Cross-training effect of chronic whole-body vibration exercise: a randomized controlled study.

Purpose: To determine whether unilateral leg whole-body vibration (WBV) strength training induces strength gain in the untrained contralateral leg muscle. The secondary aim was to determine the potential role of spinal neurological mechanisms regarding the effect of WBV exercise on contralateral strength training.Materials and Methods: Forty-two young adult healthy volunteers were randomized into two groups: WBV exercise and Sham control. An isometric semi-squat exercise during WBV was applied regularly through 20 sessions. WBV training was applied to the right leg in the WBV group and the left leg was isolated from vibration. Sham WBV was applied to the right leg of participants in the Control group. Pre- and post-training isokinetic torque and reflex latency of both quadricepses were evaluated.Results: The increase in the strength of right (vibrated) knee extensors was 9.4 ± 10.7% in the WBV group (p = .001) and was 1.2 ± 6.6% in the Control group (p = .724). The left (non-vibrated) extensorsvibrated) knee extensors w4 ± 8.4% in the WBV group (p = .038), whereas it decreased by 1.4 ± 7.0% in the Control (p = .294). The strength gains were significant between the two groups. WBV induced the reflex response of the quadriceps muscle in the vibrated ipsilateral leg and also in the non-vibrated contralateral leg, though with a definite delay. The WBV-induced muscle reflex (WBV-IMR) latency was 22.5 ± 7.7 ms for the vibrated leg and 39.3 ± 14.6 ms for the non-vibrated leg.Conclusions: Chronic WBV training has an effect of the cross-transfer of strength to contralateral homologous muscles. The WBV-induced muscular reflex may have a role in the mechanism of cross-transfer strength.

Comparison of effectiveness of different exercise programs in treatment of failed back surgery syndrome: A randomized controlled trial.

BACKGROUND: Failed back surgery syndrome (FBSS) is a condition characterized by persistent pain following back surgeries. OBJECTIVE: To determine the effects of different exercises programs in FBSS. METHODS: A Single-blind, randomized, controlled trial designed. One hundred participants with failed back surgery syndrome were randomly assigned to three different exercises groups (Isokinetic, Dynamic lumbar stabilization (DLS), and home exercises (HE) groups) and a control group. Patients were evaluated before and after 8-week exercise program and follow-ups at the 3rd and 6th months after the exercise program. Finger-floor distance and lumbar Schober for lumbar mobility, visual analog scale (VAS) for pain, modified Oswestry disability index, Beck depression inventory, fear-avoidance attitudes survey, and progressive-isoinertial weight lifting test were used as follow-up parameters. Lumbar muscle strength was assessed with the isokinetic dynamometer. RESULTS: VAS levels were decreased from 67.7 to 22.8 in isokinetic and from 68.7 to 25.0 in DLS and from 64.6 to 47.1 in HE groups at the end of the program (p< 0.05). Also, all of other follow-up parameters of the isokinetic and DLS exercise groups viewed significant improvements compared to the control group. CONCLUSIONS: According to our results either isokinetic or DLS exercises are more effective in FBSS patients.

Investigating the effectiveness of postural muscle electrostimulation and static posturography feedback exercises in elders with balance disorder.

BACKGROUND: Deterioration associated with aging in the erect posture and balance to change the location of the center increased the rate of fall in older age is one of the reasons. Loss of muscle strength is one of the major factors affecting the posture. In this prospective, randomized and controlled study, it was aimed to investigate the effectiveness of strengthening postural muscles through electrostimulation or by applying biofeedback exercises with static posturography in patients aged 60 years and over with balance disorder. METHODS: Patients aged between 60-80 years, who applied to Istanbul Faculty of Medicine Physical Medicine and Rehabilitation Department outpatient clinic and had been diagnosed with balance disorder using the Timed Up and Go (TUG) test, were included. 250 patients were screened, from them 67 patients were enrolled and 57 of them completed the study. Patients were randomized to three groups. The patients in Tetrax® group (TG) group (n:18) participated in a 15-minute exercise with Tetrax® which consisted of 15 minutes exercise session 3 times weekly for 4 weeks. The patients in EG group (n:19) received an electrostimulation program of postural muscles of 40 minutes per session 3 times weekly for 4 weeks. Patients in the control group (n:20) did 6-week balance exercises which were performed by other groups as well. 48 out of 57 patients attended the 6th-month control. As determinants of balance status Timed Up and Go Test (TUG), Berg Balance Scale (BBS) and Fall Index measured by Tetrax® were calculated at baseline, 1-month and 6-month follw up assesments. The patient's quality of life was assesed by Turkish version of World Health Organisation Quality of Life Questionnaire in Older Adults (WHOQOL-OLD.TR) at baseline and 6-month follow up assesments. RESULTS: TUG values in both EG and TG decreased significantly between baseline assesment and 1-month (mean differences for TG: -4,00 ± 1,309 and EG -2,588 ± 1,839 p= 0,002 for the each of groups) and baseline assesment and 6-month (mean differences for TG: -2,933± 1,223 and EG -2,058 ± 1,477 p= 0,003 for the each of groups). A significant increase was determined in BBS values between baseline and 1-month (mean differences for TG: 4.000 ± 2,360 and EG: 3,529 ± 2,672 p= 0,031 for the each of groups). Fall Index (FI) measured by Tetrax® decreased between baseline assesment and 1-month (p= 0,185), and 6-month (p= 0,086) respectively, also between 1-month and 6-month follow up assesments (p= 0,627), but all of them were not significant changes. In all three groups the quality of life (p= 0,951) improved. Exercises conducted with Tetrax® were more effective than electrostimulation of postural muscles in increasing TUG values and decreasing BBS values. CONCLUSIONS: Even though applying electrostimulation to postural muscles affected patients positively compared to pre-treatment, exercises performed with Tetrax® were more effective than the electrostimulation protocol to postural muscles in reducing balance disorder and this well-being continued even in the 6th month.

