The effect of foot strike pattern on achilles tendon load during running

Achilles Tendon Loading during Running Estimated Via Shear Wave Tensiometry: A Step Toward Wearable Kinetic Analysis

PURPOSE

Understanding muscle-tendon forces (e.g., triceps surae and Achilles tendon) during locomotion may aid in the assessment of human performance, injury risk, and rehabilitation progress. Shear wave tensiometry is a noninvasive technique for assessing in vivo tendon forces that has been recently adapted to a wearable technology. However, previous laboratory-based and outdoor tensiometry studies have not evaluated running. This study was undertaken to assess the capacity for shear wave tensiometry to produce valid measures of Achilles tendon loading during running at a range of speeds.

METHODS

Participants walked (1.34 m·s -1 ) and ran (2.68, 3.35, and 4.47 m·s -1 ) on an instrumented treadmill while shear wave tensiometers recorded Achilles tendon wave speeds simultaneously with whole-body kinematic and ground reaction force data. A simple isometric task allowed for the participant-specific conversion of Achilles tendon wave speeds to forces. Achilles tendon forces were compared with ankle torque measures obtained independently via inverse dynamics analyses. Differences in Achilles tendon wave speed, Achilles tendon force, and ankle torque across walking and running speeds were analyzed with linear mixed-effects models.

RESULTS

Achilles tendon wave speed, Achilles tendon force, and ankle torque exhibited similar temporal patterns across the stance phase of walking and running. Significant monotonic increases in peak Achilles tendon wave speed (56.0-83.8 m·s -1 ), Achilles tendon force (44.0-98.7 N·kg -1 ), and ankle torque (1.72-3.68 N·m·(kg -1 )) were observed with increasing locomotion speed (1.34-4.47 m·s -1 ). Tensiometry estimates of peak Achilles tendon force during running (8.2-10.1 body weights) were within the range of those estimated previously via indirect methods.

CONCLUSIONS

These results set the stage for using tensiometry to evaluate Achilles tendon loading during unobstructed athletic movements, such as running, performed in the field.

Whipping or tearing? The biomechanics of Achilles tendinopathy in rearfoot strike runners

BACKGROUND

Two biomechanical mechanisms for the development of Achilles tendinopathy in runners have been proposed: A whipping mechanism characterized by prolonged and excessive rearfoot eversion, and a tearing mechanism characterized by high eccentric plantar flexor forces. The purpose of this pilot study was to determine if runners with and without a history of Achilles tendinopathy exhibited gait biomechanics consistent with either of these mechanisms.

METHODS

Seven male runners with previous or current Achilles tendinopathy and seven healthy male control runners were evaluated by three-dimensional gait analysis. Peak rearfoot eversion angle, rearfoot eversion excursion, duration of rearfoot eversion, and peak rearfoot inversion angle were compared between groups to evaluate the whipping mechanism of injury. Peak dorsiflexion angle, peak dorsiflexion velocity, and peak ankle power absorption were compared between groups to evaluate the tearing mechanism. Additionally, rearfoot eversion angle and sagittal plane ankle power waveforms were compared between groups using statistical parametric mapping.

FINDINGS

There were no differences in any rearfoot eversion, inversion, or dorsiflexion variables or waveforms during running in the Achilles tendinopathy group compared to controls.

INTERPRETATION

Rearfoot strike runners with Achilles tendinopathy do not exhibit running biomechanics consistent with either the whipping or tearing mechanisms of injury.

Mechanics of the foot and ankle joints during running using a multi-segment foot model compared with a single-segment model

The primary purpose of this study was to compare the ankle joint mechanics, during the stance phase of running, computed with a multi-segment foot model (MULTI; three segments) with a traditional single segment foot model (SINGLE). Traditional ankle joint models define all bones between the ankle and metatarsophalangeal joints as a single rigid segment (SINGLE). However, this contrasts with the more complex structure and mobility of the human foot, recent studies of walking using more multiple-segment models of the human foot have highlighted the errors arising in ankle kinematics and kinetics by using an oversimplified model of the foot. This study sought to compare whether ankle joint kinematics and kinetics during running are similar when using a single segment foot model (SINGLE) and a multi-segment foot model (MULTI). Seven participants ran at 3.1 m/s while the positions of markers on the shank and foot were tracked and ground reaction forces were measured. Ankle joint kinematics, resultant joint moments, joint work, and instantaneous joint power were determined using both the SINGLE and MULTI models. Differences between the two models across the entire stance phase were tested using statistical parametric mapping. During the stance phase, MULTI produced ankle joint angles that were typically closer to neutral and angular velocities that were reduced compared with SINGLE. Instantaneous joint power (p<0.001) and joint work (p<0.001) during late stance were also reduced in MULTI compared with SINGLE demonstrating the importance of foot model topology in analyses of the ankle joint during running. This study has highlighted that considering the foot as a rigid segment from ankle to MTP joint produces poor estimates of the ankle joint kinematics and kinetics, which has important implications for understanding the role of the ankle joint in running.

Full-Field Strain Measurements of the Muscle-Tendon Junction Using X-ray Computed Tomography and Digital Volume Correlation

We report, for the first time, the full-field 3D strain distribution of the muscle-tendon junction (MTJ). Understanding the strain distribution at the junction is crucial for the treatment of injuries and to predict tear formation at this location. Three-dimensional full-field strain distribution of mouse MTJ was measured using X-ray computer tomography (XCT) combined with digital volume correlation (DVC) with the aim of understanding the mechanical behavior of the junction under tensile loading. The interface between the Achilles tendon and the gastrocnemius muscle was harvested from adult mice and stained using 1% phosphotungstic acid in 70% ethanol. In situ XCT combined with DVC was used to image and compute strain distribution at the MTJ under a tensile load (2.4 N). High strain measuring 120,000 µε, 160,000 µε, and 120,000 µε for the first principal stain (εp1), shear strain (γ), and von Mises strain (εVM), respectively, was measured at the MTJ and these values reduced into the body of the muscle or into the tendon. Strain is concentrated at the MTJ, which is at risk of being damaged in activities associated with excessive physical activity.

Effects of a 12-week gait retraining program on the Achilles tendon adaptation of habitually shod runners

PURPOSE

This study investigated the effects of a 12-week gait retraining program on the morphological and mechanical properties of the Achilles tendon (AT) during running on the basis of real-time dynamic ultrasound imaging.

METHODS

A total of 30 male recreational runners who were used to wearing cushioned shoes with a rearfoot strike (RFS) pattern were recruited. They were randomized into a retraining group (RG, n = 15) and a control group (CG, n = 15). The RG group was asked to run in five-fingered minimalist shoes with a forefoot strike (FFS) pattern, and the CG group was asked to keep their strike pattern. Three training sessions were performed per week. All the participants in RG uploaded running tracks obtained through a mobile application (.jpg) after each session for training supervision. The ground reaction force, kinematics, and kinetics of the ankle joint at 10 km/h were collected using an instrumented split-belt treadmill and a motion capture system. The morphological (length and cross-sectional area) and mechanical characteristics (force, stress, strain, etc.) of AT in vivo were recorded and calculated with a synchronous ultrasonic imaging instrument before and after the intervention. Repeated two-way ANOVA was used to compare the aforementioned parameters.

