Identification of feigned ankle plantar and dorsiflexors weakness in normal subjects

Based on the limited ability of the human being to voluntarily control submaximal eccentric exertions, previous studies have indicated that isokinetic testing with a combined concentric–eccentric exercise protocol could effectively identify submaximal (feigned) effort in various muscle groups by showing an abnormally high eccentric to concentric ratio (ECR). The objective of this study was to determine the validity and accuracy of an ECR-based isokinetic test in identifying feigned ankle weakness. Thirty-eight normal subjects performed maximal and feigned efforts in an isokinetic concentric and eccentric ankle plantar- and dorsiflexion protocol with two different velocities, 30 and 120° s⁻¹. The isokinetic parameters ECR and the derivatives DEC (difference between ECR at high speed of motion and ECR at low speed of motion) and SEC (sum of ECR at high speed of motion plus the ratio between eccentric peak torque at high speed and concentric peak torque at low speed) were calculated. The ECR, DEC and SEC scores were significantly greater in feigned conditions for ankle plantarflexion, but not for dorsiflexion. Using optimal cutoff scores based on 99% tolerance intervals, it was disclosed that the most efficient parameter was the SEC, identifying 92% of the feigned efforts with 99% confidence, indicating that the ankle plantarflexors are less controllable in fast eccentric conditions than that in concentric conditions. The ECR-based parameters are valid for effectively identifying feigned plantarflexion effort with high accuracy, but do not allow the detection of feigned dorsiflexion weakness.     

Agonist and antagonist muscle activation during maximal and submaximal isokinetic fatigue tests of the knee extensors

The purpose of this study was to examine the differences in electromyographic activity of agonist and antagonist knee musculature between a maximal and a submaximal isokinetic fatigue protocol. Fourteen healthy males (age: 24.3 ± 2.5 years) performed 25 maximal (MIFP) and 60 submaximal (SIFP) isokinetic concentric efforts of the knee extensors at 60° s⁻¹, across a 90° range of motion. The two protocols were performed a week apart. The EMG activity of vastus medialis (VM), vastus lateralis (VL) and biceps femoris (BF) were recorded using surface electrodes. The peak torque (PT) and average EMG (aEMG) were expressed as percentages of pre-fatigue maximal value. One-way analysis of variance indicated a significant (p < 0.05) decline of PT during the maximal (45.7%) and submaximal (46.8%) protocols. During the maximal test, the VM and VL aEMG initially increased and then decreased. In contrast, VM and VL aEMG continuously increased during submaximal testing (p < 0.05). The antagonist (BF) aEMG remained constant during maximal test but it increased significantly and then declined during the submaximal testing. The above results indicate that agonist and antagonist activity depends on the intensity of the selected isokinetic fatigue test.     

The effect of saddle position on maximal power output and moment generating capacity of lower limb muscles during isokinetic cycling

Saddle position affects mechanical variables during submaximal cycling, but little is known about its effect on mechanical performance during maximal cycling. Therefore, this study relates saddle position to experimentally obtained maximal power output and theoretically calculated moment generating capacity of hip, knee and ankle muscles during isokinetic cycling. Ten subjects performed maximal cycling efforts (5 s at 100 rpm) at different saddle positions varying ± 2 cm around the in literature suggested optimal saddle position (109% of inner leg length), during which crank torque and maximal power output were determined. In a subgroup of 5 subjects, lower limb kinematics were additionally recorded during submaximal cycling at the different saddle positions. A decrease in maximal power output was found for lower saddle positions. Recorded changes in knee kinematics resulted in a decrease in moment generating capacity of biceps femoris, rectus femoris and vastus intermedius at the knee. No differences in muscle moment generating capacity were found at hip and ankle. Based on these results we conclude that lower saddle positions are less optimal to generate maximal power output, as it mainly affects knee joint kinematics, compromising mechanical performance of major muscle groups acting at the knee.     

The effects of fatigue on the resultant joint moment, agonist and antagonist electromyographic activity at different angles during dynamic knee extension efforts.

