Adaptation of skeletal muscle to immobilization in a shortened position

Mucopolysaccharidosis (MPS IIIA) mice have increased lung compliance and airway resistance, decreased diaphragm strength, and no change in alveolar structure

Mucopolysaccharidosis type IIIA (MPS IIIA) is characterized by neurological and skeletal pathologies caused by reduced activity of the lysosomal hydrolase, sulfamidase, and the subsequent primary accumulation of undegraded heparan sulfate (HS). Respiratory pathology is considered secondary in MPS IIIA and the mechanisms are not well understood. Changes in the amount, metabolism, and function of pulmonary surfactant, the substance that regulates alveolar interfacial surface tension and modulates lung compliance and elastance, have been reported in MPS IIIA mice. Here we investigated changes in lung function in 20-wk-old control and MPS IIIA mice with a closed and open thoracic cage, diaphragm contractile properties, and potential parenchymal remodeling. MPS IIIA mice had increased compliance and airway resistance and reduced tissue damping and elastance compared with control mice. The chest wall impacted lung function as observed by an increase in airway resistance and a decrease in peripheral energy dissipation in the open compared with the closed thoracic cage state in MPS IIIA mice. Diaphragm contractile forces showed a decrease in peak twitch force, maximum specific force, and the force-frequency relationship but no change in muscle fiber cross-sectional area in MPS IIIA mice compared with control mice. Design-based stereology did not reveal any parenchymal remodeling or destruction of alveolar septa in the MPS IIIA mouse lung. In conclusion, the increased storage of HS which leads to biochemical and biophysical changes in pulmonary surfactant also affects lung and diaphragm function, but has no impact on lung or diaphragm structure at this stage of the disease.NEW & NOTEWORTHY Heparan sulfate storage in the lungs of mucopolysaccharidosis type IIIA (MPS IIIA) mice leads to changes in lung function consistent with those of an obstructive lung disease and includes an increase in lung compliance and airway resistance and a decrease in tissue elastance. In addition, diaphragm muscle contractile strength is reduced, potentially further contributing to lung function impairment. However, no changes in parenchymal lung structure were observed in mice at 20 wk of age.

The Structural Adaptations That Mediate Disuse-Induced Atrophy of Skeletal Muscle

The maintenance of skeletal muscle mass plays a fundamental role in health and issues associated with quality of life. Mechanical signals are one of the most potent regulators of muscle mass, with a decrease in mechanical loading leading to a decrease in muscle mass. This concept has been supported by a plethora of human- and animal-based studies over the past 100 years and has resulted in the commonly used term of 'disuse atrophy'. These same studies have also provided a great deal of insight into the structural adaptations that mediate disuse-induced atrophy. For instance, disuse results in radial atrophy of fascicles, and this is driven, at least in part, by radial atrophy of the muscle fibers. However, the ultrastructural adaptations that mediate these changes remain far from defined. Indeed, even the most basic questions, such as whether the radial atrophy of muscle fibers is driven by the radial atrophy of myofibrils and/or myofibril hypoplasia, have yet to be answered. In this review, we thoroughly summarize what is known about the macroscopic, microscopic, and ultrastructural adaptations that mediated disuse-induced atrophy and highlight some of the major gaps in knowledge that need to be filled.

Muscle fascicle and sarcomere adaptation in response to Achilles tendon elongation in an animal model

Permanent loss of muscle function seen after an Achilles tendon rupture may partly be explained by tendon elongation and accompanying shortening of the muscle. Muscle fascicle length shortens, serial sarcomere number is reduced, and the sarcomere length is unchanged after Achilles tendon transection (ATT), and these changes are mitigated with suturing. The method involved in this study was a controlled laboratory study. Two groups of rats underwent ATT on one side with a contralateral control (CTRL): A) ATT with 3 mm removal of the Achilles tendon and no suturing (substantial tendon elongation), and B) ATT with suture repair (minimal tendon elongation). The operated limb was immobilized for 2 wk to reduce load. Four weeks after surgery the rats were euthanized, and hindlimbs were analyzed for tendon length, gastrocnemius medialis (GM) muscle mass, length, fascicle length, sarcomere number and length. No differences were observed between the groups, and in both groups the Achilles tendon length was longer (15.2%, P < 0.001), GM muscle mass was smaller (17.5%, P < 0.001), and muscle length was shorter (8.2%, P < 0.001) on the ATT compared with CTRL side. GM fascicle length was shorter (11.2%, P < 0.001), and sarcomere number was lower (13.8%, P < 0.001) on the ATT side in all regions. Sarcomere length was greater in the proximal (5.8%, P < 0.001) and mid (4.2%, P = 0.003), but not distal region on the ATT side. In this animal model, regardless of suturing, ATT resulted in tendon elongation, loss of muscle mass and length, and reduced serial sarcomere number, which resulted in an "overshoot" lengthening of the sarcomeres.NEW & NOTEWORTHY Following acute Achilles tendon rupture, patients are often left with functional deficits. The specific reason remains largely unknown. The shortened muscle leads to reduced fascicle length, in turn leading to adaptation by reduced serial sarcomere numbers. Surprisingly, this adaptation appears to "overshoot" and lead to increased sarcomere length. The present animal model advances understanding of how muscle sarcomeres, which are difficult to measure in humans, are affected when undue elongation takes place after tendon rupture.

Medial gastrocnemius muscle fascicle function during heel-rise after non-operative repair of Achilles tendon rupture

BACKGROUND

To better understand muscle remodelling in dynamic conditions after an Achilles tendon rupture, this study examined the length of medial gastrocnemius muscle fascicles during a heel-rise at 6- and 12-months after non-operative ATR treatment.

METHODS

Participants (15 M, 3F) were diagnosed with acute Achilles tendon rupture. Medial gastrocnemius subtendon length, fascicle length and pennation angle were assessed in resting conditions, and fascicle shortening during bi- and unilateral heel-rises.

FINDINGS

Fascicle shortening was smaller on the injured side (mean difference [95% CI]: -9.7 mm [-14.7 to -4.7 mm]; -11.1 mm [-16.5 to -5.8 mm]) and increased from 6- to 12 months (4.5 mm [2.8-6.3 mm]; 3.2 mm [1.4-4.9 mm]) in bi- and unilateral heel-rise, respectively. The injured tendon was longer compared to contralateral limb (2.16 cm [0.54-3.79 cm]) and the length decreased over time (-0.78 cm [-1.28 to -0.29 cm]). Tendon length correlated with fascicle shortening in bilateral (r = -0.671, p = 0.002; r = -0.666, p = 0.003) and unilateral (r = -0.773, p ≤ 0.001; r = -0.616, p = 0.006) heel-rise, at 6- and 12-months, respectively. In the injured limb, the change over time in fascicle shortening correlated with change in subtendon length in unilateral heel-rise (r = 0.544, p = 0.02).

INTERPRETATION

This study showed that the lengths of the injured tendon and associated muscle can adapt throughout the first year after rupture when patients continue physiotherapy and physical exercises. For muscle, measures of resting length may not be very informative about adaptations, which manifest themselves during functional tasks such as unilateral heel-rise.

Changes in tendon length and excursion following extensor tendon grafting at the distal radioulnar joint

IV.

