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BACKGROUND: It is important for clinicians and researchers to perform dynamic postural control evaluation for predicting musculoskeletal conditions, injury prevention, and rehabilitation. OBJECTIVE: The purpose of this study was to investigate the relationship (1) between the eccentric strength of the knee extensors and star excursion balance test (SEBT), and (2) between the knee proprioception and SEBT. METHODS: Forty healthy young adults participated in this study. The eccentric peak torque (EPT) of the knee extensors, joint position sense, and force sense were measured. The participants also performed SEBT. Pearson’s product-moment correlation and multiple linear regression analysis were used to determine the relationship between the variables and SEBT. RESULTS: The posteromedial direction of the SEBT was positively and strongly correlated with EPT (r= 0.74, P< 0.01). The anterior and posterolateral directions were positively and moderately correlated with EPT (r= 0.46, P< 0.01, and r= 0.69, P< 0.01, respectively.). However, knee proprioception was not correlated with all the directions of SEBT (P> 0.05). According to the results of multiple linear regression analysis, EPT of the knee extensors significantly predicted SEBT reach distances. CONCLUSION: The eccentric strength of the knee extensors seems to be an essential factor in dynamic postural control. However, the knee proprioception did not show a significant correlation with SEBT.

We examined whether the magnitude of muscle damage indicated by changes in maximal voluntary isometric contraction (MVIC) strength 1 to 3 d after unaccustomed eccentric exercise (ECC) was correlated with changes in central and peripheral neuromuscular parameters immediately post-ECC.Twenty participants (19-36 yr) performed six sets of eight eccentric contractions of the knee extensors. Rate of force development (RFD) during knee extensor MVIC, twitch force, rate of force development (RFDRT) and rate of relaxation (RRRT) of the resting twitch, maximal M-wave (MMAX), voluntary activation, silent period duration, motor-evoked potentials (MEP) and short-interval intracortical inhibition were assessed before, immediately after, and 1 to 3 d post-ECC. Relationships between changes in these variables immediately post-ECC and changes in MVIC strength at 1 to 3 d post-ECC were examined by Pearson product-moment (r) or Spearman correlations.Maximal voluntary isometric contraction strength decreased (-22.2% ± 18.4%) immediately postexercise, and remained below baseline at 1 (-16.3% ± 15.2%), 2 (-14.7% ± 13.2%) and 3 d post-ECC (-8.6% ± 15.7%). Immediately post-ECC, RFD (0-30-ms: -38.3% ± 31.4%), twitch force (-45.9% ± 22.4%), RFDRT (-32.5% ± 40.7%), RRRT (-38.0% ± 39.7%), voluntary activation (-21.4% ± 16.5%) and MEP/MMAX at rest (-42.5% ± 23.3%) also decreased, whereas the silent period duration at 10%-MVIC increased by 26.0% ± 12.2% (P0.05). Decreases in RFD at 0 to 30 ms, 0 to 50 ms, and 0 to 100 ms immediately post-ECC were correlated (P0.05) with changes in MVIC strength at 1 d (r = 0.56-0.60) and 2 d post-ECC (r = 0.53-0.63). Changes in MEP/MMAX at 10%-MVIC immediately post-ECC were correlated with changes in MVIC strength at 1 d (r = -0.53) and 2 d (r = -0.54) post-ECC (P0.05).The magnitude of decrease in MVIC strength at 1 to 3 d after ECC was associated with the magnitude of changes in RFD and MEP/MMAX immediately post-ECC. However, based on individual data, these markers were not sensitive for the practical detection of muscle damage.

Clinical Scenario: Knee pathologies often require rehabilitation to address the loss of knee-extensor (KE) strength, function, and heightened pain. However, in the early stages of rehabilitation, higher loads may be contraindicated. Blood flow restriction (BFR) resistance training does not require high loads and has been used clinically to promote strength improvements in a variety of injured populations. BFR resistance training may be an effective alternative to high-intensity resistance training during early rehabilitation of knee pathologies. Clinical Question: Following a knee injury, does BFR resistance training improve KE strength and function, and reduce patient-reported pain? Summary of Key Findings: Four randomized controlled trial studies met the inclusion criteria. Each included study evaluated the use of BFR resistance training on knee pathologies and the effects on KE strength, functional outcomes, and pain compared with high- or low-load resistance training. All 4 studies reported significant improvements in KE strength, function, and pain through a variety of outcome measures, following BFR resistance training use as the treatment. Clinical Bottom Line: There is consistent evidence to support the use of BFR resistance training as a treatment intervention following knee injury and as a means to improve KE strength and function and to reduce pain. Strength of Recommendation: Grade A evidence supporting the use of BFR resistance training for improvement in KE strength and function, and the reduction of patient-reported pain following an acute or chronic knee pathology.

Objectives: Prolonged muscle weakness after total hip arthroplasty (THA) remains a problem. Despite increasing physical activity up to 3 years after surgery, muscle strength was decreased to 80–90% of the healthy side 2 years after THA. The objective of the present study was to identify the nutritional factors related to muscle weakness 1 year after THA. Methods: Persons who underwent THA were divided into 2 groups according to the cutoff point of knee extensor strength that represents functional limitation: a normal-strength group of 71 persons and a muscle weakness group of 91 persons. The investigators assessed lower limb isometric strength, the 10-m timed gait test, and daily intakes of energy and nutrients from preoperative to 1 year after THA. The differences in nutrient intakes between the 2 groups (normal-strength group and muscle weakness group) were examined by multiple logistic regression analysis. Results: There was a significant difference between the groups in energy intake. Daily protein intake was related to knee extension strength gain above the cutoff point 1 year after THA. Conclusions and Implications: The present study suggested that to prevent prolonged muscle weakness after THA, a sufficient protein intake as well as an exercise intervention may be needed even half a year or after.

PURPOSE To compare the clinical and radiological outcomes in patients undergoing anterior cruciate ligament reconstruction (ACLR) with, or without, LARS augmentation. METHODS One-hundred and thirty-six patients that underwent double-bundle ACLR with (DB Hams/LARS, n = 67), or without (DB Hams, n = 69), LARS augmentation, were assessed clinically and with Magnetic Resonance Imaging (MRI) at a minimum of 7-years post-surgery. Patients were assessed via patient-reported outcome measures (PROMs), KT-1000 (laxity), isokinetic knee extensor and flexor strength and a 4-hop test battery. Limb symmetry indices (LSIs) were calculated. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) evaluated knee status via MRI. Sport participation, secondary operations, ACL re-tears and contralateral ACL tears were reported. RESULTS No differences (n.s.) were observed in demographics, PROMs, KT-1000 scores or strength and hop LSIs. Normal (

