The role of muscle strength on tendon adaptability in old age.

PURPOSE: The purpose of the study was to determine: (1) the relationship between ankle plantarflexor muscle strength and Achilles tendon (AT) biomechanical properties in older female adults, and (2) whether muscle strength asymmetries between the individually dominant and non-dominant legs in the above subject group were accompanied by inter-limb AT size differences. METHODS: The maximal generated AT force, AT stiffness, AT Young's modulus, and AT cross-sectional area (CSA) along its length were determined for both legs in 30 women (65 ± 7 years) using dynamometry, ultrasonography, and magnetic resonance imaging. RESULTS: No between-leg differences in triceps surae muscle strength were identified between dominant (2798 ± 566 N) and non-dominant limb (2667 ± 512 N). The AT CSA increased gradually in the proximo-distal direction, with no differences between the legs. There was a significant correlation (P < 0.05) of maximal AT force with AT stiffness (r = 0.500) and Young's modulus (r = 0.414), but only a tendency with the mean AT CSA. However, region-specific analysis revealed a significant relationship between maximal AT force and the proximal part of the AT, indicating that this region is more likely to display morphological adaptations following an increase in muscle strength in older adults. CONCLUSIONS: These findings demonstrate that maximal force-generation capabilities play a more important role in the variation of AT stiffness and material properties than in tendon CSA, suggesting that exercise-induced increases in muscle strength in older adults may lead to changes in tendon stiffness foremost due to alterations in material rather than in its size.

Retention of gait stability improvements over 1.5 years in older adults: effects of perturbation exposure and triceps surae neuromuscular exercise.

The plantarflexors play a crucial role in recovery from sudden disturbances to gait. The objective of this study was to investigate whether medium (months)- or long(years)-term exercise-induced enhancement of triceps surae (TS) neuromuscular capacities affects older adults' ability to retain improvements in reactive gait stability during perturbed walking acquired from perturbation training sessions. Thirty-four adult women (65 ± 7 yr) were recruited to a perturbation training group ( n = 13) or a group that additionally completed 14 wk of TS neuromuscular exercise ( n = 21), 12 of whom continued with the exercise for 1.5 yr. The margin of stability (MoS) was analyzed at touchdown of the perturbed step and the first recovery step following eight separate unexpected trip perturbations during treadmill walking. TS muscle-tendon unit mechanical properties and motor skill performance were assessed with ultrasonography and dynamometry. Two perturbation training sessions (baseline and after 14 wk) caused an improvement in the reactive gait stability to the perturbations (increased MoS) in both groups. The perturbation training group retained the reactive gait stability improvements acquired over 14 wk and over 1.5 yr, with a minor decay over time. Despite the improvements in TS capacities in the additional exercise group, no benefits for the reactive gait stability following perturbations were identified. Therefore, older adults' neuromotor system shows rapid plasticity to repeated unexpected perturbations and an ability to retain these adaptations in reactive gait stability over a long time period, but an additional exercise-related enhancement of TS capacities seems not to further improve these effects. NEW & NOTEWORTHY Older adults' neuromotor system shows rapid plasticity to repeated exposure to unexpected perturbations to gait and an ability to retain the majority of these adaptations in reactive recovery responses over a prolonged time period of 1.5 yr. However, an additional exercise-related enhancement of TS neuromuscular capacities is not necessarily transferred to the recovery behavior during unexpected perturbations to gait in older adults.

Tibia segment deformation in response to simulated muscle forces: a cadaveric study with a novel optical segment tracking (OST) approach.

