Core strength training altered the motor control strategies and joint kinematics for the trunk and the lower extremity by increasing the trunk flexion angle, VM:VL activation ratio, and H:Q activation ratio and reducing the knee valgus and hip adduction angles.
Article clinical Relevance:
Training core muscles can modify the biomechanics associated with ACL injuries in a side-step cutting task; thus, core strength training might be considered in ACL injury prevention programs to alter the lower extremity alignment in the frontal plane and muscle activations during sports-related tasks.
Core training Program
Warm-up, 1.3-km / 15 min jogging
Leg raise: Week 1-5: 1 set x 12 reps, Week 6-10: 1 set x 20 reps
Crunch: Week 1-5: 1 set x 12 reps, Week 6-10: 1 set x 20 reps
Superman: Week 1-5: 1 set x 12 reps, Week 6-10: 1 set x 20 reps
Plank hip twist Week 1-5: 1 set x 60 sec, Week 6-10: 1 leg for 30 seconds and then switched legs
Prone-plank Week 1-5: 1 set x 60 sec, Week 6-10: 1 leg for 30 seconds and then switched legs
Side-plank (both sides): Week 1-5: 1 set x 60 sec, Week 6-10: 1 leg for 30 seconds and then switched side
Supine bridge hold: Week 1-5: 1 set x 60 sec, Week 6-10: 1 leg for 30 seconds and then switched side
Movement re-training is considered an important element of rehabilitation after ACLR, but there is a lack of knowledge on the ‘how’ and ‘what’ movement re-training should occur after ACLR.
In its basic form, movement re-training after ACLR is about progressing a patient through gradually more demanding tasks from the point of being able to walk to being able to perform highly complex sports movements. However, there is a lack of guidance on when to implement certain tasks (e.g. when to begin running) and how to transition between tasks. This paper presents a 10 task progressions system which can form an important aspect of the movement-based re-training process, providing structure and patient autonomy. Monitoring knee function and movement and neuromuscular status to safely transition between these tasks is important.
1. Normal walking gait 2. Bilateral squat 3. Unilateral foundation exercises – Single leg squat4. Bilateral landing5. Running6. Bilateral plyometrics – Bilateral drop jump 7. Unilateral landing/ deceleration –Single leg deceleration8. Unilateral plyometrics –Single leg drop jump 9. Change of direction ability/coordination – 90º cut maneuver10. Sport-specific movements – Movement control under sport specific change of direction SUMMARY Establishing clear task-based progressions can provide structure to a rehabilitation approach and give autonomy and motivation to a patient after ACLR. This clinical commentary presents 10 task-based progression which can be used by clinicians for their patients who intend to return to sporting activity after ACLR. Progression through a task and between tasks is based on respecting the joint, strength, movement quality and muscle soreness. The presented task-based framework is evidence informed and based on applying theory into practice.
The aim of this study was to investigate the effects of repeated application of BFR+EMS on preserving skeletal muscle mass and strength during a period of limb disuse. It was hypothesized that repeated BFR+EMS treatment would be more effective than repeated BFR treatment without EMS for attenuating the loss of quadriceps mass and knee-extension strength during a 14-day leg unloading period
Subjects
A mixed-sex group of 30 healthy, young individuals (14 males, 16 females; age: 22 ± 3 years; body mass index: 23 ± 3 kg.m -2) who were naïve to BFR training were recruited from the university and surrounding community.
Study design
Participants were randomly allocated to either the control (CON; n = 10), BFR (n = 10), or BFR+EMS (n = 10) group. All three groups underwent a 14-day period of single-leg muscle unloading through use of a knee brace and crutches. Unloading was performed using the left leg of all participants to allow safe operation of a motor vehicle during the study. Over the 14-day unloading period, participants had no intervention (CON), or underwent treatment with either BFR or BFR+EMS twice daily, 5 times per week, for a total of 20 treatment sessions.
Interventions
BFR was performed with the participant in a sitting position using arterial occlusion accomplished via a PTSi automated tourniquet system (Delfi Medical Innovations Inc. Vancouver, Canada). Full arterial occlusion was chosen to maximize the metabolic stimulus and adaptive training response (18). An 11-cm wide tourniquet cuff was positioned proximally around the left thigh and inflated to a pressure that was minimally superior to systolic pressure (≥ 2 mmHg), allowing for arterial occlusion. This pressure, also referred to as the lowest effective occlusion pressure (LOP).
