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Cabral HV, Inglis JG, Cudicio A, Cogliati M, Orizio C, Yavuz US, Negro F. Muscle contractile properties directly influence shared synaptic inputs to spinal motor neurons. J Physiol 2024; 602:2855-2872. [PMID: 38709959 DOI: 10.1113/jp286078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/18/2024] [Indexed: 05/08/2024] Open
Abstract
Alpha band oscillations in shared synaptic inputs to the alpha motor neuron pool can be considered an involuntary source of noise that hinders precise voluntary force production. This study investigated the impact of changing muscle length on the shared synaptic oscillations to spinal motor neurons, particularly in the physiological tremor band. Fourteen healthy individuals performed low-level dorsiflexion contractions at ankle joint angles of 90° and 130°, while high-density surface electromyography (HDsEMG) was recorded from the tibialis anterior (TA). We decomposed the HDsEMG into motor units spike trains and calculated the motor units' coherence within the delta (1-5 Hz), alpha (5-15 Hz), and beta (15-35 Hz) bands. Additionally, force steadiness and force spectral power within the tremor band were quantified. Results showed no significant differences in force steadiness between 90° and 130°. In contrast, alpha band oscillations in both synaptic inputs and force output decreased as the length of the TA was moved from shorter (90°) to longer (130°), with no changes in delta and beta bands. In a second set of experiments (10 participants), evoked twitches were recorded with the ankle joint at 90° and 130°, revealing longer twitch durations in the longer TA muscle length condition compared to the shorter. These experimental results, supported by a simple computational simulation, suggest that increasing muscle length enhances the muscle's low-pass filtering properties, influencing the oscillations generated by the Ia afferent feedback loop. Therefore, this study provides valuable insights into the interplay between muscle biomechanics and neural oscillations. KEY POINTS: We investigated whether changes in muscle length, achieved by changing joint position, could influence common synaptic oscillations to spinal motor neurons, particularly in the tremor band (5-15 Hz). Our results demonstrate that changing muscle length from shorter to longer induces reductions in the magnitude of alpha band oscillations in common synaptic inputs. Importantly, these reductions were reflected in the oscillations of muscle force output within the alpha band. Longer twitch durations were observed in the longer muscle length condition compared to the shorter, suggesting that increasing muscle length enhances the muscle's low-pass filtering properties. Changes in the peripheral contractile properties of motor units due to changes in muscle length significantly influence the transmission of shared synaptic inputs into muscle force output. These findings prove the interplay between muscle mechanics and neural adaptations.
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Affiliation(s)
- Hélio V Cabral
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - J Greig Inglis
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Alessandro Cudicio
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Marta Cogliati
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Claudio Orizio
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Utku S Yavuz
- Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
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2
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Almansoof HS, Nuhmani S, Muaidi Q. Role of kinetic chain in sports performance and injury risk: a narrative review. J Med Life 2023; 16:1591-1596. [PMID: 38406779 PMCID: PMC10893580 DOI: 10.25122/jml-2023-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/02/2023] [Indexed: 02/27/2024] Open
Abstract
The kinetic chain refers to the body's intricate coordination of various segments to perform a specific activity involving precise positioning, timing, and speed. This process is based on task-oriented and activity-specific pre-programmed muscle activation patterns enhanced by repeated practice. It demands muscular eccentric strength, joint flexibility, and musculotendinous elastic energy storage. The body core (lumbopelvic-hip complex) forms the kinetic chains' central point of activities in most sports because it facilitates load transfers to and from the limbs. The kinetic chain relationship with fascia, peripheral nerves, and tensegrity is fundamental to holistic human body movements. The kinetic chain function demands neuromuscular, sensorimotor, and neurocognitive control. Any blockage or defect in the kinetic chain can develop compensatory patterns, high demands on distal parts, and overuse and overload injuries. Taking a holistic approach and evaluating the integrity of the kinetic chain in athletes can significantly enhance efforts to improve sports performance and mitigate injury risk.
