Different frequency treadmill running in immobilization-induced muscle atrophy and ankle joint contracture of rats

We investigated the effects of different frequencies of treadmill running on immobilization-induced soleus and gastrocnemius muscle atrophy and ankle joint contracture in rats using morphology and histochemistry. The right ankle joint of rat was immobilized for 2 weeks. Thereafter, the rats were randomly assigned to four groups for 6 weeks of exercise under different conditions: free cage activity and free remobilization (FR), once-a-week treadmill running (low-frequency running program (LFR)), three-time-a-week running (middle-frequency running program (MFR)), and six-time-a-week running (high-frequency running program (HFR)) groups. Two weeks of immobilization significantly reduced the cross-sectional area of soleus type I (62%, P<0.05) and type II muscle fibers (66%, P<0.05), gastrocnemius type I (78%, P<0.05) and type II muscle fibers (68%, P<0.05), and the range of ankle joint movement (46%, P<0.05). Immobilization also increased the ratio of type II to total fiber numbers in the soleus (P<0.05), and gastrocnemius (P<0.05), and induced pathological changes in muscle fibers. Some of these changes could not be corrected by free remobilization; however, the LFR, MFR, and HFR groups clearly recovered toward normal levels with exercise frequency, the effect on muscle recovery being more beneficial in the MFR and HFR groups. In addition, the range of ankle joint contracture was improved in LFR, MFR, and HFR groups in comparison with that in the FR group. These findings indicate that treadmill running exercise improved the immobilization-induced muscle fiber histochemical alterations and the range of the ankle motion in rats. Running three times and six times a week was more beneficial for recovery of immobilization-induced muscle atrophy and joint contracture compared with no running or once-a-week running.     

Morphological comparison of different protocols of skeletal muscle remobilization in rats after hindlimb suspension

The aim of this study was to evaluate and compare the efficacy of different remobilization protocols in different skeletal muscles considering the changes induced by hindlimb suspension of the tail. Thirty-six female Wistar rats were divided into six groups: control I, control II, suspended, suspended free, suspended trained on a declined treadmill and suspended trained on a flat treadmill. Fragments of soleus and tibialis anterior (TA) muscle were frozen and processed by different histochemical methods. The suspended soleus showed a significant increase in the proportional number of intermediate/hybrid fibers and a decrease in the number of type I fibers. Some of these changes proved to be reversible after remobilization. The three remobilization programs led to the recovery of both the proportional number of fibers and their size. The TA muscle presented a significant increase in the number and size of type I fibers and a cell size reduction of type IIB fibers, which were recovered after training on a declined treadmill and free movement. Especially regarding the soleus, the present findings indicate that, among the protocols, training on a declined treadmill was found to induce changes of a more regenerative nature, seemingly indicating a better tissue restructuring after the suspension procedure.     

Skeletal muscle HSP expression in response to immobilization and remobilization

Heat shock proteins play an important regulatory role in the cellular defence. Oxidative stress is one of the factors inducing heat shock protein expression. This study tested the effects of 4 weeks of immobilization and subsequent remobilization on heat shock protein expression and oxidative stress in the lateral gastrocnemius and plantaris muscles of the rat. Active mobilization or free mobilization protocols were used for remobilization. In active mobilization, strenuous uphill treadmill running, twice a day, was started immediately after the immobilization and lasted for six days. Rats in the free mobilization group moved freely in their cages immediately after the immobilization. Expression of heat shock proteins was upregulated during the recovery from immobilization, especially in the lateral gastrocnemius muscle in the active mobilization group. However, markers of oxidative stress, such as protein carbonyls and 4-hydroxynonenal protein adducts, or activities of the antioxidant enzymes glutathione peroxidase and glutathione reductase, did not change after the immobilization and subsequent recovery. In summary, following immobilization, both intensive and spontaneous exercise upregulated the heat shock protein expressions in the lateral gastrocnemius muscle and partly in the plantaris muscle, which may contribute to the recovery from immobilization atrophy.     

