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Efficacy of Repetitive Stepping as a Test of Quadriceps Fatigue: Comparison to Isokinetic Exercise. Scholes CJ PhD 1,2,3 McDonald MD PhD 2 Coolican MRJ FRACS 1 Parker DA FRACS 1 Parker AW PhD 3 1 Sydney Orthopaedic Research Institute
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Efficacy of Repetitive Stepping as a Test of Quadriceps Fatigue: Comparison to Isokinetic Exercise Scholes CJ PhD1,2,3 McDonald MD PhD2 Coolican MRJ FRACS1 Parker DA FRACS1 Parker AW PhD3 1 Sydney Orthopaedic Research Institute 2 School of Human Movement Studies, Queensland University of Technology 3Institute of Health & Biomedical Innovation, Queensland University of Technology Australian Orthopaedic Association 70th Annual Scientific Meeting Adelaide, 2010
Conflict of Interest There is no conflict of interest in this research project
Quadriceps Function • Strength and endurance critical to knee function • Implications of dysfunction following surgery • Quadriceps avoidance (Lewek et al 2002) • Joint loading (Shelbourne et al 2004) • Functional instability (Hurd et al 2007) • Endurance improves performance of functional activities
Introduction • Dynamometry – ‘gold standard’ • Limitations • Cost (~$100k) • Space • Dedicated specialist personnel • Need for a clinical alternative
Aim Validate a functional protocol to induce and quantify quadriceps fatigue compared to isokinetic dynamometry
Methods • Participants • Male undergraduates • 20.6+2.5yrs • 1.78+0.05m • 72.3+8.8kg • Repetitive Stepping • Additional Weight • Step Height • Start-end Postures • Speed
Methods • Dynamometry • 50 Repetitions • Concentric-Eccentric • Range-of-motion 900 • Speed 600/sec
Methods - Fatigue Indicators • Peak power • Inverse dynamics • Integrated torque/time
Methods - Fatigue Indicators • Surface Electromyography • Wireless (Zerowire, Italy) • VM, VL, RF • Standardised placement
Results - Protocol Comparison * ^ ^Significant difference between muscles * Significant difference between stepping and isokinetic
Discussion • Stepping induced greater fatigue compared to previous studies (Coventry et al 2006; Bonato et al 2001) • Isokinetic exercise also induced greater fatigue compared to previous studies (Molinari et al 2006) • Combined eccentric-concentric action • Differential isokinetic fatigue pattern agrees with previous studies (Molinari et al 2006)
Discussion • Lack of studies quantifying fatigue progression in quadriceps during functional task • Parallel fatigue could be related to joint stability and balance during stepping • Increased variability in power production • Load sharing between hip and knee
Conclusions • Stepping protocol valid method to induce quadriceps fatigue • not as effective as isokinetic exercise • Potential future model for clinic-based fatigue assessment
Future clinical tool • Adjustments to the protocol to reduce variability • Validity and reliability for surgically-repaired knees • Modify protocol for patient populations • Effects of rehabilitation • Clinical measurements – fatigue indicators • Steps to exhaustion • Stepping frequency