Search

This study aimed to examine the temporal dynamics of muscle-tendon adaptation and whether differences between their sensitivity to mechano-metabolic stimuli would lead to non-uniform changes within the triceps surae (TS) muscle-tendon unit (MTU). Twelve young adults completed a 12-week training intervention of unilateral isometric cyclic plantarflexion contractions at 80% of maximal voluntary contraction until failure to induce a high TS activity and hence metabolic stress. Each participant trained one limb at a short (plantarflexed position, 115°: PF) and the other at a long (dorsiflexed position, 85°: DF) MTU length to vary the mechanical load. MTU mechanical, morphological, and material properties were assessed biweekly via simultaneous ultrasonography-dynamometry and magnetic resonance imaging. Our hypothesis that tendon would be more sensitive to the operating magnitude of tendon strain but less to metabolic stress exercise was confirmed as tendon stiffness, Young's modulus, and tendon size were only increased in the DF condition following the intervention. The PF leg demonstrated a continuous increment in maximal AT strain (i.e., higher mechanical demand) over time along with lack of adaptation in its biomechanical properties. The premise that skeletal muscle adapts at a higher rate than tendon and does not require high mechanical load to hypertrophy or increase its force potential during exercise was verified as the adaptive changes in morphological and mechanical properties of the muscle did not differ between DF and PF. Such differences in muscle-tendon sensitivity to mechano-metabolic stimuli may temporarily increase MTU imbalances that could have implications for the risk of tendon overuse injury., (© 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Studies previously conducted on high jump have yielded important information regarding successful performance. However, analyses in competitive scenarios have often disregarded athletes' unsuccessful attempts. This study aimed to investigate the biomechanical differences between successful and unsuccessful jumps during competition. High-speed video footage (200 Hz) was obtained from 11 athletes during the 2018 Men's World Athletics Indoor Championship Final. From each athlete, one successful (SU) and one unsuccessful (UN) jump at the same bar height were included in the analysis, leaving seven athletes in total. Following whole-body 3D manual digitization, several temporal and kinematic variables were calculated for the run-up, take-off, and flight phases of each jump. During SU jumps, athletes raised the center of mass to a greater extent ( p  < 0.01) from take-off. Touchdown in SU jumps was characterized by a faster anteroposterior velocity ( p  < 0.05), lower backward lean ( p  < 0.05), and changes in joint angles for the stance and trail limbs ( p  < 0.05). Athletes also shortened the final contact time during SU jumps ( p  < 0.01) after producing a longer flight time in the final step of the run-up ( p  < 0.05). Elite-level high jumpers undertake a series of adjustments to successfully clear the bar after UN jumps. These adjustments reinforce the importance of the run-up in setting the foundations for take-off and bar clearance. Furthermore, the findings demonstrate the need for coaches to be mindful of the adjustments required in stance and trail limbs when looking to optimize feedback to athletes during training and competition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Nicholson, Epro, Merlino, Walker and Bissas.)

In response to a mechanical stimulus, tendons have a slower tissue renewal rate compared with muscles. This could, over time, lead to a higher mechanical demand (experienced strain) for the tendon, especially when a high strain magnitude exercise is repeated without sufficient recovery. The current study investigated the adaptive responses of the human triceps surae (TS) muscle-tendon unit (MTU) and extracellular matrix turnover-related biomarkers to repetitive high tendon strain cyclic loading. Eleven young adult males performed a progressive resistance exercise over 12 consecutive days, consisting of high Achilles tendon (AT) strain cyclic loading (90% MVC) with one leg once a day (LegT1) and the alternate leg three times a day (LegT3). Exercise-related changes in TS MTU mechanical properties and serum concentrations of extracellular matrix turnover-related biomarkers were analysed over the intervention period. Both legs demonstrated similar increases in maximal AT force (∼10%) over the 12 day period of exercise. A ∼20% increase in maximal AT strain was found for LegT3 (P<0.05) after 8 consecutive exercise days, along with a corresponding decrease in AT stiffness. These effects were maintained even after a 48 h rest period. The AT mechanical properties for LegT1 were unaltered. Biomarker analysis revealed no sign of inflammation but there was altered collagen turnover and a delay in collagen type I synthesis. Accordingly, we suggest that tendon is vulnerable to frequent high magnitude cyclic mechanical loading as accumulation of micro-damage can potentially exceed the rate of biological repair, leading to increased maximal tendon strain., Competing Interests: Competing interests The authors declare no competing or financial interests., (© 2023. Published by The Company of Biologists Ltd.)

