Methods of Muscle Tone Diagnosis: History
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Barbora Kopecká
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David Ravnik
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Karel Jelen
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Václav Bittner

“Muscle tone” is a clinically important and widely used term and palpation is a crucial skill for its diagnosis. However, the term is defined rather vaguely, and palpation is not measurable objectively. Therefore, several methods have been developed to measure muscle tone objectively, in terms of biomechanical properties of the muscle. 

  • soft tissue mechanical properties
  • muscle tone
  • myotonometry

1. Objective Methods of Muscle Tone Diagnosis

Latash and Zatsiorski [1] defined three possible approaches to the concept of muscle tone, from which the respective methods of its objectification proceed. The first one is based on the definition of tone as the resistance of a muscle to movement at a given joint. This approach was used by McPherson [2] and Brennan [3] in their works and proposed devices. They used the resistive force of the spring that kept the segment of the respective musculoskeletal system out of the physiological position in a given joint to determine the degree of spasticity. The very same principle is the basis of the widely used subjective assessment of spasticity based on the Ashworth scale or its modified version [4][5][6]. However, these methods assess the mechanical properties of the entire musculoskeletal chain, including the joint. Thus, they are not focused on a single muscle and small changes in muscle tone and the mechanical properties of a particular muscle (elasticity, viscosity) are difficult to determine from them, see [7][8].
The second approach is to use an EMG, where muscle tone is taken as the initial resting signal level without muscle activation. This is the approach taken by Jacobson [9], but as views on muscle tone have changed, this method has proven inadequate: Adrian and Bronk [10] found that completely relaxed normal muscle shows no spontaneous electrical activity, but under such conditions, quantifiable muscle tone (in terms of hypo-, eu-, or hypertonia) can still be detected. Latash and Zatsiorski [1] also point out that complete relaxation might not be possible in certain patients or for specific measurement scenarios.
The third group of methods are indentation stress tests. Their principle is to press a tip (indenter) of known geometry into a body surface and monitor the mechanical response, or the load characteristics, of the underlying tissue. Two types of such devices, often called myotonometers, can be distinguished. In the first case, the oscillatory response of the tissue to a single, short, rectangular pulse of the indenter is evaluated. Probably the most well-known representative of these devices is the Myoton, or the latest model MyotonPRO [11][12]. The reliability of the method varies between 0.74–0.93 (95% CIAvg), in different measurements [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Its application is so far limited to superficial muscles and other soft tissues. It cannot examine deep, hard-to-palpate muscles and cannot measure thin or small muscles. A major shortcoming of the device is that it uses tapping, an impulse different from normal palpation, which can elicit an unwanted reflex response in the tissue that can distort the result.
The second subgroup consists of myotonometers whose indenter pushes against the tissue to a predefined depth or to a predefined resistance force at a defined but relatively low speed, and then it returns. Such devices essentially simulate the palpation technique described above. The output is the dependence of the resistive force of the tissue on the indentation depth of the indenter and takes the form of a hysteresis curve. The first devices of this type were originally developed to determine the pressure required to induce pain in soft tissue [28]; only later was a measurement of pliability added [29], but this was not very reliable [30]. Gradually, different authors [31][32][33][34][35][36][37][38] worked on developing more accurate and user-friendly solutions. For some of these first devices, it was necessary to perform the indentation manually, which did not allow a constant force or speed of tip indentation to be ensured [31]. Consequently, some authors developed manual instruments that perform the indentation and calculation of rheological properties automatically, but the necessity of manual stabilization causes inaccuracies in the obtained results. For example, Leonard et al.’s Myotonometer [34], which shows variable reliability between 0.42 and 1.00 when used on selected muscles in different experimental settings [39][40][41], is worth mentioning. Other instruments [37][38][42] have a fixed design that minimizes the unreliability associated with examiner participation at the cost of less user friendliness. For example, the CMT (computerized muscle tonometer) has been found to have a reliability between 0.82 and 0.97 (95% CIAvg) [37][43]. Another option is to attach the device directly to the segment to be measured. In combination with constant tissue deformation by the indenter, this option is used by the MC Sensor [44].
A general criticism of Latash and Zatsiorski [1] against indentation methods is that they treat tone as a passive property only. Thus, they do not consider its participation in active movement and posturing since the examinee is always instructed to relax. However, it can be argued that, in manual palpation, complete relaxation is a requirement for correct examination as well according to some authors [45], and even Latash and Zatsiorski [1] admit that muscle tone can be defined based on the state when the muscle is “relaxed to the maximum of the examinee’s abilities”.
From a physical point of view, it is important to note that the measurement of the load characteristic alone only allows a limited assessment of the mechanical properties of the tissues under examination. It is usually based on a descriptive characterization of the tissue response curve as a function of its load. Only by using a suitable mathematical model can the viscoelastic properties of the indented tissue layers be identified. However, the validation of these models is quite complicated and often tied to computational simulations.
In addition to indentation stress tests, there are efforts to determine the mechanical properties of musculoskeletal soft tissues using free vibration techniques (e.g., [46]). Again, information on the rheological properties of the affected muscle tissue can be extracted from these using a suitable mathematical model. However, there are once more limitations associated with the validation of mathematical models, see above.
An alternative to strain stress testing, standing outside of Latash and Zatsiorski’s [1] categories and currently coming to the fore, is non-invasive imaging. Ultrasonic elastography [47][48][49], where the propagation of acoustic waves is sensed by ultrasound, has a relatively long history and widespread use. There are already many approaches for the use of ultrasound in the assessment of tissue rheological properties [50], the most widely used being the supersonic shear wave imaging (SSI) [51]. The method has so far been attributed with a variable reliability ranging between 0.67 and 0.92 (95% CIAvg) by various studies [15][22][23][52][53][54][55][56][57][58][59][60][61][62][63][64].
Magnetic resonance elastography (MRE) is a more costly and time consuming but also more accurate option [65][66][67][68]. Magnetic resonance imaging captures the propagation of mechanical waves in the tissue, and stiffness can then be inferred from both the wavelength and the speed of propagation. Low [69] aptly called this technique “virtual palpation.” MRE can even be used for measurement under dynamic conditions in real time [70]. The most advanced technique uses the 3T magnetic field, with a reliability of 0.65–0.98 (95% CIAvg) on selected muscles [71][72].
Given the high variability of the reliability indices, a variance decomposition was used for selected methods (MyotonPRO, CMT, SSI). Results show that the intra-class variability of the reliability indices is significantly higher than the inter-class variability in all the analyzed methods. This virtually makes it impossible to compare the results from different measurements, even if the objective method used was the same.
In order to supplement this, infrared thermography can be mentioned as an indirect method of muscle tone assessment offered by Maršáková and Nováková [73]. In this technique, the body surface temperature is compared with the palpation findings, and the method can only be described as indicative.

