Contributions to successful trip recovery in younger and older adults

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Whole body coordination and knee movement control during five rehabilitation exercises

Knee rehabilitation exercises to improve motor control, target movement fluency and displacement variability. Although knee movement in the frontal plane during exercise is routinely assessed in clinical practice, optimal knee control remains poorly understood. In this study, twenty-nine healthy participants (height: 1.73±0.11 m, mass: 73.5±16.4 kg, age: 28.0±6.9 years) performed four repetitions of five rehabilitation exercises whilst motion data were collected using the VICON PlugInGait full body marker set. Fluency and displacement variability were calculated for multiple landmarks, including Centre of Mass (CoM) and knee joint centres. Fluency was calculated as the inverse of the average number of times a landmark velocity in the frontal plane crossed zero. Variability was defined as the standard deviation of the frontal plane movement trajectories. CoM fluency and displacement variability were significantly different between tasks (p<0.001). CoM displacement variability was consistently smallest compared to the constituent landmarks (p<0.005). This was interpreted as a whole body strategy of compensatory variability constraining CoM frontal plane movement. Ipsilateral knee fluency (p<0.01) and displacement variability (p<0.001) differed substantially between tasks. The role of the weight-bearing knee seemed dependent on task constraints of the overall movement and balance, as well as constraints specific for knee joint stability

Motor control strategies during double leg squat following anterior cruciate ligament rupture and reconstruction: an observational study

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 (SYMMsup) and of the % support moment by the knee (SYM%supkn) in CONT (R2 = -0.07). Data distribution average indicated good symmetry. ACLR showed a significant correlation between SYMMsup and SYM%supkn (R2 = 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 SYMMsup and SYM%supkn (R2 = 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

Activity progression for anterior cruciate ligament injured individuals

Background: Functional exercises such as distance hop, squatting and gait are important in the rehabilitation of anterior cruciate ligament deficient and reconstructed individuals but movement compensations and incomplete recovery persist. This study aimed to; 1. Identify how these tasks pose different challenges; 2. Evaluate if these activities challenge anterior cruciate ligament groups differently compared to controls. Methods: Motion and force data were collected during distance hop, squatting and gait for 20 anterior cruciate ligament deficient, 21 reconstructed and 21 controls. Findings: For all groups knee range of motion was greatest during squatting, intermediate during hopping and smallest during gait (p < 0.01). Peak internal knee extensor moments were greatest during distance hop (p < 0.01). The mean value of peak knee moments were reduced in squatting and gait (p < 0.01) compared to hop. Peak internal extensor moments were significantly larger during squatting and external adductor moments during gait (p < 0.01). Fluency was highest during squatting (p < 0.01). Anterior cruciate ligament demonstrated good recovery of gait but anterior cruciate ligament deficient adopted a strategy of increased fluency (p < 0.01). During squatting knee range of motion and peak internal knee extensor moment were reduced in anterior cruciate ligament (p < 0.01). Both anterior cruciate ligament groups hopped a shorter distance (p < 0.01) and had reduced knee range of motion (p < 0.025). Anterior cruciate ligament reconstructed had reduced fluency (p < 0.01). Interpretation: Distance hop was the most challenging activity; squatting and gait were of similar difficulty but challenged patients in different ways. Despite squatting being an early, less challenging exercise, anterior cruciate ligament groups demonstrated numerous compensation strategies, indicating that this may be more challenging for anterior cruciate ligament than gait

The clinical effectiveness of self-care interventions with an exercise component to manage knee conditions: a systematic review

Objective. Treatment of knee conditions should include approaches to support self-care and exercise based interventions. The most effective way to combine self-care and exercise has however not been determined sufficiently. Therefore the aim was to evaluate the clinical effectiveness of self-care programmes with an exercise component for individuals with any type of knee conditions. Methods. A keyword search of Medline, CINAHL, Amed, PsycInfo, Web of Science, and Cochrane databases was conducted up until January 2015. Two reviewers independently assessed manuscript eligibility against inclusion/exclusion criteria. Study quality was assessed using the Downs and Black quality assessment tool and the Cochrane Risk of Bias Tool. Data were extracted about self-care and exercise intervention type, control intervention, participants, length of follow-up, outcome measures, and main findings. Results. From the 7392 studies identified through the keyword search the title and abstract of 5498 were screened. The full text manuscripts of 106 studies were retrieved to evaluate their eligibility. Twenty-one manuscripts met the inclusion/exclusion criteria. Conclusion. The treatment potential of combined self-care and exercise interventions has not been maximised because of limitations in study design and failure to adequately define intervention content. Potentially the most beneficial self-care treatment components are training self-management skills, information delivery, and goal setting. Exercise treatment components could be strengthened by better attention to dose and progression. Modern technology to streamline delivery and support self-care should be considered. More emphasis is required on using self-care and exercise programmes for chronic condition prevention in addition to chronic condition management

Virtual reality based double leg squat exercise: preliminary study [Poster]

The aim of this study was to examine the effect of different types of augmented feedback, based on movement analysis, on squatting performance. Eight healthy volunteers performed three double leg squatting tests with and without feedback. Initial results from this pilot study showed that kinetic squatting strategies could be altered by kinetic more than by kinematic feedback

Patellofemoral joint compression forces in backward and forward running

AbstractPatellofemoral pain (PFP) is a common injury and increased patellofemoral joint compression forces (PFJCF) may aggravate symptoms. Backward running (BR) has been suggested for exercise with reduced PFJCF.The aims of this study were to (1) investigate if BR had reduced peak PFJCF compared to forward running (FR) at the same speed, and (2) if PFJCF was reduced in BR, to investigate which biomechanical parameters explained this. It was hypothesized that (1) PFJCF would be lower in BR, and (2) that this would coincide with a reduced peak knee moment caused by altered ground reaction forces (GRFs).Twenty healthy subjects ran in forward and backward directions at consistent speed. Kinematic and ground reaction force data were collected; inverse dynamic and PFJCF analyses were performed.PFJCF were higher in FR than BR (4.5±1.5; 3.4±1.4BW; p<0.01). The majority of this difference (93.1%) was predicted by increased knee moments in FR compared to BR (157±54; 124±51Nm; p<0.01). 54.8% of differences in knee moments could be predicted by the magnitude of the GRF (2.3±0.3; 2.4±0.2BW), knee flexion angle (44±6; 41±7) and center of pressure location on the foot (25±11; 12±6%) at time of peak knee moment. Results were not consistent in all subjects.It was concluded that BR had reduced PFJCF compared to FR. This was caused by an increased knee moment, due to differences in magnitude and location of the GRF vector relative to the knee. BR can therefore be used to exercise with decreased PFJCF