Hip Extensor Moments Research Articles

Gait kinetics of total hip replacement patients—A large scale, long-term follow-up study

BackgroundIt is not known if lower limb gait kinetics of total hip replacement (THR) patients reach normal levels at long term follow-up post-operatively. MethodsThree-dimensional gait analysis was performed on 134 THR patients with identical implants 10-years post-operatively. Lower limb moments and powers were compared between different age strata (54–64 years, 65–69 years, 70–74 years, 75–79 years and over 80 years) and a normal elderly control group. ResultsHip extensor moment and hip power generation were significantly reduced in all age groups compared to normal. External hip rotation moment was significantly reduced in all age groups, apart from the youngest group, compared to normal. However, in contrast to previous short term follow-up studies there was no significant difference in hip abduction moment between any of the age groups and the normal group. ConclusionThis large cohort study shows that, at long term follow-up following THR, some hip joint kinetics (hip extensor and external rotation moments and hip power generation) do not reach normal levels, but that peak abduction moment is preserved. THR patients recovery could potentially benefit from intensive rehabilitation focusing on hip extension and external rotation in the post-operative, and perhaps preoperative, period.

Does trampoline or hard surface jumping influence lower extremity alignment?

[Purpose] To determine whether repetitive trampoline or hard surface jumping affects lower extremity alignment on jump landing. [Subjects and Methods] Twenty healthy females participated in this study. All subjects performed a drop vertical jump before and after repeated maximum effort trampoline or hard surface jumping. A three-dimensional motion analysis system and two force plates were used to record lower extremity angles, moments, and vertical ground reaction force during drop vertical jumps. [Results] Knee extensor moment after trampoline jumping was greater than that after hard surface jumping. There were no significant differences between trials in vertical ground reaction force and lower extremity joint angles following each form of exercise. Repeated jumping on a trampoline increased peak vertical ground reaction force, hip extensor, knee extensor moments, and hip adduction angle, while decreasing hip flexion angle during drop vertical jumps. In contrast, repeated jumping on a hard surface increased peak vertical ground reaction force, ankle dorsiflexion angle, and hip extensor moment during drop vertical jumps. [Conclusion] Repeated jumping on the trampoline compared to jumping on a hard surface has different effects on lower limb kinetics and kinematics. Knowledge of these effects may be useful in designing exercise programs for different clinical presentations.

Vertical Jump Biomechanics Altered With Virtual Overhead Goal.

Virtual environments with real-time feedback can simulate extrinsic goals that mimic real life conditions. The purpose was to compare jump performance and biomechanics with a physical overhead goal (POG) and with a virtual overhead goal (VOG). Fourteen female subjects participated (age: 18.8 ± 1.1 years, height: 163.2 ± 8.1 cm, weight 63.0 ± 7.9 kg). Sagittal plane trunk, hip, and knee biomechanics were calculated during the landing and take-off phases of drop vertical jump with different goal conditions. Repeated-measures ANOVAs determined differences between goal conditions. Vertical jump height displacement was not different during VOG compared with POG. Greater hip extensor moment (P < .001*) and hip angular impulse (P < .004*) were found during VOG compared with POG. Subjects landed more erect with less magnitude of trunk flexion (P = .002*) during POG compared with VOG. A virtual target can optimize jump height and promote increased hip moments and trunk flexion. This may be a useful alternative to physical targets to improve performance during certain biomechanical testing, screening, and training conditions.

Evidence of compensatory joint kinetics during stair ascent and descent in Parkinson’s disease

BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk. ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD. MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated. ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients. ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.

