Comparison of Blood Flow Restriction Interventions to Standard Rehabilitation After an Anterior Cruciate Ligament Injury: A Systematic Review

BACKGROUND

Blood flow restriction training (BFR-t) data are heterogeneous. It is unclear whether rehabilitation with BFR-t after an anterior cruciate ligament (ACL) injury is more effective in improving muscle strength and muscle size than standard rehabilitation.

PURPOSE

To review outcomes after an ACL injury and subsequent reconstruction in studies comparing rehabilitation with and without BFR-t.

STUDY DESIGN

Systematic review. Level of evidence, 3.

METHODS

A search of English-language human clinical studies published in the past 20 years (2002-2022) was carried out in 5 health sciences databases, involving participants aged 18-65 undergoing rehabilitation for an ACL injury. Outcomes associated with muscle strength, muscle size, and knee-specific patient-reported outcome measures (PROMs) were extracted from studies meeting inclusion criteria and compared.

RESULTS

The literature search identified 279 studies, of which 5 met the selection criteria. Two studies suggested that BFR-t rehabilitation after an ACL injury improved knee or thigh muscle strength and muscle size compared with rehabilitation consisting of comparable and higher load resistance training, with two studies suggesting the opposite. The single study measuring PROMs showed improvement compared to traditional rehabilitation, with no difference in muscle strength or size.

CONCLUSION

BFR-t after an ACL injury seems to benefit muscle strength, muscle size, and PROM scores compared with standard rehabilitation alone. However, only 1 large study included all these outcomes, which has yet to be replicated in other settings. Further studies utilizing similar methods with a common set of outcome measures are required to confirm the effects of BFR-t on ACL rehabilitation.

Reliability of transcranial magnetic stimulation measurements of maximum activation of the knee extensors in young adult males

PURPOSE

METHODS: RESULTS: CONCLUSION.

Mechanical and morphological determinants of peak power output in elite cyclists

Mechanical peak power output (PPO) is a determinant of performance in sprint cycling. The purpose of this study was to examine the relationship between PPO and putative physiological determinants of PPO in elite cyclists, and to compare sprint performance between elite sprint and endurance cyclists. Thirty-five elite cyclists (18 endurance; 17 sprint) performed duplicate sprint cycling laboratory tests to establish PPO and its mechanical components. Quadriceps femoris (Q_VOL ) and hamstring muscle volume (HAM_VOL ) were assessed with MRI, vastus lateralis pennation angle (Pθ_VL ) and fascicle length (FL_VL ) were determined with ultrasound imaging, and neuromuscular activation of three muscles was assessed using EMG at PPO during sprint cycling. For the whole cohort, there was a wide variability in PPO (range 775-2025 W) with very large, positive, bivariate relationships between PPO and Q_VOL (r = .87), HAM_VOL (r = .71), and Pθ_VL (r = .81). Step-wise multiple regression analysis revealed that 87% of the variability in PPO between cyclists was explained by two variables Q_VOL (76%) and Pθ_VL (11%). The sprint cyclists had greater PPO (+61%; P < .001 vs endurance), larger Q_VOL (P < .001), and BF_VOL (P < .001) as well as more pennate vastus lateralis muscles (P < .001). These findings emphasize the importance of quadriceps muscle morphology for sprint cycling events.

Isovelocity vs. Isoinertial Sprint Cycling Tests for Power- and Torque-cadence Relationships

Sprint cycling performance is heavily dependent on mechanical peak power output (PPO) and the underlying power- and torque-cadence relationships. Other key indices of these relationships include maximum torque (T_MAX), cadence (C_MAX) and optimal cadence (C_OPT). Two common methods are used in the laboratory to ascertain PPO: isovelocity and isoinertial. Little research has been carried out to compare the magnitude and reliability of these performance measures with these two common sprint cycling assessments. The aim of this study was to compare the magnitude and reliability of PPO, T_MAX, C_MAX and C_OPT measured with isovelocity and isoinertial sprint cycling methods. Two experimental sessions required 20 trained cyclists to perform isoinertial sprints and then isovelocity sprints. For each method, power-cadence and torque-cadence relationships were established, and PPO and C_OPT were interpolated and T_MAX and C_MAX were extrapolated. The isoinertial method produced significantly higher PPO (p<0.001) and T_MAX (p<0.001) than the isovelocity method. However, the isovelocity method produced significantly higher C_OPT (p<0.001) and C_MAX (p=0.002). Both sprint cycling tests showed high levels of between-session reliability (isoinertial 2.9-4.4%; isovelocity 2.7-4.0%). Functional measures of isovelocity and isoinertial sprint cycling tests were highly reliable but should not be used interchangably.

Reliability of traditional and task specific reference tasks to assess peak muscle activation during two different sprint cycling tests

