Ultrasound imaging to assess skeletal muscle architecture during movements: a systematic review of methods, reliability, and challenges

The Diagnostic Value of Musculoskeletal Ultrasound in the Quantitative Evaluation of Skeletal Muscle in Chronic Thyrotoxic Myopathy: A Single-Center Study in China

Objective

This study aimed to evaluate the quadriceps femoris in patients with chronic thyrotoxic myopathy (CTM) using musculoskeletal ultrasound and to explore its practical clinical value for the diagnosis of CTM.

Methods

A total of 241 subjects recruited from the First Affiliated Hospital of Guangxi Medical University were surveyed for detailed medical history and underwent grip strength tests, fixed-distance walking, and quadriceps femoris ultrasound examinations. Differences in muscle parameters between the CTM, non-CTM, and healthy groups were analyzed. An Receiver operating characteristic (ROC) curve was established to analyze the predictive value of various ultrasound measurements for CTM, and Spearman correlation analysis and binary logistic regression were applied to explore the factors associated CTM.

Results

The quadriceps femoris contraction index, muscle thickness, muscle cross-sectional area, and pennation angle in the CTM group were significantly lower than those in the non-CTM and healthy groups (p<0.01). The ROC curve prediction showed that the pennation angle had the best sensitivity and specificity for diagnosing myogenesis, with an area under the curve of 89%. Moreover, the pennation angle of the CTM group was positively correlated with step speed (r=0.245, p=0.031) and body surface area (r=0.276, p=0.014), but negatively correlated with age (r=-0.306, p=0.007). Regression analysis showed that the quadriceps femoris contraction index, muscle thickness, pennation angle, and cross-sectional area were factors that related the CTM. After adjusting for potential confounding factors, the association between Muscle Bundle Length and CTM became significant (OR=1.99, 95% CI: 1.22, 3.35, p=0.007). Muscular echo in patients was observed to varying degrees of enhancement.

Conclusion

Musculoskeletal ultrasonography in the quantitative analysis of muscle parameters and muscle echo of the quadriceps femoris can provide essential imaging evidence for predicting CTM.

Ultrasound elastography of back muscle biomechanical properties: a systematic review and meta-analysis of current methods

OBJECTIVES

To report the current elastography methods used to quantify back muscles' biomechanical characteristics in patients with musculoskeletal disorders (MSKd) and inform on their reliability, validity, and responsiveness.

METHODS

MEDLINE, Embase, CINAHL, Cochrane library and grey literature were consulted. Predefined criteria allowed for study selection and data extraction. The quality of evidence was rated using the COSMIN tool. Data were meta-analyzed in terms of pooled intraclass correlation coefficient (pICC) for reliability and pooled standardized mean difference (pSMD) for validity and responsiveness. Heterogeneity was assessed.

RESULTS

Seventy-nine studies were included in the meta-analysis (total number of participants N = 3178). Three elastography methods were identified: strain imaging (SI; number of cohorts M = 26), shear wave imaging (SWI; M = 50), and vibration sonoelastography (VSE; M = 3). Strain imaging and SWI studies reported good reliability measurement properties (pICC > 0.70) and a medium pSMD (0.58 for SI and 0.60 for SWI; p ≤ 0.020) in discriminating MSKd from controls' condition (validity). Strain imaging studies reported a medium pSMD (0.64; p = 0.005) in detecting within-group changes over time, whereas SWI pSMD was very high (1.24; p = 0.005). Only SWI reported significant but small pSMD (0.30; p = 0.003) in detecting between-group changes over time. The small number of VSE studies could not be meta-analyzed. Heterogeneity was high (I-squared > 90%; p < 0.001).

CONCLUSIONS

Elastography presents good reliability results and a medium pSMD in discriminating MSKd from control conditions. Responsiveness data suggest detectable changes within groups over time using SI and SWI, calling for long-term longitudinal studies. Assessing changes between groups over time using elastography still needs to be proven. Highly significant heterogeneity limits meta-analytic results.

CRITICAL RELEVANCE STATEMENT

While still in its early-stage exploration phase, musculoskeletal ultrasound elastography may reliably quantify back muscles' biomechanics in asymptomatic individuals, moderately discriminate back musculoskeletal disorders and detect biomechanical changes over time in these conditions, calling for long-term longitudinal studies.

KEY POINTS

Ultrasound elastography is reviewed for back pain and related musculoskeletal disorder assessments. Growing literature supports good reproducibility, some validity and responsiveness. Back muscle elastography considers assumptions calling for standardized protocols.

Three-dimensional architecture and moment arms of human rotator cuff muscles in vivo: Interindividual, intermuscular, and intramuscular variations

The human rotator cuff consists of four muscles, each with a complex, multipennate architecture. Despite the functional and clinical importance, the architecture of the human rotator cuff has yet to be clearly described in humans in vivo. The purpose of this study was to investigate the intramuscular, intermuscular, and interindividual variations in architecture and moment arms of the human rotator cuff. Muscle volumes, fascicle lengths, physiological cross-sectional areas (PCSAs), pennation angles, and moment arms of all four rotator cuff muscles were measured from mDixon and diffusion tensor imaging (DTI) scans of the right shoulders of 20 young adults. In accordance with the most detailed dissections available to date, we found substantial intramuscular variation in fascicle length (coefficients of variation (CVs) ranged from 26% to 40%) and pennation angles (CVs ranged from 56% to 62%) in all rotator cuff muscles. We also found substantial intermuscular and interindividual variations in muscle volumes, but relatively consistent mean fascicle lengths, pennation angles, and moment arms (CVs for all ≤17%). Moreover, when expressed as a proportion of total rotator cuff muscle volume, the volumes of individual rotator cuff muscles were highly consistent between individuals and sexes (CVs ≤16%), suggesting that rotator cuff muscle volumes scale uniformly, at least in a younger population without musculoskeletal problems. Together, these data indicate limited interindividual and intermuscular variability in architecture, which may simplify scaling routines for musculoskeletal models. However, the substantial intramuscular variation in architecture questions the validity of previously reported mean architectural parameters to adequately describe rotator cuff function.

Chronic Adaptions in Quadriceps Fascicle Mechanics Are Related to Altered Knee Biomechanics After Anterior Cruciate Ligament Reconstruction

Following anterior cruciate ligament reconstruction (ACLR), patients exhibit abnormal walking mechanics and quadriceps dysfunction. Quadriceps dysfunction has been largely attributed to muscle atrophy and weakness. While important, these factors do not capture intrinsic properties of muscle that govern its ability to generate force and withstand load. While fascicle abnormalities after ACLR have been documented in early stages of recovery (<12 mo), long-term effects of ACLR on fascicle mechanics remain unexplored. We evaluated quadriceps fascicle mechanics during walking 3 years post-ACLR and examined the relationship with knee mechanics. Participants included 24 individuals with ACLR and 24 Controls. Linear mixed models compared the ACLR, Contralateral, and Controls limbs for (1) quadriceps strength, (2) fascicle architecture and mechanics, and (3) knee mechanics. No difference in strength or overall fascicle length excursions was found between limbs. The ACLR limb exhibited longer fascicles at heel strike and peak knee extension moment (P < .001-.004), and smaller fascicle angles at heel strike, peak knee extension moment, and overall suppressed fascicle angle excursions (P < .001-.049) relative to the Contralateral and/or Control limb. This indicates an abnormality in fascicle architecture and mechanics following ACLR and suggests abnormalities in contractile function that cannot be explained by muscle weakness and may contribute to long-term gait irregularities.

Wearing an ultrasound probe during walking does not influence lower limb joint kinematics in adolescents with cerebral palsy and typically developing peers

BACKGROUND

Enhancing traditional three-dimensional gait analysis with a portable ultrasound device at the lower-limb muscle-tendon level enables direct measurement of muscle and tendon lengths during walking. However, it is important to consider that the size of the ultrasound probe and its attachment on the lower limb may potentially influence gait pattern.

RESEARCH QUESTION

What is the effect of wearing an ultrasound probe at the lower limb in adolescents with cerebral palsy and typically developing peers?

METHODS

Eleven individuals with cerebral palsy and nine age-matched typically developing peers walking barefoot at their self-selected speed were analyzed. Data collection occurred under three conditions: the reference condition (GAIT), and two conditions involving placement of the ultrasound probe over the distal medial gastrocnemius-Achilles tendon junction (MTJ) and over the medial gastrocnemius mid-belly to capture fascicles (FAS). Data processing included calculating differences between conditions using root mean square error (RMSE) for joint kinematics and comparing them to the overall mean difference. Additionally, Spearman correlations were calculated to examine the relationship between kinematic RMSEs and walking speed.

