The effects of foam rolling on ankle dorsiflexion range of motion in healthy adults: A systematic literature review

BackgroundReduced ankle dorsiflexion is associated with lower limb injury and dysfunction, with static stretching mostly used to increase ankle range of motion. Foam rolling is an alternative intervention, shown to immediately increase ankle range of motion, while the long-term application has conflicting evidence.AimsTo assess the effects of single and multiple foam rolling interventions on ankle dorsiflexion range of motion in healthy adults and appraise the methodological quality of the included studies.DesignSystematic literature review.MethodsFive electronic databases were systematically searched to identify randomised controlled trials reporting the effects of foam rolling on ankle dorsiflexion. Data was extracted from studies that met the inclusion criteria and independently appraised by each reviewer using the PEDro scale.ResultsThirty-two articles were identified; six studies included foam rolling compared to other interventions on ankle dorsiflexion range of motion. Five of the six studies reported a significant increase (p < 0.05) in ankle dorsiflexion within groups compared to baseline measurements, after a single foam rolling intervention. One study found a significant within group increase in long-term effects after foam rolling on ankle dorsiflexion over seven weeks. The mean PEDro score for all studies was 6/10 indicating a high-quality level of evidence.ConclusionThere is strong evidence suggesting that foam rolling may be effective in increasing range of motion in a healthy adult population in the short term up to 30 min; however, definitive conclusions on long-term effects cannot be drawn due to a lack of evidence, with further research recommended.     

Effect of myofascial release on lower limb range of motion,sit and reach and horizontal jump distance in male university students

ObjectiveEvaluate the effects of Myofascial release (MR) on lower limb ROM, sit and reach and horizontal jump distance in male university students.Study designQuasi-experimental study.BackgroundMR is a technique that aims to stretch fascia to increase range of motion (ROM), relieve pressure points and improve performance. However, there is limited evidence of its actual effects on flexibility and physical performance.MethodsTwenty-one uninjured, male university students received MR (11 on the first session and the other 10 on the second session 24 h later), completed lower limb ROM assessments, the sit and reach and the horizontal jump tests in a randomized order. MR was performed before the tests with a myofascial stick in the anterior and posterior aspects of the right and left thigh and calf muscles. Each muscle group was massaged for 90 s, totaling 9 min of MR. The testing conditions with MR and without MR were compared using Student t-tests and the effect sizes (ES) were calculated.ResultsThere were no significant differences between the testing conditions on horizontal jump distance. However, the sit and reach distance (28 ± 9 vs. 32 ± 9 cm, p = 0.001; ES = 0.44), left hip extension (10 ± 2 vs. 8 ± 2°, p = 0.006; ES = 1.00) and left plantar flexion (36 ± 7 vs. 39 ± 7°, p = 0.044; ES = 0.43) were higher with MR.ConclusionsMR increased sit and reach distance, left hip extension and plantar flexion, but it did not affect horizontal jump distance in uninjured, male university students.     

Effects of foam rolling on performance and recovery: A systematic review of the literature to guide practitioners on the use of foam rolling

BackgroundFoam Rolling (FR) is currently used by athletes at all levels. It is not known whether FR is more effective being used as a warm up to aid performance or more effectively used as a cool-down for recovery. Therefore, the purpose of this systematic review was to determine the effects of FR on performance and recovery.MethodsA customized search strategy was conducted to search seven electronic databases: Google Scholar; Science Direct; Pubmed Central; Pubmed; ISI Web of Science; Medline and Scopus. The database search was limited to journals published in English between January 2006 and June 2019. Any study design, for example, cross-over, repeated measures, randomized-control trials, was considered, as long as one of the interventions was using a FR. Studies that tested FR combined with other techniques were also considered, as long as one of the conditions was FR only.ResultsA total of 49 articles met the inclusion criteria.ConclusionFR may reduce muscle stiffness and increase ROM and should be used in combination with dynamic stretching and active warm-up before a training session. Furthermore, the optimum dosage to achieve these flexibility benefits seems to be a total 90s–120s of FR. FR reduced DOMS and increased PPT, and therefore may optimize recovery from training. Future studies on the effects of FR should include true controls or sham groups, and consider the FR experience of the athlete.Systematic Review RegistrationPROSPERO – CRD42017064976.     

