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Strong, A., Markström, J., Schelin, L. & Häger, C. (2024). Asymmetric loading strategies during squats following anterior cruciate ligament reconstruction: a longitudinal investigation with curve analyses throughout and after rehabilitation. Scandinavian Journal of Medicine and Science in Sports, 34(1), Article ID e14524.
Open this publication in new window or tab >>Asymmetric loading strategies during squats following anterior cruciate ligament reconstruction: a longitudinal investigation with curve analyses throughout and after rehabilitation
2024 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 34, no 1, article id e14524Article in journal (Refereed) Published
Abstract [en]

Investigations of kinetic asymmetries during bilateral squats following anterior cruciate ligament reconstruction (ACLR) are limited to mainly cross-sectional studies and discrete value data extracted at specific knee angles. We assessed loading asymmetries during squats longitudinally throughout rehabilitation using curve analysis and compared patient-reported outcome measures (PROMs) between those with and without asymmetry. Bodyweight squats were performed by 24 individuals (13 females) post-ACLR on three occasions: (1) Early 2.9 (1.1) months; (2) Mid 8.8 (3.1) months; (3) at Return to Sport (RTS) 13.1 (3.6) months; and 29 asymptomatic controls (22 females) once. Time-normalized between-leg asymmetry curves of sagittal plane hip, knee, and ankle moments and vertical ground reaction forces were compared using functional data analysis methods. Individual asymmetrical loading for ACLR was classified when exceeding the 95% confidence interval of controls during ≥50% of the squat. At Early, ACLR had greater asymmetry than controls for knee (15%–100% eccentric phase; 0%–100% concentric) and ankle flexion moments (56%–65% concentric). At Mid, ACLR had greater asymmetry for knee (41%–72% eccentric) and ankle flexion moments (56%–69% concentric). No between-group differences were found at RTS. From Early to RTS, ACLR reduced asymmetry for hip (21%–46% eccentric), knee (27%–58% concentric), and ankle flexion moments (21%–57% eccentric). At Early, 11/24 underloaded their ACLR knee and 1 overloaded compared with controls. At RTS, 4 underloaded and 6 overloaded. No differences in PROMs were found based on loading asymmetry. Beyond the early phase of rehabilitation from ACLR, individual-level analyses are required to reveal differing loading strategies during bilateral squats.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
ACL, athletic training, biomechanics, general sports trauma, knee, ligaments, motion analysis/kinesiology, physical therapy/rehabilitation
National Category
Physiotherapy Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-215837 (URN)10.1111/sms.14524 (DOI)001085713200001 ()37853508 (PubMedID)2-s2.0-85174402425 (Scopus ID)
Funder
Swedish Research Council, 2017‐00892Swedish Research Council, 2022‐0077Region Västerbotten, VLL‐358901Region Västerbotten, 7002795Region Västerbotten, RV966109Region Västerbotten, RV 967112Swedish National Centre for Research in Sports, FO‐2018‐0034Swedish National Centre for Research in Sports, FO20190008Swedish National Centre for Research in Sports, 2020/9 P2020‐0035Swedish National Centre for Research in Sports, 2021/9 P2022Swedish National Centre for Research in Sports, 2022/10 P2023‐0030
Available from: 2023-11-03 Created: 2023-11-03 Last updated: 2024-01-11Bibliographically approved
Grinberg, A., Strong, A., Strandberg, J., Selling, J., Liebermann, D. G., Björklund, M. & Häger, C. K. (2024). Electrocortical activity associated with movement-related fear: a methodological exploration of a threat-conditioning paradigm involving destabilising perturbations during quiet standing. Experimental Brain Research, 242(8), 1903-1915
Open this publication in new window or tab >>Electrocortical activity associated with movement-related fear: a methodological exploration of a threat-conditioning paradigm involving destabilising perturbations during quiet standing
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2024 (English)In: Experimental Brain Research, ISSN 0014-4819, E-ISSN 1432-1106, Vol. 242, no 8, p. 1903-1915Article in journal (Refereed) Published
Abstract [en]

