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Warneke K, Rabitsch T, Dobert P, Wilke J. The effects of static and dynamic stretching on deep fascia stiffness: a randomized, controlled cross-over study. Eur J Appl Physiol 2024; 124:2809-2818. [PMID: 38689040 DOI: 10.1007/s00421-024-05495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
AIM Previous stretching studies mostly investigated effects on the skeletal muscle but comprehensive explorations regarding the role of the connective tissue are scarce. Since the deep fascia has been demonstrated to be sensitive to mechanical tension, it was hypothesized that the fascia would also respond to stretching, contributing to enhanced range of motion (ROM). METHODS Forty (40) recreationally active participants (male: n = 25, female: n = 15) were included in the randomized controlled cross-over trial and allocated to different groups performing 5 min static (STAT) or dynamic (DYN) plantar flexor stretching or control condition (CC) in a random order. Pre- and immediately post-intervention, muscle and fascia stiffness, as well as muscle and fascia thickness were measured using high-resolution ultrasound and strain elastography. ROM was assessed in the ankle joint via the knee to wall test (KtW) and goniometer. RESULTS STAT reduced both, muscle and fascia stiffness (d = 0.78 and 0.42, p < 0.001, respectively), while DYN did not reduce stiffness compared to the control condition (p = 0.11-0.41). While both conditions showed significant increases in the KtW (d = 0.43-0.46, p = 0.02-0.04), no significant differences to the CC were observed for the isolated ROM testing (p = 0.09 and 0.77). There was a small correlation between fascia stiffness decreases and ROM increases (r = - 0.25, p = 0.006) but no association was found between muscle stiffness decreases and ROM increases (p = 0.13-0.40). CONCLUSION Our study is the first to reveal stretch-induced changes in fascia stiffness. Changes of fascia`s but not muscle`s mechanical properties may contribute to increased ROM following stretching.
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Affiliation(s)
- Konstantin Warneke
- Institute of Human Movement Science, Sport and Health, University of Graz, 8020, Graz, Austria.
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria.
| | - Thomas Rabitsch
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria
| | - Patrik Dobert
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria
| | - Jan Wilke
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria
- Department of Neuromotorics and Movement, University of Bayreuth, 95447, Bayreuth, Germany
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Warneke K, Turau K, Lohmann LH, Hillebrecht M, Behm DG, Konrad A, Schmidt T. Resistance Training Causes the Stretch-Induced Force Deficit-A Randomized Cross-Over Study. Sports (Basel) 2024; 12:145. [PMID: 38921839 PMCID: PMC11209436 DOI: 10.3390/sports12060145] [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: 04/05/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
PURPOSE Stretch-induced force deficit suggests an acute stretch-specific strength capacity loss, which is commonly attributed to EMG reductions. Since those deficits could also be attributed to general fatigue induced by overloading the muscle, this study aimed to compare stretching with an exhausting calf raise programme to compare strength and stretching responses. METHOD This study included 16 participants with different, high-duration calf muscle stretching effects (10, 20, 30 min of stretching) with resistance training (RT) (3 × 12 repetitions) performed until muscle failure, by using a cross-over study design with pre-post comparisons. Strength was tested via isometric plantar flexor diagnostics, while flexibility was assessed using the knee-to-wall test (KtW) and an isolated goniometer test. RESULTS Using a three-way ANOVA, RT strength decreases were greater compared to 10 and 20 min of stretching (p = 0.01-0.02), but similar to those of 30 min of stretching. ROM in the KtW showed no specific stretch-induced increases, while only the stretching conditions enhanced isolated tested ROM (p < 0.001-0.008). No RT-related isolated ROM increases were observed. CONCLUSIONS The results showed both interventions had similar effects on strength and ROM in the calf muscles. More holistic explanatory approaches such as fatigue and warm-up are discussed in the manuscript and call for further research.
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Affiliation(s)
- Konstantin Warneke
- Institute of Human Movement Science and Exercise, University of Graz, 8010 Graz, Austria;
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020 Klagenfurt am Wörthersee, Austria
| | - Katharina Turau
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany; (K.T.); (T.S.)
| | - Lars Hubertus Lohmann
- University Sport Center, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (L.H.L.); (M.H.)
- Institute of Human Movement Science and Exercise Physiology, Friedrich-Schiller University Jena, 07743 Jena, Germany
| | - Martin Hillebrecht
- University Sport Center, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (L.H.L.); (M.H.)
| | - David G. Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, P.O. Box 4200, St. John’s, NL A1C 5S7, Canada;
| | - Andreas Konrad
- Institute of Human Movement Science and Exercise, University of Graz, 8010 Graz, Austria;
| | - Tobias Schmidt
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany; (K.T.); (T.S.)
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Neto T, Johannsson J, Andrade RJ. Using ultrasound shear wave elastography to characterize peripheral nerve mechanics: a systematic review on the normative reference values in healthy individuals. Ultrasonography 2024; 43:169-178. [PMID: 38544459 PMCID: PMC11079506 DOI: 10.14366/usg.23211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 05/09/2024] Open
Abstract
Ultrasound shear wave elastography (SWE) is an emerging non-invasive imaging technique for peripheral nerve evaluation. Shear wave velocity (SWV), a surrogate measure of stiffness, holds promise as a biomarker for various peripheral nerve disorders. However, to maximize its clinical and biomechanical value, it is important to fully understand the factors that influence nerve SWV measurements. This systematic review aimed to identify the normal range of SWV for healthy sciatic and tibial nerves and to reveal the factors potentially affecting nerve SWV. An electronic search yielded 17 studies eligible for inclusion, involving 548 healthy individuals (age range, 17 to 72 years). Despite very good reliability metrics, the reported SWV values differed considerably across studies for the sciatic (1.9-9.9 m/s) and tibial (2.3-9.1 m/s) nerves. Factors such as measurement proximity to joint regions, limb postures inducing nerve axial stretching, and transducer alignment with nerve fiber orientation were associated with increased SWV. These findings suggest regional-specific nerve mechanical properties, non-linear elastic behaviour, and marked mechanical anisotropy. The impact of age and sex remains unclear and warrants further investigation. These results emphasize the importance of considering these factors when assessing and interpreting nerve SWE. While increased SWV has been linked to pathological changes affecting nerve tissue mechanics, the significant variability observed in healthy nerves highlights the need for standardized SWE assessment protocols. Developing guidelines for enhanced clinical utility and achieving a comprehensive understanding of the factors that influence nerve SWE assessments are critical in advancing the field.
