Effect of ankle joint position and electrode placement on the estimation of the antagonistic moment during maximal plantarflexion

Evidence of different sensitivity of muscle and tendon to mechano-metabolic stimuli

This study aimed to examine the temporal dynamics of muscle-tendon adaptation and whether differences between their sensitivity to mechano-metabolic stimuli would lead to non-uniform changes within the triceps surae (TS) muscle-tendon unit (MTU). Twelve young adults completed a 12-week training intervention of unilateral isometric cyclic plantarflexion contractions at 80% of maximal voluntary contraction until failure to induce a high TS activity and hence metabolic stress. Each participant trained one limb at a short (plantarflexed position, 115°: PF) and the other at a long (dorsiflexed position, 85°: DF) MTU length to vary the mechanical load. MTU mechanical, morphological, and material properties were assessed biweekly via simultaneous ultrasonography-dynamometry and magnetic resonance imaging. Our hypothesis that tendon would be more sensitive to the operating magnitude of tendon strain but less to metabolic stress exercise was confirmed as tendon stiffness, Young's modulus, and tendon size were only increased in the DF condition following the intervention. The PF leg demonstrated a continuous increment in maximal AT strain (i.e., higher mechanical demand) over time along with lack of adaptation in its biomechanical properties. The premise that skeletal muscle adapts at a higher rate than tendon and does not require high mechanical load to hypertrophy or increase its force potential during exercise was verified as the adaptive changes in morphological and mechanical properties of the muscle did not differ between DF and PF. Such differences in muscle-tendon sensitivity to mechano-metabolic stimuli may temporarily increase MTU imbalances that could have implications for the risk of tendon overuse injury.

Assessment and modelling of the activation-dependent shift in optimal length of the human soleus muscle in vivo

Previous in vitro and in situ studies have reported a shift in optimal muscle fibre length for force generation (L0) towards longer length at decreasing activation levels (also referred to as length-dependent activation), yet the relevance for in vivo human muscle contractions with a variable activation pattern remains largely unclear. By a combination of dynamometry, ultrasound and electromyography (EMG), we experimentally obtained muscle force-fascicle length curves of the human soleus at 100%, 60% and 30% EMGmax levels from 15 participants aiming to investigate activation-dependent shifts in L0 in vivo. The results showed a significant increase in L0 of 6.5 ± 6.0% from 100% to 60% EMGmax and of 9.1 ± 7.2% from 100% to 30% EMGmax (both P < 0.001), respectively, providing evidence of a moderate in vivo activation dependence of the soleus force-length relationship. Based on the experimental results, an approximation model of an activation-dependent force-length relationship was defined for each individual separately and for the collective data of all participants, both with sufficiently high accuracy (R2 of 0.899 ± 0.056 and R2 = 0.858). This individual approximation approach and the general approximation model outcome are freely accessible and may be used to integrate activation-dependent shifts in L0 in experimental and musculoskeletal modelling studies to improve muscle force predictions. KEY POINTS: The phenomenon of the activation-dependent shift in optimal muscle fibre length for force generation (length-dependent activation) is poorly understood for human muscle in vivo dynamic contractions. We experimentally observed a moderate shift in optimal fascicle length towards longer length at decreasing electromyographic activity levels for the human soleus muscle in vivo. Based on the experimental results, we developed a freely accessible approximation model that allows the consideration of activation-dependent shifts in optimal length in future experimental and musculoskeletal modelling studies to improve muscle force predictions.

Effect of the temporal coordination and volume of cyclic mechanical loading on human Achilles tendon adaptation in men

Human tendons adapt to mechanical loading, yet there is little information on the effect of the temporal coordination of loading and recovery or the dose-response relationship. For this reason, we assigned adult men to either a control or intervention group. In the intervention group, the two legs were randomly assigned to one of five high-intensity Achilles tendon (AT) loading protocols (i.e., 90% maximum voluntary contraction and approximately 4.5 to 6.5% tendon strain) that were systematically modified in terms of loading frequency (i.e., sessions per week) and overall loading volume (i.e., total time under loading). Before, at mid-term (8 weeks) and after completion of the 16 weeks intervention, AT mechanical properties were determined using a combination of inverse dynamics and ultrasonography. The cross-sectional area (CSA) and length of the free AT were measured using magnetic resonance imaging pre- and post-intervention. The data analysis with a linear mixed model showed significant increases in muscle strength, rest length-normalized AT stiffness, and CSA of the free AT in the intervention group (p < 0.05), yet with no marked differences between protocols. No systematic effects were found considering the temporal coordination of loading and overall loading volume. In all protocols, the major changes in normalized AT stiffness occurred within the first 8 weeks and were mostly due to material rather than morphological changes. Our findings suggest that-in the range of 2.5-5 sessions per week and 180-300 s total high strain loading-the temporal coordination of loading and recovery and overall loading volume is rather secondary for tendon adaptation.

Speed-specific optimal contractile conditions of the human soleus muscle from slow to maximum running speed

The soleus is the main muscle for propulsion during human running but its operating behavior across the spectrum of physiological running speeds is currently unknown. This study experimentally investigated the soleus muscle activation patterns and contractile conditions for force generation, power production and efficient work production (i.e. force-length potential, force-velocity potential, power-velocity potential and enthalpy efficiency) at seven running speeds (3.0 m s-1 to individual maximum). During submaximal running (3.0-6.0 m s-1), the soleus fascicles shortened close to optimal length and at a velocity close to the efficiency maximum, two contractile conditions for economical work production. At higher running speeds (7.0 m s-1 to maximum), the soleus muscle fascicles still operated near optimum length, yet the fascicle shortening velocity increased and shifted towards the optimum for mechanical power production with a simultaneous increase in muscle activation, providing evidence for three cumulative mechanisms to enhance mechanical power production. Using the experimentally determined force-length-velocity potentials and muscle activation as inputs in a Hill-type muscle model, a reduction in maximum soleus muscle force at speeds ≥7.0 m s-1 and a continuous increase in maximum mechanical power with speed were predicted. The reduction in soleus maximum force was associated with a reduced force-velocity potential. The increase in maximum power was explained by an enhancement of muscle activation and contractile conditions until 7.0 m s-1, but mainly by increased muscle activation at high to maximal running speed.

Longitudinal Evidence for High-Level Patellar Tendon Strain as a Risk Factor for Tendinopathy in Adolescent Athletes

BACKGROUND

High tendon strain leads to sub-rupture fatigue damage and net-catabolic signaling upon repetitive loading. While high levels of tendon strain occur in adolescent athletes at risk for tendinopathy, a direct association has not yet been established. Therefore, in this prospective longitudinal study, we examined the hypothesis that adolescent athletes who develop patellar tendon pain have shown increased levels of strain in advance.

METHODS

In 44 adolescent athletes (12-17 years old), patellar tendon mechanical properties were measured using ultrasonography and inverse dynamics at four time points during a season. Fourteen athletes developed clinically relevant tendon pain (SYM; i.e., reduction of the VISA-P score of at least 13 points), while 23 remained asymptomatic (ASYM; VISA-P score of > 87 points). Seven cases did not fall into one of these categories and were excluded. Tendon mechanical properties of SYM in the session before the development of symptoms were compared to a randomly selected session in ASYM.

RESULTS

Tendon strain was significantly higher in SYM compared to ASYM (p = 0.03). The risk ratio for developing symptoms was 2.3-fold higher in athletes with tendon strain ≥9% (p = 0.026). While there was no clear evidence for systematic differences of the force applied to the tendon or tendon stiffness between SYM and ASYM (p > 0.05), subgroup analysis indicated that tendon force increased prior to the development of symptoms only in SYM (p = 0.034).

DISCUSSIO

The study provides novel longitudinal evidence that high tendon strain could be an important risk factor for patellar tendinopathy in adolescent athletes. We suggest that inadequate adaptation of tendon stiffness to increases in muscle strength may occur if adolescent athletes are subject to mechanical loading which does not  provide effective tendon stimulation.

