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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.

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

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.

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.

Purpose Joint angle is a significant determinant of neuromuscular and metabolic function. We tested the hypothesis that previously reported correlations between knee-extensor torque complexity and metabolic rate ($${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$ m V ˙ O 2 ) would be conserved at reduced joint angles (i.e. shorter muscle lengths). Methods Eleven participants performed intermittent isometric knee-extensor contractions at 50% maximum voluntary torque for 30 min or until task failure (whichever occurred sooner) at joint angles of 30º, 60º and 90º of flexion (0º = extension). Torque and surface EMG were sampled continuously. Complexity and fractal scaling of torque were quantified using approximate entropy (ApEn) and detrended fluctuation analysis (DFA) α. $${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$ m V ˙ O 2 was determined using near-infrared spectroscopy. Results Time to task failure/end increased as joint angle decreased (P α, both P $${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$ m V ˙ O 2 increased at all joint angles (P P $${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$ m V ˙ O 2 at 90º (ApEn, r = − 0.60, P = 0.049) and 60º (ApEn, r = − 0.64, P = 0.035; DFA α, ρ = 0.68, P = 0.015). Conclusion The lack of correlation between $${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$ m V ˙ O 2 and complexity at 30º was likely due to low relative task demands, given the similar kinetics of $${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$ m V ˙ O 2 and torque complexity. An inverse correlation between $${\text{m}\dot{\text{V}}\text{O}}_{{2}}$$ m V ˙ O 2 and knee-extensor torque complexity occurs during high-intensity contractions at intermediate, but not short, muscle lengths.

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.

Context: A limitation of previous studies on squatting mechanics is that the influence of trunk and shank inclination on the knee-extensor moment (KEM) has been studied in isolation. Objective: The purpose of the current study was to determine the influence of segment orientation on the KEM during freestanding barbell squatting. Design: Repeated-measures cross sectional. Setting: University research laboratory. Participants: Sixteen healthy individuals (8 males and 8 females). Intervention: Each participant performed 8 squat conditions in which shank and trunk inclinations were manipulated. Main Outcome Measures: 3D kinematic and kinetic data were collected at 250 and 1500 Hz, respectively. Regression analysis was conducted to identify the individual relationships between the KEM and the trunk and shank inclination at 60° and 90° of knee flexion. To identify the best predictor(s) of the KEM, stepwise regression was implemented. Results: Increased shank inclination increased the KEM (P R2 = .21–.25). Conversely, increased trunk inclination decreased the KEM (P R2 = .49–.50). For the stepwise regression, trunk inclination entered first and explained the greatest variance in the KEM (all P R2 = .49–.50). Shank inclination entered second (all P R2 = .53–.54) and explained an additional 3% to 5% of the variance. Conclusions: Our results confirm that inclination of the trunk and shank have an opposing relationship with the KEM. Increased forward shank posture increases the KEM, while increased forward trunk posture decreases the KEM. However, when viewed in combination, the trunk was the superior predictor of the KEM, highlighting the fact that increased quadriceps demand created by a forward shank can be offset by trunk inclination.

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

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.

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.

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.

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.

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.

Harper, DJ, Jordan, AR, and Kiely, J. Relationships between eccentric and concentric knee strength capacities and maximal linear deceleration ability in male academy soccer players. J Strength Cond Res XX(X): 000–000, 2018—The purpose of this study was to investigate the relationships between maximal linear deceleration ability, and knee flexor (KF) and knee extensor (KE) strength. Fourteen male academy soccer players completed a 30-m linear sprint, a maximal linear deceleration test, and eccentric and concentric KF and KE contractions in both dominant leg (DL) and nondominant leg (NDL) at slower (60°·s−1) and faster (180°·s−1) angular velocities on an isokinetic dynamometer. Maximal linear deceleration ability was evaluated using distance-to-stop (DEC-DTS) and time-to-stop (DEC-TTS), with isokinetic peak torque representing KF and KE strength capacity. Relationships were established using Pearson's correlation coefficients (r) with magnitude-based inferences used to describe the uncertainty in the correlation. Both concentric KE and KF strength at 180°·s−1 in the NDL had the highest correlations with deceleration ability (r = −0.76 and r = −0.78, respectively). In the DL, concentric KE and KF strength at 180°·s−1 also had very likely large correlations with deceleration ability (r = −0.54 and −0.55, respectively). All correlations between eccentric KF strength and deceleration ability were unclear. At 180°·s−1, correlations between eccentric KE strength and deceleration ability were also unclear; however, at 60°·s−1, both DL (r = −0.63 to −0.64) and NDL (r = −0.54 to −0.55) had very likely large correlations with deceleration ability. These findings provide novel insights into the unilateral KF and KE strength capacities underpinning the ability to decelerate rapidly from high-sprint velocities.

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.

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.

This study tested the hypothesis that the magnitude of rectus femoris (RF) damage and the repeated bout effect (RBE) would be greater after knee extensor eccentric exercise performed in a supine (long RF lengths) than a sitting (short RF lengths) position, and the muscle length effects would be more prominent at the proximal than distal RF. Young untrained men were placed to one of the two groups (n = 14 per group). S group performed the knee extensor eccentric exercise in the sitting position for the first bout and the supine position for the second bout, and L group performed the exercise in the supine position for two bouts, with 4 weeks between bouts. Dependent variables included evoked and maximal voluntary isometric contraction (MVC) torque, electromyography (EMG) during MVC, muscle soreness, and shear modulus, which were measured before and 1‐3 days after each exercise bout. After the first bout, L group in comparison with S group showed greater (P

