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  • 101.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Guerra, Jamie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Limb support in response to balance provocations in women with patellofemoral pain2008In: Advances in physiotherapy, ISSN 1403-8196, Vol. 11, no 2, p. 97-103Article in journal (Refereed)
  • 102.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hodges, Paul
    Mellor, Rebecca
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Quadriceps activation in closed and in open kinetic chain exercise.2003In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 35, no 12, p. 2043-2047Article in journal (Refereed)
    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.

  • 103.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hodges, Paul
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Quadriceps EMG in Open and Closed Kinetic Chain Tasks in Women With Patellofemoral Pain.2007In: Journal of motor behavior, ISSN 0022-2895, E-ISSN 1940-1027, Vol. 39, no 3, p. 194-202Article in journal (Refereed)
    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.

  • 104.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Holmgren, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Dalén, Tore
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    The role of M. popliteus in unpredictable and in self-initiated balance provocations.2006In: Journal of Orthopaedic Research, ISSN 0736-0266, E-ISSN 1554-527X, Vol. 24, no 3, p. 524-530Article in journal (Refereed)
    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.

  • 105.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Department of Health Education and Social Work Physiotherapy, Sör-Trönderlag University College Trondheim.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brax Olofsson, Lisbeth
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Deficits in single-limb stance more than 20 years after ACL injury2013In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 15, no 2, p. 78-85Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the long-term effect on balance during single-limb stance after unilateral anterior cruciate ligament (ACL) injury across two groups who had rehabilitation including ACL reconstruction (ACLR) or a tailored physiotherapy program (ACLTPP), compared with knee-healthy controls.

    Methods: Single-limb stance was monitored for floor-supports with the contralateral foot. Single-limb stance without floor-supports was assessed with analyses of center of pressure (CoP) for further discrimination. Comparisons were made between ACLR (n = 28) and ACLTPP (n = 28) and with controls (n = 18). The injured and uninjured legs were compared within ACL-injured subjects.

    Results: Single-limb balance was equally inferior in both ACL-injured groups and on both legs compared with knee-healthy controls. In ACLR and ACLTPP, 39% and 50%, respectively, failed to stand on one leg without floor-supports with the contralateral foot. No contralateral supports occurred in knee-healthy controls. CoP measures for subjects who stood without contralateral floor-supports did not reveal any further differences. Older age and higher body mass index (BMI) correlated with larger migration of CoP.

    Conclusion: Inability to stand without contralateral supports showed that balance in single-limb stance was inferior in ACL-injured subjects, independently of which initial treatment that was given. Age and BMI need consideration in studies assessing balance in single-limb stance.

  • 106.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Faculty of Health and Social Sciences, Physiotherapy, Norwegian University of Science and Technology, NTNU, 7491 Trondheim, Norway.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Altered postural control strategies in quiet standing more than 20 years after rupture of the anterior cruciate ligament2016In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 46, p. 98-103Article in journal (Refereed)
    Abstract [en]

    Aim: To explore long-term consequences of anterior cruciate ligament (ACL) rupture on postural sway and control strategies during bilateral quiet standing, in subjects treated with or without reconstructive surgery compared to uninjured controls. Method: 70 individuals who had unilateral ACL rupture 23 +/- 2.4 years ago (33 received ACL reconstructive surgery, ACL(R), and 37 had physiotherapy only, ACL(PT)) and 33 uninjured matched controls (CTRL) (mean age 46 +/- 5.3) stood quietly with eyes closed for 3 min on a firm and on a compliant surface, respectively. Center of pressure (CoP) was registered with a force plate and postural sway was calculated from center of mass (CoM) derived from 3D kinematics. Sway density (SD) analyses of CoP assessed distance and duration of stable phases. The torque controlling postural sway was estimated from CoP-CoM. Results: Comparisons across conditions to CTRL revealed larger CoP-CoM-area in ACLR (p = 0.017, Cl: 10.95, 143.10), but not in ACL(PT). Mean distance between SD-peaks was greater for ACLR (p < 0.001, Cl: 1.73, 5.31) than for ACLRT (p = 0.006, Cl: 0.56, 4.12) relative to CTRL. Duration of SD -peaks was smaller for both ACLR and ACLRT (p < 0.001, Cl: 4.04, 1.23 and 3.82, 1.03, respectively) compared to CTRL. CoM-area in the ACL-groups did not differ from CTRL. Conclusions: ACL-injured subjects demonstrated greater postural control efforts than CTRL but without significant differences in postural sway. Control efforts were thus not directly associated with sway and further research should be focused on variance in postural control strategies.