RESULTS

A total of 28 participants completed the training. The strike angle of RG after training was significantly smaller than that before training and significantly smaller than that of CG after training (F (1, 13)  = 23.068, p < 0.001, partial η2  = 0.640). The length (F (1, 13)  = 10.086, p = 0.007, partial η2  = 0.437) and CSA (F (1, 13)  = 7.475, p = 0.017, partial η2  = 0.365) of AT in RG increased after training. A significant main effect for time was observed for the time-to-peak AT force (F (1, 13)  = 5.225, p = 0.040, partial η2  = 0.287), average (F (1, 13)  = 7.228, p = 0.019, partial η2  = 0.357), and peak AT loading rate (F (1, 13)  = 11.687, p = 0.005, partial η2  = 0.473).

CONCLUSION

Preliminary evidence indicated that a 12-week gait retraining program could exert a beneficial effect on AT. 57% (8/14) runners in RG shifted from RFS to FFS pattern. Although not all runners were categorized as FFS pattern after the intervention, their foot strike angle was reduced. Retraining primarily positively promoted AT morphological properties (i.e., CSA and length) to strengthen AT capability for mechanical loading.

Effects of Body Weight Support in Running on Achilles Tendon Loading

Achilles tendon (AT) tendinopathy is common in runners. Repetitive AT loading may play a role in etiology. Interventions such as body weight support (BWS) may reduce loading on the AT in running. Examine how ground reaction force, AT loading, foot strike, and cadence variables change in running with BWS. Twenty-four healthy female runners free from injury were examined. Participants ran on an instrumented treadmill with and without BWS using a harness-based system at a standardized speed. The system has 4 elastic cords affixed to a harness that is attached to a frame-like structure. Kinematic data and kinetic data were used in a musculoskeletal model (18 segments and 16 degrees of freedom) to determine AT loading variables, foot strike angle, and cadence. Paired t-tests were used to compare each variable between conditions. Ground reaction force was 9.0% lower with BWS (p<.05). Peak AT stress, force, and impulse were 9.4, 11.7%, and 14.8% lower when using BWS in running compared to no support (p<.05). Foot strike angle was similar (p<.05) despite cadence being reduced (p<.05). BWS may reduce AT loading and impulse variables during running. This may be important in rehabilitation efforts.

Added mass increases Achilles tendon stress in female runners

CONTEXT

Achilles tendon (AT) injuries are common in female runners and military personnel where increased AT loading may be a contributing factor. Few studies have examined AT stress during running with added mass. The purpose was to examine the stress, strain, and force placed on the AT, kinematics and temporospatial variable in running with different amounts of added mass.

DESIGN

Repeated measure design METHODS: Twenty-three female runners with a rear-foot strike pattern were participants. AT stress, strain, and force were measured during running using a musculoskeletal model that used kinematic (180 Hz) and kinetic data (1800 Hz) as input. Ultrasound data were used to measure AT cross sectional area. A repeated measures multivariate analysis of variance (α = 0.05) was used on AT loading variables, kinematics and temporospatial variables.

RESULTS

Peak AT stress, strain, and force were greatest during the 9.0 kg added load running condition (p < .0001). There was a 4.3% and 8.8% increase in AT stress and strain during the 4.5 kg and 9.0 kg added load conditions, respectively, compared to baseline. Kinematics at the hip and knee changed with added load but not at the ankle. Small changes in temporospatial variables were seen.

CONCLUSION

Added load increased stress on the AT during running. There may be an increased risk for AT injury with added load. Individuals may consider slowly progressing training with added load to allow for increased AT loading.

An Acute Transition from Rearfoot to Forefoot Strike does not Induce Major Changes in Plantarflexor Muscles Activation for Habitual Rearfoot Strike Runners

Footstrike pattern has received increased attention within the running community because there is a common belief that forefoot strike running (FFS) is more advantageous (i.e., improve performance and reduce running injuries) than rearfoot strike running (RFS) in distance running. Literature reports suggest greater knee joint flexion magnitude and initial knee angle during stance in FFS compared with RFS running We examined the EMG activation of the triceps surae muscles during an acute transition from RFS to FFS strike. We tested the hypothesis that due to larger knee flexion in FFS the gastrocnemius muscles possibly decrease their EMG activity because muscle fascicles operate under unfavorable conditions. Fourteen competitive healthy middle- and long-distance runners who were habitual RFS runners ran on a treadmill at three speeds: 12, 14, and 16 km·h-1. Each running speed was performed with both FFS and RFS patterns. Lower limb kinematics in the sagittal plane and normalized electromyography (EMG) activity of medial gastrocnemius proximal, middle and distal regions, lateral gastrocnemius and soleus muscles were compared between footstrike patterns and running speeds across the stride cycle. Contrary to our expectations, the knee joint range of motion was similar in FFS and RFS running. However, the sagittal plane ankle joint motion was greater (p < 0.01) while running with FFS, resulting in a significantly greater muscle-tendon unit lengthening (p < 0.01) in FFS compared with RFS running. In addition, medial and lateral gastrocnemius showed higher EMG activity in FFS compared with RFS running in the late swing and early stance but only for a small percentage of the stride cycle. However, strike patterns and running speed failed to induce region-specific activation differences within the medial gastrocnemius muscle. Overall, well-trained RFS runners are able to change to FFS running by altering only the ankle joint kinematics without remarkably changing the EMG activity pattern.

Running-Related Achilles Tendon Injury: A Prospective Biomechanical Study in Recreational Runners

There are relatively few running studies that have attempted to prospectively identify biomechanical risk factors associated with Achilles tendon (AT) injuries. Therefore, the aim was to prospectively determine potential running biomechanical risk factors associated with the development of AT injuries in recreational, healthy runners. At study entry, 108 participants completed a set of questionnaires. They underwent an analysis of their running biomechanics at self-selected running speed. The incidence of AT running-related injuries (RRI) was assessed after 1-year using a weekly questionnaire standardized for RRI. Potential biomechanical risk factors for the development of AT RRI injury were identified using multivariable logistic regression. Of the 103 participants, 25% of the sample (15 males and 11 females) reported an AT RRI on the right lower limb during the 1-year evaluation period. A more flexed knee at initial contact (odds ratio = 1.146, P = .034) and at the midstance phase (odds ratio = 1.143, P = .037) were significant predictors for developing AT RRI. The results suggested that a 1-degree increase in knee flexion at initial contact and midstance was associated with a 15% increase in the risk of an AT RRI, thus causing a limitation of training or a stoppage of running in runners.

Simulation of Lower Limb Muscle Activation Using Running Shoes with Different Heel-to-Toe Drops Using Opensim

BACKGROUND

Although numerous studies have been conducted to investigate the acute effects of shoe drops on running kinematics and kinetic variables, their effects on muscle forces remain unknown. Thus, the primary aim of this study was to compare the muscle force, kinematics, and kinetic variables of habitually rearfoot runners with heel-to-toe drops of negative 8 mm shoes (minimalist shoes) and positive 9 mm shoes (normal shoes) during the running stance phase by using musculoskeletal modeling and simulation techniques.

METHODS

Experimental data of lower limb kinematics, ground reaction force, and muscle activation from 16 healthy runners with rearfoot strike patterns were collected and analyzed in OpenSim. Using Matlab, the statistical parameter mapping paired t-test was used to compare the joint angle, moment, and muscle force waveform.

