Architectural adaptations of muscle to training and injury: a narrative review outlining the contributions by fascicle length, pennation angle and muscle thickness

Muscle Length of the Hamstrings Using Ultrasonography Versus Musculoskeletal Modelling

Muscle morphology is an important contributor to hamstring muscle injury and malfunction. The aim of this study was to examine if hamstring muscle-tendon lengths differ between various measurement methods as well as if passive length changes differ between individual hamstrings. The lengths of biceps femoris long head (BFlh), semimembranosus (SM), and semitendinosus (ST) of 12 healthy males were determined using three methods: Firstly, by identifying the muscle attachments using ultrasound (US) and then measuring the distance on the skin using a flexible ultrasound tape (TAPE-US). Secondly, by scanning each muscle using extended-field-of view US (EFOV-US) and, thirdly, by estimating length using modelling equations (MODEL). Measurements were performed with the participant relaxed at six combinations of hip (0°, 90°) and knee (0°, 45°, and 90°) flexion angles. The MODEL method showed greater BFlh and SM lengths as well as changes in length than US methods. EFOV-US showed greater ST and SM lengths than TAPE-US (p < 0.05). SM length change across all joint positions was greater than BFlh and ST (p < 0.05). Hamstring length predicted using regression equations is greater compared with those measured using US-based methods. The EFOV-US method yielded greater ST and SM length than the TAPE-US method. SM showed the highest change in length at different hip and knee joint positions.

Adaptations to explosive resistance training with partial range of motion are not inferior to full range of motion

We tested whether explosive resistance training with partial range of motion (ROM) would be as effective as full ROM training using a noninferiority trial design. Fifteen subjects with strength training experience took part in an explosive-concentric only-leg press training program, three times per week for 10 weeks. One leg was randomly assigned to exercise with partial ROM (ie, 9º) and the other leg to full ROM. Before and after training, we assessed leg press performance, isokinetic concentric and isometric knee extension torque, and vastus lateralis muscle architecture. Overall, both training modalities increased maximal strength and rate of force development. Training with partial ROM yielded noninferior results compared to full ROM for leg press peak power (+69 ± 47% vs. +61 ± 64%), isokinetic strength (4-6 ± 6%-12% vs. 1-6 ± 6%-10% at 30, 60, and 180˚s^-1 ), and explosive torque after 100 (47 ± 24 vs. 35 ± 22) and 150 ms (57 ± 22% vs. 42 ± 25%). The comparison was inconclusive for other functional parameters (ie, isokinetic peak torque (300˚s^-1 ), joint angle at isokinetic peak torque, explosive torque after 50 ms, and electrically evoked torque) and for muscle fascicle length and thickness, although noninferiority was established for pennation angle. However, partial ROM was not found statistically inferior to full ROM for any measured variable. Under the present conditions, the effects of explosive heavy resistance training were independent of joint ROM. Instead, these data suggest that the distinct timing of muscle work in explosive contractions confers more influence to the starting joint angle than ROM on adaptations to this type of training.

Muscle and tendon properties of the spastic lower leg after stroke defined by ultrasonography: a systematic review

INTRODUCTION

Peripheral muscle and tendon changes after stroke can influence the functional outcome of patients. The aim of this systematic review was to summarize the evidence of ultrasonographic changes in morphological muscle and tendon properties of the spastic hemiparetic lower leg in patients with first ever stroke.

EVIDENCE ACQUISITION

A systematic search was conducted through PubMed, Embase, Scopus, Cinahl, Cochrane Library, and manual searches from inception until May 1, 2020. Observational case control or cohort studies were included. Risk of bias was evaluated by using the Newcastle-Ottawa Quality Assessment Scale. Outcome parameters of interest included muscle thickness, muscle and tendon length, fascicle length, pennation angle and echo-intensity.

EVIDENCE SYNTHESIS

Nine studies investigated outcome parameters beyond one-month after stroke. We are unable to make a comprehensive statement. Nevertheless, there are some arguments for reduced muscle thickness and reduced fascicle length of the hemiplegic, spastic leg.

CONCLUSIONS

Despite the fact that objective assessment by ultrasonography holds promise for diagnosis and follow-up of spastic hemiparesis after stroke, more evidence is needed to determine how changes in morphological muscle and tendon properties are related to muscle weakness, severity of spasticity and compensation strategies such as disuse or overuse in longitudinal studies starting early after stroke.

Effect of Nordic Hamstring Exercise Training on Knee Flexors Eccentric Strength and Fascicle Length: A Systematic Review and Meta-Analysis

CONTEXT

Nordic hamstring exercise (NHE) has been widely employed to prevent hamstring strain injuries. However, it is still not clear which adaptations are responsible for the NHE preventive effects.

