Scott Cameron Wearing

Only a small number of muscle activation patterns from lower limbs have been reported and simultaneous muscle activation from several lower limb muscles have not yet been investigated. The purpose of this study was to examine any gender differences in surface electromyography (EMG) activity from six recorded lower limb muscles of the dominant limb at baseline (i.e., with the foot placed flat on the floor and in the neutral position), and during concentric and eccentric phases when performing a heel raise task. In total, 10 females and 10 males performed a standing heel raise task comprising of three continuous phases: baseline, unloading (concentric muscle action), and loading (eccentric muscle action) phases. Muscle activation from six muscles (gastrocnemius medialis, gastrocnemius lateralis, soleus, tibialis anterior, peroneus longus, and peroneus brevis) were measured using the Myon 320 EMG System. Root mean squared values of each muscle were calculated for each phase. Descriptive and inferential statistics were incorporated into the study. Statistically significant p values were set at 0.05. The results showed no significant differences between baseline, concentric, and eccentric phases with respect to each of the muscles investigated. Except for the gastrocnemius medialis at baseline and concentric phases, no significant differences were observed between genders or contractions. The data suggests that gender does not significantly influence the eccentric phase during the standing heel raise task.

Submaximal vertical hopping capitalizes on the strain energy storage-recovery mechanism associated with the stretch-shortening cycle and is emerging as an important component of progressive rehabilitation protocols in Achilles tendon injury and a determinant of readiness to return to sport. This study explored the reliability of transmission mode ultrasound in quantifying the instantaneous modulus of elasticity of human Achilles tendon during repetitive submaximal hopping. A custom-built ultrasound transmission device, consisting of a 1 MHz broadband emitter and four regularly spaced receivers, was used to measure the axial velocity of ultrasound in the Achilles tendon of six healthy young adults (mean ± SD; age 26 ± 5 years; height 1.78 ± 0.11 m; weight 79.8 ± 13.6 kg) during steady-state unilateral hopping (2.5 Hz) on a piezoelectric force plate. Vertical ground reaction force and lower limb joint kinematics were simultaneously recorded. The potential sensitivity of the technique was further explored in subset of healthy participants (n= 3) that hopped at a slower rate (1.8 Hz) and a patient who had undergone Achilles tendon rupture-repair (2.5 Hz). Reliability was estimated using the mean-within subject coefficient of variation calculated at each point during the ground-contact phase of hopping, while cross-correlations were used to explore the coordination between lower limb kinematics ground reaction forces and ultrasound velocity in the Achilles tendon. Axial velocity of ultrasound in the Achilles tendon was highly reproducible during hopping, with the mean within-subject coefficient of variation ranging between 0.1 and 2.0% across participants. Ultrasound velocity decreased immediately following touch down (−19 ± 13 ms^–1), before increasing by 197 ± 81 ms^–1, on average, to peak at 2230 ± 87 ms^–1at 67 ± 3% of ground contact phase in healthy participants. Cross-correlation analysis revealed that ultrasound velocity in the Achilles tendon during hopping was strongly associated with knee (meanr= 0.98, range 0.95–1.00) rather than ankle (meanr= 0.67, range 0.35–0.79) joint motion. Ultrasound velocity was sensitive to changes in hopping frequency in healthy adults and in the surgically repaired Achilles tendon was characterized by a similar peak velocity (2283 ± 13 ms^–1) but the change in ultrasound velocity (447 ± 21 ms^–1) was approximately two fold that of healthy participants (197 ± 81 ms^–1). Although further research is required, the technique can be used to reliably monitor ultrasound velocity in the Achilles tendon during hopping, can detect changes in the instantaneous elastic modulus of tendon with variation in hopping frequency and tendon pathology and ultimately may provide further insights into the stretch-shortening cycle and aid clinical decision concerning tendon rehabilitation protocols and readiness to return to sport.