2. Application of Objective Methods in Muscle Tone Diagnosis

Despite the shortcomings described above, objective methods offer an important advantage over subjective methods. While palpation can only assess muscle tone in terms of several levels (hypotonic/eutonic/hypertonic muscle), objective methods provide a numeric value. Therefore, provided that an appropriate methodology is followed, they allow quantification of intra- and possibly inter-individual differences in the measured components of muscle tone. This allows implementation of quantitative methods into a wide range of research areas.

2.1. Physiotherapy

In physiotherapy and rehabilitation medicine, or even neurology and other related fields, objective methods can play an important role in assessing muscle tone. First and foremost, objective muscle tone data can help the health care professional determine the lesion or other deviation from the physiological norm, its extent and degree, and possibly its nature or cause. For example, using both USE (ultrasound elastography) [74] and MRE, it has been possible to detect changes in various myopathies [75], conditions preceding pressure ulcers [76], and other muscle pathologies. Furthermore, these methods or Myoton can be used to detect stiff fascicles characteristic of myofascial trigger points [49][77][78], to assess rigidity [79][80][81][82][83] or spasticity [84]. Furthermore, Myoton, MRE, or USE have been used to investigate how changes in the rheological properties of the muscle correlate with the occurrence of various pain [85][86], changes in mobility and position of body segments [87][88][89] or previous injuries [90][91], how masticatory muscle stiffness affects masticatory abilities [92], etc.
Secondly, these methods can supplement the missing link in assessing the effectiveness of various physiotherapy interventions, such as techniques targeted at influencing muscle tone (ultrasound, soft tissue techniques, Kinesio taping, post-isometric relaxation, etc.), but also techniques targeted at another problem (symptom) or holistic techniques in which the change in muscle tone is a secondary manifestation (mobilization techniques, techniques based on neurophysiology, etc.). Similarly, of course, they can be used outside physiotherapy itself, e.g., to assess the effectiveness of medication, surgical interventions, etc. This use can contribute not only to the general validation of methods according to the rules of evidence-based medicine, but also in clinical practice for the assessment of individually implemented interventions on specific patients. For example, MRE has already been used to assess the effect of eccentric exercise [93] or positive thermotherapy [94], USE in instrumental massage [95] and botulinum toxin application [96], Myoton to assess the effectiveness of petrissage (deep muscle massage) and lymphatic drainage [97] and ischemic compression of myofascial trigger points [98], neurodynamics and instrumental soft tissue mobilization [99], strengthening and stretching exercises [100], aquatic exercise and electrical neuromodulation [101], dry needling [102], botulinum toxin and shock wave application [103], mobilization [104], and many other therapeutic modalities.
Thirdly, these methods make it possible to assess and recognize some negative influences on muscle tone objectively. For example, Myoton has been used to determine the effect of army boots on the stiffness of the lower limb muscles [105] and the effect of dental protectors on the stiffness of masticatory muscles [106]. This use in ergonomics is a separate chapter (see below).

2.2. Ergonomics

Since occupational therapy is closely related to physiotherapy, the use of these methods is, to some extent, identical in these areas. Objective methods of muscle tone assessment can be used to determine the extent of impairment [49][77][78][79][80][81][82][83][84][107], which can then help in designing appropriate therapy and possible compensatory aids.
They can also be used to assess the effect of a specific workload or work environment on the musculoskeletal system, either by comparing the results of tone measurements on specific muscles before and after working hours within a single day [108] or periodically over a longer time cycle [109], or by comparing measurements under normal circumstances and under specific working conditions [110]. At the same time, it is possible to investigate how the rheological properties found in response to work/stress correlate with factors such as age, duration of employment [109], as well as perceived pain [108].
Similarly, these methods can be used to assess the effectiveness of various ergonomic devices and measures to make work easier for workers or to minimize the adverse effects of their work on their health, especially the musculoskeletal system [111][112][113].

2.3. Sport

In the field of sports, objective methods of muscle tone assessment make it possible to investigate the influence of individual types of loads or even specific sports on the muscular apparatus or the rheological properties of the muscle. Myoton has been used for this purpose in many cases, either to measure the immediate effect (i.e., before and after exercise) [114][115][116][117] or to determine the long-term effect. The latter has been determined either by measuring it in a single individual before, during, and after a training program [118], or by simply comparing values in a specific group of athletes with the general population [119][120]. These measurements can give people information on how to enhance performance in some cases and in which cases muscle overload occurs. Thus, this information can be used to prevent injuries and chronic overuse, modify training and recovery methods, and so on. Similarly, the influence of various sports aids, such as the aforementioned dental protectors, can also be investigated [106]. Secondarily, how tone is influenced by other factors such as posture and positioning in different segments can be investigated, and how these may relate to pain [87].
Furthermore, these methods can be used to investigate how the rheological properties of skeletal muscles are related to specific sports performance. For example, measurements of pre-exercise muscle tone using Myoton have shown that, for some muscles, higher agonist muscle tone (or lower antagonist muscle tone [121]) predicts better performance both between different individuals [122][123][124] and within the same individual in the course of a day [125].
Finally, as in physiotherapy, these methods can be applied in sports to test the effectiveness of recovery procedures intended to affect muscle tone or to speed up the treatment of sports injuries. In addition to the cases in the Physiotherapy section and many others, for example, the use of negative ion patches in the field of alternative medicine [126].
Apart from one exception [120], researchers could not find any cases in which a device other than Myoton was used in sports. It can be assumed that this is mainly due to practicality, time and money savings, and availability of the method. Imaging elastography methods, especially MRE, are more likely to be available at healthcare workplaces, whereas sports research is most often performed in sports institutions and laboratories or directly at sports venues.

2.4. Basic Research

Methods of muscle tone objectification can also contribute to research on the nature of muscle tone and its behavior in specific physiological and pathological circumstances. Some authors have already used USE [127], MRE [128][129][130], or Myoton [89][92][125][131][132] to establish normative values and to investigate changes in muscle rheological properties during the day or as a function of age, gender, menstrual cycle phase, BMI, race, individual physical activity, or stride length. As mentioned above, Myoton has also served to investigate the effect of specific physical activities on the rheological properties of muscle [114][118][119][120] or how these characteristics further relate to endurance and contractile ability and muscle strength [121][123].
Others have used these methods to investigate the rheological properties of muscles and the nature of their changes in pathologies such as hyperthyroidism [133], myopathy [74][134], other neuromuscular disorders [135][136], changes due to irradiation of tumors [137], etc., but also under specific extreme conditions [110].

