Toe Touch Research Articles

Severe Ankle Injury - Baseball

HISTORY: Seventeen year-old baseball player over-ran a base, sustaining an inversion injury to the left ankle. He was initially able to bear weight, but unable to continue participation. Within an hour, he developed significant swelling and was unable to bear weight. Urgent care x-rays were negative and he was discharged with crutches and instructions for ice and elevation. He later presented to the emergency department for severe pain and was prescribed hydrocodone. He presented to the office four days post injury with moderate pain at rest, severe pain on attempts to bear weight, swelling, and blistering of the skin. He has a history of one prior ankle sprain approximately one year before that limited activities for less then a week. PHYSICAL EXAMINATION: Significant swelling of the left ankle and foot with ecchymosis extending from mid-calf to the toes. Intact and ruptured blistering of the skin. Range of motion limited to 15 degrees of combined plantar-dorsiflexion, and less then 5 degrees of inversion/inversion. Diffuse tenderness of bony and soft tissue structures of the ankle and foot. Power 3/5 in all directions. Equivocal ligament testing secondary to pain. Tolerated toe touch, but pain limited partial-weight bearing. DIFFERENTIAL DIAGNOSIS: Syndesmotic injury Occult fracture Osteochondral defect Lisfranc fracture Peroneus longus/brevis rupture Ankle sprain TEST AND RESULTS: X-Ray ankle: Osteochondral defect of the medial talar dome. CT Ankle: Osteochondral defect of the medial talar dome measuring 1.3 × 0.8 cm with surrounding sclerosis. FINAL WORKING DIAGNOSIS: Osteochondral defect Ankle Sprain TREATMENT AND OUTCOMES: Initially treated with a fracture boot, continued non-weight-bearing, ice, sequential compression, high volt electrical stimulation, and wound care. At three weeks, wounds and swelling had improved, but continued significant restriction of motion. Continued with range-of-motion and strengthening exercises as he progressed from partial to full-weigh-bearing. At five weeks, slight restriction of motion; strength improved. No mechanical symptoms. Released for activities as tolerated. Lost to follow-up, however, at seven weeks physical therapy reported back to full activity.

First Experience with Locked intramedullary nailing of the femur in Kashmir

An experience with 30 cases done between September 2002 and September 2004 at the Bone & Joint Surgery Hospital Srinagar Kashmir is reported. 30 cases of closed Diaphyseal femoral fractures were operated upon by closed antegrade intramedullary interlocking nailing and results assessed as per Pintore et al (1992). 23 cases were locked statically & 7 cases dynamically. One case was dynamised at 14 weeks. No Non-unions were noted. INTRODUCTION Femoral shaft fractures are amongst the most common fractures encountered in orthopedic practice. These may result in prolonged morbidity and extensive disability unless the treatment is appropriate (8). Reamed nailing for lower limb fractures is a well established technique (5). Interlocking nailing widens the surgical indications of nailing, allowing it to be used for comminuted fractures, on fractures too proximal or too distal to be operated on without interlocking(9)and on aseptic pseudoarthrosis(3,9). 30 cases with closed femoral fractures admitted to the Bone & joint Hospital were included in this study. The purpose of this study was to assess the results of application of this technique to these patients. MATERIAL AND METHODS 30 patients with closed diaphyseal femoral fractures were included in this study. The age of all these patients was more than 18 years. Exclusion criteria used in this study were: a-open fractures b-polytrauma c->3wk old trauma dpathological fractures e-patients with ligamentous knee injuries All patients were assessed thoroughly and investigated. SURGERY After the requisite anesthesia the patient was placed in supine position and traction table was used. The affected limb was adducted and the hip flexed to 25-30o. The foot of this limb was kept in 15 o internal rotations due to 15o anteversion. The incision was given from just distal to the greater trochanter to about 6-8cms proximal & posterior. Using a curved awl, the pyriform fossa was breached in the midplane of the femur in both AP & lateral views. Manipulative reduction of the fracture was done and a 3.2 mm guide rod was introduced. The femur was reamed over the guide wire by means of various sized reamers in 0.5 mm increments. The proximal femur was reamed 1mm more than the predetermined diameter of the nail. The nail was introduced and seated. Proximal locking was done by means of a jig and the distal locking was done by freehand technique. POSTOPERATIVE REHABILITATION After the operation immediate quadriceps muscle setting exercises and range of motion was begun on the morning after operation. Toe touch crutch walking was allowed depending upon the configuration of the fracture. Progressive weight bearing was allowed depending upon clinical & radiological union. Review was carried out monthly until final assessment First Experience with Locked intramedullary nailing of the femur in Kashmir 2 of 4 which was done at 6 months. RESULTS The results were assessed as per the following tables: 1-AGE

Changes in Hamstring Flexibility Following Supervised and Unsupervised Stretching Programs

