Voluntary Contraction of the Abdominal Muscles Increases Hip Muscle Activation During Lower-Extremity Exercises: A Critically Appraised Topic.

CLINICAL SCENARIO: Existing studies have posited that incorporating abdominal enhancement techniques during lower-extremity exercises might mitigate compensatory pelvic motions and enhance the engagement of specific hip muscles. CLINICAL QUESTION: Does performing lower-extremity exercises with abdominal enhancement techniques increase hip muscle activation levels in healthy individuals? Summary of Key Finding: After the literature review, 4 cross-sectional studies met the inclusion criteria and were included in this critically appraised topic. CLINICAL BOTTOM LINE: There is moderate evidence to support that prone hip extension with abdominal enhancement may increase gluteus maximus and hamstring muscle activity. Gluteus medius activity may not be affected by abdominal enhancement during hip abduction exercises. Strength and Recommendation: The collective findings from the 4 cross-sectional trials indicate that the incorporation of abdominal enhancement techniques during lower-extremity exercises may have the potential to enhance targeted muscle activation levels in healthy individuals. Further research is recommended to establish more robust conclusions.

Voluntary Contraction of the Abdominal Muscles During Shoulder Exercises Increases Scapular Muscle Activation: A Critically Appraised Topic.

CLINICAL SCENARIO: The fascial relationship between scapular muscles and abdominal muscles has been documented from previous studies. However, it is not yet clear whether voluntary abdominal contraction has a beneficial effect on scapular muscle activity during shoulder exercises. CLINICAL QUESTION: Do scapulothoracic muscle activation levels increase if shoulder exercises are performed with voluntary abdominal activation? Summary of Key Finding: After the literature review, 4 cross-sectional studies met the inclusion criteria and were included in this critically appraised topic. CLINICAL BOTTOM LINE: There is moderate evidence to support dynamic shoulder exercises with voluntary abdominal contraction can increase trapezius and serratus anterior muscle activation level in asymptomatic shoulders. Strength and Recommendation: Findings from 4 cross-sectional trials indicate that there is moderate evidence supporting that dynamic shoulder exercises performed with voluntary abdominal contraction can increase scapular muscle activity.

Case-based report of graded motor imagery experience in traumatic brachial plexus injury: The art of moving without moving.

BACKGROUND: We reported a 24-year-old woman who sustained multiple upper limb injuries after a traffic accident in March 2017. She sustained a C7-T1 brachial plexus injury and radial nerve injury on the left side diagnosed in November 2017. The patient underwent radial nerve reconstruction. The patient began her comprehensive therapy program in January 2018. PURPOSE: To describe the use of graded motor imagery (GMI) and outcomes after traumatic brachial plexus palsy. We presented changes in electromyographic (EMG) activity of target muscles during task execution and functional status following 10-session GMI therapy. STUDY DESIGN: Case report. METHODS: The program included 4 sessions of motor imagery and 6 sessions of a combination of motor imagery and mirror therapy. RESULTS: The patient successfully participated in the program with reported improvements in EMG activity, functional status, emotional well-being, and body awareness. CONCLUSIONS: GMI therapy appears to have peripheral motor effects, including altered surface EMG activity and contributes to a favorable outcome in the functional level of the affected arm. An improved emotional state and awareness of the affected hand could have a positive effect on function. Future long-term randomized controlled trials are needed to investigate the cumulative peripheral effects of treatment of graded motor imagery and the effects of variables mediating its effects on functional performance in patients with nerve injury.

Shoulder and Scapular Muscle Activity During Low and High Plank Variations With Different Body-Weight-Bearing Statuses.

