본 연구는 일회성 발목가동성 운동프로그램이 만성적인 발목불안정성(CAI)에 나타나는 발목가 동범위와 통증 수준에 미치는 영향을 확인하는데 목적이 있다. 연구 대상자는 발목불안정성 설문지 검사에 서 좌, 우측 평균 점수가 24점 이하인 성인여성 20명을 선정 하였으며 집단은 일회성 발목 가동성 운동프 로그램 집단(Ankle mobility exercise program, AE, n=10)과 대조군(CON, n=10)으로 구분하였다. AE 처 치는 일회성 운동에 대한 반응을 확인하기 위해 좌·우측 발목을 각각 1회(20분) 실시하였으며 처치 전후 발목불안정성 검사, 통증 및 발목가동범위를 확인하였다. 먼저 AE 프로그램을 실시한 AE 집단의 통증 수 준은 사전과 비교하여 사후 유의하게 감소하는 것으로 나타났다(p<.01). 또한 AE 프로그램 처치한 AE 집 단에서 배측굴곡이 사전과 비교하여 증가하는 것으로 나타났다(p<.05). 이러한 결과를 종합해 보면 일회성 발목 가동성 운동 프로그램은 CAI에서 나타나는 발목 통증과 발목의 가동범위를 개선시켜 결과적으로 발 목 불안정성을 완화시킬 수 있는 효과적인 운동 중재 방법이라고 생각된다.

본 연구는 외발 착지 시 신체적 특성 요인들인 발목 유연성, 성별, Q-angle이 발목 관절 상해 요인들에 미치는 영향을 분석하는데 목적이 있었다. 이를 위해 오른발을 주발로 사용하고 체육을 전공하는 20대 남성 16명(나이: 20.19±1.78 years, 체중: 69.54±10.12 kg, 신장: 173.22±4.43 cm), 여성 16명(나이: 21.05±1.53 years, 체중: 61.75±6.97 kg, 신장: 159.34±4.56 cm)을 연구대상자로 선정하였다. 외발 착지 시 신체적 특성 요인들이 발목 관절 상해에 미치는 영향을 확인하기 위하여 첫째, 발목 상해 경험에 따른 하지 관절 움직임과 관절 모멘트의 독립 t-test를 실시하였다(α = .05). 둘째, t-test를 통하여 유의한 차이를 나타낸 변인을 종속변인으로 설정하고 발목 유연성, 성별의 차이, Q-angle을 독립변인으로 지정하여 선형다중회귀분석(Multiple Linear Regression)을 사용하였다(α = .05). 본 연구결과 발목 관절 상해를 경험한 그룹은 상해를 경험하지 않은 그룹과는 다르게 발목 관절의 내전, 무릎 관절의 내측 회전을 통한 착지 전략과 기술을 사용하는 것으로 나타났다. 또한 이러한 움직임은 발목 관절의 신전 모멘트를 증가시키고, 엉덩 관절의 신전 모멘트는 감소시키는 것으로 확인되었다. 특히 발목의 배측굴곡 유연성은 발목과 무릎의 착지전략에 영향을 미치며, 성별의 차이는 발목의 신전 모멘트에 영향을 미치는 것을 알 수 있었다. 따라서 외발 착지 시 신체적 특성 요인들이 발목 관절 상해에 영향을 미치는 요인들임을 확인 할 수 있었다.

