Comparison of Muscle Activation and Co-Contraction Patterns for Trunk Muscles During Four-Point Hand-Knee and Hand-Foot Kneeling Positions / 医用生物力学

Objective To analyze the similarities and differences between four-point hand-knee position and hand-foot kneeling positions in trunk muscle activation and co-contraction, explore the possibility of hand-foot kneeling position as core stabilization exercises, so as to provide suggestions for actual training.Methods Nineteen healthy volunteers randomly performed exercises of four-point hand-knee position (4 motions) and hand-foot kneeling position (3 motions), while surface electromyography (sEMG) signals were collected from bilateral rectus abdominis, external oblique, erector spine, and multifidus muscles. The average sEMG and muscle co-contraction index (CCI) based on the sEMG signals were analyzed and compared.Results Significant differences were found in the sEMG and CCI within and between the two positions. Under four-point hand-knee position with the right hand and left leg lifting, the activation of all muscles was higher than that in the starting position. In four-point hand-knee position with the left leg lifting, the activation of ipsilateral multifidus muscle was significantly higher than that in hand-foot kneeling position. The activation degree of external oblique muscle and rectus abdominis was higher in hand-foot kneeling position with right hand lifting. A total of 28 muscle matching methods were obtained by pair-to-pair matching of 8 muscles. The starting posture in four-point hand-knee position fluctuated the least, indicating that the spine was the most stable, while the index of other exercises fluctuated in a larger range.Conclusions The possibility of hand-foot kneeling position as core stabilization exercises was proved from two aspects, namely, muscle activation and CCI. The hand-foot kneeling position and four-point hand-knee position can be used for strengthening abdominal muscles and back muscles, respectively. The four-point hand-knee position with contralateral upper and lower limbs lift is a more advanced exercise for trunk muscles, but sports injuries should be avoided.

Occupational Exposure to Knee Loading and the Risk of Osteoarthritis of the Knee: A Systematic Review and a Dose-Response Meta-Analysis

BACKGROUND: Osteoarthritis of the knee is considered to be related to knee straining activities at work. The objective of this review is to assess the exposure dose-response relation between kneeling or squatting, lifting, and climbing stairs at work, and knee osteoarthritis. METHODS: We included cohort and case–control studies. For each study that reported enough data, we calculated the odds ratio (OR) per 5,000 hours of cumulative kneeling and per 100,000 kg of cumulative lifting. We pooled these incremental ORs in a random effects meta-analysis. RESULTS: We included 15 studies (2 cohort and 13 case–control studies) of which nine assessed risks in more than two exposure categories. We considered all but one study at high risk of bias. The incremental OR per 5,000 hours of kneeling was 1.26 (95% confidence interval 1.17–1.35, 5 studies, moderate quality evidence) for a log-linear exposure dose-response model. For lifting, there was no exposure dose-response per 100,000 kg of lifetime lifting (OR 1.00, 95% confidence interval 1.00–1.01). For climbing, an exposure dose-response could not be calculated. CONCLUSION: There is moderate quality evidence that longer cumulative exposure to kneeling or squatting at work leads to a higher risk of osteoarthritis of the knee. For other exposure, there was no exposure dose-response or there were insufficient data to establish this. More reliable exposure measurements would increase the quality of the evidence.

Effects of Single Kneeling Trunk Intensive Training on Balance in Patients with Pusher Syndrome after Stroke / 中国康复理论与实践

Objective To observe the effect of single kneeling position trunk intensive training on the balance of patients with stroke Pusher syndrome. Methods From January, 2014 to February, 2016, forty patients with stroke Pusher syndrome were randomly divided into observation group and control group equally. They all accepted routine rehabilitation, while the observation group added a trunk intensive training with one knee kneeled. They were assessed with Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA) of lower limb and Sheikh's Scale of Trunk Control before and after training. Results The scores of BBS, lower limb FMA and trunk control improved in both groups after eight weeks of treatment (t>1.756, P1.827, P<0.05). Conclusion Single kneeling trunk intensive training can effectively improve the balance in stroke patients with Pusher syndrome.

Biomechanics of Hyperflexion and Kneeling before and after Total Knee Arthroplasty

The capacity to perform certain activities is frequently compromised after total knee arthroplasty (TKA) due to a functional decline resulting from decreased range of motion and a diminished ability to kneel. In this manuscript, the current biomechanical understanding of hyperflexion and kneeling before and after TKA will be discussed. Patellofemoral and tibiofemoral joint contact area, contact pressure, and kinematics were evaluated in cadaveric studies using a Tekscan pressure measuring system and Microscribe. Testing was performed on intact knees and following cruciate retaining and posterior stabilized TKA at knee flexion angles of 90degrees, 105degrees, 120degrees, and 135degrees. Three loading conditions were used to simulate squatting, double stance kneeling, and single stance kneeling. Following TKA with double stance kneeling, patellofemoral contact areas did not increase significantly at high knee flexion angle (135degrees). Kneeling resulted in tibial posterior translation and external rotation at all flexion angles. Moving from double to single stance kneeling tended to increase pressures in the cruciate retaining group, but decreased pressures in the posterior stabilized group. The cruciate retaining group had significantly larger contact areas than the posterior stabilized group, although no significant differences in pressures were observed comparing the two TKA designs (p < 0.05). If greater than 120degrees of postoperative knee range of motion can be achieved following TKA, then kneeling may be performed with less risk in the patellofemoral joint than was previously believed to be the case. However, kneeling may increase the likelihood of damage to cartilage and menisci in intact knees and after TKA increases in tibiofemoral contact area and pressures may lead to polyethyelene wear if performed on a chronic, repetitive basis.

In Vivo Biomechanics Using Dual Orthogonal Fluoroscopy after Posterior Stabilized Total Knee Arthroplasty / 대한정형외과연구학회지

This study investigated the six degrees of freedom (DOF) kinematics and three-dimensional (3D) contact during kneeling after total knee replacement arthroplasty. A total of 16 South Korean female patients (22 knees) after posteriorly stabilized (PS) TKA (LPS-Flex) performed by a single surgeon were randomly recruited. The patients were imaged using a dual fluoroscopic technique while they were kneeling from initial to maximum flexion. The acquired images and 3D models were then used to recreate the in vivo pose of the components Patients flexed their knee, on average, from 107.3degrees to 128.0degrees during the kneeling activity. Changes in kinematics included proximal, medial, posterior translation and varus rotation. Articular contact moved posteriorly by 5.9 mm and 6.4 mm in the medial and lateral compartments, respectively. Contact also moved medially by 3.2 mm and 5.8 mm in the medial and lateral compartments. A decrease in articular contact was observed in both condyles, and lateral condylar lift-off increased with flexion (P=0.0001). The tibiofemoral and cam/post articular contact data acquired in this study further suggest that kneeling may be performed by patients after clinically successful PS TKA who feel comfortable with activity and are free of