vendex and Sprains-and-Strains

To examine the value of isokinetic strength assessment for predicting risk of hamstring strain injury, and to direct future research into hamstring strain injuries.. Systematic review.. Database searches for Medline, CINAHL, Embase, AMED, AUSPORT, SPORTDiscus, PEDro and Cochrane Library from inception to April 2017. Manual reference checks, ahead-of-press and citation tracking.. Prospective studies evaluating isokinetic hamstrings, quadriceps and hip extensor strength testing as a risk factor for occurrence of hamstring muscle strain.. Independent search result screening. Risk of bias assessment by independent reviewers using Quality in Prognosis Studies tool. Best evidence synthesis and meta-analyses of standardised mean difference (SMD).. Twelve studies were included, capturing 508 hamstring strain injuries in 2912 athletes. Isokinetic knee flexor, knee extensor and hip extensor outputs were examined at angular velocities ranging 30-300°/s, concentric or eccentric, and relative (Nm/kg) or absolute (Nm) measures. Strength ratios ranged between 30°/s and 300°/s. Meta-analyses revealed a small, significant predictive effect for absolute (SMD=-0.16, P=0.04, 95% CI -0.31 to -0.01) and relative (SMD=-0.17, P=0.03, 95% CI -0.33 to -0.014) eccentric knee flexor strength (60°/s). No other testing speed or strength ratio showed statistical association. Best evidence synthesis found over half of all variables had moderate or strong evidence for no association with future hamstring injury.. Despite an isolated finding for eccentric knee flexor strength at slow speeds, the role and application of isokinetic assessment for predicting hamstring strain risk should be reconsidered, particularly given costs and specialised training required.

Topics: Athletic Injuries; Hamstring Muscles; Humans; Muscle Strength; Predictive Value of Tests; Sprains and Strains; Torque

Hamstring strain injuries are the predominant injury in many sports, costing athletes and clubs a significant financial and performance burden; therefore, the ability to identify and intervene with individuals who are considered at high risk of injury is important. One measure that has grown in popularity as an outcome variable following hamstring intervention/prevention studies and rehabilitation is the angle of peak knee flexor torque. This current opinion article will firstly introduce the measure and the processes behind it. Second, the article will summarise how the angle of peak knee flexor torque has been suggested to measure hamstring strain injury risk. Finally, the numerous limitations will be presented and the article will outline how these limitations may influence the usefulness of the angle of peak knee flexor torque measure. These include the lack of muscle specificity, the common concentric contraction mode of assessment, reliability of the measure, various neural contributions (such as rate of force development and neuromuscular inhibition), as well as the lack of prospective data showing any predictive value in the measure.

Topics: Athletic Injuries; Electric Stimulation; Humans; Isometric Contraction; Knee Joint; Leg Injuries; Muscle Contraction; Muscle, Skeletal; Recurrence; Risk Factors; Sprains and Strains; Torque

To systematically review the evidence base related to hamstring strength and flexibility in previously injured hamstrings.. Systematic review and meta-analysis.. A systematic literature search was conducted of PubMed, CINAHL, SPORTDiscus, Cochrane Library, Web of Science and EMBASE from inception to August 2015.. Full-text English articles which included studies which assessed at least one measure of hamstring strength or flexibility in men and women with prior hamstring strain injury within 24 months of the testing date.. Twenty-eight studies were included in the review. Previously injured legs demonstrated deficits across several variables. Lower isometric strength was found <7 days postinjury (d=-1.72), but this did not persist beyond 7 days after injury. The passive straight leg raise was restricted at multiple time points after injury (<10 days, d=-1.12; 10-20 days, d=-0.74; 20-30 days, d=-0.40), but not after 40-50 days postinjury. Deficits remained after return to play in isokinetically measured concentric (60°/s, d=-0.33) and Nordic eccentric knee flexor strength (d=-0.39). The conventional hamstring to quadricep strength ratios were also reduced well after return to play (60:60°/s, d=-0.32; 240:240°/s, d=-0.43) and functional (30:240°/s, d=-0.88), but these effects were inconsistent across measurement methods.. After hamstring strain, acute isometric and passive straight leg raise deficits resolve within 20-50 days. Deficits in eccentric and concentric strength and strength ratios persist after return to play, but this effect was inconsistent across measurement methods. Flexibility and isometric strength should be monitored throughout rehabilitation, but dynamic strength should be assessed at and following return to play.

Topics: Adolescent; Adult; Exercise Test; Female; Hamstring Muscles; Humans; Isometric Contraction; Knee Joint; Male; Middle Aged; Muscle Strength; Return to Sport; Sprains and Strains; Torque; Young Adult

Hamstring strain injuries are amongst the most common and problematic injuries in a wide range of sports that involve high speed running. The comparatively high rate of hamstring injury recurrence is arguably the most concerning aspect of these injuries. A number of modifiable and nonmodifiable risk factors are proposed to predispose athletes to hamstring strains. Potentially, the persistence of risk factors and the development of maladaptations following injury may explain injury recurrence. Here, the role of neuromuscular inhibition following injury is discussed as a potential mechanism for several maladaptations associated with hamstring re-injury. These maladaptations include eccentric hamstring weakness, selective hamstring atrophy and shifts in the knee flexor torque-joint angle relationship. Current evidence indicates that athletes return to competition after hamstring injury having developed maladaptations that predispose them to further injury. When rehabilitating athletes to return to competition following hamstring strain injury, the role of neuromuscular inhibition in re-injury should be considered.

Topics: Athletic Injuries; Cicatrix; Humans; Knee Joint; Muscle Weakness; Muscle, Skeletal; Muscular Atrophy; Neural Inhibition; Recurrence; Risk Factors; Sprains and Strains; Torque

The interaction of functional and mechanical deficits in chronic ankle instability remains a major issue in current research. After an index sprain, some patients develop sufficient coping strategies, while others require mechanical support. This study aimed to analyze persisting functional deficits in mechanically unstable ankles requiring operative stabilization.. We retrospectively analyzed the functional testing of 43 patients suffering from chronic, unilateral mechanical ankle instability (MAI) and in which long-term conservative treatment had failed. Manual testing and arthroscopy confirmed mechanical instability. The functional testing included balance test, gait analysis, and concentric-concentric, isokinetic strength measurements and was compared between the non-affected and the MAI ankles.. Plantarflexion, supination, and pronation strength was significantly reduced in MAI ankles. A sub-analysis of the strength measurement revealed that in non-MAI ankles, the peak pronation torque was reached earlier during pronation (maximum peak torque angle at 20° vs. 14° of supination, p < 0.001). Furthermore, active range of motion was reduced in dorsiflexion and supination. In balance testing, patients exhibited a significant increased perimeter for the injured ankle (p < 0.02). During gait analysis, we observed an increased external rotation in MAI (8.7 vs. 6.8°, p<0.02).. This study assesses functional deficits existent in a well-defined population of patients suffering from chronic MAI. Impairments of postural sway, gait asymmetries, and asymmetric isokinetic strength can be observed despite long-term functional treatment. The finding that pronation strength is particularly reduced with the foot in a close-to-accident position indicates potential muscular dysfunction in MAI. Possibly, these deficits alongside the underlying mechanical instability characterize patients requiring mechanical stabilization.

