Ground reaction force metrics are not strongly correlated with tibial bone load when running across speeds and slopes: Implications for science, sport and wearable tech

Can Ground Reaction Force Variables Preidentify the Probability of a Musculoskeletal Injury in Collegiate Distance Runners?

The incidence of lower extremity injuries in collegiate distance runners is ∼20%. Identification of a runner sustaining a potential injury remains challenging. This exploratory, cross-institutional study sought to determine whether ground reaction force (GRF) characteristics during steady-state running could identify competitive collegiate distance runners who would later sustain lower extremity injuries. Normative boundaries for 10 GRF variables during braking and propulsion were established for noninjured runners using median ± scaled median absolute deviation. A subanalysis was conducted on runners with and without impact peaks in vertical GRF to mitigate the influence of impact peaks on GRF variables. We hypothesized that prior to injury, runners who later developed an injury would have more GRF variables outside of the normative boundaries than noninjured runners. Using Cliff's method, a rank-based, nonparametric method for comparing 2 independent groups, we found no statistically significant difference between the number of variables outside the boundaries for injured and noninjured runners overall (P = .17). However, injured runners without impact peaks had more variables outside the normative boundaries than noninjured runners (P < .001). This novel analytical approach demonstrates the potential for preidentifying collegiate distance runners without impact peaks who may be at risk for injury.

Effect of acute performance fatigue on tibial bone strain during basketball maneuvers

The tibia is one of the most common sites for bone stress injury (BSI) in active individuals. BSIs are thought to occur in response to damage accumulation from repetitive loading below the tissue's yield limit. The effect of fatigue on musculoskeletal biomechanics and tibial bone strain during athletic movements remains unclear. In this study, participant-specific finite element (FE) and musculoskeletal models in 10 collegiate-basketball players were used to analyze the effect of acute performance fatigue on joint kinematics and torques, ground reaction forces (GRFs), and the magnitude and distribution of tibial bone strains during select basketball maneuvers. Participants were fatigued by performing repeated exercises wearing a weighted vest until their vertical jump height decreased by 20 %. Fatigue reduced the vertical GRF during midstance of a jump task, and lowered hip and knee peak extension torques and ankle plantarflexion. However, fatigue had limited impact on tibial bone strain magnitude and distribution during jumping. In contrast, there was a shift in peak strain timing following fatigue during a lateral cut task and reduced strain at various times of stance during sprinting. The results suggest that fatigue was induced and, if anything, reduced tibial bone strain. As increased bone strain is thought to be associated with increased BSI risk, the reduced strain observed in the current study suggests that fatigue may actually be partly protective, possibly as a result of reduced muscle activation and force production.

Repeatability of Vertical Ground Reaction Force Estimation During Running on the Athletics Track on 3 Different Days

To increase understanding in development of running injuries, the biomechanical load over time should be studied. Ground reaction force (GRF) is an important parameter for biomechanical analyses and is typically measured in a controlled lab environment. GRF can be estimated outdoors, however, the repeatability of this estimation is unknown. Repeatability is a crucial aspect if a measurement is repeated over prolonged periods of time. This study investigates the repeatability of a GRF estimation algorithm using inertial measurement units during outdoor running. Twelve well-trained participants completed 3 running sessions on different days, on an athletics track, instrumented with inertial measurement units on the lower legs and pelvis. Vertical accelerations were used to estimate the GRF. The goal was to assess the algorithm's repeatability across 3 sessions in a real-world setting, aiming to bridge the gap between laboratory and outdoor measurements. Results showed a good level of repeatability, with an intraclass correlation coefficient (2, k) of .86 for peak GRF, root mean square error of .08 times body weight (3.5%) and Pearson correlation coefficients exceeding .99 between the days. This is the first study looking into the day-to-day repeatability of the estimation of GRF, showing the potential to use this algorithm daily.

Effect of double- density foot orthoses on ground reaction forces and lower limb muscle activities during running in adults with and without pronated feet

BACKGROUND

The analysis of ground reaction forces and muscle activities during walking or running can help clinicians decide on the usage of foot orthoses, particularly in individuals with pronated feet. Here, we aimed to investigate the effects of double- density foot orthoses on running kinetics and lower limb muscle activities in adults with and without pronated feet.

METHODS

Forty male adults with pronated feet (PF: n = 20, age = 25.4 ± 0.3 years, body-mass-index [BMI] = 23.3 ± 1.2 kg/m2) and without pronated feet (WPF: n = 20, age = 26.4 ± 1.0 years, BMI = 24.0 ± 0.7 kg/m2) volunteered to participate in this study. The study was registered with the Iranian Registry of Clinical Trials (IRCT20220129053865N1). Ground reaction forces (Fx, Fy, Fz) and lower limb muscle activities (e.g., m. gastrocnemius) were recorded using surface electromyography (EMGs) during running at a constant speed of 3.2 m/s over an 18-m walkway with an embedded force plate. EMGs were normalized to maximum voluntary isometric contractions.

RESULTS

Test-retest reliability for running speed data was excellent for PF and WPF groups and for the entire study cohort with intraclass correlation coefficients > 0.95. The 2-way ANOVA revealed lower peak Fz (p = 0.011; d = 1.226), lower time-to-peak for Fx (p = 0.023, d = 1.068), Fy (p = 0.025, d = 1.056), and Fz (p = 0.045, d = 0.931) during running with foot orthoses in PF individuals. During the loading phase, PF and WPF exhibited lower gastrocnemius (WPF: p = 0.005, d = 1.608; PF: p = 0.001, d = 2.430 ) and vastus medialis (WPF: p < 0.001, d = 2.532; PF: p < 0.001, d = 2.503) activity when running with foot orthoses.

CONCLUSIONS

Although double- density foot orthoses resulted in some beneficial biomechanical effects such as lower muscle activation (e.g., m. vastus medialis) in individuals with PF, foot orthoses constructions need further modifications to achieve even better running mechanics to enhance performance and lower limbinjury occurrence.

TRIAL REGISTRATION

IRCT20220129053865N1 (Registration date 19/08/2024).

Does the Fatigue Induced by a 30-Minute Run Affect the Lower Limb Acceleration Spikes' Asymmetries?

Running-induced fatigue affects several biomechanical parameters, and yet few studies are focused on the acceleration spikes' asymmetries. This study aimed to evaluate the effects of a 30 min run on lower limbs spikes' asymmetries. Eighteen recreational runners (35.6 ± 7.5 years; seven women) performed a treadmill running protocol at a moderate speed and acceleration spikes' asymmetries and kinematic (temporal) parameters were measured via accelerometers-on the tibias and sacrum-and photogrammetry. Acceleration spikes' parameters were continuously measured and averaged per minute to assess the relationship between fatigue and acceleration spike asymmetries via a linear regression model. Right tibial acceleration spikes increased over time (r = 0.9; p < 0.001) and left tibia spikes decreased (r = 0.78; p < 0.001), with a rise in tibial load asymmetry from 9% to 25% at the end (r = 0.98; p < 0.001). This study suggest that fatigue affects the acceleration spikes of the two legs differently, with increasingly greater acceleration spikes in the right (dominant) leg. These findings should be considered, as greater asymmetries are related to overuse injuries and lower efficiency. Also, in studies focusing on running mechanics with fatigue, it is recommended that researchers collect data from both limbs, and not only from the right (dominant) leg.

Evaluating the Biomechanical Effects and Real-World Usability of a Novel Ankle Exo for Runners

Achilles tendon overuse injuries are common for long-distance runners. Ankle exos (exoskeletons and exosuits) are wearable devices that can reduce Achilles tendon loading and could potentially aid in the rehabilitation or prevention of these injuries by helping to mitigate and control tissue loading. However, most ankle exos are confined to controlled lab testing and are not practical to use in real-world running. Here, we present the design of an unpowered ankle exo aimed at reducing the load on the Achilles tendon during running while also overcoming key usability challenges for runners outside the lab. We fabricated a 500-gram ankle exo prototype that attaches to the outside of a running shoe. We then evaluated the reliability, acceptability, transparency during swing phase, and offloading assistance provided during treadmill and outdoor running tests. We found that the exo prototype reliably assisted 95-99% of running steps during indoor and outdoor tests, was deemed acceptable by more than 80% of runners in terms of comfort and feel, and did not impede natural ankle dorsiflexion during leg swing for 86% of runners. During indoor tests, the exo reduced peak Achilles tendon loads for most participants during running; however, reductions varied considerably, between near zero and 12%, depending on the participant, condition (speed and slope) and the precise tendon load metric used. This next-generation ankle exo concept could open new possibilities for longitudinal and real-world research on runners, or when transitioning into the return-to-sport phase after an Achilles tendon injury.

