Comparison of the acute effects of different techniques on the ankle joint range of motion in healthy older adults: a randomized controlled trial

AIM

This study aimed to compare the acute effects of different methods on ankle joint range of motion (ROM) in older adults.

MATERIALS AND METHODS

Seventy-eight older adults were randomly divided into three groups. After the warming-up, static stretching, proprioceptive neuromuscular facilitation (PNF) contract-relax, and roller massage were applied, at the same period. Before application, immediately after, 10 and 20 min after application, ankle joint dorsiflexion ROM was measured in the weight-bearing position.

RESULTS

No statistically significant difference between the groups in demographic characteristics and baseline ankle ROM (p = 0.413). In all groups, post-application measurements revealed increased ankle joint motion (p < 0.0125). Groups were compared, and a statistically significant difference between the three groups was found (p < 0.05). There was no significant difference in the change of ROM between the Static Stretching and PNF Stretching Groups in the change of ROM group comparisons (p = 0.089). There was a statistically significant difference in ROM changes Roller Massage Group and both Static Stretching and the PNF Stretching Group (p = 0.001).

CONCLUSION

The acute effects of roller massage, on ankle ROM, were superior to static and PNF stretching. The application of roller massage, which was shown to be an effective method for increasing ROM, can be safely applied in physiotherapy programs for older adults.

Acute and Long-Term Effects of Stretching with Whole-Body Vibration on Young's Modulus of the Soleus Muscle Measured Using Shear Wave Elastography

The effect of whole-body vibration (WBV) stretching on soleus (SOL) muscle stiffness remains unclear. Therefore, we aimed to investigate the acute and long-term effects of stretching with WBV on SOL muscle stiffness. This study employed a repeated-measures experimental design evaluating 20 healthy young males. SOL muscle stretching with WBV was performed for 5 min per day (1 min per set, five sets) over 4 weeks, for 4 days a week. Participants stretched the SOL muscle with ankle dorsiflexion in a loaded flexed knee position on a WBV device. Data were obtained to examine acute effects before stretching, immediately after stretching, and at 5, 10, 15, and 20 min. Moreover, data were obtained to examine the long-term effects before stretching, immediately after the completion of the 4-week stretching program, and at 2 and 4 weeks later. SOL muscle stiffness was measured using Young's modulus with shear wave elastography. The acute effect of SOL muscle stretching with WBV persisted for up to 20 min. Additionally, the long-term effect of stretching was better maintained than the acute effect, which was effective for up to 4 weeks (p < 0.001). Clinically, continuous stretching with WBV may be used to improve SOL muscle stiffness in rehabilitation programs.

Three Months of Strength Training Changes the Gene Expression of Inflammation-Related Genes in PBMC of Older Women: A Randomized Controlled Trial

Here, we investigate changes in inflammation-related gene-expression in peripheral mononuclear blood cells (PBMC) by strength training. A total of 14 women aged ≥65 years were randomized into 3 months of either 3×/week intensive strength training (IST: 3×10 rep at 80% 1RM), strength endurance training (SET: 2×30 reps at 40% 1RM) or control (CON: 3×30 sec stretching). Differentially expressed genes (fold change ≤0.67 or ≥1.5) were identified by targeted RNA-sequencing of 407 inflammation-related genes. A total of 98 genes (n = 61 pro-inflammatory) were significantly affected. IST and SET altered 14 genes in a similar direction and 19 genes in the opposite direction. Compared to CON, IST changed the expression of 6 genes in the same direction, and 17 genes in the SET. Likewise, 18 and 13 genes were oppositely expressed for, respectively, IST and SET compared to CON. Changes in gene expression affected 33 canonical pathways related to chronic inflammation. None of the altered pathways overlapped between IST and SET. Liver X Receptor/Retinoid X Receptor Activation (LXR/RXR) and Triggering Receptor Expressed On Myeloid Cells 1 (TREM1) pathways were enriched oppositely in both training groups. We conclude that three months IST and SET can induce changes in CLIP-related gene expression in PBMC, but by affecting different genes and related pathways.