Neuromuscular activation is considered an important determinant sprint cycling performance but requires reliable EMG amplitude measurements to facilitate sensitive assessments. The reliability of EMG measurements during sprint cycling may depend on the sprint cycling test undertaken (isovelocity or isoinertial accelerating), the reference tasks used for normalisation (isometric MVCs of a series of single muscle groups [ISO-SINGJT] or isometric cycling MVCs [ISO-CYC]), and the efficacy of the normalisation. This study aimed to compare the magnitude and between-session reliability of peak muscle activation (peak rmsEMG) during: isovelocity and isoinerital sprint cycling tests; ISO-SINGJT and ISO-CYC reference tasks; and absolute and normalised EMG during the sprint cycling tests. EMG amplitude was measured over six major muscle groups on both legs and all measurements were made over two sessions in a randomised counterbalanced design. Peak rmsEMG was assessed during both ISO-SINGJT and ISO-CYC MVCs and then during mechanical peak power output (PPO) during isovelocity (120 RPM) and isoinerital acceleration (0 to >150 RPM) sprint tests. Absolute peak rmsEMG and for the sprint tests normalised EMG values were determined, and coefficient of variation and intra-class correlation coefficients used to assess reliability. Peak rmsEMG at PPO during both sprint cycling tests was similar for the six muscle groups measured. Peak rmsEMG was higher during ISO-SINGJT than ISO-CYC for for 3 of the 6 muscle groups, but all muscle groups exhibited similar reliability for both reference tasks. Neither reference task improved the between-session reliability for either sprint test. This data highlights reservations in the use of isometric reference tasks to ascertain changes in peak muscle activation over time in during sprint cycling assessments.

High and odd impact exercise training improved physical function and fall risk factors in community-dwelling older men

High impact exercise programmes can improve bone strength, but little is known about whether this type of training further benefits fracture risk by improving physical function in older people.

OBJECTIVES

This study investigated the influence of high impact exercise on balance, muscle function and morphology in older men.

METHODS

Fifty, healthy men (65-80 years) were assigned to a 6-month multidirectional hopping programme (TG) and twenty age and physical activity matched volunteers served as controls (CG). Before and after training, muscle function (hop performance, leg press and plantar- and dorsiflexion strength) and physiological determinants (muscle thickness and architecture) as well as balance control (sway path, one leg stance duration) were measured. Resting gastrocnemius medialis (GM) muscle thickness and architecture were assessed using ultrasonography.

RESULTS

Significant improvements in hop impulse (+12%), isometric leg-press strength (+4%) and ankle plantarflexion strength (+11%), dorsiflexor strength (+20%) were found in the TG compared to the CG (ANOVA interaction, P⟨0.05) and unilateral stance time improved over time for TG. GM muscle thickness indicated modest hypertrophy (+4%), but muscle architecture was unchanged.

CONCLUSION

The positive changes in strength and balance after high impact and odd impact training would be expected to improve physical function in older adults.

Rate of force development: physiological and methodological considerations

The evaluation of rate of force development during rapid contractions has recently become quite popular for characterising explosive strength of athletes, elderly individuals and patients. The main aims of this narrative review are to describe the neuromuscular determinants of rate of force development and to discuss various methodological considerations inherent to its evaluation for research and clinical purposes. Rate of force development (1) seems to be mainly determined by the capacity to produce maximal voluntary activation in the early phase of an explosive contraction (first 50–75 ms), particularly as a result of increased motor unit discharge rate; (2) can be improved by both explosive-type and heavy-resistance strength training in different subject populations, mainly through an improvement in rapid muscle activation; (3) is quite difficult to evaluate in a valid and reliable way. Therefore, we provide evidence-based practical recommendations for rational quantification of rate of force development in both laboratory and clinical settings.

Variable-cam resistance training machines: Do they match the angle – torque relationship in humans?

The aim of this study was to determine the extent to which the resistance provided by variable-cam resistance training machines match joint torque capability. Eight variable-cam knee extension machines from six different manufacturers were assessed. Resistive torque for a constant weight/load was measured at five knee joint angles. Knee extensor muscle torque capability--the angle-torque relationship--of 10 healthy young men was determined isometrically and dynamically at the same five angles. After normalization, the two relationships were compared. The angle - torque relationship of the knee extensors displayed an inverted "U" shape as expected, with dynamic torque changing by +40% on the ascending limb (1.75 - 1.40 rad) and -60% on the descending limb (1.05-0.35 rad) of the angle - torque relationship. The angle-torque relationship of the different training machines was highly variable, but consistently less curvilinear and significantly different from knee extensor capabilities, with changes in torque of +2.5 to +22.2% (ascending limb) and +37.6 to -20.5% (descending limb). It is recommended that variable-cam resistance training machines be designed with the angle - torque relationship of the relevant joint and the inertial profile of the lifting exercise in mind.

Angiotensin-converting enzyme genotype affects the response of human skeletal muscle to functional overload

The response to strength training varies widely between individuals and is considerably influenced by genetic variables, which until now, have remained unidentified. The deletion (D), rather than the insertion (I), variant of the human angiotensin-converting enzyme (ACE) genotype is an important factor in the hypertrophic response of cardiac muscle to exercise and could also be involved in skeletal muscle hypertrophy - an important factor in the response to functional overload. Subjects were 33 healthy male volunteers with no experience of strength training. We examined the effect of ACE genotype upon changes in strength of quadriceps muscles in response to 9 weeks of specific strength training (isometric or dynamic). There was a significant interaction between ACE genotype and isometric training with greater strength gains shown by subjects with the D allele (mean +/- S.E.M.: II, 9.0+/-1.7 %; ID, 17.6 +/-2.2 %; DD, 14.9+/-1.3 %, ANOVA, P 0.05). A consistent genotype and training interaction (ID DD II) was observed across all of the strength measures, and both types of training. ACE genotype is the first genetic factor to be identified in the response of skeletal muscle to strength training. The association of the ACE I/D polymorphism with the responses of cardiac and skeletal muscle to functional overload indicates that they may share a common mechanism. These findings suggest a novel mechanism, involving the renin-angiotensin system, in the response of skeletal muscle to functional overload and may have implications for the management of conditions such as muscle wasting disorders, prolonged bed rest, ageing and rehabilitation, where muscle weakness may limit function.