Ankle range of motion and dynamic balance in recreational Sepak Takraw players with and without ankle injury - a comparative study

Background and Study Aim. Sepak Takraw (ST) is considered Malaysia's national sport, and the nature of this sport requires players to be sufficiently acrobatic. Therefore, players were expected to jump and regain their balance, challenging their dynamic balance (DB). Nonetheless, range of motion (ROM) is closely related to balance. Hence, this study aimed to compare recreational ST players' ankle ROM and DB differences with and without ankle injuries. Material and Methods. The cross-sectional study in which 30 participants were assigned purposively according to players with an ankle injury (n=15) and without ankle injury (n=15) based on the position statement of the International Ankle Consortium (IAC). One time ankle Range of Motion and Dynamic balance was measured using a universal goniometer and Star Excursion Balance Test (SEBT), respectively, for both groups. Results. Independent T-test was performed to identify the significant differences (p<0.05) of SEBT and ROM between the non-injured leg and injured leg within the injured group to the non-injured group. Ankle eversion and dorsiflexion between the injured and non-injured groups did not show any significant difference with p=0.35 & p=0.53, respectively. As for SEBT, only posteromedial and medial of the injured leg did not show a significant difference p>0.05. All other ankles ROM and the SEBT score demonstrated a statistically significant difference p<0.05. Conclusions. ROM and DB training/rehabilitation should be incorporated to all the injured group ST sports players regardless of which leg is affected to optimize ankle function and the game performance.

Effects of nail softness and stiffness with distance running shoes on ground reaction forces and vertical loading rates in male elite long-distance runners with pronated feet

Background To improve propulsion during running, athletes often wear spike shoes designed for training and/or competition. Running with spike shoes may cause pain and/or injuries. To address this problem, a modified spike shoe was tested. This study aimed to evaluate the effects of running with dual-versus single-stiffness spike running shoes on running mechanics in long-distance runners with pronated feet. Methods Sixteen male elite (national competitive level) runners (5000 or 10,000 m) aged 28.2 ± 2.5 years with pronated feet volunteered to participate in this study. To be included, participants had to have achieved personal best race times over 5- and/or 10-km races under 17 or 34 min during official running competitions. All participants were heel strikers and had a history of 11.2 ± 4.2 years of training. For the assessment of running kinetics, a force plate was imbedded into a walkway. Running kinematics were recorded using a Vicon-motion-capture system. Nike Zoom Rival shoes (Nike, Nike Zoom Rival, USA) were selected and adapted according to spike softness and stiffness. Participants ran at a constant speed of ~4.0 m/s across the walkway with both shoe conditions in randomized order. Six trials were recorded per condition. The main outcomes included peak ground reaction forces and their time-to-peak, average and instantaneous vertical loading rates, free moments, and peak ankle eversion angles. Results Paired t-tests revealed significantly lower lateral (p = 0.021, d = 0.95) and vertical (p = 0.010, d = 1.40) forces at heel contact during running with dual-stiffness spike shoes. Running with dual-stiffness spike shoes resulted in a significantly longer time-to-peak vertical (p = 0.004, d = 1.40) force at heel contact. The analysis revealed significantly lower average (p = 0.005, d = 0.46) and instantaneous (p = 0.021, d = 0.49) loading rates and peak negative free moment amplitudes (p = 0.016, d = 0.81) when running with dual-stiffness spike shoes. Finally, significantly lower peak ankle eversion angles were observed with dual-stiffness spike shoes (p < 0.001, d = 1.29). Conclusions Running in dual- compared with single-stiffness spike distance running shoes resulted in lower loading rates, free moment amplitudes, and peak ankle eversion angles of long-distance runners with pronated feet.

All-Inside Anterior Cruciate Ligament Reconstruction Using an Anterior Half of the Peroneus Longus Tendon Autograft

