Tensiomyography of selected lower-limb muscles in professional soccer players

Tensiomyography is a non-invasive method of neuromuscular assessment used to measure muscle action characteristics, muscle tone, and muscle fiber type, and provides information on acute and chronic responses of muscle to different training loads. The aims of the present study were: to analyse differences in muscle response and mechanical characteristics of two major muscles of the lower extremity in a large group of Spanish soccer players according to playing position, and to provide group norms against which clinical findings may be compared. Data were collected from 78 professional soccer players (age 26.6 ± 4.4 years; height: 179.2 ± 5.3 cm; body mass: 75.8 ± 5.3 kg). Tensiomyography was recorded from the rectus femoris (RF) and biceps femoris (BF) muscles after 2 days without take part in any strenuous exercise or training. Five tensiomyographic parameters were analyzed: maximal displacement (D_m), contraction time (T_c), sustain time (T_s), delay time (T_d), and half-relaxation time (T_r). A good to excellent intra-session reliability was found for all contractile parameters (ICC ranged from 0.78 to 0.95). No significant differences between players of any position were observed in absolute values of BF. However, significant differences were observed for T_c, T_r and T_s between the different playing positions on RF (P < 0.05, effect size ranged from 1.3 to 1.6). Professional soccer players showed muscles with ability to rapidly generate force during contractions. The neuromuscular profile provided could help in identifying the normative data that are important for the different positions in order to optimize the training and recovery process of each individual player.     

Influence of ankle functional instability on the ankle electromyography during landing after volleyball blocking

The purpose of this study was to describe, interpret and compare the EMG activation patterns of ankle muscles – tibialis anterior (TA), peroneus longus (PL) and gastrocnemius lateralis (GL) – in volleyball players with and without ankle functional instability (FI) during landing after the blocking movement. Twenty-one players with FI (IG) and 19 controls (CG) were studied. The cycle of movement analyzed was the time period between 200 ms before and 200 ms after the time of impact determined by ground reaction forces. The variables were analyzed for two different phases: pre-landing (200 ms before impact) and post-landing (200 ms after impact). The RMS values and the timing of onset activity were calculated for the three studied muscles, in both periods and for both groups. The co-activation index for TA and PL, TA and GL were also calculated. Individuals with FI presented a lower RMS value pre-landing for PL (CG = 43.0 ± 22.0; IG = 26.2 ± 8.4, p < 0.05) and higher RMS value post-landing (CG = 47.5 ± 13.3; IG = 55.8 ± 21.6, p < 0.10). Besides that, in control group PL and GL activated first and simultaneously, and TA presented a later activation, while in subjects with FI all the three muscles activated simultaneously. There were no significant differences between groups for co-activation index. Thus, the rate of contraction between agonist and antagonist muscles is similar for subjects with and without FI but the activation individually was different. Volleyball players with functional instability of the ankle showed altered patterns of the muscles that play an important role in the stabilization of the foot–ankle complex during the performance of the blocking movement, to the detriment of the ligament complex, and this fact could explain the usual complaints in these subjects.     

The influence of seat height on the mechanical function of the triceps surae muscles during steady-rate cycling

The purpose of this study was to manipulate bicycle seat height in order to perturbate muscle length, contraction velocity and excitation of soleus and medial gastrocnemius muscles. One group of female riders (n = 13) rode a stationary ergometer at 200 W and a cadence of 80 rpm. Individuals rode at a self-selected seat height, a 10% lowered and 5% raised seat position. It was hypothesized that because the two muscles would operate at decreased contraction velocities at the low seat, the integrated EMG would be less for the lowest seat position. The soleus and medial gastrocnemius muscles showed a significant decrease in integrated EMG value with decreased seat height (soleus F_2,24 = 5.4, p < 0.01, gastrocnemius F_2,24 = 51.6, p < 0.0001). The combined effect of the movement at the ankle and knee joints resulted in increased length of gastrocnemius rather than shortening at the lowered seat-height position as anticipated. This suggested that there was a greater role of knee-joint angle in determining the muscle excitation for medial gastrocnemius. The original hypothesis was accepted, confirming the importance of setting proper seat height.     

