Effect of ankle dorsiflexion on displacement and strain in the tibial nerve and biceps femoris muscle at the posterior knee during the straight leg raise: Investigation of specificity of nerve movement

BackgroundA structural differentiation maneuver has been proposed to differentiate between muscle and nerve involvement during the straight leg raise test. However, to date, the mechanical specificity of this maneuver for the tibial nerve at the posterior knee has not been tested. The aim of this study was to investigate the specificity of ankle dorsiflexion as a differentiation maneuver between the tibial nerve and the biceps femoris muscle at the posterior knee during the straight leg raise in cadavers.MethodsA cross-sectional study was carried out. In fresh frozen cadavers, with microstrain devices and Vernier calipers, strain and excursion in the tibial nerve and distal biceps femoris muscle were measured during ankle dorsiflexion at 0°, 30°, 60° and 90° of hip flexion of the straight leg raise.FindingsAnkle dorsiflexion resulted in significant distal excursion and increased strain in the tibial nerve (p < 0.05) whilst the muscle was not affected by the dorsiflexion (p > 0.05) at all hip flexion angles.InterpretationAnkle dorsiflexion was mechanically specific between the tibial nerve and biceps femoris during the straight leg raise. This study adds to evidence that, in certain circumstances, dorsiflexion may be used in differentiation of nerve and muscle disorders in the posterior knee.     

Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial

ObjectivesTo determine the efficacy of IASTM of the gastrocnemius-soleus complex in comparison to a traditional stretching intervention on dorsiflexion ROM.MethodsSixty healthy participants were randomly allocated to one of 3 groups: IASTM (n = 20), stretching (n = 20), or control group (n = 20). The dependent variables for this study was dorsiflexion range of motion (ROM) via three measurement methods which included Modified root position 1- knee extended (MRP1), Modified root position 2- knee flexed (MRP2), and weight bearing lunge test (WBLT). A multivariate analysis of variance (MANOVA) was utilized to analyze the ROM differences between the groups (IASTM, stretching, and control groups), with a post-hoc Tukey and pairwise least significant difference tests to assess individual pairwise differences between the groups.ResultsThe MANOVA found significant ROM differences between the three intervention groups (F_6,110 = 2.40, p = .032). Statistically significant differences were identified between both the IASTM and control as well as the stretching and control group through the WBLT and MRP2 assessments, but not in the MRP1 assessment. Further, there was no statistically significant difference between the IASTM and stretching groups using any of the three methods.ConclusionA single session of IASTM or stretching increased ankle dorsiflexion ROM in WBLT and MRP2. No significant difference was noted in the MRP1. Both IASTM and stretching appear to have a greater effect on soleus muscle flexibility as evidenced by ROM gains measured with the knee in a flexed position. No clinically significant difference was identified between the intervention groups in weight-bearing conditions; thus empowering patients with the use of self-stretching would seemingly be reasonable and efficient. Combined effects of stretching and IASTM warrant further investigation for increasing dorsiflexion range of motion as a summative effect is unknown.     

Does microcurrent stimulation increase the range of movement of ankle dorsiflexion in children with cerebral palsy?

Aim:?To determine whether microcurrent stimulation (MENS) increases the range of motion (ROM) of the ankle joint in children with cerebral palsy.

Design:?Twelve children with spastic hemiplegia (age range 4.5 to 16 years) with moderate myocontracture of the triceps surae, received MENS for 1?h five times a week for 4 weeks. An equally long baseline period was preceded. The assessments were: active and passive ROM of ankle dorsiflexion, popliteal flexion and ankle dorsiflexion in maximal flexion of knees in standing position while maintaining the heels in contact with the floor, one foot standing and hopping on one foot.

Results:?After the treatment with MENS, the passive ROM of ankle dorsiflexion with both knees flexed and extended (p?<?0.001) increased significantly. Increases were also observed in popliteal flexion (p?<?0.001) and ankle dorsiflexion (p?=?0.0012) during maximal flexion of the knees in a standing position. The ROM of active dorsiflexion with the knee flexed (p?<?0.05) and one foot standing (p?<?0.05) also improved. Children and parents found this treatment easy to carry out.

