Knee Flexor Research Articles

Sex Differences Exist in the Relationship Between Vertical Jump Performance Biomechanical Parameters and Hamstring/Quadriceps Ratio in Adolescent U18 Track and Field Athletes

Isokinetic metrics are suggested to be related to vertical jump performance, but little is known about the possible sex differences in this relationship in adolescent track and field athletes. The aim of the study was to examine the possible sex differences in the strength of the relationship between the kinetic parameters of the vertical squat jump with arms akimbo, the countermovement jump with arms akimbo, and the countermovement jump with free arm swing with the isokinetic parameters of the knee extensor and flexor muscles (angular velocities: 60°/s and 300°/s). In total, 35 (males: 21, females: 14) U18 track and field athletes were examined. The results revealed that the Men U18 group had higher vertical jump performance, higher values in the kinetic parameters of the vertical jump tests, higher knee extensor torque, and higher knee flexor torque in the non-dominant leg compared to the Women U18 group. Significant (p < 0.05) sex differences were observed in the relationship between the isokinetic parameters and the vertical jump performance metrics, as the Women U18 athletes relied more on the knee flexor torque than Men U18 athletes, and demonstrated a stronger negative relationship between selected isokinetic metrics and the pre-stretch gain in the vertical jump tests. In conclusion, it is recommended that young female track and field athletes minimize interlimb asymmetry and improve the convention ratio in their non-dominant leg to optimize vertical jump performance.

The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: ARandomized Controlled Trial.

30-s sit to stand (30STS). Timed Up&Go, 40-m walk test (40mWT), knee range of motion (ROM) 1-repetition maximum (1RM) leg press and knee extensor strength, maximal isometric contraction (MVIC) for the knee extensors and flexors, Knee injury and Osteoarthritis Outcome Score (KOOS), and Euroqol 5-dimensions (EQ-5D-L5) questionnaire. Data were collected at baseline (12 weeks pre-surgery), ~3 days pre-surgery, 3 and 12 months postoperatively. Intention-to-treat analysis revealed no significant between-group differences in the change from baseline to 3 and 12 months postoperatively on 30STS, TUG, or 40mFWT. Significant between-group differences were observed at 3 but not 12 months postoperatively for the corresponding changes in 1RM leg press strength, 1RM knee extensor strength, and MVIC knee extensor favoring BFR-RT. No between-group differences were observed for the delta changes from baseline in knee ROM, KOOS subscales or EQ-5D-L5 at any postoperative time points. These findings suggest that preoperative BFR-RT offered no superior effects compared with usual preoperative care on postoperative physical function or patient-reported outcomes. Preoperative BFR-RT produced amplified gains in lower limb muscle strength at 3 months postoperatively. NCT04081493.

Changes in hamstrings’ active stiffness during fatigue tasks are modulated by contraction duration rather than intensity

Despite the increase in research of hamstring stiffness through the use of ultrasound-based shear wave elastography, the active stiffness of biceps femoris long head (BFlh) and semitendinosus (ST) muscles under fatigue conditions at various contraction intensities has not been sufficiently explored. This study aimed to compare the effects of knee flexor’s isometric contraction until exhaustion performed at 20% vs. 40% of maximal voluntary isometric contraction (MVIC), on the active stiffness responses of BFlh and ST. Eighteen recreationally active males performed two experimental sessions. The knee flexors’ MVIC was assessed before the fatiguing task, which involved a submaximal isometric contraction until failure at 20% or 40% of MVIC. Active muscle stiffness of the BFlh and ST was assessed using shear wave elastography. BFlh active stiffness remained relatively unaltered at 20% of MVIC, while ST active stiffness decreased from ≅ 91% contraction time (55.79 to 44.52 kPa; p < 0.001). No intramuscular stiffness changes were noted in BFlh (36.02 to 41.36 kPa; p > 0.05) or ST (63.62 to 53.54 kPa; p > 0.05) at 40% of MVIC session. Intermuscular active stiffness at 20% of MVIC differed until 64% contraction time (p < 0.05) whereas, at 40% of MVIC, differences were observed until 33% contraction time (p < 0.05). BFlh/ST ratios were not different between intensities (20%=0.75 ± 0.24 ratio vs. 40%=0.72 ± 0.32 ratio; p > 0.05), but a steeper increase in BFlh/ST ratio was found for 20% (0.004 ± 0.003 ratio/%) compared to 40% (0.001 ± 0.003 ratio/%) of MVIC (p = 0.003). These results suggest that contraction duration could play a major role in inducing changes in hamstrings’ mechanical properties during fatigue tasks compared to contraction intensity.

