Burks, R., Daniel, D., & Losse, G. (1984).
This study was undertaken to examine the immediate effect of continuous passive motion (CPM) on anterior cruciate ligament (ACL) reconstruction stability. Ca daver knees were tested with a knee arthrometer with the anterior cruciate intact and then with the anterior cruciate sectioned. One of three anterior cruciate re constructions was then performed and stability was restored to the knee and it was again tested with the knee arthrometer. Stability was defined as being within 2 mm of the intact measurement. The three operations selected were the Marshall-Maclntosh "over-the-top," (OTT) a patellar bone-patellar tendon-tubercle bone (BTB) graft, and a semitendinosis reconstruction. The specimens were placed on a CPM device in a cooler at 38 degree F and put through a range of motion of 20 to 70 degree at 10 cycles per minute for 3 days. A success was less than a 2 mm increase in the post-CPM measurement compared to pre-CPM. All three bone-tendon-bone op erations failed. The semitendinosis operation was suc cessful in only three out of eight specimens. The OTT operation was successful in eight out of nine speci mens. The possible reasons for success and failure are discussed.Because of the potential problems with failure of an ACL with CPM it is suggested that the particular tech nique being used for an anterior cruciate reconstruction be tested prior to it being used with CPM clinically.
Βρείτε το άρθρο:
The effect of continuous passive motion on anterior cruciate ligament reconstruction stability. American Journal of Sports Medicine, 12(4), 323-327. doi: http://dx.doi.org/10.1177/036354658401200414
Kirschner, P. P.
There is still a controversial discussion in literature about the use of motor driven splints in knee surgery--as the principle of continuous passive motion, CPM. For this reason it seemed useful for an evaluation to look through the papers which were published since 1990. It was obvious, that negative results were published often before this year, but this papers are still quoted standard works. In medical data bases subito-doc.de, medscape.com, medica.de and zbmed.de 230 papers were found by search CPM, continuous passive motion and arthromot. Coincidentally there was a search for authors who were already quoted in other papers. 36 papers concerning CPM after knee surgery were utilized. The role of CPM regarding the range of motion, swelling, duration of hospital stay, use of analgesics, costs, postoperative manipulations, wound healing and thrombo embolic complications was evaluated. Although the results of this partial retrospective, partial prospective, sometimes randomized or double blinded studies are in contradiction, there can only be found a trend to better results. New clinical studies for evidence based guidelines in the handling of continuous passive motion after knee surgery are necessary.
Βρείτε το πλήρες άρθρο:
Kirschner, P. P. (2004). [CPM--continuous passive motion: Treatment of injured or operated knee-joints using passive movement. A meta-analysis of current literature]. Der Unfallchirurg, 107(4), 328-340.
Retrieved from http://search.proquest.com/docview/71867567?accountid=36196;
Lenssen Ton AF, van Steyn, Mike JA, Crijns, Yvonne HF, Waltje Eddie MH, Roox, George M et al.
BMC Musculoskeletal Disorders
9 (2008): 60-60.
Background Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. Although research suggests that Continuous Passive Motion (CPM) should be implemented in the first rehabilitation phase after surgery, there is substantial debate about the duration of each session and the total period of CPM application. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered. Methods In a randomised controlled trial we investigated the effectiveness of prolonged CPM use in the home situation as an adjunct to standardised PT. Efficacy was assessed in terms of faster improvements in range of motion (RoM) and functional recovery, measured at the end of the active treatment period, 17 days after surgery. Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were randomised over two treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e. about four days), followed by PT alone (usual care) in the first two weeks after hospital discharge. From 18 days to three months after surgery, both groups received standardised PT. The primary focus of rehabilitation was functional recovery (e.g. ambulation) and regaining RoM in the knee. Results Prolonged use of CPM slightly improved short-term RoM in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-standard PT programme. Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessments. Conclusion Although results indicate that prolonged CPM use might have a small short-term effect on RoM, routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered, since neither long-term effects nor transfer to better functional performance was detected.
