Passive Flexion Range Of Motion Research Articles

Clinical effectiveness of a standardized community-based supervised post-acute rehabilitation model after total knee arthropathy: A pilot study

Background: Hospital-based outpatient physiotherapy is the standard of care for subacute rehabilitation after total knee arthroplasty (TKA) in Singapore. This study explores the clinical effectiveness of a standardized rehabilitation model at community-based rehabilitation centers to align the appropriate utilization of tertiary and community rehabilitative resources. Methods: In this pilot study, patients who had undergone TKA were assigned to either control group (n=30) or to intervention group (n=29). The control group received usual hospital-based outpatient physiotherapy, while the intervention group received rehabilitation at a community-based rehabilitation center based on standardized institution protocol. Primary and secondary outcomes were assessed at baseline and at 3 months post TKA. Results: Baseline characteristics in both groups were not significantly different. All patients completed the study. At 3 months, there were no significant differences in the Time Up and Go test (P<0.853), median 30 s chair rise (P=0.347), knee flexion passive range of motion (P=0.933), knee extension passive range of motion (P=0.409), and presence of knee extension lag (P=0.360). There was a lower pain intensity in the intervention group compared with the control group (P=0.003). Conclusions: A community-based post-acute TKA rehabilitative model demonstrated improvements in functional outcomes, and reduced pain intensity in study participants, with these findings being similar to that of standard of care hospital-based outpatient physiotherapy. This model of care warrants further evaluation in larger clinical trials.

The effects of a preconditioning vibration rolling warm‐up on multidirectional repeated sprinting‐induced muscle damage

AbstractThe purpose of this investigation was to examine whether adding a set of vibrating foam rollers (VFR) to a regular running‐based warm‐up before a bout of multidirectional repeated sprints provides protective effects against the sprinting‐induced muscle damage. Twenty‐four elite college handball and rugby players participated in this study. After the familiarization visit, the subjects were randomly divided into either the vibration rolling (VFR) or the general warm‐up (GW) group. Before (pretest), post‐24, 48, and 72 h after the muscle‐damaging protocol (15 sets of 30‐m maximal multi directional repeated sprints), plasma creatine kinase (CK), muscle soreness, hip flexion passive range of motion (ROM), isometric strength, and hexagon agility was measured. After the VFR, the CK and DOMS were significantly less than GW (p < 0.05). In addition, when compared with the GW, the hamstring isometric strength, hexagon agility, and 0–10 m and 0–30‐m sprint performances showed faster recovery for the VFR (p < 0.05). The VFR protocol had protective effect on multidirectional repeated sprinting‐induced muscle damage markers than GW protocol. Therefore, preconditioning warm‐up activities using VFR can be integrated into a traditional sport‐specific warm‐up protocol for elite athletes before competitions/training may take advantage of this strategy to facilitate muscle recovery.

Hand function response to static progressive splinting in post-burn finger contracture

IntroductionRestoring hand function is an important determinant of the quality of life in victims of burns. The purpose of the study was to determine the changes in the functional outcome when applying a flexion static progressive splint on the metacarpophalangeal joints of the contracted fingers after a burn injury.MethodsThis study included 60 patients referred to the hand therapy clinic 6 months after the injury. They presented with a burn on the dorsal portion of the hand with limited flexion range of motion in the metacarpophalangeal joints. The participants were randomly assigned to 2 groups (30 patients each). Group A (splint group) were treated with custom-made static progressive flexion splints. Additionally, they received physical therapy and medical treatment throughout the study period (8 weeks). Group B (control group) received physical therapy and medical treatment only. The burned hand was evaluated before and after treatment by measuring the metacarpophalangeal passive range of motion, determining grip strength, and employing the Jebsen-Taylor hand function test to assess the overall hand function.ResultsA statistically significant increase in all variables occurred in both groups after the intervention, with a higher increase in group A. In groups A and B, the p-values of passive range of motion were 0.001 and 0.784, of grip strength 0.023 and 0.608, and of Jebsen-Taylor hand function test 0.048 and 0.411, respectively.ConclusionsStatic progressive splint coupled with physical therapy can optimally improve hand function in patients with restricted metacarpophalangeal flexion passive range of motion after burn injuries.