Examination of the effects of fatigue on antagonist function can provide information on the role of antagonists in limiting the resultant joint moment and stabilizing the knee. Therefore, the purpose of this study was to examine the moment, agonist and antagonist electromyographic (EMG) activity levels at different angular positions during an isokinetic muscular endurance knee extension test. Fifteen healthy males (age 22.6+/-1.9 yr) performed 34 maximal isokinetic concentric efforts of the knee extensors at 120 degrees s(-1). The EMG activity of vastus medialis and biceps femoris was recorded using surface electrodes. The motion ranged from 90 degrees to 0 degrees of knee flexion. The average moment and average EMG (AEMG) at 10-35 degrees, 36-55 degrees and 56-80 degrees angular position intervals were calculated for each repetition. Twenty eight efforts were further analysed. The moment of force demonstrated a decline of 70% at the end of the test. Two-way repeated measures analysis of variance tests indicated that this decline was significant (p < 0.05). No significant effects of angular position on fatigue moment characteristics were found. The agonist (vastus medialis) AEMG during the first repetition demonstrated a significant increase of 40-60% towards the middle part of the test (p < 0.05). In the second part of the test, the VM AEMG at longer muscle lengths was significantly higher compared to the initial efforts whereas the AEMG at short muscle lengths returned to initial values. The antagonist AEMG at all angular positions did not change significantly during the test. The decline in the resultant joint moment could be attributed to the effects of fatigue on the agonist muscle function. The agonist AEMG fatigue-patterns are dependent on the length of the muscle and may be due to alterations in the motor unit recruitment and/or activation failure in the quadriceps muscle. The biceps femoris maintains constant submaximal (21-33% of the maximum) AEMG activity which may play an important role in the stability of the knee joint. The contribution of antagonist activity to the resultant joint moment increases during the last part of an isokinetic concentric muscle endurance test.     

Effect of muscle fatigue on the compliance of the gastrocnemius medialis tendon and aponeurosis

The aim of the present study was to examine whether or not the compliance of the gastrocnemius medialis (GM) tendon and aponeurosis is influenced by submaximal fatiguing efforts. Fourteen elderly male subjects performed isometric maximal voluntary plantarflexion contractions (MVC) on a dynamometer before and after two fatiguing protocols. The protocols consisted of: (1) submaximal concentric isokinetic contractions (70% isokinetic MVC) at 60 degrees /s and (2) a sustained isometric contraction (40% isometric MVC) until failure to hold the defined moment. Ultrasonography was used to determine the elongation and strain of the GM tendon and aponeurosis. To account for the axis misalignment between ankle and dynamometer, the kinematics of the leg were captured at 120 Hz. The maximum moment decreased from 85.9+/-17.9 Nm prior fatigue to 79.2+/-19 Nm after isokinetic fatigue and to 69.9+/-16.4 Nm after isometric fatigue. The maximal strain of the GM tendon and aponeurosis before fatigue, after isokinetic and after isometric fatigue were 4.9+/-1.1%, 4.4+/-1.1% and 4.3+/-1.1% respectively. Neither the strain nor the elongation showed significant differences before and after each fatiguing task at any 100 N step of the calculated tendon force. This implies that the compliance was not altered after either the isokinetic or the isometric fatiguing task. Therefore it was concluded that the strains during the performed submaximal fatiguing tasks, were too small to provoke any structural changes in tendon and aponeurosis.     

Calibration of EMG to force for knee muscles is applicable with submaximal voluntary contractions.

PURPOSE: In this study, the influence of using submaximal isokinetic contractions about the knee compared to maximal voluntary contractions as input to obtain the calibration of an EMG-force model for knee muscles is investigated. METHODS: Isokinetic knee flexion and extension contractions were performed by healthy subjects at five different velocities and at three contraction levels (100%, 75% and 50% of MVC). Joint angle, angular velocity, joint moment and surface EMG of five knee muscles were recorded. Individual calibration values were calculated according to [C.A.M. Doorenbosch, J. Harlaar, A clinically applicable EMG-force model to quantify active stabilization of the knee after a lesion of the anterior cruciate ligament, Clinical Biomechanics 18 (2003) 142-149] for each contraction level. RESULTS: First, the output of the model, calibrated with the 100% MVC was compared to the actually exerted net knee moment at the dynamometer. Normalized root mean square errors were calculated [A.L. Hof, C.A.N. Pronk, J.A. van Best, Comparison between EMG to force processing and kinetic analysis for the calf muscle moment in walking and stepping, Journal of Biomechanics 20 (1987) 167-187] to compare the estimated moments with the actually exerted moments. Mean RMSD errors ranged from 0.06 to 0.21 for extension and from 0.12 to 0.29 for flexion at the 100% trials. Subsequently, the calibration results of the 50% and 75% MVC calibration procedures were used. A standard signal, representing a random EMG level was used as input in the EMG force model, to compare the three models. Paired samples t-tests between the 100% MVC and the 75% MVC and 50% MVC, respectively, showed no significant differences (p>0.05). CONCLUSION: The application of submaximal contractions of larger than 50% MVC is suitable to calibrate a simple EMG to force model for knee extension and flexion. This means that in clinical practice, the EMG to force model can be applied by patients who cannot exert maximal force.     

