Ankle Flexibility Research Articles

Foot and Ankle Risk Factors for Falls in Older People: A Prospective Study

Foot problems are common in older people and are associated with impaired balance and functional ability. Few prospective studies, however, have been undertaken to determine whether foot problems are a risk factor for falls. One hundred seventy-six people (56 men and 120 women, mean age 80.1, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity) and physiological falls risk factors (including vision, sensation, strength, reaction time, and balance) and were followed for 12 months to determine the incidence of falls. Seventy-one participants (41%) reported falling during the follow-up period. Compared to those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength; they were also more likely to have disabling foot pain. Discriminant function analysis revealed that decreased toe plantarflexor strength and disabling foot pain were significantly and independently associated with falls after accounting for physiological falls risk factors and age. Foot and ankle problems increase the risk of falls in older people. Interventions to address these factors may hold some promise as a falls prevention strategy.

Foot and Ankle Characteristics Associated With Impaired Balance and Functional Ability in Older People

Ageing is associated with changes to the structure and function of the foot and ankle, and there is preliminary evidence that foot problems impair balance and increase the risk of falls. To explore this in more detail, we conducted a study to determine the relative contribution of several foot and ankle characteristics to performance on a range of balance and functional tests. One hundred seventy-six people (56 men and 120 women, mean age 80.1 years, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity), sensorimotor function (including vision, sensation, strength, and reaction time), and balance and functional ability (including tests of standing balance, leaning balance, stepping, sit-to-stand, and walking speed). Many foot and ankle characteristics and sensorimotor measures were associated with performance on the balance and functional tests in univariate analyses. Multiple regression analysis consistently revealed that ankle flexibility, plantar tactile sensitivity, and toe plantarflexor strength were significant and independent predictors of balance and functional test performance, explaining up to 59% of the variance in these test scores. Foot and ankle characteristics, particularly ankle flexibility, plantar tactile sensation, and strength of toe plantarflexor muscles, are significant independent predictors of balance and functional ability in older people. Programs to improve the strength and flexibility of the foot and interventions to augment plantar sensation may be beneficial in improving mobility and reducing the risk of falls.

Reliability of clinical tests of foot and ankle characteristics in older people.

Lower-extremity problems are common in older people; however, the reliability of clinical tools used to assess foot and ankle characteristics has not been rigorously evaluated. This study evaluated the test-retest reliability of a battery of simple clinical tests of foot and ankle characteristics (tactile sensitivity of the first metatarsophalangeal joint, navicular height, foot length and width, hallux valgus severity, an overall foot problem score, ankle flexibility, ankle dorsiflexion strength, and foot pain) in 31 individuals (13 men and 18 women) aged 76 to 87 years recruited from the community. Three examiners performed the tests on two occasions approximately 2 weeks apart. Intraclass correlation coefficients and coefficients of variation were calculated for continuously scored tests, and the kappa statistic (kappa) was used to determine the reliability of hallux valgus severity grading. All of the continuously scored tests had acceptable reliability (intraclass correlation coefficients of 0.64 to 0.98; coefficients of variation of 0.6% to 15.0%), as did hallux valgus severity grading (kappa = 0.77; absolute percentage agreement, 84%). These simple clinical tests can now be used with confidence in clinical and research settings to provide reliable and functionally important information regarding foot and ankle characteristics in older people.

High- and low-ankle flexibility and motor task performance.

The effect of widely differing but normal passive ankle flexibility on function was investigated by using able-bodied males selected from the upper and lower tails of a group normally distributed for passive dorsiflexion (DF) flexibility. Ankle, knee and hip kinematics, and kinetics were quantified during stair descent, walking and standing up. The effect of DF flexibility was apparent during stair descent, but not in standing up or walking. Mean peak DF in stance phase of stair descent was 11.5 degrees lower for 'inflexible' compared with 'flexible' subjects, but the net moment about the ankle at peak DF and the timing of peak DF were comparable between groups.

Fall prevention exercise program for fall risk factor reduction of the community-dwelling elderly in Korea.

