Extremity Kinematics Research Articles

Lower Extremity Kinematic Waveform Analysis During a Single Leg Drop Task – A Single Subject Approach

Lower Extremity Kinematic Waveform Analysis During a Single Leg Drop Task – A Single Subject Approach

Feasibility of a real-time pattern-based kinematic feedback system for gait retraining in pediatric cerebral palsy.

IntroductionVisual biofeedback of lower extremity kinematics has the potential to enhance retraining of pathological gait patterns. We describe a system that uses wearable inertial measurement units to provide kinematic feedback on error measures generated during periods of gait in which the knee is predominantly extended (‘extension period’) and flexed (‘flexion period’).MethodsWe describe the principles of operation of the system, a validation study on the inertial measurement unit derived knee flexion angle on which the system is based, and a feasibility study to assess the ability of a child with cerebral palsy to modify a gait deviation (decreased swing phase knee flexion) in response to the feedback.ResultsThe validation study demonstrated strong convergent validity with an independent measurement of knee flexion angle. The gait pattern observed during training with the system exhibited increased flexion in the flexion period with maintenance of appropriate extension in the extension period.ConclusionsInertial measurement units can provide robust feedback during gait training. A child with cerebral palsy was able to interpret the novel two phase visual feedback and respond with rapid gait adaptation in a single training session. With further development, the system has the potential to support clinical retraining of deviated gait patterns.

Hip function and lower extremity kinematics during pitching motion are associated with medial elbow injury: A prospective cohort study of preadolescent baseball pitchers

Hip function and lower extremity kinematics during pitching motion are associated with medial elbow injury: A prospective cohort study of preadolescent baseball pitchers

Kinematic cluster analysis of the crouch gait pattern in children with spastic diplegic cerebral palsy using sparse K-means method

BackgroundCrouch gait pattern is a common gait pattern in children with diplegic cerebral palsy with excessive knee flexion throughout stance phase. Few studies have grouped this pattern of gait and usually have examined only the features of gait in the sagittal plane and mostly lower extremities without considering pelvis and trunk behavior. Studies usually categorize the gait pattern according to important variables from the researcher's point of view.Sparse K-means is high dimensional clustering methods that perform clustering and variable selection simultaneously even with low sample size and large number of variables. Our aim was to define existing clusters of crouch gait pattern in children with spastic diplegic cerebral palsy. MethodsCluster analysis was applied on the lower extremity, pelvis and trunk gait kinematics data of 64 limbs of children with crouch gait pattern and 64 limbs of typically developing children. Eighty-nine kinematic variables were used as input variables for clustering. FindingsFour clusters of crouch gait pattern were defined. Sparse K-means identified influential variables and identified the knee and hip flexion as a major factor in clustering. Kinematic of the trunk, pelvis and ankle was determined in each cluster. Trunk and pelvis kinematic features were strongly correlated with the knee and hip joint flexion severity. InterpretationObtained clusters were confirmed observationally. With increasing knee flexion, the kinematic of the trunk and pelvis were further away from the patterns of typically developing individuals. The clusters ranking appear to be reasonable based on the crouch severity.

Internal and external focus show similar effect on the gait kinematics in patients with patellofemoral pain: A randomised controlled trial

PurposeThe purpose of this study was to examine how attentional focus during training influences the effects of a 6-week hip-knee strength training program on pain, function, strength, and kinematics in males and females with Patellofemoral pain (PFP). MethodsSeventy-five males and females with PFP were randomly allocated to a group that trained with an internal focus (n = 25), a group that trained with an external focus (n = 25), or a control group (n = 25). All patients completed testing before (baseline) and after (posttest) the 6-week period. The primary outcome was pain, assessed by Visual Analog Scale (VAS). The secondary outcomes were function, hip muscles strength and lower extremity kinematics, assessed by Kujala Questionnaire, handheld dynamometer and a 2-D motion capture, respectively. All outcomes were measured at the baseline and after the 6-week intervention. Analysis of covariance was used to compare posttest outcomes among the groups while accounting for group differences in baseline performance. ResultsThe hip-knee strengthening exercises resulted in improved knee valgus (ES(95 % CI) = 0.43(0.26 to 0.75), p = 0.03), and external rotator strength (ES(95 % CI) = 0.51(0.12 to 0.78), p = 0.03) for males and females who trained with an external compared to internal focus. ConclusionsOur findings indicate that males and females with PFP may benefit from completing a hip-knee strengthening training program with an external focus vs. an internal focus. Physical therapists and clinicians should consider using instructions that promote an external focus when implementing hip-knee strengthening training programs with PFP patients. This result could be strengthened or re-enforced by larger studies with longer follow up.