Musculoskeletal trauma often leads to lasting psychological impacts stemming from concerns of future injuries. Often referred to as kinesiophobia or re-injury anxiety, such concerns have been shown to hinder return to physical activity and are believed to increase the risk for secondary injuries. Screening for re-injury anxiety is currently restricted to subjective questionnaires, which are prone to self-report bias. We introduce a novel approach to objectively identify electrocortical activity associated with the threat of destabilising perturbations. We aimed to explore its feasibility among non-injured persons, with potential future implementation for screening of re-injury anxiety. Twenty-three participants stood blindfolded on a translational balance perturbation platform. Consecutive auditory stimuli were provided as low (neutral stimulus [CS]) or high (conditioned stimulus [CS+]) tones. For the main experimental protocol (Protocol I), half of the high tones were followed by a perturbation in one of eight unpredictable directions. A separate validation protocol (Protocol II) requiring voluntary squatting without perturbations was performed with 12 participants. Event-related potentials (ERP) were computed from electroencephalography recordings and significant time-domain components were detected using an interval-wise testing procedure. High-amplitude early contingent negative variation (CNV) waves were significantly greater for CS+ compared with CS– trials in all channels for Protocol I (> 521-800ms), most prominently over frontal and central midline locations (P ≤ 0.001). For Protocol II, shorter frontal ERP components were observed (541-609ms). Our test paradigm revealed electrocortical activation possibly associated with movement-related fear. Exploring the discriminative validity of the paradigm among individuals with and without self-reported re-injury anxiety is warranted.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
CNV, EEG, ERP, Kinesiophobia, Moving platform, Re-injury anxiety
National Category
Neurology Physiotherapy Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-227914 (URN)10.1007/s00221-024-06873-0 (DOI)001251688200002 ()38896295 (PubMedID)2-s2.0-85196275390 (Scopus ID)
Funder
Swedish Research Council, 2016-02763Swedish Research Council, 2017‐00892Swedish Research Council, 2022-00774Region Västerbotten, VLL-358901Region Västerbotten, 7002795Region Västerbotten, RV966109Region Västerbotten, 2022–2024Region Västerbotten, RV 967112Region Västerbotten, 2022–2024Swedish National Centre for Research in Sports, FO‐2018‐0034Swedish National Centre for Research in Sports, FO-2019-00082Swedish National Centre for Research in Sports, 2020/9 P2020-0035Swedish National Centre for Research in Sports, 2021/9 P2022Swedish National Centre for Research in Sports, 2022/10 P2023-003The Kempe Foundations
Available from: 2024-07-19 Created: 2024-07-19 Last updated: 2024-07-19Bibliographically approved
Strong, A., Grip, H., Arumugam, A., Boraxbekk, C.-J., Selling, J. & Häger, C. (2023). Right hemisphere brain lateralization for knee proprioception among right-limb dominant individuals. Frontiers in Human Neuroscience, 17, Article ID 969101..
Open this publication in new window or tab >>Right hemisphere brain lateralization for knee proprioception among right-limb dominant individuals
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2023 (English)In: Frontiers in Human Neuroscience, E-ISSN 1662-5161, Vol. 17, article id 969101.Article in journal (Refereed) Published
Abstract [en]

Introduction: Studies indicate that brain response during proprioceptive tasks predominates in the right hemisphere. A right hemisphere lateralization for proprioception may help to explain findings that right-limb dominant individuals perform position matching tasks better with the non-dominant left side. Evidence for proprioception-related brain response and side preference is, however, limited and based mainly on studies of the upper limbs. Establishing brain response associated with proprioceptive acuity for the lower limbs in asymptomatic individuals could be useful for understanding the influence of neurological pathologies on proprioception and locomotion.

Methods: We assessed brain response during an active unilateral knee joint position sense (JPS) test for both legs of 19 right-limb dominant asymptomatic individuals (females/males = 12/7; mean ± SD age = 27.1 ± 4.6 years). Functional magnetic resonance imaging (fMRI) mapped brain response and simultaneous motion capture provided real-time instructions based on kinematics, accurate JPS errors and facilitated extraction of only relevant brain images.

Results: Significantly greater absolute (but not constant nor variable) errors were seen for the dominant right knee (5.22° ± 2.02°) compared with the non-dominant left knee (4.39° ± 1.79°) (P = 0.02). When limbs were pooled for analysis, significantly greater responses were observed mainly in the right hemisphere for, e.g., the precentral gyrus and insula compared with a similar movement without position matching. Significant response was also observed in the left hemisphere for the inferior frontal gyrus pars triangularis. When limbs were assessed independently, common response was observed in the right precentral gyrus and superior frontal gyrus. For the right leg, additional response was found in the right middle frontal gyrus. For the left leg, additional response was observed in the right rolandic operculum. Significant positive correlations were found between mean JPS absolute errors for the right knee and simultaneous brain response in the right supramarginal gyrus (r = 0.464, P = 0.040).

