The relative stress on the Achilles tendon during ambulation in an ankle immobiliser: implications for rehabilitation after Achilles tendon repair
Background—After Achilles tendon repair, immediate weightbearing and immobilisation closer to neutral plantarflexion are thought to limit atrophy and stiffness, but may place deleterious stress on the repair. Objectives—To estimate the relative stress on the Achilles tendon during weightbearing with...
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| Veröffentlicht in: | British journal of sports medicine 2001-10, Vol.35 (5), p.329-333 |
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| creator | Akizuki, K H Gartman, E J Nisonson, B Ben-Avi, S McHugh, M P |
| description | Background—After Achilles tendon repair, immediate weightbearing and immobilisation closer to neutral plantarflexion are thought to limit atrophy and stiffness, but may place deleterious stress on the repair. Objectives—To estimate the relative stress on the Achilles tendon during weightbearing with immobilisation in varying degrees of plantarflexion. Methods—Electromyographic (EMG) activity from the plantarflexors was recorded during walking in 10 subjects (six men, four women) without ankle pathology. Four walking conditions were examined: (a) normal walking; (b) immobilised (cam-walker) in neutral plantarflexion; (c) immobilised with a 0.5 inch heel lift; (d) immobilised with a 1 inch heel lift. EMG activity relative to plantarflexor torque was determined for each subject during isometric contractions at 25%, 50%, 75%, and 100% of maximal voluntary contraction (MVC). EMG activity during walking was calculated as a percentage of MVC based on the EMG-torque relation during graded isometric contractions. Results—During normal walking, the plantarflexor torque was estimated to be 30 (12)% (mean (SD)) of MVC, compared with 21 (15)% MVC for immobilisation in neutral (p |
| doi_str_mv | 10.1136/bjsm.35.5.329 |
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Objectives—To estimate the relative stress on the Achilles tendon during weightbearing with immobilisation in varying degrees of plantarflexion. Methods—Electromyographic (EMG) activity from the plantarflexors was recorded during walking in 10 subjects (six men, four women) without ankle pathology. Four walking conditions were examined: (a) normal walking; (b) immobilised (cam-walker) in neutral plantarflexion; (c) immobilised with a 0.5 inch heel lift; (d) immobilised with a 1 inch heel lift. EMG activity relative to plantarflexor torque was determined for each subject during isometric contractions at 25%, 50%, 75%, and 100% of maximal voluntary contraction (MVC). EMG activity during walking was calculated as a percentage of MVC based on the EMG-torque relation during graded isometric contractions. Results—During normal walking, the plantarflexor torque was estimated to be 30 (12)% (mean (SD)) of MVC, compared with 21 (15)% MVC for immobilisation in neutral (p<0.05), 17 (15)% MVC with the addition of a 0.5 inch heel lift (p<0.01), and 12 (12)% MVC with the addition of a 1 inch heel lift (p<0.01). The 1 inch heel lift resulted in less than 10° plantarflexion in all subjects. Conclusions—When the ankle is immobilised, stress on the Achilles tendon is determined by the degree of plantarflexion and the contractile activity of the plantarflexors. In the immobilised ankle, the addition of a 1 inch heel lift was sufficient to minimise plantarflexor activity during walking.</description><identifier>ISSN: 0306-3674</identifier><identifier>EISSN: 1473-0480</identifier><identifier>DOI: 10.1136/bjsm.35.5.329</identifier><identifier>PMID: 11579067</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><subject>Achilles tendon ; Achilles Tendon - physiology ; Adult ; Electrodes ; Electromyography ; EMG ; Female ; Gait - physiology ; gastrocnemius ; heel lifts ; Humans ; Immobilization - physiology ; Injuries ; Isometric Contraction ; Male ; Muscle, Skeletal - physiology ; Original ; Patients ; Rehabilitation ; soleus ; Sports medicine ; Stress, Mechanical ; Studies ; Surgery ; Tendons ; Torque ; Walkers ; Walking ; Weight-Bearing - physiology</subject><ispartof>British journal of sports medicine, 2001-10, Vol.35 (5), p.329-333</ispartof><rights>Copyright 2001 by the British Journal of Sports Medicine</rights><rights>COPYRIGHT 2001 BMJ Publishing Group Ltd.