Dynamic loading on the human musculoskeletal system -- effect of fatigue

Does exhaustion modify acceleration running signature?

Previous studies have demonstrated the acceleration signal presents a typical running signature, which allows for the extraction of reliable information. However, few studies have focused on the exhaustion-induced variability of the acceleration signature during running. The present study included 10 participants who ran at a constant speed on a treadmill until exhaustion. The participants were equipped with three accelerometers, located at the lumbar spine, tibia, and foot. The results showed that all the participants kept a constant pace throughout the test (coefficient of variation <5%). Similarities between acceleration signatures were observed using the coefficient of multiple correlation. For the longitudinal axis of the lumbar spine, the longitudinal axis of the tibia, and the anteroposterior axis of the tibia, running signatures were not affected by exhaustion (coefficient of multiple correlation >0.8). For all the other axes, the signature was impacted within and between the states of exhaustion. Signatures were particularly different for the foot sensors, which makes it difficult to use to extract reliable information. The results showed that the coefficient of multiple correlation allowed the quantification of the variability of the running signature, and that each axis and measuring point varied in how they were influenced by exhaustion.

Effect of Weighted Vest at 0%, 5% and 10% of Body Mass on Gasometry Biomarkers and Performance during a Rectangular Test in Trained Trail Runners

Trail runners (TRs) must carry an extra load of equipment, food (bars and gels) and liquids, to delay the anticipation of fatigue and dehydration during their competitions. Therefore, we aimed to evaluate how an extra load can influence the metabolic level. Thirteen well-trained trail runners performed a randomized crossover study (total n = 39), completing three treadmill running sessions with a weighted vest of 0%, 5% and 10% of their body mass during a combined test (rectangular test + ramp test). In addition, biomarkers of oxygen metabolism, acid-base and electrolyte status pre-, during and post-test, as well as the rectangular from capillary blood of the finger and time to exhaustion, were analyzed. Repeated-measures ANOVA showed no significant difference between conditions for any of the analyzed biomarkers of blood gas. However, one-way ANOVA showed a significant difference in trial duration between conditions (p ≤ 0.001). Tukey's post hoc analysis observed a significant decrease in time to exhaustion in the weighted vest of 10% compared to 0% (p ≤ 0.001) and 5% (p ≤ 0.01) and 5% compared to 0% (p = 0.030). In addition, repeated-measures ANOVA detected a significant difference in pH in the group x time interaction (p = 0.035). Our results show that increasing the weighted vest (5% and 10%) anticipates fatigue in runners trained in TR. In addition, increasing the load decreased pH by a smaller magnitude at 10% compared to 0% and 5% at the end of the exercise protocol.

Kinematics but not kinetics alterations to single-leg drop jump movements following a subject-tailored fatiguing protocol suggest an increased risk of ACL injury

Introduction

Neuromuscular fatigue causes a transient reduction of muscle force, and alters the mechanisms of motor control. Whether these alterations increase the risk of anterior cruciate ligament (ACL) injury is still debated. Here we compare the biomechanics of single-leg drop jumps before and after the execution of a fatiguing exercise, evaluating whether this exercise causes biomechanical alterations typically associated with an increased risk of ACL lesion. The intensity of the fatiguing protocol was tailored to the aerobic capacity of each participant, minimizing potential differential effects due to inter-individual variability in fitness.

Methods

Twenty-four healthy male volunteers performed single leg drop jumps, before and after a single-set fatiguing session on a cycle ergometer until exhaustion (cadence: 65-70 revolutions per minute). For each participant, the intensity of the fatiguing exercise was set to 110% of the power achieved at their anaerobic threshold, previously identified by means of a cardiopulmonary exercise test. Joint angles and moments, as well as ground reaction forces (GRF) before and after the fatiguing exercise were compared for both the dominant and the non-dominant leg.

Results

Following the fatiguing exercise, the hip joint was more extended (landing: Δ=-2.17°, p = 0.005; propulsion: Δ=-1.83°, p = 0.032) and more abducted (landing: Δ=-0.72°, p = 0.01; propulsion: Δ=-1.12°, p = 0.009). Similarly, the knee joint was more extended at landing (non-dominant leg: Δ=-2.67°, p < 0.001; dominant: Δ=-1.4°, p = 0.023), and more abducted at propulsion (both legs: Δ=-0.99°, p < 0.001) and stabilization (both legs: Δ=-1.71°, p < 0.001) hence increasing knee valgus. Fatigue also caused a significant reduction of vertical GRF upon landing (Δ=-0.21 N/kg, p = 0.003), but not during propulsion. Fatigue did not affect joint moments significantly.

Conclusion

The increased hip and knee extension, as well as the increased knee abduction we observed after the execution of the fatiguing exercise have been previously identified as risk factors for ACL injury. These results therefore suggest an increased risk of ACL injury after the execution of the participant-tailored fatiguing protocol proposed here. However, the reduced vertical GRF upon landing and the preservation of joint moments are intriguing, as they may suggest the adoption of protective strategies in the fatigued condition to be evaluated in future studied.

Quantification of daily workload, energy expenditure, and sleep of US Marine recruits throughout a 10-week boot camp

BACKGROUND

During periods of high-volume vigorous exercise, United States Marine Corps recruits often experience musculoskeletal injuries. While the program of instruction (POI) for basic training is a defined training volume, the total workload of boot camp, including movements around the base, is unknown.

OBJECTIVE

The present study aimed to quantify the daily total workload, energy expenditure, and sleep during basic recruit training at Marine Corps Recruit Depot (MCRD) San Diego.

METHODS

Eighty-four male recruits from MCRD San Diego wore wrist wearable physiological monitors to capture their complete workload (mileage from steps), energy expenditure, and sleep throughout the 10-week boot camp.

RESULTS

Marine recruits traveled an average of 11.5±3.4 miles per day (M±SD), expended 4105±823 kcal per day, and slept an average of 5 : 48±1 : 06 hours and minutes per night. While the POI designates a total of 46.3 miles of running and hiking, the actual daily average miles yielded approximately 657.6±107.2 miles over the 10-week boot camp.

CONCLUSION

Recruit training requires high physical demand and time under tension due to the cumulative volume of movements around base in addition to the POI planned physical training.

Use of subject-specific models to detect fatigue-related changes in running biomechanics: a random forest approach

Running biomechanics are affected by fatiguing or prolonged runs. However, no evidence to date has conclusively linked this effect to running-related injury (RRI) development or performance implications. Previous investigations using subject-specific models in running have demonstrated higher accuracy than group-based models, however, this has been infrequently applied to fatigue. In this study, two experiments were conducted to determine whether subject-specific models outperformed group-based models to classify running biomechanics during non-fatigued and fatigued conditions. In the first experiment, 16 participants performed four treadmill runs at or around the maximal lactate steady state. In the second experiment, nine participants performed five prolonged runs using commercial wearable devices. For each experiment, two segments were extracted from each trial from early and late in the run. For each participant, a random forest model was applied with a leave-one-run-out cross-validation to classify between the early (non-fatigued) and late (fatigued) segments. Additionally, group-based classifiers with a leave-one-subject-out cross validation were constructed. For experiment 1, mean classification accuracies for the single-subject and group-based classifiers were 68.2 ± 8.2% and 57.0 ± 8.9%, respectively. For experiment 2, mean classification accuracies for the single-subject and group-based classifiers were 68.9 ± 17.1% and 61.5 ± 11.7%, respectively. Variable importance rankings were consistent within participants, but these rankings differed from each participant to those of the group. Although the classification accuracies were relatively low, these findings highlight the advantage of subject-specific classifiers to detect changes in running biomechanics with fatigue and indicate the potential of using big data and wearable technology approaches in future research to determine possible connections between biomechanics and RRI.

