Stimuli for Adaptations in Muscle Length and the Length Range of Active Force Exertion-A Narrative Review

Effects of Stretching or Strengthening Exercise on Spinal and Lumbopelvic Posture: A Systematic Review with Meta-Analysis

BACKGROUND

Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach.

METHODS

A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied.

RESULTS

A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05).

CONCLUSION

Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.

Influence of 8-weeks of supervised static stretching or resistance training of pectoral major muscles on maximal strength, muscle thickness and range of motion

OBJECTIVES

Current research suggests static stretch-induced maximal strength increases and muscle hypertrophy with potential to substitute resistance-training routines. However, most studies investigated the plantar flexors. This study explored the effects of a static stretching program on maximal strength, hypertrophy and flexibility of the pectoralis major and compared the effects with those of traditional resistance training.

METHODS

Eighty-one (81) active participants were allocated to either a static stretching, strength-training or control group. Pectoralis stretching was applied 15 min/day, 4 days per week for 8 weeks, while resistance training trained 3 days per week, 5 × 12 repetitions.

RESULTS

There was an increase in all parameters (strength: p < 0.001, ƞ2 = 0.313, muscle thickness: p < 0.001, ƞ2 = 0.157-0.264, flexibility: p < 0.001, ƞ2 = 0.316) and a time*group interaction (strength: p = 0.001, ƞ2 = 0.154, muscle thickness: p = 0.008-0.001, ƞ2 = 0.117-0.173, flexibility: p < 0.001, ƞ2 = 0.267). Post-hoc testing showed no difference between both intervention groups regarding maximal strength and muscle thickness (p = 0.905-0.983, d = 0.036-0.087), while flexibility increased in the stretching group (p = 0.001, d = 0.789).

CONCLUSION

Stretching showed increases in maximal strength and hypertrophy, which were comparable with commonly used resistance training. Based on current literature, the influence of mechanical tension as the underlying mechanism is discussed. Furthermore, as equipment and comparatively long stretching durations are requested to induce meaningful strength increases in recreationally active participants, practical application seems limited to special circumstances.

Characterization of the vastus lateralis torque-length, and knee extensors torque-velocity and power-velocity relationships in people with Parkinson's disease

Introduction

Parkinson's disease (PD) is a prevalent neurodegenerative condition observed primarily in the elderly population that gives rise to motor and non-motor symptoms, one of which is muscle weakness. The aim of this study was to characterize the vastus lateralis torque-fascicle length (T-L) and the knee extensors torque-angular velocity (T-V) and power-angular velocity (P-V) relationships in PD patients and to investigate the influence of muscle geometry on muscle mechanics.

Methods

Participants (11 PD: patients, 9 CR: age matched healthy controls; 10 CY: young healthy controls) performed: (i) isometric contractions (e.g., MVC) to obtain the torque-angle and T-L relationships; (ii) isokinetic (e.g., iso-velocity) contractions to obtain the T-V and P-V relationships. During the experiments, the architecture of vastus lateralis (pennation angle, fascicle length, muscle thickness) was also determined by using an ultrasound apparatus.

Results

Significant differences were observed between PD patients and physically matched control groups (CR and CY) in terms of maximum isometric force (calculated as the apex of the T-L curve) and maximum mechanical power (apex of the P-V curve), but not in maximum shortening velocity. Among the mechanical variables investigated, mechanical power was able to identify differences between the less and the more affected side in PD patients, suggesting that this parameter could be useful for clinical evaluation in this population.

Conclusions

The observed results cannot be explained by differences in muscle geometry at rest (similar in the three cohorts), but rather by the muscle capacity to change in shape during contraction, that is impaired in PD patients.

Effects of chronic static stretching interventions on jumping and sprinting performance-a systematic review with multilevel meta-analysis

When improving athletic performance in sports with high-speed strength demands such as soccer, basketball, or track and field, the most common training method might be resistance training and plyometrics. Since a link between strength capacity and speed strength exists and recently published literature suggested chronic stretching routines may enhance maximum strength and hypertrophy, this review was performed to explore potential benefits on athletic performance. Based on current literature, a beneficial effect of static stretching on jumping and sprinting performance was hypothesized. A systematic literature search was conducted using PubMed, Web of Science and Google scholar. In general, 14 studies revealed 29 effect sizes (ES) (20 for jumping, nine for sprinting). Subgroup analyses for jump performance were conducted for short- long- and no stretch shortening cycle trials. Qualitative evaluation was supplemented by performing a multilevel meta-analysis via R (Package: metafor). Significant positive results were documented in six out of 20 jump tests and in six out of nine sprint tests, while two studies reported negative adaptations. Quantitative data analyses indicated a positive but trivial magnitude of change on jumping performance (ES:0.16, p = 0.04), while all subgroup analyses did not support a positive effect (p = 0.09-0.44). No significant influence of static stretching on sprint performance was obtained (p = 0.08). Stretching does not seem to induce a sufficient stimulus to meaningfully enhance jumping and sprinting performance, which could possibly attributed to small weekly training volumes or lack of intensity.

