Tendinous tissue properties after short and long-term functional overload: Differences between controls, 12 weeks and 4 years of resistance training

Aim - The potential for tendinous tissues to adapt to functional overload, especially after several years of exposure to heavy resistance training is largely unexplored. This study compared the morphological and mechanical characteristics of the patellar tendon and knee-extensor tendon-aponeurosis complex between young men exposed to long-term (4 years; n=16), short-term (12 weeks; n=15) and no (untrained controls; n=39) functional overload in the form of heavy resistance training. Methods - Patellar tendon cross-sectional area, vastus-lateralis aponeurosis area and quadriceps femoris volume, plus patellar tendon stiffness and Young's modulus, and tendon-aponeurosis complex stiffness, were quantified with MRI, dynamometry and ultrasonography. Results - As expected long-term trained had greater muscle strength and volume (+58% and +56% vs untrained, both P<0.001), as well as a greater aponeurosis area (+17% vs untrained, P<0.01), but tendon cross-sectional area (mean and regional) was not different between groups. Only long-term trained had reduced patellar tendon elongation/strain over the whole force/stress range, whilst both short-term and long-term overload groups had similarly greater stiffness/Young's modulus at high force/stress (short-term +25/22%, and long-term +17/23% vs untrained; all P<0.05). Tendon-aponeurosis complex stiffness was not different between groups (ANOVA, P = 0.149). Conclusion - Despite large differences in muscle strength and size, years of resistance training did not induce tendon hypertrophy. Both short-term and long-term overload, demonstrated similar increases in high force mechanical and material stiffness, but reduced elongation/strain over the whole force/stress range occurred only after years of overload, indicating a force/strain specific time-course to these adaptations

Age related changes in skeletal muscle mass and function

The loss of muscle mass with age (Sarcopenia) has received growing attention over the past decade. Despite efforts to provide a universal definition with clinically meaningful cut-off points for diagnosis, there is no clear consensus on how to best quantify and assess the impact of loss of muscle mass and function on functional limitations. Whilst most previous studies have used dual energy x-ray absorptiometry (DXA) to quantify this loss, chapter 2 of this thesis shows that DXA underestimates the loss of muscle mass with age in comparison to the gold standard MRI. Muscle mass per se is not enough to determine whether a person has an exceptionally low muscle mass, as it can be readily seen that a healthy tall person will have a larger muscle mass than a small person. Clinicians and researchers thus need an index of muscle mass that takes differences in stature into account and also gives an objective cut off point to define low muscle mass. In Chapter3, we show that femur volume does not significantly differ between young and old. We used this observation to introduce a new index: thigh muscle mass normalised to femur volume, or the muscle to bone ratio. This index allows the examination of the true extent of muscle atrophy within an individual. In previous studies the appendicular lean mass (determined with DXA) divided by height squared appeared to be a relatively poor predictor of functional performance. In Chapter 4, the index introduced in Chapter 3, the muscle to bone ratio, proved to be a somewhat better predictor of functional performance in the overall cohort. This was, however, not true when examining the intra-group relationships. A similar situation applied to the maximal muscle strength. In older adults, the parameter which predicted functional performance best was muscle power per body mass, measured during a counter-movement jump. Chapter 5 shows that part of the larger loss power and force than muscle mass is attributable to a left-ward shift of the torque-frequency relationship, indicative of a slowing of the muscle, and reduction in maximal voluntary activation, as assessed using the interpolated twitch technique in older adults. Chapter 5 also shows that the fatigue resistance during a series of intermittent contractions was similar in young and older adults. However, older adults could sustain a 50% maximal voluntary contraction force longer than young people. Part of this discrepancy maybe due to an age-related slowing of the muscle

Comparison of MRI and DXA to measure muscle size and age-related atrophy in thigh muscles.

OBJECTIVES Magnetic resonance imaging (MRI) and dual-energy x-ray absorptiometry (DXA) were used to examine the thigh lean mass in young and old men and women. METHODS A whole-body DXA scan was used to estimate thigh lean mass in young (20 men; 22.4±3.1y; 18 women; 22.1±2.0y) and older adults (25 men; 72.3±4.9y; 28 women; 72.0±4.5y). Thigh lean mass determined with a thigh scan on the DXA or full thigh MRI scans were compared. RESULTS Although the thigh lean mass quantified by DXA and MRI in young and older participants were correlated (R(2)=0.88; p<0.001) the magnitude of the differences in thigh lean mass between young and old was smaller with DXA than MRI (old vs. young men 79.5±13.1% and 73.4±11.2%; old vs. young women 88.6±11.8% and 79.4±12.3%, respectively). Detailed analysis of MRI revealed 30% smaller quadriceps muscles in the older than young individuals, while the other thigh muscles were only 18% smaller. CONCLUSIONS DXA underestimates the age-related loss of thigh muscle mass in comparison to MRI. The quadriceps muscles were more susceptible to age-related atrophy compared with other thigh muscles

