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Impact of initial muscle length on force deficit following lengthening contractions in mammalian skeletal muscle.

The purpose of this study was to determine whether initial muscle length influenced the extent of isometric force deficit following 20 in vitro lengthening contractions of the soleus muscle from Fischer 344 rats. Force deficit was evaluated following one of five protocols: (1) lengthening contractions from optimal muscle length (Lo) to 120% Lo; (2) lengthening contractions from 80% Lo to Lo; (3) lengthening contractions from Lo to 120% Lo but with a stimulation frequency that elicited the same force as protocol 2; (4) 20 isometric contractions at Lo; (5) 20 stretches +/- 20% Lo in inactive muscle. Following lengthening contractions, extent of force deficit significantly differed between protocols 1, 2, and 3 (P < 0.05). Maximal isometric force (Po) was decreased by approximately 32%, approximately 8%, and approximately 15% in protocols 1, 2, and 3, respectively. In contrast, neither isometric contractions nor passive stretching (protocols 4 and 5) resulted in any reduction in Po. Irrespective of muscle length, the extent of force deficit was highly correlated (R = -0.774, P < 0.001) with peak force during active lengthening. Thus, the magnitude of isometric force deficit following lengthening contractions is influenced by both initial muscle length and peak force development. These findings have important practical implications for both exercise conditioning and rehabilitation, which are discussed.

Animals↗

Maximal force during eccentric and isometric actions at different elbow angles.

The purpose of this study was to examine a course of force potentiation and/or inhibition during maximal voluntary eccentric action. Maximal voluntary force (MVC) of elbow flexion of ten healthy male volunteers was measured during isometric and isokinetic eccentric action starting from 80 degrees or 110 degrees and ending at 140 degrees elbow angle. Surface EMG was recorded from biceps brachii (BB) and brachioradialis (BR) muscles. Maximal voluntary eccentric force during the first 10 degrees of the movement was higher (P<0.001) than the maximal voluntary isometric preactivation force both in 80 degrees and in 110 degrees starting position at all three velocities (1, 2, and 4 rad s(-1)). The relative force potentiation was velocity dependent being smallest at the lowest stretching speed (P<0.01). Average EMG (aEMG) of BB and BR decreased as the joint angle increased both in eccentric and in isometric actions but the decrease in aEMG towards extension was somewhat higher in eccentric actions as compared to isometric. It was concluded that the force measured during the first 10 degrees of eccentric contraction always exceeded the maximal voluntary isometric preactivation force regardless of the joint angle or of the movement velocity. When maximal voluntary preactivation preceded the stretch, the relative force potentiation seemed to be greater at higher stretching velocities (velocity dependent) while at lower preactivation levels, the velocity dependence was not observed. Decreased muscle activation and lower maximal voluntary force towards the end of the movement suggested inhibition during maximal voluntary eccentric actions.

Adult↗

High-and low-frequency fatigue revisited.

Changes in excitation-contraction coupling have long been recognized as possible causes of the failure in function which occurs in fatigued muscle. High-frequency fatigue is characterized by an excessive loss of force at high frequencies of stimulation and rapid recovery when the frequency is reduced. Frequencies in excess of 50 Hz are rarely seen with voluntary activation of human muscle, and for this reason there has been some doubt as to whether high-frequency fatigue is a significant feature of normal activity. Recent experiments have shown that with 30 Hz stimulation there is a more rapid loss of force if the muscle is held isometric in a shortened position and the fatigue is rapidly reversed if the muscle is re-extended, even under ischaemic conditions. These findings are consistent with the accumulation of K+ in the t-tubules and interfibre spaces of the muscle. Low-frequency fatigue is characterized by a relative loss of force at low frequencies of stimulation and a slow recovery over the course of hours or even days. There is evidence from intracellular measurements that low-frequency fatigue is due to a reduction in Ca2+ release. However, there is a possibility that in the fatiguing exercise, the end sarcomeras of the fibre overextend and damage those in the middle section of the fibre. In this situation the active sarcomas would be working at a shorter length than predicted from the overall fibre length and the force-frequency curve will be shifted to the right. Measurements of the length-tension relationship of muscles damaged by stretching are consistent with this happening.

