Follow-up of ankle stiffness and electromechanical delay in immobilized children: Three cases studies

Abstract 

Clinical manual tests refer to increased ankle stiffness in children immobilized due to hip osteochondritis. The aim of the present study was to investigate musculo-articular stiffness via different techniques in immobilized children to confirm or not and quantify these observations.

Ankle stiffness was quantified monthly during the long immobilization period in three diseased children and compared to healthy age-matched children. Sinusoidal perturbations were used to evaluate musculo-articular (MA) stiffness of the ankle plantar-flexors. The stiffness index (SI_MA-EMG) was the slope of the linear relationship between angular stiffness and plantar-flexion torque normalized with electromyographic activity of the triceps surae (TS). The stiffness of the ankle plantar-flexors was also indirectly evaluated using the TS electromechanical delay (EMD).

SI_MA-EMG was greater for diseased children, and this higher stiffness was confirmed by the higher EMD values found in these immobilized children. Furthermore, both parameters indicated that ankle stiffness continues to increase through immobilization period.

This study gives a quantitative evaluation of ankle stiffness changes through the immobilization period imposed to children treated for hip osteochondritis. The use of EMD measurement to indirectly evaluate these stiffness changes is also validated. This study shed for the first time some light into the patterns of muscle modifications following immobilization in children.

Keywords: Electromechanical delay, Musculo-tendinous stiffness, Immobilization, Child development, Disease management

Abbreviations: EMD, electromechanical delay, EMG, surface electromyograms, GL, gastrocnemius lateralis, GM, gastrocnemius medialis, LCPD, Legg-Calvé-Perthes disease, MA, musculo-articular, M_max, maximal M-wave, MVC, maximal voluntary contraction, SI_MA-EMG, stiffness index, Sol, soleus, TS, triceps surae