ABSTRACT: Can, EN, Harput, G, and Turgut, E. Shoulder and scapular muscle activity during low and high plank variations with different body-weight-bearing statuses. J Strength Cond Res 38(2): 245-252, 2024-This study investigated the activation levels and activation ratios of shoulder and scapular muscles during low plank (LP) and high plank (HP) variations, with varying levels of body-mass support, including 4-point, 3-pod, and 2-point body-weight-bearing (BWB) statuses. The study was conducted with 21 healthy men (mean ± SD , 26 ± 6.5 years of age and 24.4 ± 2.4 kg·m -2 BMI). Ten different plank exercises were performed in a mixed order by changing elbow joint positions (LP and HP) and BWB statuses (2-point, 3-pod, and 4-point). Activation levels of the lower trapezius (LT), middle trapezius (MT), upper trapezius (UT), biceps brachii, triceps brachii, infraspinatus, and serratus anterior (SA) muscles were assessed with a surface electromyography device. Results of this study showed that elbow position changes resulted in higher LT ( p = 0.01) and TB ( p = 0.001) activation in HP exercises. In general, it was observed that an increase in BWB status was effective in increasing activation for the scapula and shoulder girdle muscles. The ratios of the UT muscle to the SA, LT, and MT muscles were less than 1 during side plank, bird dog, front reach, shoulder taps, and plank with shoulder external rotation exercises. High plank with toe touch exercise resulted in a marked increase in the UT activation. Therefore, it was concluded plank variations alter activation levels and activation ratios of shoulder and scapular muscles. Plank exercises may be used in shoulder rehabilitation and the progression in plank variations can be achieved by changing elbow position and BWB status based on individual requirements.

Knowledge and awareness of anterior cruciate ligament injury among Turkish professional athletes: an online survey.

The purpose of this study was to assess the awareness and knowledge of professional team sport athletes about ACL injuries, injury prevention programs, and the return to sports after ACL injuries. A total of 419 athletes representing soccer, basketball, volleyball and handball sports were included in the study. We utilized a 15-item self-report survey to assess the awareness of athletes about ACL injury, ACL injury prevention program, and return to sport after ACL injuries. Male and soccer players participated in prevention programs more than female athletes (p = 0.001). Participation in prevention programs was significantly higher in the ≥ 18 years old group than in the < 18 years old group (p = 0.040). Participants who were informed about ACL injuries were 8.4 times more likely to participate in the ACL injuries prevention program than others (OR: 8.38, 95% CI: 3.823-18.376, p < 0.001). The majority of participants believed that return to sport after ACL injury takes 6 months and 81.4% of them thought that it is not possible to do sport without an ACL. This study revealed that the awareness and performance of ACL prevention training programs among professional team sport athletes were insufficient. The athletes' knowledge regarding return to sports after ACL injuries was also inadequate. Improving athletes' knowledge of ACL injuries may lead to increased participation in ACL injury prevention programs. Thus, the provision of tailored educational interventions to athletes could potentially enhance their awareness and understanding of ACL injuries, consequently contributing towards the prevention of such injuries.

Weight-Bearing Exercises on Slideboard Increase Quadriceps and Hamstring Activation Levels and Improve Hip- and Knee-Flexion Angles in Physically Active Individuals.

CONTEXT: Slideboards are commonly used in exercise programs, but there is limited information about how they affect muscle activities during exercise. We aim to compare the activation levels of quadriceps and hamstring muscles and hip- and knee-flexion angles during lunge and single-leg squat exercises between normal ground and slideboard in physically active individuals. DESIGN: Cross-sectional study. METHODS: Thirty healthy individuals (age: 23.83 [2.84] y, body mass index: 21.75 [1.72] kg/m2) were included in the study. Surface electromyography was used to measure vastus medialis, vastus lateralis, biceps femoris, and semitendinosus activation levels during reaching and returning phases of the forward, lateral, and back lunges and squats that were performed on the normal ground and slideboard. Exercises were performed at a slow pace (60 beats/min). Hip- and knee-flexion angles during the exercises were evaluated by using 2-dimensional motion analysis. Repeated measures of analysis of variance were used for statistical analysis. RESULTS: Vastus medialis and vastus lateralis activation levels were greater during reaching and returning phases of the exercises on slideboard compared with normal ground (P < .05). However, semitendinosus and biceps femoris activity were greater only during the returning phase of the forward lunge (P < .001) and the returning phase of the back squat (P = .002, P = .009, respectively). Hip-to-knee flexion ratios were closer to 1 when the forward lunge (P < .001), back lunge (P = .004), and forward squat (P = .001) exercises were performed on a slideboard. CONCLUSION: In exercise programs that target the quadriceps and hamstring muscles, slideboards can be effectively used in exercise progressions as they can increase muscle activity. Moreover, squat and lunge exercises on slideboard with a slow pace may also be helpful for improving the balance between hip- and knee-flexion angles.

