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Stretching exercises: effect on passive extensibility and stiffness in short hamstrings of healthy subjects.

Passive muscle stretch tests are common practice in physical therapy and rehabilitation medicine. However, the effects of stretching exercises are not well known. With an instrumental straight-leg-raising set-up the extensibility, stiffness, and electromyographic activity of the hamstring muscles have been experimentally determined and the effects of stretching exercises have been evaluated. Fourteen volunteers, aged 20 to 38 years (mean 27.3) were selected from a young healthy population with the toe-touch test (finger-ground distance greater than 0cm), and a straight-leg-raising angle about 80 degrees. According to usual standards the diagnosis was short hamstrings. One group of seven subjects was treated during 4 weeks with a daily home exercise program aimed at stretching the hamstrings, whereas the untreated group was used as a control. Instrumental straight-leg-raising was performed in the subjects of both groups. The significance of the differences between the mean values was determined with the Student's t-test. Comparison of the data obtained before and after the muscle stretching program showed a slight but significant increase in the extensibility of the hamstrings accompanied with a significant increase of the stretching moment tolerated by the passive hamstring muscles. However, the elasticity remained the same. It is concluded that stretching exercises do not make short hamstrings any longer or less stiff, but only influence the stretch tolerance.

Adult↗

Biaxial constitutive relations for the passive canine diaphragm.

Samples of the muscular sheet excised from the midcostal region of dog diaphragms were subjected to biaxial loading. That is, stresses in the direction of the muscle fibers and in the direction perpendicular to the fibers in the plane of the sheet were measured at different combinations of strains in the two directions. Stress-strain relations were obtained by fitting equations to these data. In the direction of the muscle fibers, for strains up to 0.7, stress is a modestly nonlinear function of strain and ranges up to approximately 60 g/cm. In the direction perpendicular to the fibers, the sheet is stiffer and more strongly nonlinear. At a strain in the perpendicular direction of approximately 0.35, stress increases abruptly. The stress-strain relation in the muscle direction is consistent with observations of passive muscle shortening in vivo. However, the stiffness in the perpendicular direction is not high enough to explain the observation that strains in the perpendicular direction in vivo are nearly zero. We conclude that, in the passive diaphragm in vivo, stress in the direction perpendicular to the muscle fibers is small.

Animals↗

Effects of tetanic contraction of motor units of similar type on the initial stiffness to ramp stretch of the cat peroneus longus muscle.

1. The stiffness during the initial portion of a ramp stretch was measured in cat peroneus longus muscle at rest and during maximal tetanic contractions produced by increasing numbers of motor units of the same type [slow (S), fast fatigue resistant (FR), or fast fatigable (FF)]. 2. This initial ramp stiffness was defined as the ratio between tension and length change over the limited range of constant velocity extension during which tension rose linearly with length change. This stiffness was reduced by tetanic contraction of a number of motor units while other units remained inactive. The reduction had different characteristics in contractions produced by S, FR, or FF units. 3. Two brief ramp (triangular) stretches were applied at short intervals to evaluate the contribution of stable cross bridges to the changes in ramp stiffness. When the amplitude of the first stretch exceeded the presumed elastic limits of the stable cross bridges, the second ramp stretch showed a reduction of 20-60% in initial stiffness. This was seen both in passive muscles and in muscles in which several motor units were contracting. 4. When increasing numbers of motor units of the same type were activated, the initial ramp stiffness to the second of a pair of triangular stretches delivered during contraction increased almost linearly with the developed tension. The slope of this increase was 2.5 times steeper for S units than for FR units. This reflects the fact that contraction produced by S units causes a proportionally greater resistance to stretch than that of fast units.

Animals↗

Mechanical behaviour of hamstring muscles in low-back pain patients and control subjects.