Jean, LMY, Gross, DP, and Chiu, LZF. Knee extensor strength in anterior cruciate ligament-deficient individuals following normal and modified squats: a randomized controlled trial. J Strength Cond Res 36(1): 47-54, 2022-Training with barbell squats, which load the quadriceps, increases knee extensor strength. Anterior cruciate ligament (ACL) injury results in a quadriceps avoidance substitution strategy, which may impair the efficacy of barbell squat training. Modified squats to promote quadriceps loading have been proposed to facilitate restoring knee extensor strength and function. This research compared resistance training using traditional squats (TRAD) versus traditional plus modified squats (EXP) in ACL-deficient individuals. Thirty-seven ACL-deficient individuals were randomly assigned to TRAD or EXP. Knee extensor function was assessed using maximum isometric strength testing and 3D motion analysis of sit-to-stand. Effect sizes for minimum meaningful improvement were established (d = 0.28-0.47). There were no significant differences between TRAD and EXP for knee extensor strength before, in response to, or after the training interventions (p0.05). Involved limb knee extensor strength increased at 15° (95% CI [0.09, 0.27] N·m·kgBM-1, d = 0.60), 30° (95% CI [0.25, 0.48] N·m·kgBM-1, d = 0.82), 45° (95% CI [0.32, 0.58] N·m·kgBM-1, d = 0.78), and 75° (95% CI [0.18, 0.46] N·m·kgBM-1, d = 0.54) knee flexion. Involved limb knee extensor net joint moment work in sit-to-stand (95% CI [0.034, 0.135] J·kgBM-1, d = 0.48) increased in both groups. Squat training was effective for increasing involved limb isometric knee extensor strength and knee extensor work performed in the sit-to-stand. Modified squats do not seem to provide additional benefit.

PURPOSE We previously reported that the cross-sectional area of the quadriceps femoris is correlated with the sprint performance of preadolescent sprinters. This finding suggests a close relationship between knee extensor torque-enhancing morphology and sprint performance in this young population. To further clarify this issue, in this study, we examined the relationships of the quadriceps femoris muscle volume (MV) and knee extensor moment arm (MA) with sprint performance in preadolescent sprinters. METHODS The quadriceps femoris MV and knee extensor MA in 15 sprint-trained preadolescent boys were measured using magnetic resonance imaging. Sprint performance was evaluated using a personal best 100-m sprint time and the higher 50-m sprint velocity of two 50-m sprint tests. RESULTS The quadriceps femoris MV and knee extensor MA were significantly correlated with personal best 100-m sprint time (r = -0.810 and -0.752, P ≤ 0.001 for both) and 50-m sprint velocity (r = 0.814 and 0.702, P

The generalized joint hypermobility (GJH) syndrome is a condition characterized by a connective tissue disorder that may negatively affect the muscle function and muscle balance in the lower limbs. The aim of study was to compare isometric and dynamic maximal strength, total work, active optimum angle, electromyographic activity strategy, and the muscle imbalance of the knee extensors and flexors using the hamstrings/quadriceps ratio (H:Q) in individuals with GJH and without GJH (NGJH). Forty healthy untrained men and women (20 with GJH and 20 without GHJ) participated in the study. Dynamic, isometric (30° and 60°) peak torque, total work, active optimum angle, and agonist and antagonist muscle activation of knee extensors and flexors were obtained. The conventional and functional H:Q ratio were calculated using peak torque, rate of torque development, muscle activation, and total work. The dynamic and isometric peak torque, total work, active optimum angle, and agonist and antagonist muscle activation were not different between GJH and NGJH (p > 0.05). Conventional and functional H:Q ratios calculated using the different neuromuscular parameters were considered below the normative values for both groups, with no difference between groups (p > 0.05). The lack of difference between groups suggests that hypermobility does not have a greater influence on maximal strength and in underlying mechanisms related to knee extensors and flexors muscle activation and muscle balance in the knee joint.

Background Lower limb strength asymmetry is associated with re-injury after anterior cruciate ligament reconstruction (ACLR). This study investigated limb symmetry indices (LSIs) during isokinetic knee extensor and flexor assessment after ACLR. Methods Overall, 25 patients underwent isokinetic knee extensor and flexor strength assessment, 9–12 months after ACLR with a semitendinosus autograft. While patients were included if they presented with peak knee extensor (PKET) and flexor (PKFT) torque LSIs ≥ 90%, LSIs were calculated at designated points throughout the isokinetic torque range of motion, including: 15°, 30°, 45°, 60° and 75° (from 90° of knee flexion) during PKET and 15°, 30°, 45°, 60° and 75° (from full knee extension) during PKFT. T-tests investigated limb differences for PKET and PKFT, as well as at the final 75° assessment point during knee extension and flexion, between: (1) males and females, (2) those that did, or did not, undergo meniscal surgery, and (3) those undergoing ACLR on their dominant or non-dominant limb. Results Significant differences between limbs were observed for PKET at 15° (p = 0.040) and 75° (p = 0.002), and for PKFT at 60° (p = 0.001) and 75° (p 0.05) were seen based on gender, meniscal surgery or whether ACLR was on the dominant or non-dominant limb. Conclusion Despite 100% of patients demonstrating PKET and PKFT LSIs ≥ 90%, LSI differences existed at designated points throughout the knee extensor and flexor torque range of motion. Analysis of torques throughout full range should be considered in future studies, as comparison of isolated peak measures miss strength deficits.

The present study compared isometric, concentric and eccentric contractions at the same torque-time integral for changes in neuromuscular fatigue and muscle damage parameters. Healthy men (18–24 years) were placed to either isometric (ISO), concentric (CONC), or eccentric (ECC) group (n = 11/group) that performed corresponding contractions of the knee extensors to exert the same amount of torque-time integral (24,427 ± 291 Nm·s). Changes in maximal voluntary contraction (MVC) torque, voluntary activation, evoked torque at 10 Hz and 100 Hz and its ratio, M-wave amplitude, and muscle soreness were assessed immediately before and after, 1 h, 1 day and 2 days after each exercise, and were compared among the groups. MVC torque decreased immediately after ISO (− 17.0 ± 8.3%), CONC (− 21.7 ± 11.5%) and ECC (− 26.2 ± 15.6%) similarly (p = 0.35), but the decrease sustained longer (p

This study aimed to compare neuromuscular alterations and perceptions of effort and muscle pain induced by concentric and eccentric cycling performed at the same power output or effort perception. Fifteen participants completed three 30-min sessions: one in concentric at 60% peak power output (CON) and two in eccentric, at the same power output (ECCPOWER ) or same perceived effort (ECCEFFORT ). Muscle pain, perception of effort, oxygen uptake as well as rectus femoris and vastus lateralis electromyographic activities were collected when pedaling. The knee extensors maximal voluntary contraction (MVC) torque, the torque evoked by double stimulations at 100 Hz and 10 Hz (Dt100; Dt10), and the voluntary activation level (VAL) were evaluated before and after exercise. Power output was higher in ECCEFFORT than CON (89.1 ± 23.3% peak power). Muscle pain and effort perception were greater in CON than ECCPOWER (p 0.43). MVC torque, Dt100, and VAL dropped in all conditions (p

