Relationship between Ankle Range of Motion (ROM), Muscle Strength, Balance, and Fall Risk in Postmenopausal Women: A Pilot Study

Menopause is an age-dependent physiological condition associated with a natural decline in estrogen levels, which causes a progressive decrease in muscle mass and strength, and bone density. Estrogen deficiency occurring during menopause will affect both the gynecological area and the whole body which will directly act on skeletal muscle through estrogen receptors. Although various factors are associated with falls in menopausal women, impaired balance and mobility have been consistently identified as the main risk factors. Identification of the factors associated with balance and fall risk may enable therapists to design treatments to help reduce the risk of falls and the consequences. Since the impact of impaired balance and fall risk among postmenopausal women is undefined. The purpose of this study was to assess the relationship between ankle range of motion and muscle strength with balance and fall risk in post-menopausal women. The ankle ROM and muscle strength were examined by using a universal goniometer and push-pull hand-held dynamometer respectively; the balance was assessed by Y balance test (YBT) and fall risk was measured by Fall Efficacy Scale International (FES-I). Karl Pearson correlation coefficient was used to find the relationship between ankle ROM, ankle strength, balance, and fall risk among postmenopausal women which showed a low positive correlation between the ankle ROM and YBT whereas a moderate positive correlation between the ankle strength and YBT which was statistically significant. The correlation between FES-I and ankle ROM and ankle strength were high and moderate respectively which was also statistically significant. Keywords: Postmenopausal women, ankle range of motion, ankle strength, balance, fall risk, YBT

To What Extent Do Musculoskeletal Ultrasound Biomarkers Relate to Pain, Flexibility, Strength, and Function in Individuals With Chronic Symptomatic Achilles Tendinopathy?

Introduction: Achilles tendinopathy (AT) is a chronic musculoskeletal pathology best evaluated by ultrasound imaging. This cross-sectional study aimed at better understanding the relationship between musculoskeletal ultrasound biomarkers (MUBs) of Achilles tendon and localized pain, ankle flexibility, ankle strength, and functional abilities.Method: Forty-one participants with unilateral midportion chronic AT had their tendon images analyzed bilaterally in the longitudinal and transverse planes. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and Lower Extremity Functional Scale (LEFS) assessed pain and function, respectively, during standing and walking-related activities. Ankle flexibility was evaluated by weight-bearing lunge tests, while ankle isometric peak strength was measured using an instrumented dynamometer. Achilles tendon ultrasonographic images were analyzed using geometric (thickness), composition (echogenicity), and texture (homogeneity) MUBs. Discriminative validity was evaluated using paired Student's t-tests to compare MUBs between symptomatic and asymptomatic sides. Predictive validity was evaluated by computing the Pearson product-moment correlations coefficient between MUBs and pain, ankle flexibility, ankle strength, and function.Results: Significant differences were found in MUBs between the symptomatic and asymptomatic sides, confirming the discriminative validity of the selected MUBs. On the symptomatic side, thickness was found 29.9% higher (p < 0.001), echogenicity 9.6% lower (p < 0.001), and homogeneity 3.8% higher (p = 0.001) when compared with the asymptomatic side. However, predictive validity was scarcely confirmed, as most of the correlation coefficients were found negligible for the associations investigated between MUBs with localized pain, ankle flexibility, strength, and function. Only 14 statistically significant low to moderate associations were found, with negative and positive correlations ranging between −0.31 and −0.55 and between 0.34 and 0.54, respectively.Discussion: Musculoskeletal ultrasound biomarkers have a clinical utility in visualizing in vivo tendon integrity and diagnosing AT. MUBs should be valued as part of a comprehensive neuro-musculoskeletal assessment as they complement pain, flexibility, strength, and function measures. Altogether, they may inform the development and monitoring of a personalized rehabilitation treatment plan.