OBJECTIVES: A novel optical segment tracking (OST) approach reliant upon motion capturing was previously proposed to assess human tibia segment deformation. The purposes of the present study were to validate the OST approach and assess the contribution of muscular forces to the bone deformation in a well-defined ex vivo human model. METHODS: A custom-made Lower Extremity Loading Device (LELD) was developed to simulate physiological muscle contractions in six human cadaveric lower extremities. Tibia segment deformation was measured by tracking the relative movement between two marker clusters which were affixed into the proximal and distal tibia, respectively. RESULTS: Compared to the physiological norms, the simulated muscle forces remained at a low level. When quadriceps muscle was loaded with forces from 198 N to 505 N, posterior bending (0.12°-0.25°) and lateral bending (0.06°-0.21°) of the tibia segment were found. Large tibia bending angles were found when simulating the co-contraction of upper leg muscles and plantar flexors, and of all leg muscles, respectively. The standard deviations of the deformation angles between the repetitions remained at a low level. CONCLUSIONS: We conclude that the OST approach has the potential to be applied in vivo and quantify muscle-induced bone deformations.

In vivo measurements of human bone deformation using optical segment tracking: surgical approach and validation in a three-point bending test.

The purpose of the study was to validate optical segment tracking, a new method for in vivo human tibia deformation measurements and to assess bending in a three-point bending test. The approach relies upon optical motion capturing of reflecting marker clusters affixed to the bone via screws inserted three millimeters into the corticalis in local anesthesia. The method was tested in five healthy subjects. Screws were left in place for six to eight hours and a variety of exercises performed. A pain questionnaire was used to assess pain levels. PQCT-images were taken to locate screw holes in the bone. A three-point bending test was performed and repeatability evaluated. The new method shows good feasibility though this was previously considered impossible by many experts. Local anesthesia works for screw implantation and explantation. Results show linearity with an average of 0.25 degrees per 10 kg of weight applied with good repeatability (average variation coefficient 8%). Optical segment tracking is feasible for human in vivo bone deformation measurements. There is a variety of possible clinical and experimental applications including stability testing of osteosyntheses and joints, monitoring of bone healing, evaluation of exercises in physiotherapy, and assessment of bone deformation patterns in bone disease.

Effect of different running modes on the morphological, biochemical, and mechanical properties of articular cartilage.

Mechanical loading plays an important role not solely in cartilage development, but also in cartilage degeneration. Its adaptation behavior to mechanical loading has not been clearly delineated. The aim of the study was to examine the effect of different running modes (with different muscle contraction types) on morphological, biochemical, and mechanical properties of articular cartilage in the knee of growing rats. Thirty-six female Sprague-Dawley rats were randomly assigned into a nonactive age-matched control (AMC), level (LEVEL), and 20° downhill (DOWN) running group (n = 12 each). Running groups were trained on a treadmill for 30 min/day, 5 days/week for 6 weeks. Immunohistochemical staining and analysis of expression for collagen II, collagen IX, cartilage oligomeric matrix protein (COMP), and matrilin-3, histomorphometry of femoral cartilage height and femoral COMP staining height, and indentation testing of tibial articular cartilage were performed. Rats subjected to downhill running showed a significantly (P = 0.015) higher COMP staining height and a tendentially (P = 0.084) higher cartilage height in the high-weight bearing area of femoral articular cartilage. Cartilage thickness, mechanical properties, and expression of cartilage network proteins in tibial cartilage remained unaffected by different running modes. Our data suggest that joint loading induced by eccentric muscle contractions during downhill running may lead to a site-specific adaptation.

The HEPHAISTOS study: compliance and adherence with a novel orthotic device for calf muscle unloading.

The present manuscript seeks to discuss methodological aspects regarding the application of the novel unloading orthosis 'HEPHAISTOS' that has been specifically developed to study physiological effects of muscular unloading without altering the impact of gravitational loading. The 'HEPHAISTOS' has been applied in an ambulatory clinical interventional study. During gait, the 'HEPHAISTOS' significantly reduces activation and force production of calf muscles while it completely retains body mass-related force on the tibia. Eleven healthy male subjects participated in the study and followed their normal everyday lives while wearing the orthosis. Several measurement sessions have been performed to investigate the time course of structural and functional adaptations during intervention and recovery. Follow-up measurements were performed for one year after the intervention. In consideration of the experiences of a unique ambulant unloading study, organizational and methodological recommendations are discussed in this manuscript. Activity monitoring data obtained with portable accelerometers reveal unchanged gait activities and good subject compliance throughout the intervention. Moreover, electromyography (EMG) and motion data investigating gait properties on reambulation day are illustrated. These data show that during the initial steps following removal of 'HEPHAISTOS', gait was significantly asynchronous indicating an acutely altered motor control in the unloaded lower leg muscles.

