1
|
Létocart AJ, Svensson RB, Mabesoone F, Charleux F, Marin F, Dermigny Q, Magnusson SP, Couppé C, Grosset JF. Structure and function of Achilles and patellar tendons following moderate slow resistance training in young and old men. Eur J Appl Physiol 2024:10.1007/s00421-024-05461-y. [PMID: 38649478 DOI: 10.1007/s00421-024-05461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024]
Abstract
The aim of this study was to investigate the effect of aging and resistance training with a moderate load on the size and mechanical properties of the patellar (PT) and Achilles tendon (AT) and their associated aponeuroses; medial gastrocnemius (MG) and vastus lateralis (VL). Young (Y55; 24.8 ± 3.8 yrs, n = 11) and old men (O55; 70.0 ± 4.6 yrs, n = 13) were assigned to undergo a training program (12 weeks; 3 times/week) of moderate slow resistance training [55% of one repetition maximum (RM)] of the triceps surae and quadriceps muscles. Tendon dimensions were assessed using 1.5 T magnetic resonance imaging before and after 12 weeks. AT and PT cross sectional area (CSA) were determined every 10% of tendon length. Mechanical properties of the free AT, MG aponeurosis, PT, and VL aponeurosis were assessed using ultrasonography (deformation) and tendon force measurements. CSA of the AT but not PT was greater in O55 compared with Y55. At baseline, mechanical properties were generally lower in O55 than Y55 for AT, MG aponeurosis and VL aponeurosis (Young's modulus) but not for PT. CSA of the AT and PT increased equally in both groups following training. Further, for a given force, stiffness and Young's modulus also increased equally for VL aponeurosis and AT, for boths groups. The present study highlights that except for the PT, older men have lower tendon (AT, MG aponeurosis, and VL aponeurosis) mechanical properties than young men and 12-weeks of moderate slow resistance training appears sufficient to improve tendon size and mechanical adaptations in both young and older men. New and Noteworthy: These novel findings suggest that short-term moderate slow resistance training induces equal improvements in tendon size and mechanics regardless of age.
Collapse
Affiliation(s)
- Adrien J Létocart
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France.
| | - René B Svensson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Frédéric Marin
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France
| | - Quentin Dermigny
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jean-François Grosset
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France.
| |
Collapse
|
2
|
Patch DA, Andrews NA, Scheinberg M, Jacobs RA, Harrelson WM, Rallapalle V, Sinha T, Shah A. Achilles tendon disorders: An overview of diagnosis and conservative treatment. JAAPA 2023; 36:1-8. [PMID: 37751268 DOI: 10.1097/01.jaa.0000977720.10055.c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
ABSTRACT Achilles tendon-related pain affects up to 6% of the US population during their lifetime and is commonly encountered by primary care providers. An accurate diagnosis and early conservative management can improve patient quality of life and reduce unnecessary surgical consultations, saving healthcare dollars. Achilles tendon pathologies can be categorized into acute (pain lasting less than 6 weeks), chronic (pain lasting more than 6 weeks), and acute on chronic (worsening of pain with preexisting chronic Achilles tendon pathology). This article describes the diagnosis, conservative management, indications for imaging, and indications for surgical referral for acute and chronic Achilles tendon rupture, Achilles tendinitis, gastrocnemius strain, plantaris rupture, insertional Achilles tendinopathy, Haglund deformity, and noninsertional Achilles tendinopathy.
Collapse
Affiliation(s)
- David A Patch
- In the Department of Orthopedic Surgery at the University of Alabama Birmingham, David A. Patch and Nicholas A. Andrews are resident physicians; Mila Scheinberg and Roshan A. Jacobs are orthopedic research assistants; Whitt M. Harrelson, Vyshnavi Rallapalle, and Tanvee Sinha are research assistants; and Ashish Shah is a professor and director of clinical research. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Garg R, Driscoll N, Shankar S, Hullfish T, Anselmino E, Iberite F, Averbeck S, Rana M, Micera S, Baxter JR, Vitale F. Wearable High-Density MXene-Bioelectronics for Neuromuscular Diagnostics, Rehabilitation, and Assistive Technologies. SMALL METHODS 2023; 7:e2201318. [PMID: 36571435 PMCID: PMC10291010 DOI: 10.1002/smtd.202201318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/15/2022] [Indexed: 06/17/2023]
Abstract
High-density surface electromyography (HDsEMG) allows noninvasive muscle monitoring and disease diagnosis. Clinical translation of current HDsEMG technologies is hampered by cost, limited scalability, low usability, and minimal spatial coverage. Here, this study presents, validates, and demonstrates the broad clinical applicability of dry wearable MXene HDsEMG arrays (MXtrodes) fabricated from safe and scalable liquid-phase processing of Ti3 C2 Tx . The fabrication scheme allows easy customization of array geometry to match subject anatomy, while the gel-free and minimal skin preparation enhance usability and comfort. The low impedance and high conductivity of the MXtrode arrays allow detection of the activity of large muscle groups at higher quality and spatial resolution than state-of-the-art wireless electromyography sensors, and in realistic clinical scenarios. To demonstrate the clinical applicability of MXtrodes in the context of neuromuscular diagnostics and rehabilitation, simultaneous HDsEMG and biomechanical mapping of muscle groups across the whole calf during various tasks, ranging from controlled contractions to walking is shown. Finally, the integration of HDsEMG acquired with MXtrodes with a machine learning pipeline and the accurate prediction of the phases of human gait are shown. The results underscore the advantages and translatability of MXene-based wearable bioelectronics for studying neuromuscular function and disease, as well as for precision rehabilitation.
Collapse
Affiliation(s)
- Raghav Garg
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center of Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Nicolette Driscoll
- Center of Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sneha Shankar
- Center of Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Todd Hullfish
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Eugenio Anselmino
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56025, Pisa, Italy
| | - Francesco Iberite
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56025, Pisa, Italy
| | - Spencer Averbeck
- Center of Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Manini Rana
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, 78712, USA
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Josh R Baxter
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Flavia Vitale
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center of Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
4
|
Adam NC, Smith CR, Herzog W, Amis AA, Arampatzis A, Taylor WR. In Vivo Strain Patterns in the Achilles Tendon During Dynamic Activities: A Comprehensive Survey of the Literature. SPORTS MEDICINE - OPEN 2023; 9:60. [PMID: 37466866 DOI: 10.1186/s40798-023-00604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
Achilles' tendon (AT) injuries such as ruptures and tendinopathies have experienced a dramatic rise in the mid- to older-aged population. Given that the AT plays a key role at all stages of locomotion, unsuccessful rehabilitation after injury often leads to long-term, deleterious health consequences. Understanding healthy in vivo strains as well as the complex muscle-tendon unit interactions will improve access to the underlying aetiology of injuries and how their functionality can be effectively restored post-injury. The goals of this survey of the literature with a systematic search were to provide a benchmark of healthy AT strains measured in vivo during functional activities and identify the sources of variability observed in the results. Two databases were searched, and all articles that provided measured in vivo peak strains or the change in strain with respect to time were included. In total, 107 articles that reported subjects over the age of 18 years with no prior AT injury and measured while performing functional activities such as voluntary contractions, walking, running, jumping, or jump landing were included in this review. In general, unclear anatomical definitions of the sub-tendon and aponeurosis structures have led to considerable confusion in the literature. MRI, ultrasound, and motion capture were the predominant approaches, sometimes coupled with modelling. The measured peak strains increased from 4% to over 10% from contractions, to walking, running, and jumping, in that order. Importantly, measured AT strains were heavily dependent on measurement location, measurement method, measurement protocol, individual AT geometry, and mechanical properties, as well as instantaneous kinematics and kinetics of the studied activity. Through a comprehensive review of approaches and results, this survey of the literature therefore converges to a united terminology of the structures and their common underlying characteristics and presents the state-of-knowledge on their functional strain patterns.
Collapse
Affiliation(s)
- Naomi C Adam
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Colin R Smith
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, The University of Calgary, Calgary, Canada
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, and Berlin School of Movement Science, Berlin, Germany
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| |
Collapse
|
5
|
Mifsud T, Chatzistergos P, Maganaris C, Chockalingam N, Padhiar N, Stafrace KM, Gatt A. Supersonic shear wave elastography of human tendons is associated with in vivo tendon stiffness over small strains. J Biomech 2023; 152:111558. [PMID: 37004390 DOI: 10.1016/j.jbiomech.2023.111558] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Supersonic shear wave (SW) elastography has emerged as a useful imaging modality offering researchers and clinicians a fast, non-invasive, quantitative assessment of tendon biomechanics. However, the exact relationship between SW speed and in vivo tendon stiffness is not intuitively obvious and needs to be verified. This study aimed to explore the validity of supersonic SW elastography against a gold standard method to measure the Achilles tendon's in vivo tensile stiffness by combining conventional ultrasound imaging with dynamometry. Twelve healthy participants performed maximal voluntary isometric plantarflexion contractions (MVC) on a dynamometer with simultaneous ultrasonographic recording of the medial gastrocnemius musculotendinous junction for dynamometry-based measurement of stiffness. The tendon's force-elongation relationship and stress-strain behaviour were assessed. Tendon stiffness at different levels of tension was calculated as the slope of the stress-strain graph. SW speed was measured at the midportion of the free tendon and tendon Young's modulus was estimated. A correlation analysis between the two techniques revealed a statistically significant correlation for small strains (r(10) = 0.604, p =.038). SW-based assessments of in vivo tendon stiffness were not correlated to the gold standard method for strains in the tendon>10 % of the maximum strain during MVC. The absolute values of SW-based Young's modulus estimations were approximately-three orders of magnitude lower than dynamometry-based measurements. Supersonic SW elastography should be only used to assess SW speed for the detection and study of differences between tissue regions, differences between people or groups of people or changes over time in tendon initial stiffness (i.e., stiffness for small strains).
