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PubMed1999

Lactate and cardiopulmonary responses to simulated arm-pulling and leg-kicking in collegiate and recreational swimmers.

Investigations into the changes due to training in the metabolism of the arms or the legs in swimmers of different training status are limited. The purpose of this study was to compare the lactate and cardiopulmonary responses to simulated arm-pulling and leg-kicking in collegiate and recreational swimmers. Sixteen males (9 collegiate swimmers; SW, 7 recreational swimmers; RSW, mean+/-SD; age 22+/-3 years, body mass 81+/-9 kg, stature 1.84+/-0.06 m), gave written consent and performed continuous incremental exercise tests using either simulated front-crawl arm-pulling or leg-kicking. Lactate concentration (HLa) and oxygen consumption (VO2) were determined at 20 W intervals and at exhaustion (HLa(peak); VO2(peak)). The exercise intensity at a lactate concentration of 4 mM (EI4mM) and at exhaustion (EI(peak)) for arm-pulling and leg-kicking were also established. The arm:leg ratios for EI4mM, HLa(peak) and VO2(peak) were computed. The results showed that for arm-pulling, the SW had higher EI4mM (P=0.02), EI(peak) (P=0.006), but lower HLa(peak) (P=0.03) compared to the RSW. For leg-kicking, none of the responses differed significantly. These results suggest that it is rather the metabolism and local muscle endurance of the arms that are enhanced with competitive swimming endurance.

Adult↗
PubMedDate not supplied

Comparison of muscle strength and flexibility between the preferred and non-preferred leg in English soccer players.

Most soccer players have a favoured foot for kicking the ball, and it is believed that this preference may lead to an asymmetry in the strength and flexibility of the lower extremities. This study was designed to determine whether asymmetry in strength and flexibility are present in the legs of soccer players.Forty-one elite and sub-elite soccer players (age 23.4 +/- 3.8 years; height 1.81 +/- 0.06 m; body mass 81.7 +/- 9.9 kg) were studied (data are presented as mean +/- SD). The dynamic strength of knee flexors (hamstrings) and knee extensors (quadriceps) was measured using an isokinetic dynamometer at angular velocities of 1.05, 2.09, 5.23 rad/s (in a concentric mode) and 2.09 rad/s (in an eccentric mode). The concentric strength ratio (hamstrings(conc)/quadriceps(conc)) and the dynamic control ratio (hamstrings(ecc)/quadriceps(conc)) were computed. Hip joint flexibility (in flexion) was measured using a goniometer.A significant difference between the preferred and non-preferred leg was found in the knee flexors at 2.09 rad/s (119 +/- 22 versus 126 +/- 24 Nm; P < 0.05) and for the dynamic control ratio (0.79 +/- 0.13 versus 0.84 +/- 0.16 Nm; P < 0.05). In both cases the knee flexors of the preferred leg were weaker than those of the non-preferred leg. A total of 28 of the 41 players (68%) had significant musculoskeletal abnormality (imbalance >10%) in one or more specific muscle groups. No significant differences were found in flexibility of the hip joint between the preferred and non-preferred leg (P > 0.05). It is concluded that the lower strength of the knee flexor muscles of the preferred leg may be associated with the differential use of these muscle during the kicking action and thus constitutes a unique training effect associated with soccer. This in turn can lead to muscular imbalance which is generally regarded as an injury risk factor.

Adult↗
PubMed1975

Comparison between arm and leg exercise in women and men.

Arm and leg work was performed on bicycle ergometers in sitting position by fourteen women and sixteen men. Heart rate, minute volume of ventilation (VE), and oxygen consumption (VO2) were measured. Arm exercise was performed until (muscular) exhaustion, leg exercise up to a heart rate of circa 170 beats/min. At comparable work loads arm exercise evoked higher VO2, VE, and heart rate than leg exercise irrespective of sex. At comparable VO2, the heart rate and VE were higher during arm work in both sexes, VE more so among the men. With the same limbs working, the mechanical efficiency was equal in both sexes. The regression coefficients of heart rate on load or VO2 was higher for the women irrespective of work type. A close correlation was obtained between working capacity at a heart rate of 170 beats/min (W170) during leg and arm exercise and between W170 of leg exercise and W150, similarly calculated during arm work. Thus W170 of leg exercise could be calculated from either a maximal or submaximal arm work.

