Search Results (43)

Background: Visual, vestibular, proprioceptive and cutaneous sensory information is important for postural control during quiet stance. When the reliability of one source of sensory information used to detect self-motion for postural control is reduced, there may be a reweighting of inputs within and/or across the remaining sensory systems determining self-motion for postural control. Muscle vibration, which creates an illusion of muscle stretch and a compensatory movement to shorten the vibrated muscle, may be used to determine the weighting of muscle spindle Ia proprioception in postural control. The objective of this study was to determine the effect of vision occlusion on triceps surae (TS) Ia proprioceptive weighting in postural control during quiet stance, utilizing an 80 Hz muscle vibration stimulus and a quantitative measure of the body’s anterior to posterior ground center of pressure (COP) response to TS muscle vibration in subjects standing freely. Methods: Subjects (N = 41; mean (standard deviation), 19.6(2.0) years) were examined as they stood with eyes open (EO) or eyes closed (EC). Ground COP was measured during quiet standing with and without bilateral vibration of the TS muscles. Results: The mean backward COP shift induced by TS vibration was significantly greater during the EC condition compared to EO (EC: −4.93(1.62) centimeters; EO: −3.21(1.33) centimeters; p = 6.85 × 10⁻¹⁰; Cohen’s d = 1.29). Thirty-seven subjects increased, and two subjects decreased their vibration-induced COP backward shift in the EC condition compared to EO, although the magnitude of the change varied. Conclusions: The results support the idea that, for most young subjects, there is an increased triceps surae Ia proprioceptive weighting for postural control during EC stance, possibly due to the need for postural control to depend more on non-visual feedback. Full article

Background: This paper concerns the study of forces acting on the upper ankle joint of a human in static and quasi-dynamic positions. This paper aimed to determine the pressure forces on the axis of the upper ankle joint in the position of the body tilting forward and backward, as well as in a neutral position. Methods: A model with designated centres of gravity (including and excluding the weight of the platform imitating the foot) and the point of gravity imitating the proximal insertion of the triceps surae and tibialis anterior muscles was developed for this study. The forces and the weight of the tilted object were measured using dynamometers. A method for determining the arms of gravitational forces and the angle of inclination of an object is presented. The function describing the distribution of gravitational loading along its tilting part was described. Next, all measurements and calculations were referred to the human body. Results: Measurements of muscle force, body gravity, the arms of these forces, and the angles of the object’s inclination on the axis of rotation are presented. A methodology for determining the pressure force on the human upper ankle joint axis is presented. The distribution of the value of the pressure force and its components from the maximal forward, through the vertical body position, up to the maximal backward position of the body tilt, is provided. Conclusions: The ankle joint pressure force is the vector sum of the force of gravity and the force of the muscle counteracting the body tilt. This force is the smallest in the vertical body position and increases with the body tilt. It reaches 5.23 times the weight of the tilting part of the body when the body is tilted to its maximum forward position, and 3.57 times the weight when the body tilts backward. Regardless of the direction of the body tilt, the joint pressure vector always runs through the axis of the upper ankle joint. Full article

The aim of this study was to analyze the joint characteristics of the foot and ankle in competitive swimmers aged 16–18 and 19–24 years and their relationship with the presence of muscle pain during swimming. A total of 74 swimmers were evaluated: 38 ‘junior’ (16–18 years) and 36 ‘senior’ (19–24 years). The following parameters were recorded: ankle dorsiflexion, rearfoot mobility, first metatarsophalangeal dorsiflexion, presence of hallux valgus, foot posture, first ray mobility, arch height, and plantar pressure. Additionally, the frequency and location of muscle pain in the triceps surae were analyzed. A cluster analysis was performed to identify variables that differentiated both groups. Ankle dorsiflexion was limited in both groups, with a greater restriction observed in adults (p < 0.001 with an extended knee; p < 0.014 with a flexed knee). The predominant foot type was the cavus foot. The most common pain was localized in the triceps surae, followed by the plantar musculature, with no significant differences between groups. Swimmers exhibited gastrocnemius shortening, which could limit ankle dorsiflexion and contribute to the onset of muscle pain in the leg and foot. These findings suggest the importance of incorporating lower limb flexibility strategies into the training of competitive swimmers. Full article

