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Young SR, Gardiner B, Mehdizadeh A, Rubenson J, Umberger B, Smith DW. Adaptive Remodeling of Achilles Tendon: A Multi-scale Computational Model. PLoS Comput Biol 2016; 12:e1005106. [PMID: 27684554 PMCID: PMC5042511 DOI: 10.1371/journal.pcbi.1005106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/15/2016] [Indexed: 01/30/2023] Open
Abstract
While it is known that musculotendon units adapt to their load environments, there is only a limited understanding of tendon adaptation in vivo. Here we develop a computational model of tendon remodeling based on the premise that mechanical damage and tenocyte-mediated tendon damage and repair processes modify the distribution of its collagen fiber lengths. We explain how these processes enable the tendon to geometrically adapt to its load conditions. Based on known biological processes, mechanical and strain-dependent proteolytic fiber damage are incorporated into our tendon model. Using a stochastic model of fiber repair, it is assumed that mechanically damaged fibers are repaired longer, whereas proteolytically damaged fibers are repaired shorter, relative to their pre-damage length. To study adaptation of tendon properties to applied load, our model musculotendon unit is a simplified three-component Hill-type model of the human Achilles-soleus unit. Our model results demonstrate that the geometric equilibrium state of the Achilles tendon can coincide with minimization of the total metabolic cost of muscle activation. The proposed tendon model independently predicts rates of collagen fiber turnover that are in general agreement with in vivo experimental measurements. While the computational model here only represents a first step in a new approach to understanding the complex process of tendon remodeling in vivo, given these findings, it appears likely that the proposed framework may itself provide a useful theoretical foundation for developing valuable qualitative and quantitative insights into tendon physiology and pathology.
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Affiliation(s)
- Stuart R. Young
- Faculty of Engineering, Computing and Mathematics, University of Western Australia, Crawley, Western Australia, Australia
| | - Bruce Gardiner
- School of Engineering and Information Technology, Murdoch University, Murdoch, Western Australia, Australia
| | - Arash Mehdizadeh
- Faculty of Engineering, Computing and Mathematics, University of Western Australia, Crawley, Western Australia, Australia
| | - Jonas Rubenson
- Biomechanics Laboratory, Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, United States of America
- School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Brian Umberger
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - David W. Smith
- Faculty of Engineering, Computing and Mathematics, University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
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102
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Earp JE, Newton RU, Cormie P, Blazevich AJ. Faster Movement Speed Results in Greater Tendon Strain during the Loaded Squat Exercise. Front Physiol 2016; 7:366. [PMID: 27630574 PMCID: PMC5005367 DOI: 10.3389/fphys.2016.00366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Tendon dynamics influence movement performance and provide the stimulus for long-term tendon adaptation. As tendon strain increases with load magnitude and decreases with loading rate, changes in movement speed during exercise should influence tendon strain. METHODS Ten resistance-trained men [squat one repetition maximum (1RM) to body mass ratio: 1.65 ± 0.12] performed parallel-depth back squat lifts with 60% of 1RM load at three different speeds: slow fixed-tempo (TS: 2-s eccentric, 1-s pause, 2-s concentric), volitional-speed without a pause (VS) and maximum-speed jump (JS). In each condition joint kinetics, quadriceps tendon length (LT), patellar tendon force (FT), and rate of force development (RFDT) were estimated using integrated ultrasonography, motion-capture, and force platform recordings. RESULTS Peak LT, FT, and RFDT were greater in JS than TS (p < 0.05), however no differences were observed between VS and TS. Thus, moving at faster speeds resulted in both greater tendon stress and strain despite an increased RFDT, as would be predicted of an elastic, but not a viscous, structure. Temporal comparisons showed that LT was greater in TS than JS during the early eccentric phase (10-14% movement duration) where peak RFDT occurred, demonstrating that the tendon's viscous properties predominated during initial eccentric loading. However, during the concentric phase (61-70 and 76-83% movement duration) differing FT and similar RFDT between conditions allowed for the tendon's elastic properties to predominate such that peak tendon strain was greater in JS than TS. CONCLUSIONS Based on our current understanding, there may be an additional mechanical stimulus for tendon adaptation when performing large range-of-motion isoinertial exercises at faster movement speeds.
