Changes in passive tension of muscle in humans and animals after eccentric exercise

Utilizing the Pronated Forearm Technique for Measuring Glenohumeral External Rotation in Baseball Players

BACKGROUND

Alterations in glenohumeral internal rotation (GIR), glenohumeral external rotation (GER), and total range of motion (TROM) have been linked with increased injury risk. GER capacity has been measured routinely with the forearm in neutral rotation (GERN), but a recent study reported GERN was greater than GER with the forearm in pronation (GERP) in Minor League pitchers. This work has not yet been replicated or extended to other groups.

HYPOTHESIS

GERP would be significantly less than GERN in Independent League baseball pitchers, and there would be no difference in GERP or GERN measurements between this new group and the previous group of Minor League pitchers.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Goniometric measurements were recorded for bilateral GIR, GERN, and GERP, and resulting TROM for 37 Independent League baseball pitchers. These data were compared with the previous study. All motions were compared individually between groups, between throwing and nonthrowing arm, and both within and between techniques (forearm neutral or pronated).

RESULTS

GERP was significantly less than GERN for both arms within each group tested (P < 0.01). Independent League pitchers had greater between arm differences for GIR (-16.9° vs -6.9°), GERN (+15.1° vs -0.6°), and GERP (+13.1° vs -5.9°) compared with Minor League pitchers. TROM for the Independent League pitchers was not statistically different for either measurement technique, while TROM for the throwing arm of the Minor League pitchers was statistically reduced with varying effect sizes (d = 0.35-0.99) compared with the nonthrowing arm (P < 0.01).

CONCLUSION

This study confirmed earlier findings that the pronated forearm resulted in decreased GER capacity, illustrating the adaptive response to throwing and the need to evaluate for this variable.

CLINICAL RELEVANCE

GERP should be evaluated in all groups of pitchers, but there may be variations within tested groups.

Rehabilitation of the painful shoulder

Managing the painful shoulder in overhead athletes can be difficult because of a lack of time-loss injuries in overhead sports and focusing primarily on either pathoanatomic causes or movement impairments. Although managing the painful shoulder can be challenging, the combination of identifying pathoanatomic causes with movement impairments can provide a more focused rehabilitation approach directed at the causes of shoulder pain. Understanding the potential influence of scapular positioning as well as mobility and/or strength impairments on shoulder pain can help clinicians develop more directed rehabilitation programs. Furthermore, sports-specific methods such as long toss or the use of weighted balls for achieving physiological or performance-based gains have limited empirical evidence regarding their clinical and performance-based benefits, which may impede the rehabilitation process. Applying a comprehensive evaluation approach prior to and throughout the treatment process can assist clinicians with selecting the most appropriate treatment based on patient need. Reconsidering traditional treatments based on existing evidence may help refine the treatment process for overhead athletes with shoulder pain.

Mild to moderate damage in knee extensor muscles accumulates after two bouts of maximal eccentric contractions

PURPOSE

This study aimed to determine whether mild to moderate muscle damage accumulates on the knee extensors after two bouts of maximal eccentric contractions performed over two consecutive days.

METHODS

Thirty participants performed an initial bout of maximal eccentric contractions of knee extensors during the first day of the protocol (ECC1). Then, they were separated in two groups. The Experimental (EXP) group repeated the eccentric bout 24 h later (ECC2) while the Control (CON) group did not. Indirect markers of muscle damage (i.e., strength loss, muscle soreness, and shear modulus) were measured to quantify the amount of muscle damage and its time course.

RESULTS

Two days after the initial eccentric session, participants from EXP had a higher strength deficit (- 14.5 ± 10.6%) than CON (- 6.6 ± 8.7%) (P = 0.017, d = 0.9). Although both groups exhibited an increase in knee extensors shear modulus after ECC1, we found a significant increase in muscle shear modulus (+ 13.3 ± 22.7%; P < 0.01; d = 0.5) after ECC2 for the EXP group, despite the presence of mild to moderate muscle damage (i.e., strength deficit about 16%).

CONCLUSION

Although the markers of muscle damage used in the current study were indirect, they suggest that the repetition of two bouts of maximal eccentric contractions with 24 h apart induces additional muscle damage in the knee extensors in presence of mild to moderate muscle damage.

The Reliability and Validity of a Portable Three-Dimensional Scanning System to Measure Leg Volume

(1) Background: The study examined the reliability (test-retest, intra- and inter-day) and validity of a portable 3D scanning method when quantifying human leg volume. (2) Methods: Fifteen males volunteered to participate (age, 24.6 ± 2.0 years; stature, 178.9 ± 4.5 cm; body mass, 77.4 ± 6.5 kg; mean ± standard deviation). The volume of the lower and upper legs was examined using a water displacement method (the criterion) and two consecutive 3D scans. Measurements were taken at baseline, 1 h post-baseline (intra-day) and 24 h post-baseline (inter-day). Reliability and validity of the 3D scanning method was assessed using Bland-Altman limits of agreement and Pearson's product moment correlations. (3) Results: With respect to the test-retest reliability, the 3D scanning method had smaller systematic bias and narrower limits of agreement (±1%, and 3-5%, respectively) compared to the water displacement method (1-2% and 4-7%, respectively), when measuring lower and upper leg volume in humans. The correlation coefficients for all reliability comparisons (test-retest, intra-day, inter-day) would all be regarded as 'very strong' (all 0.94 or greater). (4) Conclusions: The study's results suggest that a 3D scanning method is a reliable and valid method to quantify leg volume.

Effectiveness of 448-kHz Capacitive Resistive Monopolar Radiofrequency Therapy After Eccentric Exercise-Induced Muscle Damage to Restore Muscle Strength and Contractile Parameters

CONTEXT

Exercise-induced muscle damage (EIMD) is prevalent especially in sports and rehabilitation. It causes loss in skeletal muscle function and soreness. As there are no firm preventive strategies, we aimed to evaluate the preventive efficacy of nonthermal 448-kHz capacitive resistive monopolar radiofrequency (CRMRF) therapy after eccentric bouts of EIMD response in knee flexors.

DESIGN

Twenty-nine healthy males (age: 25.2 [4.6] y) were randomized in control group (CG; n = 15) and experimental group (EG; n = 14) where EG followed 5 daily 448-kHz CRMRF therapies. All assessments were performed at baseline and post EIMD (EIMD + 1, EIMD + 2, EIMD + 5, and EIMD + 9 d). We measured tensiomyography of biceps femoris and semitendinosus to calculate contraction time, the maximal displacement and the radial velocity of contraction, unilateral isometric knee flexors maximal voluntary contraction torque, and rate of torque development in first 100 milliseconds.

RESULTS

Maximal voluntary contraction torque and rate of torque development in first 100 milliseconds decreased more in CG than in EG and recovered only in EG. Biceps femoris contraction time increased only in CG (without recovery), whereas in semitendinosus contraction time increased in EG (only at EIMD + 1) and in CG (without recovery). In both muscles, tensiomyographic maximal displacement decreased in EG (in EIMD + 1 and EIMD + 2) and in CG (without recovery). Furthermore, in both muscles, radial velocity of contraction decreased in EG (from EIMD + 1 until EIMD + 5) and in CG (without recovery).

CONCLUSION

The study shows beneficial effect of CRMRF therapy after inducing EIMD in skeletal muscle strength and contractile parameters in knee flexors.

Relationship Between Posterior Shoulder Tightness and Lower-Limb Flexibility in College Baseball Players

CONTEXT

Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players.

DESIGN

Cross-sectional study.

SETTING

University laboratory.

PARTICIPANTS

Twenty-two college baseball players (20 right-handed and 2 left-handed).

METHODS

To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs.

RESULTS

Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 = .250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P = .018) and horizontal adduction (R2 = .200, β [95% CI] = 0.447 [0.051 to 1.499], P = .019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 = .189, β [95% CI] = 0.435 [0.019 to 1.137], P = .022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 = .243, β [95% CI] = 0.493 [0.139 to 1.438], P = .010).

CONCLUSION

College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players.

