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In vivo measurements of muscle architecture (i.e. the spatial arrangement of muscle fascicles) are routinely included in research and clinical settings to monitor muscle structure, function and plasticity. However, in most cases such measurements are performed manually, and more reliable and time-efficient automated methods are either lacking completely, or are inaccessible to those without expertise in image analysis. In this work, we propose an ImageJ script to automate the entire analysis process of muscle architecture in ultrasound images: Simple Muscle Architecture Analysis (SMA). Images are filtered in the spatial and frequency domains with built-in commands and external plugins to highlight aponeuroses and fascicles. Fascicle dominant orientation is then computed in regions of interest using the OrientationJ plugin. Bland-Altman plots of analyses performed manually or with SMA indicates that the automated analysis does not induce any systematic bias and that both methods agree equally through the range of measurements. Our test results illustrate the suitability of SMA to analyse images from superficial muscles acquired with a broad range of ultrasound settings., Comment: 8 pages, 7 figures, 1 appendix

ow-load blood flow restriction (LL-BFR) training has gained increasing interest in the scientific community by demonstrating that increases in muscle mass and strength are comparable to conventional high-load (HL) resistance training. Although adaptations on the muscular level are well documented, there is little evidence on how LL-BFR training affects human myotendinous properties. Therefore, the aim of the present study was to investigate morphological and mechanical Achilles tendon adaptations after 14 wk of strength training. Fifty-five male volunteers (27.9 ± 5.1 yr) were randomly allocated into the following three groups: LL-BFR [20–35% of one-repetition maximum (1RM)], HL (70–85% 1RM), or a nonexercising control (CON) group. The LL-BFR and HL groups completed a resistance training program for 14 wk, and tendon morphology, mechanical as well as material properties, and muscle cross- sectional area (CSA) and isometric strength were assessed before and after the intervention. Both HL (+40.7%) and LL-BFR (+36.1%) training induced significant increases in tendon stiffness (P < 0.05) as well as tendon CSA (HL: +4.6%, LL-BFR: +7.8%, P < 0.001). These changes were comparable between groups without significant changes in Young’s modulus. Furthermore, gastrocnemius medialis muscle CSA and plantar flexor strength significantly increased in both training groups (P < 0.05), whereas the CON group did not show significant changes in any of the evaluated parameters. In conclusion, the adaptive change in Achilles tendon properties following low-load resistance training with partial vascular occlusion appears comparable to that evoked by high-load resistance training.NEW & NOTEWORTHY Low-load blood flow restriction (LL-BFR) training has been shown to induce beneficial adaptations at the muscular level. However, studies examining the effects on human tendon properties are rare. The findings provide first evidence that LL-BFR can increase Achilles tendon mechanical and morphological properties to a similar extent as conventional high-load resistance training. This is of particular importance for individuals who may not tolerate heavy training loads but still aim for improvements in myotendinous function.

Introduction: The effect of chronic patellar tendinopathy on tissue function and integrity is currently unclear and underinvestigated. The aim of this cohort comparison was to examine morphological, material, and mechanical properties of the patellar tendon and to extend earlier findings by measuring the ability to store and return elastic energy in symptomatic tendons. Methods: Seventeen patients with chronic (>3 months, VISA-P < 80), inferior pole patellar tendinopathy (24 4 years; male = 12, female = 5) were carefully matched to controls (25 3 years) for training status, pattern, and history of loading of the patellar tendon. Individual knee extension force, patellar tendon stiffness, stress, strain, Youngs modulus, hysteresis, and energy storage capacity, were obtained with combined dynamometry, ultrasonography, magnetic resonance imaging, and electromyography. Results: Anthropometric parameters did not differ between groups. VISA-P scores ranged from 28 to 78 points, and symptoms had lasted from 10 to 120 months before testing. Tendon proximal cross-sectional area was 61% larger in the patellar tendinopathy group than in the control group. There were no differences between groups in maximal voluntary isometric knee extension torque (p = 0.216; d < 0.31) nor in tensile tendon force produced during isometric ramp contractions (p = 0.185; d < 0.34). Similarly, tendon strain (p = 0.634; d < 0.12), hysteresis (p = 0.461; d < 0.18), and strain energy storage (p = 0.656; d < 0.36) did not differ between groups. However, patellar tendon stiffness (19%; p = 0.007; d < 0.74), stress (27%; p< 0.002; d < 0.90) and Youngs modulus (32%; p = 0.001; d < 0.94) were significantly lower in tendinopathic patients compared to healthy controls. Discussion: In this study, we observed lower stiffness in affected tendons. However, despite the substantial structural and histological changes occurring with tendinopathy, the tendon capacity to store and dissipate energy did not differ significantly. (VLID)5346698

