Search Results (321)

Objective: This study aimed to investigate whether the subjective assessments of strong and weak muscles in the Functional Myodiagnosis muscle test (FMD-MT) can be objectively and reproducibly verified using physically measurable parameters. Additionally, we sought to evaluate the reliability of the manual muscle test in order to reinforce the scientific evidence supporting this accepted, yet not widely adopted, complementary medicine method. Methods: In a crossover observational study, three experienced medical practitioners conducted the FMD-MT of the rectus femoris muscle on 24 healthy participants using a specially designed therapy bench, with all measurements recorded via an oscillogram. The study investigated the force–time integral, joint angle change, additional force load, mean force turning point 1, as well as the interrater reliability and validity of both examiner assessments and instrumental analyses for the two muscle reaction variants: strong and weak. Results: A significant difference between the response pattern of strong and weak muscles was identified for the force–time integral (p = 0.005), the change in joint angle (p < 0.001), and the additional force load (p = 0.001). No difference between strong and weak muscles could be detected regarding the force turning point 1 (p = 0.972). The examiners demonstrated 100% accuracy in identifying weak muscle reactions as weak, and 99.2% accuracy in identifying strong muscle reactions as strong (p = 0.316). The overall intra-class correlation coefficient was 0.984. The oscillogram correctly visualized weak muscle reactions in weak muscles with an accuracy of 81.7%, and strong muscle reactions in strong muscles with an accuracy of 86.7% (p = 0.289). Conclusions: The Functional Myodiagnosis muscle test (FMD-MT) enables a clear and objective differentiation between strong and weak muscles, with statistically significant differences observed in the force–time integral, additional force load, and joint angle changes. Under rigorously standardized testing conditions, the FMD-MT of the rectus femoris muscle demonstrates a validity rate of 99.6% and an excellent reliability (ICC 0.984). Consequently, the FMD muscle test proves to be a reliable, reproducible, and objective diagnostic method. Trial registration: German Register of Clinical Studies U1111-1212-6622. Full article

This study aims to investigate asymmetries in muscle activation and co-contraction of main lower limb muscles during flamenco Zap-3 footwork with consideration of the footwork speed and dancer proficiency. Twelve flamenco dancers participated, including six professionals and six amateurs. Each participant performed the Zap-3 sequence under three speed conditions: 160 beats per minute (bpm), 180 bpm and the fastest speed level (F). The normalized surface electromyography was recorded in the gastrocnemius medialis (GM), biceps femoris (BF), tibialis anterior (TA) and rectus femoris (RF) in the dominant (DL) and non-dominant leg (NDL). The co-contraction index was also calculated for selected muscle pairs. The results showed that significant asymmetries occurred only in professional dancers and exclusively at the F speed level. Specifically, the value of the GM in the NDL was higher than that of the DL (p < 0.05, d = 1.97); the value of the BF in the DL was higher than that of the NDL (p < 0.05, d = 1.86) and the co-contraction index of BF/RF in the DL was higher than that of the NDL (p < 0.05, d = 1.87). Understanding these asymmetries may help to inform individualized training strategies aimed at optimizing performance and reducing potential risks. Full article

Background: Ultrasound (U/S) can be used to evaluate skeletal muscle characteristics in clinical and sports settings. Handheld U/S devices have recently emerged as a cheaper and portable alternative to conventional U/S systems. However, further research is warranted on their reliability. We assessed the reliability and inter-device agreement between a handheld U/S device (Clarius L15 HD₃) and a more conventional U/S system (GE LOGIQ e) for measuring the thickness of the rectus femoris (RF) and vastus intermedius (VI). Methods: Cross-sectional images of the RF and VI muscles were obtained in 20 participants by two assessors, and on two separate occasions by one of those assessors, using the Clarius L15 HD₃ and GE LOGIQ e devices. RF and VI thickness measurements were obtained to determine the intra-rater reliability, inter-rater reliability, and inter-device agreement. Results: All intraclass correlation coefficients (ICCs) were above 0.9 for intra-rater reliability (range: 0.94 to 0.97), inter-rater reliability (ICC: 0.97), and inter-device agreement (ICC: 0.98) when comparing the two devices in assessing RF and VI thickness. For the RF, the Bland–Altman plot revealed a mean difference of 0.06 ± 0.07 cm, with limits of agreement ranging from 0.21 to −0.09, whereas for the VI, the Bland–Altman plot showed a mean difference of 0.07 ± 0.10 cm, with limits of agreement ranging from 0.27 to −0.13. Conclusions: The handheld Clarius L15 HD₃ was reliable and demonstrated high agreement with the more conventional GE LOGIQ e for assessing the thickness of the RF and VI in young, healthy adults. Full article

