The association between loss of ankle dorsiflexion range of movement, and hip adduction and internal rotation during a step down test

Lower limb muscles' thicknesses are weakly associated with dynamic knee valgus during single-leg squat in women with patellofemoral pain

INTRODUCTION

Patellofemoral pain (PFP) patients often show an altered lower limb alignment during the single-leg squat (SLS). There is evidence that proximal and distal-to-the-knee muscle alterations can modify the lower limb alignment in PFP patients. However, we observed a lack of studies investigating the possible association between the thickness and strength of proximal and distal-to-the-knee muscles and lower limb alignment during SLS in women with PFP. Therefore, this study aimed to investigate the association between the thickness and strength of lower limb muscles and dynamic knee valgus (DKV) during SLS in women with PFP.

METHODS

Cross-sectional study, where fifty-five women with PFP were submitted to the following evaluations: (1) muscle thickness (MT) of Gluteus Medius (GMed), Gluteus Maximus (GMax), Vastus Lateralis (VL), and Tibialis Anterior (TA); (2) isometric peak torque of hip abductors, hip external rotators, knee extensors, and foot inversors; and (3) DKV during SLS.

RESULTS

There was a significant negative association between GMax's MT and DKV (r = -0.32; p = 0.01), and between TA's MT and DKV (r = -0.28; p = 0.03). No significant correlations were observed between isometric torques and DKV. Regression analysis found that GMax's MT explained 10% of the DKV's variance during SLS.

DISCUSSION

Poor lower limb alignment during SLS is weakly associated with proximal and distal-to-the-knee muscle thicknesses, with no association with isometric torque in PFP women.

CONCLUSION

Our results suggest that other factors besides strength and muscle thicknesses may explain and improve lower limb alignment in women with PFP.

The relationship of peak ankle dorsiflexion angle with lower extremity biomechanics during walking

PURPOSE

Abnormal lower limb movement patterns have been observed during walking in individuals with limited ankle dorsiflexion. The purpose of this study was to investigate the relationships of peak ankle dorsiflexion angle during the stance phase of walking with the lower extremity biomechanics at the corresponding moment and to determine a cutoff value of functional limited ankle dorsiflexion during walking.

METHODS

Kinematic and kinetic data of 70 healthy participants were measured during walking. Spearman's correlation coefficients were calculated to establish the association between peak ankle dorsiflexion and angle and moment of ankle, knee, and hip, ground reaction force, and pelvic movement at peak ankle dorsiflexion. All variables significantly related to peak ankle dorsiflexion were extracted as a common factor by factor analysis. Maximally selected Wilcoxon statistic was used to perform a cutoff value analysis.

RESULTS

Peak ankle dorsiflexion positively correlated with ankle plantar flexion moment (r = 0.432; p = 0.001), ankle external rotation moment (r = 0.251; p = 0.036), hip extension angle (r = 0.281; p = 0.018), hip flexion moment (r = 0.341; p = 0.004), pelvic ipsilateral rotation angle (r = 0.284; p = 0.017), and medial, anterior, and vertical ground reaction force (r = 0.324; p = 0.006, r = 0.543; p = 0.001, r = 0.322; p = 0.007), negatively correlated with knee external rotation angle (r = -0.394; p = 0.001) and hip adduction angle (r = -0.256; p = 0.032). The cutoff baseline value for all 70 participants was 9.03°.

CONCLUSIONS

There is a correlation between the peak ankle dorsiflexion angle and the lower extremity biomechanics during walking. If the peak ankle dorsiflexion angle is less than 9.03°, the lower limb movement pattern will change significantly.

Is there hip muscle weakness in adults with chronic non-specific low back pain? A cross-sectional study

BACKGROUND

Patients with chronic low back pain may present changes in hip muscles. However, there is still limited and controversial evidence of the association between hip muscle weakness and chronic low back pain and whether this weakness can be assessed with functional tests. The purpose of this study was to assess whether there is hip muscle weakness in patients with non-specific chronic low back pain and whether there is an association between the positive Trendelenburg and Step-Down tests and hip muscle strength.

METHODS

This cross-sectional study included 40 patients with chronic low back pain and 40 healthy participants, assessed in an outpatient clinic in Vitória, Espírito Santo, Brazil. Muscle strength was measured for the hip abductors, adductors, extensors, internal rotators, and external rotators using isometric manual dynamometry and functional stability was measured by the Trendelenburg and Step-Down tests. Muscle strength was compared using the t test for independent samples and the chi-square test. The association between the tests and strength was performed using a binary logistic regression analysis.

RESULTS

Healthy participants showed a statistically significant greater muscle strength for the right hip abductors (mean difference [MD]: 28.1%, 95% confidence interval [CI]: 9.4 to 46.9), right adductors (MD: 18.7%, 95% CI: 6.2 to 31.2), right internal rotators (MD: 8.7%, 95% CI: 1.5 to 15.8), right extensors (MD: 21.1%, 95% CI: 6.2 to 31.2), left abductors (MD: 30.4%, 95% CI: 11.9 to 49), left adductors (MD: 18.4%, 95% CI: 3.7 to 33.2), and left extensors (MD: 21.6%, 95% CI: 6.6 to 36.5). There was no difference between groups for the positive functional tests, and there was no association between the tests and hip muscle strength.

