Assessing the knee flexion range of motion after total knee arthroplasty: Technology versus senses

IntroductionFollowing total knee arthroplasty surgery, attention should be paid to post-operative knee range of motion to achieve daily activities. Goniometer assessment is widely used to assess the range of motion in the post-operative period. This study aimed to determine the inter-rater ability of a smartphone application and visual estimation of the knee joint after total knee arthroplasty among different professions that commonly work together and compare whether any method is superior to another.MethodRange of motion measurements was performed by four clinicians as two physiotherapists and two orthopedic fellows. They utilized the Goniometer Reports application for smartphones, universal goniometer, and visual estimation to measure angles of knees which was operated. A two-way mixed model of intra-class correlation coefficient (ICC) with a 95% confidence level was used to assess inter-rater reliability.ResultsThirteen patients (11 female) and 20 knees (10 right) were assessed. The ICCs were found excellent both for between methods and between raters.ConclusionOur results show that technology seems a more accurate way to determine the knee range of motion after knee arthroplasty compared to senses. However, in lack of technological resources or time, or to avoid possible infection, visual estimation also could provide useful information.     

全膝关节置换术后关节活动范围的影响因素分析

目的:探讨全膝关节置换术后关节活动范围的影响因素,从而制订相应的康复治疗方案。方法:21例接受全膝关节置换术的患者入组,采用HSS评分法对所有患者进行术前膝关节功能评估,应用关节量角器对膝关节进行关节活动范围测定。采用Pearson相关分析法对术前各因素与术后1、2周及出院时膝关节活动范围进行相关分析。采用独立t检验对术后1、2周及出院时膝关节活动范围进行比较。结果:术前HSS总分、术前关节疼痛、术前膝关节功能、术前膝关节活动和术前屈膝畸形与术后1周膝关节活动范围成正相关,相关系数分别为0.546、0.430、0.423、0.539和0.403,P<0.05。术前所有评估因素除年龄外与术后2周和出院时关节活动度无相关。结论:术前关节疼痛、膝关节功能、膝关节活动和术前屈膝畸形与术后膝关节活动范围相关。     

全膝关节置换术后肌力训练对膝关节功能的影响

目的探讨肌力训练对全膝关节置换术后患膝关节功能恢复的影响。方法选取96例全膝关节置换患者，将其随机分为观察组及对照组。对照组患者术后给予常规康复训练；观察组患者在此治疗基础上，重点进行股四头肌及胭绳肌肌力训练。治疗2周后分别对2组患者的膝关节活动度、疼痛、股四头肌和胭绳肌肌力进行评定，并采用美国膝关节外科学会膝关节评分法（KSS）、美国特种外科医院（HSS）膝关节百分评分系统对患膝功能进行评定。结果2组患者经治疗后，其膝关节活动度及疼痛方面组间差异均无统计学意义（P〉0．05），但股四头肌、胭绳肌肌力及KSS、HSS总分组间差异均有统计学意义（P〈0．01）。结论肌力训练对全膝关节置换患者膝关节功能的恢复具有显著促进作用，可有效增强患膝关节的稳定性，改善患肢功能，提高生活质量。     

Acute neck pain: cervical spine range of motion and position sense prior to and after joint mobilization

Despite the relatively high prevalence of cervical spine pain, the efficacy of treatment procedures is limited. In the current study, range of motion and proprioception was assessed prior to and after specific cervical spine mobilisation techniques. A 44-year-old male office worker presented with a history of cervical pain of 1 day duration. He had woken with pain, stiffness and a loss of range of motion. Examination findings indicated pain to be at C5–6 on the left side. Measurement of maximal three-dimensional cervical motion was undertaken using a Zebris system. A position matching task tested the individual's ability to actively reposition their head and neck. The treatment undertaken involved grade III down-slope mobilisations on the left side at C5–6 and C6–7 in supine lying. This technique was then progressed by placing the subject in an upright sitting position, and sustained natural apophyseal glides were performed at C6.Immediately following the treatment, the patient reported a considerable decrease in pain, less difficulty in movement and reduced stiffness. Motion analyses showed the most marked percentage improvements in range of motion after treatment were in flexion (55%), extension (35%), left rotation (56%), and left lateral flexion (22%). Ipsilateral lateral flexion with axial rotation was also notably improved following treatment. No change in proprioceptive ability was found following the treatment. The findings showed that the application of standardised specific mobilisation techniques led to substantial improvements in the range of motion and the restitution of normal coupled motion.     