The purpose of this study was to measure and compare the passive elastic moment, the stiffness and the damping coefficient of the hip joint, as functions of the hip and knee joint angles in men with and without low-back pain. Two conventional tests, the straight-leg-raising test and the trunk forward flexion, were also performed and compared between these subjects. The passive elastic moment was measured using an isokinetic device in the passive mode. This device raised the lower limb from the horizontal position to the straight-leg-raising angle at a slow and constant angular velocity. A custom-made splint connected with the lever arm of the isokinetic device maintained the knee in extension and the ankle in the neutral position. The damping coefficient of the hip joint was measured for 0, 15, 45, 60, 75 and 90% of straight leg raising angle of each subject, using the suspension method based on small oscillation theory. To ensure that muscles were inactive during the passive hip moment tests, muscle activity was monitored with surface EMG. The stiffness was computed as the ratio of the change in passive elastic moment to the change in the hip angle. The passive elastic moment, the stiffness and the normalized trunk flexion were significantly different between the two groups respectively. There was, however, no difference between the two groups in the results of straight-leg-raise and damping coefficient of the hip. The passive elastic moment was a nonlinear function of the hip flexion angle and showed large intersubject differences, especially as the joint limit was approached. The damping coefficient was a polynomial function of the hip flexion angle. The measured variables were analysed using a discriminant function and it was shown that the two groups were clearly discriminable in a meaningful manner.

Journal Article↗

The effects of neuromuscular stimulation on muscle tone at the knee in paraplegia.

Resting muscle tone of the leg was measured in terms of thigh muscle stiffness and knee resonant frequency in muscles of spinal cord injured subjects who had been involved in an electrical neuromuscular stimulation training programme of the thigh muscles over at least 2 months. The thigh circumference of these patients was 6.6% larger than before training commenced (P less than 0.001) and showed increased muscle stiffness and resonant frequency compared to a similar group of paralysed subjects who had not used any neuromuscular stimulation. Resonant frequency and stiffness after the long-term training were similar to those of non-injured controls and therefore the stimulation programme seemed to reverse the effects of paralysis on muscle tone. Short periods of rest (30 min) caused increased muscle stiffness in non-injured controls and paralysed muscles trained by neuromuscular stimulation. Additional 15 min periods of neuromuscular stimulation further increased muscle stiffness in the trained muscles but also in the muscles of paralysed subjects who had no long-term neuromuscular training. In contrast, 15 min sessions of passive movement of the knee decreased muscle stiffness in long-term trained paralysed muscles and untrained paralysed muscles. Knee resonant frequency was also significantly decreased in the trained paralysed muscles. Results show that muscle tone varies depending on the amount of previous movement or rest and that although neuromuscular stimulation of paralysed muscles increases muscle stiffness and knee resonant frequency, it is in fact restoring such properties of the muscle to a state approaching that of non-injured controls.

Adult↗

The relationship between elbow flexor volume and angular stiffness at the elbow.

OBJECTIVE: The purpose of this experiment was to determine if a correlation exists between the volume of the elbow flexors and angular stiffness at the elbow, and to determine the contribution of the biceps brachii and the brachialis muscles to angular stiffness. DESIGN: This study is a descriptive, correlational study and presents a graphical model of the passive properties of muscle. BACKGROUND: The correlation between arm volume and angular stiffness has been shown, but the measurement of arm volume was not specific to the structures being strained. Pre-positioning a bi-articular muscle by stretching over one joint decreases the range of motion at the other joint and may affect the stiffness. METHODS: Angular stiffness at the elbow of 14 female and 15 male volunteers was measured, and the volume of the elbow flexors was calculated from compounded ultrasound imaging. Initial biceps length was set by pre-positioning the shoulder in two different positions. RESULTS: A significant linear relationship was observed between the slope of phase 1 of the stiffness curve and volume of the elbow flexors in both horizontal flexion (r = 0.92) and horizontal extension (r = 0.79) of the shoulder. Phase 2 of the stiffness curve showed no linear relationship to muscle volume in either shoulder position (flexion, r = 0.22; extension r = 0.33). The slopes of phases 1 and 2 were significantly greater with the shoulder in horizontal extension than in horizontal flexion. CONCLUSION: The volume of the elbow flexor muscles is a good predictor of angular stiffness in phase 1 of the curve. A model of the additive contribution of the biceps and brachialis muscles is presented to account for the increased stiffness in the shoulder extended position. RELEVANCE: Recognition of the correlation between muscle volume and stiffness, coupled with understanding that pre-positioning a bi-articular muscle may affect muscle stiffness may aid the clinician in accurately assessing muscle stiffness in patients with connective tissue disorders, neurological dysfunction and contractures.