Collapse
Affiliation(s)
- Tiziana Mifsud
- Faculty of Health Sciences, University of Malta, Msida, Malta; Department of Orthopaedics, Trauma and Sports Medicine, Mater Dei Hospital, Malta
| | - Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Constantinos Maganaris
- John Moores University, School of Sport and Exercise Sciences, Liverpool, United Kingdom
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Msida, Malta; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Nat Padhiar
- Centre for Sports & Exercise Medicine, Queen Mary University of London, United Kingdom
| | | | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
| |
Collapse
|
6
|
Finni T, de Brito Fontana H, Maas H. Force transmission and interactions between synergistic muscles. J Biomech 2023; 152:111575. [PMID: 37120913 DOI: 10.1016/j.jbiomech.2023.111575] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023]
Abstract
The classical view of muscles as independent motors has been challenged over the past decades. An alternative view has emerged in which muscles are not isolated but embedded in a three-dimensional connective tissue network that links them to adjacent muscles and other non-muscular structures in the body. Animal studies showing that the forces measured at the distal and proximal ends of a muscle are not equal have provided undisputable evidence that these connective tissue linkages are strong enough to serve as an extra pathway for muscular force transmission. In this historical review, we first introduce the terminology and anatomy related to these pathways of muscle force transmission and provide a definition for the term epimuscular force transmission. We then focus on important experimental evidence indicating mechanical interactions between synergistic muscles that may affect force transmission and/or influence the muscles' force generating capacity. We illustrate that there may exist different expressions of the highly relevant force-length properties depending on whether the force is measured at the proximal or distal tendon and depending on the dynamics of surrounding structures. Changes in length, activation level or disruption of the connective tissue of neighboring muscles, can affect how muscles interact and produce force on the skeleton. While most direct evidence is from animal experiments, studies on humans also suggest functional implications of the connective tissues surrounding muscles. These implications may explain how distant segments, which are not part of the same joint system, affect force generation at a given joint, and, in clinical conditions, explain observations from tendon transfer surgeries, where a muscle transferred to act as an antagonist continues to produce agonistic moments.
Collapse
Affiliation(s)
- Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Finland
| | - Heiliane de Brito Fontana
- Department of Morphological Sciences, School of Biological Sciences, Federal University of Santa Catarina, Brazil
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands.
| |
Collapse
|
7
|
Myofascial force transmission between the calf and the dorsal thigh is dependent on knee angle: an ultrasound study. Sci Rep 2023; 13:3738. [PMID: 36878944 PMCID: PMC9988973 DOI: 10.1038/s41598-023-30407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
A recent in-vivo experiment has shown that force can be transmitted between the gastrocnemius and the hamstring muscles due to a direct tissue continuity. However, it remains unclear if this mechanical interaction is affected by the stiffness of the structural connection. This study therefore aimed to investigate the impact of the knee angle on myofascial force transmission across the dorsal knee. A randomized, cross-over study was performed, including n = 56 healthy participants (25.36 ± 3.9 years, 25 females). On two separate days, they adopted a prone position on an isokinetic dynamometer (knee extended or 60° flexed). In each condition, the device moved the ankle three times from maximal plantarflexion to maximal dorsal extension. Muscle inactivity was ensured using EMG. High-resolution ultrasound videos of the semimembranosus (SM) and the gastrocnemius medialis (GM) soft tissue were recorded. Maximal horizontal tissue displacement, obtained using cross-correlation, was examined as a surrogate of force transmission. SM tissue displacement was higher at extended (4.83 ± 2.04 mm) than at flexed knees (3.81 ± 2.36 mm). Linear regression demonstrated significant associations between (1) SM and GM soft tissue displacement (extended: R2 = 0.18, p = 0.001; flexed: R2 = 0.17, p = 0.002) as well as (2) SM soft tissue displacement and ankle range of motion (extended: R2 = 0.103, p = 0.017; flexed: R2 = 0.095, p = 0.022). Our results further strengthen the evidence that local stretching induces a force transmission to neighboring muscles. Resulting remote exercise effects such as increased range of motion, seem to depend on the stiffness of the continuity.Trial registration: DRKS (Deutsches Register Klinischer Studien), registration number DRKS00024420, first registered 08/02/2021, https://drks.de/search/de/trial/DRKS00024420 .
Collapse
|
8
|
Klaiber LR, Schlechtweg S, Wiedemann R, Alt W, Stutzig N. Local displacement within the Achilles tendon induced by electrical stimulation of the single gastrocnemius muscles. Clin Biomech (Bristol, Avon) 2023; 102:105901. [PMID: 36791484 DOI: 10.1016/j.clinbiomech.2023.105901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The Achilles tendon consists of three subtendons, but their functional meaning is still unknown. There are several approaches for the examination in-vivo using sonographic imaging, however, there is no approach for in-vivo examination with respect to the single subtendons of the m. triceps surae. The study's aim was to reveal the single subtendons of the m. triceps surae. METHODS The Achilles tendon of 17 subjects was analysed. The muscles (m. gastrocnemius lateralis and medialis) were stimulated separately using neuromuscular electrical stimulation. The intensity of muscle contraction was controlled using electromyographic data. Sonographic videos of the Achilles tendon were recorded during muscle contraction. A speckle tracking algorithm was used to analyse the moving areas within the Achilles tendon during the initial phase of contraction. FINDINGS The muscles were activated at 10-20% of the maximal M-wave. Isolated contraction of m. gastrocnemius lateralis led to local displacement in the lateral part of the Achilles tendon's cross-section whereas isolated contraction of m. gastrocnemius medialis led to displacement in the medial part and to a larger size of the area where initial displacement took place (m. gastrocnemius lateralis to medialis approximately 1:2). INTERPRETATION The results demonstrate that isolated contractions of m. gastrocnemius lateralis and medialis lead to individual displacements which significantly differ. The differences in position and size of the area of the local displacement indicate an independent individual function. Unlike other studies generally investigating the AT in-vivo using muscle stimulation and ultrasonic imaging, this study investigated the AT's cross-section which had never been investigated before.
Collapse
Affiliation(s)
| | - Sascha Schlechtweg
- Institute of Sport and Movement Science, University of Stuttgart, Germany
| | - Rika Wiedemann
- Institute of Sport and Movement Science, University of Stuttgart, Germany
| | - Wilfried Alt
- Institute of Sport and Movement Science, University of Stuttgart, Germany
| | - Norman Stutzig
- Institute of Sport and Movement Science, University of Stuttgart, Germany
| |
Collapse
|
9
|
Merry K, Napier C, Waugh CM, Scott A. Foundational Principles and Adaptation of the Healthy and Pathological Achilles Tendon in Response to Resistance Exercise: A Narrative Review and Clinical Implications. J Clin Med 2022; 11:4722. [PMID: 36012960 PMCID: PMC9410084 DOI: 10.3390/jcm11164722] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Therapeutic exercise is widely considered a first line fundamental treatment option for managing tendinopathies. As the Achilles tendon is critical for locomotion, chronic Achilles tendinopathy can have a substantial impact on an individual's ability to work and on their participation in physical activity or sport and overall quality of life. The recalcitrant nature of Achilles tendinopathy coupled with substantial variation in clinician-prescribed therapeutic exercises may contribute to suboptimal outcomes. Further, loading the Achilles tendon with sufficiently high loads to elicit positive tendon adaptation (and therefore promote symptom alleviation) is challenging, and few works have explored tissue loading optimization for individuals with tendinopathy. The mechanism of therapeutic benefit that exercise therapy exerts on Achilles tendinopathy is also a subject of ongoing debate. Resultingly, many factors that may contribute to an optimal therapeutic exercise protocol for Achilles tendinopathy are not well described. The aim of this narrative review is to explore the principles of tendon remodeling under resistance-based exercise in both healthy and pathologic tissues, and to review the biomechanical principles of Achilles tendon loading mechanics which may impact an optimized therapeutic exercise prescription for Achilles tendinopathy.
Collapse
Affiliation(s)
- Kohle Merry
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Christopher Napier
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Charlie M. Waugh
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| |
Collapse
|
10
|
Funaro A, Shim V, Crouzier M, Mylle I, Vanwanseele B. Subject-Specific 3D Models to Investigate the Influence of Rehabilitation Exercises and the Twisted Structure on Achilles Tendon Strains. Front Bioeng Biotechnol 2022; 10:914137. [PMID: 35875495 PMCID: PMC9299361 DOI: 10.3389/fbioe.2022.914137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
The Achilles tendon (AT) is the largest tendon of the human body and has a primary role in locomotor activities. The complex structure of the AT includes twisting of three sub-tendons, non-uniform tissue deformations and differential triceps surae muscle forces. The main aim of this study was to investigate the impact of commonly used rehabilitation exercises (walking on heels, walking on toes, unilateral heel rise, heel drop with extended knee and heel drop with the knee bent) and different twists on AT strains. 3D freehand ultrasound based subject-specific geometry and subject-specific muscle forces during different types of rehabilitation exercises were used to determine tendon strains magnitudes and differences in strains between the sub-tendons. In addition, three Finite Element models were developed to investigate the impact of AT twist. While walking on heels developed the lowest average strain, heel drop with knee bent exhibited the highest average strain. The eccentric heel drop resulted in higher peak and average strain, compared to concentric heel rise for all the three models. The isolated exercises (heel rise and heel drop) presented higher average strains compared to the functional exercises (walking tasks). The amount of twist influences the peak strains but not the average. Type I consistently showed highest peak strains among the five rehabilitation exercises. The ranking of the exercises based on the AT strains was independent of AT twist. These findings might help clinicians to prescribe rehabilitation exercises for Achilles tendinopathy based on their impact on the AT strains.
Collapse
Affiliation(s)
- Alessia Funaro
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Marion Crouzier
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Ine Mylle
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | | |
Collapse
|
11
|
Stafilidis S, Kopper-Zisser C. Ankle joint rotation and exerted moment during plantarflexion dependents on measuring- and fixation method. PLoS One 2021; 16:e0253015. [PMID: 34464390 PMCID: PMC8407569 DOI: 10.1371/journal.pone.0253015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
We examined the effect of ankle joint fixation vs increased foot pressure (aiming to reduce dynamometer-subject elasticity (DSE)) on the exerted moment during plantarflexion contraction. We also examined the joint rotation in dependence of the measuring site (forefoot, rearfoot) and the foot condition (fixed, free). We hypothesized higher exerted moments due to reduced DSE compared to fixed condition and an effect of fixation on the joint rotation in dependence of the measuring site. Fourteen healthy individuals (28.7±6.9y) completed in randomized order maximal isometric plantarflexions in four different positions (0-3-6-9 cm) and two ankle joint conditions (fixed-free). Kinematics of the rear- and forefoot were obtained synchronously. We found higher moment in the fixed compared to the free condition at all positions. The maximum moment in the fixed condition did not differ at any position. At the fixed condition, the forefoot rotation did not differ at any position (~5°) while at free condition we observed a significant rotation reduction (form ~12 to ~5°). The rearfoot rotation did not differ between conditions at any position while a significant joint angle reduction was observed (~10 to ~6° and ~12 to ~6°; fixed-free respectively). The results indicate that with appropriate foot fixation the maximum moment can be achieved irrespective of the position. With the foot secured, the measuring site influences the rotational outcome. We suggest that for a minimization of the joint rotation a fixation and the forefoot-measuring site should be preferred. Additionally, for unconstrained foot kinematic observations both measuring sites can be obtained.
