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Center JA, Willy RW, Elias ARC, Mischke JJ. Validity of a commercially available load cell dynamometer in measuring isometric knee extension torque in patients with knee disorders. Phys Ther Sport 2024:S1466-853X(24)00051-8. [PMID: 38702203 DOI: 10.1016/j.ptsp.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Assess the validity of hand-held dynamometry (HHD) and the Tindeq Progressor (TP) in assessing peak isometric knee extension torque and limb symmetry index (LSI) versus isokinetic dynamometer (IKD). DESIGN Prospective cross-sectional study. SETTING Laboratory. PARTICIPANTS 31 individuals with unilateral knee disorders (21 female; 28.3 ± 11 years). MAIN OUTCOME MEASURES Peak isometric knee extension torque; Knee extension LSI. RESULTS Strong to almost perfect (p < 0.001) correlations (Cohen's Kappa k) with IKD were found for both devices for peak torque of the uninvolved limb (HHD [k = 0.84], TP [k = 0.91]) and involved limb (HHD [k = 0.93], TP [k = 0.98]). For LSI, moderate to strong (p < 0.001) correlations with IKD were found for HHD (k = 0.79) and TP (k = 0.89). Mean bias errors were equivalent for determining LSI (HHD = 0.02%; TP = 0.03%). Both HHD and TP were highly sensitive (96.2-100.0%) and specific (100.0%) at the 70% LSI threshold. TP showed higher sensitivity and specificity at the 90% LSI threshold. CONCLUSION HHD and TP are valid in measuring isometric knee extension torque with the reference standard IKD. TP showed superior validity in identifying LSI. TP also shows greater specificity in identifying the 90% LSI threshold.
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Affiliation(s)
- John A Center
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA.
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - Audrey R C Elias
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - John J Mischke
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
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Merry K, MacPherson MM, Blazey P, Fearon A, Hunt M, Morrissey D, Napier C, Reid D, Whittaker JL, Willy RW, Scott A. Current practice, guideline adherence, and barriers to implementation for Achilles tendinopathy rehabilitation: a survey of physical therapists and people with Achilles tendinopathy. BMJ Open Sport Exerc Med 2024; 10:e001678. [PMID: 38347858 PMCID: PMC10860067 DOI: 10.1136/bmjsem-2023-001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 02/15/2024] Open
Abstract
Objective To explore clinical practice patterns of physical therapists (PTs) who treat people with Achilles tendinopathy (AT), and identify perceived barriers and facilitators for prescribing and engaging with therapeutic exercise among PTs and people with AT. Methods Two cross-sectional surveys were electronically distributed between November 2021 and May 2022; one survey was designed for PTs while the second was for people with AT. Survey respondents answered questions regarding their physical therapy training and current practice (PTs), injury history and management (people with AT), and perceived barriers and facilitators (PTs and people with AT). Results 341 PTs and 74 people with AT completed the surveys. In alignment with clinical practice guidelines, more than 94% of PTs surveyed (97% of whom had some form of advanced musculoskeletal training) prioritise patient education and therapeutic exercise. Patient compliance, patient knowledge, and the slow nature of recovery were barriers to prescribing therapeutic exercise reported by PTs, while time, physical resources, and a perceived lack of short-term treatment effectiveness were barriers for people with AT. Conclusions Consistent with clinical practice guidelines, PTs with advanced training reported prioritising therapeutic exercise and education for managing AT. However, both PTs and people with AT identified many barriers to prescribing or engaging with therapeutic exercise. By addressing misconceptions about the time burden and ineffectiveness of exercise, and by overcoming access issues to exercise space and equipment, PTs may be able to improve intervention adherence and subsequently outcomes for people with AT.
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Affiliation(s)
- Kohle Merry
- Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Paul Blazey
- Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Angie Fearon
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, southeastern Australia, Australia
| | - Michael Hunt
- Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Dylan Morrissey
- Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, London, UK
| | - Christopher Napier
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Duncan Reid
- Physiotherapy, Auckland University of Technology, Auckland, New Zealand
| | - Jackie L Whittaker
- Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard W Willy
- Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, Montana, USA
| | - Alex Scott
- Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
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3
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Vickery-Howe DM, Bonanno DR, Dascombe BJ, Drain JR, Clarke AC, Hoolihan B, Willy RW, Middleton KJ. Physiological, perceptual, and biomechanical differences between treadmill and overground walking in healthy adults: A systematic review and meta-analysis. J Sports Sci 2023; 41:2088-2120. [PMID: 38350022 DOI: 10.1080/02640414.2024.2312481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
This systematic review and meta-analysis aims to compare physiological, perceptual and biomechanical outcomes between walking on a treadmill and overground surfaces. Five databases (CINAHL, EMBASE, MEDLINE, SPORTDiscus, Web of Science) were searched until September 2022. Included studies needed to be a crossover design comparing biomechanical, physiological, or perceptual measures between motorised-treadmill and overground walking in healthy adults (18-65 years) walking at the same speed (<5% difference). The quality of studies were assessed using a modified Downs and Black Quality Index. Meta-analyses were performed to determine standardised mean difference ± 95% confidence intervals for all main outcome measures. Fifty-five studies were included with 1,005 participants. Relative oxygen consumption (standardised mean difference [95% confidence interval] 0.38 [0.14,0.63]) and cadence (0.22 [0.06,0.38]) are higher during treadmill walking. Whereas stride length (-0.36 [-0.62,-0.11]) and step length (-0.52 [-0.98,-0.06]) are lower during treadmill walking. Most kinetic variables are different between surfaces. The oxygen consumption, spatiotemporal and kinetic differences on the treadmill may be an attempt to increase stability due to the lack of control, discomfort and familiarity on the treadmill. Treadmill construction including surface stiffness and motor power are likely additional constraints that need to be considered and require investigation. This research was supported by an Australian Government Research Training Program (RTP) scholarship. Protocol registration is CRD42020208002 (PROSPERO International Prospective Register of Systematic Reviews) in October 2020.
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Affiliation(s)
- D M Vickery-Howe
- Sports, Performance and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - D R Bonanno
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - B J Dascombe
- Applied Sport Science and Exercise Testing Laboratory, School of Life and Environmental Sciences, University of Newcastle, Ourimbah, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - J R Drain
- Human and Decision Sciences Division, Defence Science and Technology Group, Fishermans Bend, Australia
| | - A C Clarke
- Sports, Performance and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - B Hoolihan
- Applied Sport Science and Exercise Testing Laboratory, School of Life and Environmental Sciences, University of Newcastle, Ourimbah, Australia
| | - R W Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - K J Middleton
- Sports, Performance and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Van Waerbeke C, Willy RW, Jacques A, Berton E, Paquette MR, Rao G. Increasing load carriage and running speed differentially affect the magnitude, variability and coordination patterns of muscle forces. J Biomech 2023; 159:111794. [PMID: 37690366 DOI: 10.1016/j.jbiomech.2023.111794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
The study aims to investigate the effects of different loads and speed during running on inter- and intra-individual muscle force amplitudes, variabilities and coordination patterns. Nine healthy participants ran on an instrumentalized treadmill with an empty weight vest at two velocities (2.6 m/s and 3.3 m/s) or while carrying three different loads (4.5, 9.1, 13.6 kg) at 2.6 m/s while kinematics and kinetics were synchronously recorded. The major lower limb muscle forces were estimated using a musculoskeletal model. Muscle force amplitudes and variability, as well as coordination patterns were compared at the group and at the individual level using respectively statistical parametric mapping and covariance matrices combined with multidimensional scaling. Increasing the speed or the load during running increased most of the muscle force amplitudes (p < 0.01). During the propulsion phase, increasing the load increased muscle force variabilities around the ankle joint (modification of standard deviation up to 5% of body weight (BW), p < 0.05) while increasing the speed decreased variability for almost all the muscle forces (up to 10% of BW, p < 0.05). Each runner has a specific muscle force coordination pattern signature regardless of the different experimental conditions (p < 0.05). Yet, this individual pattern was slightly adapted in response to a change of speed or load (p < 0.05). Our results suggest that adding load increases the amplitude and variability of muscle force, but an increase in running speed decreases the variability. These findings may help improve the design of military or trail running training programs and injury rehabilitation by progressively increasing the mechanical load on anatomical structures.
