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The immediate effect of different calf muscle stretching techniques on ankle dorsiflexion range of motion and dynamic balance in women workers wearing high-heeled shoes

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Weerasak Tapanya at University of Phayao
Weerasak Tapanya
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Objective: The purpose of this study was to examine the immediate effect of different calf muscle stretching techniques on ankle dorsiflexion range of motion and dynamic balance in women workers wearing high-heeled shoes. Methods: Comparing the effects of dynamic stretching and proprioceptive neuromuscular facilitation stretching (PNF stretching) in 28 volunteers aged 21-45 years who had worn high-heeled shoes of minimum 5 centimeters, 20 hours per week for at least 1 year. Ankle dorsiflexion range of motion in weight bearing lunge position and Star Excursion Balance Test (SEBT) were performed before and after each technique of stretching. Results: The results showed ankle dorsiflexion range of motion and SEBT score significantly increased after both stretching techniques (p
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90


The immediate effect of different calf muscle stretching techniques on ankle dorsiflexion range of motion and
dynamic balance in women workers wearing high-heeled shoes



Department of Physical Therapy, Faculty of Allied Health Sciences, University of Phayao, Phayao Province, Thailand
 

Received September 

Abstract
Objective: The purpose of this study was to examine the immediate effect of different calf muscle stretching
techniques on ankle dorsiflexion range of motion and dynamic balance in women workers wearing high-heeled
shoes.
Methods: Comparing the effects of dynamic stretching and proprioceptive neuromuscular facilitation stretching
(PNF stretching) in 28 volunteers aged 21-45 years who had worn high-heeled shoes of minimum 5 centimeters,
20 hours per week for at least 1 year. Ankle dorsiflexion range of motion in weight bearing lunge position and Star
Excursion Balance Test (SEBT) were performed before and after each technique of stretching.
Results: The results showed ankle dorsiflexion range of motion and SEBT score significantly increased after both
stretching techniques (p<0.01) with no significant difference of mean change between both stretching techniques.
Conclusion: PNF stretching and dynamic stretching can increase ankle dorsiflexion range of motion and dynamic
balance. Therefore, both techniques of stretching exercise program should be recommended to female wearing
high-heeled shoes to increase ankle dorsiflexion range of motion and dynamic balance.

Keywords: Dynamic stretching, PNF stretching, high-heeled shoes, ankle dorsiflexion range of motion, balance
. Doi: 10.14456/jams.2016.8
90


The immediate effect of different calf muscle stretching techniques on ankle dorsiflexion range of motion and
dynamic balance in women workers wearing high-heeled shoes



Department of Physical Therapy, Faculty of Allied Health Sciences, University of Phayao, Phayao Province, Thailand
 

Received September 

Abstract
Objective: The purpose of this study was to examine the immediate effect of different calf muscle stretching
techniques on ankle dorsiflexion range of motion and dynamic balance in women workers wearing high-heeled
shoes.
Methods: Comparing the effects of dynamic stretching and proprioceptive neuromuscular facilitation stretching
(PNF stretching) in 28 volunteers aged 21-45 years who had worn high-heeled shoes of minimum 5 centimeters,
20 hours per week for at least 1 year. Ankle dorsiflexion range of motion in weight bearing lunge position and Star
Excursion Balance Test (SEBT) were performed before and after each technique of stretching.
Results: The results showed ankle dorsiflexion range of motion and SEBT score significantly increased after both
stretching techniques (p<0.01) with no significant difference of mean change between both stretching techniques.
Conclusion: PNF stretching and dynamic stretching can increase ankle dorsiflexion range of motion and dynamic
balance. Therefore, both techniques of stretching exercise program should be recommended to female wearing
high-heeled shoes to increase ankle dorsiflexion range of motion and dynamic balance.

Keywords: Dynamic stretching, PNF stretching, high-heeled shoes, ankle dorsiflexion range of motion, balance
Vol. 49 No. 1 January 2016 Bull Chiang Mai Assoc Med Sci 91
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   
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บทคัดย่อ
วัตถุประสงค์: 

วิธีการ:    

      


ผลการศึกษา:
p

สรุปผลการศึกษา: 



วารสารเทคนิคการแพทย์เชียงใหม่ 2559; 49(1): 90-99
ค�ารหัส:
 
. Doi: 10.14456/jams.2016.8
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  
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 

   

 
 
    



stretching)

  
 13

      






13 

 

 

 





      
  12 

     


  3,14 
  
 


