Assessment of Repeated Measurement Variance in Shear Wave Elastography of the Medial and Lateral Gastrocnemius and Soleus

The use of shear wave elastography (SWE) as a method to measure intrinsic muscle stiffness is gaining increasing interest in the scientific community. To date, a few studies exist that have evaluated reliability of SWE of the gastrocnemius muscle under various conditions. However, data on day-to-day variance, inter-rater variance and frame use in reporting stiffness is missing. PURPOSE: The purpose of this study was to calculate the variance of repeated measures for SWE in 2 different muscles using different raters and to analyze the number of elastogram frames needed for stiffness assessment. METHODS: 12 raters measured SWE of the gastrocnemius and soleus in 2 different ankle positions of 1 subject (12 different subjects total) on 5 separate days, and calculated stiffness using both velocity (m/s) and young’s modulus model (kPa) based on 10 separate elastogram frames. All subjects lay prone on the exam table with their bare foot and ankle hanging off. SWE of the visual center of the lateral head (LH) and medial head (MH) of the gastrocnemius, as well as the medial and lateral portion of the soleus were taken when the ankle was in a relaxed position (how the ankle naturally lay off the end of table) and a neutral position (requiring a strap to slightly dorsiflex the ankle joint to 90 degrees. RESULTS: Variance of young’s modulus model data (kPa) were analyzed using a Bayesian model. Muscles and muscle state (neutral or relaxed) were considered to be fixed effects, and the variance components (for subject, rater, day, frame, and error) were estimated using a hyperprior structure for those effects. Variance component results for day (0.186) and frame (0.063) were very low. Variance components for rater (6.170) and subject (6.126). Variance of random error was higher than expected at 62.620, indicating incidences of non-systematic abnormal kPa measurement values. CONCLUSION: SWE measurements are consistent day to day results with minimal variation indicating that controlled multiple day measurements are valid. Rater variance indicates an expected variability of 2.5 Kpa combined for all muscles and positions tested. Frame variance indicates that 10 frames are not necessary for calculation of kPa values which has not been established in current literature

Acute Stretching Effect on Hamstring Muscle Stiffness using Elastography

Having first been introduced in the 1990s, shear wave elastography (SWE) has more recently been used to investigate intrinsic muscle stiffness. While studies have shown SWE to be an effective way of determining muscle stiffness, few have been conducted to measure the effects of stretching on the hamstring muscles. PURPOSE: to determine if there is a measurable difference of hamstring muscle stiffness with acute stretching using ultrasound elastography. METHODS: 16 subjects participated in this study (11 men and 5 women). Mean age 23.4 ± 2.6yrs for men and 21.2 ±1.5 for women. Mean height (cm) is 180.3± 4.7 for men and 172.7±2.5 for women. Mean weight (kg) is 76.8±9.7 for men and 70.0±14.9 for women. Participants lay supine and positioned to 90° hip and 90° knee flexion. Each participant came in for two sessions that consisted of (1) static stretching and (2) PNF stretching protocols. Maximum ROM of the knee joint, force, and muscle stiffness of the biceps femoris (BF), semimembranosus (SM) and semitendinosus (ST) were recorded both before and 1 minute after stretching. RESULTS: After accounting for age, weight and height, there was no significant difference between the use of static and PNF stretching techniques on either velocity (p= 0.4805) or kPa (p=0.5423) stiffness values. Both static and PNF stretching resulted in significant reductions in both velocity and kPa stiffness (pCONCLUSION: Stiffness as measured using SWE decreases following an acute stretching session for both static and PNF stretching techniques. This suggests alterations to intrinsic muscle characteristics beyond just “stretch tolerance” as suggested in previous literature. Changes in both ROM and force also support this claim. Further research on retention of decreased stiffness are needed as acute stretching has previously been shown to be temporary. Longer term stretching studies to determine if intrinsic muscle stiffness changes models plastic deformation are also needed and may help better elucidate duration and stretch technique differences

Comparison of Gastrocnemius Shear Wave Elastography Stiffness Over 5 Different Zones