Background and objective\ud Deep learning approaches are common in image processing, but often rely on supervised learning, which requires a large volume of training images, usually accompanied by hand-crafted labels. As labelled data are often not available, it would be desirable to develop methods that allow such data to be compiled automatically. In this study, we used a Generative Adversarial Network (GAN) to generate realistic B-mode musculoskeletal ultrasound images, and tested the suitability of two automated labelling approaches.\ud \ud Methods\ud We used a model including two GANs each trained to transfer an image from one domain to another. The two inputs were a set of 100 longitudinal images of the gastrocnemius medialis muscle, and a set of 100 synthetic segmented masks that featured two aponeuroses and a random number of ‘fascicles’. The model output a set of synthetic ultrasound images and an automated segmentation of each real input image. This automated segmentation process was one of the two approaches we assessed. The second approach involved synthesising ultrasound images and then feeding these images into an ImageJ/Fiji-based automated algorithm, to determine whether it could detect the aponeuroses and muscle fascicles.\ud \ud Results\ud Histogram distributions were similar between real and synthetic images, but synthetic images displayed less variation between samples and a narrower range. Mean entropy values were statistically similar (real: 6.97, synthetic: 7.03; p = 0.218), but the range was much narrower for synthetic images (6.91 – 7.11 versus 6.30 – 7.62). When comparing GAN-derived and manually labelled segmentations, intersection-over-union values- denoting the degree of overlap between aponeurosis labels- varied between 0.0280 – 0.612 (mean ± SD: 0.312 ± 0.159), and pennation angles were higher for the GAN-derived segmentations (25.1° vs. 19.3°; p < 0.001). For the second segmentation approach, the algorithm generally performed equally well on synthetic and real images, yielding pennation angles within the physiological range (13.8–20°).\ud \ud Conclusions\ud We used a GAN to generate realistic B-mode ultrasound images, and extracted muscle architectural parameters from these images automatically. This approach could enable generation of large labelled datasets for image segmentation tasks, and may also be useful for data sharing. Automatic generation and labelling of ultrasound images minimises user input and overcomes several limitations associated with manual analysis.

The interaction between the Achilles tendon and the triceps surae muscles seems to be modulated differently with various task configurations. Here we tested the hypothesis that the increased forces and ankle joint work during running under contrasting conditions (altered speed or load) would be met by different, time-dependent adjustments at the muscle-tendon level. Ultrasonography, electromyography, kinematics, and ground reaction force measurements were used to examine Achilles tendon, gastrocnemius, and soleus muscle mechanics in 16 runners in four different running conditions, consisting of a combination of two different speeds (preferred and +20% of preferred speed) and two loading conditions (unloaded and +20% of body mass). Positive ankle joint work increased similarly (+13%) with speed and load. Gastrocnemius and soleus muscle fascicle length and peak velocity were not altered by either condition, suggesting that contractile conditions are mostly preserved despite the constraints imposed in this experimental design. However, at higher running speed, tendon length changes were unaltered but mean muscle electromyographic activity increased in gastrocnemius (+10%, P < 0.01) and soleus (+14%, P < 0.01). Conversely, when loading was increased, mean muscle activity remained similar to unloaded conditions but the mean velocity of gastrocnemius fascicles was reduced and tendon recoil increased (+29%, P < 0.01). Collectively, these results suggest that the neuromuscular system meets increased mechanical demands by favoring economical force production when enough time is available. peerReviewed