Effects of level running-induced fatigue on running kinematics: A systematic review and meta-analysis

BACKGROUND

Runners have a high risk of acquiring a running-related injury. Understanding the mechanisms of impact force attenuation into the body when a runner fatigues might give insight into the role of running kinematics on the aetiology of overuse injuries.

RESEARCH QUESTIONS

How do running kinematics change due to running-induced fatigue? And what is the influence of experience level on changes in running kinematics due to fatigue?

METHODS

Three electronic databases were searched: PubMed, Web of Science, and Scopus. This resulted in 33 articles and 19 kinematic quantities being included in this review. A quality assessment was performed on all included articles and meta-analyses were performed for 18 kinematic quantities.

RESULTS AND SIGNIFICANCE

Main findings included an increase in peak acceleration at the tibia and a decrease in leg stiffness after a fatiguing protocol. Additionally, level running-induced fatigue increased knee flexion at initial contact and maximum knee flexion during swing. An increase in vertical centre of mass displacement was found in novice but not in experienced runners with fatigue. Overall, runners changed their gait pattern due to fatigue by moving to a smoother gait pattern (i.e. more knee flexion at initial contact and during swing, decreased leg stiffness). However, these changes were not sufficient to prevent an increase in peak accelerations at the tibia after a fatigue protocol. Large inter-individual differences in responses to fatigue were reported. Hence, it is recommended to investigate changes in running kinematics as a result of fatigue on a subject-specific level since group-level analysis might mask individual responses.

Running-induced fatigue and impact loading in runners: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to synthesise and clarify the effect of running-induced fatigue on impact loading during running. Eight electronic databases were systematically searched until April 2021. Studies that analysed impact loading over the course of a run, in adult runners free of medical conditions were included. Changes in leg stiffness, vertical stiffness, shock attenuation, peak tibial accelerations, peak ground reaction forces (GRF) and loading rates were extracted. Subgroup analyses were conducted depending on whether participants were required to run to exhaustion. Thirty-six studies were included in the review, 25 were included in the meta-analysis. Leg stiffness decreased with running-induced fatigue (SMD -0.31, 95% CI -0.52, -0.08, moderate evidence). Exhaustive and non-exhaustive subgroups were different for peak tibial acceleration (Chi² = 3.79, p = 0.05), with limited evidence from exhaustive subgroups showing an increase in peak tibial acceleration with fatigue. Findings for vertical GRF impact peak and peak braking force were conflicting based on exhaustive and non-exhaustive protocols (Chi² = 3.83, p = 0.05 and Chi² = 5.10, p = 0.02, respectively). Moderate evidence suggests leg stiffness during running decreases with fatigue. Given the non-linear relationship between leg stiffness and running economy, this may have implications for performance.

Between-Day Reliability of Commonly Used IMU Features during a Fatiguing Run and the Effect of Speed

The purpose of this study was to determine if fatigue-related changes in biomechanics derived from an inertial measurement unit (IMU) placed at the center of mass (CoM) are reliable day-to-day. Sixteen runners performed two runs at maximal lactate steady state (MLSS) on a treadmill, one run 5% above MLSS speed, and one run 5% below MLSS speed while wearing a CoM-mounted IMU. Trials were performed to volitional exhaustion or a specified termination time. IMU features were derived from each axis and the resultant. Feature means were calculated for each subject during non-fatigued and fatigued states. Comparisons were performed between the two trials at MLSS and between all four trials. The only significant fatigue state × trial interaction was the 25th percentile of the results when comparing all trials. There were no main effects for trial for either comparison method. There were main effects for fatigue state for most features in both comparison methods. Reliability, measured by an intraclass coefficient (ICC), was good-to-excellent for most features. These results suggest that fatigue-related changes in biomechanics derived from a CoM-mounted IMU are reliable day-to-day when participants ran at or around MLSS and are not significantly affected by slight deviations in speed.

Effects of Central and Peripheral Fatigue on Impact Characteristics during Running

Fatigue and impact can represent an injury risk factor during running. The objective of this study was to compare the impact transmission along the locomotor system between the central and peripheral fatigued states during running. Tibial and head acceleration as well as shock attenuation in the time- and frequency-domain were analyzed during 2-min of treadmill running in the pre- and post-fatigue state in eighteen male popular runners (N = 18). The impact transmission was measured before and after a 30-min central fatigue protocol on the treadmill or a peripheral fatigue protocol in the quadricep and hamstring muscles using an isokinetic dynamometer. The time-domain acceleration variables were not modified either by peripheral or central fatigue (p > 0.05). Nevertheless, central fatigue increased the maximum (p = 0.006) and total (p = 0.007) signal power magnitude in the high-frequency range in the tibia, and the attenuation variable in the low- (p = 0.048) and high-frequency area (p = 0.000), while peripheral fatigue did not cause any modifications in the frequency-domain variables (p > 0.05). Furthermore, the attenuation in the low (p = 0.000)- and high-frequency area was higher with central fatigue than peripheral fatigue (p = 0.003). The results demonstrate that central fatigue increases the severity of impact during running as well as the attenuation of low and high components.

Changes in segment coordination variability and the impacts of the lower limb across running mileages in half marathons: Implications for running injuries

BACKGROUND

Segment coordination variability (CV) is a movement pattern associated with running-related injuries. It can also be adversely affected by a prolonged run. However, research on this topic is currently limited. The purpose of this study was to investigate the effects of a prolonged run on segment CV and vertical loading rates during a treadmill half marathon.

METHODS

Fifteen healthy runners ran a half marathon on an instrumental treadmill in a biomechanical laboratory. Synchronized kinematic and kinetic data were collected every 2 km (from 2 km until 20 km), and the data were processed by musculoskeletal modeling. Segment CVs were computed from the angle-angle plots of selected pelvis-thigh, thigh-shank, and shank-rearfoot couplings using a modified vector coding technique. The loading rate of vertical ground reaction force was also calculated. A one-way MANOVA with repeated measures was performed on each of the outcome variables to examine the main effect of running mileage.

RESULTS

Significant effects of running mileage were found on segment CVs (p ≤ 0.010) but not on loading rate (p = 0.881). Notably, during the early stance phase, the CV of pelvis frontal vs. thigh frontal was significantly increased at 20 km compared with the CV at 8 km (g = 0.59, p = 0.022). The CV of shank transverse vs. rearfoot frontal decreased from 2 km to 8 km (g = 0.30, p = 0.020) but then significantly increased at both 18 km (g = 0.05, p < 0.001) and 20 km (g = 0.36, p < 0.001).

CONCLUSION

At the early stance, runners maintained stable CVs on the sagittal plane, which could explain the unchanged loading rate throughout the half marathon. However, increased CVs on the frontal/transverse plane may be an early sign of fatigue and indicative of possible injury risk. Further studies are necessary for conclusive statements in this regard.

