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Bilateral asymmetries in max effort single-leg vertical jumps.

While asymmetries in the lower extremity during jumping may have implications during rehabilitation, it is not clear if healthy subjects should be expected to jump equivalently on each leg. Therefore, the goal of this study was to determine if asymmetries exist in maximal effort single-leg vertical jumps. After obtaining university-approved informed consent, 13 men and 12 women with competitive volleyball playing experience and no injuries of the lower-extremity that would predispose them to asymmetries participated. After thorough warm-up, five maximal effort vertical jumps with countermovement were performed on each leg (random order) with ground reaction forces and lower extremity kinematics recorded. The best three jumps from each leg were analyzed, assigning the leg with the highest jump height average as the dominant side. Asymmetry was assessed by determining statistical significance in the dominant versus non-dominant sides (p < 0.05). A significant interaction existed between side and gender for thigh length and peak vertical ground reaction force. Women had a significantly shorter thigh and men a greater peak vertical ground reaction force on their dominant side. All other parameters were assessed as whole group. Jumps were significantly greater off the dominant leg (2.8 cm on average). No other differences between sides were observed. Significant differences in magnitude (p < 0.05) existed between the men and women in jump height, several anthropometric parameters, minimum ankle and hip angles, and vertical ground reaction forces (peak and average). In conclusion, though a person may jump slightly higher on one leg relative to the other, and women may jump slightly differently than men, the magnitude of the difference should be relatively small and due to the multi-factorial nature of jump performance, individual parameters related to performance may not be consistently different.

Adult↗

Effect of leg length on bench stepping efficiency in children.

The effect of leg length on relative oxygen consumption (VO2), heart rate (HR), and minute ventilation (VE) during stepping was examined in 30 boys ages 8-12 years. Stepping height was varied to correspond to 30, 40, and 50% of the individual's leg length while maintaining a constant exercise load. There were no significant differences in VO2, HR, and VE among the three stepping conditions. The effects of knee joint angle, leg length, and the ratio of leg length to body weight were further assessed by comparing the top third and bottom third of the sample when classified on these anthropometric measurements. No significant differences were found between the high and low groups when classified according to knee joint angle; however, ventilation was higher for the longer legged subjects and for subjects having a low leg length to body weight index. It was concluded that leg length does not influence the physiologic responses of young boys to moderate stepping exercise.

Body Height↗

The effect of 15 weeks of exercise on balance, leg strength, and reduction in falls in 40 women aged 65 to 89 years.

OBJECTIVE: Risk of falling increases as people age, and decreased leg strength and poor balance have been implicated as contributors. Our aims were to:1) assess the efficacy of a fall-prevention exercise program on balance and leg strength in women aged 65 to 89 years and 2) conduct a 1-year follow-up to determine the effect of exercise on fall rates. METHODS: Forty women were classified by falling history and fear of falling and assigned to exercise and control groups using stratified randomization. We used the Berg Balance Scale, Get-up and Go, Functional Reach, and Wall-Sit Tests to evaluate changes in balance and leg strength before and after a supervised 15-week exercise program (31-hr sessions/week). We conducted 1-year follow-up telephone interviews and compared the number of falls reported by exercise and control groups.The study used a 2 x 2 (exercise/control by pretest/post-test) factorial design with the testing times being a repeated factor, so we used analysis of variance (ANOVA) to evaluate differences between the 2 groups across testing times. Power analysis computed a priori with STPLAN software (Version 4.2) showed that a sample size of 40 was necessary to determine statistical differences in balance and leg strength. RESULTS: Exercise subjects showed significant improvement on 5 of 14 items (5.2%, p < or = 05 to 34.4%, p < or = .01) in the Berg Balance Scale and on the total score (6.8%, p < or = .05). Leg strength increased significantly (p < or = .05) on post-test as measured by the Wall-Sit Test. Control subjects reported 6 falls and exercise subjects no falls during the follow-up year, but this difference was not significant using Fischer's exact test (p=.106). CONCLUSION: The exercise program resulted in increased balance and leg strength, but did not result in a significant difference in falls during the follow-up period. Further research with a larger and possibly older sample is needed to more adequately investigate this question. Health care providers who work with older women should provide exercise programs in which balance and leg strength are emphasized.

