what motion needs to be neutralized during dorsiflexion
J Athl Railroad train. 2011 January-Feb; 46(one): 5–10.
Ankle-Dorsiflexion Range of Motion and Landing Biomechanics
Chun-Man Fong
*Athletic Training Services, Boston University, MA
J. Troy Blackburn
†Neuromuscular Research Laboratory, University of N Carolina at Chapel Loma
Marc F. Norcross
†Neuromuscular Research Laboratory, University of Due north Carolina at Chapel Hill
Melanie McGrath
‡Department of Health, Physical Instruction, and Recreation, Academy of Nebraska, Omaha
Darin A. Padua
§Sports Medicine Enquiry Laboratory, University of North Carolina at Chapel Colina
Abstract
Context:
A smaller amount of ankle-dorsiflexion displacement during landing is associated with less knee-flexion deportation and greater footing reaction forces, and greater basis reaction forces are associated with greater genu-valgus displacement. Additionally, restricted dorsiflexion range of move (ROM) is associated with greater knee-valgus displacement during landing and squatting tasks. Considering large ground reaction forces and valgus displacement and limited knee-flexion displacement during landing are anterior cruciate ligament (ACL) injury risk factors, dorsiflexion ROM restrictions may be associated with a greater risk of ACL injury. Even so, it is unclear whether clinical measures of dorsiflexion ROM are associated with landing biomechanics.
Objective:
To evaluate relationships between dorsiflexion ROM and landing biomechanics.
Design:
Descriptive laboratory study.
Setting:
Research laboratory.
Patients or Other Participants:
30-five healthy, physically active volunteers.
Intervention(s):
Passive dorsiflexion ROM was assessed under extended-knee joint and flexed-knee conditions. Landing biomechanics were assessed via an optical motion-capture organization interfaced with a force plate.
Main Event Measure(s):
Dorsiflexion ROM was measured in degrees using goniometry. Articulatio genus-flexion and human knee-valgus displacements and vertical and posterior ground reaction forces were calculated during the landing task. Simple correlations were used to evaluate relationships between dorsiflexion ROM and each biomechanical variable.
Results:
Significant correlations were noted betwixt extended-knee dorsiflexion ROM and articulatio genus-flexion displacement (r = 0.464, P = .029) and vertical (r = −0.411, P = .014) and posterior (r = −0.412, P = .014) ground reaction forces. All correlations for flexed-knee dorsiflexion ROM and knee-valgus deportation were nonsignificant.
Conclusions:
Greater dorsiflexion ROM was associated with greater knee-flexion deportation and smaller ground reaction forces during landing, thus inducing a landing posture consistent with reduced ACL injury risk and limiting the forces the lower extremity must blot. These findings suggest that clinical techniques to increment plantar-flexor extensibility and dorsiflexion ROM may exist important additions to ACL injury-prevention programs.
Keywords: flexibility, extensibility, kinematics, kinetics, anterior cruciate ligament, force attenuation
Anterior cruciate ligament (ACL) injury typically occurs during athletic participation via a noncontact mechanism involving planting, pivoting, or landing (or a combination of these).i A smaller amount of knee-flexion displacement, greater knee joint-valgus deportation, and greater vertical and posterior ground reaction forces during landing purportedly increase ACL loading and injury chance.2 – ,4 These biomechanical factors are interrelated, in that "stiff" landings characterized by an erect landing posture and less sagittal-plane displacement result in greater ground reaction forces than a more flexed landing posture.5 , 6 Similarly, greater footing reaction forces are associated with greater articulatio genus-valgus displacement and moment.ii
The joints of the lower extremity function in concert in the sagittal plane to benumb landing forces, such that greater motion at one articulation is typically accompanied past greater motion at side by side joints.5 , vii , 8 Although almost authors studying ACL injury and landing biomechanics have focused on the knee and hip, considerably less attending has been devoted to the talocrural joint. The ankle plantar flexors play a substantial function in the absorption of landing forces,5 , 9 and a smaller corporeality of sagittal-plane ankle displacement (dorsiflexion) during landing results in greater summit landing forces.five , viii , x Additionally, the sagittal-airplane coupling of the lower extremity jointsfive , vii suggests that less dorsiflexion deportation during landing is accompanied past less articulatio genus-flexion and hip-flexion displacement. This notion is supported by Kovacs et al,viii who reported greater vertical basis reaction forces and smaller dorsiflexion, knee-flexion, and hip-flexion displacements during heel-to-toe landings than with forefoot-commencement landings. Hagins et aleleven restricted the available dorsiflexion range of movement (ROM) during landing past having participants land on an inclined surface and reported greater human knee-valgus displacement and posterior footing reaction forces compared with landing on a apartment surface that permitted full dorsiflexion displacement. Similarly, Sigward et al12 demonstrated that individuals with less passive dorsiflexion ROM demonstrated greater knee-valgus circuit during landing. Furthermore, Bell et al13 noted that medial articulatio genus displacement (valgus) during a controlled squatting task was diminished when the bachelor dorsiflexion ROM was increased by placing a wedge under the calcaneus, indicating that dorsiflexion ROM influences frontal-plane human knee move. In combination, these results propose that restricted dorsiflexion ROM may increase ACL loading and injury chance via association with less knee-flexion displacement, greater knee-valgus deportation, and greater basis reaction forces during landing.
