Background: The Nordic hamstring exercise is a closed-chain exercise that effectively activates all lower extremity muscles, but there is a lack of consideration of ankle joint which affects exercise effectiveness. One of the major advantages of the Nordic exercise have been known as strengthening lower extremity extensors. This manifests the exercise increases activities of the ankle plantar flexors as well as hip extensors. Objectives: To investigated the impacts of changes in ankle position on the lower extremity musculature and subjective difficulties during the Nordic hip extension exercise. Design: Cross-sectional study. Methods: Twenty the healthy male participants participated in this study. Participants perform three variations of the Nordic exercises including three ankle positions. Each Nordic exercise was defined as ankle position (neutral, dorsiflexion and plantar flexion). During the Nordic exercise, erector spine (ES), gluteus maximus (GM), biceps femoris (BF), gastrocnemius (GCM) activities and subjective difficulties (Borg RPE score) were measured. Results: Muscular activities of the biceps femoris and gastrocnemius were significantly different among the three ankle conditions, which showed controversial results (P<.05). The biceps femoris activity was significantly higher with the dorsiflexion condition, compared to the others (P<.05). On the other hand, activity of the gastrocnemius was significantly higher with the plantarflexion position compared to the others (P<.05). Conclusion: Present study suggests the ankle positional changes could affect lower muscular activities during the Nordic exercise. Although it is difficult to affirm the causes due to limited data, selective activation of the biceps femoris might accomplish with ankle dorsi flexion and that of the gastrocnemius might accomplish with the ankle plantarflexion during the Nordic exercises.

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.

Background: Ankle sprain is one of the most common musculoskeletal injuries in the sports population or during usual daily life activities. The sprain can cause functional ankle instability (FAI), and it is very important to treat FAI. However, the optimum intervention method for FAI has yet to be determined. Objects: This study investigated the impact that virtual reality (VR) training program on balance with ankle kinesio taping for FAI. Methods: Twenty-two people were selected for the study and randomly divided into the experimental (n = 11) and the control group (n = 11). The experimental group had attached kinesio taping on the ankle and then implemented a virtual reality exercise program for 30 minutes a day. Nintendo Wii Fit Plus was used for the VR intervention three times a week for four weeks. The control group performed only two measurements without intervention. Results: There were no statistically significant differences in overall, anterior-posterior (AP), medial-lateral (ML) index of the static balance, and significant differences in overall, AP, ML index of the dynamic balance when taping and VR exercise were applied at the same time (p < 0.05). There were no significant differences in overall and ML index of static and dynamic balance compared with before and after assessment between the experimental and the control group, and found differences in AP index of static and dynamic balance (p < 0.05). Conclusion: Kinesio taping may not influence the balance of FAI as great as people expected. VR approach does not affect the static balance of FAI, but it influences dynamic balance in overall, AP, ML index. The authors suggest that VR-based exercises can be used as an additional concept in clinicians for FAI or as part of a home program because the exercises still have limitations.

Background: Vibration exercise after ankle surgery improves proprioception and ankle muscle strength through vibration stimulation. Objective: To examine the effects of vibration exercise on the ankle stability. Design: Randomized controlled clinical trial (single blind) Methods: Twenty soccer players were randomly divided into experimental group and control group. The Vibration exercise program was conducted 12 weeks and 3 times a week. Ankle joint proprioceptive sensory test and Isokinetic muscle strength test were performed using Biodex system pro Ⅲ to measure plantar flexion / dorsiflexion and eversion / inversion motion. Results: The result of isokinetic test of ankle joint is showed significant improvement in all measurement items, such as leg flexion, lateral flexion, external and internal muscle forces, compared to previous ones by performing vibration movements for 12 weeks. However, in the comparison group, plantar flexor (30°), eversion muscle (120°), inversion (30°) of limb muscle strength were significantly improvedcompared with the previous phase; was no significant difference in dorsi-flexion. There was no significant difference between groups in all the items. Conclusions: In this study, we analyzed the effects of rehabilitation exercise on soccer players who had reconstructed with an ankle joint ligament injury through vibration exercise device. As a result, we could propose an effective exercise method to improve the ability, and confirmed the applicability as an appropriate exercise program to prevent ankle injuries and help quick return.