Effects of Two Foot-Ankle Interventions on Foot Structure, Function, and Balance Ability in Obese People with Pes Planus

Obese people are prone to foot deformities such as flat feet. Foot management programs are important to prevent them. This study investigated the effects of two foot-ankle interventions on balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions in obese people with pes planus for four weeks. The experiment was designed as a randomized controlled trial. Twenty-four participants who met the inclusion criteria were selected, and they were randomly assigned to either a short foot group (SFG) or proprioceptive neuromuscular facilitation group (PNFG) according to foot-ankle intervention. Two interventions were commenced three times a week for 20 min over four weeks. The tests were conducted at two intervals: pre-intervention and at four weeks. The tests were conducted in the following order: the patient-specific functional scale test (PSFS), an ultrasound of the plantar fascia, the navicular drop test, balance test, and the four-way ankle strength test. Two groups showed significant differences in balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions between pre-test and post-test (p < 0.05). PNFG had significantly higher dorsiflexor and invertor strength than SFG (p < 0.05). SF and PNF interventions were effective to improve balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions in obese people with pes planus. Additionally, PNF intervention is more beneficial in increasing the dorsiflexor and invertor strength compared to SF intervention.

Relationship between ankle strength and range of motion and postural stability during single-leg quiet stance in trained athletes

The aim of this study was to determine the relationship between strength of ankle plantar and dorsal flexors and range of motion (RoM), and body sway variables during single-leg quiet stance, in highly trained athletes. The participants for this study were young athletes from 9 disciplines (n = 655). Center of pressure (CoP) velocity, amplitude, and frequency were measured during single-leg quiet stance. Moreover, athletes were measured for passive ankle plantar flexion (PF) and dorsal flexion (DF) RoM, and for rate of torque development (RTD) in the 0–50 (RTD50) and 0–200 ms time windows (RTD200). Ankle strength and RoM could not predict CoP velocity total, anterior–posterior (AP), and medial–lateral (ML) (p > 0.05). However, PFRTD50 and PFRoM and PFRoM positively influenced CoP amplitude in ML direction (p < 0.001, R2 = 0.10). Moreover, CoP frequency in ML direction significantly increased with lower PFRTD50, DFRTD50, DFRTD200, PFRoM, and DFRoM (p < 0.05). We have demonstrated that ankle strength and RoM were related to single-leg quiet stance postural balance in trained athletes. The ankle RoM showed the greatest influence on CoP variables in ML directions.

Comparison between gymnasts and non-gymnasts in isometric strength of the lower limbs

Muscle asymmetries in gymnasts are common and can lead to injury. We aimed to determine differences in hip, knee, and ankle strength between female gymnasts and non-gymnasts, and secondly, to determine the effect of strength training intervention. Fifteen gymnasts (aged 11.19 ± 1.89 years) and 15 non-gymnasts (aged 10.92 ± 1.96 years) performed unilateral isometric maximal voluntary contractions of the hip (extensor, flexor, abductor, adductor, internal and external rotator), knee and ankle flexors and extensors on a dynamometer. Inter-limb asymmetries (ILAs) were compared across strength outcomes (MVC torque) and groups. ILAs was calculated based on the strength measurements. The gymnasts were retested after 8 weeks, during which the participants performed 5 weeks of regular training and 3 weeks of targeted strength training intervention. We found significant differences between groups in most observed hip strength parameters, but not in knee and ankle strength. The intervention did not significantly affect any parameter of ILAs. Gymnasts and non-gymnasts differ in hip strength parameters. A longer intervention program may decrease ILA parameters.

Effects of Passive Bi-axial Ankle Movement Training with Electrical Stimulation on Ankle Sensorimotor Functions in Stroke Patients: A Randomized Controlled Pilot Study

Background: This study was conducted to investigate the effect of passive biaxial ankle movement training synchronized with electrical stimulation therapy (AMT-EST) on ankle proprioception, ankle strength, balance, and gait in chronic stroke patients. We observed the changes in ankle sensorimotor function after stroke.Methods: Thirty-five stroke patients were randomized to an experimental or control group, and 30 patients completed the trials. The experimental group received AMT-EST on the affected ankle for 30 minutes a day, 5 times a week for 4 weeks, for a total of 20 sessions. The control group received electrical stimulation therapy on the affected ankle. The primary outcome measures were ankle proprioception, passive range of motion, and strength. The secondary outcome measures were balance and gait-related functional abilities.Results: Compared with those in the control group, the participants in the experimental group who received AMT-EST showed significant post-training improvement in ankle proprioception of eversion (P<0.05). The ankle passive range of motion (inversion and eversion), ankle strength (dorsiflexion, plantarflexion, inversion, and eversion), and functional abilities (Fugl–Meyer Assessment, Berg Balance Scale, Timed Up and Go test, Fall Efficacy Scale, and walking speed) significantly improved in the experimental group (P<0.05). Significant group×time interactions were observed in ankle passive range of motion (inversion and eversion), ankle strength (dorsiflexion), and Fugl–Meyer Assessment (P<0.05). All ankle proprioception moderately correlated with ankle passive range of motion (eversion), ankle strength (dorsiflexion and eversion), the Berg Balance Scale, and Fugl–Meyer Assessment (P<0.05).Conclusions: Biaxial AMT-EST effectively increased ankle proprioception, range of motion, strength, and functional abilities in chronic stroke patients. These findings suggest that AMT-EST can be proposed as a novel ankle rehabilitation program for chronic stroke patients with ankle sensorimotor impairment.Trial registration: This study was approved by the Institutional Review Board at a rehabilitation hospital (NRC-2017-04-035, National Rehabilitation Center, Seoul, South Korea) and retrospectively registered at a clinical trial registry on January 31, 2020 (CRIS, KCT0004688, https://cris.nih.go.kr/).