Neural control of leg stiffness during hopping in boys and men

The purpose of the study was to investigate whether boys and men utilise different control strategies whilst hopping. Eleven boys (11–12 yr old) and ten men completed hopping at 1.5 Hz, 3.0 Hz and at their preferred frequency. A footswitch measured contact and flight times, from which leg stiffness was calculated. Simultaneously, surface electromyograms (EMGs) of selected lower limb muscles were recorded and quantified for each 30 ms period during the first 120 ms post-ground contact. At 1.5 Hz there were no differences between the groups in relative stiffness or muscle activity. At 3.0 Hz men had significantly shorter contact times (P = 0.013), longer flight times (P = 0.002), greater relative stiffness (P = 0.01) and significantly greater soleus (P = 0.012) and vastus lateralis (P < 0.001) activity during the initial 30 ms post-ground contact. At the preferred frequency men hopped significantly faster than the boys (P = 0.007), with greater leg stiffness (P < 0.01) and with more extensor activity in most time periods. Boys and men demonstrated similar control strategies when hopping at a slow frequency, but when hopping frequency increased men were able to better increase feedforward and reflex muscle activity to hop with greater relative stiffness.     

Validity of trunk extensor and flexor torque measurements using isokinetic dynamometry

This study aimed to evaluate the validity and test–retest reliability of trunk muscle strength testing performed with a latest-generation isokinetic dynamometer. Eccentric, isometric, and concentric peak torque of the trunk flexor and extensor muscles was measured in 15 healthy subjects. Muscle cross sectional area (CSA) and surface electromyographic (EMG) activity were respectively correlated to peak torque and submaximal isometric torque for erector spinae and rectus abdominis muscles. Reliability of peak torque measurements was determined during test and retest sessions. Significant correlations were consistently observed between muscle CSA and peak torque for all contraction types (r = 0.74−0.85; P < 0.001) and between EMG activity and submaximal isometric torque (r ⩾ 0.99; P < 0.05), for both extensor and flexor muscles. Intraclass correlation coefficients were comprised between 0.87 and 0.95, and standard errors of measurement were lower than 9% for all contraction modes. The mean difference in peak torque between test and retest ranged from −3.7% to 3.7% with no significant mean directional bias. Overall, our findings establish the validity of torque measurements using the tested trunk module. Also considering the excellent test–retest reliability of peak torque measurements, we conclude that this latest-generation isokinetic dynamometer could be used with confidence to evaluate trunk muscle function for clinical or athletic purposes.     

Delayed onset of electromyographic activity of the vastus medialis relative to the vastus lateralis may be related to physical activity levels in females with patellofemoral pain

The aims of this study were to examine group differences in muscle activation onset of the vastus medialis (VM) in relation to the vastus lateralis (VL) and pain level during stair ascent in females with patellofemoral pain (PFP) who maintain high and moderate levels of physical activity; to determine the association between physical activity level and muscle activation onset. Forty-three females with PFP and thirty-eight pain-free females were recruited and divided into four groups based on their level of physical activity: females with PFP (n = 26) and pain-free females (n = 26) who practiced a moderate level of physical activity and females with PFP (n = 17) and pain-free females (n = 12) who practiced an intense amount of physical activity. Participants were asked to ascend a seven-step staircase and the VM and VL activation onset was determined. Females with PFP who practiced high level of physical activity demonstrated delayed onset of VM (4.06 ms) compared to healthy females (−14.4 ms). Conversely, females with PFP who practiced moderate level of physical activity did not present VM delay (−2.48 ms) in comparison to healthy females (−9.89 ms). Furthermore, physical activity significantly correlated to the muscle activation onset difference (p = 0.005; R = 0.60). These findings may explain why controversial results regarding VM and VL muscle activation onset have been found.     

