Richard W. Willy

Kinematic and Kinetic Comparison of Running in Standard and Minimalist Shoes

PURPOSE The purpose of this study was to determine whether running in a minimalist shoe results in a reduction in ground reaction forces and alters kinematics over standard shoe running. The secondary purpose of this study was to determine whether within-session accommodation to a novel minimalist shoe occurs. METHODS Subjects were 14 male, rearfoot striking runners who had never run in a minimalist shoe. Subjects were tested while running 3.35 m·s(-1) for 10 min on an instrumented treadmill in a minimalist and a standard shoe as three-dimensional lower extremity kinematics and kinetics were evaluated. Data were collected at minute 1 and then again after 10 min of running in both shoe conditions to evaluate accommodation to the shoe conditions. RESULTS Shoe-time interactions were not found for any of the variables of interest. Minimalist shoe running resulted in no changes in step length (P = 0.967) or in step rate (P = 0.230). At footstrike, greater knee flexion (P = 0.001) and greater dorsiflexion angle (P = 0.025) were noted in the minimalist shoe. Vertical impact peak (P = 0.017) and average vertical loading rate (P < 0.000) were greater during minimalist shoe running. There were main effects of time as dorsiflexion angle decreased (P = 0.035), foot inclination at footstrike decreased (P = 0.048), and knee flexion at footstrike increased (P = 0.002), yet the vertical impact peak (P = 0.002) and average vertical loading rate (P < 0.000) increased. CONCLUSIONS Running in a minimalist shoe appears to, at least in the short term, increase loading of the lower extremity over standard shoe running. The accommodation period resulted in less favorable landing mechanics in both shoes. These findings bring into question whether minimal shoes will provide enough feedback to induce an alteration that is similar to barefoot running.

Are mechanics different between male and female runners with patellofemoral pain

INTRODUCTION Patellofemoral pain (PFP) has often been attributed to abnormal hip and knee mechanics in females. To date, there have been few investigations of the hip and knee mechanics of males with PFP. The purpose of this study was to compare the lower extremity mechanics and alignment of male runners with PFP with healthy male runners and female runners with PFP. We hypothesized that males with PFP would move with greater varus knee mechanics compared with male controls and compared with females with PFP. Furthermore, it was hypothesized that males with PFP would demonstrate greater varus alignment. METHODS A gait and single-leg squat analysis was conducted on each group (18 runners per group). Measurement of each runners tibial mechanical axis was also recorded. Motion data were processed using Visual 3D (C-Motion, Bethesda, MD). ANOVAs were used to analyze the data. RESULTS Males with PFP ran and squatted in greater peak knee adduction and demonstrated greater peak knee external adduction moment compared with healthy male controls. In addition, males with PFP ran and squatted with less peak hip adduction and greater peak knee adduction compared with females with PFP. The static measure of mechanical axis of the tibial was not different between groups. However, a post hoc analysis revealed that males with PFP ran with greater peak tibial segmental adduction. CONCLUSION Males with PFP demonstrated different mechanics during running and during a single-leg squat compared with females with PFP and with healthy males. Based upon the results of this study, therapies for PFP may need to be sex specific.

Influence of step length and landing pattern on patellofemoral joint kinetics during running

Elevated patellofemoral joint kinetics during running may contribute to patellofemoral joint symptoms. The purpose of this study was to test for independent effects of foot strike pattern and step length on patellofemoral joint kinetics while running. Effects were tested relative to individual steps and also taking into account the number of steps required to run a kilometer with each step length. Patellofemoral joint reaction force and stress were estimated in 20 participants running at their preferred speed. Participants ran using a forefoot strike and rearfoot strike pattern during three different step length conditions: preferred step length, long (+10%) step length, and short (−10%) step length. Patellofemoral kinetics was estimated using a biomechanical model of the patellofemoral joint that accounted for cocontraction of the knee flexors and extensors. We observed independent effects of foot strike pattern and step length. Patellofemoral joint kinetics per step was 10–13% less during forefoot strike conditions and 15–20% less with a shortened step length. Patellofemoral joint kinetics per kilometer decreased 12–13% using a forefoot strike pattern and 9–12% with a shortened step length. To the extent that patellofemoral joint kinetics contribute to symptoms among runners, these running modifications may be advisable for runners with patellofemoral pain.

In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture

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.

Preinjury and Postinjury Running Analysis Along With Measurements of Strength and Tendon Length in a Patient With a Surgically Repaired Achilles Tendon Rupture

STUDY DESIGN Case report. BACKGROUND The Achilles tendon is the most frequently ruptured tendon, and the incidence of Achilles tendon rupture has increased in the last decade. The rupture generally occurs without any preceding warning signs, and therefore preinjury data are seldom available. This case represents a unique opportunity to compare preinjury running mechanics with postinjury evaluation in a patient with an Achilles tendon rupture. CASE DESCRIPTION A 23-year-old female sustained a right complete Achilles tendon rupture while playing soccer. Running mechanics data were collected preinjury, as she was a healthy participant in a study on running analysis. In addition, patient-reported symptoms, physical activity level, strength, ankle range of motion, heel-rise ability, Achilles tendon length, and running kinetics were evaluated 1 year after surgical repair. OUTCOMES During running, greater ankle dorsiflexion and eversion and rearfoot abduction were noted on the involved side postinjury when compared to preinjury data. In addition, postinjury, the magnitude of all kinetics data was lower on the involved limb when compared to the uninvolved limb. The involved side displayed differences in strength, ankle range of motion, heel rise, and tendon length when compared to the uninvolved side 1 year after injury. DISCUSSION Despite a return to normal running routine and reports of only minor limitations with running, considerable changes were noted in running biomechanics 1 year after injury. Calf muscle weakness and Achilles tendon elongation were also found when comparing the involved and uninvolved sides.