A randomized comparison of pre-and post-experimental design was used to examine the effects of a fall prevention exercise program (FPEP) on muscle strength, ankle flexibility, balance, instrumental activities of daily living (IADLs), and depression for the community-dwelling elderly in Korea. Twenty-two subjects were assigned to an experimental group and twenty-three to a control group. The experimental group participated in a 4-day-per week FPEP of 8 weeks duration, twice a week by direct instruction and twice a week with videotaped instruction by the program instructor at each senior center. The eight-week FPEP turned out to be significantly effective in enhancing muscle strength, ankle flexibility and balance, and in reducing depression, after intervention among community-dwelling elderly in Korea. IADLs, however, was not changed by the intervention. Further research with a larger sample and longer follow up period is needed to expand our understanding about the effects of FPEP. Future study is also recommended to differentiate between the effects of FPEP by direct instruction and by videotaped.

Sitting and rising from the floor are influenced by morphologic and functional variables

Objetivamos estudar a influência de variáveis morfo-funcionais nas ações de sentar e levantar do solo, avaliadas pelo Teste Sentar-Levantar (TSL). Randomicamente, em 160 policiais fisicamente ativos, selecionamos 42, dentre os que alcançaram escore máximo nas ações do TSL, e 49, dentre os demais. A idade variou entre 18 a 45 anos (74 ± 10 kg e 176 ± 7 cm [média ± dp]). Foram medidos ou calculados: circunferência abdominal (CA), somatória de seis dobras cutâneas (X 6dc), percentual de gordura (% g), IMC, relação entre dobras cutâneas superiores e inferiores (RDCSI), flexibilidade específica e geral em 11 movimentos (Flexiteste), distância em salto horizontal máximo (DSHM) e equilíbrio (Teste de Romberg). A análise fatorial não identificou o desempenho nas ações de sentar e levantar em qualquer um dos quatro fatores que explicavam 69% da variação total da amostra. A regressão múltipla verificou associações entre o sentar e DSHM, IMC, CA e flexibilidade de tornozelo e entre o levantar e DSHM, CA, idade e flexibilidade geral (p < 0,01). A análise canônica apontou que os desempenhos, se avaliados em conjunto, foram mais associados com idade, IMC, RDCSI, X 6dc, CA, DSHM, e flexibilidade no tornozelo, joelho, quadril e tronco (rc = 0,63, p < 0,01). Conclui-se que o TSL pode fornecer indicadores simples da aptidão funcional em adultos

Effects of Hatha Yoga Practice on the Health-Related Aspects of Physical Fitness.

Ten healthy, untrained volunteers (nine females and one male), ranging in age from 18-27 years, were studied to determine the effects of hatha yoga practice on the health-related aspects of physical fitness, including muscular strength and endurance, flexibility, cardiorespiratory fitness, body composition, and pulmonary function. Subjects were required to attend a minimum of two yoga classes per week for a total of 8 weeks. Each yoga session consisted of 10 minutes of pranayamas (breath-control exercises), 15 minutes of dynamic warm-up exercises, 50 minutes of asanas (yoga postures), and 10 minutes of supine relaxation in savasana (corpse pose). The subjects were evaluated before and after the 8-week training program. Isokinetic muscular strength for elbow extension, elbow flexion, and knee extension increased by 31%, 19%, and 28% (p<0.05), respectively, whereas isometric muscular endurance for knee flexion increased 57% (p<0.01). Ankle flexibility, shoulder elevation, trunk extension, and trunk flexion increased by 13% (p<0.01), 155% (p<0.001), 188% (p<0.001), and 14% (p<0.05), respectively. Absolute and relative maximal oxygen uptake increased by 7% and 6%, respectively (p<0.01). These findings indicate that regular hatha yoga practice can elicit improvements in the health-related aspects of physical fitness. (c)2001 CHF, Inc.

