Alteration in corticospinal excitability, talocrural joint range of motion, and lower extremity function following manipulation in non-disabled individuals

Background: Clinical outcomes of manual therapy procedures, including manipulation, have been studied. However, mechanisms underlying observed improvements remain unclear. Objective: To determine the effect of ankle joint manipulation on corticospinal excitability, ankle dorsiflexion range of motion (DF ROM), and lower extremity functional behavior in nondisabled individuals. Method: Six nondisabled individuals (age range: 31-50 years) received the main outcomes measurements of this study, before and after long axis distraction manipulation of the talocrural joint. Main outcomes measures were motor evoked potential (MEP) amplitude of gastrocnemius (GN) and tibialis anterior (TA) using transcranial magnetic stimulation, ankle DF ROM with the knee flexed and extended using standard goniometric techniques, and unilateral anterior squat reach (ASR) distance. All subjects received the main outcomes measures. Results: Significant increase in GN MEP amplitude (P \u3c .05), but not TA MEP amplitude, were documented following intervention. Significant improvements also were noted in ankle DF ROM with knee extended and flexed (P \u3c .001) and ASR distance (P \u3c .05) Significant correlations were found between standardized change in GN MEP amplitude and ankle dorsiflexion with knee flexed (ρ = .582, ρ 2 = .339, P \u3c .01), and standardized changes in GN MEP amplitude and ASR distance (ρ = .601, ρ 2 = .361, P \u3c .01). Conclusions: Increased corticospinal excitability appears to mediate improvements in ankle DF ROM and lower extremity function following long axis distraction manipulation 1 Assistant Professor, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, to the talocrural joint in nondisabled individuals. These results establish comparative values with which to compare the corticospinal responses to manual therapy intervention in individuals with pathology. INTRODUCTION Ankle sprains are the most common injury to the ankle joint, affecting up to 2 million people and approximately 53 per 10,000 individuals per year. 1,2 Ankle sprains are common in younger and active individuals. 3-8 Certain sports and work activities may result in an even higher incidence and risk for injury. 9-15 Ankle sprains are a clinically important problem because they result in a substantial number of missed work days 8 and participation in sports activity, 3,5 as well as lead to potential early arthritic changes in the talocrural joint. 16 The prognosis for functional recovery following ankle sprain typically includes a rapid clinical improvement within the first two weeks after injury. 17 However, a series of recent studies indicate a subgroup of individuals appears predisposed to continued pain, functional deficits, and prolonged risk for additional reinjury between 6 weeks and 3 years post injury. 17-25 The prolonged disability associated with ankle sprains represents the possibility of increased direct and indirect health care costs associated with ankle sprains, and may be reduced through identification of optimal approaches to clinical management. One reason for continued pain and elevated risk for reinjury may be limited ankle joint mobility, which may occur as either a cause or consequence of ankle sprain. Limited ankle dorsiflexion has been documented as a major short-term sequel to ankle sprain. 26,27 In addition, several studies have identified limited talocrural joint dorsiflexion range of motion (DF ROM) as an important predisposing factor to ankle sprains. 28-30 Limited ankle DF ROM will position the talocrural joint in plantar flexion during weight bearing activities. This position is notable because the most common mechanism of injury for ankle sprains involves plantar flex-ion and inversion of the ankle and foot. The injury mechanism places excessive load on the anterior talofibular ligament (ATFL). With failure of ATFL, secondary restraint to inversion occurs by way of the calcaneo-fibular and posterior talofibular ligaments, placing them at similar risk for injury. Thus, limited ankle DF ROM may result in injury and consequent structural and functional compromise of the ankle lateral collateral ligaments. Physical therapists use mobilization and manipulation to improve ankle DF ROM following ankle sprains. Despite the intuitive appeal of applying these procedures to promote parallel improvements in talocrural DF ROM and functioning in individuals following ankle sprains, this notion has been the focus of relatively few prospective studies. 31 Pellow and Brantingham 32 were among the first to report reduced pain and improved function in individuals with ankle sprains receiving an ankle mortise distraction technique. Whitman and colleagues 33 reported rapid functional improvement after talocrural manipulation in a competitive volleyball player with a mild unilateral

Within-day test-retest reliability of transcranial magnetic stimulation measurements of corticomotor excitability for gastrocnemius and tibialis anterior muscles

Background: Manual therapy interventions targeting the talocrural joint can improve gait and balance functions in individuals following ankle sprains. Less is known about the underlying mechanisms of functional improvements after manual therapy. One hypothesis involves change in corticomotor excitability (CE) following manual therapy procedures. Transcranial magnetic stimulation (TMS) is a brain imaging method that could provide important information regarding potential changes in CE associated with manual therapy techniques applied to the talocrural joint. However, within-day reliability of TMS to measure CE must first be established in order to measure CE changes associated with manual therapy procedures. Objective: To determine the within-day test-retest reliability of TMS CE measures for gastrocnemius (GAS) and tibialis anterior (TA) for use in test-retest designs assessing corticomotor excitability in manual therapy and exercise studies. Method: TMS measures, including motor evoked potential (MEP) amplitude and cortical silent period (CSP), were completed twice on the same day under resting and active conditions in n = 6 nondisabled participants. The absolute reliability (coefficient of variation), relative reliability (intraclass correlation coefficient), standard error of measures, and minimal detectable change outside the 95% confidence interval were calculated for both GAS and TA muscles in each experimental condition. Results: There were no statistically significant differences between the first and second TMS measurements. TMS measurements for GAS and TA demonstrated good absolute and relative test-retest reliability under the active condition, but not the resting condition. Discussion: TMS under the active condition can be reliably used to assess CE even in postural muscles with a small cortical representation area, such as GAS