The effects of chronic concentric and eccentric training on position sense and joint reaction angle of the knee extensors

The aim of the present study was to compare the effect of chronic concentric or eccentric training on position sense and joint reaction angle, in healthy, untrained young men. Twenty-four men were randomly assigned into a pure concentric (CT) or a pure eccentric (ET) group and performed for 8 weeks, one training session/week, 75 maximal knee extensors contractions. Before and 48 h after the first (W1) and the last (W8) training sessions, knee joint position sense and joint reaction angle were assessed at three different knee angles (i.e. 30°, 45° and 60°). At the same time points, indirect indices of exercise-induced muscle damage (EIMD) were evaluated (i.e. range of motion [ROM], optimal angle, maximum isometric, concentric and eccentric torques, delayed onset muscle soreness [DOMS] and blood creatine kinase concentrations [CK]). Forty-eight hours post W1, position sense, reaction angle and all EIMD indices were significantly changed for both groups (p < 0.05; η²: 0.125-0.618), however, greater alterations were observed after ET. Significant correlations were found, in both groups, between the training-induced changes of position sense, reaction angles and the changes of EIMD biomarkers (r: -0.855-0.825; p < 0.005). No significant changes were found 48 h post W8 for position sense, reaction angle and EIMD indices (p > 0.285) for both CT or ET groups. In conclusion, exercise-induced changes in position sense and reaction angle, were related to the magnitude of EIMD, and not by the type of muscle contraction per se. HighlightsExercise induced changes in position sense and reaction angle, were related to the magnitude of EIMD, and not by the type of muscle contraction per se.After the 1st training session eccentric exercise caused greater disturbances, compared to concentric exercise, in EIMD indices which caused concomitant disturbances to position sense and knee reaction angle.8 weeks of either eccentric or concentric training leads to preservation of position sense and knee reaction angle 48 h after maximal intensity exercise of either types of muscle contraction.

Contractile properties are less affected at long than short muscle length after eccentric exercise

PURPOSE

The aim of the present study was to investigate whether the electrically evoked muscle responses are differently affected over time by the knee joint angle after an exercise-induced muscle damage (EIMD). We hypothesized that low-frequency-evoked responses would be less affected at long than short muscle length, and that mechanisms located within the muscle and tendinous tissues would be involved.

METHODS

Fifteen males performed 45 min loaded downhill walking (DW) exercise. Maximal voluntary contraction torque (MVC), optimal angle for torque production, voluntary activation level (VAL), twitch, doublet at 10 and 100 Hz (Db10 and Db100, respectively), rate of torque development (RTD), post-activation potentiation (PAP), muscle shear elastic modulus (µ) and aponeurosis stiffness were assessed before, after, and 4, 24, 48, 72 and 168 h after the exercise at a knee angle of 40°, 90° and 120° (0°: full extension).

RESULTS

MVC, VAL and Db100 were similarly decreased across joint angles after the DW and optimal angle was not affected. Twitch, Db10, Db10/Db100, PAP and RTD were less affected and muscle µ more increased at long than short muscle lengths (p < 0.05), especially during the first 24 h after the DW exercise.

CONCLUSION

Low-frequency-evoked responses were more preserved at long than short muscle length the first 24 h after the DW exercise, suggesting that joint angle should be taken into account to assess muscular alterations after EIMD. This length-dependence could be associated to the higher sensitivity to Ca²⁺ and the higher increase in muscle stiffness at long than short muscle length.

Short-time recovery skeletal muscle from dexamethasone-induced atrophy and weakness in old female rats

BACKGROUND

Several pathological conditions (atrophy, dystrophy, spasticity, inflammation) can change muscle biomechanical parameters. Our previous works have shown that dexamethasone treatment changes skeletal muscle tone, stiffness, elasticity. Exercise training may oppose the side effects observed during dexamethasone treatment. The purpose of this study was to examine the changes in biomechanical parameters (tone, stiffness, elasticity) of skeletal muscle occurring during dexamethasone treatment and subsequent short-time recovery from glucocorticoid-induced muscle atrophy and weakness, as well as the effect of mild therapeutic exercise.

METHODS

17 old female rats, aged 22 months were used in this study. The hand-held and non-invasive device (MyotonPRO, Myoton Ltd., Tallinn, Estonia) was used to study changes in biomechanical properties of muscle. Additionally, body and muscle mass, hind limb grip strength were assessed.

FINDINGS

Results showed that dexamethasone treatment alters muscle tone, stiffness and elasticity. During 20-day recovery period all measured parameters gradually improved towards the average baseline, however, remaining significantly lower than these values. The body and muscle mass, hind limb grip strength of the rats decreased considerably in the groups that received glucocorticoids. After 20 days of recovery, hind limb grip strength of the animals was slightly lower than the baseline value and mild therapeutic exercise had a slight but not significant effect on hind limb grip strength. Biomechanical parameters improved during the recovery period, but only dynamic stiffness and decrement retuned to baseline value.

INTERPRETATION

The study results show that monitoring muscle biomechanical parameters allows to assess the recovery of atrophied muscle from steroid myopathy.

Using Shear-Wave Elastography to Assess Exercise-Induced Muscle Damage: A Review

Shear-wave elastography is a method that is increasingly used to assess muscle stiffness in clinical practice and human health research. Recently, shear-wave elastography has been suggested and used to assess exercise-induced muscle damage. This review aimed to summarize the current knowledge of the utility of shear-wave elastography for assessment of muscle damage. In general, the literature supports the shear-wave elastography as a promising method for assessment of muscle damage. Increases in shear modulus are reported immediately and up to several days after eccentric exercise, while studies using shear-wave elastography during and after endurance events are showing mixed results. Moreover, it seems that shear modulus increases are related to the decline in voluntary strength loss. We recommend that shear modulus is measured at multiple muscles within a muscle group and preferably at longer muscle lengths. While further studies are needed to confirm this, the disruption of calcium homeostasis seems to be the primary candidate for the underlying mechanism explaining the increases in shear modulus observed after eccentric exercise. It remains to be investigated how well the changes in shear modulus correlate with directly assessed amount of muscle damage (biopsy).

Acute effect of resistance exercise at different velocities on stiffness and vascularity of the biceps brachii muscle: a preliminary study

Background

Resistance exercise can be defined as the percentage of maximal strength (%1 repetition maximum) used for a particular exercise. Shear wave elastography (SWE) is a robust and novelty imaging technique that provides information regarding tissue stiffness. Superb microvascular imaging (SMI) is a non-irradiating technique that can provide quantitative measurement of muscle blood flow non-invasively.

Purpose

To compare the acute effects of low- and high-velocity resistance exercise on stiffness and blood flow in the biceps brachii muscle (BBM) using SWE and SMI.

Material and Methods

This prospective study included 60 healthy men (mean age=28.9 years; age range=26–34 years). BBM stiffness was measured by using SWE at rest, after low- and high-velocity resistance exercise, and muscle blood flow was also evaluated by SMI. Resistance exercise was performed using a dumbbell with a mass adjusted to 70%–80% of one-repetition maximum.

Results

The stiffness values increased significantly from resting to high- and low-velocity resistance exercises. There was no significant difference between the elastography values of the BBM after the high- and low-velocity resistance exercise. The blood flow increased significantly from resting to high- and low-velocity resistance exercises. Blood flow increase after low-velocity exercise was significantly higher compared to high-velocity exercise.

Conclusion

While muscle stiffness parameters and blood flow significantly increased from resting after both high- and low-velocity resistance exercises, blood flow significantly increased after low-velocity exercise compared to high-velocity exercise. This can mean that metabolic stress, an important trigger for muscle development, is more likely to occur in low-velocity exercise.

Eccentric muscle contraction potentiates titin stiffness-related contractile properties in rat fast-twitch muscles

This study was conducted to examine the effects of an acute bout of eccentric muscle contraction (ECC) on titin stiffness-related contractile properties in rat fast-twitch skeletal muscles. Intact gastrocnemius muscles were electrically stimulated in situ to undergo 200-repeated ECCs. Immediately after cessation of the stimulation, the superficial regions of the muscles were dissected and subjected to biochemical and skinned fiber analyses. Small heat shock protein αB-crystallin in the muscle fraction enriched for myofibrillar proteins was increased by ECC. ECC resulted in an increase in the titin-based passive force. Protein kinase A-treatment decreased the passive force only in ECC-subjected but not in rested fibers. ECC decreased the maximum Ca²⁺-activated force at a sarcomere length (SL) of 2.4 μm and had no effect on myofibrillar-Ca²⁺ sensitivity at 2.6-μm SL. In both rested and ECC-subjected fibers, these two variables were higher at 3.0-μm SL than at 2.4- or 2.6-μm SL. The differences in the two variables between the short and long SLs were greater in ECC-subjected than in rested fibers. These results indicate that an acute bout of ECC potentiates titin-based passive force, maximum active force at long SLs, and length-dependent activation and suggest that this potentiation may resist muscle fatigue in the muscles of the exercising body.

The effects of eccentric exercise on passive hamstring muscle stiffness: Comparison of shear-wave elastography and passive knee torque outcomes

The aim of our study was to assess eccentric-exercise-induced changes in passive knee joint torque, passive knee joint stiffness and shear modulus at of the hamstring muscles. We hypothesized that eccentric exercise would elicit an increase in all outcomes. Fourteen healthy volunteers (age = 25.5±4.7 years) performed eccentric exercise protocol. Before and after 0h, 1h, 24h and 48h, we measured the shear modulus of hamstring muscles using shear-wave elastography and passive knee joint stiffness on isokinetic dynamometer. After eccentric exercise, the shear modulus of biceps femoris increased after 0h (22.4 ± 34.1 %; p = 0.021) and for semitendinosus after 0h (14.5 ± 4.9 %), 1h (16.2 ± 6.5 %) and 24h (16.6 ± 8.3 %) (p = 0.005-0.015). There were no changes for semimembranosus and no changes in passive knee joint moment measures. There were also no correlations between the two methods. Eccentric exercise increased shear modulus of hamstring muscles, while passive joint torque was not affected. This suggests that shear-wave elastography could be more sensitive than torque measures to intra-muscular changes induced by eccentric exercise.