Accidental Falls↗

[Prevalence and causes of reflux in deep venous system of the leg in patients with insufficiency of superficial veins].

UNLABELLED: The aim of the prospective study was to find out the following: 1. What is the prevalence of deep vein reflux of the leg in patients with superficial vein reflux detected by ultrasonography? 2. What are the possible causes of deep vein insufficiency of the leg retrospectively detectable on the basis of targeted medical history? 3. Is the incidence of identified deep vein insufficiency of the leg gender specific? The sample consisted of 100 legs with superficial vein reflux detected on ultrasonography (C1 - C4 / CEAP) of 79 randomized patients (59 women aged 45 +/- 12 years and 20 men aged 52 +/- 15 years). We collected the medical history of all patients and examined them for any vascular diseases of the leg. Superficial and deep venous system of the leg was examined by routine duplex ultrasonography with 7.5 a 10 MHz linear probe in B-mode, colour flow mapping and pulse Doppler using Valsalva manoeuvre and manual compression of thigh. During the examination, patients lay both prone and on their back. RESULTS: Prevalence of deep vein reflux in patients with superficial vein reflux detected by ultrasonography was 43 %. Prevalence of deep vein reflux in patients only with primary venous insufficiency (i.e. personal medical history without phlebothrombosis of the leg, trauma, surgery or plaster fixation) was 35.4% in our sample. The possible causes of deep vein reflux in our patients are the following: overweight and obesity (58.6%), primary valvular insufficiency (35.4%), secondary valvular insufficiency--post-thrombotic, post-traumatic (34.9%) and various combinations of these factors. Deep vein insufficiency increased with the BMI. Deep vein reflux was significantly more frequent in men (80%) as compared with women (54.2%).

Body Mass Index↗

Leg length inequality in total hip replacement.

Clinical and radiographic leg length inequality and pelvic tilt were measured in the erect posture in 36 patients before and after total hip replacement. Good correlation was observed between clinical and radiographic evaluations of pelvic tilt, assessed as height difference between iliac crests. Intraoperative alteration of leg length correlated well with changes in pelvic tilt but not with changes in true radiographic leg length inequality. It is suggested that adjustment of leg length during total hip arthroplasty should aim at correction of preoperative pelvic tilt observed during clinical and radiographic examination. True leg length, assessed as the height of the vertex of the femoral or prosthetic head is misleading. It does not reveal functional leg length, which is determined not only by the true leg length but also by the position of the hip joint on the pelvic wall.

Adult↗

Different tissue plasminogen activator release in the arm and leg during venous occlusion is equalized after DDAVP infusion.

The mechanism of tissue plasminogen activator (t-PA) release during arm and leg venous occlusions and DDAVP (1-desamino-8-D-arginine vasopressin) infusion was studied in 10 healthy males. The following determinations were carried out on venous blood: t-PA antigen (ELISA), t-PA activity, and t-PA inhibitor (PAI) activity (amidolytic assays). Before DDAVP, there was a 270% t-PA antigen increase in the arm at the end of occlusion as opposed to only a 40% increase in the leg. After DDAVP, t-PA antigen at the end of arm and leg occlusion reached an equal level which was significantly higher than in the arm before DDAVP. The study produced no evidence of PAI release during venous occlusion of a limb. It is concluded that DDAVP is able to elicit t-PA release from arm as well as from leg vessels. The poor fibrinolytic response of leg vessels to venous occlusion is not due to a high PAI release or t-PA stores depletion in leg vessels, but rather to low basal t-PA release in leg vessels.

Adult↗

Precise measurement of functional leg length inequality and changes due to cervical spine rotation in pain-free students.

