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Malus J, Urbaczka J, Hamill J, Rygelova M, Monte A, Horka V, Uchytil J. Does an acute transition to different footwear conditions affect walking patterns in people with different experiences of minimalist footwear? Gait Posture 2024; 113:258-264. [PMID: 38968820 DOI: 10.1016/j.gaitpost.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 06/21/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Minimalistic footwear provides adequate toe space, tripod function, improving foot function, muscle activation and stability during walking similarly to barefoot walking. Due to the increasing popularity of this specific footwear, there is a lack of research focusing on general users of minimalistic footwear. RESEARCH QUESTION Does annual walking in minimalistic footwear affect gait biomechanics? METHODS Cross-sectional study involving twenty participants in a minimalistic footwear group with both experience (MFE) and no experience (NMFE). Participants walked in three different conditions (barefoot, minimalistic, and neutral footwear) in the laboratory at normal human walking speed. RESULTS A significant main effect of groups regardless of footwear conditions show significantly greater values during walking in minimalistic footwear and barefoot in the stride length (p=0.035, p=0.003, respectively), and stride width (p=0.047, p=0.028, respectively) in the NMFE group compared to MFE group. The significant differences in the main effects of footwear regardless of experience were found in stance time (p<0.001), steps per minute (p<0.001), stride length (<0.001), foot adduction in TO (p<0.001), foot eversion angle in IC and TO (p<0.001, p<0.001, respectively), foot progression angle (p<0.001), ankle dorsiflexion angle in IC and TO (p<0.001, p<0.001, respectively), in ankle eversion angle in IC and TO (p<0.001, p<0.001, respectively), knee flexion angle in IC and TO (p<0.001; p<0.001, respectively), and in knee flexion range of motion (p<0.001). SIGNIFICANCE Based on our findings, barefoot walking should be used primarily during daily activities if the environment is conducive. Only one year of experience with minimalistic footwear seems insufficient and an intervention should be incorporated to change the gait pattern when transitioning to full minimalistic footwear walking.
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Affiliation(s)
- Jan Malus
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava 70200, Czech Republic.
| | - Jan Urbaczka
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava 70200, Czech Republic.
| | - Joseph Hamill
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava 70200, Czech Republic; Department of Kinesiology, University of Massachusetts, Amherst, USA.
| | - Marketa Rygelova
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava 70200, Czech Republic.
| | - Andrea Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Veronika Horka
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava 70200, Czech Republic.
| | - Jaroslav Uchytil
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava 70200, Czech Republic.
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Slovák L, Zahradník D, Land WM, Sarvestan J, Hamill J, Abdollahipour R. Response of Knee Joint Biomechanics to Landing Under Internal and External Focus of Attention in Female Volleyball Players. Motor Control 2024; 28:341-361. [PMID: 38702047 DOI: 10.1123/mc.2023-0151] [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] [Received: 12/20/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
The aim of this study was to examine the effect of attentional focus instructions on the biomechanical variables associated with the risk of anterior cruciate ligament injury of the knee joint during a drop landing task using a time series analysis. Ten female volleyball players (age: 20.4 ± 0.8 years, height: 169.7 ± 7.1 cm, mass: 57.6 ± 3.1 kg, experience: 6.3 ± 0.8 years) performed landings from a 50 cm height under three different attentional focus conditions: (1) external focus (focus on landing as soft as possible), (2) internal focus (focus on bending your knees when you land), and (3) control (no-focus instruction). Statistical parameter mapping in the sagittal plane during the crucial first 30% of landing time showed a significant effect of attentional focus instructions. Despite the similarity in landing performance across foci instructions, adopting an external focus instruction promoted reduced vertical ground reaction force and lower sagittal flexion moment during the first 30% of execution time compared to internal focus, suggesting reduced knee loading. Therefore, adopting an external focus of attention was suggested to reduce most biomechanical risk variables in the sagittal plane associated with anterior cruciate ligament injuries, compared to internal focus and control condition. No significant differences were found in the frontal and horizontal planes between the conditions during this crucial interval.
