Christophe Cornu

Electromechanical delay revisited using very high frame rate ultrasound.

Electromechanical delay (EMD) represents the time lag between muscle activation and muscle force production and is used to assess muscle function in healthy and pathological subjects. There is no experimental methodology to quantify the actual contribution of each series elastic component structures that together contribute to the EMD. We designed the present study to determine, using very high frame rate ultrasound (4 kHz), the onset of muscle fascicles and tendon motion induced by electrical stimulation. Nine subjects underwent two bouts composed of five electrically evoked contractions with the echographic probe maintained over 1) the gastrocnemius medialis muscle belly (muscle trials) and 2) the myotendinous junction of the gastrocnemius medialis muscle (tendon trials). EMD was 11.63 +/- 1.51 and 11.67 +/- 1.27 ms for muscle trials and tendon trials, respectively. Significant difference (P < 0.001) was found between the onset of muscle fascicles motion (6.05 +/- 0.64 ms) and the onset of myotendinous junction motion (8.42 +/- 1.63 ms). The noninvasive methodology used in the present study enabled us to determine the relative contribution of the passive part of the series elastic component (47.5 +/- 6.0% of EMD) and each of the two main structures of this component (aponeurosis and tendon, representing 20.3 +/- 10.7% and 27.6 +/- 11.4% of EMD, respectively). The relative contributions of the synaptic transmission, the excitation-contraction coupling, and the active part of the series elastic component could not be directly quantified with our results. However, they suggest a minor role of the active part of the series elastic component that needs to be confirmed by further experiments.

Plyometric training effects on Achilles tendon stiffness and dissipative properties

The aim of this study was to determine the effects of 14 wk of plyometric training on mechanical properties of the Achilles tendon. Nineteen subjects were randomly assigned to trained or control group. Cross-sectional area (CSA), stiffness, and dissipation coefficient of the Achilles tendon were measured before and after the training period. In the trained group, a decrease in dissipation coefficient (-35.0%; P<0.05) and an upward trend in stiffness (+24.1%) of the Achilles tendon was found, without any changes in Achilles tendon CSA (P>0.05). Plyometric training enhances the muscular tension transmission mainly through a reduction in energy dissipated by the tendon. The lack of changes in the Achilles tendon CSA indicates that changes in mechanical properties would mainly result from a qualitative change in tendinous tissues rather than from changes in the geometry of the Achilles tendon.

Characterization of muscle belly elastic properties during passive stretching using transient elastography

Passive muscle stretching can be used in vivo to assess the viscoelastic properties of the entire musculo-articular complex, but does not allow the specific determination of the muscle or tendon viscoelasticity. In this respect, the local muscle hardness (LMH) of the gastrocnemius medialis (GM) belly was measured during a passive ankle stretching of 10 subjects using transient elastography. A Biodex isokinetic dynamometer was used to stretch ankle plantar flexors, to measure ankle angle, and the passive torque developed by the ankle joint in resistance to the stretch. Results show that the LMH increased during the stretching protocol, with an averaged ratio between maximal LMH and minimal LMH of 2.62+/-0.46. Furthermore, LMH-passive torque relationships were nicely fitted using a linear model with mean correlation coefficients (R(2)) of 0.828+/-0.099. A good reproducibility was found for the maximal passive torque (ICC=0.976, SEM=2.9Nm, CV=5.5%) and the y-intercept of the LMH-passive torque relationship (ICC=0.893, SEM=105Pa, CV=7.8%). However, the reproducibility was low for the slope of this relationship (ICC=0.631, SEM=10.35m(-2), CV=60.4%). The y-intercept of the LMH-passive torque relationship was not significantly changed after 10min of static stretching. This result confirms the finding of a previous study indicating that changes in passive torque following static stretching could be explained by an acute increase in muscle length without any changes in musculo-articular intrinsic mechanical properties.

Neuromuscular and muscle-tendon system adaptations to isotonic and isokinetic eccentric exercise.

OBJECTIVE To present the properties of an eccentric contraction and compare neuromuscular and muscle-tendon system adaptations induced by isotonic and isokinetic eccentric trainings. SYNTHESIS An eccentric muscle contraction is characterized by the production of muscle force associated to a lengthening of the muscle-tendon system. This muscle solicitation can cause micro lesions followed by a regeneration process of the muscle-tendon system. Eccentric exercise is commonly used in functional rehabilitation for its positive effect on collagen synthesis but also for resistance training to increase muscle strength and muscle mass in athletes. Indeed, eccentric training stimulates muscle hypertrophy, increases the fascicle pennation angle, fascicles length and neural activation, thus inducing greater strength gains than concentric or isometric training programs. Eccentric exercise is commonly performed either against a constant external load (isotonic) or at constant velocity (isokinetic), inducing different mechanical constraints. These different mechanical constraints could induce structural and neural adaptive strategies specific to each type of exercise. CONCLUSION The literature tends to show that isotonic mode leads to a greater strength gain than isokinetic mode. This observation could be explained by a greater neuromuscular activation after IT training. However, the specific muscle adaptations induced by each mode remain difficult to determine due to the lack of standardized, comparative studies.