  • 107.
    Svedmark, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University Of Gävle, Gävle, Sweden.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Impact of workplace exposure and stress on neck pain and disabilities in women: a longitudinal follow-up after a rehabilitation intervention2018In: Annals of Work exposure and Health, ISSN 2398-7308, Vol. 62, no 5, p. 591-603Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim was to evaluate if pain, disability, and work productivity are influenced by physical and psychosocial work exposures as well as by stress, up to 1 year after a randomized controlled trial treatment intervention, and to determine whether any such association differed between treatment and control groups.

    Methods: Ninety-seven working women suffering non-specific neck pain (n = 67 treatment group, n = 30 control group) were followed from end of treatment intervention and at 9- and 15-month follow-ups, respectively. Physical and psychosocial exposures, as well as perceived stress, were assessed after the treatment intervention. Pain, neck disability, and work productivity were assessed at baseline, after intervention 3 months later and at 9- and 15-month follow-ups. Longitudinal assessment was conducted using the exposure level at 3 months as predictor of pain, disability, and work productivity at 3, 9, and 15 months, respectively. Mixed models were used to estimate longitudinal associations, accounting for within-individual correlation of repeated outcome measures by incorporation of a random intercept. Age and duration of neck pain were adjusted for in all models. To evaluate group differences, interactions between exposures and treatment groups were estimated.

    Results: High perceived stress was associated with more neck pain, more neck disability, and decreased work productivity in both cross-sectional and longitudinal analyses. High ‘control of decision’ was associated with less neck pain, less neck disability, and higher work productivity in cross-sectional analyses but only to less disability and higher productivity in longitudinal analyses. Shoulder/arm load was the only physical exposure variable that was significantly associated with work productivity in the univariate analyses. Only small differences were observed between treatment and control groups.

    Conclusion: High perceived stress and low ‘control of decision’ were associated with more neck pain, increased neck disability, and decreased work productivity. Treatment interventions for individuals with neck pain should take into account psychosocial workplace exposures and stress to improve intermediate and long-term results.

  • 108.
    Svedmark, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Djupsjöbacka, Mats
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Jull, Gwendolen
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
    Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain?: A randomized controlled trial2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, article id 408Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The evidence for the effect of treatments of neck pain is modest. In the absence of causal treatments, a possibility is to tailor the treatment to the individuals' functional limitations and symptoms. The aim was to evaluate treatment effects of a tailored treatment versus a non-tailored treatment. Our hypothesis was that tailored treatment (TT) would have better effect on pain intensity and disability than either non-tailored treatment (NTT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that TT and NTT would both have better effect than TAU.

    METHOD: One hundred twenty working women with subacute and chronic non-specific neck pain were allocated to 11 weeks of either TT, NTT or TAU in a randomized controlled trial with follow-ups at 3, 9 and 15 months. The TT was designed from a decision model based on assessment of function and symptoms with defined cut-off levels for the following categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, impaired eye-head-neck control, trapezius myalgia and cervicogenic headache. Primary outcomes were pain and disability. Secondary outcomes were symptoms, general improvement, work productivity, and pressure pain threshold of m. trapezius.

    RESULTS: Linear mixed models analysis showed no differences between TT and NTT besides work productivity favoring TT at 9- and 15-months follow-ups. TT and NTT improved significantly more than TAU on pain, disability and symptoms at 3-month follow-up. General improvement also favored TT and NTT over TAU at all follow-ups.

    CONCLUSION: Tailored treatment according to our proposed decision model was not more effective than non-tailored treatment in women with subacute and chronic neck pain. Both tailored and non-tailored treatments had better short-term effects than treatment-as-usual, supporting active and specific exercise therapy, although therapist-patient interaction was not controlled for. Better understanding of the importance of functional impairments for pain and disability, in combination with a more precise tailoring of specific treatment components, is needed to progress.

    TRIAL REGISTRATION: Current Controlled Trials ISRCTN 49348025. Registered 2 August 2011.