Quantitative measurement of ankle passive flexibility using an arthrometer on sprained ankles

Objective. The purpose of this study was to quantitatively examine the flexibility of sprained ankles using an arthrometer device and compare the differences in flexibility between ankles following the first sprains and ankles with repeated severe sprains and chronic symptoms. Design. A retrospective in vivo study was used. Background. Many in vitro studies have demonstrated a significant role of joint flexibility in determining mechanical laxity of human cadaveric ankles after sectioning of the lateral ligaments, but few in vivo studies have used the technique to provide objective measurement on the sprained ankles. Furthermore, there is a lack of extensive studies that compared the difference in the ankle flexibility between ankles following the first sprain and ankles with multiple repeated severe sprains and chronic symptoms. Methods. A total of 27 subjects with unilateral ankle sprains participated in this study. The subjects were divided into a first injury group (group A, n=12) and a chronic symptom group (group B, n=15) based on the history of their ankle injuries. The ankle flexibility in anterior drawer and inversion/eversion tests was measured in both ankles of the subjects using an arthrometer device, the ankle flexibility tester – a six-degree-of-freedom instrumented linkage used for measurements of applied forces/moments and resultant rotations and/or translations of the ankle joint complex. The difference in ankle flexibility between the injured ankle and the contralateral intact side was analyzed. Results. The flexibility in anterior drawer test of the injured ankles significantly increased compared to the intact ankles of the same individual in group B, but the same difference was not significant in group A. There were more subjects in group B (46.6%) than in group A (33.3%) who showed a sign of mechanical laxity in their injured ankles. Conclusions. The results indicated that the approach with measurement of ankle flexibility may be a potential tool used to detect the mechanical laxity in the sprained ankles. A tendency was found that patients with multiple ankle sprains and chronic symptoms had a higher occurrence rate of mechanical laxity. The result of the present study may also be interpreted that the ankles with mechanical laxity had higher risk of re-injury and leading to chronic symptoms. Relevance A non-invasive and objective measurement of ankle flexibility has potential to be developed into a diagnostic tool for the mechanical laxity of sprained ankles. The finding of this study may help clinicians in the plan of patient treatment.

The functional ambulation performance of elderly fallers and non-fallers walking at their preferred velocity

The purpose of the researchers was to determine if there is a difference in the Functional Ambulation Performance score and step/extremity ratio of senior adults with and without a history of falls walking at a preferred velocity. A random sample of twenty-four senior adults was selected to participate in this study. The participants underwent several tests for balance, strength, ankle flexibility, and foot sensation. Statistical analysis of the two groups demonstrated a significant decrease in FAP score for those with a history of falls. They had lower values for step/extremity ratios, mean normalized velocity, and greater values for step times, heel to heel base of support, and percent in double support. There was also a significant decrease in balance, strength, and tactile sensation between the two groups. These findings suggest that there is a measurable decrease in the performance of gait in senior adults who have fallen that may be related to diminished strength, balance, and tactile sensation.

Laxity and flexibility of the ankle following reconstruction with the Chrisman-Snook procedure.

The effect of reconstruction of the anterior talofibular ligament with the Chrisman-Snook procedure on neutral zone laxity (anterior-posterior displacement at low loads) and flexibility (a measure of the nonlinear load-displacement response) of the ankle was investigated in vitro during the anterior drawer test. Neutral zone laxity was defined as the magnitude of anterior-posterior displacement of the ankle joint at +/- 2.5 N of applied load. The flexibility parameter was defined as the slope of a line between the natural logarithm of the anterior load applied to the ankle and the resulting displacement. After reconstruction with the Chrisman-Snook procedure, the values for neutral zone laxity of the ankle were significantly less than normal at 0 degree of plantar flexion, whereas the flexibility values were significantly greater than normal. This study revealed that, after the Chrisman-Snook procedure, values for ankle flexibility are not restored to normal even if those for neutral zone laxity are reduced to less than normal. The findings suggest that this nonanatomical reconstruction procedure does not reproduce normal kinematics of the ankle joint. This may help explain some of the adverse clinical reports associated with the Chrisman-Snook reconstruction procedure.

