Ralph Nisell

Mechanics of the Knee A study of joint and muscle load with clinical applications

The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg box was quantified using a computerized static sagittal plane body model. Surface electromyography of quadriceps and hamstrings muscles was normalized and expressed as a percentage of an isometric maximum voluntary test contraction. Working with straight knees and the trunk flexed forwards induced extending knee load moments of maximum 55 Nm. Lifting the box with flexed knees gave flexing moments of 50 Nm at the beginning of the lift, irrespective of whether the burden was between or in front of the feet. During machine milking, a level difference between operator and cow of 0.70 m - 1.0 m significantly lowered the knee extending moments. To quantify the force magnitudes acting in the tibio-femoral and patello-femoral joints, a local biomechanical model of the knee was developed using a combination of cadaver knee dissections and lateral knee radiographs of healthy subjects. The moment arm of the knee extensor was significantly shorter for women than for men, which resulted in higher knee joint forces in women if the same moment was produced. A diagram for quantifying patellar forces was worked out. The force magnitudes given by the knee joint biomechanical model correlated well with experimentally forces measured by others. During the parallel squat in powerlifting, the maximum flexing knee load moment was estimated to 335-550 Nm when carrying a 382.5 kg burden and the in vivo force of a complete quadriceps tendon-muscle rupture to between 10,900 and 18,300 N. During isokinetic knee extension, the tibio-femoral compressive force reached peak magnitudes of 9 times body weight and the anteroposterior shear force was close to 1 body weight at knee angles straighter than 60 degrees, indicating that high forces stress the anterior cruciate ligament. A proximal resistance pad position decreased the shear force considerably, and this position is recommended in early rehabilitation after anterior cruciate ligament repairs or reconstructions. The methods presented quantify muscle activity, sagittal knee joint moments and forces, enabling assessments to be made of different work postures, training exercises and joint derangements.

Joint forces in extension of the knee: Analysis of a mechanical model

A two-dimensional model of the tibio-femoral joint was constructed by using the results of cadaver knee dissections together with radiographic landmarks on healthy knees loaded at various angles of flexion. The tibio-femoral compressive force during isometric knee extension had the same magnitude as the patellar tendon force. The tibio-femoral shear force changed direction from posterior at full flexion to anterior when the knee was extended, indicating that high forces may arise in the anterior cruciate was extended, indicating that high forces may arise in the anterior cruciate ligament in the straight knee. Women developed some 20 per cent higher knee joint forces than men for the same extending muscular moment higher knee joint forces than men for the same extending muscular moment, since womens patellar tendon moment arms were found to be shorter. The model presented may be used for quantifying tibio-femoral forces during knee extending activities.

Tibiofemoral joint forces during isokinetic knee extension

Using a Cybex II, eight healthy male subjects performed isokinetic knee extensions at two different speeds (30 and 180 deg/sec) and two different positions of the resistance pad (proximal and distal). A sagittal plane, biomechanical model was used for calculating the mag nitude of the tibiofemoral joint compressive and shear forces. The magnitude of isokinetic knee extending moments was found to be significantly lower with the resistance pad placed proximally on the leg instead of distally. The tibiofemoral compressive force was of the same magnitude as the patellar tendon force, with a maximum of 6300 N or close to 9 times body weight (BW). The tibiofemoral shear force changed direction from being negative (tibia tends to move posteriorly in relation to femur) to a positive magnitude of about 700 N or close to 1 BW, indicating that high forces arise in the ACL when the knee is extended more than 60°. The anteriorly directed shear force was lowered consid erably by locating the resistance pad to a proximal position on the leg. This model may be used when it is desirable to control stress on the ACL, e.g., in the rehabilitative period after ACL repairs or reconstruc tions.

Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study.

OBJECTIVE To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis. METHODS A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual analog scale (VAS), Grippit, Timed-Stands Test, Escola Paulista de Medicina Range of Motion scale, walking in a figure-of-8, a visual analog scale for pain, the Health Assessment Questionnaire disability index, a self-reported physical activity questionnaire, and the Disease Activity Score in 28 joints. All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed. Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity (> or =30 minutes, moderately intensive activity, most days of the week). RESULTS The retention rates after 1 year were 82% in the intervention group and 85% in the control group. The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before (47% versus 51%; P > 0.05) and after (54% versus 44%; P > 0.05) the intervention. Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS (P = 0.025) and muscle strength (Timed-Stands Test; P = 0.000) (Grippit; P = 0.003), but not in any other variables assessed. CONCLUSION A 1-year coaching program for healthy physical activity resulted in improved perceived health status and muscle strength, but the mechanisms remain unclear, as self-reported physical activity at healthy level did not change.

