Compartmental fasciotomy and isolating a muscle from neighboring muscles interfere with myofascial force transmission within the rat anterior crural compartment

Low-Intensity Resistance Exercise Based on Myofascial Chains Alters the Lower-Limb Tension and Improves Health Status in Female Individuals With Knee Osteoarthritis

BACKGROUND

Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants.

METHODS

Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension.

RESULTS

Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P < .001), decreased ankle plantar flexion range (P = .023), ankle resting position more inclined to dorsiflexion (P = .017), increased ankle dorsiflexion stiffness (P = .005), and lower ankle plantar flexion stiffness (P = .034). After exercise intervention, the knee OA group self-reported less knee pain (P < .001), improved physical function (P < .001), increased maximum dorsiflexion (P = .021), and increased plantar flexion range (P < .001). While plantar flexion stiffness increased (P = .037), dorsiflexion stiffness decreased (P = .015) and ankle resting position moved toward dorsiflexion (P = .002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA.

CONCLUSIONS

The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension.

Force transmission and interactions between synergistic muscles

The classical view of muscles as independent motors has been challenged over the past decades. An alternative view has emerged in which muscles are not isolated but embedded in a three-dimensional connective tissue network that links them to adjacent muscles and other non-muscular structures in the body. Animal studies showing that the forces measured at the distal and proximal ends of a muscle are not equal have provided undisputable evidence that these connective tissue linkages are strong enough to serve as an extra pathway for muscular force transmission. In this historical review, we first introduce the terminology and anatomy related to these pathways of muscle force transmission and provide a definition for the term epimuscular force transmission. We then focus on important experimental evidence indicating mechanical interactions between synergistic muscles that may affect force transmission and/or influence the muscles' force generating capacity. We illustrate that there may exist different expressions of the highly relevant force-length properties depending on whether the force is measured at the proximal or distal tendon and depending on the dynamics of surrounding structures. Changes in length, activation level or disruption of the connective tissue of neighboring muscles, can affect how muscles interact and produce force on the skeleton. While most direct evidence is from animal experiments, studies on humans also suggest functional implications of the connective tissues surrounding muscles. These implications may explain how distant segments, which are not part of the same joint system, affect force generation at a given joint, and, in clinical conditions, explain observations from tendon transfer surgeries, where a muscle transferred to act as an antagonist continues to produce agonistic moments.

Neurobiological tensegrity: The basis for understanding inter-individual variations in task performance?

Bernstein's (1996) levels of movement organization includes tonus, the muscular-contraction level that primes individual movement systems for (re)organizing coordination patterns. The hypothesis advanced is that the tonus architecture is a multi-fractal tensegrity system, deeply reliant on haptic perception for regulating movement of an individual actor in a specific environment. Further arguments have been proposed that the tensegrity-haptic system is implied in all neurobiological perception and -action. In this position statement we consider whether the musculoskeletal system can be conceptualized as a neurobiological tensegrity system, supporting each individual in co-adapting to many varied contexts of dynamic performance. Evidence for this position, revealed in investigations of judgments of object properties, perceived during manual hefting, is based on each participant's tensegrity. The implication is that the background organizational state of every individual is unique, given that no neurobiological architecture (musculo-skeletal components) is identical. The unique tensegrity of every organism is intimately related to individual differences, channeling individualized adaptations to constraints (task, environment, organismic), which change over different timescales. This neurobiological property assists transitions from one stable state of coordination to another which is needed in skill adaptation during performance. We conclude by discussing how tensegrity changes over time according to skill acquisition and learning.

Principles of the Mechanism for Epimuscular Myofascial Loads Leading to Non-uniform Strain Distributions Along Muscle Fiber Direction: Finite Element Modeling

Sarcomere lengths and their changes are key determinants of muscle active force production. Recent studies indicate inhomogeneity of sarcomere lengths within the muscle. Studies utilizing magnetic resonance imaging (MRI) analyses for quantifying local muscle tissue strains and diffusion tensor imaging (DTI) analyses allowing for determination of their components along muscle fascicles show that those length changes can be non-uniform. Specifically, two questions arise regarding the muscle’s length change heterogeneities along the muscle fiber direction: (1) How can a passively lengthened muscle show shortened regions? (2) How can an isometric contracting muscle show lengthened parts? Using finite element modeling and studying principles of the mechanism of strain heterogeneity along the muscle fiber direction, the aim was to test the following hypothesis: epimuscular myofascial loads can lead locally to strains opposing those elsewhere within the muscle that are determined by the globally imposed conditions. The geometry of the model was defined by the contour of a longitudinal slice of the rat extensor digitorum longus (EDL) muscle belly. Three models were studied: (1) isolated muscle (muscle modeled fully isolated from its surroundings) and models aiming at representing the principles of a muscle in its in vivo context including (2) extramuscularly connected muscle (muscle’s connections to non-muscular structures are modeled exclusively) and (3) epimuscularly connected muscle (additionally muscle’s connections to neighboring muscle are modeled). Three cases were studied: passive isometric muscle with imposed relative position change (Case I), passive lengthened muscle (Case II), and active isometric muscle with imposed relative position change (Case III). The findings indicated non-uniform strains for all models except for zero strain in model (1) in Case I, but models (2) and (3) also showed strains opposing the imposed effect. Case I: model (3) showed shortened and lengthened sections (up to 35.3%), caused exclusively by imposed relative position change. Case II: models (2) and (3) showed shortened sections (up to 12.7 and 19.5%, respectively) in addition to lengthened sections. Case III: models (2) and (3) showed lengthened sections (up to 5 and 23.4%, respectively) in addition to shortened sections. These effects get more pronounced with stiffer epimuscular connections. Assessments of forces exerted on the muscle by the epimuscular connections showed that such strain heterogeneities are ascribed to epimuscular myofascial loads determined by muscle relative position changes.

Structural and Functional Changes in the Coupling of Fascial Tissue, Skeletal Muscle, and Nerves During Aging

Aging is a one-way process associated with profound structural and functional changes in the organism. Indeed, the neuromuscular system undergoes a wide remodeling, which involves muscles, fascia, and the central and peripheral nervous systems. As a result, intrinsic features of tissues, as well as their functional and structural coupling, are affected and a decline in overall physical performance occurs. Evidence from the scientific literature demonstrates that senescence is associated with increased stiffness and reduced elasticity of fascia, as well as loss of skeletal muscle mass, strength, and regenerative potential. The interaction between muscular and fascial structures is also weakened. As for the nervous system, aging leads to motor cortex atrophy, reduced motor cortical excitability, and plasticity, thus leading to accumulation of denervated muscle fibers. As a result, the magnitude of force generated by the neuromuscular apparatus, its transmission along the myofascial chain, joint mobility, and movement coordination are impaired. In this review, we summarize the evidence about the deleterious effect of aging on skeletal muscle, fascial tissue, and the nervous system. In particular, we address the structural and functional changes occurring within and between these tissues and discuss the effect of inflammation in aging. From the clinical perspective, this article outlines promising approaches for analyzing the composition and the viscoelastic properties of skeletal muscle, such as ultrasonography and elastography, which could be applied for a better understanding of musculoskeletal modifications occurring with aging. Moreover, we describe the use of tissue manipulation techniques, such as massage, traction, mobilization as well as acupuncture, dry needling, and nerve block, to enhance fascial repair.