Abstract: AminiAghdam, S, Epro, G, James, D, and Karamanidis, K. Leaning the trunk forward decreases patellofemoral joint loading during uneven running. J Strength Cond Res 36(12): 3345-3351, 2022-Although decline surfaces or a more upright trunk posture during running increase the patellofemoral joint (PFJ) contact force and stress, less is known about these kinetic parameters under simultaneous changes to the running posture and surface height. This study aimed to investigate the interaction between Step (10-cm drop-step and level step) and Posture (trunk angle from the vertical: self-selected, ∼15°; backward, ∼0°; forward, ∼25°) on PFJ kinetics (primary outcomes) and knee kinematics and kinetics as well as hip and ankle kinetics (secondary outcomes) in 12 runners at 3.5 ms -1 . Two-way repeated measures analyses of variance ( α = 0.05) revealed no step-related changes in peak PFJ kinetics across running postures; however, a decreased peak knee flexion angle and increased joint stiffness in the drop-step only during backward trunk-leaning. The Step main effect revealed significantly increased peak hip and ankle extension moments in the drop-step, signifying pronounced mechanical demands on these joints. The Posture main effect revealed significantly higher and lower PFJ kinetics during backward and forward trunk-leaning, respectively, when compared with the self-selected condition. Forward trunk-leaning yielded significantly lower peak knee extension moments and higher hip extension moments, whereas the opposite effects occurred with backward trunk-leaning. Overall, changes to the running posture, but not to the running surface height, influenced the PFJ kinetics. In line with the previously reported efficacy of forward trunk-leaning in mitigating PFJ stress while even or decline running, this technique, through a distal-to-proximal joint load redistribution, also seems effective during running on surfaces with height perturbations., (Copyright © 2021 National Strength and Conditioning Association.)

Locomotor training based in virtual reality (VR) is promising for motor skill learning, with transfer of VR skills in turn required to benefit daily life locomotion. This study aimed to assess whether VR-adapted obstacle avoidance can be transferred to a physical obstacle and whether such transfer is retained after 1 week. Thirty-two young adults were randomly divided between two groups. A control group (CG) merely walked on a treadmill and an intervention group (IG) trained crossing 50 suddenly-appearing virtual obstacles. Both groups crossed three physical obstacles (transfer task) immediately after training (T1) and 1 week later (T2, transfer retention). Repeated practice in VR led to a decrease in toe clearance along with greater ankle plantarflexion and knee extension. IG participants crossed physical obstacles with a lower toe clearance compared to CG but revealed significantly higher values compared to the VR condition. VR adaptation was fully retained over 1 week. For physical obstacle avoidance there were differences between toe clearance of the third obstacle at T1 and the first obstacle at T2, indicating only partial transfer retention. We suggest that perception-action coupling, and thus sensorimotor coordination, may differ between VR and the physical world, potentially limiting retained transfer between conditions., (© 2022. The Author(s).)

Abstract: Lambrianides, Y, Epro, G, Smith, K, Mileva, K, James, D, and Karamanidis, K. Impact of different mechanical and metabolic stimuli on the temporal dynamics of muscle strength adaptation. J Strength Cond Res 36(11): 3246-3255, 2022-A fundamental task in exercise physiology is to determine and ultimately improve the adaptations that take place in the human body, an integrated network of various physiological systems, for example, muscle, tendon, and bone. Investigating the temporal dynamics (time course) of adaptations in these diverse systems may help us gain new knowledge about the functioning of the neuromotor system in healthy and pathological conditions. The aim of this review was to explore the temporal dynamics of muscular strength adaptations in studies implementing a resistance training intervention. In addition, we categorized these studies under mechanical or metabolic stimuli to identify whether certain stimuli cause faster muscle strength gains. Searches were performed using PubMed and Google Scholar databases. The review comprised 708 subjects from 57 training groups within 40 studies that met the inclusion criteria. The results revealed that the mean time point of first significant increase in muscle strength of all studies was 4.3 weeks, and the corresponding increase was on average about 17%. A plateau in muscle strength increase (∼25%) was found to occur between weeks 8 and 12. Categorization into stimuli groups revealed that performing training in a hypoxic environment is likely to produce a leftward shift (∼25% increase at ∼2.8 weeks) in the dose-response relationship compared with blood flow restriction and supplementation. However, stimuli that cause faster muscle strength gains may also induce imbalanced adaptation between the muscle and the surrounding biological structures, potentially triggering a degradation in some parts of the network (i.e., leading to an increased risk of injury)., (Copyright © 2022 National Strength and Conditioning Association.)

