Modulation of work and power by the human lower-limb joints with increasing steady-state locomotion speed

Relationship Between External Training Load and Session Rating of Perceived Exertion Training Impulse in Elite Sprinters

PURPOSE

To quantify the change in session rating of perceived exertion training impulse (RPE-TRIMP) that may occur in response to increased running distance at 3 running velocity ranges in elite sprinters.

METHODS

We monitored training load in elite sprinters (women: n = 7; men: n = 11) using wearable Global Positioning System technology and RPE-TRIMP for a total of 681 individual training sessions during a 22-week competition-preparation period. Internal training load was operationalized by RPE-TRIMP, and external training load was operationalized by distance covered in 3 velocity ranges. A linear mixed-effects model with athlete as a random effect was fit to RPE-TRIMP with total distance covered at ≤69.99% (low-velocity running [LVR]), 70% to 84.99% (high-velocity running [HVR]), and 85% to 100% (very-high-velocity running [VHVR]) of individual maximum velocity.

RESULTS

Increased running distance in all 3 velocity ranges (LVR, HVR, and VHVR) resulted in a significant (P < .001) increase in RPE-TRIMP. Coefficients (95% CIs) were .10 (.08-.11) for LVR, .23 (.18-.28) for HVR, and .44 (.35-.53) for VHVR. A 50-m increase in running distance covered in the LVR, HVR, and VHVR velocity ranges was associated with increases in RPE-TRIMP of 5, 11.5, and 22 arbitrary units, respectively.

CONCLUSIONS

Internal training load, calculated as RPE-TRIMP, increased with increases in total distance covered in the LVR, HVR, and VHVR velocity ranges (P < .001). RPE-TRIMP can be a practical solution for monitoring global training-session load in elite sprinters.

How Humans Run Faster: The Neuromechanical Contributions of Functional Muscle Groups to Running at Different Speeds

How the neuromechanics of the lower limb functional muscle groups change with running speed remains to be fully elucidated, with implications for our understanding of human locomotion, conditioning, and injury prevention. This study compared the neuromechanics (ground reaction and joint kinetics, kinematics and muscle activity) of middle-distance athletes running on an instrumented treadmill at six wide-ranging speeds (2.78-8.33 m·s-1). Ground reaction forces and kinematics were analyzed using inverse dynamics to calculate flexor and extensor joint torques, and positive and negative work done by these torques. Contributions of each functional muscle group to the total positive and negative work done by the limb during stance, swing, and the whole stride were quantified. During stance, the ankle plantar flexors were the major energy generator and absorber (>60%) at all speeds, but their contribution to whole stride energy generation and absorption declined with speed. Positive work by the hip extensors rose superlinearly with speed during stance (3-fold) and especially during swing (12-fold), becoming the biggest energy generator across the whole stride at >5 m·s-1. Knee flexor and extensor negative work also rose superlinearly with speed during swing, with the knee flexors becoming the greatest energy absorber over the whole stride at >7.22 m·s-1. Across speeds, plantar flexor peak moment and positive work accounted for 97% and 96% of the variance in step length, and swing hip extension peak moment and positive work accounted for 98% and 99% of the variance in step frequency. There were pronounced speed, phase (stance/swing), and work (positive/negative) dependent contributions of the different functional muscle groups during running, with extensive implications for conditioning and injury prevention.

Human foot muscle strength and its association with sprint acceleration, cutting and jumping performance, and kinetics in high-level athletes

The primary objective of this study was to investigate the relationship between metatarsophalangeal joint (MTPj) flexion torque and sprint acceleration, cutting and jumping performance, and kinetics. A secondary aim was to explore this relationship when MTP flexion strength was associated with other foot and lower limb neuromuscular outputs. After an initial MTPj flexion torque assessment using a custom-built dynamometer, 52 high-level athletes performed the following tasks on a force platform system: maximal sprint acceleration, 90-degree cutting, vertical and horizontal jumps, and foot-ankle hops. Their foot posture, foot passive stiffness and foot-ankle reactive strength were assessed using the Foot Posture Index, the Arch Height Index Measurement System and the Foot-Ankle Rebound Jump Test. Ankle plantarflexion and knee extension isometric torque were assessed using an isokinetic dynamometer. During maximal speed sprinting, multiple linear regressions suggested a major contribution of MTPj flexion torque, foot passive stiffness and foot-ankle reactive strength to explain 28% and 35% of the total variance in the effective vertical impulse and contact time. Ankle plantarflexor and quadriceps isometric torques were aggregately contributors of acceleration performance and separate contributors of cutting and jumping performance. In conclusion, MTPj flexion torque was more strongly associated with sprinting performance kinetics especially at high-speed.

A New Index to Evaluate Running Coordination Based on Notational Analysis

The aim of this study was 1) to define a new index to describe running coordination, named % of coordination, and 2) to examine whether it could represent an order parameter in relation to running velocity. Twelve international middle-distance athletes (six males and six females) performed three trials at easy, 5000 m pace and sprint velocities while filmed from a lateral view at 240 Hz. Notational analysis of six lower-limb key events corresponding to touchdown, mid-stance and flight phases was performed with high values of intra- (maximum standard deviation = 7 ms) and inter-operator (maximum systematic bias = 6 ms) reliability. Running velocity manipulations resulted in substantial and progressive increases in stride length, stride frequency (all p's < 0.001) and % of coordination (p < 0.001; η²p = 0.77), while duty factor showed a progressive reduction (p < 0.001, R2c = 0.86). However, % of coordination depended on the stride phase (p < 0.001; η²p = 0.78), with greater time gaps between key events in touchdown and mid-stance than in the flight phase. Results confirmed that % of coordination can illustrate changes in movement organisation, representing an easy tool for evaluating the running technique of competitive athletes.

Tapping Into Skeletal Muscle Biomechanics for Design and Control of Lower Limb Exoskeletons: A Narrative Review

Lower limb exoskeletons and exosuits ("exos") are traditionally designed with a strong focus on mechatronics and actuation, whereas the "human side" is often disregarded or minimally modeled. Muscle biomechanics principles and skeletal muscle response to robot-delivered loads should be incorporated in design/control of exos. In this narrative review, we summarize the advances in literature with respect to the fusion of muscle biomechanics and lower limb exoskeletons. We report methods to measure muscle biomechanics directly and indirectly and summarize the studies that have incorporated muscle measures for improved design and control of intuitive lower limb exos. Finally, we delve into articles that have studied how the human-exo interaction influences muscle biomechanics during locomotion. To support neurorehabilitation and facilitate everyday use of wearable assistive technologies, we believe that future studies should investigate and predict how exoskeleton assistance strategies would structurally remodel skeletal muscle over time. Real-time mapping of the neuromechanical origin and generation of muscle force resulting in joint torques should be combined with musculoskeletal models to address time-varying parameters such as adaptation to exos and fatigue. Development of smarter predictive controllers that steer rather than assist biological components could result in a synchronized human-machine system that optimizes the biological and electromechanical performance of the combined system.

Injury and performance related biomechanical differences between recreational and collegiate runners

Introduction

Running related injuries (RRI) are common, but factors contributing to running performance and RRIs are not commonly compared between different types of runners.

Methods

We compared running biomechanics previously linked to RRIs and performance between 27 recreational and 35 collegiate runners. Participants completed 5 overground running trials with their dominant limb striking a force plate, while outfitted with standardised footwear and 3-dimensional motion capture markers.

Results

Post hoc comparisons revealed recreational runners had a larger vertical loading rate (194.5 vs. 111.5 BW/s, p < 0.001) and shank angle (6.80 vs. 2.09, p < 0.001) compared with the collegiate runners who demonstrated greater vertical impulse (0.349 vs. 0.233 BWs, p < 0.001), negative impulse (-0.022 vs. -0.013 BWs, p < 0.001), positive impulse (0.024 vs. 0.014 BWs, p < 0.001), and propulsive force (0.390 vs. 0.333 BW, p = 0.002). Adjusted for speed, collegiate runners demonstrated greater total support moment (TSM), plantar flexor moment, knee extensor moment, hip extensor moment, and had greater proportional plantar flexor moment contribution and less knee extensor moment contribution to the TSM compared with recreational runners. Unadjusted for speed, collegiate runners compared with recreational had greater TSM and plantar flexor moment but similar joint contributions to the TSM.

