Sports Medicine

, Volume 13, Issue 6, pp 393–407 | Cite as

Effects of Physical Activity on Some Components of the Skeletal System

  • Nicola Maffulli
  • John B. King
Review Article


Sporting activities impose on the skeletal system forces of a high intensity and frequency. Ligaments, bone and tendons behave in a time-dependent load-extension fashion, and it is important for both scientists and clinicians to consider, for example, the alterations in failure properties shown by ligaments, tendons and bone at different rates of deformation. Whether the ability of the skeletal system to withstand stress can be improved with appropriate training is still controversial. The effects of physical exercise depend on the modality, intensity and duration with which the exercise itself is performed. Moreover, genetic factors, also influencing growth and hormonal status, may exert a significant influence on the response of a given tissue to an external load. Overloading may cause a lesion, and this may decrease or annihilate performance capability. The skeletal system may not be resistant enough, and so it may prove limiting to intensive physical activity. In vitro studies on resistance of a single tissue have not taken into consideration the specific resistance of that structure in vivo, and the results so obtained cannot be readily extrapolated to sporting activities, as in vivo muscles, joints, tendons, ligaments and cartilage act as one. This article reviews some of the possible beneficial and detrimental effects of intense exercise on various components of the skeletal system, focusing on its ability to withstand and adapt to stresses and allow maximal performance.


Bone Mineral Density Anterior Cruciate Ligament Bone Mass Articular Cartilage Collagen Fibril 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Abrahams M. Mechanical behavior of tendon in vitro. Medical and Biological Engineering 5: 433–443, 1967CrossRefGoogle Scholar
  2. Altman MI. Stress fractures: revisited. Journal of the Royal Society of Health 105: 139–143, 1985PubMedCrossRefGoogle Scholar
  3. Amiel D, Frank CB, Harwood FL, Akeson H. Tendons and ligaments: a morphological and biochemical comparison. Journal of Orthopaedic Research 1: 257–265, 1984PubMedCrossRefGoogle Scholar
  4. Amis AA. Biomechanics of ligaments. In Jenkins DHR (Ed.) Ligament injuries and their treatment, pp. 3–28, Chapman and Hall, London, 1985Google Scholar
  5. Anderson CE. The structure and function of cartilage. Journal of Bone and Joint Surgery 44A: 77–786, 1962Google Scholar
  6. Arms SW, Pope `MH, Boyle JB, Davignon PJ, Johnson RJ. Knee medial collateral ligament strain. Proceedings of the 28th Annual Orthopaedic Research Society, New Orleans, p. 47, 1982Google Scholar
  7. Astrand P-O, Rodahl K. Textbook of work physiology, 3rd ed, McGraw-Hill International Editions, New York, 1986Google Scholar
  8. Atkinson PJ, Weatherall JA, Weidmann SM. Changes in density of human femoral cortex with age. Journal of Bone and Joint Surgery 44B: 496–502, 1962Google Scholar
  9. Baker J, Frankel VH, Burstein A. Fatigue fractures: biomechanical considerations. Journal of Bone and Joint Surgery 54B: 1345–1346, 1972Google Scholar
  10. Barfred T. Experimental rupture of the Achilles tendon: comparison of ruptures in rats of different ages and living under different conditions. Acta Orthopaedica Scandinavica 42: 406–428, 1971CrossRefGoogle Scholar
  11. Basset CAI. Current concepts of bone formation. Journal of Bone and Joint Surgery 44A: 1217–1244, 1962Google Scholar
  12. Bailey DA, McCulloch RG. Bone tissue and physical activity. Canadian Journal of Sports Sciences 15: 229–239, 1990Google Scholar
  13. Beaupre GS, Orr TE, Carter DR. An approach for time-dependent bone modeling and remodeling: theoretical development. Journal of Orthopaedic Research 8: 651–661, 1990PubMedCrossRefGoogle Scholar
  14. Beverly ME, Rider TA, Evans MJ, Smith R. Local bone mineral response to brief exercise that stresses the skeleton. British Medical Journal 299: 233–235, 1989PubMedCrossRefGoogle Scholar
  15. Bevier WC, Wiswell RA, Pyka G, Kozak KC, Newhall KM, et al. Relationship of body composition, muscle strength, and aerobic capacity to bone mineral density in older men and women. Journal of Bone Mineral Research 4: 421–432, 1989CrossRefGoogle Scholar
