer of support moment from knee to ankle and/or hip of injured leg. These were combined in different proportions, but with the same effect on the knee moment. ACLD showed no significant correlation between SYM(Msup) and SYM%sup(kn) (R(2) = 0.015). Data distribution average indicated reduced symmetry. ACLD therefore used an avoidance strategy: reducing squat depth and subsequently the support moment in the injured leg and the knee contribution. CONCLUSIONS ACLD and ACLR individuals used different squatting strategies compared to controls, with ACLR using controlled and ACLD using avoidance behavior regarding knee loading. This has major implications for rehabilitation as these kinetic strategies cannot be observed, but result in the injured leg not being exercised as intended.
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Affiliation(s)
- Paulien E Roos
- School of Healthcare Sciences, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
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29
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Schellenberg F, Lindorfer J, List R, Taylor WR, Lorenzetti S. Kinetic and kinematic differences between deadlifts and goodmornings. Sports Med Arthrosc Rehabil Ther Technol 2013; 5:27. [PMID: 24314057 PMCID: PMC3878967 DOI: 10.1186/2052-1847-5-27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/26/2013] [Indexed: 11/10/2022]
Abstract
Background In order to improve training performance, as well as avoid overloading during prevention and rehabilitation exercises in patients, the aim of this study was to understand the biomechanical differences in the knee, hip and the back between the exercises “Goodmornings” (GMs) and “Deadlifts” (DLs). Methods The kinetics and kinematics of 13 subjects, performing GMs and DLs with an additional 25% (GMs), 25% and 50% (DLs) body weight (BW) on the barbell were analysed. Using the kinetic and kinematic data captured using a 3D motion analysis and force plates, an inverse approach with a quasi-static solution was used to calculate the sagittal moments and angles in the knee, hip and the trunk. The maximum moments and joint angles were statistically tested using ANOVA with a Bonferroni adjustment. Results The observed maximal flexion angle of the knee was 5.3 ± 6.7° for GMs and 107.8 ± 22.4° and 103.4 ± 22.6° for DLs with 25% and 50% BW respectively. Of the hip, the maximal flexion angle was 25% smaller during GMs compared to DLs. No difference in kinematics of the trunk between the two exercises was observed. For DLs, the resulting sagittal moment in the knee was an external flexion moment, whereas during GMs an external extension moment was present. Importantly, no larger sagittal knee joint moments were observed when using a heavier weight on the barbell during DLs, but higher sagittal moments were found at the hip and L4/L5. Compared to GMs, DLs produced a lower sagittal moment at the hip using 25% BW while generating the same sagittal moment at L4/L5. Conclusions The two exercises exhibited different motion patterns for the lower extremities but not for the trunk. To strengthen the hip while including a large range of motion, DLs using 50% BW should be chosen. Due to their ability to avoid knee flexion or a knee flexion moment, GMs should be preferentially chosen over DLs as ACL rupture prevention exercises. Here, in order to shift the hamstring to quadriceps ratio towards the hamstrings, GMs should be favoured ahead of DLs using 50% BW before DLs using 25% BW.
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Affiliation(s)
| | | | | | | | - Silvio Lorenzetti
- Institute for Biomechanics, ETH Zurich, HCI E 351, Wolfgang-Pauli-Strasse 10, 8093 Zürich, Switzerland.
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Lee NK, Son SM, Nam SH, Kwon JW, Kang KW, Kim K. Effects of progressive resistance training integrated with foot and ankle compression on spatiotemporal gait parameters of individuals with stroke. J Phys Ther Sci 2013; 25:1235-7. [PMID: 24259765 PMCID: PMC3820171 DOI: 10.1589/jpts.25.1235] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/15/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effect of progressive resistance training (PRT) integrated with foot and ankle compression on the gait ability of post-stroke patients. [Subjects and Methods] Participants were randomly allocated to two groups: the PRT group (n=14) and the control group (n=14). Subjects in the PRT group received training for 30 minutes, five days per week, for a period of six weeks. Gait ability was evaluated using the RsScan system. [Results] Use of PRT integrated with foot and ankle compression resulted in significant improvements in temporal parameters (gait velocity, step time, and double limb support) and spatial parameters (step length, stride length, and heel-to- heel base of support). [Conclusion] Progressive resistance training integrated with foot and ankle compression improved the gait ability of stroke patients. These results suggest the feasibility and suitability of integration of PRT with foot and ankle compression for individuals with stroke.
