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Function of the Distal Part of the Vastus Medialis Muscle As a Generator of Knee Extension Twitch Torque

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Function of the Distal Part of the Vastus Medialis Muscle As a Generator of Knee Extension Twitch Torque Journal of Functional Morphology and Kinesiology Article Function of the Distal Part of the Vastus Medialis Muscle as a Generator of Knee Extension Twitch Torque Yoshitsugu Tanino *, Takaki Yoshida, Wataru Yamazaki, Yuki Fukumoto, Tetsuya Nakao and Toshiaki Suzuki Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, 2-11-1Wakaba, Kumatori, Sennan, Osaka 590-0482, Japan; [email protected] (T.Y.); [email protected] (W.Y.); [email protected] (Y.F.); [email protected] (T.N.); [email protected] (T.S.) * Correspondence: [email protected] Received: 30 November 2020; Accepted: 16 December 2020; Published: 18 December 2020 Abstract: The distal part of the vastus medialis (VM) (VM obliquus: VMO) muscle acts as the medial stabilizer of the patella. However, it has been known to facilitate VMO contraction during training of the quadriceps femoris muscle in knee joint rehabilitation. This study aimed to examine the contribution degree of VMO as a knee joint extension torque generator. Sixteen healthy male volunteers participated in this study. Electrical muscle stimulation (EMS) was performed on VMO at 60◦ knee angle for 20 min to induce muscle fatigue. Knee extension twitch torques (TT) at 90◦ and 30◦ knee angle evoked by femoral nerve stimulation were measured before and after EMS. Although each TT at 90◦ and 30◦ knee angle significantly decreased after EMS, the decreased TT rate in both joint angles showed no significant difference. Our results show that VMO might contribute to the generation of the knee joint torque at the same level in the range from flexion to extension. Therefore, it was suggested that the facilitating the neural drive for VMO is important during the quadriceps femoris muscle strengthening exercise. Keywords: electrical muscle stimulation; knee extension; muscle fatigue; twitch torque; vastus medialis 1. Introduction Torque generated at the knee through contraction of the quadriceps femoris muscle is essential for locomotion in humans. This torque affects the functional convalescence of patients with knee joint disease such as knee osteoarthritis and knee cruciate ligament injuries [1,2]. Therefore, the tension of the quadriceps femoris muscle should be transmitted to the tibial tuberosity to efficiently generate knee joint extension torque. The patella provides a component force to pull tibial tuberosity forward by bringing an angle of tilt to the patellar tendon in the sagittal plane in addition to lengthening the moment arm of the quadriceps femoris muscle and promotes efficiency of the torque occurrence [3]. However, due to the traction angle known as the Q-angle in the quadriceps femoris muscle, “laterally-directed force” acts on the patella during the muscle contraction [4]. The tension of the distal part of vastus medialis (VM obliquus: VMO) is known to stabilize the patella and efficiently generate knee joint extension torque [4–6]. Based on a muscle fiber orientation, VMO is not primarily involved in knee joint extension [5,7], but is thought to be the source that indirectly contributes to the knee joint extension torque, as mentioned above. Many therapists also believe that VMO contraction is an important function in knee rehabilitation [8]. However, the actual contribution of VMO in generating knee joint extension torque remains unclear. To investigate this, we tried to selectively induce the muscle fatigue of VMO for noninvasive in vivo examination because muscle fatigue is defined as a condition of inability J. Funct. Morphol. Kinesiol. 2020, 5, 98; doi:10.3390/jfmk5040098 www.mdpi.com/journal/jfmk J. Funct. Morphol. Kinesiol. 2020, 5, 98 2 of 6 J. Funct. Morphol. Kinesiol. 2020, 5, x FOR PEER REVIEW 2 of 6 toinduce generate the the muscle expected fatigue force of [VMO9]. Therefore, for noninvasive we used in electrical vivo examination muscle stimulation because muscle (EMS) fatigue to induce is VMOdefined fatigue as ina condition this study of and inability knee jointto generate extension the torque expected was force investigated [9]. Therefore, before we and used after electrical the fatigue task.muscle With stimulation regard to knee(EMS) joint to induce torque, VMO the twitchfatigue torquein this study (TT) evokedand knee by joint femoral extension nerve torque stimulation was wasinvestigated used as an before index and because after thethe activityfatigue task. pattern With of re thegard quadriceps to knee joint femoris torque, muscle the twitch is di fftorqueerent among(TT) participantsevoked by underfemoral voluntary nerve stimulation contraction. was This used study as an aimed index to because examine the the activity contribution pattern degreeof the of VMOquadriceps as a knee femoris joint extension muscle is torquedifferent generator. among participants under voluntary contraction. This study aimed to examine the contribution degree of VMO as a knee joint extension torque generator. 