Animals↗

Stress incontinence of urine; a consideration of etiologic factors in women.

Urinary continence in women is intimately associated with adequate support of the neck of the bladder. Any increase in tone of the bladder musculature, or in the intravesicular pressure, substantially increases the liability to incontinence. Obstetrical trauma may cause stress incontinence by disrupting supports of the neck of the bladder and by stretching the fascial structures of the posterior portion of the neck of the bladder. Minor injury not grossly demonstrable may occur in this way and upset the very delicate balance existing between the forces of the detrusor muscle and the resistance of the urethrovesical junction.In correcting the defects associated with stress incontinence, there are specific indications for various methods-active exercise, plastic reconstruction of the bladder and urethral supports, and the various operations for suspension of the neck of the bladder.

Abdominal Cavity↗

Management of a patient with lacerations of the tendons of the extensor digitorum and extensor indicis muscles to the index finger.

The purpose of this report is to describe the management of a 30-year-old male truck driver following a zone-VI (metacarpal level) laceration of the tendons of the extensor digitorum and extensor indicis muscles to the index finger. Surgical repair was performed 6 days after the injury and was followed by a 32-day period of short-arm cast immobilization. Physical therapy was begun immediately following cast removal. At about 8 to 10 days into the rehabilitation process, we became concerned about an increasing extensor lag (active extension less than passive extension), which affected the treatment program. We hypothesized that the scar at the tendon repair site had become excessively lengthened, and we therefore discontinued all flexion stretching and emphasized active extension. Additionally, we rested the joint in extension using a static splint except during exercise. As the patient's extensor lag improved, we increased the vigor of active extension exercise to promote tendon gliding and elongate restricting adhesions. The patient regained full range of motion and was able to return to work at full duty. The immobilization period implemented postoperatively in this case represents a traditional, conservative approach. The case emphasizes the need for careful monitoring and interpretation of both active and passive range of motion following tendon repair.

Adult↗

Prior eccentric contractions impair maximal insulin action on muscle glucose uptake in the conscious rat.

Our aim was to examine the effect of prior eccentric contractions on insulin action locally in muscle in the intact conscious rat. Anesthetized rats performed one-leg eccentric contractions through the use of calf muscle electrical stimulation followed by stretch of the active muscles. Two days later, basal and euglycemic clamp studies were conducted with the rats in the awake fasted state. Muscle glucose metabolism was estimated from 2-[14C(U)]deoxy-D-glucose and D-[3-3H] glucose administration, and comparisons were made between the eccentrically stimulated and nonstimulated (control) calf muscles. At midphysiological insulin levels, effects of prior eccentric exercise on muscle glucose uptake were not statistically significant. Maximal insulin stimulation revealed reduced incremental glucose uptake above basal (P < 0.05 in the red gastrocnemius; P < 0.1 in the white gastrocnemius and soleus) and impaired net glycogen synthesis in all eccentrically stimulated muscles (P < 0.05). We conclude that prior eccentric contractions impair maximal insulin action (responsiveness) on local muscle glucose uptake and glycogen synthesis in the conscious rat.

Animals↗

Function and biomechanics of tendons.

Tendon is a highly organized connective tissue joining muscle to bone, capable of resisting high tensile forces while transmitting forces from muscle to bone. The dense, regularly arranged collagenous tissue is made up of fibers, cells of various shapes and ground substance. The mechanical and physiological characteristics of collagen (nearly 85% of the dry weight of tendon) dictate the qualities of tendon. In addition, tendon is flexible so that it can bend at joints, as well as acting as a damping tissue to absorb shock and limit potential damage to muscle (1). Tendon also shows a degree of extensibility. If the strain used to stretch a tendon could be recovered, a beneficial elastic effect would be achieved. Muscles lengthen and shorten in a cyclical manner. During the lengthening period, elastic energy can be stored and used as elastic recoil. For example, the Achilles tendon is stretched late in the stance phase as the triceps surae muscles contract and the ankle dorsiflexes. Prior to plantarflexion, muscle activation ceases and stored energy helps to initiate planter flexion.