The Essex-Lopresti lesion.

The Essex-Lopresti lesion represents a severe injury of the forearm unit. In the 1940s, it's pathology and consequences have already been mentioned by several authors. Over the course of time, the pathophysiology of the lesion was displayed in more detail. Therefore, an intensive analysis of the involved anatomic structures was done. The interosseous membrane was shown to play a major role in stabilising the forearm unit, in the situation of a fractured radial head, which is the primary stabiliser of the longitudinal forearm stability. Moreover, biomechanical analyses showed a relevant attribution of the distal radio-ulnar joint to the forearm stability. If, in the case of a full-blown Essex-Lopresti lesion, the radial head, the interosseous membrane and the distal radio-ulnar joint are injured, proximalisation of the radius will take place and will come along with secondary symptoms at the elbow joint and the wrist. According to actual studies, the lesion seems to occur more often than realised up to now. Thus, to avoid missing the complex injury, subtle clinical diagnosis combined with adequate imaging has to be undertaken. If the lesion is confirmed, several operative treatment options are available, yet not proofed to be sufficient.

[Braking capacity after hip arthroplasty - effect of prosthesis design and preoperative status]. / Bremsfähigkeit von Patienten nach endoprothetischer Versorgung des Hüftgelenks - Einfluss von Prothesendesign und präoperativem Status.

BACKGROUND: Driving a car is an important everyday activity. However, the patients' desire to resume driving at an early stage after hip arthroplasty is often faced by the uncertainty about their driving ability. Only little evidence is available to support the clinical decision-making with regard to driving competence after conventional total hip arthroplasty (THA). However, there is no proof that the results observed after THA can be transferred to hip resurfacing arthroplasty (HRA) patients. Due to physiological advantages, i.e., patient age and activity, as well as the special biomechanical implant characteristics, HRA patients could be expected to achieve normal braking capacity at an earlier stage in the rehabilitation process than THA patients. This could be achieved by an accelerated postoperative recovery or could depend on the preoperative vantage point concerning the patients' braking capacity. PATIENTS AND METHODS: To verify this hypothesis HRA and THA patients were compared to healthy subjects concerning their ability to perform an emergency braking manoeuvre in a car simulator before surgery, and at 6 weeks and 3 months after operation. Furthermore, postoperative recovery rates were compared between the two groups of patients. In addition, correlations between pre- and postoperative braking capacity were tested. Reaction time, movement time and force-time integral on the brake pedal were analysed. RESULTS: Except for a deficient preoperative force-time integral, no significant differences were detected in HRA patients compared to healthy controls. In contrast THA patients required, pre- as well as postoperatively, a longer movement time and exhibited a smaller force-time integral. The two patient groups did not show any significant difference in recovery rates of movement time and force-time integral. However, considering the two patient groups as a whole, a significant correlation was detected between existing pre- and postoperative deficits. CONCLUSION: In conclusion, it can be confirmed that HRA patients resume normal braking capacity at an earlier stage in their rehabilitation process than THA patients. Patients recommended for HRA recover braking capacity at the latest six weeks after surgery. This capacity clearly depends on the better preoperative status of the HRA patients and is not determined by a faster recovery rate. General patient-related advantages as well as biomechanical aspects of HRA have thus no influence on the recovery rates of braking capacity during the first three months after surgery. Due to the increasing outpatient rehabilitation regime after HRA, further studies are necessary to detect the turning point after surgical impairment within the first six weeks after surgery. Concerning the THA patients we recommend a longer safety distance when driving a car for up to three months after the operation. However, patients, especially those assigned to THA, should be made aware of their most likely already existing preoperative deficit. For clinical practice a rough estimation of postoperative braking capacity seems to be possible based on group assignment (HRA/THA). Nevertheless, deviators cannot be detected by this group classification. As driving simulator systems usually are not available in hospitals, a more accurate prognosis, i.e., based on established clinical scores, would be helpful.