RESULTS

No significant differences in stance phase duration or walking speed were observed among the three conditions. Average RMSEs were below 5° for all parameters and condition comparisons in both groups. In both the TD and CP groups, RMSE values during the swing phase were higher than those during the stance phase for all joints. No significant correlations were found between height or body mass and swing phase RMSEs. In the CP group, there was a significant correlation between joint kinematics RMSEs and differences in walking speed at the hip, knee and ankle joints when comparing the MTJ condition with the GAIT condition.

SIGNIFICANCE

This study confirms joint kinematics alterations are smaller than 5° due to wearing to the leg an ultrasound probe during walking.

Experiment-guided tuning of muscle-tendon parameters to estimate muscle fiber lengths and passive forces

The workflow to simulate motion with recorded data usually starts with selecting a generic musculoskeletal model and scaling it to represent subject-specific characteristics. Simulating muscle dynamics with muscle-tendon parameters computed from existing scaling methods in literature, however, yields some inconsistencies compared to measurable outcomes. For instance, simulating fiber lengths and muscle excitations during walking with linearly scaled parameters does not resemble established patterns in the literature. This study presents a tool that leverages reported in vivo experimental observations to tune muscle-tendon parameters and evaluates their influence in estimating muscle excitations and metabolic costs during walking. From a scaled generic musculoskeletal model, we tuned optimal fiber length, tendon slack length, and tendon stiffness to match reported fiber lengths from ultrasound imaging and muscle passive force-length relationships to match reported in vivo joint moment-angle relationships. With tuned parameters, muscle contracted more isometrically, and soleus's operating range was better estimated than with linearly scaled parameters. Also, with tuned parameters, on/off timing of nearly all muscles' excitations in the model agreed with reported electromyographic signals, and metabolic rate trajectories varied significantly throughout the gait cycle compared to linearly scaled parameters. Our tool, freely available online, can customize muscle-tendon parameters easily and be adapted to incorporate more experimental data.

Determination of muscle shape deformations of the tibialis anterior during dynamic contractions using 3D ultrasound

Purpose

In this paper, we introduce a novel method for determining 3D deformations of the human tibialis anterior (TA) muscle during dynamic movements using 3D ultrasound.

Materials and Methods

An existing automated 3D ultrasound system is used for data acquisition, which consists of three moveable axes, along which the probe can move. While the subjects perform continuous plantar- and dorsiflexion movements in two different controlled velocities, the ultrasound probe sweeps cyclically from the ankle to the knee along the anterior shin. The ankle joint angle can be determined using reflective motion capture markers. Since we considered the movement direction of the foot, i.e., active or passive TA, four conditions occur: slow active, slow passive, fast active, fast passive. By employing an algorithm which defines ankle joint angle intervals, i.e., intervals of range of motion (ROM), 3D images of the volumes during movement can be reconstructed.

Results

We found constant muscle volumes between different muscle lengths, i.e., ROM intervals. The results show an increase in mean cross-sectional area (CSA) for TA muscle shortening. Furthermore, a shift in maximum CSA towards the proximal side of the muscle could be observed for muscle shortening. We found significantly different maximum CSA values between the fast active and all other conditions, which might be caused by higher muscle activation due to the faster velocity.

Conclusion

In summary, we present a method for determining muscle volume deformation during dynamic contraction using ultrasound, which will enable future empirical studies and 3D computational models of skeletal muscles.

Test-retest reliability of gastrocnemius medialis fascicle force-length relationship

Fascicle force-length relationship is one major basic mechanical property of skeletal muscle, subsequently influencing movement mechanics. While force-length properties are increasingly described through ultrafast ultrasound imaging, their test-retest reliability remains unknown. Using ultrafast ultrasound, and electrically evoked contractions at various ankle angles, gastrocnemius medialis fascicle force-length relationship was assessed twice, few days apart, in sixteen participants. The test-retest reliability of the resulting fascicle force-length relationship key parameters - i.e., maximal force (Fmax), and optimal fascicle length (L0) - was evaluated considering (i) all the trials obtained at each ankle joint and (ii) the mean of the two trials obtained at each tested angle. Considering all trials, L0 indicated a 'high' test-retest reliability, with intra-class correlation coefficients (ICC) of 0.89 and Fmax a 'moderate' reliability (ICC = 0.71), while when averaging the two trials L0 reliability was 'very-high' (ICC = 0.91), and Fmax reliability 'moderate' (ICC = 0.73). All values of coefficient of variation and standard error of measurement were low, i.e., ≤7.7 % and ≤0.35 cm for L0 and ≤3.4 N for Fmax, respectively. Higher absolute reliability was reported for L0 than Fmax, with better reliability when averaging the two trials at each angle. All these parameters, in accordance with the limit of agreement, demonstrated that L0 and Fmax test-retest reliability is acceptable, particularly when averaging multiple points obtained at a given angle. Interestingly, the shape of the fascicle force-length relationship is more variable. Therefore, L0 and Fmax can be used to compare between days-effects following an intervention, while a comparison of fascicle operating lengths may require more precautions.

Association between physical fitness tests and neuromuscular properties

PURPOSE

While various fitness tests have been developed to assess physical performances, it is unclear how these tests are affected by differences, such as, in morphological and neural factors. This study was aimed to investigate associations between individual differences in physical fitness tests and neuromuscular properties.

METHODS

One hundred and thirty-three young adults participated in various general physical fitness tests and neuromuscular measurements. The appendicular skeletal muscle mass (ASM) was estimated by bioelectrical impedance analysis. Echo intensity (EI) was evaluated from the vastus lateralis. During submaximal knee extension force, high-density surface electromyography of the vastus lateralis was recorded and individual motor unit firings were detected. Y-intercept (i-MU) and slope (s-MU) from the regression line between the recruitment threshold and motor unit firing rate were calculated.

RESULTS

Stepwise multiple regression analyses revealed that knee extension strength could be explained (adjusted R2 = 0.712) by ASM (β = 0.723), i-MU (0.317), EI (- 0.177), and s-MU (0.210). Five-sec stepping could be explained by ASM (adjusted R2 = 0.212). Grip strength, side-stepping, and standing broad jump could be explained by ASM and echo intensity (adjusted R2 = 0.686, 0.354, and 0.627, respectively). Squat jump could be explained by EI (adjusted R2 = 0.640). Counter-movement jump could be explained by EI and s-MU (adjusted R2 = 0.631). On the other hand, i-MU and s-MU could be explained by five-sec stepping and counter-movement jump, respectively, but the coefficients of determination were low (adjusted R2 = 0.100 and 0.045).

CONCLUSION

Generally developed physical fitness tests were mainly explained by morphological factors, but were weakly affected by neural factors involved in performance.

Reproducibility of freehand vs. foam cast as well as the intrarater reliability of foam cast ultrasound scans assessing the muscle architecture and tissue organization of the gastrocnemius medialis and vastus lateralis muscles

Background

This study compares the reproducibility of freehand (FH) vs. foam cast (FC) scans and investigates the intrarater reliability of the ultrasound FC muscle architecture and tissue organization measurements of the gastrocnemius medialis (GM) and vastus lateralis (VL) muscles with fixed and repositioning FC scans.

Methods

Thirteen young adults (22 ± 3 years) underwent repeated sagittal B-mode ultrasound measurements of GM and VL. FH, FC, and repositioned FC scans were conducted. Muscle architecture measurements included muscle thickness (MT), pennation angle (PA), and fascicle length (FL). Spatial frequency analysis assessed muscle tissue organization.

Results

MT decreased from 2.1 to 1.8 cm in GM and from 2.4 to 2.2 cm in VL with the FC compared with the FH. Reproducibility between the FH and the FC showed poor to good intraclass correlation coefficients (ICCs) for MT (0.46-0.77) and PA (0.09-0.86) as well as poor to moderate ICCs for FL (0.41), with very low to moderate test-retest variability (TRV) (4%-18%). Tissue organization indicated low to good ICCs (0.21-0.80) with low to moderate TRV (4%-19.5%). The re-scanning results of fixed FC indicated excellent ICCs for MT (0.95-0.996), good for PA (0.77-0.90), and moderate for FL (0.73-0.76), with low TRV (5%-10%) for both muscles. Tissue organization displayed moderate to good ICCs (0.61-0.87) with very low to low TRV (4%-9%). For repositioned FC scans in GM and VL, MT showed good to excellent ICCs (0.86-0.98) with very low to low TRV (2%-8%). PA and FL demonstrated moderate to good ICCs (0.57-0.75), with very low to moderate TRV (2%-13%). Tissue organization revealed ICCs ranging from poor to good (0.13-0.87) for both muscles, with low to moderate TRV (5%-18%).