Hip kinetics during gait are clinically meaningful outcomes in young boys with Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is an X-linked genetic neuromuscular disorder characterized by progressive proximal to distal muscle weakness. The success of randomized clinical trials for novel therapeutics depends on outcome measurements that are sensitive to change. As the development of motor skills may lead to functional improvements in young boys with DMD, their inclusion may potentially confound clinical trials. Three-dimensional gait analysis is an under-utilized approach that can quantify joint moments and powers, which reflect functional muscle strength. In this study, gait kinetics, kinematics, spatial-temporal parameters, and timed functional tests were quantified over a one-year period for 21 boys between 4 and 8 years old who were enrolled in a multisite natural history study. At baseline, hip moments and powers were inadequate. Between the two visits, 12 boys began a corticosteroid regimen (mean duration 10.8±2.4 months) while 9 boys remained steroid-naïve. Significant between-group differences favoring steroid use were found for primary kinetic outcomes (peak hip extensor moments (p=.007), duration of hip extensor moments (p=.007), peak hip power generation (p=.028)), and spatial-temporal parameters (walking speed (p=.016) and cadence (p=.021)). Significant between-group differences were not found for kinematics or timed functional tests with the exception of the 10m walk test (p=.03), which improves in typically developing children within this age range. These results indicate that hip joint kinetics can be used to identify weakness in young boys with DMD and are sensitive to corticosteroid intervention. Inclusion of gait analysis may enhance detection of a treatment effect in clinical trials particularly for young boys with more preserved muscle function.

Hip kinematics and kinetics in persons with and without cam femoroacetabular impingement during a deep squat task

BackgroundPrevious studies have indicated that hip and pelvis kinematics may be altered during functional tasks in persons with femoroacetabular impingement. The purpose of this study was to compare hip and pelvis kinematics and kinetics during a deep squat task between persons with cam femoroacetabular impingement and pain-free controls. MethodsFifteen persons with cam femoroacetabular impingement and 15 persons without cam femoroacetabular impingement performed a deep squat task. Peak hip flexion, abduction, and internal rotation, and mean hip extensor, adductor, and external rotator moments were quantified. Independent t-tests (α<0.05) were used to evaluate between group differences. FindingsCompared to the control group, persons with cam femoroacetabular impingement demonstrated decreased peak hip internal rotation (15.2° (SD 9.5°) vs. 9.4° (SD 7.8°); P=0.041) and decreased mean hip extensor moments (0.56 (SD 0.12) Nm/kg vs. 0.45 (SD 0.15) Nm/kg; P=0.018). In addition persons in the cam femoroacetabular impingement group demonstrated decreased posterior pelvis tilt during squat descent compared to the control group, resulting in a more anteriorly tilted pelvis at the time peak hip flexion (12.5° (SD 17.1°) vs. 23.0° (SD 12.4°); P=0.024). InterpretationThe decreased hip internal rotation observed in persons with cam femoroacetabular impingement may be the result of bony impingement. Furthermore, the decrease in posterior pelvis tilt may contribute to impingement by further approximating the femoral head–neck junction with the acetabulum. Additionally, decreased hip extensor moments suggest that diminished hip extensor muscle activity may contribute to decreased posterior pelvis tilt.

Changes in Sagittal Plane Kinematics and Kinetics after Distal Release of Medial Hamstrings in Cerebral Palsy

The purpose of this study is to analyze the effect of distal release of the medial hamstrings on the gait of patients who had spastic cerebral palsy. Twenty-two patients had preoperative and postoperative gait analysis. Standard parameters, such as cadence, velocity, and stride length, were evaluated, as were sagittal plane motion graphs of the pelvis, hip, knee, and ankle, in addition to sagittal plane kinetic analysis. Extension of the knee in stance phase significantly improved postoperatively (p &lt; 0.002), and the improvement was accompanied by a proportional decrease in knee flexion during swing with minimal net gain in the arc of knee motion. Knee range of motion could be improved more by concomitant rectus transfer in selected patients. The statistically significant increase in anterior pelvic tilt (p &lt; 0.002) has been a main concern. There was no significant change in the hip extensor moments or power generation during stance. Increased knee extension during stance after distal release of medial hamstrings is the kinematic gain that improved the gait pattern in cerebral palsy patients. The authors recommend a concomitant rectus transfer to help improve the knee range of motion in patients with rectus over-firing during swing, hence avoiding a stiff knee gait.

Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis

Purpose: The aim of this study was to examine the effect of 6 min of walking on fatigue, exertion and spatiotemporal, kinematic and kinetic gait parameters in people with multiple sclerosis (MS). Methods: Thirty-four people with MS with moderate levels of disability completed measures of fatigue, exertion and instrumented gait analysis before and after 6-min trials of rest and walking (using a modified 6-min walk test, m6MWT). Ten age- and gender-matched healthy controls completed analysis before and after the m6MWT. Results: The MS group had a significant increase in self-reported fatigue following the m6MWT; however, there was no effect on spatiotemporal gait parameters. During stance on the more affected side ankle dorsiflexion at initial contact decreased, while knee and hip flexor moments and hip power absorption increased. On the less affected side ankle and knee power absorption, and hip extensor moment all increased. Healthy controls showed increases in joint kinetics likely due to increased walking speeds following m6MWT. Conclusion: For people with MS, ankle dorsiflexion angle reduces at initial contact following walking induced fatigue, while increased power absorption at the hip, knee and ankle indicate gait inefficiencies that may contribute to higher levels of fatigue and exertion.Implications for RehabilitationThe modified 6-min walk test (m6MWT) leads to significant increases in self-reported fatigue and exertion in people with MS.Following the m6MWT, there is significantly reduced ankle dorsiflexion angle at initial contact in the more affected leg in people with MS. This reveals an important walking-induced kinematic change that should be the target of future orthotic and strengthening interventions.In people with MS, increased power absorption primarily during the stance phase of gait following the m6MWT reveals important walking-induced muscle weakness that should also be monitored in future strengthening and gait retraining interventions.

Changes in Joint Contributions to the Support Impulse During an Acute Transition to Barefoot Running

INTRODUCTION: The knee is the most commonly injured joint from running participation. Relative to shod rear-foot strike (RFS) running, a forefoot strike (FFS) is associated with a shift in mechanical demand from the knee to the ankle. Accordingly, a FFS has been promoted as a method to reduce injury rates. Largely attributed to its association with a FFS among habituated populations, barefoot running has risen in popularity. However, recent investigations indicate that habitually shod runners do not innately adopt a FFS when acutely transitioning to barefoot running. Thus, it is unknown whether altered joint demands are a function of the adopted foot strike pattern or running barefoot. PURPOSE: To examine the relative contribution of the ankle, knee and hip to the support impulse in habitually shod runners during an acute bout of barefoot running. METHODS: 22 habitually shod RFS runners performed over-ground running shod and barefoot. Runners were grouped according to their barefoot foot strike pattern: RFS, mid-foot strike (MFS), and FFS. The support impulse was a measure of the cumulative ankle, knee and hip extensor moments during absorption (initial contact to peak knee flexion). The relative contributions of the ankle, knee, and hip were calculated as a percentage. RESULTS: 5 runners adopted a FFS, 9 adopted a MFS, and 8 maintained a RFS during the barefoot condition. There were no differences in support impulse magnitude (p>0.05). All barefoot runners demonstrated increased ankle contribution relative to shod (p≤0.028) while only MFS runners demonstrated reduced knee and hip contribution (p≤0.021). FFS demonstrated a trend towards decreased knee contribution (p=0.095). FFS and MFS runners had a larger ankle contribution and lesser knee contribution than RFS runners (p≤0.021). Furthermore, when shod, the FFS runners presented with greater ankle contribution than RFS runners (p≤0.007). CONCLUSIONS: Similar to previous research, there was an increase in the demands at the ankle across all foot strike patterns while only MFS runners presented with reduced demands at the knee and hip. FFS runners demonstrated a trend towards reduced knee demands suggesting that adopting a FFS or MFS when running barefoot can reduce knee injury risk. However, due to the increased demands at the ankle, it is important that all habitually shod runners gradually transition to barefoot running.

Lower Extremity Joint Kinetics Do Not Differ Between Different Athletic Upper Body Positions

