Reduced Range Of Motion Research Articles

Surgical nuances and construct patterns influence construct stiffness in C1-2 stabilizations: a biomechanical study of C1-2 gapping and advanced C1-2 fixation

PurposeStabilization of C1-2 using a Harms–Goel construct with 3.5 mm titanium (Ti) rods has been established as a standard of reference (SOR). A reduction in craniocervical deformities can indicate increased construct stiffness at C1-2. A reduction in C1-2 can result in C1-2 joint gapping. Therefore, the authors sought to study the biomechanical consequences of C1-2 gapping on construct stiffness using different instrumentations, including a novel 6-screw/3-rod (6S3R) construct, to compare the results to the SOR. We hypothesized that different instrument pattern will reveal significant differences in reduction in ROM among constructs tested.MethodsThe range of motion (ROM) of instrumented C1-2 polyamide models was analyzed in a six-degree-of-freedom spine tester. The models were loaded with pure moments (2.0 Nm) in axial rotation (AR), flexion extension (FE), and lateral bending (LB). Comparisons of C1-2 construct stiffness among the constructs included variations in rod diameter (3.5 mm vs. 4.0 mm), rod material (Ti. vs. CoCr) and a cross-link (CLX). Construct stiffness was tested with C1-2 facets in contact (Contact Group) and in a 2 mm distracted position (Gapping Group). The ROM (°) was recorded and reported as a percentage of ROM (%ROM) normalized to the SOR. A difference > 30% between the SOR and the %ROM among the constructs was defined as significant.ResultsAmong all constructs, an increase in construct stiffness up to 50% was achieved with the addition of CLX, particularly with a 6S3R construct. These differences showed the greatest effect for the CLX in AR testing and for the 6S3R construct in FE and AR testing. Among all constructs, C1-2 gapping resulted in a significant loss of construct stiffness. A protective effect was shown for the CLX, particularly using a 6S3R construct in AR and FE testing. The selection of rod diameter (3.5 mm vs. 4.0 mm) and rod material (Ti vs. CoCr) did show a constant trend but did not yield significance.ConclusionThis study is the first to show the loss of construct stiffness at C1-2 with gapping and increased restoration of stability using CLX and 6S3R constructs. In the correction of a craniocervical deformity, nuances in the surgical technique and advanced instrumentation may positively impact construct stability.

Evaluation of osteoarthritis questionnaire check list to select pain that can be alleviated with exercise in patients with hip osteoarthritis and harris hip score below 60 points

Evaluation of osteoarthritis questionnaire check list to select pain that can be alleviated with exercise in patients with hip osteoarthritis and harris hip score below 60 points

Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study.

ObjectiveAnterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation. MethodsNondestructive flexibility tests (1.5 Nm) performed on 6 cervical C2–7 cadaveric specimens intact and after discectomy (C3–6) in 3 instrumented conditions: allograft with anterior plate (G+P), PCC with allograft and plate (PCC+G+P), and PCC with allograft alone (PCC+G). Range of motion (ROM) data were analyzed using 1-way repeated-measures analysis of variance. ResultsAll instrumented conditions resulted in significantly reduced ROM at the 3 instrumented levels (C3–6) compared to intact spinal segments in flexion, extension, lateral bending, and axial rotation (p < 0.001). No significant difference in ROM was found between G+P and PCC+G+P conditions or between G+P and PCC+G conditions, indicating similar stability between these conditions in all directions of motion. ConclusionAll instrumented conditions resulted in considerable reduction in ROM. The added reduction in ROM through the addition of PCCs did not reach statistical significance. Circumferential fusion with anterior allograft, without plate and with PCCs, has comparable stability to ACDF with allograft and plate.

