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Khair RM, Sukanen M, Finni T. Achilles Tendon Stiffness: Influence of Measurement Methodology. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1522-1529. [PMID: 39079832 DOI: 10.1016/j.ultrasmedbio.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/15/2024] [Accepted: 06/16/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE Mechanical stiffness derived from force-elongation curves is fundamentally different from shear wave (SW) elastography-based tissue properties. We compared these techniques, with a total of five methods of assessing Achilles tendon (AT) stiffness. METHODS Seventeen participants (12 male and 5 female) with unilateral AT rupture performed submaximal contractions at 30% and 10% maximal isometric contraction torque of the un-injured limb. SW velocity was acquired at rest. Force-elongation curves were assessed from the free AT and the medial gastrocnemius (MG) tendon. Mechanical stiffness was determined near the end of the linear region of the force-elongation curve and from the toe region. Bivariate correlations between mechanical stiffness and SW velocity, as well as pairwise t-tests between limbs, were computed. RESULTS In the injured limb, SW velocity correlated with MG tendon and free AT toe-region stiffness during 10% (r = 0.59, p = 0.020 and r = 0.60, p = 0.011, respectively) and 30% of submaximal contractions (r = 0.56, p = 0.018 and r = 0.67, p = 0.004, respectively). The un-injured limb showed no associations. In both limbs pooled together, SW velocity correlated with MG tendon toe-region stiffness in 30% of submaximal contractions (r = 0.43, p = 0.012). Free tendon mechanical stiffness was lower in the injured limb, with a mean difference of 148.5 Nmm⁻¹ (95% CI: 35.6-261.3, p = 0.013), while SW velocity was higher in the injured limb (1.67 m × s⁻¹, 95% CI; -2.4 to -0.9, p < 0.001). CONCLUSION SW elastography may reflect AT viscoelastic properties at the initial slope of the force-length curve with strains <1% but cannot offer insight into AT mechanics at higher loads. Extended toe regions in the injured limb could have caused the association between mechanical stiffness and SW-based stiffness.
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Affiliation(s)
- Ra'ad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.
| | - Maria Sukanen
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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Magris R, Monte A, Nardello F, Trinchi M, Vigolo N, Negri C, Moghetti P, Zamparo P. Effects of minute oscillation stretching training on muscle and tendon stiffness and walking capability in people with type 2 diabetes. Eur J Appl Physiol 2024:10.1007/s00421-024-05596-y. [PMID: 39249539 DOI: 10.1007/s00421-024-05596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/21/2024] [Indexed: 09/10/2024]
Abstract
AIM we investigated the effects of a 10 week training program (i.e., minute oscillatory stretching; MOS) on the mechanical responses and walking capability in people with type 2 diabetes (T2D). METHODS seventeen T2D patients performed maximum voluntary contractions of the plantar flexor muscles during which Achilles tendon stiffness (kT) and muscle-tendon stiffness (kM) were evaluated at different percentages of the maximum voluntary force (MVC). In addition, each participant was requested to walk at different walking speeds (i.e. 2, 3, 4, 5, and 6 kmh-1) while their net energy cost of walking (Cnet), cumulative EMG activity per distance travelled (CMAPD) and kinematic parameters (step length, step frequency, the ankle/knee range of motion) were evaluated. RESULTS maximum tendon elongation increased after MOS training, and kT significantly decreased (between 0 and 20% of MVC). No differences were observed for muscle elongation or kM after training. Cnet decreased after training (at the slowest tested speeds) while no changes in CMAPD were observed. Step length and ankle ROM during walking increased after training at the slowest tested speeds, while step frequency decreased; no significant effects were observed for knee ROM. CONCLUSION these results indicate the effectiveness of 10 weeks of MOS training in reducing tendon stiffness and the energy cost during walking in people with T2D. This training protocol requires no specific instrumentation, can be easily performed at home, and has a high adherence (92 ± 9%). It could, thus, be useful to mitigate mechanical tendon deterioration and improve physical behaviour in this population.
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Affiliation(s)
- Riccardo Magris
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Nardello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Trinchi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicolò Vigolo
- Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Negri
- Integrated University Hospital of Verona - Endocrinology, Diabetology and Metabolic Diseases Unit, Verona, Italy
| | - Paolo Moghetti
- Department of Medicine, University of Verona, Verona, Italy
| | - Paola Zamparo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Létocart AJ, Svensson RB, Mabesoone F, Charleux F, Marin F, Dermigny Q, Magnusson SP, Couppé C, Grosset JF. Structure and function of Achilles and patellar tendons following moderate slow resistance training in young and old men. Eur J Appl Physiol 2024; 124:2707-2723. [PMID: 38649478 DOI: 10.1007/s00421-024-05461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024]
Abstract
The aim of this study was to investigate the effect of aging and resistance training with a moderate load on the size and mechanical properties of the patellar (PT) and Achilles tendon (AT) and their associated aponeuroses; medial gastrocnemius (MG) and vastus lateralis (VL). Young (Y55; 24.8 ± 3.8 yrs, n = 11) and old men (O55; 70.0 ± 4.6 yrs, n = 13) were assigned to undergo a training program (12 weeks; 3 times/week) of moderate slow resistance training [55% of one repetition maximum (RM)] of the triceps surae and quadriceps muscles. Tendon dimensions were assessed using 1.5 T magnetic resonance imaging before and after 12 weeks. AT and PT cross sectional area (CSA) were determined every 10% of tendon length. Mechanical properties of the free AT, MG aponeurosis, PT, and VL aponeurosis were assessed using ultrasonography (deformation) and tendon force measurements. CSA of the AT but not PT was greater in O55 compared with Y55. At baseline, mechanical properties were generally lower in O55 than Y55 for AT, MG aponeurosis and VL aponeurosis (Young's modulus) but not for PT. CSA of the AT and PT increased equally in both groups following training. Further, for a given force, stiffness and Young's modulus also increased equally for VL aponeurosis and AT, for boths groups. The present study highlights that except for the PT, older men have lower tendon (AT, MG aponeurosis, and VL aponeurosis) mechanical properties than young men and 12-weeks of moderate slow resistance training appears sufficient to improve tendon size and mechanical adaptations in both young and older men. New and Noteworthy: These novel findings suggest that short-term moderate slow resistance training induces equal improvements in tendon size and mechanics regardless of age.
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Affiliation(s)
- Adrien J Létocart
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France.
| | - René B Svensson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Frédéric Marin
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France
| | - Quentin Dermigny
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jean-François Grosset
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France.
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Patel SH, Campbell NW, Emenim CE, Farino DO, Damen FW, Rispoli JV, Goergen CJ, Haus JM, Sabbaghi A, Carroll CC. Patellar tendon biomechanical and morphologic properties and their relationship to serum clinical variables in persons with prediabetes and type 2 diabetes. J Orthop Res 2024; 42:1653-1669. [PMID: 38400550 PMCID: PMC11222058 DOI: 10.1002/jor.25816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/08/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
Tendon biomechanical properties and fibril organization are altered in patients with diabetes compared to healthy individuals, yet few biomarkers have been associated with in vivo tendon properties. We investigated the relationships between in vivo imaging-based tendon properties, serum variables, and patient characteristics across healthy controls (n = 14, age: 45 ± 5 years, body mass index [BMI]: 24 ± 1, hemoglobin A1c [HbA1c]: 5.3 ± 0.1%), prediabetes (n = 14, age: 54 ± 5 years, BMI: 29 ± 2; HbA1c: 5.7 ± 0.1), and type 2 diabetes (n = 13, age: 55 ± 3 years, BMI: 33 ± 2, HbA1c: 6.7 ± 0.3). We used ultrasound speckle-tracking and measurements from magnetic resonance imaging (MRI) to estimate the patellar tendon in vivo tangent modulus. Analysis of plasma c-peptide, interleukin-1β (IL-1β), IL-6, IL-8, tumor necrosis factor-α (TNF-α), adiponectin, leptin, insulin-like growth factor 1 (IGF-1), and C-reactive protein (CRP) was completed. We built regression models incorporating statistically significant covariates and indicators for the clinically defined groups. We found that tendon cross-sectional area normalized to body weight (BWN CSA) and modulus were lower in patients with type 2 diabetes than in healthy controls (p < 0.05). Our regression analysis revealed that a model that included BMI, leptin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), age, and group explained ~70% of the variability in BWN CSA (R2 = 0.70, p < 0.001). For modulus, including the main effects LDL, groups, HbA1c, age, BMI, cholesterol, IGF-1, c-peptide, leptin, and IL-6, accounted for ~54% of the variability in modulus (R2 = 0.54, p < 0.05). While BWN CSA and modulus were lower in those with diabetes, group was a poor predicter of tendon properties when considering the selected covariates. These data highlight the multifactorial nature of tendon changes with diabetes and suggest that blood variables could be reliable predictors of tendon properties.
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Affiliation(s)
- Shivam H. Patel
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | | | - Chinonso E. Emenim
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Dominick O. Farino
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Frederick W. Damen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Joseph V. Rispoli
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Craig J. Goergen
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Jacob M. Haus
- School of Kinesiology, University of Michigan, Ann Arbor, MI
| | | | - Chad C. Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
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McMahon G, Cook J. Female Tendons are from Venus and Male Tendons are from Mars, But Does it Matter for Tendon Health? Sports Med 2024:10.1007/s40279-024-02056-7. [PMID: 39075272 DOI: 10.1007/s40279-024-02056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 07/31/2024]
Abstract
Tendons play fundamental roles in the execution of human movement and therefore understanding tendon function, health and disease is important for everyday living and sports performance. The acute mechanical behavioural and physiological responses to short-term loading of tendons, as well as more chronic morphological and mechanical adaptations to longer term loading, differ between sexes. This has led some researchers to speculate that there may be a sex-specific injury risk in tendons. However, the link between anatomical, physiological and biomechanical sex-specific differences in tendons and their contributory role in the development of tendon disease injuries has not been critically evaluated. This review outlines the evidence surrounding the sex-specific physiological and biomechanical responses and adaptations to loading and discusses how this evidence compares to clinical evidence on tendon injuries and rehabilitation in the Achilles and patellar tendons in humans. Using the evidence available in both sports science and medicine, this may provide a more holistic understanding to improve our ability to enhance human tendon health and performance in both sexes.
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Affiliation(s)
- Gerard McMahon
- Sport and Exercise Sciences Research Institute, School of Sport, Ulster University, York Street, Belfast, North Ireland, BT15 1ED, UK.
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC, Australia
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Epanomeritakis IE, Eleftheriou A, Economou A, Lu V, Khan W. Mesenchymal Stromal Cells for the Enhancement of Surgical Flexor Tendon Repair in Animal Models: A Systematic Review and Meta-Analysis. Bioengineering (Basel) 2024; 11:656. [PMID: 39061739 PMCID: PMC11274147 DOI: 10.3390/bioengineering11070656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Flexor tendon lacerations are primarily treated by surgical repair. Limited intrinsic healing ability means the repair site can remain weak. Furthermore, adhesion formation may reduce range of motion post-operatively. Mesenchymal stromal cells (MSCs) have been trialled for repair and regeneration of multiple musculoskeletal structures. Our goal was to determine the efficacy of MSCs in enhancing the biomechanical properties of surgically repaired flexor tendons. A PRISMA systematic review was conducted using four databases (PubMed, Ovid, Web of Science, and CINAHL) to identify studies using MSCs to augment surgical repair of flexor tendon injuries in animals compared to surgical repair alone. Nine studies were included, which investigated either bone marrow- or adipose-derived MSCs. Results of biomechanical testing were extracted and meta-analyses were performed regarding the maximum load, friction and properties relating to viscoelastic behaviour. There was no significant difference in maximum load at final follow-up. However, friction, a surrogate measure of adhesions, was significantly reduced following the application of MSCs (p = 0.04). Other properties showed variable results and dissipation of the therapeutic benefits of MSCs over time. In conclusion, MSCs reduce adhesion formation following tendon injury. This may result from their immunomodulatory function, dampening the inflammatory response. However, this may come at the cost of favourable healing which will restore the tendon's viscoelastic properties. The short duration of some improvements may reflect MSCs' limited survival or poor retention. Further investigation is needed to clarify the effect of MSC therapy and optimise its duration of action.
