Arthrogenic Muscle Inhibition Research Articles

Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial.

Various pathophysiological contexts can be accompanied by weakness, arthrogenic muscle inhibition, and even disability. In this scenario, peripheral nerve stimulation has been studied not only for pain management but also for the improvement of neuromuscular parameters. For this purpose, the use of Transcutaneous Electrical Nerve Stimulation (TENS) has typically been investigated, but recently, the use of ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) has gained popularity. In this regard, electrical stimulation has a predisposition to activate Type II muscle fibers and has been shown to be capable of generating short-term potentiation by increasing calcium sensitivity. However, the evidence of pPNS applied in humans investigating such variables is rather limited. This pilot study aimed to assess the feasibility of the methodology and explore the potential of pPNS in enhancing hip extension performance in individuals suffering from knee pain, comparing it with TENS. Twelve participants were divided into pPNS and TENS groups, undergoing pre- and post-intervention assessments of peak concentric power (W), strength (N), execution speed (m/s), and one-repetition maximum (1RM) (kg) estimation. For pPNS, two needles were positioned adjacent to the superior and inferior gluteal nerves under ultrasound guidance. For TENS, electrodes were positioned between the posterosuperior iliac spine and the ischial tuberosity, and halfway between the posterosuperior iliac spine and the greater trochanter. The interventions consisted of 10 stimulations of 10 s at a frequency of 10 Hz with a pulse width of 240 μs, with rest intervals of 10 s between stimulations. Peripheral nerve stimulation significantly improved concentric power at 30% (p = 0.03) and 50% (p = 0.03) of 1RM, surpassing TENS, which showed minimal changes. No significant strength differences were observed post-intervention in either group. This work presents evidence where pPNS applied to the gluteal nerves results in an enhanced performance of hip extension at submaximal loads. However, this improvement does not seem to be reflected in short-term changes in the estimation of the 1RM by the force-velocity profile.

Can Arthrogenic Muscle Inhibition Exist in Peroneal Muscles Among People with Chronic Ankle Instability? A Cross-sectional Study.

Ankle sprains lead to an unexplained reduction of ankle eversion strength, and arthrogenic muscle inhibition (AMI) in peroneal muscles is considered one of the underlying causes. This study aimed to observe the presence of AMI in peroneal muscles among people with chronic ankle instability (CAI). Sixty-three people with CAI and another sixty-three without CAI conducted maximal voluntary isometric contraction (MVIC) and superimposed burst (SIB) tests during ankle eversion, then fifteen people with CAI and fifteen without CAI were randomly invited to repeat the same tests to calculate the test-retest reliability. Electrical stimulation was applied to the peroneal muscles while the participants were performing MVIC, and the central activation ratio (CAR) was obtained by dividing MVIC torque by the sum of MVIC and SIB torques, representing the degree of AMI. The intra-class correlation coefficients were 0.77 (0.45-0.92) and 0.92 (0.79-0.97) for the affected and unaffected limbs among people with CAI, and 0.97 (0.91-0.99) and 0.93 (0.82-0.97) for the controlled affected and unaffected limbs among people without CAI; Significant group × limb interaction was detected in the peroneal CAR (p = 0.008). The CARs were lower among people with CAI in the affected and unaffected limbs, compared with those without CAI (affected limb = 82.54 ± 9.46%, controlled affected limb = 94.64 ± 6.37%, p < 0.001; unaffected limb = 89.21 ± 8.04%, controlled unaffected limb = 94.93 ± 6.01%, p = 0.016). The CARs in the affected limbs were lower than those in the unaffected limbs among people with CAI (p = 0.023). No differences between limbs were found for CAR in the people without CAI (p = 0.10). Bilateral AMI of peroneal muscles is observed among people with CAI. Their affected limbs have higher levels of AMI than the unaffected limbs.

Difference of Knee Strength Recovery Between Revision and Primary ACL Reconstruction.

