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The manual muscle test (MMT) is a flexible diagnostic tool, which is used in many disciplines, applied in several ways. The main problem is the subjectivity of the test. The MMT in the version of a “break test” depends on the tester’s force rise and the patient’s ability to resist the applied force. As a first step, the investigation of the reproducibility of the testers’ force profile is required for valid application. The study examined the force profiles of n = 29 testers (n = 9 experiences (Exp), n = 8 little experienced (LitExp), n = 12 beginners (Beg)). The testers performed 10 MMTs according to the test of hip flexors, but against a fixed leg to exclude the patient’s reaction. A handheld device recorded the temporal course of the applied force. The results show significant differences between Exp and Beg concerning the starting force (padj = 0.029), the ratio of starting to maximum force (padj = 0.005) and the normalized mean Euclidean distances between the 10 trials (padj = 0.015). The slope is significantly higher in Exp vs. LitExp (p = 0.006) and Beg (p = 0.005). The results also indicate that experienced testers show inter-tester differences and partly even a low intra-tester reproducibility. This highlights the necessity of an objective MMT-assessment. Furthermore, an agreement on a standardized force profile is required. A suggestion for this is given.
The manual muscle test (MMT) is a flexible diagnostic tool, which is used in many disciplines, applied in several ways. The main problem is the subjectivity of the test. The MMT in the version of a “break test” depends on the tester’s force rise and the patient’s ability to resist the applied force. As a first step, the investigation of the reproducibility of the testers’ force profile is required for valid application. The study examined the force profiles of n = 29 testers (n = 9 experiences (Exp), n = 8 little experienced (LitExp), n = 12 beginners (Beg)). The testers performed 10 MMTs according to the test of hip flexors, but against a fixed leg to exclude the patient’s reaction. A handheld device recorded the temporal course of the applied force. The results show significant differences between Exp and Beg concerning the starting force (padj = 0.029), the ratio of starting to maximum force (padj = 0.005) and the normalized mean Euclidean distances between the 10 trials (padj = 0.015). The slope is significantly higher in Exp vs. LitExp (p = 0.006) and Beg (p = 0.005). The results also indicate that experienced testers show inter-tester differences and partly even a low intra-tester reproducibility. This highlights the necessity of an objective MMT-assessment. Furthermore, an agreement on a standardized force profile is required. A suggestion for this is given.
Bisher ist die Ursache für die Entstehung der meisten Skoliosen noch ungeklärt und damit eine kausale Behandlung der Betroffenen unmöglich. Die vorliegende Arbeit geht davon aus, dass der Auslöser für die sogenannte idiopathische Skoliose eine funktionelle Störung von Muskeln ist, die sich in einer verminderten relativen Haltekraft äußert. Durch gezielte willkürliche Muskelanspannungen könnte es möglich sein, kompensatorisch auf die Deformität einzuwirken, um damit ein Fortschreiten zu verhindern bzw. sogar eine Regression hervorzurufen. Insbesondere Patientengruppen mit einem hohen Progressionsrisiko, wie Jugendliche im Wachstumsalter, könnten davon profitieren.
Ein Muskeltraining kann mit unterschiedlichsten Hilfsmitteln und Methoden erfolgen. Eine Möglichkeit bietet auch das Klettern. Im Kern wird daher ein Trainingskonzept zum Therapeutischen Klettern bei Jugendlichen mit Skoliose vorgestellt. Dabei beruft sich der Autor auf das Potsdamer Modell. Dieses Modell erlaubt es, gezielte Kraftübungen systematisiert an der Kletterwand in Absprunghöhe umzusetzen. Materielle Sicherungsmaßnahmen sind dadurch nicht erforderlich und eventuell notwendige Korrekturen bzw. Hilfestellungen können direkt erfolgen. Hauptinhalt eines Trainings nach dem vorgestellten Konzept sind spielerische Bewegungserfahrung innerhalb der Sportart Klettern und ein Systembouldertraining.
In einem beigefügten Übungskatalog werden für letzteres Möglichkeiten der praktischen Umsetzun-gen gegeben. Die Übungen fokussieren sich auf die Aktivierung und das Training wirbelkörperdero-tierender Muskeln. Im Hauptteil einer Trainingseinheit können sie dann in Kombination mit der Kor-rektur der Seitverbiegung und des sagittalen Profils (3D Autokorrektur) unter Aufsicht eines geschul-ten Therapeuten durchgeführt werden. Die Arbeit erhebt den Anspruch, einem Leser vom Fach, die Auswahl der Übungen und die darin enthaltene individuelle Anpassung an den Patienten aus funktionell-anatomischer Sicht zu begründen.
