Males and females have different muscle activity patterns during gait after ACL injury and reconstruction

Kinematic and kinetic changes following anterior cruciate ligament (ACL) rupture and reconstruction (ACLR) have been fundamental to the understanding of mechanical disrupted load as it contributes to the development of posttraumatic osteoarthritis. These analyses overlook the potential contribution of muscle activity as it relates to the joint loading environment. Males and females classified as non-copers present with unique knee kinematics and kinetics after ACL injury. The purpose of this study was to perform sex-specific analyses in these individuals to explore muscle activity timing during gait after ACL rupture. Thirty-nine participants (12 females, 27 males) were enrolled. Muscle activity during gait was evaluated before and after pre-operative physical therapy, and six months after ACLR. Surface electromyography data were evaluated to determine timing (e.g., the time the muscle activity begins (‘On’) and ends (‘Off’)) for seven muscles: vastus lateralis and medialis (VL, VM), lateral and medial hamstrings (LH, MH), lateral and medial gastrocnemius (LG, MG), and soleus (SOL). General linear models with generalized estimating equations detected the effects of limb and time for muscle activity timing. Males presented with more limb asymmetries before and after pre-operative PT in the VL On (p < 0.001) and Off (p = 0.007), VM On and Off (p < 0.001), and MH off (p < 0.001), but all limb differences resolved by six months post ACLR. Changes in muscle activity in males were pervasive over time in both limbs. Females presented with no interlimb differences pre-operatively, and only involved limb VL off (p = 0.027) and VM off (p = 0.003) and the LH off in both limbs (p < 0.038) changed over time. Our data indicate that inter-limb differences in muscle activity across time points and changes in muscle activity timing over the course of physical therapy were sex specific. Males presented with more inter-limb differences in muscle activity across time points, and females presented with fewer asymmetries before and after pre-operative physical therapy. These data support that sex-specific adaptations should be taken into consideration when assessing biomechanical changes after ACLR.     

Knee and Hip Joint Kinematics Predict Quadriceps and Hamstrings Neuromuscular Activation Patterns in Drop Jump Landings

PurposeThe purpose was to assess if variation in sagittal plane landing kinematics is associated with variation in neuromuscular activation patterns of the quadriceps-hamstrings muscle groups during drop vertical jumps (DVJ).MethodsFifty female athletes performed three DVJ. The relationship between peak knee and hip flexion angles and the amplitude of four EMG vectors was investigated with trajectory-level canonical correlation analyses over the entire time period of the landing phase. EMG vectors consisted of the {vastus medialis(VM),vastus lateralis(VL)}, {vastus medialis(VM),hamstring medialis(HM)}, {hamstring medialis(HM),hamstring lateralis(HL)} and the {vastus lateralis(VL),hamstring lateralis(HL)}. To estimate the contribution of each individual muscle, linear regressions were also conducted using one-dimensional statistical parametric mapping.ResultsThe peak knee flexion angle was significantly positively associated with the amplitudes of the {VM,HM} and {HM,HL} during the preparatory and initial contact phase and with the {VL,HL} vector during the peak loading phase (p<0.05). Small peak knee flexion angles were significantly associated with higher HM amplitudes during the preparatory and initial contact phase (p<0.001). The amplitudes of the {VM,VL} and {VL,HL} were significantly positively associated with the peak hip flexion angle during the peak loading phase (p<0.05). Small peak hip flexion angles were significantly associated with higher VL amplitudes during the peak loading phase (p = 0.001). Higher external knee abduction and flexion moments were found in participants landing with less flexed knee and hip joints (p<0.001).ConclusionThis study demonstrated clear associations between neuromuscular activation patterns and landing kinematics in the sagittal plane during specific parts of the landing. These findings have indicated that an erect landing pattern, characterized by less hip and knee flexion, was significantly associated with an increased medial and posterior neuromuscular activation (dominant hamstrings medialis activity) during the preparatory and initial contact phase and an increased lateral neuromuscular activation (dominant vastus lateralis activity) during the peak loading phase.     

