The Role of Eccentric Training and Pain Neuroscience Education (PNE) to Improve Quadriceps Muscle Strength, and Function in Post ACL Repair: A Case Report

Background: A 19-year-old man presented with right knee pain while bearing weight on the right leg and difficulty bending the right knee. He was diagnosed with a complete -tear of the anterior cruciate ligament. After ACL reconstruction this individual was referred to physical therapy treatment. Objective: To investigate if neuroscience pain education, and eccentric training, have any therapeutic significance in post-ACL reconstructive patients. Method: After assessment, the first day of the first week, introduced a treatment protocol consisting of basic range of motion (ROM) and isometric exercises for three sets of 10–30 sec hold. From first to fourth week eccentric exercises along with pain neuroscience education (PNE) sessions were given on alternate days, with three sessions for PNE and eccentric exercises until fourth week. Result: As shown in this study, treatment with a combination of PNE and eccentric training results in improved quadriceps muscle strength, range of motion, and overall function. Conclusion: This report suggested that PNE in conjunction with eccentric exercise has clinical merit. Clinical implication of study is examining the effectiveness of this approach should be conducted in the form of well-designed, clinical studies.

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Physiotherapy and Electrical Stimulation Effects on Strength of M. Quadriceps, Knee Range of Motion and Pain in Patients Following Anterior Cruciate Ligament Operation

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i16.740 ◽

2019 ◽

Vol 1 (16) ◽

Author(s):

Justina Marčiulionytė ◽

Justinas Škikas ◽

Saulė Sipavičienė

Keyword(s):

Anterior Cruciate Ligament ◽

Electrical Stimulation ◽

Muscle Strength ◽

Range Of Motion ◽

Cruciate Ligament ◽

Quadriceps Muscle ◽

Control Group ◽

Study Group ◽

Quadriceps Muscle Strength ◽

Anterior Cruciate

Background. Research aim was to analyze the quadriceps muscle strength recovery after anterior cruciate ligament reconstruction using electrical stimulation and physical therapy. Methods. There were two randomly selected groups, with eight people in each group. The selection criteria were that the subjects had to have anterior cruciate ligament operation six weeks prior and were very active physically. One group was for research (study group), the other one for reference (control group). The study group had electrical stimulation combined with physical therapy exercises two times a week, for 45 minutes. The control group had exercises to strengthen the quadriceps muscle also two times a week, for 45 minutes. Both groups were tested before and after the research. The things evaluated during the test were – visual pain scale (VAS) scores, quadriceps muscle strength during extension and ﬂexion using (R. Lovett) scoring system and goniometry showing degrees of extension and ﬂexion. Results. Comparing both study and control groups, there was statistically signifcant improvement (p < 0.05), however the study group recovered faster and had statistically greater benefts. Conclusions. After 6 weeks of physiotherapy, the range of motion, quadriceps muscle strength increased and pain decreased in the operated leg. 1. After 6 weeks of physiotherapy and electrical stimulation, the range of motion, quadriceps muscle strength increased and pain decreased in the operated leg. 2. After 6 weeks of physiotherapy and electrical stimulation, the range of motion, quadriceps muscle strength, pain in the operated leg changed more in the study group than in subjects who received only physical therapy.Keywords: anterior cruciate ligament, electrical stimulation, quadriceps muscle, ligament reconstruction, muscle strength.

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Blood Flow Restriction Training Applied With High-Intensity Exercise Does Not Improve Quadriceps Muscle Function After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546520904008 ◽

2020 ◽

Vol 48 (4) ◽

pp. 825-837 ◽

Cited By ~ 1

Author(s):

Michael T. Curran ◽

Asheesh Bedi ◽

Christopher L. Mendias ◽

Edward M. Wojtys ◽

Megan V. Kujawa ◽

...