The effect of talocrural joint manipulation on range of motion at the ankle

OBJECTIVE: To determine whether a single high-velocity, low-amplitude thrust manipulation to the talocrural joint altered ankle range of motion. DESIGN: A randomized, controlled and blinded study. SUBJECTS: Asymptomatic male and female volunteers (N = 41). METHODS: Subjects were randomly assigned into either an experimental group (n = 20) or a control group (n = 21). Both ankles of subjects in the experimental group were manipulated by using a single high-velocity, low-amplitude thrust to the talocrural joint. Pretest and posttest measurements of passive dorsiflexion range of motion were taken. RESULTS: No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects. A significantly greater pretest dorsiflexion range of motion existed in those ankles in which manipulation produced an audible cavitation. CONCLUSION: Manipulation of the ankle does not increase dorsiflexion range of motion in asymptomatic subjects. Ankles that displayed a greater pretest range of dorsiflexion were more likely to cavitate, raising the possibility that ligament laxity may be associated with the tendency for ankles to cavitate.     

The effect of foam rollers of varying densities on range of motion recovery

ObjectiveThis study aimed to compare the effect of different density foam rollers on range of motion recovery.MethodTen active men completed two, 3-day trials in random order. During the experimental trials, all participants performed 2 min of foam rolling (FR) using a medium-density (medium trial) or hard-density (hard trial) foam roller on the right posterior thigh after completing the 90-min Loughborough Intermittent Shuttle Test (LIST). The hip joint range of motion (ROM), muscle hardness, and muscle soreness were assessed before and after the LIST and at 0 min, 20 min, 60 min, 24 h, and 48 h after FR intervention. Serum creatine kinase (CK) concentrations were assessed before the LIST and at 60 min, 24 h, and 48 h after FR intervention. The contralateral leg in each trial was used as a control.ResultsThe ROM at 0 min, 20 min, 60 min, 24 h, and 48 h after FR intervention were higher in the right leg (the massage leg) than in the left leg (the contralateral leg) (p < 0.05). In the right leg, the ROM at 0 min after FR intervention was higher than after the LIST (p < 0.05). There were no significant differences between the medium and hard trials for ROM. Muscle hardness, muscle soreness, and serum CK concentration were not affected by FR.ConclusionFR has a positive effect on ROM recovery. Moreover, the two roller densities provided similar ROM recovery.     

Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain

Restrictions in ankle dorsiflexion range of motion (ROM) have been associated with decreased posterior talar glide in individuals with an acute lateral ankle sprain. Talocrural joint mobilizations may be used to restore joint arthrokinematics. Our purpose was to examine the effects of a single bout of anterior to posterior (AP) talocrural joint mobilization on self-reported function, dorsiflexion ROM, and posterior talar translation in individuals with an acute lateral ankle sprain. This single-blinded, randomized controlled trial utilized 17 volunteers (nine treatment and eight control) with an acute lateral ankle sprain (grade I/II) who were immobilized for a period of 1–7 days. The treatment group received a single 30-second bout of grade III AP talocrural joint mobilization the day their immobilization device was removed, while the control group did not receive any intervention. Active dorsiflexion ROM and posterior talar translation were assessed before, immediately after, and 24 hours after receipt of the treatment or control interventions. Self-reported function and pain were assessed before and 24 hours after the receipt of the treatment or control interventions using the foot and ankle disability index. Collectively all groups demonstrated improved dorsiflexion ROM and self-reported function. There was a significant decrease in pain perception at 24-hour follow-up for the treatment group. A single bout of AP talocrural joint mobilizations may not have an immediate effect on ankle dorsiflexion ROM, posterior talar translation, or self-reported function; however, they may have an immediate effect on pain perception in individuals with an acute lateral ankle sprain.     

