Ultrasound segmentation analysis via distinct and completed anatomical borders.

PURPOSE: Segmenting ultrasound images is important for precise area and/or volume calculations, ensuring reliable diagnosis and effective treatment evaluation for diseases. Recently, many segmentation methods have been proposed and shown impressive performance. However, currently, there is no deeper understanding of how networks segment target regions or how they define the boundaries. In this paper, we present a new approach that analyzes ultrasound segmentation networks in terms of learned borders because border delimitation is challenging in ultrasound. METHODS: We propose a way to split the boundaries for ultrasound images into distinct and completed. By exploiting the Grad-CAM of the split borders, we analyze the areas each network pays attention to. Further, we calculate the ratio of correct predictions for distinct and completed borders. We conducted experiments on an in-house leg ultrasound dataset (LEG-3D-US) as well as on two additional public datasets of thyroid, nerves, and one private for prostate. RESULTS: Quantitatively, the networks exhibit around 10% improvement in handling completed borders compared to distinct borders. Similar to doctors, the network struggles to define the borders in less visible areas. Additionally, the Seg-Grad-CAM analysis underscores how completion uses distinct borders and landmarks, while distinct focuses mainly on the shiny structures. We also observe variations depending on the attention mechanism of each architecture. CONCLUSION: In this work, we highlight the importance of studying ultrasound borders differently than other modalities such as MRI or CT. We split the borders into distinct and completed, similar to clinicians, and show the quality of the network-learned information for these two types of borders. Additionally, we open-source a 3D leg ultrasound dataset to the community https://github.com/Al3xand1a/segmentation-border-analysis .

Preoperative Rehabilitation Enhances Mental and Physical Well-Being in Anterior Cruciate Ligament-Injured Individuals: A Mixed Methods Study.

CONTEXT: Rehabilitation after an anterior cruciate ligament injury is recommended to be started soon after the injury. When surgery is required, research supports the delivery of physiotherapy before anterior cruciate ligament reconstruction (prehabilitation) to optimize recovery and positive outcomes. Individuals attending prehabilitation have never been questioned regarding their adherence to prehabilitation, perception of utility in meeting needs, upcoming events, or anticipated recovery goals. DESIGN: Mixed methods cross-sectional study: Methods: 25 individuals before anterior cruciate ligament reconstruction (43% of eligible individuals from 12 clinics during the delivery period) were surveyed on their mindset and recovery expectancies. Semistructured interviews conducted in 9 of 25 participants assessed their lived experience of prehabilitation. RESULTS: Participants reported that preventing a reinjury (96% of responses) and feeling confident during daily activities about their knee (92%) were the higher rating expectations at this stage of their treatment course. Three themes were developed from the interviews and analyses. (1) Participants reported that prehabilitation was a period full of challenges with memories of the injury and uncertainties. (2) They viewed prehabilitation as a step to move forward by finding support and self-motivating. (3) They believed that prehabilitation would have positive impacts on the treatment outcomes. Participants were confident that prehabilitation would accelerate the recovery of muscle volume (88%) and strength (84%). CONCLUSION: Participants had positive experiences of prehabilitation, aligning with the findings on functional outcomes in the existing literature on prehabilitation.

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

PURPOSE: This study aimed to determine whether mild to moderate muscle damage accumulates on the knee extensors after two bouts of maximal eccentric contractions performed over two consecutive days. METHODS: Thirty participants performed an initial bout of maximal eccentric contractions of knee extensors during the first day of the protocol (ECC1). Then, they were separated in two groups. The Experimental (EXP) group repeated the eccentric bout 24 h later (ECC2) while the Control (CON) group did not. Indirect markers of muscle damage (i.e., strength loss, muscle soreness, and shear modulus) were measured to quantify the amount of muscle damage and its time course. RESULTS: Two days after the initial eccentric session, participants from EXP had a higher strength deficit (- 14.5 ± 10.6%) than CON (- 6.6 ± 8.7%) (P = 0.017, d = 0.9). Although both groups exhibited an increase in knee extensors shear modulus after ECC1, we found a significant increase in muscle shear modulus (+ 13.3 ± 22.7%; P < 0.01; d = 0.5) after ECC2 for the EXP group, despite the presence of mild to moderate muscle damage (i.e., strength deficit about 16%). CONCLUSION: Although the markers of muscle damage used in the current study were indirect, they suggest that the repetition of two bouts of maximal eccentric contractions with 24 h apart induces additional muscle damage in the knee extensors in presence of mild to moderate muscle damage.

