The effect of the partially restricted sit-to-stand task on biomechanical variables in subjects with and without Parkinson’s disease

The aim of this study was to explore the electromyographic, kinetic and kinematic patterns during a partially restricted sit-to-stand task in subjects with and without Parkinson’s disease (PD). If the trunk is partially restricted, different behavior of torques and muscle activities could be found and it can serve as a reference of the deterioration in the motor performance of subjects with PD. Fifteen subjects participated in this study and electromyography (EMG) activity of the tibialis anterior (TA), soleus (SO), vastus medialis oblique (VMO), biceps femoris (BF) and erector spinae (ES) were recorded and biomechanical variables were calculated during four phases of the movement. Subjects with PD showed more flexion at the ankle, knee and hip joints and increased knee and hip joint torques in comparison to healthy subjects in the final position. However, these joint torques can be explained by the differences in kinematic data. Also, the hip, knee and ankle joint torques were not different in the acceleration phase of movement. The use of a partially restricted sit-to-stand task in PD subjects with moderate involvement leads to the generation of joint torques similar to healthy subjects. This may have important implications for rehabilitation training in PD subjects.     

Sitting movement in elderly subjects with and without Parkinson’s disease: A biomechanical study

The aim of the present study was to compare kinetic, kinematic, and electromyographic variables during the sitting movement between healthy elderly and in those with Parkinson’s disease (PD) with moderate involvement. We hypothesized that subjects with PD would show difficulty in selecting the muscles for the task and that this could be related to the co-activation pattern and would be reflected in the behavior of some biomechanical variables. Fifteen subjects participated in this study, seven healthy subjects (NN group) and eight with Parkinson’s disease. Electromyography (EMG) activity of the tibialis anterior (TA), soleus (SO), vastus medialis oblique (VMO), biceps femoris (BF), and erector spinae (ES) were recorded, and biomechanical variables were calculated, during four phases of the sitting movement. Compared to healthy subjects, the subjects with PD showed more flexion at the ankle, knee, and hip joints in the initial position and lower joint velocity. However, the EMG activity and hip, knee, and ankle joint torques were not different during all phases of movement. The sitting movement in PD subjects with moderate involvement generates EMG activity and joint torques similar to healthy elderly subjects. Only a reduced movement velocity was found in PD patients during the sitting task.     

Lower extremity extension force and electromyography properties as a function of knee angle and their relation to joint torques: implications for strength diagnostics

The purpose of this study was to evaluate whether and how isometric multijoint leg extension strength can be used to assess athletes' muscular capability within the scope of strength diagnosis. External reaction forces (Fext) and kinematics were measured (n = 18) during maximal isometric contractions in a seated leg press at 8 distinct joint angle configurations ranging from 30 to 100° knee flexion. In addition, muscle activation of rectus femoris, vastus medialis, biceps femoris c.l., gastrocnemius medialis, and tibialis anterior was obtained using surface electromyography (EMG). Joint torques for hip, knee, and ankle joints were computed by inverse dynamics. The results showed that unilateral Fext decreased significantly from 3,369 ± 575 N at 30° knee flexion to 1,015 ± 152 N at 100° knee flexion. Despite maximum voluntary effort, excitation of all muscles as measured by EMG root mean square changed with knee flexion angles. Moreover, correlations showed that above-average Fext at low knee flexion is not necessarily associated with above-average Fext at great knee flexion and vice versa. Similarly, it is not possible to deduce high joint torques from high Fext just as above-average joint torques in 1 joint do not signify above-average torques in another joint. From these findings, it is concluded that an evaluation of muscular capability by means of Fext as measured for multijoint leg extension is strongly limited. As practical recommendation, we suggest analyzing multijoint leg extension strength at 3 distinct knee flexion angles or at discipline-specific joint angles. In addition, a careful evaluation of muscular capacity based on measured Fext can be done for knee flexion angles ≥ 80°. For further and detailed analysis of single muscle groups, the use of inverse dynamic modeling is recommended.     

