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Kugach K, Stark NEP, Farah HG, Hansen RM, Arena SL, Queen RM. Total ankle arthroplasty improves discrete and continuous stance phase gait symmetry. Gait Posture 2024; 113:272-279. [PMID: 38970929 DOI: 10.1016/j.gaitpost.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/17/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is used to treat symptomatic end-stage ankle arthritis (AA). However, little is known about TAA's effects on gait symmetry. RESEARCH QUESTION Determine if symmetry changes from before surgery through two years following TAA utilizing the normalized symmetry index (NSI) and statistical parametric mapping (SPM). METHODS 141 patients with end-stage unilateral AA were evaluated from a previously collected prospective database, where each participant was tested within two weeks of surgery (Pre-Op), one year and two years following TAA. Walking speed, hip extension angle and moment, hip flexion angle, ankle plantarflexion angle and moment, ankle dorsiflexion angle, weight acceptance (GRF1), and propulsive (GRF2) vertical ground reaction forces were calculated for each limb. Gait symmetry was assessed using the NSI. A linear mixed effects model with a single response for each gait symmetry variable was used to examine the fixed effect of follow-up time (Pre-Op, Post-1 yr, Post-2 yr) and the random effect of participant with gait speed as a covariate in the model. A one-dimensional repeated measures analysis of variance (ANOVA) statistical parameter mapping (SPM) was completed to examine differences in the time-series NSI to determine regions of significant differences between follow-up times. RESULTS Relative to Pre-Op values, GRF1, and GRF2 showed increased symmetry for discrete metrics and the time-series NSI across sessions. Hip extension moment had the largest symmetry improvement. Ankle plantarflexion angle was different between Pre-Op and Post-2 yr (p=0.010); and plantarflexion moment was different between Pre- Op and each post-operative session (p<0.001). The time-series Ankle Angle NSI was greater during the early stance phase in the Pre-Op session compared to Post-2 yr. SIGNIFICANCE Symmetry across most of the stance phase improved following TAA indicating that TAA successfully improves gait symmetry and future work should determine if these improvements restore symmetry to levels equivalent with health age-match controls.
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Affiliation(s)
- Kelly Kugach
- Department of Orthopaedic Surgery, Virginia Tech - Carilion School of Medicine, Roanoke, VA 24014, USA
| | - Nicole E-P Stark
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Hassan-Galaydh Farah
- Translational Biology, Medicine & Health, Virginia Tech, Roanoke, VA, 24014, USA
| | - Robyn M Hansen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Sara L Arena
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Robin M Queen
- Department of Orthopaedic Surgery, Virginia Tech - Carilion School of Medicine, Roanoke, VA 24014, USA; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA.
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2
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Kember LS, Myer GD, Lloyd RS. Interlimb kinetic asymmetries during the tuck jump assessment are more exposed following kinetic stabilization. Phys Ther Sport 2024; 67:61-67. [PMID: 38593626 PMCID: PMC11178106 DOI: 10.1016/j.ptsp.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To analyse interlimb kinetics and asymmetries during the tuck jump assessment (TJA), before and after kinetic stabilization, to identify injury risk in healthy female athletes. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS Twenty-five healthy females (age 21.0 ± 1.83 yrs; height 1.68 ± 0.06 m; body mass 69.4 ± 10.7 kg). MAIN OUTCOME MEASURES Kinetics were measured during 10-s trials of the TJA and absolute asymmetries compared, before and after kinetic stabilization using paired sample t-tests. Statistical parametric mapping (SPM) compared vertical ground reaction force (VGRF) data for each limb during the jumping cycles before and after stabilization. RESULTS Small to moderate increases in interlimb asymmetries were observed after stabilization for VGRF, relative vertical leg stiffness, average loading rate, total and propulsive impulse, peak braking and propulsive force (p < 0.05). SPM revealed significant interlimb differences between 77-98% and 83-99% of ground contact for the jumping cycles pre- and post-stabilization respectively. CONCLUSIONS Larger asymmetries were evident after kinetic stabilization, with increased VGRF in the non-dominant limb. We speculate that participants sacrificed interlimb landing symmetry to achieve kinetic stability, which may reflect a primal landing strategy that forgoes movement quality. Assessing lower limb biomechanics using the TJA should involve examining kinetic stability and interlimb kinetic asymmetries.
