Yaşlı Bireylerin Kas Tendon Morfolojisinin Fiziksel Performans ve Denge Üzerine Etkisi

Abstract

Amaç: Yaşlanma süreci ile kas-tendon morfolojisi değişmektedir. Bu çalışmanın amacı, yaşlı bireylerde alt ekstremite ile ilişkili kas-tendon morfolojisinin, fonksiyonel hareket ve denge yeteneği ile ilişkisini incelemektir. Gereç ve Yöntem: Araştırmaya yaş ortalaması 65-80 yıl arasında değişen 60 (erkek= 27, kadın= 33) yaşlı birey dahil edildi. Rectus femoris, biceps femoris, tibialis anterior ve gastroknemius kaslarının mekanik özellikleri ile; patellar tendon ve Aşil Tendonunun mekanik özellikleri Myoton® PRO cihazı ile değerlendirildi. Bireylerin bilişsel fonksiyonları Mini Mental Test (MMSE) ile, fiziksel performansları ve denge fonksiyonları ise Berg Denge Ölçeği (BDÖ), Zamanlı kalk ve Yürü Testi (ZKYT) ve 30 sn otur kalk Testi ile değerlendirildi. Bulgular: Çalışmanın sonuçlarına göre rectus femoris kas esnekliği ile 30 sn otur kalk testi arasında pozitif bir korelasyon vardır (p=0,011). Alt ekstremite distalinde yer alan gastroknemius ve Aşil Tendonunun esnekliği BDÖ sonuçları ile ilişkili bulundu. (p=0,035**; p=0,016**). Alt ekstremitede yer alan kasların kas tonus verilerine bakıldığında, tibialis anterior ve Aşil Tendon tonusunun denge üzerinde etkili olduğu bulundu (p=0,030; p<0,001). Sonuç: Bu araştırmadan elde edilen sonuçlara göre; alt ekstremitenin distalinde yer alan kas tonus değerleri denge ile ilişkili bulunmuştur. Yaşlı bireylerin fonksiyonel hareketler sırasında dengelerini koruyabilmek için, proksimal kas zayıflığını distalde yer alan kaslar ile; özellikle de ayak-ayak bileği stratejileri ile telafi ettiği öngörülmüştür. Çalışmadan elde edilen sonuçlar, yaşlı bireylerin ayak bileği çevresinde yer alan kas ve tendonlardaki mekanik özelliklerde oluşan değişimlerin, fonksiyonel hareket kapasitesini etkileyeceğini gösterdi.

Keywords

• kas
• tendon
• mekanik özellikler
• fiziksel performans.

Effect of Muscle Tendon Morphology on Physical Performance and Balance in Elderly Individuals

Abstract

Objectives: Muscle-tendon morphology changes with the aging process. This study aimed to examine the relationship between lower extremity-related muscle-tendon morphology and functional movement and balance ability in elderly individuals. Materials and Methods: 60 (male = 27, female = 33) elderly individuals with an average age of 65–80 years were included in the study. The mechanical properties of the rectus femoris, biceps femoris, patellar tendon, tibialis anterior Achilles Tendon and gastrocnemius muscles were evaluated with the Myoton® PRO device. Individuals' cognitive functions were evaluated with the Mini-Mental Test (MMSE), and their physical performance and balance functions were evaluated with the Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and 30-second Sit-and-Go Test. Results: According to the results of the study, there was a positive correlation between rectus femoris muscle elasticity and the 30-second sit-to-stand test (p = 0.011). gastrocnemius and Achilles elasticity in the distal lower extremity were found to be associated with BBS results. (p=0.035**; p=0.016**). When the muscle tone data of the muscles in the lower extremity were examined, it was found that tibialis anterior and Achilles Tendon tone were effective on balance (p = 0.030; p<0.001). Conclusion: According to the results obtained from this research, muscle tone values in the distal lower extremity were found to be related to balance. For elderly individuals to maintain their balance during functional movements, proximal muscle weakness is compensated by the distal muscles. It is predicted that it will be compensated, especially with foot-ankle strategies. The results obtained from the study showed that changes in the mechanical properties of the muscles and tendons around the ankle of elderly individuals will affect their functional movement capacity.

