The Myometric Assessment of Achilles Tendon and Soleus Muscle Stiffness before and after a Standardized Exercise Test in Elite Female Volleyball and Handball Athletes-A Quasi-Experimental Study.

Background: The high prevalence of injuries in female athletes necessitates a course of action that not only enhances research in this field but also incorporates improved prevention programs and regular health monitoring of highly stressed structures such as tendons and muscles. Since myometry is already used by coaches and physiotherapists, it is important to investigate whether tissue stiffness varies in different types of sports, and whether such measures are affected by an acute training session. Methods: Myometric measurements of the Achilles tendon (AT) and soleus muscle (SM) were performed in the longitudinal plane and relaxed tendon position. In total, 38 healthy professional female athletes were examined, applying a quasi-experimental study design, with subgroup analysis performed for different sports. To investigate the stiffness of the AT and SM, 24 female handball and volleyball athletes performed a standardized maximal incremental performance test on a treadmill. In this subgroup, myometric measurements were taken before and after the exercise test. Results: The measurements showed no significant difference between the mean pre- (AT: 661.46 N/m; SM 441.48 N/m) and post-exercise stiffness (AT: 644.71 N/m; SM: 439.07 N/m). Subgroup analysis for different types of sports showed significantly lower AT and SM stiffness in swimming athletes compared to handball (p = 0.002), volleyball (p = 0.000) and hammer throw athletes (p = 0.008). Conclusions: Myometry can be performed on the same day as an acute training session in healthy female professional volleyball and handball athletes. Female swimmers have significantly lower AT and SM stiffness compared to female handball, volleyball and hammer throw athletes. These results show that the stiffness differences in the AT and SM can be assessed by myometry.

Sitting for Too Long, Moving Too Little: Regular Muscle Contractions Can Reduce Muscle Stiffness During Prolonged Periods of Chair-Sitting.

In modern Western societies, sedentary behavior has become a growing health concern. There is increasing evidence that prolonged sitting periods can be associated with musculoskeletal disorders. While it is generally recognized that back muscle activity is low during chair-sitting, little is known about the consequences of minor to no muscle activity on muscle stiffness. Muscle stiffness may play an important role in musculoskeletal health. This study investigated the effects of regular muscle contractions on muscle stiffness in a controlled experiment in which participants sat for 4.5 h. Neuromuscular electrical stimulation in the lumbar region of the back was applied to trigger regular muscle contractions. Using stiffness measurements and continuous motion capturing, we found that prolonged sitting periods without regular muscle contractions significantly increased back muscle stiffness. Moreover, we were able to show that regular muscle contractions can prevent those effects. Our results highlight the importance of consistent muscle activity throughout the day and may help explain why prolonged periods of chair-sitting increase the susceptibility to common pathological conditions such as low back pain.

Integrating a Potentiometer into a Knee Brace Shows High Potential for Continuous Knee Motion Monitoring.

Continuous monitoring of knee motion can provide deep insights into patients' rehabilitation status after knee injury and help to better identify their individual therapeutic needs. Potentiometers have been identified as one possible sensor type for continuous monitoring of knee motion. However, to verify their use in monitoring real-life environments, further research is needed. We aimed to validate a potentiometer-embedded knee brace to measure sagittal knee kinematics during various daily activities, as well as to assess its potential to continuously monitor knee motion. To this end, the sagittal knee motion of 32 healthy subjects was recorded simultaneously by an instrumented knee brace and an optoelectronic reference system during activities of daily living to assess the agreement between these two measurement systems. To evaluate the potentiometer's behavior during continuous monitoring, knee motion was continuously recorded in a subgroup (n = 9) who wore the knee brace over the course of a day. Our results show a strong agreement between the instrumented knee brace and reference system across all investigated activities as well as stable sensor behavior during continuous tracking. The presented potentiometer-based sensor system demonstrates strong potential as a device for measuring sagittal knee motion during daily activities as well as for continuous knee motion monitoring.