Skeletal Muscle Shape Change in Relation to Varying Force Requirements Across Locomotor Conditions

Contractions of skeletal muscles to generate in vivo movement involve dynamic changes in contractile and elastic tissue strains that likely interact to influence the force and work of a muscle. However, studies of the in vivo dynamics of skeletal muscle and tendon strains remain largely limited to bipedal animals, and rarely cover the broad spectra of movement requirements met by muscles that operate as motors, struts, or brakes across the various gaits that animals commonly use and conditions they encounter. Using high-speed bi-planar fluoromicrometry, we analyze in vivo strains within the rat medial gastrocnemius (MG) across a range of gait and slope conditions. These conditions require changes in muscle force ranging from decline walk (low) to incline gallop (high). Measurements are made from implanted (0.5–0.8 mm) tantalum spheres marking MG mid-belly width, mid-belly thickness, as well as strains of distal fascicles, the muscle belly, and the Achilles tendon. During stance, as the muscle contracts, muscle force increases linearly with respect to gait–slope combinations, and both shortening and lengthening fiber strains increase from approximately 5 to 15% resting length. Contractile change in muscle thickness (thickness strain) decreases (r² = 0.86; p = 0.001); whereas, the change in muscle width (width strain) increases (r² = 0.88; p = 0.001) and tendon strain increases (r² = 0.77; p = 0.015). Our results demonstrate force-dependency of contractile and tendinous tissue strains with compensatory changes in shape for a key locomotor muscle in the hind limb of a small quadruped. These dynamic changes are linked to the ability of a muscle to tune its force and work output as requirements change with locomotor speed and environmental conditions.

Significance of epimuscular myofascial force transmission under passive muscle conditions

In the past 20 yr, force transmission via connective tissue linkages at the muscle belly surface, called epimuscular myofascial force transmission, has been studied extensively. In this article, the effects of epimuscular linkages under passive muscle conditions are reviewed. Several animal studies that included direct (invasive) measurements of force transmission have shown that different connective tissue structures serve as an epimuscular pathway and that these tissues have sufficient stiffness, especially at supraphysiological muscle lengths and relative positions, to transmit substantial passive forces (up to 15% of active optimal force). Exact values of lumped tissue stiffness for different connective tissue structures have not yet been estimated. Experiments using various imaging techniques (ultrasound, MRI, shear wave elastography) have yielded some, but weak, evidence of epimuscular myofascial force transmission for passive muscles in humans. At this point, the functional consequences of epimuscular pathways for muscle and joint mechanics in the intact body are still unknown. Potentially, however, these pathways may affect sensory feedback and, thereby, neuromuscular control. In addition, altered epimuscular force transmission in pathological conditions may also contribute to changes in passive range of joint motion.

Composition, Architecture, and Functional Implications of the Connective Tissue Network of the Extraocular Muscles

Purpose

We examined the pattern and extent of connective tissue distribution in the extraocular muscles (EOMs) and determined the ability of the interconnected connective tissues to disseminate force laterally.

Methods

Human EOMs were examined for collagens I, III, IV, and VI; fibronectin; laminin; and elastin using immunohistochemistry. Connective tissue distribution was examined with scanning electron microscopy. Rabbit EOMs were examined for levels of force transmission longitudinally and transversely using in vitro force assessment.

Results

Collagens I, III, and VI localized to the endomysium, perimysium, and epimysium. Collagen IV, fibronectin, and laminin localized to the basal lamina surrounding all myofibers. All collagens localized similarly in the orbital and global layers throughout the muscle length. Elastin had the most irregular pattern and ran longitudinally and circumferentially throughout the length of all EOMs. Scanning electron microscopy showed these elements to be extensively interconnected, from endomysium through the perimysium to the epimysium surrounding the whole muscle. In vitro physiology demonstrated force generation in the lateral dimension, presumably through myofascial transmission, which was always proportional to the force generated in the longitudinally oriented muscles.

Conclusions

A striking connective tissue matrix interconnects all the myofibers and extends, via perimysial connections, to the epimysium. These interconnections are significant and allow measurable force transmission laterally as well as longitudinally, suggesting that they may contribute to the nonlinear force summation seen in motor unit recording studies. This provides strong evidence that separate compartmental movements are unlikely as no region is independent of the rest of the muscle.

Investigating canine elbow joint stabilisation through mechanical constraints of the deep fascia and other soft tissues

The objective of this research was to investigate how the range of flexion and extension of the canine elbow joint is constrained by the mechanical connections and attachments of soft tissue structures. The skin, a section of deep fascia and several muscles from both forelimbs from six adult greyhounds and seven other breeds were sequentially transected or removed, over 13 steps. During each step, repeated measurements of elbow flexion and extension were recorded using a goniometer. Only marginally significant changes to the range of flexion occurred in any of the 13 steps or overall for the greyhounds. Clearly significant changes to extension occurred in several dissection steps. Removing the skin resulted in a significant increase in elbow extension of 1.7° ± 0.3 (P < 0.001) in the greyhounds and 1.6° ± 0.3 (P < 0.001) in the other breeds. Severing the deep fascia from the humerus and its connections across the elbow joint resulted in the largest significant change in elbow extension of 9.9° ± 0.3 (P < 0.001) in the greyhounds and 6.9° ± 0.7 (P < 0.001) in the other breeds. Transecting the biceps brachii m. close to the elbow resulted in an increase of 2.8° ± 0.3 (P < 0.001) in the greyhounds but a non-significant change in the other breeds. Transecting the extensor carpi radialis m. from its origin resulted in an increase of 5.5° ± 0.4 (P < 0.001) in the greyhounds and 3.9° ± 0.7 (P < 0.001) in the other breeds. These results suggest that the collagenous framework and attachments of the skin, deep fascia, and extensor carpi radialis m., play a significant role in the function of the canine elbow by restricting it from overextension and hence stabilising it during periods of loading, in a variety of different canine breeds, and that these structures are functionally integrated into the way the forelimb supports the bodyweight separately from any involvement of muscle tone or muscle movements. Observations on the anatomical connections of the deep fascia between the cranial distal humerus and the antebrachial fascia highlighted its probable importance in relating movements between the shoulder and the carpus.

Limited mechanical effects of intermuscular myofascial connections within the intact rat anterior crural compartment

Skeletal muscles of the rat anterior crural compartment are mechanically connected by epimuscular myofascial connections, but the relevance for mechanical muscle function within physiological ranges of joint motion is unclear. We evaluated the net effect at the ankle joint of epimuscular myofascial connections between tibialis anterior (TA) and extensor digitorum longus (EDL) muscles in the rat (n=8) and determined which anatomical structures may mediate such epimuscular mechanical interactions. We assessed (1) effects of knee angle (i.e. changes in EDL length and position relative to TA) and interactions of knee angle with fasciotomy and proximal EDL tenotomy on TA ankle moment and (2) the effect of knee angle on TA and EDL ankle moment summation. Knee angle was varied between 60° and 130°. Ankle angle was kept constant (90°). TA and EDL were excited individually and simultaneously (TA&EDL). The mathematical sum of individual TA and EDL moments was compared with the moment exerted by TA&EDL to assess the extent of non-additive ankle moment summation. Magnitude of TA ankle moment was not affected by knee angle, but frontal plane moment direction was. However, dissections indicated that this was not caused by the compartmental fascia or EDL length changes. Moment summation was non-additive in magnitude (+1.1±1.1% mean±s.d.) and frontal plane direction. The latter was affected by knee angle and ranged from +0.2±0.3° at 60° to +1.1±0.6° at 130°. As the net effects found were very limited, we conclude that myofascial connections between muscles in the anterior crural compartment have limited mechanical relevance during normal movement.