Keywords

• muscle
• tendon
• mechanical properties
• physical performance.

References

1. Akagi, R., Yamashita, Y. ve Ueyasu, Y. (2015, Nov). Age-related differences in muscle shear moduli in the lower extremity. Ultrasound in Medicine & Biology, 41(11), 2906-2912. https://doi.org/https://www.doi.org/10.1016/j.ultrasmedbio.2015.07.011.
2. Aruin, A. S. (2001, Apr). Simple lower extremity two-joint synergy. Perceptual and Motor Skills, 92(2), 563-568. https://doi.org/https://www.doi.org/10.2466/pms.2001.92.2.563.
3. Aydoğan Arslan, S., Demirci, C. S., Katirci Kirmaci, Z., Uğurlu, K. ve Keskin, E. D. (2021). Reliability and validity of Turkish version of The Brief-BESTest in stroke patients. Topics in Stroke Rehabilitation, 28(7), 488-497. https://doi.org/https://www.doi.org/10.1080/10749357.2020.1841424.
4. Bloem, B. R., Allum, J. H., Carpenter, M. G. ve Honegger, F. (2000, Feb). Is lower leg proprioception essential for triggering human automatic postural responses? Experimental Brain Research, 130(3), 375-391. https://doi.org/https://www.doi.org/10.1007/s002219900259.
5. Burke, T. N., França, F. J. R., Meneses, S. R. F. d., Pereira, R. M. R. ve Marques, A. P. (2012). Postural control in elderly women with osteoporosis: comparison of balance, strengthening and stretching exercises. A randomized controlled trial. Clinical Rehabilitation, 26(11), 1021-1031. https://doi.org/https://www.doi.org/10.1177/0269215512442204.
6. Chuang, L. L., Wu, C. Y. ve Lin, K. C. (2012). Reliability, validity, and responsiveness of myotonometric measurement of muscle tone, elasticity, and stiffness in patients with stroke. Archives of Physical Medicine and Rehabilitation, 93(3), 532-540. https://doi.org/https://www.doi.org/10.1016/j.apmr.2011.09.014.
7. Clifford, A. M. ve Holder-Powell, H. (2010, Jul). Postural control in healthy individuals. Clinical Biomechanics (Bristol, Avon), 25(6), 546-551. https://doi.org/https://www.doi.org/10.1016/j.clinbiomech.2010.03.005.
8. Cruz-Montecinos, C., Besomi, M., Acevedo-Valenzuela, N., Cares-Marambio, K., Bustamante, A., Guzmán-González, B., Tapia-Malebrán, C., Sanzana-Cuche, R., Calatayud, J. ve Méndez-Rebolledo, G. (2022, 2022/10/01/). Soleus muscle and Achilles tendon compressive stiffness is related to knee and ankle positioning. Journal of Electromyography and Kinesiology, 66, 102698. https://doi.org/https:///www.doi.org/10.1016/j.jelekin.2022.102698.