Decreased taurine concentration in skeletal muscles after exercise for various durations

PURPOSE: To examine the changes of taurine concentrations in blood and skeletal muscles after transient exercise. METHODS: Rats were placed on a treadmill set at 25 m.min-1. The animals were divided into four groups: control (no exercise) and exercise groups 1, 2, and 3. The exercise duration for groups 1, 2, and 3 was 30, 60, and 100 +/- 12.5 min (to exhaustion: mean +/- SD), respectively. We examined the plasma concentrations of taurine and lactate, the serum concentrations of sodium and chloride ions, as well as the skeletal muscle taurine content in the soleus (slow-twitch fiber dominant type), gastrocnemius (slow- and fast-twitch fiber mix type), and plantaris and extensor digitorum longus (fast-twitch fiber dominant type) muscles. RESULTS: Although the plasma taurine concentration was not affected by the increased exercise duration, that in skeletal muscles was significantly decreased. The gastrocnemius and plantaris muscles from the exercise group 3 had a significantly lower concentration of taurine than those of the control group. The extensor digitorum longus taurine concentration from the different exercise groups was significantly decreased compared with that from the control group. However, there was no significant difference among the exercise groups. CONCLUSION: Taurine concentration was decreased in all skeletal muscles after exercise, regardless of the duration. Moreover, this decrease was specific to fast-twitch dominant fibers. However, under these conditions, the plasma taurine concentration remained unchanged.     

Hyperbaric oxygen increases the contractile function of regenerating rat slow muscles

Human trials of hyperbaric oxygen (HBO) treatment of sports-related muscle injuries are equivocal. Although most human skeletal muscles are composed of mixed muscle fiber types, it is unclear whether HBO affects fiber types differently. PURPOSE: We tested the hypothesis that HBO can enhance the functional properties of regenerating rat soleus muscles that are composed predominantly of slow fibers. METHODS: After intramuscular injection of bupivacaine hydrochloride to induce the degeneration of all fibers within the soleus muscle, treated rats received daily HBO treatment at 3 atmospheres absolute. RESULTS: In untreated rats, injured muscles demonstrated a reduced force-producing capacity (control soleus vs injured soleus, 220.3 +/- 2.5 vs 157.6 +/- 3.3 kN.m(-2) at 25 d postinjury, respectively, P < 0.05) and contained smaller regenerating muscle fibers than uninjured soleus muscles (fiber cross sectional area in control soleus vs injured soleus, 2289 +/- 164 vs 1154 +/- 92 microm 2 at 25 d postinjury, respectively, P < 0.05). The regenerating soleus muscles of HBO-treated rats demonstrated a greater force-producing capacity as a percentage of contralateral control muscles than the regenerating muscles from untreated rats at 14 d postinjury (regenerating HBO-soleus peak tension and untreated soleus peak tension, 42.9 +/- 1.9 and 35.8 +/- 3.9% of contralateral control muscles, respectively, P < 0.05), but no effect of treatment was observed at 25 d postinjury. CONCLUSION: HBO enhanced the contractile properties of regenerating rat soleus muscles after myotoxic injury, but this improvement was not sustained for the duration of the regenerative process. The data indicate that the outcome of HBO treatment of a muscle injury may be influenced by the fiber type composition of the injured muscle.     

Morphology of immobilized skeletal muscle and the effects of a pre- and postimmobilization training program

The hind limbs of mice were immobilized with plaster cast for different periods of time, and the atrophy of the anterior tibial muscle was examined by measuring fiber cross sections. In a second series of experiments, mice were trained on a treadmill before and after immobilization. The most pronounced decrease in fiber diameters was observed during the 1st week; during prolonged immobilization, only a moderate atrophy occurred. Red fibers were found to be more susceptible to immobilization atrophy than white fibers. The ultrastructural observations extended to loss and fragmentation of myofibrils, mitochondria, and the sarcotubular system. Some fibers split and appeared to undergo segmental necrosis, which was followed by invasion of leucocytes into the muscle. Still while immobilized, the muscles exhibited a regenerative capacity; satellite cells differentiated to myoblasts, which fused to myotubes, being the precursors of new muscle fibers. This was already observed during the 1st week of immobilization. The effect of training after immobilization was documented by an increase of fiber diameters. The ultrastructural alterations, however, in these muscles were severe; it was concluded that a postimmobilization training has to be undertaken very carefully. When the muscles were trained before immobilization, the atrophy was almost negligible. A preimmobilization training can probably prevent the muscle from developing severe atrophy.     