Introduction: During running and jumping activities, elastic energy is utilized to enhance muscle mechanical output and efficiency. However, training-induced variations in tendon spring-like properties remain under-investigated. The present work extends earlier findings on sport-specific profiles of tendon stiffness and cross-sectional area to examine whether years of distinct loading patterns are reflected by tendons' ability to store and return energy. Methods:Ultrasound scans were performed to examine the morphological features of knee extensor and plantar flexor muscle-tendon units in elite ski jumpers, distance runners, water polo players, and sedentary controls. Tendon strain energy and hysteresis were measured with combined motion capture, ultrasonography, and dynamometry. Results: Apart from the fractional muscle-to-tendon cross-sectional area ratio being lower in the knee extensors of ski jumpers (−31%) and runners (−33%) than in water polo players, no difference in the considered muscle-tendon unit morphological features was observed between groups. Similarly, no significant difference in tendon energy storage or energy return was detected between groups. In contrast, hysteresis was lower in the patellar tendon of ski jumpers (−33%) and runners (−30%) compared to controls, with a similar trend for the Achilles tendon (significant interaction effect and large effect sizes η2 = 0.2). Normalized to body mass, the recovered strain energy of the patellar tendon was ~50% higher in ski jumpers than in water polo players and controls. For the Achilles tendon, recovered strain energy was ~40% higher in ski jumpers and runners than in controls. Discussion: Advantageous mechanical properties related to tendon spring-like function are observed in elite athletes whose sport require effective utilization of elastic energy. However, the mechanisms underpinning the better tendon capacity of some athletes to retain elastic energy could not be ascribed to intrinsic or morphological features of the lower limb muscle-tendon unit.

Introduction: During running and jumping activities, elastic energy is utilized to enhance muscle mechanical output and efficiency. However, training-induced variations in tendon spring-like properties remain under-investigated. The present work extends earlier findings on sport-specific profiles of tendon stiffness and cross-sectional area to examine whether years of distinct loading patterns are reflected by tendons' ability to store and return energy. Methods: Ultrasound scans were performed to examine the morphological features of knee extensor and plantar flexor muscle-tendon units in elite ski jumpers, distance runners, water polo players, and sedentary controls. Tendon strain energy and hysteresis were measured with combined motion capture, ultrasonography, and dynamometry. Results: Apart from the fractional muscle-to-tendon cross-sectional area ratio being lower in the knee extensors of ski jumpers (31%) and runners (33%) than in water polo players, no difference in the considered muscle-tendon unit morphological features was observed between groups. Similarly, no significant difference in tendon energy storage or energy return was detected between groups. In contrast, hysteresis was lower in the patellar tendon of ski jumpers (33%) and runners (30%) compared to controls, with a similar trend for the Achilles tendon (significant interaction effect and large effect sizes 2 = 0.2). Normalized to body mass, the recovered strain energy of the patellar tendon was 50% higher in ski jumpers than in water polo players and controls. For the Achilles tendon, recovered strain energy was 40% higher in ski jumpers and runners than in controls. Discussion: Advantageous mechanical properties related to tendon spring-like function are observed in elite athletes whose sport require effective utilization of elastic energy. However, the mechanisms underpinning the better tendon capacity of some athletes to retain elastic energy could not be ascribed to intrinsic or morphological features of the lower limb muscle-tendon unit. (VLID)1773031