Injuries to the soleus muscle are often unrecognized, which increases the risk of complete tearing. Consequently, it results in the need for a long break in sports. This is mainly because the soleus muscle is complex, and the clinical signs of injury are difficult to capture, which can mimic Achilles tendinopathy and tennis player’s calves. This muscle has a complex connective tissue structure with three intramuscular tendons, which makes it challenging to interpret pathological muscle conditions. Injuries to the soleus muscle can be acute or chronic and are usually considered to be a minor discomfort by both the patient and the sports medicine physician, leading to a relatively quick return to sports activity with a high risk of re-injury. This narrative literature review aims to explore the diagnostic challenges and treatment failures associated with soleus muscle injuries, highlighting the critical lack of standardized protocols and a comprehensive understanding of the nuances of these injuries, which requires the collection of qualitative data from clinical case studies, quantitative data from imaging studies and rehabilitation outcomes, and expert opinion to formulate evidence-based guidelines to improve patient management. Calf muscle pain symptoms should not be ignored because the injury may become chronic, and the lack of treatment adequate to the actual cause of the pain increases the risk of the injury deepening, including complete rupture. High-resolution ultrasonography and magnetic resonance imaging are recommended methods for differentially diagnosing soleus muscle injury in conjunction with physical examination to make a precise and reliable diagnosis. A soleus muscle injury case report and a comprehensive proposal for conservative treatment supplement our literature review. Full article

The state of frailty is a clinical–biological syndrome that affects the older population with a higher risk of functional dependence. Animal models can provide a tool to study this complex scenario. In the present work, we analyzed the physical and behavioral hallmarks of end-point status in 16-month-old mice (C57BL/6J) according to animal welfare regulations compared to age-matched counterparts with normal aging. A group of 6-month-old mice was added to control for age bias. First, we identified ‘structural kyphosis’ (visible and unmodifiable deformation in locomotion) correlated with piloerection as the hallmarks of the physical frailty phenotype compared to the ‘postural kyphosis’ (adjustment to counteract increased visceral volume but attenuated during locomotion) of old mice with normal aging. Alopecia (barbering) was presented in both old groups. Normal levels of exploratory activity in the corner test for neophobia and triceps surae muscle weight but an increased latency of rearing indicated the poorest emotional phenotype, with a possible contribution of structural kyphosis. The presence of hepatomegaly and splenomegaly counteracted the significant WAT loss commonly associated with end-of-life traits, which should have a normal body weight but preserved muscle mass. Full article

Background/Objectives: Acute ruptures of the Achilles Tendon (AT) are common injuries in the active population, in particular among men aged 30 to 50. Full functional recovery after this kind of injury is long and challenging and nowadays there is no universal “gold standard” strategy when dealing with them. Methods: When it comes to surgical treatment, various techniques have been described: in case of a typical lesion at the midportion of the tendon (which is the most common type), the basic principle of surgical repair is the end-to-end suture of the tendon stumps. The AT (“calcaneal tendon” according to the International Anatomical Terminology) is the strongest tendon of the human body, it is the conjunct tendon of the two Gastrocnemii Muscles and the Soleus Muscle and has a well-recognizable twisted structure: the subtendon from the Medial Head of the Gastrocnemius attaches postero-laterally on the calcaneal tendon footprint, the subtendon from the Lateral Head of the Gastrocnemius attaches antero-laterally and the subtendon from the Soleus attaches medially, therefore creating a 90° twist of the tendon structure. Results: the twisted structure of the human AT is of central importance to its biomechanics, since it gives the tendon a higher resistance to deformation and concurs in supination of the subtalar joint during gait. Conclusions: given the abovementioned anatomical and biomechanical premises, we believe that the restoration of the subtendons anatomy can lead to a better functional recovery of the Triceps Surae—Achilles Tendon complex, therefore we recently decided to adopt for open surgical repair the Direct Anatomical Reconstruction of the Achilles Tendon, which we describe in the present article. Full article

