Stacey A. Meardon

Effects of step length on patellofemoral joint stress in female runners with and without patellofemoral pain.

BACKGROUNDnPatellofemoral pain is common among runners and is frequently attributed to increased patellofemoral joint stress. The purpose of our study was to examine the effects of changing step length during running on patellofemoral joint stress per step and stress per mile in females with and without patellofemoral pain.nnnMETHODSnTen female runners with patellofemoral pain and 13 healthy female runners performed running trials at 3.7m/s in three conditions: preferred step length, at least +10% step length, and at least -10% step length. Knee flexion angles and internal knee extension moments served as inputs for a biomechanical model to estimate patellofemoral joint stress per step. We also estimated total patellofemoral joint stress per mile based on the number of steps necessary to run a mile during each condition.nnnFINDINGSnPatellofemoral joint stress per step increased 31% in the long step length condition (P<.001) and decreased 22.2% in the short step length condition (P<.001). Despite the inverse relationship between step length and number of steps required to run a mile, patellofemoral joint stress per mile increased 14% in the long step length condition (P<.001) and decreased 7.5% in the short step length condition (P<.001).nnnINTERPRETATIONnThese results suggest a direct relationship between step length and patellofemoral joint loads. Total stress per mile experienced at the patellofemoral joint decreased with a short step length despite the greater number of steps necessary to cover this distance. These findings may have relevance with respect to both prevention and treatment of patellofemoral joint pain.

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.

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 5k 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.

In-Shoe Loading in Rearfoot and Non-Rearfoot Strikers during Running Using Minimalist Footwear

Recent trends promote a barefoot running style to reduce injury. Minimalist shoes are designed to mimic the barefoot running with some foot protection. However, it is unknown how minimalist shoes alter plantar loading. Our purpose was to compare plantar loads between rearfoot strikers and non-rearfoot strikers after 4 weeks of running in minimalist footwear. 30 females were provided Vibram(®) Bikila shoes and instructed to gradually transition to running in these shoes. Plantar loading was measured using an in-shoe pressure sensor after the 4 weeks. Multivariate analysis was performed to detect differences in loading between rearfoot and non-rearfoot strikers in different plantar regions. Differences in plantar loading occurred between foot strike patterns running in minimalist footwear. Pressure and force variables were greater in the metatarsals and lower in the heel region in non-rearfoot strikers. Peak pressure for the whole foot was greater in non-rearfoot strikers while no difference was observed in maximum force or contact time for the whole foot between strike types. Allowing time for accommodation and adaptation to different stresses on the foot may be warranted when using minimalist footwear depending on foot strike pattern of the -runner.

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.

The effects of running cadence manipulation on plantar loading in healthy runners.

Our purpose was to evaluate effects of cadence manipulation on plantar loading during running. Participants (n=38) ran on a treadmill at their preferred speed in 3 conditions: preferred, 5% increased, and 5% decreased while measured using in-shoe sensors. Data (contact time [CT], peak force [PF], force time integral [FTI], pressure time integral [PTI] and peak pressure [PP]) were recorded for 30 right footfalls. Multivariate analysis was performed to detect differences in loading between cadences in the total foot and 4 plantar regions. Differences in plantar loading occurred between cadence conditions. Total foot CT and PF were lower with a faster cadence, but no total foot PP differences were observed. Faster cadence reduced CT, pressure and force variables in both the heel and metatarsal regions. Increasing cadence did not elevate metatarsal loads; rather, total foot and all regions were reduced when healthy runners increased their cadence. If a 5% increase in cadence from preferred were maintained over each mile run the impulse at the heel would be reduced by an estimated 565 body weights*s (BW*s) and the metatarsals 140-170u2009BW*s per mile run despite the increased steps taken. Increasing cadence may benefit overuse injuries associated with elevated plantar loading.

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.

Primary and secondary effects of real-time feedback to reduce vertical loading rate during running.