Progression of the difficulty of agility exercises in sport is often achieved by changing the stability of the support surface via graded sensorimotor training devices. However, little is known about the challenge imposed to postural equilibrium by these graded devices. This study quantified the instability provided by four sensorimotor training devices typically used to enhance athletic performance; three progressively unstable balance pads (ST1–3) and an oscillatory platform (PM). Twenty-five (13 female, 12 male) young adults (age, 26 ± 3 yr; height, 1.76 ± 0.10 m; and weight, 69 ± 12 kg), completed seven unipedal balance conditions involving stable and progressively unstable surfaces that involved four sensorimotor training devices (ST1-3, PM) and their combination (PM-ST1, PM-ST2). An inertial sensor, mounted over the lumbar spine, was used to monitor Centre of Mass (COM) displacement in each condition. Potential differences in COM displacement between conditions were assessed using a mixed-model analysis of variance. COM displacement differed between training devices; with a progressive, though non-linear, increase in COM displacement from the most (ST1) to the least (ST3) stable balance pad. However, there was no significant difference in COM displacement between the least stable balance pad (ST3) and the oscillatory platform used in isolation (PM) or in combination with balance pads (PM-ST1, PM-ST2). These novel findings have important practical implications for the design of progressive sensorimotor training programs in sport.

The capacity of foot-strike running patterns to influence the functional properties of the Achilles tendon is controversial. This study used transmission-mode ultrasound to investigate the influence of habitual running foot-strike pattern on Achilles tendon properties during barefoot walking and running. Fifteen runners with rearfoot (RFS) and 10 with a forefoot (FFS) foot-strike running pattern had ultrasound transmission velocity measured in the right Achilles tendon during barefoot walking (≈1.1 ms⁻¹) and running (≈2.0 ms⁻¹). Temporospatial gait parameters, ankle kinematics and vertical ground reaction force were simultaneously recorded. Statistical comparisons between foot-strike patterns were made using repeated measure ANOVAs. FFS was characterised by a significantly shorter stance duration (−4%), greater ankle dorsiflexion (+2°), and higher peak vertical ground reaction force (+20% bodyweight) than RFS running (P < .05). Both groups adopted a RFS pattern during walking, with only the relative timing of peak dorsiflexion (3%), ground reaction force (1–2%) and peak vertical force loading rates (22–23%) differing between groups (P < .05). Peak ultrasound transmission velocity in the Achilles tendon was significantly higher in FFS during walking (≈100 ms⁻¹) and running (≈130 ms⁻¹) than RFS (P < .05). Functional Achilles tendon properties differ with habitual footfall patterns in recreational runners.

Introduction Achilles tendon rehabilitation protocols commonly recommend a gradual increase in walking speed to progressively intensify tendon loading. This study used transmission-mode ultrasound to evaluate the influence of walking speed on loading of the human Achilles tendon in vivo. Methods Axial transmission speed of ultrasound was measured in the right Achilles tendon of 33 adults (mean ± SD: age, 29 ± 3 yr; height, 1.725 ± 0.069 m; weight, 71.4 ± 19.9 kg) during unshod, steady-state treadmill walking at three speeds (slow, 0.85 ± 0.12 ms; preferred, 1.10 ± 0.13 m·s⁻¹; fast, 1.35 ± 0.20 m·s⁻¹). Ankle kinematics, spatiotemporal gait parameters and vertical ground reaction force were simultaneously recorded. Statistical comparisons were made using repeated-measures ANOVA models. Results Increasing walking speed was associated with higher cadence, longer step length, shorter stance duration, greater ankle plantarflexion, higher vertical ground reaction force peaks, and a greater loading rate (P < 0.05). Maximum (F_1,38 = 7.38, P < 0.05) and minimum (F_1,46 = 8.95, P < 0.05) ultrasound transmission velocities in the Achilles tendon were significantly lower (16–23 m·s⁻¹) during the stance but not swing phase of gait, with each increase in walking speed. Conclusions Despite higher vertical ground reaction forces and greater ankle plantarflexion, increasing walking speed resulted in a reduction in the axial transmission velocity of ultrasound in the Achilles tendon; indicating a speed-dependent reduction in tensile load within the triceps surae muscle–tendon unit during walking. These findings question the rationale for current progressive loading protocols involving the Achilles tendon, in which reduced walking speeds are advocated early in the course of treatment to lower Achilles tendon loads.

