We use the lunge test to gauge stiffness in the ankle complex. The lower threshold for ankle joint dorsiflexion is 35 degrees, below which the ROM is considered insufficient and may be significant in pathology
Members do not see these Ads. Sign Up.
Is there an upper threshold over which we consider the ankle joint complex to be insufficiently stiff? I was describing to a patient tonight the theory behind zones of optimal leg stiffness and I wondered whether the more compliant the leg, the greater likelihood of soft tissue injury theory would apply here
I don't recall seeing anyuthing about it before but I'm sure someone will find something, making me look like the thing that I am..........lazy
Thanks to all
Robin
Tags:
-
-
Kleg - leg stiffness is intersting stuff but you have to read - leg stiffness
and yes a more compliant leg there may be a link to more soft tissue injury but it is not a simple.
Your at a level of understanding now where you don´t get the answers go do some reading and there is lots of it. -
Mike,
Bit of a brash reply in my opinion, especially as I don't think you have quite understood what Robin is asking. The way I interpreted the original question was as follows (please correct me if I am wrong Robin):
The weight bearing lunge test is a way of obtaining an indication of ankle joint dorsiflexion stiffness. Previous studies have suggested this may be an indicator of increased lower extremity injury risk. The authors (Gabbe, Pope, Bennell et al) seem to have identified a minimum value for this test (a tibial angle of at least 35 degrees) - failure to achieve this may increase aforementioned injury risk. If there is such as thing as increased ankle joint dorsiflexion stiffness (a tibial angle of less than 35 degrees), then is there also such a thing as decreased ankle joint stiffness?? i.e. Can the ankle joint be TOO compliant and will this carry with it any similar/different risks?
Is that the gist of what you were asking Robin? -
Anyways not offence was intended just a small kick in the ass.
Anyway if I got it wrong end of the question - Sorry and I´ll leave you too it. -
Ian - you were spot on
Mike - you are spot on. I am lazy and I do need to do some reading and understanding. A good kick up the bum taken -
Cool - in which case here are my thoughts:
As far as I am aware there is no 'range' suggested in the literature for the tibial angle values of the Lunge test, there is only a lower threshold (35-38 degrees from memory). Anectodally, I often see angles of 40-45 degrees achieved. To achieve significantly more than this would, to my mind at least, require the individual to have global ligamentous laxity. It seems intuitive that this may correlate with a particular set of potential problems.
If you need/want all of the lunge test articles let me know and I'll ping them over. -
When doing an assessment, ankle lunge test is one of the main tests that I always perform. I measure in barefoot (as I have them barefoot at the time) If the range looks even remotely limited, I make a point of measuring in their shoe/runners .
I don't measure in the footwear if the test looks ok in barefoot. I seem to recall somewhere, someone had written that the patient had a reduced ankle lunge test when in footwear. Has anyone experienced this? Am I doing something completely wrong by not doing this?
Anyway, the real reason I posted this is because I was wondering what types of injuries one might envisage coming across in a patient with an excessively high angle when performing an ankle lunge test.
I was thinking along the lines of any of the soft tissues that resist dorsiflexion moments. Any suggestions?
Thanks
Robin -
Eric -
Eric make and important point re weightbearing and nonweightbearing examination.
If you think about weight bearing exam Robin and the Gastroc/Sol is ´not´stiff enough what would be the major problems with Gait.
hint: think of the Gastroc/Sol complex as a spring or Catapult. -
-
Eric -
(break from reading)...If I'm working along correctly here reduced stiffness in the leg has to be accomodated in gait by the CNS and responds by increasing stiffness in the foot. My thought to go along with that is that would this patient profile ( the ones Robin is discussing)not also be considered to have isolated soleus weakness comparitavely speaking? And as the solues may act agonistically with the ACL might this type of person be susceptable to a potential ACL injury? A less stiff leg sitting on a stiffer foot with a weak soleus playing a sport might get an ACL damaged more often than a healthy subject. At least that is how I'm seeing that with the stiffness idea. Am I out of it? or getting there? Although I'm kind of tired at the moment .....pes anserine bursitis as well?...going to bed..
