Modulation of gluteus medius activity reflects the potential of the muscle to meet the mechanical demands during perturbed walking

Impact of visual rotations on heading direction and center of mass control during steady-state gait

Visual information is essential to navigate the environment and maintain postural stability during gait. Visual field rotations alter the perceived heading direction, resulting in gait trajectory deviations, known as visual coupling. It is unclear how center of mass (CoM) control relative to a continuously changing base of support (BoS) is adapted to facilitate visual coupling. This study aimed to characterize mediolateral (ML) balance control during visual coupling in steady-state gait. Sixteen healthy participants walked on an instrumented treadmill, naive to sinusoidal low-frequency (0.1 Hz) rotations of the virtual environment around the vertical axis. Rotations were continuous with 1) high or 2) low amplitude or were 3) periodic with 10-s intervals. Visual coupling was characterized with cross-correlations between CoM trajectory and visual rotations. Balance control was characterized with the ML margin of stability (MoSML) and by quantifying foot placement control as the relation between CoM dynamics and lateral foot placement. Visual coupling was strong on a group level (continuous low: 0.88, continuous high: 0.91, periodic: 0.95) and moderate to strong on an individual level. Higher rotation amplitudes induced stronger gait trajectory deviations. The MoSML decreased toward the deviation direction and increased at the opposite side. Foot placement control was similar compared with regular gait. Furthermore, pelvis and foot reorientation toward the rotation direction was observed. We concluded that visual coupling was facilitated by reorientating the body and shifting the extrapolated CoMML closer to the lateral BoS boundary toward the adjusted heading direction while preserving CoM excursion and foot placement control.NEW & NOTEWORTHY Healthy, naive participants were unaware of subtle, low-frequency rotations of the visual field but still coupled their gait trajectory to a rotating virtual environment. In response, participants decreased their margin of stability toward the new heading direction, without changing the center of mass excursion magnitude and foot placement strategy.

Validity of muscle activation estimated with predicted ground reaction force in inverse dynamics based musculoskeletal simulation during gait

The inverse dynamics based musculoskeletal simulation needs ground reaction forces (GRF) as an external force input. GRF can be predicted from kinematic data. However, the validity of estimated muscle activation using the predicted GRF has remained unclear. Therefore, the purpose of this study was to determine the validity of estimated muscle activation with predicted GRF in the inverse dynamics based musculoskeletal simulation. To perform musculoskeletal simulations, an open-source motion capture dataset that contains gait data from 50 healthy subjects was used. CusToM was used for the musculoskeletal simulations. Two sets of inverse dynamics and static optimization were performed, one used predicted GRF (PRED) and another used experimentally measured GRF (EXP). Pearson's correlation was calculated to evaluate the similarity between EMG and estimated muscle activations for both PRED and EXP. To compare PRED and EXP, paired t-tests were used to compare the trial-wise muscle activation similarity and residuals. Relationships between joint moments and residuals were also tested. The overall muscle activation similarity was comparable in PRED (R = 0.477) and EXP (R = 0.475). The residuals were 2-4 times higher in EXP compared to PRED (P < 0.001). The hip flexion-extension moment was correlated to sagittal plane residual moment (R = 0.467). The muscle activations estimated using predicted GRF were comparable to that with measured GRF in the inverse dynamics based musculoskeletal simulation. Prediction of GRF helps to perform musculoskeletal simulations where the force plates are not available.

Individuals with knee osteoarthritis show few limitations in balance recovery responses after moderate gait perturbations

BACKGROUND

Knee osteoarthritis causes structural joint damage. The resultant symptoms can impair the ability to recover from unexpected gait perturbations. This study compared balance recovery responses to moderate gait perturbations between individuals with knee osteoarthritis and healthy individuals.

METHODS

Kinematic data of 35 individuals with end-stage knee osteoarthritis, and 32 healthy individuals in the same age range were obtained during perturbed walking on a treadmill at 1.0 m/s. Participants received anteroposterior (acceleration or deceleration) or mediolateral perturbations during the stance phase. Changes from baseline in margin of stability, step length, step time, and step width during the first two steps after perturbation were compared between groups using a linear regression model. Extrapolated center of mass excursion was descriptively analyzed.

