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Wilbert J, Brown S, Weinhandl JT, Tatarski R, Zhang S. Effects of Small and Normalized Q-Factor Changes and Knee Alignment on Knee Biomechanics during Stationary Cycling. Bioengineering (Basel) 2024; 11:879. [PMID: 39329621 PMCID: PMC11428608 DOI: 10.3390/bioengineering11090879] [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: 06/24/2024] [Revised: 07/31/2024] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Increasing inter-pedal distance (Q-Factor: QF) in cycling increases peak internal knee abduction moments (KAbM). The effect of smaller and normalized changes in QF has not been investigated. The purposes of this study were to examine changes in KAbM with small and normalized increases and whether static knee alignment accounts for any changes in knee biomechanics in cycling. Fifteen healthy participants were included (age: 22.7 ± 2.5 years, BMI: 23.95 ± 3.21 kg/m2). Motion capture and instrumented pedals collected kinematic and pedal reaction force (PRF) data, respectively, while participants cycled at five different QFs. Each participant's mechanical axis angle (MAA) was estimated using motion capture. Each participant's QFs were normalized by starting at 160 mm and increasing by 2% of the participant's leg length (L), where the five QF conditions were as follows: QF1 (160), QF2 (160 + 0.02 × L), QF3 (160 + 0.04 × L), QF4 (160 + 0.06 × L), and QF5 (160 + 0.08 × L). A linear mixed model was performed to detect differences between QF conditions. KAbM increased by more than 30% in QF5 from QF1, QF2, QF3, and QF4. Medial PRF increased by at least 20% in QF5 from QF1, QF2, and QF3. MAA had varying degrees of correlation with the variables of interest. These results suggest that KAbM is more sensitive to changes in QF at greater QF increases.
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Affiliation(s)
| | | | | | | | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee-Knoxville, 1914 Andy Holt Avenue, Knoxville, TN 37996, USA
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Wang Y, Mei Q, Jiang H, Hollander K, Van den Berghe P, Fernandez J, Gu Y. The Biomechanical Influence of Step Width on Typical Locomotor Activities: A Systematic Review. SPORTS MEDICINE - OPEN 2024; 10:83. [PMID: 39068296 PMCID: PMC11283446 DOI: 10.1186/s40798-024-00750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Step width is a spatial variable in the frontal plane, defined as the mediolateral distance between the heel (forefoot during sprinting) of bilateral feet at initial contact. Variations in step width may impact the lower limb biomechanics. This systematic review aimed to synthesize the published findings to determine the influence of acute changes in step width on locomotion biomechanics and provide implications for injury prevention and enhanced sports performance. METHODS Literature was identified, selected, and appraised in accordance with the methods of a systematic review. Four electronic databases (Web of Science, MEDLINE via PubMed, Scopus, and ScienceDirect) were searched up until May 2023 with the development of inclusion criteria based on the PICO model. Study quality was assessed using the Downs and Black checklist and the measured parameters were summarized. RESULTS Twenty-three articles and 399 participants were included in the systematic review. The average quality score of the 23 studies included was 9.39 (out of 14). Step width changed the kinematics and kinetics in the sagittal, frontal, and transverse planes of the lower limb, such as peak rearfoot eversion angle and moment, peak hip adduction angle and moment, knee flexion moment, peak knee internal rotation angle, as well as knee external rotation moment. Alteration of step width has the potential to change the stability and posture during locomotion, and evidence exists for the immediate biomechanical effects of variations in step width to alter proximal kinematics and cues to impact loading variables. CONCLUSION Short-term changes in step width during walking, running, and sprinting influenced multiple lower extremity biomechanics. Narrower step width may result in poor balance and higher impact loading on the lower extremities during walking and running and may limit an athlete's sprint performance. Increasing step width may be beneficial for injury rehabilitation, i.e., for patients with patellofemoral pain syndrome, iliotibial band syndrome or tibial bone stress injury. Wider steps increase the supporting base and typically enhance balance control, which in turn could reduce the risks of falling during daily activities. Altering the step width is thus proposed as a simple and non-invasive treatment method in clinical practice.
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Affiliation(s)
- Yuan Wang
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China
- Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Qichang Mei
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China.
- Research Academy of Grand Health, Ningbo University, Ningbo, China.
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
| | - Hanhui Jiang
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China
- Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | | | - Justin Fernandez
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China
- Research Academy of Grand Health, Ningbo University, Ningbo, China
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China.
- Research Academy of Grand Health, Ningbo University, Ningbo, China.
