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Baggaley M, Haider I, Bruce O, Khassetarash A, Edwards WB. Tibial strains are sensitive to speed perturbations, but not grade perturbations, during running. J Exp Biol 2024; 227:jeb246770. [PMID: 38725420 DOI: 10.1242/jeb.246770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/19/2024] [Indexed: 05/31/2024]
Abstract
A fatigue-failure process is hypothesized to govern the development of tibial stress fractures, where bone damage is highly dependent on the peak strain magnitude. To date, much of the work examining tibial strain during running has ignored uphill and downhill running despite the prevalence of this terrain. This study examined the sensitivity of tibial strain to changes in running grade and speed using a combined musculoskeletal-finite element modelling routine. Seventeen participants ran on a treadmill at ±10, ±5 and 0 deg; at each grade, participants ran at 3.33 m s-1 and at a grade-adjusted speed of 2.50 and 4.17 m s-1 for uphill and downhill grades, respectively. Force and motion data were recorded in each grade and speed combination. Muscle and joint contact forces were estimated using inverse-dynamics-based static optimization. These forces were applied to a participant-adjusted finite element model of the tibia. None of the strain variables (50th and 95th percentile strain and strained volume ≥4000 με) differed as a function of running grade; however, all strain variables were sensitive to running speed (F1≥9.59, P≤0.03). In particular, a 1 m s-1 increase in speed resulted in a 9% (∼260 με) and 155% (∼600 mm3) increase in peak strain and strained volume, respectively. Overall, these findings suggest that faster running speeds, but not changes in running grade, may be more deleterious to the tibia.
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Affiliation(s)
- Michael Baggaley
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada, T2N 1N4
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, Canada, T2N 4Z6
| | - Ifaz Haider
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada, T2N 1N4
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, Canada, T2N 4Z6
| | - Olivia Bruce
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada, T2N 1N4
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, Canada, T2N 4Z6
- Department of Radiology, Stanford University, 300 Pasteur Dr., Stanford, CA 94305, USA
| | - Arash Khassetarash
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada, T2N 1N4
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, Canada, T2N 4Z6
- Canadian Sport Institute, 151 Canada Olympic Road, Calgary, AB, Canada, T3B 6B7
- Department of Education and Kinesiology, Vancouver Island University, 900 Fifth St, Nanaimo, BC, Canada, V9R 5S5
| | - W Brent Edwards
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada, T2N 1N4
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, Canada, T2N 4Z6
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Rice H, Seynnes O, Werkhausen A. Effect of increased running speed and weight carriage on peak and cumulative tibial loading. Scand J Med Sci Sports 2023; 33:2516-2523. [PMID: 37642291 DOI: 10.1111/sms.14476] [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: 03/06/2023] [Revised: 07/11/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Tibial stress injuries are a burdensome injury among military recruits. Military activities include running and the carriage of additional weight, and this may be related to the high risk of bone stress injuries. The aim of this study was to quantify tibial loading when running at two different speeds, with and without additional weight, and to quantify their combined influence. METHODS Fourteen male distance runners who ran at least 40 km per week ran barefoot on a force-instrumented treadmill in four conditions representing preferred running speed (mean (SD) 3.1 (0.3) m/s) and 20% increased running speed (3.8 (0.4) m/s), with and without 20% of body weight carried in a weight vest. Kinematics and kinetics were synchronously collected. Bending moments were estimated about the medial-lateral axis of the tibial centroid located 1/3rd of the length from distal to proximal. Static equilibrium was ensured at each 1% of stance. Peak bending moments were obtained in addition to cumulative-weighted loading, where weighted loading accounted for the relative importance of the magnitude of the bending moment and the quantity of loading using a bone-dependent weighting factor. RESULTS There were no interaction effects for running speed and weight carriage on peak or cumulative tibial loading. Running at a 20% faster speed increased peak and cumulative loading per kilometer by 8.0% (p < 0.001) and 4.8% (p < 0.001), respectively. Carriage of an additional 20% of body weight increased peak and cumulative loading per kilometer by 6.6% (p < 0.001) and 8.5% (p < 0.001), respectively. INTERPRETATION Increasing the physical demand of running by increasing speed or weight carriage increased peak tibial loading and cumulative tibial loading per kilometer, and this may increase the risk of tibial stress injury. Running speed and weight carriage independently influenced tibial loading.
