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A theory for equinus gait in cerebral palsy (CP) is that the strong plantarflexors prevent the weak dorsiflexors from achieving dorsiflexion, thereby causing the ankle to be in a plantarflexed position. Recent work has indicated t...
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A theory for equinus gait in cerebral palsy (CP) is that the strong plantarflexors prevent the weak dorsiflexors from achieving dorsiflexion, thereby causing the ankle to be in a plantarflexed position. Recent work has indicated that both the ankle dorsiflexors and plantarflexors are weak. The purpose of this research was to theoretically and experimentally demonstrate that equinus deformity gait could be a compensatory strategy for plantarflexor weakness. It was hypothesized that children with CP utilize an equinus position during gait as a consequence of their weakness. A two-dimensional, sagittal plane model estimating plantarflexor forces through the Achilles tendon was developed. Five able-bodied (AB) children were tested utilizing heel-toe and progressively increasing toe walking strategies. Four children with CP were tested as they walked using their equinus gait. Results demonstrated that AB children assuming the toe walking stance progressively reduced the plantarflexor force when compared to their heel-toe walking trials. However, their toe walking strategy could not reduce the plantarflexor force level to that of the children with CP during the gait cycle. It was concluded that the equinus deformity posture complemented the CP children's plantarflexor weakness. Therefore, by implementing a concomitant strategy to maintain a reduced force state, equinus deformity could be used as a compensatory mechanism for individuals with plantarflexor weakness.
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Objectives: The primary aim was to establish normative values of isometric plantarflexor muscle strength in professional male rugby union players and compare forwards with backs. The secondary aims were to examine how individual p...
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Objectives: The primary aim was to establish normative values of isometric plantarflexor muscle strength in professional male rugby union players and compare forwards with backs. The secondary aims were to examine how individual playing position or age influences isometric plantarflexor strength. Design: Cross-sectional. Setting: Testing at professional rugby clubs. Participants: 355 players (201 forwards and 154 backs) from 9 clubs in the English Premiership club competition. Main outcome measures: Maximal unilateral isometric plantarflexion strength was measured, using a Fysiometer C-Station, in a seated position with a flexed knee and in maximal available dorsiflexion. Values are reported normalised to body mass and specific to playing position. Results: Mean combined limb isometric plantarflexion strength for the group was 193.1 kg (SD 32) or 1.86 xBW. (SD 0.31). Forwards were significantly weaker than backs (forwards = 1.75xBW (SD 0.26), backs = 2.00xBW (SD 0.28) (p=<0.0001)). Age category revealed no influence on plantarflexor strength. Conclusion: This study presents normative isometric plantarflexion strength values for professional male rugby union players. Forwards are typically relatively weaker than backs.
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Background and purpose: Achilles tendon is the most commonly injured part in the lower limb, especially in athletes. Treatment options for Achilles tendinopathy and total rupture are well described; however, there is a lack of inf...
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Background and purpose: Achilles tendon is the most commonly injured part in the lower limb, especially in athletes. Treatment options for Achilles tendinopathy and total rupture are well described; however, there is a lack of information regarding treatment protocols for partial tears. Thus, the purpose of this case report was to describe the examination, intervention and outcomes of patient who suffered an acute Achilles tendon partial tear. Case description: A case is described here, in which the diagnosis of Achilles tendon partial tear was based on both magnetic resonance imaging and physical evaluation. Both the patient and the physical therapy team opted for non-surgical treatment. A 12-week course of conservative treatment including exercise, tendon loading, electrical stimulation, and photobiomodulation is described. Outcomes: Ankle dorsiflexion range of motion and hop tests. Discussion: This case report demonstrated that non-surgical treatment for Achilles tendon partial tear was effective for this patient and enabled the athlete to return to pre-injury levels of activity 6 months following the injury.
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Stair negotiation poses a substantial physical demand on the musculoskeletal system and this challenging task can place individuals at risk of falls. Peripheral arterial disease (PAD) can cause intermittent claudication (IC) pain ...