RESULTS

The results revealed differences in the sagittal ankle and hip angles and sagittal knee moments between the different heel-to-toe drops of running shoes. Specifically, it showed that the negative 8 mm running shoes led to significantly smaller values than the positive 9 mm running shoes in terms of the angle of ankle dorsiflexion, ankle eversion, knee flexion, hip flexion, and hip internal and hip external rotation. The peak ankle dorsiflexion moment, ankle plantarflexion moment, ankle eversion moment, knee flexion moment, knee abduction moment, and knee internal rotation also decreased obviously with the minimalist running shoes, while the lateral gastrocnemius, Achilleas tendon, and extensor hallucis longus muscles were obviously greater in the minimalist shoes compared to normal shoes. The vastus medialis, vastus lateralis and extensor digitorum longus muscles force were smaller in the minimalist shoes.

CONCLUSIONS

Runners may shift to a midfoot strike pattern when wearing negative running shoes. High muscle forces in the gastrocnemius lateral, Achilleas tendon, and flexor hallucis longus muscles may also indicate an increased risk of Achilleas tendonitis and ankle flexor injuries.

The load borne by the Achilles tendon during exercise: A systematic review of normative values

The Achilles tendon (AT) can be exposed to considerable stress during athletic activities and is often subject to pathologies such as tendinopathies. When designing a prevention or rehabilitation protocol, mechanical loading is a key factor to consider. This implies being able to accurately determine the load applied to the AT when performing exercises that stress this tendon. A systematic review was performed to synthesize the load borne by the AT during exercises/activities. Three databases (Pubmed, Embase and Cochrane) were searched for articles up to May 2021, and only the studies assessing the AT load in newtons relative to body-weight (BW) on humans during activities or exercises were included. Most of the 11 included studies assessed AT load when running or walking (N = 10), and only three tested exercises were usually performed during rehabilitation. The load on the tendon ranged from 2.7 to 3.95 BW when walking, from 4.15 to 7.71 BW when running, and from 0.41 to 7.3 BW according to the strengthening exercise performed. From the collected data, a progression of exercises progressively loading the Achilles tendon, as well as the possible connections with walking and running activities, could be defined. However, the trends highlighted in the relationship between tendon loading and walking or running speeds present some inconsistencies. Further research is still needed to clarify them, but also to complete the data set in healthy and injured people.

Peak tibial acceleration should not be used as indicator of tibial bone loading during running

Peak tibial acceleration (PTA) is a widely used indicator of tibial bone loading. Indirect bone loading measures are of interest to reduce the risk of stress fractures during running. However, tibial compressive forces are caused by both internal muscle forces and external ground reaction forces. PTA might reflect forces from outside the body, but likely not the compressive force from muscles on the tibial bone. Hence, the strength of the relationship between PTA and maximum tibial compression forces in rearfoot-striking runners was investigated. Twelve runners ran on an instrumented treadmill while tibial acceleration was captured with accelerometers. Force plate and inertial measurement unit data were spatially aligned with a novel method based on the centre of pressure crossing a virtual toe marker. The correlation coefficient between maximum tibial compression forces and PTA was 0.04 ± 0.14 with a range of -0.15 to +0.28. This study showed a very weak and non-significant correlation between PTA and maximum tibial compression forces while running on a level treadmill at a single speed. Hence, PTA as an indicator for tibial bone loading should be reconsidered, as PTA does not provide a complete picture of both internal and external compressive forces on the tibial bone.  .

Foundational Principles and Adaptation of the Healthy and Pathological Achilles Tendon in Response to Resistance Exercise: A Narrative Review and Clinical Implications

Therapeutic exercise is widely considered a first line fundamental treatment option for managing tendinopathies. As the Achilles tendon is critical for locomotion, chronic Achilles tendinopathy can have a substantial impact on an individual's ability to work and on their participation in physical activity or sport and overall quality of life. The recalcitrant nature of Achilles tendinopathy coupled with substantial variation in clinician-prescribed therapeutic exercises may contribute to suboptimal outcomes. Further, loading the Achilles tendon with sufficiently high loads to elicit positive tendon adaptation (and therefore promote symptom alleviation) is challenging, and few works have explored tissue loading optimization for individuals with tendinopathy. The mechanism of therapeutic benefit that exercise therapy exerts on Achilles tendinopathy is also a subject of ongoing debate. Resultingly, many factors that may contribute to an optimal therapeutic exercise protocol for Achilles tendinopathy are not well described. The aim of this narrative review is to explore the principles of tendon remodeling under resistance-based exercise in both healthy and pathologic tissues, and to review the biomechanical principles of Achilles tendon loading mechanics which may impact an optimized therapeutic exercise prescription for Achilles tendinopathy.

Self-reported foot strike patterns and sonographic evidence of Achilles tendinopathy in asymptomatic marathon runners

It is unknown whether ultrasound findings and symptoms of Achilles tendinopathy in runners correlate with foot strike patterns. We aimed to examine the relationships among Achilles tendon ultrasound findings in runners with or without Achilles tendinopathy, their foot strike patterns, and their training regimens. We recruited marathon runners 18 years of age or older with no history of Achilles tendon pain or surgery participating in the 2018 DONNA Marathon. Participants completed surveys and underwent Achilles tendon sonographic evaluations and were categorized by foot strike patterns. Seventy-nine runners were included; 22 (28%) with forefoot, 30 (38%) midfoot, and 27 (34%) hindfoot strike patterns. Foot strike pattern was not associated with tendon hyperaemia (P = 1.00) or hypoechogenicity (P = .97), and there was no association of cross-sectional area of the Achilles tendon with peak weekly distance while training. Sonographic characteristics of Achilles tendinopathy did not correlate with foot strike patterns or training regimens. Although not statistically significant, it is worth noting that cross-sectional area was 1 mm² larger per every 1 kg/m² increase in body mass index.

Estimation of Fine-Grained Foot Strike Patterns with Wearable Smartwatch Devices

People who exercise may benefit or be injured depending on their foot striking (FS) style. In this study, we propose an intelligent system that can recognize subtle differences in FS patterns while walking and running using measurements from a wearable smartwatch device. Although such patterns could be directly measured utilizing pressure distribution of feet while striking on the ground, we instead focused on analyzing hand movements by assuming that striking patterns consequently affect temporal movements of the whole body. The advantage of the proposed approach is that FS patterns can be estimated in a portable and less invasive manner. To this end, first, we developed a wearable system for measuring inertial movements of hands and then conducted an experiment where participants were asked to walk and run while wearing a smartwatch. Second, we trained and tested the captured multivariate time series signals in supervised learning settings. The experimental results obtained demonstrated high and robust classification performances (weighted-average F1 score > 90%) when recent deep neural network models, such as 1D-CNN and GRUs, were employed. We conclude this study with a discussion of potential future work and applications that increase benefits while walking and running properly using the proposed approach.

Exercise Effects on the Biomechanical Properties of the Achilles Tendon—A Narrative Review

Simple Summary

The Achilles tendon influences the running economy because of its ability to store and release strain energy, and it remains one of the most vulnerable tendons among athletes and recreational runners. Exercised-related mechanical loading appears to induce changes in the Achilles tendon morphology and mechanical material properties. Both acute and relatively long-term exercise induces tendon adaptation, although biomechanical changes, e.g., cross-sectional area, plantarflexion moment, Young’s modulus, and stiffness, in response to exercise duration, type, and loading-regimes differ widely. Furthermore, a strong Achilles tendon can be developed by chronic exposure to habitual mechanical loading from daily exercise, which is associated with greater energy storage, release and overall health.