  16. Blanton PL, Biggs NL. Ultimate tensile strength of fetal and adult human tendons. Journal of Biomechanics 3: 181–189, 1970PubMedCrossRefGoogle Scholar
  17. Block JE, Friedlander AL, Brooks GA, Steiger P, Stubbs HA, et al. Determinants of bone density among athletes engaged in weight-bearing and non-weight-bearing activity. Journal of Applied Physiology 67: 110–1105, 1989Google Scholar
  18. Bloom W, Fawcett D. Textbook of histology, pp. 144–154, WB Saunders C. Philadelphia, 1971Google Scholar
  19. Brody DM, Running injuries. Ciba Clinical Symposia 32: 4, 1980Google Scholar
  20. Brooke MH, Kaiser KF. Muscle fiber types: how many and what kind. Archives of Neurology 23: 369–379, 1970PubMedCrossRefGoogle Scholar
  21. Bullough PG, Goodfellow J, O’Connor JJ. The relationship between degenerative changes and load bearing in the human hip. Journal of Bone and Joint Surgery 55B: 746–758, 1973Google Scholar
  22. Burry HC. Sport, exercise and arthritis. British Journal of Rheumatology 26: 386–388, 1987PubMedCrossRefGoogle Scholar
  23. Buyers PD, Contepomi CA, Farkas TA. Post-mortem study of the hip joint. III. Correlation between observations. Annals of the Rheumatic Diseases 35: 122–126, 1976CrossRefGoogle Scholar
  24. Cann CE, Martin MC, Genant HK. Decreased spinal mineral content in amenorrheic women. Journal of the American Medical Association 251: 626–629, 1984PubMedCrossRefGoogle Scholar
  25. Carbon R, Sambrook PN, Deakin V, Flicker P, Eisman JA, et al. Bone density of elite female athletes with stress fractures. Medical Journal of Australia 153: 373–376, 1990PubMedGoogle Scholar
  26. Carter DR. Mechanical loading history and skeletal biology. Journal of Biomechanics 20: 1095–1109, 1987PubMedCrossRefGoogle Scholar
  27. Cetta C, Tenni R, Zanaboni G, DeLuca G, Ippolito E, et al. Biochemical and morphological modifications in rabbit Achilles tendon during maturation and ageing. Biochemical Journal 204: 61–67, 1982PubMedGoogle Scholar
  28. Chow R, Harrison JE, Notarius C. Effect of two randomised exercise programmes on bone mass of healthy postmenopausal women. British Medical Journal 295: 1441–1445, 1987PubMedCrossRefGoogle Scholar
  29. Ciullo JV, Jackson DW. Track and field. In Schneider RC et al. (Ed) Sports injuries, pp. 212–246, Williams and Wilkins, Baltimore, 1985Google Scholar
  30. Cochran FVB. A primer of orthopaedic biomechanics, Churchill Livingstone, New York, 1982Google Scholar
  31. Colling-Saltin AS. Skeletal muscle development in the human foetus and during childhood. In Beng & Eriksson (Eds) Children and exercise IX, p. 193, University Park Press, Baltimore, 1980Google Scholar
  32. Cook SD, Kester MA, Brunet ME, Haddad Jr RJ. Biomechanics of running shoe performance. Clinics in Sports Medicine 4: 619–632, 1985PubMedGoogle Scholar
  33. Cornwall MW. Biomechanics of noncontractile tissue. Physical Therapy 64: 1869–1973, 1984PubMedGoogle Scholar
  34. Crowninshield RD, Pope MH, The strength and failure characteristics of rat medial collateral ligaments. Journal of Trauma 16: 99–105, 1976PubMedCrossRefGoogle Scholar
  35. Dalen N, Laftman P, Ohlsen H, Stromberg L. The effect of athletic activity on bone mass in human diaphysial bone. Orthopedics 8: 1139–1141, 1985PubMedGoogle Scholar
  36. Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Waldon CL, et al. Weight bearing exercise training and lumbar bone mineral content in postmenopausal women. Annals of Internal Medicine 108: 824–828, 1988PubMedGoogle Scholar
  37. Davidson RG, Taunton JE. Achilles tendinitis. Medical Sports Science 23: 71–79, 1987Google Scholar
  38. Day WH, Swanson SAV, Freeman MAR. Contact pressures in the loaded human cadaver hip. Journal of Bone and Joint Surgery 57B: 302–313, 1975Google Scholar
  39. Dhuper S, Warren M, Brooks-Gunn J, Fox R. Effects of hormonal status on bone density in adolescent girls. Journal of Clinical Endocrinology and Metabolism 71: 1083–1088, 1990PubMedCrossRefGoogle Scholar
  40. Drinkwater BL, Nilson K, Ott S, Chesnut CH. Bone mineral density after resumption of menses in amenorrhoic athletes. Journal of the Americal Medical Association 256: 380–382, 1986CrossRefGoogle Scholar
