Relationship of Knee Extensor Strength and

Hopping ~ e s Performance
t in the ~ssessmentof
Lower Extremity Function
Hilary 6. Greenberger, MS, PT, OCS'
Mark V. Paterno, MS, PT2

sokinetic strength testing has Traditionally, open kinetic chain rehabilitation and evaluation have been used as the primary
been used as a primary assess- tool to assess a patient's strength and readiness to progress to a higher functional level. More
ment tool to determine a pa- recently, closed kinetic chain activities have been developed and well documented as an alternate
tient's strength, ability to means to prepare and evaluate a patient's ability to return to a higher functional level. However, a
progress to advanced activities, dearth in recent literature comparing the correlation between an open kinetic chain isokinetic
and ability to return to a maximum strength test and performance on a functional performance test exists. Therefore, the purpose of this
level of function (1,24). This type of study was to examine the relationship behveen a knee extensor strength and functional performance
training and testing is referred to as test, specifically the one-legged hop for distance. Twenty subjects (X = 20.7 years), with no prior
Downloaded from www.jospt.org by 49.35.99.37 on 07/12/19. For personal use only.

open kinetic chain exercise, where history of lower extremity injury, participated in the study consisting of isokinetic evaluation of the
the muscle acts in isolation to per- quadriceps muscle using a Kinetic Communicator and a one-legged hop for distance. lsokinetic
form a task, accomplished through testing was performed at 240Ysec. All tests were performed on the dominant and nondominant
incorporation of a combination of limbs. Pearson product moment correlation coefficients for peak toque and distance hopped were
several joints united successfully .78 for the dominant leg and .65 for the nondominant leg (p < .05). These results support the belief
where the end segment is not fixed that isokinetic strength does not correlate strongly with functional tasks.
(11.23). This method was previously
Key Words: functional testing, muscle strength, knee
viewed as the optimal rehabilitation
approach for various lower extremity ' Assistant Professor, lthaca College, Departmentof Physical Therapy, Ithaca, NY 14850
Staff Physical Therapist, Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH. Mr. Patemo
J Orthop Sports Phys Ther 1995.22:202-206.

injuries as rehabilitation protocols was a physical therapy student at lthaca College at the time this study was conducted.
from the late 1970s and early 1980s
emphasized open kinetic chain exer-
cise throughout treatment. Success muscles necessary to accomplish a ity functional performance tests per-
with open kinetic chain isokinetic functional task through the use of a formed in a closed kinetic chain are
strength tests was used as an indica- combination of several joints succes- an extremely valuable evaluative tool
tion to progress to higher levels of sively when the end segment is fixed (1,4,8,17,18,20,22,26).Since func-
activity (5,6,24). (11,23). tional performance tests attempt to
Recently, literature has suggested Literature suggests that rehabili- reproduce an environment with
that isolated muscle testing does not tation in a closed kinetic chain is a forces experienced daily, they are
give enough information on a pa- safer and more functional way to considered more functional and
tient's functional ability, especially in treat and evaluate lower extremity should be included in the assessment
the sports arena (11,la). Addition- injuries (4,lO,23,29). This suggestion of a patient's readiness to return to
ally, training only in an open kinetic is particularly true in the rehabilita- their previous level of function (2-4,
chain cannot sufficiently prepare the tion of patients following anterior 8,9,16,22,25-27). Specifically, the
patient to return to a dynamic func- cruciate ligament injury as the forces one-legged hop for distance simulates
tional level (l8,2l). Hence, closed produced with closed kinetic chain a task frequently needed in various
kinetic chain testing and rehabilita- activities result in less anterior tibia1 sports and functional activities. In
tion were developed. Closed kinetic translation than open kinetic chain fact, the International Knee Docu-
chain exercise of the lower extremity activities (10,23,30,31). Several au- mentation Committee (IDKC) has
is a dynamic incorporation of several thors have agreed that lower extrem- incorporated a functional one-legged