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Affiliation(s)
- Haifa Saleh Almansoof
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Qassim Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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3
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A Minimal Sensor Inertial Measurement Unit System Is Replicable and Capable of Estimating Bilateral Lower-Limb Kinematics in a Stationary Bodyweight Squat and a Countermovement Jump. J Appl Biomech 2023; 39:42-53. [PMID: 36652950 DOI: 10.1123/jab.2022-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 01/19/2023]
Abstract
This study aimed to validate a 7-sensor inertial measurement unit system against optical motion capture to estimate bilateral lower-limb kinematics. Hip, knee, and ankle sagittal plane peak angles and range of motion (ROM) were compared during bodyweight squats and countermovement jumps in 18 participants. In the bodyweight squats, left peak hip flexion (intraclass correlation coefficient [ICC] = .51), knee extension (ICC = .68) and ankle plantar flexion (ICC = .55), and hip (ICC = .63) and knee (ICC = .52) ROM had moderate agreement, and right knee ROM had good agreement (ICC = .77). Relatively higher agreement was observed in the countermovement jumps compared to the bodyweight squats, moderate to good agreement in right peak knee flexion (ICC = .73), and right (ICC = .75) and left (ICC = .83) knee ROM. Moderate agreement was observed for right ankle plantar flexion (ICC = .63) and ROM (ICC = .51). Moderate agreement (ICC > .50) was observed in all variables in the left limb except hip extension, knee flexion, and dorsiflexion. In general, there was poor agreement for peak flexion angles, and at least moderate agreement for joint ROM. Future work will aim to optimize methodologies to increase usability and confidence in data interpretation by minimizing variance in system-based differences and may also benefit from expanding planes of movement.
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Merry K, Napier C, Waugh CM, Scott A. Foundational Principles and Adaptation of the Healthy and Pathological Achilles Tendon in Response to Resistance Exercise: A Narrative Review and Clinical Implications. J Clin Med 2022; 11:4722. [PMID: 36012960 PMCID: PMC9410084 DOI: 10.3390/jcm11164722] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Therapeutic exercise is widely considered a first line fundamental treatment option for managing tendinopathies. As the Achilles tendon is critical for locomotion, chronic Achilles tendinopathy can have a substantial impact on an individual's ability to work and on their participation in physical activity or sport and overall quality of life. The recalcitrant nature of Achilles tendinopathy coupled with substantial variation in clinician-prescribed therapeutic exercises may contribute to suboptimal outcomes. Further, loading the Achilles tendon with sufficiently high loads to elicit positive tendon adaptation (and therefore promote symptom alleviation) is challenging, and few works have explored tissue loading optimization for individuals with tendinopathy. The mechanism of therapeutic benefit that exercise therapy exerts on Achilles tendinopathy is also a subject of ongoing debate. Resultingly, many factors that may contribute to an optimal therapeutic exercise protocol for Achilles tendinopathy are not well described. The aim of this narrative review is to explore the principles of tendon remodeling under resistance-based exercise in both healthy and pathologic tissues, and to review the biomechanical principles of Achilles tendon loading mechanics which may impact an optimized therapeutic exercise prescription for Achilles tendinopathy.
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Affiliation(s)
- Kohle Merry
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Christopher Napier
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Charlie M. Waugh
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
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5
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Relationship of Vertical Jump Performance and Ankle Joint Range of Motion: Effect of Knee Joint Angle and Handedness in Young Adult Handball Players. Sports (Basel) 2022; 10:sports10060086. [PMID: 35736826 PMCID: PMC9228190 DOI: 10.3390/sports10060086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/14/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of the study is to examine the effect of the ankle joint range of motion (ROM) on the vertical jump (VJ) performance of adult handball players. The active (ACT) and passive (PAS) ankle joint ROM of 12 male members of the U21 National Handball Team with the knee joint at 0°, 40°, and 90° flexion (0° = fully extended knee) was evaluated using a video analysis measuring method. Participants also performed maximum VJ with (CMJ) and without (SQJ) countermovement, as well as with (AS) and without (NAS) an arm swing. Statistical analyses included 2 × 2 × 3 MANOVA, 2 × 2 repeated measures ANOVA, and Pearson’s correlation. Results reveal that PAS-ROM was larger (p < 0.05) in all knee joint flexion angles. ROM was smaller (p < 0.05) by approximately 10° at 0° compared to 90° knee flexion. No lateral effects on ROM due to the handedness of the players were observed. AS and CM resulted in increased jump height (p < 0.05). Finally, ACT-ROM when the knee joint was flexed at 40° was highly correlated (r ≥ 0.66, p < 0.05) with VJ performance except for CMJ-AS. In conclusion, the differences in the bi-articular gastrocnemius muscle flexibility due to the alteration of the angular position of the examined joints affected the ability to generate impulse during the VJ tests.