The Association of Gastrocnemius Tightness, Genu Valgum and Hallux Valgus: A Prospective Case-Control Study

There has been much debate regarding the aetiology and pathogenesis of hallux valgus and it appears to be multifactorial with contracture or tightness of the Achilles tendon and more specifically the gastrocnemius being implicated as an intrinsic factor. The purpose of this study was to look at the association of gastrocnemius tightness, genu valgum and hallux valgus. A prospective case-control study with 25 patients in each group was carried out over a 12-month period. The case group observed adult patients who were referred primarily because of symptomatic hallux valgus and were assessed for the following: hallux valgus stage; presence or absence of isolated gastrocnemius tightness; presence or absence of genu valgum. The control group excluded those with pre-existing hallux valgus, genu valgum and rheumatoid arthritis and were assessed for isolated gastrocnemius tightness. There was a statistically significant association between the presence of genu valgum and hallux valgus when comparing both groups with a p < .001. There was also a statistically significant association between the Silfverskiöld test and the presence of hallux valgus, as well as the Silfverskiöld test and the presence of genu valgum with a p < .001. This study is the first to describe the association of gastrocnemius tightness, genu valgum and hallux valgus. Further studies are required to assess this relationship but knowledge and awareness of it can be applied by clinicians when considering the most appropriate management options with patients.

Comparison of the Acute Effects of Hold-Relax and Static Stretching among Older Adults

Simple Summary

It is well known that stretching interventions are effective in improving age-related changes in range of motion (ROM) and muscle stiffness. We investigated the effects of various stretching interventions, such as static stretching and hold–relax stretching, on ROM and muscle stiffness in older adults to establish the most effective stretching technique. Our results showed that static stretching and hold–relax stretching increased ROM, which could be contributed by not change in muscle stiffness, but stretch tolerance. Conversely, medial gastrocnemius muscle stiffness decreased only after a static stretching intervention and not after hold–relax stretching. Our results indicated that static stretching intervention improved ROM and muscle stiffness in older adults.

Abstract

Various stretching techniques are generally recommended to counteract age-related declines in range of motion (ROM) and/or increased muscle stiffness. However, to date, an effective stretching technique has not yet been established for older adults. Consequently, we compared the acute effects of hold relax stretching (HRS) and static stretching (SS) on dorsiflexion (DF) ROM and muscle stiffness among older adults. Overall, 15 elderly men and nine elderly women (70.2 ± 3.9 years, 160.8 ± 7.8 cm, 59.6 ± 9.7 kg) were enrolled, and both legs were randomized to either HRS or SS stretching. We measured DF ROM and muscle stiffness using a dynamometer and ultrasonography before and after 120 s of HRS or SS interventions. Our multivariate analysis indicated no significant interaction effects, but a main effect for DF ROM. Post-hoc tests revealed that DF ROM was increased after both HRS and SS interventions. Moreover, multivariate analysis showed a significant interaction effect for muscle stiffness. Post-hoc tests revealed that muscle stiffness was decreased significantly after only SS intervention. Taken together, our results indicated that both HRS and SS interventions are recommended to increase ROM, and SS is recommended to decrease muscle stiffness in older adults.

Both the resistance training session and the static stretching after exercise does not affect the pectoralis major stiffness of well-trained men

Previous evidence suggests the intense resistance training session can increase the muscle hardness, while stretching protocols with high intensity and volume can decrease it. However, it remains unknown the effects of an exercise and a less intensive stretching maneuver on muscle stiffness of well-trained men. Herein we (i) analyze the acute effects of heavy bench press exercise on the pectoralis major muscle shear modulus of well-trained men and (ii) assess the effectiveness of a 1-min stretching maneuver applied on this muscle after the exercise using shear wave elastography. Fourteen participants performed three sets of bench press from 8 to 13 repetitions maximum. Immediately after the exercise, their right shoulder was passively stretched for 1 min (stretched side) while their left arm stayed relaxed along the side of the body (control side). Elastographic images were acquired for the pectoralis major mid-region of both sides before the exercise, immediately after the intervention and after 5 min of rest. Our results revealed that both the bench press exercise and the static stretching does not affect the pectoralis major shear modulus of well-trained men. Conversely, the shear modulus significantly decreased at 5 min after intervention with respect to immediately after, for both the stretched (from 5.52 to 4.29 kPa) and the control sides (from 5.87 to 4.56 kPa). Therefore, both resistance training session and 1-min static stretching were not sufficient to significantly change the pectoralis major muscle stiffness of well-trained men.

