Validity and reliability of peak tibial accelerations as real-time measure of impact loading during over-ground rearfoot running at different speeds

Studies seeking to determine the effects of gait retraining through biofeedback on peak tibial acceleration (PTA) assume that this biometric trait is a valid measure of impact loading that is reliable both within and between sessions. However, reliability and validity data were lacking for axial and resultant PTAs along the speed range of over-ground endurance running. A wearable system was developed to continuously measure 3D tibial acceleration and to detect PTAs in real-time. Thirteen rearfoot runners ran at 2.55, 3.20 and 5.10 m·s⁻¹ over an instrumented runway in two sessions with re-attachment of the system. Intraclass correlation coefficients (ICCs) were used to determine within-session reliability. Repeatability was evaluated by paired T-tests and ICCs. Concerning validity, axial and resultant PTAs were correlated to the peak vertical impact loading rate (LR) of the ground reaction force. Additionally, speed should affect impact loading magnitude. Hence, magnitudes were compared across speeds by RM-ANOVA. Within a session, ICCs were over 0.90 and reasonable for clinical measurements. Between sessions, the magnitudes remained statistically similar with ICCs ranging from 0.50 to 0.59 for axial PTA and from 0.53 to 0.81 for resultant PTA. Peak accelerations of the lower leg segment correlated to LR with larger coefficients for axial PTA (r range: 0.64–0.84) than for the resultant PTA per speed condition. The magnitude of each impact measure increased with speed. These data suggest that PTAs registered per stand-alone system can be useful during level, over-ground, rearfoot running to evaluate impact loading in the time domain when force platforms are unavailable in studies with repeated measurements.     

Effect of step width manipulation on tibial stress during running

Narrow step width has been linked to variables associated with tibial stress fracture. The purpose of this study was to evaluate the effect of step width on bone stresses using a standardized model of the tibia. 15 runners ran at their preferred 5 k running velocity in three running conditions, preferred step width (PSW) and PSW±5% of leg length. 10 successful trials of force and 3-D motion data were collected. A combination of inverse dynamics, musculoskeletal modeling and beam theory was used to estimate stresses applied to the tibia using subject-specific anthropometrics and motion data. The tibia was modeled as a hollow ellipse. Multivariate analysis revealed that tibial stresses at the distal 1/3 of the tibia differed with step width manipulation (p=0.002). Compression on the posterior and medial aspect of the tibia was inversely related to step width such that as step width increased, compression on the surface of tibia decreased (linear trend p=0.036 and 0.003). Similarly, tension on the anterior surface of the tibia decreased as step width increased (linear trend p=0.029). Widening step width linearly reduced shear stress at all 4 sites (p<0.001 for all). The data from this study suggests that stresses experienced by the tibia during running were influenced by step width when using a standardized model of the tibia. Wider step widths were generally associated with reduced loading of the tibia and may benefit runners at risk of or experiencing stress injury at the tibia, especially if they present with a crossover running style.     

Subject-specific and group-based running pattern classification using a single wearable sensor

The objective of this study was to determine whether subject-specific or group-based models provided better classification accuracy to identify changes in biomechanical running gait patterns across different inclination conditions. The classification process was based on measurements from a single wearable sensor using a total of 41,780 strides from eleven recreational runners while running in real-world and uncontrolled environment. Biomechanical variables included pelvic drop, ground contact time, braking, vertical oscillation of pelvis, pelvic rotation, and cadence were recorded during running on three inclination grades: downhill, −2° to −7°; level, −0.2° to +0.2°; and uphill, +2° to +7°. An ensemble and non-linear machine learning algorithm, random forest (RF), was used to classify inclination condition and determine the importance of each of the biomechanical variables. Classification accuracy was determined for subject-specific and group-based RF models. The mean classification accuracy of all subject-specific RF models was 86.29%, while group-based classification accuracy was 76.17%. Braking was identified as the most important variable for all the runners using the group-based model and for most of the runners based on a subject-specific models. In addition, individual runners used different strategies across different inclination conditions and the ranked order of variable importance was unique for each runner. These results demonstrate that subject-specific models can better characterize changes in gait biomechanical patterns compared to a more traditional group-based approach.     

