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Influence of Foot Position on Lower Extremity Muscle Activation Casey Darling University of North Dakota

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Influence of Foot Position on Lower Extremity Muscle Activation Casey Darling University of North Dakota University of North Dakota UND Scholarly Commons Physical Therapy Scholarly Projects Department of Physical Therapy 2012 Influence of Foot Position on Lower Extremity Muscle Activation Casey Darling University of North Dakota Follow this and additional works at: https://commons.und.edu/pt-grad Part of the Physical Therapy Commons Recommended Citation Darling, Casey, "Influence of Foot Position on Lower Extremity Muscle Activation" (2012). Physical Therapy Scholarly Projects. 622. https://commons.und.edu/pt-grad/622 This Scholarly Project is brought to you for free and open access by the Department of Physical Therapy at UND Scholarly Commons. It has been accepted for inclusion in Physical Therapy Scholarly Projects by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. INFLUENCE OF FOOT POSITION ON LOWER EXTREMITY MUSCLE ACTIVATION by Casey Darling Bachelor of Science in Athletic Training University of North Dakota, 2006 A Scholarly Project Submitted to the Graduate Faculty of the Department of Physical Therapy School of Medicine University of North Dakota in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy Grand Forks, North Dakota May, 2012 i This Scholarly Project, submitted by Casey Darling in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy from the University of North Dakota, has been read by the Advisor and Chairperson of Physical Therapy under whom the work has been done and is hereby approved. __________________________ (Graduate School Advisor) __________________________ (Chairperson, Physical Therapy) ii PERMISSION Title Influence of Foot Position on Lower Extremity Muscle Activation Department Physical Therapy Degree Doctor of Physical Therapy In presenting this Scholarly Project in partial fulfillment of the requirements for a graduate degree from the University of North Dakota, I agree that the Department of Physical Therapy shall make it freely available for inspection. I further agree that permission for extensive copying for scholarly purposes may be granted by the professor who supervised my work or, in his absence, by the Chairperson of the department. It is understood that any copying or publication or other use of this Scholarly Project or part thereof for financial gain shall not be allowed without my written permission. It is also understood that due recognition shall be given to me and the University of North Dakota in any scholarly use which may be made of any material in this Scholarly Project. Signature _______________________ Date _______________________ iii TABLE OF CONTENTS LIST OF TABLES ....................................................................................................... v ABSTRACT ............................................................................................................... vi CHAPTER I. INTRODUCTION .............................................................................. 1 II. METHODS .......................................................................................... 8 III. RESULTS .......................................................................................... 11 IV. DISCUSSION .................................................................................... 20 REFERENCES .......................................................................................................... 22 iv LIST OF TABLES Table Page 1. Friedman’s Test for All Muscles Tested................................................................13 2-1. ANOVA for Tibialis Anterior................................................................................13 2-2. ANOVA for Lateral Gastrocnemius......................................................................14 2-3. ANOVA for Rectus Femoris.................................................................................14 2-4. ANOVA for Biceps Femoris.................................................................................15 2-5. ANOVA for Gluteus Medius.................................................................................15 2-6. ANOVA for Gluteus Maximus..............................................................................16 3-1. Mauchly’s Test for Tibialis Anterior.....................................................................16 3-2. Mauchly’s Test for Lateral Gastrocnemius............................................................17 3-3. Mauchly’s Test for Rectus Femoris.......................................................................17 3-4. Mauchly’s Test for Biceps Femoris.......................................................................18 3-5. Mauchly’s Test for Gluteus Medius......................................................................18 3-6. Mauchly’s Test for Gluteus Maximus...................................................................19 v ABSTRACT The anterior cruciate ligament (ACL) in the knee is often sprained or torn in injuries resulting from jumping, cutting, or hyperextension of the knee. When the knee is put under a valgus, varus, or rotatory stress it can put strain on the ACL. Lower extremity motor control can help control the amount of varus and valgus stress on the knee. Lower extremity muscle control is involved with preventing this stress and resulting injuries. This study was performed to determine whether the position of the foot (neutral, supination, and pronation) has an effect on lower extremity muscle activity during single-leg squats. Six muscles were measured with EMG while the subjects performed single-leg squats with the foot in various subtalar positions. The muscles measured were gluteus maximus, gluteus medius, biceps femoris, rectus femoris, lateral gastrocnemius, and tibialis anterior. The study produced significant differences in EMG activity for the gluteus maximus, lateral gastrocnemius, and biceps femoris. However, more research needs to be performed to prove if foot position has significant influence on lower extremity muscle activity and how it affects the ACL. vi CHAPTER I INTRODUCTION AND LITERATURE REVIEW The anterior cruciate ligament (ACL) in the knee is often sprained or torn in injuries resulting from jumping, cutting, or hyperextension of the knee. This is especially true in athletic individuals who put themselves in these situations more often than sedentary people. When the knee is put under a valgus, varus, or rotatory stress (which occurs during athletic activity) it can put strain on the ACL. Lower extremity motor control can help control the amount of varus and valgus stress on the knee. It has been suggested in research1,2 that lower extremity muscle control is involved with preventing this stress and resulting injuries. This study was performed to determine whether the position of the foot (neutral, supination, and pronation) has an effect on lower extremity muscle activity during single-leg squats. Anatomy and Physiology The ACL is a 3-piece twisted ligament that attaches to the distal posterior femur and proximal anterior tibia. It serves to prevent the tibia from moving anteriorly on the femur and also stabilizes the tibia against excessive internal rotation and serves as a 1 secondary restraint for valgus or varus stress with collateral ligament damage. The ligament is tight when the knee is in extension and works with the thigh muscles to stabilize the knee joint.3 An intact ACL resists forces up to 2500 N before failing.4 These forces include resisting knee hyperextension, cutting, and accelerating/decelerating activities. It is highly probable that ACL injuries are more likely to occur during multi- planar rather than single-planar mechanisms of injury.5 ACL tears can be treated conservatively in the older or inactive population, but are usually surgically repaired in an active individual regardless of age. The surgery involves replacing the sprained or ruptured ligament with either an allograft or autograft by tunneling through the bone and securing it in place. The surgery usually requires a somewhat lengthy (about 6 months) rehabilitation to return to prior level of function. This length of recovery is vastly improved compared to 20 or 30 years ago, when tearing an ACL meant the end of any athletic career. Advances in medicine have resulted in patients returning to both professional and recreational sports, usually with no recurrence or injury. Problems An ACL tear and the resulting surgery and rehabilitation can cause many hardships for an individual and his or her family including financial, social, and functional problems. Advances in health care have greatly reduced the amount of time and severity of functional disability caused by these injuries, but the cost has increased greatly. A conservative estimate of the average cost of an ACL tear, including repair and rehabilitation, is $17,000 to $25,000 per injury.1 This cost can also be in addition to the loss of participation in entire sports seasons, decreased scholarship funding for 2 prospective college athletes, lowered academic performance, possible long term disability, and a significantly greater risk of developing osteoarthritis.6 An ACL tear usually involves trauma to more anatomical structures in the knee than the single ligament alone. Joint capsules, menisci, additional ligaments, and joint surface cartilage can all be damaged from stress or shearing forces. When these structures are damaged, it can lead to instability and poor arthrokinematics. This can result in bone
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