Abstract

The morphological and mechanical properties (e.g., stiffness, stress, and force) of the Achilles tendon (AT) are generally associated with its tendinosis and ruptures, particularly amongst runners. Interest in potential approaches to reduce or prevent the risk of AT injuries has grown exponentially as tendon mechanics have been efficiently improving. The following review aims to discuss the effect of different types of exercise on the AT properties. In this review article, we review literature showing the possibility to influence the mechanical properties of the AT from the perspective of acute exercise and long-term training interventions, and we discuss the reasons for inconsistent results. Finally, we review the role of the habitual state in the AT properties. The findings of the included studies suggest that physical exercise could efficiently improve the AT mechanical properties. In particular, relatively long-term and low-intensity eccentric training may be a useful adjunct to enhance the mechanical loading of the AT.

Effects of 12-week transition training with minimalist shoes on Achilles tendon loading in habitual rearfoot strike runners

Minimalist shod runners have reported greater material and mechanical properties of the Achilles tendon (AT) due to increased loading than runners who wear more cushioned running shoes. This study aimed to investigate the effects of 12-week transition training from conventional shoes to minimalist shoes on AT loading in habitual rearfoot strike runners. Seventeen healthy male habitual rearfoot strikers completed 12-week transition training. They were instructed either to run in minimalist shoes with a forefoot strike pattern (MIN + FFS, n = 9) or run in minimalist shoes but were free to develop their strike pattern (MIN, n = 8). Ultrasound images were captured to determine the cross-sectional area of the AT. Sagittal plane ankle kinematics and ground reaction forces were recorded simultaneously to quantify ankle joint mechanics and AT loading. The strike angle significantly decreased in MIN + FFS after the transition training, indicating a flatter foot at initial contact, whereas no changes were observed in MIN. After training, a significant increase in peak plantarflexion moment was observed for MIN + FFS (15.4%) and MIN (7.6%). Significantly increased peak AT force, peak loading rate and peak stress were observed after training in both groups. Specifically, MIN + FFS had a greater increase in peak AT force (20.3% versus 10.1%), peak loading rate (37.2% versus 25.4%) and peak AT stress (13.7% versus 8.1%) than MIN. Furthermore, for both groups, there were no significant differences in the moment arm and cross-sectional area of the AT observed before and after 12 weeks of training. The results of this study suggested that it was insufficient to promote the morphological adaptation of the AT, but the mechanical loading of the AT was adapted during running after 12-week transition training with minimalist shoes in MIN + FFS and MIN. Preliminary evidence showed that a gradual transition to minimalist shoes with a forefoot strike pattern may be beneficial to the mechanical loading of the AT.

Stepping Back to Minimal Footwear: Applications Across the Lifespan

Minimal footwear has existed for tens of thousands of years and was originally designed to protect the sole of the foot. Over the past 50 yr, most footwear has become increasingly more cushioned and supportive. Here, we review evidence that minimal shoes are a better match to our feet, which may result in a lower risk of musculoskeletal injury.

Analysis of ground reaction forces and muscle activity in individuals with anterior cruciate ligament reconstruction during different running strike patterns

BACKGROUND

Anterior cruciate ligament reconstruction provides successful clinical outcomes. However, reconstruction cannot restore normative lower limb mechanics during running. While numerous studies have investigated running characteristics in individuals with anterior cruciate ligament reconstruction, no study has been compared foot strike patterns among them.

RESEARCH QUESTION

If ground reaction forces and lower extremity muscle activities in individuals with anterior cruciate ligament reconstruction and healthy control ones differ during three running strike patterns?

METHODS

In this cross-sectional study, fourteen healthy adult males and fourteen adult males with anterior cruciate ligament reconstruction were recruited to participate. Surface electromyography of selected lower limb muscles and ground reaction forces were measured during three-strike patterns: rearfoot strike pattern, midfoot strike pattern, and forefoot strike pattern during barefoot running (∼ 3.3 m/s).

RESULTS

The results revealed that the strike patterns influenced the peak lateral ground reaction force (P < 0.001) and peak vertical impact ground reaction force (P = 0.002) during the stance phase of running for both groups. The strike pattern also influenced the tibialis anterior (P < 0.001) and vastus lateralis (P = 0.035) activities during the early stance phase for both groups. However, the vastus medialis (P = 0.030) presented reduced activity, and the biceps femoris (P = 0.039) presented increased activity in the anterior cruciate ligament reconstruction group. Tibialis anterior (P = 0.021), gastrocnemius medialis (P < 0.001) and vastus medialis (P < 0.001) presented lesser activity irrespective of strike patterns in the anterior cruciate ligament reconstruction group.

SIGNIFICANCE

Running with a forefoot strike pattern may be associated with lesser rearfoot eversion due to lower peak lateral ground reaction forces than running with a rearfoot strike pattern or midfoot strike pattern. Moreover, the altered muscle activities could contribute to the elevated risk of future joint injury in the anterior cruciate ligament reconstruction population.

Effects of running-induced fatigue on plantar pressure distribution in runners with different strike types

BACKGROUND

Running induced-fatigue is an important factor in running related injuries. Runners with different strike types have different running mechanics and suffer from different injury patterns. Underlying mechanism of this difference is not well understood.

RESEARCH QUESTION

The aim of this study was to examine the effects of running-induced fatigue on plantar pressure distribution in runners with different strike types.

METHODS

30 rearfoot (age = 21.56 ± 2.28 years; height = 1.67 ± 0.08 m; mass = 61.43 ± 11.57 kg; BMI = 21.77 ± 2.9 kg∙m^-2) and 30 forefoot (age = 19.73 ± 1.68 years; height = 1.71 ± 0.08 m; mass = 65.7 ± 13.45; BMI = 22.53 ± 3.39 kg∙m^-2) strike male and female recreational runners were recruited to this study. Participants ran in 3.3 m/s barefoot along the plantar pressure measuring device (Footscan®, Rsscan International) before and after running-induced fatigue. Fatigue protocol was performed on a treadmill. Peak plantar pressure and peak plantar force (% body weight), contact time and medio-lateral force ratio were calculated while running. Repeated measures ANOVA test was used to investigate the effect of running-induced fatigue on plantar pressure variables (p ≤ 0.05).

RESULTS

After running-induced fatigue, in the rearfoot strike group, increases in loading of medial and lateral portions of the heel, first metatarsal and big toe was observed, and in lesser toes and in the forefoot push off phase, the medio-lateral force ratio decreased. While, in the forefoot strike group first to third metatarsals loading increased and fifth metatarsal loading decreased after fatigue, and medio-lateral force ratio in the foot flat and forefoot push off phase increased. In both groups contact time increased after fatigue.

SIGNIFICANCE

Our data indicate that running-induced fatigue has different effects on plantar pressure distribution pattern in runners with different strike type. These different effects reflect different adaptation strategies in runners with different strike types, and could explain existence of different injury patterns in runners with different strike types.

