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Context: The Y-Balance Test Lower Quarter (YBT-LQ) is a widely utilized tool for evaluating dynamic postural control, requiring a combination of mobility and strength. This study aimed to investigate the combined relationship between isometric thigh muscle strength and joint kinematics on YBT-LQ performance. Design: Cross-sectional laboratory study. Methods: Isometric quadriceps and hamstrings strength were measured before the YBT-LQ in 39 healthy participants (27 females and 12 males). The test was performed under 3-dimensional markerless motion capture, where joint kinematics were extracted from the maximum reach position from each direction. Three multivariable linear regression models were then used to determine the strongest combination of predictors for YBT-LQ performance. Results: Greater hamstrings strength and increased knee flexion, ankle dorsiflexion, and trunk ipsilateral-flexion joint angles explained 56.8% (P <.001) of the variance in anterior reach. Hip flexion, knee flexion, and ankle dorsiflexion angles were the strongest predictors for posteromedial reach distance, explaining 73.0% of the variance (P <.001). Last, 43.3% (P <.001) of the variance in posterolateral reach distance was predicted by hamstring strength and knee-flexion angle. Conclusions: These results emphasize the importance of hamstring strength in YBT-LQ performance across different reach directions. Additionally, the kinematics illustrate a potential movement strategy for maximizing reach distance on the YBT-LQ in healthy individuals. Clinicians can utilize this information to guide interventions aimed at improving dynamic postural control, particularly by focusing on increasing hamstring strength and testing for impairments in specific movement patterns. [ABSTRACT FROM AUTHOR]

Background: Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. Method: The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. Results: Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. Conclusions: HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently. [ABSTRACT FROM AUTHOR]

Postpartum mothers are susceptible to lumbopelvic pain which may be exacerbated by loading, like carrying their infant in arms and with baby carriers. Nulliparous women carrying infant mannequins may biomechanically mimic mother–infant dyad, but this has not been studied. The purpose of our study was to investigate biomechanical differences of 10 mothers carrying their infants and 10 nulliparous women carrying infant mannequins under 3 gait conditions: carrying nothing, carrying in arms, and carrying in a baby carrier (babywearing). Spatiotemporal gait parameters, peak ground reaction forces and impulses, and lower extremity and trunk kinematics were collected using motion capture and force plates and compared using a mixed 2 × 3 (parity × condition) analysis of variance (α ≤.05). The largest differences occurred between carrying conditions: carrying in arms or babywearing increased vertical and anteroposterior ground reaction forces, trunk extension, ankle dorsiflexion, and hip and knee flexion. Kinematic differences were identified between arms and babywearing conditions. Together this suggests alterations in joint loading for both groups. Our study also contributes a novel understanding of postpartum health by demonstrating alterations in step time, anterior forces, and ankle and knee mechanics, suggesting that during gait, mothers carrying their own infants choose different propulsive strategies than nulliparous women carrying mannequins. [ABSTRACT FROM AUTHOR]

Purpose: Optimal ankle dorsiflexion range of motion plays a vital role in attaining the essential crouched posture necessary for excelling in speed skating. The purpose of this study was to determine how the ankle dorsiflexion angle evolves throughout a day of training and to identify the factors that influence this angle. Methods: Thirty short-track speed skaters, from 2 teams, participated in this study. The maximum ankle dorsiflexion angle was obtained in a lunge position facing a wall, using a digital inclinometer. All measures were obtained 3 times per side, 6 times per day, on 2 training days separated by at least a week. We conducted multiple tests to study the impact of repetition, day, side, team level, sex, and moment on the ankle dorsiflexion angle. Results: The 3 times repeated measures and the 2 days of training did not have a significant influence on the results. There was a statistically significant difference between the first time point of the day and the 5 other time points for both ankles. Moreover, the influence of sex and team level was not statistically significant. Conclusions: The results indicate that there are significant changes in ankle dorsiflexion range of motion but only after the first warm-up of the day. Such findings could enable team staff to enhance athletes' precompetition preparation and tailor ankle mobility training regimens more effectively. [ABSTRACT FROM AUTHOR]

Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was.43 during the landing phase (P =.04) and with peak hip internal rotation was −.68 (P <.001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r =.40, P =.05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test. [ABSTRACT FROM AUTHOR]

This report describes a new configuration of the extensor digitorum longus (EDL) with two heads and two main tendons divided into four slips. During routine cadaver dissection, unilateral (right) EDL muscle belly and tendon variations were identified. The morphometric measurements of the EDL were conducted using Image J software. Two bellies and two tendons of the EDL muscle were observed in the right leg of an 87-year-old male cadaver. The second belly of the EDL muscle originates 2 cm below the first belly. The tendons originate at the ends of the muscle bellies. First and second tendons split into two more slips after passing through the same tunnel below the extensor retinaculum. The first tendon was divided into two tendon slips attached to the extensor expansion of the second and third toes, whereas the second tendon was divided into two tendon slips attached to the extensor expansion of the fourth and fifth toes on the dorsum of the foot. The width of the muscle belly for the tendons of 2nd and 3rd toes was 1.10 ± 0.06 cm, while it was 1.39 ± 0.04 cm for that of the 4th and 5th toes. The developmental variations in the EDL muscles can be asymptomatic. This variant of the EDL muscle may cause entrapment under the extensor retinaculum, potentially restricting ankle dorsiflexion. This limitation can also affect walking. Consequently, paying attention to this variance is crucial for surgical planning and interpretation of radiological scans. [ABSTRACT FROM AUTHOR]

Split tendon transfer of the posterior tibialis (SPOTT) is a surgical procedure in which the split posterior tibialis tendon is transferred posterior to the fibula (PO) with insertion on the peroneus brevis tendon to rebalance the forces across the hindfoot. Routing of the split tendon through the interosseous membrane (IO) is a variation with the potential benefit of augmenting ankle dorsiflexion in swing. Does IO routing improve ankle dorsiflexion in swing and/or varus in stance compared to PO routing? A retrospective chart review was completed to identify forty-two patients who underwent a SPOTT procedure for equinovarus foot deformity. 14 patients received IO routing and 28 received PO routing. Two main outcomes: maximum ankle dorsiflexion in swing and average ankle coronal angle in stance were analyzed using a mixed effects model. Both the IO and PO routing significantly improved maximum dorsiflexion in swing (p = 0.018 and p = 0.001, respectively.) There was no significant difference in the maximum dorsiflexion during swing, post-operatively, between the two groups (p = 0.431). Pre-operatively, patients in the IO group exhibited significantly more average ankle varus during stance, with a median of 6.7 degrees of varus compared to a median of 1.8 degrees of varus in the PO group (p = 0.024). The IO group yielded a statistically significant reduction in average ankle varus during stance (p < 0.001) whereas there was no significant change in the PO group (p = 0.138). There was no difference between groups in proportion of patients that achieved an average ankle coronal angle during stance within one SD of normative data (between −8.7 and 0.7 degrees, p = 0.381). The SPOTT procedure utilized for correction of spastic equinovarus foot deformity, can improve ankle kinematics with routing of the tendon through the IO membrane or posterior to the fibula if performed concurrently with the appropriate tendon lengthening to address equinus contracture. More clinical studies are needed to better understand potential confounding factors. • Two split tendon transfer approaches achieved desired ankle varus during stance. • Two split tendon transfer approaches improved dorsiflexion during swing. • Posterior tendon routing exhibited higher chance of under-correction. [ABSTRACT FROM AUTHOR]