Βρείτε το πλήρες άρθρο:
"Lenssen, T. A. F., van Steyn, M.,J.A., Crijns, Y. H. F., Waltje, E. M. H., Roox, G. M., Geesink, R. J. T., . . . De Bie, R.,A. (2008). Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty. BMC Musculoskeletal Disorders, 9, 60-60. doi: http://dx.doi.org/10.1186/1471-2474-9-60 "
KONSTANTINOS GIANNAKOPOULOS, ANASTASIA BENEKA, AND PARASKEVI MALLIOU
Department of Physical Education and Sports Science, Democritus University of Thrace, 69100 Komotini, Greece.
ABSTRACT. Giannakopoulos, K., A. Beneka, and P. Malliou. Isolated versus complex exercise in strengthening the rotator cuff muscle group. J. Strength Cond. Res. 18(2):144–148. 2004.—The purpose of this study was to compare 2 different training modes in improving shoulder cuff muscular performance.
Thirty-nine participants were randomly assigned into 3 groups: the isolated group exercised using 2-kg dumbbells; the complex group used a protocol with complex exercises; and the control group had no training. All participants trained for 6 weeks (3 times per week) and were evaluated isokinetically before (pretest) and after the training period (posttest).
Results showed that the complex group significantly improved their muscular performance, but the isolated group did not, indicating that isolated exercises are only effective when the training goal is to strengthen the weaker muscle group, but they must be replaced by more complex and closed-kinetic exercises in order to obtain considerable improvement of the rotator cuff strength.
The authors propose that a strengthening program should start with isolated movements for better stimulation of the weaker muscles and continue with complex exercise for more impressive strengthening.
KEY WORD: internal/external rotators, peak torque values.
P C Malliou, K Giannakopoulos, A G Beneka, A Gioftsidou, G Godolias
Br J Sports Med 2004;38:766–772. doi: 10.1136/bjsm.2003.009548
Background: Many studies have compared different training methods for improving muscular performance, but more investigations need to be directed to the restoration of muscular imbalances.
Objective: To determine the most effective training for altering strength ratios in the shoulder rotator cuff.
Methods: Forty eight physical education students were randomly assigned to four groups (12 per group):
Testing was performed in the supine position with the glenohumeral joint in 90˚ of abduction in the coronal lane, with a range of motion of 0–90˚ of external rotation and 0–65˚ of internal rotation at angular velocities of 60, 120, and 180˚/s. The test procedure was performed before and after the exercise period of six weeks.
Results: One way analysis of variance found no differences between the groups for the initial tests.
Analysis of variance with repeated measures showed that the strength ratios in all the experimental groups had altered after the exercise period, with the isokinetic group showing the most significant improvement.
Conclusions: Isokinetic strengthening is the most effective method of altering strength ratios of the rotator cuff muscle.
Br J Sports Med 2004; 38: 766-772
Θέμα: Ο λειτουργικός ρόλος των στροφαίων του ώμου απαιτεί αντικειμενική αξιολόγηση για την ανίχνευση πιθανών μυϊκών δυσαναλογιών και ασταθειών. Για το λόγο αυτό η παρούσα εργασία επιχειρεί μία συγκριτικη μελέτη διαφορετικών μεθόδων εξάσκησης με στόχο τον καθορισμό των πιο αποδοτικών από αυτές για την μεταβολή της αναλογίας δύναμης στους στροφείς τους ώμου. Τα αποτελέσματα της έρευνας δείχνουν ότι η ισοκινητική είναι η πιο αποτελεσματική μέθοδος για την επίτευξη της μυίκής ενδυνάμωσης.
Journal of Strength and Conditioning Research, 2004, 18(1), 114-148
Θέμα: Η συγκεκριμένη εργασία παρουσιάζει και συγκρίνει δύο διαφορετικούς τρόπους εξάσκησης του μυϊκού συμπλέγματος των στροφαίων του ώμου κατά τη διάρκεια ενός πειραματικού προγράμματος. Μία σειρά τόσο από απόλυτα επικεντρωμένες όσο και από πολυμερείς ασκήσεις εφαρμόσθηκαν σε μία ομάδα συμμετεχόντων κατά τη διάρκεια 6 εβδομάδων. Τα αποτελέσματα της μελέτης δείχνουν οτι ένα πρόγραμμα ενδυνάμωσης των μυών πρέπει να ξεκινά με επικεντρωμένες ασκήσεις για ενίσχυση των πιο αδύναμων μυών και να συνεχίζει με πολυμερείς ασκήσεις για καθολική ενδυνάμωση.
