Differences in lower extremity alignment between males and females. Potential predisposing factors for knee injury.

AIM: The goal of this study was to compare measures of lower extremity alignment between males and females, which may account for gender differences in anterior cruciate ligament injury rates. Static lower extremity alignment has been implicated as predisposing individuals to anterior cruciate ligament injury and may vary between males and females. An initial step in identifying relevant risk factors for injury is to determine those factors that vary between genders. METHODS: Thirty male and 27 female college aged individuals with no history of lower extremity injury participated. Three indices of lower extremity alignment were measured on each subject: quadriceps angle, thigh foot angle, and subtalar joint range of motion ratio. RESULTS: Q-angles in females exceeded values for males by 4.4 degrees (p<0.001). Thigh foot angle for females was 3.6 degrees greater than for males (p=0.020). Subtalar joint movement ratio did not vary between genders (p=0.573). CONCLUSION: Previous research suggests that abnormal alignment may predispose individuals to anterior cruciate ligament injury. The present findings may help to explain the difference in anterior cruciate ligament injury rates between males and females. Any tangible links between lower extremity alignment and anterior cruciate ligament injury rates must be confirmed with prospective studies.

Acute effects of locomotor training on overground walking speed and H-reflex modulation in individuals with incomplete spinal cord injury.

OBJECTIVE: The purpose of this study was to assess the effect of a single bout of a locomotor-training paradigm on overground walking speed and H-reflex modulation of individuals with incomplete spinal cord injury (SCI). METHODS: Self-selected and maximum walking speeds and soleus H-reflexes (H/M ratios) during standing and stance and swing phases of walking (self-selected velocity) were obtained from 4 individuals with American Spinal Injury Association impairment classification D. Data were collected immediately before and after a single bout of locomotor training with body weight support on a treadmill. The pretraining H/M ratios of the SCI subjects were also compared with values from 4 able-bodied subjects who did not receive the intervention. Maximum H/M ratios while standing and during midstance and midswing phases of overground walking were considerably greater in the SCI subjects than in the control subjects. RESULTS: After the single bout of training, self-selected and maximum overground walking speeds of the subjects with SCI increased by 26% and 25%, respectively. Furthermore, H-reflexes were significantly more depressed in the SCI subjects during overground walking (28% less during stance, 34% less during swing). CONCLUSIONS: Although preliminary, these findings indicate that a single bout of locomotor training produced immediate increases in walking velocity and acute neurophysiologic changes in individuals with incomplete SCI.

Modulations of soleus H-reflex excitability during gait initiation: central versus peripheral influences.

Soleus and tibialis anterior electromyogram (EMG) and soleus H-reflexes were recorded from the stance limb of an individual who suffered a traumatic peroneal nerve injury and of four nonimpaired individuals during gait initiation. The control subjects also initiated walking after swaying forward (sway-gait initiation), which eliminated the initial tibialis anterior activation. During the initial period of gait initiation, H-reflexes were depressed to 43% of standing values during normal-gait initiation and 86% during sway-gait initiation in the nonimpaired subjects. H-reflexes of the nerve-injured subject were depressed to 37%, even though no tibialis anterior EMG was observed. The findings support the view that reciprocal inhibition of the soleus during a task, which normally involves tibialis anterior activation, is due to a centrally mediated process.

Facilitation of quadriceps activation following a concentrically controlled knee flexion movement: the influence of transition rate.