Keyword(s):

Muscle Strength ◽

High Intensity ◽

Muscle Function ◽

Controlled Trial ◽

Cruciate Ligament ◽

Quadriceps Muscle ◽

High Intensity Exercise ◽

Quadriceps Muscle Strength ◽

Flow Restriction ◽

Anterior Cruciate

Background: A major goal of rehabilitation after anterior cruciate ligament reconstruction (ACLR) is restoring quadriceps muscle strength. Unfortunately, current rehabilitation paradigms fall short of this goal, such that substantial quadriceps muscle strength deficits can limit return to play and increase the risk of recurrent injuries. Blood flow restriction training (BFRT) involves the obstruction of venous return to working muscles during exercise and may lead to better recovery of quadriceps muscle strength after ACLR. Purpose: To examine the efficacy of BFRT with high-intensity exercise on the recovery of quadriceps muscle function in patients undergoing ACLR. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 34 patients (19 female, 15 male; mean age, 16.5 ± 2.7 years; mean height, 169.0 ± 19.7 cm; mean weight, 73.2 ± 17.7 kg) scheduled to undergo ACLR were randomly assigned to 1 of 4 groups: concentric (n = 8), eccentric (n = 8), concentric with BFRT (n = 9), and eccentric with BFRT (n = 9). The exercise component of the intervention consisted of patients performing a single-leg isokinetic leg press, at an intensity of 70% of the patients’ 1-repetition maximum during either the concentric or eccentric action, for 4 sets of 10 repetitions 2 times per week for 8 weeks beginning at 10 weeks postoperatively. Patients randomized to the BFRT groups performed the leg-press exercise with a cuff applied to the thigh, set to a limb occlusion pressure of 80%. Isometric and isokinetic (60 deg/s) quadriceps peak torque, quadriceps muscle activation, and rectus femoris muscle volume were assessed before ACLR, after BFRT, and at the time that patients returned to activity and were converted to the change in values from baseline for analysis. Also, 1-way analyses of covariance were used to compare the change in values for each dependent variable between groups after BFRT and at return to activity ( P ≤ .05). Results: No significant differences were found between groups for any outcome measures at either time point ( P > .05). Conclusion: An 8-week BFRT plus high-intensity exercise intervention did not significantly improve quadriceps muscle strength, activation, or volume. On the basis of our findings, the use of BFRT in conjunction with high-intensity resistance exercise in patients undergoing ACLR to improve quadriceps muscle function may not be warranted. Registration: NCT03141801 ( ClinicalTrials.gov identifier)

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Muscle strength after the anterior cruciate ligament reconstruction via contralateral bone-tendon-bone autograft

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00399-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Takaki Sanada ◽

Eiji Uchiyama ◽

Hiroshi Iwaso ◽

Atsushi Fukai

Keyword(s):

Muscle Strength ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Quadriceps Muscle ◽

Return To Sports ◽

Quadriceps Muscle Strength ◽

Early Return ◽

Anterior Cruciate ◽

Reconstructed Knee ◽

Tegner Activity Scale

Abstract Purpose The anterior cruciate ligament (ACL) reconstruction via a contralateral bone-tendon-bone (C-BTB) autograft was introduced to encourage early return to sports. The purpose of this study is to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return-to-sports modification by investigating the chronological changes of muscle strength after surgery. Methods Fifteen patients who had underwent C-BTB ACL reconstruction were compared with a matched group of 15 patients of ipsilateral BTB (I-BTB) ACL reconstruction. The clinical outcomes of the time of return-to-sports, Tegner activity scale and the rate of second ACL injuries, the tibial anterior translation measurement, and knee extension and flexion muscle strength were assessed. Results Within 12 months after surgery, 14 of 15 patients from both groups returned to preinjury sports. The median time to return to sports after surgery was 6.5 months in the C-BTB group and 8.0 months in the I-BTB group (p = 0.021). No significant difference was noted with regard to the Tegner activity scale, reinjury rate or mean instrumental anterior tibial translation. The quadriceps muscle strength in the ACL-reconstructed knee compared with the opposite knee in both groups at 5 months after surgery was 120.6% in the C-BTB group and 70.0% in the I-BTB group (p < 0.001). However, the quadriceps muscle strength of the non-reconstructed limb, which instructed the graft harvested knee in the C-BTB and the intact knee in the I-BTB group, compared with that of the preoperative uninjured limb, was 74.5% in the C-BTB group and 118.7% in the I-BTB group (p = 0.0021) 5 months after surgery. Moreover, the quadriceps muscle strength of the reconstructed knee compared with the preoperative normal limb was 88.8% and 81.5% in the C-BTB and I-BTB groups, respectively (p = 0.38). Conclusions ACL reconstruction via the C-BTB autograft indicated better quadriceps muscle strength from early stage after surgery compared with I-BTB ACL reconstruction. However, the ostensible rapid symmetrical muscle strength recovery was attributed to strength deficits compared to the preoperative condition at the donor site limb and ACL-reconstructed limb. Level of evidence Level: Level: 4.