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Affiliation(s)
| | - Richard W Willy
- Division of Physical Therapy & Health Sciences, University of Montana, Missoula, MT 59812, United States
| | | | - Eric Berton
- Aix Marseille Univ, CNRS, ISM, Marseille, France
| | - Max R Paquette
- College of Health Sciences, University of Memphis, Memphis, TN, United States
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Sancho I, Willy RW, Morrissey D, Malliaras P, Lascurain-Aguirrebeña I. Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study. Phys Ther Sport 2023; 60:26-33. [PMID: 36640640 DOI: 10.1016/j.ptsp.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To estimate Achilles tendon forces and their relationship with self-reported pain in runners with Achilles tendinopathy (AT) during common rehabilitation exercises. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS 24 recreational male runners (45.92 (8.24) years old; 78.20 (8.01) kg; 177.17 (6.69) cm) with symptomatic AT. MAIN OUTCOME MEASURES Kinematic and kinetic data were collected to estimate Achilles tendon forces during 12 commonly prescribed exercises. Achilles tendon forces were estimated from biomechanical data and normalised to the participant's bodyweight. The secondary aim was to investigate the relationship between Achilles tendon forces and pain during these exercises. RESULTS Two exercise clusters were identified based on Achilles tendon forces. Cluster1 included various exercises including double heel raises, single heel raises, and walking (range: 1.10-2.76 BWs). Cluster2 included running, jumping and hopping exercises (range: 5.13-6.35 BWs). Correlation between tendon forces and pain was at best low for each exercise (range: -0.43 - 0.20). Higher force exercises lead to more tendon load for a given amount of pain (R2 = 0.7505; y = 0.2367x + 0.6191). CONCLUSION This study proposes a hierarchical exercise progression based on Achilles tendon forces to guide treatment of runners with AT. Achilles tendon forces and pain are not correlated in runners with AT.
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Affiliation(s)
- Igor Sancho
- Sports and Exercise Medicine, William Harvey Research Institute. Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Physiotherapy Department, University of Deusto, San Sebastian, Spain.
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA.
| | - Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute. Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Physiotherapy Department, Barts Health NHS Trust, London, UK.
| | - Peter Malliaras
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Australia.
| | - Ion Lascurain-Aguirrebeña
- Faculty of Medicine & Nursing, Physiotherapy, Department of Physiology, University of the Basque Country UPV/EHU, Leioa, Spain.
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Dijkstra HP, Mc Auliffe S, Ardern CL, Kemp JL, Mosler AB, Price A, Blazey P, Richards D, Farooq A, Serner A, McNally E, Mascarenhas V, Willy RW, Stankovic I, Oke JL, Khan KM, Glyn-Jones S, Clarke M, Greenhalgh T. Infographic. Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome-natural history of primary cam morphology to inform clinical practice and research priorities on conditions affecting the young person's hip. Br J Sports Med 2023; 57:382-384. [PMID: 36650034 PMCID: PMC9985723 DOI: 10.1136/bjsports-2022-106094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/19/2023]
Affiliation(s)
- H Paul Dijkstra
- Department for Continuing Education, University of Oxford, Oxford, UK .,Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Sean Mc Auliffe
- Department of Physical Therapy & Rehabilitation Science, Qatar University, Doha, Qatar.,Department of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Clare L Ardern
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada.,Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea Britt Mosler
- Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Amy Price
- Department of Anesthesia, Informatics and Media Lab, Stanford University School of Medicine, Stanford, California, USA
| | - Paul Blazey
- Center for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Abdulaziz Farooq
- FIFA Medical Centre of Excellence, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andreas Serner
- FIFA Medical, Federation Internationale de Football Association, Zurich, Switzerland
| | | | - Vasco Mascarenhas
- Advanced Imaging Research Consortium UIME, Hospital da Luz, Lisboa, Portugal
| | - Richard W Willy
- Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA
| | - Ivan Stankovic
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Dijkstra HP, Mc Auliffe S, Ardern CL, Kemp JL, Mosler AB, Price A, Blazey P, Richards D, Farooq A, Serner A, McNally E, Mascarenhas V, Willy RW, Oke JL, Khan KM, Glyn-Jones S, Clarke M, Greenhalgh T. Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 1-definitions, terminology, taxonomy and imaging outcomes. Br J Sports Med 2022; 57:bjsports-2022-106085. [PMID: 36588401 PMCID: PMC9985727 DOI: 10.1136/bjsports-2022-106085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Primary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers do not yet agree on important primary cam morphology elements. We aimed to ascertain and improve the level of agreement on primary cam morphology definitions, terminology, taxonomy and imaging outcome measures. METHODS To collect and aggregate informed opinions, an expert panel-the Young Athlete's Hip Research Collaborative-rated primary cam morphology definition, terminology, taxonomy and imaging outcome statements through an online Delphi exercise followed by an online meeting to explore areas of tension and dissent. Reporting followed Conducting and REporting DElphi Studies. RESULTS A diverse and inclusive Delphi panel (n=65 for rounds 1 and 2, representing 18 countries; 6 stakeholder groups; 40% women) agreed on 35 of 47 statements in 4 domains, while surfacing areas of tension and dissent. This Delphi panel agreed on four key issues essential to moving research and clinical care forward around primary cam morphology. They agreed on: (1) definition, confirming its conceptual attributes (tissue type, size, location, shape and ownership); (2) terminology-use 'morphology' and not terms with a negative connotation like 'lesion', 'abnormality' or 'deformity'; (3) taxonomy, distinguishing between primary and secondary cam morphology, and (4) imaging outcomes, a continuous bone/cartilage alpha angle on radial femoral head-neck MRI for primary cam morphology aetiology research. CONCLUSION This consensus provides athletes, patients, clinicians and researchers with a strong foundation to guide more precise communication, better clinical decision-making and higher value research about primary cam morphology and its natural history.
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Affiliation(s)
- H Paul Dijkstra
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Sean Mc Auliffe
- Department of Physical Therapy & Rehabilitation Science, Qatar University, Doha, Qatar
- Department of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Clare L Ardern
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- La Trobe Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Amy Price
- Department of Anesthesia, Informatics and Media Lab, Stanford University School of Medicine, Stanford, California, USA
| | - Paul Blazey
- Center for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Abdulaziz Farooq
- FIFA Medical Centre of Excellence, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andreas Serner
- FIFA Medical, Federation Internationale de Football Association, Zurich, Switzerland
| | | | - Vasco Mascarenhas
- Advanced Imaging Research Consortium UIME, Hospital da Luz, Lisboa, Portugal
| | - Richard W Willy
- Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Dijkstra HP, Mc Auliffe S, Ardern CL, Kemp JL, Mosler AB, Price A, Blazey P, Richards D, Farooq A, Serner A, McNally E, Mascarenhas V, Willy RW, Oke JL, Khan KM, Glyn-Jones S, Clarke M, Greenhalgh T. Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 2-research priorities on conditions affecting the young person's hip. Br J Sports Med 2022; 57:bjsports-2022-106092. [PMID: 36588402 PMCID: PMC9985764 DOI: 10.1136/bjsports-2022-106092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Primary cam morphology is highly prevalent in many athlete populations, causing debilitating hip osteoarthritis in some. Existing research is mired in confusion partly because stakeholders have not agreed on key primary cam morphology elements or a prioritised research agenda. We aimed to inform a more rigorous, inclusive and evidence-based approach to research on primary cam morphology and its natural history by working towards agreement on a set of research priorities for conditions affecting the young person's hip. METHODS An international expert panel-the Young Athlete's Hip Research (YAHiR) Collaborative-rated research priority statements through an online two-round Delphi exercise and met online to explore areas of tension and dissent. Panellists ranked the prioritised research statements according to the Essential National Health Research (ENHR) ranking strategy. Reporting of results followed REPRISE (REporting guideline for PRIority SEtting of health). RESULTS A diverse Delphi panel (n=65, Delphi rounds 1 and 2; three ENHR strategy surveys: n=49; n=44; n=42) from 18 countries representing six stakeholder groups, prioritised and ranked 18 of 38 research priority statements. The prioritised statements outlined seven research domains: (1) best practice physiotherapy, (2) rehabilitation progression and return to sport, (3) exercise intervention and load management, (4) primary cam morphology prognosis and aetiology, (5) femoroacetabular impingement syndrome prognosis and aetiology, (6) diagnostic criteria, and (7) screening. The panel recommended areas of tension and dissent for the research community to focus on immediately. CONCLUSION While informing more rigorous, inclusive and evidence-based research, this consensus is a roadmap for researchers, policy-makers and funders to implement research dedicated to reducing the cost and burden of hip disease related to primary cam morphology.