Introduction: Sarcopenia is a systemic condition linked to increased morbidity and mortality in older adults. Point-of-Care Ultrasound (POCUS) offers a rapid, bedside method to assess muscle mass. This study evaluates the diagnostic accuracy of POCUS compared to Dual-energy X-ray Absorptiometry (DXA), the gold standard method, and explores its prognostic value in old patients undergoing surgery for hip fractures. Patients and Methods: In this prospective, single-center study, 126 patients aged ≥ 70 years and hospitalized with hip fractures were included. Sarcopenia was defined according to the revised 2018 EWGSOP2 criteria. Muscle mass was assessed by the Appendicular Skeletal Muscle Mass Index (ASMI) using DXA and by the thickness of the rectus femoris (RF) muscle using POCUS. Results: Of the 126 included patients, 52 had both DXA and POCUS assessments, and 43% of them met the diagnostic criteria for sarcopenia or severe sarcopenia. RF muscle thickness measured by POCUS was significantly associated with ASMI (R² = 0.30; p < 0.001). POCUS showed a fair diagnostic accuracy in women (AUC 0.652) and an excellent accuracy in men (AUC 0.905). Optimal diagnostic thresholds according to Youden’s index were 5.7 mm for women and 9.3 mm for men. Neither RF thickness, ASMI, nor sarcopenia status predicted mortality or major postoperative complications. Conclusions: POCUS is a promising, accessible tool for diagnosing sarcopenia in old adults with hip fractures. Nonetheless, its prognostic utility remains uncertain and should be further evaluated in long-term studies. Full article

Background: Persistent neuromuscular deficits following anterior cruciate ligament reconstruction (ACLR) are frequently attributed to arthrogenic muscle inhibition (AMI). The type of autologous graft used may influence the trajectory of neuromuscular recovery. Objective: To investigate the influence of graft type—bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT)—on the contractile properties of periarticular knee muscles over a 9-month post-operative period. Hypothesis: Each graft type would result in distinct recovery patterns of muscle contractility, as measured by tensiomyography (TMG). Methods: Thirty-one patients undergoing ACLR with BPTB (n = 8), HT (n = 12), or QT (n = 11) autografts were evaluated at 3, 6, and 9 months post-operatively. TMG was used to measure contraction time (Tc) and maximal displacement (Dm) in the rectus femoris, vastus medialis, vastus lateralis, and biceps femoris. Results: Significant within-group improvements in Tc and Dm were observed across all graft types from 3 to 9 months (Tc: p < 0.001 to p = 0.02; Dm: p < 0.001 to p = 0.01). The QT group showed the most pronounced Tc reduction in RF (from 30.16 ± 2.4 ms to 15.44 ± 1.6 ms, p < 0.001) and VM (from 31.05 ± 2.6 ms to 18.65 ± 1.8 ms, p = 0.004). In contrast, HT grafts demonstrated limited Tc recovery in BF between 6 and 9 months compared to BPTB and QT (p < 0.001), indicating a stagnation phase. BPTB exhibited persistent bilateral deficits in both quadriceps and BF at 9 months. Conclusions: Autograft type significantly influences neuromuscular recovery patterns after ACLR. TMG enables objective, muscle-specific monitoring of contractile dynamics and may support future individualized rehabilitation strategies. Full article

