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

Effectiveness of Kinesio tape in the treatment of patients with patellofemoral pain syndrome: A systematic review and meta-analysis

OBJECTIVE

To evaluate the clinical effectiveness of the Kinesio tape in the treatment of patellofemoral pain syndrome (PFPS) by meta-analysis.

METHODS

Two investigators independently conducted an electronic literature search to assess the outcomes of intramuscular patches for PFPS. Electronic databases included PubMed, Embase, Web of Science, Cochrane Library, Wanfang Database, Chinese Journal Full Text Database (CNKI), and Wipo Database from November 2023. Extracted inclusion indicators included pain score VAS or NRS, knee function assessment knee pain syndrome (Kujala) score, and knee symptom score Lysholm knee score scale. Data were extracted and then meta-analyzed using Review Manager 5.3 software and Stata 17.0 software.

RESULT

Fourteen studies were included, all of which were randomized controlled studies. The results showed that short-term pain relief was superior in the Kinesio tape (KT) group compared with the control group, with a statistically significant difference in the results (MD = -1.54, 95% CI [-2.32, -0.76], P = .0001); medium-term pain relief was superior in the KT group compared with the control group, with a statistically significant difference in the results (MD = -0.84, 95% CI [-1.50, -0.18], P = .01); long-term pain relief in the KT group was better than the control group, with statistically different results (MD = -0.56, 95% CI [-0.98, -0.13], P < .00001). In contrast, there was no significant difference between the KT group and the control group in the assessment of knee function (MD = -0.98, 95% CI [-4.03, 2.06], P = .03), and there was no significant difference between the KT group and the control group in the Lysholm knee score scale score of knee symptoms (MD = 4.18, 95% CI [-6.70, 15.05], P = .45).

CONCLUSION

Kinesio taping can effectively relieve the pain of PFPS, but has no significant effect on the improvement of knee joint function and symptoms.

Activity-Dependent Compensation at the Hip and Ankle at 8 Years After the Reconstruction of Isolated and Combined Posterior Cruciate Ligament Injuries

BACKGROUND

After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living.

PURPOSE

To assess long-term alterations in lower limb mechanics in patients after PCLR.

STUDY DESIGN

Descriptive laboratory study.

METHODS

A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping.

RESULTS

Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee (P = .005). During the sit-to-stand task, higher flexion angles during the midcycle (P = .017) and lower external rotation angles (P = .049) were found in the reconstructed knee; sagittal knee (P = .001) and hip (P = .016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle (P = .006 and P = .040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task (P = .010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb (P < .001).

CONCLUSION

Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand.

CLINICAL RELEVANCE

After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments.

Accurately and effectively predict the ACL force: Utilizing biomechanical landing pattern before and after-fatigue

BACKGROUND AND OBJECTIVE

As a fundamental exercise technique, landing can commonly be associated with anterior cruciate ligament (ACL) injury, especially during after-fatigue single-leg landing (SL). Presently, the inability to accurately detect ACL loading makes it difficult to recognize the risk degree of ACL injury, which reduces the effectiveness of injury prevention and sports monitoring. Increased risk of ACL injury during after-fatigue SL may be related to changes in ankle motion patterns. Therefore, this study aims to develop a highly accurate and easily implemented ACL force prediction model by combining deep learning and the explored relationship between ACL force and ankle motion pattern.

METHODS

First, 56 subjects' during before and after-fatigue SL data were collected to explore the relationship between the ankle initial contact angle (AIC), ankle range of motion (AROM) and peak ACL force (PAF). Then, the musculoskeletal model was developed to simulate and calculate the ACL force. Finally, the ACL force prediction model was constructed by combining the explored relationship and sparrow search algorithm (SSA) to optimize the extreme learning machine (ELM) and long short-term memory (LSTM).

RESULTS

There was almost a stronger linear relationship between the PAF and AIC (R = -0.70), AROM (R2 = -0.61). By substituting AIC and AROM as independent variables in the SSA-ELM prediction model, the model shows excellent prediction performance because of very strong correlation (R2 = 0.9992,  MSE = 0.0023,  RMSE = 0.0474). Based on the equal scaling by combining results of SSA-ELM and SSA-LSTM, the prediction model achieves excellent performance in ACL force prediction of the overall waveform (R2 = 0.9947,  MSE = 0.0076,  RMSE = 0.0873).

CONCLUSION

By increasing the AIC and AROM during SL, the lower limb joint energy dissipation can be increased and the PAF reduced, thus reducing the impact loads on the lower limb joints and reducing ACL injuries. The proposed ACL dynamic load force prediction model has low input variable demands (sagittal joint angles), excellent generalization capabilities and superior performance in terms of high accuracy. In the future, we plan to use it as an accurate ACL injury risk assessment tool to promote and apply it to a wider range of sports training and injury monitoring.

Acute effects of foam rolling on ankle dorsiflexion and squat exercise patterns in extreme conditioning program practitioners: A randomized clinical trial

BACKGROUND/OBJECTIVES

Joint and muscle overloads commonly occur in extreme conditioning programs (ECP), which require great physical fitness for their practice. For its execution, good functional performance, mobility and adequate movement patterns are required. The fascial system plays a fundamental role in performance in ECP and one of the techniques used to improve joint mobility and movement pattern is the self-myofascial release using a foam roller (FR). Our objective of this study was to evaluate the effect of FR in ankle dorsiflexion (DF) range of motion (ROM), assessed with the Lunge Test, and also in the squat movement pattern, assessed using the Technique smartphone application, in ECP practitioners.

METHODS

The study was carried out with 18 ECP practitioners who practiced for over four months and had a mean age of 30.94 years. The participants were randomized and allocated into two groups: control and intervention. The FR was self-applied bilaterally in the sural triceps region for 90 seconds. Tests to assess DF ROM and squat movement pattern were applied before and immediately after using FR (intervention group) or after three-minute rest (control group).

RESULTS

The use of the FR promoted an immediate increase in ankle DF ROM during the Lunge Test and during the squat and a decrease in dynamic knee valgus during the squat.

CONCLUSION

The FR can be used as a tool for an acute increase in DF ROM and a decrease in dynamic knee valgus, having a positive impact in improving movement patterns.

