Sports Medicine Research: In the Lab & In the Field: Overcoming Fear May Not Help Your Post ACL Walk (Sports Med Res)

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Tuesday, August 14, 2018

Overcoming Fear May Not Help Your Post ACL Walk

Association Between Kinesiophobia and Walking Gait Characteristics in Physically Active Individuals with Anterior Cruciate Ligament Reconstruction

Luc-Harkey BA, Franz JR, Losina E, & Pietrosimone B.  Gait and Posture. Published online June 15, 2018 64: 220-225. DOI: 10.1016/j.gaitpost.2018.06.029

Take Home Message: Kinesiophobia was unrelated to gait characteristics during a walk among physically active individuals with an anterior cruciate ligament reconstruction.

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Anterior cruciate ligament (ACL) reconstruction involves a challenging and difficult rehabilitation process, which is relatively successful in returning patients to physical activity. Unfortunately, too often patients fail to return to pre-injury levels of activity, pain, and gait mechanics.  Most patients experience some sort of fear of reinjury/movement or gait avoidance patterns after an ACL injury. A persons’ fear of reinjury/movement may contribute to gait changes; however, this is untested. Hence, these researchers explored if fear of re-injury/movement related to gait characteristics among physically active individuals after an ACL reconstruction. They investigated 30 participants between the ages of 18 to 35 years who had an autograft ACL reconstruction at least 6 months prior to the study.  Participants completed the Tampa Scale of Kinesiophobia scale and then completed a 60 second walk at their self-selected comfort speed to investigate a variety of gait biomechanical variables including walking speed, ground reaction force, rate of loading, and limb symmetries.  The authors found no significant associations between fear of re-injury/movement and any of the gait variables.  They also found that overall the participants often failed to return to pre-injury activity levels based on self-reported Tegner activity levels.    

These researchers were the first to find that fear of re-injury/movement is unrelated to how a participant walks after an ACL reconstruction.  It would be interesting to see if these findings continued to be true as individuals started to jog, run, or do other sport-specific tasks.  The researchers noted that the average age of their population was 20 and that the average time since ACL reconstruction was 4 years.  It may be interesting to see how kinesiophobia scores change over time or differ across age groups after a reconstruction to see if there is any effect on gait mechanics over time.  It was interesting to see that the findings of this research supported previous studies about many patients with an ACL reconstruction failing to return to pre-injury activity levels.  It would have been interesting to see how this group’s activity levels compared to age-matched healthy controls to explore if it was the ACL reconstruction or the natural change of activity levels with age that was a primary driver for not returning to the same level of activity.  Also, the reported limb symmetry indices are predominantly within the range of clinical norms, but it may also be interesting to see if kinesiophobia scores related to any of the gait variables among those who failed to meet clinical norms/cutoffs.  Ultimately, kinesiophobia scores don’t relate to gait variables.  So, while kinesiophobia may warrant clinical attention for a variety of reasons it is likely that clinicians need to separately focus on interventions that target gait modifications.

Questions for Discussion:  What are your patients telling you about why they walk differently?  Is there anything that you have seen that contributes to gait changes?

Written by: NicoleCattano
Reviewed by: Jeffrey Driban

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