Collapse
Affiliation(s)
- Savvas Stafilidis
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Institute of Sport Science, Sport, University of Vienna, Vienna, Austria
- * E-mail:
| | - Carina Kopper-Zisser
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Institute of Sport Science, Sport, University of Vienna, Vienna, Austria
| |
Collapse
|
12
|
Mazzo MR, Weinman LE, Giustino V, Mclagan B, Maldonado J, Enoka RM. Changes in neural drive to calf muscles during steady submaximal contractions after repeated static stretches. J Physiol 2021; 599:4321-4336. [PMID: 34292610 DOI: 10.1113/jp281875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/19/2021] [Indexed: 01/27/2023] Open
Abstract
KEY POINTS Repeated static-stretching interventions consistently increase the range of motion about a joint and decrease total joint stiffness, but findings on the changes in muscle and connective-tissue properties are mixed. The influence of these stretch-induced changes on muscle function at submaximal forces is unknown. To address this gap in knowledge, the changes in neural drive to the plantar flexor muscles after a static-stretch intervention were estimated. Neural drive to the plantar flexor muscles during a low-force contraction increased after repeated static stretches. These findings suggest that adjustments in motor unit activity are necessary at low forces to accommodate reductions in the force-generating and transmission capabilities of the muscle-tendon unit after repeated static stretches of the calf muscles. ABSTRACT Static stretching decreases stiffness about a joint, but its influence on muscle-tendon unit function and muscle activation is unclear. We investigated the influence of three static stretches on changes in neural drive to the plantar flexor muscles, both after a stretch intervention and after a set of maximal voluntary contractions (MVCs). Estimates of neural drive were obtained during submaximal isometric contractions by decomposing high-density electromyographic signals into the activity of individual motor units from medial gastrocnemius, lateral gastrocnemius and soleus. Motor units were matched across contractions and an estimate of neural drive to the plantar flexors was calculated by normalizing the cumulative spike train to the number of active motor units (normalized neural drive). Mean discharge rate increased after the stretch intervention during the 10% MVC task for all recorded motor units and those matched across conditions (all, P = 0.0046; matched only, P = 0.002), recruitment threshold decreased for motor units matched across contractions (P = 0.022), and discharge rate at recruitment was elevated (P = 0.004). Similarly, the estimate of normalized neural drive was significantly greater after the stretch intervention at 10% MVC torque (P = 0.029), but not at 35% MVC torque. The adjustments in motor unit activity required to complete the 10% MVC task after stretch may have been partially attenuated by a set of plantar flexor MVCs. The increase in neural drive required to produce low plantar-flexion torques after repeated static stretches of the calf muscles suggests stretch-induced changes in muscle and connective tissue properties.
Collapse
Affiliation(s)
- Melissa R Mazzo
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Logan E Weinman
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Valerio Giustino
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Bailey Mclagan
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - John Maldonado
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| |
Collapse
|
13
|
Edama M, Takabayashi T, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Otani H. Classification by degree of twisted structure of the fetal Achilles tendon. Surg Radiol Anat 2021; 43:1691-1695. [PMID: 34263342 DOI: 10.1007/s00276-021-02803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to classify the twisted structure of the fetal Achilles tendon. METHODS The study was conducted using 30 legs from 15 Japanese fetuses (mean weight, 1764.6 ± 616.9 g; mean crown-rump length, 283.5 ± 38.7 mm; 16 males, 14 females). According to attachment to the deep layer of the calcaneal tuberosity, cases showing only soleus attachment were classified as least twist (Type I), cases showing both lateral head of the gastrocnemius and soleus were classified as moderate twist (Type II), and cases with only lateral head of the gastrocnemius were classified as extreme twist (Type III). RESULTS Viewing the Achilles tendon from cranially shows a structure twisted counterclockwise on the right side and clockwise on the left. The Achilles tendon was Type I in 4 legs (13%), Type II in 23 legs (77%), and Type III in 3 legs (10%). CONCLUSIONS The twisted structure of the Achilles tendon can be classified as early as the second trimester and is similar to that seen in adults.
Collapse
Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan.
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Hiroki Otani
- Department of Developmental Biology, Faculty of Medicine, Shimane University, Izumo, 690-8504, Japan
| |
Collapse
|
14
|
Shan X, Otsuka S, Li L, Kawakami Y. Inhomogeneous and anisotropic mechanical properties of the triceps surae muscles and aponeuroses in vivo during submaximal muscle contraction. J Biomech 2021; 121:110396. [PMID: 33836425 DOI: 10.1016/j.jbiomech.2021.110396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/19/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to identify characteristics of the triceps surae muscles and aponeuroses stiffness in vivo, during graded isometric submaximal plantarflexion efforts. A total of twelve healthy male subjects (age: 27 ± 4 years) participated and were required to stay at rest (0% MVC) and perform isometric submaximal plantar flexion contractions (20%, 40%, 60% of MVC) on a dynamometer. Young's modulus of triceps surae muscles and the adjoining aponeuroses between gastrocnemii and soleus at the proximal and distal sites were obtained in the longitudinal direction (along muscle's line of action) during at rest and submaximal plantar flexions. Additionally, Young's modulus of adjoining aponeuroses in the transverse direction at the distal sites was also calculated. Young's modulus of LG (lateral gastrocnemius), SOL-lat (lateral part of soleus) and LPS (superficial aponeurosis of LG) at the proximal site showed significant (p < 0.001) graded increase response to the submaximal contraction levels. Besides, in the lateral side, significant differences in the Young's modulus of aponeuroses were observed between longitudinal and transverse directions at rest and during contractions (p < 0.002). Changes of aponeuroses length were significantly correlated with Young's modulus changes of the proximal gastrocnemii muscle bellies (r = 0.43-0.45, p = 0.006-0.008) and superficial aponeuroses (r = 0.49-0.60, p < 0.002). The results further indicate that the triceps surae muscles and aponeuroses showed inhomogeneous and anisotropic mechanical properties during submaximal muscle contractions, and the stiffening effect of muscle belly possibly make influence on the mechanical properties of aponeuroses during muscle contractions, especially for the lateral gastrocnemius.
Collapse
Affiliation(s)
- Xiyao Shan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Shun Otsuka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan; Department of Anatomy, Aichi Medical University, Nagakute, Japan
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yasuo Kawakami
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.
| |
Collapse
|
15
|
M Khair R, Stenroth L, Péter A, Cronin NJ, Reito A, Paloneva J, Finni T. Non-uniform displacement within ruptured Achilles tendon during isometric contraction. Scand J Med Sci Sports 2021; 31:1069-1077. [PMID: 33464638 DOI: 10.1111/sms.13925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 01/21/2023]
Abstract
The purpose of this study was investigate tendon displacement patterns in non-surgically treated patients 14 months after acute Achilles tendon rupture (ATR) and to classify patients into groups based on their Achilles tendon (AT) displacement patterns. Twenty patients were tested. Sagittal images of AT were acquired using B-mode ultrasonography during ramp contractions at a torque level corresponding to 30% of the maximal isometric plantarflexion torque of the uninjured limb. A speckle tracking algorithm was used to track proximal-distal movement of the tendon tissue at 6 antero-posterior locations. Two-way repeated measures ANOVA for peak tendon displacement was performed. K-means clustering was used to classify patients according to AT displacement patterns. The difference in peak relative displacement across locations was larger in the uninjured (1.29 ± 0.87 mm) than the injured limb (0.69 ± 0.68 mm), with a mean difference (95% CI) of 0.60 mm (0.14-1.05 mm, P < .001) between limbs. For the uninjured limb, cluster analysis formed 3 groups, while 2 groups were formed for the injured limb. The three distinct patterns of AT displacement during isometric plantarflexion in the uninjured limb may arise from subject-specific anatomical variations of AT sub-tendons, while the two patterns in the injured limb may reflect differential recovery after ATR with non-surgical treatment. Subject-specific tendon characteristics are a vital determinant of stress distribution across the tendon. Changes in stress distribution may lead to variation in the location and magnitude of peak displacement within the free AT. Quantifying internal tendon displacement patterns after ATR provides new insights into AT recovery.
Collapse
Affiliation(s)
- Ra'ad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Annamária Péter
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.,Department for Health, University of Bath, Bath, UK
| | - Aleksi Reito
- Central Finland Health Care District, Jyväskylä, Finland
| | - Juha Paloneva
- Central Finland Health Care District, Jyväskylä, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
16
|
Fouré A, Gondin J. Skeletal Muscle Damage Produced by Electrically Evoked Muscle Contractions. Exerc Sport Sci Rev 2021; 49:59-65. [PMID: 33122596 DOI: 10.1249/jes.0000000000000239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Understanding the physiological/mechanical mechanisms leading to skeletal muscle damage remains one of the challenges in muscle physiology. This review presents the functional, structural, and cellular consequences of electrically evoked submaximal isometric contractions that can elicit severe and localized skeletal muscle damage. Hypotheses related to underlying physiological and mechanical processes involved in severe and localized muscle damage also are discussed.
Collapse
Affiliation(s)
- Alexandre Fouré
- Inter-university Laboratory of Human Mouvement Biology (LIBM), University of Lyon, UCBL-Lyon1, EA 7424, Villeurbanne, France
| | - Julien Gondin
- NeuroMyoGene Institute, Univ Lyon, CNRS 5310, INSERM U1217, UCBL 1, Lyon, France
| |
Collapse
|
17
|
M-Mode Ultrasound Examination of Soleus Muscle in Healthy Subjects: Intra- and Inter-Rater Reliability Study. Healthcare (Basel) 2020; 8:healthcare8040555. [PMID: 33322505 PMCID: PMC7763654 DOI: 10.3390/healthcare8040555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022] Open
Abstract
Objective: M-mode ultrasound imaging (US) reflects the motion of connective tissue within muscles. The objectives of this study were to evaluate inter-rater and intra-rater reliability of soleus muscle measurements between examiners with different levels of US experience in asymptomatic subjects and to investigate the level of soleus muscle isometric activity in two positions (knee extended and knee flexed at 30°). Methods: Thirty volunteers without a history of ankle pain were evaluated with US examinations of the soleus muscle. Each muscle was scanned independently by two evaluators. Muscle at rest thickness, maximal isometric contraction thickness, time and velocity measures were detailed and blinded to the other examiner. Results: Intra- and inter-rater reliability at rest, in maximal isometric contraction thickness, contraction time and contraction velocity measures for both positions (extended and flexed knee) were reported from good to excellent for all outcome measurements. The position with the knee extended reported a statistically significant increase in thickness after motion showing 1.33 ± 0.27 mm for measurements at rest thickness with knee extended versus 1.50 ± 0.29 mm for measurements at end thickness with the knee in flexed position (p = 0.001), as well as 1.31 ± 0.23 mm for rest thickness with the knee in flexed position measurements with respect to 1.34 ± 0.24 mm for maximal isometric contraction thickness with extended knee measurements (p = 0.058). Conclusions: This study found that intra- and inter-examiner reliability of M-mode ultrasound imaging of the soleus muscle was excellent in asymptomatic subjects and the soleus muscle activity was different between the position with the knee extended and the position with the knee flexed.
