Effects of Forefoot Shoe on Knee and Ankle Loading during Running in Male Recreational Runners

Objectives: Although overuse running injury risks for the ankle and knee are high, the effect of different shoe designs on Achilles tendon force (ATF) and Patellofemoral joint contact force (PTF) loading rates are unclear. Therefore, the primary objective of this study was to compare the ATF at the ankle and the PTF and Patellofemoral joint stress force (PP) at the knee using different running shoe designs (forefoot shoes vs. normal shoes). Methods: Fourteen healthy recreational male runners were recruited to run over a force plate under two shoe conditions (forefoot shoes vs. normal shoes). Sagittal plane ankle and knee kinematics and ground reaction forces were simultaneously recorded. Ankle joint mechanics (ankle joint angle, velocity, moment and power) and the ATF were calculated. Knee joint mechanics (knee joint angle velocity, moment and power) and the PTF and PP were also calculated. Results: No significant differences were observed in the PTF, ankle plantarflexion angle, ankle dorsiflexion power, peak vertical active force, contact time and PTF between the two shoe conditions. Compared to wearing normal shoes, wearing the forefoot shoes demonstrated that the ankle dorsiflexion angle, knee flexion velocity, ankle dorsiflexion moment extension, knee extension moment, knee extension power, knee flexion power and the peak patellofemoral contact stress were significantly reduced. However, the ankle dorsiflexion velocity, ankle plantarflexion velocity, ankle plantarflexion moment and Achilles tendons force increased significantly. Conclusions: These findings suggest that wearing forefoot shoes significantly decreases the patellofemoral joint stress by reducing the moment of knee extension, however the shoes increased the ankle plantarflexion moment and ATF force. The forefoot shoes effectively reduced the load on the patellofemoral joint during the stance phase of running. However, it is not recommended for new and novice runners and patients with Achilles tendon injuries to wear forefoot shoes.     

Rapid torque development in older female fallers and nonfallers: A comparison across lower-extremity muscles

The objective of this study was to compare reaction time, joint torque, rate of torque development, and magnitude of neuromuscular activation of lower-extremity muscles in elderly female fallers and nonfallers. Participants included 11, elderly, female fallers (71.3 ± 5.4 years) and twelve nonfallers (71.3 ± 6.2 years) who completed a fall risk questionnaire. Then, maximal, voluntary, isometric contractions of the knee and ankle muscles were performed in reaction to a visual cue to determine joint torque, rate of torque development, reaction time, and nervous activation of agonists and antagonists. Results indicated that significantly more fallers reported “dizziness upon rising”, “use of balance altering medications”, “stress or depression”, “not enough sleep”, “arthritis in lower body”, “chronic pain in lower body”, and “tiring easily while walking” (all P < 0.05). Normalized dorsiflexion and plantarflexion strength scores (summation of peak torque, rate of torque development and impulse) were lower in fallers than in nonfallers (P < 0.05). When summed across lower-extremity muscle groups, fallers demonstrated 19% lower peak torque and 29% longer motor time (P < 0.05). In conclusion, comprehensive fall risk screening and prevention programs should address both neuromuscular and non-muscular factors, and, weakness of the ankle dorsiflexors and plantarflexors should be further studied as potential contributors to falls in older adults.     

A noninvasive technique for in vivo measurement of joint torques of biarticular muscles.

The objective of this work was to develop a noninvasive method to measure the joint torques produced by biarticular muscles at two joints simultaneously. During intramuscular stimulation of the cat medial gastrocnemius (MG) muscle, torques at the ankle and knee joints were calculated from forces measured in two dimensions at the end point of the cat paw under isometric conditions. The method was verified by the known anatomical properties of cat MG muscle and the tibialis anterior (TA) muscle. The MG muscle was shown to produce a significant flexion torque at the knee, besides an extension torque at the ankle. This was in agreement with its anatomical arrangement. The TA muscle produced primarily an ankle flexion torque. The small knee torque, due to measurement errors, yielded an estimate of measurement accuracy of 3.0 +/- 2.1% (n = 52). The coupling ratio of the MG muscle, defined as T(ankle)/T(knee), varied significantly with both knee and ankle angles. The profile of MG mechanical coupling agreed qualitatively with changes in limb configuration. The method can be used to measure recruitment properties of electrically stimulated biarticular muscles, and may potentially be used to study the biomechanics of biarticular coupling.     