Effects of 12-week gait retraining on plantar flexion torque, architecture, and behavior of the medial gastrocnemius in vivo

Objective

This study aims to explore the effects of 12-week gait retraining (GR) on plantar flexion torque, architecture, and behavior of the medial gastrocnemius (MG) during maximal voluntary isometric contraction (MVIC).

Methods

Thirty healthy male rearfoot strikers were randomly assigned to the GR group (n = 15) and the control (CON) group (n = 15). The GR group was instructed to wear minimalist shoes and run with a forefoot strike pattern for the 12-week GR (3 times per week), whereas the CON group wore their own running shoes and ran with their original foot strike pattern. Participants were required to share screenshots of running tracks each time to ensure training supervision. The architecture and behavior of MG, as well as ankle torque data, were collected before and after the intervention. The architecture of MG, including fascicle length (FL), pennation angle, and muscle thickness, was obtained by measuring muscle morphology at rest using an ultrasound device. Ankle torque data during plantar flexion MVIC were obtained using a dynamometer, from which peak torque and early rate of torque development (RTD50) were calculated. The fascicle behavior of MG was simultaneously captured using an ultrasound device to calculate fascicle shortening, fascicle rotation, and maximal fascicle shortening velocity (Vmax).

Results

After 12-week GR, 1) the RTD50 increased significantly in the GR group (p = 0.038), 2) normalized FL increased significantly in the GR group (p = 0.003), and 3) Vmax increased significantly in the GR group (p = 0.018).

Conclusion

Compared to running training, GR significantly enhanced the rapid strength development capacity and contraction velocity of the MG. This indicates the potential of GR as a strategy to improve muscle function and mechanical efficiency, particularly in enhancing the ability of MG to generate and transmit force as well as the rapid contraction capability. Further research is necessary to explore the effects of GR on MG behavior during running in vivo.

Functional specialisation and coordination of myonuclei

Myofibres serve as the functional unit for locomotion, with the sarcomere as fundamental subunit. Running the entire length of this structure are hundreds of myonuclei, located at the periphery of the myofibre, juxtaposed to the plasma membrane. Myonuclear specialisation and clustering at the centre and ends of the fibre are known to be essential for muscle contraction, yet the molecular basis of this regionalisation has remained unclear. While the 'myonuclear domain hypothesis' helped explain how myonuclei can independently govern large cytoplasmic territories, novel technologies have provided granularity on the diverse transcriptional programs running simultaneously within the syncytia and added a new perspective on how myonuclei communicate. Building upon this, we explore the critical cellular and molecular sources of transcriptional and functional heterogeneity within myofibres, discussing the impact of intrinsic and extrinsic factors on myonuclear programs. This knowledge provides new insights for understanding muscle development, repair, and disease, but also opens avenues for the development of novel and precise therapeutic approaches.

The effect of neuromuscular electrical stimulation applied at different muscle lengths on muscle architecture and sarcomere morphology in rats

Neuromuscular electrical stimulation (NMES) is often used to increase muscle strength and functionality. Muscle architecture is important for the skeletal muscle functionality. The aim of this study was to investigate the effects of NMES applied at different muscle lengths on skeletal muscle architecture. Twenty-four rats were randomly assigned to four groups (two NMES groups and two control groups). NMES was applied on the extensor digitorum longus muscle at long muscle length, which is the longest and stretched position of the muscle at 170° plantar flexion, and at medium muscle length, which is the length of the muscle at 90° plantar flexion. A control group was created for each NMES group. NMES was applied for 8 weeks, 10 min/day, 3 days/week. After 8 weeks, muscle samples were removed at the NMES intervention lengths and examined macroscopically, and microscopically using a transmission electron microscope and streo-microscope. Muscle damage, and architectural properties of the muscle including pennation angle, fibre length, muscle length, muscle mass, physiological cross-sectional area, fibre length/muscle length, sarcomere length, sarcomere number were then evaluated. There was an increase in fibre length and sarcomere number, and a decrease in pennation angle at both lengths. In the long muscle length group, muscle length was increased, but widespread muscle damage was observed. These results suggest that the intervention of NMES at long muscle length can increase the muscle length but also causes muscle damage. In addition, the greater longitudinal increase in muscle length may be a result of the continuous degeneration-regeneration cycle.