The effect of lower-limb prosthetic alignment on muscle activity during sit-to-stand

People with a transtibial amputation (TTA) have altered motion during daily tasks, which may be influenced by prosthetic alignment. This study aimed to determine the effect of medial/lateral prosthetic alignment shifts on muscle activity, measured by integrated electromyography (iEMG), and to compare muscle activity between people with and without TTA during sit-to-stand. We quantified ground reaction forces and three-dimensional center-of-mass position to interpret muscle activity results. Compared to the prescribed alignment, the bilateral knee extensors had greater activity in the medial alignment (p < 0.001) and the amputated side gluteus medius and less activity in the lateral alignment (p = 0.035), which may be a result of altered muscular requirements for postural control. In people with TTA, smaller intact side gluteus medius activity was associated with frontal plane motion of the center-of-mass, which was not observed in non-amputees. Compared to non-amputees, people with TTA had greater iEMG in the intact side tibialis anterior (p = 0.031) and amputated side rectus femoris (p < 0.001), which may be required to brake the body center-of-mass in the absence of amputated side tibialis anterior. These results suggest that lateral alignment shifts may reduce muscle activity during sit-to-stand for people with TTA and emphasize the importance of analyzing sit-to-stand in three dimensions.     

Neuromuscular activation of quadriceps bellies during tasks performed in the same biomechanical condition in patients undergoing total knee arthroplasty

ObjectiveTo investigate neuromuscular activation of quadriceps bellies during different tasks in patients before and after total knee arthroplasty (TKA).MethodsTwenty-six patients scheduled for TKA and 16 control subjects performed three isometric tasks: knee extension (KE), hip flexion (HF), hip flexion with contralateral hip extension (HFE). Surface electromyography signals of rectus femoris, vastus medialis and vastus lateralis were collected the day before (T0), at one (T1) and three (T2) days after surgery, whereas control subjects underwent a single evaluation. The Root Mean Square peak normalized for its highest value during the three tasks (nRMS-peak) was used as index of maximum neuromuscular activation for each belly. Sixteen patients performed the postoperative assessment, due to the placement of an elastomeric pump aimed at reducing pain in 10 patients.ResultsPatients showed lower rectus femoris nRMS-peak during KE compared to HF and HFE before and after surgery (p < 0.001), as occurred in control subjects. Differently from control subjects, patients showed higher vastus medialis and vastus lateralis nRMS-peak during HF compared to KE at T1 (p = 0.008) and T2 (p = 0.039).ConclusionTKA modified quadriceps neuromuscular activation during different tasks performed the same biomechanical condition. These findings may be considered in planning physiotherapy interventions after TKA.     

Agonist muscle activity and antagonist muscle co-activity levels during standardized isotonic and isokinetic knee extensions

This study aimed to analyze the effects of the contraction mode (isotonic vs. isokinetic concentric conditions), the joint angle and the investigated muscle on agonist muscle activity and antagonist muscle co-activity during standardized knee extensions. Twelve healthy adult subjects performed three sets of isotonic knee extensions at 40% of their maximal voluntary isometric torque followed by three sets of maximal isokinetic knee extensions on an isokinetic dynamometer. For each set, the mean angular velocity and the total external amount of work performed were standardized during the two contraction modes. Surface electromyographic activity of vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), semitendinosus (ST) and biceps femoris (BF) muscles was recorded. Root mean square values were then calculated for each 10° between 85° and 45° of knee extension (0° = horizontal position). Results show that agonist muscle activity and antagonist muscle co-activity levels are significantly greater in isotonic mode compared to isokinetic mode. Quadriceps activity and hamstrings co-activity are significantly lower at knee extended position in both contraction modes. Considering agonist muscles, VL reveals a specific pattern of activity compared to VM and RF; whereas considering hamstring muscles, BF shows a significantly higher co-activity than ST in both contraction modes. Results of this study confirmed our hypothesis that higher quadriceps activity is required during isotonic movements compared to isokinetic movements leading to a higher hamstrings co-activity.     