In this study, the effects of walking speed on lower limb muscle activity and gait parameters during over-ground walking were investigated in individuals with chronic stroke. Twenty-four patients with chronic stroke participated in a cross-sectional repeated-measures study, walking 20 m at three different speeds: slow (80% of self-selected speed), self-selected, and maximal speed. Surface electromyography was used to measure muscle activity in five paretic-side muscles (rectus femoris, biceps femoris, tibialis anterior, gastrocnemius, and gluteus medius), while gait parameters, including stride length, stance and swing phases, single-limb support time, and the gait asymmetry index were assessed using a triaxial accelerometer. As walking speed increased, activity in the rectus femoris, biceps femoris, and gastrocnemius muscles significantly increased during the stance and swing phases (p < 0.05), whereas the gluteus medius activity tended to decrease. Stride length on the paretic and non-paretic sides significantly increased with faster walking speed (p < 0.05); however, no significant improvements were observed in other gait parameters or gait asymmetry. These findings suggest that although increasing walking speed enhances specific muscle activities, it does not necessarily improve overall gait quality or symmetry. Therefore, rehabilitation programs should incorporate multidimensional gait training that addresses speed and neuromuscular control factors such as balance and proprioception. Full article

Background: This study investigates differences in muscle co-contraction and peak electromyography (EMG) activity between novice and advanced Taekwondo athletes during consecutive roundhouse (bandal chagui) kicks, examining the influence of body composition and experience level. Methods: Sixteen Taekwondo athletes (12 males, 4 females; mean age: 20.5 ± 4.3 years) were divided into novice (n = 8) and advanced (n = 8) groups. Muscle co-contraction indices and peak EMG activity across 15 consecutive kicks were assessed in key lower limb muscles, including the biceps femoris (BF), lateral gastrocnemius (LG), rectus femoris (RF), soleus (SO), semitendinosus (ST), tibialis anterior (TA), vastus lateralis (VL), and vastus medialis (VM). Results: Advanced athletes exhibited significantly higher co-contraction indices in BF–RF, VM–BF, and SO–TA pairs (p < 0.05) and increased peak EMG trends in the BF and LG (p < 0.05). Novice athletes showed significantly reduced peak EMG increases in the RF, VM, and VL. EMG trends were influenced by body composition, with principal component analysis indicating that higher fat mass and lower muscle mass were associated with greater variations in muscle activation. Conclusions: These findings suggest that advanced athletes refine motor control through increased co-contraction, improving stability and efficiency, while novices exhibit less optimized coordination patterns. This study provides insights into the neuromechanical adaptations associated with expertise development in Taekwondo. Full article

Background and Objective: This study aimed to examine the possibility of using surface electromyography (sEMG) to aid in assessing the correctness of overhead deep squat performance. Electromyography signals were recorded for 20 athletes from the lower (rectus femoris (RF), vastus medialis (VM), biceps femoris (BF), and gluteus (GM)) and upper (deltoid (D), latissimus dorsi (L)) muscles. The sEMG signals were categorized into three groups based on physiotherapists’ evaluations of deep squat correctness. Methods: The raw sEMG signals were filtering at 10–250 Hz, and then the mean frequency, median frequency, and kurtosis were calculated. Next, the maximum excitation of the muscles expressed in percentage of maximum voluntary contraction (%MVC) and co-activation index (CAI) were estimated. To determine the muscle excitation level, the pulse interference filter and variance analysis of the sEMG signal derivative were applied. Next, analysis of variance (ANOVA) tests, that is, nonparametric Kruskal–Wallis and post hoc tests, were performed. Results: The parameter that most clearly differentiated the groups considered turned out to be %MVC. The statistically significant difference with a large effect size in the excitation of RF & GM (p = 0.0011) and VM & GM (p = 0.0002) in group 3, where the correctness of deep squat execution was the highest and ranged from 85% to 92%, was pointed out. With the decrease in the correctness of deep squat performance, an additional statistically significant difference appeared in the excitation of RF & BF and VM & BF for both groups 2 and 1, which was not present in group 3. However, in group 2, with the correctness of the deep squat execution at 62–77%, the statistically significant differences in muscle excitation found in group 3 were preserved, in contrast to group 1, with the lowest 23–54% correctness of the deep squat execution, where the statistical significance of these differences was not confirmed. Conclusions: The results indicate that sEMG can differentiate muscle activity and provide additional information for physiotherapists when assessing the correctness of deep squat performance. The proposed analysis can be used to evaluate the correctness of physical exercises when physiotherapist access is limited. Full article