Collapse
|
18
|
Létocart A, Grosset JF. Achilles Tendon Adaptation to Neuromuscular Electrical Stimulation: Morphological and Mechanical Changes. Int J Sports Med 2020; 42:651-661. [PMID: 33285575 DOI: 10.1055/a-1270-7568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
It remains unclear whether neuromuscular electrical stimulation can induce sufficient tendon stress to lead to tendon adaptations. Thus, we investigated the effect of such a training program on the triceps surae muscle following the morphological and mechanical properties of the Achilles tendon. Eight men participated in a 12-week high-frequency neuromuscular electrical stimulation training program of the triceps surae muscle under isometric conditions. Ultrasonography was used pre- and post-intervention to quantify cross-sectional area, free length, and total length of the Achilles tendon, as well as the myotendinous junction elongation during a maximal isometric ramp contraction under plantar flexion. Neuromuscular electrical stimulation training does not lead to changes in Achilles tendon free and total length, cross-sectional area, or maximal elongation capacity. However, a significant increase was evidenced in maximal tendon force post-training (+25.2%). Hence, Young's Modulus and maximal stress were significantly greater after training (+12.4% and +23.4%, respectively). High-frequency neuromuscular electrical stimulation training induces repeated stress sufficient to lead to adaptations of mechanical properties of the Achilles tendon. Thus, this training technique may be of particular interest as a new rehabilitation method in tendinopathy management or to counteract the effect of hypo-activity.
Collapse
|
19
|
A proposal for a new classification of soleus muscle morphology. Ann Anat 2020; 232:151584. [PMID: 32810614 DOI: 10.1016/j.aanat.2020.151584] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The soleus muscle (SM) is located in the superficial posterior compartment of the leg, together with the gastrocnemius muscle (GM) and plantaris muscle. There is little information on the morphological variability (pennation) of the SM. The aim of the study is to characterize the variations in the morphology of the pennation of the SM and to create the first accurate classification. MATERIAL AND METHODS Eighty lower limbs (40 left, and 40 right) fixed in 10% formalin solution were examined. The morphology of the central tendon, medial and lateral aponeuroses was evaluated, together with the pennation angle. RESULTS In all cases, the soleus muscle was present. Four types could be distinguished based on muscle fibre morphology. In order of frequency: Type 1 - bipennate (43.75%); Type 4 - non-pennate (36.25%); Type 2 - unipennate (15%); Type 3 - multipennate (5%). No significant difference in type distribution was observed with regard to body side (p=0.9018) or gender (p=0.0844). CONCLUSION The soleus muscle is characterized by high morphological variability. Based on the pennation angle, four types (1-4) of soleus muscle are distinguishable.
Collapse
|
20
|
Gains CC, Correia JC, Baan GC, Noort W, Screen HRC, Maas H. Force Transmission Between the Gastrocnemius and Soleus Sub-Tendons of the Achilles Tendon in Rat. Front Bioeng Biotechnol 2020; 8:700. [PMID: 32766214 PMCID: PMC7379440 DOI: 10.3389/fbioe.2020.00700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/04/2020] [Indexed: 01/19/2023] Open
Abstract
The Achilles tendon (AT) is comprised of three distinct sub-tendons bound together by the inter-subtendon matrix (ISTM). The interactions between sub-tendons will have important implications for AT function. The aim of this study was to investigate the extent to which the ISTM facilitates relative sliding between sub-tendons, and serves as a pathway for force transmission between the gastrocnemius (GAS) and soleus (SOL) sub-tendons of the rat AT. In this study, ATs were harvested from Wistar rats, and the mechanical behavior and composition of the ISTM were explored. To determine force transmission between sub-tendons, the proximal and distal ends of the GAS and SOL sub-tendons were secured, and the forces at each of these locations were measured during proximal loading of the GAS. To determine the ISTM mechanical behavior, only the proximal GAS and distal SOL were secured, and the ISTM was loaded in shear. Finally, for compositional analysis, histological examination assessed the distribution of matrix proteins throughout sub-tendons and the ISTM. The results revealed distinct differences between the forces at the proximal and distal ends of both sub-tendons when proximal loading was applied to the GAS, indicating force transmission between GAS and SOL sub-tendons. Inter-subtendon matrix tests demonstrated an extended initial low stiffness toe region to enable some sub-tendon sliding, coupled with high stiffness linear region such that force transmission between sub-tendons is ensured. Histological data demonstrate an enrichment of collagen III, elastin, lubricin and hyaluronic acid in the ISTM. We conclude that ISTM composition and mechanical behavior are specialized to allow some independent sub-tendon movement, whilst still ensuring capacity for force transmission between the sub-tendons of the AT.
Collapse
Affiliation(s)
- Connor C Gains
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Janaina C Correia
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Guus C Baan
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Wendy Noort
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Hazel R C Screen
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| |
Collapse
|
21
|
Wearable Sensors Measure Ankle Joint Changes of Patients with Parkinson's Disease before and after Acute Levodopa Challenge. PARKINSON'S DISEASE 2020; 2020:2976535. [PMID: 32351681 PMCID: PMC7171676 DOI: 10.1155/2020/2976535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/13/2020] [Accepted: 02/22/2020] [Indexed: 11/17/2022]
Abstract
Background Previous studies found levodopa could improve the activity of the ankle joints of patients with Parkinson's disease (PD). But ankle joint movement is composed of four motion ranges. The specific changes of four motion ranges in PD remain unknown. Objective The purpose of this study was to decompose the complex ankle joint movement, measure ankle joint changes before and after the acute levodopa challenge test (ALCT), and investigate the effects of these parameters on gait performance. Methods 29 PD patients and 30 healthy control subjects (HC) completed the Instrumented Stand and Walk (ISAW) test and gait parameters were collected by the JiBuEn gait analysis system. The percentage of improvement of gait data and the UPDRS III in the on-drug condition (ON) were determined with respect to the off-drug condition (OFF). Results We observed a reduction in the heel strike angle (HS), 3-plantarflexion (3-PF) angle, and 4-dorsiflexion (4-DF) angle of ankle joints. We did not find significant difference in the toe-off angle (TO), 1-plantarflexion (1-PF) angle, and 2-dorsiflexion (2-DF) angle among three groups. Stride length improvement rate was significantly correlated with HS (r s = 0.616, P < 0.001) and 3-PF (r s = 0.639, P < 0.001) improvement rates. The improvement in the sum of rigidity items (UPDRS motor subsection item 22) was also correlated with HS (r s = 0.389, P=0.037) and 3-PF (r s = 0.373, P=0.046) improvement rates. Conclusions Exogenous levodopa supplementation can significantly reduce the rigidity of patients with PD, improve their 3-PF and 4-DF of ankle joint kinematic parameters, and ultimately enhance their gait.
Collapse
|
22
|
Ultrasound speckle tracking of Achilles tendon in individuals with unilateral tendinopathy: a pilot study. Eur J Appl Physiol 2020; 120:579-589. [DOI: 10.1007/s00421-020-04317-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
|
23
|
Park KB, Joo SY, Park H, Rhee I, Shin JK, Abdel-Baki SW, Kim HW. Architecture of the Triceps Surae Muscles Complex in Patients with Spastic Hemiplegia: Implication for the Limited Utility of the Silfverskiöld Test. J Clin Med 2019; 8:jcm8122096. [PMID: 31805732 PMCID: PMC6947161 DOI: 10.3390/jcm8122096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022] Open
Abstract
The Silfverskiöld test has long been used as an important tool for determining the affected muscles of the triceps surae in patients with equinus deformity. However, the test may not reflect the altered interactions between the muscles of the triceps which are affected by spasticity. The purpose of this study was to compare the architectural properties of the triceps surae muscles complex using ultrasonography, between hemiplegic patients and typically-developing children. Specifically, we wished to examine any differences in the architecture of the three muscles with various angle configurations of the knee and ankle joints. Ultrasound images of the medial gastrocnemius, lateral gastrocnemius, and soleus were acquired from paretic (group I) and non-paretic (group II) legs of ten patients and the legs (group III) of 10 age-matched normal children. A mixed model was used to evaluate the differences in the measurements of muscle architecture among the groups and the effects of various joint configurations on the measurements within the muscles. Compared to the results of measurements in groups II and III, the fascicle length was not different in the medial gastrocnemius of a paretic leg but it was longer in the lateral gastrocnemius and shorter in the soleus; the pennation angle was smaller in both medial and lateral gastrocnemii and was not different in the soleus; and the muscle thickness was found to be reduced in the three muscles of the paretic leg. Contrary to the observations in both the medial and lateral gastrocnemii, the fascicle length was increased and the pennation angle was decreased in the soleus with an increase of knee flexion. Through the current simulation study of the Silfverskiöld test using ultrasonography, we found that the changes detected in the architectural properties of the three muscles induced by systematic variations of the position at the ankle and the knee joints were variable. We believe that the limited utility of the Silfverskiöld test should be considered in determining an appropriate operative procedure to correct the equinus deformity in patients with altered architecture of the muscles in conditions such as cerebral palsy, as the differing muscle architectures of the triceps surae complex may affect the behavior of the muscles during the Silfverskiöld test.
Collapse
Affiliation(s)
- Kun-Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Sun Young Joo
- Department of Orthopaedic Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Incheon 21431, Korea;
| | - Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (H.P.); (J.-K.S.)
| | - Isaac Rhee
- Medical course, University of Melbourne Melbourne Medical School, 3010 Melbourne, Australia;
| | - Jong-Kwan Shin
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (H.P.); (J.-K.S.)
| | - Sharkawy Wagih Abdel-Baki
- Department of Orthopaedic Surgery, Aswan University Hospital, Aswan University Faculty of Medicine, Aswan 81528, Egypt;
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-2180
| |
Collapse
|
24
|
Lawson A, Noorkoiv M, Masci L, Mohagheghi AA. Ankle Joint Position and the Reliability of Ultrasound Tissue Characterization of the Achilles Tendon: A Pilot Study. Med Sci Monit 2019; 25:6884-6893. [PMID: 31516131 PMCID: PMC6755937 DOI: 10.12659/msm.915685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Imaging of the Achilles tendon using ultrasound tissue characterization (UTC) involves taking up the slack of the tendon by including dorsiflexion of the ankle. This pilot study aimed to determine whether different longitudinal tension applied to the Achilles tendon during imaging affected the reliability of UTC. Material/Methods Nine asymptomatic active volunteers, aged between 23–49 years underwent imaging of 17 Achilles tendons. Three positions of tension included plantar grade, 50%, and 100% of maximal dorsiflexion, with a range of 18–32°. Ranges were established and standardized using an isokinetic dynamometer. A test and re-test process was conducted at each position to determine the intraclass correlation coefficients (ICCs) and minimum detectable change (MDC) per echotype. Images were analyzed using UTC software. Results Plantar grade positioning images could not be obtained. ICCs for each echotype I–IV between test 1 and test 2 were 0.965, 0.962, 0.858, 0.739 at 100% dorsiflexion (95% CI, 0.86–0.99, 0.84–0.99, 0.51–0.97, and 0.2–0.94), and 0.771, 0.551, 0.569, 0.429 at 50% dorsiflexion (95% CI, 0.29–0.94, −0.09–0.88, −0.01–0.88, and −0.15–0.82). The MDC per echotype I–IV ranged between 4.1–1.0% of echotype data at 100% dorsiflexion, and 17.2–6.3% at 50% dorsiflexion. Conclusions Testing at maximum dorsiflexion provided improved reliability when using UTC in healthy individuals. The ICC at 100% dorsiflexion was increased, and the MDC was reduced for all echotypes. Therefore, standardizing test positions when using UTC is advisable for reliable comparison of results between studies.
