Tine Alkjær

The effects of neuromuscular training on knee joint motor control during sidecutting in female elite soccer and handball players.

Objective:The project aimed to implement neuromuscular training during a full soccer and handball league season and to experimentally analyze the neuromuscular adaptation mechanisms elicited by this training during a standardized sidecutting maneuver known to be associated with non-contact anterior cruciate ligament (ACL) injury. Design:The players were tested before and after 1 season without implementation of the prophylactic training and subsequently before and after a full season with the implementation of prophylactic training. Participants:A total of 12 female elite soccer players and 8 female elite team handball players aged 26 ± 3 years at the start of the study. Intervention:The subjects participated in a specific neuromuscular training program previously shown to reduce non-contact ACL injury. Methods:Neuromuscular activity at the knee joint, joint angles at the hip and knee, and ground reaction forces were recorded during a sidecutting maneuver. Neuromuscular activity in the prelanding phase was obtained 10 and 50 ms before foot strike on a force plate and at 10 and 50 ms after foot strike on a force plate. Results:Neuromuscular training markedly increased before activity and landing activity electromyography (EMG) of the semitendinosus (P < 0.05), while quadriceps EMG activity remained unchanged. Conclusions:Neuromuscular training increased EMG activity for the medial hamstring muscles, thereby decreasing the risk of dynamic valgus. This observed neuromuscular adaptation during sidecutting could potentially reduce the risk for non-contact ACL injury.

Evaluation of the walking pattern in two types of patients with anterior cruciate ligament deficiency: copers and non-copers

The purpose of the present study was to investigate whether different walking patterns in healthy subjects and in coper and non-coper subjects with deficient anterior cruciate ligaments could be quantified. An inverse dynamics approach was used to calculate joint kinematics and kinetics for flexion and extension. EMG signals of the hamstrings and quadriceps muscles were recorded. The results showed that the peak knee flexion angle was greater in the copers than in the controls. There was a positive correlation between the peak knee extensor moment and peak knee flexion angle. Furthermore, at a given peak knee flexion angle, the peak knee extensor moment was significantly larger in the controls than in the non-copers. The hip extensor moment in the copers was significantly larger than that of the non-copers and the controls. In conclusion, the three groups walked according to different patterns. It is suggested that the copers stabilized their knee joint by co-contraction of the hamstrings and quadriceps muscles, while the non-copers lacked this ability. Instead, the non-copers reduced the knee extensor moment in order to decrease anterior displacement of the tibia. The walking pattern differences observed between the copers and non-copers may explain their different post-injury activity levels.

Comparison of inverse dynamics calculated by two- and three-dimensional models during walking

The purpose of the study was to compare joint moments calculated by a two- (2D) and a three-dimensional (3D) inverse dynamics model to examine how the different approaches influenced the joint moment profiles. Fifteen healthy male subjects participated in the study. A five-camera video system recorded the subjects as they walked across two force plates. The subjects were invited to approach a walking speed of 4.5 km/h. The ankle, knee and hip joint moments in the sagittal plane were calculated by 2D and 3D inverse dynamics analysis and compared. Despite the uniform walking speed (4.53 km/h) and similar footwear, relatively large inter-individual variations were found in the joint moment patterns during the stance phase. The differences between individuals were present in both the 2D and 3D analysis. For the entire sample of subjects the overall time course pattern of the ankle, knee and hip joint moments was almost identical in 2D and 3D. However, statistically significant differences were observed in the magnitude of the moments, which could be explained by differences in the joint centre location and joint axes used in the two approaches. In conclusion, there were differences between the magnitude of the joint moments calculated by 2D and 3D inverse dynamics but the inter-individual variation was not affected by the different models. The simpler 2D model seems therefore appropriate for human gait analysis. However, comparisons of gait data from different studies are problematic if the calculations are based on different approaches. A future perspective for solving this problem could be to introduce a standard proposal for human gait analysis.