본 연구의 목적은 딥 스쿼트 동작 시 발목 관절 유연성이 무릎 관절의 운동역학적 요인들간의 관련성을 분석하는데 있었다. 본 연구는 최근 1년간 하지 근골격계 병력이 없는 성인 남성 19명과 여성 8명이 연구대상자로 참여하였다. 딥 스쿼드 시 발목 관절 유연성과 하지 관절의 운동역학적 요인들과 상관관계를 검증하기 위해 pearson의 적률상관계수(pearson’s correlation coefficient)를 이용하였고(SPSS 24.0, Armonk, NY, USA), 통계적으로 유의미한 상관성을 나타낸 변인들은 단순회기분석(simple regression analysis)을 실시하였으며, 유의 수준은 .05로 설정하였다. 본 연구를 통해 발목 관절 유연성과 무릎 관절의 압력을 결정하는 최대 관절모멘트와 관절반발력 요인들 간의 관련성을 확인할 수 있었다. 그러므로 근력 트레이닝 시 딥 스쿼트와 같은 무릎 관절에 많은 부하를 발생시킬 수 있는 운동을 적용할 때 개인에 신체적 특성 중 발목 관절의 유연성의 정도를 확인하는 것은 신체의 안정성과 무릎 관절의 상해 위험성을 감소시킬 수 있는 운동 강도를 설정하는데 도움이 될 수 있을 것으로 기대한다.

본 연구의 목적은 유도 허벅다리걸기 기술 발휘 시 발목 관절의 테이핑 처치가 하지 관절과 압 력중심(COP, center of pressure)에 미치는 영향을 분석하는데 있었다. 대학 유도 선수 20명(연령, 20.9±0.8세; 신장, 168.6±7.4cm; 체중, 73.5±11.6kg; 신체질량지수, 25.7±2.6kg/m2)이 참여하였으며, 발목 관절 테이핑 처치 전과 후의 2가지 조건에서 허벅다리걸기 기술 발휘 시 지지다리 관절의 각도와 압 력중심 요인을 분석하여 다음의 결과를 도출하였다. E2(t=2.411, p=.027) E4(t=2.388, p=.029)시점에서 발목 관절의 각도는 테이핑 처지 전에 비해 처치 후 발목의 각도가 통계적으로 적은 수치를 나타내었고, E2(t=-2.343, p=.032) E3(t=-4.531, p=.000)시점에서 힙 관절의 각도는 통계적으로 크게 나타났다. 그리 고 발목 관절 테이핑 처치 후 좌·우의 COP 이동은 상대를 메치는 P3 국면에서 통계적으로 크게 나타났으 며(t=2.670, p=.016), 전·후의 COP 이동은 상대의 무게 중심을 기울이는 P1 국면에서 통계적으로 적은 수 치를 나타내었다(t=2.846, p=.011). 그러므로 허벅다리걸기를 특기로 사용하는 유도 선수들은 발목 관절 테이핑으로 인해 발생하는 지지관절의 운동 기능과 COP의 이동범위를 고려하여 사용하는 것에 대하여 제 안하고자 한다.

Background: Deficits of both ankle dorsiflexion range of motion (DFROM) and dynamic balance are shown in persons with chronic ankle instability and the elderly, with the risk of falls. Objects: This study aims to investigate the relationship between DFROM and dynamic balance in elderly subjects and young adults. Methods: Fifty-nine subjects were divided into three groups: ankle stability young group (SY), ankle instability young group (IY) and ankle stability older group (SO). We recruited three old subjects with ankle instability, but excluded them during a pilot testing due to the safety issue. DFROM was measured by weight bearing lunge test (WBLT) and dynamic balance was measured via star excursion balance test (SEBT) in anteromedial, medial, and posteromedial directions. The group differences in WBLT and SEBT and each group’s correlation between WBLT and SEBT were detected using the R statistical software package. Results: The dorsiflexion range of motion was significantly different between the SY, IY, and SO groups. The SO group showed the highest DFROM and IY group showed the lowest DFROM (SY: 45.88±.66˚, IY: 39.53±1.63˚, SO: 47.94±.50˚; p<.001). However, the SO group showed the lowest dynamic balance score for all SEBT directions (SY: 87.24±2.05 ㎝, IY: 83.20±1.30 ㎝, SO: 77.23±2.07 ㎝; p<.05) and there was no relationship between the dorsiflexion range of motion and dynamic balance in any group. Conclusion: Our findings suggest that ankle DFROM is not a crucial factor for dynamic stability regardless of aging and ankle instability. Other factors such as muscle strength or movement coordination should be considered for training dynamic balance. Therefore, we need to establish the rehabilitation process by measuring and treating ROM, balance, and muscle strength when treating young adults with and without ankle instability as well as elderly people.

