Paul DeVita

Effect of landing stiffness on joint kinetics and energetics in the lower extremity.

Ground reaction forces (GRF), joint positions, joint moments, and muscle powers in the lower extremity were compared between soft and stiff landings from a vertical fall of 59 cm. Soft and stiff landings had less than and greater than 90 degrees of knee flexion after floor contact. Ten trials of sagittal plane film and GRF data, sampled at 100 and 1000 Hz, were obtained from each of eight female athletes and two landing conditions. Inverse dynamics were performed on these data to obtain the moments and powers during descent (free fall) and floor contact phases. Angular impulse and work values were calculated from these curves, and the conditions were compared with a correlated t-test. Soft and stiff landings averaged 117 and 77 degrees of knee flexion. Larger hip extensor (0.010 vs 0.019 N.m.s.kg-1; P less than 0.01) and knee flexor (-0.010 vs -0.013 N.m.s.kg-1; P less than 0.01) moments were observed during descent in the stiff landing, which produced a more erect body posture and a flexed knee position at impact. The shapes of the GRF, moment, and power curves were identical between landings. The stiff landing had larger GRFs, but only the ankle plantarflexors produced a larger moment (0.185 vs 0.232 N.m.s.kg-1; P less than 0.01) in this condition. The hip and knee muscles absorbed more energy in the soft landing (hip, -0.60 vs -0.39 W.kg-1; P less than 0.01; knee, -0.89 vs -0.61 W.kg-1; P less than 0.01), while the ankle muscles absorbed more in the stiff landing (-0.88 vs -1.00 W.kg-1; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial.

IMPORTANCE Knee osteoarthritis (OA), a common cause of chronic pain and disability, has biomechanical and inflammatory origins and is exacerbated by obesity. OBJECTIVE To determine whether a ≥10% reduction in body weight induced by diet, with or without exercise, would improve mechanistic and clinical outcomes more than exercise alone. DESIGN, SETTING, AND PARTICIPANTS Single-blind, 18-month, randomized clinical trial at Wake Forest University between July 2006 and April 2011. The diet and exercise interventions were center-based with options for the exercise groups to transition to a home-based program. Participants were 454 overweight and obese older community-dwelling adults (age ≥55 years with body mass index of 27-41) with pain and radiographic knee OA. INTERVENTIONS Intensive diet-induced weight loss plus exercise, intensive diet-induced weight loss, or exercise. MAIN OUTCOMES AND MEASURES Mechanistic primary outcomes: knee joint compressive force and plasma IL-6 levels; secondary clinical outcomes: self-reported pain (range, 0-20), function (range, 0-68), mobility, and health-related quality of life (range, 0-100). RESULTS Three hundred ninety-nine participants (88%) completed the study. Mean weight loss for diet + exercise participants was 10.6 kg (11.4%); for the diet group, 8.9 kg (9.5%); and for the exercise group, 1.8 kg (2.0%). After 18 months, knee compressive forces were lower in diet participants (mean, 2487 N; 95% CI, 2393 to 2581) compared with exercise participants (2687 N; 95% CI, 2590 to 2784, pairwise difference [Δ](exercise vs diet )= 200 N; 95% CI, 55 to 345; P = .007). Concentrations of IL-6 were lower in diet + exercise (2.7 pg/mL; 95% CI, 2.5 to 3.0) and diet participants (2.7 pg/mL; 95% CI, 2.4 to 3.0) compared with exercise participants (3.1 pg/mL; 95% CI, 2.9 to 3.4; Δ(exercise vs diet + exercise) = 0.39 pg/mL; 95% CI, -0.03 to 0.81; P = .007; Δ(exercise vs diet )= 0.43 pg/mL; 95% CI, 0.01 to 0.85, P = .006). The diet + exercise group had less pain (3.6; 95% CI, 3.2 to 4.1) and better function (14.1; 95% CI, 12.6 to 15.6) than both the diet group (4.8; 95% CI, 4.3 to 5.2) and exercise group (4.7; 95% CI, 4.2 to 5.1, Δ(exercise vs diet + exercise) = 1.02; 95% CI, 0.33 to 1.71; P(pain) = .004; 18.4; 95% CI, 16.9 to 19.9; Δ(exercise vs diet + exercise), 4.29; 95% CI, 2.07 to 6.50; P(function )< .001). The diet + exercise group (44.7; 95% CI, 43.4 to 46.0) also had better physical health-related quality of life scores than the exercise group (41.9; 95% CI, 40.5 to 43.2; Δ(exercise vs diet + exercise) = -2.81; 95% CI, -4.76 to -0.86; P = .005). CONCLUSIONS AND RELEVANCE Among overweight and obese adults with knee OA, after 18 months, participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels than those in the exercise group; those in the diet group had greater reductions in knee compressive force than those in the exercise group. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00381290.

