Changes In Lower Limb Kinematics Research Articles

Reliability of kinematic waveforms during gait analysis with total hip arthroplasty patients

PurposeThe aim of the study was to determine the test-retest reliability of lower limb kinematic waveforms derived from 3D gait analysis (3DGA) in patients following total hip arthroplasty (THA). MethodsEight (7 ​M:1F; age: 70 ​± ​7 years; height: 1.68 ​± ​0.11 ​m; mass: 85 ​± ​20 ​kg) adults with a unilateral THA attended test and retest sessions. 3DGA was undertaken with participants walking at a self-selected pace along a 7 ​m walkway within each session. The standard error or the measurement (SEM) was calculated for hip, knee and ankle joint angles in all three planes, over the walking gait cycle. ResultsThe SEM ranged from 2.9 to 4.1°, 2.7–3.7° and 1.9–3.9°, in the sagittal, frontal and traverse planes at the hip. At the knee the SEM ranged from 1.6 to 4.2°, 1.0–1.9° and 1.3–2.9° in the sagittal, frontal and transverse planes, respectively. While the SEM ranged from 0.7 to 2.0°, 1.2–2.3° and 2.9–4.0° in the sagittal, frontal and transverse planes at the ankle. ConclusionsThe findings demonstrate that 3DGA provides a reliable means of quantifying lower limb kinematics over the walking gait cycle in patients following THA, with all SEM values below the 5° threshold previously suggested to identify clinically meaningful differences. The SEM values reported may aid in the interpretation of changes in lower limb kinematics in patients following THA.

Immediate effects of hip strap and foot orthoses on self-reported measures and lower limb kinematics during functional tasks in individuals with patellofemoral osteoarthritis: protocol for a randomised crossover clinical trial

BackgroundElevated patellofemoral joint stress has been associated with patellofemoral osteoarthritis (PFOA). Changes in lower limb kinematics, such as excessive femoral adduction and internal rotation and excessive rearfoot eversion during the stance phase of functional activities, may increase patellofemoral stress. There is a lack of studies that assess the effects of interventions for controlling femur and subtalar joint movements during functional activities on self-reported measures in individuals with PFOA. Thus, the primary aim of the study is to determine the immediate effects of the hip strap and foot orthoses during level-ground walking and the single-leg squat test on self-reported outcomes. The secondary aim is to investigate whether the hip strap and foot orthoses result in the kinematic changes that these devices are purported to cause.MethodsTwenty-nine individuals with PFOA aged 50 years or older will take part in the study. The main outcome is pain intensity. The secondary outcomes are other self-reported measures (global rating of change, acceptable state of symptoms, ease of performance, and confidence) and lower limb kinematics (peak femoral adduction and internal rotation, and peak rearfoot eversion). These outcomes will be assessed during functional tasks performed under three conditions: (i) control condition, (ii) hip strap intervention, and (iii) foot orthoses intervention. To investigate whether these interventions result in the lower limb kinematic changes that they are purported to cause, three-dimensional kinematics of the femur and rearfoot will be captured during each task. Linear mixed models with two fixed factors will be used to test associations between the interventions (control, hip strap, and foot orthoses) and conditions (level-ground walking and single-leg squat test) as well as interactions between the interventions and conditions.DiscussionTo the best of the authors’ knowledge, this is the first study to evaluate the immediate effects of the hip strap and foot orthoses on self-reported measures and lower limb kinematics during functional tasks in individuals with PFOA. The findings of this study will enable future trials to investigate the effects of these interventions in rehabilitation programmes.Trial registrationClinicalTrials.gov NCT04332900. Registered on 3 April 2020.

Effects of Back-Support Exoskeleton Use on Lower Limb Joint Kinematics and Kinetics During Level Walking.

We assessed the effects of using a passive back-support exoskeleton (BSE) on lower limb joint kinematics and kinetics during level walking. Twenty young, healthy participants completed level walking trials while wearing a BSE (backXTM) with three different levels of hip-extension support torque (i.e., no torque, low, and high) and in a control condition (no-BSE). When hip extension torques were required for gait-initial 0-10% and final 75-100% of the gait cycle-the BSE with high supportive torque provided ~10 Nm of external hip extension torque at each hip, resulting in beneficial changes in participants' gait patterns. Specifically, there was a ~10% reduction in muscle-generated hip extension torque and ~15-20% reduction in extensor power. During the stance-swing transition, however, BSE use produced undesirable changes in lower limb kinematics (e.g., 5-20% increase in ankle joint velocity) and kinetics (e.g., ~10% increase in hip flexor, knee extensor, and ankle plantarflexor powers). These latter changes likely stemmed from the need to increase mechanical energy for propelling the leg into the swing phase. BSE use may thus increase the metabolic cost of walking. Whether such use also leads to muscle fatigue and/or postural instability in long-distance walking needs to be confirmed in future work.