Background: The peroneus longus tendon (PLT) has been used as a graft in many orthopaedic surgical procedures because of its comparable biomechanical strength with the native anterior cruciate ligament (ACL). Despite its potential, few studies have been performed to investigate the clinical reliability of ACL reconstruction using a PLT autograft. Purpose: To assess the clinical outcomes and donor-site morbidity of ACL reconstruction using an anterior half of the PLT (AHPLT) autograft in patients with an isolated ACL injury. Study Design: Case series; Level of evidence, 4. Methods: Between January 2016 and January 2017, a total of 21 patients with an isolated ACL injury underwent all-inside single-bundle ACL reconstruction using an AHPLT autograft. Knee stability was assessed using the Lachman test, pivot-shift test, and KT-2000 arthrometer (side-to-side difference) with 134-N anterior force and at 30° of knee flexion. Knee function was evaluated using the International Knee Documentation Committee score, Lysholm score, and Tegner score. Donor-site morbidity was assessed using ankle eversion and plantarflexion strength as well as the American Orthopaedic Foot & Ankle Society scoring system and the Foot and Ankle Disability Index. Results: At a mean final follow-up of 40.1 months (range, 36-48 months), the KT-2000 arthrometer side-to-side difference was significantly lower compared with preoperatively (1.1 ± 0.62 vs 7.0 ± 2.18 mm, respectively; P < .001). The mean preoperative International Knee Documentation Committee, Lysholm, and Tegner scores were 52.0 ± 8.27, 50.9 ± 8.50, and 1.8 ± 0.87, respectively, increasing significantly to 94.2 ± 2.61, 95.2 ± 2.64, and 6.8 ± 1.50, respectively, at final follow-up ( P < .001 for all). All patients had grade 5 muscle strength in ankle eversion and plantarflexion at the donor site, with mean American Orthopaedic Foot & Ankle Society and Foot and Ankle Disability Index scores of 96.8 and 97.6, respectively. No complications or reoperations occurred. Conclusion: All-inside ACL reconstruction using an AHPLT autograft produced good functional scores and stability without obvious ankle-site morbidity.

Lower limb biomechanics in individuals with chronic ankle instability during gait: a case-control study

Background Individuals with chronic ankle instability (CAI) exhibit many biomechanical changes to lower limbs during walking. However, only a few studies have investigated the differences in lower limb biomechanics of individuals with CAI compared to healthy controls using a comprehensive approach including kinematic, kinetic and electromyography (EMG) measures. Consequently, the theoretical framework explaining the biomechanical adaptations in individuals with CAI is mostly based on the results of studies including heterogenous methods and participants’ specificities (e.g., level of disability). More studies using a comprehensive approach are needed to better understand the biomechanical adaptations associated with CAI. The objective of this case-control study was to identify the kinematic, kinetic and EMG differences between individuals with CAI and healthy controls during walking. Methods Twenty-eight individuals with CAI and 26 healthy controls were recruited to walk at a self-selected speed during which lower limb kinematics, kinetics and EMG were analysed. Ankle and knee angles and moments as well as gluteus medius, vastus lateralis, gastrocnemius lateralis, peroneus longus and tibialis anterior muscles activity were compared between the CAI and control groups using one-dimensional statistical parametric mapping. Results The CAI group exhibited greater ankle inversion angles from 14 to 48% of the stance phase (%SP) (p = 0.008), ankle eversion moments from 40 to 78%SP (p < 0.001), knee abduction moments from 3 to 6%SP and peroneus longus muscle activity from 0 to 15%SP (p = 0.003) and 60 to 76%SP (p = 0.003) compared to the control group. No significant between-group differences in ankle sagittal and transverse angles and moments, knee angles, knee sagittal and transverse moments as well as gluteus medius, vastus lateralis, gastrocnemius lateralis and tibialis anterior muscles activity were found. Conclusions During the first half of the stance phase, individuals with CAI could be at more risk of sustaining recurrent LAS mostly due to greater ankle inversion angles. However, the greater ankle eversion moments and peroneus longus muscle activity during the second half of the stance phase were an efficient mechanism to correct this maladaptive gait pattern and allowed to attenuate the faulty ankle movements during the pre-swing phase.

Rounding the base: A lower extremity biomechanical analysis in softball players

Contacting the base is a common injury mechanism for base runners in softball, with ankle sprains being the most common type of injury, but it is not known how the base affects lower extremity mechanics. The purpose of this study was to analyze lower extremity biomechanics while rounding a base. Sixteen recreationally active females with previous softball experience completed two base rounding conditions. A base was securely placed on the force place for the with base (WB) condition, and an outline of the base was taped on the force plate for the no base (NB) condition. Three-dimensional right-leg hip, knee, and ankle kinematics and kinetics were measured during the stance phase of the base rounding and analyzed using statistical parametric mapping (SPM). The WB condition resulted in decreased hip abduction ( p = 0.034), increased dorsiflexion ( p = 0.012), and decreased inversion ( p < 0.001) angles. Increased hip extension ( p < 0.001) and hip abduction ( p = 0.016) moments were exhibited during the WB condition. Decreased hip abduction ( p = 0.026), ankle plantarflexor ( p < 0.001), and ankle eversion ( p < 0.001) moments were also exhibited in the WB condition. The base acts as a lateral banking surface, reducing variables associated with ankle sprains, and likely assists in propelling base runners to the next base without injury.

