Joint angle affects volitional and magnetically-evoked neuromuscular performance differentially

This study examined the volitional and magnetically-evoked neuromuscular performance of the quadriceps femoris at functional knee joint angles adjacent to full extension. Indices of volitional and magnetically-evoked neuromuscular performance (N= 15 healthy males; 23.5 ± 2.9 years; 71.5 ± 5.4 kg; 176.5 ± 5.5 cm) were obtained at 25°; 35° and 45° of knee flexion. Results showed that volitional and magnetically-evoked peak force (PFV; PTFE, respectively) and electromechanical delay (EMDV; EMDE, respectively) were enhanced by increased knee flexion. However, greater relative improvements in volitional compared to evoked indices of neuromuscular performance were observed with increasing flexion from 25° to 45° (e.g. EMDV; EMDE: 36% vs. 11% improvement, respectively; F[2,14] = 6.8; p < 0.05). There were no significant correlations between EMDV and EMDE or PFV and PTFE, respectively at analogous joint positions. These findings suggest that the extent of the relative differential between volitional and evoked neuromuscular performance capabilities is joint angle-specific and not correlated with performance capabilities at adjacent angles, but tends to be smaller with increased flexion. As such, effective prediction of volitional from evoked performance capabilities at both analogous and adjacent knee joint positions would lack robustness

Repeated exercise stress impairs volitional but not magnetically evoked electromechanical delay of the knee flexors

The effects of serial episodes of fatigue and recovery on volitional and magnetically evoked neuromuscular performance of the knee flexors were assessed in twenty female soccer players during: (i) an intervention comprising 4x35s maximal static exercise; (ii) a control condition. Volitional peak force (PFV) was impaired progressively (-16 % vs. baseline: 235.3±54.7 to 198.1±38.5 N) by the fatiguing exercise and recovered to within -97 % of baseline values following six-minutes of rest. Evoked peak twitch force (PTFE) was diminished subsequent to the fourth episode of exercise (23.3 %: 21.4±13.8 vs. 16.4±14.6 N) and remained impaired at this level throughout the recovery. Impairment of volitional electromechanical delay performance (EMDV) following the first episode of exercise (25.5 % :55.3±11.9 vs. 69.5±24.5 ms) contrasted with concurrent improvement (10.0 %: 24.5±4.7 vs. 22.1±5.0 ms) in evoked electromechanical delay (EMDE) (p <0.05) and this increased disparity between EMDE and EMDV remained during subsequent periods of intervention and recovery. The fatiguing exercise provoked substantial impairments to volitional strength and EMDV that showed differential patterns of recovery. However, improved EMDE performance might identify a dormant capability for optimal muscle responses during acute stressful exercise and an improved capacity to maintain dynamic joint stabilty during critical episodes of loading

Longer Electromechanical Delay Impairs Hamstrings Explosive Force versus Quadriceps

Introduction Explosive neuromuscular performance refers to the ability to rapidly increase force in response to neuromuscular activation. The lower explosive force production of the hamstrings relative to the quadriceps could compromise knee joint stability and increase the risk of anterior cruciate ligament injury. However, the time course of the rise in explosive force of the hamstrings and quadriceps from their initial activation, and thus the explosive hamstrings-to-quadriceps (H/Q) force ratio, has not been documented.Methods The neuromuscular performance of 20 untrained males was assessed during a series of isometric knee flexion and extension contractions, with force and surface EMG of the hamstrings and quadriceps recorded during explosive and maximum voluntary contractions. Hamstrings force was expressed relative to quadriceps force to produce hamstring-to-quadriceps ratios of explosive H/Q force and H/Q maximum voluntary force. For the explosive contractions, agonist electromechanical delay (EMD), agonist and antagonist neural activation were assessed.Results The quadriceps was 79% stronger than the hamstrings, but quadriceps explosive force was up to 480% greater than the hamstrings from 25 to 50 ms after first activation. Consequently, the explosive H/Q force ratio was very low at 25 and 50 ms (0%–17%) and significantly different from H/Q maximum voluntary force ratio (56%). Hamstrings EMD was 95% greater than quadriceps EMD (44.0 vs 22.6 ms), resulting in a 21-ms later onset of force in the hamstrings that appeared to explain the low explosive H/Q force ratio in the early phase of activation.Conclusions Prolonged hamstrings EMD appears to impair early phase (0–50 ms) explosive force production relative to the quadriceps and may render the knee unstable and prone to anterior cruciate ligament injury during this period