Design of a Portable Biofeedback System for Monitoring Femoral Load During Partial Weight-Bearing Walking

Patients with femoral fractures are typically advised to undergo partial weight-bearing (PWB) gait training during the postoperative rehabilitation period to facilitate bone healing and restore lower limb function. Various current portable biofeedback devices monitor ground reaction force (GRF) to assess the femoral loading of patients with fractures during PWB walking. However, due to the influence of muscle forces and the complexity of load transmission in the lower limbs, GRF may not accurately reflect the internal forces in the femur during walking. In this study, we developed an innovative biofeedback device that incorporates inertial measurement units and pressure-sensitive insoles. Utilizing data collected from 12 participants, a physics-informed temporal convolutional network (PITCN) method was proposed to estimate the internal femoral loading. The performance of the PITCN method was compared with two other machine learning approaches and a baseline method, demonstrating superior predictive capabilities. The study also revealed that, irrespective of the weight-bearing level during walking, the peak femoral loading consistently exceeded the peak GRF. Moreover, the timing of the peak values for these two forces within each gait cycle may not always coincide. These findings further emphasize the necessity of monitoring and providing feedback on the actual femoral loading, rather than solely relying on GRF, during PWB gait training for patients with fractures. The developed system is a non-invasive, reliable, and portable device that provides audio feedback. It shows potential as a viable solution for gait rehabilitation training in daily life, contributing to the enhancement of patients' rehabilitation outcomes.

Estimating Ground Reaction Forces From Inertial Sensors

OBJECTIVE

Our aim is to determine if data collected with inertial measurement units (IMUs) during steady-state running could be used to estimate ground reaction forces (GRFs) and to derive biomechanical variables (e.g., contact time, impulse, change in velocity) using lightweight machine-learning approaches. In contrast, state-of-the-art estimation using LSTMs suffers from prohibitive inference times on edge devices, requires expensive training and hyperparameter optimization, and results in black box models.

METHODS

We proposed a novel lightweight solution, SVD Embedding Regression (SER), using linear regression between SVD embeddings of IMU data and GRF data. We also compared lightweight solutions including SER and k-Nearest-Neighbors (KNN) regression with state-of-the-art LSTMs.

RESULTS

We performed extensive experiments to evaluate these techniques under multiple scenarios and combinations of IMU signals and quantified estimation errors for predicting GRFs and biomechanical variables. We did this using training data from different athletes, from the same athlete, or both, and we explored the use of acceleration and angular velocity data from sensors at different locations (sacrum and shanks).

CONCLUSION

Our results illustrated that lightweight solutions such as SER and KNN can be similarly accurate or more accurate than LSTMs. The use of personal data reduced estimation errors of all methods, particularly for most biomechanical variables (as compared to GRFs); moreover, this gain was more pronounced in the lightweight methods.

SIGNIFICANCE

The study of GRFs is used to characterize the mechanical loading experienced by individuals in movements such as running, which is clinically applicable to identify athletes at risk for stress-related injuries.

Validation of Markerless Motion Capture for Soldier Movement Patterns Assessment Under Varying Body-Borne Loads

Field performance of modern soldiers is affected by an increase in body-borne load due to technological advancements related to their armour and equipment. In this project, the Theia3D markerless motion capture system was compared to the marker-based gold standard for capturing movement patterns of participants wearing various body-borne loads. The aim was to estimate lower body joint kinematics, gastrocnemius lateralis and medialis muscle activation patterns, and lower body joint reaction forces from the two motion capture systems. Data were collected on 16 participants performing three repetitions of walking and running under four body-borne load conditions by both motion capture systems simultaneously. A complete musculoskeletal analysis was completed in OpenSim. Strong correlations ( r > 0.8 ) and acceptable differences were observed between the kinematics of the marker-based and markerless systems. Timing of muscle activations of the gastrocnemius lateralis and medialis, as estimated through OpenSim from both systems, agreed with the ones measured using electromyography. Joint reaction force results showed a very strong correlation ( r > 0.9 ) between the systems; however, the markerless model estimated greater joint reaction forces when compared the marker-based model due to differences in muscle recruitment strategy. Overall, this research highlights the potential of markerless motion capture to track participants wearing body-borne loads.

Differences in Body Composition, Bone Density, and Tibial Microarchitecture in Division I Female Athletes Participating in Different Impact Loading Sports

Sport participation affects body composition and bone health, but the association between sport, body composition, and bone health in female athletes is complex. We compared areal bone mineral density (aBMD, DXA) and tibial volumetric bone mineral density (vBMD), geometry, microarchitecture, and estimated strength (HR-pQCT) in cross-country runners (n = 22), gymnasts (n = 23) and lacrosse players (n = 35), and investigated associations of total body lean mass (TBLM), team, and their interaction with tibial bone outcomes. Total body (TB), total hip (TH), femoral neck (FN), and lumbar spine (LS) aBMD were higher in gymnasts than runners (p < 0.001); FN and LS aBMD were higher in gymnasts than lacrosse players (p ≤ 0.045); and TB, TH, FN, and LS aBMD were higher in lacrosse players than runners (p ≤ 0.013). At the distal tibial metaphysis, total area (Tt.Ar) was higher in gymnasts than runners (p = 0.004); cortical area and thickness (Ct.Ar, Ct.Th) were higher in lacrosse players than runners (p ≤ 0.044); trabecular separation (Tb.Sp) was higher in runners than gymnasts (p = 0.031); and failure load was higher in both gymnasts and lacrosse players than runners (p ≤ 0.012). At the tibial diaphysis, Tt.Ar, Ct.Ar, cortical perimeter (Ct.Pm), and failure load were higher in gymnasts than runners (p ≤ 0.040). In multiple linear regression analyses, TBLM was significantly associated with metaphyseal failure load (ß = 0.30, p = 0.042), and diaphyseal Tt.Ar and Ct.Pm (ß = 6.17, p = 0.003; ß = 0.59, p = 0.010). Bone health can vary among different sport types and is associated with TBLM, which may be a modifiable factor to maintain or improve bone health.

Physical activity and joint health: Implications for knee osteoarthritis disease pathophysiology and mechanics

Knee osteoarthritis is experienced by hundreds of millions of people worldwide and is a major cause of disability. Although enhancing physical activity levels and the participation in exercise programmes has been proved to improve the debilitating illness of osteoarthritis, many do not engage in recommended levels of physical activity. One of the reported barriers to exercise engagement is the perception that physical activity can damage joint health and is attributed to the incorrect perception of 'wear and tear'. We posit that these perceptions arise from uncertainty and ambiguity generated from conflicting research findings. In this review, we explore the complex relationship between knee osteoarthritis and physical activity. We demonstrate how factors contribute to the uncertainty around the effects of physical activity on joint tissue metabolism, structure and function. The aim of this review is to demonstrate how a nuanced approach to the relationship between physical activity and knee osteoarthritis can help to dispel misconceptions, leading to better management strategies and improved quality of life for patients.

Quantification of Ground Reaction Forces During the Follow Through in Trained Male Cricket Fast Bowlers: A Laboratory-Based Study

Ground reaction forces (GRFs) are known to be high during front foot contact of fast bowling deliveries in cricket. There is a lack of published data on the GRFs during follow through foot contacts. The aim of this study was to quantify and compare peak GRFs and impulse of the delivery stride and the follow through of fast bowling deliveries. Ten trained male fast bowlers (ball release speed mean ± SD; 32.6 ± 2.3 m/s) competing in the Men's Victorian Premier League participated in the study. Peak GRF and impulse data were collected using in-ground force plates in a laboratory setting. Linear mixed modelling of GRFs and impulse showed a significant effect of foot strike (p < 0.001). Front foot contact had the greatest magnitude of peak vertical GRF (5.569 ± 0.334 BW) but was not significantly greater than back foot recontact (4.471 ± 0.285 BW) (p = 0.07). Front foot impact had the greatest vertical impulse (0.408 ± 0.018 BW·s) but was similar to back foot (0.377 ± 0.012 BW·s) and front foot (0.368 ± 0.006 BW·s) recontacts (p = 0.070 to 0.928). The high GRF and impulse during the follow through highlights the need for further kinetic and kinematic research on this phase of the fast bowling delivery.