Muscle-Tendon Behavior and Kinetics in Gastrocnemius Medialis During Forefoot and Rearfoot Strike Running

The present study aimed to clarify the effect of the foot strike pattern on muscle-tendon behavior and kinetics of the gastrocnemius medialis during treadmill running. Seven male participants ran with 2 different foot strike patterns (forefoot strike [FFS] and rearfoot strike [RFS]), with a step frequency of 2.50 Hz and at a speed of 2.38 m/s for 45 seconds on a treadmill with an instrumented force platform. The fascicle behavior of gastrocnemius medialis was captured using a B-mode ultrasound system with a sampling rate of 75 Hz, and the mechanical work done and power exerted by the fascicle and tendon were calculated. At the initial contact, the fascicle length was significantly shorter in the FFS than in the RFS (P = .001). However, the fascicular velocity did not differ between strike patterns. Higher tendon stretch and recoil were observed in the FFS (P < .001 and P = .017, respectively) compared with the RFS. The fascicle in the positive phase performed the same mechanical work in both the FFS and RFS; however, the fascicle in the negative phase performed significantly greater work in the FFS than in the RFS (P = .001). RFS may be advantageous for requiring less muscular work and elastic energy in the series elastic element compared with the FFS.

Quantifying mechanical loading and elastic strain energy of the human Achilles tendon during walking and running

The purpose of the current study was to assess in vivo Achilles tendon (AT) mechanical loading and strain energy during locomotion. We measured AT length considering its curve-path shape. Eleven participants walked at 1.4 m/s and ran at 2.5 m/s and 3.5 m/s on a treadmill. The AT length was defined as the distance between its origin at the gastrocnemius medialis myotendinous junction (MTJ) and the calcaneal insertion. The MTJ was tracked using ultrasonography and projected to the reconstructed skin surface to account for its misalignment. Skin-to-bone displacements were assessed during a passive rotation (5°/s) of the ankle joint. Force and strain energy of the AT during locomotion were calculated by fitting a quadratic function to the experimentally measured tendon force-length curve obtained from maximum voluntary isometric contractions. The maximum AT strain and force were affected by speed (p < 0.05, ranging from 4.0 to 4.9% strain and 1.989 to 2.556 kN), yet insufficient in magnitude to be considered as an effective stimulus for tendon adaptation. Besides the important tendon energy recoil during the propulsion phase (7.8 to 11.3 J), we found a recoil of elastic strain energy at the beginning of the stance phase of running (70-77 ms after touch down) between 1.7 ± 0.6 and 1.9 ± 1.1 J, which might be functionally relevant for running efficiency.

Exercise Progression to Incrementally Load the Achilles Tendon

PURPOSE

The purposes of our study were to evaluate Achilles tendon loading profiles of various exercises and to develop guidelines to incrementally increase the rate and magnitude of Achilles tendon loading during rehabilitation.

METHODS

Eight healthy young adults completed a battery of rehabilitation exercises. During each exercise, we collected three-dimensional motion capture and ground reaction force data to estimate Achilles tendon loading biomechanics. Using these loading estimates, we developed an exercise progression that incrementally increases Achilles tendon loading based on the magnitude, duration, and rate of tendon loading.

RESULTS

We found that Achilles tendon loading could be incrementally increased using a set of either isolated ankle movements or multijoint movements. Peak Achilles tendon loads varied more than 12-fold, from 0.5 bodyweights during a seated heel raise to 7.3 bodyweights during a forward single-leg hop. Asymmetric stepping movements like lunges, step ups, and step downs provide additional flexibility for prescribing tendon loading on a side-specific manner.

CONCLUSION

By establishing progressions for Achilles tendon loading, rehabilitative care can be tailored to address the specific needs of each patient. Our comprehensive data set also provides clinicians and researchers guidelines on how to alter magnitude, duration, and rate of loading to design new exercises and exercise progressions based on the clinical need.

The rate of tendon failure in a collagen fibre recruitment-based model

Accurate characterization of the mechanical response of collagenous tissues is critical for investigations into mechanisms of soft tissue injury. These tissues are inherently viscoelastic, exhibiting strain-rate dependent stiffnesses, creep, and stress-relaxation. The strain-rate features of the failure portion of the stress-strain curve are less well developed. Collagen-distribution based models are improving and capable of reproducing the non-linear aspects of the elastic response of soft tissues, but still require parameterization of failure regions. Therefore, the purpose of this investigation, was to determine whether the parameters characterizing the rate of damage accumulation in a collagen-distribution model are proportional to strain rate. Fifty rat tail tendons were subjected to one of five different strain rates (0.01, 0.05, 0.1, 0.15, 0.20 s^-1) until failure in an uni-axial strain test. To test the hypothesis that the parameters associated with damage rate are proportional to strain rate, a collagen distribution model was employed with the parameters describing the rate of fibre damage being obtained by least-squares and regressed against the strain rate. The breaking function was found to be proportional to strain rate, with a proportionality constant of 60.7 s^-1. Properties characterizing the failure portion of the stress-strain curves for rat tail tendons are also reported. The Young's Modulus did not vary with strain rate and was found to be 103.3 ± 49.5 MPa. Similarly, failure stresses and strains did not vary across the strain rates tested, and were 15.6 ± 6.1 MPa and 32.2 ± 9.1%, respectively.

Leg Stiffness and Vertical Stiffness of Habitual Forefoot and Rearfoot Strikers during Running

Foot strike patterns influence the running efficiency and may be an injury risk. However, differences in the leg stiffness between runners with habitual forefoot (hFFS) and habitual rearfoot (hRFS) strike patterns remain unclear. This study aimed at determining the differences in the stiffness, associated loading rate, and kinematic performance between runners with hFFS and hRFS during running. Kinematic and kinetic data were collected amongst 39 runners with hFFS and 39 runners with hRFS running at speed of 3.3 m/s, leg stiffness (Kleg), and vertical stiffness (Kvert), and impact loads were calculated. Results found that runners with hFFS had greater Kleg (P = 0.010, Cohen′s d = 0.60), greater peak vertical ground reaction force (vGRF) (P = 0.040, Cohen′s d = 0.47), shorter contact time(t_c) (P < 0.001, Cohen′s d = 0.85), and smaller maximum leg compression (ΔL ) (P = 0.002, Cohen′s d = 0.72) compared with their hRFS counterparts. Runners with hFFS had lower impact peak (IP) (P < 0.001, Cohen′s d = 1.65), vertical average loading rate (VALR) (P < 0.001, Cohen′s d = 1.20), and vertical instantaneous loading rate (VILR) (P < 0.001, Cohen′s d = 1.14) compared with runners with hRFS. Runners with hFFS landed with a plantar flexed ankle, whereas runners with hRFS landed with a dorsiflexed ankle (P < 0.001, Cohen′s d = 3.35). Runners with hFFS also exhibited more flexed hip (P = 0.020, Cohen′s d = 0.61) and knee (P < 0.001, Cohen′s d = 1.15) than runners with hRFS at initial contact. These results might indicate that runners with hFFS were associated with better running economy through the transmission of elastic energy.

Rearfoot, Midfoot, and Forefoot Motion in Naturally Forefoot and Rearfoot Strike Runners during Treadmill Running

Different location and incidence of lower extremity injuries have been reported in rearfoot strike (RFS) and forefoot strike (FFS) recreational runners. These might be related to functional differences between the two footstrike patterns affecting foot kinematics and thus the incidence of running injuries. The aim of this study was to investigate and compare the kinematic patterns of foot joints between naturally RFS and FFS runners. A validated multi-segment foot model was used to measure 24 foot kinematic variables in long-distance recreational runners while running on a treadmill. These variables included the three-dimensional relative motion between rearfoot, midfoot, and forefoot segments. The footstrike pattern was identified using kinematic data and slow-motion videos. Functional analysis of variance was used to compare the time series of these variables between RFS (n = 49) and FFS (n = 25) runners. In FFS runners, the metatarsal bones were less tilted with respect to the ground, and the metatarsus was less adducted with respect to the calcaneus during stance. In early stance, the calcaneus was more dorsiflexed with respect to the shank and returned to a more plantarflexed position at push-off. FFS runners showed a more adducted calcaneus with respect to the shank and a less inverted midfoot to the calcaneus. The present study has showed that the footstrike angle characterizes foot kinematics in running. These data may help shed more light on the relationship between foot function and running-related injuries.

