Frontal Range Of Motion Research Articles

Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion

Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.

Influence of circumferential ankle pressure of shoe collar on the kinematics, dynamic stability, electromyography, and plantar pressure during normal walking.

The shoe's collar plays a significant role in supporting the ankle during walking. Since the protective effect of the collar requires the circular embracing of the ankle and shank, a stiffer collar might be involved with increased circumferential ankle pressure (CAP). It is not clear how collar CAP affects walking performance. Therefore, this study was aimed at examining the influence of the collar CAP on the kinematics, dynamic stability, electromyography (EMG), and plantar pressure during normal walking. Sixteen healthy male participants walked on a treadmill while wearing a custom-designed high-collar shoe with 10 (low), 30 (medium), and 60 mmHg (high) CAP conditions, and the joint angles, dynamic stability index, EMG, and plantar pressure were measured. While the low CAP condition did not affect the ankle range of motion (ROM), The high CAP condition restricted both the ankle sagittal and frontal ROM, whereas the medium CAP condition limited only the ankle frontal ROM. The knee and hip ROM did not differ between conditions. The dynamic stability for the high and medium CAP cases was comparable but significantly higher than that of the low CAP condition. The ankle muscle activity and corresponding co-contraction increased with increasing CAP for gastrocnemius medialis (GM), soleus (SOL), peroneus longus (PL), tibialis anterior (TA) muscles in the weight acceptance and push-off phases but not in the single limb support. Knee muscle activity, including vastus lateralis (VL) and semitendinosus (SEMI) was similar between all conditions. A higher relative pressure was observed under the lateral aspect of the heel when walking in the high CAP condition. The results suggest that a high-collar shoe with a high CAP may not be an appropriate choice for walking owing to the injury risk factors and limited walking efficiency. A medium CAP is associated with certain advantages and, thus, a superior choice for high-collar shoe design.

Effectiveness of Insole Colour on Impact Loading and Lower-Limb Kinematics When Running at Preferred and Nonpreferred Speeds.

While colour of red can play a significant role in altering human perception and performances, little is known about its perceptual-motor effect on running mechanics. This study examined the effects of variations in insole colours on impact forces, ankle kinematics, and trial-to-trial reliability at various running speeds. Sixteen male recreational runners ran on instrumented treadmill at slow (90%), preferred (100%), and fast (110%) running speeds when wearing insoles in red, blue, and white colours. We used synchronized force platform and motion capturing system to measure ground reaction force, ankle sagittal and frontal kinematics, and movement variability. A two-way (colour x speed) ANOVA with repeated measures was performed with Bonferroni adjusted post hoc comparisons, with alpha set at 0.05. Data analyses indicated that participants demonstrated higher impact and maximum loading rate of ground reaction force, longer stride length, shorter contact time, and smaller touchdown ankle inversion as well as larger ankle sagittal range of motion (RoM), but smaller frontal RoM in fast speed as compared with preferred (P < 0.05) and slow speeds (P < 0.001). Although insole colour had minimal effect on mean values of any tested variables (P > 0.05), participants wearing red-coloured orthoses showed higher coefficient of variation values for maximum loading rate than wearing blue insoles (P=0.009). These results suggest that running at faster speed would lead to higher impact loading and altered lower-limb mechanics and that colour used on the tops of insoles influences the wearers' movement repeatability, with implications for use of foot insole in running.

Restricting ankle dorsiflexion does not mitigate the benefits of external focus of attention on landing biomechanics in healthy females.

