Isokinetic Evaluation Research Articles

The Clinical Efficacy of Extracorporeal Shock Wave Therapy Combined with Platelet Rich Plasma and Exercise for Lateral Epicondylitis: Prospective Randomized Sham-Controlled Ultrasonographic Study.

To evaluate the combined effect of two different regenerative therapies, extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP), along with therapeutic exercise, in patients with lateral epicondylitis (LE). Prospective, Randomized, Sham-Controlled Trial. Outpatient clinic. Ninety one patients with LE for >3 months were randomly allocated into 3 groups. Participants were assigned to PRP+ESWT, Sham PRP +ESWT, or ESWT only treatment group. All groups received exercise therapy. The primary outcome was the VAS pain score. Secondary outcomes included handgrip strength, Patient-rated Tennis Elbow Evaluation (PRTEE), Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Short Form 36 (SF-36), ultrasonographic assessments (common extensor tendon [CET] measurement and total ultrasonography scale score [TUSS]), and isokinetic evaluation. Participants were evaluated three times: pre-treatment (T0), after 4 weeks (T1), and after 12 weeks (T2). The PRP group showed superiority over other groups in terms of VAS (activity and night) scores at follow-ups. With regard to the secondary outcomes, in the short term, the PRP group demonstrated a statistically significant difference in the PRTEE-function. In the 12th week, PRP outperformed only against ESWT in all PRTEE parameters, and also showed superior Quick DASH scores to the other groups. In handgrip strength, the PRP group demonstrated superiority over the Sham PRP group at T1 and over both groups at T2. In the isokinetic evaluation, PRP group showed superiority over the Sham PRP group in both wrist flexion/extension peak torque scores during follow-ups. No significant differences were found in any of the ultrasonographic parameters, including CET thickness and TUSS scores, between the groups at the 4th and 12th week. The combined application of ESWT and PRP in the management of LE has demonstrated superior efficacy, as evidenced by significant improvements in clinical parameters.

Association between intra and inter-limb strength asymmetry with sprint kinematics and force-velocity profile in youth team athletes

BackgroundMaximal force plays a pivotal role in enhancing performance across various dynamic sports, particularly in sprinting biomechanics. However, muscle strength asymmetry among major muscle groups like the hamstrings and quadriceps may hinder sprint performance and raise injury risks. This study examines how intra- and inter-limb strength asymmetry relates to sprint kinematics and the power-force–velocity profile in youth athletes. MethodsSeventy-four youth athletes from football, volleyball, and handball completed two testing sessions, 48 h apart. Assessments included anthropometric measurements, sprint tests, and isokinetic dynamometer strength evaluations at 60°.s−1 and 180°.s−1. Sprint kinematics were analyzed using the Optojump Next system, and force–velocity profile variables were determined via Samozino’s method. Asymmetry analysis used a standard percentage difference equation. ResultsWeak to moderate correlations (r = −0.46 to 0.45) were found between strength asymmetry and sprint parameters, suggesting limited impact of asymmetry on sprint kinematics and kinetics. Although most participants showed asymmetry levels below the 15% threshold deemed functionally significant, outliers had asymmetry values up to 42%, indicating considerable variability. ConclusionsLower extremity strength asymmetry moderately affects sprint kinematics and force–velocity profiles in young team athletes, challenging traditional views. Further research is needed to explore the mechanisms between strength asymmetry and sprint performance, aiming to inform targeted training interventions that optimize performance and reduce injury risks in youth athletes.

Do Elite Female Judokas Show Asymmetry in the Internal and External Rotators of the Shoulder? A One-Dimensional and Principal Component Approach