What is the central question of this study? Is there a critical threshold beyond which the loss of muscle contractility is regulated by the level of muscle activation during single-limb exercise of differing intensities and volumes? What is the main finding and its importance? Plateaus in the decline in muscle contractility during single-limb knee extension depended on both exercise volume and contraction intensity. A plateau was only evident with an increase in exercise volume. Muscle activation increased and did not decline despite substantial reductions in contractility. The findings indicate that the decrease in muscle contractility exhibited by resistance-trained men during the performance of submaximal isometric contractions with the knee extensors was not regulated by the level of muscle activation.Our study examined the influence of contraction intensity and exercise volume on changes in muscle contractility and activation of the knee extensor muscles. Maximal voluntary torque (MVT) and rate of change in torque, surface electromyograms, voluntary activation, V-waves and quadriceps resting twitch measures were assessed in 10 resistance-trained men during two experimental sessions. Each session began with an initial baseline series of contractions at a fixed intensity of 40% or 80% MVT. The 40%-only session continued with five contractions to task failure at 40% MVT. The 80% session continued with five contractions to failure each at 80%, 60% and 40% MVT. Greater reductions in MVT were observed during the baseline contractions of the 40%-only session compared with the 80% session at each matched-volume time point (P 0.05), with similar changes in twitch values (P 0.001). MVT and twitch values plateaued at each intensity during the 80% session and were significantly different across intensities: 80%60%40% (P 0.001). There were no differences for measures during the five contractions at 40% MVT performed on the different days, despite a greater volume of exercise performed prior to the 40% MVT during the 80% session. At each contraction intensity, a plateau in contractility loss was observed as more contractions were performed. We found that initial increases in muscle activation were maintained in the presence of increases in exercise volume and, in contrast to the critical-threshold hypothesis, did not decline in parallel with reductions in muscle contractility.

Identifying the factors that contribute to individual differences in mid-level intensity neuromuscular fatigue is essential to improve performance and effective exercise in training and rehabilitation. This study investigated factors affecting individual differences in knee extensor fatigue induced by sustained isometric mid-level contractions. Twenty-six healthy young men performed a sustained fatiguing contraction to task failure at 40% maximal voluntary contraction (MVC) torque of the knee extensors. The MVC torque (TQMVC), evoked triplet torque (TQTRI), and voluntary activation (VA%) of the knee extensors were determined before and after the fatiguing task. Differences in TQMVC, TQTRI, and VA% before and after the fatiguing task were examined, and the relationship between TQMVC and TQTRI or VA% after the fatiguing task normalized to baseline was examined using Pearson product-moment correlation analysis. TQMVC and TQTRI decreased significantly after the fatiguing task (31.1% decrease for TQMVC, 38.8% decrease for TQTRI, p < 0.001), whereas VA% did not change significantly (4.2% increase for VA%, p = 0.057). After the fatiguing task, the normalized TQMVC was significantly correlated with the normalized TQTRI (r = 0.617, p < 0.001), but not with the normalized VA% (r = 0.348, p = 0.082). Individual differences in knee extensor fatigue induced by sustained mid-level contraction were more affected by peripheral fatigue than by central fatigue. Therefore, focusing on fatigue resistance in peripheral areas is important to improve endurance in moderate-intensity exercises.

Background: Compared with normoxia, repeated short (5–10 s) sprints (>10 efforts) with incomplete recovery (≤30 s) in hypoxia likely cause substantial performance reduction accompanied by larger metabolic disturbances and magnitude of neuromuscular fatigue. However, the effects of hypoxia on performance of repeated long (30 s) “all-out” efforts with near complete recovery (4.5 min) and resulting metabolic and neuromuscular adjustments remain unclear. Purpose: The intention was to compare acute performance, metabolic, and neuromuscular responses across repeated Wingates between hypoxia and normoxia. Methods: On separate visits, 6 male participants performed 4 × 30-second Wingate efforts with 4.5-minute recovery in either hypoxia (fraction of inspired oxygen: 0.145) or normoxia. Responses to exercise (muscle and arterial oxygenation trends, heart rate, and blood lactate concentration) and the integrity of neuromuscular function in the knee extensors were assessed for each exercise bout. Results: Mean (P = .80) and peak (P = .92) power outputs, muscle oxygenation (P = .88), blood lactate concentration (P = .72), and perceptual responses (all Ps > .05) were not different between conditions. Arterial oxygen saturation was significantly lower, and heart rate higher, in hypoxia versus normoxia (P Ps Ps > .05). Conclusion: Despite heightened arterial hypoxemia and cardiovascular solicitation, hypoxic exposure during 4 repeated 30-second Wingate efforts had no effect on performance and accompanying metabolic and neuromuscular adjustments.

Brandenberger, KJ, Warren, GL, Ingalls, CP, Otis, JS, and Doyle, JA. Downhill running impairs activation and strength of the elbow flexors. J Strength Cond Res 35(8): 2145-2150, 2021-The purpose of this study was to determine if knee extensor injury induced by 1 hour of downhill running attenuated force production in the elbow flexors. Subjects completed either downhill running for 1 hour (injured group; n = 6) or sedentary behavior (control group; n = 6). Strength and voluntary activation (%VA) were measured by isometric twitch interpolation of the elbow flexor and knee extensor muscles at the following time points in relation to the injury: before injury (Pre), after injury (Post), 24 hours after injury (24Post), and 48 hours after injury (48Post). Mean (±SE) knee extensor strength was significantly reduced (53.5 ± 9.9%) Post and remained reduced at 24Post and 48Post in the injury group. Knee extensor muscle twitch strength was reduced Post and 24Post after the downhill run (p0.022). Elbow flexor muscle strength was significantly reduced Post (13.2 ± 3.9%) and 24Post (17.3 ± 4.0%). Elbow flexor muscle twitch strength was not significantly different at any time point. Elbow flexor muscle %VA was not significantly reduced compared with Pre, at Post (16.2 ± 5.1%), 24Post (20.9 ± 6.7%), or 48Post (12.9 ± 4.5%). A 1-hour downhill run significantly injured the knee extensors. The elbow flexor muscles remained uninjured, but strength of these muscles was impaired by reduced %VA. These data suggest muscle injury can lead to prolonged strength deficits in muscles distant from the injury and should be accounted for when scheduling training that may lead to delayed-onset muscle soreness.

Soft tissue sarcomas about the patellar tendon necessitate wide resection and thus present a significant reconstructive challenge. This article describes the novel use of a synthetic mesh graft to reconstruct the knee extensor mechanism as a single stage procedure after wide en bloc resection of an extraskeletal myxoid chondrosarcoma (EMC) in a patient with an invasive mass that was intimately associated with her patellar tendon.