Posterior shoulder stiffness was associated with shoulder pain during throwing in college baseball players: assessment of shear wave elastography

PURPOSE

To investigate shoulder stiffness on the throwing and non-throwing sides in college baseball players using ultrasound shear wave elastography (SWE), and investigate the relationship between stiffness and shoulder pain during throwing.

METHODS

Forty-nine college baseball players (98 shoulders) were recruited. Shoulder range of motion was evaluated. SWE was used to measure stiffness of the bilateral supraspinatus tendons, infraspinatus tendons, subscapularis tendons, supraspinatus muscles, infraspinatus muscles (ISPM), and posterior capsules. Participants were divided into pain and no pain groups based on the presence or absence of shoulder pain during throwing within 1 month before measurements on the throwing side. Items were compared between the throwing and non-throwing sides, and between the pain and no pain groups. Factors affecting shoulder pain during throwing were also investigated via multiple logistic regression analysis.

RESULTS

Compared with the non-throwing side, the throwing side had significantly greater external rotation at 90° abduction, significantly lesser internal rotation at 0° abduction and internal rotation at 90° abduction (AbdIR), significantly higher SWE values of the infraspinatus tendon, ISPM, and posterior capsule, and significantly lower SWE values of the subscapularis tendon. Compared with the no pain group, the pain group had a significantly higher SWE value of the ISPM, and significantly lesser AbdIR. Increased ISPM SWE values and decreased AbdIR were significantly correlated with shoulder pain during throwing.

CONCLUSIONS

The posterior tissue was stiffer than the anterior tissue on the throwing side. Decreased AbdIR and increased ISPM stiffness may be correlated with shoulder pain during throwing.

Muscle Shear Elastic Modulus Provides an Indication of the Protection Conferred by the Repeated Bout Effect

Background: The neuromuscular system is able to quickly adapt to exercise-induced muscle damage (EIMD), such that it is less affected by subsequent damaging exercise, a phenomenon known as the repeated bout effect (RBE). The objective was to determine whether the mechanical properties of the quadriceps, as evaluated by shear wave elastography (SWE), were less affected when a second bout of eccentric-biased exercise was performed 2 weeks later. It was hypothesized that the first bout would confer protection against extensive muscle damage through an adaptation of the muscle stiffness before the second bout (i.e., higher muscle stiffness).

Methods: Sixteen males performed two identical bouts of downhill walking separated by 2 weeks (45 min at 4.5 km.h−1; gradient: 25%; load: 30% of the body mass). Rectus femoris (RF) and vastus lateralis (VL) resting shear elastic modulus (µ) and EIMD symptoms were measured before and up to 7 days following the exercise bouts. Changes in neuromuscular function was evaluated by maximal voluntary contraction torque, voluntary activation level, evoked mechanical response to single and double (10 and 100 Hz doublets) electrical stimulation. An index of protection (IP) was calculated for EIMD symptoms to assess magnitude the RBE.

Results: EIMD symptoms were less affected after the second than the first exercise bout. RF and VL-µ increased (p &lt; 0.001) only after the first exercise. RF µ was elevated up to 2 weeks after the end of the first exercise (p &lt; 0.001) whereas VL µ was only increased up to 24 h. The increase in µ observed 2 weeks after the end of the first exercise was correlated with the IP; i.e., attenuation of alterations in muscle µ, 10 Hz-doublet amplitude and rate of torque development after the second exercise bout (p &lt; 0.05).

Conclusion: We showed that muscle µ assessed by SWE was sensitive to the RBE, with a differential effect between VL and RF. The persistent increase in µ was associated with the attenuation of neuromuscular impairments observed after the second bout, suggesting that the increased muscle stiffness could be a “protective” adaptation making muscles more resistant to the mechanical strain associated to eccentric contractions.

Changes in blood bone markers after the first and second bouts of whole-body eccentric exercises

The present study compared the first (EC1) and second (EC2) bouts of whole-body eccentric exercises to examine the effects of the magnitude of muscle damage on changes in blood bone markers. Fifteen sedentary young men performed nine eccentric exercises of arm, leg and trunk muscles, and repeated them two weeks later. Blood samples were taken before and two hours and one to five days following each bout to analyze plasma creatine kinase (CK) activity and myoglobin concentration, serum tartrate resistant acid phosphatase (TRAP), type 1 C-terminal telopeptide (CTX-1), procollagen type I N-terminal propeptide (P1NP), bone-specific alkaline phosphatase (BAP), undercarboxylated-osteocalcin (ucOCN), carboxylated-osteocalcin (cOCN), and leptin concentrations. All except ucOCN changed significantly (P<0.05) after both bouts. When comparing bouts for peak changes, P1NP (bone formation marker) and CTX-1 (bone resorption marker) increased less after EC2 (peak: 137±96% and 7±6%, respectively) than after EC1 (146±80% and 30±21%, respectively), whereas BAP (bone formation marker) increased more after EC2 (18±16%) than after EC1 (4±15%) (P<0.05). Leptin (49±58%) and cOCN (14±10%) increased more (P<0.05) after EC2 than after EC1 (-30±15%, 9±26%). Significant (P<0.05) correlations were evident between peak CK activity and peak CTX-1 (r=0.847), P1NP (r=0.815), BAP (r=-0.707), ucOCN (r=0.627), cCON (r=-0.759) and leptin (r=-0.740) changes after EC1, but many of these correlations disappeared after EC2. This was also found for the relationships between other muscle damage markers (myoglobin, muscle soreness and muscle strength) and the bone markers. It was concluded that bone turnover was affected by eccentric exercise, but muscle damage was unfavorable for bone formation.

Effect of shod and barefoot running on muscle mechanical properties

BACKGROUND

Barefoot runners have a higher probability of lower leg and foot disorders compared to runners wearing traditional running shoes. However, the site of muscle stress due to barefoot running has not been reported. This study aimed to investigate the effects of shod and barefoot running on muscle mechanical properties.

METHODS

A total of 18 healthy male subjects were included in this study and were assigned to either the shod running group or the barefoot running group. While the shod group ran on the treadmill at a speed of 75% heart rate reserve for 45 min with shoes, the barefoot group ran without shoes after warm up session. As an index of muscle stiffness, the shear wave velocity (SWV) of the eleven lower extremity muscles were measured at rest before and after exercise using shear wave elastography.

RESULTS

The tibialis posterior SWV was increased after running in the shod (3.67 ± 0.41 m/s to 3.90 ± 0.45 m/s) and barefoot (3.70 ± 0.36 m/s to 4.02 ± 0.54 m/s) groups. In contrast, the vastus lateralis SWV was increased only in the shod group (2.62 ± 0.32 m/s to 2.80 ± 0.34 m/s), while the peroneus muscle SWV increased only in the barefoot group (3.24 ± 0.48 m/s to 3.50 ± 0.55 m/s and 2.92 ± 0.5 m/s to 3.11 ± 0.49 m/s for the superficial and deep layers, respectively).

CONCLUSIONS

The shod condition selectively influences changes in the stiffness of the vastus lateralis and peroneus muscles during running but has no effect on the tibialis posterior.

Why exercise builds muscles: titin mechanosensing controls skeletal muscle growth under load

Muscles sense internally generated and externally applied forces, responding to these in a coordinated hierarchical manner at different timescales. The center of the basic unit of the muscle, the sarcomeric M-band, is perfectly placed to sense the different types of load to which the muscle is subjected. In particular, the kinase domain of titin (TK) located at the M-band is a known candidate for mechanical signaling. Here, we develop a quantitative mathematical model that describes the kinetics of TK-based mechanosensitive signaling and predicts trophic changes in response to exercise and rehabilitation regimes. First, we build the kinetic model for TK conformational changes under force: opening, phosphorylation, signaling, and autoinhibition. We find that TK opens as a metastable mechanosensitive switch, which naturally produces a much greater signal after high-load resistance exercise than an equally energetically costly endurance effort. Next, for the model to be stable and give coherent predictions, in particular for the lag after the onset of an exercise regime, we have to account for the associated kinetics of phosphate (carried by ATP) and for the nonlinear dependence of protein synthesis rates on muscle fiber size. We suggest that the latter effect may occur via the steric inhibition of ribosome diffusion through the sieve-like myofilament lattice. The full model yields a steady-state solution (homeostasis) for muscle cross-sectional area and tension and, a quantitatively plausible hypertrophic response to training, as well as atrophy after an extended reduction in tension.