The rise of the longitudinal arch when sitting, standing, and walking: Contributions of the windlass mechanism.

The original windlass mechanism describes a one-to-one coupling between metatarsal joint dorsiflexion and medial longitudinal arch rise. The description assumes a sufficiently stiff plantar aponeurosis and absence of foot muscle activity. However, recent research calls for a broader interpretation of the windlass mechanism that accounts for an extensible plantar aponeurosis and active foot muscles. In this study, we investigate the rise of the arch in response to toe dorsiflexion when sitting, standing, and walking to discuss the windlass mechanism's contributions in static and dynamic load scenarios. 3D motion analysis allowed a kinematic investigation of the rise and drop of the arch relative to the extent of toe dorsiflexion. The results suggest that static windlass effects poorly predict the relationship between arch dynamics and metatarsophalangeal joint motion during dynamic load scenarios, such as walking. We were able to show that toe dorsiflexion resulted in an immediate rise of the longitudinal arch during sitting and standing. In contrast, a decrease in arch height was observed during walking, despite toe dorsiflexion at the beginning of the push-off phase. Further, the longitudinal arch rose almost linearly with toe dorsiflexion in the static loading scenarios, while the dynamic load scenario revealed an exponential rise of the arch. In addition to that, the rate of change in arch height relative to toe motion was significantly lower when sitting and standing compared to walking. Finally, and most surprisingly, arch rise was found to correlate with toe dorsiflexion only in the dynamic loading scenario. These results challenge the traditional perspective of the windlass mechanism as the dominating source of foot rigidity for push-off against the ground during bipedal walking. It seems plausible that other mechanisms besides the windlass act to raise the foot arch.

An Identical Twin Study on Human Achilles Tendon Adaptation: Regular Recreational Exercise at Comparatively Low Intensities Can Increase Tendon Stiffness.

Achilles tendon adaptation is a key aspect of exercise performance and injury risk prevention. However, much debate exists about the adaptation of the Achilles tendon in response to exercise activities. Most published research is currently limited to elite athletes and selected exercise activities. Also, existing studies on tendon adaptation do not control for genetic variation. Our explorative cross-sectional study investigated the effects of regular recreational exercise activities on Achilles tendon mechanical properties in 40 identical twin pairs. Using a handheld oscillation device to determine Achilles tendon mechanical properties, we found that the Achilles tendon appears to adapt to regular recreational exercise at comparatively low intensities by increasing its stiffness. Active twins showed a 28% greater Achilles tendon stiffness than their inactive twin (p < 0.05). Further, our research extends existing ideas on sport-specific adaptation by showing that tendon stiffness seemed to respond more to exercise activities that included an aerial phase such as running and jumping. Interestingly, the comparison of twin pairs revealed a high variation of Achilles tendon stiffness (305.4-889.8 N/m), and tendon adaptation was only revealed when we controlled for genetic variance. Those results offer new insights into the impact of genetic variation on individual Achilles tendon stiffness, which should be addressed more closely in future studies.

Phantom material testing indicates that the mechanical properties, geometrical dimensions, and tensional state of tendons affect oscillation-based measurements.

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.

Effect of the upward curvature of toe springs on walking biomechanics in humans.

Although most features of modern footwear have been intensively studied, there has been almost no research on the effects of toe springs. This nearly ubiquitous upward curvature of the sole at the front of the shoe elevates the toe box dorsally above the ground and thereby holds the toes in a constantly dorsiflexed position. While it is generally recognized that toe springs facilitate the forefoot's ability to roll forward at the end of stance, toe springs may also have some effect on natural foot function. This study investigated the effects of toe springs on foot biomechanics in a controlled experiment in which participants walked in specially-designed sandals with varying curvature in the toe region to simulate toe springs ranging from 10 to 40 degrees of curvature. Using inverse dynamics techniques, we found that toe springs alter the joint moments and work at the toes such that greater degrees of toe spring curvature resulted in lower work requirements during walking. Our results help explain why toe springs have been a pervasive feature in shoes for centuries but also suggest that toe springs may contribute to weakening of the foot muscles and possibly to increased susceptibility to common pathological conditions such as plantar fasciitis.