Can Static Stretching Reduce Stiffness of the Triceps Surae in Older Men?

Purpose

The purpose of this study was to investigate reductions of muscle stiffness induced by static stretching in older and younger men.

Methods

Twenty older (62–83 yr) and 20 younger (21–24 yr) men were recruited. Ankle dorsiflexion static stretching was consisted of 90 s × 5 repetitions. Before and after the stretching, the dorsiflexion range of motion (RoM), passive plantar flexion torque, and shear modulus (an index of stiffness) of the medial (MG) and lateral gastrocnemius and the soleus were measured.

Results

RoM, passive torque, and shear modulus of the triceps surae measured at the maximal dorsiflexion angle before stretching were significantly lower for the older group than the younger group. This suggests a weak stretching intensity for older compared with younger people. The stretching significantly improved RoM for both groups. For the older group, a significant reduction in passive torque was only observed at a 15° dorsiflexion angle, and the shear modulus was significantly decreased only for the distal region of MG. For the younger group, passive torque was significantly reduced for the entire RoM, and a significant decrease in shear modulus was found for the central and distal regions of MG and lateral gastrocnemius. A significant correlation between the muscle shear modulus measured at the maximal dorsiflexion angle before stretching and a stretching-induced decrease in muscle shear modulus was observed for older and younger participants. This indicates that the higher stretching intensity can reduce more muscle stiffness.

Conclusion

Static stretching can reduce muscle stiffness regardless of age, although the stretching effect on muscle stiffness was limited for older people. This might be due to a lower stretching intensity for older than younger people.

Strength Endurance Training but Not Intensive Strength Training Reduces Senescence-Prone T Cells in Peripheral Blood in Community-Dwelling Elderly Women

Aging is characterized by a progressive decline in immune function known as immunosenescence. Although the causes of immunosenescence are likely to be multifactorial, an age-associated accumulation of senescent T cells and decreased naive T-cell repertoire are key contributors to the phenomenon. On the other hand, there is a growing consensus that physical exercise may improve immune response in aging. However, the optimum training modality required to obtain beneficial adaptations in older subjects is lacking. Therefore, we aimed to investigate the effects of exercise modality on T-cell phenotypes in older women. A total of 100 women (aged ≥ 65 years) were randomized to either intensive strength training (80% of one-repetition maximum ), strength endurance training (40% one-repetition maximum), or control (stretching exercise) for 2-3 times per week during 6 weeks. The T-cell percentages and absolute counts were determined using flow cytometry and a hematology analyzer. C-reactive protein was measured using immunonephelometry. We report for the first time that 6 weeks of strength endurance training significantly decreased the basal percentage and absolute counts of senescence-prone T cells, which was positively related to the number of training sessions performed. Conceivably, training protocols with many repetitions-at a sufficiently high external resistance-might assist the reduction of senescence-prone T cells in older women.

Whole-body vibration and stretching enhances dorsiflexion range of motion in individuals with chronic ankle instability

OBJECTIVE

The purpose of this study was to determine if WBV performed concurrently with static stretching was more effective than static stretching alone to increase dorsiflexion ROM (DFROM) in individuals with chronic ankle instability (CAI).

DESIGN

Controlled laboratory study.

PARTICIPANTS

Thirty-nine participants with CAI (history of ankle sprain, a feeling of "giving way" during activity, and a qualifying Foot and Ankle Ability Measure Ankle score) were divided into 3 groups (normative (N), static stretch (SS), and static stretch with vibration (SV)). Participants stretched the triceps surae 4 days/wk for 3 wks. Vibration was imposed at 34 Hz and 1.8 mm.