Force fluctuations are modulated by alternate muscle activity of knee extensor synergists during low-level sustained contraction.

The study examined the hypothesis that altered synergistic activation of the knee extensors leads to cyclic modulation of the force fluctuations. To test this hypothesis, the force fluctuations were investigated during sustained knee extension at 2.5% of maximal voluntary contraction force for 60 min in 11 men. Surface electromyograms (EMG) were recorded from the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) muscles. The SD of force and average EMG (AEMG) of each muscle were calculated for 30-s periods during alternate muscle activity. Power spectrum of force was calculated for the low- (< or =3 Hz), middle- (4-6 Hz), and high-frequency (8-12 Hz) components. Alternate muscle activity was observed between RF and the set of VL and VM muscles. The SD of force was not constant but variable due to the alternate muscle activity. The SD was significantly greater during high RF activity compared with high VL and VM activity (P < 0.05), and the correlation coefficient between the SD and AEMG was significantly greater in RF [0.736 (SD 0.095), P < 0.05] compared with VL and VM. Large changes were found in the high-frequency component. During high RF activity, the correlation coefficient between the SD and high-frequency component [0.832 (SD 0.087)] was significantly (P < 0.05) greater compared with other frequency components. It is suggested that modulations in knee extension force fluctuations are caused by the unique muscle activity in RF during the alternate muscle activity, which augments the high-frequency component of the fluctuations.     

Alternate muscle activity observed between knee extensor synergists during low-level sustained contractions.

To determine quantitatively the features of alternate muscle activity between knee extensor synergists during low-level prolonged contraction, a surface electromyogram (EMG) was recorded from the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) in 11 subjects during isometric knee extension exercise at 2.5% of maximal voluntary contraction (MVC) for 60 min (experiment 1). Furthermore, to examine the relation between alternate muscle activity and contraction levels, six of the subjects also performed sustained knee extension at 5.0, 7.5, and 10.0% of MVC (experiment 2). Alternate muscle activity among the three muscles was assessed by quantitative analysis on the basis of the rate of integrated EMG sequences. In experiment 1, the number of alternations was significantly higher between RF and either VL or VM than between VL and VM. Moreover, the frequency of alternate muscle activity increased with time. In experiment 2, alternating muscle activity was found during contractions at 2.5 and 5.0% of MVC, although not at 7.5 and 10.0% of MVC, and the number of alternations was higher at 2.5 than at 5.0% of MVC. Thus the findings of the present study demonstrated that alternate muscle activity in the quadriceps muscle 1) appears only between biarticular RF muscle and monoarticular vasti muscles (VL and VM), and its frequency of alternations progressively increases with time, and 2) emerges under sustained contraction with force production levels < or =5.0% of MVC.     

The frequency of alternate muscle activity is associated with the attenuation in muscle fatigue.

Alternate muscle activity between synergist muscles has been demonstrated during low-level sustained contractions [< or =5% of maximal voluntary contraction (MVC) force]. To determine the functional significance of the alternate muscle activity, the association between the frequency of alternate muscle activity during a low-level sustained knee extension and the reduction in knee extension MVC force was studied. Forty-one healthy subjects performed a sustained knee extension at 2.5% MVC force for 1 h. Before and after the sustained knee extension, MVC force was measured. The surface electromyogram was recorded from the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) muscles. The frequency of alternate muscle activity for RF-VL, RF-VM, and VL-VM pairs was determined during the sustained contraction. The frequency of alternate muscle activity ranged from 4 to 11 times/h for RF-VL (7.0 +/- 2.0 times/h) and RF-VM (7.0 +/- 1.9 times/h) pairs, but it was only 0 to 2 times/h for the VL-VM pair (0.5 +/- 0.7 times/h). MVC force after the sustained contraction decreased by 14% (P < 0.01) from 573.6 +/- 145.2 N to 483.3 +/- 130.5 N. The amount of reduction in MVC force was negatively correlated with the frequency of alternate muscle activity for the RF-VL and RF-VM pairs (P < 0.001 and r = 0.65 for both) but not for the VL-VM pair. The results demonstrate that subjects with more frequent alternate muscle activity experience less muscle fatigue. We conclude that the alternate muscle activity between synergist muscles attenuates muscle fatigue.     

