Kinematic alterations of the ankle in subjects with generalized joint hypermobility compared with the controls: A cross-sectional study

Abstract

IntroductionGeneralized joint hypermobility (GJH) is a hereditary connective tissue disease in which the range of motion (ROM) of multiple joints exceeds the normal range, and the ROM varies with age, gender, and ethnicity. At present, the six-degree-of-freedom (6-DOF) of ankle kinematics among people with GJH have not been studied. To investigate the kinematic characteristics in the ankle during treadmill gait of university students with generalized joint hypermobility compared to normal participants. We hypothesized that compared to the participants in the control group, those with GJH would exhibit kinematic characteristics of poorer active motion stability in the ankle during treadmill gait.MethodsHealthy university student volunteers aged 18–24 (excluding those with a history of ankle trauma, etc.) were recruited and divided into a control group (50 volunteers) and a GJH group (Beighton score ≥4, 50 volunteers). Data of the 6-DOF kinematics of ankle was collected using a 3D gait analysis system. Variables were evaluated using independent t-tests and Wilcoxon signed-rank tests.ResultsIn the proximal/distal parameter, proximal displacement was significantly increased in the GJH group compared with the control group during 4–9% and 96–97% of the gait phase (loading response and terminal swing phase), with an increase of (0.1–0.2 cm, p < .05). Regarding the proximal/distal, internal/external, plantarflexion/dorsiflexion, and anterior/posterior parameters, the participants with GJH exhibited greater ROM than those in the control group throughout the gait cycle (0.24 ± 0.22 cm vs. 0.19 ± 0.15 cm, p = 0.047, 5.56 ± 2.90° vs. 4.48 ± 3.30°, p = .020, 23.05 ± 5.75° vs. 20.36 ± 4.91°, p < .001, 0.65 ± 0.30 cm vs. 0.55 ± 0.27 cm, p = .018). However, ROM of inversion/eversion translation was found to be decreased in the GJH group compared to the control group (8.92 ± 1.59° vs. 9.47 ± 1.37°, p = .009). In addition, there was no statistical difference between the GJH group and the control group in ROM of medial/lateral translation (0.05 ± 0.06 cm vs. 0.04 ± 0.05 cm, p = .131).ConclusionOur results confirm that our hypothesis is not valid. Although there were a few differences in each gait parameter of the ankle between the GJH group and the control group, the difference was not significant. These results indicate that the presence of GJH has less effect on ankle kinematics and enhance our knowledge of the relationship between GJH and 6-DOF of ankle kinematics.

The strength of balance: Strength and dynamic balance in children with and without hypermobility

“…It has been demonstrated in previous studies that neuromuscular strategies in individuals with GJH are different from those with normal mobility [ 73 , 74 ]. For instance, the ankle is considered to be overactive in children with GJH as studies on electromyography have found activation of ankle muscles to be significantly higher in children with GJH [ 7 ], whereas the ankle strategy is only utilized in children with normal mobility during very difficult tasks. In performing the single leg hop test, Junge et al found that children with GJH have an increased activation of the gastrocnemius muscles, which was significantly different from children with normal mobility [ 71 ].…”

“…GJH is typically of genetic origin but may also be acquired through exercises, stretching or trauma [ 3 , 4 ]. Although GJH enhances activities that require flexibility, it also poses risk for complications, specifically musculoskeletal symptoms [ 5 – 7 ]. The initial assumption by previous authors has been that a hypermobile joint is unstable, predisposing it to repetitive micro-traumas that destroy mechanoreceptors over time [ 8 , 9 ].…”

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“…GJH is typically of genetic origin but may also be acquired through exercises, stretching or trauma [3,4]. Although GJH enhances activities that require flexibility, it also poses risk for complications, specifically musculoskeletal symptoms [5][6][7]. The initial assumption by previous authors has been that a hypermobile joint is unstable, predisposing it to repetitive microtraumas that destroy mechanoreceptors over time [8,9].…”

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“…GJH is typically of genetic origin but may also be acquired through exercises, stretching or trauma [3,4]. Although GJH enhances activities that require flexibility, it also poses risk for complications, specifically musculoskeletal symptoms [5][6][7]. The initial assumption by previous authors has been that a hypermobile joint is unstable, predisposing it to repetitive microtraumas that destroy mechanoreceptors over time [8,9].…”