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Affiliation(s)
- Na Kyung Lee
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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Rehabilitation after ACL injury: a fluoroscopic study on the effects of type of exercise on the knee sagittal plane arthrokinematics. BIOMED RESEARCH INTERNATIONAL 2013; 2013:248525. [PMID: 24066288 PMCID: PMC3770016 DOI: 10.1155/2013/248525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 12/28/2022]
Abstract
A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (P < 0.05). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (P = 0.002) and 15° (P = 0.012). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise.
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Smith AJ, Flaxman TE, Speirs AD, Benoit DL. Reliability of knee joint muscle activity during weight bearing force control. J Electromyogr Kinesiol 2012; 22:914-22. [DOI: 10.1016/j.jelekin.2012.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 03/19/2012] [Accepted: 03/26/2012] [Indexed: 01/12/2023] Open
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Manske RC, Prohaska D, Lucas B. Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives : Critical reviews in rehabilitation medicine. Curr Rev Musculoskelet Med 2012; 5:59-71. [PMID: 22249750 DOI: 10.1007/s12178-011-9109-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Injuries to the anterior cruciate ligament are common. Surgical reconstruction is more prevalent than ever. This review article discusses treatment of the patient following surgical reconstruction of the anterior cruciate ligament. Various phases of rehabilitation are discussed with emphasis on early return of passive motion, early weight bearing, bracing, kinetic chain exercises, neuromuscular electrical stimulation and accelerated rehabilitation. Although evidence exists for the treatment of the surgically reconstructed cruciate ligament, more is needed to better define specific timeframes for advancement. Evidence exists that many of these young individuals are not fully returning to unlimited high level activities. This review article presents some of the latest evidence regarding anterior cruciate ligament rehabilitation in an attempt to help the busy clinician understand and relate basic and clinical research to rehabilitation of a patient following reconstruction.
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Affiliation(s)
- Robert C Manske
- Department of Physical Therapy, Wichita State University, 1845 North Fairmount, Wichita, KS, USA,
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de Paula Leite Cury R, Kiyomoto HD, Rosal GF, Bryk FF, de Oliveira VM, de Camargo OPA. REHABILITATION PROTOCOL AFTER ISOLATED POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. Rev Bras Ortop 2012; 47:421-7. [PMID: 27047844 PMCID: PMC4799460 DOI: 10.1016/s2255-4971(15)30122-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 10/04/2011] [Indexed: 11/29/2022] Open
Abstract
To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject.