The purpose of this study was to investigate the effects of a single floss band treatment of the thigh on hip and knee range of motion (ROM), knee extensor passive resistive torque (PRT), knee extensor maximum voluntary contraction (MVC) torque, and countermovement jump (CMJ) height.Sixteen healthy male volunteers were tested before and after both the flossing treatment and the control condition, in random order. For the flossing treatment, the floss band was wound around both thighs for 120 s, and the subject was then asked to perform 20 squats. During the control treatment, only the 20 squats were performed. Before and after the treatments, knee and hip ROM were assessed using a Thomas test with 3D motion caption. The PRT and MVC of the knee extensors were measured with a dynamometer, and the electromyographic (EMG) signal was collected from the vastus lateralis. CMJs were performed on a force plate.Compared to the control condition, the flossing treatment showed a positive effect on the MVC of the knee extensors (

Background Loss of knee extensor strength in individuals with knee osteoarthritis (KOA) may induce inter-limb strength asymmetries and alter functionality. The aims were to analyse whether the condition of the uninvolved knee (advanced to severe KOA or no affection) may induce different degrees of knee extensor strength asymmetry in individuals with KOA and to study whether functionality may differ in cases of unilateral or bilateral KOA. Methods Sixty-eight subjects with advance-to-severe KOA were categorized into two groups (unilateral or bilateral KOA). The knee extensor strength ratio (KESR), and self-reported and performance-based functionality were analysed and compared. Sex and age were independent factors. One- and two-way analysis of variance assessed for significant between-group differences (95% confidence interval (CI)). Results Participants with unilateral KOA presented with 20% knee extensor strength asymmetry. The mean difference with the bilateral KOA group in terms of Knee Extensors Strength Ratio was 0.2 (95% CI 0–0.3; P = 0.021), of the Oxford Knee Scale score was 4.2 (95% CI 3.4–5.1; P = 0.037), and of the Timed Up and Go was 1.3 s (95% CI 0.5–2.2; P > 0.05). There were significant sex and age interactions (P Conclusions Individuals with unilateral or bilateral KOA present with different degrees of knee extensor strength asymmetry. The non-affected knee seems to help to better develop functional tasks in cases of unilateral condition. The findings may help the design of tailored strengthening interventions in which each knee condition in individuals with KOA should be considered.

Recently, we proposed the hypothesis that weekly running volume and preferred running pace may play a role in preserving ankle joint kinetics in middle-age runners as ankle joint kinetics were generally similar in young and middle-aged runners with similar running volume and preferred pace. To further address this hypothesis, we compared lower extremity joint kinetics between high and low training volume runners in both young and middle-aged groups. Joint kinetics calculated from 3D kinematic and ground reaction force data during over-ground running at 2.7 m·s-1 from young and middle-aged runners who ran low or high weekly volume were analyzed. A two-factor analysis of variance was used to compare joint kinetics between age and running volume groups. Positive hip work was greater in middle-aged compared to young runners (P = .005). Plantarflexor torque (P = .009) and positive ankle work (P = .042) were greater in young compared to middle-aged runners. Positive ankle work was also greater in the high compared to the low volume group (P = .021). Finally, age by volume interactions were found for knee extensor torque (P = .024), negative knee work (P = .018), and positive knee work (P = .019) but not for ankle and hip joint kinetics. These findings suggest less distal-to-proximal difference in positive joint work with high running volume in both young and middle-aged runners as a result of greater power generation at the ankle. Given the age main effects, our findings are also the first to suggest the age-related distal-to-proximal shift in joint kinetics appears in middle-aged runners.

Ultrasonography-derived cross-sectional area (CSA) and echo intensity (EI) are increasingly utilized by investigators to study muscle size and quality, respectively. We sought to examine age, sex, and region (proximal, middle, distal) differences in vastus lateralis and rectus femoris CSA and EI, and determine whether correction for subcutaneous fat thickness influences the magnitude of EI differences. Fifteen younger men (mean age = 23 years), 15 younger women (aged 21 years), 11 older men (aged 74 years), and 15 older women (aged 70 years) participated. Clear differences were observed among age, sex, and region for vastus lateralis CSA (p ≤ 0.013, d = 0.38–0.73), whereas rectus femoris CSA was only different between younger and older participants at the proximal region (p = 0.017, d = 0.65). Uncorrected EI was greatest at the distal region of both muscles (p < 0.001, d = 0.59–1.38), with only the younger men having significantly lower EI values than the other groups (p ≤ 0.043, d = 0.37–0.63). Subcutaneous fat correction resulted in a marked increase in the magnitude of sex-specific EI differences (p ≤ 0.032, d ≥ 0.42). Additionally, subcutaneous fat correction increased the uniformity of EI throughout the thigh. These findings highlight considerable region-specific differences in muscle size and quality among younger and older men and women and highlight the need to correct for subcutaneous fat thickness when examining EI. Novelty Rectus femoris CSA is similar between younger and older adults except at the most proximal site evaluated. Age- and sex-specific differences in uncorrected EI are nonuniform across the thigh. Correction for subcutaneous fat thickness substantially increased EI in women, resulting in greater sex differences.

Introduction Fatigue-related group III/IV muscle afferent firing from agonist, antagonist or distal muscles impairs the ability to drive the elbow flexors maximally, that is, reduces voluntary activation. In the lower limb, the effect of feedback from distal muscles on the proximal knee extensors is unknown. Here, we test whether maintained group III/IV afferent feedback from the plantarflexor muscles reduces voluntary activation of the knee extensors. Methods On 2 d, voluntary activation of the knee extensors during maximal voluntary contractions (MVCs) was assessed in 12 participants before and after a 3-min fatiguing task of the plantarflexors. On 1 d, an inflatable cuff around the calf occluded blood flow for 2 min immediately postexercise (cuff day). The other day had no occlusion (no-cuff day). Supramaximal stimulation of the femoral nerve elicited superimposed twitches during MVC of the knee extensors and resting twitches 2 to 3 s after relaxation. Pain (0-10 point scale) was reported throughout. Results In the 2 min after the 3-min fatiguing plantarflexor task, voluntary activation was 5.3% (SD, 7%) lower on the cuff day than on the no-cuff day (P = 0.045), and MVC force was reduced by 13% (SD, 16%) (P = 0.021). The resting twitch was similar on both days (P = 0.98). Pain rated 4.9 points higher with the cuff inflated (P = 0.001). Conclusions Maintained group III/IV afferent feedback from the fatigued plantarflexor muscles reduced maximal force and voluntary activation of the unfatigued knee extensors, suggesting that afferents from the calf act centrally to inhibit the ability to drive the motoneurones of the knee extensors.

