Structural and physical-functional deficits in lower limbs with fractures and treated surgically

Abstract Introduction: A fracture is a traumatic bone injury that can occur from a variety of causes. Although the repercussions of fractures on the musculoskeletal system are documented, studies with more comprehensive outcomes and later stages of injury are still scarce. Objective: To evaluate the structural and physical-functional adaptations in individuals who suffered unilateral lower limb fractures treated surgically. Methods: Thirty-two patients of both genders, aged between 18 and 59 years, with a diagnosis of unilateral fracture of the lower limb and hospital discharge of at least one year, participated in the study. The affected lower limb was compared to the healthy lower limb of all participants using the outcome measures: vastus lateral muscle thickness (ultrasonography), knee extension and flexion strength (isokinetic dynamometer), ankle dorsiflexion range of motion of the distance from the foot to the wall) and functional fitness of the lower limb (single and triple horizontal jump test). Results: Statistically significant differences were found between the limbs affected and not affected in the measurements of muscle thickness (p = 0.0001), knee extension force (p = 0.0094), dorsiflexion amplitude (p = 0.0004) and functional performance (p = 0.0094, single jump and = 0.0114, triple jump). In all significant outcomes, the values of the affected limb were smaller than that of the non-affected limb. The peak torque of the knee flexor muscles did not show a statistically significant difference between limbs (p = 0.0624). Conclusion: Individuals who have undergone a surgically treated unilateral fracture of the lower limb present important structural and physical-functional late changes in relation to the non-affected limb.

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Effects of Adding Inter-Set Static Stretching to Flywheel Resistance Training on Flexibility, Muscular Strength, and Regional Hypertrophy in Young Men

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073770 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3770

Author(s):

Masatoshi Nakamura ◽

Hirotaka Ikezu ◽

Shigeru Sato ◽

Kaoru Yahata ◽

Ryosuke Kiyono ◽

...

Keyword(s):

Resistance Training ◽

Lower Limb ◽

Muscular Strength ◽

Young Men ◽

Muscle Thickness ◽

Peak Torque ◽

Knee Extension ◽

Static Stretching ◽

Joint Flexibility ◽

Significant Difference

Performing static stretching (SS) during resistance training (RT) rest periods is posited to potentiate muscular adaptations, but the literature is scarce on the topic. Thus, the purpose of this study was to investigate the effects of adding inter-set SS to a lower-limb flywheel RT program on joint flexibility, muscular strength, and regional hypertrophy. Sixteen untrained male adults (21 ± 1 y) completed the study, where they performed progressive flywheel bilateral squatting twice a week for 5 weeks. One leg of each participant was randomly allocated to perform SS during the inter-set rest period (RT+SS), while the other leg served as control (RT only). Before and after the intervention, knee flexion range of motion; knee extension isometric, concentric, and eccentric peak torque; 1-repetition maximum; and muscle thickness of the lower-limb muscles were assessed. Following the training period, additional effects were observed for the inter-set SS side on increasing joint flexibility (p < 0.05), whereas the average increase in strength measures was 5.3% for the control side, and 10.1% for the inter-set SS side, however, SS intervention induced significantly greater gains only for knee extension isometric strength, but not for dynamic 1-RM, concentric, and eccentric tests. Hamstrings and gluteus maximus did not hypertrophy with training; increases quadriceps muscle thickness depended on the site/portion analyzed, but no significant difference was observed between legs (average: RT = 7.3%, RT+SS = 8.0%). The results indicate that adding inter-set SS to RT may provide large gains in flexibility, slightly benefits for muscular strength (especially for isometric action), but do not impact muscle hypertrophy in untrained young men.

