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Pain felt while performing rehabilitation exercises could be a reason for the low adherence of knee osteoarthritis patients to physical rehabilitation. Reducing compressive forces on the most affected knee regions may help to mitigate the pain. Knee frontal plane positioning with respect to pelvis and foot (functional knee alignment) has been shown to modify the mediolateral distribution of the tibiofemoral joint contact force in walking. Hence, different functional knee alignments could be potentially used to modify joint loading during rehabilitation exercises. The aim was to understand whether utilizing different alignments is an effective strategy to unload specific knee areas while performing rehabilitation exercises. Eight healthy volunteers performed 5 exercises with neutral, medial, and lateral knee alignment. A musculoskeletal model was modified for improved prediction of tibiofemoral contact forces and used to evaluate knee joint kinematics, moments, and contact forces. Functional knee alignment had only a small and inconsistent effect on the mediolateral distribution joint contact force. Moreover, the magnitude of tibiofemoral and patellofemoral contact forces, knee moments, and measured muscle activities was not significantly affected by the alignment. Our results suggest that altering the functional knee alignment is not an effective strategy to unload specific knee regions in physical rehabilitation.

The human semitendinosus muscle is characterized by a tendinous inscription separating proximal (STprox) and distal (STdist) neuromuscular compartments. As each compartment is innervated by separate nerve branches, potential exists for the compartments to operate and be controlled independently. However, the morphology and function of each compartment have not been thoroughly examined in a human adult population. Further, the distal semitendinosus tendon is typically harvested for use in anterior cruciate ligament reconstruction (ACLR) surgery, which induces long-term morphological changes to the semitendinosus muscle-tendon unit. It remains unknown if muscle morphological alterations following ACLR are uniform between STprox and STdist. Here, we performed magnetic resonance imaging on ten individuals who had undergone ACLR involving an ipsilateral distal semitendinosus tendon graft 14 ± 6 months prior, extracting morphological parameters of the whole ST muscle and each individual muscle compartment from both the (non-injured) contralateral and surgical legs. In the contralateral non-surgical leg, volume and length of STprox were lower than STdist. No between-compartment differences in volume or length were found for ACLR legs, likely due to greater shortening of STdist compared to STprox after ACLR. The maximal anatomical cross-sectional area of both compartments was substantially smaller on the ACLR leg, but did not differ between STprox and STdist on either leg. The absolute and relative differences in STprox morphology on the ACLR leg were strongly correlated with the corresponding between-leg differences in STdist morphological parameters. Specifically, greater morphological differences in one compartment were highly correlated with large differences in the other compartment, and vice versa for smaller differences. These relationships indicate that despite the heterogeneity in compartment length and volume, compartment atrophy is not independent or random. Further, the tendinous inscription endpoints were generally positioned at the same proximodistal level as the compartment maximal anatomical cross-sectional areas, providing a wide area over which the tendinous inscription could mechanically interact with compartments. Overall, results suggest the two human semitendinosus compartments are not mechanically independent.

Achilles tendon (AT) rupture leads to long-term structural and functional impairments. Currently, the predictors of good recovery after rupture are poorly known. Thus, we aimed to explore the interconnections between structural, mechanical, and neuromuscular parameters and their associations with factors that could explain good recovery in patients with non-surgically treated AT rupture. A total of 35 patients with unilateral rupture (6 females) participated in this study. Muscle-tendon structural, mechanical, and neuromuscular parameters were measured 1-year after rupture. Interconnections between the inter-limb differences (Δ) were explored using partial correlations, followed by multivariable linear regression to find associations between the measured factors and the following markers that indicate good recovery: 1) tendon length, 2) tendon non-uniform displacement, and 3) flexor hallucis longus (FHL) normalized EMG amplitude difference between limbs. Δmedial gastrocnemius (MG) (β = −0.12, p = 0.007) and Δlateral gastrocnemius (β = −0.086, p = 0.030) subtendon lengths were associated with MG tendon Δstiffness. MG (β = 11.56, p = 0.003) and soleus (β = 2.18, p = 0.040) Δsubtendon lengths explained 48 % of variance in FHL EMG amplitude. Regression models for tendon length and non-uniform displacement were not significant. Smaller inter-limb differences in Achilles subtendon lengths were associated with smaller differences in the AT stiffness between limbs, and a smaller contribution of FHL muscle to the plantarflexion torque. In the injured limb, the increased contribution of FHL appears to partially counteract a smaller contribution from MG due to the elongated tendon, however the role of FHL should not be emphasized during rehabilitation to allow recovery of the TS muscles. peerReviewed

The purpose of this study was investigate tendon displacement patterns in non-surgically treated patients 14 months after acute Achilles tendon rupture (ATR) and to classify patients into groups based on their Achilles tendon (AT) displacement patterns. Twenty patients were tested. Sagittal images of AT were acquired using B-mode ultrasonography during ramp contractions at a torque level corresponding to 30% of the maximal isometric plantarflexion torque of the uninjured limb. A speckle tracking algorithm was used to track proximal-distal movement of the tendon tissue at 6 antero-posterior locations. Two-way repeated measures ANOVA for peak tendon displacement was performed. K-means clustering was used to classify patients according to AT displacement patterns. The difference in peak relative displacement across locations was larger in the uninjured (1.29 ± 0.87 mm) than the injured limb (0.69 ± 0.68 mm), with a mean difference (95% CI) of 0.60 mm (0.14-1.05 mm, P < .001) between limbs. For the uninjured limb, cluster analysis formed 3 groups, while 2 groups were formed for the injured limb. The three distinct patterns of AT displacement during isometric plantarflexion in the uninjured limb may arise from subject-specific anatomical variations of AT sub-tendons, while the two patterns in the injured limb may reflect differential recovery after ATR with non-surgical treatment. Subject-specific tendon characteristics are a vital determinant of stress distribution across the tendon. Changes in stress distribution may lead to variation in the location and magnitude of peak displacement within the free AT. Quantifying internal tendon displacement patterns after ATR provides new insights into AT recovery.

