Normative Values of Weight Bearing Lunge Test among Non-Athlete Females - A Criterion Based Study

Introduction

The ankle joint, one of the most commonly utilized joints, usually exhibits musculoskeletal problems.¹ The ankle dorsiflexion joint's range of motion is necessary for a variety of daily activities, including walking, getting out of a chair, ascending stairs, and running.² Dorsiflexor muscle flexibility and range of motion are essential for carrying dynamic athletic motions including cutting, side-stepping, jumping, and landing.³ Better passive open chain dorsiflexion range of motion (ROM) during a jump-landing exercise has been associated with increased hip and knee flexion as well as decreased ground reaction forces (GRFs).⁴ For those with more dorsiflexion ROM, greater sagittal-plane displacement on landing is associated with a less erect posture, allowing the body to more efficiently absorb stressors.⁵

According to Harris (1991), some activities such as sprinting need an ankle dorsiflexion range of 20 to 30 degrees; but others, such as walking, ascending stairs, and kneeling, require only a range of 10 degrees. When the ankle does not fully flex, compensations that might cause injuries are more likely to occur.^6,7

This movement restriction is typically seen in clinical settings following an accident or immobilization. Daily activities suffer and the risk of lower limb overuse injuries rises when the ankle's dorsiflexion range of motion is reduced.⁸ Because of the anatomical features of the ankle joint, healing and rehabilitation following injury may be challenging. The movement of the ankle joint is influenced by the distal tibiofibular joint, proximal tibiofemoral joint, inter-tarsal joints, and distal metatarsophalangeal joints.⁹ One of the most common injuries, acute and overuse injuries to the ankle joint and surrounding tissues have been associated to increased injury risk by decreased ankle dorsiflexion range of motion (DROM).¹⁰ Alterations in ankle dorsiflexion range of motion (ROM) have been associated to ankle injuries, ankle sprains, functional hallux limitus, hip and back injuries, metatarsalgia, heel discomfort, nerve entrapment, ankle joint equinus, patellar and ankle injuries, among other conditions.^11,12

Because of this, the stability and mobility of the joints close by and far away affect how flexible the ankle is. Furthermore, abnormal lower extremity biomechanics may be caused by workouts that restrict ankle dorsiflexion during the closed chain strengthening phase.¹³

One of the several mechanical problems in ankle function associated with chronic ankle instability may be a deficiency in the range of motion of the ankle-joint dorsiflexion. During the rehabilitation phase, the range of motion in the ankle joint is assessed to determine the patient's prognosis. An accurate evaluation of ankle joint range of motion is required in both clinical rehabilitation and research to determine the efficacy of a therapeutic intervention.^14-16

Inadequate ankle dorsiflexion range of motion or a decline in dorsiflexion ROM may worsen chronic conditions like patellar tendinopathy, Achilles tendinopathy, chronic ankle instability, metatarsal stress fractures, plantar fasciitis, anterior knee pain, and noncontact anterior cruciate ligament injuries.^17-19

Range of motion (ROM) measurements are believed to be essential in establishing the efficacy of physiotherapy for both the general population and specific groups.^20,21 Numerous instruments, such as goniometers, tape measures, reflex markers, computerized digital goniometers, inclinometers, and more can be used to measure the ankle joint's range of motion.²² In clinical settings, inclinometer, tape measurement, and goniometer tests are commonly performed.²³ Almost all of these measurement methods include obtaining measurements without any weight on the subject. The range of motion of the ankle joint can be assessed in both weight-bearing and non-weight-bearing positions. The majority of everyday tasks that people perform are correlated with their ankle range of motion as measured in the weight-bearing position. Thus, as compared to non-weight-bearing studies, weight-bearing measurements usually imitate practical tasks and provide relevant measurements. One method involves having the subject do a weight-bearing lunge test while their lung capacity is being measured. Despite the fact that this method is considered valid and reliable, the literature has few weight bearing lunge test criteria. The weight-bearing lunge test developed by Bennell is used in this study to assess dorsiflexion in college girls of the proper age. The normative value derived from this study can be used as a reference range in the evaluation and rehabilitation of individuals undergoing treatment for different musculoskeletal conditions.

Although paramedics are familiar with the weight bearing lunge test procedure, it is not performed very frequently. The weight bearing lunge test is cautiously or practically used to examine ankle dorsiflexion because of a lack of expertise on how to interpret it. The majority of rehabilitation-focused therapists never even attempt to compare the results of their patients' weight-bearing lunge tests for range of motion with the reference standard. The healing process is impeded as a result, and the goal of a rehabilitation plan is not met. The findings of the weight bearing lunge test must be compared to reference criteria that are appropriate for the person's age group, gender, race, or ethnicity in order to ensure a successful rehabilitation outcome. Due to the difficulty in establishing appropriate standards, weight bearing lunge tests are often not used in clinical settings. Therefore, the significance of ankle dorsiflexion in female college students in the Dakshina Kannada district of Karnataka was examined in this study.

Material and Methods

A criterion-based study using convenience sampling was conducted among 400 female patients at Alva’s Education Foundation, Moodbidri, Dakshina Kannada Mangalore, Karnataka. The study used hand dominance, height, weight and weight-bearing lunge test as outcome measures using universal measuring tape.