STUDY DESIGN: Single group repeated measures design. OBJECTIVE: To determine if the rate of transition between knee flexion and extension influences the subsequent concentric activation of the quadriceps and knee extension torque during reciprocal movements. BACKGROUND: Preloading a muscle by stretching, a prior isometric or eccentric muscle action, or a prior movement controlled concentrically by the antagonist muscle group increases the maximal torque-generating capability of the agonist. We hypothesized that the rate of transition from the prior movement may be the critical factor that influences the degree of muscle facilitation and torque potentiation. Rapid reversal of antagonistic movements has been postulated as a potential facilitatory mechanism. METHODS: Knee extension torque and electromyographic (EMG) amplitude (dependent variables) from 2 of the vasti muscles were recorded while subjects (N = 20; 12 men, 8 women, mean age, 28.5+/-2.68 years) maximally activated their quadriceps at 3 constant angular velocities, 100 degrees/s, 200 degrees/s, and 300 degrees/s, and 2 preload conditions, SLOW and RAPID (independent variables). In the SLOW transition condition, subjects actively flexed their knee to 110 degrees from an extended position, paused in this position for 3 seconds, and then extended to 0 degrees. In the RAPID transition condition, the same movement from knee flexion to extension was performed without a pause. RESULTS: Peak torque, the root-mean-square (RMS) average, peak (peak rectified and smoothed), and initial (100 milliseconds prior to torque onset) EMG amplitudes were all significantly greater during the RAPID transition condition. Peak torque decreased with increasing movement velocity. There were no interactions between the preload conditions and angular velocity on peak torque or the EMG amplitude variables. There was also no influence of velocity on the EMG amplitude variables. CONCLUSIONS: The effect of preloading the quadriceps by prior concentric activation of the hamstrings is dependent on the rate of transition between the flexion and extension movements and is due primarily to neural facilitation.

Effect of a reduced base of support in standing and balance training on the soleus H-reflex.

The present study provides evidence that a reflex at the segmental level can adapt over a two hour experiment in a functionally appropriate manner in response to a balance training task. Subjects (N=9) received soleus (S) H-reflexes in blocks of seven trials while free standing on a normal base-of-support (NBOS) and while standing on a plafform with a reduced base-of-support (RBOS) in the sagittal plane. During the RBOS condition, the H-reflex served as a postural perturbation. Subjects were instructed to suppress the H-reflex when it was evoked, as an attempt to maintain a balanced state. Background EMG from the S and tibialis anterior muscles, the S M-wave, and stimulus current were maintained at a constant level during the experiment. Subjects initially received a block of NBOS trials, followed by 4 RBOS blocks (training), a second NBOS block, four additional RBOS blocks, and a third NBOS block with the protocol repeated on three different days (D1, D2 and D3) within the same week. The S H/M ratio was depressed 9% upon standing on the RBOS. With training the S H/M ratio decreased by 22% on Dl, 18% on D2 and 6% on D3. The ratio between the H-reflex and background S EMG (H-reflex gain) decreased 10% on D1, 40% on D2 and 23% on D3 when the first NBOS and first RBOS blocks were compared. Due to a slight increase in the S EMG across blocks, the H-reflex gain decreased considerably more across blocks than the H/M ratio. Although the S H/M ratio underwent an 7% decrease from D1 to D3, the differences were not significant. Individually, however, six of the nine subjects decreased their H/M ratios from 12-42% across days. The results may reflect the inception of longer-term adaptations of the segmental stretch reflex system.

Differential control during maximal concentric and eccentric loading revealed by characteristics of the electromyogram.

Maximal eccentric loading has been associated with higher levels of spindle afferent activity but lower levels of integrated EMG as compared to maximal concentric loading. Elbow flexor EMG was recorded from 17 subjects during concentric (CONC) and eccentric (ECC) elbow flexion at 70 degrees s(-1) using a Kin-Com dynamometer. We hypothesized that peak EMG amplitude would be more sensitive to fluctuations in facilitation by the spindle primary afferents via the segmental stretch reflex pathway, and that the mean EMG would be more reflective of the ongoing level of muscle activation. A ratio of peak to mean EMG (P/M EMG ratio) was predicted to be larger during maximal eccentric loading than maximal concentric loading. The peak EMG (P<0.013) and the P/M EMG ratio (P<0.001) were significantly greater during the ECC condition than the CONC condition. In a subgroup of three subjects who underwent 3 weeks of eccentrically biased weight training, EMG, peak torque and torque variability were assessed before and after training. P/M EMG ratio decreased, while peak torque and torque variability increased following the training. Differences in the P/M EMG ratio appear to reflect differences in the way eccentric and concentric muscle actions are controlled and do not simply represent less control during the eccentric task.