Background\ud Achilles tendon rupture appears to alter stiffness and length of the tendon. These alterations may affect the function of tendon in force transmission and in energy storage and recovery. We studied the mechanical properties of the Achilles' tendon post-rupture and their association with function.\ud Methods\ud Twenty-four (20 males, 4 females) participants (mean age: 43 y, 176 cm, 81 kg) were recruited. Ultrasonography and dynamometry were used to assess the muscle-tendon unit morphological and mechanical properties of non-surgically treated patients 1-year post rupture.\ud Findings\ud Injured tendons were longer with difference of 1.8 cm (95%CI: 0.5–1.9 cm; P < 0.001), and thicker by 0.2 mm (0.2–0.3 mm; P < 0.01). Medial gastrocnemius cross-sectional area was 1.0 cm2 smaller (0.8–1.1 cm2; P < 0.001), fascicles were 0.6 cm shorter (0.5–0.7 cm; P < 0.001) and pennation angle was 2.5° higher (1.3–3.6°; P < 0.001) when compared to the uninjured limb. We found no differences between injured and uninjured tendon stiffness 1-year post-rupture (mean difference: 29.8 N/mm, −7.7–67.3 N/mm; P = 0.170). The injured tendon showed 1.8 mm (1.2–2.4 mm; P < 0.01) lower elongation during maximal voluntary isometric contractions. Patient-reported functional outcome was related to the tendon resting length (β = 0.68, r(10) = 4.079, P = 0.002). Inter-limb differences in the medial gastrocnemius fascicle length were related to inter-limb differences in maximum contractions (β = 1.17, r(14) = 2.808, P = 0.014).\ud Interpretation\ud Longer Achilles tendon resting length was associated with poorer self-evaluated functional outcome. Although the stiffness of non-surgically treated and uninjured tendons was similar 1-year post rupture, plantar flexion strength deficit was still present, possibly due to shorter medial gastrocnemius fascicle length.

Knee ligaments and tendons play an important role in stabilizing and controlling the motions of the knee. Injuries to the ligaments can lead to abnormal mechanical loading of the other supporting tissues (e.g., cartilage and meniscus) and even osteoarthritis. While the condition of knee ligaments can be examined during arthroscopic repair procedures, the arthroscopic evaluation suffers from subjectivity and poor repeatability. Near infrared spectroscopy (NIRS) is capable of non-destructively quantifying the composition and structure of collagen-rich connective tissues, such as articular cartilage and meniscus. Despite the similarities, NIRS-based evaluation of ligament composition has not been previously attempted. In this study, ligaments and patellar tendon of ten bovine stifle joints were measured with NIRS, followed by chemical and histological reference analysis. The relationship between the reference properties of the tissue and NIR spectra was investigated using partial least squares regression. NIRS was found to be sensitive towards the water (R2CV = .65) and collagen (R2CV = .57) contents, while elastin, proteoglycans, and the internal crimp structure remained undetectable. As collagen largely determines the mechanical response of ligaments, we conclude that NIRS demonstrates potential for quantitative evaluation of knee ligaments. publishedVersion

The Achilles tendon (AT) is composed of three distinct in-series elastic subtendons, arising from different muscles in the triceps surae. Independent activation of any of these muscles is thought to induce sliding between the adjacent AT subtendons. We aimed to investigate displacement patterns during voluntary contraction (VOL) and selective transcutaneous stimulation of medial (MGstim) and lateral (LGstim) gastrocnemius between ruptured and healthy tendons, and to examine the representative areas of AT subtendons. Twenty-eight patients with unilateral AT rupture performed bilateral VOL at 30% of the maximal isometric un-injured plantarflexion torque. AT displacement was analysed from sagittal B-mode ultrasonography images during VOL, MGstim and LGstim. Three-way ANOVA revealed a significant two-way interaction of contraction type*location on the tendon displacement (F(10-815)=3.72, p

In this study, we aimed to describe lower limb kinematic and muscle activation patterns and then to examine the potential associations between those variables and skating speed in highly trained ice-hockey players. Twelve players (age 18.4-22.0 years) performed five maximal 30-metre forward skating sprints. Skating speeds, muscle activities from eight lower limb muscles (gluteus maximus, gluteus medius, adductor magnus, rectus femoris, vastus lateralis, biceps femoris, tibialis anterior and soleus), and sagittal plane joint angles from the hip and knee joint were measured. A lower activity of the gluteus maximus (r = -0.651, p = 0.022, β = -0.08) and a reduced gluteus maximus to rectus femoris coactivity (r = -0.786, p = 0.002, β = -3.26) during the recovery phase were found to be associated with faster skating speed. No significant associations were observed between sagittal plane hip and knee kinematics and skating speed. This study provides evidence that muscle activities during the recovery phase of skating may have an important role in skating performance.