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Affiliation(s)
- Hannah Rice
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Olivier Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Amelie Werkhausen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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Rubio JE, Tong J, Sundaramurthy A, Subramani AV, Kote VB, Baggaley M, Edwards WB, Reifman J. Differences in running biomechanics between young, healthy men and women carrying external loads. Front Bioeng Biotechnol 2023; 11:1250937. [PMID: 37854880 PMCID: PMC10579583 DOI: 10.3389/fbioe.2023.1250937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023] Open
Abstract
During U.S. Army basic combat training (BCT), women are more prone to lower-extremity musculoskeletal injuries, including stress fracture (SF) of the tibia, with injury rates two to four times higher than those in men. There is evidence to suggest that the different injury rates are, in part, due to sex-specific differences in running biomechanics, including lower-extremity joint kinematics and kinetics, which are not fully understood, particularly when running with external load. To address this knowledge gap, we collected computed tomography images and motion-capture data from 41 young, healthy adults (20 women and 21 men) running on an instrumented treadmill at 3.0 m/s with loads of 0.0 kg, 11.3 kg, or 22.7 kg. Using individualized computational models, we quantified the running biomechanics and estimated tibial SF risk over 10 weeks of BCT, for each load condition. Across all load conditions, compared to men, women had a significantly smaller flexion angle at the trunk (16.9%-24.6%) but larger flexion angles at the ankle (14.0%-14.7%). Under load-carriage conditions, women had a larger flexion angle at the hip (17.7%-23.5%). In addition, women had a significantly smaller hip extension moment (11.8%-20.0%) and ankle plantarflexion moment (10.2%-14.3%), but larger joint reaction forces (JRFs) at the hip (16.1%-22.0%), knee (9.1%-14.2%), and ankle (8.2%-12.9%). Consequently, we found that women had a greater increase in tibial strain and SF risk than men as load increases, indicating higher susceptibility to injuries. When load carriage increased from 0.0 kg to 22.7 kg, SF risk increased by about 250% in women but only 133% in men. These results provide quantitative evidence to support the Army's new training and testing doctrine, as it shifts to a more personalized approach that shall account for sex and individual differences.
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Affiliation(s)
- Jose E. Rubio
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Junfei Tong
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Aravind Sundaramurthy
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Adhitya V. Subramani
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Vivek Bhaskar Kote
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - W. Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
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Van Waerbeke C, Willy RW, Jacques A, Berton E, Paquette MR, Rao G. Increasing load carriage and running speed differentially affect the magnitude, variability and coordination patterns of muscle forces. J Biomech 2023; 159:111794. [PMID: 37690366 DOI: 10.1016/j.jbiomech.2023.111794] [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: 03/31/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
The study aims to investigate the effects of different loads and speed during running on inter- and intra-individual muscle force amplitudes, variabilities and coordination patterns. Nine healthy participants ran on an instrumentalized treadmill with an empty weight vest at two velocities (2.6 m/s and 3.3 m/s) or while carrying three different loads (4.5, 9.1, 13.6 kg) at 2.6 m/s while kinematics and kinetics were synchronously recorded. The major lower limb muscle forces were estimated using a musculoskeletal model. Muscle force amplitudes and variability, as well as coordination patterns were compared at the group and at the individual level using respectively statistical parametric mapping and covariance matrices combined with multidimensional scaling. Increasing the speed or the load during running increased most of the muscle force amplitudes (p < 0.01). During the propulsion phase, increasing the load increased muscle force variabilities around the ankle joint (modification of standard deviation up to 5% of body weight (BW), p < 0.05) while increasing the speed decreased variability for almost all the muscle forces (up to 10% of BW, p < 0.05). Each runner has a specific muscle force coordination pattern signature regardless of the different experimental conditions (p < 0.05). Yet, this individual pattern was slightly adapted in response to a change of speed or load (p < 0.05). Our results suggest that adding load increases the amplitude and variability of muscle force, but an increase in running speed decreases the variability. These findings may help improve the design of military or trail running training programs and injury rehabilitation by progressively increasing the mechanical load on anatomical structures.