Discussion

Greater ankle joint contribution may be more efficient and allow for greater capacity to increase speed. Improving plantarflexor function during running provides a strategy to improve running speed among recreational runners. Moreover, differences in joint kinetics and ground reaction force characteristics suggests that recreational and collegiate runners may experience different types of RRI.

Smooth and accurate predictions of joint contact force time-series in gait using over parameterised deep neural networks

Alterations in joint contact forces (JCFs) are thought to be important mechanisms for the onset and progression of many musculoskeletal and orthopaedic pain disorders. Computational approaches to JCFs assessment represent the only non-invasive means of estimating in-vivo forces; but this cannot be undertaken in free-living environments. Here, we used deep neural networks to train models to predict JCFs, using only joint angles as predictors. Our neural network models were generally able to predict JCFs with errors within published minimal detectable change values. The errors ranged from the lowest value of 0.03 bodyweight (BW) (ankle medial-lateral JCF in walking) to a maximum of 0.65BW (knee VT JCF in running). Interestingly, we also found that over parametrised neural networks by training on longer epochs (>100) resulted in better and smoother waveform predictions. Our methods for predicting JCFs using only joint kinematics hold a lot of promise in allowing clinicians and coaches to continuously monitor tissue loading in free-living environments.

The Effect of Fatigue on Lower Limb Joint Stiffness at Different Walking Speeds

The aim of this study was to assess the stiffness of each lower limb joint in healthy persons walking at varying speeds when fatigued. The study included 24 subjects (all male; age: 28.16 ± 7.10 years; height: 1.75 ± 0.04 m; weight: 70.62 ± 4.70 kg). A Vicon three-dimensional analysis system and a force plate were used to collect lower extremity kinematic and kinetic data from the participants before and after walking training under various walking situations. Least-squares linear regression equations were utilized to evaluate joint stiffness during single-leg support. Three velocities significantly affected the stiffness of the knee and hip joint (p < 0.001), with a positive correlation. However, ankle joint stiffness was significantly lower only at maximum speed (p < 0.001). Hip stiffness was significantly higher after walking training than that before training (p < 0.001). In contrast, knee stiffness after training was significantly lower than pre-training stiffness in the same walking condition (p < 0.001). Ankle stiffness differed only at maximum speed, and it was significantly higher than pre-training stiffness (p < 0.001). Walking fatigue appeared to change the mechanical properties of the joint. Remarkably, at the maximum walking velocity in exhaustion, when the load on the hip joint was significantly increased, the knee joint’s stiffness decreased, possibly leading to joint instability that results in exercise injury.

External Mechanical Work in Runners With Unilateral Transfemoral Amputation

Carbon-fiber running-specific prostheses have enabled individuals with lower extremity amputation to run by providing a spring-like leg function in their affected limb. When individuals without amputation run at a constant speed on level ground, the net external mechanical work is zero at each step to maintain a symmetrical bouncing gait. Although the spring-like “bouncing step” using running-specific prostheses is considered a prerequisite for running, little is known about the underlying mechanisms for unilateral transfemoral amputees. The aim of this study was to investigate external mechanical work at different running speeds for unilateral transfemoral amputees wearing running-specific prostheses. Eight unilateral transfemoral amputees ran on a force-instrumented treadmill at a range of speeds (30, 40, 50, 60, 70, and 80% of the average speed of their 100-m personal records). We calculated the mechanical energy of the body center of mass (COM) by conducting a time-integration of the ground reaction forces in the sagittal plane. Then, the net external mechanical work was calculated as the difference between the mechanical energy at the initial and end of the stance phase. We found that the net external work in the affected limb tended to be greater than that in the unaffected limb across the six running speeds. Moreover, the net external work of the affected limb was found to be positive, while that of the unaffected limb was negative across the range of speeds. These results suggest that the COM of unilateral transfemoral amputees would be accelerated in the affected limb’s step and decelerated in the unaffected limb’s step at each bouncing step across different constant speeds. Therefore, unilateral transfemoral amputees with passive prostheses maintain their bouncing steps using a limb-specific strategy during running.

The mechanical energetics of walking across the adult lifespan

PURPOSE

Understanding what constitutes normal walking mechanics across the adult lifespan is crucial to the identification and intervention of early decline in walking function. Existing research has assumed a simple linear alteration in peak joint powers between young and older adults. The aim of the present study was to quantify the potential (non)linear relationship between age and the joint power waveforms of the lower limb during walking.

METHODS

This was a pooled secondary analysis of the authors' (MT, KD, JJ) and three publicly available datasets, resulting in a dataset of 278 adults between the ages of 19 to 86 years old. Three-dimensional motion capture with synchronised force plate assessment was performed during self-paced walking. Inverse dynamics were used to quantity joint power of the ankle, knee, and hip, which were time-normalized to 100 stride cycle points. Generalized Additive Models for location, scale and shape (GAMLSS) was used to model the effect of cycle points, age, walking speed, stride length, height, and their interaction on the outcome of each joint's power.

RESULTS

At both 1m/s and 1.5 m/s, A2 peaked at the age of 60 years old with a value of 3.09 (95% confidence interval [CI] 2.95 to 3.23) W/kg and 3.05 (95%CI 2.94 to 3.16), respectively. For H1, joint power peaked with a value of 0.40 (95%CI 0.31 to 0.49) W/kg at 1m/s, and with a value of 0.78 (95%CI 0.72 to 0.84) W/kg at 1.5m/s, at the age of 20 years old. For H3, joint power peaked with a value of 0.69 (95%CI 0.62 to 0.76) W/kg at 1m/s, and with a value of 1.38 (95%CI 1.32 to 1.44) W/kg at 1.5m/s, at the age of 70 years old.

CONCLUSIONS

Findings from this study do not support a simple linear relationship between joint power and ageing. A more in-depth understanding of walking mechanics across the lifespan may provide more opportunities to develop early clinical diagnostic and therapeutic strategies for impaired walking function. We anticipate that the present methodology of pooling data across multiple studies, is a novel and useful research method to understand motor development across the lifespan.

The Training of Medium- to Long-Distance Sprint Performance in Football Code Athletes: A Systematic Review and Meta-analysis

Background

Within the football codes, medium-distance (i.e., > 20 m and ≤ 40 m) and long-distance (i.e., > 40 m) sprint performance and maximum velocity sprinting are important capacities for success. Despite this, no research has identified the most effective training methods for enhancing medium- to long-distance sprint outcomes.

Objectives

This systematic review with meta-analysis aimed to (1) analyse the ability of different methods to enhance medium- to long-distance sprint performance outcomes (0–30 m, 0 to > 30 m, and the maximum sprinting velocity phase [V_max]) within football code athletes and (2) identify how moderator variables (i.e., football code, sex, age, playing standard, phase of season) affected the training response.

Methods

We conducted a systematic search of electronic databases and performed a random-effects meta-analysis (within-group changes and pairwise between-group differences) to establish standardised mean differences (SMDs) with 95% confidence intervals and 95% prediction intervals. This identified the magnitude and direction of the individual training effects of intervention subgroups (sport only; primary, secondary, tertiary, and combined training methods) on medium- to long-distance sprint performance while considering moderator variables.

Results

In total, 60 studies met the inclusion criteria (26 with a sport-only control group), totalling 111 intervention groups and 1500 athletes. The within-group changes design reported significant performance improvements (small–moderate) between pre- and post-training for the combined, secondary (0–30 and 0 to > 30 m), and tertiary training methods (0–30 m). A significant moderate improvement was found in the V_max phase performance only for tertiary training methods, with no significant effect found for sport only or primary training methods. The pairwise between-group differences design (experimental vs. control) reported favourable performance improvements (large SMD) for the combined (0 to > 30 m), primary (V_max phase), secondary (0–30 m), and tertiary methods (all outcomes) when compared with the sport-only control groups. Subgroup analysis showed that the significant differences between the meta-analysis designs consistently demonstrated a larger effect in the pairwise between-group differences than the within-group change. No individual training mode was found to be the most effective. Subgroup analysis identified that football code, age, and phase of season moderated the overall magnitude of training effects.

