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2001; 81:1810-1816.PHYS THER.
Binder-Macleod
Wayne Scott, Jennifer Stevens and Stuart A
Human Skeletal Muscle Fiber Type Classifications
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Human Skeletal Muscle Fiber Type
Classifications
H
uman skeletal muscle is composed of a heterogenous collection of
muscle fiber types.
1–3
This range of muscle fiber types allows for the
wide variety of capabilities that human muscles display. In addition,
muscle fibers can adapt to changing demands by changing size or
fiber type composition. This plasticity serves as the physiologic basis for
numerous physical therapy interventions designed to increase a patient’s
force development or endurance. Changes in fiber type composition also may
be partially responsible for some of the impairments and disabilities seen in
patients who are deconditioned because of prolonged inactivity, limb immo-
bilization, or muscle denervation.
2
Over the past several decades, the number
of techniques available for classifying muscle fibers has increased, resulting in
several classification systems. The objective of this update is to provide the
basic knowledge necessary to read and interpret research on human skeletal
muscle.
Muscle fiber types can be described using histochemical, biochemical, mor-
phological, or physiologic characteristics; however, classifications of muscle
fibers by different techniques do not always agree.
1
Therefore, muscle fibers
that may be grouped together by one classification technique may be placed
in different categories using a different classification technique. A basic
understanding of muscle structure and physiology is necessary to understand
the muscle fiber classification techniques.
[Scott W, Stevens J, Binder-Macleod SA. Human skeletal muscle fiber type classifications. Phys Ther.
2001;81:1810–1816.]
Key Words: Human skeletal muscle plasticity, Muscle fiber types.
Wayne Scott, Jennifer Stevens, Stuart A Binder-Macleod
1810 Physical Therapy . Volume 81 . Number 11 . November 2001
Update
䢇
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Review of Muscle Fiber Anatomy and
Physiology
Muscle fibers are composed of functional units called
sarcomeres.
3
Within each sarcomere are the myofibrillar
proteins myosin (the thick filament) and actin (the thin
filament). The interaction of these 2 myofibrillar pro-
teins allows muscles to contract (Fig. 1).
4
Several classi-
fication techniques differentiate fibers based on differ-
ent myosin structures (isoforms) or physiologic
capabilities.
1,2,5
The myosin molecule is composed of 6
polypeptides: 2 heavy chains and 4 light chains (2
regulatory and 2 alkali). A regulatory and an alkali light
chain are associated with each of the heavy chains. The
heavy chains contain the myosin heads that interact with
actin and allow muscle to contract (Fig. 1).
4
The myosin
heavy chain in the head region also contains an adeno-
sine triphosphate (ATP) binding site and serves as the
enzyme (adenosinetriphosphatase [ATPase]) for hydro-
lyzing ATP into adenosine diphosphate (ADP) and
inorganic phosphate (P
I
), which provides the energy
necessary for muscle contraction. The thin filament is
made of actin and 2 regulatory proteins, troponin and
tropomyosin.
3
When the muscle fiber receives a stimulus
in the form of an action potential, Ca
2⫹
is released from
the sarcoplasmic reticulum. The calcium then binds to
troponin and, through tropomyosin, exposes a myosin
binding site on the actin
molecule (Fig. 1).
4
In
the presence of ATP,
the myosin head binds
to actin and pulls the
thin filament along the
thick filament, allowing
the sarcomere to shorten. As long as Ca
2⫹
and ATP are
present, the myosin heads will attach to the actin mole-
cules, pull the actin, release, and reattach. This process
is known as cross-bridge cycling. The speed at which
cross-bridge cycling can occur is limited predominantly
by the rate that the ATPase of the myosin head can
hydrolyze ATP.
Muscle Fiber Typing
Initially, whole muscles were classified as being fast or
slow based on speeds of shortening.
3
This division also
corresponded to a morphological difference, with the
fast muscles appearing white in some species, notably
birds, and the slow muscles appearing red. The redness
is the result of high amounts of myoglobin and a high
capillary content.
3
The greater myoglobin and capillary
content in red muscles contributes to the greater oxida-
tive capacity of red muscles compared with white mus-
cles. Histological analysis shows that there is a correla-
W Scott, PT, MPT, is a doctoral student in the Interdisciplinary Graduate Program in Biomechanics and Movement Science, University of Delaware.
J Stevens, PT, MPT, is a doctoral student in the Interdisciplinary Graduate Program in Biomechanics and Movement Science, University of
Delaware.
