Development Of Overuse Injuries Research Articles

Classification of the foot kinematics during gait and the characteristics of the knee and hip kinematics in individuals with pronated foot

Overuse injuries are often caused by pronated foot and the associated abnormal lower-extremity kinematics during dynamic activities. Various patterns of foot kinematics are observed among individuals with pronated feet during dynamic activities, resulting in different dynamic kinematics of the proximal joint. This study aimed to identify the foot kinematic patterns during gait among individuals with pronated feet and evaluate the relationship between these foot kinematic patterns and the hip and knee kinematics. A three-dimensional motion capture system was used to collect data regarding the foot, knee, and hip kinematics during the stance phase of gait of 42 individuals with pronated feet. A hierarchical cluster analysis method was used to identify the optimal number of clusters based on the foot kinematics, including navicular height (NH) at initial contact and dynamic navicular drop (DND). The differences in the cluster and demographic variables were examined. One-dimensional statistical parametric mapping was used to evaluate the differences in the time histories of the NH, knee, and hip kinematics during the stance phase. Three subgroups were identified on the basis of the NH and DND: Cluster 1, moderate NH at initial contact and larger DND; Cluster 2, highest NH at initial contact and smaller DND; and Cluster 3, lowest NH at initial contact and smaller DND. The hip adduction angle of Cluster 1 was significantly higher than that of Cluster 3 from the 0% to 51% stance phases. Further longitudinal studies are needed to clarify the relationship between identified subgroups and the development of overuse injuries.

A novel push\u2013pull central-lever mechanism reduces peak forces and energy-cost compared to hand-rim wheelchair propulsion during a controlled lab-based experiment

BackgroundHand-rim wheelchair propulsion is straining and mechanically inefficient, often leading to upper limb complaints. Previous push–pull lever propulsion mechanisms have shown to perform better or equal in efficiency and physiological strain. Propulsion biomechanics have not been evaluated thus far. A novel push–pull central-lever propulsion mechanism is compared to conventional hand-rim wheelchair propulsion, using both physiological and biomechanical outcomes under low-intensity steady-state conditions on a motor driven treadmill.MethodsIn this 5 day (distributed over a maximum of 21 days) between-group experiment, 30 able-bodied novices performed 60 min (5 × 3 × 4 min) of practice in either the push–pull central lever wheelchair (n = 15) or the hand-rim wheelchair (n = 15). At the first and final sessions cardiopulmonary strain, propulsion kinematics and force production were determined in both instrumented propulsion mechanisms. Repeated measures ANOVA evaluated between (propulsion mechanism type), within (over practice) and interaction effects.ResultsOver practice, both groups significantly improved on all outcome measures. After practice the peak forces during the push and pull phase of lever propulsion were considerably lower compared to those in the handrim push phase (42 ± 10 & 46 ± 10 vs 63 ± 21N). Concomitantly, energy expenditure was found to be lower as well (263 ± 45 vs 298 ± 59W), on the other hand gross mechanical efficiency (6.4 ± 1.5 vs 5.9 ± 1.3%), heart-rate (97 ± 10 vs 98 ± 10 bpm) and perceived exertion (9 ± 2 vs 10 ± 1) were not significantly different between modes.ConclusionThe current study shows the potential benefits of the newly designed push–pull central-lever propulsion mechanism over regular hand rim wheelchair propulsion. The much lower forces and energy expenditure might help to reduce the strain on the upper extremities and thus prevent the development of overuse injury. This proof of concept in a controlled laboratory experiment warrants continued experimental research in wheelchair-users during daily life.

Torsional deformities and overuse injuries: what does the literature tell us.

Overuse injuries imply the occurrence of a repetitive or an increased load on a specific anatomical segment which is unable to recover from this redundant microtrauma, thus leading to an inflammatory process of tendons, physis, bursa, or bone.Even if the aetiology is controversial, the most accepted is the traumatic one.Limb malalignment has been cited as one of the major risk factors implicated in the development of overuse injuries.Many authors investigated correlations between anatomical deviations and overuse injuries, but results appear mainly inconclusive.Establishing a causal relationship between mechanical stimuli and symptoms will remain a challenge, but 3D motion analysis, musculoskeletal, and finite element modelling may help in clarifying which are the major risk factors for overuse injuries.