MAIN OUTCOME MEASURES

DFROM was assessed in a straight and bent-leg position.

RESULTS

No differences were detected at any time in the N or SS group, however SS did exhibit large effect sizes with 95% confidence intervals (CI) that did not cross zero from baseline to 3 weeks for both measures. The SV group demonstrated increased DFROM from baseline for both time points and a large effect size with 95% CI that did not cross zero from post tx-1 to post tx-2.

CONCLUSIONS

Static stretching with WBV increases DFROM in participants with CAI more effectively than static stretching alone.

Bend Don't Break: Stretching Improves Scores on a Battery of Fall Assessment Tools in Older Adults

CONTEXT

Falls and loss of autonomy are often attributed in large part to musculoskeletal impairments in later adulthood. Age-related declines in flexibility contribute to late adulthood musculoskeletal impairment. The novel sitting-rising test has been proposed to be a quick, effective screening of musculoskeletal fitness, fall risk, and all-cause mortality in older adults. The timed up and go and 5 times sit-to-stand tests are two of the 3 most evidence-supported performance measures to assess fall risk.

OBJECTIVE

This study aimed to determine if 5 weeks of flexibility training could increase sitting-rising test, timed up and go, and 5 times sit-to-stand scores in community-dwelling older adults.

PARTICIPANTS

Forty-seven adults aged 60 years and older (mean age = 66.7 y, SD = 4.1) participated in this study. Participants completed a static stretching protocol consisting of 3 weekly 1-hour stretching sessions.

RESULTS

The protocol improved flexibility as seen in sit-and-reach scores and improved scores on all outcome variables. Specifically, there was a significant increase in sitting-rising test scores from preintervention (M = 7.45, SD = 1.45) to postintervention (M = 8.04, SD = 1.36), t(42) = -5.21, P < .001. Timed up and go scores demonstrated a significant decrease from preintervention (M = 8.85, SD = 1.32) to postintervention (M = 8.20, SD = 1.35), t(46) = 5.10, P < .001. Five times sit-to-stand scores demonstrated a significant decrease from preintervention (M = 12.57, SD = 2.68) to postintervention (M = 10.46, SD = 2.06), t(46) = 6.62, P < .001. Finally, significant increases in sit-and-reach scores were associated with improved functional performance (r = -.308, P = .03).

CONCLUSION

Findings suggest that flexibility training can be an effective mode of low-level exercise to improve functional outcomes. Static stretching may help to improve musculoskeletal health, promote autonomy, and decrease mortality in community-dwelling older adults.

Calf muscle stretching is ineffective in increasing ankle range of motion or reducing plantar pressures in people with diabetes and ankle equinus: A randomised controlled trial

BACKGROUND

Limited ankle dorsiflexion, or equinus, is associated with elevated plantar pressures, which have been implicated in the development and non-healing of foot ulcer. A stretching intervention may increase ankle dorsiflexion and reduce plantar pressures in people with diabetes.

METHODS

Two arm parallel randomised controlled trial from September 2016 to October 2017. Adults with diabetes and ankle equinus (≤5° dorsiflexion) were randomly allocated to receive an 8 week static calf stretching intervention or continue with their normal activities. Primary outcome measures were change in weight bearing and non-weight bearing ankle dorsiflexion and forefoot peak plantar pressure. Secondary outcome measures were forefoot pressure time integrals and adherence to the stretching intervention.

FINDINGS

68 adults (mean (standard deviation) age and diabetes duration 67.4 (10.9) years and 14.0 (10.8) years, 64.7% male) were randomised to stretch (n = 34) or usual activity (n = 34). At follow up, no significant differences were seen between groups (adjusted mean difference) for non-weight (+1.3°, 95% CI:-0.3 to 2.9, p = 0.101) and weight bearing ankle dorsiflexion (+0.5°, 95% CI:-2.6 to 3.6, p = 0.743) or forefoot in-shoe (+1.5 kPa, 95% CI:-10.0 to 12.9, p = 0.803) or barefoot peak pressures (-19.1 kPa, 95% CI:-96.4 to 58.1, p = 0.628). Seven of the intervention group and two of the control group were lost to follow up.

