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Kim J, McSweeney SC, Hollander K, Horstman T, Wearing SC. Adolescents running in conventional running shoes have lower vertical instantaneous loading rates but greater asymmetry than running barefoot or in partial-minimal shoes. J Sports Sci 2023; 41:774-787. [PMID: 37571975 DOI: 10.1080/02640414.2023.2240174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
Footwear may moderate the transiently heightened asymmetry in lower limb loading associated with peak growth in adolescence during running. This repeated-measures study compared the magnitude and symmetry of peak vertical ground reaction force and instantaneous loading rates (VILRs) in adolescents during barefoot and shod running. Ten adolescents (age, 10.6 ± 1.7 years) ran at self-selected speed (1.7 ± 0.3 m/s) on an instrumented treadmill under three counter-balanced conditions; barefoot and shod with partial-minimal and conventional running shoes. All participants were within one year of their estimated peak height velocity based on sex-specific regression equations. Foot-strike patterns, peak vertical ground reaction force and VILRs were recorded during 20 seconds of steady-state running. Symmetry of ground reaction forces was assessed using the symmetry index. Repeated-measures ANOVAs were used to compare conditions (α=.05). Adolescents used a rearfoot foot-strike pattern during barefoot and shod running. Use of conventional shoes resulted in a lower VILR (P < .05, dz = 0.9), but higher VILR asymmetry (P < .05) than running barefoot (dz = 1.5) or in partial-minimal shoes (dz = 1.6). Conventional running shoes result in a lower VILR than running unshod or in partial-minimal shoes but may have the unintended consequence of increasing VILR asymmetry. The findings may have implications for performance, musculoskeletal development and injury in adolescents.
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Affiliation(s)
- Jae Kim
- Complete Rehab Allied Health Clinic, Brisbane, Australia
| | - Simon C McSweeney
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Karsten Hollander
- Institute of Exercise Science & Sports Medicine, Medical School Hamburg, Hamburg, Germany
| | - Thomas Horstman
- Conservative and Rehabilitative Orthopaedics, Technical University Munich, Munich, Germany
| | - Scott C Wearing
- Conservative and Rehabilitative Orthopaedics, Technical University Munich, Munich, Germany
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Sudlow A, Galantine P, Vercruyssen F, Peyrot N, Raymond JJ, Duché P. Which Factors Influence Running Gait in Children and Adolescents? A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054621. [PMID: 36901631 PMCID: PMC10001902 DOI: 10.3390/ijerph20054621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 06/01/2023]
Abstract
In recent years, running has dramatically increased in children and adolescents, creating a need for a better understanding of running gait in this population; however, research on this topic is still limited. During childhood and adolescence multiple factors exist that likely influence and shape a child's running mechanics and contribute to the high variability in running patterns. The aim of this narrative review was to gather together and assess the current evidence on the different factors that influence running gait throughout youth development. Factors were classified as organismic, environmental, or task-related. Age, body mass and composition, and leg length were the most researched factors, and all evidence was in favour of an impact on running gait. Sex, training, and footwear were also extensively researched; however, whereas the findings concerning footwear were all in support of an impact on running gait, those concerning sex and training were inconsistent. The remaining factors were moderately researched with the exception of strength, perceived exertion, and running history for which evidence was particularly limited. Nevertheless, all were in support of an impact on running gait. Running gait is multifactorial and many of the factors discussed are likely interdependent. Caution should therefore be taken when interpreting the effects of different factors in isolation.
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Affiliation(s)
- Anthony Sudlow
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
| | - Paul Galantine
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
| | - Fabrice Vercruyssen
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
| | - Nicolas Peyrot
- Mouvement-Interactions-Performance, MIP, UR 4334, Faculty of Sport Sciences, Le Mans University, 72000 Le Mans, France
| | - Jean-Jacques Raymond
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
- Unité de Médecine et de traumatologie du Sport, CHITS Hôpital Sainte Musse, 83100 Toulon, France
| | - Pascale Duché
- Impact of Physical Activity on Health Research Unit, Faculty of Sport Sciences, University of Toulon, Campus La Garde, 83160 Toulon, France
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DeJong Lempke AF, Whitney KE, Collins SE, d'Hemecourt PA, Meehan Iii WP. Biomechanical running gait assessments across prevalent adolescent musculoskeletal injuries. Gait Posture 2022; 96:123-129. [PMID: 35642825 DOI: 10.1016/j.gaitpost.2022.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND While there is substantial information available regarding expected biomechanical adaptations associated with adult running-related injuries, less is known about adolescent gait profiles that may influence injury development. RESEARCH QUESTIONS Which biomechanical profiles are associated with prevalent musculoskeletal lower extremity injuries among adolescent runners, and how do these profiles compare across injury types and body regions? METHODS We conducted a cross-sectional study of 149 injured adolescents (110 F; 39 M) seen at a hospital-affiliated injured runner's clinic between the years 2016-2021. Biomechanical data were obtained from 2-dimensional video analyses and an instrumented treadmill system. Multivariate analyses of variance covarying for gender and body mass index were used to compare continuous biomechanical measures, and Chi-square analyses were used to compare categorical biomechanical variables across injury types and body regions. Spearman's rho correlation analyses were conducted to assess the relationship of significant outcomes. RESULTS Patients with bony injuries had significantly higher maximum vertical ground reaction forces (bony: 1.87 body weight [BW] vs. soft tissue: 1.79BW, p = 0.05), and a higher proportion of runners with contralateral pelvic drop at midstance (χ2 =5.3, p = 0.02). Maximum vertical ground reaction forces and pelvic drop were significantly yet weakly correlated (ρ = 0.20, p = 0.01). Foot strike patterns differed across injured body regions, with a higher proportion of hip and knee injury patients presenting with forefoot strike patterns (χ2 =22.0, p = 0.01). SIGNIFICANCE These biomechanical factors may represent risk factors for injuries sustained by young runners. Clinicians may consider assessing these gait adaptations when treating injured adolescent patients.
