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Caroline Nicol and Paavo V. Komi

Magnitude of the reflex contribution to force enhancement was investigated in vivo during passive stretches of the Achilles tendon (AT) of one female subject. Thirty passive (5 × 6) dorsiflexions were induced by a motorized ankle ergometer. Achilles tendon force (ATF) was sensed by a buckle transducer applied surgically around the right AT. Single passive stretches resulted in a low but rather linear ATF increase in the absence of EMG (surface electrodes) activity. In the presence of reflexes, a clear ATF enhancement occurred 13–15 ms after the beginning of the EMG reflex responses. In double dorsiflexions at either 1.2 or 1.9 rad · s-1, which were separated by a maintained stretched position of either 40 or 90 ms, the first stretch resulted in initial linear ATF increase, followed by an additional force enhancement during the plateau phase. This reflexly induced increase represented 94 ± 4 N and 184 ± 1 N, respectively, for the 40 and the 90 ms plateaus, corresponding to 210 ± 85% and 486 ± 177% enhancements as compared to the first passive stretch effect. The results suggest further that timing of the stretch during the twitch response influences the magnitude and rate of force potentiation.

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Robert A. Weinert-Aplin, Anthony M.J. Bull and Alison H. McGregor

Conservative treatments such as in-shoe orthotic heel wedges to treat musculoskeletal injuries are not new. However, weak evidence supporting their use in the management of Achilles tendonitis suggests the mechanism by which these heel wedges works remains poorly understood. It was the aim of this study to test the underlying hypothesis that heel wedges can reduce Achilles tendon load. A musculoskeletal modeling approach was used to quantify changes in lower limb mechanics when walking due to the introduction of 12-mm orthotic heel wedges. Nineteen healthy volunteers walked on an inclinable walkway while optical motion, force plate, and plantar pressure data were recorded. Walking with heel wedges increased ankle dorsiflexion moments and reduced plantar flexion moments; this resulted in increased peak ankle dorsiflexor muscle forces during early stance and reduced tibialis posterior and toe flexor muscle forces during late stance. Heel wedges did not reduce overall Achilles tendon force during any walking condition, but did redistribute load from the medial to lateral triceps surae during inclined walking. These results add to the body of clinical evidence confirming that heel wedges do not reduce Achilles tendon load and our findings provide an explanation as to why this may be the case.

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Feng-Hua Tsai, I-Hua Chu, Chun-Hao Huang, Jing-Min Liang, Jia-Hroung Wu and Wen-Lan Wu

investigate the effects of different types of taping (AT-Ankle, AT-Achilles, KT-Achilles) on functional performance and changes in Achilles tendon force (ATF) and EMG activities in kendo athletes. We hypothesize that (1) taping will influence the jump distance. A longer jump distance could provide a wider

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Dominic James Farris, Erica Buckeridge, Grant Trewartha and Miranda Polly McGuigan

This study assessed the effects of orthotic heel lifts on Achilles tendon (AT) force and strain during running. Ten females ran barefoot over a force plate in three conditions: no heel lifts (NHL), with 12 mm heel lifts (12HL) and with 18 mm heel lifts (18HL). Kinematics for the right lower limb were collected (200 Hz). AT force was calculated from inverse dynamics. AT strain was determined from kinematics and ultrasound images of medial gastrocnemius (50 Hz). Peak AT strain was less for 18HL (5.5 ± 4.4%) than for NHL (7.4 ± 4.2%) (p = .029, effect size [ES] = 0.44) but not for 12HL (5.8 ± 4.8%) versus NHL (ES = 0.35). Peak AT force was significantly (p = .024, ES = 0.42) less for 18HL (2382 ± 717 N) than for NHL (2710 ± 830 N) but not for 12HL (2538 ± 823 N, ES = 0.21). The 18HL reduced ankle dorsiflexion but not flexion-extension ankle moments and increased the AT moment arm compared with NHL. Thus, 18HL reduced force and strain on the AT during running via a reduction in dorsiflexion, which lengthened the AT moment arm. Therefore, heel lifts could be used to reduce AT loading and strain during the rehabilitation of AT injuries.

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Herman van Werkhoven and Stephen J. Piazza

Scholz and colleagues, 4 we hypothesized a negative correlation between peak Achilles tendon force estimated during running and heel length. Lastly, we hypothesized that toe length would correlate positively with metabolic cost as shorter toes would afford less leverage to the GRF in terminal stance

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Sharon J. Dixon and David G. Kerwin

In this study, a modeling method was developed to estimate Achilles tendon forces in running. Owing to the common use of heel lift devices in the treatment of Achilles tendon injury, we investigated the influence of increased heel lift on Achilles tendon loading. The hypothesis was that heel lift manipulation can influence maximum Achilles tendon force. Responses to heel lift variation were found to differ among 3 elite runners demonstrating distinct running styles. A rearfoot and a midfoot striker demonstrated significant increases in maximum Achilles tendon force with increased heel lift, whereas a forefoot striker demonstrated no changes in maximum Achilles tendon force values with heel lift manipulation (p < .05). Analysis of the factors contributing to the observed changes in maximum Achilles tendon force highlighted the influence of the moment arm of ground reaction force and the moment arm of the Achilles tendon about the ankle joint center. The finding that increased heel lift may increase maximum Achilles tendon force suggests that caution is advised in the routine use of this intervention. The different responses to heel lift increase between subjects highlight the importance of classifying subjects based on running style.