Freezing of gait (FOG) during gait initiation in patients with Parkinson's disease (PD) is associated with anticipatory postural adjustments (APAs) with diminishing amplitude, leading to a risk of falls. Assistance with ankle dorsiflexion function by external devices improve APAs during gait initiation, however, the effect of training to improve ankle dorsiflexion function on APAs during gait initiation is unclear. Does ankle dorsiflexion training improve APAs and FOG during gait initiation in patients with PD? This 4-week prospective controlled trial included 30 patients with PD, who were divided into two groups: the control group, which received only conventional inpatient rehabilitation, and the intervention group, which received ankle dorsiflexion training in addition to inpatient rehabilitation. Ankle dorsiflexion training consisted of strengthening ankle dorsiflexion muscles and transferring weight backwards while standing. The primary outcomes were displacement of the center of pressure (COP) and electromyography of the tibialis anterior muscle during gait initiation as APAs. The secondary outcome was the New freezing of gait questionnaire (NFOGQ) to determine the severity of FOG. We analyzed differences in treatment effects between groups and within groups. In the intervention group, the anteroposterior component of COP displacement and muscle activity of the tibialis anterior muscle increased significantly and NFOGQ decreased after the intervention. After intervention, the anteroposterior component of COP displacement showed a significant intervention effect. Ankle dorsiflexion training for patients with PD improves APAs and FOG during gait initiation and may reduce the risk of falls. • APAs during gait initiation generate the weight shift required for stepping. • Ankle dorsiflexion training increased APAs during gait initiation in patients with PD. • Ankle dorsiflexion training reduced FOG during gait initiation in patients with PD. • Muscle strengthening for ankle dorsiflexion increased APAs during gait initiation. [ABSTRACT FROM AUTHOR]

Background: Hemophilia is characterized by degenerative joint damage. Patients with hemophilic arthropathy present joint damage, reduced range of motion, and decreased strength and functional capacity. Myofascial release therapy aims to decrease pain and improve tissue mobility and functionality. Objectives: To evaluate the safety and efficacy of myofascial release therapy in patients with hemophilic ankle arthropathy. Method: Single-blind randomized controlled trial. Fifty-eight adult patients with hemophilia were randomly allocated to the experimental group (myofascial release therapy with foam roller) or the control group (no intervention whatsoever). The daily home protocol of myofascial release therapy for the lower limbs using a foam roller lasted eight consecutive weeks. The primary variable was the safety of myofascial release therapy (weekly telephone follow-up). The secondary variables were pain intensity (visual analog scale), range of motion (goniometer), functional capacity (2-Minute Walk Test) and muscle strength (dynamometer), at baseline and at 8 and 10 weeks. Results: During the experimental phase, none of the patients in the experimental group developed ankle hemarthrosis. There were statistically significant changes in time*group interaction in ankle dorsal flexion (F[1.75] = 10.72; p <.001), functional capacity (F[1.16] = 5.24; p =.009) and gastrocnemius strength (F[2] = 26.01; p <.001). The effect size of the changes after the intervention was medium-large in pain intensity (d = −1.77), functional capacity (d = 1.34) and gastrocnemius strength (d = 0.76). Conclusion: Myofascial release therapy is a safe form of physical therapy for patients with hemophilia. Myofascial release therapy can effectively complement prophylactic pharmacological treatment in patients with hemophilic arthropathy, improving range of motion in dorsal flexion, functional capacity and gastrocnemius strength. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the effect duration of a talocrural mobilization on individuals with restricted dorsiflexion during a static weight bearing lunge test (WBLT) and dynamic 3D motion capture-based peak ankle dorsiflexion during a forward step down (FSD) task. Secondarily, we aimed to correlate any immediate changes in ankle mobility with concurrent changes in proximal joint kinematics during the FSD post-mobilization. Methods: Seventy-six individuals were screened for dorsiflexion restriction, of which 26 (15 females, 22.3 ± 2.2 years old, body mass index 25.2 ± 2.9 kg/m2) qualified with a WBLT of ≤ 35° on at least one limb. A baseline WBLT measure and 3D motion capture of 5 consecutive FSD repetitions on a 6-inch box were obtained. Participants then viewed an instructional video of a talocrural joint self-mobilization using a resistance band. WBLT and FSD were collected again immediately post-mobilization and at 5-min intervals for 60 min or until the WBLT returned to baseline for 2 consecutive measures. Results: WBLT dorsiflexion showed a mean increase of 6.5 degrees (p < 0.001) post-mobilization. The effect faded over time and no longer differed from baseline 25 min post-mobilization (p = 0.964). Dynamic peak ankle dorsiflexion did not change post-mobilization at any time point (p ≥ 0.546). No 3D kinematic time-course changes were observed at the hip or knee. However, immediate raw alterations in dorsiflexion correlated with alterations for hip and knee flexion. Discussion/Conclusion: A talocrural joint mobilization increased static dorsiflexion per the WBLT for a 20–25-min period with regression to baseline. However, increased dynamic ankle dorsiflexion was not observed during the FSD task. Improved mobility alone does not appear to change movement patterns. Clinicians should be aware of both effect duration and the potential need for task-specific training to better facilitate dynamic utilization of increased mobility. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the relationships between knee and ankle strength and horizontal deceleration performance following different sprint distances. Fifty-seven (n = 41male, n = 16 female) youth team-sports athletes completed: a) 5-m and 10-m horizontal deceleration ability (HDA) tests; b) concentric (60°/s, 180°/s) and eccentric (30°/s) relative peak torque (PT) measurements of the knee extensor (KE) and flexor (KF) muscles and the ankle plantarflexion (APF) and dorsiflexion (ADF) muscles in an isokinetic dynamometer. Pearson’s correlation coefficients revealed that concentric at 60°/s and eccentric at 30°/s KE were mostly related to deceleration performance both in HDA5-m (r = −0.50 to −0.61, p < 0.05) and HDA10-m tests (r = −0.50 to −0.63, p < 0.05). Moreover, a significant correlation was observed between concentric APF and average deceleration (DECavg) measured from HDA5-m test in both the dominant leg (DL) and non-dominant leg (NDL) (r = −0.52 to −0.53, p < 0.05), but not to 10-m horizontal deceleration performance. The current results indicate that deceleration performance varies in its demands on knee and ankle strength across different sprint distances. Athletes who frequently decelerate over short distances should focus not only on strengthening their knee strength but also on prioritising ankle strength. [ABSTRACT FROM AUTHOR]

Background: Ankle joint position sense (AJPS) accuracy and postural control are crucial for maintaining balance and stability, particularly in individuals with plantar fasciitis who may experience proprioceptive and functional impairments. Understanding how psychosocial factors, such as pain catastrophizing, and biomechanical measures, like muscle strength and gait parameters related to proprioception and postural control, can inform more effective treatment approaches. This study aimed to (1) examine the relationship between AJPS accuracy and biomechanical factors—including postural stability, lower limb muscle strength, and gait parameters—in individuals with plantar fasciitis d (2) analyze the impact of psychosocial factors, including pain catastrophizing, physical activity level, and quality of life, on AJPS accuracy and postural control in this population. Methods: A total of 126 participants (63 with plantar fasciitis and 63 controls) were recruited. AJPS was assessed using a digital inclinometer across four movement directions (plantarflexion, dorsiflexion, inversion, eversion). Postural stability metrics (antero-posterior and medio-lateral sway) were measured using computerized posturography, while muscle strength in plantar flexors, dorsiflexors, inverters, and evertors was assessed with a hand-held dynamometer. Gait parameters (step length, cadence, stance time) were captured via 3D motion capture. Pain catastrophizing, physical activity, and quality of life were evaluated using validated questionnaires (PCS, IPAQ, FHSQ). Results: Significant differences were observed in AJPS accuracy between groups, with plantar fasciitis patients showing higher AJPS error in plantarflexion (mean difference = 1.22°, p < 0.001) and dorsiflexion (mean difference = 1.31°, p < 0.001). Pain catastrophizing was a significant predictor of AJPS in plantarflexion (β = -0.05, p = 0.001). Postural stability was negatively correlated with AJPS accuracy, particularly in mediolateral sway (r = -0.32, p = 0.037), while physical activity and quality of life had minimal effects. Conclusion: This study highlights the impact of pain catastrophizing on proprioceptive deficits in plantar fasciitis, emphasizing the importance of addressing psychological as well as biomechanical factors in treatment. Integrating cognitive-behavioral strategies may enhance proprioceptive accuracy and stability outcomes in this population. [ABSTRACT FROM AUTHOR]

