Activation of vastus medialis obliquus among individuals with patellofemoral pain syndrome

The purpose of this study was to determine whether various positions of the lower extremity affect the muscle activity of the vastus medialis obliquus (VMO) differently during both open and closed kinetic chain exercise conditions among patients with patellofemoral pain syndrome (PFPS). Patients who presented with symptoms consistent with PFPS completed a series of open kinetic chain and closed kinetic chain exercises in which VMO activity was measured and compared. Statistical analysis revealed that there is less than a 0.001% (open kinetic chain) or 0.005% (closed kinetic chain) chance that all positions activate the VMO equally. In open kinetic exercise, maximum VMO activity was achieved with terminal knee extension with medial tibial rotation. During closed kinetic exercises, squats with external rotation were preferred for maximum VMO activation. Therefore, our results highlight the importance of including both the open and closed kinetic chain exercises into rehabilitation programs for patients with PFPS.     

Myoelectric manifestations of fatigue in vastus lateralis,medialis obliquus and medialis longus muscles

The purpose of this study was to determine whether surface electromyography (EMG) assessment of myoelectric manifestations of muscle fatigue is capable of detecting differences between the vastus lateralis and medialis muscles which are consistent with the results of previous biopsy studies. Surface EMG signals were recorded from the vastus medialis longus (VML), vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles during isometric knee extension contractions at 60% and 80% of the maximum voluntary contraction (MVC) for 10 s and 60 s, respectively. Initial values and rate of change of mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signal were calculated. Comparisons between the two force levels revealed that the initial values of MNF for the VL muscle were greater at 80% MVC compared to 60% MVC (P < 0.01). Comparisons between the vasti muscles demonstrated lower initial values of CV for VMO compared to VL at 60% MVC (P < 0.01) and lower than VML and VL at 80% MVC (P < 0.01). In addition, initial values of MNF were higher for VL with respect to both VML and VMO at 80% MVC (P < 0.01) and initial estimates of ARV were higher for VMO compared to VML at both force levels (P < 0.01 at 60% MVC and P < 0.05 at 80% MVC). For the sustained contraction at 80% MVC, VL demonstrated a greater decrease in CV over time compared to VMO (P < 0.05).These findings suggest that surface EMG signals and their time course during sustained isometric contractions may be useful to non-invasively describe functional differences between the vasti muscles.     

Patellar taping increases vastus medialis oblique activity in the presence of patellofemoral pain.

A common rehabilitation strategy for patellofemoral pain syndrome (PFPS), which lacks scientific evidence, includes pulling the patella medially with tape to reduce pain and increase the vastus medialis oblique (VMO) muscle activity. The purpose of this study was to examine the effect of various patellar taping procedures on force production, EMG activity of the VMO and vastus lateralis (VL) muscles, and perceived pain experienced by 30 women (27.3 +/- 1.53), half diagnosed with PFPS. The perceived pain, force, and EMG of the VMO and VL, were recorded while subjects performed maximal isokinetic leg presses at 30 degrees /s for each of the following patellar taping conditions: no tape (control), no glide (placebo), medial and lateral glide (experimental). The medial and placebo procedures significantly (P < 0.01) reduced perceived pain (70-80%) in PFPS subjects. Although patellar taping did not influence leg press force (P > 0.05), it increased the VMO activity and decreased the VL activity in PFPS subjects but had the opposite effect in healthy subjects. The findings suggest that taping the patella medially can contribute positively to PFPS rehabilitation. Because the medial glide and placebo taping conditions had similar effects, it is proposed that the benefits of patellar taping are not due to a change in patellar position but rather due to enhanced support of the patellofemoral ligaments and/or pain modulation via cutaneous stimulation.     

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

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

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.     

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.     