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.

Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation.

PURPOSE Accelerated rehabilitation for anterior cruciate ligament (ACL) injury and reconstruction surgery is designed to return injured people to athletic activities in approximately 6 months. The small amount of empirical data on this population suggests, however, that the torque at the knee joint may not return until 22 months after surgery during walking and even longer during running. Although the rehabilitation has ended and individuals have returned to preinjury activities, gait mechanics appear to be abnormal at the end of accelerated programs. The purpose of this study was to compare lower extremity joint kinematics, kinetics, and energetics between individuals having undergone ACL reconstruction and accelerated rehabilitation and healthy individuals. METHODS Eight ACL-injured and 22 healthy subjects were tested. Injured subjects were tested 3 wk and 6 months (the end of rehabilitation) after surgery. Ground reaction force and kinematic data were combined with inverse dynamics to predict sagittal plane joint torques and powers from which angular impulse and work were derived. RESULTS The difference in all kinematic variables between the two tests for the ACL group averaged 38% (all P < 0.05). The kinematics were not different between the ACL group after rehabilitation and healthy subjects. Angular impulses and work averaged 100% difference for all joints (all P < 0.05) between tests for the ACL group. After rehabilitation, the differences between injured and healthy groups in angular impulse and work at both the hip and knee remained large and averaged 52% (all P < 0.05). CONCLUSIONS Results indicated that after reconstruction surgery and accelerated rehabilitation for ACL injury, humans walk with normal kinematic patterns but continue to use altered joint torque and power patterns.

Muscle pre- and coactivity during downward stepping are associated with leg stiffness in aging

We have previously reported that elderly compared to young women executed downward stepping with substantially greater leg stiffness. Because antagonist muscle coactivity increases joint stiffness we hypothesized that increased leg stiffness in aging is associated with increased muscle coactivity. We also explored the possibility that the magnitude of the preparatory muscle activity preceding impact also differed between young and old subjects. Young (n=11, 20. 8 yr) and old (n=12, 69 yr) women performed downward stepping from a platform set at 20% body height. The leg was modeled as a simple mass-spring system. From video and ground reaction force data leg stiffness was computed as the ratio of force under the foot and the linear shortening of the limb. EMG activity of the vastus lateralis, biceps femoris, gastrocnemius lateralis, and tibialis anterior were recorded with a telemetric system. Elders compared to young subjects had 64% greater leg stiffness during downward stepping. Muscle activity over a 200-ms period preceding touch down was 136% greater in elderly than in young subjects. Biceps femoris and tibialis anterior coactivity during ground contact was 120% greater in the elders. Muscle pre- and coactivity, respectively, accounted for about 50% of the variance in leg stiffness. In conclusion, elderly people elevate muscle pre- and coactivity during downward stepping to stiffen the leg in compensation for impaired neuromotor functions.

Gait adaptations before and after anterior cruciate ligament reconstruction surgery

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.

Interaction between age and gait velocity in the amplitude and timing of antagonist muscle coactivation

Old adults execute single-joint voluntary movements with heightened antagonist muscle coactivation and altered timing between agonist and antagonist muscles. It is less clear if old adults adopt similar strategies during the most common form of activity of daily living, gait, and if age and gait velocity interact. We compared antagonist muscle activation amplitude and onset, offset, and activation duration of the vastus lateralis, biceps femoris, tibialis anterior, and gastrocnemius lateralis from surface EMG in 17 young (age 19-25) and 17 old adults (age 71-85) while walking at 1.2, 1.5, and 1.8m/s. All participants were healthy and highly mobile. The activation level of the four muscles when each acted as the antagonist was, on the average, 83% higher in old vs young adults (for each muscle p<0.05). In two of four muscles this activation increased with gait velocity in young but not in old adults. The inter-burst interval between TA and GL was two-fold (83 ms) longer in young vs old adults and at higher gait velocities it became 14% (24 ms) shorter in young but 51% (31 ms) longer in old adults (interaction, p=0.015). It is concluded that there is an interaction between age and gait velocity in the amplitude and timing of antagonist muscle coactivation.