FINDINGS

After all perturbation modes, extrapolated center of mass trajectories overlapped between individuals with knee osteoarthritis and healthy individuals. Participants predominantly responded to mediolateral perturbations by adjusting their step width, and to anteroposterior perturbations by adjusting step length and step time. None of the perturbation modes yielded between-group differences in changes in margin of stability and step width during the first two steps after perturbation. Small between-group differences were observed for step length (i.e. 2 cm) of the second step after mediolateral and anteroposterior perturbations, and for step time (i.e. 0.01-0.02 s) of first step after mediolateral perturbations and the second step after outward and belt acceleration perturbations.

INTERPRETATION

Despite considerable pain and damage to the knee joint, individuals with knee osteoarthritis showed comparable balance recovery responses after moderate gait perturbations to healthy participants.

A comparison of the effects of mediolateral surface and foot placement perturbations on balance control and response strategies during walking

BACKGROUND

Balance perturbation studies during walking have improved our understanding of balance control in various destabilizing conditions. However, it is unknown to what extent balance recovery strategies can be generalized across different types of mediolateral balance perturbations.

RESEARCH QUESTION

Do similar mediolateral perturbations (foot placement versus surface translation) have similar effects on balance control and corresponding balance response strategies?

METHODS

Kinetic and kinematic data were previously collected during two separate studies, each with 15 young, healthy participants walking on an instrumented treadmill. In both studies, medial and lateral balance perturbations were applied at 80% of the gait cycle either by a treadmill surface translation or a pneumatic force applied to the swing foot. Differences in balance control (frontal plane whole body angular momentum) and balance response strategies (hip abduction moment, ankle inversion moment, center of pressure excursion and frontal plane trunk moment) between perturbed and unperturbed gait cycles were evaluated using statistical parametric mapping.

RESULTS

Balance disruptions after foot placement perturbations were larger and sustained longer compared to surface translations. Changes in joint moment responses were also larger for the foot placement perturbations compared to the surface translation perturbations. Lateral hip, ankle, and trunk strategies were used to maintain balance after medial foot placement perturbations, while a trunk strategy was primarily used after surface translations.

SIGNIFICANCE

Surface and foot placement perturbations influence balance control and corresponding response strategies differently. These results can help inform the development of perturbation-based balance training interventions aimed at reducing fall risk in clinical populations.

Muscular and Kinematic Responses to Unexpected Translational Balance Perturbation: A Pilot Study in Healthy Young Adults

Falls and fall-related injuries are significant public health problems in older adults. While balance-controlling strategies have been extensively researched, there is still a lack of understanding regarding how fast the lower-limb muscles contract and coordinate in response to a sudden loss of standing balance. Therefore, this pilot study aims to investigate the speed and timing patterns of multiple joint/muscles' activities among the different challenges in standing balance. Twelve healthy young subjects were recruited, and they received unexpected translational balance perturbations with randomized intensities and directions. Electromyographical (EMG) and mechanomyographical (MMG) signals of eight dominant-leg's muscles, dominant-leg's three-dimensional (3D) hip/knee/ankle joint angles, and 3D postural sways were concurrently collected. Two-way ANOVAs were used to examine the difference in timing and speed of the collected signals among muscles/joint motions and among perturbation intensities. This study has found that (1) agonist muscles resisting the induced postural sway tended to activate more rapidly than the antagonist muscles, and ankle muscles contributed the most with the fastest rate of response; (2) voluntary corrective lower-limb joint motions and postural sways could occur as early as the perturbation-induced passive ones; (3) muscles reacted more rapidly under a larger perturbation intensity, while the joint motions or postural sways did not. These findings expand the current knowledge on standing-balance-controlling mechanisms and may potentially provide more insights for developing future fall-prevention strategies in daily life.

Systematic Review of the Importance of Hip Muscle Strength, Activation, and Structure in Balance and Mobility Tasks

OBJECTIVE

The aim of this systematic review was to identify the associations of the hip abductor muscle strength, structure, and neuromuscular activation on balance and mobility in younger, middle-aged, and older adults.

DATA SOURCES

We followed PRISMA guidelines and performed searches in PubMed, Embase, CINAHL, and Physiotherapy Evidence Database.