As the population ages, there is a growing burden owing to musculoskeletal diseases, such as knee osteoarthritis, and subsequent functional decline. In the absence of a cure, there is a need to identify factors amenable to intervention to prevent or slow this process. The Multicenter Osteoarthritis Study cohort was developed for this purpose. In this study, associations between variability in peak knee flexor and extensor torque at baseline and worsening of pain and physical function over the subsequent 60 mos were assessed in a cohort of 2680 participants. The highest quartile of baseline knee flexor torque variability was found to be associated longitudinally with worsening pain (fourth quartile s estimate, mean ± SE, 0.49 ± 0.19; P = 0.0115; with R2 = 0.28 and P for trend across quartiles = 0.0370) and physical function scores (fourth quartile s estimate, mean ± SE, 1.39 ± 0.64; P = 0.0296; with R2 = 0.25 and P for trend across quartiles = 0.0371), after adjusting for baseline knee osteoarthritis and maximum knee flexor torque. There were no associations between baseline knee extensor torque and worsening pain or physical function by 60 mos. The presence of greater variability in maximum knee flexor strength may identify patients who may benefit from therapies aimed at preventing worsening knee pain and physical function.

Transcutaneous electrical stimulation (TES) is used to activate muscles when volitional capacity is impaired but potential benefits are limited by rapid force loss (fatigue). Most TES fatigue protocols employ constant-frequency trains, with stimuli at a fixed interstimulus interval (ISI); however, a brief ISI between the first two pulses (variable-frequency train, VFT) to maximize the catchlike property of muscle can attenuate fatigue development. The purpose of this study was to investigate if a VFT that simulates intrinsic variability of voluntary motor unit discharge rates would also mitigate fatigue, owing to the sensitivity of muscle to acute activation history.On two visits, 24 healthy adults (25.3 ± 3.7 years; 12 females) received 3 min of intermittent TES to the quadriceps of the dominant leg. Trains of eight pulses at 10 Hz were delivered with a constant (100 ms) or variable ISI (80-120 ms). Contractile impulse, rate of force development (RFD), and rate of relaxation (RFR) were determined for each tetanus RESULTS: During fatigue and recovery, contractile impulse did not differ between protocols (p ≥ 0.796) and sexes (p ≥ 0.493), with values of 77 ± 17% control at task end and 125 ± 19% control 2 min later. RFD and RFR also showed no effect of the protocol (p ≥ 0.310) or participant sex (p ≥ 0.119). Both measures slowed (38 ± 23% and 33 ± 22%, respectively) but dissociated during recovery as RFD remained 16 ± 18% below control at 5 min, whereas RFR recovered to control by 30 s (101 ± 22%).Contrary to expectations, the VFT protocol did not attenuate fatigue development, which suggests no benefit to mimicking the inherent variability of motor unit discharge rates.

Corso, M, Liang, L, Tran, S, Howitt, S, Srbely, J, and Mior, SA. The immediate effect of spinal manipulation on ball velocity and neuromuscular function during an instep kick in former Varsity soccer players: a feasibility study. J Strength Cond Res 36(9): 2558-2565, 2022-Spinal manipulation (SM) has been shown to increase ball velocity (BV) in soccer players. Evidence suggests that SM modulates responses at spinal or cortical levels to enhance force production in asymptomatic populations. No studies have explored the underlying neuromuscular mechanisms contributing to changes in BV post-SM in soccer players. We assessed the feasibility of measuring change in BV and neuromuscular function after SM in former Varsity level soccer players with a pre-post study design. Three to 5 maximal instep kicks were performed before and after SM at the L3-5 level. Ball velocity was measured using high-speed camera. Activation of lower limb and trunk musculature was recorded with electromyography. Outcomes included ease of recruitment, scheduling and data capture, as well as expectation and perception of SM effect and adverse events (AE). Fifteen potential subjects were recruited over 1.5 months. Eleven were scheduled (24-31 years; 8 females, 3 males). Two subjects reported mild AE after maximal voluntary isometric contraction testing. A significant increase in BV (mean change: 1.75 m·s -1 [95% confidence interval: 0.5-3.0]) and a trend to increased peak-activation of knee extensors (90.7%) were observed post-SM. Findings suggest that our recruitment strategy and methodology are feasible in a larger trial with some modifications. Our preliminary findings support previous research by suggesting that increased BV may be mediated through increased activation of knee extensors during the kick. Our findings may offer additional insight into the underlying neuromuscular mechanisms contributing to immediate change in BV post-SM.

OBJECTIVE Obesity is a major and functionally important problem in polio survivors. The aim of this study was to investigate the prevalence of obesity using body mass index and percentage body fat in polio survivors and to analyze the relationship between obesity and mobility. DESIGN Eighty-four polio survivors were included. Anthropometric parameters, knee extensor strength, and the Short Physical Performance Battery were evaluated. A questionnaire was used to explore the late effects of poliomyelitis. Obesity was determined using both body mass index and percentage body fat. RESULTS The prevalence of obesity in polio survivors was 39.3% and 81.5% using the body mass index and percentage body fat criteria, respectively. The Short Physical Performance Battery scores were significantly different between the obese and nonobese groups as determined by percentage body fat (P < 0.05). Only percentage body fat was significantly associated with mobility after controlling for the confounding variables in obese polio survivors (P < 0.05). CONCLUSIONS Obesity in polio survivors was underestimated when the body mass index criteria were used. Percentage body fat was a significantly associated factor for mobility in obese polio survivors. Obesity determined by percentage body fat criteria is useful to address obesity-related problems in polio survivors.