After a stroke, antagonist muscle activation during agonist command impedes movement. This study compared measurements of antagonist muscle activation using surface bipolar EMG in the gastrocnemius medialis (GM) and high-density (HD) EMG in the GM and soleus (SO) during isometric submaximal and maximal dorsiflexion efforts, with knee flexed and extended, in 12 subjects with chronic hemiparesis. The coefficients of antagonist activation (CAN) of GM and SO were calculated according to the ratio of the RMS amplitude during dorsiflexion effort to the maximal agonist effort for the same muscle. Bipolar CAN (BipCAN) was compared to CAN from channel-specific (CsCAN) and overall (OvCAN) normalizations of HD-EMG. The location of the CAN centroid was explored in GM, and CAN was compared between the medial and lateral portions of SO. Between-EMG system differences in GM were observed in maximal efforts only, between BipCAN and CsCAN with lower values in BipCAN (p < 0.001), and between BipCAN and OvCAN with lower values in OvCAN (p < 0.05). The CAN centroid is located mid-height and medially in GM, while the CAN was similar in medial and lateral SO. In chronic hemiparesis, the estimates of GM hyperactivity differ between bipolar and HD-EMGs, with channel-specific and overall normalizations yielding, respectively, higher and lower CAN values than bipolar EMG. HD-EMG would be the way to develop personalized rehabilitation programs based on individual antagonist activations. Full article

The literature offers limited information on the effect of obesity on the rate of force development (RFD), a critical parameter for mobility in older adults. The objectives of this study were to explore the influence of obesity on the RFD in older adults and to examine the association between this neuromuscular parameter and walking speed. The participants (42 older adults) were classified into two groups: the control group (CG, n = 22; mean age = 81.13 ± 4.02 years; body mass index (BMI) = 25.13 ± 3.35 kg/m²), and the obese group (OG, n = 20; mean age = 77.71 ± 2.95 years; BMI = 34.46 ± 3.25 kg/m²). Walking speed (m/s) was measured using the 10 m walking test. Neuromuscular parameters of the plantar flexors were evaluated during a maximal voluntary contraction test using a dynamometer. The RFD was calculated from the linear slop of the force–time curve in the following two phases: from the onset of the contraction to 50 ms (RFD_0–50) and from 100 to 200 ms (RFD_100–200). The gait speed was lower in the OG compared to the CG (p < 0.001). The RFD_50/100 and RFD_100/200 were lower in the OG compared to the CG (p < 0.001). The RFD_50/100 was found to be the predominant influencer on gait speed in the OG. In conclusion, obesity negatively impacts the RFD in older adults and RFD stands out as the primary factor among the studied parameters influencing gait speed. Full article

Background: The reduction of muscular hypertonia is important in the treatment of various diseases or rehabilitation. This study aims to test the efficacy of a 5 Hz mechanical muscle stimulation (tapotement massage) in comparison to a 5 Hz repetitive peripheral magnetic stimulation (rPMS) on the neuromuscular reflex response. Methods: In a randomized control trial, 15 healthy volunteers were administered with either 5 Hz rPMS, tapotement massage, or rPMS sham stimulation. The posterior tibial nerve was stimulated with rPMS and sham stimulation. The Achilles tendon was exposed to a mechanically applied high-amplitude 5 Hz repetitive tendon tapotement massage (rTTM). The tendon reflex (TR) was measured for the spinal response of the soleus muscle. Results: After rPMS, there was a reduction of the TR response (−9.8%, p ≤ 0.034) with no significant changes after sham stimulation. Likewise, TR decreased significantly (−17.4%, p ≤ 0.002) after Achilles tendon tapotement intervention. Conclusions: These findings support the hypothesis that both afferent 5 Hz sensory stimulations contributed to a modulation within the spinal and/or supraspinal circuits, which resulted in a reduction of the spinal reflex excitability. The effects could be beneficial for patients with muscle hypertonia and could improve the functional results of rehabilitation programs. Full article