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
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Zou J, Zhang X, Zhang Y, Jin Z. Prediction of medial knee contact force using multisource fusion recurrent neural network and transfer learning. Med Biol Eng Comput 2024; 62:1333-1346. [PMID: 38182944 DOI: 10.1007/s11517-023-03011-w] [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: 06/21/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
Estimation of knee contact force (KCF) during gait provides essential information to evaluate knee joint function. Machine learning has been employed to estimate KCF because of the advantages of low computational cost and real-time. However, the existing machine learning models do not adequately consider gait-related data's temporal-dependent, multidimensional, and highly heterogeneous nature. This study is aimed at developing a multisource fusion recurrent neural network to predict the medial condyle KCF. First, a multisource fusion long short-term memory (MF-LSTM) model was established. Then, we developed a transfer learning strategy based on the MF-LSTM model for subject-specific medial KCF prediction. Four subjects with instrumented tibial prostheses were obtained from the literature. The results showed that the MF-LSTM model could predict medial KCF to a certain high level of accuracy (the mean of ρ = 0.970). The transfer learning model improved the prediction accuracy (the mean of ρ = 0.987). This study shows that the MF-LSTM model is a powerful and accurate computational tool for medial KCF prediction. Introducing transfer learning techniques could further improve the prediction performance for the target subject. This coupling strategy can help clinicians accurately estimate and track joint contact forces in real time.
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Affiliation(s)
- Jianjun Zou
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Xiaogang Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China.
| | - Yali Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Zhongmin Jin
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
- School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
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Zou J, Zhang X, Zhang Y, Li J, Jin Z. Prediction on the medial knee contact force in patients with knee valgus using transfer learning approaches: Application to rehabilitation gaits. Comput Biol Med 2022; 150:106099. [PMID: 36150250 DOI: 10.1016/j.compbiomed.2022.106099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/21/2022] [Accepted: 09/10/2022] [Indexed: 11/03/2022]
Abstract
The Knee contact force (KCF) is a key factor in evaluating knee joint function of patients with knee osteoarthritis. In vivo measurement of KCF based on the instrumented implants is limited due to the ethical issues and technical complexities. Machine learning can be used to predict tibiofemoral compartment contact forces. However, anthropometric differences between individuals make the accurate predictions challenging. The purpose of this study was to develop transfer learning models to predict the medial KCF of patients with knee valgus in rehabilitation gaits. Four subjects with instrumented tibial prostheses were considered, including one with knee valgus and three with normal knee joint alignment. Two transfer learning models were proposed: a fine-tuning model and an adaptive model. In particular, a synchronization method for extracting experimental data in a complete gait cycle was developed, since different types of experimental data have different sampling frequencies. The transfer learning models were pre-trained by the experiment data of patients with normal knee joint alignment, and re-trained by the data of the patient with knee valgus. Predictions of the transfer learning models and traditional machine learning model were validated against the in vivo measurements. The proposed transfer learning models were tested within two levels: the single subject (Level 1) and multiple subjects (Level 2). The results show that the two transfer learning models could more accurately predict the medial KCF of patients with knee valgus than the traditional machine learning model. The performance of the fine-tuning model is better than that of the adaptive model. Compared with the traditional machine learning and inverse dynamics analysis, transfer learning represents a much easier and more accurate method. It can be introduced to help clinicians validate and adjust the rehabilitation gait for specific patients.
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Affiliation(s)
- Jianjun Zou
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Xiaogang Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China.
| | - Yali Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Junyan Li
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Zhongmin Jin
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, China; School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710049, China; School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
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Medial and Lateral Tibiofemoral Compressive Forces in Patients Following Unilateral Total Knee Arthroplasty During Stationary Cycling. J Appl Biomech 2022; 38:179-189. [PMID: 35588765 DOI: 10.1123/jab.2020-0324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022]
Abstract
Patients following unilateral total knee arthroplasty (TKA) display interlimb differences in knee joint kinetics during gait and more recently, stationary cycling. The purpose of this study was to use musculoskeletal modeling to estimate total, medial, and lateral tibiofemoral compressive forces for patients following TKA during stationary cycling. Fifteen patients of unilateral TKA, from the same surgeon, participated in cycling at 2 workrates (80 and 100 W). A knee model (OpenSim 3.2) was used to estimate total, medial, and lateral tibiofemoral compressive forces for replaced and nonreplaced limbs. A 2 × 2 (limb × workrate) and a 2 × 2 × 2 (compartment × limb × workrate) analysis of variance were run on the selected variables. Peak medial tibiofemoral compressive force was 23.5% lower for replaced compared to nonreplaced limbs (P = .004, G = 0.80). Peak medial tibiofemoral compressive force was 48.0% greater than peak lateral tibiofemoral compressive force in nonreplaced limbs (MD = 344.5 N, P < .001, G = 1.6) with no difference in replaced limbs (P = .274). Following TKA, patients have greater medial compartment loading on their nonreplaced compared to their replaced limbs and ipsilateral lateral compartment loading. This disproportionate loading may be cause for concern regarding exacerbating contralateral knee osteoarthritis.