Overhead squat assessment reflects treadmill running kinematics

PURPOSE

Overhead squat assessment (OHSA) is a pre-activity dynamic movement analysis tool used to define deviations from an ideal motion pattern which known as compensation. Compensatory movements may result from abnormality in myofascial activity, length-tension relationships, neuro-motor control strategies, osteokinematics and arthrokinematics. The aim of this study is to identify the association between selected biomechanical variables of the ankle, knee, hip, pelvis, torso during OHSA and 16 km/h treadmill running tasks.

METHODS

Thirteen national long distance male runners (17.3 ± 0.5 age (years); 5.89 ± 1.95 experience (years), 57.9 ± 3.7 body mass (kg); 175.4 ± 5.7 height (cm)) participated in this 2controlled laboratory study. Three-dimensional kinematics were collected at 250 Hz using a 9-camera Qualisys motion analysis system (Qualisys AB, Goteborg, Sweden) while participants performed 16 km/h treadmill running and OHSA tasks.

RESULTS

Correlation coefficients demonstrated that OHSA pelvic anterior tilt angle was in a positive association with foot strike (FS), mid-stance (MS), and toe-off (TO) pelvic anterior tilt angles and MS tibial internal rotation on talus, MS ankle pronation, MS hip internal rotation. OHSA pelvic anterior tilt angle was in a negative association with TO hip extension. OHSA maximal hip adduction was positively correlated with MS and stance maximal knee adduction. FS, MS, stance maximal angular dorsiflexion values were positively correlated with OHSA dorsiflexion. Increased OHSA dorsiflexion angle was negatively associated with TO plantar flexion. OHSA pronation was positively associated with MS and stance pronation. MS hip internal rotation, MS hip adduction angles were increased, and MS ankle dorsiflexion was significantly decreased with the increase of trunk forward lean relative to tibia during OHSA.

CONCLUSIONS

OHSA was associated with some important and dysfunction-related hip, knee and ankle kinematics. Running coaches, may use OHSA as an assessment tool before the corrective training plan to detect injury-related compensation patterns to reduce the risk of injury and improve running technique.

An Anterior Cruciate Ligament (ACL) Injury Risk Screening and Reduction Program for High School Female Athletes: A Pilot Study

Background

Anterior cruciate ligament (ACL) injury causes physical, mental, and financial burdens. Therefore, it is imperative to screen, identify, and educate athletes who are at high-risk. The combination of screening and education could identify those at risk and potentially reduce future injuries.

Purpose

The purpose was to conduct a feasible community pre-season screening program for high school female athletes for the presence of known modifiable risk factors that predispose them to sustaining a non-contact ACL injury.

Study Design

Non-experimental prospective study.

Methods

A convenience sample of 15 healthy female athletes were recruited from local high schools, consisting of 11 soccer players and four basketball players.  A pre-season screening program was designed encompassing four stations that addressed modifiable neuromuscular and biomechanical risk factors including range of motion (ROM), jump-landing technique, strength, and balance. Athletes were categorized into high-risk versus low-risk groups based on cutoff scores previously established in the literature.

Results

Every athlete met the high-risk cutoff score for at least one extremity during the ROM screening, and some met high-risk cutoff scores for more than one ROM. Out of all four categories tested, lower extremity ROM demonstrated the greatest deficits.

Conclusion

This study identified athletes as having multiple modifiable risk factors that can be addressed with training and exercises. This supports implementing a pre-season program aimed at screening for injury risk factors.

Level of Evidence

Level 3.

Moderate reliability of the lateral step down test amongst experienced and novice physical therapists

BACKGROUND/INTRODUCTION

The lateral step-down test is used to appraise movement quality in patients with patellofemoral pain (PFP), however, it is unclear if reliability of the test is affected by physical therapist experience.

OBJECTIVE

Determine if there is a difference in reliability between 'experienced' and 'novice' physical therapists appraising movement quality of patients with PFP during the lateral step-down test.

METHODS

Three 'experienced' and 3 'novice' physical therapists analyzed movement quality of 22 participants [mean age (SD) 28.25 (6.5) years] with PFP. Physical therapists viewed two-dimensional videos of participants performing the lateral step-down test and appraised the quality with a score (0-1 = 'good'; 2-3 = 'fair', and 4-5 = 'poor') at baseline and 1 week. Inter- and intra-rater reliability were calculated with kappa and percent agreement. Differences between the groups were assessed with the chi-square test with an a priori alpha level of < 0.05.

RESULTS

Inter- and intra-rater reliability ranged from fair to moderate (ĸ = 0.40-0.65). There was no difference in reliability between 'experienced' and 'novice' physical therapists at baseline (p = .13) or 1 week post testing (p = .94).

CONCLUSIONS

There was no difference in reliability between 'experienced' and 'novice' physical therapists using categories to appraise movement quality during the lateral step-down test for patients with chronic PFP.

The Results of Orthopaedic Medical Examinations in Adolescent Amateur Weightlifters

Few studies have reported injuries and physical characteristics in adolescent weightlifters. The purpose of this study was to report the results of orthopaedic medical examinations in adolescent amateur weightlifters that were performed cross-sectionally from 2012 to 2019. The orthopaedic medical examination included physical examinations, generalized joint laxity, muscle and joint tightness, static alignment, muscle volume of the lower extremities, and medial longitudinal arch of the foot (the height from the tip of the navicular tubercle to the ground surface). A questionnaire survey regarding pain in the spine and lower extremities was also performed. A total of 99 adolescent weightlifters were included (male/female, 71/28; mean age, 16.2 ± 0.2 years). A total of 9.1% had received orthopaedic treatments, with spine injuries being the most prevalent. Of those who had not received orthopaedic treatments, 31.1% had pain in the spine or lower extremities (for >4 weeks). There were no significant gender differences in the incidence of pain or positive findings of physical examinations. Female weightlifters had a more reduced dorsiflexion of the ankle joint than male weightlifters (p = 0.02). Male weightlifters had a lower flexibility of the quadriceps than female weightlifters. The results of orthopaedic medical examinations in this study may help clinicians and young weightlifters to prevent injuries in competitive weightlifting.