Restricted ankle dorsiflexion can promote aberrant biomechanics associated with risk for knee injury during dynamic activities. Attentionally focused instructions have been used to improve high-risk knee biomechanics during landing tasks. Yet, it is unknown whether attentionally focused instruction can effectively improve landing patterns in the presence of a mechanical restriction on the ankle. Therefore, our purpose was to determine whether restricting ankle dorsiflexion by use of bracing mitigated the effects of attentional foci on landing biomechanics in healthy females. We used a crossover design to investigate lower extremity biomechanics in 19 healthy females between the ages of 18-35 during a series of jump-landing tasks. Participants completed 6 blocks of 3 jump-landings on separate force platforms in a randomized order based on brace condition (brace, no brace) and mode of attentional foci (neutral, internal focus [IF], external focus [EF]). Attentionally focused instructions were provided immediately prior to 3 practice jump-landings, followed by 5 test jump-landings with self-controlled feedback only. Ankle bracing decreased peak dorsiflexion and sagittal range of motion (ROM) (mean difference: 5.7-5.8°), and peak inversion and frontal ROM (mean difference: 2.4-3.0°). However, hip flexion ROM (mean difference: 1.8°) increased compared to the no brace condition. Regardless of ankle bracing, EF instruction increased peak hip flexion (mean difference: 4.9°) and hip flexion range of motion (mean difference: 3.8-4.6°), while decreasing peak knee valgus (mean difference: 0.8-1.0°) and knee valgus moment (mean difference: 0.04Nm/kg). Additionally, EF instruction increased peak hip abduction to a similar degree when braced (mean difference: 3.6-4.0°) and not braced (mean difference: 2.1-2.5°). Lastly, EF instruction increased hip abduction ROM only when braced (mean difference: 2.3-2.4°), but decreased peak knee valgus power only when not braced (mean difference: 0.18W/kg). Our findings indicate that mechanically restricting ankle dorsiflexion does not mitigate the ability of EF instruction to enhance jump-landing performance by means of improving hip and knee biomechanics in healthy females. However, our findings suggest an improved ability to control the rate of knee valgus loading when not braced. Therefore, we conclude that EF instruction remains a viable clinical strategy to improve landing patterns in the presence of restricted ankle dorsiflexion, yet this approach may be ineffective to reduce the rate of knee joint loading.

Persistence Of Altered Kinematics Following A Typical Training Run At 24hrs

Running participation has increased since the 1970’s, concomitant with the rise in popularity has been the rise in running related injuries. Epidemiological studies have reported 2.5 to 33.0 injuries for every 1000 hours of running, with most common injuries being overuse knee injuries. There is a common consensus that altered hip and knee kinematics are risk factors for developing overuse injuries. Previously we demonstrated altered gait kinematics as result of fatigue following a high intensity interval training run (HIIT). These fatigue induced alterations in kinematics could place runners at greater risk of developing an overuse injury. To date, the time course of recovery for gait kinematics is unknown. If these gait changes remain at the onset of the next training run this could be a precursor to overuse injury. PURPOSE: To examine the time course of kinematic changes immediately after and 24hr post HIIT. METHODS: Twenty (10F, 10M) healthy recreational runners performed a HIIT session consisting of six repetitions of 800 meters, each run at 1km.h-1 under the speed at VO2 max, with a 1:1 work: rest ratio. Kinematics were examined during a 6-minute, medium intensity run, performed at halfway between the speeds at lactate threshold and lactate turnpoint. The 6-min run was performed pre, post, and 24hr post HIIT. Maximum angle and range of motion (RoM) of the hip and knee during ground contact were analysed in sagittal and frontal planes. One way repeated measures ANOVA was performed to assess changes over time. RESULTS: Hip frontal angles were significantly increased with time for both maximum angles (P < 0.001) and RoM (P = 0.001). Post hoc analysis revealed a significant increase in maximum hip adduction angle immediately post (P < 0.001, d = 0.91) and at 24hr post (P < 0.001, d = 0.86) compared to pre. Hip frontal RoM was also increased significantly at post (P < 0.001, d = 0.85) and at 24hr (P < 0.001, d = 0.74). Knee kinematics were affected by time for maximum angle of knee frontal plane (P = 0.046) and sagittal plane knee RoM (P = 0.015). However, there was no presence of altered knee kinematics at 24hr. CONCLUSION: The HIIT session induced kinematic alterations to the hip frontal angles. In some runners these alterations were still present 24 hours after HIIT. For these runners, this could increase the risk of developing overuse injuries.