In vivo diffusion tensor imaging of the human calf muscle

PURPOSE: To demonstrate the feasibility of in vivo calf muscle fiber tracking in human subjects. MATERIALS AND METHODS: An EPI-based diffusion tensor imaging (DTI) sequence with six-direction diffusion gradient sensitization was implemented, and DT images were acquired at 3 Tesla on five subjects using an extremity coil. The mean diffusivity, fractional anisotropy (FA), and fiber angle (with respect to the magnet z-axis) were measured in different muscles, and fibers were tracked from several regions of interest (ROIs). RESULTS: The fiber orientations in the current DTI studies agree well with those determined in previous spectroscopic studies. The orientation angles ranged from 13.4 degrees in the lateral gastrocnemius to 48.5 degrees in the medial soleus. The diffusion ellipsoid in muscle tissue is anisotropic and approximates a prolate model, as shown by color maps of the anisotropy. Fibers were tracked from the different muscle regions, and the unipennate and bipennate structure of muscle fibers was visualized. CONCLUSION: The study clearly shows that in vivo fiber tracking of muscle fibers is feasible and could potentially be applied to study muscle structure function relationships.     

Muscle degeneration after exercise in rats

To search for morphological changes in muscle, related to overuse syndromes of muscle due to exercise, groups of untrained rats ran on a treadmill for 1 h at submaximal intensity. Each group was sacrificed at a different interval after the end of the exercise. To evaluate the physiologic load, the colonic temperature and blood lactate level were determined. The right hindlimb was fixated with buffered glutaraldehyde, injected into the femoral artery, and different muscles were dissected and prepared for electron and light microscopy. The muscles of the left limb were frozen in liquid Freon and used for histochemistry. Signs of degeneration were noted in the soleus, rectus femoris, and vastus lateralis muscles, but were absent in the gastrocnemius, tibialis anterior, extensor digitorum, and biceps femoris muscles. Immediately after exercise, only minor signs of degeneration were observed at the ultrastructural level, while after 2-3 h degeneration became clearly visible at the light microscopic level. The most pronounced changes were observed 24-48 h after exercise, whereafter regeneration occurred. Only 2%-5% of all fibers in the soleus muscle showed signs of degeneration, while in the vastus lateralis and rectus femoralis muscle less than 0.5% of the fibers were affected. The affected fibers showed degeneration only in segments with a length between 150-1250 micrometers. The affected fibers in the soleus and vastus lateralis muscles belong to the type I population, while in the rectus femoris type I as well as type II fibers were affected.     

Shortened T2 after exercise in ischemic skeletal muscle

PURPOSE: To detect skeletal muscle ischemia with transverse relaxometry after ischemic exercise. MATERIALS AND METHODS: Ten subjects with intermittent claudication were studied. T2 was measured in the gastrocnemius and soleus muscles (m. gastrocnemius and m. soleus) at rest and repeatedly after exercise during 45 minutes of recovery. Prior to MRI a symptom-limited treadmill exercise was performed, and the ankle-arm blood pressure index (AAI) was measured at rest and after exercise. RESULTS: In the 14 legs with ischemic pain, a diverging response was found in the calf: T2 increased in m. gastrocnemius by 5.6% +/- 4.9%, but decreased in m. soleus by -1.2% +/- 4.4% (P < 0.001). Moreover, 13 regions in legs with ischemic pain and reduced AAI (from 0.7 +/- 0.2 at rest to 0.31 +/- 0.15 after exercise) had shortened T2 (-3.6% +/- 1.8%) immediately after exercise. This finding was most frequent in m. soleus and two regions of m. gastrocnemius. Recovery was delayed in the latter two regions. CONCLUSION: T2 may identify ischemic muscles after hypoxic exercise. Shortened T2 suggests a reduced water content (e.g., distribution volume of water) and may affect the upslope kinetics of an extravascular perfusion tracer. The different responses to ischemia by the soleus and gastrocnemius muscle may be due in part to their different fiber type compositions.     