The Effect of Isometric Exercise Position on the Effectiveness of Isolated Work of the Thigh Flexor Muscles Based on the Results of the sEMG Study.

The main function of the hamstring muscles is to bend the knee joint and support the function of the hip extensors. Their frequent injuries are the result of overload related to, among others, dynamic running or jumping, and inadequate preparation for athletics activities. The asymmetry of the work of individual flexor muscle groups is clearly marked in the case of valgus or varus of the knee joint, i.e., in different positions of the lower limb. The aim of the study was to determine the position and form of a rehabilitation exercise in which an isolated group of muscles flexing the knee joint will show the greatest bioelectrical activity. The study involved 25 students of the Jagiellonian University Medical College. The students were aged 20-26. The average age was 22.9 (±1.4). The study participants included 17 women with an average age of 23.0 (±1.1) and 8 men with an average age of 22.6 (±1.9). Women constituted 68% and men 32% of all respondents. All participants agreed to participate in the study. Surface electromyography measurements in both lower limbs provided an initial number of 50 cases. The activity of the knee flexor muscles during isometric contraction with resistance was measured in correlation with three foot and lower leg settings: internal rotation, neutral position, and external rotation. The bioelectrical activity of the semitendinosus muscle is significantly higher (p < 0.01) in the internal rotation position than in the neutral position of the lower leg, while the bioelectrical activity of the biceps femoris muscle is inversely higher (p < 0.01) in the external rotation position than in the neutral position. The results are significant for both average and maximum values of muscle stimulation. During isometric contraction with resistance, the semitendinosus muscle shows the greatest bioelectrical activity in the internal rotation position of the lower leg and foot, and the biceps femoris muscle in the external rotation position of the lower leg and foot. The above information has important implicational applications when improving isolated groups of hamstrings. In the future, this may contribute to more effective rehabilitation of patients with injuries of the muscles described in the article.

Transforming rehabilitation: A narrative review on reversible knee flexor contracture assistive devices

Abstract: Joint contracture, marked by restricted joint movement due to connective tissue and muscle shortening, is a common complication in chronic musculoskeletal conditions such as osteoarthritis, osteonecrosis, rheumatoid arthritis, healed septic joint, and postsurgical complications. This limitation adversely impacts joint mobility and flexibility, increasing the likelihood of physical constraints. Contractures elevate the risk of impaired self-care, limited physical mobility, and hindered social activities, emphasizing the critical need to manage such contractures. The study aims to find the most appropriate, effective, user-friendly mechanical device to treat reversible knee flexor contracture. Method of a literature review was conducted utilizing PubMed, Google Scholar, and the physiotherapy evidence database (PEDro) up to April 2023. The inclusion criteria comprised studies related to flexion contracture (FC), written in English languages were included. The literature searched using the terms “flexion contracture, hamstring contracture, knee flexor contracture, burn contracture, knee joint hypomobility, and devices for flexion contracture.” Result after applying the selection criteria, the initial screening of literature gives 35,400 results on Google Scholar, PubMed, and PEDro. Subsequently, 128 articles underwent screening based on abstract and full-text availability in the English language. Following this, seven articles were selected and thoroughly reviewed, which included randomized control trials, systematic reviews, and exploratory studies. The study concluded the use of conventional physiotherapy interventions, coupled with assistive devices, diminishes the burden on physiotherapists and provides effective improvements to patients with FCs.