Deformational behaviour of knee cartilage and changes in serum cartilage oligomeric matrix protein (COMP) after running and drop landing.

OBJECTIVE: To investigate (1) the effect of running and drop landing interventions on knee cartilage deformation and serum cartilage oligomeric matrix protein (COMP) concentration and (2) if the changes in cartilage volume correlate with the changes in serum COMP level. METHODS: Knee joint cartilage volume and thickness were determined using magnetic resonance imaging (MRI) as well as COMP concentration from serum samples before and after in vivo loading of 14 healthy adults (seven male and seven female). Participants performed different loading interventions of 30 min duration on three different days: (1) 100 vertical drop landings from a 73 cm high platform, (2) running at a velocity of 2.2m/s (3.96 km), and (3) resting on a chair. Blood samples were taken immediately before, immediately after and 0.5h, 1h, 2h and 3h post intervention. Pre- and post-loading coronal and axial gradient echo MR images with fat suppression were used to determine the patellar, tibial and femoral cartilage deformation. RESULTS: Serum COMP levels increased immediately after the running (+30.7%, pre: 7.3U/l, 95% confidence interval (CI): 5.6, 8.9, post: 9.1U/l, 95% CI: 7.2, 11.0, P=0.001) and after drop landing intervention (+32.3%, pre: 6.8U/l, 95% CI: 5.3, 8.4; post: 8.9U/l, 95% CI: 6.8, 10.9, P=0.001). Cartilage deformation was more pronounced after running compared to drop landing intervention, with being significant (volume: P=0.002 and thickness: P=0.001) only in the lateral tibia. We found a significant correlation (r(2)=0.599, P=0.001) between changes in serum COMP (%) and in cartilage volume (%) after the drop landing intervention, but not after running. CONCLUSIONS: In vivo exercise interventions differentially regulate serum COMP concentrations and knee cartilage deformations. The relation between changes in COMP and in cartilage volume seems to depend on both mechanical and biochemical factors.

What do we currently know from in vivo bone strain measurements in humans?

Bone strains are the most important factors for osteogenic adaptive responses. During the past decades, scientists have been trying to describe the relationship between bone strain and bone osteogenic responses quantitatively. However, only a few studies have examined bone strains under physiological condition in humans, owing to technical difficulty and ethical restrictions. The present paper reviews previous work on in vivo bone strain measurements in humans, and the various methodologies adopted in these measurements are discussed. Several proposals are made for future work to improve our understanding of the human musculoskeletal system. Literature suggests that strains and strain patterns vary systematically in response to different locomotive activities, foot wear, and even different venues. The principal compressive, tension and engineering shear strain, compressive strain rate and shear strain rate in the tibia during running seem to be higher than those during walking. The high impact exercises, such as zig-zag hopping and basketball rebounding induced greater principal strains and strain rates in the tibia than normal activities. Also, evidence suggests an increase of tibia strain and strain rate after muscle fatigue, which strongly supports the opinion that muscle contractions play a role on the alteration of bone strain patterns.

Relative movements between the tibia and femur induced by external plantar shocks are controlled by muscle forces in vivo.

