Open and closed kinetic chain exercises for meniscus lesions / 中国组织工程研究

BACKGROUND: Both open and closed kinetic chain exercises can be applied to meniscal lesions in the knee joint, but their mechanisms are different. There is still no clinical report on the improvement of meniscus lesions by the two exercise methods OBJECTIVE: To observe the effects of open kinetic chain exercise and closed kinetic chain exercise on meniscus lesions in young patients. METHODS: Forty-nine young patients with meniscus lesions were treated with rehabilitation and conservative treatments. They were randomly divided into two groups using a random digital table method: A biofeedback open kinetic chain group (n=25) treated with basic therapy combined with terminal knee extension biofeedback training, and a leg press closed kinetic chain group (n=24) treated with basic therapy combined with single-leg press training. The basic treatment included electro-acupuncture, manipulation therapy and unarmed exercise therapy. Biofeedback open chain training was conducted with Myotrac infiniti biofeedback instrument produced by Thought, Canada. Closed chain training with leg press was conducted using pedal accessories of GYM80 intelligent strength training system, Germany. All the trainings were conducted once a day for 3 consecutive weeks. Curative effects were assessed by joint range of motion (ROM) during knee joint flexion and extension, total ROM, visual analogue scale score, modified Lysholm knee score, and activity of daily living score. The study protocol was implemented in line with the relevant requirements of Sichuan Provincial Orthopedic Hospital. All the patients were informed of the study procedures. RESULTS AND CONCLUSION: Assessment for ROM: After treatment, the ROM during joint flexion and extension and total ROM in the biofeedback open kinetic chain group were significantly better than the baseline (P 0.05). Assessment for pain and function: The two groups had statistically significant improvements on visual analogue scale score, modified Lysholm knee score, and activity of daily living score after treatment (P < 0.05). Compared with the biofeedback open kinetic chain group, the activity of daily living score was higher in the leg press closed kinetic chain group (P < 0.05). The two groups had satisfactory effects on the knee joint ROM, pain and functional performance. Therefore, biofeedback open kinetic chain exercise has a better improvement on the knee joint ROM, while the leg press closed kinetic chain exercise shows better outcomes in the improvement of knee functional performance and activity of daily living based on the basis of pain control.

Effect of Various Movements on Shoulder External Rotators / 中国康复理论与实践

Objective To investigate the activities of infraspinatus (IS) and posterior deltoid (PD) under shoulder external rotation at open kinetic chain (OKC) and closed kinetic chain (CKC) exercise with shoulder abduction 0° and 90° to determine the optimal external rotation rehabilitation exercise.Methods From April to June, 2018, 19 healthy adults finished the movement of 0° OKC, 0° CKC, 90° OKC and 90°CKC. The root mean square (RMS) of IS and PD was recorded with surface electromyography (sEMG), then the standardized RMS (RMS％), ratio of IS/PD and onset time of activation were calculated.Results RMS％ of PD was the minimal at 90° CKC, and was less than that of 0° CKC (P ＜ 0.05). IS/PD was the most at90° CKC, and was more than that of 90° OKC (P ＜ 0.05). The onset time of IS was the earliest in 90° CKC, and earlier than that of 90° OKC (P ＜ 0.05) and 0°OKC (P ＜ 0.05). The onset time of PD was the latest in 0° CKC, and latter than that of 90° OKC (P ＜ 0.05).Conclusion 90°CKC activates IS mostly and earliest, which can be used in early rehabilitation for rotator cuff injury.