Conclusions

This review provides the first systematic review and meta-analysis of all sprint performance development methods exclusively in football code athletes. Secondary, tertiary, and combined training methods appeared to improve medium-long sprint performance of football code athletes. Tertiary training methods should be implemented to enhance V_max phase performance. Nether sport-only nor primary training methods appeared to enhance medium to long sprint performance. Performance changes may be attributed to either adaptations specific to the acceleration or V_max phases, or both, but not exclusively V_max. Regardless of the population characteristics, sprint performance can be enhanced by increasing either the magnitude or the orientation of force an athlete can generate in the sprinting action, or both.

Trial Registration

OSF registration https://osf.io/kshqn/.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01552-4.

Mechanical energy and propulsion mechanics in roller-skiing double-poling at increasing speeds

Objectives

The aim of this study was to examine the effect of speed on mechanical energy fluctuations and propulsion mechanics in the double-poling (DP) technique of cross-country skiing.

Methods

Kinematics and dynamics were acquired while fourteen male skiers performed roller-skiing DP on a treadmill at increasing speeds (15, 21 and 27 km∙h^-1). Kinetic (E_kin), potential (E_pot), and total (E_body) body mechanical energy and pole power (P_pole) were calculated. Inverse dynamics was used to calculate arm power (P_arm). Trunk+leg power (P_T+L) was estimated, as was the power associated with body movements perpendicular to goal-direction (E.body⊥).

Results

E_kin and E_pot fluctuated out-of-phase throughout the cycle, at first sight indicating that pendulum-like behaviour occurs partly in DP. However, during the swing phase, the increase in E_pot (body heightening) was mainly driven by positive P_T+L, while the decrease in E_kin was lost to rolling friction, and during the poling phase, considerable positive P_arm generation occurs. Thus, possible exchange between E_kin and E_pot seem not to occur as directly and passively as in classic pendulum locomotion (walking). During the poling phase, E.body⊥fluctuated out-of-phase with P_pole, indicating a transfer of body energy to P_pole. In this way, power generated by trunk+leg mainly during the swing phase (body heightening) can be used in the poling phase as pole power. At all speeds, negative P_T+L occurred during the poling phase, suggesting energy absorption of body energy not transferred to pole power. Thus, DP seem to resemble bouncing ball-like behaviour more than pendulum at faster speeds. Over the cycle, P_arm contribution to P_pole (external power) was 63% at 15 km∙h^-1 and 66% at 21 and 27 km∙h^-1, with the remainder being P_T+L contribution.

Conclusions

When speed increases in level DP, both power production and absorption by trunk+leg actions increase considerably. This enhanced involvement of the legs at faster speeds is likely a prerequisite for effective generation of pole power at high speeds with very short poling times. However, the relative trunk+leg power contribution did not increase at the speeds studied here.

Sprinting kinematics and inter-limb coordination patterns at varying slope inclinations

Uphill training is applied to induce specific overload on the musculoskeletal system to improve sprinting mechanics. This study aimed to identify unique kinematic features of uphill sprinting at different slopes and to suggest practical implications based on comparisons we early stance phase. At take-off, steeper slopes induced significantly more extended joint angles and higher ROMs during the late stance phase. Compared with moderate slopes, more anti-phase coordination patterns were detected at steeper slopes. Thus, uphill sprinting at steeper slopes shares essential kinematic features with the early acceleration phase of level sprinting. Moderate inclinations induce biomechanical adaptations similar to those in the late acceleration phase of level sprinting. Hence, the specific transfer of uphill sprinting to acceleration depends on the slope inclinations.

The effect of speed on Achilles tendon forces and patellofemoral joint stresses in high-performing endurance runners

Achilles tendinopathy and patellofemoral pain are common running injuries associated with increased Achilles tendon (AT) forces and patellofemoral joint (PFJ) stresses. This study examined AT forces and PFJ stresses at different running speeds in high-performing endurance runners. Twenty runners ran overground at four running speeds (3.3, 3.9, 4.8, and 5.6 m/s). AT forces and PFJ stresses were estimated from kinematic and kinetic data. Repeated measures ANOVA with partial eta squared effect sizes was conducted to assess differences between running speeds. Increased peak AT forces (19.5%; p < 0.001) and loading rates (57.3%; p < 0.001) from 3.3 m/s to 5.6 m/s were observed. Cumulative AT loading was greater in the faster speeds compared to the slower speeds. Faster running speeds resulted in increased peak plantar flexor moments, increased peak plantar flexion angles, and a more flexed knee and an anterior center of pressure position at touchdown. Peak PFJ stress was lower in the slowest speed (3.3 m/s) compared to the faster running speeds (3.9-5.6 m/s; p = 0.005). PFJ stress loading rate significantly increased (43.6%; p < 0.001). Greater AT loading observed could be associated with strategies such as increased plantar flexor moments and altered lower body position at touchdown which are commonly employed to generate greater ground contact forces. Greater AT and PFJ loading rates were likely due to shorter ground contact times and therefore less time available to reach the peak. Running at faster speeds could increase the risk of developing Achilles tendinopathy and patellofemoral pain or limit recovery from these injuries without sufficient recovery.

Vertical and Horizontal Hop Performance: Contributions of the Hip, Knee, and Ankle

BACKGROUND

Single-leg vertical and horizontal hop tests are commonly used to assess performance of healthy athletes and as a measure of progress during rehabilitation from knee injury. It is unclear if they measure similar aspects of leg function, as the relative joint contributions of the hip, knee, and ankle joints during propulsion and landing are unknown.

HYPOTHESIS

The proportion of work done by the hip, knee, and ankle will not be the same for these 2 jump types and will vary for propulsive and landing phases.

STUDY DESIGN

Cross-sectional cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Twenty physically active participants completed instrumented single-leg hop analysis in both vertical and horizontal directions. Joint peak power, work generated or absorbed, and percentage contribution of each joint during propulsive and landing phases were compared between tasks using paired t tests.

RESULTS

Vertical hop was performed with roughly similar contributions of the hip, knee, and ankle for both propulsion (31%, 34%, 35%, respectively) and landing (29%, 34%, 37%, respectively). Horizontal hop distance was mostly (87%) determined by the hip and ankle (44% and 43%), but landing was mostly (65%) performed by the knee with lesser contribution from the hip and ankle (24% and 11%). Propulsive phase showed a proximal-to-distal temporal sequence for both hop types, but landing was more complex.

CONCLUSION

Performance during vertical and horizontal hops (jump height and jump distance, respectively) measures different aspects of hip, knee, and ankle function during the propulsive and landing phases.

CLINICAL RELEVANCE

Assessment of knee joint function during rehabilitation should not be done using a horizontal hop. The knee contributes about a third to vertical hop height, but only about an eighth to horizontal hop distance. Practitioners carrying out performance testing using either vertical or horizontal hops should be mindful of the relative contributions for meaningful training inferences to be derived.

The Training of Short Distance Sprint Performance in Football Code Athletes: A Systematic Review and Meta-Analysis

Background

Short-sprint (≤ 20 m) performance is an important quality for success in the football codes. Therefore, developing an evidence base for understanding training methods to enhance short-sprint performance is key for practitioners. However, current systematic reviews are limited by (1) a lack of focus on football code athletes, (2) a lack of consideration of all training modalities and (3) a failure to account for the normal training practices undertaken by intervention groups within their analysis. Therefore, this review aimed to (1) conduct a systematic review of the scientific literature evaluating training interventions upon short-sprint performance within football code athletes, (2) undertake a meta-analysis to assess the magnitude of change of sport-sprint performance following training interventions and (3) identify how moderator variables affect the training response.