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Affiliation(s)
- Alexandra F DeJong Lempke
- Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA.
| | - Kristin E Whitney
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sara E Collins
- Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Pierre A d'Hemecourt
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - William P Meehan Iii
- Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Maillane-Vanegas S, Luiz-de-Marco R, Narciso PH, Faustino-da-Silva YVDS, Kemper H, Ribeiro Agostinete R, A Fernandes R. More than Sports Participation: The Role of Ground Reaction Force, Osteocalcin and Lean Soft Tissue on Bone Density Accrual in Adolescents: ABCD Growth Study. J Clin Densitom 2022; 25:61-72. [PMID: 34391643 DOI: 10.1016/j.jocd.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/21/2021] [Accepted: 07/06/2021] [Indexed: 11/22/2022]
Abstract
The objective of this study was to identify predictors of 12-mo areal bone density accrual in different body segments, lean soft tissue, and osteogenic characteristics attributed to sports participation among adolescent girls and boys. Adolescents (Girls [n = 64], [aged = 14.7]); Boys [n = 129], [aged = 14.6]) were stratified into three groups according to their engagement in different sports (Control [n = 68], Swimming [n = 25], and Weight-bearing sports [n = 100]). Areal bone density (aBMD [g/cm²]) and lean soft tissue (LST) [kg] were measured by dual-energy x-ray absorptiometry (DXA; Lunar DPX-NT; General Electric Healthcare, Little Chalfont, Buckinghamshire, United Kingdom). The ground reaction force (GRF) index attributed to sports participation (Sport-GRF) was created considering the GRF attributed to each sport, body weight of the adolescent, and the amount of time spent in sports participation. Osteocalcin levels (ng/mL) were estimated from a venous blood sample. Multiple regression analysis showed that after adjusting for covariates, the models involving sport-GRF, LST (Δ), and osteocalcin explained 15.8% to 76.2% of the aBMD gains. Specifically in girls, OC was only associated with lower limb aBMD accrual. In boys, however, sport ground reaction forces were positively associated with total spine aBMD accrual. Furthermore, the LST (Δ) was positively associated with aBMD accrual in all body sites (β = 0.003 to 0.011) in both sexes. Increases in LST contributed significantly to gains in aBMD accrual in both sexes, being a more important predictor of changes in bone outcomes than ground reaction forces and osteocalcin.
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Affiliation(s)
- Santiago Maillane-Vanegas
- Post-Graduation Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise LIVE, Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil.
| | - Rafael Luiz-de-Marco
- Post-Graduation Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise LIVE, Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Pedro Henrique Narciso
- Laboratory of InVestigation in Exercise LIVE, Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | | | - Han Kemper
- Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ricardo Ribeiro Agostinete
- Post-Graduation Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise LIVE, Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Rômulo A Fernandes
- Post-Graduation Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise LIVE, Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
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Feyzioğlu Ö, Öztürk Ö, Muğrabi S. Effects of custom-made insoles on foot pressure redistribution, gait parameters, and pain in calcaneal apophysitis-a pretest and posttest study. Prosthet Orthot Int 2021; 45:532-537. [PMID: 34561380 DOI: 10.1097/pxr.0000000000000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Calcaneal apophysitis is a self-limiting disorder that often affects adolescents with a high level of activity and leads to increased pain severity, impairments in gait parameters, and poor health-related quality of life. OBJECTIVE To investigate the combination of custom-made insoles and exercise on foot pressure distribution, spatial-temporal gait parameters, and pain intensity in patients with calcaneal apophysitis. STUDY DESIGN A one-group pretest-posttest design. METHODS Forty patients, aged between 8 and 15 years, diagnosed with calcaneal apophysitis, were included in this study. Patients were asked to use the custom-made insoles and to perform a home exercise program for 3 days a week. The duration of treatment was 4 weeks. The pain severity was evaluated with the Visual Analog Scale. The spatial-temporal gait parameters and foot pressure distribution were assessed with the Zebris FDM-THM-S treadmill system before and after the treatment. RESULTS At posttreatment assessment, there were significant changes in step length, stance phase percentage, swing phase percentage, and gait speed (P < 0.05), except step width and cadence (P > 0.05). Moreover, significant differences were found in forefoot, midfoot, and rearfoot pressure distribution (P < 0.05). There was also a significant decrease in pain intensity during activity compared to the pretreatment (P < 0.05). CONCLUSION Our study results suggest that the combination of the custom-made insoles and exercise program created improvements in spatial-temporal gait parameters and foot pressure distribution by reducing the pain severity.