Maximum voluntary joint torque as a function of joint angle and angular velocity: model development and application to the lower limb

Measurements of human strength can be important during analyses of physical activities. Such measurements have often taken the form of the maximum voluntary torque at a single joint angle and angular velocity. However, the available strength varies substantially with joint position and velocity. When examining dynamic activities, strength measurements should account for these variations. A model is presented of maximum voluntary joint torque as a function of joint angle and angular velocity. The model is based on well-known physiological relationships between muscle force and length and between muscle force and velocity and was tested by fitting it to maximum voluntary joint torque data from six different exertions in the lower limb. Isometric, concentric and eccentric maximum voluntary contractions were collected during hip extension, hip flexion, knee extension, knee flexion, ankle plantar flexion and dorsiflexion. Model parameters are reported for each of these exertion directions by gender and age group. This model provides an efficient method by which strength variations with joint angle and angular velocity may be incorporated into comparisons between joint torques calculated by inverse dynamics and the maximum available joint torques.     

Length-tension properties of ankle muscles in chronic human spinal cord injury

Contracture, or loss of range of motion (ROM) of a joint, is a common clinical problem in individuals with spinal cord injury (SCI). In order to measure the possible contribution of changes in muscle length to the loss of ankle ROM, the active force vs. angle curves for the tibialis anterior (TA) and gastrocnemiussoleus (GS) were measured in 20 participants, 10 with SCI, and 10 gender and age matched, neurologically intact (NI) individuals. Electrical stimuli were applied to the TA and GS motor nerves at incremented angles of the entire ROM of the ankle and the resulting ankle and knee torques were measured using a multi-axis load cell. The muscle forces of the TA and GS were calculated from the torque measurements using estimates of their respective moment arms and the resulting forces were plotted against joint angle. The force–angle relation for the GS at the ankle (GSA) was significantly shifted into plantar flexion in SCI subjects, compared to NI controls (t-test, p<0.001). Similar results were obtained based upon the GS knee (GSK) force–angle measurements (p<0.05). Conversely, no significant shift in the force–angle relation was found for the TA (p=0.138). Differences in the passive ROM were consistent with the force–angle changes. The ROM in the dorsiflexion direction was significantly smaller in SCI subjects compared to NI controls (p<0.05) while the plantar flexion ROM was not significantly different (p=0.114). Based upon these results, we concluded that muscle shortening is an important component of contracture in SCI.     

Lower extremity extension force and electromyography properties as a function of knee angle and their relation to joint torques: implications for strength diagnostics

The purpose of this study was to evaluate whether and how isometric multijoint leg extension strength can be used to assess athletes' muscular capability within the scope of strength diagnosis. External reaction forces (Fext) and kinematics were measured (n = 18) during maximal isometric contractions in a seated leg press at 8 distinct joint angle configurations ranging from 30 to 100° knee flexion. In addition, muscle activation of rectus femoris, vastus medialis, biceps femoris c.l., gastrocnemius medialis, and tibialis anterior was obtained using surface electromyography (EMG). Joint torques for hip, knee, and ankle joints were computed by inverse dynamics. The results showed that unilateral Fext decreased significantly from 3,369 ± 575 N at 30° knee flexion to 1,015 ± 152 N at 100° knee flexion. Despite maximum voluntary effort, excitation of all muscles as measured by EMG root mean square changed with knee flexion angles. Moreover, correlations showed that above-average Fext at low knee flexion is not necessarily associated with above-average Fext at great knee flexion and vice versa. Similarly, it is not possible to deduce high joint torques from high Fext just as above-average joint torques in 1 joint do not signify above-average torques in another joint. From these findings, it is concluded that an evaluation of muscular capability by means of Fext as measured for multijoint leg extension is strongly limited. As practical recommendation, we suggest analyzing multijoint leg extension strength at 3 distinct knee flexion angles or at discipline-specific joint angles. In addition, a careful evaluation of muscular capacity based on measured Fext can be done for knee flexion angles ≥ 80°. For further and detailed analysis of single muscle groups, the use of inverse dynamic modeling is recommended.     

