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Wang S, Feng C, Chen X, Shan M, Niu W. A biomechanical evaluation of firefighters' musculoskeletal loads when carrying self-contained breathing apparatus in walking and running. JOURNAL OF SAFETY RESEARCH 2023; 87:1-14. [PMID: 38081685 DOI: 10.1016/j.jsr.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Musculoskeletal loading data are needed to design ergonomic intervention for firefighters. This study aimed to quantify the firefighters' musculoskeletal loads during self-contained breathing apparatus (SCBA) carriage and evaluate the effectiveness of shoulder strap length variation for the prevention of SCBA-related injuries. METHOD Twelve firefighters (height: 174.6 ± 2.4 cm, mass: 67 ± 3.5 kg, BMI = 22 ± 1 kg/m2) participated the walking and running protocols with no SCBA equipped and three varying-strapped SCBAs conditions. Joint range of motion and surface electromyography (sEMG) were synchronously measured. Subsequently, joint kinematics was inputted for subject-specific musculoskeletal modeling to estimate muscle forces and joint reaction forces, while the sEMG was used to validate the model. Repeated measures analysis of variance was used for the main effects (p < 0.05). Independent samples t-test was performed to determine differences between walking and running. RESULTS Walking with SCBA increased the rectus femoris force and hip reaction force by 34.92% [F = 53.629; p < 0.001; η2 = 0.317] and 34.71% [F = 53.653; p < 0.001; η2 = 0.517], the growth rate was 54.2% [F = 76.487; p < 0.001; η2 = 0.418] and 51.19% [F = 69.201; p < 0.001; η2 = 0.652] during running, respectively. Running with SCBA significantly increased the knee reaction force by 63.04% [F = 83.960; p < 0.001; η2 = 0.797], while only 18.49% increase during walking. Adjusting SCBA shoulder strap length significantly altered the rectus abdominis force and L4/L5 reaction force during walking and running. CONCLUSIONS Results revealed that rectus femoris activity, hip and knee exertion was sensitive to SCBA carriage. The variation of shoulder strap length has potential to influence the risk of low back pain (LBP). PRACTICAL APPLICATIONS The findings suggest that fire services promote targeting physical training at firefighters' hip and knee regions. Test firefighters in this study were not advisable to adjust their shoulder strap at loose-fitting condition. The compatibility design of the trunk morphology and SCBA back-mounted frame was suggested for the management of LBP.
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Affiliation(s)
- Shitan Wang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China; Laboratory of Biomechanics and Rehabilitation Engineering, School of Medicine, Tongji University, Shanghai 200092, China
| | - Chenglong Feng
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China; Laboratory of Biomechanics and Rehabilitation Engineering, School of Medicine, Tongji University, Shanghai 200092, China
| | - Xinpeng Chen
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China
| | - Mianjia Shan
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China; Laboratory of Biomechanics and Rehabilitation Engineering, School of Medicine, Tongji University, Shanghai 200092, China
| | - Wenxin Niu
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China; Laboratory of Biomechanics and Rehabilitation Engineering, School of Medicine, Tongji University, Shanghai 200092, China.
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Rubio JE, Tong J, Sundaramurthy A, Subramani AV, Kote VB, Baggaley M, Edwards WB, Reifman J. Differences in running biomechanics between young, healthy men and women carrying external loads. Front Bioeng Biotechnol 2023; 11:1250937. [PMID: 37854880 PMCID: PMC10579583 DOI: 10.3389/fbioe.2023.1250937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023] Open
Abstract
During U.S. Army basic combat training (BCT), women are more prone to lower-extremity musculoskeletal injuries, including stress fracture (SF) of the tibia, with injury rates two to four times higher than those in men. There is evidence to suggest that the different injury rates are, in part, due to sex-specific differences in running biomechanics, including lower-extremity joint kinematics and kinetics, which are not fully understood, particularly when running with external load. To address this knowledge gap, we collected computed tomography images and motion-capture data from 41 young, healthy adults (20 women and 21 men) running on an instrumented treadmill at 3.0 m/s with loads of 0.0 kg, 11.3 kg, or 22.7 kg. Using individualized computational models, we quantified the running biomechanics and estimated tibial SF risk over 10 weeks of BCT, for each load condition. Across all load conditions, compared to men, women had a significantly smaller flexion angle at the trunk (16.9%-24.6%) but larger flexion angles at the ankle (14.0%-14.7%). Under load-carriage conditions, women had a larger flexion angle at the hip (17.7%-23.5%). In addition, women had a significantly smaller hip extension moment (11.8%-20.0%) and ankle plantarflexion moment (10.2%-14.3%), but larger joint reaction forces (JRFs) at the hip (16.1%-22.0%), knee (9.1%-14.2%), and ankle (8.2%-12.9%). Consequently, we found that women had a greater increase in tibial strain and SF risk than men as load increases, indicating higher susceptibility to injuries. When load carriage increased from 0.0 kg to 22.7 kg, SF risk increased by about 250% in women but only 133% in men. These results provide quantitative evidence to support the Army's new training and testing doctrine, as it shifts to a more personalized approach that shall account for sex and individual differences.