A few studies report that shear wave elastography (SWE) is a reliable method of measuring gastrocnemius muscle stiffness. To date there are no studies assessing variance in stiffness measures at different locations on the muscle. This led us to ask whether the spot at which gastrocnemius stiffness is measured matters. PURPOSE: To determine if measurement site on the medial and lateral gastrocnemius affects SWE stiffness values. METHODS: Twelve subjects (3 men, 9 women) completed this study (Mean age is 23.0 (SD = 1.0) for men and 21.7 (SD = 2.0) for women (t p = 0.3035). Mean height (cm) is 179.5 (SD = 2.9) for men and 167.1 (SD = 7.8) for women (t p = 0.0256). Mean weight (kg) is 74.9 (SD =10.4) for men and 62.5 (SD = 9.7) for women (t p = 0.0892). Subjects wore shorts and lay prone on a treatment table with their bare feet hanging off the edge of the table. Ultrasound images to confirm borders of the medial and lateral gastrocnemius were confirmed and marked. SWE of both the Medial head (MG) and lateral head (LG) were taken with each head area divided into 4 zones (1=superior medial, 2=superior lateral, 3=inferior medial, 4= inferior lateral). A fifth zone was collected at the center of the muscle at 70% of the length of the lateral malleolus to lateral femoral epicondyle. All 5 points were assessed for SWE in both a relaxed and neutral (900) ankle joint position. Three separate elastogram frames were used to calculate muscle stiffness using both the velocity (m/s) and young’s modulus model (kPa) utilizing an overall area analysis for each. RESULTS: MG velocity and kPa values were significantly greater than LG in the relaxed and neutral positions (pCONCLUSION: MG stiffness is greater than LG regardless of position while intrinsic stiffness of MG increases more relative to LG when placed in neutral. Measurement of stiffness is best represented at the center of the muscle belly in the neutral position, but zones 2,3 and 5 produce similar stiffness values in the relaxed position

Massage Gun Use at a Lower Frequency Does Not Alter Blood Flow

Data has shown that whole body vibration can affect blood flow velocity in arteries and improves cutaneous blood flow. However, there is very limited information available on therapeutic localized vibration. Massage guns have become very popular with little to no research validating their efficacy. It is currently unknown if massages guns can affect arterial blood flow. PURPOSE: To determine if massage gun treatment at 30Hz improves and retains blood flow in the popliteal artery as compared to a control condition. METHODS: There were 12 participants in this study (8 males and 4 females). The mean age was 22.7±1.6 yrs, the mean height was 181.1± 11.8 cm, and the mean weight was 78.2±16.2 kg. Participants wore shorts that allowed us to access their popliteal artery using ultrasound imaging. Participants wore electrodes to control the measurement of blood flow from widest artery diameter. Participants lay prone with a foam roller under their ankles to slightly elevate their feet. After ten minutes of rest, ultrasound imaging was used to find the participant’s popliteal artery behind the knee and took two baseline measurements. We measured the mean velocity of blood flow (TAmean) and volume flow (VolF). We measured subjects on 4 different days (30Hz at 5 minutes, 30Hz 10 minutes, Control 5 minutes, Control 10 minutes). Measurements of TAmean and VolF were measured at multiple time points after treatment. RESULTS: A two-factor repeated measures analysis was performed. Each subject was measured under all levels of condition (1=30hz 5 min, 4=Control 5 mi, 5=30hz 10 min, 8=Control 10 min) and time (baseline, post, post1-5, 7, 9, 11, 13, 15, 17, 19). TA mean is significantly greater in 30Hz versus control (p=0.0349). TAmean varies across time, and the effect of the condition on TAmean is related to time (p=0.0104). There is not a significant difference in flow between 30Hz and control (p=0.2425). Blood flow varies across time (pCONCLUSION: Use of a massage gun at a lower frequency setting of 30Hz may cause slight increases in velocity but does not increase mean blood flow as compared to control. Lower frequency settings on massage guns may not be benefit blood flow in the massaged muscle group

Effect of Localized Vibration Using Massage Gun at 40hz and 50hz on Blood Flow

Data has shown that whole body vibration can positively affect blood flow, however, there are very few studies on the effect of localized therapeutic vibration on arterial blood flow. Occupational studies looking at localized vibration effects on skin blood flow normally include high frequency settings. In the last few years, massage guns have become popular, but they operate at lower frequencies. Currently, there is no data on the effects of localized vibration from massage guns on arterial blood flow. PURPOSE: To compare the effects of two different frequencies of localized vibration on blood flow in the popliteal artery. METHODS: 12 subjects participated in this study (8 males and 4 females). Mean age was 22.7±1.6 years; mean height was 181.1±11.8 cm; mean weight was 78.2±16.2 kg. Participants wore shorts to give access to the popliteal artery. Participants were hooked to ECG leads to control measurement of artery diameter and then laid on a treatment table in a prone position with a foam roller under their ankles. Once at resting heart rate, baseline blood flow readings were taken using ultrasound, which measured TA Mean and Volume Flow. The participants were then randomly given a 5-minute treatment of control with no vibration or vibration at 40hz or 50hz. Blood flow readings were taken immediately post-treatment and then every minute for 5 minutes after. RESULTS: A two-factor repeated measures analysis was performed. Each subject was measured under all levels of condition (Control 5 min, 40hz 5 min, and 50hz 5 min) and time (baseline, post, post1-5). TA Mean and Volume Flow for both 40hz and 50hz were significantly greater than control (p=0.0020 and p=0.0110 respectively). The effect of time was significant (

