Influence of dynamic stretching on ankle joint stiffness, vertical stiffness and running economy during treadmill running.

The purpose of the present study was to investigate whether and how dynamic stretching of the plantarflexors may influence running economy. A crossover design with a minimum of 48 h between experimental (dynamic stretching) and control conditions was used. Twelve recreational runners performed a step-wise incremental protocol to the limit of tolerance on a motorised instrumented treadmill. The initial speed was 2.3 m/s, followed by increments of 0.2 m/s every 3 min. Dynamic joint stiffness, vertical stiffness and running kinematics during the initial stage of the protocol were calculated. Running economy was evaluated using online gas-analysis. For each participant, the minimum number of stages completed before peak O2 uptake (V̇O2peak) common to the two testing conditions was used to calculate the gradient of a linear regression line between V̇O2 (y-axis) and speed (x-axis). The number of stages, which ranged between 4 and 8, was used to construct individual subject regression equations. Non-clinical forms of magnitude-based decision method were used to assess outcomes. The dynamic stretching protocol resulted in a possible decrease in dynamic ankle joint stiffness (-10.7%; 90% confidence limits ±16.1%), a possible decrease in vertical stiffness (-2.3%, ±4.3%), a possibly beneficial effect on running economy (-4.0%, ±8.3%), and very likely decrease in gastrocnemius medialis muscle activation (-27.1%, ±39.2%). The results indicate that dynamic stretching improves running economy, possibly via decreases in dynamic joint and vertical stiffness and muscle activation. Together, these results imply that dynamic stretching should be recommended as part of the warm-up for running training in recreational athletes examined in this study.

A systematic review with meta-analysis of the StartReact effect on motor responses in stroke survivors and healthy individuals.

Control of limb movements may be impaired after stroke due to the loss of connectivity between the cerebral cortex and spinal cord. A notion to improve motor function in stroke survivors is to use alternate motor fibers, such as the reticulospinal tract (RST), which originate from the brainstem and terminate at different levels of spinal cord. One way of targeting the RST is to use a "StartReact" protocol to foster premature release of a preplanned movement in response to a startling stimulus. Our aim was to find support for the preservation of such StartReact effect in stroke survivors. We conducted a systematic review with meta-analysis of literature published in English up to September 2020, to explore differences in motor responses to startling stimuli in StartReact effects. Protocol of the study was registered (PROSPERO Registration No. CRD42020191581). PubMed, Google Scholar, Web of Science, PsycINFO, and Science Direct were searched for relevant literature. The meta-analysis contained six studies involving a total of 151 stroke and healthy participants. Muscle onset latency data were extracted from the qualifying studies and compared using RevMan. StartReact effect was present in both stroke and healthy groups, represented by shortened muscle onset latency when startling stimulus was present. There was considerable heterogeneity of the outcome measures, which was attributed to the range of motor impairments among stroke survivors and methodologies used. Our findings support the notion of preservation of preprogramming ability and suitability of RST and StartReact effect for motor rehabilitation following stroke.

The mechanisms of adaptation for muscle fascicle length changes with exercise: Implications for spastic muscle.

We are proposing optimal training conditions that can lead to an increase in the number of serial sarcomeres (SSN) and muscle fascicle length (FL) in spastic muscles. Therapeutic interventions for increasing FL in clinical populations with neurological origin, in whom relative shortness of muscle fascicles contributed to the presentation of symptoms such as spasticity, contracture, and limited functional abilities, do not generally meet these conditions, and therefore, result in less than satisfactory outcomes. Based on a review of literature, we argue that protocols of exercise interventions that led to sarcomerogenesis, and increases in SSN and FL in healthy animal and human models satisfied three criteria: 1) all involved eccentric exercise at appropriately high velocity; 2) resulted in positive strain of muscle fascicles; and 3) momentary deactivation in the stretched muscle. Accordingly, to increase FL in spastic muscles, new exercise protocols in which the three presumed criteria are satisfied, must be developed, and long-term muscle architectural and functional adaptations to such trainings must be examined.