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Cho S, Lee KD, Park HS. A Mobile Cable-Tensioning Platform to Improve Crouch Gait in Children with Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1092-1102. [PMID: 35442888 DOI: 10.1109/tnsre.2022.3167472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Gait impairment represented by crouch gait is the main cause of decreases in the quality of lives of children with cerebral palsy. Various robotic rehabilitation interventions have been used to improve gait abnormalities in the sagittal plane of children with cerebral palsy, such as excessive flexion in the hip and knee joints, yet in few studies have postural improvements in the coronal plane been observed. The aim of this study was to design and validate a gait rehabilitation system using a new cable-driven mechanism applying assist in the coronal plane. We developed a mobile cable-tensioning platform that can control the magnitude and direction of the tension vector applied at the knee joints during treadmill walking, while minimizing the inertia of the worn part of the device for less obstructing the natural movement of the lower limbs. To validate the effectiveness of the proposed system, three different treadmill walking conditions were performed by four children with cerebral palsy. The experimental results showed that the system reduced hip adduction angle by an average of 4.57 ± 1.79° compared to unassisted walking. Importantly, we also observed improvements of hip joint kinematics in the sagittal plane, indicating that crouch gait can be improved by postural correction in the coronal plane. The device also improved anterior and lateral pelvic tilts during treadmill walking. The proposed cable-tensioning platform can be used as a rehabilitation system for crouch gait, and more specifically, for correcting gait posture with minimal disturbance to the voluntary movement.
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7
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Yeh CH, Calder JD, Antflick J, Bull AMJ, Kedgley AE. Maximum dorsiflexion increases Achilles tendon force during exercise for midportion Achilles tendinopathy. Scand J Med Sci Sports 2021; 31:1674-1682. [PMID: 33864294 DOI: 10.1111/sms.13974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
Rehabilitation is an important treatment for non-insertional Achilles tendinopathy. To date, eccentric loading exercises (ECC) have been the predominant choice; however, mechanical evidence underlying their use remains unclear. Other protocols, such as heavy slow resistance loading (HSR), have shown comparable outcomes, but with less training time. This study aims to identify the effect of external loading and other variables that influence Achilles tendon (AT) force in ECC and HSR. Ground reaction force and kinematic data during ECC and HSR were collected from 18 healthy participants for four loading conditions. The moment arms of the AT were estimated from MRIs of each participant. AT force then was calculated using the ankle torque obtained from inverse dynamics. In the eccentric phase, the AT force was not larger than in the concentric phase in both ECC and HSR. Under the same external load, the force through the AT was larger in ECC with the knee bent than in HSR with the knee straight due to increased dorsiflexion angle of the ankle. Multivariate regression analysis showed that external load and maximum dorsiflexion angle were significant predictors of peak AT force in both standing and seated positions. Therefore, to increase the effectiveness of loading the AT, exercises should apply adequate external load and reach maximum dorsiflexion during the movement. Peak dorsiflexion angle affected the AT force in a standing position at twice the rate of a seated position, suggesting standing could prove more effective for the same external loading and peak dorsiflexion angle.
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Affiliation(s)
- Chia-Han Yeh
- Department of Bioengineering, Imperial College London, London, UK
| | - James D Calder
- Department of Bioengineering, Imperial College London, London, UK.,Fortius Clinic, London, UK
| | | | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College London, London, UK
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8
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Panoutsakopoulos V, Kotzamanidou MC, Papaiakovou G, Kollias IA. The Ankle Joint Range of Motion and Its Effect on Squat Jump Performance with and without Arm Swing in Adolescent Female Volleyball Players. J Funct Morphol Kinesiol 2021; 6:jfmk6010014. [PMID: 33546291 PMCID: PMC7931004 DOI: 10.3390/jfmk6010014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 11/16/2022] Open
Abstract
A flexible ankle joint is suggested to be a contributing factor for vertical squat jump (SQJ) performance. The purpose of the study was to investigate the effect of the active (ACT) and passive (PAS) ankle joint range of motion (ROM) on SQJ performed by adolescent female volleyball players. ACT and PAS ankle ROM at knee extension angles of 90, 140, and 180 degrees (180 degrees: full extension) were measured with a video analysis method for 35 female post-pubertal volleyball players (16.3 ± 1.1 yrs, 1.80 ± 0.04 m, 68.8 ± 6.8 kg). Additionally, the players fulfilling previously recommended criteria were assigned to the flexible (n = 10) and inflexible (n = 8) groups and executed SQJ with and without an arm swing on a force-plate. Results of the 2 × 2 × 3 MANOVA revealed a significant (p < 0.05) flexibility type and knee angle effect, as ankle ROM was larger in PAS compared to ACT and as the knee joint progressed from 90 to 180 degrees extension. The 2 × 2 ANOVA revealed a significant (p < 0.05) group effect, as flexible players jumped higher in the arm swing SQJ, along with a significant arm swing effect on key SQJ kinetic parameters. In conclusion, a more flexible ankle joint result in improved SQJ performance. Therefore, ankle flexibility training should be implemented in youth volleyball players.