The impact of outdoor walking surfaces on lower-limb coordination and variability during gait in healthy adults

BackgroundInter-joint coordination and variability during gait provide insight into control and adaptability of the neuromuscular system. To date, coordination research has been restricted to laboratory settings, and it is unclear how these findings translate to real-world, outdoor walking environments. Research QuestionCompared to flat walking, to what extent do outdoor surfaces impact lower-limb inter-joint coordination and variability during gait, in healthy adults? MethodsData from inertial measurement units placed on the lower-back, thigh, and shank were extracted from thirty healthy young adults (15 females, 23.5 ± 4.2 years) during outdoor walking on flat (paved sidewalk); irregular (cobblestone, grass); sloped (slope-up, slope-down); and banked (banked-right, banked-left) surfaces. Sagittal joint angles for the right knee and hip were computed and partitioned by gait phase (stance and swing). Continuous Relative Phase analysis determined inter-joint coordination and variability for the knee-hip joint pair using Mean Absolute Relative Phase (MARP) and Deviation Phase (DP), respectively. One-way repeated measures ANOVAs tested surface effects. Post-hoc Bonferroni adjusted surface comparisons were assessed. ResultsSignificant knee-hip surface effects were seen during all gait phases for MARP (p < 0.001) and DP (p ≤ 0.001). Compared to flat walking, grass prompted more in-phase coordination (smaller MARP) during stance and swing phase (p ≤ 0.003). Slope-up caused more in-phase coordination during stance (p < 0.001), while slope-down caused more out-of-phase coordination during stance and swing (p ≤ 0.003), compared to the flat surface. Sloped surfaces prompted more variable (larger DP) knee-hip coordination (p ≤ 0.001), compared to flat walking during stance and swing phase. SignificanceCompared to flat walking, changes in knee-hip coordination and variability were greatest on slope-up/slope-down surfaces. This could reflect greater changes in lower-limb kinematics on sloped surfaces and/or a neuromuscular response to the demands of a more challenging task.

Neuromechanics of Middle-Distance Running Fatigue: A Key Role of the Plantarflexors?

This study aimed to investigate the changes in lower limb kinematics, kinetics, and muscle activation during a high-intensity run to fatigue (HIRF). Eighteen male and female competitive middle-distance runners performed a HIRF on an instrumented treadmill at a constant but unsustainable middle-distance speed (~3 min) based on a preceding maximum oxygen uptake (V˙O2max) test. Three-dimensional kinematics and kinetics were collected and compared between the start, 33%, 67%, and the end of the HIRF. In addition, the activation of eight lower limb muscles of each leg was measured with surface EMG (sEMG). Time to exhaustion was 181 ± 42 s. By the end of the HIRF (i.e., vs the start), ground contact time increased (+4.0%), whereas flight time (-3.2%), peak vertical ground reaction force (-6.1%), and vertical impulse (-4.1%) decreased (all P < 0.05), and joint angles at initial contact became more (dorsi)flexed (ankle, +1.9°; knee, +2.1°; hip, +3.6°; all P < 0.05). During stance, by the end of the HIRF: peak ankle plantarflexion moment decreased by 0.4 N·m·kg-1 (-9.0%), whereas peak knee extension moment increased by 0.24 N·m·kg-1 (+10.3%); similarly, positive ankle plantarflexion work decreased by 0.19 J·kg-1 (-13.9%), whereas positive knee extension work increased by 0.09 J·kg-1 (+33.3%; both P < 0.05) with no change in positive hip extension work. Hip extensor surface EMG amplitude increased during the late swing phase (+20.9-37.3%; P < 0.05). Running at a constant middle-distance pace led primarily to the fatigue of the plantarflexors with a compensatory increase in positive work done at the knee. Improving the fatigue resistance of the plantarflexors might be beneficial for middle-distance running performance.

Improvements in skilled walking associated with kinematic adaptations in people with spinal cord injury