Increased lower extremity injury risk has been speculated to relate with out-of-plane upper body position while performing running, cutting, and landing tasks. It remains poorly understood if athletic tasks that require different upper body positions do influence lower extremity kinetics. PURPOSE: To investigate if four different athletic upper body positions affect lower extremity joint kinetics. METHODS: Thirty healthy participants (23.4±4.3years, 1.70±0.11m, 72.8±14.9kg) volunteered for the study. Participants performed 5 landings from a 45cm box using four different upper body positions: 1) arms at chest level while holding a basketball (CH), 2) arms extended at chest level holding a basketball (FR), 3) arms extended straight up over head (UP), and 4) placing hands on hips (HIP). Forty markers were placed on the lower extremity. Trajectory and ground reaction force (GRF) data were collected at 200 and 1000Hz, respectively. Data were filtered with a 4th order Butterworth low pass filter with cutoff frequencies of 7 and 15Hz for trajectory and GRF data, respectively. Peak joint moments were attained between initial contact and minimum vertical displacement of center of mass; hip and knee flexor and extensor moments normalized to body mass and height (Nm/Kgm) were calculated. Peak vertical GRF was calculated for each arm position. Repeated measures ANOVAs and Bonferroni pairwise comparisons examined differences across conditions. RESULTS: CH position (-0.74±0.29 Nm/Kgm) presented lower knee flexor moment than UP (-0.81±0.26 Nm/Kgm) and HIP (-0.89±0.27 Nm/Kgm) positions (p0.05). CONCLUSIONS: Overall, It is noteworthy that when landing with the arms above the head and landing with the hands on the hips, the knee joint flexor moment significantly increased when compared with holding a ball at chest level. The higher knee flexor moment may increase the stress transmitted to the tibia, and result in a detrimental loading for the knee articular cartilage. When developing intervention strategies, health professionals should consider the effects of various arm positions on lower extremity kinetics to potentially minimize excessive knee joint loading.

Biomechanical Role of the Hip in Maintaining Balance during Standing Forward Reach

During reactions to external anterior-posterior (AP) postural perturbations, it has been demonstrated that the hip strategy (HS) is employed only when balance risk is high and the ankle strategy (AS) is inadequate. In quiet standing the ankle plays a major role in maintenance of AP balance while the role of the hip is limited to medial-lateral (ML) control. This has led to the hypothesis that use of HS during self-initiated AP movements that are relatively safe or involve small center of mass (COM) excursions indicates poor balance, possibly due to deficits in ankle musculature. Consequently, comprehensive balance tests like BESTest focus on hip strength in the frontal plane and ankle strength in the sagittal plane. PURPOSE: To elucidate the biomechanical role of the hip during self-initiated standing forward reach. This movement pattern is used in several clinical balance screens including BESTest, Berg Balance Scale and Functional Reach Test. METHODS: 5 healthy young participants stood with their right shoulder flexed to 90°. A yardstick was placed parallel to the floor at the level of the acromion. They were instructed to reach forward as far as possible without taking a step and without raising their heels off the floor. 3 trials each were collected with 2 different instructions - do not bend the hip (AS) and bend the hip (HS). 2 force plates and an 11 camera motion capture system were used to obtain joint angles and moments, and whole-body COM and center of pressure (COP) excursions. RESULTS: Reach distance normalized by height was significantly higher during HS (Δ= 4.5±1.3 cm; p=0.008). This was accompanied by a significantly higher peak hip extensor moment (Δ= 0.41±0.13 Nm/kg; p=0.014). However, the maximum COM and COP excursions and peak ankle plantarflexor moment were not significantly different between strategies. CONCLUSIONS: Using HS allowed participants to reach further without increasing the balance risk as assessed by COM and COP excursions. Based on these findings, it is likely that in a functional situation where an individual is required to reach a fixed distance, using HS will achieve the goal with smaller COP and COM excursions compared to AS. Therefore, use of HS may not necessarily be a last resort indicating absence of ankle strength and the hip should not be ignored during assessment and retraining of AP balance.

Cutting mechanics: relation to performance and anterior cruciate ligament injury risk.

Quick changes of direction during running (cutting) are necessary for successful performance of many sports but are associated with noncontact anterior cruciate ligament (ACL) injuries. Currently, it is not known how biomechanics associated with fast performance of cutting tasks relate to the mechanics associated with increased risk for injury. Without this knowledge, the technique emphasized in injury prevention programs may be at odds with the demands of cutting tasks. The purposes of this study were to 1) identify whole body and/or joint mechanics that are related to completion times of 45° and 90° cuts and, from these variables, 2) determine which variables are predictors of performance (i.e., completion time) and/or ACL injury risk (i.e., peak knee adductor moment). Whole body and joint biomechanics were analyzed during the execution of two sidestep cutting maneuvers (to 45° and 90°) in 25 healthy experienced soccer players. Pearson correlation coefficients and stepwise multiple regression were used to analyze relations between variables. The variables predictive of 45° cut performance included hip extensor moment and hip sagittal plane power generation as well as medial-lateral center-of-mass to center-of-pressure separation distance. This separation distance was also predictive of peak knee adductor moment. During the 90° cut, medial-lateral ground reaction force impulse and hip frontal plane power generation were predictive of performance whereas hip internal rotation and knee extensor moment were predictive of peak knee adductor moment. These relations have important implications for ACL injury prevention programs. Although restricting frontal and transverse plane movement has been emphasized in many programs, these movement recommendations may not be appropriate for cutting tasks performed at greater angles.

