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Stretching is applied to lengthen shortened muscles in pathological conditions such as joint contractures. We investigated (i) the acute effects of different types of stretching, i.e. constant length (CL) and constant force (CF) stretching, on acute deformations and changes in passive mechanical properties of medial gastrocnemius muscle (MG) and (ii) the association of acute muscle–tendon deformations or changes in mechanical properties with the impulse or maximal strain of stretching. Forty-eight hindlimbs from 13 male and 12 female Wistar rats (13 weeks old, respectively 424.6 ± 35.5 and 261.8 ± 15.6 g) were divided into six groups (n = 8 each). The MG was initially stretched to a length at which the force was 75%, 95%, or 115% of the force corresponding to estimated maximal dorsiflexion and held at either CF or CL for 30 min. Before and after the stretching protocol, the MG peak force and peak stiffness were assessed by lengthening the passive muscle to the length corresponding to maximal ankle dorsiflexion. Also, the muscle belly length and tendon length were measured. CF stretching affected peak force, peak stiffness, muscle belly length, and tendon length more than CL stretching (p < 0.01). Impulse was associated only with the decrease in peak force, while maximal strain was associated with the decrease in peak force, peak stiffness, and the increase in muscle belly length. We conclude that CF stretching results in greater acute deformations and changes in mechanical properties than CL stretching, which appears to be dependent predominantly on the differences in imposed maximal strain.

Inertial measurement units (IMUs) are a potentially useful tool for clinicians and researchers in assessing spine movement biomechanics and neuromuscular control patterns. This study assessed the between-day reliability of the HIKOB FOX IMU in measuring local dynamic stability (LDS) and variability of trunk movements in patients with chronic low back pain (LBP). The local divergence exponent (λmax) was used to quantify LDS and the mean standard deviation (MeanSD) between cycles was used to quantify variability during 30 repetitive cycles of flexion/extension, rotation, and complex movement tasks. For λmax the average coefficient of variation (CV) was ~10% in the flexion/extension and rotation tasks, and all CV values were max ranged from 0.28 to 0.81. Reliability of λmax was similar between the pelvis and thorax segments (CV: ~10%, ICC: 0.48–0.78) and worse for the lumbar spine (CV: ~15%, ICC: 0.28–0.59). The CV for MeanSD was typically in the range of 20–30%, with even greater CV in the non-primary axes during each task (30–52%). Similarly, ICC values were lowest about the anterior-posterior axis in the flexion/extension task (ICC: 0.15–0.29) and largest about the longitudinal axis in the rotation task (ICC: 0.76–0.88). The moderate between-day reliability of λmax in the sagittal and transverse planes offers improvement over manual and subjective tests with poor reliability that are currently used in clinics. The minimal detectable differences presented give a threshold for change in research and rehabilitation in patients with LBP.

Ageing affects balance control resulting in a greater amplitude of sway and alterations in structure of the sway time series. Recurrence quantification analysis (RQA) has been used to determine the structure of center-of-pressure (CoP; a measure that reflects standing postural control) data as a means to quantify how CoP repeats itself / recurs below a certain threshold. This study aimed to determine how the method of threshold determination, below which a recurrence is defined, affects the within-session reliability of RQA in an elderly population. Within-session reliability of RQA of CoP motion in the anterior-posterior and mediolateral directions was assessed in 267 individuals (>65 years old) when standing on firm or foam surface with eyes open or closed for each of two recurrence threshold methods. One threshold method sets the recurrence threshold level such that the recurrence rate is fixed to 5%, the other method sets the recurrence threshold based on 27% of the mean distance between all points from which recurrences are quantified. Reliability across four 30-s balance trials within each of four balance conditions (firm vs. foam, eyes open vs. closed) was determined using intra-class correlation, standard error of measurement and minimal detectable change. ICCs were better, the standard error of measurement and minimal detectable change were smaller when the recurrence threshold was set to 5% using the fixed recurrence threshold. Fixing recurrence rate improves the within session reliability of RQA and could increase sensitivity to identify fall risk.