IntroductionIndividuals with motor-incomplete SCI (m-iSCI) remain limited community ambulators, partly because they have difficulty with the skilled walking requirements of everyday life that require adaptations in inter-joint coordination and range of motion of the lower limbs. Following locomotor training, individuals with SCI show improvements in skilled walking and walking speed, however there is limited understanding of how adaptations in lower limb kinematics following training contribute to improvements in walking.ObjectiveTo determine the relationship between changes in lower limb kinematics (range of motion and inter-joint coordination) and improvements in walking function (walking speed and skilled walking) following locomotor training.MethodsLower limb kinematics were recorded from 8 individuals with chronic m-iSCI during treadmill walking before and after a 3-month locomotor training program. Data were also collected from 5 able-bodied individuals to provide normative values. In individuals with SCI, muscle strength was used to define the stronger and weaker limb. Motion analysis was used to determine, hip, knee and ankle angles. Joint angle-angle plots (cyclograms) were used to quantify inter-joint coordination. Shape differences between pre-and post-training cyclograms were used to assess the changes in coordination and their relation to improvements in walking function. Walking function was assessed using the 10MWT for walking speed and the SCI-FAP for skilled walking. Comparing pre- and post-training cyclograms to the able-bodied pattern was used to understand the extent to which changes in coordination involved the recovery of normative motor patterns.ResultsFollowing training, improvements in skilled walking were significantly related to changes in hip-ankle coordination (ρ = − .833, p = 0.010) and knee range of motion (ρ = .833, p = 0.010) of the weaker limb. Inter-joint coordination tended to revert towards normative patterns, but not completely. No relationships were observed with walking speed.ConclusionLarger changes in hip-ankle coordination and a decrease in knee range of motion in the weaker limb during treadmill walking were related to improvements in skilled walking following locomotor training in individuals with SCI. The changes in coordination seem to reflect some restoration of normative patterns and the adoption of compensatory strategies, depending on the participant.

Is Fatigue a Risk Factor for Anterior Cruciate Ligament Rupture?

Neuromuscular fatigue is a commonly accepted risk factor for anterior cruciate ligament (ACL) injury. It has been proposed that fatigue leads to transient reductions in muscle strength, and deleterious changes in lower limb kinematics and kinetics, during potentially hazardous tasks such as cutting or landing. The purpose of this clinical commentary is to (1) highlight the complexity of fatigue; (2) discuss the theoretical basis by which it is thought to contribute to ACL injury; and (3) critically discuss the evidence underpinning this hypothesis. Despite a significant amount of research, none of the published fatigue protocols appear to have any consistent effect on any lower limb kinematic or kinetic variables known to increase ACL injury risk. On the contrary, fatigued athletes appear to land with greater peak knee and hip flexion angles, and lower landing forces than unfatigued athletes-all of which are considered favourable movement strategies for reducing ACL loading. These data support recent analyses demonstrating no relationship between player workload in training and competition and the occurrence of ACL injury in sport.

Acute Effects of Small Changes in Bicycle Saddle Height on Gross Efficiency and Lower Limb Kinematics

The aim of the present study was to assess the acute effects of small changes in bicycle saddle height on gross efficiency (GE) and lower-limb kinematics. Well-trained cyclists (n = 14) performed a submaximal pedaling test (~70-75% of the v[Combining Dot Above]O2max) at constant cadence (90 rpm). It consisted of 3 randomized sets of 6 minutes with the preferred saddle height, 2% higher and 2% lower. Gross efficiency was significantly lower and oxygen consumption (v[Combining Dot Above]O2) was significantly higher when raising the saddle (GE = 19.9 ± 1.5%; V[Combining Dot Above]O2max = 43.8 ml·kg·min) than when lowering it (GE = 20.4 ± 1.3%; V[Combining Dot Above]O2 = 42.8 ml·kg·min). Additionally, a change of 0.8% in GE (20.6 ± 1.6% to 19.8 ± 1.6%, p < 0.05) was observed when comparing the positions where the best and worst GE was obtained. A significant effect of the small changes in saddle height on lower limb kinematics was also observed (p < 0.05). The differences between lower and higher saddle positions, in hip, knee, and ankle joints were an increase of extension (~4, 7, and 8°, respectively), a decrease of flexion (~3, 4, and 4°, respectively) and, consequently, an increase of the range of movement (~1, 3, and 4°, respectively). The results of the present study indicate that small changes in saddle height affected GE and lower limb kinematics The observed changes in lower limb kinematics could justify, in part, the GE changes. Further research should evaluate long-term effects of these small modifications in the seat height on GE and lower limb kinematics.

Effects of muscle-damaging exercise on physiological, metabolic, and perceptual responses during two modes of endurance exercise