Different grafting procedures are available to restore knee stability after revision anterior cruciate ligament (ACL) reconstruction. We compared knee strength recovery between ACL revision surgery and primary reconstruction. One hundred and ten patients with ACL revision surgery were matched with 110 patients with primary reconstruction based on the graft procedure. The isokinetic knee strength had been assessed for the first 9 months post-surgery. Knee laxity, function, and activity score were also evaluated. Limb symmetry index for knee extensor and flexor strength was not different at 4-, 6- and 9-months post-surgery between revision surgery and primary reconstruction. These results depended on ipsilateral or contralateral graft choice. Ipsilateral hamstring tendon (HT) and contralateral bone-patellar-tendon-bone (BPTB) graft procedures were similar for a revision of a BPTB graft failure. Contralateral HT procedure was better than ipsilateral BPTB procedure for a revision of a HT graft failure. The early recovery of isokinetic knee strength after ACL revision surgery regardless of the HT or BPTB procedures, was similar to the recovery after primary ACL reconstruction with the same graft technique. These results apparently depended on a temporary quadriceps arthrogenic muscle inhibition and on a persistent donor site morbidity, concerning the new and the previous grafts, respectively.

Incidence of and Risk Factors for Arthrogenic Muscle Inhibition in Acute Anterior Cruciate Ligament Injuries: A Cross-Sectional Study and Analysis of Associated Factors From the SANTI Study Group

Background: Arthrogenic muscle inhibition (AMI) is a process in which neural inhibition after injury or surgery to the knee results in quadriceps activation failure and knee extension deficit. Purpose: To determine the incidence and spectrum of the severity of AMI after acute anterior cruciate ligament (ACL) injury using the Sonnery-Cottet classification, to determine the interobserver reliability of the classification system, and to investigate potential important factors associated with AMI after ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients who had an acute ACL injury between October 2021 and February 2022 were considered for study inclusion. Eligible patients underwent a standardized physical examination at their first outpatient appointment. This included an assessment of quadriceps inhibition, identification of any extension deficits, and grading of AMI and its reversibility according to the Sonnery-Cottet classification. Results: A total of 300 consecutive patients with acute ACL ruptures were prospectively enrolled in the study. Of them, 170 patients (56.7%) had AMI. Patients evaluated with AMI showed a significantly inferior Lysholm score, International Knee Documentation Committee score, Simple Knee Value, and Knee injury and Osteoarthritis Outcome Score than patients without AMI (P < .0001). Multivariate analysis revealed that the presence of effusion, concomitant injuries, and high pain scores were associated with a significantly greater risk of AMI. Additional associations with the presence of AMI included a short duration between injury and evaluation, the use of crutches, and using a pillow as a support at night. In contrast, a previous ACL injury was associated with significantly lower odds of developing AMI (OR, 0.025; 95% CI, 0-0.2; P = .014). Among the 170 patients with AMI, 135 patients (79%) showed a resolution of their inhibition at the end of the consultation after application of simple exercises; the remaining 35 patients required specific rehabilitation. Interobserver reliability of the classification system was almost perfect (95% CI, 0.86-0.99). Conclusion: AMI occurs in over half of patients with acute ACL injuries. When it occurs, it is easily reversible in the majority of patients with simple exercises targeted at abolishing AMI. The presence of “red flags” should increase the index of suspicion for the presence of AMI, and these include the presence of an effusion, high pain scores, a short time between injury and evaluation, multiligament injuries, the use of crutches, and using a pillow as a support at night. Patients with a history of ipsilateral or contralateral ACL injury are at a significantly lower risk of AMI than those with a first-time ACL injury.

Transcutaneous Electrical Nerve Stimulation Provides Early Recovery from Arthrogenic Muscle Inhibition Post-Anterior Cruciate Ligament Reconstruction

Abstract Background: Quadriceps weakness that ensues anterior cruciate ligament (ACL) reconstruction, a common procedure done in sportspersons, is a hindrance in the active rehabilitation and delays return to sport. This weakness of quadriceps muscle is a complex neural phenomenon ascribed to arthrogenic muscle inhibition (AMI). Purpose: The purpose of the study was to assess the effectiveness of transcutaneous electrical nerve stimulation (TENS) in AMI post-ACL reconstruction (ACLR). Methods: A prospective randomized study involving 60 patients with isolated ACL injury above 18 years of age were included. Patients with osteoarthritis knee, multiligament injury, previous knee surgery, and inflammatory knee pathology were excluded from the study. Patients were divided into Groups A and B (n = 30, each). Group A received TENS therapy with exercises and ice packs, whereas Group B received only exercise and ice packs post-ACLR. All patients were assessed subjectively using Visual Analog Scale score for pain, Lysholm, and IKDC score for functional outcome pre and postoperatively on day 2, 1 month, 3 months, 6 months, and 1 year. Objective assessment was done by measuring thigh girth (10 cm above knee joint line) and isometric quadriceps strength (using David Biofeedback Strength Evaluation Machine) pre and postoperatively at day 2, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year. Results: Pain decreased in both groups at 1 month, 3 months, and 6 months, but there was significantly lower pain in Group A in comparison to Group B at 1 month (P = 0.003), 3 months (P = 0.001), and 6 months (P ≤ 0.0001). There was no pain at 1 year in both the groups. Lysholm score improved in both groups, but there was statistically significantly better Lysholm score in Group A in comparison to Group B at each follow-up. IKDC score improved in both groups, but the improvement in Group A was significantly higher than Group B at each follow-up. No significant difference in mean thigh girth was observed. Mean quadriceps strength was similar in both groups except at 6 months where Group A was better than Group B (&lt;0.001). Conclusion: Addition of TENS in ACLR rehabilitation decreases pain and provides better clinical outcome.

