Triceps surae muscle forces during dynamic exercises in patients with Achilles tendinopathy: A cross-sectional study.

PURPOSE: The aim of this study was to investigate the individual triceps surae muscle forces during the execution of six different functional movements and rehabilitation exercises in patients with Achilles tendinopathy compared to a control group. METHODS: Triceps surae muscle forces of 15 participants with Achilles tendinopathy (AT) and 15 healthy controls were estimated through a combination of experimental data and musculo-skeletal modeling. Three-dimensional motion capture and force plates were used to collect the ankle and knee joint angles and moments during three functional movements (walking, heel walking, and toe walking) and three rehabilitation exercises (bilateral heel drop, unilateral heel drop with extended knee and with flexed knee). A dynamic optimization method was used to obtain the modeled triceps surae muscle forces. Force-sharing strategies were calculated at the peak triceps surae muscle force and compared between groups. RESULTS: Lower peak triceps surae forces were obtained for the AT group during dynamic exercises. Across all exercises, the average contribution of the soleus (SOL) to the total triceps surae muscle force was the largest (60.83 ± 13.89% [AT] > 56.90 ± 16.18% [healthy]), followed by the gastrocnemius medialis (29.87 ± 10.67% [AT] < 32.19 ± 12.90% [healthy]) and the gastrocnemius lateralis (9.30 ± 4.31% [AT] < 10.91 ± 4.66% [healthy]). The triceps surae force-sharing strategy was different for the toe walking, heel walking, and the bilateral and unilateral heel drop with extended knee. CONCLUSION: This study provides evidence for altered triceps surae muscle force-sharing strategies during dynamic tasks in patients with AT. The influence of altered muscle force-sharing on the subtendon nonuniformity and/or the tendon loading should be explored in future work.

Distal-to-proximal joint mechanics redistribution is a main contributor to reduced walking economy in older adults.

Age-related neural and musculoskeletal declines affect mobility and the quality of life of older adults. To date, the mechanisms underlying reduced walking economy in older adults still remain elusive. In this study, we wanted to investigate which biomechanical factors were associated with the higher energy cost of walking in older compared with young adults. Fourteen younger (24 ± 2 years) and fourteen older (74 ± 4 years) adults were tested. Plantarflexor strength and Achilles tendon stiffness were evaluated during a dynamometer test. Medial gastrocnemius fascicle length, ground reaction forces, joint kinematics, and oxygen consumption were measured during walking treadmill at 0.83 and 1.39 m.s-1 . Energy cost of walking, lower-limb joint mechanics, muscle-tendon unit, and tendinous tissues length were calculated. The energy cost of walking was higher at 0.83 m.s-1 (+16%; P = .005) and plantarflexor strength lower (-31%; P = .007) in older adults. Achilles tendon stiffness and medial gastrocnemius fascicle length changes did not differ between older and young adults. The reduction in ankle mechanics was compensated by increases in hip mechanics in older adults during walking. The hip extensor moment was the only significant predictor of the energy cost of walking (adjusted R2 : 0.35-0.38). The higher energy cost in older adults is mainly associated with their distal-to-proximal redistribution of joint mechanics during walking possibly due to plantarflexor weakness. In our study, medial gastrocnemius fascicle and tendinous tissue behavior did not explain the higher energy cost of walking in older compared to young adults.

A Novel Accelerometry-Based Metric to Improve Estimation of Whole-Body Mechanical Load.

While the Player Load is a widely-used parameter for physical demand quantification using wearable accelerometers, its calculation is subjected to potential errors related to rotational changes of the reference frame. The aims of this study were (i) to assess the concurrent validity of accelerometry-based Player Load against force plates; (ii) to validate a novel metric, the Accel'Rate overcoming this theoretical issue. Twenty-one recreational athlete males instrumented with two triaxial accelerometers positioned at the upper and lower back performed running-based locomotor movements at low and high intensity over six in-series force plates. We examined the validity of the Player Load and the Accel'Rate by using force plates. Standard error of the estimate was small to moderate for all tested conditions (Player Load: 0.45 to 0.87; Accel'Rate: 0.25 to 0.95). Accel'Rate displayed trivial to small mean biases (-1.0 to 6.1 a.u.) while the Player Load displayed systematic very large to extremely large mean biases (17.1 to 226.0 a.u.). These findings demonstrate a better concurrent validity of the Accel'Rate compared to the Player Load. This metric could be used to improve the estimation of whole-body mechanical load, easily accessible in sport training and competition settings.

