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

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

Research output: Contribution to journalArticle

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 1 2017

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Anterior Cruciate Ligament Reconstruction
Cryotherapy
Extremities
Confidence Intervals
Isometric Contraction
Torque
Knee
Body Mass Index
Exercise Therapy
Volunteers
Healthy Volunteers

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

Cite this

Unilateral quadriceps strengthening with disinhibitory cryotherapy and quadriceps symmetry after anterior cruciate ligament reconstruction. / Kuenze, Christopher M.; Kelly, Adam R.; Jun, Hyung Pil; Eltoukhy, Moataz Mohamed.

In: Journal of Athletic Training, Vol. 52, No. 11, 01.11.2017, p. 1010-1018.

Research output: Contribution to journalArticle

@article{cce432fbf47b4764b85c829b963f0f24,
title = "Unilateral quadriceps strengthening with disinhibitory cryotherapy and quadriceps symmetry after anterior cruciate ligament reconstruction",
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.",
keywords = "Cross-education, Disinhibitory modalities, Limb symmetry index, Quadriceps central activation ratio, Quadriceps strength",
author = "Kuenze, {Christopher M.} and Kelly, {Adam R.} and Jun, {Hyung Pil} and Eltoukhy, {Moataz Mohamed}",
year = "2017",
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doi = "10.4085/1062-6050-52.10.13",
language = "English (US)",
volume = "52",
pages = "1010--1018",
journal = "Journal of Athletic Training",
issn = "1062-6050",
publisher = "National Athletic Trainers' Association Inc.",
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TY - JOUR

T1 - Unilateral quadriceps strengthening with disinhibitory cryotherapy and quadriceps symmetry after anterior cruciate ligament reconstruction

AU - Kuenze, Christopher M.

AU - Kelly, Adam R.

AU - Jun, Hyung Pil

AU - Eltoukhy, Moataz Mohamed

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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.

AB - 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.

KW - Cross-education

KW - Disinhibitory modalities

KW - Limb symmetry index

KW - Quadriceps central activation ratio

KW - Quadriceps strength

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