Objective To test the effects of hot-water immersion on the rapid force production and parameters of neuromuscular function in healthy adults. Design Cross-sectional study. Methods Fifteen healthy adults (24.9 ± 5.6 years; 178 ± 11.4 cm; 72.8 ± 16.2 kg) performed neuromuscular assessments before, after and ∼15 min after either 90 min of 42 °C (hot) or 36 °C (sham-condition) water immersion (lower body). Knee extensors rate of torque development (RTD) was measured during explosive voluntary contraction in the interval of 0−50 ms (RTDV50) and 0−150 ms (RTDV150) and during electrically-evoked contractions by single twitches (RTDtwitch) and low- and high-frequencies doublets (RTD20Hz and 100Hz). Rate of EMG rise (RER) was calculated for voluntary contractions and half-relaxation time (HRT) and electromechanical delay (EMD) was measured during single twitches. Results After the hot-water immersion (when rectal and muscle temperature were elevated [↑1 °C and ↑2.4 °C, respectively]), RTDV50, RTD20Hz and RTD100Hz significantly increased and HRT decreased when compared to baseline and sham-condition (p Conclusion Increased muscle temperature provoked by 42 °C hot-water immersion increases the early phase of the RTD (

Background: The majority of people who work as tea plantation pickers are powerful. They carry heavy loads of tea on their backs while the roads are quite dangerous and sometimes cause problems. A balance training program has proven to reduce postural sway, increasing leg muscle strength and improving balance strategies. Objective:The aim of this study was to determine the effect of Vladimir Janda balance training methods with an external load on postural sway and leg muscle strength of tea pickers. Methods: The study design used was quasi-experimental with a randomized control group pretest-posttest design. Subjects were tea pickers consisting of a productive age group of 15 people and 15 people as a control treatment group. The Vladimir Janda method balance exercises were conducted over five weeks consisting of 5 phases. Phase I-IV were carried out 5 times a week, while the V phase was done 3 times a week and each session lasted 15 minutes. Postural sway was measured with a posturometer. Leg muscle strength was measured by a back-leg dynamometer. The statistical tests used were Independent T-test and the Mann-Whitney test. Results:The statistical test for the control and treatment groups using the Mann-Whitney test showed p = 0.001, meaning no external load effects on postural sway. Independent t-test showed p = 0.000, meaning there are differences in the effect between the treatment and control groups after being given balance exercises to increase leg muscle strength. Logistic regression test results obtained the ROC value of 0.917, meaning the Vladimir Janda balance training can affect the postural sway and knee extensor muscle strength by 91.7%. Conclusion: The Vladimir Janda balance exercise method can reduce postural sway and increase the strength of knee extensor muscles and ankle flexor Dorsi muscles. External loads can affect the postural sway.

We compared the acute effects of parallel back squat performed from different resistance training configurations on neuromuscular performance. Twenty-eight young adults underwent 4 experimental conditions: inter-repetition rest, traditional, traditional to failure, and rest-pause in the parallel back squat in a randomized, counterbalanced, and cross-over design. The neuromuscular performance was assessed through peak torque of knee extensors and flexors at two angular velocities (90 and 120 º/s) in three moments (before, post, and post-30 min). The peak torque of the knee extensors and flexors at 90 and 120 º/s decreased immediately after training for traditional, traditional to failure, and rest-pause (–8.1% to –17.7%, P0.05). Our results suggest the inter-repetition rest configuration seems to be a more appropriate strategy for maintaining the lower limb neuromuscular performance after a resistance training session.

The main purpose of the present study was to investigate maturation-related changes in force-related factors in gymnasts and untrained girls. A total of 60 female participants were divided into two groups of gymnasts and untrained individuals. Each group had three subgroups of preadolescents, adolescents, and adults according to Tanner's scale. Informed consent forms were obtained from each participant. After familiarity and initial measurements, each subject performed three maximal voluntary isometric contractions (MVIC) of the knee extensors at five different angles to determine the optimal angle of force production. The rate of force development (RFD) was calculated using the torque data. The EMG signal of the rectus femoris muscle was recorded during the MVIC test to measure voluntary activation (RMS). Gymnasts had more absolute torque in all three age groups (P

The spectral properties of surface electromyographic (EMG) signal in the rectus femoris (RF) and the coactivation in the medial hamstrings (MH) were investigated in 45 stroke subjects (22 ± 12 days post-onset) and 30 age-matched healthy controls who performed unilateral knee extensions at maximum effort (100% MVC) and during 5-s force-matching tasks (10, 30, 50% MVC). The spectral properties were obtained through a power spectrum analysis based on Fast Fourier Transform. The coactivation was measured as the MH amplitude (%max) and MH/RF amplitude ratio. Force variability was expressed as the coefficient of variation. Both knee extensors and flexors were weaker in the paretic leg than the non-paretic and control legs (p

BACKGROUND Lower-limb amputees have increased metabolic costs during walking that may be mitigated by maintaining quadriceps strength and power following amputation. However, there are no current studies investigating the relationship between thigh strength and walking performance in individuals with transfemoral amputation. OBJECTIVE To quantify the relationship between intact limb quadriceps strength in transfemoral amputees and six-minute walk test (6MWT) performance. DESIGN Descriptive laboratory study. SETTING Laboratory. PARTICIPANTS Eleven participants with unilateral transfemoral amputations from trauma or osteosarcoma (4 women/7 men, 46.21 ± 12.68 years old, 28.24 ± 20.57 years following amputation). INTERVENTIONS Strength and power testing on the intact limb followed by 6MWT with a flowmeter to measure oxygen uptake (VO2 ). MAIN OUTCOME MEASURES Strength included mass-normalized peak torque, average torque, and average power. 6MWT measures included total distance traveled and VO2 normalized to distance and mass. Significant correlations (P ≤ .05) were retained for a regression analysis. RESULTS Peak isokinetic knee extensor torque was correlated with total VO2 (r = -.60, P = .05) and distance traveled (r = .84, P = .001). Average isokinetic knee extensor torque was correlated with total VO2 (r = -.61, P = .046) and distance traveled (r = .85, P = .001). Average knee extensor power was correlated with total VO2 (r = -.67, P = .026) and distance traveled (r = .88, P

Purpose This study examined the relationships of knee extensor strength and quadriceps femoris size with sprint performance in sprinters. Methods Fifty-eight male sprinters and 40 body size-matched male non-sprinters participated in this study. The knee extensor isometric and isokinetic strengths were measured using a dynamometer. The isokinetic strength measurements were performed with slow and fast velocities at 60°/s and 180°/s, respectively. The quadriceps femoris muscle volume (MV) was measured using magnetic resonance imaging. The relative knee extensor strengths and quadriceps femoris MV were calculated by normalizing to body mass. Results Absolute and relative knee extensor strengths during two velocity isokinetic contractions, but not during isometric contraction, were significantly higher in sprinters than in non-sprinters (P = 0.047 to P = 0.018). In sprinters, there were positive correlations between all three knee extensor strengths and quadriceps femoris MV (r = 0.421 to 0.531, P = 0.001 to r = −0.477 and −0.409, P = 0.001 and Conclusions These findings suggest that despite the presence of the relationship between muscle strength and size, the knee extensor strength may be related to superior sprint performance in sprinters independently of the quadriceps femoris muscularity.

The bench press is commonly used to measure upper-body strength. While much emphasis has been placed on the upper-body, little is known about how the lower-body can play a role in bench press performance. Leg-drive is a technique that includes flexing the knee so the feet line up posterior to the knee joint, while simultaneously contracting the knee extensors isometrically during the lift. The purpose of this study was to compare strength characteristics of lifters in a standard bench press versus a leg-drive bench press over the course of 5-weeks of training. Twenty-three recreationally active males (age: 22.4 ± 2.1 years, height: 175.0 ± 5.9 cm, mass: 78.4 ± 9.5 kg) were randomized into a standard bench or leg-drive bench press group. Participants performed four sets to failure, two times per week for five weeks. Variables of interests were training volume and 1-repetition maximum (1RM) strength. For training volume, a 2 × 5 (group × week) repeated measures analysis of variance (RMANOVA) was used. For the 1RM’s, a 2 × 2 × 2 (group × press type × time) RMANOVA was used. A priori alpha levels were set to 0.05. Over time, both groups showed an approximate 6% increase in 1RM strength. Training volume for week 4 was 5.6% less than week 5, but was not different from weeks 1 through 3. No between-group differences were observed for 1RM strength or training volume. This results of this work indicates that 5 weeks of leg-drive training is effective in increasing 1RM strength, but was not more effective than standard bench press training. Practically, lifters should choose either lifting style based on personal preference.