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.     

Quadriceps femoris electromyogram during concentric, isometric and eccentric phases of fatiguing dynamic knee extensions

The objective of this study was to examine the superficial quadriceps femoris (QF) muscle electromyogram (EMG) during fatiguing knee extensions. Thirty young adults were evaluated for their one-repetition maximum (1RM) during a seated, right-leg, inertial knee extension. All subjects then completed a single set of repeated knee extensions at 50% 1RM, to failure. Subjects performed a knee extension (concentric phase), held the weight with the knee extended for 2s (isometric phase), and lowered the weight in a controlled manner (eccentric phase). Raw EMG of the vastus medialis (VM), vastus lateralis (VL) and rectus femoris (RF) muscles were full-wave rectified, integrated and normalized to the 1RM EMG, for each respective phase and repetition. The EMG median frequency (f(med)) was computed during the isometric phase. An increase in QF muscle EMG was observed during the concentric phase across the exercise duration. VL EMG was greater than the VM and RF muscles during the isometric phase, in which no significant changes occurred in any of the muscles across the exercise duration. A significant decrease in EMG across the exercise duration was observed during the eccentric phase, with the VL EMG greater than the VM and RF muscles. A greater decrease in VL and RF muscle f(med) during the isometric phase, than the VM muscle, was observed with no gender differences. The findings demonstrated differential recruitment of the superficial QF muscle, depending on the contraction mode during dynamic knee extension exercise, where VL muscle dominance appears to manifest across the concentric-isometric-eccentric transition.     

Role of kinesiophobia in the selective motor control during gait in patients with low back-related leg pain

Fear of movement has been related to changes in motor function in patients with low back pain, but little is known about how kinesiophobia affects selective motor control during gait (ability of muscles performing distinct mechanical functions) in patients with low back-related leg pain (LBLP). The aim of the study was to determine the association between kinesiophobia and selective motor control in patients with LBLP. An observational cross-sectional study was performed on 18 patients. Outcome included: kinesiophobia using the Tampa Scale of Kinesiophobia; pain mechanism using Leeds Assessment of Neuropathic Signs and Symptoms; disability using Roland-Morris Disability Questionnaire; mechanosensitivity using Straight Leg Raise. Surface electromyography was used to assess selective motor control during gait by examining the correlation and coactivation in muscle pairs involved in the stance phase. Pairs included vastus medialis (VM) and medial gastrocnemius (MG), causing opposite moments around the knee joint, and gluteus medius (GM) and MG, as muscles with distinct mechanical functions (weight acceptance vs. propulsion). A strong association was observed between kinesiophobia and correlation (r = 0.63; p = 0.005) and coactivation (r = 0.69; p = 0.001) between VM versus MG. A moderate association was observed between kinesiophobia and correlation (r = 0.58; p = 0.011) and coactivation (r = 0.55; p = 0.019) between GM versus MG. No significant associations were obtained for other outcomes. A high kinesiophobia is associated with low selective motor control of the muscles involved in the weight acceptance and propulsion phases during gait in patients with LBLP. Fear of movement was better associated with decreased neuromuscular control than other clinical variables such as pain mechanism, disability, and mechanosensitivity.     