วิธีการศึกษา
Variables Mean+SD
Age (years) 29.14±4.91
Weight (kilograms) 
Height (centimeters) 160.68±6.88
Leg length (centimeters) 83.32±4.45
Heel-height (centimeters) 
Wearing high-heeled shoes
(hours/week)
42.50±12.92
Table 1 Subjects demographic data (mean±standard
deviation).
92

  
 

  10 
 
 11



 
 12 
   


 

   

 
 
    



stretching)

  
 13

      






13 

 

 

 





      
  12 

     


  3,14 
  
 


วิธีการศึกษา
Variables Mean+SD
Age (years) 29.14±4.91
Weight (kilograms) 
Height (centimeters) 160.68±6.88
Leg length (centimeters) 83.32±4.45
Heel-height (centimeters) 
Wearing high-heeled shoes
(hours/week)
42.50±12.92
Table 1 Subjects demographic data (mean±standard
deviation).
Vol. 49 No. 1 January 2016 Bull Chiang Mai Assoc Med Sci 93
 

  
   
15
 

 16
 
   

11
 
 
13 
 




Figure 1 Dynamic Stretching. A, Starting position; B, Stretching position
1
Figures
Figure 1 Dynamic Stretching
A, Starting position; B, Stretching position

with agonist contraction technique17

     
 


    


  
  



94
1
Figure 2 Proprioceptive neuromuscular facilitation stretching; PNF stretching
Figure 2 Proprioceptive neuromuscular facilitation stretching; PNF stretching.


   
   


 
13
 


   




 

     


  



18 
   


SEBT score = “(Anterior distance+Posterolateral
distance+Posteromedial distance) x 100” / “3 (Leg length)”


     

94
1
Figure 2 Proprioceptive neuromuscular facilitation stretching; PNF stretching
Figure 2 Proprioceptive neuromuscular facilitation stretching; PNF stretching.


   
   


 
13
 


   




 

     


  



18 
   


SEBT score = “(Anterior distance+Posterolateral
distance+Posteromedial distance) x 100” / “3 (Leg length)”


     

Vol. 49 No. 1 January 2016 Bull Chiang Mai Assoc Med Sci 95


ICC3,1 p3,1p<0.002

1
Figures
Figure 3 Star excursion balance test; SEBT
A, Anterior direction; B, Posterolateral direction; C, Posteromedial direction
Figure 3 Star Excursion Balance Test; SEBT. A, Anterior direction; B, Posterolateral direction; C, Posteromedial direction

   
 
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
 
p<0.05
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   

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(p
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96
  

   

Table 2 
Variables PNF stretching Dynamic stretching Mean difference between pre &
post
pre post pre post PNF DYN p-value
SEBT score 2.51±0.23 #2.54±0.25 †0.21±0.11  0.16
Anterior  2.95±0.21# 2.91±0.20†0.18±0.15 0.15±0.19 0.51
Posteromedial 2.42±0.34 2.65±2.28#2.42±0.38 2.61±0.31†0.23±0.18 0.19±0.18 0.38
Posterolateral 2.34±0.36 2.56±0.33#2.44±0.33 †0.22±0.21 0.13±0.25 0.11
Ankle dorsiflexion
ROM (degrees)
 # †6.82±4.00  0.06
# Significant greater than Pre-PNF stretching at p<0.01
†Significant greater than Pre-dynamic stretching at p<0.01
PNF - PNF stretching, DYN - Dynamic stretching
 
 
   
(p



   
19

   

 20  

 
  

    


 20 
 
 
วิจารณ์ผล  
 

 11 

 
  
 
12 



 

 
 
    
 
   

  

    
   
96
  

   

Table 2 
Variables PNF stretching Dynamic stretching Mean difference between pre &
post
pre post pre post PNF DYN p-value
SEBT score 2.51±0.23 #2.54±0.25 †0.21±0.11  0.16
Anterior  2.95±0.21# 2.91±0.20†0.18±0.15 0.15±0.19 0.51
Posteromedial 2.42±0.34 2.65±2.28#2.42±0.38 2.61±0.31†0.23±0.18 0.19±0.18 0.38
Posterolateral 2.34±0.36 2.56±0.33#2.44±0.33 †0.22±0.21 0.13±0.25 0.11
Ankle dorsiflexion
ROM (degrees)
 # †6.82±4.00  0.06
# Significant greater than Pre-PNF stretching at p<0.01
†Significant greater than Pre-dynamic stretching at p<0.01
PNF - PNF stretching, DYN - Dynamic stretching
 
 
   
(p



   
19

   

 20  

 
  

    


 20 
 
 
วิจารณ์ผล  
 

 11 

 
  
 
12 



 

 
 
    
 
   

  

    
   
Vol. 49 No. 1 January 2016 Bull Chiang Mai Assoc Med Sci 

   
 





สรุปผลการศึกษา
 


 



  
13


 



 
  
20-22  

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 


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กิติกรรมประกาศ
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 
 
 

2013, 225.
        