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Affiliation(s)
- Ricardo de Paula Leite Cury
- Instructing Professor and Head of the Knee Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil
| | - Henry Dan Kiyomoto
- Professor in the Physiotherapy Course, São Camilo University Center and São Judas Tadeu University; Researcher in the Biomechanics Laboratory, São Judas Tadeu University, São Paulo, SP, Brazil
| | - Gustavo Fogolin Rosal
- Researcher in the Biomechanics Laboratory, São Judas Tadeu University, São Paulo, SP, Brazil
| | - Flávio Fernandes Bryk
- Professor in the Musculoskeletal Physiotherapy Specialization Course and Physiotherapist in the Knee and Sports Traumatology Groups, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Victor Marques de Oliveira
- Instructing Professor in the Knee Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil
| | - Osmar Pedro Arbix de Camargo
- Adjunct Professor in the Knee Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil
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Karandikar N, Vargas OOO. Kinetic chains: a review of the concept and its clinical applications. PM R 2012; 3:739-45. [PMID: 21871418 DOI: 10.1016/j.pmrj.2011.02.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/03/2011] [Accepted: 02/19/2011] [Indexed: 01/29/2023]
Abstract
During the past decade, our understanding of biomechanics and its importance in rehabilitation has advanced significantly. The kinetic chain, a concept borrowed from engineering, has helped us better understand the underlying physiology of human movement. This understanding, in turn, has facilitated the development of new and more rational rehabilitation strategies. The kinetic chain concept has application in a wide spectrum of clinical conditions, including musculoskeletal medicine, sports medicine, and neurorehabilitation, as well as prosthetics and orthotics. The purpose of this review is to provide insights into the biomechanics related to the concept of kinetic chains, with a specific focus on closed kinetic chains and its clinical applications in rehabilitation.
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Affiliation(s)
- Ninad Karandikar
- Department of PM&R, University of Kentucky, 2050 Versailles Blvd, Lexington, KY 40504, USA.
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Latella C, Kidgell DJ, Pearce AJ. Reduction in corticospinal inhibition in the trained and untrained limb following unilateral leg strength training. Eur J Appl Physiol 2011; 112:3097-107. [DOI: 10.1007/s00421-011-2289-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 12/13/2011] [Indexed: 10/14/2022]
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Kozánek M, Hosseini A, Van de Velde SK, Moussa ME, Gill TJ, Li G. Kinematic evaluation of the step-up exercise in anterior cruciate ligament deficiency. Clin Biomech (Bristol, Avon) 2011; 26:950-4. [PMID: 21652128 PMCID: PMC3189507 DOI: 10.1016/j.clinbiomech.2011.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Step-up exercise is one of the most commonly utilized exercises during rehabilitation of patients after both anterior cruciate ligament (ACL) injury and reconstruction. Currently, insurance providers increasingly required a trial of intensified rehabilitation before surgical reconstruction is attempted. The purpose of this study was to investigate whether this "safe" rehabilitation exercise in the setting of ACL deficiency can cause altered knee kinematics. METHODS Thirty patients with unilateral ACL rupture were recruited for this study. The mean time from injury was 3.3 months. Tibiofemoral kinematics were determined during a step-up exercise using a combination of magnetic resonance imaging (MRI), dual fluoroscopy and advanced computer modeling. FINDINGS The ACL-injured knee displayed an average 5° greater external tibial rotation than the uninjured knee (P<0.05), during the last 30% of step-up. The ACL-injured knee also demonstrated on average 2.5 mm greater anterior tibial shift during the last 40% of stance phase (P<0.01). In addition, during the last 30% of stance the tibia of the ACL-deficient knee tended to shift more medially (~1 mm) as the knee approached full extension (P<0.01). INTERPRETATION The data confirmed the initial hypothesis as it was found that ACL deficient knees demonstrated significantly increased anterior tibial translation, medial tibial translation and external tibial rotation toward the end of the step-up as the knee approached full extension. Intensive rehabilitation utilizing the step-up exercise in the setting of ACL deficiency can potentially introduce repetitive microtrauma by way of altered kinematics.