Acute shoe effects on Achilles tendon loading in runners with habitual rearfoot strike pattern

OBJECTIVES

Although the overuse injury rate of the Achilles tendon (AT) for running is high, the effect of shoe conditions on AT loading remains unclear. Hence, this study aims to determine the mechanical properties of AT during running under different shoe conditions (minimalist vs. conventional shoes).

DESIGN

This work is a controlled laboratory study.

METHODS

Sixteen healthy male rearfoot strike runners were recruited to complete over ground running trials at 3.33 m/s (±5%) under two shoe conditions (minimalist shoes: INOV-8 Bare-XF 210; conventional shoes: NIKE AIR ZOOM PEGASUS 34). Sagittal plane ankle kinematics and ground reaction forces were simultaneously recorded. Ankle joint mechanics (ankle joint angle and moment) and the mechanical properties (peak force, impulse, stress, strain, and their corresponding peak rate) of the AT were calculated.

RESULTS

In comparison with conventional shoes, wearing minimalist shoes showed significant changes (p < 0.05): (1) decreased strike angle (48.92 ± 9.01 vs. 41.04 ± 8.69°); (2) increased ankle moment (2.34 ± 0.44 vs. 2.55 ± 0.46 Nm/kg); (3) increased peak AT force (5.85 ± 1.22 vs. 6.24 ± 1.13 BW), AT force impulse (0.65 ± 0.13 vs. 0.70 ± 0.13 BW·s), peak AT loading rate (109.94 ± 9.33 vs. 118.84 ± 26.62 BW/s), and average loading rate (48.42 ± 15.64 vs. 54.90 ± 17.47 BW/s); (4) decreased time to peak AT force (126.31 ± 20.68 vs. 117.77 ± 17.62 ms); (5) increased AT stress (66.96 ± 14.59 vs. 71.89 ± 14.74 MPa), strain (8.19 ± 1.77 vs. 8.78 ± 1.80 %), peak AT stress rate (66.96 ± 14.59 vs. 71.89 ± 14.74 MPa/s), and strain rate (148.71 ± 48.52 vs. 167.28 ± 42.82 %/s).

CONCLUSION

Increased AT force, loading rate, and stress were observed in runners who habitually wear conventional shoes with rearfoot strike patterns when they wore minimalist shoes. Hence, we recommend a gradual transition to minimalist shoes for runners who habitually wear conventional shoes with rearfoot strike patterns.

A one-dimensional collagen-based biomechanical model of passive soft tissue with viscoelasticity and failure

INTRODUCTION

Strains and sprains of soft tissues, including tendons and ligaments, are frequently occurring injuries. Musculoskeletal models show great promise in prediction and prevention of these injuries. However, these models rarely account for the viscoelastic properties of ligaments and tendons, much less their failure properties. The purpose of this project was to develop, simplify, and analyze a collagen-distribution model to address these limitations.

MODEL DEVELOPMENT

A distribution-moment approximation was applied to an existing partial differential equation model to reduce its computational complexity. The resulting model was equipped with a Voigt model in series, which endowed it with viscoelastic properties in addition to failure properties.

RESULTS

The model was able to reproduce the characteristic toe, linear, and failure regions ubiquitous throughout in-vitro tests on tissue specimens. In addition, it was able to reproduce a tri-phasic creep test consisting of an initial deformation, a steady-state, and failure. Stress-relaxation and hysteresis were also reproducible by the model.

DISCUSSION AND CONCLUSION

The ability to reproduce so many characteristics of biological tissues suggests more bio-fidelity was achieved by the reduced model was other currently available models. Future work to further improve its bio-fidelity is proposed for specific tendons and ligaments.

A Pilot Study of Musculoskeletal Abnormalities in Patients in Recovery from a Unilateral Rupture-Repaired Achilles Tendon

The purpose of this study was to compare the inter-limb joint kinematics, joint moments, muscle forces, and joint reaction forces in patients after an Achilles tendon rupture (ATR) via subject-specific musculoskeletal modeling. Six patients recovering from a surgically repaired unilateral ATR were included in this study. The bilateral Achilles tendon (AT) lengths were evaluated using ultrasound imaging. The three-dimensional marker trajectories, ground reaction forces, and surface electromyography (sEMG) were collected on both sides during self-selected speed during walking, jogging and running. Subject-specific musculoskeletal models were developed to compute joint kinematics, joint moments, muscle forces and joint reaction forces. AT lengths were significantly longer in the involved side. The side-to-side triceps surae muscle strength deficits were combined with decreased plantarflexion angles and moments in the injured leg during walking, jogging and running. However, the increased knee extensor femur muscle forces were associated with greater knee extension degrees and moments in the involved limb during all tasks. Greater knee joint moments and joint reaction forces versus decreased ankle joint moments and joint reaction forces in the involved side indicate elevated knee joint loads compared with reduced ankle joint loads that are present during normal activities after an ATR. In the frontal plane, increased subtalar eversion angles and eversion moments in the involved side were demonstrated only during jogging and running, which were regarded as an indicator for greater medial knee joint loading. It seems after an ATR, the elongated AT accompanied by decreased plantarflexion degrees and calf muscle strength deficits indicates ankle joint function impairment in the injured leg. In addition, increased knee extensor muscle strength and knee joint loads may be a possible compensatory mechanism for decreased ankle function. These data suggest patients after an ATR may suffer from increased knee overuse injury risk.

A simple instrumented insole algorithm to estimate plantar flexion moments

BACKGROUND

Plantar flexion is critical for ambulatory function but there are few wearable solutions to monitor loading.

RESEARCH QUESTION

The purpose of this study was to develop and validate a method to calculate plantar flexion moment using a commercially-available instrumented insole.

METHODS

Seven healthy young adults completed a battery of functional activities to characterize a range of plantar flexion loading which included single leg heel raise, step down, and drop jump as well as walking and running at comfortable speeds. Lower extremity trajectories were captured using motion capture and ground reaction forces were recorded with embedded force plates as well as the instrumented insole. We compared plantar flexion moment calculated by the instrumented insole to 'gold standard' inverse dynamics.

RESULTS

We found that estimating plantar flexion moment using our instrumented insole algorithm compared favorably to moments calculated using inverse dynamics across all activities. Errors in the maximum plantar flexion moments were less than 10 % for all activities, averaging 4.9 %. Root mean square errors across the entire activity were also small, averaging 1.0 % bodyweight * height. Additionally, the calculated wave forms were strongly correlated with inverse dynamics (R_xy > 0.964).

SIGNIFICANCE

Our findings demonstrate the utility and fidelity of a simple method for estimating plantar flexion moment using a commercially available instrumented insole. By leveraging this simple methodology, it is now feasible to prospectively track and eventually prescribe plantar flexion loading outside of the clinic to improve patient outcomes.

Biomechanical risk factors for running-related injury differ by sample population: A systematic review and meta-analysis

BACKGROUND

The role of biomechanical variables of running gait in the development of running related injury has not been clearly elucidated. Several systematic reviews have examined running biomechanics and its association with particular running related injuries. However, due to retrospective designs, inferences into the cause of these injuries are limited. Although prospective studies have been completed, no quantitative analysis pooling these results has been completed.