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Affiliation(s)
- H Paul Dijkstra
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Sean Mc Auliffe
- Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
- Department of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Clare L Ardern
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- La Trobe Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Amy Price
- Department of Anesthesia, Informatics and Media Lab, Stanford University School of Medicine, Stanford, California, USA
| | - Paul Blazey
- Center for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Abdulaziz Farooq
- FIFA Medical Centre of Excellence, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andreas Serner
- FIFA Medical, Federation Internationale de Football Association, Zurich, Switzerland
| | | | - Vasco Mascarenhas
- Advanced Imaging Research Consortium UIME, Hospital da Luz, Lisboa, Portugal
| | - Richard W Willy
- School of Physical Therapy, University of Montana, Missoula, Montana, USA
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Esculier JF, Besomi M, Silva DDO, Passigli S, Rathleff MS, Van Middelkoop M, Barton C, Callaghan MJ, Harkey MS, Hoens AM, Krowchuk NM, Teoli A, Vicenzino B, Willy RW, Hunt MA. Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-sectional International Multilanguage Online Survey. Orthop J Sports Med 2022; 10:23259671221124141. [PMID: 36199830 PMCID: PMC9528027 DOI: 10.1177/23259671221124141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Running is a popular sport with widely recognized health benefits. Given the high rates of knee injury in runners and the growing prevalence of knee osteoarthritis (KOA), it may be useful to assess perceptions about running and knee joint health. Purpose: The objectives of this study were to (1) explore and compare the perceptions of the general public (PUB) and health care professionals (HCPs) on the topic of running and knee health and (2) explore recommendations about running and knee health provided by HCPs. Study Design: Cross-sectional study. Methods: We conducted an online survey between June 18 and October 1, 2020. The questionnaire included questions on running and knee health, and HCPs were asked about their typical recommendations and level of confidence in providing recommendations on the topic. Perceptions (proportions) were compared between the PUB and HCPs using the chi-square test. Results: In total, 4521 responses (PUB, n = 2514; HCPs, n = 2007) were analyzed. A greater proportion of HCPs perceived regular running as healthy for knees (86% vs 68%; P < .001). More of the PUB than HCPs ( P < .001) believed that running frequently (29% vs 13%), long distances (54% vs 45%), and on hard surfaces (60% vs 36%) increased the risk of developing KOA. Running for those with KOA was perceived by the PUB as posing an increased risk of getting more knee pain (48%) and needing joint replacement surgery (38%), more so than by HCPs (26% and 17%, respectively). The majority of HCPs reported being relatively confident in providing evidence-based recommendations about running and knee health and mostly recommended that runners with KOA modify training parameters instead of quit. Conclusion: More HCPs perceived running as healthy for knees when compared with the PUB. Most HCPs felt confident in providing evidence-based recommendations about running and knee health.
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Affiliation(s)
| | - Manuela Besomi
- Investigation performed at University of British Columbia, Vancouver, Canada
| | | | - Samuele Passigli
- Investigation performed at University of British Columbia, Vancouver, Canada
| | | | | | - Christian Barton
- Investigation performed at University of British Columbia, Vancouver, Canada
| | | | - Matthew S. Harkey
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Alison M. Hoens
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Natasha M. Krowchuk
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Anthony Teoli
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Bill Vicenzino
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Richard W. Willy
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Michael A. Hunt
- Investigation performed at University of British Columbia, Vancouver, Canada
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10
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Corrigan P, Hornsby S, Pohlig RT, Willy RW, Cortes DH, Silbernagel KG. Tendon loading in runners with Achilles tendinopathy: Relations to pain, structure, and function during return-to-sport. Scand J Med Sci Sports 2022; 32:1201-1212. [PMID: 35488734 PMCID: PMC9972464 DOI: 10.1111/sms.14178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 12/27/2022]
Abstract
We aimed to (1) compare pain, tendon structure, lower limb function, and Achilles tendon loads while running between limbs in runners with Achilles tendinopathy, and (2) explore the relations of pain, tendon structure, and lower limb function to Achilles tendon loads while running. Twenty runners with Achilles tendinopathy participated in this pilot study. Pain was assessed with questionnaires, quantitative sensory testing, and functional testing. Tendon morphology and mechanical properties were evaluated with ultrasound imaging, continuous shear wave elastography, and ultrasound imaging combined with dynamometry. Lower limb function was assessed with an established test battery. Achilles tendon loads were estimated from biomechanical data acquired during running. Compared to the least symptomatic limb, the most symptomatic limb had lower scores on the Victorian Institute of Sports Assessment - Achilles questionnaire and worse pain during drop countermovement jumping, hopping, and running. Tendon thickness and cross-sectional area were greater, and Young's modulus, drop countermovement jump height, and plyometric quotient during hopping were lower on the most symptomatic limb. Side-to-side differences in drop countermovement jump height were significantly associated with side-to-side differences in Achilles tendon peak forces and average loading rates during running. Various measures of pain, structure, and function differ between limbs in runners with Achilles tendinopathy during return-to-sport. Tendon forces, however, do not differ between limbs during comfortable running. In addition to measures that differ between limbs, measures of performance during drop countermovement jumping may aid in clinical decision-making during return-to-sport because they are associated with tendon forces while running.
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Affiliation(s)
- Patrick Corrigan
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, Missouri, USA,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Samantha Hornsby
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Ryan T. Pohlig
- College of Health Sciences Biostatistics Core Facility, University of Delaware, Burlington, Vermont, USA
| | - Richard W. Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Daniel H. Cortes
- Department of Mechanical Engineering, Penn State University, State College, Pennsylvania, USA
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11
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Sancho I, Morrissey D, Willy RW, Tayfur A, Lascurain-Aguirrebeña I, Barton C, Malliaras P. Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study. Phys Ther Sport 2022; 55:241-247. [DOI: 10.1016/j.ptsp.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 10/24/2022]
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12
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Willy RW, Hoglund L, Glaviano NR, Bolgla LA, Bazett-Jones DM. Survey of confidence and knowledge to manage patellofemoral pain in readers versus NonReaders of the physical therapy clinical practice guideline. Phys Ther Sport 2022; 55:218-228. [DOI: 10.1016/j.ptsp.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 12/21/2022]
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13
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Hutchinson LA, Lichtwark GA, Willy RW, Kelly LA. The Iliotibial Band: A Complex Structure with Versatile Functions. Sports Med 2022; 52:995-1008. [PMID: 35072941 PMCID: PMC9023415 DOI: 10.1007/s40279-021-01634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/20/2022]
Abstract
The development of a pronounced iliotibial band (ITB) is an anatomically distinct evolution of humans. The mechanical behaviour of this “new” structure is still poorly understood and hotly debated in current literature. Iliotibial band syndrome (ITBS) is one of the leading causes of lateral knee pain injuries in runners. We currently lack a comprehensive understanding of the healthy behaviour of the ITB, and this is necessary prior to further investigating the aetiology of pathologies like ITBS. Therefore, the purpose of this narrative review was to collate the anatomical, biomechanical and clinical literature to understand how the mechanical function of the ITB is influenced by anatomical variation, posture and muscle activation. The complexity of understanding the mechanical function of the ITB is due, in part, to the presence of its two in-series muscles: gluteus maximus (GMAX) and tensor fascia latae (TFL). At present, we lack a fundamental understanding of how GMAX and TFL transmit force through the ITB and what mechanical role the ITB plays for movements like walking or running. While there is a range of proposed ITBS treatment strategies, robust evidence for effective treatments is still lacking. Interventions that directly target the running biomechanics suspected to increase either ITB strain or compression of lateral knee structures may have promise, but clinical randomised controlled trials are still required.
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Affiliation(s)
- L A Hutchinson
- School of Human Movement and Nutrition, The University of Queensland, Brisbane, QLD, Australia.