STUDY SELECTION

Study selection included: (1) studies with patients aged 18 years or older and (2) studies that measured hip abduction torque, surface electromyography, and/or muscle structure and compared these measures with balance or mobility outcomes.

DATA EXTRACTION

The extracted data included the study population, setting, sample size, sex, and measurement evaluated.

DATA SYNTHESIS

The present systematic review is composed of 59 research articles including a total of 2144 young, middle-aged, and older adults (1337 women). We found that hip abductor strength is critical for balance and mobility function, independent of age. Hip abductor neuromuscular activation is also important for balance and mobility, although it may differ across ages depending on the task. Finally, the amount of fat inside the muscle appears to be one of the important factors of muscle structure influencing balance.

CONCLUSIONS

In conclusion, a change in all investigated variables (hip abduction torque, neuromuscular activation, and intramuscular fat) appears to have an effect during balance or mobility tasks across age ranges and may elicit better performance. Future studies are necessary to confirm the effect of these variables across age ranges and the effects of interventions.

Improvement in gait stability in older adults after ten sessions of standing balance training

Balance training aims to improve balance and transfer acquired skills to real-life tasks. How older adults adapt gait to different conditions, and whether these adaptations are altered by balance training, remains unclear. We hypothesized that reorganization of modular control of muscle activity is a mechanism underlying adaptation of gait to training and environmental constraints. We investigated the transfer of standing balance training, shown to enhance unipedal balance control, to gait and adaptations in neuromuscular control of gait between normal and narrow-base walking in twenty-two older adults (72.6 ± 4.2 years). At baseline, after one, and after ten training sessions, kinematics and EMG of normal and narrow-base treadmill walking were measured. Gait parameters and temporal activation profiles of five muscle synergies were compared between time-points and gait conditions. Effects of balance training and an interaction between training and gait condition on step width were found, but not on synergies. After ten training sessions step width decreased in narrow-base walking, while step width variability decreased in both conditions. Trunk center of mass displacement and velocity, and the local divergence exponent, were lower in narrow-base compared to normal walking. Activation duration in narrow-base compared to normal walking was shorter for synergies associated with dominant leg weight acceptance and non-dominant leg stance, and longer for the synergy associated with non-dominant heel-strike. Time of peak activation associated with dominant leg stance occurred earlier in narrow-base compared to normal walking, while it was delayed in synergies associated with heel-strikes and non-dominant leg stance. The adaptations of synergies to narrow-base walking may be interpreted as related to more cautious weight transfer to the new stance leg and enhanced control over center of mass movement in the stance phase. The improvement of gait stability due to standing balance training is promising for less mobile older adults.

Individual muscle responses to mediolateral foot placement perturbations during walking

Walking requires active control of frontal plane balance through adjustments to mediolateral foot placement and ground reaction forces. Previous work on mediolateral balance perturbations and control of foot placement has often focused on the bilateral gluteus medius muscles. However, additional leg and trunk muscles can influence foot placement by transferring power to the foot and pelvis during swing. Thus, the purpose of this study was to determine individual muscle contributions to balance control following medial and lateral foot placement perturbations. Ten participants performed treadmill walking trials which included perturbations immediately before randomized heel strikes. Muscle contributions to foot placement, ground reaction forces, trunk power and frontal plane external moments during representative perturbed and unperturbed gait cycles were estimated using musculoskeletal modeling and simulation. Net muscle contributions to foot placement were 61 ± 50% more medial during the first recovery step following lateral perturbations and 28 ± 14% less medial in the second recovery step following medial perturbations. Following lateral perturbations, the swing gluteus medius performed 57 ± 50% more lateral work and the stance gluteus medius performed 61 ± 50% more medial work on the foot. Following medial perturbations, the erector spinae performed 39 ± 33% less lateral work on the foot. Changes in net muscle work on the foot were inconsistent with changes in step width, suggesting that changes in step width were not due to active muscle control but rather the mechanical effect of the perturbation. These outcomes provide a foundation for future studies analyzing balance control in populations at risk of falling.