Validity and Reliability of 3-D Ultrasound Imaging to Measure Hamstring Muscle and Tendon Volumes.

OBJECTIVE: The validity and reliability of 3-D ultrasound (US) in estimation of muscle and tendon volume was assessed in a very limited number of muscles that can be easily immersed. The objective of the present study was to assess the validity and reliability of muscle volume measurements for all hamstring muscle heads and gracilis (GR), as well as tendon volume for the semitendinosus (ST) and GR using freehand 3-D US. METHODS: Three-dimensional US acquisitions were performed for 13 participants in two distinct sessions on separate days, in addition to one session dedicated to magnetic resonance imaging (MRI). Volumes of ST, semimembranosus (SM), biceps femoris short (BFsh) and long (BFlh) heads, and GR muscles and from the tendon from semitendinosus (STtd) and gracilis (GRtd) were collected. RESULTS: The bias and the 95% confidence intervals of 3-D US compared with MRI ranged from -1.9 mL (-0.8%) to 1.2 mL (1.0%) for muscle volume and from 0.01 mL (0.2%) to -0.03 mL (-2.6%) for tendon volume. For muscle volume assessed using 3-D US, intraclass correlation coefficients (ICCs) ranged from 0.98 (GR) to 1.00, and coefficients of variation (CV) from 1.1% (SM) to 3.4% (BFsh). For tendon volume, ICCs were 0.99, and CVs between 3.2% (STtd) and 3.4% (GRtd). CONCLUSION: Three-dimensional US can provide a valid and reliable inter-day measurement of hamstrings and GR for both muscle and tendon volumes. In the future, this technique could be used as an outcome for strengthening interventions and potentially in clinical environments.

A Very Low Volume of Nordic Hamstring Exercise Increases Maximal Eccentric Strength and Reduces Hamstring Injury Rate in Professional Soccer Players.

The aim of this study was to determine whether the inclusion of a very low volume (1 set of 3 maximal repetitions) of eccentric-biased Nordic hamstring program of 21 weeks induced an increase in maximal eccentric strength and whether its magnitude was influenced by the compliance rate. The secondary aim of this study was to determine whether this eccentric-biased Nordic hamstring program was effective at reducing hamstring injury rate. Twenty-three professional soccer players formed the experimental group and undertook regular in-season hamstring strength training and monitoring for 21 weeks. Data from 23 players in the immediately preceding cohort (previous year) were included as a control group. The subdivision of the experimental group revealed that the high compliance subgroup (∼13 d between sessions) exhibited higher changes in maximal eccentric strength compared with the low compliance group (∼24 d between sessions; +26.5%; 95% confidence interval, 7.1%-45.9%; P < .001; g = 1.2). Five hamstring injuries (22%) were recorded in the experimental group and 9 (39%) in the control group, corresponding to a nonsignificant 2.7-fold lower risk (P = .12) of suffering hamstring injury in the experimental group. The current study demonstrates that the inclusion of a very low volume of eccentric-biased Nordic hamstring program for 21 weeks induced an increase in maximal eccentric strength (∼15%) in professional soccer players, the magnitude of which depended on the players' compliance. We also found that this program was efficient (2.7-fold lower risk), although nonsignificant, at reducing hamstring injury rate in professional soccer players.

Hamstring muscle activation strategies during eccentric contractions are related to the distribution of muscle damage.