Sex differences in muscle morphology of the knee flexors and knee extensors

Introduction Females experience higher risk of anterior cruciate ligament (ACL) injuries; males experience higher risk of hamstring strain injuries. Differences in injury may be partially due to sex differences in knee flexor (KF) to knee extensor (KE) muscle size ratio and the proportional size of constituent muscles. Purpose To compare the absolute and proportional size, and mass distribution, of individual KE and KF muscles, as well as overall size and balance (size ratio) of these muscle groups between the sexes. Methods T1-weighted axial plane MR images (1.5T) of healthy untrained young males and females (32 vs 34) were acquired to determine thigh muscle anatomical cross-sectional area(ACSA). Maximal ACSA (ACSAmax) ofconstituent muscles, summated for KF and KE muscle groups, and the KF:KE ratio were calculated. Results Females had 25.3% smaller KE ACSAmax (70.9±12.1 vs 93.6±10.3 cm2; P<0.001) and 29.6% smaller KF ACSAmax than males (38.8±7.3cm2 vs 55.1±7.3cm2; P<0.001).Consequently, females had lower KF:KE ACSA ratio (P = 0.031). There were sex differences in the proportional size of 2/4 KE and 5/6 KF. In females, vastus lateralis (VL), biceps femoris long-head (BFlh) and semimembranosus (SM) were a greater proportion and sartorius(SA), gracilis (GR) and biceps femoris short-head (BFsh) a smaller proportion of their respective muscle groups compared to males (All P<0.05). Conclusion Sex differences in KF:KE ACSAmax ratio may contribute to increased risk of ACL injury in females. Sex discrepancies in absolute and proportional size of SA, GR, VL and BFlh may contribute further anatomical explanations for sex differences in injury incidence

Evaluating the between-day reliability and likelihood of change of a test battery incorporating vastus lateralis muscle thickness, ankle-brachial pressure index, maximal voluntary torque, and six-minute walk test in patients with claudication

Objective: The study aims to evaluate the between-day reliability of a proposed test battery for patients with claudication that can be used for monitoring the effectiveness of exercise interventions and other therapeutic strategies tailored to this patient population.Methods: Twenty-five men with claudication were recruited. The test battery consisted of the Vastus Lateralis muscle thickness (VL-MT), ankle-brachial pressure index (ABI), unilateral isometric knee extension maximal voluntary torque (MVT) and 6-minute walk test (6MWT). A single investigator conducted the tests for each patient on two separate testing sessions (T1 and T2) 5–7 days apart.Results: Good to excellent reliability was observed for VL-MT (ICC = 0.95, 95% LOA = ±3.10 mm, SEM = 0.81 mm), ABI (ICC = 0.97, 95% LOA = ±0.10, SEM = 0.02), MVT (ICC = 0.97, 95% LOA = ±24.0 N·m, SEM = 6.31 N·m), 6MWT distance (ICC = 0.99, 95% LOA = ±39.6 m, SEM = 11.0 m), 6MWT time to claudication (ICC = 0.99, 95% LOA = ±30.8 s, SEM = 7.8 s), and 6MWT ratings of pain (ICC = 0.87, 95% LOA = ±2.4 CR-10 +, SEM = 0.7 CR-10 +). Analysis derived from reliability data indicates a change of 1.4 mm for VL-MT, 0.14 for ABI, 12 N·m for MVT, 25 m for 6MWT distance, 15 s for 6MWT time to claudication and 1 CR-10 + for 6MWT ratings of pain is required to be interpreted as the minimum ‘likely’ change (76% chance).Conclusions: The test battery provides a reliable assessment of patients with claudication and can be widely used to evaluate the effects of exercise programmes and other therapeutic interventions. For the individual, changes in VL-MT, ABI, MVT, and 6MWT greater than the minimum likely change as a result of an exercise programme or an intervention are likely changes and less influenced by error associated with the test.</p

The influence of patellar tendon and muscle-tendon unit stiffness on quadriceps explosive strength in man

