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     

Reliability of measurements of knee extensor muscle strength using a pull-type hand-held dynamometer

[Purpose] The purpose of this study was to examine the intra-examiner and inter-examiner reliabilities of measurements of knee extensor muscle strength using a pull-type hand-held dynamometer (HHD). [Subjects] Fifty-four healthy adults (35 males; average age, 23 years) participated in this study. [Methods] Knee extensor muscle strength of each leg was measured three times using the HHD. To examine the intra- and inter-examiner reliabilities, measurements were performed by two examiners, a physical therapist and a physical therapy student. [Results] The intra-examiner reliabilities, ICC (1, 1) and ICC (1, 3) ranged from 0.94–0.99. The inter-examiner reliabilities, ICC (2, 1) and ICC (3, 1) ranged from 0.90–0.92 for the right leg, and 0.88−0.90 for the left leg. Neither constant nor proportional errors were found by Bland-Altman analysis. [Conclusion] Intra-examiner and inter-examiner reliabilities were acceptable, indicating that muscle strength can be measured with the pull-type HHD without dependence on skill of measurement. Pain was not caused by measurements with the pull-type HHD.Key words: Inter-examiner reliability, Intra-examiner reliability, Hand-held dynamometer     

Reliability and validity of measurements of cervical retraction strength obtained with a hand-held dynamometer

Objectives: The purpose of this study was to describe the reliability and validity of measurements of cervical retraction strength obtained with a hand held dynamometer (HHD) from healthy adults.

Background: Impaired neck muscle strength is related to neck pain, abnormal posture, and various cervical pathologies. While sophisticated devices to objectively measure neck strength exist, many are not practicable in typical orthopedic practices or have questionable validity and reliability.

Methods: Forty participants were included in the analysis of neck strength using isometric testing with an HHD fixed in a cradle on a table top. The highest neck retraction force recorded in Newtons (N) for each participant, was used for data analysis.

Results: Both intratester and intertester reliability were excellent as judged by intraclass correlation coefficients (ICCs) (.885 – .974) and minimal detectable change (MDC) (21.1 to 47.6 N). Validity was confirmed on the basis of expected gender and age differences (ie, men were stronger than women and younger participants were stronger than older participants).

Conclusion: Fixed HHD is a reliable and valid tool for measuring isometric neck retraction strength in ostensibly healthy adults. Its value in the assessment of individuals with neck pathology awaits further examination.     

Reliability of shoulder range of motion comparing a goniometer to a digital level

Abstract

The clinical use of digital levels, for joint measurement, may be a viable alternative to standard goniometry. The purpose of this study was to determine the intra- and intertester reliability of a construction grade digital level compared to the standard universal goniometer for measurements for active assisted shoulder range of motion (ROM). Two experienced physical therapists measured shoulder flexion, external rotation (ER), and internal rotation (IR) ROM bilaterally, on two different occasions, in 20 patients (9 males, 11 females, 18–79 years old) with unilateral shoulder pathology, using a goniometer and a digital level. Relative reliability was assessed by using intraclass correlation coefficients (ICC), and absolute reliability was assessed by using 95% limits of agreement (LOA). Intratester ICCs ranged from 0.91 to 0.99, and LOA ranged from 3° to 9° for measurements made with the goniometer and digital level. Intertester ICCs ranged from 0.31 to 0.95, and LOA ranged from 6° to 25°. For the comparison of goniometric vs. digital level ROM, ICCs ranged from 0.71 to 0.98. ER and IR ROM were 3–5° greater for the digital level than the goniometer (p < 0.01). Goniometric vs. digital level LOA ranged from 6° to 11° for shoulder flexion. Both measurement techniques had excellent intratester reliability, but for intertester reliability ICCs were 20% lower and LOA were 2.3 times higher than intratester values. Reliability estimates were similar between the digital level and the goniometer. However, because glenohumeral rotation was 3–5° greater for the digital level than the goniometer (systematic error), the two methods cannot be used interchangeably. On the basis of the average intratester LOA for the goniometer and the digital level, a change of 6–11° is needed to be certain that true change has occurred. For comparison of measures made by two different therapists, a change is of 15° is required to be certain a true change has occurred. A digital level can be used to reliably measure shoulder ROM but should not be used interchangeably with a standard goniometer.     

