Weight-bearing ankle dorsiflexion range of motion-can side-to-side symmetry be assumed?

Retracted Article: Validity and Reliability of Sensor-based Measures of Lower Limb Range of Motion in Soccer Players: a Cross-sectional Study

Ein Defizit der Beweglichkeit gilt als Risikofaktor für Verletzungen der unteren Extremität im Fußball. Zur Messung des Bewegungsausmaßes (Range of Motion [ROM]) eines Gelenks werden analoge Goniometer verwendet. Zunehmend entwickelte sensorbasierte Verfahren wurden hinsichtlich ihrer Testgüte noch nicht hinreichend untersucht. Ziel dieser Studie war die Bestimmung der Übereinstimmungsvalidität sowie der Intratester- und Intertester-Reliabilität sensorbasierter Messungen des Bewegungsumfangs der unteren Extremität bei Fußballspielern. 36 beschwerdefreie Amateurfußballer (Alter: 26,3 ± 4,7 Jahre) wurden in die Studie eingeschlossen. Aus 5 Physiotherapeuten wurden 3 zufällig bestimmt, um die Messungen durchzuführen. Zwei Tester führten die Messungen (1. ROM Knie aus Langsitz; 2. Streckdefizit Knie aus Langsitz; 3. ROM Knie aus Stand; 4. ROM Sprunggelenk Dorsalextension [DE] während Ausfallschritt; 5. ROM Sprunggelenk Plantarflexion [PF] aus Sitz auf dem Stuhl) mit dem digitalen Sensor durch (Index-Test). Der 3. Tester übernahm die Messungen mit dem analogen Goniometer nach Neutral-Null-Methode mit den Probanden in Rückenlage (Referenzstandard). Zur statistischen Analyse wurden der Pearson-Korrelationskoeffizient r, Bland-Altman-Analysen (BAA) und der Intraklassenkorrelationskoeffizient (ICC) verwendet (p ≤ 0,05). Nur bei den Messungen 4 und 5 zeigten sich in der BAA akzeptable mittlere Differenzen von 8,4° (DE) und −10,2° (PF). Bei Messung 1 lag eine moderate Korrelation (r = 0,582) vor. Die sensorbasierten Messungen des Bewegungsumfangs des Knie- und Sprunggelenks wiesen eine exzellente Intra- und Intertesterreliabilität auf (ICC = 0,949–0,986; ICC = 0,895–0,968). Mit dem hier verwendeten etablierten Referenzstandard zeigten sie jedoch nur eine eingeschränkte Übereinstimmung, was mit den unterschiedlichen Ausgangspositionen von Index-Test und Referenzstandard erklärt werden kann.

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

Background

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

Hypothesis/Purpose

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

Study Design

Cross-Sectional Study.

Methods

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

Results

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

Conclusion

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

Level of Evidence

2b.

Differences and relationships between weightbearing and non-weightbearing dorsiflexion range of motion in foot and ankle injuries

BACKGROUND

This study aimed to: (1) identify assessment methods that can detect greater ankle dorsiflexion range of motion (DROM) limitation in the injured limb; (2) determine whether differences in weightbearing measurements exist even in the absence of DROM limitations in the injured limb according to non-weightbearing measurements; and (3) examine associations between DROM in the weightbearing and non-weightbearing positions and compare those between a patient group with foot and ankle injuries and a healthy group.

METHODS

Eighty-two patients with foot and ankle injuries (e.g., fractures, ligament and tendon injuries) and 49 healthy individuals participated in this study. Non-weightbearing DROM was measured under two different conditions: prone position with knee extended and prone position with knee flexed. Weightbearing DROM was measured as the tibia inclination angle (weightbearing angle) and distance between the big toe and wall (weightbearing distance) at maximum dorsiflexion. The effects of side (injured, uninjured) and measurement method on DROM in the patient groups were assessed using two-way repeated-measures ANOVA and t-tests. Pearson correlations between measurements were assessed. In addition, we analyzed whether patients without non-weightbearing DROM limitation (≤ 3 degrees) showed limitations in weightbearing DROM using t-tests with Bonferroni correction.

RESULTS

DROM in patient groups differed significantly between legs with all measurement methods (all: P < 0.001), with the largest effect size for weightbearing angle (d = 0.95). Patients without non-weightbearing DROM limitation (n = 37) displayed significantly smaller weightbearing angle and weightbearing distance on the injured side than on the uninjured side (P < 0.001 each), with large effect sizes (d = 0.97-1.06). Correlation coefficients between DROM in non-weightbearing and weightbearing positions were very weak (R = 0.17, P = 0.123) to moderate (R = 0.26-0.49, P < 0.05) for the patient group, and moderate to strong for the healthy group (R = 0.51-0.69, P < 0.05).