2. Materials and Methods 2. Materials and Methods 2.1. Participants 2.1. Participants Sixteen healthy male volunteers without a history of knee joint injuries participated in this study.Sixteen Their mean healthy and male standard volunteers deviations without a (SD) history of age,of knee height, joint injuries and weight participated were 20.7 in this0.6 study. years , ± 172.3Their5.9 mean cm and, and standard 61.2 6.2 deviations kg, respectively. (SD) of age, We height, sufficiently and weight explained were 20.7 the ± purpose, 0.6 years, method, 172.3 ± 5.9 risk, cm,± and 61.2 ± 6.2 kg,± respectively. We sufficiently explained the purpose, method, risk, and and renunciation upon their participation; written informed consent was obtained from all participants. renunciation upon their participation; written informed consent was obtained from all participants. This study was approved by the Research Ethic Review Committee of Kansai University of Health This study was approved by the Research Ethic Review Committee of Kansai University of Health Sciences (approval number: 18–41, approval date: 16 February 2019). Sciences (approval number: 18–41, approval date: 16 February 2019). 2.2. Measurement of Knee Extension Torque 2.2. Measurement of Knee Extension Torque Knee joint extension torques were measured from the dominant leg using the Biodex System 3 Knee joint extension torques were measured from the dominant leg using the Biodex System 3 isokinetic dynamometer (Biodex Medical Systems Inc., Shirley, NY, USA). In addition, the leg used isokinetic dynamometer (Biodex Medical Systems Inc., Shirley, NY, USA). In addition, the leg used toto kick kick a balla ball was was considered considered as as the the dominant dominant side.side. The measurement measurement procedure procedure for for the the knee knee joint joint torquetorque in in the the isokinetic isokinetic dynamometer dynamometer waswas followed,followed, matched matched with with the the participants’ participants’ knee knee joint joint and and dynamometerdynamometer axes, axes, and and regulated regulated usingusing aa leverlever arm le lengthngth of of attachment attachment so so that that a pad a pad could could fit fitthe the distaldistal leg leg in in the the sitting sitting position. position. TheThe inclinationinclination angl anglee of of the the backrest backrest was was adjusted adjusted so so that that the the flexion flexion angleangle of of the the hip hip joint joint was was 60 60°◦ (0 (0°◦ indicating indicating neutralneutral position of of flexion/extension) flexion/extension) (Figure (Figure 1).1). FigureFigure 1. 1.Experimental Experimental setup. setup. LeftLeft picturepicture shows the position position of of electrical electrical muscle muscle stimulation stimulation (EMS) (EMS) electrodeselectrodes on on the the vastus vastus medialis medialis obliquus obliquus musclemuscle andand electrical stimulator stimulator to to evoke evoke the the twitch twitch torque torque (TT).(TT). The The position position of of stimulus stimulus electrodes electrodes connectedconnected to an electrical electrical stimulator stimulator device device is isshown shown in inthe the rightright figure. figure. TheThe femoral femoral nerve nerve was was percutaneously percutaneously stimulatedstimulated at at the the Scarpa’s Scarpa’s triangle triangle to to evoke evoke TT TT using using an an electricalelectrical stimulator stimulator device, device, i.e., electromyogrami.e., electromyogram machine machine Viking Viking Quest versionQuest version 9.0 (Natus 9.0 Neurology(Natus Inc.,Neurology Middleton, Inc., WI, Middleton, USA). A self-adhesive-type WI, USA). A self-adh disposableesive-type disk electrodedisposable (20 disk mm electrode diameter) (20 was mm used asdiameter) the cathode was of used stimulus as the electrode cathode of and stimulus was attached electrode to and the was femoral attached nerve to throughthe femoral the femoralnerve arterythrough pulse the palpation femoral artery in the pulse Scarpa’s palpation triangle. in the Then, Scarpa’s a square triangle. self-adhesive-type Then, a square disposableself-adhesive-type electrode (40disposable50 mm) electrode was used (40 as × an 50 anode mm) was and used attached as an to an theode greater and attached trochanter to the of greater the femur trochanter percutaneously of the × (Figurefemur1). percutaneously Electrical stimulus (Figure was 1). defined Electrical as a stimulus rectangular was wave defined of 0.5 as ms a rectangular duration with wave 120% of intensity0.5 ms of the stimulation, requiring the maximum TT (supramaximal stimulation). TT was measured
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