Conclusions:?MENS relieves myocontracture and can enhance conventional rehabilitation programmes for children with cerebral palsy.     

The Single Leg Squat Test: A “Top-Down” or “Bottom-Up” Functional Performance Test?

BackgroundMedial knee deviation (MKD) during the single leg squat test (SLST) is a common clinical finding that is often attributed to impairments of proximal muscular structures. Investigations into the relationship between MKD and the foot and ankle complex have provided conflicting results, which may impact clinicians’ interpretation of the SLST.PurposeThe purpose of this study was to compare ankle dorsiflexion range of motion (ROM) and foot posture in subjects that perform the SLST with MKD (fail) versus without MKD (pass).HypothesisThere will be a difference in ankle dorsiflexion ROM and/or foot posture between healthy individuals that pass and fail the SLST for MKD.Study DesignCross-sectional study.MethodsSixty-five healthy, active volunteers (sex = 50 female, 15 male; age = 25.2 +/- 5.6 years; height = 1.7 +/- .1 m; weight = 68.5 +/- 13.5 kg) who demonstrated static balance and hip abductor strength sufficient for performance of the SLST participated in the study. Subjects were divided into pass and fail groups based on visual observation of MKD during the SLST. Foot Posture Index (FPI-6) scores and measures of non-weight bearing and weight bearing active ankle dorsiflexion (ROM) were compared.ResultsThere were 33 individuals in the pass group and 32 in the fail group. The groups were similar on age (p = .899), sex (p = .341), BMI (p = .818), and Tegner Activity Scale score (p = .456). There were no statistically significant differences between the groups on the FPI-6 (pass group mean = 2.5 +/- 3.9; fail group mean = 2.3 +/- 3.5; p = .599), or any of the measures of dorsiflexion range of motion (non-weight bearing dorsiflexion with knee extended: pass group = 6.9^o +/- 3.7^o, fail group = 7.8^o +/- 3.0^o; non-weight bearing dorsiflexion with knee flexed: pass group = 13.5^o +/- 5.6^o, fail group = 13.9^o +/- 5.3^o; weight bearing dorsiflexion: pass group = 42.7^o +/- 6.0^o, 42.7^o +/- 8.3^o, p = .611).ConclusionsFailure on the SLST is not related to differences in clinical measures of active dorsiflexion ROM or foot posture in young, healthy individuals. These findings suggest that clinicians may continue using the SLST to assess neuromuscular performance of the trunk, hip, and knee without ankle dorsiflexion ROM or foot posture contributing to results.Level of EvidenceLevel 3.     

Age and passive ankle stiffness in healthy women

The purpose of the study was to evaluate passive joint stiffness in ankles of young (aged 21-40 years; n = 15), middle-aged (aged 41-60 years; n = 15), and young elderly (aged 61-80 years; n = 15) women. The effect of knee position on passive joint stiffness was also evaluated by testing the subjects with the knee flexed (90 degrees) and with the knee extended (0 degrees). A torque motor system was used to record angular displacement and resistive torque during a 6 degrees/sec ankle rotation from 10 degrees of plantar flexion to 10 degrees of dorsiflexion (DF). Passive torque and passive elastic stiffness were measured at 0, 5, and 10 degrees of DF. Both measures increased nonlinearly as the ankle was rotated into DF, but showed no significant differences between the three age groups tested. There was also no significant difference in the passive stiffness measurements when the knee was flexed or extended. We concluded that within the range of motion tested, the factors of age and knee position do not affect the passive stiffness observed in the ankle joints of healthy women. We have now established baseline values of passive ankle joint stiffness for healthy women during DF within a functional ROM, which will be useful in the clinical evaluation of passive ankle joint stiffness and in studies where treatment efficacy is being investigated.     

