Changes in Ankle Range of Motion and Gastrocnemius Pennation Angle according to Static Achilles Tendon Stretching Exercise Application Time in Healthy Adults : Randomized Cross-Over Trial

Abstract Background: Subcutaneous, spontaneous, complete ruptures of the Achilles tendon are usually caused indirectly by trauma associated with rapid movement. When minimally invasive Achilles tendon repair is performed, an active rehabilitation protocol can be implemented that allows for fast, measurable progress, reduced tissue atrophy, and an improved range of motion, thereby reducing pain and increasing patients’ overall physical well-being. However, overestimating the effectiveness of rehabilitative interventions can lead to arbitrary advancements in rehabilitation that significantly exceed the permitted levels of daily or professional activity. This issue can lead to various side effects and slow rehabilitation. The aim of the study was to evaluate the influence of adverse effects on objective outcomes after minimally invasive Achilles tendon repair.Methods: The study included 36 individuals with complete Achilles tendon rupture who underwent the percutaneous Ma-Griffith technique. The same rehabilitation protocol was used.Results: Five side effects were identified during rehabilitation: deformation of the repair construct (DRC), irritation of the sural nerve (SNI), morning ankle stiffness (MAS), edema of the soft tissue around the tendon (OST) and suture knots. DRC and MAS were associated with a longer time being required to achieve full ankle range of motion. SNI and OST were associated with a longer time being required to meet the criteria for dynamic training. None of the side effects were related to the isokinetic strength of the ankle plantar and dorsiflexors.Conclusions: The incidence of the assessed side effects in the postoperative period is not related to the type of activity, whether it is professional or amateur. Among the identified side effects, deformation of the regenerated shape of the heel tendon and MAS cause a delay in the recovery of full ankle range of motion. Calf nerve irritation and soft tissue swelling increase the time it takes to meet the criteria for starting dynamic training.Trial registration:The study was approved by the ethics committee of the Academy of Physical Education in Katowice (no. 13/2007)

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Arthroscopically-Asissted Achilles Tendon Repair; Long-Term Results

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00222 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0022

Author(s):

Akın Turgut ◽

Mert Zeynel Asfuroğlu

Keyword(s):

Achilles Tendon ◽

Range Of Motion ◽

Sural Nerve ◽

Plantar Flexion ◽

Tendon Repair ◽

Long Term Results ◽

Calf Circumference ◽

Achilles Tendon Repair ◽

Arthroscopically Assisted

Objectives: The ruptures of the Achilles tendon (AT) are relatively common. Since there is no consensus on the best method of the repair of the AT; the treatment is determined on the preference of the surgeon and the patient. The study evaluating the cadaveric and short term clinical results done by our clinic in 2002, has shown us that arthroscopically Achilles tendon repair can be good choise in achilles tendon ruptures. Methods: Fortyfour patients who underwent arthroscopically assisted achilles tendon repair during 1997-2011 in Osmangazi University Orthopaedics and Traumatology Department were retrospectively observed. The mean follow-up time was 69,7 months. One of patients had bilateral rupture. The diagnosis was based on loss of plantar flexion strength, palpation of the gap in the tendon, and a positive Thompson test. MRI and USG were used when needed. The ruptures were left-sided in nineteen patients and right-sided in twentysix. The cause of the rupture was recreational sports activity in thirtyeight, fall from height in four, missing a step in a staircase in two. Return the regular activity, ankle range of motion as compared with the opposite side, calf circumference, and ability to walk and stand tiptoe were recorded. All patients were operated on within 2-32 days after the rupture. Thirtysix operations were performed under spinal anesthesia and eight operations were performed under general anesthesia. Tourniquet was always used. Before starting the procedure, the rupture site and location of the gap are marked. Using the common videoarthroscopic instruments, a 70 degrees scope was inserted into the AT through the stab incision made previously, and the torn ends of the tendon were visualized with plantar flexion an extension of the ankle. After the visualization of the torn ends of the tendon and repair by the technique of Ma and Griffith care was focused to contact the ends of the tendon anatomically; then the sutures were knotted. A short leg circular cast with the ankle in slight plantar flexion was applied. American Orthopaedics Foot-Ankle Society (AOFAS) score was used to evaluate the long-term results.. Results: All patients had satisfactory results that no reruptures had occurred. No significant difference in range of motion of the ankle and calf circumference between the opposite sides was observed in any patient. All patients could walk and stand on tiptoe. AOFAS mean score was 94.5 (65-100). The interval from injury to return to regular work and activities was 8-10 weeks. All the patients were able to return back to their activity level before surgery. In three patients temporary sural hypoestesia, in one patient permanent sural hipoestesia and in one patient wound enfection appeared. No sensory deficit was detected in the temporary sural hypoestesia patients after postoperative second year controls. Medical care was supported to the patient with the wound enfection and the enfection was under control in the early stages. Conclusion: In summary; arthroscopically-assisted percutaneous repair of AT appears to overcome some certain problems of open, conservative and percutaneous techniques; but the neurovascular structure damage risk especially the sural nerve remains a potent problem. Accurate knowledge of the anatomy appears to be a solution. Novel percutaneous repairs have been promising to minimize the risk of sural nerve damage.