The Use of a Single Trunk-Mounted Accelerometer to Detect Changes in Center of Mass Motion Linked to Lower-Leg Overuse Injuries: A Prospective Study.

Movement dynamics during running was previously characterized using a trunk-mounted accelerometer, and were associated with a history of overuse injuries. However, it remains unknown if these measures are also linked to the development of overuse injuries. The aim of this study was therefore to determine how movement dynamics alter in response to fatigue, and the possible link with developing lower-leg overuse injuries during a six-month follow-up period. Two hundred and eight movement science university students completed a 12-min all-out run while wearing a trunk-mounted accelerometer. Dynamic stability, dynamic loading and spatiotemporal measures were extracted from the accelerometer. Participants sustaining an injury within the 6-month period demonstrated significantly higher RMS ratio values in the vertical direction and lower RMS ratio values in the anteroposterior direction, and lower impact acceleration values in the anteroposterior direction in an unfatigued state compared to the uninjured group. They also demonstrated an increase in dynamic loading in the horizontal plane during the run. In addition, with running fatigue both groups exhibited changes in dynamic stability and loading measures. These results show the potential of using a single trunk-mounted accelerometer to detect changes in movement dynamics that are linked to lower-leg overuse injuries.

Surface properties affect the interplay between fascicles and tendinous tissues during landing.

PURPOSE: Muscle-tendon units are forcefully stretched during rapid deceleration events such as landing. Consequently, tendons act as shock absorbers by buffering the negative work produced by muscle fascicles likely to prevent muscle damage. Landing surface properties can also modulate the amount of energy dissipated by the body, potentially effecting injury risk. This study aimed to evaluate the influence of three different surfaces on the muscle-tendon interactions of gastrocnemius medialis (GM), and vastus lateralis (VL) during single- and double-leg landings from 50 cm. METHODS: Ultrasound images, muscle activity and joint kinematics were collected for 12 participants. Surface testing was also performed, revealing large differences in mechanical behavior. RESULTS: During single-leg landing, stiffer surfaces increased VL fascicle lengthening and velocity, and muscle activity independent of joint kinematics while GM length changes showed no difference between surfaces. Double-leg landing resulted in similar fascicle and tendon behavior despite greater knee flexion angles on stiffer surfaces. CONCLUSION: This demonstrates that VL fascicle lengthening is greater when the surface stiffness increases, when performing single-leg landing. This is due to the combination of limited knee joint flexion and lower surface absorption ability which resulted in greater mechanical demand mainly withstood by fascicles. GM muscle-tendon interactions remain similar between landing surfaces and types. Together, this suggests that surface damping properties primarily affect the VL muscle-tendon unit with a potentially higher risk of injury as a result of increased surface stiffness when performing single-leg landing tasks.

Interactions between fascicles and tendinous tissues in gastrocnemius medialis and vastus lateralis during drop landing.

Animal tendons have been shown to act as shock absorbers to protect muscle fascicles from exercise-induced damage during landing tasks. Meanwhile, the contribution of tendinous tissues to damping activities such as landing has been less explored in humans. The aim of this study was to analyze in vivo fascicle-tendon interactions during drop landing to better understand their role in energy dissipation. Ultrafast ultrasound images of the gastrocnemius medialis (GM) and vastus lateralis (VL), lower limb electromyographic activity, 2-D kinematics, and ground reaction forces were collected from twelve participants during single- and double-leg drop landings from various heights. For both muscles, length changes were higher in tendinous tissues than in fascicles, demonstrating their key role in protecting fascicles from rapid active lengthening. Increasing landing height increased lengthening and peak lengthening velocity of VL fascicle and GM architectural gear ratio, whereas GM fascicle displayed similar length and velocity patterns. Single-leg landing lengthens the tendinous tissues of GM and, to a greater degree, VL muscles, without affecting the fascicles. These findings demonstrate the adjustment in fascicle-tendon interactions to withstand mechanical demand through the tendon buffer action and fascicle rotation. The higher VL fascicle contribution to negative work as the drop height increases would suggest muscle-specific damping responses during drop landing. This can originate from the distal-to-proximal sequence of joint kinetics, from differences in muscle and tendon functions (one- and two-joint muscles), architectural and morphological properties (eg, tendon stiffness), as well as from the muscle activity of the GM and VL muscles.

Test-retest reliability of gastrocnemius medialis fascicle force-length relationship.