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Affiliation(s)
| | - Richard W Willy
- Division of Physical Therapy & Health Sciences, University of Montana, Missoula, MT 59812, United States
| | | | - Eric Berton
- Aix Marseille Univ, CNRS, ISM, Marseille, France
| | - Max R Paquette
- College of Health Sciences, University of Memphis, Memphis, TN, United States
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De Starkey KR, Groth AM, Thyssen RR, Kernozek TW. Added mass increases Achilles tendon stress in female runners. Foot (Edinb) 2023; 56:102028. [PMID: 37011454 DOI: 10.1016/j.foot.2023.102028] [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: 01/03/2022] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
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.
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Affiliation(s)
- Katelyn R De Starkey
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Ashley M Groth
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Ryan R Thyssen
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA.
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Abbott A, Wang C, Stamm M, Mulcahey MK. Part II: Risk Factors for Stress Fractures in Female Military Recruits. Mil Med 2023; 188:93-99. [PMID: 35253041 DOI: 10.1093/milmed/usac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Stress fractures (SFx) represent a significant proportion of injuries in military recruits internationally. Stress fractures disproportionately affect female recruits, a disparity that has similarly been consistently demonstrated in female athletes. Stress fractures result in medical morbidity, financial burden, and medical discharge from military service. This review presents current literature regarding SFx risk factors to identify and/or mitigate in this high-risk population. METHODS A literature review was conducted using PubMed to find relevant articles. We utilized keywords stress fracture, military, recruits, female, risk factors, modifiable, non-modifiable, overuse, nutrition, and/or prevention. Articles older than 10 years (published before 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review. RESULTS Modifiable risk factors for SFx include nutritional deficiency, especially of iron, vitamin D, and possibly calcium, poor physical fitness, suboptimal training programming for injury development and recovery, load carriage, and military footwear. Non-modifiable risk factors include female sex, greater height, lower weight and body mass index in females but lower or higher weight and body mass index in males, lower body fat percentage, and lower bone mineral density. In addition, menstrual dysfunction, low energy availability, later age at menarche, and iron deficiency pose unique risks to female recruits. Preventive measures include leadership education, programs with recovery considerations, and risk factor screening. CONCLUSION This review, Part II of a two-part series, guides multidisciplinary management of military recruits, especially females, who are at risk for developing SFx. Unique nuances of the military recruit require specific knowledge to reduce high incidence rates of injury internationally.
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Affiliation(s)
- Alexandra Abbott
- Department of Pediatrics, University of California, Los Angeles, CA 90095, USA
| | - Cindy Wang
- Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Michaela Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70118, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70118, USA
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Survey on Video-Based Biomechanics and Biometry Tools for Fracture and Injury Assessment in Sports. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This work presents a survey literature review on biomechanics, specifically aimed at the study of existent biomechanical tools through video analysis, in order to identify opportunities for researchers in the field, and discuss future proposals and perspectives. Scientific literature (journal papers and conference proceedings) in the field of video-based biomechanics published after 2010 were selected and discussed. The most common application of the study of biomechanics using this technique is sports, where the most reported applications are american football, soccer, basketball, baseball, jumping, among others. These techniques have also been studied in a less proportion, in ergonomy, and injury prevention. From the revised literature, it is clear that biomechanics studies mainly focus on the analysis of angles, speed or acceleration, however, not many studies explore the dynamical forces in the joints. The development of video-based biomechanic tools for force analysis could provide methods for assessment and prediction of biomechanical force associated risks such as injuries and fractures. Therefore, it is convenient to start exploring this field. A few case studies are reported, where force estimation is performed via manual tracking in different scenarios. This demonstration is carried out using conventional manual tracking, however, the inclusion of similar methods in an automated manner could help in the development of intelligent healthcare, force prediction tools for athletes and/or elderly population. Future trends and challenges in this field are also discussed, where data availability and artificial intelligence models will be key to proposing new and more reliable methods for biomechanical analysis.