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Affiliation(s)
- Michal Kozánek
- Bioengineering Laboratory, Massachusetts General Hospital, GRJ 1215, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
- Harvard Comnbined Orthopaedic Residency Program, Massachusetts General Hospital, WHT 535, 55 Fruit St, Boston, MA 02114, USA
- I. Department of Orthopaedics and Traumatology, Comenius University Faculty of Medicine, Faculty Hospital Ružinov, Ružinovská 4810/6, Bratislava 82101, Slovakia
| | - Ali Hosseini
- Bioengineering Laboratory, Massachusetts General Hospital, GRJ 1215, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Samuel K. Van de Velde
- Bioengineering Laboratory, Massachusetts General Hospital, GRJ 1215, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Mohamed E. Moussa
- Bioengineering Laboratory, Massachusetts General Hospital, GRJ 1215, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
- Harvard Comnbined Orthopaedic Residency Program, Massachusetts General Hospital, WHT 535, 55 Fruit St, Boston, MA 02114, USA
| | - Thomas J. Gill
- Bioengineering Laboratory, Massachusetts General Hospital, GRJ 1215, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
- Harvard Comnbined Orthopaedic Residency Program, Massachusetts General Hospital, WHT 535, 55 Fruit St, Boston, MA 02114, USA
| | - Guoan Li
- Bioengineering Laboratory, Massachusetts General Hospital, GRJ 1215, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
- Harvard Comnbined Orthopaedic Residency Program, Massachusetts General Hospital, WHT 535, 55 Fruit St, Boston, MA 02114, USA
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Moser ADDL, Malucelli MF, Bueno SN. Cadeia cinética aberta e fechada: uma reflexão crítica. FISIOTERAPIA EM MOVIMENTO 2010. [DOI: 10.1590/s0103-51502010000400014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Desde 1973, quando Steidler procedeu à transposição dos princípios de cadeia cinética aberta e fechada da mecânica para a reabilitação, muitos estudos têm sido feitos sobre as consequências dos exercícios envolvendo tais cadeias, mas pouco tem se estudado sobre a validade de tal definição, seus benefícios e riscos. A comunidade da reabilitação associou a definição de CCA e CCF a alguns exemplos clássicos de exercícios, sem questionar se os componentes envolvidos na definição eram suficientes para estabelecer este conceito. MÉTODO: As autoras realizaram uma revisão bibliográfica que incluiu artigos com o conceito de cadeia cinética aberta e fechada e livros de cinesiologia, mecânica e dinâmica, buscando aproximações e divergências na definição e nos conceitos. RESULTADOS: Na mecânica as cadeias abordadas são cinemáticas e não cinéticas e a transposição desses conceitos para a reabilitação foi literal, favorecendo o uso dos termos como sinônimos, mesmo existindo uma diferença entre eles: a cadeia cinemática não considera as forças causadoras do movimento ou do equilíbrio, já a cadeia cinética as considera. O termo cadeia cinética aberta não é mencionado na mecânica. CONCLUSÕES: Todos os exercícios envolvendo apenas uma articulação deveriam ser chamados exercícios isolados e o termo cadeia cinética fechada deveria ser dividido em três categorias: cadeia cinemática fechada, cadeia cinemática restrita e cadeia cinemática, concordando com o grau de liberdade de cada cadeia. Sugere-se que esses termos deveriam ser usados para descrever exercícios de múltiplas articulações, concordando com o grau de liberdade de cada exercício.
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Abstract
As anterior cruciate ligament (ACL) reconstruction has evolved to less invasive, more anatomical approaches, rehabilitation of the injured athlete has likewise become more progressive and innovative, with a sound understanding of graft and fixation strength and biologic healing-remodeling constraints. This review discusses these innovations including specific considerations before surgery, when planning rehabilitation timetables, and the importance of reestablishing nonimpaired active and passive knee range of motion and biarticular musculotendinous extensibility in positions of function. Concepts of self-efficacy or confidence and reestablishing the “athlete role” are also addressed. Since ACL injury and reinjury are largely related to the influence of structure-form-function on dynamic knee joint stability, the interrelationships between sensorimotor, neuromuscular, and conventional resistance training are also discussed. Although pivot shift “giving way” relates to function loss following ACL injury, anterior translational laxity often does not. Although there is growing evidence that progressive eccentric training may benefit the patient following ACL reconstruction, there is less evidence supporting the use of functional ACL knee braces. Of considerable importance is selecting and achieving a criteria-based progression to sports-specific training, reestablishing osseous homeostasis and improved bone density, blending open and closed kinetic chain exercises at the appropriate time period, and appreciating the influence of the trunk, upper extremities, and sports equipment use on knee loads. We believe that knee dysfunction and functional recovery should be considered from a local, regional, and global perspective. These concepts are consolidated into our approach to prepare patients for return to play including field testing and maintenance training.
