Imperial College London

Dr Caroline Alexander

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Senior Lecturer; Adjunct Reader
 
 
 
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Contact

 

caroline.alexander

 
 
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Location

 

Department of PhysiotherapyCharing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

48 results found

To M, Strutton P, Alexander C, 2019, Central fatigue is greater than peripheral fatigue in people with Joint Hypermobility Syndrome, Journal of Electromyography and Kinesiology, Vol: 48, Pages: 197-204, ISSN: 1050-6411

Purpose: People with Joint Hypermobility Syndrome (JHS) suffer with fatigue. The purpose of this project was to investigate the contribution of central and peripheral fatigue.Methods: Electrical stimulation of the musculocutaneous nerve to biceps brachii, and transcranial magnetic stimulation over the motor cortex supplying biceps brachii were used. Peripheral and central fatigue were assessed during a control, fatiguing and recovery phase protocol. Results: JHS participants perceived greater fatigue during the protocol compared to a control group and did not recover. Central and peripheral fatigue did not occur in the control group. However, the JHS group showed central fatigue. MEP amplitude increased in the JHS group during the fatiguing protocol (p<0.01) before recovering. Superimposed twitch amplitude increased in the JHS group during the fatiguing protocol and stayed elevated during the recovery phase (p<0.04). Time to peak (TTP) amplitude of the torque generated by the TMS was longer in the JHS group (p<0.05). RMS during MVCs decreased during the fatiguing protocol reaching significance during the recovery phase (p<0.01).Conclusion: JHS participants suffered central but not peripheral fatigue. A modified strength programme to target this is discussed.

Journal article

Alexander C, To M, 2019, Are people with joint hypermobility syndrome slow to strengthen?, Archives of Physical Medicine and Rehabilitation, Vol: 100, Pages: 1243-1250, ISSN: 0003-9993

ObjectivesTo investigate whether the rate of change of muscle strength in people with joint hypermobility syndrome (JHS) who have anterior knee pain (AKP) differs when compared to 2 control groups who have AKP and to evaluate the relationship between strength and pain as well as the effect of strength upon activity and knee function.DesignA cohort study, with 3 groups: JHS with AKP, generalized joint hypermobility with AKP (GJH), and normal flexibility with AKP (control group [CG]). Follow-up appointments were performed every 2 weeks for 16 weeks.SettingThe physiotherapy outpatient department within a London (United Kingdom) hospital.ParticipantsA total of 102 people, aged between 18 and 55 years, were recruited between July 2014 and March 2016; 47 JHS, 29 GJH, and 26 CG (N=102). After 16 weeks, 31, 20, and 21 participants completed the study, respectively. Participants were recruited from support groups, a London hospital group and university, local sports centers, and clubs.InterventionsIndividualized leg exercises for 16 weeks.Main Outcome MeasureMuscle torque generated from the lower limb, every 2 weeks for 16 weeks.ResultsThere was no difference in the rate of change of concentric muscle strength between the JHS group and the CG or GJH group (P>.88 and P>.97). There was no difference in the rate of change of eccentric muscle strength between the JHS group and the CG or GJH group (P>.60 and P>.94). However, people with JHS were significantly weaker than the other 2 groups, taking 3 to 4 months to reach the baseline strength of the GJH group.ConclusionPeople with JHS can strengthen at the same rate as other people in pain.

Journal article

To M, Simmonds J, Alexander CM, 2016, Where do people with Joint Hypermobility Syndrome present in secondary care? The prevalence in a general hospital and the challenges of classification, Musculoskeletal Care, Vol: 15, Pages: 3-9, ISSN: 1557-0681

Aim:Joint Hypermobility Syndrome (JHS) is an inherited disorder of the connective tissue and can lead to widespread pain, joint instability and fatigue. In order to understand where patients with musculoskeletal symptoms and JHS present to in secondary care we have established the prevalence of JHS within the pain management service, a general rheumatology clinic and an orthopaedic clinic of a single general hospital.Method:A total of 138 patients attending the pain management service, a general rheumatology clinic and an orthopaedic clinic were surveyed for Joint Hypermobility Syndrome as part of their usual care using the Brighton criteria. Results:The pain management and general rheumatology clinics both demonstrated a similar prevalence of 39.1% and 37.0% respectively. The orthopaedic clinic demonstrated a much lower prevalence of 10.9%. Conclusion:There were a higher number of people with JHS presenting to the pain management and general rheumatology clinics than the orthopaedic clinic. This reflects an appropriate pathway for this multiple joint pathology. The difficulty in classifying people with JHS is discussed as these figures may reflect an over classification of the condition.

