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Gunterstockman BM, Carmel J, Bechard L, Yoder A, Farrokhi S. Rearfoot Strike Run Retraining for Achilles Tendon Pain: A Two-patient Case Series. Mil Med 2024; 189:e942-e947. [PMID: 37975221 DOI: 10.1093/milmed/usad436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/25/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Running-related injuries are prevalent in the military and are often related to physical fitness test training. Non-rearfoot striking while running is known to increase the risk of Achilles tendon injuries because of the high eccentric energy absorption by the elastic components of the planarflexor muscle-tendon complex. However, there is limited evidence to suggest benefits of converting runners with Achilles tendon pain to use a rearfoot strike. METHODS This is a case series of two active-duty Service members with chronic, running-related Achilles tendon pain that utilized a natural non-rearfoot strike pattern. Both patients were trained to utilize a rearfoot strike while running through the use of real-time visual feedback from wearable sensors. RESULTS The trained rearfoot strike pattern was retained for over one month after the intervention, and both patients reported improvements in pain and self-reported function. CONCLUSIONS This case series demonstrated the clinical utility of converting two non-rearfoot strike runners to a rearfoot strike pattern to decrease eccentric demands on the plantarflexors and reduce Achilles tendon pain while running.
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Affiliation(s)
| | | | - Laura Bechard
- Naval Medical Center San Diego, San Diego, CA 92134, USA
- Henry Jackson Foundation, Bethesda, MD 20817, USA
| | - Adam Yoder
- Henry Jackson Foundation, Bethesda, MD 20817, USA
- DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA 92134, USA
| | - Shawn Farrokhi
- Naval Medical Center San Diego, San Diego, CA 92134, USA
- DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA 92134, USA
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
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Mousavi SH, Khorramroo F, Jafarnezhadgero A. Gait retraining targeting foot pronation: A systematic review and meta-analysis. PLoS One 2024; 19:e0298646. [PMID: 38427634 PMCID: PMC10906845 DOI: 10.1371/journal.pone.0298646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/27/2024] [Indexed: 03/03/2024] Open
Abstract
Foot pronation is a prevalent condition known to contribute to a range of lower extremity injuries. Numerous interventions have been employed to address this issue, many of which are expensive and necessitate specific facilities. Gait retraining has been suggested as a promising intervention for modifying foot pronation, offering the advantage of being accessible and independent of additional materials or specific time. We aimed to systematically review the literature on the effect of gait retraining on foot pronation. We searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 20 June 2023. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify studies reporting the effect of different methods of gait-retraining on foot pronation. Outcomes of interest were rearfoot eversion, foot pronation, and foot arch. Two authors separately extracted data from included studies. Data of interest were study design, intervention, variable, sample size and sex, tools, age, height, weight, body mass index, running experience, and weekly distance of running. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. Fifteen studies with a total of 295 participants were included. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. Results of single studies indicated that reducing foot progression angle (MD 2.1, 95% CI 0.62, 3.58), lateralizing COP (MD -3.3, 95% CI -4.88, -1.72) can effectively reduce foot pronation. Overall, this study suggests that gait retraining may be a promising intervention for reducing foot pronation; Most of the included studies demonstrated significant improvements in foot pronation following gait retraining. Changing center of pressure, foot progression angle and forefoot strike training appeared to yield more favorable outcomes. However, further research is needed to fully understand its effectiveness and long-term benefits.
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Affiliation(s)
- Seyed Hamed Mousavi
- Faculty of Sport Sciences and Health, Department of Sport Injuries and Biomechanics, University of Tehran, Tehran, Iran
| | - Fateme Khorramroo
- Faculty of Sport Sciences and Health, Department of Sport Injuries and Biomechanics, University of Tehran, Tehran, Iran
| | - Amirali Jafarnezhadgero
- Faculty of Educational Science and Psychology, Department of Sport Managements and Biomechanics, University of Mohaghegh Ardabili, Ardabil, Iran
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Huber A, Verhoff D. A One Session Gait Retraining Protocol with Metronome Augmentation Increases Cadence in Novice and Recreational Runners. Int J Sports Phys Ther 2024; 19:1494-1502. [PMID: 38179589 PMCID: PMC10761631 DOI: 10.26603/001c.90909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
Background Running is a common leisure physical activity that carries a risk for running related injury (RRI). Non-experienced runners are more likely to sustain RRIs. One form of gait retraining focuses on increasing cadence to improve running biomechanics related to RRI. Protocols for increasing cadence must be pragmatic to be implemented into clinical practice. Hypothesis/Purpose The purpose of this study was to determine if a pragmatic protocol including one instructional session, followed by independent gait retraining with metronome augmentation resulted in increased cadence and altered biomechanics in novice and recreational runners. Study Design Randomized Controlled Trial. Methods Thirty-three novice or recreational adult runners completed a 12 Minute Cooper Run on an indoor track. Variables measured during the 12 Minute Cooper Run included distance, rate of perceived exertion (RPE), heart rate (HR), and 3-D biomechanics using inertial measurement units (IMUs). After baseline testing, the intervention group received instruction and five minutes of gait retraining at a cadence set 5-10% higher than baseline with metronome augmentation (Pro Metronome- Tempo, Beat; by Xiao Yixiang). They then ran two to three times a week for two weeks up to 30 minutes per session with the metronome set at the new cadence. After two weeks, repeat testing using the same protocol was completed. A Mann-Whitney U test analyzed differences between groups. Results Cadence at one minute (p = 0.037) and average cadence over the entire run (p=0.002) increased in the intervention group only with a large effect size (Cohens d = 0.837). No other group differences were found. Conclusion A pragmatic gait retraining protocol with metronome augmentation including one instructional and four to six independent sessions over a two-week duration increased cadence without negative effects on HR, RPE, distance. Biomechanics did not change with this intervention. Further research with pragmatic gait retraining protocols that increase cadence are needed with larger sample sizes, repeated measures over time, across runners of various abilities and experience levels. Level of Evidence Level 2.
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Affiliation(s)
- Angie Huber
- Doctor of Physical Therapy University of Findlay
| | - Dave Verhoff
- Doctor of Physical Therapy University of Findlay
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Spomer AM, Conner BC, Schwartz MH, Lerner ZF, Steele KM. Audiovisual biofeedback amplifies plantarflexor adaptation during walking among children with cerebral palsy. J Neuroeng Rehabil 2023; 20:164. [PMID: 38062454 PMCID: PMC10704679 DOI: 10.1186/s12984-023-01279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Biofeedback is a promising noninvasive strategy to enhance gait training among individuals with cerebral palsy (CP). Commonly, biofeedback systems are designed to guide movement correction using audio, visual, or sensorimotor (i.e., tactile or proprioceptive) cues, each of which has demonstrated measurable success in CP. However, it is currently unclear how the modality of biofeedback may influence user response which has significant implications if systems are to be consistently adopted into clinical care. METHODS In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 [12.5,15.5] years) adapted their gait patterns during treadmill walking (6 min/modality) with audiovisual (AV), sensorimotor (SM), and combined AV + SM biofeedback before and after four acclimation sessions (20 min/session) and at a two-week follow-up. Both biofeedback systems were designed to target plantarflexor activity on the more-affected limb, as these muscles are commonly impaired in CP and impact walking function. SM biofeedback was administered using a resistive ankle exoskeleton and AV biofeedback displayed soleus activity from electromyography recordings during gait. At every visit, we measured the time-course response to each biofeedback modality to understand how the rate and magnitude of gait adaptation differed between modalities and following acclimation. RESULTS Participants significantly increased soleus activity from baseline using AV + SM (42.8% [15.1, 59.6]), AV (28.5% [19.2, 58.5]), and SM (10.3% [3.2, 15.2]) biofeedback, but the rate of soleus adaptation was faster using AV + SM biofeedback than either modality alone. Further, SM-only biofeedback produced small initial increases in plantarflexor activity, but these responses were transient within and across sessions (p > 0.11). Following multi-session acclimation and at the two-week follow-up, responses to AV and AV + SM biofeedback were maintained. CONCLUSIONS This study demonstrated that AV biofeedback was critical to increase plantarflexor engagement during walking, but that combining AV and SM modalities further amplified the rate of gait adaptation. Beyond improving our understanding of how individuals may differentially prioritize distinct forms of afferent information, outcomes from this study may inform the design and selection of biofeedback systems for use in clinical care.
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Affiliation(s)
- Alyssa M Spomer
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
- Gillette Children's, 200 University Avenue East, Stop 490105, St. Paul, MN, 55101, USA.
| | - Benjamin C Conner
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Michael H Schwartz
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Gillette Children's, 200 University Avenue East, Stop 490105, St. Paul, MN, 55101, USA
| | - Zachary F Lerner
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
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Dillon S, Burke A, Whyte EF, O’Connor S, Gore S, Moran KA. Running towards injury? A prospective investigation of factors associated with running injuries. PLoS One 2023; 18:e0288814. [PMID: 37590281 PMCID: PMC10434952 DOI: 10.1371/journal.pone.0288814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/04/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Given the high incidence and heavy burden of running related injuries, large-scale, prospective multifactorial investigations examining potential risk factors are warranted. This study aimed to identify factors associated with running related injuries and to evaluate their potential in injury screening. STUDY DESIGN Prospective cohort study. MATERIALS AND METHODS Two hundred and seventy-four recreational runners were recruited. Clinical measures (strength, range of motion, foot position), injury and training history (via questionnaire), impact loading (via accelerometery) and running technique measures were collected at baseline. Runners were tracked for injury for one year via fortnightly check-ins. A binary logistic regression, (injury versus no injury), was performed for each variable univariably, and then adjusting for age, sex and mileage. A multivariable regression was also performed to evaluate the model's discriminative ability. RESULTS Of the 225 runners included in the final analysis 52% experienced a running related injury. Injury history in the past year, less navicular drop, and measures of running technique (knee, hip, and pelvis kinematics) were associated with increased odds of injury (p < .05). The multivariable logistic regression model was statistically significant, χ2(11) = 56.45, p < .001, correctly classifying 74% of cases with a sensitivity and specificity of 72% and 76%, respectively. The area under the receiver operating characteristic curve was 0.79 (CI95% = 0.73-0.85), demonstrating acceptable discriminative ability. CONCLUSIONS This study found a number of clinical and running technique factors to be associated with prospective running related injuries among recreational runners. With the exception of injury history, the factors identified as being significantly associated with injury may be modifiable and therefore, could form the basis of interventions. Range of motion, spatiotemporal parameters and strength measures were not associated with injury and thus their utilisation in injury prevention practices should be reconsidered.