Generalisation of adaptations is key to effective stability control facing variety of postural threats during daily life activity. However, in a previous study we could demonstrate that adaptations to stability control do not necessarily transfer to an untrained motor task. Here, we examined the dynamic stability and modular organisation of motor responses to different perturbations (i.e. unpredictable gait-trip perturbations and subsequent loss of anterior stability in a lean-and-release protocol) in a group of young and middle-aged adults (n = 57; age range 19-53 years) to detect potential neuromotor factors limiting transfer of adaptations within the stability control system. We hypothesized that the motor system uses different modular organisation in recovery responses to tripping and lean-and-release, which may explain lack in positive transfer of adaptations in stability control. After eight trip-perturbations participants increased their dynamic stability during the first recovery step (p < 0.001), yet they showed no significant improvement to the untrained lean-and-release transfer task compared to controls who did not undergo the perturbation exposure (p = 0.44). Regarding the neuromuscular control of responses, lower number of synergies (3 vs. 4) was found for the lean-and-release compared to the gait-trip perturbation task, revealing profound differences in both the timing and function of the recruited muscles to match the biomechanical specificity of different perturbations. Our results provide indirect evidence that the motor system uses different modular organisation in diverse perturbation responses, what possibly inhibits inter-task generalisation of adaptations in stability control., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The assessment of the force-length relationship under mechanical loading is widely used to evaluate the mechanical properties of tendons and to gain information about their adaptation, function, and injury. This study aimed to provide a time-efficient ultrasound method for assessing Achilles tendon mechanical properties. On two days, eleven healthy young non-active adults performed eight maximal voluntary isometric ankle plantarflexion contractions on a dynamometer with simultaneous ultrasonographic recording. Maximal tendon elongation was assessed by digitizing ultrasound images at rest and at maximal tendon force. Achilles tendon stiffness index was calculated from the ratio of tendon force-to-strain. No within- and between-day differences were detected between the proposed method and manual frame by frame tracking in Achilles tendon maximal force, maximal elongation, maximal strain, and stiffness index. The overall coefficient of variation between trials ranged from 3.4% to 10.3% and average difference in tendon tracking between methods was less than 0.6% strain. Furthermore, an additional assessment demonstrated significant differences between elite athletes, healthy young, and older adults in Achilles tendon force and stiffness index. Hence, the analysis has the potential to reliably and accurately monitor changes in Achilles tendon mechanical properties due to aging and altered mechanical loading in a time-efficient manner.

Use of head-mounted displays (HMDs) and hand-held displays (HHDs) may affect the effectiveness of stability control mechanisms and impair resistance to falls. This study aimed to examine whether the ability to control stability during locomotion is diminished while using HMDs and HHDs. Fourteen healthy adults (21-46 years) were assessed under single-task (no display) and dual-task (spatial 2-n-back presented on the HMD or the HHD) conditions while performing various locomotor tasks. An optical motion capture system and two force plates were used to assess locomotor stability using an inverted pendulum model. For perturbed standing, 57% of the participants were not able to maintain stability by counter-rotation actions when using either display, compared to the single-task condition. Furthermore, around 80% of participants (dual-task) compared to 50% (single-task) showed a negative margin of stability (i.e., an unstable body configuration) during recovery for perturbed walking due to a diminished ability to increase their base of support effectively. However, no evidence was found for HMDs or HHDs affecting stability during unperturbed locomotion. In conclusion, additional cognitive resources required for dual-tasking, using either display, are suggested to result in delayed response execution for perturbed standing and walking, consequently diminishing participants' ability to use stability control mechanisms effectively and increasing the risk of falls.

Background: The assessment of stability recovery performance following perturbations contributes to the determination of fall resisting skills. This study investigated the association between stability recovery performances in two perturbation tasks (lean-and-release versus tripping)., Methods: Healthy adults (12 young: 24 ± 3 years; 21 middle-aged: 53 ± 5 years; 11 old: 72 ± 5 years) were suddenly released from a forward-inclined position attempting to recover stability with a single step. In a second task, all participants experienced a mechanically induced trip during treadmill walking. To assess dynamic stability performance, the antero-posterior margin of stability (MoS), the base of support (BoS), and the rate of increase in BoS were determined at each foot touchdown (TD) for both tasks., Results: Only weak to moderate correlations in dynamic stability performance parameters were found between the two tasks (0.568 > r > 0.305, 0.001 < p < 0.04). A separation of participants according to the number of steps required to regain stability in the lean-and-release task revealed that multiple- (more than one step) compared to single-steppers showed a significantly lower MoS at TD (p = 0.003; g = 1.151), lower BoS at TD (p = 0.019; g = 0.888) and lower rate of increase in BoS until TD (p = 0.002; g = 1.212) after release. Despite these profound subgroup differences in the lean-and-release task, no differences between multiple- and single-steppers were observed in the stability recovery performance during tripping., Conclusion: The results provide evidence that the ability to effectively control dynamic stability following a sudden balance disturbance in adults across a wide age range is limited in its generalisation for different perturbation tasks., (© 2021. The Author(s).)

