Assessment and modelling of the activation-dependent shift in optimal length of the human soleus muscle in vivo.

Previous in vitro and in situ studies have reported a shift in optimal muscle fibre length for force generation (L0) towards longer length at decreasing activation levels (also referred to as length-dependent activation), yet the relevance for in vivo human muscle contractions with a variable activation pattern remains largely unclear. By a combination of dynamometry, ultrasound and electromyography (EMG), we experimentally obtained muscle force-fascicle length curves of the human soleus at 100%, 60% and 30% EMGmax levels from 15 participants aiming to investigate activation-dependent shifts in L0 in vivo. The results showed a significant increase in L0 of 6.5 ± 6.0% from 100% to 60% EMGmax and of 9.1 ± 7.2% from 100% to 30% EMGmax (both P < 0.001), respectively, providing evidence of a moderate in vivo activation dependence of the soleus force-length relationship. Based on the experimental results, an approximation model of an activation-dependent force-length relationship was defined for each individual separately and for the collective data of all participants, both with sufficiently high accuracy (R2 of 0.899 ± 0.056 and R2 = 0.858). This individual approximation approach and the general approximation model outcome are freely accessible and may be used to integrate activation-dependent shifts in L0 in experimental and musculoskeletal modelling studies to improve muscle force predictions. KEY POINTS: The phenomenon of the activation-dependent shift in optimal muscle fibre length for force generation (length-dependent activation) is poorly understood for human muscle in vivo dynamic contractions. We experimentally observed a moderate shift in optimal fascicle length towards longer length at decreasing electromyographic activity levels for the human soleus muscle in vivo. Based on the experimental results, we developed a freely accessible approximation model that allows the consideration of activation-dependent shifts in optimal length in future experimental and musculoskeletal modelling studies to improve muscle force predictions.

Effect of the temporal coordination and volume of cyclic mechanical loading on human Achilles tendon adaptation in men.

Human tendons adapt to mechanical loading, yet there is little information on the effect of the temporal coordination of loading and recovery or the dose-response relationship. For this reason, we assigned adult men to either a control or intervention group. In the intervention group, the two legs were randomly assigned to one of five high-intensity Achilles tendon (AT) loading protocols (i.e., 90% maximum voluntary contraction and approximately 4.5 to 6.5% tendon strain) that were systematically modified in terms of loading frequency (i.e., sessions per week) and overall loading volume (i.e., total time under loading). Before, at mid-term (8 weeks) and after completion of the 16 weeks intervention, AT mechanical properties were determined using a combination of inverse dynamics and ultrasonography. The cross-sectional area (CSA) and length of the free AT were measured using magnetic resonance imaging pre- and post-intervention. The data analysis with a linear mixed model showed significant increases in muscle strength, rest length-normalized AT stiffness, and CSA of the free AT in the intervention group (p < 0.05), yet with no marked differences between protocols. No systematic effects were found considering the temporal coordination of loading and overall loading volume. In all protocols, the major changes in normalized AT stiffness occurred within the first 8 weeks and were mostly due to material rather than morphological changes. Our findings suggest that-in the range of 2.5-5 sessions per week and 180-300 s total high strain loading-the temporal coordination of loading and recovery and overall loading volume is rather secondary for tendon adaptation.

Speed-specific optimal contractile conditions of the human soleus muscle from slow to maximum running speed.