Muscle morphology and architecture of the medial gastrocnemius between typically developing children with different ancestral background

Muscle ultrasonography is frequently used to improve the understanding of musculoskeletal impairments in children with spastic cerebral palsy (SCP). So far, most studies on muscle morphology and architecture have included typically developing children and children with SCP with similar ancestry, being mainly Caucasian. Less is known about differences in muscle morphology between children with different ancestral backgrounds. Therefore, the aim of this study was to compare muscle morphology and architecture of the medial gastrocnemius in typically developing children with African, South Asian and Southeast Asian descent from Suriname. This explorative cohort study identified children as Maroon (Ghana, African descent), Hindustani (India, South Asian) or Javanese (Indonesia, Southeast Asian), aged 5-10 years. Using 3D freehand ultrasound with the subject prone, the following medial gastrocnemius parameters were defined: muscle tendon unit (MTU) length, muscle belly length, tendon length, muscle volume, muscle thickness, anatomical cross-sectional area (ACSA), fascicle length, pennation angle, and physiological cross-sectional area (PCSA). In addition, differences between ancestral groups were assessed for the length of the MTU, muscle, tendon and fascicles in two passive stretch conditions corresponding to an externally applied joint torque of 1Nm and 4Nm. One-way ANOVA with post hoc t-tests were used to investigate differences between the ancestral groups. In total, 100 Hindustani (n = 34), Javanese (n = 34) and Maroon (n = 32) children were included. For statistical analyses, we matched the children by age, which resulted in groups of 25 children per ancestral group (n = 75). There were no differences found in MTU length, muscle belly length, ACSA, PCSA and muscle volume. Tendon length, fascicle length and pennation angle were different between ancestral groups. Compared to Javanese children, tendon length was longer (p = 0.001) and pennation angle (p = 0.001) was larger in Maroon children and fascicle length was shorter in both Maroon and Hindustani children (p < 0.001). While there was a difference found in MTU length at different conditions of passive stretch between ancestries, no differences were found in the muscle, tendon and fascicles. This is the first study that investigated macroscopic morphological and architectural parameters for the medial gastrocnemius in one extended cohort of typically developing children, stratified in three ancestral subgroups. The current results imply that ancestry-specific reference data for children are needed, especially for tendon length, fascicle length and pennation angle when investigating altered muscle morphology in neurological or neuromuscular pathologies, such as SCP. Future studies should report the ancestral background when describing muscle morphology and architecture of children and ancestral specifications should be included in normative databases.

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

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

Functional popliteal angle tests improve identification of short hamstring muscle-tendon length in patients with a central neurological lesion

This study introduces a functional exercise protocol to improve the identification for short hamstring muscle-tendon length (HMTL), a common contributor to crouch gait in patients with central neurological lesions (CNL). The functional exercise protocol incorporates a knee extension movement with hip in a flexed position, while standing on one leg (functional popliteal angle test) and walking with large steps to the current standard protocol (walking at comfortable speed and as fast as possible). The main aim was to establish whether the new protocol allows better determination of maximum HMTLs and diagnostics of short HMTL in patients with a CNL. Lower limb 3D marker position data from 39 patient limbs and 10 healthy limbs performing the exercises were processed in OpenSim to extract HMTLs. The new protocol provoked significantly larger HMTLs compared to the current standard protocol. The total number of limbs classified as having too short HMTLs reduced from 16 to 4 out of a total of 30 limbs walking in crouch. The new protocol improves determination of maximum HMTL, thereby improving short HMTL diagnostics and identification of patients in need of lengthening treatment. Inter-individual variability observed among patients, indicating the need to include all exercises for comprehensive diagnosis.

Physiology of Stretch-Mediated Hypertrophy and Strength Increases: A Narrative Review

Increasing muscle strength and cross-sectional area is of crucial importance to improve or maintain physical function in musculoskeletal rehabilitation and sports performance. Decreases in muscular performance are experienced in phases of reduced physical activity or immobilization. These decrements highlight the need for alternative, easily accessible training regimens for a sedentary population to improve rehabilitation and injury prevention routines. Commonly, muscle hypertrophy and strength increases are associated with resistance training, typically performed in a training facility. Mechanical tension, which is usually induced with resistance machines and devices, is known to be an important factor that stimulates the underlying signaling pathways to enhance protein synthesis. Findings from animal studies suggest an alternative means to induce mechanical tension to enhance protein synthesis, and therefore muscle hypertrophy by inducing high-volume stretching. Thus, this narrative review discusses mechanical tension-induced physiological adaptations and their impact on muscle hypertrophy and strength gains. Furthermore, research addressing stretch-induced hypertrophy is critically analyzed. Derived from animal research, the stretching literature exploring the impact of static stretching on morphological and functional adaptations was reviewed and critically discussed. No studies have investigated the underlying physiological mechanisms in humans yet, and thus the underlying mechanisms remain speculative and must be discussed in the light of animal research. However, studies that reported functional and morphological increases in humans commonly used stretching durations of > 30 min per session of the plantar flexors, indicating the importance of high stretching volume, if the aim is to increase muscle mass and maximum strength. Therefore, the practical applicability seems limited to settings without access to resistance training (e.g., in an immobilized state at the start of rehabilitation), as resistance training seems to be more time efficient. Nevertheless, further research is needed to generate evidence in different human populations (athletes, sedentary individuals, and rehabilitation patients) and to quantify stretching intensity.

What Are We Aiming for in Eccentric Hamstring Training: Angle-Specific Control or Supramaximal Stimulus?

CONTEXT

Different resistance exercise determinants modulate the musculotendinous adaptations following eccentric hamstring training. The Nordic Hamstring Exercise (NHE) can be performed 2-fold: the movement velocity irreversibly increases toward the end of the range of motion or it is kept constant.

