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The intrinsic force production capability of human muscle can be expressed as "Specific Tension," or, the maximum force generated per cross-sectional area of muscle fibers. This value can be used to determine, for example, whether muscle quality changes during exercise, atrophy, disease, or hypertrophy. A value of 22.5 N/cm 2 for mammalian muscle has generally become accepted based on detailed studies of small mammals. Determining the specific tension of human muscle is much more challenging as almost all determinations are indirect. Calculation of human muscle specific tension requires an understanding of that muscle's contribution to joint torque, its activation magnitude, tendon compliance, and joint moment arm. Determining any of these parameters is technically challenging in humans and thus, it is no surprise that human specific tension values reported vary from 2 to 73 N/cm 2 . In this systematic review, we screened 1,506 published papers and identified the 30 studies published between 1983 and 2023 that used appropriate methods and which reported 96 human specific tension values. We weighted each parameter based on whether it was directly measured, estimated, or calculated based on the literature, with decreasing weighting used, the more indirect the methods. Based on this exhaustive review of the relevant human literature, we suggest that the most accurate value that should be used for human muscle specific tension is 26.8 N/cm 2 .

Musculoskeletal models are valuable for studying and understanding the human body in a variety of clinical applications that include surgical planning, injury prevention, and prosthetic design. Subject-specific models have proven to be more accurate and useful compared to generic models. Nevertheless, it is important to validate all models when possible. To this end, gracilis muscle-tendon parameters were directly measured intraoperatively and used to test model predictions. The aim of this study was to evaluate the benefits and limitations of systematically incorporating subject-specific variables into muscle models used to predict passive force and fiber length. The results showed that incorporating subject-specific values generally reduced errors, although significant errors still existed. Optimization of the modeling parameter "tendon slack length" was explored in two cases: minimizing fiber length error and minimizing passive force error. The results showed that using all subject-specific values yielded the most favorable outcome in both models and optimization cases. However, the trade-off between fiber length error and passive force error will depend on the specific circumstances and research objectives due to significant individual errors. Notably, individual fiber length and passive force errors were as high as 20% and 37% respectively. Finally, the modeling parameter "tendon slack length" did not correlate with any real-world anatomical length., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Transition of data acquisition out of the laboratory, into the real world offers a previously inaccessible perspective of physical function. This proves to be beneficial when assessing surgical intervention, especially after a traumatic brachial plexus injury (BPI) causing loss of motor function in an upper extremity (UE). Moving towards the use of real world data in clinical practice as an outcome measure, this study developed a method to report bilateral UE activity in patients with BPI. Three groups of ten subjects each participated in this study-healthy controls, subjects with traumatic BPI prior to surgical treatment (pre-), and subjects who had surgical reconstruction to treat BPI (post-). Subjects wore four activity monitors on bilateral forearms and upper arms for four days. Tri-axial acceleration data were used to calculate asymmetry indices for forearm and upper arm usage. Analysis revealed a bimodal distribution in the post- group, prompting division of this group into two subgroups based on injury type: pan-plexus and upper trunk. While median asymmetry indices at the forearm and upper arm were decreased in the post- group when compared to the pre- group, these differences were not significant. Compared to controls, the pre-surgery group (p < 0.0001, p < 0.0001) and post-surgery group with pan-plexus injuries (p = 0.0074, p = 0.0242) both exhibited statistically significant differences in forearm and upper arm asymmetry, respectively. Further investigation to establish clinically significant differences in asymmetry index is warranted. Importantly, analyzing the activity of UEs following treatment of a BPI provides objective real world evidence of function., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Intramuscular pressure (IMP) reflects forces produced by a muscle. Age is one of the determinants of skeletal muscle performance. The present study aimed to test whether IMP mirrors known age-related muscular changes. We simultaneously measured the tibialis anterior (TA) IMP, compound muscle action potential (CMAP), and ankle torque in thirteen older adults (60-80 years old) in vivo by applying different stimulation intensities and frequencies. We found significant positive correlations between the stimulation intensity and IMP and CMAP. Increasing stimulation frequency caused ankle torque and IMP to increase. The electromechanical delay (EMD) (36 ms) was longer than the onset of IMP (IMPD) (29 ms). Compared to the previously published data collected from young adults (21-40 years old) in identical conditions, the TA CMAP and IMP of older adults at maximum intensity of stimulation were 23.8% and 39.6% lower, respectively. For different stimulation frequencies, CMAP, IMP, as well as ankle torque of older adults were 20.5%, 24.2%, and 13.2% lower, respectively. Surprisingly, the EMD did not exhibit any difference between young and older adults and the IMPD was consistent with the EMD. Data supporting the hypotheses suggest that IMP measurement is an indicator of muscle performance in older adults., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Intramuscular pressure (IMP) shows promise for estimating individual muscle tension in vivo. However, previous pressure measurements show high variability during isometric contraction and poor correlation with tension during dynamic contraction. We hypothesized that enhanced sensor anchoring/orientation would improve tension estimation and thus developed a novel pressure sensor with a barbed housing. Sensors were inserted into the tibialis anterior (TA) of New Zealand White rabbits (N = 8) both parallel and perpendicular to the fiber orientation. We measured muscle stress and IMP during both isometric and dynamic contractions. Passive stress showed good agreement for both insertion directions across muscle lengths (ICC > 0.8). Active stress and IMP agreement were good (ICC = 0.87 ± 0.04) for perpendicular insertions but poor (ICC = 0.21 ± 0.22) for parallel insertions across both dynamic contractions and isometric contractions within the muscle's range of motion. These findings support use of IMP measurements to estimate muscle tension across a range of contraction conditions.