"Acute responses to barefoot running are related to changes in kinematics, mechanical load, and inflammatory profile"

This study investigated the acute effects of barefoot (BF) running on biomechanical parameters and cytokine concentrations. Seventy-one habitually shod runners had biomechanical parameters evaluated during running shod (SH) and BF, while a sub-group of 19 runners had their inflammatory profile analyzed before and after a running session, using their habitual shoes or barefoot. Running BF changed spatiotemporal and joint kinematics, including the stride frequency (increased) and length (decreased), and foot strike pattern (more plantarflexed ankle at initial contact). An increased impact force was observed (p < 0.05), while joint moment, power, and work were also affected by BF running: a shift of joint load from the knee and hip to the ankle occurred (p < 0.05). In cytokine levels, maintenance (all cytokines, except Eotaxin, IL-12p40, IL-2, IL5, and MIP-1 beta) or reductions (IL-12p40, IL-2, and IL5) were observed as an acute response to BF running, what means to keep or reduce the levels of pro-inflammatory cytokines and immunological/chemoattraction proteins when compared to SH. Summarily, a single session of BF running may not represent enough stress to induce changes in the inflammatory profile. Besides the increased impact force, the joint load was reduced during short-term BF running. Nevertheless, short-term BF running should be cautiously applied due to the shift of joint load from the knee and hip to the ankle.

Lower limb joint loading during high-impact activities: implication for bone health

Osteoporosis results in low-trauma fractures affecting millions globally, in particular elderly populations. Despite the inclusion of physical activity in fracture prevention strategies, the optimal bone-strengthening exercises remain uncertain, highlighting the need for a deeper understanding of lower limb joint loading dynamics across various exercise types and levels. This study examines lower limb joint loading during high-impact exercises across different intensities. A total of 40 healthy, active participants were recruited (mean ± SD: age of 40.3 ± 13.1 yr; height 1.71 ± 0.08 m; and mass 68.44 ± 11.67 kg). Motion capture data and ground reaction forces of 6 different exercises: a self-selected level of walking, running, countermovement jump, squat jump, unilateral hopping, and bilateral hopping were collected for each participant. Joint reaction forces were estimated using lower body musculoskeletal models developed in OpenSim. Running and hopping increased joint forces compared to walking, notably at the hip (83% and 21%), knee (134% and 94%), and ankle (94% and 77%), while jump exercises reduced hip and ankle loading compared to walking (36% and 19%). Joint loading varied with exercise type and intensity, with running faster increasing forces on all joints, particularly at the hip. Sprinting increased forces at the hip but lowered knee and ankle forces. Higher jumps intensified forces on all joints, while faster hopping reduced forces. The wide variation of lower limb joint loading observed across the exercises tested in this study underscores the importance of implementing diverse exercise routines to optimize overall bone health and strengthen the musculoskeletal structure. Practitioners must therefore ensure that exercise programs include movements that are specifically suitable for their intended purpose.

Methods for Evaluating Tibial Accelerations and Spatiotemporal Gait Parameters during Unsupervised Outdoor Movement

The purpose of this paper is to introduce a method of measuring spatiotemporal gait patterns, tibial accelerations, and heart rate that are matched with high resolution geographical terrain features using publicly available data. These methods were demonstrated using data from 218 Marines, who completed loaded outdoor ruck hikes between 5-20 km over varying terrain. Each participant was instrumented with two inertial measurement units (IMUs) and a GPS watch. Custom code synchronized accelerometer and positional data without a priori sensor synchronization, calibrated orientation of the IMUs in the tibial reference frame, detected and separated only periods of walking or running, and computed acceleration and spatiotemporal outcomes. GPS positional data were georeferenced with geographic information system (GIS) maps to extract terrain features such as slope, altitude, and surface conditions. This paper reveals the ease at which similar data can be gathered among relatively large groups of people with minimal setup and automated data processing. The methods described here can be adapted to other populations and similar ground-based activities such as skiing or trail running.

Predicting Musculoskeletal Loading at Common Running Injury Locations Using Machine Learning and Instrumented Insoles

INTRODUCTION

Wearables have the potential to provide accurate estimates of tissue loads at common running injury locations. Here we investigate the accuracy by which commercially available instrumented insoles (ARION; ATO-GEAR, Eindhoven, The Netherlands) can predict musculoskeletal loading at common running injury locations.

METHODS

Nineteen runners (10 males) ran at five different speeds, four slopes, with different step frequencies, and forward trunk lean on an instrumented treadmill while wearing instrumented insoles. The insole data were used as input to an artificial neural network that was trained to predict the Achilles tendon strain, and tibia and patellofemoral stress impulses and weighted impulses (damage proxy) as determined with musculoskeletal modeling. Accuracy was investigated using leave-one-out cross-validation and correlations. The effect of different input metrics was also assessed.

RESULTS

The neural network predicted tissue loading with overall relative percentage errors of 1.95 ± 8.40%, -7.37 ± 6.41%, and -12.8 ± 9.44% for the patellofemoral joint, tibia, and Achilles tendon impulse, respectively. The accuracy significantly changed with altered running speed, slope, or step frequency. Mean (95% confidence interval) within-individual correlations between modeled and predicted impulses across conditions were generally nearly perfect, being 0.92 (0.89 to 0.94), 0.95 (0.93 to 0.96), and 0.95 (0.94 to 0.96) for the patellofemoral, tibial, and Achilles tendon stress/strain impulses, respectively.

CONCLUSIONS

This study shows that commercially available instrumented insoles can predict loading at common running injury locations with variable absolute but (very) high relative accuracy. The absolute error was lower than the methods that measure only the step count or assume a constant load per speed or slope. This developed model may allow for quantification of in-field tissue loading and real-time tissue loading-based feedback to reduce injury risk.

Tibial acceleration alone is not a valid surrogate measure of tibial load in response to stride length manipulation

PURPOSE

This study aimed to evaluate the relationship between peak tibial acceleration and peak ankle joint contact forces in response to stride length manipulation during level-ground running.

METHODS

Twenty-seven physically active participants ran 10 trials at preferred speed in each of 5 stride length conditions: preferred, ±5%, and ±10% of preferred stride length. Motion capture, force platform, and tibial acceleration data were directly measured, and ankle joint contact forces were estimated using an inverse-dynamics-based static optimization routine.

RESULTS

In general, peak axial tibial accelerations (p < 0.001) as well as axial (p < 0.001) and resultant (p < 0.001) ankle joint contact forces increased with stride length. When averaged within the 10 strides of each stride condition, moderate positive correlations were observed between peak axial acceleration and joint contact force (r = 0.49) as well as peak resultant acceleration and joint contact force (r = 0.51). However, 37% of participants illustrated either no relationship or negative correlations. Only weak correlations across participants existed between peak axial acceleration and joint contact force (r = 0.12) as well as peak resultant acceleration and ankle joint contact force (r = 0.18) when examined on a step-by-step basis.

CONCLUSION

These results suggest that tibial acceleration should not be used as a surrogate for ankle joint contact force on a step-by-step basis in response to stride length manipulations during level-ground running. A 10-step averaged tibial acceleration metric may be useful for some runners, but an initial laboratory assessment would be required to identify these individuals.

Consumer-priced wearable sensors combined with deep learning can be used to accurately predict ground reaction forces during various treadmill running conditions

Ground reaction force (GRF) data is often collected for the biomechanical analysis of running, due to the performance and injury risk insights that GRF analysis can provide. Traditional methods typically limit GRF collection to controlled lab environments, recent studies have looked to combine the ease of use of wearable sensors with the statistical power of machine learning to estimate continuous GRF data outside of these restrictions. Before such systems can be deployed with confidence outside of the lab they must be shown to be a valid and accurate tool for a wide range of users. The aim of this study was to evaluate how accurately a consumer-priced sensor system could estimate GRFs whilst a heterogeneous group of runners completed a treadmill protocol with three different personalised running speeds and three gradients. Fifty runners (25 female, 25 male) wearing pressure insoles made up of 16 resistive sensors and an inertial measurement unit ran at various speeds and gradients on an instrumented treadmill. A long short term memory (LSTM) neural network was trained to estimate both vertical ( G R F v ) and anteroposterior ( G R F a p ) force traces using leave one subject out validation. The average relative root mean squared error (rRMSE) was 3.2% and 3.1%, respectively. The mean ( G R F v ) rRMSE across the evaluated participants ranged from 0.8% to 8.8% and from 1.3% to 17.3% in the ( G R F a p ) estimation. The findings from this study suggest that current consumer-priced sensors could be used to accurately estimate two-dimensional GRFs for a wide range of runners at a variety of running intensities. The estimated kinetics could be used to provide runners with individualised feedback as well as form the basis of data collection for running injury risk factor studies on a much larger scale than is currently possible with lab based methods.

