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Cutaneous reflexes of the human leg during passive movement.

1. Four experiments tested the hypothesis that movement-induced discharge of somatosensory receptors attenuates cutaneous reflexes in the human lower limb. In the first experiment, cutaneous reflexes were evoked in the isometrically contracting tibialis anterior muscle (TA) by a train of stimuli to the tibial nerve at the ankle. The constancy of stimulus amplitudes was indirectly verified by monitoring M waves elicited in the abductor hallucis muscle. There was a small increase in the reflex excitation (early latency, EL) during passive cycling movement of the leg compared with when the leg was stationary, a result opposite to that hypothesized. There was no significant effect on the magnitude of the subsequent inhibitory reflex component (middle latency, ML), even with increased rate of movement, or on the latency of any of the reflex components. 2. In the second experiment, the two reflex components (EL and ML) elicited in TA at four positions in the movement cycle were compared with corresponding reflexes elicited with the limb stationary at those positions. Despite the markedly different degree of stretch of the leg muscles, movement phase exerted no statistically significant effect on EL or ML reflex magnitudes. 3. In the third experiment, taps to the quadriceps tendon, to elicit muscle spindle discharge, had no effect on the magnitude of ML in TA muscle. The conditioning attenuated EL magnitude for the first 110 ms. Tendon tap to the skin over the tibia revealed similar attenuation of EL. 4. The sural nerve was stimulated at the ankle in the fourth experiment. TA EMG reflex excitatory and inhibitory responses still showed no significant attenuation with passive movement. Initial somatosensory evoked potentials (SEPs), measured from scalp electrodes, were attenuated by movement. 5. The results indicate that there is separate control of transmission in Ia and cutaneous pathways during leg movement. This suggests that modulation of the cutaneous reflex during locomotion is not the result of inhibition arising from motion-related sensory receptor discharge.

Adult↗

An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnancy.

OBJECTIVE: To investigate gestational and postural changes in diameter and blood flow in the proximal deep leg veins during pregnancy. DESIGN: A longitudinal, prospective observational study. SETTING: The ultrasound department of a teaching maternity hospital. POPULATION: Twenty-four healthy women with uncomplicated singleton pregnancies. METHODS: Real-time and duplex Doppler ultrasound assessments of the vessel diameter, flow velocity and respiratory flow fluctuation in the proximal deep leg veins of women serially measured from the first trimester of pregnancy to six weeks postnatally. MAIN OUTCOME MEASURES: The effects of increasing gestation and the adoption of the left lateral position on the above parameters. RESULTS: An increase in vessel diameter and a fall in flow velocity with increasing gestation was observed. However, no change in venous flow variation was observed. Delivery had reverse effects. Flow velocity was slower in the left than right legs, but on adoption of the left lateral position an increase in flow velocity and venous flow variation was observed in both legs during pregnancy. CONCLUSIONS: These data are consistent with the observed increase in incidence and pattern of deep venous thrombosis in pregnancy and may aid interpretation of duplex Doppler ultrasound examinations for deep venous thrombosis in pregnancy. Postural changes should be part of this evaluation. The gravid uterus may not be the sole cause for postural changes in deep venous flow velocity.

Blood Flow Velocity↗

Redistribution of skin blood flow during leg dependency in peripheral arterial occlusive disease.

A disturbed autoregulation of cutaneous blood flow in legs with peripheral arterial occlusive disease (PAOD) has previously been demonstrated for circumscribed skin areas. In the present study, posturally-induced changes of skin perfusion distribution along ischaemic limbs were investigated topographically in 35 PAOD patients by means of fluorescein perfusography. Among the 68 legs studied, 7 had patent arteries and 61 could be assigned to FONTAINE stages I to IV. Limbs with peripheral skin lesions (stage IV) were further differentiated according to either healing (stage IV+) or non-healing (stage IV-) on conservative treatment. Sitting-up always led to prolonged calf as well as foot fluorescein appearance times (AT) except for legs in stage III or IV- disease. In the latter two groups, decreased sitting as compared to supine AT foot-to-calf ratios indicated a relative shift of dye delivery from proximal towards distal skin regions during posture. In contrast, this measure of blood flow redistribution did not change in the other groups. The redirection of fluorescein influx was significantly correlated with the systolic arterial pressure ankle-to-arm ratios. In conclusion, besides small perfusion pressure increases or passive microvessel distension, a shift of the peripheral resistance ratios may contribute to the improved blood supply of ischaemic skin regions during leg dependency. An arteriolar vasoparalysis does not regularly exist in limbs with skin lesions not primarily originating from ischaemia (stage IV+).