DESIGN

This cross-sectional study aimed to investigate if the downward acceleration angle (DWAangle) can be used as a classification parameter to distinguish between increasing and constant velocity NHE execution. Furthermore, the kinetic and kinematic differences of these 2 NHE execution conditions were examined by analyzing the DWAangle in relation to the angle of peak moment.

METHODS

A total of 613 unassisted NHE repetitions of 12 trained male sprinters (22 y, 181 cm, 76 kg) were analyzed.

RESULTS

The majority of analyzed parameters demonstrated large effects. NHEs with constant velocity  (n = 285) revealed significantly higher impulses (P < .001; d = 2.34; + 61%) and fractional time under tension (P < .001; d = 1.29; +143%). Although the generated peak moments were significantly higher for constant velocity (P = .003; d = 0.29; +4%), they emerged at similar knee flexion angles (P = .167; d = 0.28) and revealed on average just low relationships to the DWAangle (Rmean2=22.4%). DWAangle highly correlated with the impulse (Rmean2=60.8%) and δ (DWAangle-angle of peak moment; Rmean2=83.6%).

CONCLUSIONS

Relating DWAangle to angle of peak moment assists to distinguish between significantly different NHE execution, which will potentially elicit different musculotendinous adaptations. These insights are essential for coaches and athletes to understand how to manipulate eccentric hamstring training to change its purpose.

Greater Gastrocnemius Muscle Hypertrophy After Partial Range of Motion Training Performed at Long Muscle Lengths

ABSTRACT

Kassiano, W, Costa, B, Kunevaliki, G, Soares, D, Zacarias, G, Manske, I, Takaki, Y, Ruggiero, MF, Stavinski, N, Francsuel, J, Tricoli, I, Carneiro, MAS, and Cyrino, ES. Greater gastrocnemius muscle hypertrophy after partial range of motion training performed at long muscle lengths. J Strength Cond Res 37(9): 1746-1753, 2023-Whether there is an optimal range of motion (ROM) to induce muscle hypertrophy remains elusive, especially for gastrocnemius. This study aimed to compare the changes in gastrocnemius muscle thickness between calf raise exercise performed with full ROM (FULL ROM ), partial ROM performed in the initial (INITIAL ROM ), and final (FINAL ROM ) portions of the ROM. Forty-two young women performed a calf training program for 8 weeks, 3 days·week -1 , with differences in the calf raise ROM configuration. The calf raise exercise was performed in a pin-loaded, horizontal, leg-press machine, in 3 sets of 15-20 repetition maximum. The subjects were randomly assigned to 1 of the 3 groups: FULL ROM (ankle: -25° to +25°), INITIAL ROM (ankle: -25° to 0°), and FINAL ROM (ankle: 0° to +25°), where 0° was defined as an angle of 90° of the foot with the tibia. The muscle thickness measurements of medial and lateral gastrocnemius were taken by means of B-mode ultrasound. INITIAL ROM elicited greater medial gastrocnemius increases than FULL ROM and FINAL ROM (INITIAL ROM = +15.2% vs. FULL ROM = +6.7% and FINAL ROM = +3.4%; p ≤ 0.009). Furthermore, INITIAL ROM elicited greater lateral gastrocnemius increases than FINAL ROM (INITIAL ROM = +14.9% vs. FINAL ROM = +6.2%; p < 0.024) but did not significantly differ from FULL ROM (FULL ROM = +7.3%; p = 0.060). The current results suggest that calf training performed at longer muscle lengths may optimize gastrocnemius muscle hypertrophy in young women. Therefore, when prescribing hypertrophy-oriented training, the inclusion of the calf raise exercise performed with partial ROM in the initial portion of the excursion should be considered.

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

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

Speed Matters in Nordic Hamstring Exercise: Higher Peak Knee Flexor Force during Fast Stretch-Shortening Variant Compared to Standard Slow Eccentric Execution in Elite Athletes