Sports activity level after ACL reconstruction is predicted by vastus medialis or vastus medialis obliquus thickness, single leg triple hop distance or 6-m timed hop, and quality of life score.

PURPOSE: Recovery after anterior cruciate ligament reconstruction (ACLR) may take > 2 years, and younger athletes have higher re-injury risk. The purpose of this prospective longitudinal study was to determine how the early to mid-term Tegner Activity Level Scale (TALS) scores of athletically active males ≥ 2 years post-ACLR follow-up was predicted by bilateral isokinetic knee extensor and flexor torque, quadriceps femoris thickness, single leg hop test performance, and self-reported knee function (Knee Injury and Osteoarthritis Outcome Score (KOOS); International Knee Documentation Committee (IKDC) Subjective Assessment score). METHODS: After ACLR with a hamstring tendon autograft and safely returning to sports at least twice weekly, 23 men (18.4 ± 3.5 years of age) were evaluated at final follow-up (mean = 4.5, range = 2-7 years). Exploratory forward stepwise multiple regression was used to determine the relationship between independent surgical and non-surgical lower limb variables peak concentric isokinetic knee extensor-flexor torque at 60°/sec and 180°/sec, quadriceps femoris muscle thickness, single leg hop test profile results, KOOS subscale scores, IKDC Subjective Assessment scores, and time post-ACLR on TALS scores at final follow-up. RESULTS: Subject TALS scores were predicted by KOOS quality of life subscale score, surgical limb vastus medialis obliquus (VMO) thickness, and surgical limb single leg triple hop for distance (SLTHD) performance. Subject TALS scores were also predicted by KOOS quality of life subscale score, non-surgical limb vastus medialis (VM) thickness, and non-surgical limb 6 m single leg timed hop (6MSLTH) performance. CONCLUSION: TALS scores were influenced differently by surgical and non-surgical lower extremity factors. At ≥ 2 years post-ACLR, ultrasound VM and VMO thickness measurements, single leg hop tests that challenge knee extensor function, and self-reported quality of life measurements predicted sports activity levels. The SLTHD test may be better than the 6MSLTH for predicting long-term surgical limb function.

Altered Ankle Muscle Activation at 2-Year Post Achilles Tendon Repair: An Age, Gender, and Activity Level-Matched Comparison With Healthy Subjects.

CONTEXT: The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2 y postsurgery) with age, gender, and activity level-matched healthy control group subjects. DESIGN: Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. METHODS: Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. RESULTS: Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. CONCLUSIONS: Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. LEVEL OF EVIDENCE: Level III.

Association between quadriceps muscle thickness and knee function in anterior cruciate ligament reconstructed athletes: a cross-sectional study.

OBJECTIVE: This study aimed to investigate the association between vastus medialis obliquus (VMO), rectus femoris (RF), and vastus lateralis (VL) muscle thickness and quadriceps isokinetic strength, single-leg hop performance, and self-reported knee function in male athletes who had undergone anterior cruciate ligament reconstruction (ACLR). METHODS: Forty-two male athletes [mean ± standard deviation, age: 21.4 ± 3.4 years], who had undergone ACLR and had cleared to return to activity, were included in this study. Real-time ultrasound images of VMO, RF, and VL thicknesses were obtained from both reconstructed and contralateral limbs. Concentric quadriceps peak torque at 60°/s and 180°/s, single-leg hop for Distance (SLHD), and self-reported knee function scores were also assessed. Linear regression analysis and student t tests were used for statistical analysis. RESULTS: In reconstructed limb, greater VMO, RF, and VL thicknesses were associated with greater quadriceps peak torque at 60°/s (p = .008, r2 = 0.46) and at 180°/s (p = .006, r2 = 0.47). Greater quadriceps thickness was related to greater SLHD score in reconstructed limb (p = .002, r2 = 0.21). Self-reported knee function scores were not related to quadriceps thickness. VMO, RF, and VL thicknesses were smaller in reconstructed limb compared to contralateral limb (p < .001, p = .01, and p = .002, respectively). CONCLUSION: Quadriceps thickness by using ultrasound was associated with concentric quadriceps strength and single-leg hop distance in individuals who had undergone ACLR. However, quadriceps thickness was not related to self-reported knee function. The ultrasonography may be included in the evaluation of the knee function after ACLR, and it may be a useful and easy method in the follow-up of the quadriceps strength recovery following ACLR.