Experimentally reduced hip abductor function during walking: Implications for knee joint loads

Hip and knee functions are intimately connected and reduced hip abductor function might play a role in development of knee osteoarthritis (OA) by increasing the external knee adduction moment during walking. The purpose of this study was to test the hypothesis that reduced function of the gluteus medius (GM) muscle would lead to increased external knee adduction moment during level walking in healthy subjects. Reduced GM muscle function was induced experimentally, by means of intramuscular injections of hypertonic saline that produced an intense short-term muscle pain and reduced muscle function. Isotonic saline injections were used as non-painful control. Fifteen healthy subjects performed walking trials at their self-selected walking speed before and immediately after injections, and again after 20 min of rest, to ensure pain recovery. Standard gait analyses were used to calculate three-dimensional trunk and lower extremity joint kinematics and kinetics. Surface electromyography (EMG) of the glutei, quadriceps, and hamstring muscles were also measured. The peak GM EMG activity had temporal concurrence with peaks in frontal plane moments at both hip and knee joints. The EMG activity in the GM muscle was significantly reduced by pain (-39.6%). All other muscles were unaffected. Peaks in the frontal plane hip and knee joint moments were significantly reduced during pain (-6.4% and -4.2%, respectively). Lateral trunk lean angles and midstance hip joint adduction and knee joint extension angles were reduced by 1 degrees . Thus, the gait changes were primarily caused by reduced GM function. Walking with impaired GM muscle function due to pain significantly reduced the external knee adduction moment. This study challenge the notion that reduced GM function due to pain would lead to increased loads at the knee joint during level walking.

Salivary Cortisol Level, Salivary Flow Rate, and Masticatory Muscle Activity in Response to Acute Mental Stress: A Comparison between Aged and Young Women

Background: Age-related effects on physiological stress reactions regarding changes in salivary cortisol concentration, saliva flow rate, and masticatory muscle activity, as well as the corresponding perceived mental stress and performance in response to acute stressors, have not yet been fully described. Objective: Thus, the aim of this study was to assess the age-related variations in these variables in response to minor acute and naturalistic stressors in terms of computer tasks. Methods: 13 aged (60–70 years old) and 13 young (20–30 years old) women with frequent practice and long experience with computer use were recruited by personal contact and flyers. The subjects were healthy and had full dental arches and no orofacial pain. The computer tasks were randomized and comprised a mentally demanding, modified Stroop colour-word test (CWT) and a less demanding reference test, both with a duration of 20 min and with equal physical demand. Visual analogue scales for global assessment of mental stress and perceived task difficulty and performance, measurements of saliva flow rate and cortisol concentration (unstimulated whole saliva), as well as surface electromyography of the temporalis and masseter muscles were used for assessment, and Spearman correlation analysis and Anova with repeated measures were used for statistical evaluation. Results: The perceived task-related stress and task difficulty were significantly higher and the personal satisfaction with the task performance significantly poorer in the aged women. The cortisol concentration, indicating the stress level, showed a small, but significant increase in response to the tasks. Also the saliva flow rate increased. This response was most pronounced in the aged and during the CWT. The average electromyogram varied significantly between age groups and tasks, with higher levels and shorter relative periods with gaps in the aged women and in the CWT. In addition, the peak activity of the jaw elevator muscles at mouse clicking was significantly elevated as a form of co-activation or attention-related activity. Conclusions: The study showed marked differences in the response to mental demands in aged as compared with young women. The mental stress, reflected by increases of salivary cortisol concentration, saliva flow rate, visual analogue scale ratings, and activity level of the jaw elevator muscles, was more pronounced in the aged women in response to the computer tasks.

Nordic Walking does not reduce the loading of the knee joint

The use of Nordic Walking (NW) as a rehabilitation modality has increased considerably. NW (walking with poles) is advocated as a healthy physical activity that reduces the load on the knees. Few studies using the techniques of NW exist, and the findings are contradictory. The aim of this study was to investigate whether NW reduces the loadings upon the knee joint compared with walking without poles (NP). Seven experienced female NW instructors volunteered. Three‐dimensional gait analyses were performed. Internal flexor and extensor joint moments were calculated using an inverse dynamics approach and the knee joint compressive forces were calculated. No differences in compression or shear forces between NW and NP were found. The peak knee flexion angles were larger during NW (−32.5±6.0°) compared with NP (−28.2±4.2°). The hip range of motion (ROM) was significantly increased during NW (64.4±10.2°) compared with NP (57.8±9.7°); no differences in the knee and ankle joint ROM were observed. The changes in the joint angles were not followed by changes in the joint dynamics. The present study does not support the statement that NW reduces the load on the knees.