Comparisons of Accuracy of Knee Joint Motion During Closed verse Open Kinetic Chain Tasks in Subjects with Flexible Flatfeet

PURPOSE: This study examined the effects of flexible flatfeet on the accuracy of knee joint motions in closed and open kinetic chain tasks. METHODS: Twenty-four healthy participants were recruited for this study. The subjects were divided into two groups using a navicular drop (ND) test: flexible flatfoot group (n=12, male: 6, aged 22.00±2.22 years) and age-matched control group (n=12, males: 6, aged 22.17±1.53 years). The accuracy of knee motion was measured quantitatively by tracing through the flexion and extension motion of the knee joints in the closed kinetic chain and the open kinetic chain. RESULTS: There was a significant difference in the accuracy index between the groups in closed kinetic chain task, but there was no significant difference in the open kinetic chain task. In addition, there was a significant difference in the accuracy index between the closed kinetic chain and the open kinetic chain task in the flexible flatfoot group. In addition, a significant negative correlation was observed between the ND and accuracy index in the closed kinematic chain task, but there was no significant relationship between the ND and accuracy index in the open kinematic chain task. CONCLUSION: Flexible flatfeet can affect the accuracy of the adjacent joints, such as the knee joint in the closed kinematic chain.

Lower limb muscle mechanics during isokinetic pedaling / 中华物理医学与康复杂志

Objective To document and analyze thepeak force and work during isokinetic pedaling at different linear speeds and the flexion-extension peak force ratio.Methods Thirty healthy adults were tested using the Legpress system of the IsoMED 2000 apparatus.Peak force,work and the flexion-extension peak force ratio were recorded and analyzed during isokinetic pedalingat 5 and 50 cm/s.Results The peak force applied and work done by the lower limbs were both significantly lowerwhen pedaling at 50 cm/s than at 5 cm/s.There was no significant difference in peak force or work between the left and right legs at 50 cm/s.The peak force ratio at 50 cm/s was significantly higher than at 5 cm/s.Conclusion The mechanical characteristics of the leg muscles during isokinetic pedaling vary greatly.It is advisable to choose different linear speeds or training modes accordingly.

Open and closed kinetic chain exercises promote the recovery of function after anterior cruciate ligament reconstruction / 中华物理医学与康复杂志

Objective To compare the clinical effects of open kinetic chain (OKC) exercises with those of closed kinetic chain (CKC) exercises and limited open kinetic chain combined with closed kinetic chain exercises on rehabilitation after the anterior cruciate ligament reconstruction.Methods Ninety-four patients recovering from single-bundle anterior ligament reconstructions were enrolled and randomly divided into an OKC group (n =33),a CKC group (n =30) or a limited open kinetic chain combined with closed kinetic chain group (combined group) (n =31).Lysholm score,International Knee Documentation Committee (IKDC) score,KT-1000,and active and passive range of motion were evaluated for the 3 groups three and six months after the surgery.Results Three months after surgery,significant differences were found among the 3 groups in Lysholm scores [(87.00±4.79),(83.67± 3.55) and (86.71±3.62) respectively],IKDC scores [(89.45±4.79),(86.40±3.76) and (88.58±3.60) respectively],KT-1000[(1.99±0.30),(1.05±0.26) and (1.02±0.24) mm],as well as active and passive range of motion [(10.06±2.06),(7.73±1.41) and (8.10±1.35) mm;(9.76±2.26),(7.87±1.89) and (8.39±1.62) mm] (P＜ 0.05).Six months after surgery,no significant differences were found in Lysholm scores and IKDC scores(P＞0.05),but significant differences were found in KT-1000,and active and passive range of motion(P＜0.05) compared to those at 3 months after surgery.Moreover,there were no significant differences between the OKC and combined groups in Lysholm scores and IKDC scores(P＞0.05),but significant differences between them in active and passive range of motion (P＜0.05).There were no significant differences between the CKC and combined groups in Lysholm scores,IKDC scores,KT-1000,and active and passive range of motion(P＜0.05).Conclusion Combining limited open kinetic chain exercise with closed kinetic chain exercise is safe and reliable in the rehabilitation after anterior cruciate ligament reconstruction.

