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Francis D, Kotteeswaran K, Padinhare Veedu P. Severity of Neuropathy-Related Disability and Associated Factors of Diabetic Peripheral Neuropathy in a Tertiary Healthcare Center: A Comparative Cross-Sectional Study. Cureus 2024; 16:e55568. [PMID: 38576639 PMCID: PMC10994166 DOI: 10.7759/cureus.55568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The widespread presence of diabetic peripheral neuropathy (DN) and its related variables among diagnosed diabetes mellitus (DM) patients in Kerala lacks sufficient evidence. The objective of this study was to evaluate the frequency of DN and its related risk variables among those with DM who were receiving care at a tertiary health institution in Kerala. MATERIALS AND METHODS This study was conducted in a tertiary health center in Kerala using a cross-sectional design. The diagnosis of diabetes was established by assessing the glycated hemoglobin A1c (HbA1c) level and the fasting blood glucose (FBG) level. A validated survey questionnaire was employed to gather demographic data as well as the medical history of DM and associated ailments. A thorough physical examination, BMI, and blood pressure were recorded. Dermatological, musculoskeletal, neurological, and vascular assessments were conducted. The subjects were assessed for neuropathy using a neuropathy disability score (NDS). Consequently, those who met the criteria for DM were classified into two groups: those with neuropathy and those without neuropathy. All research participants underwent laboratory examinations such as blood lipid profiles, HbA1c, and vitamin B12 complex concentrations. RESULTS The study included 200 DM patients; 120 men and 80 women. Study participants were 40-70 years old, with a median age of 53. The prevalence of DN significantly increased with age (p<0.001). The longer a patient had DM, the higher the prevalence of DN, and this variance in percentage was statistically significant (p<0.009) with an OR (odds ratio) of 9.246. A statistically significant 81 (40.5%) of participants graduated, compared to 119 (59.5%) with only higher secondary education or less (OR = 2.042; p = 0.014). Approximately 107 (53.5%) of individuals earned an income under two lakhs, and this disparity was deemed statistically significant (p = 0.003) with an OR of 2.357. In the group of individuals being studied, 53 (26.5%) of them experienced a decrease in pressure sensation, 47 (23.5%) had a decrease or absence of vibration perception, 48 (24%) had an absence or decreased pinprick response, and 46 (23%) had an absent ankle reflex. The study found that the most commonly reported symptoms were tingling (n = 44; 22%), numbness (n = 42; 21%), burning (n = 37; 18.5%), pricking (n = 29; 14.5%), and pain (n = 27; 13.5%). A strong association was found between DN and glycemic status, namely, FBG levels exceeding 140 mg/dL (OR = 4.511, p < 0.001) and HbA1c levels exceeding 6.5% (OR = 3.87, p < 0.001). The prevalence of abnormal vitamin B12 levels in individuals with DN was 63% (p = 0.19), indicating that the finding was not statistically significant. Within the group of individuals with DN being studied, 22% exhibited mild neuropathy, 34% displayed moderate neuropathy, and 44% had severe neuropathy. The DN individuals had significantly reduced ankle dorsiflexion in cases of severe NDS scores compared to those with mild to moderate NDS scores (p = 0.009). During the binary logistic regression analysis, it was shown that the duration of DM (OR = 1.73; p = 0.038) and FBG levels (OR = 2.87; p = 0.018) were determined as predictors for DN. CONCLUSION The findings of this study reveal that the duration of diabetes, age, literacy level, income, HbA1c, and FBG were substantially related to a higher likelihood of DN among diabetic patients.
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Affiliation(s)
- Daris Francis
- Department of Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, IND
| | - Kandaswami Kotteeswaran
- Department of Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, IND
| | - Pramod Padinhare Veedu
- Department of Physiotherapy, Lourde Institute of Allied Health Sciences, Taliparamba, IND
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Francis D, Kandaswami K, Padinhare Veedu P, Ponniah Subramanian A. Effect of Exercises for Strengthening the Intrinsic Muscles of the Foot and Improving Ankle Mobility on Patients of Diabetic Peripheral Neuropathy. Cureus 2024; 16:e56553. [PMID: 38646253 PMCID: PMC11027948 DOI: 10.7759/cureus.56553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Background and objectives The study aimed to compare the efficacy of standard home care versus structured ankle mobility exercises in enhancing ankle and foot joint range of motion (ROM) among individuals with diabetes mellitus (DM). Additionally, it investigated the impact of foot intrinsic muscle strengthening exercises on hallux grip force in those with Diabetic Peripheral Neuropathy (DN). Materials and methods In a study of 200 patients with Diabetic Neuropathy (DN), selected from 345 screened diabetics with stable glucose levels and routine monitoring at a tertiary care facility, the efficacy of structured exercises versus standard care was evaluated. Participants, aged 40-70 years with mild neuropathic symptoms (neuropathy disability score of 3 to 5), were divided into two groups. Group 1 received standard care per International Diabetic Foot guidelines, while Group 2 performed targeted foot intrinsic muscle strengthening and ankle mobility exercises over eight weeks. The range of motion (ROM) for ankle and first metatarsophalangeal (MTP) joints and hallux grip force were measured, showing significant improvements in Group 2. Analysis was done using IBM SPSS. Results The average age of the individuals in group 1 (n=100) was 53.87±5.42 years, whereas the average age of the subjects in group 2 (n=100) was 54.23±4.69 years. The study included a total of 97 male participants, with 48 in group 1 and 49 in group 2. The groups exhibited homogeneity in terms of age, gender, duration of DM, and BMI (p>,0.05). When comparing the ROM for ankle dorsiflexion between the groups, it was shown that subjects in group 2 had a substantially higher ROM following exercise for both the right (27.97°±5.3° Vs 19.24°±2.54°) and left (28.55°±4.61° Vs 18.22°±1.14°) ankles compared to the patients in group 1 (p<,0.01). Nevertheless, there were statistically insignificant differences (p>,0.05) observed within the groups, both before and after the exercises, for all the variables examined except for right and left ankle dorsiflexion, and right ankle plantarflexion in group 2. Group 2 subjects exhibited a considerably greater hallux grip force compared to group 1 subjects. The mean enhanced paper grip strength for the right and left big toe of group 2 was 44±3.58 N and 43.2±2.62 N respectively. The mean enhanced paper grip force for the right and left big toe of group 1 was 38±3.11 N and 37.92±2.13 N respectively. A statistically highly significant difference was observed for hallux grip force between the groups (p<,0.01). Conclusion The findings of this study suggest that performing the foot intrinsic muscle strengthening and ankle mobility exercises on the foot and ankle joints can potentially enhance ROM and hallux grip force in patient groups with DN.
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Affiliation(s)
- Daris Francis
- Department of Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, IND
| | - Kotteeswaran Kandaswami
- Department of Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, IND
| | - Pramod Padinhare Veedu
- Department of Physiotherapy, Lourde Institute of Allied Health Sciences, Thaliparamba, IND
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Koshino Y, Takabayashi T, Akuzawa H, Mizota T, Numasawa S, Kobayashi T, Kudo S, Hikita Y, Akiyoshi N, Edama M. Differences and relationships between weightbearing and non-weightbearing dorsiflexion range of motion in foot and ankle injuries. J Orthop Surg Res 2024; 19:115. [PMID: 38308266 PMCID: PMC10837980 DOI: 10.1186/s13018-024-04599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/28/2024] [Indexed: 02/04/2024] Open
Abstract
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.
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Affiliation(s)
- Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-Ku, Sapporo, 060-0812, Japan.
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiroshi Akuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Takeshi Mizota
- Department of Rehabilitation, Soejima Orthopedic Hospital, Takeo, Saga, Japan
| | - Shun Numasawa
- Department of Rehabilitation, Takarazuka University of Medical and Health Care, Takarazuka, Japan
| | - Takumi Kobayashi
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Shintarou Kudo
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
- AR-Ex Medical Research Center, Tokyo, Japan
| | | | - Naoki Akiyoshi
- Department of Rehabilitation, J Medical Oyumino, Chiba, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Rao Y, Yang N, Gao T, Zhang S, Shi H, Lu Y, Ren S, Huang H. Effects of peak ankle dorsiflexion angle on lower extremity biomechanics and pelvic motion during walking and jogging. Front Neurol 2024; 14:1269061. [PMID: 38362013 PMCID: PMC10867967 DOI: 10.3389/fneur.2023.1269061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/17/2023] [Indexed: 02/17/2024] Open
Abstract
Objective Ankle dorsiflexion during walking causes the tibia to roll forward relative to the foot to achieve body forward. Individuals with ankle dorsiflexion restriction may present altered movement patterns and cause a series of dysfunction. Therefore, the aim of this research was to clearly determine the effects of peak ankle dorsiflexion angle on lower extremity biomechanics and pelvic motion during walking and jogging. Method This study involved 51 subjects tested for both walking and jogging. The motion capture system and force measuring platforms were used to synchronously collect kinematics and kinetics parameters during these activities. Based on the peak ankle dorsiflexion angle during walking, the 51 subjects were divided into a restricted group (RADF group, angle <10°) and an ankle dorsiflexion-unrestricted group (un-RADF group, angle >10°). Independent-Sample T-tests were performed to compare the pelvic and lower limb biomechanics parameters between the groups during walking and jogging test on this cross-sectional study. Results The parameters that were significantly smaller in the RADF group than in the un-RADF group at the moment of peak ankle dorsiflexion in the walking test were: ankle plantar flexion moment (p < 0.05), hip extension angle (p < 0.05), internal ground reaction force (p < 0.05), anterior ground reaction force (p < 0.01), pelvic ipsilateral tilt angle (p < 0.05). In contrast, the external knee rotation angle was significantly greater in the RADF group than in the un-RADF group (p < 0.05). The parameters that were significantly smaller in the RADF group than in the un-RADF group at the moment of peak ankle dorsiflexion in the jogging test were: peak ankle dorsiflexion angle (p < 0.01); the anterior ground reaction force (p < 0.01), the angle of pelvic ipsilateral rotation (p < 0.05). Conclusion This study shows that individuals with limited ankle dorsiflexion experience varying degrees of altered kinematics and dynamics in the pelvis, hip, knee, and foot during walking and jogging. Limited ankle dorsiflexion alters the movement pattern of the lower extremity during walking and jogging, diminishing the body's ability to propel forward, which may lead to higher injury risks.
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Affiliation(s)
- Yi Rao
- Department of Rehabilitation, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Nan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Tianyu Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Si Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Haitao Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Yiqun Lu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Hongshi Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China
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Adillón C, Gallegos M, Treviño S, Salvat I. Ankle Joint Dorsiflexion Reference Values in Non-Injured Youth Federated Basketball Players: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11740. [PMID: 36142013 PMCID: PMC9517286 DOI: 10.3390/ijerph191811740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
(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.
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Affiliation(s)
- Cristina Adillón
- Faculty of Medicine and Health Sciences, Department of Medicine and Surgery, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain
| | - Montse Gallegos
- Health Department, Catalan Basketball Federation, 08018 Barcelona, Spain
| | - Silvia Treviño
- Health Department, Catalan Basketball Federation, 08018 Barcelona, Spain
| | - Isabel Salvat
- Faculty of Medicine and Health Sciences, Department of Medicine and Surgery, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain
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Simondson J, Simondson D, Formby C, Brock K. The Ankle Lunge Test for measurement of dorsiflexion in individuals following stroke; reliability, validity and evaluation of change following intervention for spasticity of the lower limb. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 27:e1925. [PMID: 34644454 DOI: 10.1002/pri.1925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/14/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The Ankle Lunge Test (ALT) is a reliable method of measuring weight bearing ankle dorsiflexion range, a key component of gait, in healthy ankles and a range of musculoskeletal conditions. The aim of this study is to evaluate the reliability and concurrent validity of the ALT in people with stroke and investigate whether change in ALT is observed following treatment of spasticity with Botulinum Toxin. METHODOLOGY Repeated Measure Design: Forty stroke survivors were recruited for reliability testing. Twenty three stroke survivors were evaluated with the ALT before and after treatment of the lower limb with Botulinum Toxin. Measurement with the ALT was performed for all participants. For the reliability group, two physiotherapists evaluated the ALT on Day 1 and one therapist re-evaluated the ALT one to 5 days later. For the change evaluation group, the ALT was tested prior to and six to eight weeks after intervention. Other measures evaluated were velocity, the Functional Ambulation Category, Timed Up and Go and the Modified Tardieu Scale. RESULTS Intra-rater, inter-rater and test-retest reliability yielded intra-class correlation coefficients at or above 0.92. Moderate correlations were found between the ALT and velocity r = 0.605 (p < 0.01), the Timed Up and Go r = -0.598 (p < 0.01) and the Functional Ambulation Category r = 0.380 (p < 0.05). Following intervention with Botulinum Toxin, there was significant (p < 0.02) improvement in the ALT; pre-median 20 mm (IQR -25 to 35) to post-median 21 mm (IQR 0 to 40) and the Timed Up and Go; pre-median 21.40 s (IQR 13.43 to 28.82) to post-median 20.08 s (IQR 14.06 to 28.47). CONCLUSION/SIGNIFICANCE The ALT is a reliable and valid measure which may be applied in clinical practice to evaluate change in weight bearing ankle dorsiflexion in people with stroke.
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Affiliation(s)
- Janine Simondson
- Physiotherapy Department, Health Independence Program & Rehabilitation Unit, St Vincent's Hospital Melbourne, St George's Health Service, Kew, Victoria, Australia
| | - David Simondson
- Physiotherapy Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Claire Formby
- Health Independence Program, St Vincent's Hospital Melbourne, St George's Health Service, Kew, Victoria, Australia
| | - Kim Brock
- Physiotherapy Department, Health Independence Program & Rehabilitation Unit, St Vincent's Hospital Melbourne, St George's Health Service, Kew, Victoria, Australia
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Zunko H, Vauhnik R. Reliability of the weight-bearing ankle dorsiflexion range of motion measurement using a smartphone goniometer application. PeerJ 2021; 9:e11977. [PMID: 34616594 PMCID: PMC8464192 DOI: 10.7717/peerj.11977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/24/2021] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Helena Zunko
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia, Ljubljana, Slovenia
| | - Renata Vauhnik
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia, Ljubljana, Slovenia.,Arthron, Institute for Joints and Sport Injuries, Slovenia, Ljubljana, Slovenia
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Taylor JB, Wright ES, Waxman JP, Schmitz RJ, Groves JD, Shultz SJ. Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing. Sports Health 2021; 14:328-335. [PMID: 34096370 DOI: 10.1177/19417381211019683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, High Point, North Carolina
| | - Elena S Wright
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina.,Department of Implementation Science, Division of Public Health Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Healthcare Innovation, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Justin P Waxman
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - James D Groves
- Department of Physical Therapy, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
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Hamano N, Shitara H, Tajika T, Ichinose T, Sasaki T, Kuboi T, Shimoyama D, Kamiyama M, Miyamoto R, Endo F, Nakase K, Kobayashi T, Yamamoto A, Takagishi K, Chikuda H. Relationship between the Lower Limb Function and Shoulder and Elbow Injuries in Elementary School Baseball Pitchers. Prog Rehabil Med 2021; 6:20210015. [PMID: 33728384 PMCID: PMC7952376 DOI: 10.2490/prm.20210015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/03/2021] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryosuke Miyamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kurumi Nakase
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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Hernández-Guillén D, Tolsada-Velasco C, Roig-Casasús S, Costa-Moreno E, Borja-de-Fuentes I, Blasco JM. Association ankle function and balance in community-dwelling older adults. PLoS One 2021; 16:e0247885. [PMID: 33661991 PMCID: PMC7932177 DOI: 10.1371/journal.pone.0247885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Ankle function declines with age. The objective of this study was to investigate the association between ankle function and balance in older adults, with a focus on range of motion (ROM) and strength. Methods This was a cross-sectional study that included 88 healthy community-dwelling older adults. Ankle mobility was measured while bearing weight (lunge test) and not bearing weight. The plantar-flexor muscle strength was assessed using a hand-held dynamometer. Balance was measured in terms of dynamic balance and mobility (timed up and go test), monopodal and bipodal static balance with open and closed eyes (single-leg stand test and platform measures), and margins of stability (functional reach test). Linear correlation and multiple regression analyses were conducted with a 95% CI. Results and discussion Most participants had limited ankle mobility (n = 75, 86%). Weight-bearing ankle dorsiflexion ROM was the strongest predictor of dynamic balance and included general mobility and stability ( Radj2 = [0.34]; β = [-0.50]). In contrast, plantar-flexor muscle strength was a significant predictor of static standing balance with open eyes ( Radj2 = [0.16–0.2]; β = [0.29–0.34]). Overall, weight-bearing ankle dorsiflexion ROM was a more representative measure of balance and functional performance; however, a non-weight-bearing mobility assessment provides complementary information. Therefore, both measures can be used in clinical practice. Conclusion This study supports the concept that ankle mobility contributes to the performance of dynamic tasks, while the plantar-flexor muscle strength helps to develop a standing static balance. Identification of alterations in ankle function is warranted and may assist in the design of tailored interventions. These interventions can be used in isolation or to augment conventional balance training in order to improve balance performance in community-dwelling older adults.
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Affiliation(s)
- David Hernández-Guillén
- Group of Physiotherapy in the Ageing Processes, Departament de Fisioteràpia, Universitat de València, Valencia, Spain
- * E-mail:
| | | | - Sergio Roig-Casasús
- Group of Physiotherapy in the Ageing Processes, Departament de Fisioteràpia, Universitat de València, Valencia, Spain
- Hospital Politècnic i Universitari La Fe, Valencia, Spain
| | | | | | - José-María Blasco
- Group of Physiotherapy in the Ageing Processes, Departament de Fisioteràpia, Universitat de València, Valencia, Spain
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11
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Lee J, Cynn H, Park D. Combined effect of gastrocnemius stretching with self-stabilising talus during subtalar supination on ankle kinematics in subjects with limited ankle dorsiflexion. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-182183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jihyun Lee
- Department of Physical Therapy, Baekseok University, Korea
| | - Heonseock Cynn
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Korea
| | - Donghwan Park
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Korea
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12
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Hernández-Guillén D, Blasco JM. A Randomized Controlled Trial Assessing the Evolution of the Weight-Bearing Ankle Dorsiflexion Range of Motion Over 6 Sessions of Talus Mobilizations in Older Adults. Phys Ther 2020; 100:645-652. [PMID: 31944252 DOI: 10.1093/ptj/pzaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/19/2019] [Accepted: 11/17/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Ankle range of motion declines with age, affecting mobility and postural control. OBJECTIVE The objective of this study was to investigate the effects of a talus mobilization-based intervention among healthy community-dwelling older adults presenting with limited weight-bearing ankle dorsiflexion range of motion and determine how ankle mobility evolved over the treatment. DESIGN This was a randomized clinical trial. SETTING This study was conducted in an outpatient clinic. PARTICIPANTS Community-dwelling, older adults over 60 years of age who had limited ankle mobility participated in this study. INTERVENTIONS The experimental intervention consisted of 6 sessions of manual therapy applied in the ankle joint. The control group received the same volume of sham treatment. MEASUREMENTS The primary outcome was the weight-bearing ankle dorsiflexion range of motion as measured using the lunge test. Data were collected at 9 time points: baseline, after each session, and follow-up. RESULTS A total of 36 participants were analyzed. A single session of mobilization increased ankle range of motion by 8 degrees (95% confidence interval = 6 to 11). At the end of the sixth session, this effect had increased slightly to 11 degrees (95% confidence interval = 9 to 13). Significant between-group differences were found throughout the intervention. LIMITATIONS Optimal dose and effects from follow-up evaluations for treatment volumes of fewer than 6 sessions remain unknown. CONCLUSIONS Six sessions of a talus mobilization-based intervention in healthy community-dwelling older adults found that the greatest mobility gain in terms of the weight-bearing ankle dorsiflexion range of motion is produced after the first session. Additional sessions produce smaller improvements with a slight upward trend. Importantly, the restoration of joint mobility is enhanced over time after the end of the intervention.
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Affiliation(s)
- David Hernández-Guillén
- Group in Physiotherapy in the Ageing Process, Social and Health Care Strategies, Department of Physiotherapy, University of Valencia, Calle Gascó Oliag 5, 46010 Valencia, Spain
| | - José-María Blasco
- Group in Physiotherapy in the Ageing Process, Social and Health Care Strategies, Department of Physiotherapy, University of Valencia
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13
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Chan O, Malhotra K, Buraimoh O, Cullen N, Welck M, Goldberg A, Singh D. Gastrocnemius tightness: A population based observational study. Foot Ankle Surg 2019; 25:517-522. [PMID: 30321953 DOI: 10.1016/j.fas.2018.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/17/2018] [Accepted: 04/03/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrocnemius tightness is believed to be associated with multiple musculoskeletal pathologies such as back pain, plantar fasciitis and metatarsalgia. Although surgical treatment of gastrocnemius tightness is gaining popularity the objective definition of a gastrocnemius contracture has not been determined. The aim of our study was therefore to quantify gastrocnemius tightness in a normal population. METHODS Adult participants with no obvious foot and ankle pathology were recruited. Gastrocnemius tightness was quantified using a weightbearing lunge test. Maximal ankle-foot dorsiflexion was measured on participants with the knee in full extension and flexed to 20° using a digital inclinometer. The ankle-foot dorsiflexion index or ADI (difference in ankle dorsiflexion with the knee extended and flexed) was calculated. The ADI values were plotted on a histogram to identify the distribution of values and were compared according to participant demographics. RESULTS 800 limbs from 400 participants were examined. There was a wide distribution of absolute values of maximal ankle-foot dorsiflexion ranging from 8 to 52°. The ADI ranged from 0 to19° and approximated to a normal distribution. The mean ADI was 6.04±3.49° and was positively correlated with age (r=0.132, P<0.001) and negatively correlated with physical activity (r=-0.88, P=0.015). CONCLUSION(S) Our study is the first to quantify gastrocnemius tightness in a large healthy adult population with differences observed by age and physical activity. We have defined an easy and reproducible weightbearing test that can be used in both research and clinical settings. The majority of the population have some degree of gastrocnemius tightness and values of ADI greater than 13° (>2 SD of the mean), as measured by the lunge test, may be considered abnormal.
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Affiliation(s)
- Oliver Chan
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom.
| | - Karan Malhotra
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Olatunbosun Buraimoh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Nick Cullen
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Matthew Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Andy Goldberg
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Dishan Singh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
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14
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Banwell HA, Uden H, Marshall N, Altmann C, Williams CM. The iPhone Measure app level function as a measuring device for the weight bearing lunge test in adults: a reliability study. J Foot Ankle Res 2019; 12:37. [PMID: 31333763 PMCID: PMC6617898 DOI: 10.1186/s13047-019-0347-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Ankle joint range of motion is a frequently assessed measure used by health care clinicians who manage lower limb pathologies to identify ankle equinus and/or other joint motion concerns that may negatively impact on function. The purpose of this study was to assess a new iPhone application (the level function of the 'Measure application'), for measuring the weightbearing ankle lunge test in a healthy adult population (reliability) and measuring known angles (validity) when compared to a digital inclinometer. Methods To determine intra-rater reliability, inter-rater reliability and concurrent validity, 168 measures were conducted on 21 participants. Participants were preconditioned prior to assessment, and two experienced raters measured ankle dorsiflexion range of motion in the knee extended and knee flexed positions of the weight bearing lunge test, using an iPhone level function (of the Measure application) and a digital inclinometer in a randomised order, over two timepoints. Concurrent validity was also determined by comparison of measures of the two devices at known surface angles (0 and 15 degrees) in multiple planes. Reliability and validity were determined with intraclass correlation coefficients, concurrent validity was explored with the Bland Altman plot and an intraclass correlation coefficient. The Standard Error of the Mean and the minimal detectable change were also explored. Results The intra-rater reliability using the iPhone and inter-rater reliability using the digital inclinometer, in the knee extended position, were ICC 0.85 respectively, indicating good reliability. All other intra-rater reliability and inter-rater reliability for both devices and both leg positions were over ICC 0.90, indicating excellent reliability. Concurrent validity between the two devices on a flat and known angle surface were ICC 1.0 (Limits of Agreement - 1.0 to 0.61), indicating excellent validity, with good validity demonstrated by a Bland Altman plot of all measures in all positions (ICC of 0.84 (Limits of agreement = - 4.51 to 6.49)). Conclusion The use of the iPhone level measure, within the Measurement App has demonstrated to be an easy and reliable measurement tool to determine ankle joint dorsiflexion during the weightbearing lunge test in healthy adults.
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Affiliation(s)
- Helen A Banwell
- 1International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia 5001 Australia.,2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Hayley Uden
- 2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Nicole Marshall
- 2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Carlie Altmann
- 2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Cylie M Williams
- 2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia.,3Allied Health, Peninsula Health, Frankston, Victoria 3199 Australia.,4School of Primary and Allied Health, Monash University, Frankston, Victoria 3199 Australia
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15
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Wik EH, Auliffe SM, Read PJ. Examination of Physical Characteristics and Positional Differences in Professional Soccer Players in Qatar. Sports (Basel) 2018; 7:sports7010009. [PMID: 30602694 PMCID: PMC6358794 DOI: 10.3390/sports7010009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 12/26/2022] Open
Abstract
Physical characteristics in professional soccer differ between competition levels and playing positions, and normative data aid practitioners in profiling their players to optimize performance and reduce injury risk. Given the paucity of research in Arabic soccer populations, the purpose of this study was to provide position-specific normative values for professional players competing in the Qatar Stars League. One hundred and ninety-five players completed a musculoskeletal assessment as part of an annual periodic health examination. Tests included measures of range of motion (hip, ankle, and hamstring), bilateral and unilateral jump performance, and quadriceps/hamstring (isokinetic/NordBord), hip adduction/abduction (eccentric), and groin (isometric) strength. Descriptive data were examined, and positional differences were analyzed using a one-way analysis of variance (ANOVA). Goalkeepers were significantly heavier (p < 0.01), had a higher body mass index (p < 0.05) than outfield positions and demonstrated greater absolute strength. Defenders were the strongest relative to body mass, and these differences were significant (p < 0.05) versus goalkeepers and strikers. No meaningful between-group comparisons were apparent for jumping or range of motion tests. Compared to mean values from other professional leagues, soccer players in Qatar appear to be shorter, lighter and display inferior strength and jump capacities. These data can be used to tailor training and rehabilitation programs to the specifics of the league and position in which the athletes compete.
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Affiliation(s)
- Eirik Halvorsen Wik
- Aspetar Sports Injury and Illness Prevention Programme (ASPREV), Aspetar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar.
| | - Seán Mc Auliffe
- Athlete Health and Performance Research Centre (AHP), Aspetar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar.
| | - Paul James Read
- Athlete Health and Performance Research Centre (AHP), Aspetar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar.
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16
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Searle MOsteo A, Spink MJ, Chuter VH. Validation of a weight bearing ankle equinus value in older adults with diabetes. J Foot Ankle Res 2018; 11:62. [PMID: 30479667 PMCID: PMC6249959 DOI: 10.1186/s13047-018-0306-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/05/2018] [Indexed: 12/13/2022] Open
Abstract
Background Accurate measurement of ankle joint dorsiflexion is clinically important as a restriction has been linked to many foot and ankle pathologies, as well as increased ulcer risk and delayed ulcer healing in people with diabetes. Use of the reliable weight bearing (WB) Lunge test is limited as normal and restricted ranges for WB ankle joint dorsiflexion are not identified. Additionally the extent of WB dorsiflexion restriction that results in clinically adverse outcomes is unclear. Therefore the aim of this investigation is to validate a proposed weight bearing equinus value (dorsiflexion < 30°) in unimpaired cohorts, and secondly to investigate any clinical effects this degree of ankle dorsiflexion restriction has on forefoot plantar pressure variables in older adults with diabetes. Methods Ankle dorsiflexion was measured using a Lunge test with the knee extended in young adults without diabetes (YA) and older adults with diabetes (DA). In-shoe and barefoot plantar pressure was recorded for the DA group. Spearman’s correlation was calculated to determine any association between the presence of ankle equinus and plantar pressure variables in the DA group. DA group differences in people with and without an equinus were examined. Results A weight bearing equinus of < 30°, assessed in a lunge using an inclinometer placed on the anterior tibia, falls within the restricted range in young unimpaired cohorts. In the DA group this degree of ankle restriction had a fair and significant association with elevated barefoot forefoot peak pressure (r = 0.274, p = 0.005) and pressure-time integrals (r = 0.321, p = .001). The DA equinus group had significantly higher barefoot peak pressure (mean kPa (SD): 787.1 (246.7) vs 652.0 (304.5), p = 0.025) and pressure-time integrals (mean kPa (SD): 97.8 (41.6) vs 80.4 (30.5), p = 0.017) than the DA non equinus group. Conclusions We support a preliminary weight bearing ankle equinus value of < 30°. This value represents a restricted range in young adults and is correlated with increased forefoot plantar pressure variables in older adults with diabetes. Mean population weight bearing ankle dorsiflexion data presented here for older adults with diabetes, will allow use of the more functional Lunge test with knee extended in research and clinical practice.
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Affiliation(s)
- A Searle MOsteo
- 1School of Health Sciences, Faculty of Health, University of Newcastle, PO Box 127, Ourimbah, NSW 2258 Australia
| | - M J Spink
- 1School of Health Sciences, Faculty of Health, University of Newcastle, PO Box 127, Ourimbah, NSW 2258 Australia
| | - V H Chuter
- 1School of Health Sciences, Faculty of Health, University of Newcastle, PO Box 127, Ourimbah, NSW 2258 Australia.,2Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, PO Box 127, Ourimbah, NSW 2258 Australia
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17
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Awatani T, Enoki T, Morikita I. Inter-rater reliability and validity of angle measurements using smartphone applications for weight-bearing ankle dorsiflexion range of motion measurements. Phys Ther Sport 2018; 34:113-120. [PMID: 30267968 DOI: 10.1016/j.ptsp.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the inter-rater reliability, validity, and error of angle measurements for ankle dorsiflexion range of motion while in the weight-bearing position using a smartphone application. DESIGN Reliability and validity study. SETTING Measurement positions were performed by one experienced examiner. PARTICIPANTS Eighteen volunteers participated in the study. Three examiners (examiner 1 and examiner 2 had completed the course to become qualified certified athletic trainers and examiner 3 did not belong to the course) performed smartphone application measurements. MAIN OUTCOME MEASURES Ankle dorsiflexion range of motion was measured in the lunge position. Radiographic measurements were performed using a bony landmark. The markerless method for application measurements was used, using a body part as a landmark. RESULTS Using the markerless method for application measurements, the intra-class correlation coefficients were 0.945. Using Pearson's correlation coefficient and intra-class correlation coefficients to compare the radiographic measurements and markerless method for application measurements, three examiners showed very high correlation (r > 0.9) and almost perfect (>0.81) intra-class correlation coefficient. Error values were less than 5° according to examiner 1 and examiner 2. CONCLUSION Smartphone application measurements using the markerless method of ankle dorsiflexion range of motion exhibited inter-rater reliability and high validity.
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Affiliation(s)
- Takenori Awatani
- Faculty of Sports Science, Kyushu Kyoritsu University, 1-8 Jiyuugaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8585, Japan; Graduate School of Sport and Exercise Sciences, Osaka University of Health and Sport Sciences, 1-1 Asashirodai, Kumatori-cho, Sennann-gunn, Osaka, 590-0496, Japan.
| | - Taisuke Enoki
- Faculty of Education, Osaka Kyoiku University, 4-698-1 Asahigaoka, Kashiwara, Osaka, 582-8582 Japan
| | - Ikuhiro Morikita
- Graduate School of Sport and Exercise Sciences, Osaka University of Health and Sport Sciences, 1-1 Asashirodai, Kumatori-cho, Sennann-gunn, Osaka, 590-0496, Japan; Faculty of Physical Education, Osaka University of Health and Sport Sciences, 1-1 Asashirodai, Kumatori-cho, Sennann-gunn, Osaka, 590-0496, Japan
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18
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Searle A, Spink MJ, Chuter VH. Weight bearing versus non-weight bearing ankle dorsiflexion measurement in people with diabetes: a cross sectional study. BMC Musculoskelet Disord 2018; 19:183. [PMID: 29859538 PMCID: PMC5985059 DOI: 10.1186/s12891-018-2113-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- A Searle
- School of Health Sciences, Faculty of Health, University of Newcastle, PO Box 127, Ourimbah, NSW, 2258, Australia.
| | - M J Spink
- School of Health Sciences, Faculty of Health, University of Newcastle, PO Box 127, Ourimbah, NSW, 2258, Australia
| | - V H Chuter
- School of Health Sciences, Faculty of Health, University of Newcastle, PO Box 127, Ourimbah, NSW, 2258, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, 2308, Australia
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Kang MH. Influence of ankle dorsiflexion range of motion on heel-rise time during gait. J Phys Ther Sci 2018; 30:694-696. [PMID: 29765182 PMCID: PMC5940474 DOI: 10.1589/jpts.30.694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/19/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the correlation between weight-bearing (WB) and non-WB ankle dorsiflexion (DF) range of motion (ROM) and ankle movement during gait, including heel-rise time and ankle DF at heel-rise. [Subjects and Methods] Thirty healthy male subjects were recruited for this study. Ankle DF ROM of both feet was measured under the WB and non-WB conditions. Heel-rise time and ankle DF at heel-rise in both feet during gait were measured using a motion analysis system. Pearson product moment correlations were used to identify correlation ankle DF ROM and ankle movement during gait. [Results] Heel-rise time and ankle DF at heel rise were significantly correlated with WB ankle DF ROM. However, no correlations were found between ankle movement during gait and non-WB ankle DF ROM. [Conclusion] These findings demonstrate that WB ankle DF ROM measurements can be used to predict heel-rise time and ankle DF at heel-rise.
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Affiliation(s)
- Min-Hyeok Kang
- Department of Physical Therapy, International University of Korea: 965 Dongburo, Munsaneup, Jinju, Gyeongsangnam-do 52833, Republic of Korea
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Todoroff M. Dynamic Deep Squat: Lower-Body Kinematics and Considerations Regarding Squat Technique, Load Position, and Heel Height. Strength Cond J 2017. [DOI: 10.1519/ssc.0000000000000278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kang MH, Oh JS. Relationship Between Weightbearing Ankle Dorsiflexion Passive Range of Motion and Ankle Kinematics During Gait. J Am Podiatr Med Assoc 2017; 107:39-45. [PMID: 28271931 DOI: 10.7547/14-112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Measurement of weightbearing ankle dorsiflexion (DF) passive range of motion (PROM) has been suggested as a way to estimate ankle kinematics during gait; however, no previous study has demonstrated the relationship between ankle DF during gait and ankle DF PROM with knee extension. We examine the relationship between maximum ankle DF during gait and nonweightbearing and weightbearing ankle DF PROM with knee extension. METHODS Forty physically active individuals (mean ± SD age, 21.63 ± 1.73 years) participated in this study. Ankle DF PROM with knee extension was measured in the nonweightbearing and weightbearing conditions; maximum ankle DF during gait was assessed using a three-dimensional motion analysis system. The relationship between each variable was calculated using the Pearson product moment correlation coefficient, and the difference in ankle DF PROM between the nonweightbearing and weightbearing conditions was analyzed using a paired t test. RESULTS The weightbearing measurement (r = 0.521; P < .001) for ankle DF PROM showed a greater correlation with maximum ankle DF during gait than did the nonweightbearing measurement (r = 0.245; P = .029). Ankle DF PROM was significantly greater in the weightbearing than in the nonweightbearing condition (P < .001) despite a significant correlation between the two measurements (r = 0.402; P < .001). CONCLUSIONS These findings indicate that nonweightbearing and weightbearing measurements of ankle DF PROM with knee extension should not be used interchangeably and that weightbearing ankle DF PROM with the knee extended is more appropriate for estimating ankle DF during gait.
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Affiliation(s)
- Min-Hyeok Kang
- Department of Physical Therapy, Inje University, Gimhae-si, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, Inje University, Gimhae-si, Republic of Korea
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The Association of Ankle Dorsiflexion Range of Motion With Hip and Knee Kinematics During the Lateral Step-down Test. J Orthop Sports Phys Ther 2016; 46:1002-1009. [PMID: 27686412 DOI: 10.2519/jospt.2016.6621] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study. Background Altered hip and knee kinematics have been associated with several knee disorders, including anterior cruciate ligament tear, patellofemoral pain, and iliotibial band syndrome. Limited ankle dorsiflexion (DF) range of motion (ROM), which has been linked with some of these disorders, has also been associated with altered knee kinematics. Objective To explore the association of ankle DF ROM with hip and knee kinematics during a step-down task. Methods Thirty healthy participants underwent a 3-D analysis of hip and knee kinematics during a lateral step-down test, followed by measurement of ankle DF ROM in weight bearing (WB) and non-weight bearing (NWB). Participants were dichotomized using the median values into low- and high-DF subgroups within both WB and NWB. Hip and knee kinematics were compared between the low- and high-DF subgroups. Results Participants in the low-DF subgroups exhibited greater peak hip adduction (WB, P = .02; NWB, P<.01) and greater peak knee external rotation (WB, P = .02; NWB, P<.01) compared with participants in the high-DF subgroups. In addition, participants in the low-DF WB subgroup exhibited decreased peak knee flexion compared with participants in the high-DF WB subgroup (P<.01). Conclusion Individuals with lower ankle DF ROM exhibited hip and knee kinematics previously associated with several knee disorders, suggesting that this impairment may be involved in the pathogenesis of the same disorders. Assessment of ankle DF ROM may be useful as part of a preparticipation screening. Furthermore, deficits in ankle DF ROM may need to be addressed in individuals with altered movement patterns. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6621.
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Ankle dorsiflexion: what is normal? Development of a decision pathway for diagnosing impaired ankle dorsiflexion and M. gastrocnemius tightness. Arch Orthop Trauma Surg 2016; 136:1203-1211. [PMID: 27418341 DOI: 10.1007/s00402-016-2513-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Impaired ankle dorsiflexion (ADF) is known to increase forefoot pressure, which is associated to various pathologies affecting the foot and ankle. M. gastrocnemius tightness (MGT) is its most common cause. Up to date we are missing a standardized examination procedure, norm values, and a valid decision pathway to diagnose impaired ADF and MGT. The aim of this study was to define norm values for ADF using a standardized examination procedure. These were used to define a decision pathway to diagnose impaired ADF and MGT. MATERIALS AND METHODS 64 young, asymptomatic subjects were examined. Based on a standardized examination procedure, bilateral ADF, both with the knee extended and flexed, non-weight bearing and weight bearing, was assessed by three investigators. Inter-rater test reliability and norm values for ADF were calculated. Side differences were analyzed. ADF differences between the knee extended and flexed were calculated. RESULTS The standardized examination procedure revealed high ICC values (0.876-0.915). ADF values with the knee extended for the left/right limb were 22.7° ± 5.9° [95 % CI 21.2°-24.3°]/23.4° ± 6.5° [95 % CI 21.7°-25.1°] non-weight bearing and 33.3° ± 5.5° [95 % CI 31.9°-34.7°]/33.6° ± 5.6° [95 % CI 32.1°-35.0°] weight bearing. Physiological side differences with the knee extended were <6° (95 % CI). Knee flexion resulted in an approximate ADF increase of 10°. CONCLUSIONS Based on an extensive systematic approach, physiological values for ADF were assessed in a large asymptomatic population. This allowed the definition of a decision pathway to diagnose impaired ADF and MGT. Patients presenting with pathologies associated with impaired ADF should be examined according to the herein presented examination protocol. This systematic approach provides a consistent definition of impaired ADF and MGT, which is the prerequisite to study the effectiveness of treatment strategies for MGT.
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Baumbach SF, Braunstein M, Regauer M, Böcker W, Polzer H. Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination. J Vis Exp 2016. [PMID: 27500825 DOI: 10.3791/53446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20° of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20° flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.
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Affiliation(s)
- Sebastian F Baumbach
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | - Mareen Braunstein
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | - Markus Regauer
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital
| | | | - Hans Polzer
- Foot and Ankle Surgery, Munich University Hospital; Department of Trauma Surgery, Munich University Hospital;
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Intra-rater reliability and agreement of various methods of measurement to assess dorsiflexion in the Weight Bearing Dorsiflexion Lunge Test (WBLT) among female athletes. Phys Ther Sport 2016; 23:37-44. [PMID: 27665249 DOI: 10.1016/j.ptsp.2016.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To examine the intra-observer reliability and agreement between five methods of measurement for dorsiflexion during Weight Bearing Dorsiflexion Lunge Test and to assess the degree of agreement between three methods in female athletes. DESIGN Repeated measurements study design. SETTING Volleyball club. PARTICIPANTS Twenty-five volleyball players. MAIN OUTCOME MEASUREMENTS Dorsiflexion was evaluated using five methods: heel-wall distance, first toe-wall distance, inclinometer at tibia, inclinometer at Achilles tendon and the dorsiflexion angle obtained by a simple trigonometric function. For the statistical analysis, agreement was studied using the Bland-Altman method, the Standard Error of Measurement and the Minimum Detectable Change. Reliability analysis was performed using the Intraclass Correlation Coefficient. RESULTS Measurement methods using the inclinometer had more than 6° of measurement error. The angle calculated by trigonometric function had 3.28° error. The reliability of inclinometer based methods had ICC values < 0.90. Distance based methods and trigonometric angle measurement had an ICC values > 0.90. Concerning the agreement between methods, there was from 1.93° to 14.42° bias, and from 4.24° to 7.96° random error. CONCLUSION To assess DF angle in WBLT, the angle calculated by a trigonometric function is the most repeatable method. The methods of measurement cannot be used interchangeably.
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Zusammenhang von Knieflexion und Beweglichkeit im Sprunggelenk. MANUELLE MEDIZIN 2015. [DOI: 10.1007/s00337-015-0023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kang MH, Lee DK, Kim SY, Kim JS, Oh JS. The influence of gastrocnemius stretching combined with joint mobilization on weight-bearing ankle dorsiflexion passive range of motion. J Phys Ther Sci 2015; 27:1317-8. [PMID: 26157209 PMCID: PMC4483387 DOI: 10.1589/jpts.27.1317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/11/2015] [Indexed: 12/26/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effect of gastrocnemius
stretching combined with talocrural joint mobilization on weight-bearing ankle
dorsiflexion passive range of motion. [Subjects] Eleven male subjects with bilateral
limited ankle dorsiflexion passive range of motion with knee extended participated in this
study. [Methods] All subjects received talocrural joint mobilization while performing
gastrocnemius stretching. Ankle dorsiflexion passive range of motion was measured using an
inclinometer under weight-bearing conditions before and immediately after intervention. A
paired t-test was used to analyze the difference between weight-bearing ankle dorsiflexion
passive range of motion pre- and post-intervention. [Results] A significant increase in
weight-bearing ankle dorsiflexion passive range of motion was found post-intervention
compared with pre-intervention. [Conclusion] These findings demonstrate that gastrocnemius
stretching combined with joint mobilization is effective for increasing weight-bearing
ankle dorsiflexion passive range of motion.
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Affiliation(s)
- Min-Hyeok Kang
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Dong-Kyu Lee
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Soo-Yong Kim
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Jun-Seok Kim
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Kang MH, Oh JS, Kwon OY, Weon JH, An DH, Yoo WG. Immediate combined effect of gastrocnemius stretching and sustained talocrural joint mobilization in individuals with limited ankle dorsiflexion: A randomized controlled trial. ACTA ACUST UNITED AC 2015; 20:827-34. [PMID: 25907146 DOI: 10.1016/j.math.2015.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 02/16/2015] [Accepted: 03/26/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although gastrocnemius stretching and talocrural joint mobilization have been suggested as effective interventions to address limited ankle dorsiflexion passive range of motion (DF PROM), the effects of a combination of the two interventions have not been identified. OBJECTIVE The aim of the present study was to compare the effects of gastrocnemius stretching combined with joint mobilization and gastrocnemius stretching alone. DESIGN A randomized controlled trial. METHODS In total, 24 individuals with limited ankle DF PROM were randomized to undergo gastrocnemius stretching combined with joint mobilization (12 feet in 12 individuals) or gastrocnemius stretching alone (12 feet in 12 individuals) for 5 min. Ankle kinematics during gait (time to heel-off and ankle DF before heel-off), ankle DF PROM, posterior talar glide, and displacement of the myotendinous junction (MTJ) of the gastrocnemius were assessed before and after the interventions. The groups were compared using two-way repeated measures analysis of variance. RESULTS/FINDINGS Greater increases in the time to heel-off and ankle DF before heel-off during gait and posterior talar glide were observed in the stretching combined with joint mobilization group versus the stretching alone group. Ankle DF PROM and displacement of the MTJ of the gastrocnemius were increased significantly after the interventions in both groups, with no significant difference between them. CONCLUSIONS These findings suggest that gastrocnemius stretching with joint mobilization needs to be considered to improve ankle kinematics during gait.
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Affiliation(s)
- Min-Hyeok Kang
- Department of Physical Therapy, Graduate School, INJE University, Gimhae, Gyeongsangnam-do, South Korea.
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, INJE University, Gimhae, Gyeongsangnam-do, South Korea.
| | - Oh-Yun Kwon
- Laboratory of Kinetic Ergocise based on Movement Analysis, Department of Physical Therapy, YONSEI University, Wonju, Gangwon-do, South Korea.
| | - Jong-Hyuk Weon
- Department of Physical Therapy, JOONGBU University, Chubu-myeon, Geumsan-gun, Chungcheongnam-do, South Korea.
| | - Duk-Hyun An
- Department of Physical Therapy, College of Biomedical Science and Engineering, INJE University, Gimhae, Gyeongsangnam-do, South Korea.
| | - Won-Gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, INJE University, Gimhae, Gyeongsangnam-do, South Korea.
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Rabin A, Kozol Z, Finestone AS. Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study. J Foot Ankle Res 2014; 7:48. [PMID: 25426172 PMCID: PMC4243387 DOI: 10.1186/s13047-014-0048-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/31/2014] [Indexed: 11/25/2022] Open
Abstract
Background Achilles tendinopathy (AT) is a prevalent condition among runners and military personnel. Although ankle dorsiflexion (DF) range of motion (ROM) as measured with the knee bent has not been previously associated with AT, the literature concerning its role is limited. In addition, the role of lower extremity movement pattern in the pathogenesis of AT has not been studied prospectively. The purpose of this study was to further explore the role of ankle DF ROM as measured with the knee bent and that of lower extremity movement pattern as risk factors for mid-portion AT. Methods Seventy healthy male military recruits (mean ± SD age, height and body mass of 19.6 ± 1.0 years, 176.0 ± 10.0 cm, and 71.5 ± 7.4 kg) participated in this study. Ankle DF ROM as measured with the knee bent in weight-bearing (WB) and non-weight-bearing (NWB), as well as lower extremity quality of movement during a lateral step down (LSD) test were measured at baseline. Participants were then followed for a 6-month period of army basic training with recording of the development of AT. Results Five participants developed AT during training. Participants that developed AT had a more limited NWB ankle DF ROM (27.40 versus 21.10, p = 0.025). The quality of lower extremity movement did not differ between injured and uninjured participants (p = 0.361). Conclusions A more limited ankle DF ROM as measured in NWB with the knee bent increases the risk of developing AT among military recruits taking part in intensive physical training.
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Affiliation(s)
- Alon Rabin
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Zvi Kozol
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Aharon S Finestone
- Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zerrifin, Israel ; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel ; Israel Defense Force Medical Corps, Haifa, Israel
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Rabin A, Kozol Z, Spitzer E, Finestone AS. Weight-bearing ankle dorsiflexion range of motion-can side-to-side symmetry be assumed? J Athl Train 2014; 50:30-5. [PMID: 25329350 DOI: 10.4085/1062-6050-49.3.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT In clinical practice, the range of motion (ROM) of the non involved side often serves as the reference for comparison with the injured side. Previous investigations of non-weight-bearing (NWB) ankle dorsiflexion (DF) ROM measurements have indicated bilateral symmetry for the most part. Less is known about ankle DF measured under weight-bearing (WB) conditions. Because WB and NWB ankle DF are not strongly correlated, there is a need to determine whether WB ankle DF is also symmetrical in a healthy population. OBJECTIVE To determine whether WB ankle DF is bilaterally symmetrical. A secondary goal was to further explore the correlation between WB and NWB ankle DF ROM. DESIGN Cross-sectional study. SETTING Training facility of the Israeli Defense Forces. PATIENTS OR OTHER PARTICIPANTS A total of 64 healthy males (age = 19.6 ± 1.0 years, height = 175.0 ± 6.4 cm, and body mass = 71.4 ± 7.7 kg). MAIN OUTCOME MEASURE(S) Dorsiflexion ROM in WB was measured with an inclinometer and DF ROM in NWB was measured with a universal goniometer. All measurements were taken bilaterally by a single examiner. RESULTS Weight-bearing ankle DF was greater on the nondominant side compared with the dominant side (P < .001). Non-weight-bearing ankle DF was not different between sides (P = .64). The correlation between WB and NWB DF was moderate, with the NWB DF measurement accounting for 30% to 37% of the variance of the WB measurement. CONCLUSIONS Weight-bearing ankle DF ROM should not be assumed to be bilaterally symmetrical. These findings suggest that side-to-side differences in WB DF may need to be interpreted while considering which side is dominant. The difference in bilateral symmetry between the WB and NWB measurements, as well as the only moderate level of correlation between them, suggests that both measurements should be performed routinely.
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Affiliation(s)
- Alon Rabin
- Department of Physiotherapy, Ariel University, Israel
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Immediate effect of walking with talus-stabilizing taping on ankle kinematics in subjects with limited ankle dorsiflexion. Phys Ther Sport 2014; 15:156-61. [DOI: 10.1016/j.ptsp.2013.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 12/26/2022]
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Baumbach SF, Brumann M, Binder J, Mutschler W, Regauer M, Polzer H. The influence of knee position on ankle dorsiflexion - a biometric study. BMC Musculoskelet Disord 2014; 15:246. [PMID: 25053374 PMCID: PMC4118219 DOI: 10.1186/1471-2474-15-246] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculus gastrocnemius tightness (MGT) can be diagnosed by comparing ankle dorsiflexion (ADF) with the knee extended and flexed. Although various measurement techniques exist, the degree of knee flexion needed to eliminate the effect of the gastrocnemius on ADF is still unknown. The aim of this study was to identify the minimal degree of knee flexion required to eliminate the restricting effect of the musculus gastrocnemius on ADF. METHODS Bilateral ADF of 20 asymptomatic volunteers aged 18-40 years (50% female) was assessed prospectively at six different degrees of knee flexion (0°, 20°, 30°, 45°, 60°, 75°, Lunge). Tests were performed following a standardized protocol, non weightbearing and weightbearing, by two observers. Statistics comprised of descriptive statistics, t-tests, repeated measurement ANOVA and ICC. RESULTS 20 individuals with a mean age of 27 ± 4 years were tested. No significant side to side differences were observed. The average ADF [95% confidence interval] for non weightbearing was 4° [1°-8°] with the knee extended and 20° [16°-24°] for the knee 75° flexed. Mean weightbearing ADF was 25° [22°-28°] for the knee extended and 39° [36°-42°] for the knee 75° flexed. The mean differences between 20° knee flexion and full extension were 15° [12°-18°] non weightbearing and 13° [11°-16°] weightbearing. Significant differences of ADF were only found between full extension and 20° of knee flexion. Further knee flexion did not increase ADF. CONCLUSION Knee flexion of 20° fully eliminates the ADF restraining effect of the gastrocnemius. This knowledge is essential to design a standardized clinical examination assessing MGT.
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Affiliation(s)
- Sebastian F Baumbach
- Department of Trauma Surgery - Campus Innenstadt, Munich University Hospital, Nussbaumstr, 20, 80336 Munich, Germany.
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Terada M, Harkey MS, Wells AM, Pietrosimone BG, Gribble PA. The influence of ankle dorsiflexion and self-reported patient outcomes on dynamic postural control in participants with chronic ankle instability. Gait Posture 2014; 40:193-7. [PMID: 24768526 DOI: 10.1016/j.gaitpost.2014.03.186] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/05/2014] [Accepted: 03/26/2014] [Indexed: 02/02/2023]
Abstract
We investigated the influence of ankle dorsiflexion range of motion (DF-ROM) and self-reported patient outcomes on dynamic postural control assessed with the Star Excursion Balance Test (SEBT) in individuals with chronic ankle instability (CAI). Twenty-nine participants with self-reported CAI volunteered. The primary outcome measurements were categorized into clinician-and patient-generated. Clinician-generated outcome measurements included anterior (SEBT-A), posteriormedial (SEBT-PM) and posteriorlateral (SEBT-PL) reach distances (cm) normalized by leg length (cm) of the SEBT, maximum weight-bearing dorsiflexion (WB-DF) (cm), and open-chain DF-ROM (°). Self-reported patient-generated outcome measures included the foot and ankle ability measure and the level of perceived pain, stiffness, stability, and function of their involved ankle on a 10-cm visual analog scale (VAS). Pearson product moment correlations were used to examine the relationship of the SEBT performances with DF-ROM and self-reported patient outcome measures. A multiple linear regression was performed to determine the influence of patient- and clinician-generated measures on the SEBT. SEBT-A performance was significantly and fairly correlated with WB-DF (r=0.410, p=0.014), perceived ankle stiffness (r=0.477, p=0.014), and open-chain DF-ROM (r=0.404, p=0.015). The strongest predictor of the variance in SEBT-A was the combination of the variance in WB-DF and VAS-stiffness (R2=0.348, p=0.004). There were no significant correlations with the SEBT-PM and SEBT-PL. WB-DF and VAS-stiffness may represent targets for intervention that need to be addressed to produce the best outcome in participants with CAI when altered dynamic postural control is detected on the SEBT-A.
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Affiliation(s)
- Masafumi Terada
- Musculoskeletal Health and Movement Science Laboratory, Department of Kinesiology, University of Toledo, Toledo, OH, United States.
| | - Matthew S Harkey
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ashley M Wells
- Musculoskeletal Health and Movement Science Laboratory, Department of Kinesiology, University of Toledo, Toledo, OH, United States
| | - Brian G Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Phillip A Gribble
- Musculoskeletal Health and Movement Science Laboratory, Department of Kinesiology, University of Toledo, Toledo, OH, United States
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