SA Binder-Macleod, PT, PhD, is Chair and Professor, Department of Physical Therapy, University of Delaware, Newark, DE 19716 (USA)
(sbinder@udel.edu). Address all correspondence to Dr Binder-Macleod.
All authors provided concept/research design and writing. Michael Higgins, Michael Lewek, Darcy Reisman, Scott Stackhouse, and Glenn Williams
provided consultation (including review of the manuscript before submission).
Dr Binder-Macleod was supported by a grant from the National Institutes of Health (HD36787). Mr Scott and Ms Stevens were supported by a
training grant from the National Institutes of Health (T32 HD07490).
This article was submitted August 1, 2000, and was accepted April 1, 2001.
Classifications of
muscle fibers by
different techniques
do not always
agree.
Physical Therapy . Volume 81 . Number 11 . November 2001 Scott et al . 1811
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tion between myosin ATPase activity
and the speed of muscle shortening.
6
This histochemical analysis led to the
original division of muscle fibers into
type I (slow) and type II (fast). Cur-
rently, muscle fibers are typed using 3
different methods: histochemical
staining for myosin ATPase, myosin
heavy chain isoform identification,
and biochemical identification of met-
abolic enzymes.
Myosin ATPase Staining
In humans, myosin ATPase hydrolysis
rates for fast fibers are 2 to 3 times
greater than those of slow fibers.
7
However, myosin ATPase histochemi-
cal staining, which is widely used for
classifying muscle fibers, does not eval-
uate myosin ATPase hydrolysis rates.
1
Fibers are separated based solely on
staining intensities because of differ-
ences in pH sensitivity, not because of
the relative hydrolysis rates of
ATPases.
1
Advances in the histochem-
ical staining technique used to evalu-
ate myosin ATPase have led to 7 rec-
ognized human muscle fiber types
(Fig. 2).
1
Originally, fibers were iden-
tified as type I, IIA, or IIB.
1,5
More
recently, types IC, IIC, IIAC, and IIAB,
which have intermediate myosin ATPase staining char-
acteristics, have been identified. The slowest fiber, type
IC, has staining characteristics more like those of type I
fibers, whereas the fastest fiber, type IIAC, stains more
like type IIA. Type IIAB fibers have intermediate staining
characteristics between type IIA and IIB fibers. Because
these delineations are based on qualitative analysis of
stained fibers, it remains possible that more fiber types
will be identified in the future. In summary, the 7 human
muscle fiber types, as identified by myosin ATPase
histochemical staining are (from slowest to fastest): types
I, IC, IIC, IIAC, IIA, IIAB, and IIB (Fig. 2).
1,3,5
These
divisions are based on the intensity of staining at differ-
ent pH levels, and, as such, any given fiber could be
grouped differently by different researchers. Further-
more, not all studies use all 7 fiber types. Some research-
ers place all muscle fibers into just the original 3 fiber
types.
Myosin Heavy Chain Identification
Identification of different myosin heavy chain isoforms
also allows for fiber type classification (Fig. 2).
1
The differ-
ent myosin ATPase-based fibers correspond to different
myosin heavy chain isoforms.
1,8
This is not surprising
because the myosin heavy chains contain the site that serves
Figure 2.
Comparison of 3 different skeletal muscle fiber type classifications:
histochemical staining for myosin adenosinetriphosphatase (mATPase),
myosin heavy chain identification, and biochemical identification of
metabolic enzymes. Note: in humans, MHCIIb are now more accurately
referred to as MHCIIx/d. The question marks indicate the poor correla-
tion between biochemical and myosin heavy chain or mATPase fiber
type classification schemes.
Figure 1.
Regulatory function of troponin and tropomyosin. Troponin is a small globular protein with 3
subunits (TnT, TnI, TnC). (A) Resting condition: Tropomyosin under resting conditions blocks the
active sites of actin, preventing actin and myosin from binding. (B) Contraction: When troponin
binds with Ca
2⫹
, it undergoes a conformational change and pulls tropomyosin from the blocking
position on the actin filament, allowing myosin heads to form cross-bridges with actin. From
Plowman SA, Smith DL. Exercise Physiology for Health, Fitness, and Performance. Boston, Mass:
Allyn & Bacon; 1997:433. Copyright 1997 by Allyn & Bacon. Reprinted/adapted by
permission.