  41. Elliot DH. Structure and function of mammalian tendon. Biological Reviews 40: 392–421, 1965CrossRefGoogle Scholar
  42. Field J, Belding MS, Martin AW. An anlysis of the relationship between basal and metabolism and summated tissue respiration in the rat. Journal of Cellular and Comparative Physiology 14: 143–151, 1939CrossRefGoogle Scholar
  43. Finsterbush A, Friedman B. Reversibility of joint changes produced by immobilisation in rabbits. Clinical Orthopaedics and Related Research 111: 290–298, 1975PubMedCrossRefGoogle Scholar
  44. Frankel VH, Burnstein AH. Orthopaedic biomechanics, Lea and Febiger, Philadelphia, 1970Google Scholar
  45. Frost HM. The mechanostat: a proposed pathogenetic mechanism of osteoporosis and the bone mass effects of mechanical and non-mechanical agents. Bone and Mineral 2: 73–85, 1987PubMedGoogle Scholar
  46. Fukada E, Yasuda I. On the piezoelectric effect of bone. Journal of the Physiological Society of Japan 12: 1158–1162, 1957CrossRefGoogle Scholar
  47. Gamble JG, Edwards CC, Max SR. Enzymatic adaptation in ligaments during immobilization. American Journal of Sports Medicine 12: 221–228, 1984PubMedCrossRefGoogle Scholar
  48. Gardner DL. Structure and function of connective tissue and joints. In Scott JT (Ed.) Copeman’s textbook of the rheumatic diseases, 6th ed. pp. 199–250, Churchill Livingstone, Edinburgh, 1986Google Scholar
  49. Gillespie JA. The nature of bone changes associated with nerve injuries and disuse. Journal of Bone and Joint Surgery 36B: 464–473, 1954Google Scholar
  50. Gilsanz V, Gibbens DT, Roe TF, Carlos M, Senac MO, et al. Vertebral bone density in children: effects of puberty. Radiology 166: 847–850, 1988PubMedGoogle Scholar
  51. Grimby G, Saltin B. The ageing muscle. Clinical Physiology 3: 209–218, 1983PubMedCrossRefGoogle Scholar
  52. Grood ES, Noyes FR. Cruciate ligament prosthesis: strength, creep and fatigue properties. Journal of Bone and Joint Surgery 58A: 1083–1088, 1976Google Scholar
  53. Harper J, Amiel D, Harper E. Collagenase production by rabbit ligaments and tendon. Connective Tissue Research 17: 253–259, 1988PubMedCrossRefGoogle Scholar
  54. Harris R, Millard RB. Clearance of radioactive sodium from the knee joint. Clinical Science 15: 9–15, 1956PubMedGoogle Scholar
  55. Hart RT. Remodeling finite element calculations of strain-induced in vivo bone remodeling. Transactions of the Orthopaedic Research Society 13: 99, 1988Google Scholar
  56. Haut RC, Little RW. Rheological properties of canine anterior cruciate ligaments. Journal of Biomechanics 2: 289–298, 1969PubMedCrossRefGoogle Scholar
  57. Heisler L. Compendium anatomicum, p. 234, Huberts, Breslaw, 1933Google Scholar
  58. Ho G, Tice `AD. Comparison of nonseptic and septic bursitis. Archives of Internal Medicine 139: 1269–1273, 1979PubMedCrossRefGoogle Scholar
  59. Hou JC-H, Salem G, Zernicke RF, Barnard RJ. Structural and mechanical adaptations of immature trabecular bone to strenuous exercise. Journal of Applied Physiology 69: 1309–1314, 1990PubMedGoogle Scholar
  60. Ingelmark BE. Morpho-physiological aspects of gymnastic exercise. Federation Internationale de l’Education Physique Bullettin 27: 37–41, 1957Google Scholar
  61. Ingelmark BE, Ekholm R. A study on variation in the thickness of articular cartilage in association with rest and periodical load. Uppsala Lakaforenings Forhandligar 53: 61, 1948Google Scholar
  62. Jackson DS. Chondroitin sulphuric acid as a factor in the stability of tendon. Biochemical Journal 54: 638–634, 1953PubMedGoogle Scholar
  63. Kainberger FM, Engel H, Barton P, Huebsch P, Neuhold A, et al. Injury of the Achilles tendon: diagnosis with sonography. American Journal of Roentgenology 155: 1031–1036, 1990PubMedGoogle Scholar
  64. Kennedy JC, Hawkins RJ, Willis RB. Tension studies of human knee ligaments: yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments. Journal of Bone and Joint Surgery 58A: 350–355, 1976Google Scholar
  65. Kennedy JC, Hawkins RJ, Willis RB. Strain gauge analysis of knee ligament. Clinical Orthopaedics and Related Research 129: 225–229, 1977PubMedGoogle Scholar