Response of Knee Extensor Muscle-Tendon Unit Stiffness to Unaccustomed and Repeated High-Volume Eccentric Exercise

The purposes of this study were to investigate the muscle-tendon unit stiffness response and to compare the stiffness with those of other indirect markers induced by two bouts of unaccustomed eccentric exercise. Eleven untrained men performed two bouts of 200 maximal eccentric contractions of the right quadriceps 4 weeks apart. Changes in stiffness, pain evoked by stretching and pressure, plasma creatine kinase (CK) activity, and muscle thickness were followed for 7 days after each bout. Stiffness and pain peaked immediately and 1 day after the first exercise bout, whereas CK and thickness were highest 4 and 7 days after the first exercise bout, respectively (p < 0.05 for all). Muscular pain, thickness, and stiffness responses were lower by 53.3%, 99%, and 11.6%, respectively, after the repeated bout compared to after the first bout (p < 0.05 for all), while CK activity response did not differ significantly between bouts. High responders for an increase in muscle-tendon unit stiffness showed a repeated-bout effect for stiffness, pain, and CK activity (by 29%, 65%, and 98%, p < 0.05 for all), but the repeated-bout effect was not that clear in low responders. These findings suggest that a repeated eccentric exercise bout effect on stiffness in quadriceps is mostly not associated with muscle pain and CK activity, but there are large individual differences.

Molecular Mechanisms of Muscle Tone Impairment under Conditions of Real and Simulated Space Flight

Kozlovskaya et al. [1] and Grigoriev et al. [2] showed that enormous loss of muscle stiffness (atonia) develops in humans under true (space flight) and simulated microgravity conditions as early as after the first days of exposure. This phenomenon is attributed to the inactivation of slow motor units and called reflectory atonia. However, a lot of evidence indicating that even isolated muscle or a single fiber possesses substantial stiffness was published at the end of the 20th century. This intrinsic stiffness is determined by the active component, i.e. the ability to form actin-myosin cross-bridges during muscle stretch and contraction, as well as by cytoskeletal and extracellular matrix proteins, capable of resisting muscle stretch. The main facts on intrinsic muscle stiffness under conditions of gravitational unloading are considered in this review. The data obtained in studies of humans under dry immersion and rodent hindlimb suspension is analyzed. The results and hypotheses regarding reduced probability of cross-bridge formation in an atrophying muscle due to increased interfilament spacing are described. The evidence of cytoskeletal protein (titin, nebulin, etc.) degradation during gravitational unloading is also discussed. The possible mechanisms underlying structural changes in skeletal muscle collagen and its role in reducing intrinsic muscle stiffness are presented. The molecular mechanisms of changes in intrinsic stiffness during space flight and simulated microgravity are reviewed.

Comparison of Interventional Strategies to Improve Recovery after Eccentric Exercise-Induced Muscle Fatigue

The aim of this study was to compare the effects of various recovery techniques on muscle tissue after eccentric exercise-induced muscle fatigue (EIMF). Forty subjects (24.3 ± 2.6 years; 77.45 ± 8.3 kg; 177.0 ± 6.4 cm; 24.66 ± 1.6 kg∙m^-2) were randomly assigned to one of the following groups: manual therapy (n =10, MT), mechanical vibration (n = 10, MV), percussion therapy (n = 10, PT) or foam roller (n = 10, FR). The contraction time (Tc) and the radial displacement (Dm) of the gastrocnemius was evaluated through tensiomyography (TMG). The application of the different techniques had positive effects for Tc and Dm in the treated leg compared to the untreated leg (F = 50.01, p < 0.01, η²p = 0.58 and F = 27.58, p < 0.01, η²p = 0.43, respectively) and for the interaction of the factors (Time x Leg x Therapy: F = 5.76, p < 0.01, η²p = 0.32 and F = 5.93, p < 0.01, η²p = 0.33, respectively). The results of the various methods used were similar: Tc (F = 0.17, p = 0.917; η²p = 0.01) and Dm (F = 3.30, p = 0.031, η²p = 0.22). PT interventions show potential for restoring muscle compliance and reducing stiffness, similar to MT and possibly more effective (cost-time relationship) compared to MV or FR.

Quantifying Dysfunction of the Lumbar Multifidus Muscle After Radiofrequency Neurotomy and Fusion Surgery: A Preliminary Study

The multifidus is an important muscle for the active stabilization of the spine. Unfortunately, clinical procedures such as posterior lumbar fusion (PLF) and radio frequency neurotomy (RFN) cause injury to these muscles affecting their function. However, evaluating multifidus function using traditional biomechanical methods is challenging due to its unique anatomical features. The change in muscle shear modulus during contraction has been corrected to force generation for several skeletal muscles. Therefore, the change in shear modulus can be used to quantify muscle contraction. The objective of this study was to evaluate multifidus dysfunction by comparing changes in shear modulus during muscle contraction in healthy individuals and patients who received RFN and PLF in the lumbar spine. We used our recently developed protocol which consists of measuring changes of multifidus shear modulus at lying prone, sitting up, and sitting up with the arms lifted. In healthy individuals, the median multifidus shear modulus increased progressively from prone, sitting, and sitting with arms raised: 18.55 kPa, 27.14 kPa, and 38.45 kPa, respectively. A moderate increase in shear modulus for these body positions was observed in PLF patients: 9.81 kPa, 17.26 kPa, and 21.85 kPa. In RFN patients, the shear modulus remained relatively constant: 14.44 kPa, 16.57 kPa, and 17.26 kPa. Overall, RFN and PLF caused a reduction in the contraction of multifidus muscles. However, the contraction of multifidus muscle slightly increased during multifidus activation in PLF patients, while it did not change in RFN patients. These preliminary measurements suggest that the proposed protocol using SWE can provide important information about the function of individual spine muscles to guide the design and evaluation of postsurgical rehabilitation protocols.

Pathophysiology of exercise-induced muscle damage and its structural, functional, metabolic, and clinical consequences

Extreme or unaccustomed eccentric exercise can cause exercise-induced muscle damage, characterized by structural changes involving sarcomere, cytoskeletal, and membrane damage, with an increased permeability of sarcolemma for proteins. From a functional point of view, disrupted force transmission, altered calcium homeostasis, disruption of excitation-contraction coupling, as well as metabolic changes bring about loss of strength. Importantly, the trauma also invokes an inflammatory response and clinically presents itself by swelling, decreased range of motion, increased passive tension, soreness, and a transient decrease in insulin sensitivity. While being damaging and influencing heavily the ability to perform repeated bouts of exercise, changes produced by exercise-induced muscle damage seem to play a crucial role in myofibrillar adaptation. Additionally, eccentric exercise yields greater hypertrophy than isometric or concentric contractions and requires less in terms of metabolic energy and cardiovascular stress, making it especially suitable for the elderly and people with chronic diseases. This review focuses on our current knowledge of the mechanisms underlying exercise-induced muscle damage, their dependence on genetic background, as well as their consequences at the structural, functional, metabolic, and clinical level. A comprehensive understanding of these is a prerequisite for proper inclusion of eccentric training in health promotion, rehabilitation, and performance enhancement.

Jakyakgamcho-tang in the relief of delayed-onset muscle soreness in healthy adults: study protocol for a randomized, double-blind, placebo-controlled, crossover design clinical trial

Background

Muscle soreness after exercise, called delayed-onset muscle soreness (DOMS), may cause significant changes in muscle function and may increase the risk of sports injuries. Therefore, various therapeutic strategies have been studied to help recovery after exercise. Jakyakgamcho-tang (JGT) is a widely prescribed herbal medicine to treat muscle pain and cramps in traditional Eastern medicine. The aim of this study is to evaluate the effect of JGT for reducing pain and improving muscle damage after exercise.

Methods

This study is a randomized, double-blind, placebo-controlled, crossover design clinical trial. A total of 30 healthy male adults will be recruited. Subjects who voluntarily wish to participate in this study will be hospitalized for 4 days. On the first day, the subjects will perform a standardized treadmill exercise for 1 h to induce DOMS. After the exercise, the subjects will take either JGT or a placebo for 3 days. After a more than 1 week wash-out period, the subjects will repeat the same process with the other drug. Pain intensity, calf circumference, and pain threshold will be measured as outcome measures. Blood tests and blood pressure will be measured as safety assessments. In addition, blood tests for muscle damage and inflammation markers, such as creatine kinase, interleukin-6, and C-reactive protein, will be analyzed.

Discussion

This will be the first trial to assess the effect of JGT on exercise-induced muscle soreness. Our findings will provide valuable data to determine the clinical effects of JGT on DOMS.

Trial registration

Clinical Research Information Sevice, KCT0003457. Registered on 29 January 2019.