Effects of various walking intensities on leg muscle fatigue and plantar pressure distributions

Background

Physical activity may benefit health and reduce risk for chronic complications in normal and people with diabetes and peripheral vascular diseases. However, it is unclear whether leg muscle fatigue after weight-bearing physical activities, such as brisk walking, may increase risk for plantar tissue injury. In the literature, there is no evidence on the effect of muscle fatigue on plantar pressure after various walking intensities. The objectives of this study were to investigate the effects of various walking intensities on leg muscle fatigue and plantar pressure patterns.

Methods

A 3 × 2 factorial design, including 3 walking speeds (1.8 (slow and normal walking), 3.6 (brisk walking), and 5.4 (slow running) mph) and 2 walking durations (10 and 20 min) for a total of 6 walking intensities, was tested in 12 healthy participants in 3 consecutive weeks. The median frequency and complexity of electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius medialis (GM) were used to quantify muscle fatigue. Fourier transform was used to compute the median frequency and multiscale entropy was used to calculate complexity of EMG signals. Peak plantar pressure (PPP) values at the 4 plantar regions (big toe, first metatarsal head, second metatarsal head, and heel) were calculated.

Results

Two-way ANOVA showed that the walking speed (at 1.8, 3.6, 5.4 mph) significantly affected leg muscle fatigue, and the duration factor (at 10 and 20 min) did not. The one-way ANOVA showed that there were four significant pairwise differences of the median frequency of TA, including walking speed of 1.8 and 3.6 mph (185.7 ± 6.1 vs. 164.9 ± 3.0 Hz, P = 0.006) and 1.8 and 5.4 mph (185.7 ± 6.1 vs. 164.5 ± 5.5 Hz, P = 0.006) for the 10-min duration; and walking speed of 1.8 and 3.6 mph (180.0 ± 5.9 vs. 163.1 ± 4.4 Hz, P = 0.024) and 1.8 and 5.4 mph (180.0 ± 5.9 vs. 162.8 ± 4.9 Hz, P = 0.023) for the 20-min duration. The complexity of TA showed a similar trend with the median frequency of TA. The median frequency of TA has a significant negative correlation with PPP on the big toe ( r = -0.954, P = 0.003) and the first metatarsal head ( r = -0.896, P = 0.016).

Conclusions

This study demonstrated that brisk walking and slow running speeds (3.6 and 5.4 mph) cause an increase in muscle fatigue of TA compared to slow walking speed (1.8 mph); and the increased muscle fatigue is significantly related to a higher PPP.

Biomechanical Response of the Lower Extremity to Running-Induced Acute Fatigue: A Systematic Review

Objective: To investigate (i) typical protocols used in research on biomechanical response to running-induced fatigue, (ii) the effect of sport-induced acute fatigue on the biomechanics of running and functional tests, and (iii) the consistency of analyzed parameter trends across different protocols.

Methods: Scopus, Web of Science, Pubmed, and IEEE databases were searched using terms identified with the Population, Interest and Context (PiCo) framework. Studies were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and appraised using the methodological index for non-randomized studies MINORS scale. Only experimental studies with at least 10 participants, which evaluated fatigue during and immediately after the fatiguing run were included. Each study was summarized to record information about the protocol and parameter trends. Summary trends were computed for each parameter based on the results found in individual studies.

Results: Of the 68 included studies, most were based on in-lab (77.9%) protocols, endpoint measurements (75%), stationary measurement systems (76.5%), and treadmill environment (54.4%) for running. From the 42 parameters identified in response to acute fatigue, flight time, contact time, knee flexion angle at initial contact, trunk flexion angle, peak tibial acceleration, CoP velocity during balance test showed an increasing behavior and cadence, vertical stiffness, knee extension force during MVC, maximum vertical ground reaction forces, and CMJ height showed a decreasing trend across different fatigue protocols.

Conclusion: This review presents evidence that running-induced acute fatigue influences almost all the included biomechanical parameters, with crucial influence from the exercise intensity and the testing environment. Results indicate an important gap in literature caused by the lack of field studies with continuous measurement during outdoor running activities. To address this gap, we propose recommendations for the use of wearable inertial sensors.

Plantar Pressure Variability and Asymmetry in Elderly Performing 60-Minute Treadmill Brisk-Walking: Paving the Way towards Fatigue-Induced Instability Assessment Using Wearable In-Shoe Pressure Sensors

Evaluation of potential fatigue for the elderly could minimize their risk of injury and thus encourage them to do more physical exercises. Fatigue-related gait instability was often assessed by the changes of joint kinematics, whilst planar pressure variability and asymmetry parameters may complement and provide better estimation. We hypothesized that fatigue condition (induced by the treadmill brisk-walking task) would lead to instability and could be reflected by the variability and asymmetry of plantar pressure. Fifteen elderly adults participated in the 60-min brisk walking trial on a treadmill without a pause, which could ensure that the fatigue-inducing effect is continuous and participants will not recover halfway. The plantar pressure data were extracted at baseline, the 30th minute, and the 60th minute. The median of contact time, peak pressure, and pressure-time integrals in each plantar region was calculated, in addition to their asymmetry and variability. After 60 min of brisk walking, there were significant increases in peak pressure at the medial and lateral arch regions, and central metatarsal regions, in addition to their impulses (p < 0.05). In addition, the variability of plantar pressure at the medial arch was significantly increased (p < 0.05), but their asymmetry was decreased. On the other hand, the contact time was significantly increased at all plantar regions (p < 0.05). The weakened muscle control and shock absorption upon fatigue could be the reason for the increased peak pressure, impulse, and variability, while the improved symmetry and prolonged plantar contact time could be a compensatory mechanism to restore stability. The outcome of this study can facilitate the development of gait instability or fatigue assessment using wearable in-shoe pressure sensors.

Influence of Prolonged Running and Training on Tibial Acceleration and Movement Quality in Novice Runners

CONTEXT

Changes in lower limb loading and movement quality after prolonged running and training periods might influence injury risks in runners.

OBJECTIVES

To assess (1) the effects of a single prolonged run and a 3-week running training program on peak tibial acceleration (PTA) during running and Functional Movement Screen (FMS) criterion tests, and (2) the relationship between running volume during the 3-week training program and changes in PTA and FMS scores after training.

DESIGN

Case series.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Ten novice runners (age = 27 ± 7 years) with 15 ± 14 months of running experience, who ran on average 19.6 ± 4.8 km per week at a preferred pace of 7:05 ± 1:30 minutes per km.

MAIN OUTCOME MEASURE(S)

Participants completed a 30-minute submaximal prolonged treadmill run and 3-week training program with 25% increases in weekly running volume. Peak tibial acceleration and the deep-squat and active straight-leg-raise criterion FMS test scores were assessed before and after the prolonged run at enrollment and after the training program (ie, 3 testing sessions).

RESULTS

No differences in PTA or FMS scores were observed among the 3 testing times. Although the changes in PTA (r = 0.57) and FMS aggregate score (r = 0.15) were not significantly correlated with training volume, training volume explained 32% of the variance in the PTA change from before to after training.

CONCLUSIONS

Our findings suggest that tibial acceleration and movement quality were not influenced by a single submaximal-effort prolonged run or a 3-week training period. However, novice runners who have a greater increase in running volume might be more susceptible to training-related changes in tibial acceleration than those whose running volume is less.

Validating Wearable Sensors Using Self-Reported Instability among Patients with Knee Osteoarthritis

BACKGROUND

Self-perceived instability among patients with knee osteoarthritis (OA) is defined as giving way, buckling, or shifting of the knee during activities, especially walking. Although instability is a leading cause of mobility decline with knee OA, methods for quantifying the symptom, determining the mechanisms, and establishing effective interventions remain unclear. Recently, data outputs (ie, linear acceleration and its time-derivative, jerk) from wearable sensors are showing strong associations with self-perceived instability among patients with other knee pathologies and may offer insight into OA-related instability.