The Immediate Effect of Cross-Education on the Quadriceps Arthrogenic Muscle Inhibition in Women with Unilateral Knee Osteoarthritis

The Immediate Effect of Cross-Education on the Quadriceps Arthrogenic Muscle Inhibition in Women with Unilateral Knee Osteoarthritis

Incidence and risk factors for arthrogenic muscle inhibition in acute anterior cruciate ligament injuries: A cross sectional study and analysis of associated factors

Incidence and risk factors for arthrogenic muscle inhibition in acute anterior cruciate ligament injuries: A cross sectional study and analysis of associated factors

Rehabilitation of Patients with Arthrogenic Muscular Inhibition in Pathologies of Knee Using Virtual Reality.

Arthrogenic muscle inhibition (AMI) refers to muscular alterations that are generated, producing biomechanical motor control and movement problems, leading to deficiencies in strength and atrophy. Currently, there exist methods that involve virtual reality (VR) and have been well perceived by physiotherapists. The present research measured the potential benefits in terms of therapeutic adherence and speed of recovery, through a comparative analysis in a healthcare provider institution, in Medellín, Colombia, with and without the aid of VR. For this purpose, dynamometry, and surface electromyography (sEMG) signal acquisition tools were used. The treatment involved neuromodulation, ranges of motion and mobility work, strengthening and reintegration into movement, complemented with TENS, NMENS and therapeutic exercise, where the patient was expected to receive a satisfactory and faster adherence and recovery. A group of 15 people with AMI who include at least 15 min of VR per session in their treatment were compared with another group who received only the base treatment, i.e., the control group. Analyzing the variables individually, it is possible to affirm that VR, as a complement, statistically significantly improved the therapeutic adherence in 33.3% for CG and 37.5% for IG. Additionally, it increased strength with both legs, the symmetry between them, and decreased the level of pain and stiffness that is related to mobility.

Dry Needling for Arthrogenic Muscle Inhibition of Quadriceps Femoris in Patients after Reconstruction of Anterior Cruciate Ligament: a Protocol for a Randomized Controlled Trial.

: Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR. : A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit. : The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.

Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction.

Outcomes following anterior cruciate ligament reconstruction(ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).

Effect Of Arthrogenic Muscle Inhibition On Peroneal Muscle Strength Among People With Chronic Ankle Instability

Effect Of Arthrogenic Muscle Inhibition On Peroneal Muscle Strength Among People With Chronic Ankle Instability

The effect of blood flow restriction in low-intensity load exercise on isokinetic strength of the quadriceps muscles in knee osteoarthritis

Link of Video Abstract: https://youtu.be/tduoO-xy3ZE Introduction: Cartilage destruction in knee osteoarthritis (KOA) caused the inflammation process. It makes the patient complain of knee pain, tends to immobilize, and induced neural inhibition (Arthrogenic muscle inhibition) on the quadriceps muscle as a knee stabilator and shock absorbent. These caused quadriceps weakness. The combination of blood flow restriction (BFR) and low-intensity resistance training (LIRT) showed an improvement in isotonic peak torque significantly, but the prescription is varied and limited in Indonesia. Patient and Methods: This was a clinical experimental study with randomized control trial with pre and post-test design. The subjects were 28 KOA patients (50-70 years old). The intervention group (n=14) received a combination of low-load resistance training (30% 1-RM; 75 repetitions) and BFR (50 mmHg). The control group (n=14) received low load resistance training only (30% 1-RM; 75 repetitions). Both groups received training 2 times per week with a Q-bench machine for 6 weeks. Isokinetic peak torque was assessed before and after the training program. Results: There was a significant improvement in isokinetic peak torque before and after the training program in both groups (intervention group p=0.001; control group p=0.000). There was a significant improvement of delta isokinetic peak torque between both groups (p=0.018) and post-test between both groups (p=0.044). The effect size value of the intervention group was 1.22 (very large) and the control group was 0.89 (large). Conclusions: The addition of BFR on LIRT for 6 weeks can improve isokinetic quadriceps strength in patients with knee osteoarthritis