Background: Functional ankle instability (FAI) indicating a decrease in muscle strength, proprioception, neuromuscular control, balance and postural control function. Objective: To investigate the effect of jumping exercise on the supporting surface on the ankle muscle thickness, proprioceptive sensation, and balance in adults with FAI. Design: Randomized Controlled Trial. Methods: Twenty young people with FAI were randomly assigned to the unstable supporting surface jump group (N=10) and the stable supporting surface jump group (N=10). The intervention was conducted three times a week for eight weeks, and for 30 minutes per session. Trampoline was used as an unstable support surface and the stable support surface was carried out on a regular floor. The thickness of the tibialis anterior muscle and medial gastrocnemius muscle was measured by ultrasonography, and the proprioception of dorsiflexion and plantarflexion was measured using an electrogoniometer. The dynamic balance was also measured with a balance meter. Results: The the muscle thickness of the medial gastrocnemius muscle was significantly higher in the stable supporting surface jump group than in the unstable supporting surface jump group (p<.05). Furthermore, the plantar flexion proprioception and dynamic balance were significantly improved in the unstable supporting surface jump group than in the stable supporting surface jump group in the intergroup comparison (p<.05). Conclusions: The conclusion has been reached in this study that the jumping exercise on the unstable supporting surface could be a more effective in improving FAI than the regular surface.

The purpose of this study was to identify the effect of proprioceptive neuromuscular facilitation (PNF) stretching exercise and joint mobilization on ankle joint range of motion (ROM), plantar pressure, and balance in subjects with stroke. Thirty patients (n=30) were organized into three groups, each of which received different treatments: PNF stretching (n=10), joint mobilization (n=10), and joint mobilization and PNF stretching combined (n=10). Each group received three exercise sessions per week for four weeks. The ankle ROM was measured using a goniometer, and plantar pressure and balance ability were measured using BioResque static posturography. In comparison within each group, the joint mobilization group and the joint mobilization with PNF stretching group showed significant improvements in ankle ROM, plantar pressure, and balance ability (p<.05). In comparison between the groups, a statistically significant difference was found in SECS change between the PNF stretching group, joint mobilization group and the joint mobilization with PNF stretching group. This study found demonstrates that the joint mobilization and joint mobilization with the PNF stretching methods were effective in improving ankle ROM, plantar pressure, and balance ability in stroke patients.

The purpose of this study was to investigate the effects of sling exercise on muscle activity and balance on football players with chronic ankle instability. Eight subjects performed Biodex and sling exercises for four weeks and compared the muscle activity and balance ability of the uninjured and injured feet. Stable and unstable foot % MVIC did not change significantly after treatment in all muscles. The total balance ability was not significantly different between the two groups, however, increased only in the unstable side. The anterior/posterior balance ability also represented no significant difference between the groups and was significantly improved only in the unstable side. The medial/lateral balance ability was not significantly different between the groups and was significantly improved only in the unstable side. This study suggests that sling exercise contributes to improving % MVIC, total balance ability, anterior/ posterior balance ability, and medial/lateral balance ability of the unstable side.

The purpose of this study was to investigate the effect of heel off stairway walking exercise on the increase of muscle activity and balance activity of the ankle joint muscles in university students with functional ankle instability. The conservative treatment for the control group consisted of stairway walking (n=10) and the experimental group consisted of heel off stairway walking (n=11). The therapeutic intervention of the control and experimental groups was performed a total of 12 exercise sessions, 3 times per week for 4 weeks. To compare the two groups, the level of ankle disability was assessed by using the EMG, BT4 and Pedoscan in pre-treatment and post-treatment. Muscle activity increased in both the experimental groups and control groups in each group, however there was no significant difference between the groups. Balance ability did not show any significant difference. This study demonstrates that heel-off stairway walking is effective in significantly increasing muscle activity, however did not significantly improve balance ability.