OBJECTIVE

To examine discriminant and convergent validity of using data outputs from wearable sensors to quantify self-reported instability among patients with knee OA.

DESIGN

Secondary analysis of a cross-sectional study.

SETTING

Primary recruitment from an institutional outpatient physical therapy clinic and collection completed in an institutional research laboratory.

PATIENTS

Thirty-nine total participants. The OA group included 26 participants with radiographic evidence of moderate to severe knee OA in the medial compartment; knee pain >3 out of 10, and a walking speed of ≥1.0 m/s. The control group included 13 participants with no history of knee OA. Participants with current or history of low back, hip, or foot/ankle injury; knee replacement; skeletal realignment surgery; or comorbidities that limit walking, pregnancy, and inability to walk without an assistive device were excluded.

INTERVENTIONS

N/A MAIN OUTCOME MEASURES: Data output from wearable sensors at the tibia.

RESULTS

Midstance acceleration (P = .01) and jerk (P = .04) were significantly greater for those with than without knee OA. Acceleration was significantly associated with self-reported instability (Spearman's rho = -0.63, P < .01).

CONCLUSIONS

Data from wearable sensors are a valid measurement for exploring the mechanisms and risks of instability among patients with knee OA.

Effect of running-induced fatigue on lower limb mechanics in novice runners

BACKGROUND

Running-induced fatigue has received much attention in recent years. However, very few studies have investigated the effect of fatigue on lower limb biomechanics in three planes.

OBJECTIVE

This study was designed to investigate biomechanical changes in the lower limb in three planes following running-induced fatigue.

METHODS

Fifteen male novice runners were included in the study and performed three running trails pre- and post-fatigue. Wilcoxon signed-rank tests or paired-sample t tests were used to analyze the data.

RESULTS

Lower limb biomechanics significantly changed, especially kinetic parameters, when fatigue occurred. The peak ankle dorsiflexion angle and range of motion of the knee joint in the frontal plane increased. As for kinetic parameters, in the ankle joint, the peak external rotation moment, peak abduction power and peak internal rotation power increased. In the knee joint, the peak abduction and external rotation moment, peak flexion power, peak adduction and abduction power also increased. In the hip joint, the peak flexion moment was decreased, peak adduction and abduction moment, peak external rotation power, peak adduction and abduction power moment were increased.

CONCLUSION

The findings of this study may contribute to our understanding of the impact of fatigue and provide some helpful information to prevent related injuries.

The effects of military style ruck marching on lower extremity loading and muscular, physiological and perceived exertion in ROTC cadets

Military ruck marching with load carriage increases ground reaction forces, which are related to bone stress injuries (BSI). This study's purpose was to examine whether a ruck march increases impact loading and to describe muscular, physiological and perceived exertion in Army Reserve Officer Training Corps (ROTC) cadets. Secondary purposes examined relationships among loading changes after the ruck march and baseline characteristics. Fifteen Army ROTC cadets performed a 4-mile march. Lower extremity loading and muscular, physiological and perceived exertion were measured pre- and post-march. Results indicated significant increases in peak impact force and loading rate and decreases in ankle dorsiflexion and plantarflexion strength. Factors that might have been related to changes seen in lower extremity loading did not yield any compelling relationships to explain those changes. In conclusion, the ruck march led to increased peak impact force and loading rate, which have been shown to be related to the risk of BSI. Practitioner summary: This study examined ROTC cadets ankle strength and lower extremity loading before and after a ruck march. We found that lower extremity loading increased after the march, and ankle dorsiflexion (DF) strength decreased, despite the cadets not feeling fatigued. These changes are consistent with risk factors for bone stress injuries. Abbreviations: BSI: bone stress injury; ROTC: Reserve Officer Training Corps; PIF: peak impact force; LR: loading rate; RPE: rate of perceived exertion; APFT: Army physical fitness test; DF: dorsiflexors; PF: plantar-flexors; INV: invertors; EV: evertors; HHD: handheld dynamometer; %HRmax: percentage of maximum heart rate.

Can Directed Compliant Running Reduce the Magnitude of Variables Associated With the Development of Running Injuries?

Ó Catháin, CP, Richter, C, and Moran, K. Can directed compliant running reduce the magnitude of variables associated with the development of running injuries? J Strength Cond Res XX(X): 000-000, 2020-Running is one of the most popular modes of activity worldwide and provides numerous health benefits. However, impact forces associated with the foot contacting the ground have been implicated in the development of running related injuries. As such, previous studies have used various methods to alter running to reduce the magnitude of these impact forces. However, it is unclear what kinematic changes facilitate this reduced loading or how loading further up the body changes. In this study, verbal direction was used to teach subjects to run with a more compliant running technique. Kinetic and kinematics characteristics of each subjects "normal" running technique and new "compliant technique" were measured in a fatigued and unfatigued state. Energy expenditure of each running style was also measured. Verbally directed compliant running significantly decreased (17%) vertical ground reaction force impact peaks, sacral (41%) and head (28%) impact accelerations, and increased energy expenditure (21%), in comparison with normal running. Findings suggest that verbally directed compliant running may reduce the magnitude of variables associated with the development of running injuries.

The relationship between ground reaction force components and peak power according to induced fatigue during 16-km walking

The previous reviewed studies on inducement of fatigue through long-time walking were not only very confined, but also not cleared on relationship among variables of fatigue inducement active force, decay rate, and power. This study analyzed relationship between power and component of ground reaction force after fatigue being induced through 16-km walking. The fatigue of adult males and females (n=16) was induced through 16-km walking. Then power, measured for pre and post of fatigue inducement, was evaluated by maximal vertical jump on ground reaction force plate. Variables of vertical jump heights, active force, power, and decay rate showed decreased tendency after fatigue inducement, which followed significant difference (P<0.05) and also positive correlation of r=0.628 (R²=39%) of between vertical jump heights and power and r=0.589 (R²=34%) of between active force and decay rate respectively. That is, long-time walking for pursuing of exercise rehabilitation, health promotion and leisure activity has been preferred. In the view of this, this study suggested the necessity to understand the relation between fatigue and power to prevent a potential possibility of injury during long-time walking.

Kinematics and shock attenuation during a prolonged run on the athletic track as measured with inertial magnetic measurement units

BACKGROUND

Tibial stress fractures are common running related injury and their etiology may include biomechanical factors like impact forces, shock attenuation, lower limb kinematics and how these factors are influenced by intense or prolonged running. Inertial-magnetic measurement units (IMUs) have recently emerged as an alternative to motion capture but their use to date was mostly limited to segmental and joint motion.

RESEARCH QUESTION

The present study sought to examine the effects of a prolonged run on shock attenuation, peak tibial and sacral acceleration (PTA, PSA), and lower limb kinematics using IMUs.

METHODS

Ten trained male runners (31 +/- 5 yr, 183 +/- 3 cm, 76 +/- 9 kg) performed a twenty-minute prolonged run on an athletic track at estimated lactate threshold speed. Eight IMUs, positioned over the feet, lower and uppers legs, sacrum and sternum, were used to calculate joint kinematics, impact parameters and shock attenuation in the time domain (1-(PSA/PTA)*100).