Ankle Joint Dorsiflexion Reference Values in Non-Injured Youth Federated Basketball Players: A Cross-Sectional Study

(1) Background: The aim of the present study was to establish ankle joint dorsiflexion reference values among youth federated basketball players. (2) Methods: Cross-sectional study. The participants were basketball players who belonged to youth basketball developmental teams (female and male) from under-12 (U12) to under-17 (U17) categories. Ankle joint dorsiflexion range of motion was evaluated with the weight-bearing lunge test through the Leg Motion system. The distance achieved was recorded in centimeters. (3) Results: 693 basketball players who met the eligibility criteria and volunteered to participate were included in the study. The mean (SD) of ankle joint dorsiflexion was 10.68 (2.44) cm and the reference values were: excessive hypomobility < 6.09 (0.54) cm; hypomobility 6.09 (0.88) cm-8.43 (0.77) cm; normal 8.44 (0.77)-13.11 (0.79) cm; hypermobility 13.11 (0.74)-15.44 (0.86) cm; and excessive hypermobility >15.44 (0.86) cm. (4) Conclusions: This study provides ankle joint dorsiflexion reference values in youth basketball players from 12 to under 17 years old.

The association and reliability of the frontal plane projection angle during the lateral step down test on knee function in patients with patellofemoral pain

BACKGROUND

The lateral step-down test is used by physical therapists (PT) to identify movement faults in patients with patellofemoral pain (PFP). The FPPA is a measure of knee valgus and PTs have access to open source video analysis software and high quality smart phones and video cameras to implement 2D video analysis into practice. The purpose of our study was to determine the reliability of PTs measuring the frontal plane projection angle (FPPA) during the lateral step-down test, and to determine if the FPPA was associated with pain, self-reported knee function and fear of movement.

METHODS

Twenty-two subjects (mean age[SD] = 27.8 [6.6] years, females n = 14, males n = 8) with PFP were analyzed by six PTs using 2D video analysis software. The FPPA was measured during the lateral step down test. Numeric Pain Rating Scale (NPRS), Anterior Knee Pain Scale (AKPS) and the Tampa Scale of Kinesiophobia (TSK) were collected. Intraclass correlation (ICC) was used to assess for PT measurement reliability. Correlations between outcomes were calculated using Spearman correlation coefficient and standard error of measurement (SEM) and minimal detectable change (MDC) were reported.

RESULTS

Reliability amongst PTs measuring the FPPA was good (ICC [95 %CI] = 0.85 [0.72-0.93]; SEM = 3.33°, MDC = 9.20°). There were no significant correlations (p > 0.05) between FPPA and NPRS(ρ = -0.046), AKPS(ρ = 0.066), or TSK(ρ = -0.204).

CONCLUSIONS

Although reliability measuring FPPA was good, the large SEM and MDC associated with this measurement may limit its clinical utility in those with PFP.

Immediate Effect of Lower-Leg Kinesio Taping on Ankle Dorsiflexion and Gait Parameters in Chronic Stroke with Foot Drop

OBJECTIVE

Kinesio taping (KT) and proprioceptive neuromuscular facilitation (PNF) are interventions mainly used in clinical settings to improve gait after stroke. Lower-leg KT using the concept of PNF (PNF-KT) has been shown to enhance the recovery of gait speed in patients with stroke. But, the effect of PNF-KT on the ankle movement and gait parameters in stroke patients is unclear. We aimed to investigate the immediate effects of PNF-KT on ankle dorsiflexion range of motion (DF-ROM) and gait parameters in patients with stroke with foot drop.

MATERIALS AND METHODS

For the A-KT condition, tape was attached to the gastrocnemius and tibialis anterior muscles, and tape for eversion was attached. In the PNF-KT condition, tape was attached to the tibialis anterior, extensor hallucis and digitorum muscles. Ankle movement was measured as the ankle DF-ROM using an iSEN system. Gait ability was assessed using the GAITRite system. The measured gait variables were gait velocity, cadence, and step length (both sides).

RESULTS

A-KT and PNF-KT significantly improved the ankle DF-ROM, gait velocity, cadence, and the affected- and unaffected-side step length compared to that with no taping. Moreover, PNF-KT significantly increased the ankle DF-ROM, gait velocity, cadence, and the affected- and unaffected-side step length compared to that with A-KT.

CONCLUSIONS

PNF-KT applied to the affect side improved ankle DF-ROM and gait parameters in hemiplegic stroke patients than no taping, A-KT. Lower-leg PNF-KT may be a useful intervention in a rehabilitation program to improve ankle DF-ROM and gait parameters in chronic stroke patients with foot drop in clinical settings.

Chronic and Residual Effects of a Two-Week Foam Rolling Intervention on Ankle Flexibility and Dynamic Balance

Background

Foam rolling has been shown to acutely improve joint range of motion (ROM). However, limited knowledge exists on the chronic and residual effects. The primary purpose of this study was to examine the chronic and residual effects of a 2-week roller–massager intervention on ankle dorsiflexion ROM and dynamic balance.

Methods

Forty-two participants (24.3 ± 2.5 years, 33 males, 9 females) were randomly assigned to either roller-massage (RM) or control group (= no intervention). Ankle ROM was assessed with the weight-bearing lunge test (WBLT) and dynamic balance with the Y-Balance test for both limbs. The RM group was instructed to roll their calf muscles for three sets of 60 s per leg on 6 days a week over 2 weeks. Acute effects were measured during baseline testing for dorsiflexion ROM and dynamic balance immediately after foam rolling. Chronic and residual effects were measured 1 day and 7 days after the intervention period. Multivariate ANOVA was performed for post-hoc comparisons to determine acute, chronic, and residual effects.

Results

Significant acute and chronic foam rolling effects (p <0.05) were found for ankle dorsiflexion ROM. The chronic increase in ROM slightly decreased 7 days post-intervention but remained significantly above baseline (p < 0.05). Regarding dynamic balance, there were no acute but chronic (p < 0.05) and residual (p < 0.05) effects.

Conclusion

Using a roller–massager for a 2-week period chronically increases ROM and dynamic balance. These increases are still significant 7 days post-intervention emphasizing the sustainability of foam rolling effects.

Immediate effect of manual therapy techniques on the limitation of ankle dorsiflexion: a randomized, controlled, blind clinical trial protocol

Background

The range of motion (RoM) of dorsiflexion (DF) plays an important role in human mobility, such as absorption of body weight during gait deceleration, jump landings, balance, and eccentric movements. This limitation can generate potentially damaging movements. This way, evaluating techniques for DF RoM increase could help improve immediate performance in such functional activities. This being the case, the objective of this study will be to verify the sum effect of different joint mobilization techniques for DF gain in persons practicing physical activities and its relationship with functional performance and balance.