A Review of the Validity and Reliability of Accelerometer-Based Metrics From Upper Back-Mounted GNSS Player Tracking Systems for Athlete Training Load Monitoring

ABSTRACT

Dawson, L, Beato, M, Devereux, G, and McErlain-Naylor, SA. A review of the validity and reliability of accelerometer-based metrics from upper back-mounted GNSS player tracking systems for athlete training load monitoring. J Strength Cond Res 38(8): e459-e474, 2024-Athlete load monitoring using upper back-mounted global navigation satellite system (GNSS) player tracking is common within many team sports. However, accelerometer-based load monitoring may provide information that cannot be achieved with GNSS alone. This review focuses on the accelerometer-based metrics quantifying the accumulation of accelerations as an estimation of athlete training load, appraising the validity and reliability of accelerometer use in upper back-mounted GNSS player tracking systems, the accelerometer-based metrics, and their potential for application within athlete monitoring. Reliability of GNSS-housed accelerometers and accelerometer-based metrics are dependent on the equipment model, signal processing methods, and the activity being monitored. Furthermore, GNSS unit placement on the upper back may be suboptimal for accelerometer-based estimation of mechanical load. Because there are currently no feasible gold standard comparisons for field-based whole-body biomechanical load, the validity of accelerometer-based load metrics has largely been considered in relation to other measures of training load and exercise intensity. In terms of convergent validity, accelerometer-based metrics (e.g., PlayerLoad, Dynamic Stress Load, Body Load) have correlated, albeit with varying magnitudes and certainty, with measures of internal physiological load, exercise intensity, total distance, collisions and impacts, fatigue, and injury risk and incidence. Currently, comparisons of these metrics should not be made between athletes because of mass or technique differences or between manufacturers because of processing variations. Notable areas for further study include the associations between accelerometer-based metrics and other parts of biomechanical load-adaptation pathways of interest, such as internal biomechanical loads or methods of manipulating these metrics through effective training design.

Self-selected running gait modifications reduce acute impact loading, awkwardness, and effort

Impact loading has been associated with running-related injuries, and gait retraining has been suggested as a means of reducing impact loading and lowering the risk of injury. However, gait retraining can lead to increased perceived awkwardness and effort. The influence of specifically trained and self-selected running gait modifications on acute impact loading, perceived awkwardness and effort is currently unclear. Sixteen habitual rearfoot/midfoot runners performed forefoot strike pattern, increased step rate, anterior trunk lean and self-selected running gait modifications on an instrumented treadmill based on real-time biofeedback. Impact loading, perceived awkwardness and effort scores were compared among the four gait retraining conditions. Self-selected gait modification reduced vertical average loading rate (VALR) by 25.3%, vertical instantaneous loading rate (VILR) by 27.0%, vertical impact peak (VIP) by 16.8% as compared with baseline. Forefoot strike pattern reduced VALR, VILR and peak tibial acceleration. Increased step rate reduced VALR. Anterior trunk lean did not reduce any impact loading. Self-selected gait modification was perceived as less awkward and require less effort than the specifically trained gait modification (p < 0.05). These findings suggest that self-selected gait modification could be a more natural and less effortful strategy than specifically trained gait modification to reduce acute impact loading, while the clinical significance remains unknown.

Comparison of ground reaction forces as running speed increases between male and female runners

Introduction: The biomechanics associated with human running are affected by gender and speed. Knowledge regarding ground reaction force (GRF) at various running speeds is pivotal for the prevention of injuries related to running. This study aimed to investigate the gait pattern differences between males and females while running at different speeds, and to verify the relationship between GRFs and running speed among both males and females. Methods: GRF data were collected from forty-eight participants (thirty male runners and eighteen female runners) while running on an overground runway at seven discrete speeds: 10, 11, 12, 13, 14, 15 and 16 km/h. Results: The ANOVA results showed that running speed had a significant effect (p < 0.05) on GRFs, propulsive and vertical forces increased with increasing speed. An independent t-test also showed significant differences (p < 0.05) in vertical and anterior-posterior GRFs at all running speeds, specifically, female runners demonstrated higher propulsive and vertical forces than males during the late stance phase of running. Pearson correlation and stepwise multiple linear regression showed significant correlations between running speed and the GRF variables. Discussion: These findings suggest that female runners require more effort to keep the same speed as male runners. This study may provide valuable insights into the underlying biomechanical factors of the movement patterns at GRFs during running.

Impact accelerations during a prolonged run using a microwavable self-customised foot orthosis

The use of custom-made foot orthoses has been associated with numerous benefits, such as decreased impact accelerations. However, it is not known whether this effect could be due to better customisation. The present study analysed the effects of the first generation of  a microwavable prefabricated self-customised foot orthosis vs. a prefabricated standard one on impact accelerations throughout a prolonged run. Thirty runners performed two tests of 30-min running on a treadmill, each one with an orthosis condition. Impact acceleration variables of tibia and head were recorded every 5 min. Microwavable self-customised foot orthosis increased the following variables in the first instants compared to the prefabricated standard one: tibial peak (min1: 6.5 (1.8) vs. 6.0 (1.7) g, P = .009, min5: 6.6 (1.7) vs. 6.2 (1.7) g, P = .035), tibial magnitude (min1: 8.3 (2.6) vs. 7.7 (2.4) g, P = .030, min5: 8.5 (2.6) vs. 7.9 (2.5) g, P = .026) and shock attenuation (min1: 61.4 (16.8) vs. 56.3 (16.3)%, P = .014, min5: 62.0 (15.5) vs. 57.2 (15.3)%, P = .040), and tibial rate throughout the entire run (504.3 (229.7) vs. 422.7 (212.9) g/s, P = .006). However, it was more stable throughout 30-min running (P < .05). These results show that the shape customisation entailed by the thermoformable material does not provide impact acceleration improvements.

Effect of age on ankle biomechanics and tibial compression during stair descent

BACKGROUND

Stress fracture is a concern among older adults, as age-related decrements in ankle neuromuscular function may impair their ability to attenuate tibial compressive forces experienced during daily locomotor tasks, such as stair descent. Yet, it is unknown if older adults exhibit greater tibial compression than their younger counterparts when descending stairs.

RESEARCH QUESTION

Do older adults exhibit differences in ankle biomechanics that alter their tibial compression during stair descent compared to young adults, and is there a relation between tibial compression and specific changes in ankle biomechanics?

METHODS

Thirteen young (18-25 years) and 13 older (> 65 years) adults had ankle joint biomechanics and tibial compression quantified during a stair descent. Discrete ankle biomechanics (peak joint angle and moment, and joint stiffness) and tibial compression (maximum and impulse) measures were submitted to an independent t-test, while ankle joint angle and moment, and tibial compression waveforms were submitted to an independent statistical parametric mapping t-test to determine group differences. Pearson correlation coefficients (r) determined the relation between discrete ankle biomechanics and tibial compression measures for all participants, and each group.

RESULTS

Older adults exhibited smaller maximum tibial compression (p = 0.004) from decreases in peak ankle joint angle and moment between 17 % and 34 % (p = 0.035), and 20-31 % of stance (p < 0.001) than young adults. Ankle biomechanics exhibited a negligible to weak correlation with tibial compression for all participants, with peak ankle joint moment and maximum tibial compression (r = -0.48 ± 0.32) relation the strongest. Older adults typically exhibited a stronger relation between ankle biomechanics and tibial compression (e.g., r = -0.48 ± 0.47 vs r = -0.27 ± 0.52 between peak ankle joint moment and maximum tibial compression).

SIGNIFICANCE

Older adults altered ankle biomechanics and decreased maximum tibial compression to safely execute the stair descent. Yet, specific alterations in ankle biomechanics could not be identified as a predictor of changes in tibial compression.