The effect of the partially restricted sit-to-stand task on biomechanical variables in subjects with and without Parkinson’s disease

The aim of this study was to explore the electromyographic, kinetic and kinematic patterns during a partially restricted sit-to-stand task in subjects with and without Parkinson’s disease (PD). If the trunk is partially restricted, different behavior of torques and muscle activities could be found and it can serve as a reference of the deterioration in the motor performance of subjects with PD. Fifteen subjects participated in this study and electromyography (EMG) activity of the tibialis anterior (TA), soleus (SO), vastus medialis oblique (VMO), biceps femoris (BF) and erector spinae (ES) were recorded and biomechanical variables were calculated during four phases of the movement. Subjects with PD showed more flexion at the ankle, knee and hip joints and increased knee and hip joint torques in comparison to healthy subjects in the final position. However, these joint torques can be explained by the differences in kinematic data. Also, the hip, knee and ankle joint torques were not different in the acceleration phase of movement. The use of a partially restricted sit-to-stand task in PD subjects with moderate involvement leads to the generation of joint torques similar to healthy subjects. This may have important implications for rehabilitation training in PD subjects.     

Gait biomechanics of skipping are substantially different than those of running

The inherit injury risk associated with high-impact exercises calls for alternative ways to achieve the benefits of aerobic exercise while minimizing excessive stresses to body tissues. Skipping presents such an alternative, incorporating double support, flight, and single support phases. We used ground reaction forces (GRFs), lower extremity joint torques and powers to compare skipping and running in 20 healthy adults. The two consecutive skipping steps on each limb differed significantly from each other, and from running. Running had the longest step length, the highest peak vertical GRF, peak knee extensor torque, and peak knee negative and positive power and negative and positive work. Skipping had the greater cadence, peak horizontal GRF, peak hip and ankle extensor torques, peak ankle negative power and work, and peak ankle positive power. The second vs first skipping step had the shorter step length, higher cadence, peak horizontal GRF, peak ankle extensor torque, and peak ankle negative power, negative work, and positive power and positive work. The first skipping step utilized predominately net negative joint work (eccentric muscle action) while the second utilized predominately net positive joint work (concentric muscle action). The skipping data further highlight the persistence of net negative work performed at the knee and net positive work performed at the ankle across locomotion gaits. Evidence of step segregation was seen in distribution of the braking and propelling impulses and net work produced across the hip, knee, and ankle joints.ConclusionsSkipping was substantially different than running and was temporally and spatially asymmetrical with successive foot falls partitioned into a dominant function, either braking or propelling whereas running had a single, repeated step in which both braking and propelling actions were performed equally.     

Obesity is not associated with increased knee joint torque and power during level walking

While it is widely speculated that obesity causes increased loads on the knee leading to joint degeneration, this concept is untested. The purpose of the study was to identify the effects of obesity on lower extremity joint kinetics and energetics during walking. Twenty-one obese adults were tested at self-selected (1.29m/s) and standard speeds (1.50m/s) and 18 lean adults were tested at the standard speed. Motion analysis and force platform data were combined to calculate joint torques and powers during the stance phase of walking. Obese participants were more erect with 12% less knee flexion and 11% more ankle plantarflexion in self-selected compared to standard speeds (both p<0.02). Obese participants were still more erect than lean adults with approximately 6 degrees more extension at all joints (p<0.05, for each joint) at the standard speed. Knee and ankle torques were 17% and 11% higher (p<0.034 and p<0.041) and negative knee work and positive ankle work were 68% and 11% higher (p<0.000 and p<0.048) in obese participants at the standard speed compared to the slower speed. Joint torques and powers were statistically identical at the hip and knee but were 88% and 61% higher (both p<0.000) at the ankle in obese compared to lean participants at the standard speed. Obese participants used altered gait biomechanics and despite their greater weight, they had less knee torque and power at their self-selected walking speed and equal knee torque and power while walking at the same speed as lean individuals. We propose that the ability to reorganize neuromuscular function during gait may enable some obese individuals to maintain skeletal health of the knee joint and this ability may also be a more accurate risk indicator for knee osteoarthritis than body weight.     

Kinematic, kinetic and EMG patterns during downward squatting.