Hamstring strain injuries are prevalent in many sports. Research has demonstrated that the Nordic hamstring exercise (NHE), a knee-dominant exercise addressing the posterior chain muscles, can aid in reducing the risk of hamstring injuries in athletes. However, most research on hamstring injury prevention has focused on performing the eccentric version of the NHE (NHE_ECC). In contrast, in sports, it is quite frequent for athletes to use an eccentric-concentric version of the NHE. Additionally, eccentric NHE is typically performed using a slow, controlled tempo. The effect of a fast stretch-shortening cycle NHE (NHE_SSC) compared to standard slow NHE_ECC on peak knee flexor force has not been investigated. The aim of the study was therefore to investigate fast NHE_SSC vs. standard slow NHE_ECC. Our hypothesis posited that peak knee flexor force would be greater for fast NHE_SSC compared with standard slow NHE_ECC. The study involved 22 elite athletes (actively competing in both national and international events) consisting of female (n = 10) and male (n = 7) track and field athletes and male football players (n = 5), aged 17-31 years. The participants performed maximum trials of slow NHE_ECC and fast NHE_SSC repetitions in which measurement of bilateral peak knee flexor force was conducted at the ankle with the use of a load cell. During the NHEs, a linear encoder was used to measure both the position where the peak knee flexor force was recorded and the average eccentric velocity. SSC contributed to an enhanced NHE performance, where bilateral absolute peak knee flexor force was 13% higher for fast NHE_SSC vs. standard slow NHE_ECC (822 vs. 726 N, p < 0.01, ES = 0.54). Participants achieved a 32% greater forward distance at the breakpoint stage during NHE_ECC compared to the coupling phase for NHE_SSC (54 vs. 41 cm, p < 0.001, ES = 1.37). Eccentric average velocity was more than three times higher for NHE_SSC compared with NHE_ECC (0.38 vs. 0.12 m/s, p < 0.001, ES = 3.25). The key findings of this study were that SSC contributed to an enhanced NHE performance, where absolute peak knee flexor force was 13% greater for fast NHE_SSC compared to standard slow NHE_ECC. The fast NHE_SSC could therefore be an interesting alternative to the standard slow NHE_ECC execution, as it may offer potential advantages for sprint performance, as well as hamstring injury prevention and rehabilitation.

Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy

BACKGROUND

While the effect of static stretching for individuals with cerebral palsy is questionable, recent results suggest that the combination with activation seems promising to improve muscle-tendon properties and function. Therefore, this study analyzed the effects of 8-week proprioceptive neuromuscular facilitation stretching on the gastrocnemius medialis muscle-tendon properties, muscle strength, and the ankle joint in children with spastic cerebral palsy in comparison to static stretching.

METHODS

Initially, 24 children with spastic cerebral palsy were randomly assigned to a static stretching (10.7 ± 1.8 years) or proprioceptive neuromuscular facilitation stretching group (10.9 ± 2.6 years). Plantar flexors were manually stretched at home for 300 s and ∼ 250-270 s per day four times a week for eight weeks, respectively. Assessments of ankle joint function (e.g., range of motion), muscle-tendon properties, and isometric muscle strength were conducted using 3D motion capture, 2D ultrasound, dynamometry, and electromyography. A mixed analysis of variance was used for the statistical analysis.

FINDINGS

Stretching adherence was high in the proprioceptive neuromuscular facilitation stretching (93.1%) and static stretching group (94.4%). No significant changes (p > 0.05) were observed in ankle joint function, muscle-tendon properties, and isometric muscle strength after both interventions. Moreover, no differences (p > 0.05) were found between the stretching techniques.

INTERPRETATION

The findings support the idea that manual stretching (neither proprioceptive neuromuscular facilitation stretching nor static stretching) performed in isolation for eight weeks may not be appropriate to evoke significant changes in muscle-tendon properties, voluntary muscle strength, or joint function in children with spastic cerebral palsy.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04570358.

Antero-Posterior Mandibular Excursion in Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Device: A Retrospective Cohort Study

Since obstructive sleep apnea (OSA) management with a mandibular advancement device (MAD) is likely to be life-long, potential changes in mandibular movements during therapy should be investigated. The purpose of this study was to use a method that has already been shown to be reliable in order to determine whether the range of antero-posterior mandibular excursion, the procedure upon which MAD titration is based, varies between baseline (T0) and at least 1 year of treatment (T1). The distance between maximal voluntary protrusion and maximal voluntary retrusion determined using the millimetric scale of the George Gauge was retrospectively collected from the medical records of 59 OSA patients treated with the MAD and compared between T0 and T1. A regression analysis was performed to evaluate the influence of treatment time, MAD therapeutic advancement and the patient's initial characteristics in excursion range variation. A statistically significant increase of 0.80 ± 1.52 mm (mean ± standard deviation, p < 0.001) was found for antero-posterior mandibular excursion. The longer the treatment time (p = 0.044) and the smaller the patient's mandibular excursion at T0 (p = 0.002), the greater the increase was. These findings could be explained by a muscle-tendon unit adaptation to the forward mandibular repositioning induced by the MAD. During MAD therapy, patients can develop a wider range of antero-posterior mandibular excursion, especially those with a smaller initial excursion capacity.

Morphological Medial Gastrocnemius Muscle Growth in Ambulant Children with Spastic Cerebral Palsy: A Prospective Longitudinal Study

Only cross-sectional studies have demonstrated muscle deficits in children with spastic cerebral palsy (SCP). The impact of gross motor functional limitations on altered muscle growth remains unclear. This prospective longitudinal study modelled morphological muscle growth in 87 children with SCP (age range 6 months to 11 years, Gross Motor Function Classification System [GMFCS] level I/II/III = 47/22/18). Ultrasound assessments were performed during 2-year follow-up and repeated for a minimal interval of 6 months. Three-dimensional freehand ultrasound was applied to assess medial gastrocnemius muscle volume (MV), mid-belly cross-sectional area (CSA) and muscle belly length (ML). Non-linear mixed models compared trajectories of (normalized) muscle growth between GMFCS-I and GMFCS-II&III. MV and CSA growth trajectories showed a piecewise model with two breakpoints, with the highest growth before 2 years and negative growth rates after 6-9 years. Before 2 years, children with GMFCS-II&III already showed lower growth rates compared to GMFCS-I. From 2 to 9 years, the growth rates did not differ between GMFCS levels. After 9 years, a more pronounced reduction in normalized CSA was observed in GMFCS-II&III. Different trajectories in ML growth were shown between the GMFCS level subgroups. These longitudinal trajectories highlight monitoring of SCP muscle pathology from early ages and related to motor mobility. Treatment planning and goals should stimulate muscle growth.