The Biomechanics of Musculoskeletal Tissues during Activities of Daily Living: Dynamic Assessment Using Quantitative Transmission-Mode Ultrasound Techniques

The measurement of musculoskeletal tissue properties and loading patterns during physical activity is important for understanding the adaptation mechanisms of tissues such as bone, tendon, and muscle tissues, particularly with injury and repair. Although the properties and loading of these connective tissues have been quantified using direct measurement techniques, these methods are highly invasive and often prevent or interfere with normal activity patterns. Indirect biomechanical methods, such as estimates based on electromyography, ultrasound, and inverse dynamics, are used more widely but are known to yield different parameter values than direct measurements. Through a series of literature searches of electronic databases, including Pubmed, Embase, Web of Science, and IEEE Explore, this paper reviews current methods used for the in vivo measurement of human musculoskeletal tissue and describes the operating principals, application, and emerging research findings gained from the use of quantitative transmission-mode ultrasound measurement techniques to non-invasively characterize human bone, tendon, and muscle properties at rest and during activities of daily living. In contrast to standard ultrasound imaging approaches, these techniques assess the interaction between ultrasound compression waves and connective tissues to provide quantifiable parameters associated with the structure, instantaneous elastic modulus, and density of tissues. By taking advantage of the physical relationship between the axial velocity of ultrasound compression waves and the instantaneous modulus of the propagation material, these techniques can also be used to estimate the in vivo loading environment of relatively superficial soft connective tissues during sports and activities of daily living. This paper highlights key findings from clinical studies in which quantitative transmission-mode ultrasound has been used to measure the properties and loading of bone, tendon, and muscle tissue during common physical activities in healthy and pathological populations.

Technologically advanced running shoes reduce oxygen cost and cumulative tibial loading per kilometer in recreational female and male runners

Technologically advanced running shoes (TARS) improve performance compared to classical running shoes (CRS). Improved race performance has been attributed to metabolic savings in male runners, but it remains unclear if these same benefits are experienced among females and in recreational runners. The mechanisms behind these benefits are still not fully understood despite the need for optimisation, and their influence on injury mechanisms has not been explored. Here we combined biomechanical, physiological, and modelling approaches to analyse joint mechanics, oxygen uptake, and tibial load in nineteen male and female recreational runners running with CRS and TARS at their individual lactate threshold speed (12.4 ± 1.9 km/h). Oxygen uptake was 3.0 ± 1.5% lower in TARS than in CRS. Ankle dorsiflexion, joint moment and joint power were reduced in TARS compared to CRS at various phases of stance including midstance, while knee joint mechanics were mostly similar throughout. There were no significant differences for tibial bending moment during the stance phase but cumulative tibial damage per kilometre was 12 ± 9% lower in TARS compared to CRS. Our results suggest that running with TARS reduces oxygen cost in recreational female and male runners, which may partly be explained by differences in lower limb joint mechanics. The lower cumulative tibial bone load with TARS may allow runners to run longer distances in this type of shoe compared to CRS.

Advancing Exoskeleton Development: Validation of a Robotic Surrogate to Measure Tibial Strain

Bone stress injuries are prevalent among athletes and military recruits and can significantly compromise training schedules. The development of an ankle-foot orthosis to reduce tibial load and enable a faster return to activity will require new device testing methodologies capable of capturing the contribution of muscular force on tibial strain. Thus, an actuated robotic surrogate leg was developed to explore how tibial strain changes with different ankle-foot orthosis conditions. The purpose of this work was to assess the reliability, scalability, and behavior of the surrogate. A dual actuation system consisting of a Bowden cable and a vertical load applied to the femur via a material testing system, replicated the action-reaction of the Achilles-soleus complex. Maximum and minimum principal strain, maximum shear strain, and axial strain were measured by instrumented strain gauges at five locations on the tibia. Strains were highly repeatable across tests but did not consistently match in vivo data when scaled. However, the stiffness of the ankle-foot orthosis strut did not systematically affect tibial load, which is consistent with in vivo findings. Future work will involve improving the scalability of the results to match in vivo data and using the surrogate to inform exoskeletal designs for bone stress injuries.

Tibial strains are sensitive to speed perturbations, but not grade perturbations, during running

A fatigue-failure process is hypothesized to govern the development of tibial stress fractures, where bone damage is highly dependent on the peak strain magnitude. To date, much of the work examining tibial strain during running has ignored uphill and downhill running despite the prevalence of this terrain. This study examined the sensitivity of tibial strain to changes in running grade and speed using a combined musculoskeletal-finite element modelling routine. Seventeen participants ran on a treadmill at ±10, ±5 and 0 deg; at each grade, participants ran at 3.33 m s-1 and at a grade-adjusted speed of 2.50 and 4.17 m s-1 for uphill and downhill grades, respectively. Force and motion data were recorded in each grade and speed combination. Muscle and joint contact forces were estimated using inverse-dynamics-based static optimization. These forces were applied to a participant-adjusted finite element model of the tibia. None of the strain variables (50th and 95th percentile strain and strained volume ≥4000 με) differed as a function of running grade; however, all strain variables were sensitive to running speed (F1≥9.59, P≤0.03). In particular, a 1 m s-1 increase in speed resulted in a 9% (∼260 με) and 155% (∼600 mm3) increase in peak strain and strained volume, respectively. Overall, these findings suggest that faster running speeds, but not changes in running grade, may be more deleterious to the tibia.

Increasing Step Rate Reduces Peak and Cumulative Insole Force in Collegiate Runners

PURPOSE

The primary goal of this study was to examine changes in peak insole force and cumulative weighted peak force (CWPF)/km with increased step rate in collegiate runners. The secondary goal was to determine whether sacral acceleration correlates with insole force when increasing step rate.

METHODS

Twelve collegiate distance runners ran 1000 m outdoors at 3.83 m·s -1 at preferred and 10% increased step rates while insole force and sacral acceleration were recorded. Cumulative weighted peak force/km was calculated from insole force based on cumulative damage models. The effects of step rate on peak insole force and CWPF·km -1 were tested using paired t tests or Wilcoxon tests. Correlation coefficients between peak axial (approximately vertical) sacral acceleration times body mass and peak insole force were calculated on cohort and individual levels.

RESULTS

Peak insole force and CWPF·km -1 decreased ( P < 0.001) with increased step rate. Peak axial sacral acceleration did not correlate with peak insole force on the cohort level ( r = 0.35, P = 0.109) but did within individuals (mean, r = 0.69-0.78; P < 0.05).

CONCLUSIONS

Increasing step rate may reduce peak vGRF and CWPF·km -1 in collegiate runners. Therefore, clinicians should consider step rate interventions to reduce peak and cumulative vGRF in this population. Individual-specific calibrations may be required to assess changes in peak vGRF in response to increasing step rate using wearable accelerometers.

Engraving Polyamide Layers by In Situ Self-Etchable CaCO3 Nanoparticles Enhances Separation Properties and Antifouling Performance of Reverse Osmosis Membranes

Nanovoids within a polyamide layer play an important role in the separation performance of thin-film composite (TFC) reverse osmosis (RO) membranes. To form more extensive nanovoids for enhanced performance, one commonly used method is to incorporate sacrificial nanofillers in the polyamide layer during the exothermic interfacial polymerization (IP) reaction, followed by some post-etching processes. However, these post-treatments could harm the membrane integrity, thereby leading to reduced selectivity. In this study, we applied in situ self-etchable sacrificial nanofillers by taking advantage of the strong acid and heat generated in IP. CaCO3 nanoparticles (nCaCO3) were used as the model nanofillers, which can be in situ etched by reacting with H+ to leave void nanostructures behind. This reaction can further degas CO2 nanobubbles assisted by heat in IP to form more nanovoids in the polyamide layer. These nanovoids can facilitate water transport by enlarging the effective surface filtration area of the polyamide and reducing hydraulic resistance to significantly enhance water permeance. The correlations between the nanovoid properties and membrane performance were systematically analyzed. We further demonstrate that the nCaCO3-tailored membrane can improve membrane antifouling propensity and rejections to boron and As(III) compared with the control. This study investigated a novel strategy of applying self-etchable gas precursors to engrave the polyamide layer for enhanced membrane performance, which provides new insights into the design and synthesis of TFC membranes.

Rethinking running biomechanics: a critical review of ground reaction forces, tibial bone loading, and the role of wearable sensors

This study presents a comprehensive review of the correlation between tibial acceleration (TA), ground reaction forces (GRF), and tibial bone loading, emphasizing the critical role of wearable sensor technology in accurately measuring these biomechanical forces in the context of running. This systematic review and meta-analysis searched various electronic databases (PubMed, SPORTDiscus, Scopus, IEEE Xplore, and ScienceDirect) to identify relevant studies. It critically evaluates existing research on GRF and tibial acceleration (TA) as indicators of running-related injuries, revealing mixed findings. Intriguingly, recent empirical data indicate only a marginal link between GRF, TA, and tibial bone stress, thus challenging the conventional understanding in this field. The study also highlights the limitations of current biomechanical models and methodologies, proposing a paradigm shift towards more holistic and integrated approaches. The study underscores wearable sensors' potential, enhanced by machine learning, in transforming the monitoring, prevention, and rehabilitation of running-related injuries.