The aim of this study was to investigate the kinematic, kinetic, and electromyographic pattern before, during and after downward squatting when the trunk movement is restricted in the sagittal plane. Eight healthy subjects performed downward squatting at two different positions, semisquatting (40 degrees knee flexion) and half squatting (70 degrees knee flexion). Electromyographic responses of the vastus medialis oblique, vastus medialis longus, rectus femoris, vastus lateralis, biceps femoris, semitendineous, gastrocnemius lateralis, and tibialis anterior were recorded. The kinematics of the major joints were reconstructed using an optoelectronic system. The center of pressure (COP) was obtained using data collected from one force plate, and the ankle and knee joint torques were calculated using inverse dynamics. In the upright position there were small changes in the COP and in the knee and ankle joint torques. The tibialis anterior provoked the disruption of this upright position initiating the squat. During the acceleration phase of the squat the COP moved posteriorly, the knee joint torque remained in flexion and there was no measurable muscle activation. As the body went into the deceleration phase, the knee joint torque increased towards extension with major muscle activities being observed in the four heads of the quadriceps. Understanding these kinematic, kinetic and EMG strategies before, during and after the squat is expected to be beneficial to practitioners for utilizing squatting as a task for improving motor function.     

Muscle activation of patients suffering from asymmetric ankle osteoarthritis during isometric contractions and level walking – A time–frequency analysis

Asymmetric osteoarthritis (OA) is a common type of OA in the ankle joint. OA also influences the muscles surrounding a joint, however, little is known about the muscle activation in asymmetric ankle OA. Therefore, the aim of this study was to characterize the patients’ muscle activation during isometric ankle torque measurements and level walking. Surface electromyography (EMG) was measured of gastrocnemius medialis (GM) and lateralis (GL), soleus (SO), tibialis anterior (TA), and peroneus longus (PL) in 12 healthy subjects and 12 ankle OA patients. To obtain time and frequency components of the EMG power a wavelet transformation was performed. Furthermore, entropy was introduced to characterize the homogeneity of the wavelet patterns.Patients produced lower plantar- and dorsiflexion torques and their TA wavelet spectrum was shifted towards lower frequencies. While walking, the patients’ muscles were active with a lower intensity and over a broader time–frequency region. In contrast to controls and varus OA patients, maximal GM activity of valgus OA patients lagged behind the activity of GL and SO. In both tasks, PL of the valgus patients contained more low frequency power. The results of this study will help to assess whether surgical interventions of ankle OA can reestablish the muscle activation patterns.     

Knee and ankle joint torque-angle relationships of multi-joint leg extension

The force-length-relation (F-l-r) is an important property of skeletal muscle to characterise its function, whereas for in vivo human muscles, torque-angle relationships (T-a-r) represent the maximum muscular capacity as a function of joint angle. However, since in vivo force/torque-length data is only available for rotational single-joint movements the purpose of the present study was to identify torque-angle-relationships for multi-joint leg extension. Therefore, inverse dynamics served for calculation of ankle and knee joint torques of 18 male subjects when performing maximum voluntary isometric contractions in a seated leg press. Measurements in increments of 10° knee angle from 30° to 100° knee flexion resulted in eight discrete angle configurations of hip, knee and ankle joints. For the knee joint we found an ascending-descending T-a-r with a maximum torque of 289.5° ± 43.3 Nm, which closely matches literature data from rotational knee extension. In comparison to literature we observed a shift of optimum knee angle towards knee extension. In contrast, the T-a-r of the ankle joint vastly differed from relationships obtained for isolated plantar flexion. For the ankle T-a-r derived from multi-joint leg extension subjects operated over different sections of the force-length curve, but the ankle T-a-r derived from isolated joint efforts was over the ascending limb for all subjects. Moreover, mean maximum torque of 234.7 ± 56.6 Nm exceeded maximal strength of isolated plantar flexion (185.7 ± 27.8 Nm). From these findings we conclude that muscle function between isolated and more physiological multi-joint tasks differs. This should be considered for ergonomic and sports optimisation as well as for modelling and simulation of human movement.     