RESULTS

PTA increased while PSA and shock attenuation did not change following the prolonged run. Hip and knee flexion at midstance decreased. Vertical lower leg angle at initial contact did not change.

CONCLUSION

By using IMUs, it was shown that a prolonged run at estimated lactate threshold speed had significant effects on kinematics and tibial acceleration parameters. By modifying hip and knee joint kinematics during stance, the body was able to maintain sacral acceleration possibly by shifting from active shock attenuation to more passive mechanisms.

SIGNIFICANCE

The present study shows that inertial sensors can be used in outdoor running to measure joint kinematics and kinetic parameters like PTA, PSA and shock attenuation simultaneously. The results of this study show new insights into how the body copes with impact during prolonged running.

A time to exhaustion model during prolonged running based on wearable accelerometers

Defining relationships between running mechanisms and fatigue can be a major asset for optimising training. This article proposes a biomechanical model of time to exhaustion according to indicators derived from accelerometry data collected from the body. Ten volunteers were recruited for this study. The participants were equipped with 3 accelerometers: on the right foot, at the tibia and at the L4-L5 lumbar spine. A running test was performed on a treadmill at 13.5 km/h until exhaustion. Thirty-one variables were deployed during the test. Multiple linear regressions were calculated to explain the time to exhaustion from the indicators calculated on the lumbar, tibia and foot individually and simultaneously. Time to exhaustion was predicted for simultaneous measurement points with r 2 = 0.792 and 21 indicators; for the lumbar with r 2 = 0.568 and 11 indicators; for the tibia with r 2 = 558 and 11 indicators; and for the foot with r 2 = 0.626 and 12 indicators. This study allows the accurate modelling of the time to exhaustion during a running-based test using indicators from accelerometer measurements. The individual models highlight that the location of the measurement point is important and that each location provides different information. Future studies should focus on homogeneous populations to improve predictions and errors.

The measurement of tibial acceleration in runners-A review of the factors that can affect tibial acceleration during running and evidence-based guidelines for its use

BACKGROUND

Impact loading in runners, assessed by the measurement of tibial acceleration, has attracted substantial research attention. Due to potential injury links, particularly tibial fatigue fractures, tibial acceleration is also used as a clinical monitoring metric. There are contributing factors and potential limitations that must be considered before widespread implementation.

AIM

The objective of this review is to update current knowledge of the measurement of tibial acceleration in runners and to provide recommendations for those intending on using this measurement device in research or clinical practice.

METHODS

Literature relating to the measurement of tibial acceleration in steady-state running was searched. A narrative approach synthesised the information from papers written in English. A range of literature was identified documenting the selection and placement of accelerometers, the analysis of data, and the effects of intrinsic and extrinsic factors.

RESULTS AND DISCUSSION

Tibial acceleration is a proxy measurement for the impact forces experienced at the tibia commonly used by clinicians and researchers. There is an assumption that this measure is related to bone stress and strain, however this is yet to be proven. Multi-axis devices should be secured firmly to the tibia to limit movement relative to the underlying bone and enable quantification of all components of acceleration. Additional frequency analyses could be useful to provide a more thorough characterisation of the signal.

CONCLUSIONS

Tibial accelerations are clearly affected by running technique, running velocity, lower extremity stiffness, as well as surface and footwear compliance. The interrelationships between muscle pre-activation and fatigue, stiffness, effective mass and tibial acceleration still require further investigation, as well as how changes in these variables impact on injury risk.

Biomechanical approach in facilitating long-distance walking of elderly people using footwear modifications

BACKGROUND

Long-distance walking is a convenient way for prompting physical activity of elderly people. However, walking ability declines with aging.

RESEARCH QUESTION

This study assessed if silicone insoles with heel lifts (named here the prescribed insoles) could facilitate long-distance walking of older adults.

METHODS

Fifteen adults aged over 65, who did not have obvious lower-limb problems, walked on a treadmill for totally 60 min in two separate walking sessions: 1) with the prescribed insoles, and 2) with original insoles of the standardized shoes. Gait tests using force plates and a motion analysis system, and subjective evaluation using visual analog and Borg's CR10 scales were conducted at different time points of the treadmill walking.

RESULTS

Objective gait anaylsis showed that without using the prescribed insoles, there were significant reductions (p < 0.05) in stance time, vertical ground reaction force, ankle dorsiflexion angle and ankle power generation of the dominant leg after the 60-minute treadmill walk. Such significant reductions were not observed in the same group of subjects upon using the prescribed insoles. Meanwhile, significant improvements in subjective perception of physical exertion, pain and fatigue were observed.

SIGNIFICANCE

Heel lifts and silicone insoles are generally used to relieve plantar pain and reduce strain of plantar flexors in patients. This study showed they might also be solutions to facilitate long-distance walking of older adults, an approach which could prompt their physical activity.

Aging may negatively impact movement smoothness during stair negotiation

Stairs represent a barrier to safe locomotion for some older adults, potentially leading to the adoption of a cautious gait strategy that may lack fluidity. This strategy may be characterized as unsmooth; however, stair negotiation smoothness has yet to be quantified. The aims of this study were to assess age- and task-related differences in head and body center of mass (COM) acceleration patterns and smoothness during stair negotiation and to determine if smoothness was associated with the timed "Up and Go" (TUG) test of functional movement. Motion data from nineteen older and twenty young adults performing stair ascent, stair descent, and overground straight walking trials were analyzed and used to compute smoothness based on the log-normalized dimensionless jerk (LDJ) and the velocity spectral arc length (SPARC) metrics. The associations between TUG and smoothness measures were evaluated using Pearson's correlation coefficient (r). Stair tasks increased head and body COM acceleration pattern differences across groups, compared to walking (p < 0.05). LDJ smoothness for the head and body COM decreased in older adults during stair descent, compared to young adults (p ≤ 0.015) and worsened with increasing TUG for all tasks (-0.60 ≤ r ≤ -0.43). SPARC smoothness of the head and body COM increased in older adults, regardless of task (p < 0.001), while correlations showed improved SPARC smoothness with increasing TUG for some tasks (0.33 ≤ r ≤ 0.40). The LDJ outperforms SPARC in identifying age-related stair negotiation adaptations and is associated with performance on a clinical test of gait.

Shock attenuation in the human lumbar spine during walking and running

During locomotion, each step generates a shock wave that travels through the body toward the head. Without mechanisms for attenuation, repeated shocks can lead to pathology. Shock attenuation (SA) in the lower limb has been well studied, but little is known about how posture affects SA in the spine. To test the hypothesis that lumbar lordosis (LL) contributes to SA, 27 adults (14 male, 13 female) walked and ran on a treadmill. Two lightweight, tri-axial accelerometers were affixed to the skin overlying T12/L1 and L5/S1. Sagittal plane accelerations were analyzed using power spectral density analysis, and lumbar SA was assessed within the impact-related frequency range. 3D kinematics quantified dynamic and resting LL. To examine the effects of intervertebral discs on spinal SA, supine MRI scans were used to measure disc morphology. The results showed no association between LL and SA during walking, but LL correlated with SA during running (P<0.01, R²=0.30), resulting in as much as 64% reduction in shock signal power among individuals with the highest LL. Patterns of lumbar spinal motion partially explain differences in SA: larger amplitudes of LL angular displacement and slower angular displacement velocity during running were associated with greater lumbar SA (P=0.008, R²=0.41). Intervertebral discs were associated with greater SA during running (P=0.02, R²=0.22) but, after controlling for disc thickness, LL remained strongly associated with SA (P=0.001, R²=0.44). These findings support the hypothesis that LL plays an important role in attenuating impact shocks transmitted through the human spine during high-impact, dynamic activities such as running.