The purpose of this study was to investigate the role of muscle activation on the relative motion between tibia and femur. Impacts were initiated under the heels of four volunteers in three different activation levels of muscles crossing the extended knee joint: 0%, 30% and 60% of previously performed maximal voluntary isometric contractions. Impact forces were measured and tibial and femoral accelerations and displacements were determined by means of accelerometry. The accelerometers were mounted on the protruding ends of intracortical pins, inserted into the distal aspect of the femur and proximal aspect of the tibia. Under the 0%-condition the impact force (475±64N) led to 2.3±1.2mm knee compression and to 2.4±1.9mm medio-lateral and 4.4±1.1mm antero-posterior shear. The impact forces increased significantly with higher activation levels (619±33N (30%), 643±147N (60%)), while the knee compression (1.5±1.2, 1.4±1.3mm) and both medio-lateral shear (1.8±1.4, 1.5±1.1mm) and antero-posterior shear (2.6±1.3, 1.5±1.1mm) were significantly reduced. This study indicated that muscles are effective in controlling the relative motion between tibia and femur when the knee is subjected to external forces.

Different mechanical loading protocols influence serum cartilage oligomeric matrix protein levels in young healthy humans.

The purpose of the study was to investigate whether a relationship between the loading mode of physical activity and serum cartilage oligomeric matrix protein (COMP) concentration exists and whether the lymphatic system contributes to COMP release into the serum. Serum COMP levels were determined in healthy male subjects before, after and at 18 further time points within 7 h at four separate experimental days with four different loading interventions. The loading intervention included high impact running exercise, slow but deep knee bends, and lymphatic drainage of 30 min duration, respectively, and a resting protocol. The serum COMP levels were measured using a commercially available quantitative enzyme-linked immunosorbent assay. An increase (p < 0.001) in serum COMP concentration was detected immediately after 30 min running exercise. Slow but deep knee bends did not cause any significant changes in serum COMP levels. Lymphatic drainage also had no effect on the serum COMP concentration. After 30 min of complete rest the serum COMP level was significantly (p = 0.008) reduced. The elevation of COMP serum concentration seems to depend on the loading mode of the physical activity and to reflect the extrusion of COMP fragments from the impact loaded articular cartilage or synovial fluid.

Altered squat jumping mechanics after specific exercise.

This study examined squat jumping (SJ) mechanics following length restricted strength training regimens of the knee extensors and flexors. SJ from a 110 degrees knee joint angle starting position and isometric moment-knee angle relations of knee extensors and flexors were analysed in 16 athletes before and directly after 8 weeks of strength training regimens that were restricted to knee joint angles corresponding to long muscle-tendon unit (MTU) length for the knee extensors and flexors. SJ mechanics were studied using a two-dimensional kinematic model with three rigid bodies (upper leg, lower leg, foot) in combination with force plates measurements of ground reaction force in the right and left lower extremity. Centre of mass jumping height significantly (p<0.05) increased post training, but this was not explained by enhanced absolute power generation in the knee joint. However, post training small but significant (p<0.05) shifts to smaller knee joint angles occurred in the normalized [% Max.] knee joint angle dependent power generation in the right and left knee joint during SJ. The isometric moment-knee angle relation of the knee extensors was also significantly (p<0.05) shifted to longer MTU lengths of knee extensors. Length restricted strength training may alter the mechanical situation during both isometric contractions and dynamic athletic movements.

Moment-angle relations after specific exercise.

This study examined the amount and time-course of shifts in the moment-knee angle relation of the quadriceps (QF) and hamstring (HAM) muscles in response to different length-restricted strength training regimens. Thirty-two athletes were divided into three different training groups (G1-3): G1 performed isometric training at knee joint angles corresponding to long muscle-tendon unit (MTU) length for QF and HAM; G2 conducted concentric-eccentric contraction cycles that were restricted to a knee joint range of motion corresponding to predominantly long MTU length for QF and HAM; G3 combined the protocols of G1 and G2. Moment-knee angle and EMG-knee angle relations of QF and HAM were measured on five different occasions: two times before, after five and eight weeks of training and four weeks post training. Moments and EMG-data of each subject were normalized to the largest value produced at any knee joint position [% Max.]. Obtained by curve fitting, the optimal knee joint angle for QF moment production was significantly (P<0.05) shifted to longer MTU length in G1 and G3 after 5 weeks of training and in G2 after 8 weeks of training. Contrary, no significant shifts were detected for HAM. Our data suggest that the predominant MTU length during loading is a major trigger for human force-length adaptations.