CONCLUSION

Patients with chronic low back pain tend to have hip abductors, adductors, and extensors weakness. Furthermore, the functional tests should not be associated to hip muscle strength in patients with chronic low back pain.

Comparing kinematic asymmetry and lateral step-down test scores in healthy, chronic ankle instability, and patellofemoral pain syndrome female basketball players: a cross-sectional study

We aimed to understand whether ankle dorsiflexion range of motion (ROM) and dynamic knee valgus (DKV) kinematic inter-limb asymmetries would be associated with the Lateral Step-Down Test (LSD) in basketball players with chronic ankle instability (CAI), patellofemoral pain (PFP) and healthy controls (HC). An observational cross-sectional study with a between-subject design was employed. Female basketball athletes with CAI (n = 20), PFP (n = 20) and HC (n = 20) were recruited. Ankle dorsiflexion-ROM, DKV angle during a single-limb squat, and LSD quality were measured bilaterally. The Asymmetry index (ASI) was calculated to identify between-limb percentage imbalances. The correlation matrix between the tasks was calculated. Ankle dorsiflexion-ROM was less in the CAI and PFP than in the HC group regardless of limb (p < 0.001). DKV angle was greater in the CAI and PFP than in the HC group bilaterally (p < 0.001). LSDs were similar between the PFP and CAI groups (p = 0.698) but worse than the HC group (p = 0.001). The ASI showed asymmetry across all tasks (p < 0.001), with the greatest asymmetry for the DKV angle. The correlation matrix between tasks on both limbs was significant (p < 0.05). Our findings suggest significant asymmetries in ankle dorsiflexion-ROM and frontal plane knee control are present in female basketball athletes with CAI and PFP, and thus, highlights need to evaluate and reduce limb asymmetries in these populations.

Relationship Between Posterior Shoulder Tightness and Lower-Limb Flexibility in College Baseball Players

CONTEXT

Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players.

DESIGN

Cross-sectional study.

SETTING

University laboratory.

PARTICIPANTS

Twenty-two college baseball players (20 right-handed and 2 left-handed).

METHODS

To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs.

RESULTS

Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 = .250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P = .018) and horizontal adduction (R2 = .200, β [95% CI] = 0.447 [0.051 to 1.499], P = .019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 = .189, β [95% CI] = 0.435 [0.019 to 1.137], P = .022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 = .243, β [95% CI] = 0.493 [0.139 to 1.438], P = .010).

CONCLUSION

College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players.

Association of Proximal and Distal Factors With Lower Limb Kinematics During a Classical Ballet Jump

CONTEXT

Excessive dynamic lower limb misalignment may predispose ballet dancers to jump-related injuries. However, it is unknown whether proximal and distal factors influence this movement pattern. The aim of this study was to investigate whether hip abduction strength, foot alignment, and ankle dorsiflexion range of motion (ROM) are associated with peak angles of hip adduction and internal rotation and knee abduction during the preparation and landing phases of a classical ballet jump.

DESIGN

Cross-sectional study.

METHODS

Forty-one healthy amateur ballet dancers were included. Hip abduction strength was evaluated isometrically using a handheld dynamometer, foot alignment was determined by the shank-forefoot alignment, and weight-bearing ankle dorsiflexion ROM was measured by performing the lunge test. Peak hip and knee angles were analyzed 3-dimensionally during the preparation and landing phases of a single-leg jump. A Pearson correlation matrix was used to investigate the association of hip abduction strength, shank-forefoot alignment, and ankle dorsiflexion ROM with peak angles of hip adduction and internal rotation and knee abduction during the preparation and landing phases of the jump.

RESULTS

Greater hip abduction strength was associated with greater peak hip internal rotation angle (r = .43, P < .05), but not with peak hip adduction and knee abduction angles during the preparation phase of the jump. There were no associations of shank-forefoot alignment and ankle dorsiflexion ROM with peak hip and knee angles during the preparation (r = -.23 to .36, P > .05) and landing (r = -.20 to .24, P > .05) phases of the jump. There was no association of hip abduction strength with peak hip and knee angles during the landing phase of the jump (r = -.28 to .16, P > .05).

CONCLUSION

Hip abductors strengthening, correction of foot misalignments, and increasing ankle dorsiflexion ROM may not prevent excessive hip and knee movements during a classical ballet single-leg jump in amateur dancers.