Ankle Joint Position and the Reliability of Ultrasound Tissue Characterization of the Achilles Tendon: A Pilot Study.

BACKGROUND Imaging of the Achilles tendon using ultrasound tissue characterization (UTC) involves taking up the slack of the tendon by including dorsiflexion of the ankle. This pilot study aimed to determine whether different longitudinal tension applied to the Achilles tendon during imaging affected the reliability of UTC. MATERIAL AND METHODS Nine asymptomatic active volunteers, aged between 23-49 years underwent imaging of 17 Achilles tendons. Three positions of tension included plantar grade, 50%, and 100% of maximal dorsiflexion, with a range of 18-32°. Ranges were established and standardized using an isokinetic dynamometer. A test and re-test process was conducted at each position to determine the intraclass correlation coefficients (ICCs) and minimum detectable change (MDC) per echotype. Images were analyzed using UTC software. RESULTS Plantar grade positioning images could not be obtained. ICCs for each echotype I-IV between test 1 and test 2 were 0.965, 0.962, 0.858, 0.739 at 100% dorsiflexion (95% CI, 0.86-0.99, 0.84-0.99, 0.51-0.97, and 0.2-0.94), and 0.771, 0.551, 0.569, 0.429 at 50% dorsiflexion (95% CI, 0.29-0.94, -0.09-0.88, -0.01-0.88, and -0.15-0.82). The MDC per echotype I-IV ranged between 4.1-1.0% of echotype data at 100% dorsiflexion, and 17.2-6.3% at 50% dorsiflexion. CONCLUSIONS Testing at maximum dorsiflexion provided improved reliability when using UTC in healthy individuals. The ICC at 100% dorsiflexion was increased, and the MDC was reduced for all echotypes. Therefore, standardizing test positions when using UTC is advisable for reliable comparison of results between studies.

Dynamic stretching is not detrimental to neuromechanical and sensorimotor performance of ankle plantarflexors.

The acute effects of two dynamic stretching (DS) protocols on changes in the ankle range of motion (RoM), neuromechanical, and sensorimotor properties of the plantarflexor muscle group were examined. Eighteen participants received slow (SDS) or fast dynamic stretching (FDS) on two separate days. Outcome measures were assessed pre- and 2 minutes post-interventions, and included maximum dorsiflexion angle, maximum isometric torque at neutral ankle position, maximum concentric and eccentric torques, force matching capacity, joint position sense and medial gastrocnemius muscle and tendon strain. Possibly and likely small increases in dorsiflexion RoM were observed after SDS (mean ± 90% confidence intervals; 1.8 ± 1.2°) and FDS (2.1 ± 1.2°), respectively. Very likely moderate decreases in muscle strain after SDS (-38.0 ± 20.6%) and possibly small decrease after FDS (-13.6 ± 21.2%) were observed. SDS resulted in a likely beneficial small increase in tendon strain (25.3 ± 29.7%) and a likely beneficial moderate increase after FDS (41.4 ± 44.9%). Effects on strength were inconsistent. Possibly small effect on positional error after SDS (-27.1 ± 37.5%), but no clear effect after FDS was observed. Both DS protocols increased RoM, and this was more due to an increase in tendon elongation rather than the muscle. However, SDS showed greater improvement than FDS in both neuromechanical and sensorimotor performance, and hence, SDS can be recommended as part of warm-up in sporting contexts.

Effects of an acute bout of dynamic stretching on biomechanical properties of the gastrocnemius muscle determined by shear wave elastography.