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Affiliation(s)
| | - Andreas Eleftheriou
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (A.E.); (A.E.); (V.L.)
| | - Anna Economou
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (A.E.); (A.E.); (V.L.)
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (A.E.); (A.E.); (V.L.)
| | - Wasim Khan
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
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7
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van Dam L, Terink R, van den Akker-Scheek I, Zwerver J. Intra- and inter-operator reliability of measuring compressive stiffness of the patellar tendon in volleyball players using a handheld digital palpation device. PLoS One 2024; 19:e0304743. [PMID: 38917106 PMCID: PMC11198853 DOI: 10.1371/journal.pone.0304743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
This observational study aimed to evaluate the intra- and inter-operator reliability of a digital palpation device in measuring compressive stiffness of the patellar tendon at different knee angles in talent and elite volleyball players. Second aim was to examine differences in reliability when measuring at different knee angles, between dominant and non-dominant knees, between sexes, and with age. Two operators measured stiffness at the midpoint of the patellar tendon in 45 Dutch volleyball players at 0°, 45° and 90° knee flexion, on both the dominant and non-dominant side. We found excellent intra-operator reliability (ICC>0.979). For inter-operator reliability, significant differences were found in stiffness measured between operators (p<0.007). The coefficient of variance significantly decreased with increasing knee flexion (2.27% at 0°, 1.65% at 45° and 1.20% at 90°, p<0.001). In conclusion, the device appeared to be reliable when measuring compressive stiffness of the patellar tendon in elite volleyball players, especially at 90° knee flexion. Inter-operator reliability appeared to be questionable. More standardized positioning and measurement protocols seem necessary.
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Affiliation(s)
- Lotte van Dam
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
- Department of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rieneke Terink
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes Zwerver
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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8
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Wearing SC, Hooper SL, Langton CM, Keiner M, Horstmann T, Crevier-Denoix N, Pourcelot P. The Biomechanics of Musculoskeletal Tissues during Activities of Daily Living: Dynamic Assessment Using Quantitative Transmission-Mode Ultrasound Techniques. Healthcare (Basel) 2024; 12:1254. [PMID: 38998789 PMCID: PMC11241410 DOI: 10.3390/healthcare12131254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
The measurement of musculoskeletal tissue properties and loading patterns during physical activity is important for understanding the adaptation mechanisms of tissues such as bone, tendon, and muscle tissues, particularly with injury and repair. Although the properties and loading of these connective tissues have been quantified using direct measurement techniques, these methods are highly invasive and often prevent or interfere with normal activity patterns. Indirect biomechanical methods, such as estimates based on electromyography, ultrasound, and inverse dynamics, are used more widely but are known to yield different parameter values than direct measurements. Through a series of literature searches of electronic databases, including Pubmed, Embase, Web of Science, and IEEE Explore, this paper reviews current methods used for the in vivo measurement of human musculoskeletal tissue and describes the operating principals, application, and emerging research findings gained from the use of quantitative transmission-mode ultrasound measurement techniques to non-invasively characterize human bone, tendon, and muscle properties at rest and during activities of daily living. In contrast to standard ultrasound imaging approaches, these techniques assess the interaction between ultrasound compression waves and connective tissues to provide quantifiable parameters associated with the structure, instantaneous elastic modulus, and density of tissues. By taking advantage of the physical relationship between the axial velocity of ultrasound compression waves and the instantaneous modulus of the propagation material, these techniques can also be used to estimate the in vivo loading environment of relatively superficial soft connective tissues during sports and activities of daily living. This paper highlights key findings from clinical studies in which quantitative transmission-mode ultrasound has been used to measure the properties and loading of bone, tendon, and muscle tissue during common physical activities in healthy and pathological populations.
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Affiliation(s)
- Scott C. Wearing
- School of Medicine and Health, Technical University of Munich, 80992 Munich, Bavaria, Germany
| | - Sue L. Hooper
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
| | - Christian M. Langton
- Griffith Centre of Rehabilitation Engineering, Griffith University, Southport, QLD 4222, Australia
| | - Michael Keiner
- Department of Exercise and Training Science, German University of Health and Sport, 85737 Ismaning, Bavaria, Germany
| | - Thomas Horstmann
- School of Medicine and Health, Technical University of Munich, 80992 Munich, Bavaria, Germany
| | | | - Philippe Pourcelot
- INRAE, BPLC Unit, Ecole Nationale Vétérinaire d’Alfort, 94700 Maisons-Alfort, France
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9
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Carroll CC, Campbell NW, Lewis RL, Preston SE, Garrett CM, Winstone HM, Barker AC, Vanos JM, Stouder LS, Reyes C, Fortino MA, Goergen CJ, Hass ZJ, Campbell WW. Greater Protein Intake Emphasizing Lean Beef Does Not Affect Resistance Training-Induced Adaptations in Skeletal Muscle and Tendon of Older Women: A Randomized Controlled Feeding Trial. J Nutr 2024; 154:1803-1814. [PMID: 38604504 DOI: 10.1016/j.tjnut.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Although experimental research supports that resistance training (RT), especially with greater dietary protein intake, improves muscle mass and strength in older adults, comparable research on tendons is needed. OBJECTIVES We assessed the effects of a protein-rich diet emphasizing lean beef, compared with 2 control diets, on RT-induced changes in skeletal muscle and tendon size and strength in older women. METHODS We randomly assigned women [age: 66 ± 1 y, body mass index (BMI): 28 ± 1] to groups that consumed 1) 0.8 g total protein/kg body weight/day from mixed food sources (normal protein control, n = 16); 2) 1.4 g/kg/d protein from mixed food sources (high protein control, n = 17); or 3) 1.4 g/kg/d protein emphasizing unprocessed lean beef (high protein experimental group, n = 16). Participants were provided with all foods and performed RT 3 times/wk, 70% of 1-repetition maximum for 12 wk. We measured quadriceps muscle volume via magnetic resonance imaging (MRI). We estimated patellar tendon biomechanical properties and cross-sectional area (CSA) using ultrasound and MRI. RESULTS Dietary intake did not influence RT-induced increases in quadriceps strength (P < 0.0001) or muscle volume (P < 0.05). We noted a trend for an RT effect on mean tendon CSA (P = 0.07), with no differences among diets (P > 0.05). Proximal tendon CSA increased with RT (P < 0.05) with no difference between dietary groups (P > 0.05). Among all participants, midtendon CSA increased with RT (P ≤ 0.05). We found a decrease in distal CSA in the 0.8 g group (P < 0.05) but no change in the 1.4 g group (P > 0.05). Patellar tendon MRI signal or biomechanical properties were unchanged. CONCLUSIONS Our findings indicated that greater daily protein intake, emphasizing beef, did not influence RT-induced changes in quadriceps muscle strength or muscle volume of older women. Although we noted trends in tendon CSA, we did not find a statistically significant impact of greater daily protein intake from beef on tendon outcomes. This trial was registered at clinicaltrials.gov as NCT04347447.
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Affiliation(s)
- Chad C Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States.
| | - Nathan Wc Campbell
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Rebecca L Lewis
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Sarah E Preston
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Chloe M Garrett
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Hannah M Winstone
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Anna C Barker
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Johnny M Vanos
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Lucas S Stouder
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Camila Reyes
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Matthew A Fortino
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Craig J Goergen
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Zachary J Hass
- School of Nursing, Purdue University, West Lafayette, IN, United States; School of Industrial Engineering, Purdue University, West Lafayette, IN, United States; Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, United States
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
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10
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Wegener F, Ritterbusch A, Saal C, Baumgart C, Hoppe MW. Myotonometry and extended field-of-view ultrasound imaging allow reliable quantification of patellar tendon stiffness and length at rest and during maximal load, whereas several restrictions exist for the Achilles tendon. Front Sports Act Living 2024; 6:1379506. [PMID: 38859890 PMCID: PMC11163091 DOI: 10.3389/fspor.2024.1379506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Stiffness and length are well-established tendon parameters in sports and medicine. Myotonometry and ultrasound imaging are the commonly used methods to quantify these parameters. However, further studies are needed to clarify the reliability of these methods, especially when assessing maximally loaded tendons and when conducted by different experienced investigators. This study aimed to determine the intra- and interrater reliabilities of measuring the stiffness and length of the patellar tendon (PT) and Achilles tendon (AT) using the myotonometry method and the extended field-of-view ultrasound (EFOV-US) technique at rest and maximal load performed by different experienced investigators. Methods Twenty-seven participants were examined on three different days by one experienced investigator and one novice investigator. Primary outcomes were the intraclass correlation coefficient (ICC) and associated 95% confidence interval (95% CI), coefficient of variation (CV), standard error of measurement (SEM), and minimal detectable change (MDC) across the measurement days and investigators. Results For PT measurements at rest and maximal load, the estimated ICCs for stiffness and length were ≥.867 and ≥.970, respectively, with 95% CIs ranging from poor (.306) to excellent (.973) and good (.897) to excellent (.999). The CV, SEM, and MDC for PT stiffness and length were ≤5.2% and ≤2.0%, ≤39.3 N/m and ≤0.9 mm, and ≤108.9 N/m and ≤2.6 mm, respectively. For AT measurements, some restrictions were evident for stiffness at rest and both parameters at maximal load. However, regarding AT length at rest, the estimated ICC was ≥.996, with an excellent 95% CI (.987-.999). The CV, SEM, and MDC for AT length at rest were 2.8%, ≤1.1 mm, and ≤2.9 mm, respectively. Conclusion The estimated ICCs show good to excellent reliability for the myotonometry method and the EFOV-US technique for measuring PT stiffness and length at rest and maximal load for experienced and novice investigators. However, some restrictions are evident for the AT, especially for measurements at maximal load.
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Affiliation(s)
- Florian Wegener
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Arne Ritterbusch
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Christian Saal
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Christian Baumgart
- Department of Movement and Training Science, Faculty of Humanities and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Matthias W. Hoppe
- Department of Exercise Science, Institute of Sport Science and Motology, Faculty of Educational Sciences, Philipps University of Marburg, Marburg, Germany
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11
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Sahinis C, Kellis E. Distal hamstrings tendons mechanical properties at rest and contraction using free-hand 3-D ultrasonography. Scand J Med Sci Sports 2024; 34:e14621. [PMID: 38597348 DOI: 10.1111/sms.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/10/2024] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
Tendon properties impact human locomotion, influencing sports performance, and injury prevention. Hamstrings play a crucial role in sprinting, particularly the biceps femoris long head (BFlh), which is prone to frequent injuries. It remains uncertain if BFlh exhibits distinct mechanical properties compared to other hamstring muscles. This study utilized free-hand three-dimensional ultrasound to assess morphological and mechanical properties of distal hamstrings tendons in 15 men. Scans were taken in prone position, with hip and knee extended, at rest and during 20%, 40%, 60%, and 80% of maximal voluntary isometric contraction of the knee flexors. Tendon length, volume, cross-sectional area (CSA), and anteroposterior (AP) and mediolateral (ML) widths were quantified at three locations. Longitudinal and transverse deformations, stiffness, strain, and stress were estimated. The ST had the greatest tendon strain and the lowest stiffness as well as the highest CSA and AP and ML width strain compared to other tendons. Biceps femoris short head (BFsh) exhibited the least strain, AP and ML deformation. Further, BFlh displayed the highest stiffness and stress, and BFsh had the lowest stress. Additionally, deformation varied by region, with the proximal site showing generally the lowest CSA strain. Distal tendon mechanical properties differed among the hamstring muscles during isometric knee flexions. In contrast to other bi-articular hamstrings, the BFlh high stiffness and stress may result in greater energy absorption by its muscle fascicles, rather than the distal tendon, during late swing in sprinting. This could partly account for the increased incidence of hamstring injuries in this muscle.
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Affiliation(s)
- Chrysostomos Sahinis
- Department of Physical Education and Sport Sciences at Serres, Laboratory of Neuromechanics, Aristotle University of Thessaloniki, Serres, Greece
| | - Eleftherios Kellis
- Department of Physical Education and Sport Sciences at Serres, Laboratory of Neuromechanics, Aristotle University of Thessaloniki, Serres, Greece
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12
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Ritsche P, Franchi MV, Faude O, Finni T, Seynnes O, Cronin NJ. Fully Automated Analysis of Muscle Architecture from B-Mode Ultrasound Images with DL_Track_US. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:258-267. [PMID: 38007322 DOI: 10.1016/j.ultrasmedbio.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/27/2023]
Abstract
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.
