Abstract
Introduction
Reduced dorsiflexion (DF) is a key clinical consideration when assessing and managing lower limb injuries. Decreased ankle dorsiflexion (DF) has been identified as a risk factor for several lower limb injuries such as lateral ankle sprains, Achilles tendinopathy and anterior cruciate ligament rupture (Bennell et al, 1998). Limited DF may also lead to abnormal lower limb biomechanics during closed kinetic chain exercises resulting in overpronation, increased knee valgus and medial knee displacement as well as reducing activation of quadriceps and soleus activity (Macrum et al, 2012).
The weight bearing lunge test (WBLT) has been shown as a functional and reliable method of measuring DF in a weight bearing lunge position (Bennell et al, 19980. Although there are many different versions of the WBLT, to date there is no stipulation as to the exact position of the back foot whilst in the lunge position. Therefore, it has not yet been investigated whether a restriction of DF ROM of the back foot could affect the measurement given at the front foot. The purpose of this study was to determine whether back position affects front foot DF ROM using the weight bearing lunge test.
Methods
40 healthy adults (age = 27.3 ± 5.65) who participate in cutting and pivoting sports volunteered to participate in this study. Ankle DF range of movement measurements were obtained using the WBLT in three different back foot positions (back foot heel down, back foot heel up and back foot completely off the ground) over three different testing sessions at least 48 hours apart. All measurements were taken using a tape measure (to the nearest cm) using the distance from the big toe to the wall technique (Bennell et al, 1998). All measurements were obtained three times using the dominant leg (defined as the one they would predominantly kick with) and the mean was used for analysis. Differences between testing positions were determined using a one-way ANOVA to determine whether the back-foot position affects front foot range of movement.
Results
Differences between groups were found (F = 6.315, P=0.02). A Tukey post-hoc analysis revealed DF ROM was statistically higher when the back foot was completely off the ground (11.73.51, p =0.002) when compared to the back-foot heel down (9.03 ± 3.48). DF ROM was also statistically higher when the back-foot heel was up (10.98 3.45, p= 0.036) when compared to the back-foot heel down. There was no significant difference found between the back-foot heel up and back foot heel up completely (P=.622).
Conclusions
Results show that whilst performing the WBLT, DF ROM differs whether the patients back heel is up (the patient is on their toes) or their back foot is flat. It is not known from this study what back foot position is more accurate for DF ROM measurement but what this study does show is that practitioners do need to state what position they have used to ensure consistency between testing sessions. This is particularly important when there are teams of practitioners all looking after the same athletes.
References
Bennell K., Talbot R., Wajswelner H., Techovanich W., Kelly D (1998). Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 44,175-180
Konor M, M., Morton S., Eckerson J, M., Grindstaff, T, L (2012). Reliability of three measures of ankle dorsiflexion range of motion. Int J Sports Phys Ther. 7(3),270-287
Macrum E, Bell D, R., Boling M., Lewek M., Padua D (2012). Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle activation patterns during a squat. J Sport Rehabil. 21, 144-150
Reduced dorsiflexion (DF) is a key clinical consideration when assessing and managing lower limb injuries. Decreased ankle dorsiflexion (DF) has been identified as a risk factor for several lower limb injuries such as lateral ankle sprains, Achilles tendinopathy and anterior cruciate ligament rupture (Bennell et al, 1998). Limited DF may also lead to abnormal lower limb biomechanics during closed kinetic chain exercises resulting in overpronation, increased knee valgus and medial knee displacement as well as reducing activation of quadriceps and soleus activity (Macrum et al, 2012).
The weight bearing lunge test (WBLT) has been shown as a functional and reliable method of measuring DF in a weight bearing lunge position (Bennell et al, 19980. Although there are many different versions of the WBLT, to date there is no stipulation as to the exact position of the back foot whilst in the lunge position. Therefore, it has not yet been investigated whether a restriction of DF ROM of the back foot could affect the measurement given at the front foot. The purpose of this study was to determine whether back position affects front foot DF ROM using the weight bearing lunge test.
Methods
40 healthy adults (age = 27.3 ± 5.65) who participate in cutting and pivoting sports volunteered to participate in this study. Ankle DF range of movement measurements were obtained using the WBLT in three different back foot positions (back foot heel down, back foot heel up and back foot completely off the ground) over three different testing sessions at least 48 hours apart. All measurements were taken using a tape measure (to the nearest cm) using the distance from the big toe to the wall technique (Bennell et al, 1998). All measurements were obtained three times using the dominant leg (defined as the one they would predominantly kick with) and the mean was used for analysis. Differences between testing positions were determined using a one-way ANOVA to determine whether the back-foot position affects front foot range of movement.
Results
Differences between groups were found (F = 6.315, P=0.02). A Tukey post-hoc analysis revealed DF ROM was statistically higher when the back foot was completely off the ground (11.73.51, p =0.002) when compared to the back-foot heel down (9.03 ± 3.48). DF ROM was also statistically higher when the back-foot heel was up (10.98 3.45, p= 0.036) when compared to the back-foot heel down. There was no significant difference found between the back-foot heel up and back foot heel up completely (P=.622).
Conclusions
Results show that whilst performing the WBLT, DF ROM differs whether the patients back heel is up (the patient is on their toes) or their back foot is flat. It is not known from this study what back foot position is more accurate for DF ROM measurement but what this study does show is that practitioners do need to state what position they have used to ensure consistency between testing sessions. This is particularly important when there are teams of practitioners all looking after the same athletes.
References
Bennell K., Talbot R., Wajswelner H., Techovanich W., Kelly D (1998). Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 44,175-180
Konor M, M., Morton S., Eckerson J, M., Grindstaff, T, L (2012). Reliability of three measures of ankle dorsiflexion range of motion. Int J Sports Phys Ther. 7(3),270-287
Macrum E, Bell D, R., Boling M., Lewek M., Padua D (2012). Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle activation patterns during a squat. J Sport Rehabil. 21, 144-150
| Original language | English |
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| Publication status | Published - 2019 |