Conclusion

The FC systematically reduced MT by 2-3 mm. Furthermore, reproducibility revealed low ICCs and high data variability for several muscle architecture and tissue organization parameters. Thus, switching methods within a single study is not recommended. Nevertheless, FC ultrasound scans demonstrated excellent intrarater reliability for assessing MT. In the case of fixed FC scans particularly, moderate to excellent ICCs were observed for all muscle architecture and tissue organization parameters, accompanied by very low to low variability. Therefore, FC scans are recommended for investigating acute effects on muscle architecture and tissue organization when the FC remains on the leg throughout the period of measurements.

The role of pennation angle and architectural gearing to rate of force development in dynamic and isometric muscle contractions

BACKGROUND

Associations between muscle architecture and rate of force development (RFD) have been largely studied during fixed-end (isometric) contractions. Fixed-end contractions may, however, limit muscle shape changes and thus alter the relationship between muscle architecture an RFD.

AIM

We compared the correlation between muscle architecture and architectural gearing and knee extensor RFD when assessed during dynamic versus fixed-end contractions.

METHODS

Twenty-two recreationally active male runners performed dynamic knee extensions at constant acceleration (2000°s-2) and isometric contractions at a fixed knee joint angle (fixed-end contractions). Torque, RFD, vastus lateralis muscle thickness, and fascicle dynamics were compared during 0-75 and 75-150 ms after contraction onset.

RESULTS

Resting fascicle angle was moderately and positively correlated with RFD during fixed-end contractions (r = 0.42 and 0.46 from 0-75 and 75-150 ms, respectively; p < 0.05), while more strongly (p < 0.05) correlated with RFD during dynamic contractions (r = 0.69 and 0.73 at 0-75 and 75-150 ms, respectively; p < 0.05). Resting fascicle angle was (very) strongly correlated with architectural gearing (r = 0.51 and 0.73 at 0-75 ms and 0.50 and 0.70 at 75-150 ms; p < 0.05), with gearing in turn also being moderately to strongly correlated with RFD in both contraction conditions (r = 0.38-0.68).

CONCLUSION

Resting fascicle angle was positively correlated with RFD, with a stronger relationship observed in dynamic than isometric contraction conditions. The stronger relationships observed during dynamic muscle actions likely result from different restrictions on the acute changes in muscle shape and architectural gearing imposed by isometric versus dynamic muscle contractions.

Fully Automated Analysis of Muscle Architecture from B-Mode Ultrasound Images with DL_Track_US

OBJECTIVE

B-mode ultrasound can be used to image musculoskeletal tissues, but one major bottleneck is analyses of muscle architectural parameters (i.e., muscle thickness, pennation angle and fascicle length), which are most often performed manually.

METHODS

In this study we trained two different neural networks (classic U-Net and U-Net with VGG16 pre-trained encoder) to detect muscle fascicles and aponeuroses using a set of labeled musculoskeletal ultrasound images. We determined the best-performing model based on intersection over union and loss metrics. We then compared neural network predictions on an unseen test set with those obtained via manual analysis and two existing semi/automated analysis approaches (simple muscle architecture analysis [SMA] and UltraTrack). DL_Track_US detects the locations of the superficial and deep aponeuroses, as well as multiple fascicle fragments per image.

RESULTS

For single images, DL_Track_US yielded results similar to those produced by a non-trainable automated method (SMA; mean difference in fascicle length: 5.1 mm) and human manual analysis (mean difference: -2.4 mm). Between-method differences in pennation angle were within 1.5°, and mean differences in muscle thickness were less than 1 mm. Similarly, for videos, there was overlap between the results produced with UltraTrack and DL_Track_US, with intraclass correlations ranging between 0.19 and 0.88.

CONCLUSION

DL_Track_US is fully automated and open source and can estimate fascicle length, pennation angle and muscle thickness from single images or videos, as well as from multiple superficial muscles. We also provide a user interface and all necessary code and training data for custom model development.

Quantitative Muscle Fascicle Tractography Using Brightness-Mode Ultrasound

A muscle's architecture, defined as the geometric arrangement of its fibers with respect to its mechanical line of action, impacts its abilities to produce force and shorten or lengthen under load. Ultrasound and other noninvasive imaging methods have contributed significantly to our understanding of these structure-function relationships. The goal of this work was to develop a MATLAB toolbox for tracking and mathematically representing muscle architecture at the fascicle scale, based on brightness-mode ultrasound imaging data. The MuscleUS_Toolbox allows user-performed segmentation of a region of interest and automated modeling of local fascicle orientation; calculation of streamlines between aponeuroses of origin and insertion; and quantification of fascicle length, pennation angle, and curvature. A method is described for optimizing the fascicle orientation modeling process, and the capabilities of the toolbox for quantifying and visualizing fascicle architecture are illustrated in the human tibialis anterior muscle. The toolbox is freely available.

Energy transfer in reactive movements as a function of individual stretch load

Background: By directly recording electromyographic activity profiles and muscle-tendon interaction, this study aimed to elucidate the mechanisms why well-trained track and field athletes (experts) are able to outperform untrained individuals without former systematic experience in reactive jump training (novices). In particular, reactive power output and the elastic recoil properties of the muscle-tendon unit (MTU) were of special interest. For this purpose, stiffness regulation on muscle and joint level, energy management in terms of storing or dissipating elastic energy were compared between experts and novices during various stretch loads. Methods: Experts were compared with novices during reactive drop jumps (DJs) from drop heights ranging between 25 and 61 cm. Delta kinetic energy (Ekin) was calculated as the difference between the Ekin at take-off and ground contact (GC) to determine energy management. By recording electromyography of the lower limb muscles, in vivo fascicle dynamics (gastrocnemius medialis) and by combining kinematics and kinetics in a 3D inverse dynamics approach to compute ankle and knee joint kinetics, this study aimed to compare reactive jump performance, the neuromuscular activity and muscle-tendon interaction between experts and novices among the tested stretch loads. Results: Experts demonstrated significantly higher power output during DJs. Among all drop heights experts realized higher delta Ekin compared to novices. Consequently, higher reactive jump performance shown for experts was characterized by shorter GC time (GCT), higher jump heights and higher neuromuscular activity before and during the GC phase compared to novices. Concomitantly, experts were able to realize highest leg stiffness and delta Ekin in the lowest stretch load; however, both groups compensated the highest stretch load by prolonged GCT and greater joint flexion. On muscle level, experts work quasi-isometrically in the highest stretch load, while in novices GM fascicles were forcefully stretched. Conclusion: Group-specific stiffness regulation and elastic recoil properties are primarily influenced by the neuromuscular system. Due to their higher neuromuscular activity prior and during the GC phase, experts demonstrate higher force generating capacity. A functionally stiffer myotendinous system through enhanced neuromuscular input enables the experts loading their elastic recoil system more efficiently, thus realizing higher reactive power output and allowing a higher amount of energy storage and return. This mechanism is regulated in a stretch load dependent manner.

Improved Fascicle Length Estimates From Ultrasound Using a U-net-LSTM Framework

Brightness-mode (B-mode) ultrasound has been used to measure in vivo muscle dynamics for assistive devices. Estimation of fascicle length from B-mode images has now transitioned from time-consuming manual processes to automatic methods, but these methods fail to reach pixel-wise accuracy across extended locomotion. In this work, we aim to address this challenge by combining a U-net architecture with proven segmentation abilities with an LSTM component that takes advantage of temporal information to improve validation accuracy in the prediction of fascicle lengths. Using 64,849 ultrasound frames of the medial gastrocnemius, we semi-manually generated ground-truth for training the proposed U-net-LSTM. Compared with a traditional U-net and a CNNLSTM configuration, the validation accuracy, mean square error (MSE), and mean absolute error (MAE) of the proposed U-net-LSTM show better performance (91.4%, MSE =0.1± 0.03 mm, MAE =0.2± 0.05 mm). The proposed framework could be used for real-time, closed-loop wearable control during real-world locomotion.

What good is a measure of muscle length? The how and why of direct measurements of skeletal muscle motion

Over the past 50 years our understanding of the central role that muscle motion has in powering movement has accelerated significantly. Fundamental to this progress has been the development of methods for measuring the length of muscles and muscle fibers in vivo. A measurement of muscle fiber length might seem a trivial piece of information on its own. Yet when combined with knowledge of the properties of skeletal muscle it has proven a powerful tool for understanding the mechanics and energetics of locomotion and informing models of motor control. In this perspective we showcase the value of direct measurements of muscle fiber length from four different techniques: sonomicrometry, fluoromicrometry, magnetomicrometry, and ultrasound. For each method, we review its history and provide a high-level user's guide for researchers choosing tools for measuring muscle length in vivo. We highlight key insights that these measurements have provided, including the importance of passive elastic mechanisms and how skeletal muscle properties govern locomotor performance. The diversity of locomotor behaviors revealed across comparative studies has provided an important tool for discovering the rules for muscle function that span vertebrate locomotion more broadly, including in humans.