Effects of using an unstable inclined board on active and passive ankle range of motion in patients with ankle stiffness

[Purpose] The present study assessed the effects of using an unstable inclined board on the active and passive ankle range of motion in patients with ankle stiffness. [Subjects] The study included 10 young female patients with ankle stiffness. [Methods] The patients were divided into the following two groups: a group that performed ankle dorsiflexion stretching exercises using a wooden inclined board and a group that performed stretching exercises using an air-cushioned inclined board (unstable inclined board). Active and passive ankle dorsiflexion angles were measured bilaterally using a goniometer. [Results] Both inclined boards significantly increased active and passive ankle dorsiflexion. After performing ankle stretching exercises, active dorsiflexion significantly increased the unstable inclined board compared to that using the wooden inclined board. However, the passive dorsiflexion angles did not differ significantly between the two groups after ankle stretching exercises. [Conclusion] The use of an unstable inclined board might stimulate activation of the ankle dorsiflexors in addition to stretching muscle or tissue. Active ankle dorsiflexion was more effectively improved with stretching exercises using an unstable inclined board than with exercises using a wooden inclined board.Key words: Inclined board, Stretching exercise, Unstable surface     

Gains in range of ankle dorsiflexion using three popular stretching techniques

Among modern stretching techniques none has clearly been shown to be the most effective for increasing range of motion. The most common stretching method comparisons are between static stretching (SS) and one or more Proprioceptive Neuromuscular Facilitation (PNF) technique(s). The two most frequently implemented PNF techniques are: contract-relax (CR); and contract-relax-antagonist-contract (CRAC). Previous comparative investigations among stretching methods have primarily observed changes in straight-leg hip flexion as a result of lengthening the hamstrings, a two-joint muscle. The present study observed gains in range of motion among three stretching methods (SS, CR, CRAC) of a joint limited by a single joint muscle, the soleus. Twelve subjects performed each of the three methods on separate days. Significant differences were observed among all methods (p = .001). Further analysis revealed the CRAC method was superior to the CR method (p less than .01), and the CR method was superior to the SS method (p less than .01). Significant pre-post-treatment gains in range of motion were observed as a result of the CR and CRAC methods, but not the SS method. The results of this study support the findings of those previous investigations for two-joint muscles in which PNF techniques were more effective than static stretching for increasing range of motion. Also, a reciprocal activation (CRAC in the present study) was the most effective for increasing range of motion.     

Reliability of measuring hip abductor strength following total knee arthroplasty using a hand-held dynamometer

Purpose: To investigate the test–retest reliability of measuring hip abductor strength in patients with total knee arthroplasty (TKA) using a hand-held dynamometer (HHD) with two different types of resistance: belt and manual resistance. Method: Test–retest reliability of 30 subjects (17 female, 13 male, 71.9?±?7.4 years old), 9.2?±?2.7 days post TKA was measured using belt and therapist resistance. Retest reliability was calculated with intra-class coefficients (ICC_3,1) and 95% confidence intervals (CI) for both the group average and the individual scores. A paired t-test assessed whether a difference existed between the belt and therapist methods of resistance. Results: ICCs were 0.82 and 0.80 for the belt and therapist resisted methods, respectively. Hip abductor strength increases of 8?N (14%) for belt resisted and 14?N (17%) for therapist resisted measurements of the group average exceeded the 95% CI and may represent real change. For individuals, hip abductor strength increases of 33?N (72%) (belt resisted) and 57?N (79%) (therapist resisted) could be interpreted as real change. Conclusions: Hip abductor strength can be reliably measured using HHD in the clinical setting with the described protocol. Belt resistance demonstrated slightly higher test–retest reliability.

• Implications for Rehabilitation

• Reliable measurement of hip abductor muscle strength in patients with TKA is important to ensure deficiencies are addressed in rehabilitation programs and function is maximized.

• Hip abductor strength can be reliably measured with a hand-held dynamometer in the clinical setting using manual or belt resistance.

     

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.     