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Stair negotiation poses a substantial physical demand on the musculoskeletal system and this challenging task can place individuals at risk of falls. Peripheral arterial disease (PAD) can cause intermittent claudication (IC) pain in the calf and results in altered gait mechanics during level walking. However, whether those with PAD-IC adopt alternate strategies to climb stairs is unknown. Twelve participants with PAD-IC (six bilateral and six unilateral) and 10 healthy controls were recruited and instructed to ascend a five-step staircase whilst 3D kinematic data of the lower-limbs were recorded synchronously with kinetic data from force plates embedded into the staircase on steps two and three. Limbs from the unilateral group and both limbs from the bilateral claudicants were categorised as claudicating (N = 18), asymptomatic (N = 6) and control (N=10). Claudicants walked more slowly than healthy controls (trend; P = < 0.066). Both claudicating- and asymptomatic-limb groups had reduced propulsive GRF (P = 0.025 and P = 0.002, respectively) and vertical GRF (P = 0.005 and P = 0.001, respectively) compared to controls. The claudicating-limb group had a reduced knee extensor moment during forward continuance (P = 0.060), ankle angular velocity at peak moment (P = 0.039) and ankle power generation (P = 0.055) compared to the controls. The slower gait speed, irrespective of laterality of symptoms, indicates functional capacity was determined by the limitations of the claudicating limb. Reduced ankle power generation and angular velocity (despite adequate plantarflexor moment) implies velocity-dependent limitations existed in the calf. The lack of,notable compensatory strategies indicates reliance on an impaired muscle group to accomplish this potentially hazardous task, highlighting the importance of maintaining plantarflexor strength and power in those with PAD-IC. (C) 2017 Elsevier.B.V. All rights reserved.
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During walking older adults rely less on ankle and more on hip work than young adults. Disproportionate declines in plantarflexor strength may be a mechanism underlying this proximal work redistribution. We tested the hypothesis t...
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During walking older adults rely less on ankle and more on hip work than young adults. Disproportionate declines in plantarflexor strength may be a mechanism underlying this proximal work redistribution. We tested the hypothesis that proximal redistribution is more apparent in older compared to young adults and in sedentary compared to active individuals over multiple walking speeds. We recruited 18 young (18-35 yrs) and 17 older (65-80 yrs) physically active and sedentary adults. Participants completed five trials at four Walking speeds as marker positions and ground reaction forces were collected. Sagittal plane net joint moments were computed using inverse dynarnics. Instantaneous joint powers for the ankle, knee, and hip were computed as products of net joint moments and joint angular velocities. Positive joint work was computed by integrating hip, knee, and ankle joint powers over time in early, mid, and late stance, respectively. Relative joint work was expressed as a percentage of total work. Isokinetic strength of lower limb flexor and extensor muscles was measured. Older adults had lower relative ankle (p = 0.005) and higher relative hip (p = 0.007) work than young adults for multiple speeds. Non-significant trends (p<0.10) indicating sedentary participants had lower relative ankle (p = 0.068) and higher relative hip work (p = 0.087) than active adults were observed. Age-related differences in plantarflexor strength were not disproportionate compared to strength differences in knee and hip musculature. Age influenced proximal work redistribution over multiple walking speeds. Physical activity status showed a similar trend for proximal work redistribution, but failed to reach statistical significance. (C) 2016 Elsevier B.V. All rights reserved.
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Background: Ankle plantarflexor muscle impairment contributes to asymmetrical postural control poststroke. Objective: This study examines the relationship of plantarflexor electromyography (EMG) with anterior-posterior center of p...
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Background: Ankle plantarflexor muscle impairment contributes to asymmetrical postural control poststroke. Objective: This study examines the relationship of plantarflexor electromyography (EMG) with anterior-posterior center of pressure (APCOP) in people poststroke during progressive challenges to standing balance. Methods: Ten people poststroke and 10 controls participated in this study. Anteriorly directed loads of 1% body mass (BM) were applied to the pelvis every 25-40 s until 5%BM was reached. Cross-correlation values between plantarflexor EMG and APCOP (EMG:APCOP) position and velocity were compared. Results: EMG:APCOP velocity correlations were stronger than EMG: APCOP position across all muscles (p < .01), and correlations were predominately stronger in the nonparetic compared with the paretic leg (p < .05). Increasing challenge to standing balance reduced asymmetry of EMG:APCOP relationships. Conclusions: These data suggest that sensory information reflected in APCOP velocity interacts more strongly with plantarflexor activity in people poststroke and controls than APCOP position. Furthermore, increasing challenge to standing balance reduces postural control asymmetry between legs poststroke.