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Affiliation(s)
- Jacob E Earp
- Human Performance Laboratory, Department of Kinesiology, University of Rhode IslandKingston, RI, USA; Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan UniversityJoondalup, WA, Australia
| | - Robert U Newton
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University Joondalup, WA, Australia
| | - Prue Cormie
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan UniversityJoondalup, WA, Australia; Institute for Health and Ageing, Australian Catholic UniversityMelbourne, VIC, Australia
| | - Anthony J Blazevich
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University Joondalup, WA, Australia
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103
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Couppé C, Svensson RB, Heinemeier KM, Thomsen EW, Bayer ML, Christensen L, Kjær M, Magnusson SP, Schjerling P. Quantification of cell density in rat Achilles tendon: development and application of a new method. Histochem Cell Biol 2016; 147:97-102. [PMID: 27565969 DOI: 10.1007/s00418-016-1482-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2016] [Indexed: 01/03/2023]
Abstract
Increased tendon cell nuclei density (TCND) has been proposed to induce tendon mechanical adaptations. However, it is unknown whether TCND is increased in tendon tissue after mechanical loading and whether such an increase can be quantified in a reliable manner. The aim of this study was to develop a reliable method for quantification of TCND and to investigate potential changes in TCND in rat Achilles tendons in response to 12 weeks of running. Eight adult male Sprague-Dawley rats ran (RUN) on a treadmill with 10° incline, 1 h/day, 5 days/wk (17-20 m/min) for 12 weeks (which improved tendon mechanical properties) and were compared with 11 control rats (SED). Tissue-Tek-embedded cryosections (10 µm) from the mid region of the Achilles tendon were cut longitudinally on a cryostat. Sections were stained with alcian blue and picrosirius red. One blinded investigator counted the number of tendon cell nuclei 2-3 times in three separate regions of the mid longitudinal tendon sections with fields of 390 μm × 280 μm. Unpaired t tests were used for the statistical analysis (mean ± SE). Typical Error % for replicate counts was 5.5 and 14 % coefficient of variation for the three regions. There was no difference in TCND between running rats versus control rats (nuclei per image (≈105 μm2): RUN, 152 ± 9; SED, 146 ± 8, p = 0.642). This new method provided reproducible quantification of TCND. There was no difference in TCND despite improvements in tendon mechanics, which suggests that cell number is not a major cause for altered tendon mechanical properties with loading.
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Affiliation(s)
- Christian Couppé
- IOC Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Building 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark. .,Musculoskeletal Rehabilitation Research Unit, Department of Physical Therapy, Bispebjerg Hospital, Copenhagen, Denmark.
| | - René B Svensson
- IOC Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Building 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - Katja M Heinemeier
- IOC Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Building 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Wøjdemann Thomsen
- IOC Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Building 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - Monika Lucia Bayer
- IOC Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Building 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | | | - Michael Kjær
- IOC Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Building 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - S Peter Magnusson
- IOC Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Building 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.,Musculoskeletal Rehabilitation Research Unit, Department of Physical Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Peter Schjerling
- IOC Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Building 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
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104
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Wiesinger HP, Rieder F, Kösters A, Müller E, Seynnes OR. Are Sport-Specific Profiles of Tendon Stiffness and Cross-Sectional Area Determined by Structural or Functional Integrity? PLoS One 2016; 11:e0158441. [PMID: 27362657 PMCID: PMC4928785 DOI: 10.1371/journal.pone.0158441] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/16/2016] [Indexed: 01/13/2023] Open
Abstract
The present study aimed to determine whether distinct sets of tendon properties are seen in athletes engaged in sports with contrasting requirements for tendon function and structural integrity. Patellar and Achilles tendon morphology and force-deformation relation were measured by combining ultrasonography, electromyography and dynamometry in elite ski jumpers, distance runners, water polo players and sedentary individuals. Tendon cross-sectional area normalized to body mass2/3 was smaller in water polo players than in other athletes (patellar and Achilles tendon; -28 to -24%) or controls (patellar tendon only; -9%). In contrast, the normalized cross-sectional area was larger in runners (patellar tendon only; +26%) and ski jumpers (patellar and Achilles tendon; +21% and +13%, respectively) than in controls. Tendon stiffness normalized to body mass2/3 only differed in ski jumpers, compared to controls (patellar and Achilles tendon; +11% and +27%, respectively) and to water polo players (Achilles tendon only; +23%). Tendon size appears as an adjusting variable to changes in loading volume and/or intensity, possibly to preserve ultimate strength or fatigue resistance. However, uncoupled morphological and mechanical properties indicate that functional requirements may also influence tendon adaptations.