-
Muscle-tendon interaction and elastic energy usage in human walking
Ishikawa, Masaki, Paavo V. Komi, Michael J. Grey, Vesa
Lepola, and Gert-Peter Bruggemann. Muscle-tendon interaction and
elastic energy usage in human walking. J Appl Physiol 99: 603– 608, 2005.
First published April 21, 2005;
-
OK - just to be clear about my thinking
The reason that I linked to the leg stiffness at first was because my thought process was:
Decreased ankle joint stiffness would require input from the CNS to increase the overall stiffness of the leg to maintain an optimal shift in COM throughout the gait cycle. For example inceased stiffness at the knee. Possible greater increase in bone stress(whatever that may be)
HOwever, if the CNS is feeding back that the ankle joint is dorsiflexing too quickly, it might increase knee stiffness but will it not also attempt to increase the stiffness at the ankle joint by increasing the gastroc/soleus load? In the case of a forefoot striking runner,is it not feasible that the increased demand on the gastroc/soleus complex to increase the ankle joint stiffness to maintain the COM position might be enough to cause pathology.
When we look at decreased 1st ray stiffness, we see pathologies relating to structures attempting reduce the medial column/1st ray dorsiflexion moments. Is it not possible with the ankle?
Robin -
I don't see why knee stiffness would have to increase to achieve forward progression in gait when there was low ankle stiffness.
In the forefoot striking runner, at contact, the ankle joint stiffness is a shock absorber. There will usually be some ankle dorsiflexion and this will cause high loads in the Achilles tendon when acting as a shock absorber. Once the foot is loaded, there is not much control of the center of mass by the foot or leg in running. Momentum. The control comes more from foot placement at landing.
The loads on the Achilles are much more from active muscle contraction than passive stretch/ stiffness.
Eric -
Just thinking out loud here...
Thanks -
A good place to look to understand the energetics of gait is the work of David Winter.
It sounds like you are talking about forward progression. In that case, Winter showed that in gait the body slowed its progression when the CoM was behind the stance foot and it accelerated forward after body moved anterior to the stance leg. It was a pretty straigthforward exchange of kinetic energy for potential energy and back again. The momentum of the body is decreased as it is lifted up over the stance limb and then falls forward to regain momentum till the other foot contacts. Low stiffness at the ankle is not a problem in this scenario.
Eric -
I was thinking about vertical translation of the COM when I said relative to the ground. When I said preserve I meant maintain. Sorry.
I will read Winter as well.
Thankyou. -
-
The lunge test measures the range of motion of a number of joints (i.e. ankle, subtalar, midtarsal, and midfoot joints) but does not necessarily measure stiffness of these joints. To measure stiffness, more than one data point is necessary on the load vs deformation curve.
In many of the responses to your question here, I believe that some people may be discussing running biomechanics and others are talking about walking biomechanics. Since walking and running biomechanics are very different from each other when it comes to ankle joint dorsiflexion kinematics and kinetics, if you, or the person answering your question, doesn't indicate whether they are talking about walking or running, then any discussion basically becomes useless.
The lunge test, as it is typically done with the knee flexed and ankle dorsiflexed, probably has little bearing on injuries or the production of normal gait during walking since it is done with the ankle dorsiflexed and the knee flexed. During walking, maximum ankle dorsiflexion occurs when the knee is nearly fully extended so the lunge test probably doesn't apply for walking, but applies more for running mechanics where knee and ankle joint dorsiflexion occurs at the same time. -
Does anyone have access to Manual Therapy journal? I can't seem to access it via my Athens account. From the current issue:
Matthew C. Hoch, Patrick O. McKeon
Normative range of weight-bearing lunge test performance asymmetry in healthy adults
Manual Therapy, Volume 16, Issue 5, (October 2011) p516-519
Loading...
- Similar Threads - Lunge Test stiff
-
- Replies:
- 1
- Views:
- 6,098
-
- Replies:
- 1
- Views:
- 6,155
-
- Replies:
- 2
- Views:
- 6,004
-
- Replies:
- 20
- Views:
- 19,424
-
- Replies:
- 1
- Views:
- 7,986
-
- Replies:
- 9
- Views:
- 6,888
-
- Replies:
- 5
- Views:
- 13,618