Biarticular mechanisms of the gastrocnemii muscles enhance ankle mechanical power and work during running

The objective of the study was to explore how biarticular mechanisms of the gastrocnemii muscles may provide an important energy source for power and work at the ankle joint with increasing running speed. Achilles tendon force was quantified as a proxy of the triceps surae muscle force and the contribution of the monoarticular soleus and the biarticular gastrocnemii to the mechanical power and work performed at the ankle joint was investigated in three running speeds (transition 2.0 m s-1, slow 2.5 m s-1, fast 3.5 m s-1). Although the contribution of the soleus was higher, biarticular mechanisms of the gastrocnemii accounted for a relevant part of the performed mechanical power and work at the ankle joint. There was an ankle-to-knee joint energy transfer in the first part of the stance phase and a knee-to-ankle joint energy transfer during push-off via the gastrocnemii muscles, which made up 16% of the total positive ankle joint work. The rate of knee-to-ankle joint energy transfer increased with speed, indicating a speed-related participation of biarticular mechanisms in running. This energy transfer via the gastrocnemii seems to occur with negligible energy absorption/production from the quadriceps vasti contractile elements and is rather an energy exchange between elastic structures.

Contractile Work of the Soleus and Biarticular Mechanisms of the Gastrocnemii Muscles Increase the Net Ankle Mechanical Work at High Walking Speeds

Increasing walking speed is accompanied by an increase of the mechanical power and work performed at the ankle joint despite the decrease of the intrinsic muscle force potential of the soleus (Sol) and gastrocnemius medialis (GM) muscles. In the present study, we measured Achilles tendon (AT) elongation and, based on an experimentally determined AT force-elongation relationship, quantified AT force at four walking speeds (slow 0.7 m.s-1, preferred 1.4 m.s-1, transition 2.0 m.s-1, and maximum 2.6 ± 0.3 m.s-1). Further, we investigated the mechanical power and work of the AT force at the ankle joint and, separately, the mechanical power and work of the monoarticular Sol at the ankle joint and the biarticular gastrocnemii at the ankle and knee joints. We found a 21% decrease in maximum AT force at the two higher speeds compared to the preferred; however, the net work of the AT force at the ankle joint (ATF work) increased as a function of walking speed. An earlier plantar flexion accompanied by an increased electromyographic activity of the Sol and GM muscles and a knee-to-ankle joint energy transfer via the biarticular gastrocnemii increased the net ATF mechanical work by 1.7 and 2.4-fold in the transition and maximum walking speed, respectively. Our findings provide first-time evidence for a different mechanistic participation of the monoarticular Sol muscle (i.e., increased contractile net work carried out) and the biarticular gastrocnemii (i.e., increased contribution of biarticular mechanisms) to the speed-related increase of net ATF work.

Quantification of patellar tendon strain and opportunities for personalized tendon loading during back squats

Tendon strain during exercise is a critical regulatory factor in tendon adaptive responses and there are indications for an optimal range of strain that promotes tendon adaptation. Back squats are used to improve patellar tendon properties in sport and clinical settings. To date, the operating patellar tendon strain during back squats is unknown and current recommendations for individual exercise loading are based on the one repetition maximum (1RM). Here, we quantified patellar tendon strain during loaded back squats at 40, 60 and 80% of the 1RM and during maximum isometric knee extension contractions (MVC) using ultrasonography. Kinematics, ground reaction forces and muscle electromyographic activity were also recorded. Additionally, maximum tendon strain during the MVC and the percentage of 1RM were used as explanatory variables to estimate the individual patellar tendon strain during the squats. Strain increased with increasing 1RM loading (4.7 to 8.2%), indicating that already medium-loading back squats may provide a sufficient stimulus for tendon adaptation. The individual variability was, however, too high to generalize these findings. Yet, there was a high agreement between the individually estimated and measured patellar tendon strain (R² = 0.858) during back squats. We argue that this approach may provide new opportunities for personalized tendon exercise.

Adolescent boys who participate in sports exhibit similar ramp torque control with young men despite differences in strength and tendon characteristics

PURPOSE

The goal of this paper was to determine if sports participation influences torque control differently for adolescent boys and young men during a slow ramp task.

METHODS

Twenty-one adolescent boys (11 athletes) and 31 young men (16 athletes) performed a slow ramp increase in plantar flexion torque from 0 to maximum. We quantified torque control as the coefficient of variation (CV) of torque during the ramp and quantified the Achilles tendon mechanical properties using ultrasonography.

RESULTS

Relative to adolescent boys, young men were taller, heavier, stronger, and had a longer and stiffer Achilles tendon. However, these characteristics were not different between athletes and non-athletes in adolescent boys. For the CV of torque, there was a significant interaction with sports participation, indicating that only adolescent boys who were non-athletes had greater variability than young men. The CV of torque of all participants was predicted from the maximum torque and torque oscillations from 1 to 2 Hz, whereas the CV of torque for adolescent boys was predicted only from torque oscillations from 1 to 2 Hz.

CONCLUSION

These findings suggested that adolescent boys who participate in sports exhibited lower torque variability during a slow ramp task, which was not explained by differences in Achilles tendon properties or strength.

Towards modern understanding of the Achilles tendon properties in human movement research

The Achilles tendon (AT) is the strongest tendon in humans, yet it often suffers from injury. The mechanical properties of the AT afford efficient movement, power amplification and power attenuation during locomotor tasks. The properties and the unique structure of the AT as a common tendon for three muscles have been studied frequently in humans using in vivo methods since 1990's. As a part of the celebration of 50 years history of the International Society of Biomechanics, this paper reviews the history of the AT research focusing on its mechanical properties in humans. The questions addressed are: What are the most important mechanical properties of the Achilles tendon, how are they studied, what is their significance to human movement, and how do they adapt? We foresee that the ongoing developments in experimental methods and modeling can provide ways to advance knowledge of the complex three-dimensional structure and properties of the Achilles tendon in vivo, and to enable monitoring of the loading and recovery for optimizing individual adaptations.

The load borne by the Achilles tendon during exercise: A systematic review of normative values

The Achilles tendon (AT) can be exposed to considerable stress during athletic activities and is often subject to pathologies such as tendinopathies. When designing a prevention or rehabilitation protocol, mechanical loading is a key factor to consider. This implies being able to accurately determine the load applied to the AT when performing exercises that stress this tendon. A systematic review was performed to synthesize the load borne by the AT during exercises/activities. Three databases (Pubmed, Embase and Cochrane) were searched for articles up to May 2021, and only the studies assessing the AT load in newtons relative to body-weight (BW) on humans during activities or exercises were included. Most of the 11 included studies assessed AT load when running or walking (N = 10), and only three tested exercises were usually performed during rehabilitation. The load on the tendon ranged from 2.7 to 3.95 BW when walking, from 4.15 to 7.71 BW when running, and from 0.41 to 7.3 BW according to the strengthening exercise performed. From the collected data, a progression of exercises progressively loading the Achilles tendon, as well as the possible connections with walking and running activities, could be defined. However, the trends highlighted in the relationship between tendon loading and walking or running speeds present some inconsistencies. Further research is still needed to clarify them, but also to complete the data set in healthy and injured people.

In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries-An Ancillary Analysis of Data from a Controlled Clinical Trial

BACKGROUND

As inter-limb asymmetries can be associated with higher injury risk, we aimed to investigate their role in Achilles tendinopathy patients.

METHODS

In Achilles tendinopathy patients (n = 41), we assessed inter-limb asymmetries of mechanical, material, and morphological musculoskeletal properties and function and how those were affected by 12 weeks of exercise intervention (high-load protocol, n = 13; Alfredson protocol, n = 11). Moreover, we assessed whether asymmetry reductions correlated with improved Patient-Reported Outcomes (VISA-A score).

RESULTS

At baseline, tendinopathic tendons demonstrated lower tendon force (p = 0.017), lower tendon stress (p < 0.0001), larger tendon cross-sectional area (CSA) (p < 0.001), and increased intratendinous (p = 0.042) and tendon overall (p = 0.021) vascularization. For the high-load group, PRE-to-POST asymmetry comparisons revealed an asymmetry increase for the counter-movement jump (CMJ) (p = 0.034) and PRE-to-POST VISA-A score improvements correlated with CSA asymmetry reductions (p = 0.024). Within the Alfredson group, PRE-to-POST VISA-A score improvements correlated with CMJ asymmetry reductions (p = 0.044) and tendon stiffness asymmetry increases (p = 0.037). POST-to-POST in-between group comparisons revealed lower asymmetry in the high-load group for tendon elongation (p = 0.021) and tendon strain (p = 0.026).

CONCLUSIONS

The tendinopathic limb differs from the asymptomatic limb while therapeutic exercise interventions have little effect on asymmetries. Asymmetry reductions are not necessarily associated with tendon health improvements.

Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial

BACKGROUND

Assuming that the mechanisms inducing adaptation in healthy tendons yield similar responses in tendinopathic tendons, we hypothesized that a high-loading exercise protocol that increases tendon stiffness and cross-sectional area in male healthy Achilles tendons may also induce comparable beneficial adaptations in male tendinopathic Achilles tendons in addition to improving pain and function.

