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Matthew C. Hoch, David R. Mullineaux, Richard D. Andreatta, Robert A. English, Jennifer M. Medina-McKeon, Carl G. Mattacola and Patrick O. McKeon

Context:

A single talocrural joint-mobilization treatment has improved spatiotemporal measures of postural control but not ankle arthrokinematics in individuals with chronic ankle instability (CAI). However, the effects of multiple treatment sessions on these aspects of function have not been investigated.

Objective:

To examine the effect of a 2-wk anterior-to-posterior joint-mobilization intervention on instrumented measures of single-limb-stance static postural control and ankle arthrokinematics in adults with CAI.

Design:

Repeated measures.

Setting:

Research laboratory.

Participants:

12 individuals with CAI (6 male, 6 female; age 27.4 ± 4.3 y, height 175.4 ± 9.78 cm, mass 78.4 ± 11.0 kg).

Intervention:

Subjects received 6 treatments sessions of talocrural grade II joint traction and grade III anterior-to-posterior joint mobilization over 2 wk.

Main Outcome Measures:

Instrumented measures of single-limb-stance static postural control (eyes open and closed) and anterior and posterior talar displacement and stiffness were assessed 1 wk before the intervention (baseline), before the first treatment (preintervention), 24–48 h after the final treatment (postintervention), and 1 wk later (1-wk follow-up). Postural control was analyzed as center-of-pressure velocity, center-of-pressure range, the mean of time-to-boundary minima, and standard deviation of time-to-boundary minima in the anteroposterior and mediolateral directions for each visual condition.

Results:

No significant differences were identified in any measures of postural control (P > .08) or ankle arthrokinematics (P > .21).

Conclusions:

The 2-wk talocrural joint-mobilization intervention did not alter instrumented measures of single-limb-stance postural control or ankle arthrokinematics. Despite the absence of change in these measures, this study continues to clarify the role of talocrural joint mobilization as a rehabilitation strategy for patients with CAI.

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Matthew J. Moncrieff and Lori A. Livingston

Context:

Structural and coronal-plane-alignment characteristics of the lower limb are frequently cited as factors contributing to knee pathologies.

Objective:

The purpose of this study was to determine the accuracy and reliability characteristics of a digital-photographic-goniometric method (DPGM) of measurement for 2-dimensional (2D) coronal-plane lower limb measurements of the quadriceps (Q) angle, tibiofemoral (TF) angle, and femur length in human participants adopting a self-selected- or Romberg-stance position.

Design:

Reliability study.

Setting:

University motion-analysis laboratory.

Participants:

A convenience sample of 20 healthy young adult men and women.

Main Outcome Measures:

Intraclass correlation coefficients (ICCs), 95% confidence intervals, and standard error of the measurements.

Results:

Intratester- and intertester-reliability coefficients for the Q angle (ICCs .458–845 and .257–737) were consistently lower than those for the TF angle (ICCs .627–.904 and .700–.839) or femur length (ICCs .867–.958 and .866–.944). Q angles were also significantly larger (13.4%) in the Romberg- vs self-selected-stance position (P < .001) and larger (20.2%) in the left limb than the right limb.

Conclusions:

The DPGM has the potential to produce accurate and reliable measurements of selected 2D lower limb measures. However, the reliability characteristics depend on the ability of the testers to correctly and repeatably landmark the anatomical sites used to define the measurements of interest and might be influenced by other factors such as the stance position adopted, the complexity of the variable (ie, number of anatomical landmarks and segments), and the size of the captured image. Further investigation of these latter factors is warranted.

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Matthew C. Hoch, David R. Mullineaux, Kyoungkyu Jeon and Patrick O. McKeon

Single joint kinematic alterations have been identified during gait in those with chronic ankle instability (CAI). The purpose of this study was to compare sagittal plane hip, knee, and ankle kinematics during walking in participants with and without CAI. Twelve individuals with CAI and 12 healthy individuals walked on a treadmill at 1.5 m/s. Three-dimensional kinematics were analyzed using mean ensemble curves and independent t tests. Participants with CAI demonstrated less lower extremity flexion during the absorption phase of stance and the limb placement phase of swing, which may have implications for limb placement at initial contact.

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Karen P. DePauw and Gudrun Doll-Tepper

Inclusion has been a topic of discussions and debate among adapted physical activity professionals since the 1980s. Although the initial discussions focused primarily on inclusion as a place or placement, the discourse today about inclusion must be expanded to incorporate issues of context, disability rights, and social justice. Inclusion must now be reconceptualized as an attitude or a process. Progressive inclusion and acceptance is not a myth but a reality. As international attention and efforts are focused on physical education as a right of all children, APA professionals must forego bandwagons and adopt a strong philosophical stance that guides our efforts toward achieving inclusive physical education.

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Christopher L. MacLean, Richard van Emmerik and Joseph Hamill

The purpose of this study was to analyze the influence of a custom foot orthotic (CFO) intervention on lower extremity intralimb coupling during a 30-min run in a group of injured runners and to compare the results to a control group of healthy runners. Three-dimensional kinematic data were collected during a 30-min run on healthy female runners (Shoe-only) and a group of female runners who had a recent history of overuse injury (Shoe-only and Shoe with custom foot orthoses). Results from the study revealed that the coordination variability and pattern for the some couplings were influenced by history of injury, foot orthotic intervention and the duration of the run. These data suggest that custom foot orthoses worn by injured runners may play a role in the maintenance of coordination variability of the tibia (transverse plane) and calcaneus (frontal plane) coupling during the Early Stance phase. In addition, it appears that the coupling angle between the knee (transverse plane) and rearfoot (frontal plane) joints becomes more symmetrical in the late stance phase as a run progresses.