What is the central question of this study? \ud Do tendon and/or muscle–tendon unit stiffness influence rate of torque development? What is the main finding and its importance? In our experimental conditions, some measures of relative (to maximal voluntary torque and tissue length) muscle–tendon unit stiffness had small correlations with voluntary/evoked rate of torque development over matching torque increments. However, absolute and relative tendon stiffness were unrelated to voluntary and evoked rate of torque development. Therefore, the muscle aponeurosis but not free tendon influences the relative rate of torque development. Factors other than tissue stiffness more strongly determine the absolute rate of torque development. The influence of musculotendinous tissue stiffness on contractile rate of torque development (RTD) remains opaque. In this study, we examined the relationships between both patellar tendon (PT) and vastus lateralis muscle–tendon unit (MTU) stiffness and the voluntary and evoked knee-extension RTD. Fifty-two healthy untrained men completed duplicate laboratory sessions. Absolute and relative RTD were measured at 50 N m or 25% maximal voluntary torque (MVT) increments from onset and sequentially during explosive voluntary and evoked octet isometric contractions (supramaximal stimulation; eight pulses at 300 Hz). Isometric MVT was also assessed. Patellar tendon and MTU stiffness were derived from simultaneous force and ultrasound recordings of the PT and vastus lateralis aponeurosis during constant RTD ramp contractions. Absolute and relative (to MVT and resting tissue length) stiffness (k) was measured over identical torque increments as RTD. Pearson's correlations tested relationships between stiffness and RTD measurements over matching absolute/relative torque increments. Absolute and relative PT k were unrelated to equivalent voluntary/evoked (r = 0.020–0.255, P = 0.069–0.891). Absolute MTU k was unrelated to voluntary or evoked RTD (r ≤ 0.191, P ≥ 0.184), but some measures of relative MTU k were related to relative voluntary/evoked RTD (e.g. RTD for 25–50% MVT, r = 0.374/0.353, P = 0.007/0.014). In conclusion, relative MTU k explained a small proportion of the variance in relative voluntary and evoked RTD (both ≤19%), despite no association of absolute MTU k or absolute/relative PT k with equivalent RTD measures. Therefore, the muscle-aponeurosis component but not free tendon was associated with relative RTD, although it seems that an overriding influence of MVT negated any relationship of absolute MTU k and absolute RTD

Training-specific functional, neural, and hypertrophic adaptations to explosive- vs. sustained-contraction strength training

Training specificity is considered important for strength training, although the functional and underpinning physiological adaptations to different types of training, including brief explosive contractions, are poorly understood. This study compared the effects of 12 wk of explosive-contraction (ECT, n = 13) vs. sustained-contraction (SCT, n = 16) strength training vs. control (n = 14) on the functional, neural, hypertrophic, and intrinsic contractile characteristics of healthy young men. Training involved 40 isometric knee extension repetitions (3 times/wk): contracting as fast and hard as possible for ∼1 s (ECT) or gradually increasing to 75% of maximum voluntary torque (MVT) before holding for 3 s (SCT). Torque and electromyography during maximum and explosive contractions, torque during evoked octet contractions, and total quadriceps muscle volume (QUADSVOL) were quantified pre and post training. MVT increased more after SCT than ECT [23 vs. 17%; effect size (ES) = 0.69], with similar increases in neural drive, but greater QUADSVOL changes after SCT (8.1 vs. 2.6%; ES = 0.74). ECT improved explosive torque at all time points (17-34%; 0.54 ≤ ES ≤ 0.76) because of increased neural drive (17-28%), whereas only late-phase explosive torque (150 ms, 12%; ES = 1.48) and corresponding neural drive (18%) increased after SCT. Changes in evoked torque indicated slowing of the contractile properties of the muscle-tendon unit after both training interventions. These results showed training-specific functional changes that appeared to be due to distinct neural and hypertrophic adaptations. ECT produced a wider range of functional adaptations than SCT, and given the lesser demands of ECT, this type of training provides a highly efficient means of increasing function

Neural adaptations after 4 years vs. 12 weeks of resistance training vs. untrained