Large inter-individual variability of activation strategies is observed during hamstring strengthening exercises but their consequences remain unexplored. The objective of this study was to determine whether individual activation strategies are related to the distribution of damage across the hamstring muscle heads semimembranosus (SM), semitendinosus (ST), and biceps femoris (BF) after eccentric contractions. 24 participants performed 5 sets of 15 maximal eccentric contractions of knee flexors on a dynamometer, while activation of each muscle head was assessed using surface electromyography. Knee flexion maximal isometric strength was assessed before exercise and 48 h afterward. Shear modulus was measured using shear wave elastography before exercise and 30 min afterward to quantify the distribution of damage across the hamstring muscle heads. At 48 h, maximal knee flexion torque had decreased by 15.9% ± 16.9% (p < 0.001). Although no differences between activation ratios of each muscle were found during the eccentric exercise (all p > 0.364), we reported a heterogeneous distribution of damage, with a larger change in shear modulus of ST/Hams than SM/Hams (+70.8%, p < 0.001) or BF/Hams (+50.3%, p < 0.001). A large correlation was found between the distribution of activation and the distribution of damage for ST/Hams (r = 0.69; p < 001). This study provides evidence that the distribution of activation during maximal eccentric contractions has mechanical consequences for synergist muscles. Further studies are needed to understand whether individual activation strategies influence the distribution of structural adaptations after a training program.

Less common synaptic input between muscles from the same group allows for more flexible coordination strategies during a fatiguing task.

This study aimed to determine whether neural drive is redistributed between muscles during a fatiguing isometric contraction, and if so, whether the initial level of common synaptic input between these muscles constrains this redistribution. We studied two muscle groups: triceps surae (14 participants) and quadriceps (15 participants). Participants performed a series of submaximal isometric contractions and a torque-matched contraction maintained until task failure. We used high-density surface electromyography to identify the behavior of 1,874 motor units from the soleus, gastrocnemius medialis (GM), gastrocnemius lateralis (GL), rectus femoris, vastus lateralis (VL), and vastus medialis (VM). We assessed the level of common drive between muscles in the absence of fatigue using a coherence analysis. We also assessed the redistribution of neural drive between muscles during the fatiguing contraction through the correlation between their cumulative spike trains (index of neural drive). The level of common drive between VL and VM was significantly higher than that observed for the other muscle pairs, including GL-GM. The level of common drive increased during the fatiguing contraction, but the differences between muscle pairs persisted. We also observed a strong positive correlation of neural drive between VL and VM during the fatiguing contraction (r = 0.82). This was not observed for the other muscle pairs, including GL-GM, which exhibited differential changes in neural drive. These results suggest that less common synaptic input between muscles allows for more flexible coordination strategies during a fatiguing task, i.e., differential changes in neural drive across muscles. The role of this flexibility on performance remains to be elucidated.NEW & NOTEWORTHY Redundancy of the neuromuscular system theoretically allows for a redistribution of the neural drive across muscles (i.e., between-muscle compensation) during a fatiguing contraction. Our results suggest that a high level of common input between muscles (e.g., vastus lateralis and medialis) represents a neural constraint making it less likely to redistribute the neural drive across these muscles. In this way, redistribution was only observed across muscles that share little common synaptic input (e.g., gastrocnemius lateralis and medialis).

Individual differences in the distribution of activation among the hamstring muscle heads during stiff-leg Deadlift and Nordic hamstring exercises.

The aim of this study was to compare the distribution of activation among the three heads of the hamstring between a knee flexion-oriented exercise (Nordic hamstring) and a hip extension-oriented exercise (stiff-leg Deadlift) at the group and individual level. Data were collected for 20 participants. Muscle activation of the semimembranosus (SM), semitendinosus (ST), and biceps femoris (BF) was estimated using surface electromyography (EMG) during Nordic hamstring and stiff-leg Deadlift exercises. Although Nordic hamstring exercise induced a higher normalized RMS EMG value for BF (64.5 ± 17.4%) compared to SM (48.6 ± 14.6%; P<0.001) and ST (55.9 ± 17.4%; P < 0.001), the greatest active muscle varied between individuals. Similar interindividual differences in the greatest active muscle were found for the stiff-leg Deadlift exercise. Regarding the distribution of activation, the stiff-leg Deadlift favoured the contribution of the SM compared to ST (P < 0.001, 18/20 participants) whereas the Nordic hamstring exercise favoured the contribution of the ST compared to SM (P < 0.001, 19/20 participants). Importantly, these tasks affected the contribution of the activation of BF in different ways between individuals. The distribution of activation across the three muscles was well correlated between the two exercises (r values ≥ 0.42).

IFSS-Net: Interactive Few-Shot Siamese Network for Faster Muscle Segmentation and Propagation in Volumetric Ultrasound.