Effects of fatigue on the temporal neuromuscular control of vastus medialis muscle in humans

The effects of muscle fatigue on the temporal neuromuscular control of the vastus medialis (VM) muscle were investigated in 19 young male subjects. The electromyogram (EMG) activities of VM and the force generation capacities of the quadriceps muscle were monitored before and after a fatigue protocol. In response to light signals, which were triggered randomly, the subjects made three maximal isometric knee extensions. This was then followed by the fatigue protocol which consisted of 30 isometric maximal voluntary contractions at a sequence of 5-s on and 5-s off. Immediately after the exercise to fatigue, the subjects performed another three maximal isometric contractions in response to the light signals. The effects of fatigue on the temporal neuromuscular control were then investigated by dividing the total reaction time (TRT) into premotor time (PMT) and electromechanical delay (EMD). The TRT was defined as the time interval between the light signal and the onset of the knee extension force. The PMT was defined as the time from the light signal to the onset of EMG activities of VM, and EMD as the time interval between onset of EMG activities to that of force generation. Following the contractions to fatigue there was a significant decrease in peak force (Fpeak, P = 0.016), an increase in the root mean square (rms)-EMG: Fpeak quotient (P = 0.001) but an insignificant change in the median frequency (P = 0.062) and rms-EMG (P = 0.119). Significant lengthening of mean EMD was found after the fatigue protocol [0.0396 (SD 0.009) vs. 0.0518 (SD 0.016) s P<0.001]. The lengthening of EMD in VM would affect the stabilizing effect of the patella during knee extension. The faster mean PMT [0.2445 (SD 0.093) vs. 0.2075 (SD 0.074) s, P = 0.042] following the fatigue protocol might have compensated for the lengthened EMD and contributed to the insignificant change in the mean TRT [0.284 (SD 0.09) vs. 0.259 (SD 0.073) s, P = 0.164]. This was probably related to the low level of fatigue (15% decrease in force) and the stereotyped nature of the action such that the effects of the fatigue on neuromuscular control were likely to have been attributable to peripheral processes.     

Geometrical factors in surface EMG of the vastus medialis and lateralis muscles.

Surface EMG signals detected in dynamic conditions are affected by a number of artefacts. Among them geometrical factors play an important role. During movement the muscle slides with respect to the skin because of the variation of its length. Such a shift can considerably modify sEMG amplitude. The purpose of this work is to assess geometrical artefacts on sEMG during isometric contractions at different muscle lengths.The average rectified value (ARV) of 15 single differential signals was obtained by means of a linear array of 16 bar electrodes from the vastus medialis and lateralis muscles. The knee angle was changed from 75 degrees to 165 degrees in steps of 30 degrees and voluntary isometric contractions at a low, medium and high force level were performed for each angle. The ARV pattern was normalized with respect to the mean activity to compare signals from different joint angles. From the data collected it was possible to separate the geometrical changes from the changes due to different intensities of activation.In three out of five subjects, we found (within the resolution of our measures) a 1 cm shift for the vastus medialis muscle while no shift was observed for the other two subjects. For the vastus lateralis muscle a 1 cm shift was found in two out of four subjects. Such a shift produces the main contribution to geometrical artefacts. To avoid such artefacts the innervation zones should be located and the EMG electrodes should not be placed near them.     

The minimum number of contractions required to examine the EMG amplitude versus isometric force relationship for the vastus lateralis and vastus medialis

Studies have demonstrated that the electromyographic (EMG) amplitude versus submaximal isometric force relationship is relatively linear. The purpose of this investigation was to determine the minimum number of contractions required to study this relationship. Eighteen men (mean age = 23 years) performed isometric contractions of the leg extensors at 10–90% of the maximum voluntary contraction (MVC) in 10% increments while surface EMG signals were detected from the vastus lateralis and vastus medialis. Linear regression was used to determine the coefficient of determination, slope coefficient, and y-intercept for each muscle and force combination with successively higher levels included in the model (i.e., 10–30%, … 10–90% MVC). For the slope coefficients, there was a main effect for force combination (P < .001). The pairwise comparisons showed there was no difference from 10–60% through 10–90% MVC. For the y-intercepts, there were main effects for both muscle (vastus lateralis [4.3 μV RMS] > vastus medialis [−3.7 μV RMS]; P = .034) and force combination (P < .001), with similar values shown from 10–50% through 10–90% MVC. The linearity of the absolute EMG amplitude versus isometric force relationship for the vastus lateralis and vastus medialis suggests that investigators may exclude high force contractions from their testing protocol.     