Small directional treadmill perturbations induce differential gait stability adaptation

Introducing unexpected perturbations to challenge gait stability is an effective approach to investigate balance control strategies. Little is known about the extent to which people can respond to small perturbations during walking. This study aimed to determine how subjects adapted gait stability to multidirectional perturbations with small magnitudes applied on a stride-by-stride basis. Ten healthy young subjects walked on a treadmill that either briefly decelerated belt speed (“stick”), accelerated belt speed (“slip”), or shifted the platform medial-laterally at right leg mid-stance. We quantified gait stability adaptation in both anterior-posterior and medial-lateral directions using margin of stability and its components, base of support, and extrapolated center of mass. Gait stability was disrupted upon initially experiencing the small perturbations as margin of stability decreased in the stick, slip, and medial shift perturbations and increased in the lateral shift perturbation. Gait stability metrics were generally disrupted more for perturbations in the coincident direction. Subjects employed both feedback and feedforward strategies in response to the small perturbations, but mostly used feedback strategies during adaptation. Subjects primarily used base of support (foot placement) control in the lateral shift perturbation and extrapolated center of mass control in the slip and medial shift perturbations. These findings provide new knowledge about the extent of gait stability adaptation to small magnitude perturbations applied on a stride-by-stride basis and reveal potential new approaches for balance training interventions to target foot placement and center of mass control.

NEW & NOTEWORTHY Little is known about if and how humans can adapt to small magnitude perturbations experienced on a stride-by-stride basis during walking. Here, we show that even small perturbations disrupted gait stability and that subjects could still adapt their reactive balance control. Depending on the perturbation direction, subjects might prefer adjusting their foot placement over their center of mass and vice versa. These findings could help potentially tune balance training to target specific aspects of balance.

Effects of initial foot position on postural responses to lateral standing surface perturbations in younger and older adults

BACKGROUND

An age-related decline in standing balance control in the medio-lateral direction is associated with increased risk of falls. A potential approach to improve postural stability is to change initial foot position (IFP).

RESEARCH QUESTIONS

In response to a lateral surface perturbation, how are lower extremity muscle activation levels different and what are the effects of different IFPs on muscle activation patterns and postural stability in younger versus older adults?

METHODS

Ten younger and ten older healthy adults participated in this study. Three IFPs were tested [Reference (REF): feet were placed parallel, shoulder-width apart; Toes-out with heels together (TOHT): heels together with toes pointing outward; Modified Semi-Tandem (M-ST): the heel of the anterior foot was placed by the big toe of the posterior foot]. Unexpected lateral translations of the standing surface were applied. Electromyographic (EMG) activity of the lower extremity muscles, standard deviation (SD) of the body's CoM acceleration (SD of CoMAccel), and center of pressure (CoP) sway area were compared across IFPs and age.

RESULTS

Activation levels of the muscles serving the ankle and gluteus medius were greater than for the knee joint muscles and gluteus maximus in the loaded leg across all IFPs in both groups. TOHT showed greater EMG peak amplitude of the soleus and fibularis longus compared to REF, and had smaller SD of CoMAccel and CoP sway area than M-ST. Compared to younger adults, older adults demonstrated lower EMG peak amplitude and delayed peak timing of the fibularis longus and greater SD of CoMAccel and CoP sway area in all IFPs during balance recovery.

SIGNIFICANCE

During standing balance recovery, ankle muscles and gluteus medius are important active responders to unexpected lateral surface perturbations and a toes-out IFP could be a viable option to enhance ankle muscle activation that diminishes with age to improve postural stability.

Augmented Hip Proprioception Influences Mediolateral Foot Placement During Walking

Hip abductor proprioception contributes to the control of mediolateral foot placement, which varies with step-by-step fluctuations in pelvis dynamics. Prior work has used hip abductor vibration as a sensory probe to investigate the link between vibration within a single step and subsequent foot placement. Here, we extended prior findings by applying time and location varying vibration in every step, seeking to predictably manipulate the continuous, step-by-step relationship between pelvis dynamics and foot placement. We compared participants' (n = 32; divided into two groups of 16 with slightly different vibration control) gait behavior across four treadmill walking conditions: 1) No feedback; 2) Random feedback, with vibration unrelated to pelvis motion; 3) Augmented feedback, with vibration designed to evoke proprioceptive feedback paralleling the actual pelvis motion; 4) Disrupted feedback, with vibration designed to evoke proprioceptive feedback inversely related to pelvis motion. We hypothesized that the relationship between pelvis dynamics and foot placement would be strengthened by Augmented feedback but weakened by Disrupted feedback. For both participant groups, the strength of the relationship between pelvis dynamics at the start of a step and foot placement at the end of a step was significantly (p ≤ 0.0002) influenced by the feedback condition. The link between pelvis dynamics and foot placement was strongest with Augmented feedback, but not significantly weakened with Disrupted feedback, partially supporting our hypotheses. Our approach to augmenting proprioceptive feedback during gait may have implications for clinical populations with a weakened relationship between pelvis motion and foot placement.