Ankle-dorsiflexion ROM can be increased via a diverseness of training and clinical techniques.14 – ,16 Thus, dorsiflexion ROM is a modifiable gene that may serve as a mechanism by which ACL injury chance can exist attenuated. Yet how clinical measures of dorsiflexion ROM influence landing biomechanics is unclear. The study from the most contempo consensus meeting on noncontact ACL injuries indicated that "little information exist regarding the feasibility and effectiveness of screening the 'at-hazard' population."4(p1527) Identifying clinically based assessments that discriminate this at-adventure population would exist invaluable for ACL injury-prevention efforts. Therefore, the purpose of our investigation was to evaluate the relationships betwixt clinical measures of dorsiflexion ROM and human knee-flexion deportation, knee-valgus displacement, and vertical and posterior ground reaction forces during landing. Nosotros hypothesized that greater dorsiflexion ROM would be associated with (1) smaller vertical and posterior ground reaction forces, (ii) less knee joint-valgus displacement, and (iii) greater knee-flexion displacement, thereby placing the lower extremity in a position consistent with reduced ACL loading and injury take a chance.
METHODS
Participants
Thirty-five physically active individuals (17 men, 18 women; age = 20.5 ± 1.v years, acme = 1.7 ± 0.one grand, mass = 73.four ± 14.1 kg) volunteered for this study. Exclusion criteria (determined by questionnaire) were existing neurologic and lower extremity chronic atmospheric condition, history of acute lower extremity injury within the 6 months earlier data collection, and history of lower extremity surgery. All data were collected in a single testing session, and all procedures were conducted on the dominant leg, defined as the leg used to kick a ball for maximum altitude. All participants read and signed an approved informed consent document earlier data collection. The study was canonical by the university'southward institutional review board.
Procedures
Passive ankle-dorsiflexion ROM was measured in 2 positions (extended knee and flexed knee) using a standard manual goniometer. For the extended-knee assessment, volunteers were seated on a treatment table with the knees fully extended (0°) and the feet hanging off the end of the table. For the flexed-articulatio genus assessment, they were seated with the popliteal space at the border of the tabular array and the knees in 90° of flexion. Goniometric measurements were taken to confirm proper knee-flexion angles before ROM measurements. For each ROM measurement, the participant was completely relaxed; the investigator passively moved the ankle into dorsiflexion from a neutral starting position (ie, ninety° angle between shank and foot segments) until a firm end feel was elicited. The axis of the goniometer was centered over the lateral malleolus and the arms were aligned with the fibular shaft and the caput of the fifth metatarsal. Five measurements were taken in each position. All ROM measurements were collected by the same investigator (C.Thou.F.), and analysis of these data revealed high reliability and precision beyond trials (extended-human knee assessment: intraclass correlation coefficient [three,i] = 0.xc, standard mistake of measurement = i.eight°; flexed-knee assessment: intraclass correlation coefficient [3,1] = 0.84, standard error of measurement = 2.6°).