The influence of wearing an ultrasound device on gait in children with cerebral palsy and typically developing children

BACKGROUND

Ultrasonography with motion analysis enables dynamic imaging of medial gastrocnemius (MG) muscles and tendons during gait. This revealed pathological muscle-tendon dynamics in children with spastic cerebral palsy (CP) compared to typically developing (TD) children. However, wearing an ultrasound probe on the lower leg could interfere with gait and bias muscle length changes observed with ultrasound.

RESEARCH QUESTION

Does wearing an ultrasound probe on the MG influence gait in children with CP and TD children?

METHODS

Eighteen children with spastic CP and 16 age-matched TD children walked at comfortable walking speed on an instrumented treadmill. One baseline gait condition (BASE) and two conditions with an ultrasound probe and custom-made probe holder were measured: on the mid-muscle fascicles (FAS) and on the muscle-tendon junction (MTJ). The effect of condition and group on spatiotemporal parameters, hip, knee and ankle kinematics, ankle moment, ankle power, and modeled MG muscle-tendon unit (MTU) length was assessed using two-way repeated measures ANOVA's. Statistical non-parametric mapping was applied for time-series. Post-hoc paired-samples t-tests were conducted, and the root mean square difference was calculated for significant parts.

RESULTS

Children took wider steps during FAS (CP, TD) and MTJ (TD) compared to BASE, and during FAS compared to MTJ (CP). Hip extension was lower (2.7°) during terminal stance for MTJ compared to FAS for TD only. There was less swing knee flexion (FAS 4.9°; MTJ 4.0°) and ankle plantarflexion around toe-off (FAS 3.0°; MTJ 2.4°) for both ultrasound placements, with no group effect. Power absorption during loading response was slightly increased for both ultrasound placements (0.12 W/kg), with no group effect. MTU shortened less in swing for both ultrasound placements (FAS 3.6 mm; MTJ 3.7 mm), with no group effect.

SIGNIFICANCE

Wearing an ultrasound probe causes minimal lower-limb gait alterations and MTU length changes that are mostly similar in CP and TD.

A clustering-based method for estimating pennation angle from B-mode ultrasound images

B-mode ultrasound (US) is often used to noninvasively measure skeletal muscle architecture, which contains human intent information. Extracted features from B-mode images can help improve closed-loop human-robotic interaction control when using rehabilitation/assistive devices. The traditional manual approach to inferring the muscle structural features from US images is laborious, time-consuming, and subjective among different investigators. This paper proposes a clustering-based detection method that can mimic a well-trained human expert in identifying fascicle and aponeurosis and, therefore, compute the pennation angle. The clustering-based architecture assumes that muscle fibers have tubular characteristics. It is robust for low-frequency image streams. We compared the proposed algorithm to two mature benchmark techniques: UltraTrack and ImageJ. The performance of the proposed approach showed higher accuracy in our dataset (frame frequency is 20 Hz), that is, similar to the human expert. The proposed method shows promising potential in automatic muscle fascicle orientation detection to facilitate implementations in biomechanics modeling, rehabilitation robot control design, and neuromuscular disease diagnosis with low-frequency data stream.

In vivoestimation of anisotropic mechanical properties of the gastrocnemius during functional loading with MR elastography

Objective.In vivoimaging assessments of skeletal muscle structure and function allow for longitudinal quantification of tissue health. Magnetic resonance elastography (MRE) non-invasively quantifies tissue mechanical properties, allowing for evaluation of skeletal muscle biomechanics in response to loading, creating a better understanding of muscle functional health.Approach. In this study, we analyze the anisotropic mechanical response of calf muscles using MRE with a transversely isotropic, nonlinear inversion algorithm (TI-NLI) to investigate the role of muscle fiber stiffening under load. We estimate anisotropic material parameters including fiber shear stiffness (μ1), substrate shear stiffness (μ2), shear anisotropy (ϕ), and tensile anisotropy (ζ) of the gastrocnemius muscle in response to both passive and active tension.Main results. In passive tension, we found a significant increase inμ1,ϕ,andζwith increasing muscle length. While in active tension, we observed increasingμ2and decreasingϕandζduring active dorsiflexion and plantarflexion-indicating less anisotropy-with greater effects when the muscles act as agonist.Significance. The study demonstrates the ability of this anisotropic MRE method to capture the multifaceted mechanical response of skeletal muscle to tissue loading from muscle lengthening and contraction.

The effect of specific bioactive collagen peptides on function and muscle remodeling during human resistance training

AIM

Bioactive collagen peptides (CP) have been suggested to augment the functional, structural (size and architecture), and contractile adaptations of skeletal muscle to resistance training (RT), but with limited evidence. This study aimed to determine if CP vs. placebo (PLA) supplementation enhanced the functional and underpinning structural, and contractile adaptations after 15 weeks of lower body RT.

METHODS

Young healthy males were randomized to consume either 15 g of CP (n = 19) or PLA (n = 20) once every day during a standardized program of progressive knee extensor, knee flexor, and hip extensor RT 3 times/wk. Measurements pre- and post-RT included: knee extensor and flexor isometric strength; quadriceps, hamstrings, and gluteus maximus volume with MRI; evoked twitch contractions, 1RM lifting strength, and architecture (with ultrasound) of the quadriceps.

RESULTS

Percentage changes in maximum strength (isometric or 1RM) did not differ between-groups (0.684 ≤ p ≤ 0.929). Increases in muscle volume were greater (quadriceps 15.2% vs. 10.3%; vastus medialis (VM) 15.6% vs. 9.7%; total muscle volume 15.7% vs. 11.4%; [all] p ≤ 0.032) or tended to be greater (hamstring 16.5% vs. 12.8%; gluteus maximus 16.6% vs. 12.9%; 0.089 ≤ p ≤ 0.091) for CP vs. PLA. There were also greater increases in twitch peak torque (22.3% vs. 12.3%; p = 0.038) and angle of pennation of the VM (16.8% vs. 5.8%, p = 0.046), but not other muscles, for CP vs. PLA.

CONCLUSIONS

CP supplementation produced a cluster of consistent effects indicating greater skeletal muscle remodeling with RT compared to PLA. Notably, CP supplementation amplified the quadriceps and total muscle volume increases induced by RT.

Tissue Characterization of Puborectalis Muscle From 3-D Ultrasound

Pelvic floor (PF) muscles have the role of preventing pelvic organ descent. The puborectalis muscle (PRM), which is one of the female PF muscles, can be damaged during child delivery. This damage can potentially cause irreversible muscle trauma and even lead to an avulsion, which is disconnection of the muscle from its insertion point, the pubic bone. Ultrasound imaging allows diagnosis of such trauma based on comparison of geometric features of a damaged muscle with the geometric features of a healthy muscle. Although avulsion, which is considered severe damage, can be diagnosed, microdamage within the muscle itself leading to structural changes cannot be diagnosed by visual inspection through imaging only. Therefore, we developed a quantitative ultrasound tissue characterization method to obtain information on the state of the tissue of the PRM and the presence of microdamage in avulsed PRMs. The muscle was segmented as the region of interest (ROI) and further subdivided into six regions of interest (sub-ROIs). Mean echogenicity, entropy and shape parameter of the statistical distribution of gray values were analyzed on two of these sub-ROIs nearest to the bone. The regions nearest to the bones are also the most likely regions to exhibit damage in case of disconnection or avulsion. This analysis was performed for both the muscle at rest and the muscle in contraction. We found that, for PRMs with unilateral avulsion compared with undamaged PRMs, the mean echogenicity (p = 0.02) and shape parameter (p < 0.01) were higher, whereas the entropy was lower (p < 0.01). This method might be applicable to quantification of PRM damage within the muscle.

Rate of force development relationships to muscle architecture and contractile behavior in the human vastus lateralis

In this study, we tested the hypotheses that (i) rate of force development (RFD) is correlated to muscle architecture and dynamics and that (ii) force-length-velocity properties limit knee extensor RFD. Twenty-one healthy participants were tested using ultrasonography and dynamometry. Vastus lateralis optimal fascicle length, fascicle velocity, change in pennation angle, change in muscle length, architectural gear ratio, and force were measured during rapid fixed-end contractions at 60° knee angle to determine RFD. Isokinetic and isometric tests were used to estimate individual force-length-velocity properties, to evaluate force production relative to maximal potential. Correlation analyses were performed between force and muscle parameters for the first three 50 ms intervals. RFD was not related to optimal fascicle length for any measured time interval, but RFD was positively correlated to fascicle shortening velocity during all intervals (r = 0.49-0.69). Except for the first interval, RFD was also related to trigonometry-based changes in muscle length and pennation angle (r = 0.45-0.63) but not to architectural gear ratio. Participants reached their individual vastus lateralis force-length-velocity potential (i.e. their theoretical maximal force at a given length and shortening velocity) after 62 ± 24 ms. Our results confirm the theoretical importance of fascicle shortening velocity and force-length-velocity properties for rapid force production and suggest a role of fascicle rotation.