The effects of antagonist moment on the resultant knee joint moment during isokinetic testing of the knee extensors

The purpose of this study was to examine the effects of moment of antagonistic muscle on the resultant joint moment during isokinetic eccentric and concentric efforts of the knee extensors. Ten males performed maximum eccentric and concentric knee extension and flexion efforts on a Biodex dynamometer at 0.52 rad · s⁻¹ (30° · s⁻¹). Electromyographic (EMG) activity of vastus medialis and biceps femoris (hamstrings) was also recorded. The antagonistic moment of the hamstrings was determined by recording the integrated EMG (iEMG)/moment relationship at different levels of muscle effort. The iEMG/moment curves were fitted using second-degree polynomials. The polynomials were then used to predict the antagonistic moment exerted by the hamstrings from the antagonist iEMG. The antagonistic moment had a maximum of 42.92 Nm and 28.97 Nm under concentric and eccentric conditions respectively; paired t-tests indicated that this was a significant difference (P < 0.05). These results indicate that the resultant joint moment of knee extensors is the result of both agonist and antagonist muscle activation. The greater antagonist muscle activity under concentric activation conditions may be partly responsible for the lower resultant joint concentric moment of knee extensors compared with the corresponding eccentric activation. The antagonist moment significantly affects comparisons between the isokinetic moments and agonist EMG and in vitro force measurements under different testing (muscle action and angular velocity) conditions. Accepted: 25 February 1997     

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.     

Activation of human quadriceps femoris during isometric, concentric, and eccentric contractions.

Maximal and submaximal activation level of the right knee-extensor muscle group were studied during isometric and slow isokinetic muscular contractions in eight male subjects. The activation level was quantified by means of the twitch interpolation technique. A single electrical impulse was delivered, whatever the contraction mode, on the femoral nerve at a constant 50 degrees knee flexion (0 degrees = full extension). Concentric, eccentric (both at 20 degrees /s velocity), and isometric voluntary activation levels were then calculated. The mean activation levels during maximal eccentric and maximal concentric contractions were 88.3 and 89.7%, respectively, and were significantly lower (P < 0.05) with respect to maximal isometric contractions (95.2%). The relationship between voluntary activation levels and submaximal torques was linearly fitted (P < 0.01): comparison of slopes indicated lower activation levels during submaximal eccentric compared with isometric or concentric contractions. It is concluded that reduced neural drive is present during 20 degrees /s maximal concentric and both maximal and submaximal eccentric contractions. These results indicate a voluntary activation dependency on both tension levels and type of muscular actions in the human knee-extensor muscle group.     

Effects of submaximal and maximal long-lasting contractions on the compliance of vastus lateralis tendon and aponeurosis in vivo

The present study investigated the effects of submaximal sustained and maximal repetitive contractions on the compliance of human vastus lateralis (VL) tendon and aponeurosis in vivo using two different fatiguing protocols. Twelve male subjects performed three maximum voluntary isometric contractions (MVC) of the knee extensors before and after two fatiguing protocols on a dynamometer. The first fatiguing protocol consisted of a long-lasting sustained isometric knee extension contraction at 25% MVC until failure (inability to hold the defined load). The second fatiguing protocol included long-lasting isokinetic (90°/s) knee extension contractions, where maximum moment was exerted and failure was proclaimed when this value fell below 70% of unfatigued maximum isokinetic moment. Ultrasonography was used to determine the elongation and strain of the VL tendon and aponeurosis. Muscle fatigue was indicated by a significant decrease in maximum resultant knee extension moment (p < 0.05) observed during the MVCs after both long-lasting contractions. No significant (p > 0.05) differences in elongation and strain of the VL tendon and aponeurosis were found, when compared every 300 N (tendon force) before and after the fatiguing protocols. The present data indicate, that the VL tendon and aponeurosis in vivo do not suffer from changes in the compliance neither after long-lasting static mechanical loading (strain ～3.2%) nor after long-lasting cyclic mechanical loading (strain 6.2–5.5%).     