Background/Aims: Asymmetry of the internal (IR) and external (ER) shoulder rotators can increase the risk of injuries in judokas. Discrete analyses are usually performed in time series data, but they can have biases by removing trends, so other approaches have been proposed to avoid these biases such as statistical parametric mapping (SPM) and principal component analysis (PCA). This study analyzed the asymmetry in the shoulder rotators in female judokas, comparing dominant (D) vs. non-dominant (ND) upper limbs. Methods: For this, 11 elite athletes (age: 20.1 ± 2.9 yrs.; experience: 4.0 ± 0.5 yrs.; body mass: 66.0 ± 14.6 kg; height: 1.6 ± 0.1 m; BMI: 24.8 ± 4.3 kg/m2), were evaluated in an isokinetic dynamometer (Cybex® Humac/Norm Dynamometer CSMI, 502140, Stoughton, MA, USA). All participants performed the concentric (CON/CON) isokinetic evaluations of internal and external rotation of the shoulder in 60°/s and 180°/s angular velocities. Results: There was no significative asymmetry between IR vs. ER at 60°/s; similar results were observed at 180°/s when analyzed by PCA or SPM methods (p > 0.05 for all comparison). There was no difference between peak torque at 60°/s or 180°/s (p > 0.05 for all comparison). Conclusions: no asymmetry was observed in IR and ER in elite female athletes, regardless of the analysis method.

Preliminary results of acute Achilles tendon rupture treated with platelet-rich plasma and immobilization

Objective: Evaluate preliminary functional results, return to sport, re-rupture rate of acute Achilles rupture treated with one applicationof platelet-rich plasma (PRP), and immobilization.Methods: A prospective analytical study was performed in patients with acute Achilles tendon rupture treated conservatively, associatedwith a single local application of PRP within 10 days of injury. The sample comprised 28 patients diagnosed and monitored by the sameteam for a minimum of 12 months. The American Foot and Ankle Society Functional Rating Scale (AOFAS), Achilles tendon totalrupture score (ATRS), visual analog scale (VAS), and Achilles tendon resting angle (ATRA) were evaluated, the time of return to sportsactivities and isokinetic strength were evaluated at the different follow-up times and injury site using magnetic resonance imaging.Results: The variance analysis of the AOFAS, ATRA, and VAS scores showed a significant difference at six and 12 months regardingthe initial score and according to the injury site. The mean time to return to sports activities was 197 days, 85.7% had homogeneoustendons, and heel-rise type 2 was achieved in 28.6% at six months and 60.7% at 12 months.Conclusion: The protocol proposed by our study for Achilles tendon rupture significantly improved all the scores evaluated comparedto the initial condition and the isokinetic evaluations, obtaining even better results in proximal injuries. Level of Evidence IV; Therapeutic studies investigating the results of treatment; Case series.

Subacromial balloon spacer improves isokinetic performance in patients with massive irreparable rotator cuff tear.

The aim of this study was to analyse clinical, functional and shoulder kinematics results using subacromial balloon spacer in nonreparable massive rotator cuff tears. Subacromial balloon spacer was hypothesised to improve shoulder kinematics and increases clinical and functional outcomes scores in nonreparable massive rotator cuff tears. This is a prospective study in massive rotator cuff tears. From October 2021 to October 2022, a total of 127 shoulders suffering massive rotator cuff tears were initially evaluated. All patients were evaluated preoperatively, at 6 and 12 months. Patients' patient-reported outcome measures (PROM) subjective values using visual analogue scale (VAS) and the Spanish Western Ontario Rotator Cuff Index (WORC) version were analysed. We also evaluated objective outcomes: constant score, range of movement and kinematic shoulder analysis (isokinetic test to evaluate internal and external rotation forces). Statistical analysis was conducted using SPSS software; continuous variables were presented as means and standard deviations (SDs). Seventeen nonrepairable massive rotator cuff tears were finally included. Three patients required reverse shoulder arthroplasty before 6 months postoperative. After 1-year follow-up, objective and subjective (PROM) outcome scores and isokinetic measurements improved in 13 patients. Preoperative VAS improved from 6.5 ± 2.1 to 2 ± 1.9 points on average at 1-year follow-up and WORC index from 1603 ± 217.3 to 699 ± 361.6. Constant score from 42.1 ± 13.1 on average and at 1-year follow-up increased to 60.8 ± 14.7. Range of movement also improved in elevation 122.2 ± 39.3 to 166.9 ± 25.8, abduction 120.3 ± 38.6 to 134.6 ± 21.1, external rotation 30.3 ± 19.7 to 86.1 ± 13.8 and internal rotation L4-T12 on average at 1-year follow-up. Isokinetic evaluation showed functional improvement 1 year after implantation. Both internal and external rotation improved compared with their healthy shoulder. External rotation improved from 30.3° ± 19.7° preoperatively to 86.1° ± 13.8° (43.7% in the isokinetic study) and internal rotation from L4 preoperatively to L1 (49.8% in isokinetic study) on average. Among the different alternatives for irreparable rotator cuff injuries surgical treatment, subacromial balloon spacer is an effective alternative in selected patients, both in terms of clinical-functional improvement and short-term isokinetic results. Level II.