Neuromuscular efficiency during sit to stand movement in women with knee osteoarthritis

The purpose of this study was to investigate the neuromuscular efficiency of women with knee osteoarthritis (OA) when performing a sit-to-stand movement and during maximum strength efforts. Twelve women with unilateral knee OA (age 60.33 ± 6.66 years, height 1.61 ± 0.05 m, mass 77.08 ± 9.2 kg) and 11 controls (age 56.54 ± 5.46 years, height 1.64 ± 0.05 m, mass 77.36 ± 13.34 kg) participated in this study. Subjects performed a sit-to-stand movement from a chair while position of center of pressure and knee angular speed were recorded. Furthermore, maximal isokinetic knee extension and flexion strength at 60°/s, 120°/s and 150°/s was measured. Surface, electromyography (EMG) from the biceps femoris (BF), vastus lateralis (VL) and vastus medialis (VM) was recorded during all tests. Analysis of variance (ANOVA) showed that during the sit-to-stand OA group demonstrated significantly lower knee angular speed (44.49 ± 9.61°/s vs. 71.68 ± 19.86°/s), a more posterior position of the center of pressure (39.20 ± 7.02% vs. 41.95 ± 2.49%) and a higher antagonist BF activation (57.13 ± 20.55% vs. 32.01 ± 19.5%) compared with controls (p < 0.05). Further, women with knee OA demonstrated a lower Moment-to-EMG ratio than controls in extension and eccentric flexion at 60°/s and 150°/s, while the opposite was found for concentric flexion at 60°/s (p < 0.05). Among other factors, the slower performance of the sit-to-stand movement in women with OA is due to a less efficient use of the knee extensor muscles (less force per unit of EMG) and, perhaps, a higher BF antagonist co-activation. This may lead subjects with OA to adopt a different movement strategy compared with controls.     

Does epimuscular myofascial force transmission occur between the human quadriceps muscles in vivo during passive stretching?

This study sought to examine the shear modulus (i.e., an force index) of three quadriceps muscles [i.e., vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF)] during passive stretching to determine whether epimuscular myofascial force transmission occurs across muscles. Secondly, this study compared the shear modulus between the quadriceps muscles, in both proximal and distal regions. Twelve healthy individuals were assessed during a passive knee flexion maneuver between 0° and 90° of knee flexion with the hip in two positions: flexed (80°) vs. neutral (0°). Muscle electrical activity was also assessed during the testing. No differences were observed between the hip testing positions for myoelectric activity (p > 0.43), and for VL and VM shear modulus (p = 0.12–0.98). Similarly, there were no differences between the proximal and distal regions for all muscles (p = 0.42–0.93). RF showed a higher shear modulus with the hip in the neutral position (p = 0.004). With the hip flexed, the VL showed the greatest shear modulus among the tested muscles (p < 0.025); while with the hip in the neutral position, no differences were observed for shear modulus between VL and RF (p = 0.817). These findings suggest that epimuscular myofascial force transmission (at a muscle belly level) does not occur between the quadriceps muscles when passively flexing the knee until 90°. Whether epimuscular myofascial force transmission occurs in the quadriceps muscles bellies with greater muscle stretch (either through knee flexion or hip extension) remains to be examined.     

Effects of agonist and antagonist muscle fatigue on muscle coactivation around the knee in pubertal boys.

In many activities the knee joint flexes and extends actively with the involvement of both knee extensor and flexor muscle groups. Consequently the examination of the muscle activity during reciprocal movements may provide useful information on the function of these two muscle groups during fatigued conditions. Therefore, the purpose of this study was to examine the activity of antagonist muscles during a reciprocal isokinetic fatigue test of the knee extensors and flexors. Fifteen healthy pubertal males (age 13.8+/-0.8 years) performed 22 maximal isokinetic concentric efforts of the knee extensors at 60 degrees s(-1). The EMG activity of vastus medialis (VM), vastus lateralis (VL) and biceps femoris (BF) was recorded using surface electrodes. The motion ranged from 100 to 0 degrees of knee flexion. The average moment and average EMG (AEMG) at 10-30 degrees, 31-50 degrees, 51-70 degrees and 71-90 degrees angular position intervals were calculated for each repetition. Twenty efforts were further analyzed. Two-way repeated measures analysis of variance (ANOVA) tests indicated a significant decline of moment during the test (p<0.025). The VM and VL AEMG at longer muscle lengths increased significantly as the test progressed whereas the AEMG at short muscle lengths (10-30 degrees ) did not significantly change. The agonist AEMG of BF during the first repetition demonstrated a significant increase after the ninth repetition (p<0.025). The antagonist AEMG of all muscles did not change significantly during the test. These results indicate that there is consistent antagonist activity during both extension and flexion phases of an isokinetic reciprocal fatigue test. It can be concluded that during an isokinetic reciprocal fatigue test, both knee extensors and flexors are fatigued. However, this condition does not have a significant effect on the EMG patterns of these muscles when acting as antagonists during the test.     