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Affiliation(s)
- Lucy S Kember
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
| | - Gregory D Myer
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA. https://twitter.com/gregmyer11
| | - Rhodri S Lloyd
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK; Sport Performance Research Institute, New Zealand, Auckland University of Technology, Auckland, New Zealand; Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand. https://twitter.com/DrRSLloyd
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3
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Van Hooren B, Lennartz R, Cox M, Hoitz F, Plasqui G, Meijer K. Differences in running technique between runners with better and poorer running economy and lower and higher milage: An artificial neural network approach. Scand J Med Sci Sports 2024; 34:e14605. [PMID: 38511261 DOI: 10.1111/sms.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Prior studies investigated selected discrete sagittal-plane outcomes (e.g., peak knee flexion) in relation to running economy, hereby discarding the potential relevance of running technique parameters during noninvestigated phases of the gait cycle and in other movement planes. PURPOSE Investigate which components of running technique distinguish groups of runners with better and poorer economy and higher and lower weekly running distance using an artificial neural network (ANN) approach with layer-wise relevance propagation. METHODS Forty-one participants (22 males and 19 females) ran at 2.78 m∙s-1 while three-dimensional kinematics and gas exchange data were collected. Two groups were created that differed in running economy or weekly training distance. The three-dimensional kinematic data were used as input to an ANN to predict group allocations. Layer-wise relevance propagation was used to determine the relevance of three-dimensional kinematics for group classification. RESULTS The ANN classified runners in the correct economy or distance group with accuracies of up to 62% and 71%, respectively. Knee, hip, and ankle flexion were most relevant to both classifications. Runners with poorer running economy showed higher knee flexion during swing, more hip flexion during early stance, and more ankle extension after toe-off. Runners with higher running distance showed less trunk rotation during swing. CONCLUSION The ANN accuracy was moderate when predicting whether runners had better, or poorer running economy, or had a higher or lower weekly training distance based on their running technique. The kinematic components that contributed the most to the classification may nevertheless inform future research and training.
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Affiliation(s)
- Bas Van Hooren
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Nutrition and Movement Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rebecca Lennartz
- Machine Learning and Data Analytics Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maartje Cox
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Nutrition and Movement Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Fabian Hoitz
- Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Guy Plasqui
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Nutrition and Movement Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Nutrition and Movement Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands
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4
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Stark NEP, Streamer J, Queen R. Patients with unilateral ankle arthritis have decreased discrete and time-series limb symmetry compared to healthy controls. J Orthop Res 2023; 41:1953-1964. [PMID: 36866826 PMCID: PMC10440243 DOI: 10.1002/jor.25541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Patients with ankle arthritis (AA) have side-to-side limb differences at the ankle and in spatiotemporal measures; however, the degree of symmetry between limbs has not been compared to a healthy population. The purpose of this study was to determine differences in limb symmetry during walking for discrete and time-series measures when comparing patients with unilateral AA to healthy participants. Thirty-seven AA and 37 healthy participants were age, gender, and body mass index matched. Three-dimensional gait mechanics and ground reaction force (GRF) were captured during four to seven walking trails. GRF and hip and ankle mechanics were extracted bilaterally for each trial. The Normalized Symmetry Index and Statistical Parameter Mapping were used to assess discrete and time-series symmetry, respectively. Discrete symmetry was analyzed using linear mixed-effect models to determine significant differences between groups (α = 0.05). Compared to healthy participants, patients with AA had decreased weight acceptance (p = 0.017) and propulsive (p < 0.001) GRF, ankle plantarflexion (p = 0.021), ankle dorsiflexion (p = 0.010), and ankle plantarflexion moment (p < 0.001) symmetry. Significant regions of difference were found between limbs and groups throughout the stance phase for the vertical GRF force (p < 0.001), the ankle angle during push-off (p = 0.047), the plantarflexion moment (p < 0.001), and the hip extension angle (p = 0.034) and moment (p = 0.010). Patients with AA have decreased symmetry in the vertical GRF and at the ankle and hip during the weight acceptance and propulsive portions of the stance phase. Therefore, clinicians should try a non improving symmetry focusing on changing hip and ankle mechanics during the weight acceptance and propulsive phases of gait.