Shock attenuation, spatio-temporal and physiological parameter comparisons between land treadmill and water treadmill running

PURPOSE

The purpose of this study was to compare shock attenuation, spatio-temporal and physiological parameters during water immersed (depth: anterior superior iliac spine) aquatic treadmill (ATM) running and land based treadmill (LTM) running matched for speed.

METHODS

Six participants completed 15 min running under 2 conditions (LTM and ATM) in a randomised and balanced order, matched for speed. Synchronised tri-axial accelerometers placed at the distal tibia, lumbar region, and forehead were used to identify running dynamics and measure acceleration on impact and its attenuation. Expired respiratory gases and heart rate were sampled on a breath-by-breath basis for physiological variable collection throughout each trial.

RESULTS

Participants experienced reduced accelerations on impact at the distal tibia (p < 0.0001) but not the lower back (p = 0.1363) or forehead (p = 0.0551) during ATM compared to LTM. Consequently, large reductions in shock attenuation occurred during the ATM compared to LTM (p = 0.0001). Stride frequency was greater (p < 0.0001) and stride length was shorter (p = 0.0341) as a result of reduced swing time (p = 0.0201) for LTM, whilst ATM running increased physiological demand for both heart rate (p < 0.0001) and O₂ (p < 0.0001) compared to LTM.

CONCLUSION

These findings show ATM reduces impact stress on the passive structures of the lower limbs whilst increasing physiological demand when running at matched speeds.

Exertion and pain do not alter coordination variability in runners with iliotibial band syndrome

BACKGROUND

Iliotibial band syndrome is a common overuse running injury which results in altered mechanics. While injuries alter discrete mechanics, they may also cause a change in coordination variability, the stride-to-stride organization of runners' movement patterns. Uninjured and injured runners may experience a change in coordination variability during a run to exertion due to fatigue, pain, or a combination of these factors. The aim of the current study was to determine if runners with iliotibial band syndrome and uninjured runners display different segment coordination variability across the course of a run to exertion.

METHODS

3D kinematics were collected as 13 uninjured runners and 12 runners with iliotibial band syndrome ran on a treadmill. A modified vector coding technique was used to calculate coordination variability during stance for segment couples of interest. Coordination variability was compared between uninjured and injured runners at the beginning and end of the run. The influence of pain on coordination variability was also examined.

FINDINGS

There were no differences in coordination variability at the beginning or end of the run between uninjured runners and those with iliotibial band syndrome. The change in coordination variability due to the run was not different between uninjured runners, injured runners who experienced no change in pain, and injured runners who did experience a change in pain.

INTERPRETATION

Runners do not constrain the patterns of segment motion they use in response to exertion nor does it appear that occurrence of pain during running results in a differential change in coordination variability.

Surface effects on dynamic stability and loading during outdoor running using wireless trunk accelerometry

Despite frequently declared benefits of using wireless accelerometers to assess running gait in real-world settings, available research is limited. The purpose of this study was to investigate outdoor surface effects on dynamic stability and dynamic loading during running using tri-axial trunk accelerometry. Twenty eight runners (11 highly-trained, 17 recreational) performed outdoor running on three outdoor training surfaces (concrete road, synthetic track and woodchip trail) at self-selected comfortable running speeds. Dynamic postural stability (tri-axial acceleration root mean square (RMS) ratio, step and stride regularity, sample entropy), dynamic loading (impact and breaking peak amplitudes and median frequencies), as well as spatio-temporal running gait measures (step frequency, stance time) were derived from trunk accelerations sampled at 1024Hz. Results from generalized estimating equations (GEE) analysis showed that compared to concrete road, woodchip trail had several significant effects on dynamic stability (higher AP ratio of acceleration RMS, lower ML inter-step and inter-stride regularity), on dynamic loading (downward shift in vertical and AP median frequency), and reduced step frequency (p<0.05). Surface effects were unaffected when both running level and running speed were added as potential confounders. Results suggest that woodchip trails disrupt aspects of dynamic stability and loading that are detectable using a single trunk accelerometer. These results provide further insight into how runners adapt their locomotor biomechanics on outdoor surfaces in situ.

Effect of the Fatigue Induced by a 110-km Ultramarathon on Tibial Impact Acceleration and Lower Leg Kinematics

Ultramarathon runners are exposed to a high number of impact shocks and to severe neuromuscular fatigue. Runners may manage mechanical stress and muscle fatigue by changing their running kinematics. Our purposes were to study (i) the effects of a 110-km mountain ultramarathon (MUM) on tibial shock acceleration and lower limb kinematics, and (ii) whether kinematic changes are modulated according to the severity of neuromuscular fatigue. Twenty-three runners participated in the study. Pre- and post-MUM, neuromuscular tests were performed to assess knee extensor (KE) and plantar flexor (PF) central and peripheral fatigue, and a treadmill running bouts was completed during which step frequency, peak acceleration, median frequency and impact frequency content were measured from tibial acceleration, as well as foot-to-treadmill, tibia-to-treadmill, and ankle flexion angles at initial contact, and ankle range of motion using video analysis. Large neuromuscular fatigue, including peripheral changes and deficits in voluntary activation, was observed in KE and PF. MVC decrements of ~35% for KE and of ~28% for PF were noted. Among biomechanical variables, step frequency increased by ~2.7% and the ankle range of motion decreased by ~4.1% post-MUM. Runners adopting a non rearfoot strike pre-MUM adopted a less plantarflexed foot strike pattern post-MUM while those adopting a rearfoot strike pre-MUM tended to adopt a less dorsiflexed foot strike pattern post-MUM. Positive correlations were observed between percent changes in peripheral PF fatigue and the ankle range of motion. Peripheral PF fatigue was also significantly correlated to both percent changes in step frequency and the ankle angle at contact. This study suggests that in a fatigued state, ultratrail runners use compensatory/protective adjustments leading to a flatter foot landing and this is done in a fatigue dose-dependent manner. This strategy may aim at minimizing the overall load applied to the musculoskeletal system, including impact shock and muscle stretch.

Fatigue Alters Landing Shock Attenuation During a Single-Leg Vertical Drop Jump

BACKGROUND

Landings in fatigue conditions are considered to be one of the factors that cause noncontact anterior cruciate ligament (ACL) injury. Additionally, it is known that fatigue alters lower extremity landing strategies and decreases the ability to attenuate shock during landing.

PURPOSE

To determine characteristics of knee kinematics and shock attenuation during the landing phase of a single-leg vertical drop jump in a fatigued condition. The hypothesis was that knee kinematics during the landing phase of a single-leg vertical drop jump would demonstrate a significant difference between before and after fatigue.

STUDY DESIGN

Controlled laboratory study.

METHODS

Thirty-four college females participated in this experiment. They were randomly assigned to either the fatigue (n = 17) or control group (n = 17). The fatigue group performed the single-leg vertical drop jump before and after the fatigue protocol, which was performed on a bike ergometer. Knee kinematics data were obtained from the 3-dimensional motion analysis system. The ratio of each variable (%) was calculated, comparing the pre- to postfatigue protocol. Unpaired t tests were used to compare changes in kinematic variables between the fatigue-induced group and control group.