CONCLUSIONS

DROM limitations due to foot and ankle injuries may be overlooked if measurements are only taken in the non-weightbearing position and should also be measured in the weightbearing position. Furthermore, DROM measurements in non-weightbearing and weightbearing positions may assess different characteristics, particularly in patient group.

LEVEL OF EVIDENCE

Level IV, cross-sectional study.

Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof-of-concept RCT

INTRODUCTION

People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs.

DESIGN AND METHODS

Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1st MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance.

RESULTS

At T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%).

CONCLUSIONS

Combining ankle and 1st MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk.

TRIAL REGISTRATION

https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03195855 .

Effectiveness of the Rehabilitation Training Combined with Maitland Mobilization for the Treatment of Chronic Ankle Instability: A Randomized Controlled Trial

The study aims to determine whether routine rehabilitation training combined with the Maitland mobilization is more effective than routine rehabilitation training alone in patients with chronic ankle instability, intending to provide a novel rehabilitation strategy for chronic ankle instability. A total of 48 subjects were divided into three groups: EG (Maitland mobilization and routine rehabilitation), CG (routine rehabilitation), and SG (sham mobilization and routine rehabilitation). The intervention was performed three times each week for 4 weeks, for a total of 12 sessions. Before and after the intervention, the muscle strength, star excursion balance test (SEBT), weight-bearing dorsiflexion range of motion (WB-DFROM), ankle range of movement, Cumberland ankle instability tool (CAIT), self-comfort visual analog scale (SCS-VAS), and self-induced stability scale (SISS-VAS) were assessed. The results showed that the improvement of SEBT, WB-DFROM, and active ankle range of movement without the pain in EG was more obvious than CG and SG, but the improvement of the self-report of ankle severity and muscle strength was not. Compared with routine rehabilitation training alone, routine rehabilitation training combined with Maitland mobilization for patients with chronic ankle instability may provide more benefit in terms of balance and ankle range of movement than routine rehabilitation alone, but the improvement in muscle strength was not evident enough.

Reliability of the weight-bearing ankle dorsiflexion range of motion measurement using a smartphone goniometer application

Background

Weight-bearing ankle dorsiflexion range of motion measurement (weight-bearing lunge test) is gaining in popularity because it mimics lower extremity function in daily physical activities. The purpose of the study is to assess the intra-rater and the inter-rater reliability of the weight-bearing ankle dorsiflexion range of motion measurement with a flexed knee using a smartphone application Spirit Level Plus installed on an Android smartphone.

Methods

Thirty-two young, healthy subjects participated in the study and were measured in four sessions by two examiners. One measurement was taken on each ankle in every session. Eight measurements were taken from each participant. A total of 256 were taken from all the participants. The measurements for the individual subject were repeated no sooner than 24 hours after the first session. In order to assess the reliability, intraclass correlation coefficients (ICC), standard error measurements (SEM) and minimal detectable change (MDC) at the 95% confidence interval were calculated.

Results

Statistical data analysis revealed moderate intra-rater reliability for the right ankle (ICC = 0.72, 95% CI [0.49–0.85]) and good intra-rater reliability for the left ankle (ICC = 0.82, 95% CI [0.66–0.91]). Inter-rater reliability is moderate for the right (ICC = 0.73, 95% CI [0.52–0.86]) and the left ankle (ICC = 0.65, 95% CI [0.39–0.81]).

Conclusion

The observed method is moderately reliable and appropriate when the main objective is to assess ankle dorsiflexion mobility in weight-bearing when weight-bearing is not contraindicated. The concurrent validity of the Spirit Level Plus application is excellent.

