Maximal Active Range Of Motion Research Articles

Do Muscle Changes Contribute to the Neurological Disorder in Spastic Paresis?

BackgroundAt the onset of stroke-induced hemiparesis, muscle tissue is normal and motoneurones are not overactive. Muscle contracture and motoneuronal overactivity then develop. Motor command impairments are classically attributed to the neurological lesion, but the role played by muscle changes has not been investigated.MethodsInteraction between muscle and command disorders was explored using quantified clinical methodology—the Five Step Assessment. Six key muscles of each of the lower and upper limbs in adults with chronic poststroke hemiparesis were examined by a single investigator, measuring the angle of arrest with slow muscle stretch (XV1) and the maximal active range of motion against the resistance of the tested muscle (XA). The coefficient of shortening CSH = (XN-XV1)/XN (XN, normally expected amplitude) and of weakness CW = (XV1-XA)/XV1) were calculated to estimate the muscle and command disorders, respectively. Composite CSH (CCSH) and CW (CCW) were then derived for each limb by averaging the six corresponding coefficients. For the shortened muscles of each limb (mean CSH > 0.10), linear regressions explored the relationships between coefficients of shortening and weakness below and above their median coefficient of shortening.ResultsA total of 80 persons with chronic hemiparesis with complete lower limb assessments [27 women, mean age 47 (SD 17), time since lesion 8.8 (7.2) years], and 32 with upper limb assessments [18 women, age 32 (15), time since lesion 6.4 (9.3) years] were identified. The composite coefficient of shortening was greater in the lower than in the upper limb (0.12 ± 0.04 vs. 0.08 ± 0.04; p = 0.0002, while the composite coefficient of weakness was greater in the upper limb (0.28 ± 0.12 vs. 0.15 ± 0.06, lower limb; p < 0.0001). In the lower limb shortened muscles, the coefficient of weakness correlated with the composite coefficient of shortening above the 0.15 median CSH (R = 0.43, p = 0.004) but not below (R = 0.14, p = 0.40).ConclusionIn chronic hemiparesis, muscle shortening affects the lower limb particularly, and, beyond a threshold of severity, may alter descending commands. The latter might occur through chronically increased intramuscular tension, and thereby increased muscle afferent firing and activity-dependent synaptic sensitization at the spinal level.

Journey-Deuce bicompartmental knee arthroplasty with the addition of computer navigation achieves good clinical outcomes and implant survivalat 10years.

To report 10-year outcomes and survivorship in patients undergoing bicompartmental knee arthroplasty (BCKA) using the Journey-Deuce prosthesis in a consecutive prospective case series. Between November 2006 and November 2009, 41 patients with a mean age of 69.6years (range 51-86) underwent 51 bicompartmental knee arthroplasties with the Journey-Deuce knee prosthesis. All patients presented with symptomatic medial and patellofemoral compartment osteoarthritis, with intact cruciate ligaments and a preserved lateral compartment on plain radiographs and Magnetic Resonance Imaging. Clinical assessment was undertaken pre-surgery and at 1, 2, 5 and 10years post-surgery using the Oxford Knee Score (OKS), EuroQol Group 5-Dimension self-reported questionnaire (EQ-5D) and maximal active range of motion (ROM). 30 patients (37 knees) were followed-up at a mean time of 11.4years (SD 1.1; range 10.5-14.0). Eight patients (ten knees) were deceased and three could not be contacted at final review. No major component revision was performed. Pre-operative OKS 25.4 (SD 5.2; range 15-40), knee flexion 116.4° (SD 10.3°; range 100°-140°) and EQ-5D 70.5 (SD 19.9; range 25-95). 10-year OKS 43.5 (SD 4.1; range 32-48), knee flexion 127.3° (SD 11.1°; range 105°-144°) and EQ-5D 77.4 (SD 9.3; range 60-100). The OKS (p < 0.0001), EQ-5D (p = 0.024) and active knee flexion ROM (p < 0.0001) all significantly improved from pre-surgery to 1-year post-surgery, with no further significant changes in these scores between any post-operative time period up until 10years. 32% (7/22) of tibial and 45% (10/22) of femoral components showed progressive radiolucencies between 2 and 5-year and 10-year follow-up. This is the largest cohort of patients having undergone BCKA (with the Journey-Deuce prosthesis) with longest follow-up described in the literature. At 10years, patients presented with significantly improved clinical outcomes, comparable to other surgical arthroplasty options. No major component revision was performed. Progressive radiolucencies were noted in 32% of tibial and 45% of femoral components without corresponding clinical signs of loosening. Level III.