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Affiliation(s)
- Paul Ritsche
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Martino V Franchi
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Taija Finni
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Olivier Seynnes
- Department for Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland; School of Sport & Exercise, University of Gloucestershire, Gloucester, UK
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13
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Crotty ED, Furlong LAM, Harrison AJ. Ankle and Plantar Flexor Muscle-Tendon Unit Function in Sprinters: A Narrative Review. Sports Med 2023:10.1007/s40279-023-01967-1. [PMID: 37989833 DOI: 10.1007/s40279-023-01967-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
Maximal sprinting in humans requires the contribution of various muscle-tendon units (MTUs) and joints to maximize performance. The plantar flexor MTU and ankle joint are of particular importance due to their role in applying force to the ground. This narrative review examines the contribution of the ankle joint and plantar flexor MTUs across the phases of sprinting (start, acceleration, and maximum velocity), alongside the musculotendinous properties that contribute to improved plantar flexor MTU performance. For the sprint start, the rear leg ankle joint appears to be a particularly important contributor to sprint start performance, alongside the stretch-shortening cycle (SSC) action of the plantar flexor MTU. Comparing elite and sub-elite sprinters revealed that elite sprinters had a higher rate of force development (RFD) and normalized average horizontal block power, which was transferred via the ankle joint to the block. For the acceleration phase, the ankle joint and plantar flexor MTU appear to be the most critical of the major lower limb joints/MTUs. The contribution of the ankle joint to power generation and positive work is minimal during the first stance, but an increased contribution is observed during the second stance, mid-acceleration, and late-acceleration. In terms of muscular contributions, the gastrocnemius and soleus have distinct roles. The soleus acts mainly as a supporter, generating large portions of the upward impulse, whereas the gastrocnemius acts as both an accelerator and a supporter, contributing significantly to propulsive and upward impulses. During maximum velocity sprinting the ankle joint is a net dissipater of energy, potentially due to the greater vertical loading placed on the plantar flexors. However, the ankle joint is critical for energy transfer from proximal joints to ground force application to maintain velocity. In terms of the contribution of musculoskeletal factors to ankle joint and plantar flexor performance, an optimal plantar flexor MTU profile potentially exists, which is possibly a combination of several musculoskeletal factors, alongside factors such as footwear and technique.
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Affiliation(s)
- Evan D Crotty
- Sport and Human Performance Research Centre, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
| | - Laura-Anne M Furlong
- Sport and Human Performance Research Centre, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Andrew J Harrison
- Sport and Human Performance Research Centre, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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14
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Miller T, Bello UM, Tsang CSL, Winser SJ, Ying MTC, Pang MYC. Using ultrasound elastography to assess non-invasive, non-pharmacological interventions for musculoskeletal stiffness: a systematic review and meta-analysis. Disabil Rehabil 2023:1-15. [PMID: 37668241 DOI: 10.1080/09638288.2023.2252744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness. METHODS A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed. RESULTS Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders (g = 1.488, 95% CI = 0.320-2.655, p = 0.013). Analyses for other intervention types and patient groups were underpowered. CONCLUSION Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Umar M Bello
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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15
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Götschi T, Held V, Klucker G, Niederöst B, Aagaard P, Spörri J, Passini FS, Snedeker JG. PIEZO1 gain-of-function gene variant is associated with elevated tendon stiffness in humans. J Appl Physiol (1985) 2023; 135:165-173. [PMID: 37227181 PMCID: PMC10625831 DOI: 10.1152/japplphysiol.00573.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 05/26/2023] Open
Abstract
Prolonged periods of increased physical demands can elicit anabolic tendon adaptations that increase stiffness and mechanical resilience or conversely can lead to pathological processes that deteriorate tendon structural quality with ensuing pain and potential rupture. Although the mechanisms by which tendon mechanical loads regulate tissue adaptation are largely unknown, the ion channel PIEZO1 has been implicated in tendon mechanotransduction, with human carriers of the PIEZO1 gain-of-function variant E756del displaying improved dynamic vertical jump performance compared with noncarriers. Here, we sought to examine whether increased tendon stiffness in humans could explain this increased performance. We assessed tendon morphological and mechanical properties with ultrasound-based techniques in 77 participants of Middle- and West-African descent, and we measured their vertical jumping performance to assess potential functional consequences in the context of high tendon strain-rate loading. Carrying the E756del gene variant (n = 30) was associated with 46.3 ± 68.3% (P = 0.002) and 45.6 ± 69.2% (P < 0.001) higher patellar tendon stiffness and Young's modulus compared with noncarrying controls, respectively. Although these tissue level measures strongly corroborate the initial postulate that PIEZO1 plays an integral part in regulating tendon material properties and stiffness in humans, we found no detectable correlation between tendon stiffness and jumping performance in the tested population that comprised individuals of highly diverse physical fitness level, dexterity, and jumping ability.NEW & NOTEWORTHY The E756del gene variant causes overactivity of the mechanosensitive membrane channel PIEZO1 and is suspected to upregulate tendon collagen cross linking. In human carriers of E756del, we found increased patellar tendon stiffness but similar tendon lengths and cross-sectional areas, directly supporting the premise that PIEZO1 regulates human tendon stiffness at the level of tissue material properties.
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Affiliation(s)
- Tobias Götschi
- Laboratory for Orthopaedic Biomechanics, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - Victoria Held
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Gianna Klucker
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Barbara Niederöst
- Laboratory for Orthopaedic Biomechanics, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - Per Aagaard
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Fabian S Passini
- Laboratory for Orthopaedic Biomechanics, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - Jess G Snedeker
- Laboratory for Orthopaedic Biomechanics, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
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16
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Finni T, Vanwanseele B. Towards modern understanding of the Achilles tendon properties in human movement research. J Biomech 2023; 152:111583. [PMID: 37086579 DOI: 10.1016/j.jbiomech.2023.111583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 04/24/2023]
Abstract
The Achilles tendon (AT) is the strongest tendon in humans, yet it often suffers from injury. The mechanical properties of the AT afford efficient movement, power amplification and power attenuation during locomotor tasks. The properties and the unique structure of the AT as a common tendon for three muscles have been studied frequently in humans using in vivo methods since 1990's. As a part of the celebration of 50 years history of the International Society of Biomechanics, this paper reviews the history of the AT research focusing on its mechanical properties in humans. The questions addressed are: What are the most important mechanical properties of the Achilles tendon, how are they studied, what is their significance to human movement, and how do they adapt? We foresee that the ongoing developments in experimental methods and modeling can provide ways to advance knowledge of the complex three-dimensional structure and properties of the Achilles tendon in vivo, and to enable monitoring of the loading and recovery for optimizing individual adaptations.
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Affiliation(s)
- Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Finland.
| | - Benedicte Vanwanseele
- Faculty of Movement and Rehabilitation Science, Human Movement Biomechanics Research Group, KU Leuven, Belgium
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17
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de Sousa AMM, Cavalcante JGT, Bottaro M, Vieira DCL, Babault N, Geremia JM, Corrigan P, Silbernagel KG, Durigan JLQ, Marqueti RDC. The Influence of Hip and Knee Joint Angles on Quadriceps Muscle-Tendon Unit Properties during Maximal Voluntary Isometric Contraction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3947. [PMID: 36900958 PMCID: PMC10002253 DOI: 10.3390/ijerph20053947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Determining how the quadriceps femoris musculotendinous unit functions, according to hip and knee joint angles, may help with clinical decisions when prescribing knee extension exercises. We aimed to determine the effect of hip and knee joint angles on structure and neuromuscular functioning of all constituents of the quadriceps femoris and patellar tendon properties. Twenty young males were evaluated in four positions: seated and supine in both 20° and 60° of knee flexion (SIT20, SIT60, SUP20, and SUP60). Peak knee extension torque was determined during maximal voluntary isometric contraction (MVIC). Ultrasound imaging was used at rest and during MVIC to characterize quadriceps femoris muscle and tendon aponeurosis complex stiffness. We found that peak torque and neuromuscular efficiency were higher for SUP60 and SIT60 compared to SUP20 and SIT20 position. We found higher fascicle length and lower pennation angle in positions with the knee flexed at 60°. The tendon aponeurosis complex stiffness, tendon force, stiffness, stress, and Young's modulus seemed greater in more elongated positions (60°) than in shortened positions (20°). In conclusion, clinicians should consider positioning at 60° of knee flexion rather than 20°, regardless if seated or supine, during rehabilitation to load the musculotendinous unit enough to stimulate a cellular response.
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Affiliation(s)
- Alessandra Martins Melo de Sousa
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília 72220275, Brazil
| | | | - Martim Bottaro
- College of Physical Education, University of Brasília, Brasília 70910900, Brazil
| | - Denis César Leite Vieira
- College of Physical Education, University of Brasília, Brasília 70910900, Brazil
- Centre d’Expertise de la Performance, INSERM U1093 CAPS, Sports Science Faculty, University of Burgundy, 21078 Dijon, France
| | - Nicolas Babault
- Centre d’Expertise de la Performance, INSERM U1093 CAPS, Sports Science Faculty, University of Burgundy, 21078 Dijon, France
| | - Jeam Marcel Geremia
- Exercise Research Laboratory, School of Physical Education, Physical Therapy, and Dance, Federal University of Rio Grande do Sul, Porto Alegre 90690200, Brazil
| | - Patrick Corrigan
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO 63104, USA
| | | | - João Luiz Quaglioti Durigan
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília 72220275, Brazil
| | - Rita de Cássia Marqueti
- Laboratory of Molecular Analysis, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília 72220275, Brazil
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18
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Götschi T, Schärer Y, Gennisson JL, Snedeker JG. Investigation of the relationship between tensile viscoelasticity and unloaded ultrasound shear wave measurements in ex vivo tendon. J Biomech 2023; 146:111411. [PMID: 36509025 DOI: 10.1016/j.jbiomech.2022.111411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Mechanical properties of biological tissues are of key importance for proper function and in situ methods for mechanical characterization are sought after in the context of both medical diagnosis as well as understanding of pathophysiological processes. Shear wave elastography (SWE) and accompanying physical modelling methods provide valid estimates of stiffness in quasi-linear viscoelastic, isotropic tissue but suffer from limitations in assessing non-linear viscoelastic or anisotropic material, such as tendon. Indeed, mathematical modelling predicts the longitudinal shear wave velocity to be unaffected by the tensile but rather the shear viscoelasticity. Here, we employ a heuristic experimental testing approach to the problem to assess the most important potential confounders, namely tendon mass density and diameter, and to investigate associations between tendon tensile viscoelasticity with shear wave descriptors. Small oscillatory testing of animal flexor tendons at two baseline stress levels over a large frequency range comprehensively characterized tensile viscoelastic behavior. A broad set of shear wave descriptors was retrieved on the unloaded tendon based on high frame-rate plane wave ultrasound after applying an acoustic deformation impulse. Tensile modulus and strain energy dissipation increased logarithmically and linearly, respectively, with the frequency of the applied strain. Shear wave descriptors were mostly unaffected by tendon diameter but were highly sensitive to tendon mass density. Shear wave group and phase velocity showed no association with tensile elasticity or strain rate-stiffening but did show an association with tensile strain energy dissipation. The longitudinal shear wave velocity may not characterize tensile elasticity but rather tensile viscous properties of transversely isotropic collagenous tissues.
