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Volume 38 (2022): Issue 4 (Aug 2022)

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A 3-Dimensional Gait Analysis of the Effects of Fatigue-Induced Reduced Foot Adductor Muscle Strength on the Walking of Healthy Subjects

Rogerio Pessoto Hirata, Alexander W. Erbs, Erik Gadsbøll, Rannvá Winther, Sanne H. Christensen, and Morten Bilde Simonsen

Dysfunction of the tibialis posterior muscle is the most common cause of adult acquired flat foot. Tibialis posterior muscle weakness has been observed in several patient populations, including those in the early stages of rheumatoid arthritis. However, the influence of tibialis posterior weakness on gait mechanics is not fully understood, although gait instability has been reported. In 24 healthy participants, 3-dimension lower limb kinematics and kinetics during walking were evaluated bilaterally, before and after, a muscle fatigue protocol aiming to decrease the right foot adductor muscles strength, including the tibialis posterior muscle. The 3-dimension gait kinematics and kinetics were analyzed with statistical parametric mapping. The stance phase duration was increased for the right side. The right ankle external rotation moment decreased, and the left hip extension moment increased with reduced muscle strength compared with normal strength conditions. These changes are similar in patients with dysfunction in the tibialis posterior muscle, indicating that compensatory strategies observed in these patients might be related to the loss of tibialis posterior muscle strength. Such strategies may involve the unaffected side.

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Does the Achilles Tendon Influence Foot Strike Patterns During an Exhaustive Run?

Jan Urbaczka, Dominik Vilimek, and Daniel Jandacka

The study purpose was to investigate whether there is a relationship between the Achilles tendon (AT) length, moment arm length, and the foot strike pattern (FP) change during an exhaustive run (EXR) in nonrearfoot FP runners. Twenty-eight runners were recruited and divided into 2 groups (highly trained/moderately trained) according to their weekly training volume. Participants underwent the graded exercise test, the EXR with biomechanical analysis at the beginning, and at the end, and the magnetic resonance imaging scan of the AT. Correlations were used to assess associations between FP change (value of the difference between end and beginning) and the selected performance and AT variables. AT length significantly correlated with the FP change according to foot strike angle (r = −.265, P = .049). The AT moment arm length significantly correlated with the FP change according to strike index during EXR (r = −.536, P = .003). Multiple regression showed that AT length was a significant predictor for the FP change according to foot strike angle if the second predictor was the graded exercise test duration and the third predictor was training group association. These results suggest that a runner’s training volume, along with a longer AT and AT moment arm appear to be associated with the ability to maintain a consistent FP during EXR by nonrearfoot FP runners.

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2021 ISB World Athletics Award for Biomechanics: The Subtalar Joint Maintains “Spring-Like” Function While Running in Footwear That Perturbs Foot Pronation

Michael J. Asmussen, Glen A. Lichtwark, and Jayishni N. Maharaj

Humans have the remarkable ability to run over variable terrains. During locomotion, however, humans are unstable in the mediolateral direction and this instability must be controlled actively—a goal that could be achieved in more ways than one. Walking research indicates that the subtalar joint absorbs energy in early stance and returns it in late stance, an attribute that is credited to the tibialis posterior muscle-tendon unit. The purpose of this study was to determine how humans (n = 11) adapt to mediolateral perturbations induced by custom-made 3D-printed “footwear” that either enhanced or reduced pronation of the subtalar joint (modeled as motion in 3 planes) while running (3 m/s). In all conditions, the subtalar joint absorbed energy (ie, negative mechanical work) in early stance followed by an immediate return of energy (ie, positive mechanical work) in late stance, demonstrating a “spring-like” behavior. These effects increased and decreased in footwear conditions that enhanced or reduced pronation (P ≤ .05), respectively. Of the recorded muscles, the tibialis posterior (P ≤ .05) appeared to actively change its activation in concert with the changes in joint energetics. We suggest that the “spring-like” behavior of the subtalar joint may be an inherent function that enables the lower limb to respond to mediolateral instabilities during running.

