Managing post-operative complications in a patient with excessive ankle stiffness: A case study addressing gait biomechanics and EMG

Khorramroo, Fateme; Mousavi, Seyed Hamed; Minoonejad, Hooman; Sorkhabi, Masoud

doi:10.22059/sshr.2023.368736.1111

Managing post-operative complications in a patient with excessive ankle stiffness: A case study addressing gait biomechanics and EMG

Document Type : Research Paper

Authors

¹ Department of Sport Injuries and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Iran.

² Department of Sport Injuries and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Iran

³ Department of Orthopedic, Helsingborg Hospital, Helsingborg, Sweden

10.22059/sshr.2023.368736.1111

Abstract

Background: Instrument Assisted Soft Tissue Mobilization (IASTM) and electrotherapy have shown to help alleviating post-operation complications and affect gait kinematics and muscle strength.
Aim: This case study aimed to manage the post-operative complications in a patient with investigate excessive ankle stiffness with kinetics, kinematics and Electromyography (EMG) approach.
Materials and Methods: A 41-year-old female with post-operation complications including decreased right ankle range of motion (ROM) and strength underwent a 12-week of IASTM and Electrotherapy. Gait analysis was performed before and after the intervention.
Results: The results showed notable improvements in ankle 3-dimensional (3D) ROM, power, moment, velocity, cadence, step length, ground reaction force (GRF) and decreased stiffness, muscles activity, single and double support time. Ankle dorsiflexion ROM was not notably increased during gait.
Conclusion: Findings suggest that a 12-week intervention of IASTM and electrotherapy can improve gait mechanics and reduce muscle activity in a patient with excessive ankle stiffness.

Keywords

References

[1] Hussain F. “Common sporting injuries of lower limbs and its management”. Br J Sports Med. 2010; 44 (Suppl 1): i2-3.

[2] Neumann H, O’Shea P, Nielson JP, Climstein M. “A physiological comparison of the short-leg walking cast and an ankle-foot orthosis walker following 6 weeks of immobilization”. Orthopedics. 1989; 12(11): 1429-34.

[3] Shaffer MA, Okerehe E, Esterhai J, Elliott MA, Walter GA, Yim SH, et al. “Effects of immobilization on plantar-flexion torque, fatigue resistance, and functional ability following an ankle fracture”. Phys Ther. 2000 Aug; 80(8): 769-80.

[4] Macrum E, Bell DR, Boling M, Lewek M, Padua D. “Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat”. J Sport Rehabil. 2012; 21(2): 144-50. doi: 10.1123/jsr.21.2.144.

[5] K Vandenborne MAE. “Longitudinal study of skeletal muscle adaptations during immobilization and rehabilitation”. Muscle & Nerve. 1997; 21(8): 1006-1012. 10.1002/(sici)10974598(199808)21:8<1006:aid-mus4>3.0.co;2-c.

[6] Geboers JFM, Van Tuijl JH, Seelen HAM, Drost MR. “Effect of immobilization on ankle dorsiflexion strength”. Scand J Rehabil Med. 2000 Jun; 32(2): 66–71.

[7] Vandenborne K, Walter GA, Abdus S, Okereke E, Shaffer M, Tahernia D, Esterhai MAE. “Longitudinal study of skeletal muscle adaptations during immobilization and rehabilitation”. Muscle Nerve. 1998 ug; 21(8): 1006-12. doi: 10.1002/(sici)1097-4598(199808)21:8<1006::aid-mus4>3.0.co;2-c.

[8] Skaaret I, Steen H, Niratisairak S, Swanson D, Holm I. “Postoperative changes in vertical ground reaction forces, walking barefoot and with ankle-foot orthoses in children with Cerebral Palsy”. Clinical Biomechanics. 2021; 84: 105336. doi: 10.1016/j.clinbiomech.2021.105336.

[9] Lynch SA, Renström PAFH. “Treatment of acute lateral ankle ligament rupture in the athlete”. Sports Medicine. 2012 Sep; 27(1): 61-71. doi: 10.2165/00007256-199927010-00005.

[10] Ota S, Ueda M, Aimoto K, Suzuki Y, Sigward SM. “Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait”. Knee. 2014; 21(3): 669-75. doi: 10.1016/j.knee.2014.01.006.

