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J Appl Physiol 114: 761769, 2013.
First published January 10, 2013; doi:10.1152/japplphysiol.01430.2011.
Kwah LK, Pinto RZ, Diong J, Herbert RD. Reliability and validity of measuring muscle fascicle lengths and pennation. For example,
ultrasound measurements of muscle fascicle length and pennation in humans: extended field-of-view imaging (20, 64) has allowed observa-
a systematic review. J Appl Physiol 114: 761769, 2013. First published tion of long muscle fascicles under static conditions (53), use
January 10, 2013; doi:10.1152/japplphysiol.01430.2011.Ultrasound im- of flat ultrasound probes has made observation of muscle
aging is widely used to measure architectural features of human
fascicle lengths during activities such as walking and running
skeletal muscles in vivo. We systematically reviewed studies of the
reliability and validity of two-dimensional ultrasound measurement of
more feasible (1, 37), and tracking software has reduced the
muscle fascicle lengths or pennation angles in human skeletal mus- burden of measuring fascicle lengths from video sequences
cles. A comprehensive search was conducted in June 2011. Thirty-six (37, 40, 45, 55). For these reasons, ultrasound is often preferred
reliability studies and six validity studies met the inclusion criteria. to magnetic resonance imaging in measuring muscle fascicle
Data from these studies indicate that ultrasound measurements of lengths and pennation in humans.
muscle fascicle lengths are reliable across a broad range of experi- Several studies have investigated the reliability of ultrasound
mental conditions [intraclass correlation coefficient (ICC) and r val- measurement of muscle fascicle lengths and pennation. A
ues were always 0.6, and coefficient of variation values were smaller number of studies have examined validity by compar-
Reliability
1. Was the ultrasound measurement procedure described in sufficient detail 33 (92) 1, 2, 68, 1014, 18, 21, 24, 26, 27, 30, 31, 34, 36, 4144,
to permit its replication? 4650, 5254, 56, 60
2. Were participants characteristics under study stable during research? 33 (92) 1, 68, 1013, 18, 21, 23, 24, 2628, 30, 31, 34, 36,
4144, 4650, 5254, 57, 60
3. Were examiners blinded to each others results or to prior results? 2 (6) 0, 43
4. Were appropriate measures used for calculating reliability? 34 (94) 1, 2, 5, 7, 8, 1014, 18, 21, 24, 2628, 30, 31, 34, 36,
4143, 4650, 5254, 56, 57, 60
5. Were appropriate measures used for calculating precision of estimates of 5 (14) 18, 36, 47, 53, 60
reliability?
Validity
1. Was the ultrasound measurement procedure described in sufficient detail 4 (67) 4, 29, 30, 52
to permit its replication?
2. Was the anatomical inspection procedure described in sufficient detail to 4 (67) 4, 12, 29, 52
permit its replication?
3. Were the measurements blinded? 2 (33) 28, 30
4. Were appropriate measures used for calculating validity? 1 (17) 29
5. Were appropriate measures used for calculating precision of estimates of 0
validity?
Values are no. of studies, with percentages in parentheses.
Subjects Healthy (32) 1, 2, 68, 1013, 18, 21, 23, 24, 2628, 30, 31, 34, 36, 4144,
4750, 52, 53, 56, 57
Diseased/injured/received intervention (6) 2, 14, 46, 47, 54, 60
Examiners Radiologist/sonographer (3) 30, 36, 54
Not qualified/not stated examiner (33) 1, 2, 68, 1014, 18, 21, 23, 24, 2628, 31, 34, 4144, 4650,
52, 53, 56, 57, 60
Muscles examined Ssp (1), TB (1), BB (1), Br (1), EDC (1), VL (15), MG (13), Ssp (30), TB (28), BB (14), Br (24), EDC (10), VL (2, 68,
TA (4), Sol (4), LG (3), VI (2), RF (2), BF (1), VM (1) 11, 14, 21, 23, 26, 42, 47, 53, 56, 57, 60), MG (1, 13, 14,
18, 27, 34, 36, 41, 44, 46, 48, 49, 52), TA (11, 14, 31, 50),
Sol (13, 27, 44, 54), LG (27, 43, 44), VI (6, 56),
RF (6, 47), BF (12), VM (6)
State of muscle Relaxed (29) 2, 68, 10, 1214, 18, 21, 23, 2628, 30, 36, 4144, 4648,
49*, 50, 5254, 60
Contracted (19) 1*, 10, 11*, 13, 18, 21, 23, 26, 27, 30, 31*, 34*, 41, 42, 44,
48, 50, 52, 57
Method of ultrasound Stationary probe (31) 1, 2, 68, 1114, 18, 21, 23, 24, 2628, 30, 31, 34, 4144,
imaging 4749, 52, 54, 56, 57, 60
Moving probe/extended-field-of-view (5) 10, 36, 46, 50, 53
Method of fascicle length Digital (21) 1, 2, 6, 7, 1114, 18, 30, 31, 34, 36, 41, 43, 46, 49, 50, 52,
measurement 53, 60
Manual (6) 21, 24, 26, 27, 44, 54
Unclear/not stated (9) 8, 10, 23, 28, 42, 47, 48, 56, 57
Aspect of study repeated Ultrasound sessions (21) 1, 2, 6, 13, 18, 23, 28, 30, 34, 36, 4143, 46, 4850, 52, 53,
56, 60
Images (20) 1, 6, 1012, 14, 21, 24, 26, 31, 34, 36, 41, 43, 44, 47, 48, 50,
0.0 8.3%, and SEM 0.3 0.6) (1, 6, 10, 11, 14, 21, 24, 26, Reliability (muscles). Vastus lateralis and medial gastrocne-
31, 34, 36, 41, 43, 47, 48, 50, 53, 54). mius were the muscles most commonly imaged for reliability.