Topics: Adult; Ankle Injuries; Ankle Joint; Arthroscopy; Biomechanical Phenomena; Chronic Disease; Cross-Sectional Studies; Female; Gait Analysis; Humans; Joint Instability; Male; Muscle Strength; Physical Functional Performance; Pronation; Range of Motion, Articular; Retrospective Studies; Sprains and Strains; Supination; Torque

Plyometric training is a widely used method to improve performance in healthy athletes. It is highly recommended in the late stage of rehabilitation of many lower limb injuries. However, its effects on muscle strength and function in management of lateral ankle sprain have not been reported. Therefore, the objective of the current study was to determine the effects of plyometric training versus resistive exercises on muscle strength and function following acute lateral ankle sprain.. Twenty-two athletes (aged from 20 to 35 years) of both sexes with grade I or II unilateral inversion ankle sprain participated in the study (at least 3 weeks after acute injury). They were randomly assigned to two groups. The first group received plyometric training, whereas the second one received resistive training for 6 weeks. Isokinetic peak torque/body weight for invertors and evertors at 30 degrees/s and 120 degrees/s and functional tests were assessed before and after training.. Both plyometric and resistive training improve isokinetic evertor and invertor peak torques and functional performance of athletes p < 0.05. There were no significant differences between groups concerning peak torque/body weight for invertors and evertors at both speeds measured p > 0.05. The functional test measures of the plyometric group were significantly higher than that of resistive group.. Plyometrics were more effective than resistive exercises in improving functional performance of athletes after lateral ankle sprain.

Topics: Adult; Ankle Injuries; Athletic Injuries; Female; Humans; Male; Muscle Contraction; Muscle Stretching Exercises; Prospective Studies; Resistance Training; Sprains and Strains; Torque

Functional ankle instability, orthoses, and passive resistive torque tolerated have not been researched. The purpose of the study was to evaluate the passive resistance torque exerted by a flexible and semirigid orthosis for individuals with chronic instability. Twenty-two subjects were evaluated on the passive ankle resistance unit during unbraced, flexible, and semirigid brace conditions. Data from the final three trials for each condition were analyzed using a multiple analysis of variance with repeated measures for resistive torque and inversion range of motion. The semirigid and flexible braces tolerated significantly greater torque forces and less inversion range than the unbraced condition (P < 0.000). External orthotic support, in particular that of a semirigid orthosis, may be beneficial toward reducing injury or be an effective prophylactic for the healthy population.

Topics: Adult; Ankle; Ankle Injuries; Ankle Joint; Chronic Disease; Humans; Joint Instability; Movement; Orthotic Devices; Sprains and Strains; Torque

We tested the hypothesis that the magnitude of changes in indirect muscle damage markers would be greater after maximal elbow flexor eccentric exercise in the supinated (shorter biceps brachii) than neutral wrist (longer) position, and the difference in the magnitude would be associated with greater elongation over contractions for the supinated than neutral position, rather than the initial muscle length. Ten untrained men (21-39 years) performed two bouts of 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors in the supinated position for one arm and neutral position for the other arm separated by 2 weeks in a randomized order. Biceps brachii myotendinous junction (MTJ) movements during eccentric contractions were recorded by B-mode ultrasonography, and the displacement from the start to end of each contraction was quantified. Peak torque (supinated: 367.8 ± 112.5 Nm, neutral: 381.5 ± 120.4 Nm) and total work (1816 ± 539 J, 1865 ± 673 J) produced during eccentric contractions were similar between conditions. The average MTJ displacement increased (P < .05) from the 1st set (8.0 ± 2.0 mm) to 10th set (15.8 ± 1.9 mm) for the supinated condition, but no such increase was found in the neutral condition (1st set: 5.1 ± 1.0 mm, 10th set: 5.0 ± 0.8 mm). Changes in indirect muscle damage markers (maximal voluntary isometric contraction torque, range of motion, serum creatine kinase activity, and muscle soreness) after exercise were greater (P < .05) for the supinated than neutral condition. These results suggest that the greater muscle damage marker changes for the supinated than neutral wrist position was associated with the greater muscle lengthening (strain).

Topics: Adult; Analysis of Variance; Biomarkers; Creatine Kinase; Elbow Joint; Humans; Isometric Contraction; Male; Muscle, Skeletal; Myalgia; Pain Measurement; Posture; Random Allocation; Range of Motion, Articular; Sprains and Strains; Supine Position; Tendons; Torque; Ultrasonography; Wrist; Young Adult

There is a lack of definitive evidence supporting deficits in voluntary activation in participants with prior hamstring injury; moreover, it remains unknown if spinal mechanisms contribute to suspected deficits.. This study aimed to determine the effect of prior hamstring strain injury on knee flexor concentric and eccentric strength, voluntary activation, surface electromyographic (sEMG) activity, and stretch and tendon reflex amplitudes.. Twenty-five participants were recruited, 12 with a history of unilateral hamstring strain injury of at least moderate severity. Voluntary activation, strength, and sEMG activity were recorded during maximal eccentric and concentric knee flexor contractions at 60°·s. Stretch and tendon reflexes were also recorded at rest.. Previously injured limbs exhibited lower levels of voluntary activation (mean difference = -24.1%, 95% confidence interval [CI] = -34.1% to -14.0%, P < 0.001), strength (mean difference vs control group = -0.37 Nm·kg, 95% CI = -0.71% to -0.03 N·m·kg, P = 0.03), and normalized sEMG (mean difference = -17%, 95% CI = -32% to -2%, P = 0.02) during maximal eccentric knee flexor contractions compared with control group. No such differences were seen in concentric contractions. Stretch reflexes (mean difference = -3.8%, 95% CI = -6.8 to -0.8, P = 0.02) and tendon reflexes (mean difference = -13%, 95% CI = -26% to 0%, P = 0.04) were also lower in previously injured compared with control biceps femoris muscles.. Moderate to severe hamstring strain injury is associated with long-term deficits in voluntary activation during maximal eccentric contraction. Hamstring injury history is also associated with deficits in stretch reflex and tendon reflex amplitude.