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Affiliation(s)
- Tobias Götschi
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Switzerland.
| | | | - Jean-Luc Gennisson
- Université Paris-Saclay, Inserm, CNRS, CEA, Laboratoire d'Imagerie Biomédicale Multimodale (BioMaps), Service Hospitalier Frédéric Joliot, 4 place du général Leclerc, 91401 ORSAY, France
| | - Jess G Snedeker
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Switzerland
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Henriksen P, Junge T, Bojsen-Møller J, Juul-Kristensen B, Thorlund JB. Supervised, Heavy Resistance Training Is Tolerated and Potentially Beneficial in Women with Knee Pain and Knee Joint Hypermobility: A Case Series. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:8367134. [PMID: 38655168 PMCID: PMC11022762 DOI: 10.1155/2022/8367134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 04/26/2024]
Abstract
Introduction Adults with generalised joint hypermobility including knee joint hypermobility (GJHk) report more knee joint symptoms when compared to adults without GJHk. There is no consensus on best practice for symptom management. For instance, controversy exists regarding the appropriateness and safety of heavy resistance training as an intervention for this specific group. This case series aims to describe a supervised, progressive heavy resistance training program in adults with GJHk and knee pain, the tolerability of the intervention, and the outcomes of knee pain, knee-related quality of life, muscle strength, proprioception, and patellar tendon stiffness through a 12-week period. Materials and Methods Adults with GJHk and knee pain were recruited to perform supervised, progressive heavy resistance training twice a week for 12 weeks. The main outcome was the tolerability of the intervention. Secondary outcomes were knee pain during a self-nominated activity (VASNA); Knee injury and Osteoarthritis Outcome Score (KOOS); Tampa Scale of Kinesiophobia (TSK); maximal quadriceps voluntary isometric contraction and rate of torque development; 5 repetition maximum strength in five different leg exercises; single leg hop for distance; knee proprioception and patellar tendon stiffness. Results In total, 16 women (24.2 years, SD 2.5) completed at least 21/24 training sessions. No major adverse events were observed. On average, VASNA decreased by 32.5 mm (95% CI 21.4-43.6), in addition to improvements in KOOS and TSK scores. These improvements were supported by an increase in all measures of lower extremity muscle strength, knee proprioception, and patellar tendon stiffness. Conclusion Supervised heavy resistance training seems to be well tolerated and potentially beneficial in young women with GJHk and knee pain.
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Affiliation(s)
- Peter Henriksen
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tina Junge
- Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Jens Bojsen-Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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20
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Lazarczuk SL, Maniar N, Opar DA, Duhig SJ, Shield A, Barrett RS, Bourne MN. Mechanical, Material and Morphological Adaptations of Healthy Lower Limb Tendons to Mechanical Loading: A Systematic Review and Meta-Analysis. Sports Med 2022; 52:2405-2429. [PMID: 35657492 PMCID: PMC9474511 DOI: 10.1007/s40279-022-01695-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exposure to increased mechanical loading during physical training can lead to increased tendon stiffness. However, the loading regimen that maximises tendon adaptation and the extent to which adaptation is driven by changes in tendon material properties or tendon geometry is not fully understood. OBJECTIVE To determine (1) the effect of mechanical loading on tendon stiffness, modulus and cross-sectional area (CSA); (2) whether adaptations in stiffness are driven primarily by changes in CSA or modulus; (3) the effect of training type and associated loading parameters (relative intensity; localised strain, load duration, load volume and contraction mode) on stiffness, modulus or CSA; and (4) whether the magnitude of adaptation in tendon properties differs between age groups. METHODS Five databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE) were searched for studies detailing load-induced adaptations in tendon morphological, material or mechanical properties. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated and data were pooled using a random effects model to estimate variance. Meta regression was used to examine the moderating effects of changes in tendon CSA and modulus on tendon stiffness. RESULTS Sixty-one articles met the inclusion criteria. The total number of participants in the included studies was 763. The Achilles tendon (33 studies) and the patella tendon (24 studies) were the most commonly studied regions. Resistance training was the main type of intervention (49 studies). Mechanical loading produced moderate increases in stiffness (standardised mean difference (SMD) 0.74; 95% confidence interval (CI) 0.62-0.86), large increases in modulus (SMD 0.82; 95% CI 0.58-1.07), and small increases in CSA (SMD 0.22; 95% CI 0.12-0.33). Meta-regression revealed that the main moderator of increased stiffness was modulus. Resistance training interventions induced greater increases in modulus than other training types (SMD 0.90; 95% CI 0.65-1.15) and higher strain resistance training protocols induced greater increases in modulus (SMD 0.82; 95% CI 0.44-1.20; p = 0.009) and stiffness (SMD 1.04; 95% CI 0.65-1.43; p = 0.007) than low-strain protocols. The magnitude of stiffness and modulus differences were greater in adult participants. CONCLUSIONS Mechanical loading leads to positive adaptation in lower limb tendon stiffness, modulus and CSA. Studies to date indicate that the main mechanism of increased tendon stiffness due to physical training is increased tendon modulus, and that resistance training performed at high compared to low localised tendon strains is associated with the greatest positive tendon adaptation. PROSPERO registration no.: CRD42019141299.
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Affiliation(s)
- Stephanie L Lazarczuk
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia.
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Steven J Duhig
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Anthony Shield
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rod S Barrett
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Matthew N Bourne
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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21
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Escriche-Escuder A, Cuesta-Vargas AI, Casaña J. Modelling and in vivo evaluation of tendon forces and strain in dynamic rehabilitation exercises: a scoping review. BMJ Open 2022; 12:e057605. [PMID: 35879000 PMCID: PMC9328104 DOI: 10.1136/bmjopen-2021-057605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Although exercise is considered the preferred approach for tendinopathies, the actual load that acts on the tendon in loading programmes is usually unknown. The objective of this study was to review the techniques that have been applied in vivo to estimate the forces and strain that act on the human tendon in dynamic exercises used during rehabilitation. DESIGN Scoping review. DATA SOURCES Embase, PubMed, Web of Science and Google Scholar were searched from database inception to February 2021. ELIGIBILITY CRITERIA Cross-sectional studies available in English or Spanish language were included if they focused on evaluating the forces or strain of human tendons in vivo during dynamic exercises. Studies were excluded if they did not evaluate tendon forces or strain; if they evaluated running, walking, jumping, landing or no dynamic exercise at all; and if they were conference proceedings or book chapters. DATA EXTRACTION AND SYNTHESIS Data extracted included year of publication, study setting, study population characteristics, technique used and exercises evaluated. The studies were grouped by the types of techniques and the tendon location. RESULTS Twenty-one studies were included. Fourteen studies used an indirect methodology based on inverse dynamics, nine of them in the Achilles and five in the patellar tendon. Six studies implemented force transducers for measuring tendon forces in open carpal tunnel release surgery patients. One study applied an optic fibre technique to detect forces in the patellar tendon. Four studies measured strain using ultrasound-based techniques. CONCLUSIONS There is a predominant use of inverse dynamics, but force transducers, optic fibre and estimations from strain data are also used. Although these tools may be used to make general estimates of tendon forces and strains, the invasiveness of some methods and the loss of immediacy of others make it difficult to provide immediate feedback to the individuals.
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Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
- Department of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jose Casaña
- Department of Physiotherapy, University of Valencia, Valencia, Spain
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22
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McMahon G. No Strain, No Gain? The Role of Strain and Load Magnitude in Human Tendon Responses and Adaptation to Loading. J Strength Cond Res 2022; 36:2950-2956. [DOI: 10.1519/jsc.0000000000004288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Kubo K, Ikebukuro T, Yata H. Mechanical properties of muscles and tendon structures in middle-aged and young men. Sci Rep 2022; 12:1702. [PMID: 35105932 PMCID: PMC8807618 DOI: 10.1038/s41598-022-05795-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/18/2022] [Indexed: 12/01/2022] Open
Abstract
The purpose of this study was to compare the mechanical properties of muscles and tendon structures for plantar flexor muscles at various strain rates and jump performances using single joint between middle-aged and young men in order to clarify the mechanisms of age-related decline in power output during vertical jump of middle-aged people previously reported. Passive muscle stiffness of the medial gastrocnemius muscle was determined based on passive muscle force and fascicle length during passive stretching at four angular velocities. Active muscle stiffness was calculated based on changes in muscle force and fascicle length during stretching at five angular velocities after submaximal isometric contractions. Maximal elongation and hysteresis of tendon structures were assessed from estimated muscle force—tendon elongation during ramp and ballistic contractions. Two kinds of unilateral jump heights using only ankle joint (no-countermovement and countermovement jumps) were measured. No significant differences in passive and active muscle stiffness, tendon structure properties (except for maximal elongation during ramp contraction), or jump heights were found between middle-aged and young men. The results suggest that the mechanical properties of muscles and tendon structures for plantar flexor muscles and jump performances using only ankle joint do not show age-related changes in middle-aged men.
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Affiliation(s)
- Keitaro Kubo
- Department of Life Science, The University of Tokyo, Meguro, Tokyo, Japan.
| | | | - Hideaki Yata
- Sports Science Laboratory, Wako University, Machida, Tokyo, Japan
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24
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Henriksen P, Brage K, Junge T, Juul-Kristensen B, Bojsen-Møller J, Thorlund JB. Concurrent validity and intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness. ULTRASOUND 2022; 30:18-27. [PMID: 35173775 PMCID: PMC8841948 DOI: 10.1177/1742271x21994609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
Introduction Assessment of tendon stiffness in vivo traditionally involves maximal muscle contractions, which can be challenging in pain populations. Alternative methods are suggested, although the clinimetric properties are sparse. This study investigated the concurrent validity and the intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness. Methods Patellar tendon stiffness was assessed in 17 healthy adults with (a) the dynamometer and B-mode ultrasonography method (DBUS) and (b) the strain elastography method. Correlations between the two methods were analysed using Kendall’s Tau-b. The relative reliability of both methods was evaluated using intraclass correlation coefficient (ICC). The absolute reliability was presented by Bland–Altman plots, standard error of measurement (SEM) and minimum detectable change (MDC). Results No correlation was found between the two methods, irrespective of reference tissue in strain elastography (Kendall’s Tau-b Hoffa = –0.01 (p = 1.00), Kendall’s Tau-b subcutis = 0.04 (p = 0.87)). Tracking of the tendon elongation in the DBUS method had good to excellent relative reliability (ICC = 0.95 (95% confidence interval – CI: 0.85–0.98)) and high absolute reliability (SEM = 0.04 mm (1%), MDC = 0.11 mm (3%)). The strain elastography method had good to excellent relative reliability, regardless of reference tissue (ICC Hoffa = 0.95 (95% CI: 0.86–0.98), ICC subcutis = 0.94 (95% CI: 0.82–0.98)), but low absolute reliability (SEM Hoffa = 0.06 (20%), MDC Hoffa = 0.18 (60%), SEM subcutis = 0.12 (41%), MDC subcutis = 0.32 (110%)). Conclusions No concurrent validity existed for DBUS and strain elastography, suggesting that the two methods measure different tendon properties. The overall reliability for the DBUS method was high, but the absolute reliability was low for strain elastography stiffness ratios. Therefore, the strain elastography method may not be recommended for tracking differences in patellar tendon stiffness in healthy adults.
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Affiliation(s)
- P Henriksen
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - K Brage
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - T Junge
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - B Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - J Bojsen-Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Institute for Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - JB Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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25
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Machado E, Lanferdini FJ, da Silva ES, Geremia JM, Sonda FC, Fletcher JR, Vaz MA, Peyré-Tartaruga LA. Triceps Surae Muscle-Tendon Properties as Determinants of the Metabolic Cost in Trained Long-Distance Runners. Front Physiol 2022; 12:767445. [PMID: 35058793 PMCID: PMC8764303 DOI: 10.3389/fphys.2021.767445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study aimed to determine whether triceps surae's muscle architecture and Achilles tendon parameters are related to running metabolic cost (C) in trained long-distance runners. Methods: Seventeen trained male recreational long-distance runners (mean age = 34 years) participated in this study. C was measured during submaximal steady-state running (5 min) at 12 and 16 km h-1 on a treadmill. Ultrasound was used to determine the gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and soleus (SO) muscle architecture, including fascicle length (FL) and pennation angle (PA), and the Achilles tendon cross-sectional area (CSA), resting length and elongation as a function of plantar flexion torque during maximal voluntary plantar flexion. Achilles tendon mechanical (force, elongation, and stiffness) and material (stress, strain, and Young's modulus) properties were determined. Stepwise multiple linear regressions were used to determine the relationship between independent variables (tendon resting length, CSA, force, elongation, stiffness, stress, strain, Young's modulus, and FL and PA of triceps surae muscles) and C (J kg-1m-1) at 12 and 16 km h-1. Results: SO PA and Achilles tendon CSA were negatively associated with C (r 2 = 0.69; p < 0.001) at 12 km h-1, whereas SO PA was negatively and Achilles tendon stress was positively associated with C (r 2 = 0.63; p = 0.001) at 16 km h-1, respectively. Our results presented a small power, and the multiple linear regression's cause-effect relation was limited due to the low sample size. Conclusion: For a given muscle length, greater SO PA, probably related to short muscle fibers and to a large physiological cross-sectional area, may be beneficial to C. Larger Achilles tendon CSA may determine a better force distribution per tendon area, thereby reducing tendon stress and C at submaximal speeds (12 and 16 km h-1). Furthermore, Achilles tendon morphological and mechanical properties (CSA, stress, and Young's modulus) and triceps surae muscle architecture (GM PA, GM FL, SO PA, and SO FL) presented large correlations with C.