OBJECTIVES

The aim of this study was to investigate the effects of NHE on knee flexors eccentric strength and fascicle length.

EVIDENCE ACQUISITION

The search strategy included MEDLINE, PEDro, and Cochrane CENTRAL from inception to April 2020. Randomized clinical trials that have analyzed the effects of NHE training on hamstring eccentric strength and/or fascicle length were included.

EVIDENCE SYNTHESIS

From the 1932 studies identified, 12 were included in the systematic review, and 9 studies presented suitable data for the meta-analysis. All studies demonstrated strength increments in response to NHE training (10%-15% and 16%-26% in tests performed on the isokinetic dynamometer and on the NHE device, respectively), as well as significant enhancement of biceps femoris long head fascicle length (12%-22%). Meta-analysis showed NHE training was effective to increase knee flexors eccentric strength assessed with both isokinetic tests (0.68; 95% confidence interval, 0.29 to 1.06) and NHE tests (1.11; 95% confidence interval, 0.62 to 1.61). NHE training was also effective to increase fascicle length (0.97; 95% confidence interval, 0.46 to 1.48).

CONCLUSIONS

NHE training has the potential of increasing both knee flexors eccentric strength and biceps femoris long head fascicle length.

Differences in Lower Limb Strength and Structure After 12 Weeks of Resistance, Endurance, and Concurrent Training

PURPOSE

To investigate strength and structural adaptations after 12 weeks of resistance, endurance cycling, and concurrent training.

METHODS

Thirty-two healthy males undertook 12 weeks of resistance-only (RT; n = 10), endurance-only (END; n = 10), or concurrent resistance and endurance training (CONC; n = 12). Biceps femoris long head (BFlh) architecture, strength (3-lift 1-repetition maximum), and body composition were assessed.

RESULTS

Fascicle length of the BFlh reduced 15% (6%) (P < .001) and 9% (6%) (P < .001) in the END and CONC groups postintervention, with no change in the RT group (-4% [11%], P = .476). All groups increased BFlh pennation angle (CONC: 18% [9%], RT: 14% [8%], and END: 18% [10%]). Thickness of the BFlh increased postintervention by 7% (6%) (P = .002) and 7% (7%) (P = .003) in the CONC and RT groups, respectively, but not in the END group (0% [3%], P = .994). Both the CONC and RT groups significantly increased by 27% (11%) (P < .001) and 33% (12%) (P < .001) in 3-lift totals following the intervention, with no changes in the END cohort (6% [6%], P = .166). No significant differences were found for total body (CONC: 4% [2%], RT: 4% [2%], and END: 3% [2%]) and leg (CONC: 5% [3%], RT: 6% [3%], and END: 5% [3%]) fat-free mass.

CONCLUSIONS

Twelve weeks of RT, END, or CONC significantly modified BFlh architecture. This study suggests that conventional resistance training may dampen BFlh fascicle shortening from cycling training while increasing strength simultaneously in concurrent training. Furthermore, the inclusion of a cycle endurance training stimulus may result in alterations to hamstring architecture that increase the risk of future injury. Therefore, the incorporation of endurance cycling training within concurrent training paradigms should be reevaluated when trying to modulate injury risk.

THICKNESS AND CROSS-SECTIONAL AREA OF THE ACHILLES TENDON IN MARATHON RUNNERS: A CROSS-SECTIONAL STUDY

ABSTRACT Introduction: This study aimed to measure thickness and cross-sectional area of the Achilles tendon (AT), and the range of motion of the ankle joint in dorsiflexion of amateur marathon runners compared to non-active people. Objectives: To analyze the relationship between cross-sectional area and thickness of the Achilles tendon in marathon runners and age, anthropometric characteristics (height and body mass), training habits, running experience, marathon performance, and range of motion in the ankle joint. Methods: Achilles tendon thickness and cross-sectional area were measured using ultrasound images of the left leg in 97 male amateur marathon runners (age 42.0 ± 9.6 years; height 175 ± 6 cm; and body mass 73.7 ± 8.6 kg), and 47 controls (39.9 ± 11.6 years; 176 ± 7 cm; 79.6 ± 16.1 kg). Results: Achilles tendon thickness (4.81 ± 0.77 vs. 4.60 ± 0.66 mm; p = 0.01) and cross-sectional area (60.41 ± 14.36 vs. 53.62 ± 9.90 mm2; p < 0.01) were greater in the marathon runners than in non-active people. Achilles tendon thickness has been correlated, in a weak but significant manner, with years of running experience. Moreover, marathon runners showed increased ankle range of motion (81.81 ± 6.93 vs. 77.86 ± 7.27 grades; p<0.01). Conclusion: Male amateur marathon runners have hypertrophy of the Achilles tendon compared to non-active people, and this enlargement is mediated by running experience. In addition, range of motion in ankle dorsiflexion is favored by marathon training. Level of evidence III; Retrospective study.