Clinical treatments of skeletal muscle weakness are hindered by a lack of an approach to evaluate individual muscle force. Intramuscular pressure (IMP) has shown a correlation to muscle force in vivo, but patient to patient and muscle to muscle variability results in difficulty of utilizing IMP to estimate muscle force. The goal of this work was to develop a finite element model of whole skeletal muscle that can predict IMP under passive and active conditions to further investigate the mechanisms of IMP variability. A previously validated hypervisco-poroelastic constitutive approach was modified to incorporate muscle activation through an inhomogeneous geometry. Model parameters were optimized to fit model stress to experimental data, and the resulting model fluid pressurization data were utilized for validation. Model fitting was excellent (root-mean-square error or RMSE <1.5 kPa for passive and active conditions), and IMP predictive capability was strong for both passive (RMSE 3.5 mmHg) and active (RMSE 10 mmHg at in vivo lengths) conditions. Additionally, model fluid pressure was affected by length under isometric conditions, as increases in stretch yielded decreases in fluid pressurization following a contraction, resulting from counteracting Poisson effects. Model pressure also varied spatially, with the highest gradients located near aponeuroses. These findings may explain variability of in vivo IMP measurements in the clinic, and thus help reduce this variability in future studies. Further development of this model to include isotonic contractions and muscle weakness would greatly benefit this work.

Introduction: Intramuscular pressure (IMP) is the fluid pressure generated within skeletal muscle and directly reflects individual muscle tension. The purpose of this study was to assess the development of force, IMP, and electromyography (EMG) in the tibialis anterior (TA) muscle during ramped isometric contractions and evaluate electromechanical delay (EMD)., Methods: Force, EMG, and IMP were simultaneously measured during ramped isometric contractions in eight young, healthy human subjects. The EMD between the onset of force and EMG activity (Δt-EMG force) and the onset of IMP and EMG activity (Δt EMG-IMP) were calculated., Results: A statistically significant difference (p < 0.05) was found between the mean force-EMG EMD (36 ± 31 ms) and the mean IMP-EMG EMD (3 ± 21 ms)., Conclusions: IMP reflects changes in muscle tension due to the contractile muscle elements., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The passive properties of skeletal muscle are often overlooked in muscle studies, yet they play a key role in tissue function in vivo. Studies analyzing and modeling muscle passive properties, while not uncommon, have never investigated the role of fluid content within the tissue. Additionally, intramuscular pressure (IMP) has been shown to correlate with muscle force in vivo and could be used to predict muscle force in the clinic. In this study, a novel model of skeletal muscle was developed and validated to predict both muscle stress and IMP under passive conditions for the New Zealand White Rabbit tibialis anterior. This model is the first to include fluid content within the tissue and uses whole muscle geometry. A nonlinear optimization scheme was highly effective at fitting model stress output to experimental stress data (normalized mean square error or NMSE fit value of 0.993) and validation showed very good agreement to experimental data (NMSE fit values of 0.955 and 0.860 for IMP and stress, respectively). While future work to include muscle activation would broaden the physiological application of this model, the passive implementation could be used to guide surgeries where passive muscle is stretched.

Finite element models of skeletal muscle typically ignore the biphasic nature of the tissue, associating any time dependence with a viscoelastic formulation. In this study, direct experimental measurement of permeability was conducted as a function of specimen orientation and strain. A finite element model was developed to identify how various permeability formulations affect compressive response of the tissue. Experimental and modeling results suggest the assumption of a constant, isotropic permeability is appropriate. A viscoelastic only model differed considerably from a visco-poroelastic model, suggesting the latter is more appropriate for compressive studies.

Intramuscular pressure (IMP), defined as skeletal muscle interstitial fluid pressure, reflects changes in individual muscle tension and may provide crucial insight into musculoskeletal biomechanics and pathologies. IMP may be measured using fiber-optic fluid pressure sensors, provided the sensor is adequately anchored to and shielded from surrounding muscle tissue. Ineffective anchoring enables sensor motion and inadequate shielding facilitates direct sensor-tissue interaction, which result in measurement artifacts and force-IMP dissociation. The purpose of this study was to compare the effectiveness of polyimide and nitinol protective housing designs to anchor pressure sensors to muscle tissue, prevent IMP measurement artifacts, and optimize the force-IMP correlation. Anchoring capacity was quantified as force required to dislodge sensors from muscle tissue. Force-IMP correlations and non-physiological measurement artifacts were quantified during isometric muscle activations of the rabbit tibialis anterior. Housing structural integrity was assessed after both anchoring and activation testing. Although there was no statistically significant difference in anchoring capacity, nitinol housings demonstrated greater structural integrity and superior force-IMP correlations. Further design improvements are needed to prevent tissue accumulation in the housing recess associated with artificially high IMP measurements. These findings emphasize fundamental protective housing design elements crucial for achieving reliable IMP measurements.