Effects of the Suboccipital Muscle Inhibition Technique on the Range of Motion of the Ankle Joint and Balance According to Its Application Duration: A Randomized Controlled Trial

This study aimed to investigate the effects of suboccipital muscle inhibition technique (SMIT) on active range of motion (AROM) of the ankle joint, lunge angle (LA), and balance in healthy adults, according to the duration of its application. A total of 80 participants were randomly allocated to the 4-min suboccipital muscle inhibition (SMI) group (SMI_4M, n = 20), 8-min SMI group (n = 20), 4-min sham-SMI (SSMI) group (n = 20), and 8-min SSMI group (n = 20). Accordingly, the SMIT and sham SMIT were applied for 4 min or 8 min in the respective groups. AROM of dorsiflexion and LA were assessed, and a single leg balance test (SLBT) was performed before and after the intervention. AROM (4 min, p < 0.001; 8 min, p < 0.001), LA (4 min, p < 0.001; 8 min, p < 0.001), and SLBT (4 min, p < 0.001; 8 min, p < 0.001) significantly improved after SMI application. Compared with the SSMI group, the SMI group showed a significant increase in AROM (p < 0.001), LA (p < 0.001), and SLBT (p < 0.001). Except for SLBT (p = 0.016), there were no significant interactions between intervention and application duration. The results suggest that the SMIT, at durations of both 4 and 8 min, could be effective tools for improving AROM, LA, and balance.

Structural Integration Case Report: a Global Intervention Challenging the Limitations of Local Rehabilitation

BACKGROUND

Conventional rehabilitation for musculoskeletal injuries post-surgery is generally site-specific and aims to return the person to 'normal' function. Commonly, conventional treatment focuses locally and little or no attention is given to comorbidities, other symptoms, postural compensations, or adaptations either pre-existing or resulting from the injury. Structural Integration (SI) is a manual therapy applied to and focusing on fascial continuities throughout the whole body. This case report explores SI as a global, whole-body intervention for rehabilitation.

PURPOSE

To examine the effects of a whole-body approach that addresses local and global symptoms following ankle surgery.

METHODS

The Anatomy Trains Structural Integration (ATSI formerly KMI) 12-series protocol was applied and a selection of outcome measures were used to track progress and assess the efficacy of SI. Ankle mobility and function was assessed primarily using Weight-Bearing Lunge Test and Lower Extremity Functional Scale. Local pain was reported using the McGill Pain Questionnaire. General well-being was evaluated using subjective questioning and the WHO Quality of Life Questionnaire.

RESULTS

Local results included increased mobility and function to affected leg, and reduced pain and swelling. Global results included an improvement in physical and psychological well-being, with the reduction of pain and dysfunction in other areas.

CONCLUSION

This case report demonstrates global benefits of a whole-body approach when structural integration is applied during rehabilitation. More clinical research that includes SI is needed to determine if the local and global results shown in this case study can be demonstrated in additional rehabilitation populations.

Video-based biomechanical analysis of an unexpected Achilles tendon rupture in an Olympic sprinter

We used image-processing techniques to determine the moment (i.e., image frame) of the Achilles tendon (AT) rupture in an Olympic sprinter. This report may be unique due to the difficulty in conducting motion capture analyses during injury events. Our report includes one female Olympic sprinter, 29 years old (body mass: 56 kg, height: 1.68 m, and body mass index: 19.8 kg/m²) with a high-competitive profile history (2008 and 2012 Olympic Games participation; South American record holder in 100- and 200-m; Pan-American gold medalist in 200-m and 4 × 100-m relay) who suffered a complete AT rupture in the left leg while exercising in the final phase of rehabilitation following an Achilles tendinopathy in the contralateral limb. The greater dorsiflexion found at the moment of the injury and the delayed control of heel position indicated the presence of uncontrolled dorsiflexion, which potentially generated excessive eccentric stress over the tendon and, thus, the AT rupture. Here we discuss the relevance of lower leg alignment, the movements' characteristics, and the history of Achilles tendinopathy in the contralateral leg on the occurrence of the AT rupture.

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

OBJECTIVES

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

DESIGN

Randomised, repeated measures design.

SETTING

Sports clubs.

PARTICIPANTS

52 athletes participating in cutting and pivoting sports.

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

WITHIN-SESSION RELIABILITY FOR INTER-LIMB ASYMMETRIES IN ANKLE DORSIFLEXION RANGE OF MOTION MEASURED DURING THE WEIGHT-BEARING LUNGE TEST

BACKGROUND

The identification of asymmetrical inter-limb ankle dorsiflexion range of motion (DF ROM) has the potential to influence the course of treatment during the rehabilitation process, with limitations in ankle DF ROM potentially increasing injury risk. However, reliability for methods to identify ankle DF ROM asymmetries remain under described in the literature.

PURPOSE

To determine the reliability of the trigonometric calculation method for measuring ankle DF ROM during the weight-bearing lunge test (WBLT) for both a single limb and the symmetry values. The secondary purpose was to establish values of ankle DF ROM asymmetry and identify the influence of leg dominance on ankle DF ROM.

STUDY DESIGN

Cross-sectional study.