Adrenal Cortex Hormones↗

The isolated and combined effects of selected physical activity and ibuprofen on delayed-onset muscle soreness.

Delayed-onset muscle soreness refers to the skeletal muscle pain that is experienced following eccentric exercise. The aim of the present study was to examine the physiological effects of physical activity with or without ibuprofen on delayed onset muscle soreness. Forty-four non-athletic male volunteers (age 24.3 +/- 2.4 years) were randomly assigned to one of four groups: physical activity (n = 11), ibuprofen (n = 11), physical activity and ibuprofen (combination, n = 11), or control (n = 11). The physical activity programme comprised 5 min of walking and jogging, 10 min of static stretching of the hands and shoulder girdle, and 5 min of concentric movements with sub-maximal contractions. The total amount of ibuprofen consumed by a single individual was 2800 mg; this was taken from 1 h before the eccentric actions up to 48 h after it. Delayed onset muscle soreness was induced by performing 70 eccentric contractions of the biceps muscle of the non-dominant side on a modified arm curl machine. Perceived muscle soreness, maximal eccentric contraction, creatine kinase enzyme activity and elbow range of motion were assessed 1 h before and 1, 24 and 48 h after the eccentric actions. The results indicated that, after the eccentric actions, soreness increased (P < 0.001) across time in all groups, with the highest values being recorded at 24 h. At 24 and 48 h, greater soreness (P < 0.001) was observed in the control group than in the physical activity and combination groups. After the eccentric actions, creatine kinase increased and was elevated (P < 0.001) compared with baseline in all groups, with values returning to baseline in the physical activity and combination groups by 48 h. However, creatine kinase in the control and ibuprofen groups was still significantly higher than at baseline after 48 h. Creatine kinase was higher (P < 0.001) in the control group than in physical activity and combination groups at 24 and 48 h. There was also a reduction (P < 0.001) in elbow range of motion across time. This reduction in elbow range of motion was greater (P < 0.001) in the control and ibuprofen groups than in the physical activity and combination groups at 1, 24 and 48 h. The reduction in maximum eccentric contraction was greater (P < 0.001) in the control and ibuprofen groups than in the physical activity group at 24 and 48 h and the combination group at 48 h. In conclusion, the results add to our understanding of the effects of physical activity and the combination of physical activity and ibuprofen in reducing the severity of muscle soreness induced by eccentric exercise. Physical activity conducted before eccentric exercise alleviates muscle soreness. Our results indicate that physical activity with or without ibuprofen helps to prevent delayed-onset muscle soreness.

Adult↗

The effect of exercise, thyroid status and insulin-induced hypoglycaemia on the Achilles tendon reflex time in man.

The effect of moderate exercise on the Achilles tendon reflex half-relaxation time (ART) was observed in 28 hypothyroid, 35 euthyroid, and 20 hyperthyroid subjects of comparable age and sex. Both the resting ART and the decrease after exercise (delta ART) were longer in hypothyroid patients and shorter in hyperthyroid patients as compared to the euthyroid group. delta ART was strongly related to the resting ART rather than to the free thyroxine index. In four hypothyroid subjects, the half-time of recovery of the ART after exercise was similar, approx. 24 min. Insulin-hypoglycaemia in eight resting endocrine patients also caused a fall in ART similar to the post-exercise delta ART in the same patients. A possible catecholamine effect is indicated by the smaller post-exercise delta ART in nine hypertensive patients receiving chronic propranolol treatment, 320 mg daily, than that of a control group matched for age, sex, and resting ART. These studies suggest that submaximal exercise largely removes the differential effect of thyroid status on skeletal muscle contractility as measured indirectly by the ART. The effects of exercise and induced insulin-hypoglycaemia on delta ART may be mediated in part by endogenous catecholamines.

