Loading rate and contraction type effects on the human Achilles tendon force-elongation relationship

IntroductionWhile it is accepted that tendons are viscoelastic, the loading rate of contractions is often not strictly controlled when assessing human tendon mechanical properties in vivo. Given the potential benefits of sustained constant load isometric contractions for in vivo tendon property assessment, we aimed to determine if sustained submaximal isometric plantarflexion contractions result in a similar force-elongation relationshipand stiffness of the Achilles tendon (AT) to other loading methods.MethodsThe AT mechanical properties (elongation and stiffness) of the dominant leg inten male adults (26.5±5.5y) were assessed during isometric plantarflexion contractions by integrating dynamometry and ultrasonography (Aloka α7, Tokyo, Japan).Measurements were taken on two consecutive days and the results from all participants on day one and seven participants on day two (three excluded due to measurement problems) were pooled for the analysis. Maximum voluntary contractions (MVC; high loading rate), ramp maximum force contractions with three seconds loading (RAMP; lower loading rate), and sustained contractions (held for three seconds) at forces of 25%, 50% and 80% of the maximal tendon force with the lower loading rate (SUS) were conducted.ResultsA two way repeated measures ANOVA with method and tendon force level as factors revealed a significant method (P<0.001) effecton tendon elongation. Post hoc tests with Bonferroni corrections revealed significantlygreater tendon elongation in SUS compared withMVC (P=0.001) and RAMP(P=0.002),but no differences in tendon elongationbetween MVC and RAMP(P=0.077).A one way ANOVA with method as a factor did not reveal a significant method effect on tendon stiffness(P=0.079; MVC: 653.6±220.9 N/mm; RAMP: 694.8±190.3 N/mm; SUS: 564.2±148.1 N/mm).ConclusionSustained plantarflexion contractions appear to lead to an increased AT elongation for a given force, presumably due to the reduced influence of the loading rate on the viscoelastic behaviour of the tendon during the sustained contractions. However,AT stiffness was not significantly different between methods, suggesting that the differences in the rate of elongation occurred prior to the linear region of the force elongation relationship. Sustained isometric contractions appear to be appropriate for assessing AT stiffness in vivo, although potential differences in tendon elongation should be considered when comparing results with other methods

Loading rate and contraction duration effects on in vivo human Achilles tendon mechanical properties.

Tendons are viscoelastic, which implies loading rate dependency, but loading rates of contractions are often not controlled during assessment of human tendon mechanical properties in vivo. We investigated the effects of sustained submaximal isometric plantarflexion contractions, which potentially negate loading rate dependency, on the stiffness of the human Achilles tendon in vivo using dynamometry and ultrasonography. Maximum voluntary contractions (high loading rate), ramp maximum force contractions with 3 s loading (lower loading rate) and sustained contractions (held for 3 s) at 25%, 50% and 80% of maximal tendon force were conducted. No loading rate effect on stiffness (25-80% max. tendon force) was found. However, loading rate effects were seen up to 25% of maximum tendon force, which were reduced by the sustained method. Sustained plantarflexion contractions may negate loading rate effects on tendon mechanical properties and appear suitable for assessing human Achilles tendon stiffness in vivo

Aging and the effects of a half marathon on Achilles tendon force-elongation relationship.

PURPOSE: We aimed to determine whether there are different changes in Achilles tendon (AT) mechanical properties in middle-aged, compared to younger runners that might indicate that tendon fatigue, induced by long-distance running, is age-dependent. METHODS: 27 middle-aged (50-67 years) and 22 younger (21-29 years) participants ran a 21 km route at their own pace (mean and SD: old: 3.1 ± 0.3 m s(-1); young: 3.6 ± 0.5 m s(-1)). We tested for changes in the AT force-elongation relationship using dynamometry and ultrasonography during isometric voluntary ankle plantarflexion ramp contractions, conducted 20-28 h pre-run, immediately pre-run, immediately post-run and 20-28 h post-run. Stride frequency and number were examined to estimate cyclic tensile loading characteristics of the tendon during running. RESULTS: Muscle strength decreased significantly (P < 0.05) in both groups immediately post-run (old: 17 %; young: 11 %) and recovered to baseline within 20-28 h post-run. AT stiffness did not change for the younger adults, whereas the middle-aged adults showed a significant (P < 0.05) decrease in AT stiffness (22 %). However, tendon stiffness recovered to baseline 20-28 h post-run. Middle-aged, compared to young adults, demonstrated significantly (P < 0.05) greater stride frequency and number, but no correlations with tendon fatigue changes were determined (R (2) ≤ 0.038). CONCLUSIONS: The results suggest that the plasticity of the AT in response to short-term mechanical loading may be age dependent and that the AT length-tension properties of middle-aged runners may be more vulnerable to change following running compared to younger athletes. However, the observed AT changes in the middle-aged runners dissipated within 20-28 h post-run, suggesting that a tendon viscoelastic recovery mechanism may occur in vivo

Deployment of ACT antimalarials for treatment of malaria: challenges and opportunities