Methodology

This is a randomized, controlled, and blind clinical trial. Fifty-four (54) volunteers will be recruited, aged between 18 and 40 years, who have DF limitations. After checking eligibility criteria, the participants will be submitted to a physiotherapeutic evaluation. A researcher, blind to evaluation and treatment, will perform the randomization of patients in groups: (A) Joint Mobilization - Mulligan Concept and (B) Joint Mobilization - Maitland Method. All volunteers will be submitted by two blind evaluators for randomization and treatment groups. They will realize the initial evaluation (A0), immediately after techniques (A1) and after 3–4 days of the technique application (A2). A different researcher, blind for evaluation, will perform the treatment, according to the randomization group.

Discussion

It is already known that DF RoM limitation can lead to compensatory and potentially damaging lower limb movements and that joint mobilizations are effective to treatment. However, there is no consensus whether the application of these techniques would also improve aspects of dynamic postural balance and performance in individuals practicing physical activity, and whether the sum of two joint mobilization techniques could enhance this effect.

Trial registration

Brazilian Registry of Clinical Trials (ReBEC) RBR-93xv9t. Registered on 09 April 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05858-6.

Hip and Knee Weakness and Ankle Dorsiflexion Restriction in Individuals Following Lateral Patellar Dislocation: A Case-Control Study

OBJECTIVE

To explore the relationship between ankle dorsiflexion range of motion (ROM) and hip and knee muscle strength between patients with a history of patellar dislocation (PD) to healthy controls.

DESIGN

Case-control study.

SETTING

Orthopedical specialty outpatient clinic at a tertiary hospital.

PARTICIPANTS

Eighty-eight individuals were recruited; 44 individuals aged 16 years or older, of both sexes, with a history of at least one episode of atraumatic unilateral or bilateral PD requiring emergency care (14 men; 30 women; mean age 20 years) and 44 healthy (control) individuals (11 men; 33 women; mean age 21 years) matched for age, weight, and height to PD cases.

INTERVENTION

Assessment of hip and knee strength and ankle dorsiflexion ROM.

OUTCOME MEASURES

Ankle dorsiflexion ROM was assessed through the lunge test with a goniometer. Hip and knee muscle strength was evaluated through isometric hand-held dynamometry. Differences between healthy and control individuals were assessed using Student t Tests and Mann-Whitney U Test.

RESULTS

Patellar dislocation individuals presented with a reduced ankle dorsiflexion ROM [mean difference (MD): 9 degrees; effect size (ES): 1.39; P < 0.001] and generalized hip and knee weakness (MD range: 4.74 kgf to 31.4 kgf; ES range: 0.52-2.35; P < 0.05) compared with healthy subjects.

CONCLUSION

Individuals with a history of PD have reduced ankle dorsiflexion ROM and hip and knee muscle strength compared with healthy controls.

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.

Functional Evaluation of Ankle Joint After 1-Stage Secondary Debulking Procedure After Flap Reconstruction

OBJECTIVE

Free or local flaps that are used to reconstruct the lower limb often result in poor functional outcome because of bulkiness of the flap and scar contracture over ankle joint region. The aim of this study was to evaluate the functional results of ankle joint after 1-stage secondary debulking procedure for lower limb trauma.

MATERIAL AND METHODS

From January of 2002 to October of 2018, debulking procedures were performed for 66 patients after flap reconstructions of the lower limb. Thirty-eight patients (group 1) of foot injury without ankle joint involvement and 20 patients (group 2) with ankle joint involvement were included. Range of motion (ROM) of ankle joint before and after debulking procedure was measured after 6 months of follow-up.

RESULTS

After debulking procedure, all the patients were able to dress in their preinjury shoes without any difficulty and with ease of ambulation. For all patients, with or without ankle involvement, the postdebulking ROM versus predebulking ROM improved significantly (P < 0.01). The ROM improvements for patients with ankle involvement were significantly better then patients without ankle involvement (P = 0.032).

CONCLUSIONS

One-stage debulking procedure can provide long-term constant, reliable, thin skin coverage for the lower limb after flap reconstruction with improved ankle ROM. This allows better functional results, especially for lower limb trauma patients with initial ankle involvement.

Weak Hip Strength Increases Dynamic Knee Valgus in Single-Leg Tasks of Collegiate Female Athletes

Clinical Scenario: Dynamic knee valgus (DKV) is a mechanical alteration in the knee that leads to increased risk of injury. Weakness of hip musculature in hip abduction (HABD), extension (HEXT), and external rotation (HER) may contribute to increased DKV in single-leg landing tasks. Focused Clinical Question: Is decreased hip strength associated with an increase in DKV during a single-leg landing task in collegiate female athletes? Summary of Key Findings: Three studies were included: One randomized control trial (RCT), one cohort study, and one case-control. All three studies found that decreases in HABD and HER strength contributed to increased DKV during single-leg landing tasks. One study also found that the hip extensors contribute to controlling hip adduction, a common factor in many mechanisms of injuries. These three studies recommended strengthening HABD, HEXT, and HER to decrease DKV and reduce the risk of injury at the knee. Clinical Bottom Line: Weak HABD, HEXT, and HER contribute to increased DKV in college female athletes, but strengthening HABD, HEXT, and HER can lead to decreases in DKV and, overall, reduce the risk of injury at the knee. Strength of Recommendation: These articles were graded with a level of evidence of III or higher, giving a grade of B strength of recommendation that weak HABD, HEXT, and HER are associated with increased DKV in collegiate female athletes.

Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing

BACKGROUND

Restricted ankle dorsiflexion range of motion (DFROM) has been linked to lower extremity biomechanics that place an athlete at higher risk for injury. Whether reduced DFROM during dynamic movements is due to restrictions in joint motion or underutilization of available ankle DFROM motion is unclear.

HYPOTHESIS

We hypothesized that both lesser total ankle DFROM and underutilization of available motion would lead to high-risk biomechanics (ie, greater knee abduction, reduced knee flexion).

