Ultrasound Technology for Examining the Mechanics of the Muscle, Tendon, and Ligament

  • Glen Lichtwark
Reference work entry


Ultrasound imaging provides a means to look inside the body and examine how tissues respond to mechanical stress or muscle contraction. As such, it can provide a valuable tool for understanding how muscle, tendon, and ligament mechanics influence the way we move, or vice versa, in health and disease, or to understand how and why these tissues might get injured due to chronic or acute loading. This chapter explores the basic concepts of ultrasound and how it can be used to examine muscle, tendon, and ligament structure and mechanical function. It introduces different techniques, like conventional B-mode imaging, three-dimensional ultrasound, and various forms of elastography that can be used to quantify geometrical and mechanical properties of the muscle, tendon, and ligament. Furthermore, methods to quantify muscle and tendon mechanical function during dynamic human movement are explored, and recommendations provided on which techniques are most suitable for different biomechanical investigations. Finally, some predictions about how new ultrasound imaging technologies might continue to advance our understanding of human motion are proposed and explored.


Biomechanical imaging Stress Strain 3D ultrasound Tissue tracking Elastography 


  1. Alexander RM, Bennet-Clark HC (1977) Storage of elastic strain energy in muscle and other tissues. Nature 265:114–117CrossRefGoogle Scholar
  2. Ates F, Hug F, Bouillard K, Jubeau M, Frappart T, Couade M, Bercoff J, Nordez A (2015) Muscle shear elastic modulus is linearly related to muscle torque over the entire range of isometric contraction intensity. J Electromyogr Kinesiol 25:703–708CrossRefGoogle Scholar
  3. Bolsterlee B, Gandevia SC, Herbert RD (2016a) Effect of transducer orientation on errors in ultrasound image-based measurements of human medial gastrocnemius muscle fascicle length and Pennation. PLoS One 11:e0157273CrossRefGoogle Scholar
  4. Bolsterlee B, Gandevia SC, Herbert RD (2016b) Ultrasound imaging of the human medial gastrocnemius muscle: how to orient the transducer so that muscle fascicles lie in the image plane. J Biomech 49:1002–1008CrossRefGoogle Scholar
  5. Bouillard K, Hug F, Guevel A, Nordez A (2012) Shear elastic modulus can be used to estimate an index of individual muscle force during a submaximal isometric fatiguing contraction. J Appl Physiol (1985) 113:1353–1361CrossRefGoogle Scholar
  6. Braekken IH, Majida M, Engh ME, Bo K (2009) Test-retest reliability of pelvic floor muscle contraction measured by 4D ultrasound. Neurourol Urodyn 28:68–73CrossRefGoogle Scholar
  7. Chernak Slane L, Thelen DG (2014) The use of 2D ultrasound elastography for measuring tendon motion and strain. J Biomech 47:750–754CrossRefGoogle Scholar
  8. Cooperberg PL, Barberie JJ, Wong T, Fix C (2001) Extended field-of-view ultrasound. Semin Ultrasound CT MR 22:65–77CrossRefGoogle Scholar
  9. Cronin NJ, Carty CP, Barrett RS, Lichtwark G (2011) Automatic tracking of medial gastrocnemius fascicle length during human locomotion. J Appl Physiol (1985) 111:1491–1496CrossRefGoogle Scholar
  10. Darby J, Hodson-Tole EF, Costen N, Loram ID (2012) Automated regional analysis of B-mode ultrasound images of skeletal muscle movement. J Appl Physiol (1985) 112:313–327CrossRefGoogle Scholar
  11. Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG (2007) OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng 54:1940–1950CrossRefGoogle Scholar
