Skip to main content
SpringerLink
Log in

Characteristics of the static muscle stiffness of ankle plantar flexors in individuals with chronic ankle instability

  • Original Article–Orthopedics
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Purpose

Individuals with chronic ankle instability (CAI) have deficits in closed kinetic chain dorsiflexion that may perpetuate injury. Determining the characteristics of muscle stiffness in the plantar flexors of individuals with CAI may help in developing appropriate treatments. We aimed to highlight the characteristics of static muscle stiffness in ankle plantar flexor muscles during the passive dorsiflexion of the ankle joint in individuals with CAI.

Methods

A total of 30 patients were included in the study based on the International Ankle Consortium criteria. The patients were categorized evenly into healthy, coper, and CAI groups (i.e., 10 patients in each group). After measuring the dorsiflexion range of motion (non-weight-bearing/weight-bearing) of the ankle joint, the static muscle stiffness measurements of the medial gastrocnemius, lateral gastrocnemius, soleus, and peroneus longus were obtained. The measurements were performed during the knee joint's extension and 50° flexion and passive dorsiflexion between the range of 40° plantar flexion and 20° dorsiflexion.

Results

The dorsiflexion range of motion of the CAI group was significantly smaller than that of the healthy and coper groups in the weight-bearing position. No interaction was observed for muscle stiffness in both the knee flexion and extension positions, and no significant differences were identified among the three groups. The shear modulus of the soleus at 20° ankle dorsiflexion with knee flexion had a significant negative correlation with the weight-bearing range of motion of the ankle.

Conclusion

The limitation in the weight-bearing dorsiflexion range of motion in CAI was largely due to factors other than the increased elasticity of the ankle plantar flexor muscles.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Data availability

Authors are prepared to release data upon request.

References

  1. Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train. 2019;54:572–88.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Houston MN, Hoch JM, Hoch MC. Patient-reported outcome measures in individuals with chronic ankle instability: a systematic review. J Athl Train. 2015. https://doi.org/10.4085/1062-6050-50.9.01.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Martin RL, Davenport TE, Fraser JJ, et al. Ankle stability and movement coordination impairments: lateral ankle ligament sprains revision 2021. J Orthop Sports Phys Ther. 2021;51:CPG1–80.

    Article  PubMed  Google Scholar 

  4. Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52:956.

    Article  PubMed  Google Scholar 

  5. Gabriner ML, Houston MN, Kirby JL, et al. Contributing factors to star excursion balance test performance in individuals with chronic ankle instability. Gait Posture. 2015;41:912–6.

    Article  PubMed  Google Scholar 

  6. Weerasekara I, Osmotherly P, Snodgrass S, et al. Clinical benefits of joint mobilization on ankle sprains: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2018;99:1395-1412 e5.

    Article  PubMed  Google Scholar 

  7. Handoll HH, Rowe BH, Quinn KM, et al. Interventions for preventing ankle ligament injuries. Cochrane Database Syst Rev. 2001;3: CD000018.

    Google Scholar 

  8. Doherty C, Bleakley C, Delahunt E, et al. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51:113–25.

    Article  PubMed  Google Scholar 

  9. Judson LJ, Churchill SM, Barnes A, et al. Joint moments and power in the acceleration phase of bend sprinting. J Biomech. 2020;101: 109632.

    Article  PubMed  Google Scholar 

  10. Weinhandl JT, Smith JD, Dugan EL. The effects of repetitive drop jumps on impact phase joint kinematics and kinetics. J Appl Biomech. 2011;27:108–15.

    Article  PubMed  Google Scholar 

  11. Maisetti O, Hug F, Bouillard K, et al. Characterization of passive elastic properties of the human medial gastrocnemius muscle belly using supersonic shear imaging. J Biomech. 2012;45:978–84.

    Article  PubMed  Google Scholar 

  12. Koo TK, Guo JY, Cohen JH, et al. Relationship between shear elastic modulus and passive muscle force: an ex-vivo study. J Biomech. 2013;46:2053–9.

    Article  PubMed  Google Scholar 

  13. Liu J, Qian Z, Wang K, et al. Non-invasive quantitative assessment of muscle force based on ultrasonic shear wave elastography. Ultrasound Med Biol. 2019;45:440–51.

    Article  PubMed  Google Scholar 

  14. Eby SF, Song P, Chen S, et al. Validation of shear wave elastography in skeletal muscle. J Biomech. 2013;46:2381–7.

    Article  PubMed  Google Scholar 

  15. Le Sant G, Nordez A, Hug F, et al. Effects of stroke injury on the shear modulus of the lower leg muscle during passive dorsiflexion. J Appl Physiol (1985). 2019;126:11–22.

    Article  PubMed  Google Scholar 

  16. Kobayashi T, Watanabe K, Ito T, et al. The Effect of novel ankle-realigning socks on dynamic postural stability in individuals with chronic ankle instability. Int J Sports Phys Ther. 2019;14:264–72.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014;48:1014–8.

    Article  PubMed  Google Scholar 

  18. Hiller CE, Refshauge KM, Bundy AC, et al. The Cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehabil. 2006;87:1235–41.

    Article  PubMed  Google Scholar 

  19. Morse CI. Gender differences in the passive stiffness of the human gastrocnemius muscle during stretch. Eur J Appl Physiol. 2011;111:2149–54.

    Article  PubMed  Google Scholar 

  20. Bennell KL, Talbot RC, Wajswelner H, et al. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 1998;44:175–80.

    Article  PubMed  Google Scholar 

  21. Powden CJ, Hoch JM, Hoch MC. Reliability and minimal detectable change of the weight-bearing lunge test: a systematic review. Man Ther. 2015;20:524–32.