Among control methods for robotic exoskeletons, biologically inspired control based on central pattern generators (CPGs) offer a promising approach to generate natural and robust walking patterns. Compared to other approaches, like model-based and machine learning-based control, the biologically inspired control provides robustness to perturbations, requires less computational power, and does not need system models or large learning datasets. While it has shown effectiveness, a comprehensive evaluation of its user experience is lacking. Thus, this study addressed this gap by investigating the performance of a state-of-the-art adaptive CPG-based exoskeleton control system (intelligent mode) under a multi-metric analysis (involving three-dimensional gait analysis, muscle activity, oxygen consumption, user comfort, and exoskeleton performance scores) and comparing it to a standard commercial exoskeleton control system (default mode). A cross-over design with randomized allocation in Thai healthy and independently walking adults ensured participants experienced both modes. All participants were assigned into two groups to receive an alternate sequence of walking with the intelligent mode or the default mode of the lower-limb exoskeleton Exo-H3 at high and normal speed. From eight participants, the intelligent mode-driven exoskeleton (adaptive exoskeleton) showed a significantly lower velocity, stride, and step lengths than the default mode-driven exoskeleton (non-adaptive exoskeleton). This setup significantly increased anterior pelvic tilt during mid-swing at normal speed (3.69 ± 1.77 degrees, p = 0.001) and high speed (2.52 ± 1.69 degrees, p = 0.004), hip flexion during stance phase with ankle dorsiflexion, and used less oxygen consumption at high speed (-2.03 ± 2.07 ml/kg/min) when compared to the default one. No significant differences of muscle activity, user comfort and exoskeleton performance scores between the two modes. Further exoskeletal modification in terms of hardware and control is still needed to improve the temporal spatial, kinematics, user comfort, and exoskeleton performance. [ABSTRACT FROM AUTHOR]

Background: Falls and fall consequences in older adults are global health issues. Previous studies have compared postural sways or stepping strategies between older adults with and without fall histories to identify factors associated with falls. However, more in-depth neuromuscular/kinematic mechanisms have remained unclear. This study aimed to comprehensively investigate muscle activities and joint kinematics during reactive balance control in older adults with different fall histories. Methods: This pilot observational study recruited six community-dwelling older fallers (≥1 fall in past one year) and six older non-fallers, who received unpredictable translational balance perturbations in randomized directions and intensities during standing. The whole-body center-of-mass (COM) displacements, eight dominant-leg joint motions and muscle electrical activities were collected, and analyzed using the temporal and amplitude parameters. Results: Compared to non-fallers, fallers had significantly: (a) smaller activation rate of the ankle dorsiflexor, delayed activation of the hip flexor/extensor, larger activation rate of the knee flexor, and smaller agonist-antagonist co-contraction in lower-limb muscles; (b) larger knee/hip flexion angles, longer ankle dorsiflexion duration, and delayed timing of recovery in joint motions; and (c) earlier downward COM displacements and larger anteroposterior overshooting COM displacements following unpredictable perturbations (p < 0.05). Conclusions: Compared to non-fallers, fallers used more suspensory strategies for reactive standing balance, which compensated for inadequate ankle/hip strategies but resulted in prolonged recovery. A further longitudinal study with a larger sample is still needed to examine the diagnostic accuracies and training values of these identified neuromuscular/kinematic factors in differentiating fall risks and preventing future falls of older people, respectively. [ABSTRACT FROM AUTHOR]

Difficulties in the accurate evaluation of tibiofibular clear space in plain radiographs are diagnostic problems in the clinical setting of syndesmosis injury. This study aimed to quantify the anterior tibiofibular gap (ATFG) with weight-bearing using ultrasonography. In total, 32 healthy adults (16 men and 16 women) with 64 feet participated in this cross-sectional study. The ATFG was measured along the anterior inferior tibiofibular ligament for a US assessment conducted in both sitting and standing postures. The ankle joint was set on the tilt table at four different angles as follows: plantar flexion, 20° (P20); neutral position (N); dorsiflexion, 20° (D20); and dorsiflexion, 20°+ external rotation, 30° (D20ER30). The ankle joint position, sex, and side-to-side values were compared with and without weight-bearing. Under all ankle angle conditions, the ATFG was wider in the standing posture than in the sitting posture (p < 0.001). In both sitting and standing postures, the ATFG widened with increasing dorsiflexion angle, eventually reaching a maximum at D20ER30. The widening ratio (D20ER30/N) in the standing posture was higher in women than in men (p < 0.05). No statistical differences were identified side-to-side differences in the ATFG. Ultrasound measurements for identifying unphysiological increases in ATFG with weight bearing, especially given the side-to-side differences, may provide a means for quantitatively assessing syndesmosis injury in a clinical setting. Further research is warranted to clarify direct attribution as a clinical diagnostic utility of the ATFG measurements for syndesmosis injuries. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine whether individuals with chronic ankle instability (CAI) can activate the fibularis longus compartments with high-density surface electromyography (HD-sEMG) biofeedback to the same extent as those without CAI, and to analyze the effect of ankle position on compartment activation in individuals with CAI using HD-sEMG feedback. Methods: There were 16 volunteers per group (CAI and No-CAI). The sEMG amplitude at each compartment (anterior and posterior) and the barycenter of the spatial sEMG amplitude distribution of the fibularis longus were recorded during eversion in neutral and plantar flexion positions at 30% and 70% of maximum voluntary contraction force, both with and without visual feedback on the spatial sEMG amplitude distribution. Results: sEMG amplitude of the posterior compartment of the fibularis longus in the CAI group trained with HD-sEMG feedback during eversion at 70% maximum voluntary contraction (in plantar flexion) was significantly higher than without HD-sEMG feedback (95% CI = 3.75–34.50% root mean square) and was similar to the activation of the No-CAI group (95% CI = −14.34% to 34.20% root mean square). Furthermore, individuals with CAI who underwent training with HD-sEMG feedback in plantar flexion exhibited a posterior displacement of the barycenter (95% CI = 0.56–2.84 mm). Conclusions: Utilizing HD-sEMG feedback during eversion in plantar flexion position increases activation of the fibularis longus posterior compartment in individuals with CAI to the same extent as healthy people. HD-sEMG–based topographic maps can serve as effective feedback training to restore motor control of the ankle. Long-term efficacy for improving motor function requires investigation through longitudinal studies. [ABSTRACT FROM AUTHOR]

Background: The foam roller is considered a versatile tool. Along with an active warm-up, it appears to positively affect range of motion, stability, muscle stiffness, and perceived exertion with no reductions in performance. Hypothesis/Purpose: The main purpose of the study was to observe the effects of the utilization of a foam roller during the warm-up on ankle mobility and lower limb stability, and secondarily, to assess if any induced effects were sustained over time. Study design: Randomized controlled trial. Methods: Twenty-two healthy male subjects were randomly assigned to two groups: the control group, which only carried out a general warm-up over a period of four months, and the foam roller group, which followed a specific warm-up routine using a foam roller for a period of three months plus one month of follow-up in which no foam rolling was performed. Two outcome measurements were taken pre- and post- intervention to assess ankle mobility: the Dorsi-Flexion Lunge test and the Y-Balance test (YBT) for the lower quarter. Outcomes were measured at three time points: before the protocol was initiated, at the end of the protocol (at 12 weeks), and after a one-month follow-up period (at 16 weeks). Results: A significant increase was observed in the dorsiflexion of the right (p < 0.001) and left (p < 0.001) ankles in the experimental group. Significant increases were also noticed in the anterior (p < 0.003), posteromedial (p < 0.050), and posterolateral (p < 0.050) reach distances of the right leg and in the anterior (p < 0.002), posteromedial (p < 0.010), and posterolateral (p < 0.030) reach distances of the left leg during the YBT in the experimental group. The control group also showed significant differences in the right (p < 0.007) and left (p < 0.010) anterior reach distances on the YBT. At the one-month follow-up period, the improvements that had been obtained in both groups were lost, except for the dorsiflexion of the right ankle (p < 0.050) and right (p < 0.010) and left (p < 0.030) anterior reach distance on the YBT in the experimental group. Conclusions: The foam roller can be used as a part of a pre-training warm-up routine to enhance the dorsiflexion range of motion and performance on the YBT. Level of Evidence: 3. Registered as a clinical trial at ClinicalTrials.gov with registration number: NCT05971316. [ABSTRACT FROM AUTHOR]