A deficit to reach the isokinetic velocity in youth wheelchair users with spina bifida

Introduction The self-paced adopted by wheelchair users in their postural transfers and locomotion may require sufficient levels of speed-strength in the upper limbs. In clinical practice, we observed limited functional independence and social participation. Objectives This study aimed to investigate and compare the speed-strength relationship between wheelchair users with spina bifida (SB) and typically developing youth. In particular, to analyze if SB wheelchair users reached the preset velocities in the isokinetic evaluation of shoulder and elbow. Design Cross-sectional observational study. Setting Ribeirão Preto Medical School of the University of São Paulo. Participants and Procedures SB (SB; n = 11) and controls (CT; n = 22) performed the isokinetic assessment of shoulder abductors (SAB), adductors (SAD), flexors (SFL), extensors (SEX), and elbow flexors (EFL) and extensors (EEX) at velocities of 60 and 120degree.s−1. The analysis of covariance was used to identify the intergroup differences in muscle performance. Outcome Measures The values of peak torque (PT), power (Pow), time to peak torque (tPT) and the percentage to reach the isokinetic velocity. Results The percentage to reach 120degree.s−1 was moderate-to-low for both groups (26-75.9%). CT presented a significantly greater relative risk of reaching the preset velocities than SB. SB presented higher PT and Pow for SAB and SFL at 60degree.s−1, higher PT for SFL and EEX at 120degree.s−1, and lower tPT for SFL at 120degree.s−1 compared to CT. Conclusion SB had difficulty reaching 120degree.s−1, probably related to neuromuscular differences. However, arm movements in their daily tasks seem to maintain the ability to produce PT and Pow.

Systematized review: Isokinetic evaluation in the assessment of upper extremity sports

Objective: A systematized review was carried out to identify the studies that during the last ten years have used isokinetic equipment in sports in which the upper extremity is the basis of its practice, to provide an updated and detailed view of its use, methodologies and the variables used to express their results. Methods: A systematized search of 10 years of information was carried out, according to the PRISMA process, in the databases: Scopus, Web of Science, Pubmed, CINAHL, using combined terms: «isokinetic» «upper extremity», «upper limb», « sport», «exercises», «upper extremity». Results: 9406 articles were identified in the databases for review, of which only 46 were selected based on inclusion criteria. Among the sports evaluated, 25 articles correspond to sports with overhead throws (basketball, volleyball, baseball, handball, among others), followed by Paralympic sports with six articles (basketball and volleyball). Sports such as swimming, judo, weightlifting, water polo, or combined sports complete the list. The shoulder rotator muscles were the most evaluated and the concentric-concentric modality was the most used. The variable moment is the most reported, but the evaluation methodologies and selected speeds differ significantly between studies. Conclusion: The methodologies used are varied (i.e., selection of speed, type of muscular contraction, positioning, and dominance), and their selection was not always oriented toward the functionality of sports practice. In addition, it was observed that some studies needed to specify the isokinetic modality used, leaving a gap in relevant information within the study methods and affecting their future replicability. Keywords: Isokinetic evaluation; Isokinetic; upper extremity sports; upper limb.

Effect of Limb Dominance on Chronic Ankle Instability: Does It Matter?

Our study aimed to examine preoperative differences in strength and balance between dominant foot (DF) and nondominant foot (non-DF) of individuals undergoing ligament stabilization surgery in the general population. Patients with records of preoperative evaluation, including isokinetic dynamometric strength evaluation, Y-balance test (YBT), and Foot and Ankle Outcome Score (FAOS), were included in the study. The DF was the preferred leg for accurately kicking a ball through a goal. Statistical analysis determined the differences between DF and non-DF and the correlations between muscle strength, balance, and FAOS. There was no statistically significant difference between DF and non-DF regarding evertor and invertor muscle strength (p=0.082-0.951). The YBT revealed no significant difference between the two groups (p=0.082-0.951). There was a significant correlation between the evertor peak torque and total work deficits at 30°/s (p=0.022), as well as the evertor peak torque deficit at 120°/s (p=0.048). No significant differences in muscle strength and balance were found between DF and non-DF in nonathletes with chronic ankle instability. Peroneal muscle strength deficit was associated with functional impairment. Tailored interventions are needed to address limb dominance and muscle strength deficits in CAI management.

