Physiotherapy research international : the journal for researchers and clinicians in physical therapy · 2026
Push-Pull Ratio and Ankle Dorsiflexion Strength in Nurse Home Residents: Novel Insights Into Fall Prevention Strategies.
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Del-Cuerpo Indya, Jiménez-Lupión Daniel, Rubio-Oltra Julián, Chirosa-Ríos Ignacio, Chirosa-Ríos Luis Javier, Jerez-Mayorga Daniel
Аннотация
BACKGROUND AND PURPOSE: Falls are a leading cause of disability and mortality in older adults. Muscle strength, neuromuscular activation, and balance, particularly the push-pull ratio (PPR), play key roles in fall prevention. The purpose of this study is to analyze among muscle strength, time to peak force (TP), and PPR between fallers and non-fallers in nursing home residents.
METHODS: A total of 51 older adults participated in the study. Participants were classified as fallers or non-fallers based on their fall history in the past year. Isometric muscle strength assessments were conducted using a functional electromechanical dynamometer (FEMD) to evaluate knee extension, ankle dorsiflexion, bilateral seated bench press, and bilateral seated row. The PPR was calculated as the ratio of push to pull peak force (PF).
RESULTS: No significant differences were found in knee extension or upper limb strength parameters. However, fallers exhibited significantly higher ankle dorsiflexion PF (p = 0.013), mean force (MF) (p = 0.034), and impulse (p = 0.011), along with a longer TP (p = 0.017). Additionally, fallers demonstrated a significantly lower PPR (p = 0.032), indicating a possible imbalance between pushing and pulling movements.
DISCUSSION: These findings suggest that fallers may rely more on dorsiflexor strength, potentially as a compensatory mechanism for deficits in proximal muscle activation. The lower PPR highlights the importance of muscle balance in postural stability. Future interventions should consider targeted neuromuscular training to enhance explosive strength, improve muscle coordination, and reduce fall risk in older adults.
METHODS: A total of 51 older adults participated in the study. Participants were classified as fallers or non-fallers based on their fall history in the past year. Isometric muscle strength assessments were conducted using a functional electromechanical dynamometer (FEMD) to evaluate knee extension, ankle dorsiflexion, bilateral seated bench press, and bilateral seated row. The PPR was calculated as the ratio of push to pull peak force (PF).
RESULTS: No significant differences were found in knee extension or upper limb strength parameters. However, fallers exhibited significantly higher ankle dorsiflexion PF (p = 0.013), mean force (MF) (p = 0.034), and impulse (p = 0.011), along with a longer TP (p = 0.017). Additionally, fallers demonstrated a significantly lower PPR (p = 0.032), indicating a possible imbalance between pushing and pulling movements.
DISCUSSION: These findings suggest that fallers may rely more on dorsiflexor strength, potentially as a compensatory mechanism for deficits in proximal muscle activation. The lower PPR highlights the importance of muscle balance in postural stability. Future interventions should consider targeted neuromuscular training to enhance explosive strength, improve muscle coordination, and reduce fall risk in older adults.