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Affiliation(s)
- Sarah Dillon
- School of Allied Health, University of Limerick, Limerick, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Aoife Burke
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Enda F. Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Siobhán O’Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Shane Gore
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Kieran A. Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
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Willwacher S, Robbin J, Eßer T, Mai P. [Motion analysis systems in research and for practicing orthopedists]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04404-3. [PMID: 37391676 DOI: 10.1007/s00132-023-04404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Complex biomechanical motion analysis can provide relevant information for a variety of orthopedic problems. When purchasing motion analysis systems, in addition to the classical measurement quality criteria (validity, reliability, objectivity), spatial and temporal conditions, as well as the requirements for the qualification of the measuring personnel should be considered. APPLICATION In complex movement analysis, systems are used to determine kinematics, kinetics and muscle activity (electromyography). This article gives an overview of methods of complex biomechanical motion analysis for use in orthopaedic research or for individual patient care. In addition to the use for pure movement analysis, the use of movement analysis methods in the field of biofeedback training is discussed. ACQUISITION For the specific acquisition of motion analysis systems, it is recommended to contact professional societies (e.g., the German Society for Biomechanics),universities with existing motion analysis facilities or distributors in the field of biomechanics.
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Affiliation(s)
- Steffen Willwacher
- Institute for Advanced Biomechanics and Motion Studies, Hochschule Offenburg, Max-Planck-Str. 1, 77656, Offenburg, Deutschland.
| | - Johanna Robbin
- Institute for Advanced Biomechanics and Motion Studies, Hochschule Offenburg, Max-Planck-Str. 1, 77656, Offenburg, Deutschland
| | - Tanja Eßer
- Institut für Funktionelle Diagnostik, Köln, Deutschland, Im Mediapark 2, 50670
| | - Patrick Mai
- Institute for Advanced Biomechanics and Motion Studies, Hochschule Offenburg, Max-Planck-Str. 1, 77656, Offenburg, Deutschland
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Gruber AH. The "impacts cause injury" hypothesis: Running in circles or making new strides? J Biomech 2023; 156:111694. [PMID: 37364393 DOI: 10.1016/j.jbiomech.2023.111694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
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.
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Affiliation(s)
- Allison H Gruber
- The H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA.
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Eisenhardt D, Kits A, Madeleine P, Samani A, Clarke DC, Kristiansen M. Augmented-reality swim goggles accurately and reliably measure swim performance metrics in recreational swimmers. Front Sports Act Living 2023; 5:1188102. [PMID: 37389272 PMCID: PMC10304285 DOI: 10.3389/fspor.2023.1188102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
Background Swimmers commonly access performance metrics such as lap splits, distance, and pacing information between work bouts while they rest. Recently, a new category of tracking devices for swimming was introduced with the FORM Smart Swim Goggles (FORM Goggles). The goggles have a built-in see-through display and are capable of tracking and displaying distance, time splits, stroke, and pace metrics in real time using machine learning and augmented reality through a heads-up display. The purpose of this study was to assess the validity and reliability of the FORM Goggles compared with video analysis for stroke type, pool length count, pool length time, stroke rate, and stroke count in recreational swimmers and triathletes. Method A total of 36 participants performed mixed swimming intervals in a 25-m pool across two identical 900-m swim sessions performed at comparable intensities with 1 week interval. The participants wore FORM Goggles during their swims, which detected the following five swim metrics: stroke type, pool length time, pool length count, stroke count, and stroke rate. Four video cameras were positioned on the pool edges to capture ground truth video footage, which was then manually labeled by three trained individuals. Mean (SD) differences between FORM Goggles and ground truth were calculated for the selected metrics for both sessions. The absolute mean difference and mean absolute percentage error were used to assess the differences of the FORM Goggles relative to ground truth. The test-retest reliability of the goggles was assessed using both relative and absolute reliability metrics. Results Compared with video analysis, the FORM Goggles identified the correct stroke type at a rate of 99.7% (N = 2,354 pool lengths, p < 0.001), pool length count accuracy of 99.8%, and mean differences (FORM Goggles-ground truth) for pool length time: -0.10 s (1.49); stroke count: -0.63 (1.82); and stroke rate: 0.19 strokes/min (3.23). The test-retest intra-class correlation coefficient (ICC) values between the two test days were 0.793 for pool length time, 0.797 for stroke count, and 0.883 for stroke rate. Overall, for pool length time, the residuals were within ±1.0s for 65.3% of the total pool lengths, for stroke count within ±1 stroke for 62.6% of the total pool lengths, and for stroke rate within ±2 strokes/min for 66.40% of the total pool lengths. Conclusion The FORM Goggles were found valid and reliable for the tracking of pool length time, pool length count, stroke count, stroke rate, and stroke type during freestyle, backstroke, and breaststroke swimming in recreational swimmers and triathletes when compared with video analysis. This opens perspectives for receiving real-time information on performance metrics during swimming.
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Affiliation(s)
- Dan Eisenhardt
- Sport Sciences—Performance and Technology, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Aidan Kits
- Department of Biomedical Physiology and Kinesiology and Sports Analytics Group, Simon Fraser University, Burnaby, BC, Canada
| | - Pascal Madeleine
- Sport Sciences—Performance and Technology, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Afshin Samani
- Sport Sciences—Performance and Technology, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - David C. Clarke
- Department of Biomedical Physiology and Kinesiology and Sports Analytics Group, Simon Fraser University, Burnaby, BC, Canada
| | - Mathias Kristiansen
- Sport Sciences—Performance and Technology, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
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Jung CK, Kim J, Rhim HC. Validation of an Ear-Worn Wearable Gait Analysis Device. SENSORS (BASEL, SWITZERLAND) 2023; 23:1244. [PMID: 36772282 PMCID: PMC9921138 DOI: 10.3390/s23031244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Wearable devices capable of measuring gait parameters may provide a means to more economical gait analysis compared to conventional equipment comprising of a motion capture system and a forced treadmill. Beflex Coach (Beflex, Republic of Korea) is one such device but worn on the ear as Bluetooth earphones, unlike other wearables worn on the wrist, feet, or torso. In this study, the validity of the device was examined against a motion capture system and a forced treadmill for walking and running parameters. Five walking parameters (cadence, single support time, double support time, vertical oscillation (VO), and instantaneous vertical loading rate (IVLR)) and six running parameters (cadence, stance time, flight time, peak force, VO, and IVLR) were studied. Twenty young adults participated in walking or running on a forced treadmill at different speeds (walking: 0.8, 1.25, and 1.7 m/s for walking; running: 2, 2.5, and 3 m/s) while the two systems operated simultaneously. As a result, all parameters showed excellent associations (ICC > 0.75) and good agreements in Bland-Altman plots. The results of the study support the potential use of the ear-worn device as an inexpensive gait analysis equipment.
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Affiliation(s)
- Chang Keun Jung
- Beflex Research Center, Beflex Inc., Seoul 06628, Republic of Korea
| | - Jinkyuk Kim
- Beflex Research Center, Beflex Inc., Seoul 06628, Republic of Korea
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA
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Frasie A, Houry M, Plourde C, Robert MT, Bouyer LJ, Roy JS. Feedback for the prevention and rehabilitation of work-related musculoskeletal disorders: A systematic review. Work 2023; 76:61-94. [PMID: 36872834 DOI: 10.3233/wor-220545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (WRMSDs) remain a challenge despite research aimed at improving their prevention and treatment. Extrinsic feedback has been suggested for the prevention and rehabilitation of WRMSDs to improve sensorimotor control, and ultimately to reduce pain and disability. However, there are few systematic reviews on the effectiveness of extrinsic feedback for WRMSDs. OBJECTIVE To perform a systematic review investigating the effect of extrinsic feedback for the prevention and rehabilitation of WRMSDs. METHODS Five databases (CINAHL, Embase, Ergonomics Abstract, PsycInfo, PubMed) were searched. Studies of various designs assessing the effects of extrinsic feedback during work tasks on three outcomes (function, symptoms, sensorimotor control) in the context of prevention and rehabilitation of WRMSDs were included. RESULTS Forty-nine studies were included, for a total sample of 3387 participants (including 925 injured) who performed work-related tasks in the workplace (27 studies) or in controlled environments (22 studies). The use of extrinsic feedback was shown to be effective in controlled environments for short-term prevention of functional limitations and sensorimotor alterations (very limited to moderate evidence) and for improving, in injured participants, function, symptoms and sensorimotor control (moderate evidence). In the workplace, it was shown to be effective for short-term prevention of functional limitations (limited evidence). There was conflicting evidence regarding its effect for WRMSD rehabilitation in the workplace. CONCLUSION Extrinsic feedback is an interesting complementary tool for the prevention and rehabilitation of WRMSDs in controlled environments. More evidence is needed regarding its effect for the prevention and rehabilitation of WRMSDs in the workplace.
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Affiliation(s)
- Antoine Frasie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Maxime Houry
- Centre d'Études des Transformations des Activités Physiques etSportives (CETAPS), Université de Rouen, Rouen, France
| | - Charles Plourde
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Maxime T Robert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurent J Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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The Effect of Real-Time Tibial Acceleration Feedback on Running Biomechanics During Gait Retraining: A Systematic Review and Meta-Analysis. J Sport Rehabil 2023; 32:449-461. [PMID: 36791728 DOI: 10.1123/jsr.2022-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To explore the immediate and retention effect of real-time tibial acceleration feedback on running biomechanics during gait retraining. METHODS Five electronic databases were searched to identify relevant studies published before May 2022. The included studies were evaluated for methodological quality and bias risk, and data were extracted. A meta-analysis was conducted on the primary outcomes, including peak tibial acceleration (PTA) and vertical ground reaction force. Subgroup analysis was performed by gender, feedback criterion, mode, dosage, fading, retention period, and running environment to evaluate the source of heterogeneity. Qualitative analysis was performed to describe other variables. RESULTS Fourteen studies (174 participants) were eligible. Meta-analysis showed that real-time tibial acceleration feedback reduced PTA (P < .01, P < .01), vertical impact peak (P = .004, P < .01), vertical average loading rate (P < .01, P < .01), and vertical instantaneous loading rate (P < .01, P < .01) after feedback and during retention period (5 min-12 mo). Subgroup analysis showed that the immediate effect of vertical impact peak was more noticeable with mixed gender (P = .005) and fading feedback (P = .005) conditions, and the retention effect of PTA was more noticeable with high feedback dosage (P < .01) and fading feedback (P < .01) conditions. CONCLUSIONS Real-time tibial acceleration feedback can reduce PTA and vertical ground reaction force during gait retraining, and for periods of 5 minutes to 12 months when the feedback is removed.