A series of blinded studies to determine the feasibility of documenting functional leg length inequalities and changes in functional leg length in normal and non-normal patients were performed. A new apparatus designed to minimize or eliminate subjective components of inequality assessment, while attaining high levels of precision, was developed. Subjects were evaluated for presence of cervical spine lesion by five independent examiners and grouped into "lesioned" and "nonlesioned" categories. Subjects' leg length inequalities were measured by different evaluators as well as multiple measurements by a single evaluator to determine interrater and intrarater reliability coefficients. Measurements were taken on both flat and hi-low tables for changes during active cervical spine rotation. In addition, leg length measurements were taken during induced tetanic contraction by ipsilateral galvanic paravertebral muscle stimulation. Results indicated an absence of any significant effect of head rotation, type of table, galvanic stimulation, or any difference between persons classified as cervically lesioned or not cervically lesioned. Interrater and intrarater reliability coefficients for the measuring apparatus were statistically significant with small error variances. Failure to obtain subjects with frank pain as well as absence of an applied cephalad pressure (as is performed clinically) during leg length evaluation were considered as possible explanations for the failure to detect an effect of head rotation in the leg lengths. Discussion addresses the need for sensitive leg length inequality assessment techniques which eliminate subjectivity and contribute to decreased error variances.

Adult↗

Studies on leg and foot ulcers.

The medical records of patients with leg and foot ulcers caused by vascular disorders were investigated in Göteborg in 1980. The prevalence was estimated to be about 0.3%. The median age of all patients was 73 years. Sixty per cent of the patients were women. There were small differences in the number of leg and foot ulcers cases in each age-group per 1000 inhabitants between men and women. The prevalence of ulcers increased rapidly with age, especially after the age of 70. Seventeen per cent of the patients had ulcers on the medial side of the leg around the ankle only and about 30% on the feet only. Leg and foot ulcer patients were treated by several different specialties and mostly (76%) as outpatients only. From the total of 1377 ulcer patients, 350 patients, who had consulted the Department of Dermatology in 1980 were asked to come for an interview in 1984. Ulcers had been present at some time in each of the years 1981, 1982 and 1983 in 44% of the interviewed patients. During 1980, 24% of the ulcers healed and did not recur before the end of the study. During the follow-up period (3.5 years) 27% of the patients had died. The mortality rate for the leg and foot ulcer patients during the follow-up period was twice as high for both men and women as for the same age groups in the population of Göteborg, during the same years. The risk of dying from ischaemic heart disease was also approximately doubled, but the risk of dying from malignancies was the same. Compression bandages are the most important in the treatment of venous leg ulcers. The pressure under a bandage is proportional to the number of bandage layers with constant stretch. A simple method of regulating the highest comfortable sub-bandage pressure was developed. The number of bandage layers was increased gradually with the same stretch in 30 patients. The reproducibility of the method was tested for different nurses. Compression bandages are often applied for long-term treatment as double bandages. Six women treated for long periods with double bandages for venous leg ulcers developed painful, bright red, glistening skin lesions with pustules, denuded skin and scales as in intertriginous candidiasis. Cultures showed growth of Candida albicans and antimycotic treatment resulted in relief of pain and healing of skin lesions.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

[Comparative studies of the venous system of the arm and leg before and after delivery].

Venous occlusion plethysmographic measurements were performed on the legs of ten non-pregnant subjects on ten consecutive days, in order to demonstrate the reproducibility of this method. In the third trimester of gestation and on the seventh day post partum, venous occlusion plethysmographic studies and vein caliber measurements were performed on arms and legs of 20 patients. A significant reduction in leg vein diameter following delivery was found. There were no differences in the diameters of arm veins measured in the third trimester and post partum. The results of venous occlusion plethysmography, as an indicator of venous function, revealed no differences between the third trimester and post partum in either the arm or the leg. Since hormonal changes during gestation must affect the entire venous system, i.e., also the arms and legs, mechanical displacement of the blood drainage pathways by the gravid uterus is most probably responsible for the significant dilatation of leg veins in the third trimester. A displacement of the higher sections of the femoral vein was demonstrated by Doppler sonography. Increased distensibility of the veins in the third trimester, continuing post partum, is probably the measurable basis of the much higher incidence of varicosis among women who have had children. It appears possible to detect extreme dilatations of leg veins sonographically, and to counter the increased risk of thrombosis and perhaps also to reduce the risk of later varicosis by timely compression treatment.