Discussion: Our findings support a general right brain hemisphere lateralization for proprioception (knee JPS) of the lower limbs regardless of which limb is active. Better proprioceptive acuity for the non-dominant left compared with the dominant right knee indicates that right hemisphere lateralization may have meaningful implications for motor control.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
proprioception, functional magnetic resonance imaging (fMRI), brain, motion capture, functional laterality, lower extremities, knee, motor control
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-205033 (URN)10.3389/fnhum.2023.969101 (DOI)000923723200001 ()36742357 (PubMedID)2-s2.0-85147250341 (Scopus ID)
Funder
Swedish Research CouncilRegion Västerbotten, VLL-358901Region Västerbotten, RV966109Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Available from: 2023-02-20 Created: 2023-02-20 Last updated: 2024-01-17Bibliographically approved
Grinberg, A., Strong, A., Strandberg, J., Selling, J., Liebermann, D. G., Björklund, M. & Häger, C. (2022). An electroencephalography-based approach to evaluate movement-related anxiety in physically active adults and following anterior cruciate ligament injury. In: : . Paper presented at Society for Neuroscience 2022 Meeting, San Diego, Carliforna, USA, November 12-16, 2022. , Article ID 84186.
Open this publication in new window or tab >>An electroencephalography-based approach to evaluate movement-related anxiety in physically active adults and following anterior cruciate ligament injury
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2022 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Psychophysiological consequences often persist following musculoskeletal trauma and can result in vastly decreased quality of life. Re-injury anxiety is particularly common among individuals following anterior cruciate ligament (ACL) injury. Existing assessments of re-injury anxiety are, however, restricted to subjective suboptimal questionnaires, which may result in under-reporting and thus poorer injury management. We propose a novel approach to objectively quantify arousal response to movement-related anxiety. A new experimental paradigm was implemented to induce and record a conditioned electrophysiological response to a sudden perturbation, experienced to be potentially injurious.

Objective: To explore the feasibility of detecting anxiety-associated electrocortical response and to evaluate its discriminative ability between asymptomatic individuals and those who had experienced an ACL injury.

Methods: Physically-active asymptomatic persons and individuals post-ACL reconstruction stood blindfolded on a perturbation platform capable of generating high-acceleration translations (1.5 m/s2). Auditory stimuli were repeatedly presented in four-second intervals, as either low- or high-frequency tones. Half of the high-frequency tones were followed 1.5 seconds later by a destabilizing perturbation in one of eight randomized directions. The two tone conditions were thus termed ‘Neutral’ and ‘Anxiety’, as the high-frequency tone was intended to invoke an arousal response in anticipation of a potential perturbation. Event-related potentials (ERP) were computed for nine electrodes by averaging 100 Neutral and 100 Anxiety trials. Significant ERP components were identified using functional data analysis. Paired difference-waves’ amplitudes (Neutral - Anxiety) were compared between groups.

Results: ERP correlates of anxiety were detected for both groups in frontal and central midline locations, with an observable contingent negative variation (CNV) from 500 ms post-stimulus in Anxiety compared with Neutral trials. This ERP component is reflective of a threat-induced arousal response, associated with attention and expectancy of an anxiety-relevant event. Preliminary data indicate no group differences in CNV amplitudes.

Conclusions: Objective evaluation of an arousal response to movement-related anxiety was found to be feasible, resulting in a threat-induced CNV. Further investigation will elucidate the discriminative power of such an approach to differentiate between individuals with high and low re-injury anxiety, as well as potential associations with existing patient-reported outcome measures.