Intramuscular pressure correlates strongly with muscle tension and is a promising tool for quantifying individual muscle force. However, clinical application is impeded by measurement variability that is not fully understood. Previous studies point to regional differences in IMP, specifically increasing pressure with muscle depth. Based on conservation of mass, intramuscular pressure and volumetric strain distributions may be inversely related. Therefore, we hypothesized volumetric strain would decrease with muscle depth. To test this we quantified 3D volumetric strain in the tibialis anterior of 12 healthy subjects using Cine Phase Contrast Magnetic Resonance Imaging. Cine Phase Contrast data were collected while a custom apparatus rotated the subjects' ankle continuously between neutral and plantarflexion. A T2-weighted image stack was used to define the resting tibials anterior position. Custom and commercial post-processing software were used to quantify the volumetric strain distribution. To characterize regional strain changes, the muscle was divided into superior-inferior sections and either medial-lateral or anterior-posterior slices. Mean volumetric strain was compared across the sections and slices. As hypothesized, volumetric strain demonstrated regional differences with a decreasing trend from the anterior (superficial) to the posterior (deep) muscle regions. Statistical tests showed significant main effects and interactions of superior-inferior and anterior-posterior position as well as superior-inferior and medial-lateral position on regional strain. These data support our hypothesis and imply a potential relationship between regional volumetric strain and intramuscular pressure. This finding may advance our understanding of intramuscular pressure variability sources and lead to more reliable measurement solutions in the future., Competing Interests: statement The authors report no conflict of interest., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The passive tensile properties of skeletal muscle play a key role in its physiological function. Previous research has identified conflicting reports of muscle transverse isotropy, with some data suggesting the longitudinal direction is stiffest, while others show the transverse direction is stiffest. Accurate constitutive models of skeletal muscle must be employed to provide correct recommendations for and observations of clinical methods. The goal of this work was to identify transversely isotropic tensile muscle properties as a function of post mortem handling. Six pairs of tibialis anterior muscles were harvested from Giant Flemish rabbits and split into two groups: fresh testing (within four hours post mortem), and non-fresh testing (subject to delayed testing and a freeze/thaw cycle). Longitudinal and transverse samples were removed from each muscle and tested to identify tensile modulus and relaxation behavior. Longitudinal non-fresh samples exhibited a higher initial modulus value and faster relaxation than longitudinal fresh, transverse fresh, and transverse rigor samples (p<0.05), while longitudinal fresh samples were less stiff at lower strain levels than longitudinal non-fresh, transverse fresh, and transverse non-fresh samples (p<0.05), but exhibited more nonlinear behavior. While fresh skeletal muscle exhibits a higher transverse modulus than longitudinal modulus, discrepancies in previously published data may be the result of a number of differences in experimental protocol. Constitutive modeling of fresh muscle should reflect these data by identifying the material as truly transversely isotropic and not as an isotropic matrix reinforced with fibers., Competing Interests: Statement The authors have no financial or other conflicts of interest to report., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: Regional variability in interstitial fluid pressure confounds use of intramuscular pressure measurement to assess muscle force. It is hypothesized that interstitial flow is dependent on intramuscular pressure. The goal of this study was to assess the feasibility of using fluorescent microspheres to evaluate movement of interstitial fluid in skeletal muscle., Methods: Two diameters of fluorescent microspheres were injected into the rat tibialis anterior during both static (n = 6) and passively lengthened (10% strain) experimental conditions (n = 6). Microsphere dispersion was evaluated using confocal imaging of transverse muscle sections., Results: Fluorescent microspheres tracked interstitial fluid while not penetrating the muscle fiber. When compared with the static condition, significantly greater dispersion (P = 0.003) was seen with passively lengthened conditions (17 ± 9% vs. 31 ± 7%, respectively). Dispersion did not differ for the 2 microsphere sizes (P = 0.811)., Conclusions: Fluorescent microspheres track movement of interstitial fluid, and dispersion is dependent on passive lengthening. Muscle Nerve 54: 444-450, 2016., (© 2016 Wiley Periodicals, Inc.)

Introduction: Computational modeling of skeletal muscle requires characterization at the tissue level. While most skeletal muscle studies focus on hyperelasticity, the goal of this study was to examine and model the nonlinear behavior of both time-independent and time-dependent properties of skeletal muscle as a function of strain., Materials and Methods: Nine tibialis anterior muscles from New Zealand White rabbits were subject to five consecutive stress relaxation cycles of roughly 3% strain. Individual relaxation steps were fit with a three-term linear Prony series. Prony series coefficients and relaxation ratio were assessed for strain dependence using a general linear statistical model. A fully nonlinear constitutive model was employed to capture the strain dependence of both the viscoelastic and instantaneous components., Results: Instantaneous modulus (p<0.0005) and mid-range relaxation (p<0.0005) increased significantly with strain level, while relaxation at longer time periods decreased with strain (p<0.0005). Time constants and overall relaxation ratio did not change with strain level (p>0.1). Additionally, the fully nonlinear hyperviscoelastic constitutive model provided an excellent fit to experimental data, while other models which included linear components failed to capture muscle function as accurately., Conclusions: Material properties of skeletal muscle are strain-dependent at the tissue level. This strain dependence can be included in computational models of skeletal muscle performance with a fully nonlinear hyperviscoelastic model., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Intramuscular pressure (IMP), a correlate of muscle tension, may fill an important clinical testing void. A barrier to implementing this measure clinically is its non-uniform distribution, which is not fully understood. Pressure is generated by changes in fluid mass and volume, therefore 3D volumetric strain distribution may affect IMP distribution. The purpose of this study was to develop a method for quantifying 3D volumetric strain distribution in the human tibialis anterior (TA) during passive tension using cine phase contrast (CPC) MRI and to assess its accuracy and precision.Five healthy subjects each participated in three data collections. A custom MRI-compatible apparatus repeatedly rotated a subject's ankle between 0° and 26° plantarflexion while CPC MRI data were collected. Additionally, T2-weighted images of the lower leg were collected both before and after the CPC data collection with the ankle stationary at both 0° and 26° plantarflexion for TA muscle segmentation. A 3D hexahedral mesh was generated based on the TA surface before CPC data collection with the ankle at 0° plantarflexion and the node trajectories were tracked using the CPC data. The volumetric strain of each element was quantified.Three tests were employed to assess the measure accuracy and precision. First, to quantify leg position drift, the TA segmentations were compared before and after CPC data collection. The Hawsdorff distance measure (error) was 1.5  ±  0.7 mm. Second, to assess the surface node trajectory accuracy, the deformed mesh surface was compared to the TA segmented at 26° of ankle plantarflexion. This error was 0.6  ±  0.2 mm. Third, the standard deviation of volumetric strain across the three data collections was calculated for each element and subject. The median between-day variability across subjects and mesh elements was 0.06 mm3 mm(-3) (95% confidence interval 0.01 to 0.18 mm3 mm(-3)). Overall the results demonstrated excellent accuracy and precision.