Personalized machine learning approach to injury monitoring in elite volleyball players

ABSTRACT We implemented a machine learning approach to investigate individual indicators of training load and wellness that may predict the emergence or development of overuse injuries in professional volleyball. In this retrospective study, we collected data of 14 elite volleyball players (mean ± SD age: 27 ± 3 years, weight: 90.5 ± 6.3 kg, height: 1.97 ± 0.07 m) during 24 weeks of the 2018 international season. Physical load was tracked by manually logging the performed physical activities and by capturing the jump load using wearable devices. On a daily basis, the athletes answered questions about their wellness, and overuse complaints were monitored via the Oslo Sports Trauma Research Center (OSTRC) questionnaire. Based on training load and wellness indicators, we identified subgroups of days with increased injury risk for each volleyball player using the machine learning technique Subgroup Discovery. For most players and facets of overuse injuries (such as reduced sports participation), we have identified personalized training load and wellness variables that are significantly related to overuse issues. We demonstrate that the emergence and development of overuse injuries can be better understood using daily monitoring, taking into account interactions between training load and wellness indicators, and by applying a personalized approach. Highlights With detailed, athlete-specific monitoring of overuse complaints and training load, practical insights in the development of overuse injuries can be obtained in a player-specific fashion contributing to injury prevention in sports. A multi-dimensional and personalized approach that includes interactions between training load variables significantly increases the understanding of overuse issues on a personal basis. Jump load is an important predictor for overuse injuries in volleyball.

Relationship of Overuse Injuries and Extrascholastic Sport Participation in High School Athletes 2009-2010 through 2015-2016.

Overuse injuries (injuries due to repetitive loads with inadequate rest) can negatively affect high school athletes, but limited data exist on the effect of sports participation outside of the school-sanctioned season on the development of overuse injuries. Compare overuse injury patterns among high school athletes who participate in extrascholastic athletics to those participating only in scholastic sports. Descriptive cross-sectional, secondary analysis of injury data collected on high school athletes across 22 sports over the 2009-2010 through 2015-2016 academic years. Deidentified data collected as part of the High School Reporting Information Online study (HS RIO). High school athletes from a large convenience sample of U.S. high schools. Injury proportion ratios (IPRs) were computed overall and for individual sports to compare the proportion of overuse injuries in athletes competing in extrascholastic sports to athletes participating only in scholastic athletics. Overall, extrascholastic athletes experienced a higher proportion of overuse injuries compared to scholastic-only athletes (IPR = 1.21, 95% confidence interval [CI] 1.13-1.30), but this association varied by sport. Among extrascholastic athletes, a higher proportion of overuse injuries occurred in those simultaneously playing the same sport outside the school setting (IPR = 1.32, 95% CI 1.11-1.57) as well as having experienced an injury within the past year (IPR = 1.63, 95% CI 1.36-1.95) compared to those sustaining non-overuse injuries. Overuse injuries were associated with extrascholastic athletics and occurred in higher proportion in extrascholastic athletes who were playing the same sport in more than one league.

Evaluation of Rock Climbing Related Injuries in Older Athletes

With the growing enthusiasm from people of all ages about rock climbing and bouldering, adaptions and medical conditions of the older athlete have become increasingly important. We aimed to analyze injury demographics, distribution, and severity for the older rock-climbing athlete. During a 3-y period, we performed a single-center injury surveillance in athletes ≥35 y of age presenting with rock climbing-related injuries or complaints. A standard questionnaire and examination protocol were conducted. A total of 198 patients (age 44.2±7.1 [35-77] y) (mean±SD, with range) with 275 independent injuries were recorded. Ninety percent of all injuries affected the upper extremity, 6% the lower extremity, and 4% other body regions. The Union Internationale des Associations d'Alpinisme injury scores were 2.0±0.3 (1-4), and no fatalities occurred. Acute injuries were observed in 32% and overuse injuries in 68% of all injuries. Among the overuse injuries, 47% were classified as degenerative overuse conditions. Athlete age did not significantly correlate with the development of overuse injuries and UIAA injury score, but subgroup analysis showed a weak correlation of the climber age with the development of degenerative conditions (P<0.05). The leading diagnosis of degenerative conditions was subacromial impingement syndrome of the shoulder. Compared to younger athletes, older rock climbers demonstrate a higher proportion of overuse injuries, especially degenerative conditions. Profound knowledge of climbing injuries patterns and conditions in older rock climbers is crucial to prevent injuries among all age groups and to decrease the number of degenerative injuries.