The Effect of Exercises with Blood Flow Restriction in the Limbs on the Development of Muscle Strength and Hypertrophy: A Pilot Study

Weight training with regulated blood flow in the limbs is characterized by low load intensity ranging from 30-50% of the one repetition maximum. The aim of the study was to assess the effect of weight training with regulated blood flow in the limbs on changes in muscle strength and hypertrophy. The research sample consisted of 5 participants aged 26.40±7.16 years who performed 10-week intervention program. The weekly microcycle consisted of three training sessions, which intensity was regulated by inflatable cuffs placed on proximal parts of upper and lower limbs. Body composition was assessed with InBody 720. Muscle strength of knee and elbow flexors and extensors was assessed with Cybex HUMAC NORM isokinetic dynamometer at four speeds ranging from 60-240°·s-1, supplemented by front squat and bench press with emphasis on speed during the concentric phase of the movement. The results showed an increase in knee flexor muscle strength that was not statistically significant. The present pilot-study points to the need for further verification of methods how to use regulated blood flow in training related to muscle strength and hypertrophy.

Tale of quadriceps and hamstring muscle strength after ACL reconstruction: a systematic review with longitudinal and multivariate meta-analysis

ObjectiveThis study aimed to investigate how knee extensor and flexor strength change over time after anterior cruciate ligament reconstruction (ACLR).DesignSystematic review with longitudinal meta-analysis.Data sourcesMedline, Embase, CINAHL, Scopus, Cochrane CENTRAL...

Age Is a New Indicator of Long-Ball Kicking Performance in Young Soccer Players: Analysing Kinanthropometry, Flexibility and Strength

(1) Background: The kick of the ball in soccer is considered one of the most important technical gestures in soccer. Despite this, there is little evidence on ball-striking performance factors in base soccer. The main objectives of the present study were to identify the potential factors of long-ball kicking (LBK) performance and to determine the target training cut-off for LBK performance in young soccer players. (2) Methods: A cross-sectional observational study was conducted with 31 soccer players, with ages ranging from 12 to 18 years. Age, anthropometric data, sport experience, range of motion (ROM) and maximal isometric strength (MIS) of the lower limb were noted. Kick-of-the-ball performance was assessed by maximum ball displacement per kick. A k-mean cluster analysis determined two groups according to ball-kicking performance: low group (LPG-LBK) and high group (HPG-LBK). (3) Results: Differences were found between both groups in age, body mass, body mass index, leg length and knee flexion ROM (BF10 ≤ 6.33; δ ≥ 0.86 (moderate or higher)). Among the factors discussed above, age was the strongest predictor of ball-striking performance (odds ratio = 2.867; p = 0.003). The optimal cut-off for age predicting those players most likely to have a higher ball-striking performance was determined to be 13.5 years (p = 0.001; area under the curve = 85.3%). (4) Conclusions: Age over 13.5 increases the chances of a higher optimal ball-striking performance. The flexibility (knee flexion ROM) and strength (knee flexors) must be specifically trained in soccer players beginning at an early age.

Running Plus Strength Training Positively Affects Muscle Strength and Quality in Both Younger (Below 50 Years Old) and Older (Above 50 Years Old) Women.

Sarcopenia is a muscular disease characterized by loss of muscular strength and function, affecting mainly women, and associated with increased mortality risk. The aim of this study was to compare active women with inactive women of different age groups regarding muscle mass, strength, and muscle quality. This study included 147 women (85 runners and 62 inactive), divided into <50 and ≥50 years old. Participants were evaluated for knee flexor and extensor peak torque (PT), body composition, and training habits. For knee extensor muscles, there was an age group effect (F(2.146) = 40.5; p < 0.001) on absolute PT (Nm); an age group effect (F(2.146) = 44.1; p < 0.001) and a physical activity group effect (F(2.146) = 113.0; p < 0.001) on PT adjusted by body mass (Nm/kg); and an age group effect (F(2.146) = 36.9; p < 0.001) and a physical activity group effect (F(2.146) = 6.1; p = 0.014) on PT adjusted by lean mass (Nm/kgLM). There was no interaction effect. In both age groups, active women had greater strength and higher muscle quality than inactive women, but the difference in strength, muscle mass, and muscle quality between younger and older women were the same among runners and inactive women.

Physical and Muscular Performance in a Professional Soccer Player with a Posterior Cruciate Ligament Injury Following an Isokinetic Exercise Program: A Case Report.