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The Comparison between Isokinetic Knee Muscles Strength in the Ipsilateral and Contralateral Limbs and Correlating with Function of Patients with Stroke

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-1700612 ◽

2019 ◽

Vol 10 (04) ◽

pp. 683-689

Author(s):

Fayaz Khan ◽

Haris Anjamparuthikal ◽

Mohamed Faisal Chevidikunnan

Keyword(s):

Lower Limb ◽

Knee Flexion ◽

Peak Torque ◽

Lower Limbs ◽

Isokinetic Strength ◽

Isokinetic Dynamometer ◽

Knee Strength ◽

Torque Measurements ◽

Significant Difference ◽

Knee Muscle

Abstract Objective The aim of this study is to compare the isokinetic knee muscles peak torque measurements and proprioception between the affected and intact limbs of patients with stroke, in addition to finding the correlation between knee muscles strength and lower limb function. Methods Twelve patients with stroke (mean age 64.33 ± 6.140 years), with 3 to 7 months poststroke who can walk 25 feet independently without using or using assistive devices and full passive range of motion were included in the study. Biodex isokinetic dynamometer was used for measuring isokinetic strength at 90°/s, 120°/s, and 150°/s and isometric strength at 60°/s in both flexors and extensors of the knee, whereas proprioception was measured at 45°/s knee flexion, all for affected and intact limbs. Functional measurements were assessed using the Fugl-Meyer Assessment for Lower Limb scale and Barthel Index (BI). Results The differences shown were found to be statistically significant between affected and intact limbs in isokinetic 90°/s flexion (p = 0.005), extension (p = 0.0013), and isometric at 60°/s flexion (p < 0.0001) knee muscle strengths and also the proprioception (p = 0.05). Significant positive correlation was found between isokinetic affected side knee flexion at 90°/s (r = 0.903) with BI (r = 0.704). Conclusion There is a significant difference in peak torque measurements between affected and normal lower limbs of poststroke patients, as well as a significant correlation between the knee strength and lower limb functions. Furthermore, it can also be concluded that the differences in knee proprioception between the affected and intact limbs were shown to be significant.

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Impact of home-based squat training with two-depths on lower limb muscle parameters and physical functional tests in older adults

Scientific Reports ◽

10.1038/s41598-021-86030-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Akito Yoshiko ◽

Kohei Watanabe

Keyword(s):

Older Adults ◽

Physical Function ◽

Lower Limb ◽

Muscle Thickness ◽

Peak Torque ◽

Knee Extension ◽

Functional Tests ◽

Leg Press ◽

Home Based ◽

Deep Squat

AbstractThis study investigated the effect of home-based shallow and deep squat trainings on knee extension peak torque, muscle thickness, one-repetition maximum (1RM) leg press, and physical function in older individuals. Sixteen participants were randomly assigned to the shallow squat group (SS group; age, 71.0 ± 4.0 years) or deep squat group (DS group, age; 68.6 ± 3.6 years). Chairs of 40-cm height and chairs with a cushion of 20-cm height (60-cm in total) were used as the depth targets for squats, with participants instructed to sink until their hip touched the chair and cushion. Participants performed four sets of squats per day (35 repetitions per set), three days per week, for 12 weeks at their home. Knee extension peak torque, muscle thickness of quadriceps femoris (e.g., vastus lateralis, rectus femoris, and vastus intermedius), and physical function were measured at weeks 0 (baseline), 4, 8, and 12. Maximal isometric knee extension peak torque, muscle thickness, and walking speed did not change significantly over the 12-week training period in either group (P > 0.05). However, compared with the baseline, there was significant improvement in the results of 30-s sit-to-stand repetition tests after weeks 8 and 12 in both groups (P < 0.05). Additionally, 1RM leg press results were significantly improved after weeks 4 and 12 in the DS group, and weeks 4, 8, and 12 in the SS group (P < 0.05). Results indicate that home-based weight-bearing squat training improves lower limb function in older adults, as well as performance in physical functional tests related to activities of daily living. Moreover, such training benefits older adults regardless of whether squats are shallow or deep.

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Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-200986 ◽

2021 ◽

pp. 1-9

Author(s):

Lucas Sousa Macedo ◽

Renato Polese Rusig ◽

Gustavo Bersani Silva ◽

Alvaro Baik Cho ◽

Teng Hsiang Wei ◽

...