INTERPRETATION

Our data failed to show a statistically significant or clinically meaningful effect of static calf muscle stretching on ankle range of motion, or plantar pressures, in people with diabetes and ankle equinus.

Six weeks of strength endurance training decreases circulating senescence-prone T-lymphocytes in cytomegalovirus seropositive but not seronegative older women

Background

Ageing is associated with a decline in immune function termed immunosenescence. This process is characterized amongst others by less naive T-cells and more senescent phenotypes, which have been implicated in the pathogenesis of many age-related diseases. Thus far, reports regarding the long-term adaptation effects of exercise on T-cell phenotypes are scant and largely equivocal. These inconsistencies may be due to potential contributors to immunosenescence, particularly cytomegalovirus infection, which is considered a hallmark of T-cell senescence. Therefore, we sought to investigate the impact of cytomegalovirus serostatus on the distribution of peripheral T-cell subsets following long-term exercise in older women.

Methods

One hundred women (aged 65 years and above) were randomized to 3 times/weekly training at either intensive strength training (3 × 10 repetitions at 80% of one-repetition maximum, n = 31), strength endurance training (2 × 30 repetitions at 40% of one-repetition maximum, n = 33), or control (passive stretching exercise, n = 36) for 6 weeks. All training sessions were supervised by trained instructors to minimize the risk of injury and to ensure that the participants adhered to the training protocol throughout the entire range of motion. The T-cell percentages and absolute blood counts were determined before and after 6 weeks (24 h–48 h after the last training session) using flow cytometry and a haematology analyser. Cytomegalovirus antibodies were measured in serum using Architect iSystem and cytomegalovirus serostatus was balanced in the three intervention groups. C-reactive protein was measured using immunonephelometry.

Results

We report for the first time that 6 weeks of strength endurance training significantly decreased senescence-prone T-cells along with a small increase in the number of CD8– naive T-cells in blood. The absolute counts of senescent-like T-cells decreased by 44% (from 26.03 ± 35.27 to 14.66 ± 21.36 cells/μL, p < 0.01) and by 51% (from 6.55 ± 12.37 to 3.18 ± 6.83 cells/μL, p < 0.05) for the CD8+ and CD8– T-cell pools, respectively. Intriguingly, these changes were observed in cytomegalovirus seropositive, but not cytomegalovirus seronegative individuals.

Conclusions

In conclusion, the present study shows that strength endurance training leads to a reduction in circulating senescence-prone T-cells in cytomegalovirus seropositive older women. It remains to be established if monitoring of peripheral senescence-prone T-cells may have utility as cellular biomarkers of immunosenescence.

Electronic supplementary material

The online version of this article (10.1186/s12979-019-0157-8) contains supplementary material, which is available to authorized users.

Acute effects of static stretching on the shear elastic moduli of the medial and lateral gastrocnemius muscles in young and elderly women

PURPOSE

Generally, static stretching (SS) is the recommended intervention for a decline in the range of motion among elderly adults. However, no study has investigated the acute effects of SS on the shear elastic modulus in elderly people. The aims of the present study were to investigate the acute effects of SS on the shear elastic moduli of the medial and lateral gastrocnemius muscles and to examine the differences in these acute effects between young and elderly women.

METHODS

This study included 15 healthy young women (age: 23.1 ± 3.4 years) and 15 healthy elderly women (age: 75.9 ± 2.8 years) with no history of neuromuscular disease or musculoskeletal injury involving the lower limbs. The shear elastic moduli of the medial and lateral gastrocnemius muscles (MG and LG, respectively) were measured using ultrasound shear wave elastography at 30° plantar flexion, 0°, and 20° dorsiflexion before and immediately after 5 min of SS with the knee extended.

RESULTS

The shear elastic moduli of the MG and LG in all ankle position decreased after SS in both the young and elderly women, and there were no significant differences in the percent changes in the shear elastic moduli of the MG and LG at all ankle positions between the young and elderly women.

CONCLUSIONS

These results suggested that 5 min of SS might be effective for decreasing shear elastic modulus in both young and elderly women and that the effects on shear elastic modulus are similar between young and elderly women.