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Affiliation(s)
- Lukáš Slovák
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - David Zahradník
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - William M Land
- Department of Kinesiology, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Javad Sarvestan
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Biomechanics and Functional Morphology Laboratory, CIPER, Faculdade de Motricidade Humana, University of Lisbon, Lisboa, Portugal
| | - Joseph Hamill
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
| | - Reza Abdollahipour
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
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Jandacka D, Casula V, Hamill J, Vilimek D, Jandackova VK, Elavsky S, Uchytil J, Plesek J, Skýpala J, Golian M, Burda M, Nieminen MT. Regular Running Is Related to the Knee Joint Cartilage Structure in Healthy Adults. Med Sci Sports Exerc 2024; 56:1026-1035. [PMID: 38233979 DOI: 10.1249/mss.0000000000003386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE The purpose of this study was to determine whether regular running distance and biomechanics are related to medial central femur cartilage (MCFC) structure. METHODS The cross-sectional study sample consisted of 1164 runners and nonrunners aged 18-65 yr. Participants completed questionnaires on physical activity and their running history. We performed quantitative magnetic resonance imaging of knee cartilage-T2 relaxation time (T2) mapping (high T2 indicates cartilage degeneration)-and a running biomechanical analysis using a three-dimensional motion capture system. A 14-d monitoring of the physical activity was conducted. RESULTS Those aged 35-49 yr were at 84% higher odds of having MCFC T2 in the highest level (85th percentile, P < 0.05) compared with youngest adults indicating that MCFC structures may be altered with aging. Being male was associated with 34% lower odds of having T2 at the highest level ( P < 0.05) compared with females. Nonrunners and runners with the highest weekly running distance were more likely to have a high T2 compared with runners with running distance of 6-20 km·wk -1 ( P < 0.05). In addition, the maximal knee internal adduction moment was associated with a 19% lower odds of having T2 at the highest level ( P < 0.05). CONCLUSIONS Females compared with males and a middle-aged cohort compared with the younger cohort seemed to be associated with the degeneration of MCFC structures. Runners who ran 6-20 km·wk -1 were associated with a higher quality of their MCFC compared with highly active individuals and nonrunners. Knee frontal plane biomechanics was related to MCFC structure indicating a possibility of modifying the medial knee collagen fibril network through regular running.
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Affiliation(s)
- Daniel Jandacka
- Department of Human Movement Studies, University of Ostrava, Ostrava, CZECH REPUBLIC
| | - Victor Casula
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, FINLAND
| | | | - Dominik Vilimek
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, CZECH REPUBLIC
| | - Vera K Jandackova
- Department of Human Movement Studies, University of Ostrava, Ostrava, CZECH REPUBLIC
| | - Steriani Elavsky
- Department of Human Movement Studies, University of Ostrava, Ostrava, CZECH REPUBLIC
| | - Jaroslav Uchytil
- Department of Human Movement Studies, University of Ostrava, Ostrava, CZECH REPUBLIC
| | - Jan Plesek
- Department of Human Movement Studies, University of Ostrava, Ostrava, CZECH REPUBLIC
| | - Jiri Skýpala
- Department of Human Movement Studies, University of Ostrava, Ostrava, CZECH REPUBLIC
| | - Milos Golian
- Department of Human Movement Studies, University of Ostrava, Ostrava, CZECH REPUBLIC
| | - Michal Burda
- Institute for Research and Applications of Fuzzy Modeling, University of Ostrava, CE IT4Innovations, Ostrava, CZECH REPUBLIC
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Bini RR, Serrancoli G, Santiago PRP, Pinto A, Moura F. Validity of Neural Networks to Determine Body Position on the Bicycle. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2023; 94:905-912. [PMID: 35575754 DOI: 10.1080/02701367.2022.2070103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
Purpose: With the increased access to neural networks trained to estimate body segments from images and videos, this study assessed the validity of some of these networks in enabling the assessment of body position on the bicycle. Methods: Fourteen cyclists pedaled stationarily in one session on their own bicycles while video was recorded from their sagittal plane. Reflective markers attached to key bony landmarks were used to manually digitize joint angles at two positions of the crank (3 o'clock and 6 o'clock) extracted from the videos (Reference method). These angles were compared to measurements taken from videos generated by two deep learning-based approaches designed to automatically estimate human joints (Microsoft Research Asia-MSRA and OpenPose). Results: Mean bias for OpenPose ranged between 0.03° and 1.81°, while the MSRA method presented errors between 2.29° and 12.15°. Correlation coefficients were stronger for OpenPose than for the MSRA method in relation to the Reference method for the torso (r = 0.94 vs. 0.92), hip (r = 0.69 vs. 0.60), knee (r = 0.80 vs. 0.71), and ankle (r = 0.23 vs. 0.20). Conclusion: OpenPose presented better accuracy than the MSRA method in determining body position on the bicycle, but both methods seem comparable in assessing implications from changes in bicycle configuration.