Effects of the COVID-19 confinement period on hip strength, flexibility and muscle injury rate in professional soccer players.

OBJECTIVES: This study aimed to examine the effects of COVID-19 confinement on hamstring eccentric strength, hip adduction-abduction strength, and posterior chain flexibility in professional male soccer players. We also aimed to investigate whether muscle strength and flexibility would change when the players returned to play after COVID-19 confinement. METHODS: Thirty professional male soccer (Age; 24.9 ± 4.8 yrs, BMI; 22.7 ± 1.4 kg/m2) players participated in this study. Hamstring eccentric strength, hip abduction-adduction strength and posterior chain flexibility (PCF) were measured before (time 1) and after the home confinement period (time 2) and after return to play (time 3). Repeated measures of ANOVA was used for statistical analysis. RESULTS: PCF decreased from time 1 to time 2 (p = 0.005) but it increased from time 2 to time 3 (p = 0.03). Hamstring eccentric strength decreased from time 1 to time 2 for both dominant (p = 0.002) and non-dominant (p = 0.04) limbs and no difference was observed between time 2 and time 3 (p > 0.05). Hip abductor and adductor strength did not change between time 1 and time 2 (p > 0.05) but they increased from time 2 and time 3 in the dominant limb (p < 0.05). Five players (16%) had muscle injuries including hamstrings and adductors when they returned to play. CONCLUSION: This study showed that 8-week COVID-19 confinement had an adverse effect on hamstring eccentric strength and PCF and 3 players had hamstring muscle injuries when they returned to play. Therefore, soccer players can be at risk of hamstring muscle injuries due to long-term detraining. Hip abductor and adductor strength seem not to be negatively affected by 8-week COVID-19 confinement. However, 2 players had adductor strain when they returned to play.

Translation, cross-cultural adaptation, and validation of the Turkish version of the shoulder instability-return to sport (SI-RSI) after injury scale.

To translate and culturally adapt the shoulder instability-return to sport after injury (SI-RSI) scale into Turkish (SI-RSI-Tr) and examine the psychometric properties of the Turkish version of athletes following a traumatic shoulder instability. The SI-RSI was translated into Turkish using Beaton guidelines. Sixty-nine patients with shoulder instability completed the translated SI-RSI, Western Ontario Shoulder Instability Index (WOSI), the Tampa Scale of Kinesiophobia (TSK), and the Walch-Duplay Scores. We analysed the internal consistency, agreement, reliability, and validity of the SI-RSI-Tr. The SI-RSI-Tr demonstrated excellent internal consistency (Cronbach's alpha = 0.92), test-retest reliability (ICC = 0.95), and feasibility with no ceiling or floor effect. SI-RSI-Tr correlated with WOSI total score (r = -0.824, p < 0.001), its subscales: WOSI-physical (r = -0.683, p < 0.001), WOSI-sports (r = -0.832, p < 0.001), WOSI-lifestyle (r = -0.739, p < 0.001), and WOSI-emotions (r = -0.734, p < 0.001) respectively), Walch-Duplay (r = 0.840, p < 0.001) and TSK (r = -0.828, p < 0.001) scores. The Turkish SI-RSI is a reliable, internally consistent, and valid tool for athletes with shoulder instability. Researchers and clinicians could safely use the SIRSI-Tr to evaluate the shoulder-specific psychological factors on return to sports following an episode of shoulder instability.

Star excursion balance test scores under different conditions: Effects of arms position and shoe-wear.