Role of passive and active myostimulation for the changing levels of some cytokines

Injury to the anterior cruciate ligament (ACL) of the knee joint is complicated by development of arthrogenic muscle inhibition due to disregulating afferent influences on the excitability of the spinal and supraspinal tracts. The aim of our work was to study electromyography parameters, and myokine levels in the course of myostimulation in traumatic ACL injury.&#x0D; 28 male athletes with traumatic ACL injuries participated in the study. On admission to the clinic, all patients underwent electromyographic examination of the injured limb by the means of Viking Quest EMG/ EP apparatus (Nicolet, USA). Some patients, 10 days before starting the surgical treatment, underwent passive electrical myostimulation (EMS) of the quadriceps femoris muscle using the INTELECT Advanced device (Chattanooga (DJO), USA). Further on, all patients underwent arthroplasty using a Karl Storz arthroscope (Germany). In the postoperative period, during immobilization for 2-weeks, the patients received EMS. After removing the orthosis, the patients switched to active training. The cytokine levels were studied using ELISA reagent kits from Vector-Best, Novosibirsk (IL-6), or from Cloud-Clone Corp. (China) for TGF1assays. Statistical processing of the material was carried out using the Statistica package. vers.10.0 (StatSoft Inc., USA).&#x0D; The highest average amplitude (V) was recorded by electromyography in healthy individuals. In patients of the main group, significantly lower values of the average amplitude were recorded. After a 10-day EMS, a significant increase to the reference values of healthy individuals was noted. In the postsurgical dynamics, EMG indicators without EMS treatment remained at the same low levels. Meanwhile, the values following EMS treatment were comparable with those in healthy individuals, thus reflecting a faster and better muscle recovery after injury. The levels of IL-6 and TGF-1 cytokines (myokines) significantly exceeded the initial levels in the course of EMS. The biological significance of increased IL-6 levels during the muscle exercise may consist the activation of AMP kinase and/or phosphatidylinositol-3-kinase at the level of skeletal muscles thus providing more efficient supply of energy substrate to the muscles. TGF-1 promotes fibroblast proliferation, thus increasing collagen content.&#x0D; Passive and active EMS leads to an improvement in electromyography parameters, along with increased concentration of myokines (IL-6 and TGF-1) in peripheral blood, thus promoting improvement of energy balance, increasing the anti-inflammatory and repair potential of the damaged tissues.

Persistence of neuromuscular activation deficit in the lower limb at 3-years of follow-up after ACL reconstruction surgery

BackgroundAlmost all patients experience neuromuscular disorders of the quadriceps after knee trauma or surgery such as anterior cruciate ligament (ACL) reconstruction. This phenomenon is described in literature as arthrogenic muscle inhibition (AMI). It can be detrimental to patients and cause complications. However, few studies have evaluated the long-term persistence of deficits arising from this, following ACL reconstruction. PurposeBy comparing neuromuscular activation in the lower limb after ACL reconstruction with the unaffected lower limb, after more than 3-years of follow-up, this study aimed to evaluate the possible persistence of long-term deficits after surgery. MethodsFifty-one patients who underwent ACL reconstruction in 2018 were included in the study, with a minimum follow-up of 3 years. The neuromuscular activation deficit was assessed using the Biarritz Activation Score-Knee (BAS-K), whose intra- and inter-observer reproducibility was also evaluated. The ACL-RSI, KOOS, SANE Leg, Tegner and IKDC scores were also evaluated. ResultsThe mean BAS-K score of the knee that underwent surgery was 21.8/50 versus 37.9/50 in the healthy knee (p < 0.05). The SANE leg score was 76.8/100 versus 97.6/100 (p < 0.05). The mean IKDC was 84.17 (±12.7). The mean KOOS was 86.2 (±9.2). The mean ACL-RSI was 70 (±7.9) and the Tegner score was 6.3 (±1.2). Intra- and inter-observer reproducibility was satisfactory for the BAS-K score. ConclusionWe found that the neuromuscular activation deficit was high (roughly 42%) at more than 3-years of follow-up after ACL reconstruction. The deficit is not limited to the quadriceps and affects the whole limb. Our findings highlight the need for appropriate rehabilitation after ACL surgery, targeting the corticospinal level in particular.Level of Evidence III: prognostic retrospective case-control study.

Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study

BackgroundPersistent anterior knee pain and subsequent patellofemoral joint (PFJ) osteoarthritis (OA) are common symptoms after anterior cruciate ligament reconstruction (ACLR). Quadriceps weakness and atrophy is also common after ACLR. This can be contributed by arthrogenic muscle inhibition and disuse, caused by joint swelling, pain, and inflammation after surgery. With quadriceps atrophy and weakness are associated with PFJ pain, this can cause further disuse exacerbating muscle atrophy. Herein, this study aims to identify early changes in musculoskeletal, functional and quality of health parameters for knee OA after 5 years of ACLR.MethodsPatients treated with arthroscopically assisted single-bundle ACLR using hamstrings graft for more than 5 years were identified and recruited from our clinic registry. Those with persistent anterior knee pain were invited back for our follow-up study. For all participants, basic clinical demography and standard knee X-ray were taken. Likewise, clinical history, symptomatology, and physical examination were performed to confirm isolated PFJ pain. Outcome measures including leg quadriceps quality using ultrasound, functional performance using pressure mat and pain using self-reported questionnaires (KOOS, Kujala and IKDC) were assessed. Interobserver reproducibility was assessed by two reviewers.ResultsA total of 19 patients with unilateral injury who had undergone ACLR 5-years ago with persistent anterior knee pain participated in this present study. Toward the muscle quality, thinner vastus medialis and more stiffness in vastus lateralis were found in post-ACLR knees (p < 0.05). Functionally, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb with increasing knee flexion. In accordance, rectus femoris muscle stiffness in the ACLR knee was significantly correlated with pain (p < 0.05).ConclusionIn this study, it was found that patients having higher degree of anterior knee pain were associated with higher vastus medialis muscle stiffness and thinner vastus lateralis muscle thickness. Similarly, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb leading to an abnormal PFJ loading. Taken together, this current study helped to indicate that persistent quadriceps muscle weakness is potential contributing factor to the early development of PFJ pain.

Effect of electrical stimulation of the thigh muscles on the level of interleukin-6 in traumatic injuries of the anterior cruciate ligament of the knee joint

Traumatic damage to the anterior cruciate ligament leads to impaired support and mechanical instability of the limb. One of the frequent complications after injury is arthrogenic muscle inhibition due to inhibition of the quadriceps muscle and the development of functional contracture. On the contrary, one of the indicators of high muscle activity is a sufficient level in the blood of functional muscle proteins – myokines, in particular interleukin-6, which are expressed and released by muscle fibers. The aim of the study was to study the level of interleukin-6 in men with damage to the anterior cruciate ligament in the dynamics of electromyostimulation of the quadriceps femoris. The study involved 23 men, mean age 34.8±2.2 years, with traumatic injury of the anterior cruciate ligament, who, 10 days before surgery, underwent electromyostimulation of the quadriceps femoris using the INTELECT® Advanced device (Chattanooga (DJO), USA). The control group consisted of 12 healthy men, mean age 32.2±2.4 years. The level of IL-6 was determined in the blood serum before electromyostimulation, and in dynamics using a kit for enzyme immunoassay (Vector-Best, Novosibirsk). The obtained data were processed using the Statistica licensed software package v. 10.0. The basal level of IL-6 in the main group was 1.28 (0.87-1.72) pg/mL, which is significantly lower than in healthy individuals 5.2 (3.8-6.1) pg/mL and is due to a low level of physical activity due to functional contracture of the quadriceps muscle. In the dynamics of electromyostimulation on the 5th day, the level of IL-6 significantly increased by 3.2 times from the basal level, on the 10th day by 4.6 times, while not exceeding that of the group of healthy individuals. With the reduction of myocytes, the concentration of myokine interleukin-6 increased in the cytoplasm of cells, which contributes to the accumulation of macroergs in the muscle cell, due to myokine-dependent activation of glycogenolysis. The reparative and anti-inflammatory properties of IL-6 are realized in stimulated striated muscles by the classical signaling mechanism that can block the activation of the universal intracellular transcription factor NF-κB in relation to the production of pro-inflammatory cytokines. Thus, electromyostimulation before the start of surgical treatment leads to an increase in the concentration of myokine IL-6 in the blood, which contributes to an increase in the anti-inflammatory and reparative potential of damaged tissues.