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Dana Forrest, Janet S. Dufek and John A. Mercer

The purpose of this study was to determine if ground reaction forces were influenced by shoe design (adult vs. youth) for female children when running. Subjects (n = 10, 12.0 ± 1.1 years old; 154 ± 4.9 cm; 46.2 ± 14.3 kg; shoe size 3.5–7 youth) were fit with a shoe model available in youth and adult sizes. Subjects ran 10 trials per shoe condition across a force platform placed in the middle of a 9-m runway. Impact force, second maximum force, loading rate, stance time and average vertical ground reaction forces were recorded for each trial. Shoes underwent a mechanical impact test with peak force, peak acceleration, and percent energy returned recorded. Each variable was compared between shoe conditions. From the impact testing, it was determined that peak force, peak acceleration and percent energy return were 7.1%, 7.1%, and 18.9% greater, respectively, for the youth vs. adult shoe (p < .001). From the running tests, it was determined that loading rate was different (p = .009) between shoe conditions whereas impact force, second maximum force, average force and stance time were not different between shoes (p > .01). Young girls had a greater loading rate when running in youth vs. adult shoes even though the shoe size was the same.

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Astrid Bergland, Hilde Sylliaas, Gun Britt Jarnlo and Torgeir Bruun Wyller

The aim of this study was to investigate walking and health among woman age 75 yr or older, in the associations between the highest step up performed without support by an individual and balance, walking, and health among women age 75+. Records of the highest step, balance, walking, and health were made for 307 women age 75–93 yr living in the community. Eighty percent managed to climb steps higher than 20 cm. There was a statistically significant negative relationship between age and stair-climbing capacity. The highest steps registered were significantly and independently associated with a short time on the timed up-and-go test, long functional reach, low body weight, lack of perceived difficulty walking outdoors, low number of “missteps” when walking in a figure of 8, longer time in one-leg stance, ability to carry out tandem stance, no walking aids outdoors, and not being afraid of falling. These variables together explained 67% of the variance in the step-height score.

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Jonathan Sinclair, Sarah J. Hobbs, Laurence Protheroe, Christopher J. Edmundson and Andrew Greenhalgh

Biomechanical analysis requires the determination of specific foot contact events. This is typically achieved using force platform information; however, when force platforms are unavailable, alternative methods are necessary. A method was developed for the determination of gait events using an accelerometer mounted to the distal tibia, measuring axial accelerations. The aim of the investigation was to determine the efficacy of this method. Sixteen participants ran at 4.0 m/s ±5%. Synchronized tibial accelerations and vertical ground reaction forces were sampled at 1000 Hz as participants struck a force platform with their dominant foot. Events determined using the accelerometer, were compared with the corresponding events determined using the force platform. Mean errors of 1.68 and 5.46 ms for average and absolute errors were observed for heel strike and of –3.59 and 5.00 ms for toe-off. Mean and absolute errors of 5.18 and 11.47 ms were also found for the duration of the stance phase. Strong correlations (r = .96) were also observed between duration of stance obtained using the two different methods. The error values compare favorably to other alternative methods of predicting gait events. This suggests that shank-mounted accelerometers can be used to accurately and reliably detect gait events.

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Yuki Uto, Tetsuo Maeda, Ryoji Kiyama, Masayuki Kawada, Ken Tokunaga, Akihiko Ohwatashi, Kiyohiro Fukudome, Tadasu Ohshige, Yoichi Yoshimoto and Kazunori Yone

The purpose of this study was to determine whether a lateral wedge insole reduces the external knee adduction moment during slope walking. Twenty young, healthy subjects participated in this study. Subjects walked up and down a slope using 2 different insoles: a control flat insole and a 7° lateral wedge insole. A three-dimensional motion analysis system and force plate were used to examine the knee adduction moment, the ankle valgus moment, and the moment arm of the ground reaction force to the knee joint center in the frontal plane. The lateral wedge insole significantly decreased the moment arm of the ground reaction force, resulting in a reduction of the knee adduction moment during slope walking, similar to level walking. The reduction ratio of knee adduction moment by the lateral wedge insole during the early stance of up-slope walking was larger than that of level walking. Conversely, the lateral wedge insole increased the ankle valgus moment during slope walking, especially during the early stance phase of up-slope walking. Clinicians should examine the utilization of a lateral wedge insole for knee osteoarthritis patients who perform inclined walking during daily activity, in consideration of the load on the ankle joint.

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Robert A. Weinert-Aplin, Anthony M.J. Bull and Alison H. McGregor

Conservative treatments such as in-shoe orthotic heel wedges to treat musculoskeletal injuries are not new. However, weak evidence supporting their use in the management of Achilles tendonitis suggests the mechanism by which these heel wedges works remains poorly understood. It was the aim of this study to test the underlying hypothesis that heel wedges can reduce Achilles tendon load. A musculoskeletal modeling approach was used to quantify changes in lower limb mechanics when walking due to the introduction of 12-mm orthotic heel wedges. Nineteen healthy volunteers walked on an inclinable walkway while optical motion, force plate, and plantar pressure data were recorded. Walking with heel wedges increased ankle dorsiflexion moments and reduced plantar flexion moments; this resulted in increased peak ankle dorsiflexor muscle forces during early stance and reduced tibialis posterior and toe flexor muscle forces during late stance. Heel wedges did not reduce overall Achilles tendon force during any walking condition, but did redistribute load from the medial to lateral triceps surae during inclined walking. These results add to the body of clinical evidence confirming that heel wedges do not reduce Achilles tendon load and our findings provide an explanation as to why this may be the case.