EFFECTS OF A FITNESS PROGRAM ON GAIT AND SELF ESTEEM OF OLDER ADULTS911

The ability of older adults to retain skill and mobility in daily activities is an important aspect of a quality lifestyle. The problem investigated in the present study was to determine the effects of two fitness/flexibility programs on the gait and mobility characteristics of older adults (age over 65 years). Three groups of female subjects, a pool exercise group (N=24), a walking exercise group (N=25) and a control group (N=17) underwent a series of pretests. These consisted of evaluation of joint flexibility using a Leighton flexometer; bilateral grip strength, as well as a sit and reach test. All subjects were filmed using two shuttered video cameras while walking along a marked walkway, and the film was analyzed in detail using biomechanical techniques to determine the three dimensional gait and lower limb mobility characteristics of each subject. As well, three measures of self-esteem were administered to the subjects at the beginning of the study. The two experimental groups were then enrolled in one of two 12-week exercise programs and all three groups then underwent a post test. Statistical comparison of the test results was conducted using ANOVA to determine the significance of the differences between the pre and post test scores. The exercise subjects improved in hip and lower back flexibility and ankle flexibility, grip strength of both hands, and the total of both hands, and in several biomechanical variables of gait, including stride length, stride rate, stance time, toe clearance, average velocity, vertical displacement of the CG and pelvic displacement. There were no significant differences in the psychological variables measured from pre test to post test.

Ankle flexibility and injury patterns in dancers.

Lower-extremity injuries are common among dancers and cause significant absences from rehearsals and performances. For this study of lower-extremity injuries in 101 ballet and 47 modern dance students, injuries requiring medical attention sustained over 1 academic year were associated with the following data obtained at the beginning of the school year: ankle flexibility, sex, dance discipline, previous injury, body mass index, and years of training. Eighty-three of the 148 students (age range, 12 to 28 years) reported prior lower-limb injuries, the most common being ankle sprains (28% of all dancers). Previous leg injuries correlated significantly with lower dorsiflexion measurements and with more new injuries. Female students had greater ankle and first metatarsophalangeal flexibility. Modern dancers had greater ankle inversion. Ninety-four students sustained 177 injuries during the study, including 75 sprains or strains and 71 cases of tendinitis. Thirty-nine percent (N = 69) were ankle injuries; 18% (N = 33) were knee injuries; 23% (N = 40) were foot injuries; and 20% (N = 35) were either hip or thigh injuries. Sixty-seven percent (N = 78) of the injured students were ballet dancers. Age, years of training, body mass index, sex, and ankle range of motion measurement had no predictive value for injury; previous injury and dance discipline both correlated with increased risk of injury.

A six-degrees-of-freedom instrumented linkage for measuring the flexibility characteristics of the ankle joint complex

Diagnosis of ligament injuries to the ankle joint complex is a difficult clinical problem which relies primarily on manual physical examination and on radiographic evaluations. In an attempt to develop a reliable, quantitative diagnostic tool for such injuries we developed a six-degrees-of-freedom instrumented linkage: (Ankle Flexibility Tester—AFT), capable of measuring the flexibility characteristics of the ankle joint complex in vivo. The unique non-serial structure of this linkage was such that these characteristics were recorded directly in an anatomical coordinate system which enhanced clinical interpretation. The goal of the present study was to develop this linkage and to test its accuracy and its test-retest reliability. The positional accuracy of the AFT was measured and was found to be better than 0.5 mm for translation and 1.2° for rotations. The results obtained from a study conducted on two cadaveric specimens indicate negligible effect of loading rate on the flexibility characteristics within the range of possible manually applied loads. Finally, the reliability of the AFT was examined from test-retest studies conducted on a total of thirteen young healthy volunteers. The intraclass correlation coefficient: (ICC),, calculated from the test-retest data, indicated a reliability higher than 0.85. It was concluded that the high reliability and accuracy of the AFT, its simplicity of operation, the easy alignment procedure, the on-line load-displacement results, and the elimination of complex data processing render this device suitable for use in the clinic as well as in the research laboratory.