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EFEITOS DO DEEP RUNNING SOBRE A AMPLITUDE DE MOVIMENTO E A CAPACIDADE FUNCIONAL DOS MEMBROS SUPERIORES DE MULHERES MASTECTOMIZADAS: RELATO DE CASOS

Revista Científica JOPEF ◽

10.34059/ciejop.2019v27i1-11 ◽

2019 ◽

pp. 121-131

Keyword(s):

Range Of Motion ◽

Upper Limb ◽

Functional Capacity ◽

External Rotation ◽

Treatment Protocol ◽

Range Of Movement ◽

Flexion Extension ◽

Before And After ◽

In The Beginning ◽

And Function

Introduction: Breast cancer is the most common type of cancer among women in Brazil and in the worl. The surgical treatment procedure may cause severe morbidity in the upper limb homolateral to surgery, including the reduction of the range of motion, with consequent impairment of function. A physiotherapeutic approach has an important role in the recover range of motion and the functionality of these women, guaranteeing the occupational, domestestic, familiar and conjugated activities, and, in this way, also improving the quality of life. Objectives: To analyse chances in the shoulder's range of motion and the functional capacity of the upper limbs, promoted by the deep running procedure in women with late postoperative mastectomy. Methods: All the patients were submitted to an evaluation in the beginning and end of the treatment, including: goniometry of flexion, extension, abduction, adduction, internal and external rotation of the shoulder joint; and function capacity analysis in activities that involve the upper members by DASH questionnaire. The treatment protocol includes twelve sessions of deep running, realized twice a week, in deep pool, for 20-minute during six weeks. Results: Were submitted to treatment a total of 4 patients. Despite the improvement in the numerical values, statistically significant differences were not found on the range of movements and in the functional capacity of upper members before and after the deep running sessions in post-mastectomy women. Conclusion: Deep running had effects on the numerical values of range of movement and upper limb functionality in women in the late postoperative period of the mastectomy procedure, but without statistically significant differences.

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Comparison of Y-Balance Test Performance by maturation status in youth distance runners

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00084 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Mitchell J. Rauh ◽

Micah C. Garcia ◽

David M. Bazett-Jones ◽

Jason T. Long ◽

Kevin R. Ford ◽

...

Keyword(s):

Muscle Strength ◽

Quadriceps Muscle ◽

Limb Length ◽

Distance Running ◽

Distance Runners ◽

Long Distance ◽

Balance Test ◽

Convenience Sample ◽

Quadriceps Muscle Strength ◽

Increased Risk

Background: Distance running is a popular interscholastic sport, but also has an associated high risk of running-related injuries. Recent literature suggests that functional tests may help to identify athletes at increased risk of injury. The Y-Balance Test (YBT) is an objective measure used to assess functional muscle strength and balance and to expose asymmetries between tested limbs. Purpose: To determine if YBT performance was associated with maturation status in healthy, youth distance runners. We hypothesized that mid-pubertal (MP) runners would demonstrate less functional reach distance than pre-pubertal (PrP) or post-pubertal (PoP) runners. Methods: A convenience sample of 142 (Females: n=79, Males: n=63) uninjured youth runners (ages 13.5±2.7 years; weekly running distance: 18.2±20.4 km) were recruited from the local community. All runners met inclusion criteria, indicating that they were between 9 and 19 years old and participated in long-distance running activities such as school/club track and field, cross country, road races, trail running, and/or soccer. The runners completed a modified Pubertal Maturational Observation Scale (PMOS), then were screened for right (R) and left (L) anterior (ANT), posteromedial (PM) and posterolateral (PL) reach distances (cm) normalized by lower limb length (cm). Composite reach distance was calculated by the sum of the three reach distances divided by three times the limb length multiplied by 100 for R and L limbs. ANOVA with Bonferroni post hoc tests were used to compare maximum normalized reach distances for the three directions and composite reach distance by maturation status and sex. Results: Overall, 31.7% were classified as PrP status, 26.1% as MP, and 42.3% as PoP, with similar percentages by sex ( p=0.84). The only significant mean difference was found for R ANT maximum normalized reach distance between PrP and PoP ( p=0.02), indicating a greater normalized reach in PrP athletes. No significant mean differences were found for R or L PM and PL maximum normalized reach distances, or for R or L composite reach distances, by maturation status or when stratified by maturation and sex ( p>0.05). Conclusions: In this sample of youth runners, the YBT was only a discriminator of anterior reach distance between pre-pubertal and post-pubertal runners. As decreased anterior reach is associated with reduced quadriceps muscle strength and anterior knee pain, reduced anterior reach in post-pubertal runners may potentially signify an increased risk of sustaining a running-related injury. Thus, preventive efforts to ensure good functional quadriceps muscle strength may be merited.