Aim: A limited number of studies have demonstrated the effects of Graston and static stretching on different muscle groups and sports performance. The study aimed to investigate the immediate effect of the Graston technique on vertical jump performance and ankle range of motion in athletes. Material and Method: A quasi-experimental study included 30 participants aged 18-40 among active, licensed basketball players between January 2023 and May 2023. The 30 participants were divided into a graston group (n=15) and a static stretching group (n=15). A vertical jump test was performed for performance after the ankle joint range of motion was measured with a goniometer. Behind the first assessment session, a Graston or static stretching was applied to the groups. Thereafter, the vertical jump performance and goniometer measurement was repeated. Results: Graston and static stretching had similar results in vertical jump performance (p<0.05). Graston on the gastrocnemius, soleus muscles and Achilles tendon was superior to static stretching, particularly in left foot dorsiflexion (p<0.05). Conclusion: Graston application can be preferred to increase vertical jumping and ankle range of motion performance in athletes with similar and superior effects to static stretching. Including Graston and static stretching in the rehabilitation protocols can provide an effective range of motion and jumping performance. [ABSTRACT FROM AUTHOR]

The number of amputees worldwide is increasing for different reasons, such as diseases, accidents, and acts of violence. In developing countries, conventional prosthetic feet like the Solid Ankle Cushion Heel (SACH) foot are commonly used because of their affordability, ease of maintenance, and use. To improve the features of the SACH foot, a new prosthetic foot was developed that resembles it but has a flexible keel. The new foot consists of a wooden keel, carbon fiber reinforced polymer support, and a flexible filler material, silicone rubber, that provides flexibility to the foot's movement. The process of pouring liquid silicone rubber and rice husk ash into a metal mold. The new foot was tested for fatigue foot life and dorsiflexion angle using devices such as the Fatigue Foot Tester and dorsiflexion tester to estimate its expected life. The outcomes were relative to those of the SACH feet, and it was found that the new foot has a better fatigue life of 510,382 steps compared to 473,241 steps for the SACH foot. Additionally, the new foot has a higher dorsiflexion angle of 5.7° compared to 2.3° for the SACH foot. [ABSTRACT FROM AUTHOR]

Context: Decreased muscle strength and balance in patients with functional ankle instability (FAI) can be effectively improved by ankle strength training. Low-load blood flow restriction (LL-BFR) training increases muscle size and strength, but there is limited evidence from studies on muscle strength and balance in FAI patients. Objective: To study the effects of LL-BFR training versus high-load training (HLT) on muscle strength and balance in FAI patients. Design: Randomized controlled trial. Participants: Forty-six young adults with a history of FAI. Interventions: Participants in the LL-BFR and HLT groups performed 4 sets (30 x 15 x 15 x 15) of ankle training at 20% to 40% of the one-repetition maximum and 70% to 85% one-repetition maximum, respectively, twice a week for 6 weeks. Main Outcome Measure(s): Plantar flexion, dorsiflexion, inversion, and eversion muscle strength, and the Y-balance test scores were assessed at baseline and after 3 and 6 weeks; the thickness of the tibialis anterior, triceps surae, and peroneus longus muscles were assessed at baseline and after 6 weeks. Results: Inversion, eversion, dorsiflexion, and plantar flexion muscle strength; tibialis anterior, triceps surae, and peroneus longus thickness; and Y-balance test scores were significantly increased in the LL-BFR group after 3 and 6 weeks compared with baseline (P < .05), with no significant difference between the LL-BFR and HLT groups after 6 weeks (P > .05). However, at the end of 3 weeks, eversion muscle strength and Y-balance test scores were significantly higher in the LL-BFR group than in the HLT group (P < .05). Conclusions: Over 6 weeks, LL-BFR training was as effective as HLT in improving ankle muscle strength, muscle thickness, and balance in FAI patients, but LL-BFR training improved the ankle eversion muscle strength and dynamic balance more than HLT did in the early stages of the intervention. This finding will provide a new intervention strategy for the clinical rehabilitation of FAI patients. [ABSTRACT FROM AUTHOR]

Background: Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants. Methods: Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension. Results: Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P <.001), decreased ankle plantar flexion range (P =.023), ankle resting position more inclined to dorsiflexion (P =.017), increased ankle dorsiflexion stiffness (P =.005), and lower ankle plantar flexion stiffness (P =.034). After exercise intervention, the knee OA group self-reported less knee pain (P <.001), improved physical function (P <.001), increased maximum dorsiflexion (P =.021), and increased plantar flexion range (P <.001). While plantar flexion stiffness increased (P =.037), dorsiflexion stiffness decreased (P =.015) and ankle resting position moved toward dorsiflexion (P =.002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA. Conclusions: The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension. [ABSTRACT FROM AUTHOR]

Context: Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players. Design: Cross-sectional study. Setting: University laboratory. Participants: Twenty-two college baseball players (20 right-handed and 2 left-handed). Methods: To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs. Results: Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 =.250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P =.018) and horizontal adduction (R2 =.200, β [95% CI] = 0.447 [0.051 to 1.499], P =.019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 =.189, β [95% CI] = 0.435 [0.019 to 1.137], P =.022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 =.243, β [95% CI] = 0.493 [0.139 to 1.438], P =.010). Conclusion: College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players. [ABSTRACT FROM AUTHOR]

Ankle sprains are prevalent among athletes, and decreased ankle dorsiflexion range of motion (ADROM) can contribute to these injuries. Various tests like the Y Balance Test (YBT), Single Leg Hop for Distance (SLHD), Weight-Bearing Lunge Test (WBLT), and Body Mass Index (BMI) are used to evaluate ankle function. The primary purpose of this study was to find out the correlation between ADROM and SLHD, WBLT, YBT, and BMI. Fifty-two collegiate athletes were recruited after eliminating athletes with a history of injuries to the lower extremities. The study discovered strong positive correlations between YBT anterior reach, ADROM (r = 0.72, p

Background: Low-frequency acupuncture is used to maintain skeletal muscle flexibility and improve joint range of motion; however, its definite effects are unclear. This study aimed to determine the effects of low-frequency acupuncture on muscle and fascial stiffness and ankle dorsiflexion range of motion. Methods: The participants included 12 randomly selected healthy adults. The medial head of the gastrocnemius muscle was selected as the target muscle, and changes in hardness and dorsiflexion range of motion of the ankle joint in the deep fascia, muscle, and deep intermuscular fascia of the same region were measured before and after low-frequency acupuncture intervention. Acupuncture needles were inserted until they passed through the deep intermuscular fascia and electrically stimulated at a frequency of 2 Hz for 15 min. The 12 right legs were the intervention legs, and the 12 left legs were the non-intervention legs. Results: In the intervention leg, hardness increased in the deep fascia immediately after low-frequency acupuncture, but decreased in all regions (deep fascia, muscle, and deep intermuscular fascia) after 15 min. The rate of change in hardness was the greatest in the muscles and deep intermuscular fascia. Additionally, the ankle's dorsiflexion range of motion increased after 15 min. In contrast, the non-intervention leg showed no significant changes in stiffness or ankle dorsiflexion angle. Conclusions: Low-frequency acupuncture may decrease muscle stiffness and improve fascial gliding. The change in hardness tended to be greater in the deeper areas. [ABSTRACT FROM AUTHOR]