Muscle contributions to propulsion and braking during walking and running: Insight from external force perturbations

There remains substantial debate as to the specific contributions of individual muscles to center of mass accelerations during walking and running. To gain insight, we altered the demand for muscular propulsion and braking by applying external horizontal impeding and aiding forces near the center of mass as subjects walked and ran on a treadmill. We recorded electromyographic activity of the gluteus maximus (superior and inferior portions), the gluteus medius, biceps femoris, semitendinosus/membrinosus, vastus medialis, lateral and medial gastrocnemius and soleus. We reasoned that activity in a propulsive muscle would increase with external impeding force and decrease with external aiding force whereas activity in a braking muscle would show the opposite. We found that during walking the gastrocnemius and gluteus maximus provide propulsion while the vasti are central in providing braking. During running, we found that the gluteus maximus, vastus medialis, gastrocnemius and soleus all contribute to propulsion.     

Muscle contributions to propulsion and braking during walking and running: Insight from external force perturbations

There remains substantial debate as to the specific contributions of individual muscles to center of mass accelerations during walking and running. To gain insight, we altered the demand for muscular propulsion and braking by applying external horizontal impeding and aiding forces near the center of mass as subjects walked and ran on a treadmill. We recorded electromyographic activity of the gluteus maximus (superior and inferior portions), the gluteus medius, biceps femoris, semitendinosus/membrinosus, vastus medialis, lateral and medial gastrocnemius and soleus. We reasoned that activity in a propulsive muscle would increase with external impeding force and decrease with external aiding force whereas activity in a braking muscle would show the opposite. We found that during walking the gastrocnemius and gluteus maximus provide propulsion while the vasti are central in providing braking. During running, we found that the gluteus maximus, vastus medialis, gastrocnemius and soleus all contribute to propulsion.     

Steroid myopathy: evaluation of fiber atrophy with T2 relaxation time--rabbit and human study

PURPOSE: To determine whether muscle fiber atrophy associated with steroid myopathy can be detected with T2 relaxation time. MATERIALS AND METHODS: Animal and human studies were approved by the ethics committee. Informed consent was obtained. Twelve rabbits were divided into a group that received 3 mg/kg of triamcinolone subcutaneously each day for 10 consecutive days (n = 6) and a control group that received saline (n = 6). Magnetic resonance (MR) imaging was performed before and after treatment. T2 and fat deposition ratio (FDR) of soleus and gastrocnemius muscles before and after treatment and between control rabbits and rabbits treated with steroids were compared by using two-way repeated analysis of variance and Bonferroni post hoc test to evaluate effects of steroid treatment. After imaging, rabbits were sacrificed. Extracellular space ratio (ECSR) and fiber diameter were examined. Correlation among T2, ECSR, and diameter of type 2 muscle fibers was analyzed with a Pearson correlation test with Bonferroni correction in gastrocnemius to determine factors affecting T2. In humans, T2 relaxation time and FDR of both muscles were compared between volunteers not treated with steroids and patients treated with steroids by using an unpaired t test to evaluate the effects of steroids. RESULTS: In rabbits, T2 of gastrocnemius muscle was significantly (P < .01) longer after steroid treatment than before steroid treatment and was also significantly (P < .01) longer than after saline administration. T2 of the gastrocnemius showed no significant difference in control rabbits before or after saline administration or in control rabbits and rabbits before steroid administration. T2 of the soleus muscle or FDR of either muscle showed no significant difference. There was a significant correlation (P < .01) among T2, ECSR, and diameter of type 2 muscle fibers in the gastrocnemius. In humans, T2 of the gastrocnemius was significantly (P < .01) longer in patients than in volunteers. T2 of the soleus or FDR of either muscle showed no significant difference. CONCLUSION: Muscle fiber atrophy associated with steroid myopathy is detectable as prolongation of T2 relaxation time in the gastrocnemius muscle; the authors believe prolongation of T2 relaxation time is mainly due to increased ECSR reflecting type 2 muscle fiber atrophy.     

Effect of recovery mode following hind-limb suspension on soleus muscle composition in the rat.