RESULTS

Peak knee flexion angular velocity increased significantly in the fatigue group (106.1% ± 8.0%) in comparison with the control group (100.7% ± 6.6%) (P < .05). However, peak knee flexion angle and acceleration had no differences between each group. Peak knee adduction/abduction angle, velocity, and acceleration also had no differences between each group.

CONCLUSION

Fatigue decreased the ability to attenuate shock by increasing angular velocity in the direction of knee flexion during single-leg drop jump landing. These findings indicate the need to evaluate the ability to attenuate shock by measuring knee flexion angular velocity when fatigue is considered.

CLINICAL RELEVANCE

Measuring knee angular velocity during landings might be an important evaluation parameter in the consideration of the knee injury prevention.

Complex network models reveal correlations among network metrics, exercise intensity and role of body changes in the fatigue process

The aims of the present study were analyze the fatigue process at distinct intensity efforts and to investigate its occurrence as interactions at distinct body changes during exercise, using complex network models. For this, participants were submitted to four different running intensities until exhaustion, accomplished in a non-motorized treadmill using a tethered system. The intensities were selected according to critical power model. Mechanical (force, peak power, mean power, velocity and work) and physiological related parameters (heart rate, blood lactate, time until peak blood lactate concentration (lactate time), lean mass, anaerobic and aerobic capacities) and IPAQ score were obtained during exercises and it was used to construction of four complex network models. Such models have both, theoretical and mathematical value, and enables us to perceive new insights that go beyond conventional analysis. From these, we ranked the influences of each node at the fatigue process. Our results shows that nodes, links and network metrics are sensibility according to increase of efforts intensities, been the velocity a key factor to exercise maintenance at models/intensities 1 and 2 (higher time efforts) and force and power at models 3 and 4, highlighting mechanical variables in the exhaustion occurrence and even training prescription applications.

Mechanical Impedance and Its Relations to Motor Control, Limb Dynamics, and Motion Biomechanics

The concept of mechanical impedance represents the interactive relationship between deformation kinematics and the resulting dynamics in human joints or limbs. A major component of impedance, stiffness, is defined as the ratio between the force change to the displacement change and is strongly related to muscle activation. The set of impedance components, including effective mass, inertia, damping, and stiffness, is important in determining the performance of the many tasks assigned to the limbs and in counteracting undesired effects of applied loads and disturbances. Specifically for the upper limb, impedance enables controlling manual tasks and reaching motions. In the lower limb, impedance is responsible for the transmission and attenuation of impact forces in tasks of repulsive loadings. This review presents an updated account of the works on mechanical impedance and its relations with motor control, limb dynamics, and motion biomechanics. Basic questions related to the linearity and nonlinearity of impedance and to the factors that affect mechanical impedance are treated with relevance to upper and lower limb functions, joint performance, trunk stability, and seating under dynamic conditions. Methods for the derivation of mechanical impedance, both those for within the system and material-structural approaches, are reviewed. For system approaches, special attention is given to methods aimed at revealing the correct and sufficient degree of nonlinearity of impedance. This is particularly relevant in the design of spring-based artificial legs and robotic arms. Finally, due to the intricate relation between impedance and muscle activity, methods for the explicit expression of impedance of contractile tissue are reviewed.

Foot posture, leg length discrepancy and low back pain--their relationship and clinical management using foot orthoses--an overview

Mechanical low back pain (LBP) is a very common, expensive, and significant health issue in the western world. Functional musculoskeletal conditions are widely thought to cause mechanical low back pain. The role of foot posture and leg length discrepancy in contributing to abnormal biomechanics of the lumbopelvic region and low back pain is not sufficiently investigated. This critical review examines the evidence for the association between foot function, particularly pronation, and mechanical LBP. It also explores the evidence for a role for foot orthoses in the treatment of this condition. There is a body of evidence to support the notion that foot posture, particularly hyperpronation, is associated with mechanical low back pain. Mechanisms that have been put forward to account for this finding are based on either mechanical postural changes or alterations in muscular activity in the lumbar and pelvic muscles. More research is needed to explore and quantify the effects of foot orthoses on chronic low back pain, especially their effects on lumbopelvic muscle function and posture. The clinical implications of this work are significant since foot orthoses represent a simple and potentially effective therapeutic measure for a clinical condition of high personal and social burden.

Low-frequency accelerations over-estimate impact-related shock during walking

During gait, a failure to acknowledge the low-frequency component of a segmental acceleration signal will result in an overestimation of impact-related shock and may lead to inappropriately drawn conclusions. The present study was undertaken to investigate the significance of this low-frequency component in two distinctly different modalities of gait: barefoot (BF) and shod (SHOD) walking. Twenty-seven participants performed five walking trials at self-selected speed in each condition. Peak positive accelerations (PPA) at the shank and spine were first derived from the time-domain signal. The raw acceleration signals were then resolved in the frequency-domain and the active (low-frequency) and impact-related components of the power spectrum density (PSD) were quantified. PPA was significantly higher at the shank (P<0.0001) and spine (P=0.0007) in the BF condition. In contrast, no significant differences were apparent between conditions for shank (P=0.979) or spine (P=0.178) impact-related PSD when the low-frequency component was considered. This disparity between approaches was due to a significantly higher active PSD in both signals in the BF condition (P<0.0001; P=0.008, respectively), due to kinematic differences between conditions (P<0.05). These results indicate that the amplitude of the low-frequency component of an acceleration signal during gait is dependent on knee and ankle joint coordination behaviour, and highlight that impact-related shock is more accurately quantified in the frequency-domain following subtraction of this component.

The effects of load carriage and muscle fatigue on lower-extremity joint mechanics

Military personnel are commonly afflicted by lower-extremity overuse injuries. Load carriage and muscular fatigue are major stressors during military basic training.

PURPOSE

To examine effects of load carriage and muscular fatigue on lower-extremity joint mechanics during walking.

METHOD

Eighteen men performed the following tasks: unloaded walking, walking with a 32-kg load, fatigued walking with a 32-kg load, and fatigued walking. After the second walking task, muscle fatigue was elicited through a fatiguing protocol consisting of metered step-ups and heel raises with a 16-kg load. Each walking task was performed at 1.67 m x s(-1) for 5 min. Walking movement was tracked by a VICON motion capture system at 120 Hz. Ground reaction forces were collected by a tandem force instrumented treadmill (AMTI) at 2,400 Hz. Lower-extremity joint mechanics were calculated in Visual 3D.

RESULTS

There was no interaction between load carriage and fatigue on lower-extremity joint mechanics (p > .05). Both load carriage and fatigue led to pronounced alterations of lower-extremity joint mechanics (p < .05). Load carriage resulted in increases of pelvis anterior tilt, hip and knee flexion at heel contact, and increases of hip, knee, and ankle joint moments and powers during weight acceptance. Muscle fatigue led to decreases of ankle dorsiflexion at heel contact, dorsiflexor moment, and joint power at weight acceptance. In addition, muscle fatigue increased demand for hip extensor moment and power at weight acceptance.

CONCLUSION

Statistically significant changes in lower-extremity joint mechanics during loaded and fatigued walking may expose military personnel to increased risk for overuse injuries.

Effects of heel lifting on transtibial amputee gait before and after treadmill walking: a case study

BACKGROUND

Prosthetic alignment is usually unchanged once optimized. However, a previous study indicated that long-distance walking significantly altered gait patterns, suggesting some alignment adjustments after walking are required. This study investigated the effects of alignment changes (by inserting a heel lift) on gait of a transtibial amputee before and after treadmill walking.