Keyword(s):

Computed Tomography ◽

Upper Limb ◽

Computed Tomography Angiography ◽

Lower Limb ◽

High Energy ◽

Lower Limbs ◽

Added Value ◽

Vascular Lesions ◽

Limb Injuries ◽

Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

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Reliability of a New Portable Dynamometer for Assessing Hip and Lower Limb Strength

Applied Sciences ◽

10.3390/app11083391 ◽

2021 ◽

Vol 11 (8) ◽

pp. 3391

Author(s):

Jan Marušič ◽

Goran Marković ◽

Nejc Šarabon

Keyword(s):

Lower Limb ◽

External Rotation ◽

Peak Torque ◽

Knee Extension ◽

Lower Limb Muscles ◽

Lower Limb Strength ◽

Flexion Extension ◽

Strength Tests ◽

Hip Abduction ◽

Maximal Peak

The purpose of this study was to evaluate intra- and inter-session reliability of the new, portable, and externally fixated dynamometer called MuscleBoard® for assessing the strength of hip and lower limb muscles. Hip abduction, adduction, flexion, extension, internal and external rotation, knee extension, ankle plantarflexion, and Nordic hamstring exercise strength were measured in three sessions (three sets of three repetitions for each test) on 24 healthy and recreationally active participants. Average and maximal value of normalized peak torque (Nm/kg) from three repetitions in each set and agonist:antagonist ratios (%) were statistically analyzed; the coefficient of variation and intra-class correlation coefficient (ICC2,k) were calculated to assess absolute and relative reliability, respectively. Overall, the results display high to excellent intra- and inter-session reliability with low to acceptable within-individual variation for average and maximal peak torques in all bilateral strength tests, while the reliability of unilateral strength tests was moderate to good. Our findings indicate that using the MuscleBoard® dynamometer can be a reliable device for assessing and monitoring bilateral and certain unilateral hip and lower limb muscle strength, while some unilateral strength tests require some refinement and more extensive familiarization.

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Unilateral and Bilateral Strength Asymmetry among Young Elite Athletes of Various Sports

Medicina ◽

10.3390/medicina56120683 ◽

2020 ◽

Vol 56 (12) ◽

pp. 683

Author(s):

Maros Kalata ◽

Tomas Maly ◽

Mikulas Hank ◽

Jakub Michalek ◽

David Bujnovsky ◽

...

Keyword(s):

Lower Limb ◽

Elite Athletes ◽

Lower Limbs ◽

Knee Extensors ◽

Young Athletes ◽

Lower Limb Muscles ◽

Significant Difference ◽

Strength Asymmetry ◽

Main Factor ◽

Objective Type

Background and objective: Type of physical activity may influence morphological and muscular asymmetries in the young population. However, less is known about the size of this effect when comparing various sports. The aim of this study was to identify the degree of bilateral asymmetry (BA) and the level of unilateral ratio (UR) between isokinetic strength of knee extensors (KE) and flexors (KF) among athletes of three different types of predominant locomotion in various sports (symmetric, asymmetric and hybrid). Material and methods: The analyzed group consisted of young elite athletes (n = 50). The maximum peak muscle torque of the KE and KF in both the dominant (DL) and non-dominant (NL) lower limb during concentric muscle contraction at an angular velocity of 60°·s−1 was measured with an isokinetic dynamometer. Results: Data analysis showed a significant effect of the main factor (the type of sport) on the level of monitored variables (p = 0.004). The type of sport revealed a significant difference in the bilateral ratio (p = 0.01). The group of symmetric and hybrid sports achieved lower values (p = 0.01) of BA in their lower limb muscles than those who played asymmetric sports. The hybrid sports group achieved higher UR values (p = 0.01) in both lower limbs. Conclusions: The results indicate that sports with predominantly symmetrical, asymmetrical, and hybrid types of locomotion affected the size of the BA, as well as the UR between KE and KF in both legs in young athletes. We recommend paying attention to regular KE and KF strength diagnostics in young athletes and optimizing individual compensatory exercises if a higher ratio of strength asymmetry is discovered.

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Can Hip Joint Position affect Quadriceps Muscle Responses during Knee Extension Exercise?