OBJECTIVES

We investigated the effectiveness of high-loading exercise in Achilles tendinopathy in terms of inducing mechanical (tendon stiffness, maximum strain), material (Young's modulus), morphological (tendon cross-sectional area (CSA)), maximum voluntary isometric plantar flexor strength (MVC) as well as clinical adaptations (Victorian Institute of Sports Assessment-Achilles (VISA-A) score and pain (numerical rating scale (NRS))) as the primary outcomes. As secondary outcomes, drop (DJ) and counter-movement jump (CMJ) height and intratendinous vascularity were assessed.

METHODS

We conducted a controlled clinical trial with a 3-month intervention phase. Eligibility criteria were assessed by researchers and medical doctors. Inclusion criteria were male sex, aged between 20 and 55 years, chronic Achilles tendinopathy confirmed by a medical doctor via ultrasound-assisted assessment, and a severity level of less than 80 points on the VISA-A score. Thirty-nine patients were assigned by sequential allocation to one of three parallel arms: a high-loading intervention (training at ~ 90% of the MVC) (n = 15), eccentric exercise (according to the Alfredson protocol) as the standard therapy (n = 15) and passive therapy (n = 14). Parameters were assessed pre- and-post-intervention. Data analysis was blinded.

RESULTS

Primary outcomes: Plantar flexor MVC, tendon stiffness, mean CSA and maximum tendon strain improved only in the high-loading intervention group by 7.2 ± 9.9% (p = 0.045), 20.1 ± 20.5% (p = 0.049), 8.98 ± 5.8% (p < 0.001) and -12.4 ± 10.3% (p = 0.001), respectively. Stiffness decreased in the passive therapy group (-7.7 ± 21.2%; p = 0.042). There was no change in Young's modulus in either group (p > 0.05). The VISA-A score increased in all groups on average by 19.8 ± 15.3 points (p < 0.001), while pain (NRS) dropped by -0.55 ± 0.9 points (p < 0.001).

SECONDARY OUTCOMES

CMJ height decreased for all groups (-0.63 ± 4.07 cm; p = 0.005). There was no change in DJ height and vascularity (p > 0.05) in either group.

CONCLUSION

Despite an overall clinical improvement, it was exclusively the high-loading intervention that induced significant mechanical and morphological adaptations of the plantar flexor muscle-tendon unit. This might contribute to protecting the tendon from strain-induced injury. Thus, we recommend the high-loading intervention as an effective (alternative) therapeutic protocol in Achilles tendinopathy rehabilitation management in males.

CLINICAL TRIALS REGISTRATION NUMBER

NCT02732782.

Fused ultrasound and electromyography-driven neuromuscular model to improve plantarflexion moment prediction across walking speeds

Background

Improving the prediction ability of a human-machine interface (HMI) is critical to accomplish a bio-inspired or model-based control strategy for rehabilitation interventions, which are of increased interest to assist limb function post neurological injuries. A fundamental role of the HMI is to accurately predict human intent by mapping signals from a mechanical sensor or surface electromyography (sEMG) sensor. These sensors are limited to measuring the resulting limb force or movement or the neural signal evoking the force. As the intermediate mapping in the HMI also depends on muscle contractility, a motivation exists to include architectural features of the muscle as surrogates of dynamic muscle movement, thus further improving the HMI’s prediction accuracy.

Objective

The purpose of this study is to investigate a non-invasive sEMG and ultrasound (US) imaging-driven Hill-type neuromuscular model (HNM) for net ankle joint plantarflexion moment prediction. We hypothesize that the fusion of signals from sEMG and US imaging results in a more accurate net plantarflexion moment prediction than sole sEMG or US imaging.

Methods

Ten young non-disabled participants walked on a treadmill at speeds of 0.50, 0.75, 1.00, 1.25, and 1.50 m/s. The proposed HNM consists of two muscle-tendon units. The muscle activation for each unit was calculated as a weighted summation of the normalized sEMG signal and normalized muscle thickness signal from US imaging. The HNM calibration was performed under both single-speed mode and inter-speed mode, and then the calibrated HNM was validated across all walking speeds.

Results

On average, the normalized moment prediction root mean square error was reduced by 14.58 % (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p=0.012$$\end{document}p=0.012) and 36.79 % (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p<0.001$$\end{document}p<0.001) with the proposed HNM when compared to sEMG-driven and US imaging-driven HNMs, respectively. Also, the calibrated models with data from the inter-speed mode were more robust than those from single-speed modes for the moment prediction.

Conclusions

The proposed sEMG-US imaging-driven HNM can significantly improve the net plantarflexion moment prediction accuracy across multiple walking speeds. The findings imply that the proposed HNM can be potentially used in bio-inspired control strategies for rehabilitative devices due to its superior prediction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-022-01061-z.

Triceps Surae Muscle-Tendon Properties as Determinants of the Metabolic Cost in Trained Long-Distance Runners

Purpose: This study aimed to determine whether triceps surae’s muscle architecture and Achilles tendon parameters are related to running metabolic cost (C) in trained long-distance runners.

Methods: Seventeen trained male recreational long-distance runners (mean age = 34 years) participated in this study. C was measured during submaximal steady-state running (5 min) at 12 and 16 km h^–1 on a treadmill. Ultrasound was used to determine the gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and soleus (SO) muscle architecture, including fascicle length (FL) and pennation angle (PA), and the Achilles tendon cross-sectional area (CSA), resting length and elongation as a function of plantar flexion torque during maximal voluntary plantar flexion. Achilles tendon mechanical (force, elongation, and stiffness) and material (stress, strain, and Young’s modulus) properties were determined. Stepwise multiple linear regressions were used to determine the relationship between independent variables (tendon resting length, CSA, force, elongation, stiffness, stress, strain, Young’s modulus, and FL and PA of triceps surae muscles) and C (J kg^–1m^–1) at 12 and 16 km h^–1.

Results: SO PA and Achilles tendon CSA were negatively associated with C (r² = 0.69; p < 0.001) at 12 km h^–1, whereas SO PA was negatively and Achilles tendon stress was positively associated with C (r² = 0.63; p = 0.001) at 16 km h^–1, respectively. Our results presented a small power, and the multiple linear regression’s cause-effect relation was limited due to the low sample size.

Conclusion: For a given muscle length, greater SO PA, probably related to short muscle fibers and to a large physiological cross-sectional area, may be beneficial to C. Larger Achilles tendon CSA may determine a better force distribution per tendon area, thereby reducing tendon stress and C at submaximal speeds (12 and 16 km h^–1). Furthermore, Achilles tendon morphological and mechanical properties (CSA, stress, and Young’s modulus) and triceps surae muscle architecture (GM PA, GM FL, SO PA, and SO FL) presented large correlations with C.

Development of Muscle-Tendon Adaptation in Preadolescent Gymnasts and Untrained Peers: A 12-Month Longitudinal Study

PURPOSE

The current study investigated the effects of long-term athletic training on the development of the triceps surae muscle-tendon unit in preadolescence.

METHODS

Eleven preadolescent untrained children and a group of 21 artistic gymnastics athletes of similar age (9 ± 1.7 yr) and maturity (Tanner stages I and II) participated in the study. The measurements were conducted every 3 months for 1 yr, and training volume and duration of the athletes were documented. Plantar flexor muscle strength, Achilles tendon stiffness, maximum tendon strain, and gastrocnemius medialis morphometrics were measured by integrating kinematics, ultrasonography, and dynamometry. A linear mixed-effects model was used to analyze the investigated parameters.

RESULTS

We found greater muscle strength (P < 0.001) in athletes compared with nonathletes but no differences in Achilles tendon stiffness (P = 0.252), indicating a training-induced imbalanced adaptation of muscle strength and tendon stiffness in preadolescent athletes. Although pennation angle (P = 0.490), thickness (P = 0.917), and fascicle length (P = 0.667) did not differ between groups, we found higher fluctuations in pennation angle and muscle strength over 1 yr in athletes. The imbalanced adaptation of muscle strength and tendon stiffness together with greater fluctuations of muscle strength resulted in greater tendon strain fluctuations over 1 yr (P = 0.017) and a higher frequency of athletes with high-level tendon strain (≥9%) compared with nonathletes.

CONCLUSIONS

The findings indicate an increased mechanical demand for the tendon in preadolescent athletes that could have implications for the risk of tendon overuse injury. Therefore, we recommend the implementation of individual training approaches to preserve a balanced adaptation within the triceps surae muscle-tendon unit in preadolescent athletes.