The purpose of this investigation was to assess the muscular strength of the knee extensors and flexors muscles, agility and functionality between dominant leg (DL) vs. non-dominant leg (NDL) of professional soccer players during pre-season. Twenty-two healthy male professional soccer players (25.1 ± 3.8 years; 182.1 ± 5.9 cm; 79.3 ± 5.4 kg; body fat 14.6 ± 3.8%) from a club of the Brazilian second-division soccer league participated in this study. All soccer players underwent three tests to assess strength, power, and physical performance with an interval of 48 h inter-sessions. During the first assessment session, isokinetic tests were performed in which athletes performed maximal isokinetic concentric and eccentric contractions, as well as maximal isometric contractions. In the second and third assessment sessions, single leg step down and agility tests were performed, respectively. Maximum voluntary isometric contraction (MVIC) results showed a significant difference (p

Choe, KH, Coburn, JW, Costa, PB, and Pamukoff, DN. Hip and knee kinetics during a back-squat and deadlift. J Strength Cond Res 35(5): 1364-1371, 2021-The back-squat and deadlift are performed to improve hip and knee extensor function. The purpose of this study was to compare lower extremity joint kinetics (peak net joint moments [NJMs] and positive joint work [PJW]) between the back-squat and deadlift. Twenty-eight resistance-trained subjects (17 men: 23.7 ± 4.3 years, 1.76 ± 0.09 m, 78.11 ± 10.91 kg; 11 women: 23.0 ± 1.9 years, 1.66 ± 0.06 m, 65.36 ± 7.84 kg) were recruited. One repetition maximum (1RM) testing and biomechanical analyses occurred on separate days. Three-dimensional biomechanics of the back-squat and deadlift were recorded at 70 and 85% 1RM for each exercise. The deadlift demonstrated larger hip extensor NJM than the back-squat {3.59 (95% confidence interval [CI]: 3.30-3.88) vs. 2.98 (95% CI: 2.72-3.23) Nm·kg-1, d = 0.81, p < 0.001}. However, the back-squat had a larger knee extensor NJM compared with the deadlift (2.14 [95% CI: 1.88-2.40] vs. 1.18 [95% CI: 0.99-1.37] Nm·kg-1, d = 1.44 p < 0.001). More knee PJW was performed during the back-squat compared with the deadlift (1.85 [95% CI: 1.60-2.09] vs. 0.46 [95% CI: 0.35-0.58] J·kg-1, d = 2.10, p < 0.001). However, there was more hip PJW during the deadlift compared with the back-squat (3.22 [95% CI: 2.97-3.47] vs. 2.37 [95% CI: 2.21-2.54] J·kg-1, d = 1.30, p < 0.001). Larger hip extensor NJM and PJW during the deadlift suggest that individuals targeting their hip extensors may yield greater benefit from the deadlift compared with the back-squat. However, larger knee extensor NJM and PJW during the back-squat suggest that individuals targeting their knee extensor muscles may benefit from incorporating the back-squat compared with the deadlift.

Anterior cruciate ligament (ACL) reconstruction using hamstring tendons may involve harvesting of the gracilis tendon in addition to the semitendinosus tendon (ST) depending on the size of the ST graft. However, the effect of gracilis harvesting in addition to ST harvesting on muscle strength, such as the hamstring-to-quadriceps (HQ) ratio, remains unclear. Hence, this study aimed to investigate the effect of gracilis harvesting on subsequent knee muscle strength. Eighty-two patients who underwent ACL reconstruction were included in this retrospective study. They were divided into the following two groups depending on the tendon graft used for ACL reconstruction: the ST group (41 patients) and the semitendinosus tendon/gracilis tendon (STG) group (41 patients). The isokinetic peak torque of the knee extensor and flexor was measured using a BIODEX dynamometer at a velocity of 60°/s and 180°/s, respectively, 3 and 6 months after ACL reconstruction. The groups were compared in terms of the limb symmetry index (LSI) and HQ ratio. The significant difference in the knee flexor of the LSI at 6 months after ACL reconstruction was as follows: ST group, 120.3 ± 28.3 vs STG group, 105.6 ± 19.0 (p

Luedke, LE, Heiderscheit, BC, Williams, DSB, and Rauh, MJ. Factors associated with self-selected step rate in high school cross country runners. J Strength Cond Res 35(4): 1141-1148, 2021-Recommendations for step rate, or cadence, during distance running come from varying perspectives including performance, running economy, and injury risk. Studies of adult runners suggest that running experience and leg length may influence step rate, but limited evidence is available on factors that influence adolescent runner step rates. The purpose was to evaluate relationships between running experience, anthropometric factors, and lower extremity muscle strength with self-selected step rate in adolescent runners. Sixty-eight high school cross country runners (47 young women; age 16.2 ± 1.3 years) reported height, body mass, and running experience. Mean step rate was assessed at 3.3 m·s-1 and self-selected (mean 3.8 ± 0.5 m·s-1) speeds. Leg length and peak isometric strength of the hip abductors, knee extensors, and flexors were also measured. Step rates at 3.3 m·s-1 {r (95% confidence interval [CI]) = 0.44 [0.22, 0.61], p0.001} and self-selected (r [95% CI] = 0.45 [0.20, 0.66], p0.001) speeds were correlated with running experience. Step rates at 3.3 m·s-1 and self-selected speeds were inversely associated with body mass (r [95% CI] = -0.32 [-0.52, -0.09], p = 0.007 and r [95% CI] = -0.34 [-0.53, -0.11], p = 0.005, respectively), height (r [95% CI] = -0.40 [-0.58, -0.18], p = 0.01 and r [95% CI] = -0.32 [-0.52, -0.09], p = 0.008, respectively), and leg length (r [95% CI] = -0.48 [-0.64, -0.27], p0.001 and r [95% CI] = -0.35 [-0.52, -0.12], p = 0.004, respectively). No significant relationships were found between isometric strength values and step rate at either speed (p0.05). Adolescent runners with greater running experience displayed higher step rates. Hence, the lower step rates in runners with less experience may factor in the higher injury risk previously reported in novice runners. Runners with shorter leg length displayed higher step rates. Step rate recommendations should consider runner experience and anthropometrics.