Immediate effects of a direct myofascial release technique on hip and cervical flexibility in inactive females with hamstring shortening: A randomized controlled trial

BackgroundCurrently, greater background is required about the effectiveness of myofascial release (MFR) on muscle flexibility.ObjectiveOur goal was to determine the immediate effect of a direct MFR technique on hip and cervical flexibility in inactive females with hamstring shortening.MethodThe sample group included 68 female university students, randomly divided into a control group (n = 34) and an experimental group (n = 34). A placebo technique was used with the control group, and direct MFR on the posterior thigh region was used with the experimental group.ResultsThe mixed factorial ANOVA did not show significant intergroup differences (p > 0.05). In the experimental group, Bonferroni post hoc test showed significant intragroup differences between pre-test and post-test 1, as well as between pre-test and post-test 2 for the three ischiotibial muscle flexibility tests (p < 0.001). Cervical flexion range of motion showed significant differences between pre-test and post-test 1 (p < 0.001).ConclusionsWe conclude that the protocol based on a single direct MFR intervention was no more effective than the placebo in improving flexibility both locally at the hamstring level and remotely at the level of the cervical extensor muscles. Future research should consider different MFR techniques on the immediate increase in muscle flexibility and the long-term effect of MFR, as well as consider different intervention groups.     

The effect of tibio-femoral traction mobilization on passive knee flexion motion impairment and pain: a case series

The purpose of this case series was to explore the effects of tibio-femoral (TF) manual traction on pain and passive range of motion (PROM) in individuals with unilateral motion impairment and pain in knee flexion. Thirteen participants volunteered for the study. All participants received 6 minutes of TF traction mobilization applied at end-range passive knee flexion. PROM measurements were taken before the intervention and after 2, 4, and 6 minutes of TF joint traction. Pain was measured using a visual analog scale with the TF joint at rest, at end-range passive knee flexion, during the application of joint traction, and immediately post-treatment. There were significant differences in PROM after 2 and 4 minutes of traction, with no significance noted after 4 minutes. A significant change in knee flexion of 25.9°, which exceeded the MDC_95, was found when comparing PROM measurements pre- to final intervention. While pain did not change significantly over time, pain levels did change significantly during each treatment session. Pain significantly increased when the participant’s knee was passively flexed to end range; it was reduced, although not significantly, during traction mobilization; and it significantly decreased following traction. This case series supports TF joint traction as a means of stretching shortened articular and periarticular tissues without increasing reported levels of pain during or after treatment. In addition, this is the first study documenting the temporal aspects of treatment effectiveness in motion restoration.     

系统康复治疗对下肢制动后膝关节活动范围的影响

对院内康复治疗和院外锻炼对股骨干骨折术后病人及不同康复时机对下肢骨折术后病人膝关节活动范围的影响进行临床观察，结果表明：康复治疗组术后１２个月时患肢膝关节活动范围为１２９．２９°±２５．８６°，对照组为６２．１２°±４８．３９°，两组差异非常显著（Ｐ＜０．０１）；在本组病例中下肢骨折术后１２个月时膝关节活动范围的改善与术后开始康复治疗间隔时间呈显著负相关（ｒ＝－０．７３，Ｐ＜０．０１）。说明下肢骨折术后康复治疗在改善制动后膝关节功能方面明显优于自行锻炼，康复治疗得越早，效果越明显。     

Shoulder pain, range of motion, and functional motor skills after acute tetraplegia