Muscle architecture variations along the human semitendinosus and biceps femoris (long head) length

The purpose of this study was to examine whether muscle architecture of the long head of biceps femoris (BF) and semitendinosus (ST) muscles varies along their length. The ST and BF muscles were dissected and removed from their origins in eight cadaveric specimens (age range 67.8–73.4 years). One-way analysis of variance designs were used to compare fascicle length (FL), pennation angle (PA) and muscle thickness (MT) between proximal, mid-belly and distal positions. Tendon and muscle length properties were also quantified. For the BF muscle, one-way analysis of variance tests showed a higher PA (23.96 ± 3.82°) and FL (7.12 ± 0.48 cm) proximally than distal positions (PA = 17.78 ± 1.95° and FL = 6.35 ± 0.89 cm, respectively). For the ST, there was a significantly (p < 0.05) lower PA (8.81 ± 1.22°) and FL (13.10 ± 1.54 cm) proximally than distally (PA = 14.69 ± 1.09° and FL = 15.49 ± 2.30 cm, respectively). Muscle thickness significantly increased from distal to more proximal positions (p < 0.05). These data suggest that the ST and BF architecture is not uniform and that measurement of these parameters largely depends on the measurement site. Modeling these muscles by assuming a uniform architecture along muscle length may yield less accurate representation of human hamstring muscle function.     

The relationship of corticospinal excitability with pain,motor performance and disability in subjects with chronic wrist/hand pain

There is a growing body of evidence of changes in corticospinal excitability associated with musculoskeletal disorders, however there is a lack of knowledge of how these changes relate to measures of pain, motor performance and disability. An exploratory study was performed utilizing Transcranial Magnetic Stimulation to investigate differences in corticospinal excitability in the Abductor Pollicis Brevis (APB) between 15 pain-free subjects and 15 subjects with chronic wrist/hand pain and to determine how corticospinal excitability was associated with measures of pain (visual analog scale, AUSCAN™), hand motor performance (isometric and key pinch strength, Purdue Pegboard Test), disability (AUSCAN™), and spinal motoneuronal excitability. Input–output curves demonstrated increased corticospinal excitability of the APB in the affected hand of subjects with chronic pain (p < 0.01). Changes in corticospinal excitability were significantly correlated with pain intensity (r = 0.77), disability (r = 0.58), and negatively correlated with motoneuronal excitability (r = −0.57). Corticospinal excitability in subjects with heterogeneous injuries of the wrist/hand was associated with disability and pain.     

Effect of the contraction of medial rotators of the tibia on the electromyographic activity of vastus medialis and vastus lateralis

PurposeThis study attempted to assess if the resisted contraction of medial rotators of the tibia increases the ratio between the activity of vastus medialis (VM) and vastus lateralis (VL) during maximal isometric contractions (MIC) of the quadriceps femoral (QF) muscle at 90° of knee flexion.MethodsAbout 24 female subjects participated in this study, performing four series MIC of the QF. In the first series subjects performed only MIC of the QF muscle, whereas in the other three there was MIC of the QF with resisted contraction of medial rotators of the tibia, with the tibia positioned in medial, neutral and lateral rotation. During each contraction, VM and VL electromyographic signal (EMGs) and QF force were collected, being the EMGs root mean square (RMS) used to access the activity level of these muscles.ResultsThe use of the General Linear Model (GLM) test showed that for α = 0.05 there was a significant increase in the VM:VL ratio when the resisted contraction of medial rotators of the tibia was performed with the tibia in medial (p = <0.0001), neutral (p = <0.0001) and lateral rotation (p = 0.001). The same test showed that during MIC of the QF associated to resisted contraction of medial rotators of the tibia there were no significant differences in the VM:VL ratio between the three tibial rotation positions adopted (p = 0.866 [medial–neutral]; p = 0.106 [medial–lateral]; p = 0.068 [neutral–lateral]).ConclusionsThe resisted contraction of medial rotators of the tibia increases the VM:VL ratio during MIC of the QF and the tibial rotation position does not influence the VM:VL ratio during MIC associated to resisted contraction of medial rotators of the tibia.     