Evaluation de la force musculaire chez le lombalgique chronique: Comparaison entre reeducation isocinetique et reeducation classique

Chronic low back pain is a public health problem in view of its functional repercussions and the functional rehabilitation is an integral part of its management. To compare the evolution of muscle strentgh of spinal extensors and flexors in chronic low back pain patients after an isokinetic rehabilitation protocol and a conventional rehabilitation one. This was a prospective and comparative study carried out in the Physical Medicine Department of the Tunis Military Hospital over a period of 7 months. Fifty patients were included, randomly divided into two groups of 25. The first group (G1) benefited from an isokinetic rehabilitation protocol and the second one (G2) from a classic active physiotherapy. We performed a clinical (Sorensen test and Shirado test) and isokinetic evaluation of the trunk muscles before and after rehabilitation. The mean age of the general population was 42±8.6 years old. Clinical evaluation showed a deficit in the extensor and flexor muscles of the spine, more important in the extensors in both groups. After rehabilitation, there was a significant improvement in clinical tests of muscular endurance in G1 and G2. Isokinetic assessment showed a greater muscle deficit in the extensors in both groups. After isokinetic rehabilitation, peak torque for flexors and extensors increased by 21% and 23% respectively, power was 34% and 37% higher, and total work increased by 26% and 47%. On the other hand, the (F/E) ratios were unchanged for all three speeds. In Group 2, peak torque values for flexors and extensors increased by 22 and 15% respectively, power was higher by 31 and 23% and total work was also up by 29 and 17%, while F/E ratios were also unchanged. Group 1 showed the greatest improvement in extensor strength at 60°/s, and in power at 90°/s for the various muscles. In our study, we concluded that endurance and muscular strength improved the most after isokinetic rehabilitation.

Isokinetic testing protocol-based discharge criteria after anterior ligament reconstruction: A systematic review

BACKGROUND: The return to activities and sports after the anterior cruciate ligament (ACL) reconstruction is a critical decision. OBJECTIVE: To verify the most used elements during the isokinetic evaluation for discharge after ACL reconstruction. METHODS: Systematic review (PROSPERO CRD42021224433). Research in the literature: PubMed, Medline, SciELO, Lilacs, CENTRAL, PEDro, Web of Science and Embase, in February 2022. Studies that performed isokinetic evaluation during the discharge period in male patients aged 18 to 59 years after ACL reconstruction. Descriptive synthesis on the most used parameters during isokinetic evaluation as a discharge criteria after ACL reconstruction. RESULT: Twenty-three studies involving 1,792 participants were included. Medium and high quality evidence identified that most isokinetic evaluations targeted only muscle strength after rehabilitation of the ACL (peak moment). CONCLUSION: The most used elements during the isokinetic evaluation were: angular velocity of 60∘/s, 1 set of 5 repetitions, concentric mode and peak moment.

Acute effect of static stretching and pilates stretching on the concentric muscle strength of the knee extensors and flexors

IntroductionThe effects of stretching exercises on muscle strength have been widely researched in the literature, however, there are no studies investigating the effects of Pilates stretching. ObjectiveTo compare the effects of static stretching and Pilates stretching on the concentric muscle strength of the knee extensors and flexors. Method102 trained young adults were randomized into three groups: static stretching (n = 33); Pilates stretching (n = 34); control (n = 35). Isokinetic evaluation of the knee extensor and flexor muscles was performed at 60°/s and 180°/s, pre and post acute intervention with stretching. Interventions in the static stretching and Pilates stretching groups occurred in 3 sets x 30 s for each body region considered (a-knee extensor muscles; b-knee flexor muscles). The control group did not perform any intervention. ResultsNo difference (p > 0.05) was observed between the groups after the intervention. There was only a significant intragroup improvement for the control group on the isokinetic muscle strength of the knee flexors at 180°/s, with a moderate effect size, considering the entire sample (p = 0.040; d = 0.42) and when considering only male gender (p = 0.010; d = 0.60). ConclusionStatic stretching or Pilates stretching performed as a warm-up did not impair or enhance the concentric muscle strength performance of the knee extensors and flexors. In this way, both forms of stretching can be considered as preparatory exercises before muscle strength training.