The soleus is the main muscle for propulsion during human running but its operating behavior across the spectrum of physiological running speeds is currently unknown. This study experimentally investigated the soleus muscle activation patterns and contractile conditions for force generation, power production and efficient work production (i.e. force-length potential, force-velocity potential, power-velocity potential and enthalpy efficiency) at seven running speeds (3.0 m s-1 to individual maximum). During submaximal running (3.0-6.0 m s-1), the soleus fascicles shortened close to optimal length and at a velocity close to the efficiency maximum, two contractile conditions for economical work production. At higher running speeds (7.0 m s-1 to maximum), the soleus muscle fascicles still operated near optimum length, yet the fascicle shortening velocity increased and shifted towards the optimum for mechanical power production with a simultaneous increase in muscle activation, providing evidence for three cumulative mechanisms to enhance mechanical power production. Using the experimentally determined force-length-velocity potentials and muscle activation as inputs in a Hill-type muscle model, a reduction in maximum soleus muscle force at speeds ≥7.0 m s-1 and a continuous increase in maximum mechanical power with speed were predicted. The reduction in soleus maximum force was associated with a reduced force-velocity potential. The increase in maximum power was explained by an enhancement of muscle activation and contractile conditions until 7.0 m s-1, but mainly by increased muscle activation at high to maximal running speed.

Longitudinal Evidence for High-Level Patellar Tendon Strain as a Risk Factor for Tendinopathy in Adolescent Athletes.

BACKGROUND: High tendon strain leads to sub-rupture fatigue damage and net-catabolic signaling upon repetitive loading. While high levels of tendon strain occur in adolescent athletes at risk for tendinopathy, a direct association has not yet been established. Therefore, in this prospective longitudinal study, we examined the hypothesis that adolescent athletes who develop patellar tendon pain have shown increased levels of strain in advance. METHODS: In 44 adolescent athletes (12-17 years old), patellar tendon mechanical properties were measured using ultrasonography and inverse dynamics at four time points during a season. Fourteen athletes developed clinically relevant tendon pain (SYM; i.e., reduction of the VISA-P score of at least 13 points), while 23 remained asymptomatic (ASYM; VISA-P score of > 87 points). Seven cases did not fall into one of these categories and were excluded. Tendon mechanical properties of SYM in the session before the development of symptoms were compared to a randomly selected session in ASYM. RESULTS: Tendon strain was significantly higher in SYM compared to ASYM (p = 0.03). The risk ratio for developing symptoms was 2.3-fold higher in athletes with tendon strain ≥9% (p = 0.026). While there was no clear evidence for systematic differences of the force applied to the tendon or tendon stiffness between SYM and ASYM (p > 0.05), subgroup analysis indicated that tendon force increased prior to the development of symptoms only in SYM (p = 0.034). DISCUSSIO: The study provides novel longitudinal evidence that high tendon strain could be an important risk factor for patellar tendinopathy in adolescent athletes. We suggest that inadequate adaptation of tendon stiffness to increases in muscle strength may occur if adolescent athletes are subject to mechanical loading which does not  provide effective tendon stimulation.

The Power of Musification: Sensor-Based Music Feedback Improves Arm Swing in Parkinson's Disease.

BACKGROUND: Reduction of arm swing during gait is an early and common symptom in Parkinson's disease (PD). By using the technology of a mobile phone, acceleration of arm swing can be converted into a closed-loop musical feedback (musification) to improve gait. OBJECTIVES: To assess arm swing in healthy subjects and the effects of musification on arm swing amplitude and other gait parameters in patients with PD. METHODS: Gait kinematics were analyzed in 30 patients during a 320 m walk in 3 different conditions comprising (1) normal walking; (2) focused swinging of the more affected arm; and (3) with musification of arm swing provided by the iPhone application CuraSwing. The acceleration of arm swing was converted into musical feedback. Arm swing range of motion and further gait kinematics were analyzed. In addition, arm swing in patients was compared to 32 healthy subjects walking at normal, slow, and fast speeds. RESULTS: Musification led to a large and bilateral increase of arm swing range of motion in patients. The increase was greater on the more affected side of the patient (+529.5% compared to baseline). In addition, symmetry of arm swing, sternum rotation, and stride length increased. With musical feedback patients with PD reached arm swing movements within or above the range of healthy subjects. CONCLUSIONS: Musification has an immediate effect on arm swing and other gait kinematics in PD. The results suggest that closed-loop musical feedback is an effective technique to improve walking in patients with PD.