The effects of walking speed on forefoot,hindfoot and ankle joint motion

BackgroundFoot and ankle joint kinematic differences have been identified between healthy subjects and subjects with various pathologies suffering from foot and ankle impairments. Changes in temporal factors such as walking speed and double stance time are also found in these pathological conditions. As such, in theory, these factors would also influence the kinematics and hence make it difficult to ascertain the effects of the disease on the kinematics. The aim of this study was to analyse foot and ankle kinematics from gait recordings of healthy subjects walking at comfortable and slower speeds.MethodsGait patterns of 14 healthy subjects were recorded. The subjects were first asked to walk at a comfortable speed and then at predefined speeds of 75% and 50% of their comfortable walking speed respectively. Temporal variables were calculated. Foot and ankle joint kinematics were determined from marker-recordings.FindingsThe subjects walked at mean velocities of 1.28 m/s, 0.97 m/s and 0.65 m/s. With decreasing walking speed the minimum tibio-talar plantar-flexion and maximum hallux dorsi-flexion at toe-off decreased significantly between 3° and 9°. The minimum medial arch at toe-off and minimum midfoot supination at mid-stance were significantly affected by the walking speed. The corresponding individual session differences were small (1°–2°), but the reliability was high and hence the differences were considered clinically relevant.InterpretationWalking speed significantly affected foot and ankle kinematics. Studies aiming to improve the understanding of the effects of foot and ankle pathologies on foot and ankle kinematics should take the walking speed into account.     

Acute effects of stretching duration on the range of motion of elderly women

The effect of the duration of static stretching as well as that of multiple stretches in acute stretching protocols has not been extensively examined in the elderly. The aim of the present study was to investigate the acute effects of stretching duration on the range of motion (ROM) of the lower extremities and the trunk in elderly women, when stretching is performed once or in multiple repetitions while controlling the total amount of the time spent in one stretching session. Twenty sedentary subjects aging 65–85 years old (mean age=75.9) participated in this study. Subjects were recruited through advertisements in the local newspapers, as well as by word to mouth. Participants were healthy with no history of musculoskeletal or neurological disease. Subjects performed three static stretching protocols lasting for 60 s each, in non-consecutive training sessions. The first stretching protocol comprised of a 60 s stretch (1×60), the second of two 30 s stretches (2×30), whereas the third was of four 15 s stretches (4×15). ROM was determined during hip flexion, extension and abduction, knee flexion, and ankle dorsiflexion for the right and left side of the body, as well as during trunk flexion, using a flexometer and a goniometer. A mixed within—and between—subjects analysis of variance (ANOVA) with repeated measures revealed similar ROM values between both sides of the body, for all measured joints. No significant differences were observed between the stretching protocols. Further statistical analysis indicated significant (P<0.001) improvements after the stretching exercises, in all flexibility protocols. The findings suggest that a single 60-s static stretch of the lower extremities and trunk's muscles produced the same effect as two 30 s and four 15 s stretches, during a flexibility training session involving sedentary elderly women.     

Effect of maintained stretch on the range of motion of the human ankle joint

The effectiveness of maintained stretch in expanding the range of motion of the human ankle joint was assessed in a population of normal adults. Controlled movements were imposed upon the ankle, and triceps surae and tibialis anterior electromyograms were monitored to ensure that only passive joint properties generated ankle torque. We found that a majority of subjects (7 of 12) showed evidence of muscle activity sufficient to distort a subjective assessment of changes in range of motion. For the remaining five subjects, a 60-s maintained stretch produced a small decrease in the torque subsequently generated by an imposed dorsiflexing movement, but this effect was transient and largely disappeared following 300 s of rest at a neutral position. This short-term effect is consistent with the viscoelastic properties of collagenous material stretched during such treatment and is unlikely to lead to long-term increases in range of motion. RELEVANCE: The results of these experiments indicate that subjective assessments of changes in joint range of motion may be distorted by voluntary and reflexive muscle activation. Moreover the presumed increases in range of motion produced by maintained stretch in our normal subjects were small and transient. These results suggest that future assessments of the long-term efficacy of this treatment must monitor muscle activity and take into account known viscoelastic properties of collagenous materials.     

Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits

This study investigated effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on relative risk of selected injuries in 1093 male Army recruits undertaking 12 weeks of intensive training. Prior to training, ankle dorsiflexion range was measured and recruits were allocated to stretch and control groups using a quasi-random procedure. The stretch group stretched calf muscles under supervision prior to all intense exercise. The control group stretched upper limb muscles instead. Forty-eight injuries were recorded. Survival analysis indicated that ankle dorsiflexion range was a strong predictor of injury (p = 0.03). Definitive evidence of an effect of stretching on injury risk was not found (p = 0.76), but the sample size may have been insufficient to detect such an effect.     

Soleus muscle electromyographic activity and ankle dorsiflexion range of motion during four stretching procedures

Volitional muscle contractions are used frequently in some combination with muscle stretching to promote muscle relaxation and to increase range of motion. In this study, muscle lengthening procedures were evaluated in the ankle plantar flexors. Four soleus muscle stretching procedures--static stretch (SS), hold relax (HR) (isometric plantar flexor contraction before stretch), agonist contract (AC) (dorsiflexor contraction assisting stretch), and hold relax-agonist contraction (HR-AC)--were performed in the sagittal plane by 12 physically active adults. The dorsiflexion angle, soleus muscle electromyogram, and soleus muscle motoneuron excitability as determined by the Hoffmann-reflex (H-reflex) amplitude were measured throughout the duration of each stretch. The range of dorsiflexion achieved at the end of the stretch did not differ significantly between stretching procedures, although in 8 of the 12 subjects and in the subject group as a whole, the AC and HR-AC procedures were associated with higher levels of soleus muscle EMG than the levels in the SS and HR procedures (p less than .01). The H-reflex amplitudes during the AC and HR-AC procedures were smaller than the amplitudes during the SS and HR procedures (p less than .001), suggesting the possibility of reciprocal inhibition during the agonist contraction. Increased tonic EMG levels produced by input from other neural pathways affecting alpha motoneurons in the AC and HR-AC procedures may have masked this inhibitory reflex. In healthy adults, a complicated procedure, involving muscle contractions for decreasing active resistance to stretch, may be unnecessary because active resistance to stretch is minimal and muscle relaxation during stretch appears to have little or no direct effect on the ROM achieved.     

The effects of ankle bracing on motion of the knee and the hip joint during trunk rotation tasks

BACKGROUND: The use of prophylactic ankle braces is common during athletic activities since the ankle is one of the most commonly injured joints. Past studies have focused on the effects of ankle braces on ankle movement restriction, preventing injuries, proprioception, balance and athletic performance. However, the influence of ankle restriction on other joints has not been studied. The constraint of ankle movement may lead to an increased loading on the knee joint, which could be a potential risk of knee injuries during athletic activities. The primary goal of the current study was to determine quantitatively the effect of an ankle brace on the knee axial rotation during two different trunk turning tasks. METHODS: Ten healthy subjects performed trunk turning movements while standing on one leg: turning sideways to catch a ball and turning sideways to touch a target with the shoulder. The tasks were performed with and without an ankle brace worn on the supporting leg. The trunk axial rotation in reference to the floor and three dimensional joint angular motions of the ankle, knee and hip were determined. FINDINGS: The use of an ankle brace resulted in reduced trunk axial rotation during the ball catching tasks, and increased knee axial rotation during the target touching tasks. INTERPRETATION: The results of this study showed that the effect of the ankle brace on the knee axial rotation depended on the context of the tasks performed. Under situations that required forceful trunk turning movement while standing on a single leg, the ankle braces may cause an increase in the knee axial rotation indicating higher risk of knee injury.     