International audience; Purpose: Ultramarathon running includes two main types of events: single-stage race (SSR) and multistage races (MSR). Direct comparison of neuromuscular fatigue and recovery after SSR versus MSR race of comparable distance and elevation has never been performed. The aim of this study was to assess neuromuscular fatigue and recovery after two ultramarathons of equal distance performed either (i) in a single stage or (ii) in four successive days.Methods: Thirty-one runners participated in the study: 17 ran 169 km in a single-stage race and 14 performed around 40 km·d over 4 d. The two races were performed on the same course. Neuromuscular function was tested before (PRE), after (POST), and 2 (D + 2), 5 (D + 5) and 10 (D + 10) days after the races. Neuromuscular function was evaluated on both knee extensors (KE) and plantar flexors (PF) with voluntary and evoked contractions using electrical (femoral and tibial, respectively) nerve stimulation.Results: Reduction of voluntary activation measured in the KE was greater (i.e., central fatigue) for SSR than MSR directly after the race (-23% vs -7%), P < 0.01). Reductions in evoked mechanical KE and PF responses on relaxed muscle (i.e., peripheral fatigue) of both KE and PF took longer to recover in MSR than in SSR.Conclusions: Performing prolonged running exercise over several days, each separated by rest, elicits more prolonged impairments in contractile function compared with single-stage ultramarathon, whereas single-stage mountain ultramarathon ran on the same course is associated with greater central fatigue.

Abnormal tracking of the patella is a hallmark sign of patellar instability (PI). Gait deviations and strength deficits may exacerbate abnormal tracking. The identification of modifiable gait deviations and strength deficits can aid in developing more effective management strategies for individuals with PI. The purpose of this study was to identify modifiable gait and strength deficits in subjects with PI.32 subjects (16 PI, 16 controls, 3 males/13 females in each group, 21.1 years old, 23.5 BMI), performed an instrumented gait analysis while walking at 1.5 m per second. Subjects' peak hip adduction angles, external rotation angles, hip abduction moments, knee flexion angles, knee adduction angles, and knee extensor moments were measured during walking. Hip abduction, hip external rotation, and knee extension strength were assessed with a handheld dynamometer.Individuals with PI displayed significantly lower peak knee adduction angles (1.8 ± 2.8° PI, 5.5 ± 4.5° control, p .01) and peak hip abduction moments (0.2 ± 0.1 Nm/kg*m PI, 0.4 ± 0.1 Nm/kg*m control, p .01). Subjects with PI were weaker in knee extension strength (14.5 ± 4.1 kg/m PI, 23.8 ± 7.2 kg/m control, p .01), hip abduction strength (12.1 ± 2.0 kg/m PI, 17.8 ± 4.0 kg/m control, p .01), and hip external rotation strength (5.5 ± 1.9 kg/m PI, 7.1 ± 1.3 kg/m control, p = .01).Subjects with patellar instability have smaller joint moments and a more valgus knee position while walking. Coupled with deficits in muscle strength, this likely contributes to subjective reports of chronic patellar instability.III.

This study investigated the acute effects of seated and supine knee extension exercise on muscle swelling, torque, and work output. Twelve resistance-trained men performed two isokinetic concentric-only knee-extension training protocols at different hip positions in a counter-balanced order. They completed the knee extension exercise in the seated (hip angle at 85°) and supine (hip angle at 180°) positions. The torque and work output were assessed during each set. Moreover, muscle thickness of the middle and proximal vastus lateralis and rectus femoris were evaluated before and after each protocol and used as an indicator of muscle swelling. Middle rectus femoris and proximal vastus lateralis thickness increased significantly (p=0.01) with no difference between exercise variations. However, the middle vastus lateralis thickness increased (p=0.01) only after the seated knee extension exercise (~7%). Knee extensors’ peak torque and work output were approximately 8% higher (p=0.04) in the seated when compared to the supine hip position. There was a similar decrease in torque and work output throughout both protocols (p=0.98). In conclusion, seated knee extension exercises produced greater torque, work output, and muscle swelling in the vastus lateralis when compared to the supine knee extension exercise.

Leg-extensor rate of power development (RPD) decreases during aging. This study aimed to identify the underlying mechanism of the age-related decline in RPD during a fast acceleration in terms of in vivo vastus lateralis (VL) fascicle shortening behavior. Thirty-nine men aged between 25 and 69 years performed three maximal isokinetic leg-extensor tests with a fixed initial acceleration of 45° knee extension in 150 ms until 340°/s knee angular velocity. RPD, VL activity, and ultrasound images were recorded to assess (relative) fascicle shortening and mean shortening velocity for the phases of electromechanical delay, pretension, and acceleration. Our findings show that fascicle shortening and mean shortening velocity during a fast action increase with aging (0.002 per year, P = .035 and 0.005 s-1 per year, P = .097, respectively), mainly due to a higher amount of shortening in the phase of electromechanical delay. The ratio of VL fascicle length over upper leg length at rest showed a negative correlation (r = -.46, P = .004) with RPD/body mass, while pennation angle at rest showed a trend toward a positive correlation (r = .28, P = .089). To conclude, our findings indicate that the ability to reach high VL fascicle shortening velocities in vivo is not reduced in older men while performing preprogrammed fast accelerations. The greater amount of fascicle shortening in old age is probably the result of age-related differences in the tendinous properties of the muscle-tendon complex, forcing the fascicles to shorten more in order to transmit the muscle force to the segment. ispartof: SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS vol:30 issue:10 pages:1878-1887 ispartof: location:Denmark status: published