Journal Article↗

Non-reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity.

In this study, we have measured the passive, the intrinsic, and the reflex-mediated mechanical response to stretch of the ankle extensors and flexors in 13 spastic multiple sclerosis patients and 10 healthy control subjects. In the ankle flexors, the patients had no reflex-mediated stiffness. The passive stiffness was increased by 138% (95% confidence interval: 26-91%) and the intrinsic stiffness by 79% (41-158%) when compared with the healthy subjects. In the ankle extensors, the reflex-mediated stiffness and the intrinsic stiffness of the patients were equal to the reflex-mediated and the intrinsic stiffness in healthy subjects. The passive stiffness was increased by 152% (41-352%). We conclude that spastic muscles in multiple sclerosis patients have an increased non-reflex stiffness (passive plus intrinsic stiffness), and that the reflex-mediated stiffness in the extensors during a sustained voluntary contraction does not differ significantly from healthy subjects.

Adult↗

Interplay between passive tension and strong and weak binding cross-bridges in insect indirect flight muscle. A functional dissection by gelsolin-mediated thin filament removal.

The interplay between passive and active mechanical properties of indirect flight muscle of the waterbug (Lethocerus) was investigated. A functional dissection of the relative contribution of cross-bridges, actin filaments, and C filaments to tension and stiffness of passive, activated, and rigor fibers was carried out by comparing mechanical properties at different ionic strengths of sarcomeres with and without thin filaments. Selective thin filament removal was accomplished by treatment with the actin-severving protein gelsolin. Thin filament, removal had no effect on passive tension, indicating that the C filament and the actin filament are mechanically independent and that passive tension is developed by the C filament in response to sarcomere stretch. Passive tension increased steeply with sarcomere length until an elastic limit was reached at only 6-7% sarcomere extension, which corresponds to an extension of 350% of the C filament. The passive tension-length relation of insect flight muscle was analyzed using a segmental extension model of passive tension development (Wang, K, R. McCarter, J. Wright, B. Jennate, and R Ramirez-Mitchell. 1991. Proc. Natl. Acad. Sci. USA. 88:7101-7109). Thin filament removal greatly depressed high frequency passive stiffness (2.2 kHz) and eliminated the ionic strength sensitivity of passive stiffness. It is likely that the passive stiffness component that is removed by gelsolin is derived from weak-binding cross-bridges, while the component that remains is derived from the C filament. Our results indicate that a significant number of weak-binding cross-bridges exist in passive insect muscle at room temperature and at an ionic strength of 195 mM. Analysis of rigor muscle indicated that while rigor tension is entirely actin based, rigor stiffness contains a component that resists gelsolin treatment and is therefore likely to be C filament based. Active tension and active stiffness of unextracted fibers were directly proportional to passive tension before activation. Similarly, passive stiffness due to weak bridges also increased linearly with passive tension, up to a limit. These correlations lead us to propose a stress-activation model for insect flight muscle in which passive tension is a prerequisite for the formation of both weak-binding and strong-binding cross-bridges.

Actins↗

Passive, intrinsic and reflex-mediated stiffness in the ankle extensors of hemiparetic patients.

The total mechanical response to a stretch in a contracting muscle is the sum of the response from the properties of the fibres contracting prior to the stretch (intrinsic properties), the response from the passive tissues and the response from the stretch reflex-mediated contraction of the muscle fibres. The passive, the intrinsic and the reflex-mediated mechanical response to a 4 degrees stretch of the ankle extensors in both legs of nine spastic hemiparetic patients and, as control, the left ankle extensors in eight healthy subjects were measured. The stretch was imposed at the top of a maintained contraction, which was varied from zero to maximal contraction. The torque increments, measured 200 ms after stretch, were converted into stiffness by dividing by the amplitude of the stretch. We found that the reflex stiffness of the spastic and contralateral leg was within the normal range of the reflex stiffness in healthy subjects, and that the passive stiffness of the spastic and the contralateral leg is larger than the passive stiffness in healthy subjects, whereas the intrinsic stiffness is unchanged in the spastic extensor muscles.