Background: Even though both landing stability and ankle dorsiflexion stiffness (ankle DR-stiffness) have been independently identified as risk factors associated with non-contact injuries, no study has specifically investigated the relationship between these two variables. Methods: Twenty male recreational athletes volunteered to participate in this study. Their ankle DF-ROM based on the weight-bearing lunge test, and landing stability based on the dynamic postural stability index (DPSI) and time to stabilization (TTS) were evaluated during a single-leg landing (SLL). Results: There was no statistically significant difference among ankle DF-ROM, ankle DF-stiffness, DPSI, and TTS during the SLL task (p >.05). Although a moderately positive relationship was observed between ankle DF-ROM and ankle DF-stiffness (p =.177; r =.354 [95% CI, -.153 to.653]) and a moderately negative relationship between ankle DF-ROM and TTS (p =.163; r = -.375 [95% CI, -.598 to.098]), these were not statistically significant. Conclusion: The findings indicate that ankle DF-stiffness as an independent variable, does not significantly affect landing stability based on the TTS and DPSI indexes. However, its interaction with other variables, such as sex, age, and the nature of the movement task, may influence landing stability. This study area warrants further research. [ABSTRACT FROM AUTHOR]

Purpose: Although arthroscopic repair of the deltoid ligament is becoming a popular procedure, no studies have assessed which bundles of the deltoid ligament can be reached by anterior ankle arthroscopy. This study aimed to assess the feasibility of the arthroscopic repair of the deep layer of the deltoid ligament. In addition, it aimed to correlate which fascicle of the superficial layer of the deltoid ligament corresponds to the deep fascicle visualised by arthroscopy. Methods: Arthroscopy was performed in 12 fresh frozen ankles by two foot and ankle surgeons. With the arthroscope introduced through the anterolateral portal, the medial compartment and the deltoid ligament were explored in ankle dorsiflexion without distraction. Using a suture passer introduced percutaneously, the most posterior fibres of the deep deltoid ligament visualised by anterior arthroscopy were tagged. Then, the ankles were dissected to identify the deep and superficial bundles of the deltoid ligament tagged with a suture. Results: In all specimens (100%), the intermediate part of the tibiotalar fascicle, corresponding to the fibres originating from the anterior colliculus, was tagged with a suture. The posterior part of the tibiotalar fascicle was never tagged with a suture. In all specimens, the intermediate part of the tibiotalar fascicle grasped by the suture correlated with the tibiospring fascicle of the superficial layer. Conclusions: The current study demonstrates the feasibility of the arthroscopic repair of the deep fascicle of the deltoid ligament. By performing anterior arthroscopy, it is possible to visualise and repair the intermediate part of the tibiotalar fascicle (deep layer of the deltoid ligament). These fibres correspond to the tibiospring fascicle of the superficial layer. The clinical relevance of the current study is that the arthroscopic repair of the deep layer of the deltoid ligament is feasible through anterior ankle arthroscopy. Level of Evidence: Not applicable. [ABSTRACT FROM AUTHOR]

Objective: To compare the haemodynamic effects of different ankle movements combined ankle and toe movements on the femoral vein of the lower extremity. Methods: 28 healthy volunteers participated in the study. Doppler ultrasound was used to measure peak systolic velocity and time-averaged mean velocity of the common femoral vein during ankle dorsiflexion, ankle dorsiflexion with simultaneous toe extension, ankle plantarflexion, and ankle plantarflexion with simultaneous toe flexion. Results: In comparison to the resting state, both ankle alone or ankle combined with toe movement showed statistically significant differences (p <.01). However, there were no significant difference in the velocity of the common femoral vein between ankle alone and ankle combined with toe movement (p >.05). It is noteworthy that dorsiflexion of the ankle resulted in the highest peak velocity of blood flow. Conclusion: The impact of ankle movement, with or without toe movement, the velocity of the common femoral vein is not significantly correlated. [ABSTRACT FROM AUTHOR]

This study investigated the effects of ankle dorsiflexion angle adjustments in ankle–foot orthoses (AFOs) on the gait of healthy individuals. Fifteen healthy participants engaged in treadmill walking tasks while wearing AFOs with dorsiflexion angles set at 0°, 5°, 10°, and 15°. Three-dimensional treadmill gait analysis was used to collect data during treadmill walking. The analysis focused on toe clearance and the contribution of the vertical component of limb shortening (LS), and compared them across different dorsiflexion angles. The results indicated a significant increase in toe clearance at 10° (median [interquartile change]: 5.03 [0.90] vs. 5.98 [1.18], p < 0.01) and 15° (5.03 [0.90] vs. 5.82 [1.11], p < 0.01) dorsiflexion angle conditions compared to the 0° condition. Similarly, LS demonstrated significant increases at 10° (4.89 [1.97] vs. 5.87 [1.31], p < 0.01) and 15° (4.89 [1.97] vs. 5.61 [1.65], p < 0.01) conditions when compared with the 0° condition. These findings support the notion that higher dorsiflexion angles in AFOs lead to increased toe clearance and LS, suggesting the effectiveness of dorsiflexion angle adjustments as a strategy to address reduced toe clearance. [ABSTRACT FROM AUTHOR]

The addition of highly responsive lightweight foam and a stiff plate in the midsole of long-distance road racing shoes has yielded significant energetic cost savings that have translated to notable improvements in performance. This new foam and stiff plate technology have since been implemented in long-distance track spikes, where performances have also improved. However, the impact of spikes with advanced footwear technology (AFT) on distance running biomechanics has been studied minimally to date. Therefore, the purpose of this study was to compare running biomechanics between two spikes which incorporate AFT (Nike ZoomX Dragonfly, Nike Air Zoom Victory) to a traditional spike (Nike Zoom Matumbo). Seventeen competitive collegiate female runners completed 60 m trials at their 5k race pace in each spike condition while outfitted with IMU sensors and plantar pressure insoles. We observed significantly lower peak ankle dorsiflexion in the Dragonfly and Victory compared to the Matumbo and lower whole foot, forefoot and rearfoot peak and average pressure in the Dragonfly compared to the Matumbo and Victory. The acute biomechanical alterations observed in this study warrant future investigation into the association between running biomechanics and racing performance in track spikes with advanced footwear technology. [ABSTRACT FROM AUTHOR]

Tissue flossing involves wrapping a rubber band around a muscle group for a few minutes while performing joint motion, enhancing ankle joint torque and range of motion. As limited ankle dorsiflexion range of motion and plantar flexion muscle weakness are risk factors for sports injury, assessing the therapeutic effects of tissue flossing is important. This study aimed to evaluate the immediate effects of calf tissue flossing on enhancing ankle joint torque and dorsiflexion range of motion. We conducted a randomized controlled crossover trial involving 19 healthy adult males who received two interventions (low and high-pressure tissue flossing bands) and a control condition (underwrap). Each intervention was applied for 2 minutes on the non-dominant calf, with 5--10 days between sessions. A pressure sensor placed on the posterior calf monitored the wrapping compression force. The intervention exercise comprised six voluntary isometric contractions of the ankle at three angles (20° plantar flexion, neutral 0°, and 10° dorsiflexion) for 3 seconds each using a dynamometer. The maximal isometric ankle plantar flexion torque and dorsiflexion range of motion were evaluated pre- and post-intervention. Significant interactions were observed in ankle plantar flexion torque at 10° dorsiflexion (p < 0.01) but not at 0° or 20° plantar flexion. The low- and high-pressure bands significantly enhanced ankle plantar flexion torque by 4.3 Nm (effect size [ES]: 0.14, p = 0.02) and 4.9 Nm (ES: 0.15, p < 0.05), respectively, and also enhanced the ankle dorsiflexion range of motion by 1.7° (ES: 0.43, p < 0.01) and 1.3° (ES: 0.35, p = 0.02), respectively, compared to the control. The low- and high-pressure band conditions had comparable effects on torque and range of motion. A few minutes of the calf tissue flossing intervention significantly enhanced ankle plantar flexion torque and dorsiflexion range of motion, although the effect sizes were trivial to small. [ABSTRACT FROM AUTHOR]