The use of a single inertial sensor to estimate 3-dimensional ground reaction force during accelerative running tasks

The purpose of this investigation was to determine the feasibility of using a single inertial measurement unit (IMU) placed on the sacrum to estimate 3-dimensional ground reaction force (F) during linear acceleration and change of direction tasks. Force plate measurements of F and estimates from the proposed IMU method were collected while subjects (n = 15) performed a standing sprint start (SS) and a 45° change of direction task (COD). Error in the IMU estimate of step-averaged component and resultant F was quantified by comparison to estimates from the force plate using Bland-Altman 95% limits of agreement (LOA), root mean square error (RMSE), Pearson’s product-moment correlation coefficient (r), and the effect size (ES) of the differences between the two systems. RMSE of the IMU estimate of step-average F ranged from 37.70 N to 77.05 N with ES between 0.04 and 0.47 for SS while for COD, RMSE was between 54.19 N to 182.92 N with ES between 0.08 and 1.69. Correlation coefficients between the IMU and force plate measurements were significant (p ≤ 0.05) for all values (r = 0.53 to 0.95) except the medio-lateral component of step-average F. The average angular error in the IMU estimate of the orientation of step-average F was ≤10° for all tasks. The results of this study suggest the proposed IMU method may be used to estimate sagittal plane components and magnitude of step-average F during a linear standing sprint start as well as the vertical component and magnitude of step-average F during a 45° change of direction task.     

In vivo assessment of the interaction of patellar tendon tibial shaft angle and anterior cruciate ligament elongation during flexion

A potential cause of non-contact anterior cruciate ligament (ACL) injury is landing on an extended knee. In line with this hypothesis, studies have shown that the ACL is elongated with decreasing knee flexion angle. Furthermore, at low flexion angles the patellar tendon is oriented to increase the anterior shear component of force acting on the tibia. This indicates that knee extension represents a position in which the ACL is taut, and thus may have an increased propensity for injury, particularly in the presence of excessive force acting via the patellar tendon. However, there is very little in vivo data to describe how patellar tendon orientation and ACL elongation interact during flexion. Therefore, this study measured the patellar tendon tibial shaft angle (indicative of the relative magnitude of the shear component of force acting via the patellar tendon) and ACL length in vivo as subjects performed a quasi-static lunge at varying knee flexion angles. Spearman rho rank correlations within each individual revealed that flexion angles were inversely correlated to both ACL length (rho = −0.94 ± 0.07, mean ± standard deviation, p < 0.05) and patellar tendon tibial shaft angle (rho = −0.99 ± 0.01, p < 0.05). These findings indicate that when the knee is extended, the ACL is both elongated and the patellar tendon tibial shaft angle is increased, resulting in a relative increase in anterior shear force on the tibia acting via the patellar tendon. Therefore, these data support the hypothesis that landing with the knee in extension is a high risk scenario for ACL injury.     

Dynamic balance during running using running-specific prostheses

Running is beneficial for physical, social, and emotional health, and participating in physical activity, including running, is becoming more popular for people with an amputation. However, this population has a greater risk of falling relative to people without an amputation, which may be a barrier to running. Understanding how dynamic balance is maintained during running is important for removing this barrier. To investigate dynamic balance, we quantified whole-body angular momentum in eight people with a unilateral transtibial amputation (TTA) using running-specific prostheses (RSPs) compared to eight people without TTA during running at 2.5, 3.0, and 3.5 m/s. People with TTA had greater ranges of whole-body angular momentum compared to people without TTA in the frontal and sagittal planes (p < 0.01). These greater ranges resulted from smaller peak medial, lateral, and braking ground reaction forces from the amputated leg compared to the intact leg and people without TTA. Reduced RSP mass relative to the biological leg also influenced whole-body angular momentum as evidenced by smaller ranges of amputated leg angular momentum compared to the intact leg in the frontal and sagittal planes. Smaller amputated leg angular momentum corresponded with smaller contralateral arm angular momentum in the sagittal plane (p < 0.01). People with TTA maintain balance during running with altered muscle coordination and prosthesis characteristics. Restoring mediolateral force generation through prosthetic design advances may help in regulating the frontal plane component of whole-body angular momentum for people with TTA, with potential to improve their ability to maintain balance during running.     

