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      Prediction Model of Soleus Muscle Depth Based on Anthropometric Features: Potential Applications for Dry Needling

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          Abstract

          This study was conducted to investigate if anthropometric features can predict the depth of the soleus muscle, as assessed with ultrasound imaging, in a sample of healthy individuals to assist clinicians in the application of dry needling. A diagnostic study to calculate the accuracy of a prediction model for soleus muscle depth, as assessed with ultrasonography, in the middle-third and distal-third of the calf, based on anthropometric features such as age, height, weight, body mass index (BMI), calf length, mid-third and distal-third calf girth, was conducted on 48 asymptomatic healthy subjects (75% male) involving a total of 96 calves. Multiple linear regression analyses were used to determine which variables contributed significantly to the variance in the soleus muscle depth at middle-third and distal-third of the calf by gender. Women were found to have a deeper soleus muscle than men ( p < 0.001). Weight, height, BMI, and mid-third calf perimeter explained 69.9% of variance in men, whereas mid-third calf perimeter, calf length, height, and distal-third calf girth explained 73% of the variance in women of the distal-third soleus depth ( p < 0.001). Additionally, mid-third calf girth and calf length explained 28.8% of variance in men, whereas mid-third calf perimeter, calf length, and weight explained 67.8% of variance in women of the mid-third soleus depth ( p < 0.001). This study identified anthropometric features that predict soleus muscle depth, as assessed with ultrasound, in asymptomatic individuals, but these features are different in men and women. Our findings could assist clinicians in choosing the proper length of the needle to avoiding passing through the soleus during dry needling.

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          Functional anatomy of the Achilles tendon.

          The Achilles tendon is the strongest and thickest tendon in the human body. It is also the commonest tendon to rupture. It begins near the middle of the calf and is the conjoint tendon of the gastrocnemius and soleus muscles. The relative contribution of the two muscles to the tendon varies. Spiralisation of the fibres of the tendon produces an area of concentrated stress and confers a mechanical advantage. The calcaneal insertion is specialised and designed to aid the dissipation of stress from the tendon to the calcaneum. The insertion is crescent shaped and has significant medial and lateral projections. The blood supply of the tendon is from the musculotendinous junction, vessels in surrounding connective tissue and the osteotendinous junction. The vascular territories can be classified simply in three, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. This leaves a relatively hypovascular area in the mid-portion of the tendon where most problems occur. The Achilles tendon derives its innervation from the sural nerve with a smaller supply from the tibial nerve. Tenocytes produce type I collagen and form 90% of the cellular component of the normal tendon. Evidence suggests ruptured or pathological tendon produce more type III collagen, which may affect the tensile strength of the tendon. Direct measurements of forces reveal loading in the Achilles tendon as high as 9 KN during running, which is up to 12.5 times body weight.
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            Sonographic studies of human soleus and gastrocnemius muscle architecture: gender variability.

            The purpose of this study was to establish if there are gender differences in muscle architecture in relaxed human soleus and gastrocnemius muscles of normal, live subjects. Ultrasonography was used to measure fiber bundle length, muscle thickness, and angles of pennation in a total of ten predetermined sites in the medial and lateral heads of gastrocnemius and the anterior and posterior soleus in 19 males and 16 females. Percentage differences between males and females for each parameter were recorded. Gender differences were statistically analyzed using multivariate analysis of variance. In the gastrocnemius and soleus muscles of males and females the differences between the overall fiber bundle length, angle of pennation and muscle thickness were statistically significant (P < 0.05). Overall, females were found to have longer average muscle fiber bundle length and males thicker muscles and larger angles of pennation. The greatest percentage differences of the architectural parameters between males and females were in the posterior soleus: 13% difference in fiber length and 26% difference in angle of pennation in the midline of posterior soleus and 26% difference in muscle thickness of the lateral part of posterior soleus. No correlation was found between leg length and fiber length, angle of pennation or muscle thickness. Fiber length (decreased), angle of pennation (greater) and muscle thickness (greater) of most parts of the gastrocnemius and soleus muscles were significantly different in males and females. Leg length of males and females did not correlate to these architectural parameters.
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              Latent myofascial trigger points.

              A latent myofascial trigger point (MTP) is defined as a focus of hyperirritability in a muscle taut band that is clinically associated with local twitch response and tenderness and/or referred pain upon manual examination. Current evidence suggests that the temporal profile of the spontaneous electrical activity at an MTP is similar to focal muscle fiber contraction and/or muscle cramp potentials, which contribute significantly to the induction of local tenderness and pain and motor dysfunctions. This review highlights the potential mechanisms underlying the sensory-motor dysfunctions associated with latent MTPs and discusses the contribution of central sensitization associated with latent MTPs and the MTP network to the spatial propagation of pain and motor dysfunctions. Treating latent MTPs in patients with musculoskeletal pain may not only decrease pain sensitivity and improve motor functions, but also prevent latent MTPs from transforming into active MTPs, and hence, prevent the development of myofascial pain syndrome.
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                Author and article information

                Journal
                Diagnostics (Basel)
                Diagnostics (Basel)
                diagnostics
                Diagnostics
                MDPI
                2075-4418
                07 May 2020
                May 2020
                : 10
                : 5
                : 284
                Affiliations
                [1 ]Department of Physiotherapy, Faculty of Education and Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain; ecimadevilla@ 123456ucjc.edu
                [2 ]Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
                [3 ]Private Professional Practice, Madrid, Spain; ladislao.laguna@ 123456alumno.ucjc.edu
                [4 ]Department of Pharmacy, Faculty of Health Sciences, Alfonso X el Sabio University, Villanueva de la Cañada, 28691 Madrid, Spain; fdejesus@ 123456uax.es
                [5 ]Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02155, USA; clelandj@ 123456franklinpierce.edu
                [6 ]Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain; cesar.fernandez@ 123456urjc.es (C.F.-d.-l.-P.); joseluis.arias@ 123456urjc.es (J.L.A.-B.)
                [7 ]Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28933 Madrid, Spain
                Author notes
                [* ]Correspondence: javalera@ 123456ucjc.edu ; Tel.: +34-653-766-841
                Author information
                https://orcid.org/0000-0002-3379-8392
                https://orcid.org/0000-0003-3772-9690
                https://orcid.org/0000-0001-8548-4427
                Article
                diagnostics-10-00284
                10.3390/diagnostics10050284
                7277950
                32392836
                7f455a9c-75c4-4fd4-a74a-628ae9111438
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 28 March 2020
                : 05 May 2020
                Categories
                Article

                soleus muscle,ultrasound,depth,anthropometric,gender
                soleus muscle, ultrasound, depth, anthropometric, gender

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