Ipsilateral transfer of motor skill from lower to upper limb in healthy adults: A randomized controlled trial.

BACKGROUND AND PURPOSE: Whereas motor skills of the untrained upper limb (UL) can improve following practice with the other UL, it has yet to be determined if an UL motor skill can improve following practice of that skill with the lower limb (LL). METHODS: Forty-five healthy subjects randomly participated in a 10-minute single-session intervention of (1) practicing 50 reaching movement (RM) sequences with the non-dominant left LL toward light switches (LL group); or (2) observing the identical 50 light switches sequences (Switches Observation (SO) group); or (3) observing nature films (Nature Observation (NO) group). RM sequence performance with the left UL toward the light switches was tested before and immediately after the intervention and retested after 24 h. RESULTS: Reaching response time improved in the LL group more than in the SO and NO groups in the posttest (pBonferroni = 0.038 and pBonferroni < 0.001, respectively), and improved in the LL group more than in the NO group in the retest (pBonferroni = 0.004). Percentage of fails did not differ between groups across the timepoints. CONCLUSIONS: It appears that the actual practice of the RM sequence skill with the UL together with the cognitive element embedded in the observation of the RM sequences contributes to ipsilateral transfer from LL to UL.

Regaining motion among patients with shoulder pathology - are all exercises equal?

Background: Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Methods: Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. Results: The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P ≤ 0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P = 0.002) and a greater perceived level of difficulty compared with the table slide (P = 0.006). Conclusions: Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM.

The effect of action observation combined with high-definition transcranial direct current stimulation on motor performance in healthy adults: A randomized controlled trial.

Action observation (AO) can improve motor performance in humans, probably via the human mirror neuron system. In addition, there is some evidence that transcranial direct current stimulation (tDCS) can improve motor performance. However, it is yet to be determined whether AO combined with tDCS has an enhanced effect on motor performance. We investigated the effect of AO combined with high-definition tDCS (HD-tDCS) targeting the inferior parietal lobe (IPL) and inferior frontal gyrus (IFG), the main aggregates of the human mirror neuron system, on motor performance in healthy adults and compared the immediate vs. 24-h retention test effects (anodal electrodes were placed over these regions of interest). Sixty participants were randomly divided into three groups that received one of the following single-session interventions: (1) observation of a video clip that presented reaching movement sequences toward five lighted units + active HD-tDCS stimulation (AO + active HD-tDCS group); (2) observation of a video clip that presented the same reaching movement sequences + sham HD-tDCS stimulation (AO + sham HD-tDCS group); and (3) observation of a video clip that presented neutral movie while receiving sham stimulation (NM + sham HD-tDCS group). Subjects' reaching performance was tested before and immediately after each intervention and following 24 h. Subjects performed reaching movements toward units that were activated in the same order as the observed sequence during pretest, posttest, and retest. Occasionally, the sequence order was changed by beginning the sequence unexpectedly with a different activated unit. Outcome measures included mean Reaching Time and difference between the Reaching Time of the unexpected and expected reaching movements (Delta). In the posttest and retest, Reaching Time and Delta improved in the AO + sham HD-tDCS group compared to the NM + HD-sham tDCS group. In addition, at posttest, Delta improved in the AO + active HD-tDCS group compared to the NM + sham HD-tDCS group. It appears that combining a montage of active HD-tDCS, which targets the IPL and IFG, with AO interferes with the positive effects of AO alone on the performance of reaching movement sequences.

Bending the Elbow During Shoulder Flexion Facilitates Greater Scapular Upward Rotation and a More Favorable Scapular Muscle Activation Pattern.

