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Concept: Semimembranosus muscle


BACKGROUND: A common goal of persons post-stroke is to regain community ambulation. The plantar flexor muscles play an important role in propulsion generation and swing initiation as previous musculoskeletal simulations have shown. The purpose of this study was to demonstrate that simulation results quantifying changes in plantar flexor activation and function in individuals post-stroke were consistent with (1) the purpose of an intervention designed to enhance plantar flexor function and (2) expected muscle function during gait based on previous literature. METHODS: Three-dimensional, forward dynamic simulations were created to determine the changes in model activation and function of the paretic ankle plantar flexor muscles for eight patients post-stroke after a 12-weeks FastFES gait retraining program. RESULTS: An median increase of 0.07 (Range [-0.01,0.22]) was seen in simulated activation averaged across all plantar flexors during the double support phase of gait from pre- to post-intervention. A concurrent increase in walking speed and plantar flexor induced forward center of mass acceleration by the plantar flexors was seen post-intervention for seven of the eight subject simulations. Additionally, post-training, the plantar flexors had an simulated increase in contribution to knee flexion acceleration during double support. CONCLUSIONS: For the first time, muscle-actuated musculoskeletal models were used to simulate the effect of a gait retraining intervention on post-stroke muscle model predicted activation and function. The simulations showed a new pattern of simulated activation for the plantar flexor muscles after training, suggesting that the subjects activated these muscles with more appropriate timing following the intervention. Functionally, simulations calculated that the plantar flexors provided greater contribution to knee flexion acceleration after training, which is important for increasing swing phase knee flexion and foot clearance.

Concepts: Knee, Sartorius muscle, Flexion, Extension, Semitendinosus muscle, Semimembranosus muscle, Popliteus muscle, Musculoskeletal system


It has been suggested that deep squats could cause an increased injury risk of the lumbar spine and the knee joints. Avoiding deep flexion has been recommended to minimize the magnitude of knee-joint forces. Unfortunately this suggestion has not taken the influence of the wrapping effect, functional adaptations and soft tissue contact between the back of thigh and calf into account. The aim of this literature review is to assess whether squats with less knee flexion (half/quarter squats) are safer on the musculoskeletal system than deep squats. A search of relevant scientific publications was conducted between March 2011 and January 2013 using PubMed. Over 164 articles were included in the review. There are no realistic estimations of knee-joint forces for knee-flexion angles beyond 50° in the deep squat. Based on biomechanical calculations and measurements of cadaver knee joints, the highest retropatellar compressive forces and stresses can be seen at 90°. With increasing flexion, the wrapping effect contributes to an enhanced load distribution and enhanced force transfer with lower retropatellar compressive forces. Additionally, with further flexion of the knee joint a cranial displacement of facet contact areas with continuous enlargement of the retropatellar articulating surface occurs. Both lead to lower retropatellar compressive stresses. Menisci and cartilage, ligaments and bones are susceptible to anabolic metabolic processes and functional structural adaptations in response to increased activity and mechanical influences. Concerns about degenerative changes of the tendofemoral complex and the apparent higher risk for chondromalacia, osteoarthritis, and osteochondritis in deep squats are unfounded. With the same load configuration as in the deep squat, half and quarter squat training with comparatively supra-maximal loads will favour degenerative changes in the knee joints and spinal joints in the long term. Provided that technique is learned accurately under expert supervision and with progressive training loads, the deep squat presents an effective training exercise for protection against injuries and strengthening of the lower extremity. Contrary to commonly voiced concern, deep squats do not contribute increased risk of injury to passive tissues.

Concepts: Vertebral column, Cartilage, Osteoarthritis, Knee, Joint, Flexion, Extension, Semimembranosus muscle


INTRODUCTION: Many studies regarding spinal sagittal alignment were focused mainly on above-hip structures, not considering the knee joint. Knee-spine syndrome was proposed earlier, but the mechanism of this phenomenon has not been revealed. The aim of the study was to demonstrate how spinopelvic alignment and sagittal balance change in response to simulated knee flexion in normal non-diseased population. METHODS: Thirty young male were enrolled in the study cohort. Two motion-controlled knee braces were used to simulate knee flexion of 0°, 15°, and 30° settings. Whole spine and lower extremity lateral radiographs were taken at each knee setting of 0°, 15°, and 30° flexion. Spinal and pelvic parameters were measured, including two angular parameters, femoropelvic angle (FPA) and femoral tilt angle (FTA). RESULTS: The following equation can be made; PT (pelvic tilt) = FPA + FTA. The mean values of FPA and lumbar lordosis decreased significantly at 15° and 30° knee settings compared to the parameters at the 0° knee setting, while the mean values of pelvic tilt and sacral slope rarely changed. Results also showed FTA was not correlated with PT, but strongly correlated with FPA (R = -0.83, p < 0.01). CONCLUSIONS: The knee flexion resulted in decrease of lumbar lordosis without a significant change of pelvic posture in non-diseased population group.