Tensiomyography Derived Parameters Reflect Skeletal Muscle Architectural Adaptations Following 6-Weeks of Lower Body Resistance Training

Measurement of muscle specific contractile properties in response to resistance training (RT) can provide practitioners valuable information regarding physiological status of individuals. Field based measurements of such contractile properties within specific muscle groups, could be beneficial when monitoring efficacy of training or rehabilitation interventions. Tensiomyography (TMG) quantifies contractile properties of individual muscles via an electrically stimulated twitch contraction and may serve as a viable option in the aforementioned applications. Thus, aims of this study were; (i) to investigate the potential use of TMG to quantify training adaptations and differences, in response to exercise specific lower limb RT; and (ii) investigate any associations between TMG parameters and accompanying muscle architectural measures. Non-resistance trained male participants (n = 33) were randomly assigned to 1 of 3 single-exercise intervention groups (n = 11 per group); back squat (BS), deadlift (DL), or hip thrust (HT). Participants completed a 6-week linearized training program (2× per week), where the assigned exercise was the sole method of lower body training. Pre- and post-intervention testing of maximal dynamic strength was assessed by one repetition maximum (1RM) of BS, DL, and HT. Radial muscle belly displacement (Dm) and contraction time (Tc) were obtained via TMG from the rectus femoris (RF) and vastus lateralis (VL) pre- and post-intervention, alongside muscle architectural measures (pennation angle and muscle thickness). All three groups displayed significant increases all 1RM strength tests (p < 0.001; pη2 = 0.677-0.753). Strength increases were accompanied by significant overall increases in RF muscle thickness (p < 0.001, pη2 = 0.969), and pennation angle (p = 0.007, pη2 = 0.220). Additionally, an overall reduction in RF Dm (p < 0.001, pη2 = 0.427) was observed. Significant negative relationships were observed between RF Dm and pennation angle (p = 0.003, r = -0.36), and with RF Dm and muscle thickness (p < 0.001, r = -0.50). These findings indicate that TMG is able to detect improved contractile properties, alongside improvements in muscle function within an untrained population. Furthermore, the observed associations between Dm and muscle architecture suggest that TMG contractile property assessments could be used to obtain information on muscle geometry.

Passive muscle tension increases in proportion to intramuscular fluid volume

During extended bouts of exercise, muscle can increase in volume by as much as 20% as vascular fluid moves into the tissue. Recent findings suggest that the fluid content of muscle can influence the mechanics of force production; however, the extent to which natural volume fluctuations should be expected to influence muscle mechanics in vivo remains unclear. Here, using osmotic perturbations of bullfrog muscle, we explored the impacts of physiologically relevant volume fluctuations on a fundamental property of muscle: passive force production. We found that passive force and fluid volume were correlated over a 20% increase in muscle volume, with small changes in volume having significant effects on force (e.g. a 5% volume increase results in a >10% passive force increase). A simple physical model of muscle morphology reproduces these effects. These findings suggest that physiologically relevant fluid fluxes could alter passive muscle mechanics in vivo and affect organismal performance.

Regional differences in Ca2+ entry along the proximal-middle-distal muscle axis during eccentric contractions in rat skeletal muscle

Eccentric (ECC) contraction-induced muscle damage is associated with calcium ion (Ca²⁺) influx from the extracellular milieu through stretch-activated channels. It remains unknown whether Ca²⁺ influx consequent to repetitive ECC contractions is nonuniform across different muscle regions. We tested the hypothesis that there are regional differences in Ca²⁺ entry along the proximal-middle-distal muscle axis. Tibialis anterior (TA) muscles of adult male Wistar rats were exposed by reflecting the overlying skin and fasciae and ECC contractions evoked by peroneal nerve stimulation paired with simultaneous ankle extension (50 times/set, 2 protocols: 1 set and 10 sets). During ECC in the proximal, middle, and distal TA, we determined 1) muscle fiber extension by high-speed camera (200 frames/s) and 2) Ca²⁺ accumulation by in vivo bioimaging (Ca²⁺-sensitive probe Fura-2-acetoxymethyl ester). Muscle fiber extension from resting was significantly different among regions (i.e., proximal, 4.0%: < middle, 11.2%: < distal, 17.0%; ECC phase length at 500th contraction). Intracellular Ca²⁺ accumulation after 1 set of ECC was higher in the distal (1.46 ± 0.04, P < 0.05) than the proximal (1.27 ± 0.04) or middle (1.26 ± 0.05) regions. However, this regional Ca²⁺ accumulation difference disappeared by 32.5 min after the 1 set protocol when the muscle was quiescent and by contraction set 5 for the 10-set protocol. The initial preferential ECC-induced Ca²⁺ accumulation observed distally was associated spatially with the greater muscle extension compared with that of the proximal and middle regions. Disappearance of the regional Ca²⁺ accumulation disparity in quiescent and ECC-contracting muscle might be explained, in part, by axial Ca²⁺ propagation and account for the uniformity of muscle damage across regions evident 3 days post-ECC.NEW & NOTEWORTHY After 1 set of 50 eccentric (ECC) contractions in the anterior tibialis muscle, intracellular Ca²⁺ ([Ca²⁺]i) accumulation evinces substantial regional heterogeneity that is spatially coherent with muscle length changes (i.e., distal [Ca²⁺]i > middle, proximal). However, irrespective of whether 50 or 500 ECC contractions are performed, this heterogeneity is subsequently abolished, at least in part, by axial intracellular Ca²⁺ propagation. This Ca²⁺ homogenization across regions is consistent with the absence of any interregional difference in muscle damage 3 days post-ECC.

Muscular Pre-activation Can Boost the Maximal Explosive Eccentric Adaptive Force

The improvement of power is an objective in training of athletes. In order to detect effective methods of exercise, basic research is required regarding the mechanisms of muscular activity. The purpose of this study is to investigate whether or not a muscular pre-activation prior to an external impulse-like force impact has an effect on the maximal explosive eccentric Adaptive Force (xpAFecc_max). This power capability combines different probable power enhancing mechanisms. To measure the xpAFecc_max an innovative pneumatic device was used. During measuring, the subject tries to hold an isometric position as long as possible. In the moment in which the subjects' maximal isometric holding strength is exceeded, it merges into eccentric muscle action. This process is very close to motions in sports, where an adaptation of the neuromuscular system is required, e.g., force impacts caused by uneven surfaces during skiing. For investigating the effect of pre-activation on the xpAFecc_max of the quadriceps femoris muscle, n = 20 subjects had to pass three different pre-activation levels in a randomized order (level 1: 0.4 bar, level 2: 0.8 bar, level 3: 1.2 bar). After adjusting the standardized pre-pressure by pushing against the interface, an impulse-like load impacted on the distal tibia of the subject. During this, the xpAFecc_max was detected. The maximal voluntary isometric contraction (MVIC) was also measured. The torque values of the xpAFecc_max were compared with regard to the pre-activation levels. The results show a significant positive relation between the pre-activation of the quadriceps femoris muscle and the xpAFecc_max (male: p = 0.000, η²= 0.683; female: p = 0.000, η²= 0.907). The average percentage increase of torque amounted +28.15 ± 25.4% between MVIC and xpAFecc_max with pre-pressure level 1, +12.09 ± 7.9% for the xpAFecc_max comparing pre-pressure levels 1 vs. 2 and +2.98 ± 4.2% comparing levels 2 and 3. A higher but not maximal muscular activation prior to a fast impacting eccentric load seems to produce an immediate increase of force outcome. Different possible physiological explanatory approaches and the use as a potential training method are discussed.

Alterations of Elastic Property of Spastic Muscle With Its Joint Resistance Evaluated From Shear Wave Elastography and Biomechanical Model

This study aims to quantify passive muscle stiffness of spastic wrist flexors in stroke survivors using shear wave elastography (SWE) and to correlate with neural and non-neural contributors estimated from a biomechanical model to hyper-resistance measured during passive wrist extension. Fifteen hemiplegic individuals after stroke with Modified Ashworth Scale (MAS) score larger than one were recruited. SWE were used to measure Young's modulus of flexor carpi radialis muscle with joint from 0° (at rest) to 50° flexion (passive stretch condition), with 10° interval. The neural (NC) and non-neural components i.e., elasticity component (EC) and viscosity component (VC) of the wrist joint were analyzed from a motorized mechanical device NeuroFlexor® (NF). Combining with a validated biomechanical model, the neural reflex and muscle stiffness contribution to the increased resistance can be estimated. MAS and Fugl-Meyer upper limb score were also measured to evaluate the spasticity and motor function of paretic upper limb. Young's modulus was significantly higher in the paretic side of flexor carpi radialis than that of the non-paretic side (p < 0.001) and it increased significantly from 0° to 50° of the paretic side (p < 0.001). NC, EC, and VC on the paretic side were higher than the non-paretic side (p < 0.05). There was moderate significant positive correlation between the Young's Modulus and EC (r = 0.565, p = 0.028) and VC (r = 0.645, p = 0.009) of the paretic forearm flexor muscle. Fugl-Meyer of the paretic forearm flexor has a moderate significant negative correlation with NC (r = -0.578, p = 0.024). No significant correlation between MAS and shear elastic modulus or NF components was observed. This study demonstrated the feasibility of combining SWE and NF as a non-invasive approach to assess spasticity of paretic muscle and joint in stroke clinics. The neural and non-neural components analysis as well as correlation findings of muscle stiffness of SWE might provide understanding of mechanism behind the neuromuscular alterations in stroke survivors and facilitate the design of suitable intervention for them.