METHODS

Ankle DF ROM was measured bilaterally in 50 healthy and recreationally active participants (28 men, 22 women, age = 22 ± 4 years, height = 172.8 ± 10.8 cm, body mass 71.5 ± 15.1 kg), using the trigonometric measurement method during the WBLT. Each ankle was measured twice in a single testing session to establish within-session reliability.

RESULTS

Values are presented for asymmetries in DF ROM. No differences were identified between the dominant and non-dominant limb (p = 0.862). Within-session reliability for measuring a single limb was classified as 'good' (ICC = 0.98) with a minimal detectable change value of 1.7 °. For measuring ankle DF ROM asymmetry, reliability was established as 'good' (ICC = 0.85) and a minimal detectable change value of 2.1 ° was determined.

CONCLUSIONS

Although symmetry in ankle DF ROM may not be assumed, the magnitude of asymmetry may be less than previously reported in a population of recreationally active individuals. Discrepancies between previous research and the findings of the present study may have been impacted by differences in measurement methods. Furthermore, clinicians should be aware that the error associated with measures of asymmetry for ankle DF ROM during the WBLT is greater than that of a single limb.

LEVEL OF EVIDENCE

2b.

Does gender and ankle injury history affect weightbearing dorsiflexion in elite artistic gymnasts?

OBJECTIVES

To establish normative data for weightbearing dorsiflexion (WBDF) in elite artistic gymnasts.

DESIGN

Quasi-experimental design with descriptive analysis (mean, SD, 95% CI). Use of independent t-test to analyse gender differences, and dependent t-test to analyse WBDF injured limb compared to contralateral uninjured limb.

SETTING

Data Collection at British Gymnastics Lilleshall National Sports Centre during national squad training camp.

PARTICIPANTS

55 Participants of the British Gymnastics National Artistic Squad (27 male and 28 female).

MAIN OUTCOME MEASURE

Weightbearing lunge test to measure WBDF using a digital inclinometer.

RESULTS

There was no significant difference (p > 0.05) for gender and WBDF, although females had less range and greater variability (female mean ± SD = 45.0°±6.8°, 95% CI 42.6°, 47.6°; male mean ± SD 45.6°±5.4°, 95% CI 43.7°, 47.6°). There was a significant difference (t[23] = -3.259, p < 0.05) for previous injury and WBDF (uninjured mean ± SD 47.4°±5.7°, 95% CI 45.0°, 49.8°; injured 45.1°±6.0°, 95% CI 42.6°, 47.7°).

CONCLUSIONS

Gymnasts with a unilateral injury history have significantly less WBDF in the injured limb compared to the contralateral uninjured limb. Females have less WBDF than males, however this was not significant. Further research is needed to establish if this deficit in WBDF after injury is an issue during gymnasts' landings.

Different Cleat Models Do Not Influence Side Hop Test Performance of Soccer Players with and Without Chronic Ankle Instability

The lateral ankle sprain is one of the most common sport injury, representing 10-30% of all musculoskeletal disorders. The lateral ankle sprain is induced by sport gestures involving changes of direction and landing manoeuvres and constitutes a risk factor for the occurrence of chronic ankle instability. Although cleat models and performance have been already explored, no study has evaluated this relationship in athletes with chronic ankle instability. Therefore, the purpose of the study was to analyse the influence of different soccer cleat models on Side Hop Test performance of athletes with and without chronic ankle instability. Thirty-nine athletes were divided into two groups, a chronic ankle instability group (n = 20) and a healthy group (n = 19). Each participant performed the Side Hop Test, executing 10 consecutive jumps on dry artificial grass with 4 cleat models. The Qualisys System and two force platforms were used to analyse the test runtime, the distance travelled and the mean velocity. No statistically significant interaction was observed between the group and the cleat model for all variables evaluated. In addition, no differences were observed between models or groups. In this specific test, performance does not seem to be influenced by different cleat models on dry artificial grass in athletes with and without chronic ankle instability.