Concepts: Vertebral column, Knee, Joint, Sartorius muscle, Flexion, Extension, Semimembranosus muscle, Popliteus muscle


Abstract Characteristics of 32 international and 41 local under-17 (U-17) (14.5-16.5 years) roller hockey players were considered in the context of discrimination by competitive level using training history, anthropometry, skeletal maturation, and several laboratory and field performance tests. More international (42%) than local (22%) players were advanced in maturity status. International players had slightly less hockey experience (years), but had more practice sessions and match time (minutes) during the season. Local players were shorter and attained better performance in the 25-m dash, while international players performed better in sit-ups, ball throw and 20-m shuttle run. The fatigue index derived from the Wingate anaerobic test was higher among local players, while peak torques of knee extension and flexion were greater in international players. Stepwise discriminant function correctly classified 85% of players by competitive level based on grip strength, ratio of eccentric and concentric knee extension, number of training sessions, playing time and fatigue index. The results suggested an interaction among strength, anaerobic fitness and training plus game time as factors in discriminating international from local level players and by inference in the selection and development of youth roller hockey players.

Concepts: Knee, Performance, Flexion, Extension, Discrimination, Semitendinosus muscle, Semimembranosus muscle


Objective: To evaluate the effects of a 20-min gait training session using the Lokomat® combined with a negative kinematic constraint on the non-paretic limb and a positive kinematic constraint on the paretic limb, on peak knee flexion and other biomechanical parameters in chronic hemiparetic subjects. Design: Preliminary study, before-after design. Subjects: Fifteen hemiparetic subjects. Methods: Subjects were evaluated using 3-dimensional gait analysis before, immediately after the end of the training, and after a 20-min rest period. The positive constraint increased the range of motion of the paretic limb (hip and knee), while the negative constraint reduced the range of motion of the non-paretic limb (hip and knee). Results: Peak knee flexion and other, kinematic, kinetic and spatiotemporal, parameters were significantly improved following the training session. These positive effects occurred predominantly in the paretic limb. Moreover, there was no worsening of biomechanical parameters of the non-paretic limb despite the use of negative constraint on this limb. These effects persisted for at least 20 min following the end of the gait training session. Conclusion: This type of training may be effective to improve gait in hemiparetic patients. A larger investigation of the training programme is justified.

Concepts: Stroke, Knee, Sartorius muscle, Classical mechanics, Kinematics, Flexion, Extension, Semimembranosus muscle


The purpose of this study was to investigate changes in muscle oxygenation of knee extensor and plantar flexor muscles during repeated muscle contractions under the same condition. In addition, we compared changes in muscle oxygenation between superficial and deep regions of both muscles.

Concepts: Knee, Muscle contraction, Sartorius muscle, Flexion, Extension, Semitendinosus muscle, Semimembranosus muscle, Popliteus muscle


Manipulating joint range of motion during squat training may have differential effects on adaptations to strength training with implications for sports and rehabilitation. Consequently, the purpose of this study was to compare the effects of squat training with a short vs. a long range of motion. Male students (n = 17) were randomly assigned to 12 weeks of progressive squat training (repetition matched, repetition maximum sets) performed as either a) deep squat (0-120° of knee flexion); n = 8 (DS) or (b) shallow squat (0-60  of knee flexion); n = 9 (SS). Strength (1 RM and isometric strength), jump performance, muscle architecture and cross-sectional area (CSA) of the thigh muscles, as well as CSA and collagen synthesis in the patellar tendon, were assessed before and after the intervention. The DS group increased 1 RM in both the SS and DS with ~20 ± 3 %, while the SS group achieved a 36 ± 4 % increase in the SS, and 9 ± 2 % in the DS (P < 0.05). However, the main finding was that DS training resulted in superior increases in front thigh muscle CSA (4-7 %) compared to SS training, whereas no differences were observed in patellar tendon CSA. In parallel with the larger increase in front thigh muscle CSA, a superior increase in isometric knee extension strength at 75° (6 ± 2 %) and 105° (8 ± 1 %) knee flexion, and squat-jump performance (15 ± 3 %) were observed in the DS group compared to the SS group. Training deep squats elicited favourable adaptations on knee extensor muscle size and function compared to training shallow squats.