Purpose: The purpose of this study was to retrospectively investigate the effect of the severity of acute graft-versus-host disease (GVHD) on physical function after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: 76 patients were included as subjects of this study. Severity of acute GVHD was classified according to the method defined by Grucksberg. To evaluate physical function, the knee extensor strength and six-minute walk distance (6MWD) were performed. Results: Among these patients, 54% developed acute GVHD; of these, 32%, 54%, and 15% of patients had grade I, grade II, and grades III–IV GVHD, respectively. In the grade I–II groups, mild acute GVHD following allo-HSCT resulted in a gradual decline in physical function, which improved at discharge. However, in cases of severe acute GVHD, physical function deteriorated, implementation of rehabilitation became difficult, and the decline in physical function persisted even at discharge. Conclusion: These results indicate that severe acute GVHD negatively affects physical function leading to longer hospital days because of inadequate rehabilitation interventions.

Sustained isometric maximal voluntary contractions (IMVCs) have blood flow occlusive effects on the microvasculature. However, it is unknown if this effect would be magnified with additional blood flow restriction via a cuff and what the influence on fatigue development would be. Twelve healthy male participants performed a 1-min IMVC of the knee extensors with and without additional blood flow occlusion induced by pneumatic cuff in counterbalanced order on separate days. Vastus lateralis muscle deoxygenation was estimated via near-infrared spectroscopy–derived tissue oxygen saturation (SmO2) throughout the fatiguing contraction. Central and peripheral measures of neuromuscular fatigue (NMF) were assessed via surface electromyography (EMG) and force responses to voluntary contractions and peripheral nerve/transcranial magnetic stimulations before, immediately after, and throughout an 8-min recovery period. SmO2, force, and EMG amplitude decreased during the 1-min IMVC, but there were no between-condition differences. Similarly, no significant (p > 0.05) between-condition differences were detected for any dependent variable immediately after the fatiguing contraction. Transcranial magnetic stimulation (TMS)-derived voluntary activation was lower (p < 0.05) in the no-cuff condition during the recovery period. Sustained IMVC results in a similar degree of muscle deoxygenation and NMF as IMVCs with additional occlusion, providing further evidence that a sustained IMVC induces full ischemia. Novelty NMF etiology, muscle oxygenation, and corticospinal factors during an IMVC are similar with or without an occlusion cuff. Contrary to all other measures, TMS-evaluated voluntary activation returned to baseline faster following the occluded condition.

West, JT, Miller, WM, Jeon, S, and Ye, X. The effects of a preconditioning rolling session on subsequent eccentric exercise-induced muscle damage. J Strength Cond Res 34(8): 2112-2119, 2020-The aim of this study was to examine the effects of a preexercise unilateral quadriceps muscle rolling intervention on subsequent ipsilateral (IPSI) or contralateral (CTRA) knee extension eccentric exercise-induced muscle damage. Twenty-seven healthy volunteers (14 men) underwent an eccentric exercise protocol (6 sets of 10 repetitions with 75% of the maximal isometric strength) with a single-leg knee extension machine. Before the eccentric exercise, the subjects were randomly assigned to either (a) IPSI group: rolling the ipsilateral knee extensor muscles, (b) CTRA: rolling the contralateral muscles, or (c) Control: sitting for 6 minutes (same duration as the rolling intervention protocol) relaxed. The muscle soreness, passive knee extension range of motion, and knee extension isometric strength were measured before, immediately, 24 hours, and 48 hours after exercise. The magnitudes of the range of motion decrement were attenuated in both the IPSI (p = 0.031) and CTRA (p = 0.014) groups 24 hours after the eccentric exercise, when compared with the control. Isometric strength (p = 0.783) and muscle soreness (p = 0.586) responses were not significantly different among the 3 groups (time points and sexes merged). Additionally, women displayed an overall faster recovery than men in isometric strength (p = 0.001) and muscle soreness (p = 0.024), evidenced by the measurements at 48 hours after exercise. Our study suggests that unilateral quadriceps rolling intervention before high-intensity muscle-damaging exercise has a beneficial effect on maintaining range of motion in both the ipsilateral and contralateral muscles.

To assess if the alteration of neuromuscular properties of knee extensors muscles during heavy exercise co-vary with the SCV ($${\dot{{\rm{V}}}{\rm{O}}}_{2}$$V̇O2 slow component), eleven healthy male participants completed an incremental ramp test to exhaustion and five constant heavy intensity cycling bouts of 2, 6, 10, 20 and 30 minutes. Neuromuscular testing of the knee extensor muscles were completed before and after exercise. Results showed a significant decline in maximal voluntary contraction (MVC) torque only after 30 minutes of exercise (−17.01% ± 13.09%; p

AIM To assess effects of growth on lower limb maximal isometric muscle strength (MIMS) development in children with developmental coordination disorder (DCD). METHOD This observational study used hand-held dynamometry to evaluate MIMS (hip abductors, flexors, extensors; knee flexors and extensors; ankle dorsiflexors) in children with DCD (n=33, 12 females, 21 males, 6-12y, mean [SD] age 9y [2y]). Regression analysis compared changes in MIMS for similar changes in growth (height or body mass) for children with DCD and typically developing children (pre-existing database, n=183), controlling for age and sex. RESULTS For the same height gain, the gain in muscle strength was 37.3% to 69.2% less in children with DCD compared with typically developing children, with significantly lower slopes (p-value between

The force-generating capacities of human skeletal muscles are interrelated, highlighting a common construct of limb strength. This study aimed to further determine whether there is an intermuscular relationship in maximal voluntary activation capacities and contractile kinetics of human muscles. Twenty-six young healthy individuals participated in this study. Isometric maximal voluntary contraction (MVC) torque, voluntary activation level (VAL), and doublet twitch contractile kinetics (contraction time and half-relaxation time) evoked by a paired supramaximal peripheral nerve stimulation at 100 Hz were obtained in elbow flexors, knee extensors, plantar flexors and dorsiflexors of the dominant limb. Peak MVC torque had significant positive correlations between all muscle group pairs (all P values

