Chronic changes in muscle architecture and aponeurosis structure following calf muscle strain injuries.
calf strain
connective tissue
dynamic ultrasound imaging
muscle injuries
Journal
Scandinavian journal of medicine & science in sports
ISSN: 1600-0838
Titre abrégé: Scand J Med Sci Sports
Pays: Denmark
ID NLM: 9111504
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
revised:
02
06
2023
received:
02
03
2023
accepted:
09
08
2023
medline:
20
11
2023
pubmed:
25
8
2023
entrez:
25
8
2023
Statut:
ppublish
Résumé
Muscle strain injuries in the human calf muscles are frequent sports injuries with high recurrence. Potential structural and functional changes in the medial head of the musculus gastrocnemius (GM) and the associated aponeurosis are not well documented. To test whether a GM muscle strain injury affects muscle fascicle length, pennation angle, and the morphology of the deep aponeurosis at rest and during muscle contraction long time after the injury. Additionally, electromyography (EMG) of the GM and the soleus muscle during a unilateral heel rise was measured in the injured and uninjured calf. GM fascicle length, pennation angle, and aponeurosis thickness was analyzed on dynamic ultrasonography (US) recordings in 10 participants with a chronic calf strain. In addition, US images taken across the distal portion and mid-belly of the GM were analyzed at three different ankle positions. EMG recordings were obtained during a unilateral heel rise. The pennation angle of the injured distal GM was significantly larger compared to the uninjured GM in the contracted, but not the relaxed state. Pennation angle increased more in the injured compared to the uninjured GM during contraction. Fascicle length was shorter in the most distal portion of the injured GM. Fascicles at the distal portion of the injured GM showed a pronounced curvilinear shape as the muscle contracted and the aponeurosis was enlarged in the injured compared to the uninjured GM. The ratio between GM and soleus EMG activity showed a significantly higher relative soleus activity in the injured compared to the healthy calf. The greater change in pennation angle and curvilinear fascicle shape during contraction suggest that a long-term consequence after a muscle strain injury is that some muscle fibers at the distal GM are not actively engaged. The significantly enlarged aponeurosis indicates a substantial and long-lasting connective tissue involvement following strain injuries.
Sections du résumé
BACKGROUND
BACKGROUND
Muscle strain injuries in the human calf muscles are frequent sports injuries with high recurrence. Potential structural and functional changes in the medial head of the musculus gastrocnemius (GM) and the associated aponeurosis are not well documented.
PURPOSE
OBJECTIVE
To test whether a GM muscle strain injury affects muscle fascicle length, pennation angle, and the morphology of the deep aponeurosis at rest and during muscle contraction long time after the injury. Additionally, electromyography (EMG) of the GM and the soleus muscle during a unilateral heel rise was measured in the injured and uninjured calf.
METHODS
METHODS
GM fascicle length, pennation angle, and aponeurosis thickness was analyzed on dynamic ultrasonography (US) recordings in 10 participants with a chronic calf strain. In addition, US images taken across the distal portion and mid-belly of the GM were analyzed at three different ankle positions. EMG recordings were obtained during a unilateral heel rise.
RESULTS
RESULTS
The pennation angle of the injured distal GM was significantly larger compared to the uninjured GM in the contracted, but not the relaxed state. Pennation angle increased more in the injured compared to the uninjured GM during contraction. Fascicle length was shorter in the most distal portion of the injured GM. Fascicles at the distal portion of the injured GM showed a pronounced curvilinear shape as the muscle contracted and the aponeurosis was enlarged in the injured compared to the uninjured GM. The ratio between GM and soleus EMG activity showed a significantly higher relative soleus activity in the injured compared to the healthy calf.
CONCLUSION
CONCLUSIONS
The greater change in pennation angle and curvilinear fascicle shape during contraction suggest that a long-term consequence after a muscle strain injury is that some muscle fibers at the distal GM are not actively engaged. The significantly enlarged aponeurosis indicates a substantial and long-lasting connective tissue involvement following strain injuries.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2585-2597Subventions
Organisme : Bispebjerg Hospital
Organisme : Kulturministeriet
Informations de copyright
© 2023 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.
Références
Hägglund M, Waldén M, Ekstrand J. Injury recurrence is lower at the highest professional football level than at national and amateur levels: does sports medicine and sports physiotherapy deliver? Br J Sports Med. 2016;50:751-758.
Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men's professional football, since 2001: a 13-year longitudinal analysis of the UEFA elite Club injury study. Br J Sports Med. 2016;50:731-737.
Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. Br J Sports Med. 2017;51:1189-1194.
Hägglund M, Waldén M, Ekstrand J. Risk factors for lower extremity muscle injury in professional soccer: the UEFA injury study. Am J Sports Med. 2013;41:327-335.