Muscle-specific economy of force generation and efficiency of work production during human running

Human running features a spring-like interaction of body and ground, enabled by elastic tendons that store mechanical energy and facilitate muscle operating conditions to minimize the metabolic cost. By experimentally assessing the operating conditions of two important muscles for running, the soleus and vastus lateralis, we investigated physiological mechanisms of muscle work production and muscle force generation. We found that the soleus continuously shortened throughout the stance phase, operating as work generator under conditions that are considered optimal for work production: high force-length potential and high enthalpy efficiency. The vastus lateralis promoted tendon energy storage and contracted nearly isometrically close to optimal length, resulting in a high force-length-velocity potential beneficial for economical force generation. The favorable operating conditions of both muscles were a result of an effective length and velocity-decoupling of fascicles and muscle-tendon unit, mostly due to tendon compliance and, in the soleus, marginally by fascicle rotation.

Recovery from Achilles Tendon Repair: A Combination of Postsurgery Outcomes and Insufficient Remodeling of Muscle and Tendon

INTRODUCTION

Achilles tendon rupture (ATR) patients have persistent functional deficits in the triceps surae muscle-tendon unit (MTU). The complex remodeling of the MTU accompanying these deficits remains poorly understood. The purpose of the present study was to associate in vivo and in silico data to investigate the relations between changes in MTU properties and strength deficits in ATR patients.

METHODS

Eleven male subjects who had undergone surgical repair of complete unilateral ATR were examined 4.6 ± 2.0 (mean ± SD) yr after rupture. Gastrocnemius medialis (GM) tendon stiffness, morphology, and muscle architecture were determined using ultrasonography. The force-length relation of the plantar flexor muscles was assessed at five ankle joint angles. In addition, simulations (OpenSim) of the GM MTU force-length properties were performed with various iterations of MTU properties found between the unaffected and the affected side.

RESULTS

The affected side of the patients displayed a longer, larger, and stiffer GM tendon (13% ± 10%, 105% ± 28%, and 54% ± 24%, respectively) compared with the unaffected side. The GM muscle fascicles of the affected side were shorter (32% ± 12%) and with greater pennation angles (31% ± 26%). A mean deficit in plantarflexion moment of 31% ± 10% was measured. Simulations indicate that pairing an intact muscle with a longer tendon shifts the optimal angular range of peak force outside physiological angular ranges, whereas the shorter muscle fascicles and tendon stiffening seen in the affected side decrease this shift, albeit incompletely.

CONCLUSIONS

These results suggest that the substantial changes in MTU properties found in ATR patients may partly result from compensatory remodeling, although this process appears insufficient to fully restore muscle function.

Prevention of strain-induced impairments of patellar tendon micromorphology in adolescent athletes

High-level patellar tendon strain may cause impairments of the tendon's micromorphological integrity in growing athletes and increase the risk for tendinopathy. This study investigated if an evidence-based tendon exercise intervention prevents high-level patellar tendon strain, impairments of micromorphology and pain in adolescent basketball players (male, 13-15 years). At three time points over a season (M1-3), tendon mechanical properties were measured using ultrasound and dynamometry, proximal tendon micromorphology with a spatial frequency analysis and pain and disability using VISA-P scores. The control group (CON, n = 19) followed the usual strength training plan, including sprint and change-of-direction drills. In the intervention group (INT, n = 14), three sessions per week with functional exercises were integrated into the training, providing repetitive high-magnitude tendon loading for at least 3 s per repetition. The frequency of high-level strain (ie, ≥9%) continuously decreased in INT, while tending to increase in CON since tendon force increased in both (p < 0.001), yet tendon stiffness only in INT (p = 0.004). In CON, tendon strain was inversely associated with tendon peak spatial frequency at all time points (p < 0.05), indicating impairments of tendon micromorphological integrity with higher strain, but not at M2 and M3 in INT. Descriptively, the fraction of asymptomatic athletes at baseline was similar in both groups (~70%) and increased to 100% in M3 in INT, while remaining unchanged in CON. We suggest that functional high-load tendon exercises could reduce the prevalence of high-level patellar tendon strain and associated impairments of its micromorphology in adolescent athletes, providing new opportunities for tendinopathy prevention.

Quantifying mechanical loading and elastic strain energy of the human Achilles tendon during walking and running

The purpose of the current study was to assess in vivo Achilles tendon (AT) mechanical loading and strain energy during locomotion. We measured AT length considering its curve-path shape. Eleven participants walked at 1.4 m/s and ran at 2.5 m/s and 3.5 m/s on a treadmill. The AT length was defined as the distance between its origin at the gastrocnemius medialis myotendinous junction (MTJ) and the calcaneal insertion. The MTJ was tracked using ultrasonography and projected to the reconstructed skin surface to account for its misalignment. Skin-to-bone displacements were assessed during a passive rotation (5°/s) of the ankle joint. Force and strain energy of the AT during locomotion were calculated by fitting a quadratic function to the experimentally measured tendon force-length curve obtained from maximum voluntary isometric contractions. The maximum AT strain and force were affected by speed (p < 0.05, ranging from 4.0 to 4.9% strain and 1.989 to 2.556 kN), yet insufficient in magnitude to be considered as an effective stimulus for tendon adaptation. Besides the important tendon energy recoil during the propulsion phase (7.8 to 11.3 J), we found a recoil of elastic strain energy at the beginning of the stance phase of running (70-77 ms after touch down) between 1.7 ± 0.6 and 1.9 ± 1.1 J, which might be functionally relevant for running efficiency.

Effects of long-term athletic training on muscle morphology and tendon stiffness in preadolescence: association with jump performance

Purpose

Evidence on training-induced muscle hypertrophy during preadolescence is limited and inconsistent. Possible associations of muscle strength and tendon stiffness with jumping performance are also not investigated. We investigated the thickness and pennation angle of the gastrocnemius medialis muscle (GM), as indicators for potential muscle hypertrophy in preadolescent athletes. Further, we examined the association of triceps surae muscle–tendon properties with jumping performance.

Methods

Eleven untrained children (9 years) and 21 similar-aged artistic gymnastic athletes participated in the study. Muscle thickness and pennation angle of the GM were measured at rest and muscle strength of the plantar flexors and Achilles tendon stiffness during maximum isometric contractions. Jumping height in squat (SJ) and countermovement jumps (CMJ) was examined using a force plate. We evaluated the influence of normalised muscle strength and tendon stiffness on jumping performance with a linear regression model.

Results

Muscle thickness and pennation angle did not differ significantly between athletes and non-athletes. In athletes, muscle strength was greater by 25% and jumping heights by 36% (SJ) and 43% (CMJ), but Achilles tendon stiffness did not differ between the two groups. The significant predictor for both jump heights was tendon stiffness in athletes and normalised muscle strength for the CMJ height in non-athletes.

Conclusion

Long-term artistic gymnastics training during preadolescence seems to be associated with increased muscle strength and jumping performance but not with training-induced muscle hypertrophy or altered tendon stiffness in the plantar flexors. Athletes benefit more from tendon stiffness and non-athletes more from muscle strength for increased jumping performance.

Vastus Lateralis Architecture Changes During Pregnancy - A Longitudinal Study

While the incidence of falls has been described to increase with pregnancy, the mechanism behind this is unclear. Pregnancy associated changes in lower extremity muscle strength could be a possible factor influencing injury risk. Thus, the aim of this longitudinal study was to investigate muscle strength and architectural properties of the lower limbs in different stages of pregnancy and postpartum. In nineteen pregnant women (30 ± 4 years) and fifteen non-pregnant controls (28 ± 4 years) muscle strength and architectural properties of the vastus lateralis muscle were assessed combining dynamometry, ultrasound, kinematic, and electromyographic measurements. Body mass and body composition were determined using bioimpedance analysis. In the pregnant women, the measurements were conducted in the 16 ± 4th (EP) and 29 ± 4th week of pregnancy (LP) as well as in the 32 ± 9th week postpartum (PP). Muscle thickness and pennation angle of the fascicles significantly increased at LP, while muscle strength remained constant during and after pregnancy. Body mass, skeletal muscle mass, fat mass, intracellular and extracellular water also peaked at LP. Postpartum values did not differ from the controls. Changes in the muscle properties were not related to changes in body mass and body composition. Conditions during pregnancy promote changes in the vastus lateralis architecture indicating muscle hypertrophy. However, pregnancy did not increase muscle strength while body mass progressively increases. Therefore, in the event of balance perturbations pregnant women may not be able to meet the requirements for the increased physical demand.

