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THE INFLUENCE OF BODY POSITION ON LOAD RANGE DURING ISOKINETIC
KNEE EXTENSION/FLEXION
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1Palm Beach Community College, Boca Raton, FL, USA
2California State University, Fullerton, Fullerton, CA, USA
3Florida Atlantic University, Davie, FL, USA
4Manhattan College, Bronx, NY, USA
| Received |
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06 March 2006 |
| Accepted |
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09
July 2006 |
| Published |
|
01
September 2006 |
©
Journal of Sports Science and Medicine (2006) 5, 400 - 406
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| ABSTRACT |
| Isokinetic range of motion (ROM) has three distinct phases: rate
of velocity development (RVD), load range (LR), and deceleration (DCC).
The purpose of this study was to determine if differences in isokinetic
knee extension/flexion LR exist between body positions. Ten subjects
(4 males and 6 females, age 29.3 ± 5.4 yrs, ht 1.71 ± 0.10 m, wt 71.9
± 12.9 kg) volunteered to participate in the seated vs. prone investigation
and nine different subjects (4 males and 5 females, age 29.5 ± 6.9
yrs, ht 1.72 ± 0.09 m, wt 69.0 ± 13.8 kg) volunteered to participate
in the seated vs. supine study. Each subject completed 3 maximal reciprocal
concentric/concentric repetitions of dominant knee extension/flexion
on a Biodex System 2 isokinetic dynamometer at 60, 120, 180, 240 and
360 deg·sec-1 in the supine or prone and seated positions. Repeated
measures ANOVA revealed that only seated flexion at 360 deg·sec-1
(57.6 ± 1.7 degrees) elicited significantly (p < 0.05) greater
LR than prone (49.2 ± 2.8 degrees). No significant differences in
LR extension or flexion existed at any velocity between the supine
vs. seated positions. ANOVA also demonstrated differences between
seated vs. prone torque, work and power at most velocities while there
was no difference between seated vs. supine. LR is the only phase
of an isokinetic repetition where quantifiable resistance is maintained
and this data appears to support that it may not be position-dependent
but position may alter traditional performance variables.
KEY
WORDS: Rate of velocity development, acceleration, deceleration.
|
| INTRODUCTION |
Isokinetic knee extension/flexion performance has customarily
been measured in either the seated, prone or supine position. Previous
research has shown that the dissimilar length-tension relationships
and neurophysiological mechanisms, such as propagation of the stretch
shortening cycle, inherent in these positions may produce disparate
levels of peak torque, work, and power through a velocity spectrum
(Kramer et al., 1996;
Worrell et al., 1990;
Worrell et al., 1989).
Isokinetic evaluation of positional changes in testing the trunk musculature
has also been shown to elicit significantly dissimilar levels of torque
production (Findley et al., 2000).
Given that the clinician has a variety of setup choices when exercising
the knee extensors, they may manipulate body position according to
torque goals. Since all three positions measure performance in an
open kinetic chain, the seated position is often preferable, as it
may provide an increase in back support and lumbar stabilization in
a manner consistent with subject comfort (Worrell et al., 1989;
Brown and Whitehurst, 2000).
However, some clinicians maintain the change in anatomical range of
motion (ROM) coupled with the length tension properties of the quadriceps
inherent in the prone and/or supine positions, may better simulate
sport and task-specific movement (Worrell et al., 1989;
Brown and Whitehurst, 2000).