Passive Biaxial Ankle Movement Training with Electrical Stimulation for Ankle Sensorimotor Function in Chronic Stroke

BackgroundPost stroke had both ankle sensory and motor impairments that affect ankle motor control. The purpose of this study was to investigate the effect of passive biaxial ankle movement training coupled with electrical stimulation (AMT-EST) on ankle proprioception, ankle strength, balance, and gait in chronic stroke. MethodsThirty-five stroke subjects were randomized to an experimental or control group, and 30 subjects completed the trials. The experimental group received AMT-EST on the affected ankle for 30 minutes a day, 5 times a week for 4 weeks, for a total of 20 sessions. The control group received electrical stimulation therapy on the affected ankle. The primary outcome measures were ankle proprioception, passive range of motion, and strength. The secondary outcome measures were balance and gait-related functional abilities. ResultsThe experimental group showed significant post-training improvement in ankle proprioception of eversion, the ankle passive range of motion (inversion and eversion), ankle strength (dorsiflexion, plantarflexion, inversion, and eversion) Fugl–Meyer Assessment (FM-A), Berg Balance Scale (BBS), Timed Up and Go test, Fall Efficacy Scale, and walking speed (p < 0.05). Significant group×time interactions were observed in ankle passive range of motion (inversion and eversion), ankle strength (dorsiflexion), and FM-A (p < 0.05). All ankle proprioception moderately correlated with ankle passive range of motion (eversion), ankle strength (dorsiflexion and eversion), the BBS, and FM-A (p < 0.05). ConclusionsThe findings suggest that AMT-EST can be proposed as an ankle rehabilitation program for people with chronic stroke with ankle sensorimotor impairment.Trial RegistrationKCT0004688. Registered 01 Jan 2020

A three-week intervention emphasized diagonal eccentric contraction on balance and joint position sense and ankle strength in subjects with ankle instability: A randomized controlled trial

BACKGROUND: Problems related to ankle instability, decreased proprioceptive sensation, altered static and dynamic balance abilities are suggested as major representative factors that contribute to the recurrence of ankle sprains. OBJECTIVE: To assess the effect of a three-week intervention (intervention emphasizing diagonal eccentric contraction (IEDEC) and intervention of general exercise (IGE)) on static and dynamic balance abilities, ankle strength and joint position sense at pre- and post-intervention, and at two- and three-week post-intervention. METHODS: Twenty-five participants with ankle instability, including a history of ankle sprain and recurrent episodes of giving way, were enrolled in the study. They were randomly classified into the IEDEC group (n= 12) and the IGE group (n= 13). Dynamic balance was examined using the Y Balance Test, four-way ankle strength was measured, and the static balance was evaluated using the total displacement of the center of pressure (COP). To identify the joint position error, eversion and inversion of the ankle angle were measured. RESULTS: The results revealed significant increases in ankle dynamic stability and strength at two and three weeks post-intervention (p< 0.05). Similarly, the total displacement of the COP differed significantly over time, with a higher COP during the initial measurement than at two and three weeks intervention (p< 0.05) General balance training with IEDEC can improve position sense during ankle inversion (p< 0.05). CONCLUSION: General balance training with IEDEC improved the position sense of the inversion. Combined therapeutic intervention, such as with the manual technique, could be a beneficial approach to maximize the treatment effects.