Posterior Mechanics of Lumbar and Ankle Mobility

Author: Philip A. Croatan

A. T. Still University

Ankle Mobility

The joint-by-joint approach (JJA)describes the body as an alternating series of stable segments moving on mobile joints (Boyle). The ankle serves as a region of mobility and is  therefore a primary component of ambulation and activities of daily living. However, it is not  uncommon for mobility to be loss in this region due to faulty and subsequent compensatory  movement patterns of muscles (Thompson, Hoyen, & Barthel, 2009). Common ankle mobility  issues occur as a result of imbalances between anterior and posterior tibial muscles. Ankle immobility may surface as the inability to perform dorsi and or plantar flexion (Nickelston,  2007). The tibialis anterior is the primary mover of dorsi flexion and inverts the foot. Dorsi  flexion is not a powerful movement, but it is important to prevent toe drag when walking. The  fibularis muscles, gastrocnemius, and soleus are the primary actors of plantar flexion. Plantar flexion is the most powerful movement of the ankle however because it lifts the entire weight of the body. It is the essential force that allows forward thrust when walking and running. The tibialis anterior is a superficial muscle of the anterior leg, the fibularis muscles are superficial lateral muscles over the fibula, and the triceps surae (gastrocnemius and soleus) form the posterior calf inserting into the Achilles tendon (Anatomy, 2012)

Reciprocal Inhibition occurs when the increased neural drive in a specific muscle causes decreased neural drive in its functional antagonist (Nickelston, 2007). In example, the gastrocnemius has been observed as a common location for short muscle and increased neural drive. Subsequently, this influences lengthening of the tibialis anterior and manifest as weakened muscle relative to its normal functional capacity. Altered mechanics throughout the kinetic chain lead to compensatory pattern that causes anthrokinetic dysfunction in the entire body, analyzing based on the joint-by-joint approach and theory of regional interdependence described by Janda. When ankle mobility is compromised, stability of the knee is sacrificed to compensate for the lack of mobility (Page, Frank, and Lardner, 2010). The squat is a functional movement and is commonly included in many movement screens. When preforming the squat, the tibialis anterior initiates the movement. Any inhibition of this muscle can result in a shift of center of pressure projection and require a greater cost of the patellofemoral joint. Compensation for decreased neural drive of tibialis anterior leads to increased knee valgus displacement, which then causes hyperactivity of the soleus muscles, and then quadricep inhibition (Gawda, Zawadka,Skublewska-Paszkowska, Smołka, & Łukasik, 2017). This logic describes the common aeitiology of patellofemoral pain syndrome. 

Treatment of reciprocal inhibition is generally aimed at stimulating and increasing the response of the muscle spindle of the psuedoparetic muscle Nickelstone, 2007). Janda describes a sequence of faciliatatory techniques such as dry needling, followed by strengthening exercises but not resistance (Page, Frank, & Lardner, 2010). Whole body vibration is therapeutic technique appropriate for weakness due to tightness and stretching, as well as reciprocal inhibition.

Lumbar Spine Mobility 

The Lumbar Spine is inherently a stable joint region. Lower back pain (LBP) has become an increasingly more common symptom affecting clinical and non-clinical populations. Pelvic alignment is directly connected with spinal alignment as spinal flexion at the lumbosacral region is directly proportional to compression forces acting on intervertebral discs and load shift to the non-contractile structures of the vertebral column (Protasiewicz-Fałdowska, Hadała, Dzienisiewicz, Kowalska-Miranowicz, Gryckiewicz, & Kowalski, 2014). A common postural stress pattern is muscle shortening at the lumbosacral L5-S1 joint articulation and reciprocal inhibition of the gluteus medius, which further leads to compensatory patterns at the hip. The tensor fascia latae and iliotibial band become hyperactive and causes subsequent inhibition of the vastus medialis oblique(Nickelstone, 2007: Beach, Frost, Clark, Maly, & Callaghan, 2014). Misbalancing forces increase femoral flexion, internal rotation, and adduction which increases stress to the knee. The lumbar loading patterns and injury potential can be highly sensitive to personal movement strategies; therefore, clinical interventions that facilitate identifying personal characteristics that promote potentially injurious loading patterns are recommended (Kaya, Ergun, & Hayran, 2012). Reduced or restricted hip mobility reflects strong correlation with multiple pathologies of the hip and lumbar. Research suggests skilled joint mobilization followed with appropriate permanent reinforcing movements. Modern methods selected to reinforce low back stability and improve function are based on choosing directional motion, motor control, and stimulating deep, as well as superficial muscles engagement. Minimal training burdens in early stages facilitate increasing neural pathways and increase motor units to replace pathological patterns (Reiman & Matheson, 2013). 

Resources

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Beach, T. A. C., Frost, D. M., Clark, J. M., Maly, M. R., & Callaghan, J. P. (2014). Unilateral ankle immobilization alters the kinematics and kinetics of lifting. Work, 47(2), 221–234. https://doi-org.p.atsu.edu/10.3233/WOR-121573

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Gawda, P., Zawadka, M., Skublewska-Paszkowska, M., Smołka, J., & Łukasik, E. (2017). Biomechanika Przysiadu W Rehabilitacji I Treningu Sportowym. / Biomechanics of the Squat in Rehabilitation and Sports Training. Polish Journal of Sports Medicine / Running head: POSTERIOR MECHANICS OF LUMBAR AND ANKLE MOBILITY 6 Medycyna Sportowa, 33(2), 87–96. Retrieved from http://p.atsu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=125671646&site=eds-live

Kaya, D. O., Ergun, N., & Hayran, M. (2012). Effects of different segmental spinal stabilization  exercise protocols on postural stability in asymptomatic subjects: Randomized controlled trial. Journal of Back & Musculoskeletal Rehabilitation, 25(2), 109–116. Retrieved from http://p.atsu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=87554688&site=eds-live

Nickelston, P. (2007, May). Art of chiropractic: Lower crossed syndrome and knee pain. Dynamic Chiropractic, 25(11), 8-41. [34 pages]

Page, P., Lardner, R., & Frank, C. (2010). Assessment and Treatment of Muscle Imbalance : The Janda Approach. Champaign, IL: Human Kinetics, Inc. Retrieved from http://p.atsu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=698372&site=ehost-live&scope=site

Protasiewicz-Fałdowska, H., Hadała, M., Dzienisiewicz, A., Kowalska-Miranowicz, H., Gryckiewicz, S., & Kowalski, I. M. (2014). Training of flexion and rotation of the lumbar-sacral spine based on Kinetic Control. Polish Annals of Medicine / Rocznik Medyczny, 21(1), 45–50. https://doi-org.p.atsu.edu/10.1016/j.poamed.2014.02.002

Reiman, M. P., & Matheson, J. W. (2013). Restricted Hip Mobility: Clinical Suggestions for Self-Mobilization and Muscle Re-Education. International Journal of Sports Physical Therapy, 8(5), 729–740. Retrieved from http://p.atsu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=98372845&site=eds-live

Thompson, G. H., Hoyen, H. A., & Barthel, T. (2009). Tibialis anterior tendon transfer after clubfoot surgery. Clinical Orthopaedics And Related Research, 467(5), 1306–1313. https://doi-org.p.atsu.edu/10.1007/s11999-009-0757-2

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