Association of clinically-measured and dynamic ankle dorsiflexion assessed by markerless motion capture during the drop-jump task on landing biomechanics and risk of ankle injury in military personnel undergoing 10 weeks of physical training

Objectives: Determine the influence of clinically-measured maximum dorsiflexion, dynamic peak dorsiflexion and percent of clinically-measured maximum dorsiflexion used during a drop-jump task on landing biomechanics and risk of ankle injury in military personnel.

Design: Prospective cohort study.

Methods: 672 participants (122 women) enrolled. The weightbearing lunge test assessed clinically-measured maximum dorsiflexion averaged across limbs (degrees). Markerless motion capture and force plates collected lower extremity kinematic and kinetic data during a drop-jump task. Percent of clinically-measured maximum dorsiflexion used during landing was calculated as dynamic peak dorsiflexion divided by clinically-measured value, multiplied by 100 (%). De-identified injury data was derived from military physical therapists. Simple linear regression analysis determined the association between dorsiflexion measures and landing biomechanics. Simple binary logistic regression analyses identified predictors of ankle injuries. Statistical significance was set at α = 0.05.

Results: Eighteen participants sustained a traumatic ankle injury from a landing. All measures of dorsiflexion were associated with movement patterns that countered the stiff-legged landing strategy with dynamic measures showing a higher predictive value. Protective factors against ankle injury included height (odds ratio: 0.818, p = 0.006) and weight (odds ratio: 0.824, p = 0.023) for women. Relative braking impulse was a risk factor for men (odds ratio: 1.890, p = 0.001).

Conclusions: Greater clinically-measured and dynamic measures of dorsiflexion were associated with movement patterns that countered the stiff-legged landing strategy but neither measure of dorsiflexion predicted ankle injury risk. Resultant biomechanics and anthropometrics influenced ankle injury risk to warrant recognition for injury prevention initiatives.