Lower Extremity Pain and Pitching Kinematics and Kinetics in Collegiate Softball Pitchers

The primary aims of the study were (1) to examine kinematics and kinetics of those pitching with and without lower extremity pain in collegiate softball pitchers, and (2) to determine if there was an association between the lower extremity pain and lower extremity kinematics, trunk kinematics, and shoulder kinetics in collegiate softball pitchers. Thirty-seven NCAA Division I female collegiate softball pitchers (19.8±1.3 yrs,173.7±7.7 cm, 79.0±12.4 kg) participated. Participants were divided into two groups, those who were currently experiencing lower extremity pain and those who were not. Participants threw three rise ball pitches. Kinematic data were collected at 100 Hz using an electromagnetic tracking system. Mann-Whitney U tests revealed no significant kinematic or kinetic differences between pitchers with and without lower extremity pain. Additionally, there were no significant correlations between pain and recorded kinematic and kinetic variables. Considering there were no biomechanical differences observed between pitchers, coaches and athletic trainers should take caution with athlete assessment since athletes may not display altered biomechanics. Further examination into the duration and degree of pain is needed in an attempt to fully understand the implication of pain and pitching mechanics.

EFFECTS OF SURFACE ON TRIPLE HOP DISTANCE AND KINEMATICS.

The single leg triple hop (SLTH) test is often utilized by rehabilitation practitioners as a functional performance measure in a variety of patient groups. Accuracy and consistency are important when measuring the patient progress and recovery. Administering the SLTH test on different surfaces, consistent with the patient's sport, may affect the hop distances and movement biomechanics. The purpose of this study was to examine the effects of court and turf surfaces on the hop distance, limb symmetry index (LSI), and lower extremity kinematics of a SLTH test. Recreationally active female participants (n=11, height 163.8 ± 7.1cm, mass 63.1 ± 7.1kg, age 18.9 ± 0.9yrs), without injury, volunteered to participate in the study. Three maximal effort SLTH test trials on two different surfaces (court, synthetic turf) were collected and analyzed using 3D motion analysis techniques. Outcome variables included SLTH test distances and LSI values and sagittal plane kinematics including trunk, hip, knee and ankle range of motion (ROM) during the last two landings of each SLTH test trial. The second landing involves an absorption phase and propulsion phase in contrast to the final landing which involves absorption and final balance on the single leg. Paired t-tests were used to determine differences between surfaces in hop distance and LSI values. Two-way repeated measures ANOVA were used to determine differences between surfaces in kinematic variables. The total SLTH test distance was not statistically different between the court (4.11 ± 0.47m) and turf (4.03 ± 0.42m, p=0.47) surfaces. LSI for the court surface was 100.8 ± 3.0% compared to 99.7 ± 3.0% for turf surface, which was not statistically different (p=0.30). Knee flexion ROM was significantly less (p=0.04) on the turf compared to the court surface during the second landing. Ankle flexion range of motion was also significantly less (p=0.03) during the second landing on turf compared to court. Type of surface influenced landing kinematics but not total SLTH test distance. When evaluating the quality of landings during a SLTH test, it may be warranted to observe each type of landing and the type of surface used during single leg tests. 2.

Type of unanticipated stimulus affects lower extremity kinematics and kinetics during sidestepping

ABSTRACT Including an unanticipated stimulus has significant impacts on lower extremity biomechanics during dynamic movements. It is unknown how a live, human defender affects lower extremity biomechanics. The purpose of this study was thus to determine the effects of two types of unanticipated stimuli (visual stimulus; defensive opponent) on lower extremity kinematics and kinetics in males and females during 45° sidestepping trials. Eight males and eight females completed two unanticipated stimuli sidestepping conditions. Numeric visual analog scales for reaction difficulty and movement realism were collected and analysed using a 2 × 2 mixed-model ANOVA. Three-dimensional hip, knee, and ankle kinematics and kinetics were measured during the stance phase of the sidestep and analysed using statistical parametric mapping. Participants reported greater difficulty and less realistic movements with the visual stimulus. Unanticipated stimulus main effects were observed for knee abduction angle, and hip extension and adduction, and knee extension and adduction moments. Sex main effects were observed for hip flexion, hip abduction, and ankle dorsiflexion angles, as well as hip abduction, ankle plantarflexion and ankle eversion moments and vertical ground reaction forces. Participants responded differently to two unanticipated stimuli. Careful consideration should be used when determining the type of unanticipated stimulus used.