Methods

A systematic search of electronic databases was conducted. A random-effects meta-analysis was performed to establish standardised mean difference with 95% confidence intervals. This identified the magnitude and direction of the individual training effects of intervention subgroups (primary, secondary, combined-specific, tertiary and combined training methods) on short-sprint performance while considering moderator variables (i.e., football code, sex, age, playing standard, phase of season).

Results

121 studies met the inclusion criteria, totalling 3419 athletes. Significant improvements (small-large) were found between pre- and post-training in short-sprint performance for the combined, secondary, tertiary and combined-specific training methods. No significant effect was found for primary or sport only training. No individual mode was found to be the most effective. Between-subgroup analysis identified that football code, age, playing standard and phase of season all moderated the overall magnitude of training effects.

Conclusions

This review provides the largest systematic review and meta-analysis of short-sprint performance development methods and the only one to assess football code athletes exclusively. Practitioners can apply combined, secondary and tertiary training methods to improve short-sprint performance within football code athletes. The application of sport only and primary methods does not appear to improve short-sprint performance. Regardless of the population characteristics, short-sprint performance can be enhanced by increasing either or both the magnitude and the orientation of force an athlete can generate in the sprinting action.

Trial Registration

OSF registration https://osf.io/kshqn/.

Electronic supplementary material

The online version of this article (10.1007/s40279-020-01372-y) contains supplementary material, which is available to authorized users.

Improvements in Match-Related Physical Performance of Professional Soccer Players After the Application of an on-Field Training Program for Hamstring Injury Rehabilitation

CONTEXT

Although there are multiple, validated return-to-play programs following hamstring strain injuries, no studies have evaluated their changes in match performance parameters.

OBJECTIVES

The aim of this study was twofold as follows: (1) to determine the changes in match-based physical performance parameters in professional soccer players before and after sustaining a hamstring strain injury and undergoing a soccer-specific rehabilitation program and (2) to observe the progress of these performance parameters 6 to 10 weeks after the player returned from injury.

DESIGN

Prospective, quasi-experimental longitudinal study.

SETTING

Soccer playing and training grounds.

PARTICIPANTS

Nineteen players suffering a hamstring strain injury from 2 male professional teams playing in the Spanish professional football league (La Liga) were followed during the 2015-2016, 2016-2017, and 2017-2018 seasons.

INTERVENTION

Participation in on-field training program following a hamstring injury.

MAIN OUTCOME MEASURES

Match global positioning system data were collected in the following stages: prior to injury (PRE), after return to play (RTP), program, and 6 to 10 weeks following RTP (C2). Peak velocities and distances ran at sprint velocities showed most likely improvements in C2 versus PRE, and very likely improvements in RTP versus PRE.

RESULTS

The distances ran at high and very high intensities, the average velocity, and work-to-rest ratio showed very likely improvements in C2 versus RTP and likely improvements in RTP versus PRE. Likely improvements were observed for all variables in C2 versus RTP. The authors' results showed an improvement of physical performance during competitive match after RTP, compared with PRE. There was a steady progression in the progress, and in 8 months following RTP, there was no injury reported in the players.

CONCLUSIONS

The current findings may indicate that the hamstring muscle complex not only recovered completely from the injury but could also withstand a greater training and match load reducing the risk of reinjury.

Age and training volume influence joint kinetics during running

Recently, we proposed the hypothesis that weekly running volume and preferred running pace may play a role in preserving ankle joint kinetics in middle-age runners as ankle joint kinetics were generally similar in young and middle-aged runners with similar running volume and preferred pace. To further address this hypothesis, we compared lower extremity joint kinetics between high and low training volume runners in both young and middle-aged groups. Joint kinetics calculated from 3D kinematic and ground reaction force data during over-ground running at 2.7 m·s^-1 from young and middle-aged runners who ran low or high weekly volume were analyzed. A two-factor analysis of variance was used to compare joint kinetics between age and running volume groups. Positive hip work was greater in middle-aged compared to young runners (P = .005). Plantarflexor torque (P = .009) and positive ankle work (P = .042) were greater in young compared to middle-aged runners. Positive ankle work was also greater in the high compared to the low volume group (P = .021). Finally, age by volume interactions were found for knee extensor torque (P = .024), negative knee work (P = .018), and positive knee work (P = .019) but not for ankle and hip joint kinetics. These findings suggest less distal-to-proximal difference in positive joint work with high running volume in both young and middle-aged runners as a result of greater power generation at the ankle. Given the age main effects, our findings are also the first to suggest the age-related distal-to-proximal shift in joint kinetics appears in middle-aged runners.

The effect of a running training intervention on ankle power generation in children and adolescents with cerebral palsy: A randomized controlled trial

BACKGROUND

Children and adolescents with cerebral palsy who are classified as Gross Motor Function Classification Scale level I or II are usually able to run but lack ankle power generation for push-off. The aim of this study was to analyze the efficacy of a running training program in improving ankle power generation in children and adolescents with cerebral palsy.

METHODS

This randomized controlled trial compared kinematic and spatiotemporal data collected during running from 38 children and adolescents with unilateral or bilateral cerebral palsy before and after a 12-week running program. Normalized speed, stride length, cadence, foot strike pattern, peak ankle power generation, peak hip flexor power generation in swing and propulsion strategy were calculated. Linear mixed models were developed to analyze differences between groups.

FINDINGS

At follow-up the intervention group had increased normalized speed of running (t = -3.68 p < .01) while the control group got slower (t = 3.17 p < .01). In running, children in Gross Motor Function Classification Scale level II in the intervention group increased ankle power (t = 2.49 p = .01) while the control group did not change (t = 0.38 p = .71). In sprinting, children in Gross Motor Function Classification Scale levels I and II in the intervention group maintained ankle power (level I t = 0.32 p = .75; level II t = 1.56 p = .12) while those in the control group decreased ankle power (level I t = 4.69 p < .01; level II t = 2.52 p = .01). Most within-group differences did not result in significant between-group differences at follow-up.

INTERPRETATION

Power generation for running may be responsive to targeted intervention in children with cerebral palsy.

The Biomechanics of Competitive Male Runners in Three Marathon Racing Shoes: A Randomized Crossover Study

BACKGROUND

We have shown that a prototype marathon racing shoe reduced the metabolic cost of running for all 18 participants in our sample by an average of 4%, compared to two well-established racing shoes. Gross measures of biomechanics showed minor differences and could not explain the metabolic savings.

OBJECTIVE

To explain the metabolic savings by comparing the mechanics of the shoes, leg, and foot joints during the stance phase of running.

METHODS

Ten male competitive runners, who habitually rearfoot strike ran three 5-min trials in prototype shoes (NP) and two established marathon shoes, the Nike Zoom Streak 6 (NS) and the adidas adizero Adios BOOST 2 (AB), at 16 km/h. We measured ground reaction forces and 3D kinematics of the lower limbs.

RESULTS

Hip and knee joint mechanics were similar between the shoes, but peak ankle extensor moment was smaller in NP versus AB shoes. Negative and positive work rates at the ankle were lower in NP shoes versus the other shoes. Dorsiflexion and negative work at the metatarsophalangeal (MTP) joint were reduced in the NP shoes versus the other shoes. Substantial mechanical energy was stored/returned in compressing the NP midsole foam, but not in bending the carbon-fiber plate.

CONCLUSION

The metabolic savings of the NP shoes appear to be due to: (1) superior energy storage in the midsole foam, (2) the clever lever effects of the carbon-fiber plate on the ankle joint mechanics, and (3) the stiffening effects of the plate on the MTP joint.

