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SATOSHI KASAHARA, RPT, PhD1), JUNJI EBATA, RPT2), MITSUHIKO TAKAHASHI, RPT, PhD1)
1)
Division of Physical Therapy, Department of Health Sciences, Hokkaido University School
of Medicine: West 5, North 12, Kita-ku, Sapporo, 060-0812, Japan. TEL +81 11-706-3391,
FAX +81 11-706-3391, E-mail: kasahara@cme.hokudai.ac.jp
2)
Department of Rehabilitation, KKR Sapporo Medical Center
Abstract. The purpose of this study was to evaluate the repeated one-leg heel-rise test method of ankle
plantar flexors in MMT with kinetic measuring devices and electromyograms (EMG). Seven healthy
young males (age, 23 ± 2 y) with no prior history of fractures or surgery involving the lower limbs
participated in this study. The ankle and knee motions from flexible electrogoniometers (EGM), ground
reaction forces (GRF) and center of pressure (COP) from one force plate and the root-mean-square (RMS)
and mean-power-frequency (MPF) from EMG in the medial head of the gastrocnemius and soleus muscles
during the repeated one-leg heel-rise test. Kinetic and kinematic data from EGM, GRF and COP were
unchanged during the tests. Although the RMS in both muscles and the MPF in the soleus muscles were
unchanged during this test, the MPF in the gastrocnemius muscles decreased with the number of iterations
(r=–0.79, p<0.001). The MPF of the gastrocnemius muscles in the late phase was significantly lower that
in the early and middle phases (respectively, p<0.05, p<0.05). Our results show that this repeated motion
method estimates muscle endurance rather than the muscle power.
Key words: Manual muscle testing (MMT), Ankle plantar flexors, Muscle fatigue
(This article was submitted May 8, 2007, and was accepted Jul. 4, 2007)
Fig. 3. The root-mean-square (RMS) and mean power frequency (MPF) during the repeated one-leg heel-rise test. The
left panel (a) shows RMS and number of iterations and the right panel (b) shows MPF and number of iterations.
The filled circles ( ) indicate the gastrocenemius muscle and the filled triangles ( ) indicated the soleus muscle.
Linear regressions have been calculated for each data set.
37.9 ± 1.9, 47.9 ± 1.0 degree, respectively (p<0.01). was no change in the MPF of the soleus muscle
All subjects were unable to raise their heels to the during heel-rise movement.
full range of motion, and thus failed to satisfy the
condition for movement range “from 0 degrees up DISCUSSION
to 45 degrees” indicated by the 7th edition of
MMT1). The present study showed no changes in motor
There were no significant differences between PF performance during the repeated one-leg heel-rise
θmax (F(17,108)=0.508) or PF velocity test in healthy young males. There was no change
(F(17,108)=0.355) and the number of iterations, and in RMS and MPF of the EMG in the gastrocnemius
KF θmax was always constant (F(17,108)=0.119). muscle of ankle plantar flexors decreased with
There was no significant difference between trials increasing number of repetitions. There were no
in both maximum COPx (F(17,108)=0.312) and COPy changes in either the RMS or MPF of the EMG of
(F(17,108)=0.569) displacement. The peak Fz GRF the soleus muscle during this test.
was unchanged during the heel-rise movement Our study shows that the changes in muscle
(F(17,108)=0.104). From these kinematic and kinetic activities are different between the gastrocnemius
variances, similar motor performances were and the soleus muscle in the ankle plantar flexors.
accomplished over 20 one-leg heel-rise tests. The change in the MPF of the EMG has been used
RMS of the medial head of the gastrocnemius and to evaluate the muscle fatigue12, 13). The decrease in
soleus muscles showed no change during heel-rise MPF is mainly a result of the decrease in action
movement (Fig. 3a). There was a trend towards potential conduction velocity14, 15). This decrease in
decreased MPF of the medial head of the action potential conduction velocity has been found
gastrocnemius muscle with increasing number of to be related to the lactate concentration in the
heel-rises (R=–0.79, P<0.001, Fig. 3b). The late muscle 16) . Gerdel et al. 17) found correlations
phase differed from the early (P<0.01) and middle between MPF and the single amplitude of the EMG,
phases (P<0.01, Table 1). On the other hand, there and suggest that a decrease in MPF along with an
255
increase or no change in the single amplitude of the although we support the essential qualification of
EMG is considered to be a practical measurement of “normal” is 20 times or more in healthy young
muscle fatigue. According to the definition by males, the criteria repetition of “normal” should
Lindström et al. 13) , no change in RMS and a consider the subject’s weight, sex and age24).
decrease in MPF indicates the development of Muscle strength generally includes the functions
muscle fatigue. Therefore, our study suggests of power and endurance25). Most MMT evaluate
fatigue in the medial head of the gastrocnemius, but muscle power, but the ankle plantar flexion in MMT
not in the soleus muscle during repeated one-leg does not. Finally, our EMG results show muscle
heel-rise test in healthy young males. fatigue in the ankle plantar flexors during the
The EMG data of the soleus muscle did not repeated one-leg heel-rise test, and suggest that this
change during this motor task. The soleus is located test estimates muscle endurance rather than muscle
in a deeper position than the gastrocnemius, and it is power. Therefore, to estimate muscle power, the
generally accepted that the gastrocnemius is development of new method is required. Finally,
composed of a mix of fast- and slow-twitch muscle although the motor performance of the 20 repeated
fibers while the soleus is primarily composed one-leg heel-rise movement does not change if
mostly of slow-twitch muscle fibers 18–20) . The MMT is used to assess the muscle power of the
difference in muscle fatigue between the two ankle plantar flexors in healthy young males,
muscles may be related to the characteristics of the muscle fatigue may potentially occur in the ankle
muscle fiber–the soleus being dominated by type I plantar flexors. Since repetitive movements
fibers21). Svantesson et al.4, 22, 23) and Österberg et examine muscle endurance rather than power, an
al.13) reported that muscle fatigue appeared in both improvement in MMT will be required to strictly
the gastrocnemius and the soleus during a standing estimate the muscle power of the ankle plantar
heel-rise test. We instructed subjects to accomplish flexors in the future.
the one-leg heel-rise 20 times, whereas Svantesson
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