Joint tissue mechanics (e.g., stress and strain) are believed to have a major involvement in the onset and progression of musculoskeletal disorders, e.g., knee osteoarthritis (KOA). Accordingly, considerable efforts have been made to develop musculoskeletal finite element (MS-FE) models to estimate highly-detailed tissue mechanics that predict cartilage degeneration. However, creating such models is time-consuming and requires advanced expertise. This limits these complex, yet promising MS-FE models to research applications with few participants and making the models impractical for clinical assessments. Also, these previously developed MS-FE models are not assessed for any activities other than the gait. This study introduces and validates a semi-automated rapid state-of-the-art MS-FE modeling and simulation toolbox incorporating an electromyography (EMG) assisted MS model and a muscle-force driven FE model of the knee with fibril-reinforced poro(visco)elastic cartilages and menisci. To showcase the usability of the pipeline, we estimated joint- and tissue-level knee mechanics in 15 KOA individuals performing different daily activities. The pipeline was validated by comparing the estimated muscle activations and joint mechanics to existing experimental data. Also, to examine the importance of EMG-assisted MS analyses, results were compared against outputs from the same FE models but driven by static-optimization-based MS models. The EMG-assisted MS-FE pipeline bore a closer resemblance to experiments, compared to the static-optimization-based MS-FE pipeline. More importantly, the developed pipeline showed great potentials as a rapid MS-FE analysis toolbox to investigate multiscale knee mechanics during different activities of individuals with KOA.

Tissue-level stress-relaxation of ligaments and tendons in the toe region is characterized by fast and long-term relaxations and an increase in relaxation magnitude with strain. Characterizing the compositional and structural origins of these phenomena helps in the understanding of mechanisms of ligament and tendon function and adaptation in health and disease. A three-step tensile stress-relaxation test was conducted on dumbbell-shaped pieces of bovine knee ligaments and patellar tendon (PT) ( n = 10 knees). Their mechanical behaviour was characterized by a fibril-reinforced poroviscoelastic material model, able to describe characteristic times and magnitudes of fast and long-term relaxations. The crimp angle and length of tissues were measured with polarized light microscopy, while biochemical contents were determined by colorimetric biochemical methods. The long-term relaxation time was longer in the anterior cruciate ligament (ACL) and PT compared with collateral ligaments ( p < 0.05). High hydroxyproline content predicted greater magnitude and shorter time of both fast and long-term relaxation. High uronic acid content predicted longer time of long-term relaxation, whereas high crimp angle predicted higher magnitude of long-term relaxation. ACL and PT are better long-term stabilizers than collateral ligaments. The long-term relaxation behaviour is affected or implied by proteoglycans and crimp angle, possibly relating to slow structural reorganization of the tissue.

© 2017 The Authors. Background: Handgrip strength (HGS) is used to identify individuals with low muscle strength (dynapenia). The influence of the number of attempts on maximal HGS is not yet known and may differ depending on age and health status. This study aimed to assess how many attempts of HGS are required to obtain maximal HGS. Methods: Three cohorts (939 individuals) differing in age and health status were included. HGS was assessed three times and explored as continuous and dichotomous variable. Paired t-test, intraclass correlation coefficients (ICC) and Bland-Altman analysis were used to test reproducibility of HGS. The number of individuals with misclassified dynapenia at attempts 1 and 2 with respect to attempt 3 were assessed. Results: Results showed the same pattern in all three cohorts. Maximal HGS at attempts 1 and 2 was higher than at attempt 3 on population level (P < 0.001 for all three cohorts). ICC values between all attempts were above 0.8, indicating moderate to high reproducibility. Bland-Altman analysis showed that 41.0 to 58.9% of individuals had the highest HGS at attempt 2 and 12.4 to 37.2% at attempt 3. The percentage of individuals with a maximal HGS above the gender-specific cut-off value at attempt 3 compared with attempts 1 and 2 ranged from 0 to 50.0%, with a higher percentage of misclassification in middle-aged and older populations. Conclusions: Maximal HGS is dependent on the number of attempts, independent of age and health status. To assess maximal HGS, at least three attempts are needed if HGS is considered to be a continuous variable. If HGS is considered as a discrete variable to assess dynapenia, two attempts are sufficient to assess dynapenia in younger populations. Misclassification should be taken into account in middle-aged and older populations.

Mechanical material properties of ligaments originate from their biochemical composition and structural organization. However, it is not yet fully elucidated how biochemical contents vary between knee ligaments and patellar tendon (PT) and how they relate with mechanical properties. The purpose of this study was to compare water, collagen, proteoglycan and elastin contents between bovine knee ligaments and PT and correlate them with tensile material properties. Hydroxyproline (collagen), uronic acid (proteoglycan) and elastin contents per wet and dry weights were measured using colorimetric biochemical methods for bovine knee ligament and PT samples (n = 10 knees). Direct comparison and correlation with multiple linear regression were performed against biomechanical properties measured in our earlier study. Anterior cruciate ligament (ACL) and PT exhibited lower hydroxyproline content per wet weight compared with other ligaments (p < 0.05). Cruciate ligaments had higher uronic acid content per dry weight compared with collateral ligaments (p < 0.05). Posterior cruciate ligament had higher elastin content than ACL (p < 0.05). Higher hydroxyproline content per wet weight implied higher Young’s modulus, strength and toughness. Quantitatively, higher elastin content per wet weight predicted higher toe region nonlinearity and Young’s modulus whereas higher uronic acid content per dry weight predicted lower Young’s modulus, yield stress and toughness. Differences between ligaments in biochemical composition highlight differences in their physiological function and loading regimes. As expected, collagen content showed similar trend with stiffness and strength. The predictive role of proteoglycan and elastin contents on the mechanical properties might indicate their important functional role in ligaments.