Development of Muscle-Tendon Adaptation in Preadolescent Gymnasts and Untrained Peers: A 12-Month Longitudinal Study.

PURPOSE: The current study investigated the effects of long-term athletic training on the development of the triceps surae muscle-tendon unit in preadolescence. METHODS: Eleven preadolescent untrained children and a group of 21 artistic gymnastics athletes of similar age (9 ± 1.7 yr) and maturity (Tanner stages I and II) participated in the study. The measurements were conducted every 3 months for 1 yr, and training volume and duration of the athletes were documented. Plantar flexor muscle strength, Achilles tendon stiffness, maximum tendon strain, and gastrocnemius medialis morphometrics were measured by integrating kinematics, ultrasonography, and dynamometry. A linear mixed-effects model was used to analyze the investigated parameters. RESULTS: We found greater muscle strength (P < 0.001) in athletes compared with nonathletes but no differences in Achilles tendon stiffness (P = 0.252), indicating a training-induced imbalanced adaptation of muscle strength and tendon stiffness in preadolescent athletes. Although pennation angle (P = 0.490), thickness (P = 0.917), and fascicle length (P = 0.667) did not differ between groups, we found higher fluctuations in pennation angle and muscle strength over 1 yr in athletes. The imbalanced adaptation of muscle strength and tendon stiffness together with greater fluctuations of muscle strength resulted in greater tendon strain fluctuations over 1 yr (P = 0.017) and a higher frequency of athletes with high-level tendon strain (≥9%) compared with nonathletes. CONCLUSIONS: The findings indicate an increased mechanical demand for the tendon in preadolescent athletes that could have implications for the risk of tendon overuse injury. Therefore, we recommend the implementation of individual training approaches to preserve a balanced adaptation within the triceps surae muscle-tendon unit in preadolescent athletes.

Postural Balance Ability and the Effect of Visual Restriction on Older Dancers and Non-Dancers.

Dance has been suggested to be an advantageous exercise modality for improving postural balance performance and reducing the risk of falls in the older population. The main purpose of this study was to investigate whether visual restriction impacts older dancers and non-dancers differently during a quiet stance balance performance test. We hypothesized higher balance performance and greater balance deterioration due to visual restriction in dancers compared with non-dancers, indicating the superior contribution of the visual channel in the expected higher balance performances of dancers. Sixty-nine (38 men, 31 women, 74 ± 6 years) healthy older adults participated and were grouped into a Greek traditional dance group (n = 31, two to three times/week for 1.5 h/session, minimum of 3 years) and a non-dancer control group (n = 38, no systematic exercise history). The participants completed an assessment of one-legged quiet stance trials using both left and right legs and with eyes open while standing barefoot on a force plate (Wii, A/D converter, 1,000 Hz; Biovision) and two-legged trials with both eyes open and closed. The possible differences in the anthropometric and one-legged balance parameters were examined by a univariate ANOVA with group and sex as fixed factors. This ANOVA was performed using the same fixed factors and vision as the repeated measures factor for the two-legged balance parameters. In the one-legged task, the dance group showed significantly lower values in anteroposterior and mediolateral sway amplitudes (p = 0.001 and p = 0.035) and path length measured in both directions (p = 0.001) compared with the non-dancers. In the two-legged stance, we found a significant vision effect on path length (p < 0.001) and anteroposterior amplitude (p < 0.001), whereas mediolateral amplitude did not differ significantly (p = 0.439) between closed and open eyes. The dance group had a significantly lower CoP path length (p = 0.006) and anteroposterior (p = 0.001) and mediolateral sway amplitudes (p = 0.003) both in the eyes-open and eyes-closed trials compared with the control group. The superior balance performance in the two postural tasks found in the dancers is possibly the result of the coordinated, aesthetically oriented intersegmental movements, including alternations between one- and two-legged stance phases, that comes with dance. Visual restriction resulted in a similar deterioration of balance performance in both groups, thus suggesting that the contribution of the visual channel alone cannot explain the superior balance performance of dancers.