A Comparison of a Step Load Unilateral and Bilateral Resistance Training Program on the Strength and Power of the Lower Limbs in Soccer Players

The purpose of the investigation was to determine the influence of a four-week unilateral (UNI) and bilateral (BIL) resistance training program on peak torque and peak power of the lower limbs in soccer players. Background: We evaluated the effects of a 3:1 step load training program using UNI and BIL forms of exercises on the level of peak torque and peak power of the knee joint extensors and flexors. Methods: The study included 16 division I soccer players having the highest number of matches played in the first round of the season. The motor tests included isokinetic evaluation of peak torque and peak power of the extensors and flexors of the knee joint. Results: The results showed that both types of training sessions were equally effective. Only in terms of power during knee flexion, unilateral training contributed to improvement, whereas bilateral training did not. Conclusions: The use of periodization using a step load progression based on an extended eccentric phase of the movement during the preseason period in combination with UNI training may increase peak torque and peak power of knee flexors and extensors in soccer players.

Infraspinatus function impairment after arthroscopic Bankart repair with Hill Sachs remplissage. Isokinetic, functional, and radiographic analysis

PurposeArthroscopic Bankart repair with Hill Sachs remplissage (BHSR) is an option for anterior shoulder instability with humeral defect. Our hypothesis was that infraspinatus capsulo-tenodesis is an effective solution, with good clinical results and no consequences on shoulder strength and ranges of motion. MethodsWe performed a retrospective case-control study involving 22 patients operated with arthroscopic BHSR. We compared isokinetic evaluation of both shoulders using a dynanometer in concentric, eccentric force and endurance. Ranges of motion were measured using a goniometer and compared to the contralateral unaffected side. Functional assessment included Constant, Rowe, Walch and Duplay and WOSI scores. Healing and fatty degeneration were analyzed with magnetic resonance imaging. ResultsAt mean 37.2 months follow-up, 21 patients (95.4%) were satisfied or very satisfied with the intervention. Range of motion in external rotation of the affected side decreased by 10.8° in adduction and 6° at 90° of abduction (p<0.05). Deficit in external rotation strength of the affected side greater than 15% was found in all isokinetic tests (p<0.05). Walch and Duplay, Rowe, WOSI and adjusted Constant average scores were respectively 71.05±14.1 (40–90), 67.63±19.7 (15–100), 34.6%±19.9 (8.43–76.23) and 69.8±13.57 (36.7–101). Postoperative MRI showed good capsulo-tenodesis healing without infraspinatus muscle fatty degeneration. ConclusionArthroscopic BHSR provides satisfactory functional outcomes but significant infraspinatus functional impairments in both strength and ranges of motion in external rotation. Level of evidenceIII; case-control study.

Abstract 12093: Bi-Ventricular Cardiac Adaptations to 20 Weeks of High-Intensity Resistance Training in Healthy Untrained Men: A 3D Echocardiography Longitudinal Study

Introduction: The historical description of cardiac remodelling between strength and endurance athletes, made by Morganroth in the 1970s, has been challenged with the advancements in our understanding of the protective effect of Valsalva manoeuvres and the emergence of sophisticated imaging techniques for cardiac function assessment. Objective: We aimed to analyze the kinetics of muscular and cardiac responses to 20 weeks of high-intensity resistance training in healthy untrained volunteers. Methods: A total of 27 young and healthy men with an average age of 22.8±3.2 years participated in a 20-week strength training program. The training program intensity was guided by 1-Repetition Maximum (RM) testing. Before and after 12 and 20 weeks of training, participants were assessed using body composition analysis, electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing ( V O 2peak ), and muscle isokinetic dynamometry. Anova was utilized to analyse time effect. Results: Among the initial cohort, 22 subjects completed the study protocol. Arterial blood pressure significantly decreased at both time points. Isokinetic evaluation confirmed increases in maximal strength for quadriceps (Δ 0-20wk =+46.8Nm, P&lt;0.001), hamstrings (Δ 0-20wk =+25.3Nm, P=0.025), triceps (Δ 0-20wk =+11.6Nm, P=0.005), and biceps (Δ 0-20wk =+9.2Nm, P=0.023). Regarding cardiac analysis, after 20 weeks of training 3D left ventricular (LV) mass increased (120.1±15.4 to 133.7±16.3 g, P=0.018), with an augmentation in both septal wall (6.1±1.1 to 7.2±1.4 mm, P=0.027) and posterior wall thickness (5.5±1.3 to 7.1±1.3 mm, P&lt;0.001). 3D LV end-diastolic volume increased by 7.28% without reaching a significant difference. Right ventricular (RV) wall thickness also increased (3.33±0.73 to 3.89±0.8 mm, P=0.04), with a slight non-significant augmentation of 3D RV end-diastolic volume by 7.89%. No significant changes were found in LV and RV systolic or diastolic function. Conclusions: This study demonstrated that our 20-week high-intensity strength training program resulted in a rapid and significant increase in muscular strength. The cardiac response to strength training showed a moderate biventricular response like that of endurance athlete