Volume 22 Number 5 November 1995 JOSPT

 RESEARCH STUDY
--

Male (N = 7) Female ( N = 13) Combined (N = 20) Functional Test

Subject - - -
X SD X SD X SD On the day of functional testing,
Age (years) 21.9 2.9 20.1 0.8 20.7 1.9 the subject warmed up for 5 minutes
Height (cm) 180.7 7.1 166.7 6.0 171.7 9.3 on a stationary bike. Following this,
Weight (kg) 75.6 9.7 59.7 5.7 65.1 10.6 the subject received an explanation
TABLE. Subject characteristics. of the one-legged hop for distance.
Subjects were asked to stand on one
leg and their heel was positioned on
hop into its knee ligament evaluation kinetic chain functional performance
a piece of athletic tape, which was
form as its only determinant of a pa- tests. Therefore, the purpose of this
affixed to a standard linoleum block
tient's functional level, further fortify- study was to determine the relation-
floor. Subjects were instructed to
ing the belief that horizontal h o p ship between knee extensor strength keep both hands behind their back
ping is an aspect of function (7). of the quadriceps and performance to eliminate their use in generating
Recently, various functional per- on a one-legged hop for distance test momentum. The subject was then
formance tests have been developed on subjects with no prior history of asked to execute three warm-ups by
to better assess the patient's ability to knee injury. hopping horizontally and landing on
return to a higher level of function.
the supporting leg. This was followed
Functional performance tests such as
by a 30-second rest. Finally, three
shuttle runs (10,19,20), carioca runs
(10,19,20), and single-leg hops (1,8) METHODS maximal efforts, with the subject h o p
have been studied to determine their ping as far as possible, were exe-
usefulness in the evaluation of pa- Subjects cuted. The subject was required to
tients with lower extremity dysfunc- land on one leg. Failure to land on
Twenty subjects (seven males and the supporting leg resulted in a re-
tion. Specifically, these tests were de-
13 females) from a college commu- hop. This occurred in approximately
signed to evaluate the patient's dy-
Downloaded from www.jospt.org by 49.35.99.37 on 07/12/19. For personal use only.

nity, representing a sample of conve- 5 1 0 % of the subjects. Prior to maxi-

namic functional level, taking into
nience, served as participants for this mal hopping, charcoal was placed on
account strength, endurance, power,
and coordination (21). study. Subject characteristics are out- the heel of the subject's shoe to mark
Isokinetic testing in an open lined in the Table. To be included in the floor surface upon landing. Mea-
chain has been used to evaluate the study, subjects had to meet the surements were taken from heel to
strength. However, studies have indi- following criteria: I) no prior history heel with a standard measuring tape.
cated a lack of strong correlation be- of unresolved pain, injury, or surgery Following each hop, the subject was
tween involved extremity physical to either hip, knee, or ankle and positioned 2 feet lateral to the previ-
characteristics, such as the results of 2) currently not taking prescription ous hop. Large cardboard plates were
J Orthop Sports Phys Ther 1995.22:202-206.

resisted strength tests and func- medication for pain. Approval for the placed over the recorded mark of the
tional tests. This weak correlation study was obtained from the Ithaca previous hop to eliminate its use as a
College Human Subjects Review visual cue. The subject then repeated
Board. Prior to any testing, informed this protocol two more times for a
total of three trials. The same proto-
There was a significant consent forms were signed by all par-
ticipants. col on the opposite leg was then per-
correlation between formed. The leg tested first was ran-
domized by a coin flip. No audio
distance hopped and Procedure cues were given and subjects were
asked to wear the same pair of ath-
knee extensor strength. All subjects participated in two
letic shoes on both testing days.
20-minute sessions separated by at
least 72 hours of rest. On the first
day, patient medical screening and lsokinetic Test
has been shown in patients with
ACMeficient knees (18) as well as selected physical characteristics were On the day of isokinetic testing,
with patients following total hip re- assessed. Leg dominance was assessed the subjects had their right and left
placement (28). by asking the subject to take a step quadriceps evaluated on a Kinetic-
Based on this review of the litera- forward and kick a soccer ball which Communicator (Kin-Com, Chattecx
ture, it might be surmised that isoki- was rolling toward the center of their Corp., Chattanooga, TN). The s u b
netic strength may not necessarily legs "as if you were kicking a ball into ject was stabilized in a seated position
guarantee patient success with closed a soccer goal." with four Velcro@straps. Individual