Lower Extremity Kinematic and Kinetic Asymmetries during Running.

The primary aims of this investigation were to describe the magnitude of asymmetries of common variables during running among healthy athletes and to determine if sex and speed influence magnitudes of asymmetry. This study analyzed routinely collected running gait data on healthy Division I collegiate athletes. All athletes had no history of lower extremity surgery, no lower extremity injuries for 3 months before testing, and running data available at 2.68, 2.95, 3.35, 3.80, and 4.47 m·s-1. Asymmetries were calculated for ground reaction forces, spatiotemporal metrics, joint kinematics, and joint kinetics. Separate linear mixed-effects models assessed the influence of sex, speed, and the interaction on asymmetries of interest. z Scores were calculated for significant effects to further assess the magnitude of differences. Results from 204 athletes were included. The magnitude of asymmetry varied depending on the variable of interest, with asymmetries ≤3° observed for joint kinematics and greater asymmetries observed among joint work asymmetries ranging from 10% to 40%. No significant interactions between sex and speed were observed. Differences in sex and speed were noted; however, the effect sizes were very small based on z score comparison (-0.17 ≤ z ≤ 0.36) and were unlikely to be meaningful. The magnitude of asymmetry varies considerably depending on the running gait variable. Interpretation of between-limb asymmetry in running mechanics needs to be specific to the variable of interest, whereas sex or running speed seem to be minor factors.

Extreme kinematic misalignment in IllustrisTNG galaxies: the origin, structure, and internal dynamics of galaxies with a large-scale counterrotation

ABSTRACT We provide an in-deep analysis of 25 galaxies with substantial counterrotation from IllustrisTNG100 simulations in the stellar mass range 2×109−3×1010 M⊙. The counterrotation is a result of an external gas infall ≈2–8 Gyr ago. The infall leads to the removal of pre-existing gas, which is captured and mixed together with the infalling component. This mixture ends up in the counterrotating gaseous disc where ${\approx}90{{\ \rm per\ cent}}$ of counterrotating stars formed in-situ. During the early phases of the infall, gas can be found in extended structures which, in some galaxies, are similar to (nearly-) polar ring-like components. We suggest that the AGN activity does not cause the counterrotation, although it is efficiently triggered by the retrograde gas infall, and it correlates well with the misaligned component appearance. We also find the vertical-to-radial velocity dispersion ratio above unity implying the importance of misalignment in shaping the velocity ellipsoids.

Biceps Tendon Changes and Pitching Mechanics in Youth Softball Pitchers.

With the lack of pitch count regulation, youth softball pitchers are experiencing unremitting high stresses on the anterior shoulder. The purpose of this study was to examine the association of acute changes in the long head of the biceps tendon with pitching kinematics and kinetics in youth softball pitchers following an acute bout of pitching. Twenty-three softball pitchers (12.17±1.50 yrs.; 160.32±9.41 cm; 60.40±15.97 kg) participated. To investigate the association between biceps tendon changes and kinematic and kinetic changes from pre- to post-simulated game, each biceps tendon measure was split into those whose biceps tendon thickness, width, and/or area increased pre- to post-simulated game, and those whose did not. There were significant differences in biceps tendon longitudinal thickness (Z=- 2.739, p=0.006) and pitch speed; as well as a difference between groups in biceps tendon transverse thickness and the amount of change in trunk rotation at the start of the pitching motion (p=0.017) and the amount of change in trunk flexion at ball release (p=0.030). This study illustrates the association of trunk and lower extremity kinematics and shoulder kinetics with morphologic changes in the biceps tendon with an acute bout of windmill softball pitching.

Comparison of Center of Pressure and Kinematic Differences in Grand Plié With and Without the Barre.