External lateral stabilization can help identify stability control mechanisms during steady-state walking. The degree of step-by-step foot placement control and step width are known to decrease when walking with external lateral stabilization. Here, we investigated the effect of external lateral stabilization on ankle moment control in healthy participants. Ankle moment control complements foot placement, by allowing a corrective center-of-pressure shift once the foot has been placed. This is reflected by a model predicting this center-of-pressure shift based on the preceding foot placement error. Here, the absolute explained variance accounted for by this model decreased when walking with external lateral stabilization. In other words, we found a reduction in the contribution of step-by-step ankle moment control to mediolateral gait stability when externally stabilized. Concurrently, foot placement error and the average center-of-pressure shift remained unchanged.

A Huxley-type cross-bridge model is attractive because it is inspired by our current understanding of the processes underlying muscle contraction, and because it provides a unified description of muscle's mechanical behavior and metabolic energy expenditure. In this study, we determined the computational cost for task optimization of a largeish-scale musculoskeletal model in which muscles are represented by a 2-state Huxley-type cross-bridge model. Parameter values defining the rate functions of the Huxley-type cross-bridge model could be chosen such that the steady-state force-velocity relation resembled that of a Hill-type model. Using these parameter values, maximum-height squat jumping was used as the example task to evaluate the computational cost of task optimization for a skeletal model driven by a Huxley-type cross-bridge model. The optimal solutions for the Huxley- and Hill-type muscle models were similar for all mechanical variables considered. Computational cost of the Huxley-type cross-bridge model was much higher than that of the Hill-type model. Compared to the Hill-type model, the number of state variables per muscle was large (2 vs about 18,000), the integration step size had to be about 100 times smaller, and the computational cost per integration step was about 100 times higher.

With mechanical loading as the main risk factor for LBP in mind, exoskeletons are designed to reduce the load on the back by taking over a part of the required moment. The present study assessed the effect of a passive exoskeleton on back and abdominal muscle activation, hip and lumbar flexion and on the contribution of both the human and the exoskeleton to the L5/S1 net moment, during static bending at five different hand heights. Two configurations of the exoskeleton (LOW & HIGH) differing in angle-torque characteristics were tested. L5/S1 moments generated by the subjects were significantly reduced (15–20% for the most effective type) at all hand heights. LOW generated 4–11 Nm more support than HIGH at 50%, 25% and 0% upright stance hand height and HIGH generated 4–5 Nm more support than LOW at 100% and 75%. Significant reductions (11–57%) in back muscle activity were found compared to WITHOUT for both exoskeletons for some conditions. However, EMG reductions compared to WITHOUT were highly variable across subjects and not always significant. The device allowed for substantial lumbar bending (up to 70°) so that a number of participants showed the flexion-relaxation phenomenon, which prevented further reduction of back EMG by the device and even an increase from 2% to 6% MVC in abdominal activity at 25% hand height. These results indicate that flexion relaxation and its interindividual variation should be considered in future exoskeleton developments.

Accurate coordination of mediolateral foot placement, relative to the center of mass kinematic state, is one of the mechanisms which ensures mediolateral stability during human walking. Previously, we found that shoes constraining ankle moments decreased foot placement accuracy, presumably by impairing control over movement of the swing leg. As such, ankle moment constraints can be seen as a perturbation of foot placement. Direct mechanical perturbations of the swing leg trajectory can improve foot placement accuracy as an after-effect. Here, we asked whether constrained ankle moments could have a similar effect. If confirmed, this would offer a simple training tool for individuals with impaired foot placement control. Participants (n=19) walked in three conditions; normal (baseline, 10 minutes), while wearing shoes constraining ankle moments (training, 15 minutes), and normal again (after-effects, 10 minutes). Foot placement accuracy was calculated as the percentage of variance in foot placement that could be predicted based on the center of mass kinematic state in the preceding swing phase. When walking with constrained ankle moments, foot placement accuracy decreased initially compared to baseline, but it gradually improved over time. In the after-effect condition, foot placement accuracy was higher than during baseline, but this difference was not significant. When walking with constrained ankle moments, we observed increased step width, decreased stride time and reduced local dynamic stability. In conclusion, constraining ankle moment control deteriorates foot placement accuracy. A non-significant trend towards improved foot placement accuracy after prolonged exposure to constrained ankle moments, allows for speculation on a training potential.