Intermuscular force transmission along myofascial chains: a systematic review

The present review aims to provide a systematic overview on tensile transmission along myofascial chains based on anatomical dissection studies and in vivo experiments. Evidence for the existence of myofascial chains is growing, and the capability of force transmission via myofascial chains has been hypothesized. However, there is still a lack of evidence concerning the functional significance and capability for force transfer. A systematic literature research was conducted using MEDLINE (Pubmed), ScienceDirect and Google Scholar. Studied myofascial chains encompassed the superficial backline (SBL), the back functional line (BFL) and the front functional line (FFL). Peer-reviewed human dissection studies as well as in vivo experiments reporting intermuscular tension transfer between the constituents of a myofascial chain were included. To assess methodic quality, two independent investigators rated studies by means of validated assessment tools (QUACS and PEDro Scale). The literature research identified 1022 articles. Nine studies (moderate to excellent methodological quality) were included. Concerning the SBL and the BFL, there is moderate evidence for force transfer at all three transitions (based on six studies), and one of two transitions (three studies). One study yields moderate evidence for a slight, but not significant force transfer at one transition in the FFL. The findings of the present study indicate that tension can be transferred between some of the examined adjacent structures. Force transfer might have an impact in overuse conditions as well as on sports performance. However, different methods of force application and measurement hinder the comparability of results. Considering anatomical variations in the degree of continuity and histological differences of the linking structures is crucial for interpretation. Future studies should focus on the in vivo function of myofascial continuity during isolated active or passive tissue tensioning.

Effects of muscle activation on shear between human soleus and gastrocnemius muscles

Lateral connections between muscles provide pathways for myofascial force transmission. To elucidate whether these pathways have functional roles in vivo, we examined whether activation could alter the shear between the soleus (SOL) and lateral gastrocnemius (LG) muscles. We hypothesized that selective activation of LG would decrease the stretch-induced shear between LG and SOL. Eleven volunteers underwent a series of knee joint manipulations where plantar flexion force, LG, and SOL muscle fascicle lengths and relative displacement of aponeuroses between the muscles were obtained. Data during a passive full range of motion were recorded, followed by 20° knee extension stretches in both passive conditions and with selective electrical stimulation of LG. During active stretch, plantar flexion force was 22% greater (P < 0.05) and relative displacement of aponeuroses was smaller than during passive stretch (P < 0.05). Soleus fascicle length changes did not differ between passive and active stretches but LG fascicles stretched less in the active than passive condition when the stretch began at angles of 70° and 90° of knee flexion (P < 0.05). The activity-induced decrease in the relative displacement of SOL and LG suggests stronger (stiffer) connectivity between the two muscles, at least at flexed knee joint angles, which may serve to facilitate myofascial force transmission.

Adaptation of physiological cross-sectional area and serial number of sarcomeres after tendon transfer of rat muscle

Tendon transfer surgery to a new extensor insertion was performed for musculus flexor carpi ulnaris (FCU) of young adult rats, after which animals were allowed to recover. Mechanical properties and adaptive effects on body mass, bone growth, serial number of sarcomeres, and muscle physiological cross-sectional area were studied. Between the transfer and control groups, no differences were found for body mass and forearm length growth. In contrast, transferred muscles had a 19% smaller physiological cross-sectional area and 25% fewer sarcomeres in series within its muscle fibers than control muscles, i.e., a deficit in muscle belly growth is present. Our present results confirm our the length of previous work showing a limited capability of changing the adapted transferred FCU muscle belly, as the muscle-tendon complex is stretched, so that most of the acute FCU length change must originate from the tendon. This should most likely be attributed to surgery-related additional and/or altered connective tissue linkages at the muscle-tendon boundary. The substantially increased FCU tendon length found, after recovery from surgery and adaptation to the conditions of the transferred position, is likely to be related to such enhanced stretching of the FCU tendon.

No functionally relevant mechanical effects of epimuscular myofascial connections between rat ankle plantar flexors

Triceps surae muscles are mechanically connected by the shared Achilles tendon and by epimuscular myofascial connections. We aimed to assess effects of proximal lengthening of gastrocnemius (GA) and plantaris muscles, imposed by changes in knee angle, on (i) the magnitude and direction of the 3D ankle moment exerted by the soleus (SO) muscle, and on (ii) mechanical interaction between ankle plantar flexor muscles during co-activation of GA muscle, in the rat (n=9). Ankle angle was kept constant (90°), while knee angle was varied between 60° and 130°. At each knee angle, SO was excited individually as well as simultaneously with GA (SO&GA). The mathematical sum of individual SO and GA ankle moments was compared with the ankle moment exerted by SO&GA to assess nonlinear summation. Knee angle did not affect the magnitude of the SO ankle moment (p=0.695). Moment directions in the transverse (p=0.050) and frontal (p=0.008) planes were affected by knee angle, but dissection indicated that this was not caused by length changes of the two-joint synergistic muscles. Nonlinear summation was found in the magnitude (-1.4±1.9%, mean±s.d., p&lt;0.001) and in the frontal plane vector direction of the ankle moment (0.13±0.23°, p=0.003), however, the extent did not change with knee angle. While SO&GA contraction increased Achilles tendon length compared to rest, this length was not knee angle dependent (p=0.649). Despite that intermuscular force transmission per se cannot be excluded, we conclude that in vivo the mechanical effects of epimuscular myofascial connections between rat ankle plantar flexors are not functionally relevant.

Intramuscular connective tissue differences in spastic and control muscle: a mechanical and histological study

Cerebral palsy (CP) of the spastic type is a neurological disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks. Secondary to the spasticity, muscle adaptation is presumed to contribute to limitations in the passive range of joint motion. However, the mechanisms underlying these limitations are unknown. Using biopsies, we compared mechanical as well as histological properties of flexor carpi ulnaris muscle (FCU) from CP patients (n = 29) and healthy controls (n = 10). The sarcomere slack length (mean 2.5 µm, SEM 0.05) and slope of the normalized sarcomere length-tension characteristics of spastic fascicle segments and single myofibre segments were not different from those of control muscle. Fibre type distribution also showed no significant differences. Fibre size was significantly smaller (1933 µm2, SEM 190) in spastic muscle than in controls (2572 µm2, SEM 322). However, our statistical analyses indicate that the latter difference is likely to be explained by age, rather than by the affliction. Quantities of endomysial and perimysial networks within biopsies of control and spastic muscle were unchanged with one exception: a significant thickening of the tertiary perimysium (3-fold), i.e. the connective tissue reinforcement of neurovascular tissues penetrating the muscle. Note that this thickening in tertiary perimysium was shown in the majority of CP patients, however a small number of patients (n = 4 out of 23) did not have this feature. These results are taken as indications that enhanced myofascial loads on FCU is one among several factors contributing in a major way to the aetiology of limitation of movement at the wrist in CP and the characteristic wrist position of such patients.