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Can Anthropometry be Used to Dictate Participant-Specific Thigh Marker Placements Which Minimize Error in Hip Joint Center Estimation?

Jessa M. Buchman-Pearle and Stacey M. Acker

Specific participant characteristics may be leveraged to dictate marker placements which reduce soft tissue artifact; however, a better understanding of the relationships between participant characteristics and soft tissue artifact are first required. The purpose of this study was to assess the accuracy in which measures of whole-body and thigh anthropometry could predict mislocation error of the hip joint center, tracked using skin-mounted marker clusters. Fifty participants completed squatting and kneeling, while pelvis and lower limb motion were recorded. The effect of soft tissue artifact was estimated from 6 rigid thigh marker clusters by evaluating their ability to track the position of the hip joint center most like the pelvis cluster. Eighteen backward stepwise linear regressions were performed using 10 anthropometric measures as independent variables and the mean of the peak difference between the thigh and pelvis cluster-tracked hip joint centers. Fourteen models significantly predicted error with low to moderate fit (R = .38–.67), explaining 14% to 45% of variation. Partial correlations indicated that soft tissue artifact may increase with soft tissue volume and be altered by local soft tissue composition. However, it is not recommended that marker placement be adjusted based on anthropometry alone.

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Head Kinematics in Youth Ice Hockey by Player Speed and Impact Direction

Abigail G. Swenson, Bari A. Schunicht, Nicholas S. Pritchard, Logan E. Miller, Jillian E. Urban, and Joel D. Stitzel

Hockey is a fast-paced sport known for body checking, or intentional collisions used to separate opponents from the puck. Exposure to these impacts is concerning, as evidence suggests head impact exposure (HIE), even if noninjurious, can cause long-term brain changes. Currently, there is limited understanding of the effect of impact direction and collision speed on HIE. Video analysis was used to determine speed and direction for 162 collisions from 13 youth athletes. These data were paired with head kinematic data collected with an instrumented mouthpiece. Relationships between peak resultant head kinematics and speeds were evaluated with linear regression. Mean athlete speeds and relative velocity between athletes ranged from 2.05 to 2.76 m/s. Mean peak resultant linear acceleration, rotational velocity, and rotational acceleration were 13.1 g, 10.5 rad/s, and 1112 rad/s2, respectively. Significant relationships between speeds and head kinematics emerged when stratified by contact characteristics. HIE also varied by direction of collision; most collisions occurred in the forward-oblique (ie, offset from center) direction; frontal collisions had the greatest magnitude peak kinematics. These findings indicate that HIE in youth hockey is influenced by speed and direction of impact. This study may inform future strategies to reduce the severity of HIE in hockey.

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Using Simultaneous Confidence Bands to Calculate the Margin of Error in Estimating Typical Biomechanical Waveforms

William Anderst, Shaquille Charles, Milad Zarei, Ashika Mani, Naomi Frankston, Elliott Hammersley, Gehui Zhang, MaCalus Hogan, and Robert T. Krafty

Studies of human movement usually collect data from multiple repetitions of a task and use the average of all movement trials to approximate the typical kinematics or kinetics pattern for each individual. Few studies report the expected accuracy of these estimated mean kinematics or kinetics waveforms for each individual. The purpose of this study is to demonstrate how simultaneous confidence bands, which is an approach to quantify uncertainty across an entire waveform based on limited data, can be used to calculate margin of error (MOE) for waveforms. Bilateral plantar pressure data were collected from 70 participants as they walked over 4 surfaces for an average of at least 300 steps per surface. The relationship between MOE and the number of steps included in the analysis was calculated using simultaneous confidence bands, and 3 methods commonly used for pointwise estimates: intraclass correlation, sequential averaging, and T-based MOE. The conventional pointwise approaches underestimated the number of trials required to estimate biomechanical waveforms within a desired MOE. Simultaneous confidence bands are an objective approach to more accurately estimate the relationship between the number of trials collected and the MOE in estimating typical biomechanical waveforms.