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Nineteen active female athletes (age, 20.0 ± 1.3 years; height, 1.61 ± 0.06 m; mass, 67.0 ± 10.7 kg) participated. Maximal ankle DFROM (clinical measure of ankle DFROM [DF-CLIN]) was measured in a weightbearing position with the knee flexed. Lower extremity biomechanics were measured during a drop vertical jump with 3-dimensional motion and force plate analysis. The percent of available DFROM used during landing (DF-%USED) was calculated as the peak DFROM observed during landing divided by DF-CLIN. Univariate linear regressions were performed to identify whether DF-CLIN or DF-%USED predicted knee and hip biomechanics commonly associated with injury risk.

RESULTS

For every 1.0° less of DF-CLIN, there was a 1.0° decrease in hip flexion excursion (r² = 0.21, P = 0.05), 1.2° decrease in peak knee flexion angles (r² = 0.37, P = 0.01), 0.9° decrease in knee flexion excursion (r² = 0.40, P = 0.004), 0.002 N·m·N^-1·cm^-1 decrease in hip extensor work (r² = 0.28, P = 0.02), and 0.001 N·m·N^-1·cm^-1 decrease in knee extensor work (r² = 0.21, P = 0.05). For every 10% less of DF-%USED, there was a 3.2° increase in peak knee abduction angles (r² = 0.26, P = 0.03) and 0.01 N·m·N^-1·cm^-1 lesser knee extensor work (r² = 0.25, P = 0.03).

CONCLUSION

Lower levels of both ankle DFROM and DF-%USED are associated with biomechanics that are considered to be associated with a higher risk of sustaining injury.

CLINICAL RELEVANCE

While total ankle DFROM can predict some aberrant movement patterns, underutilization of available ankle DFROM can also lead to higher risk movement strategies. In addition to joint specific mobility training, clinicians should incorporate biomechanical interventions and technique feedback to promote the utilization of available motion.

Acute Effects of Gastrocnemius/Soleus Self-Myofascial Release Versus Dynamic Stretching on Closed-Chain Dorsiflexion

CONTEXT

Limited ankle dorsiflexion (DF) range of motion has been correlated with decreased flexibility of the gastrocnemius/soleus complex. Decreased ankle DF range of motion can lead to an increase in lower-extremity injuries, for example, acute ankle sprains, Achilles tendinopathy.

OBJECTIVE

The purpose of this study was to determine whether a single application of the intervention to the gastrocnemius/soleus complex via multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques acutely improved ankle DF.

DESIGN

Subjects were assigned to groups via random card selection. Investigators provided verbal cues as needed to yield correct performance of interventions. Both interventions were performed twice for 1 minute using a dynamic walking rest of 30.48 m at a self-selected pace between interventions. Statistical analyses were completed using a 1-way analysis of variance, at α level ≤ .05.

SETTING

A convenience sample study.

PARTICIPANTS

A total of 42 asymptomatic physical therapy students (18 females and 24 males) with mean age of 26.12 (4.03) years volunteered to participate.

INTERVENTIONS

Multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques.

MAIN OUTCOME MEASURES

Weight-bearing right ankle DF measurements were recorded in centimeters using a forward lunge technique (intraclass correlation coefficient = .98, .97, and .96).

RESULTS

Data analysis revealed no significant difference between the 3 groups in all pre-post measurements (P = .82). Mean (SD) measurements from pretest to posttest for myofascial release, dynamic stretching, and combination interventions were 0.479 (0.7) cm, 0.700 (0.7) cm, and 0.907 (1.4) cm, respectively.

CONCLUSION

Until further studies are conducted, the selection of technique to increase ankle DF range of motion should be based on each individual patient's ability, preference, and response to treatment.

Lower Extremity Kinematics of the Y-Balance Test in Healthy and ACL Injured Adolescent Females

BACKGROUND

Adolescent females are at significant risk for sustaining an ACL injury. The Y-Balance Test (YBT) is frequently used to evaluate neuromuscular control and lower extremity function. However, few studies have quantified 2D lower extremity kinematics during performance of the YBT, and there is an absence of kinematic data specific to at-risk adolescent females.

PURPOSE

To examine lower extremity joint kinematics during execution of the YBT by healthy and ACL-injured adolescent females.

STUDY DESIGN

Prospective cohort.

METHODS

Twenty-five healthy and ten ACL-injured (mean time from injury 143 days) adolescent females were assessed using the YBT. Sagittal and frontal plane knee and ankle motion was video recorded during execution of the YBT anterior reach movement. Ankle dorsi-flexion, knee flexion, and knee valgus angles were quantified via kinematic analysis. ANOVAs with a post hoc Bonferroni correction were used to compare YBT scoring (%LL) and kinematic data between groups. Pearson product-moment correlations determined the relationship between kinematic data and YBT scoring.

RESULTS

Healthy and ACL-injured subjects demonstrated similar YBT scores and lower extremity kinematic data. Healthy subjects demonstrated a weak positive correlation between ankle dorsiflexion and YBT scoring, and a weak negative correlation between knee valgus and YBT scoring. These relationships did not exist for ACL-injured subjects. Kinematic data for both groups also demonstrated a large degree of variability, regardless of YBT score.

CONCLUSIONS

Adolescent females frequently utilize a variety of lower extremity movement strategies when performing a functional movement task, and scoring on the YBT offers limited insight regarding lower extremity joint kinematics and ACL-injury risk in a physically active adolescent female population.

LEVEL OF EVIDENCE

Level 3.

The Dorsiflexion Range of Motion Screen: A Validation Study

BACKGROUND

Limited ankle dorsiflexion (DF) is associated with ankle sprains and other lower extremity injuries. Current ankle measurements can be laborious to perform in an athletic environment.

PURPOSE

The purpose of this study was to determine the reliability and discriminant validity of a novel closed-chain ankle DF ROM test, the standing ankle dorsiflexion screen (SADS).

STUDY DESIGN

Reliability and validity study.

METHODS

Thirty-seven healthy subjects participated in the study. Two raters measured closed-chain ankle DF range of motion (ROM) using a modified lunge position with an electronic inclinometer. Four raters measured ankle DF using the SADS. Reliability was calculated using intraclass correlation coefficients (ICC) and kappa coefficients for the raters using an electronic inclinometer and the SADS scale, respectively. An independent t-test compared the SADS categories of "behind" and "beyond" to the modified lunge test ROM (p<0.05).