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Range of motion, muscle torque and training habits in runners with and without Achilles tendon problems

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/bf01560205 ◽

1993 ◽

Vol 1 (3-4) ◽

pp. 195-199 ◽

Cited By ~ 22

Author(s):

Y. Haglund-Åkerlind ◽

E. Eriksson

Keyword(s):

Achilles Tendon ◽

Range Of Motion ◽

Muscle Torque ◽

Training Habits ◽

And Training

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Effects of long-term athletic training on muscle morphology and tendon stiffness in preadolescence: association with jump performance

European Journal of Applied Physiology ◽

10.1007/s00421-020-04490-7 ◽

2020 ◽

Vol 120 (12) ◽

pp. 2715-2727

Author(s):

Nikolaos Pentidis ◽

Falk Mersmann ◽

Sebastian Bohm ◽

Erasmia Giannakou ◽

Nickos Aggelousis ◽

...

Keyword(s):

Muscle Strength ◽

Achilles Tendon ◽

Muscle Hypertrophy ◽

Muscle Thickness ◽

Pennation Angle ◽

Triceps Surae ◽

Plantar Flexors ◽

Tendon Stiffness ◽

Jumping Performance

Abstract Purpose Evidence on training-induced muscle hypertrophy during preadolescence is limited and inconsistent. Possible associations of muscle strength and tendon stiffness with jumping performance are also not investigated. We investigated the thickness and pennation angle of the gastrocnemius medialis muscle (GM), as indicators for potential muscle hypertrophy in preadolescent athletes. Further, we examined the association of triceps surae muscle–tendon properties with jumping performance. Methods Eleven untrained children (9 years) and 21 similar-aged artistic gymnastic athletes participated in the study. Muscle thickness and pennation angle of the GM were measured at rest and muscle strength of the plantar flexors and Achilles tendon stiffness during maximum isometric contractions. Jumping height in squat (SJ) and countermovement jumps (CMJ) was examined using a force plate. We evaluated the influence of normalised muscle strength and tendon stiffness on jumping performance with a linear regression model. Results Muscle thickness and pennation angle did not differ significantly between athletes and non-athletes. In athletes, muscle strength was greater by 25% and jumping heights by 36% (SJ) and 43% (CMJ), but Achilles tendon stiffness did not differ between the two groups. The significant predictor for both jump heights was tendon stiffness in athletes and normalised muscle strength for the CMJ height in non-athletes. Conclusion Long-term artistic gymnastics training during preadolescence seems to be associated with increased muscle strength and jumping performance but not with training-induced muscle hypertrophy or altered tendon stiffness in the plantar flexors. Athletes benefit more from tendon stiffness and non-athletes more from muscle strength for increased jumping performance.

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In vivo physiological cross-sectional area and specific force are reduced in the gastrocnemius of elderly men

Journal of Applied Physiology ◽

10.1152/japplphysiol.01186.2004 ◽

2005 ◽

Vol 99 (3) ◽

pp. 1050-1055 ◽

Cited By ~ 138

Author(s):

Christopher I. Morse ◽

Jeanette M. Thom ◽

Neil D. Reeves ◽

Karen M. Birch ◽

Marco V. Narici

Keyword(s):