 
 
 
 
       
 
 
 
 
 
 
เอกสารอ้างอิง
98
 
 
 
 
 
 
 
 

 
 
 
 
 
 
2582-8.
 
 
 
              
 
 
 

2013, 225.
        
 
 
 
 
       
 
 
 
 
 
 
เอกสารอ้างอิง
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Changes in Ankle Range of Motion and Muscle Strength in Habitual Wearers of High-Heeled Shoes
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  • Mar 2013
Although cross-sectional biomechanical studies have reported that wearing high-heeled shoes can change the musculoskeletal system of the lower extremities, the long-term effects of wearing such shoes on the ankle remain unknown. The aim of this study was to reveal changes in ankle range of motion and muscle strength in habitual wearers of high-heeled shoes and to provide information for clinicians undertaking functional evaluations of the ankles of such patients. Habitual wearers of high-heeled shoes (n = 10; age, 23.9 ± 2.7 years) and wearers of flat shoes (n = 10; age, 23.8 ± 2.1 years) were selectively recruited, and the range of motion, maximal voluntary isometric force, and concentric contraction power of their ankles were measured. Wearers of high-heeled shoes showed increased ankle range of motion on plantarflexion at 25 degrees and inversion at 10 degrees compared to flat shoe wearers (P < .05) but decreased dorsiflexion (about 17 degrees) and eversion (13 degrees; P < .05). Concentric contraction power in ankle eversion was also 2 times higher in wearers of high-heeled shoes (P < .05). These subjects had functional deformity of the ankle in a supinated direction and increased eversion power. We cautiously recommend that habitual wearers of high-heeled shoes (those who walk in such shoes for more than 5 hours more than 6 times a week) undertake intensive ankle stretching exercises in the direction of dorsiflexion as well as eversion.
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Dynamic Balance Differences as Measured by the Star Excursion Balance Test Between Adult-aged and Middle-aged Women
Article
Full-text available
  • Sep 2011
Middle-aged women have less postural control than younger women. The Star Excursion Balance Test is a functional and inexpensive postural control measurement tool that is sensitive to age-related changes in balance. The middle-aged females will experience lower excursion scores compared with the younger women. Fifty-three healthy, recreationally active women were divided into 2 groups: adult-aged (n = 29; age range, 23-39 years) and middle-aged (n = 24; age range, 40-54 years). Each participant performed 3 reaches for 3 trials (anteromedial, medial, posteromedial) in a randomized order. The 3 reach trials were converted to a normalized value (percentage of participant's height) and assessed as an overall mean for the 1-way analysis of variance. Intraclass correlation coefficients and 95% confidence intervals were calculated. No differences were found for body mass index and height; however, age was different between groups (P < 0.01). Intraclass correlation coefficient(2,3) values for the 3 directions ranged from 0.72 to 0.97. The adult-aged women were able to reach farther in all 3 directions when tested with the Star Excursion Balance Test (6.8-7.6 cm, P < 0.05). Lower postural control scores based on the Star Excursion Balance Test were found for the older women. The younger women were able to reach approximately 7 cm farther during the anterior, anteromedial, and posteromedial excursions.
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On muscle, tendon and high heels
Article
Full-text available
  • Aug 2010
  • J EXP BIOL
Wearing high heels (HH) places the calf muscle-tendon unit (MTU) in a shortened position. As muscles and tendons are highly malleable tissues, chronic use of HH might induce structural and functional changes in the calf MTU. To test this hypothesis, 11 women regularly wearing HH and a control group of 9 women were recruited. Gastrocnemius medialis (GM) fascicle length, pennation angle and physiological cross-sectional area (PCSA), the Achilles' tendon (AT) length, cross-sectional area (CSA) and mechanical properties, and the plantarflexion torque-angle and torque-velocity relationships were assessed in both groups. Shorter GM fascicle lengths were observed in the HH group (49.6+/-5.7 mm vs 56.0+/-7.7 mm), resulting in greater tendon-to-fascicle length ratios. Also, because of greater AT CSA, AT stiffness was higher in the HH group (136.2+/-26.5 N mm(-1) vs 111.3+/-20.2 N mm(-1)). However, no differences in the GM PCSA to AT CSA ratio, torque-angle and torque-velocity relationships were found. We conclude that long-term use of high-heeled shoes induces shortening of the GM muscle fascicles and increases AT stiffness, reducing the ankle's active range of motion. Functionally, these two phenomena seem to counteract each other since no significant differences in static or dynamic torques were observed.
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To stretch or not to stretch: The role of stretching in injury prevention and performance
Article
Full-text available
  • Apr 2010
  • SCAND J MED SCI SPOR
