Imperial College London

Dr Caroline Alexander

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Practice (Musculoskeletal Physiotherapy)
 
 
 
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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
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58 results found

Bates A, McGregor A, Alexander C, 2021, Comparing sagittal plane kinematics and kinetics of gait and stair climbing between hypermobile and non-hypermobile people; a cross-sectional study, BMC Musculoskeletal Disorders, Vol: 22, Pages: 1-9, ISSN: 1471-2474

Background: Joint Hypermobility Syndrome (JHS) presents with a range of symptoms including widespread joint hypermobility and chronic arthralgia. The study objective was to investigate whether impairments in JHS are due to hypermobility or another factor of JHS by identifying impairments in gait and stair-climbing tasks; an activity that is demanding and so may better show differences between the cohorts.Methods: 68 adults participated; 23 JHS, 23 Generalised Joint Hypermobility (GJH), and 22 Normal Flexibility (NF). Inclusion criteria for JHS participants were a positive classification using the Brighton Criteria, for GJH a Beighton Score ≥4, and for NF a Beighton Score <4 with no hypermobile knees. Participants were recorded with a 10-camera Vicon system whilst they performed gait and stair-climbing. Temporal-spatial, and sagittal plane kinematic and kinetic outcome measures were calculated and input to statistical analyses by statistical parametric mapping (SPM).Results: During the gait activity JHS had significantly greater stride time and significantly lower velocity than NF, and significantly greater stride time, lower velocity, and lower stride length than GJH. SPM analysis showed no significant differences between groups in gait kinematics. There were significant differences between groups for gait moments and powers; people with JHS tended to have lower moments and generate less power at the ankle, and favour power generation at the knee. A similar strategy was present in stair ascent. During stair descent people with JHS showed significantly more hip flexion than people with NF.Conclusions: As there was only one significant difference between GJH and NF we conclude that impairments cannot be attributed to hypermobility alone, but rather other factor(s) of JHS. The results show that both gait and stair-climbing is impaired in JHS. Stair-climbing results indicate that JHS are using a knee-strategy and avoiding use of the ankle, which may be a factor f

Journal article

Newington L, Wells M, Adonis A, Bolton L, Bolton Saghdaoui L, Coffey M, Crow J, Fadeeva Costa O, Hughes C, Savage M, Pakzad-Shahabi L, Alexander Cet al., 2021, A qualitative systematic review and thematic synthesis exploring the impacts of clinical academic activity by healthcare professionals outside medicine, BMC Health Services Research, Vol: 21, ISSN: 1472-6963

Background: There are increasing opportunities for healthcare professionals outside medicine to be involved in and lead clinical research. However, there are few roles within these professions that include time for research. In order to develop such roles, and evaluate effective use of this time, the range of impacts of this clinical academic activity need to be valued and understood by healthcare leaders and managers. To date, these impacts have not been comprehensively explored, but are suggested to extend beyond traditional quantitative impact metrics, such as publications, citations and funding awards. Methods: Ten databases, four grey literature repositories and a naïve web search engine were systematically searched for articles reporting impacts of clinical academic activity by healthcare professionals outside medicine. Specifically, this did not include the direct impacts of the research findings, rather the impacts of the research activity. All stages of the review were performed by a minimum of two reviewers and reported impacts were categorised qualitatively according to a modified VICTOR (making Visible the ImpaCT Of Research) framework. Results: Of the initial 2,704 identified articles, 20 were eligible for inclusion. Identified impacts were mapped to seven themes: impacts for patients; impacts for the service provision and workforce; impacts to research profile, culture and capacity; economic impacts; impacts on staff recruitment and retention; impacts to knowledge exchange; and impacts to the clinical academic. Conclusions: Several overlapping sub-themes were identified across the main themes. These included the challenges and benefits of balancing clinical and academic roles, the creation and implementation of new evidence, and the development of collaborations and networks. These may be key areas for organisations to explore when looking to support and increase academic activity among healthcare professionals outside medicine. The modified VICTO

Journal article

Clunie GM, Belsi A, Roe JWG, Alexander CM, Sandhu G, McGregor Aet al., 2021, Not just dyspnoea: swallowing as a concern for adults with laryngotracheal stenosis undergoing airway reconstruction, Dysphagia, ISSN: 0179-051X