A comparison of surface and fine wire EMG recordings of gluteus medius during selected maximum isometric voluntary contractions of the hip

Electromyographic (EMG) studies into gluteus medius (GMed) typically involve surface EMG electrodes. Previous comparisons of surface and fine wire electrode recordings in other muscles during high load isometric tasks suggest that recordings between electrodes are comparable when the muscle is contracting at a high intensity, however, surface electrodes record additional activity when the muscle is contracting at a low intensity. The purpose of this study was to compare surface and fine wire recordings of GMed at high and low intensities of muscle contractions, under high load conditions (maximum voluntary isometric contractions, MVICs). Mann–Whitney U tests compared median electrode recordings during three MVIC hip actions; abduction, internal rotation and external rotation, in nine healthy adults. There were no significant differences between electrode recordings in positions that evoked a high intensity contraction (internal rotation and abduction, fine wire activity >77% MVIC; effect size, ES < 0.42; p > 0.277). During external rotation, the intensity of muscle activity was low (4.2% MVIC), and surface electrodes recorded additional myoelectric activity (ES = 0.67, p = 0.002). At low levels of muscle activity during high load isometric tasks, the use of surface electrodes may result in additional myoelectric recordings of GMed, potentially reflective of cross-talk from surrounding muscles.     

Sex differences in jaw muscle duty factors during exercise in two environments: A pilot study

It is unknown if females and males use jaw muscles similarly during exercise. This pilot study assessed jaw elevator muscle duty factors (DFs = time of muscle activity/total recording time) at repeated sessions to test if DFs are reliable and different between sexes during exercises in two environments. Ten female and seven male subjects recruited from university soccer teams provided informed consent. Surface electromyography was recorded from masseter and temporalis muscles during biting and leg-extension laboratory exercises. Average activities to produce 20 N bite-forces for each muscle and subject determined thresholds (5–80%·T20 N) for subject-specific DF calculations during exercises performed in laboratory and natural environments. Subjects self-recorded via portable electromyography equipment during in-field leg-extension and weight-lifting exercises. Effects of variables on DFs were assessed via ANOVA (α = 0.05) and simple effects testing (Bonferroni-adjusted p ⩽ 0.012). All subjects used jaw muscles during exercises in both environments. DFs between laboratory sessions were reliable (R = 0.84). During laboratory exercises, male temporalis DFs were significantly higher than female DFs from both muscles (p ⩽ 0.001). During in-field exercises females had higher DFs during weight-lifting while males had higher DFs during leg-extensions. In-field sex differences were significant at most thresholds and showed larger effect sizes for leg-extension compared to weight-lifting exercises.     

Ultrasonographic quantification of architectural response in tibialis anterior to neuromuscular electrical stimulation

While muscle contraction in voluntary efforts has been widely investigated, little is known about contraction during neuromuscular electrical stimulation (NMES). The aim of this study was to quantify in vivo muscle architecture of agonist and antagonist muscles at the ankle joint during NMES. Muscle fascicle lengths and pennation angles of the tibialis anterior (TA) and lateral gastrocnemius muscles were assessed via ultrasonography in 8 healthy young males. Measures were obtained during maximal NMES and torque-matched voluntary dorsiflexion contractions. In the TA, NMES induced a shorter fascicle length (67.2 ± 8.1 mm vs 74.6 ± 11.4 mm; p = 0.04) and a greater pennation angle (11.0 ± 2.4° vs 9.3 ± 2.5°; p = 0.03) compared with voluntary torque-matched dorsiflexion contractions. Architectural responses in the antagonist lateral gastrocnemius muscle did not significantly differ from rest or between voluntary and electrically induced contractions (p > 0.05). Contraction of the antagonist muscle was not a contributing factor to a greater fascicle shortening and increased pennation angle in the TA during NMES. TA architectural response during NMES likely arose from the contribution of muscle synergists during voluntary contractions coupled with a potentially localized contractile activity under the stimulation electrodes during NMES induced contractions.     

