• Korean Journal of Applied Biomechanics
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• v.31 no.1
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• pp.30-36
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• 2021

Objective: The objective of the present study was to analyze the relationship between strength of the lower extremity's joints and their local dynamic stability (LDS) of gait in elderly women. Method: Forty-five elderly women participated in this study. Average age, height, mass, and preference walking speed were 73.5±3.7 years, 153.8±4.8 cm, 56.7±6.4 kg, and 1.2±0.1 m/s, respectively. They were tested torque peak of the knee and ankle joints with a Human Norm and while they were walking on a treadmill at their preference speed for a long while, kinematic data were obtained using six 3-D motion capture cameras. LDS of the lower extremity's joints were calculated in maximum Lyapunov Exponent (LyE). Correlation coefficients between torque of the joints and LyE were obtained using Spearman rank. Level of significance was set at p<.05. Results: Knee flexion torque and its LDS was negatively associated with adduction-abduction and flexion-extension movement (p<.05). In addition, ratio of the knee flexion torque to extension and LDS was negatively related to internal-external rotation. Conclusion: In conclusion, knee flexion strength should preferentially be strengthened to increase LDS of the lower extremity's joints for preventing from small perturbations during walking in elderly women.

• Physical Therapy Korea
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• v.30 no.4
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• pp.275-280
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• 2023

Background: Although warm-ups before exercise are widely accepted, research on sex differences in improving hamstring flexibility is limited. Differences in the physical and physiological characteristics between males and females may result in different responses to warm-ups. Objects: This study aimed to examine sex differences in the effects of specific warm-up on hamstring flexibility. Methods: This study included 24 young adults with hamstring tightness. The participants performed five maximal knee extensions and flexions at 90° flexion of the hip, and the maximal knee extension angle was measured in real-time using a smartphone clinometer application. Results: The groups did not significantly affect the maximal knee extension angle but showed a significant effect for repetition (p = 0.002) and group-repetition interaction (p = 0.002). Males had no significant change in hamstring flexibility; however, females showed a significant increase in flexibility in the 5^th trial compared with the 1^st trial (p = 0.041). These results demonstrated sex-specific differences in flexibility improvement over time. Conclusion: The findings of this study suggest that specific warm-up can successfully improve hamstring flexibility in females. This may be due to various factors, such as muscle stiffness of the lower extremity, estrogen levels, and temperature sensitivity. In clinical settings, specific warm-up might be helpful for females who participate in sports or activities, such as running or jumping, which require a full range of motion in the hip and knee joints.

• Physical Therapy Korea
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• v.11 no.4
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• pp.1-6
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• 2004

The kinematics involved in different landing strategies may be related to the occurrence of trauma. Several sources suggest that the angle of knee extension on touchdown and impact with the ground determines the magnitude of the impact force and, indirectly, knee loading. This study compared the initial knee angle and maximum knee flexion angle at the instant of impact on drop-landings between healthy men and women. In this study, 60 participants (30 males, 30 females) dropped from a height of 43 cm. A digital camera and video motion analysis software were used to analyze the kinematic data. When landing, there was significant difference between the two groups ($15.67{\pm}6.05^{\circ}$ in male, $24.10{\pm}6.34^{\circ}$ in female) in the mean knee flexion angle. The range of knee flexion on landing ($44.06{\pm}10.97^{\circ}$ in male, $36.96{\pm}9.99^{\circ}$ in female) also differed significantly (p<.05). The greater knee flexion that was observed in the male subjects would be expected to decrease their risk of injury. Women land with smaller range of knee flexion than men and this might increase the likelihood of a knee injury.

• Korean Journal of Applied Biomechanics
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• v.16 no.1
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• pp.31-41
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• 2006