Electromyographic and kinematic analysis of females with excessive medial knee displacement in the overhead squat

Dynamic knee valgus is a multi-planar motion that has been associated with anterior cruciate ligament injuries and patellofemoral pain syndrome. Clinical assessment of dynamic knee valgus is usually performed through visual appearance of medial knee displacement (MKD) during the overhead squat. The aim of this study is to identify the kinematic and neuromuscular parameters associated with MKD. Twenty-two females performed an overhead squat and were assigned to the control group (n = 14) or the MKD group (n = 8). Electromyography and kinematic data of the lower extremity were collected. We observed MKD to exhibit greater muscle activity in the following muscles: adductor magnus, biceps femoris, vastus lateralis and vastus medialis muscles during the eccentric phase of the overhead squat. No group differences were observed during the concentric phase. Regarding the kinematics, the MKD group showed higher knee internal rotation and, knee abduction and ankle abduction, compared to controls. The combined information from the muscle activity results and kinematics of squat helps to explain the occurrence of excessive medial knee displacement and, hence, providing relevant information for health professionals to address this injury risk factor.     

Test-retest reliability of EMG and peak torque during repetitive maximum concentric knee extensions.

The aim of this study was to investigate the reliability of peak torque and surface electromyography (EMG) variable's root mean square (RMS) and mean frequency (MNF) during an endurance test consisting of repetitive maximum concentric knee extensions. Muscle fatigue has been quantified in several ways, and in isokinetic testing it is based on a set of repetitive contractions. To assess test-retest reliability, two sets of 100 dynamic maximum concentric knee extensions were performed using an isokinetic dynamometer. The two series were separated by 7-8 days. The subjects relaxed during the passive flexion phase. Twenty (10 men and 10 women) clinically healthy subjects volunteered.Peak torque and EMG from rectus femoris, vastus medialis, vastus lateralis and biceps femoris were recorded. RMS and MNF were calculated from the EMG signal. The reliability was calculated with intraclass correlation coefficient ICC (1.1) and standard error of measurements (SEM). The reliability of peak torque was good (ICC=0.93) and SEM showed low values. ICC was good for absolute RMS of rectus femoris (ICC>/=0.80), vastus medialis (ICC>/=0.88) and vastus lateralis (ICC>/=0.82) and MNF of rectus femoris (ICC>/=0.82) and vastus medialis (ICC>/=0.83). Peak torque, and MNF and RMS of rectus femoris and vastus medialis are reliable variables obtained from an isokinetic endurance test of the knee extensors.     

The influence of knee alignment on lower extremity kinetics during squats

The squat is an assessment of lower extremity alignment during movement, however there is little information regarding altered joint kinetics during poorly performed squats. The purpose of this study was to examine changes in joint kinetics and power from altered knee alignment during a squat. Thirty participants completed squats while displacing the knee medially, anteriorly, and with neutral alignment (control). Sagittal and frontal plane torques at the ankle, knee, and hip were altered in the descending and ascending phase of the squat in both the medial and anterior malaligned squat compared to the control squat. Ankle and trunk power increased and hip power decreased in the medial malaligned squat compared to the control squat. Ankle, knee, and trunk power increased and hip power decreased in the anterior malaligned squat compared to the control squat. Changes in joint torques and power during malaligned squats suggest that altered knee alignment increases ankle and trunk involvement to execute the movement. Increased anterior knee excursion during squatting may also lead to persistent altered loading of the ankle and knee. Sports medicine professionals using the squat for quadriceps strengthening must consider knee alignment to reduce ankle and trunk involvement during the movement.     