The purpose of this study was to determine what differences exist when performing grand plié with and without the barre. Differences in center of pressure (COP) sway, trunk kinematics, and lower extremity kinematics were used in this analysis for both first (P1) and fifth positions (P5). It was hypothesized that use of the barre would result in decreased COP sway, but increased asymmetries in trunk and lower extremity kinematics would be seen compared with the same movements performed without the barre in both positions. Sixteen collegiate dancers (1 male, 15 female) performed three trials of grand plié in P1 and P5 (right leg crossed in front) with or without the barre, for a total of 12 trials. For the barre condition (BC), participants demonstrated less time to complete grand plié, slightly less depth in grand plié, and decreased anterior-posterior (AP) sway compared to the without barre condition (WBC). The BC condition showed increased peak left trunk rotation, right knee flexion, decreased right and left peak hip flexion, and increased right hip abduction in both P1 and P5. Comparing P1 to P5, there was decreased AP sway, decreased peak left trunk rotation, decreased peak right and left hip flexion, increased left hip abduction, and decreased right knee flexion in both BC and WBC conditions. For the BC, there was increased right hip abduction in P1 compared to P5. Our results indicate that while use of the barre provides proprioceptive information, which helps dancers to control balance and learn a motor control strategy, grand plié should also be taught without the barre to challenge the dancer's balance control with different movement patterns in space.

Influence of heel design on lower extremity biomechanics and comfort perception in overground running

ABSTRACT The study investigated whether an alteration of the shoe heel curvature would influence lower extremity biomechanics and comfort perception in running. Twenty recreational habitual rearfoot strikers performed five running trials in running shoes with three different heel curvature designs (short-parallel, long-parallel and oblique curvatures). Synchronised force plate and motion capturing systems were used to collect three-dimensional lower extremity joint kinetics and kinematics, followed by subjective comfort perception on the 15 cm Visual Analogue Scale. The results showed that participants wearing oblique and long-parallel curvature shoes exhibited larger initial frontal shoe-ground angle (p= 0.003, p= 0.016) and ankle inversion angle (p= 0.008, p= 0.032) as well as higher maximum sagittal foot slap velocity (p= 0.041, p = 0.011) compared with a short-parallel curvature shoe. When wearing the short-parallel curvature shoe, participants had better rearfoot stability perception than the oblique curvature shoes (p = 0.028). These results suggest that the short parallel curvature shoes had better motion control and stability perception than the other two curvature conditions. However, the design of heel curvature seems to have minimal influence on the cushioning related variables in running.

Crouch gait or flexed-knee gait in cerebral palsy – Is there a difference? A systematic review

Flexed knee gait is a common gait dysfunction in individuals with bilateral spastic cerebral palsy (BSCP) and is often addressed with single event multilevel surgery (SEMLS). SEMLS has been shown to have positive short-term effects especially on sagittal knee joint kinematics with less knee flexion during stance phase. However, mid- and long-term observations are rare, and results are reported in discrete parameters or summary statistics where temporal aspects are not considered.Does the improved knee joint kinematics after patellar tendon shortening (PTS) as part of SEMLS persist in the long-term in individuals with BSCP?Data of instrumented gait analysis of twelve participants (females/males: 5/7, mean age: 15.3 ± 3.4 years) with BSCP treated with PTS as part of SEMLS were retrospectively analyzed. Participants had had follow-up gait analysis 1, 5 and 7 years or more after surgery. Three-dimensional lower extremity kinematics of walking at a self-selected speed were collected using a 12-camera motion capture system and 4 embedded force plates. One-dimensional statistical parametric mapping (SPM) was used for data analysis, permitting time point comparisons of continuous data.Time point comparison revealed no significant differences in the sagittal plane for knee joint kinematics (p > 0.05) over the tree measurement time points. Hip and ankle joint kinematics as well as normalised walking speed remained stable over the observation period.This is the first study investigating lower extremity kinematics in patients with BSCP and flexed knee gait after SEMLS with SPM. Results demonstrate that positive effects on sagittal knee joint kinematics of PTS as part of SEMLS persist up to 9 years after surgery and progressivity does not reoccur. Thus, if clinical examination indicates an operation in individuals with BSCP, improved kinematics through SEMLS persist into adulthood. With the relatively new statistical procedure SPM gait can be displayed and analysed in established joint angle curves making them easier to understand (e.g. physiotherapists, movement scientists, physicians).