Fascicle force-length relationship is one major basic mechanical property of skeletal muscle, subsequently influencing movement mechanics. While force-length properties are increasingly described through ultrafast ultrasound imaging, their test-retest reliability remains unknown. Using ultrafast ultrasound, and electrically evoked contractions at various ankle angles, gastrocnemius medialis fascicle force-length relationship was assessed twice, few days apart, in sixteen participants. The test-retest reliability of the resulting fascicle force-length relationship key parameters - i.e., maximal force (Fmax), and optimal fascicle length (L0) - was evaluated considering (i) all the trials obtained at each ankle joint and (ii) the mean of the two trials obtained at each tested angle. Considering all trials, L0 indicated a 'high' test-retest reliability, with intra-class correlation coefficients (ICC) of 0.89 and Fmax a 'moderate' reliability (ICC = 0.71), while when averaging the two trials L0 reliability was 'very-high' (ICC = 0.91), and Fmax reliability 'moderate' (ICC = 0.73). All values of coefficient of variation and standard error of measurement were low, i.e., ≤7.7 % and ≤0.35 cm for L0 and ≤3.4 N for Fmax, respectively. Higher absolute reliability was reported for L0 than Fmax, with better reliability when averaging the two trials at each angle. All these parameters, in accordance with the limit of agreement, demonstrated that L0 and Fmax test-retest reliability is acceptable, particularly when averaging multiple points obtained at a given angle. Interestingly, the shape of the fascicle force-length relationship is more variable. Therefore, L0 and Fmax can be used to compare between days-effects following an intervention, while a comparison of fascicle operating lengths may require more precautions.

Running 40 Minutes under Temperate or Hot Environment Does Not Affect Operating Fascicle Length.

PURPOSE: Muscle mechanics is paramount in our understanding of motor performance. However, little is known regarding the sensitivity of fascicle dynamics and connective tissues stiffness to exercise duration and ambient temperature during running, both increasing muscle temperature. This study aimed to determine gastrocnemius medialis (GM) fascicle dynamics in vivo during running in temperate and hot conditions, as well as muscle-tendon unit responses. METHODS: Using ultrafast ultrasound, 15 participants (8 men, 7 women; 26 ± 3 yr) were tested before, during (2 and 40 min), and after a running task (40 min at 10 km·h -1 ) in temperate (TEMP; ~23°C) and hot (HOT: ~38°C) conditions. RESULTS: Although core, skin temperatures, and heart rate increased from the beginning to the end of the exercise and in a larger extent in HOT than TEMP ( P < 0.001), the physiological stress elicited did not alter running temporal parameters and GM fascicle operating lengths, with similar behavior of the fascicles on their force-length relationship, over time (2 vs 40 min) or across condition (TEMP vs HOT; P ≥ 0.248). Maximal voluntary force production did not reported statistical changes after exercise ( P = 0.060), and the connective tissues stiffness measured (i.e., passive muscle and stiffness of the series-elastic elements) did not show neither time ( P ≥ 0.281), condition ( P ≥ 0.256) nor time-condition interaction ( P ≥ 0.465) effect. CONCLUSIONS: This study revealed that prolonged running exercise does not alter muscle-tendon unit properties and interplay, which are not influenced by ambient temperature. These findings may rule out potential detrimental effects of heat on muscle properties and encourage further investigations on longer and more intense running exercise.

Effects of Surface Properties on Gastrocnemius Medialis and Vastus Lateralis Fascicle Mechanics During Maximal Countermovement Jumping.