Kenneth McLeod, Sara Morley, Andrew Matsushima
J. Biomedical Science and Engineering, 2012, 5, 194-201 JBiSE
doi:10.4236/jbise.2012.54025 Published Online April 2012 (http://www.SciRP.org/journal/jbise/)
Muscle imbalances are a well accepted cause of mus-culo-skeletal pain, yet clinicians lack a simple, non- invasive, and reproducible means to assess muscle effort during activities of daily living. To address this issue, we have been developing vibromyography (VMG) as a means to quantitatively assess muscle mechanical effort such that accurate muscle effort ratios can be determined in the clinic. In this study, VMG was used to characterize muscle imbalances in older adults with low-level knee pain while they per-formed step-up and step-down activities. In addition to determining whether VMG can identify the im-balances previously reported in individuals with knee pain, we address the question of whether these knee muscle imbalances were a likely cause of knee pain, or whether the imbalances represented a coping re-sponse for pre-existing knee pain. A population (N = 30) of 35 - 85 year old men and women with a total of 42 painful knees were assessed. Robust multiple step- wise regression analysis identified weak hip abductor muscle effort relative to hamstring muscle effort as the best predictor of knee pain (p = 0.00006), with weak vastus lateralis effort in eccentric contraction, relative to concentric contraction, being the second best predictor (p = 0.0003). Muscle imbalances were able to account for 40% of the variation in reported pain, and the observed pattern of increasing knee pain with increasing quadriceps strength during con-centric contraction leads us to infer that the observed muscle imbalances are not the result of a protective action by the individual, but rather are a principle cause of the knee pain.
Keywords: Vibromyography; Knee Pain; Muscle Balance; Osteoarthritis
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Mark J McElroy, Aaron J Johnson, Michael G Zywiel and Michael A Mont
Expert Rev. Med. Devices 8(1), 57–65 (2011)
Persistent pain and dysfunction following total knee arthroplasty require treatment beyond standard rehabilitation. This article discusses devices used to prevent and treat decreased range of motion. If deficits remain after initial standard therapy, multiple devices exist that can be used for nonoperative treatment. Load-control devices apply a constant force, producing variable soft-tissue displacement as tissues stretch. Static progressive stretch devices use the principle of stress relaxation by applying progressively increasing constant displacements. Both types of devices are reported to be effective in treating persistent knee stiffness. The authors feel that future developments will occur in improving treatment protocols for these devices.
..."Using CPM led to shorter hospital stays by a difference of approximately 1 day (95% CI: 0.03–1.35 days, based on 382 patients), improved active knee flexion at 2-week follow-up by a mean of 4.3° (95% CI: 2.0–6.6°, based on 286 patients) and lowered the incidence of postoperative manipulation by a relative risk of 0.12 (95% CI: 0.03–0.53, based on three trials). "...
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Canadian Journal of Clinical Medicine
Θέμα: Το σύστημα VAX-D είναι ένα μηχάνημα αποσυμπίεσης προγενέστερο του DRS. Η συγκεκριμένη εργασία αποτελεί μία μελέτη της αποδοτικότητας του VAX-D. Συγκεκριμένα, επιλέχθηκαν άτομα με πόνο χαμηλά στην πλάτη, στα οποία είχε γίνει σύσταση για νευροχειρουργική αντιμετώπιση του προβλήματος. Τα αποτελέσματα της έρευνας αποδεικνύουν ότι το VAX-D όχι μόνο απαλύνει τον πόνο, αλλά ασκεί ευεργετική επίδραση στον βασικό παράγοντα που είναι υπέυθυνος για τις δισκογενείς παθήσεις.
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