Adult↗

Sex comparison of extensibility, passive, and active stiffness of the knee flexors.

OBJECTIVE: To compare extensibility, and passive and active stiffness of the knee flexors between males and females. DESIGN: An experimental design utilized 15 males and 15 females to identify sex differences in active extensibility, and active and passive stiffness of the knee flexors. BACKGROUND: Muscle stiffness appears to contribute to joint stability from both mechanical and neuromuscular perspectives. Differences in knee flexor stiffness may partially explain higher female anterior cruciate ligament injury rates. METHODS: Active knee flexor extensibility was assessed as subjects extend the knee from a fixed hip position, measuring the final knee position. Passive knee flexor stiffness was calculated as the slope of the moment-angle curve resulting from controlled passive knee extension. Active knee flexor stiffness was assessed by loading the lower extremity with 10% total body mass, and measuring the damping effect of the knee flexors on imposed vibratory motion about the knee joint. RESULTS: Females displayed greater active extensibility (P<0.05), while males displayed greater active (P<0.05) and passive (P<0.05) knee flexor stiffness. Sex differences in active and passive knee flexor stiffness were not significant following normalization to anthropometric characteristics. CONCLUSIONS: The knee flexor musculature in males is less extensible and displays greater active and passive stiffness compared to females. However, these differences may be functions of greater mass and height in males.

Adult↗

Passive stiffness characteristics of ankle plantar flexors in hemiplegia.

OBJECTIVE: To assess the feasibility and reliability of ankle plantar flexor stiffness measurements in hemiplegia. DESIGN: Repeated measurements in five consecutive weeks. BACKGROUND: In hemiplegia, an equinovarus positioning of the foot might be caused by an increased stiffness of the m. triceps surae. METHODS: In eight hemiplegic patients the net joint torque of passive muscle stretch was measured as a function of ankle-angle by a dynamometer, at both sides. Ankle-stiffness was characterised and also a biomechanical model of the passive muscle was fitted. RESULTS: In the vast majority of measurements it was possible to obtain measurements that were not distorted by involuntary muscle contraction. These measurements showed for the angle at which a passive plantar moment of 10 N m was reached a standard error of measurement of less than 2.7 degrees. The muscle model showed the increased stiffness as a shortening of the muscle-fibre-length. CONCLUSION: The feasibility of this method to measure muscle stiffness was fair to good in hemiplegic patients. Provided the abandoning of involuntary muscle activity, the reproducibility warrants application in clinical practice at an individual level. The use of the model relates this changes to a shortened m. soleus and/or m. gastrocnemius. RelevanceEffective clinical decisions for treatment of equinovarus positioning of the foot in the hemiplegic individual, should consider excessive involuntary contractions of the m. triceps surae complex (i.e., spasticity), as well as shortened muscle tissue resulting in high stiffness. Despite the importance of increased stiffness there have been no validated methods of measurement.

Adult↗

The effects of geometry, elasticity, and external pressures on the diastolic pressure-volume and stiffness-stress relations. How important is the pericardium?

The concept of an incremental elastic modulus is applied in the quantification of passive elastic stiffness-stress relations of intact heart muscle, and a transmural pressure-volume relation for the left ventricle is subsequently derived in terms of geometry, muscle elasticity, and external pressures to assess their importance. Physiological and clinical applications of this method indicate that: (1) stiffness-stress relations obtained on the basis of pressure-volume data from dog hearts are not significantly different from those obtained from muscle strips excised from these same hearts; (2) shape and the presence of right ventricular, pericardial, or pleural pressures are of secondary importance in an assessment of passive elastic stiffness; and (3) dramatic shifts in the left ventricular intracavity pressure-volume relations following drug interventions are primarily due to the presence of substantial pericardial pressures; however, the transmural pressure-volume relations are not markedly altered, implying no alteration in the intrinsic ventricular compliance.