Topics: Afferent Pathways; Athletic Injuries; Electromyography; Hamstring Muscles; Humans; Knee; Male; Muscle Contraction; Muscle Strength; Reflex, Stretch; Sprains and Strains; Tendons; Torque; Young Adult

Determine whether clinically feasible tests of isometric lower limb strength and range of motion (ROM) in Australian Football (AF) athletes are useful in Periodic Health Examinations to identify persistent deficits following hamstring strain injury (HSI).. Case-control.. Thirty-seven male, semi-professional AF athletes (mean±SD; age, 20.2±2.9years; height, 1.7±0.5m; mass, 81±9.2kg) participated, ten athletes (37%) reported HSI within the previous three seasons of competition. Comparisons of pre-season isometric knee flexion and hip extension strength variables (peak force, torque and torque normalised to body mass) and hip, knee and ankle ROM measures were made between athletes with and without past-history of HSI using linear mixed-effect models. A logistic regression evaluated whether any of the outcome measures could differentiate athletes with a past-history of HSI.. Knee flexion peak force, torque and torque normalised to body mass were significantly reduced in athletes with a past-history of HSI (coefficient, 95% CI) (-44.8N, -86.3 to -3.3), (-22.2Nm, -40.5 to -3.7) and (-0.2Nmkg. Deficits in isometric peak knee flexion strength persist for up to three seasons following HSI in AF athletes. Isometric knee flexion strength testing may be a clinically feasible option for Periodic Health Examinations and inform tertiary injury prevention strategies.

Topics: Adolescent; Athletes; Athletic Injuries; Australia; Case-Control Studies; Football; Hamstring Muscles; Hip; Humans; Knee Joint; Leg Injuries; Male; Muscle Strength; Range of Motion, Articular; Sprains and Strains; Torque; Young Adult

The aim of this study was to quantify the contributions of lower extremity joint torques and the mechanical power of lower extremity muscle groups to further elucidate the loadings on hamstring and the mechanics of its injury. Eight national-level male sprinters performed maximum-velocity sprint running on a synthetic track. The 3D kinematic data and ground reaction force (GRF) were collected synchronously. Intersegmental dynamics approach was used to analyze the lower extremity joint torques and power changes in the lower extremity joint muscle groups. During sprinting, the GRF during the stance phase and the motion-dependent torques (MDT) during the swing phase had a major effect on the lower extremity movements and muscle groups. Specifically, during the stance phase, torque produced and work performed by the hip and knee muscles were generally used to counteract the GRF. During the swing phase, the role of the muscle torque changed to mainly counteract the effect of MDT to control the movement direction of the lower extremity. Meanwhile, during the initial stance and late swing phases, the passive torques, namely, the ground reaction torques and MDT produced by the GRF and the inertial movement of the segments of the lower extremity, applied greater stress to the hamstring muscles.

Topics: Adolescent; Athletes; Biomechanical Phenomena; Computer Simulation; Gait; Hip Joint; Humans; Imaging, Three-Dimensional; Joints; Kinetics; Knee; Knee Joint; Lower Extremity; Male; Motion; Muscle Contraction; Muscle, Skeletal; Running; Sprains and Strains; Stress, Mechanical; Torque; Young Adult

Ankle sprain is the most common sport-related injury and eccentric weakness of ankle evertors is regarded as a significant muscular deficit related to chronic ankle instability. However, the eccentric performance of the evertors is rarely assessed by clinicians because procedures used for research purposes (i.e. isokinetic tests) are not easily applicable in daily practice.. The present study assessed the ability of two different testing procedures to distinguish between groups of 12 healthy subjects or 12 patients suffering from chronic ankle instability. On the one hand, the strength of evertors was assessed with a goldstandard isokinetic procedure. On the other hand, we assessed the ability of the subjects to control ankle inversion during weight bearing (functional standing test).. Data showed no significant difference between groups for isokinetic peak torque values normalized to body weight. Conversely, the functional test revealed a significantly impaired ability to control ankle inversion during weight bearing in subjects with chronic ankle instability.. This suggests that this easy-to-apply functional test is better suited compared to isokinetic testing procedures to assess weakness of evertors in patients suffering from chronic ankle instability. Moreover, this test may also be used to objectively monitor improvements during rehabilitation or progression in prevention protocols.

Topics: Ankle Injuries; Ankle Joint; Female; Humans; Joint Instability; Male; Muscle Strength Dynamometer; Muscle Weakness; Postural Balance; Sprains and Strains; Torque; Weight-Bearing; Young Adult

Passive muscle tension is increased after damaging eccentric exercise. Hamstring-strain injury is associated with damaging eccentric muscle actions, but no research has examined changes in hamstring passive muscle tension throughout a simulated sport activity. The authors measured hamstring passive tension throughout a 90-min simulated soccer match (SAFT90), including the warm-up period and every 15 min throughout the 90-min simulation.. Passive hamstring tension of 15 amateur male soccer players was measured using the instrumented straight-leg-raise test. Absolute torque (Nm) and slope (Nm/°) of the recorded torque-angular position curve were used for data analysis, in addition to total leg range of motion (ROM). Players performed a 15-min prematch warm-up, then performed the SAFT90 including a 15-min halftime rest period.. Reductions in passive stiffness of 20-50° of passive hip flexion of 22.1-29.2% (P < .05) were observed after the warm-up period. During the SAFT90, passive tension increased in the latter 20% of the range of motion of 10.1-10.9% (P < .05) concomitant to a 4.5% increase in total hamstring ROM (P = .0009).. The findings of this study imply that hamstring passive tension is reduced after an active warm-up that includes dynamic stretching but does not increase in a pattern suggestive of eccentric induced muscle damage during soccer-specific intermittent exercise. Hamstring ROM and passive tension increases are best explained by improved stretch tolerance.

Topics: Biomechanical Phenomena; Hamstring Muscles; Humans; Male; Range of Motion, Articular; Soccer; Sprains and Strains; Torque; Warm-Up Exercise; Young Adult

The repeated bout effect characterizes the protective adaptation after a single bout of unaccustomed eccentric exercise that induces muscle damage. Sarcomerogenesis and increased tendon compliance have been suggested as potential mechanisms for the repeated bout effect by preventing muscle fascicles from being stretched onto the descending limb of the length-tension curve (the region where sarcomere damage is thought to occur). In this study, evidence was sought for three possible mechanical changes that would support either the sarcomerogenesis or the increased tendon compliance hypotheses: a sustained rightward shift in the fascicle length-tension relationship, reduced fascicle strain amplitude, and reduced starting fascicle length.. Subjects (n = 10) walked backward downhill (5 km·h, 20% incline) on a treadmill for 30 min on two occasions separated by 7 d. Kinematic data and medial gastrocnemius fascicle lengths (ultrasonography) were recorded at 10-min intervals to compare fascicle strains between bouts. Fascicle length-torque curves from supramaximal tibial nerve stimulation were constructed before, 2 h after, and 2 d after each exercise bout.. Maximum torque decrement and elevated muscle soreness were present after the first, but not the second, backward downhill walking bout signifying a protective repeated bout effect. There was no sustained rightward shift in the length-torque relationship between exercise bouts, nor decreases in fascicle strain amplitude or shortening of the starting fascicle length.. Protection from a repeated bout of eccentric exercise was conferred without changes in muscle fascicle strain behavior, indicating that sarcomerogenesis and increased tendon compliance were unlikely to be responsible. As fascicle strains are relatively small in humans, we suggest that changes to connective tissue structures, such as extracellular matrix remodeling, are better able to explain the repeated bout effect observed here.