Occupation related differences in the thickness of metatarsal fat pads: an in vivo assessment in a young male adult population

Background: The foot combines mechanical complexities with structural strength to withstand pressure and the metatarsal fat pads play a major role in this.Methods Material: In this study, we determined the metatarsal fat pad thickness of 40 male students that constituted a control group and an age-matched 40 male auto mechanic artisans within Abakaliki metropolis, southeast Nigeria, which served as the quasi-experimental group. Evaluation was made using a brightness mode ultrasound system. Their weights, heights, foot length, foot breadth and mid foot circumference were measured.Results: Results show a significant (P&lt;0.05) difference in the mid-foot circumference and metatarsal fat pad thickness between the control (9.99±0.55cm and 2.04±0.35mm respectively) and artisans (9.58±2.0.59cm and 2.50±2.0.38mm respectively). However, there was no significant (P&gt;0.05) differences in the foot breadth and length between the control (9.86±0.84cm and 26.96±1.03cm) and artisans (10.03±0.54cm and 26.16±1.39cm).Conclusion: These findings indicate that occupation related physical activity that increases plantar pressure can induce an unprecedented thickening of the Metatarsal fat pads thereby reducing elasticity and shock absorbing ability of the fat pads. This could trigger the development of overuse injuries of the foot and plantar foot ulcers. The assessment could also serve as a guidepost in the biomechanical evaluation of the metatarsal fat pad thickness.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.245-250

Asymmetry between lower limbs during rested and fatigued state running gait in healthy individuals

Although normal gait is often considered symmetrical in healthy populations, differences between limbs during walking suggest that limbs may be used preferentially for braking or propulsion. The purpose of this study was to evaluate kinematic and kinetic variables, at both rested state and following a two-stage treadmill fatiguing run, for asymmetry between limbs. Kinematic (240Hz) and kinetic (960Hz) running data were collected bilaterally for 20 physically active individuals at both rested and fatigued states. Symmetry angles were calculated to quantify asymmetry magnitude at rested and fatigued states. Paired t-tests were used to evaluate differences between right and left limbs at rested and fatigued states, as well as rested and fatigued states symmetry angles. Variables that have been previously associated with the development of overuse injuries, such as knee internal rotation, knee stiffness, loading rate, and adduction free moment, were found to be significantly different between limbs at both rested and fatigued states. Significant differences in vertical stiffness were found, potentially indicating functional asymmetry during running. Symmetry angle was used to investigate changes in percentage of asymmetry at rested and fatigued states. Small (1–6%), but significant decreases in vertical stiffness, loading rate, and free moment symmetry angles indicate that these variables may become more symmetrical with fatigue. Knee internal rotation and knee stiffness became more asymmetrical with fatigue, increasing by 14% and 5.3%, respectively. The findings of the current study indicate that fatigue induced changes in gait may progress knee movement pattern asymmetry.

Do lower extremity kinematics and training variables affect the development of overuse injuries in runners? ‐ a prospective study

Background The incidence of running injuries appears to be multifactorial, e.g. with regard to training errors or kinematics of the lower extremity [1,2]. To date, studies examining differences between healthy and injured runners are mainly retrospective, and therefore not able to determine whether these differences are the cause or effect of injury. The goal of this prospective study is to evaluate whether the development of overuse injuries in initially healthy subjects is caused by alterations in lower extremity kinematics and/or training habits.