Achilles Tendon↗

Acute effects of stretching on the neuromechanical properties of the triceps surae muscle complex.

Previous research has shown that an acute bout of passive muscle stretching can diminish performance in certain movements where success is a function of maximal force and/or power output. Two possible mechanisms that might account for such findings are a change in active musculotendinous stiffness and a depression of muscle activation. To investigate the likelihood of these two mechanisms contributing to a post-stretch reduction in performance, we examined the acute effects of stretching on the active stiffness and muscle activation of the triceps surae muscle group during maximal single-joint jumps with movement restricted to the ankle joint. Ten males performed both static (SJ) and countermovement (CMJ) jumps before and after passively stretching the triceps surae. Electrical activity of the triceps surae during each jump was determined by integrating electromyographic recordings (IEMG) over the course of the movement. Triceps surae musculotendinous stiffness was calculated before and after stretching using a technique developed by Cavagna (1970). Following stretching, a significant decrease [mean (SD) 7.4 (1.9)%; P<0.05] in jump height for the CMJ occurred, but for the SJ, no significant ( P>0.05) change in jump height was found. A small but significant decrease [2.8 (1.24)%; P<0.05] in stiffness was noted, but the magnitude of this change was probably not sufficient for it to have been a major factor underlying the decline in CMJ performance. Paradoxically, after stretching, the SJ exhibited a significant ( P<0.05) decrease in IEMG, but the IEMG for the CMJ remained unchanged ( P>0.05). It appears that an acute bout of stretching can impact negatively upon the performance of a single-joint CMJ, but it is unlikely that the mechanism responsible is a depression of muscle activation or a change in musculotendinous stiffness.

Achilles Tendon↗

Thin-fiber mechanoreceptors reflexly increase renal sympathetic nerve activity during static contraction.

The renal vasoconstriction induced by the sympathetic outflow during exercise serves to direct blood flow from the kidney toward the exercising muscles. The renal circulation seems to be particularly important in this regard, because it receives a substantial part of the cardiac output, which in resting humans has been estimated to be 20%. The role of group III mechanoreceptors in causing the reflex renal sympathetic response to static contraction remains an open question. To shed some light on this question, we recorded the renal sympathetic nerve responses to static contraction before and after injection of gadolinium into the arterial supply of the statically contracting triceps surae muscles of decerebrate unanesthetized and chloralose-anesthetized cats. Gadolinium has been shown to be a selective blocker of mechanogated channels in thin-fiber muscle afferents, which comprise the afferent arm of the exercise pressor reflex arc. In decerebrate (n = 15) and chloralose-anesthetized (n = 12) cats, we found that gadolinium (10 mM; 1 ml) significantly attenuated the renal sympathetic nerve and pressor responses to static contraction (60 s) after a latent period of 60 min; both responses recovered after a latent period of 120 min. We conclude that thin-fiber mechanoreceptors supplying contracting muscle are involved in some of the renal vasoconstriction evoked by the exercise pressor reflex.

Anesthetics, Intravenous↗

Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults.

BACKGROUND: Although inactivity is an important contributor to impaired functioning and disability with age, little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken. METHODS: One hundred three adults age 65 years and older, recruited via population-based methods, were randomized to 12 months of community-based, moderate-intensity endurance and strengthening exercises (Fit & Firm) or stretching and flexibility exercises (Stretch & Flex). A combination of class- and home-based exercise formats was used. Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention. RESULTS: Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects. Stretch & Flex subjects reported greater improvements in bodily pain, and Stretch & Flex men evidenced greater improvements in flexibility relative to Fit & Firm subjects. Although overall exercise adherence was high in both exercise conditions (approximately 80%), subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions. CONCLUSIONS: Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes. This represents one of the first studies to report significant improvements in an important quality of life outcome-bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults.

Activities of Daily Living↗

[Vacuum therapy].