  66. Kiviranta I, Tammi M, Jurvelin J, Saamanen A, Helminen HJ. Moderate running exercise augments glycosaminoglycans and thickness of articular cartilage in the knee joint of young beagle dogs. Journal of Orthopaedic Research 6: 188–195, 1988PubMedCrossRefGoogle Scholar
  67. Knorzer E, Folkhard W, Geercken W, Boschert C, Koch MH, et al. New aspects of the etiology of tendon rupture: an analysis of time-resolved dynamic-mechanical measurements using synchrotron radiation. Archives of Orthopaedic and Trauma Surgery 105: 113–120, 1986CrossRefGoogle Scholar
  68. Komi PV, Viitasalo JHT, Havu M, Thorstensson A, Sjodin B, et al. Skeletal muscle fiber and muscle enzyme activities in mon-ozygous and dizygous twins of both sexes. Acta Physiologica Scandinavica 100: 385–392, 1977PubMedGoogle Scholar
  69. Kopecky S, Niepel GA, Kostka D. Anatomocke podklady k nauke o entezopatiach. Fysiatricky Vestnick 42: 316–320, 1964 (cited in Niepel GA, Sit’aj S. Enthesopathy. Clinics in Rheumatic Diseases 5: 857–872, 1979)Google Scholar
  70. Kvist M, Jarvinen M. Clinical, histochemical and biomechanical features in repair of muscle and tendon injuries. International’ Journal of Sports Medicine 3 (Suppl. 1): 12–14, 1982CrossRefGoogle Scholar
  71. Kvist H, Kvist M. The operative treatment of chronic calcaneal paratendinitis. Journal of Bone and Joint Surgery 62B: 353–361, 1980Google Scholar
  72. Lagergren C, Lindholm A. Vascular distribution — the Achilles tendon. Acta Chirurgica Scandinavica 116: 491–495, 1958Google Scholar
  73. Lane NE, Bloch DA, Jones HH, Marshall WH, Wood PD, et al. Long distance running, bone density, and osteoarthritis. Journal of the American Medical Association 255: 1147–1151, 1986PubMedCrossRefGoogle Scholar
  74. Lanyon LE. Functional strain as a determinant for bone remodelling. Calcified Tissue International 36: 556–561, 1984CrossRefGoogle Scholar
  75. Lanyon LE. Bone loading, exercise, and the control of bone mass: the physiological basis for the prevention of osteoporosis. Bone — Clinical and Biochemical News and Reviews 6: 19–21, 1989Google Scholar
  76. Lanyon LE, Magee PT, Baggot BA. The relationship of functional stress and strain to the processes of bone remodelling: an experimental study on the sheep radius. Journal of Biomechanics 12: 593–600, 1979PubMedCrossRefGoogle Scholar
  77. Laros GS, Tipton CM, Cooper RR. Influence of physical activity on ligament insertion in the knees of dogs. Journal of Bone and Joint Surgery 53A: 275–286, 1971Google Scholar
  78. Larsson L, Grimby G, Karlsson J. Muscle strength and speed of movement in relation to age and muscle morphology. Journal of Applied Physiology 46: 451–456, 1979PubMedGoogle Scholar
  79. Li J-Y, Specker BL, Ho ML, Tsang RC. Bone mineral content in black and white children 1 to 6 years of age: early appearance of race and sex differences. American Journal of Diseases of Children 143: 1346–1349, 1989PubMedGoogle Scholar
  80. Liel Y, Edwards J, Shary J, Spicer KM, Gordon L, et al. The effect of race and body habitus on bone mineral density of the radius, hip, and spine in premenopausal women. Journal of Clinical Endocrinology and Metabolism 66: 1247–1250, 1988PubMedCrossRefGoogle Scholar
  81. Maffulli N. Skeletal system: a limiting factor to sports performance? A brief review. Journal of Orthopaedic Rheumatology 2: 123–132, 1989Google Scholar
  82. Maffulli N, Regine R, Angelillo M, Capasso G, Filice S. Ultrasound diagnosis of Achilles tendon pathology in runners. British Journal of Sports Medicine 21: 158–162, 1987PubMedCrossRefGoogle Scholar
  83. Mains DB, Andrews JL, Stonecipher T. Medial and anteroposterior ligamentous stability of the human knee measured with a stress apparatus. American Journal of Sports Medicine 5: 144–153, 1977PubMedCrossRefGoogle Scholar
  84. Mankin HG. The response of articular cartilage to mechanical injury. Journal of Bone and Joint Surgery 64A: 460–466, 1982Google Scholar
  85. Mankin HG, Lippiello L. Biochemical metabolic abnormalities in articular cartilage from osteoarthritic hips. Journal of Bone and Joint Surgery 52A: 424–434, 1970Google Scholar
  86. Marcus R, Cann R, Madvig P. Menstrual function and bone mass in elite women distance runners: endocrine and metabolic features. Annals of Internal Medicine 102: 158–163, 1985PubMedGoogle Scholar