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Walker EM, Nelson M, Drew MD, Krammer SM, Brown TN. Tibial compression during sustained walking with body borne load. J Biomech 2022; 133:110969. [PMID: 35144087 PMCID: PMC9020434 DOI: 10.1016/j.jbiomech.2022.110969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/04/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
This study determined if sustained walking with body borne load increases tibial compression, and whether increases in tibial compression are related to vertical GRFs. Thirteen participants had tibial compression and vertical GRF measures quantified while walking at 1.3 m/s for 60 min with body borne load. Each tibial compression (maximum and impulse) and GRF measure (peak, impulse, impact peak and loading rate) were submitted to a RM ANOVA to test the main effect and interaction between load (0, 15, and 30 kg) and time (minute 0, 30 and 60), and correlation analyses determined the relation between tibial compression and vertical GRF measures for each load and time. Each tibial compression and GRF measure increased with the addition of body borne load (all: p < 0.001). Time impacted impact peak (p = 0.034) and loading rate (p = 0.017), but no other GRF or tibial compression measure (p > 0.05). Although both tibial compression and vertical GRFs increased with load, vertical GRF measures exhibited negligible to weak (r: -0.37 to 0.35), and weak to moderate (r: -0.62 to 0.59) relation with maximum and impulse of tibial compression with each body borne load. At each time point, GRF measures exhibited negligible to weak (r: -0.39 to 0.27), and weak to moderate (r: -0.53 to 0.65) relation with maximum and impulse of tibial compression, respectively. Walking with body borne load increased tibial compression, and may place compressive forces on the tibia that lead to stress fracture. But, increases in tibial compression may not stem from concurrent increases in vertical GRFs.
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Affiliation(s)
| | - Miranda Nelson
- Dept. of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, USA
| | - Micah D. Drew
- Dept. of Kinesiology, Boise State University, Boise, ID, USA
| | | | - Tyler N. Brown
- Biomedical Engineering, Boise State University, Boise, ID, USA,Dept. of Kinesiology, Boise State University, Boise, ID, USA
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Krajewski KT, Allen IT, Johnson CC, Dever DE, Ahamed NU, Flanagan SD, Mi Q, Anderst WJ, Connaboy C. Loaded forced-marching shifts mechanical contributions proximally and disrupts stride-to-stride joint work modulation in recruit aged women. Gait Posture 2021; 88:22-27. [PMID: 33957553 DOI: 10.1016/j.gaitpost.2021.04.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Military personnel in combat roles often perform gait tasks with additional load, which can affect the contributions of joint mechanical work (positive and negative). Furthermore, different locomotion patterns can also affect joint specific work contributions. While mean behavior of joint work is important to understanding gait, changes in joint kinetic modulation, or the regulation/control of stride-to-stride joint work variability is necessary to elucidate locomotor system function. Suboptimal modulation exhibited as a stochastic time-series (large fluctuation followed by an opposite smaller fluctuation) could potentially affect locomotion efficiency and portend injury risk. It remains unclear how the locomotor system responds to a combination of load perturbations and varying locomotion patterns. RESEARCH QUESTION What are the interactive effects of load magnitude and locomotion pattern on joint positive/negative work and joint work modulation in healthy, active, recruit-aged women? METHODS Eleven healthy, active, recruit-aged (18-33 years) women ran and forced-marched (walking at a velocity an individual would typically jog) in bodyweight (BW), an additional 25 % of BW (+25 %BW) and an additional 45 % of BW (+45 %BW) conditions at a velocity above their gait transition velocity. Joint work was calculated as the time integral of joint power. Joint work modulation was assessed with detrended fluctuation analysis (DFA) on consecutive joint work time-series. RESULTS Joint work contributions shifted proximally for forced-marching demonstrated by lesser (p < .001) positive/negative ankle work but greater (p = .001) positive hip work contributions compared to running. Running exhibited optimal positive ankle work modulation compared to forced-marching (p = .040). Knee and ankle negative joint work modulation was adversely impacted compared to the hip during forced-marching (p < .001). SIGNIFICANCE Employing forced-marching gait while under loads of 25 and 45 % of BW reduces the ability of the plantar-flexors and knee extensors to optimally contribute to energy absorption and propulsion in recruit-aged women, potentially reducing metabolic efficiency and increasing injury risk.