| | - G A Lichtwark
- School of Human Movement and Nutrition, The University of Queensland, Brisbane, QLD, Australia
| | - R W Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - L A Kelly
- School of Human Movement and Nutrition, The University of Queensland, Brisbane, QLD, Australia
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14
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Alexander JLN, Willy RW, Culvenor AG, Barton CJ. Infographic. Running Myth: recreational running causes knee osteoarthritis. Br J Sports Med 2021; 56:357-358. [PMID: 34819274 DOI: 10.1136/bjsports-2021-104342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/03/2022]
Affiliation(s)
- James L N Alexander
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia .,Evado Studios Nelson Bay, Nelson Bay, New South Wales, Australia
| | - Richard W Willy
- Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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15
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Napier C, Willy RW. The Prevention and Treatment of Running Injuries: A State of the Art. Int J Sports Phys Ther 2021; 16:968-970. [PMID: 34386275 PMCID: PMC8329326 DOI: 10.26603/001c.25754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Christopher Napier
- Department of Physical Therapy, University of British Columbia; Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University
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16
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Napier C, Paquette MR, Willy RW. Foot Pain - Running. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764236.27620.8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Murphy SP, Willy RW, Rosales AM, Hailes WS, Dodds PS, Ruby BC. Effects Of Exertion And Load On Postural Control Metrics Following Strenuous Load Carriage. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761088.07109.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Meardon SA, Derrick TR, Willson JD, Baggaley M, Steinbaker CR, Marshall M, Willy RW. Peak and Per-Step Tibial Bone Stress During Walking and Running in Female and Male Recreational Runners. Am J Sports Med 2021; 49:2227-2237. [PMID: 34077287 DOI: 10.1177/03635465211014854] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Athletes, especially female athletes, experience high rates of tibial bone stress injuries (BSIs). Knowledge of tibial loads during walking and running is needed to understand injury mechanisms and design safe running progression programs. PURPOSE To examine tibial loads as a function of gait speed in male and female runners. STUDY DESIGN Controlled laboratory study. METHODS Kinematic and kinetic data were collected on 40 recreational runners (20 female, 20 male) during 4 instrumented gait speed conditions on a treadmill (walk, preferred run, slow run, fast run). Musculoskeletal modeling, using participant-specific magnetic resonance imaging and motion data, was used to estimate tibial stress. Peak tibial stress and stress-time impulse were analyzed using 2-factor multivariate analyses of variance (speed*sex) and post hoc comparisons (α = .05). Bone geometry and tibial forces and moments were examined. RESULTS Peak compression was influenced by speed (P < .001); increasing speed generally increased tibial compression in both sexes. Women displayed greater increases in peak tension (P = .001) and shear (P < .001) than men when transitioning from walking to running. Further, women displayed greater peak tibial stress overall (P < .001). Compressive and tensile stress-time impulse varied by speed (P < .001) and sex (P = .006); impulse was lower during running than walking and greater in women. A shear stress-time impulse interaction (P < .001) indicated that women displayed greater impulse relative to men when changing from a walk to a run. Compared with men, women displayed smaller tibiae (P < .001) and disproportionately lower tibial forces (P≤ .001-.035). CONCLUSION Peak tibial stress increased with gait speed, with a 2-fold increase in running relative to walking. Women displayed greater tibial stress than men and greater increases in stress when shifting from walking to running. Sex differences appear to be the result of smaller bone geometry in women and tibial forces that were not proportionately lower, given the womens' smaller stature and lower mass relative to men. CLINICAL RELEVANCE These results may inform interventions to regulate running-related training loads and highlight a need to increase bone strength in women. Lower relative bone strength in women may contribute to a sex bias in tibial BSIs, and female runners may benefit from a slower progression when initiating a running program.
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Affiliation(s)
- Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | | | - John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Michael Baggaley
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Margaret Marshall
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
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19
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Abstract
Bone stress injuries (BSIs) occur at inopportune times to invariably interrupt training. All BSIs in runners occur due to an "error" in workload wherein the interaction between the number and magnitude of bone tissue loading cycles exceeds the ability of the tissue to resist the repetitive loads. There is not a single optimal bone workload, rather a range which is influenced by the prevailing scenario. In prepubertal athletes, optimal bone workload consists of low-repetitions of fast, high-magnitude, multidirectional loads introduced a few times per day to induce bone adaptation. Premature sports specialization should be avoided so as to develop a robust skeleton that is structurally optimized to withstand multidirectional loading. In the mature skeleton, optimal workload enables gains in running performance but minimizes bone damage accumulation by sensibly progressing training, particularly training intensity. When indicated (e.g., following repeated BSIs), attempts to reduce bone loading magnitude should be considered, such as increasing running cadence. Determining the optimal bone workload for an individual athlete to prevent and manage BSIs requires consistent monitoring. In the future, it may be possible to clinically determine bone loads at the tissue level to facilitate workload progressions and prescriptions.
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Affiliation(s)
- Stuart J Warden
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, 1140 W. Michigan St., CF-124, Indianapolis, IN, 46202, USA.
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, USA.
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Richard W Willy
- School of Physical Therapy & Health Sciences, University of Montana, Missoula, MT, USA
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20
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Napier C, Willy RW, Hannigan BC, McCann R, Menon C. The Effect of Footwear, Running Speed, and Location on the Validity of Two Commercially Available Inertial Measurement Units During Running. Front Sports Act Living 2021; 3:643385. [PMID: 33981991 PMCID: PMC8107270 DOI: 10.3389/fspor.2021.643385] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Most running-related injuries are believed to be caused by abrupt changes in training load, compounded by biomechanical movement patterns. Wearable technology has made it possible for runners to quantify biomechanical loads (e.g., peak positive acceleration; PPA) using commercially available inertial measurement units (IMUs). However, few devices have established criterion validity. The aim of this study was to assess the validity of two commercially available IMUs during running. Secondary aims were to determine the effect of footwear, running speed, and IMU location on PPA. Materials and Methods: Healthy runners underwent a biomechanical running analysis on an instrumented treadmill. Participants ran at their preferred speed in three footwear conditions (neutral, minimalist, and maximalist), and at three speeds (preferred, +10%, −10%) in the neutral running shoes. Four IMUs were affixed at the distal tibia (IMeasureU-Tibia), shoelaces (RunScribe and IMeasureU-Shoe), and insole (Plantiga) of the right shoe. Pearson correlations were calculated for average vertical loading rate (AVLR) and PPA at each IMU location. Results: The AVLR had a high positive association with PPA (IMeasureU-Tibia) in the neutral and maximalist (r = 0.70–0.72; p ≤ 0.001) shoes and in all running speed conditions (r = 0.71–0.83; p ≤ 0.001), but low positive association in the minimalist (r = 0.47; p < 0.05) footwear condition. Conversely, the relationship between AVLR and PPA (Plantiga) was high in the minimalist (r = 0.75; p ≤ 0.001) condition and moderate in the neutral (r = 0.50; p < 0.05) and maximalist (r = 0.57; p < 0.01) footwear. The RunScribe metrics demonstrated low to moderate positive associations (r = 0.40–0.62; p < 0.05) with AVLR across most footwear and speed conditions. Discussion: Our findings indicate that the commercially available Plantiga IMU is comparable to a tibia-mounted IMU when acting as a surrogate for AVLR. However, these results vary between different levels of footwear and running speeds. The shoe-mounted RunScribe IMU exhibited slightly lower positive associations with AVLR. In general, the relationship with AVLR improved for the RunScribe sensor at slower speeds and improved for the Plantiga and tibia-mounted IMeasureU sensors at faster speeds.
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Affiliation(s)
- Christopher Napier
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, United States
| | - Brett C Hannigan
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Ryan McCann
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, United States
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada.,Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
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21
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Gabbett T, Sancho I, Dingenen B, Willy RW. When progressing training loads, what are the considerations for healthy and injured athletes? Br J Sports Med 2021; 55:947-948. [PMID: 33837004 DOI: 10.1136/bjsports-2020-103769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Tim Gabbett
- Gabbett Performance Solutions, Brisbane, Queensland, Australia .,Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Igor Sancho
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Physiotherapy Department, University of Deusto, San Sebastian, Spain
| | - Bart Dingenen
- Reval Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Richard W Willy
- Physical Therapy and Movement Science, University of Montana Missoula, Missoula, Montana, USA
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22
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Pazzinatto MF, Silva DDO, Willy RW, Azevedo FM, Barton CJ. Fear of movement and (re)injury is associated with condition specific outcomes and health-related quality of life in women with patellofemoral pain. Physiother Theory Pract 2020; 38:1254-1263. [PMID: 33106118 DOI: 10.1080/09593985.2020.1830323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Investigate the association of fear of movement and (re)injury with clinical outcomes in women with patellofemoral pain (PFP). METHODS This cross-sectional study included 92 women with PFP who completed the TAMPA scale for kinesiophobia. The TAMPA score and its two subscales - activity avoidance and somatic focus were correlated with BMI, physical activity level, pain catastrophizing scale, health-related quality of life, pain sensitivity via pressure pain threshold, self-reported disability, and worst knee pain in last month. RESULTS Greater fear of movement and (re)injury, activity avoidance, and somatic focus were correlated with lower local pain sensitivity (rho = -0.29 to -0.55), lower health-related quality of life (rho = -0.38 to -0.42), greater pain catastrophizing (rho = 0.41 to 0.47), and greater self-reported disability (rho = -0.31 to -0.52). Greater fear of movement and (re)injury and activity avoidance were correlated with adjacent and remote pain sensitivity (rho = -0.24 to -0.39). Greater fear of movement and (re)injury and somatic focus were correlated with greater worst knee pain in last month (rho = 0.21 to 0.32). Fear of movement and (re)injury predicted pain measures, disability, and health-related quality of life (p ≤ 0.010). CONCLUSION The relationship of greater fear of movement and (re)injury with greater disability, pain catastrophizing, pain sensitization, and poorer health-related quality of life highlights the potential importance of considering this psychological feature of PFP during assessment and management.