CASE DESCRIPTION AND METHODS

The subject walked, without heel lifts, on a treadmill until perception of fatigue. Gait changes upon heel lifting at the prosthetic side were studied before and after the treadmill walking

FINDINGS AND OUTCOMES

For this subject before the treadmill walking, heel lifting induced drop-off with increased prosthetic-side knee flexion at mid-stance and pre-swing. The sound limb outreached to stabilize the gait. After the treadmill walking, the same heel lift did not induce drop-off. It reduced the plantar flexor power generation, potentially delaying its fatigue.

CONCLUSION

After walking prosthetic-side heel lifting could be beneficial.

CLINICAL RELEVANCE

Many lower-limb amputees have difficulties in long-distance walking due to muscle fatigue. This case study proposes that appropriate alignment changes after some walking potentially relieve fatigue and encourage them to walk longer distances.

Effects of long-distance walking on socket-limb interface pressure, tactile sensitivity and subjective perceptions of trans-tibial amputees

PURPOSE

Many trans-tibial amputees could not tolerate long-distance walking. Lack of walking could explain for the increased cardiovascular diseases mortality rate. This study investigated the effects of long-distance walking (LDW) on socket-limb interface pressure, tactile sensitivity of the residual limb, and subjective feedbacks, which potentially identified the difficulties in LDW.

METHOD

Five male unilateral trans-tibial amputees walked on a level treadmill for a total of one hour at comfortable speed. Tactile sensitivity of the residual limb and socket-limb interface pressure during over-ground walking were measured before and after the treadmill walking. Modified Prosthesis Evaluation Questionnaires were also administered.

RESULTS

After the treadmill walking, the socket-limb interface pressure and the tactile sensitivity at the popliteal depression area were significantly reduced. This corresponds well with the questionnaire results showing that the level of discomfort and pain of the residual limb did not increase. The questionnaire revealed that there were significant increases in fatigue level at the sound-side plantar flexors, which could lead to impaired dynamic stability.

CONCLUSIONS

Fatigue of sound-side plantar-flexor was the main difficulty faced by the five subjects when walking long-distances. This finding might imply the importance of refining prosthetic components and rehabilitation protocols in reducing the muscle fatigue.

IMPLICATIONS FOR REHABILITATION

• After long-distance walking (LDW) of the trans-tibal amputee subjects, there were significant increases in fatigue level at the plantar flexors. These might explain the reduced walking stability as perceived by the subjects. • LDW did not produce any problems in residual-limb comfort and pain feeling. These were in line with the significant reductions of socket-limb interface pressure and the tactile sensitivity at the popliteal depression after LDW. • Refinements of prosthetic components and rehabilitation protocols should be attempted to reduce the fatigue of the plantar flexors and facilitate LDW.

Long-distance walking effects on trans-tibial amputees compensatory gait patterns and implications on prosthetic designs and training

Trans-tibial amputees are advised to walk as much as able people to achieve healthy and independent life. However, they usually have difficulties in doing so. Previous researches only included data from a few steps when studying the gait of amputees. Walking over a long distance was rarely examined. The objective of this study was to investigate the changes in spatial-temporal, kinetic and kinematic gait parameters of trans-tibial amputees after long-distance walking. Six male unilateral trans-tibial amputees performed two sessions of 30-min walking on a level treadmill at their self-selected comfortable speed. Gait analysis was undertaken over-ground: (1) before walking, (2) after the 1st walking session and (3) after the 2nd walking session. After the long-distance walking, changes in spatial-temporal gait parameters were small and insignificant. However, the sound side ankle rocker progression and push-off were significantly reduced. This was due to the fatigue of the sound side plantar flexors and was compensated by the greater effort in the prosthetic side. The prosthetic side knee joint showed significantly increased flexion and moment during loading response to facilitate the anterior rotation of the prosthetic shank. The prosthetic side hip extensors also provided more power at terminal stance to facilitate propulsion. Endurance training of the sound side plantar flexors, and improvements in the prosthetic design to assist anterior rotation of the prosthetic shank should improve long-distance walking in trans-tibial amputees.

The relationship between anterior tibial acceleration, tibial slope, and ACL strain during a simulated jump landing task

BACKGROUND

Knee joint morphology contributions to anterior cruciate ligament (ACL) loading are rarely considered in the injury prevention model. This may be problematic as the knee mechanical response may be influenced by these underlying morphological factors. The goal of the present study was to explore the relationship between posterior tibial slope (which has been recently postulated to influence knee and ACL loading), impact-induced anterior tibial acceleration, and resultant ACL strain during a simulated single-leg landing.

METHODS

Eleven lower limb cadaveric specimens from female donors who had had a mean age (and standard deviation) of 65 ± 10.5 years at the time of death were mounted in a testing apparatus to simulate single-limb landings in the presence of pre-impact knee muscle forces. After preconditioning, specimens underwent five impact trials (mean impact force, 1297.9 ± 210.6 N) while synchronous three-dimensional joint kinetics, kinematics, and relative anteromedial bundle strain data were recorded. Mean peak tibial acceleration and anteromedial bundle strain were quantified over the first 200 ms after impact. These values, along with radiographically defined posterior tibial slope measurements, were submitted to individual and stepwise linear regression analyses.

RESULTS

The mean peak anteromedial bundle strain (3.35% ± 1.71%) was significantly correlated (r = 0.79; p = 0.004; ß = 0.791) with anterior tibial acceleration (8.31 ± 2.77 m/s-2), with the times to respective peaks (66 ± 7 ms and 66 ± 4 ms) also being significantly correlated (r = 0.82; p = 0.001; ß = 0.818). Posterior tibial slope (mean, 7.6° ± 2.1°) was significantly correlated with both peak anterior tibial acceleration (r = 0.75; p = 0.004; ß = 0.786) and peak anteromedial bundle strain (r = 0.76; p = 0.007; ß = 0.759).

CONCLUSIONS

Impact-induced ACL strain is directly proportional to anterior tibial acceleration, with this relationship being moderately dependent on the posterior slope of the tibial plateau.

Backpack load affects lower limb muscle activity patterns of female hikers during prolonged load carriage

This study investigated the effect of prolonged load carriage on lower limb muscle activity displayed by female recreational hikers. Electromyography (EMG) signals from vastus lateralis (VL), biceps femoris (BF), semitendinosus (ST), tibialis anterior (TA) and gastrocnemius (GM) were recorded for fifteen female hikers carrying four loads (0%, 20%, 30% and 40% body weight (BW)) over 8 km. Muscle burst duration, muscle burst onset relative to initial contact and integrated EMG signals (iEMG) were calculated to evaluate muscle activity, whereas the shift in mean power frequency (MPF) was used to evaluate muscle fatigue. Increased walking distance significantly decreased the MPF of TA; decreased the iEMG for VL, ST and GM; and shortened VL muscle burst duration. Furthermore, carrying 20-40% BW loads significantly increased VL and GM iEMG and increased BF muscle burst duration, whereas a 40% BW load caused a later VL muscle burst onset. The differences observed in muscle activity with increased load mass seem to be adjustments aimed at maintaining balance and attenuating the increased loads placed on the lower limbs during gait. Based on the changes in muscle activity, a backpack load limit of 30% BW may reduce the risk of lower limb injury for female hikers during prolonged walking.