Animals↗

Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain.

One important mechanical function of the lumbar spine is to support the upper body by transmitting compressive and shearing forces to the lower body during the performance of everyday activities. To enable the successful transmission of these forces, mechanical stability of the spinal system must be assured. The purpose of this study was to develop a method and to quantify the mechanical stability of the lumbar spine in vivo during various three-dimensional dynamic tasks. A lumbar spine model, one that is sensitive to the various ways that individuals utilize their muscles and ligaments, was used to estimate the lumbar spine stability index three times per second throughout the duration of each trial. Anatomically, this model included a rigid pelvis, ribcage, five vertebrae, 90 muscle fascicles and lumped parameter discs, ligaments and facets. The method consisted of three sub-models: a cross-bridge bond distribution-moment muscle model for estimating muscle force and stiffness from the electromyogram, a rigid link segment body model for estimating external forces and moments acting on the lumbar vertebrae, and an 18 degrees of freedom lumbar spine model for estimating moments produced by 90 muscle fascicles and lumped passive tissues. Individual muscle forces and their associated stiffness estimated from the EMG-assisted optimization algorithm, along with external forces were used for calculating the relative stability index of the lumbar spine for three subjects. It appears that there is an ample stability safety margin during tasks that demand a high muscular effort. However, lighter tasks present a potential hazard of spine buckling, especially if some reduction in passive joint stiffness is present. Several hypotheses on the mechanism of injury associated with low loads and aetiology of chronic back pain are presented in the context of lumbar spine stability.

Journal Article↗

Passive stiffness of pressure-induced hypertrophied cat myocardium.

The effect of myocardial hypertrophy on passive stiffness was determined from the stress (sigma)-strain relationship of right ventricular papillary muscles from 18 pulmonary artery-banded and 21 non-banded cats. By use of Lagrangian strain, (1-lo)lo is initial muscle length, and instantaneous stress elastic constants beta and alpha were calculated from the equation sigma = alpha(ebeta epsilon - 1). Elastic stiffness (d sigma/d epsilon) was determined from the formula d sigma/d epsilon = beta alpha + alpha beta. Banding produced an average increase in RV mass of 70%. Beta averaged 14.2 +/- 0.9 (SEM) and 16.0 +/- 0.8 in the non-hypertrophied and hypertrophied muscles, respectively (NS). However, elastic stiffness was significantly greater in hypertrophied muscles over the entire stress range. Contractile function varied widely among hypertrophied muscles but was not related to changes in stiffness. Thus, moderate degrees of pressure-induced hypertrophy are associated with a modest increase in the passive stiffness properties of the muscle, independent of changes in contractile function.

Animals↗

Quantifying skeletal muscle properties in cadaveric test specimens: effects of mechanical loading, postmortem time, and freezer storage.

Investigators currently lack the data necessary to define the state of skeletal muscle properties within cadaveric specimens. The purpose of this study is to define the temporal changes in the postmortem properties of skeletal muscle as a function of mechanical loading and freezer storage. The tibialis anterior of the New Zealand white rabbit was chosen for study. Modulus and no-load strain were found to vary significantly from live after eight hours postmortem. Following the changes that occur during rigor mortis, a stable region of postmortem, post-rigor properties occurred between 36 to 72 hours postmortem. A freeze-thaw process was not found to have a significant effect on the post-rigor response. The first loading cycle response of post-rigor muscle was unrepeatable but stiffer than live passive muscle. After preconditioning, the post-rigor muscle response was repeatable. The preconditioned post-rigor response was less stiff than the live passive response due to a significant increase in no-load strain. Failure properties of postmortem muscle were found to be significantly different from live passive muscle with a significant decrease in failure stress (61 percent) and energy (81 percent), while failure strain was unchanged. These results suggest that the post-rigor response of cadaveric muscle is unaffected by freezing but sensitive to even a few cycles of mechanical loading.

Animals↗

The role of collagen crosslinking in the increased stiffness of avian dystrophic muscle.