Changes in tibiofemoral contact forces during running in response to in-field gait retraining

ABSTRACT We evaluated the efficacy of an in-field gait retraining programme using mobile biofeedback to reduce cumulative and peak tibiofemoral loads during running. Thirty runners were randomised to either a retraining group or control group. Retrainers were asked to increase their step rate by 7.5% over preferred in response to real-time feedback provided by a wrist mounted running computer for 8 routine in-field runs. An inverse dynamics driven musculoskeletal model estimated total and medial tibiofemoral joint compartment contact forces. Peak and impulse per step total tibiofemoral contact forces were immediately reduced by 7.6% and 10.6%, respectively (P < 0.001). Similarly, medial tibiofemoral compartment peak and impulse per step tibiofemoral contact forces were reduced by 8.2% and 10.6%, respectively (P < 0.001). Interestingly, no changes were found in knee adduction moment measures. Post gait retraining, reductions in medial tibiofemoral compartment peak and impulse per step tibiofemoral contact force were still present (P < 0.01). At the 1-month post-retraining follow-up, these reductions remained (P < 0.05). With these per stance reductions in tibiofemoral contact forces in mind, cumulative tibiofemoral contact forces did not change due to the estimated increase in number of steps to run 1 km.

Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running

Study Design Level 4, controlled laboratory study. Background Little is known regarding how the potential differences between treadmill and overground running may affect patellofemoral joint and Achilles tendon loading characteristics. Objectives To compare measures of loading of the patellofemoral joint and Achilles tendon across treadmill and overground running in healthy, uninjured runners. Methods Eighteen healthy runners ran at their self-selected speed on an instrumented treadmill and overground, while 3-D running mechanics were sampled. A musculoskeletal model derived peak load, rate of loading, and estimated cumulative load per 1 km of continuous running for the patellofemoral joint and Achilles tendon for each condition. Data were analyzed via paired t tests and Pearson correlations to detect differences and assess relationships, respectively, between the 2 running mediums. Results No differences (P>.05) were found between treadmill and overground running for peak load, rate of loading, or estimated cumulative patellofemoral joint stress per 1 km of continuous running. However, treadmill running resulted in 12.5% greater peak Achilles tendon force (P<.001), 15.6% greater loading rate of Achilles tendon force (P<.001), and 14.2% greater estimated cumulative Achilles tendon force per 1 km of continuous running (P<.001) compared with overground running. There were strong (r>0.70) and moderate agreements (r>0.50) for most patellofemoral joint and Achilles measures, respectively, between treadmill and overground running. Conclusion No differences were observed in loading characteristics to the patellofemoral joint between running mediums; however, treadmill running resulted in greater Achilles tendon loading compared with overground running. Future investigations should examine whether sudden bouts of treadmill running may increase the risk of mechanical overload of the Achilles tendon in runners who habitually train overground. J Orthop Sports Phys Ther 2016;46(8):664-672. Epub 12 May 2016. doi:10.2519/jospt.2016.6494.

Elevated Knee Joint Kinetics and Reduced Ankle Kinetics Are Present During Jogging and Hopping After Achilles Tendon Ruptures

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.

The high frequency component of the vertical ground reaction force is a valid surrogate measure of the impact peak

Identification of the impact peak (IP) from the vertical ground reaction force (vGRF) is required to calculate indices of impact loading during running. The IP, however, is not always clearly discernible. Previous researchers have estimated the timing of the IP using surrogate methods, the most common of which is a set time point of 13% stance (TPS). Information contained within the high frequency (HiF) component of the vGRF may also have a utility as a surrogate measure, but the validity of either approach is currently unknown. The purpose of this study is to evaluate the criterion validity for a newly proposed HiF method and the previously used TPS method against a criterion measure for a group of rear-foot striking runners. Fifty participants ran at a standardized speed (3.3 m·s(-1)) on an instrumented treadmill. Five consecutive stance phases were analyzed for the participants dominant limb. Bland-Altman was used to assess agreement between the criterion method and each surrogate method. Good agreement of the HiF and TPS methods with the criterion method indicate that both methods are likely to be valid surrogate approaches to estimate vGRF impact loading indices. For all impact loading indices, smaller bias and limits of agreement (LOA) were observed with the HiF method when compared to the TPS method. Therefore, it is concluded that the HiF method should be used in preference to the TPS method when it is available.

Sex differences in running mechanics and patellofemoral joint kinetics following an exhaustive run

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.