RESULTS

Excellent ICC values (0.95 [95% CI (0.92,0.97)]) and high kappa values were observed (0.61-0.81), with high percent agreement (86-94%). There was a significant difference in ankle DF ROM between the nominally scored "behind" and "beyond" categories, regardless of rater or trial analyzed (behind: 41.3° ± 4.7°; beyond: 51.8°± SD 6.1°, p <0.001).

CONCLUSIONS

The SADS was observed to have excellent interrater reliability and high discriminant validity. Furthermore, there was a distinct closed chain ankle DF ROM difference between the "behind" and "beyond" SADS nominal scores.

CLINICAL RELEVANCE

The SADS can be used as a quick and efficient closed chain ankle DF ROM screen.

LEVEL OF EVIDENCE

2b.

Relationship between the Lower Limb Function and Shoulder and Elbow Injuries in Elementary School Baseball Pitchers

Objectives

We aimed to examine the relationship between the hip range of motion (ROM) and ankle ROM and throwing-related shoulder and elbow injuries in elementary school baseball pitchers.

Methods

This retrospective comparative study (Level of evidence: Level III) included 195 baseball pitchers (mean age 10.8±1.0 years, range 8-12 years). All pitchers underwent physical function measurements, including height, weight, shoulder strength, and hip and ankle ROM. Shoulder and elbow injury was defined as shoulder and elbow pain that the pitchers had been aware of in the past or at the time of medical checkups. The results for the injured and non-injured groups were then compared.

Results

The shoulder ROM and strength in the injured and non-injured groups did not differ to a statistically significant extent. The hip external rotation on the dominant side (injured vs. non-injured: 48.9±11.1° vs. 53.3±9.7°, P<0.01), the hip internal rotation on the non-dominant side (injured vs. non-injured: 36.6±12.0° vs. 40.9±11.0°, P=0.01), and ankle plantar flexion on the non-dominant side (injured vs. non-injured: 52.0±6.8° vs. 54.3±6.7°, P=0.02) were significantly smaller in the injured group than in the non-injured group.

Conclusions

The hip external rotation ROM on the dominant side and the hip internal rotation and ankle plantar flexion on the non-dominant side were significantly lower in the injured group than in the non-injured group. These results may suggest measures to reduce the incidence of elbow and shoulder injuries in elementary school baseball pitchers.

Simple verbal instructions are able to improve quality of movement during the lateral step-down test in healthy females

INTRODUCTION

Altered movement patterns during weight-bearing activities have been associated with knee injuries and can be clinically assessed using the lateral step-down test (LSD). It is possible that verbal feedback can improve movement patterns, but it remains unknown whether verbal feedback can improve movement quality during the LSD.

PURPOSE

To investigate whether verbal feedback can immediately improve visual movement quality and trunk, pelvis and lower limb kinematics in healthy females during the LSD.

METHODS

34 healthy females were assessed visually and with 3D kinematics while performing the LSD. Participants were divided into Good Movement Group (GG; n = 18) and Poor Movement Group (PG; n = 16) based on the LSD score. The feedback involved verbal instructions aimed at improving trunk, pelvis, hip and knee alignment during the test. Lower limb flexibility and strength were assessed for group comparisons and to investigate associations between all variables. Data analyses were performed using repeated-measures two-way ANOVAs and Spearman correlation tests.

RESULTS

Feedback immediately improved movement quality, especially in participants of the GG [mean difference (MD) = 2.2 points; P < 0.001]. The PG showed greater pelvic drop (MD = 5.1°; P = 0.012), greater hip adduction (MD = 5.4°; P = 0.028) and less hip flexion (MD = 8.4°; P = 0.016) than the GG. Quality of movement had positive correlations with pelvic drop (r = 0.39; P = 0.02), hip adduction (r = 0.45; P = 0.01) and hip flexion (r = 0.49; P < 0.01) kinematics.

CONCLUSIONS

Verbal feedback improved movement quality during the LSD in healthy females. Females with worst movement quality showed greater pelvic drop and hip adduction, which are often found in individuals with knee disorders.

A novel single-leg squat test with speed and accuracy requirements: Reliability and validity in anterior cruciate ligament reconstructed individuals

BACKGROUND

Some traditional single-leg squat tests focused on number of repetitions may not demand precise control of lower limb dynamic alignment, especially in the frontal and transverse planes. The primary objective of this study was to evaluate test-retest reliability and construct validity of a novel single-leg squat test - the 'precision-squat test' (PST) - designed to assess performance under varying task demands that can impact the execution of lower limb movements. A secondary objective was to investigate whether musculoskeletal factors predict performance in the PST in healthy individuals.

METHODS

Thirty healthy participants were assessed to verify test-retest reliability. To verify the test's construct validity, we compared the performance of 21 anterior cruciate ligament reconstructed (ACLR) individuals and 21 matched controls. Finally, 36 healthy individuals were assessed to verify the musculoskeletal factors related to PST performance. All participants performed the PST: they executed single-leg squats while moving a laser pointer (attached to the thigh) between two targets. We varied target size and distance between targets to manipulate the task difficulty.

RESULTS

Reliability of the PST was excellent at all demand levels (intraclass correlation coefficient (ICC)_(3,2) > 0.93). Squat time increased under test conditions involving higher task difficulty (P < 0.001) and in ACLR individuals compared with age-matched controls (P < 0.05). Regression analyses revealed that reduced knee extensors and hip external rotators torques are related to increased squat time (P < 0.05).

CONCLUSIONS

PST is a valid and reliable tool to assess performance of healthy and ACLR individuals. In addition, hip and knee strength are associated with performance during the test.