    Article  PubMed  Google Scholar 

  22. Le Sant G, Nordez A, Andrade R, et al. Stiffness mapping of lower leg muscles during passive dorsiflexion. J Anat. 2017;230:639–50.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hermens HJ, Freriks B, Disselhorst-Klug C, et al. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10:361–74.

    Article  CAS  PubMed  Google Scholar 

  24. Hislop HJ, Avers D, Brown M. Daniels and Worthingham’s muscle testing: techniques of manual examination and performance testing. 10th ed. St. Louis: Elsevier; 2018.

    Google Scholar 

  25. Shiina T. JSUM ultrasound elastography practice guidelines: basics and terminology. J Med Ultrason. 2013;40:309–23.

    Article  Google Scholar 

  26. Kodesho T, Taniguchi K, Kato T, et al. Intramuscular differences in shear modulus of the rectus femoris muscle during passive knee flexion. Eur J Appl Physiol. 2021;121:1441–9.

    Article  PubMed  Google Scholar 

  27. Freitas SR, Antunes A, Salmon P, et al. Does epimuscular myofascial force transmission occur between the human quadriceps muscles in vivo during passive stretching? J Biomech. 2019;83:91–6.

    Article  PubMed  Google Scholar 

  28. Hug F, Lacourpaille L, Maisetti O, et al. Slack length of gastrocnemius medialis and Achilles tendon occurs at different ankle angles. J Biomech. 2013;46:2534–8.

    Article  PubMed  Google Scholar 

  29. Koo TK, Guo JY, Cohen JH, et al. Quantifying the passive stretching response of human tibialis anterior muscle using shear wave elastography. Clin Biomech (Bristol, Avon). 2014;29:33–9.

    Article  PubMed  Google Scholar 

  30. Xu J, Hug F, Fu SN. Stiffness of individual quadriceps muscle assessed using ultrasound shear wave elastography during passive stretching. J Sport Health Sci. 2018;7:245–9.

    Article  PubMed  Google Scholar 

  31. Denegar CR, Hertel J, Fonseca J. The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002;32:166–73.

    Article  PubMed  Google Scholar 

  32. Tabrizi P, McIntyre WM, Quesnel MB, et al. Limited dorsiflexion predisposes to injuries of the ankle in children. J Bone Joint Surg Br. 2000;82:1103–6.

    Article  CAS  PubMed  Google Scholar 

  33. Terada M, Pietrosimone BG, Gribble PA. Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review. J Athl Train. 2013;48:696–709.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Pope R, Herbert R, Kirwan J. Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits. Aust J Physiother. 1998;44:165–72.

    Article  PubMed  Google Scholar 

  35. Youdas JW, Krause DA, Egan KS, et al. The effect of static stretching of the calf muscle-tendon unit on active ankle dorsiflexion range of motion. J Orthop Sports Phys Ther. 2003;33:408–17.

    Article  PubMed  Google Scholar 

  36. Caputo AM, Lee JY, Spritzer CE, et al. In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Sports Med. 2009;37:2241–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kobayashi T, Saka M, Suzuki E, et al. In vivo kinematics of the talocrural and subtalar joints during weightbearing ankle rotation in chronic ankle instability. Foot Ankle Spec. 2014;7:13–9.

    Article  PubMed  Google Scholar 

  38. Kobayashi T, Suzuki E, Yamazaki N, et al. Fibular malalignment in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2014;44:872–8.

    Article  PubMed  Google Scholar 

  39. Powden CJ, Hoch JM, Hoch MC. Rehabilitation and improvement of health-related quality-of-life detriments in individuals with chronic ankle instability: a meta-analysis. J Athl Train. 2017;52:753–65.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Chino K, Takahashi H. Measurement of gastrocnemius muscle elasticity by shear wave elastography: association with passive ankle joint stiffness and sex differences. Eur J Appl Physiol. 2016;116:823–30.

    Article  PubMed  Google Scholar 

  41. Miyamoto N, Hirata K, Miyamoto-Mikami E, et al. Associations of passive muscle stiffness, muscle stretch tolerance, and muscle slack angle with range of motion: individual and sex differences. Sci Rep. 2018;8: 8274.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Saeki J, Ikezoe T, Yoshimi S, et al. Menstrual cycle variation and gender difference in muscle stiffness of triceps surae. Clin Biomech (Bristol, Avon). 2019;61:222–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The study was supported by the Japan Society for the Promotion of Science (Grant No. 19K19916).

Author information

Authors and Affiliations

  1. Department of Rehabilitation, Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, 2-10 Satomi, Chitose, Hokkaido, 066-0055, Japan

    Takumi Kobayashi, Keita Kinami, Ayuka Takahashi & Konatsu Taniguchi

  2. Department of Sport Science and Research, Japan Institute of Sports Sciences (JISS), Tokyo, Japan

    Taiki Kodesho

  3. Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan

    Keigo Taniguchi

Authors
  1. Takumi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taiki Kodesho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keita Kinami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ayuka Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Konatsu Taniguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keigo Taniguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takumi Kobayashi.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical statements

The study protocol was approved by the ethics committee of the author’s institution.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kobayashi, T., Kodesho, T., Kinami, K. et al. Characteristics of the static muscle stiffness of ankle plantar flexors in individuals with chronic ankle instability. J Med Ultrasonics 50, 561–570 (2023). https://doi.org/10.1007/s10396-023-01360-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-023-01360-5

Keywords

Search

Navigation