1 muscular function assessment gallagher - oeh ch 21 –muscle strength is a complex function that...
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Muscular Function Assessment
• Gallagher - OEH ch 21– Muscle strength is a complex function
that can vary with the methods of assessment
• Garg - – A comparison of isokinetic lifting
strength - speed and box size• Wolf -
– relationships between grip strength work capacity and recovery
• OUTLINE• Definitions and introduction• Assessment methods• Variables impacting performance• Recovery of performance
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Muscle Function• Gallagher• Strength - capacity to produce a force or
torque with a voluntary muscle contraction
• Power - Force * distance * time-1
• Endurance -ability to sustain low force requirements over extended period of time
• Measurement of human strength– Cannot be measured directly– interface between subject and device
influences measurement– Fig 21.1 Biomechanical eg.
• Q = (F * a)/b or c or d• force from muscle is always the same • results are specific to circumstances
• dynamic strength - motion around joint– variable speed - difficult to compare
• static or isometric strength- no motion– easy to quantify and compare – not representative of dynamic activity
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Factors Affecting Strength• Gender• Age• Anthropometry• Psychological factors - motivation
– table 21.1
• Task influence– Posture
• fig 21.2 angle and force production
– Duration• Fig 21.3
– Velocity of Contraction• Fig 21.4
– Muscle Fatigue
– Static vs dynamic contractions
– Frequency and work / rest ratio
– Temperature and Humidity• inc from 20-27 C - dec 10-20% in capacity
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Strength Testing (intro)• Isometric strength testing
– standardized procedures
– 4-6 sec, 30-120 sec rest
– standardized instruction
• postures, body supports, restraint systems, and environmental factors
– worldwide acceptance and adoption
• Dynamic strength
– isoinertial (isotonic)- mass properties of an object are held constant
– Psychophysical - subject estimate of (submax) load - under set conditions
– isokinetic strength
• through ROM at constant velocity
• Uniform position on F / V curve
• Standardized• Isolated muscle groups
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Strength testing• Testing for worker selection and
placement– Used to ensure that worker can tolerate
physical aspects of job– similar rates of overexertion injuries for
stronger and weaker workers
• Key principles– Strength test employed must be directly
related to work requirements• must be tied to biomechanical
analysis
• Isometric analysis fig 21.5– for each task - posture of torso and
extremities is documented (video)• recreate postures using software
– values compared to pop. norms • industrial workers
– estimate % capable of level of exertion– predict forces acting on lumbar spine
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Isometric Considerations• Discomfort and fatigue in isometrics
thought to result from ischemia– Increasing force, increases
intramuscular pressure which approaches then exceeds perfusion pressure - lowering then stopping blood flow
– Partial occlusion at 20-25% MVC– Complete occlusion above 50% MVC
• Fig 15-19 Astrand– Max hold time affected by % of MVC– Recommend less than 15% for long
term requirements
• Fig 15-20 Astrand– With repeated isometric contractions a
combination of Force and Frequency determine endurance
– Optimal work / rest ratio of 1/2– Frequency important as well (Astrand)
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Isoinertial Testing• Consider - biomechanics and grip
– Stabilization requirements
– justification of cut off scores
• Examples from industry• SAT - strength aptitude testing
– air force standard testing
– Pre-selected mass - increase to criterion level - success or failure
– found incremental weight lifted to 1.83m to be best test as well as safe and reliable
• PILE - progressive inertial lifting evaluation
– lumbar and cervical lifts -progressive weight - 4 lifts / 20 seconds
• standards normalized for age, gender and body weight
– variable termination criteria• voluntary, 85 % max HR, 55-60% body
weight
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Psychophysical testing• psychophysical methods
– workers adjust demand to acceptable levels for specified conditions
– provides ‘submax’ endurance estimate• Procedure -
– subject manipulate one variable-weight– Either test : starting heavy or light– add / remove weight to fair workload– Fair defined as : without straining,
becoming over tired, weakened, over heated or out of breath
• Study must use large number’s of subjects– evaluate / design jobs within
determined capacities by workers– 75% of workers should rate as
acceptable• If demand is over this acceptance level; 3
times the injury rate observed to occur
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Psychophysical (cont)• Summary
– Table 21.2 (Snook and Cirello)
• Advantages– realistic simulation of industrial
tasks
– very reproducible - related to incidence of low back injury
• Disadvantages– results can exceed “safe” as
determined through other methodology
– biomechanical, physiological
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Isokinetic Testing• Isokinetic testing
– Evaluates muscular strength throughout a range of motion at a constant velocity
– Consider - velocity, biomechanics– However;
• humans do not move at constant velocity
• isokinetic tests usually isolated joint movements
• may not be reflective of performance ability
• Redesign of isokinetic testing – multi joint simulation tasks for industry
• fig 21.8• Better, as they require core
stabilization• still in development, therefore
limited validity
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Comparing Isokinetic Strength (Garg)
• Goal of research– determine effects of speed of lifting and