Non-uniform mechanical activity of quadriceps muscle during fatigue by repeated maximal voluntary contraction in humans

To determine the non-uniform surface mechanical activity of human quadriceps muscle during fatiguing activity, surface mechanomyogram (MMG), or muscle sound, and surface electromyogram (EMG) were recorded from the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) muscles of seven subjects during unilateral isometric knee extension exercise. Time- and frequency-domain analyses of MMG and of EMG fatigued by 50 repeated maximal voluntary contractions (MVC) for 3 s, with 3-s relaxation in between, were compared among the muscles. The mean MVC force fell to 49.5 (SEM 2.0)% at the end of the repeated MVC. Integrated EMG decreased in a similar manner in each muscle head, but a marked non-uniformity was found for the decline in integrated MMG (iMMG). The fall in iMMG was most prominent for RF, followed by VM and VL. Moreover, the median frequency of MMG and the relative decrease in that of EMG in RF were significantly greater (P < 0.05) than those recorded for VL and VM. These results would suggest a divergence of mechanical activity within the quadriceps muscle during fatiguing activity by repeated MVC. Accepted: 19 January 1999     

Influence of knee alignment on quadriceps cross-sectional area

Previous studies of methods for stimulating the individual muscles composing the quadriceps femoris have not considered the structural features of a subject's knee joint. In this study, we compared the ratios of the individual muscles composing the quadriceps between subjects with different knee alignments using magnetic resonance (MR) imaging.A total of 18 healthy males were examined: 6 normal knees (age, 23.0±0.6 yr; femorotibial angle (FTA), 176.8±0.4°), 6 genu varum (age, 21.8±2.9 yr; FTA, 181.7±2.6°) and 6 genu valgum (age, 21.0±1.6 yr; FTA, 172.3±1.5°). The cross-sectional areas (CSAs) of quadriceps muscles were obtained by MR imaging of the entire left thigh. The CSAs of the vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM) and vastus intermedius (VI) muscles were obtained by MR imaging of the entire left thigh in a supine position. The VM/VL ratio was also obtained by dividing the CSA of the VM by that of the VL and compared among the three groups of subjects with different knee alignments.The genu varum group showed a significantly higher %CSA of VM in the CSA of the quadriceps (VM/Quad) (49.0±2.6%) than values for the other two groups. The genu valgum group showed significantly higher values of RF/Quad (15.2±2.1%) and VL/Quad (40.6±4.0%) than the other groups. The VM/VL ratio was significantly higher in the genu varum than in values for the other two groups.This difference in CSA, in respect to knee alignment, may be considered when devising muscle training programs.     

Experimental quadriceps muscle pain impairs knee joint control during walking.

Pain is a cardinal symptom in musculoskeletal diseases involving the knee joint, and aberrant movement patterns and motor control strategies are often present in these patients. However, the underlying neuromuscular mechanisms linking pain to movement and motor control are unclear. To investigate the functional significance of muscle pain on knee joint control during walking, three-dimensional gait analyses were performed before, during, and after experimentally induced muscle pain by means of intramuscular injections of hypertonic saline (5.8%) into vastus medialis (VM) muscle of 20 healthy subjects. Isotonic saline (0.9%) was used as control. Surface electromyography (EMG) recordings of VM, vastus lateralis (VL), biceps femoris, and semitendinosus muscles were synchronized with the gait analyses. During experimental muscle pain, the loading response phase peak knee extensor moments were attenuated, and EMG activity in the VM and VL muscles was reduced. Compressive forces, adduction moments, knee joint kinematics, and hamstring EMG activity were unaffected by pain. Interestingly, the observed changes persisted when the pain had vanished. The results demonstrate that muscle pain modulated the function of the quadriceps muscle, resulting in impaired knee joint control and joint instability during walking. The changes are similar to those observed in patients with knee pain. The loss of joint control during and after pain may leave the knee joint prone to injury and potentially participate in the chronicity of musculoskeletal problems, and it may have clinically important implications for rehabilitation and training of patients with knee pain of musculoskeletal origin.     