Inter- and Intra-Rater Reliability of Handheld Dynamometry for Lower Extremity Strength Testing in Pre-Professional Dancers

Handheld dynamometry (HHD) using external fixation has demonstrated high inter- and intra-rater reliability. Handheld dynamometry offers an objective way to quantify strength; however, setting up external stabilization devices for HHD can be time consuming. This study examined the reliability of HHD for lower extremity strength in dancers using body weight stabilization. Twenty-six pre-professional dancers (age: 20.64 ± 2.21 years) were recruited and assessed by three testers: an experienced physical therapist (ePT), a novice physical therapist (nPT), and a student physical therapist (SPT). To avoid testing fatigue, dancers were divided into two testing groups and were evaluated on separate weekends. Testers used HHD to test isometric force production of six muscle groups in the first cohort and seven different muscle groups in the second cohort. Testing positions were standardized and utilized a “make” test protocol. Intra-class correlation coefficients (ICC), 95% confidence interval, and standard error of measurement were calculated for each position. Inter-rater reliability was > 0.75 for all ICC measures except knee extension and ankle eversion. Intra-rater reliability was > 0.75 for all ICC measures except the ePT (tester A) day 2 for hip extension, internal rotation seated, knee extension, and ankle dorsiflexion; nPT (tester B) day 1 knee flexion; and SPT (tester C) for day 1 knee extension and ankle eversion and days 1 and 2 for ankle dorsiflexion and inversion. It is concluded that HHD can reliably measure force production of hip, knee, and ankle muscle groups without use of external fixation devices.

Predictive potentials of 8 muscle strength actions, KOOS-pain, and Örebro-psychosocial difficulties on self-reported activities-of-daily-life function in patients with knee osteoarthritis: an exploratory regression-based cross-sectional study

BackgroundThe aim of the study was to explore the relative predictive potentials of a discriminative and comprehensive set of lower-limb muscle strength factors onto self-reported physical-activities-of-daily-life-function (SR-ADL-function) in patients with knee osteoarthritis (KOA), when adjusting for prior known strong prospective predictors in a statistical model which covers the functional domains of the International Classification of Function, Disability, and Health (ICF). MethodsThe design was exploratory, patient-only, cross-sectional, and multivariable regression-based, rotating 8 strength-variables onto a hierarchical model. The setting was an Osteoarthritis-school in a secondary-care hospital in Norway. The participants were 28 Caucasian patients with mild-to-moderate symptomatic and radiographic KOA (mean age 61; 64% women) referred by general physicians to an osteoarthritis-school. Excluded patients had trauma to the lower limbs, BMI >35, and age beyond 45 to 70. The dependent/outcome variable was SR-ADL-function (Knee Injury and Osteoarthritis Outcome Score [KOOS-ADL]). The known predictors were prior documented discriminative KOOS-Pain and psychosocial difficulties (Örebro Musculoskeletal Pain Questionnaire), together with 8 candidate predictor lower-limb muscle-strength actions (Biodex and Commander II dynamometer recorded).ResultsMutually adjusted for pain and psychosocial difficulties (R2 = 0.71), the predicting muscle-strength actions explained the following unique variances in SR-ADL-function: hip external rotation 7.6% (p<0.010), ankle eversion 4.0% (p=0.050), hip internal rotation 3.8% (p=0.060), ankle inversion 3.6% (p=0.066). The remaining 4 muscle-strength actions explained from 2.0% to 1.2% (p>0.099), where knee extensor strength explained the least unique variance. Flipped, the current three best potential prediction models explained the following substantial proportions of variance in SR-ADL-function: 1) KOOS-pain, 66%; 2) KOOS-pain and Örebro psychosocial difficulties, 71%; and 3) KOOS-pain, Örebro psychosocial difficulties, and hip external rotation strength, 78%.ConclusionsAdjusted for pain and psychosocial difficulties, hip rotations and ankle eversion-inversion strength indicate substantial cross-sectional potentials for predicting SR-ADL-function for patients with KOA aged 45 to 70 in primary/hospital health-care. Relevant for future prevention and prediction/treatment studies, however, we suggest clinical researchers to consider the current muscle-strength actions together with the even stronger biopsychosocial predictors KOOS-pain and Örebro psychosocial difficulties for future ICF domain-covering models of SR-ADL. Future confirmative studies are needed to refute or generalize these pioneering exploratory conclusions.