Untethered muscle tracking using magnetomicrometry

Muscle tissue drives nearly all movement in the animal kingdom, providing power, mobility, and dexterity. Technologies for measuring muscle tissue motion, such as sonomicrometry, fluoromicrometry, and ultrasound, have significantly advanced our understanding of biomechanics. Yet, the field lacks the ability to monitor muscle tissue motion for animal behavior outside the lab. Towards addressing this issue, we previously introduced magnetomicrometry, a method that uses magnetic beads to wirelessly monitor muscle tissue length changes, and we validated magnetomicrometry via tightly-controlled in situ testing. In this study we validate the accuracy of magnetomicrometry against fluoromicrometry during untethered running in an in vivo turkey model. We demonstrate real-time muscle tissue length tracking of the freely-moving turkeys executing various motor activities, including ramp ascent and descent, vertical ascent and descent, and free roaming movement. Given the demonstrated capacity of magnetomicrometry to track muscle movement in untethered animals, we feel that this technique will enable new scientific explorations and an improved understanding of muscle function.

Quadriceps Muscle Action and Association With Knee Joint Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction

Insufficient quadriceps force production and altered knee joint biomechanics after anterior cruciate ligament reconstruction (ACLR) may contribute to a heightened risk of osteoarthritis. Quadriceps muscle lengthening dynamics affect force production and knee joint loading; however, no study to our knowledge has quantified in vivo quadriceps dynamics during walking in individuals with ACLR or examined correlations with joint biomechanics. Our purpose was to quantify bilateral vastus lateralis (VL) fascicle length change and the association thereof with gait biomechanics during weight acceptance in individuals with ACLR. The authors hypothesized that ACLR limbs would exhibit more fascicle lengthening than contralateral limbs. The authors also hypothesized that ACLR limbs would exhibit positive correlations between VL fascicle lengthening and knee joint biomechanics during weight acceptance in walking. The authors quantified VL contractile dynamics via cine B-mode ultrasound imaging in 18 individuals with ACLR walking on an instrumented treadmill. In partial support of our hypothesis, ACLR limb VL fascicles activated without length change on average during weight acceptance while fascicle length on the contralateral limb decreased on average. The authors found a positive association between fascicle lengthening and increase in knee extensor moments in both limbs. Our results suggest that examining quadriceps muscle dynamics may elucidate underlying mechanisms relevant to osteoarthritis.

Seeing inside a body in motion

Adhesive ultrasound patches can provide medical imaging for patients on the go.

AEPUS: a tool for the Automated Extraction of Pennation angles in Ultrasound images with low Signal-to-noise ratio for plane-wave imaging

The penetrating ability of ultrasound (US) com-bined with its real-time operation make it the perfect tool for investigating muscle contraction mechanics during complex functional tasks, e.g., locomotion. Changes in fascicle lengths and pennation angles of muscle fascicles strongly correlate with the capacity of skeletal muscles to produce forces, thereby represent fundamental parameters to be tracked. While the gold standard for extracting these features from US images is still based on manual annotation, the availability of recording devices capable of generating big data of muscle dynamics makes such manual approach unfeasible, setting the need for automated muscle images annotation tools. Existing approaches, however, are seriously limited, also in view of the continuous developments and technology ad-vancements for ultrafast US and plane-wave imaging. In fact, they rely on conventional (slow) B-mode imaging, make use of point tracking approaches (which often fail due to out-of-plane motion), or can only operate on very high quality images. To overcome all these limitations, we present AEPUS, an automated image labeling tool capable of extracting pennation angles from low quality images using a very small number of plane waves, therefore making it capable of exploiting all the benefits of ultrafast US. Clinical Relevance - Ultrasound is a standard research tool to investigate alterations of spastic muscles in children with Cerebral Palsy. We propose a reliable and time-efficient method to track muscle features in ultrasound images and support clinical biomechanists in their analyses.

Reliability and accuracy of ultrasound image analyses completed manually versus an automated tool

Analysis of Brightness-mode ultrasound-captured fascicle angle (FA) and fascicle length (FL) can be completed manually with computer-based programs or by automated programs. Insufficient data exists regarding reliability and accuracy of automated tools. Therefore, the purpose of this study was to determine the test-retest reliability of automatic and manual ultrasound analyses, while determining accuracy of the automatic tool against the manual equivalent. Twenty-three participants (mean ± SD; age = 24 ± 4 years; height = 172.2 ± 10.5 cm; body mass = 73.1 ± 16.1 kg) completed one laboratory visit consisting of two trials where vastus lateralis muscle architecture was assessed with ultrasound. Images were taken at both lower (10 MHz) and higher frequency (12 MHz). Images were analyzed manually in an open-source imaging program and automatically using a separate open-source macro function. Test-retest reliability statistics were calculated for automatic and manual analyses. Accuracy was determined with validity statistics and were calculated for automatic analyses. The results show that manual ultrasound analyses for FA and FL for both lower and higher frequency displayed good reliability (ICC_2,1 = 0.75-0.86). However, automatic ultrasound analyses for FA and FL revealed moderate reliability (ICC_2,1 = 0.61-0.72) for the lower frequency images and poor reliability (ICC_2,1 = 0.16-0.27) for higher frequency images. When assessed against manual techniques, automatic analyses presented greater total error (TE) and standard error of the estimate (SEE) for FA at lower frequency (constant error (CE) = -3.91°, TE = 5.57°, SEE = 3.45°) than higher (CE = -2.78°, TE = -4.54°, SEE = 2.45°). For FL, the higher frequency error (CE = 0.92 cm, TE = 2.12 cm, SEE = 1.15 cm) was similar to lower frequency error (CE = 1.98 cm, TE = 3.66 cm, SEE = 1.57 cm). The findings overall show that manual analyses had good reliability and low absolute error, while demonstrating the automated counterpart had poor to moderate reliability and large errors in analyses. These findings may be impactful as they highlight the good reliability and low error associated with manually analyzed ultrasound images and validate a novel automatic tool for analyzing ultrasound images. Future work should focus on improving reliability and decreasing error in automated image analysis tools. Automated tools are promising for the field as they eliminate biases between analysts and may be more time efficient than manual techniques.

Muscle forces and fascicle behavior during three hamstring exercises

Knowledge about muscular forces and fascicle behavior during hamstring exercises can optimize exercise prescription, but information on these outcomes across different exercises is lacking. We aimed to characterize and compare lower‐limb muscle forces and biceps femoris long head muscle fascicle behavior between three hamstring exercises: the Nordic hamstring curl (NHC), single‐leg Roman chair (RCH), and single‐leg deadlift (DL). Ten male participants performed the exercises while full‐body kinematics, ground reaction forces, surface muscle activation, and biceps femoris long head fascicle behavior were measured. Mean fascicle length was highest in the DL, followed by the RCH and NHC. Fascicle lengthening was higher in the NHC compared with the RCH and DL, with no difference between the RCH and DL. Biceps femoris short and long head, semitendinosus, and semimembranosus peak forces were generally higher in the NHC compared with the RCH and DL, while mean forces during the eccentric phase were generally not different between the NHC and RCH. Peak forces in the NHC coincided with low biceps femoris long head and semimembranosus muscle activation. The NHC generally has the highest peak hamstring muscle forces and results in more fascicle lengthening when compared to the DL and RCH. The NHC may therefore be most effective to promote increases in fascicle length. While the NHC may be effective to promote biceps femoris short head and semitendinosus strength adaptations, the RCH and DL may be more effective to promote strength increases in the biceps femoris long head and semimembranosus.

Intermuscular adipose tissue in Type 2 diabetes mellitus: Non-invasive quantitative imaging and clinical implications

Intermuscular adipose tissue (IMAT) is an ectopic fat depot found beneath the fascia and within the muscles. IMAT modulates muscle insulin sensitivity and triggers local and systemic chronic low-grade inflammation by producing cytokines and chemokines, which underlie the pathogenesis of Type 2 diabetes mellitus (T2DM). Imaging techniques have been increasingly used to non-invasively quantify IMAT in patients with diabetes in research and healthcare settings. In this study, we systematically reviewed the cell of origin and definition of IMAT, and the use of quantitative and functional imaging technology pertinent to the etiology, risk factors, lifestyle modification, and therapeutic treatment of diabetes. The purpose of this article is to provide important insight into the current understanding of IMAT and future prospects of targeting IMAT for T2DM control.