Background: The multiple hop test is an active performance test that has been commonly used to assess individuals with functional ankle instability. Previous studies have suggested that insufficiency of dynamic postural stability and passive stability during dynamic activities can have an influence on performance in the multiple hop test. However, no study has investigated the effects of dynamic postural stability training and ankle bracing on multiple hop test performance in individuals with functional ankle instability. Objects: The purpose of this study was to compare the immediate effects of dynamic postural stability training versus ankle bracing in the performance of the multiple hop test for participants with functional ankle instability. Methods: Twenty-nine participants with functional ankle instability who scored below 24 in the Cumberland Ankle Instability Tool were selected. The participants were randomly divided into two groups: a dynamic postural stability training group (n1=14) and an ankle bracing control group (n2=15). The multiple hop tests were performed before and after applying each intervention. Dynamic postural stability training was performed using visual-feedback-based balance-training equipment; participants in this group were asked to perform a heel raise in a standing position while watching the centering of their forefoot pressure to prevent excessive ankle inversion. Ankle bracing was applied in the control group. Results: When comparing the pre- and post-intervention period for both groups, both methods significantly improved the results of the multiple hop test (p<.05). However, no significant differences were shown between the dynamic postural stability training and ankle bracing groups (p>.05). Conclusion: Both dynamic postural stability training and ankle bracing showed significant improvement (2.85 seconds and 2.05 seconds, respectively) in test performance. Further study is needed to determine the long-term effects of dynamic postural stability training and to determine whether insufficient dynamic postural stability is a causative factor for functional ankle instability.

The common features of walking in patients with stroke include decreased gait velocity and increased asymmetrical gait pattern. The purpose of this study was to identify important factors related to impairments in gait velocity and asymmetry in chronic stroke patients. The subjects were 30 independently ambulating subjects with chronic stroke. The subjects’ impairments were examined, including the isokinetic peak torque of knee extensors, knee flexors, ankle plantarflexors, and ankle dorsiflexors. Passive and active ranges of motion (ROM) of the ankle joint, ankle plantarflexor spasticity, joint position senses of the knee and ankle joint, and balance were examined together. In addition, gait velocity and temporal and spatial asymmetry were evaluated with subjects walking at their comfortable speed. Pearson correlations and multiple regressions were used to measure the relationships between impairments and gait speed and impairments and asymmetry. Regression analyses revealed that ankle passive ROM and peak torque of knee flexors were important factors for gait velocity (R2=.41), while ankle passive ROM was the most important determinant for temporal asymmetry (R2=.35). In addition, knee extensor peak torque was the most significant factor for gait spatial asymmetry (R2=.17). Limitation in ankle passive ROM and weakness of the knee flexor were major contributors to slow gait velocity. Moreover, limited passive ROM in the ankle influenced the level of temporal gait asymmetry in chronic stroke patients. Our findings suggest that stroke rehabilitation programs aiming to improve gait velocity and temporal asymmetry should include stretching exercise for the ankle joint.

The purpose of this study was to examine the relationships between the ankle dorsiflexion passive range of motion (DF PROM) under a non-weight bearing condition and the normalized reach distance in three directions of the Y-Balance Test (YBT). Sixty-one healthy adults (32 males and 29 females, age: 23.0±3.0 years, height: 169.3±8.9 ㎝, weight: 61.9±5.4 ㎏) participated in this study. The ankle DF PROM was measured using a goniometer. To assess dynamic balance, all subjects performed three trials to determine the maximum lower extremity reach in the anterior, posteromedial, and posterolateral directions of the YBT. The relationship between the ankle DF PROM and both the normalized reach distance in each direction and the composite score of the YBT were analyzed using the Pearson correlation. Only the normalized reach distance in the anterior direction of the YBT was significantly related to the ankle DF PROM measured under a non-weight bearing condition (r=.50, p＜.001). Neither the normalized reach distances in the posterior directions nor the composite score of the YBT were significantly correlated with the ankle DF PROM measured under a non-weight bearing condition. These findings suggest that ankle DF PROM does not affect the overall dynamic balance of the lower extremity, with only the anterior dynamic balance affected among the three directions.