Reflex facilitation during the stretch-shortening cycle.

Maximal torque during the concentric phase of a movement has been shown to be enhanced by prior eccentric muscle actions, a movement strategy referred to as the stretch-shortening cycle. Although the mechanical basis for this enhancement is well established, the neural component is not. We hypothesized that brief high-frequency bursts of spindle afferent discharge during the eccentric phase of the stretch-shortening cycle could be one mechanism for facilitating the volitional drive. To test this hypothesis, three sets of experiments were done. In the first (N=15), we demonstrated that both the peak and mean EMG of the soleus (S) and lateral gastrocnemius (LG) muscles were considerably greater during a reciprocal hopping (RHOP) task than for maximum isometric contractions (MIVCs). In the second experiment, we tested whether the dynamic nature of the RHOP or the eccentric phase of the RHOP contributed to the EMG potentiation. Peak and mean EMG produced with a concentric hop (CHOP), in which the lengthening phase of the hop was eliminated, were compared with that produced with the RHOP and MIVCs conditions (N=7). The RHOP produced greater peak EMG than either the CHOP or the MIVCs while the mean EMG for both hopping conditions was considerably more than the MIVCs. In the final experiment, we attempted to mimic the brief high-frequency burst of spindle afferent activity during the lengthening phase of the stretch-shortening cycle in the absence of muscle length changes. High-frequency (100 Hz) afferent stimulation (HFS) was delivered during MIVCs. At rest, the HFS produced negligible EMG activity but when superimposed over MIVCs produced a marked potentiation of the S EMG over values obtained during MIVCs alone. Evidence that HFS synchronizes the EMG associated with volitional activation is also provided. We conclude that a substantial but brief facilitation and possible synchronization of the neural drive is provided by the spindle afferents during the eccentric phase of the stretch-shortening cycle.

Effect of oral creatine supplementation on isokinetic torque production.

PURPOSE: This study was conducted to examine the effect of oral creatine supplementation on the decline in peak isokinetic torque of the quadriceps muscle group during an endurance test. METHODS: Twenty-three active, but untrained, male subjects performed isokinetic strength tests on a Cybex II dynamometer at 180 degrees x s(-1). The protocol consisted of pre- and post-tests with five sets of 30 maximum volitional contractions with a 1-min rest period between sets. Subjects returned to perform the posttest after 5 d of placebo (4 x 6 g glucose x d(-1), N = 12) or creatine (4 x 5 g creatine + 1 g glucose x d(-1), N = 11) supplementation. Supplements and testing were administered in a double blind fashion. Peak torque was measured during each contraction and the 30 contractions were averaged for each set. RESULTS: A three-way mixed ANOVA with one between factor (placebo vs creatine) and two within factors (pre/post supplementation and sets 1-5) revealed no significant interactions, P > 0.05. The placebo vs creatine main effect was also nonsignificant, whereas the pre/post and set effects were significant (P < 0.05). Peak torque increased (approximately 3%) from pre- to post-testing, (P = 0.04), but the absolute magnitude of the differences is unlikely to be of any practical significance. Peak torque decreased from sets 1 to 4, whereas sets 4 and 5 were not different. A priori contrasts comparing the creatine group's performance pre vs post test for the fourth and fifth sets were nonsignificant (P > 0.05). CONCLUSIONS: Based on within and between group comparisons, we were unable to detect an ergogenic effect of oral creatine supplementation on the decline in peak torque during isokinetic exercise at 180 degrees x s(-1).

Effects of isometric quadriceps activation on the Q-angle in women before and after quadriceps exercise.