Foot strike pattern,step rate,and trunk posture combined gait modifications to reduce impact loading during running

Elevated impact loading can be detrimental to runners as it has been linked to the increased risk of tibial stress fracture and plantar fasciitis. The objective of this study was to investigate the combined effects of foot strike pattern, step rate, and anterior trunk lean gait modifications on impact loading in runners. Nineteen healthy runners performed 12 separate gait modification trials involving: three foot strike patterns (rearfoot, midfoot, and forefoot strike), two step rates (natural and 10% increased), and two anterior trunk lean postures (natural and 10-degree increased flexion). Overall, forefoot strike combined with increased step rate led to the lowest impact loading rates, and rearfoot strike combined with anterior trunk lean led to the highest impact loading rates. In addition, there were interaction effects between foot strike pattern and step rate on awkwardness and effort, such that it was both more natural and easier to transition to a combined gait modification involving forefoot strike and increased step rate than to an isolated gait modification involving either forefoot strike or increased step rate. These findings could help to inform gait modifications for runners to reduce impact loading and associated injury risks.     

Using biofeedback to reduce left arm extensor EMG of string players during musical performance

Electromyographic (EMG) feedback offers a mechanism for helping musicians reduce specific muscle tension during performance. Nine intermediate to advanced level string players participated in a four-session, pretest/posttest design study to determine (1) if left forearm extensor EMG could be reduced using biofeedback, (2) if reductions in EMG would generalize to a no-feedback condition, and (3) if reductions in EMG would generalize from extensors to flexors. Results indicate that biofeedback did facilitate significant decreases in EMG, that the reductions in EMG did generalize to a no-feedback condition, and that generalization from extensors to flexors did not occur.     

Estimation of vertical ground reaction force during running using neural network model and uniaxial accelerometer

Wearable technology has been viewed as one of the plausible alternatives to capture human motion in an unconstrained environment, especially during running. However, existing methods require kinematic and kinetic measurements of human body segments and can be complicated. This paper investigates the use of neural network model (NN) and accelerometer to estimate vertical ground reaction force (VGRF). An experimental study was conducted to collect sufficient samples for training, validation and testing. The estimated results were compared with VGRF measured using an instrumented treadmill. The estimates yielded an average root mean square error of less than 0.017 of the body weight (BW) and a cross-correlation coefficient greater than 0.99. The results also demonstrated that NN could estimate impact force and active force with average errors ranging between 0.10 and 0.18 of BW at different running speeds. Using NN and uniaxial accelerometer can (1) simplify the estimation of VGRF, (2) reduce the computational requirement and (3) reduce the necessity of multiple wearable sensors to obtain relevant parameters.     

Contributions of proximal and distal moments to axial tibial rotation during walking and running

The purpose of this study was to determine the cause and effect relationship between tibial internal rotation and pronation of the foot during walking and heel-toe running. This would allow predictions of orthotic effectiveness in reducing knee pain related to excessive internal tibial rotation. Kinematic and force plate data were collected from twenty subjects performing ten running and ten walking trials across a force plate. Using a least-squares algorithm, attitude matrices for each segment in each frame were obtained and the angular velocity vector of the tibia was calculated. The intersegmental moment at the ankle was calculated from ground reaction force and kinematic data, and the power flow from foot to tibia associated with axial tibial rotation was calculated. In walking, all subjects exhibited a clear power flow from tibia to foot during most of the stance phase, indicating that the foot was following the body. This suggests that the use of foot orthoses to reduce knee pain associated with tibial rotation during walking will not be successful. During running, power flow was also mainly proximal to distal, but there were brief periods of opposite power flow. There was more variability between subjects during running, with five subjects having large distal to proximal power flow peaks. These observations may explain and support previous work that has found variable clinical effects of orthoses between patients.     