Clinical Effect of End-range Maitland Mobilization in the Management of Knee Osteoarthritis - A Pilot Study.

Different manual therapy techniques and conservative therapy have been used separately for alleviation of pain and improvement of physical function in patients with knee osteoarthritis (KOA). However, no study has reported the effect of combination of these treatment modalities in the management of KOA. Our aim was to test the feasibility of the study design and to compare the effect of end-range Maitland mobilization to conservative therapy in KOA. Fifteen patients (conservative therapy group: CG) received conservative therapy alone, fifteen patients (Maitland plus conservative therapy group: M+CG) received additionally end-range Maitland mobilization during the 3-week study period. Outcomes were pain intensity, measured with visual analogue scale (VAS) in general and during functional activities, passive range of motion (PROM) and peak muscle force during knee flexion and extension, Timed Up and Go test and 6-Minute Walk Test (6MWT). All outcomes improved significantly in both groups. Magnitude of changes was significantly greater in M+CG compared to CG regarding all VAS pain scores, flexion PROM of both knees, right hamstring peak muscle force and 6MWT. With few modifications, this study design seems feasible for the comparison of end-range Maitland mobilization with conservative therapy in KOA. Moreover, end-range Maitland mobilization in addition to conservative therapy appeared more effective in relief of pain and improvement of functional status than conservative therapy alone in KOA.

Posterior Thigh Foam Rolling Increases Knee Extension Fatigue and Passive Shoulder Range-of-Motion.

Monteiro, ER, Costa, PB, Corrêa Neto, VG, Hoogenboom, BJ, Steele, J, and da Silva Novaes, J. Posterior thigh foam rolling increases knee extension fatigue and passive shoulder range-of-motion. J Strength Cond Res 33(4): 987-994, 2019-The purpose of this study was to analyze the acute effects of different foam rolling (FR) volumes on knee extensors fatigue and shoulder passive range-of-motion (PROM). Twelve recreationally active women were recruited for participation in 2 experiments separated by 3 weeks, and the same subjects performed all procedures in each experiment. In experiment 1, subjects performed 3 sets of knee extensions using a predetermined 10 repetition maximum load to momentary concentric failure: control condition (CG) with passive rest and 2 FR conditions for the hamstrings using 2 volumes (60 and 120 seconds; FR60 and FR120, respectively). Experiment 2 consisted of 2 shoulder flexion and extension baseline PROM tests. Following baseline measures, subjects performed a single 60-second bout of FR on the hamstrings. Outcome PROM measures were measured through manual goniometry immediately (post-0), 10 minutes (post-10), 20 minutes (post-20), 30 minutes (post-30), 24 hours (post-24), and 48 hours (post-48) after the intervention to assess the effects on PROM over an extended period. Fatigue index indicated significantly greater fatigue resistance for CG when compared with FR60 (p = 0.035; [INCREMENT]% = 6.49) and FR120 (p = 0.002; [INCREMENT]% = 9.27), and there were no significant differences between FR60 and FR120 (p = 0.513; [INCREMENT]% = 2.78). Shoulder flexion PROM increased in post-0 as compared to baseline 1 (p = 0.002; d = 1.58), baseline 2 (p < 0.001; d = 1.92), and baseline higher measurement (p < 0.001; d = 1.59) and remained increased for post-10 as compared to baseline 2 (p = 0.017; d = 1.55). Shoulder extension PROM increased in post-0 as compared to baseline 1 (p < 0.001; d = 2.61), baseline 2 (p < 0.001; d = 2.83), and baseline higher measurement (p < 0.001; d = 2.59) and remained increased for post-10 as compared to baseline 1 (p < 0.001; d = 1.93), baseline 2 (p < 0.001; d = 2.16), and baseline higher measurement (p < 0.001; d = 1.91) and post-20 as compared to baseline 1 (p = 0.008; d = 1.58), baseline 2 (p = 0.001; d = 1.85), and baseline higher measurement (p = 0.011; d = 1.55). Foam rolling volumes equal to or greater than 60 seconds are detrimental to the ability to continually produce force in the lower extremity and should not be applied to the hamstrings muscle group between sets of knee extensions. PROM results indicate that FR applied to the hamstrings demonstrates an increase in both shoulder flexion and extension PROM. This work may have important clinical (rehabilitation) implications, as it demonstrates global effects of FR on functional outcomes.