Adult↗
PubMed2002

Biomechanical differences in soccer kicking with the preferred and the non-preferred leg.

The aims of this study were to examine the release speed of the ball in maximal instep kicking with the preferred and the non-preferred leg and to relate ball speed to biomechanical differences observed during the kicking action. Seven skilled soccer players performed maximal speed place kicks with the preferred and the non-preferred leg; their movements were filmed at 400 Hz. The inter-segmental kinematics and kinetics were derived. A coefficient of restitution between the foot and the ball was calculated and rate of force development in the hip flexors and the knee extensors was measured using a Kin-Com dynamometer. Higher ball speeds were achieved with the preferred leg as a result of the higher foot speed and coefficient of restitution at the time of impact compared with the non-preferred leg. These higher foot speeds were caused by a greater amount of work on the shank originating from the angular velocity of the thigh. No differences were found in muscle moments or rate of force development. We conclude that the difference in maximal ball speed between the preferred and the non-preferred leg is caused by a better inter-segmental motion pattern and a transfer of velocity from the foot to the ball when kicking with the preferred leg.

Biomechanical Phenomena↗
PubMed2005

Leg coverage with towels during regional deep hyperthermia treatment and its effect on pelvic temperature and temperature distribution.

INTRODUCTION: The feasibility and its effects on pelvic temperature distribution of covering the legs with towels during the second half of the deep hyperthermia treatment (DHT) is evaluated. PATIENTS AND METHODS: Patients treated with DHT and radiotherapy were randomized to an alternating treatment schedule: 2nd and 4th treatment or 3rd and 5th treatment with the legs covered with towels in the second half of the treatment. Intra-luminal temperatures (vesical, vaginal and rectal) classified as tumour indicative (TI) or tumour contact (TC), oral temperature, applied maximum power and power at the end of the treatment were measured and compared between the two treatment schedules. RESULTS: Fourteen female patients receiving a total of 51 treatments, 24 with and 27 without towels, were included for analysis. The mean intra-luminal, TI and TC temperatures, standard deviation and range for each site were calculated. The applied power was documented. There were no significant differences in any of the measured temperatures. There were no significant differences in the applied power. In only three treatments, the towels were removed preliminarily. CONCLUSION: In the authors' experience, covering the legs with towels during the second half of DHT does not result in significantly higher or more homogeneous pelvic temperatures. There is no indication that the TC and TI temperatures are higher compared to all pelvic temperatures when towels are applied. Regarding the used power, there is no significant decrease with towels placed on the legs. Coverage of the legs does not increase the systemic temperature. Isolating the legs with a water-perfused heater is considered.

Adult↗
PubMed2004

Reciprocal inhibition and corticospinal transmission in the arm and leg in patients with autosomal dominant pure spastic paraparesis (ADPSP).