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Affiliation(s)
- Tiago Neto
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Johanna Johannsson
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Ricardo J. Andrade
- Nantes University, Movement - Interactions - Performance, MIP, UR 4334, 44000, Nantes, France
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
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4
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Hirata K, Akagi R. Acute effect of static stretching on non-muscular tissue stiffness and joint flexibility: a comparative study between older and young men. Eur J Appl Physiol 2024; 124:793-803. [PMID: 37702788 DOI: 10.1007/s00421-023-05307-z] [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: 05/01/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Non-muscular tissue stiffness is assumed to have a negative impact on joint flexibility, and a reduction in non-muscular tissue stiffness may be important, especially in older adults. The present study aimed to compare the acute effects of static stretching on non-muscular tissue stiffness between older and young adults and to investigate whether a decrease in tissue stiffness improves joint flexibility. METHODS Twenty older (62-83 years) and 20 young (21-24 years) males participated. Ankle dorsiflexion static stretching (five sets of 90 s each) was performed, and before and after stretching, the ankle dorsiflexion range of motion (RoM), passive ankle joint stiffness, and shear wave speed (SWS) (an index of stiffness) of the sciatic nerve, tibial nerve, and posterior thigh fascia were measured. RESULTS Stretching led to an increase in RoM and a decrease in passive joint stiffness in both groups (P < 0.001) with no significant between-group differences (P ≥ 0.055). The between-group difference in the effect of stretching on SWS was evident only for the sciatic nerve, and a decline in sciatic nerve SWS was only observed in the older adult group (pre-stretching: 2.5 ± 0.3 m/s; post-stretching: 2.3 ± 0.4 m/s; P = 0.027). A significant positive repeated-measures correlation was observed between the sciatic nerve SWS and passive joint stiffness (P = 0.014, rrm = 0.540). CONCLUSION The reduction in sciatic nerve stiffness by stretching was noticeable in older men and led to improved joint flexibility. These findings may provide insight into tissue adaptation by stretching and may be used to explore effective exercises for improving joint flexibility in older adults.
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Affiliation(s)
- Kosuke Hirata
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan.
| | - Ryota Akagi
- Graduate School of Engineering and Science, Shibaura Institute of Technology, Saitama-shi, Saitama, Japan.
- College of Systems Engineering and Science, Shibaura Institute of Technology, 307 Fukasaku, Minuma-ku, Saitama-shi, Saitama, 337-8570, Japan.
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5
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Ciuffreda G, Bueno-Gracia E, Albarova-Corral I, Montaner-Cuello A, Pérez-Rey J, Pardos-Aguilella P, Malo-Urriés M, Estébanez-de-Miguel E. In Vivo Effects of Joint Movement on Nerve Mechanical Properties Assessed with Shear-Wave Elastography: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:343. [PMID: 38337859 PMCID: PMC10855485 DOI: 10.3390/diagnostics14030343] [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: 01/12/2024] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave elastography (SWE). Greater tensile loads can lead to greater stiffness, which can be quantified using SWE. Therefore, this study aimed to conduct a systematic review and meta-analysis to perform an overview of the effect of joint movements on nerve mechanical properties in healthy nerves. The initial search (July 2023) yielded 501 records from six databases (PubMed, Embase, Scopus, Web of Science, Cochrane, and Science Direct). A total of 16 studies were included and assessed with a modified version of the Downs and Black checklist. Our results suggest an overall tendency for stiffness increase according to a pattern of neural tensioning. The main findings from the meta-analysis showed a significant increase in nerve stiffness for the median nerve with wrist extension (SMD [95%CI]: 3.16 [1.20, 5.12]), the ulnar nerve with elbow flexion (SMD [95%CI]: 2.91 [1.88, 3.95]), the sciatic nerve with ankle dorsiflexion (SMD [95%CI]: 1.13 [0.79, 1.47]), and the tibial nerve with both hip flexion (SMD [95%CI]: 2.14 [1.76, 2.51]) and ankle dorsiflexion (SMD [95%CI]: 1.52 [1.02, 2.02]). The effect of joint movement on nerve stiffness also depends on the nerve segment, the amount of movement of the joint mobilized, and the position of other joints comprised in the entirety of the nerve length. However, due to the limited number of studies, many aspects of nerve behavior together with the effect of using different ultrasound equipment or transducers for nerve stiffness evaluation still need to be fully investigated.
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Affiliation(s)
- Gianluca Ciuffreda
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
| | - Elena Bueno-Gracia
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Isabel Albarova-Corral
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Alberto Montaner-Cuello
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Jorge Pérez-Rey
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Pilar Pardos-Aguilella
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Miguel Malo-Urriés
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Elena Estébanez-de-Miguel
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain; (E.B.-G.); (I.A.-C.); (A.M.-C.); (J.P.-R.); (P.P.-A.); (M.M.-U.)
- PhysiUZerapy: Health Sciences Research Group, University of Zaragoza, Calle Domingo Miral S/N, 50009 Zaragoza, Spain
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Albuquerque Brandão MC, de Carvalho Teixeira G, Fernandes de Oliveira L. Acute Effects of Stretching Exercises on Posterior Chain: Analysis of Shear Modulus by Elastography SSI. TRANSLATIONAL SPORTS MEDICINE 2023; 2023:5582277. [PMID: 38654914 PMCID: PMC11023729 DOI: 10.1155/2023/5582277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 04/26/2024]
Abstract
The posterior chain muscles of the lower limb include the hamstrings and triceps surae, along with the Achilles tendon. This study aimed to investigate the acute effects of static stretching exercises commonly used in clinical and training settings on the shear modulus (µ) of these muscles and tendon using Supersonic Shear-Wave Imaging (SSI) elastography. Fifteen healthy adults participated in the study, performing stretching exercises for hamstrings and triceps surae. Shear modulus and joint range of motion (ROM) were measured before and after the stretching protocols. The hip and ankle mean ROM significantly increased by 19.27% and 24.10%, respectively. However, the stretching protocol did not significantly alter in µ of the hamstrings, the gastrocnemius muscles, and the Achilles tendon. K-means clustering analysis identified a group where the subjects with lower initial ROM showed higher amplitude gains and a significant decrease in the semimembranosus stiffness after stretching. These findings suggest that the stretching protocol was effective in improving joint mobility but not sufficient to elicit immediate mechanical changes in muscle and tendon stiffness. Neural adaptations and nonmuscular structures might contribute to increased ROM. The study highlights the importance of considering individual initial ROM and subsequent responses when evaluating the effects of stretching exercises on muscle and tendon properties.
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Affiliation(s)
- Maria Clara Albuquerque Brandão
- Laboratório de Biomecânica, Programa de Engenharia Biomédica—COPPE, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Gabriela de Carvalho Teixeira
- Laboratório de Biomecânica, Programa de Engenharia Biomédica—COPPE, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Liliam Fernandes de Oliveira
- Laboratório de Biomecânica, Programa de Engenharia Biomédica—COPPE, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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7
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Takeuchi K, Nakamura M, Fukaya T, Konrad A, Mizuno T. Acute and Long-Term Effects of Static Stretching on Muscle-Tendon Unit Stiffness: A Systematic Review and Meta-Analysis. J Sports Sci Med 2023; 22:465-475. [PMID: 37711702 PMCID: PMC10499138 DOI: 10.52082/jssm.2023.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023]
Abstract
Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in the range of motion after static stretching. However, to date, the effects of acute and long-term static stretching on MTS are not well understood. The purpose of this meta-analysis was to investigate the effects of acute and long-term static stretching training on MTS, in young healthy participants. PubMed, Web of Science, and EBSCO published before January 6, 2023, were searched and finally, 17 papers were included in the meta-analysis. Main meta-analysis was performed with a random-effect model and subgroup analyses, which included comparisons of sex (male vs. mixed sex and female) and muscle (hamstrings vs. plantar flexors) were also performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on MTS. For acute static stretching, the result of the meta-analysis showed a moderate decrease in MTS (effect size = -0.772, Z = -2.374, 95% confidence interval = -1.409 - -0.325, p = 0.018, I2 = 79.098). For long-term static stretching, there is no significant change in MTS (effect size = -0.608, Z = -1.761, 95% CI = -1.284 - 0.069, p = 0.078, I2 = 83.061). Subgroup analyses revealed no significant differences between sex (long-term, p = 0.209) or muscle (acute, p =0.295; long-term, p = 0.427). Moreover, there was a significant relationship between total stretching duration and MTS in acute static stretching (p = 0.011, R2 = 0.28), but not in long-term stretching (p = 0.085, R2 < 0.01). Whilst MTS decreased after acute static stretching, only a tendency of a decrease was seen after long-term stretching.