Habitual foot strike pattern does not affect simulated triceps surae muscle metabolic energy consumption during running

Foot strike pattern affects ankle joint work and triceps surae muscle-tendon dynamics during running. Whether these changes in muscle-tendon dynamics also affect triceps surae muscle energy consumption is still unknown. In addition, as the triceps surae muscle accounts for a substantial amount of the whole-body metabolic energy consumption, changes in triceps surae energy consumption may affect whole-body metabolic energy consumption. However, direct measurements of muscle metabolic energy consumption during dynamic movements is difficult. Model-based approaches can be used to estimate individual muscle and whole-body metabolic energy consumption based on Hill type muscle models. In this study, we use an integrated experimental and dynamic optimization approach to compute muscle states (muscle forces, lengths, velocities, excitations and activations) of 10 habitual midfoot/forefoot striking and nine habitual rearfoot striking runners while running at 10 and 14 km h^-1 The Achilles tendon stiffness of the musculoskeletal model was adapted to fit experimental ultrasound data of the gastrocnemius medialis muscle during ground contact. Next, we calculated triceps surae muscle and whole-body metabolic energy consumption using four different metabolic energy models provided in the literature. Neither triceps surae metabolic energy consumption (P>0.35) nor whole-body metabolic energy consumption (P>0.14) was different between foot strike patterns, regardless of the energy model used or running speed tested. Our results provide new evidence that midfoot/forefoot and rearfoot strike patterns are metabolically equivalent.

Lower-limb joint mechanics during maximum acceleration sprinting

We explored how humans adjust the stance phase mechanical function of their major lower-limb joints (hip, knee, ankle) during maximum acceleration sprinting. Experimental data [motion capture and ground reaction force (GRF)] were recorded from eight participants as they performed overground sprinting trials. Six alternative starting locations were used to obtain a dataset that incorporated the majority of the acceleration phase. Experimental data were combined with an inverse-dynamics-based analysis to calculate lower-limb joint mechanical variables. As forward acceleration magnitude decreased, the vertical GRF impulse remained nearly unchanged whereas the net horizontal GRF impulse became smaller as a result of less propulsion and more braking. Mechanical function was adjusted at all three joints, although more dramatic changes were observed at the hip and ankle. The impulse from the ankle plantar-flexor moment was almost always larger than those from the hip and knee extensor moments. Forward acceleration magnitude was linearly related to the impulses from the hip extensor moment (R ²=0.45) and the ankle plantar-flexor moment (R ²=0.47). Forward acceleration magnitude was also linearly related to the net work done at all three joints, with the ankle displaying the strongest relationship (R ²=0.64). The ankle produced the largest amount of positive work (1.55±0.17 J kg^-1) of all the joints, and provided a significantly greater proportion of the summed amount of lower-limb positive work as running speed increased and forward acceleration magnitude decreased. We conclude that the hip and especially the ankle represent key sources of positive work during the stance phase of maximum acceleration sprinting.

Energetics of Walking With a Robotic Knee Exoskeleton

The authors tested 4 young healthy subjects walking with a powered knee exoskeleton to determine if it could reduce the metabolic cost of locomotion. Subjects walked with a backpack loaded and unloaded, on a treadmill with inclinations of 0° and 15°, and outdoors with varied natural terrain. Participants walked at a self-selected speed (average 1.0 m/s) for all conditions, except incline treadmill walking (average 0.5 m/s). The authors hypothesized that the knee exoskeleton would reduce the metabolic cost of walking uphill and with a load compared with walking without the exoskeleton. The knee exoskeleton reduced metabolic cost by 4.2% in the 15° incline with the backpack load. All other conditions had an increase in metabolic cost when using the knee exoskeleton compared with not using the exoskeleton. There was more variation in metabolic cost over the outdoor walking course with the knee exoskeleton than without it. Our findings indicate that powered assistance at the knee is more likely to decrease the metabolic cost of walking in uphill conditions and during loaded walking rather than in level conditions without a backpack load. Differences in positive mechanical work demand at the knee for varying conditions may explain the differences in metabolic benefit from the exoskeleton.

The timing of locomotor propulsion in healthy adults walking at multiple speeds

In computational models of human walking, both magnitude and timing of locomotor propulsion are important for mechanical and metabolic efficiency, suggesting that these are likely tightly controlled by the neuromuscular system. Studies of actual human walking have focused primarily on magnitude-related measures of propulsion, often ignoring its timing. The purpose of this study was to quantify the timing of onset and peak propulsion relative to contralateral heel strike (HS) in healthy, young adults walking at multiple speeds. Propulsion was quantified at the ground-level using the anterior component of the anteroposterior ground reaction force, the limb-level using individual limb power, and the joint-level using ankle power. Contrary to common computational models, most of our timing-related measures indicated that propulsion occurred after contralateral HS. Timing-related measures of propulsion also changed with walking speed - as speed increased, individuals initiated propulsion earlier in the support phase. Timing of locomotor propulsion is theoretically important for walking performance, especially metabolic efficiency, and could therefore provide important clinical information. This study provides a set of relatively simple metrics that can be used to quantify propulsion and benchmark data that can be used for future comparisons with individuals or populations with gait impairments.

Lower extremity joints and muscle groups in the human locomotor system alter mechanical functions to meet task demand

To facilitate movement through mechanically complex environments, terrestrial animals have evolved locomotor systems capable of flexibly altering internal mechanics to meet external demands. They do this by shifting imposed workloads between joints/muscle groups (central mechanical flexibility) and/or by altering the function of individual joints/muscle groups (local mechanical flexibility). In human locomotion research, central mechanical flexibility is well established and regularly reported. Local mechanical flexibility at major lower extremity joints and muscle groups, however, has received relatively less attention. We used an emerging biomechanical analysis known as functional indexing to test the hypothesis that lower extremity joints and muscle groups within the human locomotor system alter their mechanical function to meet altered locomotor demands. Thirteen healthy adults walked across a range of speeds (0.8, 1.2, 1.6, 2.0 m s^-1) and slopes (0 deg, +5 deg, +10 deg) to determine whether hip, knee and ankle joints and their extensors and flexors altered their mechanical function in response to increased speed and slope. As walking speed increased, the knee and its extensors altered their function to behave more like mechanical springs while the ankle and its extensors altered their function to behave more like motors. As slope increased, all three joints and their extensors decreased spring- and damper-like behavior and increased motor-like behavior. Our results indicate that humans - similarly to many other terrestrial animals - utilize local mechanical flexibility to meet the demands of the locomotor task at hand.

Ankle Joint Dynamic Stiffness in Long-Distance Runners: Effect of Foot Strike and Shoes Features

Foot strike mode and footwear features are known to affect ankle joint kinematics and loading patterns, but how those factors are related to the ankle dynamic properties is less clear. In our study, two distinct samples of experienced long-distance runners: habitual rearfoot strikers (n = 10) and habitual forefoot strikers (n = 10), were analysed while running at constant speed on an instrumented treadmill in three footwear conditions. The joint dynamic stiffness was analysed for three subphases of the moment–angle plot: early rising, late rising and descending. Habitual rearfoot strikers displayed a statistically (p < 0.05) higher ankle dynamic stiffness in all combinations of shoes and subphases, except in early stance in supportive shoes. In minimal-supportive shoes, both groups had the lowest dynamic stiffness values for early and late rising (initial contact through mid-stance), whilst the highest stiffness values were at late rising in minimal shoes for both rearfoot and forefoot strikers (0.21 ± 0.04, 0.24 ± 0.06 (Nm/kg/°∙100), respectively). In conclusion, habitual forefoot strikers may have access to a wider physiological range of the muscle torque and joint angle. This increased potential may allow forefoot strikers to adapt to different footwear by regulating ankle dynamic stiffness depending upon the motor task.

A biomechanical study of the relationship between running velocity and three-dimensional lumbosacral kinetics

Faster running is not performed with proportional increase in all joint torque/work exertions. Although previous studies have investigated lumbopelvic kinetics for a single velocity, it is unclear whether each lumbopelvic torque should increase for faster running. We examined the relationship between running velocity and lumbopelvic kinetics. We calculated the three-dimensional lumbosacral kinetics of 10 male sprinters during steady-state running on a temporary indoor running track at five target velocities: 3.0 (3.20 ± 0.16), 4.5 (4.38 ± 0.18), 6.0 (5.69 ± 0.47), 7.5 (7.30 ± 0.41), and maximal sprinting (9.27 ± 0.36 m/s). The lumbosacral axial rotation torque increased more markedly (from 0.37 ± 0.06 to 1.99 ± 0.46 Nm/kg) than the extension and lateral flexion torques. The increase in the axial rotation torque was larger above 7.30 m/s. Conversely, the extension and lateral flexion torques plateaued when running velocity increased above 7.30 m/s. Similar results were observed for mechanical work. The results indicate that faster running required larger lumbosacral axial rotation torque. Conversely, the extension and lateral flexion torques were relatively invariant to running velocity above 7 m/s, implying that faster running below 7 m/s might increase the biomechanical loads causing excessive pelvic posterior tilt and excessive pelvic drop which has the potential to cause pain/injury related to lumbopelvic extensors and lateral flexors, whereas these biomechanical loads might not relate with running velocity above 7 m/s.