Loading and knee flexion after stroke: Less does not equal more

It is believed that force feedback can modulate lower extremity extensor activity during gait. The purpose of this research was to determine the role of limb loading on knee extensor excitability during the late stance/early swing phase of gait in persons post-stroke. Ten subjects with chronic hemiparesis post-stroke participated in (1) seated isolated quadriceps reflex testing with ankle loads of 0–0.4N m/kg and (2) gait analysis on a treadmill with 0%, 20% or 40% body weight support. Muscle reflex responses were recorded from vastus lateralis (VL), rectus femoris (RF), and vastus medialis (VM) during seated testing. Knee kinematics and quadriceps activity during late stance/early swing phase of gait were compared across loading conditions. Although isolated loading of the ankle plantarflexors at 0.2 N m/kg reduced VM prolonged response (p = 0.04), loading did not alter any other measure of quadriceps excitability (all p > 0.08). During gait, the use of BWS did not influence knee kinematics (p = 0.18) or muscle activity (all p > 0.17) during late stance/early swing phase. This information suggests that load sensed at the ankle has minimal effect on the ipsilateral quadriceps of individuals post-stroke during late stance. It appears that adjusting limb loading during rehabilitation may not be an effective tool to address stiff-knee gait following stroke.     

Decrease in maximal voluntary contraction by tonic vibration applied to a single synergist muscle in humans.

The purpose of the study was to examine the effect of prolonged tonic vibration applied to a single synergist muscle on maximal voluntary contraction (MVC) and maximal rate of force development (dF/dt(max)). The knee extension MVC force and surface electromyogram (EMG) from the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) during MVC were recorded before and after vibration of RF muscle at 30 Hz for 30 min. MVC, dF/dt(max), and the integrated EMG (iEMG) of RF decreased significantly after prolonged tonic vibration in spite of no changes in iEMG of VL and VM. The present results indicate that MVC and dF/dt(max) may be influenced by the attenuated Ia afferent functions of a single synergist muscle.     

Limb and sex-related differences in knee muscle co-contraction exist 3 months after anterior cruciate ligament reconstruction

Interlimb and sex-based differences in gait mechanics and neuromuscular control are common after anterior cruciate ligament reconstruction (ACLR). Following ACLR, individuals typically exhibit elevated co-contraction of knee muscles, which may accelerate knee osteoarthritis (OA) onset. While directed (medial/lateral) co-contractions influence tibiofemoral loading in healthy people, it is unknown if directed co-contractions are present early after ACLR and if they differ across limbs and sexes. The purpose of this study was to compare directed co-contraction indices (CCIs) of knee muscles in both limbs between men and women after ACLR. Forty-five participants (27 men) completed overground walking at a self-selected speed 3 months after ACLR during which quadriceps, hamstrings, and gastrocnemii muscle activities were collected bilaterally using surface electromyography. CCIs of six muscle pairs were calculated during the weight acceptance interval. The CCIs of the vastus lateralis/biceps femoris muscle pair (lateral musculature) was greater in the involved limb (vs uninvolved; p = 0.02). Compared to men, women exhibited greater CCIs in the vastus medialis/lateral gastrocnemius and vastus lateralis/lateral gastrocnemius muscle pairs (p < 0.01 and p = 0.01, respectively). Limb- and sex-based differences in knee muscle co-contractions are detectable 3 months after ACLR and may be responsible for altered gait mechanics.