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Motor control of the knee: kinematic and EMG studies of healthy individuals and people with patellofemoral pain
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patellofemoral pain (PFP) is believed to be associated with deficits in coordination between the different heads of the quadriceps muscle; however, considerable debate exists in the literature regarding the presence of such a deficit. Discrepancies between studies may be explained by differences in experimental tasks, such as whether the task is performed with open (OKC) or closed kinetic chain (CKC), or whether the activity is voluntary or triggered. Particular interest has been directed toward the function of the vastus medialis obliquus (VMO), which is a short muscle with limited ability to exert torque across the knee joint, but probably has a particular role in controlling patellofemoral joint position. Another short muscle that may influence knee joint position control is popliteus (POP), which is located in the back of the knee.

This thesis investigates task specific activity of quadriceps in CKC versus OKC and studies the relative activity between the four heads of the quadriceps in PFP subjects compared to controls without knee pain in voluntary activity (CKC and OKC) and postural responses to balance perturbations. In addition, this thesis investigates the presumed function of POP for control of joint position in postural tasks in healthy individuals.

All subjects were of normal weight and height and between 18 and 40 years. Quadriceps activity was tested for isometric with identical joint configuration in CKC and OKC, and it was performed as a reaction time task. Balance perturbations were elicited by unpredictable anterior and posterior translations of the support surface. Function of POP was investigated in unpredictable support surface translations and in self induced provocations to balance by moving the arms. Muscle activity was recorded with electromyography (EMG). Optic kinematic analysis was used to obtain specific movement responses to perturbations of balance.

The quadriceps muscles were activated differently in CKC and OKC. VMO was activated earlier and to a greater degree in CKC. Rectus femoris was activated earlier and to a greater degree in OKC. PFP subjects reacted slower in both CKC and OKC, but there was no difference between groups in the relative activity between the different heads of the quadriceps. In the unpredictable support surface translation in the anterior direction, PFP subjects responded with earlier onset of VMO and with greater trunk and hip flexion in the anterior translation. POP activation in response to support surface translations in both directions occurred before all other muscles measured. In the self-initiated provocations of balance, POP was activated after the initiation of the balance provocation.

This thesis concludes that quadriceps activity was task specific. The lack of difference between groups in OKC and CKC, and the difference between groups in postural responses suggest that variations in motor behaviour may occur only in tasks habitually performed. Differences in muscle activation patterns may be related to compensatory strategies to unload the quadriceps muscles and the patellofemoral joint. Furthermore, this thesis suggests that POP muscle may have a particular role in active control of the knee joint.

Place, publisher, year, edition, pages
Umeå: Samhällsmedicin och rehabilitering , 2005. , 90 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 987
Keyword [en]
Kinematics; Kinetic chain tasks; Knee; Motor Control; Muscle activity; Patellofemoral pain; Unpredictable perturbations
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-644ISBN: 91-7305-951-X (print)OAI: oai:DiVA.org:umu-644DiVA: diva2:144110
Public defence
2005-12-16, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2005-11-22 Created: 2005-11-22 Last updated: 2015-01-21Bibliographically approved
List of papers
1. Quadriceps activation in closed and in open kinetic chain exercise.
Open this publication in new window or tab >>Quadriceps activation in closed and in open kinetic chain exercise.
Show others...
2003 (English)In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 35, no 12, 2043-2047 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: For treatment of various knee disorders, muscles are trained in open or closed kinetic chain tasks. Coordination between the heads of the quadriceps muscle is important for stability and optimal joint loading for both the tibiofemoral and the patellofemoral joint. The aim of this study was to examine whether the quadriceps femoris muscles are activated differently in open versus closed kinetic chain tasks. METHODS: Ten healthy men and women (mean age 28.5 +/- 0.7) extended the knees isometrically in open and closed kinetic chain tasks in a reaction time paradigm using moderate force. Surface electromyography (EMG) recordings were made from four different parts of the quadriceps muscle. The onset and amplitude of EMG and force data were measured. RESULTS: In closed chain knee extension, the onset of EMG activity of the four different muscle portions of the quadriceps was more simultaneous than in the open chain. In open chain, rectus femoris (RF) had the earliest EMG onset while vastus medialis obliquus was activated last (7 +/- 13 ms after RF EMG onset) and with smaller amplitude (40 +/- 30% of maximal voluntary contraction (MVC)) than in closed chain (46 +/- 43% MVC). CONCLUSIONS: Exercise in closed kinetic chain promotes more balanced initial quadriceps activation than does exercise in open kinetic chain. This may be of importance in designing training programs aimed toward control of the patellofemoral joint.

Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-4849 (URN)10.1249/01.MSS.0000099107.03704.AE (DOI)14652500 (PubMedID)
Available from: 2005-11-22 Created: 2005-11-22 Last updated: 2017-12-14Bibliographically approved
2. Quadriceps EMG in Open and Closed Kinetic Chain Tasks in Women With Patellofemoral Pain.
Open this publication in new window or tab >>Quadriceps EMG in Open and Closed Kinetic Chain Tasks in Women With Patellofemoral Pain.
2007 (English)In: Journal of motor behavior, ISSN 0022-2895, E-ISSN 1940-1027, Vol. 39, no 3, 194-202 p.Article in journal (Refereed) Published
Abstract [en]

The authors investigated whether the discrepancy noted in the literature regarding delayed and decreased activity in vastus medialis obliquus (VMO) in people with patellofemoral pain (PFP) depends on the nature of the open kinetic chain (OKC) and the closed kinetic chain (CKC) in the experimental task. They hypothesized that activity in VMO would be more delayed and decreased in CKC tasks than in OKC tasks. Women with PFP (n = 17) and healthy controls (n = 17) performed isometric quadriceps contractions in CKC and OKC tasks. The authors manipulated only the application of resistance. Electromyographs (EMGs) showed that participants with PFP reacted later and activated the quadriceps more in the CKC task but had intramuscular quadriceps coordination similar to that of controls. The nature of the OKC task or the CKC task does not seem to explain contradictory findings regarding VMO activation.

Keyword
EMG, motor control, quadriceps, relative timing
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-14596 (URN)10.3200/JMBR.39.3.194-202 (DOI)17550871 (PubMedID)
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2017-12-14Bibliographically approved
3. Quadriceps activity and movement reactions in response to unpredictable sagittal support-surface translations in women with patellofemoral pain.
Open this publication in new window or tab >>Quadriceps activity and movement reactions in response to unpredictable sagittal support-surface translations in women with patellofemoral pain.
2008 (English)In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 18, no 2, 298-307 p.Article in journal (Refereed) Published
Abstract [en]

Patellofemoral pain (PFP) may be related to unfavorable knee joint loading. Delayed and/or reduced activity of vastus medialis obliquus (VMO) and different movement patterns have been identified in individuals with PFP in some studies, whereas other studies have failed to show a difference compared to non-affected controls. The discrepancy between study results may depend on the different tasks that have been investigated. No previous study has investigated these variables in postural responses to unpredictable perturbations in PFP. Whole body three dimensional kinematics and surface EMG of quadriceps muscles activation was studied in postural responses to unpredictable support surface translations in 17 women with PFP who were pain free at the time of testing, and 17 matched healthy controls. The results of the present study showed earlier onset of VMO activity and associated changes in kinematics to anterior platform translation in the PFP subjects. We suggest that the relative timing between the portions quadriceps muscles may be task specific and part of an adapted response in attempt to reduce knee joint loading. This learned response appears to remain even when the pain is no longer present.

Keyword
knee, muscle coordination, kinematics
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-9374 (URN)10.1016/j.jelekin.2006.10.004 (DOI)17158068 (PubMedID)
Available from: 2008-03-27 Created: 2008-03-27 Last updated: 2017-12-14Bibliographically approved
4. The role of M. popliteus in unpredictable and in self-initiated balance provocations.
Open this publication in new window or tab >>The role of M. popliteus in unpredictable and in self-initiated balance provocations.
2006 (English)In: Journal of Orthopaedic Research, ISSN 0736-0266, E-ISSN 1554-527X, Vol. 24, no 3, 524-530 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to determine whether m. popliteus (POP) activity would contribute to the control of knee joint position in unpredictable and in self-initiated provocations of standing balance. Ten healthy women (age 25.2 +/- 4.5 years, means and SD) without known knee pathology were tested for postural reactions (1) to unpredictable support surface translations in anterior and posterior directions, and (2) in self-initiated balance provocations in a reaction time (RT) forward reach-and-grip task. Electromyographic activity was recorded from POP and other leg muscles plus the deltoid muscle. Three-dimensional kinematics were captured for the knee joint and the body centre of mass was calculated. POP was active first of all the muscles recorded, regardless of translation direction, and knee joint movements elicited were either knee extension or external rotation of the tibia. In the RT task, the POP was active after initiation of reaching movement, and there was little consistency in the kinematic response. POP activity was not direction specific in response to support surface translation, but appeared triggered from reactive knee joint movement. The response to the support-surface translation suggests that POP served to control knee joint position rather than posture. In the RT task, we could not deduce whether POP activity was attributed to knee joint control or to postural control. Copyright 2006 Orthopaedic Research Society.

Keyword
Adult, Biomechanics, Electromyography, Female, Humans, Knee Joint/*physiology, Motor Activity, Muscle; Skeletal/*physiology, Musculoskeletal Equilibrium/*physiology
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-14304 (URN)10.1002/jor.20057 (DOI)16456827 (PubMedID)
Available from: 2008-01-03 Created: 2008-01-03 Last updated: 2017-12-14Bibliographically approved

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