Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing

Effect of Sex and Lateral Ankle Sprain History on Dorsiflexion Range Of Motion Asymmetry During the Weight Bearing Lunge Test

Background

Reduced dorsiflexion range of motion (DFROM) which is commonly seen following lateral ankle sprain (LAS) has the potential to influence lower extremity biomechanics which have been linked to increased injury risk in the female athlete. Current research on the effect of sex and LAS history on DFROM is limited.

Hypothesis/Purpose

This study had three aims 1) to determine the effect of sex, leg dominance and LAS history on DFROM, 2) to determine the effect of sex and LAS history on magnitude of DFROM symmetry and 3) to examine the association of sex on direction (whether dominant or non-dominant limb had the higher DFROM) of symmetry.

Study Design

Cross-Sectional Study.

Methods

DFROM was measured bilaterally in 105 recreational athletes all participating in multidirectional sports using the tape measurement method during the weight bearing lunge test (WBLT). A mean of three measurements was used for analysis. A 3-way mixed ANOVA was carried out to determine the interaction between sex, LAS history and leg dominance on DFROM and a 2-way ANOVA for the effect of sex and LAS history on asymmetry. A chi-square test was used to determine the association of sex and direction of asymmetry.

Results

The results indicate no significant effect of sex, LAS history, and leg dominance on DFROM (p=0.65). Main effects were significant for sex and LAS on DFROM. The mean asymmetry for all participants was reported as 12.25±14.76cm. No significant effect of sex and LAS history on magnitude of asymmetry was reported. There was a significant association of sex and direction of asymmetry (χ2(1) = 11.26, p = 0.00). Sixty-five-point two percent of males were shown to have higher DFROM of their non-dominant limb compared to 75% of females who were higher in their dominant limb.

Conclusion

Findings from this study suggest that DFROM is affected by sex and LAS history. While females have increased DFROM compared to males, those with LAS history are more likely to have a decreased DFROM on the involved side. The results also indicate that interlimb asymmetries in DFROM are present in athletes, therefore practitioners should exercise caution when using bilateral comparisons in injury and return to play assessments.

Level of Evidence

2b.

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.

A new method applied for explaining the landing patterns: Interpretability analysis of machine learning

As one of many fundamental sports techniques, the landing maneuver is also frequently used in clinical injury screening and diagnosis. However, the landing patterns are different under different constraints, which will cause great difficulties for clinical experts in clinical diagnosis. Machine learning (ML) have been very successful in solving a variety of clinical diagnosis tasks, but they all have the disadvantage of being black boxes and rarely provide and explain useful information about the reasons for making a particular decision. The current work validates the feasibility of applying an explainable ML (XML) model constructed by Layer-wise Relevance Propagation (LRP) for landing pattern recognition in clinical biomechanics. This study collected 560 groups landing data. By incorporating these landing data into the XML model as input signals, the prediction results were interpreted based on the relevance score (RS) derived from LRP. The interpretation obtained from XML was evaluated comprehensively from the statistical perspective based on Statistical Parametric Mapping (SPM) and Effect Size. The RS has excellent statistical characteristics in the interpretation of landing patterns between classes, and also conforms to the clinical characteristics of landing pattern recognition. The current work highlights the applicability of XML methods that can not only satisfy the traditional decision problem between classes, but also largely solve the lack of transparency in landing pattern recognition. We provide a feasible framework for realizing interpretability of ML decision results in landing analysis, providing a methodological reference and solid foundation for future clinical diagnosis and biomechanical analysis.