Lower extremity biomechanical data were sampled during a landing task using a seven-camera motility-capture system (Vicon Movement Systems, Centennial, CO) interfaced with a force plate (Bertec Corporation, Columbus, OH). Participants were fitted with spandex shorts and shirt, and 25 retro-reflective markers were practical bilaterally over the acromion processes, anterior-superior iliac spines, greater trochanters, inductive thighs, medial and lateral femoral epicondyles, anterior shanks, medial and lateral malleoli, calcaneus, and first and fifth metatarsal heads using double-sided tape; a single marker was placed on the sacrum. Markers used to represent anatomical landmarks on the foot segment were placed over the volunteer's shoes in estimated locations. Markers were digitized from a static trial during which the participant stood as motionless every bit possible with the arms abducted to 90° to create a segment-linkage model of the lower extremity. Knee-articulation and ankle-joint centers were divers as the midpoints between markers on the medial and lateral epicondyles and malleoli, respectively. These medial markers were then removed for landing trials. The location of the hip-articulation center was estimated from the digitized markers on the left and right anterior-superior iliac spine as described by Bell et al.17
Landing trials began with participants standing atop a box xxx cm in height placed 40% of the person's height from the leading edge of the force plate. He or she was instructed to jump off the box horizontally and land on both feet, with the dominant foot positioned on the force plate. This task represents a hybrid of the driblet landing6 , 18 and the jump landing3 used in previous research considering we wanted to target characteristics of both maneuvers. Specifically, the drib spring is primarily vertical in nature; thus, it does not mimic the horizontal-loading components that typically accompany dynamic tasks. Additionally, musculus activity during the bound landing is used to resist the downward acceleration of the body and to produce lower extremity extension to propel the trunk upward on the subsequent vertical bound. Considering nosotros were especially interested in the loading phase of the landing and how dorsiflexion ROM influenced landing biomechanics during this phase, we chose to include but the landing portion of the jump landing so that any associated muscle action would be used for controlling downward acceleration. Volunteers were allowed up to iii practice trials to familiarize themselves with the task. Lower extremity kinematics and kinetics were sampled during the jump-landing chore, with the first v successful trials used for information assay. Unsuccessful trials occurred when participants landed with whatsoever portion of the dominant foot off the strength plate or lost their balance subsequently landing; these trials were discarded and repeated until 5 successful trials were obtained.
Information Sampling and Reduction
Kinematic and kinetic data were sampled at 150 Hz and 1500 Hz, respectively, and fourth dimension synchronized using Vicon Nexus motion-capture software (Vicon Motility Systems). Raw three-dimensional marker coordinates and basis reaction forces were imported into MotionMonitor software (Innovative Sports Preparation, Inc, Chicago, IL) and low-pass filtered at ten Hz (fourth-order Butterworth). The global axis system was established such that the positive x-axis, y-axis, and z-axis represented forward, left, and upward directions, respectively. Genu-articulation angles were calculated as Euler angles (YXZ sequence), defined every bit motion of the shank reference frame relative to the thigh reference frame. Knee-flexion and knee-valgus displacements and peak vertical and posterior ground reaction forces were identified during the loading phase of landing using custom software (LabVIEW, National Instruments Corporation, Austin, TX). The loading phase was defined as the time interval betwixt initial ground contact and peak knee flexion, with initial ground contact identified every bit the instant at which the vertical ground reaction force exceeded 10 North. Ground reaction strength data were normalized to body weight earlier statistical assay.
Statistical Assay
All dependent variables were averaged over the five trials for use in statistical analyses. Eight separate Pearson bivariate correlation analyses were conducted to evaluate the relationships between talocrural joint-dorsiflexion ROM in the ii positions (4 analyses per position) and knee-flexion displacement, knee-valgus displacement, and top vertical and posterior ground reaction force, respectively. Statistical significance was established a priori as α ≤ .05.
RESULTS
Descriptive statistics for all dependent variables are presented in Table one. Correlation coefficients and probability statistics for the extended-human knee and flexed-knee dorsiflexion ROM assessments are presented in Tables two and three, respectively. Meaning correlations were observed between extended-genu dorsiflexion ROM and knee-flexion displacement (r = 0.464, P = .029), vertical footing reaction force (r = −0.411, P = .014), and posterior ground reaction force (r = −0.412, P = .014). The correlation for knee joint-valgus displacement was nonsignificant (r = −0.290, P = .091). All correlations between flexed-knee dorsiflexion ROM and the biomechanical variables of interest were nonsignificant (P > .05).