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Bennett HJ, Valenzuela KA, Sievert ZA, Haegele JA. Lower extremity coordination during walking in persons who are blind and sighted controls: A preliminary report. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2022. [DOI: 10.1177/0264619620941892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Walking is the most common mode of physical activity for individuals who are blind. However, this population tends to be physically inactive, possibly due to alterations in coordination patterns during walking. Therefore, the purpose of this study was to examine lower extremity coordination patterns during walking in persons who are blind, and age-, sex-, and body mass index–matched sighted controls. Five persons who are blind performed level walking independently (with a cane) and with a human guide. Sighted controls walked at matched speeds for both conditions. A 10-camera motion capture system was used to record segmental kinematics during both walking conditions. Angle–angle plots and modified vector coding was used to present inter-limb (left/right thigh) and intra-limb (ankle–hip, ankle–knee, and knee–hip) couplings across both walking conditions for each group. Frequency of coupling patterns was compared between groups using Mann–Whitney’s U tests. Inter- and intra-limb coordination patterns were similar between both groups during independent and guided walking conditions (all p > .05). Angle–angle plots depict reduced segmental and joint motion in persons who are blind compared with sighted controls. Although the visual feedback system is integral for coordination during complex tasks, persons who are blind perform level walking with similar lower extremity coordination patterns to sighted controls. Reductions in spatiotemporal and range of motion are likely linked to a more hesitant stepping pattern due to unfamiliarity with the environment.
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Bennett HJ, Ringleb SI, Bobzien J, Haegele JA. Are Gait Biomechanics Related to Physical Activity Engagement? An Examination of Adolescents with ASD. Med Sci Sports Exerc 2021; 54:447-455. [PMID: 34628448 DOI: 10.1249/mss.0000000000002810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Adolescents with autism spectrum disorder (ASD) rarely meet physical activity (PA) guidelines, thus not reaping associated health benefits. Although many barriers exist, abnormal or inefficient gait biomechanics could negatively impact engagement in PA. This study has two purposes: first, to compare total body mechanical work between adolescents with ASD and neurotypical age, sex, and body mass index matched controls, and second to determine whether gait biomechanics are significantly related to engagement in PA. METHODS Twenty-five adolescents (age 13-18 years) with ASD and seventeen neurotypical controls (eight with ASD had no match) participated in the study. Three-dimensional motion capture and force platforms were used to record and analyze gait biomechanics at self-selected speeds and a standardized 1.3 m/s. Total body mechanical work (sum of joint works across lower extremity, low back, torso, and shoulders) was compared between groups (n = 17 for each) and speeds using a mixed model analysis of variance. Average daily light (LPA), moderate to vigorous (MVPA), and total PA was recorded for the entire dataset with ASD using triaxial accelerometers worn for one week. Regression analyses were performed between work, stride time variability, speed, and stride length with each PA variable. RESULTS Adolescents with ASD generated 9% more work compared to the controls (p=0.016). Speed and stride length were significant regressors of LPA, MVPA, and total PA, explaining greater than 0.20 variance (p<0.02 for all regressions). CONCLUSION Although adolescents with ASD walked with significantly greater work, the complex full-body variable is not significantly related to engagement in PA. In agreement with research spanning multiple populations and ages, speed and stride length are indicative of PA engagement in adolescents with ASD.
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Affiliation(s)
- Hunter J Bennett
- Department of Human Movement Sciences Department of Mechanical & Aerospace Engineering Department of Communication Disorders & Special Education, Old Dominion University, Norfolk, VA
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Walking lower extremity biomechanics of adolescents with autism spectrum disorder. J Biomech 2021; 119:110332. [PMID: 33677230 DOI: 10.1016/j.jbiomech.2021.110332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/29/2021] [Accepted: 02/12/2021] [Indexed: 11/23/2022]
Abstract
Although the literature indicates children with autism spectrum disorder (ASD) walk at slower speeds and altered kinematics compared to neurotypical controls, no research has examined walking at matched speeds. This study examined biomechanical differences between adolescents with ASD and matched (age, sex, and body mass index) neurotypical controls. Lower extremity biomechanics of seventeen adolescents with ASD and seventeen controls were compared at matched speeds: self-selected and a standardized 1.3 m/s. Controls exhibited greater eversion angles and hip abduction moments compared to those with ASD. This study found adolescents, which may have a more mature gait than young children, walk with a similar pattern in the propulsive plane (i.e. sagittal) as neurotypical controls, but with alterations in the supportive plane (i.e. frontal).