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Measures of Lower Body Strength Associated With Injuries in Australian Special Forces Selection Candidates

Tim L.A. Doyle, AuraLea C. Fain, Jodie A. Wills, Daniel Cooper, Kevin Toonen, and Benjamin Kamphius

The diverse and grueling nature of activities undertaken during Special Forces selection makes it difficult to develop physical training to improve performance and reduce injury risk. It is generally accepted that increased strength is protective against injury, but it is unclear if this is evident in a Special Forces selection environment. This study investigated the effect of the rigors of a Special Forces selection course has on performance of the isometric mid-thigh pull, countermovement jump, squat jump, drop landing, elastic utilization ratio (EUR), and injury occurrence. Throughout the course, 26% of participants sustained a preventable lower limb injury, with 65% of these occurring at the knee. The uninjured had higher values of absolute strength as measured by isometric mid-thigh pull peak absolute force (3399 [371] N, 3146 [307] N; P = .022) and lower EUR (0.94 [0.08], 1.01 [0.09]; P = .025) compared to the injured. Preventable knee injury was significantly correlated with isometric mid-thigh pull (r = −.245, P = .031) and EUR (r = .227, P = .044). The selection course altered EUR for uninjured individuals only (P = .004). Findings indicate that individuals with higher strength levels may be at a lower risk of injury than their weaker counterparts.

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The Nonintuitive Contributions of Individual Quadriceps Muscles to Patellar Tracking

Seong-won Han, Andrew Sawatsky, and Walter Herzog

The purpose of this study was to quantify the contribution of the individual quadriceps muscles to patellar tracking. The individual and/or combined quadriceps muscles were activated in rabbits (n = 6) during computer-controlled flexion/extension of the knee. Three-dimensional patellar tracking was measured for the vastus lateralis, vastus medialis, and rectus femoris when activated alone and when activated simultaneously at different frequencies, producing a range of knee extensor torques. Patellar tracking changed substantially as a function of knee extensor torque and differed between muscles. Specifically, when all quadriceps muscles were activated simultaneously, the patella shifted more medially and proximally and rotated and tilted more medially compared with when vastus lateralis and rectus femoris were activated alone (P < .05), whereas vastus medialis activation alone produced a similar tracking pattern to that observed when all quadriceps muscles were activated simultaneously. Furthermore, patellar tracking for a given muscle condition shifted more medially and proximally and rotated and tilted more medially with increasing knee extensor torques across the entire range of knee joint angles. The authors conclude that patellar tracking depends crucially on knee extensor force/torque and that vastus medialis affects patellar tracking in a distinctly different way than vastus lateralis and rectus femoris, which produce similar tracking patterns.

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Patellofemoral Joint Loading in Forward Lunge With Step Length and Height Variations

Rafael F. Escamilla, Naiquan Zheng, Toran D. MacLeod, Rodney Imamura, Shangcheng Wang, Kevin E. Wilk, Kyle Yamashiro, and Glenn S. Fleisig

The objective was to assess how patellofemoral loads (joint force and stress) change while lunging with step length and step height variations. Sixteen participants performed a forward lunge using short and long steps at ground level and up to a 10-cm platform. Electromyography, ground reaction force, and 3D motion were captured, and patellofemoral loads were calculated as a function of knee angle. Repeated-measures 2-way analysis of variance (P < .05) was employed. Patellofemoral loads in the lead knee were greater with long step at the beginning of landing (10°–30° knee angle) and the end of pushoff (10°–40°) and greater with short step during the deep knee flexion portion of the lunge (50°–100°). Patellofemoral loads were greater at ground level than 10-cm platform during lunge descent (50°–100°) and lunge ascent (40°–70°). Patellofemoral loads generally increased as knee flexion increased and decreased as knee flexion decreased. To gradually increase patellofemoral loads, perform forward lunge in the following sequence: (1) minimal knee flexion (0°–30°), (2) moderate knee flexion (0°–60°), (3) long step and deep knee flexion (0°–100°) up to a 10-cm platform, and (4) long step and deep knee flexion (0°–100°) at ground level.