STUDY DESIGN: Single-group test-retest design with correlation analysis. OBJECTIVES: (1) To confirm that the Q-angle decreases with isometric quadriceps activation (IQA), (2) to determine if the decrease in the Q-angle with IQA is related to the magnitude of the Q-angle at rest, and (3) to determine if a vigorous bout of exercise affects the change in the Q-angle with IQA. BACKGROUND: The Q-angle represents an estimate of the resultant force of the quadriceps on the patella and is a predictor of lateral movement of the patella under dynamic conditions. METHODS AND MEASURES: Q-angles were assessed in 22 nonimpaired women (mean +/- SD age, 22.3 +/- 4.9 years) while standing relaxed and during IQA. Subjects then rode a cycle ergometer until a preset number of repetitions per minute was unable to be maintained. Q-angles were again assessed while subjects were relaxed and during IQA. RESULTS: There was a significant decrease (mean +/- SD, 5.7 +/- 4.2 degrees) in the Q-angle with IQA compared with relaxed standing. There was a significant relationship (r=0.72) between the Q-angle at rest and the change with IQA. The cycle ergometer exercise resulted in a small (0.5 degrees) but significantly greater decrease in the Q-angle with IQA compared with relaxed standing. CONCLUSIONS: The Q-angle decreases with IQA, and the magnitude of this decrease is dependent on the magnitude of the Q-angle at rest. Our findings support the view that an excessive Q-angle may predispose women to greater lateral displacement of the patella during vigorous activities and sports in which the quadriceps muscle is stressed.

Modulation of triceps surae H-reflexes as a function of the reflex activation history during standing and stepping.

The facilitatory effectiveness of spindle afferent feedback is controlled by modulation of segmental reflex excitability such that the level of muscle activation is appropriate for the task. Phase-dependent modes of reflex modulation have been well-characterized. We hypothesized that segmental reflex excitability of the triceps surae was also modulated in a manner associated with the activation history of the spindle afferents and the segmental reflex pathway during isometric contractions, standing and stepping. In the first experiment. pairs of soleus (S) H-reflexes were evoked 80 ms apart with equal strength stimuli at rest and while subjects isometrically contracted their S against loads of 10%. 20%. and 50% of their maximum voluntary efforts. The percent depression of the second H-reflex relative to the first was used as a measure of the effect of reflex activation history. At rest, the second H-reflexes were depressed an average of 73% relative to the first. The degree of depression was progressively reduced as the plantarflexion torque increased. In the second experiment, paired H-reflexes were obtained from the S and medial (MG) and lateral gastrocnemii (LG) muscles while subjects were standing and during the stance phase of step initiation. The degree of depression of the second H-reflex during standing ( > 78%) was similar in magnitude to that produced at rest in Experiment I. At the end of the stance phase of stepping. depression of the second H-reflex of all three muscles was reduced to less than 25%. We conclude that the segmental reflex excitability is modulated as a function of the reflex activation history during these tasks.

Postural modulation of the segmental reflex: effect of body tilt and postural sway.

This purpose of this study was to clarify the relationship between segmental reflex excitability and posture and to investigate potential mechanisms responsible for modulation of the H-reflex (HR) in unsupported standing. Soleus (S) and lateral gastrocnemius (LG) HRs were recorded from subjects (N=12S, N=11LG) while their static posture was altered from supine to vertical (5 positions). This was compared to an unsupported standing position in which the subjects naturally underwent a small degree of postural sway, a dynamic posture condition. Although individual profiles suggested varied relationships between the S and LGHR and the angle of body tilt, the group data did not reveal significant differences. There was, however, a significant (p < .01) decrease in the S (43% 49%) and LG (34%-46%) HR when subjects stood without support compared to all static postures. This decrease occurred even though the tonic or background activity of the S and LG was present only when subjects were free standing. To determine whether weight-bearing was responsible for the HR depression, 3 additional conditions were compared (N=3), supported standing without weight-bearing (90 degrees NWB), supported standing with weight-bearing (90 degrees WB), and free standing. Again, S and LGHRs were depressed only when subjects were free standing. Presynaptic inhibition presumably accounts for the depression of the HR in unsupported standing. Data from 8 of the subjects were collected under the same 6 conditions using a shorter interstimulus interval (1 Hz stimulus instead of 0.1 Hz) which produced low frequency depression (LFD) of the S and LG HR. LFD reduced the amplitude of the S HR an average of 43% (p < .05) when subjects were in a supported static position but only 21% when subjects were free standing. Although tonic activity of the S was present only when subjects were free standing, in 2 (of 8) individuals the EMG in free standing was not measurably different from static conditions. In these individuals, free standing still depressed the SHR by 35%; however, the shorter stimulus interval now produced the same degree of LFD when subjects were free standing (35%) as when they were standing with support (37%). The data suggest that 2 presynaptic mechanisms, although independent, interact to control spindle afferent feedback when subjects are free standing. Postural sway appears to be necessary to reduce the gain of the HR when subjects are standing, whereas, LFD is influenced by the degree of muscle activation.