Differential Effects of Different Warm-up Protocols on Repeated Sprints-Induced Muscle Damage.

Chen, CH, Ye, X, Wang, YT, Chen, YS, and Tseng, WC. Differential effects of different warm-up protocols on repeated sprints-induced muscle damage. J Strength Cond Res 32(11): 3276-3284, 2018-The purpose of this investigation was to examine whether adding a set of hamstring resistance exercise or dynamic stretching to a regular running-based warm-up before a bout of repeated sprints provides protective effects against the sprinting-induced muscle damage. Twelve elite tennis players participated in this study. After the familiarization, subjects completed 3 separate randomly sequenced experimental visits, during which 3 different warm-up interventions were performed before the muscle-damaging protocol (12 sets of 30-m maximal repeated sprints): 5 minutes of running (control); control with single leg slide curl (SLC); and control with active hamstring stretching (AHS). Before, immediately (POST0), 1 day (POST1), and 2 days after (POST2) the sprints, hip flexion passive range of motion, hamstring muscle thickness and pennation angle, muscle stiffness, and knee flexion concentric peak torque were measured. Repeated sprints have induced muscle damage in all 3 visits. For AHS, the muscle thickness and stiffness values at POST2 were significantly lower than those of other 2 protocols. In addition, the decrements of concentric strength at POST0, POST1, and POST2 for AHS were also significantly less than those of control and SLC. Therefore, adding a set of dynamic hamstrings stretching to a regular warm-up protocol before repeated sprints has protective effect on the sprinting-induced muscle damage. Athletes whose competitions are densely scheduled (e.g., tennis player in a tournament) may take advantage of this strategy to facilitate muscle recovery from the potential muscle damage, thus, to get maximal recovery for the subsequent competitions.

Sex specific associations between biomechanical recovery and clinical recovery after total hip arthroplasty

BackgroundThere are sex-specific gait differences in men and women before and after total hip arthroplasty (THA) but we do not know their impact on clinical outcomes. The objective of this study was to identify sex-specific associations between pre- and postoperative changes in pain and function and (i) gait mechanics, (ii) passive range of motion, and (iii) abductor strength. MethodsPre- and one-year postoperative data were identified from a data repository (n = 124; 64 Women; Age 61 (SD 10); BMI 29 (SD 5)). We used linear regression analysis to identify sex-specific associations between Harris Hip Score pain and function subscores, and sagittal plane hip kinematics and 3D hip kinetics during gait, hip abductor strength, and passive hip range of motion (RoM). FindingsCombinations of biomechanical variables predicted up to 24% of the variation in pain improvement and up to 27% of the variation in functional improvement. In men, increased peak external rotation moments were associated with pain improvement. Passive flexion RoM and peak extension moments were associated with functional improvement. In women, increased passive adduction RoM and peak external rotation moments were associated with pain improvement. Peak adduction moments and passive flexion RoM were associated with functional improvement. InterpretationsThe different associations between improvement in clinical outcomes and improvement in gait, passive RoM, and abductor strength suggest that the biomechanical path to recovery may be different in men and women.