Predicting overstriding with wearable IMUs during treadmill and overground running

Running injuries are prevalent, but their exact mechanisms remain unknown largely due to limited real-world biomechanical analysis. Reducing overstriding, the horizontal distance that the foot lands ahead of the body, may be relevant to reducing injury risk. Here, we leverage the geometric relationship between overstriding and lower extremity sagittal segment angles to demonstrate that wearable inertial measurement units (IMUs) can predict overstriding during treadmill and overground running in the laboratory. Ten recreational runners matched their strides to a metronome to systematically vary overstriding during constant-speed treadmill running and showed similar overstriding variation during comfortable-speed overground running. Linear mixed models were used to analyze repeated measures of overstriding and sagittal segment angles measured with motion capture and IMUs. Sagittal segment angles measured with IMUs explained 95% and 98% of the variance in overstriding during treadmill and overground running, respectively. We also found that sagittal segment angles measured with IMUs correlated with peak braking force and explained 88% and 80% of the variance during treadmill and overground running, respectively. This study highlights the potential for IMUs to provide insights into landing and loading patterns over time in real-world running environments, and motivates future research on feedback to modify form and prevent injury.

E-Textiles for Sports and Fitness Sensing: Current State, Challenges, and Future Opportunities

E-textiles have emerged as a fast-growing area in wearable technology for sports and fitness due to the soft and comfortable nature of textile materials and the capability for smart functionality to be integrated into familiar sports clothing. This review paper presents the roles of wearable technologies in sport and fitness in monitoring movement and biosignals used to assess performance, reduce injury risk, and motivate training/exercise. The drivers of research in e-textiles are discussed after reviewing existing non-textile and textile-based commercial wearable products. Different sensing components/materials (e.g., inertial measurement units, electrodes for biosignals, piezoresistive sensors), manufacturing processes, and their applications in sports and fitness published in the literature were reviewed and discussed. Finally, the paper presents the current challenges of e-textiles to achieve practical applications at scale and future perspectives in e-textiles research and development.

Sensor location influences the associations between IMU and motion capture measurements of impact landing in healthy male and female runners at multiple running speeds

This study investigated the relationships between inertial measurement unit (IMU) acceleration at multiple body locations and 3D motion capture impact landing measures in runners. Thirty healthy runners ran on an instrumented treadmill at five running speeds (9-17 km/h) during 3D motion capture. Axial and resultant acceleration were collected from IMUs at the distal and proximal tibia, distal femur and sacrum. Relationships between peak acceleration from each IMU location and patellofemoral joint (PFJ) peak force and loading rate, impact peak and instantaneous vertical loading rate (IVLR) were investigated using linear mixed models. Acceleration was positively related to IVLR at all lower limb locations (p < 0.01). Models predicted a 1.9-3.2 g peak acceleration change at the tibia and distal femur, corresponding with a 10% IVLR change. Impact peak was positively related to acceleration at the distal femur only (p < 0.01). PFJ peak force was positively related to acceleration at the distal (p = 0.03) and proximal tibia (p = 0.03). PFJ loading rate was positively related to the tibia and femur acceleration in males only (p < 0.01). These findings suggest multiple IMU lower limb locations are viable for measuring peak acceleration during running as a meaningful indicator of IVLR.

Speed and surface steepness affect internal tibial loading during running

BACKGROUND

Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury. Runners encounter varied surface steepness (gradients) when running outdoors and may adapt their speed according to the gradient. This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients.

METHODS

Twenty recreational runners ran on a treadmill at 3 different speeds (2.5 m/s, 3.0 m/s, and 3.5 m/s) and gradients (level: 0%; uphill: +5%, +10%, and +15%; downhill: -5%, -10%, and -15%). Force and marker data were collected synchronously throughout. Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1% of stance. Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse. Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses.

RESULTS

There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress. Higher running speeds resulted in greater tibial loading. Running uphill at +10% and +15% resulted in greater tibial loading than level running. Running downhill at -10% and -15% resulted in reduced tibial loading compared to level running. There was no difference between +5% or -5% and level running.

CONCLUSION

Running at faster speeds and uphill on gradients ≥+10% increased internal tibial loading, whereas slower running and downhill running on gradients ≥-10% reduced internal loading. Adapting running speed according to the gradient could be a protective mechanism, providing runners with a strategy to minimize the risk of tibial stress injuries.

Predicting Tissue Loads in Running from Inertial Measurement Units

BACKGROUND

Runners have high incidence of repetitive load injuries, and habitual runners often use smartwatches with embedded IMU sensors to track their performance and training. If accelerometer information from such IMUs can provide information about individual tissue loads, then running watches may be used to prevent injuries.

METHODS

We investigate a combined physics-based simulation and data-based method. A total of 285 running trials from 76 real runners are subjected to physics-based simulation to recover forces in the Achilles tendon and patella ligament, and the collected data are used to train and test a data-based model using elastic net and gradient boosting methods.

RESULTS

Correlations of up to 0.95 and 0.71 for the patella ligament and Achilles tendon forces, respectively, are obtained, but no single best predictive algorithm can be identified.

CONCLUSIONS

Prediction of tissues loads based on body-mounted IMUs appears promising but requires further investigation before deployment as a general option for users of running watches to reduce running-related injuries.

3D Tibial Acceleration and Consideration of 3D Angular Motion Using IMUs on Peak Tibial Acceleration and Impulse in Running

PURPOSE

Peak tibial acceleration (PTA) is defined as the peak acceleration occurring shortly after initial contact, often used as an indirect measure of tibial load. As the tibia is a rotating segment around the ankle, angular velocity and angular acceleration should be included in PTA. This study aimed to quantify three-dimensional tibial acceleration components over two different sensor locations and three running speeds, to get a better understanding of the influence of centripetal and tangential accelerations on PTA typically measured in running. Furthermore, it explores tibial impulse as an alternative surrogate measure for tibial load.

METHODS

Fifteen participants ran 90 s on a treadmill at 2.8, 3.3, and 3.9 m·s -1 , with inertial measurement units (IMUs) located distally and proximally on the tibia.

RESULTS

Without the inclusion of rotational accelerations and gravity, no significant difference was found between axial PTA between both IMU locations, whereas in the tangential sagittal plane axis, there was a significant difference. Inclusion of rotational accelerations and gravity resulted in similar PTA estimates at the ankle for both IMU locations and caused a significant difference between PTA based on the distal IMU and PTA at the ankle. The impulse showed more consistent results between the proximal and distal IMU locations compared with axial PTA.

CONCLUSIONS

Rotational acceleration of the tibia during stance differently impacted PTA measured proximally and distally at the tibia, indicating that rotational acceleration and gravity should be included in PTA estimates. Furthermore, peak acceleration values (such as PTA) are not always reliable when using IMUs because of inconsistent PTA proximally compared with distally on an individual level. Instead, impulse seems to be a more consistent surrogate measure for the tibial load.

Incline and decline running alters joint moment contributions but not peak support moments in individuals with an anterior cruciate ligament reconstruction and controls

Individuals with an anterior cruciate ligament reconstruction (ACLR) commonly exhibit altered gait patterns, potentially contributing to an increased risk of osteoarthritis (OA). Joint moment contributions (JMCs) and support moments during incline and decline running are unknown in healthy young adults and individuals with an ACLR. Understanding these conditional joint-level changes could explain the increased incidence of OA that develops in the long term. Therefore, this knowledge may provide insight into the rehabilitation and prevention of OA development. We aimed to identify the interlimb and between-group differences in peak support moments and subsequent peak ankle, knee, and hip JMCs between individuals with an ACLR and matched controls during different sloped running conditions. A total of 17 individuals with unilateral ACLR and 17 healthy individuals who were matched based on sex, height, and mass participated in this study. The participants ran on an instrumented treadmill at an incline of 4°, decline of 4°, incline of 10°, and decline of 10°. The last 10 strides of each condition were used to compare the whole-stance phase support moments and JMCs between limbs, ACLR, and control groups and across conditions. No differences in JMCs were identified between limbs or between the ACLR and healthy control groups across all conditions. Support moments did not change among the different sloped conditions, but JMCs significantly changed. Specifically, ankle and knee JMCs decreased and increased by 30% and 33% from an incline of 10° to a decline of 10° running. Here, the lower extremities can redistribute mechanics across the ankle, knee, and hip while maintaining consistent support moments during incline and decline running. Our data provide evidence that those with an ACLR do not exhibit significant alterations in joint contributions while running on sloped conditions compared to the matched controls. Our findings inform future research interested in understanding the relationship between sloped running mechanics and the incidence of deleterious acute or chronic problems in people with an ACLR.