The influence of training-induced sarcomerogenesis on the history dependence of force

The increase or decrease in isometric force following active muscle lengthening or shortening, relative to a reference isometric contraction at the same muscle length and level of activation, are referred to as residual force enhancement (rFE) and residual force depression (rFD), respectively. The purpose of these experiments was to investigate the trainability of rFE and rFD on the basis of serial sarcomere number (SSN) alterations to history-dependent force properties. Maximal rFE/rFD measures from the soleus and extensor digitorum longus (EDL) of rats were compared after 4 weeks of uphill or downhill running with a no-running control. SSN adapted to the training: soleus SSN was greater with downhill compared with uphill running, while EDL demonstrated a trend towards more SSN for downhill compared with no running. In contrast, rFE and rFD did not differ across training groups for either muscle. As such, it appears that training-induced SSN adaptations do not modify rFE or rFD at the whole-muscle level.

Pre-stretching of the Hamstrings Before Squatting Acutely Increases Biceps Femoris Thickness Without Impairing Exercise Performance

Background: Bilateral squat exercise is widely used in resistance training (RT) programs to increase lower limb strength and muscle mass, but this exercise does not result in significant hypertrophy of the hamstrings. It has been speculated that stretching between sets with a certain degree of tension results in muscle hypertrophy, while acute stretching could decrease performance during maximal contractions.

Objective: This study investigated the acute effects of hamstring stretching before bilateral squatting on muscle thickness (MT), electromyography (EMG), and total training volume (TTV) on exercise performance.

Methods: Fourteen resistance-trained young men, with ∼7.5 years of RT experience, performed the 10 repetition maximum (RM) for the barbell squat in two sessions (test–retest) separated by period after 48 h. Participants engaged in two resistance exercise conditions separated by a 1 week recovery interval: one session employed hamstrings stretching and the other did not include hamstrings stretching. Before and after each resistance exercise session, the thickness of the quadriceps muscles and biceps femoris long head were obtained by ultrasound imaging. Moreover, the EMG amplitudes for the quadriceps muscles, biceps femoris, and iliocostalis muscles were recorded during back squat performance. The TTV was also evaluated for each exercise session.

Results: A significant increase in MT was observed after every set in both conditions for the evaluated quadriceps muscles (all p < 0.05), while for the biceps femoris, this effect was found only in the stretching condition (p < 0.05). EMG activity increased in the rectus femoris, vastus lateralis, and vastus medialis for the stretching condition. For the non-stretching condition, activity only increased in the vastus lateralis and medialis. There was no difference in EMG activity for the biceps femoris and iliocostalis in both conditions.

Conclusion: Stretching the hamstrings immediately before each set of the back squat can be used to acutely increase biceps femoris thickness without impairing squat performance.

Current advances and research in ultrasound imaging to the assessment and management of musculoskeletal disorders

Currently evidence-based practice has given scientific weight to the physical therapist profession; it is essential that all medical professional and physical therapists know the usefulness of new tools that optimize the effectiveness of their interventions and allow the growing of the scientific knowledge base. The use of ultrasound imaging (USI) by physiotherapists has evolved in recent years, consolidating as an increasingly standardized technique, low cost compared to other imaging techniques, quickly of execution, feasible and reliable tool. USI offers a wide range of opportunities in clinical practice as well as in different research areas. Therefore, ultrasound has been currently used as a diagnostic tool by physicians and in recent years there has been an expansion of the use of ultrasound equipment by non-physicians professionals such as physical therapist or physical trainers, who incorporates USI as a means of assessing musculoskeletal system architecture and composition, musculoskeletal changes in dysfunction, pain or injury conditions, as an interventional technique assisting echo-guided procedures or using the visual real-time information as a biofeedback in control motor approaches, as guiding tool in clinical decisions as well as to improve the understanding of tissue adaptations to exercise or movement. The purpose of this article is to review and provide an overview about the currently research of the USI applications and their benefits for the diagnosis and management in individuals with musculoskeletal conditions.

Identifying the Structural Adaptations that Drive the Mechanical Load-Induced Growth of Skeletal Muscle: A Scoping Review

The maintenance of skeletal muscle mass plays a critical role in health and quality of life. One of the most potent regulators of skeletal muscle mass is mechanical loading, and numerous studies have led to a reasonably clear understanding of the macroscopic and microscopic changes that occur when the mechanical environment is altered. For instance, an increase in mechanical loading induces a growth response that is mediated, at least in part, by an increase in the cross-sectional area of the myofibers (i.e., myofiber hypertrophy). However, very little is known about the ultrastructural adaptations that drive this response. Even the most basic questions, such as whether mechanical load-induced myofiber hypertrophy is mediated by an increase in the size of the pre-existing myofibrils and/or an increase in the number myofibrils, have not been resolved. In this review, we thoroughly summarize what is currently known about the macroscopic, microscopic and ultrastructural changes that drive mechanical load-induced growth and highlight the critical gaps in knowledge that need to be filled.