  87. Marti R, Knobloch M, Tschopp A, Jucker A, Howald H. Is excessive running predictive of degenerative hip disease? Controlled study of former elite athletes. Brsitish Medical Journal 299: 91–93, 1989CrossRefGoogle Scholar
  88. Matkovic V, Fontana D, Tominac C, Chesnut CH. Factors which influence peak bone mass formation: a study of calcium balance and the inheritance of bone mass in adolescent females. American Journal of Clinical Nutrition 52: 878–888, 1990PubMedGoogle Scholar
  89. Mazess RB, Whedon GD. Immobilization and bone. Calcified Tissue International 35: 265–267, 1983PubMedCrossRefGoogle Scholar
  90. McDermott M, Freyne P. Osteoarthrosis in runners with knee pain. British Journal of Sports Medicine 17: 84–87, 1983PubMedCrossRefGoogle Scholar
  91. McDonald F, Houston WJB. An in vivo assessment of muscular activity and the importance of electrical phenomena in bone remodelling. Journal of Anatomy 172: 165–175, 1990PubMedGoogle Scholar
  92. Michna H. Organisation of collagen fibrils in tendon: changes induced by anabolic steroid. II. Functional and ultrastructural studies. Virchows Archiv (B) 52: 75–86, 1986aCrossRefGoogle Scholar
  93. Michna H. Organisation of collagen fibrils in tendon: changes induced by anabolic steroid. II. A morphometric and stereologic analysis. Virchows Archiv (B) 52: 87–98, 1986bCrossRefGoogle Scholar
  94. Michna H. Intra- and extra-cellular lysosomes in tendon tissue of the mouse after treatment with anabolic steroid hormone: ultrastructural and cytochemical study. Acta Anatomica (Basel) 134: 57–61, 1989CrossRefGoogle Scholar
  95. Michna H, Hartmann G. Hypertrophy, androgens and tendon karyometry: functional and experimental investigations. Gegenbaurs Morphologische Jahrbuch 134: 903–912, 1988Google Scholar
  96. Michna H, Hartmann G. Adapatation of tendon collagen to exercise. International Orthopaedics 13: 161–165, 1989PubMedCrossRefGoogle Scholar
  97. Montoye HJ, Smith EL, Fardon DF, Howley ET. Bone mineral in senior tennis players. Scandinavian Journal of Sports Sciences 2: 26–32, 1980Google Scholar
  98. Morrison JB. Function of the knee joint in various activities. Biomedical Engineering 4: 573–580, 1969PubMedGoogle Scholar
  99. Moseley HF, Goldie I. The arterial pattern of the rotator cuff of the shoulder. Journal of Bone and Joint Surgery 45B: 780, 1963Google Scholar
  100. Myburgh KH, Hutchins J, Fataar AB, Hough SE, Noakes TD. Low bone density is an etiologic factor for stress fracture in athletes. Annals of Internal Medicine 113: 754–759, 1990PubMedGoogle Scholar
  101. Nakagawa Y, Totsuka M, Sato T, Fukuda Y, Hirota K. Effect of disuse on the ultrastructure of the achilles tendon in rats. European Journal of Applied Physiology 59: 239–242, 1989CrossRefGoogle Scholar
  102. Niepel GA, Sit’aj S. Enthesopathy. Clinics in Rheumatic Diseases 5: 857–872, 1979Google Scholar
  103. Nordin M, Frankel VH. Basic biomechanics of the skeletal system, Lea and Febinger, Philadelphia, 1980Google Scholar
  104. Noyes FR, Delucas JL, Torvik PJ. Biomechanics of ligament failure. I. An anlaysis of strain-rate sensitivity and mechanics of failure in primates. Journal of Bone and Joint Surgery 56A: 236–253, 1974aGoogle Scholar
  105. Noyes FR, Torvik PJ, Hyde WB. Biomechancis of ligament failure. II. An analysis of immobilization, exercise and reconditioning effects in primates. Journal of Bone and Joint Surgery 56A: 1406–1418, 1974bGoogle Scholar
  106. Orwoll ES, Ferar J, Oviatt S, McClug MR, Huntington K. The relationship of swimming exercise to bone mass in men and women. Archives of Internal Medicine 149: 2197–2200, 1989PubMedCrossRefGoogle Scholar
  107. Ott SM. Attainment of peak bone mass. Journal of Clinical Endocrinology and Metabolism 71: 1082A–1082C, 1990PubMedCrossRefGoogle Scholar
  108. Palmoski MJ, Brandt KD. Running inhibits the reversal of atrophic changes in canine knee cartilage after removal of a leg cast. Arthritis and Rheumatism 24: 1329–1337, 1981PubMedCrossRefGoogle Scholar
  109. Palmoski MJ, Colyer RA, Brandt KD. Joint motion in the absence of normal loading does not maintain normal articular cartilage. Arthritis and Rheumatism 23: 325–334, 1980PubMedCrossRefGoogle Scholar
