De ossium tuberculosi : dissertatio inauguralis medico-chirurgica / quam consensu et auctoritate gratiosi medicorum ordinis in Universitate Literarum Caesarea Dorpatensi ad gradum doctoris medicinae rite adipiscendum loco consueto publice defendet auctor Julius a Mebes

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Aspects of Isometric Contractions and Static Balance in Women with Symptomatic and Asymptomatic Joint Hypermobility

Objective: The aim of the current study was to identify the differences in strength, balance and muscle activity between women with normal mobility and those with generalized joint hypermobility (GJH) with and without symptoms. Methods: A total of 195 women, 67 normomobile (NM) and 128 hypermobile (HM), were included in this explorative cross-sectional study, whereby 56 were classified as symptomatically hypermobile (HM-s) and 47 as asymptomatically hypermobile (HM-as). Peak force (Fmax) and rate of force development (RFD) were measured during single-leg maximal voluntary isometric contractions of the knee extensor and flexor muscles in a sitting position. Balance was investigated on a force plate by calculating the anterior-posterior and medio-lateral sway while maintaining a single-leg stance for 15 seconds. During the sway measurements, muscle activity of six leg muscles was recorded using surface electromyography. The NM and HM groups were compared using independent samples t-tests, whereas the NM, HM-s and HM-as groups were compared using one-way ANOVAs with Tukey post-hoc tests (significance level p ≤ 0.05). Results: While no statistically significant differences were found for Fmax, RFD and postural sway between the three groups, semitendinosus muscle activity showed a difference between the NM and HM (p=0.019) as well as between the NM and HM-as groups (p=0.020). Conclusions: No clinically meaningful differences were found between the three groups. This might be possibly due to the fact that the performance measurements were not sensitive and the motor tasks not challenging enough to detect differences in neuromuscular behavior of the investigated groups

Effect of resistance training on muscle properties and function in women with generalized joint hypermobility: a single-blind pragmatic randomized controlled trial.

BACKGROUND Generalized joint hypermobility is defined as an excessive range of motion in several joints. Having joint hypermobility is not a pathology, but when associated with pain and other symptoms, it might affect health and function. Evidence for physiotherapy management is sparse and resistance training might be a possible intervention. Thus, the effects of 12-week resistance-training on muscle properties and function in women with generalized joint hypermobility were evaluated. METHODS In this single-blind randomized controlled trial women between 20 and 40 years with generalized joint hypermobility (Beighton score at least 6/9) were included. Participants were randomly allocated to 12-week resistance training twice weekly (experimental) or no lifestyle change (control). Resistance training focused on leg and trunk muscles. Primary outcome was muscle strength; additional outcomes included muscle properties, like muscle mass and density, functional activities, pain and disability. Training adherence and adverse events were recorded. RESULTS Of 51 participating women 27 were randomised to training and 24 into the control group. In each group 11 women had joint hypermobility syndrome, fulfilling the Brighton criteria, while 24 (89%) in the training group and 21 (88%) in the control group mentioned any pain. The mean strength of knee extensors varied in the training group from 0.63 (sd 0.16) N/bm before training to 0.64 (sd 0.17) N/bm after training and in the control group from 0.53 (sd 0.14) N/bm to 0.54 (sd 0.15) N/bm. For this and all other outcome measures, no significant differences between the groups due to the intervention were found, with many variables showing high standard deviations. Adherence to the training was good with 63% of participants performing more than 80% of sessions. One adverse event occurred during training, which was not clearly associated to the training. Four participants had to stop the training early. CONCLUSIONS No improvement in strength or muscle mass by self-guided resistance training was found. Low resistance levels, as well as the choice of outcome measures were possible reasons. A more individualized and better guided training might be important. However, program adherence was good with few side effects or problems triggered by the resistance training. TRIAL REGISTRATION This trial was prospectively registered in the ISRCTN registry ( www.isrctn.com , BMC, Springer Nature) on July 16, 2013 as ISRCTN90224545 . The first participant was enrolled at October 25, 2013

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