Ultrasound Imaging as a Diagnostic Tool to Assess the Functional Status of Muscles after a Spinal Cord Injury

The aim of this study was to evaluate the use of ultrasound imaging (USI) as a diagnostic tool to assess muscle function after a spinal cord injury (SCI). Ultrasound videos of the gastrocnemius medialis muscle were recorded both at rest and during attempted maximum voluntary contraction (MVC) for fifteen participants with a SCI and fifteen able-bodied controls. Measurements were repeated at monthly intervals for participants in the SCI group during their inpatient stay. Differences in muscle echogenicity and thickness were detected between both able-bodied and SCI groups and subgroups of SCI participants, suggesting USI can detect and monitor changes in muscle structure which are characteristic of atrophy. Decreased muscle movement in the SCI groups was also detected during attempted MVC. The ability of USI to distinguish between different levels of function demonstrates the potential of USI as a quantitative tool to assess muscles.

Recovery of Abdominal Muscle Thickness and Contractile Function in Women after Childbirth

Abdominal muscles may be both morphologically and functionally affected by pregnancy. Dysfunction of the muscles can lead to persistent postpartum low back pain. The recovery process of the abdominal muscles following childbirth is not well understood. This study aimed to demonstrate the changes in the thickness and contractile function of abdominal muscles during the first six months postpartum. Nine perinatal and 15 nulliparous females participated. The thicknesses and contraction/relaxation thickness ratios of the rectus abdominis (RA), external abdominal oblique (EO), internal abdominal oblique (IO), and transverse abdominis (TrA) were measured using ultrasound images from 36–39 weeks’ gestation until six months postpartum. The RA, IO, and TrA muscles were thinner in perinatal females than controls at 36–39 weeks of gestation (4.8 vs. 9.47 mm (RA), 5.45 vs. 7.73 mm (IO), 2.56 vs. 3.38 mm (TrA), respectively). The thinner IO muscle persisted for six months after delivery. The decreased TrA thickness ratio persisted until four months post-delivery. Abdominal muscle thickness and contractile function decreased in the postpartum period. Therefore, abdominal muscle exercises might help prevent postpartum symptoms; however, because deterioration of muscle function is significant in the first four months, careful attention should be paid to exercise intensity. The study limitation was a relatively small sample size, thus future studies should involve more participants.

Prolonged sitting and physical inactivity are associated with limited hip extension: A cross-sectional study

BACKGROUND

It is possible that physical inactivity and prolonged sitting could lead to changes in muscle properties or bony limitations which may reduce passive hip extension.

OBJECTIVES

This study explored the association between passive hip extension and sitting/physical activity patterns.

DESIGN

Cross sectional study.

METHOD

The modified Thomas Test is a clinical test used to characterise hip flexion contracture. This test was used to measure passive hip extension across 144 individuals. In addition, sitting behaviours and physical activity patterns were quantified using the Global Physical Activity Questionnaire. Cut off points were defined for low/high physical activity (150 min per week), prolonged sitting (>7 h per day) and minimal sitting (<4 h per day). ANOVA testing was then used to compare passive hip extension between three groups, defined using the specified thresholds: low activity & prolonged sitting, high activity & minimal sitting and high activity & prolonged sitting.

RESULTS

A total of 98 participants were allocated to one of the three groups which were shown to differ significantly in passive hip extension (P < 0.001). Importantly, there was 6.1° more passive hip extension in the high activity & minimal sitting group when compared to the low activity & prolonged sitting group.

CONCLUSION

This study is the first to demonstrate an association between passive hip extension and prolonged sitting/physical inactivity. It is possible that these findings indicate a physiological adaptation in passive muscle stiffness. Further research is required to understand whether such adaptation may play a role in the aetiology of musculoskeletal pain linked to prolonged sitting.

Surgical repair of the supraspinatus: architectural changes in the muscle pre- and postoperatively

INTRODUCTION

Shortening of the tendon and muscle is recognised as a strong predictor for surgical failure of supraspinatus tendon tears. Changes in muscle architecture following repair have not been thoroughly investigated. We aimed to compare the architecture of the supraspinatus pre- and postoperatively.

METHODS

We recruited eight participants with full-thickness supraspinatus tears. Images of the supraspinatus were captured preoperatively (pre-op) and postoperatively at one (post-op1), three (post-op2) and six (post-op3) months in relaxed and contracted states (0° and 60° glenohumeral abduction). Fibre bundle length (FBL), pennation angle (PA) and muscle thickness (MT) were quantified. Self-reported function, and maximal isometric abduction and external rotation strengths were assessed.

RESULTS

Mean FBL increased from pre-op to post-op1 (p = 0.001) in the relaxed state and from pre-op to post-op2 (p = 0.002) in the contracted state. Decrease in FBL was observed from post-op2 to post-op3 in the relaxed state. Mean PA decreased from pre-op to post-op1 (p < 0.001) in the relaxed state, but increased from post-op2 to post-op3 in both relaxed (p = 0.006) and contracted (p = 0.004) states. At post-op3, external rotation (p = 0.009) and abduction (p = 0.005) strengths were greater than at post-op2. Overall function increased by 47.67% from pre-op to post-op3.

CONCLUSION

Lengthening of the supraspinatus occurs with surgery, altering the length-tension relationship of the muscle, which can compromise muscle function and lead to inferior surgical outcomes. These findings may guide clinicians to optimise loads, velocities and shoulder ranges for effective postoperative rehabilitation.

Effects of short duration stretching on disuse muscle atrophy in immobilized rat soleus muscles

The purpose of this study was to determine whether short duration stretching is ameliorating for disuse muscle atrophy in immobilized rat soleus muscles. Eighteen male Wistar rats (age, 8 weeks; weight, 311.0 ± 35.6 g) were divided randomly into control (n=3) and experimental (n=15) groups. Bilateral ankles of each rat in the experimental group were fixed in full planter flexion with a plaster cast. After the experimental groups rats were immobilized for 4 weeks, animals were divided into three groups: immobilization alone (group I, n=3), stretch training for 30 min/day for 1 or 3 weeks after remobilization (group S, n=6), and spontaneous recovery (non stretch training) for 1 or 3 weeks after remobilization (group NS, n=6). At the end of the experimental periods, the soleus muscle was extracted from hindlimb, and the frozen sections were stained with myofibrillar adenosine triphosphatase. After 1 week of remobilization, the means of the muscle fiber diameters for type I fibers in group S had increased significantly compared with group NS, but those for type II fibers in group S did not significantly differ from that for group NS. After 3 weeks of remobilization, the means of the muscle fiber diameters for types I and II fibers in group S had increased significantly compared with group NS. No difference in the fiber type distribution were observed between the experimental group. Our findings suggest that short duration stretching induces recovery from disuse muscle atrophy after joint fixation.

Use it or lose it: multiscale skeletal muscle adaptation to mechanical stimuli

Skeletal muscle undergoes continuous turnover to adapt to changes in its mechanical environment. Overload increases muscle mass, whereas underload decreases muscle mass. These changes are correlated with, and enabled by, structural alterations across the molecular, subcellular, cellular, tissue, and organ scales. Despite extensive research on muscle adaptation at the individual scales, the interaction of the underlying mechanisms across the scales remains poorly understood. Here, we present a thorough review and a broad classification of multiscale muscle adaptation in response to a variety of mechanical stimuli. From this classification, we suggest that a mathematical model for skeletal muscle adaptation should include the four major stimuli, overstretch, understretch, overload, and underload, and the five key players in skeletal muscle adaptation, myosin heavy chain isoform, serial sarcomere number, parallel sarcomere number, pennation angle, and extracellular matrix composition. Including this information in multiscale computational models of muscle will shape our understanding of the interacting mechanisms of skeletal muscle adaptation across the scales. Ultimately, this will allow us to rationalize the design of exercise and rehabilitation programs, and improve the long-term success of interventional treatment in musculoskeletal disease.