CONTEXT: Decreased scapular upward rotation (UR) and diminished activation of the serratus anterior (SA) and lower trapezius (LT) are often observed among patients with subacromial impingement syndrome. Maintaining the elbow fully flexed during shoulder flexion may limit glenohumeral motion due to passive insufficiency of the triceps brachii and therefore facilitate greater scapular UR and increased scapular muscle activation. OBJECTIVES: To compare scapular UR, SA, upper trapezius (UT), middle trapezius, and LT activation levels between shoulder flexion with the elbow extended (Flexion-EE) to shoulder flexion with the elbow fully flexed (Flexion-EF). This study hypothesized that Flexion-EF would result in greater scapular UR, greater SA and LT activation, and a lower UT/SA and UT/LT activation ratio compared with Flexion-EE. DESIGN: Cross-sectional study. SETTING: A clinical biomechanics laboratory. PARTICIPANTS: Twenty-two healthy individuals. MAIN OUTCOME MEASURES: Scapular UR and electromyography signal of the SA, UT, middle trapezius, and LT, as well as UT/SA and UT/LT activation ratio were measured during Flexion-EE and Flexion-EF. RESULTS: Flexion-EF resulted in greater scapular UR compared with Flexion-EE (P < .001). Flexion-EF resulted in greater SA activation, lower UT activation, and a lower UT/SA activation ratio compared with Flexion-EE (P < .001). CONCLUSIONS: Fully flexing the elbow during shoulder flexion leads to increased scapular UR primarily through greater activation of the SA. This exercise may be of value in circumstances involving diminished scapular UR, decreased activation of the SA, and an overly active UT such as among patients with subacromial impingement syndrome.

The Effects of Instruction Manipulation on Motor Performance Following Action Observation.

The effects of action observation (AO) on motor performance can be modulated by instruction. The effects of two top-down aspects of the instruction on motor performance have not been fully resolved: those related to attention to the observed task and the incorporation of motor imagery (MI) during AO. In addition, the immediate vs. 24-h retention test effects of those instruction's aspects are yet to be elucidated. Forty-eight healthy subjects were randomly instructed to: (1) observe reaching movement (RM) sequences toward five lighted units with the intention of reproducing the same sequence as fast and as accurate as possible (Intentional + Attentional group; AO+At); (2) observe the RMs sequence with the intention of reproducing the same sequence as fast and as accurate as possible and simultaneously to the observation to imagine performing the RMs (Intentional + attentional + MI group; AO+At+MI); and (3) observe the RMs sequence (Passive AO group). Subjects' performance was tested before and immediately after the AO and retested after 24 h. During each of the pretest, posttest, and retest, the subject performed RMs toward the units that were activated in the same order as the observed sequence. Occasionally, the sequence order was changed by beginning the sequence with a different activated unit. The outcome measures were: averaged response time of the RMs during the sequences, difference between the response time of the unexpected and expected RMs and percent of failures to reach the target within 1 s. The averaged response time and the difference between the response time of the unexpected and expected RMs were improved in all groups at posttest compared to pretest, regardless of instruction. Averaged response time was improved in the retest compared to the posttest only in the Passive AO group. The percent of failures across groups was higher in pretest compared to retest. Our findings suggest that manipulating top-down aspects of instruction by adding attention and MI to AO in an RM sequence task does not improve subsequent performance more than passive observation. Off-line learning of the sequence in the retention test was improved in comparison to posttest following passive observation only.

Listening Effort Among Adults With and Without Attention-Deficit/Hyperactivity Disorder.

Purpose Few studies have assessed listening effort (LE)-the cognitive resources required to perceive speech-among populations with intact hearing but reduced availability of cognitive resources. Attention/deficit/hyperactivity disorder (ADHD) is theorized to restrict attention span, possibly making speech perception in adverse conditions more challenging. This study examined the effect of ADHD on LE among adults using a behavioral dual-task paradigm (DTP). Method Thirty-nine normal-hearing adults (aged 21-27 years) participated: 19 with ADHD (ADHD group) and 20 without ADHD (control group). Baseline group differences were measured in visual and auditory attention as well as speech perception. LE using DTP was assessed as the performance difference on a visual-motor task versus a simultaneous auditory and visual-motor task. Results Group differences in attention were confirmed by differences in visual attention (larger reaction times between congruent and incongruent conditions) and auditory attention (lower accuracy in the presence of distractors) among the ADHD group, compared to the controls. LE was greater among the ADHD group than the control group. Nevertheless, no group differences were found in speech perception. Conclusions LE is increased among those with ADHD. As a DTP assumes limited cognitive capacity to allocate attentional resources, LE among those with ADHD may be increased because higher level cognitive processes are more taxed in this population. Studies on LE using a DTP should take into consideration mechanisms of selective and divided attention. Among young adults who need to continuously process great volumes of auditory and visual information, much more effort may be expended by those with ADHD than those without it. As a result, those with ADHD may be more prone to fatigue and irritability, similar to those who are engaged in more outwardly demanding tasks.