Análisis cinemático del ángulo de proyección frontal de rodilla en 2D: enfoque metodológico

La evaluación cinemática del comportamiento del miembro inferior en tres dimensiones (3D) requiere el uso de alta tecnología, formación especializada y laboratorios que no se ajustan a las demandas del ámbito clínico y deportivo. La valoración del APFR (ángulo de proyección frontal de rodilla)en dos dimensiones (2D) ha mostrado consistentemente su validez, objetividad y confiabilidad al ser comparada con la metodología de análisis en 3D para la detección del valgo dinámico asociado al incremento de torques externos de aducción y rotación interna de cadera durante la ejecución de tareas funcionales que exigen control muscular excéntrico. El valgo dinámico ha mostrado ser un predictor de lesión del ligamento cruzado anterior y de síndrome de dolor patelofemoral, especialmente en mujeres. La detección oportuna y el seguimiento del comportamiento cinemático con instrumentos de bajo costo, poca complejidad y un nivel de experticia básico utilizando análisis en 2D, se perfila como estrategia de valoración importante en el entrenamiento deportivo y el abordaje clínico para la prevención y rehabilitación de lesiones de rodilla asociados a estos desórdenes del movimiento. Por tanto, esta revisión narrativa pretende proveer de conocimientos esenciales para la correcta valoración, interpretación y análisis del APFR en Fisioterapeutas y Profesionales del Deporte.

The relationship between ankle dorsiflexion range of motion, frontal plane projection angle, and patellofemoral pain syndrome

BACKGROUND

Ankle range of motion abnormalities have been often linked with alteration in knee kinematics leading to the development of patellofemoral pain syndrome (PFPS). Literature exploring the relationship between ankle dorsiflexion range of motion (DF ROM) and knee kinematics during functional tasks is scanty. This study aims to assess the relation between ankle DF ROM and frontal plane projection angle (FPPA), one of the knee kinematic variables, in individuals with and without PFPS during a step-down test.

METHODS

This is a case-control study in which seventy PFPS patients and other 70 asymptomatic control subjects had their ankle DF ROM measured using an inclinometer with the knee flexed and extended. Their FPPA angles were measured using Kinovea software while doing the step-down test.

RESULTS

When the two groups were compared, ankle DF ROM measured with the knee flexed was higher in the control group (33.15 ± 4.96) than in the PFPS group (30.20 ± 6.93) (p = 0.03). In both the PFPS group and the control group, the correlation between FPPA and ankle DF ROM with the knee flexed was statistically insignificant (p = 0.075 and 0.323 respectively).

CONCLUSION

Decreased ankle DF ROM can be one of the contributing factors to the development of PFPS in the context of greater dynamic knee valgus.

The influence of task type and movement speed on lower limb kinematics during single-leg tasks

BACKGROUND

Single-leg squats and step-downs are commonly used to assess kinematic variables that may be linked to injuries. Task type and movement speed may influence the outcomes of interest because of different balance requirements.

RESEARCH QUESTION

What is the influence of task type and movement speed on lower limb kinematics?

METHODS

This is a cross-sectional within-subjects study where 22 physically active females performed three single-leg functional tasks (Squat, Anterior step-down, and Lateral step-down) at three movement speeds (slow [5 s], fast [2 s], and self-selected), while three-dimensional kinematic variables were recorded. Displacement values from the initial position in single-leg support until 60° or peak knee flexion were calculated. Two-way repeated measures ANOVA was used to compare tasks and speeds, and Cohen's d effect size (ES) was calculated for significant pairwise comparisons.

RESULTS

At 60°, lateral step-down presented the greatest hip adduction (large ES) and internal rotation (small ES). The anterior step-down had the lowest knee abduction displacement while the squat had the greatest (small to medium ES). At peak knee flexion, values increased but differences between tasks followed a similar pattern. Slow speed induced smaller displacement angles at the knee and hip (trivial to small ES).

SIGNIFICANCE

When knee abduction is the variable of interest, the SLS may be the best test since it elicits the greatest displacement, but when evaluating hip motion, SD_LAT might be best. Knee abduction and internal rotation were lowest in the slow condition, suggesting that faster speed may be more appropriate to detect abnormal movement patterns. However, the small difference in absolute values (i.e., degrees of movement) may indicate that the differences are not clinically significant, particularly for speed comparisons. Researchers and clinicians should take this into consideration when choosing the most appropriate task and the instruction to give during its execution.

Preliminary study on acute effects of an intervention to increase dorsiflexion range of motion in reducing medial knee displacement

BACKGROUND

Dynamic knee valgus, visually represented as medial knee displacement, is associated with anterior cruciate ligament injury. Recently, restrictions in ankle dorsiflexion range of motion have been associated with medial knee displacement. Therefore, interventions potentially increasing ankle dorsiflexion range of motion could alleviate medial knee displacement. The purpose of this pilot study was to explore the acute effects of an intervention to increase ankle dorsiflexion range of motion and reduce medial knee displacement in individuals who display medial knee displacement that is corrected with a heel lift.

METHODS

Eight young participants who displayed medial knee displacement corrected with a heel lift completed a single-session intervention aimed at increasing dorsiflexion range of motion. Immediately before and after the intervention session, dorsiflexion range of motion in three static conditions (passive straight-knee, passive bent-knee, and weight-bearing lunge) and medial knee displacement during an overhead squat were assessed.