Objectives: To comprehensively examine the association between spinopelvic alignment and muscle shortening in healthy young men, focusing on the individual and interactive effects of thoracic kyphosis, lumbar lordosis, and anterior pelvic tilt using SHapley Additive exPlanation (SHAP) analysis. Methods: Forty-one healthy young adult men participated in this cross-sectional study. Thoracic kyphosis, lumbar lordosis, and anterior pelvic tilt were measured using a flexible curve ruler and inclinometer. Muscle length indices for six muscles (iliopsoas, rectus femoris, gluteus maximus, hamstrings, back extensors, and abdominals) were assessed via standardized physical examinations and image analysis. A machine learning model was developed, and SHAP analysis applied to determine individual and interactive contributions of spinopelvic angles to each muscle length index. Results: SHAP analysis showed that hip-related muscle shortening (iliopsoas, rectus femoris, hamstrings, gluteus maximus) was influenced by both individual alignments and interactions, especially between thoracic kyphosis and lumbar lordosis. Lumbar lordosis was most associated with iliopsoas shortening (SHAP = −0.09), while anterior pelvic tilt was linked to hamstring shortening (SHAP = −0.30). Thoracic kyphosis was the key factor for rectus femoris shortening (SHAP = −0.05). Interactive effects exceeded individual contributions for the rectus femoris, gluteus maximus, and hamstrings. In contrast, spinal alignment had minimal influence on the back extensors and abdominals. Conclusions: Both individual and intersegmental spinal alignments are associated with muscle shortening, particularly in hip-related muscles. The interaction between thoracic kyphosis and lumbar lordosis plays a pivotal role. These findings underscore the importance of evaluating segmental spinal interactions when assessing muscle flexibility and posture. Full article

This study aimed to (1) determine and compare the magnitude and direction of asymmetry in lower limbs neuromuscular properties, range of motion, strength and muscle electrical activity (EMG) in well-trained male road cyclist across categories (elite, under-23 and junior); (2) establish test- and age-specific asymmetry thresholds for these variables to enable individualized classification; and (3) examine the relationship between these lateral asymmetries and performance in a maximal incremental cycle ergometer test. Fifty-five well-trained road cyclists were assessed through tensiomyography (TMG), active knee extension test (AKE), leg press and EMG of vastus lateralis (VL-EMG) during a maximal incremental cycling test. Junior cyclists showed lower asymmetry in VM than elite cyclists, but greater asymmetry in AKE. No significant differences were found in strength or VL-EMG during the maximal incremental cycle ergometer test. The magnitude and direction of lateral asymmetry differs between tests (TMG: 11.3–21.3%; AKE: 2.3%; leg-press: 9.8–31.9%; VL-EMG: 20.8–22.7%). Multiple linear regression revealed a significant predictive model for maximal incremental cycling ergometer performance based on lateral asymmetry in AKE, leg press and VL and rectus femoris contraction time (R²_a = 0.23). These reference data can support trainers in monitoring and managing lateral asymmetry throughout the cyclists’ season. Full article