Muscle-specific economy of force generation and efficiency of work production during human running.

Human running features a spring-like interaction of body and ground, enabled by elastic tendons that store mechanical energy and facilitate muscle operating conditions to minimize the metabolic cost. By experimentally assessing the operating conditions of two important muscles for running, the soleus and vastus lateralis, we investigated physiological mechanisms of muscle work production and muscle force generation. We found that the soleus continuously shortened throughout the stance phase, operating as work generator under conditions that are considered optimal for work production: high force-length potential and high enthalpy efficiency. The vastus lateralis promoted tendon energy storage and contracted nearly isometrically close to optimal length, resulting in a high force-length-velocity potential beneficial for economical force generation. The favorable operating conditions of both muscles were a result of an effective length and velocity-decoupling of fascicles and muscle-tendon unit, mostly due to tendon compliance and, in the soleus, marginally by fascicle rotation.

Prevention of strain-induced impairments of patellar tendon micromorphology in adolescent athletes.

High-level patellar tendon strain may cause impairments of the tendon's micromorphological integrity in growing athletes and increase the risk for tendinopathy. This study investigated if an evidence-based tendon exercise intervention prevents high-level patellar tendon strain, impairments of micromorphology and pain in adolescent basketball players (male, 13-15 years). At three time points over a season (M1-3), tendon mechanical properties were measured using ultrasound and dynamometry, proximal tendon micromorphology with a spatial frequency analysis and pain and disability using VISA-P scores. The control group (CON, n = 19) followed the usual strength training plan, including sprint and change-of-direction drills. In the intervention group (INT, n = 14), three sessions per week with functional exercises were integrated into the training, providing repetitive high-magnitude tendon loading for at least 3 s per repetition. The frequency of high-level strain (ie, ≥9%) continuously decreased in INT, while tending to increase in CON since tendon force increased in both (p < 0.001), yet tendon stiffness only in INT (p = 0.004). In CON, tendon strain was inversely associated with tendon peak spatial frequency at all time points (p < 0.05), indicating impairments of tendon micromorphological integrity with higher strain, but not at M2 and M3 in INT. Descriptively, the fraction of asymptomatic athletes at baseline was similar in both groups (~70%) and increased to 100% in M3 in INT, while remaining unchanged in CON. We suggest that functional high-load tendon exercises could reduce the prevalence of high-level patellar tendon strain and associated impairments of its micromorphology in adolescent athletes, providing new opportunities for tendinopathy prevention.

A Functional High-Load Exercise Intervention for the Patellar Tendon Reduces Tendon Pain Prevalence During a Competitive Season in Adolescent Handball Players.

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.

Neuromotor Dynamics of Human Locomotion in Challenging Settings.

Is the control of movement less stable when we walk or run in challenging settings? Intuitively, one might answer that it is, given that challenging locomotion externally (e.g., rough terrain) or internally (e.g., age-related impairments) makes our movements more unstable. Here, we investigated how young and old humans synergistically activate muscles during locomotion when different perturbation levels are introduced. Of these control signals, called muscle synergies, we analyzed the local stability and the complexity (or irregularity) over time. Surprisingly, we found that perturbations force the central nervous system to produce muscle activation patterns that are less unstable and less complex. These outcomes show that robust locomotion control in challenging settings is achieved by producing less complex control signals that are more stable over time, whereas easier tasks allow for more unstable and irregular control.

Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes.