Purpose: Recent studies identified a redistribution of positive mechanical work from distal to proximal joints during prolonged runs, which might partly explain the reduced running economy observed with running-induced fatigue. Higher mechanical demand of plantar flexor muscle-tendon units, for example, through minimal footwear, can lead to an earlier onset of fatigue, which might affect the redistribution of lower extremity joint work during prolonged runs. Therefore, the purpose of this study was to examine the effects of a racing flat and cushioned running shoe on the joint-specific contributions to lower extremity joint work during a prolonged fatiguing run., Methods: On different days, 18 runners performed two 10-km runs with near-maximal effort in a racing flat and a cushioned shoe on an instrumented treadmill synchronized with a motion capture system. Joint kinetics and kinematics were calculated at 13 predetermined distances throughout the run. The effects of shoes, distance, and their interaction were analyzed using a two-factor repeated-measures ANOVA., Results: For both shoes, we found a redistribution of positive joint work from the ankle (-6%) to the knee (+3%) and the hip (+3%) throughout the entire run. Negative ankle joint work was higher (P < 0.01) with the racing flat compared with the cushioned shoe. Initial differences in foot strike patterns between shoes disappeared after 2 km of running distance., Conclusions: Irrespective of the shoe design, alterations in the running mechanics occurred in the first 2 km of the run, which might be attributed to the existence of a habituation rather than fatigue effect. Although we did not find a difference between shoes in the fatigue-related redistribution of joint work from distal to more proximal joints, more systematical studies are needed to explore the effects of specific footwear design features., (Copyright © 2020 by the American College of Sports Medicine.)

Rapid stepping to preserve stability is a crucial action in avoiding a fall. It is also an important measure in the assessment of fall-resisting skills. We examined whether volitional step execution correlates with recovery stepping performance after sudden balance loss for adults of different ages. In addition, we investigated whether volitional step performance can discriminate between individuals with high and low balance recovery capabilities, i.e. between those making single versus multiple steps after balance perturbation. Healthy adults (28 young, 43 middle-aged and 26 older; 24 ± 4, 52 ± 5 and 72 ± 5 years respectively) performed a single step in the anterior direction volitionally in response to a mechanical stimulus to the heel. In a second stepping task, participants experienced sudden anterior balance loss in a lean-and-release protocol. For both tasks, an optical motion capture system was used to assess stepping kinematics. We found on average 28% shorter reaction times, 46% faster maximal step velocities and 48% higher rates of increase in base of support across all participants after sudden balance loss compared to volitional stepping (p < 0.001). There was a significant age-related decline in recovery stepping performance after sudden balance loss: 24/26 older, 15/43 middle-aged and none of the younger adults required two or more steps to regain balance (p < 0.001). Multiple- compared to single-steppers had on average 23% shorter step lengths and 12% lower maximal step velocities for the lean-and-release task (p < 0.01). Multiple-steppers also had reduced rates of increase in base of support for both stepping tasks (14% for balance recovery and 11% for volitional stepping). Furthermore, in examining the relationship between the results of the two tasks, only weak to moderate correlations were observed for step velocity and rate of increase in base of support (0.36 ≤ r ≤ 0.52; p < 0.001). Thus, performance in volitional step execution has a low potential to explain variability in recovery response after sudden balance loss in adults across the lifespan and hence seems less suitable to be used to identify deficiencies in reactive stepping responses necessary to cope with sudden balance disturbances., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Differences in muscle and tendon responsiveness to mechanical stimuli and time courses of adaptive changes may disrupt the interaction of the musculotendinous unit (MTU), increasing the risk for overuse injuries. We monitored training-induced alterations in muscle and tendon biomechanical properties in elite jumpers over 4 years of athletic training to detect potential non-synchronized adaptations within the triceps surae MTU. A combined cross-sectional and longitudinal investigation over 4 years was conducted by analyzing triceps surae MTU mechanical properties in both legs via dynamometry and ultrasonography in 67 elite track and field jumpers and 24 age-matched controls. Fluctuations in muscle and tendon adaptive changes over time were quantified by calculating individual residuals. The cosine similarity of the relative changes of muscle strength and tendon stiffness between sessions served as a measure of uniformity of adaptive changes. Our cross-sectional study was unable to detect clear non-concurrent differences in muscle strength and tendon stiffness in elite jumpers. However, when considering the longitudinal data over several years of training most of the jumpers demonstrated greater fluctuations in muscle strength and tendon stiffness and hence tendon strain compared to controls, irrespective of training period (preparation vs. competition). Moreover, two monitored athletes with chronic Achilles tendinopathy showed in their affected limb lower uniformity in MTU adaptation as well as higher fluctuations in tendon strain over time. Habitual mechanical loading can affect the MTU uniformity in elite jumpers, leading to increased mechanical demand on the tendon over an athletic season and potentially increased risk for overuse injuries., Competing Interests: KK has equity in Protendon GmbH & Co. KG, whose measurement device and software was used for the data processing and analysis in this study. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Karamanidis and Epro.)

Aging negatively affects balance recovery responses after trips and slips. We hypothesize that older people can benefit from brief treadmill-based trip and slip perturbation exposure despite reduced muscular capacities, but with neuropathology, their responsiveness to these perturbations will be decreased. Thus, to facilitate long-term benefits and their generalizability to everyday life, one needs to consider the individual threshold for perturbation dose.

