Semitendinosus and biceps femoris long head activity during the single leg bridge test in healthy individuals.

INTRODUCTION: The single leg bridge test (SLBT) has been suggested as a clinical test to examine function, screen injury risk, and monitor the effectiveness of rehabilitation programes targeting the hamstring. This study aimed to determine the inter-day reliability and repeatability of both SLBT performance, semitendinosus (ST), and biceps femoris long head (BFlh) surface electromyography (sEMG) responses and characterise the BFlh and ST electrical activity during the SLBT performed until exhaustion in healthy individuals. METHODS: Twelve physically active young men without previous hamstring injury were tested for the number of repetitions attained, and sEMG signal median frequency and amplitude in both ST and BFlh of each lower limb, randomly in two sessions, with a seven-day interval between sessions. RESULTS: High reliability [ICC = 0.85] was found for the number of SLBT repetitions attained. Reliability of sEMG outcomes showed better results for ST (ICC = 0.62-0.91) than for BFlh (ICC = 0.39-0.81), and a high to very-high repeatability was found for both ST (ICC = 0.91-0.84) and BFlh (ICC = 0.91-0.85). sEMG median frequency decreased and amplitude increased for both BFlh (p ≤ 0.001) and ST (p ≤ 0.039) at the end of SLBT, suggesting localised fatigue. CONCLUSIONS: The SLBT performed by healthy individuals until exhaustion proved to be reliable and to induce fatigue in both BFlh and ST, where the sEMG median frequency and amplitude can be measured on different days with acceptable reliability and high repeatability, suggesting its potential future use in both practical and clinical settings.

Semitendinosus and biceps femoris long head active stiffness response until failure in professional footballers with vs. without previous hamstring injury.

This study sought to examine the active stiffness of semitendinosus (ST) and biceps femoris long head (BFlh) during a knee flexor isometric contraction at 20% of maximal voluntary isometric contraction until failure in elite footballers (n = 50, age: 22.3 ± 5.3 years; height: 1.82 ± 0.08 m; body mass: 74.7 ± 9.0 kg). Active stiffness was assessed using ultrasound-based shear wave elastography by means of shear modulus quantification. Comparisons were performed between limbs with (n = 11) vs. without (n = 89) previous hamstring injury. A similar time until failure in the knee flexor fatigue task was observed between groups (p = .401). At the start of the task, lower limbs with previous hamstring injury showed a lower BFlh active stiffness (31.0.1 ± 10.4 kPa, p = .023) and BFlh/ST active stiffness ratio (0.50 ± 0.29), and no differences for ST (72.8 ± 26.8 kPa, p = .221) compared to lower limbs without previous hamstring injuries (BFlh: 38.0 ± 9.6 kPa; ST: 64.0 ± 18.4 kPa; BFlh/ST: 0.65 ± 0.27). During the task, the ST active stiffness in both groups decreased from 80% of task time (p = .032), in the absence of changes in BFlh active stiffness (p = .534), resulting in an increase in BFlh/ST active stiffness from 80% of task time (p = .029). No differences between limbs were observed during the fatigue task for all parameters (p > .099). Future research is warranted to verify if the differences found represent an increased risk of hamstring injury. HighlightsThe hamstring's active stiffness response to a fatigue protocol in soccer athletes with a history of injury is unknown.Athletes with previous injury showed less active stiffness in the biceps femoris long head.Similar response to fatigue was observed between athletes with and without hamstring injury history.

Effects of knee flexor submaximal isometric contraction until exhaustion on semitendinosus and biceps femoris long head shear modulus in healthy individuals.

This study examined whether a knee flexor isometric contraction at 20% of maximal voluntary isometric contraction until exhaustion would alter the biceps femoris long head (BFlh) and semitendinosus (ST) active stiffness, assessed using ultrasound-based shear wave elastography. Twelve healthy individuals participated in 2 sessions separated by 7 days. Time to exhaustion was similar in both sessions (day 1: 443.8 ± 192.5 s; day 2: 474.6 ± 131.7 s; p = 0.323). At the start of the fatigue task, the ST showed greater active stiffness than the BFlh (p < 0.001), with no differences between days (p = 0.08). The ST active stiffness then decreased from 40% of the task time to exhaustion (- 2.2 to - 13.3%, p = 0.027) until the end of the task (- 16.1 to - 22.9%, p = 0.012), while no significant changes were noted in the BFlh (p = 0.771). Immediately after the fatigue task, a decrease in active stiffness was observed in the ST (- 11.8 to - 17.8%, p < 0.001), but not in the BFlh (p = 0.551). Results were consistent between the 2 testing sessions (p = 0.07-0.959). The present results indicate that fatigue alters the hamstring active stiffness pattern.