Morphological and Mechanical Properties of the Quadriceps Femoris Muscle-Tendon Unit From Adolescence to Adulthood: Effects of Age and Athletic Training

The combined effects of mechanical loading and maturation during adolescence are still not well understood. The purpose of the study was to investigate the development of the quadriceps femoris muscle-tendon unit from early adolescence (EA), late adolescence (LA) to young adulthood (YA), and examine how it is influenced by athletic training in a cross-sectional design. Forty-one male athletes and forty male non-athletes from three different age groups (EA: 12-14 years, n = 29; LA: 16-18 years, n = 27; and YA: 20-35 years, n = 25) participated in the present study. Maximum strength of the knee extensor muscles, architecture of the vastus lateralis (VL) muscle and patellar tendon stiffness were examined using dynamometry, motion capture, electromyography, and ultrasonography. Muscle strength and tendon stiffness significantly increased (p < 0.001) from EA to LA without any further alterations (p > 0.05) from LA to YA. Athletes compared to non-athletes showed significantly greater (p < 0.001) absolute muscle strength (EA: 3.52 ± 0.75 vs. 3.20 ± 0.42 Nm/kg; LA: 4.47 ± 0.61 vs. 3.83 ± 0.56 Nm/kg; and YA: 4.61 ± 0.55 vs. 3.60 ± 0.53), tendon stiffness (EA: 990 ± 317 vs. 814 ± 299 N/mm; LA: 1266 ± 275 vs. 1110 ± 255 N/mm; and YA: 1487 ± 354 vs. 1257 ± 328), and VL thickness (EA: 19.7 ± 3.2 vs. 16.2 ± 3.4 mm; LA: 23.0 ± 4.2 vs. 20.1 ± 3.3 mm; and YA: 25.5 ± 4.2 vs. 23.9 ± 3.9 mm). Athletes were more likely to reach strain magnitudes higher than 9% strain compared to non-athlete controls (EA: 28 vs. 15%; LA: 46 vs. 16%; and YA: 66 vs. 33%) indicating an increased mechanical demand for the tendon. Although the properties of the quadriceps femoris muscle-tendon unit are enhanced by athletic training, their development from early-adolescence to adulthood remain similar in athletes and non-athletes with the major alterations between early and LA. However, both age and athletic training was associated with a higher prevalence of imbalances within the muscle-tendon unit and a resultant increased mechanical demand for the patellar tendon.

Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes

High mechanical strain is thought to be one of the main factors for the risk of tendon injury, as it determines the mechanical demand placed upon the tendon by the working muscle. The present study investigates the association of tendon mechanical properties including force, stress and strain, and measures of tendon micromorphology and neovascularization, which are thought to be indicative of tendinopathy in an adolescent high-risk group for overuse injury. In 16 adolescent elite basketball athletes (14–15 years of age) we determined the mechanical properties of the patellar tendon by combining inverse dynamics with magnetic resonance and ultrasound imaging. Tendon micromorphology was determined based on a spatial frequency analysis of sagittal plane ultrasound images and neovascularization was quantified as color Doppler area. There was a significant inverse relationship between tendon strain and peak spatial frequency (PSF) in the proximal tendon region (r = −0.652, p = 0.006), indicating locally disorganized collagen fascicles in tendons that are subjected to high strain. No such associations were present at the distal tendon site and no significant correlations were observed between tendon force or stress and tendon PSF as well as between tendon loading and vascularity. Our results suggest that high levels of tendon strain might associate to a micromorphological deterioration of the collagenous network in the proximal patellar tendon, which is also the most frequent site affected by tendinopathy. Neovascularization of the tendon on the other hand seems not to be directly related to the magnitude of tendon loading and might be a physiological response to a high frequency of training in this group. Those findings have important implications for our understanding of the etiology of tendinopathy and for the development of diagnostical tools for the assessment of injury risk.

Triceps Surae Muscle-Tendon Unit Properties in Preadolescent Children: A Comparison of Artistic Gymnastic Athletes and Non-athletes

Knowledge regarding the effects of athletic training on the properties of muscle and tendon in preadolescent children is scarce. The current study compared Achilles tendon stiffness, plantar flexor muscle strength and vertical jumping performance of preadolescent athletes and non-athletes to provide insight into the potential effects of systematic athletic training. Twenty-one preadolescent artistic gymnastic athletes (9.2 ± 1.6 years, 15 girls) and 11 similar-aged non-athlete controls (9.0 ± 1.7 years, 6 girls) participated in the study. The training intensity and volume of the athletes was documented for the last 6 months before the measurements. Subsequently, vertical ground reaction forces were measured with a force plate to assess jumping performance during squat (SJ) and countermovement jumps (CMJ) in both groups. Muscle strength of the plantar flexor muscles and Achilles tendon stiffness were examined using ultrasound, electromyography, and dynamometry. The athletes trained 6 days per week with a total of 20 h of training per week. Athletes generated significantly greater plantar flexion moments normalized to body mass compared to non-athletes (1.75 ± 0.32 Nm/kg vs. 1.31 ± 0.33 Nm/kg; p = 0.001) and achieved a significantly greater jump height in both types of jumps (21.2 ± 3.62 cm vs. 14.9 ± 2.32 cm; p < 0.001 in SJ and 23.4 ± 4.1 cm vs. 16.4 ± 4.1 cm; p < 0.001 in CMJ). Achilles tendon stiffness did not show any statistically significant differences (p = 0.413) between athletes (116.3 ± 32.5 N/mm) and non-athletes (106.4 ± 32.8 N/mm). Athletes were more likely to reach strain magnitudes close to or higher than 8.5% strain compared to non-athletes (frequency: 24% vs. 9%) indicating an increased mechanical demand for the tendon. Although normalized muscle strength and jumping performance were greater in athletes, gymnastic-specific training in preadolescence did not cause a significant adaptation of Achilles tendon stiffness. The potential contribution of the high mechanical demand for the tendon to the increasing risk of tendon overuse call for the implementation of specific exercises in the athletic training of preadolescent athletes that increase tendon stiffness and support a balanced adaptation within the muscle-tendon unit.

Patellar Tendon Stiffness Is Not Reduced During Pregnancy

It is believed that hormonal changes during pregnancy lead to an increased compliance in ligaments and tendons, increasing the risk to suffer from connective tissue injuries particularly during exercise. While the laxity of the pelvic ligaments may increase to facilitate childbirth, to our knowledge no study has ever investigated the mechanical properties of human tendons in different stages of pregnancy. Thus, the purpose of our longitudinal study was to investigate the mechanical properties of the patellar tendon in different stages of pregnancy and postpartum. Nineteen pregnant women (30 ± 4 years) and 11 non-pregnant controls (28 ± 3 years) performed maximum isometric knee extension contractions on a dynamometer. Muscle strength and mechanical properties of the patellar tendon were determined integrating ultrasound, kinematic, and electromyographic measurements. In pregnant women, measurements were performed in the 16 ± 4th week of pregnancy (EP), the 29 ± 4th week of pregnancy (LP) and 32 ± 9th weeks postpartum (PP). On average, muscle strength as well as patellar tendon stiffness, force, and relative strain did not change during pregnancy and did not differ from non-pregnant controls. Tendon length measured at 90° knee flexion continuously increased during and after pregnancy (tendon length PP>EP; PP>controls). Our results indicate that patellar tendon stiffness is not universally affected by pregnancy. We found no evidence to support the often stated assumption that tendons would become more compliant during pregnancy. However, variability between individuals as well as the progressive increase in tendon rest length during and after pregnancy and its implications on injury risk need to be further examined.

Development of a Non-invasive Methodology for the Assessment of Muscle Fibre Composition

The percentage area of fast twitch fibres of a muscle is a major determinant of muscle mechanical power and, thus, an important biomarker for the evaluation of training processes. However, the invasive character of the assessment (muscle biopsy) limits the wide application of the biomarker in the training praxis. Our purpose was to develop a non-invasive method for the assessment of fast twitch fibre content in human soleus muscle. From a theoretical point of view, the maximum muscle mechanical power depends on the fibre composition, the muscle volume and muscle specific tension. Therefore, we hypothesised that the percentage area of type II fibres would show a correlation with the maximum muscle mechanical power normalised to muscle volume and specific muscle contractile strength (i.e., plantar flexion moment divided by muscle cross-sectional area). In 20 male adults, the percentage area of type II fibres, volume and maximum cross-sectional area of the soleus muscle as well as the maximum plantar flexion moment and the maximum mechanical power were measured using muscle biopsies, magnetic resonance imaging and dynamometry. The maximum mechanical power normalised to muscle volume and specific muscle contractile strength provided a significant relationship (r = 0.654, p = 0.002) with the percentage area of type II fibres. Although the proposed assessment parameter cannot fully replace histological measurements, the predictive power of 43% can provide a relevant contribution to performance diagnostics in the training praxis.