A scoping review of methods used in musculoskeletal soft tissue and nerve shear wave elastography studies

This scoping review of shear wave elastography (SWE) articles in musculoskeletal soft tissue and nerve research demonstrates methodological heterogeneity resulting from a lack of standardized data collection and reporting requirements. Seven literature databases were searched for original articles published in English from 2004-2020 that examine human skeletal muscles, tendons, and nerves in vivo. Although 5,868 records were initially identified, only 375 reports met inclusion criteria. Of the 375 articles, 260 examined 89 unique muscles, 94 examined 14 unique tendons, and 43 examined 8 unique nerves. Cohorts were often small (n = 11-20) and young (mean = 20-29 years), and participants were typically tested in the prone position. Regarding equipment, a variety of ultrasound systems (n = 11), ultrasound models (n = 18), and transducers (n = 19) were identified. Only 11% of articles contained information on the use of electromyography to confirm absence of muscle activity, and only 8% reported measurement depth. Since musculoskeletal soft tissue and nerve stiffness can vary significantly based on data collection methods, it is essential to standardize SWE collection and reporting procedures. This will allow SWE to serve as a valid and reproducible tool for assessing tissue pathology, disease progression, and response to intervention within a variety of musculoskeletal and nerve-related disorders.

TimTrack: A drift-free algorithm for estimating geometric muscle features from ultrasound images

Ultrasound imaging is valuable for non-invasively estimating fascicle lengths and other features of pennate muscle, especially when performed computationally. Effective analysis techniques to date typically use optic flow to track displacements from image sequences, but are sensitive to integration drift for longer sequences. We here present an alternative algorithm that objectively estimates geometric features of pennate muscle from ultrasound images, without drift sensitivity. The algorithm identifies aponeuroses and estimates fascicle angles to derive fascicle lengths. Length estimates of human vastus lateralis and gastrocnemius fascicles in healthy subjects (N = 9 and N = 17 respectively) compared well (overall root-mean-square difference, RMSD = 0.52 cm) to manual estimates by independent observers (n = 3), with overall coefficient of multiple correlation (CMC) of 0.98. Our tests yielded accuracy (CMC, RMSD) and processing speed similar to or exceeding that of state-of-the-art algorithms. The algorithm requires minimal manual intervention and can optionally extrapolate fascicle lengths that extend beyond the image frame. It thus facilitates automated analysis of ultrasound images without drift.

The influence of muscle-belly and tendon gearing on the energy cost of human walking

This study combines metabolic and kinematic measurements at the whole‐body level, with EMG and ultrasound measurements to investigate the influence of muscle‐tendon mechanical behavior on the energy cost (C_net) of walking (from 2 to 8 km·h⁻¹). Belly gearing (Gb = Δmuscle‐belly length/Δfascicles length) and tendon gearing (Gt = ∆muscle‐tendon unit length/∆muscle‐belly length) of vastus lateralis (VL) and gastrocnemius medialis (GM) were calculated based on ultrasound data. Pendular energy recovery (%R) was calculated based on kinematic data, whereas the cumulative activity per distance travelled (CMAPD) was calculated for the VL, GM, tibialis anterior, and biceps femoris as the ratio between their EMG activity and walking speed. Finally, total CAMPD (CMAPD_TOT) was calculated as the sum of the CMAPD of all the investigate muscles. C_net and CMAPD_TOT showed a U‐shaped behavior with a minimum at 4.2 and 4.1 km·h⁻¹, respectively; while %R, VL, and GM belly gearing showed an opposite trend, reaching a maximum (60% ± 5%, 1.1 ± 0.1 and 1.5 ± 0.1, respectively), between 4.7 and 5 km·h⁻¹. Gt was unaffected by speed in GM (3.5 ± 0.1) and decreased as a function of it in VL. A multiple stepwise linear regression indicated that %R has the greatest influence on C_net, followed by CMAPD_TOT and GM belly gearing. The role of Gb on C_net could be attributed to its role in determining muscle work: when Gb increases, fascicles shortening decreases compared with that of the muscle‐belly, thereby reducing the energy cost of contraction.

A Human-Centered Machine-Learning Approach for Muscle-Tendon Junction Tracking in Ultrasound Images

Biomechanical and clinical gait research observes muscles and tendons in limbs to study their functions and behaviour. Therefore, movements of distinct anatomical landmarks, such as muscle-tendon junctions, are frequently measured. We propose a reliable and time efficient machine-learning approach to track these junctions in ultrasound videos and support clinical biomechanists in gait analysis. In order to facilitate this process, a method based on deep-learning was introduced. We gathered an extensive data set, covering 3 functional movements, 2 muscles, collected on 123 healthy and 38 impaired subjects with 3 different ultrasound systems, and providing a total of 66864 annotated ultrasound images in our network training. Furthermore, we used data collected across independent laboratories and curated by researchers with varying levels of experience. For the evaluation of our method a diverse test-set was selected that is independently verified by four specialists. We show that our model achieves similar performance scores to the four human specialists in identifying the muscle-tendon junction position. Our method provides time-efficient tracking of muscle-tendon junctions, with prediction times of up to 0.078 seconds per frame (approx. 100 times faster than manual labeling). All our codes, trained models and test-set were made publicly available and our model is provided as a free-to-use online service on https://deepmtj.org/.

Ultrasound-Derived Features of Muscle Architecture Provide Unique Temporal Characterization of Volitional Knee Motion

Sonomyography, or dynamic ultrasound imaging of skeletal muscle, has gained significant interest in rehabilitation medicine. Previously, correlations relating sonomyography features of muscle contraction, including muscle thickness, pennation angle, angle between aponeuroses and fascicle length, to muscle force production, strength and joint motion have been established. Additionally, relationships between grayscale image intensity, or echogenicity, with maximum voluntary isometric contraction of muscle have been noted. However, the time relationship between changes in various sonomyography features during volitional motion has yet to be explored, which would highlight if unique information pertaining to muscle contraction and motion can be obtained from this real-time imaging modality. These new insights could inform how we assess muscle function and/or how we use this modality for assistive device control. Thus, our objective was to characterize the time synchronization of changes in five features of rectus femoris contraction extracted from ultrasound images during seated knee extension and flexion. A cross-correlation analysis was performed on data recorded by a handheld ultrasound system as able-bodied subjects completed seated trials of volitional knee extension and flexion. Changes in muscle thickness, angle between aponeuroses, and mean image echogenicity, a change in brightness of the grayscale image, preceded changes in our estimates of pennation angle and fascicle length. The leading nature of these features suggest they could be objective features for early detection of impending joint motion. Finally, multiple sonomyographic features provided unique temporal information associated with this volitional task.Clinical Relevance-This work evaluates the time relationship between five commonly reported features of skeletal muscle architecture during volitional motion, which can be used for targeted clinical assessments and intent detection.

Age-related changes to triceps surae muscle-subtendon interaction dynamics during walking

Push-off intensity is largely governed by the forces generated by the triceps surae (TS) muscles (gastrocnemius-GAS, soleus-SOL). During walking, the TS muscles undergo different fascicle kinematics and contribute differently to biomechanical subtasks. These differences may be facilitated by the Achilles tendon (AT), which is comprised of subtendons that originate from the TS muscles. We and others have revealed non-uniform displacement patterns within the AT—evidence for sliding between subtendons that may facilitate independent muscle actuation. However, in older adults, we have observed more uniform AT tissue displacements that correlate with reduced push-off intensity. Here, we employed dual-probe ultrasound imaging to investigate TS muscle length change heterogeneity (GAS–SOL) as a determinant of reduced push-off intensity in older adults. Compared to young, older adults walked with more uniform AT tissue displacements and reduced TS muscle length change heterogeneity. These muscle-level differences appeared to negatively impact push-off intensity—evidenced by between-group differences in the extent to which TS muscle length change heterogeneity correlates with mechanical output across walking tasks. Our findings suggest that the capacity for sliding between subtendons may facilitate independent TS muscle actuation in young adults but may restrict that actuation in older adults, likely contributing to reduced push-off intensity.