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DeJong Lempke AF, Stephens SL, Fish PN, Thompson XD, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Sensor-based gait training to reduce contact time for runners with exercise-related lower leg pain: a randomised controlled trial. BMJ Open Sport Exerc Med 2022; 8:e001293. [PMID: 36353183 PMCID: PMC9639130 DOI: 10.1136/bmjsem-2021-001293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To assess the effects of a 4-week randomised controlled trial comparing an outdoor gait-training programme to reduce contact time in conjunction with home exercises (contact time gait-training feedback with home exercises (FBHE)) to home exercises (HEs) alone for runners with exercise-related lower leg pain on sensor-derived biomechanics and patient-reported outcomes. Design Randomised controlled trial. Setting Laboratory and field-based study. Participants 20 runners with exercise-related lower leg pain were randomly allocated into FBHE (4 male (M), 6 female (F), 23±4 years, 22.0±4.3 kg/m2) or HE groups (3 M, 7 F, 25±5 years, 23.6±3.9 kg/m2). Interventions Both groups completed eight sessions of HEs over 4 weeks. The FBHE group received vibrotactile feedback through wearable sensors to reduce contact time during outdoor running. Primary and secondary outcome measures Patient-reported outcome measures (PROMs) and outdoor gait assessments were conducted for both groups at baseline and 4 weeks. PROMs were repeated at 6 weeks, and feedback retention was assessed at 6 weeks for the FBHE group. Repeated measures analyses of variance were used to assess the influence of group and timepoint on primary outcomes. Results The FBHE group reported increased function and recovery on PROMs beyond the HE group at 6 weeks (p<0.001). There was a significant group by time interaction for Global Rating of Change (p=0.004) and contact time (p=0.002); the FBHE group reported greater subjective improvement and reduced contact time at 4 and 6 weeks compared with the HE group and compared with baseline. The FBHE group had increased cadence (mean difference: 7 steps/min, p=0.01) at 4 weeks during outdoor running compared with baseline. Conclusion FBHE was more effective than HE alone for runners with exercise-related lower leg pain, manifested with improved PROMs, reduced contact time and increased cadence. Trial registration number NCT04270565.
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Affiliation(s)
| | | | - Pamela N Fish
- Kidney Center, Fresenius Medical Care, Knoxville, Tennessee, USA
| | | | - Joseph M Hart
- Orthopaedics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David J Hryvniak
- Physical Medicine & Rehabilitation, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Jordan S Rodu
- Statistics, University of Virginia, Charlottesville, Virginia, USA
| | - Jay Hertel
- Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Review of Real-Time Biomechanical Feedback Systems in Sport and Rehabilitation. SENSORS 2022; 22:s22083006. [PMID: 35458991 PMCID: PMC9028061 DOI: 10.3390/s22083006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
Real-time biomechanical feedback (BMF) is a relatively new area of research. The potential of using advanced technology to improve motion skills in sport and accelerate physical rehabilitation has been demonstrated in a number of studies. This paper provides a literature review of BMF systems in sports and rehabilitation. Our motivation was to examine the history of the field to capture its evolution over time, particularly how technologies are used and implemented in BMF systems, and to identify the most recent studies showing novel solutions and remarkable implementations. We searched for papers in three research databases: Scopus, Web of Science, and PubMed. The initial search yielded 1167 unique papers. After a rigorous and challenging exclusion process, 144 papers were eventually included in this report. We focused on papers describing applications and systems that implement a complete real-time feedback loop, which must include the use of sensors, real-time processing, and concurrent feedback. A number of research questions were raised, and the papers were studied and evaluated accordingly. We identified different types of physical activities, sensors, modalities, actuators, communications, settings and end users. A subset of the included papers, showing the most perspectives, was reviewed in depth to highlight and present their innovative research approaches and techniques. Real-time BMF has great potential in many areas. In recent years, sensors have been the main focus of these studies, but new types of processing devices, methods, and algorithms, actuators, and communication technologies and protocols will be explored in more depth in the future. This paper presents a broad insight into the field of BMF.
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The Effectiveness of Gait Retraining on Running Kinematics, Kinetics, Performance, Pain, and Injury in Distance Runners: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:192-A5. [PMID: 35128941 DOI: 10.2519/jospt.2022.10585] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of running gait retraining on kinematics, kinetics, performance, pain, and injury in distance runners. DESIGN Intervention systematic review with meta-analysis. LITERATURE SEARCH Seven electronic databases from inception to March 2021. TRIAL SELECTION CRITERIA Randomized controlled trials that (1) evaluated running gait retraining compared to no intervention, usual training, placebo, or standard care and (2) reported biomechanical, physiological, performance, or clinical outcomes. DATA SYNTHESIS Random-effects metaanalyses were completed, and the certainty of evidence was judged using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We categorized interventions into step rate, non-rearfoot footstrike, impact, ground contact time, and multiparameter subgroups. RESULTS We included 19 trials (673 participants). Moderate-certainty evidence indicated step rate gait retraining increased step rate (SMD 1.03 [95% confidence interval {CI}: 0.63, 1.44]; number of trials (N): 4; I2: 0%) and reduced average vertical loading rate (SMD -0.57 [95% CI, -1.05 to -0.09], N: 3; I2: 0%). Low-certainty evidence indicated non-rearfoot footstrike retraining increased knee flexion at initial contact (SMD 0.74 [95% CI, 0.11 to 1.37]; N: 2; I2: 0%), but did not alter running economy (SMD 0.21 [95% CI, -1.11 to 1.52]; N: 3; I2: 19%).). Low-certainty evidence indicated multiparameter retraining did not alter running economy (SMD 0.32 [-0.39, 1.02]; N: 3; I2: 19%) or performance (SMD 0.14 [95% CI, -4.87 to 4.58]; N: 2; I2: 18%). Insufficient trials reported on pain outcomes. Two trials demonstrated reduced 1-year injury incidence following gait retraining. CONCLUSIONS Gait retraining interventions altered step rate and knee kinematics, lowered vertical loading rates, and did not affect running performance. J Orthop Sports Phys Ther 2022;52(4):192-206. Epub 05 Feb 2022. doi:10.2519/jospt.2022.10585.
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Souza Júnior JRD, Rabelo PHR, Lemos TV, Barbosa GMP, Matheus JPC. Knowledge, interest, and preference for gait retraining programs in street runners: a cross-sectional study. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21016929012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Some treatment modalities have been used to prevent or treat running-related musculoskeletal injuries, among them, gait retraining. This study aimed to evaluate street runners’ knowledge, interest, and preference for gait retraining programs and assess if these aspects differ between runners with and without history of injury. This is a cross-sectional study with 100 runners. Initially, a text showing what gait retraining was about was presented to participants. Then, they answered questions about their knowledge (yes x no) and interest (yes x no) on the programs. Subsequently, a text showing how fully and partially supervised programs would be conducted was offered to participants. Then, they reported their preference for one of them (fully x partially supervised). We found that most athletes were unaware of gait retraining programs (69.8%), though they showed great interest in performing them after explanation (87.1%). We observed no preference for a fully (48.2%) or partially supervised (51.8%) protocol. We also found a statistical difference in knowledge (p=0.029) in favor of participants with history of injury. Despite the growing evidence available, we observed that most runners lack any prior knowledge of this modality. Due to the great interest and lack of preference for different protocols shown, we suggest that healthcare providers who treat this population offer the programs described to patients.
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16
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Souza Júnior JRD, Rabelo PHR, Lemos TV, Barbosa GMP, Matheus JPC. Conhecimento, interesse e preferência por programas de retreinamento de corrida em corredores de rua: estudo transversal. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21016929012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
RESUMO Com o intuito de prevenir ou reabilitar lesões musculoesqueléticas relacionadas à corrida, algumas modalidades de tratamento têm sido utilizadas, entre elas o retreinamento de corrida. O objetivo deste estudo foi avaliar o conhecimento, o interesse e a preferência acerca de programas de retreinamento de corrida por parte de corredores de rua e verificar se esses aspectos diferem entre corredores sem e com histórico de lesão. Trata-se de estudo transversal feito com 100 corredores. Inicialmente, um texto mostrando do que se tratava o retreinamento de corrida foi apresentado aos participantes, que então responderam com relação ao conhecimento (sim ou não) e ao interesse na realização (sim ou não). Posteriormente, um texto mostrando como seria a realização de um programa supervisionado e outro parcialmente supervisionado foi apresentado aos participantes, que responderam acerca de sua preferência por um deles (supervisionado ou parcialmente supervisionado). Constatou-se que a maioria desconhece os programas de retreinamento de corrida (69,8%), porém houve um alto interesse (87,1%) na realização do programa após a leitura do texto. Os participantes não apresentaram preferência por um protocolo totalmente supervisionado (48,2%) ou parcialmente supervisionado (51,8%). Foi encontrada uma diferença estatística quanto ao conhecimento (p=0,029) a favor dos participantes com histórico de lesão. Apesar das crescentes evidências disponíveis, observou-se que a maioria dos corredores não tem conhecimento prévio sobre esta modalidade. Devido ao alto interesse e à ausência de preferência por diferentes protocolos, sugere-se que os programas descritos sejam apresentados aos pacientes por profissionais da saúde que trabalhem com essa população.