Adult↗

Resolution of pain associated with varicose and telangiectatic leg veins after compression sclerotherapy.

Many patients presenting for treatment of superficial varicosities and telangiectasias on the legs are seeking relief of pain or discomfort in addition to cosmetic improvement. Of 215 sclerotherapy patients, 114 (53%) complained of various painful symptoms involving areas of telangiectasias (vessels 0.1-1 mm in diameter) and varicosities (vessels greater than 1 mm in diameter). In order to determine whether sclerotherapy is effective in reducing leg pain and discomfort, hundreds of patients receiving two or more treatment sessions of compression sclerotherapy with hypertonic saline were surveyed for the pretreatment and post-treatment presence of numerous symptoms associated with telangiectasias and varicosities of the leg. For all symptoms combined, the overall reported relief of pain was 85% (p less than 0.001). Side effects from the treatment were minimal. These results indicate that sclerotherapy for telangiectasias and varicosities is not only a cosmetic procedure but a safe and valuable medical therapeutic modality, highly effective in relieving leg pain and discomfort.

Adolescent↗

Reflex sympathetic dystrophy. The other villain in chronic venous leg ulcers.

BACKGROUND: There are no previous reports addressing a link between leg ulcers and the reflex sympathetic dystrophy (RSD) syndrome. OBJECTIVE: The purpose of this study was to define the incidence and characteristics of a possible RSD leg ulcer syndrome. METHODS: Leg ulcers encountered in private practice were retrospectively analyzed for the presence of 12 clinical features ("special traits"), four of them because of their known association with RSD, and eight because they were suspected of resulting from vasospastic ischemia. RESULTS: Among 111 ulcer episodes, 35 (31.5%) were associated with RSD, 14 (12.6%) with arteriosclerosis obliterans, and 62 (55.9%) were caused by pure venous insufficiency. The mean score of "special traits" was 5.03 in the RSD category, 2.57 in the arteriosclerosis obliterans category, and 1.66 in pure venous insufficiency cases. CONCLUSION: It is concluded that an RSD leg ulcer syndrome does indeed exist and that it is common and easy to diagnose. Verification by prospective studies is called for.

Adult↗

Delayed full-thickness grafting of lower leg defects following removal of skin malignancies.

BACKGROUND: Closure of wounds on the lower leg can be difficult. If primary closure of local flap repair cannot be accomplished, grafting is usually the next option. Full-thickness grafts are, generally superior to split-thickness grafts, but may not survive immediate postoperative grafting on the lower leg. OBJECTIVE: The purpose of this report is to demonstrate another approach to treatment of lower leg wounds. METHODS: Thirteen patients with lower leg wounds were successfully closed with a delayed full-thickness skin graft. CONCLUSION: This study demonstrates that delayed full-thickness grafting of the lower extremities may have advantages over other methods.

Adolescent↗

532-nm Nd:YAG and 595-nm pulsed dye laser treatment of leg telangiectasia using ultralong pulse duration.

BACKGROUND: Telangiectatic leg veins have been treated using lasers with variable success. OBJECTIVE: We aimed to examine the efficacy and tolerability of a 595-nm pulsed dye laser (PDL) and a 532-nm Nd:YAG laser using ultralong pulse duration to improve leg telangiectasias with a single treatment. METHODS: Ten subjects with leg telangiectasias up to 1.0 mm in diameter participated in the study. The telangiectatic patch was divided into two approximately equal adjacent areas. The first area was treated with a 532-nm Nd:YAG laser at a fluence of 20 J/cm2 and a pulse duration of 50 ms using a contact cooling device. The second area was treated with a 595-nm PDL at a fluence of 25 J/cm2 and a pulse duration of 40 ms using cryogen spray precooling. Each area was treated once only. Photographic evaluation was used for an assessment of response. RESULTS: Two of 10 subjects had less than 25%, 3 had 25% to 50%, 2 had 50% to 75%, and 3 had more than 75% improvement after single treatment with a 532-nm Nd:YAG laser. Similarly, 2 of 10 subjects had less than 25%, 2 had 25% to 50%, and 6 had 50% to 75% improvement with the 595-nm PDL. Hyperpigmentation occurred in one subject treated with the 532-nm Nd:YAG laser and two subjects treated with the 595-nm PDL. No blistering, crusting, hypopigmentation, or scarring were observed. CONCLUSION: Both lasers using ultralong pulse width improved leg telangiectasias after a single treatment with minimal adverse reactions.