The comprehensive treatment for an athlete who sustains a complete posterior cruciate ligament (PCL) injury remains unclear. The purpose of this case report is to describe the effects of an isokinetic exercise program on muscle performance and physical function in a professional soccer player with a PCL injury. Case Report. A 23-year-old male professional soccer player injured his right knee (non-dominant) during a soccer match, with magnetic resonance imaging confirming a complete PCL rupture. The athlete completed 23 sessions of isokinetic treatment over nine weeks to improve physical function and muscle performance. The concentric mode was used to evaluate quadriceps and hamstrings performance isokinetically at angular velocities of 60 °/s, 120 °/s, and 300 °/s. The LEFS questionnaire was used to evaluate physical function. The assessment occurred before starting the treatment and at the end of nine weeks. An athlete with similar anthropometric characteristics was invited to participate and serve as a control, in order to better understand the athlete's assessment results. After nine weeks, peak torque normalized to body mass (PT/BM) improved to 4.0 N.m/kg for knee extensors (control: 3.6 Nm/kg) and 2.3 N.m/kg for knee flexors (control: 1.9 Nm/kg) at 60 °/s. This increase in PT was reflected in the hamstrings-to-quadriceps (H:Q) ratio post-treatment (57 %). At the end of treatment, the athlete returned to sports activities with 98.7 % restored physical function as measured by the LEFS (Score: 79 points). The results demonstrated that the isokinetic treatment improved knee functional capacity, with increased PT/BM for knee extensors and flexors and enhanced torque-holding capacity, indicating improved muscle performance. 5.

Females demonstrate lower levels of activity, psychological readiness and strength symmetry after anterior cruciate ligament reconstruction than males, and also recovery of quadriceps strength and hop symmetry is delayed in females undergoing reconstruction with a quadriceps tendon autograft.

To investigate sex-based recovery differences in patients undergoing anterior cruciate ligament reconstruction (ACLR) with a hamstring (HT) or quadriceps (QT) tendon autograft. This study included 97 patients, including 50 females (HT = 25, QT = 25) and 47 males (HT = 24, QT = 23), assessed presurgery and at 12- and 24-month postoperatively via surveys, laxity, isokinetic knee extensor and flexor torque and a 6-hop performance battery. Limb symmetry indices (LSIs) were calculated. Outcomes were compared between males and females, as well as within each graft type. Males reported significantly higher Tegner scores at 12 (p = 0.029) and 24 (p = 0.031) months, Anterior Cruciate Ligament Return to Sport after Injury scores at 12 (p = 0.009) and 24 (p = 0.010) months, and a significantly higher lateral hop LSI at 12 (p = 0.045) months, knee extensor torque LSI at 12 (p = 0.020) months, and knee flexor torque LSI at 12 (p = 0.001) and 24 (p = 0.039) months. Females undergoing ACLR with a QT (vs. HT) graft demonstrated a lower knee extensor torque LSI at 12 (p = 0.006) months, a lower lateral hop LSI at 12 (p = 0.038) months, and a lower medial hop LSI at 12 (p = 0.042) months. Females reported less activity and psychological readiness, as well as strength symmetry. Furthermore, the recovery of quadriceps strength and hop symmetry was delayed in females (vs. males) undergoing ACLR with a QT graft. A better understanding of these differences will assist in counselling on expectations, determining the most appropriate graft construct and permitting more targeted rehabilitation. Level IV.

Eccentric Exercise-induced Muscle Damage And The Repeated Bout Effect Between The Elbow And Knee Flexors

Eccentric Exercise-induced Muscle Damage And The Repeated Bout Effect Between The Elbow And Knee Flexors

Should individuals with unilateral transtibial amputation carry a load on their intact or prosthetic side?

Carrying side loads often occurs during activities of daily living. As walking is most unstable mediolaterally, side load carriage may further compromise gait biomechanics, especially for transtibial amputees (TTAs). This study investigated the effects of side load carriage on gait kinetics during steady-state walking to determine which side, intact or prosthetic, TTAs should carry a load. Twelve unilateral TTAs wore a passive-elastic foot and carried a side load of 13.6 kg while walking at their self-selected speed. Kinetic metrics, including ground reaction force peaks and impulses, loading and unloading rates, and joint moments and powers, were analyzed. TTAs had smaller propulsive forces on their intact limb during the prosthetic side load condition. During the intact side load condition, they exhibited smaller hip flexor moment in late stance and smaller knee flexor moment at the end of swing on their intact limb. They had higher hip and knee abductor moments on their intact limb and prosthetic limb in early and late stance during the contralateral side load condition. TTAs generated higher hip extensor power at weight acceptance during the ipsilateral side load. Significant interactions were observed in hip extensor power and abductor moment, suggesting strong associations between hip extensor power generation and the ipsilateral side load and between hip abductor moment and the contralateral side load. These mixed results demonstrate some kinetic changes due to side load carriage and suggest that the side TTAs should carry a load depends on the desired effects, primarily on their intact limb.