FINDINGS

The single-session training program increased participants' dorsiflexion range of motion in all three static conditions (p = 0.0005 for straight-knee, 0.02 for bent-knee, and 0.01 for lunge) with moderate to large effect sizes (0.55-1.18). Additionally, the training resulted in a significant reduction in medial knee displacement during the overhead squat (p = 0.02).

INTERPRETATION

The finding indicate that our interventional protocol appears beneficial in increasing dorsiflexion range of motion among individuals with medial knee displacement. Additionally, improving dorsiflexion range of motion may be a promising direction for reducing medial knee displacement, which is a risk factor for anterior cruciate ligament injury.

Female athletes with ligament dominance exhibiting altered hip and ankle muscle co-contraction patterns compared to healthy individuals during single-leg landing

BACKGROUND

Anterior cruciate ligament (ACL) injury is one of the most serious knee injuries and occurs frequently during exercise. Altered hip and ankle muscle co-contraction patterns may contribute to dynamic knee valgus and ACL injury mechanisms. Lack of dynamic control of ground reaction force (GRF) is known to be contributing factor for ACL injury by placing excessive force on passive structures. Muscle co-contraction is a dynamic mechanism for GRF absorption. Therefore, any alterations in co-contraction might be a risk factor for ACL injury. Ligament dominance is a term to define individuals who rely more on ACL ligament for GRF control.

RESEARCH QUESTION

This study aimed to compare the muscle co-contraction patterns of distal and proximal knee muscles during single leg landing in female athletes with and without ligament dominance.

METHODS

This is a cross-sectional study. A total of 54 female athletes were assigned to the healthy (n = 27) and ligament dominance (n = 27) group based on their Tuck Jump test scores. The electromyography activity of the gluteus medius, adductor longus, tibialis anterior, peroneus longus, medial and lateral gastrocnemius was measured by an electromyography in drop down a 30-cm-high stair. A Multivariate Analysis of Variance (MANOVA) was used for statistical analysis (p ≤ 0.05).

RESULTS

The two groups demonstrated an overall significantly different muscle co-contraction patterns (P < 0.05). There was a decreased in co-contraction of proximal group and an increased co-contraction in the distal muscles in ligament dominant group.

SIGNIFICANCE

The findings have provided evidence to support the notion of neuromuscular imbalances in ligament dominance deficit. These findings can be useful for the coaches and experts to design preventive exercises and modify the current programs for the people affected by ligament dominance.

Three-dimensional joint kinematic and two-dimensional quality of movement comparison between lateral and forward step-downs

OBJECTIVES

While lateral and forward step-down tasks are commonly used, they may have different kinematic and performance demands that could influence clinical assessment and rehabilitation. Therefore, the purpose of this study was to compare 3D lower extremity kinematics and 2D quality of movement between the tasks.

DESIGN

Cross-sectional comparative study.

SETTING

Research laboratory.

PARTICIPANTS

Thirty healthy adults (18 females, age = 23.2 ± 1.4 years, BMI = 23.9 ± 2.2 kg/m²).

MAIN OUTCOME MEASURES

Participants underwent 3D and 2D motion analysis. 3D variables were peak hip, knee, and ankle angles. Dichotomous clinical criteria were used for 2D assessment. An alpha level of 0.05 was used for statistical analyses.

RESULTS

In the sagittal plane, the forward step-down averaged 7° more knee flexion (p < 0.001, d = 2.30) and 4° more ankle dorsiflexion (p < 0.001, d = 1.72), but 2° less hip flexion (p = 0.001, d = 0.64). In the frontal plane, forward step-downs averaged 1° more hip adduction (p = 0.006, d = 0.54) and 1° more ankle eversion (p < 0.001, d = 1.04). The forward step-down elicited 2D movement faults more often (p = 0.003).

CONCLUSIONS

The increased knee flexion and ankle dorsiflexion demands of the forward step-down were accompanied by increases in frontal plane aberrations. The forward step-down may be more challenging for individuals with reduced tolerance to loaded knee flexion and/or limited ankle mobility.

A novel manual therapy technique is effective for short-term increases in tibial internal rotation range of motion

The coupled motions of tibial internal rotation (T-IR) and ankle dorsiflexion (DF) are necessary for proper lower-limb function. Anecdotally, clinicians have been performing techniques to restore T-IR to improve ankle DF, however, no evidence exists to support their efficacy. Therefore, the two objectives were to: (a) determine the effectiveness of a manual therapy technique for improving T-IR range of motion (ROM) and (b) Examine the relationship between ankle DF and T-IR ROM. Twenty-four participants qualified to participate and were randomly allocated to either the control (n=12) or manual therapy (n=12) group. Closed-chain ankle DF and T-IR ROM were assessed at baseline and immediately posttreatment. Control group participants sat quietly for 5 minutes. The experimental group performed 3 sets of 15 repetitions of a manual therapy, mobilization with movement technique. With the patient in a kneeling lunge position, the examiner wrapped an elastic band around the tibia and fibula and was instructed to lunge forward while the examiner simultaneously manually internally rotated the lower leg. T-IR ROM significantly increased following the intervention for the manual therapy group when compared to the control group. There were no significant changes in standing or kneeling DF ROM. No significant correlation was found between T-IR and both standing and kneeling DF ROM. A single mobilization with movement treatment is effective for improving tibial IR ROM in the short-term compared to no treatment. However, active tibial IR and end-range dorsiflexion range of motion do not appear to be correlated based on these methods.