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Affiliation(s)
- Kellen T Krajewski
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Ian T Allen
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Camille C Johnson
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dennis E Dever
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nizam U Ahamed
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn D Flanagan
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qi Mi
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chris Connaboy
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
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O'Leary TJ, Rice HM, Greeves JP. Biomechanical Basis of Predicting and Preventing Lower Limb Stress Fractures During Arduous Training. Curr Osteoporos Rep 2021; 19:308-317. [PMID: 33635518 DOI: 10.1007/s11914-021-00671-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Stress fractures at weight-bearing sites, particularly the tibia, are common in military recruits and athletes. This review presents recent findings from human imaging and biomechanics studies aimed at predicting and preventing stress fractures. RECENT FINDINGS Peripheral quantitative computed tomography (pQCT) provides evidence that cortical bone geometry (tibial width and area) is associated with tibial stress fracture risk during weight-bearing exercise. The contribution of bone trabecular microarchitecture, cortical porosity, and bone material properties in the pathophysiology of stress fractures is less clear, but high-resolution pQCT and new techniques such as impact microindentation may improve our understanding of the role of microarchitecture and material properties in stress fracture prediction. Military studies demonstrate osteogenic outcomes from high impact, repetitive tibial loading during training. Kinetic and kinematic characteristics may influence stress fracture risk, but there is no evidence that interventions to modify biomechanics can reduce the incidence of stress fracture. Strategies to promote adaptive bone formation, in combination with improved techniques to assess bone strength, present exciting opportunities for future research to prevent stress fractures.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, Hampshire, UK
- Division of Surgery and Interventional Science, UCL, London, UK
| | - Hannah M Rice
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, Hampshire, UK.
- Division of Surgery and Interventional Science, UCL, London, UK.
- Norwich Medical School, University of East Anglia, Norwich, UK.
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11
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Increases in Load Carriage Magnitude and Forced Marching Change Lower-Extremity Coordination in Physically Active, Recruit-Aged Women. J Appl Biomech 2021; 37:343-350. [PMID: 34051696 DOI: 10.1123/jab.2020-0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
The objective was to examine the interactive effects of load magnitude and locomotion pattern on lower-extremity joint angles and intralimb coordination in recruit-aged women. Twelve women walked, ran, and forced marched at body weight and with loads of +25%, and +45% of body weight on an instrumented treadmill with infrared cameras. Joint angles were assessed in the sagittal plane. Intralimb coordination of the thigh-shank and shank-foot couple was assessed with continuous relative phase. Mean absolute relative phase (entire stride) and deviation phase (stance phase) were calculated from continuous relative phase. At heel strike, forced marching exhibited greater (P < .001) hip flexion, knee extension, and ankle plantar flexion compared with running. At mid-stance, knee flexion (P = .007) and ankle dorsiflexion (P = .04) increased with increased load magnitude for all locomotion patterns. Forced marching (P = .009) demonstrated a "stiff-legged" locomotion pattern compared with running, evidenced by the more in-phase mean absolute relative phase values. Running (P = .03) and walking (P = .003) had greater deviation phase than forced marching. Deviation phase increased for running (P = .03) and walking (P < .001) with increased load magnitude but not for forced marching. With loads of >25% of body weight, forced marching may increase risk of injury due to inhibited energy attenuation up the kinetic chain and lack of variability to disperse force across different supportive structures.