Background: Aging results in adaptations which may affect the control of motor units. Objective: We sought to determine if younger and older men recruit motor units at similar force levels. Design: Cross-sectional, between-subjects design. Setting: Controlled laboratory setting. Participants: Twelve younger (age = 25 ± 3 years) and twelve older (age = 75 ± 8 years) men. Measurements: Participants performed isometric contractions of the dominant knee extensors at a force level corresponding to 50% maximal voluntary contraction (MVC). Bipolar surface electromyographic (EMG) signals were detected from the vastus lateralis. A surface EMG signal decomposition algorithm was used to quantify the recruitment threshold of each motor unit, which was defined as the force level corresponding to the first firing. Recruitment thresholds were expressed in both relative (% MVC) and absolute (N) terms. To further understand age-related differences in motor unit control, we examined the mean firing rate versus recruitment threshold relationship at steady force. Results: MVC force was greater in younger men (p = 0.010, d = 1.15). Older men had lower median recruitment thresholds in both absolute (p = 0.005, d = 1.29) and relative (p = 0.001, d = 1.53) terms. The absolute recruitment threshold range was larger for younger men (p = 0.020; d = 1.02), though a smaller difference was noted in relative terms (p = 0.235, d = 0.50). These findings were complimented by a generally flatter slope (p = 0.070; d = 0.78) and lower y-intercept (p = 0.009; d = 1.17) of the mean firing rate versus recruitment threshold relationship in older men. Conclusion: Older men tend to recruit more motor units at lower force levels. We speculate that recruitment threshold compression may be a neural adaptation serving to compensate for lower motor unit firing rates and/or denervation and subsequent re-innervation in aged muscle.

International audience; Physiological signals present fluctuations that can be assessed from their temporal structure, also termed complexity. The complexity of a physiological signal is usually quantified using entropy estimators, such as Sample Entropy. Recent studies have shown a loss of force signal complexity with the development of neuromuscular fatigue. However, these studies did not consider the stationarity of the force signals which is an important prerequisite of Sample Entropy measurements. Here, we investigated the effect of the potential nonstationarity of force signals on the kinetics of neuromuscular fatigue-induced change in force signal's complexity. Eleven men performed submaximal intermittent isometric contractions of knee extensors until exhaustion. Neuromuscular fatigue was assessed from changes in voluntary and electrically evoked contractions. Sample Entropy values were computed from submaximal force signals throughout the fatiguing task. The Dickey-Fuller test was used to statistically investigate the stationarity of force signals and the Empirical Mode Decomposition was applied to detrend these signals. Maximal voluntary force, central voluntary activation and muscle twitch decreased throughout the task (all p < 0.05), indicating the development of global, central and peripheral fatigue, respectively. We found an increase in Sample Entropy with fatigue (p = 0.024) when not considering the nonstationarity of force signals (i.e. 43% of the signals). After applying the Empirical Mode Decomposition, we found a decrease in Sample Entropy with fatigue (p = 0.002). These findings confirm the presence of nonstationarity in force signals during submaximal isometric contractions which influences the kinetics of change in Sample Entropy with neuromuscular fatigue.

A practice session is common prior to strength testing. However, the benefits of practice have not been previously reported. The purpose of this study was to determine the effect of a practice session on peak torque, mean torque and between trial variability across three test days. We hypothesized that peak and mean torque would be higher and less variable the second and third test days than the first. Twenty-five healthy, young participants completed 3 maximal voluntary isometric and isokinetic knee extensions on three separate days. No difference in isometric torque was found between days 1 and 2, but there was a significant decrease in isokinetic torque (8.45 Nm). There was a significant decrease in both mean isometric and isokinetic torque from day 1 to day 3 (12.67 and 13.59 Nm). Contrary to our hypothesis, no benefit from a practice session was found. Healthy, young adults are able to produce peak knee extensor torques on the first day of testing and do not demonstrate any benefit from additional testing. Thus, a practice day preceding isometric and isokinetic knee extensor strength testing may not be necessary when testing healthy, young participants, and may, in fact, negatively impact subsequent strength measurements.

Summary Background There is no final consensus regarding the ideal surgical technique for the treatment of patellar dislocation. The aim of this retrospective pilot study was to describe muscle strength, body composition, self-reported physical performance, and pain in male patients after patellar dislocation treatment with two different surgical techniques: medial patellofemoral ligament (MPFL) reconstruction vs. the Elmslie-Trillat procedure. Methods Isokinetic testing of knee extensor muscles was performed using a Biodex System 3 pro dynamometer at an angular velocity of 60°/s. Body composition was measured with bioelectrical impedance analysis (Nutribox). Self-reported physical performance and pain were assessed by the SF-36 subscales of physical functioning, role physical and bodily pain. The outcome variables of peak torque normalized to participant’s body mass (Nm/kg), lean body mass, phase angle, self-reported physical performance, and pain were compared between the study groups. Results Of the 12 included male patients, 6 had been treated with MPFL reconstruction (age: median = 33 years, range = 18–38 years; BMI: median = 26 kg/m2, range = 23–29) and 6 with the Elmslie-Trillat procedure (age: median = 26 years, range = 19–32 years; BMI: median = 23 kg/m2, range = 19–28). No statistically significant differences were found between the groups in any outcome parameter of muscle strength, body composition, self-reported physical performance, or pain. Conclusions The results of the present pilot study revealed that MPFL reconstruction shows equal results to the Elmslie-Trillat procedure, with respect to isokinetic knee muscle strength, body composition, self-reported physical performance and pain in male patients suffering from recurrent patellar dislocation.

