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Kimberly Pratt and Richard Bohannon

Context:

Stretching exercise regimens are routinely prescribed to increase range of motion (ROM) and diminish injuries.

Objective:

To examine the effect of a 3-minute passive stretch on ankle-dorsiflexion ROM in a nonpathological population.

Setting:

University laboratory.

Design:

Prospective, randomized, controlled study.

Participants:

24 apparently healthy volunteers.

Interventions:

Subjects stood with their heels suspended from the edge of a platform. The experimental subjects stretched for 3 minutes on 3 consecutive days.

Main Outcome Measures:

Passive ankle-dorsiflexion ROM.

Results:

Ankle-dorsiflexion ROM increased significantly (P < .0005) over the course of each day’s stretch. No significant gains in ankle-dorsiflexion ROM were realized over 3 days.

Conclusions:

These findings suggest the need for further research to determine the stretching frequency and duration that will result in lasting increases in ankle-dorsiflexion ROM

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Rebecca L. Begalle, Meghan C. Walsh, Melanie L. McGrath, Michelle C. Boling, J. Troy Blackburn and Darin A. Padua

The ankle, knee, and hip joints work together in the sagittal plane to absorb landing forces. Reduced sagittal plane motion at the ankle may alter landing strategies at the knee and hip, potentially increasing injury risk; however, no studies have examined the kinematic relationships between the joints during jump landings. Healthy adults (N = 30; 15 male, 15 female) performed jump landings onto a force plate while three-dimensional kinematic data were collected. Joint displacement values were calculated during the loading phase as the difference between peak and initial contact angles. No relationship existed between ankle dorsiflexion displacement during landing and three-dimensional knee and hip displacements. However, less ankle dorsiflexion displacement was associated with landing at initial ground contact with larger hip flexion, hip internal rotation, knee flexion, knee varus, and smaller plantar flexion angles. Findings of the current study suggest that restrictions in ankle motion during landing may contribute to contacting the ground in a more flexed position but continuing through little additional motion to absorb the landing. Transverse plane hip and frontal plane knee positioning may also occur, which are known to increase the risk of lower extremity injury.

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James W. Youdas, Timothy J. McLean, David A. Krause and John H. Hollman

Context:

Posterior calf stretching is believed to improve active ankle dorsiflexion range of motion (AADFROM) after acute ankle-inversion sprain.

Objective:

To describe AADFROM at baseline (postinjury) and at 2-wk time periods for 6 wk after acute inversion sprain.

Design:

Randomized trial.

Setting:

Sports clinic.

Participants:

11 men and 11 women (age range 11–54 y) with acute inversion sprain.

Intervention:

Standardized home exercise program for acute inversion sprain.

Main Outcome Measure:

AADFROM with the knee extended.

Results:

Time main effect on AADFROM was significant (F 3,57 = 108, P < .001). At baseline, mean active sagittal-plane motion of the ankle was 6° of plantar flexion, whereas at 2, 4, and 6 wk AADFROM was 7°, 11°, and 11°, respectively.

Conclusions:

AADFROM increased significantly from baseline to week 2 and from week 2 to week 4. Normal AADFROM was restored within 4 wk after acute inversion sprain.

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Elisabeth Macrum, David Robert Bell, Michelle Boling, Michael Lewek and Darin Padua

Context:

Limitations in gastrocnemius/soleus flexibility that restrict ankle dorsiflexion during dynamic tasks have been reported in individuals with patellofemoral pain (PFP) and are theorized to play a role in its development.

Objective:

To determine the effect of restricted ankle-dorsiflexion range of motion (ROM) on lower extremity kinematics and muscle activity (EMG) during a squat. The authors hypothesized that restricted ankle-dorsiflexion ROM would alter knee kinematics and lower extremity EMG during a squat.

Design:

Cross-sectional.

Participants:

30 healthy, recreationally active individuals without a history of lower extremity injury.

Interventions:

Each participant performed 7 trials of a double-leg squat under 2 conditions: a nowedge condition (NW) with the foot flat on the floor and a wedge condition (W) with a 12° forefoot angle to simulate reduced plantar-flexor flexibility.