Ankle-Foot Continuous Passive Motion Device for Mobilization of Acute Stroke Patients

Purpose: To develop a continuous passive motion (CPM) device for the passive motion of the paretic ankle-foot and investigate the effect of continuous passive motion of bedridden, hemiparetic acute stroke patients. Methods: 49 patients with stroke were investigated. Results in stroke patients (device group) were compared with those of 15 control subjects (manual group) also with stroke but not treated by device. The period of the treatment was 7 days; the duration was 30 minutes per day by CPM device in the device group. The efficacy of the device was evaluated by scales used in the clinical routine (6th item of National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale (MAS), modified Rankin Scale (mRS)). Ankle’s passive range of motion (PROM) and flexible equinovalgus deformitiy were measured every day with a goniometer. Results: 6th item of NIHSS score improved by -0.76 (SD = 0.56) points in the device group (p < 0.001) compared to the baseline values; the mean change in the manual group was -0.33 (SD = 0.62) points (p = 0.055). The mean of MAS decreased significantly by -0.53 (SD = 1.12) point in the device group (p < 0.001). The ankle’s mean plantar flexion PROM increased by 3.41 (SD = 5.19) degrees in the device group (p < 0.001). Significant improvement of the mean dorsiflexion in the PROM of the ankle was also detected (p = 0.019). The equinovalgus improved significantly by -5.12 (SD = 8.02) degrees (p < 0.001) in the device group. The scores of the mRS also improved significantly in the device group (p < 0.001). Conclusion: In the early phase of rehabilitation, ankle-foot continuous passive motion device treatment combined with manual therapy improved the ankle’s PROM better than manual therapy alone; in addition, device treatment decreased the foot’s equinovalgus, improved the 6th item NIHSS score, and decreased the severity of spasticity.

In Vivo Ultrasound Measurement of Posterior Femoral Glide During Hip Joint Mobilization in Healthy College Students

Descriptive study. To measure femoral translational glide in vivo during posterior hip joint mobilization and to interpret data in the context of the normal arthrokinematic glide necessary for hip flexion. Joint play, or translational glide available at a joint, is largely influenced by the geometry of the articular surfaces. The high degree of congruence between the articular surfaces at the hip and the substantial arc of concavity of the acetabulum suggests that the amount of translational glide available at the hip should be very small. Twenty subjects received manual posteriorly directed hip mobilization at a force equal to 50% of their body weight, while concurrent ultrasound imaging of the joint was performed. Images were captured before and during application of the target mobilization force. Femoroacetabular distance for each image was measured, and the average of the 3 greatest differences between corresponding before/during mobilization values represented the translational glide produced. The amplitude of arthrokinematic glide (tangential glide) was calculated using the measured femoral head radius and hip flexion passive range of motion for each subject. The average posterior femoral translational glide was 2.0 mm (range, 0.8-4.2 mm). The average calculated tangential glide required for hip flexion passive range of motion was 53.8 mm (range, 43.2-64.8 mm). The average translational glide as a percentage of tangential glide was 3.8% (range, 1.5%-7.9%). Translational glides at the hip are small, particularly in the context of the amplitude of glide necessary for normal hip flexion range of motion.

Effects of Different Heating Modalities on Hip Flexion Passive Range of Motion

Context:Therapeutic modalities are routinely administered to increase fexibility, but the relative effects of different modes of tissue heating on passive range of motion (PROM) are unknown.Objective:To assess the relative effects of active exercise on a stationary bicycle, moist hot pack treatment, and warm whirlpool treatment on hip fexion PROM.Design:Repeated measures.Subjects:24 males and 20 females between the ages 18 and 24 years.Main Outcome MeasureHip fexion PROM measured by an inclinometer.Results:Repeated measures analysis of variance identified a significant difference among the heating methods, F(1, 43) = 32.41;p&lt; .001. Active exercise produced the greatest change in hip fexion PROM.Conclusions:All three treatment methods produced an increase in hip fexion PROM, but active exercise produced a significantly greater increase than moist hot pack and warm whirlpool treatments.