Background: Performance in strength and functional testing is important when considering return to sport after anterior cruciate ligament (ACL) reconstruction. Both knee extensor strength and the single-leg squat (SLS) have been used in this context. Purpose: To evaluate the relationship between knee extensor strength and SLS performance after primary ACL reconstruction. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A prospective cohort of 100 patients was assessed 6 and 12 months after primary ACL reconstruction with a hamstring tendon autograft. Knee extensor peak torque was measured. Three sequential SLSs were performed, and the maximum flexion angle identified from frame-by-frame video analysis was used as the measure of squat performance. A limb symmetry index (LSI) was calculated and satisfactory performance defined as ≥90%. Results: Extensor mechanism strength deficits were seen in 75% of patients at 6 months and 57% at 12 months postoperatively. Mean extensor mechanism strength showed a large improvement between 6 and 12 months (123.6 vs 147.8 N·m, respectively; P < .001; Cohen d = 1.10), and while there was also a statistically significant improvement in the mean maximum flexion angle, the change was small (66.1° vs 68.1°, respectively; P = .011; Cohen d = 0.26). There was a weak positive correlation between knee extensor strength and the SLS maximum flexion angle at 6 months ( r = 0.342; P < .001) and 12 months ( r = 0.245; P = .014). An SLS LSI Conclusion: Extensor mechanism strength deficits are common after ACL reconstruction but reduce between 6 and 12 months. The SLS maximum flexion angle has a weak linear relationship to knee extensor strength. SLS performance has high specificity but low sensitivity in identifying extensor mechanism strength deficits. The SLS maximum flexion angle is therefore a suboptimal surrogate test to identify extensor mechanism strength deficits as diagnosed by isokinetic dynamometric testing. However, unsatisfactory SLS performance indicates a very high chance of underlying extensor mechanism weakness.

Transcranial magnetic stimulation (TMS)-induced relaxation rate reflects intrinsic muscle contractile properties by interrupting the drive from the central nervous system during voluntary muscle contractions. To determine the appropriateness of knee-extensor muscle relaxation measurements induced by TMS, this study aimed to establish both the within- and between-session reliability before and after a fatiguing exercise bout. Eighteen participants (9 females, 9 males, age 25 ± 2 years, height 171 ± 9 cm, body mass 68.5 ± 13.5 kg) volunteered to participate in two identical sessions approximately 30 days apart. Maximal and submaximal neuromuscular evaluations were performed with TMS six times before (PRE) and at the end (POST) of a 2-min sustained maximal voluntary isometric contraction. Within- and between-session reliability of PRE values were assessed with intraclass correlation coefficient (ICC2,1, relative reliability), repeatability coefficient (absolute reliability), and coefficient of variation (variability). Test-retest reliability of post-exercise muscle relaxation rates was assessed with Bland-Altman plots. For both the absolute and normalized peak relaxation rates and time to peak relaxation, data demonstrated low variability (e.g. coefficient of variation ≤ 7.8) and high reliability (e.g. ICC2,1 ≥ 0.963). Bland-Altman plots showed low systematic errors. These findings establish the reliability of TMS-induced muscle relaxation rates in unfatigued and fatigued knee-extensor muscles, showing that TMS is a useful technique that researchers can use when investigating changes in muscle relaxation rates both in unfatigued and fatigued knee-extensor muscles.

Background: Muscle soreness after a competition or a training session has been a concern of runners due to its harmful effect on performance. It is not known if stronger individuals present a lower level of muscle soreness after a strenuous physical effort. The aim of this study was to investigate whether the pre-race muscle strength or the V˙O2max level can predict muscle soreness 24, 48 and 72 h after a full marathon in men. Methods: Thirty-one marathon runners participated in this study (age, 40.8 ± 8.8 years old, weight, 74.3 ± 10.4 kg, height, 174.2 ± 7.6 cm, maximum oxygen uptake, V˙O2max, 57.7 ± 6.8 mL/kg/min). The isokinetic strength test for thigh muscles and the V˙O2max level was performed 15–30 days before the marathon and the participants were evaluated for the subjective feeling of soreness before, 24, 48 and 72 h after the marathon. Results: The participants presented more pain 24 h after the race (median = 3, IQR = 1) than before it (median = 0, IQR = 0) (p &lt, 0.001), and the strength values for the knee extensor muscles were significantly associated with muscle soreness assessed 24 h after the race (p = 0.028), but not 48 (p = 0.990) or 72 h (p = 0.416) after the race. The V˙O2max level was not associated with the muscle pain level at any moment after the marathon. Conclusions: Marathon runners who presented higher muscular strength for the knee extensor muscles presented lower muscle soreness 24 h after the race, but not after 48 h or 72 h after the race. Therefore, the muscle soreness level 3 days after a marathon race does not depend on muscle strength.

PURPOSE The effects of short-term blood flow restriction (BFR) exercise on muscle blood flow perfusion and performance during high-intensity exercise were determined in elite para-alpine standing skiers to assess whether this would be an effective training regimen for elite athletes with disabilities. METHODS Nine national-level para-alpine standing skiers (mean age, 20.67 ± 1.34 y; four women) were recruited. Non-dominant lower limbs were trained with BFR (eight in final analyses); dominant lower limbs without BFR (seven in final analyses). The 2-week protocol included high-load resistance, local muscle endurance (circuit resistance training), and aerobic endurance (stationary cycling) training performed 4 times/wk, with BFR during local muscle endurance and aerobic endurance sessions. Muscle strength was measured by maximal voluntary isometric contraction (MVIC) in the knee extensors; microcirculatory blood perfusion (MBP), by laser doppler blood flow; and muscle strength and endurance, by the total amount of work (TW) performed during high-intensity centrifugal and concentric contractions. RESULTS BFR significantly increased absolute and relative MVIC (P < 0.001, P = 0.001), MBP (P = 0.011, P = 0.008), and TW (P = 0.006, P = 0.007) from pretraining values, whereas only absolute MVIC increased without BFR (P = 0.047). However, the MVIC increase with BFR exercise (35.88 ± 14.83 N·m) was significantly greater (P = 0.040) than without BFR exercise (16.71 ± 17.79 N·m). CONCLUSIONS Short-term BFR exercise significantly increased strength endurance, muscle strength, and microcirculatory blood perfusion in national-level para-alpine standing skiers. Our study provides new evidence that BFR exercise can improve local muscle blood perfusion during high-intensity exercise and informs BFR exercise strategies for athletes with disabilities.