2407 Sport-specific flexibility programs have become popular recently among athletic populations for enhancing physical performance and reducing risk of flexibilityrelated injuries. These flexibility programs however, are often the least supervised component of the overall training regime for the athlete. PURPOSE: To compare the effects of supervision on a stretching program designed to increase the flexibility of the hamstring musculotendinous unit. METHODS: Forty-eight subjects between the ages of 18 and 22 were assigned to either a supervised (S) or unsupervised (US) group. The standing stance phase stretch, the standing forward swing phase stretch, and the sitting toe touch stretch were demonstrated to all subjects. The US group was instructed to perform the stretches on their own prior to a cardiovascular fitness class. A trained exercise leader led the S group through the stretches prior to their cardiovascular fitness class. The stretching protocol for both groups included three sets of each stretch 3 days a week, gradually increasing the duration from 10 seconds to 30 seconds throughout the study. Prior to and following 10 weeks of training, hamstring flexibility was measured using the active-knee-extension test for right (RAKET) and left (LAKET) legs, and the modified sit-and-reach test using the Cailliet technique for right (RMSR) and left (LMSR) legs. A general linear model 2 × 2 factorial ANOVA statistical design was employed. If pretest differences occurred, ANCOVA was used with pretest scores used as the covariate to control for any influence pretest score had on improvement. RESULTS: Between group differences revealed significantly greater improvement for S on RMSR (1.2 ± .6 vs .38 ± 2.1 inches, p < .01), and LMSR (1.4 ± 1.7 vs .21 ± 1.8 inches, p < .05). For pre-post differences within groups and gender differences see table below. CONCLUSION: The intervention used was effective increased flexibility for both supervised and unsupervised subjects, but supervision provided additional benefits for improving hamstring flexibility.Table

HAMSTRING FLEXIBILITY AND MUSCLE STIFFNESS

653 The passive torque-angle curve of the hamstrings was measured in persons defined as flexible (able to touch ground, n=7) or tight (unable, n=6) on a clinical toe touch test. Resistance was measured as passive knee flexion torque (Nm) in a modified dynamometer (Magnusson, J Physiol, 1996). Maximal ROM was defined as the angle that induced a stretching sensation. Torque, angle and speed (0.09 rad·s-1) were continuously recorded during passive knee extension to max ROM. Cross-sectional area (CSA) was obtained (MRI) for biceps femoris longus (bf), semitendinosus (st) and semi-membranosus (sm). Changes in muscle length and lever arm were calculated from anatomical modeling. Tensile muscle stress (F/CSA) was calculated for each 0.002 rad of total ROM as passive torque/effective muscle lever length(assuming even distribution). Results are reported as mean±sem. Max ROM(Δ rad) was greater in flexible (1.48±.06) than tight(1.01±.06) subjects, p<0.01. Torque-stiffness (ΔNm/Δrad) in final 10% ROM was greater in flexible (102±12) than tight (65+9), p<0.01. CSA was similar in the 2 groups, p>0.05. In the final 1 cm of muscle length change muscle-stiffness (N/cm2) was greater in flexible than tight subjects(p<0.01): bf; 1734±333 vs. 444±81, st; 1561±320 vs. 289±61, sm; 1206±146 vs. 391±62. In the final 10% of muscle length change muscle-stiffness (N/cm2) was greater in flexible than tight subjects (p<0.01): bf; 2206±420 vs. 516±109, st; 1294±255 vs. 284±62, sm; 1575±296 vs. 415±77. In conclusion, during stretching passive stress and strain on the separate hamstring muscles is greater in flexible than tight persons. Thus, muscular flexibility and maximal muscle stiffness may be related to tensile tolerance.

Computer-aided video analysis of vertebrofemoral motion during toe touching in healthy subjects

Objective: Despite widespread use of the toe touch test, the relative contribution from vertebral and hip movements has not been clearly established, largely because of unsatisfactory measurement techniques. This study aimed to reinvestigate the kinematics of toe touching by combining computerized videotape analysis with a new model of reference marker placement. Method: Twenty-two subjects were videotaped during active toe touching from upright standing. Computer software was then used to derive the sagittal thoracic, lumbar, and hip angles at .02-sec intervals throughout the movement. Results: Hip flexion was directly proportional to toe touch distance (TTD) (r 2 = .71) but not lumbar flexion (r 2 = .17) or thoracic (r 2 = .20) excursion. On average there was .8° of thoracolumbar flexion for every 1° of hip flexion; however, there were wide variations between subjects. In 19 of 22 subjects the thoracic spine flexed and extended relatively equal amounts during the test resulting in a small total thoracic excursion of 4.8° flexion in unsuccessful toe touchers and 4.0° extension in successful toe touchers. Conclusion: The separate contributions of hip, lumbar, and thoracic mobility to toe touching or any other vertebrofemoral motion can only be accurately determined by a measurement strategy that uses the plane of the pelvis to separate vertebral from hip motion and uses tangents at the limits of the thoracic and lumbar regions to separate lumbar from thoracic motion. Using this model the authors found that TTD is not a reliable indicator of either vertebral or hip mobility.

Isokinetic Trunk Strength and Lifting Strength Measures

Fifty-eight back pain patients and 21 entry-level Postal Service workers without low-back pain were evaluated using a variety of lumbar function measures. Isolated trunk strength and full lifting strength were gauged with isokinetic and isometric methods. Lumbar range-of-motion was computed using toe-touch and goniometers. Conventional clinical techniques such as toe touch and straight leg raise were effective in distinguishing back-injured from normal subjects. Isometric and isokinetic peak force and torque tests failed to show significant differences between low-back pain and job applicant groups. When compared with published norms, our job applicant group was significantly deconditioned. Our data suggest that asymptomatic, deconditioned subjects could be mistaken for back-impaired patients or symptom magnifiers.

Effects of Selected Extensibility Exercises on the Flexibility of the Hip Joint

Abstract Thirty-three college men doing the toe touch test were used as subjects to ascertain the relative contribution of selected extensibility exercises, arranged with progressive increases, to the flexibility of the hip joint. The subjects performed six tests over a 5-week period. The first and sixth tests had no warm-up while the second through fifth tests had various degrees of warm-up. Results indicate that tests which included extensibility exercises allowed the subject to display greater flexibility (P .01).