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Ph.D. Thesis – H. Longpré Mcmaster University – Rehabilitation Science Ph.D. Thesis – H. Longpré McMaster University – Rehabilitation Science MUSCLE CONTRIBUTIONS TO KNEE LOADS IN HEALTHY YOUNG WOMEN Ph.D. Thesis – H. Longpré McMaster University – Rehabilitation Science MUSCLE FUNCTION CONTRIBUTIONS TO KNEE LOADING DURING STATIC AND DYNAMIC ACTIVITIES IN HEALTHY YOUNG WOMEN By Heather S. Longpré, B.Sc.Eng., M.E.Sc. A Thesis Submitted to the School of Graduate Studies in partial fulfilment of the requirements for the degree Doctor of Philosophy School of Rehabilitation Science McMaster University ©Copyright by Heather Longpré, November 2014 i Ph.D. Thesis – H. Longpré McMaster University – Rehabilitation Science DOCTOR OF PHILOSOPHY (2014) McMaster University School of Rehabilitation Science Hamilton, Ontario TITLE: Muscle function contributions to knee loading during static and dynamic activities in healthy young women AUTHOR: Heather S. Longpré, B.Sc.Eng. (The University of Western Ontario, London, Ontario), M.E.Sc. (Queen’s University, Kingston, Ontario) SUPERVISOR: Dr. Monica R. Maly NUMBER OF PAGES: xiv, 188 ii Ph.D. Thesis – H. Longpré McMaster University – Rehabilitation Science ABSTRACT Lower extremity muscles are primary contributors to knee loading during static and dynamic activities. The underlying philosophy of this thesis contends that a more robust understanding of the relationships between muscle function and the loading environment in the healthy knee is needed for clinicians to prescribe effective lower extremity muscle training programs. The primary objectives were to (i) identify changes in knee mechanics and muscle function during gait, static squats and lunges after lower extremity neuromuscular fatigue, (ii) explore relationships between knee loading, and peak knee extensor and flexor strength and power, and (iii) identify isometric standing muscle training postures which elicit minimal medial knee loads. In the studies addressing objective (i), isotonic lower extremity fatigue reduced the peak knee extension moment during gait, decreased vastus lateralis activation, and decreased mean knee moments during static lunging. These findings indicated that fatigue altered muscle recruitment strategies and may have concurrently altered the knee loading environment during these submaximal tasks. However, these biomechanical alterations are not consistent with those in knee osteoarthritis or ligament injury. In the studies addressing objective (ii), peak knee extension torque and power were important in describing healthy knee loading during the early and late stance phases of gait, respectively. Finally in the studies addressing objective (iii), isometric muscle training postures were identified which targeted quadriceps and hamstrings muscle activation without overloading the medial compartment of the knee. Muscle activation levels required to increase lower limb torque production capacity can be achieved by iii Ph.D. Thesis – H. Longpré McMaster University – Rehabilitation Science performing squats and lunges and these postures elicit lower knee moments than those experienced during gait. This work expands the understanding of healthy knee function and the relationships between muscle function and mechanical knee loading. These insights will contribute toward the future creation of muscle training programs and guidelines for knee OA or ACL injury. iv Ph.D. Thesis – H. Longpré McMaster University – Rehabilitation Science ACKNOWLEDGEMENTS I wish to acknowledge, with gratitude, my debt of thanks to several individuals without whom this work would not have been accomplished. Firstly, I would like to express my deepest appreciation to my supervisor, Dr. Monica Maly. I am extraordinarily lucky to have benefitted from Dr. Maly’s support, dedication, and guidance. Monica, thank you for being a teacher when I needed to learn, a leader when I needed direction, a mentor when I needed support, and a friend every step of the way. I am so grateful to have been part of the outstanding team that you have built. Thank you for giving me opportunities to challenge my boundaries and to discover my passions. Special thanks to the members of my thesis advisory committee who have kept me on track and focused through my doctoral work. Dr. Jim Potvin, thank you for helping me to navigate through the technical details and for your thought provoking questions during our meetings. Dr. Norma MacIntyre, thank you for caring about the finest details of my work. You helped me to develop depth and focus while offering a valuable clinical perspective to our discussions. Dr. Michael Pierrynowski, thank you for always reminding me of the big picture. I now routinely question my personal philosophies in all aspects of my life. Special mention to Dr. Paul Stratford who has kindly offered his guidance and expertise over the course of my doctoral education, and to Dr. Joy MacDermid who graciously stepped in as a mentor and supporter. I think it rare to find a collaborator, colleague and friend as brilliant, kind, wise, and caring as Dr. Stacey Acker. Stacey, thank you for guiding me through the past seven (!) years. Yours is a shoulder that I know I can always lean on and I will forever offer the v Ph.D. Thesis – H. Longpré McMaster University – Rehabilitation Science same to you in return. I owe enormous thanks to Ayesha Johnson, a colleague and friend. Ayesha, it has been a great pleasure to watch you become an ace researcher. Thank you for your tireless commitment to helping me through my data collections. With great pleasure and pride, I have had the opportunity to participate in the development of the MacMobilize laboratory, led by Dr. Maly. Through this initiative, I have gained lasting friendships with several colleagues. My thanks go out to all members of the MacMobilize lab who truly demonstrate the qualities and characteristics of a team. Kristina, Neha, Nick, Christine, Ange, and Connie, I have benefitted immensely from your expertise, technical skills, insights, curiosity, and friendships. A great deal of thanks must be extended to a few very special friends. Ila, your love, optimism, and belief in me give me the courage to venture out of my comfort zone. Thanks to the Olynyk, Lee, and Pierce families for being my extended family and providing tireless amounts of fun and good cheer. I am most fortunate to have truly gained a new family through my marriage. My most sincere thanks are extended to Joe, Robbie, and Mackenzie for welcoming me as a Longpré and for continuously supporting my dreams. My parents and brother, Heidi, Richard, and David Linley, receive my deepest gratitude and love for their unending encouragement and reassurance. I thank you with all my heart for your emotional and financial support of my academic and personal pursuits. Finally, to my wonderful husband, Joe, your endless support, encouragement, and patience have allowed me to accomplish my loftiest goals. Thank you for being my best friend, my sounding board, and my number one cheerleader. I love you! vi Ph.D. Thesis – H. Longpré McMaster University – Rehabilitation Science TABLE OF CONTENTS Chapter One ........................................................................................................................ 1 Introduction ......................................................................................................................... 1 1.1 Motivation ................................................................................................................. 1 1.2 Key Topics ................................................................................................................ 1 1.2.1 The Knee Adduction Moment ........................................................................... 1 1.2.2 Muscle Activation and Coactivation .................................................................. 3 1.2.3 Muscle Strength ................................................................................................. 5 1.2.4 Alternative Measures of Muscle Function beyond Strength .............................. 7 1.3 Objectives ................................................................................................................. 8 1.4 Benefits and Impact .................................................................................................. 9 1.5 Thesis Organization and Structure ............................................................................ 9 1.6 References ............................................................................................................... 12 Chapter Two ...................................................................................................................... 23 Biomechanical Changes at the Knee after Lower Limb Fatigue in Healthy Young Women ........................................................................................................................................... 23 2.1 Abstract ................................................................................................................... 24 2.2 Introduction ............................................................................................................. 26 2.3 Methods ................................................................................................................... 28 2.3.1 Participants ....................................................................................................... 28 2.3.2 Design .............................................................................................................. 29 2.3.3
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