International Journal of Sports Medicine ◽

10.1055/a-1179-8374 ◽

2020 ◽

Vol 41 (13) ◽

pp. 929-935

Author(s):

Denis César Leite Vieira ◽

Marco Aurélio Araujo Dourado ◽

Lucas Ugliara ◽

Joao Luiz Quagliotti Durigan ◽

Brad J. Schoenfeld ◽

...

Keyword(s):

Vastus Lateralis ◽

Muscle Thickness ◽

Rectus Femoris ◽

Peak Torque ◽

Quadriceps Muscle ◽

Knee Extension ◽

Knee Extensors ◽

Work Output ◽

Before And After ◽

Knee Extension Exercise

AbstractThis study investigated the acute effects of seated and supine knee extension exercise on muscle swelling, torque, and work output. Twelve resistance-trained men performed two isokinetic concentric-only knee-extension training protocols at different hip positions in a counter-balanced order. They completed the knee extension exercise in the seated (hip angle at 85°) and supine (hip angle at 180°) positions. The torque and work output were assessed during each set. Moreover, muscle thickness of the middle and proximal vastus lateralis and rectus femoris were evaluated before and after each protocol and used as an indicator of muscle swelling. Middle rectus femoris and proximal vastus lateralis thickness increased significantly (p=0.01) with no difference between exercise variations. However, the middle vastus lateralis thickness increased (p=0.01) only after the seated knee extension exercise (~7%). Knee extensors’ peak torque and work output were approximately 8% higher (p=0.04) in the seated when compared to the supine hip position. There was a similar decrease in torque and work output throughout both protocols (p=0.98). In conclusion, seated knee extension exercises produced greater torque, work output, and muscle swelling in the vastus lateralis when compared to the supine knee extension exercise.

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Assessment of balance, gait, lower limb strength and functionality in sarcopenic and non-sarcopenic elderlies

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2020.18.807 ◽

2020 ◽

Vol 18 ◽

pp. 1-7

Author(s):

Alice Martins Magalhães ◽

Daniella Macedo Cerceau ◽

Kênia Kiefer Parreiras de Menezes ◽

Gabriela Vieira Oliveira ◽

Bárbara Batista Gomes

Keyword(s):

Muscle Mass ◽

Lower Limb ◽

Gait Speed ◽

Functional Performance ◽

Cross Sectional Study ◽

Lower Limbs ◽

Balance Test ◽

Cross Sectional ◽

Speed Test ◽

Lower Limb Strength

Background: Sarcopenia is the involuntary loss of muscle mass predicted by aging and is associated with an increased likelihood ofunfavorable results, such as falls, mortality and functional disabilities. Objective: Evaluate balance, gait speed, lower limb strength andfunctionality in sarcopenic and non-sarcopenic elderly. Methods: Cross-sectional study, carried out with 68 subjects aged 60 years orover, residents of the community and possessing an independent gait. The assessment instruments were bioimpedance, balance test,four-meter gait speed test, chair support test and SPPB. Results: The prevalence of sarcopenia in the population of the present studywas 43.3%. In the group of non-sarcopenic subjects, a correlation was found between all the variables evaluated. In the group ofsarcopenic subjects, a correlation was found between lower limbs strength and gait speed. Conclusion: The skeletal muscle mass ofa sarcopenic elderly is related to their lower limb strength and gait speed, but it does not present a significant correlation with balanceand functional performance. Further studies are needed to clarify the behavior of balance, gait speed, lower limb strength and functionalperformance variables when compared to the decrease in muscle mass inherent in aging.

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Relationship Between 3 Single-Leg Functional Performance Tests for Netball Noncontact Knee Injury Prevention Screening in Uninjured Female Adult Players

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0345 ◽

2021 ◽

pp. 1-7

Author(s):

Nicholas C. Clark ◽

Elaine M. Mullally

Keyword(s):