Proximal, Local, and Distal Muscle Morphology in Women With Patellofemoral Pain

Objective:

The objective of this study was to compare proximal, local, and distal muscle morphology in women with and without patellofemoral pain (PFP).

Materials and Methods:

Proximal, local, and distal muscle thicknesses (MTs) were obtained with B-mode sonography in healthy (control group [CG], n = 20) and PFP (PFP group, n = 20) women. In addition, muscle mass was measured by the sum of the synergistic MTs. Data were analyzed by independent t-test, Mann-Whitney U test, and effect size.

Results:

PFP women had smaller gluteus medius ( P = .02, d = 0.7), vastus medialis ( P < .01, d = 1.0), and flexor digitorum brevis ( P < .01, d = 1.0) MT and greater gastrocnemius medialis ( P = .04, d = 0.6) MT than CG. Quadriceps muscle mass ( P = .01, d = 0.8) and foot muscle mass ( P = .008, d = 0.9) were smaller, while plantar flexor muscle mass was greater in the PFP group than in CG ( P = .01, d = 0.8).

Conclusion:

PFP women have proximal, local, and distal MT alterations in comparison with CG, which may explain possible changes in muscle strength and functionality.

Back foot influence on dorsiflexion using three different positions of the weight bearing lunge test

OBJECTIVES

To determine whether back foot (BF) position influences dorsiflexion range of motion (DFROM) during three different positions of the weight bearing lunge test (WBLT).

DESIGN

Randomised, repeated measures design.

SETTING

Sports clubs.

PARTICIPANTS

52 athletes participating in cutting and pivoting sports.

MAIN OUTCOME MEASURES

DFROM was obtained using a WBLT in three different BF positions: BF heel in full contact with the floor, BF heel raised off the floor and BF was non weight bearing (NWB). All measurements were obtained using three methods: inclinometer at the tibial tuberosity, toe to wall distance and goniometer angle from the lateral malleolus to the fibula head. Differences between testing positions were determined using a repeated measures one-way ANOVA and reliability analysis was performed using the Intraclass Correlation Coefficient (ICC).

RESULTS

DFROM was statistically significantly different for all three positions of the WBLT for each measurement technique (P < .001). These results were associated with large effect sizes for all BF positions and measurement techniques. Reliability ICC values were excellent for all measurements (ICC 0.94-0.99).

CONCLUSIONS

Results show that DFROM differs depending upon the position of the BF during the WBLT. Further research is needed to establish the reproducibility of these three BF positions due to the variability observed.

Bottom-Up Kinetic Chain in Drop Landing among University Athletes with Normal Dynamic Knee Valgus

The study investigated the influence of ankle strength and its range of motion (ROM) on knee kinematics during drop landing. Fifteen male and fifteen female university athletes with a normal range of dynamic knee valgus (DKV) (knee frontal plane projection angle: men = 3° to 8°, females = 7° to 13°) were recruited. They performed drop landing at height 30 cm and 45 cm with three-dimensional motion capture and analysis. Knee angles were compared at specific landing phases. Isokinetic ankle strength was tested at 60°/s angular velocity while the weight-bearing lunge test was conducted to evaluate ankle ROM. For males, strength for both plantarflexors and dorsiflexors were associated with knee kinematics at both heights (30 cm: r = −0.50, p = 0.03; 45 cm: r = −0.45, p = 0.05) during maximum vertical ground reaction force (MVGRF) phase. For females, ankle invertor strength and knee kinematics were associated at both 30cm (r = 0.53; p = 0.02,) and 45 cm landing heights (r = 0.49, p = 0.03), while plantarflexor strength and knee kinematics showed a significant association during initial contact (r = 0.70, p < 0.01) and MVGRF (r = 0.55, p = 0.02) phases at height 30 cm only. Male and female athletes with normal range of DKV showed a significant relationship between ankle strength and knee kinematics at specific landing phases. These relationships varied with increased landing height.

High-energy dose of therapeutic ultrasound in the treatment of patellar tendinopathy: protocol of a randomized placebo-controlled clinical trial

BACKGROUND

Patellar tendinopathy is an extremely debilitating condition and its treatment usually requires a combination of clinical approaches. Therapeutic ultrasound (TUS) is one of the most available electrophysical agent in rehabilitation settings; however, there is also a lack of high-quality studies that test different dosimetric aspects of TUS. Thus, the purpose of this study is to evaluate the short-, medium-, and long-term effects of the combination of high-energy TUS with a rehabilitation program for patellar tendinopathy.