</rights><rights>Copyright: 2001 Copyright 2001 by the British Journal of Sports Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b615t-8788ac13fc97662a04b925627a04c7cba84f75026a4214a42b3d5706a49300e43</citedby><cites>FETCH-LOGICAL-b615t-8788ac13fc97662a04b925627a04c7cba84f75026a4214a42b3d5706a49300e43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724396/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724396/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11579067$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Akizuki, K H</creatorcontrib><creatorcontrib>Gartman, E J</creatorcontrib><creatorcontrib>Nisonson, B</creatorcontrib><creatorcontrib>Ben-Avi, S</creatorcontrib><creatorcontrib>McHugh, M P</creatorcontrib><title>The relative stress on the Achilles tendon during ambulation in an ankle immobiliser: implications for rehabilitation after Achilles tendon repair</title><title>British journal of sports medicine</title><addtitle>Br J Sports Med</addtitle><description>Background—After Achilles tendon repair, immediate weightbearing and immobilisation closer to neutral plantarflexion are thought to limit atrophy and stiffness, but may place deleterious stress on the repair. Objectives—To estimate the relative stress on the Achilles tendon during weightbearing with immobilisation in varying degrees of plantarflexion. Methods—Electromyographic (EMG) activity from the plantarflexors was recorded during walking in 10 subjects (six men, four women) without ankle pathology. Four walking conditions were examined: (a) normal walking; (b) immobilised (cam-walker) in neutral plantarflexion; (c) immobilised with a 0.5 inch heel lift; (d) immobilised with a 1 inch heel lift. EMG activity relative to plantarflexor torque was determined for each subject during isometric contractions at 25%, 50%, 75%, and 100% of maximal voluntary contraction (MVC). EMG activity during walking was calculated as a percentage of MVC based on the EMG-torque relation during graded isometric contractions. Results—During normal walking, the plantarflexor torque was estimated to be 30 (12)% (mean (SD)) of MVC, compared with 21 (15)% MVC for immobilisation in neutral (p<0.05), 17 (15)% MVC with the addition of a 0.5 inch heel lift (p<0.01), and 12 (12)% MVC with the addition of a 1 inch heel lift (p<0.01). The 1 inch heel lift resulted in less than 10° plantarflexion in all subjects. Conclusions—When the ankle is immobilised, stress on the Achilles tendon is determined by the degree of plantarflexion and the contractile activity of the plantarflexors. In the immobilised ankle, the addition of a 1 inch heel lift was sufficient to minimise plantarflexor activity during walking.</description><subject>Achilles tendon</subject><subject>Achilles Tendon - physiology</subject><subject>Adult</subject><subject>Electrodes</subject><subject>Electromyography</subject><subject>EMG</subject><subject>Female</subject><subject>Gait - physiology</subject><subject>gastrocnemius</subject><subject>heel lifts</subject><subject>Humans</subject><subject>Immobilization - physiology</subject><subject>Injuries</subject><subject>Isometric Contraction</subject><subject>Male</subject><subject>Muscle, Skeletal - physiology</subject><subject>Original</subject><subject>Patients</subject><subject>Rehabilitation</subject><subject>soleus</subject><subject>Sports medicine</subject><subject>Stress, Mechanical</subject><subject>Studies</subject><subject>Surgery</subject><subject>Tendons</subject><subject>Torque</subject><subject>Walkers</subject><subject>Walking</subject><subject>Weight-Bearing - physiology</subject><issn>0306-3674</issn><issn>1473-0480</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkk1v1DAQhiMEotvCkSuKQEIcyGLHcRxzQFqtaEGqyqGlV8vJTna9deytnVTlb_CLmXRXbYGKypY_Zh6_Y48nSV5RMqWUlR_rdeymjE_5lOXySTKhhWAZKSryNJkQRsqMlaLYS_ZjXBNCc06q58kepVxIUopJ8utsBWkAq3tzBWnsA8SYepf2aJ41K2MtxLQHt0DbYgjGLVPd1cPIo8W4VI_9wkJqus7XxpoI4RNuNtY0N1BMWx8wxEqP3n57ULc9hH8CBNhoE14kz1ptI7zczQfJj8MvZ_Ov2fH3o2_z2XFWl5T3WSWqSjeUtY0UZZlrUtQy52UucNWIptZV0QpO8lIXOS1wqNmCC4JbyQiBgh0kn7e6m6HuYNGA64O2ahNMp8NP5bVRf3qcWamlv1JU5AWTJQq82wkEfzlA7FVnYgPWagd-iErQHBNe8UdBWlFOBBEIvv0LXPshOMwCBsUfo1TmEqk3W2qpLSjjWo_Xa0ZJNROSc1lJitCHB6AlOMCneAetQfN9PHsAx7aAzjT_4ZvgYwzQ3uaNEjUWphoLUzGuuGI3d359P9l39K4S7wRN7OH61q_DhUKv4OrkfK4Oz0-L-ckRUafIv9_ydbd-JPZva8P8Ig</recordid><startdate>20011001</startdate><enddate>20011001</enddate><creator>Akizuki, K H</creator><creator>Gartman, E J</creator><creator>Nisonson, B</creator><creator>Ben-Avi, S</creator><creator>McHugh, M P</creator><general>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</general><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Group</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20011001</creationdate><title>The