  110. Parfitt AM. The contribution of bone histology to understand the pathogenesis and improving the management of osteoporosis. Clinical Investigations in Medicine 5: 163–167, 1982Google Scholar
  111. Parfitt AM. The cellular basis of bone remodelling: the quantum concept re-examined in light of recent advances in cell biology of bone. Calcified Tissue International 36 (Suppl. 1): 37–45, 1984CrossRefGoogle Scholar
  112. Parry DAD, Barnes GRG, Craig AS. A comparison of the size distribution of collagen fibrils in connective tissues as a function of age, and a possible relation between fibril size distribution and mechanical properties. Proceedings of the Royal Society of London, Biology 203: 305–321, 1978CrossRefGoogle Scholar
  113. Pauwels F, Biomechanics of normal and diseased hip: theoretical foundation, technique and results of treatment: an atlas, Sperling-Verlag, Berlin, 1976Google Scholar
  114. Peakock Jr EE. A study of the circulation in normal tendons and healing grafts. Annals of Surgery 149: 415–428, 1959CrossRefGoogle Scholar
  115. Pocock NA, Eisman JA, Hopper JL, Yeates MG, Sambrook PN, et al. Genetic determinants of bone mass in adults: a twin study. Journal of Clinical Investigations 80: 706–710, 1987CrossRefGoogle Scholar
  116. Pollitzer WS, Anderson JJB. Ethnic and genetic differences in bone mass: a review with a hereditary vs environmental perspective. American Journal of Clinical Nutrition 50: 1244–1259, 1989PubMedGoogle Scholar
  117. Radin EL. Tissue response to injury. IV. Articular cartilage. Current Orthopaedics 1: 391–396, 1987CrossRefGoogle Scholar
  118. Radin EL, Burr DB. Hypothesis: joints can heal. Seminars in Arthritis and Rheumatism 13: 293–302, 1984PubMedCrossRefGoogle Scholar
  119. Radin EL, Ehrlich MG, Chernack R, Abernethy P, Paul IL, et al. Effect of impulsive loading on the knee joints of rabbits. Clinical Orthopaedics and Related Research 131: 288–293, 1978PubMedGoogle Scholar
  120. Radin EL, Paul JL, Tolkoff MJ. Subchondral bone changes in patients with early degenerative disease. Arthritis and Rheumatism 13: 400–405, 1970PubMedCrossRefGoogle Scholar
  121. Radin EL, Rose RM. Role of subchondral bone in the initiation and progression of cartilage damage. Clinical Orthopaedics and Related Research 213: 34–40, 1986PubMedGoogle Scholar
  122. Raspanti M, Ottani V, Ruggeri A. Subfibrillar architecture and functional properties of collagen: a comparative study in rat tendons. Journal of Anatomy 172: 157–164, 1990PubMedGoogle Scholar
  123. Reilly JP, Nicholas JA. The chronically inflamed bursa. Clinics in Sports Medicine 6: 345–370, 1987PubMedGoogle Scholar
  124. Riggs BI, Milton III J. Involutional osteoporosis. New England Journal of Medicine 314: 1676–1686, 1986PubMedCrossRefGoogle Scholar
  125. Rockwell JC, Sorensen AM, Baker S, Leahy D, Stock JL, et al. Weight training decreases bone density in premenopausal women: a prospective study. Journal of Clinical Endocrinology and Metabolism 71: 988–993, 1990PubMedCrossRefGoogle Scholar
  126. Rothman RH, Slogoth S. The effect of immobilization on the vascular bed of the tendon. Surgery Gynecology and Obstetrics 24: 1064–1066, 1967Google Scholar
  127. Ruben JA, Bennet AF. Intense exercise, bone structure and blood calcium levels in vertebrates. Nature 291: 411–413, 1981PubMedCrossRefGoogle Scholar
  128. Rubin CT, Hausman MR. The cellular basis of Wolff s law: trans-duction of physical stimuli to skeletal adaptation. Rheumatological Diseases Clinics of North America 14: 503–517, 1988Google Scholar
  129. Rubin CT, McLeod KJ, Bain SD. Functional strains and cortical bone adaptation: epigenetic assurance of skeletal integrity. Journal of Biomechanics 23 (Suppl. 1): 43–54, 1990PubMedCrossRefGoogle Scholar
  130. Salmons S, Henriksson J. The adaptive response of skeletal muscle to increased use. Muscle and Nerve 4: 84–105, 1981CrossRefGoogle Scholar
  131. Salter RB, Simmonds DF, Malcom BV, Rumble EJ, et al. The biological effects of continuous passive motion on the healing of full-thickness defects in articular cartilage: an experimental investigation in rabbits. Journal of Bone and Joint Surgery 62A: 1232–1251, 1980Google Scholar