Propulsion strategy in running in children and adolescents with cerebral palsy

BACKGROUND

Running is a fundamental movement skill important for participation in physical activity. Children with cerebral palsy (CP) who are classified at Gross Motor Function Classification Scale (GMFCS) level I and II are able to run but may be limited by neuromuscular impairments.

RESEARCH QUESTION

To describe the propulsion strategy (PS) during running of children and adolescents with CP.

METHODS

This cross-sectional study used kinematic and kinetic data collected during running from 40 children and adolescents with unilateral or bilateral CP and 21 typically developing (TD) children. Maximum speed, peak ankle power generation (A2), peak hip flexor power generation in swing (H3) and PS (PS = A2/(A2 + H3)) were calculated. Linear mixed models were developed to analyze differences between groups.

RESULTS

Maximum speed, A2 and PS were significantly less in children with CP GMFCS level I than in TD children and significantly less in children in GMFCS level II than level I. For children with CP, A2 and PS were significantly smaller in affected legs than non-affected legs. In affected legs, H3 was significantly larger in children in GMFCS level II than GMFCS level I but not different between TD children and children in GFMCS level II.

SIGNIFICANCE

The contribution of ankle plantarflexor power to forward propulsion in running is reduced in young people with CP and is related to GMFCS level. This deficit appears to be compensated in part by increased hip flexor power generation but limits maximum sprinting speed.

Comparison of lower extremity joint mechanics between healthy active young and middle age people in walking and running gait

Progression of age can influence gait characteristics. Previous research has investigated lower extremity joint mechanics between young and elderly people in locomotion, however little is known about whether differences exist between young and middle age people. Ten young healthy subjects (22.8 ± 5.3 years) and ten middle age healthy subjects (50.7 ± 6.0 years) engaged in treadmill walking (from 0.8 to 2.0 m/s) and running (from 1.8 to 3.8 m/s). The middle age group had higher ankle plantar flexor moment angular impulse (p = 0.002), total support moment impulse (p = 0.016), and hip stance positive work (p = 0.029) across walking speeds. Additionally, the middle age group had higher knee flexion angle at ground contact in walking (p = 0.005) and running (p = 0.037). These findings indicate that moderate age affects changes in ankle and hip kinetic characteristics in walking, and knee kinematic patterns in both walking and running.

Mechanical energetics and dynamics of uphill double-poling on roller-skis at different incline-speed combinations

Objectives

The purpose of this study was to investigate the effect of different incline-speed combinations, at equal external power outputs, on the mechanics and energetics of the double-poling (DP) technique in cross-country skiing.

Methods

Fourteen elite male cross-country skiers performed treadmill DP on roller-skis at low, moderate, and high mean external power outputs (P_mean) up a shallow incline (5%, INC5), at which DP is preferred, and up a steep incline (12%, INC12), at which DP is not preferred. Speed was set to produce equal P_mean at both inclines. From recorded kinematics and dynamics, arm power (P_arm) and trunk+leg power (P_T+L) were derived, as were pole propulsion power (P_pole) and body mechanical energy perpendicular to the treadmill surface (E_body⊥).

Results

Over a locomotion cycle, the arms contributed 63% to P_mean at INC5 but surprisingly only 54% at INC12 (P<0.001), with no effect of P_mean (P = 0.312). Thus, the trunk and legs contributed substantially to P_mean both at INC5 (37%) and INC12 (46%). At both inclines, P_T+L generation during the swing phase increased approximately linearly with P_mean, which increased E_body⊥. Within the poling phase, ~30–35% of the body energy which was developed during the preceding swing phase was transferred into propulsive pole power on both inclines. At INC5, the amount of negative P_T+L during the poling phase was larger than at INC12, and this difference increased with P_mean.

Conclusions

The considerable larger amount of negative P_T+L during poling at INC5 than at INC12 indicate that the legs and trunk generate more power than ‘necessary’ during the swing phase and thus must absorb more energy during the poling phase. This larger surplus of P_T+L at INC5 seems necessary for positioning the body and poles so that high P_arm generation can occur in a short time. At INC12, less P_arm is generated, probably due to less advantageous working conditions for the arms, related to body and pole positioning. These incline differences seem linked to shorter swing and longer poling times during steep uphill DP, which are due to the increased influence of gravity and slower speed at steep inclines.

Development of a Mechanistic Hypothesis Linking Compensatory Biomechanics and Stepping Asymmetry during Gait of Transfemoral Amputees

Objective

Gait asymmetry is a common adaptation observed in lower-extremity amputees, but the underlying mechanisms that explain this gait behavior remain unclear for amputees that use above-knee prostheses. Our objective was to develop a working hypothesis to explain chronic stepping asymmetry in otherwise healthy amputees that use above-knee prostheses.

Methods

Two amputees (both through-knee; one with microprocessor knee, one with hydraulic knee) and fourteen control subjects participated. 3D kinematics and kinetics were acquired at normal, fast, and slow walking speeds. Data were analyzed for the push-off and collision limbs during a double support phase. We examined gait parameters to identify the stepping asymmetry then examined the external work rate (centre of mass) and internal (joint) power profiles to formulate a working hypothesis to mechanistically explain the observed stepping asymmetry.

Results

Stepping asymmetry at all three gait speeds in amputees was characterized by increased stance phase duration of the intact limb versus relatively normal stance phase duration for the prosthesis limb. The prosthesis limb contributed very little to positive and negative work during the double support phase of gait. To compensate, the intact leg at heel strike first provided aid to the deficient prosthetic ankle/foot during its push-off by doing positive work with the intact knee, which caused a delayed stance phase pattern. The resulting delay in toe-off of the intact limb then facilitated the energy transfer from the more robust intact push-off limb to the weaker colliding prosthesis side. This strategy was observed for both amputees.

Conclusions

There is a sound scientific rationale for a mechanistic hypothesis that stepping asymmetry in amputee participants is a result of a motor adaptation that is both facilitating the lower-leg trajectory enforced by the prosthesis while compensating for the lack of work done by the prosthesis, the cost of which is increased energy expenditure of the intact knee and both hips.

Lower-limb joint work and power are modulated during load carriage based on load configuration and walking speed

Soldiers regularly transport loads weighing >20 kg at slow speeds for long durations. These tasks elicit high energetic costs through increased positive work generated by knee and ankle muscles, which may increase risk of muscular fatigue and decrease combat readiness. This study aimed to determine how modifying where load is borne changes lower-limb joint mechanical work production, and if load magnitude and/or walking speed also affect work production. Twenty Australian soldiers participated, donning a total of 12 body armor variations: six different body armor systems (one standard-issue, two commercially available [cARM1-2], and three prototypes [pARM1-3]), each worn with two different load magnitudes (15 and 30 kg). For each armor variation, participants completed treadmill walking at two speeds (1.51 and 1.83 m/s). Three-dimensional motion capture and force plate data were acquired and used to estimate joint angles and moments from inverse kinematics and dynamics, respectively. Subsequently, hip, knee, and ankle joint work and power were computed and compared between armor types and walking speeds. Positive joint work over the stance phase significantly increased with walking speed and carried load, accompanied by 2.3-2.6% shifts in total positive work production from the ankle to the hip (p < 0.05). Compared to using cARM1 with 15 kg carried load, carrying 30 kg resulted in significantly greater hip contribution to total lower-limb positive work, while knee and ankle work decreased. Substantial increases in hip joint contributions to total lower-limb positive work that occur with increases in walking speed and load magnitude highlight the importance of hip musculature to load carriage walking.