Electromyographic analysis during pull,forward punch,elevation and overhead throw after conservative treatment or capsular shift at patient with multidirectional shoulder joint instability

PurposeThe aim of this study was to compare the muscle activity of patients with multidirectional instability treated in a conservative or complex manner (capsular shift with postoperative rehabilitation) and the muscle activity of stable shoulder joints before and after treatment during pull, push, and elevation of upper extremities and during overhead throw.ScopeThe study was carried out on 34 patients with multidirectional shoulder instability treated non-operatively, on 31 patients with multidirectional shoulder instability treated operatively, and on 50 healthy subjects. Signals were recorded by surface EMG from eight different muscles. The mean and standard deviation of the maximum amplitude of normalized voluntary electrical activity for the different movement types and time broadness values during overhead throw were determined for each muscle in all groups and compared with each other.ConclusionThe centralization of the glenohumeral joint and the reduction of instability is attempted to be ensured by the organism through increasing the role of rotator cuff muscles (p = 0.009) and decreasing the role of the deltoid, biceps brachii, and pectoralis maior muscles (p = 0.007). At patients after short-term and long-term conservative treatment, the maximum amplitude of normalized voluntary electrical activity of stabilizer muscles is significantly higher (p = 0.006), and that of accelerator muscles is significantly lower (p = 0.005) and the time broadness is significantly longer (p = 0.01) than that of the control group. At patients after complex treatment (open capsular shift with postoperative conservative rehabilitation) the characteristic of the muscle pattern is similar (p = 0.19) to the control group.The complex treatment resolves the labral ligamentous abnormalities by operative treatment and restores the impaired muscular control by postoperative rehabilitation, whereas the conservative treatment restores only the muscular control.     

Quantification of abdominal and pelvic floor muscle synergies in response to voluntary pelvic floor muscle contractions

The relative levels of pelvic floor muscle (PFM) activation and pressure generated by maximum voluntary PFM contractions were investigated in healthy continent women. The normal sequence of abdominal and PFM activation was determined.Fifteen women performed single and repeated maximum voluntary PFM contractions in supine, sitting and standing. PFM electromyographic (EMG) signals and associated intra-vaginal pressure data were recorded simultaneously. Surface EMG data were recorded from rectus abdominus (RA), external obliques (EO), internal obliques (IO) and transversus abdominus (TA).Abdominal and PFM EMG and intra-vaginal pressure amplitudes generated during voluntary PFM contractions were not different among the positions. Muscle activation sequence differed by position. In supine, EO activation preceded all other muscles by 27 ms (p = 0.043). In sitting, all of the muscles were activated simultaneously. In standing, RA and EO were activated 11 and 17 ms, respectively, prior to the PFMs and TA and IO were activated 10 and 12 ms, respectively, after the PFMs (p ≪ 0.001).The results suggest that women are able to perform equally strong PFM contractions in supine, sitting and standing, however the pattern of abdominal and PFM activation varies by position. These differences may be related to position-dependent urine leakage in women with stress incontinence.     