[11] Sanzo P. “The effects of extracorporeal shockwave therapy on pain, function, range of motion, and strength in patients with insertional Achilles tendinosis”. International Journal of Medical and Health Sciences. 2013; 7(6): 299-305. doi: 10.18857/jkpt.2022.34.3.91.

[12] Andrew L, Miners TLB, Miners AL, Bougie TL. “Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy”. J Can Chiropr Assoc. 2011; 55(4): 269-79. PMID: 22131563; PMCID: PMC3222702.

[13] Lorenz D. “Eccentric exercise interventions for tendinopathies”. Strength Cond J. 2010 Apr; 32(2): 90-8.

[14] Munari D, Serina A, Leonardelli A, Lanza D, Caramori A, Guerrini A, et al. “Effects of deep heating modalities on the morphological and elastic properties of the non-insertional region of achilles tendon: A pilot study”. International Journal of Hyperthermia. 2022; 39(1): 222-8. doi: 10.1080/02656736.2022.2026497.

[15] Kim YK, Cho SY, Lee KH. “Effects of transcutaneous electrical nerve stimulation and instrument-assisted soft tissue mobilization combined treatment on chronic low back pain: A randomized controlled trial”. J Back Musculoskelet Rehabil. 2021; 34(5): 895-902. doi: 10.3233/BMR-200369.

[16] Ikeda N, Otsuka S, Kawanishi Y, Kawakami Y. “Effects of instrument-assisted soft tissue mobilization on musculoskeletal properties”. Med Sci Sports Exerc. 2019 Oct; 51(10): 2166-72.

[17] Kinser AM, Ramsey MW, O’Bryant HS, Ayres CA, Sands WA, Stone MH. “Vibration and stretching effects on flexibility and explosive strength in young gymnasts”. Med Sci Sports Exerc. 2008 Jan; 40(1): 133-40.

[18] Nakano J, Yamabayashi C, Scott A, Reid WD. “The effect of heat applied with stretch to increase range of motion: a systematic review”. Phys Ther Sport. 2012 Aug; 13(3): 180-8. doi: 10.1016/j.ptsp.2011.11.003.

[19] Young R, Nix S, Wholohan A, Bradhurst R, Reed L. “Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis”. J Foot Ankle Res. 2013 Nov; 6(1): 1-10. doi: 10.1186/1757-1146-6-46.

[20] Joseph MF, Taft K, Moskwa M, Denegar CR. “Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding”. J Sport Rehabil. 2012; 21(4): 343-53. doi: 10.1123/jsr.21.4.343.

[21] Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. “Development of recommendations for SEMG sensors and sensor placement procedures”. Journal of Electromyography and Kinesiology. 2000; 10(5): 361-74.

[22] Chang TT, Li Z, Zhu YC, Wang XQ, Zhang ZJ. “Effects of self-myofascial release using a foam roller on the stiffness of the gastrocnemius-Achilles tendon complex and ankle dorsiflexion range of motion”. Front Physiol. 2021 Sep; 12. doi: 10.3389/fphys.2021.718827.

[23] “How the Graston Technique Works”. Available from: https://www.spine-health.com/treatment/chiropractic/how-graston-technique-works.

[24] Wee H, Voloshin A. “Transmission of vertical vibration to the human foot and ankle”. Ann Biomed Eng. 2013 Jun; 41(6): 1172-80. doi: 10.1007/s10439-013-0760-3.

[25] Melham TJ, Sevier TL, Malnofski MJ, Wilson JK, Helfst RH. “Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): A case report”. Med Sci Sports Exerc. 1998; 30(6): 801-4.

[26] Baniasad M, Farahmand F, Arazpour M, Zohoor H. “Coordinated activities of trunk and upper extremity muscles during walker-assisted paraplegic gait: A synergy study”. Hum Mov Sci. 2018; 62: 184-93. doi: 10.1016/j.humov.2018.10.002.

[27] Lavery KP, McHale KJ, Rossy WH, Theodore G. “Ankle impingement”. J Orthop Surg Res. 2016; 11(1): 1-7. doi: 10.1186/s13018-016-0430-x.