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Affiliation(s)
- Özlem Feyzioğlu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Özgül Öztürk
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Fares MY, Salhab HA, Khachfe HH, Fares J, Haidar R, Musharrafieh U. Sever's Disease of the Pediatric Population: Clinical, Pathologic, and Therapeutic Considerations. Clin Med Res 2021; 19:132-137. [PMID: 34531270 PMCID: PMC8445662 DOI: 10.3121/cmr.2021.1639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022]
Abstract
Sever's disease is an underreported prevalent pediatric condition that causes heel pain in children worldwide. It is often described as an overuse injury that can present with either unilateral or bilateral heel pain. Even though the exact mechanism of injury is unknown, it is often thought it involves repetitive stress and pressure on the calcaneal growth plate. Diagnosing Sever's disease mainly relies on a thorough clinical investigation and physical examination, with a positive squeeze test usually sufficient to establish diagnosis. Nevertheless, radiographic imaging can help exclude other differential diagnoses. Therapeutic options of Sever's disease are mostly conservative, and these include rest, physical therapy, kinesiotherapy, and orthoses. Educating parents and coaches on the symptomatology and presentation of Sever's disease is pivotal for the establishment of efficient preventive interventions and earlier diagnoses. This study presents a case of a pediatric patient with Sever's disease and offers medical insight into the diagnostic, clinical, pathologic, and therapeutic characteristics of this condition, in light of the current existing literature.
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Affiliation(s)
- Mohamad Y Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
- College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Hamza A Salhab
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hussein H Khachfe
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Rachid Haidar
- Department of Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
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Wearing SC, Kuhn L, Pohl T, Horstmann T, Brauner T. Transmission-Mode Ultrasound for Monitoring the Instantaneous Elastic Modulus of the Achilles Tendon During Unilateral Submaximal Vertical Hopping. Front Physiol 2020; 11:567641. [PMID: 33343380 PMCID: PMC7744658 DOI: 10.3389/fphys.2020.567641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022] Open
Abstract
Submaximal vertical hopping capitalizes on the strain energy storage-recovery mechanism associated with the stretch-shortening cycle and is emerging as an important component of progressive rehabilitation protocols in Achilles tendon injury and a determinant of readiness to return to sport. This study explored the reliability of transmission mode ultrasound in quantifying the instantaneous modulus of elasticity of human Achilles tendon during repetitive submaximal hopping. A custom-built ultrasound transmission device, consisting of a 1 MHz broadband emitter and four regularly spaced receivers, was used to measure the axial velocity of ultrasound in the Achilles tendon of six healthy young adults (mean ± SD; age 26 ± 5 years; height 1.78 ± 0.11 m; weight 79.8 ± 13.6 kg) during steady-state unilateral hopping (2.5 Hz) on a piezoelectric force plate. Vertical ground reaction force and lower limb joint kinematics were simultaneously recorded. The potential sensitivity of the technique was further explored in subset of healthy participants (n = 3) that hopped at a slower rate (1.8 Hz) and a patient who had undergone Achilles tendon rupture-repair (2.5 Hz). Reliability was estimated using the mean-within subject coefficient of variation calculated at each point during the ground-contact phase of hopping, while cross-correlations were used to explore the coordination between lower limb kinematics ground reaction forces and ultrasound velocity in the Achilles tendon. Axial velocity of ultrasound in the Achilles tendon was highly reproducible during hopping, with the mean within-subject coefficient of variation ranging between 0.1 and 2.0% across participants. Ultrasound velocity decreased immediately following touch down (−19 ± 13 ms–1), before increasing by 197 ± 81 ms–1, on average, to peak at 2230 ± 87 ms–1 at 67 ± 3% of ground contact phase in healthy participants. Cross-correlation analysis revealed that ultrasound velocity in the Achilles tendon during hopping was strongly associated with knee (mean r = 0.98, range 0.95–1.00) rather than ankle (mean r = 0.67, range 0.35–0.79) joint motion. Ultrasound velocity was sensitive to changes in hopping frequency in healthy adults and in the surgically repaired Achilles tendon was characterized by a similar peak velocity (2283 ± 13 ms–1) but the change in ultrasound velocity (447 ± 21 ms–1) was approximately two fold that of healthy participants (197 ± 81 ms–1). Although further research is required, the technique can be used to reliably monitor ultrasound velocity in the Achilles tendon during hopping, can detect changes in the instantaneous elastic modulus of tendon with variation in hopping frequency and tendon pathology and ultimately may provide further insights into the stretch-shortening cycle and aid clinical decision concerning tendon rehabilitation protocols and readiness to return to sport.
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Affiliation(s)
- Scott C Wearing
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Faculty of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Larissa Kuhn
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Torsten Pohl
- Faculty of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Thomas Horstmann
- Faculty of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Torsten Brauner
- Department of Sport Science, German University of Health and Sport, Ismaning, Germany
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