Main Outcome Measures:

3-dimensional hip and knee kinematics, medial knee displacement (MKD), and ankle-dorsiflexion angle. EMG of vastus medialis oblique (VMO), vastus lateralis (VL), lateral gastrocnemius (LG), and soleus (SOL). One-way repeated-measures ANOVAs were performed to determine differences between the W and NW conditions.

Results:

Compared with the NW condition, the wedge produced decreased peak knee flexion (P < .001, effect size [ES] = 0.81) and knee-flexion excursion (P < .001, ES = 0.82) while producing increased peak ankle dorsiflexion (P = .006, ES = 0.31), ankle-dorsiflexion excursion (P < .001, ES = 0.31), peak knee-valgus angle (P = .02, ES = 0.21), and MKD (P < .001, ES = 2.92). During the W condition, VL (P = 0.002, ES = 0.33) and VMO (P = .049, ES = 0.20) activity decreased while soleus activity increased (P = .03, ES = 0.64) compared with the NW condition. No changes were seen in hip kinematics (P > .05).

Conclusions:

Altering ankle-dorsiflexion starting position during a double-leg squat resulted in increased knee valgus and MKD, as well as decreased quadriceps activation and increased soleus activation. These changes are similar to those seen in people with PFP.

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Mikael Scohier, Dominique De Jaeger and Benedicte Schepens

The purpose of this study was to mechanically evoke a triceps surae stretch reflex during the swing phase of running, to study its within-the-step phase dependency. Seven participants ran on a treadmill at 2.8 m·s−1 wearing an exoskeleton capable of evoking a sudden ankle dorsiflexion. We measured the electromyographic activity of the soleus, medial and lateral gastrocnemii just after the perturbation to evaluate the triceps surae stretch reflex. Similar perturbations were also delivered at rest. Our results showed that the stretch reflex was suppressed during the swing phase of running, except in late swing where a late reflex response was observed. At rest, all triceps surae muscles showed an early reflex response to stretch. Our findings suggest that the triceps surae short/medium-latency stretch reflex cannot be evoked during swing phase and thus cannot contribute to the control of the locomotor pattern after aperturbation during this phase.

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Jacob J. Janicki, Craig L. Switzler, Bradley T. Hayes and Charlie A. Hicks-Little

Context:

Functional movement screening (FMS) has been gaining popularity in the fields of sports medicine and performance. Currently, limited research has examined whether FMS screening that identifies low FMS scores is attributed primarily to limits in range of motion (ROM).

Objective:

To compare scores from the FMS hurdle-step movement with ROM measurements for ankle dorsiflexion and hip flexion (HF).

Design:

Correlational research design.

Setting:

Sports medicine research laboratory.

Participants:

20 healthy active male (age 21.2 ± 2.4 y, weight 77.8 ± 10.2 kg, height 180.8 ± 6.8 cm) and 20 healthy active female (21.3 ± 2.0 y, 67.3 ± 8.9 kg, 167.4 ± 6.6 cm) volunteers.

Intervention:

All 40 participants completed 3 trials of the hurdle-step exercise bilaterally and goniometric ROM measurements for active ankle dorsiflexion and HF.

Main Outcome Measures:

Correlations were determined between ROM and FMS scores for right and left legs. In addition, mean data were compared between FMS scores, gender, and dominant and nondominant limbs.

Results:

There were no significant correlations present when all participants were grouped. However, when separated by gender significant correlations were identified. There was a weak correlation with HF and both hurdle-step (HS) and average hurdle-step (AHS) scores on both left (r = .536, P = .015 and r = .512, P = .012) and right (r = .445, P = .049 and r = .565, P = .009) legs for women. For men, there was a poor negative correlation of HF and both HS and AHS on the left leg (r = –.452, P = .045 and r = .451, P = .046).

Conclusion:

Our findings suggest that although hip and ankle ROMs do not have a strong relationship with FMS hurdle-step scores, they are a contributing factor. More research should be conducted to identify other biomechanical factors that contribute to individual FMS test scores.