The primary purpose of this study was to compare static and dynamic optimization muscle force and work predictions during the push phase of wheelchair propulsion. A secondary purpose was to compare the differences in predicted shoulder and elbow kinetics and kinematics and handrim forces. The forward dynamics simulation minimized differences between simulated and experimental data (obtained from 10 manual wheelchair users) and muscle co-contraction. For direct comparison between models, the shoulder and elbow muscle moment arms and net joint moments from the dynamic optimization were used as inputs into the static optimization routine. RMS errors between model predictions were calculated to quantify model agreement. There was a wide range of individual muscle force agreement that spanned from poor (26.4% Fmax error in the middle deltoid) to good (6.4% Fmax error in the anterior deltoid) in the prime movers of the shoulder. The predicted muscle forces from the static optimization were sufficient to create the appropriate motion and joint moments at the shoulder for the push phase of wheelchair propulsion, but showed deviations in the elbow moment, pronation-supination motion and hand rim forces. These results suggest the static approach does not produce results similar enough to be a replacement for forward dynamics simulations, and care should be taken in choosing the appropriate method for a specific task and set of constraints. Dynamic optimization modeling approaches may be required for motions that are greatly influenced by muscle activation dynamics or that require significant co-contraction., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The purpose of this study was to develop an objective, quantitative tool for the diagnosis of lower extremity dystonia. Frequency domain analysis was performed on surface and fine-wire electromyography (EMG) signals collected from the lower extremity musculature of ten patients with suspected dystonia while performing walking trials at self-selected speeds. The median power frequency (MdPF) and percentage of total power contained in the low frequency range (%AUCTotal) were determined for each muscle studied. Muscles exhibiting clinical signs of dystonia were found to have a shift of the MdPF to lower frequencies and a simultaneous increase in the %AUCTotal. A threshold frequency of 70Hz identified dystonic muscles with 73% sensitivity and 63% specificity. These results indicate that frequency analysis can accurately distinguish dystonic from non-dystonic muscles., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Skeletal muscle tissue provides support and mobility of the musculoskeletal system. Numerical modeling of muscle tissue aids in understanding disease pathophysiology, however, the effectiveness is dependent on accurately accounting for various tissue phenomena. Muscle modeling is made difficult due to the multitude of constituents that contribute to elastic and viscous mechanisms. Often, deterministic single fiber or fiber bundle studies are undertaken to examine these contributions. However, examination of whole, intact and structurally altered tissue and comparison to findings at the myofibril scale can help elucidate tissue mechanics. Stress relaxation tests at 10% strain were performed on 28 New Zealand White rabbit's tibialis anterior muscles for whole, intact muscle and sub-sectioned muscle samples. Additionally, to aid in examining viscous effects, sub groups were tested with and without a phosphate buffered saline bath. The steady-state elastic modulus was not significantly different between groups. Interestingly, sectioning did result in a negative Poisson's ratio following tensile loading. Additionally, sectioning resulted in altering the viscous tissue response as the time to reach steady-state was significantly faster than whole muscle samples (p<0.05), as well as the linear relaxation rate from 0 to 0.1 (p<0.01), 1 to 10 (p<0.05), and 10 to 100 s (p<0.05). Bathing tissue resulted in a significantly greater amount of percent stress relaxation for whole muscle (p<0.01). These findings provide new insight into the differing mechanical characteristics of whole and sectioned muscle tissue., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: The moment, a force applied at a distance, is responsible for movement and balance. A key component of the moment is the moment arm. The moment arms of nine muscles surrounding the ankle complex during motion in three planes, were studied., Materials and Methods: Five cadaveric feet were mounted in a testing device that created moments in the sagittal, coronal and transverse planes. Axial and tendon loads were applied as the foot was passively moved in these planes. Tendon excursions and bone kinematics were monitored. The moment arm was calculated using the tendon excursion method and averaged across all specimens., Results: The largest average moment arm during plantarflexion/dorsiflexion, was the Achilles (mean, 53.1; SD, 5.1 mm). During internal/external rotation the largest moment arm was the peroneus brevis (mean, 20.5; SD, 6.4 mm). During inversion/eversion, the largest moment arm was the peroneus longus (31 mm; SD, 2.3 mm)., Conclusion: This study quantified the functional moment arms of nine tendons of the ankle/foot. The involvement of multiple tendons in multiple planes of motion should be considered in computational models and when deciding treatments., Clinical Relevance: The correlation between moment arms and muscle function has significant effects on treatment efficacy. Information on the balance of moments around the ankle will assist in achieving optimal biomechanical behavior following operative treatments.