  132. Savvas M, Studd JWW, Fogelman I, Dooley M, Montgomery J, et al. Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women. British Medical Journal 297: 331–333, 1988PubMedCrossRefGoogle Scholar
  133. Schantz P, Henriksson J. Increases in myofibrillar ATPase intermediate in human skeletal muscle fibers in response to endurance training. Muscle and Nerve 6: 553–556, 1983PubMedCrossRefGoogle Scholar
  134. Schatzker MD, Branemark PI. Intravital observations on the microvascular anatomy and microcirculation of the tendon. Acta Orthopaedica Scandinavica (Suppl. 126): 1–62, 1969Google Scholar
  135. Schoenbauer HR. Diseases of the Achilles tendon. Wiener Klin-ische Wochenschrift (Suppl.) 1–47, 1986Google Scholar
  136. Semb H. The breaking strength of normal and immobilized cortical bone. Acta Orthopaedica Scandinavica 37: 131–140, 1966PubMedCrossRefGoogle Scholar
  137. Simkin PA, Huang A, Benedict RS. Effects of exercise on blood flow to canine articular tissues. Journal of Orthopaedic Research 8: 297–303, 1990PubMedCrossRefGoogle Scholar
  138. Sinaki M. Exercise and osteoporosis. Archives of Physical Medicine and Rehabilitation 70: 220–229, 1989PubMedGoogle Scholar
  139. Sinaki M, McPhee MC, Hodgson SF, Merritt JM, Offord KP. Relationship between bone mineral density of spine and strength of back extensors in healthy postmenopausal women. Mayo Clinic Proceedings 61: 116–122, 1986PubMedGoogle Scholar
  140. Smith EL, Gilligan G, McAdam M, Ensing CP, Smith PE. Deterring bone loss by exercise intervention in premenopausal and postmenopausal women. Calcified Tissue International 44: 312–321, 1989PubMedCrossRefGoogle Scholar
  141. Sommer H-M. The biomechanical and metabolic effect of a running regime on the Achilles tendon in the rat. International Orthopaedics 11: 71–75, 1987PubMedCrossRefGoogle Scholar
  142. Staff PH. The effects of physical activity on joints, cartilage, tendons and ligaments. Scandinavian Journal of Social Medicine (Suppl. 29): 59–63, 1982Google Scholar
  143. Stanitski LL, McMarter JH, Scranton PE. On the nature of stress fractures. American Journal of Sports Medicine 6: 391–396, 1978.PubMedCrossRefGoogle Scholar
  144. Steiner ME, Grana WA, Chillag K, Schelberg-Karnes E. The effects of exercise on antero-posterior knee laxity. American Journal of Sports Medicine 14: 24–29, 1986PubMedCrossRefGoogle Scholar
  145. Subotnick SI. The biomechanics of running: implications for the prevention of foot injuries. Sports Medicine 2: 144–153, 1985PubMedCrossRefGoogle Scholar
  146. Swanson SAV. Lubrication of joints. In McKibbin B (Ed.) Recent advances in orthopaedics, Vol. 2, pp. 115–127, Churchill Livingstone, Edinburgh, 1975Google Scholar
  147. Tammi M, Saamanen AM, Jauhiainen A, Malminen O, Kiviranta I, et al. Proteoglycan alterations in rabbit knee articular cartilage following physical exercise and immobilisation. Connective Tissue Research 11: 45–55, 1983PubMedCrossRefGoogle Scholar
  148. Taunton JE, Clement DB, Webber D. Lower extremity fracture stresses in athletes. Physician and Sportsmedicine 9: 77–86, 1981Google Scholar
  149. Tipton CM, Matthes RD, Maynard JA, Carey RA. The influence of physical activity on ligaments and tendons. Medicine and Science in Sports 7 165–1, 1975PubMedGoogle Scholar
  150. Tipton CM, Vailas AC, Matthes RD. Experimental studies on the influence of physical activity on ligaments, tendons and joint: a brief review. Acta Medica Scandinavica (Suppl.) 711: 157–168, 1986Google Scholar
  151. Torchia ME, Ruff CB. A quantitative assessment of cross-sectional cortical bone remodeling in femoral diaphysis following hip arthroplasty in elderly women. Journal of Orthopaedic Research 8: 833–891, 1990CrossRefGoogle Scholar
  152. Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis: a new concept of its pathogenesis. Clinical Orthopaedics and Related Research 118: 164–168, 1976PubMedGoogle Scholar
  153. Vailas AC, Tipton CM, Matthes RD, Gart M. Physical activity and its influence on the repair process of medial collateral ligaments. Connective Tissue Research 9: 25–31, 1981PubMedCrossRefGoogle Scholar
  154. Van Brocklin JD, Ellis DG. A study on the mechanical behavior of the toe extensor tendon under applied stress. Archives of Physical Medicine and Rehabilitation 46: 369–373, 1965Google Scholar