Effect of ankle sprain brostrom surgery on the lower extremity kinematics chain during sit-to-stand task

Effect of ankle sprain brostrom surgery on the lower extremity kinematics chain during sit-to-stand task

Effects of 12-week cadence retraining on impact peak, load rates and lower extremity biomechanics in running.

BackgroundExcessive impact peak forces and vertical load rates are associated with running injuries and have been targeted in gait retraining studies. This study aimed to determine the effects of 12-week cadence retraining on impact peak, vertical load rates and lower extremity biomechanics during running.MethodsTwenty-four healthy male recreational runners were randomised into either a 12-week cadence retraining group (n = 12), which included those who ran with a 7.5% increase in preferred cadence, or a control group (n = 12), which included those who ran without any changes in cadence. Kinematics and ground reaction forces were recorded simultaneously to quantify impact force variables and lower extremity kinematics and kinetics.ResultsSignificantly decreased impact peak (1.86 ± 0.30 BW vs. 1.67 ± 0.27 BW, P = 0.003), vertical average load rates (91.59 ± 18.91 BW/s vs. 77.31 ± 15.12 BW/s, P = 0.001) and vertical instantaneous load rates (108.8 ± 24.5 BW/s vs. 92.8 ± 18.5 BW/s, P = 0.001) were observed in the cadence retraining group, while no significant differences were observed in the control group. Foot angles (18.27° ± 5.59° vs. 13.74° ± 2.82°, P = 0.003) and vertical velocities of the centre of gravity (CoG) (0.706 ± 0.115 m/s vs. 0.652 ± 0.091 m/s, P = 0.002) significantly decreased in the cadence retraining group at initial contact, but not in the control group. In addition, vertical excursions of the CoG (0.077 ± 0.01 m vs. 0.069 ± 0.008 m, P = 0.002) and peak knee flexion angles (38.6° ± 5.0° vs. 36.5° ± 5.5°, P < 0.001) significantly decreased whilst lower extremity stiffness significantly increased (34.34 ± 7.08 kN/m vs. 38.61 ± 6.51 kN/m, P = 0.048) in the cadence retraining group. However, no significant differences were observed for those variables in the control group.ConclusionTwelve-week cadence retraining significantly increased the cadence of the cadence retraining group by 5.7%. This increased cadence effectively reduced impact peak and vertical average/instantaneous load rates. Given the close relationship between impact force variables and running injuries, increasing the cadence as a retraining method may potentially reduce the risk of impact-related running injuries.

Organisation of instep kicking in young U11 to U20 soccer players

ABSTRACT Aim: The main purpose of the study was to investigate kicking kinematics and performance in young-trained soccer players according to age, playing status, and biological maturity.Methods: Youth male soccer players (N = 105) from five age groups (under-11, under-13, under-15, under-17, and under-20) were evaluated. Four digital video cameras (300 Hz) captured the participants’ lower extremity and ball kinematics during penalty kick trials using dominant limb.Results: It was possible to identify non-linear differences in angular joint kinematics (displacement and velocity) of hip, knee and ankle across age-groups. Kicked ball speed and lower extremity mechanical factors discriminated among under-15 players with distinct status (e.g., ball speed and foot-to-ball speed ratio: starters > non-starters and non-participating substitutes; effect size = 1.05 to 1.49 [large]). Estimated maturity offset was not correlated with performance outputs in any age-group (r = −0.28 to 0.39; P > 0.05).Conclusion: We conclude that from ages ~10 to 19 years, differences in kicking kinematics and performance vary across time in youth players. Transition phase between under-13 to under-15 appears the most sensible period for powerful instep kick performance development. Kicking speed in youth soccer is discriminated according to player status, but not estimated biological maturity.

Kinematic and Coordination Variability in Runners with and Without Patellofemoral Pain