Journal article

Bates AV, McGregor AH, Alexander CM, 2016, Reliability and minimal detectable change of gait kinematics in people who are hypermobile, GAIT & POSTURE, Vol: 44, Pages: 37-42, ISSN: 0966-6362

Journal article

Alexander C, 2015, The difference of Park and Streitberger single-blind needles from Takakura double-blind needle Author response, JOURNAL OF INTEGRATIVE MEDICINE-JIM, Vol: 13, Pages: 214-214, ISSN: 2095-4964

Journal article

Navsaria R, Ryder DM, Lewis JS, Alexander CMet al., 2015, The Elbow-EpiTrainer: a method of delivering graded resistance to the extensor carpi radialis brevis. Effectiveness of a prototype device in a healthy population, BRITISH JOURNAL OF SPORTS MEDICINE, Vol: 49, Pages: 318-+, ISSN: 0306-3674

Journal article

Shaheen AF, Bull AMJ, Alexander CM, 2015, Rigid and Elastic taping changes scapular kinematics and pain in subjects with shoulder impingement syndrome; an experimental study, JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY, Vol: 25, Pages: 84-92, ISSN: 1050-6411

Journal article

Bates AV, Alexander CM, 2015, Kinematics and kinetics of people who are hypermobile. A systematic review, GAIT & POSTURE, Vol: 41, Pages: 361-369, ISSN: 0966-6362

Journal article

Drachman DB, Kaminski HJ, 2015, NEUROMUSCULAR JUNCTION AS ACHILLES' HEEL: YET ANOTHER AUTOANTIBODY? Response, NEUROLOGY, Vol: 84, Pages: 214-215, ISSN: 0028-3878

Journal article

To M, Alexander C, 2015, The effects of Park sham needles: a pilot study, JOURNAL OF INTEGRATIVE MEDICINE-JIM, Vol: 13, Pages: 20-24, ISSN: 2095-4964

Journal article

Alexander C, Schabrun S, 2015, Non-invasive brain stimulation in the measurement and treatment of musculoskeletal disorders., Grieve’s Modern Musculoskeletal Physiotherapy

Book chapter

Kassam J, Alexander C, 2014, A PILOT STUDY TO PREPARE FOR AN INVESTIGATION OF CORTICOSPINAL EXCITABILITY IN PEOPLE WITH JOINT HYPERMOBILITY SYNDROME, 15th Annual European Congress of Rheumatology (EULAR), Publisher: BMJ PUBLISHING GROUP, Pages: 1088-1089, ISSN: 0003-4967

Conference paper

Matthews D, Murtagh P, Risso A, Jones G, Alexander CMet al., 2013, Does interhemispheric communication relate to the bilateral function of muscles? A study of scapulothoracic muscles using transcranial magnetic stimulation, JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY, Vol: 23, Pages: 1370-1374, ISSN: 1050-6411

Journal article

Shaheen AF, Villa C, Lee Y-N, Bull AMJ, Alexander CMet al., 2013, Scapular taping alters kinematics in asymptomatic subjects, JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY, Vol: 23, Pages: 326-333, ISSN: 1050-6411

Journal article

MacDonald R, Tanner J, Alexander CM, Skew P, Foell J, Rutte S, Harley Set al., 2012, Order and Disorder ‐ Unravelling Motor Function and Dysfunction., International Musculoskeletal Medicine, Vol: 2, Pages: 76-82

Journal article

Greenwood NL, Duffell LD, Alexander CM, McGregor AHet al., 2011, Electromyographic activity of pelvic and lower limb muscles during postural tasks in people with benign joint hypermobility syndrome and non hypermobile people. A pilot study, Man Ther