METHODS

This will be a randomized, placebo-controlled trial with blinding of patients, assessors, and therapist. The setting is an outpatient physical therapy clinic. We will recruit 66 participants (male and female) aged between 18 and 40 years and presenting with patellar tendinopathy. A treatment combining high-energy dose TUS and a rehabilitation program for patellar tendinopathy will be delivered twice a week for 8 weeks. The control group will receive the same treatment, but with a placebo TUS. The effectiveness of the intervention will be measured at the beginning (baseline), midpoint (4 weeks), and end of treatment (8 weeks), as well as at 3- and 6-months post-treatment. Primary outcomes will be pain intensity (visual analogue scale, VAS), and VISA-P questionnaire and primary time points will be baseline (T0) and the end of the program (T2). Also, IPAQ-short form questionnaire, muscle strength (manual dynamometry), 2D kinematics, pain pressure threshold (PPT) algometry, thermography, and magnetic resonance imaging (MRI) will be collected.

DISCUSSION

TUS will be applied in an attempt to enhance the results obtained with the rehabilitation program proposed in this study, as well as stimulate some repair responses in individuals undergoing treatment for patellar tendinopathy, which in turn may optimize and improve treatment programs for patellar tendinopathy as well as to establish new guidelines for the application of TUS.

TRIAL REGISTRATION

This study was prospectively registered at April-3rd-2018 and updated at September-1st-2019 in the Brazilian Registry of Clinical Trials (REBEC) under the registration number: RBR-658n6w.

Does treatment duration of manual therapy influence functional outcomes for individuals with chronic ankle instability: A systematic review with meta-analysis?

QUESTION

Can manual therapy improve functional outcomes for individuals with chronic ankle instability?

DESIGN

Systematic review with meta-analysis of randomized controlled trials.

PARTICIPANTS

Individuals with chronic ankle instability.

INTERVENTION

Manual therapy is defined as an intervention that involves joint mobilization, and mobilization with movement.

OUTCOME MEASURE

The primary outcome is patient reported function (PRF) questionnaires scores, the secondary outcomes are ankle dorsiflexion range of motion (DFROM) and balance control.

RESULTS

Four studies were included (n = 208, mean age = 24.4) in the meta-analysis, with moderate to high quality on the PEDro scale (range 6-8). For patient reported function (PRF) questionnaires, two studies reported significant improvement after six-session manual therapy measured by foot and ankle ability measures sport subscale (FAAMS) and Cumberland ankle instability tool (CAIT), respectively. For DFROM, one session manual therapy had no significant effect on the weight-bearing lunge test (WBLT) (3 studies, n = 147, SMD = 1.24 (95%CI -0.87 to 3.36), I² = 96%) or non-weight-bearing inclinometer test (2 studies, n = 47, MD = 3.41° (95%CI -0.26 to 7.09),I² = 43%), while six-sessions manual therapy showed, a significantly positive effect on WBLT(2 studies, n = 80, SMD = 2.39, (95% CI 0.55, to 4.23), I² = 93%). For the SEBT, one-session manual therapy had no significant effect on overall star excursion balance test (SEBT) score (3 studies, n = 137,MD = 2.05,95%CI (-0.96,5.05), I² = 75%), while qualitative analysis of 2 included studies showed significant improvement both on the SEBT score and single limb balance test (SLBT).

CONCLUSIONS

Six sessions rather than one session of manual therapy improves ankle functional performance for individuals with CAI.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42017054715.

Self-massage prior to stretching improves flexibility in young and middle-aged adults

We examined the influence of stretching alone (SS) or combined with self-massage (SM) on maximal ankle dorsiflexion angle, maximal voluntary contraction (MVC) torque and calf muscle activity, and subcutaneous tissue thickness in 15 young (25 ± 3 years) and 15 middle-aged (45 ± 5 years) adults. Participants performed two sessions of calf muscle stretches (3x 30-s stretches, 30-s rest): stretch after a 60-s control condition (SS) and stretch after 60 s of self-massage with therapy balls (SM). Evaluations were performed before and 5 min after the intervention. Linear mixed effects model revealed no main effect for age on ROM or MVC and significant main effects for treatment and time. Change in ankle angle was greater after SM: SS = 3.1 ± 2°, SM = 6.2 ± 3.3° (Hedges' g = 0.98, p < 0.001). Similar results were observed for MVC torque: SS = -4 ± 16%, SM = 12 ± 16% (Hedges' g = 0.97, p = 0.0001). Changes in MVC torque and absolute EMG amplitude were correlated, but subcutaneous tissue thickness was not altered by treatment. The gains in ROM were more pronounced in less flexible middle-aged adults, underscoring the need to include flexibility exercises in their training.