Comparing the Effectiveness of Blood Flow Restriction and Traditional Heavy Load Resistance Training in the Post-Surgery Rehabilitation of Anterior Cruciate Ligament Reconstruction Patients: A UK National Health Service Randomised Controlled Trial

BACKGROUND

We implemented a blood flow restriction resistance training (BFR-RT) intervention during an 8-week rehabilitation programme in anterior cruciate ligament reconstruction (ACLR) patients within a National Health Service setting.

OBJECTIVE

To compare the effectiveness of BFR-RT and standard-care traditional heavy-load resistance training (HL-RT) at improving skeletal muscle hypertrophy and strength, physical function, pain and effusion in ACLR patients following surgery.

METHODS

28 patients scheduled for unilateral ACLR surgery with hamstring autograft were recruited for this parallel-group, two-arm, single-assessor blinded, randomised clinical trial following appropriate power analysis. Following surgery, a criteria-driven approach to rehabilitation was utilised and participants were block randomised to either HL-RT at 70% repetition maximum (1RM) (n = 14) or BFR-RT (n = 14) at 30% 1RM. Participants completed 8 weeks of biweekly unilateral leg press training on both limbs, totalling 16 sessions, alongside standard hospital rehabilitation. Resistance exercise protocols were designed consistent with standard recommended protocols for each type of exercise. Scaled maximal isotonic strength (10RM), muscle morphology of the vastus lateralis of the injured limb, self-reported function, Y-balance test performance and knee joint pain, effusion and range of motion (ROM) were assessed at pre-surgery, post-surgery, mid-training and post-training. Knee joint laxity and scaled maximal isokinetic knee extension and flexion strength at 60°/s, 150°/s and 300°/s were measured at pre-surgery and post-training.

RESULTS

Four participants were lost, with 24 participants completing the study (12 per group). There were no adverse events or differences between groups for any baseline anthropometric variable or pre- to post-surgery change in any outcome measure. Scaled 10RM strength significantly increased in the injured limb (104 ± 30% and 106 ± 43%) and non-injured limb (33 ± 13% and 39 ± 17%) with BFR-RT and HL-RT, respectively, with no group differences. Significant increases in knee extension and flexion peak torque were observed at all speeds in the non-injured limb with no group differences. Significantly greater attenuation of knee extensor peak torque loss at 150°/s and 300°/s and knee flexor torque loss at all speeds was observed with BFR-RT. No group differences in knee extensor peak torque loss were found at 60°/s. Significant and comparable increases in muscle thickness (5.8 ± 0.2% and 6.7 ± 0.3%) and pennation angle (4.1 ± 0.3% and 3.4 ± 0.1%) were observed with BFR-RT and HL-RT, respectively, with no group differences. No significant changes in fascicle length were observed. Significantly greater and clinically important increases in several measures of self-reported function (50-218 ± 48% vs. 35-152 ± 56%), Y-balance performance (18-59 ± 22% vs. 18-33 ± 19%), ROM (78 ± 22% vs. 48 ± 13%) and reductions in knee joint pain (67 ± 15% vs. 39 ± 12%) and effusion (6 ± 2% vs. 2 ± 2%) were observed with BFR-RT compared to HL-RT, respectively.

CONCLUSION

BFR-RT can improve skeletal muscle hypertrophy and strength to a similar extent to HL-RT with a greater reduction in knee joint pain and effusion, leading to greater overall improvements in physical function. Therefore, BFR-RT may be more appropriate for early rehabilitation in ACLR patient populations within the National Health Service.

Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport

OBJECTIVE

To systematically review risk factors for hamstring strain injury (HSI).

DESIGN

Systematic review update.

DATA SOURCES

Database searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI.

METHOD

Search result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI.

RESULTS

The 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury.

SUMMARY/CONCLUSION

Older age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial.

How New Technology Is Improving Physical Therapy

PURPOSE OF REVIEW

As rehabilitation patient volume across the age spectrum increases and reimbursement rates decrease, clinicians are forced to produce favorable outcomes with limited resources and time. The purpose of this review is to highlight new technologies being utilized to improve standardization and outcomes for patients rehabilitating orthopedic injuries ranging from sports medicine to trauma to joint arthroplasty.

RECENT FINDINGS

A proliferation of new technologies in rehabilitation has recently occurred with the hope of improved outcomes, better patient compliance and safety, and return to athletic performance. These include technologies applied directly to the patient such as exoskeletons and instrumented insoles to extrinsic applications such as biofeedback and personalized reference charts. Well-structured randomized trials are ongoing centered around the efficacy and safety of these new technologies to help guide clinical necessity and appropriate application. We present a range of new technologies that may assist a diverse population of orthopedic conditions. Many of these interventions are already supported by level 1 evidence and appear safe and feasible for most clinical settings.