[28] Chan O, Malhotra K, Buraimoh O, Cullen N, Welck M, Goldberg A, et al. “Gastrocnemius tightness: A population based observational study”. Foot and Ankle Surgery. 2019; 25(4): 517-22. doi: 10.1016/j.fas.2018.04.002.

[29] Hickey B, Dalmau-Pastor M, Karlsson J, Calder J. “Hindfoot endoscopic release of the posterior ankle capsuloligamentous structures improves ankle dorsiflexion range, function and pain in patients with painful limitation of ankle dorsiflexion”. Journal of ISAKOS. 2020; 5(1): 21-5. doi: 10.1136/jisakos-2019-000338.

[30] Lui TH. “Arthroscopic capsular release of the ankle joint”. Arthrosc Tech. 2016; 5(6): e1281-6. doi: 10.1016/j.eats.2016.07.019.

[31] Schauer T, Seel T, Bunt ND, Müller P, Moreno JC. “Realtime EMG analysis for transcutaneous electrical stimulation assisted gait training in stroke patients.” The Research Project BeMobil. 2016; 49(32): 183-7. doi: 10.1016/j.ifacol.2016.12.211.

[32] Paillard T, Noé F, Passelergue P, Dupui P. “Electrical stimulation superimposed onto voluntary muscular contraction”. Sports Med. 2005; 35(11): 951-66.

[33] Abdul Jabbar K, Seah WT, Lau LK, Pang BWJ, Ng DHM, Tan QLL, et al. “Fast gait spatiotemporal parameters in adults and association with muscle strength- The Yishun study”. Gait Posture. 2021 Mar; 85: 217-23. doi: 10.1016/j.gaitpost.2021.01.001.

[34] Zeni JAJ, Higginson JS. “Differences in gait parameters between healthy subjects and persons with moderate and severe knee osteoarthritis: A result of altered walking speed?”. Clin Biomech. 2009 May; 24(4): 372-8.

[35] Madadi-Shad M, Jafarnezhadgero AA, Sheikhalizade H, Dionisio VC. “Effect of a corrective exercise program on gait kinetics and muscle activities in older adults with both low back pain and pronated feet: A double-blind, randomized controlled trial”. Gait Posture. 2020; 76: 339-45. doi: 10.1016/j.gaitpost.2019.12.026.

[36] Jonsdottir J, Recalcati M, Rabuffetti M, Casiraghi A, Boccardi S, Ferrarin M. “Functional resources to increase gait speed in people with stroke: strategies adopted compared to healthy controls”. Gait Posture. 2009; 29(3): 355-9.

[37] Gaudreault N, Gravel D, Nadeau S, Houde S, Gagnon D. “Gait patterns comparison of children with Duchenne muscular dystrophy to those of control subjects considering the effect of gait velocity”. Gait Posture. 2010; 32(3): 342-7. doi: 10.1016/j.gaitpost.2010.06.003.

[38] Stoquart G, Detrembleur C, Lejeune T. “Effect of speed on kinematic, kinetic, electromyographic and energetic reference values during treadmill walking”. Clinical Neurophysiology. 2008; 38(2): 105-16.

[39] Kim S, Yu J. “Changes of gait parameters and lower limb dynamics in recreational runners with achilles tendinopathy”. J Sports Sci Med. 2015; 14(2): 284. PMID: 25983576; PMCID: PMC4424456.

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Managing post-operative complications in a patient with excessive ankle stiffness: A case study addressing gait biomechanics and EMG

References

[1] Hussain F. “Common sporting injuries of lower limbs and its management”. Br J Sports Med. 2010; 44 (Suppl 1): i2-3.

[2] Neumann H, O’Shea P, Nielson JP, Climstein M. “A physiological comparison of the short-leg walking cast and an ankle-foot orthosis walker following 6 weeks of immobilization”. Orthopedics. 1989; 12(11): 1429-34.

[3] Shaffer MA, Okerehe E, Esterhai J, Elliott MA, Walter GA, Yim SH, et al. “Effects of immobilization on plantar-flexion torque, fatigue resistance, and functional ability following an ankle fracture”. Phys Ther. 2000 Aug; 80(8): 769-80.