In the therapy of vasculogenic impotence, the Vacuum Device has been proposed up to now as an "external" prosthesis device with the aim of obtaining a penile erection of sufficient rigidity for penetration, in patients afflicted by vascular or neurological disorders. In the eighties, the experience gained with the use of Intra Cavernous Injections (C.I.D.) (using papaverine, phentolamine and prostaglandin), demonstrated not to be an exclusively palliative therapy ("pharmacological prosthesis"), but to represent as well a sort of "vasoactive exercise" of the erectile tissue. In the nineties, many wondered what could be a valid alternative to the C.I.D. Taking this into consideration, we modified the method of application of Vacuum Therapy. The device was used once a day without the constrictive band applied to the penis root, in order to generate a passive action on the erectile tissue, a sort of "stretching" for the smooth muscle fibers. From January 1990 to December 1991, we treated 78 pts. afflicted by erectile failure. The patients were divided into 3 groups (26 each) of distinct therapy: the first was treated weekly with only endocavernous papaverine administration (20 mg.), the second underwent daily Vacuum Therapy exclusively (10'-15') and the third received a combined therapy: Vacuum Device, daily and C.I.D. with Papaverine (20 mg.) once a week. The results of this treatment are as follows: the patients who underwent Vacuum Therapy daily (2nd and 3rd groups) showed, at the end of the treatment (6 months), a significant improvement in spontaneous erectile ability (14 Pts.-53.8% in the 2nd group; 17 Pts-65.3% in the 3rd group).(ABSTRACT TRUNCATED AT 250 WORDS)

Erectile Dysfunction↗

[Fibromyalgic syndrome: new perspectives in rehabilitation and management. A review].

Fibromyalgia is a chronic syndrome, characterized by widespread body pain and pain at specific tender points, whose etiology and pathogenesis is still unknown. Patient can also exhibit a range of other symptoms including irritable bowel syndrome, chest pain, anxiety, fatigue, sleep disturbance, headache. The prevalence of fibromyalgia ranges from 1-3% in the general population, and the condition is more common among female than males. Contrary to the situation a few years ago, the most widely accepted hypothesis now evoke central nervous system mechanisms, whose local functions could influence also periferical microvascular activity at tender points. There are many findings supporting the hypothesis of different endogenic and exogenic factors that lead to chronic local hypoxia in muscle tissue. Currently, therapy is polipragmatic and is aimed at reducing the pain. A range of medical treatment had been used to treat fibromyalgia. Pharmacological therapy aims to enhance the pain threshold and to support sleep. Nonpharmaceutical treatment modalities, such as exercise, massage, idrotherapy can be helpful. Future studies should investigate the possible benefits of new strategies that may combine the effects of hot pool water, stretching exercises, massage and relaxation benefits of balneotherapy.

Fibromyalgia↗

The "bench-presser's shoulder": an overuse insertional tendinopathy of the pectoralis minor muscle.

BACKGROUND: Tendinopathies of the rotator cuff muscles, biceps tendon and pectoralis major muscle are common causes of shoulder pain in athletes. Overuse insertional tendinopathy of pectoralis minor is a previously undescribed cause of shoulder pain in weightlifters/sportsmen. OBJECTIVES: To describe the clinical features, diagnostic tests and results of an overuse insertional tendinopathy of the pectoralis minor muscle. To also present a new technique of ultrasonographic evaluation and injection of the pectoralis minor muscle/tendon based on use of standard anatomical landmarks (subscapularis, coracoid process and axillary artery) as stepwise reference points for ultrasonographic orientation. METHODS: Between 2005 and 2006, seven sportsmen presenting with this condition were diagnosed and treated at the Cape Shoulder Institute, Cape Town, South Africa. RESULTS: In five patients, the initiating and aggravating factor was performance of the bench-press exercise (hence the term "bench-presser's shoulder"). Medial juxta-coracoid tenderness, a painful active-contraction test and bench-press manoeuvre, and decrease in pain after ultrasound-guided injection of a local anaesthetic agent into the enthesis, in the absence of any other clinically/radiologically apparent pathology, were diagnostic of pectoralis minor insertional tendinopathy. All seven patients were successfully treated with a single ultrasound-guided injection of a corticosteroid into the enthesis of pectoralis minor followed by a period of rest and stretching exercises. CONCLUSIONS: This study describes the clinical features and management of pectoralis minor insertional tendinopathy, secondary to the bench-press type of weightlifting. A new pain site-based classification of shoulder pathology in weightlifters is suggested.