OBJECTIVES: To investigate (1) the prevalence and course of shoulder pain in acute tetraplegia and (2) its relationship with range of motion (ROM) and function and any associated risk factors. DESIGN: A longitudinal prospective study. SETTING: Spinal injury unit in an Australian hospital. PARTICIPANTS: Inpatients with acute tetraplegia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographics, pain intensity, shoulder ROM, and functional motor skills. RESULTS: The prevalence of pain during rehabilitation was 85%. Risk factors associated with pain during rehabilitation included age less than 30 years or more than 50 years (F=8.892, P=.064), admission motor level at C2-5 (F=5.833, P=.016), admission sensory level at C2-5 (F=7.543, P=.006), lower left upper limb (P=.005; 95% confidence interval [CI], -14.74 to -2.86) and total American Spinal Injury Association motor scores (P=.009; 95% CI, -29.53 to -4.67), and a shorter duration of bedrest (F=5.794, P=.055). Subjects with pain lost ROM in left abduction (P=.038; 95% CI, -25.9 to -0.9) and right abduction (P=.05; 95% CI, -30 to 9.3). No relationship existed between shoulder pain and functional motor skills on discharge. CONCLUSION: Shoulder pain is common in acute tetraplegia and is associated with loss of shoulder ROM. Risk factors identified include age, injury level, and duration of bedrest. Areas for further study are identified.     

Effects of myofascial release on flexibility and electromyographic activity of the lumbar erector spinae muscles in healthy individuals

ObjectiveTo investigate the effects of myofascial release on the flexibility and electromyographic activity of the lumbar erector spinae muscle in healthy individuals.MethodsTen healthy subjects were recruited to an intervention protocol of myofascial release techniques: (1) superficial myofascial release; (2) deep myofascial release apply along 10 sessions, twice a week, with 40 min per sessions. The outcomes evaluated were flexibility (Toe-Touch Test) and electromyography activity (EMG) of the lumbar erector spinae muscle (Iliocostalis and Longissimus bilaterally) during the movement of extension-flexion of the trunk. Paired t-test was used to compare the electromyographic outcomes, while the Wilcoxon test was used to compare the flexibility outcomes.ResultsThe myofascial release techniques increased the flexibility (p = 0.005; r = 0.88) and have no influence over the electromyographic activity of the right iliocostalis (p = 0.179; r = 0.43), right longissimus (p = 0.877; r = 0.05), left iliocostalis (p = 0.386; r = 0.29) and left longissimus (p = 0.418; r = 0.27).ConclusionsThe application of myofascial release techniques increase flexibility and did not influence over the electromyographic activity of the lumbar erector spinae muscles in healthy individuals. Further studies should include a larger sample with a sham group and/or compare EMG activity of the lumbar erector spinae muscles with patients with low back pain during the movement of extension-flexion of the trunk.     

Aggressive continuous passive motion exercise does not improve knee range of motion after total knee arthroplasty

Aims and objectives. The aim of this study was to evaluate the effects of continuous passive motion on the range of motion, postoperative pain and life quality of patients undergoing total knee arthroplasty within six months after the operation. Background. Total knee arthroplasty reduces pain and improves range of motion of the osteoarthritic knee joint. Continuous passive motion increases postoperative movement, but there is some controversy regarding whether aggressive continuous passive motion can improve range of motion or life quality, and whether it induces more pain. Design. A prospective controlled study was conducted in a medical centre in Taiwan from January to December 2006. Methods. One hundred and seven patients were recruited. The patients underwent the basic rehabilitation protocols (the control group) or the basic rehabilitation protocols and additional daily use of continuous passive motion for more than six hours per day (the experimental group). The range of motion, modified Short Form‐36 (SF‐36) and semi‐quantitative visual analogue scale were recorded. Results. Range of motion increased from 109° preoperatively to 125° at six months postoperatively in the treatment group and from 111° preoperatively to 125° at six months postoperatively in the control group. Visual analogue scale decreased from 7·78 preoperatively to 0·37 at six months postoperatively in the treatment group and from 7·92 preoperatively to 0·21 at six months postoperatively in the control group. The SF‐36 improved from 3·76 preoperatively to 1·77 at six months postoperatively in the treatment group and from 3·68 preoperatively to 1·83 at six months postoperatively in the control group. There was no significant difference in range of motion, visual analogue scale and SF‐36 between groups at each visit. Conclusion. With the advances in total knee arthroplasty surgical technique, aggressive continuous passive motion does not provide obvious benefits. Relevance to clinical practice. Total knee arthroplasty can alleviate pain and improve range of motion, but aggressive continuous passive motion does not provide additional benefits.     