Adult↗

Tapping into the influence of keratinocyte allografts and biocenosis on healing of chronic leg ulcers: split-ulcer controlled pilot study.

BACKGROUND: Cultured keratinocytes may represent an alternative therapy aiming at boosting leg ulcer healing. There is no evidence-based study comparing objectively the healing rate of split-ulcer portions covered or not covered by cultured keratinocytes. OBJECTIVE: To assess the effect of cultured keratinocytes on the healing rate of leg ulcers. METHOD: Five applications of fresh (cela, XCELLentis, Ghent, Belgium) or frozen (CryoCeal, XCELLentis) cultured allogeneic keratinocytes were performed at weekly intervals to treat large leg ulcers (mean diameter > 5 cm) in four patients. A split-ulcer study was designed to secure a control area covered only by petrolatum gauze. Clinical, planimetric, bacteriologic, and immunohistologic assessments of the keratinocyte-treated and control parts of the ulcers were performed. RESULTS: Compared with controls, planimetry revealed a beneficial effect afforded by cryopreserved cultured keratinocytes on the ulcer healing rate of two of four ulcers (+12 and 81%). The healing effect was obtained on the ulcers associated with the lowest bacterial load. Cultured keratinocytes did not qualitatively and quantitatively modify the ulcer biocenosis. They did not affect the number of any type of inflammatory cells present in the granulation tissue (type I dermal dendrocytes, macrophages, T lymphocytes, granulocytes). No specific side effect of cultured keratinocytes was evidenced. CONCLUSION: In this small case series, it appears that cultured allogeneic keratinocytes may be helpful in the healing process of venous leg ulcers. However, a clean wound with reduced bacterial load seems to be the prerequisite condition for obtaining a beneficial effect.

Aged↗

Duplex ultrasonography-guided foam sclerotherapy of incompetent perforator veins in a patient with bilateral venous leg ulcers.

BACKGROUND: Recent advances in the form of foam sclerotherapy have extended the indications for sclerotherapy in the treatment of varicose veins. OBJECTIVES: (1) To see if perforator veins can be closed by using foam sclerotherapy; (2) to evaluate whether using foam sclerotherapy for treatment of incompetent perforator veins has an influence on venous leg ulcer healing. METHODS: Incompetent perforator veins above bilateral venous leg ulcers were treated with duplex ultrasonography-guided sclerotherapy using polidocanol foam. RESULTS: After 4 days, significant improvement in the ulcers was visible; after 10 days, one ulcer had closed; and within 3 weeks, both ulcers were closed. Control duplex ultrasonography showed closed perforator veins. CONCLUSION: This case illustrates that duplex ultrasonography-guided foam sclerotherapy is an effective and minimally invasive way of treating incompetent perforator veins. The fast healing of the venous leg ulcers in this case report indicates that foam sclerotherapy could be a promising addition in the treatment of venous leg ulceration with incompetent perforator veins.

Female↗

The prevalence of leg ulcers in older people: implications for community nursing.

The prevalence of chronic leg ulcers has been investigated in older people living in the community. This condition has a low prevalence, but major health costs are associated with frequent home nursing visits, community nursing services being the main providers of care. An estimate was made of the prevalence of chronic leg ulcers in a cross-sectional random sample of noninstitutionalized older people living in a major Australian city (N = 1,050). The prevalence estimate is compatible with estimates of 1% in the over-60 age group found in Swedish and Northern American studies. Age-adjusted gender ratios demonstrate slightly higher prevalence in females than males (1.25:1). Implications for community nursing services for primary, secondary, and tertiary prevention are outlined and include education programs for seniors dispelling myths that leg ulcers are a natural part of aging, screening for venous and arterial peripheral vascular disease in the older community, collaborative nurse and podiatrist foot care clinics, and the location of leg ulcer clinics in geriatric day care centers.

Age Distribution↗

Peripheral arterial disease in African Americans: clinical characteristics, leg symptoms, and lower extremity functioning.