The purpose of this study was to compare the effects of two different recovery modes from hind-limb suspension-induced hypodynamia on whole body and muscle (soleus) growth as well as soleus composition and size changes of different fiber types within this same muscle. Following 28 days of tail-suspension, rats were returned to their cages and sedentarily recovered (HS), or were exercised by running on a treadmill 5 days/wk, at progressively increasing workloads (HR) for one month. Sedentary and running control groups of animals (CS, CR) were also evaluated for comparative purposes. The exercise program, which was identical for CR and HR groups, had no effect on body wt., soleus wt., soleus muscle composition or fiber size in CR rats. Atrophied soleus muscle and reduced soleus wt./body wt. ratio (both 60% of control) had returned to control values by day 7 of recovery in both suspended groups despite the fact that whole body wt. gain was significantly reduced (p less than 0.05) in HR as compared to HS rats. Atrophied soleus Type I fiber mean cross-sectional area in both HR and HS groups demonstrated similar and significant (p less than 0.01) increases during recovery. Increases in Type IIa and IIc fiber area during this same period were significant only in the HR group. While the percentage area of muscle composed of Type I fibers increased in both hypodynamic groups during recovery, the reduction in area percentage of muscle made up of Type IIa fibers was again only significant in the HR group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Capillarization in skeletal muscle of rats with cardiac hypertrophy

PURPOSE: Exercise intolerance during chronic heart failure (CHF) is localized mainly in skeletal muscle. A decreased capillarization may impair exchange of oxygen between capillaries and muscle tissue and in this way contribute to exercise intolerance. We assessed changes in capillary supply in plantaris and diaphragm muscles of a rat aorta-caval fistula (ACF) preparation, a volume overload model for CHF. METHODS: An ACF was created under equithesin anesthesia. Plantaris and diaphragm muscles were removed 6 wk postsurgery and examined for myosin heavy chain (MyHC) content and capillary supply. RESULTS: Cardiac hypertrophy was 96% (P < 0.002) after ACF. The Type IIb MyHC content of the plantaris muscles increased (33.9 +/- 3.3 vs 49.8 +/- 3.8%; mean +/- SEM) at the expense of Type IIa MyHC (17.6 +/- 1.8 vs 11.2 +/- 1.7%) in ACF rats (P < 0.05). In the diaphragm, the number of Type I (32.1 +/- 2.3 vs 40.6 +/- 2.7%) and IIb fibers (40.6 +/- 1.9 vs 49.6 +/- 3.6%) increased at the expense of Type IIa fibers (26.8 +/- 2.5 vs 9.4 +/- 0.9%) (P < 0.05). The capillary number per fiber did not change, and this indicated that no capillary loss occurred with ACF. Also, the capillary density was maintained in the diaphragm and plantaris muscles of ACF rats. Furthermore, the coupling between fiber type, size, and metabolic type of surrounding fibers, with the capillary supply to a fiber, was maintained in rats with an ACF. CONCLUSION: The cardiac hypertrophy induced by volume overload seems adequate to prevent atrophy and changes in the microcirculation of limb and diaphragm muscles.     

Calf muscle atrophy and Achilles tendon healing following experimental tendon division and surgery in rats

We used a rat model to study the effects of immobilization of the calf muscle-tendon complex after an experimental Achilles tendon repair. Immobilizations of the complex in either a relaxed or tensioned position were compared by histochemical and morphometric analyses at the site of the tendon injury as well as in the gastrocnemius and soleus muscle bellies. The type of immobilization did not affect the healing of the tendon injury because no reruptures occurred in either of the treatment groups and the average tendon end-to-end distance did not differ between the groups. However, immobilization in a relaxed position led to a significantly more extensive fiber atrophy in the calf muscles. In clinical practice, these results suggest that rehabilitation after Achilles tendon surgery can be early and gradually tension- and load-increasing without a significant increase in the risk of rerupture of the tendon.     

Morphohistochemical study of skeletal muscles in rats after experimental flight on "Kosmos-1887"

Morphometric and histochemical methods were used to examine the soleus, gastrocnemius (medial portion), quadriceps femoris (central portion) and biceps brachii muscles of Wistar SPF rats two days after the 13-day flight on Cosmos-1887. It was found that significant atrophy developed only in the soleus muscle. The space flight did not change the percentage content of slow (type I) and fast (type II) fibers in fast twitch muscles. During two days at 1 g the slow soleus muscle developed substantial circulation disorders, which led to interstitial edema and necrotic changes. The gastrocnemius muscle showed small foci containing necrotic myofibers. Two days after recovery no glycogen aggregates were seen in myofibers, which were previously observed in other rats examined 4--8 hours after flight. An initial stage of muscle readaptation to 1 g occurred, when NAD.H2-dehydrogenase activity was decreased.     

