Achilles tendon mechanical properties during walking and running are underestimated when its curvature is not accounted for

Effects of a 12-week gait retraining program on the Achilles tendon adaptation of habitually shod runners

PURPOSE

This study investigated the effects of a 12-week gait retraining program on the morphological and mechanical properties of the Achilles tendon (AT) during running on the basis of real-time dynamic ultrasound imaging.

METHODS

A total of 30 male recreational runners who were used to wearing cushioned shoes with a rearfoot strike (RFS) pattern were recruited. They were randomized into a retraining group (RG, n = 15) and a control group (CG, n = 15). The RG group was asked to run in five-fingered minimalist shoes with a forefoot strike (FFS) pattern, and the CG group was asked to keep their strike pattern. Three training sessions were performed per week. All the participants in RG uploaded running tracks obtained through a mobile application (.jpg) after each session for training supervision. The ground reaction force, kinematics, and kinetics of the ankle joint at 10 km/h were collected using an instrumented split-belt treadmill and a motion capture system. The morphological (length and cross-sectional area) and mechanical characteristics (force, stress, strain, etc.) of AT in vivo were recorded and calculated with a synchronous ultrasonic imaging instrument before and after the intervention. Repeated two-way ANOVA was used to compare the aforementioned parameters.

RESULTS

A total of 28 participants completed the training. The strike angle of RG after training was significantly smaller than that before training and significantly smaller than that of CG after training (F (1, 13)  = 23.068, p < 0.001, partial η2  = 0.640). The length (F (1, 13)  = 10.086, p = 0.007, partial η2  = 0.437) and CSA (F (1, 13)  = 7.475, p = 0.017, partial η2  = 0.365) of AT in RG increased after training. A significant main effect for time was observed for the time-to-peak AT force (F (1, 13)  = 5.225, p = 0.040, partial η2  = 0.287), average (F (1, 13)  = 7.228, p = 0.019, partial η2  = 0.357), and peak AT loading rate (F (1, 13)  = 11.687, p = 0.005, partial η2  = 0.473).

CONCLUSION

Preliminary evidence indicated that a 12-week gait retraining program could exert a beneficial effect on AT. 57% (8/14) runners in RG shifted from RFS to FFS pattern. Although not all runners were categorized as FFS pattern after the intervention, their foot strike angle was reduced. Retraining primarily positively promoted AT morphological properties (i.e., CSA and length) to strengthen AT capability for mechanical loading.

ISB clinical biomechanics award winner 2023: Medial gastrocnemius muscle and Achilles tendon interplay during gait in cerebral palsy

BACKGROUND

The interplay between the medial gastrocnemius muscle and the Achilles tendon is crucial for efficient walking. In cerebral palsy, muscle and tendon remodelling alters the role of contractile and elastic components. The aim was to investigate the length changes of medial gastrocnemius belly and fascicles, and Achilles tendon to understand their interplay to gait propulsion in individuals with cerebral palsy.

METHODS

Twelve young individuals with cerebral palsy and 12 typically developed peers were assessed during multiple gait cycles using 3D gait analysis combined with a portable ultrasound device. By mapping ultrasound image locations into the shank reference frame, the medial gastrocnemius belly, fascicle, and Achilles tendon lengths were estimated throughout the gait cycle. Participants with cerebral palsy were classified into equinus and non-equinus groups based on their sagittal ankle kinematics.

FINDINGS

In typically developed participants, the Achilles tendon undertook most of the muscle-tendon unit lengthening during stance, whereas in individuals with cerebral palsy, this lengthening was shared between the medial gastrocnemius belly and Achilles tendon, which was more evident in the equinus group. The lengthening behaviour of the medial gastrocnemius fascicles resembled that of the Achilles tendon in cerebral palsy.

INTERPRETATION

The findings revealed similar length changes of the medial gastrocnemius fascicles and Achilles tendon, highlighting the enhanced role of the muscle in absorbing energy during stance in cerebral palsy. These results, together with the current knowledge of increased intramuscular stiffness, suggest the exploitation of intramuscular passive forces for such energy absorption.

Correlations between Achilles tendon material and structural properties and quantitative magnetic resonance imagining in different athletic populations

Achilles tendon stiffness (kAT) and Young's modulus (yAT) are important determinants of tendon function. However, their evaluation requires sophisticated equipment and time-consuming procedures. The goal of this study was twofold: to compare kAT and yAT between populations using the classical approach proposed in the literature (a combination of ultrasound and force data) and the MRI technique to understand the MRI's capability in determining differences in kAT and yAT. Furthermore, we investigated potential correlations between short and long T2* relaxation time, kAT and yAT to determine whether T2* relaxation time may be associated with material or structural properties. Twelve endurance and power athlete, and twelve healthy controls were recruited. AT T2* short and long components were measured using standard gradient echo MRI at rest, while kAT and yAT were evaluated using the classical method (combination of ultrasound and dynamometric measurements). Power athletes had the highest kAT (3064 ± 260, 2714 ± 260 and 2238 ± 189 N/mm for power athletes, endurance athletes and healthy control, respectively) and yAT (2.39 ± 0.28, 1.64 ± 0.22 and 1.97 ± 0.32 GPa for power athletes, endurance athletes and healthy control, respectively) and the lowest T2* short component (0.58 ± 0.07, 0.77 ± 0.06 and 0.74 ± 0.08 ms for power athletes, endurance athletes and healthy control, respectively). Endurance athletes had the highest T2* long component value. No correlations were reported between T2* long component, kAT or yAT in the investigated populations, whereas the T2* short component was negatively correlated with yAT. These results suggest that T2* short component could be used to investigate the differences in AT material properties in different populations.