[4] Macrum E, Bell DR, Boling M, Lewek M, Padua D. “Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat”. J Sport Rehabil. 2012; 21(2): 144-50. doi: 10.1123/jsr.21.2.144.

[5] K Vandenborne MAE. “Longitudinal study of skeletal muscle adaptations during immobilization and rehabilitation”. Muscle & Nerve. 1997; 21(8): 1006-1012. 10.1002/(sici)10974598(199808)21:8<1006:aid-mus4>3.0.co;2-c.

[6] Geboers JFM, Van Tuijl JH, Seelen HAM, Drost MR. “Effect of immobilization on ankle dorsiflexion strength”. Scand J Rehabil Med. 2000 Jun; 32(2): 66–71.

[7] Vandenborne K, Walter GA, Abdus S, Okereke E, Shaffer M, Tahernia D, Esterhai MAE. “Longitudinal study of skeletal muscle adaptations during immobilization and rehabilitation”. Muscle Nerve. 1998 ug; 21(8): 1006-12. doi: 10.1002/(sici)1097-4598(199808)21:8<1006::aid-mus4>3.0.co;2-c.

[8] Skaaret I, Steen H, Niratisairak S, Swanson D, Holm I. “Postoperative changes in vertical ground reaction forces, walking barefoot and with ankle-foot orthoses in children with Cerebral Palsy”. Clinical Biomechanics. 2021; 84: 105336. doi: 10.1016/j.clinbiomech.2021.105336.

[9] Lynch SA, Renström PAFH. “Treatment of acute lateral ankle ligament rupture in the athlete”. Sports Medicine. 2012 Sep; 27(1): 61-71. doi: 10.2165/00007256-199927010-00005.

[10] Ota S, Ueda M, Aimoto K, Suzuki Y, Sigward SM. “Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait”. Knee. 2014; 21(3): 669-75. doi: 10.1016/j.knee.2014.01.006.

[11] Sanzo P. “The effects of extracorporeal shockwave therapy on pain, function, range of motion, and strength in patients with insertional Achilles tendinosis”. International Journal of Medical and Health Sciences. 2013; 7(6): 299-305. doi: 10.18857/jkpt.2022.34.3.91.

[12] Andrew L, Miners TLB, Miners AL, Bougie TL. “Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy”. J Can Chiropr Assoc. 2011; 55(4): 269-79. PMID: 22131563; PMCID: PMC3222702.

[13] Lorenz D. “Eccentric exercise interventions for tendinopathies”. Strength Cond J. 2010 Apr; 32(2): 90-8.

[15] Kim YK, Cho SY, Lee KH. “Effects of transcutaneous electrical nerve stimulation and instrument-assisted soft tissue mobilization combined treatment on chronic low back pain: A randomized controlled trial”. J Back Musculoskelet Rehabil. 2021; 34(5): 895-902. doi: 10.3233/BMR-200369.

[16] Ikeda N, Otsuka S, Kawanishi Y, Kawakami Y. “Effects of instrument-assisted soft tissue mobilization on musculoskeletal properties”. Med Sci Sports Exerc. 2019 Oct; 51(10): 2166-72.

[17] Kinser AM, Ramsey MW, O’Bryant HS, Ayres CA, Sands WA, Stone MH. “Vibration and stretching effects on flexibility and explosive strength in young gymnasts”. Med Sci Sports Exerc. 2008 Jan; 40(1): 133-40.

[18] Nakano J, Yamabayashi C, Scott A, Reid WD. “The effect of heat applied with stretch to increase range of motion: a systematic review”. Phys Ther Sport. 2012 Aug; 13(3): 180-8. doi: 10.1016/j.ptsp.2011.11.003.

[19] Young R, Nix S, Wholohan A, Bradhurst R, Reed L. “Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis”. J Foot Ankle Res. 2013 Nov; 6(1): 1-10. doi: 10.1186/1757-1146-6-46.

[20] Joseph MF, Taft K, Moskwa M, Denegar CR. “Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding”. J Sport Rehabil. 2012; 21(4): 343-53. doi: 10.1123/jsr.21.4.343.

[21] Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. “Development of recommendations for SEMG sensors and sensor placement procedures”. Journal of Electromyography and Kinesiology. 2000; 10(5): 361-74.

