The effects of joint damage on muscle function, proprioception and rehabilitation

doi:10.1054/math.1997.0281

Manual Therapy

Volume 2, Issue 1, February 1997, Pages 11-17

https://doi.org/10.1054/math.1997.0281 Get rights and content

Abstract

SUMMARY. The paper summarizes a series of studies investigating reduced quadriceps femoris activation and its effect on rehabilitation of patients with traumatic and arthritic knee damage. It incorporates findings from related research fields and speculates on the physiological causes of reduced voluntary activation following joint damage and its clinical implications.

Arthrogenic reduction in voluntary activation is the inability to maximally activate muscles acting across damaged joints. This phenomenon may cause muscle weakness by preventing complete activation of the muscle and if prolonged may result in muscle fibre atrophy, and may possibly impede rehabilitation.

In patients with anterior cruciate ligament (ACL) deficient knees the reduction in quadriceps femoris activation was related to the amount of joint damage sustained and caused some quadriceps femoris weakness. Patients with isolated ACL ruptures had a small reduction of quadriceps femoris activation that did not impede conservative rehabilitation. However, patients with ACL ruptures and associated joint damage had a large reduction in activation and responded poorly to rehabilitation. Operative stabilization of ACL-deficient limbs may increase activation and improve efficacy of rehabilitation.

Quadriceps femoris activation was also reduced in patients with mild knee osteoarthritis, who responded well to rehabilitation.

Following joint damage, abnormal articular afferent information may decrease α-motoneurone excitability, reducing voluntary quadriceps femoris activation. If joint damage is extensive the resulting large reduction in activation may prevent the threshold for stimulation of muscle hypertrophy from being reached, which impedes rehabilitation. Abnormal articular afferent information may also decrease γ-motoneurone excitability causing proprioceptive deficits. Rehabilitation which increases α-motoneurone excitability may also increase γ-motoneurone excitability, improving proprioception.

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Cited by (140)