The primary purpose of a TKA is to restore normal knee function Therefore, ideally, a TKA should: (a) maintain the natural leverage of the knee joint muscles to ensure generating adequate knee muscle moments to accomplish daily tasks such as rising from climbing stairs; (b) provide adequate knee joint stability. A 16-channel MyoResearch XP EMG system was used to collect the differential input surface electromyography signals VM, VL, RF, BF, ST during climbing/descending stair tests. A Peak Motion Measurement System was used to collect the kinematic and kinetic data. AKIN-COM Ill isokinetic dynamometer was used for EMG of VM, VL, RF, BF and ST during maximal voluntary contraction. I Quadriceps EMG results for the VM of the passed 1year group limb demonstrated significant less RMS EMG than that of the passed 3year group limb $60^{\circ}-15^{\circ}$ of knee flexion(p<0.05). The VL of the passed 1year group limb also demonstrated significants less RMS EMG than that of the passed 3year group limb from $60^{\circ}-45^{\circ}$ of knee flexion(p<0.05). Similar to the VM and VL, the RF of the passed 1year group limb showed less RMS EMG than that of the passed 3year group limb from $60^{\circ}-30^{\circ}$ do knee flexion(p<0.05). Hamstring EMG results for the BF of the passed 1year group limb demonstrated less RMS EMG than that of the passed 3year group limb from $75^{\circ}-15^{\circ}$ of knee flexion(p<0.05). The passed 1year group limb tended to have less ADD displacement(p<0.071) than that of the passed 3year group limb. There was no significant difference of the ABD displacement between the passed 1year group and the passed 3year group limbs(p<0.73). The passed 3year group used compensatory adaptation movement strategies to compensate for the strength deficit of passed 3year group limbs. The passed 3year group limb also increased the quadriceps muscle activation level to produce more knee extension moment to compensate for the short quadriceps moment arm. The passe 3year group limb might have an unstable knee joint in the medio-Iateral direction during the climbing/descending by showing a tendency of more ADD displacement and greater hamming co-activation EMG than the passed 1year group limbs. The TKA design was not able to help the knee joint to produce adequate knee extension moment with less quadriceps muscle effort. I think that old man needs continuous exercise for muscle strength.

• Archives of Reconstructive Microsurgery
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• v.23 no.2
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• pp.101-104
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• 2014

Reconstruction of soft tissue defects of the knee has always been a challenging task for plastic surgeons. Various reconstructive choices are available depending on the location, size, and depth of the defect relative to the knee joint. Defects on the knee joint have several characteristic features. The use of a free flap is preferred for reconstructions involving obliteration of large-cavity defects, but recipient pedicle isolation can be difficult because of the extent of the injury zone. Furthermore, the true defect during knee joint flexion is larger than during knee joint extension, and a durable flap is necessary for joint movement. We report for the first time on the use of pedicled perforator flaps for reconstruction of bilateral knee defects in a 76-year-old woman. The operative procedure required skeletonizing the perforators of an antero-lateral thigh flap and antero-medial thigh flap and rotating the flap in the defect. The patient returned to normal daily activity and had a full range of motion two months after the accident. The shorter operating time with decreased donor site morbidity and its durability make this flap a valuable alternative for soft tissue reconstruction of the knee.

• Physical Therapy Korea
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• v.8 no.2
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• pp.65-72
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• 2001

The purpose of this study was to investigate the effect of knee exercises on the onset times of vastus medialis oblique muscle (VMO) and vastus lateralis muscle (VL) and in healthy subjects. Fifteen subjects (7 men, 8 women) in a mean age of 26.4 years participated in the study. Electromyographic (EMG) signals were recorded from the VMO and VL under four exercises. Knee exercises consisted of open kinematic terminal knee extension, straight leg raising, isometric hip adduction exercise, and closed kinematic terminal knee extension. No significant differences were found in the onset times of EMG activities of VMO and VL in the four exercises. There were also no significant differences among the exercises. These results coincided with previous studies that found no difference between onset of VMO and VL. However, it is difficult to say that there is no difference between onset of VMO and VL in healthy subjects. To confirm this results, further researches that follow same on set determination metod and exercises are needed. Not only is the study of onset time of muscle needed, but also the studies of the amount of activation and the rate of increase of muscle activation are needed.

• Physical Therapy Korea
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• v.24 no.3
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• pp.40-46
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• 2017

Background: The active knee extension (AKE) test commonly used to assess the flexibility of the hamstring muscles. Many researchers have tested the reliability of the AKE test; however, no published studies have examined the intrarater and interrater reliability of the AKE test using a PBU. Objects: The purpose of this study was to determine the intrarater and interrater reliability of the AKE test performed with a pressure biofeedback unit (PBU) on healthy subjects. Methods: Sixteen healthy male participants volunteered and gave informed consent to participate in this study. Two raters conducted AKE tests independently with a PBU. Each knee was measured twice, and the AKE testing was repeated one week after the first round of testing. Results: The interrater reliability's intraclass correlation coefficients ($ICC_{2,1}$) were .887~.986 for the right knees and .915~.988 for the left knees. In addition, the intrarater (test-retest) reliability ($ICC_{3,1}$) values ranged between .820~.915 and .820~.884 for Raters 1 and 2, respectively. The values for the standard error of mesurement were low for all tests ($.81{\sim}2.97^{\circ}$); the calculated minimum detectable change was $2.24{\sim}8.21^{\circ}$. Conclusion: These findings suggest that the AKE test performed with a PBU had excellent interrater and intrarater reliability for assessing hamstring flexibility in healthy young males.