Agreement Between Visual Assessment and 2-Dimensional Analysis During Jump Landing Among Healthy Female Athletes.

CONTEXT: Altered movement patterns, including increased frontal-plane knee movement and decreased sagittal-plane hip and knee movement, have been associated with several knee disorders. Nevertheless, the ability of clinicians to visually detect such altered movement patterns during high-speed athletic tasks is relatively unknown. OBJECTIVE: To explore the association between visual assessment and 2-dimensional (2D) analysis of frontal-plane knee movement and sagittal-plane hip and knee movement during a jump-landing task among healthy female athletes. DESIGN: Cross-sectional study. SETTING: Gymnasiums of participating volleyball teams. PATIENTS OR OTHER PARTICIPANTS: A total of 39 healthy female volleyball players (age = 21.0 ± 5.2 years, height = 172.0 ± 8.6 cm, mass = 64.2 ± 7.2 kg) from Divisions I and II of the Israeli Volleyball Association. MAIN OUTCOME MEASURE(S): Frontal-plane knee movement and sagittal-plane hip and knee movement during jump landing were visually rated as good, moderate, or poor based on previously established criteria. Frontal-plane knee excursion and sagittal-plane hip and knee excursions were measured using free motion-analysis software and compared among athletes with different visual ratings of the corresponding movements. RESULTS: Participants with different visual ratings of frontal-plane knee movement displayed differences in 2D frontal-plane knee excursion ( P < .01), whereas participants with different visual ratings of sagittal-plane hip and knee movement displayed differences in 2D sagittal-plane hip and knee excursions ( P < .01). CONCLUSIONS: Visual ratings of frontal-plane knee movement and sagittal-plane hip and knee movement were associated with differences in the corresponding 2D hip and knee excursions. Visual rating of these movements may serve as an initial screening tool for detecting altered movement patterns during jump landings.

Ulnar Nerve Conduction Block Using Surface Kilohertz Frequency Alternating Current: A Feasibility Study.

The aim of this study was to test the effects of kilohertz frequency alternating current (KHFAC) surface stimulation applied to the ulnar nerve on force and myoelectrical activity of the abductor digiti minimi (ADM) muscle. Eighteen healthy volunteers (age: 27.6 ± 7.9 years; 10 males, 8 females) were included in the study. Each subject participated in one session during which a biphasic 7 kHz rectangular pulse was delivered above the medial epicondyle of the humerus to induce ulnar nerve blocking. ADM electromyographic (EMG) activity and contraction force were measured before (Pre), immediately after, and following 5 and 10 min post stimulation (post 1, post 2). The results showed that EMG activity decreased immediately after stimulation compared to prestimulation, it returned to the level of prestimulation at 5 min (post 1), and decreased again at 10 min (post 2). Furthermore, analysis of compound adjusted z-score indicated significant decrease of force and myoelectrical activity immediately, and 10 min post stimulation. The findings, which demonstrate that KHFAC surface stimulation of the ulnar nerve may decrease the motor activity of intrinsic hand muscle, can help to develop future methods of neuromodulation to treat hand spasticity.

The association of visually-assessed quality of movement during jump-landing with ankle dorsiflexion range-of-motion and hip abductor muscle strength among healthy female athletes.