Which ROMs Lead to Rome? A Systematic Review of the Effects of Range of Motion on Muscle Hypertrophy

ABSTRACT

Kassiano, W, Costa, B, Nunes, JP, Ribeiro, AS, Schoenfeld, BJ, and Cyrino, ES. Which ROMs lead to Rome? a systematic review of the effects of range of motion on muscle hypertrophy. J Strength Cond Res XX(X): 000-000, 2022-Resistance exercise range of motion (ROM) influences muscular adaptations. However, there are no consistent practical guidelines about the optimal ROM for maximizing muscle hypertrophy. The objective of this article was to systematically review the literature for studies that compared the effects of full ROM (fROM) and partial ROM (pROM) on muscle hypertrophy. PubMed/MEDLINE, Scopus, and Web of Science databases were searched to identify articles from the earliest record up to and including April 2022. We calculated the effect size (ES) scores of the variables of interest. Eleven studies were included in the review. Full ROM and pROM performed in the initial part of the ROM elicited greater muscle hypertrophy of the rectus femoris, vastus lateralis, biceps brachii, and brachialis distal sites (between-groups ES: 0.20-0.90) than pROM performed in the final part of the ROM. fROM elicited greater muscle growth on the gluteus maximus and adductors than pROM in the final part of the ROM (between-groups ES: 0.24-0.25). Initial pROM produced more favorable proximal rectus femoris hypertrophy than fROM (between-groups ES: 0.35-0.38). pROM in the middle part of the ROM elicited greater triceps brachii hypertrophy than fROM (between-group ES: 1.21). In conclusion, evidence suggests that when training at a longer muscle length-through either pROM or fROM-some muscles, such as quadriceps femoris, biceps brachii, and triceps brachii, tend to experience optimal growth. Thus, the use pROM in the initial part of the excursion in combination with fROM training should be considered when prescribing hypertrophy-oriented resistance training programs.

A comprehensive normative reference database of muscle morphology in typically developing children aged 3-18 years-a cross-sectional ultrasound study

During childhood, muscle growth is stimulated by a gradual increase in bone length and body mass, as well as by other factors, such as physical activity, nutrition, metabolic, hormonal, and genetic factors. Muscle characteristics, such as muscle volume, anatomical cross-sectional area, and muscle belly length, need to continuously adapt to meet the daily functional demands. Pediatric neurological and neuromuscular disorders, like cerebral palsy and Duchenne muscular dystrophy, are characterized by impaired muscle growth, which requires treatment and close follow-up. Nowadays ultrasonography is a commonly used technique to evaluate muscle morphology in both pediatric pathologies and typically developing children, as it is a quick, easy applicable, and painless method. However, large normative datasets including different muscles and a large age range are lacking, making it challenging to monitor muscle over time and estimate the level of pathology. Moreover, in order to compare individuals with different body sizes as a result of age differences or pathology, muscle morphology is often normalized to body size. Yet, the usefulness and practicality of different normalization techniques are still unknown, and clear recommendations for normalization are lacking. In this cross-sectional cohort study, muscle morphology of four lower limb muscles (medial gastrocnemius, tibialis anterior, the distal compartment of the semitendinosus, rectus femoris) was assessed by 3D-freehand ultrasound in 118 typically developing children (mean age 10.35 ± 4.49 years) between 3 and 18 years of age. The development of muscle morphology was studied over the full age range, as well as separately for the pre-pubertal (3-10 years) and pubertal (11-18 years) cohorts. The assumptions of a simple linear regression were checked. If these assumptions were fulfilled, the cross-sectional growth curves were described by a simple linear regression equation. Additional ANCOVA analyses were performed to evaluate muscle- or gender-specific differences in muscle development. Furthermore, different scaling methods, to normalize muscle morphology parameters, were explored. The most appropriate scaling method was selected based on the smallest slope of the morphology parameter with respect to age, with a non-significant correlation coefficient. Additionally, correlation coefficients were compared by a Steiger's Z-test to identify the most efficient scaling technique. The current results revealed that it is valid to describe muscle volume (with exception of the rectus femoris muscle) and muscle belly length alterations over age by a simple linear regression equation till the age of 11 years. Normalizing muscle morphology data by allometric scaling was found to be most useful for comparing muscle volumes of different pediatric populations. For muscle lengths, normalization can be achieved by either allometric and ratio scaling. This study provides a unique normative database of four lower limb muscles in typically developing children between the age of 3 and 18 years. These data can be used as a reference database for pediatric populations and may also serve as a reference frame to better understand both physiological and pathological muscle development.