Simple Muscle Architecture Analysis (SMA): An ImageJ macro tool to automate measurements in B-mode ultrasound scans

In vivo measurements of muscle architecture (i.e. the spatial arrangement of muscle fascicles) are routinely included in research and clinical settings to monitor muscle structure, function and plasticity. However, in most cases such measurements are performed manually, and more reliable and time-efficient automated methods are either lacking completely, or are inaccessible to those without expertise in image analysis. In this work, we propose an ImageJ script to automate the entire analysis process of muscle architecture in ultrasound images: Simple Muscle Architecture Analysis (SMA). Images are filtered in the spatial and frequency domains with built-in commands and external plugins to highlight aponeuroses and fascicles. Fascicle dominant orientation is then computed in regions of interest using the OrientationJ plugin. Bland-Altman plots of analyses performed manually or with SMA indicate that the automated analysis does not induce any systematic bias and that both methods agree equally through the range of measurements. Our test results illustrate the suitability of SMA to analyse images from superficial muscles acquired with a broad range of ultrasound settings.

Bilateral differences in hamstring coordination in previously injured elite athletes

Hamstring strain injuries (HSIs) involve tissue disruption and pain, which can trigger long-term adaptations of muscle coordination. However, little is known about the effect of previous HSIs on muscle coordination and in particular, after the completion of rehabilitation and in the absence of symptoms. This study aimed to determine if elite athletes with a prior unilateral HSI have bilateral differences in coordination between the hamstring muscle heads after returning to sport. Seventeen athletes with a unilateral history of biceps femoris (BF) injury participated in the experiment. Surface electromyography was recorded from three hamstring muscles [BF, semimembranosus (SM), and semitendinosus] during submaximal isometric torque-matched tasks at 20% and 50% of maximal voluntary contraction. The product of normalized electromyographic amplitude with functional physiological cross-sectional area (PCSA) and moment arm was considered as an index of individual muscle torque. The contribution of the injured muscle to total knee flexion torque was lower in the injured than the uninjured limb (-5.6 ± 10.2%, P = 0.038). This reduced contribution of BF was compensated by a higher contribution of the SM muscle in the injured limb (+5.6 ± 7.5%, P = 0.007). These changes resulted from a lower contribution of PCSA from the injured muscle (BF) and a larger contribution of activation from an uninjured synergist muscle (SM). In conclusion, bilateral differences in coordination were observed in previously injured athletes despite the completion of rehabilitation. Whether these bilateral differences in hamstring coordination could constitute an intrinsic risk factor that contributes to the high rate of hamstring injury recurrence remains to be investigated.NEW & NOTEWORTHY We used an experimental approach, combining the assessment of muscle activation, physiological cross-sectional area, and moment arm to estimate force-sharing strategies among hamstring muscles during isometric knee flexions. We tested athletes with a history of hamstring injury. We observed a lower contribution of the injured biceps femoris to the total knee flexor torque in the injured limb than in the contralateral limb. This decreased contribution was mainly due to selective atrophy of the injured biceps femoris muscle and was compensated by an increased activation of the semimembranosus muscle.

Comparison of lower limb muscle architecture and geometry in distance runners with rearfoot and forefoot strike pattern

We examined the association between footfall pattern and characteristics of lower limb muscle function and compared lower limb muscle function between forefoot and rearfoot runners. Fifteen rearfoot and 16 forefoot runners were evaluated using ultrasonography of the gastrocnemii and tibialis anterior while strike index and heel strike angle quantified footfall pattern. Higher strike index was associated with lower medial gastrocnemius echo intensity (p = 0.05), lower lateral gastrocnemius echo intensity (p = 0.04), smaller tibialis anterior pennation angle (p = 0.05), and longer lateral gastrocnemius fascicle length (p = 0.04). Larger heel strike angle was associated with smaller medial gastrocnemius cross-sectional area (p = 0.04), shorter lateral gastrocnemius fascicle length (p < 0.01), and lower plantar flexion moment (p < 0.01). Larger plantar flexion moment was associated with lesser medial gastrocnemius echo intensity (p = 0.04), lesser lateral gastrocnemius echo intensity (p = 0.03), and greater lateral gastrocnemius fascicle length (p = 0.02). A smaller plantar flexion moment, larger heel strike angle, lower tibialis anterior echo intensity, larger tibialis anterior pennation angle, and smaller lateral gastrocnemius pennation angle were observed in rearfoot compared to forefoot runners (p < 0.05). Lower limb muscle architecture is associated with footfall pattern and ankle mechanics during running. Abbreviation: EMG: electromyographic; MG: medial gastrocnemius; LG: lateral gastrocnemius; TA: tibialis anterior; EI: echo intensity; CSA: cross-sectional area; PA: pennation angle; FL: fascicle length; FT: fat thickness.