OBJECTIVE: To explore the association between ankle dorsiflexion (DF) range of motion (ROM), and hip abductor muscle strength, to visually-assessed quality of movement during jump-landing. DESIGN: Cross-sectional. SETTING: Gymnasium of participating teams. PARTICIPANTS: 37 female volleyball players. MAIN OUTCOME MEASURES: Quality of movement in the frontal-plane, sagittal-plane, and overall (both planes) was visually rated as "good/moderate" or "poor". Weight-bearing Ankle DF ROM and hip abductor muscle strength were compared between participants with differing quality of movement. RESULTS: Weight-bearing DF ROM on both sides was decreased among participants with "poor" sagittal-plane quality of movement (dominant side: 50.8° versus 43.6°, P = .02; non-dominant side: 54.6° versus 45.9°, P = .01), as well as among participants with an overall "poor" quality of movement (dominant side: 51.8° versus 44.0°, P < .01; non-dominant side: 56.5° versus 45.1°, P < .01). Weight-bearing ankle DF on the non-dominant side was decreased among participants with a "poor" frontal-plane quality of movement (53.9° versus 46.0°, P = .02). No differences in hip abductor muscle strength were noted between participants with differing quality of movement. CONCLUSIONS: Visual assessment of jump-landing can detect differences in quality of movement that are associated with ankle DF ROM. Clinicians observing a poor quality of movement may wish to assess ankle DF ROM.

Utility of the Overhead Squat and Forward Arm Squat in Screening for Limited Ankle Dorsiflexion.

Rabin, A and Kozol, Z. Utility of the overhead squat and forward arm squat in screening for limited ankle dorsiflexion. J Strength Cond Res 31(5): 1251-1258, 2017-Limited ankle dorsiflexion (DF) range of motion (ROM) has been implicated in several lower extremity disorders. Effective screening for DF ROM may, therefore, help to identify "at risk" individuals. The primary purpose of this study was to determine the utility of 2 screening tests in detecting limited ankle DF ROM. Fifty-three healthy participants underwent an overhead squat (OS) test and a forward arm squat (FAS) test, as well as bilateral testing of weight-bearing and non-weight-bearing ankle DF ROM. Participants whose DF ROM fell below 1 SD from the sample average were considered to have limited DF ROM. The sensitivity, specificity, positive, and negative likelihood ratio (LR) of the OS and FAS in detecting individuals with limited DF ROM was calculated. The sensitivity of the OS was 1.00 regardless of the mode or the side of testing, whereas specificity ranged from 0.34 to 0.36. The positive LR of the OS ranged from 1.52 to 1.56, whereas negative LR was 0.00. The sensitivity of the FAS ranged from 0.56 to 0.70, whereas specificity ranged from 0.84 to 0.88. The positive and negative LR of the FAS ranged from 3.49 to 6.02, and 0.34 to 0.53, respectively. Our findings suggest that the OS and FAS may be used as complementing tests in screening for ankle DF limitation. Because of its excellent sensitivity, the OS should be performed first, and if negative, may confidently rule out limited DF ROM. However, given a positive OS, testing should proceed with the FAS, to more confidently rule in limited DF ROM.

The Association of Ankle Dorsiflexion Range of Motion With Hip and Knee Kinematics During the Lateral Step-down Test.

Study Design Controlled laboratory study. Background Altered hip and knee kinematics have been associated with several knee disorders, including anterior cruciate ligament tear, patellofemoral pain, and iliotibial band syndrome. Limited ankle dorsiflexion (DF) range of motion (ROM), which has been linked with some of these disorders, has also been associated with altered knee kinematics. Objective To explore the association of ankle DF ROM with hip and knee kinematics during a step-down task. Methods Thirty healthy participants underwent a 3-D analysis of hip and knee kinematics during a lateral step-down test, followed by measurement of ankle DF ROM in weight bearing (WB) and non-weight bearing (NWB). Participants were dichotomized using the median values into low- and high-DF subgroups within both WB and NWB. Hip and knee kinematics were compared between the low- and high-DF subgroups. Results Participants in the low-DF subgroups exhibited greater peak hip adduction (WB, P = .02; NWB, P<.01) and greater peak knee external rotation (WB, P = .02; NWB, P<.01) compared with participants in the high-DF subgroups. In addition, participants in the low-DF WB subgroup exhibited decreased peak knee flexion compared with participants in the high-DF WB subgroup (P<.01). Conclusion Individuals with lower ankle DF ROM exhibited hip and knee kinematics previously associated with several knee disorders, suggesting that this impairment may be involved in the pathogenesis of the same disorders. Assessment of ankle DF ROM may be useful as part of a preparticipation screening. Furthermore, deficits in ankle DF ROM may need to be addressed in individuals with altered movement patterns. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6621.