METHODS

A systematic review of MEDLINE, CINAHL, and PubMed was completed. Articles included used prospective study designs, human subjects currently completing a regular running program, and a minimum 12-week follow-up period. Excluded articles had no biomechanical data reported, participants who were beginning runners or military recruits, or had an intervention provided.

FINDINGS

Thirteen studies met these criteria. Pooled analyses were completed if two or more studies were available with samples that investigated the same sex and competition level. A qualitative synthesis was completed when pooled analysis was not possible. Five unique running samples were identified and allowed for pooled analyses of variables in mixed-sex collegiate runners and female recreational runners. Moderate evidence exists for increased hip adduction and reduced peak rearfoot eversion as risk factors for running related injury in female recreational runners. Variables differed in other samples of runners.

INTERPRETATION

A runner's sex and competition level may affect the relationship between biomechanical factors and the development of running related injury. Hip adduction and rearfoot eversion may be important factors related to running related injury in female recreational runners. Further investigation of biomechanical factors in running injury is warranted.

Twelve-Week Gait Retraining Reduced Patellofemoral Joint Stress during Running in Male Recreational Runners

Purpose

To explore the changes in knee sagittal angle and moment and patellofemoral joint (PFJ) force and stress before and after 12-week gait retraining.

Methods

A total of 30 healthy male recreational runners were randomized into a control group (n = 15) who ran in their original strike pattern using minimalist shoes or experimental group (n = 15) who ran in a forefoot strike pattern using minimalist shoes during the 12-week gait retraining. The kinematic and kinetic data of the dominant leg of the participants during the 12 km/h running were collected by 3D motion capture systems and 3D force platforms. Besides, the biomechanical property of the PFJ was calculated on the basis of the joint force model and the regression equation of the contact area.

Results

After the 12-week gait retraining, 78% of the rearfoot strikers turned into forefoot strikers. Peak knee extension moment and peak PFJ stress decreased by 13.8% and 13.3% without altering the running speed, respectively. Meanwhile, no changes in maximum knee flexion angle/extension moment and PFJ force/stress were observed for the control group.

Conclusion

The 12-week gait retraining effectively reduced the PFJ stress, thereby providing a potential means of reducing the risk of patellofemoral pain syndrome while running.

Foot strike pattern during running alters muscle-tendon dynamics of the gastrocnemius and the soleus

Running is thought to be an efficient gait due, in part, to the behavior of the plantar flexor muscles and elastic energy storage in the Achilles tendon. Although plantar flexor muscle mechanics and Achilles tendon energy storage have been explored during rearfoot striking, they have not been fully characterized during forefoot striking. This study examined how plantar flexor muscle-tendon mechanics during running differs between rearfoot and forefoot striking. We used musculoskeletal simulations, driven by joint angles and electromyography recorded from runners using both rearfoot and forefoot striking running patterns, to characterize plantar flexor muscle-tendon mechanics. The simulations revealed that foot strike pattern affected the soleus and gastrocnemius differently. For the soleus, forefoot striking decreased tendon energy storage and fiber work done while the muscle fibers were shortening compared to rearfoot striking. For the gastrocnemius, forefoot striking increased muscle activation and fiber work done while the muscle fibers were lengthening compared to rearfoot striking. These changes in gastrocnemius mechanics suggest that runners planning to convert to forefoot striking might benefit from a progressive eccentric gastrocnemius strengthening program to avoid injury.

Acute responses to barefoot 5 km treadmill running involve changes in landing kinematics and delayed onset muscle soreness

BACKGROUND

Barefoot running has gained popularity among physical activity practitioners, but there is a lack of information regarding the acute adaptations to this running technique without supervision. Information about acute adaptations can help to define the best way to insert barefoot running in the routine of runners willing to, and also provide orientation for those people who want to experience this technique.

RESEARCH QUESTION

What acute adaptations can be observed among recreational runners exposed to barefoot running?

METHODS

Sagittal 2D kinematics, plantar pressure, foot sensitivity and delayed onset muscle soreness were compared between conditions of shod and barefoot running in 13 recreational runners who performed two trials of 5 km treadmill running.

RESULTS

We found an acute effect of barefoot running on foot landing that changes from a rearfoot strike to a forefoot strike pattern. This change most likely contributed to the increase in neuromuscular recruitment of calf muscles (i.e. gastrocnemius and soleus) resulting in higher perception of delayed onset muscle soreness. Barefoot running also elicited higher stride cadence. Plantar pressure before and after running revealed higher pressure in the different foot regions after barefoot running. Foot sensitivity increased after running regardless of the footwear condition.

CONCLUSION

Barefoot running has acute effects on running technique including higher perception of delayed onset muscle soreness in the 48 h following the exercise.

SIGNIFICANCE

Our results highlight the importance of following participants for days after a first session of barefoot running in order to properly manage the acute adaptation periods as well provide precise advices for those trying the barefoot technique.

Plantar load characteristics among runners with different strike patterns during preferred speed

Objectives

This study aimed to compare the plantar loads between habitual rearfoot strike (RFS) and non-RFS (NRFS) during running under the participant’s preferred speed.

Methods

A total of 66 (36 RFS, 30 NRFS) healthy amateur male runners were included in our study. In-shoe pressure sensors were utilised to the test plantar loads when participants were running using their preferred foot strike pattern and running speed (RFS: 3.2 ± 0.3 m/s; NRFS: 3.4 ± 0.4 m/s).

Results

Results indicated that running speed has a significant effect on the total contact area [F (1, 64) = 7.061, P = 0.01, η² = 0.101], which also affects midfoot and forefoot regions. No significant difference was found on the total maximum force, force-time-integral, peak pressure (PP) and pressure-time-integral (PTI), but the total contact area of RFS was higher than that of NRFS runners [F (1, 64) = 77.406, P < 0.001, η² = 0.551]. Plantar loads were mainly focused on the heel and midfoot for RFS runners in all variables, and NRFS runners experienced increased PP and PTI in medial forefoot regions.

Conclusion

Habitual runners tend to adjust their contact area according to the running speed through midfoot and forefoot regions. RFS runners remain susceptible to high impact force on the heel and midfoot, and NRFS runners experience high impact force in the first metatarsal regions. Therefore, runners should note this situation to avoid running-related injuries.

A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months

BACKGROUND

Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP.

PURPOSE

To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome.

RESULTS

After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction (P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12° [95% CI, 1.88°-4.37°]), hip adduction (MD, 3.99° [95% CI, 2.01°-5.96°]), and knee flexion (MD, 4.09° [95% CI, 0.04°-8.15°]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale.

CONCLUSION

A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately.

REGISTRATION

NCT03067545 (ClinicalTrials.gov identifier).