Collapse
Affiliation(s)
- Arturo Lawson
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University, London, United Kingdom
| | - Marika Noorkoiv
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University, London, United Kingdom
| | | | - Amir A Mohagheghi
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University, London, United Kingdom
| |
Collapse
|
25
|
Svensson RB, Couppé C, Agergaard A, Ohrhammar Josefsen C, Jensen MH, Barfod KW, Nybing JD, Hansen P, Krogsgaard M, Magnusson SP. Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- René B. Svensson
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg‐Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Christian Couppé
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg‐Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
- Department of Physical Therapy Bispebjerg‐Frederiksberg Hospital Copenhagen Denmark
| | - Anne‐Sofie Agergaard
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg‐Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
- Department of Physical Therapy Bispebjerg‐Frederiksberg Hospital Copenhagen Denmark
| | - Christian Ohrhammar Josefsen
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg‐Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Mikkel Holm Jensen
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg‐Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Kristoffer Weisskirchner Barfod
- Department of Orthopedic Surgery, Sports Orthopedic Research Center–Copenhagen Copenhagen University Hospital Amager‐Hvidovre Denmark
| | - Janus D. Nybing
- Department of Radiology, Musculoskeletal Imaging Research Unit Bispebjerg‐Frederiksberg Hospital Copenhagen Denmark
| | - Philip Hansen
- Department of Radiology, Musculoskeletal Imaging Research Unit Bispebjerg‐Frederiksberg Hospital Copenhagen Denmark
| | - Michael Krogsgaard
- Section for Sports Traumatology, Department of Orthopedic Surgery Bispebjerg‐Frederiksberg Hospital Copenhagen Denmark
| | - S. Peter Magnusson
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg‐Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
- Department of Physical Therapy Bispebjerg‐Frederiksberg Hospital Copenhagen Denmark
| |
Collapse
|
26
|
Bojsen-Møller J, Magnusson SP. Mechanical properties, physiological behavior, and function of aponeurosis and tendon. J Appl Physiol (1985) 2019; 126:1800-1807. [DOI: 10.1152/japplphysiol.00671.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
During human movement, the muscle and tendinous structures interact as a mechanical system in which forces are generated and transmitted to the bone and energy is stored and released to optimize function and economy of movement and/or to reduce risk of injury. The present review addresses certain aspects of how the anatomical design and mechanical and material properties of the force-transmitting tissues contribute to the function of the muscle-tendon unit and thus overall human function. The force-bearing tissues are examined from a structural macroscopic point of view down to the nanoscale level of the collagen fibril. In recent years, the understanding of in vivo mechanical function of the force-bearing tissues has increased, and it has become clear that these tissues adapt to loading and unloading and furthermore that force transmission mechanics is more complex than previously thought. Future investigations of the force-transmitting tissues in three dimensions will enable a greater understanding of the complex functional interplay between muscle and tendon, with relevance for performance, injury mechanisms, and rehabilitation strategies.
Collapse
Affiliation(s)
- Jens Bojsen-Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Section for Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - S. Peter Magnusson
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational and Physical Therapy, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
27
|
Stenroth L, Thelen D, Franz J. Biplanar ultrasound investigation of in vivo Achilles tendon displacement non-uniformity. TRANSLATIONAL SPORTS MEDICINE 2019; 2:73-81. [PMID: 31008448 PMCID: PMC6472705 DOI: 10.1002/tsm2.61] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The Achilles tendon is a common tendon for the medial and lateral gastrocnemius and soleus muscles. Non-uniform Achilles tendon regional displacements have been observed in vivo which may result from non-uniform muscle loading and intra-tendinous shearing. However, prior observations are limited to the sagittal plane. This study investigated Achilles tendon tissue displacement patterns during isometric plantarflexor contractions in the coronal and sagittal planes. Fourteen subjects (5 female, 9 male, 26±3 yr) performed maximal isometric plantarflexor contractions with the knee in full extension and flexed to 110°. An ultrasound transducer positioned over the free Achilles tendon collected beam formed radio frequency (RF) data at 70 frames/s. Localized tissue displacements were analyzed using a speckle tracking algorithm. We observed non-uniform Achilles tendon tissue displacements in both imaging planes. Knee joint posture had no significant effect on tissue displacement patterns in either imaging plane. The non-uniform Achilles tendon tissue displacements during loading may arise from the anatomical organization of the sub-tendons associated with the three heads of the triceps surae. The biplanar investigation suggests that greatest displacements are localized to tissue likely to belong to soleus sub-tendon. This study adds novel information with possible implications for muscle coordination, function and muscle-tendon injury mechanisms.
Collapse
Affiliation(s)
- Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Finland
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Finland
| | - Darryl Thelen
- Department of Mechanical Engineering, University of Wisconsin – Madison, USA
- Department of Biomedical Engineering, University of Wisconsin – Madison, USA
| | - Jason Franz
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, USA
| |
Collapse
|
28
|
Shan X, Otsuka S, Yakura T, Naito M, Nakano T, Kawakami Y. Morphological and mechanical properties of the human triceps surae aponeuroses taken from elderly cadavers: Implications for muscle-tendon interactions. PLoS One 2019; 14:e0211485. [PMID: 30735517 PMCID: PMC6368299 DOI: 10.1371/journal.pone.0211485] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/15/2019] [Indexed: 11/21/2022] Open
Abstract
The human triceps surae (two gastrocnemii and soleus) has aponeuroses in the proximal and distal aspects, the latter of which insert into the calcaneus by sharing the common Achilles tendon. These tendinous tissues are known to have elasticity and upon muscle contraction the aponeurosis is stretched both longitudinally (along the muscle’s line of action) and transversely. Higher aponeurosis transverse deformability has been documented, but there is a paucity of information on the morphology and mechanical properties of human aponeurosis. This study aimed to identify morphological and mechanical characteristics of the human triceps surae aponeuroses. Twenty-five triceps surae muscle-tendon units were procured from 13 human donors (formalin fixed, 6 males, 7 females) aged 67–91 years. Specimens of aponeuroses were excised from the eight regions (posterior and anterior regions of the gastrocnemius medialis and lateralis, medial and lateral parts of soleus; proximal, middle, and distal sites each, 2–4 cm × 2–4 cm). Aponeurosis thickness was measured using a digital caliper. Uniaxial tensile tests were implemented to determine the mechanical properties of specimens loaded longitudinally (along the muscle’s line of action) and transversely. The aponeurosis thickness showed significant differences between muscles and sites, while Young’s modulus showed direction-dependent (longitudinal vs. transverse) differences within sites. Results show different morphology and mechanical properties of aponeuroses between synergist muscles. The reason for site-dependent differences in stiffness is due to a reduced aponeurosis thickness rather than a reduction in the material property. The anisotropic elastic feature (differences between longitudinal and transverse directions) of the aponeuroses was more pronounced than previous in vivo findings, suggesting inherent material design of the aponeurosis that matches three-dimensional contractile behavior of muscle fibers.
Collapse
Affiliation(s)
- Xiyao Shan
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shun Otsuka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tomiko Yakura
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takashi Nakano
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yasuo Kawakami
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
- Department of Anatomy, Aichi Medical University, Nagakute, Aichi, Japan
- * E-mail:
| |
Collapse
|
29
|
Allexandre D, Androwis GJ, Saleh S, Benony B, Yue GH. Design of a low-cost MRI compatible plantarflexion force measurement device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3950-3953. [PMID: 30441224 DOI: 10.1109/embc.2018.8513374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Investigating the neural correlates of ankles' joint rotation is critical to better understand the underlying deficit in balance or posture control in the clinical population. This work describes the design and characteristics of a low-cost MRI compatible isometric plantarflexion force measurement device. The device is fully adjustable to the particular height and shoe size of participants. Each individual force sensor has an operational linear range up to 80-100kg amounting to a force range up to 180kg when combining the two sensors, which is well above the maximal force for the majority of the population. Preliminary neuroimaging tests suggest that performing submaximal ankle plantar flexions on the device induce minimal motion artifacts on fMRI signal that are within an acceptable range.
Collapse
|
30
|
Combining in silico and in vitro experiments to characterize the role of fascicle twist in the Achilles tendon. Sci Rep 2018; 8:13856. [PMID: 30218024 PMCID: PMC6138712 DOI: 10.1038/s41598-018-31587-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/16/2018] [Indexed: 02/07/2023] Open
Abstract
The Achilles tendon (AT), the largest tendon in the human body has a unique structural feature, that is the fascicles in the AT display spiral twist. However, their functional and structural roles are still unclear. We used subject-specific computational models and tissue mechanical experiment to quantitatively characterize the role of fascicle twist in the Achilles tendon. Ten subject-specific finite element (FE) models of the Achilles tendon were developed from ultrasound images. Fascicle twist was implemented in these models using the material coordinate system available in our FE framework. Five different angles (0~60°) were implemented and material property optimization was performed for each of them (total 50 sets) using results from uniaxial stretch experiment. We showed that fascicle twist allows for even distribution of stress across the whole tendon, thus improving tissue strength. The predicted rupture load increased up to 40%. A number of connective tissues display similar fascicle twists in their structure. The resulting non-uniform strain distribution has been hypothesized as a primary factor in tissue degeneration and injuries. Therefore, our technique will be used to design biomechanically informed training and rehabilitation protocols for management of connective tissue injuries and degeneration.
Collapse
|
31
|
Titan A, Andarawis-Puri N. Tendinopathy: Investigating the Intersection of Clinical and Animal Research to Identify Progress and Hurdles in the Field. JBJS Rev 2018; 4:01874474-201610000-00002. [PMID: 27792676 DOI: 10.2106/jbjs.rvw.15.00088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Biological treatments, surgical interventions, and rehabilitation exercises have been successfully used to treat tendinopathy, but the development of effective treatments has been hindered by the lack of mechanistic data regarding the pathogenesis of the disease. While insightful, clinical studies are limited in their capacity to provide data regarding the pathogenesis of tendinopathies, emphasizing the value of animal models and cell culture studies to fill this essential gap in knowledge. Clinical pathological findings from imaging studies or histological analysis are not universal across patients with tendinopathy and have not been clearly associated with the onset of symptoms. There are several unresolved controversies, including the cellular changes that accompany the tendinopathic disease state and the role of inflammation. Additional research is needed to correlate the manifestations of the disease with its pathogenesis, with the goal of reaching a field-wide consensus on the pathology of the disease state. Such a consensus will allow standardized clinical practices to more effectively diagnose and treat tendinopathy.