Biomechanical loading during running: can a two mass-spring-damper model be used to evaluate ground reaction forces for high-intensity tasks?

Running impact forces expose the body to biomechanical loads leading to beneficial adaptations, but also risk of injury. High-intensity running tasks, especially, are deemed highly demanding for the musculoskeletal system, but loads experienced during these actions are not well understood. To eventually predict GRF and understand the biomechanical loads experienced during such activities in greater detail, this study aimed to (1) examine the feasibility of using a simple two mass-spring-damper model, based on eight model parameters, to reproduce ground reaction forces (GRFs) for high-intensity running tasks and (2) verify whether the required model parameters were physically meaningful. This model was used to reproduce GRFs for rapid accelerations and decelerations, constant speed running and maximal sprints. GRF profiles and impulses could be reproduced with low to very low errors across tasks, but subtler loading characteristics (impact peaks, loading rate) were modelled less accurately. Moreover, required model parameters varied strongly between trials and had minimal physical meaning. These results show that although a two mass-spring-damper model can be used to reproduce overall GRFs for high-intensity running tasks, the application of this simple model for predicting GRFs in the field and/or understanding the biomechanical demands of training in greater detail is likely limited.

Effect of Training-Induced Changes in Achilles Tendon Stiffness on Muscle-Tendon Behavior During Landing

During rapid deceleration of the body, tendons buffer part of the elongation of the muscle–tendon unit (MTU), enabling safe energy dissipation via eccentric muscle contraction. Yet, the influence of changes in tendon stiffness within the physiological range upon these lengthening contractions is unknown. This study aimed to examine the effect of training-induced stiffening of the Achilles tendon on triceps surae muscle–tendon behavior during a landing task. Twenty-one male subjects were assigned to either a 10-week resistance-training program consisting of single-leg isometric plantarflexion (n = 11) or to a non-training control group (n = 10). Before and after the training period, plantarflexion force, peak Achilles tendon strain and stiffness were measured during isometric contractions, using a combination of dynamometry, ultrasound and kinematics data. Additionally, testing included a step-landing task, during which joint mechanics and lengths of gastrocnemius and soleus fascicles, Achilles tendon, and MTU were determined using synchronized ultrasound, kinematics and kinetics data collection. After training, plantarflexion strength and Achilles tendon stiffness increased (15 and 18%, respectively), and tendon strain during landing remained similar. Likewise, lengthening and negative work produced by the gastrocnemius MTU did not change detectably. However, in the training group, gastrocnemius fascicle length was offset (8%) to a longer length at touch down and, surprisingly, fascicle lengthening and velocity were reduced by 27 and 21%, respectively. These changes were not observed for soleus fascicles when accounting for variation in task execution between tests. These results indicate that a training-induced increase in tendon stiffness does not noticeably affect the buffering action of the tendon when the MTU is rapidly stretched. Reductions in gastrocnemius fascicle lengthening and lengthening velocity during landing occurred independently from tendon strain. Future studies are required to provide insight into the mechanisms underpinning these observations and their influence on energy dissipation.

Muscle morphology of the vastus lateralis is strongly related to ergometer performance, sprint capacity and endurance capacity in Olympic rowers

Rowers need to combine high sprint and endurance capacities. Muscle morphology largely explains muscle power generating capacity, however, little is known on how muscle morphology relates to rowing performance measures. The aim was to determine how muscle morphology of the vastus lateralis relates to rowing ergometer performance, sprint and endurance capacity of Olympic rowers. Eighteen rowers (12♂, 6♀, who competed at 2016 Olympics) performed an incremental rowing test to obtain maximal oxygen consumption, reflecting endurance capacity. Sprint capacity was assessed by Wingate cycling peak power. M. vastus lateralis morphology (volume, physiological cross-sectional area, fascicle length and pennation angle) was derived from 3-dimensional ultrasound imaging. Thirteen rowers (7♂, 6♀) completed a 2000-m rowing ergometer time trial. Muscle volume largely explained variance in 2000-m rowing performance (R² = 0.85), maximal oxygen consumption (R² = 0.65), and Wingate peak power (R² = 0.82). When normalized for differences in body size, maximal oxygen consumption and Wingate peak power were negatively related in males (r = -0.94). Fascicle length, not physiological cross-sectional area, attributed to normalized peak power. In conclusion, vastus lateralis volume largely explains variance in rowing ergometer performance, sprint and endurance capacity. For a high normalized sprint capacity, athletes may benefit from long fascicles rather than a large physiological cross-sectional area.