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Affiliation(s)
- Esthevan Machado
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Fábio Juner Lanferdini
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Biomecânica, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Edson Soares da Silva
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jeam Marcel Geremia
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Francesca Chaida Sonda
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jared R. Fletcher
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Marco Aurélio Vaz
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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26
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Friede MC, Innerhofer G, Fink C, Alegre LM, Csapo R. Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals? Phys Ther Sport 2021; 54:44-52. [PMID: 35007886 DOI: 10.1016/j.ptsp.2021.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Iliotibial band syndrome (ITBS) is presumably caused by excessive tension in the iliotibial band (ITB) leading to compression and inflammation of tissues lying beneath it. Usually managed conservatively, there is a lack of scientific evidence supporting the treatment recommendations, and high symptom recurrence rates cast doubt on their causal effectiveness. This review discusses the influence of common physiotherapeutic measures on risk factors contributing to tissue compression beneath the ITB. METHODS The potential pathogenic factors are presented on the basis of a simple biomechanical model showing the forces acting on the lateral aspect of the knee. Existent literature on the most commonly prescribed physiotherapeutic interventions is critically discussed against the background of this model. Practical recommendations for the optimization of physiotherapy are derived. RESULTS According to biomechanical considerations, ITBS may be promoted by anatomical predisposition, joint malalignments, aberrant activation of inserting muscles as well as excessive ITB stiffness. Hip abductor strengthening may correct excessive hip adduction but also increase ITB strain. Intermittent stretching interventions are unlikely to change the ITB's length or mechanical properties. Running retraining is a promising yet understudied intervention. CONCLUSIONS High-quality research directly testing different physiotherapeutic treatment approaches in randomized controlled trials is needed.
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Affiliation(s)
- Miriam C Friede
- Carinthia University of Applied Sciences, Department of Physiotherapy, Klagenfurt, Austria.
| | - Gunnar Innerhofer
- University of Innsbruck, Department of Sport Science, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt Sports and Joint Surgery, Innsbruck, Austria; University for Health Sciences, Medical Informatics and Technology, Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Hall, Austria
| | - Luis M Alegre
- University of Castilla-La Mancha, GENUD Toledo Research Group, Toledo, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Robert Csapo
- University of Vienna, Department of Sport Science, Vienna, Austria
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27
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Krikelis G, Pain MTG, Furlong LAM. Sources of Error When Measuring Achilles Tendon Mechanics During the Stance Phase of Running. J Biomech Eng 2021; 143:094505. [PMID: 34008851 DOI: 10.1115/1.4051221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 11/08/2022]
Abstract
In recent years, the use of methods to investigate muscle-tendon unit function that combine motion capture with ultrasound (MoCapUS) has increased. Although several limitations and individual errors of these methods have been reported, the total error from all the potential sources together has not been estimated. The aim of this study was to establish the total error in the Achilles tendon (AT) measurements, specifically its length (ATL), strain (ATS), and moment arm (ATMA) acquired with MoCapUS during running. The total error from digitizing, marker movement, ultrasound calibration, and probe rotation errors caused mean ATL error of 4.2 ± 0.6 mm, mean ATMA error of 0.1 ± 0.1 mm, and could potentially alter measured ATS by a mean 2.9 ± 0.2%. Correcting both the calcaneus insertion position (CIP) and properly synchronizing ultrasound and motion capture data caused changes of up to 5.4 ± 1.7 mm in ATL and 11.6 ± 1.3 mm in ATMA. CIP correction and synchronization caused a similar amount of change in ATL, as well as ATS. However, the ATMA change was almost exclusively due to the CIP correction. Finally, if all sources of error were combined, the total ATL error could reach 13.1 mm, the total ATMA error could reach 14.4 mm, and ATS differences could reach up to ± 6.7%. The magnitude of such errors emphasizes the fact that MoCapUS-based AT measurements must be interpreted within the scope of their corresponding errors.
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Affiliation(s)
- Giorgos Krikelis
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Matthew T G Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Laura-Anne M Furlong
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
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28
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Couppé C, Svensson RB, Skovlund SV, Jensen JK, Eriksen CS, Malmgaard-Clausen NM, Nybing JD, Kjaer M, Magnusson SP. Habitual side-specific loading leads to structural, mechanical and compositional changes in the patellar tendon of young and senior life-long male athletes. J Appl Physiol (1985) 2021; 131:1187-1199. [PMID: 34382838 DOI: 10.1152/japplphysiol.00202.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Effects of life-long physical activity on tendon function have been investigated in cross-sectional studies, but these are at risk of "survivorship" bias. Here, we investigate if life-long side-specific loading is associated with greater cross-sectional area (CSA), mechanical properties, cell density (DNA content) and collagen cross-link composition of the male human patellar tendon (PT), in vivo. Nine seniors and six young male life-long elite badminton players and fencers were included. CSA of the PT obtained by 3-tesla MRI, and ultrasonography-based bilateral PT mechanics were assessed. Collagen fibril characteristics, enzymatic cross-links, non-enzymatic glycation (autofluorescence), collagen and DNA content were measured biochemically in PT biopsies. The elite athletes had a ≥15% side-to-side difference in maximal knee extensor strength, reflecting chronic unilateral sport-specific loading patterns. The PT CSA was greater on the lead extremity compared with the non-lead extremity (17 %, p=0.0001). Furthermore, greater tendon stiffness (18 %, p=0.0404) together with lower tendon stress (22 %, p=0.0005) and tendon strain (18 %, p=0.0433) were observed on the lead extremity. No effects were demonstrated from side-to-side for glycation, enzymatic cross-link, collagen, and DNA content (50%, p=0.1160). Moreover, tendon fibril density was 87±28 fibrils/μm2 on the lead extremity and 68±26 fibrils/μm2 on the non-lead extremity (28%, p=0.0544). Tendon fibril diameter was 86±14 nm on the lead extremity and 94±14 nm on the non-lead extremity (-9%, p=0.1076). These novel data suggest that life-long side-specific loading in males yields greater patellar tendon size and stiffness possibly with concomitant greater fibril density but without changes of collagen cross-link composition.
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Affiliation(s)
- Christian Couppé
- Institute of Sports Medicine Copenhagen, Bispebjerg-Frederiksberg Hospitals, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Bispebjerg-Frederiksberg Hospitals, Denmark
| | - Sebastian V Skovlund
- Institute of Sports Medicine Copenhagen, Bispebjerg-Frederiksberg Hospitals, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Denmark
| | | | | | | | - Janus Damm Nybing
- Department of Radiology, Bispebjerg-Frederiksberg Hospitals, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Bispebjerg-Frederiksberg Hospitals, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Bispebjerg-Frederiksberg Hospitals, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Denmark
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29
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Quinlan JI, Franchi MV, Gharahdaghi N, Badiali F, Francis S, Hale A, Phillips BE, Szewczyk N, Greenhaff PL, Smith K, Maganaris C, Atherton PJ, Narici MV. Muscle and tendon adaptations to moderate load eccentric vs. concentric resistance exercise in young and older males. GeroScience 2021; 43:1567-1584. [PMID: 34196903 PMCID: PMC8492846 DOI: 10.1007/s11357-021-00396-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
Resistance exercise training (RET) is well-known to counteract negative age-related changes in both muscle and tendon tissue. Traditional RET consists of both concentric (CON) and eccentric (ECC) contractions; nevertheless, isolated ECC contractions are metabolically less demanding and, thus, may be more suitable for older populations. However, whether submaximal (60% 1RM) CON or ECC contractions differ in their effectiveness is relatively unknown. Further, whether the time course of muscle and tendon adaptations differs to the above is also unknown. Therefore, this study aimed to establish the time course of muscle and tendon adaptations to submaximal CON and ECC RET. Twenty healthy young (24.5 ± 5.1 years) and 17 older males (68.1 ± 2.4 years) were randomly allocated to either isolated CON or ECC RET which took place 3/week for 8 weeks. Tendon biomechanical properties, muscle architecture and maximal voluntary contraction were assessed every 2 weeks and quadriceps muscle volume every 4 weeks. Positive changes in tendon Young's modulus were observed after 4 weeks in all groups after which adaptations in young males plateaued but continued to increase in older males, suggesting a dampened rate of adaptation with age. However, both CON and ECC resulted in similar overall changes in tendon Young's modulus, in all groups. Muscle hypertrophy and strength increases were similar between CON and ECC in all groups. However, pennation angle increases were greater in CON, and fascicle length changes were greater in ECC. Notably, muscle and tendon adaptations appeared to occur in synergy, presumably to maintain the efficacy of the muscle-tendon unit.
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Affiliation(s)
- Jonathan Iain Quinlan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,National Institute for Health Research, Birmingham Biomedical Research Centre At University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK
| | - Martino Vladimiro Franchi
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK.,Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Nima Gharahdaghi
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK
| | - Francesca Badiali
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK
| | - Susan Francis
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Andrew Hale
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Bethan Eileen Phillips
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK
| | - Nathaniel Szewczyk
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK.,Ohio Musculoskeletal and Neurological Institute (OMNI) and Department of Biomedical Sciences, Ohio University, Athens, OH, 43147, USA
| | - Paul Leonard Greenhaff
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK
| | - Kenneth Smith
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK
| | | | - Phillip James Atherton
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK
| | - Marco Vincenzo Narici
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, University of Nottingham's Royal Derby Hospital Centre, Nottingham, UK. .,Department of Biomedical Sciences, University of Padova, Padova, Italy. .,CIR-MYO Myology Center, University of Padova, Padova, Italy.
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Stäudle B, Seynnes O, Laps G, Göll F, Brüggemann GP, Albracht K. Recovery from Achilles Tendon Repair: A Combination of Postsurgery Outcomes and Insufficient Remodeling of Muscle and Tendon. Med Sci Sports Exerc 2021; 53:1356-1366. [PMID: 33433154 DOI: 10.1249/mss.0000000000002592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Achilles tendon rupture (ATR) patients have persistent functional deficits in the triceps surae muscle-tendon unit (MTU). The complex remodeling of the MTU accompanying these deficits remains poorly understood. The purpose of the present study was to associate in vivo and in silico data to investigate the relations between changes in MTU properties and strength deficits in ATR patients. METHODS Eleven male subjects who had undergone surgical repair of complete unilateral ATR were examined 4.6 ± 2.0 (mean ± SD) yr after rupture. Gastrocnemius medialis (GM) tendon stiffness, morphology, and muscle architecture were determined using ultrasonography. The force-length relation of the plantar flexor muscles was assessed at five ankle joint angles. In addition, simulations (OpenSim) of the GM MTU force-length properties were performed with various iterations of MTU properties found between the unaffected and the affected side. RESULTS The affected side of the patients displayed a longer, larger, and stiffer GM tendon (13% ± 10%, 105% ± 28%, and 54% ± 24%, respectively) compared with the unaffected side. The GM muscle fascicles of the affected side were shorter (32% ± 12%) and with greater pennation angles (31% ± 26%). A mean deficit in plantarflexion moment of 31% ± 10% was measured. Simulations indicate that pairing an intact muscle with a longer tendon shifts the optimal angular range of peak force outside physiological angular ranges, whereas the shorter muscle fascicles and tendon stiffening seen in the affected side decrease this shift, albeit incompletely. CONCLUSIONS These results suggest that the substantial changes in MTU properties found in ATR patients may partly result from compensatory remodeling, although this process appears insufficient to fully restore muscle function.