Near infrared spectroscopy (NIRS) is an analytical technique for determining the chemical composition or structure of a given sample. For several decades, NIRS has been a frequently used analysis tool in agriculture, pharmacology, medicine, and petrochemistry. The popularity of NIRS is constantly growing as new application areas are discovered. Contrary to mid infrared spectral region, the absorption bands in near infrared spectral region are often non-specific, broad, and overlapping. Analysis of NIR spectra requires multivariate methods which are highly subjective to noise arising from instrumentation, scattering effects, and measurement setup. NIRS measurements are also frequently performed outside of a laboratory which further contributes to the presence of noise. Therefore, preprocessing is a critical step in NIRS as it can vastly improve the performance of multivariate models. While extensive research regarding various preprocessing methods exists, selection of the best preprocessing method is often determined through trial-and-error. A more powerful approach for optimizing preprocessing in NIRS models would be to automatically compare a large number of preprocessing techniques (e.g., through grid-search or hyperparameter tuning). To enable this, we present, nippy, an open-source Python module for semi-automatic comparison of NIRS preprocessing methods (available at https://github.com/uef-bbc/nippy). We provide here a brief overview of the capabilities of nippy and demonstrate the typical usage through two examples with public datasets.

The purpose of this study was to determine the reliability and validity of ultrasonography for measurement of hamstring muscle and semitendinosus (ST) tendon cross-sectional area (CSA). On two consecutive days, muscle anatomical CSA (ACSA) and ST tendon CSA were measured at standardized positions (30%-80% of thigh length; half the distance from the distal muscle-tendon junction to the popliteal crease) on 12 legs using ultrasonography and compared with corresponding magnetic resonance imaging measures. Inter-day intraclass correlation coefficients were good-to-excellent (0.882-0.996) for all assessed muscle and tendon sites. The limits of agreement widths were narrowest (range: 17%-52%) when muscle ACSA was large but were wide at sites with relatively small ACSA (≤184%) and for ST tendon CSA (range: 72%). Results suggest ultrasound-based measures of individual hamstring muscle maximal ACSA are reliable and valid and ST tendon CSA measures are reliable but require comparison with cadaveric or intra-operative measurements to verify validity.

Computational models of the knee joint are useful for evaluating stresses and strains within the joint tissues. However, the outcome of those models is sensitive to the material model and material properties chosen for ligaments, the collagen reinforced tissues connecting bone to bone. The purpose of this study was to investigate different compositionally motivated material models and further to develop a model that can accurately reproduce experimentally measured stress-relaxation data of bovine anterior cruciate ligament (ACL). Tensile testing samples were extracted from ACLs of bovine knee joints (N = 10) and subjected to a three-step stress-relaxation test at the toe region. Data from the experiments was averaged and one average finite element model was generated to replicate the experiment. Poroelastic and different fibril-reinforced poro(visco)elastic material models were applied, and their material parameters were optimized to reproduce the experimental force-time response. Material models with only fluid flow mediated relaxation were not able to capture the stress-relaxation behavior (R2 = 0.806, 0.803 and 0.938). The inclusion of the viscoelasticity of the fibrillar network improved the model prediction (R2 = 0.978 and 0.976), but the complex stress-relaxation behavior was best captured by a poroelastic model with a nonlinear two-relaxation-time strain-recruited viscoelastic fibrillar network (R2 = 0.997). The results suggest that in order to replicate the multi-step stress-relaxation behavior of ACL in tension, the fibrillar network formulation should include the complex nonlinear viscoelastic phenomena.

Preprocessing is important for near infrared spectroscopy applications as it reduces noise and improves prediction accuracy of models. We present a toolbox for automatically combining different preprocessing strategies for spectral data.

The Achilles tendon is a common tendon for the medial and lateral gastrocnemius and soleus muscles. Non‐uniform Achilles tendon regional displacements have been observed in vivo which may result from non‐uniform muscle loading and intratendinous shearing. However, prior observations are limited to the sagittal plane. This study investigated Achilles tendon tissue displacement patterns during isometric plantarflexor contractions in the coronal and sagittal planes. Fourteen subjects (5 female, 9 male, 26 ± 3 year) performed maximal isometric plantarflexor contractions with the knee in full extension and flexed to 110°. An ultrasound transducer positioned over the free Achilles tendon collected beam formed radio frequency (RF) data at 70 frames/s. Localized tissue displacements were analyzed using a speckle tracking algorithm. We observed non‐uniform Achilles tendon tissue displacements in both imaging planes. Knee joint posture had no significant effect on tissue displacement patterns in either imaging plane. The non‐uniform Achilles tendon tissue displacements during loading may arise from the anatomical organization of the sub‐tendons associated with the three heads of the triceps surae. The biplanar investigation suggests that greatest displacements are localized to tissue likely to belong to soleus subtendon. This study adds novel information with possible implications for muscle coordination, function, and muscle‐tendon injury mechanisms. peerReviewed