Effects of a 20-Week High-Intensity Strength Training Program on Muscle Strength Gain and Cardiac Adaptation in Untrained Men: Preliminary Results of a Prospective Longitudinal Study.

As strength sports gain popularity, there is a growing need to explore the impact of sustained strength training on cardiac biventricular structure and function, an area that has received less attention compared to the well-established physiological cardiac adaptation to endurance training. This study aims to implement a 20-week high-intensity strength training program to enhance maximal muscle strength and evaluate its impact on cardiac biventricular adaptation in healthy, untrained men. A total of 27 healthy and untrained young men (mean age 22.8, SD 3.2 years) participated in a strength training program designed to increase muscle strength. The training program involved concentric, eccentric, and isometric exercise phases, conducted over a consecutive 20-week time frame with a frequency of 3 weekly training sessions. Participants were evaluated before and after 12 and 20 weeks of training through body composition analysis (bioelectrical impedance), a 12-lead resting electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing, and muscle isokinetic dynamometry. The progression of strength training loads was guided by 1-repetition maximum (RM) testing during the training program. Of the initial cohort, 22 participants completed the study protocol. No injuries were reported. The BMI (mean 69.8, SD 10.8 kg/m² vs mean 72, SD 11 kg/m²; P=.72) and the fat mass (mean 15.3%, SD 7.5% vs mean 16.5%, SD 7%; P=.87) remained unchanged after training. The strength training program led to significant gains in 1-RM exercise testing as early as 4 weeks into training for leg extension (mean 69.6, SD 17.7 kg vs mean 96.5, SD 31 kg; P<.001), leg curl (mean 43.2, SD 9.7 kg vs mean 52.8, SD 13.4 kg; P<.001), inclined press (mean 174.1, SD 41.1 kg vs mean 229.2, SD 50.4 kg; P<.001), butterfly (mean 26.3, SD 6.2 kg vs mean 32.5, SD 6.6 kg; P<.001), and curl biceps on desk (mean 22.9, SD 5.2 kg vs mean 29.6, SD 5.2 kg; P<.001). After 20 weeks, the 1-RM leg curl, bench press, pullover, butterfly, leg extension, curl biceps on desk, and inclined press showed significant mean percentage gains of +40%, +41.1%, +50.3%, +63.5%, +80.1%, +105%, and +106%, respectively (P<.001). Additionally, the isokinetic evaluation confirmed increases in maximal strength for the biceps (+9.2 Nm), triceps (+11.6 Nm), quadriceps (+46.8 Nm), and hamstrings (+25.3 Nm). In this paper, only the training and muscular aspects are presented; the cardiac analysis will be addressed separately. This study demonstrated that a short-term high-intensity strength training program was successful in achieving significant gains in muscle strength among previously untrained young men. We intend to use this protocol to gain a better understanding of the impact of high-intensity strength training on cardiac physiological remodeling, thereby providing new insights into the cardiac global response in strength athletes. ClinicalTrials.gov NCT04187170; https://clinicaltrials.gov/study/NCT04187170.