The lacertus fibrosus of the biceps brachii muscle: an anatomical study

PURPOSE

The lacertus fibrosus (LF) is involved in various surgical procedures. However, the anatomy, morphometry, topography and biomechanical involvements of LF are not clear. The purpose of this study was to determine the anatomical and morphometric variations of LF, and to correlate this with anthropometric and morphometric measurements of the upper limb. Furthermore, the presence or absence of a deep layer of LF was verified using forearm cross-sections and dissections.

METHODS

This anatomical study was performed by observation of dissections and transverse sections obtained from 50 cadavers. Morphometric analyses [length and width of LF and biceps tendon, stature, length of upper limb, forearm, bi-epicondylar width, forearm perimeter, biceps brachii muscle perimeter (BBm)] were also performed.

RESULTS

The results demonstrated that there was no significant correlation between LF morphology and morphometric upper limb measurements. The deep layer of LF was observed in all specimens.

CONCLUSION

Results of this paper indicate that the LF presents individual characteristics such as length and width. The deeper layer of LF was observed on all specimens. The possible role of LF in force transmission during flexion, BBm moment arm adjustment and supination reduction is discussed in view of these results.

Dissection of a single rat muscle-tendon complex changes joint moments exerted by neighboring muscles: implications for invasive surgical interventions

The aim of this paper is to investigate mechanical functioning of a single skeletal muscle, active within a group of (previously) synergistic muscles. For this purpose, we assessed wrist angle-active moment characteristics exerted by a group of wrist flexion muscles in the rat for three conditions: (i) after resection of the upper arm skin; (ii) after subsequent distal tenotomy of flexor carpi ulnaris muscle (FCU); and (iii) after subsequent freeing of FCU distal tendon and muscle belly from surrounding tissues (MT dissection). Measurements were performed for a control group and for an experimental group after recovery (5 weeks) from tendon transfer of FCU to extensor carpi radialis (ECR) insertion. To assess if FCU tenotomy and MT dissection affects FCU contributions to wrist moments exclusively or also those of neighboring wrist flexion muscles, these data were compared to wrist angle-moment characteristics of selectively activated FCU. FCU tenotomy and MT dissection decreased wrist moments of the control group at all wrist angles tested, including also angles for which no or minimal wrist moments were measured when activating FCU exclusively. For the tendon transfer group, wrist flexion moment increased after FCU tenotomy, but to a greater extent than can be expected based on wrist extension moments exerted by selectively excited transferred FCU. We conclude that dissection of a single muscle in any surgical treatment does not only affect mechanical characteristics of the target muscle, but also those of other muscles within the same compartment. Our results demonstrate also that even after agonistic-to-antagonistic tendon transfer, mechanical interactions with previously synergistic muscles do remain present.

Human spastic Gracilis muscle isometric forces measured intraoperatively as a function of knee angle show no abnormal muscular mechanics

BACKGROUND

To show whether mechanics of activated spastic muscle are representative of the functional deficiencies clearly apparent in the joints, our goal was to test the following hypotheses: (1) The muscle's joint range of force exertion is narrow, and (2) high muscle forces are available at low muscle length.

METHODS

During remedial surgery, we measured the forces of the Gracilis muscle of spastic cerebral palsy patients (n=7, 10 limbs tested) as a function of knee joint angle from flexion (120°) to full extension (0°).

FINDINGS

The spastic Gracilis exerted non-zero forces for the entire knee angles studied. For four limbs, the peak force was exerted at the highest length. For the remainder limbs, the closest knee angle of peak force exertion to 120° was 66°. Maximally 79.1%, and for most limbs only a much lower percentage (minimally 22.4%) of peak Gracilis force (mean 41.59N (SD 41.76N)) was available at 120° knee flexion. Moreover, a clinical metric was obtained showing that the occurrence of a contracture was not correlated significantly with key determinants of knee angle-Gracilis force characteristics.

INTERPRETATION

Our hypotheses are rejected: the spastic Gracilis has no narrow operational joint range of force exertion and no supreme active resistance capacity to stretch at low length. We conclude that if activated alone, spastic muscle shows no abnormal mechanics representative of joint movement disorder. Simultaneous stimulation of other muscles as in daily activities may change this situation.

BTX-A Administration to the Target Muscle Affects Forces of All Muscles Within an Intact Compartment and Epimuscular Myofascial Force Transmission

Measurement of forces of mono- and bi-articular muscles of an entire intact muscle compartment can allow for a comprehensive assessment of the effects of Botulinum toxin type A (BTX-A) both at and beyond the injection site, and in conditions close to those in vivo. The goal was to test the hypotheses that BTX-A affects (1) the forces of not only the injected but also the noninjected muscles of the compartment, and (2) epimuscular myofascial force transmission (EMFT). Two groups of Wistar rats were tested: Control (no BTX-A injected) and BTX (0.1 units of BTX-A were injected exclusively to the mid-belly of TA). Isometric forces were measured simultaneously at the distal tendons of the tibialis anterior (TA) at different lengths, the restrained extensor digitorum longus (EDL) and the extensor hallucis longus (EHL) muscles and at the proximal tendon of EDL. Five days post-injection, BTX-A did affect the total forces of all muscles significantly: (1) The TA force decreased differentially (by 46.6%–55.9%) for most lengths such that a significant negative correlation was found between force reductions and increased muscle length. The maximum TA force decreased by 47.3%. However, the muscle’s length range of force production did not change significantly. (2) Distal and proximal EDL forces decreased (on average by 67.8% and 62.9%, respectively). (3) The EHL force also decreased (on average by 9.2%). The passive forces of only the TA showed a significant increase at higher lengths. EMFT effects were shown for the control group: (1) at the shortest TA lengths, the EDL proximo-distal force differences were in favor of the distal force, which was reversed at higher lengths. (2) the EHL force measured at the shortest TA length decreased (by 34%) as a function of TA lengthening. After BTX-A exposure, such EMFT effects disappeared for the EDL, whereas they remained as profound for the EHL. Exposure to BTX-A does affect forces of all muscles operating in an intact compartment. For the BTX-A injected muscle, the reduction in muscle force becomes less pronounced at higher muscle lengths. BTX-A also has effects on EMFT, however, these effects are not uniform within the anterior crural compartment. Decreased forces of the noninjected synergistic muscles suggest the presence of unintended additional effects of BTX-A both for the targeted distal joint and for the nontargeted proximal joint.