Foot placement modifies kinematics and kinetics during drop jumping

PURPOSE Sprinting, bouncing, and spontaneous landings are associated with a forefoot contact whereas walking, running, and jumping are associated with heel-toe foot placement. Because such foot placement strategies influence landing mechanics or the ensuing performance, the purpose of this work was to compare lower extremity kinematics and kinetics and muscle activation patterns between drop vertical jumps performed with heel-toe (HTL) and forefoot (FFL) landings. METHODS Ten healthy male university students performed two types of drop jump from a 0.4-m high box placed 1.0-m from the center of the force plate. They were instructed to either land first on the ball of the feet without the heels touching the ground during the subsequent vertical jump, i.e., forefoot landing jump (FFL), or to land on the heels followed by depression of the metatarsals, i.e., heel-toe landing jump (HTL). Three successfully performed trials per jump type were included in the analysis. The criteria for selection of the correct jumps was proper foot position at contact as judged from video records and the shape of force-time curve. RESULTS The first peak and second peak determined from the vertical force-time curves were 3.4 times greater and 1.4 times lower for HTL compared with those with FFL (P<0.05). In the flexion phase of HTL, the hip and knee joints contributed 40% and 45% to the total torque, whereas during FFL the greatest torque contributions were 37% for both the knee and ankle joints. During the extension phase, the greatest torque contributions to the total torque were 41% and 45% by the knee and ankle joints during HTL and 34% and 55% during FFL. During the flexion phase, power production was 20% greater (P<0.05) in HTL than in FFL, whereas during the extension phase power production was 40% greater in FFL than in HTL. In the flexion phase of HTL the hip and knee joints produced the greatest power, and during the extension phase the knee and ankle joints produced the greatest power. In contrast, during both the flexion and extension phases of FFL, the knee and ankle joints produced the greatest power. The EMG activity of gluteus, vastus lateralis, and plantar flexor muscles was similar between HTL and FFL in most cases except for the greater vastus lateralis EMG activity during precontact phase in HTL than in FFL and the greater gastrocnemius activity in FFL than in HTL. CONCLUSION Foot placement strategy modifies the individual joint contributions to the total power during drop jumping.

Errors in alignment of center of pressure and foot coordinates affect predicted lower extremity torques

The purpose of the study was to quantify the effect of errors in spatial alignment between the center of pressure recorded from a force platform and the coordinates of the foot recorded from film on resultant joint torques in the lower extremity during the stance phase of gait. Two-dimensional kinematic and kinetic data from eight subjects performing walking and running were analyzed using inverse dynamics with the obtained center of pressure values and with +/- 0.5 and +/- 1.0 cm shifts in the anteroposterior location of the center of pressure under the support foot. Shifting the center of pressure posteriorly increased the flexor (dorsiflexor) torques at the hip and ankle and decreased the extensor (plantarflexor) torques at these joints. This shift also caused an increase in the extensor and a decrease in the flexor torques at the knee. Shifting the center of pressure anteriorly caused the opposite effects at each joint. The +/- 0.5 and +/- 1.0 cm shifts in the location of the center of pressure caused, on average, 7 and 14% changes, respectively, in maximum joint torque and angular impulse values. Relative transition times between flexor and extensor torques were either increased or decreased, on average, by 7 and 13%, respectively for the two conditions over all trials. Based on these results, it is concluded that due to potential errors in the spatial alignment of kinetic and kinematic data, joint torques in the literature on gait should be considered as approximations of the true values.

Mechanisms Responsible for the Age-Associated Increase in Coactivation of Antagonist Muscles

Age alters the control of voluntary movement. A frequently observed adaptation is the increased agonist and antagonist muscle coactivation. Here we examine the evidence for spinal circuits mediating this change in motor behavior and propose the hypothesis that cortical mechanisms also contribute to this age-associated change in muscle coactivation.