Topics: Adaptation, Physiological; Adult; Biomechanical Phenomena; Female; Humans; Male; Muscle, Skeletal; Myalgia; Sarcomeres; Sprains and Strains; Tendons; Torque; Walking; Young Adult

The potential mechanisms of hamstring strain injuries in athletes are not well understood. The study, therefore, was aimed at understanding hamstring mechanics by studying loading conditions during maximum-effort overground sprinting.. Three-dimensional kinematics and ground reaction force data were collected from eight elite male sprinters sprinting at their maximum effort. Maximal isometric torques of the hip and knee were also collected. Data from the sprinting gait cycle were analyzed via an intersegmental dynamics approach, and the different joint torque components were calculated.. During the initial stance phase, the ground reaction force passed anteriorly to the knee and hip, producing an extension torque at the knee and a flexion torque at the hip joint. Thus, the active muscle torque functioned to produce flexion torque at the knee and extension torque at the hip. The maximal muscle torque at the knee joint was 1.4 times the maximal isometric knee flexion torque. During the late swing phase, the muscle torque counterbalanced the motion-dependent torque and acted to flex the knee joint and extend the hip joint. The loading conditions on the hamstring muscles were similar to those of the initial stance phase.. During both the initial stance and late swing phases, the large passive torques at both the knee and hip joints acted to lengthen the hamstring muscles. The active muscle torques generated mainly by the hamstrings functioned to counteract those passive effects. As a result, during sprinting or high-speed locomotion, the hamstring muscles may be more susceptible to high risk of strain injury during these two phases.

Topics: Biomechanical Phenomena; Gait; Hip; Humans; Knee; Male; Muscle, Skeletal; Risk Factors; Running; Sprains and Strains; Thigh; Torque; Weight-Bearing; Young Adult

Fatigue-induced alterations in foot mechanics may lead to structural overload and injury.. To investigate how a high-intensity running exercise to exhaustion modifies ankle plantar-flexor and dorsiflexor strength and fatigability, as well as plantar-pressure distribution in adolescent runners.. Controlled laboratory study.. Academy research laboratory.. Eleven male adolescent distance runners (age = 16.9 ± 2.0 years, height = 170.6 ± 10.9 cm, mass = 54.6 ± 8.6 kg) were tested.. All participants performed an exhausting run on a treadmill. An isokinetic plantar-flexor and dorsiflexor maximal-strength test and a fatigue test were performed before and after the exhausting run. Plantar-pressure distribution was assessed at the beginning and end of the exhausting run.. We recorded plantar-flexor and dorsiflexor peak torques and calculated the fatigue index. Plantar-pressure measurements were recorded 1 minute after the start of the run and before exhaustion. Plantar variables (ie, mean area, contact time, mean pressure, relative load) were determined for 9 selected regions.. Isokinetic peak torques were similar before and after the run in both muscle groups, whereas the fatigue index increased in plantar flexion (28.1%; P = .01) but not in dorsiflexion. For the whole foot, mean pressure decreased from 1 minute to the end (-3.4%; P = .003); however, mean area (9.5%; P = .005) and relative load (7.2%; P = .009) increased under the medial midfoot, and contact time increased under the central forefoot (8.3%; P = .01) and the lesser toes (8.9%; P = .008).. Fatigue resistance in the plantar flexors declined after a high-intensity running bout performed by adolescent male distance runners. This phenomenon was associated with increased loading under the medial arch in the fatigued state but without any excessive pronation.

Topics: Adolescent; Ankle Injuries; Ankle Joint; Athletic Injuries; Exercise Test; Humans; Male; Muscle Fatigue; Pressure; Pronation; Running; Sprains and Strains; Torque

The medial collateral (MCL) and anterior cruciate ligaments (ACL) are, respectively, the primary and secondary ligamentous restraints against knee abduction, which is a component of the valgus collapse often associated with ACL rupture during athletic tasks. Despite this correlation in function, MCL ruptures occur concomitantly in only 20% to 40% of ACL injuries.. The purpose of this investigation was to determine how athletic tasks load the knee joint in a manner that could lead to ACL failure without concomitant MCL failure. It was hypothesized that (1) the ACL would provide greater overall contribution to intact knee forces than the MCL during simulated motion tasks and (2) the ACL would show greater relative peak strain compared with the MCL during simulated motion tasks.. Controlled laboratory study.. A 6-degrees-of-freedom robotic manipulator articulated 18 cadaveric knees through simulations of kinematics recorded from in vivo drop vertical jump and sidestep cutting tasks. Specimens were articulated in the intact-knee and isolated-ligament conditions. After simulation, each ACL and MCL was failed in uniaxial tension along its fiber orientations.. During a drop vertical jump simulation, the ACL experienced greater peak strain than the MCL (6.1% vs 0.4%; P < .01). The isolated ACL expressed greater peak anterior force (4.8% vs 0.3% body weight; P < .01), medial force (1.6% vs 0.4% body weight; P < .01), flexion torque (8.4 vs 0.4 N·m; P < .01), abduction torque (2.6 vs 0.3 N·m; P < .01), and adduction torque (0.5 vs 0.0 N·m; P = .03) than the isolated MCL. During failure testing, ACL specimens preferentially loaded in the anteromedial bundle failed at 637 N, while MCL failure occurred at 776 N.. During controlled physiologic athletic tasks, the ACL provides greater contributions to knee restraint than the MCL, which is generally unstrained and minimally loaded.. Current findings support that multiplanar loading during athletic tasks preferentially loads the ACL over the MCL, leaving the ACL more susceptible to injury. An enhanced understanding of joint loading during in vivo tasks may provide insight that enhances the efficacy of injury prevention protocols.

Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biomechanical Phenomena; Body Weight; Cadaver; Exercise; Female; Humans; Knee Injuries; Knee Joint; Male; Medial Collateral Ligament, Knee; Middle Aged; Random Allocation; Range of Motion, Articular; Risk Factors; Robotics; Rupture; Sports; Sprains and Strains; Stress, Physiological; Torque

The assessment of muscle function is a cornerstone in the management of subjects who have sustained a lateral ankle sprain. The ankle range of motion being relatively small, the use of preloading allows to measure maximal strength throughout the whole amplitude and therefore to better characterize ankle muscles weaknesses. This study aimed to assess muscle strength of the injured and uninjured ankles in subjects with a lateral ankle sprain, to document the timeline of strength recovery, and to determine the influence of sprain grade on strength loss.. Maximal torque of the periarticular muscles of the ankle in a concentric mode using a protocol with maximal preloading was tested in 32 male soldiers at 8 weeks and 6 months post-injury.. The evertor muscles of the injured ankles were weaker than the uninjured ones at 8 weeks and 6 months post-injury (P<0.0001, effect size=0.31-0.42). Muscle weaknesses also persisted in the plantarflexors of the injured ankles at 8 weeks (P=0.0014, effect size=0.52-0.58) while at 6 months, only the subjects with a grade II sprain displayed such weaknesses (P<0.0001, effect size 0.27-0.31). The strength of the invertor and dorsiflexor muscles did not differ between sides.. The use of an isokinetic protocol with preloading demonstrates significant but small strength deficits in the evertor and plantarflexor muscles. These impairments may contribute to the high incidence of recurrence of lateral ankle sprain in very active individuals.