Benign joint hypermobility syndrome (BJHS) is associated with the early development of certain degenerative conditions, which may be associated with altered muscle activity. This pilot study compared muscle activation patterns during postural tasks between people with BJHS who do not have pain and people with normal flexibility (control group). Sixteen subjects aged 22-45 years (8 with BJHS) were selected from a population recruited to a larger study. Electromyographic activity of erector spinae (ES), gluteus medius (GM), and lower limb (rectus femoris (RF), semitendinosus (ST), tibialis anterior (TA) and gastrocnemius lateralis) muscles was assessed, and chosen based on the muscles being tested in the larger study. Subjects carried out 30 s of quiet standing (QS) and one-leg standing (OLS), both with eyes open (EO) and eyes closed (EC). Both groups had significantly more TA activity, and control subjects had significantly more GM activity, during OLS EC compared with QS. GM activity was not significantly different between groups. Compared with the BJHS group, control subjects had significantly less ST activation overall, significantly more ES activity during OLS EC and significantly less RF-ST co-contraction during QS. This study has noted differences in muscle activation patterns between pain-free hypermobile people and control subjects, specifically involving muscles surrounding the pelvis and hip. This pilot data suggests that strategies for stabilising the body during balancing tasks may be relevant to injury risk in people with BJHS. While results need to be verified with a larger subject sample, this study is important in developing new treatments for hypermobile people

Journal article

Elliott SC, Hanson JR, Wellington J, Alexander CMet al., 2011, Reflex control of posterior shoulder muscles from arm afferents in healthy people, J Electromyogr.Kinesiol., Vol: 21, Pages: 1087-1091

In order to position the hand during functional tasks, control of the shoulder is required. Heteronymous reflexes from the upper limb to shoulder muscles are used to assist in this control. To investigate this further, the radial and ulnar nerves were stimulated at elbow level whilst surface electromyographic activity of posterior deltoid, infraspinatus and latissimus dorsi muscles were recorded. In addition, the cutaneous branch of the radial nerve and the skin of the fifth digit were stimulated in order to investigate any cutaneous contribution to reflex activity. Reflexes were evoked in all three of these shoulder muscles from hand and/or forearm afferents. However, the reflexes differed; whereas both excitatory and inhibitory reflexes were evoked in posterior deltoid and infraspinatus, the reflexes in latissimus dorsi were mainly excitatory. Cutaneomuscular reflexes were seldom evoked here, but when they were present they were generally evoked at longer latencies than the reflexes evoked by mixed nerve stimulation. The results suggest a role for reflexes originating from the forearm and/or hand in the control of the shoulder

Journal article

Wightman F, Delves S, Alexander CM, Strutton PHet al., 2011, Differences in descending control of external oblique and latissimus dorsi muscles in humans: a preliminary study, Motor Control, Vol: 15, Pages: 405-418

Descending bilateral control of external oblique (EO) and latissimus dorsi (LD) was investigated using transcranial magnetic stimulation. Contralateral (CL) motor evoked potential (MEP) thresholds were lower and latencies were shorter than for ipsilateral (IL) MEPs. Hotspots for EO were symmetrical; this was not the case for LD. The volumes of drive to the left and right muscles were not different. The laterality index was not different between the left and right muscles. The average index for the EO muscles was closer to zero than that for LD, suggesting a stronger IL drive to EO. The symmetry of drive to each muscle did not differ; however, the symmetry of drive varies within a subject for different muscles and between subjects for the same muscle. The findings may be useful in understanding a number of clinical conditions relating to the trunk and also for predicting the outcome of rehabilitative strategies

Journal article

Shaheen AF, Alexander CM, Bull AM, 2011, Tracking the scapula using the scapula locator with and without feedback from pressure-sensors: A comparative study, J Biomech., Vol: 44, Pages: 1633-1636

BACKGROUND: The scapula locator method has associated intra-observer and inter-observer errors caused by the dependency on the observer to locate the scapular landmarks. The potential effect of the pressures applied by the observer on the measured scapular kinematics when this method is used has also been overlooked so far. The aim of this study was to investigate the effect of using feedback on the pressures applied on the scapula using the locator on the intra-observer and inter-observer reliabilities of the method as well as on the kinematics obtained using this method. METHODS: Three observers tracked the scapular motion of the dominant shoulder of each subject using the locator with no reference to pressure-feedback for three trials of bilateral elevation in the scapular plane and using the locator with pressure-feedback for three other trials. Variations between the measurements obtained were used to calculate the intra-observer errors and variations between the measurements obtained by the three observers for the same subject were used to calculate inter-observer errors. Repeated-measures ANOVA tests were used to look at differences between the two methods in terms of intra-observer and inter-observer errors and scapular kinematics. FINDINGS: Using pressure-feedback reduced the intra-observer errors but had no effect on the inter-observer errors. Different scapular kinematics was measured using the two methods. INTERPRETATIONS: Pressure-feedback improves the reliability of the scapula locator method. Differences in the scapular kinematics suggest that unregulated pressures have an effect on the physiological scapular motion