The purpose of this study was to compare the change in electromyography (EMG) activity in the gluteus maximus (G-max) and the gluteus medius (G-med) in subjects with and without chronic ankle instability (CAI) during three functional postures. Twenty four females were recruited for this study. Subjects were assigned into two groups: with CAI (n1=12) and without CAI (n2=12). The assessment postures were rotational squat, one leg stand above a gradient and crossed leg-sway. Electromyographic activities of the G-max and the G-med were recorded using surface EMG and was normalized using the maximal voluntary isometric contraction elicited using a manual muscle testing. Independent t-test was used to determine the statistical differences between two groups during the three functional postures. The comparisons of the three posture between two groups were performed using a one-way repeated analysis of variance. A Bonferroni adjustment used for post hoc analysis. The activation of EMG on G-max performing the one leg stand above a gradient and crossed leg-sway in subjects with CAI is significantly higher than normal group (p<.05). The activation of EMG on the G-max during the rotational squat was significantly increased, compared to those of the one leg stand above a gradient and crossed leg-sway (p<.05). The activation of EMG on G-med performing three exercise at CAI is significantly higher than normal group (p<.05). The activation of EMG on the G-med during the crossed leg-sway was significantly increased, compared to the rotational squat (p<.05). This study provides valuable information for clinician who research CAI.

The purpose of this study was to investigate the immediate effect of fabric ankle-foot orthosis on spatiotemporal gait parameters, compared to a barefoot condition in children with spastic cerebral palsy. Eleven children with spastic cerebral palsy participated in this study. Spatiotemporal gait parameters were measured with the GAITRite system. Fabric ankle-foot orthosis significantly improved Timed Up and Go test time and gait velocity. There was no significant difference in cadence. The step time significantly improved in both the more and less affected foot compared to the barefoot condition. The step length of the affected foot also significantly improved, but there was no significant difference in the step length of the less affected foot. There was significant improvement in the stride length of both the affected and less affected foot, but no significant difference in single stance or double stance. The fabric ankle-foot orthosis could improve stability, and selective control of the joint and promote better walking in children with cerebral palsy. Consequently, the fabric ankle-foot orthosis might be an alternative assistive device for neurological populations as a primary role instead of the typical ankle-foot orthosis.

The purpose of this study was to examine the differentiation of proprioception, invertor and evertor muscle strength, and time to peak torque at a velocity of 300 °/sec of the ankle joint in people with or without functional ankle instability (FAI). Nineteen subjects with a history of ankle sprain participated. All subjects were divided into FAI group (n1=9, Cumberland ankle instability tool (CAIT)≤24) and a control group (n2=10) based on their CAIT scores. Isokinetic dynamometer was used to measure the sense of active joint position of the ankle at mid-range and end-range of an inversion motion and invertor as well as the evertor muscle strength and time to peak torque at 300 °/s. The FAI group showed a statistically reduction in invertor and evertor muscle strength and time to peak torque when compared to the control group (p<.05). Muscle strength and time to peak torque of the invertor and evertor, as well as the sense of active joint position at end-range were also lower in the FAI group than in the control (p<.05). Correlations between CAIT score and position sense at end-range (r=-.577) and invertor muscle strength (r=.554) were statistically significant (p<.05). Individuals with FAI showed reduction in invertor and evertor muscle strength and recruitment time as well as in proprioception of the ankle joint. Thus, proprioception and invertor and evertor muscle strength of the ankle joint at fast angular velocity may be investigated when examining and planning care for individuals with FAI.