This entry is adapted from the peer-reviewed paper 10.3390/s23167189

References

  1. Latash, M.L.; Zatsiorsky, V. Biomechanics and Motor Control: Defining Central Concepts; Academic Press: Cambridge, UK, 2016; pp. 85–98.
  2. McPherson, J.J.; Kreimeyer, D.; Aalderks, M.; Gallagher, T. A comparison of dorsal and volar resting hand splints in the reduction of hypertonus. Am. J. Occup. Ther. 1982, 36, 664–670.
  3. Brennan, J.B. Response to stretch of hypertonic muscle groups in hemiplegia. Br. Med. J. 1959, 1, 1504–1507.
  4. Kolar, P. Clinical Rehabilitation; Alena Kobesová: Praha, Czech Republic, 2014.
  5. Bohannon, R.W.; Smith, M.B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys. Ther. 1987, 67, 206–207.
  6. Ehler, E.J.N. Spasticita-klinické škály. Neurol. Praxi 2015, 16, 20–23.
  7. Fenn, W.O.; Garvey, P.H. The measurement of the elasticity and viscosity of skeletal muscle in normal and pathological cases; a study of socalled “muscle tonus”. J. Clin. Investig. 1934, 13, 383.
  8. Tognella, F.; Mainar, A.; Vanhoutte, C.; Goubel, F. A mechanical device for studying mechanical properties of human muscles in vivo. J. Biomech. 1997, 30, 1077–1080.
  9. Jacobson, E. Innervation and “tonus” of striated muscle in man. J. Nerv. Ment. Dis. 1943, 97, 197–203.
  10. Adrian, E.D.; Bronk, D.W. The discharge of impulses in motor nerve fibres: Part II. The frequency of discharge in reflex and voluntary contractions. J. Physiol. 1929, 67, i3–i151.
  11. Mullix, J.; Warner, M.; Stokes, M. Testing muscle tone and mechanical properties of rectus femoris and biceps femoris using a novel hand held MyotonPRO device: Relative ratios and reliability. Work. Pap. Health Sci. 2012, 1, 1–8.
  12. Peipsi, A.; Kerpe, R.; Jäger, H.; Soeder, S.; Gordon, C.; Schleip, R. Myoton pro: A novel tool for the assessment of mechanical properties of fascial tissues. J. Bodyw. Mov. Ther. 2012, 16, 527.
  13. Aird, L.; Samuel, D.; Stokes, M. Quadriceps muscle tone, elasticity and stiffness in older males: Reliability and symmetry using the MyotonPRO. Arch. Gerontol. Geriatr. 2012, 55, e31–e39.
  14. Feng, Y.N.; Li, Y.P.; Liu, C.L.; Zhang, Z.J. Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO. Sci. Rep. 2018, 8, 17064.
  15. Kelly, J.P.; Koppenhaver, S.L.; Michener, L.A.; Proulx, L.; Bisagni, F.; Cleland, J.A. Characterization of tissue stiffness of the infraspinatus, erector spinae, and gastrocnemius muscle using ultrasound shear wave elastography and superficial mechanical deformation. J. Electromyogr. Kinesiol. 2018, 38, 73–80.
  16. Lohr, C.; Braumann, K.M.; Reer, R.; Schroeder, J.; Schmidt, T. Reliability of tensiomyography and myotonometry in detecting mechanical and contractile characteristics of the lumbar erector spinae in healthy volunteers. Eur. J. Appl. Physiol. 2018, 118, 1349–1359.
  17. Albin, S.R.; Koppenhaver, S.L.; Bailey, B.; Blommel, H.; Fenter, B.; Lowrimore, C.; Smith, A.C.; McPoil, T.G. The effect of manual therapy on gastrocnemius muscle stiffness in healthy individuals. Foot 2019, 38, 70–75.
  18. Chen, G.; Wu, J.; Chen, G.; Lu, Y.; Ren, W.; Xu, W.; Xu, X.; Wu, Z.; Guan, Y.; Zheng, Y.; et al. Reliability of a portable device for quantifying tone and stiffness of quadriceps femoris and patellar tendon at different knee flexion angles. PLoS ONE 2019, 14, e0220521.
  19. Tas, S.; Salkin, Y. An investigation of the sex-related differences in the stiffness of the Achilles tendon and gastrocnemius muscle: Inter-observer reliability and inter-day repeatability and the effect of ankle joint motion. Foot 2019, 41, 44–50.
  20. Li, Y.P.; Feng, Y.N.; Liu, C.L.; Zhang, Z.J. Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon: A randomized controlled trial. Medicine 2020, 99, e19519.
  21. Yu, J.F.; Chang, T.T.; Zhang, Z.J. The Reliability of MyotonPRO in Assessing Masseter Muscle Stiffness and the Effect of Muscle Contraction. Med. Sci. Monit. 2020, 26, e926578.
  22. Bravo-Sánchez, A.; Abián, P.; Sánchez-Infante, J.; Esteban-Gacía, P.; Jiménez, F.; Abián-Vicén, J. Objective Assessment of Regional Stiffness in Vastus Lateralis with Different Measurement Methods: A Reliability Study. Sensors 2021, 21, 3213.
  23. Pimentel-Santos, F.; Rodrigues Manica, S.; Masi, A.T.; Lagoas-Gomes, J.; Santos, M.B.; Ramiro, S.; Sepriano, A.; Nair, K.; Gomes-Alves, P.; Costa, J.; et al. Lumbar myofascial physical properties in healthy adults: Myotonometry vs. shear wave elastography measurements. Acta Reumatol. Port. 2021, 46, 110–119.
  24. Çevik Saldıran, T.; Kara, İ.; Kutlutürk Yıkılmaz, S. Quantification of the forearm muscles mechanical properties using Myotonometer: Intra- and Inter-Examiner reliability and its relation with hand grip strength. J. Electromyogr. Kinesiol. 2022, 67, 102718.
  25. Li, Y.P.; Liu, C.L.; Zhang, Z.J. Feasibility of Using a Portable MyotonPRO Device to Quantify the Elastic Properties of Skeletal Muscle. Med. Sci. Monit. 2022, 28, e934121.