Review of Shoulder Range of Motion in the Throwing Athlete: Distinguishing Normal Adaptations from Pathologic Deficits

PURPOSE OF REVIEW

Overhand (OH) throwers demonstrate a unique motion profile of the shoulder joint complex. This manuscript reviews normal adaptations in the OH thrower and contrast findings with pathologic motion deficits.

RECENT FINDINGS

Multiple adaptations in range of motion have been associated with increased risk for arm injury. The use of a more conservative cutoff value for glenohumeral internal rotation deficit and horizontal adduction in younger throwers may help reduce injury risk. Deficits in glenohumeral internal rotation, total range of motion, shoulder flexion, and external rotation insufficiency have all been proposed as means to identify OH throwers at risk for arm injury, but conflicting evidence exists. Understanding normal adaptation due to repetitive stress of throwing is essential to effective management of these athletes. Adaptive change in bone and soft tissues is normal and contributes to the unique motion profiles expected in throwers. The causative link between normal adaptation and shoulder and elbow injury remains uncertain.

Changes in Shear Modulus of the Lumbar Multifidus Muscle during Different Body Positions

Multifidus function is important for active stabilization of the spine, but it can be compromised in patients with chronic low back pain and other spine pathologies. Force production and strength of back muscles are often evaluated using isometric or isokinetic tests, which lack the ability to quantify multifidi contribution independent of the erector spinae and adjacent hip musculature. The objective of this study is to evaluate localized force production capability in multifidus muscle using ultrasound Shear Wave Elastography (SWE) in healthy individuals. Three different body positions were considered: lying prone, sitting up, and sitting up with the right arm lifted. This positions were chosen to progressively increase multifidus contraction and to minimize body motion during measurements. Shear modulus was measured at the superficial and deeper layers of the multifidus. Repeatability and possible sources of error of the shear modulus measurements were analyzed. Multifidus shear modulus (median (IQR)) increased from prone, i.e. 16.15 (6.69) kPa, to sitting up, i.e. 27.28 (15.72) kPa, to sitting up with the right arm lifted position, i.e. 45.02 (25.27) kPa. Multifidi shear modulus in the deeper layer of the multifidi were lower than the superficial layer, suggesting lower muscle contraction. Intraclass correlation coefficients (ICCs) for evaluation of shear modulus by muscle layer were found to be excellent (ICCs=0.76-0.80). Results suggest the proposed protocol could quantify local changes in spinal muscle function in healthy adults; further research in patients with spine pathology is warranted.

The relationship between stiffness and pain following unaccustomed eccentric exercise: the effects of gentle stretch and repeated bout

PURPOSE

To determine how muscle stiffness and pain which develop after eccentric exercise are affected by gentle stretching and repeated exercise.

METHODS

Twenty-one healthy female participants undertook eccentric exercise of the elbow flexors and changes in resting elbow flexion angle (REFA; a measure of muscle stiffness), pain on stretch scale, pain elicited by pressure (PPT pain, a measure of mechanoreceptor hypersensitivity), and upper arm girth were followed for 7 days after exercise. The effects of gentle passive stretching on pain and muscle stiffness were investigated 2 and 4 days after exercise. Eleven participants also repeated the exercise with the same arm 6 weeks after the first bout.

RESULTS

There was a significant relationship between the pain on stretch scale and increased REFA (day 4; R² = 0.65, p < 0.001), whereas there was no relationship between REFA and PPT pain. REFA was reduced by passive stretching and pain on stretch scale was also reduced from 3.0 (1.4, 5.1) to 0.75 (0.0, 2.0) [median (IQR), p = 0.01]. PPT pain was unaffected by the passive stretching, as was muscle swelling. Following the repeated bout, increases in REFA were much reduced, as was pain on stretch scale (p = 0.02). However, PPT pain was not significantly different between the two bouts of exercise.

CONCLUSIONS

The results indicate that reductions in pain on stretch scale, either by gentle passive stretching or as the result of repeated exercise, are primarily due to reductions in muscle stiffness which develops after eccentric exercise, whereas mechanoreceptor hypersensitivity is relatively unaffected.

Assessment of Skeletal Muscle Contractile Properties by Radial Displacement: The Case for Tensiomyography

Skeletal muscle operates as a near-constant volume system; as such muscle shortening during contraction is transversely linked to radial deformation. Therefore, to assess contractile properties of skeletal muscle, radial displacement can be evoked and measured. Mechanomyography measures muscle radial displacement and during the last 20 years, tensiomyography has become the most commonly used and widely reported technique among the various methodologies of mechanomyography. Tensiomyography has been demonstrated to reliably measure peak radial displacement during evoked muscle twitch, as well as muscle twitch speed. A number of parameters can be extracted from the tensiomyography displacement/time curve and the most commonly used and reliable appear to be peak radial displacement and contraction time. The latter has been described as a valid non-invasive means of characterising skeletal muscle, based on fibre-type composition. Over recent years, applications of tensiomyography measurement within sport and exercise have appeared, with applications relating to injury, recovery and performance. Within the present review, we evaluate the perceived strengths and weaknesses of tensiomyography with regard to its efficacy within applied sports medicine settings. We also highlight future tensiomyography areas that require further investigation. Therefore, the purpose of this review is to critically examine the existing evidence surrounding tensiomyography as a tool within the field of sports medicine.

Minimal Evidence for a Secondary Loss of Strength After an Acute Muscle Injury: A Systematic Review and Meta-Analysis

BACKGROUND

An immediate loss of strength follows virtually all types of muscle injury but there is debate whether the initial strength loss is maximal or if a secondary loss of strength occurs during the first 3 days post-injury.

OBJECTIVE

The objective of this analysis was to conduct a systematic review and meta-analysis of the research literature to determine if a secondary loss of strength occurs after an injurious initiating event.

METHODS

Literature searches were performed using eight electronic databases (e.g., PubMed, Cochrane Library). Search terms included skeletal muscle AND (injur* OR damage*) AND (strength OR force OR torque). The extracted strength data were converted to a standard format by calculating the standardized mean difference, which is reported as the effect size (ES) along with its 95 % confidence interval (CI). The calculation of ES was designed so that a negative ES that was statistically less than zero would be interpreted as indicating a secondary loss of strength.

RESULTS

A total of 223 studies with over 4000 human and animal subjects yielded data on 262 independent groups and a total of 936 separate ESs. Our overall meta-analysis yielded a small-to-medium, positive overall ES that was statistically greater than zero (overall ES = +0.34, 95 % CI 0.27-0.40; P < 0.00000001). Considerable variation in ES was observed among studies (I ² = 86 %), which could be partially explained by the research group conducting the study, sex of the subject, day of post-injury strength assessment, whether fatigue was present immediately post-injury, and the muscle group injured. From the subgroup meta-analyses probing these variables, 36 subgroup ESs were calculated and none were statistically less than zero.

CONCLUSION

Overall, our findings do not support the presence of a secondary loss of strength following an acute muscle injury, and strongly suggest that strength, on average, recovers steadily over the first 3 days post-injury.

Acute effect of wearing compression stockings on lower leg swelling and muscle stiffness in healthy young women

Compression stockings are known to be effective in reducing peripheral oedema or leg swelling by increasing tissue pressure and venous blood flow. While previous studies on compression stockings have focused on its prolonged, preventive effect on leg swelling, the aim of this study was to investigate an acute effect of wearing compression stockings on lower leg swelling and muscle stiffness. Twenty healthy women aged 18-23 years participated in the experiment conducted in the evening, in which they wore below-knee graduated compression stockings and rested in a seated position for 30 min. Before and after the application of stockings, maximum calf circumference, volume, extracellular water resistance (RECW ) and muscle stiffness of the right lower leg were determined by tape measure, water displacement volumetry, segmental bioelectrical impedance spectroscopy and ultrasound shear-wave elastography, respectively. The maximum calf circumference and the reciprocal of RECW (an index of extracellular fluid volume) significantly decreased after the application of stockings, whereas the total lower leg volume and the stiffness (shear modulus) of the medial gastrocnemius muscle tended to decrease. These changes, except for that in the medial gastrocnemius muscle stiffness, were opposite to those from morning to evening studied in the subgroup of participants (n = 8). However, partial correlation analysis failed to detect significant associations among these changes. These results suggest that even for a short period of application, compression stockings have some positive effects against lower leg swelling.

