Clinical trial NCT05015088: Effectiveness of Gastrocnemius Stretching
Official title: Effectiveness of Gastrocnemius Stretching
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Gastrocnemius Tightness
Lead sponsor: Regis University
Sponsor class: OTHER
Collaborators: name: University of Colorado, Denver
First posted: 2021-08-20
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: OTHER
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Healthy individuals

Brief summary: The aims of this study are to: (1) determine muscle activation of the tibialis posterior muscle during different common gastrocnemius stretches and (2) radiographically quantify the tibial-calcaneal angle during the common stretching positions. We hypothesize that stretching over the edge of a step with the arch supported will minimize the activation of the tibialis posterior muscle in addition to increasing the tibial-calcaneal angle.

Detailed description: Many studies have assessed the effect of dynamic and passive support of the medial longitudinal arch. The posterior tibial tendon is the main dynamic stabilizer of the medial longitudinal arch, although peroneus/fibularis longus, flexor digitorum longus, and flexor hallucis longus also contribute to a lesser degree. Passive structures also a play role in supporting the arch and include the plantar fascia, plantar ligaments and spring ligament. These plantar structures aid in preventing collapse of the arch during weight bearing.

Several studies have demonstrated that increased tension from the triceps surae can lead to flattening of the arch. Gastrocnemius muscle tightness in particular is thought to be partially responsible for many forefoot and midfoot conditions in non-neurologically impaired patients. Therefore, identifying effective ways to stretch the gastrocnemius muscle without creating increased stress through dynamic structures that support the longitudinal arch may be important for the management of individuals with limited gastrocnemius flexibility.

Common ways to stretch the gastrocnemius include a runner's stretch, stretching with the foot fully supported on a ramp, stretching with the arch of the foot supported on the edge of step and the heel dropping down toward the ground and lastly, stretching with the ball of the foot supported on the edge of a step and the heel dropping down toward the ground. To our knowledge no other studies have assessed the muscle activation of the tibialis posterior muscle via indwelling EMG activation in addition to radiographic measurements to determine the effectiveness of common gastrocnemius stretches. Therefore, the aims of this study are to determine muscle activation of the tibialis posterior muscle during different common gastrocnemius stretches and to radiographically quantify the tibial-calcaneal angle. We hypothesize that stretching over the edge of a step with the arch supported will minimize the activation of the tibialis posterior muscle in addition to increasing the tibial-calcaneal angle more than the other stretching positions.

Eligibility criteria: Inclusion Criteria:

• 20 healthy subjects between the ages of 18 to 65 years old.

Exclusion Criteria:

* any boney or tendinous foot/ankle operative procedure
* diagnosis of neuromuscular disorder
* any previous ankle fracture or degenerative changes that would limit dorsiflexion range of motion
* no obvious gait asymmetries demonstrated through observation
* participants who are pregnant will be excluded from participation in the study

Primary outcomes:
measure: EMG activation
timeFrame: up to 6 months
measure: Radiographic evaluation
timeFrame: up to 6 months
Secondary outcomes:
measure: Relationship between foot posture and radiographic evaluation of tibia-calcaneal angle
timeFrame: up to 6 months
Other outcomes:
Locations:
city: Denver
country: United States
facility: Regis University
state: Colorado
Study officials:
affiliation: Regis University
name: Stephanie Albin, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Mueller TJ. Acquired flatfoot secondary to tibialis posterior dysfunction: biomechanical aspects. J Foot Surg. 1991 Jan-Feb;30(1):2-11.
citation: Thordarson DB, Schmotzer H, Chon J, Peters J. Dynamic support of the human longitudinal arch. A biomechanical evaluation. Clin Orthop Relat Res. 1995 Jul;(316):165-72.
citation: Huang CK, Kitaoka HB, An KN, Chao EY. Biomechanical evaluation of longitudinal arch stability. Foot Ankle. 1993 Jul-Aug;14(6):353-7. doi: 10.1177/107110079301400609.
citation: DiGiovanni CW, Kuo R, Tejwani N, Price R, Hansen ST Jr, Cziernecki J, Sangeorzan BJ. Isolated gastrocnemius tightness. J Bone Joint Surg Am. 2002 Jun;84(6):962-70. doi: 10.2106/00004623-200206000-00010.
citation: Maeda N, Komiya M, Nishikawa Y, Morikawa M, Tsutsumi S, Tashiro T, Fukui K, Kimura H, Urabe Y. Effect of Acute Static Stretching on the Activation Patterns Using High-Density Surface Electromyography of the Gastrocnemius Muscle during Ramp-Up Task. Sensors (Basel). 2021 Jul 15;21(14):4841. doi: 10.3390/s21144841.