Impairments in muscle shape changes affect metabolic demands during in-vivo contractions

The uncoupling behaviour between muscle belly and fascicle shortening velocity (i.e. belly gearing), affects mechanical output by allowing the muscle to circumvent the limits imposed by the fascicles' force-velocity relationship. However, little is known about the 'metabolic effect' of a decrease/increase in belly gearing. In this study, we manipulated the plantar flexor muscles' capacity to change in shape (and hence belly gearing) by using compressive multidirectional loads. Metabolic, kinetic, electromyography activity and ultrasound data (in soleus and gastrocnemius medialis) were recorded during cyclic fixed-end contractions of the plantar flexor muscles in three different conditions: no load, +5 kg and +10 kg of compression. No differences were observed in mechanical power and electrophysiological variables as a function of compression intensity, whereas metabolic power increased as a function of it. At each compression intensity, differences in efficiency were observed when calculated based on fascicle or muscle behaviour and significant positive correlations (R2 range: 0.7-0.8 and p > 0.001) were observed between delta efficiency (ΔEff: Effmus-Efffas) and belly gearing (Vmus/Vfas) or ΔV (Vmus-Vfas). Thus, changes in the muscles' capacity to change in shape (e.g. in muscle stiffness or owing to compressive garments) affect the metabolic demands and the efficiency of muscle contraction.

Towards modern understanding of the Achilles tendon properties in human movement research

The Achilles tendon (AT) is the strongest tendon in humans, yet it often suffers from injury. The mechanical properties of the AT afford efficient movement, power amplification and power attenuation during locomotor tasks. The properties and the unique structure of the AT as a common tendon for three muscles have been studied frequently in humans using in vivo methods since 1990's. As a part of the celebration of 50 years history of the International Society of Biomechanics, this paper reviews the history of the AT research focusing on its mechanical properties in humans. The questions addressed are: What are the most important mechanical properties of the Achilles tendon, how are they studied, what is their significance to human movement, and how do they adapt? We foresee that the ongoing developments in experimental methods and modeling can provide ways to advance knowledge of the complex three-dimensional structure and properties of the Achilles tendon in vivo, and to enable monitoring of the loading and recovery for optimizing individual adaptations.

The interplay between gastrocnemius medialis force-length and force-velocity potentials, cumulative EMG activity and energy cost at speeds above and below the walk to run transition speed

NEW FINDINGS

What is the central question of the study? Are the changes in force potentials (at the muscle level) related with metabolic changes at speeds above and below the walk-to-run transition? What is the main finding and its importance? The force-length and force-velocity potentials of gastrocnemius medialis during human walking decrease as a function of speed; this decrease is associated with an increase in cumulative EMG activity and in the energy cost of locomotion. Switching from fast walking to running is associated to an increase in the force potentials, supporting the idea that the 'metabolic trigger' that determines the transition from walking to running is ultimately driven by a reduction of the muscle's contractile capacity.

ABSTRACT

The aim of this study was to investigate the interplay between the force-length (F-L) and force-velocity (F-V) potentials of gastrocnemius medialis (GM) muscle fascicles, the cumulative muscle activity per distance travelled (CMAPD) of the lower limb muscles (GM, vastus lateralis, biceps femori, tibialis anterior) and net energy cost (Cnet ) during walking and running at speeds above and below the walk-to-run transition speed (walking: 2-8 km h-1 ; running: 6-10 km h-1 ). A strong association was observed between Cnet and CMAPD: both changed significantly with walking speed but were unaffected by speed in running. The F-L and F-V potentials decreased with speed in both gaits and, at 6-8 km h-1 , were significantly larger in running. At low to moderate walking speeds (2-6 km h-1 ), the changes in GM force potentials were not associated with substantial changes in CMAPD (and Cnet ), whereas at walking speeds of 7-8 km h-1 , even small changes in force potentials were associated with steep increases in CMAPD (and Cnet ). These data suggest that: (i) the walk to run transition could be explained by an abrupt increase in Cnet driven by an upregulation of the EMG activity (e.g., in CMAPD) at sustained walking speeds (>7 km h-1 ) and (ii) the reduction in the muscle's ability to produce force (e.g., in the F-L and F-V potentials) contributes to the increase in CMAPD (and Cnet ). Switching to running allows regaining of high force potentials, thus limiting the increase in CMAPD (and Cnet ) that would otherwise occur to sustain the increase in locomotion speed.

Achilles Tendon Mechanical Behavior and Ankle Joint Function at the Walk-to-Run Transition

Walking at speeds higher than transition speed is associated with a decrease in the plantar-flexor muscle fibres’ ability to produce force and, potentially, to an impaired behaviour of the muscle−tendon unit (MTU) elastic components. This study aimed to investigate the ankle joint functional indexes and the Achilles tendon mechanical behaviour (changes in AT force and power) to better elucidate the mechanical determinants of the walk-to-run transition. Kinematics, kinetic and ultrasound data of the gastrocnemius medialis (GM) were investigated during overground walking and running at speeds ranging from 5−9 km·h−1. AT and GM MTU force and power were calculated during the propulsive phase; the ankle joint function indexes (damper, strut, spring and motor) were obtained using a combination of kinetic and kinematic data. AT force was larger in running at speeds > 6.5 km/h. The contribution of AT to the total power provided by the GM MTU was significantly larger in running at speeds > 7.5 km/h. The spring and strut indexes of the ankle were significantly larger in running at speeds > 7.5 km/h. These data suggest that the walk-to-run transition could (at least partially) be explained by the need to preserve AT mechanical behaviour and the ankle spring function.