1812 . Scott et al Physical Therapy . Volume 81 . Number 11 . November 2001
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as the ATPase. The fact that each muscle fiber can contain
more than one myosin heavy chain isoform explains the
existence of myosin ATPase fiber types other than the pure
type I, type IIA, and type IIB fibers. Although the human
genome contains at least 10 genes for myosin heavy chains,
only 3 are expressed in adult human limb muscles.
1
Myosin
heavy chain isoforms can be identified by immunohisto-
chemical analysis using antimyosin antibodies or by sodium
dodecyl sulfate–polyacrylamide gel electrophoretic (SDS-
PAGE) separation.
5
The 3 myosin isoforms that were originally identified
were MHCI, MHCIIa, and MHCIIb, and they corre-
sponded to the isoforms identified by myosin ATPase
staining as types I, IIA, and IIB, respectively.
1,3,5
Human
mixed fibers almost always contain myosin heavy chain
isoforms that are “neighbors” (ie, MHCI and MHCIIa or
MHCIIa and MHCIIb).
2
Consequently, the histochemi-
cal myosin ATPase type IC, IIC, and IIAC fibers co-
express the MHCI and MHCIIa genes to varying degrees,
whereas the type IIAB fibers coexpress the MHCIIa and
MHCIIb genes.
1
Because of its quantitative nature, iden-
tifying myosin heavy chain isoforms using single-fiber
electrophoretic separation (SDS-PAGE technique) prob-
ably represents the best method for muscle fiber typing.
Electrophoretic separation allows for the relative con-
centrations of different myosin heavy chain isoforms to
be detected in a mixed fiber.
5,8
One point regarding human myosin heavy chain iso-
forms and fiber type identification may prove confusing
to someone trying to read research literature in this area.
In small mammals, a fourth myosin heavy chain isoform,
MHCIIx or MHCIId, is present that has an intermediate
contractile speed between the MHCIIa and MHCIIb
isoform.
9
Based on several types of evidence, extending
to the level of DNA analysis, what was originally identi-
fied in humans as MHCIIb is actually homologous to
MHCIIx/d of small mammals.
2,5,9
As a result, what has
been called MHCIIb in humans is actually MHCIIx/d,
and humans do not express the fastest myosin heavy
chain isoform (MHCIIb).
5
Because the histochemical
myosin ATPase fiber type nomenclature was developed
using human muscle, type IIB fibers, which we now know
correspond to the MHCIIx/d myosin heavy chain iso-
form, are not likely to be renamed type IIX.
1
Conse-
quently, depending on the author, histochemical myosin
ATPase-based human type IIB fibers may be associated
with either MHCIIb or MHCIIx/d isoforms. It is impor-
tant to remember that in human limb muscles only 3
myosin heavy chain isoforms are present (from slowest to
fastest): MHCI, MHCIIa, and MHCIIx/d (formerly erro-
neously identified as MHCIIb).
1
Humans do not express
the fastest myosin heavy chain isoform, MHCIIb.
9
We
will associate MHCIIx/d in humans with the histochem-
ical myosin ATPase-based type IIB fiber in the remainder
of this article.
Biochemical
A third classification scheme that is often used to classify
muscle fibers combines information on muscle fiber
myosin ATPase histochemistry and qualitative histo-
chemistry for certain enzymes that reflect the energy
metabolism of the fiber (Fig. 2).
2
Histochemical myosin
ATPase fiber typing is used to classify muscle fibers as
type I or type II, which are known to correspond to slow
and fast muscle fibers, respectively.
2
The enzymes that
are analyzed reflect metabolic pathways that are either
aerobic/oxidative or anaerobic/glycolytic.
5
This classifi-
cation technique leads to 3 fiber types: fast-twitch glyco-
lytic (FG), fast-twitch oxidative (FOG), and slow-twitch
oxidative (SO).
2,3
Although a good correlation exists
between type I and SO fibers, the correlations between
type IIA and FOG and type IIB and FG fibers are more
varied.
3,10
Therefore, the type IIB fibers do not always
rely primarily on anaerobic/glycolytic metabolism, nor
do the type IIA fibers always rely primarily on aerobic/
oxidative metabolism.
5
Although, in general, fibers at
the type I end of the continuum depend on aerobic/
oxidative energy metabolism and fibers at the type IIB
end of the continuum depend on anaerobic/glycolytic
metabolism, the correlation is not strong enough for
type IIB and FG or type IIA and FOG to be used
interchangeably.