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Shah NV, Gold R, Dar QA, Diebo BG, Paulino CB, Naziri Q. Smart Technology and Orthopaedic Surgery: Current Concepts Regarding the Impact of Smartphones and Wearable Technology on Our Patients and Practice. Curr Rev Musculoskelet Med 2021; 14:378-391. [PMID: 34729710 PMCID: PMC8733100 DOI: 10.1007/s12178-021-09723-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW While limited to case reports or small case series, emerging evidence advocates the inclusion of smartphone-interfacing mobile platforms and wearable technologies, consisting of internet-powered mobile and wearable devices that interface with smartphones, in the orthopaedic surgery practice. The purpose of this review is to investigate the relevance and impact of this technology in orthopaedic surgery. RECENT FINDINGS Smartphone-interfacing mobile platforms and wearable technologies are capable of improving the patients' quality of life as well as the extent of their therapeutic engagement, while promoting the orthopaedic surgeons' abilities and level of care. Offered advantages include improvements in diagnosis and examination, preoperative templating and planning, and intraoperative assistance, as well as postoperative monitoring and rehabilitation. Supplemental surgical exposure, through haptic feedback and realism of audio and video, may add another perspective to these innovations by simulating the operative environment and potentially adding a virtual tactile feature to the operator's visual experience. Although encouraging in the field of orthopaedic surgery, surgeons should be cautious when using smartphone-interfacing mobile platforms and wearable technologies, given the lack of a current academic governing board certification and clinical practice validation processes.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
| | - Richard Gold
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- School of Medicine, Saint George's University, True Blue, West Indies, Grenada
| | - Qurratul-Ain Dar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
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18
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Gait Retraining With Visual Biofeedback Reduces Rearfoot Pressure and Foot Pronation in Recreational Runners. J Sport Rehabil 2021; 31:165-173. [PMID: 34697250 DOI: 10.1123/jsr.2021-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/19/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Running is a popular sport globally. Previous studies have used a gait retraining program to successfully lower impact loading, which has been associated with lower injury rates in recreational runners. However, there is an absence of studies on the effect of this training program on the plantar pressure distribution pattern during running. OBJECTIVE To investigate the short-term effect of a gait retraining strategy that uses visual biofeedback on the plantar pressure distribution pattern and foot posture in recreational runners. DESIGN Randomized controlled trial. SETTING Biomechanics laboratory. PARTICIPANTS Twenty-four recreational runners were evaluated (n = 12 gait retraining group and n = 12 control group). INTERVENTION Those in the gait retraining group underwent a 2-week program (4 sessions/wk, 30 min/session, and 8 sessions). The participants in the control group were also invited to the laboratory (8 times in 2 wk), but no feedback on their running biomechanics was provided. MAIN OUTCOME MEASURES The primary outcome measures were plantar pressure distribution and plantar arch index using a pressure platform. The secondary outcome measure was the foot posture index. RESULTS The gait retraining program with visual biofeedback was effective in reducing medial and lateral rearfoot plantar pressure after intervention and when compared with the control group. In the static condition, the pressure peak and maximum force on the forefoot and midfoot were reduced, and arch index was increased after intervention. After static training intervention, the foot posture index showed a decrease in the foot pronation. CONCLUSIONS A 2-week gait retraining program with visual biofeedback was effective in lowering rearfoot plantar pressure, favoring better support of the arch index in recreational runners. In addition, static training was effective in reducing foot pronation. Most importantly, these observations will help healthcare professionals understand the importance of a gait retraining program with visual biofeedback to improve plantar loading and pronation during rehabilitation.
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19
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Kuwabara A, Dyrek P, Olson EM, Kraus E. Evidence-Based Management of Medial Tibial Stress Syndrome in Runners. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Hegedus EJ, Ickes L, Jakobs F, Ford KR, Smoliga JM. Comprehensive Return to Competitive Distance Running: A Clinical Commentary. Sports Med 2021; 51:2507-2523. [PMID: 34478108 DOI: 10.1007/s40279-021-01547-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 01/02/2023]
Abstract
Running injuries are very common, and there are well-established protocols for clinicians to manage specific musculoskeletal conditions in runners. However, competitive and elite runners may experience different injuries than the average recreational runner, due to differences in training load, biomechanics, and running experience. Additionally, injury-specific rehabilitation protocols do not consider the broader goal of return to competitive running, including the unique psychosocial and cardiorespiratory fitness needs of elite athletes. This review aims to suggest a guideline for running-specific progression as part of a comprehensive rehabilitation program for injured competitive runners. Tools to evaluate an athlete's psychosocial preparedness to return to competition are presented. Recommendations are also provided for monitoring cardiorespiratory fitness of injured runners, including the nuances of interpreting these data. Finally, a six-phase training paradigm is proposed to guide clinicians as they help competitive runners transition from the early stages of injury through a full return to competition.
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Affiliation(s)
- Eric J Hegedus
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC, 27268, USA. .,Physical Therapy Program, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Lindsey Ickes
- Department of Exercise Science, One University Parkway, High Point University, High Point, NC, 27268, USA
| | - Franziska Jakobs
- Department of Exercise Science, One University Parkway, High Point University, High Point, NC, 27268, USA
| | - Kevin R Ford
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC, 27268, USA
| | - James M Smoliga
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC, 27268, USA
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21
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Dobiasch M, Stafylidis S, Baca A. Effects of different feedback variants on pacing adherence in a field based running test. INT J PERF ANAL SPOR 2021. [DOI: 10.1080/24748668.2021.1968662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Martin Dobiasch
- Centre for Sport Science and University Sports, Department for Biomechanics, Kinesiology and Computer Science in Sport, University of Vienna, Vienna, Austria
| | - Savvas Stafylidis
- Centre for Sport Science and University Sports, Department for Biomechanics, Kinesiology and Computer Science in Sport, University of Vienna, Vienna, Austria
| | - Arnold Baca
- Centre for Sport Science and University Sports, Department for Biomechanics, Kinesiology and Computer Science in Sport, University of Vienna, Vienna, Austria
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22
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Relationship between Running Spatiotemporal Kinematics and Muscle Performance in Well-Trained Youth Female Athletes. A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168869. [PMID: 34444618 PMCID: PMC8392471 DOI: 10.3390/ijerph18168869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this cross-sectional study was to analyse the relationship of neuromuscular performance and spatiotemporal parameters in 18 adolescent distance athletes (age, 15.5 ± 1.1 years). Using the OptoGait system, the power, rhythm, reactive strength index, jump flying time, and jump height of the squat jump, countermovement jump, and eight maximal hoppings test (HT8max) and the contact time (CT), flying time (FT), step frequency, stride angle, and step length of running at different speeds were measured. Maturity offset was determined based on anthropometric variables. Analysis of variance (ANOVA) of repeated measurements showed a reduction in CT (p < 0.000) and an increase in step frequency, step length, and stride angle (p < 0.001), as the velocity increased. The HT8max test showed significant correlations with very large effect sizes between neuromuscular performance variables (reactive strength index, power, jump flying time, jump height, and rhythm) and both step frequency and step length. Multiple linear regression found this relationship after adjusting spatiotemporal parameters with neuromuscular performance variables. Some variables of neuromuscular performance, mainly in reactive tests, were the predictors of spatiotemporal parameters (CT, FT, stride angle, and VO). Rhythm and jump flying time in the HT8max test and power in the countermovement jump test are parameters that can predict variables associated with running biomechanics, such as VO, CT, FT, and stride angle.
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23
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Tamburella F, Lorusso M, Tagliamonte NL, Bentivoglio F, Bigioni A, Pisotta I, Lancini M, Pasinetti S, Ghidelli M, Masciullo M, Saraceni VM, Molinari M. Load Auditory Feedback Boosts Crutch Usage in Subjects With Central Nervous System Lesions: A Pilot Study. Front Neurol 2021; 12:700472. [PMID: 34295303 PMCID: PMC8290055 DOI: 10.3389/fneur.2021.700472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Crutches are the most common walking aids prescribed to improve mobility in subjects with central nervous system (CNS) lesions. To increase adherence to the appropriate level of crutch usage, providing load-related auditory feedback (aFB) may be a useful approach. We sensorized forearm crutches and developed a custom software to provide aFB information to both user and physical therapist (PhT). Aim: Evaluate aFB effects on load control during gait by a self-controlled case series trial. Methods: A single experimental session was conducted enrolling 12 CNS lesioned participants. Load on crutch was recorded during 10 Meter Walk Test performed with and without aFB. In both cases, crutch load data, and gait speed were recorded. Usability and satisfaction questionnaires were administered to participants and PhTs involved. Results: Reliable data were obtained from eight participants. Results showed that compared to the no FB condition, aFB yielded a significant reduction in the mean load on the crutches during gait (p = 0.001). The FB did not influence gait speed or fatigue (p > 0.05). The experience questionnaire data indicated a positive experience regarding the use of aFB from both participants' and PhTs' perspectives. Conclusion: aFB significantly improves compliance with crutch use and does not affect gait speed or fatigue by improving the load placed on crutches. The FB is perceived by users as helpful, safe, and easy to learn, and does not interfere with attention or concentration while walking. Furthermore, the PhTs consider the system to be useful, easy to learn and reliable.
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Affiliation(s)
- Federica Tamburella
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Matteo Lorusso
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Nevio Luigi Tagliamonte
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Advanced Robotics and Human-Centered Technologies Research Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesca Bentivoglio
- Advanced Robotics and Human-Centered Technologies Research Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandra Bigioni
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Iolanda Pisotta
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Matteo Lancini
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Simone Pasinetti
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Marco Ghidelli
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Marcella Masciullo
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | | | - Marco Molinari
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
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de Souza Júnior JR, Rabelo PHR, Lemos TV, Esculier JF, Carto JPDS, Matheus JPC. Effects of gait retraining with focus on impact versus gait retraining with focus on cadence on pain, function and lower limb kinematics in runners with patellofemoral pain: Protocol of a randomized, blinded, parallel group trial with 6-month follow-up. PLoS One 2021; 16:e0250965. [PMID: 33979372 PMCID: PMC8116042 DOI: 10.1371/journal.pone.0250965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
Patellofemoral pain (PFP) is one of the most prevalent injuries in runners. Unfortunately, a substantial part of injured athletes do not recover fully from PFP in the long-term. Although previous studies have shown positive effects of gait retraining in this condition, retraining protocols often lack clinical applicability because they are time-consuming, costly for patients and require a treadmill. The primary objective of this study will be to compare the effects of two different two-week partially supervised gait retraining programs, with a control intervention; on pain, function and lower limb kinematics of runners with PFP. It will be a single-blind randomized clinical trial with six-month follow-up. The study will be composed of three groups: a group focusing on impact (group A), a group focusing on cadence (group B), and a control group that will not perform any intervention (group C). The primary outcome measure will be pain assessed using the Visual Analog Pain scale during running. Secondary outcomes will include pain during daily activities (usual), symptoms assessed using the Patellofemoral Disorders Scale and lower limb running kinematics in the frontal (contralateral pelvic drop; hip adduction) and sagittal planes (foot inclination; tibia inclination; ankle dorsiflexion; knee flexion) assessed using the MyoResearch 3.14-MyoVideo (Noraxon U.S.A. Inc.). The study outcomes will be evaluated before (t0), immediately after (t2), and six months (t24) after starting the protocol. Our hypothesis is that both partially supervised gait retraining programs will be more effective in reducing pain, improving symptoms, and modifying lower limb kinematics during running compared with the control group, and that the positive effects from these programs will persist for six months. Also, we believe that one gait retraining group will not be superior to the other. Results from this study will help improve care in runners with PFP, while maximizing clinical applicability as well as time and cost-effectiveness.
