Reliability of Shear Wave Elastography for the Assessment of Gastrocnemius Fascia Elasticity in Healthy Individual

The mechanical properties of deep fascia (i.e. an index of stiffness) strongly affect the development of muscle pathologies, and muscular actions, such as compartment syndromes. Actually, a clear understanding of the mechanical characterization of muscle deep fascia still lacks. The present study focuses on examining the reliability of ultrasonic shear wave elastography device (USWE) in quantifying the shear modulus of gastrocnemius fascia in healthy individual and the device’s abilities to examine the shear modulus of gastrocnemius deep fascia during ankle dorsiflexion. Twenty-one healthy males participated in the study (age: 21.48±1.17 years). The shear modulus of the medial gastrocnemius fascia (MGF) and lateral gastrocnemius fascia (LGF) were quantified at different angles using USWE during passive lengthening. The operators took turns to measure each subject’s MGF and LGF over 1-hour period and by operator B with a 2-hour interval. In the intra-operator test, the same subjects participated at the same time 5 days later. The intra-rater [ Intra-class correlation coefficient (ICC) = 0.846-0.965)] and inter-rater (ICC = 0.877-0.961) reliabilities for measuring the shear modulus of the MGF and LGF were rated as both excellent, and the standard error in measurement (SEM) was 3.49 kPa, the minimal detectable change (MDC) was 9.68 kPa. Regardless of the ankle angle, the shear modulus of the LGF were significant greater than that of the MGF (p < 0.001). The significant increase in the shear modulus both of the MGF and LGF were observed at neutral position compared to the relaxed position. This results indicate that the USWE is a technique to assess the shear modulus of gastrocnemius fascia and detect its dynamic changes during ankle dorsiflexion. USWE can be used for biomechanical study and intervention experiments of deep fascia.

Association of Ankle Dorsiflexion and Landing Forces in Jumping Athletes

Background: Dorsiflexion range of motion restriction has been associated with patellar tendinopathy, but the mechanisms of how dorsiflexion restriction could contribute to knee overload remain unknown. Hypothesis: Peak ankle dorsiflexion and ankle dorsiflexion excursion are negatively associated with peak vertical ground-reaction force (vGRF) and loading rate, and with peak patellar tendon force and loading rate, and positively associated with peak ankle plantar flexor moment. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Kinematic and kinetic data of 26 healthy recreational jumping athletes were measured during a single-leg drop vertical jump. Pearson’s correlation coefficients were calculated to establish the association between peak ankle dorsiflexion and ankle dorsiflexion excursion with peak vGRF and vGRF loading rate, with peak patellar tendon force and patellar tendon force loading rate, and with peak ankle plantar flexor moment. Results: Ankle dorsiflexion excursion negatively correlated with peak vGRF loading rate ( r = −0.49; P = 0.011) and positively correlated with peak ankle flexor plantar moment ( r = 0.52; P = 0.006). In addition, there was a positive correlation between peak ankle dorsiflexion and peak vGRF ( r = 0.39; P = 0.05). Conclusion: Ankle kinematics are associated with vGRF loading rate, ankle flexor plantar moment and peak vGRF influencing knee loads, but no association was observed between ankle kinematics and patellar tendon loads. Clinical Relevance: These results suggest that increasing ankle dorsiflexion excursion may be an important strategy to reduce lower limb loads during landings but should not be viewed as the main factor for reducing patellar tendon force.

Effects of dry needling in gluteus medius muscle in individuals with chronic ankle instability: a randomized single-blinded controlled clinical trial

IntroductionBackground: Lateral ankle sprain (LAS) is the most common musculoskeletal injuries in sport and general population. The goal of the present study was to observe the effectiveness of dry needling (DN) in gluteus medius muscle in patients with chronic ankle instability (CAI).Material and methodsA two-arm (1:1), single-blinded (participants), randomized clinical trial was performed in 40 subjects with chronic ankle instability and were divided in two groups: intervention group who received one session of dry needling in the most hyperalgesic gluteus medius myofascial trigger point (MTrP), (n = 20) and control group (n = 20). Dynamic balance, pain intensity, pain pressure threshold (PPT) and ankle dorsiflexion range of motion (ROM) were assessed at baseline, post-intervention and a 1-week follow up.ResultsThe experimental group reported significant differences with respect to the control group for the anterior and medial dynamic balance (p = .001), PPT -ATL (p = .002) and ankle dorsiflexion ROM (p = .001).ConclusionsThe findings of the present study suggested that the DN in the most hyperalgesic MTrP of the Gmed muscle may increase the anterior and medial dynamic balance, ankle ROM and PPT-ATL at short-term in individuals with CAI. Pain intensity benefits were reported in both groups. Future studies should consider DN as a possible intervention in conjunction with a physical therapy program for individuals with CAI.