Similar sensorimotor transformations control balance during standing and walking

Standing and walking balance control in humans relies on the transformation of sensory information to motor commands that drive muscles. Here, we evaluated whether sensorimotor transformations underlying walking balance control can be described by task-level center of mass kinematics feedback similar to standing balance control. We found that delayed linear feedback of center of mass position and velocity, but not delayed linear feedback from ankle angles and angular velocities, can explain reactive ankle muscle activity and joint moments in response to perturbations of walking across protocols (discrete and continuous platform translations and discrete pelvis pushes). Feedback gains were modulated during the gait cycle and decreased with walking speed. Our results thus suggest that similar task-level variables, i.e. center of mass position and velocity, are controlled across standing and walking but that feedback gains are modulated during gait to accommodate changes in body configuration during the gait cycle and in stability with walking speed. These findings have important implications for modelling the neuromechanics of human balance control and for biomimetic control of wearable robotic devices. The feedback mechanisms we identified can be used to extend the current neuromechanical models that lack balance control mechanisms for the ankle joint. When using these models in the control of wearable robotic devices, we believe that this will facilitate shared control of balance between the user and the robotic device.

The stability of human standing and walking is remarkable, given that from a mechanical point of view standing and walking are highly unstable and therefore require well-coordinated control actions from the central nervous system. The nervous system continuously receives information on the state of the body through sensory inputs, which is processed to generate descending motor commands to the muscles. It remains, however, unclear how the central nervous system uses information from multiple sensors to control walking balance. In standing balance, such sensorimotor transformations have been studied. When standing balance is perturbed, previous studies suggest that the central nervous system estimates the movement of the whole body center of mass to activate muscles and control balance. Here, we investigated whether the same sensorimotor transformations underlie control of walking balance. We found that changes in muscle activity and ankle moments in response to perturbations of walking balance were indeed proportional to center of mass movement. These findings suggest that common processes underlie control of standing and walking balance. Our work is significant because it captures the result of complex underlying neural processes in a simple relation between the body’s center of mass movement and corrective joint moments that can be implemented in the control of prostheses and exoskeletons to support balance control in a human-like manner.

Perspective on musculoskeletal modelling and predictive simulations of human movement to assess the neuromechanics of gait

Locomotion results from complex interactions between the central nervous system and the musculoskeletal system with its many degrees of freedom and muscles. Gaining insight into how the properties of each subsystem shape human gait is challenging as experimental methods to manipulate and assess isolated subsystems are limited. Simulations that predict movement patterns based on a mathematical model of the neuro-musculoskeletal system without relying on experimental data can reveal principles of locomotion by elucidating cause-effect relationships. New computational approaches have enabled the use of such predictive simulations with complex neuro-musculoskeletal models. Here, we review recent advances in predictive simulations of human movement and how those simulations have been used to deepen our knowledge about the neuromechanics of gait. In addition, we give a perspective on challenges towards using predictive simulations to gain new fundamental insight into motor control of gait, and to help design personalized treatments in patients with neurological disorders and assistive devices that improve gait performance. Such applications will require more detailed neuro-musculoskeletal models and simulation approaches that take uncertainty into account, tools to efficiently personalize those models, and validation studies to demonstrate the ability of simulations to predict gait in novel circumstances.