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Affiliation(s)
- Vassilios Panoutsakopoulos
- Biomechanics Laboratory, Department of Physical Education and Sports Sciences at Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (G.P.); (I.A.K.)
- Correspondence:
| | - Mariana C. Kotzamanidou
- Faculty of Health Sciences, Metropolitan College of Thessaloniki, 54624 Thessaloniki, Greece;
| | - Georgios Papaiakovou
- Biomechanics Laboratory, Department of Physical Education and Sports Sciences at Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (G.P.); (I.A.K.)
| | - Iraklis A. Kollias
- Biomechanics Laboratory, Department of Physical Education and Sports Sciences at Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (G.P.); (I.A.K.)
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9
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Andrade RJ, Freitas SR, Hug F, Le Sant G, Lacourpaille L, Gross R, Quillard JB, McNair PJ, Nordez A. Chronic effects of muscle and nerve-directed stretching on tissue mechanics. J Appl Physiol (1985) 2020; 129:1011-1023. [PMID: 32853116 DOI: 10.1152/japplphysiol.00239.2019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Tissue-directed stretching interventions can preferentially load muscular or nonmuscular structures such as peripheral nerves. How these tissues adapt mechanically to long-term stretching is poorly understood. This randomized, single-blind, controlled study used ultrasonography and dynamometry to compare the effects of 12-wk nerve-directed and muscle-directed stretching programs versus control on maximal ankle dorsiflexion range of motion (ROM) and passive torque, shear wave velocity (SWV; an index of stiffness), and architecture of triceps surae and sciatic nerve. Sixty healthy adults were randomized to receive nerve-directed stretching, muscle-directed stretching, or no intervention (control). The muscle-directed protocol was designed to primarily stretch the plantar flexor muscle group, whereas the nerve-directed intervention targeted the sciatic nerve tract. Compared with the control group [mean; 95% confidence interval (CI)], muscle-directed intervention showed increased ROM (+7.3°; 95% CI: 4.1-10.5), decreased SWV of triceps surae (varied from -0.8 to -2.3 m/s across muscles), decreased passive torque (-6.8 N·m; 95% CI: -11.9 to -1.7), and greater gastrocnemius medialis fascicle length (+0.4 cm; 95% CI: 0.1-0.8). Muscle-directed intervention did not affect the SWV and size of sciatic nerve. Participants in the nerve-directed group showed a significant increase in ROM (+9.9°; 95% CI: 6.2-13.6) and a significant decrease in sciatic nerve SWV (> -1.8 m/s across nerve regions) compared with the control group. Nerve-directed intervention had no effect on the main outcomes at muscle and joint levels. These findings provide new insights into the long-term mechanical effects of stretching interventions and have relevance to clinical conditions where change in mechanical properties has occurred.NEW & NOTEWORTHY This study demonstrates that the mechanical properties of plantar flexor muscles and sciatic nerve can adapt mechanically to long-term stretching programs. Although interventions targeting muscular or nonmuscular structures are both effective at increasing maximal range of motion, the changes in tissue mechanical properties (stiffness) are specific to the structure being preferentially stretched by each program. We provide the first in vivo evidence that stiffness of peripheral nerves adapts to long-term loading stimuli using appropriate nerve-directed stretching.