In vivo reverse total shoulder arthroplasty contact mechanics

Several invitro studies have investigated the biomechanics of reverse total shoulder arthroplasty (RTSA); however, few invivo studies exist. The purpose of this study was to examine invivo RTSA contact mechanics in clinically relevant arm positions. Our hypothesis was that contact would preferentially occur in the inferior region of the polyethylene liner. Forty patients receiving a primary RTSA were recruited for a prospective cohort study. All patients received the same implant design with a nonretentive liner. Stereo radiographs were taken at maximal active range of motion. Model-based radiostereometric analysis was used to identify implant position. Contact area between the polyethylene and glenosphere was measured as the geometric intersection of the 2 components and compared with respect to polyethylene liner size, arm position, and relative position within the liner. There were no differences in the proportion of contact area in any arm position between polyethylene liner sizes, ranging from 30% ± 17% to 38% ± 23% for 36-mm linersand 32% ± 21% to 41% ± 25% for 42-mm liners. Contact was equally distributed between the superior and inferior halves of the liner at each arm position (P = .06-.79); however, greater contact area was observed in the outer radius of the liner when the arm was flexed (P = .002). This study highlights that contact mechanics are similar between 36- and 42-mm liners. Contact area is generally equally distributed throughout the liner across the range of motionand not preferentially in the inferior region as hypothesized.

T1 Measuring Burn Scar Contracture: Challenging the Standard

Standard goniometry is the most commonly used method of assessing range of motion (ROM) in patients with burn scar contracture. However, standard goniometry disregards the cutaneous biomechanical influence between adjacent joint positions and skin (or scar) pliability to accommodate motion. Given that natural skin is a single, continuous piece of tissue enveloping the entire body without joints, the appropriateness of standard goniometry to quantify motion when burn scars or other integumentary impairments are the source of limitation, is called into question. We conducted a prospective, multi-center, comparative study investigating the difference between two goniometric protocols for measuring ROM outcome in burn survivors: 1) standard goniometry - based on arthrokinematics and 2) revised goniometry - based on principles of cutaneokinematics and functional positions. Maximal active ROM was measured for 11 motions, three times in each position in random order. Data were summarized using means and standard deviations and analyzed using a mixed model ANOVA with each subject representing a random effect in the model. Pearson’s Correlations were performed between the severity of limitation and the percentage of scar involvement. Data were collected for 174 joints from 66 subjects at seven different burn centers, resulting in a total of 1044 goniometric measurements for comparison. ROM findings using the revised goniometric protocol demonstrated significantly more limitation in motion 38.8 %±15.2% than the standard goniometric protocol 32.1% ±13.4% (p<.0001). Individual analyses of the motions likewise, showed significantly more limitation with the revised methods compared to the standard methods for 9/11 motions. Pearson’s correlation showed a significant positive correlation between the percentage of area affected by scarring and ROM outcome with revised goniometry (R2=.05, p=.0008) and the Δ between the revised and standard protocols (R2=.04, p=.0025) but no correlation was found with standard goniometry (R2=.015, p=.065). These findings support the notion that standard goniometry underestimates the ROM impairment for individuals whose motion is limited by burn scars. Due to the high frequency of movement related problems that burn survivors experience, ROM is a foundational outcome measure. It is used as a marker of recovery, influences function, affects quality of life and contributes to the decision of resource allocation during recovery. Therefore, having measurement methods that consider the unique characteristics of skin impairment is an important priority for both clinical reporting and future research in burn care. Clinical change in fundamental methods of measuring ROM after burn injury.