Avaliação eletromiográfica de músculos da cintura escapular e braço durante a realização de exercícios com extremidade fixa e carga axial / Electromyographic assessment of scapular girdle and arm muscles during exercises with fixed boundary and axial load

O objetivo deste estudo foi comparar a atividade eletromiográfica de músculos da cintura escapular e braço entre os exercícios wall-press 90°, wall-press 45°, bench-press e push-up, realizados com a extremidade distal do segmento fixa sobre uma superfície estável e em esforço isométrico máximo. Participaram desta pesquisa 20 voluntários do sexo masculino, sedentários e sem história de trauma ou doenças na extremidade superior. A atividade elétrica da cabeça longa do músculo bíceps braquial, da porção anterior do músculo deltóide, da porção clavicular do músculo peitoral maior e do músculo serrátil anterior foi registrada por eletromiografia de superfície. O teste modelo estatístico ANOVA e o teste post-hoc de Tukey foram utilizados para determinar diferenças entre os valores de RMS de cada músculo e em cada exercício, normalizados pela contração isométrica voluntária máxima. Os resultados do presente estudo demonstram que o músculo bíceps braquial apresentou a menor atividade eletromiográfica em comparação com os demais músculos avaliados em todos os exercícios, enquanto a porção anterior do músculo deltóide e o serrátil anterior mostraram maior atividade eletromiográfica em relação aos demais músculos nos exercícios bench-press e push-up. Esses achados demonstram que não houve semelhança na atividade eletromiográfica dos músculos avaliados durante os exercícios, porém, houve coativação muscular, visto que os exercícios ativaram todos os músculos, mesmo que em diferentes níveis. Os exercícios estudados não são indicados para ativar o músculo bíceps braquial, mas os exercícios bench-press e push-up o são para ativar a porção anterior do músculo deltóide e o serrátil anterior; o wall-press 90° e o wall-press 45° são indicados para ativar a porção anterior do músculo trapézio.

The objective of this study was to compare the electromyography activity of scapular and arm muscles in the wall-press 90°, wall-press 45°, bench-press and push-up exercises, accomplished with the distal extremity of the segment on a stable surface and in maximum isometric effort. Twenty male sedentary (23±7 years), and without trauma history or diseases in the upper extremity volunteers participated in this research. The electric activity of the long head of the muscle biceps brachii, the anterior portion of the deltoid muscle, the clavicular portion of the pectoralis major and the serratus anterior muscle was registered by electromyography surface. The ANOVA and Tukey post hoc were used to determine differences between the RMS values of each muscle and in each exercise, normalized by the maximal voluntary isometric contractions. The results of the present study demonstrated that the biceps brachii muscle presented the smallest electromyographic activity in comparison to the other muscles in all exercises, while the anterior portion of the deltoid and the serratus anterior muscles presented larger electromyography activity in relation to the other muscles in the bench-press and push-up exercises. These findings demonstrate that there was not similarity in the electromyography activity of the evaluated muscles during the exercises; however, there was a muscular coactivation, since the exercises activated all muscles, even if at different levels. The studied exercises are not recommended for activation of the biceps brachii muscle; however, the bench-press and push-up exercises are recommended to activate the anterior portion of deltoid and serratus anterior muscles. Moreover, the wall-press 90° and the wall-press 45° are recommended for activation of the upper trapezius muscle.

Atividade eletromiográfica no agachamento nas posições de 40º, 60º e 90º de flexão do joelho / Electromyograhic activity in squatting at 40°, 60° and 90° knee flexion positions