Inter and Intra Rater Reliability of Different Measurement Techniques of Weight Bearing Ankle Dorsiflexion Range of Motion

Background: Measurement of range of motion is a crucial parameter in the physiotherapeutic evaluation and follow up. Ankle dorsiflexion is important for functional activities like running, jogging, waking, stair climbing. Restricted ankle dorsiflexion is seen in various lower limb injuries. Therefore, assessment of dorsiflexion is important to assess function. Goniometer, tape measure, mobile goniometer, inclinometer is used to measure ankle dorsiflexion range of motion in weight bearing and non-weight bearing positions. Weight bearing dorsiflexion has reported higher intra and inter-rater reliability as compared to non-weight bearing ankle dorsiflexion. All these measures may be taken by the same and by different therapists in the management of one patient. Therefore, it is necessary to determine if the measurements used are reliable both within and between the therapists. Material and Methods: 50 healthy subjects were recruited and their role was explained in the study. Written consent was taken from all the subjects. Weight bearing lunge was done in which the subject was asked to stand with the heel in contact with the ground and the great toe 10 cm away from the wall and the knee touching the wall. Inclinometer, standard goniometer, mobile goniometer and tape measure were administered to check for ankle dorsifexion range of motion. Results: ICC for inter rater reliability was almost perfect for tape measure and goniometer (0.968 and 0.837 respectively) and it was substantial for inclinometer and mobile goniometer (0.746 and 0.796 respectively). ICC for intra rater reliability was almost perfect for tape measure, inclinometer and goniometer (0.965,0.894 and 0.837 respectively) and it was substantial for mobile goniometer (0.802). Conclusion: The inter-rater reliability of tape measure, goniometer is almost perfect and for mobile goniometer, inclinometer is substantial. The intra rater reliability of tape measure, inclinometer, goniometer is almost perfect and mobile goniometer is substantial. KEY WORDS: Dorsiflexion, Mobile goniometer, Tape measure, Goniometer, Inclinometer, Reliability.

Role of Spasticity Severity on the Balance of Post-stroke Patients

Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life.Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence.Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS &gt; 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured.Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence.Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.

Functional Movement Screen task scores and joint range-of-motion: a construct validity study

Little is known about the construct validity of the Functional Movement Screen (FMS). We aimed to assess associations between FMS task scores and measures of maximum joint range-of-motion (ROM) among university varsity student-athletes from 4 sports (volleyball, basketball, ice hockey, and soccer). Athletes performed FMS tasks and had their maximum ankle, hip and shoulder ROM measured. Multivariable linear regression was used to estimate associations between FMS task scores and ROM measurements. 101 university student-athletes were recruited (52 W/49 M; mean age 20.4±1.9 years). In general, athletes with higher FMS task scores had greater ROM compared to those with lower task scores. For example, athletes who scored 2 on the FMS squat task had 4˚ (95% CI, 1˚ to 7˚) more uni-articular ankle dorsiflexion ROM compared with those who scored 1, while those who scored 3 on the FMS squat task had 10˚ (4˚ to 17˚) more uni-articular ankle dorsiflexion ROM compared with those who scored 1. Large variation in ROM measurements was observed. In sum, substantial overlap in joint ROM between groups of athletes with different FMS task scores weakens the construct validity of the FMS as an indicator of specific joint ROM.

Post-activation performance enhancement after inclusion of opponent versus no opponent during isoinertial crossover step exercise: A randomized crossover trial

This study sought to determine whether the inclusion of an opponent on an isoinertial crossover step task influenced the post-activation response and power production. Twenty adult male team-sports athletes participated in a randomized crossover trial. We used a novel design in which the performance of an isoinertial flywheel exercise was tested with or without the inclusion of sport-specific constraints (inclusion of an opponent vs. no opponent) in one of the two sequences (sequence one: constraint manipulation followed by no constraint manipulation; and sequence two: no constraint manipulation followed by constraint manipulation). Maximal power was recorded during exercise; then the coefficient of variation of maximal power was estimated. Post-activation responses were measured using unilateral jump height and change-of-direction time. Also, ankle dorsiflexion range of motion was measured. The use of an isoinertial flywheel resulted in improved ankle dorsiflexion and the capacity to repeat change-of-direction. Furthermore, the inclusion of an opponent was associated with a higher variability of the power output in the concentric phase of the movement. Importantly, performing the crossover step task in front of an opponent was also linked to a positive correlation between unilateral countermovement jump and power output. We conclude that the inclusion of typical constraints of the performance environment may have induced movement adaptations to accommodate the unpredictability associated with the actions of the opponent.