Background/Objective: This study aimed to investigate the effects of regular hot water bathing (HWB), undertaken 10 min after the last training session of the day, on chronic adaptations to training in elite athletes. Methods: Six short-track (ST) speed skaters completed four weeks of post-training HWB and four weeks of post-training passive recovery (PR) according to a randomized cross-over study. During HWB, participants sat in a jacuzzi (40 °C; 20 min). Results: According to linear mixed models, maximal isometric strength of knee extensor muscles was significantly increased for training with HWB (p 0.05), including aerobic peak power output, the decline rate of jump height during 1 min-continuous maximal countermovement jumps (i.e. anaerobic capacity index), and the force-velocity relationship. Regarding specific tasks on ice, a small effect of training was found on both half-lap time and total time during a 1.5-lap all-out exercise (p = 0.0487; d = 0.23 and p = 0.0332; d = 0.21, respectively) but no additional effect of HWB was observed. Conclusion: In summary, the regular HWB protocol used in this study can induce additional effects on maximal isometric strength without compromising aerobic and anaerobic adaptations or field performance in these athletes.

BACKGROUND: Dietary protein has been related to muscle function in aging. Beyond total intake, parameters such as protein distribution across meals might also be important. OBJECTIVES: We aimed to examine prospective associations of different protein intake parameters with muscle strength and physical performance in community-dwelling older men and women. METHODS: In total, 524 men and 574 women aged 67-84 y at baseline (T1) were followed annually for 3 y (T2, T3, T4). Outcomes included handgrip strength (kPa), knee extensor strength (kg), and physical performance (Timed Up and Go, s) at T4, and their 3-y changes (T4 minus T1). Protein intake parameters were assessed using nine 24-h recalls collected over 3 y (T1, T2, T3) and included daily total intake (g/d), number of protein-providing meals and snacks, and protein distribution across meals (expressed as CV). Associations were examined by multivariable linear regression models including all protein intake parameters simultaneously. Also, the optimal protein dose (g) per meal for the maximum effect size of total daily intake was determined. RESULTS: Higher daily protein intake was associated with better knee extensor strength and physical performance at T4 in both sexes and less physical performance decline in women. Optimal protein doses per meal were 30-35 g in men and 35-50 g in women for these outcomes. In men, more uneven protein distribution was associated with better physical performance at T4 and less handgrip strength decline. In women, a higher number of protein-providing snacks was associated with better handgrip strength and knee extensor strength at T4 and less handgrip strength decline. In neither sex was number of protein-providing meals associated with outcomes. CONCLUSIONS: Higher daily protein intake, up to 30-50 g protein/meal, may contribute to better knee extensor strength and physical performance in generally well-functioning older men and women. More aspects of protein intake may contribute to muscle strength and physical performance than solely the daily quantity, notably the protein dose per meal.

Em geral, diferentes tempos de prática de treinamento podem se associar com alterada resposta neuromuscular em esportistas, durante períodos de fadiga aguda e recuperação pós-esforço. O presente trabalho foi proposto para analisar o desempenho eletromiográfico de músculos extensores do joelho após fadiga e protocolo de resfriamento muscular em universitários com diferentes históricos de prática esportiva. Os participantes (n=24) foram distribuídos em dois grupos, segundo experiência prática: G1 (6,60±0,70 anos) e G2 (11,57±0,44 anos); os procedimentos de eletromiografia foram realizados em músculos extensores do joelho durante um exercício isométrico em cadeira extensora. Não foram verificadas diferenças nas comparações entre grupos (p>0,05). Considerando-se o momento de análise, as medidas de root mean square (RMS) dos músculos vasto lateral e vasto medial foram maiores no momento pós-resfriamento, comparado aos momentos inicial e pós-exaustão (p

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive stimulator that can induce strong muscle contraction in selective regions. This study aimed to measure acute changes in skeletal muscle thickness induced by rPMS following a low-intensity exercise. Fifteen healthy young men performed an isometric knee extensor exercise at 30% of maximum strength consisting of three sets of 10 contractions on their dominant leg. rPMS was then applied on the vastus lateralis (VL) at the maximum intensity of the rPMS device. Muscle thicknesses of the rectus femoris (RF) and VL were measured using an ultrasound device and were compared among baseline, post-exercise, and post-rPMS. There were significant increases in muscle thickness of both the RF and VL post-exercise compared with baseline values (RF: baseline; 24.7±2.4, post-exercise; 25.3±2.4 mm, p =.034, VL: baseline; 27.0±2.8, post-exercise; 27.4±2.8 mm, p =.006). Compared with post-exercise, there was a significant increase post-rPMS in only the VL (VL: post-rPMS; 28.3±2.9 mm, p =.002). These findings suggest that low-intensity isometric exercise can induce acute increases in muscle thickness (muscle swelling) in synergist muscles, and rPMS following exercise can induce further acute muscle swelling via repetitive muscle contraction.

McCurdy, K, Walker, J, Kelly, C, and Polinski, M. Hip and knee extensor activation during the hip thrust and rear-foot-elevated split squat in trained females. J Strength Cond Res 35(5): 1201-1207, 2021-The aim of the study was to compare hip and knee extensor muscle activation between the hip thrust (HT) and rear-foot-elevated split squat (RFESS) within different depths and the entire range of motion. Twenty, young adult female subjects (age, 20.9 ± 1.3 years; height, 164.6 ± 7.5 cm; mass 63.2 ± 8.8 kg) with an intermediate level of resistance training experience completed the study. Three repetitions were completed at 80% of the 1-repetition maximum. Gluteus maximus, vastus lateralis, and the medial (semitendinosus and semimembranosus) and lateral (biceps femoris) hamstrings electromyographic data were compared at the top, middle, and bottom one-third of the hip range of motion and for the entire repetition. A repeated-measures analysis of variance was used to test significance set at p ≤ 0.05. All 4 muscles revealed higher (p < 0.001) activation at the top position of the HT compared with the middle and bottom, whereas higher scores (p < 0.001) were found in the bottom position during the RFESS. The HT revealed greater activity (p < 0.001) than the RFESS in all muscles at the top, whereas the RFESS showed higher scores (p < 0.001) than the HT in all muscles in the bottom position. For the entire repetition, the RFESS produce significantly greater vastus lateralis activation (59.4 vs 43.6%). The data indicate that the greatest effect for the HT is demonstrated in the top position and at the bottom for the RFESS. Thus, we recommend to implement both exercises in a training program to maximize gluteus maximus and hamstring activation across the full range of motion. For the greatest vastus lateralis activation, the RFESS is recommended.

Neuromuscular deficits in post-anterior cruciate ligament reconstruction (ACLR) individuals result in the adoption of compensatory movement strategies that alter how the knee and ACL are loaded. While it is understood that post-ACLR individuals load the knee and ACL differently than healthy controls, the challenge is quantifying the loading in the ACL as it can provide insight regarding secondary ACL tears. Computational modeling is advantageous because it provides a way to compute the forces in the ACL in individuals during dynamic tasks. Thus, this study sought to employ computational modeling to investigate differences in how the ACL is loaded during running in healthy controls and post-ACLR individuals. Sixteen post-ACLR individuals and twelve healthy controls performed a running protocol where they were instructed to run at a self-selected speed. Subject-specific computational models were generated for each participant, and joint kinematics, joint kinetics, and muscle and ACL forces were extracted from the simulations. Despite the post-ACLR individuals exhibiting significantly lower peak knee flexion angles and peak knee extensor moments than the controls, the peak ACL forces were marginally higher in post-ACLR individuals than in healthy controls (p = 0.33). These findings suggest that secondary ACL tears may be more of a reflection of the challenges faced in mimicking the structural and functional roles of the ACL with transplanted tissues rather than the effects of elevated ligament loading. The knowledge gained from this study will have significant implications for regenerative engineering and the design of more robust tissues. Individuals after an anterior cruciate ligament reconstruction (ACLR) suffer from diminished muscle function that causes them to adopt new movement patterns. A consequence of these new movement patterns is a change in the forces that are placed on the newly transplanted ACL. This study used computational modeling to compare the forces experienced by the ACL in healthy controls and post-ACLR individuals during running. No differences in ACL forces were measured between the two groups, suggesting that secondary ACL tears may be due to the altered structural integrity of the newly transplanted grafts.