  155. Viidik A. Biomechanics and functional adaption of tendon and joint ligaments, in Evans FG (Ed.) Studies on the anatomy and function of bone and joints, pp. 17–39, Springer, Berlin, 1966CrossRefGoogle Scholar
  156. Viidik A. Tensile strength: properties of Achilles tendon systems in trained and untrained rabbits. Acta Orthopaedica Scandinavica 40: 261–272, 1969PubMedCrossRefGoogle Scholar
  157. Vilarta R, Vidal B de C. Anisotropic and biomechanical properties of tendons modified by exercise and denervation: aggregation and macromolecular order in collagen bundles. Matrix 9: 55–61, 1989PubMedCrossRefGoogle Scholar
  158. Virvidakis K, Georgiou E, Korkotsidis A, Ntalles K, Proukakis C. Bone mineral content of junior competitive weight lifters. International Journal of Sports Medicine 11: 244–246, 1990PubMedCrossRefGoogle Scholar
  159. Wang CJ, Walker PJ, Wolf B. The effect of flexion and rotation on the length patterns of the ligaments of the knee. Journal of Biomechemistry 6: 587–596, 1973CrossRefGoogle Scholar
  160. Whalen RT, Carter DR, Steele CR. The relationship between physical activity and bone density. Transactions of the Orthopaedic Research Society 12: 464, 1987Google Scholar
  161. Whedon GD. Disuse osteoporosis: physiological aspects. Calcified Tissue International 36: S146–S150, 1984PubMedCrossRefGoogle Scholar
  162. White CM, Hergenboeder AC. Amenorrhea, osteopenia, and the female athlete. Pediatric Clinics of North America 37: 1125–1141, 1990PubMedGoogle Scholar
  163. Williams IF. Cellular and biochemical composition of healing tendons. In Jenkins DHR (Ed.) Ligament injuries and their treatment, pp. 43–57, Chapman and Hall, London, 1985Google Scholar
  164. Williams JA, Wagner J, Wanisch R, Heilbrun L. The effect of long distance running upon appendicular bone mineral content. Medicine and Science in Sports and Exercise 16: 223–227, 1984PubMedGoogle Scholar
  165. Williams JGP. Achilles tendon lesions in sport. Sports Medicine 3: 114–134, 1986PubMedCrossRefGoogle Scholar
  166. Wolman RL, Reeve J, Clark P, Hesp D, McNally E. Bone mineral density in elite light weight women rowers. British Journal of Rheumatology 28 (Suppl. 2): 6–7, 1989Google Scholar
  167. Woo SL, Gomez MA, Akeson WH. The time and history-dependent viscoelastic properties of the canine medial collateral ligament. Journal of Biomechanical Engineering 103: 293–298, 1981aPubMedCrossRefGoogle Scholar
  168. Woo SL, Gomez MA, Amiel D, Ritter MA, Gelberman RH. The effects of exercise on the biomechanical and biochemical properties of swine digital flexors tendons. Journal of Biomechanical Engineering 103: 51–56, 1981bPubMedCrossRefGoogle Scholar
  169. Woo SL, Gomez MA, Woo YK, Akeson WH. Mechanical properties of tendons and ligaments. II. The relationships of immobilization and exercise on tissue remodeling. Biorheology 19: 397–408, 1982PubMedGoogle Scholar
  170. Woo SL, Orlando CA, Gomez MA, Frank CB, Akeson WH. Tensile properties of the medial collateral ligament as function of age. Journal of Orthopaedic Research 4: 133–141, 1986PubMedCrossRefGoogle Scholar
  171. Woo SL, Peterson RH, Ohland KJ, Sites TJ, Danto MI. The effect of strain rate on the properties of the medial collateral ligament in skeletally immature and mature rabbits: a biomechanical and histological study. Journal of Orthopaedic Research 8: 712–721, 1990PubMedCrossRefGoogle Scholar
  172. Woo SL, Ritter MA, Amiel D, Sanders TM, Gomez MA, et al. The biomechanical and biochemical properties of swine tendons. Long term effects of exercise on the digital extensors. Connective Tissue Research 7: 177–183, 1980PubMedCrossRefGoogle Scholar
  173. Wyburn RS, Goulden BE. Fractures of the equine carpus. New Zealand Veterinary Journal 22: 133–142, 1974PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1992

Authors and Affiliations

  • Nicola Maffulli
    • 1
    • 2
  • John B. King
    • 1
    • 2
  1. 1.Department of OrthopaedicsNewham General HospitalPlaistow, LondonEngland
  2. 2.Department of Sports MedicineRoyal London Hospital Medical CollegeWhitechapel, LondonEngland

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