Table 1
Dependent Variable Descriptive Statistics
Table 2
Correlations for Extended-Knee Talocrural joint-Dorsiflexion Range of Motion
Tabular array three
Correlations for Flexed-Genu Ankle-Dorsiflexion Range of Motion
Give-and-take
Greater passive ankle-dorsiflexion ROM was associated with greater knee-flexion displacement and smaller basis reaction forces during landing. These biomechanical factors are considered risk factors for ACL injury,2 – ,4 so the findings indicate that techniques designed to increment plantar-flexor extensibility and dorsiflexion ROM may attenuate ACL injury risk by placing the lower extremity in a position consequent with reduced ACL loading, thus decreasing the forces the lower extremity must blot later on basis contact. Additionally, clinical measures of dorsiflexion ROM may be of import components of screening efforts to identify individuals at greater chance for ACL injury.
The relationships betwixt extended-articulatio genus dorsiflexion ROM and knee-flexion displacement and footing reaction forces are in agreement with our hypotheses: Individuals who displayed greater dorsiflexion ROM demonstrated smaller ground reaction forces and greater knee-flexion deportation. These findings are consistent with those of Kovacs et al,8 who evaluated the influence of foot position on landing biomechanics past having volunteers land in heel-to-toe versus forefoot-first maneuvers. Heel-to-toe landings resulted in less sagittal-aeroplane displacement at the ankle, knee, and hip and greater vertical ground reaction forces. Supplementary correlational analyses of our data indicated that greater extended-articulatio genus dorsiflexion ROM also was correlated with greater hip-flexion displacement (r = 0.357, P = .035) but not ankle-dorsiflexion displacement (r = 0.150, P = .391). The lack of correlation betwixt dorsiflexion ROM and dorsiflexion displacement may be explained past between-subjects differences in landing style. Although the mean ankle bending at initial ground contact was 35° (0° = neutral, + = plantar flexion), this value varied considerably across the sample (SD = ±15°; range, lx°), suggesting that participants adopted various landing styles from a more than dorsiflexed initial-contact angle, which restricts further dorsiflexion deportation, to a more plantar-flexed contact angle, which maximizes dorsiflexion displacement. These differences in landing styles could take influenced landing biomechanics (specifically dorsiflexion displacement) independent of passive dorsiflexion ROM.viii , 19
Fifty-fifty though extended-knee dorsiflexion ROM was significantly correlated with the biomechanical variables of involvement, none of the associated correlations were significant for flexed-knee dorsiflexion ROM. The lack of clan betwixt landing biomechanics and flexed-knee dorsiflexion ROM may be explained by knee-joint kinematics during the landing and the contribution of the gastrocnemius muscle to forcefulness attenuation. The hateful knee joint-flexion angle at initial ground contact was 11.1° ± 6.6°; the peak value was 80.2° ± 13.iii°. The extended-knee ROM measurement, performed in 0° of knee flexion, assesses the extensibility of both gastrocnemius and soleus muscles, whereas the flexed-knee measurement, performed at 90° of knee flexion, substantially isolates the soleus.twenty , 21 Therefore, the extended-articulatio genus testing position is likely a better indication of the ROM restrictions placed on dorsiflexion displacement during the landing job. Considering the gastrocnemius likely contributes substantially to force attenuation within the range of knee displacement demonstrated during the landing task we used, the fact that the flexed-knee joint dorsiflexion ROM excludes contributions of the gastrocnemius likely explains the lack of correlation with landing biomechanics.
Information technology is worth noting that although none of the correlations between flexed-articulatio genus dorsiflexion ROM and landing biomechanics were significant, these correlations all approached significance (P values = .053 to .085), suggesting statistical trends. Nosotros, therefore, conducted mail hoc power analyses, which revealed observed powers of 0.51 for knee-flexion displacement, 0.51 for knee-valgus displacement, 0.38 for vertical ground reaction force, and 0.46 for posterior basis reaction force, indicating that 68, 66, 96, and 75 participants, respectively, would exist required to accomplish statistical power of 0.lxxx for α = .05. These analyses advise that a larger sample size might have resulted in significant findings and support the need for hereafter research regarding the influence of dorsiflexion ROM on ACL injury hazard factors.