Falls are common in daily life, often caused by trips and slips and, particularly in older adults, with serious consequences. Although arm movements play an important role in balance control, there is limited research into the role of arm movements during balance recovery after tripping in older adults. We investigated how older adults use their arms to recover from a trip and the difference in the effects of arm movements between fallers (n=5) and non-fallers (n=11).Sixteen older males and females (69.7±2.3 years) walked along a walkway and were occasionally tripped over suddenly appearing obstacles. We analysed the first trip using a biomechanical model based on full-body kinematics and force-plate data to calculate whole body orientation during the trip and recovery phase. With this model, we simulated the effects of arm movements at foot-obstacle impact and during trip recovery on body orientation.Apart from an increase in sagittal plane forward body rotation at touchdown in fallers, we found no significant differences between fallers and non-fallers in the effects of arm movements on trip recovery. Like earlier studies in young adults, we found that arm movements during the recovery phase had most favourable effects in the transverse plane: by delaying the transfer of angular momentum of the arms to the body, older adults rotated the tripped side more forward thereby allowing for a larger recovery step. Older adults that are prone to falling might improve their balance recovery after tripping by learning to prolong ongoing arm movements.

The goal of the present study was to assess the effects of age and sex on trunk motor control. Fifty healthy adults (aged between 19 and 67 years, 28 males) participated in this study. Trunk motor control was assessed using force-controlled perturbations directly applied to the trunk. Admittance (inverse of lumped intrinsic and reflexive impedance) decreased with age and tended to be lower in females than males. The age effect on admittance was due to increasing intrinsic stiffness and damping with age, while intrinsic damping and position- and velocity feedback gains were lower in females than males. Feedback delays were not dependent on age. The decrease of trunk admittance with age is most likely due to increasing levels of antagonistic co-activation. Trunk admittance was (just) not significantly different between females and males, in spite of lower feedback gains and damping, possibly due to differences in trunk mass between sexes. These results imply that age and sex differences should be considered when assessing the relationship between back pain and trunk motor control.

This study evaluated the gait stability, variability, and complexity of healthy young adults on inclined surfaces. A total of 49 individuals walked on a treadmill at their preferred speed for 4min at inclinations of 6%, 8%, and 10% in upward (UP) and downward (DOWN) conditions, and in horizontal (0%) condition. Gait variability was assessed using average standard deviation trunk acceleration between strides (VAR), gait stability was assessed using margin of stability (MoS) and maximum Lyapunov exponent (λs), and gait complexity was assessed using sample entropy (SEn). Trunk variability (VAR) increased in the medial-lateral (ML), anterior-posterior, and vertical directions for all inclined conditions. The SEn values indicated that movement complexity decreased almost linearly from DOWN to UP conditions, reflecting changes in gait pattern with longer and slower steps as inclination increased. The DOWN conditions were associated with the highest variability and lowest stability in the MoS ML, but not in λs. Stability was lower in UP conditions, which exhibited the largest λs values. The overall results support the hypothesis that inclined surfaces decrease gait stability and alter gait variability, particularly in UP conditions.

Shifts of the center of pressure (CoP) through modulation of foot placement and ankle moments (CoP-mechanism) cause accelerations of the center of mass (CoM) that can be used to stabilize gait. An additional mechanism that can be used to stabilize gait, is the counter-rotation mechanism, i.e., changing the angular momentum of segments around the CoM to change the direction of the ground reaction force. The relative contribution of these mechanisms to the control of the CoM is unknown. Therefore, we aimed to determine the relative contribution of these mechanisms to control the CoM in the anteroposterior (AP) direction during a normal step and the first recovery step after perturbation in healthy adults. Nineteen healthy subjects walked on a split-belt treadmill and received unexpected belt acceleration perturbations of various magnitudes applied immediately after right heel-strike. Full-body kinematic and force plate data were obtained to calculate the contributions of the CoP-mechanism and the counter-rotation mechanism to control the CoM. We found that the CoP-mechanism contributed to corrections of the CoM acceleration after the AP perturbations, while the counter-rotation mechanism actually contributed to CoM acceleration in the direction of the perturbation, but only in the initial phases of the first step after the perturbation. The counter-rotation mechanism appeared to prevent interference with the gait pattern, rather than using it to control the CoM after the perturbation. Understanding the mechanisms used to stabilize gait may have implications for the design of therapeutic interventions that aim to decrease fall incidence.Summary statementUnderstanding the mechanisms used to stabilize gait during unperturbed and perturbed walking may have implications for the design of therapeutic interventions that aim to decrease fall incidence.