9. Dill, K. E., Begalle, R. L., Frank, B. S., Zinder, S. M. ve Padua, D. A. (2014). Altered knee and ankle kinematics during squatting in those with limited weight-bearing-lunge ankle-dorsiflexion range of motion. Journal of Athletic Training, 49(6), 723-732. https://doi.org/https://www.doi.org/10.4085/1062-6050-49.3.29.
10. Feng, Y. N., Li, Y. P., Liu, C. L. ve Zhang, Z. J. (2018). Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO. Scientific Reports, 8(1), 17064. https://doi.org/https://www.doi.org/10.1038/s41598-018-34719-7.
11. Gleim, G. W. ve McHugh, M. P. (1997, 1997/11/01). Flexibility and Its Effects on Sports Injury and Performance. Sports Medicine, 24(5), 289-299. https://doi.org/https://www.doi.org/10.2165/00007256-199724050-00001.
12. Gribble, P. ve Hertel, J. (2004). Effect of lower-extremity muscle fatigue on postural control11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Archives of Physical Medicine and Rehabilitation, 85(4), 589-592. https://doi.org/https://www.doi.org/10.1016/j.apmr.2003.06.031.
13. Guralnik, J. M. (1996). Assessing the impact of comorbidity in the older population. Annals of Epidemiology, 6(5), 376-380. https://doi.org/https://www.doi.org/10.1016/s1047-2797(96)00060-9.
14. Horak, F. ve Kuo, A. (2000). Postural adaptation for altered environments, tasks, and intentions. In J. M. Winters & P. E. Crago (Eds.), Biomechanics and Neural Control of Posture and Movement (pp. 267-281). Springer New York. https://doi.org/https://www.doi.org/10.1007/978-1-4612-2104-3_19.
15. Judge, J. O., Davis, R. B., 3rd ve Ounpuu, S. (1996). Step length reductions in advanced age: the role of ankle and hip kinetics. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 51(6), M303-M312. https://doi.org/https://www.doi.org/10.1093/gerona/51a.6.m303.
16. Kaminishi, K., Chiba, R., Takakusaki, K. ve Ota, J. (2021, 2021/10/01/). Increase in muscle tone promotes the use of ankle strategies during perturbed stance. Gait & Posture, 90, 67-72. https://doi.org/https://doi.org/10.1016/j.gaitpost.2021.08.003.
17. Keskinoglu, P., Ucku, R., Yener, G., Yaka, E., Kurt, P. ve Tunca, Z. (2009, Nov). Reliability and validity of revised Turkish version of Mini Mental State Examination (rMMSE-T) in community-dwelling educated and uneducated elderly. International Journal of Geriatric Psychiatry, 24(11), 1242-1250. https://doi.org/https://www.doi.org/10.1002/gps.2252.
18. Maganaris, C. N. ve Paul, J. P. (1999, Nov 15). In vivo human tendon mechanical properties. The Journal of Physiology, 521(Pt 1), 307-313. https://doi.org/https://www.doi.org/10.1111/j.1469-7793.1999.00307.x.
19. Maki, B. E. ve McIlroy, W. E. (1996, 1996/11/01/). Postural control in the older adult. Clinics in Geriatric Medicine, 12(4), 635-658. https://doi.org/https://doi.org/10.1016/S0749-0690(18)30193-9.
20. Melzer, I., Benjuya, N. ve Kaplanski, J. (2004, Nov). Postural stability in the elderly: a comparison between fallers and non-fallers. Age and Ageing, 33(6), 602-607. https://doi.org/https://www.doi.org/10.1093/ageing/afh218.
21. Menz, H. B., Morris, M. E. ve Lord, S. R. (2005, Dec). Foot and ankle characteristics associated with impaired balance and functional ability in older people. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 60(12), 1546-1552. https://doi.org/https://www.doi.org/10.1093/gerona/60.12.1546.
22. Mohamed, A. A. ve Jan, Y. K. (2020). Effect of adding proprioceptive exercise to balance training in older adults with diabetes: A systematic review. Current Diabetes Reviews, 16(4), 327-339. https://doi.org/https://www.doi.org/10.2174/1573399815666190712200147.