Effect of Football Shoe Collar Type on Ankle Biomechanics and Dynamic Stability during Anterior and Lateral Single-Leg Jump Landings

In this study, we investigated the effects of football shoes with different collar heights on ankle biomechanics and dynamic postural stability. Fifteen healthy college football players performed anterior and lateral single-leg jump landings when wearing high collar, elastic collar, or low collar football shoes. The kinematics of lower limbs and ground reaction forces were collected by simultaneously using a stereo-photogrammetric system with markers (Vicon) and a force plate (Kistler). During the anterior single-leg jump landing, a high collar shoe resulted in a significantly smaller ankle dorsiflexion range of motion (ROM), compared to both elastic (p = 0.031, dz = 0.511) and low collar (p = 0.043, dz = 0.446) types, while also presenting lower total ankle sagittal ROM, compared to the low collar type (p = 0.023, dz = 0.756). Ankle joint stiffness was significantly greater for the high collar, compared to the elastic collar (p = 0.003, dz = 0.629) and low collar (p = 0.030, dz = 1.040). Medial-lateral stability was significantly improved with the high collar, compared to the low collar (p = 0.001, dz = 1.232). During the lateral single-leg jump landing, ankle inversion ROM (p = 0.028, dz = 0.615) and total ankle frontal ROM (p = 0.019, dz = 0.873) were significantly smaller for the high collar, compared to the elastic collar. The high collar also resulted in a significantly smaller total ankle sagittal ROM, compared to the low collar (p = 0.001, dz = 0.634). Therefore, the high collar shoe should be effective in decreasing the amount of ROM and increasing the dynamic stability, leading to high ankle joint stiffness due to differences in design and material characteristics of the collar types.

Comparison of gait, functional activities, and patient-reported outcome measures in patients with knee osteoarthritis and healthy adults using 3D motion analysis and activity monitoring: an exploratory case-control analysis.

ObjectiveTo examine functional performance differences using kinematic and kinetic analysis between participants with and without knee osteoarthritis (OA) to determine which outcomes best characterize persons with and without knee OA.MethodsParticipants with unilateral moderate knee OA (Kellgren–Lawrence grades 2 or 3) and controls without knee pain were matched for age, gender, and body mass index. Primary outcomes included temporal parameters, joint rotations and moments, and ground reaction forces assessed via 3D motion capture during walking and ascending/descending stairs. Secondary outcomes included timed functional activities (sit to stand; tying shoelaces), 48 hrs lower limb activity monitoring, and patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, European Quality of Life–5 Dimensions).ResultsEight matched pairs were analyzed. Compared with controls, OA participants exhibited significant reductions in peak frontal hip and sagittal knee moments, and decreased peak anterior ground reaction force with the affected limb while walking. Ascending stairs, OA participants had slower speed, fewer strides per minute, longer cycle and stance times, and increased trunk range of motion (ROM) in assessments of both limbs; longer swing time and reduced ankle ROM in the affected limb; and increased knee frontal ROM in the unaffected limb. Descending stairs, OA participants had fewer strides per minute and decreased trunk transverse ROM in assessments of both limbs; increased knee frontal ROM in the affected limb; and longer strides, shorter stance and cycle times, increased trunk sagittal and decreased knee transverse ROMs in the unaffected limbs vs controls. Compared with controls, OA participants had slower walking cadence (120–130 vs 100–110 steps/min, respectively), took significantly longer on timed functional measures, and had significantly worse scores in patient-reported outcomes.ConclusionSeveral objectives and patient-reported measures examined in this study could potentially be considered as outcomes in pharmacologic or physical therapy OA trials.

