DETERMINATION OF STRUCTURAL AND FUNCTIONAL THIGH MUSCLE PROPERTIES IN A HEALTHY OLDER POPUALTION USING MRI AND ISOKINETIC DYNAMOMETRY by KAREN PAMELA RUTH VETTER B. Sc (Biochemistry) The University of British Columbia, 1997 B. Sc (PT) The University of British Columbia, 2000 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE STUDIES (Rehabilitation Sciences) THE UNIVERSITY OF BRITISH COLUMBIA October 2006 © Karen Pamela Ruth Vetter, 2006 ABSTRACT Background: No consistent findings have been reported regarding the relationship between aging muscle size and strength. This may be due to the use of an inaccurate method of muscle quantification, anatomical cross-sectional area, and a limited study of muscle group and contraction type. There is little normative data on thigh muscle size and strength, or the nature of relationships among muscle groups of the thigh in a healthy older population. Purpose: 1) To determine the relationship between muscle volume (MV) of the knee flexors, knee extensors, and hip abductors, and their associated muscle strength and fatigue. 2) To investigate the reliability and validity of stereology to determine MV, and to establish the reliability of a protocol to measure hamstring muscle fatigue. 3) To investigate thigh circumference, and determine whether or not it is representative of MV and/or strength. 4) To establish normative strength ratios for this population. Subjects: Healthy older males and females, 51-80 years old. Methods: MV was calculated from MRI's of the subject's legs, using stereology. Isokinetic and isometric strength was measured on the Kin-Corn Dynamometer, and muscle fatigue was measured using EMG during an 80% maximum voluntary contraction (MVC). Thigh circumference was determined using a Lufkin steel tape measure. Results: Average MV was 1529.57 ± 500.54 cm3 for the quadriceps, 776.46 ± 231.65 cm3 for the adductors, and 613.59 ± 159.73 cm3 for the hamstrings. All three muscle groups showed a good to excellent relationship between MV and strength (r=0.76-0.91). Thigh circumference measures at 10 cm had a strong relationship with size (r=0.55- 0.72) and strength (r=0.93) of all muscle groups. Isometric strength ratios were 0.41 for hamstring : quadriceps, and 0.37 for adductor: hamstrings, where MV ratios were 0.51 and 1.03 respectively. The hamstring : quadriceps endurance time ratio was 1.74. Conclusions: The reliability of using stereology to measure MV of the thigh muscles was established, showing strong relationships between thigh muscle size and strength. Muscle strength ratios, and the evidence supporting thigh circumference measures at proximal sites on the thigh to represent functional muscle groups, will assist therapists in the treatment of healthy older adults. TABLE OF CONTENTS Abstract ii Table of Contents iv List of Tables vi List of Figures vii Acknowledgements ix Dedication x Chapter 1 Introduction 1 Literature Review Aging Muscle 3 Quantification of Muscle Tissue 7 Functional Muscle Properties 17 Key Muscle Groups of the Thigh 19 Clinical Measure of Thigh Circumference 21 Study Purpose 27 References 36 Chapter 2: Relationships of Muscle Volume, Strength, and Thigh Circumference in a Healthy Older Population Introduction 44 Methods 49 Results 57 Discussion 72 References 85 Chapter 3: Ratios of Muscle Size, Strength and Fatigue in a Healthy Older Population Introduction 91 Methods 95 Results 96 Discussion 106 References 117 iv Chapter 4: Reliability of Surface EMG during a Submaximal Isometric Contraction of the Hamstrings Introduction 120 Methods 125 Results 131 Discussion 138 References 144 Chapter 5 Discussion 149 Strengths and Weaknesses 153 Conclusion 153 References 155 Appendices A. Reliability and Validity of Stereological Method.... 157 B. Reliability of Testing Protocol for Hip Adductor Strength 167 C. Raw Data - Muscle Volumes 169 D. Raw Data - Thigh Circumference Measures 170 E. Raw Data - EMG Median Frequency and Amplitude 172 F. Ethics Certificate of Approval (Amendment) 175 G. Subject Consent Form 177 H. Subject Recruitment Poster 181 v LIST OF TABLES Chapter 2 Table 2.1: Muscle Volume & % Non-Contractile Tissue 64 Table 2.2a: Muscle Strength of Knee Flexors, Knee Extensors, & Hip Adductors 65 Table 2.2b: Muscle Strength - Group & Male/Female Averages 66 Table 2.3: Muscle Efficiency 68 Table 2.4: Pearson-Product Moment Correlation Coefficient Values For Thigh Circumference and Muscle Volume 70 Table 2.5: Pearson-Product Moment Correlation Coefficient Values For Thigh Circumference and Muscle Strength 71 Chapter 3 Table 3.1a: Muscle Volume Ratios 100 Table 3.1b: Muscle Volume Ratios - Group and Gender Averages 100 Table 3.2a: Muscle Strength Ratios 101 Table 3.2b: Muscle Strength Ratios - Group and Gender Averages 101 Table 3.3a: Endurance Time and Ratios 102 Table 3.3b: Endurance Time and Ratios - Group and Gender Averages 102 Chapter 4 Table 4.1: EMG Median Frequency Parameters for 80% Contraction of the Hamstrings 133 Table 4.2: EMG Amplitude Parameters for 80% Contraction of the Hamstrings 136 Table 4.3: Reliability of MDF and Amplitude Measures for the 80% Contractions 137 Table 4.4: Initial and Final % Peak Amplitude for Medial and Lateral Hamstrings 137 vi LIST OF FIGURES Chapter I Figure 1.1: Different Architectural Properties of Muscle 29 Figure 1.2: Changes in Muscle Fiber Pennation Angle 30 Figure 1.3: Cavalieri's Principle of Volume Determination 31 Figure 1.4: Use of Grid on MRI 32 Figure 1.5: Posterior Thigh - Hamstring Muscle Group 33 Figure 1.6: Anterior Thigh - Quadriceps Muscle Group.. 