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Age-related deficiencies in thermoregulation diminish the capacity to defend against heat loss under conditions often encountered during activities of daily living (ADL). A potential consequence of these deficiencies is that elder...
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Age-related deficiencies in thermoregulation diminish the capacity to defend against heat loss under conditions often encountered during activities of daily living (ADL). A potential consequence of these deficiencies is that elderly individuals could have colder lower limbs, which would exacerbate the age-related decline in plantarflexor contractile properties and compromise recovery from a tripping incident Moreover, a common self-perception among the elderly is that their limbs are cold. However, this impression has never been documented, especially under ADL conditions. Our objective was to test the hypothesis that elderly individuals have lower plantarflexor temperatures than their younger counterparts. Skin temperatures above the plantarflexors of elderly and young individuals were continuously recorded during ADL in the winter months and compared under three conditions: quiescent indoor temperature, during a cold challenge, and the recovery period subsequent to the cold challenge.
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Introduction: Simulations suggest that subjects with reduced hip range of motion (ROM) and/or weakness can achieve more normal walking mechanics through compensations at the ankle. The aims of this study were to assess whether sub...
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Introduction: Simulations suggest that subjects with reduced hip range of motion (ROM) and/or weakness can achieve more normal walking mechanics through compensations at the ankle. The aims of this study were to assess whether subjects with reduced hip ROM (Stiff hip) or hip flexor weakness (Weak hip) exhibit ankle compensations during walking and investigate redistribution of power in the lower extremity joints. Methods: Retrospective gait data were reviewed (IRB-approved hip registry). Preoperative kinematicAinetic walking data were collected in patients with: adolescent hip dysplasia (AHD), femoral acetabular impingement (FAI), and Legg-Calv^ Perthes disease (Perthes), AHD patients with significantly weak hip flexors on their affected side were included (Weak hip group). The Gait Profile Score (GPS) was calculated on the affected side of the FAI and Perthes groups to identify patients who had a Stiff hip. Patients who had undergone a hip arthrodesis (Fusion) were also included (Stiff hip group). Ankle kinematics/kinetics were compared to healthy participants (Control). The total positive work of sagittal plane hip, knee and ankle power were compared along with the distribution of power. Results: Patients in the Weak/Stiff hip groups did not walk with greater ankle plantarflexion, peak push-off power or positive ankle work on their affected sides compared to Control. Ankle work contribution (percentage of total positive work) on the affected or unaffected sides was greater in the Perthes and Hip Fusion patients compared to Control. Significant gait abnormalities on the unaffected side were observed. Conclusions: Patients with a weak or stiff hip did exhibit altered ankle mechanics during walking. Greater percent ankle work contribution appeared to correspond with hip stiffness. In patients with hip pathology the redistribution of power among the lower extremity joints can highlight the importance of preserving ankle function.
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We sought to provide a more comprehensive understanding of how the individual leg muscles act synergistically to generate a ground force impulse and maximize the change in forward momentum of the body during accelerated sprinting....
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We sought to provide a more comprehensive understanding of how the individual leg muscles act synergistically to generate a ground force impulse and maximize the change in forward momentum of the body during accelerated sprinting. We combined musculoskeletal modelling with gait data to simulate the majority of the acceleration phase (19 foot contacts) of a maximal sprint over ground. Individual muscle contributions to the ground force impulse were found by evaluating each muscle's contribution to the vertical and fore-aft components of the ground force (termed "supporter" and "accelerator/brake," respectively). The ankle plantarflexors played a major role in achieving maximal-effort accelerated sprinting. Soleus acted primarily as a supporter by generating a large fraction of the upward impulse at each step whereas gastrocnemius contributed appreciably to the propulsive and upward impulses and functioned as both accelerator and supporter. The primary role of the vasti was to deliver an upward impulse to the body (supporter), but these muscles also acted as a brake by retarding forward momentum. The hamstrings and gluteus medius functioned primarily as accelerators. Gluteus maximus was neither an accelerator nor supporter as it functioned mainly to decelerate the swinging leg in preparation for foot contact at the next step. Fundamental knowledge of lower-limb muscle function during maximum acceleration sprinting is of interest to coaches endeavoring to optimize sprint performance in elite athletes as well as sports medicine clinicians aiming to improve injury prevention and rehabilitation practices.
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