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Affiliation(s)
- Marcella F Pazzinatto
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Danilo De Oliveira Silva
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA
| | - Fábio M Azevedo
- Laboratory of Biomechanics and Motor Control, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Christian J Barton
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Australia
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23
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De Oliveira Silva D, Willy RW, Barton CJ, Christensen K, Pazzinatto MF, Azevedo FM. Pain and disability in women with patellofemoral pain relate to kinesiophobia, but not to patellofemoral joint loading variables. Scand J Med Sci Sports 2020; 30:2215-2221. [DOI: 10.1111/sms.13767] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
| | - Richard W. Willy
- School of Physical Therapy and Movement Sciences University of Montana Missoula MT USA
| | - Christian J. Barton
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Surgery St Vincent's Hospital University of Melbourne Melbourne Australia
| | - Kelly Christensen
- School of Physical Therapy and Movement Sciences University of Montana Missoula MT USA
| | - Marcella F. Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
| | - Fábio M. Azevedo
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
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24
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25
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Plemmons M, Ruby B, Hanser B, Christensen K, Doutt A, Willy RW. Sex-related Differences In Patellofemoral Joint Stress With Fighting And Approach Load Carriage. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675472.67924.6e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Van Hooren B, Fuller JT, Buckley JD, Miller JR, Sewell K, Rao G, Barton C, Bishop C, Willy RW. Authors' Reply to Dewolf et al.: "Is Motorized Treadmill Running Biomechanically Comparable to Overground Running? A Systematic Review and Meta-Analysis of Cross-Over Studies". Sports Med 2020; 50:1699. [PMID: 32524455 DOI: 10.1007/s40279-020-01305-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bas Van Hooren
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Universiteitssingel 50, Maastricht, NL, 6229 ER, The Netherlands. .,Institute of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
| | - Joel T Fuller
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Jayme R Miller
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | | | | | | | - Chris Bishop
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia.,The Biomechanics Lab, Adelaide, SA, Australia
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA
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27
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Alexander JLN, Willy RW, Napier C, Bonanno DR, Barton CJ. Infographic. Running myth: switching to a non-rearfoot strike reduces injury risk and improves running economy. Br J Sports Med 2020; 55:175-176. [PMID: 32423913 DOI: 10.1136/bjsports-2020-102262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 11/03/2022]
Affiliation(s)
- James L N Alexander
- La Trobe Sports and Exercise Research Centre, La Trobe University, Melbourne, Victoria, Australia .,The Running Physiotherapist, Port Stephens, New South Wales, Australia
| | - Richard W Willy
- Department of Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA
| | - Christopher Napier
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Mechatronic Systems Engineering, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Christian J Barton
- La Trobe Sports and Exercise Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Abstract
PURPOSE OF REVIEW Movement retraining in rehabilitation is the process by which a motor program is changed with the overall goal of reducing pain or injury risk. Movement retraining is an important component of interventions to address patellofemoral pain. The purpose of this paper is to review the methods and results of current retraining studies that are aimed at reducing symptoms of patellofemoral pain. RECENT FINDINGS The majority of studies reviewed demonstrated some improvement in patellofemoral pain symptoms and overall function. However, the degree of improvement as well as the persistence of improvement over time varied between studies. The greatest pain reduction and persistent changes were noted in those studies that incorporated a faded feedback design including between 8 and 18 sessions over 2-6 weeks, typically 3-4 sessions per week. Additionally, dosage in these studies increased to 30-45 min during later sessions, resulting in 177-196 total minutes of retraining. In contrast, pain reductions and persistence of changes were the least in studies where overall retraining volume was low and feedback was either absent or continual. Faulty movement patterns have been associated with patellofemoral pain. Studies have shown that strengthening alone does not alter these patterns, and that addressing the motor program is needed to effect these changes. Based upon the studies reviewed here, retraining faulty patterns, when present, appears to play a significant role in addressing patellofemoral pain. Therefore, movement retraining, while adhering to basic motor control principles, should be part of a therapist's intervention skillset when treating patients with PFP.
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Affiliation(s)
- Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
- Spaulding National Running Center, 1575 Cambridge St, Cambridge, MA, 02138, USA.
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding National Running Center, 1575 Cambridge St, Cambridge, MA, 02138, USA
| | - Bradley S Neal
- Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - Jenevieve L Roper
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - Richard W Willy
- School of Physical Therapy & Health Sciences, University of Montana, Missoula, MT, USA
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Wolthon A, Nielsen RO, Willy RW, Taylor-Haas JA, Paquette MR. Running shoes, pronation, and injuries: do beliefs of injury risk factors among running shoe salespersons and physiotherapy students align with current aetiology frameworks? Footwear Science 2020. [DOI: 10.1080/19424280.2020.1734869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Alexander Wolthon
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden
- Department of Sport and Health Sciences, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
| | - Rasmus Oestergaard Nielsen
- Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Richard W. Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA
| | - Jeffery A. Taylor-Haas
- Division of Occupational Therapy & Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Max R. Paquette
- School of Health Studies, University of Memphis, Memphis, Tennessee, USA
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Abstract
Wearable devices are ubiquitous among runners, coaches, and clinicians with an ever-increasing number of devices coming on the market. In place of gold standard measures in the laboratory, these devices attempt to provide a surrogate means to track running biomechanics outdoors. This review provides an update on recent literature in the field of wearable devices in runners, with an emphasis on criterion validity and usefulness in the coaching and rehabilitation of runners. Our review suggests that while enthusiasm should be tempered, there is still much for runners to gain with wearables. Overall, our review finds evidence supporting the use of wearables to improve running performance, track global training loads applied to the runner, and provide real-time feedback on running speed and run cadence. Case studies illustrate the use of wearables for the purposes of performance and rehabilitation.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UNITED KINGDOM
| | - Richard W Willy
- School of Physical Therapy & Health Sciences, University of Montana, Missoula, MT
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Alexander JLN, Barton CJ, Willy RW. Infographic running myth: static stretching reduces injury risk in runners. Br J Sports Med 2019; 54:1058-1059. [PMID: 31694812 DOI: 10.1136/bjsports-2019-101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/04/2022]
Affiliation(s)
- James L N Alexander
- Sports and Excercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Christian J Barton
- Sports and Excercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard W Willy
- Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA
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Willy RW, DeVita P, Meardon SA, Baggaley M, Womble CC, Willson JD. Effects of Load Carriage and Step Length Manipulation on Achilles Tendon and Knee Loads. Mil Med 2019; 184:e482-e489. [PMID: 30839070 DOI: 10.1093/milmed/usz031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Longer steps with load carriage is common in shorter Soldiers when matching pace with taller Soldiers whereas shorter steps are hypothesized to reduce risk of injury with load carriage. The effects of load carriage with and without step length manipulation on loading patterns of three commonly injured structures were determined: Achilles tendon, patellofemoral joint (PFJ) and medial tibiofemoral joint (mTFJ). MATERIALS AND METHODS ROTC Cadets (n = 16; 20.1 years ± 2.5) walked with and without load carriage (20-kg). Cadets then altered preferred step lengths ±7.5% with load carriage. Achilles tendon, PFJ and mTFJ loads were estimated via musculoskeletal modeling. RESULTS Large increases in peak Achilles tendon load (p < 0.001, d = 1.93), Achilles tendon impulse per 1-km (p < 0.001, d = 0.91), peak mTFJ load (p < 0.001, d = 1.33), and mTFJ impulse per 1-km (p < 0.001, d = 1.49) were noted with load carriage while moderate increases were observed for the PFJ (peak: p < 0.001, d = 0.69; impulse per 1-km: p < 0.001, d = 0.69). Shortened steps with load carriage only reduced peak Achilles tendon load (p < 0.001, d = -0.44) but did not reduce Achilles impulse per km due to the resulting extra steps and also did not reduce peak or cumulative PFJ and mTFJ loads (p > 0.05). Longer steps with load carriage increased PFJ loads the most (p < 0.001, d = 0.68-0.75) with moderate increases in mTFJ forces (p < 0.001, d = 0.48-0.63) with no changes in Achilles tendon loads (p = 0.11-0.20). CONCLUSION A preferred step length is the safest strategy when walking with load carriage. Taking a shorter step is not an effective strategy to reduce loading on the Achilles tendon, PFJ, and mTFJ.