Topics: Adult; Analysis of Variance; Ankle Injuries; Ankle Joint; Exercise Therapy; Female; Humans; Male; Muscle Strength; Muscle, Skeletal; Physical Therapy Modalities; Range of Motion, Articular; Sprains and Strains; Torque; Young Adult

Hamstring strain reinjury rates can reach 30% within the initial 2 wk after return to sport (RTS). Incomplete recovery of strength may be a contributing factor. However, relative strength of the injured and unaffected limbs at RTS is currently unknown.The purpose was to characterize hamstring strength and morphology at the time of RTS and 6 months later.. Twenty-five athletes who experienced an acute hamstring strain injury participated after completion of a controlled rehabilitation program. Bilateral isokinetic strength testing and magnetic resonance imaging (MRI) were performed at RTS and 6 months later. Strength (knee flexion peak torque, work, and angle of peak torque) and MRI (muscle and tendon volumes) measures were compared between limbs and over time using repeated-measures ANOVA.. The injured limb showed a peak torque deficit of 9.6% compared to the uninjured limb at RTS (60°·s, P < 0.001) but not 6 months after. The knee flexion angle of peak torque decreased over time for both limbs (60°·s, P < 0.001). MRI revealed that 20.4% of the muscle cross-sectional area showed signs of edema at RTS with full resolution by the 6-month follow-up. Tendon volume of the injured limb tended to increase over time (P = 0.108), whereas muscle volume decreased between 4% and 5% in both limbs (P < 0.001).. Residual edema and deficits in isokinetic knee flexion strength were present at RTS but resolved during the subsequent 6 months. This occurred despite MRI evidence of scar tissue formation (increased tendon volume) and muscle atrophy, suggesting that neuromuscular factors may contribute to the return of strength.

Topics: Adolescent; Adult; Analysis of Variance; Edema; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Muscle Strength; Muscle Strength Dynamometer; Muscle, Skeletal; Range of Motion, Articular; Recovery of Function; Recurrence; Sprains and Strains; Tendons; Thigh; Time Factors; Torque; Young Adult

Syndesmosis (high ankle) sprains produce disruption of the distal tibiofibular ligaments. Forces on the distal fibula that produce these injuries are unknown.. Twenty-seven fresh-frozen lower extremities were used for this study. A load cell recorded forces acting on the distal fibula from forced ankle dorsiflexion and applied external foot torque; medial-lateral and anterior-posterior displacements of the distal fibula were recorded. Fibular forces and axial displacements were also recorded with applied axial force.. During forced ankle dorsiflexion and external foot torque tests, the distal fibula always displaced posteriorly with respect to the tibia with no measurable medial-lateral displacement. With 10 Nm dorsiflexion moment, cutting the tibiofibular ligaments approximately doubled fibular force and displacement values. Cutting the tibiofibular ligaments significantly increased fibular displacement from applied external foot torque. Fibular forces and axial displacements from applied axial weight-bearing force were highest with the foot dorsiflexed. The highest mean fibular force in the study (271.9 N) occurred with 10 Nm external foot torque applied to a dorsiflexed foot under 1000 N axial force.. Two important modes of loading that could produce high ankle sprains were identified: forced ankle dorsiflexion and external foot torque applied to a dorsiflexed ankle loaded with axial force. The distal tibiofibular ligaments restrained fibular displacement during these tests.. Residual mortise widening observed at surgery may be the result of tibiofibular ligament injuries caused by posterior displacement of the fibula. Therefore, a syndesmosis screw used to fix the fibula would be subjected to posterior bending forces from these loading modes. Ankle bracing to prevent extreme ankle dorsiflexion during rehabilitation may be advisable to prevent excessive fibular motions that could affect syndesmosis healing.

Topics: Ankle Injuries; Biomechanical Phenomena; Fibula; Humans; Ligaments, Articular; Materials Testing; Sprains and Strains; Torque; Weight-Bearing

Although muscle dysfunction caused by unfamiliar lengthening contraction is one of most important issues in sports medicine, there is little known about the molecular events on regeneration process. The purpose of this study was to investigate the temporal and spatial expression patterns of myogenin, myoD, pax7, and myostatin after acute lengthening contraction (LC)-induced injury in the rat hindlimb.. We employed our originally developed device with LC in rat gastrocnemius muscle (n = 24). Male Wistar rats were anesthetized with isoflurane (aspiration rate, 450 ml/min, concentration, 2.0%). The triceps surae muscle of the right hindlimb was then electrically stimulated with forced isokinetic dorsi-flexion (180°/sec and from 0 to 45°). Tissue contents of myoD, myogenin, pax7, myostatin were measured by western blotting and localizations of myoD and pax7 was measured by immunohistochemistry. After measuring isometric tetanic torque, a single bout of LC was performed in vivo.. The torque was significantly decreased on days 2 and 5 as compared to the pre-treatment value, and recovered by day 7. The content of myoD and pax7 showed significant increases on day 2. Myogenin showed an increase from day 2 to 5. Myostatin on days 5 and 7 were significantly increased. Immunohistochemical analysis showed that myoD-positive/pax7-positive cells increased on day 2, suggesting that activated satellite cells play a role in the destruction and the early recovery phases.. We, thus, conclude that myogenic events associate with torque recovery after LC-induced injury.