The effect of marker size on three-dimensional motion analysis of the foot.

BACKGROUND: In the field of three-dimensional motion analysis of the foot, there is little agreement on the preferred size of markers to record kinematic parameters. Although currently applied marker sizes show a considerable range, there has been no detailed investigation of the effect of marker size on the calculation of foot kinematics in the current literature. RESEARCH QUESTION: The objective of this research was to determine whether marker size impacts essential parameters that describe foot biomechanics. METHODS: Seventeen subjects participated in this randomized repeatability study. All participants had to walk on a treadmill twice to test two sets of markers (set A: small marker, 9.5 mm, 1 g; set B: large marker, 14 mm, 2 g). Three-dimensional motion capturing was used to record the trajectories of the markers. The spatial relation of the markers, as well as vertical motion of the navicular bone and the angle of the medial longitudinal arch were calculated based on the marker trajectories. In addition to motion capturing, skin rigidity was quantified by applying an oscillatory shear force to the skin. Analysis of variance, root-mean-square error calculations and linear fit methods were applied to evaluate effects of marker size on the calculation of foot kinematics and the impact of skin rigidity. RESULTS: The estimated foot kinematics appeared to be unaffected by the size of the markers. Further, there was no evidence that skin rigidity influenced the error of the marker trajectories. Interestingly, the large markers fell off more frequently. SIGNIFICANCE: The findings will be of interest to those who use marker-based three-dimensional motion capturing, especially to analyze foot biomechanics. Although the calculation of kinematic parameters appears to be unaffected by marker size, practical aspects, like accidental marker loss, favor the application of small markers.

Evolutionary anatomy of the plantar aponeurosis in primates, including humans.

The plantar aponeurosis in the human foot has been extensively studied and thoroughly described, in part, because of the incidence of plantar fasciitis in humans. It is commonly assumed that the human plantar aponeurosis is a unique adaptation to bipedalism that evolved in concert with the longitudinal arch. However, the comparative anatomy of the plantar aponeurosis is poorly known in most mammals, even among non-human primates, hindering efforts to understand its function. Here, we review previous anatomical descriptions of 40 primate species and use phylogenetic comparative methods to reconstruct the evolution of the plantar aponeurosis and its relationship to the plantaris muscle in primates. Ancestral state reconstructions suggest that the overall organization of the human plantar aponeurosis is shared with chimpanzees and that a similar anatomical configuration evolved independently in different primate clades as an adaptation to terrestrial locomotion. The presence of a plantar aponeurosis with clearly developed lateral and central bands in the African apes suggests that this structure is not prohibitive to suspensory locomotion and that these species possess versatile feet adapted for both terrestrial and arboreal locomotion. This plantar aponeurosis configuration would have been advantageous in enhancing foot stiffness for bipedal locomotion in the earliest hominins, prior to the evolution of a longitudinal arch. Hominins may have subsequently evolved thicker and stiffer plantar aponeuroses alongside the arch to enable a windlass mechanism and elastic energy storage for bipedal walking and running, although this idea requires further testing.

Sedentary behaviour at work increases muscle stiffness of the back: Why roller massage has potential as an active break intervention.

There is increasing evidence that subjects who are exposed to long sitting periods suffer from musculoskeletal discomfort and back pain. The underlying mechanism and effective prevention strategies are still largely unknown. In this study, muscle stiffness of the back was measured in 59 office workers who followed their usual desk work regime for 4.5 h in a sitting posture. The sitting period was either followed by an 8-min roller massage intervention or a controlled standing task. Results showed that muscle stiffness increased significantly after the 4.5 h sitting period. When the sitting period was followed by roller massage, the stiffness values dropped slightly below baseline stiffness. In contrast, the stiffness values remained increased when the sitting period was followed by controlled standing. This study indicates that short-duration tissue manipulation can be an effective active break between prolonged sitting periods to prevent musculoskeletal issues, such as musculoskeletal discomfort and back pain.