Comparison of active stretching technique in males with normal and limited hamstring flexibility

Objective(1) to analyse the accumulative effects of a 12-week active stretching program on hip flexion passive range of motion (HF-PROM), and (2) to compare whether participants with different PROM baseline scores (normal and limited hamstring flexibility) respond in the same way to stretching. DesignRepeated measures design. SettingControlled laboratory environment. Participants138 males were categorized according to hamstring flexibility in the unilateral passive straight-leg raise test (PSLR) and assigned to one of two groups: normal hamstring flexibility (≥80°) or limited hamstring flexibility (<80°). In each group, participants were randomly distributed into one of two treatment subgroups: (a) control or (b) active stretching. The active stretching subgroups performed 12 weeks of flexibility training, the control subgroups did not stretch. Main Outcome MeasuresHF-PROM was determined through the PSLR test. ResultsBoth stretching subgroups significantly improved (p < 0.01) their HF-PROM from baseline. The control subgroups did not. Conclusions12 weeks of an active stretching program performed 3 days per week with a daily stretch dose of 180 s improved HF-PROM in both populations (normal and limited hamstring flexibility). The stretching program was equally effective in terms of absolute improvement values for males with normal and limited hamstring flexibility.

Chronic Flexibility Improvement After 12 Week of Stretching Program Utilizing the ACSM Recommendations: Hamstring Flexibility

The ACSM flexibility training recommendations emphasize proper stretching of muscles supporting the major joints, but there is a little evidence to support this recommendation in terms of effectiveness, and which stretching parameters (technique and single stretch duration) are more adequate. A randomized controlled clinical trial design was use to investigate whether the ACSM flexibility training recommendation parameters improve hip flexion range of motion. A total of 173 subjects, 122 men (21.3+/-2.5 years; 176.33+/-8.35 cm; 74.42+/-10.80 kg) and 51 women (20.7+/-1.6 years; 163.43+/-6.57 cm; 60.12+/-7.88 kg), classified as recreationally active young adult university students were randomly assigned to 1 of 7 groups: 1 control group (no stretching) or 1 of 6 stretching groups. All stretching groups performed 12 weeks of flexibility training with a consistent stretch daily dose (180 s) and frequency (3 days per week) parameters and different stretch technique (passive or active) and single stretch duration (15, 30, or 45 s). Hip flexion passive range of motion (PROM) was determined through the bilateral straight-leg raise test before, during (at 4 and 8 weeks), and after the program (12 weeks). All stretching groups performed hip flexion PROM after flexibility training. A significant improvement was identified in mean PROM for each stretching group, but no significant differences were found between stretch technique and single stretch duration (p>0.05). The control group's mean PROM decreased (Delta PROM: -0.08 degrees, 95% confidence interval [CI]=-2.3 to 5.3), whereas all stretching groups increased PROM (Delta PROM: 15.14 degrees, 95% CI=10.19 to 23.56) in hip flexion after 12 weeks of stretching (p<0.05). The present study suggests that the current ACSM flexibility training recommendations are effective for improving hip flexion ROM in recreationally active young adults.

Factors Related to Early Recovery Rate After Partial Knee Meniscectomy

A main role of clinicians treating patients after orthopedic surgery is to inform patients about their anticipated recovery rate and recovery endpoint. In estimating recovery rate, clinicians consider a series of potentially influencing factors, including the type and severity of injury and the characteristics of the patient. Unfortunately, this is done largely without evidence to support factors believed to be important in recovery rate. To our knowledge, no studies exist where factors that might influence recovery rate after arthroscopic partial meniscectomy have been evaluated. Eighty-three patients (11 women and 72 men) were evaluated 4 days after and then again 6 weeks after knee arthroscopic partial meniscectomy surgery. Recovery rate was calculated by dividing the change in a patient's Hughston Clinic knee self-assessment questionnaire during this period by his or her baseline Hughston score and relationships to independent variables (gender, age, body mass index [BMI], injury chronicity, affected meniscus, Hughston Clinic knee self-assessment score at baseline, knee flexion passive range of motion, and knee circumference). These were evaluated using backward stepwise regression analysis. The relationship between recovery rate and the independent variables was statistically significant (P,.05) for the following variables: injury chronicity, gender, and gender/injury type combination. The most unexpected finding in this study was the statistically nonsignificant relationship between recovery rate and the following variables: age, Hughston score, BMI, knee swelling, and knee flexion passive range of motion loss.