Age-Related Changes in Achilles Tendon Stiffness and Impact on Functional Activities: A Systematic Review and Meta-Analysis

Achilles tendon stiffness determines calf muscle functioning during functional activities. However, contrasting evidence was found in studies comparing Achilles tendon stiffness in older and younger adults. Therefore, this systematic review compares Achilles tendon stiffness and elastic modulus in older and younger adults and reviews functional implications. Studies revealed by systematic bibliographic searches were included if healthy older adults were investigated, and if Achilles tendon stiffness was measured using ultrasound and dynamometry. Meta-analyses were performed to compare Achilles tendon stiffness and elastic modulus in older and younger adults. Achilles tendon stiffness (weighted standardized mean difference = 1.40, 95% confidence intervals [0.42-2.38]) and elastic modulus (weighted standardized mean difference = 1.74, 95% confidence intervals [0.99-2.49]) were decreased in older compared with younger adults. Decreased Achilles tendon stiffness was related to walking performance and balance. Possibly, decreased Achilles tendon stiffness is caused by altered elastic modulus in older adults. Training interventions increasing Achilles tendon stiffness could improve functional capacity.

The role of muscle strength on tendon adaptability in old age

PURPOSE

The purpose of the study was to determine: (1) the relationship between ankle plantarflexor muscle strength and Achilles tendon (AT) biomechanical properties in older female adults, and (2) whether muscle strength asymmetries between the individually dominant and non-dominant legs in the above subject group were accompanied by inter-limb AT size differences.

METHODS

The maximal generated AT force, AT stiffness, AT Young's modulus, and AT cross-sectional area (CSA) along its length were determined for both legs in 30 women (65 ± 7 years) using dynamometry, ultrasonography, and magnetic resonance imaging.

RESULTS

No between-leg differences in triceps surae muscle strength were identified between dominant (2798 ± 566 N) and non-dominant limb (2667 ± 512 N). The AT CSA increased gradually in the proximo-distal direction, with no differences between the legs. There was a significant correlation (P < 0.05) of maximal AT force with AT stiffness (r = 0.500) and Young's modulus (r = 0.414), but only a tendency with the mean AT CSA. However, region-specific analysis revealed a significant relationship between maximal AT force and the proximal part of the AT, indicating that this region is more likely to display morphological adaptations following an increase in muscle strength in older adults.

CONCLUSIONS

These findings demonstrate that maximal force-generation capabilities play a more important role in the variation of AT stiffness and material properties than in tendon CSA, suggesting that exercise-induced increases in muscle strength in older adults may lead to changes in tendon stiffness foremost due to alterations in material rather than in its size.

Effects of tracking landmarks and tibial point of resistive force application on the assessment of patellar tendon mechanical properties in vivo

The different methods used to assess patellar tendon elongation in vivo may partly explain the large variation of mechanical properties reported in the literature. The present study investigated the effects of tracking landmark position and tibial point of resistive force application during leg extensions in a dynamometer. Nineteen adults performed isometric contractions with a proximal and distal dynamometer shank pad position. Knee joint moments were calculated employing an inverse dynamics approach. Tendon elongation was measured using the patellar apex and either the tibial tuberosity (T) or plateau (P) as tracking landmark. Using P for tracking introduced a bias towards greater values of tendon elongation at all force levels from 100 N to maximum tendon force (TFmax; p < 0.05). The differences between landmarks considering maximum tendon strain were greater at the proximal shank pad position (p < 0.05). Tendon stiffness was lower for P compared with T, but only in intervals up to 50% of TFmax (p < 0.05). The agreement between T and P for stiffness calculated between 50% and TFmax was acceptable with the distal, but poor with the proximal pad position. We demonstrated that using the tibia plateau and not the insertion as tracking landmark clearly affects the assessment of the force-elongation curve of the patellar tendon. However, using a distal point of resistive force application and calculating tendon stiffness between 50% and TFmax seems to yield an acceptable agreement between landmarks. These findings have important implications for the assessment of tendon properties in vivo and cross-study comparisons.

Operating length and velocity of human vastus lateralis muscle during walking and running

According to the force-length-velocity relationships, the muscle force potential during locomotion is determined by the operating fibre length and velocity. We measured fascicle and muscle-tendon unit length and velocity as well as the activity of the human vastus lateralis muscle (VL) during walking and running. Furthermore, we determined the VL force-length relationship experimentally and calculated the force-length and force-velocity potentials (i.e. fraction of maximum force according to the force-length-velocity curves) for both gaits. During the active state of the stance phase, fascicles showed significantly (p < 0.05) smaller length changes (walking: 9.2 ± 4.7% of optimal length (L₀); running: 9.0 ± 8.4%L₀) and lower velocities (0.46 ± 0.36 L₀/s; 0.03 ± 0.83 L₀/s) compared to the muscle-tendon unit (walking: 19.7 ± 5.3%L₀, −0.94 ± 0.32 L₀/s; running: 34.5 ± 5.8%L₀, −2.59 ± 0.41 L₀/s). The VL fascicles operated close to optimum length (L₀ = 9.4 ± 0.11 cm) in both walking (8.6 ± 0.14 cm) and running (10.1 ± 0.19 cm), resulting in high force-length (walking: 0.92 ± 0.08; running: 0.91 ± 0.14) and force-velocity (0.91 ± 0.08; 0.97 ± 0.13) potentials. For the first time we demonstrated that, in contrast to the current general conception, the VL fascicles operate almost isometrically and close to L₀ during the active state of the stance phase of walking and running. The findings further verify an important contribution of the series-elastic element to VL fascicle dynamics.

Muscle and Tendon Adaptation in Adolescence: Elite Volleyball Athletes Compared to Untrained Boys and Girls

Though the plasticity of human tendons is well explored in adults, it is still unknown how superimposed mechanical loading by means of athletic training affects the properties of tendons during maturation. Due to the increased responsiveness of muscle to mechanical loading, adolescence is an important phase to investigate the effects of training on the mechanical properties of tendons. Hence, in the present study we compared vastus lateralis (VL) architecture, muscle strength of the knee extensor muscles and patellar tendon mechanical properties of male and female adolescent elite athletes to untrained boys and girls. Twenty-one adolescent volleyball athletes (A; 16.7 ± 1 years; 12 boys, 9 girls) and 24 similar-aged controls (C; 16.7 ± 1 years; 12 boys and girls, respectively) performed maximum isometric contractions on a dynamometer for the assessment of muscle strength and, by integrating ultrasound imaging, patellar tendon mechanical properties. Respective joint moments were calculated using an inverse dynamics approach and an electromyography-based estimation of antagonistic contribution. Additionally, the VL pennation angle, fascicle length and muscle-thickness were determined in the inactive state by means of ultrasound. Adolescent athletes produced significantly greater knee extension moments (normalized to body mass) compared to controls (A: 4.23 ± 0.80 Nm/kg, C: 3.57 ± 0.67 Nm/kg; p = 0.004), and showed greater VL thickness and pennation angle (+38% and +27%; p < 0.001). Tendon stiffness (normalized to rest length) was also significantly higher in athletes (A: 86.0 ± 27.1 kN/strain, C: 70.2 ± 18.8 kN/strain; p = 0.04), yet less pronounced compared to tendon force (A: 5785 ± 1146 N, C: 4335 ± 1015 N; p < 0.001), which resulted in higher levels of tendon strain during maximum contractions in athletes (A: 8.0 ± 1.9%, C: 6.4 ± 1.8%; p = 0.008). We conclude that athletic volleyball training provides a more efficient stimulus for muscle compared to tendon adaptation, which results in an increased demand placed upon the tendon by the working muscle in adolescent volleyball athletes. Besides implications for sport performance, these findings might have important consequences for the risk of tendon overuse injury.