National Category
Health Sciences Psychology
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-223317 (URN)
Conference
Society for Neuroscience 2022 Meeting, San Diego, Carliforna, USA, November 12-16, 2022
Available from: 2024-04-12 Created: 2024-04-12 Last updated: 2024-04-15Bibliographically approved
Grinberg, A., Strong, A., Buck, S., Selling, J. & Häger, C. K. (2022). An obstacle clearance test for evaluating sensorimotor control after anterior cruciate ligament injury: A kinematic analysis. Journal of Orthopaedic Research, 40(1)
Open this publication in new window or tab >>An obstacle clearance test for evaluating sensorimotor control after anterior cruciate ligament injury: A kinematic analysis
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2022 (English)In: Journal of Orthopaedic Research, ISSN 0736-0266, E-ISSN 1554-527X, Vol. 40, no 1Article in journal (Refereed) Published
Abstract [en]

Sensorimotor deficits, particularly proprioceptive, are often reported following rupture of the anterior cruciate ligament (ACL). High secondary injury rates and long-term negative consequences suggest that these deficits are not properly identified using current assessment methods. We explored a novel obstacle clearance test to evaluate sensorimotor control in individuals following ACL reconstruction (ACLR) and rehabilitation. Thirty-seven post-ACLR individuals, 23 nonathletic asymptomatic controls (CTRL), and 18 elite athletes stepped over a hurdle-shaped obstacle, downward vision occluded, aiming for minimal clearance. Kinematic outcomes (3D motion capture) for the leading and trailing legs, for two unpredictably presented obstacle heights, were categorized into Accuracy: vertical foot clearance and minimal distance from the obstacle; Variability: end-point and hip/knee trajectory; and Symmetry: trunk/hip/knee crossing angles, hip–knee–ankle movement, and velocity curves. Accuracy was worse for CTRL compared with both other groups. ACLR had less leading and trailing vertical foot clearance with their injured compared with their noninjured leg. ACLR and athletes had less crossing knee flexion in their injured/nondominant legs compared with their contralateral leg, both leading and trailing. ACLR showed greater trunk flexion when crossing with their injured leg, both leading and trailing. For the leading leg, ACLR showed greater asymmetry for the hip–knee–ankle velocity curve compared with elite athletes. Trailing leg trajectory variability was lower for ACLR compared with CTRL and athletes for higher obstacles. Clinical significance: Sensorimotor deficits in individuals post-ACLR were reflected by greater asymmetry and less variable (more stereotypical) trajectories rather than limb positioning ability. This consideration should be addressed in clinical evaluations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
ACL, proprioception, sensorimotor deficits, symmetry, variability
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-181643 (URN)10.1002/jor.25016 (DOI)000627471300001 ()33650722 (PubMedID)2-s2.0-85102261886 (Scopus ID)
Funder
Swedish Research Council, K2014-99X-21876-04-4Swedish Research Council, 2017-00892Västerbotten County Council, ALF VLL548501Västerbotten County Council, VLL838421Västerbotten County Council, VLL358901
Available from: 2021-06-04 Created: 2021-06-04 Last updated: 2023-03-24Bibliographically approved
Strong, A., Markström, J., Schelin, L. & Häger, C. (2022). Asymmetric loading strategies during squats following anterior cruciate ligament reconstruction: a longitudinal investigation throughout rehabilitation with curve analyses. In: F. Dela; M.F. Piacentini; J.W. Helge; Á. Calvo Lluch; E. Sáez; F. Pareja Blanco; E. Tsolakidis (Ed.), 27th annual congress of the European college of sport science: book of abstracts. Paper presented at 27th annual congress of the European college of sport science, Sevilla, Spain, August 30 - September 2, 2022 (pp. 483-483). European College of Sport Science
Open this publication in new window or tab >>Asymmetric loading strategies during squats following anterior cruciate ligament reconstruction: a longitudinal investigation throughout rehabilitation with curve analyses
2022 (English)In: 27th annual congress of the European college of sport science: book of abstracts / [ed] F. Dela; M.F. Piacentini; J.W. Helge; Á. Calvo Lluch; E. Sáez; F. Pareja Blanco; E. Tsolakidis, European College of Sport Science , 2022, p. 483-483Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

INTRODUCTION: Kinetic loading asymmetries during bilateral squats have been reported following anterior cruciate ligament reconstruction (ACLR). Evidence is however limited to discrete value data extracted at specific knee angles from cross-sectional studies where side-toside strategies are presented only at group level. It is therefore unclear whether loading asymmetries occur throughout the entire squat, whether they change during rehabilitation and how they are distributed between sides.

METHODS: Bilateral bodyweight squats were performed by 24 individuals (13 females) post-ACLR on three occasions: 1) Early rehab - 2.9(1.1) months; 2) Mid-rehab - 8.8 (3.1) months; 3) Return to sport (RTS) - 13.1 (3.6) months; and 29 asymptomatic controls (22 females) on one occasion. Motion capture and two force plates were used to calculate time-normalized curves of vertical ground reaction forces andhip, knee, and ankle moments. Outcomes were compared between sides and groups, and over time, using functional t-tests with p-values adjusted by the interval-wise testing procedure. Individual knee loading strategies, i.e., under-/overloading of the ACLR side, were classified when asymmetry in favour of the respective side exceeded the 95% pointwise confidence interval of controls during at least 50% of the squat.