OBJECTIVES: The purpose of this study was to investigate the effects of arms position (arms free or hands on the hips) and shoe-wear (with or without athletic shoe) on star excursion balance test (SEBT) scores in healthy physically active individuals. DESIGN: Cross-sectional study. METHODS: Fifty-one participants [Age: 22.74 ± 1.93 years; Body Mass Index: 22.52 ± 2.29 kg/m2] were included in the study. The anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions of the SEBT were performed under four conditions in a randomized order. Within session reliability analysis was performed for each test condition. The composite (COMP) score was calculated as the average of the normalized scores of anterior, posteromedial and posterolateral reach distances. Repeated measures of ANOVA was used for statistical analysis. RESULTS: The ANT and PM reach distances and the composite (COMP) score were found greater with shoes (ANT p = 0.004; PM p < 0.001; COMP p < 0.001). However, the difference in the scores with shoes conditions did not exceed the measurement error. On the other hand, PM and PL reach distances and the COMP score were greater with arms free conditions and the difference in the scores exceeded the measurement error. CONCLUSIONS: The results of the study suggest that the differences in the SEBT procedure should be taken into account when comparing the outcomes of different studies. In addition, measurement error values should be considered while interpreting the change in repeated measures of SEBT scores.

Effects of Whole-Body Vibration Training on Knee Muscle Strength After Anterior Cruciate Ligament Reconstruction: A Critically Appraised Topic.

Clinical Scenario: Knee muscle strength weakness after anterior cruciate ligament (ACL) reconstruction is the most commonly seen impairment. Whole-body vibration (WBV) training has been shown to improve muscle strength in both healthy and injured individuals. However, it is not clear yet if WBV training has a beneficial effect in knee muscle strength recovery after ACL reconstruction. Clinical Question: Is adding WBV training to conventional rehabilitation more effective than conventional rehabilitation at improving quadriceps and hamstring muscles strength in individuals who have undergone ACL reconstruction? Summary of Key Findings: After the literature was reviewed, 4 randomized controlled trials met the inclusion criteria and were included in this critically appraised topic. Clinical Bottom Line: There is moderate- to high-quality evidence to support that adding WBV to conventional rehabilitation programs can result in better improvement in knee muscle strength after ACL reconstruction. Strength of Recommendation: Findings from 4 randomized controlled trials indicate that there is level B evidence supporting that WBV is effective for knee muscle strength recovery in patients who had undergone ACL reconstruction.

Shoulder-Abduction Angle and Trapezius Muscle Activity During Scapular-Retraction Exercise.

CONTEXT: Scapular-retraction exercises are often prescribed to enhance scapular stabilization. OBJECTIVE: To investigate upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) activities and UT/MT and UT/LT ratios during scapular-retraction exercises with elastic resistance at different shoulder-abduction angles. DESIGN: Descriptive laboratory study. SETTING: Biomechanical analysis laboratory. PATIENTS OR OTHER PARTICIPANTS: Thirty-five asymptomatic individuals. MAIN OUTCOME MEASURE(S): Surface electromyography was used to evaluate UT, MT, and LT activities during the scapular-retraction exercise at 0°, 45°, 90°, and 120° of shoulder abduction. RESULTS: The mean muscle activity ranged from 15.8% to 54.7% maximal voluntary isometric contraction (MVIC) for UT, 30.5% to 51.6% MVIC for MT, and 21.4% to 25.5% MVIC for LT. A significant muscle × angle interaction was found (P < .001). Post hoc analysis revealed that the MT was more activated than the UT and LT during both retraction at 0° (P < .001 and P = .01, respectively) and 120° (P = .03 and P = .002, respectively). During retraction at 45° and 90°, the LT generated less activity than the UT (P = .02 and P = .03, respectively) and MT (P < .001 and P = .002, respectively). Further, UT/MT and UT/LT ratios during retraction at 0° were lower than at 45° (P = .03 and P = .001, respectively) and 90° (P < .001 and P < .001, respectively). Retraction at 90° resulted in a higher UT/LT ratio than at 45° (P = .004) and 120° (P = .004). CONCLUSIONS: Due to less UT relative to MT activity, retraction at 0°, 45°, and 120° can be preferable in early shoulder training or rehabilitation. Additionally, retraction at 90° was the most effective exercise in activating all parts of the trapezius muscle.