Is Biceps Femoris Aponeurosis Size an Independent Risk Factor for Strain Injury?

This study examined whether professional footballers with previous biceps femoris long head (BFLH) injury in the last 3-years present a smaller proximal aponeurosis (Apo-BFLH) size compared to footballers with no previous injury. We examined the Apo-BFLH and BFLH size using magnetic resonance imaging and tested the knee flexor maximal isometric strength in 80 thighs of 40 footballers. Apo-BFLH size parameters were processed using a semi-automated procedure. Outcomes were compared between thighs with (n=9) vs. without (n=71) previous BFLH injury. No differences were observed between injured and non-injured thighs for the Apo-BFLH and BFLH size parameters (p>0.05) except for Apo-BFLH volume, which was higher in the non-injured thighs of athletes with previous injury (3692.1±2638.4 mm3, p<0.006) compared to the left (2274.1±798.7 mm3) thighs of athletes without previous injury. A higher knee flexor isometric strength was observed in the injured limb of athletes with previous BFLH injury (196.5±31.9 Nm, p<0.003) compared to the left (156.2±31.4 Nm) and right (160.0±31.4 Nm) thighs of non-injured athletes. The present results suggest that BFLH proximal aponeurosis size should not be considered as an independent risk factor for strain injury.

Shear Wave Elastographic Investigation of the Immediate Effects of Slump Neurodynamics in People With Sciatica.

OBJECTIVES: Neurodynamic techniques are often used to treat people with sciatica pain, but their mechanical effects on the sciatic nerve are unknown. Shear wave elastography (SWE) has been shown to effectively estimate the stiffness of peripheral nerves in real time. The aim of this study was to use SWE to assess the effects of slump neurodynamics in the sciatic stiffness of people with sciatica. METHODS: Sixteen participants volunteered for this study. The sciatic stiffness of 8 patients with unilateral chronic sciatica and 8 healthy control participants was measured by SWE, with the participants in a prone position and during a dynamic condition (ie, ankle dorsiflexion). These measurements were performed before and immediately after the neurodynamic intervention, which consisted of a static slump position applied to the symptomatic limb of the patients with sciatica and in a randomly chosen limb of the healthy participants. RESULTS: The 8 patients with sciatica included 6 male and 2 female patients, and the 8 healthy control participants included 5 male and 3 female volunteers. Slump neurodynamics resulted in an immediate decrease in the sciatic nerve stiffness of the symptomatic limb in people with sciatica by 16.1% (effect size = 0.65; P = .019). The intervention showed no significant changes in the sciatic nerve stiffness of the healthy participants (effect size = 0.05; P = .754). CONCLUSIONS: Slump neurodynamics have the potential of decreasing the sciatic nerve stiffness in people with sciatica, and this effect can be quantified by SWE, which may provide valuable information for health professionals.

Does epimuscular myofascial force transmission occur between the human quadriceps muscles in vivo during passive stretching?

This study sought to examine the shear modulus (i.e., an force index) of three quadriceps muscles [i.e., vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF)] during passive stretching to determine whether epimuscular myofascial force transmission occurs across muscles. Secondly, this study compared the shear modulus between the quadriceps muscles, in both proximal and distal regions. Twelve healthy individuals were assessed during a passive knee flexion maneuver between 0° and 90° of knee flexion with the hip in two positions: flexed (80°) vs. neutral (0°). Muscle electrical activity was also assessed during the testing. No differences were observed between the hip testing positions for myoelectric activity (p > 0.43), and for VL and VM shear modulus (p = 0.12-0.98). Similarly, there were no differences between the proximal and distal regions for all muscles (p = 0.42-0.93). RF showed a higher shear modulus with the hip in the neutral position (p = 0.004). With the hip flexed, the VL showed the greatest shear modulus among the tested muscles (p < 0.025); while with the hip in the neutral position, no differences were observed for shear modulus between VL and RF (p = 0.817). These findings suggest that epimuscular myofascial force transmission (at a muscle belly level) does not occur between the quadriceps muscles when passively flexing the knee until 90°. Whether epimuscular myofascial force transmission occurs in the quadriceps muscles bellies with greater muscle stretch (either through knee flexion or hip extension) remains to be examined.

