Quadriceps Strengthening Research Articles

Effects of functional electrical stimulation-induced lower extremity cycling on bone density of spinal cord-injured patients.

Spinal cord-injured (SCI) patients are at increased risk for fractures secondary to neurogenic osteoporosis. Earlier research claimed physical conditioning resulted in a decreased incidence or reversal of neurogenic osteoporosis. This study evaluated the effects of functional electrical stimulation-induced lower extremity cycling (FESILEC) on the bone densities of SCI patients using dual-energy x/ray absorptiometry (DEXA). The study consisted of 12 healthy male SCI patients, aged 23 to 46 (x +/- SD, 34 +/- 6) yr. The patients were post-traumatic, complete, spastic SCI; time postinjury ranged from 2 to 19 (9.7 +/- 5.1) yr. Patients participated in a three-phase training program. Phase 1 consisted of quadriceps strengthening. Phase 2 consisted of progressive sequential stimulation of quadriceps, hamstrings, and gluteal muscles, achieving a rhythmical pedaling motion on the REGYS I ergometer. Phase 3a consisted of 30-min FESILEC sessions. DEXAs were done at baseline and at completion of Phase 3a and Phase 3b. Bone densities were done of the lumbar spine levels 2-4 (L2-4), bilateral trochanters (T), Ward's triangles (WT) and femoral necks (FN). Baseline bone density indicated no difference between L2-4 of ambulatory males and SCI males. Baseline values obtained for T, WT, and FN were, respectively, 71, 82, and 79% of ambulatory values. Results after completion of the Phase 3a training program indicated no statistically significant difference compared with baseline values. There was, however, a positive trend in the lumbar spine post-Phase 3a (L2-4, P=0.056). Eight patients continued the exercise program, using a combination of upper and lower extremity cycling (Phase 3b) for a longer period of time (25 +/- 9 wk). DEXAs done after Phase 3b indicated no change relative to baseline data or data post-Phase 3a. In conclusion, although FESILEC did not significantly increase bone density in the hip parameters of chronic SCI patients, a positive trend was observed in the lumbar spine. Further research with acute intervention, such as FESILEC during the first few months post-SCI, is warranted to further evaluate a treatment regimen to prevent or reduce neurogenic osteopenia.

Patella Dislocation.

In brief Whenever a patient has a patella dislocation, osteochondral fractures should be considered. A case study involving a 17-year-old swimmer whose knee was injured playing baseball details a patella dislocation that was accompanied by a defect of the medial patellar facet and a lateral impaction lesion of the lateral femoral gutter-both producing loose bodies. Careful physical examination and a radiographic series that includes anteroposterior, lateral, notch, and sunrise patella views assist in making an accurate diagnosis and guide the clinician to the appropriate treatment. Treatment involves a knee stabilizer followed by aggressive quadriceps strengthening. Loose bodies require arthroscopic surgery.

Anterior Knee Pain Syndrome: Role of the Vastus Medialis Oblique

Anterior knee pain syndrome (AKPS) represents a significant problem for patients and sports medicine clinicians. Many predisposing factors have been associated with AKPS. Considerable attention has been given to quadriceps strengthening. Specifically the vastus medialis oblique (VMO) muscle is targeted for selective strengthening. Because of the VMO's oblique attachment to the patella, researchers report that proper dynamic alignment of the patella is dependent on VMO control. Given the lack of scientific information and agreement concerning the rehabilitation of patients with AKPS, the clinician and patient often become frustrated with the lack of progress during rehabilitation. Therefore the purpose of this paper is to clarify the current literature concerning the role of the VMO.

Arthroscopic Lateral Release and the Lateral Patellar Compression Syndrome

An isolated arthroscopic lateral release can provide dramatic relief of anterior knee pain in a select group of patients. We believe this procedure is indicated for patients with lateral patellar compression syndrome without significant chondrosis who have not responded to nonoperative treatment. During the procedure, care must be taken to perform a complete release and to achieve hemostasis. The postoperative rehabilitation emphasizes control of swelling, patellar mobilization, and quadriceps strengthening. We strongly agree with Schonholtz et al who report that the "lateral retinacular release is not a minor procedure and should not be performed simply because it may help and it can't hurt."

Patellar Resurfacing for Patellofemoral Arthritis

Knee pain referable to the patellofemoral articulation is common in the general population. It remains a troubling problem for the orthopedic surgeon. Frequently, initial therapy, involving activity modification, anti-inflammatory medications, and isometric quadriceps strengthening, is successful in relieving symptoms. Surgical intervention is normally reserved for those patients with pain that is resistant to these modalities. Unfortunately, none of the various surgical options has proved to be totally dependable, durable, or reproducible. The results of isolated patellar and patellofemoral resurfacing procedures have been guarded. Patellar resurfacing appears to be most beneficial in younger patients with severe anterior knee pain. These individuals should be clearly warned that there is a relatively high likelihood that they will require additional surgical treatment or patellectomy at a later date. Fortunately, patellar resurfacing does not preclude patellectomy from being easily performed. Patellofemoral resurfacing, however, involves more overall involvement of the knee joint. This makes patellectomy less likely to be a successful salvage procedure. Despite our observations that knees with primary patellofemoral arthritis do not do as well after total knee replacement as those with tibio-femoral arthritis, this procedure remains the best treatment option. The durability and predictability of total knee arthroplasty are well documented. Its results far surpass those reported for isolated resurfacing procedures. With regard to patellar resurfacing as part of total knee arthroplasty, we recommend resurfacing all patellae. The literature, although not conclusive, lends support to this practice. Avoidance of metal-backed patellar components and special attention to technical details should decrease the complications associated with patellar resurfacing in future studies.(ABSTRACT TRUNCATED AT 250 WORDS)

The Use of EMG Biofeedback in Quadriceps Strengthening Exercise for Rheumatoid Arthritis Patients: A Clinical Trial

A clinical trial involving rheumatoid arthritis patients hospitalized due to an exacerbation of their disease, was initiated in order to determine whether EMG biofeedback when used in conjunction with isometric exercise enhanced quadriceps strengthening. The parameters of muscle bulk, strength and motor unit activity were measured before, during and after the trial to determine any improvements occurring. Results showed that in predominantly elderly patients there was no significant increase in quadriceps strengthening when EMG biofeed-back was used. Further, for subjects under 45 years of age, EMG biofeedback was not shown to effect significant improvement.

Evaluation of the use of a wedge in quadriceps strengthening.

The purpose of the study was to ascertain whether a wedge placed under the knee during resistive exercise enhances quadriceps strengthening and the length-tension relationship of the quadriceps. Twenty normal women students were tested for maximal isometric contraction of their left quadriceps at different knee positions. The test positions were zero, 30, 60, and 90 degrees. The greatest muscle force was recorded when the knee angle was 60 degrees and the least force was recorded when the knee extended fully. The results of the length-tension relationship of muscle obtained in this study adhered to the accepted concept. Values recorded for quadriceps force when the wedge was placed under the knee did not differ significantly from those values recorded when the wedge was not used. The use of the wedge in quadriceps exercise does not appear to be an effective means of generating greater force than when no wedge is used.