Reliability (between raters). Fewer studies investigated re- The reliability of ultrasound imaging was high to very high for
liability between raters. When two raters obtained measures supraspinatus (fascicle lengths: r 0.74 0.93, pennation
from the same muscles, the reliability of the measurement of angles: r 0.76 0.88) (30), triceps brachii (pennation angles:
muscle fascicle lengths and pennation angles was high to very r 0.87 0.95) (28), biceps brachii (pennation angles: ICC
high (fascicle lengths: ICC 0.80 0.97, r 0.74, CV 0.99, SEM 0.2) (14), brachialis (pennation angles: ICC
3.1%; pennation angles: ICC 0.80, r 0.76, and 0.84) 0.89) (24), extensor digitorum communis (pennation angles:
(10, 30, 53, 57). 0.80 0.84) (10), medial gastrocnemius (fascicle lengths:
Table 4. Muscle fascicle lengths obtained via anatomical inspection and ultrasound procedures
Muscles Anatomical Inspection, mm Ultrasound, mm Ref. Nos.
Supraspinatus
Anterior middle 54 9* 54 3* 30
59 8
Anterior deep 58 4* 57 5*
59 9
Posterior deep 30 2* 30 2*
Anterior 59 7
Posterior 36 6
Extensor digitorum communis 73 24 (men) 10
50 9 (women)
Vastus lateralis
Entire length 79 8 53
80 8
80 9
83 7
Middle 72 22 (cerebral palsy) 47
75 12 (normal)
84 14 (pretraining, training group) 2
82 12 (pretraining, control group)
92 15 (posttraining, training group)
85 11(posttraining, control group)
57 (nonoperated) 7
65 (operated)
Table 5. Muscle pennation angles obtained via anatomical inspection and ultrasound procedures
Muscles Anatomical Inspection, Ultrasound, Ref. Nos.
Supraspinatus
Anterior middle 109 31 30
Anterior deep 142 43
Anterior 121 31
Triceps brachii
Long head 14* 14* 28
16* 15*
10* 11*
9* 10*
33 16 (body builder)
15 6 (normal)
Medial head 19 8 (body builder)
11 5 (normal)
Brachialis 92 24
Extensor digitorum communis 7 1 (men) 10
6 1 (women)
Vastus lateralis
Middle 10 3 (cerebral palsy) 47
14 3 (normal)
16 3 (pretraining, training group) 2
16 2 (pretraining, control group)
16 3 (posttraining, training group)
15 2 (posttraining, control group)
17 2 (live subjects)
Continued
CMC 0.93 0.95, ICC 0.81 0.99, r 0.96, CV ralis, rectus femoris, biceps femoris, semitendinosus, soleus,
0.0 9.8%, and SEM 0 mm; pennation angles: CMC medial, and lateral gastrocnemius.
0.87 0.90, ICC 0.851.00, CV 0.0 9.8%, and SEM
0.2) (1, 14, 18, 34, 36, 41, 46, 48, 49, 52), tibialis anterior DISCUSSION
(fascicle lengths: ICC 0.93 0.99, CV 2.8 8.3%, and
SEM 1 mm; pennation angles: ICC 0.99, CV 8.3%, and To our knowledge, this is the first systematic review of
SEM 0.1) (11, 14, 31, 50), and rectus femoris (fascicle studies of the reliability and validity of ultrasound measure-
lengths: ICC 0.96 0.98; pennation angles: ICC 0.95 ment of human muscle fascicle lengths and pennation. The data
0.97) (47). Reliability was moderate to very high for vastus show 2D ultrasound provides reliable measures of human
lateralis (fascicle lengths: ICC 0.62 0.99, CV 0.0 6.8%, muscle fascicle lengths and pennation angles across a broad
SEM 0 17 mm, and SEM% 4.314.2%; pennation range of experimental conditions. Studies on validity are few,
angles: ICC 0.511.00, CV 0.0 7.5%, SEM 0.21.2, but the limited evidence suggests 2D ultrasound provides valid
and SEM% 5.0 10.9%) (2, 7, 8, 11, 14, 21, 26, 42, 47, 53, measures of human muscle fascicle lengths and pennation