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2022, Veterinary Clinics of North America - Equine Practice
Females with knee osteoarthritis use a detrimental knee loading strategy when squatting
2022, Knee
Citation Excerpt :
The elderly are most affected by this disease [3] and often have chronic disability affecting daily activities [4]. Older adults with OA have deficits in quadriceps strength [5] and muscle activation [6], and these deficits are exaggerated in women with knee OA [7]. Squatting is one of the most common and important activities of daily living for personal hygiene and independence.
The purpose of this study was to identify sex differences in lower limb kinematics, kinetics, and muscle activation patterns between individuals with osteoarthritis and healthy controls during a two-legged squat.
Thirty OA (15 females) and 30 healthy (15 females) participants performed three 2-legged squats. Sagittal and frontal plane hip, knee, and ankle kinematics and kinetics were calculated. Two-way ANOVAs (Sex X OA Status) were used to characterize differences in squatting strategies between sexes and between those with and without knee OA.
A greater decrease in sagittal hip, knee, and ankle range of motion and knee joint power was observed in the OA participants compared to the healthy controls. Females with OA had significantly reduced hip and knee adduction angles compared to the healthy females and males with OA. Females also had decreased hip power, hip flexion, and hip adduction moments and knee adduction moments compared to their male counterparts, with the greatest deficits observed in the females with OA. Females with OA also had the highest magnitude of muscle activation for the quadriceps, hamstrings, and gastrocnemius throughout the squat, while males with OA showed increased activation of the vastus lateralis and medial gastrocnemius compared to the healthy males.
OA significantly altered biomechanics and neuromuscular control during the squat, with males employing a hip-dominant strategy, allowing them to achieve a greater lower limb range of motion.
Relationship Between Postural Stability and Paraspinal Muscle Adaptation in Lame Horses Undergoing Rehabilitation
2020, Journal of Equine Veterinary Science
Citation Excerpt :
The trajectory of the COP provides insights into the process of balance control as changes in the movement of the COP are directly related to the motion of an individual’s center of mass (COM) [11,12]. Individuals with musculoskeletal injuries and/or proprioceptive deficits will have a larger COP area because of altered signaling pathways that diminish the neuromuscular responses needed to maintain postural stabilization [2,5,8–10,13]. The COP velocity has also been shown to be a reliable measure of postural stability, with a lower velocity indicative of better postural control [14,15].
Postural stability maintains balance, protects the spinal column, and allows accurate responses to destabilizing forces. The musculus multifidus (m. multifidus) is the major postural muscle located adjacent to the vertebrae along the length of the spinal column. Increased cross-sectional area (CSA) of the m. multifidus has been demonstrated in horses after a rehabilitation strengthening exercise program; however, correlation with functional postural stability has not been shown. The objective of the present study is to evaluate the relationship of the thoracolumbar m. multifidus CSA and measures of postural sway performance in lame horses undergoing rehabilitation exercises in clinical cases. Seven client-owned horses admitted to the equine rehabilitation service were included in the study. M. multifidus CSA was measured via ultrasonography at the start of a rehabilitation program (initial evaluation) and after 12 weeks of rehabilitation exercises (final evaluation). Postural sway data were also measured at initial and final evaluation. A significant increase in m. multifidus CSA was seen from initial to final evaluation. A moderate to strong correlation was present between m. multifidus CSA and postural sway variables. These results suggest that there is an association between postural stability and m. multifidus hypertrophy in lame horses undergoing individualized rehabilitation programs. However, more research is needed to provide a definitive answer on the nature of this relationship. Ideally, specific performance tests would better define and examine the relationship in which to guide clinicians in rehabilitation protocol development.
Ultrasound evaluation of the quadriceps muscles in pronated foot posture
2019, Foot
The main goal of this study was to investigate the size of all portions of the quadriceps muscles in individuals with pronated foot posture compared to normal foot posture using ultrasound imaging.
Twenty nine females with pronated foot posture and 29 age-, body weight-, body height-matched females with normal foot posture were recruited from university communities. The muscle thicknesses of the rectus femoris (RF), vastus medialis (VM), vastus medialis oblique (VMO), vastus lateralis (VL) and vastus intermedius (VI) were measured using ultrasound imaging.
The thicknesses of the RF and VMO were significantly smaller in individuals with pronated foot posture compared to normal foot posture (p < 0.05). No significant differences were observed in the VM, VL, and VI muscle thicknesses in both groups.
Based on the results of the present study, it seems that besides the foot and lower leg muscles, an integrated assessment of proximal knee muscles, especially quadriceps, is required in individuals with pronated foot posture.
Hypoesthesia after anterior cruciate ligament reconstruction: The relationship between proprioception and vibration perception deficits in individuals greater than one year post-surgery
2019, Knee
Citation Excerpt :
In contrast, other researchers found that proprioception normalized following ACL reconstructive surgery [14]. Proprioceptive loss after ACL rupture has been attributed to sensory receptor loss [4,11], meaning that sensory fibers located in the ligament are destroyed after ACL injury, leaving a void in normal afferent input from the knee to the central nervous system. This equates to a peripheral neurologic lesion as the cause of proprioception deficits.
While surgical reconstruction restores mechanical stability following anterior cruciate ligament (ACL) rupture, many experience early-onset osteoarthritis despite surgery. Neurophysiological changes are hypothesized to contribute to knee osteoarthritis progression. Proprioceptive deficits have been reported following ACL injury/reconstruction; however, vibration perception threshold (VPT) has been less studied. This study explored relationships between pain, VPT, proprioception, function, and strength following ACL-reconstruction.
Twenty individuals (27 ± 6 years; 10 males) (standard deviation) status-post ACL-reconstruction were compared with a control group. Measurements included VPT, proprioception (threshold to detect passive movement), pain, function (Knee Outcome Survey (KOS)) and isometric quadriceps strength. Group differences were assessed using Mann-Whitney U tests, side-to-side differences with Wilcoxon Signed Rank tests, and associations evaluated using Spearman correlations.
The ACL-reconstruction group had minor functional deficits (15 ± 11%) and resting pain (1.8 ± 1.7). Impaired VPT and proprioception (hypoesthesia) were demonstrated on surgical compared to contralateral and control limbs (p ≤ 0.008). Proprioception was significantly different between contralateral and control knees, but not VPT. Surgical knee proprioceptive deficits and VPT deficits were positively correlated (ρ = 0.462, p = 0.047) but not in controls (ρ = −0.042, p = 0.862). Strength was negatively correlated to pain (ρ = −0.589; p = 0.006), but not to KOS scores, proprioception or VPT (p ≥ 0.099).
Proprioceptive deficits following ACL injury have been ascribed to loss of afferent input from the torn ligament. Alternatively, multi-modality as well as contralateral sensory deficits suggest a spinal/supraspinal source of neurophysiological findings which may predispose to early osteoarthritis.
III.
Characteristics of postoperative weight bearing and management protocols for tibial plateau fractures: Findings from a scoping review
2017, Injury
To identify and describe the characteristics of existing practices for postoperative weight bearing and management of tibial plateau fractures (TPFs), identify gaps in the literature, and inform the design of future research.
Seven electronic databases and clinical trial registers were searched from inception until November 17th 2016. Studies were included if they reported on the surgical management of TPFs, had a mean follow-up time of ≥1 year and provided data on postoperative management protocols. Data were extracted and synthesized according to study demographics, patient characteristics and postoperative management (weight bearing regimes, immobilisation devices, exercises and complications).
124 studies were included involving 5156 patients with TPFs. The mean age across studies was 45.1 years (range 20.8–72; 60% male), with a mean follow-up of 34.9 months (range 12–264). The most frequent fracture types were AO/OTA classification 41-B3 (29.5%) and C3 (25%). The most commonly reported non-weight bearing time after surgery was 4–6 weeks (39% of studies), with a further 4–6 weeks of partial weight bearing (51% of studies), resulting in 9–12 weeks before full weight bearing status was recommended (55% of studies). Loading recommendations for initial weight bearing were most commonly toe-touch/<10 kg (28%), 10 kg–20 kg (33%) and progressive (39%). Time to full weight bearing was positively correlated with the proportion of fractures of AO/OTA type C (r = 0.465, p = 0.029) and Schatzker type IV–VI (r = 0.614, p < 0.001). Similar rates of rigid (47%) and hinged braces were reported (58%), most frequently for 3–6 weeks (43% of studies). Complication rates averaged 2% of patients (range 0–26%) for abnormal varus/valgus and 1% (range 0–22%) for non-union or delayed union.
Postoperative rehabilitation for TPFs most commonly involves significant non-weight bearing time before full weight bearing is recommended at 9–12 weeks. Partial weight bearing protocols and brace use were varied. Type of rehabilitation may be an important factor influencing recovery, with future high quality prospective studies required to determine the impact of different protocols on clinical and radiological outcomes.

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Review articleThe effects of joint damage on muscle function, proprioception and rehabilitation

Abstract

Review article
The effects of joint damage on muscle function, proprioception and rehabilitation