The pathophysiological mechanisms underlying the development of spasticity are not clear, but the excitability of the disynaptic reciprocal inhibitory pathway is affected in many patients with spasticity of different origin. Patients with genetically identified autosomal dominant pure spastic paraparesis (ADPSP) develop spasticity and paresis in the legs, but usually have no symptoms in the arms. Comparison of the spinal and supraspinal control of the legs and arms in these patients may therefore provide valuable information about the pathophysiology of spasticity. In the present study, we tested the hypothesis that one of the pathophysiological mechanisms of spasticity in these patients is abnormal corticospinal transmission and that this may lead to decreased reciprocal inhibition. Ten patients and 15 healthy age-matched control subjects were investigated. The patients were all spastic in the legs (with hyperactive tendon reflexes, increased muscle tone and Babinski sign), but had no neurological symptoms in the arms (except for one patient). Disynaptic reciprocal Ia inhibition of flexor carpi radialis (FCR) and soleus (SOL) motoneurons was measured (as the depression of the background FCR and SOL EMG activity and as the short latency inhibition of the FCR and SOL H-reflex evoked by radial and peroneal nerve stimulation). In addition, the latency of motor evoked potentials (MEPs) in the FCR muscle and the tibialis anterior (TA) muscle was measured. In the patients, the mean reciprocal inhibition was normal in the arms, while it was significantly decreased in the leg compared with the healthy subjects. In the patients, the average latency of MEPs in the FCR muscle was normal, while the latency to the MEP in TA muscle was significantly longer than that found in healthy subjects. Four patients, however, differed from the other patients by having significant reciprocal inhibition in the leg and a significantly shorter latency of TA MEPs than found in the other patients. The six patients without reciprocal inhibition in the leg instead had significant short latency facilitation of the SOL H-reflex and a longer TA MEP latency than seen in the healthy subjects and in the four patients with retained reciprocal inhibition. These findings support the hypothesis that disynaptic reciprocal inhibition and short latency facilitation are involved in the development of spasticity and, furthermore, they suggest a positive correlation between impairment of corticospinal transmission and decrease of reciprocal inhibition/appearance of reciprocal facilitation.

Adult↗
PubMed1996

Arm-leg pressure gradients on late follow-up after coarctation repair. Possible causes and implications.

Seventeen years after coarctation repair, 36 patients were studied by magnetic resonance imaging and exercise testing to measure residual anatomical stenosis and hormonal response to exercise, and to evaluate their effect on arm-leg gradients and on exercise hypertension. The systolic arm pressure, leg pressure and arm-leg gradient were measured at rest and during exercise. Active renin and catecholamines were measured in the plasma at rest and after peak exercise. On magnetic resonance imaging 18 patients had residual stenosis of less than 30% (group I) and 18 had residual stenosis of equal to or more than 30% (group II). At peak exercise, the arm pressure was 235 (133-296) mmHg in group I and 241 (157-286) mmHg in group II (ns), the leg pressure was 138 (111-173) mmHg in group I and 114 (75-154) mmHg in group II (P = 0.002). The adrenalin increase from rest to exercise was 32.7 +/- 9.1 pg.ml-1 in the patients with exercise hypertension and 3.1 +/- 4.7 pg.ml-1 in the patients who remained normotensive during exercise (P = 0.02). In conclusion, residual anatomical stenosis leads to a pressure drop in the legs, which influences the arm-leg gradient. Arm hypertension is not related to anatomical narrowing but to interaction of enhanced sympathetic nerve activity and structural and functional abnormality of the precoarctation vessels.

Adolescent↗
PubMed1982

Cinematographic analysis of the passive straight-leg-raising test for hamstring muscle length.

Cinematography was used to compare increases in the angle of straight leg raising in relation to the horizontal with increases in the angle of straight leg raising in relation to the pelvis during five minutes of passive straight leg raising. Cinematography was also used to monitor increases in the angle of the pelvis in relation to the horizontal. Eleven subjects underwent passive straight leg raising. Three methods similar to techniques reported in the literature were used in an attempt to stabilize each subject's pelvis during the procedure. Increases in the angle of straight leg raising in relation to the horizontal were found to be greater than increases in the angle of straight leg raising in relation to the pelvis. The differences in the increases had a high correlation with the increases in the angle of the pelvis in relation to the horizontal (r = .93). The findings suggest that pelvic stabilization is difficult and that methods used to indicate hamstring length should take pelvic rotation into account.

Adult↗
PubMed1989

Effect of heel lifts on ground reaction force patterns in subjects with structural leg-length discrepancies.