Sagittal plane inclination of the trunk and tibia have been shown to independently modulate hip and knee extensor moments during squatting. The purpose of this study was to determine if the difference between sagittal plane trunk and tibia inclinations can be used to approximate the relative demand of the hip and knee extensors across a range of squatting conditions. Kinematic and kinetic data were obtained from 16 participants during 8 squat conditions in which trunk and tibia inclination were manipulated. The average hip/knee extensor moment ratio (HKR) was calculated during the lowering (eccentric) phase of each squat condition using inverse dynamics equations. Linear regression evaluated the association between the difference in trunk and tibia inclination at peak knee flexion and the average HKR. Across all squat conditions, the difference between trunk and tibia inclinations explained 70% of the variance in the average HKR (p

Ikeda, N and Ryushi, T. Effects of 6-week static stretching of knee extensors on flexibility, muscle strength, jump performance, and muscle endurance. J Strength Cond Res 35(3): 715-723, 2021-The purpose of this study was to evaluate the changes in flexibility and muscular performance after stretching training for 6 weeks. Twelve healthy young men were assigned to a stretching group and 13 to a control group. The subjects of the stretching group performed static stretching of knee extensors for 6 weeks. Knee flexion range of motion (KFROM), leg extension strength, rate of force development (RFD) in leg extension, jump performance (squat and countermovement jump height, and index of rebound jump), and strength decrement index of 50 repetitions of isokinetic knee extension (muscle endurance) were measured before and after the interventions. In the stretching group, KFROM significantly increased from 145.2 ± 17.3 to 158.7 ± 6.3° (p < 0.05), whereas RFD significantly improved from 10,173 ± 2,401 to 11,883 ± 2,494 N·s-1 (p < 0.05). By contrast, leg extension strength and jump performance of each jump type did not improve significantly. Furthermore, muscle endurance decreased significantly. All variables remained unchanged in the control group. In conclusion, 6 weeks of stretching training of knee extensors improved KFROM and RFD in leg extension, but not leg extension strength and jump performance; moreover, muscle endurance decreased. These findings indicate that this stretching training protocol can be used by athletes in sports who require high flexibility and those who require high-power exertion.

Background Extensor mechanism function after a proximal tibial tumour excision is the major determining factor for the limb function. However, problems of extensor lag, delayed healing and poor functional outcomes exist with the previous methods of its reconstruction. We describe a novel technique of using a patellar stainless steel (SS) wire to reconstruct the extensor apparatus of the knee in non-porous coated implants and examine the functional outcome and associated complications. Methods This was a retrospective analytical interventional study. Twenty-six patients operated between 2011 and 2019 were included. Extensor lag measured at 6 months and 12 months postoperative, total range of motion at 12 months and Musculoskeletal Tumor Society (MSTS) score at the final visit were retrieved. Complications that occurred during the follow up period were noted. Patellar position was measured using comparative patellar-position-ratio. Results Mean extensor lag at 6 months was 18.5° which improved to 8.7° at 12 months. Patellar malposition and deep infection were found to be the causes of poor functional outcome. A patellar-position-ratio between 0.9 and 1.1 led to a well-functioning extensor apparatus. Four patients underwent above-knee amputations. Deep infection and amputations reduced the MSTS score. An SS wire give way after 6 months did not affect the extensor power. A medial gastrocnemius flap reduced the infection rates. Conclusion Patellar SS wiring is an effective technique for reconstructing the knee extensor apparatus following a proximal tibial tumour excision mega-prosthesis. Proper position of the SS wire prevents wire-related complications. For a well-functioning extensor apparatus, use of a gastrocnemius flap cover intra-operatively is pertinent along with lack of infection for a pain-free, stable and mobile limb.

Purpose: The purpose of this study was to verify the effectiveness of repetitive sit to stand training to improve knee extensor strength and walking ability of total knee replacement patients. Methods: In this study, 12 patients with total knee replacement patients were recruited from a rehabilitation hospital. They were divided into two groups: a repetitive sit to stand group (n=6) and a control group (n=6). They all received 30 minutes of continuous passive motion (CPM). After that, the repetitive sit to stand group performed repetitive sit to stand training, and the control group performed re sistance exercise for 15 minutes five times a week for 2 weeks. After 2 weeks of training, knee extensor strength and spatiotemporal gait parameters were measured. Knee extensor strength was measured by Biodex system 3, walking ability was measured by Biodex gait trainer 2. Paired t test was performed to verify the difference between before and after intervention within the group, and analysis of co variance was used to verify the differences between the two groups. Results: After the training periods, the repetitive sit to stand group showed a significant improvement in knee extensor muscle strength, walking speed, step length of the operated side, and step length of the non-operated side (p

To examine the effects of 10 weeks of endurance cycling training on mechanomyographic amplitude (MMGRMS)–torque relationships and muscle cross-sectional area (mCSA) of the vastus lateralis (VL) for 10 sedentary males (Age ± SD; 20.2 ± 1.9 years) and 14 sedentary females (21.9 ± 5.3 years). Participants performed maximal voluntary contractions (MVCs) and an isometric ramp up muscle action to 70% MVC of the knee extensors before (PRE) and after training at the same absolute pre-treatment submaximal torque (POSTABS). MMG was recorded from the VL and b terms were calculated from the natural log-transformed MMGRMS–torque relationships for each subject. mCSA was determined with ultrasonography. Cycling decreased MVCs from pre- (168.10 ± 58.49 Nm) to post-training (160.78 ± 58.39 Nm; p = 0.005) without changes in mCSA. The b terms were greater for POSTABS (0.623 ± 0.204) than PRE (0.540 ± 0.226; p = 0.012) and for males (0.717 ± 0.171) than females (0.484 ± 0.168; p = 0.003). mCSA was correlated with the b terms for PRE (p

Background/objectives Muscle function is a marker of current and prospective health/independence throughout life. The effects of sex and obesity (OB) on the loss of muscle function in ageing remain unresolved, with important implications for the diagnosis/monitoring of sarcopenia. To characterise in vivo knee extensors' function, we compared muscles torque and power with isometric and isokinetic tests in older men (M) and women (W), with normal range (NW) of body mass index (BMI) and OB. Subjects/methods In 70 sedentary older M and W (69 ± 5 years), NW and OB (i.e. BMI Results In absolute units, relative to BM and LLMR, sex differences were found in favour of M for all parameters of muscle function (main effect for sex, p 0.05); however, muscle function indices, when adjusted for BM, were lower in both M and W with OB compared to NW counterparts (p Conclusions We confirmed sex differences in absolute, relative to BM and LLMR muscle function in favour of men. While overall muscle function and muscle contractile quality is conserved in individuals with class I OB, muscle function normalised for BM, which defines the ability to perform independently and safely the activities of daily living, is impaired in comparison with physiological ageing.