Effects of eccentric training on mechanical properties of the plantar flexor muscle-tendon complex

Eccentric training is a mechanical loading classically used in clinical environment to rehabilitate patients with tendinopathies. In this context, eccentric training is supposed to alter tendon mechanical properties but interaction with the other components of the muscle-tendon complex remains unclear. The aim of this study was to determine the specific effects of 14 wk of eccentric training on muscle and tendon mechanical properties assessed in active and passive conditions in vivo. Twenty-four subjects were randomly divided into a trained group (n = 11) and a control group (n = 13). Stiffness of the active and passive parts of the series elastic component of plantar flexors were determined using a fast stretch during submaximal isometric contraction, Achilles tendon stiffness and dissipative properties were assessed during isometric plantar flexion, and passive stiffness of gastrocnemii muscles and Achilles tendon were determined using ultrasonography while ankle joint was passively moved. A significant decrease in the active part of the series elastic component stiffness was found (P < 0.05). In contrast, a significant increase in Achilles tendon stiffness determined under passive conditions was observed (P < 0.05). No significant change in triceps surae muscles and Achilles tendon geometrical parameters was shown (P > 0.05). Specific changes in muscle and tendon involved in plantar flexion are mainly due to changes in intrinsic mechanical properties of muscle and tendon tissues. Specific assessment of both Achilles tendon and plantar flexor muscles allowed a better understanding of the functional behavior of the muscle-tendon complex and its adaptation to eccentric training.

Muscle architecture and EMG activity changes during isotonic and isokinetic eccentric exercises.

The present study aimed to compare muscle architecture and electromyographic activity during isotonic (IT) and isokinetic (IK) knee extensors eccentric contractions. Seventeen subjects were assigned in test and reproducibility groups. During test session, subjects performed two IT and two IK sets of eccentric contractions of knee extensor muscles. Torque, angular velocity, VL architecture and EMG activity of agonist (vastus lateralis, VL; vastus medialis; rectus femoris) and antagonist (semitendinosus; biceps femoris, BF) muscles were simultaneously recorded and averaged on a 5° window. Torque–angle and angular velocity–angle relationships exhibited differences in mechanical load between the IT and IK modes. Changes in muscle architecture were similar in both modes, since VL fascicles length increased and fascicle angle decreased, resulting in a decrease in muscle thickness during eccentric contraction. Agonist activity and BF co-activity levels were higher in IT mode than in IK mode at short muscle lengths, whereas agonist activity was higher in IK mode than in IT mode at long muscle lengths. Differences in mechanical load between both modes induced specific neuromuscular responses in terms of agonist activity and antagonist co-activity. These results suggest that specific neural adaptations may occur after IT or IK eccentric training. This hypothesis needs to be tested in order to gain new insights concerning the most effective eccentric protocols based on whether the objective is sportive or clinical.

Evidence of changes in load sharing during isometric elbow flexion with ramped torque

This study aimed to: (1) test the repeatability of Supersonic Shear Imaging measures of muscle shear elastic modulus of four elbow flexor muscles during isometric elbow flexion with ramped torque; (2) determine the relationship between muscle shear elastic modulus and elbow torque for the four elbow flexor muscles, and (3) investigate changes in load sharing between synergist elbow flexor muscles with increases in elbow flexor torque. Ten subjects performed ten isometric elbow flexions consisting of linear torque ramps of 30-s from 0 to 40% of maximal voluntary contraction. The shear elastic modulus of each elbow flexor muscle (biceps brachii long head [BB(LH)], biceps brachii short head [BB(SH)], brachialis [BA], and brachoradialis [BR]) and of triceps brachii long head [TB] was measured twice with individual muscles recorded in separate trials in random order. A good repeatability of the shape of the changes in shear elastic modulus as a function of torque was found for each elbow flexor muscle (r-values: 0.85 to 0.94). Relationships between the shear elastic modulus and torque were best explained by a second order polynomial, except BA where a higher polynomial was required. Statistical analysis showed that BB(SH) and BB(LH) had an initial slow change at low torques followed by an increasing rate of increase in modulus with higher torques. In contrast, the BA shear elastic modulus increased rapidly at low forces, but plateaued at higher forces. These results suggest that changes in load sharing between synergist elbow flexors could partly explain the non-linear EMG-torque relationship classically reported for BB during isometric efforts.