Investigation of Muscle Strength, Motor Coordination and Balance in Children with Idiopathic Toe Walking: A Case-control Study

ABSTRACT Purpose: To compare muscle strength, ankle dorsiflexion range of motion (ROM), motor coordination and balance, between children with and without Idiopathic Toe Walking (ITW). Materials and methods: This is an observational case-control study. The primary outcome is the triceps surae muscle strength. The secondary outcomes are the anterior tibialis muscle strength, lower limb balance, motor coordination, and ankle dorsiflexion ROM. Thirty-eight children were recruited: 19 between 5 to 11 years old with ITW and 19 healthy (control). Ankle dorsiflexion ROM, triceps surae, anterior tibialis muscle strength, motor coordination, and balance were assessed. Results: Children with ITW showed reduced triceps surae strength [mean difference (MD): 16.2 kgf/kg*100; 95% confidence interval (CI) −32.72 to 0.28; p = .05], reduced anterior tibialis strength (MD: 8.5 kgf/kg*100; 95% CI −13.35 to −3.05; p ≤ 0.001), reduced ankle dorsiflexion ROM (MD: 19.6 degrees; 95% CI 15.43 to 23.77; p ≤ 0.001) and impaired motor coordination and balance (MD: 17.7; 95% CI −25.54 to −9.82; p ≤ 0.001) compared to healthy children. Conclusion: Children with Idiopathic Toe Walking, presented in this study, demonstrated triceps surae and anterior tibialis muscle strength reduction, ankle dorsiflexion ROM reduction, impaired motor coordination, and balance compared to healthy children.

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

BackgroundThis study was to evaluate and compare the biomechanical features of multilevel lateral lumbar interbody fusion (LLIF) with or without supplemental instrumentations.MethodsSix human lumbar specimens were tested under multidirectional nondestructive moments (7.5 N·m), with a 6 degree-of-freedom spine simulator. The overall and intervertebral range of motion (ROM) were measured optoelectronically. Each specimen was tested under the following conditions at L2–5 levels: intact; stand-alone; cage supplemented with lateral plate (LP); cage supplemented with unilateral or bilateral pedicle screw/rod (UPS or BPS).ResultsCompared with intact condition, the overall and intersegmental ROM were significantly reduced after multilevel stand-alone LLIF. The ROM was further reduced after using LP instrumentation. In flexion-extension (FE) and axial rotation (AR), pedicle screw/rod demonstrated greater overall ROM reduction compared to LP (P < 0.01), and bilateral greater than unilateral (P < 0.01). In lateral bending (LB), BPS demonstrated greater overall ROM reduction compared to UPS and LP (P < 0.01), however, UPS and LP showed similar reduction (P = 0.245). Intervertebral ROM reductions showed similar trend as the overall ones after using different types of instrumentation. However, at L2/3 (P = 0.57) and L3/4 (P = 0.097) levels, the intervertebral ROM reductions in AR were similar between UPS and LP.ConclusionsThe overall and intervertebral stability increased significantly after multilevel LLIF with or without supplemental instrumentation. BPS provided the greatest stability, followed by UPS and LP. However, in clinical practice, less invasive adjunctive fixation methods including UPS and LP may provide sufficient biomechanical stability for multilevel LLIF.

Effect of single and multilevel artificial inter-vertebral disc replacement in lumbar spine: A finite element study.

Degenerative disc disease (DDD) in lumbar spine is one of the major musculoskeletal disorders that cause low back pain (LBP). The intervertebral disc structure and dynamics of the lumbar spine are significantly affected by lumbar DDD, leading to a reduced range of motion (ROM), muscle weakness and gradual degradation. Spinal fusion and inter-vertebral disc replacement prostheses are two major surgical methods used for treating lumbar DDD. The aim of this present study is to examine biomechanical impacts of single level (L3-L4 and L4-L5) and multi level (L3-L4-L5) inter-vertebral disc replacement in lumbar spine (L2-L5) and to compare the performance with intact spine. Finite element (FE) analysis has been used to compare the mobility and stress distribution of all the models for four physiological movements, namely flexion, extension, left and right lateral bending under 6, 8 and 10 Nm moments. Spinal fusion implants completely restrict the motion of the implanted segment and increase disc stress at the adjacent levels. In contrast to that, the results single level ADR models showed closer ROM and disc stress to natural model. At the spinal segments adjacent to the implantation, single level ADR shows lower chance of disc degeneration. However, significantly increased ROM was observed in case of double level ADR.