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Bennett HJ, Valenzuela KA, Lynn SK, Weinhandl JT. Foot Rotation Gait Modifications Affect Hip and Ankle, But Not Knee, Stance Phase Joint Reaction Forces During Running. J Biomech Eng 2021; 143:021001. [PMID: 32734282 DOI: 10.1115/1.4047994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Indexed: 07/25/2024]
Abstract
Alterations of foot rotation angles have successfully reduced external knee adduction moments during walking and running. However, reductions in knee adduction moments may not result in reductions in knee joint reaction forces. The purpose of this study was to examine the effects of internal and external foot rotation on knee, hip, and ankle joint reaction forces during running. Motion capture and force data were recorded of 19 healthy adults running at 3.35 m/s during three conditions: (1) preferred (normal) and with (2) internal and (3) external foot rotation. Musculoskeletal simulations were performed using opensim and the Rajagopal 2015 model, modified to a two degree-of-freedom knee joint. Muscle excitations were derived using static optimization, including muscle physiology parameters. Joint reaction forces (i.e., the total force acting on the joints) were computed and compared between conditions using one-way analyses of variance (ANOVAs) via statistical parametric mapping (SPM). Internal foot rotation reduced resultant hip forces (from 18% to 23% stride), while external rotation reduced resultant ankle forces (peak force at 20% stride) during the stance phase. Three-dimensional and resultant knee joint reaction forces only differed at very early and very late stance phase. The results of this study indicate, similar to previous findings, that reductions in external knee adduction moments do not mirror reductions in knee joint reaction forces.
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Affiliation(s)
- Hunter J Bennett
- Department of Human Movement Sciences, 2016 Student Recreation Center, Old Dominion University, Norfolk, VA 23529
| | - Kevin A Valenzuela
- Department of Kinesiology, HHS2-203, California State University, Long Beach, CA 90840
| | - Scott K Lynn
- Department of Kinesiology, KHS 224, California State University, Fullerton, CA 92834
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, 322 HPER Building, Knoxville, TN 37996-2700
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Increased Q-factor increases medial compartment knee joint contact force during cycling. J Biomech 2021; 118:110271. [PMID: 33567380 DOI: 10.1016/j.jbiomech.2021.110271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/09/2021] [Accepted: 01/16/2021] [Indexed: 11/24/2022]
Abstract
As Q-Factor (QF: inter-pedal distance) is increased, the internal knee abduction moment (KAbM) also increases, however it is unknown if this increased KAbM is associated with increased medial compartment knee joint contact force in cycling. In the absence of in vivo measurement, musculoskeletal modeling simulations may provide a viable option for estimating knee joint contact forces in cycling. The primary purpose of this study was to investigate the effect of increasing QF on knee joint total (TCF), and medial (MCF) compartment contact force during ergometer cycling. The secondary purpose was to evaluate whether KAbM and knee extension moment are accurate predictors of MCF in cycling. Musculoskeletal simulations were performed to estimate TCF and MCF for sixteen participants cycling at an original QF (150 mm), and wide QF (276 mm), at 80 W and 80 rotations per minute. Paired samples t-tests were used to detect differences between QF conditions. MCF increased significantly, however, TCF did not change at wide QF. Peak knee extensor muscle force did not change at wide QF. Peak knee flexor muscle force was significantly reduced with wide QF. Regression analyses showed KAbM and knee extension moments explained 87.4% of the variance in MCF when considered alongside QF. The increase of MCF may be attributed to increased frontal-plane pedal reaction force moment arm. Future research may seek to implement QF modulation as a part of rehabilitation or training procedures utilizing cycling in cases where medial compartment joint loading is of importance.
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Moltó IN, Albiach JP, Amer-Cuenca JJ, Segura-Ortí E, Gabriel W, Martínez-Gramage J. Wearable Sensors Detect Differences between the Sexes in Lower Limb Electromyographic Activity and Pelvis 3D Kinematics during Running. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6478. [PMID: 33198427 PMCID: PMC7697594 DOI: 10.3390/s20226478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022]
Abstract
Each year, 50% of runners suffer from injuries. Consequently, more studies are being published about running biomechanics; these studies identify factors that can help prevent injuries. Scientific evidence suggests that recreational runners should use personalized biomechanical training plans, not only to improve their performance, but also to prevent injuries caused by the inability of amateur athletes to tolerate increased loads, and/or because of poor form. This study provides an overview of the different normative patterns of lower limb muscle activation and articular ranges of the pelvis during running, at self-selected speeds, in men and women. METHODS 38 healthy runners aged 18 to 49 years were included in this work. We examined eight muscles by applying two wearable superficial electromyography sensors and an inertial sensor for three-dimensional (3D) pelvis kinematics. RESULTS the largest differences were obtained for gluteus maximus activation in the first double float phase (p = 0.013) and second stance phase (p = 0.003), as well as in the gluteus medius in the second stance phase (p = 0.028). In both cases, the activation distribution was more homogeneous in men and presented significantly lower values than those obtained for women. In addition, there was a significantly higher percentage of total vastus medialis activation in women throughout the running cycle with the median (25th-75th percentile) for women being 12.50% (9.25-14) and 10% (9-12) for men. Women also had a greater range of pelvis rotation during running at self-selected speeds (p = 0.011). CONCLUSIONS understanding the differences between men and women, in terms of muscle activation and pelvic kinematic values, could be especially useful to allow health professionals detect athletes who may be at risk of injury.
