Effects of repeated ankle stretching on calf muscle–tendon and ankle biomechanical properties in stroke survivors

Gao, Fan; Ren, Yupeng; Roth, Elliot J.; Harvey, Richard L.; Zhang, Liqun

doi:10.1016/j.clinbiomech.2010.12.003

Cited by 104 publications

(96 citation statements)

References 50 publications

(54 reference statements)

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“…Previously, this mutant rat model has been used for neural studies exclusively (7,39,44). The mechanical properties of the spastic rat calf muscles found in the present study are consistent with the reduced functional range of motion and increased stiffness reported clinically in human limbs affected by spasticity (17,31,32,40), and the narrower active lengthforce curves estimated in in vivo studies on human GA (2,15,16). Thus the spastic rat model used in the present study mimics several important features of spasticity in human patients, and may be used to elucidate the mechanisms responsible for changes in muscle and limb mechanical properties observed in patients with spasticity.…”

Section: Discussionsupporting

confidence: 89%

“…The absolute optimum length of GA was also lower because the absolute MTU length of GA at reference length was the same in the two groups (Table 1). These findings are consistent with length-force characteristics on the basis of net ankle joint moments and ultrasound imaging of spastic GA (2,15,16). The lower optimum length and narrower length-force curve can be explained by a number of factors: shorter muscle belly, fewer sarcomeres in series, stiffer and/or shorter tendon, or a decreased distribution of mean sarcomere length between fibers.…”

Section: Discussionsupporting

confidence: 82%

“…Spastic GA was found to be stiffer than normally developed in such studies (2,3). The active lengthforce curve of the spastic GA was narrower and the optimum length was shifted to a shorter fascicle length than in normally developed GA (2,15,16). However, estimating length-force characteristics from joint moments can be misleading because this is the net effect of forces exerted by several MTUs and passive structures around the joint, which depend on their moment arms (11,30).…”

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confidence: 99%

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Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat

Olesen

Jensen

Uhlendorf

et al. 2014

Journal of Applied Physiology

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Olesen AT, Jensen BR, Uhlendorf TL, Cohen RW, Baan GC, Maas H. Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat. J Appl Physiol 117: 989-997, 2014. First published September 4, 2014 doi:10.1152/japplphysiol.00587.2014.-The purpose of the present study was to investigate muscle mechanical properties and mechanical interaction between muscles in the lower hindlimb of the spastic mutant rat. Length-force characteristics of gastrocnemius (GA), soleus (SO), and plantaris (PL) were assessed in anesthetized spastic and normally developed Han-Wistar rats. In addition, the extent of epimuscular myofascial force transmission between synergistic GA, SO, and PL, as well as between the calf muscles and antagonistic tibialis anterior (TA), was investigated. Active length-force curves of spastic GA and PL were narrower with a reduced maximal active force. In contrast, active length-force characteristics of spastic SO were similar to those of controls. In reference position (90°ankle and knee angle), higher resistance to ankle dorsiflexion and increased passive stiffness was found for the spastic calf muscle group. At optimum length, passive stiffness and passive force of spastic GA were decreased, whereas those of spastic SO were increased. No mechanical interaction between the calf muscles and TA was found. As GA was lengthened, force from SO and PL declined despite a constant muscle-tendon unit length of SO and PL. However, the extent of this interaction was not different in spastic rats. In conclusion, the effects of spasticity on length-force characteristics were muscle specific. The changes observed for GA and PL muscles are consistent with the changes in limb mechanics reported for human patients. Our results indicate that altered mechanics in spastic rats cannot be attributed to differences in mechanical interaction, but originate from individual muscular structures. muscle spasticity; mechanical properties; myofascial force transmission; muscle stiffness MUSCLE SPASTICITY HAS BEEN defined as a "velocity-depended resistance to stretch" (24) and arises secondary to upper motoneuron lesions with cerebral palsy and stroke as the most common examples (12). Individuals suffering from spasticity typically experience muscle weakness, enhanced joint stiffness, increased muscle tone, reduced range of joint motion, increased antagonistic co-contraction, and exaggerated reflexes (1,3,6,12,13,32,41,48). These effects severely impair the ability to perform daily activities, and treatment is often needed.To asses whether some of these symptoms are related to altered mechanical properties of muscle-tendon units (MTUs), passive and active length-force characteristics have been estimated as joint moment as a function of gastrocnemius (GA) fascicle length. Spastic GA was found to be stiffer than normally developed in such studies (2, 3). The active lengthforce curve of the spastic GA was narrower and the optimum length was shifted to a shorter fascicle length than in normally deve...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 82%

mentioning

confidence: 99%

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Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat

Olesen

Jensen

Uhlendorf

et al. 2014

Journal of Applied Physiology

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“…The proper range of motion in dorsiflexion in the ankle joints, in particular, is essential for performing functional activities such as walking, running, climbing, and going down stairs normally [29]. After a stroke, the range of motion in the ankle joints is restricted by a decrease in the size of muscular fibers, a decline in the number of recruitment motor units, a failure to produce proper muscular strength owing to abnormal muscle tone, and weakness or contracture of the dorsi flexor [8], a restriction that poses the risk of declining balance ability [30].…”

Section: Discussionmentioning

confidence: 99%

“…Given et al [7] reported that the muscles around the ankle joints easily develop changes in their mechanical property because they have more type I muscle fibers and connective tissue than other muscles. Owing to the characteristics of the ankle joints, stroke patients are known to be more likely to have increased spasticity and shortened fascia of the gastrocnemius on the paretic side, producing a reduced range of motion in dorsiOriginal Article flexion in the ankle joints [8]. Such changes induce incorrect transmission of somatesthesia from the joint or the muscle receptors or motor response, accompanied by inappropriate ankle strategy, causing difficulty in balance control [9,10].…”

Section: Introductionmentioning

confidence: 99%

The effect of balance training with plantar flexor stretching on range of motion, balance, and gait in stroke patients: a randomized controlled pilot trial

Park

Choi

2015

PTRS

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Objective: The aim of this study was to investigate the effect of balance training with plantar flexor stretching on ankle dorsi flexion range of motion (ROM), balance, and gait ability in stroke patients. Design: A randomized controlled pilot trial. Methods: Thirty stroke patients volunteered to participate in this study. The subjects were randomly allocated to two groups: the experimental group (n=15) received the neurodevelopment therapy plus balance training with plantar flexor stretching for 20 minutes in one session. The control group (n=15) received the same neurodevelopment therapy plus plantar flexor static stretching for 20 minutes in one session. Both groups underwent sessions four times a week, for a total of 4 weeks. Measurements included passive range of motion (PROM), active range of motion (AROM) of ankle dorsiflexion using a goniometer, timed up and go (TUG), the functional reaching test (FRT), and the 10 m walk test (10 MWT). Results: There were significant improvements in AROM and PROM of ankle dorsiflexion, TUG, and FRT scores after the intervention in the experimental group (p<0.05). However, the control group showed no statistically significant differences except for PROM of ankle dorsiflexion. The experimental group showed a significant improvement in PROM, TUG, and FRT scores compared to the control group (p<0.05). Conclusions: Balance training with plantar flexor stretching improves ankle dorsiflexion ROM and balance ability in patients with stroke. Therefore, this therapeutic intervention will be effective for rehabilitation of stroke patients in the clinical setting.

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Real‐time ultrasound elastography evaluation of achilles tendon properties in patients with mild hemiplegic stroke after rehabilitation training

Shao

Peng

Kong

et al. 2018

J of Ultrasound Medicine

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Objective This study aims to evaluate the Achilles tendon's properties after rehabilitation training in patients with stroke using real‐time ultrasound elastography. Methods A total of 24 patients with mild hemiplegic stroke in the past 6 to 12 months and unilateral lower limb movement disorder were prospectively enrolled. All patients accepted 9‐week rehabilitation training with the same schema. The 2‐dimensional elastography and real‐time elastography findings in the impaired and contralateral normal Achilles tendon were measured at pretraining and at 3, 6, and 9 weeks after training, which included tendon length, thickness, elasticity score (grade 1–3), and strain ratio of fat to tendon. The functional properties, which include the 10‐meter walk test and timed up‐and‐go scores, were evaluated before and after the 9‐week training. Results The impaired Achilles tendon had a longer length (P = .002), lower frequency of grade 1 (P = .012), and lower strain ratio (P = .009) than the contralateral tendon before training. The impaired tendons at the third, sixth, and ninth weeks after training were compared to ones before training, respectively, which revealed shorter length, increased frequency of grade 1, and increased strain ratio. The first statistically significant changes in the length were observed at the sixth week, while such changes in elasticity score and strain ratio were observed at the ninth week. Conclusions Two‐dimensional elastography and real‐time elastography can provide valuable imaging markers for quantitatively evaluating the Achilles tendon's properties after rehabilitation training in patients with stroke.

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Effects of repeated ankle stretching on calf muscle–tendon and ankle biomechanical properties in stroke survivors

Abstract: Background-The objective of this study was to investigate changes in active and passive biomechanical properties of the calf muscle-tendon unit induced by controlled ankle stretching in stroke survivors.

Cited by 104 publications

References 50 publications

Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat

Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat

The effect of balance training with plantar flexor stretching on range of motion, balance, and gait in stroke patients: a randomized controlled pilot trial

Real‐time ultrasound elastography evaluation of achilles tendon properties in patients with mild hemiplegic stroke after rehabilitation training

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