  12. Farris DJ, Lichtwark GA (2016) UltraTrack: software for semi-automated tracking of muscle fascicles in sequences of B-mode ultrasound images. Comput Methods Prog Biomed 128:111–118CrossRefGoogle Scholar
  13. Finni T, Peltonen J, Stenroth L, Cronin NJ (2013) Viewpoint: on the hysteresis in the human Achilles tendon. J Appl Physiol (1985) 114:515–517CrossRefGoogle Scholar
  14. Franz JR, Slane LC, Rasske K, Thelen DG (2015) Non-uniform in vivo deformations of the human Achilles tendon during walking. Gait Posture 41:192–197CrossRefGoogle Scholar
  15. Franz JR, Thelen DG (2015) Depth-dependent variations in Achilles tendon deformations with age are associated with reduced plantarflexor performance during walking. J Appl Physiol (1985) 119:242–249CrossRefGoogle Scholar
  16. Fukashiro S, Itoh M, Ichinose Y, Kawakami Y, Fukunaga T (1995) Ultrasonography gives directly but noninvasively elastic characteristic of human tendon in vivo. Eur J Appl Physiol Occup Physiol 71:555–557CrossRefGoogle Scholar
  17. Fukunaga T, Ichinose Y, Ito M, Kawakami Y, Fukashiro S (1997) Determination of fascicle length and pennation in a contracting human muscle in vivo. J Appl Physiol (1985) 82:354–358CrossRefGoogle Scholar
  18. Fukunaga T, Kubo K, Kawakami Y, Fukashiro S, Kanehisa H, Maganaris CN (2001) In vivo behaviour of human muscle tendon during walking. Proc Biol Sci 268:229–233CrossRefGoogle Scholar
  19. Gillett JG, Barrett RS, Lichtwark GA (2013) Reliability and accuracy of an automated tracking algorithm to measure controlled passive and active muscle fascicle length changes from ultrasound. Comput Methods Biomech Biomed Engin 16:678–687CrossRefGoogle Scholar
  20. Grieve DW, Pheasant S, Cavanagh PR (1978) Prediction of gastrocnemius length from knee and ankle joint posture. Biomechanics vi-a. University Park Press, BaltimoreGoogle Scholar
  21. Hansen P, Bojsen-Moller J, Aagaard P, Kjaer M, Magnusson SP (2006) Mechanical properties of the human patellar tendon, in vivo. Clin Biomech (Bristol, Avon) 21:54–58CrossRefGoogle Scholar
  22. Hawkins D, Hull ML (1990) A method for determining lower extremity muscle-tendon lengths during flexion/extension movements. J Biomech 23:487–494CrossRefGoogle Scholar
  23. Helfenstein-Didier C, Andrade RJ, Brum J, Hug F, Tanter M, Nordez A, Gennisson JL (2016) In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis. Phys Med Biol 61:2485–2496CrossRefGoogle Scholar
  24. Herbert RD, Gandevia SC (1995) Changes in pennation with joint angle and muscle torque: in vivo measurements in human brachialis muscle. J Physiol 484(Pt 2):523–532CrossRefGoogle Scholar
  25. Hug F, Lacourpaille L, Maisetti O, Nordez A (2013) Slack length of gastrocnemius medialis and Achilles tendon occurs at different ankle angles. J Biomech 46:2534–2538CrossRefGoogle Scholar
  26. Hug F, Tucker K, Gennisson JL, Tanter M, Nordez A (2015) Elastography for muscle biomechanics: toward the estimation of individual muscle force. Exerc Sport Sci Rev 43:125–133CrossRefGoogle Scholar
  27. Ihnatsenka B, Boezaart AP (2010) Ultrasound: basic understanding and learning the language. Int J Shoulder Surg 4:55–62CrossRefGoogle Scholar
  28. Ikai M, Fukunaga T (1968) Calculation of muscle strength per unit cross-sectional area of human muscle by means of ultrasonic measurement. Int Z Angew Physiol 26:26–32Google Scholar
  29. Jia R, Mellon S, Monk P, Murray D, Noble JA (2016) A computer-aided tracking and motion analysis with ultrasound (CAT & MAUS) system for the description of hip joint kinematics. Int J Comput Assist Radiol Surg 11:1965–1977CrossRefGoogle Scholar