Validity of the MarkWiiR for kinematic analysis during walking and running gaits

The aim of this study was to validate the MarkWiiR (MW) captured by the Nintendo Wii-Remote (100-Hz) to assess active marker displacement by comparison with 2D video analysis. Ten participants were tested on a treadmill at different walking (1<6 km · h⁻¹) and running (10<13 km · h⁻¹) speeds. During the test, the active marker for MW and a passive marker for video analysis were recorded simultaneously with the two devices. The displacement of the marker on the two axes (x-y) was computed using two different programs, Kinovea 0.8.15 and CoreMeter, for the camera and MW, respectively. Pearson correlation was acceptable (x-axis r≥0.734 and y-axis r≥0.684), and Bland–Altman plots of the walking speeds showed an average error of 0.24±0.52% and 1.5±0.91% for the x- and y-axis, respectively. The difference of running speeds showed average errors of 0.67±0.33% and 1.26±0.33% for the x- and y-axes, respectively. These results demonstrate that the two measures are similar from both the x- and the y-axis perspective. In conclusion, these findings suggest that the MarkWiiR is a valid and reliable tool to assess the kinematics of an active marker during walking and running gaits.     

Minimum time required for assessing step variability during running at submaximal velocities

This study aimed to determine the minimum time required for assessing spatiotemporal variability during continuous running at different submaximal velocities and, thereby, the number of steps required. Nineteen trained endurance runners performed an incremental running protocol, with a 3-min recording period at 10, 12, 14 and 16 km/h. Spatiotemporal parameters (contact and flight times, step length and step frequency) were measured using the OptoGait system and step variability was considered for each parameter, in terms of within-participants standard deviation (SD) and coefficient of variation (CV%). Step variability was considered over six different durations at every velocity tested: 0–10 s, 0–20 s, 0–30 s, 0–60 s, 0–120 s and 0–180 s. The repeated measures ANOVA revealed no significant differences in the magnitude of the four spatiotemporal parameters between the recording intervals at each running velocity tested (p ≥ 0.05, ICC > 0.90). The post-hoc analysis confirmed no significant differences in step variability (SD and CV% of each spatiotemporal parameter at any velocity tested) between measurements. The Bland-Altman limits of agreement method showed that longer recording intervals yield smaller systematic bias, random errors, and narrower limits of agreement, regardless of running velocity. The results suggest that the duration of the recording period required to estimate spatiotemporal variability plays an important role in the accuracy of the measurement, regardless of running velocity (10–16 km/h).     

Use of o-phthalaldehyde to reduce background during automated Edman degradation

Background generated during the cleavage step of the Edman degradation is a major obstacle to extended automated amino acid sequencing. It was demonstrated recently by A. S. Bhown, J. C. Bennett, P. H. Morgan, and J. E. Mole (1981, Anal. Biochem. 112, 158-162) that introduction of fluorescamine into the spinning cup reduced background by blocking primary amino groups at cycles where a proline residue is at the exposed amino terminus. A convenient blocking reaction program using o-phthalaldehyde which can be intercalated into the sequencing format of an automated Beckman liquid-phase sequencer is presented. The advantages of o-phthalaldehyde in blocking of primary amines when proline is amino terminal arise from its stability in aqueous solution and the ease of programmed metering of delivery to the sequencer spinning cup. The blocking reaction proved successful not only in extending sequence analyses but also in the elimination of unwanted sequences in selected peptide mixtures without the necessity of purification of the target peptide.     