Following a long period when the effectiveness of existing mono-therapies for antimalarials was steadily declining with no clear alternative, most malaria-endemic countries in Africa and Asia have adopted artemisinin combination therapy (ACT) as antimalarial drug policy. Several ACT drugs exist and others are in the pipeline. If properly targeted, they have the potential to reduce mortality from malaria substantially. The major challenge now is to get the drugs to the right people. Current evidence suggests that most of those who need the drugs do not get them. Simultaneously, a high proportion of those who are given antimalarials do not in fact have malaria. Financial and other barriers mean that, in many settings, the majority of those with malaria, particularly the poorest, do not access formal healthcare, so the provision of free antimalarials via this route has only limited impact. The higher cost of ACT creates a market for fake drugs. Addressing these problems is now a priority. This review outlines current evidence, possible solutions and research priorities

Decreased motivation in the use of insecticide-treated nets in a malaria endemic area in Burkina Faso

<p>Abstract</p> <p>Background</p> <p>The use of insecticide-treated nets (ITN) is an important tool in the Roll Back Malaria (RBM) strategy. For ITNs to be effective they need to be used correctly. Previous studies have shown that many factors, such as wealth, access to health care, education, ethnicity and gender, determine the ownership and use of ITNs. Some studies showed that free distribution and public awareness campaigns increased the rate of use. However, there have been no evaluations of the short- and long-term impact of such motivation campaigns. A study carried out in a malaria endemic area in south-western Burkina Faso indicated that this increased use declined after several months. The reasons were a combination of the community representation of malaria, the perception of the effectiveness and usefulness of ITNs and also the manner in which households are organized by day and by night.</p> <p>Methods</p> <p>PermaNet 2.0^®and Olyset^®were distributed in 455 compounds at the beginning of the rainy season. The community was educated on the effectiveness of nets in reducing malaria and on how to use them. To assess motivation, qualitative tools were used: one hundred people were interviewed, two hundred houses were observed directly and two houses were monitored monthly throughout one year.</p> <p>Results</p> <p>The motivation for the use of bednets decreased after less than a year. Inhabitants' conception of malaria and the inconvenience of using bednets in small houses were the major reasons. Acceptance that ITNs were useful in reducing malaria was moderated by the fact that mosquitoes were considered to be only one of several factors which caused malaria. The appropriate and routine use of ITNs was adversely affected by the functional organization of the houses, which changed as between day and night. Bednets were not used when the perceived benefits of reduction in mosquito nuisance and of malaria were considered not to be worth the inconvenience of daily use.</p> <p>Conclusion</p> <p>In order to bridge the gap between possession and use of bednets, concerted efforts are required to change behaviour by providing accurate information, most particularly by convincing people that mosquitoes are the only source of malaria, whilst recognising that there are other diseases with similar symptoms, caused in other ways. The medical message must underline the seriousness of malaria and the presence of the malaria vector in the dry season as well as the wet, in order to encourage the use of bednets whenever transmission can occur. Communities would benefit from impregnated bednets and other vector control measures being better adapted to their homes, thus reducing the inconvenience of their use.</p

Effect of exercise-induced enhancement of the leg-extensor muscle-tendon unit capacities on ambulatory mechanics and knee osteoarthritis markers in the elderly.

OBJECTIVE: Leg-extensor muscle weakness could be a key component in knee joint degeneration in the elderly because it may result in altered muscular control during locomotion influencing the mechanical environment within the joint. This work aimed to examine whether an exercise-induced enhancement of the triceps surae (TS) and quadriceps femoris (QF) muscle-tendon unit (MTU) capacities would affect mechanical and biological markers for knee osteoarthritis in the elderly. METHODS: Twelve older women completed a 14-week TS and QF MTU exercise intervention, which had already been established as increasing muscle strength and tendon stiffness. Locomotion mechanics and serum cartilage oligomeric matrix protein (COMP) levels were examined during incline walking. MTU mechanical properties were assessed using simultaneously ultrasonography and dynamometry. RESULTS: Post exercise intervention, the elderly had higher TS and QF contractile strength and tendon-aponeurosis stiffness. Regarding the incline gait task, the subjects demonstrated a lower external knee adduction moment and lower knee adduction angular impulse during the stance phase post-intervention. Furthermore, post-intervention compared to pre-intervention, the elderly showed lower external hip adduction moment, but revealed higher plantarflexion pushoff moment. The changes in the external knee adduction moment were significantly correlated with the improvement in ankle pushoff function. Serum COMP concentration increased in response to the 0.5-h incline walking exercise with no differences in the magnitude of increment between pre- and post-intervention. CONCLUSIONS: This work emphasizes the important role played by the ankle pushoff function in knee joint mechanical loading during locomotion, and may justify the inclusion of the TS MTU in prevention programs aiming to positively influence specific mechanical markers for knee osteoarthritis in the elderly. However, the study was unable to show that COMP is amenable to change in the elderly following a 14-week exercise intervention and, therefore, the physiological benefit of improved muscle function for knee cartilage requires further investigation