Greater loss of horizontal force after a repeated-sprint test in footballers with a previous hamstring injury

OBJECTIVES

To quantify changes in running kinetics and kinematics during a repeated-sprint test in football players, and explore the sensitivity and specificity with which these variables can identify previous hamstring injury.

DESIGN

20 Western Australia State League footballers with previous unilateral hamstring injury and 20 players without completed a 10×6-s repeated-sprint test on a non-motorised treadmill dynamometer.

METHODS

Changes in horizontal force, vertical force, contact time and flight time were compared between previously injured and uninjured legs of participants.

RESULTS

Mean horizontal force production of the previously injured leg in the injured group was 13% lower (p=0.001), and this magnitude of change was used to identify the injured legs within the cohort with 77% specificity and 85% sensitivity. Furthermore, the area under the Receiver Operating Characteristics curve (0.846) demonstrated that the between-leg difference in mean horizontal force was a good instrument for identifying previous hamstring injury.

CONCLUSIONS

There is a greater fatigued-induced change in mean horizontal force during a repeated-sprint test in legs with previous hamstring injury than the non-injured legs of the injured players or the legs of uninjured players. Such asymmetry may contribute to impaired performance in football players returning from hamstring injury and also to the high rate of hamstring re-injury. Rehabilitation and return-to-play strategies should emphasise a reduction in asymmetry, particularly during repeated high-intensity efforts. Furthermore, binary regression and Receiver Operating Characteristic analyses suggest that changes in mean horizontal force could be used to assess risk of hamstring injury, re-injury and/or return to play.

Isokinetic strength assessment offers limited predictive validity for detecting risk of future hamstring strain in sport: a systematic review and meta-analysis

Objective

To examine the value of isokinetic strength assessment for predicting risk of hamstring strain injury, and to direct future research into hamstring strain injuries.

Design

Systematic review.

Data sources

Database searches for Medline, CINAHL, Embase, AMED, AUSPORT, SPORTDiscus, PEDro and Cochrane Library from inception to April 2017. Manual reference checks, ahead-of-press and citation tracking.

Eligibility criteria for selecting studies

Prospective studies evaluating isokinetic hamstrings, quadriceps and hip extensor strength testing as a risk factor for occurrence of hamstring muscle strain.

Methods

Independent search result screening. Risk of bias assessment by independent reviewers using Quality in Prognosis Studies tool. Best evidence synthesis and meta-analyses of standardised mean difference (SMD).

Results

Twelve studies were included, capturing 508 hamstring strain injuries in 2912 athletes. Isokinetic knee flexor, knee extensor and hip extensor outputs were examined at angular velocities ranging 30–300°/s, concentric or eccentric, and relative (Nm/kg) or absolute (Nm) measures. Strength ratios ranged between 30°/s and 300°/s. Meta-analyses revealed a small, significant predictive effect for absolute (SMD=−0.16, P=0.04, 95% CI −0.31 to −0.01) and relative (SMD=−0.17, P=0.03, 95% CI −0.33 to −0.014) eccentric knee flexor strength (60°/s). No other testing speed or strength ratio showed statistical association. Best evidence synthesis found over half of all variables had moderate or strong evidence for no association with future hamstring injury.

Summary/Conclusion

Despite an isolated finding for eccentric knee flexor strength at slow speeds, the role and application of isokinetic assessment for predicting hamstring strain risk should be reconsidered, particularly given costs and specialised training required.

Design of a lightweight, tethered, torque-controlled knee exoskeleton

Lower-limb exoskeletons show promise for improving gait rehabilitation for those with chronic gait abnormalities due to injury, stroke or other illness. We designed and built a tethered knee exoskeleton with a strong lightweight frame and comfortable, four-point contact with the leg. The device is structurally compliant in select directions, instrumented to measure joint angle and applied torque, and is lightweight (0.76 kg). The exoskeleton is actuated by two off-board motors. Closed loop torque control is achieved using classical proportional feedback control with damping injection in conjunction with iterative learning. We tested torque measurement accuracy and found root mean squared (RMS) error of 0.8 Nm with a max load of 62.2 Nm. Bandwidth was measured to be phase limited at 45 Hz when tested on a rigid test stand and 23 Hz when tested on a person's leg. During bandwidth tests peak extension torques were measured up to 50 Nm. Torque tracking was tested during walking on a treadmill at 1.25 m/s with peak flexion torques of 30 Nm. RMS torque tracking error averaged over a hundred steps was 0.91 Nm. We intend to use this knee exoskeleton to investigate robotic assistance strategies to improve gait rehabilitation and enhance human athletic ability.

Joint Torque and Mechanical Power of Lower Extremity and Its Relevance to Hamstring Strain during Sprint Running

The aim of this study was to quantify the contributions of lower extremity joint torques and the mechanical power of lower extremity muscle groups to further elucidate the loadings on hamstring and the mechanics of its injury. Eight national-level male sprinters performed maximum-velocity sprint running on a synthetic track. The 3D kinematic data and ground reaction force (GRF) were collected synchronously. Intersegmental dynamics approach was used to analyze the lower extremity joint torques and power changes in the lower extremity joint muscle groups. During sprinting, the GRF during the stance phase and the motion-dependent torques (MDT) during the swing phase had a major effect on the lower extremity movements and muscle groups. Specifically, during the stance phase, torque produced and work performed by the hip and knee muscles were generally used to counteract the GRF. During the swing phase, the role of the muscle torque changed to mainly counteract the effect of MDT to control the movement direction of the lower extremity. Meanwhile, during the initial stance and late swing phases, the passive torques, namely, the ground reaction torques and MDT produced by the GRF and the inertial movement of the segments of the lower extremity, applied greater stress to the hamstring muscles.

Knee Loading Deficits During Dynamic Tasks in Individuals Following Anterior Cruciate Ligament Reconstruction

Study Design Controlled laboratory study, cross-sectional. Background Well-documented deficits in sagittal plane knee loading during dynamic tasks indicate that individuals limit the magnitude of knee loading following anterior cruciate ligament reconstruction (ACLR). It is unknown how these individuals modulate the speed of knee flexion during loading, which is particularly important as they progress to running during rehabilitation. Objective To investigate how individuals following ACLR perform dynamic knee loading tasks compared to healthy controls. Methods Two groups of recreationally active individuals participated: 15 healthy controls and 15 individuals post-ACLR (ACLR group). Participants performed 3 trials of overground running and a single-limb loading (SLL) task. Sagittal plane range of motion, peak knee extensor moment, peak knee flexion angular velocity, peak knee power absorption, and rate of knee extensor moment were calculated during deceleration. A mixed-factor multivariate analysis of variance was performed to compare differences in variables between groups (ACLR and control), limbs (within ACLR), and tasks (within control). Results Knee power absorption, knee flexion angular velocity, and rate of knee extensor moment were lower in reconstructed limbs (for the SLL task: 5.6 W/kg, 325.8°/s, and 10.5 Nm/kg/s, respectively; for running: 11.8 W/kg, 421.4°/s, and 38.2 Nm/kg/s, respectively) compared to nonsurgical limbs (for the SLL task: 9.7 W/kg, 432.0°/s, and 19.1 Nm/kg/s, respectively; for running: 18.8 W/kg, 494.1°/s, and 72.8 Nm/kg/s, respectively) during both tasks (P<.001). The magnitudes of between-limb differences in knee flexion angular velocity were similar in both tasks. Conclusion Despite lower loading demands during SLL, individuals post-ACLR exhibit deficits in knee dynamics during SLL and running, suggesting an inability or reluctance to dynamically accommodate forces at the knee when progressing to running in rehabilitation. J Orthop Sports Phys Ther 2017;47(6):411-419. doi:10.2519/jospt.2017.6912.

