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Recent research from the Musculoskeletal Research Centre, La Trobe University:

A cross-sectional study by MRC researchers Peter Malliaras and A/Prof Jill Cook investigated the association between performance factors and the presence of patellar tendon injury. These performance factors (sit and reach flexibility, ankle dorsiflexion range, jump height, ankle plantarflexor strength, years of volleyball competition and activity level) were measured in 113 male and female volleyball players. Patellar tendon health was determined by measures of pain and ultrasound imaging. The association between these performance factors and patellar tendon health (normal tendon, abnormal imaging without pain, abnormal imaging with pain) was investigated using analysis of variance. Only reduced ankle dorsiflexion range was associated with patellar tendinopathy (p < 0.05). As coupling between ankle dorsiflexion and eccentric contraction of the calf muscle is important in absorbing lower limb force when landing from a jump, reduced ankle dorsiflexion range may increase the risk of patellar tendinopathy (more details...)

The ankle joint is having to answer for more and more problems...its probably feeling as though its really being picked on :)

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
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Is anyone able to direct me to research papers that have looked at reduced ankle dorsiflexion range, be it due to taping, footwear and or lack of joint range, and its predipostion of knee injury /pain?

Any thoughts or comments appreciated.

Many thanks for any assistance.

Kind regards

Sarge.

Sarge,

This study may be a good starting point:

Pope, R., Herbert, R., and Kirwan, J. Effect of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits. Australian Physiotherapy 44(3)165-172.

(A prospective study which suggests ankle stiffness/lunge test may be predictive of injury)

Ian

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Thanks very much Ian. Great starting point. I will follow it up.
Kind regards

Sarge

I remember going to a conference in 1995, and was presented back then. The difference was that in 1995, they looked at basketballers and their "landing technique". Those that hit the ground hard (reduced/fatiguing gastrosoleal eccentric activity) with their calcaneum tended to get patella tendinopathy.

Whereas those that used their calves better eccentrically had a relatively soft landing (not sure whether pressure gauges were used under heels etc.)


This was a rare bit of research that actually made sense clinically, and was a theory that could be implemented the next monday by any physio etc. without use of specific equipment.


I think the research of Jill Cook and co. just extrapolates a little bit further.

I have used the analogy of a cricket wicketkeeper or baseball catcher many times in clinic and I think even on here at Pod Arena. If they didn't have the ROM to "go back with the ball" during catching, they would end up with huge forces imparted on their hands, wrists, and upper-limb etc. This analogy fits in this latest research. It makes sense, but don't know if it is anything new.


Jill's knowledge of the patella tendon pathology is virtually 2nd to none. But I think she just has the "physiotherapy" picture of underlying causes.
I still have an old email interaction with Jill and myself; whereby I proposed the very likely connection between foot pathomechanics and patella tendon pathology in some cases. She didn't share my enthusiasm for the connection.





Ron
Physiotherapist & Podiatrist.

Sarge,

If you have trouble getting your hands on a copy then PM me your e-mail address and I'll mail you a pdf over

Ian

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