Straight Leg Raise Continuation

Quadriceps Muscle Atrophy Clinical Trial

— SLR  

Official title:

Quadriceps Activation Comparative Analysis Based on Positioning of the Ankle During Supine Straight Leg Raise and Quad Set

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05568784
• Other study ID #: SLR Continuation
• Status: Recruiting
• Start date: April 11, 2021
• Est. completion date: July 3, 2024

Study information

• Verified date: February 2024
• Source: Andrews Research & Education Foundation
• Contact: Chandler Bridges
• Phone: 8509168584
• Email: chandler.bridges[@]andrewsref.org
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The goal of this study is to compare quadriceps muscle activation in patients recovering from lower extremity injury, such as an ACL tear. Specifically, the main objectives are as follows:

• Determine the effects of ankle positioning on quad muscle activation during straight leg raise exercises performed while the patient is lying on his or her back

• Determine if there is a difference between ankle positioning on quad muscle activation during straight leg raise exercises performed while the patient is lying on his or her back, comparing healthy versus post-operative participants

Description:

Returning quadriceps neuromuscular control and preventing atrophy is an area of intense current interest in orthopedic rehabilitation and recovery science. It is clear that returning full autonomous control of the quadriceps, including the vastus medialis obliqus (VMO), at full knee extension is an important factor in rehab and dysfunction of the quadriceps leads to a loss of physical performance and self-reported function. Quadriceps function is critical for optimal ambulation patterns and eccentric control is essential for the weight acceptance phase of gait.

Quadriceps atrophy is one of the most common post-operative side effects of anterior cruciate ligament (ACL) reconstruction, total knee arthroplasty, and many other surgeries including meniscal repairs, patella realignment procedures, and microfracture procedures. Due to the swelling within the joint after injury or surgery to the knee, the joint inflammation cascade occurs and leads to the quadriceps being arthrogenically inhibited by spinal neuron inhibition as a protective mechanism. These neural changes usually lead to decreased voluntary quadriceps contraction. Additional contributions of inhibition from post-operative pain, patient apprehension, and surgical procedure requiring protection of the repaired tissue. The sooner one regains control of the quadriceps muscles the less atrophy occurs, reductions in strength are minimized, and the more optimal the outcome is achieved for patient recovery.

Studies have shown that neuromuscular electrical stimulation (NMES), Transcutaneous electrical nerve stimulation (TENS), and biofeedback techniques can limit post-operative quadriceps atrophy and can return strength of the quadriceps back to normative values faster than without those techniques and traditional therapeutic exercise and have better long-term outcomes based on pain, functional outcomes, and return to sport participation rates.

Irradiation effect is a proprioceptive neuromuscular facilitation technique that causes an overflow of neuronal energy from distal to proximal muscles to increase muscle activity of a targeted muscle. This technique can be used to selectively recruit weaker motor units through the application of resistance or stimulation. By inducing a stronger contractile force of the quadriceps, our hope is to return quadriceps function to normal quicker with less atrophy and greater strength.

The investigators hypothesize that ankle positioning in maximal dorsiflexion (DF) changes the quantity of contraction as a percent of the reference voluntary contraction when performing a supine straight leg raise compared with having the foot in neutral (0°), relaxed, and plantarflexed (PF) positions. This may help provide insight into proper instruction and cuing for patients to return quadriceps neuromuscular control sooner and thus limiting quadriceps atrophy.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: July 3, 2024
• Est. primary completion date: April 3, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 55 Years

Eligibility

(All Participants)

Inclusion Criteria:

• Males and females ages 18-55

Exclusion Criteria:

• History of diagnosed cancer, neurological disorder, peripheral nerve injury affecting the lower limb or injury to the lower spine with radicular symptoms, which may affect quadriceps activation

• History of musculoskeletal injury to the quadriceps that may affect ability to maintain muscle contractions without excessive fatigue or discomfort

(Healthy Participants)

Exclusion Criteria:

• Injury to the knee or quadriceps muscle group within the past 12 months to the tested side

• History of lower extremity orthopedic surgery in the past 12 months to the tested side

Related Conditions & MeSH terms

• Leg Injuries
• Leg Injury
• Muscular Atrophy
• Quadriceps Muscle Atrophy

Intervention

Other:
• Straight Leg Raise exercise
Patient lying supine will lift leg to the height of the contralateral knee flexed to 90 degrees with the ankle positioned and tested in all three positions (dorsiflexion, neutral, and plantarflexion)

Locations

Country	Name	City	State
United States	Andrews Research and Education Foundation	Gulf Breeze	Florida

Sponsors (2)

Lead Sponsor	Collaborator
Andrews Research & Education Foundation	Florida

Country where clinical trial is conducted

United States, 

References & Publications (19)

Choi SA, Cynn HS, Yoon TL, Choi WJ, Lee JH. Effects of Ankle Dorsiflexion on Vastus Medialis Oblique and Vastus Lateralis Muscle Activity During Straight Leg Raise Exercise with Hip External Rotation in Patellofemoral Pain Syndrome. Journal of Musculoskeletal Pain. 2014;22(3):260-267.