Quantifying the effects of achilles tendon lengthening surgery: An intraoperative approach

Achilles tendon lengthening (ATL) is frequently used in the treatment of foot deformities. However, there is currently no objective method to determine the optimal muscle length during surgery. We developed an intraoperative approach to evaluate the passive and active forces of the triceps surae muscle group before and after ATL and aimed to test the following hypotheses: 1) the ankle passive range of motion (ROM) increases, 2) passive muscle forces decrease post-ATL, and 3) forces measured from patients with non-neurological and neurological conditions demonstrate different characteristics. Passive forces at various ankle joint positions were measured in ten patients (11.3 ± 3.0 years old) pre- and post-ATL using a force transducer attached to the Achilles tendon. In six patients, active isometric forces were measured by stimulating the triceps surae supramaximally. Passive forces decreased by 94.3% (p < 0.0001), and ROM increased by 89.4% (p < 0.0001) post-ATL. The pre-ATL passive forces were 70.8% ± 15.1% lower in patients with idiopathic foot deformities than in patients with neurological conditions (p < 0.001). The peak active force of 209.8 ± 114.3 N was achieved at an ankle angle of 38.3° ± 16.0°, where the passive force was 6.3 ± 6.7 N. The inter-individual variability was substantial in both groups. In conclusion, the hypotheses posed were supported. The present findings suggest that muscle passive and active force production as well as the inter-individual variability should be considered when planning further treatment.

Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching of the Plantar Flexors on Ankle Range of Motion and Muscle-Tendon Behavior in Children with Spastic Cerebral Palsy-A Randomized Clinical Trial

Stretching is considered a clinically effective way to prevent muscle contracture development in children with spastic cerebral palsy (CP). Therefore, in this study, we assessed the effects of a single session of proprioceptive neuromuscular facilitation (PNF) or static stretching (SS) on ankle joint range of motion (RoM) and gastrocnemius muscle-tendon behavior in children with CP. During the SS (n = 8), the ankle joint was held in maximum dorsiflexion (30 s). During the PNF stretching (n = 10), an isometric contraction (3-5 s) was performed, followed by stretching (~25 s). Ten stretches were applied in total. We collected data via dynamometry, 3D motion capture, 2D ultrasound, and electromyography, before and after the stretching sessions. A mixed ANOVA was used for the statistical analysis. Both ankle RoM and maximum dorsiflexion increased over time (F(1,16) = 7.261, p < 0.05, η² = 0.312; and F(1,16) = 4.900, p < 0.05, η² = 0.234, respectively), without any difference between groups. An interaction effect (F(1,12) = 4.768, p = 0.05, η² = 0.284) was observed for muscle-tendon unit elongation (PNF: -8.8%; SS: +14.6%). These findings suggest a positive acute effect of stretching on ankle function. However, SS acutely increased muscle-tendon unit elongation, while this decreased after PNF stretching, indicating different effects on the spastic muscles. Whether PNF stretching has the potential to cause positive alterations in individuals with CP should be elucidated in future studies.

The influence of longitudinal muscle fascicle growth on mechanical function

Skeletal muscle has the remarkable ability to remodel and adapt, such as the increase in serial sarcomere number (SSN) or fascicle length (FL) observed after overstretching a muscle. This type of remodelling is termed longitudinal muscle fascicle growth, and its impact on biomechanical function has been of interest since the 1960s due to its clinical applications in muscle strain injury, muscle spasticity, and sarcopenia. Despite simplified hypotheses on how longitudinal muscle fascicle growth might influence mechanical function, existing literature presents conflicting results partly due to a breadth of methodologies. The purpose of this review is to outline what is currently known about the influence of longitudinal muscle fascicle growth on mechanical function and suggest future directions to address current knowledge gaps and methodological limitations. Various interventions indicate longitudinal muscle fascicle growth can increase the optimal muscle length for active force, but whether the whole force-length relationship widens has been less investigated. Future research should also explore the ability for longitudinal fascicle growth to broaden the torque-angle relationship's plateau region, and the relation to increased force during shortening. Without a concurrent increase in intramuscular collagen, longitudinal muscle fascicle growth also reduces passive tension at long muscle lengths; further research is required to understand whether this translates to increased joint range of motion. Lastly, some evidence suggests longitudinal fascicle growth can increase maximum shortening velocity and peak isotonic power, however, there has yet to be direct assessment of these measures in a neurologically intact model of longitudinal muscle fascicle growth.