Multichannel EMG-based estimation of fiber conduction velocity during isometric contraction of patients with different stages of diabetic neuropathy

This study compares muscle fiber conduction velocities estimated using surface electromyography during isometric maximal voluntary contraction in different stages of diabetic neuropathy. Eighty-five adults were studied: 16 non-diabetic individuals and 69 diabetic patients classified into four neuropathy stages, defined by a fuzzy expert system: absent (n = 26), mild (n = 21), moderate (n = 11) and severe (n = 11). Average muscle fiber conduction velocities of gastrocnemius medialis, tibialis anterior, vastus lateralis and biceps femoris were assessed using linear array electrodes, and were compared by ANOVA. Conduction velocities were significantly decreased in the moderate neuropathy group for the vastus lateralis compared to other groups (from 18% to 21% decrease), and were also decreased in all diabetic groups for the tibialis anterior (from 15% to 20% from control group). Not only the distal anatomical localization of the muscle affects the conduction velocity, but also the proportion of muscle fiber type, where the tibialis anterior with greater type I fiber proportion is affected earlier while the vastus lateralis with greater type II fiber proportion is affected in later stages of the disease. Generally, the muscles of the lower limb have different responsiveness to the effects of diabetes mellitus and show a reduction in the conduction velocity as neuropathy progresses.     

Rotator cuff tendinopathy alters the muscle activity onset and kinematics of scapula

Athletes with rotator cuff (RC) tendinopathy demonstrate an aberrant pattern of scapular motion which might relate to deficits in the scapular muscles. This study aimed to determine whether alteration in scapular kinematics is associated with deficits in the activity onset of scapular muscles. Forty-three male volleyball players (17 asymptomatic and 26 with RC tendinopathy) joined the study. Three-dimensional scapular kinematics was quantified using an acromial marker cluster method. The activity onset of the upper (UT), middle (MT), and lower trapezius (LT), and serratus anterior (SA) during arm abduction was assessed with electromyography. Athletes with RC tendinopathy demonstrated less scapular upward rotation (6.6 ± 2.3 vs. 8.2 ± 1.1°, p = 0.021) in the early phase of shoulder abduction from 0° to 30° when compared to asymptomatic athletes. The tendinopathy group had delayed activity onset of LT (14.1 ± 31.4 ms vs. 74.4 ± 45.1 ms, p < 0.001) and SA (−44.9 ± 26.0 ms vs. 23.0 ± 25.2 ms, p < 0.001) relative to UT when compared to the asymptomatic group. In asymptomatic athletes, earlier activity onset of MT and LT relative to UT was associated with more scapular upward rotation during 0–30° of abduction (r = 0.665, p = 0.021) and 30–60° of abduction (r = 0.680, p = 0.015), respectively. Our findings showed the control of the scapular upward rotation is related to the activity onset of the scapular muscles in athletes.     

Reliability and minimal detectable change in scapulothoracic neuromuscular activity

Alterations in scapular muscle activity, including excess activation of the upper trapezius (UT) and onset latencies of the lower trapezius (LT) and serratus anterior (SA) muscles, are associated with abnormal scapular motion and shoulder impingement. Limited information exists on the reliability of neuromuscular activity to demonstrate the efficacy of interventions. The purpose of this study was to characterize the reproducibility of scapular muscle activity (mean activity, relative onset timing) over time and establish the minimal detectable change (MDC). Surface electromyography (sEMG) of the UT, LT, SA and anterior deltoid (AD) muscles in 16 adults were captured during an overhead lifting task in two sessions, one-week apart. sEMG data were also normalized to maximum isometric contraction and the relative onset and mean muscle activity during concentric and eccentric phases of the scapular muscles were calculated. Additionally, reliability of the absolute sEMG data during the lifting task and MVIC was evaluated. Both intrasession and intersession reliability of normalized and absolute mean scapular muscle activity, assessed with intraclass correlation coefficients (ICC), ranged from 0.62 to 0.99; MDC values were between 1.3% and 11.7% MVIC and 24 to 135 mV absolute sEMG. Reliability of sEMG during MVIC was ICC = 0.82–0.99, with the exception of intersession upper trapezius reliability (ICC = 0.36). Within session reliability of muscle onset times was ICC = 0.88–0.97, but between session reliability was lower with ICC = 0.43–0.73; MDC were between 39 and 237 ms. Small changes in scapular neuromuscular mean activity (>11.7% MVIC) can be interpreted as meaningful change, while change in muscle onset timing in light of specific processing parameters used in this study is more variable.     

