Like a lot of other things (eg supination resistance, windlass function, and “overpronation”), the Lunge Test is something I talk about and write about a lot. The main reason being is that it is a clinical text that is supported by a lot of evidence regarding its reliability and validity, especially it link to injury. Not a lot of the clinical tests that are traditionally done tick as many boxes.
The lunge test is well documented online, but is a clinical weight-beairng test of the range of motion of the ankle joint. A couple of studies have now linked a limitation in it to injuries in footballers.
My preference is to actually do the test in shoes on top of any foot orthotics that they have to see if they can reach the required 35 or so degrees that is considered normal.
Like a lot of other topics (eg overpronation and supination resistance), I have a lot to say about the windlass mechanism of the foot. The windlass mechanism is the foot’s own natural way of supporting itself, so it is crucial that it functions well and there be nothing wrong with the way that it works. Interventions used to treat foot and lower limb problems need to facilitate rather than inhibit that mechanism
Podiatry Arena has a lot of valuable information and threads on the windlass mechanism including all of the research published over many years and I wrote about our research and all of the windlass dysfunctions at my running blog. I have just been tasked with sorting the windlass mechanism page at PodiaPaedia, so looking forward to sorting that out.
Supination Resistance is another one of those topics that I find myself writing about a lot (eg here and here)and something I have been banging on about in my Clinical Biomechanics Boot Camps for years.That is how important I think that the concept is.
The concept has its origins in the concept of overpronation probably not be all that it is cranked up to be, so rather than focus on “overpronation” perhaps he focus should be on the forces that are associated with the function of the foot and pronation. It just makes a lot more intuitive sense o be focusing on the forces rather than the motions. It is the forces that actually do the damage to the tissues rather than motion. Motion is not painful.
I have certainly done a lot of research on it and unfortunately never quite got to publishing it. I did summarize most of the research done in this post.
Severs disease (or calcaneal apophysitis) is common in kids (my kids had it) and something that I write about often (eg here and here) and participate in lot of discussions about it, so check them out for more detail.
Some issues have come out of all that:
1. We still do not know if the condition is due to the excessive pull of the Achilles tendon or excessive ground impact on the growth plate. It could be one or the other or it could be both. Interestingly, there are some quite strong opinions either way as to which one it is, but in reality, we have no idea which one it is and it could easily be either one or a combination. It could also be different in different individuals.
2. Managing workload or activity levels is key and children are children, and they don’t listen. Sports levels can be reduced, but they still run around at school or when not being supervised. This really came home to me when my own daughter got it. No matter what I did to treat her, I had no control over what running around she would do at school with her friend during the lunch break.
3. There has been a lot of commentary about it being called a “disease”, especially in the context of all the recent discussion of the use of nocebic language when it comes to managing people that are in pain. It is not a disease and probably should not be called one.
4. It’s not totally clear what it is, but I like to pretend that it’s like a stress fracture of the growth plate and treat it as though it is one. It just makes sense to think like that.
My standard treatment is just education about manageing lifestyle and loads while it comes right in its own. A “Severs Disease Heel Pad” is often helpful. That is all most cases need with only a few needed more intervention than that.