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Affiliation(s)
- John Nyland
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Louisville, Louisville, KY, USA
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Postural orientation in subjects with anterior cruciate ligament injury: development and first evaluation of a new observational test battery. Knee Surg Sports Traumatol Arthrosc 2010; 18:814-23. [PMID: 19851755 DOI: 10.1007/s00167-009-0959-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
Abstract
Anterior cruciate ligament (ACL) injury is associated with mechanical instability and defective neuromuscular function, and can lead to further injury, increased joint loading and osteoarthritis. Patients with ACL injury demonstrate altered postural orientation, manifested as observable "substitution patterns" (SPs) but no one has applied a clinically useful method to systematically study postural orientation in these patients. Here, we investigated the presence of such patterns in 24 adults with ACL injury and in 49 controls, in parallel with the development and a first evaluation of a new test battery, test for SPs. The rationale behind the test for SPs was to characterize postural orientation as the ability to maintain appropriate relationships between body segments and environment during weight-bearing movements. In this first study, patients displayed SPs more frequently and/or more clearly on their injured, but also their uninjured side than did controls. Inter-rater and intra-rater reproducibility was good at a group level. Future studies of validity, responsiveness and including other subgroups of patients with ACL injury will have to prove if the test for SPs can be used in the diagnostics of defective neuromuscular function following knee injury, when planning and carrying out training and rehabilitation and when deciding appropriate time to return to activity and sports after ACL injury.
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Sekir U, Gur H, Akova B. Early versus late start of isokinetic hamstring-strengthening exercise after anterior cruciate ligament reconstruction with patellar tendon graft. Am J Sports Med 2010; 38:492-500. [PMID: 20194956 DOI: 10.1177/0363546509349490] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring strengthening after anterior cruciate ligament reconstruction is a vital component of the rehabilitation program. PURPOSE The objective of this trial was to investigate the effects of hamstring isokinetic training used in the early phase of the rehabilitation program on the stability, strength, symptoms, and functional outcomes of patients throughout 12 months after anterior cruciate ligament surgery. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 2. METHODS Forty-eight men underwent anterior cruciate ligament reconstruction with an ipsilateral bone-patellar tendon-bone autograft. The patients were randomly assigned to perform daily isokinetic hamstring exercises at postoperative 3 weeks (group I) or to perform daily isokinetic hamstring exercises at postoperative 9 weeks (group II). The patients were evaluated monthly for the first 4 months and at the 12th month for postoperative hamstring and quadriceps strength, as well as for knee function via the Cincinnati Knee Rating Scale and International Knee Documentation Committee form. RESULTS Hamstring isometric strength at 30 degrees of knee flexion (at the first and second months) and concentric isokinetic strength (at 2, 3, 4, and 12 months) at the angular velocity of 60 deg/s were significantly (P <.05-.01) greater in group I compared with group II. Average scores of the Cincinnati Knee Rating Scale for symptoms were significantly (P <.05-.001) higher in group I compared with group II at all evaluation periods. Walking and stair-climbing scores at 1, 2, 3, and 4 months and squatting score at all evaluation periods were also better (P <.05-.01) in group I compared with group II. In addition, group I exhibited better (P <.01-.001) Lachman test results compared with group II for all postoperative evaluation periods. The International Knee Documentation Committee final rating scores were significantly (P <.01) greater at 2, 3, and 4 months in group I compared with group II. CONCLUSION The results of this study suggest that hamstring as well as quadriceps strength can be increased via early hamstring strengthening after anterior cruciate ligament reconstruction with no negative impact on knee function.
