Sports Medicine Research: In the Lab & In the Field: “Unilateral” Muscle Overuse Isn’t So “Unilateral” (Sports Med Res)


Wednesday, February 20, 2013

“Unilateral” Muscle Overuse Isn’t So “Unilateral”

Effects on Contralateral Muscle after Unilateral Electrical Muscle Stimulation and Exercise

Song Y, Forsgren S, Yu J, Lorentzon R, Stal PS. PLoS One 2012;7(12):e52230

Some studies have shown that unilateral exercise can also affect the contralateral limb.  For example, strength training one limb also improves the opposite, untrained limb.  Additionally, many afflictions, like painful Achilles tendinopathy, present bilaterally, but the mechanism behind this is unknown.  This study sought to examine whether unilateral muscle overuse will produce bilateral muscle damage and how the tissue in both the exercised and contralateral limbs compares to control.  Twenty-four rabbits were divided into control or experimental groups.  The experimental group received unilateral electrical stimulation to their right triceps surae muscle and simultaneous flexion of their foot using a kicking machine that gave an ankle range of motion up to 65°, of which 20-25° was dorsiflexion and 35-40° was plantarflexion to cause eccentric loading (previously described model).  This motion was continued for 2 hours and repeated every other day for 1, 3, and 6 weeks.  The contralateral limb was left alone.  Upon sacrifice, muscle tissue from the soleus and gastrocnemius was dissected from both limbs and prepared for histological analysis.  Tissue was examined for an inflammatory response (macrophages, neutrophils/T-cells, eosinophils), neural changes (axons, Schwann cells, motor-endplates), muscle fiber degeneration and necrosis, and muscle fiber regeneration.   Overall, the authors found that the soleus muscle was more negatively affected than the gastrocnemius, which could be due to fiber type differences.  At all time points (1, 3, 6 wk), for all parameters, the exercised soleus muscle of the experimental group was more damaged than the control group, as expected.  Additionally, the damage at 6 weeks was greater than the earlier time points.  Interestingly, the non-exercised contralateral soleus muscle was also significantly different from control at 3 and 6 weeks, with even greater damage at 6 weeks.  The gastrocnemius changes in both the exercised and contralateral limbs peaked at 3 weeks.  In addition to the muscle, nerve tissue in both the gastrocnemius and soleus muscles of the exercised and contralateral limbs showed changes at 3 and 6 weeks.  Muscle and nerve tissue changes were focal.

These findings of increased turnover and damage in muscle and nerve tissue in the uninvolved limb suggest that unilateral muscle overuse also impairs the contralateral limb.  Changes to the contralateral muscles are preceded by changes to the exercised muscles.  The authors speculate that the nervous system may be one of the underlying mechanisms of the “cross-transfer” effect; however, because this model produces overuse via two mechanisms (electrical stimulation and mechanical manipulation), we cannot identify the origin of the damage.  Similarly, we cannot ascertain cause-effect relationships between the nerve and muscle damage.  While the authors did not note any functional compensation in the contralateral limb following overuse, they could have used gait analysis or EMG to monitor potential differences.  Finally, this study is limited in testing only the triceps surae; the authors did not investigate other potentially affected contralateral muscles.  While this is a basic science animal study, the findings have implications for clinical practice.  If left untreated, unilateral injury may transition to the contralateral side thereby creating a more substantial clinical problem.  In comparison to unilateral injuries, how frequently do you come across bilateral injuries in your practice?  Have you considered treating the uninjured contralateral limb in the presence of a unilateral injury to prevent a negative cross-transfer effect?

Written by: Sarah Ilkhani-Pour
Reviewed by: Stephen Thomas

Related Posts:

Song Y, Forsgren S, Yu J, Lorentzon R, & Stål PS (2012). Effects on contralateral muscles after unilateral electrical muscle stimulation and exercise. PloS one, 7 (12) PMID: 23284946


Anonymous said...

If this is carries over to humans, what if we take immobilized individuals--such as mensicus repair--and have them do single leg exercises on the uninjured leg. Would we see less muscle memory loss? Girth?

Sarah Ilkhani-Pour said...

Great thoughts; this question has been the source of plenty of research! The cross-transfer effect has been fairly well studied, and it has been shown that unilateral exercise can affect the contralateral limb in humans. Specifically, a couple studies have shown that the immobilized limb maintained strength when exercising the non-immobilized limb. Often, an increase in strength without appreciable hypertrophy is indicative of neural adaptations, so we may not expect to see girth changes.

Song et al.'s contribution to the field was raising the awareness that not only could the cross-transfer effect have benefits (improved strength in the contralateral limb), as already known, but it might also have negative effects (an overuse-like condition in the contralateral, non-exercised limb).

Anonymous said...

another paper related to this model

Meaghan McMillen said...

This study lends to the idea that there is a shared processing unit, which can have a carry over or cross over effect for opposing limbs. So often when a joint is injured it is not considered that the opposite unaffected limb is damaged. The injury is often not necessarily looked at in isolation, since most clinicians will look at the joints above and below the site of injury. However most will not consider the opposite complete limb as a possibility of injury.

Or on the opposite side of this spectrum is considering using an uninvolved limb as a source of maintaining neuromuscular control and strength. This would make sense because both limbs share a central processing unit in the brain, figuring that if the brain can tell this limb to do an action or sense something with this limb it should be able to do so with the opposite.

Many times in lower extremity injuries the progression is from double leg to single leg, which can have both limbs addressed from strength and neuromuscular points. This would help address the idea that the opposite leg is also affected by injury. However in upper extremity cases the other arm is often used in normal day to day processing but does not necessarily complete the same fine motor tasks or strengthening that the single involved limb would. I think that rehabs for the upper extremity should try to follow the same progression ideals as the lower extremity in order to address possible deficits in both limbs.

Sarah Rooney said...

Thanks for your ideas! More research needs to be devoted to this shared processing unit to understand the implications on the affected (either injured or beneficially exercised) and contralateral limbs. Additionally, we need methods to help us detect what the deficits are in both limbs and how they may contribute to injury. You make a great point in identifying differences in the upper compared to lower limbs and the potential effects of hand dominance on fine motor skills. Until we have more basic research supporting these hypotheses, however, these practices will not be implemented in clinical practice.

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