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Affiliation(s)
- José Roberto de Souza Júnior
- Sciences and Technologies in Health Post-graduation Program, University of Brasília, Brasília, Federal District, Brazil
| | - Pedro Henrique Reis Rabelo
- Sciences and Technologies in Health Post-graduation Program, University of Brasília, Brasília, Federal District, Brazil
| | - Thiago Vilela Lemos
- Department of Physical Therapy, State University of Goiás, Goiânia, Goiás, Brazil
| | - Jean-Francois Esculier
- The Running Clinic, Lac Beauport, Quebec, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - João Pedro da Silva Carto
- Sciences and Technologies in Health Post-graduation Program, University of Brasília, Brasília, Federal District, Brazil
| | - João Paulo Chieregato Matheus
- Sciences and Technologies in Health Post-graduation Program, University of Brasília, Brasília, Federal District, Brazil
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Johnson CD, Davis IS. A comparison of ground reaction force waveforms and step length between recreational endurance runners with hamstring injuries and healthy controls. Clin Biomech (Bristol, Avon) 2021; 84:105334. [PMID: 33774324 DOI: 10.1016/j.clinbiomech.2021.105334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/19/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute hamstring injuries during sprinting have been attributed, in part, to the ground reaction forces experienced during early stance. However, no studies have investigated the factors associated with overuse hamstring injuries in endurance runners. Our purpose was to compare early stance ground reaction forces and step length between runners with overuse hamstring injuries and healthy controls. METHODS 23 runners (5 men/ 18 women) who presented to a running clinic with an overuse hamstring injury were matched with healthy controls for sex, running speed and age. All participants ran on an instrumented treadmill, embedded with force plates. A 3-min warm-up was given, at a self-selected training pace, followed by 16-s of ground reaction force data collection (≈20 strides). Statistical parametric mapping was used to compared ground reaction force waveforms. Additionally, discrete force variables were calculated, including vertical average/instantaneous. Mean comparisons for discrete ground reaction force variables and step length were performed. FINDINGS Differences in ground reaction force waveforms did not reach statistical significance (p > 0.05). However, mean vertical loading rates were found to be higher in the Hamstring Injury group compared to Controls (p = 0.03-0.04) with small to moderate effect sizes (d = 0.47-0.52). No differences were found in mean step length. INTERPRETATION These results provide evidence that vertical loading rates may be associated with overuse hamstring injuries. However, further research is needed to identify the contribution of joint kinematics/kinetics and muscle activity.
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Affiliation(s)
- Caleb D Johnson
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
| | - Irene S Davis
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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Mousavi SH, van Kouwenhove L, Rajabi R, Zwerver J, Hijmans JM. The effect of changing foot progression angle using real-time visual feedback on rearfoot eversion during running. PLoS One 2021; 16:e0246425. [PMID: 33566828 PMCID: PMC7875396 DOI: 10.1371/journal.pone.0246425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
Atypical rearfoot in/eversion may be an important risk factor for running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping but a modification derived from gait retraining to correct atypical rearfoot in/eversion is lacking. We aimed to investigate changes in rearfoot in/eversion, subtalar pronation, medial longitudinal arch angle, and selected lower limb joint biomechanics while performing toe-in/toe-out running using real-time visual feedback. Fifteen female runners participated in this study. Subjects performed toe-in/toe-out running using real-time visual feedback on foot progression angle, which was set ±5° from habitual foot progression angle. 3D kinematics of rearfoot in/eversion, subtalar supination/pronation, medial longitudinal arch angle, foot progression angle, hip flexion, ab/adduction and internal/external rotation, knee flexion, ankle dorsiflexion, and ankle power were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes between three conditions. Toe-in running compared to normal and toe-out running reduced peak rearfoot eversion (mean difference (MD) with normal = 2.1°; p<0.001, MD with toe-out = 3.5°; p<0.001), peak pronation (MD with normal = -2.0°; p<0.001, MD with toe-out = -3.4; p = <0.001), and peak medial longitudinal arch angle (MD with normal = -0.7°; p = 0.022, MD with toe-out = -0.9; p = 0.005). Toe-out running significantly increased these kinematic factors compared to normal and toe-in running. Toe-in running compared to normal running increased peak hip internal rotation (MD = 2.3; p<0.001), and reduced peak knee flexion (MD = 1.3; p = 0.014). Toe-out running compared to normal running reduced peak hip internal rotation (MD = 2.5; p<0.001), peak hip ab/adduction (MD = 2.5; p<0.001), peak knee flexion (MD = 1.5; p = 0.003), peak ankle dorsiflexion (MD = 1.6; p<0.001), and peak ankle power (MD = 1.3; p = 0.001). Runners were able to change their foot progression angle when receiving real-time visual feedback for foot progression angle. Toe-in/toe-out running altered rearfoot kinematics and medial longitudinal arch angle, therefore supporting the potential value of gait retraining focused on foot progression angle using real-time visual feedback when atypical rearfoot in/eversion needs to be modified. It should be considered that changes in foot progression angle when running is accompanied by changes in lower limb joint biomechanics.
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Affiliation(s)
- Seyed Hamed Mousavi
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail: ,
| | - Laurens van Kouwenhove
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reza Rajabi
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Johannes Zwerver
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Juha M. Hijmans
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Charlton JM, Eng JJ, Li LC, Hunt MA. Learning Gait Modifications for Musculoskeletal Rehabilitation: Applying Motor Learning Principles to Improve Research and Clinical Implementation. Phys Ther 2021; 101:pzaa207. [PMID: 33351940 PMCID: PMC7899063 DOI: 10.1093/ptj/pzaa207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/04/2020] [Indexed: 12/11/2022]
Abstract
Gait modifications are used in the rehabilitation of musculoskeletal conditions like osteoarthritis and patellofemoral pain syndrome. While most of the research has focused on the biomechanical and clinical outcomes affected by gait modification, the process of learning these new gait patterns has received little attention. Without adequate learning, it is unlikely that the modification will be performed in daily life, limiting the likelihood of long-term benefit. There is a vast body of literature examining motor learning, though little has involved gait modifications, especially in populations with musculoskeletal conditions. The studies that have examined gait modifications in these populations are often limited due to incomplete reporting and study design decisions that prohibit strong conclusions about motor learning. This perspective draws on evidence from the broader motor learning literature for application in the context of modifying gait. Where possible, specific gait modification examples are included to highlight the current literature and what can be improved on going forward. A brief theoretical overview of motor learning is outlined, followed by strategies that are known to improve motor learning, and finally, how assessments of learning need to be conducted to make meaningful conclusions.
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Affiliation(s)
- Jesse M Charlton
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Richmond, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Mousavi SH, van Kouwenhove L, Rajabi R, Zwerver J, Hijmans JM. The effect of changing mediolateral center of pressure on rearfoot eversion during treadmill running. Gait Posture 2021; 83:201-209. [PMID: 33171373 DOI: 10.1016/j.gaitpost.2020.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/03/2020] [Accepted: 10/29/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Atypical rearfoot eversion is an important kinematic risk factor in running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping, yet a running gait retraining is lacking. Therefore, the aim was to investigate the effects of changing mediolateral center of pressure (COP) on rearfoot eversion, subtalar pronation, medial longitudinal arch angle (MLAA), hip kinematics and vertical ground reaction force (vGRF). METHODS Fifteen healthy female runners underwent gait retraining under three conditions. Participants were instructed to run normally, on the lateral (COP lateral) and medial (COP medial) side of the foot. Foot progression angle (FPA) was controlled using real-time visual feedback. 3D measurements of rearfoot eversion, subtalar pronation, MLAA, FPA, hip kinematics, vGRF and COP were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes in outcome between three conditions. Data were also analyzed using statistic parameter mapping. RESULTS Running on the lateral side of the foot compared to normal running and running on the medial side of the foot reduced peak rearfoot eversion (mean difference (MD) with normal 3.3°, p < 0.001, MD with COP medial 6°, p < 0.001), peak pronation (MD with normal 5°, p < 0.001, MD with COP medial 9.6°, p=<0.001), peak MLAA (MD with normal 2.3°, p < 0.001, MD with COP medial 4.1°, p < 0.001), peak hip internal rotation (MD with normal 1.8°, p < 0.001), and peak hip adduction (MD with normal running 1°, p = 0.011). Running on the medial side of the foot significantly increased peak rearfoot eversion, pronation and MLAA compared to normal running. SIGNIFICANCE This study demonstrated that COP translation along the mediolateral foot axis significantly influences rearfoot eversion, MLAA, and subtalar pronation during running. Running with either more lateral or medial COP reduced or increased peak rearfoot eversion, peak subtalar pronation, and peak MLAA, respectively, compared to normal running. These results might use as a basis to help clinicians and researchers prescribe running gait retraining by changing mediolateral COP for runners with atypical rearfoot eversion or MLAA.
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Affiliation(s)
- Seyed Hamed Mousavi
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands; University of Tehran, Faculty of Physical Education and Sport Sciences, Department of Health and Sport Medicine, Tehran, Iran.
| | - Laurens van Kouwenhove
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Reza Rajabi
- University of Tehran, Faculty of Physical Education and Sport Sciences, Department of Health and Sport Medicine, Tehran, Iran
| | - Johannes Zwerver
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, the Netherlands; Department of Sports Medicine/SportsValley, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
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YING JIMING, CHEN WENMING, WANG DUOJIN, WANG ZESHENG. ASSESSING THE POTENTIAL INFLUENCE OF DIFFERENT WALKING STRATEGIES ON PLANTAR PRESSURE DISTRIBUTION TRIGGERED BY A PORTABLE BIOFEEDBACK-BASED GAIT TRAINING DEVICE. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Plantar pressure refers to the interfacial contact pressure between the foot and the supporting surface during daily locomotor activities. Information derived from plantar pressure measures is essential in gait and posture research for diagnosing patho-mechanics associated with the musculoskeletal diseases. In particular, it is compulsory to reduce the abnormally high plantar pressure in people with diabetes for the prevention and treatment of foot ulcerations in this population. In this study, a portable biofeedback-based gait training device is developed to advocate able-bodied subjects to adopt different movement patterns in walking to manipulate the plantar pressure distribution under the foot. Through the simultaneous detection of the plantar pressure pattern and the kinematics of the lower extremity joints, it was revealed that the unloading effects for the plantar site in particular to the lateral forefoot subareas were more abundant through biofeedback-assisted gait alterations than the self-awareness control for gait adjustment. In addition, the corresponding relationship between joint coordination and pressure redistribution pattern was obtained, which could potentially be used in gait retraining interventions to correct abnormal plantar pressure patterns in people with diabetes.
