Rehabilitation programs designed to restore leg, ankle, and foot function following injury frequently ignore the proximal muscles. During athletics, these knee, hip, and trunk muscles derive much of their functional power from the foot and ankle. They also serve to integrate distal segment motions into a total movement pattern such as jumping, running, or kicking. The linkage system, which is a theoretical concept, describes the normal biomechanical and physiological interactions between proximal and distal musculoskeletal structures. Immobilization or injury of distal segments interrupts the normal generation, summation, and transmission of muscular forces across joints. Adequate measures must be taken to properly assess proximal structures for weakness and tightness and to prescribe specific exercises to prevent the migration of the effects of injury away from the involved segment.
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References
1.
. BohannonR. W.GajdosikR. L.LeVeauB. F.: Relationship of pelvic and thigh motions during unilateral and bilateral hip flexion. Phys. Ther., 65: 1501–1504, 1985.
2.
. BoothF. W.: Effect of limb immobilization on skeletal muscle. J. Appl. Physiol. 52: 1113–1118, 1982.
3.
. BoseinW. R.StaplesO. S.RussellS. W.: Residual disability following acute ankle sprains. J. Bone Joint Surg., 37A: 1237–1243, 1955.
4.
. BrunnstromS.: Clinical Kinesiology, 3rd ed. Philadelphia, F. A. Davis Co., 1972, pp. 232–236.
5.
. BurkeR. E.EdgertonV. R.: Motor unit properties and selective involvement in movement. In Exercise and Sport Sciences Reviews 3. WilmoreJ. H.KeoghJ. F. (eds.), New York, Academic Press, 1975, pp. 31–81.
6.
. DaviesG. J.GouldJ. A.: Trunk testing using a prototype Cybex II isokinetic dynamometer stabilization system. J. Orthop. Sports Phys. Ther., 3: 164–170, 1982.
7.
. De AndradeJ. R.GrantC.DixonA.: Joint distension and reflex muscle inhibition in the knee. J. Bone Joint Surg., 47A: 313–322, 1965.
8.
. EkholmJ.EklundG.SkoglundS.: On the reflex effects from the knee joint of the cat. Acta Physiol. Scand., 50: 167–174, 1960.
9.
. GardnerE.GrayD. J.O'RahillyR.: Anatomy: A Regional Study of Human Structure, 3rd ed. Philadelphia, W. B. Saunders, 1969, pp. 224.
10.
. GerberC.HoppelerH.ClaasenH. et al.: The lower extremity musculature in chronic symptomatic instability of the anterior cruciate ligament. J. Bone Joint Surg., 67A: 1034–1043, 1985.
11.
. GleimG. W.NicholasJ. A.WebbJ. N.: Isokinetic evaluation following leg injuries. Phys. Sportsmed., 6: 75–82, 1978.
12.
. GydikovA.: Pattern of discharge of different types of alpha motor neurons and motor units during voluntary and reflex activities under normal physiological conditions. In BiomechanicsV.KomiP. V. (ed.), Baltimore, University Park Press, 1976.
13.
. HaggmarkT.ErikssonE.: Hypotrophy of the soleus muscle in man after Achilles tendon rupture. Am. J. Sports Med., 7: 121–126, 1979.
14.
. HaggmarkT.JanssonE.ErikssonE.: Fiber type area and metabolic potential of the thigh muscle in man after knee surgery and immobilization. Int. J. Sports Med., 2: 12–17, 1981.
15.
. HanavanE. P.: A mathematical model of the human body. AMRL-TR-64–102. Wright-Patterson Air Force Base, Ohio, 1964.
16.
. HanavanE. P.: A personalized mathematical model of the human body. J. Spacecraft, 3: 446–448, 1966.
17.
. HershmanE.: The profile for the prevention of musculoskeletal injury. Clin. Sports Med. 3: 65–84, 1984.
18.
. HudlickaO.BassA.: Changes in blood flow and metabolism in immobilized and working muscle. In Effect of Use and Disuse on Neuromuscular Function. GutmannE.HnikP. (eds.). Amsterdam, Elsevier, 1963.
19.
. JasperS. R.FaganJ. M.TischlerM. E.: Biochemical response to chronic shortening in unloaded soleus muscle. J. Appl. Physiol., 59: 1159–1163, 1985.
20.
. JoklP.KonstadtS.: The effect of limb immobilization on muscle function and protein composition. Clin. Orthop., 174: 222–229, 1983.
21.
. JoleszF.SreterF. A.: Development, innervation, and activity pattern induced changes in skeletal muscle. Ann. Rev. Physiol., 43: 531–552, 1982.
22.
. KendallH. O.KendallF. P.WadsworthG. E.: Muscles: Testing and Function, 2nd ed. Baltimore, Williams 8#x38; Wilkins, 1971.
