ABSTRACTSlater, LV, and Hart, JM. Muscle activation patterns during different squat techniques. J Strength Cond Res 31(3)667–676, 2017—Bilateral squats are frequently used exercises in sport ...performance programs. Lower extremity muscle activation may change based on knee alignment during the performance of the exercise. The purpose of this study was to compare lower extremity muscle activation patterns during different squat techniques. Twenty-eight healthy, uninjured subjects (19 women, 9 men, 21.5 ± 3 years, 170 ± 8.4 cm, 65.7 ± 11.8 kg) volunteered. Electromyography (EMG) electrodes were placed on the vastus lateralis, vastus medialis, rectus femoris, biceps femoris, and the gastrocnemius of the dominant leg. Participants completed 5 squats while purposefully displacing the knee anteriorly (AP malaligned), 5 squats while purposefully displacing the knee medially (ML malaligned) and 5 squats with control alignment (control). Normalized EMG data (MVIC) were reduced to 100 points and represented as percentage of squat cycle with 50% representing peak knee flexion and 0 and 99% representing fully extended. Vastus lateralis, medialis, and rectus femoris activity decreased in the medio-lateral (ML) malaligned squat compared with the control squat. In the antero-posterior (AP) malaligned squat, the vastus lateralis, medialis, and rectus femoris activity decreased during initial descent and final ascent; however, vastus lateralis and rectus femoris activation increased during initial ascent compared with the control squat. The biceps femoris and gastrocnemius displayed increased activation during both malaligned squats compared with the control squat. In conclusion, participants had altered muscle activation patterns during squats with intentional frontal and sagittal malalignment as demonstrated by changes in quadriceps, biceps femoris, and gastrocnemius activation during the squat cycle.
Purpose
The purpose was to calculate the incidence of osteoarthritis in individuals following Anterior Cruciate Ligament Reconstruction (ACLR) in a large, national database and to examine the risk ...factors associated with OA development.
Methods
A commercially available insurance database was queried to identify new diagnoses of knee OA in patients with ACLR. The cumulative incidence of knee OA diagnoses in patients after ACLR was calculated and stratified by time from reconstruction. Odds ratios were calculated using logistic regression to describe factors associated with a new OA diagnosis including age, sex, BMI, meniscus involvement, osteochondral graft use, and tobacco use.
Results
A total of 10,565 patients with ACLR were identified that did not have an existing diagnosis of OA, 517 of which had a documented new diagnosis of knee OA 5 years after ACL reconstruction. When stratified by follow-up time points, the incidence of a new OA diagnosis within 6 months was 2.3%; within a 1-year follow-up was 4.1%; within 2 years, follow-up was 6.2%, within 3 years, follow-up was 8.4%; within 4 years, follow-up was 10.4%; and within 5 years, follow-up was 12.3%. Risk factors for new OA diagnoses were age (OR 2.44,
P
< 0.001), sex (OR 1.2,
P
= 0.002), obesity (OR 1.4,
P
< 0.001), tobacco use (OR = 1.3,
P
= 0.001), and meniscal involvement (OR 1.2,
P
= 0.005).
Conclusion
Approximately 12% of patients presenting within 5 years following ACLR are diagnosed with OA. Demographic factors associated with an increased risk of a diagnosis of PTOA within 5 years after ACLR are age, sex, BMI, tobacco use, and concomitant meniscal surgery. Clinicians should be cognizant of these risk factors to develop risk profiles in patients with the common goal to achieve optimal long-term outcomes after ACLR.
Level of evidence
III.
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EMUNI, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
OBJECTIVE:To identify the frequency of passing return-to-activity tests after anterior cruciate ligament reconstruction (ACLR) and to investigate the influence of patient-specific factors on pass ...rates. We hypothesized that isolated strength tests would be most difficult to pass and that graft type would be the most influential factor.
DESIGN:Cross-sectional.
SETTING:Laboratory.
PARTICIPANTS:Eighty patients with a history of primary, unilateral ACLR, and 80 healthy controls participated.