AIMS: The aim of this study was to examine the acute effects of dynamic stretching (DS) exercise on passive ankle range of motion (RoM), resting localized muscle stiffness, as measured by shear wave speed (SWS) of medial gastrocnemius muscle, fascicle strain, and thickness. METHODS/RESULTS: Twenty-three participants performed a DS protocol. Before and after stretching, SWS was measured in the belly of the resting medial gastrocnemius muscle (MGM) using shear wave elastography. DS produced small improvements in maximum dorsiflexion (+1.5° ±1.5; mean difference ±90% confidence limits) and maximum plantarflexion (+2.3° ±1.8), a small decrease in fascicle strain (-2.6% ±4.4) and a small increase in SWS at neutral resting angle (+11.4% ±1.5). There was also a small increase in muscle thickness (+4.1mm ±2.0). CONCLUSIONS: Through the use of elastography, this is the first study to suggest that DS increases muscle stiffness, decreases fascicle strain and increases muscle thickness as a result of improved RoM. These results can be beneficial to coaches, exercise and clinical scientists when choosing DS as a muscle conditioning or rehabilitation intervention.

Characterization of gait using plantar force transfer trajectory in individuals with hallux valgus deformity.

BACKGROUND: Hallux Valgus (HV) is the most common fore-foot deformity, which causes foot pain and limited motion that are encountered in podiatric and orthopedic practices. The purpose of this study is to develop a reliable pattern recognition method to identify the presence of HV based on plantar force measurements. METHOD: Forces at five discrete metatarsal regions are measured at discrete time intervals under the right foot. Under this method, it is hypothesized that force measurement at a given time interval is related to the forces at a previous time interval by using Markovian transition matrix (T matrix). Thirty volunteers' (10 with HV, 10 without HV and 10 with un-diagnosed HV) condition were examined. The use of a Markovian transition matrix for gait characterization is novel. T matrices of all the participants were obtained and compared using means and standard deviations of each of the matrix elements. The comparison was undertaken using a new measure called the "Diagnostic Ratio" (DR). Independent Sample T-test was performed on the T matrix elements. RESULTS: A significant difference was observed between the HV and non-HV groups. HV volunteers were recognized from the dispersion of the T matrices' elements. For volunteers with un-diagnosed condition exhibiting borderline DR may be interpreted as them being prone to HV. CONCLUSION: Comparison of transfer matrices using means and standard deviations of the HV and non-HV groups revealed that a DR of higher than 40% could suggest having an HV condition for five volunteers of the un-diagnosed group and two were found to be prone to getting the condition.

Mechanical and material properties of the plantarflexor muscles and Achilles tendon in children with spastic cerebral palsy and typically developing children.

BACKGROUND: Children with spastic cerebral palsy (CP) experience secondary musculoskeletal adaptations, affecting the mechanical and material properties of muscles and tendons. CP-related changes in the spastic muscle are well documented whilst less is known about the tendon. From a clinical perspective, it is important to understand alterations in tendon properties in order to tailor interventions or interpret clinical tests more appropriately. The main purpose of this study was to compare the mechanical and material properties of the Achilles tendon in children with cerebral palsy to those of typically developing children. METHODS: Using a combination of ultrasonography and motion analysis, we determined tendon mechanical properties in ten children with spastic cerebral palsy and ten aged-matched typically developing children. Specifically, we quantified muscle and tendon stiffness, tendon slack length, tendon strain, cross-sectional area, Young׳s Modulus and the strain rate dependence of tendon stiffness. FINDINGS: Children with CP had a greater muscle to tendon stiffness ratio compared to typically developing children. Despite a smaller tendon cross-sectional area and greater tendon slack length, no group differences were observed in tendon stiffness or Young׳s Modulus. The slope describing the stiffness strain-rate response was steeper in children with cerebral palsy. INTERPRETATION: These results provide us with a more differentiated understanding of the muscle and tendon mechanical properties, which would be relevant for future research and paediatric clinicians.

Does long-term passive stretching alter muscle-tendon unit mechanics in children with spastic cerebral palsy?

