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John D. Willson and Irene S. Davis

Context:

Lower extremity (LE) weakness might be associated with altered mechanics during weight bearing in subjects with patellofemoral pain syndrome (PFPS).

Objective:

To analyze LE strength, mechanics, and the association between these variables among women with and without PFPS during a simulated athletic task.

Design:

Case control.

Setting:

Motion-analysis laboratory.

Subjects:

20 women with PFPS and 20 healthy women.

Main Outcome Measures:

Peak isometric lateral trunk-flexion, hip-abduction, hip external-rotation, knee-flexion, and knee-extension strength, as well as hip- and knee-joint excursions and angular impulses during single-leg jumps.

Results:

PFPS subjects produced less hip-abduction, hip external-rotation, and trunk lateral-flexion force than the control group. The PFPS group also demonstrated greater hip-adduction excursion and hip-abduction impulses. The association between the strength measurements and LE mechanics was low.

Conclusions:

Women with PFPS demonstrate specific weaknesses and altered LE mechanics. Weakness is not, however, highly correlated with observed differences in mechanics.

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Daniel J. Petit, John D. Willson, and Joaquin A. Barrios

Efforts to compare different surface marker configurations in 3-dimensional motion analysis are warranted as more complex and custom marker sets become more common. At the knee, different markers can been used to represent the proximal shank. Often, two anatomical markers are placed over the femoral condyles, with their midpoint defining both the distal thigh and proximal shank segment ends. However, two additional markers placed over the tibial plateaus have been used to define the proximal shank end. For this experiment, simultaneous data for both proximal shank configurations were independently collected at two separate laboratories by different investigators, with one laboratory capturing a walking population and the other a running population. Common discrete knee joint variables were then compared between marker sets in each population. Using the augmented marker set, peak knee flexion after weight acceptance was less (1.2−1.7°, P < .02) and peak knee adduction was greater (0.7−1.4°, P < .001) in both data sets. Similarly, the calculated peak knee flexion moment was less by 15–20% and internal rotation moment was greater by 11–18% (P < .001). These results suggest that the calculation of knee joint mechanics are influenced by the proximal shank’s segment endpoint definition, independent of dynamic task, investigator, laboratory environment, and population in this study.

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Andrew R. Boldt, John D. Willson, Joaquin A. Barrios, and Thomas W. Kernozek

We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

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Sarah A. Roelker, Paul DeVita, John D. Willson, and Richard R. Neptune

Skipping has been proposed as a viable cross-training exercise to running due to its lower knee contact forces and higher whole-body energy expenditure. However, how individual muscle forces, energy expenditure, and joint loading are affected by differences in running and skipping mechanics remains unclear. The purpose of this study was to compare individual muscle forces, energy expenditure, and lower extremity joint contact forces between running and skipping using musculoskeletal modeling and simulations of young adults (n = 5) performing running and skipping at 2.5 m·s−1 on an instrumented treadmill. In agreement with previous work, running had greater knee and patella contact forces than skipping which was accompanied by greater knee extensor energetic demand. Conversely, skipping had greater ankle contact forces and required greater energetic demand from the uniarticular ankle plantarflexors. There were no differences in hip contact forces between gaits. These findings further support skipping as a viable alternative to running if the primary goal is to reduce joint loading at the commonly injured patellofemoral joint. However, for those with ankle injuries, skipping may not be a viable alternative due to the increased ankle loads. These findings may help clinicians prescribe activities most appropriate for a patient’s individual training or rehabilitation goals.

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Gabriel Andrade Paz, Marianna de Freitas Maia, Haroldo Gualter Santana, Humberto Miranda, Vicente Lima, and John D. Willson

Study Design: Observational study. Context: Altered frontal plane knee mechanics during dynamic tasks have been often associated with lower-extremity injuries. Strategies to decrease these risk factors and improve knee joint stability are often applied in rehabilitation and training environments. Objective: The purpose of this study was to compare knee joint frontal plane projection angles (FPPA) via 2-dimensional video analysis during drop vertical jump (DVJ) and step-down test (SDT) tasks in the preferred and nonpreferred limbs of young male and female volleyball players. Methods: A total of 60 young male (n = 29) and female (n = 31) volleyball players (13.6 [1.1] y, 62.2 [11.2] kg, and 170.8 [10] cm) participated in this study. Once the athletes were screened for inclusion and exclusion criteria, limb preference was operationally defined as the preferred kicking leg or the foot used for stair climbing. In a randomized study design, participants were asked to perform a bilateral DVJ and unilateral step-down landing tasks for both preferred and nonpreferred limb. Kinematic analysis was performed via a 2-dimensional video recording of knee joint FPPA alignment. Results: No difference was noted in FFPA during DVJ and SDT tasks between preferred and nonpreferred limbs in both male and female groups (P > .05). The FFPA was significantly higher for both limbs during DVJ versus SDT in both groups (P ≤ .05), but it was not different between male and female athletes. Conclusions: Based on these findings, clinicians may expect young male and female volleyball athletes to demonstrate similar and symmetrical lower-extremity 2-dimensional knee joint FPPA values across screening tests intended to identify lower-extremity injury risk factors. However, greater FPPA values should be expected during the more dynamic DVJ task.