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Affiliation(s)
- Kosuke Takeuchi
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe-shi, Hyogo, Japan
| | - Masatoshi Nakamura
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Nishi Kyushu University, Kanzaki-cho, Saga, Japan
| | - Taizan Fukaya
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, Togane-shi, Chiba, Japan
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria
| | - Takamasa Mizuno
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya-shi, Aichi, Japan
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8
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Takeuchi K, Nakamura M, Konrad A, Mizuno T. Long-term static stretching can decrease muscle stiffness: A systematic review and meta-analysis. Scand J Med Sci Sports 2023; 33:1294-1306. [PMID: 37231582 DOI: 10.1111/sms.14402] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
Stretch training increases the range of motion of a joint. However, to date, the mechanisms behind such a stretching effect are not well understood. An earlier meta-analysis on several studies reported no changes in the passive properties of a muscle (i.e., muscle stiffness) following long-term stretch training with various types of stretching (static, dynamic, and proprioceptive neuromuscular stretching). However, in recent years, an increasing number of papers have reported the effects of long-term static stretching on muscle stiffness. The purpose of the present study was to examine the long-term (≥2 weeks) effect of static stretching training on muscle stiffness. PubMed, Web of Science, and EBSCO published before December 28, 2022, were searched and 10 papers met the inclusion criteria for meta-analysis. By applying a mixed-effect model, subgroup analyses, which included comparisons of sex (male vs. mixed sex) and type of muscle stiffness assessment (calculated from the muscle-tendon junction vs. shear modulus), were performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on muscle stiffness. The result of the meta-analysis showed a moderate decrease in muscle stiffness after 3-12 weeks of static stretch training compared to a control condition (effect size = -0.749, p < 0.001, I2 = 56.245). Subgroup analyses revealed no significant differences between sex (p = 0.131) and type of muscle stiffness assessment (p = 0.813). Moreover, there was no significant relationship between total stretching duration and muscle stiffness (p = 0.881).
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Affiliation(s)
- Kosuke Takeuchi
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe-shi, Japan
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Department of Physical Therapy, Nishi Kyushu University, Kanzaki-cho, Japan
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria
| | - Takamasa Mizuno
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya-shi, Japan
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Rossetto G, Lopomo NF, Shaikh SZ. Longitudinal Movements and Stiffness of Lower Extremity Nerves Measured by Ultrasonography and Ultrasound Elastography in Symptomatic and Asymptomatic Populations: A Systematic Review With Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00140-0. [PMID: 37331920 DOI: 10.1016/j.ultrasmedbio.2023.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 06/20/2023]
Abstract
This study was aimed at analyzing the effectiveness of ultrasonography (US) and ultrasound elastography (UE) in evaluating longitudinal sliding and stiffness of nerves. In line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, we analyzed 1112 publications (range: 2010-2021) extracted from MEDLINE, Scopus and Web of Science focusing on specific outcomes, including shear wave velocity (m/s), shear modulus (kPa), strain ratio (SR) and excursion (mm). Thirty-three papers were included and evaluated for overall quality and risk of bias. From the analysis of data concerning 1435 participants, mean shear wave velocity (SWV) in the sciatic nerve was 6.70 ± 1.26 m/s in controls and 7.51 ± 1.73 m/s in participants presenting with leg pain; in the tibial nerve, mean SWV was 3.83 ± 0.33 m/s in controls and 3.42 ± 3.53 m/s in participants presenting with diabetic peripheral neuropathy (DPN). The mean shear modulus (SM) was 20.9 ± 9.33 kPa for sciatic nerve, whereas it was an average of 23.3 ± 7.20 kPa for the tibial nerve. Considering 146 subjects (78 experimental, 68 controls) no significant difference was observed in SWV when comparing participants with DPN with controls (standard mean difference [SMD]: 1.26, 95% confidence interval [CI]: 0.54, 1.97), whereas a significant difference was observed in the SM (SMD: 1.78, 95% CI: 1.32, 2.25); furthermore, we found significant differences between left and right extremity nerves (SMD:1.14. 95% CI: 0.45, 1.83) among 458 participants (270 with DPN and 188 controls). No descriptive statistics are available for excursion because of the variability in participants and limb positions, whereas SR is considered only a semiquantitative outcome and therefore not comparable among different studies. Despite the presence of some limitations in study designs and methodological biases, on the basis of our findings, we can conclude that US and UE are effective methods in assessing longitudinal sliding and stiffness of lower extremity nerves in both symptomatic and asymptomatic subjects.
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Affiliation(s)
- Gianluca Rossetto
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | | | - Summaiva Zareen Shaikh
- Department of Neuro-physiotherapy, SIA College of Health Sciences, College of Physiotherapy, Thane, India.
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10
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Babault N, Hitier M, Paizis C, Vieira DCL. Exploring Acute Changes in Hamstring EMG after Warm-up and Stretching Using a Multifractal Analysis. Med Sci Sports Exerc 2023; 55:1023-1033. [PMID: 36719665 DOI: 10.1249/mss.0000000000003128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION This study aimed to apply multifractal detrended fluctuation analysis (MFDFA) to surface EMG to detect neuromuscular changes after realistic warm-up procedures that was followed by various stretching exercises. METHODS Sixteen volunteers conducted two experimental sessions. Testing included two maximal voluntary contractions before, after a standardized warm-up, and after a stretching exercise (static or neurodynamic nerve gliding technique). EMG was registered on biceps femoris and semitendinosus muscles. EMG was analyzed using different parameters obtained from the singularity Hurst exponent function and multifractal power spectrum (both obtained from the multifractal detrended fluctuation analysis). RESULTS The Hurst exponent, α maximum, and peak value of the multifractal spectrum significantly decreased after warm-up as compared with baseline for both biceps femoris ( P = 0.003, P = 0.006, and P = 0.003, respectively) and semitendinosus ( P = 0.006, P = 0.013 and P = 0.01, respectively) muscles. No further alteration was obtained after static or neurodynamic nerve gliding stretching as compared with post-warm-up ( P = 1.0). No significant difference was obtained for Hurst exponent range, width, and asymmetry of the multifractal spectrum ( P > 0.05). CONCLUSIONS From the present results, EMG depicted multifractal features sensitive to detect neuromuscular changes after a warm-up procedure. An increase in multiscale complexity is revealed after warm-up without any further alteration after stretching. The multifractal spectrum depicted dominant small fluctuations that shifted toward slightly larger fluctuations that could be attributed to motor unit recruitment.