Influence of electrical stimulation on calpain and ubiquitin-proteasome systems in the denervated and unloaded rat tibialis anterior muscles

The influence of electrical stimulation on calpain and ubiquitin-proteasome systems was examined in the denervated and unloaded tibialis anterior muscles of male Wistar rats. Animals were divided into 5 groups: control, denervation, denervation plus electrical stimulation, unloading, and hindlimb unloading plus electrical stimulation groups. Due to denervation and unloading for 14 days, muscle atrophy markedly occurred in the denervated and unloading animals, and the atrophy in the former was significantly more severe than that in the latter. In the denervated muscle, the atrophy was significantly attenuated by the electrical stimulation, but not in the unloaded muscle. Overexpression of calpain-2 and ubiquitinated proteins was observed only in denervated muscles. In the unloaded animals, though the expression level of calpain-2 appeared to be slightly higher than that in the control, the expression level of ubiquitinated proteins was almost the same as that in the control. The overexpression of calpain-1, calpain-2, and ubiquitinated proteins in the denervated muscle was inhibited by the electrical stimulation. However, there was no difference in these expressions between the unloaded and unloaded plus electrical stimulation groups. The mechanism of the preventive effect of the electrical stimulation on muscle atrophy might differ between the denervated and unloaded muscles.

Whey proteins are more efficient than casein in the recovery of muscle functional properties following a casting induced muscle atrophy

The purpose of this study was to investigate the effect of whey supplementation, as compared to the standard casein diet, on the recovery of muscle functional properties after a casting-induced immobilization period. After an initial (I0) evaluation of the contractile properties of the plantarflexors (isometric torque-frequency relationship, concentric power-velocity relationship and a fatigability test), the ankle of 20 male adult rats was immobilized by casting for 8 days. During this period, rats were fed a standard diet with 13% of casein (CAS). After cast removal, rats received either the same diet or a diet with 13% of whey proteins (WHEY). A control group (n = 10), non-immobilized but pair-fed to the two other experimental groups, was also studied and fed with the CAS diet. During the recovery period, contractile properties were evaluated 7 (R7), 21 (R21) and 42 days (R42) after cast removal. The immobilization procedure induced a homogeneous depression of average isometric force at R7 (CAS: − 19.0±8.2%; WHEY: − 21.7±8.4%; P<0.001) and concentric power (CAS: − 26.8±16.4%, P<0.001; WHEY: − 13.5±21.8%, P<0.05) as compared to I0. Conversely, no significant alteration of fatigability was observed. At R21, isometric force had fully recovered in WHEY, especially for frequencies above 50 Hz, whereas it was still significantly depressed in CAS, where complete recovery occurred only at R42. Similarly, recovery of concentric power was faster at R21 in the 500−700°/s range in the WHEY group. These results suggest that recovery kinetics varied between diets, the diet with the whey proteins promoting a faster recovery of isometric force and concentric power output as compared to the casein diet. These effects were more specifically observed at force level and movement velocities that are relevant for functional abilities, and thus natural locomotion.

Nutritional strategies to counteract muscle atrophy caused by disuse and to improve recovery

Periods of immobilisation are often associated with pathologies and/or ageing. These periods of muscle disuse induce muscle atrophy which could worsen the pathology or elderly frailty. If muscle mass loss has positive effects in the short term, a sustained/uncontrolled muscle mass loss is deleterious for health. Muscle mass recovery following immobilisation-induced atrophy could be critical, particularly when it is uncompleted as observed during ageing. Exercise, the best way to recover muscle mass, is not always applicable. So, other approaches such as nutritional strategies are needed to limit muscle wasting and to improve muscle mass recovery in such situations. The present review discusses mechanisms involved in muscle atrophy following disuse and during recovery and emphasises the effect of age in these mechanisms. In addition, the efficiency of nutritional strategies proposed to limit muscle mass loss during disuse and to improve protein gain during recovery (leucine supplementation, whey proteins, antioxidants and anti-inflammatory compounds, energy intake) is also discussed.

Reversibility of abdominal wall atrophy and fibrosis after primary or mesh herniorrhaphy

OBJECTIVE

To determine whether primary or mesh herniorrhaphy reverses abdominal wall atrophy and fibrosis associated with hernia formation.

BACKGROUND

We previously demonstrated that hernia formation is associated with abdominal wall atrophy and fibrosis after 5 weeks in an animal model.

METHODS

A rat model of chronic incisional hernia was used. Groups consisted of uninjured control (UC, n = 8), sham repair (SR, n = 8), unrepaired hernia (UR, n = 8), and 2 repair groups: primary repair (PR, n = 8) or tension-free polypropylene mesh repair (MR, n = 8) hernia repair on postoperative day (POD) 35. All rats were killed on POD 70. Intact abdominal wall strips were cut perpendicular to the wound for tensiometric analysis. Internal oblique muscles were harvested for fiber type and size determination.

RESULTS

No hernia recurrences occurred after PR or MR. Unrepaired abdominal walls significantly demonstrated greater stiffness, increased breaking and tensile strengths, yield load and yield energy, a shift to increased type IIa muscle fibers than SR (15.9% vs 9.13%; P < 0.001), and smaller fiber cross-sectional area (CSA, 1792 vs 2669 μm(2); P < 0.001). PR failed to reverse any mechanical changes but partially restored type IIa fiber (12.9% vs 9.13% SR; P < 0.001 vs 15.9% UR; P < 0.01) and CSA (2354 vs 2669 μm(2) SR; P < 0.001 vs 1792 μm(2) UR; P < 0.001). Mesh-repaired abdominal walls demonstrated a trend toward an intermediate mechanical phenotype but fully restored type IIa muscle fiber (9.19% vs 9.13% SR; P > 0.05 vs 15.9% UR; P < 0.001) and nearly restored CSA (2530 vs 2669 μm(2) SR; P < 0.05 vs 1792 μm(2) UR; P < 0.001).

CONCLUSIONS

Mesh herniorrhaphy more completely reverses atrophic abdominal wall changes than primary herniorrhaphy, despite failing to restore normal anatomic muscle position. Techniques for hernia repair and mesh design should take into account abdominal wall muscle length and tension relationships and total abdominal wall compliance.

Influence of fixed muscle length and contractile properties on atrophy and subsequent recovery in the rat soleus and plantaris muscles

This study examined muscular atrophy and the recovery process induced by hindlimb unloading and joint immobilization in the rat soleus and plantaris muscles. Rats were divided into control, hindlimb unloading (HU), hindlimb unloading with ankle joint immobilization at the maximum dorsiflexion (HUD), and maximum plantarflexion (HUP) groups. The hindlimb was reloaded after fourteen days of unloading, and muscle atrophy and walking ability were assessed at 0, 3, and 7 days of reloading. A cross sectional area of muscle fibers in the soleus muscle on day 0 of reloading revealed sizes in order from the control, HUD, HUP down to the HU group, indicating that the HU group was the most atrophied among the four groups. These values in the plantaris muscle ranged in order from the control, HU, HUD, to HUP groups, the HUP group being the most atrophied among the four groups. These muscles recovered from atrophy in the same descending order, and the values in the HUD and HUP groups slowly recovered during the reloading periods. The HUD and HUP groups showed a central core lesion and reloading-induced lesions in some type I muscle fibers after the immobilization and reloading, one possible reason for the delayed recovery in these groups. The muscle atrophy in the HU, HUD, and HUP groups remained at day 7 although the walking ability appeared to be normal. Accordingly, further rehabilitation therapy might be necessary even if the functional ability appears to be normal.