Drop Foot Secondary to a Peroneal Intraneural Ganglion Connected to the Superior Tibiofibular Joint: A Case Report

Peroneal neuropathy is the most frequent mononeuropathy of the lower extremity. Intraneural ganglion cysts (INGCs) are among rare causes of peroneal nerve palsy. According to the articular (synovial) theory, the articular branch plays the key role in the pathogenesis. Patients present with pain around the fibular head and neck, motor weakness resulting in foot drop and paresthesia in the anterolateral calf and foot. Ultrasonography (US) and MRI are both useful in the diagnosis, but MRI is the best imaging modality in the demonstration of the articular connection and the relation of the cyst with adjacent structures, even without special neurography sequences. We present a 32-year-old male patient referred to our neurosurgery clinic with suspicion of lumbar radiculopathy. He presented with right foot drop which began 3 weeks prior. On examination, there was 90% loss in the ankle dorsiflexion and finger extension. Ankle eversion was also weakened. There was no low back or posterolateral thigh pain to suggest L5 radiculopathy and sciatic neuropathy. Following negative lumbar spine MRI, peripheral neuropathy was concerned. Electrodiagnostic evaluations findings were consistent with acute/subacute common peroneal nerve (CPN) axonal neuropathy. Subsequent MRI of knee showed a homogeneous, thin-walled tubular cystic lesion, extending along the course of the CPN and its articular branch. Full recovery of the neuropathy was achieved with early diagnosis and decompression via microsurgical epineurotomy. The diagnosis of INGC was confirmed by histopathologic examination. INGCs, although rare, should also be considered in the differential diagnosis of peripheral mononeuropathies.

Increased Contact Time and Strength Deficits in Runners With Exercise-Related Lower Leg Pain

Context Exercise-related lower leg pain (ERLLP) is common in runners. Objective To compare biomechanical (kinematic, kinetic, and spatiotemporal) measures obtained from wearable sensors as well as lower extremity alignment, range of motion, and strength during running between runners with and those without ERLLP. Design Case-control study. Setting Field and laboratory. Patients or Other Participants Of 32 young adults who had been running regularly (&gt;10 mi [16 km] per week) for ≥3 months, 16 had ERLLP for ≥2 weeks and 16 were healthy control participants. Main Outcome Measure(s) Both field and laboratory measures were collected at the initial visit. The laboratory measures consisted of alignment (arch height index, foot posture index, navicular drop, tibial torsion, Q-angle, and hip anteversion), range of motion (great toe, ankle, knee, and hip), and strength. Participants then completed a 1.67-mi (2.69-km) run along a predetermined route to calibrate the RunScribe devices. The RunScribe wearable sensors collected kinematic (pronation excursion and maximum pronation velocity), kinetic (impact g and braking g), and spatiotemporal (stride length, step length, contact time, stride pace, and flight ratio) measures. Participants then wore the sensors during at least 3 training runs in the next week. Results The ERLLP group had a slower stride pace than the healthy group, which was accounted for as a covariate in subsequent analyses. The ERLLP group had a longer contact time during the stance phase of running (mean difference [MD] = 18.00 ± 8.27 milliseconds) and decreased stride length (MD = −0.11 ± 0.05 m) than the control group. For the clinical measures, the ERLLP group demonstrated increased range of motion for great-toe flexion (MD = 13.9 ± 4.6°) and ankle eversion (MD = 6.3 ± 2.7°) and decreased strength for ankle inversion (MD = −0.49 ± 0.23 N/kg), ankle eversion (MD = −0.57 ± 0.27 N/kg), and hip flexion (MD = −0.99 ± 0.39 N/kg). Conclusions The ERLLP group exhibited a longer contact time and decreased stride length during running as well as strength deficits at the ankle and hip. Gait retraining and lower extremity strengthening may be warranted as clinical interventions in runners with ERLLP.

Short-Term Effect of Ankle Eversion Taping on Bilateral Acute Ankle Inversion Sprains in an Amateur College Football Goalkeeper: A Case Report

This case study aimed to investigate the short-term effects of ankle eversion taping (AET) using kinesiology tape on bilateral acute ankle inversion sprains in an amateur college soccer goalkeeper. Ankle eversion taping was applied for two weeks (average 16 h/day) on a 24-year-old goalkeeper with bilateral grade 2 acute ankle inversion sprain with swelling (left ankle more severe) during a soccer match. The subject had a foot ankle outcome score (FAOS) of 41%; visual analog scale (VAS) scores of 5/10 and 7/10 for the right and left ankles, respectively; patient-specific functional and pain scale (PSFS) score of 12/50; and limited range of motion of the ankle. The swelling disappeared after AET in both ankles. In the weight-bearing lunge test, the right and left ankle distances increased from 2 cm to 12 cm, and from 0 cm to 12 cm, respectively. The FAOS improved from 20% to 97%, while the PSFS score improved from 12/50 to 50/50. The VAS scores decreased to 0/10 for both ankles. AET is a potential clinical treatment method for acute ankle inversion sprain with swelling.