JOSPT Volume 22 Number 5 November 1995

 R E S E A R C- H .
S ,T .U-.D- Y . ...~ - .--.- -.-. .----

I Dominant I DISCUSSION
Results of this study revealed that
no significant difference existed be-
147.40 143.40 tween the dominant and nondomi-
nant limb when testing with the one-
160 100 legged hop for distance. This finding
Dlmnce 140 Average go
Jumped Peak 80 agrees with the study by Barber et al
(cm) 120 Torque 70 (4) who also found no significant
100 (Nm) 60 difference between dominant and
80 50 nondominant limbs. When testing
60 40 isokinetically at 240°/sec, no signifi-
30
40 cant difference was found between
20
20 10 the dominant and nondominant
0 0 limb. This finding, too, is in agree-
Functional Test lsokinetic Test ment with a study by Hageman et al
(13) who tested dominant and non-
FIGURE. Mean values and standard deviation o f dominant and nondominant distance hopped (cm)and dominant
and nondominant average peak toque (Nm)o f the quadriceps at 240°/sec. dominant concentric quadriceps
strength on a KinGom. However, the
straps stabilized the trunk, waist, Data Analysis tests were performed at velocities of
thigh, and leg. Stabilization at the leg 30 and 180°/sec slower then what
was as far distal as possible, while still Means and standard deviations were used in this study.
allowing full dorsiflexion at the an- were calculated for all variables. Only a moderate correlation ex-
kle. The subject executed five s u b Scores on the functional test repre- isted for both dominant and non-
maximal concentric warm-ups at sented a mean of the three maximal dominant limbs when comparing the
Downloaded from www.jospt.org by 49.35.99.37 on 07/12/19. For personal use only.

240°/sec followed by one maximal effort hops. Scores on the isokinetic functional test with the isokinetic
concentric contraction at 240°/sec. test represented the average peak test. These results are consistent with
Following a 60-second rest, the s u b torque of the three maximal effort the finding of other authors, such as
ject executed three maximal concen- concentric extensions. Paired t tests Tegner et al (26), Tibone et al (27),
tric extensions at 240°/sec, which were were used to compare the dominant Lephart et al (18), and Barher et al
recorded and used for data collection. with the nondominant limb. Pearson (4), who found a low correlation be-
The same protocol was repeated on product moment correlation coeffi- tween isokinetic testing and other
the contralateral leg. The leg tested cients were used to determine the various functional test.. Tegner et al
first was randomized as well as the or- relationship between the functional (26) reported that 35% of patients
test and isokinetic test for both the
J Orthop Sports Phys Ther 1995.22:202-206.

der of testing days. The test speed of with ACL deficiency had normal
240°/sec wa. chosen secondary to its dominant and nondominant limb. quadriceps strength at 30°/sec, but
functional nature. Functional activities An alpha level of .05 was used to de- failed to achieve normal values on a
such as walking, jogging, running, and termine the significance level for all performance test consisting of figure-
hopping all require angular velocities analyses. eight running, a one-legged hop,
at the knee of speed in excess of running up and down a special stair-
200°/sec. However, a limitation of the RESULTS case, and running up and down a
KinGom is that its fastest speed is slope.
300°/sec. Twehundred-and-forty de- Paired t tests comparing mean Tibone et al (27), while studying
grees/*~ were determined to be a distance hopped in cm revealed no a functional analysis of anterior cruci-
speed which was most frequently used significant difference between the ate ligament instability, stated that
for testing in the clinic and was closer dominant and nondominant limb on achieving quadriceps torque of 96%
to angular velocities which may be oc- the functional performance test nor of the uninvolved limb was not sufi-
cumng at the knee during the one- on the isokinetic test at 240°/sec cient to eliminate the subjective need
legged hop for distance. Similar speeds (Figure). Pearson product moment for surgical reconstruction. In addi-
of 300°/sec and 270°/sec were used by correlation coefficients revealed a tion, Tibone et al stated that even
Barber et al (4) and Lephart et al (18), statistically significant correlation though adequate quadriceps strength
respectively. Both of these studies ex- ( p < .05) between the distance was attained, the patient continued
amined the relationship between func- hopped and the average peak torque to demonstrate a significant differ-
tional testing and physical characteris- for the dominant (r = .782) and the ence between limbs with a crosscut
tics, including isokinetic testing. nondominant ( r = .649) leg. maneuver. Lephart et al (20) re-

Volume 22 Number 5 November 1995 JOSPT

 ported results consistent with Tibone reliable with healthy subjects in stud- REFERENCES
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-
JOSF'T * Volume 22 * Number 5 November 1995
 - -
R E--
S E A R--C H STUDY

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J Orthop Sports Phys Ther 1995.22:202-206.

Volume 22 Number 5 November 1995 JOSFT

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