Muscular kinetics and fatigue evaluation of knee using by isokinetic dynamometer in patients with ankylosing spondylitis.

OBJECTIVE: Ankylosing Spondylitis (AS) is an inflammatory disease that is observed with arthritis, sacroiliitis and disability. The aim of the study was to compare the strength and fatigue of knee extensor/flexor muscle group usage by isokinetic in patients with AS with controls. METHODS: Twenty-six AS diagnosed patients and twenty-six healthy volunteers with similar age, height, body weight and gender were included in this study. In both groups the isokinetic tests are conducted by isokinetic dynamometer for every subject. Knee extension/flexion patterns;peak torque, agonist/antagonist ratio and work fatigue isokinetic parameters were evaluated during the knee 60º/s, 180º/s and 240º/s angular velocities. RESULTS: Knee extension/flexion muscle strength in patient group was significantly lower compared to the control group in all angular velocities (p< 0.05). CONCLUSIONS: The study showed knee muscle weakness and fatigue in patients with AS compared to the control group.

The effect of viscosupplementation on neuromuscular control of the knee in patients with osteoarthritis.

OBJECTIVE: The aim of this study was to investigate the short-term effects of intra-articular injection of hyaluronan (Hylan G-F 20) on proprioception, isokinetic muscle force, self reported pain, and functional condition in patients with knee osteoarthritis (OA). METHODS: 63 patients with stage II-III bilateral knee OA were included in this randomized, placebo controlled, and prospective study. Subjects were randomized with 42 of them into the treatment group and 21 of them into the placebo group. Hyaluronan was intraarticularly injected into both knees of the subjects which were in the treatment group, whereas physiological saline was intraarticularly injected to the subjects which were in the placebo group. Proprioception and the isokinetic muscle force measurement were performed. Visual analogue scale (VAS) and WOMAC scale were used to evaluate pain and physical function. RESULTS: Statistical analysis was performed on 120 knees of 60 patients completing the trial. The average absolute angular error (AAAE) value showing the proprioceptive error level in the treatment group was detected to be statistically significantly lower compared to placebo at the measurements performed after the 3rd injection (p = 0.02) and after one week (p = 0.01). While there was no inter-group difference in isokinetic measurements performed at 180 and 240 degrees/sec, a significant difference was detected at the measurement performed at 60 degrees/sec in favor of the treatment group (p = 0.02). Activity and resting VAS-pain values, WOMAC parameters (except the WOMAC stiffness) were detected to be significantly lower in the treatment group. Local adverse events were not reported in any patient. CONCLUSION: In this study, it was demonstrated that intraarticular injection of hyaluronan in patients with knee OA led to a short-term increase in proprioception and isokinetic muscle force, and also significant improvements in the functional conditions of patients. Long-term studies are needed.

Isokinetic strength measurements in early knee osteoarthritis.