Immediate effect of foam roller on pain and ankle range of motion in patients with plantar fasciitis: A randomized controlled trial

Background:Stretching has been proven to be effective on pain and range of motion (ROM) in patients with plantar fasciitis. Despite recent gain in popularity and the proposed theories of effectiveness of foam roller, there is a lack of literature on the effect of foam rolling on plantar fasciitis.Objective:The objective of this study was to compare the effects of foam rolling and stretching on pain and ankle ROM in patients with plantar fasciitis.Methods:A total of 50 participants were included and randomly allocated to the stretching and foam roller groups. Visual analog scale (VAS), pressure pain thresholds (PPTs) for gastrocnemius, soleus and plantar fascia and weight-bearing lunge test (WBLT) measurements were recorded at baseline and immediately after treatment.Results:Within-group analysis has shown there is a statistically significant difference (p<0.001) in all the outcome measures in both foam roller and self-stretching groups. The between-groups analysis showed no statistical significance difference in VAS, plantar fascia PPT and WBLT parameters (with p-values of 0.171, 0.372 and 0.861, respectively); however, significant differences were found in gastrocnemius PPT (p=0.029) and soleus PPT (p=0.013).Conclusion:It was seen that both stretching and foam rolling techniques helped in reducing pain and increasing the ROM. However, the effectiveness of foam roller was superior to stretching in terms of increase in PPTs at gastrocnemius and soleus.Clinical Trial Registration No:CTRI/2018/01/011398.Name of registry:The Clinical Trials Registry — India (CTRI); https://ctri.nic.in.     

The influence of gastrocnemius stretching combined with joint mobilization on weight-bearing ankle dorsiflexion passive range of motion

[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.Key words: Gastrocnemius stretching, Talocrural joint mobilization, Weight-bearing ankle dorsiflexion     

Determination of consistent patterns of range of motion in the ankle joint with a computed tomography stress-test

Background

Measuring the range of motion of the ankle joint can assist in accurate diagnosis of ankle laxity. A computed tomography-based stress-test (3D CT stress-test) was used that determines the three-dimensional position and orientation of tibial, calcaneal and talar bones. The goal was to establish a quantitative database of the normal ranges of motion of the talocrural and subtalar joints. A clinical case on suspected subtalar instability demonstrated the relevance the proposed method.

Methods

The range of motion was measured for the ankle joints in vivo for 20 subjects using the 3D CT stress-test. Motion of the tibia and calcaneus relative to the talus for eight extreme foot positions were described by helical parameters.

Findings

High consistency for finite helical axis orientation (n) and rotation (θ) was shown for: talocrural extreme dorsiflexion to extreme plantarflexion (root mean square direction deviation (η) 5.3° and θ: SD 11.0°), talorucral and subtalar extreme combined eversion–dorsiflexion to combined inversion–plantarflexion (η: 6.7°, θ: SD 9.0° and η:6.3°, θ: SD 5.1°), and subtalar extreme inversion to extreme eversion (η: 6.4°, θ: SD 5.9°). Nearly all dorsi – and plantarflexion occurs in the talocrural joint (θ: mean 63.3° (SD 11°)). The inversion and internal rotation components for extreme eversion to inversion were approximately three times larger for the subtalar joint (θ: mean 22.9° and 29.1°) than for the talocrural joint (θ: mean 8.8° and 10.7°). Comparison of the ranges of motion of the pathologic ankle joint with the healthy subjects showed an increased inversion and axial rotation in the talocrural joint instead of in the suspected subtalar joint.

Interpretation

The proposed diagnostic technique and the acquired database of helical parameters of ankle joint ranges of motion are suitable to apply in clinical cases.     

Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis

Background and purpose

Patients with hip osteoarthritis have impairments in muscle function (muscle strength and power) and hip range of motion (ROM), and it is commonly believed that effective clinical management of osteoarthritis should address these impairments to reduce pain and disability. Therefore, the purpose of this study was to compare the short‐ and long‐term effects of 4 months of physiotherapist‐supervised strength training, physiotherapist‐supervised Nordic Walking (NW), or unsupervised home‐based exercise (HBE) on muscle function and hip ROM in patients diagnosed with hip osteoarthritis.