The effect of patella taping on vastus medialis oblique and vastus laterialis EMG activity and knee kinematic variables during stair descent

The purpose of this study was to evaluate the effect of patella taping in normal subjects. Previous work has established positive effects of patella taping on patellofemoral pain syndrome patients, but the mode of action remains unclear. It has been hypothesized that taping brings about subtle changes in the internal physiological environment of the joint. It could be expected that in normal joints taping would bring about a measurable change in function, as the joint is no longer operating in an optimal physiological environment. 10 normal female subject’s (21.4 ± 1.2 years) vastus medialis oblique (VMO) and vastus laterialis (VL) EMG activity and knee kinematics (peak stance flexion angle and angular velocity) were assessed during a step descent, with and without a taped patella. The effect of taping was to significantly decrease VMO and VL EMG activity. Taping also significantly reduced peak stance phase knee flexion and peak stance phase knee flexion angular velocity. In normal asymptomatic subjects patella taping created a situation in which their performance was changed to one similar to that of the pathological patellofemoral pain syndrome population. It would appear that taping caused the joint to function sub-optimally supporting the hypothesis that taping could change the functioning of the patellofemoral joint.     

Anatomical separation and clinical importance of two different parts of the vastus medialis muscle

In 32 corpses, either fresh or fixed, the deviations of the two heads (musculus vastus medialis longus and musculus vastus medialis obliquus) of the vastus medialis muscle from the long axis of the femur were measured. The deviations were between 15 and 18 degrees medially for the m. vastus medialis longus and between 46 and 52 degrees medially for the m. vastus medialis obliquus. Anatomical dissections of the vastus medialis muscle in 115 fixed thigh specimens could always demonstrate a clear separation between a long head of the muscle that inserts at the base (m. vastus medialis longus) and a short head (m. vastus medialis obliquus) that inserts at the medial margin of the patella. The plane of separation could be identified by a femoral nerve's branch in every case. In 17 instances the nerve's localization was superficial, in 57 in an areolar fascial plane, and in the depth between the muscles in 41 instances. The ramification of the femoral nerve's branch that runs along the separation plane showed four types of variation. With these investigations it was possible to distinguish between two individual heads of the vastus medialis muscle not only with regard to its function, but also to its anatomy.     

Non-uniform electromyographic activity during fatigue and recovery of the vastus medialis and lateralis muscles

The aim of the study was to investigate EMG signal features during fatigue and recovery at three locations of the vastus medialis and lateralis muscles. Surface EMG signals were detected from 10 healthy male subjects with six 8-electrode arrays located at 10%, 20%, and 30% of the distance from the medial (for vastus medialis) and lateral (vastus lateralis) border of the patella to the anterior superior spine of the pelvic. Subjects performed contractions at 40% and 80% of the maximal force (MVC) until failure to maintain the target force, followed by 20 2-s contractions at the same force levels every minute for 20 min (recovery). Average rectified value, mean power spectral frequency, and muscle fiber conduction velocity were estimated from the EMG signals in 10 epochs from the beginning of the contraction to task failure (time to task failure, mean ± SD, 70.7 ± 25.8 s for 40% MVC; 27.4 ± 16.8 s for 80% MVC) and from the 20 2 s time intervals during recovery. During the fatiguing contraction, the trend over time of EMG average rectified value depended on location for both muscles (P < 0.05). After 20-min recovery, mean frequency and conduction velocity of both muscles were larger than in the beginning of the fatigue task (P < 0.05) (supernormal values). Moreover, the trend over time of mean frequency during recovery was affected by location and conduction velocity values depended on location for both muscles (P < 0.05). The results indicate spatial dependency of EMG variables during fatigue and recovery and thus the necessity of EMG spatial sampling for global muscle assessment.     

Mechanomyographic and electromyographic responses of the vastus medialis muscle during isometric and concentric muscle actions

The purpose of this study was to examine the patterns for the mechanomyographic (MMG) and electromyographic (EMG) amplitude and mean power frequency (MPF) vs. torque relationships during submaximal to maximal isometric and isokinetic muscle actions. Seven men (mean +/- SD age, 22.4 +/- 1.3 years) volunteered to perform isometric and concentric isokinetic leg extension muscle actions at 20, 40, 60, 80, and 100% of maximal voluntary contraction (MVC) and peak torque (PT) on a Cybex II dynamometer. A piezoelectric MMG recording sensor was placed between bipolar surface EMG electrodes on the vastus medialis. Polynomial regression and separate 1-way repeated-measures analysis of variance were used to analyze the EMG amplitude, MMG amplitude, EMG MPF, and MMG MPF data for the isometric and isokinetic muscle actions. For the isometric muscle actions, EMG amplitude (R(2) = 0.999) and MMG MPF (R(2) = 0.946) increased to MVC, mean MMG amplitude increased to 60% MVC and then plateaued, and mean EMG MPF did not change (p > 0.05) across torque levels. For the isokinetic muscle actions, EMG amplitude (R(2) = 0.988) and MMG amplitude (R(2) = 0.933) increased to PT, but there were no significant mean changes with torque for EMG MPF or MMG MPF. The different torque-related responses for EMG and MMG amplitude and MPF may reflect differences in the motor control strategies that modulate torque production for isometric vs. dynamic muscle actions. These results support the findings of others and suggest that isometric torque production was modulated by a combination of recruitment and firing rate, whereas dynamic torque production was modulated primarily through recruitment.     