RESULTS: At Early rehab, ACLR had significantly greater (adjusted P < .05) asymmetry in knee flexion moment than controls during thetime-normalized interval of 15-100% of the eccentric phase and the entire concentric phase, as well as ankle flexion moment during 56-65% of the concentric phase. At Mid-rehab, ACLR had significantly greater asymmetry than controls for knee flexion moment during 41-72% of the eccentric phase and for ankle flexion moment during 56-69% of the concentric phase. No significant between-group differences were found at RTS. At RTS compared with Early rehab, ACLR significantly reduced asymmetry for hip (21-46%, eccentric phase), knee (27-58%, concentric phase), and ankle flexion moment (21-57%, eccentric phase). Individual asymmetry strategies for knee flexion moment atEarly rehab were mainly due to individuals underloading the ACLR side (46%) rather than overloading (4%). At RTS, however, more individuals overloaded (25%) than underloaded (17%) the ACLR side.

CONCLUSION: Curve analyses revealed significant kinetic loading asymmetries throughout bilateral bodyweight squats for our ACLR group compared with controls at Early rehab and Mid-rehab, but not at RTS. Significant reductions in hip, knee and ankle flexion moment asymmetry from Early rehab to RTS showed modifications during rehabilitation. An expected underloading strategy was evident for almost half of the ACLR participants at Early rehab, but an overloading strategy was the main reason for knee flexion moment asymmetry at RTS.Loading asymmetries during bilateral tasks should thus not be assumed due to underloading of the ACLR side, but may depend on anoverloading strategy, particularly late in rehabilitation.

Place, publisher, year, edition, pages
European College of Sport Science, 2022
National Category
Physiotherapy Sport and Fitness Sciences
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-223316 (URN)978-3-9818414-5-9 (ISBN)
Conference
27th annual congress of the European college of sport science, Sevilla, Spain, August 30 - September 2, 2022
Available from: 2024-04-12 Created: 2024-04-12 Last updated: 2024-04-15Bibliographically approved
Strong, A., Grip, H., Boraxbekk, C.-J., Selling, J. & Häger, C. (2022). Brain Response to a Knee Proprioception Task Among Persons With Anterior Cruciate Ligament Reconstruction and Controls. Frontiers in Human Neuroscience, 16, Article ID 841874.
Open this publication in new window or tab >>Brain Response to a Knee Proprioception Task Among Persons With Anterior Cruciate Ligament Reconstruction and Controls
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2022 (English)In: Frontiers in Human Neuroscience, E-ISSN 1662-5161, Vol. 16, article id 841874Article in journal (Refereed) Published
Abstract [en]

