Intraoperative experiments combined with gait analyses indicate that active state rather than passive dominates the spastic gracilis muscle's joint movement limiting effect in cerebral palsy

Kaya, Cemre S.; Bilgili, Fuat; Akalan, N.E.; Temelli, Yener; Ateş, Filiz; Yücesoy, Can A.

doi:10.1016/j.clinbiomech.2019.06.005

Cited by 23 publications

(17 citation statements)

References 39 publications

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“…Inter-and extramuscular myofascial force transmission combined is referred to as epimuscular myofascial force transmission [24]. Such force transmission has been shown to occur in human e.g., in cerebral palsy patients as shown by intraoperative experiments [25]. Different authors have proven, through multiple dissections, the anatom-ical relation between gluteus maximus and fascia lata [26], the myofascial continuity in the anterior region of the upper limb, and the tendinous muscular insertions onto the deep fascia of the upper limb [27].…”

Section: Introductionmentioning

confidence: 99%

Fascial or Muscle Stretching? A Narrative Review

et al. 2020

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Stretching exercises are integral part of the rehabilitation and sport. Despite this, the mechanism behind its proposed effect remains ambiguous. It is assumed that flexibility increases, e.g., action on muscle and tendon, respectively, but this is not always present in the stretching protocol of the exercises used. Recently, the fasciae have increased popularity and seems that they can have a role to define the flexibility and the perception of the limitation of the maximal range of motion (ROM). Deep fascia is also considered a key element to transmit load in parallel bypassing the joints, transmitting around 30% of the force generated during a muscular contraction. So, it seems impossible dividing the action of the muscles from the fasciae, but they have to be considered as a “myofascial unit”. The purpose of this manuscript is to evaluate the mechanical behavior of muscles, tendons, and fasciae to better understand how they can interact during passive stretching. Stress-strain values of muscle, tendon and fascia demonstrate that during passive stretching, the fascia is the first tissue that limit the elongation, suggesting that fascial tissue is probably the major target of static stretching. A better understanding of myofascial force transmission, and the study of the biomechanical behavior of fasciae, with also the thixotropic effect, can help to design a correct plan of stretching.

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Section: Introductionmentioning

confidence: 99%

Fascial or Muscle Stretching? A Narrative Review

et al. 2020

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“…Although the latter test was not conducted presently, the findings (i) in contrast, do not show a diminished EMFT in the long term, but judging from the elevated distally directed myofascial loads, and (ii) indicate that intermuscular connective tissue linkages between the TA and the EDL should be stiffer. This issue is relevant because for patients with CP, recent intraoperative experiments show that inter-synergistic EMFT ( Ates et al, 2018b ; Kaya et al, 2018 , 2019 , 2020 ) and also the inter-antagonistic EMFT ( Ates et al, 2014 , 2018b ; Kaya et al, 2019 , 2020 ) cause a significant increase in the force of spastic gracilis and semitendinosus muscles (above 30%, up to 70%). This suggests that the spastic hamstrings capacity to affect the pathological condition in the joint is changed by EMFT.…”

Section: Discussionmentioning

confidence: 99%

“…Muscle mechanics experiments indicate changes in muscle's length-force characteristics in response to altered mechanical conditions within which the target muscle operates: (i) In animal experiments, those changes due to coactivation of synergistic muscles include elevated agonist muscle force amplitude (e.g., by 17%) and shift of muscle's maximal force production to a different length (e.g., by several mm's, yielding an increase in muscles length range of force production by 24%) (Yucesoy et al, 2003a;Yucesoy and Huijing, 2007). (ii) In intraoperative experiments in CP patients, co-activation of synergistic and antagonistic muscles was shown to yield similar effects altering force production of the target spastic muscle compared to that measured after it is activated alone (Ates et al, 2018b;Kaya et al, 2018Kaya et al, , 2019Kaya et al, , 2020. However, previously, EMFT has been shown to be affected by BTX-A exposure in the shortterm (Yucesoy et al, 2015).…”

Section: Btx-a Effects At Large and On Mechanical Interactions Betweementioning

confidence: 98%

Long-Term Effects With Potential Clinical Importance of Botulinum Toxin Type-A on Mechanics of Muscles Exposed

Kaya

Yılmaz

Akdeniz-Doğan

et al. 2020

Front. Bioeng. Biotechnol.

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Botulinum toxin type-A (BTX-A) is widely used for spasticity management and mechanically aims at reducing passive resistance at the joint and widening joint range of movement. However, recent experiments on acute BTX-A effects showed that the injected rat tibialis anterior (TA) muscle's passive forces increased, and the length range of active force exertion (l range) did not change. Additionally, BTX-A was shown to spread into non-injected muscles in the compartment and affect their mechanics. Whether those effects persist in the long term is highly important, but unknown. The aim was to test the following hypotheses with experiments conducted in the anterior crural compartment of the rat: In the long term, BTX-A (1) maintains l range , (2) increases passive forces of the injected TA muscle, and (3) spreads into non-injected extensor digitorum longus (EDL) and the extensor hallucis longus (EHL) muscles, also affecting their active and passive forces. Male Wistar rats were divided into two groups: BTX-A and Control (0.1 units of BTX-A or only saline was injected into the TA). Isometric forces of the muscles were measured simultaneously 1-month post-injection. The targeted TA was lengthened, whereas the non-targeted EDL and EHL were kept at constant length. Hydroxyproline analysis was done to quantify changes in the collagen content of studied muscles. Two-way ANOVA test (for muscle forces, factors: TA length and animal group) and unpaired t or Mann-Whitney U test (for l range and collagen content, where appropriate) were used for statistical analyses (P < 0.05). BTX-A caused significant effects. TA: active forces decreased (maximally by 75.2% at short and minimally by 48.3%, at long muscle lengths), l range decreased (by 22.9%), passive forces increased (by 12.3%), and collagen content increased (approximately threefold). EDL and EHL: active forces decreased (up to 66.8%), passive force increased (minimally by 62.5%), and collagen content increased (approximately twofold). Therefore, hypothesis 1 was rejected and 2 and 3 were confirmed indicating that previously reported acute BTX-A effects persist and advance in the long term. A narrower l range and an elevated passive resistance of the targeted muscle are unintended mechanical effects, whereas spread of BTX-A into other compartmental muscles indicates the presence of uncontrolled mechanical effects.

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“…This may make muscle’s length–force characteristics vary in different conditions. It was shown intraoperatively in patients with cerebral palsy that spastic muscles’ force amplitude can change significantly by co-activating other muscles ( Kaya et al, 2018 , 2019 , 2020 ).…”

Section: Discussionmentioning

confidence: 99%