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Dorsey S. Williams III, Irene S. McClay and Kurt T. Manal

Runners are sometimes advised to alter their strike pattern as a means of increasing performance or in response to injury. The purpose of this study was to compare lower extremity mechanics of rearfoot strikers (RFS), who were instructed to run with a forefoot strike pattern (CFFS) to those of a preferred forefoot striker (FFS). Three-dimensional mechanics of 9 FFS and 9 CFFS were evaluated. Peak values for most kinematic and kinetic variables and all patterns of movement were not found to be statistically different between CFFS and FFS. Only peak vertical ground reaction force and peak ankle plantarflexion moment were found to be significantly lower (p ≤ .05) in the CFFS group. This suggests that RFS are able to assume a FFS pattern with very little practice that is very similar to that of a preferred FFS. The impact of changing one's strike pattern on injury risk and running performance needs further study.

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Joseph F. Seay, Peter N. Frykman, Shane G. Sauer and David J. Gutekunst

During group marches, soldiers must walk in step with one another at the same imposed cadence. The literature suggests that shorter trainees may be more susceptible to injury due to overstriding that can occur when taller recruits dictate marching cadence. This study assessed the effects of fixed cadence simulated marching at cadences above and below preferred step rate (PSR) on lower extremity joint mechanics in individuals who were unaccustomed to marching. During three separate visits, 13 volunteers walked with a 20 kg load on a force-sensing treadmill at self-selected PSR, PSR+15% (shorter strides), and PSR–15% (longer strides) at 1.3 m/s for 60 min. Two-way RM ANOVAs (cadence by time) were performed during the stance phase. Ranges of motion and anteroposterior ground reaction force increased significantly as cadence decreased (P < .03). Knee extension moment increased slightly when step rate decreased from PSR+15% (shortest strides, 0.85 ± 0.2 N m/kg) to PSR (0.87 ± 0.3 N m/kg, 3% increase); however, this increase was substantially greater (20% increase) when cadence was decreased from PSR to PSR–15% (longest strides, 1.09 ± 0.3 N m/kg). Our results indicate that overstriding during fixed-cadence marching is a factor that can substantially increase mechanical stress on lower extremity joints.

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Anthony S. Kulas, Randy J. Schmitz, Sandra J. Shultz, Mary Allen Watson and David H. Perrin

Although leg spring stiffness represents active muscular recruitment of the lower extremity during dynamic tasks such as hopping and running, the joint-specific characteristics comprising the damping portion of this measure, leg impedance, are uncertain. The purpose of this investigation was to assess the relationship between leg impedance and energy absorption at the ankle, knee, and hip during early (impact) and late (stabilization) phases of landing. Twenty highly trained female dancers (age = 20.3 ± 1.4 years, height = 163.7 ± 6.0 cm, mass = 62.1 ± 8.1 kg) were instrumented for biomechanical analysis. Subjects performed three sets of double-leg landings from under preferred, stiff, and soft landing conditions. A stepwise linear regression analysis revealed that ankle and knee energy absorption at impact, and knee and hip energy absorption during the stabilization phases of landing explained 75.5% of the variance in leg impedance. The primary predictor of leg impedance was knee energy absorption during the stabilization phase, independently accounting for 55% of the variance. Future validation studies applying this regression model to other groups of individuals are warranted.

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Wolfgang Potthast, Gert-Peter Brüggemann, Arne Lundberg and Anton Arndt

The purpose of this study was to quantify relative contributions of impact interface, muscle activity, and knee angle to the magnitudes of tibial and femoral accelerations occurring after external impacts. Impacts were initiated with a pneumatically driven impacter under the heels of four volunteers. Impact forces were quantified with a force sensor. Segmental accelerations were measured with bone mounted accelerometers. Experimental interventions were hard and soft shock interfaces, different knee angles (0°, 20°, 40° knee flexion), and muscular preactivation (0%, 30%, 60% of maximal voluntary contraction) of gastrocnemii, hamstrings, and quadriceps. Greater knee flexion led to lower impact forces and higher tibial accelerations. Increased muscular activation led to higher forces and lower tibial accelerations. The softer of the two shock interfaces under study reduced both parameters. The effects on accelerations and forces through the activation and knee angle changes were greater than the effect of interface variations. The hardness of the two shock interfaces explained less than 10% of the variance of accelerations and impact forces, whereas knee angle changes explained 25–29%, and preactivation changes explained 35–48% of the variances. It can be concluded that muscle force and knee joint angle have greater effects in comparison with interface hardness on the severity of shocks on the lower leg.