Effect of ankle position on isometric quadriceps strengthening

A prospective study of 20 normal subjects was undertaken to determine the effect of three ankle positions (active dorsiflexion, active plantar flexion, natural or rest position) on comfort and facilitation of quadriceps contraction in isometric strengthening in a supine position with the hip and knee fully extended. Surface EMG activity was found to be greatest for the vastus lateralis followed by the vastus medialis and least for the rectus femoris. Equal facilitation was apparent with either active ankle dorsiflexion or plantar flexion. Both were superior to the natural (rest) position. In situations where isometric quadriceps exercises are required, the authors recommend either active ankle dorsiflexion or plantar flexion to facilitate quadriceps strengthening. The choice between the two positions should be based on patient comfort.     

Isokinetic Training Effect of Ankle Positions on Knee Extensor Strength

[Purpose] The purpose of this study was to determine which ankle position most influences knee extensor strength in training programs for strengthening the knee extensors using three different active ankle positions. [Subjects] Twenty-one healthy adults (6 males and 15 females) participated in this study. [Methods] Subjects were trained isokinetically in knee extension and flexion at 70 or 80% of 1RM under three actively and naturally fixed, contracted ankle conditions: dorsiflexion, plantarflexion, and resting position. After each group successfully executed the training four times a week for three weeks, mean peak torque (PT) and total work (TW) variables were measured and compared at 60°/sec and 180°/sec among the three groups. [Results] Significant differences were revealed in knee extensor TW at 60°/sec, PT and TW at 180°/sec, with the greatest PT and TW observed with the ankle in active dorsiflexion position. [Conclusion] These results suggest that active ankle dorsiflexion in a knee strength training program may be more effective at increasing knee extensor strength than a resting or plantarflexion position.Key words: Ankle position, Knee extensor strength, Isokinetic training     

超声诊断糖尿病周围神经病变

目的 探讨超声在糖尿病周围神经病变(DPN)诊断中的应用价值。方法 收集我院DPN患者40例(DPN组),选取正常对照30名(正常对照组),观察两组坐骨神经、腓总神经、胫神经的连续性和神经内部回声,测量并比较两组神经的前后径(D₁)和横径(D₂),并计算横截面积(CSA)。结果 正常对照组神经纵断面声像图呈束条状高或中等回声,内含多数平行、被高回声分开断续的线状低回声;横断面呈圆形、卵圆形高回声,其内分布细点状低回声。DPN组表现为受累神经肿大、增粗,内部回声减低,神经内平行线状结构消失。DPN组坐骨神经、腓总神经、胫神经的D₁、D₂、CSA均较正常对照组明显增加,差异均有统计学意义(P均<0.01)。结论 超声能够清晰显示DPN患者受累神经结构、位置以及病变范围,对DPN有较高的诊断价值,并可指导临床选择治疗和手术方案。     

The effects of an articulated ankle-foot orthosis with resistance-adjustable joints on lower limb joint kinematics and kinetics during gait in individuals post-stroke

BackgroundResistance is a key mechanical property of an ankle-foot orthosis that affects gait in individuals post-stroke. Triple Action® joints allow independent adjustment of plantarflexion resistance and dorsiflexion resistance of an ankle-foot orthosis. Therefore, the aim of this study was to investigate the effects of incremental changes in dorsiflexion and plantarflexion resistance of an articulated ankle-foot orthosis with the Triple Action joints on lower limb joint kinematics and kinetics in individuals post-stroke during gait.MethodsGait analysis was performed on 10 individuals who were post-stroke under eight resistance settings (four plantarflexion and four dorsiflexion resistances) using the articulated ankle-foot orthosis. Kinematic and kinetic data of the lower limb joints were recorded while walking using a three-dimensional Vicon motion capture system and a Bertec split-belt instrumented treadmill.FindingsRepeated measures analysis of variance revealed that adjustment of plantarflexion resistance had significant main effects on the ankle (P < 0.001) and knee (P < 0.05) angles at initial contact, while dorsiflexion resistance had significant (P < 0.01) main effects on the peak dorsiflexion angle in stance. Plantarflexion and dorsiflexion resistance adjustments appeared to affect the peak knee flexor moment in stance, but no significant main effects were revealed (P = 0.10). Adjustment of plantarflexion resistance also demonstrated significant (P < 0.05) main effects in the peak ankle positive power in stance.InterpretationThis study demonstrated that the adjustments of resistance in the ankle-foot orthosis with the Triple Action joints influenced ankle and knee kinematics in individuals post-stroke. Further work is necessary to investigate the long-term effects of the articulated ankle-foot orthoses on their gait.     

