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Hi all.
There is some evidence to support the concept of circadian variation in joint ROM.
Essentially what this means is that joint ROM alters over a 24-hour period. This is not as simple as "stiff after exercise" or "loose in the morning, stiff at night" but seems to follow no particular pattern.
The best ref I could find for this is :
Yung P, Unsworth A, Haslock I. Measurement of stiffness in the metacarpophalangeal joint: Circadian variation. Clin Phys. Physiol Meas,. Vol 5, no 2 57-65 (1984).
I also had to do a little work on this myself and found that ankle joint complex (AJC) frontal plane ROM varied by up to 6 degrees in one subject over the course of one day. This was measured using a purpose-built rig, rather than a hand-held instrument (unpublished, but can be viewed in my MSc thesis at University of Durham, UK, if anyone is interested ).
In view of the practice of measuring Joint ROM during a biomech examination, could this variation affect overall theraputic results, and should we be looking at specific protocols when doing a biomech examination (eg measuring after loosening the AJC and subtalar joints by manipulation, or carrying out biomech examination at a specific time of day)
What do others think?
Regards,
David
My initial response is to say it is not an area I have considered.
Whether a casted orthosis could be so accurately made to account for this degree of variation during the day I suspect not ( and think of what would be charged for it. Still there's a thought!!). Whether you go for an average of the variation and post, adapt arch height or pitch the device accordingly is an interesting question.
In the case of lig laxity there may not be a need to take this variation into account In instances where limited AJC rom is considered muscular or ligamentous in origin it may be worthwhile considering if a device could be made to control GRF and torque forces that may initiate stiffening through poor proprioceptive feed back during the day:
i.e. How much of the low ROM in the morning is resulting from soft tissue stress as the day proceeds?
This is not the same as suggesting stiffness after exercise but a thought that the body may be self protecting.
All of this assumes that the circadian variation is being considered abnormal!! It may well be natures protective and adaptive measure.
Apologies if my guesses are butchering biomechanical concepts but I come at it from a very amateurish position and knowlege.
Of course it is a question that follows on nicely from Cameron's view of the importance of Saggital plane action.
"All of this assumes that the circadian variation is being considered abnormal!! It may well be natures protective and adaptive measure."
I believe it to be normal. The reference I gave provides further information, and you can get a really good flavour of what circadian variation is from reading it.
"Apologies if my guesses are butchering biomechanical concepts but I come at it from a very amateurish position and knowlege."
I think most of us who are involved in podiatric biomech will readily admit that we don't have all the answers .
Circadian variation is simply another variable to add to the melting pot.
In fact it may be more important to take this into account when carrying out research which involves examining joint ROM, rather than to apply it specifically to pod biomech.
Regards,
David
The possible peripheral and/or central origin in the mechanisms responsible for day-time fluctuation in maximal torque of the triceps surae muscle were investigated with a special emphasis on antagonist muscle coactivation. Eleven healthy male subjects (physical education students) took part in this investigation. The electromechanical properties of the plantar flexor muscles were recorded at two different times of day: between 06 : 00 h and 08 : 00 h in the morning and between 17 : 00 h and 19 : 00 h in the evening. To investigate peripheral mechanisms, the posterior tibial nerve was stimulated at rest, using percutaneous electrical stimuli, to evoke single twitch, double twitch, and maximal tetanic contraction (100 Hz). Maximal voluntary contraction of the plantar flexors was also assessed by means of the relative electromyographic activity of respective agonist and antagonist muscles (soleus, gastrocnemius medialis, gastrocnemius lateralis, and tibialis anterior). A double twitch was delivered during maximal voluntary plantar flexion to record muscle activation (i.e., interpolated twitch technique). The coactivation level of the tibialis anterior muscle during plantar flexion was calculated. The results indicated a significant decrease in maximal voluntary muscle torque of triceps surae in the evening as compared with the morning (- 7.0 %; p < 0.05). Concerning the central command, when extrapolated by the twitch interpolation technique, the decrease in mean activation level of - 6.8 % was consistent with the fluctuation in torque (- 7.0 %). Soleus muscle electromyographic activity (normalized to the M-wave) showed a significant decline (21.6 %; p < 0.001). Moreover, individual changes in MVC percentage were significantly related to those of normalized electromyographic activity of the soleus muscle (r = 0.688; p < 0.01). Thus, it indicated that the subject's capacity to activate the soleus muscle was affected by the time of day. The coactivation level in the tibialis anterior muscle during plantar flexion did not change significantly in the evening. Concerning peripheral mechanisms, we observed a decrease in maximal M-wave amplitude for soleus and gastrocnemii, associated with unchanged single twitch and tetanus torque. To conclude, impairment in soleus muscle central command seemed to be the mechanism in the origin of torque failure. Such information would be of importance in the investigation of day-time fluctuations in complex motor task performances implicating the triceps surae muscle.
Hi Admin,
Thanks for that.
Seems like we shouldn't be ignoring diurnal/circadian variation after all?
Actually, I did some work with only 7 subjects, but measured coronal ROM at the ankle joint complex (with a purpose-built rig with good reliability/repeatability) every two hours over a 12-hour period.
Time to write up and submit for publication methinks?
Hourly variation in joint ROM
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Linear Mode