  26. Muckelt, P.E.; Warner, M.B.; Cheliotis-James, T.; Muckelt, R.; Hastermann, M.; Schoenrock, B.; Martin, D.; MacGregor, R.; Blottner, D.; Stokes, M. Protocol and reference values for minimal detectable change of MyotonPRO and ultrasound imaging measurements of muscle and subcutaneous tissue. Sci. Rep. 2022, 12, 13654.
  27. McGowen, J.M.; Hoppes, C.W.; Forsse, J.S.; Albin, S.R.; Abt, J.; Koppenhaver, S.L. Myotonometry is Capable of Reliably Obtaining Trunk and Thigh Muscle Stiffness Measures in Military Cadets during Standing and Squatting Postures. Mil. Med. 2023, usad179.
  28. Fischer, A.A. Pressure threshold meter: Its use for quantification of tender spots. Arch. Phys. Med. Rehabil. 1986, 67, 836–838.
  29. Fischer, A.A. Tissue compliance meter for objective, quantitative documentation of soft tissue consistency and pathology. Arch. Phys. Med. Rehabil. 1987, 68, 122–125.
  30. Kawchuk, G.; Herzog, W. The reliability and accuracy of a standard method of tissue compliance assessment. J. Manip. Physiol. Ther. 1995, 18, 298–301.
  31. Horikawa, M.; Ebihara, S.; Sakai, F.; Akiyama, M. Non-invasive measurement method for hardness in muscular tissues. Med. Biol. Eng. Comput. 1993, 31, 623–627.
  32. Zheng, Y.; Mak, A.F. Effective elastic properties for lower limb soft tissues from manual indentation experiment. IEEE Trans. Rehabil. Eng. 1999, 7, 257–267.
  33. Murayama, M.; Nosaka, K.; Yoneda, T.; Minamitani, K. Changes in hardness of the human elbow flexor muscles after eccentric exercise. Eur. J. Appl. Physiol. 2000, 82, 361–367.
  34. Leonard, C.T.; Stephens, J.U.; Stroppel, S.L. Assessing the spastic condition of individuals with upper motoneuron involvement: Validity of the myotonometer. Arch. Phys. Med. Rehabil. 2001, 82, 1416–1420.
  35. Arokoski, J.P.; Surakka, J.; Ojala, T.; Kolari, P.; Jurvelin, J.S. Feasibility of the use of a novel soft tissue stiffness meter. Physiol. Meas. 2005, 26, 215–228.
  36. Šifta, P.; Otáhal, S.; Süssová, J.; Jaeger, M. Measurement of viscoelastic properties of soft tissue in spastic syndrome. In Proceedings of the 4th Congress for Neurorehabilitation, Hong Kong, China, 12–16 February 2006; Neurorehabilitation and Neural Repair. p. 20.
  37. Ylinen, J.; Teittinen, I.; Kainulainen, V.; Kautiainen, H.; Vehmaskoski, K.; Hakkinen, A. Repeatability of a computerized muscle tonometer and the effect of tissue thickness on the estimation of muscle tone. Physiol. Meas. 2006, 27, 787–796.
  38. Kysela, M.; Kolář, M. Myotonometer—Device for measurements of viscoelastic characteristics of soft tissues. In Proceedings of the 2016 ELEKTRO, Strbske Pleso, Slovakia, 16–18 May 2016; pp. 556–560.
  39. Leonard, C.T.; Deshner, W.P.; Romo, J.W.; Suoja, E.S.; Fehrer, S.C.; Mikhailenok, E.L. Myotonometer intra- and interrater reliabilities. Arch. Phys. Med. Rehabil. 2003, 84, 928–932.
  40. Kerins, C.M.; Moore, S.D.; Butterfield, T.A.; McKeon, P.O.; Uhl, T.L. Reliability of the myotonometer for assessment of posterior shoulder tightness. Int. J. Sports Phys. Ther. 2013, 8, 248–255.
  41. Pamukoff, D.N.; Bell, S.E.; Ryan, E.D.; Blackburn, J.T. The Myotonometer: Not a Valid Measurement Tool for Active Hamstring Musculotendinous Stiffness. J. Sport Rehabil. 2016, 25, 111–116.
  42. Williams, R.L.; Ji, W.; Howell, J.N.; Conatser, R.R., Jr. In Vivo Measurement of Human Tissue Compliance. SAE Trans. 2007, 116, 824–834.
  43. Alamaki, A.; Hakkinen, A.; Malkia, E.; Ylinen, J. Muscle tone in different joint positions and at submaximal isometric torque levels. Physiol. Meas. 2007, 28, 793–802.
  44. Dordevic, S.; Stancin, S.; Meglic, A.; Milutinovic, V.; Tomazic, S. MC sensor--a novel method for measurement of muscle tension. Sensors 2011, 11, 9411–9425.
  45. Haladová, E.; Nechvátalová, L. Vyšetřovací Metody Hybného Systému; Národní Centrum Ošetřovatelství a Nelékařských Zdravotnických Oborů: Brno, Czech Republic, 2003.
  46. Fukashiro, S.; Noda, M.; Shibayama, A. In Vivo determination of muscle viscoelasticity in the human leg. Acta Physiol. Scand. 2001, 172, 241–248.
  47. Levinson, S.F.; Shinagawa, M.; Sato, T. Sonoelastic determination of human skeletal muscle elasticity. J. Biomech. 1995, 28, 1145–1154.
  48. Hoyt, K.; Kneezel, T.; Castaneda, B.; Parker, K.J. Quantitative sonoelastography for the in vivo assessment of skeletal muscle viscoelasticity. Phys. Med. Biol. 2008, 53, 4063–4080.
  49. Sikdar, S.; Shah, J.P.; Gilliams, E.; Gebreab, T.; Gerber, L.H. Assessment of myofascial trigger points (MTrPs): A new application of ultrasound imaging and vibration sonoelastography. Annu. Int. Conf. IEEE Eng. Med. Biol. Soc. 2008, 2008, 5585–5588.
  50. Parker, K.J.; Doyley, M.M.; Rubens, D.J. Imaging the elastic properties of tissue: The 20 year perspective. Phys. Med. Biol. 2011, 56, R1–R29.
  51. Bercoff, J.; Tanter, M.; Fink, M. Supersonic shear imaging: A new technique for soft tissue elasticity mapping. IEEE Trans. Ultrason. Ferroelectr. Freq. Control 2004, 51, 396–409.
  52. Leong, H.T.; Ng, G.Y.; Leung, V.Y.; Fu, S.N. Quantitative estimation of muscle shear elastic modulus of the upper trapezius with supersonic shear imaging during arm positioning. PLoS ONE 2013, 8, e67199.