Arm↗

Responses to dynamic leg exercise in man as influenced by changes in muscle perfusion pressure.

The influences of induced alterations in muscle perfusion pressure on the physiological responses to rhythmic exercise in man were investigated. The experiments were carried out in healthy subjects performing leg exercise on a cycle ergometer at light to exhaustive work intensities. Increased muscle perfusion pressure was brought about by exposing the working legs of the supine subject to a subatmospheric pressure of -50 mm Hg (Lower Body Negative Pressure, LBNP), decreased perfusion pressure by instead applying a supraatmospheric pressure of 50 mm Hg (Leg Positive Pressure, LPP). In this way, the perfusion pressure in dynamically exercising large muscle groups could be altered in a controlled fashion. The influences of such manipulation of the perfusion pressure on the physiological adjustments to incremental-load exercise were studied and analysed. The main results and conclusions were as follows: (1) Exercise-induced increases in cardiac output were attenuated by LBNP, an effect caused by curtailment of stroke volume secondary to suction-induced sequestration of blood volume in capacitance vessels not affected by the action of the leg muscle pump. This situation resembles that of dynamic leg exercise in the upright body position. Thus, supine exercise with LBNP at -50 mm Hg seems to be a valid model of upright leg exercise, not only in that it increases perfusion pressure in working muscles but also by causing similar changes in the central circulation as a shift from supine to upright leg exercise. (2) Exercise-induced increases in systolic arterial pressure were markedly exaggerated by LPP, an effect attributable to increased exercise responses in both cardiac output and total peripheral resistance. The exaggerated pressor response supports the notion of a muscle chemoreflex drive in response to flow-restricted exercise tending to reduce the existing flow error. (3) Exercise-induced increases in O2 uptake and blood lactate concentration were both attenuated by LBNP and exaggerated by LPP. The changes in blood lactate levels are attributable to perfusion-pressure dependent variations in muscle blood flow, resulting in opposite changes in the share contributed by anaerobic metabolism to the energy release. Possible explanations for the fact that impaired muscle perfusion was associated with increased O2 uptake at given external work loads are discussed. (4) Exercise-induced responses of the pulmonary ventilation were attenuated by LBNP and markedly exaggerated by LPP.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Sickle cell leg ulcers are associated with HLA-B35 and Cw4.

We determined the HLA-A, B, C, and DR types in nine patients with sickle cell anemia (SS) who had leg ulcers or a history of leg ulcers, and in 29 control patients with SS without leg ulcers. Six (67%) of the nine patients with leg ulcers had HLA-B35 and each of these six patients also had HLA-Cw4. In contrast, only eight (28%) of the 29 control patients with SS had HLA-B35 and only three (10%) of these patients had both HLA-B35 and Cw4. The relative risk for development of leg ulcers in patients with SS who had both HLA-B35 and Cw4 was 17 times greater than that of patients without these antigens or who had only one antigen. The frequency of HLA-B35 was also significantly higher in patients with SS and leg ulcers than in a reference population (31%) consisting of 68 healthy black persons. These results suggest that genetic factors or an HLA-related altered immune response may contribute to the development of leg ulcers in sickle cell anemia.

Adolescent↗

Ergometer modification for combined arm-leg use by lower extremity amputees in cardiovascular testing and training.