We present an accurate, fast and efficient method for segmentation and muscle mask propagation in 3D freehand ultrasound data, towards accurate volume quantification. A deep Siamese 3D Encoder-Decoder network that captures the evolution of the muscle appearance and shape for contiguous slices is deployed. We use it to propagate a reference mask annotated by a clinical expert. To handle longer changes of the muscle shape over the entire volume and to provide an accurate propagation, we devise a Bidirectional Long Short Term Memory module. Also, to train our model with a minimal amount of training samples, we propose a strategy combining learning from few annotated 2D ultrasound slices with sequential pseudo-labeling of the unannotated slices. We introduce a decremental update of the objective function to guide the model convergence in the absence of large amounts of annotated data. After training with a few volumes, the decremental update strategy switches from a weak supervised training to a few-shot setting. Finally, to handle the class-imbalance between foreground and background muscle pixels, we propose a parametric Tversky loss function that learns to penalize adaptively the false positives and the false negatives. We validate our approach for the segmentation, label propagation, and volume computation of the three low-limb muscles on a dataset of 61600 images from 44 subjects. We achieve a Dice score coefficient of over 95% and a volumetric error of 1.6035 ± 0.587%.

Lower limb muscle injury location shift from posterior lower leg to hamstring muscles with increasing discipline-related running velocity in international athletics championships.

OBJECTIVE: To analyse the rates of lower limb muscle injuries in athletics disciplines requiring different running velocities during international athletics championships. DESIGN: Prospective total population study. METHODS: During 13 international athletics championships (2009-2019) national medical teams and local organizing committee physicians daily reported all newly incurred injuries using the same study design, injury definition and data collection procedures. In-competition lower limb muscle injuries of athletes participating in disciplines involving running (i.e. sprints, hurdles, jumps, combined events, middle distances, long distances, and marathon) were analysed. RESULTS: Among the 12,233 registered athletes, 344 in-competition lower limb muscle injuries were reported (36% of all in-competition injuries). The proportion, incidence rates and injury burden of lower limb muscles injuries differed between disciplines for female and male athletes. The most frequently injured muscle group was hamstring in sprints, hurdles, jumps, combined events and male middle distances runners (43-75%), and posterior lower leg in female middle distances, male long distances, and female marathon runners (44-60%). Hamstring muscles injuries led to the highest burden in all disciplines, except for female middle distance and marathon and male long distance runners. Hamstring muscles injury burden was generally higher in disciplines requiring higher running velocities, and posterior lower leg muscle injuries higher in disciplines requiring lower running velocities. CONCLUSIONS: The present study shows discipline-specific injury location in competition context. Our findings suggest that the running velocity could be one of the factors that play a role in the occurrence/location of muscle injuries.

Revealing the unique features of each individual's muscle activation signatures.

There is growing evidence that each individual has unique movement patterns, or signatures. The exact origin of these movement signatures, however, remains unknown. We developed an approach that can identify individual muscle activation signatures during two locomotor tasks (walking and pedalling). A linear support vector machine was used to classify 78 participants based on their electromyographic (EMG) patterns measured on eight lower limb muscles. To provide insight into decision-making by the machine learning classification model, a layer-wise relevance propagation (LRP) approach was implemented. This enabled the model predictions to be decomposed into relevance scores for each individual input value. In other words, it provided information regarding which features of the time-varying EMG profiles were unique to each individual. Through extensive testing, we have shown that the LRP results, and by extent the activation signatures, are highly consistent between conditions and across days. In addition, they are minimally influenced by the dataset used to train the model. Additionally, we proposed a method for visualizing each individual's muscle activation signature, which has several potential clinical and scientific applications. This is the first study to provide conclusive evidence of the existence of individual muscle activation signatures.

A Gel Pad Designed to Measure Muscle Volume Using Freehand 3-Dimensional Ultrasonography.

We developed an innovative gel pad that covers the entire lower leg to remove artifacts due to the pressure of the transducer in freehand 3-dimensional ultrasonography. In comparison to the reference method in water, this study showed that this new method was valid (bias, 3.4 mL; limit of agreement, 7.7 mL for a volume of ≈220 mL) and reliable (coefficient of variation, <1.1%) for the measurement of gastrocnemius medialis muscle volume. Considering that it is easier to use than the water tank technique, it has much promise for volumetric measurement of many muscles.

