The Elbow-EpiTrainer : A method of delivering graded resistance to the extensor carpi radialis brevis. Effectiveness of a prototype device in a healthy population

This document is the Accepted Manuscript version of the following article: Navsaria R, Ryder DM, Lewis JS, et al, 'The Elbow-EpiTrainer: a method of delivering graded resistance to the extensor carpi radialis brevi:. Effectiveness of a prototype device in a healthy population', British Journal of Sports Medicine, Vol. 49(5):318-322, March 2015, available online at: http://bjsm.bmj.com/content/49/5/318. Published by the BMJ Publishing Group Limited.Background: Tennis elbow or lateral epicondylopathy (LE) is experienced as the lateral elbow has a reported prevalence of 1.3%, with symptoms lasting up to 18 months. LE is most commonly attributed to tendinopathy involving the extensor carpi radialis brevis (ECRB) tendon. The aim of tendinopathy management is to alleviate symptoms and restore function that initially involves relative rest followed by progressive therapeutic exercise. Objective: To assess the effectiveness of two prototype exercises using commonly available clinical equipment to progressively increase resistance and activity of the ECRB. Method: Eighteen healthy participants undertook two exercise progressions. Surface electromyography was used to record ECRB activity during the two progressions, involving eccentric exercises of the wrist extensors and elbow pronation exercises using a prototype device. The two progressions were assessed for their linearity of progression using repeated ANOVA and linear regression analysis. Five participants repeated the study to assess reliability. Results: The exercise progressions led to an increase in ECRB electromyographic (EMG) activity (p0.7) between the first and second tests for five participants. Conclusions: Manipulation of resistance and leverage with the prototype exercises was effective in creating significant increases of ECRB normalised EMG activity in a linear manner that may, with future research, become useful to clinicians treating LE. In addition, between trial reliability for the device to generate a consistent load was acceptable.Peer reviewe

Geographical distribution of the ivesioids.

<p>Shaded area represents the exten of the Great Basin. Locations where climate data were sampled for the bioclimatic models for extant species are marked with dots. State names are abbreviated: AZ – Arizona, CA – California, CO – Colorado, ID – Idaho, MT – Montana, NE – Nevada, NM – New Mexico, OR – Oregon, UT – Utah, WA – Washington and WY – Wyoming. Background image by <a href="http://www.earthobservatory.nasa.gov" target="_blank">www.earthobservatory.nasa.gov</a>.</p

Projections of the ancestral model for the MRCA of the ivesioids and <i>Potentilla</i> sect. <i>Rivales</i> in (a) palaeoclimate scenario and (b) present-day scenario.

<p>Areas in red are inferred by all four climate variables and areas in yellow by three of them.</p

Optimized ancestral maximum and minimum values for the four climate variables used. Temperatures are given in °C and precipitation in millimeters.

<p>Node numbers corresponds to the numbers indicated in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358.s002" target="_blank">figure S2</a>.</p

Past Climate Change and Plant Evolution in Western North America: A Case Study in Rosaceae

<div><p>Species in the ivesioid clade of <em>Potentilla</em> (Rosaceae) are endemic to western North America, an area that underwent widespread aridification during the global temperature decrease following the Mid-Miocene Climatic Optimum. Several morphological features interpreted as adaptations to drought are found in the clade, and many species occupy extremely dry habitats. Recent phylogenetic analyses have shown that the sister group of this clade is <em>Potentilla</em> section <em>Rivales</em>, a group with distinct moist habitat preferences. This has led to the hypothesis that the ivesioids (genera <em>Ivesia</em>, <em>Horkelia</em> and <em>Horkeliella</em>) diversified in response to the late Tertiary aridification of western North America. We used phyloclimatic modeling and a fossil-calibrated dated phylogeny of the family Rosaceae to investigate the evolution of the ivesioid clade. We have combined occurrence- and climate data from extant species, and used ancestral state reconstruction to model past climate preferences. These models have been projected into paleo-climatic scenarios in order to identify areas where the ivesioids may have occurred. Our analysis suggests a split between the ivesioids and <em>Potentilla</em> sect. <em>Rivales</em> around Late Oligocene/Early Miocene (∼23 million years ago, Ma), and that the ivesioids then diversified at a time when summer drought started to appear in the region. The clade is inferred to have originated on the western slopes of the Rocky Mountains from where a westward range expansion to the Sierra Nevada and the coast of California took place between ∼12-2 Ma. Our results support the idea that climatic changes in southwestern North America have played an important role in the evolution of the local flora, by means of <em>in situ</em> adaptation followed by diversification.</p> </div

Ancestral bioclimatic models projected into palaeoclimatic scenarios.

<p>Red areas are inferred to have had a suitable climate for the ancestral population by four climate variables and areas in yellow by three. Numbers corresponds to the nodes in the ivesioid clade in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone-0050358-g003" target="_blank">figure 3</a>.</p

The sixteen climate variables that where considered for the analysis, listed with mean AUC values. Variables used in the final analysis are indicated with *.

<p>The sixteen climate variables that where considered for the analysis, listed with mean AUC values. Variables used in the final analysis are indicated with *.</p

Molecular chronogram of Rosaceae.

<p>Maximum clade credibility tree obtained from 25000 post burn-in Bayesian chronograms generated in BEAST, with median branch lengths. Grey bars at nodes represent 95% Highest Posterior Densities of node ages. The red dots indicates age constraints used for the analysis; (1) The split between Rosales and Fabales was constrained to an age of 104–115 Ma based on a previous analysis <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Wang1" target="_blank">[31]</a>, and (2) a <i>Crataegites borealis</i> fossil was used to set a conservative minimum age of 85.8 Ma on Rosaceae <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Samylina1" target="_blank">[32]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Kelley1" target="_blank">[34]</a>. Subclades of Rosaceae were calibrated using fossil data from (3) <i>Neviusia</i>, 48.7 Ma <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Wehr1" target="_blank">[35]</a>, (4) <i>Chamaebatiaria</i>, 26.85 Ma <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Axelrod1" target="_blank">[40]</a>, (5) <i>Holodiscus</i>, 34.1 Ma <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Schorn1" target="_blank">[37]</a>, (6) <i>Spiraea</i>, 48 Ma <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Wehr1" target="_blank">[35]</a>, (7) <i>Rosa</i>, 34.1 Ma <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Meyer1" target="_blank">[38]</a>, (8) <i>Fragaria</i>, 2.5 Ma <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Matthews1" target="_blank">[45]</a>, (9) <i>Potentilla</i> 11.6 Ma <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Mai1" target="_blank">[42]</a>. A uniform prior with a maximum age of 115 Ma was used for all calibration points. Also indicated are the tribes of Rosaceae (species highlighted in blue and yellow) as well as the ivesioid clade highlighted in red. Time scale from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050358#pone.0050358-Gradstein1" target="_blank">[61]</a>.</p

Number of occurrence points for the 38 ivesioids and the maximum and minimum values for the four climate variables in their models.

<p>Temperatures are given in °C and precipitation in millimeters.</p

The ivesioid clade with node numbers indicated.

<p>Posterior probability (pp.) greater than 0.5 is shown. Branches with pp. greater than 0.95 are shown with thicker lines. Nodes for which ancestral models were projected into climate scenarios are indicated with numbers in boldface.</p