Effects of Knee Injury Length on Jump Inside Kick Performances of Wushu Player

Background and Objectives: When performing the jump inside kick in Wushu, it is important to understand the rotation technique while in mid-air. This is because the score varies according to the mid-air rotation, and when landing after the mid-air rotation, it causes considerable injury to the knee. This study aimed to compare the differences in kinematic and kinetic variables between experienced and less experienced knee injuries in the Wushu players who perform 360°, 540°, and 720° jump inside kicks in self-taolu. Materials and Methods: The participants’ mean (SD) age was 26.12 (2.84) years old. All of them had suffered knee injuries and were all recovering and returning to training. The group was classified into a group with less than 20 months of injury experience (LESS IG, n = 6) and a group with more than 20 months of injury experience (MORE IG, n = 6). For kinematic measurements, jump inside kicks at three rotations were assessed by using high-speed cameras. For kinetic measurements, the contraction time and maximal displacement of tensiomyography were assessed in the vastus lateralis, vastus medialis, rectus femoris, biceps femoris, gastrocnemius lateralis, gastrocnemius medialis, and tibialis anterior. The peak torque, work per repetition, fatigue index, and total work of isokinetic moments were assessed using knee extension/flexion, ankle inversion/eversion, and ankle plantarflexion/dorsiflexion tests. Results: Although there was no difference at the low difficulty level (360°), there were significant differences at the higher difficulty levels (540° and 720°) between the LESS IG and the MORE IG. For distance and time, the LESS IG had a shorter jump distance, but a faster rotation time compared to those in the MORE IG. Due to the characteristics of the jump inside kick’s rotation to the left, the static and dynamic muscle contractility properties were mainly found to be higher in the left lower extremity than in the right lower extremity, and higher in the LESS IG than in the MORE IG. In addition, this study observed that the ankle plantarflexor in the LESS IG was significantly higher than that in the MORE IG. Conclusion: To become a world-class self-taolu athlete while avoiding knee injuries, it is necessary to develop the static and dynamic myofunctions of the lower extremities required for jumping. Moreover, it is considered desirable to train by focusing on the vertical height and the amount of rotation during jumping.

Repeatability and sensitivity of passive mechanical stiffness measurements in the triceps surae muscle-tendon complex

Measurements of muscle-tendon unit passive mechanical properties are often used to illustrate acute and chronic responses to a training stimulus. The purpose of this study was to quantify the inter-session repeatability of triceps surae passive stiffness measurements in athletic and non-athletic populations, with the view to discussing its usefulness both as a muscle-tendon profiling tool and a control measure for studies with multiple data collection sessions. The study also aimed to observe the effects of quiet standing on passive stiffness parameters. Twenty-nine men (10 cyclists, nine triathletes, 10 controls) visited the laboratory on three separate occasions, where passive stiffness tests were carried out using an isokinetic dynamometer and B-mode ultrasound. Participants were fully rested on two of the sessions and subjected to 20 min of quiet standing in the other. The passive stiffness assessment generally showed only moderate inter-session repeatability but was still able to detect inter-group differences, with triathletes showing higher passive stiffness than cyclists (p < 0.05). Furthermore, quiet standing impacted passive stiffness by causing a reduction in ankle joint range of motion, although mechanical resistance to stretch in the muscle-tendon unit at a given joint angle was relatively unaffected. These findings show that passive stiffness assessment is appropriate for detecting inter-group differences in the triceps surae and even the effects of a low-intensity task such as quiet standing, despite showing some inter-session variation. However, the inter-session variation suggests that passive stiffness testing might not be suitable as a control measure when testing participants on multiple sessions.

The reliability of measuring medial gastrocnemius muscle-tendon unit lengths during gait

BACKGROUND

Ultrasound imaging combined with 3D motion analysis allows for in-vivo assessment of muscle-tendon unit lengths during gait. The clinical relevance of analysing the medial gastrocnemius (MG) and Achilles muscle-tendon junction (MTJ), MG mid-muscle belly fascicles (FAS) and muscle thickness was shown. However, their reliability error estimations over the gait cycle is unknown.

RESEARCH QUESTION

What are the intra- and inter-session errors associated with extracting MG belly, thickness, FAS and tendon lengths using ultrasound during gait in healthy participants?

METHODS

3D gait analysis was carried out in ten healthy adults as they walked on an instrumented treadmill at a comfortable walking speed. An ultrasound probe was secured on the leg and tracked by 3D motion analysis. Images were collected during two walking trials with the probe on the MG muscle-belly to estimate FAS lengths and muscle thickness, and during two trials with the probe on the MTJ to estimate muscle-belly and tendon lengths. A second session was performed after 5 ± 4 days where a different operator placed the ultrasound probe. The standard deviation (SD) of absolute and relative lengths changes during the gait cycle over different trials were calculated per participant. SD values averaged over participants represented intra- and inter-session errors.

RESULTS

For all assessed variables, the intra-session errors were <2.2 mm, except for the FAS lengths (3.1 mm). The inter-session errors were larger than the intra-session, with the highest values found for the absolute muscle-tendon unit lengths (5.6 mm). Relative length errors were smaller than absolute length errors.

SIGNIFICANCE

Intra-session errors, which may reflect natural variability and data processing errors, seem more critical when extracting absolute FAS than muscle-tendon lengths. Standardized probe positioning on the MTJ between sessions may improve the inter-session reliability. Expressing the lengths relative to their lengths as the beginning of the gait cycle reduces the inter-session errors.

Cyclic eccentric stretching induces more damage and improved subsequent protection than stretched isometric contractions in the lower limb

PURPOSE

Controversy remains about whether exercise-induced muscle damage (EIMD) and the subsequent repeated bout effect (RBE) are caused by the stretching of an activated muscle, or the production of high force at long, but constant, muscle lengths. The aim of this study was to determine the influence of muscle fascicle stretch elicited during different muscle contraction types on the magnitude of EIMD and the RBE.

METHODS

Fourteen participants performed an initial bout of lower limb exercise of the triceps surae. One leg performed sustained static contractions at a constant long muscle length (ISO), whereas the contralateral leg performed a bout of eccentric heel drop exercise (ECC). Time under tension was matched between the ECC and ISO conditions. Seven days later, both legs performed ECC. Plantar flexor twitch torque, medial gastrocnemius (MG) fascicle length and muscle soreness were assessed before, 2 h and 2 days after each exercise bout. MG fascicle length and triceps surae surface electromyography were examined across the bouts of exercise.

RESULTS

We found that both ECC and ISO conditions elicited EIMD and a RBE. ISO caused less damage 2 h after the initial bout (14% less drop in twitch torque, P = 0.03) and less protection from soreness 2 days after the repeated bout (56% higher soreness, P = 0.01). No differences were found when comparing neuromechanical properties across exercise bouts.

CONCLUSION

For MG, the action of stretching an active muscle seems to be more important for causing damage than a sustained contraction at a long length.

Contractile behavior of the gastrocnemius medialis muscle during running in simulated hypogravity

Vigorous exercise countermeasures in microgravity can largely attenuate muscular degeneration, albeit the extent of applied loading is key for the extent of muscle wasting. Running on the International Space Station is usually performed with maximum loads of 70% body weight (0.7 g). However, it has not been investigated how the reduced musculoskeletal loading affects muscle and series elastic element dynamics, and thereby force and power generation. Therefore, this study examined the effects of running on the vertical treadmill facility, a ground-based analog, at simulated 0.7 g on gastrocnemius medialis contractile behavior. The results reveal that fascicle-series elastic element behavior differs between simulated hypogravity and 1 g running. Whilst shorter peak series elastic element lengths at simulated 0.7 g appear to be the result of lower muscular and gravitational forces acting on it, increased fascicle lengths and decreased velocities could not be anticipated, but may inform the development of optimized running training in hypogravity. However, whether the alterations in contractile behavior precipitate musculoskeletal degeneration warrants further study.

Implementing Ultrasound Imaging for the Assessment of Muscle and Tendon Properties in Elite Sports: Practical Aspects, Methodological Considerations and Future Directions

Ultrasound (US) imaging has been widely used in both research and clinical settings to evaluate the morphological and mechanical properties of muscle and tendon. In elite sports scenarios, a regular assessment of such properties has great potential, namely for testing the response to training, detecting athletes at higher risks of injury, screening athletes for structural abnormalities related to current or future musculoskeletal complaints, and monitoring their return to sport after a musculoskeletal injury. However, several practical and methodological aspects of US techniques should be considered when applying this technology in the elite sports context. Therefore, this narrative review aims to (1) present the principal US measures and field of applications in the context of elite sports; (2) to discuss, from a methodological perspective, the strengths and shortcomings of US imaging for the assessment of muscle and tendon properties; and (3) to provide future directions for research and application.

Machine learning to extract muscle fascicle length changes from dynamic ultrasound images in real-time

BACKGROUND AND OBJECTIVE

Dynamic muscle fascicle length measurements through B-mode ultrasound have become popular for the non-invasive physiological insights they provide regarding musculoskeletal structure-function. However, current practices typically require time consuming post-processing to track muscle length changes from B-mode images. A real-time measurement tool would not only save processing time but would also help pave the way toward closed-loop applications based on feedback signals driven by in vivo muscle length change patterns. In this paper, we benchmark an approach that combines traditional machine learning (ML) models with B-mode ultrasound recordings to obtain muscle fascicle length changes in real-time. To gauge the utility of this framework for 'in-the-loop' applications, we evaluate accuracy of the extracted muscle length change signals against time-series' derived from a standard, post-hoc automated tracking algorithm.