A model-based parametric study of impact force during running

This paper deals with the impact force during foot-ground impact activities such as the running. A previously developed model is used for this study. The model is a lumped-parameter one consisting of four masses connected to each other via linear springs and viscous dampers. A shoe-specific nonlinear function is used for representation of the ground reaction force. The authors have previously showed that the previous version of the model as well as its simulation is incorrect. This paper slightly modifies the previous model so as it is able to produce results in agreement with the experiments. Then, the modified model is simulated for two typical shoe types. A parametric study is also conducted. The parametric study concerns with the effects of masses, mass ratios, stiffness constants, and damping coefficients on the dynamics of the impact. It is shown that the impact forces increase as the rigid and wobbling masses increase. However, the increase in the impact forces is not the same for all the masses. It is found that the impact force increases as the touchdown velocities increase. Simulations imply that the variations of the damping coefficients result in larger variations of the impact force compared to the stiffness. The effect of the variation of gravity on the simulated impact force is also explored. It is concluded that both the first and the second peaks of the impact force are increased with gravity. An in-depth discussion is included to compare results of the current paper with results of other investigators.     

Direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact

Anterior tibial loading is a major factor involved in the anterior cruciate ligament (ACL) injury mechanism during ski impact landing. We sought to investigate the direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact of intact knee joints without quadriceps activation. Twelve porcine knee specimens were procured. Four specimens were used as non-impact control while the remaining eight were mounted onto a material-testing system at 70° flexion and subjected to simulated landing impact, which was successively repeated with incremental actuator displacement. Four specimens from the impacted group underwent pre-impact MRI for tibial plateau angle measurements while the other four were subjected to histology and microCT for cartilage morphology and volume assessment. The tibial plateau angles ranged from 29.4 to 38.8°. There was a moderate linear relationship (Y=0.16X; R²=0.64; p<0.001) between peak axial impact compressive load (Y) and peak anterior tibial load (X). The anterior and posterior regions in the impacted group sustained surface cartilage fraying, superficial clefts and tidemark disruption, compared to the control group. MicroCT scans displayed visible cartilage deformation for both anterior and posterior regions in the impacted group. Due to the tibial plateau angle, increased axial impact compressive load can directly elevate anterior tibial load and hence contribute to ACL failure during simulated landing impact. Axial impact compressive load resulted in shear cartilage damage along anterior–posterior tibial plateau regions, due to its contribution to anterior tibial loading. This mechanism plays an important role in elevating ACL stress and cartilage deformation during impact landing.     

Optimal muscle fascicle length and tendon stiffness for maximising gastrocnemius efficiency during human walking and running

Muscles generate force to resist gravitational and inertial forces and/or to undertake work, e.g. on the centre of mass. A trade-off in muscle architecture exists in muscles that do both; the fibres should be as short as possible to minimise activation cost but long enough to maintain an appropriate shortening velocity. Energetic cost is also influenced by tendon compliance which modulates the timecourse of muscle mechanical work. Here we use a Hill-type muscle model of the human medial gastrocnemius to determine the muscle fascicle length and Achilles tendon compliance that maximise efficiency during the stance phase of walking (1.2 m/s) and running (3.2 and 3.9 m/s). A broad range of muscle fascicle lengths (ranging from 45 to 70 mm) and tendon stiffness values (150-500 N/mm) can achieve close to optimal efficiency at each speed of locomotion; however, efficient walking requires shorter muscle fascicles and a more compliant tendon than running. The values that maximise efficiency are within the range measured in normal populations. A non-linear toe-region region of the tendon force-length properties may further influence the optimal values, requiring a stiffer tendon with slightly longer muscle fascicles; however, it does not alter the main results. We conclude that muscle fibre length and tendon compliance combinations may be tuned to maximise efficiency under a given gait condition. Efficiency is maximised when the required volume of muscle is minimised, which may also help reduce limb inertia and basal metabolic costs.     