For human locomotion, varying environments require adjustments of the motor system. We asked whether age affects gait balance recovery adaptation, its retention over months, and the transfer of adaptation to an untrained reactive balance task. Healthy adults (26 young, 27 middle-aged, and 25 older; average ages 24, 52, and 72 yr, respectively) completed two tasks. The primary task involved treadmill walking: either unperturbed (control; n = 39) or subject to unexpected trip perturbations (training; n = 39). A single trip perturbation was repeated after a 14-wk retention period. The secondary transfer task, before and after treadmill walking, involved sudden loss of balance in a lean-and-release protocol. For both tasks, the anteroposterior margin of stability (MoS) was calculated at foot touchdown. For the first (i.e., novel) trip, older adults required one more recovery step ( P = 0.03) to regain positive MoS compared with younger, but not middle-aged, adults. However, over several trip perturbations, all age groups increased their MoS for the first recovery step to a similar extent (up to 70%) and retained improvements over 14 wk, although a decay over time was found for older adults ( P = 0.002; middle-aged showing a tendency for decay: P = 0.076). Thus, although adaptability in reactive gait stability control remains effective across the adult life span, retention of adaptations over time appears diminished with aging. Despite these robust adaptations, the perturbation training group did not show superior improvements in the transfer task compared with age-matched controls (no differences in MoS changes), suggesting that generalizability of acquired fall-resisting skills from gait-perturbation training may be limited. NEW & NOTEWORTHY The human neuromotor system preserves its adaptability across the adult life span. However, although adaptability in reactive gait stability control remains effective as age increases, retention of recovery response adaptations over time appears to be reduced with aging. Furthermore, acquired fall-resisting skills from single-session perturbation training seem task specific, which may limit the generalizability of such training to the variety of real-life falls.

Triceps surae (TS) muscle volume can be estimated in young adults by only considering the maximal anatomical cross-sectional area (ACSA max ) and the length of the muscle due to the presence of a constant muscle-specific shape factor. This study aimed to investigate if this simplified muscle volume assessment is also applicable in older adults or if muscle-specific shape changes with aging. MRI sequences were taken from the dominant leg of 21 older female adults. The boundaries of all three TS muscles (SOL, soleus; GM, gastrocnemius medialis; GL, gastrocnemius lateralis) were manually outlined in transverse image sequences, and muscle volume for each muscle was calculated as the integral of the obtained cross-sectional areas of the contours along the whole length of the muscle (measured volume) and, in addition, by using the average muscle-specific shape factors of each muscle obtained from the ratio of the measured volume and the product of ACSA max and the muscle length (estimated volume). There were no differences in the measured and estimated muscle volumes (SOL: 357.7 ± 61.8 vs. 358.8 ± 65.3 cm 3 ; GM: 179.5 ± 32.8 vs. 179.8 ± 33.3 cm 3 ; GL: 90.2 ± 15.9 vs. 90.4 ± 14.8 cm 3 ). However, when using the reported shape factors of younger adults instead, we found a significant ( p < 0.05) overestimation of muscle volume for SOL and GM with average RMS differences of 6.1 and 7.6%, respectively. These results indicate that corrections of muscle-specific shape factors are needed when using the previously proposed simplified muscle volume assessment as aging may not only be accompanied with muscle atrophy but also changes in the shape of skeletal muscle., (Copyright © 2019 Karamanidis, Epro, König, Mersmann and Arampatzis.)

Different adaptive responses to mechanical loading between muscle and tendon can lead to non-uniform biomechanical properties within the muscle-tendon unit. The current study aimed to analyze the mechanical properties of the triceps surae muscle-tendon unit in healthy male and female elite track and field jumpers in order to detect possible inter-limb differences and intra-limb non-uniformities in muscle and tendon adaptation. The triceps surae muscle strength and tendon stiffness were analyzed in both limbs during maximal voluntary isometric plantar flexion contractions using synchronous dynamometry and ultrasonography in sixty-seven healthy young male ( n = 35) and female ( n = 32) elite international level track and field jumpers (high jump, long jump, triple jump, pole vault). Triceps surae muscle-tendon unit intra-limb uniformity was assessed using between limb symmetry indexes in the muscle strength and tendon stiffness. Independent from sex and jumping discipline the take-off leg showed a significantly higher ( p < 0.05) triceps surae muscle strength and tendon stiffness, suggesting different habitual mechanical loading between legs. However, despite these inter-limb discrepancies no differences were detected in the symmetry indexes of muscle strength (5.9 ± 9.4%) and tendon stiffness (8.1 ± 11.5%). This was accompanied by a significant correlation between the symmetry indexes of muscle strength and tendon stiffness ( r = 0.44; p < 0.01; n = 67). Thus, the current findings give evidence for a uniform muscle-tendon unit adaptation in healthy elite track and field jumpers, which can be reflected as a protective mechanism to maintain its integrity to meet the functional demand.

