Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia.

The extracellular matrix (ECM), and especially the connective tissue with its collagen, links tissues of the body together and plays an important role in the force transmission and tissue structure maintenance especially in tendons, ligaments, bone, and muscle. The ECM turnover is influenced by physical activity, and both collagen synthesis and degrading metalloprotease enzymes increase with mechanical loading. Both transcription and posttranslational modifications, as well as local and systemic release of growth factors, are enhanced following exercise. For tendons, metabolic activity, circulatory responses, and collagen turnover are demonstrated to be more pronounced in humans than hitherto thought. Conversely, inactivity markedly decreases collagen turnover in both tendon and muscle. Chronic loading in the form of physical training leads both to increased collagen turnover as well as, dependent on the type of collagen in question, some degree of net collagen synthesis. These changes will modify the mechanical properties and the viscoelastic characteristics of the tissue, decrease its stress, and likely make it more load resistant. Cross-linking in connective tissue involves an intimate, enzymatical interplay between collagen synthesis and ECM proteoglycan components during growth and maturation and influences the collagen-derived functional properties of the tissue. With aging, glycation contributes to additional cross-linking which modifies tissue stiffness. Physiological signaling pathways from mechanical loading to changes in ECM most likely involve feedback signaling that results in rapid alterations in the mechanical properties of the ECM. In developing skeletal muscle, an important interplay between muscle cells and the ECM is present, and some evidence from adult human muscle suggests common signaling pathways to stimulate contractile and ECM components. Unaccostumed overloading responses suggest an important role of ECM in the adaptation of myofibrillar structures in adult muscle. Development of overuse injury in tendons involve morphological and biochemical changes including altered collagen typing and fibril size, hypervascularization zones, accumulation of nociceptive substances, and impaired collagen degradation activity. Counteracting these phenomena requires adjusted loading rather than absence of loading in the form of immobilization. Full understanding of these physiological processes will provide the physiological basis for understanding of tissue overloading and injury seen in both tendons and muscle with repetitive work and leisure time physical activity.

Role of Extracellular Matrix in Adaptation of Tendon and Skeletal Muscle to Mechanical Loading

Forces in Joints, Skeletal Biology, Analysis of Bone Remodeling, Mechanical Properties of Bone, Fatigue and Fracture Resistance of Bone, Mechanical Adaptation of the Skeleton, Synovial Joint Mechanics, Mechanical Properties of Ligament and Tendon

Skeletal Tissue Mechanics

High-resistance strength training (HRST) is one of the most widely practiced forms of physical activity, which is used to enhance athletic performance, augment musculo-skeletal health and alter body aesthetics. Chronic exposure to this type of activity produces marked increases in muscular strength, which are attributed to a range of neurological and morphological adaptations. This review assesses the evidence for these adaptations, their interplay and contribution to enhanced strength and the methodologies employed. The primary morphological adaptations involve an increase in the cross-sectional area of the whole muscle and individual muscle fibres, which is due to an increase in myofibrillar size and number. Satellite cells are activated in the very early stages of training; their proliferation and later fusion with existing fibres appears to be intimately involved in the hypertrophy response. Other possible morphological adaptations include hyperplasia, changes in fibre type, muscle architecture, myofilament density and the structure of connective tissue and tendons. Indirect evidence for neurological adaptations, which encompasses learning and coordination, comes from the specificity of the training adaptation, transfer of unilateral training to the contralateral limb and imagined contractions. The apparent rise in whole-muscle specific tension has been primarily used as evidence for neurological adaptations; however, morphological factors (e.g. preferential hypertrophy of type 2 fibres, increased angle of fibre pennation, increase in radiological density) are also likely to contribute to this phenomenon. Changes in inter-muscular coordination appear critical. Adaptations in agonist muscle activation, as assessed by electromyography, tetanic stimulation and the twitch interpolation technique, suggest small, but significant increases. Enhanced firing frequency and spinal reflexes most likely explain this improvement, although there is contrary evidence suggesting no change in cortical or corticospinal excitability. The gains in strength with HRST are undoubtedly due to a wide combination of neurological and morphological factors. Whilst the neurological factors may make their greatest contribution during the early stages of a training programme, hypertrophic processes also commence at the onset of training.

http://performancetrainingsystems.net/Resources/Adaptations_to_Strength_Training.pdf

The adaptations to strength training : morphological and neurological contributions to increased strength.

Overuse tendinopathy is problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments. The pathology of tendinopathy has been described as degenerative or failed healing. Neither of these descriptions fully explains the heterogeneity of presentation. This review proposes, and provides evidence for, a continuum of pathology. This model of pathology allows rational placement of treatments along the continuum. A new model of tendinopathy and thoughtful treatment implementation may improve outcomes for those with tendinopathy. This model is presented for evaluation by clinicians and researchers.

https://bjsm.bmj.com/content/bjsports/43/6/409.full.pdf

Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy

The present study examined whether resistance and stretching training programmes altered the viscoelastic properties of human tendon structures in vivo. Eight subjects completed 8 weeks (4 days per week) of resistance training which consisted of unilateral plantar flexion at 70 % of one repetition maximum with 10 repetitions per set (5 sets per day). They performed resistance training (RT) on one side and resistance training and static stretching training (RST; 10 min per day, 7 days per week) on the other side. Before and after training, the elongation of the tendon structures in the medial gastrocnemius muscle was directly measured using ultrasonography, while the subjects performed ramp isometric plantar flexion up to the voluntary maximum, followed by a ramp relaxation. The relationship between estimated muscle force (Fm) and tendon elongation (L) was fitted to a linear regression, the slope of which was defined as stiffness. The hysteresis was calculated as the ratio of the area within the Fm-L loop to the area beneath the load portion of the curve. The stiffness increased significantly by 18.8 ± 10.4 % for RT and 15.3 ± 9.3 % for RST. There was no significant difference in the relative increase of stiffness between RT and RST. The hysteresis, on the other hand, decreased 17 ± 20 % for RST, but was unchanged for RT. These results suggested that the resistance training increased the stiffness of tendon structures as well as muscle strength and size, and the stretching training affected the viscosity of tendon structures but not the elasticity.