Stretching is commonly practiced before sports participation; however, effects on subsequent performance and injury prevention are not well understood. There is an abundance of literature demonstrating that a single bout of stretching acutely impairs muscle strength, with a lesser effect on power. The extent to which these effects are apparent when stretching is combined with other aspects of a pre-participation warm-up, such as practice drills and low intensity dynamic exercises, is not known. With respect to the effect of pre-participation stretching on injury prevention a limited number of studies of varying quality have shown mixed results. A general consensus is that stretching in addition to warm-up does not affect the incidence of overuse injuries. There is evidence that pre-participation stretching reduces the incidence of muscle strains but there is clearly a need for further work. Future prospective randomized studies should use stretching interventions that are effective at decreasing passive resistance to stretch and assess effects on subsequent injury incidence in sports with a high prevalence of muscle strains.
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Investigation into the long-term effects of static and PNF stretching exercises on range of motion and jump performance
Article
Full-text available
  • Feb 2009
The purpose of the present study was to investigate the long-term effects of two different stretching techniques on the range of motion (ROM) and on drop jump (DJ). DJ scores were assessed by means of a contact mat connected to a digital timer. ROM was measured by use of a goniometer. The training was carried out four times a week for 6 weeks on 10 subjects as passive static stretching (SS), and on 9 subjects as contract-relax PNF (CRPNF) stretching. The remaining nine subjects did not perform any exercises (control group). One-way Analysis of Variance (ANOVA) results indicated that the differences among groups on DJ were not statistically different (F(2,27)=.41, p>.05). ROM values were significantly higher for both stretching groups, while no change was observed for the control group. In conclusion, static and proprioceptive neuromuscular facilitation (PNF) stretching techniques improved the ROM, but neither of the stretching exercises had any statistically significant effect on the DJ scores.
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Interaction between transient change in local muscle structure and segmented leg motor responses
Article
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We investigated the interaction between transient change in the local structure of gastrocnemius muscle fibers and the segmented leg motor responses elicited by toes-up rotation of the support surface. The gastrocnemius muscle in healthy young subjects underwent a sustained 2-min. isometric stretch (Prestretch group), followed immediately by the rotations. Analysis showed that the prestretch affected the amplitude of the monosynaptic but not the automatic components of the medial gastrocnermus muscle responses (monosynaptic response: 93+/-20% of the mean of the last three rotations in the Prestretch group compared to 174+/-42% in the Control group; automatic response: 128+/-18% in the Prestretch group versus 123+/-31% in the Control group). The shortened tibialis anterior muscle response and the onset latencies of responses were not affected by prestretching the gastrocnermus muscle. The prestretch effect on the amplitude of the monosynaptic (mediated by group la afferents) but not the automatic gastrocnemius muscle response (mediated by group 11 afferents) suggests that the automatic component of the muscle response to platform rotations has a stronger supraspinal influence than the monosynaptic response and is thus less affected by local events such as prolonged stretching.
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Ankle dorsiflexion range of motion influences dynamic balance in individuals with chronic ankle instability
Article
  • Apr 2013
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Individuals with chronic ankle instability (CAI) often have impairments in ankle range of motion (ROM) and balance. There is limited evidence that these impairments are related in individuals with CAI. The purpose of this study was to determine the relationship between ankle dorsiflexion ROM and dynamic balance in individuals with CAI. Forty-five participants (age=23.2±2.8 y, height=172.1±10.8 cm, mass=70.6±13.3 kg, Foot and Ankle Ability Measure Sport= 71.2±11.7, Modified Ankle Instability Instrument= 6.4±1.3) volunteered for this study. Ankle dorsiflexion ROM was measured in a weight-bearing position while dynamic balance was measured using the Star Excursion Balance Test (SEBT) in the anterior, posteromedial, and posterolateral directions. Linear regression was used to determine the relationship between ankle dorsiflexion ROM and measures of dynamic balance. There were fair positive correlations between dorsiflexion ROM and the anterior reach direction (r = .55, r(2) = .31, P < .001), posterolateral reach direction (r = .29, r(2) = .09, P = .03), and the composite SEBT scores (r = .30, r(2) = .09, P= .02). There was little or no relationship between ankle dorsiflexion and the posteromedial reach direction (r = .01, r(2) = .001, P = .47). Ankle dorsiflexion ROM can influence dynamic balance, specifically the anterior reach portion of the SEBT. Individuals with CAI who demonstrate impairments in dorsiflexion ROM may also demonstrate difficulty with portions of the SEBT. Clinicians may use this information to better optimize rehabilitation programs that address ankle dorsiflexion ROM and dynamic balance. 5.