Improvements to Hoang et al.'s method for measuring passive length-tension properties of human gastrocnemius muscle in vivo.

While the passive mechanical properties of a musculo-articular complex can be determined using the relationship between the articular angle and the passive torque developed in resistance to motion, the properties of different structures of the musculo-articular complex cannot be easily assessed. Recently, an elegant method has been proposed to estimate the passive length-tension properties of gastrocnemius muscle-tendon unit (Hoang et al., 2005). In the present paper, two improvements of this method are proposed to decrease the number of parameters required to assess the passive length-tension relationship from 9 to 2. Furthermore, these two parameters have physical meaning as they represent a passive muscle-tendon stiffness index (alpha) and the muscle-tendon slack length (l(0)). alpha and l(0) are relevant clinical parameters to study the chronic effects of aging, training protocols or neuromuscular pathologies on the passive mechanical properties of the muscle-tendon unit. Eight healthy subjects performed passive loading/unloading cycles at 5 degrees /s with knee angle at 6 knee angles to assess the torque-angle relationships and to apply the modified method. Numerical optimization was used to minimize the squared error between the experimental and the modeled relationships. The experiment was performed twice to assess the reliability of alpha and l(0) across days. The results showed that the reliability of the two parameters was good (alpha: ICC=0.82, SEM=6.1m(-1), CV=6.3% and l(0): ICC=0.83, SEM=0.29 cm, CV=0.9%). Using a sensitivity analysis, it was shown that the numerical solution was unique. Overall, the findings may provide increased interest in the method proposed by Hoang et al. (2005).

Postural control and cognitive decline in older adults: Position versus velocity implicit motor strategy

The present study explored the impact of cognitive decline on postural control strategies in older adults with and without cognitive decline from mild cognitive impairment (MCI) to mild-to-moderate Alzheimer disease (MMAD). We hypothesized that the cognitive decline affected the postural control leading to higher bounding limits of COP velocity dynamics. Based on a cross-sectional design, 175 non-faller older adults were recruited in Angers University Hospital, France, including 50 cognitively healthy individuals [CHI] (mean age 76.42 ± 4.84 years; 30% women), 64 age- and body mass index-matched participants with MCI (mean age 77.51 ± 6.32 years; 39% women), and 61 age- and body mass index-matched participants with MMAD (mean age 78.44 ± 3.97 years; 62% women). For all data collection of postural sway, the participants were asked to maintain quiet stance on force platform. The postural test consisted of two trials of quiet stance, with eyes open and with eyes closed. The COP parameters were mean and standard deviation (SD) of position, velocity and average absolute maximal velocity (AAMV) in antero-posterior and medio-lateral directions. Overall, the analysis concerning all COP parameters revealed a significant main effect of cognitive status on velocity-based variables, with post hoc comparisons evidencing that SD velocity and AAMV increased with cognitive impairment. The current findings suggest an active control (or corrective process) of COP velocity dynamics for CHI, whereas MCI and MMAD are affected by COP movements.

Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study

Falls are common in the elderly, and potentially result in injury and disability. Thus, preventing falls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall. Clinical baseline characteristics (e.g., gender, cognitive function) were assessed in 259 home-dwelling people aged 66 to 75 that had never fallen. Likewise, global kinetic behavior of gait was recorded from 22 variables in 1036 walking tests with an accelerometric gait analysis system. Afterward, monthly telephone monitoring reported the date of the first fall over 24 months. A principal components analysis was used to assess the relationship between gait variables and fall status in four groups: non-fallers, fallers from 0 to 6 months, fallers from 6 to 12 months and fallers from 12 to 24 months. The association of significant principal components (PC) with an increased risk of first fall was then evaluated using the area under the Receiver Operator Characteristic Curve (ROC). No effect of clinical confounding variables was shown as a function of groups. An eigenvalue decomposition of the correlation matrix identified a large statistical PC1 (termed “Global kinetics of gait pattern”), which accounted for 36.7% of total variance. Principal component loadings also revealed a PC2 (12.6% of total variance), related to the “Global gait regularity.” Subsequent ANOVAs showed that only PC1 discriminated the fall status during the first 6 months, while PC2 discriminated the first fall onset between 6 and 12 months. After one year, any PC was associated with falls. These results were bolstered by the ROC analyses, showing good predictive models of the first fall during the first six months or from 6 to 12 months. Overall, these findings suggest that the performance of a standardized walking test at least once a year is essential for fall prevention.