OBJECTIVES: The describe peripheral arterial disease (PAD) in African Americans, and compare findings in African Americans and whites with PAD. DESIGN: Cross-sectional. SETTING: Three academic medical centers. PARTICIPANTS: Three hundred sixty-six whites and 76 African Americans with PAD (as defined by an ankle brachial index (ABI) <0.90) aged 55 and older identified from lower extremity arterial studies performed between 1996 and the fall of 1999. MEASUREMENTS: Comprehensive medical interview, body mass index, and neuropathy score. Functional measurements included the 6-minute walk distance, 4-m walking velocity, and the summary performance score. RESULTS: Age- and sex-adjusted results showed that African Americans had a lower mean ABI than whites (0.60 vs 0.66, P=.001), were less likely to be college graduates (13.7% vs 44.4%, P<.001), and had nearly twice the prevalence of diabetes mellitus (46.8% vs 28.0%, P=.001). After adjusting for age, sex, education level, and ABI, African Americans had a higher prevalence of no exertional leg pain (28.0% vs 18.2%, P=.044) and leg pain with exertion and rest (30.0% vs 17.3%, P=.023). African Americans had a shorter 6-minute walk distance (989 vs 1,156 ft, P<.001), a slower normal-pace 4-m walking velocity (0.79 vs 0.89 m/s, P<.001), a slower fast-pace 4-m walking velocity (1.12 vs 1.20 m/s, P=.012), and a lower summary performance score (8.8 vs 9.6, P=.018) than whites. These differences in functioning were attenuated after adjusting for age, sex, ABI, education, and leg symptoms. CONCLUSION: Poorer lower extremity functioning in African Americans was largely explained by differences in leg symptoms and, to a somewhat lesser degree, lower ABI levels and poorer education in African Americans than in whites. Further study is needed to determine whether these findings affect racial treatment disparities and poorer outcomes previously reported in African Americans than in whites with PAD.

Black or African American↗

Safety and efficiency of perilesional sclerotherapy in leg ulcer patients with postthrombotic syndrome and/or oral anticoagulation with phenprocoumon.

BACKGROUND: The positive effects of perilesional sclerotherapy for venous leg ulcers is well documented. Although many patients with venous leg ulcers require oral anticoagulation or have had a deep vein thrombosis, the effects of these factors on perilesional sclerotherapy are unknown. The aim of this study was to review effects of oral anticoagulation and/or postthrombotic syndrome on perilesional sclerotherapy. PATIENTS AND METHODS: 28 patients with venous leg ulcers were observed. 12/28 had a postthrombotic syndrome, 5/12 were on oral anticoagulants (phenprocoumon with INR 2-3). During each treatment session, 1 ml sclerosing foam (1:5, polidocanol 2 %, method of Tessari) was injected. Treatment was continued until all extrafascial veins in the 15cm surrounding the ulcer were closed. RESULTS: Closure of the perilesional veins was achieved in all patients with 2.5 +/- 1.8 injections. In 10 of 28 patients (35.7 %), just one injection was needed. More injections were needed, both in patients with postthrombotic syndrome (3.3 +/- 2.1 vs. 1.8 +/- 1.3) and on anticoagulation with phenprocoumon (4.2 +/- 1.2 vs. 2.1 +/- 1.7). There were only two complications: an ascending phlebitis up to the accessory saphenous vein and a superficial erosion at an injection site which healed within 1 week. CONCLUSIONS: Perilesional sclerotherapy with foam is a safe and efficient therapy for patients with chronic venous leg ulcers even with postthrombotic syndrome and/ or ongoing anticoagulation.

Administration, Oral↗

Calcitonin gene-related peptide (CGRP) and leg vascular resistance during head-up tilt induced hypovolaemic shock in man.

Calcitonin gene-related peptide is a potent vasodilator and its distribution in perivascular nerves suggests a role in the regulation of vascular tone. We evaluated leg vascular resistance together with total peripheral resistance and the arterial plasma concentrations of calcitonin gene-related peptide and catecholamines during 50 degrees head-up tilt induced hypotension in 7 males. During tilt mean arterial pressure, heart rate, total peripheral resistance, leg vascular resistance and plasma noradrenaline increased, while cardiac output and leg blood flow decreased. After 45 +/- 9 min (mean +/- SE) presyncopal symptoms appeared together with decreases in mean arterial pressure (81 +/- 6 to 56 +/- 9 mmHg), heart rate (97 +/- 6 to 73 +/- 8 beats min-1), leg vascular resistance (158 +/- 9 to 109 +/- 8 mmHg min l-1) and total peripheral resistance (17 +/- 3 to 10 +/- 2 mmHg min l-1) (P less than 0.01). Plasma calcitonin gene-related peptide increased from 32 +/- 3 to 35 +/- 3 pmol l-1 (P less than 0.01) and adrenaline from 1.1 +/- 0.2 to 1.7 +/- 0.3 nmol l-1 (P less than 0.01), while noradrenaline did not change. The results indicate that presyncopal symptoms induced by head-up tilt are associated with regional as well as total decreases in vascular resistance accompanied by moderate increases in arterial plasma concentrations of calcitonin gene-related peptide and adrenaline.