Objective: Investigate shoulder joint kinetics over a range of daily activity and mobility tasks associated with manual wheelchair propulsion to characterize demands placed on the shoulder during the daily activity of manual wheelchair users., Design: Case series., Subjects: Twelve individuals who were experienced manual wheelchair users., Methods: Upper extremity kinematics and handrim wheelchair kinetics were measured over level propulsion, ramp propulsion, start and stop over level terrain, and a weight relief maneuver. Shoulder intersegmental forces and moments were calculated from inverse dynamics for all conditions., Results: Weight relief resulted in significantly higher forces and ramp propulsion resulted in significantly higher moments than the other conditions. Surprisingly, the start condition resulted in large intersegmental moments about the shoulder equivalent with that of the ramp propulsion, while the demand imparted by the stop condition was shown to be equivalent to level propulsion across all forces and moments., Conclusions: This study provides characterization of daily living and mobility activities associated with manual wheelchair propulsion not previously reported and identifies activities that result in higher shoulder kinetics when compared to standard level propulsion.

Higher-order polynomial functions can be used as a constitutive model to represent the mechanical behaviour of biological materials. The goal of this study was to present a method for assessing the fit of a given constitutive three-dimensional material model. Goodness of fit was assessed using multiple parameters including the root mean square error and Hotelling's T 2-test. Specifically, a polynomial model was used to characterise the stress-strain data, varying the number of model terms used (45 combinations of between 3 and 11 terms) and the manner of optimisation used to establish model coefficients (i.e. determining coefficients either by parameterisation of all data simultaneously or averaging coefficients obtained by parameterising individual data trials). This framework for model fitting helps to ensure that a given constitutive formulation provides the best characterisation of biological material mechanics.

Of the plethora of work performed analyzing skeletal muscle tissue, relatively little has been done in the examination of its passive material properties. Previous studies of the passive properties of skeletal muscle have been primarily performed along the longitudinal material direction. In order to ensure the accuracy of the predictions of computational models of skeletal muscles, a better understanding of the tensile three-dimensional material properties of muscle tissue is necessary. To that end, the purpose of this study was to collect a comprehensive set of tensile stress-strain data from skeletal muscle tissue. Load-deformation data was collected from eighteen extensor digitorum longus muscles, dissected free of aponeuroses, from nine New Zealand White rabbits tested under longitudinal extension (LE), transverse extension (TE), or longitudinal shear (LS). The linear modulus, ultimate stress, and failure strain were calculated from stress-strain results. Results indicate that the linear modulus under LE is significantly higher than the modulus of either TE or LS. Additionally, the ultimate stress of muscle was seen to be significantly higher under LE than TE. Conversely, the failure strain was significantly higher under TE than under LE.

Objective: Quantify manual wheelchair propulsion effort during outdoor community ambulation., Design: Case series., Subjects: Thirteen individuals (12 with SCI, 1 with spina bifida) who were experienced manual wheelchair users and had no current upper extremity injury or pain complaints., Methods: Measurements were obtained from instrumented wheelchair rims during steady-state propulsion as subjects traversed outdoor concrete sidewalk terrain that included smooth level, aggregate level, and a ramp with a smooth surface. Propulsion effort was assessed using the average propulsion moment, average instantaneous power, and work for both upper extremities., Results: Propulsion effort, captured by the propulsion moment, work and power, varied across ground conditions (p<0.001). Propulsion effort was greater as the rolling resistance increased (i.e., smooth versus aggregate surfaces) and as the inclination angle progressed from level to inclined surfaces. There were no side-to-side differences across ground conditions for the propulsion moment or work. Power generation was significantly greater on the dominant compared to the non-dominant extremity during the more challenging aggregate surface and ramp conditions., Conclusions: Propulsion effort varies with demands imposed by different ground conditions. Quantification of wheelchair propulsion demands provides rehabilitations specialists with objective information to guide treatment of patients adapting to manual wheelchair use.

To determine the degree to which intramuscular pressure (IMP) and muscle force are correlated in an intact compartment, a custom pressure transducer was inserted into the rabbit tibialis anterior (TA) while activating the muscle via the peroneal nerve and measuring TA muscle force distal to the ankle retinaculum. In general, IMP was more variable compared with muscle force throughout the entire isometric length-tension relationship. In contrast to results obtained on isolated TA muscles, IMP-force relations with the compartment intact were not significantly different between the ascending and descending limbs of the length-tension curve. Specifically, average relative pressure-force coefficients of determination (r2) were 0.76 +/- 0.11 for the active ascending limb and 0.98 +/- 0.01 for the active descending limb. These data demonstrate that muscle force and IMP are fairly well correlated under isometric conditions and that this relationship is not improved by measuring IMP in an intact environment.

While much work has previously been done in the modeling of skeletal muscle, no model has, to date, been developed that describes the mechanical behavior with an explicit strain-energy function associated with the active response of skeletal muscle tissue. A model is presented herein that has been developed to accommodate this design consideration using a robust dynamical approach. The model shows excellent agreement with a previously published model of both the active and passive length-tension properties of skeletal muscle.