Operating length and velocity of human M. vastus lateralis fascicles during vertical jumping

Humans achieve greater jump height during a counter-movement jump (CMJ) than in a squat jump (SJ). However, the crucial difference is the mean mechanical power output during the propulsion phase, which could be determined by intrinsic neuro-muscular mechanisms for power production. We measured M. vastus lateralis (VL) fascicle length changes and activation patterns and assessed the force-length, force-velocity and power-velocity potentials during the jumps. Compared with the SJ, the VL fascicles operated on a more favourable portion of the force-length curve (7% greater force potential, i.e. fraction of VL maximum force according to the force-length relationship) and more disadvantageous portion of the force-velocity curve (11% lower force potential, i.e. fraction of VL maximum force according to the force-velocity relationship) in the CMJ, indicating a reciprocal effect of force-length and force-velocity potentials for force generation. The higher muscle activation (15%) could therefore explain the moderately greater jump height (5%) in the CMJ. The mean fascicle-shortening velocity in the CMJ was closer to the plateau of the power-velocity curve, which resulted in a greater (15%) power-velocity potential (i.e. fraction of VL maximum power according to the power-velocity relationship). Our findings provide evidence for a cumulative effect of three different mechanisms-i.e. greater force-length potential, greater power-velocity potential and greater muscle activity-for an advantaged power production in the CMJ contributing to the marked difference in mean mechanical power (56%) compared with SJ.

Athletic training affects the uniformity of muscle and tendon adaptation during adolescence

With the double stimulus of mechanical loading and maturation acting on the muscle-tendon unit, adolescent athletes might be at increased risk of developing imbalances of muscle strength and tendon mechanical properties. This longitudinal study aims to provide detailed information on how athletic training affects the time course of muscle-tendon adaptation during adolescence. In 12 adolescent elite athletes (A) and 8 similar-aged controls (C), knee extensor muscle strength and patellar tendon mechanical properties were measured over 1 yr in 3-mo intervals. A linear mixed-effects model was used to analyze time-dependent changes and the residuals of the model to quantify fluctuations over time. The cosine similarity (CS) served as a measure of uniformity of the relative changes of tendon force and stiffness. Muscle strength and tendon stiffness increased significantly in both groups ( P < 0.01). However, the fluctuations of muscle strength were greater [A, 17 ± 7 (SD) N·m; C, 6 ± 2 N·m; P < 0.05] and the uniformity of changes of tendon force and stiffness was lower in athletes (CS A, −0.02 ± 0.5; C, 0.5 ± 0.4; P < 0.05). Further, athletes demonstrated greater maximum tendon strain (A, 7.6 ± 1.7%; C, 5.5 ± 0.9%; P < 0.05) and strain fluctuations (A, 0.9 ± 0.4; C, 0.3 ± 0.1; P < 0.05). We conclude that athletic training in adolescence affects the uniformity of muscle and tendon adaptation, which increases the demand on the tendon with potential implications for tendon injury.

Muscle and tendon adaptation in adolescent athletes: A longitudinal study

There is evidence that a non-uniform adaptation of muscle and tendon in young athletes results in increased tendon stress during mid-adolescence. The present longitudinal study investigated the development of the morphological and mechanical properties of muscle and tendon of volleyball athletes in a time period of 2 years from mid-adolescence to late adolescence. Eighteen elite volleyball athletes participated in magnetic resonance imaging and ultrasound-dynamometry sessions to determine quadriceps femoris muscle strength, vastus lateralis, medialis and intermedius morphology, and patellar tendon mechanical and morphological properties in mid-adolescence (16 ± 1 years) and late adolescence (18 ± 1 years). Muscle strength, anatomical cross-sectional area (CSA), and volume showed significant (P < 0.05) but moderate increases of 13%, 6%, and 6%, respectively. The increase of patellar tendon CSA (P < 0.05) was substantially greater (27%) and went in line with increased stiffness (P < 0.05; 25%) and reduced stress (P < 0.05; 9%). During late adolescence, a pronounced hypertrophy of the patellar tendon led to a mechanical strengthening of the tendon in relation to the functional and morphological development of the muscle. These adaptive processes may compensate the unfavorable relation of muscle strength and tendon loading capacity in mid-adolescence and might have implications on athletic performance and tendon injury risk.

Ultrasound reveals negligible cocontraction during isometric plantar flexion and dorsiflexion despite the presence of antagonist electromyographic activity

Because of the approximate linear relationship between muscle force and muscle activity, muscle forces are often estimated during maximal voluntary isometric contractions (MVICs) from torque and surface electromyography (sEMG) measurements. However, sEMG recordings from a target muscle may contain cross-talk originating from nearby muscles, which could lead to erroneous force estimates. Here we used ultrasound imaging to measure in vivo muscle fascicle length ( Lf) changes and sEMG to measure muscle activity of the tibialis anterior, medial gastrocnemius, lateral gastrocnemius, and soleus muscles during ramp MVICs in plantar and dorsiflexion directions ( n = 8). After correcting longitudinal Lfchanges for ankle rotation, the antagonist Lfat peak antagonist root-mean-square (RMS) amplitude were significantly longer than the agonist Lfat this sEMG-matched level. On average, Lfshortened from resting length by 1.29 to 2.90 mm when muscles acted as agonists and lengthened from resting length by 0.43 to 1.16 mm when muscles acted as antagonists (depending on the muscle of interest). The lack of fascicle shortening when muscles acted as antagonists indicates that cocontraction was likely to be negligible, despite cocontraction as determined by sEMG of between 7 and 23% MVIC across all muscles. Different interelectrode distances (IEDs) over the plantar flexors revealed significantly higher antagonist RMS amplitudes for the 4-cm IEDs compared with the 2-cm IEDs, which further indicates that cross-talk was present. Consequently, investigators should be wary about performing agonist torque corrections for isometric plantar flexion and dorsiflexion based on the antagonist sEMG trace and predicted antagonist moment.

Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults

BACKGROUND

The present article systematically reviews recent literature on the in vivo adaptation of asymptomatic human tendons following increased chronic mechanical loading, and meta-analyzes the loading conditions, intervention outcomes, as well as methodological aspects.

METHODS

The search was performed in the databases PubMed, Web of Knowledge, and Scopus as well as in the reference lists of the eligible articles. A study was included if it conducted (a) a longitudinal exercise intervention (≥8 weeks) on (b) healthy humans (18 to 50 years), (c) investigating the effects on mechanical (i.e., stiffness), material (i.e., Young's modulus) and/or morphological properties (i.e., cross-sectional area (CSA)) of tendons in vivo, and was reported (d) in English language. Weighted average effect sizes (SMD, random-effects) and heterogeneity (Q and I ² statistics) of the intervention-induced changes of tendon stiffness, Young's modulus, and CSA were calculated. A subgroup analysis was conducted regarding the applied loading intensity, muscle contraction type, and intervention duration. Further, the methodological study quality and the risk of bias were assessed.

RESULTS

The review process yielded 27 studies with 37 separate interventions on either the Achilles or patellar tendon (264 participants). SMD was 0.70 (confidence interval: 0.51, 0.88) for tendon stiffness (N=37), 0.69 (0.36, 1.03) for Young's modulus (N=17), and 0.24 (0.07, 0.42) for CSA (N=33), with significant overall intervention effects (p<0.05). The heterogeneity analysis (stiffness: I ² =30%; Young's modulus: I ² =57%; CSA: I ² =21%) indicated that differences in the loading conditions may affect the adaptive responses. The subgroup analysis confirmed that stiffness adaptation significantly (p<0.05) depends on loading intensity (I ² =0%), but not on muscle contraction type. Although not significantly different, SMD was higher for interventions with longer duration (≥12 weeks). The average score of 71±9% in methodological quality assessment indicated an appropriate quality of most studies.

CONCLUSIONS

The present meta-analysis provides elaborate statistical evidence that tendons are highly responsive to diverse loading regimens. However, the data strongly suggests that loading magnitude in particular plays a key role for tendon adaptation in contrast to muscle contraction type. Furthermore, intervention-induced changes in tendon stiffness seem to be more attributed to adaptations of the material rather than morphological properties.