BACKGROUND: Cerebral palsy causes motor impairments during development and many children may experience excessive neural and mechanical muscle stiffness. The clinical assumption is that excessive stiffness is thought to be one of the main reasons for functional impairments in cerebral palsy. As such, passive stretching is widely used to reduce stiffness, with a view to improving function. However, current research evidence on passive stretching in cerebral palsy is not adequate to support or refute the effectiveness of stretching as a management strategy to reduce stiffness and/or improve function. The purpose was to identify the effect of six weeks passive ankle stretching on muscle-tendon unit parameters in children with spastic cerebral palsy. METHODS: Thirteen children (8-14 y) with quadriplegic/diplegic cerebral palsy were randomly assigned to either an experimental group (n=7) or a control group (n=6). The experimental group underwent an additional six weeks of passive ankle dorsiflexion stretching for 15 min (per leg), four days per week, whilst the control group continued with their normal routine, which was similar for the two groups. Measures of muscle and tendon stiffness, strain and resting length were acquired pre- and post-intervention. FINDINGS: The experimental group demonstrated a 3° increase in maximum ankle dorsiflexion. This was accompanied by a 13% reduction in triceps surae muscle stiffness, with no change in tendon stiffness. Additionally, there was an increase in fascicle strain with no changes in resting length, suggesting muscle stiffness reductions were a result of alterations in intra/extra-muscular connective tissue. INTERPRETATION: The results demonstrate that stretching can reduce muscle stiffness by altering fascicle strain but not resting fascicle length.

Does acute passive stretching increase muscle length in children with cerebral palsy?

BACKGROUND: Children with spastic cerebral palsy experience increased muscle stiffness and reduced muscle length, which may prevent elongation of the muscle during stretch. Stretching performed either by the clinician, or children themselves is used as a treatment modality to increase/maintain joint range of motion. It is not clear whether the associated increases in muscle-tendon unit length are due to increases in muscle or tendon length. The purpose was to determine whether alterations in ankle range of motion in response to acute stretching were accompanied by increases in muscle length, and whether any effects would be dependent upon stretch technique. METHODS: Eight children (6-14 y) with cerebral palsy received a passive dorsiflexion stretch for 5 × 20 s to each leg, which was applied by a physiotherapist or the children themselves. Maximum dorsiflexion angle, medial gastrocnemius muscle and fascicle lengths, and Achilles tendon length were calculated at a reference angle of 10 ° plantarflexion, and at maximum dorsiflexion in the pre- and post-stretch trials. FINDINGS: All variables were significantly greater during pre- and post-stretch trials compared to the resting angle, and were independent of stretch technique. There was an approximate 10 ° increase in maximum dorsiflexion post-stretch, and this was accounted for by elongation of both muscle (0.8 cm) and tendon (1.0 cm). Muscle fascicle length increased significantly (0.6 cm) from pre- to post-stretch. INTERPRETATION: The results provide evidence that commonly used stretching techniques can increase overall muscle, and fascicle lengths immediately post-stretch in children with cerebral palsy.

Method and strain rate dependence of Achilles tendon stiffness.

Tendon stiffness is calculated by dividing changes in tendon force by tendon elongation. For this purpose, participants are commonly asked to perform a maximal muscle contraction ("active" method). Alternatively tendon elongation can be achieved by means of a passive joint rotation ("passive" method). The purpose of this study was to compare Achilles tendon stiffness obtained from both methods across different tendon strain rates. Twenty adults performed a series of ramped maximum isometric plantarflexions of different durations. Passive ankle rotations of different angular velocities were also performed. Achilles tendon stiffness was obtained from a combination of motion analysis, isokinetic dynamometry and ultrasonography and compared across methods at three strain rates. At all strain rates, tendon stiffness obtained from the active method was 6% greater compared to the passive method. In spite of this systematic bias, there was good agreement between the methods. Intraclass correlation coefficients were greater than 0.98, and more than 95% of data points fell into the 95% confidence intervals. This agreement will be acceptable in many research contexts. We also found a linear increase in tendon stiffness with increasing strain rate, which must be taken into consideration when interpreting or reporting tendon stiffness.