Influence of muscle length on muscle atrophy in the mouse tibialis anterior and soleus muscles

The tibialis anterior and soleus muscles were fixed at the stretched or shortened positions to examine the influence of muscle length on muscle atrophy. Mice were divided into control (C), hindlimb suspension (HS), hindlimb suspension with ankle joint fixation at the maximum dorsiflexion (HSD), and hindlimb suspension with ankle joint fixation at the maximum plantarflexion (HSP). During the hindlimb suspension, the length of these muscles in the HS and HSP groups was very similar. Fourteen days after the hindlimb suspension, the atrophy of the tibialis anterior muscle in the HS and HSP groups was evidently milder than that in the HSD group, and that in the HS and HSP groups was very similar, suggesting that atrophy of the tibialis anterior muscle might largely depend on muscle length. Atrophy of the soleus muscle in the HSD group was milder than that in the HS and HSP groups, indicating that atrophy of the soleus muscle might also depend on muscle length. But atrophy of this muscle in the HSP group was milder than that in the HS group. These results demonstrate that some factors induced by the joint immobilization might be effective in preventing atrophy of the soleus muscle.

Sarcomere length of torn rotator cuff muscle

BACKGROUND

Sarcomere length is one of the factors related to the contractile ability of muscle. There is no report about sarcomere length of torn rotator cuff muscles. The purpose of this study was to clarify sarcomere length of torn rotator cuff muscles.

MATERIALS AND METHODS

Twenty-eight embalmed cadaver shoulders (14 shoulders with intact rotator cuff and 14 shoulders with full-thickness rotator cuff tears: an isolated tear of the supraspinatus in 3, a combined tear of the supraspinatus and infraspinatus in 4, and a combined tear of the supraspinatus, infraspinatus and subscapularis in 7) were used in this study. Muscle fiber length was measured using a digital caliper. Sarcomere length was measured by laser diffraction method.

RESULTS

Muscle fiber lengths of the supraspinatus and infraspinatus (33.0 +/- 6.5 mm and 61.5 +/- 14.0 mm, respectively) in the cuff tear group were significantly shorter than those in the intact cuff group (56.9 +/- 10.1 mm and 74.2 +/- 10.0 mm: P < .001 and P = .010). The sarcomere lengths of these muscles were 3.00 +/- 0.44 microm and 3.12 +/- 0.45 microm in the intact cuff group and 2.90 +/- 0.34 microm and 3.01 +/- 0.34 microm in the cuff tear group. The sarcomere lengths showed no significant difference (P = 0.46 and P = .37).

CONCLUSION

The sarcomere lengths of the supraspinatus and infraspinatus with torn tendons were not significantly different from those with intact tendons, although the muscle fiber lengths were significantly shorter with torn tendons.

Influence of knee flexion on plantarflexion moments after open or percutaneous Achilles tendon repair

BACKGROUND

The influence of the knee angle on plantarflexion moments after Achilles tendon repair has yet to be analyzed. It was hypothesized that flexion of the knee joint will disproportionately influence isometric plantarflexion moments after Achilles tendon repair.

MATERIALS AND METHODS

Isometric plantarflexion moments and functional heel rise performance were retrospectively assessed in 32 patients at a mean follow-up of 36.9 (+/- 17.83) months after open or percutaneous repair of acute Achilles tendon rupture. Plantarflexion moments were measured with the knee joint in 0, 30, and 60 degrees of flexion and the ankle joint positioned in neutral, 15 degrees plantar flexion and 15 degrees dorsiflexion. Data were compared between the involved and the noninvolved leg as well as between open and percutaneous repair.

RESULTS

Flexion of the knee had no significant effect on isometric plantarflexion moments in either the involved or the noninvolved leg, while at any knee angle, plantarflexion moments decreased from dorsiflexion to plantar flexion. In accordance, dynamic heel rise performance revealed no significant strength deficits between the involved and the noninvolved limb. No overall differences in plantarflexion strength were observed between open and percutaneous Achilles tendon repair.

CONCLUSION

The flexion angle of the knee had no influence on plantarflexion moments when comparing the involved with the noninvolved leg after open or percutaneous Achilles tendon repair. Weakness of plantarflexion after open or percutaneous Achilles tendon repair is determined by the position of the ankle joint rather than by the flexion angle of the knee.

The effect of muscle length and excursion on muscle contracture after tendon injury: a study in rabbit soleus muscles

If tendon repair after injury is delayed, intramuscular fibrosis occurs and finally results in irreversible muscle contracture. The purpose of this study was to determine the effect of preserving muscle length and excursion on the progression of muscle contracture after tendon injury in a rabbit soleus tenotomy model. Forty rabbits underwent tenotomy of the soleus muscles bilaterally and the tendons were managed according to the five experimental groups (N=40). In group A, the tendon was lengthened maintaining half the excursion. In group B, maximal muscle length was preserved and in group C, resting muscle length was maintained. In group D, the tendon was allowed to retract and undergo fibrosis. In group E, the tendon was partially transected and repaired. Four and 8 weeks postoperatively, soleus muscles were harvested from each hind limb and histomorphometric evaluations were performed to measure the connective tissue areas. Electrophysiological studies were carried out to measure the compound muscle action potential to assess the number of functioning muscle fibres. The results showed that maximal muscle length preservation (group B) was the most protective in preventing muscle contracture within 4 weeks of tenotomy, but this effect was gradually offset by prolonged fixation of the muscle, and 8 weeks after tenotomy, maintenance of excursion (group A) was the most protective. These observations may be helpful in the intra-operative evaluation of muscle contracture in neglected tendon ruptures, and could be applied to the management of acute tendon injuries to prevent muscle contracture when immediate anatomical reconstruction is not possible.

Morphological effects of two protocols of passive stretch over the immobilized rat soleus muscle

This study evaluated two different stretching protocols employed during a period of hind-limb immobilization in terms of their effects on muscle morphology. Quantitative data regarding the soleus muscle were obtained based on the clinical hypothesis that a high frequency of this exercise would improve the recovery of muscle structure. Twenty-four male Wistar rats were divided into four groups (n = 6 each): the control group (C); the immobilized group, in which the left hind limb was immobilized in order to maintain the soleus muscle in a fully shortened position for 3 weeks (I); the 'immobilized and stretched every 3 days' group, in which the left hind limb was immobilized as in the immobilized group, but with the soleus muscle stretched every 3 days for 40 min (Ist3); and the 'immobilized (as in the immobilized group) and stretched every 7 days' group (ISt7). All soleus muscles were excised 21 days after the beginning of the experiment, and were processed for (1) haematoxylin and eosin and myosin ATPase to evaluate muscle morphology and cross-sectional area and the proportions of the different fibre types, and (2) ultrastructural analysis. The cross-sectional area was found to have decreased in all fibre types (I, II and C), mainly in ISt7, when compared with the C group and ISt3 group. The proportion of the different fibre types did not show statistical difference between groups. Light and electron microscopy examination revealed signs of cell degeneration that was more intense in the group immobilized and stretched three times a week. In conclusion, sessions of passive stretching applied to the soleus during immobilization induce muscle fibre injury, suggesting that this therapeutic tool should be applied carefully to disused muscles.

Moving our critically ill patients: mobility barriers and benefits

Diagnosis and resuscitation for critically ill patients have improved in the last 25 years, and survival has also increased. With improvements in mortality, the field of critical care has seen increased opportunities to improve posthospital quality of life for survivors of critical illness. This article focuses particularly on how mobilization may improve quality of life for patients.