Upward squatting in individuals with and without patellofemoral pain syndrome: a biomechanical study

The purpose of the study was to test the hypothesis on whether individuals with patellofemoral pain syndrome (PFPS) try to avoid knee position during upward squatting so as not to aggravate this syndrome. Also, we tested whether PFPS would generate changes in the kinetic and electromyographic (EMG) strategies used to perform this task. Eight healthy subjects and 8 subjects with PFPS, but without a history of pain for at least 30 days, took part in the experiment. They were asked to perform upward squatting with knees initially flexed at 60° (very flexed) until reaching an upright position. Angle, velocity, and acceleration (kinematic) were reconstructed for knee and ankle joints. The torques at these joints were calculated using inverse dynamics, taking into account anthropometric and inertial characteristics of each subject, including records from force data. Only activities of major muscles were recorded. The kinetic and EMG profiles were quantified during acceleration and deceleration phases of the upward squatting. Both healthy and PFPS subjects used the same kinetic and EMG strategies to perform the upward squatting, even though the magnitude of the muscle activities were decreased for the latter group. Compared to the control group, the PFPS subjects presented larger joint ankle torques and smaller knee joint torques. However, the subjects avoided keeping their knees very flexed at the initial position. Group differences in the kinetic and EMG strategies can be explained by differences in the initial position, suggesting a protective strategy used by subjects with PFPS. Therefore, for these subjects, coaches and therapists should avoid using this exercise when the knee is required to move above 40° flexion.     

Biomechanics of human quadriceps muscles during electrical stimulation

The quadriceps muscles of neurologically intact and spinal cord injured (SCI) human subjects were stimulated with constant current pulses. Up to three, separately adjustable stimulating electrodes over the motor points for vastus medialis (VM), vastus lateralis (VL) and rectus femoris (RF) muscles were used to maximize torque generation while minimizing discomfort. The torque generated by stimulation increased as the knee was slowly flexed to about 1 rad (50-60 degrees) and decreased beyond that point (a 'negative slope' on a torque-angle curve). Despite this region of negative slope the force generated by small oscillations remained positively correlated to the angle changes. When the knee was slowly extended again from a flexed position, the torque continued to decline and therefore showed a large degree of 'hysteresis'. Of the three heads studied, only stimulation of RF muscle generally produced this behavior. VL and VM had torques that increased monotonically with knee flexion over the range studied. The torques generated with electrical stimulation of normal subjects represented up to about 30% of maximum voluntary contraction. When subjects generated similar torques voluntarily, the negative slope region and substantial hysteresis were not observed. Thus, SCI subjects may be adversely affected by hysteresis during electrically-induced transitions from sitting to standing and vice versa, while normal subjects are not.     

Angle- and gender-specific quadriceps femoris muscle recruitment and knee extensor torque

The objectives were to examine knee angle-, and gender-specific knee extensor torque output and quadriceps femoris (QF) muscle recruitment during maximal effort, voluntary contractions. Fourteen young adult men and 15 young adult women performed three isometric maximal voluntary contractions (MVC), in a random order, with the knee at 0 degrees (terminal extension), 10 degrees, 30 degrees, 50 degrees, 70 degrees, and 90 degrees flexion. Knee extensor peak torque (PT), and average torque (AT) were expressed in absolute (N m), relative (N m kg(-1)) and allometric-modeled (N m kg(-n)) units. Vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) muscle EMG signals were full-wave rectified and integrated over the middle 3 s of each contraction, averaged over the three trials at each knee angle, and normalized to the activity recorded at 0 degrees. Muscle recruitment efficiency was calculated as the ratio of the normalized EMG of each muscle to the allometric-modeled average torque (normalized to the values at 0 degrees flexion), and expressed as a percent. Men generated significantly greater knee extensor PT and AT than women in absolute, relative and allometric-modeled units. Absolute and relative PT and AT were significantly highest at 70 degrees, while allometric-modeled values were observed to increase significantly across knee joint angles 10-90 degrees. VM EMG was significantly greater than the VL and RF muscles across all angles, and followed a similar pattern to absolute knee extensor torque. Recruitment efficiency improved across knee joint angles 10-90 degrees and was highest for the VL muscle. VM recruitment efficiency improved more than the VL and RF muscles across 70-90 degrees flexion. The findings demonstrate angle-, and gender-specific responses of knee extensor torque to maximal-effort contractions, while superficial QF muscle recruitment was most efficient at 90 degrees, and less dependent on gender.     