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Affiliation(s)
- JI-MING YING
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China
| | - WEN-MING CHEN
- Academy for Engineering & Technology, Fudan University, Shanghai 200433, P. R. China
| | - DUO-JIN WANG
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China
| | - ZE-SHENG WANG
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China
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Miller EM, Crowell MS, Morris JB, Mason JS, Zifchock R, Goss DL. Gait Retraining Improves Running Impact Loading and Function in Previously Injured U.S. Military Cadets: A Pilot Study. Mil Med 2020; 186:e1077-e1087. [PMID: 33215669 DOI: 10.1093/milmed/usaa383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/16/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Running-related musculoskeletal injury (RRI) among U.S. military service members continues to negatively impact force readiness. There is a paucity of evidence supporting the use of RRI interventions, such as gait retraining, in military populations. Gait retraining has demonstrated effectiveness in altering running biomechanics and reducing running load. The purpose of this pilot study was to investigate the clinical effect of a gait retraining intervention on a military cadet population recovering from a lower-extremity RRI. MATERIALS AND METHODS The study design is a pilot study. Before study initiation, institutional approval was granted by the Keller Army Community Hospital Office of Human Research Protections. Nine rearfoot strike (RFS) runners recovering from a lower-extremity RRI at the U.S. Military Academy were prospectively enrolled and completed a gait retraining intervention. Participants followed-up with their assigned medical provider 6 times over 10 weeks for a clinical evaluation and running gait retraining. Gait retraining was provided utilizing verbal, visual, and audio feedback to facilitate a change in running foot strike pattern from RFS to non-rearfoot strike (NRFS) and increase preferred running step rate. At pre-intervention and post-intervention running ground reaction forces (GRF) [average vertical loading rate (AVLR), peak vertical GRF], kinematic (foot strike pattern) and temporospatial (step rate, contact time) data were collected. Participants self-reported their level of function via the Single Assessment Numeric Evaluation, Patient-Specific Functional Scale, and total weekly running minutes. Paired samples t-tests and Wilcoxon signed rank tests were used to compare pre- and post-intervention measures of interest. Values of P < .05 were considered statistically significant. RESULTS Nine patients completed the 10-week intervention (age, 20.3 ± 2.2 years; height, 170.7 ± 13.8 cm; mass, 71.7 ± 14.9 kg; duration of injury symptoms, 192.4 ± 345.5 days; running speed, 2.8 ± 0.38 m/s). All nine runners (100%) transitioned from RFS to NRFS. Left AVLR significantly decreased from 60.3 ± 17.0 bodyweight per second (BW/s) before intervention to 25.9 ± 9.1 BW/s after intervention (P = 0.008; effect size (d) = 2.5). Right AVLR significantly decreased from 60.5 ± 15.7 BW/s to 32.3 ± 12.5 BW/s (P < .001; d = 2.0). Similarly, step rate increased from 169.9 ± 10.0 steps per minute (steps/min) before intervention to 180.5 ± 6.5 steps/min following intervention (P = .005; d = 1.3). Single Assessment Numeric Evaluation scores improved significantly from 75 ± 23 to 100 ± 8 (P = .008; d = 1.5) and Patient-Specific Functional Scale values significantly improved from 6 ± 2.3 to 9.5 ± 1.6 (P = .007; d = 1.8) after intervention. Peak vertical GRF (left, P = .127, d = 0.42; right, P = .052, d = 0.53), contact time (left, P = 0.127, d = 0.42; right, P = 0.052, d = 0.53), and total weekly continuous running minutes (P = 0.095, d = 0.80) remained unchanged at post-intervention. All 9 patients remained injury free upon a 6-month medical record review. CONCLUSIONS In 9 military service members with a RRI, a 10-week NRFS gait retraining intervention was effective in improving running mechanics and measures of function. Patients remained injury-free 6 months following enrollment. The outcomes of this pilot study suggest that individuals recovering from certain lower-extremity RRIs may benefit from transitioning to an NRFS running pattern.
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Affiliation(s)
- Erin M Miller
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Michael S Crowell
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Jamie B Morris
- Army-Baylor Doctorate of Physical Therapy Program, United States Army Medical Center of Excellence,Fort Sam Houston, TX 78234, USA
| | - John S Mason
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Rebeca Zifchock
- Department of Civil and Mechanical Engineering, United States Military Academy, West Point, NY 10996, USA
| | - Donald L Goss
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268, USA
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Martínez-Gramage J, Albiach JP, Moltó IN, Amer-Cuenca JJ, Huesa Moreno V, Segura-Ortí E. A Random Forest Machine Learning Framework to Reduce Running Injuries in Young Triathletes. SENSORS 2020; 20:s20216388. [PMID: 33182357 PMCID: PMC7664858 DOI: 10.3390/s20216388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 12/31/2022]
Abstract
Background: The running segment of a triathlon produces 70% of the lower limb injuries. Previous research has shown a clear association between kinematic patterns and specific injuries during running. Methods: After completing a seven-month gait retraining program, a questionnaire was used to assess 19 triathletes for the incidence of injuries. They were also biomechanically analyzed at the beginning and end of the program while running at a speed of 90% of their maximum aerobic speed (MAS) using surface sensor dynamic electromyography and kinematic analysis. We used classification tree (random forest) techniques from the field of artificial intelligence to identify linear and non-linear relationships between different biomechanical patterns and injuries to identify which styles best prevent injuries. Results: Fewer injuries occurred after completing the program, with athletes showing less pelvic fall and greater activation in gluteus medius during the first phase of the float phase, with increased trunk extension, knee flexion, and decreased ankle dorsiflexion during the initial contact with the ground. Conclusions: The triathletes who had suffered the most injuries ran with increased pelvic drop and less activation in gluteus medius during the first phase of the float phase. Contralateral pelvic drop seems to be an important variable in the incidence of injuries in young triathletes.
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Affiliation(s)
- Javier Martínez-Gramage
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (I.N.M.); (J.J.A.-C.); (E.S.-O.)
- Correspondence: ; Tel.: +34-617024366
| | - Juan Pardo Albiach
- Embedded Systems and Artificial Intelligence Group, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain;
| | - Iván Nacher Moltó
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (I.N.M.); (J.J.A.-C.); (E.S.-O.)
| | - Juan José Amer-Cuenca
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (I.N.M.); (J.J.A.-C.); (E.S.-O.)
| | - Vanessa Huesa Moreno
- Triathlon Technification Program, Federación Triatlón Comunidad Valencian, 46940 Manises, Spain;
| | - Eva Segura-Ortí
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (I.N.M.); (J.J.A.-C.); (E.S.-O.)
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Hensley CP, Millican D, Hamilton N, Yang A, Lee J, Chang AH. Video-Based Motion Analysis Use: A National Survey of Orthopedic Physical Therapists. Phys Ther 2020; 100:1759-1770. [PMID: 32737503 DOI: 10.1093/ptj/pzaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/04/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Motion analysis is performed by physical therapists to assess and improve movement. Two-dimensional video-based motion analysis (VBMA) is available for smartphones/tablets and requires little to no equipment or cost. Research on VBMA use in clinical practice is limited. The purpose of this study was to examine the current use of VBMA in orthopedic physical therapist practice. METHODS Members of the Academy of Orthopaedic Physical Therapy completed an online survey. Questions examined frequency of VBMA use, reasons for use, facilitators/barriers, device/apps used, practice patterns, other certificates/degrees, and demographic information. RESULTS Among the final analysis sample of 477 respondents, 228 (47.8%) use VBMA. Of 228 VBMA users, 91.2% reported using it for ≤25% of their caseload, and 57.9% reported using their personal device to capture movement. Reasons for using VBMA included visual feedback for patient education (91.7%), analysis of movement (91.2%), and assessment of progress (51.8%). Barriers to use included lack of device/equipment (48.8%), lack of space (48.6%), and time restraint (32.1%). Those with ≤20 years of clinical experience (odds ratio [OR] = 1.83, 95% CI = 1.21-2.76), residency training (OR = 2.49, 95% CI = 1.14-5.43), and fellowship training (OR = 2.97, 95% CI = 1.32-6.66), and those from the West region of the United States (OR = 1.66, 95% CI = 1.07-2.56) were more likely to use VBMA. CONCLUSIONS More than 50% of surveyed orthopedic physical therapists do not use VBMA in clinical practice. Future research should be directed toward assessing reliability and validity of VBMA use by smartphones, tablets, and apps and examining whether VBMA use enhances treatment outcomes. Data security, patient confidentiality, and integration into the electronic medical record should be addressed. IMPACT This study is the first to our knowledge to describe the use of VBMA in orthopedic physical therapist practice in the United States. It is the first step in understanding how VBMA is used and might be used to enhance clinical assessment and treatment outcomes.
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Affiliation(s)
- Craig P Hensley
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Devyn Millican
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nida Hamilton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy Yang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alison H Chang
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, 645 N Michigan Avenue, #1100, Chicago, IL 60611 (USA)
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Gait Retraining With Real-Time Visual Feedback to Treat Patellofemoral Pain in Adult Recreational Runners: A Critically Appraised Topic. J Sport Rehabil 2020; 29:675-679. [PMID: 31711039 DOI: 10.1123/jsr.2019-0094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/22/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Patellofemoral pain (PFP) is a common knee injury in recreational adult runners, possibly caused by faulty mechanics. One possible approach to reduce this pain is to retrain the runner's gait. Current research suggests that no definitive gold standard treatment for PFP exists. Gait retraining utilizing visual feedback may reduce PFP in both the short and long term. Clinical Question: In adult runners diagnosed with PFP, does gait retraining with real-time visual feedback lead to a decrease in pain? Summary of Key Findings: A literature search was performed; 3 relevant studies utilizing gait retraining with visual feedback, pain level as an outcome measure, and follow-up measures of at least 1 month after the intervention were included. All the included studies reported a decrease in short- and long-term pain for participants following visual feedback gait retraining. In addition, biomechanical measures related to PFP, including peak hip adduction angle and the angle of contralateral pelvic drop, improved after the completion of the intervention. Clinical Bottom Line: There is level 2 evidence supporting the implementation of 8 sessions over 2 weeks of visual feedback gait retraining as a means of treating patients diagnosed with PFP. Based on current available evidence, clinicians should identify faulty mechanics of patients and implement a protocol of increasing real-time visual feedback over the first 4 sessions and decreasing visual feedback over the final 4 sessions. Strength of Recommendation: Level 2.
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Teng HL, Dilauro A, Weeks C, Odell C, Kincaid H, VanDine B, Wu WFW. Short-term effects of a trunk modification program on patellofemoral joint stress in asymptomatic runners. Phys Ther Sport 2020; 44:107-113. [PMID: 32504959 DOI: 10.1016/j.ptsp.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate short-term effects of a four-week gait retraining program using visual feedback on trunk flexion angle, patellofemoral joint (PFJ) stress, lower extremity biomechanics and motor skill automaticity. DESIGN Longitudinal interventional study. SETTINGS University research laboratory. PARTICIPANTS Twelve asymptomatic recreational runners (seven male and five female). MAIN OUTCOME MEASURES Trunk kinematics as well as lower extremity kinematics and kinetics were assessed prior to training at week 1 (baseline) and week 2, 3, 4 and 8 (retention). PFJ stress was computed using a sagittal plane model. A dual-task procedure was performed to examine automaticity. RESULTS At week 8, runners demonstrated 10.1° increase in trunk flexion angle (p < .001) and 17.8% reduction in peak PFJ stress (p < .001) compared to baseline. This is associated with a 16.8% decrease in knee extensor moment and less than 2.5° change in knee flexion angle. Participants also showed 33.3% increase in peak hip extensor moment and small reduction in peak ankle plantar flexor moment. Lastly, runners demonstrated automaticity of the modified skill with a dual-task cost of less than 3%. CONCLUSION The gait retraining program is effective to elicit short term changes in trunk position, PFJ stress, and automaticity of the new motor skill.