Physical therapy management of Pompe disease

Pompe disease (Glycogen storage disease type II, GSDII, or acid maltase deficiency) is an autosomal recessive disorder characterized by deficiency of acid alpha-glucosidase resulting in intra-lysosomal accumulation of glycogen and leading to progressive muscle dysfunction. The natural history of infantile-onset Pompe disease is characterized by hypertrophic cardiomyopathy and profound generalized weakness presenting in the first few months of life, with rapid progression and death usually occurring by one year of age. Late-onset Pompe disease is characterized by onset of symptoms after one year of age, less severe or absence of cardiac involvement and slower progression, with symptoms primarily related to progressive dysfunction of skeletal muscles and respiratory muscle involvement. Recent clinical trials of enzyme replacement therapy have begun to allow greater opportunity for potential improvement in motor status, function, and survival than ever before, with hopes of moving toward maximizing physical function for individuals with Pompe disease. Children are living longer with some achieving independent sitting, creeping, and walking-milestones typically never achieved in the untreated natural history of the disorder. With increased survival, clinical management based on an understanding of the pathology and pathokinesiology of motor function gains importance. This article reviews current knowledge regarding the motor system in Pompe disease and provides an overview of physical therapy management of Pompe disease, including management strategies for individuals on enzyme replacement therapy.

Understanding Muscle Architectural Adaptation: Macro- and Micro-Level Research

Recent research using muscle-imaging techniques has revealed a remarkable plasticity of human muscle architecture where significant changes in fascicle lengths and angles have resulted from the chronic performance, or cessation, of strong muscle contractions. However, there is a paucity of data describing architectural adaptations to chronic stretching, disuse and immobilization, illness, and aging, and those data that are available are equivocal. Understanding their impact is important in order that effective interventions for illness/injury management and rehabilitation, and programs to improve the physical capacity of workers, the aged and athletes can be determined. Nonetheless, recent advances in myocellular research could provide a framework allowing the prediction of architectural changes in these understudied areas. Examination of the site-specific response to mechanical stress of calpain-dependent ubiquitin-proteasome proteolysis, or of the cellular response to stress after the knockout (or incapacitation) of sarcomeric and cytoskeletal proteins involved in cellular signal transduction, provides an exciting paradigm by which myocellular adaptation can be described. Such research might contribute to the understanding of macro-level changes in muscle architecture.

Effects of Physical Training and Detraining, Immobilisation, Growth and Aging on Human Fascicle Geometry

In addition to its size and the extent of its neural activation, a muscle's geometry (the angles and lengths of its fibres or fascicles) strongly influences its force production characteristics. As with many other tissues within the body, muscle displays significant plasticity in its geometry. This review summarises geometric differences between various athlete populations and describes research examining the plasticity of muscle geometry with physical training, immobilisation/detraining, growth and aging. Typically, heavy resistance training in young adults has been shown to cause significant increases in fascicle angle of vastus lateralis and triceps brachii as measured by ultrasonography, while high-speed/plyometrics training in the absence of weight training has been associated with increases in fascicle length and a reduction in angles of vastus lateralis fascicles. These changes indicate that differences in geometry between various athletic populations might be at least partly attributable to their differing training regimes. Despite some inter-muscular differences, detraining/unloading is associated with decreases in fascicle angle, although little change was shown in muscles such as vastus lateralis and triceps brachii in studies examining the effects of prolonged bed rest. No research has examined the effects of other interventions such as endurance or chronic stretching training. Few data exist describing geometric adaptation during growth and maturation, although increases in gastrocnemius fascicle angle and length seem to occur until maturation in late adolescence. Although some evidence suggests that a decrease in both fascicle angle and length accompanies the normal aging process, there is a paucity of data examining the issue; heavy weight training might attenuate the decline, at least in fascicle length. A significant research effort is required to more fully understand geometric adaptation in response to physical training, immobilisation/detraining, growth and aging.

Recovery from immobilisation: responses of fast-twitch muscle fibres to spontaneous and intensive exercise in rat calf muscles

Four weeks of immobilisation with two types of re-mobilisation programmes (intensive concentric treadmill exercising during 6 days, and free exercising, and immobilisation without any re-mobilisation period were studied to clarify possible exercise-induced calf muscle damage especially in fast-twitch fibres used in running compared to non-immobilised rats housing freely in their cages. As markers of muscle injury, conventional histology, beta-glucuronidase (beta-GU) activity and fetal myosin heavy chain expression (MHC-d) were assessed on Days 0, 1, 3, 6 and 14 after the cast removal. Only minor focal hypercontraction, ruptures and necrosis of myofibrils, and weak inflammatory cell reactions were found in all samples examined, except in the controls. No MHC-d positive cells were found indicating absence of active regeneration after immobilisation or re-mobilisation. Minor increase in beta-GU activity was observed in all three muscles studied, but statistically significant increase was observed only in the samples of the free exercising group on Day 14 after the cast removal. To conclude, intensive concentric treadmill exercise for 6 days did not cause significantly more muscle damage than did free exercising re-mobilisation.

Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study

BACKGROUND

The aim of our prospective, randomized, clinical study was to compare two postoperative regimens after Achilles rupture repair and determine whether early functional treatment will give a better result than early immobilization in tension of the musculotendinous unit.

METHODS

Fifty patients with acute Achilles tendon rupture were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks or Achilles tendon immobilization in tension using a below-knee cast with the ankle in a neutral position for 6 weeks. Full weight bearing was allowed after 3 weeks in both groups. The patients were assessed clinically at 1, 3, 6, 12, and 24 weeks, and the last control visit took place at a mean of 60 (SD 6.4) weeks postoperatively.

RESULTS

The isokinetic calf muscle strength scores were excellent in 56%, good in 32%, fair in 8%, and poor in 4% of the patients in the early motion group at the last control checkup; whereas the scores in the cast group were excellent in 29%, good in 50%, and fair in 21% of the patients. The ankle performance scores were excellent or good in 88%, fair in 4%, and poor in 8% of the patients in the early motion group, whereas the scores in the cast group were excellent or good in 92% and fair in 8% of the patients. At 3 months and at the last control checkup, no significant differences were seen between the two groups with regard to pain, stiffness, subjective calf muscle weakness, footwear restrictions, range of ankle motion, isokinetic calf muscle strength, or overall outcome. The complications included one rerupture in the early motion group and one deep infection and two reruptures in the cast group. Deep infection and the rerupture in the cast group occurred in the same patient. The outcome of the complications was good in two cases and poor in one.

CONCLUSION

The isokinetic calf muscle strength results were somewhat better in the early motion group, whereas the other outcome results obtained in the two groups of patients were very similar. We recommend early functional postoperative treatment after Achilles rupture repair for athletes and well-motivated patients and for less-motivated patients and nonathletes.

Lesions of rat skeletal muscle after local block of acetylcholinesterase and neuromuscular stimulation

In skeletal muscle, a local increase of acetylcholine (ACh) in a few end plates has been hypothesized to cause the formation of contraction knots that can be found in myofascial trigger points. To test this hypothesis in rats, small amounts of an acetylcholinesterase inhibitor [diisopropylfluorophosphate (DFP)] were injected into the proximal half of the gastrocnemius muscle, and the muscle nerve was electrically stimulated for 30-60 min for induction of muscle twitches. The distal half of the muscle, which performed the same contractions, served as a control to assess the effects of the twitches without DFP. Sections of the muscle were evaluated for morphological changes in relation to the location of blocked end plates. Compared with the distal half of the muscle, the DFP-injected proximal half exhibited significantly higher numbers of abnormally contracted fibers (local contractures), torn fibers, and longitudinal stripes. DFP-injected animals in which the muscle nerve was not stimulated and that were allowed to survive for 24 h exhibited the same lesions but in smaller numbers. The data indicate that an increased concentration of ACh in a few end plates causes damage to muscle fibers. The results support the assumption that a dysfunctional end plate exhibiting increased release of ACh may be the starting point for regional abnormal contractions, which are thought to be essential for the formation of myofascial trigger points.