COMPARISON OF ANKLE JOINT LOAD IN DIFFERENT FOOT STRIKE STRATEGIES DURING STAIR ASCENT

The purpose of this study was to find a foot strike strategy that can reduce the ankle joint load during stair ascent by comparing the ankle joint load in two strategies of initial contact during stair ascent. Twenty young subjects performed ascending stairs with two strategies, i.e., rearfoot strike (RFS) and forefoot strike (FFS). Kinematic data was measured from 12 cameras and the ground reaction force was measured by a force plate inserted in the second step of four-step stairs. Stance phase was divided into three phase, i.e., weight acceptance, pull up, and forward continuance. Four ankle related kinetic variables were derived from the measured data, i.e., joint reaction force, moment, and the magnitude and moment arm of ground reaction force. Root-mean-square (RMS) was used as the representative value of the variables during each phase was compared between strategies. In the weight acceptance phase, FFS resulted in greater values of all four kinetic variables than RFS. For the pull-up and forward continuance phases, joint reaction force and ground reaction force were not different between strategies but joint moment and moment arm was greater for FFS than RFS. In weight acceptance phase, greater ground reaction forces and longer moment arm of FFS may have resulted from faster weight transfer to the ipsilateral foot and the more anterior location of center of pressure, respectively. Both have contributed greater joint moment of FFS. In pull-up and forward continuance phases, greater ankle moment of FFS was affected mainly by longer moment arms, which may reflect the persistent farther location of center of pressure from the ankle joint. The results suggest that RFS would be more advantageous than FFS in terms of ankle joint load.

ANKLE JOINT MOMENTS IN DIFFERENT FOOT STRIKE METHODS DURING STAIR DESCENT

The purpose of this study was to compare the ankle joint moments in different foot strike patterns during stair descent and to find a better strategy. Methods: Twenty young subjects participated in this study. Subjects performed two trials of descending stairs in rearfoot strike (RFS) and forefoot strike (FFS) strategies. Kinematic and kinetic data were measured by a motion capture system and force plates. Ankle joint moments, ground reaction forces, and moment arms in three planes of motion were calculated from the measured data. The root-mean-squared means of ankle joint moments, ground reaction forces, and moment arms were compared between different foot strike patterns for each phase of stair descent (weight acceptance, forward continuance, and controlled lowering). Results: In the weight acceptance phase, FFS showed greater ankle joint moments than RFS in all three (dorsi/plantar-flexion, inversion/eversion, and internal/external rotation) directions ([Formula: see text]). In the forward continuance phase, FFS showed greater dorsi/plantar moments than RFS ([Formula: see text]). In controlled lowering phase, FFS showed smaller dorsi/plantar moments than RFS ([Formula: see text]). Discussion: The greater ankle joint moments of FFS in the weight acceptance phase were influenced by both the greater GRF magnitudes and greater moment arms. The greater dorsi/plantar moments of FFS in the forward continuance phase and the smaller dorsi/plantar moment of FFS in the controlled lowering phase were dominated by the greater moment arm and the smaller ground reaction force, respectively. RFS strategy resulted in smaller ankle joint moments in the majority of stair descent phases (weight acceptance and forward continuance), therefore, RFS would be a better strategy than FFS for stair descent in terms of ankle joint load.

Do habitual foot-strike patterns in running influence functional Achilles tendon properties during gait?

The capacity of foot-strike running patterns to influence the functional properties of the Achilles tendon is controversial. This study used transmission-mode ultrasound to investigate the influence of habitual running foot-strike pattern on Achilles tendon properties during barefoot walking and running. Fifteen runners with rearfoot (RFS) and 10 with a forefoot (FFS) foot-strike running pattern had ultrasound transmission velocity measured in the right Achilles tendon during barefoot walking (≈1.1 ms^-1) and running (≈2.0 ms^-1). Temporospatial gait parameters, ankle kinematics and vertical ground reaction force were simultaneously recorded. Statistical comparisons between foot-strike patterns were made using repeated measure ANOVAs. FFS was characterised by a significantly shorter stance duration (-4%), greater ankle dorsiflexion (+2°), and higher peak vertical ground reaction force (+20% bodyweight) than RFS running (P < .05). Both groups adopted a RFS pattern during walking, with only the relative timing of peak dorsiflexion (3%), ground reaction force (1-2%) and peak vertical force loading rates (22-23%) differing between groups (P < .05). Peak ultrasound transmission velocity in the Achilles tendon was significantly higher in FFS during walking (≈100 ms^-1) and running (≈130 ms^-1) than RFS (P < .05). Functional Achilles tendon properties differ with habitual footfall patterns in recreational runners.

Recognition of Foot Strike Pattern in Asian Recreational Runners

Close to 90% of recreational runners rearfoot strike in a long-distance road race. This prevalence has been obtained from North American cohorts of runners. The prevalence of rearfoot strikers has not been extensively examined in an Asian population of recreational runners. Therefore, the aim of this study was to determine the prevalence of rearfoot, midfoot, and forefoot strikers during a long-distance road race in Asian recreational runners and compare this prevalence to reported values in the scientific literature. To do so, we classified the foot strike pattern of 950 recreational runners at the 10 km mark of the Singapore marathon (77% Asian field). We observed 71.1%, 16.6%, 1.7%, and 10.6% of rearfoot, midfoot, forefoot, and asymmetric strikers, respectively. Chi-squared tests revealed significant differences between our foot strike pattern distribution and those reported from North American cohorts (P < 0.001). Our foot strike pattern distribution was similar to one reported from elite half-marathon runners racing in Japan (Fisher exact test, P = 0.168). We conclude that the prevalence of rearfoot strikers is lower in Asian than North American recreational runners. Running research should consider and report ethnicity of participants given that ethnicity can potentially explain biomechanical differences in running patterns.

Comparison of plantar loads among runners with different strike patterns

This study aimed to explore the plantar loading variables between habitual rearfoot strike (RFS) and non-rearfoot strike (NRFS) during running. 78 healthy males participated in this study (41 RFS, 37 NRFS). In-shoe pressure sensors were used to measure plantar loading while the participants were running on a 15 m indoor runway with their preferred foot strike pattern (FSP) at 12.0 ± 5% km/h. Results indicate that force and pressure parameters were much higher in the rearfoot and midfoot regions during RFS running and relatively greater in forefoot region during NRFS running. However, compared with NRFS running, the contact area, maximum force and force-time-integrals during RFS running on total foot were 21.44% (P < 0.001, ES = 2.29), 13.99% (P = 0.006, ES = 0.64) and 21.27% (P < 0.001, ES = 0.85) higher, respectively. Total foot peak pressure and pressure-time-integral between two FSPs were similar. Higher loads in the rearfoot region may transmit to the knee joint and result in patellofemoral joint injuries. NRFS runners' higher loads in forefoot seem to be ralated to metatarsal stress fractures and compensatory damage to the Achilles tendon. Therefore, runners should choose proper FSPs according to their unique physical conditions.

Forefoot running requires shorter gastrocnemius fascicle length than rearfoot running

This study aimed to investigate the influence of foot strike patterns on the behaviour of the triceps surae muscle-tendon unit, including the Achilles tendon whose length nearly corresponds to force of the triceps surae, and the medial gastrocnemius muscle (MG) during running. Seven male volunteers ran with forefoot and rearfoot strikes at 10, 14 and 18 km h^-1 on a treadmill. The MG fascicle length was measured using ultrasonography. The in vivo length of the curved Achilles tendon was quantified by combining ultrasonography with optical motion capture of reflective markers on the right lower limb and an ultrasound probe. The forefoot strike resulted in a significantly shorter MG fascicle length at the initial contact, at Achilles tendon peak elongation, and at toe-off, than the rearfoot strike. The Achilles tendon length at initial contact was greater during the forefoot strike than during the rearfoot strike at 18 km h^-1, while its peak elongation was not significantly different during forefoot and rearfoot running. These results indicate that the MG, with a shorter length during forefoot running, manages to address demands for a similar peak force of the triceps surae than during rearfoot running.