The pattern of tibial nerve excursion with active ankle dorsiflexion is different in older people with diabetes mellitus

Background

The peripheral nervous system has an inherent capability to tolerate the gliding (excursion), stretching (increased strain), and compression associated with limb motions necessary for functional activities. The biomechanical properties during joint movements are well studied but the influence of other factors such as limb pre-positioning, age and the effects of diabetes mellitus are not well established for the lower extremity. The purposes of this pilot study were to compare the impact of two different hip positions on lower extremity nerve biomechanics during an active ankle dorsiflexion motion in healthy individuals and to determine whether nerve biomechanics are altered in older individuals with diabetes mellitus.

Methods

Ultrasound imaging was used to quantify longitudinal motion of the tibial nerve and transverse plane motion of the tibial and common fibular nerves in the popliteal fossa during active ankle movements.

Findings

In healthy individuals, ankle dorsiflexion created mean tibial nerve movement of 2.18 mm distally, 1.36 mm medially and 3.98 mm superficially. When the hip was in a flexed position there was a mean three-fold reduction in distal movement. In people with diabetes mellitus there was significantly less distal movement of the tibial nerve in the neutral hip position and less superficial movement of the nerve in both hip positions compared to healthy individuals.

Interpretation

We have documented reductions in tibial nerve excursion due to limb pre-positioning thought to pre-load the nervous system using a non-invasive methodology. Thus, lower limb pre-positioning impacts nerve biomechanics during ankle motions common in functional activities. Additionally, our findings indicate that nerve biomechanics have the potential to be altered in older individuals with diabetes mellitus compared to younger healthy individuals.     

Effect of high-intensity pulse irradiation with linear polarized near-infrared rays on muscle tone in patients with cerebrovascular disease: a randomized controlled trial

[Purpose] This study evaluated effects of a high-intensity linear polarized near-infrared ray irradiation for mitigation of muscle hypertonia. [Subjects] The subjects were 20 patients with cerebrovascular disease. [Methods] Subjects were randomly allocated to an intervention or control group. The intervention group received irradiation of the triceps surae. Passive range of motion and passive resistive joint torque of ankle dorsiflexion were measured before and after the intervention in knee extended and flexed positions. [Results] In the knee extended position, the mean changes in passive range of motion were 2.70° and −0.50° in the intervention and control groups, respectively, and the mean changes in passive resistive joint torque were −1.42 and −0.26 N·m in the intervention and control groups, respectively. In the knee flexed position, the mean changes in passive range of motion were 3.70° and 0.70° in the intervention and control groups, respectively, and the mean changes in passive resistive joint torque were −2.38 and −0.31 N·m in the intervention and control groups, respectively. In both knee positions, the mean changes in the two indices were greater in the intervention group than in the control group. [Conclusion] High-intensity linear polarized near-infrared ray irradiation increases passive range of motion and decreases passive resistive joint torque.Key words: Infrared ray, Muscle tone, Cerebrovascular disease     

The effect of spinal position on sciatic nerve excursion during seated neural mobilisation exercises: an in vivo study using ultrasound imaging

Objectives: Research has established that the amount of inherent tension a peripheral nerve tract is exposed to influences nerve excursion and joint range of movement (ROM). The effect that spinal posture has on sciatic nerve excursion during neural mobilisation exercises has yet to be determined. The purpose of this research was to examine the influence of different sitting positions (slump-sitting versus upright-sitting) on the amount of longitudinal sciatic nerve movement during different neural mobilisation exercises commonly used in clinical practice.