Objective: To quantify the electromyographic activity in the shoulder girdle musculature during ipsilateral kinetic chain exercises performed in a shoulder immobilizer in asymptomatic men., Design: Descriptive., Setting: Motion analysis laboratory at a tertiary care center., Participants: Five asymptomatic male volunteers, ages 24 to 32 years., Intervention: Fine-wire (supraspinatus, infraspinatus, upper subscapularis) and surface (deltoids, trapezii, biceps, serratus anterior) electrodes recorded electromyographic activity from each muscle during a split-stance cross-body rotation (twisting to the opposite side at high, mid, and low levels), split stance attempted ipsilateral floor touch, and attempted overhead reach. All movements were initiated from the immobilized scapula and were tested with and without a combined step., Main Outcome Measure: Mean peak normalized (percentage of maximum voluntary contraction [%MVC]) electromyographic activity of each muscle during each exercise., Results: For all exercises, biceps and infraspinatus activity remained low (<10% MVC), whereas upper subscapularis activity was moderate to very high (29%-68% MVC). Supraspinatus activity was low (<20% MVC) for all motions except the attempted overhead reach (23% MVC). Serratus electromyographic activity was less than 20% of MVC for all motions and was most responsive to added stepping (23%-136% MVC without stepping vs 24%-199% MVC with stepping). Cross-body rotation at lower heights progressively increased serratus activity while decreasing supraspinatus, upper trapezius, and anterior deltoid activity., Conclusions: Based on these electromyographic data, selected kinetic chain exercises could potentially be implemented during periods of shoulder immobilization. All exercises examined could potentially be safe after superior labral anteroposterior repair, but not after subscapularis repair. All exercises, with the exception of the attempted overhead reach, could potentially be safe after supraspinatus repair, with or without concomitant infraspinatus repair. Early activation of the serratus anterior could potentially be achieved by performing cross-body rotations, particularly at lower heights.

Intramuscular pressure (IMP) has been used to estimate muscle stress indirectly. However, the ability of this technique to estimate muscle stress under dynamic conditions is poorly characterized. Therefore, the purpose of this study was to determine the extent to which IMP is a valid surrogate for muscle stress during dynamic contractions. IMP and muscle stress were compared under steady-state isotonic conditions and during complex dynamic length changes. During concentric contractions the shape of the IMP-velocity curve mimicked the basic shape of the force-velocity curve but with much higher variability. For eccentric contractions, a precipitous drop in IMP was observed despite increased muscle stress. The dissociation between muscle stress and IMP during dynamic contractions was partially explained by sensor movement. When the muscle was not moving, IMP explained 89% +/- 5% of the variance in muscle force. However, when transducer movement occurred the linear relationship between IMP and stress was no longer observed. These findings demonstrate the difficulty in interpreting IMP under dynamic conditions when sensor movement occurs. They also illustrate the need to control transducer movement if muscle stress is to be inferred from IMP measurements such as might be desired during clinical gait testing.

Objective: To compare the muscle activation pattern in subjects with and without "snapping triceps syndrome" (dislocation of the medial head of the triceps and ulnar nerve over the medial epicondyle)., Design: Controlled study., Setting: Biomechanics laboratory., Participants: Eight male subjects (9 elbows), with symptomatic snapping triceps and 9 male controls., Interventions: Not applicable., Main Outcome Measures: Activation pattern of the 3 triceps heads during active elbow extension at 0 degrees , 45 degrees , 70 degrees , 90 degrees , and 115 degrees of flexion, recorded by fine-wire electromyography., Results: There were no significant differences between subjects and controls in the firing pattern of the triceps heads. The medial head fired first in 6 of 9 symptomatic elbows and in 7 of 9 controls at 90 degrees of flexion, and in 6 of 9 elbows of both subjects and controls at 115 degrees of flexion, positions where snapping typically occurs. There was no significant difference between the groups as to how often the medial head fired maximally., Conclusions: This study suggests the firing pattern of the triceps heads may not contribute to the pathogenesis of this syndrome. Rather, the authors believe the anatomic position of the medial head causes it to dislocate over the medial epicondyle, often resulting in ulnar neuritis.

Objective: To quantify the electromyographic activity in the shoulder girdle musculature during scapulothoracic exercises performed in a shoulder immobilizer in asymptomatic men., Design: Descriptive., Setting: Motion analysis laboratory at a tertiary care center., Participants: Five asymptomatic male volunteers ages 24 to 32 years., Intervention: Fine-wire (supraspinatus, infraspinatus, upper subscapularis) and surface (deltoids, trapezii, biceps, serratus anterior) electrodes recorded electromyographic activity from each muscle during scapular clock, elevation, depression, protraction, and retraction exercises completed during a single testing session in random order., Main Outcome Measure: Mean peak normalized (percentage of maximal voluntary contraction [MVC]) electromyographic activity of each muscle during each exercise., Results: Biceps activity was uniformly low (<20% MVC), whereas upper subscapularis activity was uniformly high (40%-63% MVC). Both scapular depression and protraction elicited low activity (<20% MVC) in the supraspinatus, infraspinatus, anterior deltoid, and biceps brachii muscles, while generally producing greater than 20% MVC activity in the trapezii and serratus. Scapular depression produced the largest serratus anterior activity (47% MVC)., Conclusions: These data are the first to describe the electromyographic activity during scapulothoracic exercises while in a shoulder immobilizer. Based on electrophysiologic data in normal volunteers, our findings suggest that during periods of shoulder immobilization: (1) scapular depression and protraction exercises could potentially be safely performed after rotator cuff repair to facilitate scapulothoracic rehabilitation, (2) all exercises studied could potentially be safe after superior labral anteroposterior shoulder repair, and (3) all exercises studied should be avoided after subscapularis repair. Further investigation in symptomatic individuals may facilitate refinement of these recommendations.