Equinus and Lengthening Techniques

Equinus is linked to most lower extremity biomechanically related disorders. Defining equinus as ankle joint dorsiflexion less than 5° of dorsiflexion with the knee extended is the basis for evaluation and management of the deformity. Consistent evaluation methodology using a goniometer with the subtalar joint in neutral position and midtarsal joint supinated while dorsiflexing the ankle with knee extended provides a consistent clinical examination. For equinus deformity with an associated disorder, comprehensive treatment mandates treatment of the equinus deformity. Surgical treatment of equinus offers multiple procedures but the Baumann gastrocnemius recession is preferred based on deformity correction without weakness.

Association between Achilles tightness and lower extremity injury in children

BACKGROUND

It is unclear whether isolated gastroc/soleus tightness can increase the risk of lower extremity injury in an otherwise healthy child.

QUESTIONS/PURPOSES

(1) Is there a difference in gastroc/soleus tightness, as represented by ankle dorsiflexion with the knee extended, in children presenting with upper versus lower extremity complaints? (2) Is there a difference in gastroc/soleus tightness in children presenting with atraumatic versus traumatic lower extremity complaints?

METHODS

We performed a cross-sectional study of 206 consecutive walking age children presenting to a county orthopedic clinic with new upper or lower extremity complaints. Passive ankle dorsiflexion was measured based on the lateral border of the foot versus the anterior lower leg with the knee fully extended and the foot in inversion.

RESULTS

Average age was 10.0 ± 4.5 years. In the 117 patients presenting with upper extremity complaints, ankle dorsiflexion was 15.0° ± 11.6°. Of the lower extremity patients, 40 presented without trauma, with dorsiflexion of 11.8° ± 14.5°, while 49 presented with trauma, with dorsiflexion of 6.5° ± 12.0°. Multiple regression analysis found significantly decreased ankle dorsiflexion with increasing age and in the lower extremity trauma group. Twelve percent of upper extremity patients had 0° or less of dorsiflexion, as compared to 25% of lower extremity nontrauma patients and 41% of lower extremity trauma patients.

CONCLUSIONS

Patients presenting with lower extremity trauma had significantly more gastroc/soleus tightness in their well leg than patients presenting with upper extremity complaints. Gastroc/soleus tightness may present a simple target for reducing lower extremity injury rates in children.

The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle

We are currently in the process of discovering that many, if not the majority, of the non-traumatic acquired adult foot and ankle problems are caused by a singular etiology: non-neuromuscular equinus or the isolated gastrocnemius contracture. There is no question that this biomechanical association exists and in time much more will be uncovered. There are three basic questions that must be answered: why would our calves tighten as we normally age, how does a tight calf, or equinus, actually cause problems remotely in the foot and ankle, and how do the forces produced by equinus cause so many seemingly unrelated pathologies in the foot and ankle? The purpose of this paper is to address the second question: how does a tight calf mechanically cause problems remotely in the foot and ankle? There has been little evidence in the literature addressing the biomechanical mechanisms by which equinus creates damaging forces upon the foot and ankle, and as a result, a precise, convincing mechanism is still lacking. Thus, the mere concept that equinus has anything to do with foot pathology is generally unknown or disregarded. The split second effect, described here, defines exactly how the silent equinus contracture creates incremental and significant damage and injury to the human foot and ankle resulting in a wide variety of pathological conditions. The split second effect is a dissenting theory based on 30 years of clinical and academic orthopedic foot and ankle experience, keen clinical observation along the way, and review of the developing literature, culminating in examination of many hours of slow motion video of normal and abnormal human gait. To my knowledge, no one has ever described the mechanism in detail this precise.

Three-dimensional analysis of foot motion after uphill walking with mobilization with movement using tape applied to the talocrural joint in women with limited ankle dorsiflexion

BACKGROUND

Previous studies that investigated mobilization with movement (MWM) treatment assessed only improvements in passive range of motion (ROM). No information is currently available regarding the efficacy of modified MWM by application of tape. Therefore, we investigated the effect of uphill walking with modified MWM using tape applied to the talocrural joint (uphill walking with MWM taping) in women with limited ankle dorsiflexion.