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Kathy J. Simpson, Jae P. Yom, Yang-Chieh Fu, Scott W. Arnett, Sean O’Rourke and Cathleen N. Brown

The objective of the study was to determine if prophylactic ankle bracing worn by females during landings produces abnormal lower extremity mechanics. Angular kinematic and ground reaction force (GRF) data were obtained for 16 athletically experienced females who performed brace and no-brace drop landings. The brace condition displayed reduced in/external rotation and flexion displacements about the ankle and knee joints and increased vertical and mediolateral GRF peak magnitudes and rate of vertical GRF application (paired t test, P < .05). The ankle and knee joints landed in a less plantar flexed and more flexed position, respectively. No significant ab/adduction outcomes may have occurred due to interparticipant variability and/or a lack of brace restriction. Conclusion: During typical landings, this lace-up brace increases vertical GRF, decreases ankle and knee joint displacements of flexion and int/external rotation, but minimally affects ab/adduction displacements.

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Dorsey S. Williams III, Irene S. McClay, Joseph Hamill and Thomas S. Buchanan

High- and low-arched feet have long been thought to function differently. The purpose of this study was to investigate the relationship between arch structure and lower extremity mechanics in runners with extreme pes planus and pes cavus. It was hypothesized that low-arched individuals would exhibit an increased rearfoot eversion excursion, eversion/tibial internal rotation ratio, and increased angular velocity in rearfoot eversion when compared to high-arched runners. In addition, it was hypothesized that high-arched runners would exhibit greater vertical loading rates. Twenty high-arched and 20 low-arched runners with histories of running-related injuries were included in this study. Low-arched runners were found to have increased rearfoot eversion excursion, eversion to tibial internal rotation ratio, and rearfoot eversion velocity. High-arched runners had increased vertical loading rate when compared to low-arched runners. These results suggest that arch structure is associated with specific lower extremity kinematics and kinetics. Differences in these parameters may subsequently lead to differences in injury patterns in high-arched and low-arched runners.

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Jessie M. Huisinga, Kendra K. Schmid, Mary L. Filipi and Nicholas Stergiou

Multiple sclerosis (MS) causes severe gait problems in relatively young individuals, yet there have been limited studies to quantitatively identify the specific gait parameters that are affected. The purpose of this study was to define any differences in biomechanical gait parameters between patients with MS and healthy controls. A total of 31 MS patients and 31 healthy controls were evaluated: joint torques and joint powers were calculated at the ankle, knee, and hip during the stance phase of gait. The self-selected walking velocity was used as a covariate in the analysis to ensure that group differences were not due to differences in walking velocity between the MS and healthy control groups. Reduced angular range, less joint torque, and reduced joint power were seen in patients with MS. We also found significant correlations between biomechanical gait parameters and EDSS score, which provides a clinical rating of disease severity. Our findings provide a quantitative assessment of the gait mechanics employed in patients with MS. The altered lower extremity mechanics observed in patients with MS reflect both a neurological and strength deficit compared with healthy controls during walking.

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Anh-Dung Nguyen, Emma F. Zuk, Andrea L. Baellow, Kate R. Pfile, Lindsay J. DiStefano and Michelle C. Boling

Context:

Risk of anterior cruciate ligament (ACL) injuries in young female athletes increases with age, appearing to peak during maturation. Changes in hip muscle strength and range of motion (ROM) during this time may contribute to altered dynamic movement patterns that are known to increase risk of ACL injuries. Understanding the longitudinal changes in hip strength and ROM is needed to develop appropriate interventions to reduce the risk of ACL injuries.

Objective:

To examine the longitudinal changes in hip strength and ROM in female youth soccer players.

Design:

Longitudinal descriptive study.

Setting:

Field setting.

Participants:

14 female youth soccer athletes (14.1 ± 1.1 y, 165.8 ± 5.3 cm, 57.5 ± 9.9 kg) volunteered as part of a multiyear risk factor screening project.

Main Outcome Measures:

Clinical measures of hip strength and ROM were collected annually over 3 consecutive years. Passive hip internal rotation (IR), external rotation (ER), abduction (ABD), and adduction (ADD) ROM were measured with a digital inclinometer. Isometric hip ABD and extension (EXT) strength were evaluated using a hand-held dynamometer. Separate repeated-measures ANOVAs compared hip strength and ROM values across 3 consecutive years (P < .05).