Remote after-effects of resistive static contractions of lower trunk depressors and upper extremity on maximal active range of motion of ankle extension in ankle fractures

Direct approaches to improve maximal active range of motion (MAROM) of restricted joints may be difficult because of pain or weakness of agonist and/or antagonist muscles. Resistive static contraction (SC) of posterior depressors (RSCPD) using a PNF pattern in the mid-range of pelvic motion increases the flexibility of remote joints, such as the upper shoulder and knee, as remote after-effects in the clinic. The purpose of this study was to investigate the remote after-effects of RSCPD on the MAROM of ankle plantar flexion in patients with isolated ankle fractures. Thirteen patients with ankle fractures (7 men and 6 women, mean age 50.9 years, SD 11.9 years) were randomly assigned to resistive SC of shoulder flexion on the affected side (SCUE), RSCPD on the affected side, and SC of the affected ankle extensors. Each SC was induced by resistance (20% MVC) generated by a manual force using a handheld dynamometer. The duration of each resistive exercise and stretch was 20 s. The % MAROM change for ankle extension after each technique was calculated by subtracting the MAROM before each technique. The mean (SD) MAROM was 3.32 (11.35)% for RSCPD, 0.64 (6.25)% for SCUE, and −5.65 (8.05)% for SC. A two-way Anova for the %MAROM change showed significant main effects for technique [F (2.24) = 3.84, P = 0.04, partial eta squared = 0.24] and individual ( P = 0.32). A post-hoc Scheffe test indicated that the % MAROM change for RSCPD was significantly larger than that for SS ( P = 0.04). RSCPD showed a significant improvement over SC, which suggests that RSCPD may have immediate remote after-effects that improve flexibility of the plantar flexor muscle in patients with ankle fracture.

Relationships between coefficients of impairments at lower limb muscles in chronic spastic paresis–Could the muscle disease impact on the neurological disease?

At the onset of hemiparesis, muscle tissue is normal and spastic overactivity is nil. Later, motor function becomes gradually hindered by: spastic myopathy (part of soft tissue contracture) and co-contraction, in addition to paresis. Relationships between these remain unclear. This retrospective study explores correlations between muscle shortening on one hand, and, spastic co-contraction and agonist paresis on the other hand. Eighty participants with chronic hemiparesis (29 W, 51 (± 13) years (mean (± SD)), time since lesion, 6.4 (± 3.2) years)) were assessed through the Five Step Assessment, at least three months after any botulinum toxin injection, in six key lower limb antagonists: soleus (SO), gastrocnemius (GN), gluteus maximus (GM), hamstrings (HS), vastus (VA), rectus femoris (RF). Coefficients of impairment were calculated as: coefficient of shortening (C SH = (X N − X V1 )/X N ; X N , normally expected amplitude; X V1 , angle of arrest upon slow stretch), coefficient of weakness (C W = (X V1 − X A )/X V1 ; X A , maximal active range of motion). For each muscle and for the mean of the six muscles, bivariate correlations between C SH and C W were explored, using Pearson's coefficients. The mean C SH are as follows: C SH-SO , 0.15 ± 0.05; C SH-GN , 0.17 ± 0.04; C SH-GM , 0.14 ± 0.08; C SH-HS , 0.06 ± 0.05; C SH-VA , 0.09 ± 0.05; C SH-RF , 0.13 ± 0.07. C W strongly correlated with C SH across the six muscles ( r = 0.30, P = 0.006). This correlation was also found individually for GN ( r = 0.43, P < 0.0001), GM ( r = 0.22, P = 0.04) and HS ( r = 0.21, P = 0.052). While causality is not explored in this study, one may speculate that spastic myopathy (assessed through coefficient of shortening) may play a role in neurologic impairments, potentially by chronic modifications of afferent volleys to the spinal cord.

Correlation between coefficients of impairment at various muscles and active function in the paretic upper limb