Collapse
Affiliation(s)
- Ashley Titan
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | | |
Collapse
|
32
|
Sotelo M, Eichelberger P, Furrer M, Baur H, Schmid S. Walking with an induced unilateral knee extension restriction affects lower but not upper body biomechanics in healthy adults. Gait Posture 2018; 65:182-189. [PMID: 30558928 DOI: 10.1016/j.gaitpost.2018.07.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unilateral knee flexion contractures (KFC) are frequently seen in orthopedic rehabilitation and often interfere with the normal gait pattern, resulting in passive and/or active secondary deviations. In order to prevent KFC-related complications such as patellofemoral pain or the knee spine syndrome, a comprehensive understanding of such deviations is necessary. RESEARCH QUESTION How does an artificially induced unilateral KFC affect whole body biomechanics in young healthy adults during gait? METHODS Twenty-four healthy young adults (females/males: 13/11; mean age: 27.3 ± 3.8 years) were included in this cross-sectional study. Using an 8-camera optical motion capture system and two embedded force plates, three-dimensional lower extremity, pelvis and trunk kinematics as well as lower extremity joint moments were derived during normal walking and walking with unilateral KFCs by means of a lightweight knee brace locked at 30° and 60° of flexion. Data were analyzed using one-dimensional statistical parametric mapping, allowing explorative group comparisons of continuous data rather than pre-defined discrete parameters. RESULTS On the braced side, increased hip flexion (p < 0.001, 1-100 % of gait cycle [%GC]), knee flexion (p < 0.001, 1-72 and 82-100 %GC) and ankle dorsiflexion angles (p < 0.001, 1-100 %GC) as well as external knee flexion moments (p < 0.001, 1-98 % of stance phase [%StPh]) and decreased ankle dorsiflexion (p < 0.001, 74-94 %StPh), hip flexion and hip adduction moments (p < 0.001, 1-32 %StPh and p < 0.001, 71-92 %StPh, respectively) were observed. The unbraced side showed similar but less pronounced deviations. Pelvis and upper body kinematics were not altered, suggesting that the lower limbs fully compensate for KFCs of less than 30°. SIGNIFICANCE Asymmetric limb loading and considerable increases in external knee flexion moments might increase the risk for adverse effects of lower extremity joints in the long-term. It seems therefore important to treat KFCs as early as possible and to implement preventive strategies to avoid possible complications.
Collapse
Affiliation(s)
- Michael Sotelo
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland
| | - Martina Furrer
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland
| | - Heiner Baur
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland
| | - Stefan Schmid
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland.
| |
Collapse
|
33
|
Bogaerts S, De Brito Carvalho C, De Groef A, Suetens P, Peers K. Non-uniformity in pre-insertional Achilles tendon is not influenced by changing knee angle during isometric contractions. Scand J Med Sci Sports 2018; 28:2322-2329. [DOI: 10.1111/sms.13230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/16/2022]
Affiliation(s)
- S. Bogaerts
- Department of Development & Regeneration; KU Leuven; Leuven Belgium
- Department of Physical and Rehabilitation Medicine; University Hospitals Leuven; Leuven Belgium
| | - C. De Brito Carvalho
- ESAT/PSI; UZ Leuven and University Hospitals Leuven; Leuven Belgium
- MIRC; KU Leuven and University Hospitals Leuven; Leuven Belgium
- INESC TEC Porto, Instituto de Engenharia de Sistemas e Computadores-Tecnologia e Ciência; Porto Portugal
| | - A. De Groef
- Department of Development & Regeneration; KU Leuven; Leuven Belgium
- Department of Physical and Rehabilitation Medicine; University Hospitals Leuven; Leuven Belgium
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - P. Suetens
- ESAT/PSI; UZ Leuven and University Hospitals Leuven; Leuven Belgium
- MIRC; KU Leuven and University Hospitals Leuven; Leuven Belgium
| | - K. Peers
- Department of Development & Regeneration; KU Leuven; Leuven Belgium
- Department of Physical and Rehabilitation Medicine; University Hospitals Leuven; Leuven Belgium
| |
Collapse
|
34
|
Moltubakk MM, Magulas MM, Villars FO, Seynnes OR, Bojsen-Møller J. Specialized properties of the triceps surae muscle-tendon unit in professional ballet dancers. Scand J Med Sci Sports 2018; 28:2023-2034. [PMID: 29723911 DOI: 10.1111/sms.13207] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 12/24/2022]
Abstract
This study compared professional ballet dancers (n = 10) to nonstretching controls (n = 10) with the purpose of comparing muscle and tendon morphology, mechanical, neural, and functional properties of the triceps surae and their role for ankle joint flexibility. Torque-angle and torque-velocity data were obtained during passive and active conditions by use of isokinetic dynamometry, while tissue morphology and mechanical properties were evaluated by ultrasonography. Dancers displayed longer gastrocnemius medialis fascicles (55 ± 5 vs 47 ± 6 mm) and a longer (207 ± 33 vs 167 ± 10 mm) and more compliant (230 ± 87 vs 364 ± 106 N/mm) Achilles tendon compared to controls. Greater passive ankle dorsiflexion range of motion (40 ± 7 vs 17 ± 9°) was seen in dancers, resulting from greater fascicle strain and greater elongation of the muscle. Peak electromyographic (EMG) activity recorded during passive stretching was lower in dancers, and at common joint angles, dancers displayed lower EMG amplitude and lower passive joint stiffness. No differences between groups were seen in maximal isometric plantar flexor torque, isokinetic peak torque, angle of peak torque, or work. In conclusion, the greater ankle joint flexibility of professional dancers seems attributed to multiple differences in morphological and mechanical properties of muscle and tendinous tissues, and to factors related to neural activation.
Collapse
Affiliation(s)
- M M Moltubakk
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - M M Magulas
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - F O Villars
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway.,Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - O R Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - J Bojsen-Møller
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
35
|
Abstract
BACKGROUND Overuse injuries are multifactorial resulting from cumulative loading. Therefore, clear differences between normal and at-risk individuals may not be present for individual risk factors. Using a holistic measure that incorporates many of the identified risk factors, focusing on multiple joint movement patterns may give better insight into overuse injuries. Lower body stiffness may provide such a measure. OBJECTIVE To identify how risk factors for Achilles tendon injuries influence measures of lower body stiffness. METHODS SPORTDiscus, Web of Science, CINAHL and PubMed were searched for Achilles tendon injury risk factors related to vertical, leg and joint stiffness in running athletes. RESULTS Increased braking force and low surface stiffness, which were clearly associated with increased risk of Achilles tendon injuries, were also found to be associated with increased lower body stiffness. High arches and increased vertical and propulsive forces were protective for Achilles tendon injuries and were also associated with increased lower body stiffness. Risk factors for Achilles tendon injuries that had unclear associations were also investigated with the evidence trending towards an increase in leg stiffness and a decrease in ankle stiffness being detrimental to Achilles tendon health. CONCLUSION Few studies have investigated the link between lower body stiffness and Achilles injury. High stiffness is potentially associated with risk factors for Achilles tendon injuries although some of the evidence is controversial. Prospective injury studies are needed to confirm this relationship. Large amounts of high-intensity or high-speed work or running on soft surfaces such as sand may increase Achilles injury risk. Coaches and clinicians working with athletes with new or reoccurring injuries should consider training practices of the athlete and recommend reducing speed or sand running if loading is deemed to be excessive.
Collapse
|
36
|
Beyer R, Agergaard AS, Magnusson SP, Svensson RB. Speckle tracking in healthy and surgically repaired human Achilles tendons at different knee angles-A validation using implanted tantalum beads. TRANSLATIONAL SPORTS MEDICINE 2018. [DOI: 10.1002/tsm2.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- R. Beyer
- Department of Physical Therapy; Bispebjerg-Frederiksberg Hospital; Copenhagen Denmark
| | - A.-S. Agergaard
- Department of Physical Therapy; Bispebjerg-Frederiksberg Hospital; Copenhagen Denmark
- Institute of Sports Medicine Copenhagen; Department of Orthopedic Surgery; Bispebjerg-Frederiksberg Hospital and Center for Healthy Aging; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - S. P. Magnusson
- Department of Physical Therapy; Bispebjerg-Frederiksberg Hospital; Copenhagen Denmark
- Institute of Sports Medicine Copenhagen; Department of Orthopedic Surgery; Bispebjerg-Frederiksberg Hospital and Center for Healthy Aging; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - R. B. Svensson
- Institute of Sports Medicine Copenhagen; Department of Orthopedic Surgery; Bispebjerg-Frederiksberg Hospital and Center for Healthy Aging; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
37
|
Marcori AJ, Moura TB, Okazaki VH. Gastrocnemius muscle activation during plantar flexion with different feet positioning in physically active young men. ISOKINET EXERC SCI 2017. [DOI: 10.3233/ies-160654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
38
|
Karakuzu A, Pamuk U, Ozturk C, Acar B, Yucesoy CA. Magnetic resonance and diffusion tensor imaging analyses indicate heterogeneous strains along human medial gastrocnemius fascicles caused by submaximal plantar-flexion activity. J Biomech 2017; 57:69-78. [DOI: 10.1016/j.jbiomech.2017.03.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/27/2016] [Accepted: 03/31/2017] [Indexed: 11/29/2022]
|
39
|
Reeves ND, Cooper G. Is human Achilles tendon deformation greater in regions where cross-sectional area is smaller? ACTA ACUST UNITED AC 2017; 220:1634-1642. [PMID: 28202585 DOI: 10.1242/jeb.157289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/11/2017] [Indexed: 01/21/2023]
Abstract
The Achilles is a long tendon varying in cross-sectional area (CSA) considerably along its length. For the same force, a smaller CSA would experience higher tendon stress and we hypothesised that these areas would therefore undergo larger transverse deformations. A novel magnetic resonance imaging-based approach was implemented to quantify changes in tendon CSA from rest along the length of the Achilles tendon under load conditions corresponding to 10%, 20% and 30% of isometric plantar flexor maximum voluntary contraction (MVC). Reductions in tendon CSA occurring during contraction from the resting condition were assumed to be proportional to the longitudinal elongations within those regions (Poisson's ratio). Rather than tendon regions of smallest CSA undergoing the greatest deformations, the outcome was region specific, with the proximal (gastrocnemius) tendon portion showing larger transverse deformations upon loading compared with the distal portion of the Achilles (P<0.01). Transverse tendon deformation only occurred in selected regions of the distal Achilles tendon at 20% and 30% of MVC, but in contrast occurred throughout the proximal portion of the Achilles at all contraction levels (10%, 20% and 30% of MVC; P<0.01). Calculations showed that force on the proximal tendon portion was ∼60% lower, stress ∼70% lower, stiffness ∼30% lower and Poisson's ratio 6-fold higher compared with those for the distal portion of the Achilles tendon. These marked regional differences in mechanical properties may allow the proximal portion to function as a mechanical buffer to protect the stiffer, more highly stressed, distal portion of the Achilles tendon from injury.