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Affiliation(s)
- Iván Nacher Moltó
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, 46113 Valencia, Spain; (J.J.A.-C.); (E.S.-O.); (J.M.-G.)
| | - Juan Pardo Albiach
- Embedded Systems and Artificial Intelligence Group, Universidad Cardenal Herrera-CEU, CEU Universities, 46113 Alfara del Patriarca, Spain;
| | - Juan José Amer-Cuenca
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, 46113 Valencia, Spain; (J.J.A.-C.); (E.S.-O.); (J.M.-G.)
| | - Eva Segura-Ortí
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, 46113 Valencia, Spain; (J.J.A.-C.); (E.S.-O.); (J.M.-G.)
| | - Willig Gabriel
- Laboratorio de Investigaciones Biomecánicas, Cátedra de Anatomía Funcional y Biomecánica, Universidad de Buenos Aires, Buenos Aires 1107, Argentina;
| | - Javier Martínez-Gramage
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, 46113 Valencia, Spain; (J.J.A.-C.); (E.S.-O.); (J.M.-G.)
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Sample DW, Thorsen TA, Weinhandl JT, Strohacker KA, Zhang S. Effects of Increased Step-Width on Knee Biomechanics During Inclined and Declined Walking. J Appl Biomech 2020; 36:292-297. [PMID: 32781436 DOI: 10.1123/jab.2019-0298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 05/18/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate effects of preferred step width and increased step width modification on knee biomechanics of obese and healthy-weight participants during incline and decline walking. Seven healthy-weight participants and 6 participants who are obese (body mass index ≥ 30) performed 5 walking trials on level ground and a 10° inclined and declined instrumented ramp system at both preferred and wide step-widths. A 2 × 2 (step-width × group) mixed-model analysis of variance was used to examine selected variables. There were significant increases in step-width between the preferred and wide step-width conditions for all 3 walking conditions (all P < .001). An interaction was found for peak knee extension moment (P = .048) and internal knee abduction moment (KAM) (P = .025) in uphill walking. During downhill walking, there were no interaction effects. As step-width increased, KAM was reduced (P = .007). In level walking, there were no interaction effects for peak medial ground reaction force and KAM (P = .007). There was a step-width main effect for KAM (P = .007). As step-width increased, peak medial ground reaction force and peak knee extension moment increased, while KAM decreased for both healthy weight and individuals who are obese. The results suggest that increasing step-width may be a useful strategy for reducing KAM in healthy and young populations.
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Influence of the initial foot contact strategy on knee joint moments during stair and ramp descent. Sci Rep 2020; 10:13922. [PMID: 32811865 PMCID: PMC7435172 DOI: 10.1038/s41598-020-70933-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022] Open
Abstract
Gait modification strategies are effective in reducing knee joint loads, which are associated with the development and progression of knee osteoarthritis (OA). However, the effect of modification of the initial foot contact method in high-loading descending task was not investigated. Here, we show that the initial foot contact strategy significantly alters knee joint moments during descending tasks. We found that the second peak flexion moment was lower for the forefoot strike (FFS) than for the rearfoot strike (RFS) in both stair and ramp descent. As for the peak adduction moment, the second peak was lower for the FFS in stair descent, but two peaks were inconsistent in ramp descent. Our results demonstrate that the knee joint loads can be reduced by simple modification of the initial foot contact strategy. In both descending modalities, the FFS may benefit people with early OA in the patellofemoral joint, whose progression is associated with the peak flexion moment. Likewise, the FFS during stair descent may benefit people with early OA in the medial knee, whose progression is associated with the peak adduction moment. The results would be helpful for prevention and rehabilitation programmes of knee OA.
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Wang S, Mo S, Chung RCK, Shull PB, Ribeiro DC, Cheung RTH. How foot progression angle affects knee adduction moment and angular impulse in people with and without medial knee osteoarthritis: a meta-analysis. Arthritis Care Res (Hoboken) 2020; 73:1763-1776. [PMID: 33242375 DOI: 10.1002/acr.24420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate effects of foot progression angle (FPA) modification on the first and second peaks of external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) in individuals with and without medial knee osteoarthritis (OA) during level walking. METHODS PubMed, Embase, CINAHL, Web of Science and SPORTDiscus were searched from inception to February 2020 by two independent reviewers. Included studies compared FPA modification (toe-in or toe-out gait) interventions to lower EKAM and/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI. RESULTS Sixteen studies were included and more than 85% of included patients were graded with Kellgren-Lawrence II-IV knee OA. Toe-in gait reduced the first EKAM peak (standard mean difference (SMD): -0.75; 95%CI: -1.05~-0.45) and KAAI (SMD: -0.46; 95%CI: -0.86~-0.07), while toe-out gait reduced the second EKAM peak (SMD: -1.04; 95%CI: -1.34~-0.75) in healthy individuals. For patients with knee OA, toe-out gait reduced the second EKAM peak (SMD: -0.53; 95%CI: -0.75~-0.31) and KAAI (SMD: -0.26; 95%CI: -0.49~-0.03) while toe-in gait did not affect both EKAM peaks and KAAI. CONCLUSION Discrepancy in biomechanical effects of FPA modification was demonstrated between individuals with and without medial knee OA. Compared with natural walking, both toe-in and toe-out gait may be more effective in lowering EKAM and KAAI in healthy individuals. Toe-out gait may reduce EKAM and KAAI in patients with mild to severe knee OA. There is insufficient data from patients with early-stage knee OA, indicating future research is required.