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Walsh GS, Low DC. Military load carriage effects on the gait of military personnel: A systematic review. APPLIED ERGONOMICS 2021; 93:103376. [PMID: 33540208 DOI: 10.1016/j.apergo.2021.103376] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
Carrying heavy loads results in biomechanical changes to gait and to an increased risk of injury in soldiers. The aim of this review is to examine the effects of military specific load carriage on the gait of soldiers. The Web of Science, PubMed and CINAHL databases were searched, a total of 1239 records were screened and 20 papers were included in the review. Participant, load and task characteristics and a summary of key findings were extracted. Due to heterogeneity in the reviewed studies, analysis was restricted to qualitative synthesis. There were limited effects on spatio-temporal variables but consistently reported increased trunk, hip and knee flexion and increased hip and knee extension moments. Muscle activation of lower limb and trunk muscles were also increased with loads. However, there were some conflicting findings for most parameters reviewed and apart from spatio-temporal parameters the findings of this review were in line with previous reviews of combined military and civilian populations.
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Affiliation(s)
- Gregory S Walsh
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, OX3 0BP, UK.
| | - Daniel C Low
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, London, UK
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13
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Unnikrishnan G, Xu C, Baggaley M, Tong J, Kulkarni S, Edwards WB, Reifman J. Effects of body size and load carriage on lower-extremity biomechanical responses in healthy women. BMC Musculoskelet Disord 2021; 22:219. [PMID: 33627093 PMCID: PMC7905550 DOI: 10.1186/s12891-021-04076-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal injuries, such as stress fractures, are the single most important medical impediment to military readiness in the U.S. Army. While multiple studies have established race- and sex-based risks associated with a stress fracture, the role of certain physical characteristics, such as body size, on stress-fracture risk is less conclusive. METHODS In this study, we investigated the effects of body size and load carriage on lower-extremity joint mechanics, tibial strain, and tibial stress-fracture risk in women. Using individualized musculoskeletal-finite-element-models of 21 women of short, medium, and tall statures (n = 7 in each group), we computed the joint mechanics and tibial strains while running on a treadmill at 3.0 m/s without and with a load of 11.3 or 22.7 kg. We also estimated the stress-fracture risk using a probabilistic model of bone damage, repair, and adaptation. RESULTS Under all load conditions, the peak plantarflexion moment for tall women was higher than those in short women (p < 0.05). However, regardless of the load condition, we did not observe differences in the strains and the stress-fracture risk between the stature groups. When compared to the no-load condition, a 22.7-kg load increased the peak hip extension and flexion moments for all stature groups (p < 0.05). However, when compared to the no-load condition, the 22.7-kg load increased the strains and the stress-fracture risk in short and medium women (p < 0.05), but not in tall women. CONCLUSION These results show that women of different statures adjust their gait mechanisms differently when running with external load. This study can educate the development of new strategies to help reduce the risk of musculoskeletal injuries in women while running with external load.
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Affiliation(s)
- Ginu Unnikrishnan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Chun Xu
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada.,The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Junfei Tong
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Sahil Kulkarni
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada.,The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.