Concepts: Muscle, Knee, Thigh, Flexion, Extension, Isometric exercise, Semitendinosus muscle, Semimembranosus muscle


The purpose of this study was to quantify the relative changes in fascicle (FL) and muscle-tendon unit (LMTU) length of the long head of the biceps femoris (BFlh) at different combinations of hip and knee joint positions. Fourteen participants performed passive knee extension trials from 0°, 45° and 90° of hip flexion. FL, LMTU, pennation angle (PA) and effective FL (FL multiplied by the cosine of the PA) of the BFlh were quantified using ultrasonography (US). Three-way analysis of variance designs indicated that at each hip angle, FL and LMTU increased and PA decreased from 90° to 0° of knee flexion. Increasing hip flexion angle from 0° to 90° led to a higher FL and LMTU and a lower PA (p < .05). The average lengthening of the LMTU and effective FL was 28.00 ± 1.82% and 85.88 ± 21.92%, respectively. The average effective FL change accounted for 51.36 ± 7.39% of LMTU change. The relationship between effective FL and LMTU was almost linear with a slope equal to 0.49 ± 0.06 (r2 = 0.52 to 0.97). To achieve greater lengthening of the fascicles of the BFlh, passive stretch with the hip flexed at least 45° and the knee reaching full extension is necessary.

Concepts: Knee, Joint, Sartorius muscle, Flexion, Extension, Semitendinosus muscle, Semimembranosus muscle, Gracilis muscle


The ability to walk contributes considerably to physical health and overall well-being, particularly in children with motor disability, and is therefore prioritized as a rehabilitation goal. However, half of ambulatory children with cerebral palsy (CP), the most prevalent childhood movement disorder, cease to walk in adulthood. Robotic gait trainers have shown positive outcomes in initial studies, but these clinic-based systems are limited to short-term programs of insufficient length to maintain improved function in a lifelong disability such as CP. Sophisticated wearable exoskeletons are now available, but their utility in treating childhood movement disorders remains unknown. We evaluated an exoskeleton for the treatment of crouch (or flexed-knee) gait, one of the most debilitating pathologies in CP. We show that the exoskeleton reduced crouch in a cohort of ambulatory children with CP during overground walking. The exoskeleton was safe and well tolerated, and all children were able to walk independently with the device. Rather than guiding the lower limbs, the exoskeleton dynamically changed the posture by introducing bursts of knee extension assistance during discrete portions of the walking cycle, a perturbation that resulted in maintained or increased knee extensor muscle activity during exoskeleton use. Six of seven participants exhibited postural improvements equivalent to outcomes reported from invasive orthopedic surgery. We also demonstrate that improvements in crouch increased over the course of our multiweek exploratory trial. Together, these results provide evidence supporting the use of wearable exoskeletons as a treatment strategy to improve walking in children with CP.

Concepts: Better, Improve, Knee, Thigh, Flexion, Extension, Semitendinosus muscle, Semimembranosus muscle


Background. Foam rolling has been shown to acutely increase range of motion (ROM) during knee flexion and hip flexion with the experimenter applying an external force, yet no study to date has measured hip extensibility as a result of foam rolling with controlled knee flexion and hip extension moments. The purpose of this study was to investigate the acute effects of foam rolling on hip extension, knee flexion, and rectus femoris length during the modified Thomas test. Methods. Twenty-three healthy participants (male = 7; female = 16; age = 22 ± 3.3 years; height = 170 ± 9.18 cm; mass = 67.7 ± 14.9 kg) performed two, one-minute bouts of foam rolling applied to the anterior thigh. Hip extension and knee flexion were measured via motion capture before and after the foam rolling intervention, from which rectus femoris length was calculated. Results. Although the increase in hip extension (change = +1.86° (+0.11, +3.61); z(22) = 2.08; p = 0.0372; Pearson’s r = 0.43 (0.02, 0.72)) was not due to chance alone, it cannot be said that the observed changes in knee flexion (change = -1.39° (-5.53, +2.75); t(22) = -0.70; p = 0.4933; Cohen’s d = - 0.15 (-0.58, 0.29)) or rectus femoris length (change = -0.005 (-0.013, +0.003); t(22) = -1.30; p = 0.2070; Cohen’s d = - 0.27 (-0.70, 0.16)) were not due to chance alone. Conclusions. Although a small change in hip extension was observed, no changes in knee flexion or rectus femoris length were observed. From these data, it appears unlikely that foam rolling applied to the anterior thigh will improve passive hip extension and knee flexion ROM, especially if performed in combination with a dynamic stretching protocol.

Concepts: Knee, Hip, Flexion, Extension, Rectus femoris, Stretching, Semimembranosus muscle