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Affiliation(s)
- Ricardo J Andrade
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,School of Allied Health Sciences, Griffith University, Brisbane and Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sandro R Freitas
- Universidade de Lisboa, Faculdade de Motricidade Humana, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
| | - François Hug
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,Institut Universitaire de France (IUF), Paris, France.,The University of Queensland, National Health and Medical Research Council (NHMRC) Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Guillaume Le Sant
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,School of Physiotherapy (IFM3R), Nantes, France
| | - Lilian Lacourpaille
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France
| | - Raphaël Gross
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,Gait Analysis Laboratory, Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
| | - Jean-Baptiste Quillard
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France
| | - Peter J McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Antoine Nordez
- Laboratory of Movement, Interactions, Performance (EA 4334), Faculty of Sport Sciences, Nantes, University of Nantes, France.,Institut Universitaire de France (IUF), Paris, France.,Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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10
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Kwon YU. Influence of maximum-graded exercise test on maximal plantarflexion and dorsiflexion torque production in the seated and supine positions. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-183198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yong Ung Kwon
- School of Health and Human Performance, Athletic Training Program, Kean University, Union, NJ, USA
- School of Management Engineering and School of Business Administration, Ulsan National Institute of Science and Technology, Ulsan, Korea
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11
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Nordez A, Gross R, Andrade R, Le Sant G, Freitas S, Ellis R, McNair PJ, Hug F. Non-Muscular Structures Can Limit the Maximal Joint Range of Motion during Stretching. Sports Med 2018; 47:1925-1929. [PMID: 28255938 DOI: 10.1007/s40279-017-0703-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Stretching is widely used in sport training and clinical practice with the aim of increasing muscle-tendon extensibility and joint range of motion. The underlying assumption is that extensibility increases as a result of increased passive tension applied to muscle-tendon units. In some stretching protocols, this condition is not always met sufficiently to trigger adaptation within the muscle-tendon unit. For example, there is experimental evidence that both acute and chronic stretching interventions may increase the maximal range of motion in the absence of changes in the passive torque-angle curve. We contend that these results are partly explained by the influence of non-muscular structures that contribute only marginally to the passive torque. The potential candidates are the nervous system and fasciae, which would play an important role in the perception of the stretch and in the limitation of the range of motion of the maximal joints. At least in part, this may explain the lack of a significant effect of some chronic stretching interventions to change passive muscle tension.
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Affiliation(s)
- Antoine Nordez
- Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France.
| | - Raphaël Gross
- Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France.,Gait Analysis Laboratory, Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
| | - Ricardo Andrade
- Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France.,Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal
| | - Guillaume Le Sant
- Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France.,School of Physiotherapy, IFM3R, Nantes, France
| | - Sandro Freitas
- Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal.,Benfica LAB, Sport Lisboa e Benfica, Lisbon, Portugal
| | - Richard Ellis
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Peter J McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - François Hug
- Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France.,NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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12
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Andrade RJ, Freitas SR, Hug F, Le Sant G, Lacourpaille L, Gross R, McNair P, Nordez A. The potential role of sciatic nerve stiffness in the limitation of maximal ankle range of motion. Sci Rep 2018; 8:14532. [PMID: 30266928 PMCID: PMC6162234 DOI: 10.1038/s41598-018-32873-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/13/2018] [Indexed: 12/11/2022] Open
Abstract
It is a long held belief that maximal joint range of motion (ROM) is restricted by muscle tension. However, it exists indirect evidence suggesting that this assumption may not hold true for some joint configurations where non-muscular structures, such as the peripheral nerves, are stretched. Direct evidences are lacking. This study aimed to determine whether a static stretching aiming to load the sciatic nerve without stretch within plantar flexors is effective to: (i) alter nerve stiffness; and (ii) increase the ankle’s maximal ROM. Passive maximal ankle ROM in dorsiflexion was assessed with the hip flexed at 90° (HIP-flexed) or neutral (HIP-neutral, 0°). Sciatic nerve stiffness was estimated using shear wave elastography. Sciatic nerve stretching induced both a 13.3 ± 7.9% (P < 0.001) decrease in the nerve stiffness and a 6.4 ± 2.6° increase in the maximal dorsiflexion ROM assessed in HIP-flexed. In addition, the decrease in sciatic nerve stiffness was significantly correlated with the change in maximal ROM in dorsiflexion (r = −0.571, P = 0.026). These effects occurred in the absence of any change in gastrocnemius medialis and biceps femoris stiffness, and ankle passive torque. These results demonstrate that maximal dorsiflexion ROM can be acutely increased by stretching the sciatic nerve, without altering the muscle stiffness.
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Affiliation(s)
- Ricardo J Andrade
- Laboratory ≪Movement, Interactions, Performance≫ (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
| | - Sandro R Freitas
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, P-1100, Lisbon, Portugal
| | - François Hug
- Laboratory ≪Movement, Interactions, Performance≫ (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France.,Institut Universitaire de France (IUF), Paris, France.,The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Guillaume Le Sant
- Laboratory ≪Movement, Interactions, Performance≫ (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France.,School of Physiotherapy (IFM3R), Nantes, France
| | - Lilian Lacourpaille
- Laboratory ≪Movement, Interactions, Performance≫ (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
| | - Raphäel Gross
- Laboratory ≪Movement, Interactions, Performance≫ (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France.,Gait Analysis Laboratory, Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
| | - Peter McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Antoine Nordez
- Laboratory ≪Movement, Interactions, Performance≫ (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France. .,Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
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Wilke J, Schleip R, Yucesoy CA, Banzer W. Not merely a protective packing organ? A review of fascia and its force transmission capacity. J Appl Physiol (1985) 2018; 124:234-244. [DOI: 10.1152/japplphysiol.00565.2017] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Recent research indicates that fascia is capable of changing its biomechanical properties. Moreover, as it links the skeletal muscles, forming a body-wide network of multidirectional myofascial continuity, the classical conception of muscles as independent actuators has been challenged. Hence, the present synthesis review aims to characterize the mechanical relevance of the connective tissue for the locomotor system. Results of cadaveric and animal studies suggest a clinically relevant myofascial force transmission to neighboring structures within one limb (e.g., between synergists) and in the course of muscle-fascia chains (e.g., between leg and trunk). Initial in vivo trials appear to underpin these findings, demonstrating the existence of nonlocal exercise effects. However, the factors influencing the amount of transmitted force (e.g., age and physical activity) remain controversial, as well as the role of the central nervous system within the context of the observed remote exercise effects.