Onset of rigor mortis is earlier in red muscle than in white muscle

Rigor mortis is thought to be related to falling ATP levels in muscles postmortem. We measured rigor mortis as tension determined isometrically in three rat leg muscles in liquid paraffin kept at 37 °C or 25 °C – two red muscles, red gastrocnemius (RG) and soleus (SO) and one white muscle, white gastrocnemius (WG). Onset, half and full rigor mortis occurred earlier in RG and SO than in WG both at 37 °C and at 25 °C even though RG and WG were portions of the same muscle. This suggests that rigor mortis directly reflects the postmortem intramuscular ATP level, which decreases more rapidly in red muscle than in white muscle after death. Rigor mortis was more retarded at 25 °C than at 37 °C in each type of muscle. Received: 17 May 1999 / Received in revised form: 9 July 1999     

Structural and metabolic characteristics of human skeletal muscle following 30 days of simulated microgravity

Percutaneous needle biopsy samples were obtained from the vastus lateralis and soleus muscles before and after 30 d of 6 degree head-down bedrest to determine the influence of this model of simulated microgravity on human skeletal muscle. Fiber atrophy was evident in both muscles with both fast-twitch and slow-twitch fiber cross-sectional areas decreasing. Predominant atrophy of slow-twitch fibers was not evident. The soleus had a greater proportion of slow-twitch fibers than the vastus lateralis before bedrest. Neither muscle showed a change in fiber type percentage with bedrest. Phosphofructokinase and lactate dehydrogenase activities in the soleus and vastus lateralis muscles were similar before and after bedrest. The activities of beta-hydroxyacyl-CoA dehydrogenase and citrate synthase, however, were reduced during bedrest with these responses being somewhat greater in the soleus. While the ultrastructure of most of the fibers of the soleus and vastus lateralis appeared normal after bedrest, evidence of remodeling was present in both muscles. The proliferation of core/targetoid lesions, honeycomb networks, regenerating satellite cells, necrotic foci and myofibrillar disorganization after bedrest indicates that force development is an important factor in determining the organization of the fine structure of muscle. The results indicate that short-duration exposure to simulated microgravity decreases fiber size and the capacity for aerobic energy supply of human skeletal muscle. Moreover, disorganization of the contractile machinery occurs. Thus, it appears that bedrest alters the "normal" load-time constraints imposed on skeletal muscle sufficiently to change its inherent structural and metabolic characteristics.     

Fiber size,type, and myosin heavy chain content in rhesus hindlimb muscles after 2 weeks at 2 G

BACKGROUND: Fiber atrophy and an increase in the percentage of fast fibers have been observed in Rhesus leg muscles after spaceflight. Hypothesis: Hypergravity will result in muscle fiber hypertrophy and an increase in the percentage of slow fibers. METHODS: Open muscle biopsies were obtained from Rhesus soleus, medial gastrocnemius (MG), and tibialis anterior (TA) muscles before and after 14 d of centrifugation (2 G) and in time-matched controls. Cage activity levels were measured by telemetry. RESULTS: Based on monoclonal antibody binding for myosin heavy chains (MHC), the fastest region of soleus contained a higher proportion of type I+II (27 vs. 13%) and had a tendency for a lower proportion of type I (38 vs. 61%, p = 0.10) fibers after than before centrifugation. There was a higher proportion of type I+II fibers in post- vs. pre-2 G (10 vs. 0.6%) MG biopsies. Fiber type distribution and MHC composition were unaffected in the TA. Overall, mean fiber sizes were unaffected by centrifugation. Average cage activity levels were 36% lower during than before 2 G. CONCLUSIONS: Our hypothesis was rejected. The changes in the proportion of fibers expressing type I MHC are the reverse of that expected with chronic loading of extensors and, paradoxically, are similar to changes observed with chronic unloading, such as occurs during spaceflight, in this primate model. The data are consistent with the observed decrease in total daily activity levels.     

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.