A Dynamic Ankle Orthosis Reduces Tibial Compressive Force and Increases Ankle Motion Compared With a Walking Boot

PURPOSE

Tibial bone stress injuries are a common overuse injury among runners and military cadets. Current treatment involves wearing an orthopedic walking boot for 3 to 12 wk, which limits ankle motion and leads to lower limb muscle atrophy. A dynamic ankle orthosis (DAO) was designed to provide a distractive force that offloads in-shoe vertical force and retains sagittal ankle motion during walking. It remains unclear how tibial compressive force is altered by the DAO. This study compared tibial compressive force and ankle motion during walking between the DAO and an orthopedic walking boot.

METHODS

Twenty young adults walked on an instrumented treadmill at 1.0 m·s -1 in two brace conditions: DAO and walking boot. Three-dimensional kinematic, ground reaction forces, and in-shoe vertical force data were collected to calculate peak tibial compressive force. Paired t -tests and Cohen's d effect sizes were used to assess mean differences between conditions.

RESULTS

Peak tibial compressive force ( P = 0.023; d = 0.5) and Achilles tendon force ( P = 0.017; d = 0.5) were moderately lower in the DAO compared with the walking boot. Sagittal ankle excursion was 54.9% greater in the DAO compared with the walking boot ( P = 0.05; d = 3.1).

CONCLUSIONS

The findings from this study indicated that the DAO moderately reduced tibial compressive force and Achilles tendon force and allowed more sagittal ankle excursion during treadmill walking compared with an orthopedic walking boot.

Increasing load carriage and running speed differentially affect the magnitude, variability and coordination patterns of muscle forces

The study aims to investigate the effects of different loads and speed during running on inter- and intra-individual muscle force amplitudes, variabilities and coordination patterns. Nine healthy participants ran on an instrumentalized treadmill with an empty weight vest at two velocities (2.6 m/s and 3.3 m/s) or while carrying three different loads (4.5, 9.1, 13.6 kg) at 2.6 m/s while kinematics and kinetics were synchronously recorded. The major lower limb muscle forces were estimated using a musculoskeletal model. Muscle force amplitudes and variability, as well as coordination patterns were compared at the group and at the individual level using respectively statistical parametric mapping and covariance matrices combined with multidimensional scaling. Increasing the speed or the load during running increased most of the muscle force amplitudes (p < 0.01). During the propulsion phase, increasing the load increased muscle force variabilities around the ankle joint (modification of standard deviation up to 5% of body weight (BW), p < 0.05) while increasing the speed decreased variability for almost all the muscle forces (up to 10% of BW, p < 0.05). Each runner has a specific muscle force coordination pattern signature regardless of the different experimental conditions (p < 0.05). Yet, this individual pattern was slightly adapted in response to a change of speed or load (p < 0.05). Our results suggest that adding load increases the amplitude and variability of muscle force, but an increase in running speed decreases the variability. These findings may help improve the design of military or trail running training programs and injury rehabilitation by progressively increasing the mechanical load on anatomical structures.

A Wearable Biofeedback Device for Monitoring Tibial Load During Partial Weight-Bearing Walking

Patients with tibial fractures are usually advised to follow a partial weight-bearing gait rehabilitation program after surgery to promote bone healing and lower limb functional recovery. Currently, the biofeedback devices used for gait rehabilitation training in fracture patients use ground reaction force (GRF) as the indicator of tibial load. However, an increasing body of research has shown that monitoring GRF alone cannot objectively reflect the load on the lower limb bones during human movement. In this study, a novel biofeedback system was developed utilizing inertial measurement units and custom instrumented insoles. Based on the data collected from experiments, a hybrid approach combining a physics-based model and neural network architectures was used to predict tibial force. Compared to the traditional physics-based algorithm, the physical guided neural networks method showed better predictive performance. The study also found that regardless of the type of weight-bearing walking, the peak tibial force was significantly higher than the peak tibial GRF, and the time at which the peak tibial compression force occurs may not be consistent with the time at which the peak vertical GRF occurs. This further supports the idea that during gait rehabilitation training for patients with tibial fractures, monitoring and providing feedback on the actual tibial force rather than just the GRF is necessary. The developed device is a non-invasive and reliable portable device that can provide audio feedback, providing a viable solution for gait rehabilitation training outside laboratory and helping to optimize patients' rehabilitation treatment strategies.

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 "impacts cause injury" hypothesis: Running in circles or making new strides?

Some of the earliest biomechanics research focused on running and the ground reaction forces generated with each step. Research in running gait accelerated in the 1970's as the growing popularity in running increased attention to the musculoskeletal injuries sustained by runners. Despite decades of high-quality research, running remains the most common cause of exercise-related musculoskeletal injuries and rates of overuse running-related injuries (RRI) have not appreciably declined since the research began. One leading area of running gait research focuses on discrete variables derived from the vertical ground reaction force, such as the vertical loading rate. Across sub-disciplines of running gait research, vertical loading rate is often discussed as the primary and undisputed variable associated with RRI despite only low to moderate evidence that retrospectively or prospectively injured runners generate greater vertical loading rates than uninjured counterparts. The central thesis of this review is that relying on vertical loading rate is insufficient to establish causal mechanisms for RRI etiology. To present this argument, this review examines the history of the 'impacts cause injury' hypothesis, including a historical look at ground reaction forces in human running and the research from which this hypothesis was generated. Additionally, a synthesis of studies that have tested the hypothesis is provided and recommendations for future research are discussed. Although it is premature to reject or support the 'impacts cause injury' hypothesis, new knowledge of biomechanical risk factors for RRI will remain concealed until research departs from the current path or adopts new approaches to previous paradigms.

Adolescents running in conventional running shoes have lower vertical instantaneous loading rates but greater asymmetry than running barefoot or in partial-minimal shoes

Footwear may moderate the transiently heightened asymmetry in lower limb loading associated with peak growth in adolescence during running. This repeated-measures study compared the magnitude and symmetry of peak vertical ground reaction force and instantaneous loading rates (VILRs) in adolescents during barefoot and shod running. Ten adolescents (age, 10.6 ± 1.7 years) ran at self-selected speed (1.7 ± 0.3 m/s) on an instrumented treadmill under three counter-balanced conditions; barefoot and shod with partial-minimal and conventional running shoes. All participants were within one year of their estimated peak height velocity based on sex-specific regression equations. Foot-strike patterns, peak vertical ground reaction force and VILRs were recorded during 20 seconds of steady-state running. Symmetry of ground reaction forces was assessed using the symmetry index. Repeated-measures ANOVAs were used to compare conditions (α=.05). Adolescents used a rearfoot foot-strike pattern during barefoot and shod running. Use of conventional shoes resulted in a lower VILR (P < .05, dz = 0.9), but higher VILR asymmetry (P < .05) than running barefoot (dz = 1.5) or in partial-minimal shoes (dz = 1.6). Conventional running shoes result in a lower VILR than running unshod or in partial-minimal shoes but may have the unintended consequence of increasing VILR asymmetry. The findings may have implications for performance, musculoskeletal development and injury in adolescents.

Dynamic knee joint stiffness during bilateral lower extremity landing 6 months after ACL reconstruction

BACKGROUND

Anterior cruciate ligament (ACL) reconstructions are associated with long-term functional impairments. Improved understanding of dynamic knee joint stiffness and work may provide insights to help address these poor outcomes. Defining the relationship between knee stiffness, work and quadriceps muscle symmetry may reveal therapeutic targets. The purposes of this study were to investigate between-limb differences in knee stiffness and work during early phase landing 6-months after an ACL reconstruction. Additionally, we investigated relationships among symmetry of knee joint stiffness and work during early-phase landing and quadriceps muscle performance symmetry.

METHODS

Twenty-nine participants (17 M, 20.0 ± 5.3 years) were tested 6-months after ACL reconstruction. Motion capture analysis was used to assess between-limb differences in knee stiffness and work during the first 60 ms of a double-limb landing. Quadriceps peak strength and rate of torque development (RTD) were assessed with isometric dynamometry. Paired t-tests and Pearson's product moment correlations were used to determine between-limb differences of knee mechanics and correlations of symmetry respectively.