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Affiliation(s)
- Nicole E-P. Stark
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
| | - Jill Streamer
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
- Department of Orthopaedic Surgery, Virginia Tech – Carilion School of Medicine, Roanoke, VA, USA
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Thorsen T, Wen C, Porter J, Reinbolt J, Weinhandl JT, Zhang S. Tibiofemoral compressive force during downhill walking in patients with primary total knee arthroplasty: A statistical parametric mapping approach. Clin Biomech (Bristol, Avon) 2023; 102:105900. [PMID: 36739666 DOI: 10.1016/j.clinbiomech.2023.105900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/09/2023] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Downhill walking is a necessary part of daily life and an effective activity in post-operative rehabilitation following total knee arthroplasty. The purpose of this study was to determine differences in the behavior of total, medial, and lateral tibiofemoral compressive forces as well as knee extensor and flexor muscle forces between different limbs of patients with total knee arthroplasty (replaced, non-replaced) during downhill and level walking. METHODS Musculoskeletal modeling and simulation were implemented to determine muscle forces and tibiofemoral compressive forces in 25 patients with total knee arthroplasty. A 2 × 2 [Limb (replaced, non-replaced) × Slope (0°, 10°)] Statistical parametric mapping repeated measures analysis of variance was conducted on selected variables. FINDINGS Statistical parametric mapping did not identify any between-limb differences for compressive or muscle forces. Differences in joint compressive and muscle forces persisted throughout different intervals of stance-phase between level and downhill walking. Knee extensor muscle forces were distinctly greater during level walking for nearly all of stance phase. Knee flexor muscle force was greater during downhill walking for >60% of stance. Statistical parametric mapping did identify regions of significance between level and downhill walking that coincided temporally (near loading response and push off) with peak joint moment and joint compressive forces traditionally reported using discrete variable analyses. INTERPRETATION Downhill walking may be a safe and useful rehabilitation tool for post-knee arthroplasty rehabilitation that will not disproportionally load either the replaced or the non-replaced joint and where the quadriceps muscles can be strengthened during a gait-specific task.
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Affiliation(s)
- Tanner Thorsen
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Chen Wen
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Jared Porter
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Jeffery Reinbolt
- Department of Mechanical, Aerospace, and Biomedical Engineering, The University of Tennessee, Knoxville, TN, USA
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA.
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Dataset of lower extremity joint angles, moments and forces in distance running. Heliyon 2022; 8:e11517. [DOI: 10.1016/j.heliyon.2022.e11517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 10/17/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
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Neal K, Williams JR, Alfayyadh A, Capin JJ, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Knee joint biomechanics during gait improve from 3 to 6 months after anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:2025-2038. [PMID: 34989019 PMCID: PMC9256843 DOI: 10.1002/jor.25250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/08/2021] [Accepted: 12/19/2021] [Indexed: 02/04/2023]
Abstract
Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty-five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two-tailed t-tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase.