Methods: High-resolution ultrasound imaging followed by frame-by-frame cross-correlation analysis was used to assess sciatic nerve excursion. Thirty-four healthy participants each performed three different neural mobilisation exercises in slump-sitting and upright-sitting. Means comparisons were used to examine the influence of sitting position on sciatic nerve excursion for the three mobilisation exercises. Linear regression analysis was used to determine whether any of the demographic data represented predictive variables for longitudinal sciatic nerve excursion.

Results: There was no significant difference in sciatic nerve excursion (across all neural mobilisation exercises) observed between upright-sitting and slump-sitting positions (P?=?0.26). Although greater body mass index, greater knee ROM and younger age were associated with higher levels of sciatic nerve excursion, this model of variables offered weak predictability (R²?=?0.22).

Discussion: Following this study, there is no evidence that, in healthy people, longitudinal sciatic nerve excursion differs significantly with regards to the spinal posture (slump-sitting and upright-sitting). Furthermore, although some demographic variables are weak predictors, the high variance suggests that there are other unknown variables that may predict sciatic nerve excursion. It can be inferred from this research that clinicians can individualise the design of seated neural mobilisation exercises, using different seated positions, based upon patient comfort and minimisation of neural mechanosensitivity with the knowledge that sciatic nerve excursion will not be significantly influenced.     

Gastrocnemius tightness on joint angle and work of lower extremity during gait

Background

Muscular tightness is a common clinical musculoskeletal disorder and is regarded as a predisposing factor for muscle injuries. In this study, a two-way mixed design ANOVA was applied to investigate the effects of the gastrocnemius tightness on the joint angle and joint work during walking.

Methods

Twenty-two patients with muscular tightness of gastrocnemius muscle (<12° of ankle dorsiflexion with knee extended) and 22 age- and gender-matched subjects with normal gastrocnemius flexibility (>15° of ankle dorsiflexion with knee extended) participated in this study. The joint angle and work at hip, knee, and ankle joints during the stance phase were analyzed at two preset cadences of 100 steps/min and 140 steps/min.

Findings

Significantly greater flexion angles at hip (P = 0.025) and knee (P = 0.001) were found in the tightness group at the time of maximal ankle dorsiflexion. Significantly less work generation at knee (P = 0.034) and greater work absorption at ankle (P = 0.024) were detected in the tightness group.

Interpretation

The subjects with gastrocnemius tightness revealed a compensatory gait pattern, which included the changes in the joint angles and associated work productions. The potential disturbance of the knee control and strain injuries of plantar flexors might be crucial in the clinical considerations for subjects with gastrocnemius tightness.     

Idiopathic toe walker child. Diagnosis and spontaneous evolution]

AIM OF THE STUDY: To analyse the clinical, the aetiological aspects, the evolution without treatment and the age of correction. MATERIAL: This history of 69 children admitted between 1973 and 1998 was analysed. Forty-one were reviewed during the growth; only 6 were treated. RESULTS: The toe walking was most often observed at the beginning of the walk between the age of 12 and 18 months. The first examination was made between 1 and 4 year old. The ankle dorsiflexion was the same, knee extended or flexed for 41 children and different in 23 cases. Identical cases were present in the family in 16 of 33 when the history family was analysed. The neurological examination was normal in 46 cases. None of the 69 children had a neurological impairment. In 32 cases, spontaneous correction occurred between 3 and 8 years: all these cases presented an ankle dorsiflexion over 10 degrees knee extended. The toe walking persisted in two cases at 10 years and in two cases at 12 and 13 years: the dorsiflexion was under 10 degrees, knee extended at initial examination in these cases. DISCUSSION AND CONCLUSION: It is possible to differentiate the toe walkers with more than 10 degrees of ankle dorsiflexion knee extended where the correction is possible without treatment and the cases with triceps contracture and less than 10 degrees of ankle dorsiflexion where the correction without triceps lengthening is questionnable.     