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Biomechanical effects of wearing high-heeled shoes
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  • Dec 2001
  • INT J IND ERGONOM
A survey of 200 young women wearing high-heeled shoes indicated frequent complaints of leg and low back pain. Consequently, an empirical study examined the biomechanical effects of three heel heights (0, 4.5, and 8 cm), while standing stationary and while walking in five, healthy, young women. Four major biomechanical effects were observed. As heel heights increased, the trunk flexion angle decreased significantly. Similarly, tibialis anterior EMG, low back EMG and the vertical movement of the body center of mass increased significantly while walking with high-heeled shoes. Due to these added stresses, wearing of high heels should be avoided.Relevance to industryIn addition to the normal physical job stresses, women workers may experience additional biomechanical stresses placed on them by fashion demands such as high heels. All these effects can significantly increase discomfort levels in those wearing high heels.
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Kinematics of high-heeled gait
Article
  • May 1990
  • ARCH PHYS MED REHAB
High-heeled shoes cause postural changes, a loss in foot function, and increased shock loadings during gait, which must be compensated by accommodations in the kinematics of body segments proximal to the feet. The hypothesis tested in this study was that there are differences in the three-dimensional kinematics of the tibia, knee, hip, pelvis, trunk, and upper trunk between low-heeled and high-heeled gait. Gait analysis of 14 subjects showed that during high-heeled gait subjects walked more slowly (p less than .001), had shorter stride lengths (p less than .001), and had higher stance time percentages (p less than .05). Kinematically, high-heeled gait compared to low-heeled gait, was characterized by significantly increased knee flexion at heelstrike (5.4 degrees vs 2.1 degrees, p less than .05) and during stance phase (22.6 degrees vs 19.2 degrees, p less than .05). During swing phase, high-heeled gait, compared to low-heeled gait, resulted in significantly lower knee flexion (66.1 degrees vs 72.1 degrees, p less than .05) and hip flexion (33.5 degrees vs 34.8 degrees, p less than .05). The range of motion of the pelvis in the sagittal plane was slightly lower in high-heeled gait than in low-heeled gait (7.0 degrees vs 7.9 degrees, p less than .05). No significant differences between low-heeled and high-heeled gait were found in the motions of the pelvis and trunk in the frontal and transverse planes. Statistical tests of intrasubject variability of angles of gait showed that five repeated trials were adequate for analysis of the tibia and knee in all planes of motion and for the hip in frontal and transverse planes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Gains in range of ankle dorsiflexion using three popular stretching techniques
Article
  • Sep 1986
  • Am J Phys Med
Among modern stretching techniques none has clearly been shown to be the most effective for increasing range of motion. The most common stretching method comparisons are between static stretching (SS) and one or more Proprioceptive Neuromuscular Facilitation (PNF) technique(s). The two most frequently implemented PNF techniques are: contract-relax (CR); and contract-relax-antagonist-contract (CRAC). Previous comparative investigations among stretching methods have primarily observed changes in straight-leg hip flexion as a result of lengthening the hamstrings, a two-joint muscle. The present study observed gains in range of motion among three stretching methods (SS, CR, CRAC) of a joint limited by a single joint muscle, the soleus. Twelve subjects performed each of the three methods on separate days. Significant differences were observed among all methods (p = .001). Further analysis revealed the CRAC method was superior to the CR method (p less than .01), and the CR method was superior to the SS method (p less than .01). Significant pre-post-treatment gains in range of motion were observed as a result of the CR and CRAC methods, but not the SS method. The results of this study support the findings of those previous investigations for two-joint muscles in which PNF techniques were more effective than static stretching for increasing range of motion. Also, a reciprocal activation (CRAC in the present study) was the most effective for increasing range of motion.
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