OBJECTIVES: One of the most important reasons for locomotor dysfunction and disability in patients with knee osteoarthritis (OA) is muscle weakness in the lower extremity. The aim of this study was to compare the isokinetic knee muscle strength of patients with early knee OA with those of healthy people. PATIENTS AND METHODS: Fifty-one patients with bilateral knee osteoarthritis who were radiologically graded as stage I or II and forty-three healthy subjects were enrolled. Western Ontario and McMaster Universities Osteoarthritis Index and 100 mm VAS were used to assess patients with knee OA. Manual muscle strength testing for quadriceps muscle and circumference measurements 10 cm above the midpatellar line were performed. Bilateral isokinetic (concentric/concentric) knee flexion and extension with the protocol of 60 degrees/sec (four repetitions), 180 degrees/sec (four repetitions) and 240 degrees/sec (20 repetitions) were performed. RESULTS: Regarding manual muscle testing of knee OA group, quadriceps muscle strength in six knees were 4/5 and in 96 knees were 5/5; whereas in the control group only two knees had 4/5 and the rest 84 knees had 5/5 muscle strengths (p=0.22). Thigh circumference measurements were statistically similar in this regard (all p values > 0.05). In all velocities knee flexor and extensor isokinetic muscle strength values were found to be significantly lower in patients with knee OA compared to healthy subjects (p<0.05). Patients with stage I OA had greater muscle strength than those of stage II (p<0.05). CONCLUSIONS: Whether being a cause or a consequence of knee OA, muscle strength loss which cannot be detected during clinical examination appears to be present during isokinetic measurements.

Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome.

The first aim is to show if there is a disorder in proprioception in cases with benign joint hypermobility syndrome (BJHS) when compared to healthy subjects. The second aim is to evaluate the effect of proprioception exercise in BJHS cases. To evaluate the proprioceptive sensibility of the knee joint with 40 BJHS and 30 healthy subjects enrolled in the study. Then, cases with BJHS were randomized into two groups; proprioceptive exercises were applied to 15 patients for 8 weeks in clinic and 25 patients were taken as controls. Outcome measures included proprioceptive sensation, AIMS2 and VAS. Proprioception is significantly impaired in cases with BJHS. In BJHS group, significant decreases in VAS levels were detected in cases who did exercise compared with cases who did not, and statistically significant improvements were detected in occupational activity. For this reason proprioception exercises cause decrease in pain and improvement of functional status in BJHS group.

Isokinetic evaluation of knee extensor/flexor muscle strength in patients with hypermobility syndrome.

Benign joint hypermobility syndrome (BJHS) is a syndrome with musculoskeletal pain originating from the increased laxity of the joints and the ligaments. The study was to compare the isokinetic strength of knee extensor/flexor muscles of BJHS patients with healthy controls. Forty patients diagnosed as having BJHS with Brighton criteria and 45 years of age, height and weight-matched healthy controls were recruited for the study. Isokinetic testing was performed with isokinetic dynamometry of Biodex System 3Pro and measurements were recorded at knee extension/flexion pattern concentrically at 60, 180, and 240 degrees/s angular velocities. The study group was also evaluated for functional impairment and pain by HAQ and VAS respectively. Knee extensor muscle strength was significantly lower in the patient group compared with the controls. It was hypothesized that the muscle weakness in the study group was related to lengthening of the quadriceps muscle and pain-related inactivity as well as joint instability and proprioception defect.

Effects of kinesthesia and balance exercises in knee osteoarthritis.

BACKGROUND: In patients with knee osteoarthritis (OA), there is a prominent loss in proprioception and kinesthesia sensation compared with control subjects of the same age and gender. OBJECTIVES: The aim of this study is the investigation of short-term clinical effects of kinesthesia and balance exercises in patients with knee OA. METHODS: This 8-week study was conducted on 66 female patients with knee OA who were randomized into 2 groups. The first group received kinesthesia and balance exercises (such as retrowalking, walking on their toes, leaning to the sides, balance board exercises, minitrampoline exercises, plyometric exercises, and so on) in addition to strengthening exercises. The second group received only strengthening exercises. RESULTS: : Statistically significant improvements were observed postexercise for both groups with respect to baseline for WOMAC, SF-36 Form, times for performing activities of daily living, isokinetic quadriceps muscle strength, and proprioceptive sensation levels. In the first group with kinesthesia training, compared with the second group, significantly greater improvements were obtained in all the subparameters that measure functional status (WOMAC-physical function value, SF-36 Form [physical function, role limitations-physical and vitality-energy or fatigue variables], 10 stairs climbing, and 10-m walking times) and in isokinetic muscle strength at high angular velocities (P < 0.05). The absolute angular error percentage (to assess proprioceptive accuracy) was significantly improved postexercise in both groups. There were no differences between the groups. CONCLUSIONS: Additive positive effects of kinesthesia and balance exercises in knee OA have been demonstrated. Used in clinical applications, they should be able to increase the functional capacities of patients. Long-term studies about efficacy and cost-effectivity of these exercises are needed.