Effect of hip joint angle on concentric knee extension torque

This study tested the hypothesis that the effect of hip joint angle on concentric knee extension torque depends on knee joint angle during a single knee extension task. Twelve men performed concentric knee extensions in fully extended and 80° flexed hip positions with maximal effort. The angular velocities were set at 30° s⁻¹ and 180° s⁻¹. The peak torque and torques attained at 30°, 50°, 70° and 90° (anatomical position = 0°) of the knee joint were compared between the two hip positions. Muscle activations of the vastus lateralis, medialis, rectus femoris and biceps femoris were determined using surface electromyography. The peak torque was significantly greater in the flexed than in the extended hip position irrespective of angular velocity. The torques at 70° and 90° of the knee joint at both angular velocities and at 50° at 180° s⁻¹ were significantly greater in the flexed than in the extended hip position, whereas corresponding differences were not found at 30° (at either angular velocity) and 50° (at 30° s⁻¹) of the knee joint. No effect of hip position on muscle activation was observed in any muscle. These results supported our hypothesis and may be related to the force–length and force–velocity characteristics of the rectus femoris.     

Estimation of instantaneous moment arms of lower-leg muscles

Muscle moment arms at the human knee and ankle were estimated from muscle length changes measured as a function of joint flexion angle in cadaver specimens. Nearly all lower-leg muscles were studied: extensor digitorum longus, extensor hallucis longus, flexor digitorum longus, flexor hallucis longus, gastrocnemius lateralis, gastrocnemius medialis, peroneus brevis, peroneus longus, peroneus tertius, plantaris, soleus, tibialis anterior, and tibialis posterior. Noise in measured muscle length was filtered by means of quintic splines. Moment arms of the mm. gastrocnemii appear to be much more dependent on joint flexion angles than was generally assumed by other investigators. Some consequences for earlier analyses are mentioned.     

A noninvasive technique for in vivo measurement of joint torques of biarticular muscles.

The objective of this work was to develop a noninvasive method to measure the joint torques produced by biarticular muscles at two joints simultaneously. During intramuscular stimulation of the cat medial gastrocnemius (MG) muscle, torques at the ankle and knee joints were calculated from forces measured in two dimensions at the end point of the cat paw under isometric conditions. The method was verified by the known anatomical properties of cat MG muscle and the tibialis anterior (TA) muscle. The MG muscle was shown to produce a significant flexion torque at the knee, besides an extension torque at the ankle. This was in agreement with its anatomical arrangement. The TA muscle produced primarily an ankle flexion torque. The small knee torque, due to measurement errors, yielded an estimate of measurement accuracy of 3.0 +/- 2.1% (n = 52). The coupling ratio of the MG muscle, defined as T(ankle)/T(knee), varied significantly with both knee and ankle angles. The profile of MG mechanical coupling agreed qualitatively with changes in limb configuration. The method can be used to measure recruitment properties of electrically stimulated biarticular muscles, and may potentially be used to study the biomechanics of biarticular coupling.     

Knee angle-dependent oxygen consumption during isometric contractions of the knee extensors determined with near-infrared spectroscopy.

Fatigue resistance of knee extensor muscles is higher during voluntary isometric contractions at short compared with longer muscle lengths. In the present study we hypothesized that this would be due to lower energy consumption at short muscle lengths. Ten healthy male subjects performed isometric contractions with the knee extensor muscles at a 30, 60, and 90 degrees knee angle (full extension = 0 degrees ). At each angle, muscle oxygen consumption (m.VO2) of the rectus femoris, vastus lateralis, and vastus medialis muscle was obtained with near-infrared spectroscopy. m.VO2 was measured during maximal isometric contractions and during contractions at 10, 30, and 50% of maximal torque capacity. During all contractions, blood flow to the muscle was occluded with a pressure cuff (450 mmHg). m.VO2 significantly (P < 0.05) increased with torque and at all torque levels, and for each of the three muscles. m.VO2 was significantly lower at 30 degrees compared with 60 degrees and 90 degrees and m.VO2 was similar (P > 0.05) at 60 degrees and 90 degrees . Across all torque levels, average (+/- SD) m.VO2 at the 30 degrees angle for vastus medialis, rectus femoris, and vastus lateralis, respectively, was 70.0 +/- 10.4, 72.2 +/- 12.7, and 75.9 +/- 8.0% of the average m.VO2 obtained for each torque at 60 and 90 degrees . In conclusion, oxygen consumption of the knee extensors was significantly lower during isometric contractions at the 30 degrees than at the 60 degrees and 90 degrees knee angle, which probably contributes to the previously reported longer duration of sustained isometric contractions at relatively short muscle lengths.     