• Journal of Digital Convergence
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• v.17 no.3
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• pp.463-471
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• 2019

The purpose of this study was to investigate the effect of muscle imbalance on motion of back squat. The isokinetic muscle strength of the 8 subjects was recorded for the knee flexion/extension by the cybex 770 dynamometer. Each subject performed 3 back squats with the long barbell with an intensity of 25% body weight(BW), 50%BW, 100%BW, 125%BW. During the back squat through the recorded kinematic data the subjects' maximum flexion and extension knee angle, center of mass displacement and V-COP were calculated for evaluation of the stability of the movement. For the statistical analysis independent t-test was used. Knee flexion angle and COM displacement are dominated by the reciprocal muscle ratio. V-COP factor was dominated by bilateral extension deficit. Based on the results we can know that as the intensity of the squat increased to a level control was difficult because the muscles' imbalance influenced the movement.

• Korean Journal of Applied Biomechanics
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• v.28 no.4
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• pp.227-236
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• 2018

Objective: The purpose of this study was to investigate the effects of a 12-week combined exercise program on gait parameters in elderly women with osteoarthritis. Method: The subjects of this study were 11 elderly women (age: $67.09{\pm}2.47$, height: $157.35{\pm}4.30cm$, weight: $62.49{\pm}6.36kg$) with knee osteoarthritis. The combined exercise program of this study was divided into aerobic exercise and lower extremity strengthening exercises. The exercises were performed for 60 minutes per session, three times a week, for a total of 12 weeks. The maximum joint moments of the hip, knee, and ankle joints with walking were obtained with 8-3D cameras (MX-T20, Vicon, USA) and 2-force plate (AMTI OR6-7-400, AMTI, USA). SPSS Windows version 23.0 was used for statistical analysis. A paired t-test was used for pre-post comparison. An alpha level of .05 was utilized in all tests. Results: The maximum extension moment was significantly higher in the hip joint after P1 on the X axis. The maximum joint moment of P3 in extension was statistically significantly lower after intervention. On the Z axis, the maximum joint moment was significantly lower after the exercise intervention at P3. There was a statistically significant increase in the extension moment of the left and right knee joints in the X axis after exercise intervention. In the right ankle joint, P1 (plantar flexion moment) showed a statistically significant high moment after exercise intervention. Conclusion: These results suggest that combined exercise, including lower limb and aerobic exercise, may have a positive effect on mobility and walking moments in patients with osteoarthritis of the knee.

• PNF and Movement
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• v.20 no.2
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• pp.295-306
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• 2022

Purpose: This study aimed to investigate the effect of robot-assisted gait training on the active ranges of motion, gait abilities, and biomechanical characteristics of gait in patients who underwent lower extremity surgery, and to verify the effectiveness and clinical usefulness of robot-assisted gait training. Methods: This study was conducted on 14 subjects who underwent lower extremity surgery. The subjects participated in robot-assisted gait training for 2 weeks. The active ranges of motion of the lower extremities were evaluated, and gait abilities were assessed using 10-m and 2-min walk tests. An STT Systems Inertial Measurement Unit was used to collect data on biomechanical characteristics during gait. Spatiotemporal parameters were used to measure cadence, step length, and velocity, and kinematic parameters were used to measure hip and knee joint movement during gait. Results: Significant improvements in the active ranges of motion of the hip and knee joints (flexion, extension, abduction, and adduction) and in the 10-m and 2-min walk test results were observed after robot-assisted gait training (p < 0.05). In addition, biomechanical characteristics of gait, spatiotemporal factors (cadence, step length, and velocity), and kinematic factors (gait hip flexion-extension, internal rotation-external rotation angle, and knee joint flexion-extension) were also significantly improved (p < 0.05). Conclusion: The results of this study are of clinical importance as they demonstrate that robot-assisted gait training can be used as an effective intervention method for patients who have undergone lower extremity surgery. Furthermore, the findings of this study are clinically meaningful as they expand the scope of robot-assisted gait training, which is currently mainly applied to patients with central nervous system conditions.