Mechanical characterization of soft tissues such as ligaments remains challenging. There is variability in the measured material parameters of ligaments, most of which is related to natural tissue variability, but some of it can be a result of using different testing protocols. Generally preconditioning (cyclic loading-unloading) is performed prior to actual tests to reduce the experimental variability. Commonly, preconditioning protocols for ligaments with a small strain level and 10 sinusoidal loading-unloading cycles are used. The effect of preconditioning and its parameters including strain level, number of cycles and number of preconditioning repetitions on the repeatability of tensile stress-relaxation tests are poorly known for knee ligaments. In the present study, forty-eight dumbbell-shaped bovine anterior cruciate ligament (ACL) samples were used to evaluate the repeatability of stress-relaxation response. Different preconditioning protocols with 2% and 6% strain levels and 1, 5 or 10 preconditioning repetitions were applied. After preconditioning, one-step stress-relaxation test was carried out twice with an hour resting period in between the tests. The equilibrium stress showed no systematic bias when only one preconditioning repetition was applied (2.0 ± 3.1% difference and p > 0.05 between repeated tests). Systematic bias in the peak-to-equilibrium stress ratio was not observed when higher strain level and number of repetitions were used (0.5 ± 1.6% difference and p > 0.05 between repeated tests). In conclusion, the commonly used preconditioning protocol is capable of producing repeatable equilibrium stress levels of bovine ACLs from stress-relaxation tests in tension. However, if repeatable peak-to-equilibrium stress ratio is desirable, higher strain and number of preconditioning repetitions are recommended.

Previous studies have shown that aging is associated with alterations in muscle architecture and tendon properties (Morse CI, Thom JM, Birch KM, Narici MV. Acta Physiol Scand 183: 291–298, 2005; Narici MV, Maganaris CN, Reeves ND, Capodaglio P. J Appl Physiol 95: 2229–2234, 2003; Stenroth L, Peltonen J, Cronin NJ, Sipila S, Finni T. J Appl Physiol 113: 1537–1544, 2012). However, the possible influence of different types of regular exercise loading on muscle architecture and tendon properties in older adults is poorly understood. To address this, triceps surae muscle-tendon properties were examined in older male endurance (OE, n = 10, age = 74.0 ± 2.8 yr) and sprint runners (OS, n = 10, age = 74.4 ± 2.8 yr), with an average of 42 yr of regular training experience, and compared with age-matched [older control (OC), n = 33, age = 74.8 ± 3.6 yr] and young untrained controls (YC, n = 18, age = 23.7 ± 2.0 yr). Compared with YC, Achilles tendon cross-sectional area (CSA) was 22% ( P = 0.022), 45% ( P = 0.001), and 71% ( P < 0.001) larger in OC, OE, and OS, respectively. Among older groups, OS had significantly larger tendon CSA compared with OC ( P = 0.033). No significant between-group differences were observed in Achilles tendon stiffness. In older groups, Young's modulus was 31-44%, and maximal tendon stress 44–55% lower, than in YC ( P ≤ 0.001). OE showed shorter soleus fascicle length than both OC ( P < 0.05) and YC ( P < 0.05). These data suggest that long-term running does not counteract the previously reported age-related increase in tendon CSA, but, instead, may have an additive effect. The greatest Achilles tendon CSA was observed in OS followed by OE and OC, suggesting that adaptation to running exercise is loading intensity dependent. Achilles tendon stiffness was maintained in older groups, even though all older groups displayed larger tendon CSA and lower tendon Young's modulus. Shorter soleus muscle fascicles in OE runners may be an adaptation to life-long endurance running.

It is known that adipose tissue mass increases with age, and that a number of hormones, collectively called adipokines, are produced by adipose tissue. For most of them it is not known whether their plasmatic levels change with age. Moreover, it is known that adipose tissue infiltration in skeletal muscle is related to sarcopenia and loss of muscle strength. In this study we investigated the age-related changes of representative adipokines and insulin-like growth factor (IGF)-1 and their effect on muscle strength. We studied the association between circulating levels of adiponectin, leptin, resistin and IGF-1 and muscle strength. This cross-sectional study included 412 subjects of different age (152 subjects aged 18-30 years and 260 subjects aged 69-81 years) recruited within the framework of the European research network project "Myoage". The levels of adiponectin (both in male and female subjects) and leptin (only in males) were significantly higher in old subjects compared to young, while those of IGF-1 were lower in old subjects. In old subjects adiponectin, resistin and the resistin/IGF-1 ratio (but not IGF-1 alone) were inversely associated with quadriceps torque, while only adiponectin was inversely associated with handgrip strength independently from percentage of fat mass, height, age, gender and geographical origin. The ratio of leptin to adiponectin was directly associated with handgrip strength in both young and old subjects. These results suggest that in humans the age-associated loss of strength is associated with the levels of representative adipokines and IGF-1.

Large forces are generated under the big toe in the push-off phase of walking. The largest flexor muscle of the big toe is the flexor hallucis longus (FHL), which likely contributes substantially to these forces. This study examined FHL function at different levels of isometric plantarflexion torque and in the push-off phase at different speeds of walking. FHL and calf muscle activity were measured with surface EMG and plantar pressure was recorded with pressure insoles. FHL activity was compared to the activity of the calf muscles. Force and impulse values were calculated under the big toe, and were compared to the entire pressed area of the insole to determine the relative contribution of big toe flexion forces to the ground reaction force. FHL activity increased with increasing plantarflexion torque level (F=2.8, P=0.024) and with increasing walking speed (F=11.608, P

In this study, mechanical properties of bovine knee ligament and tendon samples were estimated using near infrared spectroscopy (NIRS). Properties related to sample stress-relaxation characteristics were found to be suitable for NIRS-based estimation.