The purpose of this study was to determine the effect of ankle joint mobilization with movement (MWM) on the range of motion (ROM) in the ankle, on the muscle strength of lower extremities, and on spatiotemporal gait parameters in chronic hemiplegic patients. Fifteen subjects with chronic stroke were divided into two groups: an experimental group (8 subjects) and a control group (7 subjects). Both groups attended two or three sessions of physical therapy each week. The experimental group also attended additional MWM training sessions three times a week for five weeks. For both groups, the ROM of the ankle, the muscle strength of the lower extremities, and the spatiotemporal gait parameters in paretic limbs were evaluated before and after the training period. The results showed that the experimental group experienced more significant increases than did the control group in terms of passive (6.10%) and active (21.96%) ROM of the ankle, gait velocity (12.96%), and peak torque, of the knee flexor (81.39%), the knee extensor (24.88%), and the ankle plantar flexor (41.75%)(p<.05). These results suggest that MWM training in patients with chronic stroke may be beneficial in increasing ROM in the ankle, muscle strength in the lower extremities, and gait speed.

In chronic ambulatory hemiplegic patients, structural changes might be developed at both ankles possibly due to unequal and repetitive weight bearing on tendons and ligaments. We examined ankles by sonography to find out structural changes of tendons and ligaments of both ankles in ambulatory hemiplegic patients. Nineteen ambulatory hemiplegic patients over 1 year were included as study subjects. All subjects had no previous trauma or disease history in their ankle joints and they were able to walk independently or with supervision but had spastic ankles with equinovarus tendency. We examined both ankle joints by sonography to see joint effusion and measure width, thickness, and area of tendons of the tibialis anterior, tibialis posterior, and Achilles, and also ligaments of the anterior talofibular and calcaneofibular. We compared sonographic features of the hemi-side ankle with the sound-side ankle. There were no significant differences between hemi-side and sound-side ankles in almost all measured parameters of tendons and ligaments. However, the width of the hemi-side tibialis posterior tendon (8.61±1.37 mm) was narrower than the sound-side tendon (7.24±1.52 mm). With the amount of active joint motion and weight bearing possibly preventing ligament and tendon atrophy even though marked weakness, spasticity occurred during the chronic hemiplegic phase.

In dancers, intact muscular coordination is a well balanced antagonist, which could be a decisive factor in protection against injury as dancers often have hypermobile joints and their ankle joints often bear their full body weight in extreme positions. The purposes of this study were to identify the isokinetic strength to the knee and ankle and the isometric strength of the trunk in female collegiate dancers and controls. Furthermore, the study aimed to investigate the peak torque ratio of knee extension to flexion, ankle plantarflexion (PF) to dorsiflexion (DF), and dominant legs to nondominant. Twenty-one female collegiate dancers (20.0 years of age) and twenty-one female collegiate students (19.3 years of age) performed isokinetic maximum efforts of the knee extensors and flexors at and , the ankle plantarflexors and dorsiflexors at and and isometric maximum efforts of the lumbar extensors at 0˚, 12˚, 24˚, 36˚, 48˚, 60˚, and 72˚. The results were as follows: The isokinetic peak torque of the knee extensors and the ratio of knee extensors to flexors of dancers were significantly higher than those of controls (p<.01). However, the isometric peak torque of the back extensors (p<.01) and isokinetic peak torque of the ankle plantarflexors and dorsiflexors (p<.05) of dancers were significantly lower than those of controls. Further studies are needed to identify the difference in proprioception of the joints between dancers and controls.

This study was designed to examine the effects of temporary immobilization of the ankle and knee joints on standing in healthy young adults with the use of a postural control mechanism. The subjects were twenty-four college students (12 males and 12 females, aged between 20 and 28). A Biodex balance system SD 950-302 and its software were used to measure indirect balance parameters in standing. Each subject underwent postural stability tests in 4-different joint conditions: free joints, ankle immobilization only, knee immobilization only, and ankle and knee immobilization. In addition, the postural stability test was conducted once with the subject's eyes open and once with the eyes closed conditions. For data analysis of the postural stability tests, the overall stability index, antero-posterior stability index, and medio-lateral stability index were recorded. The overall stability index (p=.000) and medial-lateral index (p=.003) were significantly greater different conditions with eyes closed in postural stability. Therefore, the eyes closed condition is expected to be used as an effective postural stability training for treatment planning in patients with unstable postures. In addition, training based on the dynamic multi-segment model can improve postural stability and is available to therapeutic programs, helping people with unstable balance to reduce their risk of falling.