Vastus lateralis and vastus medialis produce distinct mediolateral forces on the patella but similar forces on the tibia in the rat

Improper activation of the quadriceps muscles vastus medialis (VM) and vastus lateralis (VL) has been implicated in the development of patellofemoral pain (PFP). This explanation of PFP assumes that VM and VL produce opposing mediolateral forces on the patella. Although studies have provided evidence for opposing actions of VM and VL on the patella, other studies have suggested that their actions might be similar. In this study, we took advantage of the experimental accessibility of the rat to directly measure the forces on the patella produced by VM and VL. We found that VM and VL produce opposing mediolateral forces on the patella when the patella was lifted away from the femur. These distinct mediolateral forces were not transmitted to the tibia, however: forces measured at the distal tibia were very similar for VM and VL. Further, when the patella was placed within the trochlear groove, the forces on the patella produced by VM and VL were very similar to one another. These results suggest that mediolateral forces produced by VM and VL are balanced by reaction forces from the trochlear groove and so are not transmitted to the tibia. These results provide a rich characterization of the mechanical actions of VM and VL and have implications about the potential role of these muscles in PFP and their neural control during behavior.     

The influence of patellofemoral joint contact geometry on the modeling of three dimensional patellofemoral joint forces

The purpose of this study was to determine the influence of patellofemoral joint contact geometry on the modeling of three-dimensional patellofemoral joint forces. To achieve this goal, patellofemoral joint reaction forces (PFJRFs) that were measured from an in-vitro cadaveric set-up were compared to PFJRFs estimated from a computer model that did not consider patellofemoral joint contact geometry. Ten cadaver knees were used in this study. Each was mounted on a custom jig that was fixed to an Instron frame. Quadriceps muscle loads were accomplished using a pulley system and weights. The force in the patellar ligament was obtained using a buckle transducer. To quantify the magnitude and direction of the PFJRF, a six-axis load cell was incorporated into the femoral fixation system so that a rigid body assumption could be made. PFJRF data were obtained at 0 degrees , 20 degrees , 40 degrees and 60 degrees of knee flexion. Following in vitro testing, SIMM modeling software was used to develop computational models based on the three-dimensional coordinates (Microscribe digitizer) of individual muscle and patellar ligament force vectors obtained from the cadaver knees. The overall magnitude of the PFJRF estimated from the computer generated models closely matched the direct measurements from the in vitro set-up (Pearson's correlation coefficient, R(2)=0.91, p<0.001). Although the computational model accurately estimated the posteriorly directed forces acting on the joint, some discrepancies were noted in the forces acting in the superior and lateral directions. These differences however, were relatively small when expressed as a total of the overall PFJRF magnitude.     

Differences between vastus medialis and lateralis excitation onsets are dependent on the relative distance of surface electrodes placement from the innervation zone location

Conflictual results between the onset of vastus medialis (VM) and vastus lateralis (VL) excitation may arise from methodological aspects related to the detection of surface electromyograms. In this study we used an array of surface electrodes to assess the effect of detection site, relative to the muscle innervation zone, on the difference between VM and VL excitation onsets. Ten healthy males performed moderate isometric knee extension at 40 % of their maximal voluntary isometric contraction. After the actual VM-VL onset was defined (estimated when action potentials were generated at the neuromuscular junctions of both muscles), we calculated the largest bias that the detection site may introduce in the VM-VL onset estimation. We also assessed whether the location often considered for positioning bipolar electrodes on each muscle leads to VM-VL onset estimations comparable to the actual VM-VL onset. Our main results revealed that a maximum absolute bias of 20.48 ms may be introduced in VM-VL onset estimations due to the electrodes’ detection site. In addition, mean differences of ∼ 12 ms in VM-VL onset estimations were attributable to largest possible discrepancies in the paired position of channels with respect to the innervation zone for VL and VM. When considering the classical location for positioning the bipolar electrodes over these muscles, differences error was subtle (∼3.4 ms) when compared with the actual VM-VL onset. Nonetheless, when accounting for the effect of relative differences in electrode position between muscles is not possible, our results suggest that a systematic absolute error of ∼ 12 ms should be considered in future studies regarding VM-VL onset estimations, suggesting that onset differences lower than that might not be clinically relevant.     