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11
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Anegawa K, Kawanishi K, Nakamura M, Izumi M, Tsutsumi M, Kudo S. Tibial nerve dynamics during ankle dorsiflexion: The relationship between stiffness and excursion of the tibial nerve. J Biomech 2023; 155:111646. [PMID: 37245388 DOI: 10.1016/j.jbiomech.2023.111646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
Peripheral nerves extend with a gradual increase in stiffness and also with excursion, namely reduction of fiber bundle waviness, to adapt to joint movements. Although the close relationships between the tibial nerve (TN) excursion and stiffness during ankle dorsiflexion in cadaver studies, the precise in vivo their relationships remain unclear. We hypothesized that the excursion of the TN can be estimated from its stiffness in vivo using shear-wave elastography. This study aimed to analyze the relationships between the TN stiffness at the plantarflexion and dorsiflexion and TN excursion during dorsiflexion using ultrasonography. Twenty-one healthy adults participated in constant-velocity movements of the ankle joint with a 20° range from the maximum dorsiflexion, and the TN was imaged using an ultrasound imaging system. The maximum flow velocity value and the TN excursion distance per dorsiflexion were then calculated as indexes of excursion using the application software Flow PIV. The shear wave velocities of the TN at plantarflexion and dorsiflexion were also measured. Based on our single linear regression, the shear wave velocities of the TN at the plantarflexion had the strongest effect on the excursion indexes, followed by the those at dorsiflexion. Ultrasonographic shear wave velocity could predict the TN excursion if measured under mild plantarflexion of the ankle joint, and might have a close biomechanical relation to the total waviness of the TN.
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Affiliation(s)
- Keisuke Anegawa
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan; Department of Rehabilitation Medicine, Ryokufukai Hospital, Osaka, Japan
| | - Kengo Kawanishi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Misaki Nakamura
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Meika Izumi
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Masahiro Tsutsumi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan; Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Shintarou Kudo
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan; Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan; Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Japan.
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12
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Thomas E, Ficarra S, Nakamura M, Paoli A, Bellafiore M, Palma A, Bianco A. Effects of Different Long-Term Exercise Modalities on Tissue Stiffness. SPORTS MEDICINE - OPEN 2022; 8:71. [PMID: 35657537 PMCID: PMC9166919 DOI: 10.1186/s40798-022-00462-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
AbstractStiffness is a fundamental property of living tissues, which may be modified by pathologies or traumatic events but also by nutritional, pharmacological and exercise interventions. This review aimed to understand if specific forms of exercise are able to determine specific forms of tissue stiffness adaptations. A literature search was performed on PubMed, Scopus and Web of Science databases to identify manuscripts addressing adaptations of tissue stiffness as a consequence of long-term exercise. Muscular, connective, peripheral nerve and arterial stiffness were considered for the purpose of this review. Resistance training, aerobic training, plyometric training and stretching were retrieved as exercise modalities responsible for tissue stiffness adaptations. Differences were observed related to each specific modality. When exercise was applied to pathological cohorts (i.e. tendinopathy or hypertension), stiffness changed towards a physiological condition. Exercise interventions are able to determine tissue stiffness adaptations. These should be considered for specific exercise prescriptions. Future studies should concentrate on identifying the effects of exercise on the stiffness of specific tissues in a broader spectrum of pathological populations, in which a tendency for increased stiffness is observed.
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13
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Brandl A, Bartsch K, James H, Miller ME, Schleip R. Influence of Rolfing Structural Integration on Active Range of Motion: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11195878. [PMID: 36233746 PMCID: PMC9570915 DOI: 10.3390/jcm11195878] [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: 09/03/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Recent work has investigated significant force transmission between the components of myofascial chains. Misalignments in the body due to fascial thickening and shortening can therefore lead to complex compensatory patterns. For the treatment of such nonlinear cause−effect pathology, comprehensive neuromusculoskeletal therapy such as the Rolf Method of Structural Integration (SI) could be targeted. Methods: A total of 727 subjects were retrospectively screened from the medical records of an SI practice over a 23-year period. A total of 383 subjects who had completed 10 basic SI sessions met eligibility criteria and were assessed for active range of motion (AROM) of the shoulder and hip before and after SI treatment. Results: Shoulder flexion, external and internal rotation, and hip flexion improved significantly (all p < 0.0001) after 10 SI sessions. Left shoulder flexion and external rotation of both shoulders increased more in men than in women (p < 0.0001) but were not affected by age. Conclusions: An SI intervention could produce multiple changes in the components of myofascial chains that could help maintain upright posture in humans and reduce inadequate compensatory patterns. SI may also affect differently the outcome of some AROM parameters in women and men.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Faculty for Psychology and Human Movement Science, Institute for Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Katja Bartsch
- Department of Sport Science and Sports, Friedrich-Alexander University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - Helen James
- Department of Physical Therapy, California State University, Fresno, CA 93740, USA
| | - Marilyn E. Miller
- Department of Physical Therapy, University of St. Augustine for Health Sciences at San Diego, San Diego, CA 92069, USA
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-24561
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14
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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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15
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Kawanishi K, Nariyama Y, Anegawa K, Tsutsumi M, Kudo S. Changes in tibial nerve stiffness during ankle dorsiflexion according to in-vivo analysis with shear wave elastography. Medicine (Baltimore) 2022; 101:e29840. [PMID: 35777040 PMCID: PMC9239598 DOI: 10.1097/md.0000000000029840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A more detailed assessment of pathological changes in the tibial nerve (TN) is needed to better assess how physical therapy influences TN pathologies. The cross-sectional nerve area can be used for TN assessment but may be influenced by individual differences in parameters, such as body height, body weight, and foot length. Therefore, there are no known reliable noninvasive quantitative methods for assessing TN neuropathy. Although recent ultrasonographic studies reported that TN stiffness changes could be used to assess TN neuropathies of the foot, these studies did not consider the joint position, and peripheral nerve tension can change with joint movement. Therefore, we considered that TN stiffness assessment could be improved by analyzing the relationship between ankle joint position and TN stiffness. This study aimed to investigate the relationship between TN stiffness and ankle angle changes using shear wave elastography. We hypothesized that the TN shear wave velocity significantly increases with ankle dorsiflexion and that the total ankle range or maximum dorsiflexion range correlates with the shear wave velocity. This cross-sectional study included 20 TNs of 20 healthy adults. Ultrasonography and shear wave elastography were used to evaluate the TN. TN stiffness was measured at 5 ankle positions as follows: maximum dorsiflexion (100% df), plantar flexion in the resting position (0% df), and 3 intermediate points (25% df, 50% df, and 75% df). TN shear wave velocity increased with an increase in ankle df angle. While total ankle range was significantly and negatively correlated with TN stiffness in all ankle positions, the maximum ankle df angle was significantly and negatively correlated only at 75% and 100% df. TN stiffness below 50% df may be affected by gliding or decreased nerve loosening, and TN stiffness above 75% df may be influenced by nerve tensioning. When measuring TN stiffness for diagnostic purposes, TN should be assessed at an ankle joint angle below 50% df.