23. Molloy, D. W., Alemayehu, E. ve Roberts, R. (1991, Jan). Reliability of a standardized mini-mental state examination compared with the traditional mini-mental state examination. The American Journal of Psychiatry, 148(1), 102-105. https://doi.org/https://www.doi.org/10.1176/ajp.148.1.102.
24. Mooney, K., Warner, M. B. ve Stokes, M. (2013). Symmetry and within-session reliability of mechanical properties of biceps brachii muscles in healthy young adult males using the MyotonPRO device. Working Papers in the Health Sciences, 1(3).
25. Narici, M. V. ve Maganaris, C. N. (2007, 2007/07//). Plasticity of the muscle-tendon complex with disuse and aging. Exercise and Sport Sciences Reviews, 35(3), 126-134. https://doi.org/https://www.doi.org/10.1097/jes.0b013e3180a030ec.
26. Onambele, G. L., Narici, M. V. ve Maganaris, C. N. (2006, Jun). Calf muscle-tendon properties and postural balance in old age. Journal of Applied Physiology (1985), 100(6), 2048-2056. https://doi.org/https://www.doi.org/10.1152/japplphysiol.01442.2005.
27. Özal, C., Aksoy, S. ve Kerem Günel, M. (2023). Influence of trunk control on gait characteristics and capacity in children with Spastic Diplegic Cerebral Palsy. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi(19), 58-67. https://doi.org/https://doi.org/10.38079/igusabder.1123778.
28. Page, P. (2012). Current concepts in muscle stretching for exercise and rehabilitation. International Journal of Sports Physical Therapy, 7(1), 109-119. .
29. Roberts, T. J. ve Azizi, E. (2011, Feb 1). Flexible mechanisms: the diverse roles of biological springs in vertebrate movement. The Journal of Experimental Biology, 214(Pt 3), 353-361. https://doi.org/https://www.doi.org/10.1242/jeb.038588.
30. Saito, A., Wakasa, M., Kimoto, M., Ishikawa, T., Tsugaruya, M., Kume, Y. ve Okada, K. (2019). Age‐related changes in muscle elasticity and thickness of the lower extremities are associated with physical functions among community‐dwelling older women. Geriatrics & Gerontology International, 19(1), 61-65. https://doi.org/https://www.doi.org/10.1111/ggi.13567.
31. Satariano, W. A., Kealey, M., Hubbard, A., Kurtovich, E., Ivey, S. L., Bayles, C. M., Hunter, R. H. ve Prohaska, T. R. (2016). Mobility disability in older adults: At the intersection of people and places. The Gerontologist, 56(3), 525-534. https://doi.org/https://www.doi.org/10.1093/geront/gnu094.
32. Seyed, H. H. ve Asghar, N. A. (2010). The role of leg and trunk muscles proprioception on static and dynamic postural control. Citius Altius Fortius, 26(1), 83-87. .
33. Song, Y., Blackwell, T., Yaffe, K., Ancoli-Israel, S., Redline, S. ve Stone, K. L. (2015). Relationships between sleep stages and changes in cognitive function in older men: The MrOS sleep study. Sleep, 38(3), 411-421. https://doi.org/https://www.doi.org/10.5665/sleep.4500.
34. Sriwarno, A. B., Shimomura, Y., Iwanaga, K. ve Katsuura, T. (2008). The relation between the changes of postural achievement, lower limb muscle activities, and balance stability in three different deep-squatting postures. Journal of Physiological Anthropology, 27 1, 11-17. https://doi.org/https://www.doi.org/10.2114/JPA2.27.11.
35. Stanev, D. ve Moustakas, K. (2019, 2019/03/06/). Stiffness modulation of redundant musculoskeletal systems. Journal of Biomechanics, 85, 101-107. https://doi.org/https://doi.org/10.1016/j.jbiomech.2019.01.017.
36. Stanziano, D. C., Roos, B. A., Perry, A. C., Lai, S. ve Signorile, J. F. (2009). The effects of an active-assisted stretching program on functional performance in elderly persons: a pilot study. Clinical Interventions in Aging, 4, 115-120. https://doi.org/https://www.doi.org/10.2147/cia.s4152.
37. Ward, A. B. (2000, 2000/09//). Assessment of muscle tone. Age and Ageing, 29(5), 385-386. https://doi.org/https://www.doi.org/10.1093/ageing/29.5.385.