  • 109.
    Svedmark, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Associations between self-rated and physical test outcomes before and after intervention in women with non-specific neck pain: Cross-sectional and longitudinal analysesManuscript (preprint) (Other academic)
    Abstract [en]

    Abstract

    Non-specific neck pain is common, especially in women. There is often a multifaceted symptom picture while the etiology remains unclear. Consequently, a wide arsenal of treatments exists. While the underlying mechanisms of pain relief are complex, the relationship between individual improvement on physical function and the neck patient’s self-rated status is also obscure. The present aim was to determine the associations between physical test outcomes involving the neck and shoulder region, and self-reported neck problems before and after (Change-scores) a treatment intervention in women with non-specific neck pain.

    Methods: Data were obtained for 120 women (aged 47±11 years) with non-specific neck pain who had participated in a previous randomized controlled trial involving physiotherapy treatment. Data were used from all participants at baseline prior to treatment for cross-sectional analysis, and for longitudinal analysis for 69 women at baseline, at the end of treatment after 3 months, and at 9-month follow-up (Change-scores). Associations between self-reported neck problems (pain, disability, symptoms) and physical test outcomes (neck-strength, flexibility, motor control) were estimated with cross-sectional (baseline) and longitudinal (Change-scores) linear regression analyses.

    Results: Neck pain was only significantly associated to the physical outcome measure Peak-Speed of cervical rotation, i.e., increased pain related to lower speed. This was true at baseline and for Change-scores at 9 months. Increased neck disability and frequency of symptoms were associated to lower neck strength and Peak-Speed at baseline, and to reduced Peak-Speed and cervical Axial-Range of Motion (A-ROM) at 3 and 9 months, respectively. Peak-Speed and A-ROM were thus the physical test outcomes with associations to changes in neck problems. At the 9-month follow-up, 26% of the variance of frequency of symptom changes was explained by changes in A-ROM and Peak-Speed, which were also inter-correlated (r=0.55).

    Conclusion: If changes in physical functioning, tested as cervical mobility and strength, have only a modest relation to the course of self-rated condition in neck disorders, then the specificity and usefulness of various assessments for decision-making, treatment and evaluation might be questioned. This also calls for reconsideration regarding acting mechanisms behind the apparent effect of, e.g., strength training on neck pain disorders.

  • 110.
    Svedmark, Åsa
    et al.
    Högskolan i Gävle,Centrum för belastningsskadeforskning, Högskolan i Gävle, Akademin för hälsa och arbetsliv (Department of occupational and public health sciences).
    Sandsjö, Leif
    Borås Universitet, MedTech/School of Engineering.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Progressive individualized EMG biofeedback training for women2012In: International society of electrophysiology and kinesiology, Brisbane, Australia 19-21 july 2012: Neuroplasticity, Motor control, Cutting-Edge Technology and Rehabilitation, 2012, p. 75-Conference paper (Other (popular science, discussion, etc.))
  • 111.
    Svedmark, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sandsjö, Leif
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Progressive individualized EMG biofeedback training for women with work related neck-shoulder pain – a feasibility study2012Conference paper (Refereed)
  • 112.
    Svensson, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hand function and reliability of outcom measures in persons with charcot-marie-tooth's disease2007Conference paper (Other academic)
  • 113.
    Svensson, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hand function in Charcot-Marie-Tooth: test-retest reliability of some measurements2006In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 20, no 10, p. 896-908Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the reliability of some measurements of hand function in people with Charcot Marie Tooth disease.

    DESIGN: Test retest study. SETTING: University, hospitals/clinics in northern Sweden.

    SUBJECTS: Twenty people with Charcot Marie Tooth disease.

    MAIN OUTCOME MEASURES: Measures of (1) dexterity; Box and Block Test and Nine-Hole Peg Test, (2) strength; Grippit instrument (grip and pinch), (3) tactile sensation; Shape Texture Identification Test. Statistics used: intraclass correlation (ICC 2.1), limits of agreement, coefficient of repeatability, coefficient of variation, and linear weighted kappa.

    RESULTS: The ICC for the Box and Block Test was very high (0.95). The limits of agreement, coefficient of repeatability (CR) (11.5 blocks/min) and coefficient of variation (CV) (8.4%) were acceptable. There was bias towards a better result on the second occasion. For the Nine-Hole Peg Test, the reliability was good if performance was within 2 min (ICC =0.99, CR = 4.3 s, CV = 3.9%). Grip strength proved to be reliable (ICC = 0.99, CR = 26.7 N, CV = 6.6%), while pinch strength was less reliable. The kappa value of the Shape Texture Identification Test was 0.87, which was considered very good although the test has limitations in terms of how well it can describe patients either performing very well or very poorly.