A new real-time visual assessment method for faulty movement patterns during a jump-landing task.

OBJECTIVE: Determine the interrater reliability of a new real-time assessment of faulty movement patterns during a jump-landing task. DESIGN: Interrater reliability study. SETTING: Human movement laboratory. PARTICIPANTS: 50 healthy females. MAIN OUTCOME MEASURES: Assessment included 6 items which were evaluated from a front and a side view. Two Physical Therapy students used a 9-point scale (0-8) to independently rate the quality of movement as good (0-2), moderate (3-5), or poor (6-8). Interrater reliability was expressed by percent agreement and weighted kappa. RESULTS: One examiner rated the quality of movement of 6 subjects as good, 34 subjects as moderate, and 10 subjects as poor. The second examiner rated the quality of movement of 12 subjects as good, 23 subjects as moderate, and 15 subjects as poor. Percent agreement and weighted kappa (95% confidence interval) were 78% and 0.68 (0.51, 0.85), respectively. CONCLUSIONS: A new real-time assessment of faulty movement patterns during jump-landing demonstrated adequate interrater reliability. Further study is warranted to validate this method against a motion analysis system, as well as to establish its predictive validity for injury.

The Association Between Visual Assessment of Quality of Movement and Three-Dimensional Analysis of Pelvis, Hip, and Knee Kinematics During a Lateral Step Down Test.

Rabin, A, Portnoy, S, and Kozol, Z. The association between visual assessment of quality of movement and three-dimensional analysis of pelvis, hip, and knee kinematics during a lateral step down test. J Strength Cond Res 30(11): 3204-3211, 2016-Altered movement patterns including contralateral pelvic drop, increased hip adduction, knee abduction, and external rotation have been previously implicated in several lower extremity pathologies. Although various methods exist for assessing movement patterns, real-time visual observation is the most readily available method. The purpose of this study was to determine whether differing visual ratings of trunk, pelvis, and knee alignment, as well as overall quality of movement, are associated with differences in 3-dimensional trunk, pelvis, hip, or knee kinematics during a lateral step down test. Trunk, pelvis, and knee alignment of 30 healthy participants performing the lateral step down were visually rated as "good" or "faulty" based on previously established criteria. An additional categorization of overall quality of movement as either good or moderate was performed based on the aggregate score of each individual rating criterion. Three-dimensional motion analysis of trunk, pelvis, hip, and knee kinematics was simultaneously performed. A faulty pelvis alignment displayed a greater peak contralateral pelvic drop (effect size [ES], 1.65; p < 0.01) and a greater peak hip adduction (ES: 1.04, p = 0.01) compared with participants with a good pelvis alignment. Participants with a faulty knee alignment displayed greater peak knee external rotation compared with participants with a good knee alignment (ES, 0.78; p = 0.02). Participants with an overall moderate quality of movement displayed increased peak contralateral pelvic drop (ES, 1.07; p = 0.01) and peak knee external rotation (ES, 0.72; p = 0.04) compared with those with an overall good quality of movement. Visual rating of quality of movement during a lateral step down test, as performed by an experienced physical therapist, is associated with differences in several kinematics previously implicated in various pathologies.

Weight-bearing ankle dorsiflexion range of motion-can side-to-side symmetry be assumed?