[22] Chang TT, Li Z, Zhu YC, Wang XQ, Zhang ZJ. “Effects of self-myofascial release using a foam roller on the stiffness of the gastrocnemius-Achilles tendon complex and ankle dorsiflexion range of motion”. Front Physiol. 2021 Sep; 12. doi: 10.3389/fphys.2021.718827.

[23] “How the Graston Technique Works”. Available from: https://www.spine-health.com/treatment/chiropractic/how-graston-technique-works.

[24] Wee H, Voloshin A. “Transmission of vertical vibration to the human foot and ankle”. Ann Biomed Eng. 2013 Jun; 41(6): 1172-80. doi: 10.1007/s10439-013-0760-3.

[25] Melham TJ, Sevier TL, Malnofski MJ, Wilson JK, Helfst RH. “Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): A case report”. Med Sci Sports Exerc. 1998; 30(6): 801-4.

[26] Baniasad M, Farahmand F, Arazpour M, Zohoor H. “Coordinated activities of trunk and upper extremity muscles during walker-assisted paraplegic gait: A synergy study”. Hum Mov Sci. 2018; 62: 184-93. doi: 10.1016/j.humov.2018.10.002.

[27] Lavery KP, McHale KJ, Rossy WH, Theodore G. “Ankle impingement”. J Orthop Surg Res. 2016; 11(1): 1-7. doi: 10.1186/s13018-016-0430-x.

[28] Chan O, Malhotra K, Buraimoh O, Cullen N, Welck M, Goldberg A, et al. “Gastrocnemius tightness: A population based observational study”. Foot and Ankle Surgery. 2019; 25(4): 517-22. doi: 10.1016/j.fas.2018.04.002.

[30] Lui TH. “Arthroscopic capsular release of the ankle joint”. Arthrosc Tech. 2016; 5(6): e1281-6. doi: 10.1016/j.eats.2016.07.019.

[31] Schauer T, Seel T, Bunt ND, Müller P, Moreno JC. “Realtime EMG analysis for transcutaneous electrical stimulation assisted gait training in stroke patients.” The Research Project BeMobil. 2016; 49(32): 183-7. doi: 10.1016/j.ifacol.2016.12.211.

[32] Paillard T, Noé F, Passelergue P, Dupui P. “Electrical stimulation superimposed onto voluntary muscular contraction”. Sports Med. 2005; 35(11): 951-66.

[33] Abdul Jabbar K, Seah WT, Lau LK, Pang BWJ, Ng DHM, Tan QLL, et al. “Fast gait spatiotemporal parameters in adults and association with muscle strength- The Yishun study”. Gait Posture. 2021 Mar; 85: 217-23. doi: 10.1016/j.gaitpost.2021.01.001.

[34] Zeni JAJ, Higginson JS. “Differences in gait parameters between healthy subjects and persons with moderate and severe knee osteoarthritis: A result of altered walking speed?”. Clin Biomech. 2009 May; 24(4): 372-8.

[36] Jonsdottir J, Recalcati M, Rabuffetti M, Casiraghi A, Boccardi S, Ferrarin M. “Functional resources to increase gait speed in people with stroke: strategies adopted compared to healthy controls”. Gait Posture. 2009; 29(3): 355-9.

[37] Gaudreault N, Gravel D, Nadeau S, Houde S, Gagnon D. “Gait patterns comparison of children with Duchenne muscular dystrophy to those of control subjects considering the effect of gait velocity”. Gait Posture. 2010; 32(3): 342-7. doi: 10.1016/j.gaitpost.2010.06.003.

[38] Stoquart G, Detrembleur C, Lejeune T. “Effect of speed on kinematic, kinetic, electromyographic and energetic reference values during treadmill walking”. Clinical Neurophysiology. 2008; 38(2): 105-16.

[39] Kim S, Yu J. “Changes of gait parameters and lower limb dynamics in recreational runners with achilles tendinopathy”. J Sports Sci Med. 2015; 14(2): 284. PMID: 25983576; PMCID: PMC4424456.

Volume 15, Issue 2July 2023Pages 145-158

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Volume 15, Issue 2
July 2023
Pages 145-158