2,5
Myosin Light Chains
The light chains of the myosin molecule also exist in
different isoforms, slow and fast, that affect the contrac-
tile properties of the muscle fiber.
3,11
Muscle fibers that
are homogeneous for a myosin heavy chain isoform
(ie, a pure fiber) may be heterogenous in regard to
myosin light chain isoforms, although, in general, fast
myosin heavy chain isoforms associate with fast myosin
light chain isoforms and slow myosin heavy chain iso-
forms associate with slow myosin light chain isoforms.
2,5,12
There is good evidence that additional proteins in muscle
fibers are coexpressed so that the various “fast” proteins are
expressed with one another and the various “slow” proteins
are expressed with one another, which suggests “a fiber
type specific program of gene expression.”
2,11,12
Motor Unit Classification
Although we have been discussing fiber types, the true
functional unit of the neuromuscular system is the
motor unit.
13,14
A motor unit is an alpha motoneuron
(originating in the spinal cord) and all of the muscle
fibers that it innervates. Based on myosin ATPase histo-
chemistry and qualitative histochemistry for enzymes
that reflect the energy metabolism of the fiber, all of the
muscle fibers of a motor unit have similar characteris-
tics.
15
Motor units can be divided into groups based on
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the contractile and fatigue characteristics of the muscle
fibers.
3,14
Based on contractile speed, motor units are
classified as either slow-twitch (S) or fast-twitch (F).
14
The F motor units are further subdivided into fast-twitch
fatigue-resistant (FR), fast-twitch fatigue-intermediate
(Fint), and fast-twitch fatigable (FF).
16,17
Motor Unit/Muscle Fiber Plasticity
Regardless of the classification scheme used to group
muscle fibers, there is overwhelming evidence that mus-
cle fibers—and therefore motor units—not only change
in size in response to demands, but they can also convert
from one type to another.
2,18,19
This plasticity in con-
tractile and metabolic properties in response to stimuli
(eg, training and rehabilitation) allows for adaptation to
different functional demands.
2
Fiber conversions
between type IIB and type IIA are the most common, but
type I to type II conversions are possible in cases of
severe deconditioning or spinal cord injury (SCI).
2,20
Less evidence exists for the conversion of type II to type
I fibers with training or rehabilitation, because only
studies that use denervated muscle that is chronically
activated with electrical stimulation have consistently
demonstrated that such a conversion is possible.
21
Changes in the muscle fiber types are also responsible
for some of the loss of function associated with decon-
ditioning.
2
Experiments in animals involving hind-limb
suspension, which unloads hind-limb muscles, and
observations of humans and rats following microgravity
exposure during spaceflight have demonstrated a shift
from slow to fast muscle fiber types.
2
In addition, numer-
ous studies on animals and humans with SCI have
demonstrated a shift from slow to fast fibers.
2,20
In
humans, detraining (ie, a decrease in muscle use from a
previously high activity level) has been shown to lead to
the same slow to fast conversion, with shifts from
MHCIIa to MHCIIx/d and possibly MHCI to MHCIIa.
2
There is also a concomitant decrease in the enzymes
associated with aerobic-oxidative metabolism.
2
In sum-
mary, decreased use of skeletal muscle can lead to a
conversion of muscle fiber types in the slow to fast
direction.
Interestingly, some of the loss of muscle performance
(eg, decreased force production) due to aging does not
appear to be only due to the conversion of muscle fibers
from one type to another, but largely due to a selective
atrophy of certain populations of muscle fiber types.
22,23
With aging, there is a progressive loss of muscle mass and
maximal oxygen uptake, leading to a reduction in mus-
cle performance and presumably some of the loss of
function (eg, decreased ability to perform activities of daily
living) seen in elderly people.
1,22,23
Age-related loss of muscle mass results primarily from a
decrease in the total number of both type I and type II
fibers and, secondarily, from a preferential atrophy of
type II fibers.
22,24
Atrophy of type II fibers leads to a
larger proportion of slow type muscle mass in aged
muscle, as evidenced by slower contraction and relax-
ation times in older muscle.
25,26
In addition, the loss of
alpha motoneurons with age results in some reinnerva-
tion of “abandoned” muscle fibers by adjacent motor
units that may be of a different type.
22,27
This may
facilitate fiber type conversion, as the reinnervated mus-
cle fibers take on the properties of the new “parent”
motor unit.
3,22
Recent evidence in aged muscle suggests
that fiber type conversion may occur, because there is a
much larger coexpression of myosin heavy chain in
older adults as compared with young individuals.