The purpose of this study was to compare the effect of resistance training (RT) duration, including years of exposure, on agonist and antagonist neuromuscular activation throughout the knee extension voluntary torque range. Fifty‐seven healthy men (untrained [UNT] n=29, short‐term RT [12WK] n=14, and long‐term RT [4YR] n=14) performed maximum and sub‐maximum (20‐80% maximum voluntary torque [MVT]) unilateral isometric knee extension contractions with torque, agonist and antagonist surface EMG recorded. Agonist EMG, including at MVT, was corrected for the confounding effects of adiposity (i.e. muscle‐electrode distance; measured with ultrasonography). Quadriceps maximum anatomical cross‐sectional area (QACSAMAX; via MRI) was also assessed. MVT was distinct for all three groups (4YR +60/+39% vs. UNT/12WK; 12WK +15% vs. UNT; 0.001<P≤0.021), and QACSAMAX was greater for 4YR (+50/+42% vs. UNT/12WK; [both] P<0.001). Agonist EMG at MVT was +44/+33% greater for 4YR/12WK ([both] P<0.001) vs. UNT; but did not differ between RT groups. The torque‐agonist EMG relationship of 4YR displayed a right/down shift with lower agonist EMG at the highest common torque (196 Nm) compared to 12WK and UNT (0.005≤P≤0.013; Effect size [ES] 0.90≤ES≤1.28). The torque‐antagonist EMG relationship displayed a lower slope with increasing RT duration (4YR<12WK<UNT; 0.001<P≤0.094; 0.56≤ES≤1.31), and antagonist EMG at the highest common torque was also lower for 4YR than UNT (‐69%; P<0.001; ES=1.18). In conclusion, 4YR and 12WK had similar agonist activation at MVT and this adaptation may be maximised during early months of RT. In contrast, inter‐muscular coordination, specifically antagonist co‐activation was progressively lower, and likely continues to adapt, with prolonged RT

Tendinous tissue properties after short and long-term functional overload: Differences between controls, 12 weeks and 4 years of resistance training.

AIM: The potential for tendinous tissues to adapt to functional overload, especially after several years of exposure to heavy resistance training is largely unexplored. This study compared the morphological and mechanical characteristics of the patellar tendon and knee-extensor tendon-aponeurosis complex between young men exposed to long-term (4 years; n=16), short-term (12 weeks; n=15) and no (untrained controls; n=39) functional overload in the form of heavy resistance training. METHODS: Patellar tendon cross-sectional area, vastus-lateralis aponeurosis area and quadriceps femoris volume, plus patellar tendon stiffness and Young's modulus, and tendon-aponeurosis complex stiffness, were quantified with MRI, dynamometry and ultrasonography. RESULTS: As expected long-term trained had greater muscle strength and volume (+58% and +56% vs untrained, both P<0.001), as well as a greater aponeurosis area (+17% vs untrained, P<0.01), but tendon cross-sectional area (mean and regional) was not different between groups. Only long-term trained had reduced patellar tendon elongation/strain over the whole force/stress range, whilst both short-term and long-term overload groups had similarly greater stiffness/Young's modulus at high force/stress (short-term +25/22%, and long-term +17/23% vs untrained; all P<0.05). Tendon-aponeurosis complex stiffness was not different between groups (ANOVA, P = 0.149). CONCLUSION: Despite large differences in muscle strength and size, years of resistance training did not induce tendon hypertrophy. Both short-term and long-term overload, demonstrated similar increases in high force mechanical and material stiffness, but reduced elongation/strain over the whole force/stress range occurred only after years of overload, indicating a force/strain specific time-course to these adaptations. This article is protected by copyright. All rights reserved

Agreement between methods and terminology used to assess the kinematics of the Nordic hamstring exercise

The Nordic hamstring exercise (NHE) is employed as a component of preventative training programmes to minimise hamstring strain injury risk. Variation in the methods and terminology used to assess the NHE makes comparison between studies difficult. We aimed to compare the utility of kinetic and kinematic metrics by comparing several collected concurrently. 18 male recreational rugby union participants completed 3 bilateral NHE repetitions on a hamstring device equipped with in-line strain gauge load cells, integrated with a 3-dimensional motion tracking system. Mean break-point angle occurred after the angle at first acceleration (121.5 ± 10.4° vs. 119.2 ± 7.1°) whereas break-torque angle (BTA) occurred later in the NHE action (126.0 ± 9.8°) showing highest correlation to the angle at greatest acceleration (123.9 ± 7.9°, r = 0.85). Future research should consider movement quality as the angular velocity of the knee joint at BTA demonstrated large variation (range = 3.6–93.4 deg·s1), with high intrasubject variability of relative trunk-to-thigh angle at peak-torque (range = 0.4–44.7°). This study proposes standardisation of methods and terminology used to define the NHE. Measuring BTA is recommended to represent the point at which hamstring muscle failure occurs, specific to the proposed injury mechanism during high-speed running