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Affiliation(s)
- Hans-Peter Wiesinger
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
- * E-mail:
| | - Florian Rieder
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Alexander Kösters
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Erich Müller
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Olivier R. Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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105
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Bayliss A, Weatherholt A, Crandall T, Farmer D, McConnell J, Crossley K, Warden S. Achilles tendon material properties are greater in the jump leg of jumping athletes. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2016; 16:105-12. [PMID: 27282454 PMCID: PMC5114353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
PURPOSE The Achilles tendon (AT) must adapt to meet changes in demands. This study explored AT adaptation by comparing properties within the jump and non-jump legs of jumping athletes. Non-jumping control athletes were included to control limb dominance effects. METHODS AT properties were assessed in the preferred (jump) and non-preferred (lead) jumping legs of male collegiate-level long and/or high jump (jumpers; n=10) and cross-country (controls; n=10) athletes. Cross-sectional area (CSA), elongation, and force during isometric contractions were used to estimate the morphological, mechanical and material properties of the ATs bilaterally. RESULTS Jumpers exposed their ATs to more force and stress than controls (all p≤0.03). AT force and stress were also greater in the jump leg of both jumpers and controls than in the lead leg (all p<0.05). Jumpers had 17.8% greater AT stiffness and 24.4% greater Young's modulus in their jump leg compared to lead leg (all p<0.05). There were no jump versus lead leg differences in AT stiffness or Young's modulus within controls (all p>0.05). CONCLUSION ATs chronically exposed to elevated mechanical loading were found to exhibit greater mechanical (stiffness) and material (Young's modulus) properties.
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Affiliation(s)
- A.J. Bayliss
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - A.M. Weatherholt
- Center for Translational Musculoskeletal Research, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - T.T. Crandall
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - D.L. Farmer
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - J.C. McConnell
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - K.M. Crossley
- School of Allied Health, College of Science, Health and Engineering, Bundoora, VIC, Australia
| | - S.J. Warden
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA,Center for Translational Musculoskeletal Research, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA,Corresponding author: Stuart J. Warden, Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, 1140 W. Michigan Street, CF-120, Indianapolis, IN 46202, USA E-mail:
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106
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Maffiuletti NA, Aagaard P, Blazevich AJ, Folland J, Tillin N, Duchateau J. Rate of force development: physiological and methodological considerations. Eur J Appl Physiol 2016; 116:1091-116. [PMID: 26941023 PMCID: PMC4875063 DOI: 10.1007/s00421-016-3346-6] [Citation(s) in RCA: 739] [Impact Index Per Article: 92.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/17/2016] [Indexed: 11/26/2022]
Abstract
The evaluation of rate of force development during rapid contractions has recently become quite popular for characterising explosive strength of athletes, elderly individuals and patients. The main aims of this narrative review are to describe the neuromuscular determinants of rate of force development and to discuss various methodological considerations inherent to its evaluation for research and clinical purposes. Rate of force development (1) seems to be mainly determined by the capacity to produce maximal voluntary activation in the early phase of an explosive contraction (first 50–75 ms), particularly as a result of increased motor unit discharge rate; (2) can be improved by both explosive-type and heavy-resistance strength training in different subject populations, mainly through an improvement in rapid muscle activation; (3) is quite difficult to evaluate in a valid and reliable way. Therefore, we provide evidence-based practical recommendations for rational quantification of rate of force development in both laboratory and clinical settings.
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Affiliation(s)
- Nicola A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Lengghalde 6, 8008, Zurich, Switzerland.