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.     

Age-related effect of static and cyclic loadings on the strain-force curve of the vastus lateralis tendon and aponeurosis

The objective of the present study was to investigate the age-related effects of submaximal static and cyclic loading on the mechanical properties of the vastus lateralis (VL) tendon and aponeurosis in vivo. Fourteen old and 12 young male subjects performed maximal voluntary isometric knee extensions (MVC) on a dynamometer before and after (a) a sustained isometric contraction at 25% MVC and (b) isokinetic contractions at 50% isokinetic MVC, both until task failure. The elongation of the VL tendon and aponeurosis was examined using ultrasonography. To calculate the resultant knee joint moment, the kinematics of the leg were recorded with eight cameras (120 Hz). The old adults displayed significantly lower maximal moments but higher strain values at any given tendon force from 400 N and up in all tested conditions. Neither of the loading protocols influenced the strain-force relationship of the VL tendon and aponeurosis in either the old or young adults. Consequently, the capacity of the tendon and aponeurosis to resist force remained unaffected in both groups. It can be concluded that in vivo tendons are capable of resisting long-lasting static (~4.6 min) or cyclic (~18.5 min) mechanical loading at the attained strain levels (4-5%) without significantly altering their mechanical properties regardless of age. This implies that as the muscle becomes unable to generate the required force due to fatigue, the loading of the tendon is terminated prior to provoking any significant changes in tendon mechanical properties.     

The duration of the inhibitory effects with static stretching on quadriceps peak torque production

Although several studies have investigated the acute effect of static stretching exercises, the duration of exercises that negatively affects performance has not been ascertained. This study was conducted to determine the acute effect of different static stretching durations on quadriceps isometric and isokinetic peak torque production. The 50 participants were randomly allocated into five equivalent sized groups and were asked to perform a stretching exercise of different duration (no stretch, 10-second stretch, 20-second stretch, 30-second stretch, and 60-second stretch). The knee flexion range of motion and the isometric and concentric isokinetic peak torques of the quadriceps were measured before and after a static stretching exercise in the four experimental groups. The same parameters were examined in the control group (no stretch) without stretching, before and after a 5-minute passive rest. There were no significant differences among groups before the experimentation regarding their physical characteristics and performances (P > 0.05). These results reflect the different groups' homogeneity. Significant knee joint flexibility increases (P < 0.001) and significant isometric and isokinetic peak torque reductions (P < 0.05-0.001) have been shown to occur only after 30 and 60 seconds of quadriceps static stretching. Stretching reduced isometric peak torque by 8.5% and 16.0%, respectively. Concerning isokinetic peak torque after 30 and 60 seconds of stretching, it was reduced by 5.5% vs. 11.6% at 60 degrees/s and by 5.8% vs. 10.0% at 180 degrees/s. We suggest that torque decrements are related to changes of muscle neuromechanical properties. It is recommended that static stretching exercises of a muscle group for more than 30 seconds of duration be avoided before performances requiring maximal strength.     

Mechanomyographic and electromyographic responses during submaximal to maximal eccentric isokinetic muscle actions of the biceps brachii

The purpose of this investigation was to determine the mechanomyography (MMG) and electromyography (EMG) amplitude and mean power frequency (MPF) vs. eccentric isokinetic torque relationships for the biceps brachii muscle. Nine adults (mean +/- SD age = 23.1 +/- 2.9 years) performed submaximal to maximal eccentric isokinetic muscle actions of the dominant forearm flexors. After determination of isokinetic peak torque (PT), the subjects randomly performed submaximal step muscle actions in 10% increments from 10 to 90% PT. Polynomial regression analyses indicated that the MMG amplitude vs. eccentric isokinetic torque relationship was best fit with a quadratic model (R(2) = 0.951), where MMG amplitude increased from 10 to 60% PT and then plateaued from 60 to 100% PT. There were linear increases in MMG MPF (r(2) = 0.751) and EMG amplitude (r(2) = 0.988) with increases in eccentric isokinetic torque, but there was no significant change in EMG MPF from 10 to 100% PT. The results suggested that for the biceps brachii, eccentric isokinetic torque was increased to approximately 60% PT through concurrent modulation of the number of active motor units and their firing rates, whereas additional torque above 60% PT was produced only by increases in firing rates. These findings contribute to current knowledge of motor-control strategies during eccentric isokinetic muscle actions and could be useful in the design of training programs.     