Methods

Secondary outcome analyses from an observer‐blinded three‐armed parallel‐design randomized controlled trial in 60+‐year‐old patients with clinical hip osteoarthritis (American College of Rheumatology criteria) who were not on a waiting list for hip replacement. One hundred and fifty‐two patients were randomized to either 4 months of physiotherapist‐supervised, moderate, progressive, strength training (n = 50), physiotherapist‐supervised NW (n = 50), or unsupervised HBE (n = 52). Maximal isometric hip and thigh muscle strength and leg extensor power and active hip ROM were assessed at baseline 2, 4, and 12 months.

Results

Intention‐to‐treat‐analyses did not show any significant between‐group differences for improvements in muscle strength and power or ROM at any time points. Short‐term significant (p < .05) increases in muscle strength were present in the physiotherapist‐supervised exercise groups and in the long‐term for muscle power in the NW‐group. All exercise modes resulted in significant increases of ROM but long‐term improvements were only shown for NW and HBE.

Discussion

Four months of physiotherapist‐supervised, progressive, moderate, and strength training was less effective than hypothesized for improving muscle strength and power in patients with hip osteoarthritis who are not awaiting hip replacement. Our results may indicate that in these patients, improvements in disability are not necessarily dependent on improvements in strength and power or ROM.     

The influence of fascial manipulation on function,ankle dorsiflexion range of motion and postural sway in individuals with chronic ankle instability

BackgroundProprioceptive deficits may attribute to functional Chronic ankle instability (CAI) with impairments in balance and postural control. Physical therapy interventions such as taping, bracing, manual therapy, and balance training play an essential role in managing ankle instabilities. Fascial Manipulation (FM) is a manual therapy technique considered to restore function by improving the joint range of motion and proprioception. However, the effects of FM on Ankle dorsiflexion range of motion (ADROM) and postural sway in athletes with chronic ankle instability are unclear.ObjectiveThis study aims to determine the effect of FM on function, ADROM, and Postural sway in athletes with CAI.DesignSingle group, pretest-posttest design.MethodsIndividuals with a history of recurrent ankle sprains with the Cumberland ankle instability tool (CAIT) score of ≤27 were included. FM was applied to the painful and densified center of coordination points on the lower limb myofascial lines based on Stecco's FM method. The outcomes measures include Foot and ankle disability index (FADI), ADROM during the weight-bearing lunge, and postural sway (excursion of the center of pressure during single limb stance).ResultsThere was a significant improvement in the FADI scores (Z = −3.626, p < 0.05), ADROM [F (2)=38.056, p<0.05], ηp ² = 0.69 following FM. However, the center of pressure excursion with both opened and closed eyes showed no differences following FM.ConclusionSince fascial manipulation had shown improvement in the function and ankle dorsiflexion range, it can be used as an adjunct treatment strategy in CAI management.     

The effects of Kinesio taping on muscle tone in healthy subjects: A double-blind,placebo-controlled crossover trial

Kinesio taping (KT) has been proposed to modulate muscle tone. However no studies have systematically studied the efficacy of KT on this primary outcome measure. The objective of this study was to determine the effect of Kinesio taping (KT) applied over the gastrocnemius muscles on muscle tone, extensibility, electromyography (EMG) and strength. Nineteen healthy subjects were enrolled in a double-blind, placebo-controlled crossover trial. KT and sham-tape were applied onto the gastrocnemius muscles of all subjects in two randomized sessions. Measurements before, at 10 min and 24 h after the intervention were taken. Outcome measurements included passive resistive torque to ankle dorsiflexion, dorsiflexion passive range of motion (PROM), surface Gastrocnemius Medialis (GM) EMG and maximal isometric voluntary force (MIVF). No significant differences were found between the sham-tape and KT groups for passive resistive torque, PROM nor maximal plantarflexion isometric voluntary force. A short-term increase of GM EMG activity was found in the KT group during the PROM mobilization, which was not maintained at 24 h following treatment. A short-term decrease in dorsiflexion force was produced 10 min after KT with respect to sham-tape application. These results demonstrate that the application of KT in the gastrocnemius muscles has no effect on healthy muscle tone, extensibility nor strength. However a short-term increase of GM EMG activity after KT treatment suggests the activation of central nervous system mechanisms, although without a therapeutic implication. Further studies with more appropriate designs are needed to clarify the physiological and therapeutic effects of this taping technique.     