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Affiliation(s)
| | | | | | - Allan Pinto
- Institute of Computing, State University of Compinas
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Skypala J, Hamill J, Sebera M, Elavsky S, Monte A, Jandacka D. Running-Related Achilles Tendon Injury: A Prospective Biomechanical Study in Recreational Runners. J Appl Biomech 2023:1-9. [PMID: 37419494 DOI: 10.1123/jab.2022-0221] [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: 08/29/2022] [Revised: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 07/09/2023]
Abstract
There are relatively few running studies that have attempted to prospectively identify biomechanical risk factors associated with Achilles tendon (AT) injuries. Therefore, the aim was to prospectively determine potential running biomechanical risk factors associated with the development of AT injuries in recreational, healthy runners. At study entry, 108 participants completed a set of questionnaires. They underwent an analysis of their running biomechanics at self-selected running speed. The incidence of AT running-related injuries (RRI) was assessed after 1-year using a weekly questionnaire standardized for RRI. Potential biomechanical risk factors for the development of AT RRI injury were identified using multivariable logistic regression. Of the 103 participants, 25% of the sample (15 males and 11 females) reported an AT RRI on the right lower limb during the 1-year evaluation period. A more flexed knee at initial contact (odds ratio = 1.146, P = .034) and at the midstance phase (odds ratio = 1.143, P = .037) were significant predictors for developing AT RRI. The results suggested that a 1-degree increase in knee flexion at initial contact and midstance was associated with a 15% increase in the risk of an AT RRI, thus causing a limitation of training or a stoppage of running in runners.
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Affiliation(s)
- Jiri Skypala
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
| | - Joseph Hamill
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA,USA
| | - Michal Sebera
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
| | - Steriani Elavsky
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
| | - Andrea Monte
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona,Italy
| | - Daniel Jandacka
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
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Malus J, Urbaczka J, Rygelova M, Casula V, Nieminen M, Monte A, Horka V, Uchytil J. Effect of Footwear Type on Biomechanical Risk Factors for Knee Osteoarthritis. Orthop J Sports Med 2023; 11:23259671231183416. [PMID: 37560612 PMCID: PMC10406632 DOI: 10.1177/23259671231183416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/31/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Regular walking in different types of footwear may increase the mediolateral shear force, knee adduction moment, or vertical ground-reaction forces that could increase the risk of early development of knee osteoarthritis (OA). PURPOSE To compare kinematic and kinetic parameters that could affect the development of knee OA in 3 footwear conditions. STUDY DESIGN Controlled laboratory study. METHODS A total of 40 asymptomatic participants performed walking trials in the laboratory at self-selected walking speeds under barefoot (BF), minimalistic (MF), and neutral (NF) footwear conditions. Knee joint parameters were described using discrete point values, and continuous curves were evaluated using statistical parametric mapping. A 3 × 1 repeated-measures analysis of variance was used to determine the main effect of footwear for both discrete and continuous data. To compare differences between footwear conditions, a post hoc paired t test was used. RESULTS Discrete point analyses showed a significantly greater knee power in NF compared with MF and BF in the weight absorption phase (P < .001 for both). Statistical parametric mapping analysis indicated a significantly greater knee angle in the sagittal plane at the end of the propulsive phase in BF compared with NF and MF (P = .043). Knee joint moment was significantly greater in the propulsive phase for the sagittal (P = .038) and frontal planes (P = .035) in BF compared with NF and MF and in the absorption phase in the sagittal plane (P = .034) in BF compared with MF and NF. A significant main effect of footwear was found for anteroposterior (propulsion, ↑MF, NF, ↓BF [P = .008]; absorption, ↑BF, MF, ↓NF [P = .001]), mediolateral (propulsion, ↑MF, NF, ↓BF [P = .005]; absorption, ↑NF, MF, ↓BF [P = .044]), and vertical (propulsion, ↑NF, BF, ↓MF [P = .001]; absorption, ↑MF, BF, ↓NF [P < .001]) ground-reaction forces. Knee power showed a significant main effect of footwear (absorption, ↑NF, MF, ↓BF [P = .015]; propulsion, ↑MF, NF, ↓BF [P = .039]). CONCLUSION Walking in MF without sufficient accommodation affected kinetic and kinematic parameters and could increase the risk of early development of knee OA.
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Affiliation(s)
- Jan Malus
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Jan Urbaczka
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Marketa Rygelova
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Victor Casula
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Miika Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Andrea Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Veronika Horka
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Jaroslav Uchytil
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
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Skypala J, Monte A, Hamill J, Plesek J, Jandacka D. Achilles tendon dimensions, ankle stiffness and footfall patterns in recreational runners. J Sports Sci 2023; 41:812-819. [PMID: 37535868 DOI: 10.1080/02640414.2023.2240631] [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] [Received: 02/12/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023]
Abstract
The main purpose of this study was to investigate the relationship among Achilles tendon (AT) dimensions, ankle joint stiffness, and footfall patterns in recreational rearfoot and non-rearfoot runners. Based on the foot strike index, a total of 107 runners were divided into rearfoot (47 females/40 males) and non-rearfoot runners (14 females/6 males). All participants had theirs AT dimensions (AT length, AT thickness, and AT moment arm) measured using a combination of ultrasound and motion capture systems. In addition, all performed running trials measured at self-selected speed in laboratory-neutral shoes. A partial correlation coefficient was used for correlations between the selected variables. The results revealed a significant relationship between ankle joint stiffness and level of footfall pattern in rearfoot (r = 0.232, p = 0.032) and non-rearfoot runners (r = -0.811, p < 0.001). The results also suggest a relationship between AT thickness and foot strike index (r = -0.486) in non-rearfoot runners. Runners whose footfall pattern is closer to the heel have greater ankle joint stiffness. Non-rearfoot runners whose footfall pattern is closer to the toe have a thinner AT. Non-rearfoot runners with thicker AT had greater ankle joint stiffness.