23.
. KennedyJ. C.AlexanderI. J.HayesK. C.: Nerve supply of the human knee and its functional importance. Am. J. Sports Med., 10: 329–335, 1982.
24.
. KnottM.VossD. E.: Proprioceptive Neuromuscular Facilitation, 2nd ed. New York, Harper and Row, 1968.
. LangranaN. A.LeeC. K.AlexanderH. et al.: Quantitative assessment of back strength using isokinetic testing. Spine, 9: 287–290, 1984.
27.
. LoPrestiC.KirkendallD.StreetG. et al.: Degree of quadriceps atrophy at 1 year post anterior cruciate repair (abstract). Med. Sci. Sports Exerc, 16: 204, 1984.
28.
. MacConnaillM. A.BasmajianJ. V.: Muscles and Movements: A Basis for Human Kinesiology (revised ed.). Huntington, NY, Robert E. Krieger Publishing Co., 1977, pp. 299–308.
29.
. MaierA.CrockettJ. R.SimpsonD. R. et al.: Properties of immobilized guinea pig hind limb muscles. Am. J. Physiol., 231: 1520–1526, 1976.
. MarinoM.LiederbachM. J.GleimG. W. et al.: Isokinetic versus manual strength assessment devices following lower extremity rehabilitation (abstract). Phys. Ther., 65: 149, 1985.
32.
. MarinoM.NicholasJ. A.GleimG. W. et al.: Efficacy of manual assessment of muscle strength using a new device. Am. J. Sports Med., 10: 85–92, 1982.
33.
. MillerD. I.: Modelling in biomechanics: an overview. Med. Sci. Sports., 11: 115–122, 1979.
34.
. MillerD. I.: Body segment contributions to sport skill performance: two contrasting approaches. Res. Q. Exerc. Sport, 51: 219–233, 1980.
35.
. MillerD. I.MorrisonW. E.: Prediction of segmental parameters using the Hanavan human body model. Med. Sci. Sports, 7: 207–212, 1975.
36.
. NicholasJ. A.: Risk factors, sports medicine and the orthopedic system: an overview. J. Sports Med., 3: 243–259, 1976.
37.
. NicholasJ. A.GrossmanR. B.HershmanE. B.: The importance of a simplified classification of motion in sports in relation to performance. Orthop. Clin. N. Am., 8: 499–532, 1977.
38.
. NicholasJ. A.StrizakA. M.VerasG.: A study of thigh muscle weakness in different pathological states of the lower extremity. Am. J. Sports Med., 4: 241–248, 1976.
39.
. SchmeirA. A.: Research work on a more precise method of determining muscle strength in poliomyelitis patients. J. Bone Joint Surg., 27: 317–326, 1945.
40.
. SmidtG. L.AmundsenL. R.DostalW. F.: Muscle strength at the trunk. J. Orthop. Sport Phys. Ther., 1: 165–170, 1980.
41.
. SutkerA. N.BarberA.JacksonD. W. et al.: Iliotibial band syndrome in distance runners. Sports Med., 2: 447–451, 1985.
42.
. ThompsenP.LucoJ. V.: Changes of weight and neuromuscular transmission in muscles of immobilized joints. J. Neurophysiol., 7: 246–251, 1944.
43.
. ThompsonN. N.GouldJ. A.DaviesG. J. et al.: Descriptive measures of isokinetic trunk testing. J. Orthop. Sports Phys. Ther., 7: 43–49, 1985.
44.
. TroupJ. D. G.ChapmanA. E.: The strength of the flexor and extensor muscles of the trunk. J. Biomech., 2: 49–62, 1969.
45.
. TurekS. L.: Orthopedics: Principles and Their Application, 3rd ed. Philadelphia, J. B. Lippincott Co., 1977, pp. 999–1000.
. WallaceL.: Rehabilitation following patellofemoral surgery. In Rehabilitation of the Surgical Knee. DaviesG. J. (ed.), Ronkonkoma, NY, Cypress, 1984, pp. 63.
48.
. WallerJ. F.Jr.MaddaloA. V.: The foot and ankle linkage system. In The Lower Extremity and Spine in Sports Medicine. NicholasJ. A.HershmanE. B. (eds.), St. Louis, C. V. Mosby Co., pp. 412–418.
49.
. WhiteM. J.DaviesC. T. M.: The effects of immobilization, after lower leg fracture, on the contractile properties of human triceps surae. Clin. Sci., 66: 277–282, 1984.
50.
. WickiewiczT. L.RoyR. R.PowellP. L. et al.: Muscle architecture of the human lower limb. Clin. Orthop., 179: 275–283, 1983.
51.
. WrightW. G.: Muscle Function. New York, Hafner Publishing Co., 1962.