High mechanical strain is thought to be one of the main factors for the risk of tendon injury, as it determines the mechanical demand placed upon the tendon by the working muscle. The present study investigates the association of tendon mechanical properties including force, stress and strain, and measures of tendon micromorphology and neovascularization, which are thought to be indicative of tendinopathy in an adolescent high-risk group for overuse injury. In 16 adolescent elite basketball athletes (14-15 years of age) we determined the mechanical properties of the patellar tendon by combining inverse dynamics with magnetic resonance and ultrasound imaging. Tendon micromorphology was determined based on a spatial frequency analysis of sagittal plane ultrasound images and neovascularization was quantified as color Doppler area. There was a significant inverse relationship between tendon strain and peak spatial frequency (PSF) in the proximal tendon region (r = -0.652, p = 0.006), indicating locally disorganized collagen fascicles in tendons that are subjected to high strain. No such associations were present at the distal tendon site and no significant correlations were observed between tendon force or stress and tendon PSF as well as between tendon loading and vascularity. Our results suggest that high levels of tendon strain might associate to a micromorphological deterioration of the collagenous network in the proximal patellar tendon, which is also the most frequent site affected by tendinopathy. Neovascularization of the tendon on the other hand seems not to be directly related to the magnitude of tendon loading and might be a physiological response to a high frequency of training in this group. Those findings have important implications for our understanding of the etiology of tendinopathy and for the development of diagnostical tools for the assessment of injury risk.

Modular organization of murine locomotor pattern in the presence and absence of sensory feedback from muscle spindles.

KEY POINTS: Locomotion on land and in water requires the coordination of a great number of muscle activations and joint movements. Constant feedback about the position of own body parts in relation to the surrounding environment and the body itself (proprioception) is required to maintain stability and avoid failure. The central nervous system may follow a modular type of organization by controlling muscles in orchestrated groups (muscle synergies) rather than individually. We used this concept on genetically modified mice lacking muscle spindles, one of the two main classes of proprioceptors. We provide evidence that proprioceptive feedback is required by the central nervous system to accurately tune the modular organization of locomotion. ABSTRACT: For exploiting terrestrial and aquatic locomotion, vertebrates must build their locomotor patterns based on an enormous amount of variables. The great number of muscles and joints, together with the constant need for sensory feedback information (e.g. proprioception), make the task of controlling movement a problem with overabundant degrees of freedom. It is widely accepted that the central nervous system may simplify the creation and control of movement by generating activation patterns common to muscle groups, rather than specific to individual muscles. These activation patterns, called muscle synergies, describe the modular organization of movement. We extracted synergies through electromyography from the hind limb muscle activities of wild-type and genetically modified mice lacking sensory feedback from muscle spindles. Muscle spindle-deficient mice underwent a modification of the temporal structure (motor primitives) of muscle synergies that resulted in diminished functionality during walking. In addition, both the temporal and spatial (motor modules) components of synergies were severely affected when external perturbations were introduced or when animals were immersed in water. These findings show that sensory feedback from group Ia/II muscle spindles regulates motor function in normal and perturbed walking. Moreover, when group Ib Golgi tendon organ feedback is lacking due to enhanced buoyancy, the modular organization of swimming is almost completely compromised.

Muscle volume reconstruction from several short magnetic resonance imaging sequences.

The gold standard to determine muscle morphological parameters is magnetic resonance imaging (MRI). To measure large muscles like the vastus lateralis (VL) in one sequence, scanners with a large field of view (FOV) and a high flux density are needed. However, large scanners are expensive and not always available. The purpose of the current study was to develop a marker-based approach to reconstruct the VL from several separate MRI sequences, acquired with a low-field MRI scanner. The VL muscle of 21 volunteers was marked at one-third and two-third of thigh length using fish oil capsules. Three consecutive MRI sequences (i.e. proximal, medial and distal part) of the thigh were captured between the markers and the muscle insertion and origin. After a manual segmentation of the VL the muscle was reconstructed using the developed approach. The muscle volume, maximal anatomical cross-sectional area and length were 715.1 ±â€¯93.4 cm3, 34.0 ±â€¯4.0 cm2 and 34.4 ±â€¯2.2 cm respectively. The procedure showed an average error between 0.9% and 2.2% for the reconstructed muscle volume, the averaged RMSD between the cross-sectional areas of two overlapping sequences were between 0.80 ±â€¯0.71 cm2 and 0.88 ±â€¯0.78 cm2. The proposed approach provides an appropriate accuracy for muscle volume assessment, as the estimated error for muscle volume calculation was quite small. The reconstruction quality depends mainly on the proper marker attachment and identification, as well as the spatial resolution of the image sequences. We are confident that the presented method can be used in most investigations regarding muscle morphology.