3D Ultrasound Imaging: Fast and Cost-effective Morphometry of Musculoskeletal Tissue

The developmental goal of 3D ultrasound imaging (3DUS) is to engineer a modality to perform 3D morphological ultrasound analysis of human muscles. 3DUS images are constructed from calibrated freehand 2D B-mode ultrasound images, which are positioned into a voxel array. Ultrasound (US) imaging allows quantification of muscle size, fascicle length, and angle of pennation. These morphological variables are important determinants of muscle force and length range of force exertion. The presented protocol describes an approach to determine volume and fascicle length of m. vastus lateralis and m. gastrocnemius medialis. 3DUS facilitates standardization using 3D anatomical references. This approach provides a fast and cost-effective approach for quantifying 3D morphology in skeletal muscles. In healthcare and sports, information on the morphometry of muscles is very valuable in diagnostics and/or follow-up evaluations after treatment or training.

Skeletal Muscle Remodeling in Response to Eccentric vs. Concentric Loading: Morphological, Molecular, and Metabolic Adaptations

Skeletal muscle contracts either by shortening or lengthening (concentrically or eccentrically, respectively); however, the two contractions substantially differ from one another in terms of mechanisms of force generation, maximum force production and energy cost. It is generally known that eccentric actions generate greater force than isometric and concentric contractions and at a lower metabolic cost. Hence, by virtue of the greater mechanical loading involved in active lengthening, eccentric resistance training (ECC RT) is assumed to produce greater hypertrophy than concentric resistance training (CON RT). Nonetheless, prevalence of either ECC RT or CON RT in inducing gains in muscle mass is still an open issue, with some studies reporting greater hypertrophy with eccentric, some with concentric and some with similar hypertrophy within both training modes. Recent observations suggest that such hypertrophic responses to lengthening vs. shortening contractions are achieved by different adaptations in muscle architecture. Whilst the changes in muscle protein synthesis in response to acute and chronic concentric and eccentric exercise bouts seem very similar, the molecular mechanisms regulating the myogenic adaptations to the two distinct loading stimuli are still incompletely understood. Thus, the present review aims to, (a) critically discuss the literature on the contribution of eccentric vs. concentric loading to muscular hypertrophy and structural remodeling, and, (b) clarify the molecular mechanisms that may regulate such adaptations. We conclude that, when matched for either maximum load or work, similar increase in muscle size is found between ECC and CON RT. However, such hypertrophic changes appear to be achieved through distinct structural adaptations, which may be regulated by different myogenic and molecular responses observed between lengthening and shortening contractions.

Velocity-specific and time-dependent adaptations following a standardized Nordic Hamstring Exercise training

The Nordic Hamstring Exercise (NHE) is effective for selective hamstring strengthening to improve muscle balance between knee flexors and extensors. The purpose of this study (within subject design of repeated measures) was to determine the effects of a standardized 4-week NHE training on thigh strength and muscle balance with concomitant kinetic and kinematic monitoring. Sixteen male sprinters (22 years, 181 cm, 76 kg) performed a standardized 4-week NHE training consisting of three sessions per week (each 3×3 repetitions). Six rope-assisted and six unassisted sessions were performed targeting at a constant knee extension angular velocity of ~15°/s across a ~90-100° knee joint range of motion. Kinetic (peak and mean moment, impulse) and kinematic parameters (eg, ROM to downward acceleration, ROM_DWA ) were recorded during selected sessions. Unilateral isokinetic tests of concentric and eccentric knee flexors and extensors quantified muscle group-, contraction mode-, and velocity-specific training adaptations. Peak moments and contractional work demonstrated strong interactions of time with muscle group, contraction modes, and angular velocities (η²>.150). NHE training increased eccentric hamstring strength by 6%-14% as well as thigh muscle balance with biggest adaptations at 150°/s 2 weeks after NHE training. Throughout the training period significant increases (P<.001) of peak (η²=.828) and mean moments (η²=.611) became apparent, whereas the impulse and the ROM_DWA of unassisted NHE repetitions remained unchanged (P>.05). A 4-week NHE training significantly strengthened the hamstrings and improved muscle balance between knee flexors and extensors. Despite the slow training velocity, biggest adaptations emerged at the highest velocity 2 weeks after training ended.

Running exposure is associated with the risk of hamstring strain injury in elite Australian footballers

Background

To investigate the association between running exposure and the risk of hamstring strain injury (HSI) in elite Australian footballers.

Methods

Elite Australian footballers (n=220) from 5 different teams participated. Global positioning system (GPS) data were provided for every athlete for each training session and match for the entire 2015 season. The occurrences of HSIs throughout the study period were reported. Receiver operator characteristic curve analyses were performed and the relative risk (RR) of subsequent HSI was calculated for absolute and relative running exposure variables related to distance covered above 10 and 24 km/hour in the preceding week/s.