Maximality of shoulder external rotation effort in patients presenting with work related injury: The clinical applicability of the DEC parameter

The aim of the present study is to examine the applicability of the isokinetic DEC parameter for identifying submaximal effort in workers with potential weakness of the shoulder external rotators. A previous study indicated that the DEC was a powerful identifier of submaximal effort of shoulder external rotation in normal volunteers. Its applicability in shoulder injury patients is of specific interest. Thus, a retrospective study of 74 (33 female and 41 male) patients who claimed compensation for work-related shoulder injury was designed. 52 patients had their injured side DEC values within the normal range and were thus labeled as maximal performers. Ten patients had higher than cutoff DEC values, indicating submaximal effort whereas 12 patients had exceedingly low DEC values. Gender comparison showed a significantly different proportion of maximal performers. Strength deficits registered in patients demonstrating maximal performance correlated with the final outcome. The findings support the application of the DEC for determination of the extent of weakness of shoulder external rotators in male patients. In terms of shoulder external rotators status in male worker injury, the results support the application of isokinetic tests both in the clinical and medicolegal sense. However, the gender discrepancy warrants further research.     

Effects of age and sex on shoulder biomechanics and relative effort during functional tasks

Age-related decline in muscle strength can compromise shoulder function, which could increase the effort needed to perform activities of daily living (ADLs). The purpose of this cross-sectional study was to determine for the first time the relative shoulder effort during ADLs in healthy young and older adults.Ten healthy young adults and ten healthy older adults were tested for maximal isokinetic torque and on a set of ADL tasks. Using inverse dynamics, the shoulder torques during ADLs were referenced to the maximal isokinetic torque and relative effort was determined.Older compared to younger adults had >40% lower isokinetic shoulder abduction strength. The ratio of peak joint torque during six ADLs over the maximal isokinetic torque, i.e., relative effort, was higher in old (∼52%) compared with young adults (∼22%, p < 0.05). Relative effort in older adults was over 40% in overhead activities and particularly high in abduction and reaching tasks, over 60%.Healthy older compared with younger adults perform most ADL tasks involving the shoulder joint with nearly twice the level of relative effort. The concomitant reductions in maximal shoulder isokinetic torque and increases in relative effort may be related to the high prevalence of musculoskeletal pain and shoulder dysfunction in old age reported in epidemiological studies.     

The maximal and submaximal vertical jump: implications for strength and conditioning

The vertical jump is a widely used activity to develop explosive strength, particularly in plyometric and maximal power training programs. It is a multijoint action that requires substantial muscular effort from primarily the ankle, knee, and hip joints. It is not known if submaximal performances of a vertical jump have a proportional or differential training effect on the major lower-limb muscles compared to maximal jump performance. Therefore, the purpose of this study was to investigate the contribution that each of the major lower-limb joints makes to vertical jump performance as jump height increases and to comment on the previously mentioned uncertainty. Adult males (N = 20) were asked to perform a series of submaximal (LOW and HIGH) and maximal (MAX) vertical jumps while using an arm swing. Force, motion, and electromyographical data were recorded during each performance and used to compute a range of kinematic and kinetic data, including ankle, knee, and hip joint torques, powers, and work done. It was found that the contribution to jump height made by the ankle and knee joints remains largely unchanged as jump height increases (work done at the ankle: LOW =1.80, HIGH = 1.97, MAX = 2.06 J.kg(-1), F = 3.596, p = 0.034; knee: LOW = 1.62, HIGH = 1.77, MAX = 1.94 J.kg(-1), F = 1.492, p = 0.234) and that superior performance in the vertical jump is achieved by a greater effort of the hip extensor muscles (work done at the hip: LOW = 1.03, HIGH = 1.84, MAX = 3.24 J.kg(-1), F = 110.143, p < 0.001). It was concluded that the role of submaximal and maximal jumps can be differentiated in terms of their effect on ankle, knee, and hip joint muscles and may be of some importance to training regimens in which these muscles need to be differentially trained.     