Reliability of quantitative muscle testing in healthy children and in children with Duchenne muscular dystrophy using a hand-held dynamometer

The purpose of this study was to examine intratester and test-retest reliability using a hand-held dynamometer for the measurement of isometric muscle strength in 28 healthy children and children with Duchenne muscular dystrophy. The Dystrophic Group consisted of 14 children diagnosed with Duchenne muscular dystrophy, and the Healthy Group consisted of 14 age-matched children with no history of orthopedic or neuromuscular disorders. One physical therapist tested hip and knee extension, elbow flexion, and shoulder abduction in each child bilaterally. A two-way analysis of variance for repeated measures was used to analyze differences between measurements taken within and across the testing sessions. Pearson product-moment correlation coefficients were determined on mean values across the testing sessions for each variable. No significant differences (p greater than .05) between measurements taken within or across testing sessions were found in either the Dystrophic Group or the Healthy Group. Correlation coefficients for the Dystrophic Group ranged from .83 to .99 for the variables tested. Correlation coefficients for the Healthy Group ranged from .74 to .99. The results suggest that the hand-held dynamometer can be used as a reliable instrument in measuring the isometric strength of selected muscles in children.     

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.     

Reliability of isometric knee extension muscle strength measurements made by a hand-held dynamometer and a belt: a comparison of two types of device

[Purpose] The purpose of the present study was to compare the reliability of 2 hand-held dynamometers (HHD-1, 2) with different designs, by performing isometric knee muscle extension measurements two times each. [Subjects] The subjects were 40 young healthy adults. [Methods] The reliability of the measurements was examined using Bland-Altman analysis. [Results] Bland-Altman analysis found a fixed bias in measurements made by HHD-1 with an average limits of agreement (LOA) value of −2.1 kgf. For HHD-2, only random errors were detected, and the minimal detectable change (MDC) was 11.4 kgf. Fixed biases were observed between the two devices with an average LOA value of 2.2 kgf. When the bodyweight ratio was used, fixed biases were observed in measurements made by both devices, and the average value of LOA was −0.03 kgf/kg. The comparison of the two devices revealed only random errors, and MDC was 0.22 kgf/kg. [Conclusion] For HHD measurements using these two devices, the appropriate number of measurements is two times, and comparison of measurement values between the two devices should be avoided.Key words: Hand-held dynamometer, Muscle strength, Reliability     

Reliability,minimal detectable change and measurement errors in knee extension muscle strength measurement using a hand-held dynamometer in young children

[Purpose] Few studies have assessed the reliability of muscle strength measurement using a hand-held dynamometer, specifically in Japanese young children. This study aims to investigate the reliability, minimal detectable change and measurement error in knee extension muscle strength measurements in young children using a hand-held dynamometer. [Participants and Methods] The study participants comprised 36 kindergarten-enrolled children of 3–6 years age. An experienced physiotherapist measured their isometric knee extension strength. Appropriate orientation and practices were performed prior to measurement. The same physiotherapist took the muscle measurements twice; and the maximum value was used as the muscle strength value. The measurements were repeated at intervals of approximately 30 min to verify reproducibility. [Results] The initial isometric knee extension strength was 10.6 ± 3.3 kgf and the Intra-class correlation coefficient (1,1) was 0.765. The standard error of measurement was 1.6 kgf and the minimal detectable change was 4.4 kgf. No significant systematic errors were observed. [Conclusion] Isometric knee extension strength measurement using a hand-held dynamometer in young children has good reliability with a low risk of systematic errors.     

Reliability of measuring the passive range of shoulder horizontal adduction using a smartphone in the supine versus the side-lying position

[Purpose] The purpose of this study was to compare the reliability of the measurement of the passive range of motion (PROM) of shoulder horizontal adduction (SHA) measurements using a smartphone for the assessment posterior shoulder tightness (PST) between the side-lying and supine test positions. [Subjects and Methods] Forty-seven subjects (mean ± age, 24.9 ± 3.5 years) without shoulder pathology were included in this study. Intra-rater and inter-rater reliabilities were determined using intraclass correlation coefficients. The SHA PROM of each subject’s dominant shoulder was measured using a smartphone by two investigators in two positions: the standard supine position, and a side-lying position on the tested side. [Results] The intra-rater reliability of the supine measurements was fair to good (ICC_3,1 = 0.72–0.89), and for the side-lying measurements was excellent (ICC_3,1 = 0.95–0.97). The inter-rater reliability of the supine measurements was fair (ICC_2,2 = 0.79) and for the side-lying measurements was excellent (ICC_2,2 = 0.94). [Conclusion] These results suggest that for healthy subjects, measurements of SHA using smartphones in the side-lying position has superior intra-rater and inter-rater reliabilities compared to the standard supine position.Key words: Reliability, Horizontal adduction, Smartphone     

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.