Experiments meet simulations: Understanding skeletal muscle mechanics to address clinical problems

Abstract

This article aims to present some novel experimental approaches and computational methods providing detailed insights into the mechanical behavior of skeletal muscles relevant to clinical problems associated with managing and treating musculoskeletal diseases. The mechanical characterization of skeletal muscles in vivo is crucial for better understanding of, prevention of, or intervention in movement alterations due to exercise, aging, or pathologies related to neuromuscular diseases. To achieve this, we suggest an intraoperative experimental method including direct measurements of human muscle forces supported by computational methodologies. A set of intraoperative experiments indicated the major role of extracellular matrix (ECM) in spastic cerebral palsy. The force data linked to joint function are invaluable and irreplaceable for evaluating individual muscles however, they are not feasible in many situations. Three-dimensional, continuum-mechanical models provide a way to predict the exerted muscle forces. To obtain, however, realistic predictions, it is important to investigate the muscle not by itself, but embedded within the respective musculoskeletal system, for example, a 6-muscle upper arm model, and the ability to obtain non-invasively, or at least, minimally invasively material parameters for continuum-mechanical skeletal muscle models, for example, by presently proposed homogenization methodologies. Botulinum toxin administration as a treatment option for spasticity is exemplified by combining experiments with modeling to find out the mechanical outcomes of altered ECM and the controversial effects of the toxin. The potentials and limitations of both experimental and modeling approaches and how they need each other are discussed.