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Affiliation(s)
- Jose E. Rubio
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Junfei Tong
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Aravind Sundaramurthy
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Adhitya V. Subramani
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Vivek Bhaskar Kote
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - W. Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
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Sundaramurthy A, Tong J, Subramani AV, Kote V, Baggaley M, Edwards WB, Reifman J. Effect of stride length on the running biomechanics of healthy women of different statures. BMC Musculoskelet Disord 2023; 24:604. [PMID: 37488528 PMCID: PMC10364351 DOI: 10.1186/s12891-023-06733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Tibial stress fracture is a debilitating musculoskeletal injury that diminishes the physical performance of individuals who engage in high-volume running, including Service members during basic combat training (BCT) and recreational athletes. While several studies have shown that reducing stride length decreases musculoskeletal loads and the potential risk of tibial injury, we do not know whether stride-length reduction affects individuals of varying stature differently. METHODS We investigated the effects of reducing the running stride length on the biomechanics of the lower extremity of young, healthy women of different statures. Using individualized musculoskeletal and finite-element models of women of short (N = 6), medium (N = 7), and tall (N = 7) statures, we computed the joint kinematics and kinetics at the lower extremity and tibial strain for each participant as they ran on a treadmill at 3.0 m/s with their preferred stride length and with a stride length reduced by 10%. Using a probabilistic model, we estimated the stress-fracture risk for running regimens representative of U.S. Army Soldiers during BCT and recreational athletes training for a marathon. RESULTS When study participants reduced their stride length by 10%, the joint kinetics, kinematics, tibial strain, and stress-fracture risk were not significantly different among the three stature groups. Compared to the preferred stride length, a 10% reduction in stride length significantly decreased peak hip (p = 0.002) and knee (p < 0.001) flexion angles during the stance phase. In addition, it significantly decreased the peak hip adduction (p = 0.013), hip internal rotation (p = 0.004), knee extension (p = 0.012), and ankle plantar flexion (p = 0.026) moments, as well as the hip, knee, and ankle joint reaction forces (p < 0.001) and tibial strain (p < 0.001). Finally, for the simulated regimens, reducing the stride length decreased the relative risk of stress fracture by as much as 96%. CONCLUSIONS Our results show that reducing stride length by 10% decreases musculoskeletal loads, tibial strain, and stress-fracture risk, regardless of stature. We also observed large between-subject variability, which supports the development of individualized training strategies to decrease the incidence of stress fracture.
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Affiliation(s)
- Aravind Sundaramurthy
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Junfei Tong
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Adhitya V Subramani
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Vivek Kote
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.
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Martin J, Kearney J, Nestrowitz S, Burke A, Sax van der Weyden M. Effects of load carriage on measures of postural sway in healthy, young adults: A systematic review and meta-analysis. APPLIED ERGONOMICS 2023; 106:103893. [PMID: 36152447 DOI: 10.1016/j.apergo.2022.103893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
Load carriage (LC) is a contributing factor to musculoskeletal injury in many occupations. Given that falls are a common mechanism of injury for those frequently engaging in LC, understanding the effects of LC on postural stability (PS) is necessary. A systematic review and meta-analysis was conducted to examine effects of LC on PS. Sixteen and 9 studies were included in the qualitative and quantitative synthesis, respectively. In most studies, it was found that LC leads to a decrease in PS with significant effects on center of pressure (COP) sway area (standardized mean difference = 0.45; p < 0.005) and COP anterior-posterior excursion (standardized mean difference = 0.52; p < 0.05). Furthermore, load magnitude and load placement are factors which can significantly affect COP measures of PS. It is recommended to minimize load magnitude and equally distribute load when possible to minimize LC effects on PS. Future research should examine additional factors contributing to differences in individual PS responses to LC such as changes in muscle activation and prior LC experience.