Perturbation training is an emerging approach to reduce fall risk in the elderly. This study examined potential differences in retention of improvements in reactive gait stability over 14 weeks resulting from unexpected trip-like gait perturbations. Twenty-four healthy middle-aged adults (41-62 years) were assigned randomly to either a single perturbation group (SINGLE, n = 9) or a group subjected to eight trip-like gait perturbations (MULTIPLE, n = 15). While participants walked on a treadmill a custom-built brake-and-release system was used to unexpectedly apply resistance during swing phase to the lower right limb via an ankle strap. The anteroposterior margin of stability (MoS) was calculated as the difference between the anterior boundary of the base of support and the extrapolated centre of mass at foot touchdown for the perturbed step and the first recovery step during the first and second (MULTIPLE group only) perturbation trials for the initial walking session and retention-test walking 14 weeks later. Group MULTIPLE retained the improvements in reactive gait stability to the perturbations (increased MoS at touchdown for perturbed and first recovery steps; p < 0.01). However, in group SINGLE no differences in MoS were detected after 14 weeks compared to the initial walking session. These findings provide evidence for the requirement of a threshold trip-perturbation dose if adaptive changes in the human neuromotor system over several months, aimed at the improvement in fall-resisting skills, are to occur., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the joint-specific contributions to the total lower-extremity joint work during a prolonged fatiguing run., Methods: Recreational long-distance runners (n = 13) and competitive long-distance runners (n = 12) performed a 10-km treadmill run with near-maximal effort. A three-dimensional motion capture system synchronized with a force-instrumented treadmill was used to calculate joint kinetics and kinematics of the lower extremity in the sagittal plane during the stance phase at 13 distance points over the 10-km run., Results: A significant (P < 0.05) decrease of positive ankle joint work as well as an increase of positive knee and hip joint work was found. These findings were associated with a redistribution of the individual contributions to total lower-extremity work away from the ankle toward the knee and hip joint which was more distinctive in the recreational runner group than in the competitive runner group. This redistribution was accomplished by significant (P < 0.05) reductions of the external ground-reaction force lever arm and joint torque at the ankle and by the significant (P < 0.05) increase of the external ground-reaction force lever arm and joint torque at the knee and hip., Conclusions: The redistribution of joint work from the ankle to more proximal joints might be a biomechanical mechanism that could partly explain the decreased running economy in a prolonged fatiguing run. This might be because muscle-tendon units crossing proximal joints are less equipped for energy storage and return compared with ankle plantar flexors and require greater muscle volume activation for a given force. To improve running performance, long-distance runners may benefit from an exercise-induced enhancement of ankle plantar flexor muscle-tendon unit capacities.

Reductions in muscular power output and performance during multi-joint motor tasks with aging have often been associated with muscle weakness. This study aimed to examine if matching younger and middle-aged adults for triceps surae (TS) muscle strength and tendon stiffness eliminates age-related differences in muscular power production during drop jump. The maximal ankle plantar flexion moment and gastrocnemius medialis tendon stiffness of 29 middle-aged (40-67 years) and 26 younger (18-30 years) healthy physically active male adults were assessed during isometric voluntary ankle plantar flexion contractions using simultaneous dynamometry and ultrasonography. The elongation of the tendon during the loading phase was assessed by digitizing the myotendinous junction of the gastrocnemius medialis muscle. Eight younger (23 ± 3 years) and eight middle-aged (54 ± 7 years) adults from the larger subject pool were matched for TS muscle strength and tendon stiffness (plantar flexion moment young: 3.1 ± 0.4 Nm/kg; middle-aged: 3.2 ± 0.5 Nm/kg; tendon stiffness: 553 ± 97 vs. 572 ± 100 N/mm) and then performed series of drop jumps from different box heights (13, 23, 33, and 39 cm) onto a force plate (sampling frequency 1000 Hz). The matched young and middle-aged adults showed similar drop jump heights for all conditions (from lowest to highest box height: 18.0 ± 3.7 vs. 19.7 ± 4.8 cm; 22.6 ± 4.2 vs. 22.9 ± 4.9 cm; 24.8 ± 3.8 vs. 23.5 ± 4.9 cm; 25.2 ± 6.2 vs. 22.7 ± 5.0 cm). However, middle-aged adults showed longer ground contact times (on average 36%), lower vertical ground reaction forces (36%) and hence lower average mechanical power (from lowest to highest box height: 2266 ± 563 vs. 1498 ± 545 W; 3563 ± 774 vs. 2222 ± 320 W; 4360 ± 658 vs. 2475 ± 528 W; 5008 ± 919 vs. 3034 ± 435 W) independent of box height. Further, leg stiffness was lower (48%) in middle-aged compared to younger adults for all jumping conditions and we found significant correlations between average mechanical power and leg stiffness (0.70 ≤ r ≤ 0.83; p < 0.01). Thus, while jumping performance appears to be unaffected when leg extensor muscle strength and tendon stiffness are maintained, the reduced muscular power output during lower limb multi-joint tasks seen with aging may be due to age-related changes in motor task execution strategy rather than due to muscle weakness.

