Elsevier

Gait & Posture

Volume 64, July 2018, Pages 114-118
Gait & Posture

Full length article
Full gait cycle analysis of lower limb and trunk kinematics and muscle activations during walking in participants with and without ankle instability

https://doi.org/10.1016/j.gaitpost.2018.06.001Get rights and content

Highlights

  • Full time-series kinematic and EMG signals were reported during walking.

  • Comparisons were drawn between healthy athletes and those with CAI.

  • Significantly increased early stance FFTBA inversion in unstable vs stable limb.

  • No other differences in kinematics or muscle activation observed between groups.

  • CAI group kinematics may predispose to episodes of giving way and recurrent sprains.

Abstract

Background

Chronic ankle instability (CAI) has previously been linked to altered lower limb kinematics and muscle activation characteristics during walking, though little research has been performed analysing the full time-series across the stance and swing phases of gait.

Research Question

The aim of this study was to compare trunk and lower limb kinematics and muscle activity between those with chronic ankle instability and healthy controls.

Methods

Kinematics and muscle activity were measured in 18 (14 males, 4 females) healthy controls (age 22.4 ± 3.6 years, height 177.8 ± 7.6 cm, mass 70.4 ± 11.9 kg, UK shoe size 8.4 ± 1.6), and 18 (13 males, 5 females) participants with chronic ankle instability (age 22.0 ± 2.7 years, height 176.8 ± 7.9 cm, mass 74.1 ± 9.6 kg, UK shoe size 8.1 ± 1.9) during barefoot walking trials, using a combined Helen Hayes and Oxford foot model. Surface electromyography (sEMG) was recorded for the tibialis anterior and gluteus medius. Full curve statistical parametric mapping was performed using independent and paired-samples T-tests.

Results

No significant differences were observed in kinematic or sEMG variables between or within groups for the duration of the swing phase of gait. A significantly increased forefoot-tibia inversion was seen in the CAI affected limb when compared to the CAI unaffected limb at 4–16% stance (p = 0.039). No other significant differences were observed.

Significance

There appears to be no differences in muscle activation and movement between CAI and healthy control groups. However, participants with CAI exhibited increased inversion patterns during the stance phase of gait in their affected limb compared to their unaffected limb. This may predispose those with CAI to episodes of giving way and further ankle sprains.

Introduction

Lateral ankle sprains are one of the most common musculoskeletal injuries in both general and sporting populations [1]. Following an acute ankle sprain, it is suggested that 32–74% of individuals have residual symptoms such as recurrent sprains, episodes of giving way and/or perceived instability [2]. Chronic ankle instability (CAI) is defined as ‘a history of recurrent ankle sprains and the sensation of giving way’ [3]. Long term, links have been established between the development of osteoarthritis and a history of CAI, suggesting abnormal kinematic movement patterns adopted may increase repetitive cartilage damage to the medial ankle [4]. Greater understanding of the biomechanics associated with CAI may aid the development of preventative measures.

Walking is of high importance in daily life, and is often problematic for people with CAI who complain of giving way sensations on uneven and level surfaces [5]. Research suggests that the position of the affected ankle joint at specific time points during the gait cycle may predispose an ankle to injury [6]. This may be associated with or caused by ankle joint instability. Research analysing frontal plane ankle kinematics during walking observed increased ankle inversion that corresponded to greater ankle inversion during more sport-specific tasks such as jump-landing [7]. Gait analysis is often used in the development of rehabilitation and injury prevention protocols, therefore any changes in full body gait kinematics need to be investigated, and where possible accounted for, as these may impact not only walking but other more dynamic movements.

Previous literature investigating sEMG found hip abductor weakness to be associated with acute ankle sprains, though it is unclear whether this is a cause or an effect of the sprain [8]. Koldenhoven et al. [9] reported increased gluteus medius activation in the late stance and early swing phase of walking in CAI participants, suggesting this may be a coping mechanism used to generate a wider base of support, or to increase lower limb stability. Decreased tibialis anterior activation was also observed resulting in increased ankle plantarflexion prior to heel strike. This loose-packed position (ligaments and the joint capsule lax and minimal joint surface contact) has been found to be unstable [10], suggesting an increased risk of ankle sprains.

Previous literature investigating CAI during walking has modelled the foot as one rigid segment [11,12], however the foot is composed of 26 bones and 20 articulated joints with a number of complex interactions [13]. Rigid segment modelling excludes motion between different segments of the foot providing inadequate information on the biomechanics of the foot [11]. De Ridder et al. [14] appears to be the first study to analyse walking using a multi-segmental foot model, comparing the use of the Ghent Foot Model to a rigid foot model in participants with CAI, copers (no symptoms of instability after a recent ankle sprain) and control participants. Results lead the authors to conclude that the multi-segmental foot model provided greater details of the intricacies of the foot, showing differences between segments when comparing groups.

Upper body kinematic analysis should be considered when investigating changes in the lower extremities as there may be a significant relationship with changes observed in proximal segments [15]. The body is a multi-linked system with the rectus femoris, hamstrings and gastrocnemius muscles crossing the hip, knee and ankles. The kinetic chain concept suggests that movement of the trunk during landing (which accounts for 35.5% body mass) will also have an impact on motion of the hip and therefore knee and ankle [16]. To the authors’ knowledge, no research has combined trunk kinematics with a full lower limb and multi-segmental foot model to address, in combination, the possible proximal and distal differences between groups.