Effect of inherent muscle length on isometric plantar flexion torque in healthy women

This study investigated the relationship between inherent muscle length and torque production in 59 healthy women. We recorded nondominant ankle range-of-motion values for each subject. These values were partitioned into quartiles for two knee positions. Women with "loose" plantar flexor muscles comprised the first quartile, and those with "tight" plantar flexor muscles the fourth quartile. Tight- and loose-muscle groups were established for the 0-degree (fully extended) and 90-degree (flexed) knee test positions for data analysis. Torque measurements were obtained using an isokinetic testing apparatus. We asked each subject to perform a maximal isometric (static) plantar flexion contraction at each of three ankle positions: 7 degrees of dorsiflexion (angle A), 0 degrees or neutral (angle B), and 30 degrees of plantar flexion (angle C). Data analysis was performed using an analysis of variance for repeated measures. Results indicated that torque produced by the tight-muscle groups was significantly greater than the torque produced by the loose-muscle groups at both knee positions (p less than .05). Additionally, the ankle ROM data obtained suggest normative data different from those currently prevalent in the literature. Findings of this study may prove valuable in the rehabilitation of ankle injuries and could be beneficial especially to physical therapists in understanding more about normal ankle function.     

Dimensional changes of the carpal tunnel and median nerve during manual mobilization of the carpal bones — Anatomical study

Study designCross-sectional study.BackgroundThe carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic and therapeutic manual techniques that appear to move and change tunnel shape is part of clinical practice.ObjectivesTo measure changes in dimensions of the carpal tunnel and median nerve with manual mobilization of the carpal bones in cadavers.MethodsA total of 20 cryopreserved upper extremities from cadaveric specimens were used in the study. The wrist was cut using an anatomical saw at the level of the pisiform. Measurements of the cross-sectional area (CSA), anteroposterior diameter (APD), transverse diameter (TD), perimeter, flattening ratio and circularity of the carpal tunnel and of the median nerve, were taken, both in the anatomical position of the wrist and during the mobilization technique of the carpal bones.ResultsDuring the mobilization technique, the tunnel CSA (p < 0.011), APD (p < 0.001) and circularity (p < 0.001) significantly increased, while TD (p < 0.001), perimeter (p < 0.004) and flattening ratio (p < 0.001), decreased. The median nerve showed similar behavioral tendencies to the tunnel but only the CSA (p < 0.005), APD (p < 0.005) and flattening ratio (p < 0.004) of the nerve showed significant differences.ConclusionApplication of external manually applied compressive force across the wrist can increase the CSA of the carpal tunnel and the median nerve in cadavers. These results are consistent with other studies in which similar results were found non-invasively using ultrasound.     

Influence of knee positions and gender on the Ober test for length of the iliotibial band

OBJECTIVE: Examine the influence of knee positions and gender on the Ober test for the length of the iliotibial band. DESIGN: A cross-sectional comparative repeated measures design. BACKGROUND: The Ober test is in widespread use, yet the influence of knee positions and gender on the test has not been reported. Such information is needed to help clarify test results. METHODS: The Ober test was administered with the knee flexed to 90 degrees and extended to 0 degrees to the right lower limb of 26 women and 23 men. The limb was lowered from abduction and the end point of hip abduction (positive angle) or hip adduction (negative angle) was measured in relation to neutral. RESULTS: The hip adduction movement was restricted more with the knee flexed than with the knee extended for both genders (P<0.009). With the knee flexed the mean hip abduction angle was less for men (+4 degrees) than for women (+6 degrees) (P<0.001), and with the knee extended the mean hip adduction angle was greater for men (-9 degrees) than for women (-4 degrees) (P<0.001). CONCLUSIONS: The Ober test with the knee flexed limited hip adduction more than with the knee extended for both men and women, and women had greater limitations than men. RELEVANCE: The Ober test with the knee flexed and with the knee extended yielded different results and may be considered different tests. Normal Ober test values for the two knee positions should be defined separately for men and women in order to understand how deviations from normal are related to pathologies.     

Ankle positions potentially facilitating greater maximal contraction of pelvic floor muscles: a systematic review and meta-analysis

Abstract

Objectives: To evaluate the effect of ankle positions on pelvic floor muscles in women.

Methods: Multiple databases were searched from inception-July 2017. Study quality was rated using the grading of recommendations, assessment, development, and evaluation system and the “threats to validity tool”.