A commercial arm-leg ergometer was adapted so that combined bilateral arm-single leg work could be performed by unilateral lower extremity amputees from their own wheelchairs. Three middle-aged to elderly unilateral amputees performed progressive discontinuous bilateral arm crank and combined bilateral arm-single leg cycle exercise tests on the same air-braked ergometer adapted for either form of ergometry. Select amputees may achieve greater peak oxygen uptakes (VO2), power outputs (PO), and heart rates (HR) during combined bilateral arm-single leg cycle testing versus bilateral arm crank testing. Following 14 weeks of combined arm-leg training on the modified ergometer, a 73-year-old above-knee amputee demonstrated peak VO2 and PO increases of 25% (+3.8 mL X kg-1 X min-1) and 33% (+25W) respectively. Combined arm-leg ergometry as described herein may activate the largest available muscle mass and elicit the greatest oxygen uptake during exercise testing. In addition this exercise modality may simultaneously condition the arms and leg, providing functional gains in both wheelchair propulsion and prosthetic ambulation.

Amputees↗

[The crossed-leg flap with the fixateur externe technic].

As an introduction statements from literature and own experience are used to show and evaluate the present possibilities for the coverage of skin and soft tissue defects. As a routine operation the stemmed cross-leg flap is further on indicated on the lower leg. For the immobilisation of the legs wer use the fixateur externe. This kind of fixation has got advantages compared to plaster casts: optimal position of the two lower legs to each other, a local and general handling of the nursing with only few problems and a subjective relief for the patient. Moreover, flaps and transplant base can be connected permanently and without tension during the operation by fine adjustment of the fixateur externe, while postoperative functional strains of the neighbouring joints are possible to a certain degree. The technique of assembling the fixateur externe, i.e. immobilisation of the legs by Schanz screws and the AO-tubular system is described in detail. The results of a collective of 21 patients with mostly infectious soft tissue defects after an osteomyelitis of the tibia were checked by control examinations. There were no disadvantages for the donor leg following the use of Schanz screws. According to the presented results the settling of cross-leg flaps has been improved by the fixateur-externe-technique. Together with other authors we can recommend this method.

Adolescent↗

Intradaily variation of the human lower leg length and short term growth--a longitudinal study in fourteen children.

In order to detect the intradaily variation of the lower leg length in fourteen children the right lower leg length was determined using a non-invasive lower leg length measuring device at three set times of each day during a study period of three weeks. The mean standard error of the determinations amounted to 0.04 mm. As far as the whole group was concerned the lower leg length decreased significantly during the time interval from 8.00 hours to 12.00 hours. (Friedman's related samples test, p less than 0.01). The decrement amounted to 0.6 mm. During the rest of the day the changes in the lower leg length were not significant. A consistent decrement of the lower leg length during the day in combination with a total growth of 1.08 mm. during the three week study period suggested that growth in length of the human lower leg occurs during the night.

Adolescent↗

Venous leg ulceration: treatment by high compression bandaging.

Venous leg ulceration is a major tissue viability problem that is becoming better recognized as clinical wound care practice changes from being anecdotal-based to research-based. The current prevalence of leg ulceration in the UK, Sweden and Australia is approximately 1 percent of the adult population, and approximately half a million in the United States. Between 70 and 90 percent of leg ulcers in the UK are venous in origin. Research has shown that graduated compression bandaging is an appropriate method of managing venous leg ulceration for many patients. Since Stemmer's work showing the usefulness of higher levels of external pressure (40 mmHg), the reliability and predictability of the four layer high compression bandaging system has been demonstrated. The purpose of this article is to introduce the extent of the venous leg ulceration problem, discuss risk factors and other aspects of venous leg ulceration, support the use of graduated compression, and describe the four layer high compression bandage system. The success of the four layer system is linked to the wider issues of using a research-based approach to the assessment and management of venous leg ulcers, and such an approach is integral to cost-effective, high quality patient care.

Bandages↗

[Good results but many complications in unilateral leg lengthening techniques].