Static stretching does not alter pre and post-landing muscle activation

<p>Abstract</p> <p>Background</p> <p>Static stretching may result in various strength and power deficiencies. Prior research has not determined, however, if static stretching causes a change in muscle activation during a functional task requiring dynamic stability. The purpose of this study was to determine if static stretching has an effect on mean pre and postlanding muscle (vastus medialis VM, vastus lateralis VL, medial hamstring MH, and biceps femoris BF) activity.</p> <p>Methods</p> <p>26 healthy, physically active subjects were recruited, from which 13 completed a 14-day static stretching regimen for the quadriceps and hamstrings. Using the data from the force plate and EMG readings, a mean of EMG amplitude was calculated for 150 msec before and after landing. Each trial was normalized to an isometric reference position. Means were calculated for the VM, VL, MH, and BF from 5 trials in each session. Measures were collected pre, immediately following the 1^ststretching session, and following 2 weeks of stretching.</p> <p>Results</p> <p>A 14-day static stretching regimen resulted in no significant differences in pre or postlanding mean EMG amplitude during a drop landing either acutely or over a 14-day period.</p> <p>Conclusions</p> <p>Static stretching, done acutely or over a 14-day period does not result in measurable differences of mean EMG amplitude during a drop landing. Static stretching may not impede dynamic stability of joints about which stretched muscles cross.</p

GROUND REACTION FORCE DIFFERENCES BETWEEN RUNNING SHOES, RACING FLATS, AND DISTANCE SPIKES IN RUNNERS

Various shoes are worn by distance runners throughout a training season. This study measured the differences in ground reaction forces between running shoes, racing flats, and distance spikes in order to provide information about the potential effects of footwear on injury risk in highly competitive runners. Ten male and ten female intercollegiate distance runners ran across a force plate at 6.7 m·s-1 (for males) and 5.7 m·s-1 (for females) in each of the three types of shoes. To control for differences in foot strike, only subjects who exhibited a heel strike were included in the data analysis. Two repeated-measures ANOVAs with Tukey's post-hoc tests (p < 0.05) were used to detect differences in shoe types among males and females. For the males, loading rate, peak vertical impact force and peak braking forces were significantly greater in flats and spikes compared to running shoes. Vertical stiffness in spikes was also significantly greater than in running shoes. Females had significantly shorter stance times and greater maximum propulsion forces in racing flats compared to running shoes. Changing footwear between the shoes used in this study alters the loads placed on the body. Care should be taken as athletes enter different phases of training where different footwear is required. Injury risk may be increased since the body may not be accustomed to the differences in force, stance time, and vertical stiffnes

Performance on the Functional Movement Screen in older active adults

Background: The Functional Movement Screen (FMS™) has become increasingly popular for identifying functional limitations in basic functional movements. This exploratory and descriptive study was undertaken to confirm feasibility of performing the FMS™ in older active adults, assess prevalence of asymmetries and to evaluate the relationship between functional movement ability, age, physical activity levels and body mass index (BMI). Methods: This is an observational study; 97 men (n = 53) and women (n = 44) between the ages of 52 and 83 participated. BMI was computed and self-reported physical activity levels were obtained. Subjects were grouped by age (5-year intervals), BMI (normal, over-weight, and obese) and sex. Each participant's performance on the FMS™ was digitally recorded for later analysis. Results: The youngest age group (50–54 years) scored highest in all seven tests and the oldest age group (75+) scored lowest in most of the tests compared to all other age groups. The subjects in the “normal weight” group performed no different than those who were in the “overweight” group; both groups performed better than the “obese” group. Of the 97 participants 54 had at least one asymmetry. The pairwise correlations between the total FMS™ score and age (r = −0.531), BMI (r = −0.270), and the measure of activity level (r = 0.287) were significant (p < 0.01 for all). Conclusion: FMS™ scores decline with increased BMI, increased age, and decreased activity level. The screen identifies range of motion- and strength-related asymmetries. The FMS™ can be used to assess functional limitations and asymmetries. Future research should evaluate if a higher total FMS™ score is related to fewer falls or injuries in the older population