Adult↗

Restless legs syndrome: a review for the renal care professionals.

Restless legs syndrome is a common neurological disorder with an estimated prevalence between 2 and 10%. It is characterised by an imperative desire to move the extremities associated with paraesthesias, motor restlessness, worsening of symptoms at rest with at least partial relief by activity, and worsening of symptoms in the evening or at night. As a consequence, patients suffer from severe sleep disturbances and, less frequently, from daytime sleepiness. The cause of restless legs syndrome remains unknown. It has been divided into idiopathic and symptomatic (secondary, e.g. uraemic restless legs syndrome) forms. Based on pharmacological, neurophysiological and imaging studies it is suggested that it is a disease of the subcortical central nervous system with involvement of the brainstem and spinal chord. Dopaminergic agents are regarded as the first choice of treatment; however, the development of augmentation of symptoms especially under levodopa therapy may be a major problem. Alternative medications are opioids and benzodiazepines. In secondary restless legs syndrome the underlying illness should be treated first, but dopaminergic drugs may also be helpful.

Dopamine Agents↗

Effects of prior arm exercise on pulmonary gas exchange kinetics during high-intensity leg exercise in humans.

For moderate work rates (i.e. below the lactate threshold, theta), oxygen uptake (Vo2) approaches the steady state mono-exponentially. At higher work rates, the Vo2 kinetics are more complex, reflecting the delayed superimposition of an additional, slow component. The mechanisms of this 'slow' component are poorly understood. It has been demonstrated, however, that while a prior bout of supra theta L cycling (with a 6 min recovery) does not significantly affect the V02 time course for a subsequent sub-theta L bout, it significantly speeds the V02 response to a subsequent supra-theta L bout (Gausche, Harmon, Lamarra & Whipp, 1989; Gerbino, Ward & Whipp, 1996). These investigators proposed that this speeding was a result of improved muscle perfusion during the exercise transient, possibly related to the residual metabolic acidaemia still present at the start of the subsequent exercise bout. To determine whether speeding of the V02 kinetics could also be induced by a bout of prior high-intensity exercise performed at a remote site (e.g. the arms), subjects each performed two 6 min bouts of high-intensity cycling (leg exercise: LE) at a work rate equivalent to 50% of lambda le' (the difference between maximum V02,LE and theta L,LE). On one occasion this was preceded by a 6 min period of cycling at 50% lambda LE and, on another, by a similar period of arm-crank exercise (arm exercise: AE) at 50% lambda LE in each case, the work bouts were separated by 6 min of unloaded pedalling. Pulmonary gas exchange variables were derived breath-by-breath. During unloaded pedalling and at minute 6 of each work bout, arterialized venous blood samples were drawn from the dorsum of the heated hand or at the wrist for analysis of PH, lactate, pyruvate, noradrenaline (NAdr), adrenaline (Adr), and potassium (K+). The difference in V02 between minute 6 and 3 of each work bout (lambda V02 ¿6-3] and the 'partial' O2 deficit (O2 Def) provided indices of the slow phase of V02 kinetics. The initial AE and LE bouts resulted in similar degrees of metabolic (lactic) acidaemia; the residual acidaemia at the end of the subsequent 6 min recovery phase was also similar for the two protocols, as were [K+], [Adr¿ and [NAdr]. The subsequent LE bouts were associated with reductions in both lambda V02[6-3] and O2 Def, relative to control, with the effect being more marked when the work was preceded by a prior LE bout than a prior AE bout: lambda V02[6-3] averaging 32 and 56% of control, respectively, and O2 Def 71 and 81%. Consequently, the increase in [lactate] and decrease in PH induced in this second LE bout were smaller when preceded by prior leg exercise than prior arm exercise. It is therefore concluded that while metabolic acidaemia induced at a site remote from the legs is associated with a less prominent slow phase of the V02 kinetics for high-intensity leg exercise, a component specific to the involved contractile units appears to exert the dominant effect. The mechanisms underlying this response are, however, presently uncertain.

Adult↗

Acute ventilatory responses to hypoxia during voluntary and electrically induced leg exercise in man.