INTERVENTIONS:Bilateral isokinetic strength, isometric strength, and single-leg hop tests were recorded during a single visit. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation measured subjective knee function, and the Tegner Activity Scale measured physical activity level.
MAIN OUTCOME MEASURES:Pass rates were calculated for 3 thresholds of absolute between-limb asymmetry0% to 10%, 11% to 15%, and 16% to 20%. Pass rates were compared by sex (male and female), graft type (patellar and hamstrings), meniscal procedure (yes and no), physical activity level (</≥ median Tegner), and time from surgery (</≥ 6 months).
RESULTS:Isokinetic quadriceps strength was consistently most difficult to pass, whereas the 6-meter timed hop and crossover hop tests were easiest. Graft type had the greatest influence on pass rates (isometric quadriceps and hamstring strength, hamstrings-to-quadriceps ratio), followed by time from surgery (6-meter timed hop and crossover hop), physical activity (IKDC), and meniscal procedure (6-meter timed hop).
CONCLUSIONS:Isokinetic quadriceps strength was the most difficult test to pass, and single-leg hop tests were the easiest. Patient-specific factors including graft type, time from surgery, physical activity level, and meniscal procedure may influence the ability to meet return-to-activity criterion after ACLR.
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an evidence-informed treatment utilizing Cognitive Behavioural Therapy (CBT) treatment principles. UP has demonstrated ...promising treatment effects comparable to single disorder protocol across several mental disorders. Its impact on personal recovery in anxiety and depression has not been examined. This study compares clinical and personal recovery outcomes of UP treatment for depression and anxiety disorders when delivered in a group vs. individual format. Retrospective chart review of outcomes was conducted for outpatients receiving 12-week individual (n = 65) and group (n = 62) UP treatment in a specialized psychiatric hospital. Descriptive and repeated measures ANOVA analyses were conducted on outcomes on Overall Depression Severity and Impairment Scale, Overall Anxiety Severity and Impairment Scale, Recovery Assessment Scale administered pre and post treatment. On average, participants in both group and individual UP treatment showed improvements in anxiety, depression, and recovery scores. Greater proportion of group participants showed improvements on two interpersonal-focused domains of personal recovery. Results indicate group UP treatment is comparably effective compared to individual UP in improving clinical and recovery outcomes, and treatment modality affects the degree of personal recovery. Overall findings offer important clinical promise of UP treatment as a transdiagnostic treatment option for individuals with anxiety and depression.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) result in persistent alterations in lower extremity movement patterns. The progression of lower extremity biomechanics from the ...time of injury has not been described.
To compare the 3-dimensional (3D) lower extremity kinematics and kinetics of walking among individuals with ACL deficiency (ACLD), individuals with ACLR, and healthy control participants from 3 to 64 months after ACLR.
We searched PubMed and Web of Science from 1970 through 2013.
We selected only articles that provided peak kinematic and kinetic values during walking in individuals with ACLD or ACLR and comparison with a healthy control group or the contralateral uninjured limb.
A total of 27 of 511 identified studies were included. Weighted means, pooled standard deviations, and 95% confidence intervals were calculated for the healthy control, ACLD, and ACLR groups at each reported time since surgery. The magnitude of between-groups (ACLR versus ACLD, control, or contralateral limb) differences at each time point was evaluated using Cohen d effect sizes and associated 95% confidence intervals. Peak knee-flexion angle (Cohen d = -0.41) and external knee-extensor moment (Cohen d = -0.68) were smaller in the ACLD than in the healthy control group. Peak knee-flexion angle (Cohen d range = -0.78 to -1.23) and external knee-extensor moment (Cohen d range = -1.39 to -2.16) were smaller in the ACLR group from 10 to 40 months after ACLR. Reductions in external knee-adduction moment (Cohen d range = -0.50 to -1.23) were present from 9 to 42 months after ACLR.
Reductions in peak knee-flexion angle, external knee-flexion moment, and external knee-adduction moment were present in the ACLD and ACLR groups. This movement profile during the loading phase of gait has been linked to knee-cartilage degeneration and may contribute to the development of osteoarthritis after ACLR.
Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) result in persistent alterations in lower extremity movement patterns. The progression of lower extremity biomechanics from the ...time of injury has not been described.
To compare the 3-dimensional (3D) lower extremity kinematics and kinetics of walking among individuals with ACL deficiency (ACLD), individuals with ACLR, and healthy control participants from 3 to 64 months after ACLR.
We searched PubMed and Web of Science from 1970 through 2013.
We selected only articles that provided peak kinematic and kinetic values during walking in individuals with ACLD or ACLR and comparison with a healthy control group or the contralateral uninjured limb.
A total of 27 of 511 identified studies were included. Weighted means, pooled standard deviations, and 95% confidence intervals were calculated for the healthy control, ACLD, and ACLR groups at each reported time since surgery. The magnitude of between-groups (ACLR versus ACLD, control, or contralateral limb) differences at each time point was evaluated using Cohen d effect sizes and associated 95% confidence intervals. Peak knee-flexion angle (Cohen d = -0.41) and external knee-extensor moment (Cohen d = -0.68) were smaller in the ACLD than in the healthy control group. Peak knee-flexion angle (Cohen d range = -0.78 to -1.23) and external knee-extensor moment (Cohen d range = -1.39 to -2.16) were smaller in the ACLR group from 10 to 40 months after ACLR. Reductions in external knee-adduction moment (Cohen d range = -0.50 to -1.23) were present from 9 to 42 months after ACLR.
Reductions in peak knee-flexion angle, external knee-flexion moment, and external knee-adduction moment were present in the ACLD and ACLR groups. This movement profile during the loading phase of gait has been linked to knee-cartilage degeneration and may contribute to the development of osteoarthritis after ACLR.
To quantify the relationship between quadriceps strength and aerobic fitness following ACLR.
42 individuals with ACLR (29F/13M, 20.2 ± 3.3years, 71.8 ± 17.4 kg, 171.1 ± 9.4 cm, 21.9 ± 21.5months ...post-surgery) and 38 healthy controls (24F/14M, 20.1 ± 1.4years, 69.8 ± 10.2 kg, 172.9 ± 8.7 cm) completed quadriceps strength testing using an instrumented dynamometer then completed an incremental treadmill test to determine aerobic fitness (VO2max). Bivariate Pearson's correlations were calculated between strength and VO2max. Significant correlations were retained for a regression analysis.
Healthy controls demonstrated significantly greater VO2max compared to the ACLR group (d = 0.56). Unilateral strength variables were significantly correlated with VO2max (P ≤ 0.006) for both groups. Normalized peak isokinetic knee extensor torque was retained in the model, which explained 20.5% of the variance in healthy VO2max and 37.2% of the variance in ACLR VO2max.
Aerobic fitness was reduced in the ACLR group in comparison to the healthy controls, despite unrestricted return to activity and similar activity levels between groups. Unilateral quadriceps strength was significantly correlated with aerobic fitness, which may be an indicator that greater unilateral strength may be a proxy for assessing aerobic fitness. Furthermore, sports medicine professionals may consider incorporating techniques and exercises during rehabilitation to improve cardiovascular fitness following ACLR.
•ACLR had reduced aerobic fitness despite unrestricted return to activity.•Unilateral quadriceps strength was significantly correlated with aerobic fitness.•Isokinetic quadriceps torque explained 37.2% of variance in ACLR aerobic fitness.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Develop a screening battery for persons with Parkinson's Disease (PD) that is easily administered in a short amount of time by community exercise professionals and measures changes in function.
An ...integrated, stakeholder-engaged, mixed methods approach included interviews and meetings with community exercise professionals on the development of a screening battery. Persons with PD (n = 57, age = 72.1 ± 8.1 years) who were already enrolled in fitness classes or individualized training at three locations participated in the screening battery twice over 8-16 weeks and provided feedback. Trends from interviews and meeting notes were identified using summative content analysis. Quantitative changes in performance were compared with paired t-tests. Cohen's d effect sizes were calculated for all significant differences.