Gait modifications are often proposed to reduce average loading rate (AVLR) during running. While many modifications may reduce AVLR, little work has investigated secondary gait changes. Thirty‐two rearfoot runners [16M, 16F, 24.7 (3.3) years, 22.72 (3.01) kg/m2, >16 km/week] ran at a self‐selected speed (2.9 ± 0.3 m/s) on an instrumented treadmill, while 3D mechanics were calculated via real‐time data acquisition. Real‐time visual feedback was provided in a randomized order to cue a forefoot strike (FFS), a minimum 7.5% decrease in step length, or a minimum 15% reduction in AVLR. AVLR was reduced by FFS (mean difference = 26.4 BW/s; 95% CI = 20.1, 32.7; P < 0.001), shortened step length (8.4 BW/s; 95% CI = 2.9, 14.0; P = 0.004), and cues to reduce AVLR (14.9 BW/s; 95% CI = 10.2, 19.6; P < 0.001). FFS, shortened step length, and cues to reduce AVLR all reduced eccentric knee joint work per km [(−48.2 J/kg*m; 95% CI = −58.1, −38.3; P < 0.001), (−35.5 J/kg*m; 95% CI = −42.4, 28.6; P < 0.001), (−23.1 J/kg*m; 95% CI = −33.3, −12.9; P < 0.001)]. However, FFS and cues to reduce AVLR also increased eccentric ankle joint work per km [(54.49 J/kg*m; 95% CI = 45.3, 63.7; P < 0.001), (9.20 J/kg*m; 95% CI = 1.7, 16.7; P = 0.035)]. Potentially injurious secondary effects associated with FFS and cues to reduce AVLR may undermine their clinical utility. Alternatively, a shortened step length resulted in small reductions in AVLR, without any potentially injurious secondary effects.

Bone stress in runners with tibial stress fracture

BACKGROUNDnCombinations of smaller bone geometry and greater applied loads may contribute to tibial stress fracture. We examined tibial bone stress, accounting for geometry and applied loads, in runners with stress fracture.nnnMETHODSn23 runners with a history of tibial stress fracture & 23 matched controls ran over a force platform while 3-D kinematic and kinetic data were collected. An elliptical model of the distal 1/3 tibia cross section was used to estimate stress at 4 locations (anterior, posterior, medial and lateral). Inner and outer radii for the model were obtained from 2 planar x-ray images. Bone stress differences were assessed using two-factor ANOVA (α=0.05). Key contributors to observed stress differences between groups were examined using stepwise regression.nnnFINDINGSnRunners with tibial stress fracture experienced greater anterior tension and posterior compression at the distal tibia. Location, but not group, differences in shear stress were observed. Stepwise regression revealed that anterior-posterior outer diameter of the tibia and the sagittal plane bending moment explained >80% of the variance in anterior and posterior bone stress.nnnINTERPRETATIONnRunners with tibial stress fracture displayed greater stress anteriorly and posteriorly at the distal tibia. Elevated tibial stress was associated with smaller bone geometry and greater bending moments about the medial-lateral axis of the tibia. Future research needs to identify key running mechanics associated with the sagittal plane bending moment at the distal tibia as well as to identify ways to improve bone geometry in runners in order to better guide preventative and rehabilitative efforts.

Differences in Joint-Position Sense and Vibratory Threshold in Runners With and Without a History of Overuse Injury

CONTEXTnA relationship between altered postural control and injury has been reported in sports. Sensorimotor function serves a fundamental role in postural control and is not often studied in runners. Persons who sustain running injury may have altered sensorimotor function contributing to risk of injury or reinjury.nnnOBJECTIVESnTo determine if differences in knee and ankle proprioception or plantar sensation exist between injured and noninjured runners.nnnDESIGNnRetrospective case-control study.nnnSETTINGnUniversity campus.nnnPARTICIPANTSnTwenty runners with a history of lower-extremity overuse injury and 20 noninjured runners were examined. Injured runners were subcategorized into 2 groups based on site of injury: foot/ankle and knee/hip.nnnMAIN OUTCOME MEASURESnActive absolute joint-repositioning error of the ankle at 20° inversion and 10° eversion and the knee at 15° and 40° flexion was assessed using an isokinetic dynamometer. Vibratory threshold at the calcaneus, arch, and great toe was determined for each subject using a handheld electric sensory threshold instrument.nnnRESULTSnRunners in the injured-foot/ankle group had increased absolute error during ankle-eversion repositioning (6.55° ± 3.58°) compared with those in the noninjured (4.04° ± 1.78°, P = .01) and the hip/knee (3.63° ± 2.2°, P = .01) groups. Runners in the injured group, as a whole, had greater sensitivity in the arch of the plantar surface (2.94 ± 0.52 V) than noninjured runners (2.38 ± 0.53 V, P = .02).nnnCONCLUSIONSnDifferences in ankle-eversion proprioception between runners with a history of ankle and foot injuries and noninjured runners were observed. Runners with a history of injury also displayed an increased vibratory threshold in the arch region compared with noninjured runners. Poor ankle-joint-position sense and increased plantar sensitivity suggest altered sensorimotor function after injury. These factors may influence underlying postural control and contribute to altered loading responses commonly observed in injured runners.