The purpose of this study was to quantify electromyographic (EMG) activity in the immobilized shoulder girdle musculature at rest and during a battery of contralateral upper limb activities. Six asymptomatic men, aged 22 to 33 years, volunteered to participate. Fine-wire (supraspinatus, infraspinatus) and surface (deltoids, trapezii, biceps, serratus anterior) electrodes recorded the mean peak normalized (percent maximal voluntary contraction [%MVC]) EMG activity from each immobilized muscle at rest and during slow, fast, and incrementally resisted contralateral upper limb motions (5, 15, and 25 lb). EMG activity in all muscles was low during quiet immobilized standing (<1.5% maximal voluntary contraction [MVC]). During slow contralateral upper limb motions, activity ranged from 0.7% to 51.6% MVC (highest in trapezii) and was less than 15% MVC in the supraspinatus, infraspinatus, and anterior deltoid. Bimanual jar opening increased biceps activity from 7.8% to 16.1% MVC. During fast contralateral upper limb motions, peak infraspinatus activity increased to 56.7% during a fast straightforward reach. Supraspinatus activity was relatively high during all resisted backward-pulling motions (25.2%-32.1% MVC), whereas resisted forward reaching produced relatively little activity in the anterior deltoid, supraspinatus, infraspinatus, or biceps. Several slow and fast motions produced high trapezius activity (>45% MVC) with low supraspinatus, biceps, and anterior deltoid activities (<10% MVC). Our findings suggest that (1) immobilized shoulder girdle muscle EMG activity during quiet standing is negligible in asymptomatic individuals; (2) contralateral upper limb motions at self-selected speeds are not likely to be harmful to healing tissues; (3) during early healing periods, patients with biceps-labral injury should minimize bimanual activities, those with supraspinatus injury should avoid backward-pulling motions, and those with infraspinatus injury should avoid fast straightforward reaches; and (4) cross-body, straightforward, or downward reaches at either a slow or fast speed may be appropriately prescribed as rehabilitative exercises that can be initiated while the shoulder remains immobilized.

A newly developed fiber optic micropressure sensor was evaluated for biocompatibility using the International Organization for Standardization (ISO) test standard 10993-6. The test material and an inert control (fused silica glass) were tested in New Zealand white rabbits. Four test specimens were implanted in the paravertebral muscles on one side of the spine about 2-5 cm from the mid-line and parallel to the spinal column. Similarly, four control specimens were implanted on the opposite side. The implantation periods were 1, 4, and 12 weeks to ensure a steady state biological tissue response. Four animals were tested at each time period. Macroscopic and microscopic observations were performed to compare the biological reactions between the test and control materials. There was an inflammatory reaction at 1 week which subsided at 4 weeks. There was fibrous tissue growth near the implant that also decreased over time. Most importantly, there was no significant difference in the biological response between the test and control materials. Therefore, we conclude that the pressure microsensor is biocompatible.

Objective: To non-invasively determine muscle activity., Design: A correlation analysis study., Background: Electromyography is traditionally used to measure the electrical activity of a muscle and can be used to estimate muscle contraction intensity. This approach, however, is limited not only in terms of the volume of tissue that can be monitored, but must be invasive if deep lying muscles are studied. We wished to avoid these limitations and used magnetic resonance elastography in an attempt to non-invasively determine muscle activity. This novel approach uses a conventional MRI system. However, in addition to the imaging gradients, an oscillating, motion sensitizing field gradient is applied to detect mechanical waves that have been generated within the tissue. The wavelength correlates with the stiffness of the muscle and hence with the activity of the muscle., Methods: Six volunteers (mean age: 30.1 years, range: 27-36 years) without orthopedic or neuromuscular abnormalities, lay supine with their legs within the coil of a MRI scanner. The wavelengths of mechanically generated shear waves in the tibialis anterior, medial and lateral head of the gastrocnemius and the soleus were measured as the subjects resisted ankle plantar-flexing (8.2 and 16.4 nm) and dorsi-flexing (20.2 and 40.4 nm) moments. The findings were then compared to EMG data collected under the same loading conditions., Results: Magnetic resonance elastography wavelengths were linearly correlated to the muscular activity as defined by electromyography. (TA, R(2)=0.89, P=0.02; MG, R(2)=0.82, P=0.05; LG, R(2)=0.88, P=0.03; S, R(2)=0.90, P=0.02), Conclusions: Magnetic resonance elastography may be a promising tool for the non-invasive determination of muscle activity., Relevance: Magnetic resonance elastography has potential as the basis for a new non-invasive approach to study in vivo muscle function.