Adolescent↗

Evaluation of treatment protocols on minimal to moderate spasticity in multiple sclerosis.

Thirty men and women diagnosed with definite multiple sclerosis (MS) were treated for ten weeks in a blinded, cross-over study. Patients with minimal to moderate spasticity were randomized to one of three sequences to evaluate the effects on MS-related spasticity of baclofen alone, stretching regimen with placebo, placebo alone, and stretching regimen with baclofen. The Cybex II isokinetic unit, timed gait, Ashworth scale, and subject's assessment of function were objective and subjective measures used to evaluate changes in hypertonicity. There was significant correlation between the Cybex and Ashworth as methods of measuring spasticity. Overall, treatment with baclofen alone significantly improved moderate quadriceps spasticity as measured by Cybex flexion scores. A trend, indicative of enhancing the beneficial effects of baclofen, was noted when stretching exercises were added to the treatment.

Adult↗

Chiropractic correction of atlantoaxial rotatory fixation.

OBJECTIVE: To discuss the diagnosis, management and possible mechanism of atlantoaxial rotatory fixation. CLINICAL FEATURES: An 11-yr-old girl with significant head tilt of 7 months' duration sought chiropractic evaluation. Her history included indirect head and neck trauma from a motor vehicle accident and prior manipulative and therapeutic treatment. There was minimal muscular hypertonicity, except for the sternocleidomastoid muscle on the side opposite head tilt. The head seemed to be locked in a classic "cock robin" position. Radiological examination revealed asymmetry of the atlanto-odontoid interval, suggesting occipital-atlantoaxial joint dysfunction. A diagnosis of atlantoaxial rotatory fixation was made. INTERVENTION AND OUTCOME: Treatment included vectored/linear, upper cervical, high-velocity, low-amplitude chiropractic manipulation of the atlas vertebra, mobilizing manipulation and stretching exercises. Complete resolution occurred. CONCLUSION: This single case study suggests that chiropractic manipulation may be a viable treatment option for atlantoaxial rotatory fixation. Further investigation into manipulation as a treatment should be pursued.

Atlanto-Axial Joint↗

A dynamometer for evaluation of dynamic muscle work.

The validation of a new dynamometer for evaluation of dynamic muscle work is presented. The device was based on a precise measurement of load displacements of any machine using gravitational loads as external resistance. It allowed, through a sensor consisting of an infrared photo interrupter, the calculation of velocity, force and power during concentric, eccentric and stretch-shortening cycle activity. To validate the dynamometer 33 male and female track and field athletes (12 throwers and 21 jumpers) participated in the study. The throwers (4 women and 8 men) were asked to perform half-squat exercises on a slide machine with a load of 100% of the subject's body mass. The day-to-day reproducibility of half-squat exercises gave a correlation coefficient of r = 0.88, 0.97 and 0.95 for average push-off force (AF), average push-off velocity (AV), and average push-off power (AP) respectively. Comparison of half-squat measurements was performed against jumping and running test evaluation by the jumpers (7 women and 14 men). The interrelationships among the different variables studied demonstrated a strong correlation between AF, AV and AP and sprinting and jumping parameters (r = 0.53-0.97; P < 0.05-0.001). Using values of AF, AV and AP developed in half-squat exercises executed with different loads, ranging from 35% to 210% of the subject's body mass, it was also possible to establish the force-velocity and power-velocity relationships for both male and female jumpers. In any individual case, the maximal error due to the measurement system was calculated to be less than 0.3%, 0.9% and 1.2% for AF, AV, and AP respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