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Krajewski KT, Dever DE, Johnson CC, Mi Q, Simpson RJ, Graham SM, Moir GL, Ahamed NU, Flanagan SD, Anderst WJ, Connaboy C. Load Magnitude and Locomotion Pattern Alter Locomotor System Function in Healthy Young Adult Women. Front Bioeng Biotechnol 2020; 8:582219. [PMID: 33042981 PMCID: PMC7525027 DOI: 10.3389/fbioe.2020.582219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction During cyclical steady state ambulation, such as walking, variability in stride intervals can indicate the state of the system. In order to define locomotor system function, observed variability in motor patterns, stride regulation and gait complexity must be assessed in the presence of a perturbation. Common perturbations, especially for military populations, are load carriage and an imposed locomotion pattern known as forced marching (FM). We examined the interactive effects of load magnitude and locomotion pattern on motor variability, stride regulation and gait complexity during bipedal ambulation in recruit-aged females. Methods Eleven healthy physically active females (18–30 years) completed 1-min trials of running and FM at three load conditions: no additional weight/bodyweight (BW), an additional 25% of BW (BW + 25%), and an additional 45% of BW (BW + 45%). A goal equivalent manifold (GEM) approach was used to assess motor variability yielding relative variability (RV; ratio of “good” to “bad” variability) and detrended fluctuation analysis (DFA) to determine gait complexity on stride length (SL) and stride time (ST) parameters. DFA was also used on GEM outcomes to calculate stride regulation. Results There was a main effect of load (p = 0.01) on RV; as load increased, RV decreased. There was a main effect of locomotion (p = 0.01), with FM exhibiting greater RV than running. Strides were regulated more tightly and corrected quicker at BW + 45% compared (p < 0.05) to BW. Stride regulation was greater for FM compared to running. There was a main effect of load for gait complexity (p = 0.002); as load increased gait complexity decreased, likewise FM had less (p = 0.02) gait complexity than running. Discussion This study is the first to employ a GEM approach and a complexity analysis to gait tasks under load carriage. Reduction in “good” variability as load increases potentially exposes anatomical structures to repetitive site-specific loading. Furthermore, load carriage magnitudes of BW + 45% potentially destabilize the system making individuals less adaptable to additional perturbations. This is further evidenced by the decrease in gait complexity, which all participants demonstrated values similarly observed in neurologically impaired populations during the BW + 45% load condition.
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Affiliation(s)
- Kellen T Krajewski
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dennis E Dever
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Camille C Johnson
- Biodynamics Laboratory, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qi Mi
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Richard J Simpson
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, United States
| | - Scott M Graham
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Gavin L Moir
- Exercise Science Department, East Stroudsburg University, East Stroudsburg, PA, United States
| | - Nizam U Ahamed
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shawn D Flanagan
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
| | - William J Anderst
- Biodynamics Laboratory, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Chris Connaboy
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States
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Liew BXW, Morris S, Netto K. Trunk-pelvis coordination during load carriage running. J Biomech 2020; 109:109949. [PMID: 32807302 DOI: 10.1016/j.jbiomech.2020.109949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
Understanding the influence of load carriage on trunk-pelvis coordination and its variability has important functional implications for athletes who need to run with load. The aim of this study was to examine the influence of load carriage on trunk-pelvis coordination in running. Thirty healthy adults performed running while wearing a 20% bodyweight backpack, and without load. Vector coding was used to quantify trunk-pelvis segmental coordination and its variability during the stance phase of running. The four coordination patterns were: 1) anti-phase (segments moving in opposite directions), in-phase (segments moving in same directions), trunk-only phase (only trunk movement), and pelvic-only phase (only pelvic movement). For each plane, the percentage of stance phase spent in a specific coordination pattern was quantified. Coordination variability for each plane was averaged over the stance phase. Mixed effects models were used to analyse the effects of load, adjusted for the covariate of sex, on coordination and its variability. Running with load increased trunk-only coordination in the sagittal plane (P < 0.001), increased anti-phase coordination in the frontal plane (P < 0.001), reduced trunk-only phase coordination in axial rotation (P < 0.001), and increased coordination variability in all three planes (Flexion-Extension: P < 0.001; Lateral flexion: P = 0.03; Axial rotation: P < 0.001). Future studies would benefit from investigating how trunk-pelvis coordination and its variability alters candidate end-point variability indices (e.g. COM displacement), and its functional implications in load carriage running.
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Affiliation(s)
- Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex CO4 3SQ, United Kingdom.
| | - Susan Morris
- School of Physiotherapy and Exercise Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Kevin Netto
- School of Physiotherapy and Exercise Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
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