Does neuromuscular electrostimulation have the potential to increase intrinsic foot muscle strength?

PURPOSE: The purpose of this study was to investigate the effect of an eight-week neuromuscular electrostimulation program on the intrinsic foot muscle strength. The results were compared with those from a passive and an active control group. METHODS: 74 healthy participants were recruited and divided into three groups: a neuromuscular electrostimulation group (n=19), a passive control group (n=15) with no further intervention, and an active control group following a running protocol with minimal shoes (n=40). The electrostimulation and running groups followed a training protocol consisting of two sessions per week over a period of eight weeks. Three characteristics of intrinsic foot muscle strength were investigated: cross sectional area of the abductor hallucis muscle, longitudinal arch stability, and intrinsic foot muscle fatigue. RESULTS: After eight weeks of intervention, the cross sectional area increased by 16.3% for the running group with a large effect size (0.801) according to Cohen's d. The electrostimulation group showed no such effect. The increase in the cross sectional area had no impact on longitudinal arch stability or intrinsic foot muscle fatigue results. CONCLUSION: This study investigated neuromuscular electrostimulation as a prevention and rehabilitation strategy. The results indicate that, compared to minimally shod running, the effects of electrostimulation on healthy participants might be too small to be detected. Further, the results provide evidence that the static navicular drop test is not sensitive enough to indicate intrinsic foot muscle strength. This appears clinically relevant, as this test is often used by therapists to evaluate patients' longitudinal arch function.

Tensile properties of the hip joint ligaments are largely variable and age-dependent - An in-vitro analysis in an age range of 14-93 years.

INTRODUCTION: Hip joint stability is maintained by the surrounding ligaments, muscles, and the atmospheric pressure exerted via these structures. It is unclear whether the ligaments are capable of preventing dislocation solely due to their tensile properties, and to what extent they undergo age-related changes. This study aimed to obtain stress-strain data of the hip ligaments over a large age range. METHODS: Stress-strain data of the iliofemoral (IL), ischiofemoral (IS) and pubofemoral ligament (PF) were obtained from cadavers ranging between 14 and 93 years using a highly standardized setting. Maximum strains were compared to the distances required for dislocation. RESULTS: Elastic modulus was 24.4 (IL), 22.4 (IS) and 24.9N/mm2 (PF) respectively. Maximum strain was 84.5%, 86.1%, 72.4% and ultimate stress 10.0, 7.7 and 6.5N/mm2 for the IL, IS and PF respectively. None of these values varied significantly between ligaments or sides. The IS' elastic modulus was higher and maximum strain lower in males. Lower elastic moduli of the PF and higher maximum strains for the IS and PF were revealed in the ≥55 compared to the <55 population. Maximum strain exceeded the dislocation distance of the IS without external hip joint rotation in females, and of the IS and cranial IL under external rotation in both genders. DISCUSSION: Tensile and failure load properties of the hip joint ligaments are largely variable. The IS and PF change age-dependently. Though the hip ligaments contribute to hip stability, the IS and cranial IL may not prevent dislocation due to their elasticity.

The Stress-Strain Data of the Hip Capsule Ligaments Are Gender and Side Independent Suggesting a Smaller Contribution to Passive Stiffness.