In naher Zukunft wird das Konzept in einer randomisiert kontrollierten Studie untersucht. Alle notwendigen Vorbereitungen wurden im Rahmen dieser Arbeit getroffen.
Isometric muscle function
(2022)
The cumulative dissertation consists of four original articles. These considered isometric muscle ac-tions in healthy humans from a basic physiological view (oxygen and blood supply) as well as possibilities of their distinction. It includes a novel approach to measure a specific form of isometric hold-ing function which has not been considered in motor science so far. This function is characterized by an adaptation to varying external forces with particular importance in daily activities and sports.
The first part of the research program analyzed how the biceps brachii muscle is supplied with oxygen and blood by adapting to a moderate constant load until task failure (publication 1). In this regard, regulative mechanisms were investigated in relation to the issue of presumably compressed capillaries due to high intramuscular pressures (publication 2).
Furthermore, it was examined if oxygenation and time to task failure (TTF) differs compared to an-other isometric muscle function (publication 3). This function is mainly of diagnostic interest by measuring the maximal voluntary isometric contraction (MVIC) as a gold standard. For that, a person pulls on or pushes against an insurmountable resistance. However, the underlying pulling or pushing form of isometric muscle action (PIMA) differs compared to the holding one (HIMA).
HIMAs have mainly been examined by using constant loads. In order to quantify the adaptability to varying external forces, a new approach was necessary and considered in the second part of the research program. A device was constructed based on a previously developed pneumatic measurement system. The device should have been able to measure the Adaptive Force (AF) of elbow ex-tensor muscles. The AF determines the adaptability to increasing external forces under isometric (AFiso) and eccentric (AFecc) conditions. At first, it was questioned if these parameters can be relia-bly assessed by use of the new device (publication 4). Subsequently, the main research question was investigated: Is the maximal AFiso a specific and independent variable of muscle function in comparison to the MVIC? Furthermore, both research parts contained a sub-question of how results can be influenced.
Parameters of local oxygen saturation (SvO2) and capillary blood filling (rHb) were non-invasively recorded by a spectrophotometer during maximal and submaximal HIMAs and PIMAs.
These were the main findings: Under load, SvO2 and rHb always adjusted into a steady state after an initial decrease. Nevertheless, their behavior could roughly be categorized into two types. In type I, both parameters behaved nearly parallel to each other. In contrast, their progression over time was partly inverse in type II. The inverse behavior probably depends on the level of deoxygenation since rHb increased reliably at a suggested threshold of about 59% SvO2. This triggered mechanism and the found homeostatic steady states seem to be in conflict with the concept of mechanically compressed capillaries and consequently with a restricted blood flow. Anatomical configuration of blood vessels might provide one hypothetical explanation of how blood flow might be maintained. HIMA and PIMA did not differ regarding oxygenation and allocation to the described types. The TTF tended to be longer during PIMA.
As a sub-question, oxygenation and TTF were compared between (HIMA) and intermittent voluntary muscle twitches during a weight holding task. TTF but not oxygenation differed significantly
(Twitch > HIMA). A changed neuromuscular control might serve as a speculative explanation of how the results can be explained. This is supported by the finding that the TTF did not correlate significantly with the extent of deoxygenation irrespective of the performed task (HIMA, PIMA or Twitch).
Other neuromuscular aspects of muscle function were considered in second part of the re-search program. The new device mentioned above detected different force capacities within four trials at two days each. Among AF measurements, the functional counterpart of a concentric muscle action merging into an isometric one was analyzed in comparison to the MVIC.
Based on the results, it can be assumed that a prior concentric muscle action does not influence the MVIC. However, the results were inconsistent and possibly influenced by systematic errors. In con-trast, maximal variables of the AF (AFisomax and AFeccmax) could be measured in a reliable way which is indicated by a high test-retest reliability. Despite substantial correlations between force variables, the AFisomax differed significantly from MVIC and AFmax, which was identical with AFeccmax in almost all cases. Moreover, AFisomax revealed the highest variability between trials.