Acute fatigue impairs neuromuscular activity of anterior cruciate ligament‐agonist muscles in female team handball players

In sports, like team handball, fatigue has been associated with an increased risk of anterior cruciate ligament (ACL) injury. While effects of fatigue on muscle function are commonly assessed during maximal isometric voluntary contraction (MVC), such measurements may not relate to the muscle function during match play. The purpose of this study was to investigate the effect of muscle fatigue induced by a simulated handball match on neuromuscular strategy during a functional sidecutting movement, associated with the incidence of ACL injury. Fourteen female team handball players were tested for neuromuscular activity [electromyography (EMG)] during a sidecutting maneuver on a force plate, pre and post a simulated handball match. MVC was obtained during maximal isometric quadriceps and hamstring contraction. The simulated handball match consisted of exercises mimicking handball match activity. Whereas the simulated handball match induced a decrease in MVC strength for both the quadriceps and hamstring muscles (P<0.05), a selective decrease in hamstring neuromuscular activity was seen during sidecutting (P<0.05). This study shows impaired ACL‐agonist muscle (i.e. hamstring) activity during sidecutting in response to acute fatigue induced by handball match play. Thus, screening procedures should involve functional movements to reveal specific fatigue‐induced deficits in ACL‐agonist muscle activation during high‐risk phases of match play.

Choice of jumping strategy in two standard jumps, squat and countermovement jump: effect of training background or inherited preference?

Six male subjects, three professional ballet dancers and three elite volleyball players, performed maximal vertical jumps from 1) a static preparatory position (squat jump), 2) starting with a countermovement (counter‐movement jump) and 3) a specific jump for ballet and for volleyball, respectively. The jumps were recorded on highspeed film (500 Hz) combined with registration of ground reaction forces, and net joint moments were calculated by inverse dynamics. The purpose was to investigate the choice of strategy in two standard jumps, squat jump and countermovement jump. The volleyball jump was performed with a sequential strategy and the ballet jump was performed with a simultaneous strategy. In the two standard jumps, the choice of strategy was individual and not related to training background. This was additionally confirmed in a test of seven ballet dancers and seven volleyball players.

Evaluation of the walking pattern in clubfoot patients who received early intensive treatment.

The walking pattern in a group of nine adult male subjects who had received early intensive treatment for congenital clubfoot was evaluated and compared to the walking pattern in a control group of 15 adult healthy male subjects. All subjects were filmed with a five-camera video system as they walked across two force plates. A three-dimensional inverse dynamics approach was used to calculate average joint angles, moments, power, and work. The results showed that there were no differences in the joint angles between the two groups. The overall patterns of the joint moments were very similar in the two groups. However, analysis revealed a smaller ankle joint moment and larger knee and hip joint moments in those with clubfoot. It was concluded that the larger knee and hip joint moments served as compensation for the smaller ankle moment. The reduced ankle moment and work developed about the ankle joint in the clubfeet could possibly be owing to weaker plantar flexors. In conclusion, gait analysis can be an important tool when evaluating treatment for clubfoot. However, further investigation is needed to determine whether the higher hip and knee joint moments observed in subjects with clubfoot may lead to the development of knee or hip joint pathologies.

Biomechanical analysis of rollator walking

BackgroundThe rollator is a very popular walking aid. However, knowledge about how a rollator affects the walking patterns is limited. Thus, the purpose of the study was to investigate the biomechanical effects of walking with and without a rollator on the walking pattern in healthy subjects.MethodsThe walking pattern during walking with and without rollator was analyzed using a three-dimensional inverse dynamics method. Sagittal joint dynamics and kinematics of the ankle, knee and hip were calculated. In addition, hip joint dynamics and kinematics in the frontal plane were calculated. Seven healthy women participated in the study.ResultsThe hip was more flexed while the knee and ankle joints were less flexed/dorsiflexed during rollator walking. The ROM of the ankle and knee joints was reduced during rollator-walking. Rollator-walking caused a reduction in the knee extensor moment by 50% when compared to normal walking. The ankle plantarflexor and hip abductor moments were smaller when walking with a rollator. In contrast, the angular impulse of the hip extensors was significantly increased during rollator-walking.ConclusionWalking with a rollator unloaded the ankle and especially the knee extensors, increased the hip flexion and thus the contribution of hip extensors to produce movement. Thus, rollator walking did not result in an overall unloading of the muscles and joints of the lower extremities. However, the long-term effect of rollator walking is unknown and further investigation in this field is needed.