Collapse
Affiliation(s)
- Neil D Reeves
- School of Healthcare Science, Faculty of Science & Engineering, Manchester Metropolitan University, John Dalton Building, Oxford Road, Manchester M1 5GD, UK
| | - Glen Cooper
- School of Mechanical, Aerospace & Civil Engineering, University of Manchester, Manchester M13 9PL, UK
| |
Collapse
|
40
|
Fröberg Å, Cissé AS, Larsson M, Mårtensson M, Peolsson M, Movin T, Arndt A. Altered patterns of displacement within the Achilles tendon following surgical repair. Knee Surg Sports Traumatol Arthrosc 2017; 25:1857-1865. [PMID: 28004174 PMCID: PMC5487597 DOI: 10.1007/s00167-016-4394-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/01/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Ultrasound speckle tracking was used to compare tendon deformation patterns between uninjured and surgically repaired Achilles tendons at 14-27-month follow-up. The hypothesis was that the non-homogenous displacement pattern previously described in uninjured tendons, where displacement within deep layers of the tendons exceeds that of superficial layers, is altered following tendon rupture and subsequent surgical repair. METHODS In the first part of this study, an in-house-developed block-matching speckle tracking algorithm was evaluated for assessment of displacement on porcine flexor digitorum tendons. Displacement data from speckle tracking were compared to displacement data from manual tracking. In the second part of the study, eleven patients with previous unilateral surgically treated Achilles tendon rupture were investigated using ultrasound speckle tracking. The difference in superficial and deep tendon displacement was assessed. Displacement patterns in the surgically repaired and uninjured tendons were compared during passive motion (Thompson's squeeze test) and during active ankle dorsiflexion. RESULTS The difference in peak displacement between superficial and deep layers was significantly (p < 0.01) larger in the uninjured tendons as compared to the surgically repaired tendons both during Thompson's test (-0.7 ± 0.2 mm compared to -0.1 ± 0.1 mm) and active dorsiflexion (3.3 ± 1.1 mm compared to 0.3 ± 0.2 mm). The evaluation of the speckle tracking algorithm showed correlations of r ≥ 0.89 between displacement data acquired from speckle tracking and the reference displacement acquired from manual tracking. Speckle tracking systematically underestimated the magnitude of displacement with coefficients of variation of less than 11.7%. CONCLUSIONS Uninjured Achilles tendons display a non-uniform displacement pattern thought to reflect gliding between fascicles. This pattern was altered after a mean duration of 19 ± 4 months following surgical repair of the tendon indicating that fascicle sliding is impaired. This may affect modulation of the action between different components of the triceps surae, which in turn may affect force transmission and tendon elasticity resulting in impaired function and risk of re-rupture.
Collapse
Affiliation(s)
- Åsa Fröberg
- Division of Orthopaedics and Biotechnology Karolinska University Hospital, Department of Clinical Sciences Intervention and Technology (Clintec), Karolinska University Hospital, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden.
| | - Ann-Sophie Cissé
- Division of Orthopaedics and Biotechnology Karolinska University Hospital, Department of Clinical Sciences Intervention and Technology (Clintec), Karolinska University Hospital, Karolinska Institute, Huddinge, 141 86 Stockholm, Sweden
| | - Matilda Larsson
- School of Technology and Health, KTH Royal Institute of Technology, Huddinge, Sweden
| | - Mattias Mårtensson
- School of Technology and Health, KTH Royal Institute of Technology, Huddinge, Sweden
| | | | - Tomas Movin
- Division of Orthopaedics and Biotechnology Karolinska University Hospital, Department of Clinical Sciences Intervention and Technology (Clintec), Karolinska University Hospital, Karolinska Institute, Huddinge, 141 86 Stockholm, Sweden ,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Anton Arndt
- Division of Orthopaedics and Biotechnology Karolinska University Hospital, Department of Clinical Sciences Intervention and Technology (Clintec), Karolinska University Hospital, Karolinska Institute, Huddinge, 141 86 Stockholm, Sweden ,The Swedish School of Sports and Health Sciences, Stockholm, Sweden
| |
Collapse
|
41
|
Handsfield GG, Inouye JM, Slane LC, Thelen DG, Miller GW, Blemker SS. A 3D model of the Achilles tendon to determine the mechanisms underlying nonuniform tendon displacements. J Biomech 2016; 51:17-25. [PMID: 27919416 DOI: 10.1016/j.jbiomech.2016.11.062] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/16/2016] [Accepted: 11/19/2016] [Indexed: 02/05/2023]
Abstract
The Achilles is the thickest tendon in the body and is the primary elastic energy-storing component during running. The form and function of the human Achilles is complex: twisted structure, intratendinous interactions, and differential motor control from the triceps surae muscles make Achilles behavior difficult to intuit. Recent in vivo imaging of the Achilles has revealed nonuniform displacement patterns that are not fully understood and may result from complex architecture and musculotendon interactions. In order to understand which features of the Achilles tendon give rise to the nonuniform deformations observed in vivo, we used computational modeling to predict the mechanical contributions from different features of the tendon. The aims of this study are to: (i) build a novel computational model of the Achilles tendon based on ultrashort echo time MRI, (ii) compare simulated displacements with published in vivo ultrasound measures of displacement, and (iii) use the model to elucidate the effects of tendon twisting, intratendon sliding, retrocalcaneal insertion, and differential muscle forces on tendon deformation. Intratendon sliding and differential muscle forces were found to be the largest factors contributing to displacement nonuniformity between tendon regions. Elimination of intratendon sliding or muscle forces reduced displacement nonuniformity by 96% and 85%, respectively, while elimination of tendon twist and the retrocalcaneal insertion reduced displacement nonuniformity by only 35% and 3%. These results suggest that changes in the complex internal structure of the tendon alter the interaction between muscle forces and tendon behavior and therefore may have important implications on muscle function during movement.
Collapse
Affiliation(s)
- Geoffrey G Handsfield
- Department of Biomedical Engineering, University of Virginia, United States; Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - Joshua M Inouye
- Department of Biomedical Engineering, University of Virginia, United States
| | - Laura C Slane
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States; Institute for Orthopaedic Research and Training, Katholieke Universiteit Leuven, Belgium
| | - Darryl G Thelen
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States; Department of Mechanical Engineering, University of Wisconsin-Madison, United States
| | - G Wilson Miller
- Department of Radiology and Medical Imaging, University of Virginia, United States
| | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, United States; Department of Orthopaedic Surgery, University of Virginia, United States; Department of Mechanical and Aerospace Engineering, University of Virginia, United States.
| |
Collapse
|
42
|
Tijs C, van Dieën JH, Baan GC, Maas H. Synergistic Co-activation Increases the Extent of Mechanical Interaction between Rat Ankle Plantar-Flexors. Front Physiol 2016; 7:414. [PMID: 27708589 PMCID: PMC5030264 DOI: 10.3389/fphys.2016.00414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 09/05/2016] [Indexed: 11/18/2022] Open
Abstract
Force transmission between rat ankle plantar-flexors has been found for physiological muscle lengths and relative positions, but only with all muscles maximally activated. The aims of this study were to assess intermuscular mechanical interactions between ankle plantar-flexors during (i) fully passive conditions, (ii) excitation of soleus (SO), (iii) excitation of lateral gastrocnemius (LG), and (iv) during co-activation of SO, and LG (SO&LG). We assessed effects of proximal lengthening of LG and plantaris (PL) muscles (i.e., simulating knee extension) on forces exerted at the distal SO tendon (FSO) and on the force difference between the proximal and distal LG+PL tendons (ΔFLG+PL) of the rat. LG+PL lengthening increased FSO to a larger extent (p = 0.017) during LG excitation (0.0026 N/mm) than during fully passive conditions (0.0009 N/mm). Changes in FSO in response to LG+PL lengthening were lower (p = 0.002) during SO only excitation (0.0056 N/mm) than during SO&LG excitation (0.0101 N/mm). LG+PL lengthening changed ΔFLG+PL to a larger extent (p = 0.007) during SO excitation (0.0211 N/mm) than during fully passive conditions (0.0157 N/mm). In contrast, changes in ΔFLG+PL in response to LG+PL lengthening during LG excitation (0.0331 N/mm) were similar (p = 0.161) to that during SO&LG excitation (0.0370 N/mm). In all conditions, changes of FSO were lower than those of ΔFLG+PL. This indicates that muscle forces were transmitted not only between LG+PL and SO, but also between LG+PL and other surrounding structures. In addition, epimuscular myofascial force transmission between rat ankle plantar-flexors was enhanced by muscle activation. However, the magnitude of this interaction was limited.
Collapse
Affiliation(s)
- Chris Tijs
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit AmsterdamAmsterdam, Netherlands; Department of Organismic and Evolutionary Biology, Harvard UniversityCambridge, MA, USA
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam Amsterdam, Netherlands
| | - Guus C Baan
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam Amsterdam, Netherlands
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam Amsterdam, Netherlands
| |
Collapse
|
43
|
Nomenclature of the tendon hierarchy: An overview of inconsistent terminology and a proposed size-based naming scheme with terminology for multi-muscle tendons. J Biomech 2016; 49:3122-3124. [DOI: 10.1016/j.jbiomech.2016.06.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 02/03/2023]
|
44
|
Cruz-Montecinos C, Cerda M, Sanzana-Cuche R, Martín-Martín J, Cuesta-Vargas A. Ultrasound assessment of fascial connectivity in the lower limb during maximal cervical flexion: technical aspects and practical application of automatic tracking. BMC Sports Sci Med Rehabil 2016; 8:18. [PMID: 27403319 PMCID: PMC4939606 DOI: 10.1186/s13102-016-0043-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/15/2016] [Indexed: 01/14/2023]
Abstract
Background The fascia provides and transmits forces for connective tissues, thereby regulating human posture and movement. One way to assess the myofascial interaction is a fascia ultrasound recording. Ultrasound can follow fascial displacement either manually or automatically through two-dimensional (2D) method. One possible method is the iterated Lucas-Kanade Pyramid (LKP) algorithm, which is based on automatic pixel tracking during passive movements in 2D fascial displacement assessments. Until now, the accumulated error over time has not been considered, even though it could be crucial for detecting fascial displacement in low amplitude movements. The aim of this study was to assess displacement of the medial gastrocnemius fascia during cervical spine flexion in a kyphotic posture with the knees extended and ankles at 90°. Methods The ultrasound transducer was placed on the extreme dominant belly of the medial gastrocnemius. Displacement was calculated from nine automatically selected tracking points. To determine cervical flexion, an established 2D marker protocol was implemented. Offline pressure sensors were used to synchronize the 2D kinematic data from cervical flexion and deep fascia displacement of the medial gastrocnemius. Results Fifteen participants performed the cervical flexion task. The basal tracking error was 0.0211 mm. In 66 % of the subjects, a proximal fascial tissue displacement of the fascia above the basal error (0.076 mm ± 0.006 mm) was measured. Fascia displacement onset during cervical spine flexion was detected over 70 % of the cycle; however, only when detected for more than 80 % of the cycle was displacement considered statistically significant as compared to the first 10 % of the cycle (ANOVA, p < 0.05). Conclusion By using an automated tracking method, the present analyses suggest statistically significant displacement of deep fascia. Further studies are needed to corroborate and fully understand the mechanisms associated with these results.
