Unilateral quadriceps strengthening with disinhibitory cryotherapy and quadriceps symmetry after anterior cruciate ligament reconstruction

Christopher M. Kuenze, Adam R. Kelly, Hyung Pil Jun, Moataz Eltoukhy

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Context: The effect of unilateral cryotherapy-facilitated rehabilitation exercise on involved-limb quadriceps function and limb symmetry in individuals with quadriceps dysfunction after anterior cruciate ligament reconstruction (ACLR) remains unclear. Objective: To measure the effect of a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening program on knee-extension strength and quadriceps central activation ratio (CAR) in participants with ACLR. Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 10 volunteers with unilateral ACLR (1 man, 9 women; age ¼ 21.0 6 2.8 years, height ¼ 164.6 6 5.0 cm, mass ¼ 64.0 6 6.1 kg, body mass index ¼ 23.7 6 2.7 kg/m2) and 10 healthy volunteers serving as control participants (1 man, 9 women; age ¼ 20.8 6 2.5 years, height ¼ 169.1 6 6.2 cm, mass ¼ 61.1 6 6.4 kg, body mass index ¼ 21.4 6 2.3 kg/m2) participated. Intervention(s): Participants with ACLR completed a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening intervention. Main Outcome Measure(s): Bilateral normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg) and quadriceps CAR (%) were assessed preintervention and postintervention. Limb symmetry index (LSI) was calculated at preintervention and postintervention testing. Preintervention between-groups differences in unilateral quadriceps function and LSI were evaluated using independent-samples t tests. Preintervention-to-postintervention differences in quadriceps function were evaluated using paired-samples t tests. Cohen d effect sizes (95% confidence interval [CI]) were calculated for each comparison. Results: Preintervention between-groups comparisons revealed less knee-extension MVIC torque and quadriceps CAR for the ACLR limb (MVIC: P ¼ .01, Cohen d ¼ 1.31 [95% CI ¼ 2.28, 0.34]; CAR: P ¼ .004, Cohen d ¼1.48 [95% CI ¼2.47, 0.49]) and uninvolved limb (MVIC: P ¼ .03, Cohen d ¼ 1.05 [95% CI ¼1.99, 0.11]; CAR: P ¼ .01, Cohen d ¼1.27 [95% CI ¼ 2.23, 0.31]) but not for the LSI (MVIC: P ¼ .46, Cohen d ¼ 0.34 [95% CI ¼ 1.22, 0.54]; CAR: P ¼ .60, Cohen d ¼ 0.24 [95% CI ¼ 0.64, 1.12]). In the ACLR group, participants had improved knee-extension MVIC torque in the involved limb (P ¼ .04, Cohen d ¼ 0.32 [95% CI ¼0.56, 1.20]) and uninvolved limb (P ¼ .03, Cohen d ¼ 0.29 [95% CI ¼ 0.59, 1.17]); however, the improvement in quadriceps CAR was limited to the involved limb (P ¼ .02, Cohen d ¼ 1.16 [95% CI ¼ 0.21, 2.11]). We observed no change in the LSI with the intervention for knee-extension MVIC torque (P ¼ .74, Cohen d ¼ 0.09 [95% CI ¼ 0.79, 0.97]) or quadriceps CAR (P ¼ .61, Cohen d ¼ 0.26 [95% CI ¼ 0.62, 1.14]). Conclusions: Two weeks of cryotherapy-facilitated exercise may improve involved-limb quadriceps function while preserving between-limbs symmetry in patients with a history of ACLR.

Original languageEnglish (US)
Pages (from-to)1010-1018
Number of pages9
JournalJournal of athletic training
Volume52
Issue number11
DOIs
StatePublished - Nov 2017

Keywords

  • Cross-education
  • Disinhibitory modalities
  • Limb symmetry index
  • Quadriceps central activation ratio
  • Quadriceps strength

ASJC Scopus subject areas

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

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