INTRODUCTION
Obviously, when climbing stairs people uses their ankles in order to realize the command of climbing and there denotes the process of ankle movement along the way and true that stair climbing is a part of daily activity as there involves the aspect of knee flexion angle and knee flexion moment upon stair climbing (Cited from, Andriacchi et al., 1980 and Jevsevar et al., 1993). Truly by then, there includes such analysis of biomechanical requirements involved in stair climbing that may possibly add to the understanding of demands from such ankle movement, ideal activity from within the human locomotion. Ideally, research studies have been realized in determining such ankle movement in relation to stair climbing such as for instance, some researchers have used stair climbing to describe changes in patient’s functional performance following knee arthroplasty (Cited from, Andriacchi et al., 1982 and Andriacchi and Galante, 1988) as well as anterior cruciate ligament deficiency (Cited from, Berchuck et al., 1990 and Andriacchi and Birac, 1993) and transtibial amputations (Cited from, Powers et al., 1997) and patellofemoral pain (Cited from, Salsich et al., 2001 and Brechter and Powers, 2002).
Aside, it is imperative to be aware and provide such ample understanding from such biomechanics and pathomechanics of lower limb during stair climbing as being essential for therapists attempting to integrate scientific findings into clinical examination and management for example, those patients with lower extremity dysfunction.
Moreover, some of peer reviewed articles do impose such ideal investigations through certain proponents as such investigating hip, knee as well as ankle joint as one study adheres that upon stair climbing found maximum external knee flexion moments during stair descent to be 2.7 times greater than during ascent. A good method do amiably involve calculation of joint moment by calculating the product of the ground reaction force vector and the perpendicular distance from the joint center to that vector (Cited from, Winter, 1991). Aside, also Wells (Cited from, 1981) found that the ground reaction method is good predictor of net joint moments for slow gait, but increasing the velocity of gait results in increased errors, especially at the hip.
LITERATURE REVIEW
For literature review, ideally such stair climbing reality incorporates a demanding locomotor job involving ankle movement for performing such activities as associated in life and living. Just like for instance, for elderly persons such stair climbing, like stepping obstacle and rising from chair, can be very challenging and that, recovering safe locomotion is often a key factor that allows patient to return home disease attack for instance (Cited from, Startzell et al., 2000).
The value of biomechanical requirements of stair climbing can be then restricted to young as well as the elderly and then concentrated on certain sagittal plane patterns. There has been recent analyses in terms of measuring kinetics of the lower limbs have shown that greater knee moments were required in the stair climbing tasks than in level walking and that the largest increase of the sagittal moment in stair climbing occurring from within knee joint (Cited from, Andriacchi et al., 1980; McFadyen and Winter, 1988). For one, in ascent manner in which knee extensor muscles have dominant role in the progression from one step to the next, assisted by the ankle plantar flexors and the hip extensors (Cited from, McFadyen and Winter, 1988; Moffet et al., 1993; Townsend et al., 1978; Joseph and Watson, 1967). Thus, the outcome then posits an increase of energy generation within the knee as compared to level walking where energy generation can be found through plantar flexors and the hip flexors and extensors respectively (Cited from, Winter, 1983; Winter, 1991).
(Mean sagittal plane angles of the hip, knee, and ankle joint during stair ascent and stair descent. The continued and dashed lines represent the mean during stair ascent and descent, respectively. The dark and pale grey shades represent the SD during stair ascent and descent)
Source: Protopapadaki, A., Drechsler, W., Cramp, M., Coutts, F. and Scott, O. (2006). Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals
In addition, several techniques and methods are being applied, executed and validated in emphasizing the movement when climbing stairs as it is crucial to understand the process pointing to:
Angles during stair ascent and descent
As one experimental study provoked that during stair ascent in stance phase as the hip and knee joints move forwards extension and the ankle joint into plantarflexion while during stair descent in stance phase the hip and knee joints move into flexion and the ankle joint into dorsiflexion as reflected in figure one. Amiably, upon stair ascent and descent the maximum hip flexion, knee flexion, and ankle dorsi/plantar flexion angles occurred during swing phase as continuous as possible indicating that stair ascent there is external knee extension moment from foot contact on the 2nd stair step, also external knee extension moment from foot contact on the 2nd stair step and external knee flexion moment of stride cycle as external ankle moment was positive in stance phase during stair ascent and descent (see figure 2) creating an external dorsiflexion moment.
(Mean sagittal plane moments of the hip, knee, and ankle joint during stair ascent and stair descent. The continued and dashed lines represent the mean during stair ascent and descent, respectively. The dark and pale grey shades represent the SD during stair ascent and descent)
Source: Protopapadaki, A., Drechsler, W., Cramp, M., Coutts, F. and Scott, O. (2006). Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals
The presence of staircase set-up
There involves one platform was imbedded in the floor just in front of the staircase, a second was under the first step and third one was mounted on a solid frame that served as the second step of the stairs. Then, every platform was independent of the surrounding wooden pieces to ensure adequate recording of the forces generated on the stairs and was tested for accuracy for force and centre of pressure recordings.
Picture below implies a good case of staircase set-up used in terms of evaluating stair climbing.
Source: Nadeau, S., McFadyen, B. and Malouin, F. (2003). Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking?
Level and stair walking assessments
According to research, level and stair gait assessments included simultaneous recordings of time, kinematic and kinetic data as distance parameters can be recorded from three foot switches located under each foot at the heel, metatarsal head and first toe as the kinematic data obtain using the Optotrak system being sampled at 75 Hz. In addition, using the analysis package from Mishac Inc., the relative angles were calculated using rotation matrices arranged in Cardanic sequence such that the local x, y and z axes corresponded respectively to abduction, adduction, rotation and flexion extention for the hip and knee joints and eversion, inversion, rotation, and dorsiflexion, plantar flexion at the ankle joint.