Characterization of Motor Performance in 200 Normal Ankles Through Isokinetic Evaluation

Category: Ankle; Sports Introduction/Purpose: The isokinetic test has been used diffusely as a way to evaluate the functional results after the rehabilitation of musculoskeletal injuries. In the ankle, in particular, most studies are related to lateral ligament injuries and Achilles tendon’s injuries. However, different protocols are used and a lack of normative values is observed in the literature. The aim of this work is to perform a global isokinetic evaluation on healthy ankles in order to propose reference values for future patients. Methods: We evaluated 100 participants (200 ankles) using the Biodex 3 System for the eversion, inversion, dorsiflexion and plantar flexion movements of the ankle. The sample consisted of individuals aged 20-60 years, with an active life and practice of recreational physical activity (non-athlete) and without previous injuries. Five repetitions for strength (N / m) and work (J) at a speed of 30º / sec and 10 repetitions for power (W) at a speed of 120º / sec were performed in our protocol. Agonist / antagonist ratio and the Muscle Deficiency Index, which globally assesses the balance between the sides for each movement, were also evaluated, as well as the demographic variables. Different statistical analyzes were performed for each parameter. Results: The mean age was 38.5 years and BMI 25.8 in 69 men and 31 women. In 78 participants, the dominant ankle was the right one. The non-dominant side was consistently stronger in all movements (p &lt; 0.001). The mean values obtained for force in each movement were 29.9N/m for eversion, 34.8N/m for inversion, 48.6N/m for dorsiflexion and 140.2 N/m for plantar flexion. Such parameters for men and women were also obtained (p &lt; 0.001) and there was no correlation between age or BMI with the maximum torque through Spearman's Correlation. The ratio of eversors/inverters was 88.8% and that of dorsiflexors/plantar flexors was 36.1%. The Muscle Deficiency Index showed a balance between the sides for each movement, with an average global difference of less than 10% between them. Conclusion: As far as we know, this is the largest isokinetic assessment of normal ankles ever performed. The sample, although not stratified, was considered homogeneous (coefficient of variation &lt; 50%), which allows to propose several normative values for a non-athlete population in the isokinetic evaluation. It would be interesting to compare these data in the future with the functional results in patients after the treatment of certain injuries.

The Effect of an Exercise Program on the Biomechanics of the Shoulder Girdle in Overhead Shooting in High-level Handball Players

Handball athletes are subjected to high loads, especially during the process of throwing or shooting overhead. These athletes often complain of pain and report unexplained loss of throwing velocity and throwing control. Shoulder dyskinesia and overuse syndrome have been identified as risk factors among elite handball athletes. Understanding the dynamics and kinematics of the throwing phase is vital for the exercise professional. This study evaluates the effect of an interventional exercise program on shoulder girdle biomechanics and overhead shooting. The sample consisted of 20 high level handball athletes from Greece. The athletes were divided into two groups: 10 in the study group, who were given the exercise program, and 10 in the control group, who only engaged in in-team handball training. Before and after the program, the following measurements were performed: a) angular measurements of abduction, adduction, flexion and extension of the shoulder; b) isokinetic evaluation of abduction flexion and adduction extension of the shoulder joint, at three angular velocities (60°/sec, 180°/sec and 300°/sec). Inferential statistics showed that there was a statistically significant difference in angular measurements with a reduction in range of motion for 10 of the study group. In the isokinetic assessment there was a statistically significant difference, in the 180°/sec velocities in flexion and extension, and in the deficit of flexion of both shoulders. In conclusion, the interventional exercise program had, to some extent, a beneficial effect on muscle strengthening of the shoulder girdle. The results of this study may suggest training guidelines, provide important information to exercise professionals, and provide feedback to handball athletes.

A Comparison Study of the Western Ontario Rotator Cuff Index, and the Constant-Murley Score with Objective Assessment of External Rotator Muscle Strength and Pain in Patients after Arthroscopic Rotator Cuff Repair.