Relationship between foot pronation and rotation of the tibia and femur during walking

ABSTRACT The purpose of this study was to test the hypothesis that the magnitude and timing of peak foot pronation would be predictive of the magnitude and timing of peak rotation of tibia and femur. Thirty subjects who demonstrated a wide range of pronation participated. Threedimensional kinematics of the foot, tibia, and femur segments were recorded during self-selected free walking trials using a six-camera VICON motion analysis system. Regression analysis demonstrated that the magnitude and timing of peak pronation was not predictive of the magnitude and timing of tibial and femoral rotation. The lack of a relationship between peak foot pronation and the rotation of the tibia and femur is contrary to the clinical hypothesis that increased pronation results in greater lower extremity rotation. It would seem, therefore, that the relationship between foot pronation and rotation of the lower extremity segments should be assessed on a patient-by-patient basis

Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630]

BACKGROUND: Posterior tibialis tendon dysfunction (PTTD) is a common cause of foot pain and dysfunction in adults. Clinical observations strongly suggest that the condition is progressive. There are currently no controlled studies evaluating the effectiveness of exercise, orthoses, or orthoses and exercise on Stage I or IIA PTTD. Our study will explore the effectiveness of an eccentric versus concentric strengthening intervention to results obtained with the use of orthoses alone. Findings from this study will guide the development of more efficacious PTTD intervention programs and contribute to enhanced function and quality of life in persons with posterior tibialis tendon dysfunction. METHODS/DESIGN: This paper presents the rationale and design for a randomized clinical trial evaluating the effectiveness of a treatment regime for the non-operative management of Stage I or IIA PTTD. DISCUSSION: We have presented the rationale and design for an RCT evaluating the effectiveness of a treatment regimen for the non-operative management of Stage I or IIA PTTD. The results of this trial will be presented as soon as they are available

Positron emission tomography and magnetic resonance imaging methods and datasets within the Dominantly Inherited Alzheimer Network (DIAN)

The Dominantly Inherited Alzheimer Network (DIAN) is an international collaboration studying autosomal dominant Alzheimer disease (ADAD). ADAD arises from mutations occurring in three genes. Offspring from ADAD families have a 50% chance of inheriting their familial mutation, so non-carrier siblings can be recruited for comparisons in case-control studies. The age of onset in ADAD is highly predictable within families, allowing researchers to estimate an individual's point in the disease trajectory. These characteristics allow candidate AD biomarker measurements to be reliably mapped during the preclinical phase. Although ADAD represents a small proportion of AD cases, understanding neuroimaging-based changes that occur during the preclinical period may provide insight into early disease stages of 'sporadic' AD also. Additionally, this study provides rich data for research in healthy aging through inclusion of the non-carrier controls. Here we introduce the neuroimaging dataset collected and describe how this resource can be used by a range of researchers

Positron emission tomography and magnetic resonance imaging methods and datasets within the dominantly inherited Alzheimer network (DIAN)

The Dominantly Inherited Alzheimer Network (DIAN) is an international collaboration studying autosomal dominant Alzheimer disease (ADAD). ADAD arises from mutations occurring in three genes. Offspring from ADAD families have a 50% chance of inheriting their familial mutation, so non-carrier siblings can be recruited for comparisons in case–control studies. The age of onset in ADAD is highly predictable within families, allowing researchers to estimate an individual’s point in the disease trajectory. These characteristics allow candidate AD biomarker measurements to be reliably mapped during the preclinical phase. Although ADAD represents a small proportion of AD cases, understanding neuroimaging-based changes that occur during the preclinical period may provide insight into early disease stages of ‘sporadic’ AD also. Additionally, this study provides rich data for research in healthy aging through inclusion of the non-carrier controls. Here we introduce the neuroimaging dataset collected and describe how this resource can be used by a range of researchers

Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes

ABSTRACTPatellar tendinopathy is highly prevalent in all ages and skill levels of volleyball athletes. To illustrate this, we discuss the clinical, biomechanical, and ultrasound imaging presentation and the intervention strategies of three volleyball athletes at different stages of their athletic career: youth, middle-aged, and collegiate. We present our examination strategies and interpret the data collected, including visual movement analysis and dynamics, relating these findings to the probable causes of their pain and dysfunction. Using the framework of the EdUReP concept, incorporating Education, Unloading, Reloading, and Prevention, we propose intervention strategies that target each athlete's specific issues in terms of education, rehabilitation, training, and return to sport. This framework can be generalized to manage patellar tendinopathy in other sports requiring jumping, from youth to middle age, and from recreational to elite competitive levels

Effect of Posterior Tibial Tendon Dysfunction on Unipedal Standing Balance Test

Foot pain and diminished functional capacity are characteristics of tibialis posterior tendon dysfunction (TPTD). This study tested the hypotheses that women with TPTD would have impaired performance of a unipedal standing balance test (USBT) and that balance performance would be related to the number of single limb heel raises (SLHR)