Acquired laryngotracheal stenosis (LTS) is a rare condition causing dyspnea and stridor. Patients often require multiple surgical procedures with no guarantee of a definitive outcome. Difficulty swallowing is a recognised problem associated with LTS and the reconstructive surgeries required to manage the condition. The breathlessness patient’s experience impacts on swallowing, and the vulnerable structures of the larynx are implicated during complex surgeries. This leads to dysphagia post-surgery, with some patients experiencing more chronic symptoms depending on the biomechanical impact of the surgery, or a pre-existing dysphagia. Despite this there is limited observational research about the dysphagia associated with LTS, with no exploration of the patient experience. Our aim was to investigate patient experience of living with LTS focussing on dysphagia in order to guide clinical practice. A qualitative study was completed using focus groups and semi-structured interviews with 24 patients who have had reconstructive surgery for LTS. Thematic analysis was used to identify three over-arching themes: The Physical Journey, The Emotional Journey and The Medical Journey. Key sub-themes included the importance of self-management and control, presence of symptoms, benefits of therapy, living with a life-long condition, fear and anxiety, autonomy, medicalisation of normal processes and the dichotomy between staff expertise and complacency. Swallowing was connected to all themes. The results are reviewed with consideration of the wider literature of lived experience particularly in relation to other chronic conditions and those that carry a high symptom burden such as head and neck cancer. Future clinical and research recommendations have been made. Akin to other clinical groups, adults with LTS are keen that management of their swallowing is person-centred and holistic.

Journal article

Kennedy DL, Vollert J, Ridout D, Alexander CM, Rice ASet al., 2021, The responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study, Pain, Pages: 1-1, ISSN: 0304-3959

ABSTRACT: The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy.With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated prior to and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change.QST results (n=76) were compared to healthy controls (n=54). At 6 months post-surgery 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (p<.001). Change in QST parameters occurred for thermal detection, thermal pain and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures were not statistically significant. Change occurred in sensory phenotype post-surgery (p<.001); sensory phenotype was associated with symptom subgroup (p=.03) and patient-rated surgical outcome (p =.02).QST derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.

Journal article

Bates A, McGregor A, Alexander C, 2021, Adaptation of balance reactions following anterior perturbations in people with Joint Hypermobility Syndrome, BMC Musculoskeletal Disorders, Vol: 22, ISSN: 1471-2474

BackgroundJoint Hypermobility Syndrome (JHS) is a Heritable Disorder of Connective tissue characterised by joint laxity and chronic widespread arthralgia. People with JHS exhibit a range of other symptoms including balance problems. To explore balance further, the objective of this study is to compare responses to forward perturbations between three groups; people who are hypermobile with (JHS) and without symptoms and people with normal flexibility.MethodsTwenty-one participants with JHS, 23 participants with Generalised Joint Hypermobility (GJH) and 22 participants who have normal flexibility (NF) stood on a platform that performed 6 sequential, sudden forward perturbations (the platform moved to the anterior to the participant). Electromyographic outcomes (EMG) and kinematics for the lower limbs were recorded using a Vicon motion capture system. Within and between group comparisons were made using Kruskal Wallis tests.ResultsThere were no significant differences between groups in muscle onset latency. At the 1st perturbation the group with JHS had significantly longer time-to-peak amplitude than the NF group in tibialis anterior, vastus medialis, rectus femoris, vastus lateralis, and than the GJH group in the gluteus medius. The JHS group showed significantly higher cumulative joint angle (CA) than the NF group in the hip and knee at the 1st and 2nd and 6th perturbation, and in the ankle at the 2nd perturbation. Participants with JHS had significantly higher CA than the GJH group at the in the hip and knee in the 1st and 2nd perturbation. There were no significant differences in TTR.ConclusionsThe JHS group were able to normalise the timing of their muscular response in relation to control groups. They were less able to normalise joint CA, which may be indicative of impaired balance control and strength, resulting in reduced stability.

Journal article

Clunie G, Roe J, Alexander C, Sandhu G, McGregor Aet al., 2021, Voice and swallowing outcomes following airway reconstruction in adults: a systematic review, The Laryngoscope, Vol: 131, Pages: 146-157, ISSN: 0023-852X

Objectives: Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact on voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.Study Design: Systematic review.Methods: Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. Results: A total of 143 abstracts were reviewed, with 67 articles selected for full text review. 20 studies met the inclusion criteria. Data extraction was completed with The Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous and there was limited information provided about rationale or reliability.Conclusion: The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there is no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement.

Journal article

Newington L, Alexander CM, Wells M, 2020, What is a clinical academic? Qualitative interviews with healthcare managers, research-active nurses and other research-active healthcare professionals outside medicine, Journal of Clinical Nursing, ISSN: 0962-1067

AIM AND OBJECTIVES: To explore the concept of 'clinical academic' from the perspectives of healthcare managers and research-active healthcare professionals outside medicine. BACKGROUND: Clinical academics are understood to be healthcare professionals who combine clinical and research responsibilities within their role. However, there is no agreed definition for this term either within or across nursing, midwifery and the other healthcare professions outside medicine. DESIGN: Qualitative service evaluation, reported using the COREQ checklist. METHODS: Semi-structured qualitative interviews were conducted with a purposive sample of eight healthcare managers and 12 research-active clinicians within a UK hospital group. Interviews were audio recorded, transcribed verbatim, and analysed using the Framework method. RESULTS: Clinical academics were described in four themes. Two themes explored the components of the role and the contribution of these individuals to their profession: combining clinical practice, research and education; and pushing boundaries. The third theme identified the clinical academic label as: a title that doesn't fit. The final theme examined a characteristic mindset of research-active clinicians. There were no clear differences in the perceptions of managers and research-active clinicians. CONCLUSIONS: Clinical academics were perceived as valuable members of their team and were able to push the boundaries to move their profession forward. Some research-active clinicians did not identify with the term 'clinical academic' and for some managers and research-active clinicians, the term was viewed as jargonistic. A clear and accepted definition would aid development of clinical academic career pathways and identities. It would also assist in evaluating the impact of these roles. RELEVANCE TO PRACTICE: As clinical academics roles and opportunities are being developed across the professions outside medicine, it is important to have a shared common understa