Knee joint neuromuscular activation performance during muscle damage and superimposed fatigue

This study examined the concurrent effects of exercise-induced muscle damage and superimposed acute fatigue on the neuromuscular activation performance of the knee flexors of nine males (age: 26.7 ± 6.1yrs; height 1.81 ± 0.05m; body mass 81.2 ± 11.7kg [mean ± SD]). Measures were obtained during three experimental conditions: (i) FAT-EEVID, involving acute fatiguing exercise performed on each assessment occasion plus a single episode of eccentric exercise performed on the first occasion and after the fatigue trial; (ii) FAT, involving the fatiguing exercise only and; (iii) CON consisting of no exercise. Assessments were performed prior to (pre) and at lh, 24h, 48h, 72h, and 168h relative to the eccentric exercise. Repeated-measures ANOVAs showed that muscle damage within the FAT-EEVID condition elicited reductions of up to 38%, 24%) and 65%> in volitional peak force, electromechanical delay and rate of force development compared to baseline and controls, respectively (F[io, 80] = 2.3 to 4.6; p to 30.7%>) following acute fatigue (Fp; i6] = 4.3 to 9.1; p ; Fp, iq = 3.9; p <0.05). The safeguarding of evoked muscle activation capability despite compromised volitional performance might reveal aspects of capabilities for emergency and protective responses during episodes of fatigue and antecedent muscle damaging exercise

Effects of acute fatigue on the volitional and magnetically-evoked electromechanical delay of the knee flexors in males and females

Neuromuscular performance capabilities, including those measured by evoked responses, may be adversely affected by fatigue; however, the capability of the neuromuscular system to initiate muscle force rapidly under these circumstances is yet to be established. Sex-differences in the acute responses of neuromuscular performance to exercise stress may be linked to evidence that females are much more vulnerable to ACL injury than males. Optimal functioning of the knee flexors is paramount to the dynamic stabilisation of the knee joint, therefore the aim of this investigation was to examine the effects of acute maximal intensity fatiguing exercise on the voluntary and magnetically-evoked electromechanical delay in the knee flexors of males and females. Knee flexor volitional and magnetically-evoked neuromuscular performance was assessed in seven male and nine females prior to and immediately after: (i) an intervention condition comprising a fatigue trial of 30-seconds maximal static exercise of the knee flexors, (ii) a control condition consisting of no exercise. The results showed that the fatigue intervention was associated with a substantive reduction in volitional peak force (PFV) that was greater in males compared to females (15.0%, 10.2%, respectively, p < 0.01) and impairment to volitional electromechanical delay (EMDV) in females exclusively (19.3%, p < 0.05). Similar improvements in magnetically-evoked electromechanical delay in males and females following fatigue (21%, p < 0.001), however, may suggest a vital facilitatory mechanism to overcome the effects of impaired voluntary capabilities, and a faster neuromuscular response that can be deployed during critical times to protect the joint system

Neuromuscular performance and exercise stress associated with the stabilisation of synovial joints

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Considerations of the Principles of Resistance Training in Exercise Studies for the Management of Knee Osteoarthritis: A Systematic Review