28
Older muscle was found to have a greater percentage of
fibers that coexpress MHCI and MHCIIa (28.5%) com-
pared with younger muscle (5%–10%).
28
Fortunately, physical therapy interventions can affect
muscle fiber types leading to improvements in muscle
performance. In the context of this update, physical
therapy interventions can be broadly divided into those
designed to increase the patient’s resistance to fatigue
and those designed to increase the patient’s force pro-
duction. It has been known for some time that training
that places a high metabolic demand on the muscle
(endurance training) will increase the oxidative capacity
of all muscle fiber types, mainly through increases in the
amount of mitochondria, aerobic/oxidative enzymes,
and capillarization of the trained muscle.
29,30
Using the
metabolic enzyme–based classification system, this
would lead to a transition from FG to FOG muscle fibers
without, necessarily, a conversion of myosin heavy chain
isoforms.
2
The myosin heavy chain composition of a muscle fiber
can change when subjected to endurance training.
19
Within type II fibers there is a transformation from IIB to
IIA, with more MHCIIa being expressed, at the expense
of MHCIIx/d.
2,19
Consequently, the percentage of pure
type IIB fibers decreases and the percentages of type
IIAB and pure type IIA fibers increase. Evidence is
lacking to demonstrate that type II fibers convert to type
I with endurance training,
19
although there does appear
to be an increase in the mixed type I and IIA fiber
populations.
2
Researchers have found that type I fibers
become faster with endurance exercise and slower with
deconditioning in humans.
31,32
This change in contrac-
tile speed is not because of a conversion of fiber types,
but rather because of changes in the myosin light chain
isoforms from slow to fast isoforms and from fast to slow
isoforms, respectively.
31,32
Because this change in muscle
contractile speed does not occur by altering the myosin
ATPase, it would not be detectable by histochemical
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fiber typing.
2
The shift from slow to fast myosin light
chain isoforms allows the slow fibers to contract at a rate
fast enough for the given exercise (eg, running, cycling),
yet retain efficient properties of energy use.
30
In sum-
mary, muscle fiber adaptations to endurance exercise
depend on fiber type, although the oxidative capacity of
all fibers is increased. Type I fibers may become faster
through myosin light chain conversion, whereas type II
fibers convert into slower, more oxidative types.
High-intensity resistance training (eg, high-load–
low-repetition training) results in changes in fiber
type similar to those seen with endurance training,
although muscle hypertrophy also plays an essential
role in producing strength gains.
33
Initial increases in
force production with high-intensity resistance train-
ing programs are largely mediated by neural factors,
rather than visible hypertrophy of muscle fibers, in
adults with no pathology or impairments.
34
Even so,
changes in muscle proteins, such as the myosin heavy
chains, do begin after a few workouts, but visible
hypertrophy of muscle fibers is not evident until
training is conducted over a longer period of time (⬎8
weeks).
33
Most researchers have found that high-intensity resis-
tance training of sufficient duration (⬎8 weeks) causes
an increase in MHCIIa composition and a correspond-
ing decrease in MHCIIx/d composition.
35–37
In many
studies of high-intensity resistance training, researchers
have also reported concomitant increases in MHCI
composition,
37
although some researchers report no
changes in MHCI composition.
38,39
Both endurance
training and resistance training result in similar reduc-
tions in myosin heavy chain coexpression, such that a
greater number of “pure” fibers are present.
40
Although
the trends in fiber type conversions are similar for
endurance training and resistance training, differences
in physiological changes that occur with each type of
exercise are also important. Endurance training
increases the oxidative capacity of muscle, whereas train-
ing to increase force production of sufficient intensity
and duration promotes hypertrophy of muscle fibers by
increasing the volume of contractile proteins in the
fibers.
Knowing the differences between human skeletal muscle
fiber types allows clinicians to understand more com-
pletely the morphological and physiological basis for the
effectiveness of physical therapy interventions, such as
endurance training and resistance training. In addition,
this knowledge also offers some explanation for the
changes in muscle that occur with age, deconditioning,
immobilization, and muscle denervation. Such knowl-
edge is helpful for the optimal design of rehabilitation
programs that target deficits in muscle morphology and
physiology.
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2001; 81:1810-1816.PHYS THER.
Binder-Macleod
Wayne Scott, Jennifer Stevens and Stuart A
Human Skeletal Muscle Fiber Type Classifications
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