Larry R. Gurchiek

The effects of a short-term exercise program on movement, pain, and mood in the elderly. Results of a pilot study.

Therapeutic effects of a short-term Tai Chi exercise program for the elderly were evaluated in a pretest-posttest quasi-experimental design. This pilot study evaluated changes in flexibility, balance, sway, pain, and mood after a short slow-motion exercise. The program consisted of a series of movements involving turning, shifting weight, bending, and arm movements in combination with diaphragmatic breathing with slow movements. The measured effects included improved balance, sway, range of motion, decreased perceived pain, and lessened trait anxiety. Participants included 11 elderly females. Instruments consisted of standard goniometry, the Multiple Affect Adjective Check List, stopwatch measures of single-leg stance and a tandem walk (sway), and visual analog measurement of pain. Findings included significant improvement (p = .05) in trait anxiety and pain perception. Improvements in mood, flexibility, and balance may have a profound effect on the incidence of falls, injuries, resulting disability, and overall quality of life.

Instrumented Measurement of Anteroposterior and Inversion-Eversion Laxity of the Normal Ankle Joint Complex

Manual examination is the most common method for the evaluation of ankle anteroposterior (AP) and inversion-eversion (I-E) laxity. Objective assessment data of normal ankle laxity must be provided before comparison with an injured ankle can be made. The purpose of this study was to compare AP translation and I-E rotation at three force loads between dominant and nondominant ankles and to assess the test-retest reliability of a portable arthrometer in obtaining these measurements. The arthrometer consists of a frame that is fixed to the foot, a pad that is attached to the tibia, and a load-measuring handle that is attached to the foot plate through which the load is applied. A six-degrees-of-freedom spatial kinematic linkage system is connected between the tibial pad and the foot frame to measure motion. Instrumented measurement testing of total AP displacement and I-E rotation of both ankles was performed in 41 subjects (21 men and 20 women; mean age, 23.8 ± 4.4 years). Subjects had no history of ankle injury. Subjects were tested in the supine position while lying on a table with the knee secured in extension and the foot positioned at 0° of flexion. Laxity was measured from total AP displacement (millimeters) during loading to 125 N of AP force and from total I-E rotation (degrees of range of motion) during loading to 4000 N-mm. Reliability was evaluated by calculating intraclass correlation coefficients (2,1) at 75 N, 100 N, and 125 N of AP force and at 2000, 3000, and 4000 N-mm torque loads. Mean differences for displacement and rotation between the dominant and nondominant ankles at each of the force and torque loads were analyzed by dependent t-tests. For both the dominant and nondominant ankles, respectively, the reliability coefficients at each of the force loads for AP displacement (range, 0.82–0.89) and I-E rotation (range, 0.86–0.97) were high. The t-test analyses showed no significant differences (P ≥ 0.05) for total AP displacement or I-E rotation between the dominant and nondominant ankles at any of the force loads. The results are clinically useful in providing information about the reliability of measures at different AP and I-E force loads using a portable ankle ligament arthrometer.

Arthrometric Measurement of Ankle-Complex Motion: Normative Values

CONTEXT Valid and reliable measurements of ankle-complex motion have been reported using the Hollis Ankle Arthrometer. No published normative data of ankle-complex motion obtained from ankle arthrometry are available for use as a reference for clinical decision making. OBJECTIVE To describe the distribution variables of ankle-complex motion in uninjured ankles and to establish normative reference values for use in research and to assist in clinical decision making. DESIGN Descriptive laboratory study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Both ankles of 50 men and 50 women (age = 21.78 ± 2.0 years [range, 19-25 years]) were tested. INTERVENTION(S) Each ankle underwent anteroposterior (AP) and inversion-eversion (I-E) loading using an ankle arthrometer. MAIN OUTCOME MEASURE(S) Recorded anterior, posterior, and total AP displacement (millimeters) at 125 N and inversion, eversion, and total I-E rotation (degrees) at 4 Nm. RESULTS Women had greater ankle-complex motion for all variables except for posterior displacement. Total AP displacement of the ankle complex was 18.79 ± 4.1 mm for women and 16.70 ± 4.8 mm for men (U = 3742.5, P < .01). Total I-E rotation of the ankle complex was 42.10 degrees ± 9.0 degrees for women and 34.13 degrees ± 10.1 degrees for men (U = 2807, P < .001). All variables were normally distributed except for anterior displacement, inversion rotation, eversion rotation, and total I-E rotation in the womens ankles and eversion rotation in the mens ankles; these variables were skewed positively. CONCLUSIONS Our study increases the available database on ankle-complex motion, and it forms the basis of norm-referenced clinical comparisons and the basis on which quantitative definitions of ankle pathologic conditions can be developed.

Joint Stability Characteristics of the Ankle Complex After Lateral Ligamentous Injury, Part I: A Laboratory Comparison Using Arthrometric Measurement

CONTEXT The mechanical property of stiffness may be important to investigating how lateral ankle ligament injury affects the behavior of the viscoelastic properties of the ankle complex. A better understanding of injury effects on tissue elastic characteristics in relation to joint laxity could be obtained from cadaveric study. OBJECTIVE To biomechanically determine the laxity and stiffness characteristics of the cadaver ankle complex before and after simulated injury to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) during anterior drawer and inversion loading. DESIGN Cross-sectional study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Seven fresh-frozen cadaver ankle specimens. INTERVENTION(S) All ankles underwent loading before and after simulated lateral ankle injury using an ankle arthrometer. MAIN OUTCOME MEASURE(S) The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. RESULTS Isolated ATFL and combined ATFL and CFL sectioning resulted in increased anterior displacement but not end-range stiffness when compared with the intact ankle. With inversion loading, combined ATFL and CFL sectioning resulted in increased range of motion and decreased end-range stiffness when compared with the intact and ATFL-sectioned ankles. CONCLUSIONS The absence of change in anterior end-range stiffness between the intact and ligament-deficient ankles indicated bony and other soft tissues functioned to maintain stiffness after pathologic joint displacement, whereas inversion loading of the CFL-deficient ankle after pathologic joint displacement indicated the ankle complex was less stiff when supported only by the secondary joint structures.

Isokinetic Eccentric Strength of the Ankle Evertors after Injury

Isokinetic tests for ankle eversion strength at 30 and 60 deg/sec. speeds for 9 patients with recurring ankle sprains detected no differences at 8 and 34 weeks postinjury.

Joint Stability Characteristics of the Ankle Complex in Female Athletes With Histories of Lateral Ankle Sprain, Part II: Clinical Experience Using Arthrometric Measurement

CONTEXT This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. OBJECTIVE To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. DESIGN Cross-sectional study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. INTERVENTION(S) All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. MAIN OUTCOME MEASURE(S) The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. RESULTS Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P < .01). CONCLUSIONS Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.