Restricted Unilateral Ankle Dorsiflexion Movement Increases Interlimb Vertical Force Asymmetries in Bilateral Bodyweight Squatting

Crowe, MA, Bampouras, TM, Small, K, and Howe, LP. Restricted unilateral ankle dorsiflexion movement increases interlimb vertical force asymmetries in bilateral bodyweight squatting. J Strength Cond Res 34(2): 332-336, 2020-The purpose of this study was to investigate the effect of unilateral restrictions in ankle-dorsiflexion range of motion (DF-ROM) on interlimb vertical ground reaction force (vGRF) asymmetries. Twenty healthy and physically active volunteers (age 23 ± 3 years; height 1.72 ± 0.1 m; mass 74.9 ± 20.3 kg) performed 3 barefoot bodyweight squats (control condition) and with a 10° custom-built forefoot wedge under the right foot to artificially imitate ankle DF-ROM restriction (wedge condition). Force data were used to calculate the mean asymmetry index score for the upper descent phase, lower descent phase, lower ascent phase, and upper ascent phase during the bilateral squat. Significant differences were found for comparisons for each phase between conditions, with effect sizes ranging between 0.7 and 1.1. Asymmetry index scores indicated that for all phases, the unrestricted limb in the wedge condition produced greater vGRF. Therefore, interlimb differences in ankle DF-ROM can cause interlimb asymmetries in vGRF during bilateral squatting. As such, athletes with asymmetrical squat mechanics should be screened for interlimb differences in ankle DF-ROM to ascertain whether it is a contributing factor.

Does the cleat model interfere with ankle sprain risk factors in artificial grass?

BACKGROUND

The cleats-surface interaction has been described as a possible risk factor for lateral ankle sprain. However, their interaction is still unknown in individuals with chronic ankle instability. The purpose of this study was to determine the influence of different soccer cleats on kinematic, kinetic and neuromuscular ankle variables on artificial grass in soccer players with and without chronic ankle instability.

METHODS

Eighty-two amateur athletes divided in two groups: 40 with chronic ankle instability and 42 without chronic ankle instability. All subjects performed 2 series of 6 consecutive crossover jumps with dominant foot, each one with one of the four models of cleats (Turf, Artificial grass, Hard and Firm ground). Cleat and group main effect and interactions of kinematic, kinetic and neuromuscular variables were analyzed according to factorial repeated measures ANOVA.

FINDINGS

No statistically significant cleat and group main effect and interactions were identified in kinematic, kinetic and electromyographic magnitude of the peroneal muscles. A main effect of the group was observed for peroneus longus activation time for TF model (p = 0.010).

INTERPRETATION

In soccer players, the contributor variables for ankle sprain were not influenced by the kind of soccer cleat used in a functional jump test on artificial grass. However, players with chronic ankle instability present delayed postural adjustments in peroneus longus with the TF model compared to players without chronic ankle instability.

Lower Quarter Y-Balance Test in healthy women 50-79 years old

The Lower Quarter Y-Balance Test (LQ-YBT), a measure of dynamic balance used in young adults, has not been adequately studied in older women. We determined the reliability, normative values, and relationships to other balance measures for LQ-YBT in women aged 50-79 years. Interrater reliability was strong, and test-retest reliability was moderate to strong. Results by decade showed women 50-59 years had significantly better scores than both older groups. There were moderate positive correlations between single leg stance, gait speed, and LQ-YBT composite score. LQ-YBT may be used as a dynamic balance assessment in healthy older women.

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

Weight bearing versus non-weight bearing ankle dorsiflexion measurement in people with diabetes: a cross sectional study

Background

Accurate measurement of ankle dorsiflexion is important in both research and clinical practice as restricted motion has been associated with many foot pathologies and increased risk of ulcer in people with diabetes. This study aimed to determine the level of association between non-weight bearing versus weight bearing ankle dorsiflexion in adults with and without diabetes, and to evaluate the reliability of the measurement tools.

Methods

One hundred and thirty-six adults with diabetes and 30 adults without diabetes underwent ankle dorsiflexion measurement non-weight bearing, using a modified Lidcombe template, and weight bearing, using a Lunge test. Pearson product-moment correlation coefficients, intraclass correlation coefficients (ICCs) with 95% confidence intervals, standard error of measurement and minimal detectable change were determined.

Results

There was a moderate correlation (r = 0.62–0.67) between weight and non-weight bearing tests in the non-diabetes group, and a negligible correlation in the diabetes group(r = 0.004–0.007). Intratester reliability was excellent in both groups for the modified Lidcombe template (ICC = 0.89–0.94) and a Lunge test (ICC = 0.83–0.89). Intertester reliability was also excellent in both groups for the Lidcombe template (ICC = 0.91) and a Lunge test (ICC = 0.88–0.93).

Conclusions

We found the modified Lidcombe template and a Lunge test to be reliable tests to measure non-weight bearing and weight bearing ankle dorsiflexion in adults with and without diabetes. While both methods are reliable, further definition of weight bearing ankle dorsiflexion normative ranges may be more relevant for clinical practice.

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.

Physical performance characteristics between male and female youth surfing athletes

BACKGROUND

Despite some knowledge about the fitness levels of elite surfers, there is limited published research examining gender differences, particularly in young athletes. The purpose of this study was to describe and compare the sex differences in physical performance characteristics of elite youth surfers. It was also aimed to study the association between physical performance variables.

METHODS

This longitudinal prospective study was based on a total of twenty male and female youth surfers who performed a battery of physical performance tests: anthropometrics, weight-bearing dorsiflexion test, Functional Movement Screen, lower extremity dynamic stability, lower limb dynamic strength, paddling and apnea test. The magnitude of differences between male and female surfers was tested and also the percentage of difference between performances.

RESULTS

When testing the correlation between the anthropometric and physical fitness variables and between performance variables, males and females presented specific intra sex results that should be interpreted by surf coaches.

CONCLUSIONS

Concerning better performance, working with young surfing athletes body composition have to be managed and the development of lower limb dynamic strength, especially for girl younger surfers. Supplementary it seems that Star Excursion Balance Test when compared bilaterally, can be a time efficiency indicator of the influence of surf training on the magnitude of lower limb asymmetry and postural control. In this way, surf coaches working with young athletes can implement appropriate and adjust training interventions.

Utility of the Overhead Squat and Forward Arm Squat in Screening for Limited Ankle Dorsiflexion

Rabin, A and Kozol, Z. Utility of the overhead squat and forward arm squat in screening for limited ankle dorsiflexion. J Strength Cond Res 31(5): 1251-1258, 2017-Limited ankle dorsiflexion (DF) range of motion (ROM) has been implicated in several lower extremity disorders. Effective screening for DF ROM may, therefore, help to identify "at risk" individuals. The primary purpose of this study was to determine the utility of 2 screening tests in detecting limited ankle DF ROM. Fifty-three healthy participants underwent an overhead squat (OS) test and a forward arm squat (FAS) test, as well as bilateral testing of weight-bearing and non-weight-bearing ankle DF ROM. Participants whose DF ROM fell below 1 SD from the sample average were considered to have limited DF ROM. The sensitivity, specificity, positive, and negative likelihood ratio (LR) of the OS and FAS in detecting individuals with limited DF ROM was calculated. The sensitivity of the OS was 1.00 regardless of the mode or the side of testing, whereas specificity ranged from 0.34 to 0.36. The positive LR of the OS ranged from 1.52 to 1.56, whereas negative LR was 0.00. The sensitivity of the FAS ranged from 0.56 to 0.70, whereas specificity ranged from 0.84 to 0.88. The positive and negative LR of the FAS ranged from 3.49 to 6.02, and 0.34 to 0.53, respectively. Our findings suggest that the OS and FAS may be used as complementing tests in screening for ankle DF limitation. Because of its excellent sensitivity, the OS should be performed first, and if negative, may confidently rule out limited DF ROM. However, given a positive OS, testing should proceed with the FAS, to more confidently rule in limited DF ROM.

The role of joint mobility in evaluating and monitoring the risk of diabetic foot ulcer

AIMS

Evaluation of how ankle joint mobility (AJM) can be useful in the identification of patients with diabetes at risk of foot ulcer (FU).

METHODS

Plantar and dorsal flexion of foot were evaluated using an inclinometer in 87 patients (54 type 2 and 33 type 1), and 35 healthy sex- and age-matched control subjects. Patients with diabetes were followed up for diagnosis of FU over the next 8 years and subsequently, patients were subdivided into: those without a history of FU (18 type 1 and 33 type 2), those who had a history of FU detected before baseline evaluation (14 type 2) and those who had history of first ulceration detected by the 8th year of the evaluation period (7 type 2).

RESULTS

Aging and diabetes caused a significant reduction in mobility of each of the movements investigated (p<0.001), whereas after adjusting for the confounding effect of age, diabetes specifically reduced plantar flexion (p<0.0001). AJM was significantly lower in those with history of previous FU compared to all the other groups (p<0.001). The first ulceration was detected in the same foot presenting lower AJM in 17 of the 22 subjects with diabetes with history of ulcer (77.27%).

CONCLUSIONS

Diabetes and aging reduce AJM although diabetes seems to reduce plantar flexion to a more specific extent. Reduced AJM is mostly associated with a previous history of FU. The evaluation of AJM is a valid and reliable ulcer risk scale that indicates which foot is at higher ulcer risk.