PHYSIOLOGICAL AND SPORT SKILL CHARACTERISTICS OF OLYMPIC DEVELOPMENTAL SOCCER ATHLETES 752

Although many studies have examined the physiological profile of soccer athletes, no comprehensive studies have been conducted on developmental soccer athletes in the United States. We investigated possible differences in physiological and sport skill status of U-81 - U-79 soccer players, by age and region. Following written informed consent, 60 Olympic Developmental athletes(age=14.6±.2 yrs; wt=60.5±1.4 kg; ht=172.4±1.2 cm) completed a battery of tests to determine oxygen consumption (VO2max), heart rate (HRmax), ventilation (VEmax), respiratory exchange ratio (Rmax), and blood pressure (BPrest/max) during a Bruce GXT. Peak power (PP), mean power (MP), fatigue index (FI), and total work output (TWO) were calculated using a Wingate test. Leg power (vertical jump - squat and countermovement),% body fat, and trunk, spine, hip, knee, and ankle flexibility measurements were assessed. Agility was assessed using five sport skills (T-test, line drill, juggling, wall volley, and Zelenka circuit). Factor analysis with subsequent MANOVAs indicated significant (p>.05) main effects across age only (mean±SEM). Table Results were comparable to norms reported for athletes of similar age and activity. In determining these athletes' status in relation to athletic norms, a more complete definition of developmental athletes optimal physiological and skill level will be possible, ultimately leading to higher quality conditioning and training regimens.

Relationship Between Isokinetic Strength, Flexibility, and Flutter Kicking Speed in Female Collegiate Swimmers

The relationship between lower extremity isokinetic strength, flexibility, and flutter kicking speed was investigated in 12 female collegiate swimmers. Isokinetic peak torques were determined at 3 selected velocities: 2.88, 6.28, and 7.85 rad · sec−1. Flexibility measurements included ankle plantar flexion and dorsiflexion as well as hamstring and lower back flexibility (sit and reach test). Flutter kicking times for 22.86 m (T1) and 45.72 m (T2) were obtained in a 22.86-m pool using a kickboard. Peak torque during knee extension at 6.28 rad · sec−1 correlated significantly with T1 (r = 0.82) and T2 (r = 0.71). There appeared to be no relationship between ankle flexibility and flutter kicking speed in this group of subjects. The sit and reach data correlated significantly (r = 0.70) only with T2. Underwater film analysis on 6 subjects showed that mean (±SD) angular velocity at the knee during the downbeat phase of the kick was 6.47 (±1.13) rad · sec−1. These results suggest that variables such as peak torque in the lower extremities play a significant role in flutter kicking performance. In addition, velocity-specific isokinetic testing of the knees should be done in excess of 6.00 rad · sec−1 in order for the dynamometer to mimic limb angular velocities recorded during actual flutter kicking performance.

水泳パフォーマンスに関与する能力の抽出とその相対的貢献度 : 大学男子一流水泳選手の場合

This study was intended to analyze the relative rate of contribution of physical structure and motor ability sub-domains contributing to swimming performance of competitive college male swimmers. Subjects were 75 highly trained college male swimmers. Fourty-three variables were selected according to hypothetical structure of physical condition for swimming performance. Factor analysis applied to the 43×43 correlation matrix has yielded 12 sub-domains of physical condition. Multiple regression analysis was then applied to swimming performance score and scores for various sub-domains to determine the relative degree of contribution of each physical condition sub-domain to the swimming performance. The results were as follows : 1. The physical condition sub-domains for top college male swimmers were represented by the following 12 factors : 1) body bulk, 2) fundamental swimming ability, 3) leg strength; 4) posture, 5) ankle flexibility, 6) arm strength, 7) body linearity, 8) endurance, 9) general flexibility, 10) trunk flexion, 11) agility and 12) coordination. 2. The best swimming record in 1982 for each subject was then standardized with the mean and standard deviation computed from official records of 1980-1982 Intercollegiate Swimming Championship Meets. These values were considered appropriate as the measure of individual's swimming performance since coefficients of variation for various swimming events and their relative speeds to the respective world record remained essentially constant. 3. Analysis of the data indicated that 4 sub-domains of physical condition, i.e., fundamental swimming ability (35.0%), coordination (26.5%),leg strength (15.9%), and posture (10.6%) had markedly higher relative rate of contribution to swimming performance. From these results, it is suggested that fundamental swimming ability (e.g., strokes in 25m swimming) and coordination (e.g., rhythm and timing control) are of great importance in producing highly trained college male swimmers. Training for muscle strength particularly on legs is also emphasized. Specific training for improving abilities in these sub-domains is recommended to add to the regular training. It should be noted that some of excellent swimmers were characterized by straightened spine curvature.