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

Tissue-directed stretching interventions can preferentially load muscular or nonmuscular structures such as peripheral nerves. How these tissues adapt mechanically to long-term stretching is poorly understood. This randomized, single-blind, controlled study used ultrasonography and dynamometry to compare the effects of 12-wk nerve-directed and muscle-directed stretching programs versus control on maximal ankle dorsiflexion range of motion (ROM) and passive torque, shear wave velocity (SWV; an index of stiffness), and architecture of triceps surae and sciatic nerve. Sixty healthy adults were randomized to receive nerve-directed stretching, muscle-directed stretching, or no intervention (control). The muscle-directed protocol was designed to primarily stretch the plantar flexor muscle group, whereas the nerve-directed intervention targeted the sciatic nerve tract. Compared with the control group [mean; 95% confidence interval (CI)], muscle-directed intervention showed increased ROM (+7.3°; 95% CI: 4.1-10.5), decreased SWV of triceps surae (varied from -0.8 to -2.3 m/s across muscles), decreased passive torque (-6.8 N·m; 95% CI: -11.9 to -1.7), and greater gastrocnemius medialis fascicle length (+0.4 cm; 95% CI: 0.1-0.8). Muscle-directed intervention did not affect the SWV and size of sciatic nerve. Participants in the nerve-directed group showed a significant increase in ROM (+9.9°; 95% CI: 6.2-13.6) and a significant decrease in sciatic nerve SWV (> -1.8 m/s across nerve regions) compared with the control group. Nerve-directed intervention had no effect on the main outcomes at muscle and joint levels. These findings provide new insights into the long-term mechanical effects of stretching interventions and have relevance to clinical conditions where change in mechanical properties has occurred.NEW & NOTEWORTHY This study demonstrates that the mechanical properties of plantar flexor muscles and sciatic nerve can adapt mechanically to long-term stretching programs. Although interventions targeting muscular or nonmuscular structures are both effective at increasing maximal range of motion, the changes in tissue mechanical properties (stiffness) are specific to the structure being preferentially stretched by each program. We provide the first in vivo evidence that stiffness of peripheral nerves adapts to long-term loading stimuli using appropriate nerve-directed stretching.

Force-sharing within the Triceps Surae: An Achilles Heel in Achilles Tendinopathy.

PURPOSE: The primary aim of this study was to determine whether the distribution of force between the three heads of the triceps surae differs between people with Achilles tendinopathy and controls. We also aimed to determine the effect of this force distribution on subtendon strain. METHODS: Data were collected for 21 participants with Achilles tendinopathy and 21, case-wise paired, asymptomatic controls. Ultrasonography was used to measure muscle volume, fascicle length, pennation angle and subtendon length at rest. Muscle activation was estimated using surface electromyography during maximal and submaximal isometric plantarflexion tasks. The product of normalized activation, physiological cross-sectional area, and the cosine of the pennation angle was considered as an index of individual muscle force. Displacement of the distal myotendinous junction of each muscle was measured during the submaximal contractions. RESULTS: The contribution of the gastrocnemius lateralis to the overall triceps surae physiological cross-sectional area and activation was 8.5% (P = 0.047, d = 0.75) and 24.7% lower (main effect group P = 0.009, d = 0.67) in people with Achilles tendinopathy than in the controls, respectively. Consequently, gastrocnemius lateralis contributed approximately 28% less (main effect group P = 0.025, d = 0.62) of the triceps surae force in people with Achilles tendinopathy. The contribution of gastrocnemius medialis and soleus was not different between groups. Subtendon strain was not different between groups (P = 0.835). CONCLUSIONS: These results provide evidence for a difference in force-sharing strategy within the triceps surae in people with Achilles tendinopathy compared with the controls. Whether this altered strategy is a cause or a consequence of Achilles tendinopathy should be explored further.

Hamstring muscle elasticity differs in specialized high-performance athletes.