Unweighted state as a sidestep preparation improve the initiation and reaching performance for basketball players

The preparatory motion of a defensive motion in contact sport such as basketball should be small and involve landing on both feet for strict time and motion constraints. We thus proposed the movement creating a unweighted state. Ten basketball players performed a choice reaction sidestepping task with and without the voluntary, continuous vertical fluctuation movement. The results indicated that the preparatory movement shortened the time of their sidestep initiation (301 vs. 314 ms, p = 0.011) and reaching performance (883 vs. 910 ms, p = 0.018) but did not increase their peak ground reaction force or movement velocity. The mechanism of the improvement was estimated to be the following: in the preparation phase, the vertical body fluctuation created the force fluctuation; after the direction signal, the unweighted state can shorten the time required to initiate the sidestepping (unweighted: 279 ms; weighted: 322 ms, p = 0.002); around the initiation phase, the dropping down of the body and weighted state can contribute to the reaching performance. We conducted additional experiment investigating muscle–tendon-complex dynamics and muscle activity using ultrasound device and electromyography. The result suggests that the building up of active state of muscle might explain the improvement of sidestepping performance.     

The role of biceps brachii and brachioradialis for the control of elbow flexion and extension movements

How do synergistic muscles interact, when their contraction aims at stabilizing and fine-tuning a movement, which is induced by the antagonistic muscle? The aim of the study was to analyze the interaction of biceps and brachioradialis during fine-tuning control tasks in comparison to load bearing ones. The surface electromyogram of biceps, brachioradialis and triceps were examined in 15 healthy subjects in dynamic flexion and extension movements with different combinations of contraction levels, joint angles and angular velocities. The measurements were conducted in two configurations, where the torque due to an external load opposes the rotational direction of the elbow flexion (load bearing tasks) or the elbow extension (fine-tuning tasks).Whereas during load bearing control tasks, similar muscular activation of biceps and brachioradialis was observed for all joint angles, angular velocities and external loads, during fine-tuning control tasks a significant difference of the muscular activation of both flexors was observed for 1 kg, F(3.639, 47.305) = 2.864, p = 0.037, and 5 kg of external load, F(1.570, 21.976) = 6.834, p = 0.008.The results confirm the synergistic muscular activation of both flexors during load bearing tasks, but suggest different control strategies for both flexors when they comprise a fine-tuning control task.     

Assessment of quadriceps muscle weakness in patients after total knee arthroplasty and total hip arthroplasty: Methodological issues

The aim of this exploratory study was to verify whether the evaluation of quadriceps muscle weakness is influenced by the testing modality (isometric vs. isokinetic vs. isoinertial) and by the calculation method (within-subject vs. between-subject comparisons) in patients 4–8 months after total knee arthroplasty (TKA, n = 29) and total hip arthroplasty (THA, n = 30), and in healthy controls (n = 19). Maximal quadriceps strength was evaluated as (1) the maximal voluntary contraction (MVC) torque during an isometric contraction, (2) the peak torque during an isokinetic contraction, and (3) the one repetition maximum (1-RM) load during an isoinertial contraction. Muscle weakness was calculated as the difference between the involved and the uninvolved side (within-subject comparison) and as the difference between the involved side of patients and controls (between-subject comparison). Muscle weakness estimates were not significantly affected by the calculation method (within-subject vs. between-subject; P > 0.05), whereas a significant main effect of testing modality (P < 0.05) was observed. Isometric MVC torque provided smaller weakness estimates than isokinetic peak torque (P = 0.06) and isoinertial 1-RM load (P = 0.008), and the clinical occurrence of weakness (proportion of patients with large strength deficits) was also lower for MVC torque. These results have important implications for the evaluation of quadriceps muscle weakness in TKA and THA patients 4–8 months after surgery.