Human Achilles tendon plasticity in response to cyclic strain: effect of rate and duration

High strain magnitude and low strain frequency are important stimuli for tendon adaptation. Increasing the rate and duration of the applied strain may enhance the adaptive responses. Therefore, our purpose was to investigate the effect of strain rate and duration on Achilles tendon adaptation. The study included two experimental groups (N=14 and N=12) and a control group (N=13). The participants of the experimental groups exercised according to a reference protocol (14 weeks, four times a week), featuring a high strain magnitude (~6.5%) and a low strain frequency (0.17 Hz, 3 s loading/3 s relaxation) on one leg and with either a higher strain rate (one-legged jumps) or a longer strain duration (12 s loading) on the other leg. The strain magnitude and loading volume were similar in all protocols. Before and after the interventions, the tendon stiffness, Young's modulus and cross-sectional area were examined using magnetic resonance imaging, ultrasound and dynamometry. The reference and long strain duration protocols induced significantly increased (P<0.05) tendon stiffness (57% and 25%), cross-sectional area (4.2% and 5.3%) and Young's modulus (51% and 17%). The increases in tendon stiffness and Young's modulus were higher in the reference protocol. Although region-specific tendon hypertrophy was also detected after the high strain rate training, there was only a tendency of increased stiffness (P=0.08) and cross-sectional area (P=0.09). The control group did not show any changes (P=0.86). The results provide evidence that a high strain magnitude, an appropriate strain duration and repetitive loading are essential components for an efficient adaptive stimulus for tendons.

Effect of exercise-induced enhancement of the leg-extensor muscle-tendon unit capacities on ambulatory mechanics and knee osteoarthritis markers in the elderly

Objective

Leg-extensor muscle weakness could be a key component in knee joint degeneration in the elderly because it may result in altered muscular control during locomotion influencing the mechanical environment within the joint. This work aimed to examine whether an exercise-induced enhancement of the triceps surae (TS) and quadriceps femoris (QF) muscle-tendon unit (MTU) capacities would affect mechanical and biological markers for knee osteoarthritis in the elderly.

Methods

Twelve older women completed a 14-week TS and QF MTU exercise intervention, which had already been established as increasing muscle strength and tendon stiffness. Locomotion mechanics and serum cartilage oligomeric matrix protein (COMP) levels were examined during incline walking. MTU mechanical properties were assessed using simultaneously ultrasonography and dynamometry.

Results

Post exercise intervention, the elderly had higher TS and QF contractile strength and tendon-aponeurosis stiffness. Regarding the incline gait task, the subjects demonstrated a lower external knee adduction moment and lower knee adduction angular impulse during the stance phase post-intervention. Furthermore, post-intervention compared to pre-intervention, the elderly showed lower external hip adduction moment, but revealed higher plantarflexion pushoff moment. The changes in the external knee adduction moment were significantly correlated with the improvement in ankle pushoff function. Serum COMP concentration increased in response to the 0.5-h incline walking exercise with no differences in the magnitude of increment between pre- and post-intervention.

Conclusions

This work emphasizes the important role played by the ankle pushoff function in knee joint mechanical loading during locomotion, and may justify the inclusion of the TS MTU in prevention programs aiming to positively influence specific mechanical markers for knee osteoarthritis in the elderly. However, the study was unable to show that COMP is amenable to change in the elderly following a 14-week exercise intervention and, therefore, the physiological benefit of improved muscle function for knee cartilage requires further investigation.

Effects of load magnitude, muscle length and velocity during eccentric chronic loading on the longitudinal growth of the vastus lateralis muscle

The present study investigated the longitudinal growth of the vastus lateralis muscle using four eccentric exercise protocols with different mechanical stimuli by modifying the load magnitude, lengthening velocity and muscle length at which the load was applied. Thirty-one participants voluntarily participated in this study in two experimental and one control group. The first experimental group (N=10) exercised the knee extensors of one leg at 65% (low load magnitude) of the maximum isometric voluntary contraction (MVC) and the second leg at 100% MVC (high load magnitude) with 90 deg s(-1) angular velocity, from 25 to 100 deg knee angle. The second experimental group (N=10) exercised one leg at 100% MVC, 90 deg s(-1), from 25 to 65 deg knee angle (short muscle length). The other leg was exercised at 100% MVC, 240 deg s(-1) angular velocity (high muscle lengthening velocity) from 25 to 100 deg. In the pre- and post-intervention measurements, we examined the fascicle length of the vastus lateralis at rest and the moment-angle relationship of the knee extensors. After 10 weeks of intervention, we found a significant increase (~14%) of vastus lateralis fascicle length compared with the control group, yet only in the leg that was exercised with high lengthening velocity. The findings provide evidence that not every eccentric loading causes an increase in fascicle length and that the lengthening velocity of the fascicles during the eccentric loading, particularly in the phase where the knee joint moment decreases (i.e. deactivation of the muscle), seems to be an important factor for longitudinal muscle growth.

Evidence of imbalanced adaptation between muscle and tendon in adolescent athletes

Adolescence may be regarded as a critical phase of tissue plasticity in young growing athletes, as the adaptation process of muscle-tendon unit is affected by both environmental mechanical stimuli and maturation. The present study investigated potential imbalances of knee extensor muscle strength and patellar tendon properties in adolescent compared with middle-aged athletes featuring long-term musculotendinous adaptations. Nineteen adolescent elite volleyball athletes [(A), 15.9 ± 0.6 years] and 18 middle-aged competitively active former elite volleyball athletes [(MA), 46.9 ± 0.6 years] participated in magnetic resonance imaging and ultrasound-dynamometry sessions to determine quadriceps femoris muscle strength, vastus lateralis morphology and patellar tendon mechanical and morphological properties. There was no significant age effect on the physiological cross-sectional area of the vastus lateralis and maximum knee extension moment (P > 0.05) during voluntary isometric contractions. However, the patellar tendon cross-sectional area was significantly smaller (A: 107.4 ± 27.5 mm(2) ; MA: 121.7 ± 39.8 mm(2) ) and the tendon stress during the maximal contractions was significantly higher in adolescent compared with the middle-aged athletes (A: 50.0 ± 10.1 MPa; MA: 40.0 ± 9.5 MPa). These findings provide evidence of an imbalanced development of muscle strength and tendon mechanical and morphological properties in adolescent athletes, which may have implications for the risk of tendon overuse injuries.

Central Factors Explain Muscle Weakness in Young Fallers With Parkinson’s Disease

Background. Muscle weakness in old Parkinson’s disease (PD) patients has been shown to impair their mobility, although the specific origin of this weakness and its relation to falls has not been well examined in young patients. Objective. This study aimed to analyze the possible contribution of central factors to muscle weakness of the triceps surae and quadriceps femoris muscles in young faller and nonfaller PD patients. Methods. Twenty-six young PD patients (fallers, n = 13 and nonfallers, n = 13) and 15 matched healthy controls performed several isometric maximal voluntary knee extension and plantar flexion contractions (MVC) of the most affected leg on a dynamometer. We estimated the maximal resultant agonist moments, the antagonistic moment of hamstrings and tibialis anterior during MVCs and the activation deficit of the quadriceps femoris and triceps surae muscles. Results. Only the Parkinson fallers showed significantly lower muscle strength, higher antagonistic moments and higher activation deficit compared with controls. Multiple regression analysis showed that the antagonistic moments and the activation deficit explained about 39% and 27%, of the variance in the maximal resultant moments of the knee extensors and the plantar flexors, respectively. Conclusions. Our findings suggest that Parkinson fallers are affected by strength impairments arising from the central nervous system and not from the peripheral muscle contractile capacity, even at early stages of the disease and young age. High-intensity resistance training may help enhance neural drive and decrease unwanted antagonistic moments and reduce the risk of falls.

Exercise-induced changes in triceps surae tendon stiffness and muscle strength affect running economy in humans

The purpose of the present study was to investigate whether increased tendon-aponeurosis stiffness and contractile strength of the triceps surae (TS) muscle-tendon units induced by resistance training would affect running economy. Therefore, an exercise group (EG, n = 13) performed a 14-week exercise program, while the control group (CG, n = 13) did not change their training. Maximum isometric voluntary contractile strength and TS tendon-aponeurosis stiffness, running kinematics and fascicle length of the gastrocnemius medialis (GM) muscle during running were analyzed. Furthermore, running economy was determined by measuring the rate of oxygen consumption at two running velocities (3.0, 3.5 ms(-1)). The intervention resulted in a ∼7 % increase in maximum plantarflexion muscle strength and a ∼16 % increase in TS tendon-aponeurosis stiffness. The EG showed a significant ∼4 % reduction in the rate of oxygen consumption and energy cost, indicating a significant increase in running economy, while the CG showed no changes. Neither kinematics nor fascicle length and elongation of the series-elastic element (SEE) during running were affected by the intervention. The unaffected SEE elongation of the GM during the stance phase of running, in spite of a higher tendon-aponeurosis stiffness, is indicative of greater energy storage and return and a redistribution of muscular output within the lower extremities while running after the intervention, which might explain the improved running economy.