  53. Lima, K.; Martins, N.; Pereira, W.; Oliveira, L. Triceps surae elasticity modulus measured by shear wave elastography is not correlated to the plantar flexion torque. Muscles Ligaments Tendons J. 2017, 7, 347–352.
  54. Taş, S.; Onur, M.R.; Yılmaz, S.; Soylu, A.R.; Korkusuz, F. Shear Wave Elastography Is a Reliable and Repeatable Method for Measuring the Elastic Modulus of the Rectus Femoris Muscle and Patellar Tendon. J. Ultrasound Med. 2017, 36, 565–570.
  55. Alfuraih, A.M.; O’Connor, P.; Hensor, E.; Tan, A.L.; Emery, P.; Wakefield, R.J. The effect of unit, depth, and probe load on the reliability of muscle shear wave elastography: Variables affecting reliability of SWE. J. Clin. Ultrasound 2018, 46, 108–115.
  56. Zhang, J.; Yu, J.; Liu, C.; Tang, C.; Zhang, Z. Modulation in Elastic Properties of Upper Trapezius with Varying Neck Angle. Appl. Bionics Biomech. 2019, 2019, 6048562.
  57. Zhou, J.; Yu, J.; Liu, C.; Tang, C.; Zhang, Z. Regional Elastic Properties of the Achilles Tendon Is Heterogeneously Influenced by Individual Muscle of the Gastrocnemius. Appl. Bionics Biomech. 2019, 2019, 8452717.
  58. Flatres, A.; Aarab, Y.; Nougaret, S.; Garnier, F.; Larcher, R.; Amalric, M.; Klouche, K.; Etienne, P.; Subra, G.; Jaber, S.; et al. Real-time shear wave ultrasound elastography: A new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients. Crit. Care 2020, 24, 34.
  59. Ma, C.Z.; Ren, L.J.; Cheng, C.L.; Zheng, Y.P. Mapping of Back Muscle Stiffness along Spine during Standing and Lying in Young Adults: A Pilot Study on Spinal Stiffness Quantification with Ultrasound Imaging. Sensors 2020, 20, 7317.
  60. Liu, X.; Yu, H.K.; Sheng, S.Y.; Liang, S.M.; Lu, H.; Gu, L.X.; Fu, P.; Pan, M. Measurement consistency of dynamic stretching muscle stiffness evaluated using shear wave elastography: Comparison among different stretched levels and ROI sizes. Med. Ultrason. 2021, 23, 55–61.
  61. Olchowy, C.; Olchowy, A.; Hadzik, J.; Dąbrowski, P.; Mierzwa, D. Dentists can provide reliable shear wave elastography measurements of the stiffness of masseter muscles: A possible scenario for a faster diagnostic process. Adv. Clin. Exp. Med. Off. Organ Wroc. Med. Univ. 2021, 30, 575–580.
  62. Abou Karam, M.; Mukhina, E.; Daras, N.; Rivals, I.; Pillet, H.; Skalli, W.; Connesson, N.; Payan, Y.; Rohan, P.Y. Reliability of B-mode ultrasound and shear wave elastography in evaluating sacral bone and soft tissue characteristics in young adults with clinical feasibility in elderly. J. Tissue Viability 2022, 31, 245–254.
  63. Niu, Y.; Yue, Y.; Zheng, Y.; Long, C.; Li, Q.; Chen, Y.; Chen, Z.; Ma, X. SWEmean of Quadriceps, a Potential Index of Complication Evaluation to Patients with Chronic Obstructive Pulmonary Disease. Int. J. Chronic Obstr. Pulm. Dis. 2022, 17, 1921–1928.
  64. Roots, J.; Trajano, G.S.; Drovandi, C.; Fontanarosa, D. Variability of Biceps Muscle Stiffness Measured Using Shear Wave Elastography at Different Anatomical Locations with Different Ultrasound Machines. Ultrasound. Med. Biol. 2023, 49, 398–409.
  65. Dresner, M.A.; Rose, G.H.; Rossman, P.J.; Muthupillai, R.; Manduca, A.; Ehman, R.L. Magnetic resonance elastography of skeletal muscle. J. Magn. Reson. Imaging 2001, 13, 269–276.
  66. Papazoglou, S.; Braun, J.; Hamhaber, U.; Sack, I. Two-dimensional waveform analysis in MR elastography of skeletal muscles. Phys. Med. Biol. 2005, 50, 1313–1325.
  67. Papazoglou, S.; Rump, J.; Braun, J.; Sack, I. Shear wave group velocity inversion in MR elastography of human skeletal muscle. Magn. Reson. Med. 2006, 56, 489–497.
  68. Klatt, D.; Papazoglou, S.; Braun, J.; Sack, I. Viscoelasticity-based MR elastography of skeletal muscle. Phys. Med. Biol. 2010, 55, 6445–6459.
  69. Low, G.; Kruse, S.A.; Lomas, D.J. General review of magnetic resonance elastography. World J. Radiol. 2016, 8, 59–72.
  70. Schrank, F.; Warmuth, C.; Gorner, S.; Meyer, T.; Tzschatzsch, H.; Guo, J.; Uca, Y.O.; Elgeti, T.; Braun, J.; Sack, I. Real-time MR elastography for viscoelasticity quantification in skeletal muscle during dynamic exercises. Magn. Reson. Med. 2020, 84, 103–114.
  71. Hong, S.H.; Hong, S.J.; Yoon, J.S.; Oh, C.H.; Cha, J.G.; Kim, H.K.; Bolster, B., Jr. Magnetic resonance elastography (MRE) for measurement of muscle stiffness of the shoulder: Feasibility with a 3 T MRI system. Acta Radiol. 2016, 57, 1099–1106.
  72. Ito, D.; Numano, T.; Ueki, T.; Habe, T.; Maeno, T.; Takamoto, K.; Igarashi, K.; Maharjan, S.; Mizuhara, K.; Nishijo, H. Magnetic resonance elastography of the supraspinatus muscle: A preliminary study on test-retest repeatability and wave quality with different frequencies and image filtering. Magn. Reson. Imaging 2020, 71, 27–36.
  73. Maršáková, K.; Nováková, T. Objektivizace výskytu svalového hypertonu metodou termografie u dětí a dospívajících s bolestmi hlavy cervikogenního původu. In Proceedings of the Sborník Příspěvků. Pohybové Aktivity Jako Prostředek Ovlivňování Člověka, Vědecká Konference FTVS UK, Praha, Czech Republic, 24 January 2003; pp. 179–182.