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Affiliation(s)
- Jiri Skypala
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Andrea Monte
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Joseph Hamill
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
- Department of Kinesiology, University of Massachusetts, Amherst, USA
| | - Jan Plesek
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Daniel Jandacka
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
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Urbaczka J, Silvernail JF, Jandacka D. Effect of training volume on footstrike patterns over an exhaustive run. Gait Posture 2022; 91:240-246. [PMID: 34753001 DOI: 10.1016/j.gaitpost.2021.10.040] [Citation(s) in RCA: 2] [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: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although footstrike pattern (FP) may not be a factor influencing running performance, 11-75% of world-class distance runners use a non-rearfoot FP. However, little attention has been paid to describe the effect of running volume on FP changes when a runner is fatigued. RESEARCH QUESTION Does the training volume provide an adequate stimulus to mitigate FP changes during an exhaustive run in non-rearfoot, habitual minimalist footwear runners? METHODS The objective of this study was to compare FP between non-rearfoot, habitual minimalist footwear runners with a moderate training volume (MT) and a high training volume (HT) during an exhaustive run on a motorized treadmill. Based on their weekly training volume (distance), twenty-eight runners were arranged into two groups paired by height and age. At the first visit, runners underwent a VO2max test to acquire their velocity for the exhaustive run. During the second visit, biomechanical and physiological analysis of the beginning and the end phase of the exhaustive run was done. RESULTS The frontal plane foot angle, the sagittal plane ankle angle at the initial contact (IC), and the foot eversion ROM showed a significant interaction effect (P < 0.05). Additionally, the sagittal plane footstrike angle, the frontal plane foot angle, the sagittal plane ankle angle, knee flexion angle at IC and foot eversion ROM showed a significant effect of fatigue (P < 0.05). Finally, the frontal plane foot angle, the sagittal plane footstrike angle, the sagittal plane ankle angle, and the knee flexion angle showed significant group effects (P < 0.05). SIGNIFICANCE The training volume affects the footstrike pattern of non-rearfoot, habitual minimalist footwear runners when they are fatigued. The highly trained runners maintained their ankle angle throughout the exhaustive running protocol, whereas the moderately trained group changed the frontal and sagittal plane characteristics of their footstrike pattern.
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Affiliation(s)
- Jan Urbaczka
- Department of Human Movement Studies, University of Ostrava, Czech Republic.
| | | | - Daniel Jandacka
- Department of Human Movement Studies, University of Ostrava, Czech Republic
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Gait Asymmetry Comparison between Subjects with and without Nonspecific Chronic Low Back Pain. Symmetry (Basel) 2021. [DOI: 10.3390/sym13112129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Individuals with chronic low back pain (LBP) report impaired somatosensory function and balance. However, there is a lack of investigation on limb motion similarities between subjects with and without LBP during gait. The aim of this study was to compare gait parameters as well as combined limb motions using the kinematic similarity index (KSI) between subjects with and without LBP. Twenty-two subjects with LBP and 19 age- and body mass index-matched control subjects participated in this study. The combined limb motions in the gait cycle of subjects with LBP were compared with those of a prototype derived from healthy subjects. The calculations resulted in response vectors that were analyzed in comparison to control-derived prototype response vectors for the normalized index at 5% increments in the gait cycle. The results of our study indicated that the KSI of the control group demonstrated higher similarities in the swing (t = 4.23, p = 0.001) and stance (t = 6.26, p = 0.001) phases compared to the LBP group. The index for the whole gait cycle was significantly different between the groups (t = 6.52, p = 0.001), especially in the midstance and swing phases. The LBP group could have adjusted the gait patterns during these specific phases. The KSI is useful for clinical outcome measures to differentiate kinematic changes and to demonstrate quantified similarities in the gait cycle between subjects with and without LBP. It is warranted to validate the KSI for the analysis of physiological gait asymmetry using a larger sample in future studies.
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