METHODS

We collected B-mode ultrasound data from the soleus muscle of six participants performing five defined ankle motion tasks: (a) seated, constrained ankle plantarflexion, (b) seated, free ankle dorsi/plantarflexion, (c) weight-bearing, calf raises (d) walking, and then a (e) mix. We trained machine learning (ML) models by pairing muscle fascicle lengths obtained from standardized automated tracking software (UltraTrack) with the respective B-mode ultrasound image input to the tracker, frame-by-frame. Then we conducted hyperparameter optimizations for five different ML models using a grid search to find the best performing parameters for a combination of high correlation and low RMSE between ML and UltraTrack processed muscle fascicle length trajectories. Finally, using the global best model/hyperparameter settings, we comprehensively evaluated training-testing outcomes within subject (i.e., train and test on same subject), cross subject (i.e., train on one subject, test on another) and within/direct cross task (i.e., train and test on same subject, but different task).

RESULTS

Support vector machine (SVM) was the best performing model with an average r = 0.70 ±0.34 and average RMSE = 2.86 ±2.55 mm across all direct training conditions and average r = 0.65 ±0.35 and average RMSE = 3.28 ±2.64 mm when optimized for all cross-participant conditions. Comparisons between ML vs. UltraTrack (i.e., ground truth) tracked muscle fascicle length versus time data indicated that ML tracked images reliably capture the salient qualitative features in ground truth length change data, even when correlation values are on the lower end. Furthermore, in the direct training, calf raises condition, which is most comparable to previous studies validating automated tracking performance during isolated contractions on a dynamometer, our ML approach yielded 0.90 average correlation, in line with other accepted tracking methods in the field.

CONCLUSIONS

By combining B-mode ultrasound and classical ML models, we demonstrate it is possible to achieve real-time tracking of human soleus muscle fascicles across a number of functionally relevant contractile conditions. This novel sensing modality paves the way for muscle physiology in-the-loop applications that could be used to modify gait via biofeedback or unlock novel wearable device control techniques that could enable restored or augmented locomotion performance.

Medial gastrocnemius muscle fascicles shorten throughout stance during sprint acceleration

The compliant nature of distal limb muscle-tendon units is traditionally considered suboptimal in explosive movements when positive joint work is required. However, during accelerative running, ankle joint net mechanical work is positive. Therefore, this study aims to investigate how plantar flexor muscle-tendon behavior is modulated during fast accelerations. Eleven female sprinters performed maximum sprint accelerations from starting blocks, while gastrocnemius muscle fascicle lengths were estimated using ultrasonography. We combined motion analysis and ground reaction force measurements to assess lower limb joint kinematics and kinetics, and to estimate gastrocnemius muscle-tendon unit length during the first two acceleration steps. Outcome variables were resampled to the stance phase and averaged across three to five trials. Relevant scalars were extracted and analyzed using one-sample and two-sample t-tests, and vector trajectories were compared using statistical parametric mapping. We found that an uncoupling of muscle fascicle behavior from muscle-tendon unit behavior is effectively used to produce net positive mechanical work at the joint during maximum sprint acceleration. Muscle fascicles shortened throughout the first and second steps, while shortening occurred earlier during the first step, where negative joint work was lower compared with the second step. Elastic strain energy may be stored during dorsiflexion after touchdown since fascicles did not lengthen at the same time to dissipate energy. Thus, net positive work generation is accommodated by the reuse of elastic strain energy along with positive gastrocnemius fascicle work. Our results show a mechanism of how muscles with high in-series compliance can contribute to net positive joint work.

A dynamic ultrasonographic in vivo study of the musculoaponeurotic architecture of the human masseter muscle

OBJECTIVE

In the present study, we sought to investigate the in vivo musculoaponeurotic architecture of the masseter muscle (MM) volumetrically with ultrasound in asymptomatic participants. It was hypothesized that the mean fiber bundle length (FBL) and mean aponeurotic height of laminae of the MM differ significantly between the relaxed state and maximally contracted state upon elevation of the mandible.

STUDY DESIGN

The MM was investigated volumetrically in 12 male and 12 female asymptomatic participants (mean age, 25.8 ± 4.1 years) using ultrasound. The mean FBL and mean height of aponeuroses in the relaxed and maximally contracted states were compared using paired t tests, with significance established at P ≤ .05. Intrarater reliability was assessed using the intraclass correlation coefficient (ICC).

RESULTS

The MM consisted of the superficial head (SH) and deep head, each arranged in multiple laminae. Fiber bundles extended between superior and inferior aponeuroses and/or bone. Statistically significant differences (P ≤ .05) were observed in mean FBL and in mean height of aponeuroses between the relaxed and contracted states only in superficial laminae of the SH.

CONCLUSIONS

These results suggest there is differential contraction of the laminae of the MM in the transition from relaxed to contracted states. Future comparison with pathologic patients can be made on the basis of an established normative database.

Gastrocnemius Medialis Contractile Behavior Is Preserved During 30% Body Weight Supported Gait Training

Rehabilitative body weight supported gait training aims at restoring walking function as a key element in activities of daily living. Studies demonstrated reductions in muscle and joint forces, while kinematic gait patterns appear to be preserved with up to 30% weight support. However, the influence of body weight support on muscle architecture, with respect to fascicle and series elastic element behavior is unknown, despite this having potential clinical implications for gait retraining. Eight males (31.9 ± 4.7 years) walked at 75% of the speed at which they typically transition to running, with 0% and 30% body weight support on a lower-body positive pressure treadmill. Gastrocnemius medialis fascicle lengths and pennation angles were measured via ultrasonography. Additionally, joint kinematics were analyzed to determine gastrocnemius medialis muscle-tendon unit lengths, consisting of the muscle's contractile and series elastic elements. Series elastic element length was assessed using a muscle-tendon unit model. Depending on whether data were normally distributed, a paired t-test or Wilcoxon signed rank test was performed to determine if body weight supported walking had any effects on joint kinematics and fascicle-series elastic element behavior. Walking with 30% body weight support had no statistically significant effect on joint kinematics and peak series elastic element length. Furthermore, at the time when peak series elastic element length was achieved, and on average across the entire stance phase, muscle-tendon unit length, fascicle length, pennation angle, and fascicle velocity were unchanged with respect to body weight support. In accordance with unchanged gait kinematics, preservation of fascicle-series elastic element behavior was observed during walking with 30% body weight support, which suggests transferability of gait patterns to subsequent unsupported walking.

In vivo oscillations of the soleus muscle can be quantified using b-mode ultrasound imaging during walking and running in humans

Impact forces, due to the foot contacting the ground during locomotion, can be considered input signals to the body that must be dissipated to prevent impact-related injuries. One proposed mechanism employed by the body to damp the impact is through vibrations of the skeletal muscles. However, there is yet to be direct in vivo measures of muscle oscillations during locomotion. This study investigated the use of 2D ultrasound imaging to quantify transverse muscle oscillations (deep-superficial displacement of the muscle boundary relative to the skin) in response to impact forces elicited by walking and running at a range of speeds. Increases in vertical impact forces with faster walking and running was consistent with changes in both magnitude and frequency in the measured oscillations of the soleus muscle; one of the main human ankle plantar flexors. Muscle oscillations contained more higher frequency components at fast running (50% signal power in frequencies below ~ 14 Hz) compared with slow walking (50% signal power contained in frequencies below ~ 5 Hz). This study provides a platform for ultrasound imaging to examine muscle oscillation responses to impact forces induced by changes in external interfaces such as shoe material, locomotion type and ground surface properties.

Chronic effects of muscle and nerve-directed stretching on tissue mechanics

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.

Novel Muscle Imaging in Inflammatory Rheumatic Diseases-A Focus on Ultrasound Shear Wave Elastography and Quantitative MRI

In recent years, imaging has played an increasing role in the clinical management of patients with rheumatic diseases with respect to aiding diagnosis, guiding therapy and monitoring disease progression. These roles have been underpinned by research which has enhanced our understanding of disease pathogenesis and pathophysiology of rheumatology conditions, in addition to their key role in outcome measurement in clinical trials. However, compared to joints, imaging research of muscles is less established, despite the fact that muscle symptoms are very common and debilitating in many rheumatic diseases. Recently, it has been shown that even though patients with rheumatoid arthritis may achieve clinical remission, defined by asymptomatic joints, many remain affected by lingering constitutional systemic symptoms like fatigue, tiredness, weakness and myalgia, which may be attributed to changes in the muscles. Recent improvements in imaging technology, coupled with an increasing clinical interest, has started to ignite new interest in the area. This perspective discusses the rationale for using imaging, particularly ultrasound and MRI, for investigating muscle pathology involved in common inflammatory rheumatic diseases. The muscles associated with rheumatic diseases can be affected in many ways, including myositis-an inflammatory muscle condition, and myopathy secondary to medications, such as glucocorticoids. In addition to non-invasive visual assessment of muscles in these conditions, novel imaging techniques like shear wave elastography and quantitative MRI can provide further useful information regarding the physiological and biomechanical status of the muscle.