CONTEXT: In clinical practice, the range of motion (ROM) of the non involved side often serves as the reference for comparison with the injured side. Previous investigations of non-weight-bearing (NWB) ankle dorsiflexion (DF) ROM measurements have indicated bilateral symmetry for the most part. Less is known about ankle DF measured under weight-bearing (WB) conditions. Because WB and NWB ankle DF are not strongly correlated, there is a need to determine whether WB ankle DF is also symmetrical in a healthy population. OBJECTIVE: To determine whether WB ankle DF is bilaterally symmetrical. A secondary goal was to further explore the correlation between WB and NWB ankle DF ROM. DESIGN: Cross-sectional study. SETTING: Training facility of the Israeli Defense Forces. PATIENTS OR OTHER PARTICIPANTS: A total of 64 healthy males (age = 19.6 ± 1.0 years, height = 175.0 ± 6.4 cm, and body mass = 71.4 ± 7.7 kg). MAIN OUTCOME MEASURE(S): Dorsiflexion ROM in WB was measured with an inclinometer and DF ROM in NWB was measured with a universal goniometer. All measurements were taken bilaterally by a single examiner. RESULTS: Weight-bearing ankle DF was greater on the nondominant side compared with the dominant side (P < .001). Non-weight-bearing ankle DF was not different between sides (P = .64). The correlation between WB and NWB DF was moderate, with the NWB DF measurement accounting for 30% to 37% of the variance of the WB measurement. CONCLUSIONS: Weight-bearing ankle DF ROM should not be assumed to be bilaterally symmetrical. These findings suggest that side-to-side differences in WB DF may need to be interpreted while considering which side is dominant. The difference in bilateral symmetry between the WB and NWB measurements, as well as the only moderate level of correlation between them, suggests that both measurements should be performed routinely.

Physiotherapy Management of People Diagnosed with de Quervain's Disease: A Case Series.

Purpose : To report the outcomes of a physiotherapy management approach for de Quervain's disease (DQD), a common hand disorder for which evidence for physiotherapy management is lacking, in 4 consecutive patients with DQD. Methods : Participants underwent a median of eight treatment sessions, consisting of mobilizations with movement, eccentric muscle training, and high-voltage electrical stimulation. Outcomes were assessed with an 11-point numeric pain rating scale (NPRS; range 1-10) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH; range 0%-100%). Result s: Median NPRS and DASH scores decreased from a baseline of 5 and 48, respectively, to 2.8 and 19 after treatment; at 6-month follow-up, all participants reported minimal pain and disability, but one participant required a corticosteroid injection shortly after discharge from physiotherapy. Conclusions : Overall outcome was considered successful for three of four patients, comparable to the success rate previously reported for corticosteroid injections. A randomized clinical trial evaluating the efficacy of this intervention seems warranted.

Objectif: Présenter les résultats d'une approche de traitement par la physiothérapie de la maladie de De Quervain, une affection de la main courante pour laquelle il y a peu de données probantes quant au traitement par la physiothérapie, chez quatre patients consécutifs ayant la maladie de De Quervain. Méthodes: Les participants ont subi une médiane de huit séances de traitement comportant des activités de mobilisation avec mouvements, de contraction musculaire excentrique et de simulation électrique à haute tension. Les résultats ont été évalués à l'aide d'une échelle numérique de cotation de la douleur à 11 points (1 à 10) et d'un questionnaire sur les déficiences du bras, de l'épaule et de la main (0 à 100%). Résultats: Les notes médianes de l'échelle numérique de cotation de la douleur et du questionnaire sur les déficiences du bras, de l'épaule et de la main ont diminué, passant de la note médiane de base de 5/10 et 48/100, respectivement, à 2,8/10 et 19/100 après le traitement; au suivi du 6e mois, les participants ont déclaré avoir une douleur et une déficience minimales, mais un participant a eu besoin d'une injection de corticostéroïdes peu de temps après la fin du traitement par la physiothérapie. Conclusions: Dans l'ensemble, le traitement est considéré comme réussi pour 3 des 4 patients, ce qui est semblable au taux de succès rapporté antérieurement pour les injections de corticostéroïdes. La tenue d'un essai clinique randomisé évaluant l'efficacité de cette intervention semble justifiée.

Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study.