In hemiparesis, motor function may be hindered to various degrees by soft tissue contracture, spasticity, spastic co-contraction and agonist paresis. This retrospective study explores correlations between neuromuscular impairments at shoulder, elbow, wrist and fingers and overall function in the paretic upper limb. Fifty-one patients with chronic hemiparesis [25 W, 48(±15) years (mean[±SD]), time since lesion, 7.7(±5.5) years] were assessed using the Five Step Assessment, at least three months after any botulinum toxin injection. The first step assessed motor function of the upper limb by the Modified Frenchay scale (MFS; score between 0 and 10). The 2nd, 3rd and 4th steps assessed coefficients of impairment in four key muscles: shoulder extensors, elbow flexors, wrist flexors and fingers flexors. These coefficients were calculated as: coefficient of shortening [C SH = (X N − X V1 )/X N ; X N , normally expected amplitude; X V1 , angle of arrest upon slow stretch], coefficient of spasticity [C SP = (X V1 − X V3 )/X V1 ; X V3 , angle of catch upon fast stretch], coefficient of weakness [C W = (X V1 − X A )/X V1 ; X A , maximal active range of motion]. For each impairment factor, a mean coefficient across the four muscles was calculated (C SHmean , C SPmean , C Wmean ). For each muscle group and for the mean, multivariable correlations were explored between C SH , C SP , C W and MFS. The MFS correlated with C SH-shoulder ( r = −0.28, P = 0.03) and C W-shoulder ( r = −0.46, P = 0.001); C W-elbow ( r = −0.45, P = 0.002); C W-wrist ( r = −0.33, P = 0.003); C W-Fingers ( r = −0.63, P < 0.0001); C Wmean ( r = −0.78, P < 0.0001). The main factors impeding motor function in chronic spastic paresis are the combination of paresis in agonist and spastic co-contraction in antagonist (limiting active motion) for shoulder extensors and for elbow, wrist and finger flexors. Soft tissue contracture for shoulder extensors also contributed to hinder motor function. Spasticity was not correlated with the mean score of MFS, whichever the muscle considered.

Coefficients of impairment in deforming spastic paresis

This position paper introduces an assessment method using staged calculation of coefficients of impairment in spastic paresis, with its rationale and proposed use. The syndrome of deforming spastic paresis superimposes two disorders around each joint: a neural disorder comprising stretch-sensitive paresis in agonists and antagonist muscle overactivity, and a muscle disorder (“spastic myopathy”) combining shortening and loss of extensibility in antagonists. Antagonist muscle overactivity includes spastic cocontraction (misdirected descending command), spastic dystonia (tonic involuntary muscle activation, at rest) and spasticity (increased velocity-dependent reflexes to phasic stretch, at rest). This understanding of various types of antagonist resistance as the key limiting factors in paretic movements prompts a stepwise, quantified, clinical assessment of antagonist resistances, elaborating on the previously developed Tardieu Scale. Step 1 quantifies limb function (e.g. ambulation speed in lower limb, Modified Frenchay Scale in upper limb). The following four steps evaluate various angles X of antagonist resistance, in degrees all measured from 0°, position of minimal stretch of the tested antagonist. Step 2 rates the functional muscle length, termed XV1 (V1, slowest stretch velocity possible), evaluated as the angle of arrest upon slow and strong passive muscle stretch. XV1 is appreciated with respect to the expected normal passive amplitude, XN, and reflects combined muscle contracture and residual spastic dystonia. Step 3 determines the angle of catch upon fast stretch, termed XV3 (V3, fastest stretch velocity possible), reflecting spasticity. Step 4 measures the maximal active range of motion against the antagonist, termed XA, reflecting agonist capacity to overcome passive (stiffness) and active (spastic cocontraction) antagonist resistances over a single movement. Finally, Step 5 rates the residual active amplitude after 15seconds of maximal amplitude rapid alternating movements, XA15. Amplitude decrement from XA to XA15 reflects fatigability. Coefficients of shortening (XN–XV1)/XN, spasticity (XV1–XV3)/XV1, weakness (XV1–XA)/XV1 and fatigability (XA–XA15)/XA are derived. A high (e.g., >10%) coefficient of shortening prompts aggressive treatment of the muscle disorder – e.g. by stretch programs, such as prolonged stretch postures –, while high coefficients of weakness or fatigability prompt addressing the neural motor command disorder, e.g. using training programs such as repeated alternating movements of maximal amplitude.

Effects of Mobilization With Movement on Pain and Range of Motion in Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to compare the immediate effects of mobilization with movement (MWM) to a sham technique in patients with shoulder impingement syndrome. MethodsA randomized controlled trial was performed. Forty-two patients (mean ± SD age, 55 ± 9 years; 81% female) satisfied eligibility criteria, agreed to participate, and were randomized into an MWM group (n = 21) or sham manual contact (n = 21). The primary outcome measures including pain intensity, pain during active range of motion, and maximal active range of motion were assessed by a clinician blinded to group allocation. Outcomes were captured at baseline and after 2 weeks of MWM treatment or sham intervention. The primary analysis was the group×time interaction. ResultsThe 2×2 analysis of variance revealed a significant group×time interaction for pain intensity during shoulder flexion (F = 7.054; P = .011), pain-free shoulder flexion (F = 32.853; P < .001), maximum shoulder flexion (F = 18.791; P < .01), and shoulder external rotation (F = 7.950; P < .01) in favor of the MWM group. No other significant differences were found. ConclusionsPatients with shoulder impingement syndrome who received 4 sessions of MWM exhibited significantly better outcomes for pain during shoulder flexion, pain-free range of shoulder flexion, maximal shoulder flexion, and maximal external rotation than those patients who were in the sham group.