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Affiliation(s)
- Ufuk Sekir
- Department of Sports Medicine, Medical School of Uludag University, 16059 Gorukle, Bursa, Turkey.
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Adouni M, Shirazi-Adl A. Knee joint biomechanics in closed-kinetic-chain exercises. Comput Methods Biomech Biomed Engin 2009; 12:661-70. [DOI: 10.1080/10255840902828375] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jan MH, Lin CH, Lin YF, Lin JJ, Lin DH. Effects of Weight-Bearing Versus Nonweight-Bearing Exercise on Function, Walking Speed, and Position Sense in Participants With Knee Osteoarthritis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2009; 90:897-904. [DOI: 10.1016/j.apmr.2008.11.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 10/31/2008] [Accepted: 11/08/2008] [Indexed: 10/20/2022]
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Richards J, Thewlis D, Selfe J, Cunningham A, Hayes C. A biomechanical investigation of a single-limb squat: implications for lower extremity rehabilitation exercise. J Athl Train 2009; 43:477-82. [PMID: 18833310 DOI: 10.4085/1062-6050-43.5.477] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Single-limb squats on a decline angle have been suggested as a rehabilitative intervention to target the knee extensors. Investigators, however, have presented very little empirical research in which they have documented the biomechanics of these exercises or have determined the optimum angle of decline used. OBJECTIVE To determine the involvement of the gastrocnemius and rectus femoris muscles and the external ankle and knee joint moments at 60 degrees of knee flexion while performing a single-limb squat at different decline angles. DESIGN Participants acted as their own controls in a repeated-measures design. PATIENTS OR OTHER PARTICIPANTS We recruited 10 participants who had no pain, injury, or neurologic disorder. INTERVENTION(S) Participants performed single-limb squats at different decline angles. MAIN OUTCOME MEASURE(S) Angle-specific knee and ankle moments were calculated at 60 degrees of knee flexion. Angle-specific electromyography (EMG) activity was calculated at 60 degrees of knee flexion. Integrated EMG also was calculated to determine the level of muscle activity over the entire squat. RESULTS An increase was seen in the knee moments (P < .05) and integrated EMG in the rectus femoris (P < .001) as the decline angle increased. A decrease was seen in the ankle moments as the decline angle increased (P = .001), but EMG activity in the gastrocnemius increased between 16 degrees and 24 degrees (P = .018). CONCLUSIONS As the decline angle increased, the knee extensor moment and EMG activity increased. As the decline angle increased, the ankle plantar-flexor moments decreased; however, an increase in the EMG activity was seen with the 24 degrees decline angle compared with the 16 degrees decline angle. This indicates that decline squats at an angle greater than 16 degrees may not reduce passive calf tension, as was suggested previously, and may provide no mechanical advantage for the knee.
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Affiliation(s)
- Jim Richards
- University of Central Lancashire, Preston, United Kingdom
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Callaghan MJ, McCarthy CJ, Oldham JA. The reliability of surface electromyography to assess quadriceps fatigue during multi joint tasks in healthy and painful knees. J Electromyogr Kinesiol 2009; 19:172-80. [PMID: 17629711 DOI: 10.1016/j.jelekin.2007.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 03/15/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022] Open
Abstract
This study's aim was to determine the between days reliability of surface EMG recordings from the superficial quadriceps during a multi joint sub-maximal fatiguing protocol. Three subject groups (healthy n=29; patellofemoral pain syndrome n=74; knee osteoarthritis n=55) performed the task at 60 maximum voluntary isometric contraction on three separate days. Spectral and amplitude EMG parameters were recorded from vastus medialis oblique, vastus lateralis and rectus femoris and were analysed for between days reliability using intraclass correlation coefficient (ICC((2,1))), the standard errors of measure and smallest detectable differences. For frequency results, initial and final frequency values had 'good' or 'excellent' reliability in all groups for all muscles. ICCs for median frequency slopes for vastus medialis oblique, vastus lateralis, and rectus femoris respectively, in the osteoarthritis group were 0.04, 0.55, and 0.72; in the patellofemoral pain group were 0.41, 0.17, and 0.33; in the healthy group were 0.68, 0.64, and 0.31. The standard errors of measurement and smallest detectable differences for all groups and for all muscles were unacceptably high. For amplitude results, ICC root mean squared initial and final values were 'good' to 'excellent' for all groups and all muscles, albeit with high measurement error. The ICCs for root mean squared slopes in all tests were 'poor' with extremely high measurement error. The poor between days reliability and high measurement error suggests that surface EMG should not be adopted to assess fatigue during multi joint sub-maximal isometric quadriceps testing.