These results indicate that maximal force capacities should be assessed separately. The adaptive holding capacity of a muscle can be lower compared to a commonly determined MVIC. This is of relevance since muscles frequently need to respond adequately to external forces. If their response does not correspond to the external impact, the muscle is forced to lengthen. In this scenario, joints are not completely stabilized and an injury may occur. This outlined issue should be addressed in future research in the field of sport and health sciences.
At last, the dissertation presents another possibility to quantify the AFisomax by use of a handheld device applied in combination with a manual muscle test. This assessment delivers a more practical way for clinical purposes.
The objective of the study is to develop a better understanding of the capillary circulation in contracting muscles. Ten subjects were measured during a submaximal fatiguing isometric muscle action by use of the O2C spectrophotometer. In all measurements the capillary-venous oxygen saturation of hemoglobin (SvO2) decreases immediately after the start of loading and levels off into a steady state. However, two different patterns (type I and type II) emerged. They differ in the extent of deoxygenation (–10.37 ±2.59 percent points (pp) vs. –33.86 ±17.35 pp, P = .008) and the behavior of the relative hemoglobin amount (rHb). Type I reveals a positive rank correlation of SvO2 and rHb (? = 0.735, P <.001), whereas a negative rank correlation (? = –0.522, P <.001) occurred in type II, since rHb decreases until a reversal point, then increases averagely 13% above the baseline value and levels off into a steady state. The results reveal that a homeostasis of oxygen delivery and consumption during isometric muscle actions is possible. A rough distinction in two types of regulation is suggested.
The regulation of oxygen and blood supply during isometric muscle actions is still unclear. Recently, two behavioral types of oxygen saturation (SvO2) and relative hemoglobin amount (rHb) in venous microvessels were described during a fatiguing holding isometric muscle action (HIMA) (type I: nearly parallel behavior of SvO2 and rHb; type II: partly inverse behavior). The study aimed to ascertain an explanation of these two regulative behaviors. Twelve subjects performed one fatiguing HIMA trial with each arm by weight holding at 60% of the maximal voluntary isometric contraction (MVIC) in a 90° elbow flexion. Six subjects additionally executed one fatiguing PIMA trial by pulling on an immovable resistance with 60% of the MVIC with each side and same position. Both regulative types mentioned were found during HIMA (I: n = 7, II: n = 17) and PIMA (I: n = 3, II: n = 9). During the fatiguing measurements, rHb decreased initially and started to increase in type II at an average SvO2-level of 58.75 ± 2.14%. In type I, SvO2 never reached that specific value during loading. This might indicate the existence of a threshold around 59% which seems to trigger the increase in rHb and could explain the two behavioral types. An approach is discussed to meet the apparent incompatibility of an increased capillary blood filling (rHb) despite high intramuscular pressures which were found by other research groups during isometric muscle actions.
Adaptive Force (AF) reflects the capability of the neuromuscular system to adapt adequately to external forces with the intention of maintaining a position or motion. One specific approach to assessing AF is to measure force and limb position during a pneumatically applied increasing external force. Through this method, the highest (AFmax), the maximal isometric (AFisomax) and the maximal eccentric Adaptive Force (AFeccmax) can be determined. The main question of the study was whether the AFisomax is a specific and independent parameter of muscle function compared to other maximal forces. In 13 healthy subjects (9 male and 4 female), the maximal voluntary isometric contraction (pre- and post-MVIC), the three AF parameters and the MVIC with a prior concentric contraction (MVICpri-con) of the elbow extensors were measured 4 times on two days. Arithmetic mean (M) and maximal (Max) torques of all force types were analyzed. Regarding the reliability of the AF parameters between days, the mean changes were 0.31–1.98 Nm (0.61%–5.47%, p = 0.175–0.552), the standard errors of measurements (SEM) were 1.29–5.68 Nm (2.53%–15.70%) and the ICCs(3,1) = 0.896–0.996. M and Max of AFisomax, AFmax and pre-MVIC correlated highly (r = 0.85–0.98). The M and Max of AFisomax were significantly lower (6.12–14.93 Nm; p ≤ 0.001–0.009) and more variable between trials (coefficient of variation (CVs) ≥ 21.95%) compared to those of pre-MVIC and AFmax (CVs ≤ 5.4%). The results suggest the novel measuring procedure is suitable to reliably quantify the AF, whereby the presented measurement errors should be taken into consideration. The AFisomax seems to reflect its own strength capacity and should be detected separately. It is suggested its normalization to the MVIC or AFmax could serve as an indicator of a neuromuscular function.