Differences in gastrocnemius muscle architecture between the paretic and non-paretic legs in children with hemiplegic cerebral palsy.

BACKGROUND: The aim of this study was to investigate the architectural alterations of skeletal muscle following hemiplegic cerebral palsy. If associated with functional and clinical measures of disability, information on muscle architecture could then be used as an objective tool in the assessment of motor disability in these patients. METHODS: Ultrasonography was used to assess in vivo the gastrocnemius muscle architecture in the paretic and non-paretic legs of eight children with cerebral palsy. FINDINGS: Fascicle length and muscle thickness at the resting ankle position were reduced in the paretic compared to the non-paretic legs by up to 18% and 20%, respectively (P<0.05), indicating a loss of both in-series and in-parallel sarcomeres in the affected muscles. However, pennation angle was similar (P>0.05) in the two legs. INTERPRETATION: The present results indicate that paresis in hemiplegic cerebral palsy may affect the geometry of skeletal muscle. Further studies are required to examine the relation between muscle architecture, severity of motor disability, and treatment.

The effects of distant and on-line visual information on the control of approach phase and step over an obstacle during locomotion.

One of the goals of this study was to examine the nature and role of distant visual information sampled during locomotion in the feedforward control of leading and trailing limb while an individual is required to step over an obstacle in the travel path. In addition we were interested in whether or not on-line visual information available while the limb (lead or trail) is stepping over the obstacle influences limb trajectory control and whether the information provided during lead limb cross would be used to calibrate movement of the trail limb. Towards this end, we manipulated availability of vision following an initial dynamic sampling period during the approach phase in proximity to the obstacle and during the lead and trail limb stepping over the obstacle. Ten participants completed 40 trials of obstacle crossing in 8 testing conditions. Initial dynamic visual sampling was sufficient to ensure successful task performance in the absence of vision in the approach phase and during both lead and trail limb stepping over the obstacle. Despite successful task performance, foot placement of the lead and trail limb before obstacle crossing and limb elevation over the obstacle were increased after withdrawal of vision in the approach area. Furthermore, the correlation between toe clearance and foot placement was diminished. While both limbs require feedforward visual information to control the step over the obstacle, only lead limb elevation was influenced by availability of on-line visual information during obstacle crossing. Results were in agreement with the notion of primacy of information inherent in the optic array over those from static samples of the environment in guiding locomotion. It is suggested that the expected proprioceptive feedback information associated with the limb posture before the obstacle, reconstructed using visual memory from dynamic sampling of the environment, mismatched with those from the actual limb position. Accordingly, participants adopted a different strategy that enabled them to clear the obstacle with a higher safety margin.

Amplitude and target diameter in motor programming of discrete, rapid aimed movements: Fitts and Peterson (1964) and Klapp (1975) revisited.

The reports by Fitts and Peterson [J. Exp. Psychol. 67(2) (1964) 103-113] and Klapp [J. Exp. Psychol. Hum. Percept. Perform. 104(2) (1975) 147-153] concerning the effects of movement amplitude and target diameter on reaction time present conflicting results. Fitts and Peterson reported that reaction time increased when movement amplitude was lengthened. Klapp reported an interaction in which target diameter effect on reaction time was moderated by movement length: for small targets, reaction time decreased with increasing movement length but reaction time remained unchanged (or increased modestly) when target diameter was large. Two experiments were conducted to replicate and examine the inconsistency in the reaction time results. For both experiments movement time results were in agreement with the predictions of Fitts' law. However, the results for reaction time were mixed: support was obtained for Klapp (1975) but not for Fitts and Peterson (1964). Further analysis identified several potential variables that could have influenced reaction time and explained the different effects on reaction time reported by Fitts and Peterson (1964) and Klapp (1975). The potential variables could include: limb posture at the start of a response; number of limb segments required to perform the task; and the effect of pooling reaction time data from targets located right and left of the start point, and from near and far targets.