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.     

Factors affecting early knee-flexion range of motion after total knee arthroplasty

[Purpose] To investigate the factors affecting the knee-flexion range of motion in the early period after total knee arthroplasty. [Participants and Methods] Ninety-nine patients who had undergone total knee arthroplasty at our hospital between 2016 and 2019 were allocated into two groups based on the presence of a 110° knee-flexion range of motion at 14 days post-surgery. From medical records, we extracted data for the participants’ basic attributes and preoperative/postoperative physical function (knee-flexion range of motion, Timed Up & Go Test results, resting/walking pain according to a numerical rating scale, and knee-extension muscle strength). Postoperative physical function was measured 14 days post-surgery. [Results] Preoperative knee-flexion range of motion, preoperative femorotibial angle, postoperative knee-extensor strength, and postoperative Timed Up & Go Test value differed significantly as factors related to achieving a 110° knee-flexion range of motion. Through further statistical analyses, we selected the preoperative knee-flexion range of motion, preoperative femorotibial angle, preoperative Timed Up & Go Test result, and postoperative knee-extension strength as factors affecting the knee-flexion range of motion at 14 days post-surgery. [Conclusion] Preoperative knee-flexion range of motion, preoperative femorotibial angle, preoperative Timed Up & Go Test result, and postoperative knee-extension strength influence knee-flexion range of motion at 14 days after total knee arthroplasty, and our findings indicate the effectiveness of active physiotherapy interventions.     

人工膝关节置换术后连续被动活动对关节功能的影响

目的观察连续被动活动(CPM)对人工膝关节置换术后膝关节功能的恢复情况,进行临床对照研究评估连续被动活动在全膝置换术后康复中的作用。方法将本院行首次全膝置换的44例患者以单纯随机抽签方法分成两组,23例术后除行物理康复治疗外辅助应用CPM康复治疗,21例患者仅行物理康复治疗。对所有患者进行术后随访,记录术后第7,10,14天,6周,6个月及1年时的关节活动范围(ROM)。结果与未应用CPM组相比,应用CPM组患者平均膝关节活动度在术后7,10,14d,6周,3,6个月及1年时分别多19°,15°,10°,8°,8°,2°和5°(t=4.763,3.621,3.529,2.614,2.507,2.178,2.117,P<0.05)。结论CPM有助于全膝置换患者术后较早恢复膝关节活动度。     

A comparison of mobilization and mobilization with movement on pain and range of motion in people with lateral ankle sprain: A randomized clinical trial

BackgroundMaitland and Mulligan mobilization techniques are two manual therapy methods to increase the range of motion following immobility treatment. The present study was conducted to compare two therapeutic methods, namely mobilization and mobilization with movement (MWM), on the pain and range of motion in people with lateral ankle sprain.MethodsA total of 40 individuals with grade two lateral ankle sprain were randomly divided into two groups, including the Maitland's mobilization intervention group, and the Mulligan's mobilization intervention group. Both groups underwent treatment every other day for two consecutive weeks. The pain intensity was measured using the Visual Analogue Scale (VAS), and the ankle dorsiflexion movement range using the Weight Bearing Lunge Test (WBLT) before and one day after the intervention.ResultsThere were no significant differences between the two groups in terms of pain (P = 0.297) and range of motion (P = 0.294) before the intervention. Meanwhile, after the intervention, a significant change was observed in both groups in terms of these variables, which indicates the effectiveness of both interventions (P < 0.001) and the greater effect of the mobilization with movement in reducing pain (P = 0.037) and increasing the range of motion (P = 0.021).ConclusionsBoth techniques significantly improved the range of motion and reduced pain in people with lateral ankle sprain, but Mulligan's technique was significantly more effective among the two, perhaps due to joining active and passive mobilizing tensile forces as well as interaction of afferents and efferents in the reflex arc.     