Isokinetic exercise is distinguished by three phases: free limb rate
of velocity development (RVD) prior to attainment of the pre-selected
velocity, load range (LR) where the pre- selected velocity is maintained,
and machine-controlled deceleration (DCC) (Brown and Whitehurst, 2000;
Brown et al., 1995a;
1995b;
1998;
Osternig, 1986;
Rathfon et al., 1991)
(Figure 1). During the initial
acceleration phase and subsequent deceleration phase no quantifiable
machine offered resistance to movement is present. Earlier research
(Brown and Whitehurst, 2000;
Brown et al., 1995b;
Kovaleski et al., 1995)
has shown that torque patterns are significantly affected when the
load range phase of motion is taken into consideration. In short,
this means that actual torque may differ by a large magnitude if evaluated
outside the load range. Since only during the LR phase is the benefit
of qualified resistance overload available (Brown et al., 1995b)
and valid interpretation of the human torque output, it would be most
desirable to establish if differences in LR are evidenced by manipulating
subject position. Due to the change in length tension properties and
subsequent contractile capabilities with varying exercise position,
perhaps similar changes in limb acceleration can be expected as well.
To date, it is unknown whether LR is position-dependent during knee
extension/flexion exercise.
Given that hip position has demonstrated incongruent torque patterns
during knee extension/flexion, with the seated position (relative
hip flexion) yielding greater torque production than the supine or
prone positions (relative hip extension) (Kramer et al., 1996;
Findley et al., 2000;
Rathfon et al., 1991),
we hypothesized that these positions may elicit differences in LR
as well. Thus, the purpose of this investigation was to determine
whether differences in knee extension/flexion LR exist between body
positions during isokinetic exercise across a velocity spectrum. |
| METHODS |
|
Ten subjects
(4 males and 6 females, age 29.3 ± 5.4 yrs, ht 1.71 ± 0.10 m, wt
71.9 ± 12.9 kg) volunteered to participate in the seated vs. prone
investigation and nine different subjects (4 males and 5 females,
age 29.5 ± 6. 9 yrs, ht 1.72 ± 0.09 m, wt 69.0 ± 13.8 kg) volunteered
to participate in the seated vs. supine study. All subjects provided
written informed consent and completed a medical history form that
was evaluated by a clinical exercise physiologist for conditions
that would preclude participation. The
project
was approved by the hospital IRB committee prior to commencement.
Seated
vs. prone testing
A calibrated Biodex System 2 isokinetic dynamometer, which has been
shown to be a valid and reliable device (Brown et al., 1993;
Taylor et al., 1991)
was assembled with the knee attachment according to the manufacturer's
specifications (Biodex Corporation, 1991).
To evaluate seated knee extension/flexion, subjects were seated
with the back attachment at 110 degrees relative to the seat and
the posterior lower-leg touching the end of the seat. While subjects
were in this position, the dynamometer fulcrum was aligned with
the lateral condyle of the dominant knee. To evaluate prone knee
extension/flexion subjects were positioned with the dynamometer
table in the flat position and the knee distal to the edge of the
pad. Following equipment set-up, subjects performed a 5-minute warm-up
on a cycle ergometer at 60-80 rpm at 1 kp to prepare the cardio-respiratory
system for strenuous activity and to facilitate optimal performance
(Mawdsley and Croft, 1982;
Osternig, 1986).
Subjects re-entered the Biodex and stabilization straps were affixed
to assure accurate, reproducible testing. Subjects were passively
moved by the dynamometer through a ROM of 90 degrees of flexion
to 0 degrees of extension. Gravity compensation analysis was performed
by the computer system software. Subjects were asked to perform
3 gradient sub-maximal and 2 maximal reciprocal concentric repetitions
of knee extension/flexion at an angular velocity of 60 deg·sec-1
for familiarization, to eliminate learning effect and to prevent
discomfort in following sessions (Mawdsley and Croft, 1982).
Following a 30 second recovery period, subjects were instructed
to perform five maximal reciprocal repetitions at the same angular
velocity. The three middle repetitions were collected by system
software and analyzed (Brown et al., 2005a;
Brown et al., 2005b).
Consistent, moderate (no yelling or screaming) verbal encouragement
was given; however, the computer screen was not made accessible
for visual feedback. Following a one-minute rest period, subjects
were tested at 120, 180, 240 and 360 deg·sec-1. Testing
position order was randomly selected (Timm and Fyke, 1993)
with a 3-7 day period between sitting and prone tests.