    CONCLUSIONS: The tested instruments can all be used to evaluate hand function in people with Charcot Marie Tooth. Certain factors, however, like limited time aspects for the Nine-Hole Peg Test and the number of trials used, should be taken into consideration. Pinch strength evaluation should be interpreted with caution.

  • 114.
    Svensson, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Waling, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip strength in children: test-retest reliability using Grippit2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 9, p. 1226-1231Article in journal (Refereed)
    Abstract [en]

    AIM: To examine the reliability of peak and sustained grip strength in children using the Grippit. We compared the reliability of one trial, the best and mean of three trials and the reliability within 6-, 10- and 14-year-old groups.

    DESIGN: Test-retest study.

    METHODS: Grip strength with the Grippit instrument was evaluated at two test occasions in 58 children. Intraclass correlation coefficient 2.1 (ICC), standard error of measurement (SEM) also expressed as a percentage value (SEM%), coefficient of repeatability and coefficient of variation were calculated.

    RESULTS: The test-retest reliability was good for both peak and sustained grip strength. The mean and best of three trials were equally reliable. Peak grip strength best of three trials, for example, was more reliable for the 6-year-olds (ICC 0.96, SEM% 6.3) and 14-year-olds (ICC 0.96, SEM% 5.2) compared to the 10-year-olds (ICC 0.78, SEM% 12.5). For peak grip strength in the whole sample, there was a systematic bias with better performance at the second measurement.

    CONCLUSION: Grip strength assessment in children with Grippit results in good relative and absolute reliability for peak and sustained grip strength. We recommend that three test trials are used. The mean of and the best of three trials are comparable.

  • 115.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brax Olofsson, Lisbeth
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Nilsson, Kjell G
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Tegner, Yelverton
    Luleå tekniska universitet .
    Lundgren, Lars
    Luleå tekniska universitet.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function2014In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 6, p. e491-e500Article in journal (Refereed)
    Abstract [en]

    Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23 ± 2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR), and 37 treated with physiotherapy alone (ACLPT). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P < 0.001), while IPAQ score was similar. ACL-injured demonstrated inferior jump capacity in injured compared with noninjured leg (6–25%,P < 0.001–P = 0.010 in the different jumps), while noninjured leg had equal jump capacity as controls. ACL groups scored 33 ± 7 and 32 ± 7 of 68 on TSK. Lower scores on Lysholm and KOOS symptom were seen for persons with moderate-to-high OA than for no-or-low OA, while there were no differences for physical activity and jump capacity. Regardless of treatment, there are still negative knee-related effects of ACL injury more than 20 years later.

  • 116.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brax Olofsson, Lisbeth
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Sor-Trondelag University College, Trondheim, Norge.
    Nilsson, Kjell G
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Anterior cruciate ligament injury after more than 20 years: II. Concentric and eccentric knee muscle strength2014In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 6, p. e501-e509Article in journal (Refereed)
    Abstract [en]

    The long-term consequences on knee muscle strength some decades after rupture of the anterior cruciate ligament (ACL) are not established. The aims of our study were to examine peak torque more than 20 years after ACL injury and to compare their knee muscle strength to that of healthy controls. We tested 70 individuals with unilateral ACL injury 23 ± 2 years after injury, whereof 33 (21 men) were treated with physiotherapy in combination with ACL reconstruction (ACLR) and 37 (23 men) with physiotherapy alone (ACLPT). These were compared with 33 age- and gender-matched controls (21 men). A Kin-Com® dynamometer (90°/s) was used to measure peak torque in knee flexion and extension in both concentric and eccentric contractions. Knee extension peak torque, concentric and eccentric, was ∼10% lower for the injured leg compared with the non-injured leg for both ACLR (P < 0.001; P < 0.001) and ACLPT (P = 0.007; P = 0.002). The ACLPT group also showed reduced eccentric knee flexion torque of the injured leg (P = 0.008). The strength of the non-injured leg in both ACL groups was equal to that of controls. No difference was seen for those with no-or-low degree of knee osteoarthritis compared to those with moderate-to-high degree of osteoarthritis. ACL injury may lead to a persistent reduction of peak torque in the injured leg, which needs to be considered across the lifespan.