腓骨近端截骨术对内翻型膝关节骨关节炎患者膝关节活动度及并发症的影响

目的 研究腓骨近端截骨术和全膝关节置换术(TKA)治疗内翻型膝关节骨关节炎(KOA)的疗效及并发症.方法 选取我院接诊的内翻型KOA患者126例(126膝),按随机数字表法分为截骨组和TKA组各63例(63膝),分别采用腓骨近端截骨术和TKA手术进行治疗,观察两组视觉模拟评分(VAS)、内翻角、膝关节活动度、膝关节功能...     

Immediate effects and associations between interoceptive accuracy and range of motion after a HVLA thrust on the thoracolumbar junction: A randomised controlled trial

BackgroundThere is paucity in the literature regarding the role of interoceptive accuracy (IAc) at predicting the effectiveness of osteopathic techniques which increase spinal mobility when directed specifically at the thoracolumbar junction (TLJ).AimsThe study aimed to explore whether a high velocity, low amplitude (HVLA) thrust of the TLJ would increase spinal mobility (measured through Range of Motion; ROM) and change IAc. Also, whether baseline IAc correlated with the post-ROM measures and change in ROM.Method21 asymptomatic participants were allocated into three conditions in a randomised order. These were; (1) a high velocity low amplitude manipulation of the TLJ; (2) sham (basic touch); and (3) a control (laying supine on a plinth). Before and following each intervention, the participants’ spinal ROM was measured using an Acumar digital inclinometer. In addition to this an ECG was used to measure their pre and post condition IAc.ResultsThere were significant increases in ROM for all condition, however, the HVLA thrust led to a significantly greater increase in ROM (p < 0.001) when compared to the control and sham. Baseline IAc was inversely associated with post-ROM but there was no association with change in ROM. The HVLA thrust did not significantly change IAc scores from pre to post intervention. Conclusions. HVLA thrust over the TLJ is a useful intervention for increasing spinal ROM. IAc maybe a useful predictor for intervention effectiveness of this technique and spinal area which could in the future be utilised by osteopaths as part of their diagnostics.     

协同护理模式在全髋关节置换术后恐动症患者中的应用

目的 探讨协同护理模式对全髋关节置换术后恐动症患者的影响.方法 选取2019年8月—2020年7月郑州市某三级甲等综合医院收治的92例全髋关节置换术后恐动症患者作为研究对象,其中2020年2月—7月入院的46例作为试验组,实施协同护理模式;2019年8月—2020年1月入院的46例作为对照组,实施常规护理.比较两组干预...     

Increased range of motion after static stretching is not due to changes in muscle and tendon structures

Background

It is known that static stretching is an appropriate means of increasing the range of motion, but information in the literature about the mechanical adaptation of the muscle–tendon unit is scarce. Therefore, the purpose of this study was to investigate the influence of a six-week static stretching training program on the structural and functional parameters of the human gastrocnemius medialis muscle and the Achilles tendon.

Methods

A total of 49 volunteers were randomly assigned into static stretching and control groups. Before and following the stretching intervention, we determined the maximum dorsiflexion range of motion with the corresponding fascicle length and pennation angle. Passive resistive torque and maximum voluntary contraction were measured with a dynamometer. Muscle–tendon junction displacement allowed us to determine the length changes in tendon and muscle, and hence to calculate stiffness. Fascicle length, pennation angle, and muscle tendon junction displacement were measured with ultrasound.

Findings

Mean range of motion increased significantly from 30.9 (5.3) to 36.3 (6.1) in the intervention group, but other functional (passive resistive torque, maximum voluntary contraction) and structural (fascicle length, pennation angle, muscle stiffness, tendon stiffness) parameters were unaltered.

Interpretation

The increased range of motion could not be explained by the structural changes in the muscle–tendon unit, and was likely due to increased stretch tolerance possibly due to adaptations of nociceptive nerve endings.