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Affiliation(s)
- Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE
| | - Jack R. Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE
| | | | - Jacob J. Capin
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Kurt Manal
- Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Thomas S. Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE
- Biomechanics and Movement Science, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
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Bertozzi F, Rabello R, Zago M, Esposito F, Sforza C. Foot dominance and ball approach angle affect whole-body instep kick kinematics in soccer players. Sports Biomech 2022:1-21. [PMID: 35993147 DOI: 10.1080/14763141.2022.2110514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
Past investigations provided limited information regarding instep kicking kinematics in soccer. It is unclear how foot dominance and ball approach angle impact whole-body kinematics and consequently the ball velocity. We aimed to analyse the effects of the ball approach angle and the foot used on the whole-body kinematics of soccer players performing an instep kick. Twenty-four soccer players performed maximal instep kicks, using the dominant and non-dominant feet, with the ball stationary or rolling from four different directions. Whole-body motion was recorded during the kicking action and kinematic time-series were extracted and resampled to 200 points equally divided into kicking and follow-through phases. 1-D statistical parametric mapping two-way ANOVA tested for the effect of ball condition and foot dominance. Ball approach angle affected most of the swinging and support limb variables and some upper body variables. Performance-related variables such as CoM, foot, and shank velocities were reduced when the ball approached posteriorly. The linear and angular velocities of the swinging limb, and CoM vertical position, were higher when kicking with dominant foot. Based on these findings, as a practical implication, coaches should vary ball approach angles and the foot used during kicking drills to improve technical effectiveness in various situations.
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Affiliation(s)
- Filippo Bertozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
- E4Sport Lab, Politecnico di Milano, Milan, Italy
| | - Rodrigo Rabello
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Jacques T, Bini R, Arndt A. Inter-limb differences in in-vivo tendon behavior, kinematics, kinetics and muscle activation during running. J Biomech 2022; 141:111209. [DOI: 10.1016/j.jbiomech.2022.111209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/28/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
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10
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Oh J, Ripic Z, Signorile JF, Andersen MS, Kuenze C, Letter M, Best TM, Eltoukhy M. Monitoring joint mechanics in anterior cruciate ligament reconstruction using depth sensor-driven musculoskeletal modeling and statistical parametric mapping. Med Eng Phys 2022; 103:103796. [DOI: 10.1016/j.medengphy.2022.103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
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Hill CN, Ross S, Peebles A, Queen RM. Continuous similarity analysis in patient populations. J Biomech 2021; 131:110916. [PMID: 34952349 DOI: 10.1016/j.jbiomech.2021.110916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Decreased movement symmetry is associated with injury risk and accelerated disease progression. Methods to analyze continuous data either cannot be used in pathologic populations with abnormal movement patterns or are not defined in terms easily incorporated into clinical care. The purpose of this study was to develop a method of describing symmetry and movement quality in continuous time-series data that results in scores that can be readily incorporated into clinical care. Two scores were developed: (1) the symmetry score (SS) which evaluates similarities in time-series data between limbs and (2) the closeness-to-healthy score (CTHS) which evaluates the similarity of time-series data to a control population. Kinetic and kinematic data from 56 end-stage unilateral ankle arthritis (A-OA) patients and 56 healthy older adults, along with 16 anterior cruciate ligament reconstruction (ACLR) patients and 16 healthy young adults were used to test the ability for SS and CTHS to differentiate between healthy and patient groups. Unpaired t-tests, Cohen's D effect sizes, and receiver-operating-curve analyses assessed group differences [SPSS, V27, α = 0.05]. Patients had worse SS than controls and A-OA patients had worse CTHS compared to controls. SS had strong predictive capability, while the predictive capability of CTHS varied. Combined with clinically accessible data collection methods, the SS and CTHS could be used to evaluate patients' baseline movement quality, assess changes due to disease progression, and during recovery. Results could be utilized in clinical decision making to assess surgical intervention urgency and efficacy of surgical interventions or rehabilitation protocols to improve side-to-side limb symmetry.