The effect of bed rest and potential of prehabilitation on patients in the intensive care unit

Declines in physical activity that accompany an admission to an intensive care unit (ICU) represent a significant stress to the body. Decreases in physical activity have been demonstrated to result in losses in functional capacity of the musculoskeletal and cardiovascular systems. These two systems are central to achieving and maintaining functional independence, which is a prerequisite for discharge from a healthcare facility, as is independent functioning of the individual in the community setting. Whereas a decrease in physical activity will result in an attenuation in the functioning of the cardiovascular and musculoskeletal systems, increases in physical activity can stimulate gains in their functional capacity. The concept of improving the functional capacity of the body to withstand anticipated musculoskeletal stressors has had limited application to the effects of inactivity associated with an ICU admission. By increasing an individual's functional capacity through increased physical activity prior to an ICU admission, it seems reasonable that the patient would retain a higher level of functional capacity over their entire ICU admission. The process of enhancing functional capacity of the individual to enable them to withstand the stressor of inactivity associated with an admission to ICU is termed prehabilitation. A generic program of prehabilitation includes warm-up, aerobic, strength, flexibility, and functional task components. The initial level of prehabilitation training and the progression of the training will be different for each individual based upon their initial functional capacity and the degree to which they individually respond to increases in physical activity. Declines in physical activity among ICU patients represents a significant health risk that may be reduced through introducing prehabilitation interventions.

Evaluation of effect of ankle-foot orthosis use on strength restoration of paretic dorsiflexors

OBJECTIVE

To assess whether a difference exists in restoration of strength between patients with a recent paresis of the dorsiflexors of the ankle using an ankle-foot orthosis (AFO) and patients without an AFO.

DESIGN

Prospective case-control study.

SETTING

Patients from regional hospitals, tested in a rehabilitation research center.

PARTICIPANTS

Twenty-nine patients with a recent (6wk-1yr) peripheral paresis, alternately assigned to a group using an AFO or a control group. There was no significant difference in duration of the paresis and in torque at entering the study (T0) between the 2 groups.

INTERVENTIONS

The use of an ankle-foot orthosis.

MAIN OUTCOME MEASURES

Isometric torque production of ankle dorsiflexors, expressed as ratio of paretic and healthy side, in 2 measurement sessions, over a period of 6 weeks (T0-T6) with the ankle in 0 degrees and 30 degrees plantarflexion.

RESULTS

Both groups had significant restoration of strength +/- standard deviation between T0 and T6 in 30 degrees flexion: non-AFO group 17% +/- 15%, AFO group 9% +/- 12%. No significant difference existed between the 2 groups (30 degrees p = .56). No significant shift in strength ratio 0 degrees :30 degrees occurred (AFO group p = .82).

CONCLUSION

The use of an orthosis does not influence restoration of strength in patients with a recent peripheral paresis of the ankle dorsiflexors.

Lipoprotein lipase activity in skeletal muscles of the rat: effects of denervation and tenotomy

The effects of denervation, tenotomy, or tenotomy with simultaneous denervation on the activity of heparin-releasable and intracellular, residual lipoprotein lipase (LPL) and triacylglycerol (TG) content were examined in rat skeletal muscles. An influence of muscle electrostimulation on denervated and tenotomized muscles was also evaluated. Activity of both LPL fractions was decreased in denervated and/or tenotomized soleus and red portion of gastrocnemius muscles. It was accompanied by a slight elevation of the intracellular TG content. Electrostimulation increased activities of both fractions of LPL in red muscles from intact hindlimbs. In stimulated denervated muscles without or with simultaneous tenotomy, activity of two LPL fractions was also enhanced, but control values were reached only in denervated soleus muscle. Electrical stimulation had no pronounced effect on LPL activity in tenotomized muscles. In conclusion, denervation and/or tenotomy decreases LPL activity in red muscles, indicating reduction of the muscle potential to utilize circulating TG. Electrostimulation only partly restores the diminished LPL activity in denervated muscles, without any effect in tenotomized ones. Thus, to maintain LPL activity in resting muscle, intact innervation and tension are needed.

Calf muscle atrophy and Achilles tendon healing following experimental tendon division and surgery in rats. Comparison of postoperative immobilization of the muscle-tendon complex in relaxed and tensioned positions

We used a rat model to study the effects of immobilization of the calf muscle-tendon complex after an experimental Achilles tendon repair. Immobilizations of the complex in either a relaxed or tensioned position were compared by histochemical and morphometric analyses at the site of the tendon injury as well as in the gastrocnemius and soleus muscle bellies. The type of immobilization did not affect the healing of the tendon injury because no reruptures occurred in either of the treatment groups and the average tendon end-to-end distance did not differ between the groups. However, immobilization in a relaxed position led to a significantly more extensive fiber atrophy in the calf muscles. In clinical practice, these results suggest that rehabilitation after Achilles tendon surgery can be early and gradually tension- and load-increasing without a significant increase in the risk of rerupture of the tendon.

Differential effects of a six-day immobilization on newborn rat soleus muscles at two developmental stages

Our objective was to determine the effects of a six-day immobilization on the musculoskeletal system of the rat during postnatal development at two key periods when the states of innervation are known to be different. This work was undertaken on the soleus muscle since it is well known that postural slow muscles show marked changes after a period of disuse. Thus, the soleus muscle was immobilized in a shortened position either when the innervation was polyneuronal or monosynaptic, respectively from 6 to 12 and from 17 to 23 days. The muscle modifications were followed by ATPase staining and myosin heavy chain (MyHC) isoform identification using monoclonal antibodies and SDS-PAGE. The functional properties of skinned fibre bundles were established by calcium/strontium (Ca/Sr) activation characteristics. In control muscles the maturation was characterized by a progressive increase of adult MyHCs (I and IIA) concomitant with a decrease in both the MyHC neo and the Ca affinity. Between 6 to 12 days, immobilization of the limb induced an increase in histochemical type IIC fibres. Using antibodies we identified new fibre types, classified as a function of their MyHC isoform co-expression. We observed an increase in expression of both MyHC neo and Ca affinity. From 17 to 23 days, the immobilization induced an increase in Ca affinity and marked changes in the MyHC isoform composition: disappearance of MyHC neo and expression of the fast MyHC IIB isoform, which in normal conditions is never expressed in the soleus muscle. We conclude that an immobilization imposed during polyneuronal innervation delays the postnatal maturation of the soleus muscle, whereas when the immobilization is performed under monosynaptic innervation the muscle evolves towards a fast phenotype using a default pathway for MyHC expression.

Clenbuterol increases the expression of myogenin but not myoD in immobilized rat muscles

Immobilization of one hindlimb of young rats in plantar flexion for 3 days led to changes in the plantaris muscles. These comprised a loss of muscle mass and a reduction in protein and RNA content, but no change in the transcript levels of the myogenic regulatory factors myogenin and myoD. Dietary administration of the beta-adrenoceptor agonist clenbuterol (2 mg/kg diet), which has been shown to ameliorate muscle wasting in a wide range of atrophic conditions, also limited muscle wasting in terms of weight, protein, and RNA in the immobilized plantaris muscles. In addition, drug treatment in immobilized plantaris muscles was associated with a marked increase in the steady-state levels of mRNA for myogenin (approximately 360% increase over control) but not myoD. These data provide the first evidence for independent changes in these two myogenic regulatory factors in immobilized muscle and suggest that the action of clenbuterol on these factors may depend on the mechanistic basis for the atrophic response.