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Affiliation(s)
- Sizhong Wang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Shiwei Mo
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Division of Sports Science and Physical Education, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Peter B Shull
- State Key Laboratory of Mechanical Systems and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Roy T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,School of Health Sciences, Western Sydney University, NSW, Australia, Penrith South
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15
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Hummer E, Murphy E, Suprak DN, Brilla L, San Juan JG. The effects of a standard elliptical vs. a modified elliptical with a converging footpath on lower limb kinematics and muscle activity. J Sports Sci 2020; 38:2382-2389. [PMID: 32600126 DOI: 10.1080/02640414.2020.1786241] [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] [Indexed: 10/24/2022]
Abstract
Elliptical trainers that increase the inter-pedal distance may have potential benefits for knee osteoarthritis by decreasing the amount of knee varus. Modifying elliptical trainers with a converging footpath and reduced inter-pedal distance may be beneficial for reducing anterior knee pathology risk by decreasing knee valgus angles. Twenty-one college students participated in a single testing session. Participants exercised on two different elliptical trainers, one modified with a converging footpath and reduced inter-pedal width, and a standard elliptical trainer. Participants exercised for 2 min at three ramps incline at 120 strides per minute and constant work rate. Three-dimensional kinematics and electromyography of the dominant lower limb were recorded. Multiple 2 × 3 (Elliptical x Incline) ANOVAs with Bonferroni corrections were used to compare the two elliptical trainers at each incline for kinematics and muscle activity. The modified elliptical trainer displayed significantly decreased peak knee valgus (p = 0.031, η p 2 = 0.234 ), peak knee flexion (p = 0.006, η p 2 = 0.246 ), and interactions for peak knee flexion (p = 0.001, η p 2 = 0.250 ) and vastus lateralis (p < 0.01, η p 2 = 0.380 ) muscle activity compared to the standard elliptical trainer. The decreased peak knee valgus and flexion angles could be beneficial for reducing long-term injury risk for anterior knee pathologies.
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Affiliation(s)
- Erik Hummer
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee , Knoxville, TN, USA
| | - Eryn Murphy
- Department of Kinesiology & Dance, New Mexico State University , Las Cruces, NM, USA
| | - David N Suprak
- Department of Health and Human Development, Western Washington University , Bellingham, WA, USA
| | - Lorrie Brilla
- Department of Health and Human Development, Western Washington University , Bellingham, WA, USA
| | - Jun G San Juan
- Department of Health and Human Development, Western Washington University , Bellingham, WA, USA
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16
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Byrnes SK, Kunic D, Rethwilm R, Böhm H, Horstmann T, Dussa CU. Compensatory mechanisms in children with idiopathic lower extremity internal rotational malalignment during walking and running. Gait Posture 2020; 79:46-52. [PMID: 32344359 DOI: 10.1016/j.gaitpost.2020.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Noticeable in-toeing gait is present in most children with internal rotational malalignment and often a reason to consult an orthopedic specialist. The risk of tripping may be higher for these patients. RESEARCH QUESTION The aim of this study was to determine compensatory mechanisms adopted by children with internal rotational deformities to avoid tripping and falling during walking and running. METHODS Sixty-nine patients between 5-18 years with idiopathic internal rotational malalignment were retrospectively included and subdivided into three groups: 18 patients with internal tibial torsion (ITT), 25 patients with internal femoral torsion (ITF) and 26 patients with both (ITB). Twenty-two typically developing age-matched children (TD) were analyzed for comparison. Three-dimensional gait data were evaluated. ANOVA's on two factors, group (ITT, ITF, ITB, TD) and movement (walking, running) with post-hoc t-tests were used to identify significant differences between groups. RESULTS All groups had significantly greater step width than TD during walking (P ≤ .002) and all torsional groups had significantly greater step width during running (P ≤ .001). Similarly, all torsional groups showed greater peak ankle dorsiflexion in swing during running than TD (P ≤ .006). Only the ITT group showed significantly greater external hip rotation than TD. When compared to TD, the ITF and ITB group had a significantly lower hip abduction moment in stance during running, but not for walking (P ≤ .032). SIGNIFICANCE Compensatory mechanisms in children with internal rotational deformities were mostly dependent on the location of rotational malalignment. All children with internal rotational malalignment had greater ankle dorsiflexion and greater step width during running. Especially in active patients, this greater ankle dorsiflexion during running may result in overuse of the ankle dorsiflexor muscles, while greater step width may have beneficial effects in normalizing knee adduction moments.