Background
Isometric muscle actions can be performed either by initiating the action, e.g., pulling on an immovable resistance (PIMA), or by reacting to an external load, e.g., holding a weight (HIMA). In the present study, it was mainly examined if these modalities could be differentiated by oxygenation variables as well as by time to task failure (TTF). Furthermore, it was analyzed if variables are changed by intermittent voluntary muscle twitches during weight holding (Twitch). It was assumed that twitches during a weight holding task change the character of the isometric muscle action from reacting (≙ HIMA) to acting (≙ PIMA).
Methods
Twelve subjects (two drop outs) randomly performed two tasks (HIMA vs. PIMA or HIMA vs. Twitch, n = 5 each) with the elbow flexors at 60% of maximal torque maintained until muscle failure with each arm. Local capillary venous oxygen saturation (SvO2) and relative hemoglobin amount (rHb) were measured by light spectrometry.
Results
Within subjects, no significant differences were found between tasks regarding the behavior of SvO2 and rHb, the slope and extent of deoxygenation (max. SvO2 decrease), SvO2 level at global rHb minimum, and time to SvO2 steady states. The TTF was significantly longer during Twitch and PIMA (incl. Twitch) compared to HIMA (p = 0.043 and 0.047, respectively). There was no substantial correlation between TTF and maximal deoxygenation independently of the task (r = − 0.13).
Conclusions
HIMA and PIMA seem to have a similar microvascular oxygen and blood supply. The supply might be sufficient, which is expressed by homeostatic steady states of SvO2 in all trials and increases in rHb in most of the trials. Intermittent voluntary muscle twitches might not serve as a further support but extend the TTF. A changed neuromuscular control is discussed as possible explanation.
The objective of the study is to develop a better understanding of the capillary circulation in contracting muscles. Ten subjects were measured during a submaximal fatiguing isometric muscle action by use of the O2C spectrophotometer. In all measurements the capillary-venous oxygen saturation of hemoglobin (SvO2) decreases immediately after the start of loading and levels off into a steady state. However, two different patterns (type I and type II) emerged. They differ in the extent of deoxygenation (–10.37 ±2.59 percent points (pp) vs. –33.86 ±17.35 pp, P = .008) and the behavior of the relative hemoglobin amount (rHb). Type I reveals a positive rank correlation of SvO2 and rHb (? = 0.735, P <.001), whereas a negative rank correlation (? = –0.522, P <.001) occurred in type II, since rHb decreases until a reversal point, then increases averagely 13% above the baseline value and levels off into a steady state. The results reveal that a homeostasis of oxygen delivery and consumption during isometric muscle actions is possible. A rough distinction in two types of regulation is suggested.
The regulation of oxygen and blood supply during isometric muscle actions is still unclear. Recently, two behavioral types of oxygen saturation (SvO(2)) and relative hemoglobin amount (rHb) in venous microvessels were described during a fatiguing holding isometric muscle action (HIMA) (type I: nearly parallel behavior of SvO(2) and rHb; type II: partly inverse behavior). The study aimed to ascertain an explanation of these two regulative behaviors. Twelve subjects performed one fatiguing HIMA trial with each arm by weight holding at 60% of the maximal voluntary isometric contraction (MVIC) in a 90 & DEG; elbow flexion. Six subjects additionally executed one fatiguing PIMA trial by pulling on an immovable resistance with 60% of the MVIC with each side and same position. Both regulative types mentioned were found during HIMA (I: n = 7, II: n = 17) and PIMA (I: n = 3, II: n = 9). During the fatiguing measurements, rHb decreased initially and started to increase in type II at an average SvO(2)-level of 58.75 & PLUSMN; 2.14%. In type I, SvO(2) never reached that specific value during loading. This might indicate the existence of a threshold around 59% which seems to trigger the increase in rHb and could explain the two behavioral types. An approach is discussed to meet the apparent incompatibility of an increased capillary blood filling (rHb) despite high intramuscular pressures which were found by other research groups during isometric muscle actions.