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Affiliation(s)
- Kengo Kawanishi
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
- Department of Rehabilitation, Kano General Hospital, Osaka, Japan
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Yuki Nariyama
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Keisuke Anegawa
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Masahiro Tsutsumi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Shintarou Kudo
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Japan
- AR-Ex Medical Research Center, Tokyo, Japan
- *Correspondence: Shintarou Kudo, Graduate School of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16 Nankoukita Suminoe Ward, Osaka City, Osaka Prefecture 559-8611, Japan (e-mail: )
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16
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Kawama R, Yanase K, Hojo T, Wakahara T. Acute changes in passive stiffness of the individual hamstring muscles induced by resistance exercise: effects of contraction mode and range of motion. Eur J Appl Physiol 2022; 122:2071-2083. [PMID: 35699758 DOI: 10.1007/s00421-022-04976-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Recent studies raise an interesting possibility that resistance exercise also decreases passive muscle stiffness, as does stretching exercise. However, little is known about how program variables of resistance exercise acutely influence muscle stiffness. We aimed to examine the acute changes in passive stiffness of the individual hamstring muscles after resistance exercises using different combinations of contraction modes and ranges of motion (ROMs). METHODS Thirteen healthy young male participants performed three sessions of resistance exercises that comprised stiff-leg deadlift with different contraction modes and exercise ROMs on separate days as follows: (1) eccentric contractions with a wide exercise ROM (EW); (2) eccentric contractions with a narrow exercise ROM (EN); and (3) concentric contractions with a wide exercise ROM (CW). Maximal joint ROM, passive torque, shear modulus of the individual hamstring muscles, and maximal isometric torque of knee flexion were measured before and 3 min, 30 min, and 60 min after completing each session. RESULTS The shear modulus of the semimembranosus was significantly lower at 3 min post-exercise (121.8 ± 16.0 kPa) than at pre-exercise (129.0 ± 18.9 kPa, p = 0.021, r = 0.45) in EW, but not in EN or CW. There were no significant changes in the shear moduli of the biceps femoris long head or the semitendinosus at any timepoint in any exercise protocols. CONCLUSIONS The present results suggest that the combination of eccentric contraction and wide ROM during resistance exercise has the potential to acutely decrease passive stiffness (shear modulus) of a specific muscle.
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Affiliation(s)
- Raki Kawama
- Graduate School of Health and Sports Science, Doshisha University, Kyoto, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Ko Yanase
- Faculty of Health and Sports Science, Doshisha University, Kyoto, Japan.,Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Hojo
- Graduate School of Health and Sports Science, Doshisha University, Kyoto, Japan.,Faculty of Health and Sports Science, Doshisha University, Kyoto, Japan
| | - Taku Wakahara
- Faculty of Health and Sports Science, Doshisha University, Kyoto, Japan. .,Human Performance Laboratory, Waseda University, Saitama, Japan.
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17
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Spatial variation in mechanical properties along the sciatic and tibial nerves: an ultrasound shear wave elastography study. J Biomech 2022; 136:111075. [DOI: 10.1016/j.jbiomech.2022.111075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022]
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18
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Zhang CG, Zhao XY, Cao J, Lin YJ, Yang L, Duan XJ. Triple Hemisection Percutaneous Achilles Tendon Lengthening for Severe Ankle Joint Deformity. Orthop Surg 2021; 13:2373-2381. [PMID: 34806335 PMCID: PMC8654661 DOI: 10.1111/os.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the efficacy of modified percutaneous Achilles tendon lengthening for severe ankle joint deformity. Methods This retrospective case series study included 33 patients with an average age of 25.2 years who underwent surgery in our hospital from April 1, 2010 to March 1, 2018. Triple hemisection percutaneous Achilles tendon lengthening was performed. One stage surgery, other soft tissue surgery or bone correction surgery could be performed. After surgery, a plaster cast was used to fix the functional position, and rehabilitation training was carried out as planned. Complications during the perioperative period were recorded. Statistical analysis of the patients' visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score before and at the last follow‐up was performed. The recurrence rate of Achilles tendon contracture at the last follow‐up and the patients' satisfaction rate were investigated. Results All patients were followed up, with an average follow‐up period of 56.31 months (8–104 months). All achieved good ankle joint function and appearance improvement And there were no infection or skin necrosis complications. In two cases, the incision was poorly healed at non‐Achilles tendon site and was cured by change of dressing. The average VAS score at the last follow‐up was reduced from (2 ± 1.48) points before surgery to (0.26 ± 0.51) points (P = 0.001), and the average AOFAS score was increased from (64.97 ± 13.56) points before surgery to (90.06 ± 10.06) points (P = 0.001). During the follow‐up period, there was no chronic rupture of Achilles tendon. There were two cases of recurrence of foot drop (5.7%), and the patients' satisfaction rate was 93.9%. Conclusion In the surgical treatment of severe ankle joint deformity, the application of triple hemisection percutaneous Achilles tendon lengthening for Achilles tendon contracture has the advantages of less trauma, beautiful incision, and reliable efficacy. The satisfaction rate of patients with this treatment is high, and it is worth promoting in the clinic.
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Affiliation(s)
- Chang-Gui Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xing-Yu Zhao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jin Cao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang-Jing Lin
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Abstract
Tensioning techniqueswere the first neurodynamic techniques used therapeutically in the management of people with neuropathies. This article aims to provide a balanced evidence-informed view on the effects of optimal tensile loading on peripheral nerves and the use of tensioning techniques. Whilst the early use of neurodynamics was centered within a mechanical paradigm, research into the working mechanisms of tensioning techniques revealed neuroimmune, neurophysiological, and neurochemical effects. In-vitro and ex-vivo research confirms that tensile loading is required for mechanical adaptation of healthy and healing neurons and nerves. Moreover, elimination of tensile load can have detrimental effects on the nervous system. Beneficial effects of tensile loading and tensioning techniques, contributing to restored homeostasis at the entrapment site, dorsal root ganglia and spinal cord, include neuronal cell differentiation, neurite outgrowth and orientation, increased endogenous opioid receptors, reduced fibrosis and intraneural scar formation, improved nerve regeneration and remyelination, increased muscle power and locomotion, less mechanical and thermal hyperalgesia and allodynia, and improved conditioned pain modulation. However, animal and cellular models also show that ‘excessive’ tensile forces have negative effects on the nervous system. Although robust and designed to withstand mechanical load, the nervous system is equally a delicate system. Mechanical loads that can be easily handled by a healthy nervous system, may be sufficient to aggravate clinical symptoms in patients. This paper aims to contribute to a more balanced view regarding the use of neurodynamics and more specifically tensioning techniques.