  74. Botar-Jid, C.; Damian, L.; Dudea, S.M.; Vasilescu, D.; Rednic, S.; Badea, R. The contribution of ultrasonography and sonoelastography in assessment of myositis. Med. Ultrason. 2010, 12, 120–126.
  75. Domire, Z.J.; McCullough, M.B.; Chen, Q.; An, K.N. Wave attenuation as a measure of muscle quality as measured by magnetic resonance elastography: Initial results. J. Biomech. 2009, 42, 537–540.
  76. Nelissen, J.L.; Sinkus, R.; Nicolay, K.; Nederveen, A.J.; Oomens, C.W.J.; Strijkers, G.J. Magnetic resonance elastography of skeletal muscle deep tissue injury. NMR Biomed. 2019, 32, e4087.
  77. Chen, Q.; Wang, H.J.; Gay, R.E.; Thompson, J.M.; Manduca, A.; An, K.N.; Ehman, R.E.; Basford, J.R. Quantification of Myofascial Taut Bands. Arch. Phys. Med. Rehabil. 2016, 97, 67–73.
  78. Jiménez-Sánchez, C.; Ortiz-Lucas, M.; Bravo-Esteban, E.; Mayoral-del Moral, O.; Herrero-Gállego, P.; Gómez-Soriano, J. Myotonometry as a measure to detect myofascial trigger points: An inter-rater reliability study. Physiol. Meas. 2018, 39, 115004.
  79. Marusiak, J.; Kisiel-Sajewicz, K.; Jaskolska, A.; Jaskolski, A. Higher muscle passive stiffness in Parkinson’s disease patients than in controls measured by myotonometry. Arch. Phys. Med. Rehabil. 2010, 91, 800–802.
  80. Marusiak, J.; Jaskolska, A.; Budrewicz, S.; Koszewicz, M.; Jaskolski, A. Increased muscle belly and tendon stiffness in patients with Parkinson’s disease, as measured by myotonometry. Mov. Disord. 2011, 26, 2119–2122.
  81. Du, L.J.; He, W.; Cheng, L.G.; Li, S.; Pan, Y.S.; Gao, J. Ultrasound shear wave elastography in assessment of muscle stiffness in patients with Parkinson’s disease: A primary observation. Clin. Imaging 2016, 40, 1075–1080.
  82. Gao, J.; Du, L.J.; He, W.; Li, S.; Cheng, L.G. Ultrasound Strain Elastography in Assessment of Muscle Stiffness in Acute Levodopa Challenge Test: A Feasibility Study. Ultrasound. Med. Biol. 2016, 42, 1084–1089.
  83. Gao, J.; He, W.; Du, L.J.; Li, S.; Cheng, L.G.; Shih, G.; Rubin, J. Ultrasound strain elastography in assessment of resting biceps brachii muscle stiffness in patients with Parkinson’s disease: A primary observation. Clin. Imaging 2016, 40, 440–444.
  84. Vasilescu, D.; Vasilescu, D.; Dudea, S.; Botar-Jid, C.; Sfrangeu, S.; Cosma, D. Sonoelastography contribution in cerebral palsy spasticity treatment assessment, preliminary report: A systematic review of the literature apropos of seven patients. Med. Ultrason. 2010, 12, 306–310.
  85. Numano, T.; Habe, T.; Ito, D.; Onishi, T.; Takamoto, K.; Mizuhara, K.; Nishijo, H.; Igarashi, K.; Ueki, T. A new technique for motion encoding gradient-less MR elastography of the psoas major muscle: A gradient-echo type multi-echo sequence. Magn. Reson. Imaging 2019, 63, 85–92.
  86. Alcaraz-Clariana, S.; Garcia-Luque, L.; Garrido-Castro, J.L.; Fernandez-de-Las-Penas, C.; Carmona-Perez, C.; Rodrigues-de-Souza, D.P.; Alburquerque-Sendin, F. Paravertebral Muscle Mechanical Properties and Spinal Range of Motion in Patients with Acute Neck or Low Back Pain: A Case-Control Study. Diagnostics 2021, 11, 352.
  87. Lee, J.-H.; Kim, H.; Shin, W.-S. Characteristics of shoulder pain, muscle tone and isokinetic muscle function according to the scapular position of elite boxers. Phys. Ther. Rehabil. Sci. 2020, 9, 98–104.
  88. Llurda-Almuzara, L.; Perez-Bellmunt, A.; Lopez-de-Celis, C.; Aiguade, R.; Seijas, R.; Casasayas-Cos, O.; Labata-Lezaun, N.; Alvarez, P. Normative data and correlation between dynamic knee valgus and neuromuscular response among healthy active males: A cross-sectional study. Sci. Rep. 2020, 10, 17206.
  89. Tennant, L.M.; Nelson-Wong, E.; Kuest, J.; Lawrence, G.; Levesque, K.; Owens, D.; Prisby, J.; Spivey, S.; Albin, S.R.; Jagger, K.; et al. A Comparison of Clinical Spinal Mobility Measures to Experimentally Derived Lumbar Spine Passive Stiffness. J. Appl. Biomech. 2020, 36, 397–407.
  90. Tan, S.; Kudas, S.; Ozcan, A.S.; Ipek, A.; Karaoglanoglu, M.; Arslan, H.; Bozkurt, M. Real-time sonoelastography of the Achilles tendon: Pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skeletal. Radiol. 2012, 41, 1067–1072.
  91. Serra-Ano, P.; Ingles, M.; Espi-Lopez, G.V.; Sempere-Rubio, N.; Aguilar-Rodriguez, M. Biomechanical and viscoelastic properties of the ankle muscles in men with previous history of ankle sprain. J. Biomech. 2021, 115, 110191.
  92. Song, C.; Yu, Y.F.; Ding, W.L.; Yu, J.Y.; Song, L.; Feng, Y.N.; Zhang, Z.J. Quantification of the Masseter Muscle Hardness of Stroke Patients Using the MyotonPRO Apparatus: Intra- and Inter-Rater Reliability and Its Correlation with Masticatory Performance. Med. Sci. Monit. 2021, 27, e928109.
  93. Green, M.A.; Sinkus, R.; Gandevia, S.C.; Herbert, R.D.; Bilston, L.E. Measuring changes in muscle stiffness after eccentric exercise using elastography. NMR Biomed. 2012, 25, 852–858.