The Maximum Lyapunov Exponent During Walking and Running: Reliability Assessment of Different Marker-Sets.

The maximum Lyapunov exponent (MLE) has often been suggested as the prominent measure for evaluation of dynamic stability of locomotion in pathological and healthy population. Although the popularity of the MLE has increased in the last years, there is scarce information on the reliability of the method, especially during running. The purpose of the current study was, thus, to examine the reliability of the MLE during both walking and running. Sixteen participants walked and ran on a treadmill completing two measurement blocks (i.e., two trials per day for three consecutive days per block) separated by 2 months on average. Six different marker-sets on the trunk were analyzed. Intraday, interday and between blocks reliability was assessed using the intraclass correlation coefficient (ICC) and the root mean square difference (RMSD). The MLE was on average significantly higher (p < 0.001) in running (1.836 ± 0.080) compared to walking (1.386 ± 0.207). All marker-sets showed excellent ICCs (>0.90) during walking and mostly good ICCs (>0.75) during running. The RMSD ranged from 0.023 to 0.047 for walking and from 0.018 to 0.050 for running. The reliability was better when comparing MLE values between blocks (ICCs: 0.965-0.991 and 0.768-0.961; RMSD: 0.023-0.034 and 0.018-0.027 for walking and running respectively), and worse when considering trials of the same day (ICCs: 0.946-0.980 and 0.739-0.844; RMSD: 0.042-0.047 and 0.045-0.050 for walking and running respectively). Further, different marker-sets affect the reliability of the MLE in both walking and running. Our findings provide evidence that the assessment of dynamic stability using the MLE is reliable in both walking and running. More trials spread over more than 1 day should be considered in study designs with increased demands of accuracy independent of the locomotion condition.

Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population.

The purpose of the study was to investigate the athletic-based specificity of muscle strength and neuromuscular control of spine stability in chronic non-specific low-back pain (LBP). Thirty elite athletes and 29 age-matched non-athletes with (15 athletes and 15 non-athletes) and without LBP (15 athletes and 14 non-athletes) participated in the study. Muscle strength was measured during maximal isometric trunk flexion and trunk extension contractions. The neuromuscular control of spine stability was analyzed by determining trunk stiffness, trunk damping, and onset times of the lumbar and thoracic erector spinae muscles after sudden perturbations (quick release experiments) as well as maximum Lyapunov exponents (local dynamic stability) using non-linear time series analysis of repetitive lifting movements. LBP was assessed using the visual analog scale. We found lower maximal trunk extension moments (p = 0.03), higher trunk damping (p = 0.018) and shorter onset times (p = 0.03) of the investigated trunk muscles in LBP patients in both athletes and non-athletes. Trunk stiffness and the local dynamic stability did not show any differences (p = 0.136 and p = 0.375, respectively) between LBP patients and healthy controls in both groups. It can be concluded that, despite the high-level of training in athletes, both athletes and non-athletes with LBP showed the same deconditioning of the lumbar extensor muscles and developed similar strategies to ensure spine stability after sudden perturbations to protect the spine from pain and damage. The findings highlight that specific training interventions for the trunk muscles are not only crucial for individuals of the general population, but also for well-trained athletes.

The effect of age and sex on the cervical range of motion - A systematic review and meta-analysis.