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Affiliation(s)
- Jan Wilke
- Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
| | - Robert Schleip
- Fascia Research Group, Neurosurgical Clinic Guenzburg of Ulm University, Ulm, Germany
| | - Can A. Yucesoy
- Institute of Biomedical Engineering, Bogazici University, Instanbul, Turkey
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
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Cho KH, Jeon Y, Lee H. Range of Motion of the Ankle According to Pushing Force, Gender and Knee Position. Ann Rehabil Med 2016; 40:271-8. [PMID: 27152277 PMCID: PMC4855121 DOI: 10.5535/arm.2016.40.2.271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the difference of range of motion (ROM) of ankle according to pushing force, gender and knee position. Methods One hundred and twenty-eight healthy adults (55 men, 73 women) between the ages of 20 and 51, were included in the study. One examiner measured the passive range of motion (PROM) of ankle by Dualer IQ Inclinometers and Commander Muscle Testing. ROM of ankle dorsiflexion (DF) and plantarflexion (PF) according to change of pushing force and knee position were measured at prone position. Results There was significant correlation between ROM and pushing force, the more pushing force leads the more ROM at ankle DF and ankle PF. Knee flexion of 90° position showed low PF angle and high ankle DF angle, as compared to the at neutral position of knee joint. ROM of ankle DF for female was greater than for male, with no significant difference. ROM of ankle PF for female was greater than male regardless of the pushing force. Conclusion To our knowledge, this is the first study to assess the relationship between pushing force and ROM of ankle joint. There was significant correlation between ROM of ankle and pushing force. ROM of ankle PF for female estimated greater than male regardless of the pushing force and the number of measurement. The ROM of the ankle is measured differently according to the knee joint position. Pushing force, gender and knee joint position are required to be considered when measuring the ROM of ankle joint.
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Affiliation(s)
- Kang Hee Cho
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yumi Jeon
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyunkeun Lee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
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15
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Krause F, Wilke J, Vogt L, Banzer W. Intermuscular force transmission along myofascial chains: a systematic review. J Anat 2016; 228:910-8. [PMID: 27001027 DOI: 10.1111/joa.12464] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Frieder Krause
- Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt am Main, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt am Main, Germany
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Mine K, Nakayama T, Milanese S, Grimmer K. Acute effects of stretching on maximal muscle strength and functional performance: A systematic review of Japanese-language randomised controlled trials. MANUAL THERAPY 2016; 21:54-62. [PMID: 26558707 DOI: 10.1016/j.math.2015.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/02/2015] [Accepted: 10/21/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is no consensus in the English-language literature regarding the best types or dosages of stretching to maximise muscle strength and functional performance. It is possible that primary research published in non-English languages provides different insights, and could add to the body of international knowledge. PURPOSE This systematic review aimed to identify and evaluate Japanese-language randomised controlled trials (RCTs) investigating acute effects of stretching on maximal strength and functional performance. METHODS Three Japanese databases and five English databases were searched from inception to 24 March 2015. Only Japanese-language RCTs examining acute effects of stretching on maximal strength and/or functional performance were included. Risk of bias in included studies was assessed using Physiotherapy Evidence Database scale. GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach was applied to evaluate the quality of evidence. Descriptive synthesis was attempted. RESULTS Seven RCTs with variable methodological quality were included. No two studies were the same, thus meta-analysis was not possible. Descriptively, because of heterogeneity of interventions and outcome measures, it was not possible to identify consensus on the benefits of stretching. GRADE approach indicated low to very low quality evidence for this topic. CONCLUSION This review of Japanese-language RCTs provided no additional information to strengthen or challenge the current English-language evidence base on acute effects of stretching on maximal strength and performance. Future Japanese-language studies should address methodological flaws exposed in this review and incorporate functional outcome measures to strengthen the international evidence base.
