Footwear and posture. Compensatory strategies for heel height.

The belief that wearing high-heeled shoes increases lumbar lordosis is firmly ingrained in clinical folklore. Proponents of negative heel footwear argue that because high positive heels increase the lumbar lordosis, negative heels will decrease the lumbar lordosis. Quantitative documentation of the assumption regarding high heels is not to be found in the literature, although sporadic attempts to prove this assumption have been made throughout the 20th Century. Although other effects, such as decreased gait speed and step length, and increased knee flexion at heel strike have been found in more than one study, no increase in lumbar lordosis has been found. Where an actual decrease in lordosis has been found, authors tend to explain it away as inconsistent with what every clinician feels that he or she has observed. We felt it appropriate, then, to conduct both a static and a dynamic study to assess the effects of heel height on lumbar spine and lower limb joint kinematics in the sagittal plane, as well as other strategies to compensate for heel height. The results indicate that the greatest compensation is at the ankle and knee. Where a significant effect occurred in the lumbar spine (males, dynamic study), high heels decreased the lumbar lordosis, i.e., resulted in less swayback rather than more.

Torque development in isokinetic training.

Twenty men were randomized into three groups that performed maximal isokinetic knee extensions five days a week for 12 weeks; a fourth group was a control group. The training protocol was different for the opposite lower extremity of each subject, such that subjects in group I trained at 36 degrees/sec with 20 or 60 repetitions, group II did 20 repetitions at 36 degrees/sec with one limb and 60 repetitions at 108 degrees/sec contralaterally, and group III trained at 108 degrees/sec with 20 or 60 repetitions. Group IV did no training. Bilateral pretraining and posttraining vastus lateralis muscle biopsies were done, and maximal torque-velocity tests (0 degrees to 234 degrees/sec at 18 degrees/sec steps) were performed every two weeks. The muscle biopsies were examined for muscle-fiber area and enzyme activity. Statistical analysis of the torque-velocity curves showed that subjects who trained at 36 degrees/sec made significant overall gains in torque and significantly greater torque gains than those training at 108 degrees/sec. Torque gains were not made uniformly during the 12 weeks of training; they occurred primarily during the initial 4 to 8 weeks. There were no significant increases in muscle-fiber areas in response to training, but there were increases in glycolytic and mitochondrial enzyme activities. These findings suggest that the critical variable for developing strength (maximal torque), at least within the context of isokinetic training, is the amount of torque developed during training.

Effect on maximal strength of submaximal exercise in Duchenne muscular dystrophy.

Four Duchenne muscular dystrophy patients, with quadriceps of at least antigravity strength, exercised one quadriceps submaximally 4 or 5 days per week for six months. The exercise was done under supervision and consisted of extending one knee from 90 degrees to full extension using the Cybex isokinetic exerciser. The other side was not exercised at all. The two sides were tested for maximal isokinetic strength monthly for twelve months and at 18 and 24 months after the beginning of the study. On the average, the exercised leg had a greater maximal torque both during and after the exercise period until the torques on both sides decreased to zero. The results indicate that submaximal exercise has no negative effect and may be of limited value in increasing strength in Duchenne muscular dystrophy.