Myofascial force transmission between the human soleus and gastrocnemius muscles during passive knee motion

The plantarflexors of the lower limb are often assumed to act as independent actuators, but the validity of this assumption is the subject of considerable debate. This study aims to determine the degree to which passive changes in gastrocnemius muscle length, induced by knee motion, affect the tension in the adjacent soleus muscle. A second aim is to quantify the magnitude of myofascial passive force transmission between gastrocnemius and adjacent soleus. Fifteen healthy volunteers participated. Simultaneous ultrasound images of the gastrocnemius and soleus muscles were obtained during passive knee flexion (0-90°), while keeping the ankle angle fixed at either 70° or 115°. Image correlation analysis was used to quantify muscle fascicle lengths in both muscles. The data show that the soleus muscle fascicles elongate significantly during gastrocnemius shortening. The approximate change in passive soleus force as a result of the observed change in fascicle length was estimated and appears to be <5 N, but this estimate is sensitive to the assumed slack length of soleus.

In muscle lengthening surgery multiple aponeurotomy does not improve intended acute effects and may counter-indicate: an assessment by finite element modelling

The goal was to assess the effects of multiple aponeurotomy on mechanics of muscle with extramuscular myofascial connections. Using finite element modelling, effects of combinations of the intervention carried out at a proximal (P), an intermediate (I) and a distal (D) location were studied: (1) Case P, (2) Case P-I, (3) Case P-D and (4) Case P-I-D. Compared to Case P, the effects of multiple interventions on muscle geometry and sarcomere lengths were sizable for the distal population of muscle fibres: e.g. at high muscle length (1) summed gap lengths between the cut ends of aponeurosis increased by 16, 25 and 27% for Cases P-I, P-D and P-I-D, respectively, (2) characteristic substantial sarcomere shortening became more pronounced (mean shortening was 26, 29, 30 and 31% for Cases P, P-I, P-D and P-I-D, respectively) and (3) fibre stresses decreased (mean stress equalled 0.49, 0.39, 0.38 and 0.33 for Cases P, P-I, P-D and P-I-D, respectively). In contrast, no appreciable effects were shown for the proximal population. The overall change in sarcomere length heterogeneity was limited. Consequently, the effects of multiple aponeurotomy on muscle length-force characteristics were marginal: (1) a limited reduction in active muscle force (maximal 'muscle weakening effect' remained between 5 and 11%) and (2) an even less pronounced change in slack to optimum length range of force exertion (maximal 'muscle lengthening effect' distally was 0.2% for Case P-I-D) were shown. The intended effects of the intervention were dominated by the one intervention carried out closer to the tendon suggesting that aponeurotomies done additionally to that may counter-indicated.

Physiological angiogenesis is a graded, not threshold, response

Angiogenesis may be induced in skeletal muscle by metabolic or mechanical factors, but whether an in vivo stimulus threshold applies for physiological angiogenesis is unknown. We compared three models of muscle overload inducing varying degrees of stretch on angiogenesis. Rat extensor digitorum longus (EDL) was overloaded by (a) extirpation of the synergist tibialis anterior (TA), (b) sectioning the distal tendon of the TA, or (c) release of the TA tendon by sectioning the retaining ligament. EDL samples were taken after 4, 7, 14 and 28 days to quantify capillary supply (alkaline phosphatase staining), and co-labelling for cell proliferation (using PCNA). The gradation of overload was confirmed by Western analysis of SERCA and CPT expression (1.6- to 7.2-fold and 8.3- to 33.9-fold changes, respectively), and the force characteristics of EDL. There was a significant increase in the number of new myonuclei only in the extirpated group after 7 days, while there was a graded increase in capillary-linked PCNA density (PCNAcap) among groups compared to controls. However, extirpation caused significant increase in PCNAcap after 7 days, whereas tenotomy showed a more modest and delayed increase at 14 days, and ligament transection induced no significant change. Muscle capillary supply followed a similar trend to that of PCNA, whereas the pro-angiogenic VEGF and Flk-1 protein levels were both up-regulated to a similar extent in all three experimental models 7–14 days after surgery. These results are consistent with the hypothesis that overload-induced angiogenesis is primarily a mechanical response, and that it is graded according to stimulus intensity.

Force transmission between synergistic skeletal muscles through connective tissue linkages

The classic view of skeletal muscle is that force is generated within its muscle fibers and then directly transmitted in-series, usually via tendon, onto the skeleton. In contrast, recent results suggest that muscles are mechanically connected to surrounding structures and cannot be considered as independent actuators. This article will review experiments on mechanical interactions between muscles mediated by such epimuscular myofascial force transmission in physiological and pathological muscle conditions. In a reduced preparation, involving supraphysiological muscle conditions, it is shown that connective tissues surrounding muscles are capable of transmitting substantial force. In more physiologically relevant conditions of intact muscles, however, it appears that the role of this myofascial pathway is small. In addition, it is hypothesized that connective tissues can serve as a safety net for traumatic events in muscle or tendon. Future studies are needed to investigate the importance of intermuscular force transmission during movement in health and disease.

The architectural design of the gluteal muscle group: implications for movement and rehabilitation

The organization of fibers within a muscle (architecture) defines the performance capacity of that muscle. In the current commentary, basic architectural terms are reviewed in the context of the major hip muscles and then specific illustrative examples relevant to lower extremity rehabilitation are presented. These data demonstrate the architectural and functional specialization of the hip muscles, and highlight the importance of muscle physiology and joint mechanics when evaluating and treating musculoskeletal disorders.

The fascia of the limbs and back--a review

Although fasciae have long interested clinicians in a multitude of different clinical and paramedical disciplines, there have been few attempts to unite the ensuing diverse literature into a single review. The current article gives an anatomical perspective that extends from the gross to the molecular level. For expediency, it deals only with fascia in the limbs and back. Particular focus is directed towards deep fascia and thus consideration is given to structures such as the fascia lata, thoracolumbar fascia, plantar and palmar fascia, along with regional specializations of deep fascia such as retinacula and fibrous pulleys. However, equal emphasis is placed on general aspects of fascial structure and function, including its innervation and cellular composition. Among the many functions of fascia considered in detail are its ectoskeletal role (as a soft tissue skeleton for muscle attachments), its importance for creating osteofascial compartments for muscles, encouraging venous return in the lower limb, dissipating stress concentration at entheses and acting as a protective sheet for underlying structures. Emphasis is placed on recognizing the continuity of fascia between regions and appreciating its key role in coordinating muscular activity and acting as a body-wide proprioceptive organ. Such considerations far outweigh the significance of viewing fascia in a regional context alone.

Assessment by Finite Element Modeling Indicates That Surgical Intramuscular Aponeurotomy Performed Closer to the Tendon Enhances Intended Acute Effects in Extramuscularly Connected Muscle

The effects of location of aponeurotomy on the muscular mechanics of extramuscularly connected muscle were assessed. Using finite element modeling, extensor digitorum longus muscle of the rat was studied for the effects of aponeurotomy performed in each of three locations on the proximal aponeurosis: (1) a proximal location (case P), (2) an intermediate location (case I), and (3) a distal location (case D). Proximo-distal force differences were more pronounced for more proximal aponeurotomy. The location also affected proximally and distally assessed muscle length-force characteristics: (1) Muscle optimum length and active slack length shifted differentially to higher lengths, increasing slack to optimum length range (for D to P: distally by 15–44%; proximally by 2–6%). (2) Muscle forces decreased at all lengths (e.g., for D to P distal optimal force=88–68% and proximal optimal force=87–60% of intact values, respectively). Increased length range and force decreases were highest for case P, as were effects on muscle geometry: gap length within the proximal aponeurosis; decreased proximal fiber population pennation angle. Parallel, but not serial, heterogeneity of sarcomere length was highest in case P: (a) For the distal fiber population, sarcomere shortening was highest; (b) for the proximal population, sarcomeres were longer. It is concluded that if aponeurotomy is performed closer to the tendon, intended surgical effects are more pronounced. For bi-articular muscle, mechanics of both proximal and distal joints will be affected, which should be considered in selecting the location of aponeurotomy for optimal results at both joints.