Collapse
Affiliation(s)
- Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile ; Laboratory of Biomechanics, San José Hospital, Santiago, Chile
| | - Mauricio Cerda
- SCIAN-Lab, Programa de Anatomía y Biología del Desarrollo, ICBM, University of Chile, Santiago, Chile
| | - Rodolfo Sanzana-Cuche
- Departamento de Ciencias Morfológicas, Facultad de Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Jaime Martín-Martín
- Escuela de Terapia Ocupacional, Facultad de Salud, Deporte y Recreación, Universidad Bernardo O Higgins, Santiago, Chile ; Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Instituto Investigacion Biomedica de Málaga (IBIMA), Universidad de Málaga, Andalucia Tech, Cátedra de Fisioterapia y DiscapacidadGrupo de Clinimetria (FE-14), Málaga, Spain
| | - Antonio Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Instituto Investigacion Biomedica de Málaga (IBIMA), Universidad de Málaga, Andalucia Tech, Cátedra de Fisioterapia y DiscapacidadGrupo de Clinimetria (FE-14), Málaga, Spain ; School of Clinical Science, Faculty of Health Sciences at Queensland University Technology, Brisbane, Australia ; Facultad de Ciencias de la Salud, Universidad de Málaga, Av. Arquitecto Peñalosa s/n (Teatinos Campus Expansion), 29009 Málaga, Spain
| |
Collapse
|
45
|
Edama M, Kubo M, Onishi H, Takabayashi T, Yokoyama E, Inai T, Watanabe H, Nashimoto S, Kageyama I. Structure of the Achilles tendon at the insertion on the calcaneal tuberosity. J Anat 2016; 229:610-614. [PMID: 27330029 DOI: 10.1111/joa.12514] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/28/2022] Open
Abstract
Findings on the twisting structure and insertional location of the AT on the calcaneal tuberosity are inconsistent. Therefore, to obtain a better understanding of the mechanisms underlying insertional Achilles tendinopathy, clarification of the anatomy of the twisting structure and location of the AT insertion onto the calcaneal tuberosity is important. The purpose of this study was to reveal the twisted structure of the AT and the location of its insertion onto the calcaneal tuberosity using Japanese cadavers. The study was conducted using 132 legs from 74 cadavers (mean age at death, 78.3 ± 11.1 years; 87 sides from men, 45 from women). Only soleus (Sol) attached to the deep layer of the calcaneal tuberosity was classified as least twist (Type I), both the lateral head of the gastrocnemius (LG) and Sol attached to the deep layer of the calcaneal tuberosity were classified as moderate twist (Type II), and only LG attached to the deep layer of the calcaneal tuberosity was classified as extreme twist (Type III). The Achilles tendon insertion onto the calcaneal tuberosity was classified as a superior, middle or inferior facet. Twist structure was Type I (least) in 31 legs (24%), Type II (moderate) in 87 legs (67%), and Type III (extreme) in 12 legs (9%). A comparison between males and females revealed that among men, 20 legs (24%) were Type I, 57 legs (67%) Type II, and eight legs (9%) Type III. Among women, 11 legs (24%) were Type I, 30 legs (67%) Type II, and four legs (9%) Type III. No significant differences were apparent between sexes. The fascicles of the Achilles tendon attach mainly in the middle facet. Anterior fibers of the Achilles tendon, where insertional Achilles tendinopathy is most likely, are Sol in Type I, LG and Sol in Type II, and LG only in Type III. This suggests the possibility that a different strain is produced in the anterior fibers of the Achilles tendon (calcaneal side) where insertional Achilles tendinopathy is most likely to occur in each type. We look forward to elucidating the mechanisms generating insertional Achilles tendinopathy in future biomedical studies based on the present results.
Collapse
Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan. .,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan.
| | - Masayoshi Kubo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Erika Yokoyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Takuma Inai
- Department of Rehabilitation, Oguma Orthopedics Clinic, Niigata, Japan
| | - Hiroshi Watanabe
- Department of Rehabilitation, Nagaoka Chuo General Hospital, Nagaoka, Japan
| | - Satoshi Nashimoto
- Department of Rehabilitation, Niigata Medical Center, Niigata, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| |
Collapse
|
46
|
Khayyeri H, Longo G, Gustafsson A, Isaksson H. Comparison of structural anisotropic soft tissue models for simulating Achilles tendon tensile behaviour. J Mech Behav Biomed Mater 2016; 61:431-443. [PMID: 27108350 DOI: 10.1016/j.jmbbm.2016.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/25/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
The incidence of tendon injury (tendinopathy) has increased over the past decades due to greater participation in sports and recreational activities. But little is known about the aetiology of tendon injuries because of our limited knowledge in the complex structure-function relationship in tendons. Computer models can capture the biomechanical behaviour of tendons and its structural components, which is essential for understanding the underlying mechanisms of tendon injuries. This study compares three structural constitutive material models for the Achilles tendon and discusses their application on different biomechanical simulations. The models have been previously used to describe cardiovascular tissue and articular cartilage, and one model is novel to this study. All three constitutive models captured the tensile behaviour of rat Achilles tendon (root mean square errors between models and experimental data are 0.50-0.64). They further showed that collagen fibres are the main load-bearing component and that the non-collagenous matrix plays a minor role in tension. By introducing anisotropic behaviour also in the non-fibrillar matrix, the new biphasic structural model was also able to capture fluid exudation during tension and high values of Poisson׳s ratio that is reported in tendon experiments.
Collapse
Affiliation(s)
- Hanifeh Khayyeri
- Department of Biomedical Engineering, Lund University, BMC D13, 22184 Lund, Sweden.
| | - Giacomo Longo
- Department of Biomedical Engineering, Lund University, BMC D13, 22184 Lund, Sweden
| | - Anna Gustafsson
- Department of Biomedical Engineering, Lund University, BMC D13, 22184 Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, BMC D13, 22184 Lund, Sweden
| |
Collapse
|
47
|
Ando R, Nosaka K, Inami T, Tomita A, Watanabe K, Blazevich AJ, Akima H. Difference in fascicle behaviors between superficial and deep quadriceps muscles during isometric contractions. Muscle Nerve 2016; 53:797-802. [DOI: 10.1002/mus.24905] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Ryosuke Ando
- Graduate School of Education and Human Development, Nagoya University, Furo, Chikusa; Nagoya Aichi 464-8601 Japan
- Centre for Exercise and Sport Science Research, School of Exercise and Health Sciences; Edith Cowan University; Perth Western Australia Australia
| | - Kazunori Nosaka
- Centre for Exercise and Sport Science Research, School of Exercise and Health Sciences; Edith Cowan University; Perth Western Australia Australia
| | - Takayuki Inami
- Centre for Exercise and Sport Science Research, School of Exercise and Health Sciences; Edith Cowan University; Perth Western Australia Australia
| | - Aya Tomita
- Graduate School of Education and Human Development, Nagoya University, Furo, Chikusa; Nagoya Aichi 464-8601 Japan
| | - Kohei Watanabe
- School of International Liberal Studies; Chukyo University; Nagoya Japan
| | - Anthony J. Blazevich
- Centre for Exercise and Sport Science Research, School of Exercise and Health Sciences; Edith Cowan University; Perth Western Australia Australia
| | - Hiroshi Akima
- Graduate School of Education and Human Development, Nagoya University, Furo, Chikusa; Nagoya Aichi 464-8601 Japan
- Research Center of Health, Physical Fitness & Sports; Nagoya University; Nagoya Japan
| |
Collapse
|
48
|
Kellis E. Biceps femoris and semitendinosus tendon/aponeurosis strain during passive and active (isometric) conditions. J Electromyogr Kinesiol 2016; 26:111-9. [DOI: 10.1016/j.jelekin.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 11/14/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022] Open
|
49
|
Collagen Homeostasis and Metabolism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 920:11-25. [DOI: 10.1007/978-3-319-33943-6_2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
50
|
Finni T, Cronin NJ, Mayfield D, Lichtwark GA, Cresswell AG. Effects of muscle activation on shear between human soleus and gastrocnemius muscles. Scand J Med Sci Sports 2015; 27:26-34. [PMID: 26643762 DOI: 10.1111/sms.12615] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
Abstract
Lateral connections between muscles provide pathways for myofascial force transmission. To elucidate whether these pathways have functional roles in vivo, we examined whether activation could alter the shear between the soleus (SOL) and lateral gastrocnemius (LG) muscles. We hypothesized that selective activation of LG would decrease the stretch-induced shear between LG and SOL. Eleven volunteers underwent a series of knee joint manipulations where plantar flexion force, LG, and SOL muscle fascicle lengths and relative displacement of aponeuroses between the muscles were obtained. Data during a passive full range of motion were recorded, followed by 20° knee extension stretches in both passive conditions and with selective electrical stimulation of LG. During active stretch, plantar flexion force was 22% greater (P < 0.05) and relative displacement of aponeuroses was smaller than during passive stretch (P < 0.05). Soleus fascicle length changes did not differ between passive and active stretches but LG fascicles stretched less in the active than passive condition when the stretch began at angles of 70° and 90° of knee flexion (P < 0.05). The activity-induced decrease in the relative displacement of SOL and LG suggests stronger (stiffer) connectivity between the two muscles, at least at flexed knee joint angles, which may serve to facilitate myofascial force transmission.
Collapse
Affiliation(s)
- T Finni
- Neuromuscular Research Center, Department of Biology of Physical Activity, University of Jyvaskyla, Jyvaskyla, Finland
| | - N J Cronin
- Neuromuscular Research Center, Department of Biology of Physical Activity, University of Jyvaskyla, Jyvaskyla, Finland
| | - D Mayfield
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - G A Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - A G Cresswell
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|