BACKGROUND: Muscle mass, strength, and power are known determinants of mobility in older adults but there is limited knowledge on the influence of muscle architecture or tendon properties on mobility. The purpose of this study was to examine the relationship between mobility and plantarflexor muscle-tendon properties in healthy older adults.METHODS: A total of 52 subjects (age 70-81 years) were measured for 6-minute walk test (6MWT), timed "up and go"-test (TUG), isometric plantarflexion strength, Achilles tendon stiffness, triceps surae muscle architecture, lower extremity lean mass, isometric leg extension strength, and leg extension power. Partial correlations and multivariate regression models adjusted for sex, age, body mass, and height were used to examine the relationship between mobility (6MWT and TUG) and lower limb muscle-tendon properties.RESULTS: Multivariate regression models revealed that Achilles tendon stiffness (p = .020), plantarflexion strength (p = .022), and medial gastrocnemius fascicle length (p = .046) were independently associated with 6MWT. Plantarflexion strength (p = .037) and soleus fascicle length (p = .031) were independently associated with TUG.CONCLUSIONS: Plantarflexor muscle-tendon properties were associated with mobility in older adults independent of lower extremity lean mass, leg extension strength, or power. Plantarflexion strength was a stronger predictor of mobility than leg extension strength or power. The novel finding of this study was that muscle architecture and tendon properties explained interindividual differences in mobility. This study highlights the importance of the plantarflexors for mobility in older adults and provides understanding of possible mechanisms of age-related decline in mobility.

Objective This study compared bioimpedance analysis (BIA) in the assessment of body composition with dual-energy X-ray absorptiometry (DXA) in 18- to 88-year-old adults. Design and Methods Body composition of 882 adults was estimated by eight-polar BIA and DXA. In addition, estimates of lean mass, fat mass, and percentage of fat were investigated across a range of age and leisure time physical activity (LTPA) groups. Results Compared to DXA, larger lean masses (mean difference 2.9 and 1.6 kg) and smaller fat masses (3.1 and 2.6 kg) were estimated by BIA in both women and men, respectively. Differences between the methods' mean values were evident in all age and LTPA groups, except in the oldest men (over 70 years). Age, waist circumference, grip strength, and LTPA explained 21% or less of the variance observed in the differences between methods. Conclusions Compared to DXA, BIA provided systematically different body composition estimates throughout the adult age span with considerable amount of intraindividual variation. The differences between estimates may be related to the BIAs' algorithm or body geometry or composition of the population used in this study. Knowledge about the methodological limitations and device comparability is essential for researchers, clinicians, and persons working in rehabilitation and sport centers.

© 2017 International Osteoporosis Foundation and National Osteoporosis Foundation Summary: Bone mineral density declines with increasing older age. We examined the levels of circulating factors known to regulate bone metabolism in healthy young and older adults. The circulating levels of dickkopf-1, osteocalcin, osteoprotegerin and sclerostin were positively associated with whole-body bone mineral density (WBMD) in older adults, despite the average WBMD being lower and circulating dickkopf-1, osteoprotegerin and sclerostin being higher in old than young. Introduction: This study aims to investigate the relationship between whole-body bone mineral density (WBMD) and levels of circulating factors with known roles in bone remodelling during ‘healthy’ ageing. Methods: WBMD and fasting plasma concentrations of dickkopf-1, fibroblast growth factor-23, osteocalcin, osteoprotegerin, osteopontin and sclerostin were measured in 272 older subjects (69 to 81 years; 52% female) and 171 younger subjects (18–30 years; 53% female). Results: WBMD was lower in old than young. Circulating osteocalcin was lower in old compared with young, while dickkopf-1, osteoprotegerin and sclerostin were higher in old compared with young. These circulating factors were each positively associated with WBMD in the older adults and the relationships remained after adjustment for covariates (r values ranging from 0.174 to 0.254, all p < 0.01). In multivariate regression, the body mass index, circulating sclerostin and whole-body lean mass together accounted for 13.8% of the variation with WBMD in the older adults. In young adults, dickkopf-1 and body mass index together accounted for 7.7% of variation in WBMD. Conclusion: Circulating levels of dickkopf-1, osteocalcin, osteoprotegerin and sclerostin are positively associated with WBMD in community-dwelling older adults, despite the average WBMD being lower and circulating dickkopf-1, osteoprotegerin and sclerostin being higher in old than young.

This study examined the contributions of individual muscles to changes in energetic cost of transport (COT) over seven walking speeds, and compared results between healthy young and elderly subjects. Twenty six participants (13 young aged 18–30; 13 old aged 70–80) were recruited. COT (O2/kg body mass/km) was calculated by standardizing the mean oxygen consumption recorded during steady state walking. Electromyography signals from 10 leg muscles were used to calculate the cumulative activity required to traverse a unit of distance (CMAPD) for each muscle at each speed. In the old group CMAPD was correlated with COT, presented higher and more variable values, and showed greater increases around optimal speed for all studied muscles. Soleus CMAPD was independent of speed in the young group, but this was not evident with aging. Greater energy cost of walking in older individuals seems to be attributable to increased energy cost of all lower limb muscles.