This paper presents a novel design for a bionic knee exoskeleton equipped with a variable stiffness actuator based on rope-driven artificial muscles. To meet the varying stiffness requirements of the knee joint across different gait modes, the actuator dynamically switches between multiple rope bundle configurations, thereby enabling effective stiffness modulation. A mathematical model of the knee exoskeleton is developed, and the mechanical properties of the selected flexible aramid fiber ropes under tensile loading are analyzed through both theoretical and experimental approaches. Furthermore, a control framework for the exoskeleton system is proposed. Wearable experiments are conducted to evaluate the effectiveness of the variable stiffness actuation in improving compliance and comfort across various gait patterns. Electromyography (EMG) results further demonstrate that the exoskeleton provides a compensatory effect on the rectus femoris muscle. Full article

Background/Objectives: Alkaptonuria (AKU) is a rare genetic disorder characterized by elevated levels of circulating homogentisic acid (HGA), which accumulates in connective tissues. The musculoskeletal system is particularly susceptible to HGA deposition, often resulting in severe ochronotic osteoarthropathy, especially in the hips, shoulders, knees, and spine. However, little is known about the effects of AKU on skeletal muscle tissue. The study aimed to evaluate changes in lower limb muscles associated with AKU. Methods: This case report describes the treatment of ochronotic osteoarthropathy in the knee of a 73-year-old male patient. Muscle properties were assessed using the MyotonPRO device. The rectus femoris, vastus medialis, and patellar tendon were examined both preoperatively and three months postoperatively. Results: Following total knee arthroplasty (TKA) of the right knee, the patient demonstrated significant improvement in functional outcomes. The MyotonPRO assessment revealed measurable differences in muscle properties between the operated and non-operated limbs. Postoperative measurements indicated improvements in muscle tone, elasticity, and viscoelastic parameters in the treated limb. Conclusions: This case report supports the effectiveness of TKA as a treatment for ochronotic osteoarthropathy. Furthermore, it is the first study to use the MyotonPRO to assess muscle and tendon properties in a patient with AKU. These findings highlight the need for further research into the muscular effects of this rare metabolic disorder. Full article

Background: This study aimed to investigate the acute changes in muscle and tendon viscoelastic properties in response to a progressive treadmill VO₂max test among professional male soccer players. Methods: Bilateral assessments at five sites—the Achilles tendon (AT), biceps femoris, semitendinosus, rectus femoris (RF), and sternocleidomastoid (SCM)—measured tone (oscillation frequency), dynamic stiffness, logarithmic decrement (elasticity), stress relaxation time, and creep. Each site was probed five times and values averaged. Repeated-measures ANOVA (Time × Side) with Bonferroni correction tested pre- to post-exercise changes; Pearson’s r examined associations with VO₂max. Results: Significant Time effects (all p < 0.05) were observed for RF frequency (η_p² = 0.226), RF creep (η_p² = 0.144), AT stiffness (η_p² ≈ 0.035), AT frequency (η_p² = 0.035), and SCM frequency (η_p² = 0.037). Post-exercise, right AT stiffness fell by 65 ± 14 N/m (p = 0.015), while left AT stiffness rose by 22 ± 9 N/m (p = 0.015). RF stiffness decreased by 28 ± 6 N/m (p < 0.001) and tone by 1.2 ± 0.3 Hz (p < 0.001), with creep (+0.08 ± 0.02; p < 0.001) and relaxation time (+1.5 ± 0.7 ms; p < 0.001) increasing. SCM tone declined by 0.8 ± 0.4 Hz (p = 0.010). Baseline RF properties—frequency (r = −0.597), stiffness (r = −0.59), relaxation time (r = 0.53), and creep (r = 0.48)—correlated moderately with VO₂max (all p < 0.05). Conclusions: These findings suggest that viscoelastic adaptations to exhaustive aerobic exercise are tissue- and side-specific, and that rectus femoris viscoelastic properties may serve as potential indicators of endurance readiness. Full article