Knee muscle strength, body composition, and balance performance of youth soccer players

BackgroundMuscle strength and balance abilities have been related to game performance injury prevention. This study aimed to (1) assess knee muscle strength performance based on intra- and inter-limb asymmetries, (2) investigate the relationships between knee muscle strength, body composition, and balance, and (3) analyze the variance in the overall stability index (OSI) explained by knee muscle strength indicators after controlling for age and body composition.MethodsThe sample included 104 young male soccer players (16.0 ± 1.6 years). Body composition, knee muscle strength, and balance ability were assessed. A paired samples t-test was used to examine differences between the preferred leg (PL) and the non-preferred leg (NPL). Pearson correlations and hierarchical multiple regression were conducted to explore the relationships between strength, body composition, and balance.ResultsNo significant inter-limb asymmetries were detected for the knee flexors (KF) and knee extensors (KE) performance. The hamstrings-to-quadriceps ratio does not suggest the existence of intra-limb asymmetries (p = 0.06). Significant and negative correlations were found between KF (r = -0.38, p ≤ 0.01) and KE (r = -0.58, p ≤ 0.01) for the PL. Concerning the NPL, KE also revealed a significant and negative relationship with balance (r = -0.30, p ≤ 0.01). Significant and positive relationships were found between bodyweight, fat-free mass, and balance. After controlling for age and body composition, knee muscle strength could explain between 13% and 30% of the variance observed in the OSI (NPL and PL, respectively).ConclusionsThe results underline knee muscle strength as an important predictor of balance. Thus, training programs targeting knee muscle strength development should be considered during the season periodization by coaches and their staff throughout the players’ developmental stages.

Stabilometry in Relation to Hip and Knee Muscle Force in Children with Surgically Treated Unilateral Slipped Capital Femoral Epiphysis.

The main aim of our study was to analyze the stabilometric parameters in relation to hip and knee muscle force in children with unilateral slipped capital femoral epiphysis (SCFE) who had undergone surgical treatment. Another objective was to compare the stabilometry in three testing situations (eyes open, eyes closed, and head retroflexed). In total, 26 patients with unilateral right SCFE treated via in situ fixation with one percutaneous screw performed stabilometry assessments under three different situations (with their eyes open, with their eyes closed, and with their head retroflexed) and isometric muscle force assessment of the bilateral hip flexors, extensors, abductors and adductors and bilateral knee flexors and extensors. No significant differences between the right side (affected hip) and left side (non-affected hip) were recorded for all of the tested muscle groups. We found significant negative correlations between the 90% confidence ellipse area (eyes open condition) and left knee extensors (p = 0.028), right knee flexors (p = 0.041), and left knee flexors (p = 0.02), respectively. When performing the comparison between the eyes open and eyes closed situations, there were significant differences in CoP path length (p < 0.0001) and maximum CoP speed (p = 0.048); the parameters increased in the eyes closed situation. Better postural stability is acquired when assessed with eyes open or with the head retroflexed in contrast with eyes closed testing.

Comparing the Acute Effects of Diagonal Mobilization and Nordic Hamstring Curls on Knee Flexion and Extension Strength: A Randomized, Double-Blinded Parallel Study in Young Soccer Players