Results:

As youth female soccer players increased in age, there were no changes in normalized hip ABD (P = .830) or EXT strength (P = .062) across 3 consecutive years. Longitudinal changes in hip ROM were observed with increases in hip IR (P = .001) and ABD (P < .001), while hip ADD (P = .009) and ER (P < .001) decreased.

Conclusions:

Anatomical changes at the hip occur as youth female soccer players increase in age. While there are no changes in hip strength, there is an increase in hip IR and ABD ROM with a concomitant decrease in hip ER and ADD ROM. The resulting asymmetries in hip ROM may decrease the activation and force producing capabilities of the hip muscles during dynamic activities, contributing to altered lower extremity mechanics known to increase the risk of ACL injuries.

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Deborah L. King and Barbara C. Belyea

Context: Landing kinematics have been identified as a risk factor for knee injury. Detecting atypical kinematics in clinical settings is important for identifying individuals at risk for these injuries. Objective: To determine the reliability of a handheld tablet and application (app) for measuring lower-extremity kinematics during drop vertical-jump landings. Design: Measurement reliability. Setting: Laboratory. Participants: 23 healthy young adults with no lower-extremity injuries and no contraindications for jumping and landing. Intervention: Subjects performed 6 drop vertical jumps that were captured with an iPad2 and analyzed with a KinesioCapture app by 2 novice and 2 experienced raters. Three trials each were captured in the frontal and sagittal planes. Main Outcome Measures: Frontal-plane projection angles, knee flexion, and hip flexion at initial contact and maximum knee flexion were measured. ICC and SEM were calculated to determine intertrial and interrater reliability. One-way ANOVAs were used to examine differences between the measured angles of the raters. Results: Average intertrial reliability ranged from .71 to .98 for novice raters and .77 to .99 for experienced raters. SEMs were 2.3-4.3° for novice raters and 1.6-3.9° for experienced raters. Interrater ICC2,1 was .39-.98 for the novice raters and .69-.93 for the experienced raters. SEMs were smallest with the experienced raters, all less than 1.5°. Conclusion: A handheld tablet and app is promising for evaluating landing kinematics and identifying individuals at risk for knee injury in a clinical setting. Intertrial reliability is good to excellent when using average trial measures. Interrater reliability is fair to excellent depending on experience level. Multiple trials should be assessed by a single rater when assessing lower-extremity mechanics with a handheld tablet and app, and results may vary with experience level or training.

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Rumit S. Kakar, Hilary B. Greenberger and Patrick O. McKeon

Context: Anterior knee pain also known as patellofemoral pain syndrome is a frequently encountered musculoskeletal disorder that worsens with activity. The multifactorial etiology of patellofemoral pain syndrome alters lower-extremity mechanics, increasing patellofemoral joint stresses during weight-bearing tasks. Kinesio and McConnell tapings are often incorporated into the treatment, but their efficacy is still unclear. Objective: To test the efficacy of Kinesio taping, McConnell taping, and sham taping in improving knee mechanics and reducing pain during activity. Design: Cross-sectional design. Setting: Clinical biomechanics laboratory. Participants: Ten participants (age: 20.3 [1.5] y, height: 169.9 [10.4] cm, and mass: 70.17 [13.1] kg) with anterior knee pain and no history of trauma. Intervention: Three trials each of squat, drop jump, and step-down tasks with 3 taping conditions in a counterbalanced order. Main Outcome Measures: Two-dimensional motion capture data of lower-extremities in frontal and sagittal planes were recorded and analyzed using 3 iPads and Spark Motion® application. Pooled effect sizes (Hedges’ g), 95% confidence intervals, and repeated-measures analysis of variance (P < .05) compared baseline and taping conditions during exercises for pain Visual Analog Scale and knee flexion in all exercises, hip abduction during step-down and drop jump, frontal plane projection during step-downs, and knee translation in sagittal plane during squats. Results: Significant reductions in Visual Analog Scale were recorded during squats between tapes (F 2.505,12.867 = 3.407, P = .04, Hedges’ g = −0.70). Pairwise comparison showed a decrease in Visual Analog Scale for sham taping (mean difference = 1.14 cm, P = .01) and Kinesio taping (mean difference = 1.54 cm, P = .02) compared with baseline during squats. Conclusions: A variety of taping methods can potentially reduce perceived pain in individuals with patellofemoral pain syndrome, allowing clinicians to perform rehabilitation exercises. Sensory effects associated with short-term taping may be sufficient enough to modify knee pain acutely by afferent input blocking nocioceptive pain before the participants could adapt. Most interestingly, the sham taping technique demonstrated promise for enhancing functional outcomes, depending on the length of the tape and area covered.