Knee proprioception deficits and neuroplasticity have been indicated following injury to the anterior cruciate ligament (ACL). Evidence is, however, scarce regarding brain response to knee proprioception tasks and the impact of ACL injury. This study aimed to identify brain regions associated with the proprioceptive sense of joint position at the knee and whether the related brain response of individuals with ACL reconstruction differed from that of asymptomatic controls. Twenty-one persons with unilateral ACL reconstruction (mean 23 months post-surgery) of either the right (n = 10) or left (n = 11) knee, as well as 19 controls (CTRL) matched for sex, age, height, weight and current activity level, performed a knee joint position sense (JPS) test during simultaneous functional magnetic resonance imaging (fMRI). Integrated motion capture provided real-time knee kinematics to activate test instructions, as well as accurate knee angles for JPS outcomes. Recruited brain regions during knee angle reproduction included somatosensory cortices, prefrontal cortex and insula. Neither brain response nor JPS errors differed between groups, but across groups significant correlations revealed that greater errors were associated with greater ipsilateral response in the anterior cingulate (r = 0.476, P = 0.009), supramarginal gyrus (r = 0.395, P = 0.034) and insula (r = 0.474, P = 0.008). This is the first study to capture brain response using fMRI in relation to quantifiable knee JPS. Activated brain regions have previously been associated with sensorimotor processes, body schema and interoception. Our innovative paradigm can help to guide future research investigating brain response to lower limb proprioception.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
anterior cruciate ligament, anterior cruciate ligament reconstruction, knee, rehabilitation, position sense, magnetic resonance imaging, neuronal plasticity
National Category
Neurosciences Physiotherapy Orthopaedics
Identifiers
urn:nbn:se:umu:diva-193644 (URN)10.3389/fnhum.2022.841874 (DOI)000780202000001 ()35392122 (PubMedID)2-s2.0-85128106075 (Scopus ID)
Funder
Swedish Research Council, 2017-00892Konung Gustaf V:s och Drottning Victorias FrimurarestiftelseSwedish National Centre for Research in Sports, P2018-0104Swedish National Centre for Research in Sports, P2019-0068Region Västerbotten, VLL548501Region Västerbotten, VLL838421Novo Nordisk
Available from: 2022-04-08 Created: 2022-04-08 Last updated: 2024-01-17Bibliographically approved
Grinberg, A., Strong, A. & Häger, C. (2022). Does a knee joint position sense test make functional sense?: Comparison to an obstacle clearance test following anterior cruciate ligament injury. Physical Therapy in Sport, 55, 256-263
Open this publication in new window or tab >>Does a knee joint position sense test make functional sense?: Comparison to an obstacle clearance test following anterior cruciate ligament injury
2022 (English)In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 55, p. 256-263Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate knee joint position sense (JPS) among individuals with anterior cruciate ligament reconstruction (ACLR), cleared for return to sport, and investigate whether JPS errors are associated with outcomes of a functional obstacle clearance test (OC; downward vision occluded).

Design: Cross-sectional.

Setting: Controlled laboratory.

Participants: Thirty-four individuals following ACLR, 23 non-athletic asymptomatic controls (CTRL), 18 athletes (ATH).

Main outcome measures: absolute error (AE) and variable error (VE) for weight-bearing knee JPS (target angles: 40°, 65°); minimal distances of the lower extremity from the obstacle (at any time and vertical clearance; two obstacle heights).

Results: Larger AE (P = 0.023) and VE (P = 0.010) were observed for CTRL compared with ACLR. CTRL also had larger OC distances for the trailing leg compared with ATH (P ≤ 0.046) and greater variability compared to both other groups (P ≤ 0.033). Moderate positive correlations (Rs ≥ 0.408, P ≤ 0.029) were observed between AE for the 40° angle and low-obstacle distances, for the injured ACLR leg.

Conclusions: Knee JPS was worse in less-active individuals rather than following ACLR. Functional assessments like our OC test should complement isolated JPS tests, as they emphasize whole-body coordination and thus constitute more relevant estimations of proprioception.

Place, publisher, year, edition, pages
Churchill Livingstone, 2022
Keywords
ACL, Functional test, Proprioception, Sensorimotor function
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-196117 (URN)10.1016/j.ptsp.2022.05.004 (DOI)000802168400005 ()35580536 (PubMedID)2-s2.0-85130122614 (Scopus ID)
Available from: 2022-06-16 Created: 2022-06-16 Last updated: 2023-01-16Bibliographically approved
Strong, A., Arumugam, A., Tengman, E., Röijezon, U. & Häger, C. (2022). Properties of tests for knee joint threshold to detect passive motion following anterior cruciate ligament injury: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 17(1), Article ID 134.
Open this publication in new window or tab >>Properties of tests for knee joint threshold to detect passive motion following anterior cruciate ligament injury: a systematic review and meta-analysis
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2022 (English)In: Journal of Orthopaedic Surgery and Research, E-ISSN 1749-799X, Vol. 17, no 1, article id 134Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Threshold to detect passive motion (TTDPM) tests of the knee joint are commonly implemented among individuals with anterior cruciate ligament (ACL) injury to assess proprioceptive acuity. Their psychometric properties (PMPs), i.e. reliability, validity and responsiveness, are however unclear. This systematic review aimed to establish the PMPs of existing knee joint TTDPM tests among individuals with ACL injury.

METHODS: The databases PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL and ProQuest were searched to identify studies that assessed the properties of knee joint TTDPM tests in individuals with ACL injury. The risk of bias for each included study was assessed at the outcome level for each test. Overall quality and levels of evidence for each property were rated according to established criteria. Meta-analyses with mean differences were conducted using random-effects models when adequate data were available.