Relationship between neuromuscular fatigue and spasticity in chronic stroke patients: A pilot study

IntroductionThe aim of this study was to assess the effects of neuromuscular fatigue on stretch reflex-related torque and electromyographic activity of spastic knee extensor muscles in hemiplegic patients. The second aim was to characterize the time course of quadriceps muscle fatigue during repetitive concentric contractions.MethodsEighteen patients performed passive, isometric and concentric isokinetic evaluations before and after a fatigue protocol using an isokinetic dynamometer. Voluntary strength and spasticity were evaluated following the simultaneous recording of torque and electromyographic activity of rectus femoris (RF), vastus lateralis (VL) and biceps femoris (BF).ResultsIsometric knee extension torque and the root mean square (RMS) value of VL decreased in the fatigued state. During the fatigue protocol, the normalized peak torque decreased whereas the RMS of RF and BF increased between the first five and last five contractions. There was a linear decrease in the neuromuscular efficiency-repetitions relationships for RF and VL. The peak resistive torque and the normalized RMS of RF and VL during passive stretching movements were not modified by the fatigue protocol for any stretch velocity.DiscussionThis study showed that localized quadriceps muscle fatigue caused a decrease in voluntary strength which did not modify spasticity intensity. Changes in the distribution of muscle fiber type, with a greater number of slow fibers on the paretic side, may explain why the stretch reflex was not affected by fatigue.     

Isokinetic Identification of Knee Joint Torques before and after Anterior Cruciate Ligament Reconstruction

The aim of this study was to evaluate the serial change of isokinetic muscle strength of the knees before and after anterior cruciate ligament reconstruction (ACLR) in physically active males and to estimate the time of return to full physical fitness. Extension and flexion torques were measured for the injured and healthy limbs at two angular velocities approximately 1.5 months before the surgery and 3, 6, and 12 months after ACLR. Significant differences (p ≤ 0.05) in peak knee extension and flexion torques, hamstring/quadriceps (H/Q) strength ratios, uninvolved/involved limb peak torque ratios, and the normalized work of these muscles between the four stages of rehabilitation were identified. Significant differences between extension peak torques for the injured and healthy limbs were also detected at all stages. The obtained results showed that 12 months of rehabilitation were insufficient for the involved knee joint to recover its strength to the level of strength of the uninvolved knee joint. The results helped to evaluate the progress of the rehabilitation and to implement necessary modifications optimizing the rehabilitation training program. The results of the study may also be used as referential data for physically active males of similar age.     

Myofascial force transmission in the lower limb: An in vivo experiment

Anatomical studies have shown structural continuity between the lumbopelvic region and the lower limb. The present study aimed to verify how simultaneous changes on knee/hip positions modify the ankle’s resting position and passive torque. Thirty-seven subjects underwent an isokinetic assessment of ankle passive torque. The relationship between the absolute values of ankle passive resistance torque and the ankle angular position was used to calculate the dependent variables: ankle resting position (position in which the passive resistance torque is zero); and ankle passive torque at 0° (torque at the neutral position of the ankle in the sagittal plane). These measures were carried out under three test conditions: 0° at knee and 0° at hip (0°/0°); 90° at knee and 90° at hip (90°/90°); and, 135° at knee and 120° at hip (135°/120°). The results demonstrated that the ankle resting position shifted towards dorsiflexion when knee/hip position changed from 0°/0° to 90°/90° and shifted towards plantar flexion when knee/hip position changed from 90°/90° to 135°/120°, achieving values close to the ones at the position 0°/0°. Similarly, passive torque reduced when knee/hip position changed from 0°/0° to 90°/90°, but it increased when knee/hip position changed from 90°/90° to 135°/120°. The unexpected changes observed in ankle passive torque and resting position due to changes in knee and hip from 90°/90° to 135°/120°, cannot be explained exclusively by forces related to tissues crossing the knee and ankle. This result supports the existence of myofascial force transmission among lower limb joints.     