relative stress on the Achilles tendon during ambulation in an ankle immobiliser: implications for rehabilitation after Achilles tendon repair</title><author>Akizuki, K H ; Gartman, E J ; Nisonson, B ; Ben-Avi, S ; McHugh, M P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b615t-8788ac13fc97662a04b925627a04c7cba84f75026a4214a42b3d5706a49300e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Achilles tendon</topic><topic>Achilles Tendon - physiology</topic><topic>Adult</topic><topic>Electrodes</topic><topic>Electromyography</topic><topic>EMG</topic><topic>Female</topic><topic>Gait - physiology</topic><topic>gastrocnemius</topic><topic>heel lifts</topic><topic>Humans</topic><topic>Immobilization - physiology</topic><topic>Injuries</topic><topic>Isometric Contraction</topic><topic>Male</topic><topic>Muscle, Skeletal - physiology</topic><topic>Original</topic><topic>Patients</topic><topic>Rehabilitation</topic><topic>soleus</topic><topic>Sports medicine</topic><topic>Stress, Mechanical</topic><topic>Studies</topic><topic>Surgery</topic><topic>Tendons</topic><topic>Torque</topic><topic>Walkers</topic><topic>Walking</topic><topic>Weight-Bearing - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Akizuki, K H</creatorcontrib><creatorcontrib>Gartman, E J</creatorcontrib><creatorcontrib>Nisonson, B</creatorcontrib><creatorcontrib>Ben-Avi, S</creatorcontrib><creatorcontrib>McHugh, M P</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Akizuki, K H</au><au>Gartman, E J</au><au>Nisonson, B</au><au>Ben-Avi, S</au><au>McHugh, M P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The relative stress on the Achilles tendon during ambulation in an ankle immobiliser: implications for rehabilitation after Achilles tendon repair</atitle><jtitle>British journal of sports medicine</jtitle><addtitle>Br J Sports Med</addtitle><date>2001-10-01</date><risdate>2001</risdate><volume>35</volume><issue>5</issue><spage>329</spage><epage>333</epage><pages>329-333</pages><issn>0306-3674</issn><eissn>1473-0480</eissn><abstract>Background—After Achilles tendon repair, immediate weightbearing and immobilisation closer to neutral plantarflexion are thought to limit atrophy and stiffness, but may place deleterious stress on the repair. Objectives—To estimate the relative stress on the Achilles tendon during weightbearing with immobilisation in varying degrees of plantarflexion. Methods—Electromyographic (EMG) activity from the plantarflexors was recorded during walking in 10 subjects (six men, four women) without ankle pathology. Four walking conditions were examined: (a) normal walking; (b) immobilised (cam-walker) in neutral plantarflexion; (c) immobilised with a 0.5 inch heel lift; (d) immobilised with a 1 inch heel lift. EMG activity relative to plantarflexor torque was determined for each subject during isometric contractions at 25%, 50%, 75%, and 100% of maximal voluntary contraction (MVC). EMG activity during walking was calculated as a percentage of MVC based on the EMG-torque relation during graded isometric contractions. Results—During normal walking, the plantarflexor torque was estimated to be 30 (12)% (mean (SD)) of MVC, compared with 21 (15)% MVC for immobilisation in neutral (p<0.05), 17 (15)% MVC with the addition of a 0.5 inch heel lift (p<0.01), and 12 (12)% MVC with the addition of a 1 inch heel lift (p<0.01). The 1 inch heel lift resulted in less than 10° plantarflexion in all subjects. Conclusions—When the ankle is immobilised, stress on the Achilles tendon is determined by the degree of plantarflexion and the contractile activity of the plantarflexors. In the immobilised ankle, the addition of a 1 inch heel lift was sufficient to minimise plantarflexor activity during walking.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</pub><pmid>11579067</pmid><doi>10.1136/bjsm.35.5.329</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Achilles tendon Achilles Tendon - physiology Adult Electrodes Electromyography EMG Female Gait - physiology gastrocnemius heel lifts Humans Immobilization - physiology Injuries Isometric Contraction Male Muscle, Skeletal - physiology Original Patients Rehabilitation soleus Sports medicine Stress, Mechanical Studies Surgery Tendons Torque Walkers Walking Weight-Bearing - physiology |
| title | The relative stress on the Achilles tendon during ambulation in an ankle immobiliser: implications for rehabilitation after Achilles tendon repair |
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