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Affiliation(s)
- Richard W Willy
- Division of Physical Therapy & Health Sciences, University of Montana, Missoula, MT
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, NC
| | - Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, NC
| | | | | | - John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC
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Alexander JLN, Barton CJ, Willy RW. Infographic. Running myth: strength training should be high repetition low load to improve running performance. Br J Sports Med 2019; 54:813-814. [PMID: 31554613 DOI: 10.1136/bjsports-2019-101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 11/03/2022]
Affiliation(s)
- James L N Alexander
- Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Christian J Barton
- Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard W Willy
- Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA
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Sancho I, Malliaras P, Barton C, Willy RW, Morrissey D. Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis. Gait Posture 2019; 73:189-201. [PMID: 31351358 DOI: 10.1016/j.gaitpost.2019.07.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/19/2019] [Accepted: 07/01/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Biomechanical alterations during running and hopping in people with Achilles tendinopathy (AT) may provide treatment and prevention targets. This review identifies and synthesises research evaluating biomechanical alterations among people with AT during running, jumping and hopping. METHOD MEDLINE, EMBASE, CiNAHL and SPORTDiscus were searched in July 2018 for case control, cross-sectional and prospective studies investigating kinematics, kinetics, plantar pressures and neuromuscular activity in AT participants during running or hopping. Study quality was assessed with a modified version of the Downs and Black quality checklist, and evidence grading applied. RESULTS 16 studies reported 249 outcomes, of which 17% differed between groups. Reduced peroneus longus (standardized mean difference [95%CI]; -0.53 [-0.98, -0.09]) and medial gastrocnemius (-0.60 [-1.05, -0.15]) amplitude in AT runners versus control was found (limited evidence). Increased hip adduction impulse 1.62 [0.69, 2.54], hip peak external rotation moment (1.55 [0.63, 2.46] and hip external rotation impulse (1.45 [0.55, 2.35]) was found in AT runners versus control (limited evidence). Reduced anterior (-0.94 [-1.64, -0.24] and greater lateral (-0.92 [-1.61, -0.22]) displacement of plantar pressure preceded AT in runners (limited evidence). Delayed onsets of gluteus medius (1.95 [1.07, 2.83] and gluteus maximus (1.26 [0.48, 2.05] and shorter duration of gluteus maximus activation (-1.41 [-2.22, -0.61] was found during shod running in the AT group versus control (limited evidence). Earlier offset time of gluteus maximus (-1.03 [-1.79, -0.27] and shorter duration of activation of gluteus medius (-0.18 [-0.24, -0.12] during running in AT runners versus control was found (limited evidence). Reduced leg stiffness was found in the affected side during submaximal hopping (-0.39 [-0.79, -0.00]) (limited evidence). CONCLUSION This review identified potential biomechanical treatment targets in people with AT. The efficacy of treatments targeting these biomechanics should be assessed. SYSTEMATIC REVIEW REGISTRY PROSPERO registration number: CRD42016048636.
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Affiliation(s)
- Igor Sancho
- Sports and Exercise Medicine. Queen Mary University of London, United Kingdom.
| | | | - Christian Barton
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia.
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, Montana, United States.
| | - Dylan Morrissey
- Sports and Exercise Medicine. Queen Mary University of London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom.
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Whittier T, Willy RW, Sandri Heidner G, Niland S, Melton C, Mizelle JC, Murray NP. The Cognitive Demands of Gait Retraining in Runners: An EEG Study. J Mot Behav 2019; 52:360-371. [PMID: 31328698 DOI: 10.1080/00222895.2019.1635983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
High impact forces during running have been associated with tibial stress injuries. Previous research has demonstrated increasing step rate will decrease impact forces during running. However, no research has determined the cognitive demand of gait retraining. The primary purpose was to determine the cognitive demand and effectiveness of field-based gait retraining. We hypothesized that in-field gait retraining would alter running mechanics without increasing cognitive workload as measured by EEG following learning. Runners with a history of tibial injury completed a gait retraining protocol which included a baseline run, retraining phase, practice phase, and re-assessment following retraining protocol. Results demonstrated an increase in the theta, beta, and gamma power within prefrontal cortex during new learning and corresponding return to baseline following skill acquisition and changes across alpha, beta, gamma, mu, and theta in the motor cortex (p < .05). In the midline superior parietal cortex, spectral power was greater for theta activity during new learning with a corresponding alpha suppression. Overall, the results demonstrated the use of EEG as an effective tool to measure cognitive demand for implicit motor learning and the effectiveness of in-field gait retraining.
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Affiliation(s)
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | | | - Samantha Niland
- 3Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - Caitlin Melton
- 3Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - J C Mizelle
- 3Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - Nicholas P Murray
- 3Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
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Pairot-de-Fontenay B, Willy RW, Elias ARC, Mizner RL, Dubé MO, Roy JS. Running Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Med 2019; 49:1411-1424. [DOI: 10.1007/s40279-019-01120-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Affiliation(s)
- Christopher Napier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,The UBC Run Clinic, Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Richard W Willy
- Division of Physical Therapy and Health Sciences, University of Montana, Missoula, Montana, USA
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Adams D, Pozzi F, Willy RW, Carrol A, Zeni J. ALTERING CADENCE OR VERTICAL OSCILLATION DURING RUNNING: EFFECTS ON RUNNING RELATED INJURY FACTORS. Int J Sports Phys Ther 2018; 13:633-642. [PMID: 30140556 PMCID: PMC6088121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Wearable devices validly assess spatiotemporal running parameters (cadence, vertical oscillation and ground contact time), but the relationship between these parameters and lower limb loading parameters (loading rate, peak vertical ground reaction force [vGRF] and braking impulse) is unknown. PURPOSE To characterize changes in lower limb loading parameters in runners instructed to run with increased cadence or low vertical oscillation, and to determine whether the change in spatiotemporal parameters predicted the changes in lower limb loading parameters. STUDY DESIGN Cross Sectional Cohort Study. METHODS Twenty healthy runners completed three running trials in three conditions: baseline, high cadence, and low vertical oscillation. Spatiotemporal parameters were measured with a wearable device and lower limb loading was measured using an instrumented treadmill. Spatiotemporal and loading parameters were analyzed between running conditions via a repeated measure ANOVA. A hierarchical regression model was used to determine if changes in spatiotemporal parameters predicted the change of loading parameters during conditions. RESULTS High cadence and low oscillation conditions reduced average vertical loading rate (p = 0.013 and p = 0.002, respectively), instantaneous vertical loading rate (p = 0.022 and p = 0.001, respectively), and peak vGRF (p = 0.025 and p < 0.001, respectively). Braking impulse was significantly lower in the high cadence condition compared to baseline (p < 0.001), but not during the low oscillation (p = 1.000). The increase in cadence during the high cadence condition predicted the reduction of instantaneous vertical loading rate (r2 = 0.213, p = 0.041) and braking impulse (r2 = 0.279, p = 0.017). The reduction in vertical oscillation was more predictive of the change of peak vGRF in both running conditions (high cadence, r2 = 0.436, p = 0.009; low oscillation r2 = 0.748, p < 0.001). CONCLUSION While both higher cadence and lower vertical oscillation resulted in reduced loading rates during running, cueing to reduce vertical oscillation was more successful in reducing peak vGRF and only the higher cadence condition reduced braking impulse. These findings will inform clinicians who wish to use wearable devices for running gait modification to select injury-specific gait retraining cues. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | | | | | - Joseph Zeni
- Rutgers University, School of Health Professions, Department of Rehabilitation and Movement Sciences, Physical Therapy Program – North, Newark, NJ, USA
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Willy RW, DeVita P, Meardon SA, Willson JD. Effects Of Load Carriage and Step Length Manipulation on Knee Loads During Walking. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536369.36306.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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Esculier JF, Willy RW, Baggaley MW, Meardon SA, Willson JD. Sex-specific kinetic and kinematic indicators of medial tibiofemoral force during walking and running. Knee 2017; 24:1317-1325. [PMID: 28978462 DOI: 10.1016/j.knee.2017.08.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/01/2017] [Accepted: 08/15/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aims were to (1) Evaluate sex-specific contributions of peak knee flexion moment (pKFM) and peak knee adduction moment (pKAM) in medial tibiofemoral joint (TFJ) force during walking and running; (2) identify kinematic variables to estimate peak medial TFJ force. METHODS Eighty-seven runners participated (36 females, 51 males; age=23.0±3.8years (1 standard deviation)). Kinematics and kinetics data were collected during treadmill walking (1.3m/s) and running (3.0±0.4m/s). Peak medial TFJ contact force was estimated using a musculoskeletal model. Linear regression analyses were used to assess the contribution of pKFM, pKAM and kinematic indicators to estimated joint forces. RESULTS During walking and running, pKAM and pKFM accounted for 74.9% and 64.5% of peak medial TFJ force variance (P<0.001), respectively. Similar pKAM contribution was found between males and females during walking (51.8% vs. 47.9%), as opposed to running (50.4% vs. 26.8%). Kinematic indicators during walking were peak knee flexion and adduction angles, regardless of sex. During running, indicators were ankle dorsiflexion at foot strike and center of mass (COM) vertical displacement in females (R2=0.364, P=0.012), and peak knee abduction angle and step length in males (R2=0.508, P=0.019). CONCLUSION We conclude from these results that pKAM and pKFM make significant but potentially sex-specific contributions to peak medial TFJ force during walking and running. Clinically, peak medial TFJ force during walking can be estimated using peak knee flexion and adduction angles in both sexes. During running, ankle dorsiflexion at foot strike and COM oscillation are best indicators among females, while knee abduction and step length are best among males.