Spring-mass running: simple approximate solution and application to gait stability

The planar spring-mass model is frequently used to describe bouncing gaits (running, hopping, trotting, galloping) in animal and human locomotion and robotics. Although this model represents a rather simple mechanical system, an analytical solution predicting the center of mass trajectory during stance remains open. We derive an approximate solution in elementary functions assuming a small angular sweep and a small spring compression during stance. The predictive power and quality of this solution is investigated for model parameters relevant to human locomotion. The analysis shows that (i), for spring compressions of up to 20% (angle of attack > or = 60 degree, angular sweep < or = 60 degree) the approximate solution describes the stance dynamics of the center of mass within a 1% tolerance of spring compression and 0.6 degree tolerance of angular motion compared to numerical calculations, and (ii), despite its relative simplicity, the approximate solution accurately predicts stable locomotion well extending into the physiologically reasonable parameter domain. (iii) Furthermore, in a particular case, an explicit parametric dependency required for gait stability can be revealed extending an earlier, empirically found relationship. It is suggested that this approximation of the planar spring-mass dynamics may serve as an analytical tool for application in robotics and further research on legged locomotion.     

Increased hip adduction during running is associated with patellofemoral pain and differs between males and females: A case-control study

Patellofemoral pain is common amongst recreational runners and associated with altered running kinematics. However, it is currently unclear how sex may influence kinematic differences previously reported in runners with patellofemoral pain. This case-control study aimed to evaluate lower limb kinematics in males and females with and without patellofemoral pain during running. Lower limb 3D kinematics were assessed in 20 runners with patellofemoral pain (11 females, 9 males) and 20 asymptomatic runners (11 females, 9 males) during a 3 km treadmill run. Variables of interest included peak hip adduction, internal rotation and flexion angles; and peak knee flexion angle, given their previously reported association with patellofemoral pain. Age, height, mass, weekly run distance and step rate were not significantly different between groups. Mixed-sex runners with patellofemoral pain were found to run with a significantly greater peak hip adduction angle (mean difference = 4.9°, d = 0.91, 95% CI 1.4–8.2, p = 0.01) when compared to matched controls, but analyses for all other kinematic variables were non-significant. Females with patellofemoral pain ran with a significantly greater peak hip adduction angle compared to female controls (mean difference = 6.6°, p = 0.02, F = 3.41, 95% CI 0.4–12.8). Analyses for all other kinematic variables between groups (males and females with/without PFP) were non-significant. Differences in peak hip adduction between those with and without patellofemoral pain during running appear to be driven by females. This potentially highlights different kinematic treatment targets between males and females. Future research is encouraged to report lower limb kinematic variables in runners with patellofemoral pain separately for males and females.     

Evaluation of an accelerometer to assess knee mechanics during a drop landing

Non-contact anterior cruciate ligament (ACL) injuries account for 70% of all ACL injuries, and can lead to missed time from activity for athletes and a predisposition for knee osteoarthritis. Prior research has shown that athletes who land in a stiff manner, with larger internal knee adduction and extension moments, are at greater risk for an ACL injury. A three-dimensional accelerometer placed at the tibial tuberosity may prove to be a low-cost means of assessing these risk factors. The primary purpose of this study was to compare tibial accelerations during drop landings with kinematic and kinetic risk factors for ACL injury measured with three-dimensional motion capture. The secondary purpose of this study was to compare these measures between soft and stiff landings. Participants were instructed to land bilaterally in preferred, soft, and stiff manners. Peak knee flexion decreased significantly from soft to stiff landings. Peak internal knee extension moment, peak anterior/posterior knee acceleration, and peak medial knee acceleration all increased significantly from soft to stiff landings. No associations were found between landing condition and either frontal plane knee angle at maximum vertical ground reaction force or peak internal knee adduction moment. Significant positive associations between kinetics and accelerations were found only in the sagittal plane. As such, while a three-dimensional accelerometer could discern between soft and stiff landings in both planes, it may be better suited to predict kinetic risk factors in the sagittal plane.