During the stance phase of a normal gait, the triceps surae muscle controls the advancement of the tibia, which contributes to knee extension. Plantar flexor weakness results in excessive dorsiflexion, and consequently, the knee loses this contribution. However, increasing knee flexion is also seen in patients with cerebral palsy who do not have plantar flexor weakness. We aimed to understand this mechanism through the use of a musculoskeletal dynamic model. The model consists of solid segments connected with rotatory joints and springs to represent individual muscles. It was positioned at different degrees of ankle plantarflexion, knee flexion, and hip flexion. The soleus muscle was activated concentrically to produce plantarflexion and push the foot against the ground. The resulting knee extension was analyzed. The principal determinant of knee flexion or extension associated with ankle plantarflexion was the position of the knee joint center. When this was anterior to the line of action of the ground reaction force (GRF), the soleus contraction resulted in increased knee flexion. The knee extension was obtained when the knee was flexed less than approximately 25°. The relation between joint angles, anthropometric parameters, and the position of the GRF was expressed in a mathematical formulation. The clinical relevance of this model is that it explains the failure of plantar flexor control on knee extension in patients with cerebral palsy, when increased knee flexion can occur even if there is a normal or plantarflexed foot position. Full article

Body weight support (BWS) and incline running (IR) are commonly used either during rehabilitation or during training separately, with many positive effects on athletes’ performance and rehabilitation. The aim of the present study was to investigate the interaction between bodyweight support and incline running on the electromyographic activity of the triceps surae and compare it to flat running. In eighteen healthy men (age: 20.3 ± 1.2 years, body weight: 70.2 ± 4.8 kg, body height: 179.6 ± 5.4 cm), the changes in electromyographic activity (EMGA) during a 10 min run with BWS (15% or 30% of body weight; in different occasions) and IR at 7%, as well as jumping performance and gait spatiotemporal parameters, were evaluated. A lower Rating of Perceived Exertion and a significant decrease in the size of the Vastus Lateralis (VL) (33.4%), Soleus (SOL) (17%), and Gastrocnemius Lateralis (GL) EMGA (28.5%, p < 0.05) but not in Gastrocnemius Medialis (GM) (10.5%, p > 0.05), was observed during BWS30% at 7% slope compared to flat running. Also, low-frequency fatigue of the quadriceps was induced only after running without BWS on a 7% slope (p = 0.011). No changes were found in jumping performance (p = 0.246) and gait spatiotemporal parameters (p > 0.05) except for flight time (p < 0.006). In conclusion, running with a slope of 7% and 30% of BWS can result in EMG activity comparable to that observed during level running. This method can also be used in prevention and rehabilitation training programs without creating fatigue. Full article

The purpose of this study was to investigate the influence of changes in muscle length on the torque fluctuations and on related oscillations in muscle activity during voluntary isometric contractions of ankle plantar flexor muscles. Eleven healthy individuals were asked to perform voluntary isometric contractions of ankle muscles at five different contraction intensities from 10% to 70% of maximum voluntary isometric contraction (MVIC) and at three different muscle lengths, implemented by changing the ankle joint angle (plantar flexion of 26°-shorter muscle length; plantar flexion of 10°-neutral muscle length; dorsiflexion of 3°-longer muscle length). Surface electromyogram (EMG) signals were recorded from the skin surface over the triceps surae muscles, and rectified-and-smoothed EMG (rsEMG) were estimated to assess the oscillations in muscle activity. The absolute torque fluctuations (quantified by the standard deviation) were significantly higher during moderate-to-high contractions at the longer muscle length. Absolute torque fluctuations were found to be a linear function of torque output regardless of muscle length. In contrast, the relative torque fluctuations (quantified by the coefficient of variation) were higher at the shorter muscle length. However, both absolute and relative oscillations in muscle activities remained relatively consistent at different ankle joint angles for all plantar flexors. These findings suggest that the torque steadiness may be affected by not only muscle activities, but also by muscle length-dependent mechanical properties. This study provides more insights that muscle mechanics should be considered when explaining the steadiness in force output. Full article