Topics: Animals; Ankle Joint; Biomechanical Phenomena; Blotting, Western; Disease Models, Animal; Hindlimb; Immunohistochemistry; Male; Muscle Contraction; Muscle Development; Muscle, Skeletal; MyoD Protein; Myogenin; Myostatin; Paired Box Transcription Factors; Rats; Rats, Wistar; Recovery of Function; Regeneration; Satellite Cells, Skeletal Muscle; Sprains and Strains; Time Factors; Torque

Osseointegrated transfemoral implants have been introduced as a prosthetic solution for above knee amputees. They have shown great promise, providing an alternative for individuals who could not be accommodated by conventional, socket-based prostheses; however, the occurrence of device failures is of concern. In an effort to improve the strength and longevity of the device, a new design has been proposed. This study investigates the mechanical behavior of the new taper-based assembly in comparison to the current hex-based connection for osseointegrated transfemoral implant systems. This was done to better understand the behavior of components under loading, in order to optimize the assembly specifications and improve the useful life of the system. Digital image correlation was used to measure surface strains on two assemblies during static loading in bending. This provided a means to measure deformation over the entire sample and identify critical locations as the assembly was subjected to a series of loading conditions. It provided a means to determine the effects of tightening specifications and connection geometry on the material response and mechanical behavior of the assemblies. Both osseoinegrated assemblies exhibited improved strength and mechanical performance when tightened to a level beyond the current specified tightening torque of 12 N m. This was shown by decreased strain concentration values and improved distribution of tensile strain. Increased tightening torque provides an improved connection between components regardless of design, leading to increased torque retention, decreased peak tensile strain values, and a more gradual, primarily compressive distribution of strains throughout the assembly.

Topics: Amputation, Surgical; Amputees; Analysis of Variance; Artificial Limbs; Biomedical Engineering; Compressive Strength; Computer Simulation; Equipment Design; Equipment Failure Analysis; Humans; Imaging, Three-Dimensional; Osseointegration; Prostheses and Implants; Prosthesis Fitting; Sprains and Strains; Stress, Mechanical; Tensile Strength; Torque; Weight-Bearing

Muscles behave as elastic springs during the initial strain phase, indicated as short range stiffness (SRS). Beyond a certain amount of strain the muscle demonstrates a more viscous behavior. The strain at which the muscle transits from elastic- to viscous-like behavior is called the elastic limit and is believed to be the result of breakage of cross-bridges between the contractile filaments. The aim of this study was to test whether the elastic limit, measured in vivo at the wrist joint, depended on the speed of lengthening. Brief extension rotations were imposed to the wrist joint (n=8) at four different speeds and at three different levels of voluntary torque using a servo controlled electrical motor. Using a recently published identification scheme, we quantified the elastic limit from measured joint angle and torque. The results showed that the elastic limit significantly increased with speed in a linear way, indicating to a constant time of approximately 30 ms before cross-bridges break. The implications for movement control of the joint are discussed.

Topics: Adult; Elasticity; Female; Humans; Male; Models, Biological; Movement; Muscle Contraction; Muscle, Skeletal; Rotation; Sprains and Strains; Torque; Wrist Joint

A thorough understanding of the biomechanics of the hamstrings during sprinting is required to optimise injury rehabilitation and prevention strategies. The main aims of this study were to compare hamstrings load across different modes of locomotion as well as before and after an acute sprinting-related muscle strain injury. Bilateral kinematic and ground reaction force data were captured from a single subject whilst walking, jogging and sprinting prior to and immediately following a significant injury involving the right semitendinosis and biceps femoris long head muscles. Experimental data were input into a three-dimensional musculoskeletal model of the body and used, together with optimisation theory, to determine lower-limb muscle forces for each locomotor task. Hamstrings load was found to be greatest during terminal swing for sprinting. The hamstrings contributed the majority of the terminal swing hip extension and knee flexion torques, whilst gluteus maximus contributed most of the stance phase hip extension torque. Gastrocnemius contributed little to the terminal swing knee flexion torque. Peak hamstrings force was also substantially greater during terminal swing compared to stance for sprinting, but not for walking and jogging. Immediately following the muscle strain injury, the hamstrings demonstrated an intolerance to perform an eccentric-type contraction. Whilst peak hamstrings force during terminal swing did not decrease post-injury, both peak hamstrings length and negative work during terminal swing were considerably reduced. These results lend support to the paradigm that the hamstrings are most susceptible to muscle strain injury during the terminal swing phase of sprinting when they are contracting eccentrically.

Topics: Adult; Biomechanical Phenomena; Humans; Lower Extremity; Male; Muscle Contraction; Muscle, Skeletal; Running; Sprains and Strains; Torque; Walking

There is some debate in the literature as to whether strength deficits exist at the ankle in individuals with chronic ankle instability (CAI). Additionally, there is evidence to suggest that knee and hip performance is altered in those with CAI. Therefore, the purpose of this study was to determine whether CAI is associated with deficits in ankle, knee, and hip torque. Fifteen subjects with unilateral CAI and fifteen subjects with healthy ankles participated. Subjects reported to the laboratory for one session during which the torque production of ankle plantar flexion/dorsiflexion, knee flexion/extension, and hip flexion/extension were measured with an isokinetic device. Subjects performed 5 maximum-effort repetitions of a concentric/concentric protocol at 60 degrees .s for both extremities. Average peak torque (APT) values were calculated. The subjects with CAI demonstrated significantly less APT production for knee flexion (F1,28 = 5.40; p = 0.03) and extension (F1,28 = 5.34; p = 0.03). Subjects with CAI exhibited significantly less APT for ankle plantar flexion in the injured limb compared with their noninjured limb (F1,28 = 6.51; p = 0.02). No significant difference in ankle dorsiflexion or hip flexion/extension APT production existed between the 2 groups. Individuals with CAI, in addition to deficits in ankle plantar flexion torque, had deficits in knee flexor and extensor torque, suggesting that distal joint instability may lead to knee joint neuromuscular adaptations. There were no similar deficits at the hip. Future research should determine what implications this has for prevention and rehabilitation of lower-extremity injury. Clinicians may need to consider including rehabilitation efforts to address these deficits when rehabilitating patients with CAI.

Topics: Adult; Ankle Injuries; Ankle Joint; Chronic Disease; Female; Hip Joint; Humans; Joint Instability; Knee Joint; Male; Range of Motion, Articular; Sprains and Strains; Torque; Young Adult

Case control study.. To classify individuals with functional ankle instability (FAI) into deficit and non-deficit categories based on the evaluation of the most common factors that have been proposed to be related to FAI.. Recent studies have suggested that FAI may be secondary to a combination of factors including ankle proprioceptive deficit, muscular weakness, impaired balance, delayed neuromuscular reaction time, and joint laxity. However, only a few authors have investigated the prevalence and association among these factors in a single group of individuals.. The above 5 factors were tested bilaterally in 21 individuals with FAI and in 16 healthy control subjects. Data were analyzed for (1) within- and between-group comparison, (2) classification of subjects with FAI into deficit and no-deficit categories, and (3) magnitude of association between factors in the subjects with FAI using Pearson bivariate correlation.. Balance control and evertors' strength were significantly less on the affected side in comparison to the unaffected side in subjects with FAI. The evertors' strength was also significantly different between the side difference of the FAI group and the side difference of the control group. Passive ankle stiffness was significantly correlated to balance control, ankle proprioception, and evertor peak torque. Individuals with FAI demonstrated a large variation in the deficit categories ranging from multiple deficits to no noticeable deficits.. Mechanical alterations in the ankle joint may influence several aspects of the ankle's functional ability. Alterations in the afferent processes, represented in this study by ankle proprioception, may effect the evertors' strength or vice versa. More importantly, individuals with FAI might exhibit high variability in ankle deficits.