Evaluation of warm-up for improvement in flexibility.

The purpose of this investigation was to evaluate the effects of warming the joints by jogging and then stretching on increases in joint flexibility. Subjects were 51 students enrolled in a physical conditioning class assigned to a jog and then stretch (JS), stretch and no jog (S), or a control group (C). Both the JS and S groups performed a series of stretching exercises 2 days a week for 9 weeks, with the JS group jogging for 5 minutes prior to stretching. Subjects were pretested and posttested for shoulder, hamstrings, trunk, and ankle flexibility with a Leighton flexometer. Results of t-tests indicated that significant increases in flexibility occurred for all of the joint angles evaluated for both the JS and S groups with the exception of trunk flexibility for the JS group. An analysis of variance (ANOVA) of gain scores indicated a significant gain in ankle flexibility for the JS group compared to S and C groups. The S group produced a significant gain in trunk flexibility compared to the JS group. Both JS and S groups were effective in improving flexibility, but when the gain scores were compared the results were variable. The data from this study again demonstrate that increases in flexibility can occur as a result of a static stretching training program. However, the results do not support the claim that warming the muscles prior to stretching by jogging will result in significant increases for all of the joint angles evaluated. Both methods offer possible advantages associated with improving joint flexibility.

Changes in Fitness Components After a Four-Week Bicycle Tour.

In brief Three men and four women, ages 19 to 60, were measured on a battery of laboratory tests before and after a four-week bicycle tour to determine the effects of long-distance bicycling on physical fitness. There was no significant body weight change, although the average total fat weight loss was 1.4 kg. Total skinfold measures showed a significant reduction, and the waist girth reduced 2%. Trunk flexion showed significant improvement, and trunk extension and ankle flexibility showed a slight reduction. Maximal oxygen intake increased significantly (11%). The greatest improvement was the mean bicycle ergometer riding time and resistance to higher work loads (17%).

Investigation of a Training Shoe as a Supplemental Conditioning Device

Abstract Varsity college football players (N = 40) at Jackson State University were pretested on leg lift strength, 6 cable-tension leg strength measures, vertical jump, standing broad jump, 10-yd dash speed, and ankle and knee flexibility. The subjects were then randomly assigned to either the experimental on control group. Both groups participated in an 8-wk conditioning program consisting of weight training 3 day wk, and endurance and agility running drills 2 day wk. The experimental group wore a supplemental training device, the “LEGG” Shoe, during the off-season conditioning sessions and to and from daily classes. The control group subjects wore regular tennis shoes during the conditioning sessions and street shoes during daily activities. Following the 8-wk conditioning program posttest data were gathered on the 12 experimental and 10 control group subjects who met all conditioning and testing requirements. The data for each variable were anlyzed using ANCOVA technique. Significant differences at th...

Strength and Flexibility of Differentially Diagnosed Educable Mentally Retarded Boys

Abstract This study was conducted to determine differences on selected tasks of flexibility and strength among intellectually typical boys, and three groups of differentially diagnosed educable mentally retarded boys. The educable mentally retarded groups were classified as non-brain-damaged, brain-damaged, and undifferentiated on the basis of neurological examinations, EEG findings, and supportive life histories. The vertical jump was used as a test of dynamic strength. Strength of grip was used to measure static strength. The tests for flexibility were ankle and hip flexion and extension. Significant differences between means were found between intellectually typical boys and all groups of educable mentally retarded boys on the vertical jump, grip strength, and ankle flexibility in favor of the intellectually typical boys. The non-brain-damaged group was superior to both the brain-damaged and undifferentiated groups on the vertical jump.