Background: Understanding the diverse acute effects elicited by physiotherapists in soccer players may be pertinent for enhancing performance and aiding in the mitigation of injury risk. Methods: Fifty regional-level soccer players aged 13 to 15 took part in a randomized double-blind trial. They were allocated randomly to either receive diagonal manual mobilization (DM) treatment or undergo a Nordic hamstring curl (NHC) intervention, designated as the control group. Evaluations were carried out before and after the interventions to gauge standing knee extensors (KE) and knee flexors (KF) strength using the ForceFrame Strength Testing System. The recorded variables encompassed average, maximal force, and maximal impulse for both KE and KF. Results: Following the intervention, evaluations showed no significant differences between groups in KF maximal force (F1,48 = 1.238; p = 0.271; ηp2 = 0.025), KF average force (F1,48 = 0.957; p = 0.333; ηp2 = 0.020), KF maximal impulse (F1,48 = 0.246; p = 0.622; ηp2 = 0.005), KE maximal force (F1,48 = 1.514; p = 0.225; ηp2 = 0.031), KE average force (F1,48 = 0.118; p = 0.733; ηp2 = 0.002), and KE maximal impulse (F1,48 = 2.540; p = 0.118; ηp2 = 0.050). Analysis within the DM group showed significant differences in KF maximal force (24.2 N; p = 0.004), KF average force (23.4 N; p = 0.001), KE maximal force (25.8 N; p = 0.005), KE average force (20.0 N; p = 0.044), and KE maximal impulse (265.9 Ns; p = 0.027), although no significant differences were found in KF maximal impulse (150.1 Ns; p = 0.058). Conclusions: This study indicates that both DM and NHC elicit similar effects on acute responses in KE and KF strength following intervention, although DM shows more favorable adaptations within the group. Perhaps DM could serve as a suitable warm-up strategy in specific circumstances, immediately influencing readiness for strength activities.

Potential financial loss and risk factors for hamstring muscle injuries in elite male Brazilian soccer players: a season-long prospective cohort pilot study.

The aim of this pilot study was to analyze the potential financial loss and a range of potential risk factors for hamstring muscle injuries in elite Brazilian soccer. Thirty-four male players (age: 25 ± 6 years; stature: 180 ± 8 cm; body mass: 78 ± 9 kg; minutes played in matches: 2243 ± 1423 min) from an elite professional soccer club were monitored during a 12-month season. Muscle injury was identified by magnetic resonance imaging and the severity was defined according to the number of days away: minimal (1-3 days), mild (4-7 days), moderate (8-28 days), severe (>28 days). Potential financial loss due to the team's under achievements was determined. Dorsiflexion range of motion, eccentric knee flexor strength and isokinetic tests were performed during the pre-season. Association between dependent variables and the occurrence of injury was evaluated. Nine hamstring muscle injuries with moderate severity were found in 8 athletes. Recovery time was 22 days off the field on average. Potential financial loss was $-43.2 million USD and earnings on merit money was 21%. Previous injury, increased flexor deficit 60° /sec and increased flexor fatigue index 300°/sec were all associated with a greater chance of hamstring muscle injury. Ankle dorsiflexion range of motion was significantly lower in the injured group (35.6 ± 3° vs. 39.1 ± 4.9°; p = 0.017, effect size = -0.74). High financial burden was found in elite Brazilian soccer during one full season. Injured athletes had high hamstring fatigue index, knee flexor strength deficit, ankle range of motion restriction and previous hamstring muscle injury when compared to non-injured athletes. Therefore, preventive approaches in professional soccer players with previous hamstring injuries should be a priority.

Artificial neural network-based control of powered knee exoskeletons for lifting tasks: design and experimental validation

Abstract This study introduces a hybrid model that utilizes a model-based optimization method to generate training data and an artificial neural network (ANN)-based learning method to offer real-time exoskeleton support in lifting activities. For the model-based optimization method, the torque of the knee exoskeleton and the optimal lifting motion are predicted utilizing a two-dimensional (2D) human–exoskeleton model. The control points for exoskeleton motor current profiles and human joint angle profiles from cubic B-spline interpolation represent the design variables. Minimizing the square of the normalized human joint torque is considered as the cost function. Subsequently, the lifting optimization problem is tackled using a sequential quadratic programming (SQP) algorithm in sparse nonlinear optimizer (SNOPT). For the learning-based approach, the learning-based control model is trained using the general regression neural network (GRNN). The anthropometric parameters of the human subjects and lifting boundary postures are used as input parameters, while the control points for exoskeleton torque are treated as output parameters. Once trained, the learning-based control model can provide exoskeleton assistive torque in real time for lifting tasks. Two test subjects’ joint angles and ground reaction forces (GRFs) comparisons are presented between the experimental and simulation results. Furthermore, the utilization of exoskeletons significantly reduces activations of the four knee extensor and flexor muscles compared to lifting without the exoskeletons for both subjects. Overall, the learning-based control method can generate assistive torque profiles in real time and faster than the model-based optimal control approach.