In vivo sliding distance on the metal‐on‐polyethylene total hip arthroplasty articulation using patient‐specific gait analysis

Metal-on-polyethylene (MoP) is the most commonly used bearing surface in primary total hip arthroplasty (THA). Polyethylene wear debris remains a major concern. Studies investigating the wear performance based on patient-specific in vivo kinematics and component orientation remains largely lacking. The primary goal of this study was to identify patterns of the distribution of sliding distance and cross-shear ratio among THA patients. A validated approach combining dual fluoroscopic imaging system and computed-tomography was utilized to quantify in vivo gait kinematics and component orientations in 48 total hips. The distribution of accumulated sliding distance and cross-shear ratio over the polyethylene bearing surface was calculated and analyzed using principal component analysis (PCA). Strong patient-specific variation in sliding distance and cross-shear ratio was observed. PCA detected two principal components (PCs) of the sliding distance that together contribute to 94.8% of the total variation. PCA detected four PCs that together contribute to 86% of the total variation of the cross-shear ratio. Regression analysis identified a positive association between cross-shear magnitude and axial and frontal range of motion (RoM). Increased cup inclination, stem anteversion, and reduced cup anteversion may lead to superiorly distributed high cross-shear region, potentially accelerating wear. Our study investigated, in vivo sliding distance and cross-shear pattern using a comprehensive patient-specific dataset and detected several wear indicators under in vivo conditions. These findings provided useful reference values that may help to assess wear in MoP THA patients. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3151-3160, 2018.

Fallers with Parkinson’s disease exhibit restrictive trunk control during walking

BackgroundThe relationship between falls and static and dynamic postural control has not been established in Parkinson’s disease (PD). The purpose was to compare the compensatory postural strategies among fallers and non-fallers with PD as well as older adults during static and dynamic movements. MethodsTwenty-five individuals with PD (11 fallers) and 17 older adults were outfitted with 6 accelerometers on the wrists, ankles, lumbar spine, and sternum, stood quietly for 30 s on a force platform, and walked back and forth for 30 s along a 15 m walkway. Root-mean-square displacement amplitude of the center of pressure (COP), COP velocity, gait spatial-temporal characteristics, trunk range of motion (ROM), and peak trunk velocities were obtained. ResultsCOP velocity in anterior-posterior was larger in older adults than those with PD (p < 0.05). Trunk frontal ROM and velocity were smaller in fallers and non-fallers with PD compared to older adults (p < 0.05). Trunk anterior-posterior ROM and velocity were smaller in fallers than non-fallers with PD and older adults (p < 0.05). In fallers with PD, negative correlations were shown between the sagittal trunk velocity and the COP velocity in the anterior-posterior direction as well as between trunk frontal velocity and COP velocity in both directions (p < 0.05). In non-fallers with PD, horizontal trunk ROM and velocity were positively correlated with COP ROM and velocity in the medial-lateral direction (p < 0.01). SignificanceDynamic postural control revealed better discrimination between groups than static. Fallers and non-fallers with PD and older adults adopted different compensatory strategies during static and dynamic movements; thereby providing important information for falls-risk assessment.

Nordic Walking improves trunk stability and gait spatial-temporal characteristics in people with Parkinson disease.

This study aimed to assess the effect of walking with Nordic Walking (NW) poles on postural stability and gait spatial-temporal characteristics in individuals with PD and to determine the cognitive load associated operating the poles. Twelve individuals with PD (age: 61.6±11.7) were asked to perform four 90 s walking trials; with/without poles and with/without verbal fluency task (category fluency) after a 6-week independent NW training. We assessed gait spatial-temporal characteristics, and trunk postural stability using the APDM accelerometry system. Trunk frontal range of motion and peak velocity were smaller in NW compared to normal walking with and without the cognitive task (p < 0.01). Cadence, gait speed and stride length decreased in both pole conditions when performed with the cognitive task (p < 0.05). However stride length was longer with poles compared to without poles. The reduced range of motion and velocity of the trunk in the frontal plane of motion suggest that NW can improve postural stability independently of the addition of a cognitive task. Compared to normal walking, spatial-temporal characteristics did not further decline when the cognitive task was combined to NW. This suggests that NW is a suitable practice for gait rehabilitation protocols in PD.