Contradictory results have been reported on the impact of ageing on structure and functions of skeletal muscle fibres, likely to be due to a complex interplay between ageing and other phenomena such as disuse and diseases. Here we recruited healthy, physically and socially active young (YO) and elderly (EL) men in order to study ageing per se without the confounding effects of impaired physical function. In vivo analyses of quadriceps and in vitro analyses of vastus lateralis muscle biopsies were performed. In EL subjects, our results show that (i) quadriceps volume, maximum voluntary contraction isometric torque and patellar tendon force were significantly lower; (ii) muscle fibres went through significant atrophy and impairment of specific force (isometric force/cross-sectional area) and unloaded shortening velocity; (iii) myosin/actin ratio and myosin content in individual muscle fibres were not altered; (iv) the muscle proteome went through quantitative adaptations, namely an up-regulation of the content of several groups of proteins among which were myofibrillar proteins and antioxidant defence systems; (v) the muscle proteome went through qualitative adaptations, namely phosphorylation of several proteins, including myosin light chain-2 slow and troponin T and carbonylation of myosin heavy chains. The present results indicate that impairment of individual muscle fibre structure and function is a major feature of ageing per se and that qualitative adaptations of muscle proteome are likely to be more involved than quantitative adaptations in determining such a phenomenon.

The present study aimed to determine whether distinct sets of tendon properties are seen in athletes engaged in sports with contrasting requirements for tendon function and structural integrity. Patellar and Achilles tendon morphology and force-deformation relation were measured by combining ultrasonography, electromyography and dynamometry in elite ski jumpers, distance runners, water polo players and sedentary individuals. Tendon cross-sectional area normalized to body mass2/3 was smaller in water polo players than in other athletes (patellar and Achilles tendon; -28 to -24%) or controls (patellar tendon only; -9%). In contrast, the normalized cross-sectional area was larger in runners (patellar tendon only; +26%) and ski jumpers (patellar and Achilles tendon; +21% and +13%, respectively) than in controls. Tendon stiffness normalized to body mass2/3 only differed in ski jumpers, compared to controls (patellar and Achilles tendon; +11% and +27%, respectively) and to water polo players (Achilles tendon only; +23%). Tendon size appears as an adjusting variable to changes in loading volume and/or intensity, possibly to preserve ultimate strength or fatigue resistance. However, uncoupled morphological and mechanical properties indicate that functional requirements may also influence tendon adaptations. Hans-Peter Wiesinger, Florian Rieder, Alexander Kösters, Erich Müller

The aim of this study was to investigate the effect of alpine skiing on patellar tendon properties in patients with total knee arthroplasty (TKA). Thirty-one adults (70.4 ± 4.7 years) with unilateral TKA were recruited 2.7 ± 0.9 years after surgery and assigned to an intervention (IG) or a control group (CG). The IG underwent a 12-week guided skiing program. Tendon stiffness, Young's modulus, and cross-sectional area (CSA) were measured before and after the intervention. In both groups, mean tendon CSA was 28% (P

This study investigated the effectiveness of recreational skiing as an intervention to improve quadriceps muscle architecture, strength, and antagonistic co-activation in patients with unilateral total knee arthroplasty (TKA). Hence, patients with TKA were assigned to either an intervention group (IG) or control group (CG). The IG completed a 12-week guided skiing program whereas the CG was instructed not to change their daily routines for the same period and was not allowed to ski. Before, after the intervention/after an 8-week retention period m. rectus femoris (RF) cross-sectional area (CSA), m. vastus lateralis muscle thickness, fascicle length, and pennation angle were measured with ultrasonography, while isometric (90° knee angle) knee extension, flexion torque and m. biceps femoris co-activation were assessed on an isokinetic dynamometer in 26 patients. There were significant and stable increases in RF CSA for the operated (10%; P 0.05). There were no significant effects for other parameters (all P > 0.05). Overall, the skiing intervention was successful in increasing muscle mass in TKA older patients.