CRITICAL ANALYSIS
Amicably, ankle movement during stair climbing or within the process of gait cycle are being simply illustrated as below graphical diagram wherein there denotes a stable, balance wave in which the dorsiflexion and plantar flexion are in parallel motion to initial contact given that foot is flat and then heel rise then toe off Simple Process of the ankle movement
Source: adapted from, McPoil, T.G., & Knecht, H.G. (1985). Biomechanics of the foot in walking: A function approach. Journal of Orthopaedic and Sports Physical Therapy, 7 (2), 69-72.
The ankle movement then astounds to the following mechanism
- plantar flexes during loading response - dorsiflexes gradually during midstance - plantar flexes during terminal stance - dorsiflexes during swing avoiding such toe drag in order to prepare to contact ground at the heel
In addition, one study indicated that when the time proportion spent in stance phase in both tasks was compared find that toe-off occurred significantly earlier by possibly 3 percent in stair climbing than in level walking resulting in longer swing phase proportion. However, there must be other factors as well because our results did not corroborate those of a recent study of (Cited from, Riener et al., 2002) that found the opposite timing. Moreover, parameters, such as velocity, cadence and stride length are partly determined by the staircase characteristics (Cited from, Livingston et al., 1991; Riener et al., 2002). Consequently, one should expect having more or less differences between the stair climbing parameters and those observed during level walking according to the stair design. Contrary to level walking, where the hip stayed in an adducted position in stance, stair climbing was characterised by concentric action of the abductor muscles that raised the pelvis on the contralateral side. This lateral elevation of the pelvis most likely helps the swinging leg to avoid the intermediate step. In level walking, energy was firstly absorbed by the hip abductors and then followed by a burst of energy generation just before toe-off.
Stair climbing induced major changes in the sagittal angular displacement patterns usually reported at the lower limbs during level walking. In comparison to level walking, more flexed attitudes of the lower limb were observed at the beginning of the stair climbing cycle and less extension at the hip was observed at toe-off. These observations reflected specific adaptations to the staircase environment. The knee and hip need to be flexed at foot contact to place the leg on the step, the end of the stance phase of stair climbing, the hips do not need to extend as much as in level gait because the contralateral step length is reduced by the geometry of the staircase, as opposed to level walking where there is no such constraint.
In addition, stair climbing do require raising the body while progressing to the next step; main task that is very demanding for the lower limb muscles as shown by the large increase in the moments and powers in stair climbing in comparison to level walking. Mechanically, this essential task is performed by the extensor muscles of the lower limb (Cited from, McFadyen and Winter, 1988). Particularly, the knee extension moment is doubled in comparison to level walking. This strong action of knee extensors in stair climbing were shown by EMG studies (Cited from, Joseph and Watson, 1967; James and Parker, 1989) that revealed high and prolonged activities of the vastus medialis and rectus femoris. Consequently, clinicians must be aware that, according to our data, stair climbing without arm rails might require values of extensor strength as high as 1.0 N m/kg to be executed normally (Cited from, McFadyen and Winter, 1988; Kowalk et al., 1996; Duncan et al., 1997).
CONCLUSION
In conclusion, ankle muscles are used but with diverse functions in every daily tasking as there can be consideration of high level of power found at the hip, as certain research studies should provide extra knowledge for instance, regarding such vigorous and pathological subjects in certain type of human movement. Notably, research evidences should provide information on how the stair climbing kinematics and kinetics are modified in subjects having different physical impairments. The stair climbing analysis in the frontal plane suggests that before re-training patients to manage steps one will need to assess if the hip abductors are able to sufficiently raise the pelvis and the contralateral limb. Therefore, as stairs climbing probably produce high stress on the lateral structures of the knee, indicated by higher abduction moments in the first part of the stance phase as compared to level walking, stair climbing training could be difficult or impossible in some knee instability disorders. The current reported patterns and magnitudes of the knee joint moment during stair climbing in the frontal plane are then similar to the findings as reported for instance Kowalk et al. in the year 1996. Then, lastly, within movements of the ankle, the challenge of stair climbing is not very different from that of level walking.
REFLECTION AND SUMMARY
Ideally, ankle movement upon stair climbing is a part of daily activity and that it is important to take ample account of the process as to how the process goes from such mechanism as the knee flexors in stair climbing have received little attention as there revealed an important role of the knee flexors during stair climbing that has not been discussed related to the energy to avoid the intermediate step of the stairs. Henceforth, confirming notion that stair climbing, do amicably require reorganisation of lower limb to the knee flexor strategy. Appropriate case came from work of [McFadyen and Winter, 1991] as clearly demonstrated that obstructed walking results in less absorption by the knee extensors followed by novel burst of energy generation by the knee flexors at the transition from stance to swing as such in obstructed walking [McFadyen and Winter, 1991]). Reflecting that, upon stair climbing, the knee-hip coordination was similar to obstructed level walking as burst of energy produced by the hip flexors (H3) was delayed in order to allow the knee flexors to generate sufficient energy to clear the intermediate step and the absorption of energy by the knee flexors was only seen late in swing within gait cycle as allowing the leg to swing earlier than during level walking. Consequently, it can be critical for such authority as well as researchers to recognize and adopt a detailed analysis of stair climbing tasks from within critical points relating to ankle movement that experimentally done in meta analysis ways through laboratory validation of tests in providing acceptable and reliable information on such aspect of the study for future reference.
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