The effect of treadmill gait training on low-frequency depression of the soleus H-reflex: comparison of a spinal cord injured man to normal subjects.

H-Reflex recruitment curves were obtained at 0.1 and 1 Hz in the right soleus of an incomplete SCI man before and after training and on 12 neurologically normal individuals. Low frequency depression (LFD) was calculated by the formula: 1 - (H-wave amplitude at 1 Hz/0.1 Hz) x 100. Training consisted of treadmill walking at the speed matching his overground fast walking. The subject trained for 30 min every other day for 10 days under supervision and then continued three times a week for 4 months at a health club. Maximum H/M ratio of the right soleus (78%) was greater than that of the normals (67%) and did not change following training (79%). The mean LFD of the SCI subject was 24% prior to training compared to 42% for the normal subjects. Following training, LFD increased to 35%. In addition, the reflex threshold appears to have increased following training. This was accompanied by 47 and 45% increases in the subject's self selected and fast gait velocities, respectively. We conclude that training adaptations enabled the SCI subject to increase his gait velocity due to an improved ability to gate peripheral afferent feedback during gait.

Postexercise potentiation of the H-reflex in humans.

UNLABELLED: Post-muscle activation effects on segmental reflexes reveal divergent results dependent upon the manner in which the muscle is activated. Electrically activating triceps surae invokes a potentiation of the Achilles' tendon reflex and the soleus (S) H-reflex termed posttetanic potentiation. In contrast, brief volitional activation produces a subsequent potentiation of tendon reflexes, whereas H-reflexes become depressed. PURPOSE: The present investigation explored the effect of an intense bout of volitional resistance exercise on the S and lateral gastrocnemius (LG) H-reflexes to determine if a potentiation of the H-reflex could be induced with physiological stimuli. METHODS: LG and S H-reflexes were obtained from 10 college age men and women before and after a vigorous bout (eight sets of 10 repetitions) of concentric-eccentric triceps surae exercise. RESULTS: Every subject displayed an initial depression of the LG (P < 0.01) and S H-reflex (P < 0.05) immediately postexercise, consistent with postactivation depression. As a group, there was a significant (P > 0.01) potentiation of the LG H/M ratio following the depression. Five of 10 subjects demonstrated this potentiation, which often lasted 10 min postexercise. The other five subjects displayed a longer and more profound early depression followed by a return to control levels. CONCLUSION: The data suggest that at least two overlapping processes are occurring, a brief depression followed by or superimposed over a longer lasting potentiation. Possible neural mechanisms and implications to strength training are discussed.

Postural modulation of the soleus H reflex in young and old subjects.