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Affiliation(s)
| | - Olivier Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Guido Laps
- Orthopaedie am Guerzenich, Cologne, GERMANY
| | - Fabian Göll
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, GERMANY
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, GERMANY
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Agergaard AS, Svensson RB, Hoeffner R, Hansen P, Couppé C, Kjaer M, Magnusson SP. Mechanical properties and UTE-T2* in Patellar tendinopathy: The effect of load magnitude in exercise-based treatment. Scand J Med Sci Sports 2021; 31:1981-1990. [PMID: 34189760 DOI: 10.1111/sms.14013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/28/2021] [Indexed: 01/18/2023]
Abstract
Loading intervention is currently the preferred management of tendinopathy, but to what extent different loading regimes influence the mechanical response in tendons is scarcely investigated. Therefore, the purposes of the investigation were to examine the effect of exercise interventions with either high or low load magnitude applied to the tendinopathic patellar tendon and the influence on its mechanical, material, and morphological properties. Forty-four men with chronic patellar tendinopathy were randomized to 12 weeks of exercising with either; 55% of 1RM throughout the period (MSR group) or 90% of 1RM (HSR group), and with equal total exercise volume in both groups. Mechanical (stiffness), material (T2* relaxation time), and morphological (cross-sectional area (CSA)) properties were assessed at baseline and after 12 weeks of intervention. MRI with ultra-short echo times (UTE) and T2*-mapping was applied to explore if T2* relaxation time could be used as a noninvasive marker for internal material alteration and early change thereof in response to intervention. There was no effect of HSR or MSR on the mechanical (stiffness), material (T2* relaxation time) or morphological (CSA) properties, but both regimes resulted in significant strength gain. In conclusion, there were no statistically superior effect of exercising with high (90%) compared to moderate (55%) load magnitude on the mechanical, material or morphological properties.
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Affiliation(s)
- Anne-Sofie Agergaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen Denmark and Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen Denmark and Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Rikke Hoeffner
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen Denmark and Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Philip Hansen
- Department of Radiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian Couppé
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen Denmark and Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen Denmark and Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen Denmark and Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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32
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Cavalcante JGT, Marqueti RDC, Corrigan P, Sousa AMM, Bottaro M, Babault N, Geremia JM, Silbernagel KG, Durigan JLQ. The effects of knee and hip joint angles on patellar tendon loading during quadriceps neuromuscular electrical stimulation. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jonathan Galvão Tenório Cavalcante
- Graduate Program of Rehabilitation Sciences University of Brasília Brasília Brazil
- College of Physical Education University of Brasília Brasília Brazil
| | - Rita de Cássia Marqueti
- Graduate Program of Rehabilitation Sciences University of Brasília Brasília Brazil
- Graduate Program of Sciences and Technology of Health University of Brasília Brasília Brazil
| | - Patrick Corrigan
- Department of Physical Therapy, Movement & Rehabilitation Sciences Northeastern University Boston MA USA
| | | | - Martim Bottaro
- College of Physical Education University of Brasília Brasília Brazil
| | - Nicolas Babault
- Centre d’Expertise de la Performance INSERM UMR1093‐CAPS UFR des Sciences du Sport University of Burgundy Franche‐Comté Dijon France
| | - Jeam Marcel Geremia
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance Federal University of Rio Grande do Sul Porto Alegre Brazil
| | | | - João Luiz Quaglioti Durigan
- Graduate Program of Rehabilitation Sciences University of Brasília Brasília Brazil
- College of Physical Education University of Brasília Brasília Brazil
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33
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Sarto F, Spörri J, Fitze DP, Quinlan JI, Narici MV, Franchi MV. Implementing Ultrasound Imaging for the Assessment of Muscle and Tendon Properties in Elite Sports: Practical Aspects, Methodological Considerations and Future Directions. Sports Med 2021; 51:1151-1170. [PMID: 33683628 PMCID: PMC8124062 DOI: 10.1007/s40279-021-01436-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Fabio Sarto
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Daniel P Fitze
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonathan I Quinlan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Marco V Narici
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- CIR-MYO Myology Centre, University of Padova, Padova, Italy
| | - Martino V Franchi
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
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Suckey MM, Benza DW, DesJardins JD, Anker JN. Upconversion Spectral Rulers for Transcutaneous Displacement Measurements. SENSORS 2021; 21:s21103554. [PMID: 34065299 PMCID: PMC8160897 DOI: 10.3390/s21103554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 11/16/2022]
Abstract
We describe a method to measure micron to millimeter displacement through tissue using an upconversion spectral ruler. Measuring stiffness (displacement under load) in muscles, bones, ligaments, and tendons is important for studying and monitoring healing of injuries. Optical displacement measurements are useful because they are sensitive and noninvasive. Optical measurements through tissue must use spectral rather than imaging approaches because optical scattering in the tissue blurs the image with a point spread function typically around the depth of the tissue. Additionally, the optical measurement should have low background and minimal intensity dependence. Previously, we demonstrated a spectral encoder using either X-ray luminescence or fluorescence, but the X-ray luminescence required an expensive X-ray source and used ionizing radiation, while the fluorescence sensor suffered from interference from autofluorescence. Here, we used upconversion, which can be provided with a simple fiber-coupled spectrometer with essentially autofluorescence-free signals. The upconversion phosphors provide a low background signal, and the use of closely spaced spectral peaks minimizes spectral distortion from the tissue. The small displacement noise level (precision) through tissue was 2 µm when using a microscope-coupled spectrometer to collect light. We also showed proof of principle for measuring strain on a tendon mimic. The approach provides a simple method to study biomechanics using implantable sensors.
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Affiliation(s)
- Melissa M. Suckey
- Department of Chemistry, Clemson University, Clemson, SC 29634, USA; (M.M.S.); (D.W.B.)
| | - Donald W. Benza
- Department of Chemistry, Clemson University, Clemson, SC 29634, USA; (M.M.S.); (D.W.B.)
- Department of Electrical and Computer Engineering, Clemson University, Clemson, SC 29634, USA
| | - John D. DesJardins
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA;
| | - Jeffrey N. Anker
- Department of Chemistry, Clemson University, Clemson, SC 29634, USA; (M.M.S.); (D.W.B.)
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA;
- Center for Optical Materials Science and Engineering (COMSET) and Environmental Toxicology Program, Clemson University, Clemson, SC 29634, USA
- Correspondence:
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35
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Abián P, Martínez F, Jiménez F, Abián-Vicén J. Morphology of the Patellar Tendon and the Contractility Response of the Quadriceps: Symmetry and Gender Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105309. [PMID: 34067639 PMCID: PMC8156345 DOI: 10.3390/ijerph18105309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/24/2023]
Abstract
The purpose of the study was to describe the differences between the dominant and non-dominant leg regarding contractility response and quadriceps strength and the morphology and stiffness of the patellar tendon (PT) in a group of physically active men and women. Fifty physically active subjects (36 men and 14 women) were evaluated for morphology and stiffness of the PT, contractility response of the rectus femoris of the quadriceps, isometric strength of the quadriceps and hamstrings, and isokinetic strength (concentric and eccentric) at 60°/s of the knee extensors. The measurements were made on the subject's dominant and non-dominant leg. The men showed a greater thickness of the PT in both legs compared to the women. Regarding the contractility response, the women recorded a 10.1 ± 16.2% (p = 0.038) greater contraction time (ct) in the dominant versus the non-dominant leg and the men recorded 11.9% (p = 0.040) higher values in the dominant leg compared to the women. In all the absolute strength measurements the men recorded higher values (p < 0.05) than the women, however, when the values were normalised with respect to the muscle mass of the leg these differences disappeared. The dominant leg showed values of isometric strength and eccentric strength at 60°/s (p < 0.05) greater than the non-dominant leg. The reference values provided in this study of the knee extensors and PT may be useful for detecting possible muscular or tendinous anomalies.
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Affiliation(s)
- Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, 28049 Madrid, Spain;
| | - Fernando Martínez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
- Correspondence: ; Tel.: +34-925268800 (ext. 5522)
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36
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Mersmann F, Laube G, Marzilger R, Bohm S, Schroll A, Arampatzis A. A Functional High-Load Exercise Intervention for the Patellar Tendon Reduces Tendon Pain Prevalence During a Competitive Season in Adolescent Handball Players. Front Physiol 2021; 12:626225. [PMID: 33776790 PMCID: PMC7987778 DOI: 10.3389/fphys.2021.626225] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/18/2021] [Indexed: 01/31/2023] Open
Abstract
Imbalances of muscle strength and tendon stiffness may increase the risk for patellar tendinopathy in growing athletes. The present study investigated if a functional high-load exercise intervention, designed to facilitate tendon adaptation and reduce muscle-tendon imbalances, may prevent patellar tendon pain in adolescent male handball players (12–14 years). Tendon pain prevalence (using VISA-P scores), knee extensor strength, vastus lateralis (VL) architecture and patellar tendon mechanical properties were measured at four measurement time points (M1–M4) over a season. The control group (CON; n = 18; age 13.1 ± 0.7 yrs, height 170 ± 8 cm, mass 58 ± 10 kg) followed the usual strength training plan, including muscular endurance and explosive strength components. In the experimental group (EXP; n = 16; 13.1 ± 0.6 yrs, 169 ± 11 cm, 58 ± 16 kg), two sessions per week with functional high-load exercises for the patellar tendon were integrated in the strength training schedule, aiming to provide repetitive high-intensity loading of at least 3 s loading duration per repetition. While in the control group 30% of the athletes reported a clinically significant aggravation of symptoms, all players in the experimental group remained or became pain-free at M2 until the end of the season. There was a similar increase of strength (normalized to body mass; CON: 3.1%, d = 0.22; EXP: 6.8%, d = 0.47; p = 0.04) and VL thickness (CON: 4.8%, d = 0.28; EXP: 5.7%, d = 0.32; p < 0.001) in both groups, but no significant changes of tendon stiffness or maximum tendon strain. Further, both groups demonstrated similar fluctuations of tendon strain over time. We conclude that functional high-load exercises can reduce the prevalence of patellar tendon pain in adolescent athletes even without a reduction of tendon strain.