Cytoplasm-to-myonucleus ratios in plantaris and soleus muscle fibres following hindlimb suspension

In multinucleated skeletal muscle fibres the size of the cytoplasmic volume-to-myonucleus ratio is related to the myosin heavy chain phenotype, with the ratio being larger in those fibres expressing the fast myosin heavy chain phenotype. It is unknown, however, whether this ratio is modulated during muscle fibre adaptation, such as that which occurs following muscle unloading. In this study the relationship between cross sectional area, myonuclear number and myosin type, in single fibres from the plantaris and soleus muscles of adult rats following 28 days of hindlimb suspension was examined. Each fibre was cut transversely into two segments; one segment was used for immunohistochemical identification of myosin type, the other for determination of cross sectional area and myonuclei number. Single fibre analysis revealed significant atrophy of both plantaris fast and soleus slow fibres; the mean cross sectional area (microns2) of these fibres, 3104 +/- 183 and 2082 +/- 107 (mean +/- SE), being 70 and 45%, respectively, of control means. The decreases in cross sectional area were not accompanied by corresponding decreases in the number of myonuclei (myonuclei/mm); in plantaris fast fibres the mean myonuclei counts were within the control range (88 +/- 8 (hindlimb suspension), 76 +/- 7 (control), in soleus slow fibres the counts were significantly increased (185 +/- 12 (hindlimb suspension), 154 +/- 11 (control)). The changes resulted in a significant decrease in the cytoplasmic volume-to-myonucleus ratio (microns3 x 10(3) for both fibre types; the mean ratios of 39 +/- 3 and 12 +/- 1, were 60% and 36% of control means for the plantaris fast and soleus slow fibres, respectively. These results indicate that following hindlimb suspension atrophy of muscle fibres the myonuclei numbers remain constant or increase and, hence, the effective cytoplasmic-to-myonucleus ratio is decreased. Further, the decreased changes are significantly greater in soleus slow than plantaris fast fibres.

Endplate dysfunction in healthy muscle following a period of disuse

The objective of this study was to test the hypothesis that muscle disuse can result in abnormal neuromuscular transmission. Six healthy volunteers (2 females, mean age = 33 years) participated in the study. Cast immobilization of one leg, for a period of 4 weeks, was used as a model of disuse; the contralateral leg was used as a control. Three testing sessions, consisting of stimulation single fiber electromyography of the soleus muscle bilaterally, were done before, immediately after, and 4 weeks after cast removal. The main outcome measure was neuromuscular jitter, measured as the mean of the consecutive differences (MCD) of single muscle fiber potentials. A mean MCD was calculated for each muscle, and the data from all subjects was pooled to calculate a sample mean MCD. The control side showed good reproducibility of results between testing sessions. The experimental side showed a significant increase of the sample mean MCD after casting when compared to: preimmobilization values (P < 0.001), and to the control side (P < 0.001). After 4 weeks of recovery, the sample mean MCD returned to preimmobilization values. This study presents evidence that muscle disuse, without any neuromuscular disease, can result in a reversible dysfunction of neuromuscular transmission.

The latissimus dorsi muscle for detrusor assistance: functional recovery after nerve division and repair

The treatment of choice for bladder atonia is clean intermittent catheterization. To eliminate the catheter-related morbidity and increase the quality of life for patients with an atonic bladder, the restoration of bladder contractility would be desirable. Based on our hypothesis that skeletal muscle might augment bladder contractility, we designed the present study to examine the ability of the latissimus dorsi muscle in situ to empty a bladder-like reservoir and to regenerate after division and repair of the supplying motor nerve. In 4 dogs, the left latissimus dorsi muscle was dissected, mobilized and wrapped around a bladder substitute (100-ml. silicone reservoir). Stimulation of the thoracodorsal nerve resulted in the evacuation of 63.8 +/- 6.2% of the reservoir's volume and a maximum pressure of 109.5 +/- 18.6 cm. H2O. Four months later, the thoracodorsal nerve supplying motor control to the muscle was transected and microsurgically reanastomosed. Using transcutaneous stimulation, we recorded the pressure generation and resulting evacuation at regular intervals for 8 months (that is, 12 months after the initial surgery). At the end of this period, the pressure was 79.3 +/- 12.1 cm. H2O (72.4% of the initial value), expelling 48.3 +/- 6.7% of total volume. This long-term study demonstrates: (1) the ability of the transposed latissimus dorsi muscle to evacuate a bladder-like reservoir; and (2) the regenerative potential of muscle and nerve after nerve transsection and repair. Use of skeletal muscle, which can be readily stimulated, may serve to facilitate bladder emptying and provide a treatment alternative to intermittent catheterization in the future.

Effects of chronic electrostimulation on rat soleus skinned fibers during hindlimb suspension

In order to counteract the changes of the contractile properties of the rat soleus occurring during 10 days of hypokinesia-hypodynamia, due to hindlimb suspension (HS), two different patterns of electrostimulation were applied to the tibial nerve. The contractile properties of single chemically skinned muscle fibers were investigated using the tension-pCa relationship characteristics, the similar or different calcium and strontium affinities, and by measuring the P/tmax kinetic parameters. Our results showed that a pattern similar to firing rates of motoneurons innervating slow twitch muscles inhibited the slow to fast fiber changes observed during HS, whereas a pattern similar to firing rates of motoneurons from fast twitch muscles seemed to favor these changes. Since neither pattern maintained the isometric contractile force developed by the soleus fibers, we concluded that the decrease in mechanical strains imposed on the muscle during unloading was the main factor for the development of atrophy, while the kinetic changes might be predominantly modulated by the nervous command.

Comparison of Functional Ability Following Percutaneous and Open Surgical Repairs of Acutely Ruptured Achilles Tendons

The purpose of our study was to evaluate the functional outcomes of two methods of surgical treatment of acute closed raptures of the Achilles tendon, specifically, the primary open repair and the percutaneous repair techniques, utilizing (a) isokinetic plantar flexion strength, (b) midcalf girth, (c) ankle joint proprioception, and (d) ankle range of motion values. As a secondary purpose, the frequency of reruptures and postsurgical complications were compared between techniques. Twenty male patients (mean age, 43.8 ± 9.4 years) who sustained complete, closed ruptures of the Achilles tendon participated in this study. Results of pairedttests revealed significant differences between postsurgical and contralateral normal limbs for 6 of 12 variables. Results of the ANOVAs revealed no significant differences between the open repair group and percutaneous repair group for any of the evaluative parameters. The significant deficits in postoperative isokinetic plantar flexion strength and midcalf girth measurements, irrespective of surgical technique, suggest an incompleteness of rehabilitation or, more likely, the physiological inability to regain these characteristics postoperatively.

Muscle length-force characteristics in relation to muscle architecture: a bilateral study of gastrocnemius medialis muscles of unilaterally immobilized rats

The geometry of rat gastrocnemius medialis muscle (GM) was studied at different muscle lengths. In addition, the number of sarcomeres in series within fibres was estimated. For muscles of immobilized legs (i.e. GM was held at in vivo smallest length) as well as those of the contralateral legs, comparison was made with controls of similar age. Immobilization periods of 4 and 6 weeks were used. For immobilized GM muscles, the number of sarcomeres in series was lower only within distal fibres after 4 weeks of immobilization. Aponeuroses were 25% shorter after both immobilization periods and no differences were found for fibre and aponeurosis angle. For GM of contralateral legs no difference with respect to controls was found regarding the number of sarcomeres in series. Aponeuroses were approximately 15% shorter and the fibre and the aponeurosis angle were also smaller. Based on these geometrical differences, it was expected that both experimental muscles should exert force over a smaller range of muscle length than controls. However, for immobilized muscles a similar range of length was found for which a possible explanation could be the more compliant aponeurosis. For contralateral muscle a 2-mm larger length range as well as a change of distribution of optimal fibre length with respect to optimal muscle length was found. For immobilized muscles indications of a distribution of optimal fibre lengths were also found but these did not differ from those of the controls. The results for contralateral muscles would indicate that the distribution may be changed under the influence of an altered use of the limb and that this may be an important factor determining the length range of active force generation.