The influence of footwear and ankle kinematics on the development of overuse injuries in runners. A prospective study

"The influence of footwear and ankle kinematics on the development of overuse injuries in runners. A prospective study." Footwear Science, 3(sup1), pp. S72–S73

A biomechanical comparison of the running gait of mature and young females

Background Due to health and social advantages, the popularity of running among mature female runners is expanding steadily. However, the incidence of running injuries and associated conditions is vast among this group. This study aimed to quantify gait parameters of mature and younger female runners to assess whether certain running characteristics predispose to debilitating conditions. It was hypothesised that mature females would exhibit greater rearfoot eversion, knee internal rotation, knee external adductor moments and loading rate of ground reaction force when compared to younger runners. Methods Fifteen mature (40–60 years) and 15 young (18–24 years) females performed 10 running trials at 3.5 m s −1 in the biomechanics laboratory. Both kinematic and ground reaction force data were collected. Signs of osteoarthritis and knee injuries were assessed using the Knee Osteoarthritis Observation Survey (KOOS) scale. Findings Mature females produced significantly higher peak rearfoot eversion, knee internal rotation, external adductor moment and loading rate of ground reaction force compared to the young participants ( p < 0.05). Interpretations Although all participants recorded “symptom free” on the KOOS scale, all variables of gait found higher among the mature group have previously been associated with development of overuse injuries and debilitating conditions, suggesting a possible predisposition towards these conditions among the mature group.

A single gyrometer inside an instrumented running shoe allows mobile determination of gait cycle and pronation velocity during outdoor running

Excessive pronation is discussed to be a factor in the development of overuse injuries. Prolonged running has been claimed to increase pronation and pronation velocity (van Gheluwe and Madsen 1997,...

Sport injuries in the paediatric and adolescent patient: a growing problem

With an increasing number of paediatric and adolescent athletes presenting with injuries due to overuse, a greater demand is put on clinicians and radiologists to assess the specific type of injury. Repetitive forces applied to the immature skeleton cause a different type of injury than those seen in adults due to the differences in vulnerability of the musculoskeletal system, especially at the site of the growth cartilage. Intrinsic and extrinsic risk factors all play a role in the development of overuse injuries. MRI plays a key role in imaging overuse injuries due to its high potential for depicting cartilaginous and soft-tissue structures. Sport-specific biomechanics are described, since this knowledge is essential for adequate MRI assessment. An overview of several sport-related injuries is presented, based on anatomical location.

Role of extracellular matrix in adaptation of tendon and skeletal muscle to mechanical loading.

The extracellular matrix (ECM), and especially the connective tissue with its collagen, links tissues of the body together and plays an important role in the force transmission and tissue structure maintenance especially in tendons, ligaments, bone, and muscle. The ECM turnover is influenced by physical activity, and both collagen synthesis and degrading metalloprotease enzymes increase with mechanical loading. Both transcription and posttranslational modifications, as well as local and systemic release of growth factors, are enhanced following exercise. For tendons, metabolic activity, circulatory responses, and collagen turnover are demonstrated to be more pronounced in humans than hitherto thought. Conversely, inactivity markedly decreases collagen turnover in both tendon and muscle. Chronic loading in the form of physical training leads both to increased collagen turnover as well as, dependent on the type of collagen in question, some degree of net collagen synthesis. These changes will modify the mechanical properties and the viscoelastic characteristics of the tissue, decrease its stress, and likely make it more load resistant. Cross-linking in connective tissue involves an intimate, enzymatical interplay between collagen synthesis and ECM proteoglycan components during growth and maturation and influences the collagen-derived functional properties of the tissue. With aging, glycation contributes to additional cross-linking which modifies tissue stiffness. Physiological signaling pathways from mechanical loading to changes in ECM most likely involve feedback signaling that results in rapid alterations in the mechanical properties of the ECM. In developing skeletal muscle, an important interplay between muscle cells and the ECM is present, and some evidence from adult human muscle suggests common signaling pathways to stimulate contractile and ECM components. Unaccostumed overloading responses suggest an important role of ECM in the adaptation of myofibrillar structures in adult muscle. Development of overuse injury in tendons involve morphological and biochemical changes including altered collagen typing and fibril size, hypervascularization zones, accumulation of nociceptive substances, and impaired collagen degradation activity. Counteracting these phenomena requires adjusted loading rather than absence of loading in the form of immobilization. Full understanding of these physiological processes will provide the physiological basis for understanding of tissue overloading and injury seen in both tendons and muscle with repetitive work and leisure time physical activity.