Insulin resistance and muscle weakness are risk factors for silent lacunar infarcts (SLI), but it is unclear whether they are still independent risk factors when adjusted for each other. In addition, the effect of their combination on SLI is completely unknown. We evaluated SLI, insulin sensitivity, and knee extensor muscle strength by magnetic resonance imaging, PREDIM, and dynamometer, respectively, in 1531 elderly people aged 65–84 years living in an urban area of Tokyo. Among the study subjects, 251 (16.4%) had SLI. Impaired insulin sensitivity (High; 1.00 [reference], Medium; 1.53 [95% confidence interval (CI) 0.94–2.48], Low; 1.86 [1.02–3.39], p for trend 0.047) and reduced muscle strength (High; 1.00 [reference], Medium; 1.40 [0.98–2.02], Low; 1.49 [1.04–2.15], p for trend 0.037) were independently associated with increased risk for SLI in the fully adjusted model. In terms of combined, subjects classified as having the lowest insulin sensitivity and lowest strength were 4.33 times (95% CI 1.64–11.45) more likely to have a SLI than those classified as having the highest insulin sensitivity and highest strength. Impaired insulin sensitivity and reduced muscle strength were independently associated with higher risk of SLI in elderly subjects, and their combination synergistically increased this risk.

Purpose: Transcranial magnetic stimulation (TMS) provides an indication of changes occurring in the corticospinal pathway. This study aimed to determine the between-day (trials 1 week apart) and within-day (trials 1 h apart) reliability of TMS and peripheral nerve stimulation.\ud \ud Methods: 22 male participants (age 23 ± 4 years; height 1.80 ± 0.07 m; body mass 75.1 ± 11.7 kg; body mass index 23.1 ± 2.5 kg.m 2) completed 2 familiarisation sessions and 3 experimental trials (trial 2 and 3 split by 1 h). The interpolated twitch technique was used to determine TMS-assessed voluntary activations (VA-TMS) superimposed on submaximal and maximal leg extension performed on a custom-built dynamometer. Reliability was assessed using equivalence tests, systematic error, 95% limits of agreement, intraclass correlation coefficient (ICC) and coefficient of variation (CV).\ud \ud Results: VA-TMS was equivalent between-day (94.1 ± 4.4% versus 93.7 ± 4.9%, P < 0.01) and within-day (93.7 ± 4.9% versus 93.7 ± 4.8%, P < 0.01). Systematic error (95% limits of agreement) for VA-TMS was 0.5% (5.1%, 4.2%) for between-day and 0.0% 2 (5.3%, 5.4%) for within-day. ICC and CV values demonstrated high reliability between-day (ICC = 0.93, CV = 2.5%) and within-day (ICC = 0.92, CV = 2.9%).\ud \ud Conclusion: Results indicate that TMS can reliably estimate the output of the motor cortex to the knee extensors, both between-day and within-day. The findings have been used to estimate sample sizes for this technique for future research.

The etiology of changes in lower-limb neuromuscular function, especially to the central nervous system, may be affected by exercise duration. Direct evidence is lacking as few studies have directly compared different race distances. This study aimed to investigate the etiology of deficits in neuromuscular function following short versus long trail-running races. Thirty-two male trail runners completed one of five trail-running races as LONG (>100 km) or SHORT (

PURPOSE To investigate the effects of a single session of either peristaltic pulse dynamic leg compressions (PPDC) or local heat therapy (HT) after prolonged intermittent shuttle running on skeletal muscle glycogen content, muscle function, and the expression of factors involved in skeletal muscle remodeling. METHODS Twenty-six trained individuals were randomly allocated to either a PPDC (n = 13) or a HT (n = 13) group. After completing a 90-min session of intermittent shuttle running, participants consumed 0.3 g·kg-1 protein plus 1.0 g·kg-1 carbohydrate and received either PPDC or HT for 60 min in one randomly selected leg, while the opposite leg served as control. Muscle biopsies from both legs were obtained before and after exposure to the treatments. Muscle function and soreness were also evaluated before, immediately after, and 24 h after the exercise bout. RESULTS The changes in glycogen content were similar (P > 0.05) between the thigh exposed to PPDC and the control thigh ~90 min (Control: 14.9 ± 34.3 vs PPDC: 29.6 ± 34 mmol·kg-1 wet wt) and ~210 min (Control: 45.8 ± 40.7 vs PPDC: 52 ± 25.3 mmol·kg-1 wet wt) after the treatment. There were also no differences in the change in glycogen content between thighs ~90 min (Control: 35.9 ± 26.1 vs HT: 38.7 ± 21.3 mmol·kg-1 wet wt) and ~210 min (Control: 61.4 ± 50.6 vs HT: 63.4 ± 17.5 mmol·kg-1 wet wt) after local HT. The changes in peak torque and fatigue resistance of the knee extensors, muscle soreness, and the mRNA expression and protein abundance of select factors were also similar (P > 0.05) in both thighs, irrespective of the treatment. CONCLUSIONS A single 1-h session of either PPDC or local HT does not accelerate glycogen resynthesis and the recovery of muscle function after prolonged intermittent shuttle running.