Muscle stimulation for the ITT was performed using a constant current high voltage stimulator (model DS7AH, Digitimer, Welwyn Garden City, Hertfordshire, UK) where evoked twitches were delivered to the knee extensors transcutaneously using two custom electrode pads, previously described by Dalton et al. (17). Electrodes were placed perpendicular to the long axis of the femur, with the proximal pad at ~5 cm above the kneecap and the distal pad ~10 cm above the proximal electrode, covering the anterior aspect of the thigh completely.
BFR + Muscle stimulation in combination
Discussion
Data reported here suggests that repeated BFR+EMS treatment represents an effective interventional strategy to attenuate muscle disuse atrophy, which is known to lead to reduced functional capacity (21- 23), a shift in fuel metabolism (24), impaired muscle insulin sensitivity (25), a decline in basal metabolic rate (26, 27), and an increase in body fat mass (28). Given the ability to use BFR+TEMS as a “passive” treatment modality requiring no external load, these data are relevant to persons immobilized from injury or illness, persons who are differentially-abled or confined to a wheelchair, astronauts living in reduced gravity environments, or others seeking to minimize the consequences of muscle disuse atrophy. Specific applications to those rehabilitating from sports and orthopaedic injuries are perhaps obvious, and with the known association of muscle mass with cardiometabolic health and acute blood sugar maintenance through glucose uptake (29, 30), it is possible that further applications exist for persons who are faced with acute or chronic forced sedentarism.
…..
However, we believe that BFR+EMS likely presents a more effective method to attenuate muscle loss compared to EMS alone as a previous study shows a greater recruitment of muscle fibers when blood flow is restricted during electrically evoked muscle contractions (37) compared to when electrically evoked muscle contractions are performed without blood flow restriction.
In conclusion
In conclusion, the combined treatment of BFR+EMS uniquely preserves muscle mass during a period of limb disuse, while BFR treatment without EMS did not protect against this expected disuse atrophy. These results suggest that BFR+EMS treatment, but not BFR treatment alone, represents an effective interventional strategy to attenuate muscle atrophy during a period of disuse and this may have implications across a variety of health and performance applications wherein disuse cannot be avoided.
Patients with poor performance on Single leg LST of the operative leg had significantly lower hip abduction strength in the surgical leg (17.6 kg) compared with the nonoperative leg (20.5 kg) (P ¼ .024). Those with good performance had similar hip abduction strength in both legs, with a mean of 20.5 kg in the surgical leg versus a mean of 20.1 kg in the nonoperative leg (P ¼ .50). Reference
See here how to measure hip strength with Kristian Thorborg. Link
Clinical cutoffs were established to identify athletes at high injury risk: hip abduction strength 35.4% BW. According to these strength cutoffs, athletes classified as low risk have an injury risk that decreases from 3% to less than 1%, while athletes classified as high risk have an injury risk that increases from 3% to 7%.
For the isometric hip abduction assessment, athletes were side-lying on a treatment table, and a strap (positioned proximal to the iliac crest and secured around the table) was used to stabilize the pelvis. The hip was abducted 30, and the dynamometer pad was placed 10 cm proximal to the lateral femoral epicondyle. Subjects then abducted their hip with maximum effort into the dynamometer pad for 5 seconds against manual resistance. Three repetitions were performed, and the average value was used for analysis
All strength measures were recorded in kilograms and expressed as a percentage of body weight (% BW).
DASH: provides excellent test-retest reliability, good internally consistency and can be considered a valid measure of physical disability and symptoms (haldorsen et al 2014, Huang et al 2015)
WORC: Most reponsive questionnaires for individuals suffering from RC disorders (pierre et al 2016, Huang et al 2015)
SPADI: Is a valid measure to assess pain and disability in patients reporting shoulder pain due to musculoskeletal pathology (Mc Dermit et al 2006, Sahinoglu 2019)
NRS: Has good sensitivity realiability and validity when used also with children and adolecents (karzioglue et al 2018, Castarlenas et al 2017)
PSFS: Supports the reliability validity and responsiveness of the PSFS in patients with a primary shoulder compliant (koehorst et al 2014)
HHD: Proved ti be a reliable tool for evaluation and measurements of medial and lateral rotator strength of the shoulder, caution that ratios vary based in on sport involvement (Riemann et al 2010, Johansson et al 2015)
Physioblog by Andreas Bjerregaard 