  94. Kennedy, P.; Macgregor, L.J.; Barnhill, E.; Johnson, C.L.; Perrins, M.; Hunter, A.; Brown, C.; van Beek, E.J.R.; Roberts, N. MR elastography measurement of the effect of passive warmup prior to eccentric exercise on thigh muscle mechanical properties. J. Magn. Reson. Imaging 2017, 46, 1115–1127.
  95. Ariji, Y.; Katsumata, A.; Hiraiwa, Y.; Izumi, M.; Iida, Y.; Goto, M.; Sakuma, S.; Ogi, N.; Kurita, K.; Ariji, E. Use of sonographic elastography of the masseter muscles for optimizing massage pressure: A preliminary study. J. Oral Rehabil. 2009, 36, 627–635.
  96. Kwon, D.R.; Park, G.Y.; Kwon, J.G. The change of intrinsic stiffness in gastrocnemius after intensive rehabilitation with botulinum toxin a injection in spastic diplegic cerebral palsy. Ann. Rehabil. Med. 2012, 36, 400–403.
  97. Kablan, N.; Alaca, N.; Tatar, Y. Comparison of the Immediate Effect of Petrissage Massage and Manual Lymph Drainage Following Exercise on Biomechanical and Viscoelastic Properties of the Rectus Femoris Muscle in Women. J. Sport Rehabil. 2021, 30, 725–730.
  98. Perez-Bellmunt, A.; Simon, M.; Lopez-de-Celis, C.; Ortiz-Miguel, S.; Gonzalez-Rueda, V.; Fernandez-de-Las-Penas, C. Effects on Neuromuscular Function after Ischemic Compression in Latent Trigger Points in the Gastrocnemius Muscles: A Randomized Within-Participant Clinical Trial. J. Manipulative Physiol. Ther. 2022, 45, 490–496.
  99. Kim, M.-J.; Kim, T.-H. Effect of neuro dynamic technique and instrument assisted soft tissue mobilization on lower extremity muscle tone, stiffness, static balance in stroke patients. J. Korean Phys. Ther. 2020, 32, 359–364.
  100. Milerská, I.; Lhotská, L. Investigation of Muscle Imbalance. In Proceedings of the 8th European Medical and Biological Engineering Conference: Proceedings of the EMBEC 2020, Portorož, Slovenia, 29 November–3 December 2020; pp. 733–739.
  101. Barassi, G.; Giannuzzo, G.; De Santis, R.; Dragonetti, A. Adaptive neuromodulation in the treatment of spasticity. J. Adv. Health Care 2020, 2.
  102. Albin, S.R.; Koppenhaver, S.L.; MacDonald, C.W.; Capoccia, S.; Ngo, D.; Phippen, S.; Pineda, R.; Wendlandt, A.; Hoffman, L.R. The effect of dry needling on gastrocnemius muscle stiffness and strength in participants with latent trigger points. J. Electromyogr. Kinesiol. 2020, 55, 102479.
  103. Megna, M.; Marvulli, R.; Fari, G.; Gallo, G.; Dicuonzo, F.; Fiore, P.; Ianieri, G. Pain and Muscles Properties Modifications after Botulinum Toxin Type A (BTX-A) and Radial Extracorporeal Shock Wave (rESWT) Combined Treatment. Endocr. Metab. Immune Disord. Drug Targets 2019, 19, 1127–1133.
  104. Park, S.J.; Kim, S.H.; Kim, S.H. Effects of Thoracic Mobilization and Extension Exercise on Thoracic Alignment and Shoulder Function in Patients with Subacromial Impingement Syndrome: A Randomized Controlled Pilot Study. Healthcare 2020, 8, 316.
  105. Wang, J.; Park, S.; Kim, J. Effect of Walking with Combat Boots on the Muscle Tone and Stiffness of Lower Extremity. J. Int. Acad. Phys. Ther. Res. 2020, 11, 2221–2228.
  106. Wang, J.S.; Seo, D.W.; Cha, J.Y. Mouthguard-effect of high-intensity weight training on masticatory muscle tone and stiffness in taekwondo athletes. J. Exerc. Rehabil. 2020, 16, 510–515.
  107. Garcia-Bernal, M.I.; Heredia-Rizo, A.M.; Gonzalez-Garcia, P.; Cortes-Vega, M.D.; Casuso-Holgado, M.J. Validity and reliability of myotonometry for assessing muscle viscoelastic properties in patients with stroke: A systematic review and meta-analysis. Sci. Rep. 2021, 11, 5062.
  108. Oha, K.; Viljasoo, V.; Merisalu, E. Prevalence of musculoskeletal disorders, assessment of parameters of muscle tone and health status among office workers. J. Agron. Res. 2010, 8, 192–200.
  109. Roja, Z.; Kalkis, V.; Vain, A.; Kalkis, H.; Eglite, M. Assessment of skeletal muscle fatigue of road maintenance workers based on heart rate monitoring and myotonometry. J. Occup. Med. Toxicol. 2006, 1, 20.
  110. Schneider, S.; Peipsi, A.; Stokes, M.; Knicker, A.; Abeln, V. Feasibility of monitoring muscle health in microgravity environments using Myoton technology. Med. Biol. Eng. Comput. 2015, 53, 57–66.
  111. Chan, V.; Duffield, R.; Watsford, M. The effects of compression garments on performance of prolonged manual-labour exercise and recovery. Appl. Physiol. Nutr. Metab. 2016, 41, 125–132.
  112. Geregei, A.; Shitova, E.; Malakhova, I.; Shuporin, E.; Bondaruk, E.; Efimov, A.; Takh, V.K. Up-to-date techniques for examining safety and physiological efficiency of industrial exoskeletons. Health Risk Anal. 2020, 147–158.
  113. Villanueva, A.; Rabal-Pelay, J.; Berzosa, C.; Gutierrez, H.; Cimarras-Otal, C.; Lacarcel-Tejero, B.; Bataller-Cervero, A.V. Effect of a Long Exercise Program in the Reduction of Musculoskeletal Discomfort in Office Workers. Int. J. Environ. Res. Public Health 2020, 17, 9042.
  114. Klich, S.; Ficek, K.; Krymski, I.; Klimek, A.; Kawczynski, A.; Madeleine, P.; Fernandez-de-Las-Penas, C. Quadriceps and Patellar Tendon Thickness and Stiffness in Elite Track Cyclists: An Ultrasonographic and Myotonometric Evaluation. Front. Physiol. 2020, 11, 607208.