Studies investigating the mechanisms influencing maximum passive joint range of motion (ROMmax) and stiffness have not objectively assessed the possible influence of stretch speed and/or arousal state. The purpose of this study was to assess the effects of arousal state and stretch speed on healthy individuals ROMmax, stiffness, gastrocnemius medialis, and soleus electromyographic activity (EMG). Fourteen participants performed one familiarization and then one testing session on separate days in the laboratory. In the familiarization (Session 1), participants practiced fast (30°/s ankle dorsiflexion) and slow (5°/s) plantar flexor stretches on an isokinetic dynamometer with the knee extended. In the experimental session (Session 2), they performed two slow, then two fast, stretches under three randomized arousal conditions: control (no music), arousing, and relaxing music. Dorsiflexion ROMmax, ankle joint stiffness, muscle activity during stretch, mean heart rate, and perception of arousal were measured. Perception of arousal was greater in the arousing than relaxing condition (p = 0.001). ROMmax was greater during fast (69.1° ± 7.8°) than slow stretches (64.9° ± 10.8°; p = 0.002) with no effect of arousal. Stiffness and EMG were higher at faster speeds, with a significantly greater percentage of stiffness observed in the arousing than the other conditions during faster stretches (p = 0.04). ROMmax was greater at the faster stretch speed despite greater stiffness and muscle activities being produced during the stretch. Thus, despite reflexive muscle activity and viscosity being higher during faster stretches, a greater, not lesser, ROMmax was observed. Arousal state, at least when altered by music, did not seem to affect ROMmax but somewhat influenced stiffness in the faster stretches. [ABSTRACT FROM AUTHOR]

Background: While a high incidence of pickleball-related falls is reported, little is known regarding factors differentiating persons with and without a fall history during play. Purpose: This study aimed to determine differences between recreational pickleball players who fell while playing and those who did not. Additional aims were to determine reasons for falling and to investigate associations among assessed factors. Study design: Cross-sectional study. Methods: Participants completed a survey reporting age, fall history, and reasons for falling during play. Hip abduction strength, single leg squat form, ankle dorsiflexion, and change of direction time using a modified T-test on a pickleball court (i.e. pickleball T-test) were assessed. Results: Among the 92 individuals participating in the study, 42% reported a fall while playing and 30% reported falling more than once. Leading reasons for reported falls were lunging and moving backward. Participants who reported falling were significantly older (z = -2.60, p = 0.009) and slower on the pickleball T-test (z = -2.10, p = 0.036) than those who did not report falling. Hip abduction strength was not associated with fall history but was associated with faster time on the pickleball T-test (left rs = -.41, p < 0.001, right rs = -.48, p < 0.001). Single leg squat form and dorsiflexion were not related to fall history. Conclusion: Falls are common among recreational pickleball players, particularly older players. Fall prevention programs for pickleball players should be considered including multi-directional lunging, lower extremity strength and power development, and change of direction training that includes moving backward. Level of evidence: 2 [ABSTRACT FROM AUTHOR]

Assessment of biomechanical features whilst running on an uneven terrain plays an important role in identifying running-related injury mechanisms. However, feedback and feedforward motor responses and adaptations, an important component of gait retraining and injury rehabilitation programs, have been less investigated during running. Therefore, the current study assessed the whole-session responses and within-session adaptation mechanisms during perturbed running. Twenty three individuals performed an eight-minute perturbed treadmill running protocol with one-sided decelerative belt perturbations. Joint angle curves and muscle activity amplitudes were analysed throughout the running cycle, in both the perturbed and contralateral leg. For the whole-session responses, the average of 10 consecutive strides during the baseline trial and all perturbed strides from the perturbed running trial were compared. To assess within-session adaptation, the first perturbation was compared to the average of the last three perturbations. Data were analysed with one-dimensional statistical parametric mapping of Paired t -tests to assess responses and adaptations to the perturbations (P < 0.025). Regarding whole-session responses (baseline vs. perturbations), statistically significant feedback (after perturbation) responses were detected in most measured joint angles and muscle activity of both perturbed and contralateral legs. Feedforward (before perturbation) responses for whole-session comparison were detected for most joint angles in the contralateral leg and only hip flexion in the perturbed leg. Feedforward muscle activities of whole-session responses were different in the biceps femoris, semitendinosus, and erector spinae of the perturbed leg, and the soleus of the contralateral leg. Regarding within-session (first vs. last three perturbations) adaptation, feedback adaptations included statistically significant changes in ankle, knee, and hip movements, and muscle activities in the perturbed leg, while the contralateral leg showed less adaptation. No significant feedforward within-session adaptations were observed in the perturbed leg, but the contralateral leg showed changes in ankle dorsiflexion, soleus activity, and erector spinae activity. Findings suggest that participants compensated perturbations during running by modifying muscle activities and movement patterns, primarily through feedback mechanisms in the perturbed leg, with limited feedforward adaptations. The current protocol may present a viable approach for testing and training postural control during running. [ABSTRACT FROM AUTHOR]

Background/Objectives: the purpose of this study was to determine the contributions of mechanical, neural, morphological, and muscle quality factors on individual differences in the maximal ankle dorsiflexion range of motion (ROM). Methods: A sample of 41 university students performed passive-dorsiflexion and morphological measurements. In the passive-dorsiflexion measurement, while the ankle was passively dorsiflexed, maximal dorsiflexion ROM was measured in addition to passive torque at a given angle and muscle–tendon junction (MTJ) displacement during the last 13° as mechanical factors, and stretch tolerance and muscle activation were measured as neural factors. In morphological measurements, the cross-sectional area, muscle thickness, muscle fascicle length, and pennation angle were measured. In addition, the echo intensity was evaluated as muscle quality. Subjects were divided into three groups (flexible, moderate, and tight) using the value of the maximal dorsiflexion ROM. Results: Maximal dorsiflexion ROM and stretch tolerance were greater in the flexible group than those in the moderate and tight groups. MTJ displacement was smaller in the flexible group than those in the moderate and tight groups. Stepwise multiple regression analysis revealed that stretch tolerance and passive torque at a given angle were selected as parameters to explain the maximal dorsiflexion ROM (adjusted R2 = 0.83). Conclusions: these results indicate that individual differences in maximal ankle dorsiflexion ROM are primarily related to mechanical and neural factors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Stroke patients generally have balance and gait dysfunction due to decreased range of motion (ROM) and muscle strength of the ankle joint. A therapist can apply a floss band to enhance ROM, pain control, jump performance, strength, myofascial release, and recovery from fatigue. This study compared the immediate effects of floss band application on ankle ROM, balance, and gait ability in stroke patients. Methods: This study randomized 40 chronic stroke patients to either the floss (n = 20) or sham (n = 20) band group. The intervention consisted of wrapping the ankle with a band (floss and sham). Balance and gait ability were measured using APDM Mobility Lab system equipment. Outcome measures were assessed at baseline and immediately after applying the floss or sham band. Results: There were significant improvements in dorsiflexion (DF), WBLT, static balance, and foot strike in those who used the floss band compared to the sham group (all p < 0.05). Conclusions: The floss band improved ankle DF, balance, and gait, indicating that it is a feasible therapeutic method for improving ankle DF, balance, and gait in chronic stroke patients. [ABSTRACT FROM AUTHOR]

Background: We conducted a cross-sectional study to examine two-leg- and one-leg-type balance characteristics in athletes and explore factors related to their balance ability. Methods: A total of 213 participants, including athletes from various sports (gymnastics, boat racing, swimming, soccer, judo, and baseball) and non-athletes, were included (142 men, 71 women, average age 21.5 ± 2.1 years). Balance ability was classified into two-leg and one-leg types using the modified index of postural stability (mIPS) in a two-leg stance and the one-legged stance duration with eyes closed (OLS). Body composition, upper and lower limb strength, and lower limb sensation were also measured. To examine the balance characteristics of each sport, the mIPS and OLS were used as dependent variables in a multiple regression model with age, height, weight, and sex as independent variables. Results: The results showed a significantly higher mIPS in gymnastics (estimate: 0.22) and boat racing (0.14), and it was lower in swimming (−0.25). The OLS was significantly higher in soccer (16.98), judo (16.23), gymnastics (9.77), and baseball (9.12) and significantly lower in swimming (7.93). Additionally, the mIPS was independently associated with knee extension strength (0.12), sensory motor variables (−0.004), and height (−0.01). The OLS was associated with skeletal muscle mass (1.85) and height (−1.42). Conclusions: In summary, gymnasts showed superior two-leg and one-leg balance; boat racers excelled in two-leg balance; swimmers showed inferior two-leg but better one-leg balance; and soccer, judo, and baseball athletes demonstrated superior one-leg balance. Additionally, the mIPS was associated with knee extensor strength, plantar pressure sensation, and height, whereas the OLS was associated with skeletal muscle mass and height. [ABSTRACT FROM AUTHOR]