Tibiofemoral joint forces during ergometer cycling

Six healthy subjects pedaled on a weight-braked bicy cle ergometer at different workloads, pedaling rates, saddle heights, and pedal foot positions. The subjects were filmed with a cine-film camera and pedal reaction forces were recorded from a force transducer mounted on the left pedal. Net knee moments were calculated using a dynamic model, and the tibiofemoral shear and compressive force magnitudes were calculated using a biomechanical model of the knee. During cycling at 120 W, 60 rpm, midsaddle height, and anterior pedal foot position, the mean peak tibiofemoral compressive force was 812 N [1.2 times body weight (BW)]. The maximum anteriorly directed tibiofemoral shear force was found to be low (37 N). The compressive and shear forces were significantly increased by an increased ergometer workload. The pedaling rate had no influence on the tibiofemoral force magnitudes. The stress on the ACL was low and could be further decreased by use of the anterior foot position instead of the posterior.

An electromyographic study of dental work

Musculoskeletal disorders are common among dentists, and have been ascribed to the demands of high precision work and sustained static loading in the neck-shoulder region, combined with a flexed and rotated cervical spine. In order to determine muscular load levels during dentistry, activity in neck, shoulder, and arm muscles was recorded using an electromyography technique (EMG). Normalized mean, median, 10th and 90th percentile EMG amplitude levels (% maximal reference contraction, %max-RVC) were calculated during ordinary dental work. Among the muscles investigated, the trapezius muscle on both sides had the highest mean (the right trapezius 9.0% and the left 7.6% of max-RVC) and 10th percentile amplitude levels (both about 2% of max-RVC). The trapezius muscles showed similar myoelectric activity on the right and left side, probably because of similar muscular static load on the both sides. The right extensor carpi radialis muscle had a significantly higher muscular load level than the left one, possibly due to stabilization demands on the dominant wrist during demanding precision work. The infraspinatus muscle had low activity level on both sides, reflecting that the dentists worked with a small degree of arm elevation and external rotation. The dentistry work thus seems to generate relatively high muscular load on both trapezius and dominant extensor-carpi-radialis, and relatively low load on the infraspinatus muscle.

Power output and work in different muscle groups during ergometer cycling.

SummaryThe aim of this study was to calculate the magnitude of the instantaneous muscular power output at the hip, knee and ankle joints during ergometer cycling. Six healthy subjects pedalled a weight-braked bicycle ergometer at 120 watts (W) and 60 revolutions per minute (rpm). The subjects were filmed with a cine camera, and pedal reaction forces were recorded from a force transducer mounted in the pedal. The muscular work at the hip, knee and ankle joint was calculated using a model based upon dynamic mechanics described elsewhere. The mean peak concentric power output was, for the hip extensors, 74.4 W, hip flexors, 18.0 W, knee extensors, 110.1 W, knee flexors, 30.0 W and ankle plantar flexors, 59.4 W. At the ankle joint, energy absorption through eccentric plantar flexor action was observed, with a mean peak power of 11.4 W and negative work of 3.4 J for each limb and complete pedal revolution. The energy production relationships between the different major muscle groups were computed and the contributions to the total positive work were: hip extensors, 27%; hip flexors, 4%; knee extensors, 39%; knee flexors, 10%; and ankle plantar flexors 20%.

The Forces of Ankle Joint Structures during Ergometer Cycling

The ankle joint moment, joint compressive force, and Achilles tendon force obtained during ergometer cycling were calculated by using a quartz force-measuring transducer mounted on the pedal. Six healthy subjects rode in 11 different ways at different workloads, pedalling rates, saddle heights, and pedal foot positions. The mean maximum dorsiflexing load moment about the ankle joint during standardized ergometer cycling was calculated to 30.9 nm. The mean ankle joint compressive force and mean Achilles tendon force measured 1008 N (1.4 times body weight) and 762 N (1.1 times body weight), respectively. The ankle joint moment was significantly changed by a change of workload or pedal foot position.

Load on knee joint and knee muscular activity during machine milking

Abstract Ten professional milkers simulated 20 different standardized machine-milking work postures. Various differences in level between milkers and cow, and various postures at each level, were studied. Knee muscular activity was recorded electromyographically. In the milking procedure when attaching the teat cups to the udder the body position was photographed and the loading moment of force about the bilateral knee axis was calculated by means of a biomechanical model. Working with straight knees resulted in comparatively high moments tending to extend the knee (with the highest mean of 56 N m). This moment was for some subjects close to their maximum strength capacity. A 65° knee angle in the standing postures with small level-difference between cow and milker gave the least knee loading moment (i.e. around zero) independently of body weight. The horizontal distance between operator and cow showed high importance for the amplitude of the knee load. The model for determining knee load can generally be...

Shoulder load during machine milking An electromyographic and biomechanical study

Abstract Ten professional milkers simulated 20 different machine-milking postures related to different vertical distances between milker and cow. The loading moment with respect to the shoulder joint bilateral axes was calculated, and EMGs from four shoulder muscles were recorded. The loading moments were related to isometric strength and EMG was standardized against an isometric maximum contraction. Muscle activity was low to moderate. Load moment increased with increasing level difference between milker and cow, but the simultaneous increase in strength utilization and muscular activation was lower than expected. About 25% of maximum shoulder flexor strength was required. The study illustrates some effects of the interaction between shoulder loading moment, trunk inclination and shoulder flexion. The method used gives load both in absolute form (loading moment) and in relation to individual capacity (strength utilization and normalized EMG).