Background: Patellofemoral pain (PFP) is a common overuse injury that has been suggested to cause abnormal gait kinematics and variability in runners with PFP. Conflicting results have been presented as to the variability of joint kinematics and joint coordination. Objective: The purpose of this study was to examine the variability of lower extremity kinematics and joint coordination in the presence of PFP and exertion. Methods: Six female runners with PFP and matched controls (CON) ran at a self-selected pace on an instrumented treadmill until exertion or pain criteria was met. Sixteen anatomical retroreflective markers and seven tracking clusters were placed on the participants’ lower extremities. Data collected for 20 steps from the beginning, middle, and end of the run were processed. Kinematic variability was assessed for each participant by calculating the standard deviation (SD) of peak knee flexion, internal rotation, and adduction angle and their velocities. Continuous relative phase (CRP) mean values were calculated from normalized phase plots for coordination relationships between knee horizontal plane motion and hip sagittal, frontal, and horizontal and ankle frontal plane motion. Coordination variability was calculated as the CRP coupling SD over 100% of stance for each time point for each participant. Statistical comparisons were assessed through a 2 (PFP vs. CON) x 3 (beginning, middle, end) repeated measures ANOVA. Results: There was an increase in variability for peak knee adduction angle, peak knee adduction velocity, hip flexion/knee rotation CRP, and knee rotation/rearfoot eversion CRP over time for the PFP group compared with CON (P&lt;0.05). Conclusion: Pain and exertion increase the variability of joint kinematics and joint coordination reflecting decreased movement control towards the end of a run.

Influence of high-heeled shoe parameters on biomechanical performance of young female adults during stair ascent motion

BackgroundHigh-heeled shoes are currently preferred by women due to contemporary aesthetics. However, high-heeled shoes may increase the effort required to ascend stairs and, hence, alter biomechanical performance.Research question: How do high-heel shoe parameters affect the pelvis position, lower extremities kinematics, and ground reaction force in young women during stair ascent motion? MethodsStair ascent experiments were performed with 20 healthy adult women. The participants were instructed to ascend a 3-step staircase, wearing heeled shoes of different heel heights and heel types and one pair of flat shoes as the control group. Changes in lower body biomechanics were analyzed with kinematics and ground reaction force variables collected from the dominant limb. A two-way repeated ANOVA was performed to determine which variables were affected by heel type and which were affected by heel height or a combination of both. ResultsAs the heel height increased, an increased range of ankle dorsiflexion-plantarflexion, as well as pelvic rotation, was observed(P = 0.039 and P = 0.003, respectively). A thinner heel type displayed a larger pelvic forward tilt movement(P = 0.026)and 1st peak vertical force(P = 0.025), as well as a smaller 2nd peak vertical force (P = 0.002). With high heels, increased external rotation of the knee, inversion and plantar flexion, and flexion values of the knee were observed. We also observed decreased external rotation of the pelvis, ankle eversion, varum, and dorsiflexion. SignificanceTo stabilize body posture during stair ascent motion with high-heeled shoes, compensatory response including increasd pelvic range of motion and changing the joint angles of the lower extremities.

Effects of 4-week impairment-based rehabilitation on jump-landing biomechanics in chronic ankle instability patients

ObjectiveTo determine effects of 4-weeks of impairment-based rehabilitation on lower extremity neuromechanics during jump-landing. DesignDescriptive laboratory study. ParticipantsTwenty-six CAI subjects (age = 21.4 ± 3.1 sex=(M = 7,F = 19), height = 169.0 ± 8.8 cm, weight = 71.0 ± 13.8 kg) completed 15 jump-landing trials prior to and following 12 supervised rehabilitation sessions. Main outcome measuresFrontal and sagittal lower extremity kinematics and kinetics and sEMG amplitudes (anterior tibialis, peroneus brevis, peroneus longus, and medial gastrocnemius). Means and 90% confidence intervals (CIs) were calculated for 100 ms prior to and 200 ms following ground contact. Areas where pre- and post-rehabilitation CIs did not overlap were considered significantly different. Kinematic and kinetic peaks and kinematic excursion were compared with paired t-test (P ≤ 0.05). ResultsFollowing rehabilitation, CAI subjects exhibited less ankle (2.1° (0.8, 3.4), P < 0.01) and hip (2.0° (0.5, 3.7), P = 0.01) frontal plane excursion and lower peak hip abduction (2.5° (0.0, 5.0), P = 0.05). There was less ankle (5.0° (1.7, 8.3), P < 0.01) and knee (3.4° (0.8, 6.0), P = 0.01) sagittal plane excursion following rehabilitation. There was decreased peroneus longus activity from 9 ms to 135 ms post ground contact and decreased peak plantar flexion moment (0.08 N∗m/kg (0.01, 0.13), P = 0.02) following rehabilitation. ConclusionProgressive impairment-based rehabilitation resulted in reductions in kinematic excursion and peroneus longus muscle activity, suggesting a more efficient landing strategy.