The lack of association between dorsiflexion ROM and knee-valgus displacement during the landing chore was opposite to our initial hypothesis. Bong et althirteen reported that valgus motion during a controlled squatting task was diminished when slack was introduced to the plantar-flexor musculature by placing a wedge under the calcaneus, thus increasing the available dorsiflexion ROM. Using a more than dynamic landing job, Hagins et al11 induced greater knee joint-valgus displacement and posterior basis reaction forces when they reduced the available dorsiflexion ROM by having volunteers land on an inclined surface, rather than on a flat surface, which permitted full dorsiflexion displacement. Similarly, Sigward et al12 demonstrated a negative correlation between dorsiflexion ROM and frontal-plane knee circuit during landing. Based on these results, we hypothesized that individuals who demonstrated less ankle-dorsiflexion ROM would display greater knee valgus during the landing job. Even so, our results were contrary to our hypotheses, probable due to a number of factors. The inclusion criteria used by Bong et al13 to place volunteers may partially explain the discrepancies in the studies' findings. These authors screened potential participants to try to identify individuals who demonstrated a reduction in medial knee displacement (MKD) when performing the squat task on the wedge versus a flat back up surface. Only 18 of 75 (24%) of the potential volunteers met this benchmark and were assigned to the MKD group. In addition, Bell et alxiii reported a mean of 8.5° for passive extended-genu dorsiflexion ROM in the MKD group, whereas the mean for our sample was xiv.3°, a difference of approximately forty%. These discrepancies advise that dorsiflexion ROM may merely influence frontal-plane knee motility in a limited pct of individuals who possess extreme ROM restrictions. It is also unclear if the demands placed on the lower extremity joints are comparable between the controlled squatting task used by Bell et al13 and the more dynamic landing job in our investigation. Furthermore, the MKD sample investigated by Bong et al13 consisted of 3 men and 15 women. Numerous investigators22 – ,24 have reported greater articulatio genus valgus in women than in men during a variety of tasks; thus, a sample equanimous primarily of women may take enhanced their power to identify an effect of dorsiflexion ROM on knee valgus in comparison with our more balanced sample (17 men, 18 women). Additionally, although Hagins et al11 used a like landing chore, they experimentally manipulated landing kinematics by altering the landing surface and evaluated differences between conditions via a repeated-measures pattern, whereas our analyses were correlational in nature and evaluated the inherent available dorsiflexion ROM. The greater statistical strength afforded past the repeated-measures design and experimental manipulation of dorsiflexion ROM may have enhanced their ability to place an effect of dorsiflexion ROM on human knee valgus, and the relatively express power of correlation analyses may have impeded our ability to do so. More of import, differences in the samples tested in these investigations also may business relationship for discrepancies: Hagins et alxi studied a homogeneous grouping of professional person dancers, whereas we studied a more heterogeneous group of individuals who met minimal physical action criteria (at least 20 minutes of physical activity a minimum of iii times per week). Although Hagins et al11 did not report mean and SD values for joint kinematics, it is probable that their homogeneous sample of professional dancers demonstrated similar landing styles and kinematics as a function of common prior training compared with the highly variable landing styles and kinematics in our sample, as evidenced past the talocrural joint angle at initial ground contact. Terminal, differences in landing tasks (vertical drop landing versus horizontal jump landing), jump heights (46 cm versus xxx cm), knee position during dorsiflexion ROM measurements (30° versus 0° and xc°), and samples (women soccer players versus men and women recreational athletes) between the report of Sigward et al12 and ours likely explain the discrepancies in findings. It is once again worth noting that the correlation between knee-flexed dorsiflexion ROM and knee valgus approached statistical significance, suggesting a trend.
The correlations betwixt dorsiflexion ROM and hip and knee displacements indicate that greater dorsiflexion ROM is associated with a less-cock posture during landing and greater sagittal-airplane joint displacement. Increased sagittal-plane joint displacement of the lower extremity increases the duration of the loading phase, allowing landing forces to be dissipated over a longer time interval, resulting in smaller meridian forces (ie, enhanced forcefulness attenuation).5 , 25 Therefore, the negative relationship between ankle-dorsiflexion ROM and ground reaction forces is likely a result of the enhanced strength-attenuation capacity afforded by greater sagittal-airplane displacement.