Achilles Tendon ◽

Voluntary Contraction ◽

Pennation Angle ◽

Specific Force ◽

Plantar Flexor ◽

Moment Arm ◽

Plantar Flexors ◽

Elderly Men ◽

Cross Sectional

Sarcopenia and muscle weakness are well-known consequences of aging. The aim of the present study was to ascertain whether a decrease in fascicle force (Ff) could be accounted for entirely by muscle atrophy. In vivo physiological cross-sectional area (PCSA) and specific force (Ff/PCSA) of the lateral head of the gastrocnemius (GL) muscle were assessed in a group of elderly men [EM, aged 73.8 yr (SD 3.5), height 173.4 cm (SD 4.4), weight 78.4 kg (SD 8.3); means (SD)] and for comparison in a group of young men [YM, aged 25.3 yr (SD 4.4), height 176.4 cm (SD 7.7), weight 79.1 kg (SD 11.9)]. GL muscle volume (Vol) and Achilles tendon moment arm length were evaluated using magnetic resonance imaging. Pennation angle and fiber fascicle length (Lf) were measured using B-mode ultrasonography during isometric maximum voluntary contraction of the plantar flexors. PCSA was estimated as Vol/Lf. GL Ff was calculated by dividing Achilles tendon force by the cosine of θ, during the interpolation of a supramaximal doublet, and accounting for antagonist activation level (assessed using EMG), Achilles tendon moment arm length, and the relative PCSA of the GL within the plantar flexor group. Voluntary activation of the plantar flexors was lower in the EM than in the YM (86 vs. 98%, respectively, P < 0.05). Compared with the YM, plantar flexor maximal voluntary contraction torque and Ff of the EM were lower by 47 and 40%, respectively ( P < 0.01). Both Vol and PCSA were smaller in the EM by 28% ( P < 0.01) and 16% ( P < 0.05), respectively. Also, pennation angle was 12% smaller in the EM, whereas there was no significant difference in Lf between the YM and EM. After accounting for differences in agonists and antagonists activation, the Ff/PCSA of the EM was 30% lower than that of the YM ( P < 0.01). These findings demonstrate that the loss of muscle strength with aging may be explained not only by a reduction in voluntary drive to the muscle, but mostly by a decrease in intrinsic muscle force. This phenomenon may possibly be due to a reduction in single-fiber specific tension.

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Effect of stretch positions on hamstring muscle length, lumbar flexion range of motion, and lumbar curvature in healthy adults

Physiotherapy Theory and Practice ◽

10.3109/09593981003703030 ◽

2010 ◽

Vol 27 (2) ◽

pp. 146-154 ◽

Cited By ~ 11

Author(s):

Nicole P Borman ◽

Elaine Trudelle-Jackson ◽

Susan S Smith

Keyword(s):

Range Of Motion ◽

Muscle Length ◽

Healthy Adults ◽

Hamstring Muscle ◽

Lumbar Flexion

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Range of Motion of the Foot as a Function of Age

Foot & Ankle ◽

10.1177/107110079201300608 ◽

1992 ◽

Vol 13 (6) ◽

pp. 336-343 ◽

Cited By ~ 74

Author(s):

B.M. Nigg ◽

V. Fisher ◽

T.L. Allinger ◽

J.R. Ronsky ◽

J.R. Engsberg

Keyword(s):

Achilles Tendon ◽

Coordinate System ◽

Range Of Motion ◽

Human Locomotion ◽

Age Group ◽

Laboratory Coordinate System ◽

Locomotor System ◽

Order Of Magnitude ◽

Motion Measurements

Movement of the foot is essential for human locomotion. The purpose of this paper was to quantify the range of motion of the foot as a function of age and to compare the rage of motion measurements for the foot in a laboratory coordinate system and a coordinate system fixed to the tibia. The measurements were taken in vivo using a range of motion instrument developed by Allinger (University of Calgary, Canada, 1990) from 121 subjects. The results suggest that: (1) the range of motion in general is greater for women than for men in the young adult group; (2) the range of motion in general is in the same order of magnitude for women and men in the oldest age group; and (3) the range of motion is about 8° smaller in dorsiflexion and about 8° higher in plantarflexion for women than for men in the oldest age group. It is speculated that physical activity and common shoe wear are factors influencing the age- and gender-dependent differences in range of motion. Furthermore, it has been shown that the range of motion values measured in a laboratory coordinate system and in a coordinate system fixed in the tibia are different in all directions except inversion. The differences in plantarflexion and dorsiflexion and inversion and eversion are relatively small. However, they are substantial for adduction and abduction. In all cases, the results were bigger for measurements in the laboratory coordinate system compared with the tibia coordinate system, because the movement of the lower leg was included in the measurements in the laboratory coordinate system. The data indicate that foot range of motion is different for women and men. Consequently, it is speculated that these differences may be related to possible overloading of the locomotor system, especially in sporting activities in which the loading of the foot is significant. The differences in the plantarflexion and dorsiflexion direction were assumed to influence the loading of the Achilles tendon, and it is suggested that some of the Achilles tendon problems may be predictable based on range of motion measurements.

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