Radiographic assessment of bone tunnels after anterior cruciate ligament reconstruction: A comparison of hamstring tendon and bone-patellar tendon-bone autografting technique.

OBJECTIVES: This study aims to compare the postoperative change of femoral and tibial tunnel widths after hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografting in primary anterior cruciate ligament (ACL) reconstruction surgery with the anteromedial portal technique. PATIENTS AND METHODS: This case-control and retrospective study included 39 patients (36 males, 3 females; mean age 30.1±7.9; range, 17 to 44 years) who underwent primary ACL reconstruction surgery with either BPTB autografting method (BPTB group, n=18) or HT autografting method (HT group, n=21) between March 2014 and December 2016. Femoral fixation was achieved with bioabsorbable screw in BPTB group and endobutton in HT group. Tibial fixation was achieved with bioabsorbable interference screw in both groups. Femoral and tibial tunnel widths of groups were compared on digital radiographs. RESULTS: When we compared the baseline values with the second-year results, the mean of femoral tunnel widths were significantly lower on radiographs at the second-year evaluation in both groups (p<0.001 for all). However, the means of tibial tunnel widths were significantly lower only in the BPTB group (p<0.001 for BPTB group and p=0.616 for HT group). Change levels of anteroposterior and lateral widths were more prominent in BPTB group than HT group (p<0.001 for all). CONCLUSION: Changes in tunnel widths show us superior ossification in BPTB grafting. This can be explained by superior bone-to-bone healing. As a result of radiological evaluation, we think that BPTB grafting can be more strong and durable.

Quadriceps and Hamstring Strength Symmetry After Anterior Cruciate Ligament Reconstruction: A Prospective Study.

OBJECTIVES: To evaluate change in involved and uninvolved quadriceps and hamstring strength and limb symmetry indices (LSI) in regular intervals over the first 6 months following anterior cruciate ligament reconstruction (ACLR). DESIGN: Prospective cohort study. PARTICIPANTS: Thirty-eight male participants (mean age: 24.2 [6.4] y, mean body mass index: 23.6 [4.2] kg/m2), who underwent ACLR were included. MAIN OUTCOME MEASURES: Isometric strength testing of the quadriceps and hamstring muscles was performed at 1, 2, 3, and 6 months after ACLR. Quadriceps and hamstring peak torques for each limb and LSI were calculated. Repeated-measures analysis of covariance and paired t tests were used to evaluate changes in strength over time and between limbs, respectively. RESULTS: Quadriceps and hamstring peak torques of the involved limb consistently increased between each time point from 1 to 6 months (P < .001 and P = .01, respectively), whereas the uninvolved limb values did not change after ACLR (P > .05). In addition, uninvolved limb peak torque values were higher than involved limb values at each time point after ACLR for both the quadriceps and hamstrings (all P < .01). At 6 months after ACLR, 28.9% of participants demonstrated LSI greater than 90% for quadriceps strength, 36.8% demonstrated LSI greater than 90% for hamstring strength, and 15.8% of participants demonstrated greater than 90% LSI for both quadriceps and hamstring strength. CONCLUSIONS: Participants demonstrated a consistent increase in quadriceps and hamstring strength of the involved limb, with no notable change in uninvolved limb strength over the 6 months after ACLR. However, at 6 months after ACLR, only approximately 16% of participants demonstrated both quadriceps and hamstring strength LSI greater than 90%, the typically recommended cutoff value for return to sport.

Postoperative rehabilitation and outcomes following arthroscopic isolated meniscus repairs: A systematic review.