Kinematic,kinetic and electromyographic differences between young adults with and without chronic ankle instability during walking

The objective of this study was to quantify the kinematic, kinetic and electromyography differences between individuals with and without chronic ankle instability (CAI) during comfortable (CW) and fast (FW) walking. Twenty-one individuals with CAI and 21 healthy controls were recruited to walk at CW and FW speeds. The dependent variables were gluteus medius, vastus lateralis, gastrocnemius lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles mean activity, ankle and knee angles and moments. Kinematic, kinetic and electromyography variables were compared between groups with a one-dimensional statistical non-parametric mapping analysis. The CAI group exhibited no significant difference for ankle angles and moments compared to the control group. However, the CAI group showed less external knee rotation from 56 to 100% (CW) and 51 to 98% (FW) and more knee abduction moment from 1 to 6% and 7 to 9% (CW) and 1 to 2% (FW) of the stance phase. Less gluteus medius muscle activity was also observed from 6 to 9% and 99 to 100% (CW) of the stance phase for the CAI group. These results suggest proximal biomechanical compensations and will help better understand the underlying deficits associated with CAI. They also indicate that regardless of walking speeds, individuals with CAI exhibit similar differences compared to healthy participants.     

MMG and EMG responses of the superficial quadriceps femoris muscles.

Eighteen adults performed isometric muscle actions of the leg extensors at 25, 50, 75, and 100% maximal voluntary contraction (%MVC) at leg flexion angles of 25, 50, and 75 degrees. The results indicated that isometric torque production increased as leg flexion angle increased (75 degrees > 50 degrees > 25 degrees). For each muscle tested (rectus femoris, vastus lateralis, and vastus medialis), the EMG amplitude increased up to 100%MVC at each leg flexion angle (25, 50, and 75 degrees). The MMG amplitude for each muscle, however, increased up to 100%MVC at 25 and 50 degrees of leg flexion, but plateaued from 75 to 100%MVC at 75 degrees of leg flexion. We hypothesize that the varied patterns for the MMG amplitude-isometric torque relationships were due to leg flexion angle differences in: (1) muscle stiffness, (2) intramuscular fluid pressure, or (3) motor unit firing frequency.     

Length and moment arm of human leg muscles as a function of knee and hip-joint angles

Lengths of muscle tendon complexes of the quadriceps femoris muscle and some of its heads, biceps femoris and gastrocnemius muscles, were measured for six limbs of human cadavers as a function of knee and hip-joint angles. Length-angle curves were fitted using second degree polynomials. Using these polynomials the relationships between knee and hip-joint angles and moment arms were calculated. The effect of changing the hip angle on the biceps femoris muscle length is much larger than that of changing the knee angle. For the rectus femoris muscle the reverse was found. The moment arm of the biceps femoris muscle was found to remain constant throughout the whole range of knee flexion as was the case for the medial part of the vastus medialis muscle. Changes in the length of the lateral part of the vastus medialis muscle as well as the medial part of the vastus lateralis muscle are very similar to those of vastus intermedius muscle to which they are adjacent, while those changes in the length of the medial part of the vastus medialis muscle and the lateral part of the vastus lateralis muscle, which are similar to each other, differ substantially from those of the vastus intermedius muscle. Application of the results to jumping showed that bi-articular rectus femoris and biceps femoris muscles, which are antagonists, both contract eccentrically early in the push off phase and concentrically in last part of this phase.     