The purpose of this study was to determine the effect of heel lifts on ground reaction force patterns in subjects with structural leg-length discrepancies (LLDs). Eighteen subjects with LLDs ranging from 4.8 to 22.2 mm participated in this study. Subject age range was from 20 to 63 years. A force platform was used to obtain ground reaction force data for four conditions. Data were collected prior to fitting of the heel lift and after a three-week break-in period. Data were analyzed by use of a two-factor within-subject analysis of variance for repeated measures. Before heel-lift fitting, maximum lateral force was greater in the short leg than in the long leg. After heel-lift fitting, maximum vertical force was greater within both legs, and maximum medical force was greater in the long leg than in the short leg. The results suggest that although heel lifts are used to achieve pelvic levelness, the use of heel lifts also resulted in increased ground reaction forces, which may cause increased joint stresses within the lower extremities.

Adult↗
PubMed2005

Circadian variation of the effects of immobility on symptoms of restless legs syndrome.

STUDY OBJECTIVES: It is now well established that symptoms of restless legs syndrome (RLS) are worsened by immobility and that their severity fluctuates according to a circadian pattern with a maximum occurring in the late evening or during the night. However, no study has ever attempted to dissociate these two effects. The objective of this study was to evaluate the nycthemeral variations in the effects of duration of immobility on symptoms of RLS. DESIGN: A 28-hour modified constant routine protocol. SETTING: Sleep Disorders Center, Montreal Sacré-Coeur Hospital. PARTICIPANTS: Seven patients with primary RLS (3 men, 4 women; mean age: 43.9 years) and seven controls matched for age (42.4 years) and gender. INTERVENTION: None. MEASUREMENTS AND RESULTS: A 40-minute Suggested Immobilization Test (SIT) was repeated every 2 hours during the 28-hour protocol in order to quantify both subjective leg discomfort and periodic leg movements (PLM). Regarding leg discomfort, a two-way ANOVA performed on patients' data revealed a significant interaction (p = 0.037) between Time within the SIT and Time of day. Simple effect analyses performed to decompose the interaction showed that the increase in leg discomfort with duration of immobility was found only on SIT 7, 8, 9, 10 and 12, which corresponds to the period between 21:20 and 08:00. In addition, in patients, a significant circadian variation (p < 0.01) was found for the 28-hour profiles of leg discomfort progression during the SIT. No interaction or Time within the SIT effect was found for controls. CONCLUSIONS: These results show that worsening of RLS symptoms by immobility is closely linked to their intrinsic circadian variation.

Adult↗
PubMed2001

Anterior approach to the sciatic nerve block: the effects of leg rotation.

In the anterior approach to the sciatic nerve block, the femur often obstructs the passage of the needle toward the sciatic nerve. In this study, by using a human cadaver model, we assessed how internal and external rotation of the leg influences the accessibility of the sciatic nerve with the anterior approach. Ten lower extremities from five adult cadavers were studied. Needles were used to simulate the anterior approach to the sciatic nerve block. The effect of leg rotation on the needle plane required to reach the sciatic nerve was studied with legs in the neutral position and then with internal and external rotation (45 degrees) of the legs. During needle placement in the neutral position, the needle could not be fully advanced to the level of the sciatic nerve because of obstruction by the lesser trochanter in 80% of attempts. Medial redirection of the needle (10 degrees--15 degrees) allowed it to pass the lesser trochanter but brought the tip of the needle too medial to the sciatic nerve. Internal rotation of the leg facilitated passage of all needles inserted at the level of the lesser trochanter. We conclude that internal rotation of the leg may significantly facilitate needle insertion in the anterior approach to sciatic block.

Adult↗
PubMed2000

The cross-leg soleus muscle flap.