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Affiliation(s)
- Hsiang-Ling Teng
- Department of Physical Therapy, California State University, Long Beach, United States.
| | - Alyssa Dilauro
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Courtney Weeks
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Christopher Odell
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Heather Kincaid
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Brittany VanDine
- Department of Physical Therapy, California State University, Long Beach, United States
| | - Will F W Wu
- Department of Kinesiology, California State University, Long Beach, United States
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35
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Moran MF, Wager JC. Influence of Gait Retraining on Running Economy: A Review and Potential Applications. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Day KA, Bastian AJ. Providing low-dimensional feedback of a high-dimensional movement allows for improved performance of a skilled walking task. Sci Rep 2019; 9:19814. [PMID: 31875040 PMCID: PMC6930294 DOI: 10.1038/s41598-019-56319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/30/2019] [Indexed: 12/28/2022] Open
Abstract
Learning a skilled movement often requires changing multiple dimensions of movement in a coordinated manner. Serial training is one common approach to learning a new movement pattern, where each feature is learned in isolation from the others. Once one feature is learned, we move on to the next. However, when learning a complex movement pattern, serial training is not only laborious but can also be ineffective. Often, movement features are linked such that they cannot simply be added together as we progress through training. Thus, the ability to learn multiple features in parallel could make training faster and more effective. When using visual feedback as the tool for changing movement, however, such parallel training may increase the attentional load of training and impair performance. Here, we developed a novel visual feedback system that uses principal component analysis to weight four features of movement to create a simple one-dimensional 'summary' of performance. We used this feedback to teach healthy, young participants a modified walking pattern and compared their performance to those who received four concurrent streams of visual information to learn the same goal walking pattern. We demonstrated that those who used the principal component-based visual feedback improved their performance faster and to a greater extent compared to those who received concurrent feedback of all features. These results suggest that our novel principal component-based visual feedback provides a method for altering multiple features of movement toward a prescribed goal in an intuitive, low-dimensional manner.
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Affiliation(s)
- Kevin A Day
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, 21205, USA
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Amy J Bastian
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Van Hooren B, Goudsmit J, Restrepo J, Vos S. Real-time feedback by wearables in running: Current approaches, challenges and suggestions for improvements. J Sports Sci 2019; 38:214-230. [PMID: 31795815 DOI: 10.1080/02640414.2019.1690960] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Injuries and lack of motivation are common reasons for discontinuation of running. Real-time feedback from wearables can reduce discontinuation by reducing injury risk and improving performance and motivation. There are however several limitations and challenges with current real-time feedback approaches. We discuss these limitations and challenges and provide a framework to optimise real-time feedback for reducing injury risk and improving performance and motivation. We first discuss the reasons why individuals run and propose that feedback targeted to these reasons can improve motivation and compliance. Secondly, we review the association of running technique and running workload with injuries and performance and we elaborate how real-time feedback on running technique and workload can be applied to reduce injury risk and improve performance and motivation. We also review different feedback modalities and motor learning feedback strategies and their application to real-time feedback. Briefly, the most effective feedback modality and frequency differ between variables and individuals, but a combination of modalities and mixture of real-time and delayed feedback is most effective. Moreover, feedback promoting perceived competence, autonomy and an external focus can improve motivation, learning and performance. Although the focus is on wearables, the challenges and practical applications are also relevant for laboratory-based gait retraining.
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Affiliation(s)
- Bas Van Hooren
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos Goudsmit
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Juan Restrepo
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Steven Vos
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
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Letafatkar A, Rabiei P, Farivar N, Alamouti G. Long‐term efficacy of conditioning training program combined with feedback on kinetics and kinematics in male runners. Scand J Med Sci Sports 2019; 30:429-441. [DOI: 10.1111/sms.13587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Amir Letafatkar
- Sports Injury and Corrective Exercises Faculty of Physical Education and Sports Sciences Kharazmi University Tehran Iran
| | - Pouya Rabiei
- Department of Physical Education and Sports Sciences Islamic Azad University Karaj Iran
| | - Niloufar Farivar
- Sports Injury and Corrective Exercises Faculty of Physical Education and Sports Sciences Kharazmi University Tehran Iran
| | - Gelareh Alamouti
- Sports Injury and Corrective Exercises Faculty of Physical Education and Sports Sciences Kharazmi University Tehran Iran
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Greenberg ET, Garcia MC, Galante J, Werner WG. Acute changes in sagittal plane kinematics while wearing a novel belt device during treadmill running. Sports Biomech 2019; 21:718-730. [PMID: 31722619 DOI: 10.1080/14763141.2019.1676462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Somatosensory feedback is used in walking retraining; however, its utility in running is less feasible due to the greater associated speeds. The purpose of this study was to examine the acute effects of wearing a novel running belt device on sagittal plane running kinematics. Ten healthy runners ran on a treadmill with and without the use of a running belt device within a repeated measures study design. Temporal-spatial characteristics and sagittal plane knee and ankle kinematics were recorded with three-dimensional motion analysis. Wilcoxon Signed-Rank Tests revealed significant decreases in centre of mass vertical displacement (z = -2.083, p = 0.003), tibial inclination at initial contact (z = -2.803, p = 0.003), and stance phase knee joint excursion (z = -2.701, p = 0.003), and greater knee flexion at initial contact (z = -2.803, p = 0.003) when the belt was donned. No differences were observed in step rate (z = -0.351, p = 0.363), foot inclination angle at initial contact (z = -2.090, p = 0.018), or peak knee flexion during stance (z = -1.172, p = 0.121). Findings suggest that donning a running belt can minimise specific high-risk biomechanical characteristics in runners with particular kinematic profiles.
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Affiliation(s)
- Eric T Greenberg
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, NY, USA
| | - Micah C Garcia
- Motion Analysis Lab, Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Juliana Galante
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, NY, USA
| | - William G Werner
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, NY, USA
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Ardakani MK, Wikstrom EA, Minoonejad H, Rajabi R, Sharifnezhad A. Hop-Stabilization Training and Landing Biomechanics in Athletes With Chronic Ankle Instability: A Randomized Controlled Trial. J Athl Train 2019; 54:1296-1303. [PMID: 31618073 DOI: 10.4085/1062-6050-550-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Hopping exercises are recommended as a functional training tool to prevent lower limb injury, but their effects on lower extremity biomechanics in those with chronic ankle instability (CAI) are unclear. OBJECTIVE To determine if jump-landing biomechanics change after a hop-stabilization intervention. DESIGN Randomized controlled clinical trial. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-eight male collegiate basketball players with CAI were divided into 2 groups: hop-training group (age = 22.78 ± 3.09 years, mass = 82.59 ± 9.51 kg, height = 187.96 ± 7.93 cm) and control group (age = 22.57 ± 2.76 years, mass = 78.35 ± 7.02 kg, height = 185.69 ± 7.28 cm). INTERVENTION(S) A 6-week supervised hop-stabilization training program that consisted of 18 training sessions. MAIN OUTCOME MEASURE(S) Lower extremity kinetics and kinematics during a jump-landing task and self-reported function were assessed before and after the 6-week training program. RESULTS The hop-stabilization program resulted in improved self-reported function (P < .05), larger sagittal-plane hip- and knee-flexion angles, and greater ankle dorsiflexion (P < .05) relative to the control group. Reduced frontal-plane joint angles at the hip, knee, and ankle as well as decreased ground reaction forces and a longer time to peak ground reaction forces were observed in the hopping group compared with the control group after the intervention (P < .05). CONCLUSIONS The 6-week hop-stabilization training program altered jump-landing biomechanics in male collegiate basketball players with CAI. These results may provide a potential mechanistic explanation for improvements in patient-reported outcomes and reductions in injury risk after ankle-sprain rehabilitation programs that incorporate hop-stabilization exercises.
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Affiliation(s)
- Mohammad Karimizadeh Ardakani
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Hooman Minoonejad
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran
| | - Reza Rajabi
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran
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Mellinger S, Neurohr GA. Evidence based treatment options for common knee injuries in runners. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S249. [PMID: 31728373 DOI: 10.21037/atm.2019.04.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The purpose of this paper is to review the current literature regarding conservative treatment options for the three most common knee injuries in runners including patellofemoral pain syndrome (PFPS), iliotibial band friction syndrome (ITBFS), and patellar tendinopathy (PT). Each diagnosis is discussed using current research to describe the pathophysiology, evaluation process, and evidence based effective treatment strategies including therapeutic exercise, manual therapy, neuromuscular re-education, and modalities. The result is a comprehensive overview of each diagnosis and a research-based approach to effectively evaluate and treat each condition for best outcomes.
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Affiliation(s)
- Simeon Mellinger
- Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA
| | - Grace Anne Neurohr
- Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA
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Phanpho C, Rao S, Moffat M. Immediate effect of visual, auditory and combined feedback on foot strike pattern. Gait Posture 2019; 74:212-217. [PMID: 31561119 DOI: 10.1016/j.gaitpost.2019.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 09/01/2019] [Accepted: 09/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A growing body of literature supports the promising effect of real-time feedback to re-train runners. However, no studies have comprehensively assessed the effects of foots trike and cadence modification using different forms of real-time feedback provided via wearable devices. RESEARCH QUESTION The purpose of the present study was to determine if a change could be made in foot strike pattern and plantar loads using real-time visual, auditory and combined feedback provided using wearable devices. METHODS Visual, auditory and combined feedback were provided using wearable devices as fifteen recreational runners ran on a treadmill at self-selected speed and increased cadence. Plantar loads and location of initial contact were measured with a flexible insole system. Repeated measures ANOVAs with Bonferroni adjusted pair-wise comparisons were used to assess statistical significance. RESULTS AND SIGNIFICANCE A significant effect of condition was noted on location of center of pressure (p < 0.01). Bonferroni-adjusted post-hoc comparisons showed that feedback conditions differed from baseline as well as the new cadence conditions, however did not differ from each other. A significant interaction effect (region x feedback) was found for plantar loads (maximum force P < 0.001). Significant effects of feedback were noted at the heel (P < 0.001), medial midfoot (P < 0.001), lateral midfoot (P < 0.001), medial forefoot (P = 0.003), central forefoot (P = 0.003), and great toe (P = 0.004) but not at the lateral forefoot (P = 0.6) or lateral toes (P = 0.507). SIGNIFICANCE The unique findings of our study showed that an anterior shift of the center of pressure, particularly when foot strike modification was combined with 10% increased cadence. We found lower heel and midfoot loads along with higher forefoot and great toe loads when foot strike modification using real-time feedback was combined with increased cadence. Our findings also suggest that auditory feedback might be more effective than visual feedback in foot-strike modification.