Correlation between different instrumentation variants and the degree of destabilization in treating cervical spondylotic spinal canal stenosis by unilateral hemilaminectomy with bilateral decompression: a biomechanical investigation

PurposeUnilateral hemilaminectomy with bilateral decompression (BDZ) was proposed as an alternative decompressive procedure in cervical spondylotic myelopathy (CSM). Despite promising clinical results, the destabilizing effect is yet unknown. We therefore performed a biomechanical study to investigate whether lateral mass screw fixation should follow BDZ.MethodsSix human C2–C7 cervical specimens were tested under various conditions: native, unilateral hemilaminectomy with bilateral decompression without/with fixation (BDZ/BDF), unilateral hemilaminectomy with bilateral decompression and unilateral foraminotomy without/with fixation (UFZ/UFF), unilateral hemilaminectomy with bilateral decompression and bilateral foraminotomy without/with fixation (BFZ/BFF), and laminectomy without/with fixation (LAZ/LAF). Instrumention was applied from C3–C6. For each condition, the three-dimensional kinematics of the cervical specimen were measured in three main loading directions with an ultrasonic motion analysis system. ANOVA was used to determine differences between the specific segment conditions to assess the parameter’s range of motion (ROM) and neutral zone (NZ).ResultsFor flexion–extension, lateral bending and axial rotation, ROM of BDZ, UFZ, BFZ and LAZ remained at the level of the native condition (p > 0.74), whereas fixation reduced ROM significantly (p < 0.01). Between BDF, UFF, BFF and LAF, no significant differences in reduction in ROM were seen (p > 0.49). Results for NZ were equivalent to ROM in flexion–extension and lateral bending. For axial rotation, NZ remained almost constant on the native level for all tested conditions.ConclusionBilateral decompression via a hemilaminectomy, even if combined with foraminotomy, could be a less invasive treatment option for multilevel CSM in patients with lordotic cervical alignment and absence of segmental instability.

Instrumentation of the sacroiliac joint with cylindrical threaded implants: A detailed finite element study of patient characteristics affecting fixation performance.

The sacroiliac joint (SIJ) is a known pain generator that, in severe cases, may require surgical fixation to reduce intra-articular displacements and allow for arthrodesis. The objective of this computational study was to analyze how the number of implants affected SIJ stabilization with patient-specific characteristics such as the pelvic geometry and bone quality. Detailed finite element models were developed to account for three pelvises of differing anatomy. Each model was tested with a normal and low bone density (LD) under two types of loading: compression only and compression with flexion and extension moments. These models were instrumented with one to three cylindrical, threaded and fenestrated implants through a posterior oblique trajectory, requiring less muscle dissection than the more common lateral trajectory used with triangular implants. Compared with the noninstrumented pelvis, the change in range of motion (ROM) and stress distribution were used to characterize joint stabilization. Noninstrumented mobility ranged from 0.86 to 2.55 mm and from 1.37° to 6.11°. Across patient-specific characteristics, the ROM reduction with one implant varied from3% to 21% for vertical and 15% to 47% for angular displacements. With two implants, the ROM reduction ranged from 12% to 41% for vertical and from 28% to 61% for angular displacements. Three implants, however, did not further improve the joint stability (14% to 42% for vertical and 32% to 63% for angular displacements). With respect to patient characteristics, an LD led to a decreased stabilization and a higher volume of stressed bone (>75% of yield stress). A better understanding of how patient characteristics affect the implant performance could help improve surgical planning of sacroiliac arthrodesis.

Biomechanical Evaluation of Oblique Lumbar Interbody Fusion with Various Fixation Options: A Finite Element Analysis.