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A single whole body vibration session influences quadriceps muscle strength, functional mobility and balance of elderly with osteopenia and/or osteoporosis? Pragmatic clinical trial

Journal of Diabetes & Metabolic Disorders ◽

10.1007/s40200-019-00392-4 ◽

2019 ◽

Vol 18 (1) ◽

pp. 73-80

Author(s):

Luanda Alves Xavier Ramos ◽

François Talles Medeiros Rodrigues ◽

Lívia Shirahige ◽

Maria de Fátima Alcântara Barros ◽

Antônio Geraldo Cidrão de Carvalho ◽

...

Keyword(s):

Clinical Trial ◽

Muscle Strength ◽

Whole Body Vibration ◽

Quadriceps Muscle ◽

Functional Mobility ◽

Whole Body ◽

Pragmatic Clinical Trial ◽

Body Vibration ◽

Quadriceps Muscle Strength

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The effect of rehabilitation on range of motion and muscle strength in patients after surgical reconstruction of the anterior cruciate ligament

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2014.03.1021 ◽

2014 ◽

Vol 57 ◽

pp. e280

Author(s):

S. Kozomara

Keyword(s):

Anterior Cruciate Ligament ◽

Muscle Strength ◽

Range Of Motion ◽

Cruciate Ligament ◽

Surgical Reconstruction ◽

Anterior Cruciate

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Quadriceps muscle strength and its relationship to radiographic knee osteoarthritis in Japanese elderly

Journal of Orthopaedic Science ◽

10.1007/s00776-013-0383-4 ◽

2013 ◽

Vol 18 (4) ◽

pp. 536-542 ◽

Cited By ~ 35

Author(s):

Go Omori ◽

Yoshio Koga ◽

Hiroshi Watanabe ◽

Masaei Tanaka ◽

Atsushi Nawata ◽

...

Keyword(s):

Muscle Strength ◽

Knee Osteoarthritis ◽

Quadriceps Muscle ◽

Quadriceps Muscle Strength ◽

Japanese Elderly ◽

Radiographic Knee Osteoarthritis

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Arthroscopic Imaging Treatment and Clinical Rehabilitation of Knee Sports Injuries

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3742 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1780-1788

Author(s):

Habaxi Kaken ◽

Shanshan Wang ◽

Wei Zhao ◽

Baoerjiang Asihaer ◽

Li Wang

Keyword(s):

Muscle Strength ◽

Knee Joint ◽

Sports Injuries ◽

Cruciate Ligament ◽

Quadriceps Muscle ◽

Lower Limbs ◽

Continuous Passive Motion ◽

Control Group ◽

Pressure Therapy ◽

Quick Recovery

This article studies the effects of arthroscopic imaging treatment and clinical rehabilitation of knee sports injuries. Arthroscopy was used to perform meniscus trimming and resection for 40 patients with knee sports injuries. The ages of the patients ranged from 20 to 60 years old. All patients received routine rehabilitation training such as continuous passive motion of the knee joint, biofeedback of the lower limbs, and air pressure therapy of the lower limbs. In addition, the control group was given muscle strength training, and the training began after the patients received the quadriceps muscle strength test. The removal of the joint cavity and the joint debridement has achieved satisfactory treatment results. In the experiment, the test cases were divided into two groups, and the sensor test platform was used for signal collection. Normal activities can be resumed 2 weeks after the operation. After a follow-up of 6 to 24 months, the knee joint pain disappeared, the joint was free of swelling, and the knee function was normal up to 93%. Arthroscopic reconstruction of the anterior and posterior cruciate ligament joint repair/reconstruction of the medial and posterolateral ligament knots is safe and feasible for the treatment of multiple ligament injuries of the knee joint. It has the advantages of less trauma and quick recovery. Early postoperative systemic and standardized rehabilitation exercises can obtain good knee joint function.

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