Noninvasive Measurement of Sciatic Nerve Stiffness in Patients With Chronic Low Back Related Leg Pain Using Shear Wave Elastography.

OBJECTIVES: The purpose of this study was to determine whether sciatic nerve stiffness is altered in people with chronic low back-related leg pain by using shear wave elastography. METHODS: In this cross-sectional study, the sciatic nerve shear wave velocity (ie, an index of stiffness) was measured in both legs of 16 participants (8 with unilateral low back-related leg pain and 8 healthy controls). Sciatic stiffness was measured during a passive ankle dorsiflexion motion performed at 2°/s in an isokinetic dynamometer. The ankle range of motion and passive torque, as well as muscle activity, were also measured. RESULTS: In people with low back-related leg pain, the affected limb showed higher sciatic nerve stiffness compared to the unaffected limb (+11.3%; P = .05). However, no differences were observed between the unaffected limb of people with low back-related leg pain and the healthy controls (P = .34). CONCLUSIONS: People with chronic low back-related leg pain have interlimb differences in sciatic nerve stiffness, as measured by a safe and noninvasive method: shear wave elastography. The changes found may be related to alterations in nerve mechanical properties, which should be confirmed by future investigations.

Hamstring stiffness pattern during contraction in healthy individuals: analysis by ultrasound-based shear wave elastography.

PURPOSE: To assess the stiffness of hamstring muscles during isometric contractions in healthy individuals, using ultrasound-based shear wave elastography to (1) determine the intra- and inter-day assessment repeatability, (2) characterize the stiffness of semitendinosus (ST) and biceps femoris long head (BFlh) along the contraction intensity, and (3) characterize stiffness distribution among the hamstring muscles and inter-limb symmetry. METHODS: Two experiments were conducted. In experiment I (n = 12), the intra-day repeatability in assessing the BFlh and ST stiffness were determined at intensities between 10-60% of maximal voluntary isometric contraction (MVIC) in a single session. In experiment II (n = 11), the stiffness of the hamstring muscles of both thighs was assessed at 20% of MVIC in the first session; and retested (for one randomly chosen thigh) in a second session. Isometric contraction of knee flexors was performed with the knee flexed at 30° and with the hip in a neutral position. RESULTS: Moderate-to-very-high intra- and inter-day repeatability was found (ICC = 0.69-0.93). The BFlh/ST stiffness ratio increased with contraction intensity. At 20% of MVIC, the ST showed the highest stiffness among the hamstring muscles (p < 0.02), with no differences between the remaining hamstring muscles (p > 0.474). No differences were found between limbs (p = 0.12). CONCLUSIONS: The stiffness distribution among the hamstring muscles during submaximal isometric contractions is heterogeneous, but symmetric between limbs, and changes depending on the contraction intensity. Shear wave elastography is a reliable tool to assess the stiffness of hamstring muscles during contraction.

Sciatic nerve stiffness is not changed immediately after a slump neurodynamics technique.

BACKGROUND: Neurodynamics techniques aim to assess and improve neural mechanosensitivity. However, there is no in vivo evidence regarding the mechanical effects of these techniques in the nerve stiffness. This study examined the immediate effects of a slump neurodynamics technique in the sciatic nerve shear wave velocity (SWV. i.e. an index of stiffness) using ultrasound-based elastography. METHODS: Fourteen healthy participants were included in this experiment. Sciatic SWV and ankle passive torque were measured during a passive ankle dorsiflexion motion (2°/s), before and immediately after 3 minutes of slump neurodynamics technique, randomly applied to one lower limb. The contralateral limb served as control. RESULTS: The slump intervention did not change the sciatic SWV (P=0.78), nor the dorsiflexion passive torque (P=0.14), throughout the ankle dorsiflexion motion. Excellent values of intra-rater repeatability (ICC=0.88, 0.68-0.96), and low values of standard error of measurement (0.59 m/s, 0.35-1.15m/s), were observed for the SWV measurements. CONCLUSIONS: The sciatic nerve stiffness of healthy participants did not change immediately after a slump neurodynamics technique, suggesting a compliance of the neural tissue to tensile loads. However, these results ought to be confirmed using other neurodynamics techniques and in other populations (e.g. peripheral neuropathies). LEVEL OF EVIDENCE: III.