ObjectiveThe aim of the present study was to clarify the biomechanical properties of oblique lumbar interbody fusion (OLIF) using different fixation methods in normal and osteoporosis spines.MethodsNormal and osteoporosis intact finite element models of L1–S1 were established based on CT images of a healthy male volunteer. Group A was the normal models and group B was the osteoporosis model. Each group included four subgroups: (i) intact; (ii) stand‐alone cage (Cage); (iii) cage with lateral plate and two lateral screws (LP); and (iv) cage with bilateral pedicle screws and rods (BPSR). The L3–L4 level was defined as the surgical segment. After validating the normal intact model, compressive load of 400 N and torsional moment of 10 Nm were applied to the superior surface of L2 to simulate flexion, extension, left bending, right bending, left rotation, and right rotation motions. Surgical segmental range of motion (ROM), cage stress, endplate stress, supplemental fixation stress, and stress distribution were analyzed in each group.ResultsCage provided the minimal reduction of ROM among all motions (normal, 82.30%–98.81%; osteoporosis, 92.04%–97.29% of intact model). BPSR demonstrated the maximum reduction of ROM (normal, 43.94%–61.13%; osteoporosis, 45.61%–62.27% of intact model). The ROM of LP was between that of Cage and BPSR (normal, 63.25%–79.72%; osteoporosis, 70%–87.15% of intact model). Cage had the minimal cage stress and endplate stress. With the help of LP and BPSR fixation, cage stress and endplate stress were significantly reduced in all motions, both in normal and osteoporosis finite element models. However, BPSR had more advantages. For cage stress, BPSR was at least 75.73% less than that of Cage in the normal model, and it was at least 80.10% less than that of Cage in the osteoporosis model. For endplate stress, BPSR was at least 75.98% less than that of Cage in the normal model, and it was at least 78.06% less than that of Cage in the osteoporosis model. For supplemental fixation stress, BPSR and LP were much less than the yield strength in all motions in the two groups. In addition, the comparison between the two groups showed that the ROM, cage stress, endplate stress, and supplemental fixation stress in the normal model were less than in the osteoporosis model when using the same fixation option of OLIF.ConclusionOblique lumbar interbody fusion with BPSR provided the best biomechanical stability both in normal and osteoporosis spines. The biomechanical properties of the normal spine were better than those of the osteoporosis spine when using the same fixation option of OLIF.

Treatment of Stifle Joint Luxation in a Cat Using a Temporary Trans-Articular Locking Plate

AbstractThe aim of this study was to report the surgical treatment of stifle joint luxation through temporary immobilization of the joint with locking plates in a cat. Stifle joint was immobilized using a temporary trans-articular locking plate applied medially. Return to function was assessed by physical and radiographic follow-up examinations. The cat had good return to function despite a reduction in range of motion. Moderate chronic gonarthritis developed, as seen radiographically. Under the limitation of this single case, temporary trans-articular plating may be considered as useful method for the treatment of long-standing, severely displaced stifle joint luxations in cats.

Preliminary Evidence That Taping Does Not Optimize Joint Coupling of the Foot and Ankle Joints in Patients with Chronic Ankle Instability.

Background: Foot–ankle motion is affected by chronic ankle instability (CAI) in terms of altered kinematics. This study focuses on multisegmental foot–ankle motion and joint coupling in barefoot and taped CAI patients during the three subphases of stance at running. Methods: Foot segmental motion data of 12 controls and 15 CAI participants during running with a heel strike pattern were collected through gait analysis. CAI participants performed running trials in three conditions: barefoot running, and running with high-dye and low-dye taping. Dependent variables were the range of motion (RoM) occurring at the different inter-segment angles as well as the cross-correlation coefficients between predetermined segments. Results: There were no significant RoM differences for barefoot running between CAI patients and controls. In taped conditions, the first two subphases only showed RoM changes at the midfoot without apparent RoM reduction compared to the barefoot CAI condition. In the last subphase there was limited RoM reduction at the mid- and rearfoot. Cross-correlation coefficients highlighted a tendency towards weaker joint coupling in the barefoot CAI condition compared to the controls. Joint coupling within the taped CAI conditions did not show optimization compared to the barefoot CAI condition. Conclusions: RoM was not significantly changed for barefoot running between CAI patients and controls. In taped conditions, there was no distinct tendency towards lower mean RoM values due to the mechanical restraints of taping. Joint coupling in CAI patients was not optimized by taping.

Heterotopic Ossification After Prestige-LP Cervical Disc Arthroplasty Is Related to Insufficient Sagittal Coverage of the Endplate By the Prosthesis.