Purpose This cross-sectional study used transmission-mode ultrasound to evaluate dynamic tendon properties during walking in surgically repaired and contralateral Achilles tendon (AT), with a median (range) post-operative period of 22 (4–58) months. It was hypothesised that the axial transmission speed of ultrasound (TSOU) during walking would be slower, indicating lower material stiffness in repaired compared with contralateral AT. Methods Ten patients [median (range) age 47 (37–69) years; height 180 (170–189) cm; weight 93 (62–119) kg], who had undergone open surgical repair of the AT and were clinically recovered according to their treating clinicians, walked barefoot on a treadmill at self-selected speed (1.0 ± 0.2 m/s). Synchronous measures of TSOU, sagittal ankle motion, vertical ground reaction force (GRF), and spatiotemporal gait parameters were recorded during 20 s of steady-state walking. Paired t tests were used to evaluate potential between-limb differences in TSOU, GRF, ankle motion, and spatiotemporal gait parameters. Results TSOU was significantly lower (≈175 m/s) in the repaired than in the contralateral AT over the entire gait cycle (P < 0.05). Sagittal ankle motion was significantly greater (≈3°) in the repaired than in the contralateral limb (P = 0.036). There were no significant differences in GRF or spatiotemporal parameters between limbs. Conclusions Repaired AT was characterised by a lower TSOU, reflecting a lower material stiffness in the repaired tendon than in the contralateral tendon. A lower material stiffness may underpin greater ankle joint motion of the repaired limb during walking and long-term deficits in the muscle-tendon unit reported with AT repair. Treatment and rehabilitation approaches that focus on increasing the material stiffness of the repaired AT may be clinically beneficial. Transmission-mode ultrasound would seem useful for quantifying tendon properties post AT rupture repair and may have the potential to individually guide rehabilitation programmes, thereby aiding safer return to physical activity. Level of evidence II.

Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls). Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm’s correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen’s d values (standardised mean difference) were reported for all significant outcomes. The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p < 0.05). The stance phase duration was also significantly higher in cases compared to both control groups (p < 0.05). The main limitations of the study were the small number of cases studied and the inability to adjust analyses for multiple factors. This study shows that plantar pressures are higher in cases with active diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration.

Measurement of tendon loading patterns during physical activity is important for understanding tendon injury. Alt-hough tendon forces have been commonly estimated from direct techniques, such as implantable transducers, these methods are highly invasive and interfere with normal gait patterns. Indirect methods such as estimates based on elec-tromyography, force plates and motion analysis are more widely used but are known to overestimate tendon loads by as much as 50% compared to direct measures. This paper explores the clinical measurement of tendon properties through the use of a novel, non-invasive guided ultrasound measurement technique. The technique takes advantage of the known relationship between transmission speed of ultrasound waves and the modulus and density of the material through which it propagates. In tendon, this relationship is governed by the classic Newtonian–Laplace equation with some adjustment for Poisson’s effects in elastic media. With application of physiological tensile load to tendon, the in-stantaneous elastic modulus of tendon increases along with the axial transmission velocity of ultrasound in the tendon. Hence, the change in transmission velocity of ultrasound is related to the magnitude of load applied to the tendon. This paper summarises the findings of a series of studies peformed within our laboratory, in which the properties and loading pattern of the Achilles or patellar tendon have been measured during common physical activities in healthy adults and in patients with tendon disorders. Ultrasound transmission velocity in healthy tendon usually ranges between 1700m/s and 2200m/s during activities, such as walking or squatting, and show a highly reproducible velocity-time pattern (typi-cal within-subject CV <5%). In addition to providing new insights into the differential loading patterns in injured ten-dons and their interplay with common rehabilitation approaches, the findings also highlight the potential of guided ul-trasound transmission techniques for functional assessment and monitoring of human tendon in vivo