The mechanics of agonistic muscles

IntroductionIn this study, we tested two assumptions that have been made in experimental studies on muscle mechanics: (i) that the torque-angle properties are similar among agonistic muscles crossing a joint, and (ii) that the sum of the torque capacity of individual muscles adds up to the torque capacity of the agonist group.MethodsMaximum isometric torque measurements were made using a specifically designed animal knee extension dynamometer for the intact rabbit quadriceps muscles (n = 10) for knee angles between 60 and 120°. The nerve branches of the vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) muscles were carefully dissected, and a custom made nerve cuff electrode was implanted on each branch. Knee extensor torques were measured for four maximal activation conditions at each knee angle: VL activation, VM activation, RF activation, and activation of all three muscles together.ResultsWith the exception of VL, the torque-angle relationships of the individual muscles did not have the shape of the torque-angle relationship obtained when all muscles were activated simultaneously. Furthermore, the maximum torque capacity obtained by adding the individual torque capacities of VL, VM and RF was approximately 20% higher than the torques produced when the three muscles were activated simultaneously.DiscussionThese results bring into question our understanding of in-vivo muscle contraction and challenge assumptions that are sometimes made in human and animal muscle force analyses.     

Effect of fatigue on single-leg hop landing biomechanics

The objective of this study was to measure adaptations in landing strategy during single-leg hops following thigh muscle fatigue. Kinetic, kinematic, and electromyographic data were recorded as thirteen healthy male subjects performed a single-leg hop in both the unfatigued and fatigued states. To sufficiently fatigue the thigh muscles, subjects performed at least two sets of 50 step-ups. Fatigue was assessed by measuring horizontal hopping ability following the protocol. Joint motion and loading, as well as muscle activation patterns, were compared between fatigued and unfatigued conditions. Fatigue significantly increased knee motion (p = 0.012) and shifted the ankle into a more dorsiflexed position (p = 0.029). Hip flexion was also reduced following fatigue (p = 0.042). Peak extension moment tended to decrease at the knee and increase at the ankle and hip (p = 0.014). Ankle plantar flexion moment at the time of peak total support moment increased from 0.8 (N x m)/kg (SD, 0.6 [N x m]/kg) to 1.5 (N x m)/kg (SD, 0.8 [N x m]/kg) (p = 0.006). Decreased knee moment and increased knee flexion during landings following fatigue indicated that the control of knee motion was compromised despite increased activation of the vastus medialis, vastus lateralis, and rectus femoris (p = 0.014, p = 0.014, and p = 0.017, respectively). Performance at the ankle increased to compensate for weakness in the knee musculature and to maintain lower extremity stability during landing. Investigating the biomechanical adaptations that occur in healthy subjects as a result of muscle fatigue may give insight into the compensatory mechanisms and loading patterns occurring in patients with knee pathology. Changes in single-leg hop landing performance could be used to demonstrate functional improvement in patients due to training or physical therapy.     

The effect of vastus medialis forces on patello-femoral contact: a model-based study

A mathematical model of the patello-femoral joint was introduced to investigate the impact of the vastus medialis (longus, obliquus) forces on the lateral contact force levels. In the model, the quadriceps were represented as five separate forces: vastus lateralis, vastus intermedius, rectus femoris, vastus medialis longus (VML), and obliquus (VMO). By varying the relative force generation ratios of the quadriceps heads, the patello-femoral contact forces were estimated. We sought to analytically determine the range of forces in the VMO and VML that cause a reduction or an increase of lateral contact forces, often the cause of patello-femoral pain. Our results indicated that increased contact forces are more dependent on combinations of muscle forces than solely VMO weakness. Moreover, our simulation data showed that the contact force levels are also highly dependent on the knee flexion angle. These findings suggest that training targeted to reduce contact forces through certain joint angles could actually result in a significant increase of the contact forces through other joint angles.