  30. Kallinen M, Suominen H (1994) Ultrasonographic measurements of the Achilles tendon in elderly athletes and sedentary men. Acta Radiol 35:560–563CrossRefGoogle Scholar
  31. Kane D, Grassi W, Sturrock R, Balint PV (2004) A brief history of musculoskeletal ultrasound: ‘from bats and ships to babies and hips’. Rheumatology (Oxford) 43:931–933CrossRefGoogle Scholar
  32. Karamanidis K, Stafilidis S, Demonte G, Morey-Klapsing G, Bruggemann GP, Arampatzis A (2005) Inevitable joint angular rotation affects muscle architecture during isometric contraction. J Electromyogr Kinesiol 15:608–616CrossRefGoogle Scholar
  33. Kawakami Y, Abe T, Fukunaga T (1993) Muscle-fiber pennation angles are greater in hypertrophied than in normal muscles. J Appl Physiol (1985a) 74:2740–2744CrossRefGoogle Scholar
  34. Kawakami Y, Ichinose Y, Fukunaga T (1998) Architectural and functional features of human triceps surae muscles during contraction. J Appl Physiol (1985b) 85:398–404CrossRefGoogle Scholar
  35. Korstanje JW, Selles RW, Stam HJ, Hovius SE, Bosch JG (2010) Development and validation of ultrasound speckle tracking to quantify tendon displacement. J Biomech 43:1373–1379CrossRefGoogle Scholar
  36. Lee SS, Lewis GS, Piazza SJ (2008) An algorithm for automated analysis of ultrasound images to measure tendon excursion in vivo. J Appl Biomech 24:75–82CrossRefGoogle Scholar
  37. Lichtwark GA, Cresswell AG, Ker RF, Reeves ND, Maganaris CN, Magnusson SP, Svensson RB, Coupe C, Hershenhan A, Eliasson P, Nordez A, Foure A, Cornu C, Arampatzis A, Morey-Klapsing G, Mademli L, Karamanidis K, Vagula MC, Nelatury SR (2013) Commentaries on viewpoint: on the hysteresis in the human Achilles tendon. J Appl Physiol (1985) 114:518–520CrossRefGoogle Scholar
  38. Lichtwark GA, Wilson AM (2005) In vivo mechanical properties of the human Achilles tendon during one-legged hopping. J Exp Biol 208:4715–4725CrossRefGoogle Scholar
  39. Lichtwark GA, Wilson AM (2006) Interactions between the human gastrocnemius muscle and the Achilles tendon during incline, level and decline locomotion. J Exp Biol 209:4379–4388CrossRefGoogle Scholar
  40. Lindop JE, Treece GM, Gee AH, Prager RW (2006) 3D elastography using freehand ultrasound. Ultrasound Med Biol 32:529–545CrossRefGoogle Scholar
  41. Loram ID, Maganaris CN, Lakie M (2006) Use of ultrasound to make noninvasive in vivo measurement of continuous changes in human muscle contractile length. J Appl Physiol (1985) 100:1311–1323CrossRefGoogle Scholar
  42. Maganaris CN (2005) Validity of procedures involved in ultrasound-based measurement of human plantarflexor tendon elongation on contraction. J Biomech 38:9–13CrossRefGoogle Scholar
  43. Maganaris CN, Paul JP (1999) In vivo human tendon mechanical properties. J Physiol 521(Pt 1):307–313CrossRefGoogle Scholar
  44. Narici MV, Binzoni T, Hiltbrand E, Fasel J, Terrier F, Cerretelli P (1996) In vivo human gastrocnemius architecture with changing joint angle at rest and during graded isometric contraction. J Physiol 496(Pt 1):287–297CrossRefGoogle Scholar
  45. Nightingale K (2011) Acoustic radiation force impulse (ARFI) imaging: a review. Curr Med Imaging Rev 7:328–339CrossRefGoogle Scholar
  46. Noorkoiv M, Nosaka K, Blazevich AJ (2010a) Assessment of quadriceps muscle cross-sectional area by ultrasound extended-field-of-view imaging. Eur J Appl Physiol 109:631–639CrossRefGoogle Scholar