Glycine receptor subunit-ß -deficiency in a mouse model of spasticity results in attenuated physical performance, growth and muscle strength

Spasticity is the most common neurological disorder associated with increased muscle contraction causing impaired movement and gait. The aim of this study was to characterize the physical performance, skeletal muscle function, and phenotype of mice with a hereditary spastic mutation (B6.Cg-Glrb^spa/J). Motor function, gait, and physical activity of juvenile and adult spastic mice and the morphological, histological, and mechanical characteristics of their soleus and gastrocnemius medialis muscles were compared with those of their wild-type (WT) littermates. Spastic mice showed attenuated growth, impaired motor function, and low physical activity. Gait of spastic mice was characterized by a typical hopping pattern. Spastic mice showed lower muscle forces, which were related to the smaller physiological cross-sectional area of spastic muscles. The muscle-tendon complex length-force relationship of adult gastrocnemius medialis was shifted toward shorter lengths, which was explained by attenuated longitudinal tibia growth. Spastic gastrocnemius medialis was more fatigue resistant than WT gastrocnemius medialis. This was largely explained by a higher mitochondrial content in muscle fibers and relatively higher percentage of slow-type muscle fibers. Muscles of juvenile spastic mice showed similar differences compared with WT juvenile mice, but these were less pronounced than between adult mice. This study shows that in spastic mice, disturbed motor function and gait is likely to be the result of hyperactivity of skeletal muscle and impaired skeletal muscle growth, which progress with age.

A Biomechanical Analysis of Shoulder Muscle Excursions During Abduction, After the Treatment of Massive Irreparable Rotator Cuff Tears Using Superior Capsular Reconstruction (SCR), Bursal Acromial Reconstruction (BAR), and SCR with BAR

Introduction

Current understanding of the biomechanical effects of treatment options for irreparable rotator cuff (RC) tears is lacking. This study examines how shoulder muscle lengths and excursions are affected by superior capsular reconstruction (SCR), bursal acromial reconstruction (BAR), and SCR with BAR, following a complete supraspinatus tear.

Method

Six fresh-frozen cadaveric shoulders were examined. Deltoid and RC muscle lengths were measured at 0, 30, 45, 60, and 90° of shoulder abduction under six conditions: (1) intact, (2) partially torn supraspinatus, (3) completely torn supraspinatus, (4) SCR, (5) SCR with BAR, and (6) BAR. Muscle excursions from 0–90° of abduction were then calculated.

Results

Subscapularis muscle lengths after SCR, BAR, and SCR with BAR were significantly greater (post-hoc Tukey HSD test; p < .01) compared to the other conditions. Supraspinatus, infraspinatus, teres minor, and deltoid lengths were not significantly different (ANOVA test; p > .01) between the conditions. All muscle excursions remained statistically similar between the conditions (ANOVA test; p > .01).

Conclusion

These findings demonstrate that the use of SCR, BAR, or SCR with BAR for a complete supraspinatus tear, may increase subscapularis muscle length while maintaining other shoulder muscle lengths. An increase in subscapularis length can allow for more effective subscapularis muscle strengthening and increased compensatory function in the long term. Additionally, all shoulder muscle excursions are preserved after partial or complete supraspinatus tears and after SCR, BAR, or SCR with BAR. Therefore, these surgical treatments can initially normalize shoulder muscle function during 0–90° of abduction, after an irreparable supraspinatus tear.

Gastrocnemius Muscle Architecture in Elite Basketballers and Cyclists: A Cross-Sectional Cohort Study

Eccentric and concentric actions produce distinct mechanical stimuli and result in different adaptations in skeletal muscle architecture. Cycling predominantly involves concentric activity of the gastrocnemius muscles, while playing basketball requires both concentric and eccentric actions to support running, jumping, and landing. The aim of this study was to examine differences in the architecture of gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) between elite basketballers and cyclists. A trained sonographer obtained three B-mode ultrasound images from GM and GL muscles in 44 athletes (25 basketballers and 19 cyclists; 24 ± 5 years of age). The images were digitized and average fascicle length (FL), pennation angle (θ), and muscle thickness were calculated from three images per muscle. The ratio of FL to tibial length (FL/TL) and muscle thickness to tibial length (MT/TL) was also calculated to account for the potential scaling effect of stature. In males, no significant differences were identified between the athletic groups in all parameters in the GM, but a significant difference existed in muscle thickness in the GL. In basketballers, GL was 2.5 mm thicker (95% CI: 0.7-4.3 mm, p = 0.011) on the left side and 2.6 mm thicker (95% CI: 0.6-5.7 mm, p = 0.012) on the right side; however, these differences were not significant when stature was accounted for (MT/TL). In females, significant differences existed in the GM for all parameters including FL/TL and MT/TL. Female cyclists had longer FL in both limbs (MD: 11.2 and 11.3 mm), narrower θ (MD: 2.1 and 1.8°), and thicker muscles (MD: 2.1 and 2.5 mm). For the GL, female cyclists had significantly longer FL (MD: 5.2 and 5.8 mm) and narrower θ (MD: 1.7 and 2.3°) in both limbs; no differences were observed in absolute muscle thickness or MT/TL ratio. Differences in gastrocnemius muscle architecture were observed between female cyclists and basketballers, but not between males. These findings suggest that participation in sport-specific training might influence gastrocnemius muscle architecture in elite female athletes; however, it remains unclear as to whether gastrocnemius architecture is systematically influenced by the different modes of muscle activation between these respective sports.