The purpose of this study was to determine the effects of training load (25% vs. 75% of one repetition maximum [1RM]) and fatigue (failure vs. non-failure) during four weeks of unilateral knee extension resistance training (RT) on maximal voluntary force in the trained and the untrained knee extensors. Healthy young adults (n = 42) were randomly assigned to control (CON, n = 9, 24 +/- 4.3 years), low-load RT to failure (LLF, n = 11, 21 +/- 1.3 years, three sets to failure at 25% of 1RM), high-load RT to failure (HLF, n = 11, 21 +/- 1.4 years, three sets to failure at 75% of 1RM), and high-load RT without failure (HLNF, n = 11, 22 +/- 1.5 years, six sets of five repetitions at 75% of 1RM) groups. Before and after the four weeks of training, 1RM, maximal voluntary isometric force, and corticospinal excitability (CSE) were measured. 1RM in the trained (20%, d = 0.70, 15%, d = 0.61) and the untrained knee extensors (5%, d = 0.27, 6%, d = 0.26) increased only in the HLF and HLNF groups, respectively. MVIC force increased only in the trained leg of the HLF (5%, d = 0.35) and HLNF groups (12%, d = 0.67). CSE decreased in the VL of both legs in the HLNF group (-19%, d = 0.44) and no changes occurred in the RF. In conclusion, high- but not low-load RT improves maximal voluntary force in the trained and the untrained knee extensors and fatigue did not further enhance these adaptations. Voluntary force improvements were unrelated to CSE changes in both legs.

Background This study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated. Methods Twenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined. Results The maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores. Conclusion The early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.

Objective To investigate the reliability of knee extensor strength measurements using a supine hand-held dynamometer (HHD) anchoring frame in patients with limited physical activity. Although an HHD is suitable for bedside use, its inter-rater reliability is low because measurements can be influenced by tester strength.Methods Maximal knee extensor isometric strength was measured using an HHD anchored to the supine frame. Three trials of three maximal contractions were assessed by two raters.Results A total of 33 inpatients who were non-ambulatory due to acute illness participated in the study. The intraclass correlation coefficients were 0.974 (inter-rater) and 0.959 (intra-rater). The minimal detectable changes in intra- and inter-observer measurements were 29.46 N (24.10%) and 36.73 N (29.26%), respectively. The limits of agreement ranged from -19.79% to 24.81% for intra-rater agreement and from -21.45% to 37.07% for inter-rater agreement.Conclusion The portable dynamometer anchoring system can measure the isometric strength of the knee extensor reliably in the supine position, and could be used for measurements in patients who have difficulty visiting the laboratory and maintaining a seated posture.

Females have been reported to utilize a feedforward control strategy during landing in which they compensate for decreased rate of torque development (RTD) of the hip extensors through earlier pre-activation of the knee extensors. The purpose of this study was to determine the influence of a 4-week hip-focused training program on hip extensor RTD and feedforward control of the hip and knee extensors. Twenty-one females underwent hip extensor RTD evaluation and electromyographic assessment of the hip and knee extensors during a drop-jump task. Post-training, there was a significant improvement in hip extensor RTD (21.68 ± 5.44 to 23.33 ± 5.45 Nm/kg s

Objective To identify clinical phenotypes of knee osteoarthritis (OA) using measures from the following domains: 1) multimorbidity; 2) psychological distress; 3) pain sensitivity; and 4) knee impairment or pathology. Design Data were collected from 152 people with knee OA and from 31 pain-free individuals. In participants with knee OA, latent profile analysis (LPA) was applied to the following measures: normalized knee extensor strength, Functional Comorbidity Index (FCI), Pain Catastrophizing Scale (PCS), and local (knee) pressure pain threshold. Comparisons were performed between empirically derived phenotypes from the LPA and healthy older adults on these measures. Comparisons were also made between pheonotypes on pain intensity, functional measures, use of health care, and history of knee injury. Results LPA resulted in a four-group solution. Compared with all other groups, group 1 (9% of the study population) had higher FCI scores. Group 2 (63%) had elevated pain sensitivity and quadriceps weakness relative to group 4 and healthy older adults. Group 3 (11%) had higher PCS scores than all other groups. Group 4 (17%) had greater leg strength, except relative to healthy older adults, and reduced pain sensitivity relative to all groups. Groups 1 and 3 demonstrated higher pain and worse function than other groups, and group 4 had higher rates of knee injury. Conclusion Four phenotypes of knee OA were identified using psychological factors, comorbidity status, pain sensitivity, and leg strength. Follow-up analyses supported the replicability of this phenotype structure, but future research is needed to determine its usefulness in knee OA care.

INTRODUCTION: This two-part study explored the safety, feasibility, and efficacy of a mild-moderate resistance isometric leg exercise program in ambulatory boys with Duchenne Muscular Dystrophy (DMD). METHODS: First, we used a dose escalation paradigm with varying intensity and frequency of leg isometric exercise to determine the dose response and safety in 10 boys. Second, we examined safety and feasibility of a 12-week in-home, remotely-supervised, mild-moderate intensity strengthening program in 8 boys. Safety measures included T(2) MRI, creatine kinase levels, and pain. Peak strength and function (time to ascend/descend 4 stairs) were also measured. RESULTS: Dose-escalation revealed no signs of muscle damage. Seven of the 8 boys completed the 12-week in-home program with a compliance of 84.9%, no signs of muscle damage, and improvements in strength (knee extensors p < 0.01; knee flexors p < 0.05) and function (descending steps p < 0.05). DISCUSSION: An in-home, mild-moderate intensity leg exercise program is safe with potential to positively impact both strength and function in ambulatory boys with DMD.

Objective Neuromuscular electrical stimulation (NMES) has been noted as an effective pre- contraction for an increase of neural and muscle factors during twitch contractions. However, it is unknown if this intervention is effective for the rate of force development (RFD), which is the ability to increase joint torque strength as quickly as possible, during tetanic contractions. NMES can be safely used by anyone, but, the strength setting of NMES requires attention so as not to cause pain. Therefore, the purpose of this study investigated whether NMES at less painful levels was effective for RFD during tetanic contractions. We also investigated effect activation by analyzing electromyogram (EMG) and RFD for each phase. Methods Eighteen healthy males were studied. Before and after NMES intervention at 10% or 20% maximal voluntary isometric contraction (MVIC) level (10%NMES, 20%NMES respectively), EMG activity and the initial phase (30-, 50-, 100-, and 200-msec) RFD were measured. Visual analog scale (VAS) was also measured as an indicator of pain during each NMES. Results 20%NMES increased EMG activity and 30-, 50-, and 100-msec of RFD during MVIC, but could not improve 200 msec of RFD. However, 10%NMES could be failed to increase all phases RFD, but VAS was lower than that of 20% NMES. Conclusion These results suggest that muscle pre-contraction using 20%NMES could induce moderate pain, but could be an effective intervention to improve RFD via neural factor activity.