Topics: Adult; Ankle Injuries; Ankle Joint; Case-Control Studies; Female; Humans; Joint Instability; Male; Muscle Weakness; Proprioception; Risk Factors; Sprains and Strains; Torque

The purpose of this study was to investigate the effects of isokinetic exercise on strength, joint position sense and functionality in recreational athletes with functional ankle instability (FAI). Strength, proprioception and balance of 24 recreational athletes with unilateral FAI were evaluated by using isokinetic muscle strength measurement, ankle joint position sense and one leg standing test. The functional ability was evaluated using five different tests. These were; single limb hopping course (SLHC), one legged and triple legged hop for distance (OLHD-TLHD), and six and cross six meter hop for time (SMHT-CSMHT). Isokinetic peak torque of the ankle invertor and evertor muscles were assessed eccentrically and concentrically at test speeds of 120 degrees /s. Isokinetic exercise protocol was carried out at an angular velocity of 120 degrees /s. The exercise session was repeated three times a week and lasted after 6 weeks. At baseline, concentric invertor strength was found to be significantly lower in the functionally unstable ankles compared to the opposite healthy ankles (p < 0.001). This difference was not present after executing the 6 weeks exercise sessions (p > 0.05). Ankle joint position sense in the injured ankles declined significantly from 2.35 +/- 1.16 to 1.33 +/- 0.62 degrees for 10 degrees of inversion angle (p < 0.001) and from 3.10 +/- 2.16 to 2.19 +/- 0.98 degrees for 20 degrees of inversion angle (p < 0.05) following the isokinetic exercise. One leg standing test score decreased significantly from 15.17 +/- 8.50 to 11.79 +/- 7.81 in the injured ankles (p < 0.001). Following the isokinetic exercise protocol, all of the worsened functional test scores in the injured ankles as compared to the opposite healthy ankles displayed a significant improvement (p < 0.01 for OLHD and CSMHT, p < 0.001 for SLHC, TLHD, and SMHT). These results substantiate the deficits of strength, proprioception, balance and functionality in recreational athletes with FAI. The isokinetic exercise program used in this study had a positive effect on these parameters.

Topics: Adult; Ankle Injuries; Ankle Joint; Exercise Test; Humans; Joint Instability; Male; Muscle Strength; Muscle Strength Dynamometer; Physical Education and Training; Proprioception; Sprains and Strains; Torque

Lateral ankle sprains occur more frequently than any other orthopedic injury. Athletes often report sustaining more injuries late in competition when fatigue is present.. To evaluate neuromuscular function of the ankle musculature after fatigue.. Experimental, pretest-posttest.. Research laboratory.. Ten female and 9 male college-aged subjects.. Fatigue was induced via continuous concentric and eccentric muscle actions of the ankle: inversion (INV), eversion (EV), plantar flexion (PF), and dorsiflexion (DF).. Peak torque (PT), peak EMG, and median frequency (MF) were calculated prefatigue and postfatigue in the tibialis anterior (TA), peroneus longus (PER), and lateral gastrocnemius (GAS) muscles.. Main effects were noted for test (P < 0.0125) in all statistical tests performed indicating changes in PT, peak EMG, and MF after fatigue.. A significant decrease in MF of the PER muscle after PF fatigue and corresponding with a decreased firing rate, may be of importance, especially with regard to the role in countering the violent moment seen with inversion ankle sprains.

Topics: Adult; Ankle Injuries; Electromyography; Female; Humans; Male; Muscle Fatigue; Muscle, Skeletal; Neuromuscular Junction; Physical Endurance; Sex Factors; Sprains and Strains; Torque

It is generally accepted that eccentric exercise, when performed by a muscle that is unaccustomed to that type of contraction, results in a delayed onset of muscle soreness (DOMS). A prolonged exposure to eccentric exercise leads to the disappearance of the signs and symptoms associated with DOMS, which has been referred to as the repeated bout effect (RBE). Although the mechanisms underlying the RBE remain unclear, several mechanisms have been proposed, including the serial sarcomere number addition following exercise induced muscle damage. In the traditional DOMS and RBE protocols, muscle injury has been treated as a global parameter, with muscle force and strain assumed to be uniform throughout the muscle. To assess the effects of muscle-tendon unit strain, fiber strain, torque and injury on serial sarcomere number adaptations, three groups of New Zealand White (NZW) rabbits were subjected to chronic repetitive eccentric exercise bouts of the ankle dorsiflexors for 6 weeks. These eccentric exercise protocols consisted of identical muscle tendon unit (MTU) strain, but other mechanical factors were systematically altered. Following chronic eccentric exercise, serial sarcomere number adaptations were not identical between the three eccentric exercise protocols, and serial sarcomere number adaptations were not uniform across all regions of the muscle. Peak torque and relaxation fiber strain were the best predictors of serial sarcomere number across all three protocols. Therefore, MTU strain does not appear to be the primary cause for sarcomerogenesis, and differential adaptations within the muscle may be explained by the nonuniform architecture of the muscle, resulting in differential local fiber strains.

Topics: Adaptation, Physiological; Animals; Female; Muscle, Skeletal; Physical Conditioning, Animal; Rabbits; Sarcomeres; Sprains and Strains; Tendons; Torque

Muscle strain injuries are some of the most frequent injuries in sports and command a great deal of attention in an effort to understand their etiology. These injuries may be the culmination of a series of subcellular events accumulated through repetitive lengthening (eccentric) contractions during exercise, and they may be influenced by a variety of variables including fiber strain magnitude, peak joint torque, and starting muscle length. To assess the influence of these variables on muscle injury magnitude in vivo, we measured fiber dynamics and joint torque production during repeated stretch-shortening cycles in the rabbit tibialis anterior muscle, at short and long muscle lengths, while varying the timing of activation before muscle stretch. We found that a muscle subjected to repeated stretch-shortening cycles of constant muscle-tendon unit excursion exhibits significantly different joint torque and fiber strains when the timing of activation or starting muscle length is changed. In particular, measures of fiber strain and muscle injury were significantly increased by altering activation timing and increasing the starting length of the muscle. However, we observed differential effects on peak joint torque during the cyclic stretch-shortening exercise, as increasing the starting length of the muscle did not increase torque production. We conclude that altering activation timing and muscle length before stretch may influence muscle injury by significantly increasing fiber strain magnitude and that fiber dynamics is a more important variable than muscle-tendon unit dynamics and torque production in influencing the magnitude of muscle injury.