Objectives: This study aimed to compare the involuntary stimulated neuromuscular response of thigh muscles in karate subgroups and non-athletes. We investigated whether karate training creates neuromuscular adaptations and if the synchronization of knee flexor and extensor muscles in karate practitioners is level-dependent. Methods: The study included 7 elite karate athletes (KE), 14 sub-elite karate athletes (KSE), 16 individuals with basic karate training (KB), and 14 non–athletes (NA). Tensiomyographic (TMG) measurements were obtained from the rectus femoris, vastus medialis, vastus lateralis, biceps femoris, and semitendinosus muscles. Indexes of Intermuscular Synchronization (IIS) were calculated for contraction time (Tc), total contraction time (TcT), and rate of muscle tension development (RMTD) as variables for the observed muscles of a given muscle group (extensors of the dominant leg, flexors of the dominant leg, extensors of the non-dominant leg, and flexors of the non-dominant leg). Results: Statistically significant differences were observed in the intermuscular synchronization indexes between karate experience levels and non-athletes. Compared to non-athletes, elite (KE), sub-elite (KSE), and beginner karateka (KB) all demonstrated shorter contraction time indexes in dominant knee extensors (p = 0.042, 0.040, and 0.013, respectively). In the non-dominant flexors, KE exhibited significantly better synchronization than KSE (p = 0.001), KB (p = 0.033), and NA (p = 0.002). For the total contraction time index, both KSE and KB outperformed NA in dominant extensors (p = 0.023 and p = 0.008), while KE showed superiority in non-dominant extensors and flexors compared to all other groups (p-values ranging from 0.002 to 0.038). Significant RMTD differences were found in the dominant leg between KE and KSE (p = 0.036) and KE and KB (p = 0.001), as well as in the non-dominant leg between KE and KB (p = 0.011) and KE and NA (p = 0.025). These findings were accompanied by statistical powers exceeding 0.80 in most cases, underscoring the robustness of the observed differences. Conclusions: These findings highlight that muscle coordination patterns, as revealed through non-invasive TMG-based indexes, are sensitive to training level and laterality in karate practitioners. Importantly, elite athletes demonstrated more synchronized activation in key muscle groups, suggesting a neuromuscular adaptation specific to high-level combat sports. From a biomechanical perspective, improved intermuscular synchronization may reflect optimized neural strategies for stability, speed, and efficiency—key components in competitive karate. Thus, this method holds promise not only for performance diagnostics but also for refining individualized training strategies in combat sports and broader athletic contexts. Full article

Boxing is a sport that has a high level of oxygen use within the Rectus Femoris muscle, with recovery between rounds important to subsequent performance. The study aimed to determine muscle oxygen use in male and female professional boxers in response to a repeated sprint stimulus. 10 male (age: 26 ± 5 years, height: 177 ± 4 cm, weight: 72 ± 6 kg) and 6 female (age: 29 ± 4 years, height: 173 ± 2 cm, weight: 73 ± 4 kg) professional boxers took part. Participants attended a single session where a Moxy near-infrared monitor was placed on the rectus femoris muscle of both legs. Participants completed 2 × 30 s Wingate-based sprint efforts with a 60 s active recovery (maintaining 60 rpm against 50 W resistance). Skeletal muscle oxygenation was recorded throughout. Significant differences were found in peak power, average speed and rate of fast desaturation between males and females (p < 0.001) in both sprints. There was a significant difference in males and females for the rate (sprint 1M: −5.6 ± 1.2%.s⁻¹, 1F: −2.3 ± 1.9%.s⁻¹, p < 0.05; sprint 2M: −4.2 ± 1.1%.s⁻¹, 2F: −1.5 ± 0.9%.s⁻¹, p < 0.05) and duration of fast desaturation (sprint 1M: 6.1 ± 1.3 s, 1F: 3.7 ± 2.8 s, p < 0.05; sprint 2M: 7.3 ± 1.6 s, 2F: 4.5 ± 1.0 s, p < 0.05) in both sprints. This study demonstrates that male professional boxers have a significantly different oxygen use and recovery in response to a high-intensity stimulus compared to female boxers. In both male and female boxers, the ability to perform subsequent high-intensity activity is dependent on the quality of the recovery from the initial high intensity activity. Therefore, there is a greater need to focus training to improve recovery kinetics in boxing. Full article