Biomechanics of In-Stance Balancing Responses Following Outward-Directed Perturbation to the Pelvis During Very Slow Treadmill Walking Show Complex and Well-Orchestrated Reaction of Central Nervous System

Multiple strategies may be used when counteracting loss of balance during walking. Placing the foot onto a new location is not efficient when walking speed is very low. Instead medio-lateral displacement of center-of-pressure, rotation of body segments to produce a lateral ground-reaction-force, and pronounced braking of movement in the plane of progression is used. It is, however, presently not known in what way these in-stance balancing strategies are interrelated. Twelve healthy subjects walked very slowly on an instrumented treadmill and received outward-directed pushes to the waist. We created experimental conditions where the use of stepping strategy to recover balance following an outward push was minimized by appropriately selecting the amplitude and timing of perturbation. Our experimental results showed that in the first part of the response the principal strategy used to counteract the effect of a perturbing push was a short but substantial increase in lateral ground-reaction-force. Concomitant slowing of the movement and related anterior displacement of center-of-pressure enabled lateral displacement of center-of-pressure which was, together with a short but substantial increase in vertical ground-reaction-force, instrumental in reducing the inevitable increase of whole-body angular momentum in the frontal plane. However, anterior displacement of center-of-pressure and increased vertical ground-reaction-force also induced an increase in whole-body angular momentum in the sagittal plane. In the second part of the response the lateral ground-reaction-force was decreased with respect to unperturbed walking thus allowing for a decrease of whole-body angular momentum in the frontal plane. Additionally, an increase in anterior ground-reaction-force in the second part of the response propelled the center-of-mass in the direction of movement, thus re-synchronizing it with the frontal plane component of the center-of-mass as well as decreasing whole-body angular momentum in the sagittal plane. The results of this study show that use of in-stance balancing strategies counteracts the effect a perturbing push imposed on the center-of-mass, re-synchronizes the movement of center-of-mass in sagittal and frontal planes to the values seen in unperturbed walking and maintains control of whole-body angular momentum in both frontal and sagittal planes.

Altered active control of step width in response to mediolateral leg perturbations while walking

During human walking, step width is predicted by mediolateral motion of the pelvis, a relationship that can be attributed to a combination of passive body dynamics and active sensorimotor control. The purpose of the present study was to investigate whether humans modulate the active control of step width in response to a novel mechanical environment. Participants were repeatedly exposed to a force-field that either assisted or perturbed the normal relationship between pelvis motion and step width, separated by washout periods to detect the presence of potential after-effects. As intended, force-field assistance directly strengthened the relationship between pelvis displacement and step width. This relationship remained strengthened with repeated exposure to assistance, and returned to baseline afterward, providing minimal evidence for assistance-driven changes in active control. In contrast, force-field perturbations directly weakened the relationship between pelvis motion and step width. Repeated exposure to perturbations diminished this negative direct effect, and produced larger positive after-effects once the perturbations ceased. These results demonstrate that targeted perturbations can cause humans to adjust the active control that contributes to fluctuations in step width.

Fast responses to stepping-target displacements when walking

Key points

Goal‐directed arm movements can be adjusted at short latency to target shifts.

We tested whether similar adjustments are present during walking on a treadmill with shifting stepping targets.

Participants responded at short latency with an adequate gain to small shifts of the stepping targets.

Movements of the feet during walking are controlled in a similar way to goal‐directed arm movements if balance is not violated.

Abstract

It is well‐known that goal‐directed hand movements can be adjusted to small changes in target location with a latency of about 100 ms. We tested whether people make similar fast adjustments when a target location for foot placement changes slightly as they walk over a flat surface. Participants walked at 3 km/h on a treadmill on which stepping stones were projected. The stones were 50 cm apart in the walking direction. Every 5–8 steps, a stepping stone was unexpectedly displaced by 2.5 cm in the medio‐lateral direction. The displacement took place during the first half of the swing phase. We found fast adjustments of the foot trajectory, with a latency of about 155 ms, initiated by changes in muscle activation 123 ms after the perturbation. The responses corrected for about 80% of the perturbation. We conclude that goal‐directed movements of the foot are controlled in a similar way to those of the hand, thus also giving very fast adjustments.

Goal‐directed arm movements can be adjusted at short latency to target shifts.

We tested whether similar adjustments are present during walking on a treadmill with shifting stepping targets.

Participants responded at short latency with an adequate gain to small shifts of the stepping targets.

Movements of the feet during walking are controlled in a similar way to goal‐directed arm movements if balance is not violated.