Seated
vs. supine testing
Methods for data collection of the supine portion of the investigation
were identical to those described above with the exception of subject
position. To evaluate supine knee extension/flexion performance,
subjects were positioned on the dynamometer table in the flat position
with the dominant knee distal to the edge of the pad and aligned
with the dynamometer's axis of rotation.
Windowed data were collected by Biodex System 2 software (Biodex
Corporation, 1991).
Since isokinetic ROM is distinguished by three phases (Figure 1): free limb RVD, LR and DCC, LR was determined by
subtracting RVD ROM and DCC ROM from total ROM using the available
cursors on-screen (Brown et al., 2005a;
Brown et al., 2005b;
Brown and Whitehurst, 2003;
Kovaleski et al., 1995;
Wilk et al., 1992).
Peak torque, total work and average power were also collected from
the three middle repetitions. Eight three way mixed factor repeated
measures 2 x 2 x 5 ANOVA (position X sex X angular velocity) were
used to analyze the mean values of each muscle group (quadriceps
and hamstrings ) by each dependent variable (load range, peak torque,
total work and average power). A-priori alpha was set at 0.05.
|
| RESULTS |
|
Subject
testing demonstrated repeated repetition coefficients of variation,
as measured by Biodex System 2 software, were at or below 8.0%.
This assisted in the reporting of reproducible and low variability
testing throughout the investigation.
Load
range
ANOVA results revealed a main effect for speed and sex for each
position and muscle group. There was also
an interaction of position by speed for the prone vs. seated data
with only seated flexion at 360 deg·sec-1 producing significantly
(p < 0.05) greater LR than prone flexion while no differences
were evident at any other velocity for flexion or extension (Table
1). There were no differences between supine vs. seated LR for
extension or flexion at any velocity (Table
2).
Peak
torque, total work and average power
Each separate ANOVA analysis (load range, peak torque, total work
and average power for each position and each muscle group) demonstrated
a significant main effect for speed and sex. For the seated vs.
prone data there was a significant interaction of position and speed
for extension peak torque (60, 240 and 360 were not different) and
flexion total work (60 and 240 were not different) otherwise all
seated values for each variable were significantly greater than
prone values (Table 3). There
were no differences between seated vs. supine values for any variable
at any velocity (Table 4).
|
| DISCUSSION |
|
This
study demonstrated that LR is not position dependent for the knee
extensors or flexors when seated, prone and seated are compared.
There was a position dependence for peak torque, total work and
average power between seated vs. prone (seated was greatest). This
is in agreement with previous researchers (Findley et al., 2000;
Kramer et al., 1996;
Rathfon et al., 1991)
and convincingly demonstrates that performance variables are altered
when the knee extensors and flexors length-tension relationship
is changed. However, the focus of this study was LR and the human
ability to achieve a constant velocity range at a given speed. As
previously explained, LR is the only phase during an isokinetic
movement where quantifiable resistance is maintained and where valid
and reliable performance data may be collected (Brown, 1995b;
Brown et al., 1998).
Since performance variables were almost completely unaffected by
body position between seated
vs. supine it would appear that those positions may be interchanged
when maximum strength values are the goal of the testing session.
However, the prone position consistently produced significantly
lower performance values when compared to the seated position. This
appears to be an anomaly since the length-tension relationship between
supine and prone is almost identical. The difference may lie in
the fact that knee extension in the supine position is gravity assisted.
Therefore, the less than optimal length-tension relationship may
be equivocated by the assistance of gravity. This is only speculation
and requires further research.
RVD is the essence of isokinetics given that it is solely responsible
for determining the range of motion spent under constant velocity,
or LR (Brown et al., 1998;
Chen et al., 1994;
Osternig, 1986).
While muscle force production characteristics are length-dependent,
it appears that limb RVD is not reliant on hip position (with the
exception of 360 deg·sec-1 in flexion). This may be a
function of the muscles ability to produce high levels of acceleration
within the mid range of length tension used in this study. Although
total knee ROM in each test was a constant 90 degrees, changes in
anatomical ROM, at the hip, were induced by varying body position.