Change in skeletal muscle stiffness after running competition is dependent on both running distance and recovery time: a pilot study

Long-distance running competitions impose a large amount of mechanical loading and strain leading to muscle edema and delayed onset muscle soreness (DOMS). Damage to various muscle fibers, metabolic impairments and fatigue have been linked to explain how DOMS impairs muscle function. Disruptions of muscle fiber during DOMS exacerbated by exercise have been shown to change muscle mechanical properties. The objective of this study is to quantify changes in mechanical properties of different muscles in the thigh and lower leg as function of running distance and time after competition. A custom implementation of Focused Comb-Push Ultrasound Shear Elastography (F-CUSE) method was used to evaluate shear modulus in runners before and after a race. Twenty-two healthy individuals (age: 23 ± 5 years) were recruited using convenience sampling and split into three race categories: short distance (nine subjects, 3–5 miles), middle distance (10 subjects, 10–13 miles), and long distance (three subjects, 26+ miles). Shear Wave Elastography (SWE) measurements were taken on both legs of each subject on the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), soleus, lateral gastrocnemius (LG), medial gastrocnemius (MG), biceps femoris (BF) and semitendinosus (ST) muscles. For statistical analyses, a linear mixed model was used, with recovery time and running distance as fixed variables, while shear modulus was used as the dependent variable. Recovery time had a significant effect on the soleus (p = 0.05), while running distance had considerable effect on the biceps femoris (p = 0.02), vastus lateralis (p < 0.01) and semitendinosus muscles (p = 0.02). Sixty-seven percent of muscles exhibited a decreasing stiffness trend from before competition to immediately after competition. The preliminary results suggest that SWE could potentially be used to quantify changes of muscle mechanical properties as a way for measuring recovery procedures for runners.

Neuromuscular adaptations in shoulder function and dysfunction

Neuromuscular activity, organized in coordinated patterns, forms the basis of task-specific function in sports and exercise. The content and extent of these patterns may be variable, but include elements of activation/inhibition, co-activation, concentric/eccentric activation, proximal-to-distal activation, plyometric activation, and preactivation stiffness. They may be based on inherent neuromuscular architecture, but are commonly affected by positive or negative adaptations to imposed functional demands. Positive neuromuscular adaptations improve the efficiency of performing the task, which can result in less energy expenditure, maximum force delivered to the task, and protection of involved joints from excessive loads/motions, and improve the effectiveness of task performance. They frequently result from specific training in task mechanics and optimal conditioning of the neuromuscular structures involved in the task. Negative neuromuscular maladaptations can affect the efficiency of performing the task, increase energy expenditure and loads, decrease the effectiveness of task performance, and can be associated with clinical presentation of injury symptoms. They can result from overload, injury, and/or limited recovery. This chapter will focus specifically on shoulder joint function to provide examples of positive adaptations and negative maladaptations. It will then provide guidelines for clinical evaluation, treatment of clinical injury, and training/conditioning, based on understanding the neuromuscular activation.

Incompressible fluid plays a mechanical role in the development of passive muscle tension

Over short time scales, muscle fibres maintain a nearly constant volume of intracellular fluid. This fluid is essential to normal biochemical function, but its role in determining the mechanical properties of muscle has been considered in only a few theoretical analyses. Here we investigate the mechanical role of fluid in a fundamental property of muscle, its development of passive tension in response to stretch. We test a model of muscle structure in which incompressible fluid directly influences passive tension by constraining the geometry of intramuscular connective tissues. This interaction is demonstrated using a simple physical model of muscle morphology comprising a fluid-filled bladder wrapped by helical fibres. The behaviour of the model is compared with that of isolated bullfrog muscle subjected to an osmotic perturbation of intracellular fluid volume. Increasing muscle volume by 40% resulted in 69% increased passive tension, occurring in a manner consistent with the behaviour of the model. These observations support the notion that the interaction of connective tissues with the muscle fibres they surround influences the mechanical behaviour of whole muscles, and highlight the role of fluid as a mechanical component of muscle.

Protection from Muscle Damage in the Absence of Changes in Muscle Mechanical Behavior

INTRODUCTION

The repeated bout effect characterizes the protective adaptation after a single bout of unaccustomed eccentric exercise that induces muscle damage. Sarcomerogenesis and increased tendon compliance have been suggested as potential mechanisms for the repeated bout effect by preventing muscle fascicles from being stretched onto the descending limb of the length-tension curve (the region where sarcomere damage is thought to occur). In this study, evidence was sought for three possible mechanical changes that would support either the sarcomerogenesis or the increased tendon compliance hypotheses: a sustained rightward shift in the fascicle length-tension relationship, reduced fascicle strain amplitude, and reduced starting fascicle length.

METHODS

Subjects (n = 10) walked backward downhill (5 km·h, 20% incline) on a treadmill for 30 min on two occasions separated by 7 d. Kinematic data and medial gastrocnemius fascicle lengths (ultrasonography) were recorded at 10-min intervals to compare fascicle strains between bouts. Fascicle length-torque curves from supramaximal tibial nerve stimulation were constructed before, 2 h after, and 2 d after each exercise bout.

RESULTS

Maximum torque decrement and elevated muscle soreness were present after the first, but not the second, backward downhill walking bout signifying a protective repeated bout effect. There was no sustained rightward shift in the length-torque relationship between exercise bouts, nor decreases in fascicle strain amplitude or shortening of the starting fascicle length.

CONCLUSIONS

Protection from a repeated bout of eccentric exercise was conferred without changes in muscle fascicle strain behavior, indicating that sarcomerogenesis and increased tendon compliance were unlikely to be responsible. As fascicle strains are relatively small in humans, we suggest that changes to connective tissue structures, such as extracellular matrix remodeling, are better able to explain the repeated bout effect observed here.

Combined effect of low back muscle fatigue and passive tissue elongation on the flexion-relaxation response

Previous literature has documented the alterations in the flexion-relaxation response of the lumbar extensor musculature to passive tissue elongation (PTE) and muscle fatigue (MF). There is no study, however, that has explored this response as a function of the combined effect of both PTE and MF, which is often seen in occupational settings. Twelve participants performed three experimental protocols on three different days to achieve (1) PTE, (2) MF and (3) PTE&MF (combined). Trunk kinematics and muscle activities were monitored to assess the effects of these protocols on the peak lumbar flexion angle and the lumbar angle of the flexion-relaxation of the trunk extensor muscles. Results showed responses to the uni-dimensional stresses (PTE and MF) consistent with those seen in the previous literature, while the combined protocol elicited responses that more closely matched the PTE protocol.

Acute effects of static stretching on muscle-tendon mechanics of quadriceps and plantar flexor muscles

PURPOSE

This study aimed to determine the acute effects of static stretching on stiffness indexes of two muscle groups with a contrasting difference in muscle-tendon proportion.

METHODS

Eleven active males were tested on an isokinetic dynamometer during four sessions randomly presented. Two sessions were dedicated to quadriceps and the two others to triceps surae muscles. Before and immediately after the stretching procedure (5 × 30 s), gastrocnemius medialis and rectus femoris fascicle length and myotendinous junction elongation were determined using ultrasonography. Passive and maximal voluntary torques were measured. Fascicle and myotendinous junction stiffness indexes were calculated.

RESULTS

After stretching, maximal voluntary torque similarly decreased for both muscle groups. Passive torque significantly decreased on triceps surae and remained unchanged on quadriceps muscles. Fascicle length increased similarly for both muscles. However, myotendinous junction elongation remained unchanged for gastrocnemius medialis and increased significantly for rectus femoris muscle. Fascicle stiffness index significantly decreased on medial gastrocnemius and remained unchanged on rectus femoris muscle. In contrast, myotendinous junction stiffness index similarly decreased on both muscles.

CONCLUSION

Depending on the muscle considered, the present results revealed different acute stretching effects. This muscle dependency appeared to affect primarily fascicle stiffness index rather than the myotendinous junction.

Changes in elbow joint's musculo-articular mechanical properties do not alter reaching-related action-perception coupling

PURPOSE

Perception of action capabilities can be altered by changes in sensorimotor processes, as showed in previous works in populations dealing with regular and pathological sensorimotor deficits. Misestimating changes in performance ability could lead to risky behavior, injury, and/or reduced performance. However, the relationship between sensorimotor processes, the action-perception coupling, and the related anatomical structures is still a matter of debate. We investigated whether changes in the muscle-tendon system's mechanical properties experimentally induced by eccentric contractions could alter the action-perception coupling (APC) in a reaching-to-grasp task, in which the participants estimated the maximal distance they predicted that they would able to reach a glass.