Implementation and Clinical Outcomes of Blood Flow Restriction Training on Adults With Cerebral Palsy: A Case Series.

Cerebral palsy (CP) is a congenital neurological disorder that causes musculoskeletal weakness and biomechanical dysfunctions. Strength training guidelines recommend at least 70% of 1-repetition maximum to increase muscle strength and mass. However, individuals with CP may not tolerate such high exercise intensity. Blood flow restriction (BFR) can induce similar gains in strength and muscle mass using loads as low as 20% to 30% 1-repetition maximum. This case series described the safety, feasibility, and acceptability of BFR in adults with CP and examined changes in muscle mass and strength. Three male participants with gross motor function classification system level 3 CP underwent strength training using a periodized 8-week BFR protocol. Outcomes included: Safety via blood pressure during and post-BFR exercises in addition to adverse event tracking; Feasibility via number of support people and time-duration of BFR exercises; Acceptability via rate of perceived discomfort (0-10) and qualitative interviews; Muscle Mass via ultrasonographic cross-sectional area of the quadriceps and hamstring; and Strength via (1) 3-repetition maximum in the leg press and knee extension, (2) isometric knee flexor and extensor muscle force measured with a hand-held dynamometer, and (3) 30-second sit-to-stand test. Participants replaced 2 exercises from their current regimen with seated knee extension and leg press exercises using progressively higher limb occlusion pressure and exercise intensity. Limb occlusion pressure started at 60%, by week 4 progressed to 80%, and then remained constant. The exercise repetition scheme progressed from fixed nonfailure repetition sets to failure-based repetition sets. Blood pressure never exceeded safety threshold, and no adverse events were reported. The BFR training was time-consuming and resource-intensive, but well-tolerated by participants (rate of perceived discomfort with a mean value of 5.8, 100% protocol adherence). Strength, as measured by 3-repetition maximum testing and 30-second sit-to-stand test, increased, but isometric muscle force and muscle mass changes were inconsistent. Blood flow restriction may be an effective means to increase strength in adults with CP who cannot tolerate high-intensity resistance training. Future research should compare BFR to traditional strength training and investigate mediators of strength changes in this population. for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A473 ).

Suspension training improves bilateral isometric strength asymmetry of knee muscles in people with multiple sclerosis

IntroductionMost people with multiple sclerosis are diagnosed with bilateral strength asymmetry in the lower limbs. Strength asymmetry increases muscle metabolic cost, muscle fatigability, postural instability, gait disturbance, imbalance, and risk of falling, and negatively affects the quality of life in PwMS. So far, the effects of rehabilitation exercises on reducing the asymmetric index in this population has not been studied convincingly. The purpose of this study was to investigate the effect of suspension exercise on bilateral isometric strength asymmetry of knee muscles in patients with multiple sclerosis. Materials & methodsIn this randomized controlled trial, twenty-seven female patients were purposively selected as the statistical sample and randomly divided into the control (n = 13, age: 34.72 ± 5.01 years) and exercise (n = 14, age: 37.62 ± 4.58 years) groups. The control group received routine care while the exercise group received the suspension exercise protocol. Isometric muscle strength and bilateral asymmetry were measured at baseline and after 8 weeks. The Biodex isokinetic dynamometer was used to measure the maximal voluntary isometric contraction of the flexor and extensor muscles of the knee. The analysis of covariance was used to analyze the data. ResultsThe isometric strength of the knee extensor muscles in the weak leg at the angle of 20° and in both legs at the angle of 70° in the exercise group improved significantly. Furthermore, the strength of the knee flexor muscles in the exercise group was increased. The amount of bilateral strength asymmetry in the knee flexor and extensor muscles at the angle of 70° significantly decreased in the exercise group. Discussions & conclusionsThese data suggest that suspension training is a practical approach to manage bilateral asymmetry in knee flexor and extensor muscle strength in patients with an EDSS of less than four.