Inclusion criteria

The study comprised non-athletic females aged between 17 and 27 years, enrolled in an undergraduate programme and willing to participate.

Exclusion criteria

Male subjects, female and male athletes, those recovering from acute or chronic lower extremity injuries, recent lower extremity injuries or surgeries, females with congenital deformities or acquired deformities, those unable to successfully complete the lunge test, those contraindicated for full weight bearing, those with a concomitant neurological or systemic disorder affecting balance, systemic illness, and ankle arthrodesis were excluded.

The 400 female research participants who met the criteria served as the subjects. Once the project received institutional approval, informed consent from all participants was obtained. Age, height in centimetres, weight in kilograms, and the dominant limb were all noted as demographic data. The range of motion (ROM) of each subject was assessed barefoot while they were in a forward lunge position.

The participants attempted to make contact with a vertical line that had been marked with tape on the wall by controlling a forward lunge while maintaining both feet steady and bending one knee. The participants were told to lunge forward while flexing their hip, knee, and ankle in an effort to connect the front of the knee to the wall while keeping full foot contact with the ground. The participants were instructed to move the great toe away from the wall if he or she was unable to reach the wall with the knee, while still keeping both feet firmly planted on the ground. The subjects were instructed to hold the posture after they had achieved the maximum distance, and the length of the great toe from the wall was measured to the closest 0.1 cm. The foot's pronation or supination was uncontrolled. The participants were permitted to lunge closer to the wall than the 10 cm mark if they were unable to reach it from their starting posture.^24-26

Results

The variables considered in descriptive statistics were age, gender, height, weight, and the weight bearing lunge test. The study included 400 participants' with an average age of 21.22 ± 2.09 (Mean±SD) years. According to anthropometric measures, the average participant weight was 54.98 kilograms, and their average height was 161.06 ± 13.33 centimetres. It was discovered that the majority of participants (n=370), or 92.5 percent were right side dominant, while the remaining subjects (n = 30), or 7.5% were left side dominant. Participants' dominant sides were distributed according to frequency, and it was found that the majority of participants were right side dominant.

The weight bearing lunge test (WBLT) had a mean and standard deviation of 11.16 ± 2.86 and 10.36 ± 2.62, respectively, on the right and left sides. For the right and left sides, the intraclass correlation coefficients were 0.885 and 0.793, respectively. The weight bearing lunge test's intra-class correlation coefficient range for the right and left sides did not significantly differ from one another. The standard error of mean demonstrated similar trend showing no discernible difference between the ranges of dorsiflexion on the right and left sides (Table 1).

To show the correlation between the right and left sides' weight bearing lunge test dorsiflexion ranges, a Bland Altman plot was created. The slope was upward. The Bland-Altman plot depicts the connection between the WBLT of the right and left limbs (Figure 1).

Discussion

The goal of this study was to perform a weight-bearing lunge test to show the range of ankle dorsiflexion in female college students. The results of this study provided data that could be utilized to support the weight bearing lunge test method as a standard for calculating ankle dorsiflexion range of motion. Additionally, this study aimed to provide details on the dorsiflexion range in females aged between 17 and 27 years.

The statistical analysis in this investigation revealed that the range of weight bearing dorsiflexion for the right and left sides was 11.1 cm and 10.3 cm, respectively.

This shows no differences in the dorsiflexion ranges between the right and left sides, and this average distance may be used as a normative value for females aged between 17 and 27 years doing a weight-bearing lunge test.

The results of Hankemeier and Thrasher's study (2014) on the mean range of ankle dorsiflexion are equivalent to the present study.^27,28 The dorsiflexion range was correctly recorded as 11.33 and 11.43 after weight bearing lunge tests were carried out on the dominant and non-dominant sides. Their stated dorsiflexion range matched, if not slightly exceeded, the dorsiflexion range recorded in this investigation. A significant element could be the inclusion of individuals in the age range of 18 to 25 years. Due to the availability of data collectors, lack of funding, and concerns about practicality, convenience sampling was utilized in this study, and only women were included. By observing the weight bearing lunge tests done by patients in clinical settings, the rehabilitative therapist may be able to learn more about the patient's prognosis and degree of impairment. The weight bearing lunge test is one of the most well-established and trustworthy procedures to evaluate ankle dorsiflexion ranges.²⁹ The weight bearing lunge test does not require any special tools, bone landmark palpation or marking, placements, or other procedures. Various demographics may benefit from the weight bearing lunge test with ankle dorsiflexion range in clinical settings.³⁰

The sample was limited to participants aged 17 to 27 years, and the approach did not compare the ankle's range of motion in dorsiflexion using an inclinometer or goniometer, which would have provided additional data. These two can be considered as the limitations of this study. This study solely included female participants, and the sample exclusively consisted of non-athletes. A smaller population was included in the convenient sample, which was restricted to a specific location.

Conclusion

The mean difference of the included participants was 0.8 cm in the weight bearing lunge test technique for dorsiflexion range of motion in the right and left sides, respectively. According to the study, the reference standard for measuring dorsiflexion range of motion in clinical practice might be the normative value.

Conflict of Interest

Nil