METHODS

Based on their repartition, volunteers performed a conditioning session the first day: a series of isokinetic elbow extension in passive condition (control group, n = 11) or when performing elbow flexors eccentric contractions (eccentric group, n = 11). Performance estimates and actual performances in a reaching-to-grasp task were completed before, and immediately, 24 hours and 48 hours after the conditioning session. Alterations of musculo-articular mechanical properties were assessed through global joint stiffness (joint passive torque through load/unload cycles) and local stiffness (muscle elastography).

RESULTS

The results showed that the APC related to reaching-to-grasp performance was not impacted by post-exercise changes in mechanical properties of the musculo-articular system.

CONCLUSION

These findings emphasize the central dimension of sensorimotor processing instead of peripheral structures to investigate the APC for an altered sensorimotor environment.

MR elastography measurement of the effect of passive warmup prior to eccentric exercise on thigh muscle mechanical properties

Purpose

To investigate the effect of warmup by application of the thermal agent Deep Heat (DH) on muscle mechanical properties using magnetic resonance elastography (MRE) at 3T before and after exercise‐induced muscle damage (EIMD).

Materials and Methods

Twenty male participants performed an individualized protocol designed to induce EIMD in the quadriceps. DH was applied to the thigh in 50% of the participants before exercise. MRE, T₂‐weighted MRI, maximal voluntary contraction (MVC), creatine kinase (CK) concentration, and muscle soreness were measured before and after the protocol to assess EIMD effects. Five participants were excluded: four having not experienced EIMD and one due to incidental findings.

Results

Total workload performed during the EIMD protocol was greater in the DH group than the control group (P < 0.03), despite no significant differences in baseline MVC (P = 0.23). Shear stiffness |G*| increased in the rectus femoris (RF) muscle in both groups (P < 0.03); however, DH was not a significant between‐group factor (P =  0.15). MVC values returned to baseline faster in the DH group (5 days) than the control group (7 days). Participants who displayed hyperintensity on T₂‐weighted images had a greater stiffness increase following damage than those without: RF; 0.61 kPa vs. 0.15 kPa, P < 0.006, vastus intermedius; 0.34 kPa vs. 0.03 kPa, P = 0.06.

Conclusion

EIMD produces increased muscle stiffness as measured by MRE, with the change in |G*| significantly increased when T₂ hyperintensity was present. DH did not affect CK concentration or soreness; however, DH participants produced greater workload during the EIMD protocol and exhibited accelerated MVC recovery.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2017;46:1115–1127.

Walking duration and slope steepness determine the effect of downslope walking on the soleus H-reflex pathway

The purpose of this study was to determine if the effect of downslope walking (DSW) on spinal excitability depends on walking duration and slope steepness, and if findings from the soleus (Sol) generalize to the tibialis anterior (TA). Sol and TA Hmax and Mmax were measured before and after four DSW doses (time/slope, min/%) on separate days (10/-15, 20/-15, 10/-25, 20/-25, n=14), and one 20-min bout of level walking (LW, n=12), always at 2.5 mph. Heart rate (HR) and ratings of perceived exertion (RPE) were measured during walking. DSW for all doses except 10/-15 caused greater Sol Hmax/Mmax depression than LW (p≤0.02), and 20/-25 caused greater Hmax/Mmax depression than 10/-15 (p≤0.01). TA H-reflex curves were substantially smaller than Sol H-reflex curves, and this study was unable to detect an effect of LW or DSW on TA Hmax/Mmax. Although HR and RPE were significantly higher during DSW at -25% than at -15% slope, group HR and RPE nevertheless peaked at relatively low values of 101.4±14.2 bpm and 12.6±2.3, respectively. In conclusion, DSW duration and slope steepness interact to determine the magnitude of Sol H-reflex depression, but these effects do not generalize to the TA.

Shear-Wave Elastography Assessments of Quadriceps Stiffness Changes prior to, during and after Prolonged Exercise: A Longitudinal Study during an Extreme Mountain Ultra-Marathon

In sports medicine, there is increasing interest in quantifying the elastic properties of skeletal muscle, especially during extreme muscular stimulation, to improve our understanding of the impact of alterations in skeletal muscle stiffness on resulting pain or injuries, as well as the mechanisms underlying the relationships between these parameters. Our main objective was to determine whether real-time shear-wave elastography (SWE) can monitor changes in quadriceps muscle elasticity during an extreme mountain ultra-marathon, a powerful mechanical stress model. Our study involved 50 volunteers participating in an extreme mountain marathon (distance: 330 km, elevation: +24,000 m). Quantitative SWE velocity and shear modulus measurements were performed in most superficial quadriceps muscle heads at the following 4 time points: before the race, halfway through the race, upon finishing the race and after recovery (+48 h). Blood biomarker levels were also measured. A significant decrease in the quadriceps shear modulus was observed upon finishing the race (3.31±0.61 kPa) (p<0.001) compared to baseline (3.56±0.63 kPa), followed by a partial recovery +48 h after the race (3.45±0.6 kPa) (p = 0.002) across all muscle heads, as well as for each of the following three muscle heads: the rectus femoris (p = 0.003), the vastus medialis (p = 0.033) and the vastus lateralis (p = 0.001). Our study is the first to assess changes in muscle stiffness during prolonged extreme physical endurance exercises based on shear modulus measurements using non-invasive SWE. We concluded that decreases in stiffness, which may have resulted from quadriceps overuse in the setting of supra-physiological stress caused by the extreme distance and unique elevation of the race, may have been responsible for the development of inflammation and muscle swelling. SWE may hence represent a promising tool for monitoring physiologic or pathological variations in muscle stiffness and may be useful for diagnosing and monitoring muscle changes.

Acute muscle and joint mechanical responses following a high-intensity stretching protocol

PURPOSE

A previous study observed a joint passive torque increase above baseline ~30 min after a high-intensity stretching. This study examined the effect of a high-intensity stretching on ankle dorsiflexion passive torque, medial gastrocnemius (MG) shear modulus, and plantar flexors maximal voluntary isometric force (MVIC).

METHOD

Participants (n = 11, age 27.2 ± 6.5 years, height 172.0 ± 10.0 cm, weight 69.5 ± 10.4 kg) underwent two stretching sessions with plantar flexors isometric contractions performed: (1) 5 min before, 1 min after, and every 10 min after stretching (MVC session); (2) 5 min before, and 60 min after the stretching (no-MVC session).

RESULTS

In both sessions, no changes were observed for MG shear modulus (p > 0.109). In the no-MVC session, passive torque decreased 1 min after stretching (-7.5 ± 8.4 %, p = 0.015), but increased above baseline 30 min after stretching (+6.3 ± 9.3 %, p = 0.049). In the MVC session, passive torque decreased at 1 min (-10.1 ± 6.3 %, p < 0.001), 10 min (-6.3 ± 8.2 %, p = 0.03), 20 min (-8.0 ± 9.2 %, p = 0.017), and 60 min (-9.2 ± 12.4 %, p = 0.034) after the stretching, whereas the MVIC decreased at 1 min (-5.0 ± 9.3 %, p = 0.04) and 10 min (-6.7 ± 8.7 %, p = 0.02) after stretching.

CONCLUSION

The ankle passive torque increase 30 min following the stretch was not due to the MG shear modulus response; consequently, response may be due to changes in surrounding connective tissue mechanical properties.

The Acute Effect of Local Vibration As a Recovery Modality from Exercise-Induced Increased Muscle Stiffness

Exercise involving eccentric muscle contractions is known to decrease range of motion and increase passive muscle stiffness. This study aimed at using ultrasound shear wave elastography to investigate acute changes in biceps brachii passive stiffness following intense barbell curl exercise involving both concentric and eccentric contractions. The effect of local vibration (LV) as a recovery modality from exercise-induced increased stiffness was further investigated. Eleven subjects performed 4 bouts of 10 bilateral barbell curl movements at 70% of the one-rep maximal flexion force. An arm-to-arm comparison model was then used with one arm randomly assigned to the passive recovery condition and the other arm assigned to the LV recovery condition (10 min of 55-Hz vibration frequency and 0.9-mm amplitude). Biceps brachii shear elastic modulus measurements were performed prior to exercise (PRE), immediately after exercise (POST-EX) and 5 min after the recovery period (POST-REC). Biceps brachii shear elastic modulus was significantly increased at POST-EX (+53 ± 48%; p < 0.001) and POST-REC (+31 ± 46%; p = 0.025) when compared to PRE. No differences were found between passive and LV recovery (p = 0.210). LV as a recovery strategy from exercise-induced increased muscle stiffness was not beneficial, probably due to an insufficient mechanical action of vibrations. Key pointsBouts of barbell curl exercise induce an immediate increased passive stiffness of the biceps brachii muscle, as evidenced by greater shear elastic modulus measured by supersonic shear imaging.The administration of a vibratory massage did not reduce this acute exercise-induced increased stiffness.