Total ankle arthroplasty (TAA) improves gait symmetry in patients with unilateral end‐stage ankle arthritis but has not been studied in patients undergoing bilateral TAA (B‐TAA), and few studies compare TAA patients to control subjects. The purpose of this study was to compare gait symmetry in U‐TAA and B‐TAA patients and healthy controls. Using prospective databases, 19 unilateral and 19 bilateral ankle arthritis patients undergoing TAA were matched to 19 control subjects by age, sex, and BMI. The Normalized Symmetry Index (NSI) was determined for joint mechanics and ground reaction forces (GRF) during walking trials at a single visit for controls and preoperatively and 1 to 2 years postoperatively for TAA patients. Data was analyzed using linear mixed‐effects models to determine differences among time points and cohorts at a significance of α = 0.05. Following surgery, B‐TAA and U‐TAA experienced improved peak plantarflexion moment symmetry (p = 0.017) but remained less symmetric than controls. B‐TAA patients had more symmetry than U‐TAA patients during peak weight acceptance GRF (p = 0.002), while U‐TAA patients had greater peak dorsiflexion symmetry than B‐TAA patients. TAA patients demonstrated more asymmetry compared to control subjects for all outcome measures. There was no significant impact of TAA on gait symmetry for GRF or peak ankle angles, and neither U‐TAA nor B‐TAA was consistently associated with higher gait symmetry. These results indicate that TAA improves symmetry during peak plantarflexion moment, and that significant gait asymmetry persists for B‐TAA and U‐TAA patients compared to healthy participants. [ABSTRACT FROM AUTHOR]

Objectives: Although numerous surgical techniques and fixation methods have been described for the treatment of hallux rigidus (HR) with arthrodesis, consensus on the gold standard treatment has not been reached. The aim of this study is to retrospectively compare the clinical and radiological outcomes of compression screw fixation and plate fixation in the treatment of HR with arthrodesis. Methods: Patients who underwent arthrodesis surgery due to HR between January 2021 and December 2023 at a single center were retrospectively reviewed. Patients who met the inclusion criteria were divided into two groups: those who underwent arthrodesis with plate fixation (PLATE) and those who underwent arthrodesis with compression screw fixation (SCREW). Demographic data including age, gender, affected side, operative time, hallux valgus angle (HVA), dorsiflexion angle, AOFAS scores, and implant irritation data were compared among patients with at least 3 months of follow-up. Results: It was observed that all patients included in the study had successful bone union without any complications. There were no significant differences between the two groups in terms of age, gender, affected side, preoperative HVA, and preoperative AOFAS scores (P= 0.970, P= 0.426, P= 0.694, P= 0.216, and P= 0.905, respectively). The mean operation time and postoperative AOFAS score were lower in the PLATE group compared to the SCREW group (P=0.006 and P=0.004, respectively). However, in the SCREW group, the dorsiflexion angle and the rate of implant irritation were lower compared to the PLATE group (P=0.016 and P=0.01, respectively). Conclusions: In the surgical treatment of HR, both plate fixation arthrodesis and compression screw arthrodesis are reliable surgical techniques. While plate fixation arthrodesis is a faster and more practical method, arthrodesis with a compression screw results in fewer complaints related to the implant and provides a more functional recovery. [ABSTRACT FROM AUTHOR]

Purpose: Identify relations of gross motor function and primary motor cortex (M1) functional activity pre and post gross motor interventions for children with unilateral cerebral palsy (UCP). Methods: Thirteen children with UCP completed a gross motor intervention. Pre/post-intervention functional MRI outcomes included the laterality index (LI), activation volume, and spatial overlap of M1 activation during active ankle dorsiflexion. Advanced gross motor function (Challenge) was assessed pre/post-intervention, and 2–6 months later. Bivariate correlations and linear regression assessed relations between neuroimaging and motor function. Results: Mean pre-intervention M1 activity was contralateral during dominant (LI = +0.85, SD 0.21) but variable during the affected (LI = +0.43, SD 0.57) ankle dorsiflexion. Changes in motor function and neuroimaging outcomes were not significantly associated. However, smaller affected ankle activation and less spatial overlap between ankle activations pre-intervention predicted Challenge improvements post-intervention (adjusted R2 = 0.74, p =.001.) Conclusions: This exploratory study identified pre-intervention neuroimaging predictors of post-intervention improvements in advanced gross motor function. [ABSTRACT FROM AUTHOR]

Objectives: According to the conventional postoperative procedure after total ankle arthroplasty (TAA), mobilization and weight-bearing is currently started after completion of wound healing. Recently, early mobilization for dorsiflexion after TAA with modified antero-lateral approach was reported to be feasible and safe. To investigate the further possibility of expediting rehabilitation, this study evaluated the feasibility and safety of early full weight-bearing and gait exercise after cemented TAA. Materials and Methods: This retrospective, observational study investigated 23 consecutive ankles (OA: 14 ankles, RA: 9 ankles) that had received cemented TAA with a modified antero-lateral approach. These ankles were divided into three groups 1. conventional postoperative protocol, 2. early dorsiflexion protocol, 3. early dorsiflexion+full weight-bearing protocol. Postoperative wound complications were observed and recorded. Number of days for hospitalization was also evaluated. Results: No postoperative complications related to wound healing were observed even after early full weight-bearing and gait exercise. Days for hospitalization was significantly shortened in early full weight-bearing and gait exercise group (group 3) from 35-38 days to 24 days. Conclusions: Within this small number of cases, early full weight-bearing and gait exercise from 7 days after cemented TAA was feasible and safe with the modified antero-lateral approach. Combination of early dorsiflexion mobilization and weight-bearing/gait exercise contributed to shortening the hospitalization day. Innovations in postoperative procedures for rehabilitation after TAA can be expected. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify the most responsive foot position for detection of isolated unstable syndesmotic injury. Methods: Fourteen paired human cadaveric lower legs were positioned in a pressure-controlled radiolucent frame and loaded under 700 N. Computed tomography scans were performed in neutral position, 15° internal / external rotation, and 20° dorsal / plantar flexion of the foot before and after cutting all syndesmotic ligaments. For each position, generated 3D models of the intact and injured distal tibiofibular joints were matched and analyzed by calculating three parameters: diastasis, anteroposterior displacement, and shortening of the fibula. Results: Transection of syndesmotic ligaments resulted in significant posterior translation of the fibula (4.34°, SD 1.63°, p < 0.01) compared to uninjured state for external rotation, significant anterior translation (-2.08°, SD 1.65°, p < 0.01) for internal rotation, and significant posterior translation (1.32°, SD 1.16°, p = 0.01) for dorsiflexion. Furthermore, the syndesmotic injury led to significantly increased clear space (0.46 mm, SD 0.46 mm, p = 0.03) in external rotation of the foot. Conclusion: External rotation of the foot under loading seems to be the most responsive position for detection of isolated syndesmotic instability. Under external rotational stress, anteroposterior instability and increased clear space resulting from a complete isolated unstable syndesmotic lesion were most evident. [ABSTRACT FROM AUTHOR]