This study aimed to examine whether the triceps surae (TS) muscle-tendon unit (MTU) mechanical properties affect gait stability and its reactive adaptation potential to repeated perturbation exposure in older adults. Thirty-four older adults each experienced eight separate unexpected perturbations during treadmill walking, while a motion capture system was used to determine the margin of stability (MoS) and base of support (BoS). Ankle plantar flexor muscle strength and Achilles tendon (AT) stiffness were analyzed using ultrasonography and dynamometry. A median split and separation boundaries classified the subjects into two groups with GroupStrong ( n = 10) showing higher ankle plantar flexor muscle strength (2.26 ± 0.17 vs. 1.47 ± 0.20 N·m/kg, means ± SD; P < 0.001) and AT stiffness (544 ± 75 vs. 429 ± 86 N/mm; P = 0.004) than GroupWeak ( n = 12). The first perturbation caused a negative ΔMoS (MoS in relation to unperturbed baseline walking) at touchdown of perturbed step (Pert R ), indicating an unstable position. GroupStrong required four recovery steps to return to ΔMoS zero level, whereas GroupWeak was unable to return to baseline within the analyzed steps. However, after repeated perturbations, both groups increased ΔMoS at touchdown of Pert R with a similar magnitude. Significant correlations between ΔBoS and ΔMoS at touchdown of the first recovery step and TS MTU capacities (0.41 < r < 0.57; 0.006 < P < 0.048) were found. We conclude that older adults with TS muscle weakness have a diminished ability to control gait stability during unexpected perturbations, increasing their fall risk, but that degeneration in muscle strength and tendon stiffness may not inhibit the ability of the locomotor system to adapt the reactive motor response to repeated perturbations. NEW & NOTEWORTHY Triceps surae muscle weakness and a more compliant Achilles tendon partly limit older adults' ability to effectively enlarge the base of support and recover dynamic stability after an unexpected perturbation during walking, increasing their fall risk. However, the degeneration in muscle strength and tendon stiffness may not inhibit the ability of the locomotor system to adapt the reactive motor response to repeated perturbations.

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., (© 2017 The Authors Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

Tendons transfer forces produced by muscle to the skeletal system and can therefore have a large influence on movement effectiveness and safety. Tendons are mechanosensitive, meaning that they adapt their material, morphological and hence their mechanical properties in response to mechanical loading. Therefore, unloading due to immobilization or inactivity could lead to changes in tendon mechanical properties. Additionally, ageing may influence tendon biomechanical properties directly, as a result of biological changes in the tendon, and indirectly, due to reduced muscle strength and physical activity. This review aimed to examine age-related differences in human leg extensor (triceps surae and quadriceps femoris) muscle-tendon unit biomechanical properties. Additionally, this review aimed to assess if, and to what extent mechanical loading interventions could counteract these changes in older adults. There appear to be consistent reductions in human triceps surae and quadriceps femoris muscle strength, accompanied by similar reductions in tendon stiffness and elastic modulus with ageing, whereas the effect on tendon cross sectional area is unclear. Therefore, the observed age-related changes in tendon stiffness are predominantly due to changes in tendon material rather than size with age. However, human tendons appear to retain their mechanosensitivity with age, as intervention studies report alterations in tendon biomechanical properties in older adults of similar magnitudes to younger adults over 12-14 weeks of training. Interventions should implement tendon strains corresponding to high mechanical loads (i.e., 80-90% MVC) with repetitive loading for up to 3-4 months to successfully counteract age-related changes in leg extensor muscle-tendon unit biomechanical properties.

Posturography is used to assess balance in clinical settings, but its relationship to gait stability is unclear. We assessed if dynamic gait stability is associated with standing balance in 12 patients with unilateral vestibulopathy. Participants were unexpectedly tripped during treadmill walking and the change in the margin of stability (MoS change ) and base of support (BoS change ) relative to nonperturbed walking was calculated for the perturbed and first recovery steps. The center of pressure (COP) path during 30-s stance with eyes open and closed, and the distance between the most anterior point of the COP and the anterior BoS boundary during forward leaning (A Dist ), were assessed using a force plate. Pearson correlations were conducted between the static and dynamic variables. The perturbation caused a large decrease in the BoS, leading to a decrease in MoS. One of 12 correlations was significant (MoS change at the perturbed step and A Dist ; r = -.595, P = .041; nonsignificant correlations: .068 ≤ P ≤ .995). The results suggest that different control mechanisms may be involved in stance and gait stability, as a consistent relationship was not found. Therefore, posturography may be of limited use in predicting stability in dynamic situations.