Motor task and muscle strength followed different adaptation patterns after anterior cruciate ligament reconstruction.

AIM: The aims of this study were: 1) to investigate the adaptations in walking, running and muscle strength after anterior cruciate ligament (ACL) reconstruction and 2) to examine the interaction between muscle strength and walking or running kinematics at different time intervals following an ACL reconstruction. METHODS: Eleven patients 3-6 months postsurgery, 11 patients 6-12 months postsurgery and 13 patients 12-24 months post surgery were filmed using two cameras (50 Hz) whilst walking (1 m/s) and running (2.5 m/s) on a treadmill. In addition, the strength of the muscles surrounding the knee, hip and ankle joints was tested using an isokinetic protocol (60 degrees/s). RESULTS: The comparison between the injured and the non-injured limbs revealed significant lower knee extension and flexion angles during the stance phase of the injured limb (P<0.05). This was found in the 3-6 month postsurgery period when walking and running and in the 6-12 month postsurgery period when mainly running. The analysis of the muscle strength revealed lower (P<0.05) maximal joint moments for the knee extensors, the knee flexors and the hip flexors of the injured limb during all the observed post surgery periods. CONCLUSION: The results of this study indicate that the adaptation of the motor task and the muscle strength follows different time patterns. This suggests that a decrease in muscle strength capabilities can be tolerated up to a certain extent by the patients when walking and during sub maximal running. However, when the decrease in muscle strength exceeds a certain threshold the biological system, being flexible, changes its locomotion strategy.

[Graft type-related versus graft type-unrelated ACL treatment: influence on adaptation of muscle strength and motor skills]. / Ersatzplastikabhängige vs. nicht ersatzplastikabhängige ACL-Behandlung. Einfluss auf die Adaptation der Muskelkräfte und den motorischen Aufgaben.

INTRODUCTION: The purposes of this study were to identify adaptational phenomena in running and walking characteristics as well as in muscle strength after an ACL injury and graft-type related ACL treatment in order to determine the effect of the different treatments on the regeneration of muscle capacity and functional motor skills for a given task. METHOD: The investigation was conducted on 11 patients with patella reconstructions (PT: patella tendon), 12 patients with semitendinosus reconstruction (ST: semitendinosus tendon) and 10 patients without reconstruction. Besides a clinical examination, the subject's walking (1 m/s) and running (2.5 m/s) characteristics were recorded by 2 cameras operating at 50 Hz. During the same test session, we determined the force potential of the muscles surrounding the hip, knee and ankle joints during isokinetic contractions. RESULTS: The comparison between injured and non-injured limbs revealed significant changes (p<0.05) only for the injured limb. For both types of reconstruction treatment the injured limb showed a significantly lower maximal knee extension joint moment as well as a lower angular displacement of the knee joint during the stance phase while walking and running (p<0.05). Furthermore, patients with PT reconstruction showed lower maximal knee flexion and hip flexion joint moments, and a lower angular displacement of the knee joint in flexion during the stance phase while running (p<0.05). The ratios of the maximal isokinetic knee extension moments between the injured and non injured limbs were lower for the reconstruction treatment compared to the treatment without reconstruction and further lower for the PT reconstructed compared to the ST reconstructed patients (p<0.05). CONCLUSIONS: The findings of the present study indicate that, using a similar regeneration programme, the muscle capacities and functional motor skills show faster regeneration processes for patients without reconstruction compared to a reconstruction treatment after an ACL injury. Concerning the reconstruction treatment, PT reconstructions seem to affect the degeneration process of the muscle capacities of the treated limb more than ST reconstructions.