This study examined the concurrent age-related differences in muscle and tendon structure and properties. Achilles tendon morphology and mechanical properties and triceps surae muscle architecture were measured from 100 subjects [33 young (24 ± 2 yr) and 67 old (75 ± 3 yr)]. Motion analysis-assisted ultrasonography was used to determine tendon stiffness, Young's modulus, and hysteresis during isometric ramp contractions. Ultrasonography was used to measure muscle architectural features and size and tendon cross-sectional area. Older participants had 17% lower ( P < 0.01) Achilles tendon stiffness and 32% lower ( P < 0.001) Young's modulus than young participants. Tendon cross-sectional area was also 16% larger ( P < 0.001) in older participants. Triceps surae muscle size was smaller ( P < 0.05) and gastrocnemius medialis muscle fascicle length shorter ( P < 0.05) in old compared with young. Maximal plantarflexion force was associated with tendon stiffness and Young's modulus ( r = 0.580, P < 0.001 and r = 0.561, P < 0.001, respectively). Comparison between old and young subjects with similar strengths did not reveal a difference in tendon stiffness. The results suggest that regardless of age, Achilles tendon mechanical properties adapt to match the level of muscle performance. Old people may compensate for lower tendon material properties by increasing tendon cross-sectional area. Lower tendon stiffness in older subjects might be beneficial for movement economy in low-intensity locomotion and thus optimized for their daily activities.

Overuse-induced injuries have been proposed as a predisposing factor for Achilles tendon (AT) ruptures. If tendons can be overloaded, their mechanical properties should change during exercise. Because there data are lacking on the effects of a single bout of long-lasting exercise on AT mechanical properties, the present study measured AT stiffness before and after a marathon. AT stiffness was determined as the slope of the force–elongation curve between 10 and 80% of maximum voluntary force. AT force–elongation characteristics were measured in an ankle dynamometer using simultaneous motion-capture-assisted ultrasonography. Oxygen consumption and ankle kinematics were also measured on a treadmill at the marathon pace. All measurements were performed before and after the marathon. AT stiffness did not change significantly from the pre-race value of 197±62 N mm−1 (mean ± s.d.) to the post-race value of 206±59 N mm−1 ( N =12, P =0.312). Oxygen consumption increased after the race by 7±10% ( P

Consensus on clinically valid diagnostic criteria for sarcopenia requires a systematical assessment of the association of its candidate measures of muscle mass, muscle strength, and physical performance on one side and muscle-related clinical parameters on the other side. In this study, we systematically assessed associations between serum albumin as a muscle-related parameter and muscle measures in 172 healthy young (aged 18–30 years) and 271 old participants (aged 69–81 year) from the European MYOAGE study. Muscle measures included relative muscle mass, i.e., total- and appendicular lean mass (ALM) percentage, absolute muscle mass, i.e., ALM/height2 and total lean mass in kilograms, handgrip strength, and walking speed. Muscle measures were standardized and analyzed in multivariate linear regression models, stratified by age. Adjustment models included age, body composition, C-reactive protein and lifestyle factors. In young participants, serum albumin was positively associated with lean mass percentage (p = 0.007) and with ALM percentage (p = 0.001). In old participants, serum albumin was not associated with any of the muscle measures. In conclusion, the association between serum albumin and muscle measures was only found in healthy young participants and the strongest for measures of relative muscle mass. peerReviewed

Pathological obstruction in lungs leads to severe decreases in muscle strength and mobility in patients suffering from chronic obstructive pulmonary disease. The purpose of this study was to investigate the interdependency between muscle strength, spirometric pulmonary functions and mobility outcomes in healthy older men and women, where skeletal muscle and pulmonary function decline without interference of overt disease. A total of 135 69- to 81-year-old participants were recruited into the cross-sectional study, which was performed as a part of European study MyoAge. Full, partial and no mediation models were constructed to assess the interdependency between muscle strength (handgrip strength, knee extension torque, lower extremity muscle power), spirometric pulmonary function (FVC, FEV1 and FEF50) and mobility (6-min walk and Timed Up and Go tests). The models were adjusted for age, sex, total fat mass, body height and site of enrolment. Partial mediation models, indicating both direct and pulmonary function mediated associations between muscle strength and mobility, fitted best to the data. Greater handgrip strength was significantly associated with higher FVC, FEV1 and FEF50 (p < 0.05). Greater muscle power was significantly associated with better performance in mobility tests. Results suggest that decline in mobility with aging may be caused by decreases in both muscle strength and power but also mediated through decreases in spirometric pulmonary function. Future longitudinal studies are warranted to better understand how loss of function and mass of the respiratory muscles will affect pulmonary function among older people and how these changes are linked to mobility decline.

SUMMARY: Currently used diagnostic measures for sarcopenia utilize different measures of muscle mass, muscle strength, and physical performance. These diagnostic measures associate differently to bone mineral density (BMD), as an example of muscle-related clinical outcome. These differences should be taken into account when studying sarcopenia.INTRODUCTION: Diagnostic measures for sarcopenia utilize different measures of muscle mass, muscle strength, and physical performance. To understand differences between these measures, we determined the association with respect to whole body BMD, as an example of muscle-related clinical outcome.METHODS: In the European cross-sectional study MYOAGE, 178 young (18-30 years) and 274 healthy old participants (69-81 years) were recruited. Body composition and BMD were evaluated using dual-energy X-ray densitometry. Diagnostic measures for sarcopenia were composed of lean mass as percentage of body mass, appendicular lean mass (ALM) as percentage of body mass, ALM divided by height squared (ALM/height(2)), knee extension torque, grip strength, walking speed, and Timed Up and Go test (TUG). Linear regression models were stratified for sex and age and adjusted for age and country, and body composition in separate models.RESULTS: Lean mass and ALM/height(2) were positively associated with BMD (P CONCLUSIONS: The associations between diagnostic measures of sarcopenia and BMD as an example of muscle-related outcome vary widely. Differences between diagnostic measures should be taken into account when studying sarcopenia.