Reductions in strength and range of motion in older persons have been associated with decreased functional mobility and risk of falls. The purpose of this research was to investigate the effect of intensive dynamic balance exercise (DBE) during 8 weeks on onset time of medial gastrocnemius and tibialis anterior muscle contraction after perturbation in older women. Thirty subjects were randomly assigned into DBE group or control group. The DBE group participated in 50 minutes 3 days a week for 8 weeks. Surface electromyography (EMG) activity was recorded from the medial gastrocnemius and tibialis anterior muscles of left side. Outcome data were collected both groups at the pre-exercise and post-exercise. Independent t-test and paired t-test were used to determine the statistical difference. Results showed that the passive range of motion and functional reach test were significantly increased in the DBE group than the control group at the post-exercise (p<.05). The onset time of both muscles and discrepancy of onset time significantly reduced in the DBE group than the control group at the post-exercise (p<.05). The onset time of both muscles were significantly reduced in the post-exercise than the pre-exercise in the DBE group (p<.05). The discrepancy of onset time in the DBE group was significantly reduced in the post-exercise than the pre-exercise (p<.05). These findings suggest that intensive dynamic balance exercise for the eight weeks was effective in improving the postural control with older persons.

The purpose of this study was to evaluate the effect of concurrent and reciprocal isometric contraction and angle of ankle joint on fatigue of concentrically contracting contralateral dorsiflexor and plantar flexor. Seventeen able-bodied subjects participated in the study. Concurrent and reciprocal isometric contraction were performed under three different ankle joint angles (dorsiflexion, neutral position, plantar flexion). During concurrent or reciprocal isometric contraction. fatigue of concentrically contracting contralateral tibialis anterior, gastrocnemius, and soleus was investigated and compared. There was no interaction between different ankle joint angles and direction of isometric contraction (p<.05). No significant differences were found among three different ankle joint angles (p<.05). Contralateral muscle fatigability was lower in reciprocal isometric contraction than that in concurrent isometric contraction (p<.05). Therefore, the findings of this study suggest that reciprocal isometric contraction is more beneficial than concurrent isometric contraction inducing less fatigability during contralateral concentric contraction.

The purpose of this study was to investigate the effects of the increasing ankle range motion program on ambulation and balance for the elderly with balance disorder. Eighteen elderly subjects were administered with a timed test twice; approximately 4 weeks apart. The exercise group participated in a fall prevention exercise class at the Y.S. Senior Welfare Center of the Seoul Metropolitan Government. The session consisted of a stationary cycle, static stretching ankle joints, balance boards, and progressive resistive exercises using the Thera-band. The results were as follows: Firstly, the increasing ankle range of motion program was effective on the exercise group. Gait-speed was improved (p<.005). Secondly, balance was significantly improved (p<.000). Thirdly, increasing ankle range of motion program was effective in ankle dorsiflexion which was the major risk factor for falls among the elderly. Differences in gait and balance between the groups were examined using a paired t-test (p<.05). The exercise group demonstrated significantly higher values of gait-speed, ankle range of motion, and balance when compared with the non-exercise group. The results of this study suggest that the increasing ankle range of motion program is an effective intervention for the elderly with balance disorder.

이 연구의 목적은 발목에 테이핑을 한 후 40 cm의 높이에서 한 발로 수직착지를 할 때 발목관절에서의 테이핑 효과를 분석하는 것이었다. 대상자는 20대의 건강한 성인 14명(남자 4명, 여자 10명) 이었다. 대상자에게 적용한 조건은 테이핑 전, 테이핑 적용, 30분 동안 트레드밀에서 걷기, 테이핑 제거상태 이었고 맥리플렉스(MacReflex)를 이용하여 발끝이 지면에 닿은 상태에서 발목이 최대 배측굴곡(dorsiflexion) 되기까지 걸린 시간,