Comparison of the effects of remote after-effects of static contractions for different upper-extremity positions and pinch-force strengths in patients with restricted wrist flexion range of motion

The objective of the study was to examine the after-effects of static contractions of upper extremity muscles in different shoulder joint positions and at different pinch-force strengths on the maximal active range of motion (MAROM) and wrist agonist/antagonist IEMG activities for patients with restricted wrist flexion range of motion (ROM) due to upper limb pain and dysfunction. The subjects were 10 outpatients (3 males, 7 females) with restricted wrist joints. These subjects performed four static contractions of upper extremity muscles in neutral and diagonal shoulder joint positions and with weak and strong pinch-force strengths in random order. Two-way repeated measures analysis of variance showed that the change in MAROM was significantly larger (P < 0.05) after diagonal-strong static contractions than after neutral-weak static contractions. There were no significant correlations between changes in MAROM and IEMG activities. These results indicate that shoulder joint position and pinch-force strength should be considered for effective induction of remote after-effects of static contractions for increasing MAROM for restricted wrist flexion ROM.

Effect of remote after-effects of resistive static contraction of the pelvic depressors on improvement of restricted wrist flexion range of motion in patients with restricted wrist flexion range of motion

The objective of the study was to compare the effects of remote after-effects of resistive static contraction of the pelvic depressors (RSCPD) with after-effects of static contraction of upper extremity muscles (SCUE) on improvement of the maximal active range of motion (MAROM) for patients with restricted wrist flexion range of motion (ROM) due to upper limb pain and dysfunction. The participants were 10 outpatients with restricted wrist joints. The mean (SD) age was 53.7 (4.4) years (range, 34-81). The subjects performed two exercise protocols (SCUE and RSCPD) in random order. One-way repeated measures ANOVA showed significant main effects in evaluation of the change in MAROM and IEMG activities for different conditions (after rest, after SCUE, and after RSCPD). The remote after-effects of RSCPD, but not those of SCUE, caused significant improvement in MAROM for restricted wrist flexion ROM.

No. 338 Comparison of the Directional After Effect of Static Contractions Through Different Upper Extremity Position and Different Pinch Force Strengths on Improvement of Maximal Active Range of Motion of Wrist

PM&RVolume 6, Issue 8S2 p. S159-S159 Poster Presentation No. 338 Comparison of the Directional After Effect of Static Contractions Through Different Upper Extremity Position and Different Pinch Force Strengths on Improvement of Maximal Active Range of Motion of Wrist Arai Mitsuo, Arai MitsuoSearch for more papers by this authorShiratani Tomoko, Shiratani TomokoSearch for more papers by this authorYanagisawa Ken, Yanagisawa KenSearch for more papers by this authorIkeda Makoto, Ikeda MakotoSearch for more papers by this author Arai Mitsuo, Arai MitsuoSearch for more papers by this authorShiratani Tomoko, Shiratani TomokoSearch for more papers by this authorYanagisawa Ken, Yanagisawa KenSearch for more papers by this authorIkeda Makoto, Ikeda MakotoSearch for more papers by this author First published: 18 September 2014 https://doi.org/10.1016/j.pmrj.2014.08.017Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume6, Issue8S28th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM)August 2014Pages S159-S159 RelatedInformation

Dynamic splinting for pronation contracture following a spinal cord injury

Background This report discusses the success of using multiple protocols/modalities to reduce forearm contracture in a 34-year-old, African American man who had suffered a spinal cord injury (SCI) over 2 years before this treatment. The patient's initial maximal active range of motion (AROM) in supination was −85° left and −60° right, and his initial passive range of motion (PROM) was +12° left and +50° right. Methods Intervention included occupational therapy five times per week and the protocols employed included manual AROM and PROM training, isometric strength training, handwriting, self-feeding and grooming training. Electrical stimulation for shoulder flexion and elbow extension, and a unique new modality, the Supination Dynasplint®, was also used for 45 min on each arm, twice daily. Results After three months, the patient regained over 40° AROM of supination in each arm. This benefitted the patient's ability to use utensils for eating, improved his handwriting skills and he regained the ability to use a urinal at night while in bed.