Reconstruction of the lower limb can be a difficult problem, especially when located over the lower third of the leg, or when a large soft-tissue defect exists. When local flap coverage is not possible, a distant flap--free or pedicled--is indicated. There are, however, circumstances that preclude the use of a free flap, and in these situations cross-leg flaps remain a viable alternative. They have been proved to be safe, are usually quick to perform, and do not require specialized facilities for postoperative monitoring. A new variation of the soleus muscle flap--the cross-leg soleus muscle flap--is described. Using this modification, the authors successfully closed large defects of the lower limb in 9 patients. The donor site defect that is left on the contralateral limb is far more acceptable than that left by conventional cross-leg fasciocutaneous or musculocutaneous flaps. The authors prefer the cross-leg soleus flap to conventional cross-leg flaps in these situations.

Adult↗
PubMed1986

Successful treatment of osteomyelitis and soft tissue infections in ischemic diabetic legs by local antibiotic injections and the end-diastolic pneumatic compression boot.

Thirty-four legs at risk of amputation due to peripheral arterial insufficiency associated with ischemic necrosis, soft tissue infections, osteomyelitis, and variable degrees of peripheral neuropathy were reported in 28 diabetic patients. Amputation had been considered in 27 legs for which standard therapies had failed for the current illness and in two legs in which standard therapy had failed for previous illnesses. Local therapy was the initial form of therapy for five legs in which standard therapy appeared likely to fail. Infection was controlled in all patients with the use of local antibiotics and compression boot therapy. Early leg amputation was avoided in all but one patient. Late leg amputation occurred in two patients who were lost to follow-up care. Osteomyelitis, ischemic necrosis, and advanced soft tissue infection were shown not to be clear-cut indications for amputation in the ischemic diabetic foot.

Aged↗
PubMed1993

Is the trunk a reference frame for calculating leg position?

Naive subjects and dancers were instructed to raise a leg laterally toward 45 degrees. The final position reached by the leg by each group of subjects was quite different: 48 degrees in dancers, i.e. close to the required value, and 56 degrees in the naive subjects. The reason for this difference was investigated. During the body weight transfer toward the supporting side prior to the leg movement, naive subjects inclined both leg and trunk laterally, whereas the dancers' trunk remained vertical. It was observed that in naive subjects the trunk inclination and the overestimation of the final leg position were closely correlated. The results suggest that in both naive subjects and dancers, the trunk axis serves as a reference value for calculating the leg position.

Adult↗
PubMed1989

Cross leg pain and trunk list.

The prognostic significance of gravity-induced trunk list and cross leg pain was investigated in 113 patients who had root tension signs from a lumbar disc lesion. Cross leg pain, (a positive contralateral straight leg raising sign) and list was associated with poor prognosis for conservative management. There was a high incidence of disc sequestration and extrusion in the operated patients with cross leg pain. It was concluded that cross leg pain is probably a contraindication to chymopapain injections, and the surgeon should be aware of the possibility of a migrated disc fragment during operation on patients with cross leg pain.

Adult↗
PubMed1994

Straight leg raising test and lumbar cerebrospinal fluid levels of vasoactive intestinal polypeptide and somatostatin in patients with low back pain.

STUDY DESIGN: Straight leg raising was recorded before myelography in 77 patients. At myelography, samples of cerebrospinal fluid were drawn and later analyzed for neuropeptides vasoactive intestinal polypeptide and somatostatin. OBJECTIVES: The study sought to examine correlations, if any, between a positive straight leg raising test and cerebrospinal fluid neuropeptide levels. METHODS: The straight leg raising test was recorded for all patients before a myelography examination was performed because of intractable leg pain symptoms. Forty-seven of the patients were men and 30 were women. Cerebrospinal fluid samples were obtained from all patients upon myelography. Levels of the neuropeptides vasoactive intestinal polypeptide and somatostatin were analyzed in a blind manner by radioimmunoassay, using commercially available radioimmunoassay kits. RESULTS: The results are compatible with previous observations that suggest cerebrospinal neuropeptide levels are altered in conjunction with neural injury or pain syndromes. In the present mixed back pain patient population, which included radicular pain symptoms due to disc herniation and lumbar stenosis, alterations in vasoactive intestinal peptide levels in particular were observed with a positive straight leg raising test. CONCLUSIONS: Nerve root injury, as suggested by a positive straight leg raising test, appears to be neurochemically linked to altered cerebrospinal fluid vasoactive intestinal peptide levels.