The purpose of this study was to quantify the relationship between intramuscular pressure (IMP) and muscle force during isometric muscle contraction of the rabbit tibialis anterior (TA) absent the effect of either bone or fascia. To quantify this relationship, length-tension experiments were performed on the isolated TA of the New Zealand White rabbit (mass=2.5+/-0.5kg, n=12). The knee was fixed in a custom jig, the distal tendon of the TA was attached to a servomotor, and a 360 microm fiber optic pressure transducer was inserted into the TA. The peroneal nerve was stimulated to define optimal length (L(0)). The length-tension curve was created using 40Hz isometric contractions with 2-min rest intervals between each contraction. Measurements began at L(0)-50%L(f) and progressed to L(0)+50%L(f), changing the length-tension in 5% L(f) increments after each contraction. Qualitatively, the length-tension curve for isometric contractions was mimicked by the length-pressure curve for both active and passive conditions. Linear regression was performed individually for each animal for the ascending and descending limb of the length-tension curve and for active and passive conditions. Pressure-force coefficients of determination ranged from 0.138-0.963 for the active ascending limb and 0.343-0.947 for the active descending limb. Passive pressure coefficients of determination ranged from 0.045-0.842 for the ascending limb and 0.672-0.982 for the descending limb. These data indicate that IMP measurement provide a fairly accurate index of relative muscle force, especially at muscle lengths longer than optimal.

The measurement of in vivo intramuscular pressure (IMP) has recently become practical and IMP appears well correlated with muscle tension. A numerical model of skeletal muscle was developed to examine the mechanisms producing IMP. Unipennate muscle is modelled as a two-dimensional material continuum that is incompressible and nonlinearly anisotropic. The finite element technique is used to calculate IMP and muscle stress during passive stretch and during isometric contraction. A novel element models the contractile portion of muscle, incorporating sarcomere length-force and velocity-force relations. A range of unipennate muscle geometries can be modelled. The model was configured to simulate the rabbit tibialis anterior muscle over a range of lengths. Simulated IMP and stress results were validated against animal experimentation data. The simulation agreed well with the experimental data over the range of 0.8-1.1 of the optimal length. Severe pressure gradients were produced near the musculo-tendinous junctions while IMP was more uniform in the central muscle belly. IMP and muscle stress in relaxed (unstimulated) muscle increased nonlinearly with muscle length. IMP and stress in isometrically contracting muscle showed a local maximum at optimal length and were reduced at shorter lengths. At muscle lengths longer than optimal, stress and IMP increased predominately due to tension in the passive elastic structures.

Objective: To investigate whether a new tissue-imaging technique, magnetic resonance elastography (MRE), offers a viable, noninvasive way to study healthy and diseased muscle., Design: Convenience sample., Setting: A magnetic resonance imaging (MRI) laboratory., Participants: Eight control subjects (4 men, 4 women), between the ages of 24 and 41 years, with normal neuromuscular examinations and histories, and 6 subjects (3 men, 3 women), ages 17 to 63 years, with lower-extremity neuromuscular dysfunction (1 with childhood poliomyelitis, 2 with flaccid, 3 with spastic paraplegia)., Interventions: Subjects lay supine with their legs within the coils of a 1.5T MRI machine, with their feet strapped to a footplate positioned so that the axes of rotation of their ankles coincided with the apparatus. All subjects were tested in a no-load (0 torque) condition. Control subjects were also evaluated as they isometrically resisted ankle dorsi- (20.2Nm, 40.5Nm) and plantar- (8.2Nm, 16.4Nm) flexion moments. Subjects with neuromuscular dysfunction were evaluated in the same manner, except 1 individual with residual lower-extremity strength who could only be tested in the resting and passive ankle dorsiflexion modes. Shear waves were induced with a 150-Hz electromechanic transducer located over the belly tibialis anterior. MRE images were collected with a gradient-echo technique gated to the transducer's motion. Wave-phase propagation was visualized with 8 equally offset images across 1 vibration-cycle., Main Outcome Measures: Changes in shear-wave wavelength (lambda) and muscle stiffness (as expressed by the shear modulus [G]) in the tibialis anterior and gastrocnemius muscles., Results: Wavelength and G differed between the groups in all the muscles studied, and increased as the load increased. Moreover, lambda and G in the neuromuscular disease group at rest (eg, 3.88+/-0.48cm; range, 2.87-4.91cm; 38.40+/-00.77kPa; range, 22.35-59.67kPa) and in the lateral gastrocnemius were, respectively, more than 1.5 and 2.4 times larger than they were in the same muscle in the control group (2.56+/-0.28cm, 16.16+/-00.19kPa; P=.0002) (1Pa=1N/m(2))., Conclusions: Shear-wave wavelength and muscle stiffness increased with load in healthy muscle. In addition, at least for our sample, these quantities differed significantly between muscles with and without neuromuscular disease. In summary, MRE appears to provide in vivo physiologic information about the mechanical properties of muscle at rest and during contraction that is not otherwise available. The potential of this technique for monitoring the effects of treatment and exercise on both healthy and diseased muscle merits further research., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

The purpose of this study was to quantify the gait of subjects receiving two injections of either botulinum A toxin or saline vehicle into the gastrocnemius muscle(s). The study group consisted of cerebral palsy patients who walked with an equinus gait pattern. This study was a randomized, double-blinded, parallel clinical trial of 20 subjects. All were studied by gait analysis before and after the injections. There were no adverse effects. Peak ankle dorsiflexion in stance and swing significantly improved in subjects who received the drug and not in controls. Results of this double blind study give support to the short term efficacy of botulinum toxin A to improve gait in selected patients with cerebral palsy.