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Skeletal muscle works as a dynamic joint stabilizer, assisting the underlying ligaments in restricting joint angulation by actively resisting external loads. Despite its clinical importance, little is known about the muscle strength required to produce torque to help ligaments restrict joint angulation within the physiological range permitted by the joint structure. In this study, we introduce a method for measuring the strength of the elbow musculature in restraining valgus angulation and present the values obtained in 20 healthy young men. Each participant was fastened to a Biodex dynamometer, with the elbow joint flexed to 90° and the varus-valgus axis aligned to the dynamometer’s rotation axis. Maximal voluntary isometric ramp contraction of shoulder internal rotators was performed while the humeroulnar joint gap was monitored with an ultrasound apparatus. The largest torque recorded while the humeroulnar joint gap did not exceed a predetermined individualized threshold was considered to be the elbow varus strength of the participant. The elbow varus strength of the dynamic stabilizer was found to be 41 ± 12 Nm, which agreed with the value estimated by our musculoskeletal model. The inter-operator reliability test indicated excellent reliability (ICC (2,1) = 0.91). These findings suggest that the present method is valid for measuring the strength of the elbow musculature in restraining the valgus angulation. Measurements of this aspect of strength are expected to provide insights for understanding and preventing elbow injuries.

Late-onset Pompe disease (LOPD) is a rare, progressive disorder characterized by limb–girdle muscle weakness and/or respiratory insufficiency, caused by acid alpha-glucosidase (GAA) gene mutations and treated with enzyme replacement therapy. We studied isometric muscle strength in eight muscle groups bilaterally using a Biodex® dynamometer, as well as the Medical Research Council sum score (MRC-SS), hand grip strength, 6 min walk distance (6MWD), 10 m walk test (10MWT) and timed up-and-go test (TUG) in 12 adult, ambulatory, treated LOPD patients and 12 age-/gender-matched healthy controls, every 6 months for 2 years. The mean isometric muscle strength showed a significant decline in right and left knee extensors at 12 months in controls (p < 0.014; p < 0.016), at 18 months in patients (p < 0.010; p < 0.007) and controls (only right side, p < 0.030) and at 24 months in both groups (p < 0.035). The mean 6MWD in patients significantly decreased after 24 months, from 451.9 m to 368.1 m (p < 0.003), whereas in controls, the mean 6MWD significantly increased after 6 months (p < 0.045) and 18 months (p < 0.020) (at 24 months p = 0.054). In patients and controls, the MRC-SS, hand grip test, 10MWT and TUG did not show significant changes (p > 0.05). We conclude that the 6MWD is a useful outcome measure to detect motor decline in treated LOPD patients.

Isometric force- or torque-time parameters are commonly reported in the research literature. The processing methods of the electronic dynamometer-derived signal may influence the outcome measures. This study determined the influence of filtering and sample rate (SR) on isometric torque-time parameters and provides specific signal processing recommendations for future studies. Twenty-three subjects performed 49 isometric maximum voluntary contractions (MVCs) of the knee extensors on an isokinetic dynamometer. Outcome measures included peak torque (PT), and rate of torque development at peak (RTDPEAK), 50 (RTD50) and 200 (RTD200) ms for seven filter conditions including low-pass filter cutoffs at 5, 10, 20, 50, 100 and 150 Hz and a notch filter at 100 and 200 Hz. Comparisons were also made across four SR conditions at 100, 500, 1000 and 2000 Hz. The RTDPEAK variable was markedly changed (−5.4 to −37.9%) for all filter frequencies compared to the 150 Hz condition and the RTD50 variable was altered for all frequencies between 50 and 5 Hz. No differences were found for RTD200. For SR, compared to the 2000 Hz condition, differences were revealed for the 100 Hz condition for the RTDPEAK and RTD50 variables. The filtering or SR did not alter PT across any of the conditions. The filter and SR applied to the signal was capable of distorting the MVC signal and skewing the torque–time parameters, specifically for the early and maximum RTD variables of the MVC curve (RTD50 and RTDPEAK). For traditional isokinetic dynamometers, a low-pass filter cutoff of 150 Hz and a SR of at least 1000 Hz is recommended when assessing early isometric force- or torque-time MVC parameters.

To evaluate isokinetic dynamometer reliability for isometric assessment of plantar flexor (PF) strength. Cross-sectional. Testing by the same physiotherapist twice during a first session (repeatability) and once during a second session (reproducibility). Twenty-two healthy subjects (44 ankles, 11 men/11 women). Isometric PF peak torque, with and without body mass normalization, at 0° and +20° of plantar flexion. Measurement reliability was evaluated using intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC). Without normalization, measurement repeatability was excellent at 0° of plantar flexion (ICC, 0.94; SEM, 6.6%; MDC, 18.4%) compared with good repeatability at +20° (ICC, 0.85; SEM, 11.1%; MDC 30.6%). Measurement repeatability following normalization was good at 0° (ICC, 0.88; SEM, 5.2%; MDC, 14.4%) and +20° (ICC, 0.79; SEM, 10.2%; MDC, 28.1%). While reproducibility was good at 0° with normalization (ICC, 0.84; SEM, 5.9%; MDC, 16.3%) or excellent without (ICC 0.92; SEM 7.5%; MDC, 20.8%), it was moderate at +20° with normalization (ICC 0.71; SEM 11.3%; MDC, 31.3%) or good without (ICC 0.78; SEM 13.0%; MDC, 36.1%). The reliability of PF maximal isometric strength is good/excellent at 0° of plantar flexion but moderate/good at +20°. •Weakness of plantar flexors can be responsible of injuries.•Neuromuscular assessment is essential for tracking a patient's strength progression overtime and can be performed with various tools, provided that they are sufficiently reliable.•Reliability of isokinetic dynamometer for isometric assessment of plantar flexors depends on the angle of the ankle: it is satisfactory at 0° but of lower quality at +20° of plantar flexion.•Reliability is better when there is body mass normalization of isometric peak torque at 0° of plantar flexion.