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Affiliation(s)
- Michael J Callaghan
- Centre for Rehabilitation Science, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
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Gullett JC, Tillman MD, Gutierrez GM, Chow JW. A Biomechanical Comparison of Back and Front Squats in Healthy Trained Individuals. J Strength Cond Res 2009; 23:284-92. [DOI: 10.1519/jsc.0b013e31818546bb] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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LOBET S, PENDEVILLE E, DALZELL R, DEFALQUE A, LAMBERT C, POTHEN D, HERMANS C. The role of physiotherapy after total knee arthroplasty in patients with haemophilia. Haemophilia 2008; 14:989-98. [DOI: 10.1111/j.1365-2516.2008.01748.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Madhavan S, Shields RK. Weight-bearing exercise accuracy influences muscle activation strategies of the knee. J Neurol Phys Ther 2008; 31:12-9. [PMID: 17419885 PMCID: PMC4034369 DOI: 10.1097/01.npt.0000260569.69863.0c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Dynamic stability of the knee joint is a research topicof increasing focus after ACL injury, stroke, and incomplete spinal cord injury. Since rehabilitation programs use functional weightbearing tasks to improve neuromuscular control of the knee, it is important to understand the adaptability of muscle control strategies during weight-bearing exercise. The purpose of this study was to compare muscle activation patterns during a single leg squat (SLS) exercise performed before and after feedback-controlled training. METHODS This was a cross-sectional comparative study. Fifteen young, healthy individuals performed the SLS exercise while tracking a sinusoidal target with flexion and extension of the knee. The SLS instrument provided bidirectional resistance that was normalized to body weight. Six trials of 10 repetitions of the SLSs were performed to quantify improved performance (learning). Electromyographic activity from five muscles that cross the knee was analyzed. Accuracy of performance was measured by calculating the error between the target and actual knee displacement. RESULTS Reduction in error measurements verified that individuals increased the accuracy of performance in each trial and retained this improvement across trials (p < 0.05). Modulation in muscle activity as a result of learning was reflected mainly in the biceps femoris, rectus femoris, and vastus lateralis muscles. CONCLUSION Increased accuracy with the SLS exercise was accompanied by a decrease in coactivation of selected musculature around the knee. This study presents a novel approach to quantify the effect of performance on muscle synergistic activation patterns during weight-bearing exercise. Controlled strengthening, as defined in this study, emphasizes accuracy of performance in conjunction with principles of strength training and has implications to knee control.
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Affiliation(s)
- Sangeetha Madhavan
- Graduate Program in Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA, USA
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Grodski M, Marks R. Exercises Following Anterior Cruciate Ligament Reconstructive Surgery: Biomechanical Considerations and Efficacy of Current Approaches. Res Sports Med 2008; 16:75-96. [DOI: 10.1080/15438620701877032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Mark Grodski
- a Department of Physical Therapy , University of Toronto , Toronto, Canada
- b Osteoarthritis Research Center , Toronto, Canada
| | - Ray Marks
- c Department of Health and Behavior Studies , Columbia University, Teachers College , New York, USA
- d Department of Health and Physical Education, Gerontological Services and Gerontology , City University of New York, York College , New York, USA
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