Thumb and finger forces produced by motor units in the long flexor of the human thumb

The uncommonly good proprioceptive performance of the long flexor of the thumb, flexor pollicis longus (FPL), may add significantly to human manual dexterity. We investigated the forces produced by FPL single motor units during a weak static grip involving all digits by spike-triggered averaging from single motor units, and by averaging from twitches produced by intramuscular stimulation. Nine adult subjects were studied. The forces produced at each digit were used to assess how forces produced in FPL are distributed to the fingers. Most FPL motor units produced very low forces on the thumb and were positively correlated with the muscle force at recruitment. Activity in FPL motor units commonly loaded the index finger (42/55 units), but less commonly the other fingers (P < 0.001). On average, these motor units produced small but significant loading forces on the index finger ( approximately 5.3% of their force on the thumb) with the same time-to-peak force as the thumb ( approximately 50 ms), but had no significant effect on other fingers. However, intramuscular stimulation within FPL did not produce significant forces in any finger. Coherence at 2-10 Hz between the thumb and index finger force was twice that for the other finger forces and the coherence to the non-index fingers was not altered when the index finger did not participate in the grasp. These results indicate that, within the long-term coordinated forces of all digits during grasping, FPL motor units generate forces highly focused on the thumb with minimal peripheral transfer to the fingers and that there is a small but inflexible neural coupling to the flexors of the index finger.

Extramuscular myofascial force transmission alters substantially the acute effects of surgical aponeurotomy: assessment by finite element modeling

Effects of extramuscular myofascial force transmission on the acute effects of aponeurotomy were studied using finite element modeling and implications of such effects on surgery were discussed. Aponeurotomized EDL muscle of the rat was modeled in two conditions: (1) fully isolated (2) with intact extramuscular connections. The specific goal was to assess the alterations in muscle length-force characteristics in relation to sarcomere length distributions and to investigate how the mechanical mechanism of the intervention is affected if the muscle is not isolated. Major effects of extramuscular myofascial force transmission were shown on muscle length-force characteristics. In contrast to the identical proximal and distal forces of the aponeurotomized isolated muscle, substantial proximo-distal force differences were shown for aponeurotomized muscle with extramuscular connections (for all muscle lengths F (dist) > F (prox) after distal muscle lengthening). Proximal optimal length did not change whereas distal optimal length was lower (by 0.5 mm). The optimal forces of the aponeurotomized muscle with extramuscular connections exerted at both proximal and distal tendons were lower than that of isolated muscle (by 15 and 7%, respectively). The length of the gap separating the two cut ends of the intervened aponeurosis decreases substantially due to extramuscular myofascial force transmission. The amplitude of the difference in gap length was muscle length dependent (maximally 11.6% of the gap length of the extramuscularly connected muscle). Extramuscular myofascial force transmission has substantial effects on distributions of lengths of sarcomeres within the muscle fiber populations distal and proximal to the location of intervention: (a) Within the distal population, the substantial sarcomere shortening at the proximal ends of muscle fibers due to the intervention remained unaffected however, extramuscular myofascial force transmission caused a more pronounced serial distribution towards the distal ends of muscle fibers. (b) In contrast, extramuscular myofascial force transmission limits the serial distribution of sarcomere lengths shown for the aponeurotomized isolated muscle in the proximal population. Fiber stress distributions showed that extramuscular myofascial force transmission causes most sarcomeres within the aponeurotomized muscle to attain lengths favorable for higher force exertion. It is concluded that acute effects of aponeurotomy on muscular mechanics are affected greatly by extramuscular myofascial force transmission. Such effects have important implications for the outcome of surgery performed to improve impeded function since muscle in vivo is not isolated both anatomically and mechanically.

Substantial effects of epimuscular myofascial force transmission on muscular mechanics have major implications on spastic muscle and remedial surgery

The specific aim of this paper is to review the effects of epimuscular myofascial force transmission on muscular mechanics and present some new results on finite element modeling of non-isolated aponeurotomized muscle in order to discuss the dependency of mechanics of spastic muscle, as well as surgery for restoration of function on such force transmission. The etiology of the effects of spasticity on muscular mechanics is not fully understood. Clinically, such effects feature typically a limited joint range of motion, which at the muscle level must originate from altered muscle length-force characteristics, in particular a limited muscle length range of force exertion. In studies performed to understand what is different in spastic muscle and what the effects of remedial surgery are, muscle is considered as being independent of its surroundings. Conceivably, this is because the classical approach in muscle mechanics is built on experimenting with dissected muscles. Certainly, such approach allowed improving our understanding of fundamental muscle physiology yet it yielded implicitly a narrow point of view of considering muscle length-force characteristics as a fixed property of the muscle itself. However, within its context of its intact connective tissue surroundings (the in vivo condition) muscle is not an isolated and independent entity. Instead, collagenous linkages between epimysia of adjacent muscles provide direct intermuscular connections, and structures such as the neurovascular tracts provide indirect intermuscular connections. Moreover, compartmental boundaries (e.g., intermuscular septa, interosseal membranes, periost and compartmental fascia) are continuous with neurovascular tracts and connect muscular and non-muscular tissues at several locations additional to the tendon origins and insertions. Epimuscular myofascial force transmission occurring via this integral system of connections has major effects on muscular mechanics including substantial proximo-distal force differences, sizable changes in the determinants of muscle length-force characteristics (e.g. a condition dependent shift in muscle optimum length to a different length or variable muscle optimal force) explained by major serial and parallel distributions of sarcomere lengths. Therefore, due to epimuscular myofascial force transmission, muscle length-force characteristics are variable and muscle length range of force exertion cannot be considered as a fixed property of the muscle. The findings reviewed presently show that acutely, the mechanical mechanisms manipulated in remedial surgery are dominated by epimuscular myofascial force transmission. Conceivably, this is also true for the mechanism of adaptation during and after recovery from surgery. Moreover, stiffened epimuscular connections and therefore a stiffened integral system of intra- and epimuscular myofascial force transmission are indicated to affect the properties of spastic muscle. We suggest that important advancements in our present understanding of such properties, variability in the outcome of surgery and considerable recurrence of the impeded function after recovery cannot be made without taking into account the effects of epimuscular myofascial force transmission.