  115. Klich, S.; Krymski, I.; Kawczyński, A. Viscoelastic properties of lower extremity muscles after elite track cycling sprint events: A case report. Cent. Eur. J. Sport Sci. Med. 2020, 29, 5–10.
  116. Lin, W.C.; Lee, C.L.; Chang, N.J. Acute Effects of Dynamic Stretching Followed by Vibration Foam Rolling on Sports Performance of Badminton Athletes. J. Sports Sci. Med. 2020, 19, 420–428.
  117. Saldiran, T.C.; Atici, E.; Rezaei, D.A.; Ozturk, O.; Uslu, B.; Ozcan, B.A.; Okudan, B. The Acute Effects of Different Intensity Whole-Body Vibration Exposure on Muscle Tone and Strength of the Lower Legs, and Hamstring Flexibility: A Pilot Study. J. Sport Rehabil. 2020, 30, 235–241.
  118. Uysal, O.; Delioglu, K.; Firat, T. The effects of hamstring training methods on muscle viscoelastic properties in healthy young individuals. Scand. J. Med. Sci. Sports 2021, 31, 371–379.
  119. Chang, T.-T.; Li, Z.; Wang, X.-Q.; Zhang, Z.-J.J. Stiffness of the gastrocnemius–Achilles tendon complex between amateur basketball players and the non-athletic general population. Front Physiol. 2020, 11, 606706.
  120. Bravo-Sanchez, A.; Abian, P.; Sousa, F.; Jimenez, F.; Abian-Vicen, J. Influence of Badminton Practice on Age-Related Changes in Patellar and Achilles Tendons. J. Aging Phys. Act. 2021, 29, 382–390.
  121. Hong, J.-H.; Lee, D.-H.; Kim, S.-E.; Seo, D.-K. Correlation between contraction ratio, endurance, and muscle tone of cervical muscles. Phys. Ther. Rehabil. Sci. 2020, 9, 302–308.
  122. Colomar, J.; Baiget, E.; Corbi, F. Influence of Strength, Power, and Muscular Stiffness on Stroke Velocity in Junior Tennis Players. Front. Physiol. 2020, 11, 196.
  123. Hara, K.; Namiki, C.; Yamaguchi, K.; Kobayashi, K.; Saito, T.; Nakagawa, K.; Ishii, M.; Okumura, T.; Tohara, H. Association between myotonometric measurement of masseter muscle stiffness and maximum bite force in healthy elders. J. Oral Rehabil. 2020, 47, 750–756.
  124. Berzosa, C.; Gutierrez, H.; Bascuas, P.J.; Arbones, I.; Bataller-Cervero, A.V. Muscle Tone and Body Weight Predict Uphill Race Time in Amateur Trail Runners. Int. J. Environ. Res. Public Health 2021, 18, 2040.
  125. Basti, A.; Yalcin, M.; Herms, D.; Hesse, J.; Aboumanify, O.; Li, Y.; Aretz, Z.; Garmshausen, J.; El-Athman, R.; Hastermann, M.; et al. Diurnal variations in the expression of core-clock genes correlate with resting muscle properties and predict fluctuations in exercise performance across the day. BMJ Open Sport Exerc. Med. 2021, 7, e000876.
  126. Ho, C.S.; Lee, M.C.; Chang, C.Y.; Chen, W.C.; Huang, W.C. Beneficial effects of a negative ion patch on eccentric exercise-induced muscle damage, inflammation, and exercise performance in badminton athletes. Chin. J. Physiol. 2020, 63, 35–42.
  127. Arda, K.; Ciledag, N.; Aktas, E.; Aribas, B.K.; Kose, K. Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. AJR Am. J. Roentgenol. 2011, 197, 532–536.
  128. Domire, Z.J.; McCullough, M.B.; Chen, Q.; An, K.N. Feasibility of using magnetic resonance elastography to study the effect of aging on shear modulus of skeletal muscle. J. Appl. Biomech. 2009, 25, 93–97.
  129. Debernard, L.; Robert, L.; Charleux, F.; Bensamoun, S.F. Analysis of thigh muscle stiffness from childhood to adulthood using magnetic resonance elastography (MRE) technique. Clin. Biomech. 2011, 26, 836–840.
  130. Kennedy, P.; Barnhill, E.; Gray, C.; Brown, C.; van Beek, E.J.R.; Roberts, N.; Greig, C.A. Magnetic resonance elastography (MRE) shows significant reduction of thigh muscle stiffness in healthy older adults. Geroscience 2020, 42, 311–321.
  131. Taş, S.; Aktaş, D. Menstrual Cycle does not Affect the Mechanical Properties of Muscle and Tendon. Muscles Ligaments Tendons J. 2020, 10, 11–16.
  132. Khowailed, I.A.; Lee, H. Neuromuscular Control of Ankle-stabilizing Muscles-specific Effects of Sex and Menstrual Cycle. Int. J. Sports Med. 2021, 42, 270–276.
  133. Bensamoun, S.F.; Ringleb, S.I.; Chen, Q.; Ehman, R.L.; An, K.N.; Brennan, M. Thigh muscle stiffness assessed with magnetic resonance elastography in hyperthyroid patients before and after medical treatment. J. Magn. Reson. Imaging 2007, 26, 708–713.
  134. McCullough, M.B.; Domire, Z.J.; Reed, A.M.; Amin, S.; Ytterberg, S.R.; Chen, Q.; An, K.N. Evaluation of muscles affected by myositis using magnetic resonance elastography. Muscle Nerve 2011, 43, 585–590.
  135. Basford, J.R.; Jenkyn, T.R.; An, K.N.; Ehman, R.L.; Heers, G.; Kaufman, K.R. Evaluation of healthy and diseased muscle with magnetic resonance elastography. Arch. Phys. Med. Rehabil. 2002, 83, 1530–1536.
  136. Drakonaki, E.E.; Allen, G.M. Magnetic resonance imaging, ultrasound and real-time ultrasound elastography of the thigh muscles in congenital muscle dystrophy. Skeletal. Radiol. 2010, 39, 391–396.
  137. Kim, Y.; An, S.Y.; Park, W.; Hwang, J.H. Detection of early changes in the muscle properties of the pectoralis major in breast cancer patients treated with radiotherapy using a handheld myotonometer. Support Care Cancer 2021, 29, 2581–2590.
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