The influence of different static postures on the soleus H reflex was assessed in 15 old (mean age = 76.3 years) and 10 young (mean age = 24.2 years) subjects. H reflex and M wave recruitment curves were obtained under 2 randomly administered conditions: (1) standing; and (2) prone. Once in place, the recording and stimulating electrodes were not removed until the completion of testing, to ensure that exact placement was maintained. A 1 msec current pulse was given transcutaneously to elicit the H reflex and M response. Static postural sway area (cm2) was assessed on a Kistler force platform using custom software (sample rate = 50 Hz/15 sec trials). Results demonstrated that the young subjects reduced the amplitude of the H reflex from the prone (Hmax/Mmax = 73.6%) to the standing (Hmax/Mmax = 59.9%) condition, whereas the old subjects did not (prone = 32.4%, standing = 38.2%). However, within the old group, 2 subgroups emerged--those who depressed the reflex similar to the young subjects (O-D, n = 6) and those who did not depress the reflex (O-ND, n = 9). Furthermore, there were significant differences in postural sway scores between the young and old, between the O-D and O-ND, but not between the O-D and young groups. These results suggest differences in the manner in which young and old subjects modulate the soleus H reflex when standing, and support the view that modulation of the stretch reflex may be important in the control of static posture.

Modulation of the triceps surae H-reflex with training.

Thirteen neurologically healthy adults were asked to balance on a specially designed balance board. This board allowed rotation in the sagittal plane only. Muscle activity of the triceps surae and tibialis anterior was sampled at 2 kHz and recorded. When the subject was balanced, soleus H-reflexes were elicited in the right leg with a constant-current stimulus pulse. The peak to peak amplitude of the soleus H-reflex served as the perturbation to the subject's balance as well as the dependent variable in question. Subjects performed three blocks (7 H-reflexes/block) of standing control trials with the balance board supported, and seven blocks of balancing trials. Prior to each block, maximal M-waves were recorded to ensure electrode stability across blocks. Results indicated that the subjects were able to significantly reduce (p < .001) the gain the soleus H-reflex while balancing and after the balance training. As a group, the subjects decreased their peak to peak amplitude of the soleus H-reflex by 26.2 percent from the initial standing block to the last balancing block. Moreover, subjects were also able to significantly reduce the gain of their standing control H-reflexes, supporting the notion of longer-term adaptability of the spinal stretch reflex. It is concluded that the progressive reduction in the H-reflex gain with short-term training may represent functional adaptation in the central nervous system.

Inhibition of the soleus H-reflex in standing man.

There exists evidence to support the notion that the segmental reflex system is not fixed and inflexible, but rather is highly modifiable under a variety of circumstances. In this study the H-wave and M-wave recruitment curves were obtained from 19 subjects, utilizing the procedures outlined by Hugon. Each subject was tested on one day under two randomly administered conditions: (1) standing; and (2) prone. Once in place, the recording and stimulating electrodes were not removed until the completion of the study, to ensure that exact placement was maintained. A percutaneous electrical stimulus (1 ms pulse) was utilized to elicit the pulse. The current was monitored with a current probe, and was increased in 2 mA increments from zero until a maximal M-wave was obtained. An analysis of variance revealed significant increases in the amplitude of the H-wave (P < 0.05) when the subject was prone with no significant increases in the M-wave. The results indicate significantly higher H/M ratios with the subjects in the prone position. Therefore, it is concluded that H-reflex amplitude is tonically depressed when the subject is maintaining a standing position.

Mechanisms underlying the training effects associated with neuromuscular electrical stimulation.

Although neuromuscular electrical stimulation (NMES) can increase the ability of muscle to exert force, the means by which this is accomplished seem to be different from those associated with voluntary exercise. The aim of the study was to determine whether the recruitment order of motor units elicited by over-the-muscle electrical stimulation is different from that achieved with voluntary activation of muscle. This difference was tested by comparing muscle twitch responses that were elicited by Hoffmann reflexes (H-reflexes) and direct motor responses (M-responses) and by examining the effect of submotor NMES on the twitch force associated with H-reflexes. Because H-reflexes represent the summed activity of many motor units, in a manner that is consistent with volitional activation, variation in the time to peak twitch force indicates changes in the population of motor units that contribute to the response. The results demonstrated that the percutaneous application of submotor NMES to the limbs of human subjects causes a faster-contracting population of motor units to be activated during a test H-reflex. Consequently, it seems that the application of NMES preferentially activates faster-contracting motor units, perhaps those that are normally only active at high exercise intensities under voluntary conditions.