Structural and functional features of human muscle-tendon unit

This paper reviews the architectural details and the in vivo behavior of the human muscle-tendon unit with the focus on the triceps surae and quadriceps femoris muscles. Recent advances in experimental techniques allow in vivo measurements of muscle-tendon architecture and function. In particular, the use of ultrasonography for measurement of tendon and muscle has expanded our knowledge in the last decade. Furthermore, the nuclear magnetic resonance imaging is opening up new insights not only for three-dimensional anatomical information but also for examining musculo-skeletal motion in vivo. While these two completely non-invasive methods provide kinematic data, in vivo force measurements still require somewhat invasive procedures and are scarce. Thus, muscle forces are frequently calculated using both simple and complex models. These models can give us suggestions for further experimental work. There is a need to examine the experimental data ranging from single-fiber experiments to the muscle function in human movement in order to understand the muscle-tendon function in vivo fully. Furthermore, appreciation of the structure-function relationships may help us to understand the entity of muscle-tendon function both from the perspective of mechanical behavior and neural control.

Intermuscular Interaction between Synergists in Rat Originates from both Intermuscular and Extramuscular Myofascial Force Transmission

The purpose of the present study is to investigate the origin of mechanical interactions between the rat extensor digitorum longus (EDL) muscle and the grouped tibialis anterior and extensor hallucis longus muscles (TA+EHL). The proximal and distal tendons of EDL as well as the tied distal tendons of TA+EHL were transected and connected to force transducers. Connective tissues at the muscle bellies of the anterior crural compartment were left intact. Supramaximal stimulation of the common peroneal nerve activated all muscles maximally and simultaneously. Length-isometric force characteristics of distal TA+EHL were assessed. Simultaneously, forces exerted at the proximal and distal tendons of EDL, kept at constant muscle-tendon complex length and position, were measured. Intermuscular interaction was tested in two conditions: (a) after full longitudinal compartmental fasciotomy, and (b) after blunt dissection of the intermuscular connective tissue linkages between EDL and TA+EHL. Note that in the latter condition, intermuscular myofascial pathways were eliminated. In the initial condition, lengthening TA+EHL by 12 mm increased proximal (by 0.14 N, i.e. 9.5%) and decreased distal EDL force (by 0.21 N, i.e. 11.8%), despite the fact that EDL muscle-tendon complex length was kept constant. Blunt dissection decreased TA+EHL and distal EDL forces at low TA+EHL lengths only, while proximal EDL force decreased for all TA+EHL lengths tested. The dissection caused no changes in the TA+EHL length effects on proximal EDL force. In contrast, the amplitude of change in the distal EDL force curve decreased significantly (by 39%) subsequent to blunt dissection. It is concluded that mechanical interaction between synergists originates from both intermuscular as well as extramuscular connective tissues. The highest contribution, however, should be ascribed to the extramuscular pathway.

Adaptation of muscle size and myofascial force transmission: a review and some new experimental results

This paper considers the literature and some new experimental results important for adaptation of muscle fiber cross-sectional area and serial sarcomere number. Two major points emerge: (1) general rules for the regulation of adaptation (for in vivo immobilization, low gravity conditions, synergist ablation, tenotomy and retinaculum trans-section experiments) cannot be derived. As a consequence, paradoxes are reported in the literature. Some paradoxes are resolved by considering the interaction between different levels of organization (e.g. muscle geometrical effects), but others cannot. (2) An inventory of signal transduction pathways affecting rates of muscle protein synthesis and/or degradation reveals controversy concerning the pathways and their relative contributions. A major explanation for the above is not only the inherently limited control of the experimental conditions in vivo, but also of in situ experiments. Culturing of mature single Xenopus muscle fibers at high and low lengths (allowing longitudinal study of adaptation for periods up to 3 months) did not yield major changes in the fiber cross-sectional area or the serial sarcomere number. This is very different from substantial effects (within days) of immobilization in vivo. It is concluded that overall strain does not uniquely regulate muscle fiber size. Force transmission, via pathways other than the myotendinous junctions, may contribute to the discrepancies reported: because of substantial serial heterogeneity of sarcomere lengths within muscle fibers creating local variations in the mechanical stimuli for adaptation. For the single muscle fiber, mechanical signalling is quite different from the in vivo or in vitro condition. Removal of tensile and shear effects of neighboring tissues (even of antagonistic muscle) modifies or removes mechanical stimuli for adaptation. It is concluded that the study of adaptation of muscle size requires an integrative approach taking into account fundamental mechanisms of adaptation, as well as effects of higher levels of organization. More attention should be paid to adaptation of connective tissues within and surrounding the muscle and their effects on muscular properties.

Pre-strained epimuscular connections cause muscular myofascial force transmission to affect properties of synergistic EHL and EDL muscles of the rat

BACKGROUND

Myofascial force transmission occurs between muscles (intermuscular myofascial force transmission) and from muscles to surrounding nonmuscular structures such as neurovascular tracts and bone (extramuscular myofascial force transmission). The purpose was to investigate the mechanical role of the epimuscular connections (the integral system of inter- and extramuscular connections) as well as the isolated role of extramuscular connections on myofascial force transmission and to test the hypothesis, if such connections are prestrained.

METHOD OF APPROACH

Length-force characteristics of extensor hallucis longus (EHL) muscle of the rat were measured in two conditions: (I) with the neighboring EDL muscle and epimuscular connections of the muscles intact: EDL was kept at a constant muscle tendon complex length. (II) After removing EDL, leaving EHL with intact extramuscular connections exclusively.

RESULTS

(I) Epimuscular connections of the tested muscles proved to be prestrained significantly. (1) Passive EHL force was nonzero for all isometric EHL lengths including very low lengths, increasing with length to approximately 13% of optimum force at high length. (2) Significant proximodistal EDL force differences were found at all EHL lengths: Initially, proximal EDL force = 1.18 +/- 0.11 N, where as distal EDL force = 1.50 +/- 0.08 N (mean +/- SE). EHL lengthening decreased the proximo-distal EDL force difference significantly (by 18.4%) but the dominance of EDL distal force remained. This shows that EHL lengthening reduces the prestrain on epimuscular connections via intermuscular connections; however; the prestrain on the extramuscular connections of EDL remains effective. (II) Removing EDL muscle affected EHL forces significantly. (1) Passive EHL forces decreased at all muscle lengths by approximately 17%. However, EHL passive force was still non-zero for the entire isometric EHL length range, indicating pre-strain of extramuscular connections of EHL. This indicates that a substantial part of the effects originates solely from the extramuscular connections of EHL. However, a role for intermuscular connections between EHL and EDL, when present, cannot be excluded. (2) Total EHL forces included significant shape changes in the length-force curve (e.g., optimal EHL force decreased significantly by 6%) showing that due to myofascial force transmission muscle length-force characteristics are not specific properties of individual muscles.

CONCLUSIONS

The pre-strain in the epimuscular connections of EDL and EHL indicate that these myofascial pathways are sufficiently stiff to transmit force even after small changes in relative position of a muscle with respect to its neighboring muscular and nonmuscular tissues. This suggests the likelihood of such effects also in vivo.

