Johanson Marie A, DeArment Amy, Hines Krystol, Riley Erin, Martin Meghan, Thomas Justin, Geist Kathleen
Emory University School of Medicine, Atlanta, GA, USA.
Foot Ankle Int. 2014 Jan;35(1):63-70. doi: 10.1177/1071100713513433. Epub 2013 Nov 20.
Limited ankle joint dorsiflexion passive range of motion (PROM) has been associated with common chronic lower extremity conditions, and clinicians often instruct patients in stretching exercises to increase dorsiflexion. However, little is known about how subtalar joint (STJ) position affects dorsiflexion at the midfoot/forefoot versus ankle/rearfoot during gastrocnemius stretching. The purpose of this study was to determine if more dorsiflexion occurs at the ankle/rearfoot and less at the midfoot/forefoot during gastrocnemius stretching with the STJ positioned in supination versus pronation.
In this repeated measures design, 27 participants (23 females, 4 males; mean age = 31.3 years, SD = 10.7) with current or recent history of lower extremity chronic conditions and less than 10 degrees ankle dorsiflexion measured with the knee in extension on the involved side(s) performed five 30-second gastrocnemius stretching trials in pronation and supination on each side in a randomly determined sequence. A 7-camera Vicon Motion Analysis System and an AMTI force plate were used to measure midfoot/forefoot dorsiflexion, ankle/rearfoot dorsiflexion, knee extension, and normalized vertical ground reaction force.
Two-way repeated measures ANOVA revealed a significant increase in midfoot/forefoot dorsiflexion when stretching in pronation compared to supination (P < .001). ANOVAs also demonstrated significantly more extension of the knee when stretching in supination compared to pronation (P < .001), and increased normalized vertical ground reaction force when stretching in supination compared to pronation (P = .032). With the numbers available, no significant difference in ankle/rearfoot dorsiflexion when stretching in supination compared to pronation could be detected (P > .05).
Gastrocnemius stretching in pronation resulted in more dorsiflexion at the midfoot/forefoot than stretching in supination.
Clinicians may want to consider STJ position during gastrocnemius stretching to either facilitate or limit recruitment of dorsiflexion motion at the midfoot/forefoot.
踝关节背屈被动活动范围（PROM）受限与常见的慢性下肢疾病有关，临床医生常指导患者进行拉伸运动以增加背屈。然而，对于在腓肠肌拉伸过程中，距下关节（STJ）位置如何影响中足/前足与踝/后足的背屈，人们知之甚少。本研究的目的是确定在腓肠肌拉伸时，当STJ处于旋后位与旋前位时，踝/后足的背屈是否更多，而中足/前足的背屈是否更少。
在这项重复测量设计中，27名参与者（23名女性，4名男性；平均年龄 = 31.3岁，标准差 = 10.7），有下肢慢性疾病的当前或近期病史，且患侧膝关节伸直时踝关节背屈小于10度，以随机确定的顺序在每侧进行五次30秒的腓肠肌拉伸试验，分别处于旋前位和旋后位。使用7台摄像机的Vicon运动分析系统和一个AMTI测力台来测量中足/前足背屈、踝/后足背屈、膝关节伸展以及归一化垂直地面反作用力。
双向重复测量方差分析显示，与旋后位拉伸相比，旋前位拉伸时中足/前足背屈显著增加（P <.001）。方差分析还表明，与旋前位拉伸相比，旋后位拉伸时膝关节伸展明显更多（P <.001），并且与旋前位拉伸相比，旋后位拉伸时归一化垂直地面反作用力增加（P = 0.032）。就现有数据而言，未检测到旋后位拉伸与旋前位拉伸时踝/后足背屈有显著差异（P >.05）。
旋前位的腓肠肌拉伸比旋后位拉伸在中足/前足产生更多的背屈。
临床医生在进行腓肠肌拉伸时可能需要考虑STJ的位置，以促进或限制中足/前足背屈运动的募集。