Although rotator cuff injures are often associated with a limited range of motion and muscle weakness, being able to conduct pain-free and efficient performances of the activities as part of daily living seems to be more important for patients. The aim of this study was to investigate the correlation between two questionnaires-the disease-specific, subjective questionnaire termed the Western Ontario Rotator Cuff Index (WORC), and the shoulder-specific, subjective-objective questionnaire Constant-Murley score (CMS), with the objective assessment of external rotator muscle strength, and the subjective assessment of pain according to the visual analog scale (VAS) in patients after arthroscopic rotator cuff repair. The study was carried out among 47 patients twice-6 and 12 months after surgery, respectively. All patients completed the WORC, the CMS, and the VAS. Isokinetic evaluation of the external rotators was performed using the Biodex 4 ProSystem. The correlations of all assessed muscle strength parameters with both the CMS and the WORC were found to be statistically significant, being mostly average during the 1st examination and mostly strong during the 2nd examination. There was a significant improvement in all assessed tools as a result of the undertaken rehabilitation. There were weak correlations present between changes in the WORC and changes in the external rotator muscle strength, with correlations between WORC-Sport and EXT900-AVERAGE-POWER and PEAK-TORQUE also being found statistically significant. Correlations of changes in the CMS scale with changes in the external rotator muscle strength were weak and statistically insignificant. It seems that the WORC questionnaire can be recommended more for the population after rotator cuff repair, which allows for a reliable assessment of patients' ability to function and its changes in various areas of life, and at the same time does not require a direct assessment by a clinician or researcher.

Relationship between Lower-Limb Bioelectrical Impedance Indicators of Hydration Status and Muscle Function in Aged Population: A Cross-Sectional Study

Background: Reduced Intracellular Water (ICW) has been related to poor muscle strength and functional capacity in aged populations. We aimed to evaluate hydration status and intracellular hydration of lower-limb lean mass in aged population and the relationship with thigh muscle function. Methods: Design and population: Cross-sectional study of community-dwelling ≥70 year old subjects. Measurements: Lower-limb hydration status was assessed by bioimpedance analysis and thigh muscle function was assessed by isokinetic evaluation. Frailty was established according to Fried criteria, sarcopenia according to EWGSOP-2 criteria, and physical performance according to the Timed Up-and-Go (TUG) test. Results: Assessed were 117 individuals (mean age 75.0 years, 50.4% women). Women had lower Fat-Free Mass (FFM), Total Body Water (TBW), and Phase Angle (PhA) values than men. Age was negatively correlated with ICW (r=-0.187; p=0.045), the ICW/FFM ratio (r=-0.192; p=0.039), and PhA (r=-0.311; p&lt;0.001). Extension and flexion strength and power of the knee were positively correlated with Total Water (TW) (L), FFM (kg), and the protein compartment (kg) of the lower-limb in both men and women, but not with TW as percentage of weight, ICW as percentage of TW, and the TW/FFM and ICW/FFM ratios, while the TUG test was negatively correlated with ICW as a percentage of TW. Conclusion: Knee flexion and extension strength, power, and work increase as thigh FFM, TBW, and protein compartment values increase. No correlation was observed between intracellular hydration and muscle function, but correlation was observed with performance. As plausible hypotheses, further studies are required to test for these correlations.

Can isokinetic test be a supportive tool for unilateral knee arthroplasty decision?

This study analyzed whether the isokinetic muscle strength of bilateral knee osteoarthritis patients undergoing unilateral total knee arthroplasty (TKA) is a predictor for prior surgery side. In the prospective study conducted between April 2021 and December 2021, 58 knees of 29 unilateral TKA candidates (6 males, 23 females; mean age: 66.7±7.4 years; range, 53 to 81 years) were enrolled. The patients were divided into surgical (n=29)and nonsurgical (n=29) groups. The knees of patients with bilateral knee osteoarthritis (Stage III or IV) according to the Kellgren-Lawrence (KL) scale were scheduled for unilateral TKA. An isokinetic testing system was used to assess knee flexor and extensor muscle strength (peak torque) at angular velocities of 60°/sec and 180°/sec (five cycles per velocity). The radiological (X-ray-based KL scale and magnetic resonance imaging-based quadriceps angle) and clinical findings (isokinetic test and Visual Analog Scale pain scores) in both groups were compared. The mean symptom duration was 10±5.4 years. The KL score and quadriceps angle showed no significant differences (p=0.056 and p=0.663, respectively). Isokinetic test results were in accordance with the clinical results of the surgery group. In the isokinetic evaluation, both the 60°/sec concentric extension (35.00 vs. 46.00, p=0.002) and flexion peak torque (18.00 vs. 26.00, p=0.001) values were significantly lower in the surgical group than in the nonsurgical group. Isokinetic testing can be a supportive tool for assessing the prior side of TKA in patients with bilateral knee osteoarthritis. Further studies are required to support these findings.