BackgroundHeterotopic ossification (HO) is a major complication after cervical disc arthroplasty (CDR) that has attracted the attention of spine surgeons. There remains a great deal of controversy regarding the surgical risk factors. The present study investigated the correlation between insufficient sagittal coverage of the prosthesis-endplate and HO after CDR and explored strategies to prevent it.Material/MethodsWe included 73 patients who underwent Prestige-LP arthroplasty. Patients were divided into HO and non-HO groups. Related data, including radiological, clinical information, were collected. HO was graded using the McAfee classification. Analysis was performed to correlate HO to the surgical segmental range of motion (ROM) at last follow-up. To evaluate the insufficient sagittal coverage of the prosthesis-endplate and other factors for developing HO, receiver operating characteristic (ROC) curves were analyzed for insufficient sagittal coverage.ResultsAmong 73 patients, 24 patients had HO at the last follow-up (HO incidence: 32.9%). The ROM in the HO group was significantly lower (P<0.001). The insufficient sagittal coverage of the upper and lower prosthesis-endplate, the height of intervertebral space, and the preoperative and postoperative ROM were related to HO (P<0.05). Multivariate logistic regression analysis showed that only insufficient sagittal coverage of the upper prosthesis-endplate was related to HO (P=0.023), and ROC curve analysis revealed that HO was more likely to occur with insufficient sagittal coverage distance ≥2.5 mm.ConclusionsHO after CDR causes a reduction in ROM, the occurrence of which is associated with insufficient sagittal coverage of the prosthesis-endplate. HO was more likely to occur with insufficient sagittal coverage distance ≥2.5 mm.

Pain sensitivity and shoulder function among breast cancer survivors compared to matched controls: a case-control study

ObjectivePersistent pain and loss of shoulder function are common adverse effects to breast cancer treatment, but the extent of these issues in comparison with healthy controls is unclear for survivors beyond 1.5 years after treatment. The purpose of this study was to benchmark differences in pressure pain thresholds (PPT), maximal isokinetic muscle strength (MIMS), and active range of motion (ROM) of females with persistent pain ≥1.5 years after breast cancer treatment (BCS) compared with pain-free matched controls (CON), and examine the presence of movement-evoked pain (MEP) during assessment of MIMS.MethodsThe PPTs of 18 locations were assessed using a pressure algometer and a numeric rating scale was used to assess intensity of MEP. Active ROM and MIMS were measured using a universal goniometer and an isokinetic dynamometer, respectively.ResultsA two-way analysis of variance revealed that PPTs across all locations, MIMS for horizontal shoulder extension/flexion and shoulder adduction, active ROM for shoulder flexion, horizontal shoulder extension, shoulder abduction, and external shoulder rotation were significantly lower for BCS compared with CON (P < 0.05). MEP was significantly higher for BCS and MEP intensity had a significant, negative correlation with PPTs (P < 0.01).Discussion/conclusionBCS with persistent pain ≥1.5 years after treatment demonstrates widespread reductions in PPTs and movement-specific reductions in MIMS and active ROM of the affected shoulder, along with MEP during physical performance assessment.Implications for cancer survivorsBCS with persistent pain ≥1.5 years after treatment shows signs of central sensitization and may benefit from individualized rehabilitation.

Treating Shoulder Pain with Trigger Point Dry Needling: A Case Report

Shoulder pain is highly prevalent even in the young population and could have a multifactorial aetiology. Myofascial Trigger Points (MTrPs) could be one of the pathophysiological basis of shoulder pain. Dry needling has shown promising results in releasing MTrPs in different muscles. Hereby, authors present a case report of a 24-year-old male with a history of shoulder pain, with no history of trauma or injury, who was referred to the physiotherapist by orthopaedic surgeon with a diagnosis of shoulder strain of muscular origin. Being a flight attendant by profession, his job involved continuous picking, pushing and lifting things during his working hours in the flights. The patient presented with severe pain and with reduced Range of Motion (ROM) mainly on left side. Following thorough assessment of the patient by the physiotherapist, the trigger point dry needling was administered. The pain was reduced as measured by Numeric Pain Rating Scale (NPRS), increasing the Pain Pressure Threshold (PPT) as measured by algometer with increase in ROM of left shoulder. After the dry needling treatment session, there was an instant improvement in the restricted ROM of shoulder which may be a consequence of the decrease in pain and improvement in muscle tone and elasticity after treatment. Although there are few papers highlighting the effectiveness of dry needling but still, there is dearth of literature that highlight the quantification (PPT) in addition to reporting of pain (score based) and ROM. Thus, the results of the present case report can assist in providing insight for examining the effectiveness of dry needling, which are subdued literature but are important to frame body of knowledge.