  47. Noorkoiv M, Stavnsbo A, Aagaard P, Blazevich AJ (2010b) In vivo assessment of muscle fascicle length by extended field-of-view ultrasonography. J Appl Physiol (1985) 109:1974–1979CrossRefGoogle Scholar
  48. Nordez A, Gallot T, Catheline S, Guevel A, Cornu C, Hug F (2009) Electromechanical delay revisited using very high frame rate ultrasound. J Appl Physiol (1985) 106:1970–1975CrossRefGoogle Scholar
  49. Obst SJ, Newsham-West R, Barrett RS (2014) In vivo measurement of human achilles tendon morphology using freehand 3-D ultrasound. Ultrasound Med Biol 40:62–70CrossRefGoogle Scholar
  50. Onambele GN, Burgess K, Pearson SJ (2007) Gender-specific in vivo measurement of the structural and mechanical properties of the human patellar tendon. J Orthop Res 25:1635–1642CrossRefGoogle Scholar
  51. Passmore E, Sangeux M (2016) Defining the medial-lateral axis of an anatomical femur coordinate system using freehand 3D ultrasound imaging. Gait Posture 45:211–216CrossRefGoogle Scholar
  52. Pearson SJ, Burgess K, Onambele GN (2007) Creep and the in vivo assessment of human patellar tendon mechanical properties. Clin Biomech (Bristol, Avon) 22:712–717CrossRefGoogle Scholar
  53. Peters A, Baker R, Sangeux M (2010) Validation of 3-D freehand ultrasound for the determination of the hip joint centre. Gait Posture 31:530–532CrossRefGoogle Scholar
  54. Pollock CM, Shadwick RE (1994) Allometry of muscle, tendon, and elastic energy storage capacity in mammals. Am J Phys 266:R1022–R1031Google Scholar
  55. Powell PL, Roy RR, Kanim P, Bello MA, Edgerton VR (1984) Predictability of skeletal muscle tension from architectural determinations in guinea pig hindlimbs. J Appl Physiol Respir Environ Exerc Physiol 57:1715–1721Google Scholar
  56. Raiteri BJ, Cresswell AG, Lichtwark GA (2016) Three-dimensional geometrical changes of the human tibialis anterior muscle and its central aponeurosis measured with three-dimensional ultrasound during isometric contractions. PeerJ 4:e2260CrossRefGoogle Scholar
  57. Rana M, Hamarneh G, Wakeling JM (2009) Automated tracking of muscle fascicle orientation in B-mode ultrasound images. J Biomech 42:2068–2073CrossRefGoogle Scholar
  58. Slane LC, Thelen DG (2014) Non-uniform displacements within the Achilles tendon observed during passive and eccentric loading. J Biomech 47:2831–2835CrossRefGoogle Scholar
  59. Slane LC, Martin J, Dewall R, Thelen D, Lee K (2016) Quantitative ultrasound mapping of regional variations in shear wave speeds of the aging Achilles tendon. Eur Radiol 27(2):474–482Google Scholar
  60. Telfer S, Woodburn J, Turner DE (2014) An ultrasound based non-invasive method for the measurement of intrinsic foot kinematics during gait. J Biomech 47:1225–1228CrossRefGoogle Scholar
  61. Treece GM, Gee AH, Prager RW, Cash CJ, Berman LH (2003) High-definition freehand 3-D ultrasound. Ultrasound Med Biol 29:529–546CrossRefGoogle Scholar
  62. Treece G, Lindop J, Chen L, Housden J, Prager R, Gee A (2011) Real-time quasi-static ultrasound elastography. Interface Focus 1:540–552CrossRefGoogle Scholar
  63. Varghese T (2009) Quasi-static ultrasound Elastography. Ultrasound Clin 4:323–338CrossRefGoogle Scholar
  64. Wakeling JM, Jackman M, Namburete AI (2013) The effect of external compression on the mechanics of muscle contraction. J Appl Biomech 29:360–364CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Sensorimotor Performance, School of Human Movement and Nutrition SciencesThe University of QueenslandSt LuciaAustralia

Section editors and affiliations

  • William Scott Selbie
    • 1
  1. 1.Has-Motion Inc.KingstonCanada

Personalised recommendations