Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction

Joseph M. Hart, Christopher M. Kuenze, David R. Diduch, Christopher D. Ingersoll

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Context: Persistent muscle weakness after anterior cruciate ligament (ACL) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition (AMI). Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI, thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL. Objective: To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy (ice bag), daily exercises, or both. Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI. Intervention(s): The patients attended 4 supervised visits over a 2-week period. They were randomly assigned to receive 20 minutes of knee-joint cryotherapy, 1 hour of therapeutic rehabilitation exercises, or cryotherapy followed by exercises. Main Outcome Measure(s): We measured quadriceps Hoffmann reflex, normalized maximal voluntary isometric contraction torque, central activation ratio using the superim-posed-burst technique, and patient-reported outcomes before and after the intervention period. Results: After the 2-week intervention period, patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques (P = .002, Cohen d effect size = 1.4) compared with those who received cryotherapy alone (P = .16, d = 0.58) or performed exercise alone (P = .16, d = 0.30). Conclusions: After ACL reconstruction, patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone.

Original languageEnglish (US)
Pages (from-to)733-739
Number of pages7
JournalJournal of Athletic Training
Volume49
Issue number6
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

Anterior Cruciate Ligament Reconstruction
Cryotherapy
Quadriceps Muscle
Rehabilitation
Exercise Therapy
Exercise
Isometric Contraction
Anterior Cruciate Ligament
Torque
Knee Joint
Muscles
Muscle Weakness
Ice
Muscle Strength
Reflex
Cross-Sectional Studies
Outcome Assessment (Health Care)
Inhibition (Psychology)

Keywords

  • Arthrogenic muscle inhibition
  • Disinhibition
  • Knee
  • Therapeutic exercises

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction. / Hart, Joseph M.; Kuenze, Christopher M.; Diduch, David R.; Ingersoll, Christopher D.

In: Journal of Athletic Training, Vol. 49, No. 6, 01.11.2014, p. 733-739.

Research output: Contribution to journalArticle

Hart, Joseph M. ; Kuenze, Christopher M. ; Diduch, David R. ; Ingersoll, Christopher D. / Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction. In: Journal of Athletic Training. 2014 ; Vol. 49, No. 6. pp. 733-739.
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abstract = "Context: Persistent muscle weakness after anterior cruciate ligament (ACL) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition (AMI). Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI, thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL. Objective: To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy (ice bag), daily exercises, or both. Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI. Intervention(s): The patients attended 4 supervised visits over a 2-week period. They were randomly assigned to receive 20 minutes of knee-joint cryotherapy, 1 hour of therapeutic rehabilitation exercises, or cryotherapy followed by exercises. Main Outcome Measure(s): We measured quadriceps Hoffmann reflex, normalized maximal voluntary isometric contraction torque, central activation ratio using the superim-posed-burst technique, and patient-reported outcomes before and after the intervention period. Results: After the 2-week intervention period, patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques (P = .002, Cohen d effect size = 1.4) compared with those who received cryotherapy alone (P = .16, d = 0.58) or performed exercise alone (P = .16, d = 0.30). Conclusions: After ACL reconstruction, patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone.",
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