OBJECTIVE: Assessment of the results and complications of limb lengthenings according to Wagner and De Bastiani. DESIGN: Retrospective. SETTING: University Hospital Groningen, the Netherlands. METHODS: Between 1978 and 1993, 10 Wagner and 23 De Bastiani limb lengthenings were performed on 16 patients with leg length discrepancy and 3 patients with short stature. The lengthening procedures were assessed for mean lengthening, healing index (treatment days per centimeter of lengthening) and complications. The residual length discrepancy was measured indirectly. Total gain in body height was measured in the short stature patients. RESULTS: For the Wagner upper leg procedures the mean lengthening was 40 mm and the healing index 81 days/cm. For the lower leg these were 37 mm and 81 days/cm respectively, for the Bastiani lengthenings because of length discrepancy the figures were 70 mm and 46 days/cm (upper leg) and 53 mm and 52 days/cm (lower leg), and for short stature 74 mm and 46 days/cm (upper leg) and 57 mm and 55 days/cm (lower leg). There were 37 complications. Lengthening in 6 Wagner and 3 De Bastiani procedures was interrupted because of several of these complications. In 9 patients with length discrepancy the final result was satisfactory, 3 patients were not yet fully grown. Four patients had a residual length discrepancy of 2.5 to 3.5 cm. The short stature patients gained an average of 13.1 cm in height. CONCLUSION: Limb lengthenings are accompanied by many complications and patients should be monitored intensively, but the results are usually good.

Adolescent↗

Why leg crossing? The influence of common postures on abdominal muscle activity.

STUDY DESIGN: Abdominal muscle activity is recorded in the supine position, unconstrained standing, and in the sitting position on an office chair with the use of backrest and armrests, with and without crossed legs. OBJECTIVES: To assess the role of oblique abdominal muscles in relation to the stability of lumbar spine and pelvis in commonly adopted unconstrained postures. SUMMARY OF BACKGROUND DATA: Cross-legged sitting is very common for men and women. No solid evidence exists for either a beneficial or a detrimental effect of this posture. No electromyographic study deals with the activity of abdominal muscles in this commonly adopted unconstrained posture. METHODS: In healthy subjects, electromyographic activity of the rectus abdomini and external and internal oblique abdominals was recorded bilaterally during commonly adopted unconstrained postures. RESULTS: The activity of the internal oblique muscle was significantly higher in the sitting position than in supine position. For the external and internal oblique abdominals, the activity was significantly higher in the standing position than in the sitting position. When sitting, the activity of the oblique abdominals is significantly lowered by crossing the legs in the preferred way (either upper legs cross or ankle on knee). In contrast, the activity of the rectus abdominis is not significantly altered by leg crossing. CONCLUSIONS: From these remarkable findings, we conclude that leg crossing is physiologically valuable. It should be studied whether leg crossing can be implemented in the design of the workplace.

Abdominal Muscles↗

Leg manifestation in alien hand syndrome.

A patient with left alien hand syndrome (AHS) accompanied by leg symptoms due to right anterior cerebral artery territory infarction is reported. Magnetic resonance imaging demonstrated that the responsible lesion involved the right anterior cingulate gyrus, supplementary motor area, medical prefrontal cortex and corpus callosum extending from the genu to the isthmus. The leg symptoms included: 1) motor perseveration manifesting as compulsive straight walking with difficulty stopping on command; 2) dissociation between mind and action resulting in going to unintended places with subsequent complaints of poor memory not due to spatial disorientation; 3) discrepancy between verbal and actual leg motor responses to auditory verbal suggestions; and 4) movement dissociation between the legs resulting in transient standing still or brief sticking to the ground, a situation simulating akinesia. As the legs usually perform together to coordinate movements of standing and walking, unlike the hands performing well-learned, skilled unimanual or bimanual coordinating movements, the counterpart in the leg of the alien hand sign in AHS was not manifested. Nevertheless, in the presence of AHS, the associated leg symptoms bear similar neurobehavioral features and should be dealt with on equal terms.

Cerebral Infarction↗