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Affiliation(s)
- Koya Mine
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia.
| | - Takashi Nakayama
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Steve Milanese
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
| | - Karen Grimmer
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
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Le Sant G, Ates F, Brasseur JL, Nordez A. Elastography Study of Hamstring Behaviors during Passive Stretching. PLoS One 2015; 10:e0139272. [PMID: 26418862 PMCID: PMC4587804 DOI: 10.1371/journal.pone.0139272] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The mechanical properties of hamstring muscles are usually inferred from global passive torque/angle relationships, in combination with adjoining tissues crossing the joint investigated. Shear modulus measurement provides an estimate of changes in muscle-tendon stiffness and passive tension. This study aimed to assess the passive individual behavior of each hamstring muscle in different stretching positions using shear wave elastography. METHODS/RESULTS The muscle shear modulus of each hamstring muscle was measured during a standardized slow passive knee extension (PKE, 80% of maximal range of motion) on eighteen healthy male volunteers. Firstly, we assessed the reliability of the measurements. Results were good for semitendinosus (ST, CV: 8.9%-13.4%), semimembranosus (SM, CV: 10.3%-11.2%) and biceps femoris long-head (BF-lh, CV: 8.6%-13.3%), but not for biceps femoris short-head (BF-sh, CV: 20.3%-44.9%). Secondly, we investigated each reliable muscle in three stretch positions: 70°, 90° and 110° of hip flexion. The results showed different values of shear modulus for the same amount of perceived stretch, with the highest measurements in the high-flexed hip situation. Moreover, individual muscles displayed different values, with values increasing or BF-lh, SM and ST, respectively. The inter-subject variability was 35.3% for ST, 27.4% for SM and 30.2% for BF-lh. CONCLUSION This study showed that the hip needs to be high-flexed to efficiently tension the hamstrings, and reports a higher muscle-tendon stress tolerance at 110° of hip angle. In addition muscles have different passive behaviors, and future works will clarify if it can be linked with rate of injury.
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Affiliation(s)
- Guillaume Le Sant
- Laboratory ‘Movement, Interactions, Performance’ (EA 4334), Faculty of Sports Sciences, University of Nantes, Nantes, France
- School of Physiotherapy (IFM3R), Nantes, France
| | - Filiz Ates
- Laboratory ‘Movement, Interactions, Performance’ (EA 4334), Faculty of Sports Sciences, University of Nantes, Nantes, France
| | | | - Antoine Nordez
- Laboratory ‘Movement, Interactions, Performance’ (EA 4334), Faculty of Sports Sciences, University of Nantes, Nantes, France
- * E-mail:
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Cruz-Montecinos C, González Blanche A, López Sánchez D, Cerda M, Sanzana-Cuche R, Cuesta-Vargas A. In vivo relationship between pelvis motion and deep fascia displacement of the medial gastrocnemius: anatomical and functional implications. J Anat 2015; 227:665-72. [PMID: 26467242 DOI: 10.1111/joa.12370] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 12/25/2022] Open
Abstract
Different authors have modelled myofascial tissue connectivity over a distance using cadaveric models, but in vivo models are scarce. The aim of this study was to evaluate the relationship between pelvic motion and deep fascia displacement in the medial gastrocnemius (MG). Deep fascia displacement of the MG was evaluated through automatic tracking with an ultrasound. Angular variation of the pelvis was determined by 2D kinematic analysis. The average maximum fascia displacement and pelvic motion were 1.501 ± 0.78 mm and 6.55 ± 2.47 °, respectively. The result of a simple linear regression between fascia displacement and pelvic motion for three task executions by 17 individuals was r = 0.791 (P < 0.001). Moreover, hamstring flexibility was related to a lower anterior tilt of the pelvis (r = 0.544, P < 0.024) and a lower deep fascia displacement of the MG (r = 0.449, P < 0.042). These results support the concept of myofascial tissue connectivity over a distance in an in vivo model, reinforce the functional concept of force transmission through synergistic muscle groups, and grant new perspectives for the role of fasciae in restricting movement in remote zones.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Laboratory of Biomechanics, San José Hospital, Santiago, Chile
| | | | | | - Mauricio Cerda
- SCIAN-Lab, Programme of Anatomy and Developmental Biology, Faculty of Medicine, ICBM, University of Chile, Santiago, Chile
| | - Rodolfo Sanzana-Cuche
- Departamento de Ciencias Morfológicas, Facultad de Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Antonio Cuesta-Vargas