Topics: Animals; Biomechanical Phenomena; Electric Stimulation; Female; Isometric Contraction; Joints; Muscle Contraction; Muscle Fibers, Skeletal; Muscle, Skeletal; Neuromuscular Junction; Physical Conditioning, Animal; Rabbits; Sprains and Strains; Tarsal Joints; Tendons; Time Factors; Torque

To determine an ankle inversion-eversion movement range part where evertor/invertor muscles torque ratio is altered after recurrent ankle lateral ligament sprains.. The ankle evertor/invertor muscles torque ratios were determined in the different range parts of angular positions by the muscle isokinetic movements.. It is important to determine the movement range part where the evertor muscle weakness after the ankle lateral ligament sprains is more expressed and a repeated trauma of the lateral ligaments is more probable.. Twenty-eight male handball players participated in the tests using an ankle isokinetic inversion-eversion movement investigation dynamometer system. Thirty-three ankle joints were uninjured, but 23 underwent recurrent lateral ligament sprains.. The ankle evertor/invertor muscles torque ratio for the sprained ankles was significantly lower in comparison with the uninjured joints in inversion positions at 50 degrees and 60 degrees of the range of movements in all applied velocities, except the slowest movement (30 degrees /s).. The recurrent ankle lateral ligament sprains reduced the evertor/invertor muscles torque ratio in the inversion positions of the range of movements and therefore the evertor muscle weakness was more expressed in the beginning of the eversion movement.

Topics: Adolescent; Adult; Ankle Injuries; Athletic Injuries; Humans; Ligaments, Articular; Male; Muscle, Skeletal; Sprains and Strains; Torque

The purpose of this study was to determine whether both neutrophils and macrophages infiltrate the hematoma site of stretch-injured rabbit tibialis anterior muscle. The Mab.198 antibody was used to detect CD11b(+) neutrophils or macrophages. Neutrophils were identified specifically by using the RPN3/57 antibody. The RAM11 antibody was used to detect macrophages. The histological characteristics of the hematoma site, torn fibers or inflammatory cells, were present primarily at 4 and 24 h, but not at 48 and 72 h after injury. A difference in the Mab.198(+) cellular concentration was detected over time between uninjured and injured muscles (P = 0.03). The injured-uninjured difference in the RPN3/57(+) or RAM11(+) cellular concentrations approached significance (P = 0.07) or else was deemed insignificant (P = 0.13), respectively. Therefore, neutrophils may predominate over RAM11(+) macrophages in stretch-injured muscle. These findings may influence the antiinflammatory strategies used to treat stretch injuries.

Topics: Animals; Antigens, Differentiation; Biomarkers; Cell Count; Disease Models, Animal; Disease Progression; Hematoma; Immunohistochemistry; Macrophage-1 Antigen; Macrophages; Muscle, Skeletal; Neutrophil Infiltration; Neutrophils; Rabbits; Sprains and Strains; Stress, Mechanical; Torque

A force balance between the ligaments, articular contact, muscles and body weight maintains knee joint stability. Thus, it is important to study anterior cruciate ligament (ACL) biomechanics, in vivo, under weightbearing conditions. Our objective was to compare the ACL strain response under weightbearing and non-weightbearing conditions and in combination with three externally applied loadings: (1) anterior-posterior shear forces, (2) internal-external torques, and (3) varus-valgus moments. A strain transducer was implanted on the ACL of 11 subjects. All joint loadings were performed with the knee at 20 degrees of flexion. A significant increase in ACL strain was observed as the knee made the transition from non-weightbearing to weightbearing. During anterior shear loading, the strain values produced during weightbearing were greater than those of the non-weightbearing knee (shear loads <40N). At higher shear loads, the strain values became equal. During axial torsion, an internal torque of 10Nm strained the ACL when the knee was non-weightbearing while an equivalent external torque did not. Weightbearing significantly increased ACL strain values in comparison to non-weightbearing with the application of external torques and low internal torques (<3Nm). The strains became equal for higher internal torques. For V-V loading, the ACL was not strained in the non-weightbearing knee. However, weightbearing increased the ACL strain values over the range of moments tested. These data have important clinical ramifications in the development of rehabilitation protocols following ACL reconstruction since weightbearing has been previously thought to provide a protective mechanism to the healing graft.

Topics: Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biomechanical Phenomena; Female; Humans; Knee Joint; Male; Middle Aged; Sprains and Strains; Stress, Mechanical; Torque; Weight-Bearing

To determine the relation of hamstring and quadriceps muscle strength and imbalance to hamstring injury using a prospective observational cohort study. A total of 102 senior male Australian Rules footballers aged 22.2 (3.6) years were tested at the start of a football season. Maximum voluntary concentric and eccentric torque of the hamstring and quadriceps muscles of both legs was assessed using a Kin-Com isokinetic dynamometer at angular velocities of 60 and 180 degrees/second. Twelve (11.8%) players sustained clinically diagnosed hamstring strains which caused them to miss one or more matches over the ensuing season.. There were no significant differences for any of the isokinetic variables comparing the injured and non-injured legs in players with unilateral hamstring strains (n=9). Neither the injured nor the non-injured leg of injured players differed from the mean of left and right legs in non-injured players for any isokinetic variable. The hamstring to opposite hamstring ratios also did not differ between injured and non-injured players. A hamstring to opposite hamstring ratio of less than 0.90 and a hamstring to quadriceps ratio of less than 0.60 were not associated with an increased risk of hamstring injury. A significantly greater percentage of players who sustained a hamstring strain reported a history of hamstring strain compared with non-injured players (p=0.02). However, this was not related to muscle weakness or imbalance.. Isokinetic muscle strength testing was not able to directly discriminate Australian Rules football players at risk for a hamstring injury.

Topics: Adult; Australia; Cohort Studies; Football; Forecasting; Humans; Male; Muscle Contraction; Muscle Weakness; Muscle, Skeletal; Prospective Studies; Recurrence; Risk Factors; Sprains and Strains; Tendon Injuries; Tendons; Torque

Strengthening of the evertor muscles is widely advocated as a key component of lateral ankle sprain rehabilitation, but our clinical observation of impaired invertor muscle performance among many patients suggested the need for this study of isokinetic performance deficiencies. Subjects were 30 physically active adolescents, ages 14-19 years, who had recently sustained a lateral ankle sprain or who had symptoms of chronic lateral ankle instability. Eversion/inversion testing was performed on a Biodex isokinetic dynamometer at speeds of 30 and 120 degrees/sec. Analysis of variance results demonstrated significantly greater (p < .05) invertor deficits than evertor deficits for both peak torque and average power at both tests speeds. The findings of this study suggest that a lateral ankle ligament injury may be associated with an invertor muscle performance deficiency, and that restoration of a normal evertor/invertor strength relationship may be accomplished through performance of an isotonic ankle strengthening program.

Topics: Adolescent; Adult; Analysis of Variance; Ankle Injuries; Chronic Disease; Exercise Therapy; Female; Humans; Isotonic Contraction; Joint Instability; Ligaments, Articular; Male; Muscle Contraction; Muscle, Skeletal; Range of Motion, Articular; Sprains and Strains; Torque