BACKGROUND: The ligaments in coherence with the capsule of the hip joint are known to contribute to hip stability. Nevertheless, the contribution of the mechanical properties of the ligaments and gender- or side-specific differences are still not completely clear. To date, comparisons of the hip capsule ligaments to other tissues stabilizing the pelvis and hip joint, e.g. the iliotibial tract, were not performed. MATERIALS & METHODS: Hip capsule ligaments were obtained from 17 human cadavers (9 females, 7 males, 13 left and 8 right sides, mean age 83.65 ± 10.54 years). 18 iliofemoral, 9 ischiofemoral and 17 pubofemoral ligaments were prepared. Uniaxial stress-strain properties were obtained from the load-deformation curves before the secant elastic modulus was computed. Strain, elastic modulus and cross sections were compared. RESULTS: Strain and elastic modulus revealed no significant differences between the iliofemoral (strain 129.8 ± 11.1%, elastic modulus 48.8 ± 21.4 N/mm2), ischiofemoral (strain 128.7 ± 13.7%, elastic modulus 37.5 ± 20.4 N/mm2) and pubofemoral (strain 133.2 ± 23.7%, elastic modulus 49.0 ± 32.1 N/mm2) ligaments. The iliofemoral ligament (53.5 ± 15.1 mm2) yielded a significantly higher cross section compared to the ischiofemoral (19.2 ± 13.2 mm2) and pubofemoral (15.2 ± 7.2 mm2) ligament. No significant gender- or side-specific differences were determined. A comparison to the published data on the iliotibial tract revealed lower elasticity and less variation in the ligaments of the hip joint. CONCLUSION: Comparison of the mechanical data of the hip joint ligaments indicates that their role may likely exceed a function as a mechanical stabilizer. Uniaxial testing of interwoven collagen fibers might lead to a misinterpretation of the mechanical properties of the hip capsule ligaments in the given setup, concealing its uniaxial properties. This underlines the need for a polyaxial test setup using fresh and non-embalmed tissues.

Quantification of material slippage in the iliotibial tract when applying the partial plastination clamping technique.

The objective of this study was to evaluate the potential of the partial plastination technique in minimizing material slippage and to discuss the effects on the tensile properties of thin dense connective tissue. The ends of twelve iliotibial tract samples were primed with polyurethane resin and covered by plastic plates to provide sufficient grip between the clamps. The central part of the samples remained in an anatomically unfixed condition. Strain data of twelve partially plastinated samples and ten samples in a completely anatomically unfixed state were obtained using uniaxial crosshead displacement and an optical image tracking technique. Testing of agreement between the strain data revealed ongoing but markedly reduced material slippage in partially plastinated samples compared to the unfixed samples. The mean measurement error introduced by material slippage was up to 18.0% in partially plastinated samples. These findings might complement existing data on measurement errors during material testing and highlight the importance of individual quantitative evaluation of errors that come along with self-made clamping techniques.

Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction.

INTRODUCTION: The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application. METHODS: Morphometric and functional data pertaining to pelvic belt effects were compared in 17 SIJ patients and 17 controls. Lumbar spine and pelvis morphometries were obtained from 3T magnetic resonance imaging. Functional electromyography data of pelvis and leg muscles and center of pressure excursions were measured in one-leg stance. The numerical rating scale was used to evaluate immediate pain-reducing effects. RESULTS: Pelvic morphometry was largely unaltered in SIJ patients and also by pelvic belt application. The angle of lumbar lateral flexion was significantly larger in SIJ patients without belt application. Muscle activity and center of pressure were unaffected by SIJ pain or by belt application in one-leg stance. Nine of 17 patients reported decreased pain intensities under moderate belt application, four reported no change and four reported increased pain intensity. For the entire population investigated here, this qualitative description was not confirmed on a statistical significant level. DISCUSSION: Minute changes were observed in the alignment of the lumbar spine in the frontal plane in SIJ patients. The potential pain-decreasing effects of pelvic belts could not be attributed to altered muscle activity, pelvic morphometry or body balance in a static short-term application. Long-term belt effects will therefore be of prospective interest.

Do cells contribute to tendon and ligament biomechanics?