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Affiliation(s)
- S Kimberly Byrnes
- Orthopedic Children's Hospital, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229, Aschau im Chiemgau, Germany; Department of Sports and Health Sciences, Institute for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Germany.
| | - Demir Kunic
- Orthopedic Children's Hospital, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229, Aschau im Chiemgau, Germany
| | - Roman Rethwilm
- Orthopedic Children's Hospital, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229, Aschau im Chiemgau, Germany
| | - Harald Böhm
- Orthopedic Children's Hospital, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229, Aschau im Chiemgau, Germany
| | - Thomas Horstmann
- Department of Sports and Health Sciences, Institute for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Germany; Medical Park St. Hubertus Klinik, Bad Wiessee, Germany
| | - Chakravarthy U Dussa
- Orthopedic Children's Hospital, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229, Aschau im Chiemgau, Germany
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Thorsen T, Strohacker K, Weinhandl JT, Zhang S. Increased Q-Factor increases frontal-plane knee joint loading in stationary cycling. JOURNAL OF SPORT AND HEALTH SCIENCE 2020; 9:258-264. [PMID: 32444150 PMCID: PMC7242219 DOI: 10.1016/j.jshs.2019.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND Q-Factor (QF), or the inter-pedal width, in cycling is similar to step-width in gait. Although increased step-width has been shown to reduce peak knee abduction moment (KAbM), no studies have examined the biomechanical effects of increased QF in cycling at different workrates in healthy participants. METHODS A total of 16 healthy participants (8 males, 8 females, age: 22.4 ± 2.6 years, body mass index: 22.78 ± 1.43 kg/m2, mean ± SD) participated. A motion capture system and customized instrumented pedals were used to collect 3-dimensional kinematic (240 Hz) and pedal reaction force (PRF) (1200 Hz) data in 12 testing conditions: 4 QF conditions-Q1 (15.0 cm), Q2 (19.2 cm), Q3 (23.4 cm), and Q4 (27.6 cm)-under 3 workrate conditions-80 watts (W), 120 W, and 160 W. A 3 × 4 (QF × workrate) repeated measures of analysis of variance were performed to analyze differences among conditions (p < 0.05). RESULTS Increased QF increased peak KAbM by 47%, 56%, and 56% from Q1 to Q4 at each respective workrate. Mediolateral PRF increased from Q1 to Q4 at each respective workrate. Frontal-plane knee angle and range of motion decreased with increased QF. No changes were observed for peak vertical PRF, knee extension moment, sagittal plane peak knee joint angles, or range of motion. CONCLUSION Increased QF increased peak KAbM, suggesting increased medial compartment loading of the knee. QF modulation may influence frontal-plane joint loading when using stationary cycling for exercise or rehabilitation purposes.
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Affiliation(s)
- Tanner Thorsen
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Kelley Strohacker
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN 37996, USA.
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Bennett HJ, Valenzuela KA, Fleenor K, Weinhandl JT. A Normative Database of Hip and Knee Joint Biomechanics During Dynamic Tasks Using Four Functional Methods With Three Functional Calibration Tasks. J Biomech Eng 2020; 142:041011. [PMID: 31513696 DOI: 10.1115/1.4044503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 12/13/2022]
Abstract
Although predicted hip joint center (HJC) locations are known to vary widely between functional methods, no previous investigation has detailed functional method-dependent hip and knee biomechanics. The purpose of this study was to define a normative database of hip joint biomechanics during dynamic movements based upon functional HJC methods and calibration tasks. Thirty healthy young adults performed arc, star arc, and two-sided calibration tasks. Motion capture and ground reaction forces were collected during walking, running, and single-leg landings (SLLs). Two sphere-fit (geometric and algebraic) and two coordinate transformation techniques were implemented using each calibration (12 total method-calibration combinations). Surprisingly, the geometric fit-two-sided model placed the HJC at the midline of the pelvis and above the iliac spines, and thus was removed from analyses. A database of triplanar hip and knee kinematics and hip moments and powers was constructed using the mean of all subjects for the eleven method-calibration combinations. A nested analysis of variance approach compared calibration [method] peak hip kinematics and kinetics. Most method differences existed between geometric fit and coordinate transformations (58 of 84 total). No arc-star arc differences were found. Thirty-two differences were found between the two-sided and arc/star arc calibrations. This database of functional method based hip and knee biomechanics serves as an important reference point for interstudy comparisons. Overall, this study illustrates that functional HJC method can dramatically impact hip biomechanics and should be explicitly detailed in future work.