Tidball JG, Salem G, Zernicke R. Site and mechanical conditions for failure of skeletal muscle in experimental strain injuries. J Appl Physiol. 1993;74:1280-1286.
Garrett WE. Muscle strain injuries. Am J Sport Med. 1996;24:S2-S8.
Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sport Med. 2007;35:197-206.
Silder A, Heiderscheit BC, Thelen DG, Enright T, Tuite MJ. MR observations of long-term musculotendon remodeling following a hamstring strain injury. Skeletal Radiol. 2008;37:1101-1109.
Bayer ML, Hoegberget-Kalisz M, Jensen MH, et al. Role of tissue perfusion, muscle strength recovery and pain in rehabilitation after acute muscle strain injury: a randomized controlled trial comparing early and delayed rehabilitation. Scand J Med Sci Sports. 2018;28:2579-2591.
Bayer ML, Hoegberget-Kalisz M, Svensson RB, et al. Chronic sequelae after muscle strain injuries: influence of heavy resistance training on functional and structural characteristics in a randomized controlled trial. Am J Sports Med. 2021;49:2783-2794.
Arellano CJ, Gidmark NJ, Konow N, Azizi E, Roberts TJ. Determinants of aponeurosis shape change during muscle contraction. J Biomech. 2016;49:1812-1817.
Azizi E, Roberts TJ. Biaxial strain and variable stiffness in aponeuroses. J Physiol. 2009;587:4309-4318.
Magnusson SP, Hansen P, Aagaard P, et al. Differential strain patterns of the human gastrocnemius aponeurosis and free tendon, in vivo. Acta Physiol Scand. 2003;177:185-195.
Bojsen-Møller J, Magnusson SP. Mechanical properties, physiological behavior, and function of aponeurosis and tendon. J Appl Physiol. 2019;126:1800-1807.
Finni T, Hodgson JA, Lai AM, Edgerton VR, Sinha S. Nonuniform strain of human soleus aponeurosis-tendon complex during submaximal voluntary contractions in vivo. J Appl Physiol. 2003;95:829-837.
Timmins RG, Shield AJ, Williams MD, Lorenzen C, Opar DA. Biceps Femoris long head architecture. Med Sci Sport Exerc. 2015;47:905-913.
Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med. 2011;39:2296-2303.
van der Horst N, Smits DW, Petersen J, Goedhart EA, FJG B. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med. 2015;43:1-8.
Marušič J, Vatovec R, Marković G, Šarabon N. Effects of eccentric training at long-muscle length on architectural and functional characteristics of the hamstrings. Scand J Med Sci Sports. 2020;30:2130-2142.
Whiteley R, Hickey JT, Vermeulen R, et al. Biceps Femoris fascicle lengths increase after hamstring injury rehabilitation to a greater extent in the injured leg. Transl Sport Med. 2022;2022:1-8.
Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39:1226-1232.
Franchi MV, Fitze DP, Raiteri BJ, Hahn D, Spörri J. Ultrasound-derived biceps Femoris long head fascicle length: extrapolation pitfalls. Med Sci Sports Exerc. 2020;52:233-243.
Opar DA, Williams MD, Timmins RG, Dear NM, Shield AJ. Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings. J Electromyogr Kinesiol. 2013;23:696-703.
Opar DA, Williams MD, Timmins RG, Dear NM, Shield AJ. Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings. Am J Sports Med. 2013;41:116-125.
Presland JD, Timmins RG, Maniar N, et al. Muscle activity and activation in previously strain-injured lower limbs: a systematic review. Sports Med. 2021;51:2311-2327.
Bayer MLML, Magnusson SPP, Kjaer M. Early versus delayed rehabilitation after acute muscle injury. N Engl J Med. 2017;377:1300-1301.
Silbernagel KG, Nilsson-Helander K, Thomeé R, Eriksson BI, Karlsson J. A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2010;18:258-264.
Zuurbier CJ, Everard AJ, van der Wees P, Huijing PA. Length-force characteristics of the aponeurosis in the passive and active muscle condition and in the isolated condition. J Biomech. 1994;27:445-453.
Buhmann R, Trajano GS, Kerr G, Shield A. Voluntary activation and reflex responses after hamstring strain injury. Med Sci Sports Exerc. 2020;52:1862-1869.
Opar DA, Williams MD, Shield AJ. Hamstring strain injuries: factors that lead to injury and re-injury. Sports Med. 2012;42:209-226.
Guex K, Degache F, Morisod C, Sailly M, Millet GP. Hamstring architectural and functional adaptations following long vs. Short Muscle Length Eccentric Training Front Physiol. 2016;7:340.
Timmins RG, Bourne MN, Shield AJ, Williams MD, Lorenzen C, Opar DA. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study. Br J Sports Med. 2016;50:1524-1535.