Prior research reports joint angles and muscle activation characteristics at discrete time points during walking [9,12], rather than whole kinematic time-series curves. Biomechanical data is one dimensional (1D) (time and kinematic or force trajectories) therefore this may result in focus bias or missing potential significance or trends during other phases of the gait cycle [17]. Statistical parametric mapping (SPM) is a concept introduced to biomechanics from brain research [18] which enables curve analysis across the whole movement [17]. Comparison between SPM and time series analysis using confidence intervals concluded SPM to be the most suitable method for analysis of 1D data, due to increased generalisability of probabilistic conclusions (with the use of hypothesis testing techniques) and the ability to present results in a more consistent manner aiding interpretation of findings [19]. De Ridder et al. [14] used SPM to compare foot kinematics between participants with CAI, copers and controls, identifying exact time periods of significantly increased forefoot inversion within the stance phase of walking.

It is suggested that combined analysis of the trunk, hip, knee and multi-segmental foot kinematics and sEMG activation patterns across the stance and swing phases of gait will provide greater insight into possible differences that exist, not just within the foot, but across the full kinetic chain. This may provide greater insight to clinicians rehabilitating those with ankle instability and may highlight areas of importance in the reduction of future ankle sprains. The aim of this study was to compare trunk, hip, knee and multi-segmental foot kinematics and muscle activation during the stance and swing phase of walking between participants with CAI and healthy controls.

Section snippets

Participants

Eighteen (14 males, 4 females) healthy controls (age 22.4 ± 3.6 years; height 177.8 ± 7.6 cm; mass 70.4 ± 11.9 kg; UK shoe size 8.4 ± 1.6), and 18 (13 males, 5 females) participants with CAI (age 22.0 ± 2.7 years; height 176.8 ± 7.9 cm; mass 74.1 ± 9.6 kg; UK shoe size 8.1 ± 1.9) participated in this study. Ethical approval was granted by the institutional ethics committee prior to testing. Written informed consent was obtained from participants and a health screen questionnaire completed prior

Results

Independent-samples t-tests revealed no significant differences (p > 0.05) between groups for age, stature, mass, or shoe size. An independent-samples t-test reported no significant difference in walking velocity when comparing the control group (1.20 ± 0.15 m s−1), and CAI group (1.18 ± 0.09 m s−1).

No significant differences were observed in FFHFA, FFTBA, HFTBA, hip, knee, or trunk angles in the sagittal, frontal, or transverse planes of motion, in the stance or swing phase, between the

Discussion

The aims of this study were to explore the differences in kinematics and muscle activation patterns between CAI participants’ unaffected and affected ankles and to compare the same variables to a matched control group throughout the gait cycle.

Increased FFTBA inversion was found in the affected limb of the CAI group when compared to its unaffected counterpart at 4–16% stance. This finding is of particular clinical interest, supporting previous hypotheses that participants with CAI may exhibit

Conclusion

Participants with CAI exhibited increased inversion patterns during the stance phase of gait in their affected limb compared to their unaffected limb. This change in movement pattern may predispose those with CAI to episodes of giving way and further ankle sprains. Increased inversion may also be a significant risk factor in more dynamic movements, thus further research should investigate these using a multi-segmental foot model. Incorporating kinetic variables into this analysis may also be

Conflict of interest

None.

References (30)

  • B. Najafi et al.

    Does footwear type impact the number of steps required to reach gait steady state? An innovative look at the impact of foot orthoses on gait initiation

    Gait Posture

    (2010)
  • C.M. O’Connor et al.

    Automatic detection of gait events using kinematic data

    Gait Posture

    (2007)
  • S. Franklin et al.

    Barefoot vs common footwear: a systematic review of the kinematic, kinetic and muscle activity differences during walking

    Gait Posture

    (2015)
  • P.A. Gribble et al.

    Consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains

    Br. J. Sport Med.

    (2016)
  • P.A. Gribble et al.

    Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium

    J. Orthop. Sports Phys. Ther.

    (2013)
  • Cited by (14)

    • Muscle activations during functional tasks in individuals with chronic ankle instability: a systematic review of electromyographical studies

      2021, Gait and Posture
      Citation Excerpt :

      The timing of activation during treadmill walking was investigated in one study [36], which reported that PL, TA, LG, RF, BF, and GM were activated earlier in CAI than in the control participants and PL was activated for a longer time interval across the entire stride cycle in CAI compared to the controls [36]. Three studies on the magnitude of muscle activations in ground walking found no differencebetween CAI and controls when considering EMG amplitude of PL, TA, MG, ST, RF, GM and Gmax [39], for TA and GM [40], and for PL and TA muscles [23], respectively. One study reported a reduced activation of GM from 6 to 9 % and 99–100 % of the stance phase in CAI compared to the controls, and no intergroup differences for PL, TA, LG, MG, and VL [41].

    • Electromyographic traces of motor unit synchronization of fatigued lower limb muscles during gait

      2021, Human Movement Science
      Citation Excerpt :

      In their study they conclude that the ankle complex is vital for the stability of the knee and its activity could facilitate the transitions between swing and stance phases. Furthermore, the work of Northeast et al.(Northeast et al., 2018) explains also that uncle instability is coupled with increased inversion patterns which can be a risk factor for injuries. As explained before, the fatigue produced by the protocol can potentially disrupt the correct patterns of the ankle complex.

    • Gluteus medius activity during gait is altered in individuals with chronic ankle instability: An ultrasound imaging study

      2019, Gait and Posture
      Citation Excerpt :

      As gait is a fundamental daily activity that requires pelvic stability for successful lower extremity movement, a deeper investigation of gluteal muscle activity throughout gait in individuals with CAI is warranted. Previous studies quantifying hip muscle activity during walking in CAI populations have primarily focused on gluteus medius (GMED) surface electromyography (EMG), and have noted subtle differences between CAI and healthy cohorts [9,10,19,20]. However, this method may not be sufficient due to cross-talk from the gluteus maximus (GMAX) and tensor fascia latae muscles as reflected in the large variability in previous outcome EMG measures [20,21].

    View all citing articles on Scopus
    View full text