Kinematic classification of iliotibial band syndrome in runners

Several inconsistent causative biomechanical factors are considered to be crucial in the occurrence of iliotibial band syndrome (ITBS). The focus of this study was on assessing differences in the kinematic characteristics between healthy runners [control group (CO)] and runners with ITBS in order to recommend treatment strategies to deal with this injury. Three-dimensional kinematics of barefoot running was used in the biomechanical setup. Both groups were matched with respect to gender, height and weight. After determining drop outs, the final population comprised 36 subjects (26 male and 10 female): 18 CO and 18 ITBS (13 male and five female, each). Kinematic evaluations indicate less hip adduction and frontal range of motion at the hip joint in runners with ITBS. Furthermore, maximum hip flexion velocity and maximum knee flexion velocity were lower in runners with ITBS. Lack of joint coordination, expressed as earlier hip flexion and a tendency toward earlier knee flexion, was found to be another discriminating variable in subjects with ITBS compared with CO subjects. We assume that an increase in range of motion at the hip joint, stretching of the hip abductors, as well as stretching the hamstrings, calf muscles and hip flexors will help treat ITBS.

Femoroacetabular impingement alters hip and pelvic biomechanics during gait: Walking biomechanics of FAI

Femoroacetabular impingement (FAI) has been reported to cause hip pain in a variety of daily activities including walking. However, the biomechanics of level gait has not been compared between FAI patients and a control group. This study quantified the affect of cam FAI on the three-dimensional (3-D) kinematics of the hip and pelvis, as well as the 3-D kinetics generated at the hip during walking. A unilateral cam impingement group (n=17) was compared to a matched control group (n=14) using between-group one-way ANOVAs. The FAI group had significantly lower peak hip abduction (p=0.009), frontal range of motion (ROM) (p=0.003), as well as attenuated pelvic frontal ROM (pelvic roll) (p=0.004) compared to the controls during level gait. There was also a trend of the impinged group having a lower sagittal ROM (p=0.047) than the controls. However, there were no kinetic differences between the two groups. Attenuated hip abduction, frontal ROM and sagittal ROM during gait in FAI individuals may be caused by soft tissue restriction, and decreased frontal pelvic ROM could result from limited mobility at the sacro-lumbar joint.

Mid-term and long-term follow-up data after placement of the Graf stabilization system for lumbar degenerative disorders

The Graf pedicle screw and ligament device is designed to provide flexible stabilization to prevent abnormal spinal movement. The purpose of this study was to investigate radiographic and clinical outcomes during a minimal 5-year follow-up period. Between 1991 and 1997, 43 consecutive patients (whose mean age was 61 years) with lumbar degenerative disease underwent decompression and stabilization in which the Graf system was placed. Data were available for 31 patients who attended follow up for the minimal 5-year period. In a retrospective review, the authors assessed measurements on radiographs, clinical results (using Japanese Orthopaedic Association [JOA] Scale scores), and low-back pain (using a visual analog scale [VAS] score), preoperatively and postoperatively at 1, 3, 5, and/or 10 years. Radiographic measurements included sagittal and frontal range of motion (ROM), regional lordosis, and posterior disc height as well as the extent of degenerative spondylolisthesis. Final follow-up JOA and VAS scores were significantly better than preoperative scores. Sagittal and frontal ROM was significantly reduced at 1 and 5 years, respectively, compared with preoperative values, and a gradual reduction persisted throughout the follow-up period. Compared with its preoperative status, the disc height ratio (adjacent segments to the operated level) was reduced 5 years after surgery. A significant inhibition of the vertebral slippage was detected only in the flexion position. Analysis of these data indicated that the Graf system eventually leads to successful fusion, suggesting the presence of stability in all three dimensions. The use of the Graf system should continue to be evaluated as an alternative device in the treatment of lumbar degenerative disease.