Background and Objectives: Biodex System® is an advanced dynamometer used for testing various biomechanical parameters of muscles. Test outcomes allow for the identification of muscle pathology and consequently lead to a clinical diagnosis. Despite being widely used for the testing and rehabilitation of the human musculoskeletal system, no universal and acceptable protocol for wrist examination has been proposed for patients with wrist pathology. In this study, the authors aim to identify the most appropriate protocol for testing the biomechanical parameters of flexors and extensors of the wrist. Materials and Methods: A group of 20 patients with symptomatic tennis elbow and 26 healthy volunteers were examined using three different protocols: isokinetic, isometric and isotonic. Protocol order for each study participant was assigned at random with a minimum of a 24 h break between protocols. All protocol parameters were set according to data obtained from a literature review and an earlier pilot study. Following completion of each protocol, participants filled out a questionnaire-based protocol, assessing pain intensity during the exam, difficulty with exam performance and post-exam muscle fatigue. Results: The isotonic protocol showed the best patient tolerance and the highest questionnaire score. There was a significant difference (p < 0.05) between the three protocols in average pain intensity reported by study participants. All participants completed the isotonic protocol, but not all patients with symptomatic tennis elbow were able to complete the isometric and isokinetic protocols. The isotonic protocol was deemed “difficult but possible to complete” by study participants. Conclusions: The isotonic protocol is most suitable for testing the flexors and extensors of the wrist. It gives the most biomechanical data of all protocols, is well tolerated by patients and rarely causes pain during examination even in symptomatic participants.

Background The decrease in recurrence rates in ventral hernia surgery have led to a redirection of focus towards other important patient-related endpoints. One such endpoint is abdominal wall function. The aim of the present study was to evaluate the reliability and external validity of abdominal wall strength measurement using the Biodex System-4 with a back abdomen unit. Material and method Ten healthy volunteers and ten patients with ventral hernias exceeding 10 cm were recruited. Test–retest reliability, both with and without girdle, was evaluated by comparison of measurements at two test occasions 1 week apart. Reliability was calculated by the interclass correlation coefficients (ICC) method. Validity was evaluated by correlation with the well-established International Physical Activity Questionnaire (IPAQ) and a self-assessment of abdominal wall strength. Results One person in the healthy group was excluded after the first test due to neck problems following minor trauma. The reliability was excellent (>0.75), with ICC values between 0.92 and 0.97 for the different modalities tested. No differences were seen between testing with and without a girdle. Validity was also excellent both when calculated as correlation to self-assessment of abdominal wall strength, and to IPAQ, giving Kendall tau values of 0.51 and 0.47, respectively, and corresponding P values of 0.002 and 0.004. Conclusion Measurement of abdominal muscle function using the Biodex System-4 is a reliable and valid method to assess this important patient-related endpoint. Further investigations will be made to explore the potential of this technique in the evaluation of the results of ventral hernia surgery, and to compare muscle function after different abdominal wall reconstruction techniques.

The present study investigated the effect of chronic neck muscle pain (defined as trapezius myalgia) on neck/shoulder muscle function during concentric, eccentric and static contraction. Forty-two female office workers with trapezius myalgia (MYA) and 20 healthy matched controls (CON) participated. Isokinetic (−60, 60 and 180° s −1) and static maximal voluntary shoulder abductions were performed in a Biodex dynamometer, and electromyography (EMG) obtained in the trapezius and deltoideus muscles. Muscle thickness in the trapezius was measured with ultrasound. Pain and perceived exertion were registered before and after the dynamometer test. The main findings were that shoulder abduction torque (at −60 and 60° s −1) and trapezius EMG amplitude (at −60, 0 and 60° s −1) were significantly lower in MYA compared with CON ( p<0.001–0.05). Deltoideus EMG and trapezius muscle thickness were not significantly different between the groups. While perceived exertion increased in both groups in response to the test ( p<0.0001), pain increased in MYA only ( p<0.0001). In conclusion, having trapezius myalgia was associated with decreased strength capacity and lowered activity of the painful trapezius muscle. The most consistent differences—in terms of both torque and EMG—were found during slow concentric and eccentric contractions. Activity of the synergistic pain free deltoideus muscle was not significantly lower, indicating specific inhibitory feedback of the painful trapezius muscle only. Parallel increase in pain and perceived exertion among MYA were observed in response to the maximal contractions, emphasizing that heavy physical exertion provokes pain increase only in conditions of myalgia.