Effects of ankle dorsiflexion limitation on lower limb kinematic patterns during a forward step-down test: A reliability and comparative study

BACKGROUND

Altered lower limb movement patterns (LLMP) during the forward step down (FSD) test have been studied in people suffering from knee instability. However, ankle dorsiflexion range of motion (ADROM) seems to be related to LLMP but no causal inference has been defined between those variables.

OBJECTIVE

Our goals were to evaluate (1) psychometric quality of the FSD test in healthy people and (2) the influence of experimental restricted ADROM on LLMP.

METHODS

Kinematics were measured by a motion capture system. Angular displacement and speed were calculated as well as center of mass (COM) and knee linear displacement. Forty-two healthy participants; firstly, performed the test three times to assess reliability, and secondly the same test in an experimental condition limiting the ADROM.

RESULTS

Reliability was excellent for all parameters (ICC: 0.75-0.99, SEM%: 2.0-34.0%). ADROM limitation significantly decreased Knee flexion range of motion (ROM) (-3.8∘), increased Hip flexion ROM (6∘), Hip adduction ROM (6.1∘), Pelvis drop ROM (3.5∘), Pelvic rotation ROM (3.1∘). No significant effect was found for Hip rotation ROM.

CONCLUSIONS

LLMP was affected by this experimental ADROM limitation in healthy people. As this limitation is often encountered in post-traumatic ankle sprain patients, clinicians should consider this point during FSD assessment test.

Knee Frontal Plane Projection Angle: A Comparison Study Between Drop Vertical Jump and Step-Down Tests With Young Volleyball Athletes

STUDY DESIGN

Observational study.

CONTEXT

Altered frontal plane knee mechanics during dynamic tasks have been often associated with lower-extremity injuries. Strategies to decrease these risk factors and improve knee joint stability are often applied in rehabilitation and training environments.

OBJECTIVE

The purpose of this study was to compare knee joint frontal plane projection angles (FPPA) via 2-dimensional video analysis during drop vertical jump (DVJ) and step-down test (SDT) tasks in the preferred and nonpreferred limbs of young male and female volleyball players.

METHODS

A total of 60 young male (n = 29) and female (n = 31) volleyball players (13.6 [1.1] y, 62.2 [11.2] kg, and 170.8 [10] cm) participated in this study. Once the athletes were screened for inclusion and exclusion criteria, limb preference was operationally defined as the preferred kicking leg or the foot used for stair climbing. In a randomized study design, participants were asked to perform a bilateral DVJ and unilateral step-down landing tasks for both preferred and nonpreferred limb. Kinematic analysis was performed via a 2-dimensional video recording of knee joint FPPA alignment.

RESULTS

No difference was noted in FFPA during DVJ and SDT tasks between preferred and nonpreferred limbs in both male and female groups (P > .05). The FFPA was significantly higher for both limbs during DVJ versus SDT in both groups (P ≤ .05), but it was not different between male and female athletes.

CONCLUSIONS

Based on these findings, clinicians may expect young male and female volleyball athletes to demonstrate similar and symmetrical lower-extremity 2-dimensional knee joint FPPA values across screening tests intended to identify lower-extremity injury risk factors. However, greater FPPA values should be expected during the more dynamic DVJ task.

Correlation between Dorsiflexion Ankle Range of Motion and Patellofemoral Pain Syndrome

Abstract The change in lower extremity movement pattern has been previously associated with severe knee disorders, including anterior cruciate ligament rupture, patellar tendinopathy, iliotibial band syndrome, and patellofemoral pain (PFP). The aim of this study was to verify the clinical reliability of ankle dorsiflexion range of motion (ADROM) measurement with weight bearing (WB) using an app on the smartphone (iHand) and to verify if there is correlation between the limitation of the ADROM and the PFP. A total of 67 women, mean age 34.3 ± 2.4, height 182 ± 3.6, weight 73.7 ± 4.2, were allocated to the control group (n = 23) and the PFP group (n = 23). Two examiners evaluated the active ADROM (lunge test) in both ankles at two times to test inter-examiner and intra-examiner reliability. It was observed in the PFP group that the mean ADROM was 17.7 ± 2.5 and the control group was 35.3 ± 6.2 (right) and 17.1 ± 2.9 and 32.9 ± 5, 4 (left). It is concluded that the use of the smartphone app proved to be reliable for clinical application in the evaluation of ADROM with WB and that there is a relation between the low DFT of DFT with the presence of patellofemoral pain.Keywords: Data Accuracy. Ankle. Patellofemoral Pain Syndrome.Resumo A alteração no padrão de movimento da extremidade inferior tem sido previamente associada com severas desordens do joelho, incluindo a ruptura do ligamento cruzado anterior, tendinopatia patelar, síndrome da banda iliotibial e dor patelofemoral - DPF. O objetivo do estudo foi verificar a confiabilidade clínica da mensuração da dorsiflexão de tornozelo - DFT com descarga de peso - WB utilizando um app no smartphone (iHand) e verificar se há correlação entre a limitação da DFT com a DPF. Participaram 67 mulheres, idade média 34,3±2,4, altura 182±3,6, peso 73,7±4,2, alocadas em grupo controle (n=23) e grupo DFP (n=23). Dois examinadores avaliaram a DFT ativa (lunge test) em ambos os tornozelos em dois momentos para se testar a confiabilidade inter-examinador e intra-examinador. O coeficiente de correlação intraclasse - CCI foi utilizado para a análise da confiabilidade das medidas. Observou-se alta confiabilidade (0,9965 [p<0,0001]) e (0,9949 [p<0,0001]) para tornozelo direito e esquerdo respectivamente. Observou-se no grupo DFP que a ADM média de DFT foi de 17,7±2,5 e grupo controle de 35,3±6,2 (direito) e 17,1±2,9 e 32,9±5,4 (esquerdo). Conclui-se que a utilização do app de smartphone se mostrou confiável para aplicação clínica na avaliação da DFT com WB e que há relação entre a baixa ADM de DFT com a presença de dor patelofemoral.Palavras-chave: Acurácia dos Dados. Tornozelo. Síndrome da Dor Patelofemoral