Journal article

Shaheen AF, Alexander CM, Bull AM, 2011, Effects of attachment position and shoulder orientation during calibration on the accuracy of the acromial tracker, J Biomech., Vol: 44, Pages: 1410-1413

The acromial tracker is used to measure scapular rotations during dynamic movements. The method has low accuracy in high elevations and is sensitive to its attachment location on the acromion. The aim of this study was to investigate the effect of the attachment position and shoulder orientation during calibration on the tracker accuracy. The tracker was attached to one of three positions: near the anterior edge of the acromion process, just above the acromial angle and the meeting point between the acromion and the scapular spine. The scapula locator was used to track the scapula during bilateral abduction simultaneously. The locator was used to calibrate the tracker at: no abduction, 30 degrees , 60 degrees , 90 degrees and 120 degrees humerothoracic abduction. ANOVA tests compared RMS errors for different attachment positions and calibration angles. The results showed that attaching the device at the meeting point between the acromion and the scapular spine gave the smallest errors and it was best to calibrate the device at 60 degrees for elevations </=90 degrees , at 120 degrees for elevations >90 degrees and at 90 degrees or 120 degrees for the full range of abduction. The accuracy of the tracker is significantly improved if attached appropriately and calibrated for the range of movement being measured

Journal article

Alexander CM, 2011, Shoulder girdle control; some mechanisms of function to dysfunction, Man Ther, Vol: 16, Pages: 42-43

Journal article

Firth BL, Dingley P, Davies ER, Lewis JS, Alexander CMet al., 2010, The effect of kinesiotape on function, pain, and motoneuronal excitability in healthy people and people with Achilles tendinopathy, Clin J Sport Med., Vol: 20, Pages: 416-421

OBJECTIVE: To investigate the effect of kinesiotape on hop distance, pain, and motoneuronal excitability in healthy people and people with Achilles tendinopathy (AT). DESIGN: Within-subject design. SETTING: An academic health science center, which is an acute London National Health Service trust. PARTICIPANTS: With ethical approval and informed consent, a convenience sample of 26 healthy people and 29 people with AT were recruited. Seven participants were lost after functional testing, leaving 24 participants in each group. INTERVENTIONS: Kinesiotape applied over the Achilles tendon. MAIN OUTCOME MEASURES: The single-leg hop test and visual analog scale were measured with and without the tape. Using the Hoffman (H) reflex, change in motoneuronal excitability of calf muscles was measured before tape application, with the tape on and after its removal. RESULTS: There were no changes to hop distance when tape was applied (P = 0.55). Additionally, there were no changes to pain (P = 0.74). The H reflex amplitude of soleus and gastrocnemius increased in the healthy group after its removal (P = 0.01 and P = 0.03, respectively), whereas the H reflex remained unchanged in people with AT (P = 0.43 and 0.16, respectively). CONCLUSIONS: Calf muscles were facilitated by kinesiotape in healthy participants. Despite this, there was no change to hop distance. Kinesiotape had no effect on hop distance, pain, or motoneuronal excitability in people with AT. These results do not support the use of kinesiotape applied in this way for this condition

Journal article

Jeremiah HM, Alexander CM, 2010, Do hypermobile subjects without pain have alteration to the feedback mechanisms controlling the shoulder girdle?, Musculoskeletal Care, Vol: 8, Pages: 157-163

OBJECTIVES: It has been reported that hypermobile subjects have proprioceptive deficits. However, it remains unclear whether pain-free subjects with hypermobility also have deficits. METHODS: Ten subjects with hypermobility and nine without hypermobility were recruited following ethical approval and informed consent. Shoulder mobility, joint position sense (JPS) and a reflex of trapezius evoked from arm afferents were compared. RESULTS: There was greater shoulder mobility in the hypermobile group (p = 0.004). There were no differences in shoulder JPS between the groups (p = 0.27), although, the hypermobile group displayed a larger degree of variability (p = 0.014). Finally, there were no differences in the latency of upper and lower trapezius reflexes evoked from arm afferents (p = 0.86 and 0.98, respectively). CONCLUSIONS: In a group of people with hypermobility without shoulder problems, there was no difference in either shoulder JPS or reflex latency when compared with a non- hypermobile group. The relevance of pain to proprioceptive deficits is discussed