Influência da ventosaterapia sobre o limiar de dor a pressão e flexibilidade muscular da cadeia posterior de membro inferior em atletas de futebol

RESUMO O objetivo deste estudo é avaliar o limiar de dor à pressão (LDP) e flexibilidade pré e pós-protocolo de ventosaterapia em toda cadeia muscular posterior do membro inferior de atletas de futebol masculino. O estudo é de intervenção de múltiplos casos, com um grupo submetido a um protocolo de ventosaterapia em região posterior de membro inferior nos trilhos anatômicos, mensurando-se a flexibilidade de flexão de quadril (FQ), extensão de joelho (EJ) e dorsiflexão de tornozelo (DT) e o LDP nos pontos gatilhos miofasciais de toda a cadeia posterior, pré e pós-intervenção no primeiro e quarto dia de coleta. A amostra foi composta por 20 atletas, sendo quatro recusas e duas perdas no decorrer do estudo, finalizando o estudo com 16 atletas no momento agudo imediato (n=32) e 14 atletas no momento agudo tardio (n=28). Para análise estatística utilizou-se o teste t-student para amostras pareadas e o nível de significância de p<0,05. Houve diferença estatística significativa no momento agudo tardio no pré e pós-intervenção para as variáveis EJ e DT, demonstrando aumento da flexibilidade após o protocolo. Conclui-se que a intervenção sobre os trilhos anatômicos em região posterior de membro inferior é capaz de aumentar a flexibilidade, porém não diminui LDP.

Static Ankle Dorsiflexion and Hip and Pelvis Kinematics During Forward Step-Down in Patients With Hip-Related Groin Pain

CONTEXT

The authors hypothesized that in people with hip-related groin pain, less static ankle dorsiflexion could lead to compensatory hip adduction and contralateral pelvic drop during step-down. Ankle dorsiflexion may be a modifiable factor to improve ability in those with hip-related groin pain to decrease hip/pelvic motion during functional tasks and improve function.

OBJECTIVE

To determine whether smaller static ankle dorsiflexion angles were associated with altered ankle, hip, and pelvis kinematics during step-down in people with hip-related groin pain.

DESIGN

Cross-sectional Setting: Academic medical center.

PATIENTS

A total of 30 people with hip-related groin pain (12 males and 18 females; 28.7 [5.3] y) participated.

INTERVENTION

None.

MAIN OUTCOME MEASURES

Weight-bearing static ankle dorsiflexion with knee flexed and knee extended were measured via digital inclinometer. Pelvis, hip, and ankle kinematics during forward step-down were measured via 3D motion capture. Static ankle dorsiflexion and kinematics were compared with bivariate correlations.

RESULTS

Smaller static ankle dorsiflexion angles were associated with smaller ankle dorsiflexion angles during the step-down for both the knee flexed and knee extended static measures. Among the total sample, smaller static ankle dorsiflexion angle with knee flexed was associated with greater anterior pelvic tilt and greater contralateral pelvic drop during the step-down. Among only those who did not require a lowered step for safety, smaller static ankle dorsiflexion angles with knee flexed and knee extended were associated with greater anterior pelvic tilt, greater contralateral pelvic drop, and greater hip flexion.

CONCLUSIONS

Among those with hip-related groin pain, smaller static ankle dorsiflexion angles are associated with less ankle dorsiflexion motion and altered pelvis and hip kinematics during a step-down. Future research is needed to assess the effect of treating restricted ankle dorsiflexion on quality of motion and symptoms in patients with hip-related groin pain.

Changes in Knee and Trunk Alignment in People With Hip Pain and Healthy Controls When Using a Decline Board During Single-Leg Squat

Context: Hip pain is associated with reduced hip muscle strength, range of movement (ROM), and decreased postural stability. Single-leg squat is a reliable and valid method to measure dynamic balance. Objective: To evaluate the influence of physical characteristics and use of a decline board on squat performance in a hip pain population. Design: Cross-sectional study setting. Clinical Patients: In total, 33 individuals scheduled for arthroscopic hip surgery were matched with 33 healthy controls. Interventions: Hip and ankle ROM, hip strength, and trunk endurance were assessed, along with knee and trunk kinematics during squat on flat and 25° decline surfaces. Main Outcome Measures: Between-group and surface differences in alignment, between-group strength and ROM, and associations between alignment and physical characteristics were assessed and determined using mixed model analysis of variance and Pearson R. Results: The hip pain group had significantly less strength and ROM for all directions except abduction strength and ankle dorsiflexion (P > .02). No differences existed between the 2 groups for trunk (P < .70) or knee displacement (P < .46) during squat on either surface. When the 2 groups were combined (n = 66), decline squat significantly reduced knee medial displacement in both limbs by approximately 1 cm (P < .01). Decline squat reduced trunk lateral movement on 1 side only (P = .03). Reduced knee displacement during decline squat showed fair association with less hip-extension strength (r = −.29), hip-flexion strength (r = −.25), and less dorsiflexion (r = −.24). Strength and range were not associated with trunk displacement. Conclusions: Decline squat reduced medial knee and lateral trunk displacement regardless of hip pain. Reductions may be greater in those with lesser hip muscle strength and dorsiflexion. Use of a decline board during squat for improving knee and trunk alignment should be considered as a goal of exercise intervention.

Effects of two exercise programmes on joint position sense, dynamic balance and countermovement jump in male amateur football players. A randomised controlled trial

Introduction: The injury prevention and warm-up exercises programmes improve physical performance and injury ratio, but it is poorly investigated in amateur football. Objectives: To assess the effects of two warm-up multi-station programmes (IAI-Programme and FIFA11+) through JPS, LSDT and CMJ. Study design: Randomised controlled trial. Methods: 36 football players were randomised into 2 groups: IAI-Programme (n = 18) and FIFA11+ (n = 18) and performed the intervention protocol for 6 weeks. JPS, LSDT and CMJ were measured at baseline, after 6, 10 and 18 weeks (from baseline). The inter-group and intra-group differences were assessed by repeated-measures analysis of variance test (ANOVA). Results: Significant differences between groups were found after 18 weeks in the absolute angular error (-2.18[-4.33,-0.047], d = 0.69, p < 0.05) of the JPS and in the CMJ (p = 0.001, ŋ²p=,0.298) in favour of IAI-Programme when compared to FIFA11 +. No significant differences between groups were found in the LSDT. There were also intra-group differences observed in the LSDT in both groups. Conclusions: IAI-Programme can provide sensitive benefits with respect to the proprioceptive ability of knee flexion and CMJ than FIFA11 +. Both IAI-Programme and FIFA11+ present improvements in the dynamic postural control measured by the LSDT.