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Sharon J. Dixon and David G. Kerwin

This study investigated the influence of heel lift interventions on the loading of the Achilles tendon for heel-toe runners. It was hypothesized that the peak Achilles tendon force and peak rate of loading would be reduced by the increase in heel lift, and that the peak Achilles tendon force would occur significantly later in stance. Achilles tendon forces were determined by calculating sagittal-plane ankle joint moments using inverse-dynamics techniques and dividing these moments by Achilles tendon moment arm lengths. Methods for estimating Achilles tendon moment arm length using skin markers were justified via MRI data for one participant. Seven participants underwent running trials under three heel lift conditions: zero, 7.5-mm, and 15-mm heel lift. Average magnitude and occurrence time of peak Achilles tendon force and peak rate of loading were determined for each condition over the 7 participants. Despite group reductions in peak Achilles tendon force and peak rate of loading for the increased heel lift conditions, statistical analysis (ANOVA) revealed no significant differences for these variables, p > 0.05. Individual participant observations highlighted varied responses to heel lift; both increases and decreases in peak Achilles tendon force were observed. For the group data, the time of peak impact force occurred significantly later in the 15-mm heel lift condition than in the zero heel lift, p < 0.05. It is suggested that the success of increased heel lift in treating Achilles tendon injury may be due to a later occurrence of peak Achilles tendon force in response to this intervention, reducing Achilles tendon average rate of loading. In addition, the individuality of Achilles tendon peak force changes with heel lift intervention highlights the need for individual participant analysis.

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Laurence Houghton, Brian Dawson and Jonas Rubenson

Effects of prolonged running on Achilles tendon properties were assessed after a 60 min treadmill run and 140 min intermittent shuttle running (simulated cricket batting innings). Before and after exercise, 11 participants performed ramp-up plantar flexions to maximum-voluntary-contraction before gradual relaxation. Muscle-tendon-junction displacement was measured with ultrasonography. Tendon force was estimated using dynamometry and a musculoskeletal model. Gradients of the ramp-up force-displacement curves fitted between 0–40% and 50–90% of the preexercise maximal force determined stiffness in the low- and high-force-range, respectively. Hysteresis was determined using the ramp-up and relaxation force-displacement curves and elastic energy storage from the area under the ramp-up curve. In simulated batting, correlations between tendon properties and shuttle times were also assessed. After both protocols, Achilles tendon force decreased (4% to 5%, P < .050), but there were no changes in stiffness, hysteresis, or elastic energy. In simulated batting, Achilles tendon force and stiffness were both correlated to mean turn and mean sprint times (r = −0.719 to −0.830, P < .050). Neither protocol resulted in fatigue-related changes in tendon properties, but higher tendon stiffness and plantar flexion force were related to faster turn and sprint times, possibly by improving force transmission and control of movement when decelerating and accelerating.

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Saira Chaudhry, Dylan Morrissey, Roger C. Woledge, Dan L. Bader and Hazel R.C. Screen

Triceps surae eccentric exercise is more effective than concentric exercise for treating Achilles tendinopathy, however the mechanisms underpinning these effects are unclear. This study compared the biomechanical characteristics of eccentric and concentric exercises to identify differences in the tendon load response. Eleven healthy volunteers performed eccentric and concentric exercises on a force plate, with ultrasonography, motion tracking, and EMG applied to measure Achilles tendon force, lower limb movement, and leg muscle activation. Tendon length was ultrasonographically tracked and quantified using a novel algorithm. The Fourier transform of the ground reaction force was also calculated to investigate for tremor, or perturbations. Tendon stiffness and extension did not vary between exercise types (P = .43). However, tendon perturbations were significantly higher during eccentric than concentric exercises (25%–40% higher, P = .02). Furthermore, perturbations during eccentric exercises were found to be negatively correlated with the tendon stiffness (R 2 = .59). The particular efficacy of eccentric exercise does not appear to result from variation in tendon stiffness or extension within a given session. However, varied perturbation magnitude may have a role in mediating the observed clinical effects. This property is subject-specific, with the source and clinical timecourse of such perturbations requiring further research.

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Tijs Delabastita, Stijn Bogaerts and Benedicte Vanwanseele

. Antagonistic activation Was antagonistic muscle activation taken into account in the Achilles tendon force calculations?  6. Synergistic activation Was muscle activation of different plantar flexor muscles taken into account in the Achilles tendon force calculations?  7. Moment arm measured Was the plantar