BACKGROUND: Achilles tendinopathy (AT) is a prevalent condition among runners and military personnel. Although ankle dorsiflexion (DF) range of motion (ROM) as measured with the knee bent has not been previously associated with AT, the literature concerning its role is limited. In addition, the role of lower extremity movement pattern in the pathogenesis of AT has not been studied prospectively. The purpose of this study was to further explore the role of ankle DF ROM as measured with the knee bent and that of lower extremity movement pattern as risk factors for mid-portion AT. METHODS: Seventy healthy male military recruits (mean ± SD age, height and body mass of 19.6 ± 1.0 years, 176.0 ± 10.0 cm, and 71.5 ± 7.4 kg) participated in this study. Ankle DF ROM as measured with the knee bent in weight-bearing (WB) and non-weight-bearing (NWB), as well as lower extremity quality of movement during a lateral step down (LSD) test were measured at baseline. Participants were then followed for a 6-month period of army basic training with recording of the development of AT. RESULTS: Five participants developed AT during training. Participants that developed AT had a more limited NWB ankle DF ROM (27.4(0) versus 21.1(0), p = 0.025). The quality of lower extremity movement did not differ between injured and uninjured participants (p = 0.361). CONCLUSIONS: A more limited ankle DF ROM as measured in NWB with the knee bent increases the risk of developing AT among military recruits taking part in intensive physical training.

Factors associated with visually assessed quality of movement during a lateral step-down test among individuals with patellofemoral pain.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To determine what physical measures are associated with visually assessed quality of movement among patients with patellofemoral pain (PFP). BACKGROUND: An altered movement pattern has been implicated as a risk factor for PFP. An understanding of physical measures associated with an altered movement pattern could potentially help guide prevention and management efforts in patients with PFP. METHODS: Seventy-nine (40 women) Israel Defense Forces soldiers referred to physical therapy with a diagnosis of PFP were included. Movement pattern was assessed visually during a lateral step-down test and rated as "good" or "moderate," based on previously established criteria. Weight-bearing and non-weight-bearing ankle dorsiflexion (DF) range of motion (ROM); hip internal and external rotation ROM; and hip abduction, hip external rotation, and knee extension strength were also assessed. Differences in physical measures between those with good versus moderate quality of movement were assessed. RESULTS: Weight-bearing DF ROM was more limited among participants with a moderate quality of movement compared to those with a good quality of movement (P<.01). Among men, non-weight-bearing DF ROM was more limited in those with a moderate quality of movement as well (P<.01). In addition, quality of movement was associated with weight-bearing DF ROM for both women (r = -0.39, P = .01) and men (r = -0.46, P<.01), and with non-weight-bearing DF ROM for men (r = -0.66, P<.01). When the subgroup of participants who exhibited more than 25° of non-weight-bearing DF ROM was assessed, those with a good quality of movement displayed greater hip external rotator and knee extensor muscle strength compared with those with a moderate quality of movement (P<.01). CONCLUSION: Ankle DF ROM should be assessed when patients with PFP demonstrate a lower quality of movement during a lateral step-down test. Lower hip muscle strength may be associated with lower quality of movement among patients with relatively greater ankle DF ROM.

Ankle dorsiflexion among healthy men with different qualities of lower extremity movement.

CONTEXT: Lower extremity movement patterns have been implicated as a risk factor for various knee disorders. Ankle-dorsiflexion (DF) range of motion (ROM) has previously been associated with a faulty movement pattern among healthy female participants. OBJECTIVE: To determine the association between ankle DF ROM and the quality of lower extremity movement during the lateral step-down test among healthy male participants. DESIGN: Cross-sectional study. SETTING: Training facility of the Israel Defense Forces. PATIENTS OR OTHER PARTICIPANTS: Fifty-five healthy male Israeli military recruits (age = 19.7 ± 1.1 years, height = 175.4 ± 6.4 cm, mass = 72.0 ± 7.6 kg). INTERVENTION(S): Dorsiflexion ROM was measured in weight-bearing and non-weight-bearing conditions using a fluid-filled inclinometer and a universal goniometer, respectively. Lower extremity movement pattern was assessed visually using the lateral step-down test and classified categorically as good or moderate. All measurements were performed bilaterally. MAIN OUTCOME MEASURE(S): Weight-bearing and non-weight-bearing DF ROM were more limited among participants with moderate quality of movement than in those with good quality of movement on the dominant side (P = .01 and P = .02 for weight-bearing and non-weight-bearing DF, respectively). Non-weight-bearing DF demonstrated a trend toward a decreased range among participants with moderate compared with participants with good quality of movement on the nondominant side (P = .03 [adjusted P = .025]). Weight-bearing DF was not different between participants with good and moderate movement patterns on the nondominant side (P = .10). Weight-bearing and non-weight-bearing ankle DF ROM correlated significantly with the quality of movement on both sides (P < .01 and P < .05 on the dominant and nondominant side, respectively). CONCLUSIONS: Ankle DF ROM was associated with quality of movement among healthy male participants. The association seemed weaker in males than in females.