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Affiliation(s)
- Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gunnar Laube
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Marzilger
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Miller T, Ying M, Sau Lan Tsang C, Huang M, Pang MYC. Reliability and Validity of Ultrasound Elastography for Evaluating Muscle Stiffness in Neurological Populations: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:5928445. [PMID: 33508855 DOI: 10.1093/ptj/pzaa188] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/04/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Ultrasound elastography is an emerging diagnostic technology used to investigate the biomechanical properties of the musculoskeletal system. The purpose of this study was to systematically review the psychometric properties of ultrasound elastography techniques for evaluating muscle stiffness in people with neurological conditions. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using software, reviewers independently screened citations for inclusion. Peer-reviewed studies that evaluated in vivo muscle stiffness in people with neurological conditions and reported relevant psychometric properties were considered for inclusion. Twenty-one articles were included for final review. Data relevant to measurement technique, site, and neurological condition were extracted. The Consensus-Based Standards for the Selection of Health Measurement Instruments checklist was used to rate the methodological quality of included studies. The level of evidence for specific measurement outcomes was determined using a best-evidence synthesis approach. RESULTS Reliability varied across populations, ultrasound systems, and assessment conditions (ie, joint/body positions, active/passive muscle conditions, probe orientation), with most studies indicating moderate to good reliability (ICC = 0.5-0.9, n = 13). Meta-analysis results showed a good overall correlation across studies (r = 0.78, 95% confidence interval = 0.64-0.86), with no between-group difference based on population (Q1 = 0.00). Convergent validity was demonstrated by strong correlations between stiffness values and measures of spasticity (n = 5), functional motor recovery or impairment (n = 5), and grayscale or color histogram pixel intensities (n = 3). Discriminant or known-groups validity was also established for multiple studies and indicated either significant between-group differences in stiffness values (n = 12) or within-group differences between more and less affected limbs (n = 6). Responsiveness was observed in all intervention studies reporting posttreatment stiffness changes (n = 6). CONCLUSIONS Overall, ultrasound elastography techniques showed moderate reliability in evaluating in vivo muscle stiffness, good convergent validity with relevant clinical assessments, and good divergent validity in discriminating tissue changes within and between groups. IMPACT Ultrasound elastography has clinical utility in assessing muscle stiffness, monitoring its temporal changes, and measuring the response to intervention in people with neurological conditions.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, S.A.R
| | - Charlotte Sau Lan Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Meizhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong, S.A.R
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Jones EJ, Kennett JE, Green DA. Spring-loaded body mass equivalent horizontal reactive countermovement jump ground contact and flight times, but not peak forces, are comparable to vertical jumping. J Biomech 2020; 116:110206. [PMID: 33485147 DOI: 10.1016/j.jbiomech.2020.110206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 11/21/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
Horizontal (cylinder-based) sledge jumping has been shown to ameliorate multi-system deconditioning induced by long-term bed-rest. However, biomechanics differ from 1 g vertical jumping, in particular prolongation of ground contact times (GCT), reduction of peak force, rate of force development (RFD) (and presumably stretch shortening cycle [SSC] efficacy) and stiffness, whilst also requiring relatively complex equipment. Thus, we sought to determine if horizontal spring-loaded countermovement jumps were more analogous to vertical jumping. 9 healthy (5 female) subjects (27 ± 7yrs; 169.0 ± 5.3 cm; 63.6 ± 2.6 kg) performed 10 reactive countermovement jumps vertically, and horizontally (randomized) when lay on a spring-loaded carriage performed against loading (at lift-off) equivalent (±6%) to their body weight. Jump kinetics, kinematics and lower limb/trunk electromyographic activity were compared between conditions (paired t-tests). Mean flight and GCTs did not differ, however, peak jump height (p = 0.003; d = -0.961) was greater when jumping horizontally. In contrast, ground reaction forces (zGRF) during take-off (p < 0.001; d = 1.645) and landing (p = 0.002; d = 1.309), peak acceleration (p = 0.001; d = 1.988), leg stiffness (p = 0.001; d = 2.371) and RFD (p = 0.023; d = 1.255) were lower horizontally. Mean rectus femoris activity was lower during landing (p = 0.033; d = 0.691) when horizontal, but did not differ during either take-off or land-lift. Mean medial gastrocnemius activity was significantly (p = 0.018; d = 0.317) lower during horizontal take-off. Spring-loading (1 g at take-off) maintained short GCTs and flight times presumably maintaining muscle SSC efficacy in a manner that appears intuitive (in young active subjects), simple, robust and potentially compatible with spaceflight. Whether appropriate jump characteristics can be achieved in older subjects and in μg/hypogravity needs to be determined. However, greater jump height, lower peak zGRF, RFD and leg stiffness along with reduced lower limb and trunk muscle activity suggests that 1 g at take-off is insufficient to replicate vertical jump biomechanics. Thus, further investigation is warranted to optimize, and evaluate spring-loaded jumping as a gravity-independent multi-systems countermeasure on Earth, and in Space.
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Affiliation(s)
- E J Jones
- Centre of Human & Applied Physiological Sciences (CHAPS), King's College London, Faculty of Life Sciences & Medicine, Guy's Campus, London SE1 1UL, UK; Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - J E Kennett
- Physical Mind London, 135 High Street, Teddington, London TW11 8HH, UK
| | - D A Green
- Centre of Human & Applied Physiological Sciences (CHAPS), King's College London, Faculty of Life Sciences & Medicine, Guy's Campus, London SE1 1UL, UK; KBR, Wyle Laboratories GmbH, Albin-Koebis Strasse 4, 51174 Cologne, Germany; Space Medicine Team, HRE-OM, European Astronaut Centre, European Space Agency, Linder Höhe, Cologne 51147, Germany.
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39
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Svensson RB, Slane LC, Magnusson SP, Bogaerts S. Ultrasound-based speckle-tracking in tendons: a critical analysis for the technician and the clinician. J Appl Physiol (1985) 2020; 130:445-456. [PMID: 33332991 DOI: 10.1152/japplphysiol.00654.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Ultrasound has risen to the forefront as one of the primary tools in tendon research, with benefits including its relatively low cost, ease of use, and high safety. Moreover, it has been shown that cine ultrasound can be used to evaluate tendon deformation by tracking the motion of anatomical landmarks during physical movement. Estimates from landmark tracking, however, are typically limited to global tissue properties, such that clinically relevant regional nonuniformities may be missed. Fortunately, advancements in ultrasound scanning have led to the development of speckle-tracking algorithms, which enable the noninvasive measurement of in vivo local deformation patterns. Despite the successes in other fields, the adaptation of speckle-tracking to tendon research has presented some unique challenges as a result of tissue anisotropy and microstructural changes under load. With no generally accepted standards for its use, current methodological approaches vary substantially between studies and research groups. Therefore, the goal of this paper is to provide a summative review of the technical complexities and variations of speckle-tracking approaches being used and the impact these decisions may have on measured results and their interpretation. Variations in these approaches currently being used with relevant technical aspects are discussed first (for the technician), followed by a discussion of the more clinical considerations (for the clinician). Finally, a summary table of common challenges encountered when implementing speckle-tracking is provided, with suggested recommendations for minimizing the impact of such potential sources of error.
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Affiliation(s)
- Rene B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laura C Slane
- Department of Mechanical Engineering, University of Rochester, Rochester, New York
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Stijn Bogaerts
- Research Unit on Locomotor and Neurological Disorders, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
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40
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Chang TT, Feng YN, Zhu Y, Liu CL, Wang XQ, Zhang ZJ. Objective Assessment of Regional Stiffness in Achilles Tendon in Different Ankle Joint Positions Using the MyotonPRO. Med Sci Monit 2020; 26:e926407. [PMID: 33071278 PMCID: PMC7583434 DOI: 10.12659/msm.926407] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Achilles tendinopathy commonly occurs in specific regions of the tendon, and Achilles tendon stiffness can be related to local pathological changes in the tendon. The MyotonPRO is a new handheld device that conveniently assesses stiffness of muscles and tendons. This study aimed to 1) evaluate the intra- and inter-rater reliability of stiffness measurements of the Achilles tendon at different ankle positions, 2) investigate the modulation of stiffness at different ankle joint angles, and 3) examine the differences between 2 regions of Achilles tendon stiffness. MATERIAL AND METHODS Thirty healthy young adults (15 men and 15 women) participated in this study. The regional Achilles tendon stiffness at 0 cm (AT-0) and 6 cm (AT-6) above the tendon insertion were evaluated by the MyotonPRO in the neutral position and 10° dorsiflexion of the ankle joint. Measurements of stiffness were taken by 2 raters on the first day and 5 days later. The stiffness data were compared by repeated measures analysis of variance (ANOVA). RESULTS The intra- and inter-rater reliability of stiffness measurements at AT-0 and AT-6 for each ankle position were good (all intraclass correlation coefficients >0.84). A significant modulation of Achilles tendon stiffness was obtained at different ankle joint angles (P<0.05). Stiffness at AT-0 was higher than at AT-6 (P<0.05) in both positions. CONCLUSIONS These results suggest the MyotonPRO reliably assessed Achilles tendon stiffness and monitors its modulation, and tendon stiffness increased with ankle dorsiflexion. Stiffness was also nonuniform along the length of the tendon.
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Affiliation(s)
- Tian-Tian Chang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Ya-Nan Feng
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China (mainland)
| | - Yi Zhu
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Chun-Long Liu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China (mainland)
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41
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Ikeda N, Yonezu T, Kawakami Y. Minute oscillation stretching: A novel modality for reducing musculo-tendinous stiffness and maintaining muscle strength. Scand J Med Sci Sports 2020; 31:104-114. [PMID: 32969540 PMCID: PMC7756383 DOI: 10.1111/sms.13830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022]
Abstract
A novel stretching modality was developed to provide repetitive small length changes to the plantar flexors undergoing passive stretch defined as "minute oscillation stretching" (MOS). This study investigated the effects of MOS on neuromuscular activity during force production, the rate of torque development (RTD), and the elastic properties of the plantar flexors and Achilles tendon. Ten healthy males participated in this study. The neuromuscular activity of the triceps surae and tibialis anterior muscles during maximal voluntary plantar flexion torque [MVT], RTD of plantar flexion, Achilles tendon stiffness, and muscle stiffness were measured before and after two types of interventions for a total of 5 minutes: static stretching (SS) and MOS at 15 Hz and without intervention (control). Achilles tendon stiffness was calculated from the tendon elongation measuring by ultrasonography. Muscle stiffness was determined for the medial gastrocnemius [MG] using shear wave elastography. The MVT, mean electromyographic amplitudes [mEMG] of MG and lateral gastrocnemius [LG], and RTD were significantly decreased following SS (MVT: -7.2 ± 7.9%; mEMG of MG: -8.7 ± 10.2%; mEMG of LG: -12.4 ± 10.5%; RTD: -6.6 ± 6.8%), but not after MOS. Achilles tendon stiffness significantly decreased after SS (-13.4 ± 12.3%) and MOS (-9.7 ± 11.5%), with no significant differences between them. Muscle stiffness significantly decreased in SS and MOS, with relative changes being significantly greater for MOS (-7.9 ± 8.3%) than SS (-2.3 ± 2.9%) interventions. All variables remained unchanged in the controls. In conclusion, MOS changed muscle-tendon compliance without loss of muscle function.
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Affiliation(s)
- Naoki Ikeda
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.,Institute for General Education, Ritsumeikan University, Kusatsu, Japan
| | - Takahisa Yonezu
- School of Physical Education, Department of Competitive Sports, Tokai University, Hiratsuka, Japan
| | - Yasuo Kawakami
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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42
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Sichting F, Kram NC. Phantom material testing indicates that the mechanical properties, geometrical dimensions, and tensional state of tendons affect oscillation-based measurements. Physiol Meas 2020; 41:095010. [PMID: 33021964 DOI: 10.1088/1361-6579/abb4b3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There is an increasing interest in the application of oscillation-based measurement techniques to evaluate the mechanical stiffness of healthy and diseased tendons. These techniques measure the stiffness of a tendon indirectly by registering the oscillation response of a tendon to an external mechanical impulse. Although these measurement techniques seem to be comparatively easy and time-saving, their applicability is implicitly limited by their indirect measurement principle. APPROACH In this study, we aim to find evidence that the oscillation response of a tendon to an external mechanical impulse is not only affected by the stiffness of a tendon but also by the tendons' cross-sectional area (CSA), length, and tension. Therefore, we reviewed the current literature on oscillation-based techniques that measure in vivo tendon properties. Further, a phantom material was used to mimic the nature of tendons and to test the impact of four factors on oscillation-based measurements. MAIN RESULTS Our results indicate that the mechanical properties, geometrical dimensions (length and CSA), and tensional state affect oscillation-based measures. Surprisingly, most studies on tendon behavior often exclusively associate their oscillation-based measurements with the mechanical stiffness of a tendon. SIGNIFICANCE While this narrow perspective bears the risk of misinterpretation or false implications, a broader understanding of oscillation-based measurements has the potential to shed new light on the interaction of muscles and tendons in vivo.
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Affiliation(s)
- Freddy Sichting
- Department of Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
| | - Nicolai C Kram
- Department of Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
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43
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Citeroni MR, Ciardulli MC, Russo V, Della Porta G, Mauro A, El Khatib M, Di Mattia M, Galesso D, Barbera C, Forsyth NR, Maffulli N, Barboni B. In Vitro Innovation of Tendon Tissue Engineering Strategies. Int J Mol Sci 2020; 21:E6726. [PMID: 32937830 PMCID: PMC7555358 DOI: 10.3390/ijms21186726] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
Tendinopathy is the term used to refer to tendon disorders. Spontaneous adult tendon healing results in scar tissue formation and fibrosis with suboptimal biomechanical properties, often resulting in poor and painful mobility. The biomechanical properties of the tissue are negatively affected. Adult tendons have a limited natural healing capacity, and often respond poorly to current treatments that frequently are focused on exercise, drug delivery, and surgical procedures. Therefore, it is of great importance to identify key molecular and cellular processes involved in the progression of tendinopathies to develop effective therapeutic strategies and drive the tissue toward regeneration. To treat tendon diseases and support tendon regeneration, cell-based therapy as well as tissue engineering approaches are considered options, though none can yet be considered conclusive in their reproduction of a safe and successful long-term solution for full microarchitecture and biomechanical tissue recovery. In vitro differentiation techniques are not yet fully validated. This review aims to compare different available tendon in vitro differentiation strategies to clarify the state of art regarding the differentiation process.