Journal article

Hamm K, Alexander CM, 2010, Challenging presumptions: is reciprocal inhibition truly reciprocal? A study of reciprocal inhibition between knee extensors and flexors in humans, Man Ther, Vol: 15, Pages: 388-393

Reciprocal inhibition (RI) between different muscles has been used as an explanation for the effect of some treatments. Consequently, there may be a presumption that RI is bi-directional and equal between every agonist antagonist muscle pair. That is, the strength of RI from agonist to antagonist is equal to that from antagonist to agonist. With this in mind we investigated RI between quadriceps and hamstrings using 2 techniques to explore if a) it is evoked between this agonist antagonist pair and b) if it is equal and opposite in strength. Firstly, electromygraphic (EMG) activity of one muscle was recorded whilst stimulating group Ia afferents from the other. The second approach involved conditioning a reflex evoked in one muscle by stimulating Ia afferents from the other. Using the first approach, short-latency inhibition thought to be RI, was observed more frequently (p<0.000) and was larger (p<0.05) from femoral nerve stimulation to hamstrings than the inhibition evoked in quadriceps by sciatic nerve stimulation. The second approach revealed a similar pattern. RI between quadriceps and hamstrings is not actually reciprocal i.e. not equal in both directions. Our presumptions about the frequency and strength of other pathways between different agonist antagonist pairs need to be assessed

Journal article

Potier TG, Alexander CM, Seynnes OR, 2009, Effects of eccentric strength training on biceps femoris muscle architecture and knee joint range of movement, Eur J Appl.Physiol, Vol: 105, Pages: 939-944

The aim was to determine whether eccentric strengthening changed the muscle architecture of human biceps femoris and consequently, knee range of motion. Twenty-two subjects were randomly assigned to control and experimental groups. The experimental group completed an eccentric strengthening programme for 8 weeks. Outcome measures included hamstring muscle strength (one repetition maximum), the passive knee extension test (PKE) (knee joint angle at which the onset of passive tension occurs), fascicle length (FL) and pennation angle (PA). One repetition maximum increased by 34% (P < 0.01), the PKE test revealed a 5% increase in joint range of motion (P = 0.01), FL increased by 34% (P = 0.01) and PA did not change (P = 0.38). This is the first report of an increase in FL in the biceps femoris following eccentric resistance training. In addition, the results might imply that this fascicle lengthening could lead to an increase in the range of motion of the knee. Clinical implications for rehabilitation and injury prevention are discussed

Journal article

Alexander CM, McMullan M, Harrison PJ, 2008, What is the effect of taping along or across a muscle on motoneurone excitability? A study using triceps surae, Man.Ther., Vol: 13, Pages: 57-62

Taping along the skin overlying lower trapezius reduces motoneurone excitability in healthy subjects [Alexander, C.M., Stynes, S., Thomas, A., Lewis, J., Harison, P.J., 2003. Does tape facilitate or inhibit the lower fibres of trapezius? Manual Therapy 8, 37-41]. It remains unclear whether this effect is: (a) specific to trapezius and (b) specific to the direction of application of the tape. In light of this, the excitability of another muscle was measured in order to see if these results were repeatable and independent of the muscle taped. Thus, the excitability of the medial and lateral gastrocnemius (MG and LG) and soleus (Sol) motoneurone pool was assessed using the Hoffman reflex (H reflex). The amplitude of this reflex was measured with the tape aligned across and then along the direction of the MG muscle fibres. Tape aligned across the fibres failed to affect motoneurone excitability (MG P=0.61, LG P=0.69, Sol P=0.17). Under tape and sports tape applied together aligned along the MG muscle reduced the excitability of both MG and LG (19% (P=0.01) and 13% (P=0.01), respectively). These observations suggest that any change to movement patterns with tape application cannot be explained by facilitation of the motoneurone excitability

Journal article

Roberts L, Wellington J, Harrison A, Alexander CMet al., 2008, Reflex connections of the infraspinatus muscle in healthy humans., Dunedin, New Zealand

Conference paper

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