box size on isokinetic strength– compare isokinetic with
• static lifting strength• psychophysically determined maximal
acceptable weight (MAW)
• Relevance of Research– Measurement of human strength is
important for job design– Important to match physical strength
requirements with worker capabilities to prevent injury
– Measurement of dynamic strength is complex
– Isokinetic strength is commonly used to measure dynamic strength
– The use of boxes instead of a bar is a better simulation of actual lifting tasks
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Methods• 9 male college students - range in
age 22-36 (table 1)• 12 lifts per hour (every 5 minutes)• lift floor to bench (.8 m)• 3 box sizes 25 - 50 cm wide• open technique - subjects choice **• Measure MAW, static strength,
isokinetic strength– MAW - adjust weight till comfortable– Static measured at origin of lift– Isokinetic evaluated at 3 speeds
• RPE on low back evaluated for all lifts
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Results• Progressive decline in mean and peak
isokinetic strength – with inc speed and inc box width– Fig 1 and 2– speed had greater impact than width
• Recommend lifting slowly
• However, high speed lifting perceived to be less stressful– RPE 10.7 (fast) vs 12.7 (slow)– Fig 3
• static strength and MAW higher correlation with mean than peak isokinetic strength– high speed - mean isokinetic - within 6%
of MAW– low speed - mean - equal to mean static
strength– Fig 4
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Recommendations• recommend
– both speed of lifting and box width should be controlled carefully
– using MAW and Static strength testing
• Static testing results in higher allowable limits for workers
• MAW - effectiveness not yet as well documented
• the complexities of isokinetic strength testing and its relationship to safe lifting capability are not fully understood
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Grip Strength, Work Capacity and Recovery
• Wolf• Investigates relationships between
strength, fatigue and work capacity that are central to occupational rehabilitation
• Musculoskeletal impairments are often expressed as loss of strength– % disability
• correlation between strength and endurance is greater than .90– endurance tests
• often assess repetitions to failure using a % of body weight
– strength test often use one rep max (isotonic) ; not always appropriate
• 1 RM= (weight) / [1- (RM * .02)]
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Grip Strength, Work Capacity and Recovery
• questions in paper– how important is strength as a
component of work capacity?– how do work capacity and strength
affect recovery time?
• Relevant research• Capacity to sustain work activity is
inversely related to power required– exponential decrease in endurance, as
demand approaches max– Walsh (Fig 1 and 2)
• after injury - loss of power leads to loss of capacity– rest from injury - often increases impact
due to muscular de-conditioning
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Background• Rehabilitation
– strengthen and condition worker to improve capacity
– Various programs (functional restoration, work conditioning, work hardening)
– Often difficult to establish and define dose of intervention precisely
• The goal is to accelerate the rate of rehab and shorten treatment time
• Physical training goals in the workplace are different from those ot athletes– Athlete: improve capacity to enhance
performance– Worker: improve capacity to minimize
the risk of injury and reduce the strain of performing tasks
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Background• Prediction equations for muscular
endurance at a given % of max contraction - constants for each muscle group (Sato)– results 10-35 % decline in strength– longer bout, lower recovery strength
• Fatigue - theory– short - high intensity exercise -
metabolic inhibition– longer duration - fatigue may be at
level of E-C coupling - ? K+ ?
• Relevance of isometric evaluation– low - due to low prevalence of
isometric activity– Greater relevance for hand
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Relationships• Research goals of Wolf study
– develop technology necessary to support a treatment strategy
– dose of exercise is able to be closely tied to expected levels of recovery
• Address issues of ;– expected work duration and capacity
– and recovery rates
• Methods- 40 healthy subjects-1/2 male
– Standard body position and instructions
– Measure isometric and isotonic max’s
– Repetitive isotonic gripping task at 25, 50 and 75 % of pre-trial max to failure
• measure isometric grip strength after 1, 5 10 and 20 min of recovery
• Take average of three trials
• Plot recovery rates of return to max strength
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Results• correlation between isometric and
isotonic strength maximums (.63)• poor correlation between isometric
or isotonic strength and duration (time) of work at either 75 or 50 %
• strong relationships between isotonic strength and work capacity (strength * time) at 75 and 50% levels (>.8)
• Isotonic strength best predictor of work capacity at 75 % level - – When compared with duration
• Work duration and isotonic strength had a similar predictive ability fro work capacity at the 50% resistance
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Recovery Results • No significant gender differences
– either for recovery time or % at any time points
– table III and fig 1
• Recovery rate and time to recovery– subjects categorized based on their time
to reach 100%– significant differences in initial degree
of recovery Fig 2 after fatigue– no differences in rate– similar slope, different starting points - – Rate of recovery, therefore related to
degree of initial strength loss (%)• This is therefore a good predictor of length
of recovery (time)
• Healthy standards - avg 20% decline in strength with protocol - 20 min recovery– variation - abnormal - intervention– standards - tables 4 and 5