Controlled intermittent shortening contractions of a muscle–tendon complex: muscle fibre damage and effects on force transmission from a single head of rat EDL

This study was performed to examine effects of prolonged (3 h) intermittent shortening (amplitude 2 mm) contractions (muscles were excited maximally) of head III of rat extensor digitorum longus muscle (EDL III) on indices of muscle damage and on force transmission within the intact anterior crural compartment. Three hours after the EDL III exercise, muscle fibre damage, as assessed by immunohistochemical staining of structural proteins (i.e. dystrophin, desmin, titin, laminin-2), was found in EDL, tibialis anterior (TA) and extensor hallucis longus (EHL) muscles. The damaged muscle fibres were not uniformly distributed throughout the muscle cross-sections, but were located predominantly near the interface of TA and EDL muscles as well as near intra- and extramuscular neurovascular tracts. In addition, changes were observed in desmin, muscle ankyrin repeat protein 1, and muscle LIM protein gene expression: significantly (P<0.01) higher (1.3, 45.5 and 2.3-fold, respectively) transcript levels compared to the contralateral muscles. Post-EDL III exercise, length-distal force characteristics of EDL III were altered significantly (P<0.05): at high EDL III lengths, active forces decreased and the length range between active slack length and optimum length increased. For all EDL III lengths tested, proximal passive and active force of EDL decreased. The slope of the EDL III length-TA+EHL force curve decreased, which indicates a decrease of the degree of intermuscular interaction between EDL III and TA+EHL. It is concluded that prolonged intermittent shortening contractions of a single head of multi-tendoned EDL muscle results in structural damage to muscle fibres as well as altered force transmission within the compartment. A possible role of myofascial force transmission is discussed.

Spastic muscle properties are affected by length changes of adjacent structures

Recent animal experiments have shown that up to 37% of muscle force may be transmitted to adjacent structures rather than reach the insertion of the muscle's tendon, and that the extent of such force transmission depends on the length and relative position of these structures. We tested whether the force-length characteristics of the distally tenotomized human flexor carpi ulnaris muscle (FCU) of nine patients with cerebral palsy varied with the change of relative length of adjacent structures induced by a change of wrist position. In four patients, the FCU exerted up to 40% more active force in a flexed wrist position at short FCU length, whereas the active force was not significantly higher in the other five. In the same manner, passive force-length characteristics of the spastic FCU changed upon changes in wrist position. Variability in myofascial force transmission may partly explain the variability in success of the FCU-transfer.

Muscle force is determined also by muscle relative position: isolated effects

Effects on force of changes of the position of extensor digitorum longus muscle (EDL) relative to surrounding tissues were investigated in rat. Connective tissue at the muscle bellies of tibialis anterior (TA), extensor hallucis longus (EHL) and EDL was left intact, to allow myofascial force transmission. The position of EDL muscle was altered, without changing EDL muscle-tendon complex length, and force exerted at proximal and distal tendons of EDL as well as summed force exerted at the distal tendons of TA and EHL muscles (TA+EHL) were measured. Proximal and distal EDL forces as well as distal TA+EHL force changed significantly on repositioning EDL muscle. These muscle position-force characteristics were assessed at two EDL lengths and two TA+EHL lengths. It was shown that changes of muscle force with length changes of a muscle is the result of the length changes per se, as well as of changes of relative position of parts of the muscle. It is concluded that in addition to length, muscle position relative to its surroundings co-determines isometric muscle force.

Effects of inter- and extramuscular myofascial force transmission on adjacent synergistic muscles: assessment by experiments and finite-element modeling

The effects of inter- and extramuscular myofascial force transmission on muscle length force characteristics were studied in rat. Connective tissues at the bellies of the experimental synergistic muscles of the anterior crural compartment were left intact. Extensor digitorium longus (EDL) muscle was lengthened distally whereas tibialis anterior (TA) and extensor hallucis longus (EHL) were kept at constant muscle-tendon complex length. Substantial differences were found in EDL force measured at the proximal and distal tendons (maximally 46% of the proximal force). EDL with intact inter- as well as extramuscular connections had an increased length range between active slack and optimum length compared to EDL with extramuscular connections exclusively: optimum muscle length was shifted by more than 2 mm. Distal EDL lengthening caused the distal force exerted by TA+EHL complex to decrease (approximately 17% of the initial force). This indicates increased intermuscular myofascial force transmission from TA+EHL muscle complex to EDL muscle. Finite-element modeling showed that: (1) Inter- and extramuscular myofascial force transmission leads to a substantial distribution of the lengths of the sarcomeres arranged in series within muscle fibers. Distribution of stress within the muscle fibers showed that the muscle fiber cannot be considered as a unit exerting equal forces at both ends. (2) Increased heterogeneity of mean fiber sarcomere lengths (i.e., a "parallel" distribution of length of sarcomeres among different muscle fibers) is found, particularly at high muscle lengths. This also explains the shift in muscle optimum length to higher lengths. It is concluded that inter- and extramuscular myofascial force transmission has substantial effects on muscle length-force characteristics.

Myofascial force transmission between a single muscle head and adjacent tissues: length effects of head III of rat EDL

Force transmission from muscle fibers via the connective tissue network (i.e., myofascial force transmission) is an important determinant of muscle function. This study investigates the role of myofascial pathways for force transmission from multitendoned extensor digitorum longus (EDL) muscle within an intact anterior crural compartment. Effects of length changes exclusively of head III of rat EDL muscle (EDL III) on myofascial force transmission were assessed. EDL III was lengthened at the distal tendon. For different lengths of EDL III, isometric forces were measured at the distal tendon of EDL III, as well as at the proximal tendon of whole EDL and at the distal tendons of tibialis anterior and extensor hallucis longus (TA+EHL) muscles. Lengthening of EDL III caused high changes in force exerted at the distal tendon of EDL III (from 0 to 1.03 +/- 0.07 N). In contrast, only minor changes were found in force exerted at the proximal EDL tendon (from 2.37 +/- 0.09 to 2.53 +/- 0.10 N). Increasing the length of EDL III decreased TA+EHL force significantly (by 7%, i.e., from 5.62 +/- 0.27 to 5.22 +/- 0.32 N). These results show that force is transmitted between EDL III and adjacent tissues via myofascial pathways. Optimal force exerted at the distal tendon of EDL III (1.03 +/- 0.07 N) was more than twice the force expected on the basis of the physiological cross-sectional area of EDL III muscle fibers (0.42 N). Therefore, a substantial fraction of this force must originate from sources other than EDL III. It is concluded that myofascial pathways play an important role in force transmission from multitendoned muscles.

The Relative Position of EDL Muscle Affects the Length of Sarcomeres Within Muscle Fibers: Experimental Results and Finite-Element Modeling

Background : Effects of extramuscular connective tissues on muscle force (experimentally measured) and lengths of sarcomeres (modeled) were investigated in rat. It was hypothesized that changes of muscle-relative position affect the distribution of lengths of sarcomeres within muscle fibers. Method of approach: The position of extensor digitorum longus muscle (EDL) relative to intact extramuscular connective tissues of the anterior crural compartment was manipulated without changing its muscle-tendon complex length. Results: Significant effects of EDL muscle relative position on proximal and distal EDL forces were found, indicating changes of extramuscular myofascial force transmission. EDL isometric force exerted at its proximal and distal tendons differed significantly. Finite-element modeling showed that the distribution of lengths of sarcomeres is altered by changes of muscle-relative position. Conclusions: It is concluded that forces exerted on a muscle via extramuscular myofascial pathways augment distributions of lengths of sarcomeres within that muscle.