The effects of long-term muscle disuse on neuromuscular function in unilateral transtibial amputees

Amy Sibley, Siobhan Strike, Sarah Moudy, Neale Tillin

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The purpose of this study was to determine: (1) whether individuals with unilateral transtibial amputations (ITTAs), who habitually disuse the quadriceps muscles of their amputated limb, provide an effective model for assessing the effects of long-term muscle disuse; and (2) the effects of such disuse on quadriceps muscle strength and neuromuscular function in this population. Nine ITTAs and nine controls performed isometric voluntary knee extensions in both limbs to assess maximal voluntary torque (MVT) and rate of torque development (RTD). The interpolated twitch technique and EMG normalised to maximal M-wave assessed neural activation, involuntary (twitch and octet) contractions assessed intrinsic contractile properties, and ultrasound images of the vastus lateralis assessed muscle architecture. Clinical gait analysis was used to measure knee kinetic data during walking at an habitual speed. ITTAs displayed 54-60%
lower peak knee extensor moments during walking in the amputated than intact/control limbs, but the intact and control limbs were comparable for loading during walking and muscle strength variables, suggesting the intact limb provides a suitable internal control for comparison to the disused amputated limb. MVT and RTD were ~60% and ~75% lower, respectively, in the amputated than intact/control limbs. The differences in MVT appeared associated with ~40% and ~43% lower muscle thickness and neural activation, respectively, whilst the differences in RTD appeared associated with the decline in MVT coupled with slowing of the intrinsic contractile properties. These results indicate considerable changes in strength and neuromuscular function with long-term
disuse, that could not be predicted from short-term disuse studies.
Original languageEnglish
Pages (from-to)408-418
Issue number3
Early online date27 Nov 2019
Publication statusE-pub ahead of print - 27 Nov 2019


  • muscle strength
  • muscle atrophy
  • neural activation
  • contractile properties
  • muscle architecture

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