Results

30 prospective HSIs occurred. For the absolute running exposure variables, weekly distance covered above 24 km/hour (>653 m, RR=3.4, 95% CI 1.6 to 7.2, sensitivity=0.52, specificity=0.76, area under the curve (AUC)=0.63) had the largest influence on the risk of HSI in the following week. For the relative running exposure variables, distance covered above 24 km/hour as a percentage of distance covered above 10 km/hour (>2.5%, RR=6.3, 95% CI 1.5 to 26.7, sensitivity=0.93, specificity=0.34, AUC=0.63) had the largest influence on the risk of HSI in the following week. Despite significant increases in the RR of HSI, the predictive capacity of these variables was limited.

Conclusions

An association exists between absolute and relative running exposure variables and elite Australian footballers' risk of subsequent HSI, with the association strongest when examining data within 7–14 days. Despite this, the use of running exposure variables displayed limited clinical utility to predict HSI at the individual level.

Hamstring Architectural and Functional Adaptations Following Long vs. Short Muscle Length Eccentric Training

Most common preventive eccentric-based exercises, such as Nordic hamstring do not include any hip flexion. So, the elongation stress reached is lower than during the late swing phase of sprinting. The aim of this study was to assess the evolution of hamstring architectural (fascicle length and pennation angle) and functional (concentric and eccentric optimum angles and concentric and eccentric peak torques) parameters following a 3-week eccentric resistance program performed at long (LML) vs. short muscle length (SML). Both groups performed eight sessions of 3–5 × 8 slow maximal eccentric knee extensions on an isokinetic dynamometer: the SML group at 0° and the LML group at 80° of hip flexion. Architectural parameters were measured using ultrasound imaging and functional parameters using the isokinetic dynamometer. The fascicle length increased by 4.9% (p < 0.01, medium effect size) in the SML and by 9.3% (p < 0.001, large effect size) in the LML group. The pennation angle did not change (p = 0.83) in the SML and tended to decrease by 0.7° (p = 0.09, small effect size) in the LML group. The concentric optimum angle tended to decrease by 8.8° (p = 0.09, medium effect size) in the SML and by 17.3° (p < 0.01, large effect size) in the LML group. The eccentric optimum angle did not change (p = 0.19, small effect size) in the SML and tended to decrease by 10.7° (p = 0.06, medium effect size) in the LML group. The concentric peak torque did not change in the SML (p = 0.37) and the LML (p = 0.23) groups, whereas eccentric peak torque increased by 12.9% (p < 0.01, small effect size) and 17.9% (p < 0.001, small effect size) in the SML and the LML group, respectively. No group-by-time interaction was found for any parameters. A correlation was found between the training-induced change in fascicle length and the change in concentric optimum angle (r = −0.57, p < 0.01). These results suggest that performing eccentric exercises lead to several architectural and functional adaptations. However, further investigations are required to confirm the hypothesis that performing eccentric exercises at LML may lead to greater adaptations than a similar training performed at SML.

Evaluation of supraspinatus strengthening exercises based on fiber bundle architectural changes

Supraspinatus strengthening is an integral part of rehabilitation programs. However, there is disparity regarding the best exercise. Thus, we investigated the effects of supraspinatus strengthening exercises on muscle fiber bundle architecture using real-time ultrasound. Participants were randomized into full-can (FC; n = 12), empty-can (EC; n = 11,) and prone horizontal abduction (PHA; n = 11) groups and performed three sessions/week for 8 weeks. Each session involved four sets of exercise for weeks 1-4 and six sets for weeks 5-8 with eight repetitions/set. Images of supraspinatus were captured in 0° (relaxed) and 60° (contracted) glenohumeral abduction. Fiber bundle length (FBL), pennation angle, and muscle thickness were measured at beginning, mid, and end of training. Maximum isometric abduction strength was measured in full-can, empty-can, and prone horizontal abduction positions using a hand-held dynamometer. FBL decreased after 4 weeks in FC [relaxed: Δ = -0.54 cm, P = 0.001, d = 0.92; contracted: Δ = -0.27 cm, P = 0.008, d = 0.27] and EC [relaxed: Δ = -0.59 cm, P = 0.008, d = 0.86; contracted: Δ = -0.36 cm, P = 0.013, d = 0.59], but not in PHA [relaxed: Δ = -0.11, P = 0.121, d = 0.31; contracted: Δ = -0.06 cm, P = 0.486, d = 0.13]. Strength increased significantly from week 4-8 only in PHA (Δ = +0.96 kg, P = 0.004, d = 0.47) when tested in prone horizontal abduction position. Maintenance of FBL with increased strength indicates prone horizontal abduction may be a better exercise to strengthen supraspinatus.