The aging musculoskeletal system experiences a general decline in structure and function, characterized by a reduced adaptability to environmental stress. We investigated whether the older human Achilles tendon (AT) demonstrates mechanosensitivity (via biomechanical and morphological adaptations) in response to long-term mechanical loading. Thirty-four female adults (60-75 years) were allocated to either a medium-term (14 weeks; N =21) high AT strain cyclic loading exercise intervention or a control group ( N =13), with 12 participants continuing with the intervention for 1.5 years. AT biomechanical properties were assessed using ultrasonography and dynamometry. Tendon cross-sectional area (CSA) was investigated by means of magnetic resonance imaging. A 22% exercise-related increment in ankle plantarflexion joint moment, along with increased AT stiffness (598.2±141.2 versus 488.4±136.9 N mm -1 at baseline), Young's modulus (1.63±0.46 versus 1.37±0.39 GPa at baseline) and about 6% hypertrophy along the entire free AT were identified after 14 weeks of strength training, with no further improvement after 1.5 years of intervention. The aging AT appears to be capable of increasing its stiffness in response to 14 weeks of mechanical loading exercise by changing both its material and dimensional properties. Continuing exercise seems to maintain, but not cause further adaptive changes in tendons, suggesting that the adaptive time-response relationship of aging tendons subjected to mechanical loading is nonlinear., (© 2017. Published by The Company of Biologists Ltd.)

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.

Preserving upright stance requires central integration of the sensory systems and appropriate motor output from the neuromuscular system to keep the centre of pressure (COP) within the base of support. Unilateral peripheral vestibular disorder (UPVD) causes diminished stance stability. The aim of this study was to determine the limits of stability and to examine the contribution of multiple sensory systems to upright standing in UPVD patients and healthy subjects. We hypothesized that closure of the eyes and Achilles tendon vibration during upright stance will augment the postural sway in UPVD patients more than in healthy subjects. Seventeen UPVD patients and 17 healthy subjects performed six tasks on a force plate: forwards and backwards leaning, to determine limits of stability, and upright standing with and without Achilles tendon vibration, each with eyes open and closed (with blackout glasses). The COP displacement of the patients was significantly greater in the vibration tasks than the controls and came closer to the posterior base of support boundary than the controls in all tasks. Achilles tendon vibration led to a distinctly more backward sway in both subject groups. Five of the patients could not complete the eyes closed with vibration task. Due to the greater reduction in stance stability when the proprioceptive, compared with the visual, sensory system was disturbed, we suggest that proprioception may be more important for maintaining upright stance than vision. UPVD patients, in particular, showed more difficulty in controlling postural stability in the posterior direction with visual and proprioceptive sensory disturbance.

The aim of this work was to examine locomotor stability and adaptation across the adult female lifespan during perturbed walking on the treadmill. 11 young, 11 middle and 14 older-aged female adults (mean and SD: 25.5(2.1), 50.6(6.4) and 69.0(4.7) years old respectively) walked on a treadmill. We applied a sustained perturbation to the swing phase of the right leg for 18 consecutive gait cycles, followed by a step with the resistance unexpectedly removed, via an ankle strap connected to a break-and-release system. The margin of stability (MoS) at foot touchdown was calculated as the difference between the anterior boundary of the base of support (BoS) and extrapolated center of mass. Older participants showed lower MoS adaptation magnitude in the early adaptation phase (steps 1-3) compared to the young and middle-aged groups. However, in the late adaptation phase (steps 16-18) there were no significant differences in adaptation magnitude between the three age groups. After removing the resistance, all three age groups showed similar aftereffects (i.e. increased BoS). The current results suggest that in old age, the ability to recalibrate locomotion to control stability is preserved, but the rate of adaptive improvement in locomotor stability is diminished., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Unilateral peripheral vestibular disorder (UPVD) causes deficient locomotor responses to novel environments due to a lack of accurate vestibular sensory information, increasing fall risk. This study aimed to examine recovery response (stability recovery actions) and adaptive feedback potential in dynamic stability of UPVD-patients and healthy control subjects during perturbed walking. 17 UPVD-patients (>6 months since onset) and 17 matched healthy control participants walked on a treadmill and were subjected to eight unexpected perturbations during the swing phase of the right leg. For each perturbation, the margin of stability (MS; state of body's centre of mass in relation to the base of support), was determined at touchdown of the perturbed leg and during the following six recovery steps. The first perturbation caused a reduced MS at touchdown for the perturbed leg compared to baseline, indicating an unstable position, with controls requiring five recovery steps to return to MS baseline and UPVD-patients not returning to baseline level within the analyzed six recovery steps. By the eighth perturbation, control subjects needed two steps, and UPVD-patients required three recovery steps, both thereby improving their recovery response with practice. However, MS at touchdown of the perturbed leg increased only for the controls after repeated perturbations, indicating adaptive feedback-driven locomotor improvements for the controls, but not for the UPVD-patients. We concluded that UPVD-patients have a diminished ability to control dynamic gait stability during unexpected perturbations, increasing their fall risk, and that vestibular dysfunction may inhibit the neuromotor system adapting the reactive motor response to perturbations., (© 2014 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.)

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.