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Affiliation(s)
- Jean-Francois Esculier
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada; Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Richard W Willy
- School of Physical Therapy & Rehabilitation Science, 32 Campus Drive, Skaggs Building 108, University of Montana, Missoula, MT 59812, United States.
| | - Michael W Baggaley
- Department of Physical Therapy, East Carolina University, 2410 Health Sciences Building, Greenville, NC 27834, United States.
| | - Stacey A Meardon
- Department of Physical Therapy, East Carolina University, 2410 Health Sciences Building, Greenville, NC 27834, United States.
| | - John D Willson
- Department of Physical Therapy, East Carolina University, 2410 Health Sciences Building, Greenville, NC 27834, United States.
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Brorsson A, Willy RW, Tranberg R, Grävare Silbernagel K. Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury. Am J Sports Med 2017; 45:3060-3068. [PMID: 28783473 DOI: 10.1177/0363546517717698] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is unknown whether the height of a heel-rise performed in the single-leg standing heel-rise test 1 year after an Achilles tendon rupture (ATR) correlates with ankle biomechanics during walking, jogging, and jumping in the long-term. PURPOSE To explore the differences in ankle biomechanics, tendon length, calf muscle recovery, and patient-reported outcomes at a mean of 6 years after ATR between 2 groups that, at 1-year follow-up, had less than 15% versus greater than 30% differences in heel-rise height. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Seventeen patients with less than 15% (<15% group) and 17 patients with greater than 30% (>30% group) side-to-side difference in heel-rise height at 1 year after ATR were evaluated at a mean (SD) 6.1 (2.0) years after their ATR. Ankle kinematics and kinetics were sampled via standard motion capture procedures during walking, jogging, and jumping. Patient-reported outcome was evaluated with Achilles tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and Foot and Ankle Outcome Score (FAOS). Tendon length was evaluated by ultrasonography. The Limb Symmetry Index (LSI = [Injured Side ÷ Healthy Side] × 100) was calculated for side differences. RESULTS The >30% group had significantly more deficits in ankle kinetics during all activities compared with patients in the <15% group at a mean of 6 years after ATR (LSI, 70%-149% and 84%-106%, respectively; P = .010-.024). The >30% group, compared with the <15% group, also had significantly lower values in heel-rise height (LSI, 72% and 95%, respectively; P < .001) and heel-rise work (LSI, 58% and 91%, respectively; P < .001) and significantly larger side-to-side difference in tendon length (114% and 106%, respectively; P = .012). Achilles tendon length correlated with ankle kinematic variables ( r = 0.38-0.44; P = .015-.027) whereas heel-rise work correlated with kinetic variables ( r = -0.57 to 0.56; P = .001-.047). LSI tendon length correlated negatively with LSI heel-rise height ( r = -0.41; P = .018). No differences were found between groups in patient-reported outcome ( P = .143-.852). CONCLUSION Height obtained during the single-leg standing heel-rise test performed 1 year after ATR related to the long-term ability to regain normal ankle biomechanics. Minimizing tendon elongation and regaining heel-rise height may be important for the long-term recovery of ankle biomechanics, particularly during more demanding activities such as jumping.
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Affiliation(s)
- Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Richard W Willy
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Roy Tranberg
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Grävare Silbernagel
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Willy RW, Brorsson A, Powell HC, Willson JD, Tranberg R, Grävare Silbernagel K. Elevated Knee Joint Kinetics and Reduced Ankle Kinetics Are Present During Jogging and Hopping After Achilles Tendon Ruptures. Am J Sports Med 2017; 45:1124-1133. [PMID: 28186834 DOI: 10.1177/0363546516685055] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Deficits in plantarflexor function are common after an Achilles tendon rupture. These deficits may result in an altered distribution of joint loads during lower extremity tasks. HYPOTHESIS We hypothesized that, regardless of treatment, the Achilles tendon-ruptured limb would exhibit deficits in ankle kinematics and joint power while exhibiting elevated knee joint power and patellofemoral joint loads during walking, jogging, and hopping. We further hypothesized that this loading pattern would be most evident during jogging and hopping. STUDY DESIGN Controlled laboratory study. METHODS Thirty-four participants (17 participants treated surgically, 17 treated nonsurgically) were tested at a mean 6.1 ± 2.0 years after an Achilles tendon rupture. Lower extremity kinematics and kinetics were assessed while participants completed walking, jogging, and single-legged hopping trials. Patellofemoral joint stress was calculated via a musculoskeletal model. Data were analyzed via mixed-model repeated analyses of variance (α = .05) and the limb symmetry index (LSI). RESULTS No differences ( P ≥ .05) were found between the surgical and nonsurgical groups. In both groups, large side-to-side deficits in the plantarflexion angle at toeoff (LSI: 53.5%-73.9%) were noted during walking, jogging, and hopping in the involved limb. Side-to-side deficits in the angular velocity were only present during jogging (LSI: 93.5%) and hopping (LSI: 92.5%). This pattern was accompanied by large deficits in eccentric (LSI: 80.8%-94.7%) and concentric (LSI: 82.2%-84.7%) ankle joint powers in the involved limb during all tasks. Interestingly, only jogging and hopping demonstrated greater knee joint loads when compared with the uninvolved limb. Concentric knee power was greater during jogging (LSI: 117.2%) and hopping (LSI: 115.9%) compared with the uninvolved limb. Similarly, peak patellofemoral joint stress was greater in the involved limb during jogging (LSI: 107.5%) and hopping (LSI: 107.1%), while only hopping had a greater loading rate of patellofemoral joint stress (LSI: 110.9%). CONCLUSION Considerable side-to-side deficits in plantarflexor function were observed during walking, jogging, and hopping in patients after an Achilles tendon rupture. As a possible compensation, increased knee joint loads were present but only during jogging and hopping. CLINICAL RELEVANCE These data suggest that after an Achilles tendon rupture, patients may be susceptible to greater mechanical loading of the knee during sporting tasks, regardless of surgical or nonsurgical treatment.
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Affiliation(s)
- Richard W Willy
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hayley C Powell
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - John D Willson
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Roy Tranberg
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Grävare Silbernagel
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Willy RW, Bigelow MA, Kolesar A, Willson JD, Thomas JS. Knee contact forces and lower extremity support moments during running in young individuals post-partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:115-122. [PMID: 27139229 DOI: 10.1007/s00167-016-4143-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/20/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE While partial meniscectomy results in a compromised tibiofemoral joint, little is known regarding tibiofemoral joint loading during running in individuals who are post-partial meniscectomy. It was hypothesized that individuals post-partial meniscectomy would run with a greater hip support moment, yielding reduced peak knee extension moments and reduced tibiofemoral joint contact forces. METHODS 3-D Treadmill running mechanics were evaluated in 23 athletic individuals post-partial meniscectomy (37.5 ± 19.0 months post-partial meniscectomy) and 23 matched controls. Bilateral hip, knee and ankle contributions to the total support moment and the peak knee extension moment were calculated. A musculoskeletal model estimated peak and impulse tibiofemoral joint contact forces. Knee function was quantified with the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS During running, the partial meniscectomy group had a greater hip support moment (p = 0.002) and a reduced knee support moment (p < 0.001) relative to the total support moment. This movement pattern was associated with a 14.5 % reduction (p = 0.019) in the peak knee extension moment. Despite these differences, there were no significant group differences in peak or impulse tibiofemoral joint contact forces. Lower KOOS Quality of Life scores were associated with greater hip support moment (p = 0.004, r = -0.58), reduced knee support moment (p = 0.006, r = 0.55) and reduced peak knee extension moment (p = 0.01, r = 0.52). CONCLUSIONS Disordered running mechanics are present long term post-partial meniscectomy. A coordination strategy that shifts a proportion of the total support moment away from the knee to the hip reduces the peak knee extension moment, but does not equate to reduced tibiofemoral joint contact forces during running in individuals post-partial meniscectomy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- R W Willy
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Mail Stop: 668 Allied Health, Greenville, NC, 27834, USA.