Immediately after ground contact, the knee is forced into flexion by vertical and posterior ground reaction forces and downward acceleration of the trunk's center of mass. These landing forces can exceed 10 times body weight26 and accept been suggested as important factors in determining ACL loading and injury risk. Hewett et al2 demonstrated prospectively that landing forces were 20% greater in individuals who sustained ACL injuries than in an uninjured cohort. Furthermore, basis reaction forces indicate anterior tibial dispatch27 and shear forcefulnessthree during landing, factors that directly contribute to ACL loading.28 , 29 Excessive quadriceps activity has also been suggested as a take a chance factor for ACL injury: cadavericxxx , 31 and in vivo32 research showed that quadriceps activation produces ACL loading and injury in vitro.33 Landing in a less-erect posture decreases quadriceps activity6 and encourages longer muscle moment artillery in the lower extremity, thus reducing the muscular-force requirements to attenuate landing forces compared with a more-cock landing posture.5 The correlations between greater dorsiflexion ROM, greater sagittal-aeroplane displacements, and smaller landing forces in our data and the likely influence on quadriceps activity suggest that ankle-dorsiflexion ROM may play an important role in the expression of ACL injury take chances factors.
Our written report provides novel information regarding how clinical measures of dorsiflexion ROM are associated with biomechanical variables suggested equally ACL injury gamble factors. These results both support and extend previous inquiry in that our ROM measures stand for those typically used in the clinical setting (ie, 0° and ninety° of knee joint flexion versus 30° for Sigward et al12) and are generalizable to a broader segment of the population (ie, men and women recreational athletes versus women soccer players12 versus individuals who met specific medial knee-displacement criteria13). Because talocrural joint-dorsiflexion ROM can be enhanced via a variety of clinical and preparation mechanisms,fourteen – ,16 implementing techniques to increase plantar-flexor extensibility and dorsiflexion ROM may be important additions to time to come ACL and lower extremity injury-prevention programs. However, the clinical application of these results should be approached with circumspection, given that a limitation of this investigation is its correlational design. The results do not suggest that greater ankle-dorsiflexion ROM causes modifications of landing posture and ground reaction forces consistent with reduced ACL injury risk but rather that these factors are simply correlated. Yet our findings provide rationale for and inform the development of future investigations to evaluate the influence of interventions designed to increase dorsiflexion ROM on landing biomechanics and ACL injury risk factors. Additionally, the fact that clinical measures of dorsiflexion ROM were associated with ACL injury adventure factors indicates that these measures may exist important factors to consider when implementing screening efforts to identify individuals at greater adventure of ACL injury. Future prospective researchers should evaluate the power of dorsiflexion ROM measures to discriminate ACL-injured versus uninjured cohorts too as the effects of interventions designed to increase dorsiflexion ROM on ACL injury risk.
The post hoc power analyses indicate the possibility that inadequate sample size express our ability to identify relationships between dorsiflexion ROM and landing biomechanics. Additionally, the force of the significant correlations in our data was low to moderate, with knee-extended dorsiflexion ROM explaining but 22%, 17%, and 17% of the variance in knee-flexion displacement, vertical ground reaction force, and posterior ground reaction force, respectively. Therefore, although dorsiflexion ROM appears to influence landing biomechanics, a large portion of the variance in these biomechanical ACL injury gamble factors is explained by other factors. Specifically, we did not evaluate electromyographic activeness of the lower extremity during the landing job. Because greater activity of the extensors, specially the quadriceps, results in larger basis reaction forces and less knee flexion during landing,6 a portion of the variance in landing biomechanics was likely attributable to variance in these factors. Furthermore, ground reaction forces and knee flexion during landing are influenced past body motion6; thus, a portion of the unexplained variance is probably attributable to trunk kinematics as well. Last, knee flexion and ground reaction forces are influenced by ankle position at initial ground contact.viii Our participants exhibited a large range of values for ankle position at initial footing contact (sixty°), so the inconsistency in this contributor to landing biomechanics probable limited the strength of the correlations.
An boosted limitation of our investigation is that we did not obtain data regarding our volunteers' previous history of talocrural joint injury. Kramer et al34 demonstrated an association between previous history of ankle injury and ACL injury risk. Talocrural joint instability influences landing kinematics and kinetics,35 , 36 only it is unclear how a history of ankle injury might have influenced our results. Moreover, restricted dorsiflexion ROM is associated with a greater risk of patellar tendon injury37; therefore, future enquiry regarding dorsiflexion ROM interventions on a variety of lower extremity injuries may be warranted. Finally, a limited trunk of knowledge exists regarding the influence of artificial restrictions of dorsiflexion ROM (eg, taping and bracing) on landing biomechanics.38 As a result, future investigators should also evaluate these influences to identify the consequences for the proximal joints of the lower extremity.
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Articles from Journal of Able-bodied Training are provided here courtesy of National Athletic Trainers Association
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017488/
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