Lower extremity coordination strategies to mitigate dynamic knee valgus during landing in males and females

Frontal and sagittal plane landing biomechanics differ between sexes but reported values don't account for simultaneous segment or joint motion necessary for a coordinated landing. Frontal and sagittal plane coordination patterns, angles, and moments were compared between 28 males and 28 females throughout the landing phase of a drop vertical jump. Females landed with less isolated thigh abduction (p = 0.018), more in-phase motion (p < 0.001), and more isolated shank adduction (p = 0.028) between the thigh and shank in the frontal plane compared with males. Females landed with less in-phase (p = 0.012) and more anti-phase motion (p = 0.019) between the thigh and shank in the sagittal plane compared with males. Females landed with less isolated knee flexion (p = 0.001) and more anti-phase motion (p < 0.001) between the sagittal and frontal plane knee coupling compared with males. Waveform and discrete metric analyses revealed females land with less thigh abduction from 20 % to 100 % and more shank abduction from 0 to 100 % of landing, smaller knee adduction at initial contact (p = 0.002), greater peak knee abduction angles (p = 0.015), smaller knee flexion angles at initial contact (p = 0.035) and peak (p = 0.034), greater peak knee abduction moments (p = 0.024), greater knee abduction angles from 0 to 13 % and 19 to 30 %, greater knee abduction moments from 19 to 25 %, and smaller knee flexion moments from 3 to 5 % of landing compared with males. Females utilize greater frontal plane motion compared with males, which may be due to different inter-segmental joint coordination and smaller sagittal plane angles. Larger knee abduction angles and greater knee adduction motion in females are due to aberrant shank abduction rather than thigh adduction.

Relationships between surrogate measures of mechanical and psychophysiological load, patellar tendon adaptations, and neuromuscular performance in NCAA division I men's volleyball athletes

Introduction

Patellar tendon adaptations occur in response to mechanical load. Appropriate loading is necessary to elicit positive adaptations with increased risk of injury and decreased performance likely if loading exceeds the capacity of the tendon. The aim of the current study was to examine intra-individual associations between workloads and patellar tendon properties and neuromuscular performance in collegiate volleyball athletes.

Methods

National Collegiate Athletics Association Division I men's volleyball athletes (n = 16, age: 20.33 ± 1.15 years, height: 193.50 ± 6.50 cm, body mass: 84.32 ± 7.99 kg, bodyfat%: 13.18 ± 4.72%) competing across 9 weeks of in-season competition participated. Daily measurements of external workloads (i.e., jump count) and internal workloads [i.e., session rating of perceived exertion (sRPE)] were recorded. Weekly measurements included neuromuscular performance assessments (i.e., countermovement jump, drop jump), and ultrasound images of the patellar tendon to evaluate structural adaptations. Repeated measures correlations (r-rm) assessed intra-individual associations among performance and patellar tendon metrics.

Results

Workload measures exhibited significant negative small to moderate (r-rm =-0.26-0.31) associations with neuromuscular performance, negative (r-rm = -0.21-0.30), and positive (r-rm = 0.20-0.32) small to moderate associations with patellar tendon properties.

Discussion

Monitoring change in tendon composition and performance adaptations alongside workloads may inform evidence-based frameworks toward managing and reducing the risk of the development of patellar tendinopathy in collegiate men's volleyball athletes.

Ankle dorsiflexion range of motion and landing postures during a soccer-specific task

INTRODUCTION

Ankle dorsiflexion range of motion (DF-ROM) has been shown to be associated with poor landing posture. However, previously used tasks have been controlled, and it is unclear whether clinical measurements of the ankle DF-ROM, are associated with landing positions during sport-specific task. This study sought to determine the relationship between ankle DF-ROM and landing positions.

METHODS

Thirty male soccer players participated in this study. The ankle DF-ROM was measured by the weight bearing lunge test in degrees using a cell phone app (TiltMeter). Landing patterns were assessed during a soccer-specific task using landing error scoring system items using Kinovea software. Simple correlations were used to evaluate the relationships between ankle DF-ROM and landing error scores.

RESULTS

Significant correlations were found between ankle DF-ROM and landing errors (r = -0.450, P = 0.006). A decreased ankle DF-ROM was associated with greater landing errors in a soccer specific situation.

CONCLUSION

These results suggest that ankle DF-ROM may serve a useful clinical measure for identifying poor landing posture in the real-world environment. Therefore, assessment of ankle DF-ROM could be included in the screening process, which could help identify the cause of the faulty motion.