Unaccustomed eccentric exercise (EE) is protective against muscle damage following a subsequent bout of similar exercise. One hypothesis suggests the existence of an alteration in motor unit (MU) behaviour during the second bout, which might contribute to the adaptive response. Accordingly, the present study investigated MU changes during repeated bouts of EE. During two bouts of exercise where maximal lengthening dorsiflexion (10 repetitions × 10 sets) was performed 3 weeks apart, maximal voluntary isometric torque (MVIC) and MU behaviour (quantified using high‐density electromyography; HDsEMG) were measured at baseline, during (after set 5), and post‐EE. The HDsEMG signals were decomposed into individual MU discharge timings, and a subset were tracked across each time point. MVIC was reduced similarly in both bouts post‐EE (Δ27 vs. 23%, P = 0.144), with a comparable amount of total work performed (∼1,300 J; P = 0.905). In total, 1,754 MUs were identified and the decline in MVIC was accompanied by a stepwise increase in discharge rate (∼13%; P < 0.001). A decrease in relative recruitment was found immediately after EE in Bout 1 versus baseline (∼16%; P < 0.01), along with reductions in derecruitment thresholds immediately after EE in Bout 2. The coefficient of variation of inter‐spike intervals was lower in Bout 2 (∼15%; P < 0.001). Our data provide new information regarding a change in MU behaviour during the performance of a repeated bout of EE. Importantly, such changes in MU behaviour might contribute, at least in part, to the repeated bout phenomenon. What is the central question of this study?Is motor unit (MU) behaviour altered during the performance of an initial and repeated bout of eccentric exercise (EE)?What is the main finding and its importance?During the repeated bout of exercise, we observed a greater contribution from lower threshold MUs to force generation along with reduced firing rate variability. Results suggest an adaptation occurs during the performance of an initial bout of exercise and contributes to the accelerated recovery that occurs following the performance of a repeated bout of EE. Importantly, our data suggest that changes in MU behaviour contribute, partly, to the repeated bout phenomenon immediately upon performing a repeated bout of eccentric activity. [ABSTRACT FROM AUTHOR]

Background Reduced dorsiflexion range of motion (DFROM) which is commonly seen following lateral ankle sprain (LAS) has the potential to influence lower extremity biomechanics which have been linked to increased injury risk in the female athlete. Current research on the effect of sex and LAS history on DFROM is limited. Hypothesis/Purpose This study had three aims 1) to determine the effect of sex, leg dominance and LAS history on DFROM, 2) to determine the effect of sex and LAS history on magnitude of DFROM symmetry and 3) to examine the association of sex on direction (whether dominant or non-dominant limb had the higher DFROM) of symmetry. Study Design Cross-Sectional Study Methods DFROM was measured bilaterally in 105 recreational athletes all participating in multidirectional sports using the tape measurement method during the weight bearing lunge test (WBLT). A mean of three measurements was used for analysis. A 3-way mixed ANOVA was carried out to determine the interaction between sex, LAS history and leg dominance on DFROM and a 2-way ANOVA for the effect of sex and LAS history on asymmetry. A chi-square test was used to determine the association of sex and direction of asymmetry. Results The results indicate no significant effect of sex, LAS history, and leg dominance on DFROM (p=0.65). Main effects were significant for sex and LAS on DFROM. The mean asymmetry for all participants was reported as 12.25±14.76cm. No significant effect of sex and LAS history on magnitude of asymmetry was reported. There was a significant association of sex and direction of asymmetry (χ²(1) = 11.26, p = 0.00). Sixty-five-point two percent of males were shown to have higher DFROM of their non-dominant limb compared to 75% of females who were higher in their dominant limb. Conclusion Findings from this study suggest that DFROM is affected by sex and LAS history. While females have increased DFROM compared to males, those with LAS history are more likely to have a decreased DFROM on the involved side. The results also indicate that interlimb asymmetries in DFROM are present in athletes, therefore practitioners should exercise caution when using bilateral comparisons in injury and return to play assessments. Level of Evidence 2b. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Trolley bags have gained popularity among students, but there is limited research comparing them to backpack-style school bags. OBJECTIVE: This study aimed to compare how carrying a backpack versus a trolley bag affects the activity of trunk and lower limb muscles in secondary school students. METHODS: Electromyographic activity was measured in 25 students (13.4±1.1 years) as they walked on level ground and up/down stairs while carrying both types of bags. The activity of the gastrocnemius, tibialis anterior, semitendinosus, rectus femoris, lumbar erector spinae, and rectus abdominis muscles was assessed on both the dominant and non-dominant sides. RESULTS: The study found significantly reduced muscle activation in most of the targeted muscles when walking on level ground with the trolley bag and when going up/down stairs with the backpack. CONCLUSIONS: Lifting a trolley bag depends on the slope of the walking surface and is more efficient on level ground, while carrying a backpack is more efficient when going up and down stairs. Since it is not practical to switch bags when encountering stairs in schools, a bag with a mixed model design incorporating features of both trolley and backpack may be more beneficial and practical for students to use. Students, parents, and teachers should be aware of the injury risks associated with carrying different types of bags. [ABSTRACT FROM AUTHOR]

Lower limb exoskeletons have been developed to improve functionality and assist with daily activities in various environments. Although these systems utilize sensors for gait phase detection, they lack anticipatory information about environmental changes, which limits their adaptability. This paper presents a vision-based intelligent gait environment detection algorithm for a lightweight ankle exosuit designed to enhance gait stability and safety for stroke patients, particularly during stair negotiation. The proposed system employs YOLOv8 for real-time environment classification, combined with a long short-term memory (LSTM) network for spatio-temporal feature extraction, enabling the precise detection of environmental transitions. An experimental study evaluated the classification algorithm and soft ankle exosuit performance through three conditions using kinematic analysis and muscle activation measurements. The algorithm achieved an overall accuracy of over 95% per class, which significantly enhanced the exosuit's ability to detect environmental changes, and thereby improved its responsiveness to various conditions. Notably, the exosuit increased the ankle dorsiflexion angles and reduced the muscle activation during the stair ascent, which enhanced the foot clearance. The results of this study indicate that advanced spatio-temporal feature analysis and environment classification improve the exoskeleton's gait assistance, improving adaptability in complex environments for stroke patients. [ABSTRACT FROM AUTHOR]

Background: Functional correlates of spastic myopathy, the muscle disorder of spastic paresis, are unknown. Objective: To explore reciprocal relationships between clinical and structural parameters of plantar flexors with i) ambulation speed, ii) dorsiflexion and plantarflexion torques in chronic hemiparesis. Methods: Cross-sectional trial in chronic stroke-induced hemiparesis (>6 months). Plantar flexors were quantified through i) the Five Step Assessment: maximal extensibility (XV1), active range of dorsiflexion (XA); ii) ultrasonography: fascicle length (Lf) and thickness (Th) of medial gastrocnemius (GAS) and soleus (SOL), knee extended in an isokinetic ergometer, ankle at 80% XV1-GAS. Maximal isometric torques in plantar flexion (PF) and dorsiflexion (DF) and maximal barefoot 10-meter ambulation speed were collected. Relationships between structural, biomechanical, clinical and functional parameters were explored using non-parametric testing (Spearman). Results: Twenty-one subjects (age 58.0±8.4, mean±SD, time since lesion 7.8±5.7 years) were recruited, with the following characteristics: ambulation speed, 0.77±0.37m/sec; XV1-SOL 92.7±10.3°; XV1-GAS 91.3±9.6°; XA-SOL 86.9±10.0°; XA-GAS 7676±14.2°; LfGAS, 58.2±18.3mm; ThGAS, 17.1±3.6 mm; LfSOL, 36.0±9.6 mm; ThSOL, 13.8±3.3mm; PF peak-torque 46.5±34.1Nm, DF peak-torque, 20.1±19.1Nm. XA-SOL and XA-GAS strongly correlated with XV1-SOL and XV1-GAS respectively (ρ = 0.74, p = 4E-04; resp ρ = 0.60, p = 0.0052). Ambulation speed moderately correlated with LfGAS (ρ = 0.51, p = 0.054), ThGAS (ρ = 0.58, p = 0.02) and LfSOL (ρ = 0.63, p = 0.009). DF and PF peak-torques both correlated with LfGAS (ρ = 0.53, p = 0.04) a; resp. ρ = 0.71, p = 0.0015). Conclusion: In chronic hemiparesis, active dorsiflexion is mostly determined by plantar flexor extensibility. Plantar flexor fascicle shortening is associated with reduced ambulation speed and ankle torques. Attempts to restore plantar flexor extensibility might be important objectives for gait rehabilitation in chronic hemiparesis. [ABSTRACT FROM AUTHOR]