The influence of Carboniferous palaeoatmospheres on plant function: an experimental and modelling assessment

Geochemical models of atmospheric evolution predict that during the late Carboniferous, ca. 300 Ma, atmospheric oxygen and carbon dioxide concentrations were 35% and 0.03%, respectively. Both gases compete with each other for ribulose-1,5-bisphosphate carboxylase/oxygenase-the primary C-fixing enzyme in C₃ land plants: and the absolute concentrations and the ratio of the two in the atmosphere have the potential to strongly influence land-plant function. The Carboniferous therefore represents an era of potentially strong feedback between atmospheric composition and plant function. We assessed some implications of this ratio of atmospheric gases on plant function using experimental and modelling approaches. After six weeks growth at 35% O₂ and 0.03% carbon dioxide, no photosynthetic acclimation was observed in the woody species Betula pubescens and Hedera helix relative to those plants grown at 21% O₂. Leaf photosynthetic rates were 29% lower in the high O₂ environment compared to the controls. A global-scale analysis of the impact of the late Carboniferous climate and atmospheric composition on vegetation function was determined by driving a process-based vegetation-biogeochemistry model with a Carboniferous global palaeoclimate simulated by the Universities Global Atmospheric Modelling Programme General Circulation Model. Global patterns of net primary productivity, leaf area index and soil carbon concentration for the equilibrium model solutions showed generally low values everywhere, compared with the present day, except for a central band in the northern land mass extension of Gondwana, where high values were predicted. The areas of high soil carbon accumulation closely match the known distribution of late Carboniferous coals. Sensitivity analysis with the model indicated that the increase in O₂ concentration from 21% to 35% reduced global net primary productivity by 18.7% or by 6.3 GtC yr^-1. Further work is required to collate and map at the global scale the distribution of vegetation types, and evidence for wildfires, for the late Carboniferous to test our predictions.     

Computational theories on the function of theta oscillations

Neural rhythms can be studied in terms of conditions for their generation, or in terms of their functional significance. The theta oscillation is a particularly prominent rhythm, reported to be present in many brain areas, and related to many important cognitive processes. The generating mechanisms of theta have extensively been studied and reviewed elsewhere; here we discuss ideas that have accumulated over the past decades on the computational roles it may subserve. Theories propose different aspects of theta oscillations as being relevant for their cognitive functions: limit cycle oscillations in neuronal firing rates, subthreshold membrane potential oscillations, periodic modulation of synaptic transmission and plasticity, and phase precession of hippocampal place cells. The relevant experimental data is briefly summarized in the light of these theories. Specific models proposing a function for theta in pattern recognition, memory, sequence learning and navigation are reviewed critically. Difficulties with testing and comparing alternative models are discussed, along with potentially important future research directions in the field.     

Computational analysis of the influence of the microenvironment on carcinogenesis

The tumour microenvironment is known to play an important role in determining the sequence of acquired phenotypic traits that characterise cancer evolution. A more precise understanding of this role could have a major influence in the understanding of cancer growth and development, and potentially in the optimisation of innovative anti-cancer treatments delivery. However, to lead such an analysis in the basis of traditional biological experiments and observations is almost utopian given the complexity of the underlying biological processes and the typical time scales involved. In this context, computer models constitute a complementary exploratory tool.In this paper we introduce a two-dimensional cellular automaton that models key cancer cell capabilities. The model has been especially designed to mimic the behaviour of a cancer colony growing in vitro and to analyse the effect of different environmental conditions on the sequence of acquisition of phenotypic traits. Our results indicate that microenvironmental factors such as the local concentration of oxygen or nutrients and cell overcrowding may determine the expansion of the tumour colony. The results also show that tumour cells evolve and that their phenotypes adapt to the microenvironment so that environmental stress determines the dominance of particular phenotypical traits.