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Affiliation(s)
- Cherice N Hill
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Shane Ross
- Department of Aerospace and Ocean Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Alexander Peebles
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
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12
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Zago M, David S, Bertozzi F, Brunetti C, Gatti A, Salaorni F, Tarabini M, Galvani C, Sforza C, Galli M. Fatigue Induced by Repeated Changes of Direction in Élite Female Football (Soccer) Players: Impact on Lower Limb Biomechanics and Implications for ACL Injury Prevention. Front Bioeng Biotechnol 2021; 9:666841. [PMID: 34291039 PMCID: PMC8287513 DOI: 10.3389/fbioe.2021.666841] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background The etiology of Anterior Cruciate Ligament (ACL) injury in women football results from the interaction of several extrinsic and intrinsic risk factors. Extrinsic factors change dynamically, also due to fatigue. However, existing biomechanical findings concerning the impact of fatigue on the risk of ACL injuries remains inconsistent. We hypothesized that fatigue induced by acute workload in short and intense game periods, might in either of two ways: by pushing lower limbs mechanics toward a pattern close to injury mechanism, or alternatively by inducing opposed protective compensatory adjustments. Aim In this study, we aimed at assessing the extent to which fatigue impact on joints kinematics and kinetics while performing repeated changes of direction (CoDs) in the light of the ACL risk factors. Methods This was an observational, cross-sectional associative study. Twenty female players (age: 20-31 years, 1st-2nd Italian division) performed a continuous shuttle run test (5-m) involving repeated 180°-CoDs until exhaustion. During the whole test, 3D kinematics and ground reaction forces were used to compute lower limb joints angles and internal moments. Measures of exercise internal load were: peak post-exercise blood lactate concentration, heart rate (HR) and perceived exertion. Continuous linear correlations between kinematics/kinetics waveforms (during the ground contact phase of the pivoting limb) and the number of consecutive CoD were computed during the exercise using a Statistical Parametric Mapping (SPM) approach. Results The test lasted 153 ± 72 s, with a rate of 14 ± 2 CoDs/min. Participants reached 95% of maximum HR and a peak lactate concentration of 11.2 ± 2.8 mmol/L. Exercise duration was inversely related to lactate concentration (r = -0.517, p < 0.01), while neither%HR max nor [La-] b nor RPE were correlated with test duration before exhaustion (p > 0.05). Alterations in lower limb kinematics were found in 100%, and in lower limb kinetics in 85% of the players. The most common kinematic pattern was a concurrent progressive reduction in hip and knee flexion angle at initial contact (10 players); 5 of them also showed a significantly more adducted hip. Knee extension moment decreased in 8, knee valgus moment increased in 5 players. A subset of participants showed a drift of pivoting limb kinematics that matches the known ACL injury mechanism; other players displayed less definite or even opposed behaviors. Discussion Players exhibited different strategies to cope with repeated CoDs, ranging from protective to potentially dangerous behaviors. While the latter was not a univocal effect, it reinforces the importance of individual biomechanical assessment when coping with fatigue.
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Affiliation(s)
- Matteo Zago
- Dipartimento di Meccanica, Politecnico di Milano, Milan, Italy.,E4Sport Laboratory, Politecnico di Milano, Lecco, Italy
| | - Sina David
- Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Filippo Bertozzi
- Dipartimento di Scienze Biomediche per la Salute, Politecnico di Milano, Milan, Italy
| | - Claudia Brunetti
- IRCCS Fondazione Santa Lucia, Rome, Italy.,Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Alice Gatti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Francesca Salaorni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Marco Tarabini
- Dipartimento di Meccanica, Politecnico di Milano, Milan, Italy.,E4Sport Laboratory, Politecnico di Milano, Lecco, Italy
| | - Christel Galvani
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Chiarella Sforza
- Dipartimento di Scienze Biomediche per la Salute, Politecnico di Milano, Milan, Italy
| | - Manuela Galli
- E4Sport Laboratory, Politecnico di Milano, Lecco, Italy.,Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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