The immediate effects of terminal knee extension exercise synchronized with audible cues on motor unit behavior in athletes with anterior cruciate ligament reconstruction: a preliminary study

Authors

  • Sakda Nitkotom, MSc student, PT Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Nakhon pathom, Thailand
  • Pongthanayos Kiratisin, PhD student, PT Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Nakhon pathom, Thailand https://orcid.org/0009-0004-4648-7798
  • Poramate Suntornon, MSc student College of Sports Science and Technology, Mahidol University, Nakhon pathom, Thailand https://orcid.org/0009-0006-8326-3202
  • Ainthira Sonsukong, PhD student, PT Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Nakhon pathom, Thailand https://orcid.org/0009-0000-4165-632X
  • Roongtiwa Vachalathiti, PhD, PT Musculoskeletal Physical Therapy Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, Thailand https://orcid.org/0000-0002-4626-1463
  • Kantheera Areerak, PhD, PT Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Nakhon pathom, Thailand https://orcid.org/0009-0001-4329-3355
  • Pisit Lertwanich, MD Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0002-1381-7330
  • Tananthorn Piamthipmanas, MD Golden Jubilee Medical Center, Mahidol University, Nakhon pathom, Thailand
  • Kornkit Chaijenkij, MD College of Sports Science and Technology, Mahidol University, Nakhon pathom, Thailand https://orcid.org/0000-0002-8708-6083
  • Patitta Rangsiyanon, PhD, PT Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Apicha Tosapornsupaluck, BSc, PT Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Komsak Sinsurin, PhD, PT Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Nakhon pathom, Thailand https://orcid.org/0000-0002-4632-3230

Keywords:

Anterior cruciate ligament reconstruction, audible cues, motor unit firing rate, motor unit action potential, neuromuscular exercise

Abstract

Background: After anterior cruciate ligament reconstruction (ACLR), the vastus medialis (VM) muscle commonly exhibits functional deficit. Incorporating a metronome during resistance exercises has been shown to improve cortical excitability. Terminal knee extension (TKE) exercise is designed to activate VM activity, especially safe for post-operative rehabilitation. Therefore, the aim of this study is to investigate the immediate effect of TKE exercise with and without audible cues on motor unit behavior in athletes with ACLR.

Materials and Methods: Two participants who underwent ACLR within the first 2 weeks were allocated into 2 groups. An experimental group performed TKE exercise with audible cues. Adding audible cues in the current study was provided with the beat sound of metronome (1 Hz). The control group performed TKE exercise without audible cues. Decomposition electromyography (dEMG) was used to assess motor unit action potential (MUAP) and motor

unit firing rate (MUFR) of VM muscle. The mean change of MUAP and MUFR were observed to compare pre- and post-exercise outcomes within and between groups.

Results: Both groups exhibited an increase of peak MUAP. TKE with audible cues showed a greater change (40.16%) than without audible cues (10.03%). A decreased average MUFR after TKE exercise was observed in both with (41.62%) and without (8.10%) audible cues.

Conclusion: After a single session of exercise, TKE with audible cues appears to enhance MUAP. This improvement may reflect changes in neural drive and adaptations in motor unit behavior. These findings might serve as a beneficial intervention to enhance rehabilitation outcomes in individuals with ACLR.

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2025-06-12

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1.
Nitkotom S, Kiratisin P, Suntornon P, Sonsukong A, Vachalathiti R, Areerak K, Lertwanich P, Piamthipmanas T, Chaijenkij K, Rangsiyanon P, Tosapornsupaluck A, Sinsurin K. The immediate effects of terminal knee extension exercise synchronized with audible cues on motor unit behavior in athletes with anterior cruciate ligament reconstruction: a preliminary study. Int. Phys. Ther. Res. Symp. 11th [Internet]. 2025 Jun. 12 [cited 2025 Jul. 11];11(1):75-88. Available from: https://conference.in.th/index.php/IPTRS2025/article/view/Nitkotom_et_al.2025

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Vol. 11 No. 1 (2025): The 11th International Physical Therapy Research Symposium 2025 (IPTRS 2025)

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