This systematic review documents the protocol characteristics of studies that used neuromuscular electrical stimulation protocols (NMES) on the plantar flexors [through triceps surae (TS) or tibial nerve (TN) stimulation] to stimulate afferent pathways. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, was registered to PROSPERO (ID: CRD42022345194) and was funded by the Greek General Secretariat for Research and Technology (ERA-NET NEURON JTC 2020). Included were original research articles on healthy adults, with NMES interventions applied on TN or TS or both. Four databases (Cochrane Library, PubMed, Scopus, and Web of Science) were systematically searched, in addition to a manual search using the citations of included studies. Quality assessment was conducted on 32 eligible studies by estimating the risk of bias with the checklist of the Effective Public Health Practice Project Quality Assessment Tool. Eighty-seven protocols were analyzed, with descriptive statistics. Compared to TS, TN stimulation has been reported in a wider range of frequencies (5–100, vs. 20–200 Hz) and normalization methods for the contraction intensity. The pulse duration ranged from 0.2 to 1 ms for both TS and TN protocols. It is concluded that with increasing popularity of NMES protocols in intervention and rehabilitation, future studies may use a wider range of stimulation attributes, to stimulate motor neurons via afferent pathways, but, on the other hand, additional studies may explore new protocols, targeting for more optimal effectiveness. Furthermore, future studies should consider methodological issues, such as stimulation efficacy (e.g., positioning over the motor point) and reporting of level of discomfort during the application of NMES protocols to reduce the inherent variability of the results. Full article

The acute rupture of the Achilles tendon is an increasingly common injury due to an active lifestyle and participation in sports, especially in the middle-aged group. We conducted a focused review of the literature and found that the acute rupture of the Achilles tendon leaves long-term changes in the structure of the triceps surae muscle, regardless of whether it was treated surgically or conservatively. Significant elongation of the Achilles tendon and atrophy of the triceps surae can be observed on the injured leg, even 4 years or more after the injury. The injury also has long-lasting consequences on movement patterns of walking, running and jumping. These compensatory strategies place stress on other musculoskeletal structures, which are then at greater risk for injury. Full article

Critically sized nerve defects cause devastating life-long disabilities and require interposition for reconstruction. Additional local application of mesenchymal stem cells (MSCs) is considered promising to enhance peripheral nerve regeneration. To better understand the role of MSCs in peripheral nerve reconstruction, we performed a systematic review and meta-analysis of the effects of MSCs on critically sized segment nerve defects in preclinical studies. 5146 articles were screened following PRISMA guidelines using PubMed and Web of Science. A total of 27 preclinical studies (n = 722 rats) were included in the meta-analysis. The mean difference or the standardized mean difference with 95% confidence intervals for motor function, conduction velocity, and histomorphological parameters of nerve regeneration, as well as the degree of muscle atrophy, was compared in rats with critically sized defects and autologous nerve reconstruction treated with or without MSCs. The co-transplantation of MSCs increased the sciatic functional index (3.93, 95% CI 2.62 to 5.24, p < 0.00001) and nerve conduction velocity recovery (1.49, 95% CI 1.13 to 1.84, p = 0.009), decreased the atrophy of targeted muscles (gastrocnemius: 0.63, 95% CI 0.29 to 0.97 p = 0.004; triceps surae: 0.08, 95% CI 0.06 to 0.10 p = 0.71), and promoted the regeneration of injured axons (axon number: 1.10, 95% CI 0.78 to 1.42, p < 0.00001; myelin sheath thickness: 0.15, 95% CI 0.12 to 0.17, p = 0.28). Reconstruction of critically sized peripheral nerve defects is often hindered by impaired postoperative regeneration, especially in defects that require an autologous nerve graft. This meta-analysis indicates that additional application of MSC can enhance postoperative peripheral nerve regeneration in rats. Based on the promising results in vivo experiments, further studies are needed to demonstrate potential clinical benefits. Full article