Measuring the 3D motion space of the human ankle

BACKGROUND

The 3D motion space of the human ankle is an important area of study in medicine. The 3D motion space can provide significant information for establishing more reasonable rehabilitation procedures and standards of ankle injury care.

OBJECTIVE

This study aims to measure the 3D motion space of the human ankle and to use mathematical methods to quantify it.

METHODS

A motion capturing system was used to simultaneously capture the 3D coordinates of points marked on the foot, and convert these coordinate values into rotation angles through trigonometric functions and vectors. The mathematical expression of the ankle's motion space was obtained by screening, arranging, and fitting the converted data.

RESULTS

The mathematical expression of the 3D motion space of the participants was obtained. We statistically analyzed the data and learned that, in terms of 3D motion space, the right foot is more flexible than the left foot and the female foot is more flexible than the male foot.

CONCLUSIONS

The adduction and abduction rotation ranges are affected by the plantar flexion or dorsal flexure rotation angles. This relationship can be expressed mathematically, which is significant in the study of the ankle joint.

The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis

OBJECTIVE

The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV).

METHODS

Electronic searches were conducted in MEDLINE, EMBASE, CINAHL and SPORTDiscus. A modified Downs and Black checklist was used for quality assessment and meta-analysis was performed to compare standardised mean differences (SMD) of ADF.

RESULTS

Seventeen studies met the inclusion criteria. Meta-analysis showed that reduced ADF is associated with participants presenting with DKV compared to controls (SMD -0.65, 95% CI -0.88 to -0.41). Subgroup analysis showed consistent results regarding different forms of ADF measurement; restriction in ADF measured in weight-bearing position (SMD -1.25, 95% CI -2.24 to -0.25), non-weight-bearing with knee flexed (SMD -0.56, 95% CI -0.97 to -0.16) or non-weight-bearing with knee extended (SMD -0.54, 95% CI -0.80 to -0.28) was significantly associated with DKV.

CONCLUSION

The meta-analysis results provide evidence that reduced ADF is correlated with DKV. The assessment of ADF in the clinical setting is important, as it may be related to harmful movement patterns of the lower limbs.

The Association of Ankle Dorsiflexion Range of Motion With Hip and Knee Kinematics During the Lateral Step-down Test

Study Design Controlled laboratory study. Background Altered hip and knee kinematics have been associated with several knee disorders, including anterior cruciate ligament tear, patellofemoral pain, and iliotibial band syndrome. Limited ankle dorsiflexion (DF) range of motion (ROM), which has been linked with some of these disorders, has also been associated with altered knee kinematics. Objective To explore the association of ankle DF ROM with hip and knee kinematics during a step-down task. Methods Thirty healthy participants underwent a 3-D analysis of hip and knee kinematics during a lateral step-down test, followed by measurement of ankle DF ROM in weight bearing (WB) and non-weight bearing (NWB). Participants were dichotomized using the median values into low- and high-DF subgroups within both WB and NWB. Hip and knee kinematics were compared between the low- and high-DF subgroups. Results Participants in the low-DF subgroups exhibited greater peak hip adduction (WB, P = .02; NWB, P<.01) and greater peak knee external rotation (WB, P = .02; NWB, P<.01) compared with participants in the high-DF subgroups. In addition, participants in the low-DF WB subgroup exhibited decreased peak knee flexion compared with participants in the high-DF WB subgroup (P<.01). Conclusion Individuals with lower ankle DF ROM exhibited hip and knee kinematics previously associated with several knee disorders, suggesting that this impairment may be involved in the pathogenesis of the same disorders. Assessment of ankle DF ROM may be useful as part of a preparticipation screening. Furthermore, deficits in ankle DF ROM may need to be addressed in individuals with altered movement patterns. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6621.