[Grading of the functional sport shoe parameter "cushioning" and "forefoot flexibility" on running shoes]. / Gradierung der funktionellen Sportschuhparameter "Dämpfung" und "Vorfussflexibilität" am Laufschuh.

On nearly every running event a heterogeneous structure of participants regarding body height and body weight can be observed. This study should figure out whether the running shoe manufacturers will consider this anthropometric variability. Moreover it should be investigated the runners needs based on different anthropometrics regarding preferred cushioning and forefoot flexibility properties. In order to check whether the running shoe manufacturers will apply a grading pattern, a dynamic material study with conventional running shoes in different sizes was conducted. In a second step a field study in Middle Europe and North America with 244 female and 227 male runners was organized. Every subject had to run and evaluate 7 different shoe modifications. Based on the material study it is to state, that the running shoe manufacturers currently do not consider a systematic grading of cushioning and forefoot flexibility properties. In contrast to this, the field study reveals the necessity to grade these properties. A shoe size dependent and a geographic grading concept are suggested. It is supposed, that the application of these grading concepts do not only provide a comfort improvement, but they also contribute to a reduction of joint loads of the lower extremities and consequently to a prevention of overuse injuries.

Modulation of mechanical and muscular load by footwear during catering.

The BGN (Berufsgenossenschaft Nahrungsmithl und Gaststätten) reports 70% of job induced days off work to be connected with traumas of the ankle joint or overloading of the leg, knee and lower back, with an increased incidence in service areas outdoors (R. Grieshaber, personal communication). Workspace environments usually contain narrow passages, slopes or stairs and sudden changes between different surfaces. The aim of this study was to investigate the biomechanical load on the lower extremity and the low back during catering service when wearing different types of footwear. Thus, the potential for altering mechanical stress experienced during catering by variations in footwear was explored. Sixteen experienced waiters followed a course typical for a combined indoor-outdoor service area. Three different types of footwear were investigated using pressure distribution measurements, rearfoot goniometry and electromyography. A discriminant analysis revealed that the factors subject, shoe and surface affect rear foot movement or pressure distribution in different ways. A MANOVA demonstrated significant differences in loading parameters between footwear types. In general, these differences increased in magnitude in critical situations, such as climbing stairs or crossing slippery surfaces. The results of this study demonstrate that manipulations to footwear offer a great potential for modulating loads experienced during catering. Based on the results, the effects of constructional features are discussed. The method proposed can be applied to evaluate shoe modifications under realistic workplace conditions.

Strain and elongation of the human gastrocnemius tendon and aponeurosis during maximal plantarflexion effort.

Regarding the strain and elongation distribution along the tendon and aponeurosis the literature is reporting different findings. Therefore, the purpose of this study was to examine in vivo the elongation and the strain of the human gastrocnemius medialis tendon and aponeurosis simultaneously at the same trial during maximal voluntary plantarflexion efforts. Twelve subjects participated in the study. The subjects performed isometric maximal voluntary contractions of their left leg on a Biodex-dynamometer. The kinematics of the leg were recorded using the Vicon 624 system with 8 cameras operating at 120 Hz. Two ultrasound probes were used to visualise the tendon (myotendinous junction region) and the distal aponeurosis of the gastrocnemius medialis respectively. The main findings were: (a) the absolute elongation of the gastrocnemius medialis tendon was different to that of the aponeurosis, (b) the strain of the gastrocnemius medialis tendon did not differ from the strain of the aponeurosis, (c) during the "isometric" plantarflexion the ankle angle exhibited significant changes, and (d) the non-rigidity of the dynamometer arm-foot system and the coactivity of the tibialis anterior both have a significant influence on the moment exerted at the ankle joint. Thus the strain of the human gastrocnemius medialis tendon and aponeurosis estimated in vivo using two-dimensional ultrasonography is uniform. To calculate the elongation of the whole tendon it is necessary to multiply the strain calculated for the examined part of the tendon by the total length of the tendon.