Journal article

Castro-Sanchez E, Alexander CM, Atchison C, Patel D, Leung W, Calamita ME, Garcia DM, Cimpeanu C, Mumbwatasai JM, Ramid D, Doherty K, Grewal HS, Otter JA, Wells EMet al., 2020, Evaluation of a personal protective equipment (PPE) support programme ('PPE Helpers') for staff during the COVID-19 pandemic in London, Journal of Hospital Infection, Vol: 109, Pages: 68-7, ISSN: 0195-6701

BackgroundThe COVID-19 pandemic has presented one of the biggest challenges to healthcare providers worldwide. The appropriate use of Personal Protective Equipment (PPE) has been essential to ensuring staff and patient safety. To counteract sub-optimal PPE practice, a PPE helper programme was developed at a large London hospital group. Based on a behaviour change model of Capability, Opportunity and Motivation (COM-B), the programme provided PPE support, advice and education to ward staff.AimEvaluation of the PPE Helper Programme.MethodsClinical and non-clinical ward staff completed a questionnaire informed by the Theoretical Domains Framework and COM-B. The questionnaire was available in paper and electronic versions. Quantitative responses were analysed using descriptive and non-parametric statistics, free-text responses were analysed thematically.FindingsOver a six-week period, PPE helpers made 268 ward visits. Overall, 261 questionnaires were available for analysis. Across the Trust, 68% of respondents reported having had contact with a PPE helper. Staff who had encountered a PPE helper responded significantly more positively to a range of statements about using PPE than those who had not. Black and Minority Ethnic (BAME) staff were significantly more anxious in relation to the adequacy of PPE. Non-clinical and redeployed staff (e.g. domestic staff) were most positive about the impact of PPE helpers. Free-text comments showed that staff found the programme supportive and would have liked it earlier in the pandemic.ConclusionA PPE Helper programme is a feasible and beneficial intervention for providing support, advice and education to ward staff during infectious disease outbreaks.

Journal article

Aldera M, Alexander C, McGregor A, 2020, Prevalence and incidence of low back pain in the Kingdom of Saudi Arabia: a systematic review, Journal of Epidemiology and Global Health, Vol: 10, Pages: 269-275, ISSN: 2210-6006

Study Design: A systematic review.Objective: To identify published studies that assess the prevalence and incidence of Low Back Pain (LBP) in the Saudi Arabian population.Methods: Six electronic databases were searched for articles published between January 1995 and December 2018. Crosssectional or cohort studies were included if they were conducted in the KSA and focused on the prevalence or incidence of LBP in adults. Case–control and retrospective studies were excluded. Studies were also excluded if they did not meet the quality criteria set out by the Joanna Briggs Institute (JBI) assessment or had a high or medium risk of bias according to the criteria proposed by Hoy et al. One independent reviewer (MAA) verified that the studies met the inclusion criteria, and three independent reviewers (MAA, AHM, CMA) assessed the quality of the studies and extracted their relevant characteristics. All the studies were assessed for quality using the JBI assessment and were assessed for risk of bias according to the Hoy et al. approach.Results: The initial search identified 158 papers; five studies met the inclusion criteria. The nature of the findings meant no meta-analysis could be performed; therefore, a narrative summary was generated to discuss the findings. The prevalence of LBP in different professional groups within a working-age group ranged between 64% and 89%.Discussion: The prevalence of LBP in the KSA has only been examined within specific professional groups, which limits the ability to generalize the finding. The review clarifies the need for further quality epidemiological studies to identify the prevalence of LBP in the general population. Many of the issues identified are problems related to occupational risk of LBP. The implication therefore is that these occupational factors need to be assessed so that risk factors for LBP among employees in KSA can be modified.

Journal article

Clunie G, Belsi A, Roe J, Alexander C, Sandhu G, McGregor Aet al., 2020, Not Just Dyspnoea – Swallowing as a Concern for Adults with Laryngotracheal Stenosis Who Undergo Reconstructive Surgery?, UK Swallowing Research Group 2020 Conference

Conference paper

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

Bates AV, Mcgregor AH, Alexander C, 2016, Comparison of prolonged unconstrained standing behaviour in people with Joint Hypermobility Syndrome and people who have normal flexibility, ESMAC, Publisher: Elsevier, ISSN: 1879-2219

Conference paper

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

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

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

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

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