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Affiliation(s)
- Richard Ellis
- School of Clinical Sciences, Active Living and Rehabilitation: Aotearoa, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Giacomo Carta
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Italy.,Neuroscience Institute Cavalieri Ottolenghi (Nico), University of Torino, Orbassano, Italy.,ASST Nord Milano, Sesto San Giovanni Hospital, Milan, Italy
| | - Ricardo J Andrade
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia.,School of Health Sciences and Social Work, Griffith University, Queensland, USA
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia.,Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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20
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Chang TT, Li Z, Zhu YC, Wang XQ, Zhang ZJ. Effects of Self-Myofascial Release Using a Foam Roller on the Stiffness of the Gastrocnemius-Achilles Tendon Complex and Ankle Dorsiflexion Range of Motion. Front Physiol 2021; 12:718827. [PMID: 34603078 PMCID: PMC8484700 DOI: 10.3389/fphys.2021.718827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Increased muscle stiffness can contribute to reduced range of motion (ROM) and impaired function. Reduced ankle dorsiflexion ROM has been associated with increased injury risk in the ankle. Self-myofascial release (SMR) has been widely used in clinical and sports settings, but the effects of SMR on gastrocnemius and Achilles tendon (AT) stiffness are unclear. Therefore, we investigated the effects of self-myofascial release using a foam roller (FR) on the stiffness of the gastrocnemius–AT complex and ankle dorsiflexion ROM. Fifty healthy, untrained, and non-sedentary participants (age=22.5±2.6years) were randomly divided into an intervention group (FR group) and a control group. The subjects in the intervention group received a single foam roller intervention (three sets of 1min), while the subjects in the control group performed a 5-min sedentary rest. Stiffness of the gastrocnemius–AT complex was evaluated using MyotonPRO and the ankle dorsiflexion ROM was assessed using the weight-bearing lunge test. For the foam roller and control groups, the between-group analysis revealed a statistically significant difference in gastrocnemius stiffness and ankle dorsiflexion ROM after intervention (p<0.05). Within-group analysis revealed a significant increase in ROM and a significant decrease in medial and lateral gastrocnemius (LG) stiffness for the foam roller group after the intervention (p<0.05). In addition, further analysis of the preintervention data revealed a significant negative correlation between ankle dorsiflexion ROM and AT stiffness (r=−0.378 and p=0.007). These results suggest that self-myofascial release using a foam roller on the calf is an effective method for decreasing the stiffness of the gastrocnemius and increasing ankle dorsiflexion ROM.
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Affiliation(s)
- Tian-Tian Chang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Zhe Li
- The First Clinical Medical School, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Yuan-Chun Zhu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China
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21
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Thomas E, Bellafiore M, Petrigna L, Paoli A, Palma A, Bianco A. Peripheral Nerve Responses to Muscle Stretching: A Systematic Review. J Sports Sci Med 2021; 20:258-267. [PMID: 34211318 PMCID: PMC8219270 DOI: 10.52082/jssm.2021.258] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Stretching is commonly used to increase range of motion and flexibility. Therefore, investigations are usually oriented towards the muscle-tendon unit. Limited evidence exists regarding potential effects of stretching on peripheral nerves which lie within muscles. The objective of this investigation will be to elucidate the responses of peripheral nerves to stretching. A literature search was performed using the following databases: Scopus, NLM Pubmed and ScienceDirect. Studies regarding the effects of stretching protocols on responses of peripheral nerves were retrieved for investigation. The NHLBI tool was used for quality assessment. Outcomes included nerve stiffness, nerve displacement, pain pressure thresholds and resistive torque. A total of 10 studies were considered eligible and were included in this investigation. The quality assessment of the studies revealed an overall "fair to good" methodological quality across the included studies. All studies except for one involved healthy participants. High heterogeneity of stretching protocols was retrieved. As a consequence of stretching, nerve stiffness (-15.6%) and pain pressure thresholds (-1.9kg) increased. Nerve displacements on each movement plane for all the considered nerves and nerve deformation were also frequently observed. Peripheral nerve responses to muscle stretching include decreased nerve stiffness and increased pain pressure thresholds. Nerve displacement also frequently occurs. It is still unclear if reduced nerve displacement may lead to clinical outcomes. There is a lack of longitudinal studies regarding peripheral nerve adaptations to stretching.
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Affiliation(s)
- Ewan Thomas
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Marianna Bellafiore
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Luca Petrigna
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Antonio Palma
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonino Bianco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
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22
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Hirata K, Yamadera R, Akagi R. Associations between Range of Motion and Tissue Stiffness in Young and Older People. Med Sci Sports Exerc 2021; 52:2179-2188. [PMID: 32348099 PMCID: PMC7497479 DOI: 10.1249/mss.0000000000002360] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental digital content is available in the text. Purpose The purpose of this study was to investigate differences in the associations between passive ankle dorsiflexion range of motion (ROM) and stiffness of the triceps surae, sciatic nerve, and deep fascia located in the posterior leg between young and older people. Methods Twenty young and twenty older males were recruited and were placed in a prone position with their hip and knee fully extended. Passive ankle dorsiflexion ROM was determined based on the onset of pain during passive dorsiflexion at 1°·s−1 using an isokinetic dynamometer. Shear wave speeds (as a stiffness index) of the triceps surae, the sciatic nerve, and the deep fascia in the posterior leg were evaluated by ultrasound shear wave elastography. Results The shear wave speeds of the medial and lateral gastrocnemius measured at 15° dorsiflexion correlated negatively with passive ROM in young but not in older participants. The shear wave speed of the sciatic nerve measured at 15° dorsiflexion correlated negatively with passive ROM only in older participants. No association was observed between passive ROM and shear wave speed of the deep fascia in the posterior leg. For data measured at maximal dorsiflexion angle (as an index of stretch tolerance), shear wave speeds of the triceps surae and passive joint torque correlated positively with passive ROM in both groups. Conclusion These results suggest that the tissues limiting passive ankle dorsiflexion ROM are muscle and nerve for young and older people, respectively, whereas stretch tolerance influences passive ROM for both groups. This implies that the relative contribution of nonmuscular tissues to joint flexibility become stronger than that of muscles with age.
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Affiliation(s)
| | - Ryosuke Yamadera
- College of Systems Engineering and Science, Shibaura Institute of Technology, Saitama-shi, Saitama, JAPAN
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Suga T, Terada M, Tomoo K, Miyake Y, Tanaka T, Ueno H, Nagano A, Isaka T. Association between plantar flexor muscle volume and dorsiflexion flexibility in healthy young males: ultrasonography and magnetic resonance imaging studies. BMC Sports Sci Med Rehabil 2021; 13:8. [PMID: 33514415 PMCID: PMC7846987 DOI: 10.1186/s13102-021-00233-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/14/2021] [Indexed: 12/17/2022]
Abstract
Background Although joint flexibility is important for human locomotion, the determinants of joint flexibility are not fully understood. In this study, we examined the relationship between dorsiflexion flexibility and plantar flexor muscle size in healthy young males. Methods and results The dorsiflexion flexibility was assessed using range of motion (ROM) and stiffness during active and passive dorsiflexion. Active ROM was defined as the maximal angle during voluntary dorsiflexion. Passive ROM was defined as the angle at the onset of pain during passive dorsiflexion. Passive stiffness was calculated as the slope of the linear portion of the torque-angle curve between 10º and 20º dorsiflexion of the ankle during passive dorsiflexion. In the first study, the plantar flexor muscle volume (MV) in 92 subjects was estimated on the basis of the lower leg length and plantar flexor muscle thickness, as measured using ultrasonography. The estimated plantar flexor MV correlated significantly with active ROM (r = -0.433), passive ROM (r = -0.299), and passive stiffness (r = 0.541) during dorsiflexion (P = 0.01 for all). In the second study, the plantar flexor MV in 38 subjects was measured using magnetic resonance imaging. The plantar flexor MV correlated significantly with plantar flexor active ROM (r = -0.484), passive ROM (r = -0.383), and passive stiffness (r = 0.592) during dorsiflexion (P = 0.05 for all). Conclusions These findings suggest that a larger plantar flexor MV is related to less dorsiflexion flexibility in healthy young males.