Equine spinal kinematics derived from different riding positions during asymmetrical bareback riding.

ABSTRACTHippotherapy in patients with neuromuscular dysfunction creates high focal pressure on the pony’s back due to bareback riding and an asymmetrical riding position. This study aimed to investigate the acute effect of asymmetrical bareback riding on the pony’s spinal kinematics, blood lactate, serum creatine kinase, heart rate, and temperament score. Eight ponies were selected, and they were walked on a treadmill for 45 min on each experimental day, including warm-up (5 min), weight-loading by mannequin (30 min), and cool-down (10 min) sessions. During the weight-loading session, three different weight distributions on the pony’s back were applied between the left and right side: 50:50 (treatment M), 70:30 (treatment L), and 30:70 (treatment R) on the first, second, and third day of the experiment, respectively. The spinal kinematics at the end of the weight-loading session revealed a slight reduction in range of motion in both flexion-extension and lateral bending during treatment R. Stride length and stride duration showed no differences between treatments. The levels of blood lactate and serum creatine kinase and results of a back examination were normal. Heart rates and temperament scores revealed that all ponies were calm throughout loading of the mannequin. This information suggests that asymmetrical bareback riding did not cause acute or serious back injury, which indicates good equine welfare in ponies used for hippotherapy.

Changes in cervical range of motion following anterior cervical discectomy with fusion - preliminary results.

The biomechanics of the cervical spine after anterior cervical discectomy with fusion (ACDF), and in particular changes in its global mobility, are phenomena that have not yet been sufficiently studied. Consequently, their effect on the eventual result of treatment is not fully understood. The aim of this study was to assess changes in global and segmental mobility of the cervical spine after ACDF. 28 patients who underwent ACDF for cervical spondylosis were examined. The study was divided into two stages: preoperative and postoperative. Range of motion (ROM) was analysed based on X-ray AP, lateral and functional images: C1-C7, C1-C2, C2-C7, C1-C4, C4-C7, and segments adjacent to the stabilisation. The patients were divided into groups depending on the length of spondylodesis and the occurrence of adjacent segment degeneration (ASDeg). A statistically significant difference was found in the total ROM of C2-C7, C1-C7 and C4-C7 after ACDF. The ROM of C2-C7 decreased by 23%, of C1-C7 by 20%, and of C4-C7 by 38%. These changes occurred by reducing the extension ROM C2-C7 by 33%, C1-C7 by 31%, and C4-C7 by 12%. There was a statistically significant (31%) reduction in total ROM in the segment above ACDF, a 41% reduction in extension ROM of this level in the non-ASDeg group, and a 73% increase in the segmental extension ROM above ACDF in patients with ASDeg. ACDF reduces the total ROM of the cervical spine in the sagittal plane. This change occurs by reducing the neck extension, and its severity depends on the length of the spondylodesis. In patients without ASDeg after ACDF, the mobility of the level above the stabilisation decreases. The occurrence of ASDeg is associated with a higher postoperative ROM of the segment located above the spondylodesis.

Sex and Stride Impact Joint Stiffness During Loaded Running.

This study determined changes in lower limb joint stiffness when running with body-borne load, and whether they differ with stride or sex. Twenty males and 16 females had joint stiffness quantified when running (4.0 m/s) with body-borne load (20, 25, 30, and 35 kg) and 3 stride lengths (preferred or 15% longer and shorter). Lower limb joint stiffness, flexion range of motion (RoM), and peak flexion moment were submitted to a mixed-model analysis of variance. Knee and ankle stiffness increased 19% and 6% with load (P < .001, P = .049), but decreased 8% and 6% as stride lengthened (P = .004, P < .001). Decreased knee RoM (P < .001, 0.9°-2.7°) and increased knee (P = .007, up to 0.12 N.m/kg.m) and ankle (P = .013, up to 0.03 N.m/kg.m) flexion moment may stiffen joints with load. Greater knee (P < .001, 4.7°-5.4°) and ankle (P < .001, 2.6°-7.2°) flexion RoM may increase joint compliance with longer strides. Females exhibited 15% stiffer knee (P = .025) from larger reductions in knee RoM (4.3°-5.4°) with load than males (P < .004). Stiffer lower limb joints may elevate injury risk while running with load, especially for females.