  • 117.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Motor control aspects in the understanding of knee disorders – implications for rehabilitation2014Conference paper (Other academic)
  • 118.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    One-leg hop – kinematic analysis ~ 20 years after anterior cruciate ligament injury.2012Conference paper (Other academic)
  • 119.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stensdotter, A.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Kinematic analysis of one-leg hop more than 20 years after anterior cruciate ligament injury2014In: Knee Surgery, Sports Traumatology, Arthroscopy, Springer, 2014, Vol. 22, p. S291-S291, article id P15-2121Conference paper (Refereed)
  • 120.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Sør-Trøndelag University College, Trondheim Norway.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    One-leg hop more than 20 years after ACL injury: kinematic analysis of persons treated with physiotherapy with or without surgery compared to healthy controlsManuscript (preprint) (Other academic)
  • 121.
    Tengman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Faculty of Health Education and Social Work, Physiotherapy, Sør-Trøndelag University College, Trondheim, Norway.
    Häger, Charlotte K
    Anterior cruciate ligament injury about 20 years post-treatment: a kinematic analysis of one-leg hop2015In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 25, no 6, p. 818-827Article in journal (Refereed)
    Abstract [en]

    Reduced dynamic knee stability, often evaluated with one-leg hops (OLHs), is reported after anterior cruciate ligament (ACL) injury. This may lead to long-standing altered movement patterns, which are less investigated. 3D kinematics during OLH were explored in 70 persons 23 +/- 2 years after ACL injury; 33 were treated with physiotherapy in combination with ACL reconstruction (ACL(R)) and 37 with physiotherapy alone (ACL(PT)). Comparisons were made to 33 matched controls. We analyzed (a) maximal knee joint angles and range of motion (flexion, abduction, rotation); (b) medio-lateral position of the center of mass (COM) in relation to knee and ankle joint centers, during take-off and landing phases. Unlike controls, ACL-injured displayed leg asymmetries: less knee flexion and less internal rotation at take-off and landing and more lateral COM related to knee and ankle joint of the injured leg at landing. Compared to controls, ACL(R) had larger external rotation of the injured leg at landing. ACL(PT) showed less knee flexion and larger external rotation at take-off and landing, and larger knee abduction at Landing. COM was more medial in relation to the knee at take-off and less laterally placed relative to the ankle at landing. ACL injury results in long-term kinematic alterations during OLH, which are less evident for ACL(R).

  • 122. Thomas, Christine K
    et al.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Klein, Cliff S
    Increases in human motoneuron excitability after cervical spinal cord injury depend on the level of injury2017In: Journal of Neurophysiology, ISSN 0022-3077, E-ISSN 1522-1598, Vol. 117, no 2, p. 684-691Article in journal (Refereed)
    Abstract [en]

    After human spinal cord injury (SCI), motoneuron recruitment and firing rate during voluntary and involuntary contractions may be altered by changes in motoneuron excitability. Our aim was to compare F-waves in single thenar motor units paralyzed by cervical SCI to those in uninjured controls because at the single unit level, F-waves primarily reflect the intrinsic properties of the motoneuron and its initial segment. With intraneural motor axon stimulation, F-waves were evident in all four participants with C4-level SCI, absent in eight with C5 or C6 injury, and present in six of 12 Uninjured participants (p<0.001). The percentage of units that generated F-waves differed across groups (C4: 30%; C5 or C6: 0%; Uninjured: 16%; p<0.001). Mean (± SD) proximal axon conduction velocity was slower after C4 SCI (64±4 m/s, n=6 units; Uninjured: 73±8 m/s, n=7 units, p=0.037). Mean distal axon conduction velocity differed by group (C4: 40±8 m/s, n=20 units; C5 or C6: 49±9 m/s, n=28; Uninjured: 60±7 m/s, n=45; p<0.001). Motor unit properties (EMG amplitude, twitch force) only differed after SCI, not by injury level (p≤0.004). Motor units with F-waves had distal conduction velocities, M-wave amplitudes, and twitch forces that spanned the respective group range, indicating that units with heterogeneous properties produced F-waves. Recording unitary F-waves has shown that thenar motoneurons closer to the SCI (C5 or C6) have reduced excitability, whereas those further away (C4) have increased excitability, which may exacerbate muscle spasms. This difference in motoneuron excitability may be related to the extent of membrane depolarization following SCI.