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Affiliation(s)
- Tadashi Suga
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, 525-8577, Kusatsu, Shiga, Japan.
| | - Masafumi Terada
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, 525-8577, Kusatsu, Shiga, Japan
| | - Keigo Tomoo
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, 525-8577, Kusatsu, Shiga, Japan
| | - Yuto Miyake
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, 525-8577, Kusatsu, Shiga, Japan
| | - Takahiro Tanaka
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, 525-8577, Kusatsu, Shiga, Japan
| | - Hiromasa Ueno
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, 525-8577, Kusatsu, Shiga, Japan.,Graduate School of Health and Sport Science, Nippon Sport Science University, Fukasawa, Setagaya-ku, Tokyo, Japan.,Research Fellow of Japan Society for the Promotion of Science, Kojimachi, Chiyoda-ku, Tokyo, Japan
| | - Akinori Nagano
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, 525-8577, Kusatsu, Shiga, Japan
| | - Tadao Isaka
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, 525-8577, Kusatsu, Shiga, Japan
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Fukaya T, Kiyono R, Sato S, Yahata K, Yasaka K, Onuma R, Nakamura M. Effects of Static Stretching With High-Intensity and Short-Duration or Low-Intensity and Long-Duration on Range of Motion and Muscle Stiffness. Front Physiol 2020; 11:601912. [PMID: 33329054 PMCID: PMC7714915 DOI: 10.3389/fphys.2020.601912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022] Open
Abstract
This study investigated the effects of static stretching (SS) delivered with the same load but using two protocols – high-intensity and short-duration and low-intensity and long-duration – on range of motion (ROM) and muscle stiffness. A total of 18 healthy students participated in the study. They randomly performed high-intensity and short-duration (120% and 100 s) or low-intensity and long-duration (50% and 240 s) SS. Outcomes were assessed on ROM, passive torque at dorsiflexion ROM, and shear elastic modulus of the medial gastrocnemius before and after static stretching. The results showed that ROM increased significantly at post-stretching compared to that at pre-stretching in both high-intensity and short-duration [+6.1° ± 4.6° (Δ25.7 ± 19.9%)] and low-intensity and long-duration [+3.6° ± 2.3° (Δ16.0 ± 11.8%)]. Also, the ROM was significantly higher at post-stretching in high-intensity and short-duration conditions than that in low-intensity and long-duration. The passive torque at dorsiflexion ROM was significantly increased in both high-intensity and short-duration [+5.8 ± 12.8 Nm (Δ22.9 ± 40.5%)] and low-intensity and long-duration [+2.1 ± 3.4 Nm (Δ6.9 ± 10.8%)] conditions, but no significant differences were observed between both conditions. The shear elastic modulus was significantly decreased in both high-intensity and short-duration [−8.8 ± 6.1 kPa (Δ − 38.8 ± 14.5%)] and low-intensity and long-duration [−8.0 ± 12.8 kPa (Δ − 22.2 ± 33.8%)] conditions. Moreover, the relative change in shear elastic modulus in the high-intensity and short-duration SS was significantly greater than that in low-intensity and long-duration SS. Our results suggest that a higher intensity of the static stretching should be conducted to increase ROM and decrease muscle stiffness, even for a short time.
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Affiliation(s)
- Taizan Fukaya
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Rehabilitation, Kyoto Kujo Hospital, Kyoto, Japan
| | - Ryosuke Kiyono
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Shigeru Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kaoru Yahata
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Koki Yasaka
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Remi Onuma
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
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25
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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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26
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Neto T, Freitas SR, Andrade RJ, Vaz JR, Mendes B, Firmino T, Bruno PM, Nordez A, Oliveira R. Shear Wave Elastographic Investigation of the Immediate Effects of Slump Neurodynamics in People With Sciatica. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:675-681. [PMID: 31633231 DOI: 10.1002/jum.15144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/28/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Neurodynamic techniques are often used to treat people with sciatica pain, but their mechanical effects on the sciatic nerve are unknown. Shear wave elastography (SWE) has been shown to effectively estimate the stiffness of peripheral nerves in real time. The aim of this study was to use SWE to assess the effects of slump neurodynamics in the sciatic stiffness of people with sciatica. METHODS Sixteen participants volunteered for this study. The sciatic stiffness of 8 patients with unilateral chronic sciatica and 8 healthy control participants was measured by SWE, with the participants in a prone position and during a dynamic condition (ie, ankle dorsiflexion). These measurements were performed before and immediately after the neurodynamic intervention, which consisted of a static slump position applied to the symptomatic limb of the patients with sciatica and in a randomly chosen limb of the healthy participants. RESULTS The 8 patients with sciatica included 6 male and 2 female patients, and the 8 healthy control participants included 5 male and 3 female volunteers. Slump neurodynamics resulted in an immediate decrease in the sciatic nerve stiffness of the symptomatic limb in people with sciatica by 16.1% (effect size = 0.65; P = .019). The intervention showed no significant changes in the sciatic nerve stiffness of the healthy participants (effect size = 0.05; P = .754). CONCLUSIONS Slump neurodynamics have the potential of decreasing the sciatic nerve stiffness in people with sciatica, and this effect can be quantified by SWE, which may provide valuable information for health professionals.
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Affiliation(s)
- Tiago Neto
- Department of Physiotherapy, LUNEX International University of Health, Exercise, and Sports, Differdange, Luxembourg
| | - Sandro R Freitas
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Ricardo J Andrade
- Movement, Interactions, and Performance Laboratory, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - João R Vaz
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Bruno Mendes
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Telmo Firmino
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal
| | - Paula M Bruno
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Antoine Nordez
- Movement, Interactions, and Performance Laboratory, 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
| | - Raúl Oliveira
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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27
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Gomes J, Neto T, Vaz JR, Schoenfeld BJ, Freitas SR. Is there a relationship between back squat depth, ankle flexibility, and Achilles tendon stiffness? Sports Biomech 2020; 21:782-795. [PMID: 32022631 DOI: 10.1080/14763141.2019.1690569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study investigated the relationship between back squat depth capacity, ankle dorsiflexion resistance to stretch and maximal range of motion (ROM), and Achilles tendon stiffness of healthy individuals (n = 20). Squat depth capacity was assessed with 2D kinematic analysis. Ankle dorsiflexion maximal ROM was assessed using a smartphone digital goniometry (lunge test) and isokinetic dynamometry (prone test). Ankle dorsiflexion resistance to stretch was assessed during the prone test. Achilles tendon stiffness was estimated at rest [using shear wave elastography (stiffness-SWE)] and during isometric contraction through tendon force-length relationship (using B-mode sonography). Squat depth was associated only with ankle dorsiflexion ROM in the lunge test (r = 0.69, p = 0.001). Ankle dorsiflexion ROM in the lunge test was associated with the ankle resistance to stretch (r = 0.46, p = 0.050) and Achilles tendon stiffness-SWE (r = 0.62, p = 0.005); and it was the only variable different between individuals with low and high squat depth capacity (p = 0.014). No other statistically significant associations were found. In conclusion, back squat depth is associated with ankle dorsiflexion ROM when the knee is flexed, without evident influence of global joint and Achilles tendon mechanical properties.