Alteration of swing leg work and power during human accelerated sprinting

This study investigated changes in lower-extremity joint work and power during the swing phase in a maximal accelerated sprinting. Twelve male sprinters performed 60 m maximal sprints while motion data was recorded. Lower-extremity joint work and power during the swing phase of each stride for both legs were calculated. Positive hip and negative knee work (≈4.3 and ≈−2.9 J kg⁻¹) and mean power (≈13.4 and ≈−8.7 W kg⁻¹) during the entire swing phase stabilized or decreased after the 26.2±1.1 (9.69±0.25 m s⁻¹) or 34.3±1.5 m mark (9.97±0.26 m s⁻¹) during the acceleration phase. In contrast, the hip negative work and mean power during the early swing phase (≈7-fold and ≈3.7-fold increase in total), as well as the knee negative work and power during the terminal swing phase (≈1.85-fold and ≈2-fold increase in total), increased until maximal speed. Moreover, only the magnitudes of increases in negative work and mean power at hip and knee joints during the swing phase were positively associated with the increment of running speed from the middle of acceleration phase. These findings indicate that the roles of energy generation and absorption at the hip and knee joints shift around the middle of the acceleration phase as energy generation and absorption at the hip during the late swing phase and at the knee during early swing phase are generally maintained or decreased, and negative work and power at hip during the early swing phase and at knee during the terminal swing phase may be responsible for increasing running speed when approaching maximal speed.

Summary: The roles of respective swing leg joints intricately change with increases in running speed during accelerated sprinting.

Adjustments with running speed reveal neuromuscular adaptations during landing associated with high mileage running training

It remains to be determined whether running training influences the amplitude of lower limb muscle activations before and during the first half of stance and whether such changes are associated with joint stiffness regulation and usage of stored energy from tendons. Therefore, the aim of this study was to investigate neuromuscular and movement adaptations before and during landing in response to running training across a range of speeds. Two groups of high mileage (HM; >45 km/wk, n = 13) and low mileage (LM; <15 km/wk, n = 13) runners ran at four speeds (2.5-5.5 m/s) while lower limb mechanics and electromyography of the thigh muscles were collected. There were few differences in prelanding activation levels, but HM runners displayed lower activations of the rectus femoris, vastus medialis, and semitendinosus muscles postlanding, and these differences increased with running speed. HM runners also demonstrated higher initial knee stiffness during the impact phase compared with LM runners, which was associated with an earlier peak knee flexion velocity, and both were relatively unchanged by running speed. In contrast, LM runners had higher knee stiffness during the slightly later weight acceptance phase and the disparity was amplified with increases in speed. It was concluded that initial knee joint stiffness might predominantly be governed by tendon stiffness rather than muscular activations before landing. Estimated elastic work about the ankle was found to be higher in the HM runners, which might play a role in reducing weight acceptance phase muscle activation levels and improve muscle activation efficiency with running training.NEW & NOTEWORTHY Although neuromuscular factors play a key role during running, the influence of high mileage training on neuromuscular function has been poorly studied, especially in relation to running speed. This study is the first to demonstrate changes in neuromuscular conditioning with high mileage training, mainly characterized by lower thigh muscle activation after touch down, higher initial knee stiffness, and greater estimates of energy return, with adaptations being increasingly evident at faster running speeds.

Effects of toe-out and toe-in gait with varying walking speeds on knee joint mechanics and lower limb energetics

Toe-out/-in gait has been prescribed in reducing knee joint load to medial knee osteoarthritis patients. This study focused on the effects of toe-out/-in at different walking speeds on first peak knee adduction moment (fKAM), second peak KAM (sKAM), knee adduction angular impulse (KAAI), net mechanical work by lower limb as well as joint-level contribution to the total limb work during level walking. Gait analysis of 20 healthy young adults was done walking at pre-defined normal (1.18m/s), slow (0.85m/s) and fast (1.43m/s) walking speeds with straight-toe (natural), toe-out (15°>natural) and toe-in (15°<natural). Repeated measure ANOVA (p<0.05) with post-hoc Tukey's test was applied for statistical analysis. Toe-out gait increased fKAM at all walking speeds (highest at normal speed) while toe-in gait reduced fKAM at all speeds (highest at fast walking speed). Toeing-in reduced KAAI at all speeds while toeing-out affected KAAI only at normal speed. Increasing walking speed generally increased fKAM for all foot positions, but it did not affect sKAM considerably. Slowing down the speed, increased KAAI significantly at all foot positions except for toe-in. At slow walking speed, hip and knee joints were found to be major energy contributors for toe-in and toe-out respectively. At higher walking speeds, these contributions were switched. The ankle joint remained unaffected by changing walking speeds and foot progression angles. Toe-out/-in gait modifications affected knee joint kinetics and lower limb energetics at all walking speeds. However, their effects were inconsistent at different speeds. Therefore, walking speed should be taken into account when prescribing toe-out/-in gait.

Comparison of crossover and jab step start techniques for base stealing in baseball

Base stealing is an important tactic for increasing the chance of scoring in baseball. This study aimed to compare the crossover step (CS) and jab step (JS) starts for base stealing start performance and to clarify the differences between CS and JS starts in terms of three-dimensional lower extremity joint kinetics. Twelve male baseball players performed CS and JS starts, during which their motion and the force they applied to the ground were simultaneously recorded using a motion-capture system and two force platforms. The results showed that the normalised average forward external power, the average forward-backward force exerted by the left leg, and the forward velocities of the whole body centre of gravity generated by both legs and the left leg were significantly higher for the JS start than for the CS start. Moreover, the positive work done by hip extension during the left leg push-off was two-times greater for the JS start than the CS start. In conclusion, this study has demonstrated that the jab step start may be the better technique for a base stealing start and that greater positive work produced by left hip extension is probably responsible for producing its larger forward ground reaction force.

Modulation of upper limb joint work and power during sculling while ballasted with varying loads

The human musculoskeletal system must modulate work and power output in response to substantial alterations in mechanical demands associated with different tasks. In particular, in water, upper limb muscles must perform net positive work to replace the energy lost against the dissipative fluid load. Where in the upper limb are work and power developed? Is mechanical output modulated similarly at all joints, or are certain muscle groups favored? This study examined, for the first time, how work and power per stroke are distributed at the upper limb joints in seven male participants sculling while ballasted with 4, 6, 8, 10 and 12 kg. Upper limb kinematics was captured and used to animate body virtual geometry. Net wrist, elbow and shoulder joint work and power were subsequently computed through a novel approach integrating unsteady numerical fluid flow simulations and inverse dynamics modeling. Across a threefold increase in load, total work and power significantly increased from 0.38±0.09 to 0.67±0.13 J kg^-1, and 0.47±0.06 to 1.14±0.16 W kg^-1, respectively. Shoulder and elbow equally supplied >97% of the upper limb total work and power, coherent with the proximo-distal gradient of work performance in the limbs of terrestrial animals. Individual joint relative contributions remained constant, as observed on land during tasks necessitating no net work. The apportionment of higher work and power simultaneously at all joints in water suggests a general motor strategy of power modulation consistent across physical environments, limbs and tasks, regardless of whether or not they demand positive net work.

Effects of two neuromuscular training programs on running biomechanics with load carriage: a study protocol for a randomised controlled trial

Background

In recent years, athletes have ventured into ultra-endurance and adventure racing events, which tests their ability to race, navigate, and survive. These events often require race participants to carry some form of load, to bear equipment for navigation and survival purposes. Previous studies have reported specific alterations in biomechanics when running with load which potentially influence running performance and injury risk. We hypothesize that a biomechanically informed neuromuscular training program would optimize running mechanics during load carriage to a greater extent than a generic strength training program.

Methods

This will be a two group, parallel randomized controlled trial design, with single assessor blinding. Thirty healthy runners will be recruited to participate in a six weeks neuromuscular training program. Participants will be randomized into either a generic training group, or a biomechanically informed training group. Primary outcomes include self-determined running velocity with a 20 % body weight load, jump power, hopping leg stiffness, knee extensor and triceps-surae strength. Secondary outcomes include running kinetics and kinematics. Assessments will occur at baseline and post-training.

Discussion

To our knowledge, no training programs are available that specifically targets a runner’s ability to carry load while running. This will provide sport scientists and coaches with a foundation to base their exercise prescription on.

Trial registration

ANZCTR (ACTRN12616000023459) (14 Jan 2016)

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1271-9) contains supplementary material, which is available to authorized users.