Female↗
PubMed1998

The importance of radiating leg pain in assessing health outcomes among patients with low back pain. Results from the Veterans Health Study.

STUDY DESIGN: Cross-sectional data were analyzed from the Veterans Health Study, an observational study of patients receiving ambulatory care. OBJECTIVE: To develop a method of stratifying patients with low back pain by combining patient reports of radiating leg pain with the results of straight leg raising tests. SUMMARY AND BACKGROUND DATA: Four hundred thirty-four participants with low back pain were identified through patient reports of ever having had low back pain, of low back pain that began more than 3 months ago, and of a health-care visit for low back pain in the past year. Four hundred twenty-eight patients with low back pain were included in the current analysis. METHODS: Participants were mailed a health-related quality of life questionnaire and had an interview that included a low back pain questionnaire and a straight leg raising test. Patients' reports of radiating leg pain and results of the straight leg raising tests were combined into four hierarchical groups. This stratification was evaluated in relation to responses to the health-related quality of life questionnaire, localized low back pain, disability, and use of medical services. RESULTS: The intensity of localized low back pain and disability increased from Group 1 (low back pain alone) to Group 4 (pain below knee with positive straight leg raising test result), whereas health-related quality of life decreased. Group 4 patients were 5.1 times more likely than were Group 1 patients to use medications for low back pain (95% confidence interval 1.2, 22.9), 6.8 times more likely to have a spinal magnetic resonance study (95% confidence interval, 2.7, 17.2), and 3.9 times more likely to have surgery (95% confidence interval, 1.3, 11.4). CONCLUSIONS: The method of measuring correlation performs well in identifying patients with different levels of localized low back pain intensity, health-related quality of life, and use of services. It may be useful in studies of health outcomes, in clinical trials, and in predicting demands on health care resources.

Aged↗
PubMed2006

Exploring how peak leg power and usual gait speed are linked to late-life disability: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002.

OBJECTIVE: To investigate the relation of both peak leg power and usual gait speed in their association with varying domains of late-life disability. DESIGN: Participants (> or =60 yrs of age, n = 1753) were from the National Health and Nutrition Examination Survey, 1999-2002. Disability in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities was obtained by self-report. Peak muscle power was the product of isokinetic peak leg torque and peak force velocity. Functional limitations were evaluated via usual gait speed, which was obtained from a 20-foot timed walk. RESULTS: Low usual gait speed was associated with disability independent of basic demographics, cognitive performance, co-morbidities, health behaviors, and inflammatory markers. The odds ratios for disabilities in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities for each standard-deviation increase in walking speed were 0.72 (95% confidence interval [CI], 0.59-0.87), 0.63 (95% CI, 0.52-0.77), 0.57 (95% CI, 0.45-0.72), 0.56 (95% CI, 0.47-0.67), and 0.74 (95% CI, 0.64-0.85), respectively. The odds ratios for disabilities in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities for each standard-deviation increase in leg power were 0.70 (95% CI, 0.55-0.89), 0.67 (95% CI, 0.53-0.86), 0.62 (95% CI, 0.47-0.83), 0.58 (95% CI, 0.47-0.72), and 0.73 (95% CI, 0.61-0.87), respectively. Supplementary adjustment for walking speed mildly attenuated the relation of leg power to disability. CONCLUSION: Peak leg power and habitual gait speed were associated with varying domains of late-life disability. The association between peak leg power and disability seems to be partially mediated through usual gait speed.

Activities of Daily Living↗