  • 123. Thomas, Christine K.
    et al.
    Häger-Ross, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Klein, Cliff S
    Effects of baclofen on motor units paralysed by chronic cervical spinal cord injury.2010In: Brain, ISSN 0006-8950, E-ISSN 1460-2156, Vol. 133, no Pt 1, p. 117-225Article in journal (Refereed)
    Abstract [en]

    Baclofen, a gamma-aminobutyric acid receptor(B) agonist, is used to reduce symptoms of spasticity (hyperreflexia, increases in muscle tone, involuntary muscle activity), but the long-term effects of sustained baclofen use on skeletal muscle properties are unclear. The aim of our study was to evaluate whether baclofen use and paralysis due to cervical spinal cord injury change the contractile properties of human thenar motor units more than paralysis alone. Evoked electromyographic activity and force were recorded in response to intraneural stimulation of single motor axons to thenar motor units. Data from three groups of motor units were compared: 23 paralysed units from spinal cord injured subjects who take baclofen and have done so for a median of 7 years, 25 paralysed units from spinal cord injured subjects who do not take baclofen (median: 10 years) and 45 units from uninjured control subjects. Paralysed motor unit properties were independent of injury duration and level. With paralysis and baclofen, the median motor unit tetanic forces were significantly weaker, twitch half-relaxation times longer and half maximal forces reached at lower frequencies than for units from uninjured subjects. The median values for these same parameters after paralysis alone were comparable to control data. Axon conduction velocities differed across groups and were slowest for paralysed units from subjects who were not taking baclofen and fastest for units from the uninjured. Greater motor unit weakness with long-term baclofen use and paralysis will make the whole muscle weaker and more fatigable. Significantly more paralysed motor units need to be excited during patterned electrical stimulation to produce any given force over time. The short-term benefits of baclofen on spasticity (e.g. management of muscle spasms that may otherwise hinder movement or social interactions) therefore have to be considered in relation to its possible long-term effects on muscle rehabilitation. Restoring the strength and speed of paralysed muscles to pre-injury levels may require more extensive therapy when baclofen is used chronically.

  • 124.
    Tronarp, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nyberg, André
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hedlund, Mattias
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    McDonough, Suzanne
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden.
    Office-cycling: a promising way to raise pain thresholds and increase metabolism with minimal compromising of work performance2018In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 5427201Article in journal (Refereed)
    Abstract [en]

    Aim: Establishing the effects of low intensity cycling (LC), moderate intensity cycling (MC), and standing at a simulated office workstation on pain modulation, work performance, and metabolic expenditure.

    Methods: 36 healthy adults (21 females), mean age 26.8 (SD 7.6) years, partook in this randomized 3 x 3 crossover trial with 75 minutes of LC on 20% of maximum aerobic power (MAP) output, 30 minutes of MC on 50% of MAP, and standing 30 minutes with 48-hour wash-out periods. Outcome measures were pain modulation (pressure pain threshold (PPT) and thermal pain threshold)), work performance (transcription, mouse pointing, and cognitive performance), and metabolic expenditure.

    Results: PPTs increased in all conditions. PPT trapezius showed the highest increase after LC, 39.3 kilopascals (kPa) (15.6; 78.6), compared to MC, 17.0 kPa (2.8; 49.9), and standing, 16.8 kPa (-5.6; 39.4),p = 0.015. Transcription was reduced during LC and MC. Mouse pointing precision was best during standing and worst and slowest during MC. Cognitive performance did not differ between conditions. Metabolic expenditure rates were 1.4 (1.3; 1.7), 3.3 (2.3; 3.7), and 7.5 (5.8; 8.7) kcal/minute during standing, LC, and MC, respectively (p < 0.001).

    Conclusions: LC seems to be the preferred option; it raised PPTs, more than doubled metabolic expenditure, whilst minimally influencing work performance.

  • 125. Öhberg, F
    et al.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nilsson, K-G
    Edström, U
    Gustavsson, O
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundström, R
    Gait analysis using a portable motion sensor system: measurements in subjects with hip implants as compared with healthy controls2012Conference paper (Other academic)
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