The initial safe range of motion of the ankle joint after three methods of internal fixation of simulated fractures of the medial malleolus

BACKGROUND: Previous studies have demonstrated the safe passive range of ankle motion for inter-bone stiffness after internal fixation under load but there is a lack of information about the safe range of ankle motion for early rehabilitation in the absence of loading. The present study was designed to assess the effect of ankle movement on inter-bone displacement characteristics of medial malleolus fractures following three types of internal fixation to determine the safe range of motion. METHODS: Five lower legs obtained during autopsy were used to assess three types of internal fixation (two with Kirschner-wires alone; two with Kirschner-wires plus tension band wiring; and, one with an AO/ASIF malleolar screw alone). Following a simulated fracture by sawing through the medial malleolus the displacement between the fractured bone ends was measured during a passive range of movement with continuous monitoring using omega (Omega) shaped transducers and a biaxial flexible goniometer. Statistical analysis was performed with repeated measures analysis of variance. FINDINGS: Inter-bone displacement was not proportional to the magnitude of movement throughout the range of ankle motion as, when separation exceeded 25 microm, there was increasingly wide separation as plantar-flexion or dorsal-flexion was increased. There was no statistical significant difference between the small amount of inter-bone displacement observed with three types of fixation within the safe range of dorsal-flexion and plantar-flexion for early rehabilitation. However the inter-bone separation when fixation utilized two Kirschner-wires alone tended to be greater than when using the other two types of fixation during dorsal-flexion and eversion. INTERPRETATION: The present study revealed a reproducible range of ankle motion for early rehabilitation which was estimated to be within the range of 20 degrees of dorsal-flexion and 10 degrees of plantar-flexion without eversion. Also, internal fixation with two Kirschner-wires alone does not seem to provide stability achieved by the other two forms of fixation.     

The effects of Mobilization with Movement on dorsiflexion range of motion,dynamic balance,and self-reported function in individuals with chronic ankle instability

Previous studies have examined the effectiveness of a manual therapy intervention known as Mobilization with Movement (MWM) to increase dorsiflexion range of motion (ROM) in individuals with chronic ankle instability (CAI). While a single talocrural MWM treatment has increased dorsiflexion ROM in these individuals, examining the effects of multiple treatments on dorsiflexion ROM, dynamic balance, and self-reported function would enhance the clinical application of this intervention. This study sought to determine if three treatment sessions of talocrural MWM would improve dorsiflexion ROM, Star Excursion Balance Test (SEBT) reach distances, and self-reported function using the Foot and Ankle Ability Measure (FAAM) in individuals with CAI. Eleven participants with CAI (5 Males, 6 Females, age: 21.5 ± 2.2 years, weight: 83.9 ± 15.6 kg, height: 177.7 ± 10.9 cm, Cumberland Ankle Instability Tool: 17.5 ± 4.2) volunteered in this repeated-measures study. Subjects received three MWM treatments over one week. Weight-bearing dorsiflexion ROM (cm), normalized SEBT reach distances (%), and self-reported function (%) were assessed one week before the intervention (baseline), prior to the first MWM treatment (pre-intervention), and 24–48 h following the final treatment (post-intervention). No significant changes were identified in dorsiflexion ROM, SEBT reach distances, or the FAAM-Activities of Daily Living scale (p > 0.05). Significant changes were identified on the FAAM-Sport (p = 0.01). FAAM-Sport scores were significantly greater post-intervention (86.82 ± 9.18%) compared to baseline (77.27 ± 11.09%; p = 0.01) and pre-intervention (79.82 ± 13.45%; p = 0.04). These results indicate the MWM intervention did not improve dorsiflexion ROM, dynamic balance, or patient-centered measures of activities of daily living. However, MWM did improve patient-centered measures of sport-related activities in individuals with CAI.