Injury Prevention ◽

Lower Limb ◽

Motor Performance ◽

Knee Injury ◽

Local Community ◽

Functional Performance ◽

Lower Limbs ◽

Coefficient Of Determination ◽

Performance Tests ◽

Knee Injury Prevention

Context: Single- versus double-leg landing events occur the majority of the time in a netball match. Landings are involved in large proportions of netball noncontact knee injury events. Of all landing-induced anterior cruciate ligament injuries, most occur during single-leg landings. Knowledge of whether different single-leg functional performance tests capture the same or different aspects of lower-limb motor performance will therefore inform clinicians’ reasoning processes and assist in netball noncontact knee injury prevention screening. Objective: To determine the correlation between the triple hop for distance (THD), single hop for distance (SHD), and vertical hop (VH) for the right and left lower limbs in adult female netball players. Design: Cross-sectional. Setting: Local community netball club. Participants: A total of 23 players (age 28.7 [6.2] y; height 171.6 [7.0] cm; mass 68.2 [9.8] kg). Interventions: There were 3 measured trials (right and left) for THD, SHD, and VH, respectively. Main Outcome Measures: Mean hop distance (percentage of leg length [%LL]), Pearson intertest correlation (r), and coefficient of determination (r2). Results: Values (right and left; mean [SD]) were as follows: THD, 508.5 (71.8) %LL and 510.9 (56.7) %LL; SHD, 183.4 (24.6) %LL and 183.0 (21.5) %LL; and VH, 21.3 (5.2) %LL and 20.6 (5.0) %LL. All correlations were significant (P ≤ .05), r/r2 values (right and left) were THD–SHD, .91/.83 and .87/.76; THD–VH, .59/.35 and .51/.26; and SHD–VH, .50/.25 and .37/.17. A very large proportion of variance (76%–83%) was shared between the THD and SHD. A small proportion of variance was shared between the THD and VH (25%–35%) and SHD and VH (17%–25%). Conclusion: The THD and SHD capture highly similar aspects of lower-limb motor performance. In contrast, the VH captures aspects of lower-limb motor performance different to the THD or SHD. Either the THD or the SHD can be chosen for use within netball knee injury prevention screening protocols according to which is reasoned as most appropriate at a specific point in time. The VH, however, should be employed consistently alongside rather than in place of the THD or SHD.

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The Effect of Prolonged Running on the Symmetry of Biomechanical Variables of the Lower Limb Joints

Symmetry ◽

10.3390/sym12050720 ◽

2020 ◽

Vol 12 (5) ◽

pp. 720

Author(s):

Zixiang Gao ◽

Qichang Mei ◽

Gusztáv Fekete ◽

Julien S Baker ◽

Yaodong Gu

Keyword(s):

Lower Limb ◽

Force Plate ◽

Knee Extension ◽

Lower Limbs ◽

Flexion Angle ◽

Camera Motion ◽

Long Distance ◽

Therapy Assessment ◽

Long Distance Running ◽

Hip Flexion

The aim of this study was to examine whether there are kinematic and kinetic differences in the lower limb and whether the symmetry of the lower extremities is different after prolonged-running. Fifteen healthy male amateur runners (age: 22 ± 1 years, height: 173 ± 8 cm, mass: 65 ± 7 kg, BMI: 21.62 ± 2 kg/m2) were recruited as participants for this study. A Vicon eight-camera motion capture system and Kistler force plate were used to collect kinematic and kinetic parameters. A motorized treadmill, 15-point Borg scale and heart rate bands were used to monitor fatigue during a running-induced fatigue protocol. Paired sample T tests were used to check statistical difference (p = 0.05) between the lower limbs and the symmetry changes in pre-fatigue and post-fatigue running sessions. The symmetry angle (SA) of the knee flexion angle, hip flexion angle and hip extension angle in post-fatigue was significantly greater than in pre-fatigue, increasing by 4.32%, 10.71%, and 23.12%, respectively. Moreover, the SA of hip flexion moment increased by 2.61%. However, the knee extension velocity and hip flexion velocity became more symmetrical than in pre-fatigue (p < 0.05), the SA decreased by 5.91% and 5.45%, respectively. Differences in limb function during post-fatigue may lead to changes of symmetry in the lower limbs. The variables of asymmetry may be used as a compensation mechanism to maintain gait stability. Physical therapy assessment of fatigue injuries and long-distance running training programs may want to consider the changes in symmetry due to limb dominance.

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