Isolating the energetic and mechanical consequences of imposed reductions in ankle and knee flexion during gait.
Emily M McCain, Theresa L Libera, Matthew E Berno and 3 others
PMID 33526053WHAT IT FOUND
Restricting an ankle or restricting ankle and knee together made 15 healthy adults use more energy to walk than wearing the knee brace without restriction.
Ankle restriction alone was not clearly different from knee restriction alone, and it did not test a treatment.
Key findings
01Walking energy cost was higher when the ankle was restricted than when the knee brace was worn unrestricted.
02Restricting the knee increased outward foot swing more than restricting the ankle.
03Restricting ankle and knee together increased energy cost more than knee restriction alone, and total positive joint power was lower than in the braced condition.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Fifteen healthy adults with a mean age of 24.2 years walked at 0.8 m/s, so the results may not apply to older or slower walkers. The study used braces to limit motion in healthy people, so it did not test a treatment and did not reproduce stroke-related weakness, motor control, reflex, or muscle efficiency changes. Knee braces were worn on both limbs in most conditions, and the no-brace condition was last, which may have changed gait compared with fully unbraced walking. The ankle stay was added and removed between conditions, and the time needed to get used to unilateral bracing is unclear. Trunk and upper-limb compensation were not measured, so they may have affected lower-limb mechanics and energy cost.
Declared interests
The publication types list NIH extramural research support. The supplied text does not include a conflict-of-interest declaration.
The easy way to misread this
Do not read the ankle results as proof that ankle-focused rehabilitation improves walking after stroke. The study restricted motion in healthy adults, and ankle restriction alone was not clearly different from knee restriction alone.