Results: Four studies were eligible for inclusion. Meta-analysis revealed significantly greater resting activity of pelvic floor muscles in neutral ankle position (?1.36 (95% CI ?2.30, ?0.42) p?= 0.004) and induced 15° dorsiflexion (?1.65 (95% CI ?2.49, ?0.81) p?= 0.0001) compared to induced 15° plantar flexion. Significantly greater maximal voluntary contraction of pelvic floor was found in dorsiflexion compared to plantar flexion (?2.28 (95% CI ?3.96, ?0.60) p?= 0.008). Meta-analyses revealed no significant differences between the neutral ankle position and 15° dorsiflexion for either resting activity (0.30 (95% CI ?0.75, 1.35) p?= 0.57) or maximal voluntary contraction (0.97 (95% CI ?0.77, 2.72) p?= 0.27).

Conclusion: Pelvic floor muscle-training for women with urinary incontinence could be performed in standing with ankles in a neutral position or dorsiflexion to facilitate greater maximal pelvic floor muscle contraction. As urethral support requires resting contraction of pelvic floor muscles, decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with urinary incontinence might potentially experience more leakage during exertion in a standing position.

• Implications for rehabilitation

• Pooled analyses revealed that maximal voluntary contraction of pelvic floor muscle is greater in induced ankle dorsiflexion than induced plantar flexion.

• As pelvic floor muscle strengthening involves achieving a greater maximal voluntary contraction, pelvic floor muscle training for women with stress urinary incontinence could be performed in standing either with ankles in a neutral position or dorsiflexion.

• Decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with stress urinary incontinence might potentially experience more leakage during exertion in a standing position.

• Women with stress urinary incontinence should be advised to wear flat shoes instead of high-heels and should be cautioned about body posture and ankle positions assumed during exercise and daily activities.

     

Joint moment-angle properties of the hip abductors and hip extensors

Purpose: Strengthening of hip joint musculature is common in the rehabilitation of the lower extremity. However, strength curves for hip abduction and extension have not been assessed when varying the position of the knee. The force-length properties of the biarticular muscles can be affected when altering the position of the knee during the production of hip moments. Methods: Maximum isometric joint moments were measured at four different angles of hip abduction and hip extension, at the two knee positions (0° and 90°). Results: The hip abduction and extension moments decreased as the hip moved from an adducted position and flexed position to an abducted position and extended position, respectively, resulting in a descending joint moment angle curve for each. Conclusion: The results indicate that position of the knee does not significantly change the normalized peak hip abduction joint moment, but the position of the knee does significantly change the normalized peak hip extension joint moment. This provides a baseline reference of hip joint moment production and can be utilized when assessing a population with a pathology or prescribing rehabilitative exercises.     

Correlations among pelvic positions and differences in lower extremity joint angles during walking in female university students

[Purpose] This study aimed to identify correlations among pelvic positions and differences in lower extremity joint angles during walking in female university students. [Subjects] Thirty female university students were enrolled and their pelvic positions and differences in lower extremity joint angles were measured. [Methods] Pelvic position, pelvic torsion, and pelvic rotation were assessed using the BackMapper. In addition, motion analysis was performed to derive differences between left and right flexion, abduction, and external rotation ranges of hip joints; flexion, abduction, and external rotation ranges of knee joints; and dorsiflexion, inversion, and abduction ranges of ankle joints, according to X, Y, and Z-axes. [Results] Pelvic position was found to be positively correlated with differences between left and right hip flexion (r=0.51), hip abduction (r=0.62), knee flexion (r=0.45), knee abduction (r=0.42), and ankle inversion (r=0.38). In addition, the difference between left and right hip abduction showed a positive correlation with difference between left and right ankle dorsiflexion (r=0.64). Moreover, differences between left and right knee flexion exhibited positive correlations with differences between left and right knee abduction (r=0.41) and ankle inversion (r=0.45). [Conclusion] Bilateral pelvic tilt angles are important as they lead to bilateral differences in lower extremity joint angles during walking.Key words: Pelvic position, Lower extremity joint angle, Walking