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Affiliation(s)
- Chutima Phanpho
- Department of Physical Therapy, 380 Second Avenue, 4th Floor New York, New York 10010-5615, United States
| | - Smita Rao
- Department of Physical Therapy, 380 Second Avenue, 4th Floor New York, New York 10010-5615, United States; Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, United States.
| | - Marilyn Moffat
- Department of Physical Therapy, 380 Second Avenue, 4th Floor New York, New York 10010-5615, United States
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Baumgartner J, Gusmer R, Hollman J, Finnoff JT. Increased stride‐rate in runners following an independent retraining program: A randomized controlled trial. Scand J Med Sci Sports 2019; 29:1789-1796. [DOI: 10.1111/sms.13509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/15/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jesson Baumgartner
- Department of Physical Medicine and Rehabilitation Mayo Clinic Rochester Minnesota
| | - Rebecca Gusmer
- Department of Physical Medicine and Rehabilitation Mayo Clinic Rochester Minnesota
| | - John Hollman
- Department of Physical Medicine and Rehabilitation Mayo Clinic Rochester Minnesota
| | - Jonathan T. Finnoff
- Department of Physical Medicine and Rehabilitation Mayo Clinic Rochester Minnesota
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An WW, Ting KH, Au IPH, Zhang JH, Chan ZYS, Davis IS, So WKY, Chan RHM, Cheung RTH. Neurophysiological Correlates of Gait Retraining With Real-Time Visual and Auditory Feedback. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1341-1349. [PMID: 31056502 DOI: 10.1109/tnsre.2019.2914187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Most people acquire motor skills through feedback-based training. How the human brain processes sensory feedbacks during training, especially in a gait training, remain largely unclear. The purpose of this paper is to explore how humans adopt a new gait pattern to reduce impacts during walking-with the aid of visual and audio feedbacks. This paper demonstrates the features of underlying brain activity in incorporating the visual or auditory cues to acquire a new gait pattern. Electroencephalography (EEG) and peak positive acceleration (PPA) of the heel were collected from 23 participants during walking on a treadmill with no feedback, with visual feedback, or with audio feedback. The feedbacks were presented after each foot strike, where a sub-threshold PPA triggered a positive feedback (green/low-pitched), and a suprathreshold PPA triggered a negative feedback (red/high-pitched). The participants were instructed to voluntarily control their gait, so that low PPA could be achieved. This control was perturbed in some sessions by an additional cognitive task, and the influence of such distraction was also explored. The PPA was significantly lower in the sessions with visual or audio feedback than in sessions without feedback, showing an immediate improvement in gait pattern, when the feedback was provided. Different feedbacks modulated neural activities at different locations and/or levels during training. Alpha event-related synchronization (ERS) was particularly increased during the encoding of auditory feedback or the introduction of a distracting task. In the meantime, prominent frontal and posterior theta ERS were coupled with negative feedback, and strong beta event-related desynchronization (ERD) was observed only in sessions with feedbacks. Our results indicate that feedback effectively enhances motor planning when acquiring a new gait.
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45
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Effects of three gait retraining techniques in runners with patellofemoral pain. Phys Ther Sport 2019; 36:92-100. [DOI: 10.1016/j.ptsp.2019.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/22/2022]
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46
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Kinematic risk factors for lower limb tendinopathy in distance runners: A systematic review and meta-analysis. Gait Posture 2019; 69:13-24. [PMID: 30658311 DOI: 10.1016/j.gaitpost.2019.01.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/05/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Abnormal kinematics have been implicated as one of the major risk factors for lower limb tendinopathy (LLT). OBJECTIVE To systematically review evidence for kinematic risk factors for LLT in runners. METHODS Individual electronic searches in PubMed, EMBASE and Web of Science were conducted. Two reviewers screened studies to identify observational studies reporting kinematic risk factors in runners with LLT compared to healthy controls. The Down and Black appraisal scale was applied to assess quality. A meta-analysis was performed provided that at least two studies with similar methodology reported the same factor. RESULTS Twenty-eight studies were included: Achilles tendinopathy (AT) (9), iliotibial band syndrome (ITBS) (17), plantar fasciopathy (PF) (2), patellar tendinopathy (PT) (1), posterior tibial tendon dysfunction (PTTD) (1). Eighteen studies were rated high-quality and ten medium-quality. The meta-analyses revealed strong evidence of higher peak knee internal rotation, moderate evidence of lower peak rearfoot eversion and knee flexion at heel strike and greater peak hip adduction in runners with ITBS. Very limited evidence revealed higher peak ankle eversion in runners with PF and PTTD or higher peak hip adduction in PT. SIGNIFICANCE Peak rearfoot eversion was the only factor reported in all included LLTs; it is a significant factor in ITBS, PT and PTTD but not in AT and PF. More prospective studies are needed to accurately evaluate the role of kinematic risk factors as a cause of LLT. Taken together, addressing rearfoot kinematic and kinematic chain movements accompanied by peak eversion should be considered in the prevention and management of LLT.
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Dos Santos AF, Nakagawa TH, Serrão FV, Ferber R. Patellofemoral joint stress measured across three different running techniques. Gait Posture 2019; 68:37-43. [PMID: 30445279 DOI: 10.1016/j.gaitpost.2018.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/17/2018] [Accepted: 11/01/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is the most common running-related injury. It has been shown in previous studies that gait retraining may have a beneficial effect on patellofemoral joint stress (PFJS). RESEARCH QUESTION Is there a reduction of PFJS across 4 running conditions: 1. runner's typical rearfoot strike pattern, 2. forefoot landing, 3. step rate increase by 10% and 4. forward trunk lean? METHODS Nineteen healthy runners (28.05 ± 5.03 years; 26.58 ± 8.85 km/week, 6.00 ± 4.51 years of running experience) completed one running trial for each condition, at the same subject-specific comfortable speed on a treadmill. Kinetic and kinematic data were collected and measures of hip, knee and ankle joint moments and PFJS were calculated. RESULTS Compared to rearfoot strike condition, peak PFJS and PFJS-time integral per step were significantly (P < 0.01) lower during forefoot landing and step rate increase conditions. PFJS per kilometer was significantly reduced for forefoot landing (17.01%; P < 0.01) and increased step rate (12.90%; P = 0.003). Forward trunk lean technique showed no significant differences in peak PFJS (P = 0.187), PFJS-time integral per step (P = 0.815) and PFJS per kilometer (P = 0.077) compared to rearfoot strike pattern. INTERPRETATION The comparison between techniques revealed greater reductions on PFJS by forefoot landing, followed by 10% step rate increase condition. These changes were the result of different lower limb movement strategies across the 2 running conditions. We conclude that compared to a rearfoot strike pattern, both a forefoot landing and step rate increase result in lower cumulative PFJS joint stress in healthy runners, with the forefoot landing being the most effective. These running technique modifications could be recommended to reduce PFJS loads and may have implications for PFP prevention.
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Affiliation(s)
- Ana Flavia Dos Santos
- Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil; Faculty of Kinesiology, University of Calgary, Calgary, Canada.
| | | | | | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Reliability of Overground Running Measures from 2D Video Analyses in a Field Environment. Sports (Basel) 2018; 7:sports7010008. [PMID: 30598031 PMCID: PMC6359244 DOI: 10.3390/sports7010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/21/2018] [Accepted: 12/25/2018] [Indexed: 12/31/2022] Open
Abstract
Two-dimensional running analyses are common in research and practice, and have been shown to be reliable when conducted on a treadmill. However, running is typically performed outdoors. Our aim was to determine the intra- and inter-rater reliability of two-dimensional analyses of overground running in an outdoor environment. Two raters independently evaluated 155 high-speed videos (240 Hz) of overground running from recreationally competitive runners on two occasions, seven days apart (test-retest study design). The reliability of foot-strike pattern (rear-foot, mid-foot, and fore-foot), foot-strike angle (°), and running speed (m/s) was assessed using weighted kappa (κ), percentage agreement, intraclass correlation coefficient (ICC), typical error (TE), and coefficient of variation (CV) statistics. Foot-strike pattern (agreement = 99.4%, κ = 0.96) and running speed (ICC = 0.98, TE = 0.09 m/s, CV = 2.1%) demonstrated excellent relative and absolute reliability. Foot-strike angle exhibited high relative reliability (ICC = 0.88), but suboptimal absolute reliability (TE = 2.5°, CV = 17.6%). Two-dimensional analyses of overground running outdoors were reliable for quantifying foot-strike pattern, foot-strike angle, and running speed, although foot-strike angle errors of 2.5° were typical. Foot-strike angle changes of less than 2.5° should be interpreted with caution in clinical settings, as they might simply reflect measurement errors.
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DeJong AF, Hertel J. Gait-training devices in the treatment of lower extremity injuries in sports medicine: current status and future prospects. Expert Rev Med Devices 2018; 15:891-909. [DOI: 10.1080/17434440.2018.1551130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Alexandra F. DeJong
- Department of Kinesiology Exercise and Sport Injury Lab, University of Virginia – Kinesiology, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology Exercise and Sport Injury Lab, University of Virginia – Kinesiology, Charlottesville, VA, USA
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50
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Mangubat ALS, Zhang JH, Chan ZYS, MacPhail AJ, Au IPH, Cheung RTH. Biomechanical Outcomes Due to Impact Loading in Runners While Looking Sideways. J Appl Biomech 2018; 34:483-487. [PMID: 29989456 DOI: 10.1123/jab.2017-0381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/11/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
A stable gaze is necessary to optimize visual conditions during running. Head accelerations generally remain stable when looking in front; however, it is unclear if this response is similar when the head is turned sideways, and whether other adaptive strategies are present to maintain this stability. The purpose of this study, therefore, was to examine whether runners maintained stable head accelerations while gazing at fixed targets in front and to their sides. The authors collected biomechanical data from 13 runners as they directed their gaze to visual targets located in front, 45°, and 90° to the sides at a random sequence. Vertical head and tibial accelerations were the primary outcome measures, while vertical loading rate, footstrike angle, contact time, stride length, and stride rate were the secondary measures. A reduction in vertical head accelerations was found in the rightmost direction (P = .04), while an increase in vertical tibial accelerations was found on the same direction (P = .02). No other significant differences were observed for the other variables. The results of this study suggest that the tibia accommodated the increased shock to maintain head stability.
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