Cervical-flexibility examination is routinely performed in neck-pain patients. However, diagnosis of cervical-flexibility impairment requires physiological reference values, which vary widely among the population. Although there is a general understanding that the cervical range of motion (RoM) alters with age and sex, the consolidated details of these variations remain lacking. A systematic review and meta-analysis was performed to evaluate the difference of cervical RoM in different age and sex populations. The quality-assessment tool for quantitative studies was applied to assess methodological quality. We identified 4,034 abstracts through a database search and 3 publications through a manual search. Thirty-four cross-sectional studies were selected for the systematic review and measuring technologies were identified. The difference in age descriptions was substantial and a strong discrepancy existed between the mobility measured by radiological and non-radiological devices. Therefore, only 11 non-radiological studies with similar age descriptions were selected for meta-analysis. Cervical RoMs varied considerably among the populations and generally decreased with age. However, this diminishment started earlier and ended later in males, and was not continuous across age in both sexes. Females normally displayed a greater RoM than males, except in lateral bending. In young subjects, the difference between males and females was not significant. For subjects in their 50s, males displayed a non-significantly greater RoM than females. The variability of cervical RoMs can be explained by different devices as well as age and sex. However, the age-dependent reduction is not continuous and differs between males and females. These findings lay the foundation for a better understanding of the incidence of age- and sex-dependent cervical disorders, and may have important implications for the long-term success of different clinical interventions.

A random-perturbation therapy in chronic non-specific low-back pain patients: a randomised controlled trial.

The purpose of the study was to assess the effectiveness of a specific rehabilitation therapy for chronic non-specific low-back pain patients, based on a random/irregular functional perturbation training induced by force disturbances to the spine. Forty patients (20 controls and 20 in the perturbation-based group) finished the whole experimental design. A random-perturbation exercise, which included variable and unpredictable disturbances, was implemented in the therapy of the perturbation-based group (13 weeks, two times per week and 1.5 h per session). The participants of the control group did not receive any specific training. Low-back pain, muscle strength, and neuromuscular control of spine stability were investigated before and after the therapy using the visual analog scale, maximal isometric and isokinetic contractions, nonlinear time series analysis, and by determining the stiffness and damping of the trunk after sudden perturbations. The perturbation-based therapy reduced patient's low-back pain (35%), increased muscle strength (15-22%), and trunk stiffness (13%), while no significant changes were observed in the control group. It can be concluded that the proposed therapy has the potential to enhance trunk muscle capability as well as sensory information processing within the motor system during sudden loading and, as a consequence, improve the stabilization of the trunk.

Athletic training affects the uniformity of muscle and tendon adaptation during adolescence.

With the double stimulus of mechanical loading and maturation acting on the muscle-tendon unit, adolescent athletes might be at increased risk of developing imbalances of muscle strength and tendon mechanical properties. This longitudinal study aims to provide detailed information on how athletic training affects the time course of muscle-tendon adaptation during adolescence. In 12 adolescent elite athletes (A) and 8 similar-aged controls (C), knee extensor muscle strength and patellar tendon mechanical properties were measured over 1 yr in 3-mo intervals. A linear mixed-effects model was used to analyze time-dependent changes and the residuals of the model to quantify fluctuations over time. The cosine similarity (CS) served as a measure of uniformity of the relative changes of tendon force and stiffness. Muscle strength and tendon stiffness increased significantly in both groups (P < 0.01). However, the fluctuations of muscle strength were greater [A, 17 ± 7 (SD) N·m; C, 6 ± 2 N·m; P < 0.05] and the uniformity of changes of tendon force and stiffness was lower in athletes (CS A, -0.02 ± 0.5; C, 0.5 ± 0.4; P < 0.05). Further, athletes demonstrated greater maximum tendon strain (A, 7.6 ± 1.7%; C, 5.5 ± 0.9%; P < 0.05) and strain fluctuations (A, 0.9 ± 0.4; C, 0.3 ± 0.1; P < 0.05). We conclude that athletic training in adolescence affects the uniformity of muscle and tendon adaptation, which increases the demand on the tendon with potential implications for tendon injury.