Harkey MS, Gribble PA, Pietrosimone BG. Disinhibitory interventions and voluntary quadriceps activation: a systematic review. J Athl Train. 2014 May-Jun;49(3):411-21. doi: 10.4085/1062-6050-49.1.04. Epub 2014 Feb 3. — View Citation

Hart JM, Pietrosimone B, Hertel J, Ingersoll CD. Quadriceps activation following knee injuries: a systematic review. J Athl Train. 2010 Jan-Feb;45(1):87-97. doi: 10.4085/1062-6050-45.1.87. — View Citation

Holm B, Kristensen MT, Bencke J, Husted H, Kehlet H, Bandholm T. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty. Arch Phys Med Rehabil. 2010 Nov;91(11):1770-6. doi: 10.1016/j.apmr.2010.07.229. — View Citation

Hopf HC, Schlegel HJ, Lowitzsch K. Irradiation of voluntary activity to the contralateral side in movements of normal subjects and patients with central motor disturbances. Eur Neurol. 1974;12(3):142-7. doi: 10.1159/000114613. No abstract available. — View Citation

Hopkins J, Ingersoll CD. Arthrogenic muscle inhibition: A limiting factor in joint rehabilitation. Journal of Sport Rehabilitation. 2000;9(2):135-159.

Hurley MV, Jones DW, Newham DJ. Arthrogenic quadriceps inhibition and rehabilitation of patients with extensive traumatic knee injuries. Clin Sci (Lond). 1994 Mar;86(3):305-10. doi: 10.1042/cs0860305. Erratum In: Clin Sci 1994 Jun;86(6):xxii. — View Citation

Lewek MD, Rudolph KS, Snyder-Mackler L. Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis. J Orthop Res. 2004 Jan;22(1):110-5. doi: 10.1016/S0736-0266(03)00154-2. — View Citation

Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005 May;87(5):1047-53. doi: 10.2106/JBJS.D.01992. — View Citation

Moore JC. Excitation overflow: an electromyographic investigation. Arch Phys Med Rehabil. 1975 Mar;56(3):115-20. — View Citation

Palmieri RM, Tom JA, Edwards JE, Weltman A, Saliba EN, Mistry DJ, Ingersoll CD. Arthrogenic muscle response induced by an experimental knee joint effusion is mediated by pre- and post-synaptic spinal mechanisms. J Electromyogr Kinesiol. 2004 Dec;14(6):631-40. doi: 10.1016/j.jelekin.2004.06.002. — View Citation

Palmieri RM, Weltman A, Edwards JE, Tom JA, Saliba EN, Mistry DJ, Ingersoll CD. Pre-synaptic modulation of quadriceps arthrogenic muscle inhibition. Knee Surg Sports Traumatol Arthrosc. 2005 Jul;13(5):370-6. doi: 10.1007/s00167-004-0547-z. Epub 2005 Feb 1. — View Citation

Palmieri-Smith RM, Kreinbrink J, Ashton-Miller JA, Wojtys EM. Quadriceps inhibition induced by an experimental knee joint effusion affects knee joint mechanics during a single-legged drop landing. Am J Sports Med. 2007 Aug;35(8):1269-75. doi: 10.1177/0363546506296417. Epub 2007 Jan 23. — View Citation

Panariello RA, Stump TJ, Allen AA. Rehabilitation and Return to Play Following Anterior Cruciate Ligament Reconstruction. Operative Techniques in Sports Medicine. 2017;25(3):181-193.

Pietrosimone BG, Grindstaff TL, Linens SW, Uczekaj E, Hertel J. A systematic review of prophylactic braces in the prevention of knee ligament injuries in collegiate football players. J Athl Train. 2008 Jul-Aug;43(4):409-15. doi: 10.4085/1062-6050-43.4.409. — View Citation

Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD. Effects of transcutaneous electrical nerve stimulation and therapeutic exercise on quadriceps activation in people with tibiofemoral osteoarthritis. J Orthop Sports Phys Ther. 2011 Jan;41(1):4-12. doi: 10.2519/jospt.2011.3447. Epub 2010 Dec 31. — View Citation

Shimura K, Kasai T. Effects of proprioceptive neuromuscular facilitation on the initiation of voluntary movement and motor evoked potentials in upper limb muscles. Hum Mov Sci. 2002 Apr;21(1):101-13. doi: 10.1016/s0167-9457(01)00057-4. — View Citation

Suter E, Herzog W, Bray RC. Quadriceps inhibition following arthroscopy in patients with anterior knee pain. Clin Biomech (Bristol, Avon). 1998 Jun;13(4-5):314-319. doi: 10.1016/s0268-0033(98)00098-9. — View Citation

Torry MR, Decker MJ, Viola RW, O'Connor DD, Steadman JR. Intra-articular knee joint effusion induces quadriceps avoidance gait patterns. Clin Biomech (Bristol, Avon). 2000 Mar;15(3):147-59. doi: 10.1016/s0268-0033(99)00083-2. — View Citation

* Note: There are 19 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Noraxon Ultium EMG	Visually monitors and records electromagnetic signals from muscle activation using diodes placed on patient	Within first 28 days post-op (Arthroscopy patients); healthy patients tested at enrollment