Neuromotor Treatment of Arthrogenic Muscle Inhibition After Knee Injury or Surgery.

Persistent weakness of the quadriceps muscles and extension deficit after knee injuries are due to specific alterations in neural excitability - a process known as arthrogenic muscle inhibition (AMI). The effects of a novel neuromotor reprogramming (NR) treatment based on the use of proprioceptive sensations associated with motor imagery and low frequency sounds have not been studied in AMI after knee injuries. This study aimed to assess quadriceps electromyographic (EMG) activity and the effects on extension deficits in persons with AMI who completed 1 session of NR treatment. We hypothesized that the NR session would activate the quadriceps and improve extension deficits. Case series. Level 4. Between May 1, 2021 and February 28, 2022, patients who underwent knee ligament surgery or sustained a knee sprain with a deficit of >30% of the vastus medialis oblique (VMO) on EMG testing in comparison with the contralateral limb after their initial rehabilitation were included in the study. The maximal voluntary isometric contraction of the VMO measured on EMG, the knee extension deficit (distance between the heel and the table during contraction), and the simple knee value (SKV) were assessed before and immediately after completion of 1 session of NR treatment. A total of 30 patients with a mean age of 34.6 ± 10.1 years (range, 14-50 years) were included in the study. After the NR session, VMO activation increased significantly, with a mean increase of 45% (P < 0.01). Similarly, the knee extension deficit significantly improved from 4.03 ± 0.69 cm before the treatment to 1.93 ± 0.68 after the treatment (P < 0.01). The SKV was 50 ± 5.43% before the treatment, and this increased to 67.5 ± 4.09% after the treatment (P < 0.01). Our study indicates that this innovative NR method can improve VMO activation and extension deficits in patients with AMI. Therefore, this method could be considered a safe and reliable treatment modality in patients with AMI after knee injury or surgery. This multidisciplinary treatment modality for AMI can enhance outcomes through the restoration of quadriceps neuromuscular function and subsequent reduction of extension deficits after knee trauma.

Arthrogenic muscle inhibition after anterior cruciate ligament injury: Injured and uninjured limb recovery over time.

It is well documented that marked weakness of the quadriceps is present after knee joint injury. This joint trauma induces a presynaptic reflex inhibition of musculature surrounding the joint, termed arthrogenic muscle inhibition (AMI). The extent to which anterior cruciate ligament (ACL) injury affects thigh musculature motor unit activity, which may affect restoration of thigh muscle strength after injury, is undetermined. A randomized protocol of knee flexion and extension isometric contractions (10%-50% maximal voluntary isometric contraction) were performed for each leg on 54 subjects with electromyography array electrodes placed on the vastus medialis, vastus lateralis, semitendinosus, and biceps femoris. Longitudinal assessments for motor unit recruitment and average firing rate were acquired at 6-month intervals for 1 year post ACL injury. The ACL-injured population demonstrated smaller quadriceps and hamstrings motor unit size (assessed via motor unit action potential peak-to-peak amplitude) and altered firing rate activity in both injured and uninjured limbs compared to healthy controls. Motor unit activity remained altered compared to healthy controls at 12 months post ACL reconstruction (ACLR). Motor unit activity was altered after ACLR up to 12 months post-surgery. Further research is warranted to optimize rehabilitation interventions that adequately address altered motor unit activity and improve safety and success with return to sport after ACLR. In the interim, evidence based clinical reasoning with a focus on development of muscular strength and power capacity should be the impetus behind rehabilitation programming to address motor control deficits.

What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis

Purpose To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI). Materials and methods Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus. Results Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03–1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01–1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14–1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16–1.87 for the tibialis anterior). Conclusions FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.

Sickle cell disease chronic joint pain: Clinical assessment based on maladaptive central nervous system plasticity.

Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients.