A weightbearing technique for the measurement of ankle joint dorsiflexion with the knee extended is reliable.
ABSTRACT Measurement of ankle joint dorsiflexion is routinely undertaken by clinicians who manage lower limb musculoskeletal pathology. This study aimed to determine the reliability of a technique to measure ankle joint dorsiflexion in a weightbearing position with the knee extended. Four raters with varying clinical experience measured ankle joint dorsiflexion in a weightbearing position with the knee extended on 30 asymptomatic participants. Measurements occurred on two occasions, 1 week apart using (i) a digital inclinometer and (ii) a clear acrylic plate apparatus. Intraclass correlation coefficients (ICCs) and 95% limits of agreement (LOAs) were calculated. Intra-rater reliability of the experienced raters was high for both the digital inclinometer (average ICC=0.88, average 95% LOA=-6.6 degrees to 4.8 degrees ) and the clear acrylic plate apparatus (average ICC=0.89, average 95% LOA=-7.2 degrees to 4.3 degrees ). Intra-rater reliability of the inexperienced rater was good to high for both the digital inclinometer (ICC=0.77, 95% LOA=-9.1 degrees to 8.3 degrees ) and the clear acrylic plate apparatus (ICC=0.89, 95% LOA=-8.1 degrees to 4.6 degrees ). Inter-rater reliability was high for both the digital inclinometer (ICC=0.95, 95% LOA=-5.7 degrees to 5.7 degrees ) and the clear acrylic plate apparatus (ICC=0.97, 95% LOA=-4.7 degrees to 4.7 degrees ). Measurements of ankle dorsiflexion in a weightbearing position with the knee extended can be performed reliably by experienced and inexperienced raters. However, the reliability of this measurement technique needs to be interpreted in the context of the purpose for which the measurement is intended.
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ABSTRACT: Calf muscle stretching programs are used to increase dorsiflexion range of motion at the ankle, yet the effects of the stretching programs on the passive properties of aged calf muscles and on standing and ambulatory function have not been studied. This initial study examined the effects of an eight-week stretching program on the passive-elastic properties of the calf muscles of older women and on selected functional activities. Nineteen women aged 65-89 years with limited dorsiflexion range of motion first completed a timed agility course, a timed 10-m walk and a standing functional reach test. A dynamometer then moved the right ankle from plantarflexion to maximal dorsiflexion and back to plantarflexion at 5 deg s(-1) to measure calf muscle passive properties. The women were randomly assigned to a group that stretched three-times a week for eight-weeks (n=10) or to a control group (n=9) that did not. The tests were repeated after the stretching program. The stretching group showed increased maximal dorsiflexion range of motion, passive resistive forces (Newtons [N]), and the absorbed and retained passive-elastic energy (deg N) (P<0.05). They also had decreased times for the agility course and the 10-m walk (P<0.05). The functional reach test did not change for either group. The eight-week stretching program most likely increased the maximal length, length extensibility and passive resistive forces of the calf muscles. Adaptations of other ankle and leg structures also may have contributed. The passive adaptations were associated with enhanced performances of ambulatory functional activities.Clinical Biomechanics 12/2005; 20(9):973-83. · 1.87 Impact Factor
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ABSTRACT: The amount of mechanical energy transferred by two-joint muscles between leg joints during squat vertical jumps, during landings after jumping down from a height of 0.5 m, and during jogging were evaluated experimentally. The experiments were conducted on five healthy subjects (body height, 1.68-1.86 m; and mass, 64-82 kg). The coordinates of the markers on the body and the ground reactions were recorded by optical methods and a force platform, respectively. By solving the inverse problem of dynamics for the two-dimensional, four-link model of a leg with eight muscles, the power developed by the joint (net muscular) moments and the power developed by each muscle were determined. The energy transferred by two-joint muscles from and to each joint was determined as a result of the time integration of the difference between the power developed at the joint by the joint moment, and the total power of the muscles serving a given joint. It was shown that during a squat vertical jump and in the push-off phase during running, the two-joint muscles (rectus femoris and gastrocnemius) transfer mechanical energy from the proximal joints of the leg to the distal ones. At landing and in the shock-absorbing phase during running, the two-joint muscles transfer energy from the distal to proximal joints. The maximum amount of energy transferred from the proximal joints to distal ones was equal to 178.6 +/- 45.7 J (97.1 +/- 27.2% of the work done by the joint moment at the hip joint) at the squat vertical jump. The maximum amount of energy transferred from the distal to proximal joints was equal to 18.6 +/- 4.2 J (38.5 +/- 36.4% of work done by the joint moment at the ankle joint) at landing. The conclusion was made that the one-joint muscles of the proximal links compensate for the deficiency in work production of the distal one-joint muscles by the distribution of mechanical energy between joints through the two-joint muscles. During the push-off phase, the muscles of the proximal links help to extend the distal joints by transferring to them a part of the generated mechanical energy. During the shock-absorbing phase, the muscles of the proximal links help the distal muscles to dissipate the mechanical energy of the body.Journal of Biomechanics 02/1994; 27(1):25-34. · 2.72 Impact Factor
Article: Isolated gastrocnemius tightness.[show abstract] [hide abstract]
ABSTRACT: Contracture of the gastrocnemius-soleus complex has well-documented deleterious effects on lower-limb function in spastic or neurologically impaired individuals. There is scarce literature, however, on the existence of isolated gastrocnemius contracture or its impact in otherwise normal patients. We hypothesized that an inability to dorsiflex the ankle due to equinus contracture leads to increased pain in the forefoot and/or midfoot and therefore a population with such pain will have less maximum ankle dorsiflexion than controls. We further postulated that the difference would be present whether the knee was extended or flexed. This investigation was a prospective comparison of maximal ankle dorsiflexion, as a proxy for gastrocnemius tension, in response to a load applied to the undersurface of the foot in two healthy age, weight, and sex-matched groups. The patient group comprised thirty-four consecutive patients with a diagnosis of metatarsalgia or related midfoot and/or forefoot symptoms. The control group consisted of thirty-four individuals without foot or ankle symptoms. The participants were clinically examined for gastrocnemius and soleus contracture and were subsequently assessed for tightness with use of a specially designed electrogoniometer. Measurements were made both with the knee extended (the gastrocnemius under tension) and with the knee flexed (the gastrocnemius relaxed). With the knee fully extended, the average maximal ankle dorsiflexion was 4.5 degrees in the patient group and 13.1 degrees in the control group (p < 0.001). With the knee flexed 90 degrees, the average was 17.9 degrees in the patient group and 22.3 degrees in the control population (p = 0.09). When gastrocnemius contracture was defined as dorsiflexion of < or = 5 degrees during knee extension, it was identified in 65% of the patients compared with 24% of the control population. However, when gastrocnemius contracture was defined as dorsiflexion of < or = 10 degrees, it was present in 88% and 44%, respectively. When gastrocnemius-soleus contracture was defined as dorsiflexion of < or = 10 degrees with the knee in 90 degrees of flexion, it was identified in 29% of the patient group and 15% of the control group. On the average, patients with forefoot and/or midfoot symptoms had less maximum ankle dorsiflexion with the knee extended than did a control population without foot or ankle symptoms. When the knee was flexed 90 degrees to relax the gastrocnemius, this difference was no longer present. Clinical Relevance: These findings support the existence of isolated gastrocnemius contracture in the development of forefoot and/or midfoot pathology in otherwise healthy people. These data may have implications for preventative and therapeutic care of patients with chronic foot problems.The Journal of Bone and Joint Surgery 06/2002; 84-A(6):962-70. · 3.23 Impact Factor