1. The acute ventilatory response to a brief period of hypoxia (AHVR) was measured in six subjects (a) at rest, (b) during electrically induced leg exercise (EEL), (c) during voluntary leg exercise at an external work rate matched to electrical exercise (EV1) and (d) during voluntary leg exercise at an internal work rate (i.e. metabolic rate) matched to electrical exercise (EV2). The end-tidal PO2 during hypoxia was 50 mmHg and the end-tidal PCO2 was held constant at 1-2 mmHg above resting values throughout each of these four protocols. 2. EEL was produced by surface electrode stimulation of the quadriceps muscles so as to cause the legs to extend at the knee and lift a set of weights via a pulley system. During EV1, each subject lifted the same weight through the same height and at the same frequency as during his EEL protocol. During EV2, the weight, the height through which it was lifted and the frequency of voluntary contractions were altered to produce a similar O2 consumption and CO2 production as during EEL. 3. In each subject, end-tidal PCO2 values showed no change between the four protocols, and in three subjects in whom they were measured, arterial PCO2 values were also similar between the protocols. Venous lactate levels did not increase after EEL or EV2. 4. The AHVR during EEL (14.1 +/- 1.42 l min-1; mean +/- S.E.M) was significantly increased (Student's paired t test) compared with rest (7.55 +/- 1.10 l min-1; P < 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Loss of power during fatigue of human leg muscles.

1. We have investigated the loss of power seen during high-intensity exercise of human leg muscles such as might occur during sprinting. Subjects exercised the quadriceps and hamstring muscle groups using a Cybex dynamometer at an angular velocity of 90 deg s-1 once a second for 6 min. At 1 min intervals the quadriceps were electrically stimulated via the femoral nerve to produce an isometric contraction which was then released into an isokinetic shortening contraction at 90 deg s-1. 2. The extent of central fatigue was assessed by comparing the force of a voluntary isokinetic contraction with that elicited by electrical stimulation during isokinetic releases. Two subjects were repeatedly tested. In the first series of experiments, exercising the quadriceps of one leg, the instantaneous power fell to about 50% over the course of 2 min and remained constant for the rest of the exercise. For one subject the voluntary and electrically stimulated forces declined in parallel while for the second subject the voluntary force was 10% less than the stimulated force at the end of the exercise. These results show that central fatigue represented a minor factor contributing no more than one-fifth of the total loss of power in these circumstances. 3. In a second series of experiments the subjects alternately contracted the quadriceps and the hamstrings of both legs in an exercise which had a high rating of perceived exertion and entailed considerable respiratory and cardiovascular effort. The time course and proportionate loss of power were very similar to those seen with the one-leg exercise and neither subject showed evidence of significant central fatigue. The pattern of force loss was very similar for the hamstrings. We conclude that, for determined subjects, afferent feedback from muscles, tendons and joints or from the respiratory and cardiovascular systems does not have a major role in inhibiting voluntary activation of the quadriceps during heavy exercise. 4. In both series of experiments the power output during electrically stimulated isokinetic contractions was reduced to 50% of the initial value after 2 min of exercise while the isometric force, measured immediately before the release, fell to only 75%. This suggests that fatigue affects isometric and shortening contractions to different extents and the loss of power may be due to a combination of factors, only one of which is evident in the loss of isometric force.

Adult↗

The control of mono-articular muscles in multijoint leg extensions in man.

1. Movements often require control of direction and a magnitude of force exerted externally on the environment. Bi-articular upper leg muscles appear to play a unique role in the regulation of the net torques about the hip and knee joints, necessary for the control of this external force. 2. The aim of this study was to test the hypothesis that the mono-articular muscles act as work generators in powerful dynamic leg extensions, which means that they should be activated primarily in the phases during which they can contribute to work, irrespective of the net joint torques required to control the external force. 3. Cycling movements of six trained subjects were analysed by means of inverse dynamics, yielding net joint torques as well as activity patterns and shortening velocities of four mono- and four bi-articular leg muscles. 4. The results show that the mono-articular muscles exert force only in the phase in which these muscles shorten, whereas this appears not to be the case for the bi-articular muscles. 5. Reciprocal patterns of activation of the rectus femoris and hamstring muscles appear to tune the distribution of net joint torques about the hip and knee joints, necessary to control the (changing) direction of the force on the pedal. 6. An analysis of running in man and additional related literature based on animal studies appears to provide further support for the hypothesis that mono- and bi-articular muscles have essentially different roles in these powerful multijoint leg extension tasks.

Bicycling↗