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Affiliation(s)
- João Gomes
- Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Tiago Neto
- Departament of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - João R Vaz
- Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | | | - Sandro R Freitas
- Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
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28
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Nakamura M, Sato S, Hiraizumi K, Kiyono R, Fukaya T, Nishishita S. Effects of static stretching programs performed at different volume-equated weekly frequencies on passive properties of muscle-tendon unit. J Biomech 2020; 103:109670. [PMID: 32035662 DOI: 10.1016/j.jbiomech.2020.109670] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 11/18/2022]
Abstract
Whether static stretching (SS) frequency has an effect on increasing the range of motion (ROM) and decreasing muscle stiffness remains unclear. Therefore, this study aimed to investigate the effects of two 6-week SS programs performed with different frequencies but generally the same duration of stretching on the passive properties of the medial gastrocnemius muscle-tendon unit. The study participants comprised 24 male volunteers randomly assigned to either the one-time/week group or the three-times/week group, performing 6 min of SS once per week and 2 min of SS thrice per week, respectively. The dorsiflexion ROM (DF ROM) and muscle stiffness of the medial gastrocnemius during passive ankle dorsiflexion were assessed using a dynamometer and ultrasonography before and after 6 weeks of SS programs. The results show that the DF ROM was increased and muscle stiffness was decreased significantly in the three-times/week group (P < 0.01 and P < 0.01, respectively), whereas no significant changes were observed in DF ROM and muscle stiffness in the one-time per week group (P = 0.25 and P = 0.32, respectively). These results suggest that a high-frequency SS program is more effective than a low-frequency SS program in increasing ROM and decreasing muscle stiffness.
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Affiliation(s)
- Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata 950-3198, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata 950-3198, Japan.
| | - Shigeru Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Kakeru Hiraizumi
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Ryosuke Kiyono
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Taizan Fukaya
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata 950-3198, Japan; Department of Rehabilitation, Kyoto Kujo Hospital, 10 Karahashirajoumoncho, Minami-ku, Kyoto 601-8453, Japan
| | - Satoru Nishishita
- Graduate School of Medicine, Kyoto University, 53 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Institute of Rehabilitation Science, Tokuyukai Medical Corporation, 3-11-1 Sakuranocho, Toyonaka, Osaka 560-0054, Japan; Kansai Rehabilitation Hospital, Tokuyukai Medical Corporation, 3-11-1 Sakuranocho, Toyonaka, Osaka 560-0054, Japan
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29
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Gamelas T, Fernandes A, Magalhães I, Ferreira M, Machado S, Silva AG. Neural gliding versus neural tensioning: Effects on heat and cold thresholds, pain thresholds and hand grip strength in asymptomatic individuals. J Bodyw Mov Ther 2019; 23:799-804. [DOI: 10.1016/j.jbmt.2019.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/22/2019] [Indexed: 12/20/2022]
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30
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Development of a novel multiphysical approach for the characterization of mechanical properties of musculotendinous tissues. Sci Rep 2019; 9:7733. [PMID: 31118478 PMCID: PMC6531478 DOI: 10.1038/s41598-019-44053-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 05/03/2019] [Indexed: 12/02/2022] Open
Abstract
At present, there is a lack of well-validated protocols that allow for the analysis of the mechanical properties of muscle and tendon tissues. Further, there are no reports regarding characterization of mouse skeletal muscle and tendon mechanical properties in vivo using elastography thereby limiting the ability to monitor changes in these tissues during disease progression or response to therapy. Therefore, we sought to develop novel protocols for the characterization of mechanical properties in musculotendinous tissues using atomic force microscopy (AFM) and ultrasound elastography. Given that TIEG1 knockout (KO) mice exhibit well characterized defects in the mechanical properties of skeletal muscle and tendon tissue, we have chosen to use this model system in the present study. Using TIEG1 knockout and wild-type mice, we have devised an AFM protocol that does not rely on the use of glue or chemical agents for muscle and tendon fiber immobilization during acquisition of transversal cartographies of elasticity and topography. Additionally, since AFM cannot be employed on live animals, we have also developed an ultrasound elastography protocol using a new linear transducer, SLH20-6 (resolution: 38 µm, footprint: 2.38 cm), to characterize the musculotendinous system in vivo. This protocol allows for the identification of changes in muscle and tendon elasticities. Such innovative technological approaches have no equivalent to date, promise to accelerate our understanding of musculotendinous mechanical properties and have numerous research and clinical applications.
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31
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Konrad A, Reiner MM, Thaller S, Tilp M. The time course of muscle-tendon properties and function responses of a five-minute static stretching exercise. Eur J Sport Sci 2019; 19:1195-1203. [PMID: 30821657 PMCID: PMC6816483 DOI: 10.1080/17461391.2019.1580319] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to investigate the time course of the changes of muscle-tendon mechanical properties and the function responses of the plantar flexor muscles following 5 × 60 s of static stretching. Fourteen healthy volunteers were tested on four separate days in a random order with three different rest times (0, 5, 10 min) after 5 × 60 s of stretching or following a control period without stretching. During each test, the dorsiflexion range of motion (RoM), passive resistive torque (PRT), and maximum voluntary contraction (MVC) were measured with a dynamometer. Ultrasonography of the gastrocnemius medialis (GM) muscle-tendon junction displacement and motion capture allowed us to determine the length changes in the tendon and muscle, respectively, and hence to calculate their stiffness. We observed an increase in RoM and decrease in MVC at 0, 5, and 10 min post-stretching. This could be attributed to an increase in muscle elongation which lasted at least 10 min. A decrease in muscle-tendon stiffness was observed immediately, but not 5 or 10 min after the stretching. A decrease in PRT and muscle stiffness was observed up to 5 min after the stretching. No changes were detected in tendon stiffness or in any variable in the control group. The effects of a 5 × 60 s static stretching exercise changes the muscle-tendon functions (RoM, MVC), which are related to mechanical changes of the muscle but not the tendon structure, respectively. Although the functional changes last for at least 10 min, changes in muscle stiffness were only observed up to 5 min after the stretching exercise.
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Affiliation(s)
- A Konrad
- Institute of Sports Science, Graz University , Graz , Austria
| | - M M Reiner
- Institute of Sports Science, Graz University , Graz , Austria
| | - S Thaller
- Institute of Sports Science, Graz University , Graz , Austria
| | - M Tilp
- Institute of Sports Science, Graz University , Graz , Austria
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