Dynamic splinting in wrist extension following distal radius fractures

BackgroundWrist flexion contracture is a common pathology which presents secondary to distal radius fractures. Joint stability, restoration and early mobilization are frequently achieved through surgical treatment after such an injury. The purpose of this retrospective study was to evaluate the initial effect of dynamic splinting on wrist extension (active range of motion), in both surgical and non-surgical patients following distal radius fractures.Methods Records were obtained from 133 patients who were treated with a Wrist Extension Dynasplint (WED) following distal radius fractures, between May 2007 and May 2009. Forty-two of these patients received surgical treatment for their fractures. This study specifically examined the initial usage of the WED as a home therapy. The retrospective analysis included categorization of patients who received the WED exclusively vs. patients who received WED treatment with concurrent hand therapy; surgical categorization included surgical patients vs. nonsurgical patients.ResultsThere was a significant improvement in maximal active range of motion (AROM) for all patients (P < 0.0001) after a mean duration of 3.9 weeks of dynamic splinting. Patients showed a mean 62% increase in active extension. There was not a significant difference between patients who had received surgical treatment for the fracture vs. nonsurgical.ConclusionThis dynamic splinting modality contributed 138 to 185 hours of stretching at the end range of motion for these patients in their first month following fracture. This unique regime is considered directly responsible for significant gains in AROM.

Contribution of the Pelvis to Gesture Leg Range of Motion in a Complex Ballet Movement

Eight skilled ballet dancers performed grand rond de jambe en l'air with the right leg as gesture leg at heights of 90° and 105° as well as their maximal active range of motion (MAR). Three-dimensional motion analysis was performed to quantify the pelvis and gesture-leg motions and to investigate the interaction between pelvic motion and increased leg height. Orientation angles of the pelvis and relative orientation angles of the gesture leg to the pelvis were computed. Events for analysis were defined based on the gesture leg motion, and the pelvis and gesture leg orientation angles at these events as well as the peak values were obtained. One-way repeated-measure ANOVA was used to determine differences among leg heights (p &lt; 0.05). In grand rond de jambe of 90° or higher, dancers gradually increased pelvic motion, especially anterior-posterior and lateral tilts, as the gesture leg height increased. Approximately 4% to 16% of the leg height at end of the ascending motion and 60% of the leg height at initiation of the descending motion were explained by posterior and anterior pelvic tilt, respectively. Maximum left lateral pelvic tilt was equivalent to approximately 45% to 60% of the maximum hip abduction. As the leg height requirement increased, dancers achieved this height primarily by increasing pelvic motion. Gesture leg motion revealed only a minor contribution. In spite of literature in dance pedagogy that suggests that the pelvis should remain immobile during grand rond de jambe, the authors conclude that the pelvis is the primary contributor to the gesture leg range of motion for increased vertical angle demands.

Correlation between physical activity and the gait characteristics and ankle joint flexibility of the elderly

The correlation between the type, duration and intensity of physical activity on the gait characteristics and the range of active ankle joint motion of the elderly were investigated in this study. Three-dimensional (3D) kinetic and kinematic assessments were performed on the normal walking patterns of 59 healthy elderly male and female subjects (aged 60–79 years). Gait analysis was performed using a high-speed video-based (3D) motion analysis system with synchronized ground-reaction force measurements. The maximal active range of motion (RoM) of the ankle joint complex of each subject was determined using an external six-degree-of-freedom flexibility assessment device. Physical activity levels were classified based on energy expenditure requirements. In general the results suggest that habitual level of physical activity did not have a significant effect on the kinetic or kinematic variables during walking, or the maximal ankle joint range of motion. Differences in ankle joint RoM and gait variables were found based on gender. No distinct benefit with respect to ankle joint range of motion or gait characteristics was provided with participation in higher-energy intensive physical activities in comparison to physical activities requiring low to moderate energy expenditures. It is speculated that the benefits of physical activity may be more pronounced in activities which demand rapid muscular strength and control movements such as recovering from a fall or obstacle avoidance.