It appears, however that these variations had no influence on RVD
and, consequently, LR.
The results of this study may be relevant to isokinetic technicians
and clinicians. Primarily, it affords practitioners the ability
to utilize dynamometer configurations that are the easiest to set
up and monitor. The isokinetic dynamometer is most commonly used
in the rehabilitation setting to train the knee, in flexion and
extension, or shoulder, in external and internal rotation (Osternig,
1986).
Both these joints can be trained from the seated position, and as
such it is often the position of choice for those in clinical practice.
Since load range during knee flexion and extension may be independent
of patient position, the practitioner can feel confident that effective
training is taking place in the seated position relative to load
range, despite a less than ideal length tension relationship. However,
the end user should remain aware that performance variables appear
to be significantly affected by body position. Many clinicians appear
to have been dissuaded from the continued use of the isokinetic
dynamometer as some would argue that its complicated set-ups are
not time efficient. If the dynamometer can be used effectively for
both the knee and the shoulder in the seated position, and pre-programmed
protocols are used, then dynamometer set-ups can be performed quickly
and easily.
The fact that load range may be independent of patient position
during knee flexion and extension will also afford clinicians the
ability to choose an appropriate training position based on patient
comfort. Again, the seated position may be the position of choice,
as it allows the patient to feel like more of an active participant
in the exercise.
Practitioners involved in selecting test and training positions
must take many factors into consideration relative to the goals
and objectives of the exercise. Torque production goals, low back
pathology, functional status and stabilization factors are but a
few of these considerations (Findley et al., 2000).
However, if goals specific to velocity overload of the quadriceps
and hamstring are required, hip position is independent of these
goals. The greatest factor related to LR may be the limbs position
relative to the end range of motion.
|
| CONCLUSIONS |
|
Due to the
fact that many rehabilitative goals are governed by protocols specific
to the overload principle, other agonist/antagonist muscle groups
should be investigated under similar circumstances to determine
if subject position influences LR. Other pairs of joints (ankle/knee,
shoulder/elbow) cannot be assumed to share this independence with
respect to LR.
Based on this information and within the limitations of this study
these results indicate that LR may not be position-dependent during
isokinetic knee extension/flexion exercise yet traditional performance
variables such as peak torque, total work and average power may
be. Therefore, it would appear that clinicians must base subject
positioning on factors other than LR.
|
| KEY
POINTS |
-
Load range is the constant velocity phase where torque is collected.
- Load
range has an inverse relationship with velocity.
- Load
range may not be position dependent for the knee extensors or
flexors.
|
| AUTHORS
BIOGRAPHY |
Brian W. FINDLEY
Employment: Palm Beach Community College, Boca Raton, Florida,
USA.
Degree: MSc.
Research interests: Education and isokinetics
E-mail: findleyb@pbcc.edu
|
|
Lee
E. BROWN
Employment: California State University, Fullerton, Fullerton,
California, USA.
Degree: EdD.
Research interests: High velocity isokinetics
E-mail: leebrown@fullerton.edu
|
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Michael
WHITEHURST
Employment: Florida Atlantic University, Davie, Florida,
USA.
Degree: EdD.
Research interests: Function in the elderly
E-mail: whitehur@fau.edu
|
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Tedd
KEATING
Employment: Manhattan College, Riverdale, New York, USA.
Degree: PhD.
Research interests: Strength and Conditioning
E-mail: tedd.keating@manhattan.edu |
|
Daniel
P. MURRAY
Employment: California State University, Fullerton, Fullerton,
California, USA.
Degree: MS, PT.
Research interests: High velocity isokinetics
E-mail: d_murray77@yahoo.com
|
|
Lisa
M. GARDNER
Employment: California State University, Fullerton, Fullerton,
California, USA.
Degree: MS.
Research interests: High velocity isokinetics
E-mail: lisabelle79@yahoo.com
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