Factors predicting knee function in patients with meniscal lesions

The relationships between the magnitude of strength and muscle activation (EMG activity) deficits during maximal isokinetic knee movements and clinical and anthropometric factors (pain, effusion, type of meniscal lesion, degenerative changes, duration of symptoms and age) were studied in a group of 34 patients 5 days (5.3 ± 6.2 days) before arthroscopic meniscectomy. Moderate correlations were found between deficits in the area under the torque-angle curve (work) and the activation level in the agonist muscles during both the extension and flexion tests at 30° s⁻¹ and 180° s⁻¹ suggesting that the decrease in the isokinetic mechanical output is dependent on the reduced muscle activation. The severity of pain during tests was the best predictive clinical factor for the size of the work and EMG deficits but each of the tollowing factors: the presence of knee effusion and thigh atrophy, the type of meniscal lesion and the age of the patients, also had some predictive value for the magnitude of the deficits. In contrast, the duration of symptoms and the presence of osteo-articular degenerative changes were not related to the preoperative isokinetic knee performance. These results suggest that older patients (especially over 45 yr) with bucket-handle meniscal tears, knee effusion, thigh atrophy and severe pain on exertion, are most likely to have poor preoperative knee isokinetic performance. Since the magnitude of the pre- and postoperative knee deficits are correlated, it is important to identify patients at risk preoperatively so that optimal rehabilitation can be instituted.     

Cardiorespiratory Optimal Point: A Submaximal Exercise Variable to Assess Panic Disorder Patients

Panic disorder (PD) patients often report respiratory symptoms and tend to perform poorly during maximal cardiopulmonary exercise testing (CPX), at least partially, due to phobic anxiety. Thus, we hypothesized that a submaximal exercise variable, minimum VE/VO₂ - hereafter named cardiorespiratory optimal point (COP) -, may be useful in their clinical assessment. Data from 2,338 subjects were retrospectively analyzed and 52 (2.2%) patients diagnosed with PD (PDG) (70% women; aged 48±13 years). PD patients were compared with a healthy control group (CG) precisely matched to number of cases, age and gender profiles. PDG was further divided into two subgroups, based on having achieved a maximal or a submaximal CPX (unwilling to continue until exhaustion). We compared COP, VO₂ max, maximum heart rate (HR max) between PDG and CG, and also COP between maximal and submaximal PD subgroups. COP was similar between PDG and CG (21.9±0.5 vs. 23.4±0.6; p = 0.07), as well as, for PD subgroups of maximal and submaximal CPX (22.0±0.5 vs. 21.6±1.3; p = 0.746). Additionally, PD patients completing a maximal CPX obtained VO₂ max (mL.kg−1.min−1) (32.9±1.57 vs 29.6±1.48; p = 0.145) and HR max (bpm) similar to controls (173±2.0 vs 168±2.7; p = 0.178). No adverse complications occurred during CPX. Although clinically safe, it is sometimes difficult to obtain a true maximal CPX in PD patients. Normalcy of cardiorespiratory interaction at submaximal effort as assessed by COP may contribute to reassure both patients and physicians that there is no physiological substrate for exercise-related respiratory symptoms often reported by PD patients.     

Mechanomyographic amplitude and mean power frequency versus torque relationships during isokinetic and isometric muscle actions of the biceps brachii.

The purpose of this investigation was to determine the mechanomyographic (MMG) amplitude and mean power frequency (MPF) versus torque (or force) relationships during isokinetic and isometric muscle actions of the biceps brachii. Ten adults (mean +/- SD age = 21.6 +/- 1.7 years) performed submaximal to maximal isokinetic and isometric muscle actions of the dominant forearm flexors. Following determination of isokinetic peak torque (PT) and the isometric maximum voluntary contraction (MVC), the subjects randomly performed submaximal step muscle actions in 10% increments from 10% to 90% PT and MVC. Polynomial regression analyses indicated that MMG amplitude increased linearly with torque during both the isokinetic (r2 = 0.982) and isometric (r2 = 0.956) muscle actions. From 80% to 100% of isometric MVC, however, MMG amplitude appeared to plateau. Cubic models provided the best fit for the MMG MPF versus isokinetic (R2 = 0.786) and isometric (R2 = 0.940) torque relationships, although no significant increase in MMG MPF was found from 10% to 100% of isokinetic PT. For the isometric muscle actions, however, MMG MPF remained relatively stable from 10% to 50% MVC, increased from 50% to 80% MVC, and decreased from 80% to 100% MVC. The results demonstrated differences in the MMG amplitude and MPF versus torque relationships between the isokinetic and isometric muscle actions. These findings suggested that the time and frequency domains of the MMG signal may be useful for describing the unique motor control strategies that modulate dynamic versus isometric torque production.