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Affiliation(s)
- Maria Rita Citeroni
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Maria Camilla Ciardulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (G.D.P.); (N.M.)
| | - Valentina Russo
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (G.D.P.); (N.M.)
- Interdepartment Centre BIONAM, Università di Salerno, via Giovanni Paolo I, 84084 Fisciano (SA), Italy
| | - Annunziata Mauro
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Mohammad El Khatib
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Miriam Di Mattia
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Devis Galesso
- Fidia Farmaceutici S.p.A., via Ponte della Fabbrica 3/A, 35031 Abano Terme (PD), Italy; (D.G.); (C.B.)
| | - Carlo Barbera
- Fidia Farmaceutici S.p.A., via Ponte della Fabbrica 3/A, 35031 Abano Terme (PD), Italy; (D.G.); (C.B.)
| | - Nicholas R. Forsyth
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Thornburrow Drive, Stoke on Trent ST4 7QB, UK;
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (G.D.P.); (N.M.)
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST5 5BG, UK
| | - Barbara Barboni
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
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Monte A, Maganaris C, Baltzopoulos V, Zamparo P. The influence of Achilles tendon mechanical behaviour on "apparent" efficiency during running at different speeds. Eur J Appl Physiol 2020; 120:2495-2505. [PMID: 32840697 PMCID: PMC7557501 DOI: 10.1007/s00421-020-04472-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
Purpose We investigated the role of elastic strain energy on the “apparent” efficiency of locomotion (AE), a parameter that is known to increase as a function of running speed (up to 0.5–0.7) well above the values of “pure” muscle efficiency (about 0.25–0.30). Methods In vivo ultrasound measurements of the gastrocnemius medialis (GM) muscle–tendon unit (MTU) were combined with kinematic, kinetic and metabolic measurements to investigate the possible influence of the Achilles tendon mechanical behaviour on the mechanics (total mechanical work, WTOT) and energetics (net energy cost, Cnet) of running at different speeds (10, 13 and 16 km h−1); AE was calculated as WTOT/Cnet. Results GM fascicles shortened during the entire stance phase, the more so the higher the speed, but the majority of the MTU displacement was accommodated by the Achilles tendon. Tendon strain and recoil increased as a function of running speed (P < 0.01 and P < 0.001, respectively). The contribution of elastic energy to the positive work generated by the MTU also increased with speed (from 0.09 to 0.16 J kg−1 m−1). Significant negative correlations (P < 0.01) were observed between tendon work and metabolic energy at each running speed (the higher the tendon work the lower the metabolic demand) and significant positive correlations were observed between tendon work and AE (P < 0.001) at each running speed (the higher the tendon work the higher the efficiency). Conclusion These results support the notion that the dynamic function of tendons is integral in reducing energy expenditure and increasing the “apparent” efficiency of running.
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Affiliation(s)
- Andrea Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, via Felice Casorati, 43, 37131, Verona, Italy
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Constantinos Maganaris
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, UK
| | - Paola Zamparo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, via Felice Casorati, 43, 37131, Verona, Italy.
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45
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Increased fascicle length but not patellar tendon stiffness after accentuated eccentric-load strength training in already-trained men. Eur J Appl Physiol 2020; 120:2371-2382. [PMID: 32772246 PMCID: PMC7560914 DOI: 10.1007/s00421-020-04462-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/04/2020] [Indexed: 01/28/2023]
Abstract
Purpose This study examined whether additional external load during the eccentric phase of lower limb strength training exercises led to greater adaptations in knee extensor strength, muscle architecture, and patellar tendon properties than traditional concentric–eccentric training in already-trained men. Methods Twenty-eight men accustomed to strength training were randomized to undertake 10 weeks of supervised traditional (TRAD) or accentuated eccentric loading (AEL) or continue their habitual unsupervised (CON) strength training. TRAD and AEL trained 2∙week−1 with a six-repetition maximum (RM) session and a ten-RM session. TRAD used the same external load in both concentric and eccentric phases, while AEL used 40% greater load during the eccentric than concentric phase. Tests were performed at pre- and post-training, including: maximum unilateral isokinetic (30°·s−1) concentric, eccentric and isometric torques by isokinetic dynamometry, unilateral isometric ramp contractions with muscle–tendon ultrasound imaging to measure tendon stiffness and hysteresis, and resting vastus lateralis and medialis fascicle angle and length measured by extended-field-of-view ultrasound. Results After training, both TRAD and AEL significantly increased maximum concentric and isometric torque (p < 0.05), but only AEL increased eccentric torque (AEL: + 10 ± 9%, TRAD: + 4 ± 9%) and vastus lateralis (AEL: + 14 ± 14%, TRAD: + 1 ± 10%) and medialis (AEL: + 19 ± 8%, TRAD: + 5 ± 11%) fascicle length. Conclusion Both TRAD and AEL increased maximum knee extensor strength but only AEL increased VL and VM fascicle length. Neither training program promoted changes in fascicle angle or changes in patellar tendon properties in our already-trained men.
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46
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Arampatzis A, Mersmann F, Bohm S. Individualized Muscle-Tendon Assessment and Training. Front Physiol 2020; 11:723. [PMID: 32670094 PMCID: PMC7332733 DOI: 10.3389/fphys.2020.00723] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/02/2020] [Indexed: 01/27/2023] Open
Abstract
The interaction of muscle and tendon is of major importance for movement performance and a balanced development of muscle strength and tendon stiffness could protect athletes from overuse injury. However, muscle and tendon do not necessarily adapt in a uniform manner during a training process. The development of a diagnostic routine to assess both the strength capacity of muscle and the mechanical properties of tendons would enable the detection of muscle-tendon imbalances, indicate if the training should target muscle strength or tendon stiffness development and allow for the precise prescription of training loads to optimize tendon adaptation. This perspective article discusses a framework of individualized muscle-tendon assessment and training and outlines a methodological approach for the patellar tendon.
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Affiliation(s)
- Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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47
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Wiesinger HP, Seynnes OR, Kösters A, Müller E, Rieder F. Mechanical and Material Tendon Properties in Patients With Proximal Patellar Tendinopathy. Front Physiol 2020; 11:704. [PMID: 32733263 PMCID: PMC7358637 DOI: 10.3389/fphys.2020.00704] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/28/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction The effect of chronic patellar tendinopathy on tissue function and integrity is currently unclear and underinvestigated. The aim of this cohort comparison was to examine morphological, material, and mechanical properties of the patellar tendon and to extend earlier findings by measuring the ability to store and return elastic energy in symptomatic tendons. Methods Seventeen patients with chronic (>3 months, VISA-P < 80), inferior pole patellar tendinopathy (24 ± 4 years; male = 12, female = 5) were carefully matched to controls (25 ± 3 years) for training status, pattern, and history of loading of the patellar tendon. Individual knee extension force, patellar tendon stiffness, stress, strain, Young’s modulus, hysteresis, and energy storage capacity, were obtained with combined dynamometry, ultrasonography, magnetic resonance imaging, and electromyography. Results Anthropometric parameters did not differ between groups. VISA-P scores ranged from 28 to 78 points, and symptoms had lasted from 10 to 120 months before testing. Tendon proximal cross-sectional area was 61% larger in the patellar tendinopathy group than in the control group. There were no differences between groups in maximal voluntary isometric knee extension torque (p = 0.216; d < −0.31) nor in tensile tendon force produced during isometric ramp contractions (p = 0.185; d < −0.34). Similarly, tendon strain (p = 0.634; d < 0.12), hysteresis (p = 0.461; d < 0.18), and strain energy storage (p = 0.656; d < 0.36) did not differ between groups. However, patellar tendon stiffness (−19%; p = 0.007; d < −0.74), stress (−27%; p< 0.002; d < −0.90) and Young’s modulus (−32%; p = 0.001; d < −0.94) were significantly lower in tendinopathic patients compared to healthy controls. Discussion In this study, we observed lower stiffness in affected tendons. However, despite the substantial structural and histological changes occurring with tendinopathy, the tendon capacity to store and dissipate energy did not differ significantly.
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Affiliation(s)
- Hans-Peter Wiesinger
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Olivier R Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Alexander Kösters
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Erich Müller
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Florian Rieder
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria.,Institute of Physical Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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48
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Obuchowicz R, Ambrozinski L, Kohut P. Influence of Load and Transducer Bandwidth on the Repeatability of In Vivo Tendon Stiffness Evaluation Using Shear Wave Elastography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320928999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: To determine how different examination protocols with the use of transducers, of different bandwidths, and applied with varied tension to tendons would influence the sonographic study results. Methods: Thirty-one participants were divided into two groups, with one subject used for theoretical investigation (A) and the remaining participants (B = 30) forming the study cohort. Both sets of participants were examined with three different transducers (SL10–3, SL15–4, and SL18–7) as well as with variable loading on the Achilles tendon (relaxed, tensed, and loaded). The resulting coverage of the color map provided qualitative tendon stiffness and quantitative tendon stiffness values. Results: The estimated mean coverage extent, using elastographic color maps, produced by the three transducers was 98%, 98%, and 99%, respectively, in the relaxed state. Likewise, in the tensed state, mean coverage was 85%, 82%, and 77% in group A and 91%, 78%, and 71% in group B, respectively. Examining tendons that were loaded, the mean coverage was 68%, 42%, and 41%, respectively. The quantitative relaxed mean tendon elasticity values were 323, 366, and 393 kPa, respectively, in group A. Likewise, the relaxed mean values were 329, 341, and 358 kPa, respectively, in group B. The quantitative tensed mean tendon elasticity values were 413, 460, and 426 kPa, respectively, in group A. Likewise the tensed mean values were 412, 440, and 436 kPa, respectively, in group B. Conclusions: Varying the tendon loading significantly influenced the color map coverage, which governs the most reliable quantitative measurements on relaxed tendons. The best color map coverage was achieved using the transducer with the lowest frequency, regardless of the tension applied.
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Affiliation(s)
- Rafał Obuchowicz
- Department of Radiology, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | | | - Piotr Kohut
- AGH University of Science and Technology, Krakow, Poland
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49
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Laurent C, Baudry S, Duchateau J. Comparison of Plyometric Training With Two Different Jumping Techniques on Achilles Tendon Properties and Jump Performances. J Strength Cond Res 2020; 34:1503-1510. [DOI: 10.1519/jsc.0000000000003604] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Seynnes OR, Cronin NJ. Simple Muscle Architecture Analysis (SMA): An ImageJ macro tool to automate measurements in B-mode ultrasound scans. PLoS One 2020; 15:e0229034. [PMID: 32049973 PMCID: PMC7015391 DOI: 10.1371/journal.pone.0229034] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/28/2020] [Indexed: 12/23/2022] Open
Abstract
In vivo measurements of muscle architecture (i.e. the spatial arrangement of muscle fascicles) are routinely included in research and clinical settings to monitor muscle structure, function and plasticity. However, in most cases such measurements are performed manually, and more reliable and time-efficient automated methods are either lacking completely, or are inaccessible to those without expertise in image analysis. In this work, we propose an ImageJ script to automate the entire analysis process of muscle architecture in ultrasound images: Simple Muscle Architecture Analysis (SMA). Images are filtered in the spatial and frequency domains with built-in commands and external plugins to highlight aponeuroses and fascicles. Fascicle dominant orientation is then computed in regions of interest using the OrientationJ plugin. Bland-Altman plots of analyses performed manually or with SMA indicate that the automated analysis does not induce any systematic bias and that both methods agree equally through the range of measurements. Our test results illustrate the suitability of SMA to analyse images from superficial muscles acquired with a broad range of ultrasound settings.
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Affiliation(s)
- Olivier R. Seynnes
- Department for Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
- * E-mail:
| | - Neil J. Cronin
- Neuromuscular Research Centre, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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