Within the European multi-centre MyoAge project, one workpackage was designed to investigate the contribution of age-related changes to muscle mass, contractile characteristics and neural control in relation to reductions in mobility in older age. The methodology has been described here. Test centres were located in Manchester, UK; Paris, France; Leiden, The Netherlands; Tartu, Estonia and Jyväskylä, Finland. In total, 182 young (18-30 years old, 52.2 % female) and 322 older adults (69-81 years old, 50 % female) have been examined. The participants were independent living, socially active and free from disease that impaired mobility levels. The older participants were selected based on physical activity levels, such that half exceeded current recommended physical activity levels and the other half had lower physical activity levels than is recommended to maintain health. Measurements consisted of blood pressure; anthropometry and body composition (dual-energy X-ray absorptiometry and magnetic resonance imaging); lung function; standing balance and cognitive function (CANTAB). Mobility was assessed using the Timed Up and Go, a 6 min walk, activity questionnaires and accelerometers to monitor habitual daily activities. Muscle strength, power, fatigue and neural activation were assessed using a combination of voluntary and electrically stimulated contractions. Fasting blood samples and skeletal muscle biopsies were collected for detailed examination of cell and molecular differences between young and older individuals. The results from this study will provide a detailed insight into "normal, healthy" ageing, linking whole-body function to the structure and function of the neuromuscular system and the molecular characteristics of skeletal muscle.

This viewpoint was stimulated by two observations: 1) the statistical skewness whereby numerous articles have reported tendon stiffness and Young9s modulus, but far fewer have reported tendon hysteresis; 2) in vivo human studies seem very often to report hysteresis values greater than 10%, suggesting either that there are methodological differences between human and animal studies, or that human tendons have a much poorer capacity to store and reutilize elastic energy. In this article we focus on the healthy human Achilles/gastrocnemius tendon (AT) since it has an important locomotor function and clearly a low AT hysteresis would allow elastic recoil for efficient locomotion. We discuss that both the measurement of tendon length and force and their correct synchronization can contribute to the variability of measures of tendon properties. Within the large variability the lower values are likely to be more valid, being consistent with animal studies.

Introduction Achilles tendon is the most common tendon to suffer for complete rupture. Physically active young adults are often treated with surgery. Most of the patients do not suffer from activity limitations after injury 3 but performance level is often significantly decreased. 1,2 The purpose of this study was to follow recovery of Achilles tendon and triceps surae muscles after complete Achilles tendon rupture and subsequent surgery. This study served as a pilot phase for future research project. Methods Three subjects were recruited to this pilot phase of the study. Subjects were first time measured 2 to 8 months after injury and followed 6 to 8 months. Plantarflexion strength was measured with isometric maximal voluntary contraction in a dynamometer, triceps surae muscle size and architecture was measured using ultrasonography and Achilles tendon stiffness was calculated from force-elongation relationship (Figure 1) measured using dynamometer and ultrasonography. Results One of the three subjects reached plantarflexion strength level comparable to healthy leg. Other two subjects improved strength during follow-up but reached only 72 and 77% of the healthy leg’s value at the end of the follow-up. Similarly to plantarflexion strength, gastrocnemius cross-sectional area recovered only in one of the three subjects during the follow-up. In the two subjects suffering from strength deficit after follow-up, pennation angle of medial gastrocnemius was larger in the injured leg during force production. Achilles tendon stiffness was not greatly different between the legs at the end of the follow-up and increased in each subject during the follow-up (Figure 2). Discussion Persistent atrophy of the calf muscles may explain why two of the subjects were not able to produce similar plantarflexion force with the injured leg 10 to 16 months after injury compared to the healthy leg. Other factors contributing to force deficit may be related to possible elongation of the injured Achilles tendon causing alterations to muscle mechanics. For example, larger pennation angle will decrease the proportion of muscle force transmitted to skeleton. In future, the aim is to start systematic collection of data from patients recovering from Achilles tendon rupture in order to understand why some develop persistent physical deficits and to gain knowledge that can be used to develop operation and rehabilitation regimes. References 1 Amin, et al . Am J Sports Med. 2013;41:1864–1868 2 Olsson, et al . Knee Surg Sports Traumatol Arthrosc. 2011;19:1385–1393 3 Strauss, et al . Injury Int J Care Injured . 2007;38:832–838

It has been postulated that human tendons are viscoelastic and their mechanical properties time-dependent. Although Achilles tendon (AT) mechanics are widely reported, there is no consensus about AT viscoelastic properties such as loading rate dependency or hysteresis, in vivo. AT force-elongation characteristics were determined from 14 subjects in an ankle dynamometer at different loading rates using motion capture assisted ultrasonography. AT stiffness and elongation were determined between 10 – 80% of maximum voluntary contraction (MVC) force at fast and slow loading rates. As subjects were unable to consistently match the target unloading rate in the slow condition, AT hysteresis was only calculated for the fast rate. There was a significant difference between the fast and the slow loading rates: 120 ± 6 vs. 21 ± 1% of MVC s-1 (mean ± standard error), respectively. However, neither stiffness (193 ± 18 N mm-1 vs. 207 ± 22 N mm-1) nor elongation at any force level (13.0 ± 1.2 mm vs. 14.3 ± 0.9 mm at 80% of MVC) were significantly different between the fast and slow loading rates. Tendon hysteresis at the fast rate was 5 ± 2%. As stiffness was not sensitive to loading rate and hysteresis was small, it was concluded that elastic properties prevail over viscous properties in the human AT. The current results support the idea that AT stiffness is independent of loading rate. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-2-212) contains supplementary material, which is available to authorized users.