- Departamento de Fisioterapia, Andalucía Tech, Cátedra de Fisioterapia y Discapacidad, Instituto de Investigacion Biomedica de Malaga (IBIMA), Clinemtria (F-14), Universidad de Malaga, Málaga, Spain.,School of Clinical Science, Faculty of Health at Queensland University Technology, Brisbane, Qld, Australia
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Andrade RJ, Lacourpaille L, Freitas SR, McNair PJ, Nordez A. Effects of hip and head position on ankle range of motion, ankle passive torque, and passive gastrocnemius tension. Scand J Med Sci Sports 2015; 26:41-7. [DOI: 10.1111/sms.12406] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 01/25/2023]
Affiliation(s)
- R. J. Andrade
- EA 4334, Laboratoire “Motricité, Interactions, Performance”; Université de Nantes; Nantes France
- CIPER; Faculdade de Motricidade Humana; Universidade de Lisboa; Dafundo Portugal
| | - L. Lacourpaille
- EA 4334, Laboratoire “Motricité, Interactions, Performance”; Université de Nantes; Nantes France
| | - S. R. Freitas
- CIPER; Faculdade de Motricidade Humana; Universidade de Lisboa; Dafundo Portugal
| | - P. J. McNair
- Health & Rehabilitation Research Institute; School of Rehabilitation and Occupation Studies; Faculty of Health and Environmental Studies; Auckland University of Technology; Auckland New Zealand
| | - A. Nordez
- EA 4334, Laboratoire “Motricité, Interactions, Performance”; Université de Nantes; Nantes France
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Hillen BK, Jindrich DL, Abbas JJ, Yamaguchi GT, Jung R. Effects of spinal cord injury-induced changes in muscle activation on foot drag in a computational rat ankle model. J Neurophysiol 2015; 113:2666-75. [PMID: 25673734 DOI: 10.1152/jn.00507.2014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 02/06/2015] [Indexed: 11/22/2022] Open
Abstract
Spinal cord injury (SCI) can lead to changes in muscle activation patterns and atrophy of affected muscles. Moderate levels of SCI are typically associated with foot drag during the swing phase of locomotion. Foot drag is often used to assess locomotor recovery, but the causes remain unclear. We hypothesized that foot drag results from inappropriate muscle coordination preventing flexion at the stance-to-swing transition. To test this hypothesis and to assess the relative contributions of neural and muscular changes on foot drag, we developed a two-dimensional, one degree of freedom ankle musculoskeletal model with gastrocnemius and tibialis anterior muscles. Anatomical data collected from sham-injured and incomplete SCI (iSCI) female Long-Evans rats as well as physiological data from the literature were used to implement an open-loop muscle dynamics model. Muscle insertion point motion was calculated with imposed ankle trajectories from kinematic analysis of treadmill walking in sham-injured and iSCI animals. Relative gastrocnemius deactivation and tibialis anterior activation onset times were varied within physiologically relevant ranges based on simplified locomotor electromyogram profiles. No-atrophy and moderate muscle atrophy as well as normal and injured muscle activation profiles were also simulated. Positive moments coinciding with the transition from stance to swing phase were defined as foot swing and negative moments as foot drag. Whereas decreases in activation delay caused by delayed gastrocnemius deactivation promote foot drag, all other changes associated with iSCI facilitate foot swing. Our results suggest that even small changes in the ability to precisely deactivate the gastrocnemius could result in foot drag after iSCI.
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Affiliation(s)
- Brian K Hillen
- Center for Adaptive Neural Systems, Arizona State University, Tempe, Arizona; School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona
| | - Devin L Jindrich
- Center for Adaptive Neural Systems, Arizona State University, Tempe, Arizona; School of Life Sciences, Arizona State University, Tempe, Arizona
| | - James J Abbas
- Center for Adaptive Neural Systems, Arizona State University, Tempe, Arizona; School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona
| | | | - Ranu Jung
- Center for Adaptive Neural Systems, Arizona State University, Tempe, Arizona; School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona; Department of Biomedical Engineering, Florida International University, Miami, Florida
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Jones LE, O'Shaughnessy DF. The Pain and Movement Reasoning Model: Introduction to a simple tool for integrated pain assessment. ACTA ACUST UNITED AC 2014; 19:270-6. [DOI: 10.1016/j.math.2014.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 01/20/2014] [Accepted: 01/29/2014] [Indexed: 02/08/2023]
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Hyperlordose der Lendenwirbelsäule durch hohe Absätze? MANUELLE MEDIZIN 2011. [DOI: 10.1007/s00337-011-0824-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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