Characteristic Plantar Pressure Distribution Patterns during Soccer-Specific Movements

Purpose To characterize in-shoe pressure measurements during different soccer-specific maneuvers on two playing surfaces to identify the main loading areas of the foot. Methods Twenty-one experienced male soccer players participated in the study (25.5 ± 1.8 years, 78.7 ± 5.4 kg, and 182.9 ± 5.7 cm). The Pedar Mobile system was used to collect plantar pressure information inside the soccer shoe. Four soccer-specific movements were performed (normal run, cutting maneuver, sprint, and goal shot) on both a grass and a red cinder surface. Results Results showed characteristic pressure distribution patterns with specific loading areas of the foot that correspond to the evaluated movements. In addition, loading patterns with higher pressure values than those observed during normal run were found. In cutting, the medial part of the foot; in sprinting, the first and second ray; and in kicking, the lateral part of the foot are predominantly loaded. No global effect of the two surfaces on pressure parameters was found. Conclusion The results of the present investigation suggest that the high load in soccer in combination with a high repetition may have an important influence in the development of overuse injuries.

Overuse Injuries in Young Athletes: An Overview

Of children between 5 and 17 years of age, it is estimated that more than 30 million are involved in organized athletic programs (Landry, 1992; NATA Research and Education Foundation, 2001). The extent of participation is highlighted by the fact that large numbers of children are involved with not only traditional school-based and agency-sponsored programs (Little League) but also club programs, summer camps, and personal training programs. These factors have created an environment in which many youngsters train and compete on a year-round basis, often in a single sport. Given these circumstances, it is not surprising that overuse injuries have become commonplace in children. A recent study found that 50% of injuries in children presenting to a sportsmedicine clinic were classified as overuse injuries (Watkins & Peabody, 1996). These injuries might not be self-limited; that is, they might not resolve without intervention (DiFiori, Puffer, Mandelbaum, & Mar, 1996). In addition, recovery from overuse injuries among children might take longer than recovery from acute injuries (Baxter-Jones, Mafulli, & Helms, 1993). Development of Overuse Injuries

The effects of repetitive contractions and ischemia on the ability to discriminate intramuscular sensation

In order to investigate whether repetitive, low-level, muscular contractions or ischemia affect the ability of subjects to discriminate electrical stimuli delivered to the forearm musculature, a total of 25 experiments was performed on a group of five healthy subjects utilizing signal detection methodology. EMG needle electrodes were inserted into the forearm extensor musculature and the discriminability of two different pairs of constant current electrical stimuli were measured for sequential blocks of 100 trials, before and after the experimental interventions. Repetitive muscular activity consisting of a 15-min typing intervention at a rate of 60-80 wpm using a numeric keypad led to a significant decrease in the ability to discriminate the non-noxious stimulus pair in the block of trials immediately following the typing intervention, which then returned to pre-intervention discrimination levels following a 5-min break. The forearm ischemia significantly impaired the ability to discriminate both the noxious and non-noxious stimulus pair in the blocks of trials during and immediately after ischemia, which then returned to pre-intervention discrimination levels following a 5-min break. These experiments demonstrate that both repetitive muscular activity and ischemia acutely decrease the ability to discriminate intramuscular sensation. The mechanism may be due to decreased cortical processing, spinal cord sensitization or peripheral ischemia of large diameter afferents. These findings may be relevant to the physiological mechanisms underlying the development of overuse injuries.

Exercise loading of tendons and the development of overuse injuries. A review of current literature.

This review examines recent studies on the effects of exercise on tendons in animal models. Although tendon adaptation to exercise has been described using histology, morphometry, ultrasonography and molecular biology, precise measurements of excess tendon loading during exercise protocols have not been reported. Only a few studies have attempted to evaluate the mechanical strength of exercised tendons. The long term effect of exercise on tendons appears to be positive, but researchers have suggested that periods of mechanical weakness occur in tendons during adaptation to loading conditions. Studies documenting changes associated with the terminal state of pathological tendons are also summarised. Unfortunately, there are no descriptions of tendon tissue in the early stages of overuse injury. Since blood flow is commonly implicated in the emergence of tendinitis, the final section covers recent work on blood flow and tendon physiology. Related research identifying cellular mediators (hyperthermia, hypoxia, and oxidative stress) involved in the development of tendinitis is also presented. Suggestions for further research into exercise loading and the development of tendon overuse injuries are made.