O objetivo deste estudo foi comparar a atividade eletromiográfica (EMG) dos músculos reto femoral, bíceps femoral, tibial anterior e sóleo no agachamento, associando a posição de tronco ereto com 2 ângulos de flexão do joelho (40° e 60°) e a posição de tronco fletido a 45° com 3 ângulos de flexão do joelho (40°, 60° e 90°). Todas as combinações foram realizadas com e sem acréscimo de carga (10kg). A amostra foi composta por 12 indivíduos saudáveis com idade de 21,1 ± 2,5 anos e massa corporal de 62,8 ± 7,4kg. O EMG dos músculos citados foi registrado, isometricamente, em 10 posições de agachamento. Para a análise estatística foi aplicada ANOVA Two-Way de Friedman e o teste Post-Hoc de Newman-Keuls. Os resultados mostraram co-ativação entre os músculos reto femoral e bíceps femoral nas posições de tronco fletido e joelho em flexão de 40º e, entre os músculos reto femoral e sóleo, nas demais posições (p < 0,05). Houve co-ativação entre o tibial anterior e bíceps femoral com o joelho a 40º, com o tronco ereto e fletido e, entre o tibial anterior e sóleo, nas demais posições (p < 0,05). Quanto à ativação muscular isolada, a maior flexão do joelho no agachamento foi um fator determinante para maior ativação dos músculos, exceto para o sóleo. A posição do tronco e a carga adicional de 10kg influenciaram a ativação muscular do reto femoral, a 60° de flexão de joelho, na qual o tronco ereto proporcionou maior ativação. E para o bíceps femoral, a 40° de flexão de joelho, na qual o tronco flexionado proporcionou maior ativação. A co-ativação entre o reto femoral e o bíceps femoral na posição de tronco fletido, e entre o reto femoral e o sóleo nas demais posições, apontam para novas possibilidades de exercícios na reabilitação.

The aim of this study was to compare the electromyographic (EMG) activity of the femoris rectus, femoris biceps, tibialis anterior and soleus muscles in squatting, associating the trunk in erect position with two angles of knee flexion (40° and 60°) and the trunk at 45° flexion with three angles of knee flexion (40°, 60° and 90°). All associations were performed with and without additional load (10 kg). The sample was composed of 12 healthy individuals with mean age of 21.1 ± 2.5 years and weight of 62.8 ± 7.4 kg. The EMG of the cited muscles was isometrically registered in 10 squatting positions. For statistical analysis, Friedman Two-Way ANOVA and the Newman-Keuls Post-Hoc test were used. The results showed co-activation between the femoris rectus and femoris biceps muscles with the trunk in flexion and at 40° of knee flexion and between the femoris rectus and soleus muscles in the other positions considered (p < 0.05). It was also possible to observe co-activation between tibialis anterior and femoris biceps muscles with knee at 40° and 60° of flexion, with the trunk erect and in flexion and between the tibialis anterior and soleus muscles in the other positions (p < 0.05). Concerning isolated muscular activation, higher knee flexion in squatting was an important factor to greater muscles activation, except for the soleus. Trunk position and the additional load of 10 kg have influenced in the muscular activation of the femoris rectus at 60° of knee flexion, in which the erect trunk provided more activation. The femoris biceps presented greater activation when the knee was in 40° of flexion and the trunk flexioned. The co-activation between the femoris rectus and biceps with the trunk in flexion, and between the femoris rectus and soleus in the other positions, lead to new possibilities of exercises in rehabilitation.

Correlation between Maximal Inclination of Sliding Rehabilitation Machine and Gait Parameters

OBJECTIVE: To investigate the relationship between variables measured by sliding rehabilitation machine and gait parameters in hemiplegic stroke patients. METHOD: Thirty-two patients with hemiplegia due to stroke were included in this study. Maximal inclinations of sliding rehabilitation machine where each patient could extend their knee and plantarflex their ankle, and the ratio of the load in affected lower limb to total body weight were measured. Clinical parameters such as functional ambulation classification, 10 meter walking time, timed up and go test, Berg balance scale, modified Barthel index, and manual muscle test were evaluated. We investigated correlations betweenvariables measured by sliding rehabilitation machine and gait parameters using Pearson test. RESULTS: Maximal inclination of sliding rehabilitation machine and the ratio of the load in affected lower limb to total body weight were significantly correlated with almost all measured clinical parameters. CONCLUSION: Sliding rehabilitation machine could be a useful and objective method to measure the closed kinetic chain strength and function of affected lower limb including gait in patients with hemiplegia due to stroke.