Effects of neuromuscular training on pain intensity and self-reported functionality for patellofemoral pain syndrome in runners: study protocol for a randomized controlled clinical trial

BACKGROUND

Patellofemoral pain syndrome (PFPS) is common and affects approximately 15% of individuals at different ages and activity levels. As a non-surgical intervention, physiotherapy is widely used to treat PFPS. Neuromuscular training exercise is one of the most effective methods for decreasing musculoskeletal pain and improving knee function. However, the effectiveness of neuromuscular training exercise for treating PFPS is not without argument. The purpose of this study is to evaluate the effect of neuromuscular training exercise on patellofemoral pain and whether the neuromuscular training exercise have more advantage effects than taping and health education.

METHODS

We will operate a prospective, single-blind, randomized controlled trial of 60 patients with patellofemoral pain. Individuals will be indiscriminately assigned to two intervention groups and a health education group. The neuromuscular training exercise which includes the muscle strength training, balance training and knee joint proprioception training, and taping group will use "Y" and "I" type taping on the participants three times a week for three months. The health education group will be given education lectures once each week and which last for three months. The primary outcome measures include the adverse events, visual analog scale for pain, and Anterior Knee Pain Scale Index, which is a knee function self-report questionnaire to evaluate the function of the knee especially for PFPS patients. The secondary outcome measures are the muscle strength and endurance of knee joint flexion and extensor muscles, knee joint proprioception, muscle thickness of the quadriceps femoris, knee function ability, and quality of life. We will manage the intention-to-treat analysis for individuals who will withdraw from this study.

DISCUSSION

According to previous studies, neuromuscular training exercise and the taping method are effective treatment for PFPS patients. In this study, we will perform a neuromuscular training exercise for patients with PFPS. We believe that this study may prove the effectiveness of neuromuscular training exercise in treating PFPS.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1800014995 . Registered on 27 February 2018.

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.

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

External ankle taping does not alter lower extremity side-step cut and straight sprint biomechanics in young adult males

Lateral ankle sprains (LAS) are one of the most common musculoskeletal injuries and as a response, clinicians often use external ankle taping prophylactically to reduce the prevalence of injuries. External ankle taping techniques have been shown to significantly reduce passive ankle range of motion; however, there is limited research on the effects of external ankle taping on lower extremity kinematics or kinetics during sport specific tasks. Therefore, our objective was to compare the effects of external ankle taping on ankle, knee and hip kinematics and kinetics compared to no taping during an anticipated sidestep cutting task and a straight sprint task. We conducted a cross-over laboratory study with 16 healthy males. Three-dimensional kinematics and kinetics were collected with a motion capture system and in-ground force plate during 5 trials of a sprint and anticipated side-step cut with or without external ankle taping. Group means and associated 90% confidence intervals were plotted across 100 data points for each task, significance being identified when the confidence intervals did not overlap for three consecutive data points. No significant kinetic or kinematic differences were identified between conditions for the tasks. External ankle taping does not influence lower extremity biomechanics during a control cutting task.

Agreement Between Visual Assessment and 2-Dimensional Analysis During Jump Landing Among Healthy Female Athletes

CONTEXT

  Altered movement patterns, including increased frontal-plane knee movement and decreased sagittal-plane hip and knee movement, have been associated with several knee disorders. Nevertheless, the ability of clinicians to visually detect such altered movement patterns during high-speed athletic tasks is relatively unknown.

OBJECTIVE

  To explore the association between visual assessment and 2-dimensional (2D) analysis of frontal-plane knee movement and sagittal-plane hip and knee movement during a jump-landing task among healthy female athletes.

DESIGN

  Cross-sectional study.

SETTING

  Gymnasiums of participating volleyball teams.

PATIENTS OR OTHER PARTICIPANTS

  A total of 39 healthy female volleyball players (age = 21.0 ± 5.2 years, height = 172.0 ± 8.6 cm, mass = 64.2 ± 7.2 kg) from Divisions I and II of the Israeli Volleyball Association.

MAIN OUTCOME MEASURE(S)

  Frontal-plane knee movement and sagittal-plane hip and knee movement during jump landing were visually rated as good, moderate, or poor based on previously established criteria. Frontal-plane knee excursion and sagittal-plane hip and knee excursions were measured using free motion-analysis software and compared among athletes with different visual ratings of the corresponding movements.

RESULTS

  Participants with different visual ratings of frontal-plane knee movement displayed differences in 2D frontal-plane knee excursion ( P < .01), whereas participants with different visual ratings of sagittal-plane hip and knee movement displayed differences in 2D sagittal-plane hip and knee excursions ( P < .01).

CONCLUSIONS

  Visual ratings of frontal-plane knee movement and sagittal-plane hip and knee movement were associated with differences in the corresponding 2D hip and knee excursions. Visual rating of these movements may serve as an initial screening tool for detecting altered movement patterns during jump landings.

The association of visually-assessed quality of movement during jump-landing with ankle dorsiflexion range-of-motion and hip abductor muscle strength among healthy female athletes

OBJECTIVE

To explore the association between ankle dorsiflexion (DF) range of motion (ROM), and hip abductor muscle strength, to visually-assessed quality of movement during jump-landing.

DESIGN

Cross-sectional.

SETTING

Gymnasium of participating teams.

PARTICIPANTS

37 female volleyball players.

MAIN OUTCOME MEASURES

Quality of movement in the frontal-plane, sagittal-plane, and overall (both planes) was visually rated as "good/moderate" or "poor". Weight-bearing Ankle DF ROM and hip abductor muscle strength were compared between participants with differing quality of movement.

RESULTS

Weight-bearing DF ROM on both sides was decreased among participants with "poor" sagittal-plane quality of movement (dominant side: 50.8° versus 43.6°, P = .02; non-dominant side: 54.6° versus 45.9°, P = .01), as well as among participants with an overall "poor" quality of movement (dominant side: 51.8° versus 44.0°, P < .01; non-dominant side: 56.5° versus 45.1°, P < .01). Weight-bearing ankle DF on the non-dominant side was decreased among participants with a "poor" frontal-plane quality of movement (53.9° versus 46.0°, P = .02). No differences in hip abductor muscle strength were noted between participants with differing quality of movement.

CONCLUSIONS

Visual assessment of jump-landing can detect differences in quality of movement that are associated with ankle DF ROM. Clinicians observing a poor quality of movement may wish to assess ankle DF ROM.