METHODS

Twelve feet of 12 women with ankle dorsiflexion < 8 degrees were studied. Passive ROM measured using a goniometer was used to select participants. Participants walked on a level walkway under 3 conditions: before exercise, after uphill walking, and after uphill walking with MWM taping. The Oxford Foot Model using 3D motion analysis system was used to examine dynamic foot kinematics, and statistical significance was determined by 1-way repeated-measures analysis of variance.

RESULTS

After uphill walking with MWM taping, peak hindfoot dorsiflexion relative to the tibia was significantly greater than that before exercise and after uphill walking. Furthermore, peak forefoot plantarflexion relative to the hindfoot, peak hindfoot plantarflexion relative to the tibia, and backward tilt of the tibia were greater than those before exercise.

CONCLUSIONS

Uphill walking with MWM taping resulted in an immediate alteration in foot motion during walking, increasing hindfoot dorsiflexion in particular.

CLINICAL RELEVANCE

Further studies are needed to investigate the long-term effects of uphill walking with MWM taping and its potential use in rehabilitation training.

Acute effects of 5 min of plantar flexor static stretching on balance and gait in the elderly

[Purpose] The purpose of this study was to examine the acute effects of five minutes of plantar flexor static stretching (PSS) on the balance and gait of the elderly. [Subjects and Methods] Twenty-five subjects aged 65 years and above performed 5 min of PSS in the form of wedge board standing. The sway length of each subject’s center of mass was measured to examine the subject’s static balance. It was measured by one minute of quiet standing with the eyes closed. Functional reach tests (FRTs), timed up and go tests (TUGs), and 10-meter walk tests (10MWTs) were performed to examine dynamic balance and gait before and after PSS. [Results] The outcome showed significant increases in sway distances (6.55 ± 5.03 cm) after stretching. However, in the FRTs, TUGs, and 10MWTs, the reach distance and time did not show any significant changes. [Conclusion] These results suggest that the elderly subjects temporarily experienced difficulties in maintaining balance immediately after the PSS but that their dynamic balance and gait were not adversely affected after a short period of time. Therefore, to prevent falls and perform exercises in a safe way, it is recommended to allow patients to rest after performing PSS.

Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review

CONTEXT

Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective.

OBJECTIVE

To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain.

DATA SOURCES

We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles.

STUDY SELECTION

Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions.

DATA EXTRACTION

We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale.

DATA SYNTHESIS

In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39).

CONCLUSIONS

Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The existing evidence suggests that clinicians need to consider what may be the limiting factor of ankle dorsiflexion to select the most appropriate treatments and interventions. Investigators should examine the relationship between improvements in dorsiflexion and patient progress using measures of patient self-reported functional outcome after therapeutic interventions to determine the most appropriate forms of therapeutic interventions to address ankle-dorsiflexion limitation.

Flexibility training and functional ability in older adults: a systematic review

Background. As indicated in a recent systematic review relating to Canada's Physical Activity Guidelines for Older Adults, exercise interventions in older adults can maintain or improve functional abilities. Less is known about the role of flexibility in the maintenance or improvement of functional abilities, and there currently does not exist a synthesis of the literature supporting a consensus on flexibility training prescription. Purpose. To systematically review the effects of flexibility-specific training interventions on measures of functional outcomes in healthy older adults over the age of 65 years. Methods. Five electronic databases were searched for intervention studies involving concepts related to aging, flexibility, functional outcomes, and training interventions. After evaluating the articles for relevance, 22 studies were considered. Results. The results suggested that while flexibility-specific interventions may have effects on range of motion (ROM) outcomes, there is conflicting information regarding both the relationship between flexibility interventions and functional outcomes or daily functioning. Conclusions. Due to the wide range of intervention protocols, body parts studied, and functional measurements, conclusive recommendations regarding flexibility training for older adults or the validity of flexibility training interventions as supplements to other forms of exercise, or as significant positive influences on functional ability, require further investigation.