Animal studies suggest that regular exposure to whole-body vibration (WBV) induces an anabolic response in bone and tendon. However, the effects of this type of intervention on human tendon properties and its influence on the muscle-tendon unit function have never been investigated. The aim of this study was to investigate the effect of WBV training on the patellar tendon mechanical, material and morphological properties, the quadriceps muscle architecture and the knee extension torque–angle relationship. Fifty-five subjects were randomized into either a vibration, an active control, or an inactive control group. The active control subjects performed isometric squats on a vibration platform without vibration. Muscle and tendon properties were measured using ultrasonography and dynamometry. Vibration training induced an increase in proximal (6.3%) and mean (3.8%) tendon cross-sectional area, without any appreciable change in tendon stiffness and modulus or in muscle architectural parameters. Isometric torque at a knee angle of 90° increased in active controls (6.7%) only and the torque–angle relation remained globally unchanged in all groups. The present protocol did not appreciably alter knee extension torque production or the musculo-tendinous parameters underpinning this function. Nonetheless, this study shows for the first time that WBV elicits tendon hypertrophy in humans.

Introduction: In vivo measurements have been used in the past two decades to investigate the effects of increased loading on tendon properties, yet the current understanding of tendon macroscopic changes to training is rather fragmented, limited to reports of tendon stiffening, supported by changes in material properties and/or tendon hypertrophy. The main aim of this review was to analyze the existing literature to gain further insights into tendon adaptations by extracting patterns of dose-response and time-course. Methods: PubMed/Medline, SPORTDiscus, and Google Scholar databases were searched for studies examining the effect of training on material, mechanical, and morphological properties via longitudinal or cross-sectional designs. Results: Thirty-five of 6440 peer-reviewed articles met the inclusion criteria. The key findings were i) the confirmation of a nearly systematic adaptation of tendon tissue to training, ii) the important variability in the observed changes in tendon properties between and within studies, and iii) the absence of a consistent incremental pattern regarding the dose-response or the time-course relation of tendon adaptation within the first months of training. However, long-term (years) training was associated with a larger tendon cross-sectional area, without any evidence of differences in material properties. Our analysis also highlighted several gaps in the existing literature, which may be addressed in future research. Conclusions: In line with some cross-species observations about tendon design, tendon cross-sectional area allegedly constitutes the ultimate adjusting parameter to increased loading. We propose here a theoretical model placing tendon hypertrophy and adjustments in material properties as parts of the same adaptive continuum (VLID)1661663

Fast acceleration is an important performance factor in handball. In addition to traditional sprint training (TST), resisted sprint training (RST) is a method often used to improve acceleration. However, studies on RST show conflicting results, and underlying mechanisms are not studied. Purpose: To compare the effects of RST, by sled towing, against traditional sprint training on sprint performance and muscle architecture. Methods: Participants (n=18) were assigned to either RST or TST and completed two training sessions of RST or TST per week (10 weeks), in addition to their normal team training. Sprint-tests (10-m and 30-m) and measurements of muscle architecture were performed pre- and post-training. Results: Beneficial effects were found in the 30-m sprint test (mean; ±90% CL) for both groups (TST=-0.31; ±0.19 s, RST=-0.16; ±0.13 s), with unclear differences between the groups. Only TST had a beneficial effect on 10-m time (-0.04; ±0.04 s), with a likely difference between the two groups (85 %, ES= 0.60). Both groups had a decrease in pennation angle (-6.0; ±3.3% for TST and -2.8; ±2.0% for RST), which had a nearly perfect correlation with percentage change in 10-m sprint performance (r=0.92). A small increase in fascicle length (5.3; ±3.9% and 4.0; ±2.1% for TST and RST, respectively) was found, with unclear differences between groups. Discussion: TST appears to be more effective than RST in enhancing 10-m sprint time. Both groups showed similar effects in 30-m sprint time. A similar, yet small, effect of sprint training on muscle architecture was observed in both groups.