Current barriers for functional screenings included time and space. Using this feedback, we developed a screening battery that took under 20 min, required little equipment, had been previously validated, could be performed in individual and group settings, and provided objective feedback that was motivating for persons with PD to continue exercising. Persons with PD demonstrated improved functional performance on sit-to-stand (d = −0.71), two-minute walk test (d = −3.83), and arm curls (d = −0.78).
Test results can be a motivator for persons with PD and lead to increased exercise adherence. Easily administered tests can show improvements in this population. Community exercise professionals are able to safely screen persons with PD to detect functional deficits and assist with programming.
Implications for Rehabilitation
Regular exercise can slow declines in physical function and quality of life in people with Parkinson's disease.
Use of physical assessments in community exercise programs can improve motivation to exercise for this population.
Physical assessments such as sit-to-stand and arm curls can be used to demonstrate improvements in people with Parkinson's disease.
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IJS, NUK, UL, UM, UPUK, VSZLJ
Many clinicians measure lower-extremity symmetry after anterior cruciate ligament reconstruction (ACLR); however, testing is completed in a rested state rather than postexercise. Testing postexercise ...may better model conditions under which injury occurs.
To compare changes in single-leg performance in healthy and individuals with history of ACLR before and after exercise.
Repeated-measures case-control.
Laboratory.
Fifty-two subjects (25 control and 27 ACLR).
Thirty minutes of exercise.
Limb symmetry and involved limb performance (nondominant for healthy) for single-leg hop, ground contact time, and jump height during the 4-jump test. Cohen d effect sizes were calculated for all differences identified using a repeated-measures analysis of variance.
Healthy controls hopped farther than ACLR before (d = 0.65; confidence interval CI, 0.09 to 1.20) and after exercise (d = 0.60; CI, 0.04 to 1.15). Those with ACLR had longer ground contact time on the reconstructed limb compared with the uninvolved limb after exercise (d = 0.53; CI, -0.02 to 1.09), and the reconstructed limb had greater ground contact time compared with the healthy control limb after exercise (d = 0.38; CI, -0.21 to 0.73). ACLR were less symmetrical than healthy before (d = 0.38; CI, 0.17 to 0.93) and after exercise (d = 0.84; CI, 0.28 to 1.41), and the reconstructed limb demonstrated decreased jump height compared with the healthy control limbs before (d = 0.75; CI, 0.19 to 1.31) and after exercise (d = 0.79; CI, 0.23 to 1.36).
ACLR became more symmetric, which may be from adaptations of the reconstructed limb after exercise. Changes in performance and symmetry may provide additional information regarding adaptations to exercise after reconstruction.
•Variable patterns of muscle volumes were observed about the hip, knee, and ankle.•Previous injury and contralateral injury likely confound volumetric profiles.•These data support the need for ...individualized assessment and intervention.
Patients with knee joint pathology present with variable muscular responses across the muscles of the lower limb and pelvis. Conventional approaches to characterizing muscle function are limited to gross strength assessments that may overlook subtle changes both in the thigh, hip and shank musculature.
To describe individualized patterns of lower extremity muscle volumes in patients with knee pathologies.
This was a retrospective case series performed in a University medical center. Nine patients diagnosed with meniscus tear recommended to undergo meniscectomy volunteered. Participants underwent 3.0 Tesla magnetic resonance imaging (MRI) of the lower extremities. Thirty-five MRI-derived muscle volumes were compared between limbs and expressed as percentage asymmetry. For additional context, z-scores were also calculated for mass- and height-normalized muscles and pre-determined muscle groupings relative to a normative database.
There were no consistent patterns observed when considering between-limb asymmetries among all patients. The ankle musculature (dorsiflexors, plantar flexors, and invertors) was the only muscle group to be consistently smaller than normal for all patients, with the psoas major and flexor hallucis longus being the only individual muscles. The severity or chronicity of injury and presence of surgical intervention did not appear to have a clear effect on muscle volumes.
Patients with a history of meniscal pathology demonstrate inconsistent patterns of lower extremity muscle volumes about the hip, knee, and ankle between limbs and in comparison to uninjured individuals. These data support the need for individualized assessment and intervention in this population.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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