RESULTS: Fifty-one studies covering 108 TTDPM tests and 1632 individuals with unilateral ACL injury were included. A moderate-to-strong level of evidence indicated insufficient quality for all of the following: convergent validity, known-groups validity, discriminative validity, responsiveness between subgroups, and responsiveness to intervention. Subgroup meta-analyses for known-groups validity did however find that a starting angle of 15° resulted in significantly worse TTDPM for knees with ACL injury compared to those of asymptomatic persons (mean difference 0.28°; 95% CI 0.03 to 0.53; P = 0.03), albeit based on only three studies. Due to the lack of evidence, it was not possible to estimate the quality of reliability, measurement error, and criterion validity, nor responsiveness from a criterion and construct approach.

CONCLUSIONS: Among persons with ACL injury, existing tests of knee joint TTDPM lack either sufficient quality or evidence for their reliability, validity and responsiveness. Significantly worse thresholds for ACL-injured knees compared to those of asymptomatic controls from a 15° starting angle and trends towards significance for some validity measures nevertheless encourage the development of standardised tests. Further research investigating the influence of modifiable test components (e.g. starting angle and motion direction) on the PMPs of knee joint TTDPM tests following ACL injury is warranted.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Kinesthesia, Proprioception, Reliability, Responsiveness, Validity
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-193157 (URN)10.1186/s13018-022-03033-4 (DOI)000764709200007 ()35246192 (PubMedID)2-s2.0-85125868799 (Scopus ID)
Funder
Swedish Research Council, 2017-00892Region Västerbotten, 7003575Region Västerbotten, 7002795Swedish National Centre for Research in Sports, P2019-0068Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Available from: 2022-03-18 Created: 2022-03-18 Last updated: 2024-03-14Bibliographically approved
Svensson, F., Aasa, U. & Strong, A. (2022). Textile electromyography electrodes reveal differences in lower limb muscle activation during loaded squats when comparing fixed and free barbell movement paths. Frontiers in Sports and Active Living, 4, Article ID 1021323.
Open this publication in new window or tab >>Textile electromyography electrodes reveal differences in lower limb muscle activation during loaded squats when comparing fixed and free barbell movement paths
2022 (English)In: Frontiers in Sports and Active Living, E-ISSN 2624-9367, Vol. 4, article id 1021323Article in journal (Refereed) Published
Abstract [en]

Introduction: Traditional recordings of muscle activation often involve time-consuming application of surface electrodes affixed to the skin in laboratory environments. The development of textile electromyography (EMG) electrodes now allows fast and unobtrusive assessment of muscle activation in ecologically valid environments. In this study, textile EMG shorts were used to assess whether performing squats with the barbell resting freely on the shoulders or using a Smith machine for a fixed barbell movement path is preferable for maximizing lower limb muscle activation.

Methods: Sixteen athletes performed free and fixed barbell squats in a gym with external loads equivalent to their body mass. Quadriceps, hamstrings and gluteus maximus activation was measured bilaterally with textile EMG electrodes embedded in shorts.

Results: Mean quadriceps activation was greater for the free compared with the fixed movement path for the right (mean difference [MD] 14μV, p = 0.04, ηp2 = 0.28) and left leg (MD 15μV, p = 0.01, ηp2 = 0.39) over the entire squat and specifically during the first half of the eccentric phase for the left leg (MD 7μV, p = 0.04, d = 0.56), second half of the eccentric phase for both legs (right leg MD 21μV, p = 0.05, d = 0.54; left leg MD 23μV, p = 0.04, d = 0.52) and the first half of the concentric phase for both legs (right leg MD 24μV, p = 0.04, d = 0.56; left leg MD 15μV, p = 0.01, d = 0.72). Greater hamstrings activation for the free path was seen for the second half of the eccentric phase (left leg MD 4μV, p = 0.03, d = 0.58) and first half of the concentric phase (right leg MD 5μV, p = 0.02, d = 0.72). No significant differences were found for gluteus maximus.

Discussion: Textile EMG electrodes embedded in shorts revealed that to maximize thigh muscle activity during loaded squats, a free barbell movement path is preferable to a fixed barbell movement path.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
RDS electromyography, weightlifting, resistance training, motor control, squat
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-205032 (URN)10.3389/fspor.2022.1021323 (DOI)000896805300001 ()36524056 (PubMedID)2-s2.0-85143911934 (Scopus ID)
Available from: 2023-02-20 Created: 2023-02-20 Last updated: 2023-02-21Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6715-6208

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