Weightbearing and nonweightbearing ankle dorsiflexion range of motion: are we measuring the same thing?

BACKGROUND: Ankle dorsiflexion range of motion has been measured in weightbearing and nonweightbearing conditions. The different measurement conditions may contribute to inconsistent conclusions regarding the role of ankle dorsiflexion in several pathologic conditions. The purpose of this study was to examine the relationship between ankle dorsiflexion range of motion as measured in weightbearing and nonweightbearing conditions. METHODS: We compared ankle dorsiflexion range of motion as measured in a weightbearing versus a nonweightbearing position in 43 healthy volunteers. Measurements were taken separately by two examiners. RESULTS: Weightbearing and nonweightbearing ankle dorsiflexion measurements produced significantly different results (P < .0001). The two measurements correlated moderately (r = 0.6 and r = 0.64 for examiners 1 and 2, respectively; P < .001). CONCLUSIONS: Weightbearing and nonweightbearing ankle dorsiflexion measurements produce significantly different results and only a moderate correlation, suggesting that these two measurements should not be used interchangeably as measures of ankle dorsiflexion range of motion.

Measures of range of motion and strength among healthy women with differing quality of lower extremity movement during the lateral step-down test.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To determine the association between hip and ankle range-of-motion measures, as well as measures of hip muscle strength, with measures of quality of lower extremity movement, as assessed visually during the lateral step-down test in healthy women. BACKGROUND: Altered lower extremity movement pattern consisting of excessive femoral adduction and internal rotation, leading to excessive knee valgus alignment, is associated with increased risk of knee ligament injury, as well as patellofemoral pain syndrome. Previous investigations of lower extremity kinematics, using 3-dimensional motion analysis systems, document an inconsistent association between hip muscle strength and lower extremity movement pattern. Currently, it is unknown whether differences in hip muscle strength or other physical measures exist among women with differing quality of lower extremity movement as assessed by visual observation. METHODS: Two physical therapists assessed the quality of movement during the lateral step-down among 29 healthy women (mean ± SD age, 24.3 ± 3.2 years). Subjects were instructed on the optimal movement pattern prior to performing the test. The quality of movement was categorized as "good" or "moderate," based on a previously established 6-point scale. Several measures of hip strength (handheld dynamometer) and hip and ankle range of motion (fluid-filled inclinometer and universal goniometer) were also assessed. Differences in strength and range-of-motion measures between women with good and women with moderate quality of movement were assessed with a Mann-Whitney U test. RESULTS: Both examiners found decreased ankle dorsiflexion range of motion, as measured with the knee bent (P<.05 and P<.01 for examiner 1 and 2, respectively) and in weight bearing (P<.001 and P<.01 for examiner 1 and 2, respectively) among women with a moderate quality of movement compared to women with a good quality of movement on the lateral step-down test. CONCLUSION: Following receipt of instructions on optimal lower extremity movement pattern, women who demonstrate a moderate quality of movement, as assessed visually during the lateral step-down test, exhibit decreased ankle dorsiflexion range of motion compared to women with a good quality of movement. Clinicians should consider evaluating ankle dorsiflexion range of motion when observing an altered lower extremity movement pattern during the lateral step-down test.