The effect of training on hamstring flexibility has been widely assessed through the measurement of the maximal range of motion or passive torque. However, these global measures do not provide direct information on the passive muscle mechanical properties of individual muscle. This characterization is crucial to better understand the effect of interventions as selective adaptations may occur among synergist muscles. Taking advantage of shear wave elastography, we aimed to determine whether elite sport athletes exhibit different passive shear modulus of hamstring heads compared to controls. Passive shear modulus was measured on semitendinosus (ST), semimembranosus (SM), and biceps femoris (BF) using shear wave elastography with the knee flexed at 60° and 90°, and 90° of hip flexion. A total of 97 elite athletes from various sports including running sprint, figure skating, fencing, field hockey, taekwondo, basketball, and soccer and 12 controls were evaluated. The shear modulus measured at 60° of knee flexion was lower in SM for figure skating (P < .001; d = 1.8), taekwondo (P < .001; d = 2.1), fencing (P = .024; d = 1.0), and soccer (P = .011; d = 0.9) compared to controls, while no difference was found for athletic sprinters, field hockey, and basketball players. Shear modulus of the BF and ST muscle was not significantly different between controls and elite athletes, regardless of the sport specialization (all P values = 1). We provide evidence that the shear modulus of the SM is altered in athletes involved in elite sport practice performed over large range of motion and/or including substantial stretching program in training content (taekwondo, figure skating, fencing, and soccer).

Individuals have unique muscle activation signatures as revealed during gait and pedaling.

Although it is known that the muscle activation patterns used to produce even simple movements can vary between individuals, these differences have not been considered to prove the existence of individual muscle activation strategies (or signatures). We used a machine learning approach (support vector machine) to test the hypothesis that each individual has unique muscle activation signatures. Eighty participants performed a series of pedaling and gait tasks, and 53 of these participants performed a second experimental session on a subsequent day. Myoelectrical activity was measured from eight muscles: vastus lateralis and medialis, rectus femoris, gastrocnemius lateralis and medialis, soleus, tibialis anterior, and biceps femoris-long head. The classification task involved separating data into training and testing sets. For the within-day classification, each pedaling/gait cycle was tested using the classifier, which had been trained on the remaining cycles. For the between-day classification, each cycle from day 2 was tested using the classifier, which had been trained on the cycles from day 1. When considering all eight muscles, the activation profiles were assigned to the corresponding individuals with a classification rate of up to 99.28% (2,353/2,370 cycles) and 91.22% (1,341/1,470 cycles) for the within-day and between-day classification, respectively. When considering the within-day classification, a combination of two muscles was sufficient to obtain a classification rate >80% for both pedaling and gait. When considering between-day classification, a combination of four to five muscles was sufficient to obtain a classification rate >80% for pedaling and gait. These results demonstrate that strategies not only vary between individuals, as is often assumed, but are unique to each individual.NEW & NOTEWORTHY We used a machine learning approach to test the uniqueness and robustness of muscle activation patterns. We considered that, if an algorithm can accurately identify participants, one can conclude that these participants exhibit discernible differences and thus have unique muscle activation signatures. Our results show that activation patterns not only vary between individuals, but are unique to each individual. Individual differences should, therefore, be considered relevant information for addressing fundamental questions about the control of movement.

Do individual differences in the distribution of activation between synergist muscles reflect individual strategies?

Individual differences in the distribution of activation between synergist muscles have been reported during a wide variety of tasks. Whether these differences represent actual individual strategies is unknown. The aims of this study were to: (i) test the between-day reliability of the distribution of activation between synergist muscles, (ii) to determine the robustness of these strategies between tasks, and to (iii) describe the inter-individual variability of activation strategies in a large sample size. Eighty-five volunteers performed a series of single-joint isometric tasks with their dominant leg [knee extension and plantarflexion at 25% of maximal voluntary contraction (MVC)] and locomotor tasks (pedalling and walking). Of these participants, 62 performed a second experimental session that included the isometric tasks. Myoelectrical activity of six lower limb muscles (the three superficial heads of the quadriceps and the three heads of the triceps surae) was measured using surface electromyography (EMG) and normalized to that measured during MVC. When considering isometric contractions, distribution of normalized EMG amplitude among synergist muscles, considered here as activation strategies, was highly variable between individuals (15.8% < CV < 42.7%) and robust across days (0.57 < ICC < 0.82). In addition, individual strategies observed during simple single-joint tasks were correlated with those observed during locomotor tasks [0.37 < r < 0.76 for quadriceps (n = 83); 0.30 < r < 0.66 for triceps surae (n = 82); all P < 0.001]. Our results provide evidence that people who bias their activation to a particular muscle do so during multiple tasks. Even though inter-individual variability of EMG signals has been well described, it is often considered noise which complicates the interpretation of data. This study provides evidence that variability results from actual differences in activation strategies.

Effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity.

BACKGROUND: The plantar fascia is exposed to repetitive tensile stress induced by cyclic loads associated with daily activities, such as walking and running. Due to overuse or abnormal foot alignment, insertional and distal (i.e., mid-substance) regions within the plantar fascia may exhibit microtears, which leads to plantar fasciopathy. Ultrasound shear wave elastography is an imaging technique to measure shear wave velocity propagating through biological tissues, considered herein as an index of tensile stress. This study aimed to quantify the effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity. METHODS: Shear wave velocity of the plantar fascia was measured in the insertional and distal regions using ultrasound shear wave elastography in sixteen healthy participants (7 males and 9 females). The measurements were performed while the toes were maintained in neutral or dorsiflexed positions. FINDINGS: When considering the insertional region, there was no significant difference in shear wave velocity between neutral toe position [mean (SEM): 5.4 (0.6) m/s] and dorsiflexed toe position [5.5 (0.5) m/s] (P = 0.88; effect size = 0.05). When considering the distal region, there was a significant difference in shear wave velocity between the neutral position [7.8 (0.4) m/s] and dorsiflexed position [9.9 (0.3) m/s] (P = 0.002; effect size = 0.88). The difference in shear wave velocity between the insertional and distal regions showed a large effect size for either neutral (P = 0.010; effect size = 0.75) or dorsiflexed toe position (P = 0.003; effect size = 0.86). INTERPRETATION: In contrast to clinical beliefs, these findings suggest that toe dorsiflexion induces non-homogeneous changes in tensile stress within the plantar fascia.

Neuromechanical coupling within the human triceps surae and its consequence on individual force-sharing strategies.

Little is known about the factors that influence the coordination of synergist muscles that act across the same joint, even during single-joint isometric tasks. The overall aim of this study was to determine the nature of the relationship between the distribution of activation and the distribution of force-generating capacity among the three heads of the triceps surae [soleus (SOL), gastrocnemius medialis (GM) and gastrocnemius lateralis (GL)]. Twenty volunteers performed isometric plantarflexions, during which the activation of GM, GL and SOL was estimated using electromyography (EMG). Functional muscle physiological cross-sectional area (PCSA) was estimated using imaging techniques and was considered as an index of muscle force-generating capacity. The distribution of activation and PCSA among the three muscles varied greatly between participants. A significant positive correlation between the distribution of activation and the distribution of PCSA was observed when considering the two bi-articular muscles at intensities ≤50% of the maximal contraction (0.51

The potential role of sciatic nerve stiffness in the limitation of maximal ankle range of motion.

It is a long held belief that maximal joint range of motion (ROM) is restricted by muscle tension. However, it exists indirect evidence suggesting that this assumption may not hold true for some joint configurations where non-muscular structures, such as the peripheral nerves, are stretched. Direct evidences are lacking. This study aimed to determine whether a static stretching aiming to load the sciatic nerve without stretch within plantar flexors is effective to: (i) alter nerve stiffness; and (ii) increase the ankle's maximal ROM. Passive maximal ankle ROM in dorsiflexion was assessed with the hip flexed at 90° (HIP-flexed) or neutral (HIP-neutral, 0°). Sciatic nerve stiffness was estimated using shear wave elastography. Sciatic nerve stretching induced both a 13.3 ± 7.9% (P < 0.001) decrease in the nerve stiffness and a 6.4 ± 2.6° increase in the maximal dorsiflexion ROM assessed in HIP-flexed. In addition, the decrease in sciatic nerve stiffness was significantly correlated with the change in maximal ROM in dorsiflexion (r = -0.571, P = 0.026). These effects occurred in the absence of any change in gastrocnemius medialis and biceps femoris stiffness, and ankle passive torque. These results demonstrate that maximal dorsiflexion ROM can be acutely increased by stretching the sciatic nerve, without altering the muscle stiffness.