Interactions between human movement and surfaces have previously been studied to understand the influence of surface properties on the mechanics and energetics of jumping. However, little is known about the muscle-tendon unit (MTU) mechanics associated with muscle activity and leg adjustments induced by different surfaces during this movement. This study aimed to examine the effects of three surfaces with different properties (artificial turf, hybrid turf, and athletic track) on the muscle mechanics and muscle excitation of the gastrocnemius medialis (GM) and vastus lateralis (VL) during maximal countermovement jumping (CMJ). Twelve participants performed maximal CMJs on the three sport surfaces. GM and VL muscle fascicles were simultaneously imaged using two ultrafast ultrasound systems (500 Hz). MTUs lengths were determined based on anthropometric models and two-dimensional joint kinematics. Surface electromyography (EMG) was used to record GM and VL muscle activity. Surface mechanical testing revealed systematic differences in surface mechanical properties (P = 0.006, η2: 0.26-0.32, large). Specifically, the highest force reduction and vertical deformation values have been observed on artificial turf (65 ± 2% and 9.0 ± 0.3 mm, respectively), while athletic track exhibited the lowest force reduction and vertical deformation values (28 ± 1% and 2.1 ± 0.1 mm, respectively) and the highest energy restitution (65 ± 1%). We observed no significant difference in CMJ performance between the three surfaces (∼35-36 cm, P = 0.66). GM and VL fascicle shortening (P = 0.90 and P = 0.94, respectively) and shortening velocity (P = 0.13 and P = 0.65, respectively) were also unaffected by the type of surface. However, when jumping from greater deformable surface, both GM muscle activity (P = 0.022, η2 = 0.18, large) and peak shortening velocity of GM MTU (P = 0.042, η2 = 0.10, medium) increased during the push-off phase. This resulted in a greater peak plantar flexion velocity late in the jump (P = 0.027, η2 = 0.13, medium). Our findings suggest that maximal vertical jumping tasks in humans is not affected by common sport surfaces with different mechanical properties. However, internal regulatory mechanisms exist to compensate for differences in surface properties.

Achilles Subtendon Structure and Behavior as Evidenced From Tendon Imaging and Computational Modeling.

The Achilles tendon is the largest and strongest tendon in the human body and is essential for storing elastic energy and positioning the foot for walking and running. Recent research into Achilles tendon anatomy and mechanics has revealed the importance of the Achilles subtendons, which are unique and semi-independent structures arising from each of the three muscular heads of the triceps surae. Of particular importance is the ability for the subtendons to slide, the role that this has in healthy tendons, and the alteration of this property in aging and disease. In this work, we discuss technical approaches that have led to the current understanding of Achilles subtendons, particularly imaging and computational modeling. We introduce a 3D geometrical model of the Achilles subtendons, built from dual-echo UTE MRI. We revisit and discuss computational models of Achilles subtendon twisting suggesting that optimal twist reduces both rupture loads and stress concentrations by distributing stresses. Second harmonic generation imaging shows collagenous subtendons within a rabbit Achilles tendon; a clear absence of signal between the subtendons indicates an inter-subtendon region on the order of 30 µm in our rabbit animal model. Entry of wheat germ agglutinin in both the inter-fascicular and the inter-subtendon regions suggests a glycoprotein-containing inter-subtendon matrix which may facilitate low friction sliding of the subtendons in healthy mammals. Lastly, we present a new computational model coupled with human exercise trials to demonstrate the magnitude of Achilles subtendon sliding which occurs during rehabilitation exercises for Achilles tendinopathy, and shows that specific exercise can maximize subtendon sliding and interface strains, without maximizing subtendon strains. This work demonstrates the value of imaging and computational modeling for probing tendon structure-function relationships and may serve to inform and develop treatments for Achilles tendinopathy.

Effect of Prior Fatiguing Sport-Specific Exercise on Field Hockey Passing Ability.

PURPOSE: To evaluate the effect of multiple sets of repeated-sprint-ability (RSA)-induced fatigue on subsequent passing-skill performance in field hockey players. METHODS: A total of 10 elite U-21 (under-21) male field hockey players performed 5 sets of a combination of RSA test (6 × 20 m, 20 s of passive recovery) followed by a 1-min passing-skill test (passing reception with subsequent passes at a predesigned target). Data on fastest sprint time and cumulated sprint time for RSA test; total number of balls played, targeted, and passing accuracy (number of balls targeted/total number of balls played) for passing-skill test; heart rate (HR), blood lactate concentration (BLa), and rating of perceived exertion (RPE)  were collected throughout the protocol. RESULTS: RSA performance was significantly impaired from set 1 to set 5 (fastest sprint time +4.1%, P < .001; cumulated sprint time +2.3%, P < .01). For a similar average number of balls played (12.8 [1.4]) during each set, number of balls targeted (-1.7%, P < .05) and passing accuracy (-3.1%, P < .05) decreased up to the third set before reimproving over the last 2 sets. Psychophysiological responses (HR, BLa, and RPE) progressively increased (P < .05) toward protocol cessation. The decrease in passing accuracy with increasing RSA cumulated sprint time was fitted to a 2nd-order polynomial function (r2 = .94, P < .05). CONCLUSION: Multiple-set RSA-induced fatigue was accompanied by passing-skill adjustment variation, suggesting a complex interaction between physiological and psychological/cognitive function to preserve passing skill under fatigued condition.