Empirical evaluation of gastrocnemius and soleus function during walking

Distinguishing gastrocnemius and soleus muscle function is relevant for treating gait disorders in which abnormal plantarflexor activity may contribute to pathological movement patterns. Our objective was to use experimental and computational analysis to determine the influence of gastrocnemius and soleus activity on lower limb movement, and determine if anatomical variability of the gastrocnemius affected its function. Our hypothesis was that these muscles exhibit distinct functions, with the gastrocnemius inducing limb flexion and the soleus inducing limb extension. To test this hypothesis, the gastrocnemius or soleus of 20 healthy participants was electrically stimulated for brief periods (90 ms) during mid- or terminal stance of a random gait cycle. Muscle function was characterized by the induced change in sagittal pelvis, hip, knee, and ankle angles occurring during the 200 ms after stimulation onset. Results were corroborated with computational forward dynamic gait models, by perturbing gastrocnemius or soleus activity during similar portions of the gait cycle. Mid- and terminal stance gastrocnemius stimulation induced posterior pelvic tilt, hip flexion and knee flexion. Mid-stance gastrocnemius stimulation also induced ankle dorsiflexion. In contrast mid-stance soleus stimulation induced anterior pelvic tilt, knee extension and plantarflexion, while late-stance soleus stimulation induced relatively little change in motion. Model predictions of induced hip, knee, and ankle motion were generally in the same direction as those of the experiments, though the gastrocnemius? results were shown to be quite sensitive to its knee-to-ankle moment arm ratio.     

Biomechanics of human quadriceps muscles during electrical stimulation

The quadriceps muscles of neurologically intact and spinal cord injured (SCI) human subjects were stimulated with constant current pulses. Up to three, separately adjustable stimulating electrodes over the motor points for vastus medialis (VM), vastus lateralis (VL) and rectus femoris (RF) muscles were used to maximize torque generation while minimizing discomfort. The torque generated by stimulation increased as the knee was slowly flexed to about 1 rad (50-60 degrees) and decreased beyond that point (a 'negative slope' on a torque-angle curve). Despite this region of negative slope the force generated by small oscillations remained positively correlated to the angle changes. When the knee was slowly extended again from a flexed position, the torque continued to decline and therefore showed a large degree of 'hysteresis'. Of the three heads studied, only stimulation of RF muscle generally produced this behavior. VL and VM had torques that increased monotonically with knee flexion over the range studied. The torques generated with electrical stimulation of normal subjects represented up to about 30% of maximum voluntary contraction. When subjects generated similar torques voluntarily, the negative slope region and substantial hysteresis were not observed. Thus, SCI subjects may be adversely affected by hysteresis during electrically-induced transitions from sitting to standing and vice versa, while normal subjects are not.     

Isometric and isokinetic muscle strength, anthropometry and physical activity in 8 and 13 year old Swedish children

Isometric muscle strength of the hand-grip and of trunk flexion and extension, and isokinetic torque of elbow and knee flexion and knee extension were assessed in a random sample of 8 and 13 year old Swedish children. The results were compared with respect to sex and age in absolute terms and relative to weight, height2 and estimates of lean body mass and cross-sectional muscle area. Daily physical activity was also estimated. The muscle strength variables were in general found to be very similar in the 8 year old boys and girls. In the 13 year old group the boys were generally stronger than the girls, in both absolute and relative terms, except for similar torque values during knee extension. The absolute and relative muscle strength and torque values were higher in the older than in the younger children, with the exception of trunk strength per unit of body weight and of lean body mass, which were similar in boys of both ages and significantly lower in the older than in the younger girls. No significant correlation was found between the estimates of physical activity and isometric and isokinetic muscle strength and torque.     

Paired nonlinear behavior of active and passive joint torques associated with preparation for walk-to-run gait transition

This study investigated the lower extremity torque's active and passive features during the walk-to-run gait transition with continuously increased walking speed. Fourteen volunteers participated in the experiment. Kinematic and kinetic data were collected synchronously. Five strides leading up the gait transition were examined. Peaks of the passive (e.g., contact) and active (e.g., generalized muscle torques), along with net joint torque, and time to peak torques exhibited significant differences at the last stride before gait transition, compared to the first four strides, at the ankle, knee, and hip joints, respectively. Selected peak joint active and passive torques showed significant and opposite trends at critical events within a stride cycle: such ankle joint right after heel-contact, knee joint during weight acceptance, and both hip and knee joints right before toe-off. The magnitude and the corresponding time to active and passive peak torque changed in a nonlinear pattern before the transition from walk to run. The lower extremity segment-interaction during gait transition appeared to be an active reorganization exemplified by the interaction between the lower extremity's active and passive torque components.