Objective: To evaluate the methodologic quality of resistance training interventions for the management of knee osteoarthritis. Data Sources: A search of the literature for studies published up to August 10, 2015, was performed on MEDLINE (OVID platform), PubMed, Embase, and Physiotherapy Evidence Database databases. Search terms associated with osteoarthritis, knee, and muscle resistance exercise were used. Study Selection: Studies were included in the review if they were published in the English language and met the following criteria: (1) muscle resistance training was the primary intervention; (2) randomized controlled trial design; (3) treatment arms included at least a muscle conditioning intervention and a nonexercise group; and (4) participants had osteoarthritis of the knee. Studies using preoperative (joint replacement) interventions with only postoperative outcomes were excluded. The search yielded 1574 results. The inclusion criteria were met by 34 studies. Data Extraction: Two reviewers independently screened the articles for eligibility. Critical appraisal of the methodology was assessed according to the principles of resistance training and separately for the reporting of adherence using a specially designed scoring system. A rating for each article was assigned. Data Synthesis: There were 34 studies that described a strength training focus of the intervention; however, the principles of resistance training were inconsistently applied and inadequately reported across all. Methods for adherence monitoring were incorporated into the design of 28 of the studies, but only 13 reported sufficient detail to estimate average dose of exercise. Conclusions: These findings affect the interpretation of the efficacy of muscle resistance exercise in the management of knee osteoarthritis. Clinicians and health care professionals cannot be confident whether nonsignificant findings are because of the lack of efficacy of muscle resistance interventions, or occur through limitations in treatment prescription and patient adherence. Future research that seeks to evaluate the effects of muscle strength training interventions on symptoms of osteoarthritis should be properly designed and adherence diligently reported. 2016 American Congress of Rehabilitation Medicine.sch_phypub4814pu

Improvement of Outcomes With Nonconcurrent Strength and Cardiovascular-Endurance Rehabilitation Conditioning After ACI Surgery to the Knee

Context: Autologous chondrocyte implantation (ACI) aims to restore hyaline cartilage. Traditionally, ACI rehabilitation is prescribed in a concurrent (CON) format. However, it is well known from studies in asymptomatic populations that CON training produces an interference effect that can attenuate strength gains. Strength is integral to joint function, so adopting a nonconcurrent (N-CON) approach to ACI rehabilitation might improve outcomes. Objective: To assess changes in function and neuromuscular performance during 48 wk of CON and N-CON physical rehabilitation after ACI to the knee. Setting: Orthopedic Hospital NHS Foundation Trust. Design: Randomized control, pilot study. Participants: 11 patients (9 male, 2 female age 32.3 ± 6.6 y; body mass 79.3 ±10.4 kg; time from injury to surgery 7.1 ± 4.9 mo [mean ± SD]) randomly allocated to N-CON:CON (2:1). Interventions: Standardized CON and N-CON physiotherapy that involved separation of strength and cardiovascular-endurance conditioning. Main Outcome Measures: Function in the single-leg-hop test, patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], International Knee Documentation Committee subjective questionnaire [IKDC]), and neuromuscular outcomes of peak force (PF), rate of force development (RFD), electromechanical delay (EMD), and sensorimotor performance (force error [FE]) of the knee extensors and flexors of the injured and noninjured legs, measured presurgery and at 6, 12, 24, and 48 wk postsurgery. Results: Factorial ANOVAs with repeated measures of group by leg and by test occasion revealed significantly superior improvements for KOOS, IKDC, PF, EMD, and FE associated with N-CON vs CON rehabilitation (F1.5,13.4 GG = 3.7-4.7, P < .05). These results confirm increased peak effectiveness of N-CON rehabilitation (~4.5-13.3% better than CON over 48 wk of rehabilitation). N-CON and CON showed similar patterns of improvement for single-leg-hop test and RFD. Conclusions: Nonconcurrent strength and cardiovascular-endurance conditioning during 48 wk of rehabilitation after ACI surgery elicited significantly greater improvements to functional and neuromuscular outcomes than did contemporary concurrent rehabilitation

Single measurement reliability and reproducibility of volitional and magnetically-evoked indices of neuromuscular performance in adults

This study documents intra-session and inter-day reproducibility (coefficient of variation [V%]) and single measurement reliability (intra-class correlations [RI]; standard error of a single...sch_phy19pub2379pub