Effects of resistance and stretching training programmes on the viscoelastic properties of human tendon structures in vivo

Purpose: The purpose of this study was to investigate the effects of plyometric and weight training protocols on the mechanical properties of muscle-tendon complex and muscle activities and performances during jumping.

Methods: Ten subjects completed 12 wk (4 d·wk-1) of a unilateral training program for plantar flexors. They performed plyometric training on one side (PT; hopping and drop jump using 40% of 1RM) and weight training on the other side (WT; 80% of 1RM). Tendon stiffness was measured using ultrasonography during isometric plantar flexion. Three kinds of unilateral jump heights using only ankle joint (squat jump: SJ; countermovement jump: CMJ; drop jump: DJ) on sledge apparatus were measured. During jumping, electromyographic activities were recorded from plantar flexors and tibial anterior muscle. Joint stiffness was calculated as the change in joint torque divided by the change in ankle angle during eccentric phase of DJ.

Results: Tendon stiffness increased significantly for WT, but not for PT. Conversely, joint stiffness increased significantly for PT, but not for WT. Whereas PT increased significantly jump heights of SJ, CMJ, and DJ, WT increased SJ only. The relative increases in jump heights were significantly greater for PT than for WT. However, there were no significant differences between PT and WT in the changes in the electromyographic activities of measured muscles during jumping.

Conclusion: These results indicate that the jump performance gains after plyometric training are attributed to changes in the mechanical properties of muscle-tendon complex, rather than to the muscle activation strategies.

Effects of plyometric and weight training on muscle-tendon complex and jump performance.

The purpose of this study was to investigate the differences in the viscoelastic properties of human tendon structures (tendon and aponeurosis) in the medial gastrocnemius muscle between men (n=16) and women (n=13). The elongation of the tendon and aponeurosis of the medial gastrocnemius muscle was measured directly by ultrasonography, while the subjects performed ramp isometric plantar flexion up to the voluntary maximum, followed by a ramp relaxation. The relationship between the estimated muscle force (Fm) and tendon elongation (L) during the ascending phase was fitted to a linear regression, the slope of which was defined as stiffness. The percentage of the area within the Fm- L loop to the area beneath the curve during the ascending phase was calculated as hysteresis. The L values at force production levels beyond 50 N were significantly greater for women than for men. The maximum strain (100xDeltaL/initial tendon length) was significantly greater in women [9.5 (1.1)%] than in men [8.1 (1.6)%]. The stiffness and Young's modulus were significantly lower in women [16.5 (3.4) N/mm, 277 (25) MPa] than in men [25.9 (7.0) N/mm, 356 (32) MPa]. Furthermore, the hysteresis was significantly lower in women [11.1 (5.9)%] than in men [18.7 (8.5)%, P=0.048]. These results suggest that there are gender differences in the viscoelastic properties of tendon structures and that these might in part account for previously observed performance differences between the genders.

Gender differences in the viscoelastic properties of tendon structures

Nine healthy men carried out head-down bed rest (BR) for 20 days Five subjects (TR) performed isometric, bilateral leg extension exercise every day, while the other four (NT) did not Before and after BR, maximal isometric knee extension force was measured Neural activation was assessed using a supramaximal twitch interpolated over voluntary contraction From a series cross-sectional magnetic resonance imaging scans of the thigh, physiological cross-sectional areas (PCSA) of the quadriceps muscles were estimated (uncorrected PCSA, volume/estimated fibre length) Decrease in mean muscle force after BR was greater in NT [−109 (SD 69)%, P < 005] than in TR [05 (SD 79)%, not significant] Neural activation did not differ between the two groups before BR, but after BR NT showed smaller activation levels Pennation angles of the vastus lateralis muscle, determined by ultrasonography, showed no significant changes in either group The PCSA decreased in NT by −78 (SD 08)% (P < 005) while in TR PCSA showed only an insignificant tendency to decrease [−38 (SD 38)%] Changes in force were related more to changes in neural activation levels than to those in PCSA The results suggest that reduction of muscle strength by BR is affected by a decreased ability to activate motor units, and that the exercise used in the present experiment is effective as a countermeasure

Changes in muscle size, architecture, and neural activation after 20 days of bed rest with and without resistance exercise.

The purpose of this study was to examine whether stretching training altered the viscoelastic properties of human tendon structures in vivo. Eight men performed the stretching training for 3 wk. Be...

https://www.physiology.org/doi/pdf/10.1152/japplphysiol.00658.2001

Keitaro Kubo

Papers

Effects of resistance and stretching training programmes on the viscoelastic properties of human tendon structures in vivo

Effects of plyometric and weight training on muscle-tendon complex and jump performance.

Gender differences in the viscoelastic properties of tendon structures

Changes in muscle size, architecture, and neural activation after 20 days of bed rest with and without resistance exercise.

Effect of stretching training on the viscoelastic properties of human tendon structures in vivo