The purpose of this study was to assess the effects of Ankle exercise on balance ability of stroke patients. Participants' balance ability were measured prior to the training and they conducted ankle exercise. As for ankle exercises, ankle stretching training and ankle muscle strengthening training were performed for 10 minutes respectively. They did warm up exercise for 5 minutes and then ankle exercise for 20 minutes. And then they did cooldown exercise for 5 minutes. Their balance ability was measured after 9 weeks. According to the results of analyzing the change of balance ability that timed up and go and Berg balance scale score significantly improved but in the control group it did not significantly decrease. In comparison between the groups, Berg balance scale score significantly improved in the ankle exercise group compared to the control group. Ankle exercise performed by stroke patients are considered to be effective in improving balance ability.

Background: Total knee arthroplasty (TKA) recovers the alignment of the knee joint, but fails to automatically restore the alignment and function of the hip and ankle joints. It may affect the alignment and stability of the knee joint, therefore therapeutic intervention in hip and ankle joint is necessary for the rehabilitation process after TKA. Objects: The aim of this study was to comparison of the effects of the two exercise methods on the coronal plane alignment after TKA. This study conducted an experiment by dividing subjects into a lower extremity isometric co-contraction group (LEIC) and a quadriceps isolated isometric contraction (QIIC) group. Methods: A total of 37 subjects were randomly assigned to the LEIC (n1=19) or the QIIC (n2=18). Exercise was applied to five times per week for three weeks, starting on the eighth day after surgery. Range of motion exercises were performed as a common intervention and then each group performed quadriceps isometric contraction exercises with 10 sets of 5 repetitions. Radiological imaging was performed prior to surgery, one month and six months after surgery. In addition, the hip-knee-ankle angle (HKA) and tibiotalar angle (TTA) were measured. Results: The HKA was close to neutral in the LEIC rather than the QIIC (p<.05). The LEIC showed varus and the QIIC exhibited valgus TTA (p<.05). In a comparison of HKA and TTA over time, there was no significant change in either group (p>.05). According to the comparison of the TTA before surgery, the LEIC showed significant changes in the varus direction (p<.05), while there was no significant change in the QIIC (p>.05). Conclusion: The LEIC method triggered changes in the TTA and brought the HKA close to the neutral. Thus, LEIC is more effective than QIIC in creating stability in the coronal plane alignment of the knee and ankle joints after TKA.

The range of motion (ROM) of ankle dorsiflexion in older women was associated with gait abnormalities and the risk of falls. The purpose of this study was to investigate the effect of self-stretching exercise on the flexibility of the plantar flexors of the ankle and the characteristics of gait in healthy elderly women. Fifteen participants were assigned randomly into an exercise (n=8) or control (n=7) group. The exercise group attended a self-stretching program approximately 30 minutes for 3 days per week for 4 weeks. The active ankle dorsiflexion ROM and gait measurements were taken prior to beginning the stretching program and 1 day after the last stretching day. Results showed that the active ankle dorsiflexion ROM was significantly increased in the exercise group than in the control group after the stretching program (p<.05). However, gait parameters, including gait speed, cadence, and stride length were not significantly different between the two groups (p>.05). The results suggest that a 4-week self-stretching program is capable of provoking a significant increase in ankle dorsiflexion ROM in elderly, community-dwelling women. Additional research is needed to investigate the effect of gait-specific exercise combined with stretching exercise on gait ability.

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.

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,

This study was conducted to determine the effects of deep breathing exercise and ankle exercise on blood flow velocity in the femoral vein. Sixteen healthy male students were recruited from Yonsei University, at Wonju. The blood flow velocities in the femoral vein were measured under three different conditions: resting, deep breathing, and ankle exercise. All subjects were given a 5-minute relaxing time in supine position prior to the study. Using a doppler ultrasound with a 8 MHz probe, the peak blood flow velocities were collected in a twenty-second-period at each condition. The subjects took a rest in between trials for the blood flow to return to its resting levels. The result showed a significant difference in peak blood flow velocities under those three conditions (p<.001). The peak blood flow velocity was highest in ankle exercise condition. The peak blood velocity was significantly higher in deep breathing condition compared with the resting condition. As a result, it is revealed that not only the muscular contractions but also the deep breathing exercises induced facilitating effects of venous return. Either of the exercise methods can be recommended to prevent blood stasis in patients with risk of deep vein thrombosis after cardiac or lower extremity surgery.ㅂ