Range of motion as an outcome measure for knee osteoarthritis interventions in clinical trials: an integrated review

Background Osteoarthritis (OA) is a progressive disease causing pain and reduced range of motion (ROM), decreasing function and activity participation. Physiotherapy interventions improve symptoms and quality of life. Goniometry is one method for measuring ROM. Objective To conduct an integrative review investigating use of ROM for participants with knee OA following physiotherapy interventions in clinical trials, including reliability, validity and responsiveness of goniometry for measuring knee ROM. Major Findings Forty-two articles fulfilled the inclusion criteria. Twenty-six studies used OA patient-reported outcome measures in addition to ROM. Twenty-eight studies reported their own psychometric data, with generally excellent inter- and intra-rater reliability. Nine reported good to excellent criterion validity. Four studies reported limited and variable data on responsiveness. Conclusions Knee ROM is commonly used as an outcome measure in clinical trials of people with knee OA. Goniometry is a reliable and valid way to measure knee ROM, and is a convenient, accessible outcome measure for clinical trials and physiotherapy practice. We suggest combining patient-reported outcome measures with goniometry may provide a more holistic view of the person’s wellbeing, function, and participation. Further research is needed to gain a broader understanding of the validity, and responsiveness specifically for people with knee OA.

Dual-task walking reduces lower limb range of motion in individuals with Parkinson's disease and freezing of gait: But does it happen during what events through the gait cycle?

It is unclear how dual-task gait influences the lower limb range of motion (RoM) in people with Parkinson's disease (PD) and freezing of gait (FOG). The lower limb kinematics during dual-task gait might differ from regular gait, but during what events in the gait cycle? This is an observational within-subjects study. Thirty-two individuals with PD and FOG underwent a gait analysis. Single and dual-task gait was assessed by a 3D motion analysis system and the RoM data of the lower limb were extracted from hips, knees and ankles in the sagittal plane. Dual-task assignment was performed using word-color interference test. To compare both gait conditions, we used two different analyses: (1) common discrete analysis to provide lower limb RoM and (2) Statistical Parametric Mapping analysis (SPM) to provide lower limb joint kinematics. A correlation between lower limb RoM and spatiotemporal gait parameters was also performed for each gait condition. Common discrete analysis evidenced reductions in RoM of hips, knees and ankles during the dual task gait when compared to single gait. SPM analysis showed reductions in flexion-extension of hip, knees and ankles joints when dual task was compared to single task gait. These reductions were observed in specific gait events as toe off (for knees and ankles) and heel strike (for all joints). The reduction in lower limb RoM was positively correlated with the reduction in step length and gait speed. Lower limb joints kinematics were reduced during toe off and heel strike in dual task gait when compared to single gait. These findings might help physiotherapists to understand the influence of dual and single walking in lower limb RoM throughout the gait cycle in people with PD and FOG.

Knee and foot contracture occur earliest in children with cerebral palsy: a longitudinal analysis of 2,693 children

Background and purpose — Joint contracture is a common problem among children with cerebral palsy (CP). To prevent severe contracture and its effects on adjacent joints, it is crucial to identify children with a reduced range of motion (ROM) early. We examined whether significant hip, knee, or foot contracture occurs earliest in children with CP. Patients and methods — This was a longitudinal study involving 27,230 measurements obtained for 2,693 children (59% boys, 41% girls) with CP born 1990 to 2018 and registered before 5 years of age in the Swedish surveillance program for CP. The analysis was based on 4,751 legs followed up for an average of 5.0 years. Separate Kaplan–Meier (KM) curves were drawn for each ROM to illustrate the proportions of contracture-free legs at a given time during the follow-up. Using a clustered bootstrap method and considering the child as the unit of clustering, 95% pointwise confidence intervals were generated for equally spaced time points every 2.5 years for each KM curve. Results — Contracture developed in 34% of all legs, and the median time to the first contracture was 10 years from the first examination. Contracture was most common in children with a higher Gross Motor Function Classification System (GMFCS) level. The first contracture was a flexion contracture preventing dorsiflexion in children with GMFCS level I or II and preventing knee extension in children with GMFCS level III to V. Interpretation — Early interventions to prevent knee and foot contractures in children with CP should be considered.