Knee abduction moment is predicted by lower gluteus medius force and larger vertical and lateral ground reaction forces during drop vertical jump in female athletes

Prospective knee abduction moments measured during the drop vertical jump task identify those at increased risk for anterior cruciate ligament injury. The purpose of this study was to determine which muscle forces and frontal plane biomechanical features contribute to large knee abduction moments. Thirteen young female athletes performed three drop vertical jump trials. Subject-specific musculoskeletal models and electromyography-informed simulations were developed to calculate the frontal plane biomechanics and lower limb muscle forces. The relationships between knee abduction moment and frontal plane biomechanics were examined. Knee abduction moment was positively correlated to vertical (R = 0.522, P < 0.001) and lateral ground reaction forces (R = 0.395, P = 0.016), hip adduction angle (R = 0.358, P < 0.023) and lateral pelvic tilt (R = 0.311, P = 0.061). A multiple regression showed that knee abduction moment was predicted by reduced gluteus medius force and increased vertical and lateral ground reaction forces (P < 0.001, R² = 0.640). Hip adduction is indicative of lateral pelvic shift during landing. The coupled hip adduction and lateral pelvic tilt were associated to the increased vertical and lateral ground reaction forces, propagating into higher knee abduction moments. These biomechanical features are associated with ACL injury and may be limited in a landing with increased activation of the gluteus medius. Targeted neuromuscular training to control the frontal pelvic and hip motion may help to avoid injurious ground reaction forces and consequent knee abduction moment and ACL injury risk.

Biarticular muscles are most responsive to upper-body pitch perturbations in human standing

Balancing the upper body is pivotal for upright and efficient gait. While models have identified potentially useful characteristics of biarticular thigh muscles for postural control of the upper body, experimental evidence for their specific role is lacking. Based on theoretical findings, we hypothesised that biarticular muscle activity would increase strongly in response to upper-body perturbations. To test this hypothesis, we used a novel Angular Momentum Perturbator (AMP) that, in contrast to existing methods, perturbs the upper-body posture with only minimal effect on Centre of Mass (CoM) excursions. The impulse-like AMP torques applied to the trunk of subjects resulted in upper-body pitch deflections of up to 17° with only small CoM excursions below 2 cm. Biarticular thigh muscles (biceps femoris long head and rectus femoris) showed the strongest increase in muscular activity (mid- and long-latency reflexes, starting 100 ms after perturbation onset) of all eight measured leg muscles which highlights the importance of biarticular muscles for restoring upper-body balance. These insights could be used for improving technological aids like rehabilitation or assistive devices, and the effectiveness of physical training for fall prevention e.g. for elderly people.

EMG-Informed Musculoskeletal Modeling to Estimate Realistic Knee Anterior Shear Force During Drop Vertical Jump in Female Athletes

The anterior cruciate ligament is the primary structural restraint to tibial anterior shear force. The anterior force occurring at the knee during landing contributes to anterior cruciate ligament injury risk, but it cannot be directly measured experimentally. The objective of this study was to develop electromyography-informed musculoskeletal simulations of the drop vertical jump motor task and assess the contribution of knee muscle forces to tibial anterior shear force. In this cross-sectional study, musculoskeletal simulations were used to estimate the muscle forces of thirteen female athletes performing a drop vertical jump using an electromyography-informed method. Muscle activation and knee loads that resulted from these simulations were compared to the results obtained with the more common approach of minimization of muscle effort (optimization-based method). Quadriceps-hamstrings and quadriceps-gastrocnemius co-contractions were progressively increased and their contribution to anterior shear force was quantified. The electromyography-informed method produced co-contraction indexes more consistent with electromyography data than the optimization-based method. The muscles that presented the largest contribution to peak anterior shear force were the gastrocnemii, likely from their wrapping around the posterior aspect of the tibia. The quadriceps-hamstring co-contraction provided a protective effect on the ACL and reduced peak anterior shear force by 292 N with a co-contraction index increase of 25% from baseline (31%), whereas a quadriceps-gastrocnemius co-contraction index of 61% increased peak anterior shear force by 797 N compared to baseline (42%). An increase in gastrocnemius contraction, which might be required to protect the ankle from the impact with the ground, produced a large quadriceps-gastrocnemius co-activation, increasing peak anterior shear force. A better understanding of each muscle's contribution to anterior shear force and, consequently, anterior cruciate ligament tension may inform subject-specific injury prevention programs and rehabilitation protocols.