OBJECTIVES: The purpose of this study was to review the current literature on rehabilitation protocols following arthroscopic meniscus repair. METHODS: A systematic literature review was performed of Medline, Scopus, and Web of Science databases to identify relevant articles from January 1990 to April 2019. Search terms were (meniscus OR meniscal repair) AND (repaired OR repair) AND (rehabilitation OR physiotherapy OR physical therapy). Each study was independently scored for methodological research quality level using the Modified Coleman Methodology Score (MCMS). The following variables were extracted from each study: publication year, study type, evidence level, subject demographics, injury mechanism, meniscus tear type, surgical procedure, rehabilitation program [immobilization, weight bearing, ROM progression, therapeutic exercises, length of follow-up, patient-reported outcome measurements, return to sport timing/criteria and failure rate/criteria. RESULTS: Eighteen studies met the inclusion criteria. The overall MCMS was moderate 59.5 ± 11.7 (range = 42-90). The average MCMS score for postoperative rehabilitation was 4.7 ± 1.18. Only 1 (5.6%) study was a prospective randomized controlled trial and 14 studies (78%) had retrospective designs. Fourteen (78%) studies suggested that return to sports should occur between 3 and 6 months post-surgery. Early range of motion and immediate weight-bearing had no influence over patient-reported outcomes or failure rates for vertical meniscus tear repairs. CONCLUSION: Low MCMS scores, primarily retrospective study designs and poorly described postoperative rehabilitation protocols made it difficult to design an evidence-based therapeutic rehabilitation program for patients following arthroscopic repair of an isolated meniscus tear. An arthroscopic isolated meniscal tear repair rehabilitation protocol is being attempted to present based on a synopsis of existing evidence.

Comparison of muscle activation levels and knee valgus between individuals with medial patellofemoral ligament reconstruction and healthy individuals during fatiguing step down task.

BACKGROUND: Medial patellofemoral ligament reconstruction becomes first-choice surgical procedure for patients with a history of lateral patellar dislocations but there is limited knowledge about neuromuscular activation patterns of individuals with a history of patellar dislocation who underwent medial patellofemoral ligament reconstruction. OBJECTIVE: The aim of this study was to compare muscle activation levels and knee valgus during step down performance test between individuals with a history of medial patellofemoral ligament reconstruction and healthy individuals. METHODS: Fifteen individuals with medial patellofemoral ligament reconstruction and 15 healthy individuals were included. Vastus medialis obliquus, vastus lateralis and gluteus medius muscle activation levels and knee valgus were measured during 60-s- step down performance test. Two-way repeated-measures of analysis of covariance was used for statistical analysis. FINDINGS: Compared to the healthy individuals, individuals with medial patellofemoral ligament reconstruction showed lower vastus medialis obliquus (p = .04) and gluteus medius (p = .005) activation levels, and higher knee valgus (p = .002) in last period of the step down performance test. INTERPRETATION: Since the significant results were only observed in the fatiguing section of the test, endurance tests may provide more information about neuromuscular control of the individuals with history of medial patellofemoral ligament reconstruction. Future studies should investigate whether endurance exercises that target to improve vastus medialis obliquus and gluteus medius activity result in better clinical outcomes than conventional programs for individuals with medial patellofemoral ligament reconstruction.

The effects of enhanced abdominal activation on quadriceps muscle activity levels during selected unilateral lower extremity exercises.

The purpose of this study was to investigate the effect of Abdominal Enhancement (AE) on the muscle activation of vastus medialis obliquus (VMO), vastus lateralis (VL) and rectus femoris (RF) muscle activation levels during eccentric, isometric and concentric phases of single leg raise (SLR), single leg wall squat (SLWS) and forward lunge (FL) exercises. Sixteen healthy individuals (Age: 24.6 ± 1.7 years) were included in the study. Internal Obliques/Transversus Abdominis (IO/TA), VMO, RF and VL muscle activation levels were measured by surface EMG during the exercises in two conditions: with and without AE. The abdominal drawing-in technique was used for AE. Repeated-measures analysis of variance was performed for statistical analysis. With AE, the average of IO/TA muscle activation level was 28.9%. VMO and VL muscle activation levels were significantly greater with AE during SLR (p = .02), SLWS (p < .001) and FL (VMO, p = .008, VL, p = .04) exercises. The effect of AE on VMO muscle activation level ranged from 2.5% to 5% (Effect size range: 0.54 to 0.91) and VL muscle activation level ranged from 2.1% to 5.5% (Effect size range: 0.35-1.24). RF muscle activation level did not change with AE (p > .05). The results of this study showed that AE increased VMO and VL muscle activities during SLR, SLWS and FL exercises but the corresponding changes were small. Even if this is not enough for muscle strengthening, exercises with AE may be used to enhance knee joint stability while controlling lumbopelvic stability.