INTRODUCTION: Acellular scaffolds are increasingly used for the surgical repair of tendon injury and ligament tears. Despite this increased use, very little data exist directly comparing acellular scaffolds and their native counterparts. Such a comparison would help establish the effectiveness of the acellularization procedure of human tissues. Furthermore, such a comparison would help estimate the influence of cells in ligament and tendon stability and give insight into the effects of acellularization on collagen. MATERIAL AND METHODS: Eighteen human iliotibial tract samples were obtained from nine body donors. Nine samples were acellularized with sodium dodecyl sulphate (SDS), while nine counterparts from the same donors remained in the native condition. The ends of all samples were plastinated to minimize material slippage. Their water content was adjusted to 69%, using the osmotic stress technique to exclude water content-related alterations of the mechanical properties. Uniaxial tensile testing was performed to obtain the elastic modulus, ultimate stress and maximum strain. The effectiveness of the acellularization procedure was histologically verified by means of a DNA assay. RESULTS: The histology samples showed a complete removal of the cells, an extensive, yet incomplete removal of the DNA content and alterations to the extracellular collagen. Tensile properties of the tract samples such as elastic modulus and ultimate stress were unaffected by acellularization with the exception of maximum strain. DISCUSSION: The data indicate that cells influence the mechanical properties of ligaments and tendons in vitro to a negligible extent. Moreover, acellularization with SDS alters material properties to a minor extent, indicating that this method provides a biomechanical match in ligament and tendon reconstruction. However, the given protocol insufficiently removes DNA. This may increase the potential for transplant rejection when acellular tract scaffolds are used in soft tissue repair. Further research will help optimize the SDS-protocol for clinical application.

Pelvic belt effects on sacroiliac joint ligaments: a computational approach to understand therapeutic effects of pelvic belts.

BACKGROUND: The sacroiliac joint is a widely described source of low back pain. Therapeutic approaches to relieve pain include the application of pelvic belts. However, the effects of pelvic belts on sacroiliac joint ligaments as potential pain generators are mostly unknown. OBJECTIVES: The aim of our study was to analyze the influence of pelvic belts on ligament load by means of a computer model. STUDY DESIGN: Experimental computer study using a finite element method. METHODS: A computer model of the human pelvis was created, comprising bones, ligaments, and cartilage. Detailed geometries, material properties of ligaments, and in-vivo pressure distribution patterns of a pelvic belt were implemented. The effects of pelvic belts on ligament strain were computed in the double-leg stance. RESULTS: Pelvic belts increase sacroiliac joint motion around the sagittal axis but decrease motion around the transverse axis. With pelvic belt application, most of the strained sacroiliac joint ligaments were relieved, especially the sacrospinous, sacrotuberous, and the interosseous sacroiliac ligaments. Sacroiliac joint motion and ligament strains were minute. These results agree with validation data from other studies. LIMITATIONS: Assigning homogenous and linear material properties and excluding muscle forces are clear simplifications of the complex reality. CONCLUSIONS: Pelvic belts alter sacroiliac joint motion and provide partial relief of ligament strain that is subjectively marked, although minimal in absolute terms. These findings confirm theories that besides being mechanical stabilizers, the sacroiliac joint ligaments are likely involved in neuromuscular feedback mechanisms. The results from our computer model help with unraveling the therapeutic mechanisms of pelvic belts.

Combined spectrophotometry and tensile measurements of human connective tissues: potentials and limitations.

Strain-dependent transmission data of nine iliotibial tract specimens are determined using a custom-built optical setup with a halogen light source and an industrial norm material testing machine. Polarized light microscopy and hematoxylin-eosin staining indicated that lateral contraction of collagen structures is responsible for total intensity variations during a 20-cycle preconditioning and a 5-cycle tensile test. Tensile force progress is opposite to total transmission progress. Due to dehydration, wavelength-specific radiation intensity shifting is determined during the test, primarily noticeable in a water absorption band between 1400 and 1500 nm. The results show the capability of integrating spectrophotometry technology into biomechanics for determining structural alterations of human collagen due to applied strain. Being more sensitive to drying, spectrophotometry may likely serve as a quality control in stress-strain testing of biological structures.