| | - M A Bigelow
- Division of Physical Therapy, College of Health Sciences, Ohio University, Athens, OH, 45701, USA
| | - A Kolesar
- Division of Physical Therapy, College of Health Sciences, Ohio University, Athens, OH, 45701, USA
| | - J D Willson
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Mail Stop: 668 Allied Health, Greenville, NC, 27834, USA
| | - J S Thomas
- Division of Physical Therapy, College of Health Sciences, Ohio University, Athens, OH, 45701, USA
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Willy RW, Meira EP. CURRENT CONCEPTS IN BIOMECHANICAL INTERVENTIONS FOR PATELLOFEMORAL PAIN. Int J Sports Phys Ther 2016; 11:877-890. [PMID: 27904791 PMCID: PMC5095941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
UNLABELLED Patellofemoral pain (PFP) has historically been a complex and enigmatic issue. Many of the factors thought to relate to PFP remain after patients' symptoms have resolved making their clinical importance difficult to determine. The tissue homeostasis model proposed by Dye in 2005 can assist with understanding and implementing biomechanical interventions for PFP. Under this model, the goal of interventions for PFP should be to re-establish patellofemoral joint (PFJ) homeostasis through a temporary alteration of load to the offended tissue, followed by incrementally restoring the envelope of function to the baseline level or higher. High levels of PFJ loads, particularly in the presence of an altered PFJ environment, are thought to be a factor in the development of PFP. Clinical interventions often aim to alter the biomechanical patterns that are thought to result in elevated PFJ loads while concurrently increasing the load tolerance capabilities of the tissue through therapeutic exercise. Biomechanics may play a role in PFJ load modification not only when addressing proximal and distal components, but also when considering the involvement of more local factors such as the quadriceps musculature. Biomechanical considerations should consider the entire kinetic chain including the hip and the foot/ankle complex, however the beneficial effects of these interventions may not be the result of long-term biomechanical changes. Biomechanical alterations may be achieved through movement retraining, but the interventions likely need to be task-specific to alter movement patterns. The purpose of this commentary is to describe biomechanical interventions for the athlete with PFP to encourage a safe and complete return to sport. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Richard W Willy
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
| | - Erik P Meira
- Black Diamond Physical Therapy, Portland, OR, USA
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Willy RW, Willson JD, Clowers K, Baggaley M, Murray N. The effects of body-borne loads and cadence manipulation on patellofemoral and tibiofemoral joint kinetics during running. J Biomech 2016; 49:4028-4033. [DOI: 10.1016/j.jbiomech.2016.10.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022]
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Bowersock CD, Willy RW, DeVita P, Willson JD. Independent effects of step length and foot strike pattern on tibiofemoral joint forces during running. J Sports Sci 2016; 35:2005-2013. [PMID: 27800702 DOI: 10.1080/02640414.2016.1249904] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to examine the effects of step length and foot strike pattern along with their interaction on tibiofemoral joint (TFJ) and medial compartment TFJ kinetics during running. Nineteen participants ran with a rear foot strike pattern at their preferred speed using a short (-10%), preferred, and long (+10%) step length. These step length conditions were then repeated using a forefoot strike pattern. Regardless of foot strike pattern, a 10% shorter step length resulted in decreased peak contact force, force impulse per step, force impulse per kilometre, and average loading rate at the TFJ and medial compartment, while a 10% increased step length had the opposite effects (all P < 0.05). A forefoot strike pattern significantly lowered TFJ and medial compartment TFJ average loading rates compared with a rear foot strike pattern (both <0.05) but did not change TFJ or medial compartment peak force, force impulse per step, or force impulse per km. The combination of a shorter step length and forefoot strike pattern produced the greatest reduction in peak medial compartment contact force (P < 0.05). Knowledge of these running modification effects may be relevant to the management or prevention of TFJ injury or pathology among runners.
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Affiliation(s)
- Collin D Bowersock
- a Department of Kinesiology , East Carolina University , Greenville , NC , USA
| | - Richard W Willy
- b Department of Physical Therapy , East Carolina University , Greenville , NC , USA
| | - Paul DeVita
- a Department of Kinesiology , East Carolina University , Greenville , NC , USA
| | - John D Willson
- b Department of Physical Therapy , East Carolina University , Greenville , NC , USA
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Blackmore T, Willy RW, Creaby MW. The high frequency component of the vertical ground reaction force is a valid surrogate measure of the impact peak. J Biomech 2016; 49:479-83. [DOI: 10.1016/j.jbiomech.2015.12.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 10/22/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
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Willy RW, Meardon SA, Schmidt A, Blaylock NR, Hadding SA, Willson JD. Changes in tibiofemoral contact forces during running in response to in-field gait retraining. J Sports Sci 2015; 34:1602-11. [DOI: 10.1080/02640414.2015.1125517] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Willson JD, Loss JR, Willy RW, Meardon SA. Sex differences in running mechanics and patellofemoral joint kinetics following an exhaustive run. J Biomech 2015; 48:4155-4159. [PMID: 26525514 DOI: 10.1016/j.jbiomech.2015.10.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/12/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
Patellofemoral joint pain (PFP) is a common running-related injury that is more prevalent in females and thought to be associated with altered running mechanics. Changes in running mechanics have been observed following an exhaustive run but have not been analyzed relative to the sex bias for PFP. The purpose of this study was to test if females demonstrate unique changes in running mechanics associated with PFP following an exhaustive run. For this study, 18 females and 17 males ran to volitional exhaustion. Peak PFJ contact force and stress, PFJ contact force and stress loading rates, hip adduction excursion, and hip and knee joint frontal plane angular impulse were analyzed between females and males using separate 2 factor ANOVAs (2 (male/female)×2 (before/after exhaustion)). We observed similar changes in running mechanics among males and females over the course of the exhaustive run. Specifically, greater peak PFJ contact force loading rate (5%, P=.01), PFJ stress loading rate (5%, P<.01), hip adduction excursion (1.3°, P<.01), hip abduction angular impulse (4%, P<.01), knee abduction angular impulse (5%, P=.03), average vertical ground reaction force loading rate (10%, P<.01) and step length (2.1cm, P=.001) were observed during exhausted running. These small changes in suspected PFP pathomechanical factors may increase a runner׳s propensity for PFP. However, unique changes in female running mechanics due to exhaustion do not appear to contribute to the sex bias for PFP.
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Affiliation(s)
- John D Willson
- East Carolina University, Department of Physical Therapy, 600 Moye Boulevard, Greenville, NC 27834, United States.
| | - Justin R Loss
- East Carolina University, Department of Physical Therapy, 600 Moye Boulevard, Greenville, NC 27834, United States; Proaxis Physical Therapy, 304 W Weaver Street, Suite 103, Carrboro, NC 27510, United States
| | - Richard W Willy
- East Carolina University, Department of Physical Therapy, 600 Moye Boulevard, Greenville, NC 27834, United States
| | - Stacey A Meardon
- East Carolina University, Department of Physical Therapy, 600 Moye Boulevard, Greenville, NC 27834, United States
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Willy RW, Buchenic L, Rogacki K, Ackerman J, Schmidt A, Willson JD. In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture. Scand J Med Sci Sports 2015; 26:197-205. [PMID: 25652871 DOI: 10.1111/sms.12413] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/26/2022]
Abstract
We sought to determine if an in-field gait retraining program can reduce excessive impact forces and peak hip adduction without adverse changes in knee joint work during running. Thirty healthy at-risk runners who exhibited high-impact forces were randomized to retraining [21.1 (± 1.9) years, 22.1 (± 10.8) km/week] or control groups [21.0 (± 1.3) years, 23.2 (± 8.7) km/week]. Retrainers were cued, via a wireless accelerometer, to increase preferred step rate by 7.5% during eight training sessions performed in-field. Adherence with the prescribed step rate was assessed via mobile monitoring. Three-dimensional gait analysis was performed at baseline, after retraining, and at 1-month post-retraining. Retrainers increased step rate by 8.6% (P < 0.0001), reducing instantaneous vertical load rate (-17.9%, P = 0.003), average vertical load rate (-18.9%, P < 0.0001), peak hip adduction (2.9° ± 4.2 reduction, P = 0.005), eccentric knee joint work per stance phase (-26.9%, P < 0.0001), and per kilometer of running (-21.1%, P < 0.0001). Alterations in gait were maintained at 30 days. In the absence of any feedback, controls maintained their baseline gait parameters. The majority of retrainers were adherent with the prescribed step rate during in-field runs. Thus, in-field gait retraining, cueing a modest increase in step rate, was effective at reducing impact forces, peak hip adduction and eccentric knee joint work.
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Affiliation(s)
- R W Willy
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - L Buchenic
- Division of Physical Therapy, Ohio University, Athens, Ohio, USA
| | - K Rogacki
- Division of Physical Therapy, Ohio University, Athens, Ohio, USA
| | - J Ackerman
- Division of Physical Therapy, Ohio University, Athens, Ohio, USA
| | - A Schmidt
- Friedrichsheim gGmbH, Orthopädisches Universitätsklinikum, Frankfurt, Germany
| | - J D Willson
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
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