Research on submaximal endurance exercise after exercise-induced muscle damage (EIMD) has produced equivocal findings. One possible explanation for this is that the responses are likely to be sensitive to the mode of endurance exercise adopted. Therefore, this study examined the influence of exercise mode (cycling vs. running) after EIMD. Twenty-four and 48 hours after EIMD, 10 male participants were measured for perceived muscle soreness, creatine kinase (CK) activity, knee extensor strength, and physiological (V˙O2, ventilation), metabolic (blood lactate), and perceptual [rating of perceived exertion (RPE)] responses during two counterbalanced 10-minute cycling and running bouts at lactate threshold. The muscle-damaging exercise was effective (p < 0.05) in increasing muscle soreness, elevating CK activity, and decreasing knee extensor strength at 24 and 48 hours. Similarly, increases in V˙O2, ventilation, and RPE were observed during both cycling and running after EIMD (p < 0.05), while blood lactate responses remained unchanged (p > 0.05). There was an interaction of time × mode for ventilation (p < 0.05), reflecting a higher relative increase for running at 24 hours post EIMD than cycling, but not for V˙O2, RPE, or blood lactate responses. The increased V˙O2 response during running could be attributed to changes in lower limb kinematics (stride length and stride frequency) and a decreased ability to utilize the stretch-shortening cycle, while the unexpectedly increased V˙O2 cycling response might be due to the recruitment of auxiliary muscles after EIMD. It is postulated that the differences in ventilation between exercise modes are due to different stimuli activating afferent fibers post-EIMD.

The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic Individuals with a Pronated Foot Type

Clinicians frequently assess movement performance during a bilateral squat to observe the biomechanical effects of foot orthotic prescription. However, the effects of rearfoot position on bilateral squat kinematics have not been established objectively to date. This study aims to investigate these effects in a population of healthy adults with a pronated foot type.Ten healthy participants with a pronated foot type bilaterally (defined as a navicular drop >9mm) performed three squats in each of three conditions: barefoot, standing on 10mm shoe pitch platforms and standing on the platforms with foam wedges supporting the rearfoot in subtalar neutral. Kinematic data was recorded using a 3D motion analysis system. Between-conditions changes in peak joint angles attained were analysed.Peak ankle dorsiflexion (p=0.0005) and hip abduction (p=0.024) were significantly reduced, while peak knee varus (p=0.028) and flexion (p=0.0005) were significantly increased during squatting in the subtalar neutral position compared to barefoot. Peak subtalar pronation decreased by 5.33° (SD 4.52°) when squatting on the platforms compared to barefoot (p=0.006), but no additional significant effects were noted in subtalar neutral.Significant changes in lower limb kinematics may be observed during bilateral squatting when rearfoot alignment is altered. Shoe pitch alone may significantly reduce peak pronation during squatting in this population, but additional reductions were not observed in the subtalar neutral position. Further research investigating the effects of footwear and the subtalar neutral position in populations with lower limb pathology is required.

The effect of functional knee brace design and hinge misalignment on lower limb joint mechanics

Knee bracing has been shown to alter lower limb joint mechanics, which may protect the anterior cruciate ligament. The effect of brace alignment and brace type, however, remains largely unknown. This study was conducted to determine whether the use of a functional knee brace, the type of brace used or its alignment relative to the knee causes biomechanical alterations to gait. Ten healthy participants took part in two walking conditions (aligned brace and misaligned brace) for two different types of brace (sleeve brace with bilateral hinges and hinge-post-shell). A non-braced condition was included as a baseline measure. Three-dimensional kinematics and force platform data were used to calculate the joint intersegmental forces and net joint moments of the ankle, knee and hip. In comparison to non-braced walking, the shell brace in its aligned position significantly reduced the peak ankle plantarflexor moment. There was a decreased peak knee flexion angle with both the aligned shell and sleeve braces. The shell brace in its aligned position significantly increased peak knee adduction and reduced peak knee internal rotation. In this sample of healthy participants, functional knee bracing failed to alter lower limb mechanics in such a way that would reduce the force transmitted to the anterior cruciate ligament. In addition, although there were brace induced changes in lower limb kinematics with 2cm of distal hinge misalignment, it is unlikely that hinge misalignment of this magnitude is detrimental to an uninjured knee joint during walking.

Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump

The purpose of this study was to identify differences in 3D kinematics, kinetics, and ankle joint muscle activity in subjects with functional instability (FI) of the ankle joint during a drop jump. Twenty-four subjects with the subjective complaint of FI of the ankle joint and 24 noninjured control subjects performed 10 single leg drop jumps onto a force-plate. Timing and magnitude of kinetic data, timing of kinematic data, and integrated EMG (IEMG) activity of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles during two 200-ms time periods either side of initial contact (IC) with the ground were analyzed and compared between groups. Subjects with FI demonstrated a significant decrease in pre-IC peroneus longus IEMG activity, which was accompanied by a change in frontal plane movement at the ankle joint during the same time period. Following IC, FI subjects were less efficient than control group subjects in reaching the closed packed position of the ankle joint. Significant differences were seen between the groups' time-averaged and peak vertical and sagittal components of ground reaction force. The altered pre-IC peroneus longus IEMG and increased inversion of the ankle joint observed in FI subjects could help to explain why subjects with FI may suffer from inversion injury to their ankle joint when subjected to an unanticipated ground contact. The kinematic and kinetic differences observed in subjects with FI may lead to repeated injury and damage to the supporting structures of the ankle joint.