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark
| | - Anthony J Blazevich
- Centre for Exercise and Sports Science Research (CESSR), School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jonathan Folland
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Neale Tillin
- Department of Life Sciences, University of Roehampton, London, UK
| | - Jacques Duchateau
- Laboratory of Applied Biology, ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
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107
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Immediate effects of whole body vibration on patellar tendon properties and knee extension torque. Eur J Appl Physiol 2015; 116:553-61. [PMID: 26708361 DOI: 10.1007/s00421-015-3316-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Reports about the immediate effects of whole body vibration (WBV) exposure upon torque production capacity are inconsistent. However, the changes in the torque-angle relationship observed by some authors after WBV may hinder the measurement of torque changes at a given angle. Acute changes in tendon mechanical properties do occur after certain types of exercise but this hypothesis has never been tested after a bout of WBV. The purpose of the present study was to investigate whether tendon compliance is altered immediately after WBV, effectively shifting the optimal angle of peak torque towards longer muscle length. METHODS Twenty-eight subjects were randomly assigned to either a WBV (n = 14) or a squatting control group (n = 14). Patellar tendon CSA, stiffness and Young's modulus and knee extension torque-angle relationship were measured using ultrasonography and dynamometry 1 day before and directly after the intervention. Tendon CSA was additionally measured 24 h after the intervention to check for possible delayed onset of swelling. RESULTS The vibration intervention had no effects on patellar tendon CSA, stiffness and Young's modulus or the torque-angle relationship. Peak torque was produced at ~70° knee angle in both groups at pre- and post-test. Additionally, the knee extension torque globally remained unaffected with the exception of a small (-6%) reduction in isometric torque at a joint angle of 60°. CONCLUSION The present results indicate that a single bout of vibration exposure does not substantially alter patellar tendon properties or the torque-angle relationship of knee extensors.
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108
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Grosse U, Syha R, Gatidis S, Grözinger G, Martirosian P, Partovi S, Nikolaou K, Robbin MR, Schick F, Springer F. MR-basedin vivofollow-up study of Achilles tendon volume and hydration state after ankle-loading activity. Scand J Med Sci Sports 2015; 26:1200-8. [DOI: 10.1111/sms.12550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- U. Grosse
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
- Department of Radiology; University Hospital Case Medical Center; Case Western Reserve University; Cleveland Ohio USA
| | - R. Syha
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - S. Gatidis
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - G. Grözinger
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - P. Martirosian
- Section on Experimental Radiology; Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - S. Partovi
- Department of Radiology; University Hospital Case Medical Center; Case Western Reserve University; Cleveland Ohio USA
| | - K. Nikolaou
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - M. R. Robbin
- Department of Radiology; University Hospital Case Medical Center; Case Western Reserve University; Cleveland Ohio USA
| | - F. Schick
- Section on Experimental Radiology; Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - F. Springer
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
- Musculoskeletal Centre X-Ray Department; Chapel Allerton Hospital; Leeds UK
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109
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Rieder F, Wiesinger HP, Kösters A, Müller E, Seynnes OR. Whole-body vibration training induces hypertrophy of the human patellar tendon. Scand J Med Sci Sports 2015; 26:902-10. [PMID: 26173589 DOI: 10.1111/sms.12522] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2015] [Indexed: 01/26/2023]
Abstract
Animal studies suggest that regular exposure to whole-body vibration (WBV) induces an anabolic response in bone and tendon. However, the effects of this type of intervention on human tendon properties and its influence on the muscle-tendon unit function have never been investigated. The aim of this study was to investigate the effect of WBV training on the patellar tendon mechanical, material and morphological properties, the quadriceps muscle architecture and the knee extension torque-angle relationship. Fifty-five subjects were randomized into either a vibration, an active control, or an inactive control group. The active control subjects performed isometric squats on a vibration platform without vibration. Muscle and tendon properties were measured using ultrasonography and dynamometry. Vibration training induced an increase in proximal (6.3%) and mean (3.8%) tendon cross-sectional area, without any appreciable change in tendon stiffness and modulus or in muscle architectural parameters. Isometric torque at a knee angle of 90° increased in active controls (6.7%) only and the torque-angle relation remained globally unchanged in all groups. The present protocol did not appreciably alter knee extension torque production or the musculo-tendinous parameters underpinning this function. Nonetheless, this study shows for the first time that WBV elicits tendon hypertrophy in humans.
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Affiliation(s)
- F Rieder
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - H-P Wiesinger
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - A Kösters
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - E Müller
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - O R Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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110
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Zhang ZJ, Ng GYF, Fu SN. Effects of habitual loading on patellar tendon mechanical and morphological properties in basketball and volleyball players. Eur J Appl Physiol 2015; 115:2263-9. [DOI: 10.1007/s00421-015-3209-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 06/25/2015] [Indexed: 01/08/2023]
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