Physical therapy management of patients undergoing limb lengthening by distraction osteogenesis

Limb lengthening by distraction osteogenesis and external fixation is used increasingly in the United States for a variety of orthopaedic conditions. Maintenance of joint motion, critical for successful outcomes, can be difficult to achieve. The rate of growth needed for distraction osteogenesis is faster than that of normal growing bone. Histogenesis of soft tissues must also occur to maintain the motion in joints above and below the limb being lengthened. Physical therapists in patients' home communities need to be knowledgeable about the aggressive management needed to prevent the loss of joint motion. This article introduces physical therapists to a commonly used external fixator, the procedure of distraction osteogenesis, and the role of functional loading. To assist in treatment planning, a physical therapy management plan is presented. Two case examples illustrate how therapists can assess a patient's status relative to the goals in the management plan and determine intervention priorities.

Immobilization-induced muscle atrophy is not reversed by lengthening the muscle

In clinical practice, repaired tendocalcaneus (Achilles tendon) ruptures are often protected in immobilization casts for 4 weeks in the fully plantar flexed position and for up to another 4 weeks after returning the ankle to joint neutral. Moderate to severe muscle atrophy occurs within 4 weeks of immobilization in plantar flexion, but it is not known if this atrophy is minimized or reversed following restoration of joint neutral position. We tested the hypothesis that the extent of atrophy could be reduced by returning the ankle to joint neutral after 4 weeks of immobilization. Eighteen rabbits were anesthetized, and their right hind-limbs were casted with the knee flexed 90 degrees and the ankle fully plantar flexed. Three animals each were studied after 3, 4, 6, or 8 weeks of immobilization. After 4 weeks of immobilization, the immobilization casts of the remaining six rabbits were modified to return the ankle to joint neutral for another 2 or 4 weeks. For muscle studies, the animals were anesthetized, and the soleus (SOL), plantaris (PLN), and gastrocnemius (GST) muscles were removed and weighed; the SOL and PLN were quick frozen and processed for histochemical fiber typing and fiber cross-sectional area measurement. All three muscles showed significantly reduced muscle weight to body weight ratios after 3 weeks of immobilization. SOL was the most affected, and GST was least affected. There was no significant further atrophy through 8 weeks of immobilization. The atrophy correlated with a significant reduction of mean fiber area (MFA) for Types I, IIo, and IIc fibers in SOL and PLN. In PLN, Type IIg fiber area was not significantly reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Muscle atrophy continues after early cast removal following tendon repair

We studied soleus (SOL), plantaris (PLN), and gastrocnemius (GST) muscles to determine whether early cast removal minimizes muscle atrophy or permits recovery from atrophy after tendon repair. After right tendocalcaneus (Achilles tendon) was transected and repaired, rabbit right hindlimbs were immobilized with the ankle plantar flexed and the knee flexed to 90 degrees. Rabbits were maintained in the cast and sacrificed at 5, 15, or 21 days postoperatively or the cast was removed on day 5 and the animals sacrificed at day 15 or 21. SOL, PLN, and GST muscles of both limbs were removed and weighed, and then histochemical analyses were performed on SOL and PLN muscles. Immobilization decreased SOL muscle wet weights, mean fiber cross-sectional area, and percentage of Type I fibers and increased the percentage of Type IIc fibers. Ten days after cast removal (i.e., postoperative day 15), SOL muscle atrophy and fiber composition did not differ significantly from continuously immobilized controls. However, 16 days after cast removal (i.e., postoperative day 21), SOL muscle fiber cross-sectional area and fiber composition were near normal, differing significantly from continuously casted controls. At each of the time intervals studied, PLN (containing many glycolytic fibers) did not atrophy as much as SOL (containing mainly oxidative fibers). Our results indicate that 1) early cast removal prevents atrophy of PLN glycolytic fibers, but not oxidative fibers in either PLN or SOL, and 2) early cast removal promotes recovery from atrophy of both oxidative and glycolytic fibers. In spite of the many differences between rabbits and humans, these findings suggest that, although early cast removal may not prevent oxidative muscle fiber atrophy after postoperative immobilization, it may facilitate recovery from atrophy.

Immobilization-induced changes in motor unit force and fatigability in the cat

The purpose of this study was to examine the effects of 3 weeks of immobilization on the mechanical properties of motor units in a cat hindlimb muscle. The muscle, tibialis posterior, was immobilized in a shortened position. Motor units were classified as type FF, F(int), FR, or S. Force, axonal conduction velocity, fatigability, and proportions of motor unit types were compared in control and immobilized muscles. All properties exhibited some change after immobilization, including slower axonal conduction velocities, greater twitch forces, slower twitch contraction times, and greater tetanic forces. In addition, most motor units were less fatigable after immobilization. The number of motor units that could not be included in one of the four classification categories increased significantly after immobilization; these units exhibited normal axon conductivity but failed to produce measurable force or associated EMG. Short-term immobilization induced a variety of physiological adaptations in neuromuscular processes that varied with motor unit type.

Myofibrillar disruption in the rabbit soleus muscle after one-week hindlimb suspension

Relevant muscle- and species-specific differences may be found in the reaction of muscles to hindlimb suspension. This problem has been studied in 5 rabbits following a one-week hindlimb suspension, and in 5 ground-based controls. The soleus and the tibialis were prepared for light and transmission electron microscopy. In suspension the animals occasionally extended and flexed the hindlimbs, but, when standing still, their hindfeet were plantar-flexed to an angle of 180 degrees. In this position the length of the soleus was determined to be 35% less than in controls, whereas that of the tibialis was 30% more. Histologically, the tibialis fibers usually exhibited a preserved sarcomeric pattern, whereas soleus fibers displayed a regular sequence of areas of shortened sarcomeres, alternating with areas of myofibrillar disruption. These findings demonstrated that hindlimb suspension induces a focal breakdown of the soleus myofibrils, probably dependent on the reduced longitudinal tension of the suspended soleus and its phasic contractions against no load. It is conceivable that similar factors could also be responsible for soleus muscle atrophy induced by hypogravity as well as by other clinical conditions during which a stressful plantar flexion of the feet occurs against no load.

Severe degeneration of rabbit vastus intermedius muscle immobilized in shortened position

The authors have previously shown that passive daily mobilization of the rabbit hind limb immobilized with the knee in extension leads to necrosis of the deep thigh muscles and myositis ossificans-like periosteal bone formation. In this study the effect of immobilization alone on the rabbit hind limb muscles was examined similarly to that of immobilized limbs. Serum creatine kinase activities increased significantly and intravenously administered Evans blue albumin showed increased vascular permeability in the deep vastus intermedius muscle even on day 1. Necrotic fibers were clearly present in the deep part of the vastus intermedius muscle on day 5 in light and electron microscopy and in enzyme histochemistry. Fibrosis and atrophy were found later. The superficial portion of the vastus intermedius and the deep contralateral nonimmobilized vastus intermedius showed degenerative changes. Bone formation was not noted. The conclusion was that the deep vastus intermedius muscle composed almost exclusively of type I fibers is exceptionally prone to damage when immobilized in a shortened position. Contact of the necrotic muscle with the underlying periosteum is not alone sufficient to induce heterotopic ossification. The additional trauma caused by daily mobilization is needed for the myositis ossificans-like bone formation.