Gastrocnemius inflexibility on foot progression angle and ankle kinetics during walking

BACKGROUND

Gastrocnemius inflexibility is a major problem in many orthopedic and neurological patients. Clinically, inflexible gastrocnemius muscles interfere with the performance of functional abilities and associate with many overuse injuries of the lower extremity. The purpose of this study was to investigate the effects of the gastrocnemius inflexibility on the foot progression angle and ankle kinetics during walking.

METHODS

There were 50 subjects, 23 patients with the inflexible gastrocnemius and 27 normal subjects, included in this investigation. Participants were asked to walk at two preset cadences of 100 steps/min and 140 steps/min. Data were collected from a motion analysis system and force plates. Kinematic and kinetic variables of gait were computed and analyzed.

FINDINGS

Compared with the control group, greater toe-out foot progression angle (P=0.001, effect size=0.314) and knee external rotation (P=0.008, effect size=0.136) were found in the inflexible group during stance phase. Furthermore, significant greater plantarflexion moment (P=0.032, effect size=0.093) and medial ground reaction force (P=0.009, effect size=0.135) during midstance were discovered in the inflexible group.

INTERPRETATION

The present results indicate that gastrocnemius inflexibility might bring about the changes in the joint angles, ankle moments and ground reaction forces. The abnormal joint alignment in the lower extremities and greater force upon joint tissue might be significant for the clinical considerations on soft tissue injuries for the patients with inflexible gastrocnemius muscles.

Myofascial trigger point therapy for triceps surae dysfunction: a case series

AIMS

The main aim of the case series was to inform further experimental research to determine the effectiveness of myofascial trigger point (MTrP) therapy for the treatment of triceps surae dysfunction.

PARTICIPANTS

Ten participants with triceps surae dysfunction were recruited (4 females and 6 males); mean age±standard deviation=43±7.1 years.

METHODS

Participants were screened for inclusion/exclusion criteria and the following outcomes measures were assessed at baseline and discharge; lower extremity functional scale (LEFS), verbal numerical rating scale (NRS), MTrP prevalence, ankle dorsiflexion range of movement (ROM) and pressure pain threshold (PPT). Intervention involved trigger point (TrP) pressure release, self MTrP release and a home stretching programme.

RESULTS

There was a high prevalence of active/latent MTrPs and possible myofascial pain syndrome (MPS) for all 10 participants at baseline. Active MTrP prevalence decreased to 0%, while latent MTrPs were still present at discharge. There were positive changes in most outcome measures (LEFS, NRS, ROM and PPT) for all 10 participants. Short term to medium term treatment outcomes (6 week post discharge) showed an overall mean LEFS increase of 11 points from 61/80 at baseline to 72/80 at discharge.

CONCLUSION

This case series suggests that a brief course of multimodal MTrP therapy would be helpful for some patients with sub-acute or chronic calf pain. Important preliminary data was gathered, that will inform more rigorous research in this under investigated area.

The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: A pilot randomised controlled trial

OBJECTIVES

The primary aim of this study was to investigate the immediate effect on restricted active ankle joint dorsiflexion range of motion (ROM), after a single intervention of trigger point (TrP) pressure release on latent soleus myofascial trigger points (MTrPs). The secondary aim was to assess aspects of the methodological design quality, identify limitations and propose areas for improvement in future research.

DESIGN

A pilot randomised control trial.

PARTICIPANTS

Twenty healthy volunteers (5 men and 15 women; mean age 21.7±2.1 years) with a restricted active ankle joint dorsiflexion.

INTERVENTION

Participants underwent a screening process to establish both a restriction in active ankle dorsiflexion and the presence of active and latent MTrPs in the soleus muscle. Participants were then randomly allocated to an intervention group (TrP pressure release) or control group (no therapy).

RESULTS

The results showed a statistically significant (p=0.03) increase of ankle ROM in the intervention compared to the control group.

CONCLUSION

This study identified an immediate significant improvement in ankle ROM after a single intervention of TrP pressure release on latent soleus MTrPS. These findings are clinically relevant, although the treatment effect on ankle ROM is smaller than a clinical significant ROM (5°). Suggestions for methodological improvements may inform future MTrP research and ultimately benefit clinical practice in this under investigated area.

Gastrocnemius tightness on joint angle and work of lower extremity during gait

BACKGROUND

Muscular tightness is a common clinical musculoskeletal disorder and is regarded as a predisposing factor for muscle injuries. In this study, a two-way mixed design ANOVA was applied to investigate the effects of the gastrocnemius tightness on the joint angle and joint work during walking.

METHODS

Twenty-two patients with muscular tightness of gastrocnemius muscle (<12 degrees of ankle dorsiflexion with knee extended) and 22 age- and gender-matched subjects with normal gastrocnemius flexibility (>15 degrees of ankle dorsiflexion with knee extended) participated in this study. The joint angle and work at hip, knee, and ankle joints during the stance phase were analyzed at two preset cadences of 100 steps/min and 140 steps/min.

FINDINGS

Significantly greater flexion angles at hip (P=0.025) and knee (P=0.001) were found in the tightness group at the time of maximal ankle dorsiflexion. Significantly less work generation at knee (P=0.034) and greater work absorption at ankle (P=0.024) were detected in the tightness group.

INTERPRETATION

The subjects with gastrocnemius tightness revealed a compensatory gait pattern, which included the changes in the joint angles and associated work productions. The potential disturbance of the knee control and strain injuries of plantar flexors might be crucial in the clinical considerations for subjects with gastrocnemius tightness.