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Affiliation(s)
- Joel Martin
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA.
| | - James Kearney
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA
| | - Sara Nestrowitz
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA
| | - Adam Burke
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA
| | - Megan Sax van der Weyden
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Virginia, USA
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Yan C, Bice RJ, Frame JW, Warden SJ, Kersh ME. Multidirectional basketball activities load different regions of the tibia: A subject-specific muscle-driven finite element study. Bone 2022; 159:116392. [PMID: 35314384 PMCID: PMC10201946 DOI: 10.1016/j.bone.2022.116392] [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: 12/21/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022]
Abstract
The tibia is a common site for bone stress injuries, which are believed to develop from microdamage accumulation to repetitive sub-yield strains. There is a need to understand how the tibia is loaded in vivo to understand how bone stress injuries develop and design exercises to build a more robust bone. Here, we use subject-specific, muscle-driven, finite element simulations of 11 basketball players to calculate strain and strain rate distributions at the midshaft and distal tibia during six activities: walking, sprinting, lateral cut, jumping after landing, changing direction from forward-to-backward sprinting, and changing direction while side shuffling. Maximum compressive strains were at least double maximum tensile strains during the stance phase of all activities. Sprinting and lateral cut had the highest compressive (-2,862 ± 662 με and -2,697 ± 495 με, respectively) and tensile (973 ± 208 με and 942 ± 223 με, respectively) strains. These activities also had the highest strains rates (peak compressive strain rate = 64,602 ± 19,068 με/s and 37,961 ± 14,210 με/s, respectively). Compressive strains principally occurred in the posterior tibia for all activities; however, tensile strain location varied. Activities involving a change in direction increased tensile loads in the anterior tibia. These observations may guide preventative and management strategies for tibial bone stress injuries. In terms of prevention, the strain distributions suggest individuals should perform activities involving changes in direction during growth to adapt different parts of the tibia and develop a more fatigue resistant bone. In terms of management, the greater strain and strain rates during sprinting than jumping suggests jumping activities may be commenced earlier than full pace running. The greater anterior tensile strains during changes in direction suggest introduction of these types of activities should be delayed during recovery from an anterior tibial bone stress injury, which have a high-risk of healing complications.
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Affiliation(s)
- Chenxi Yan
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, United States of America
| | - Ryan J Bice
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America
| | - Jeff W Frame
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America; Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, United States of America; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, United States of America; Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, United States of America; Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, United States of America.
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Paul E, Pant A, George S, Willson J, Meardon S, Vahdati A. In silicomodeling of tibial fatigue life in physically active males and females during different exercise protocols. Biomed Phys Eng Express 2022; 8. [PMID: 35393943 DOI: 10.1088/2057-1976/ac62ff] [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: 12/12/2021] [Accepted: 03/31/2022] [Indexed: 11/11/2022]
Abstract
Preventing bone stress injuries (BSI) requires a deep understanding of the condition's underlying causes and risk factors. Subject-specific computer modeling studies of gait mechanics, including the effect of changes in running speed, stride length, and landing patterns on tibial stress injury formation can provide essential insights into BSI prevention. This study aimed to computationally examine the effect of different exercise protocols on tibial fatigue life in male and female runners during prolonged walking and running at three different speeds. To achieve these aims, we combined subject-specific magnetic resonance imaging (MRI), gait data, finite element analysis, and a fatigue life prediction algorithm, including repair and adaptation's influence. The algorithm predicted a steep increase in the likelihood of developing a BSI within the first 40 days of activity. In five of the six subjects simulated, faster running speeds corresponded with higher tibial strains and higher probability of failure. Our simulations also showed that female subjects had a higher mean peak probability of failure in all four gait conditions than the male subjects studied. The approach used in this study could lay the groundwork for studies in larger populations and patient-specific clinical tools and decision support systems to reduce BSIs in athletes, military personnel, and other active individuals.
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Affiliation(s)
- Elliot Paul
- Department of Engineering, College of Engineering and Technology, East Carolina University, Greenville, NC, United States of America
| | - Anup Pant
- Department of Engineering, College of Engineering and Technology, East Carolina University, Greenville, NC, United States of America
| | - Stephanie George
- Department of Engineering, College of Engineering and Technology, East Carolina University, Greenville, NC, United States of America
| | - John Willson
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, NC, United States of America
| | - Stacey Meardon
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, NC, United States of America
| | - Ali Vahdati
- Department of Engineering, College of Engineering and Technology, East Carolina University, Greenville, NC, United States of America
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