Birgitte Hede Christensen

Neuromuscular activity and knee kinematics in adolescents with patellofemoral pain

PURPOSE This study aimed to investigate the neuromuscular control of the knee during stair descent among female adolescents with patellofemoral pain (PFP) and to report its association with self-reported clinical status assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS). METHODS Fifty-seven previously untreated female adolescents diagnosed with PFP ages 15-19 yr were recruited from schools. The control group consisted of 29 age-matched healthy female adolescents. Bipolar surface electrodes were placed on vastus medialis and vastus lateralis, and an electronic knee goniometer was placed at the knee to collect knee flexion/extension kinematics. The participants walked down a stairway consisting of 24 steps at their normal pace. Sample entropy was used to quantify the complexity of the time series from surface electromyography and kinematics during the stance phase. Self-reported clinical status was assessed by the KOOS and the maximal quadriceps torque measured using strap-mounted handheld dynamometry. RESULTS Female adolescents with PFP were characterized by altered neuromuscular knee control during stair descent, lower maximal quadriceps torque, and poorer KOOS scores across all five domains. Furthermore, a positive association was found between the complexity of surface electromyography from vastus lateralis and self-reported pain determined by KOOSpain, indicating larger impairments in neuromuscular knee control among those with the highest pain levels. CONCLUSIONS The current findings show that female adolescents with PFP are characterized by altered neuromuscular control of the knee during stair descent and lower maximal quadriceps torque. These results suggest that rehabilitation is needed and should focus on restoring neuromuscular control and muscle strength.

Between-day reliability of a hand-held dynamometer and surface electromyography recordings during isometric submaximal contractions in different shoulder positions

Functional shoulder assessments require the use of objective and reliable standardized outcome measures. Therefore, the aim of this study was to examine the between-day reliability of a hand-held dynamometer when measuring muscle strength during flexion, abduction, and internal and external rotation as well as surface electromyography (EMG) when measuring muscle activity from m. trapezius superior and deltoideus anterior. Twenty-four healthy subjects participated and performed four isometric contractions measured with a hand-held dynamometer and EMG. Both relative and absolute reliability were calculated based on the mean of the last three of the four repetitions. EMG amplitude was assessed calculating both absolute and normalized root-mean-square (RMS) values. The reliability of the hand-held dynamometer was high (LOA=3.2-7.6% and ICC=0.89-0.98). The absolute reliability for EMG showed similar results for absolute RMS values (LOA=20.0-68.4%) and normalized RMS values (LOA=42.4-66.5%). However, the results concerning the relative reliability showed higher ICC for absolute RMS values (ICC=0.82-0.92) compared with normalized values (ICC=0.57-0.72).The outcome measurements of this study with healthy subjects were found reliable and, therefore, have the potential to detect changes in muscle strength and muscle activity.