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Affiliation(s)
- Hunter J Bennett
- Department of Human Movement Sciences, Old Dominion University, 2016 Student Recreation Center, Norfolk, VA 23529
| | - Kevin A Valenzuela
- Department of Kinesiology, HHS2-203, California State University Long Beach, Long Beach, CA 90840
| | - Kristina Fleenor
- Department of Human Movement Sciences, Old Dominion University, 2016 Student Recreation Center, Norfolk, VA 23529
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, 322 HPER Building, 1914 Andy Holt Avenue, Knoxville, TN 37996-2700
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19
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Influence of foot progression angle on knee adduction and flexion moment during stair climbing in healthy individuals. Gait Posture 2019; 71:163-169. [PMID: 31071539 DOI: 10.1016/j.gaitpost.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/31/2019] [Accepted: 03/15/2019] [Indexed: 02/02/2023]
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20
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A normative database of hip and knee joint biomechanics during dynamic tasks using anatomical regression prediction methods. J Biomech 2018; 81:122-131. [DOI: 10.1016/j.jbiomech.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022]
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21
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Li Y, Bian J, Chen D, Jiang B, Zheng P, Lou Y. Reverse-Shoe Wearing Method for Treating Toe-In Gait in Children Can Lead to Hallux Valgus. Med Sci Monit 2018; 24:6157-6164. [PMID: 30180153 PMCID: PMC6134890 DOI: 10.12659/msm.909072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to compare the effect of 2 methods for treating toe-in gait in children (reverse-shoe wearing and orthopedic insoles) and to determine whether reverse-shoe wearing results in hallux valgus. Material/Methods Between July 2012 and July 2014, 337 children diagnosed with toe-in gait over 2 years were recruited. For 139 children, parents selected use of reverse-shoe wearing treatment (RS group) and for 198 children, parents selected orthopedic insoles treatment (OI group). There were 98 children in the RS group and 167 in the OI group who completed the 12-month therapy and follow-up. We excluded 28 children who failed to complete the study, and 44 children who ceased treatment within the first month were selected as controls. Patients were assessed for up to 24 months after the cessation of treatment. Foot progression angle (FPA) and presence and degree of hallux valgus angle (HVA) were recorded. Results FPA was significantly reduced after 6 months in both RS and OI groups (P<0.05). FPA returned to almost normal after 12 months of treatment, with no significant difference between the 2 groups. There were 29 cases (51 feet) of hallux valgus in the RS group after 12-month treatment; the HVA had significantly declined by 2 years after treatment with normal shoe wearing but did not return to normal. Conclusions Corrective treatment should be used with children diagnosed with toe-in gait over 2 years showing no remission. Both reverse-shoe wearing and orthopedic insoles show similar levels of treatment success, but reverse-shoe wearing has a significant adverse effect of hallux valgus.
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Affiliation(s)
- Yong Li
- Department of Pediatric Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jun Bian
- Department of Pediatric Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Dan Chen
- Department of Pediatric Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Bo Jiang
- Department of Pediatric Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Pengfei Zheng
- Department of Pediatric Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yue Lou
- Department of Pediatric Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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Hunt MA, Charlton JM, Krowchuk NM, Tse CTF, Hatfield GL. Clinical and biomechanical changes following a 4-month toe-out gait modification program for people with medial knee osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage 2018; 26:903-911. [PMID: 29709498 DOI: 10.1016/j.joca.2018.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare changes in knee pain, function, and loading following a 4-month progressive walking program with or without toe-out gait modification in people with medial tibiofemoral knee osteoarthritis. DESIGN Individuals with medial knee osteoarthritis were randomized to a 4-month program to increase walking activity with (toe-out) or without (progressive walking) concomitant toe-out gait modification. The walking program was similar between the two groups, except that the gait modification group was trained to walk with 15° more toe-out. Primary outcomes included: knee joint pain (WOMAC), foot progression angles and knee joint loading during gait (knee adduction moment (KAM)). Secondary outcomes included WOMAC function, timed stair climb, and knee flexion moments during gait. RESULTS Seventy-nine participants (40 in toe-out group, 39 in progressive walking group) were recruited. Intention-to-treat analysis showed no between-group differences in knee pain, function, or timed stair climb. However, the toe-out group exhibited significantly greater changes in foot progression angle (mean difference = -9.04° (indicating more toe-out), 95% CI: -11.22°, -6.86°; P < 0.001), late stance KAM (mean difference = -0.26 %BW*ht, 95% CI: -0.39 %BW*ht, -0.12 %BW*ht, P < 0.001) and KAM impulse (-0.06 %BW*ht*s, 95% CI: -0.11 %BW*ht*s, -0.01 %BW*ht*s; P = 0.031) compared to the progressive walking group at follow-up. The only between-group difference that remained at a 1-month retention assessment was foot progression angle, with greater changes in the toe-out group (mean difference = -6.78°, 95% CI: -8.82°, -4.75°; P < 0.001). CONCLUSIONS Though both groups experienced improvements in self-reported pain and function, only the toe-out group experienced biomechanical improvements. TRIALS REGISTRY NUMBER NCT02019108.
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Affiliation(s)
- M A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - J M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - N M Krowchuk
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - C T F Tse
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - G L Hatfield
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Department of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada.
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