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Marie A. Johanson, Brian J. Cuda, Jonathan E. Koontz, Julia C. Stell and Thomas A. Abelew

Context:

Stretching exercises are commonly prescribed for patients and healthy individuals with limited extensibility of the gastrocnemius muscle.

Objective:

To determine effects of gastrocnemius stretching on ankle dorsiflexion, knee extension, and gastrocnemius muscle activity during gait.

Design:

Randomized-control trial.

Setting:

Biomechanical laboratory.

Participants:

Sixteen volunteers (9 men and 7 women, mean age = 27 y) with less than 5° of passive ankle-dorsiflexion range of motion randomly assigned to an experimental or control group.

Intervention:

The experimental group performed gastrocnemius stretching for 3 wk.

Main Outcome Measures:

Maximum ankle dorsiflexion, maximum knee extension, and EMG amplitude of the gastrocnemius muscles were measured between heel strike and heel-off before and after intervention.

Results:

No significant effect of group or time was found on maximum ankle dorsiflexion, maximum knee extension, or EMG activity of the medial or lateral gastrocnemius muscles between heel strike and heel-off. The experimental group had significantly greater passive ankle-dorsiflexion range of motion bilaterally at posttest than the control group.

Conclusions:

Stretching did not alter joint angles or gastrocnemius muscle activity in the early to midstance phase of gait.

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David A. Krause, Beth A. Cloud, Lindsey A. Forster, Jennifer A. Schrank and John H. Hollman

Context:

Limited ankle DF (DF) range of motion (ROM) resulting from restricted gastrocnemius and soleus mobility is associated with a variety of lower extremity pathologies. Several techniques are used clinically to measure ankle DF.

Objectives:

To evaluate the reliability and minimal detectable change of DF ROM measurement, determine whether there is a difference in measured DF between techniques, and quantify the electromyographic (EMG) activity of the soleus and tibialis anterior muscles associated with the techniques.

Design:

Repeated measures.

Setting:

Controlled laboratory setting.

Participants:

39 healthy subjects, age 22–33.

Main Outcome Measures:

DF measurements using 5 different techniques including active and passive DF with the knee extended and flexed to 90° and a modified lunge. EMG activity of the soleus and anterior tibialis muscles.

Results:

Intrarater reliability values (ICC3,1) ranged from .68 to .89. Interrater reliability (ICC2,1) ranged from .55 to .82. ICCs were the greatest with the modified lunge. The minimal detectable change (MDC95) ranged from 6° to 8° among the different techniques. A significant difference in DF ROM was found between all methods. Measurements taken with active DF were greater than the same measures taken passively. The lunge position resulted in greater DF ROM than both active and passive techniques. EMG activity of the soleus was greater with active DF and the lunge than with passive DF.

Conclusions:

The modified lunge, which demonstrated excellent intrarater and interrater reliability, may best represent maximal DF. Active end-range DF was significantly greater than passive end-range DF when measured at either 0° or 90° knee flexion. Greater active DF was not explained by inhibition of the soleus. Finally, using the modified lunge, a difference between 2 measurements over time of 6° or more suggests that a meaningful change has occurred.

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Amandda de Souza, Cristiano Gomes Sanchotene, Cristiano Moreira da Silva Lopes, Jader Alfredo Beck, Affonso Celso Kulevicz da Silva, Suzana Matheus Pereira and Caroline Ruschel

to perform SMR of the lower limb muscles within 48 hours prior to the visits. Ankle dorsiflexion and hip-flexion ROMs were assessed pre- and post-SMR (short or long protocol) in both visits, and at a control condition, which was always performed at the first visit, 10 minutes before the pre

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Kimberly Somers, Dustin Aune, Anthony Horten, James Kim and Julia Rogers

Possessing adequate ankle dorsiflexion (DF) range of motion (ROM), or, by extension, improving ROM when deficient, has the potential to prevent ankle and knee injuries that may result in lower-extremity (LE) dysfunction. 1 , 2 An inverse relationship was observed between DF ROM and ankle injuries