The resting tension and stiffness in the range of sarcomere lengths 2.4-3.6 microns were studied in highly inbred normal and dystrophic chicken pectoral muscle bundles, and the results were compared with the collagen content and the extent of crosslinkage of the collagen. All parameters increased in the order normal homozygote (003/003) less than heterozygote (003/433) less than dystrophic homozygote (433/433) chickens, with the data from the heterozygotes being halfway between the two homozygotes, thus exhibiting a semi-dominant inheritance pattern. In separate experiments, lathyrism was induced by treating normal (412/412) and dystrophic (413/413) chickens with alpha-acetoaminonitrile, an inhibitor of lysyl oxydase, the enzyme responsible for the initiation of collagen crosslinkage formation. These experiments showed that the tension and stiffness in response to passive stretch did not change with lathyrism in normal muscles, whereas the tension and stiffness decreased significantly with lathyrism in dystrophic muscles. The collagen content did not change with lathryrism in both normal and dystrophic muscles. These results indicate that the increased content of collagen crosslinkages is the basis for the increased resting tension and stiffness in the dystrophic muscles of the chicken, and that the effects can be reversed by treatment with an inhibitor of collagen crosslinkage formation.

Animals↗

A model-based study of passive joint properties on muscle effort during static stance.

This study examined the impact of lower extremity joint stiffnesses and simulated joint contractures on the muscle effort required to maintain static standing postures after a spinal cord injury (SCI). Static inverse computer simulations were performed with a three-dimensional 15 degree of freedom musculoskeletal model placed in 1600 different standing postures. The required lower extremity muscle forces were calculated through an optimization routine that minimized the sum of the muscle stresses squared, which was used as an index of the muscle effort required for each standing posture. Joint stiffnesses were increased and decreased by 100 percent of their nominal values, and contractures were simulated to determine their effects on the muscle effort for each posture. Nominal muscle and passive properties for an individual with a SCI determined the baseline muscle effort for comparisons. Stiffness changes for the ankle plantar flexion/dorsiflexion, hip flexion/extension, and hip abduction/adduction directions had the largest effect on reducing muscle effort by more than 5 percent, while changes in ankle inversion/eversion and knee flexion/extension had the least effect. For erect standing, muscle effort was reduced by more than 5 percent when stiffness was decreased at the ankle plantar flexion/dorsiflexion joint or hip flexion/extension joint. With simulated joint contractures, the postural workspace area decreased and muscle effort was not reduced by more than 5 percent for any posture. Using this knowledge, methods can be developed through the use of orthoses, physical therapy, surgery or other means to appropriately augment or diminish these passive moments during standing with a neuroprosthesis.

Humans↗

Diastolic function in aortic valve disease: techniques of evaluation and pre-/postoperative changes.

Passive diastolic properties of the left ventricle are determined by several factors intrinsic or extrinsic to the ventricle. In patients with myocardial hypertrophy due to longstanding pressure or volume overload increased muscle mass and structural alterations of the myocardium are responsible for changes in passive elastic properties. Evaluation of diastolic function includes determination of ventricular (= chamber) and myocardial (= muscle) stiffness from simultaneous pressure-volume and stress-strain relations during passive diastolic filling. The slope of the pressure-volume relationship is equal to the constant of chamber stiffness and the slope of the stress-strain relationship equal to the constant of myocardial stiffness. Passive diastolic properties were determined in ten control patients and 21 patients with aortic valve disease before and 17.5 months after successful valve replacement. Ten patients presented with severe aortic stenosis, five patients with combined valve lesions and six patients with severe aortic insufficiency. Simultaneous high-fidelity pressure measurements and M-mode echocardiography were carried out in all patients. Myocardial stiffness was calculated from a viscoelastic stress-strain relationship using a nonlinear curve-fit program. Standard hemodynamic measurements showed a significant decrease in pressure and volume overload after successful valve replacement. Left ventricular muscle mass index decreased in all three groups significantly after surgery, whereas systolic ejection fraction remained unchanged pre-/postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Stenosis, Subvalvular↗