34 Figure 1.7: Medial Thigh - Adductor Muscle Group 35 Chapter 2 Figure 2.1: Examples of MRI Images Analyzed for Thigh Muscle Volume 62 Figure 2.2: Cross-sectional Anatomy of the Thigh 63 Figure 2.3: Thigh Muscle Volume for Each Gender 64 Figure 2.4: Total Muscle Volume per Group for Each Gender 65 Figure 2.5: Isometric Muscle Strength per Group for Each Gender 66 Figure 2.6: Relationship between Muscle Size and Strength 67 Figure 2.7: Muscle Volume vs Isometric Strength of the Knee Flexors 67 Figure 2.8: Muscle Volume vs Isometric Strength of the Knee Extensors 68 Figure 2.9: Muscle Volume vs Isometric Strength of the Hip Adductors 69 Figure 2.10: Total Muscle Volume of Knee Extensors vs Knee Flexors 69 Figure 2.11: Isometric Muscle Strength of the Knee Extensors vs Knee Flexors 70 Figure 2.12: Adductor Strength vs Thigh Circumference Measures 71 vii Chapter 3 Figure 3.1: Relationship between Knee Flexor and Knee Extensor Endurance Times 103 Figure 3.2: Relationship between Knee Flexor and Knee Extensor Endurance Times, (without outlier) 103 Figure 3.3: Relationship between Knee Flexor Muscle Volume and Endurance Time 104 Figure 3.4: Relationship between Knee Extensor Muscle Volume and Endurance Time 104 Figure 3.5: Relationship between Knee Flexor Strength and Endurance Time 105 Figure 3.6: Relationship between Knee Extensor Strength and Endurance Time. 105 Chapter 4 Figure 4.1: Normalized Median Frequency of the Lateral Hamstrings 133 Figure 4.2a: Initial Median Frequency of the Medial Hamstrings 134 Figure 4.2b: Final Median Frequency of the Medial Hamstrings 134 Figure 4.2c: Normalized Median Frequency of the Medial Hamstrings 135 Figure 4.3: Normalized Amplitude for the Medial Hamstrings 135 Figure 4.4: Normalized Amplitude for the Lateral Hamstrings 136 viii ACKNOWLEDGEMENTS I would like to thank my supervisor, Dr. Donna Maclntyre, for her endless support, encouragement, and ability to guide my ideas and thoughts with constructive criticism. Her patience and flexibility were greatly appreciated, and certainly helped contribute to the completion of this thesis. This experience has been a fantastic learning opportunity, and I thank Donna for sharing her wealth of knowledge with me in so many areas. I would also like to thank the other members of my committee, Dr. WD Reid and Dr. Dave Wilson, for their interest in my project, and their thoughtful and constructive suggestions along the way. Early on in my graduate studies I had the opportunity to work more closely with one of my committee members, Dr. WD Reid, and I would like to thank her for this incredible learning opportunity. I also was fortunate enough to work with a former PhD candidate, Sunita Mathur, now PhD, who was gracious enough to allow me to work with subjects from her control group, as well as to share bits of data with me in order to help complete my project. Sunita, I have learnt a great deal from you, your ability to impart knowledge on others is extraordinary. Finally, I would like to thank my family and friends for all of their support, and willingness to listen over the last three years. My fiance has never let me forget what I am capable of, and my Mom has supported me every step of the way. I thank you all so much. ix DEDICATION I dedicate this thesis to my Dad, Francis Vetter, who never saw the finished project, yet who encouraged me from the start, and who always made me believe that I could do anything that I set my mind to. It's finished Dad! x Introduction Chapter 1 CHAPTER 1 INTRODUCTION The profession of physiotherapy relies on visible macroscopic, functional muscle properties, (i.e. muscle strength, range of motion, thigh circumference measurements), in order to make inferences regarding the state of the physiology of the muscle (64). However, the assumptions currently being made regarding the functional properties of the muscle and how they relate to the structural properties of the muscle may not be correct. The size of the muscle may not be directly related to its strength or endurance, and the increase in thigh circumference measured during a rehabilitation program may not be indicative of corresponding gains in strength or function (41).