FINDINGS

Knee joint stiffness and work were significantly reduced (p < 0.01, p < 0.01) in the surgical limb (0.021 ± 0.01 Nm*(deg*kg*m)-1, -0.085 ± 0.06 J*(kg*m) -1) compared to the uninvolved limb (0.045 ± 0.01 Nm*(deg*kg*m)-1, -0.256 ± 0.10 J*(kg*m) -1). Greater knee stiffness (51 ± 22%) and work (35 ± 21%) symmetry were significantly associated with greater RTD symmetry (44.5 ± 19.4%) (r = 0.43, p = 0.02; r = 0.45, p = 0.01) but not peak torque symmetry (62.9 ± 16.1%) (r = 0.32, p = 0.10; r = 0.34, p = 0.10).

INTERPRETATION

Dynamic stiffness and energy absorption are lower in the surgical knee during landing from a jump. Therapeutic interventions that target increasing quadriceps RTD may help optimize dynamic stability and energy absorption during landing.

The influence of induced gait asymmetry on joint reaction forces

Chronic injury- or disease-induced joint impairments result in asymmetric gait deviations that may precipitate changes in joint loading associated with pain and osteoarthritis. Understanding the impact of gait deviations on joint reaction forces (JRFs) is challenging because of concurrent neurological and/or anatomical changes and because measuring JRFs requires medically invasive instrumented implants. Instead, we investigated the impact of joint motion limitations and induced asymmetry on JRFs by simulating data recorded as 8 unimpaired participants walked with bracing to unilaterally and bilaterally restrict ankle, knee, and simultaneous ankle + knee motion. Personalized models, calculated kinematics, and ground reaction forces (GRFs) were input into a computed muscle control tool to determine lower limb JRFs and simulated muscle activations guided by electromyography-driven timing constraints. Unilateral knee restriction increased GRF peak and loading rate ipsilaterally but peak values decreased contralaterally when compared to walking without joint restriction. GRF peak and loading rate increased with bilateral restriction compared to the contralateral limb of unilaterally restricted conditions. Despite changes in GRFs, JRFs were relatively unchanged due to reduced muscle forces during loading response. Thus, while joint restriction results in increased limb loading, reductions in muscle forces counteract changes in limb loading such that JRFs were relatively unchanged.

Perspectives from research and practice: A survey on external load monitoring and bone in sport

Introduction

There is limited information regarding the association between external load and estimated bone load in sport, which may be important due to the influence exercise can have on bone accrual and injury risk. The aim of this study was to identify external load measuring tools used by support staff to estimate bone load and assess if these methodologies were supported in research.

Methods

A survey was comprised of 19 multiple choice questions and the option to elaborate on if/how they monitor external load and if/how they used them to estimate bone load. A narrative review was performed to assess how external load is associated to bone in research.

Results

Participants were required to be working as support staff in applied sport. Support staff (n = 71) were recruited worldwide with the majority (85%) working with professional elite athletes. 92% of support staff monitored external load in their organisation, but only 28% used it to estimate bone load.

Discussion

GPS is the most commonly used method to estimate bone load, but there is a lack of research assessing GPS metrics with bone load. Accelerometry and force plates were among the most prevalent methods used to assess external load, but a lack of bone specific measurements were reported by support staff. Further research exploring how external load relates to bone is needed as there is no consensus on which method of external load is best to estimate bone load in an applied setting.

Newly compiled Tai Chi (Bafa Wubu) promotes lower extremity exercise: a preliminary cross sectional study

Background

Tai Chi (Bafa Wubu) is a new type of simplified Tai Chi widely practiced by Tai Chi enthusiasts that has developed and perfected simplified Tai Chi movement and enriched Tai Chi practice methods. When practicing, Tai Chi athletes and enthusiasts can choose the Bafa Wubu movements to practice according to their physical conditions. The purpose of this article is to discuss the mechanism by which Bafa Wubu promotes lower extremity exercise from the perspective of exercise biomechanics.

Objectives

This article aims to explore the scientific training methods and technical characteristics of Bafa Wubu, and its contribution to comprehensive exercise of the lower extremities, by analyzing the biomechanical characteristics of the lower extremities of participants who practice Bafa Wubu at different levels and by comparing their ground reaction force, lower limb joints, and muscles during Bafa Wubu.

Methods

A total of 16 male participants were recruited and divided into an amateur group (N = 8) and a professional group (N = 8). The data were collected by a BTS 3D infrared-based motion capture system, and Kistler 3D force plate. The lower extremity joint forces and muscle strength were calculated by anybody simulation software with inverse dynamics.

Results

During elbowing and leaning sideways with steps sideways (ELS), the ground reaction force of the professional group was significantly higher than that of the amateur group in the sagittal, vertical, and frontal axes (P < 0.01). While stepping forward, backward, and sideways, the professional group's joints loading at the hip, knee, and ankle was always higher in the vertical direction (P < 0.01). Furthermore, during warding off with steps forward (WOF), laying with steps forward (LF), and rolling back with steps backward (RBB), hip joint loading increased in the med-lat direction. During actions with steps backward and sideways, the professional group's ankle flexion/extension torque and hip abduction/rotation torque were significantly larger than those of the amateur group (P < 0.01). Different actions in Bafa Wubu activate muscles to different degrees, whereas the iliacus is mainly responsible for stabilizing postures when practitioners perform standing knee lifting motions.

Conclusions

Professional groups who have been practicing Tai Chi (Bafa Wubu) for a long time have higher ground reaction force, and the force on the three joints of the lower extremities is different for various movements, which has positive significance for exercising the joints of the lower extremities. In addition, various motions activate muscles of different types at different levels. For amateurs to practice different movements to stimulate the muscles, targeted areas of practice promote the lower extremity muscles' synergistic force. In summary, the muscles and joints of the lower extremity can obtain comprehensive and balanced exercise through Bafa Wubu.

Effect of Running-Induced Fatigue on Tibial Acceleration and the Role of Lower Limb Muscle Strength, Power, and Endurance

BACKGROUND

High-impact loads have been linked with running injuries. Fatigue has been proposed to increase impact loads, but this relationship has not been rigorously examined, including the associated role of muscle strength, power, and endurance.

PURPOSE

This study aimed to investigate the effect of fatigue on impact loading in runners and the role of muscle function in mediating changes in impact loading with fatigue.

METHODS

Twenty-eight trained endurance runners performed a fixed-intensity time to exhaustion test at 85% of V̇O 2max . Tibial accelerations were measured using leg-mounted inertial measurement units and sampled every minute until volitional exhaustion. Tests of lower limb muscle strength, power, and endurance included maximal isometric strength (soleus, knee extensors, and knee flexors), single leg hop for distance, and the one leg rise test. Changes in peak tibial acceleration (PTA, g ) were compared between time points throughout the run (0%, 25%, 50%, 75%, and 100%). Associations between the change in PTA and lower limb muscle function tests were assessed (Spearman's rho [ rs ]).

RESULTS

PTA increased over the duration of the fatiguing run. Compared with baseline (0%) (mean ± SD, 9.1 g ± 1.6 g ), there was a significant increase at 75% (9.9 g ± 1.7 g , P = 0.001) and 100% (10.1 g ± 1.8 g , P < 0.001), with no change at 25% (9.6 g ± 1.6 g , P = 0.142) or 50% (9.7 g ± 1.7 g , P = 0.053). Relationships between change in PTA and muscle function tests were weak and not statistically significant ( rs = -0.153 to 0.142, all P > 0.05).

CONCLUSIONS

Peak axial tibial acceleration increased throughout a fixed-intensity run to exhaustion. The change in PTA was not related to performance in lower limb muscle function tests.

Accurate estimation of peak vertical ground reaction force using the duty factor in level treadmill running

This study aimed to (1) construct a statistical model (SMM) based on the duty factor (DF) to estimate the peak vertical ground reaction force ( F v , max ) and (2) to compare the estimated F v , max to force plate gold standard (GSM). One hundred and fifteen runners ran at 9, 11, and 13 km/h. Force (1000 Hz) and kinematic (200 Hz) data were acquired with an instrumented treadmill and an optoelectronic system, respectively, to assess force-plate and kinematic based DFs. SMM linearly relates F v , max to the inverse of DF because DF was analytically associated with the inverse of the average vertical force during ground contact time and the latter was very highly correlated to F v , max . No systematic bias and a 4% root mean square error (RMSE) were reported between GSM and SMM using force-plate based DF values when considering all running speeds together. Using kinematic based DF values, SMM reported a systematic but small bias (0.05BW) and a 5% RMSE when considering all running speeds together. These findings support the use of SMM to estimate F v , max during level treadmill runs at endurance speeds if underlying DF values are accurately measured.