The biomechanical characteristics of wearing FitFlop™ sandals highlight significant alterations in gait pattern: A comparative study

BackgroundThe net contribution of all muscles that act about a joint can be represented as an internal joint moment profile. This approach may be advantageous when studying footwear-induced perturbations during walking since the contribution of the smaller deeper muscles that cross the ankle joint cannot be evaluated with surface electromyography. Therefore, the present study aimed to advance the understanding of FitFlop™ footwear interaction by investigating lower extremity joint moment, and kinematic and centre of pressure profiles during gait. Methods28 healthy participants performed 5 walking trials in 3 conditions: a FitFlop™ sandal, a conventional sandal and an athletic trainer. Three-dimensional ankle joint, and sagittal plane knee and hip joint moments, as well as corresponding kinematics and centre of pressure trajectories were evaluated. FindingsFitFlop™ differed significantly to both the conventional sandal and athletic trainer in: average anterior position of centre of pressure trajectory (P<0.0001) and peak hip extensor moment (P=0.001) during early stance; average medial position of centre of pressure trajectory during late stance; peak ankle dorsiflexion and corresponding range of motion; peak plantarflexor moment and total negative work performed at the ankle (all P<0.0001). InterpretationThe present findings demonstrate that FitFlop™ footwear significantly alters the gait pattern of wearers. An anterior displacement of the centre of pressure trajectory during early stance is the primary response to the destabilising effect of the mid-sole technology, and this leads to reductions in sagittal plane ankle joint range of motion and corresponding kinetics. Future investigations should consider the clinical implications of these findings.

Alterations in the lower limb joint moments precede the peripheral neuropathy diagnosis in diabetes patients.

Changes in gait patterns in individuals with diabetes and neuropathy are still inconclusive. Our aim was to identify differences in the net intralimb moments distribution and lower limb kinematics during gait in different stage of diabetes. This was an observational cross-sectional study that assessed 38 adults: a control group (n=12), a group with diabetes (n=12), and a group with diabetic neuropathy (n=14). The flexor and extensor joint moment peaks and kinematics of ankle, knee, and hip angles were compared among groups (by analysis of variance). At initial contact, both diabetes groups present more hip flexion and smaller hip extensor moment. During late midstance, hip extension decreases, and flexion moment increases in both diabetes groups. For the same diabetes groups, during push off, the hip is more flexed, and the hip extensor moment decreases. Only for the diabetes group without neuropathy is the knee markedly more flexed, and the extensor moment is higher than in the other groups. At push off, the ankle is less extended in both diabetes groups, but the ankle extensor moment is significantly smaller only in neuropathic subjects. The biomechanical modifications on the gait appeared to be a continuous process that was already revealed in patients without neuropathy. The use of the hip joint as a mechanism of forward progression of the body, instead of using the ankle, was more evident and consistent for the patients with diabetic neuropathy. The knee seems to have a major role in those with diabetes without neuropathy who presented higher extensor moments to support the body during early stance.

Propulsion phase of the single leg triple hop test in women with patellofemoral pain syndrome: a biomechanical study.

Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.

Proximal-to-Distal Sequencing in Vertical Jumping With and Without Arm Swing

Vertical jumping performance is dependent on muscle strength and motor skill. An understanding of motor skill strategies and their influence on jumping mechanics provides insight into how to improve performance. This study aimed to determine whether kinematic sequencing strategy influenced jump height, the effect of sequencing on jumping mechanics, and whether arm swing influences sequencing strategy. Women volleyball players (n = 16) performed vertical jumps with and without arm swing on force platforms while recorded with a 6-camera motion capture system. Sequencing strategy was determined as the relative time delay between pelvis and knee extension. A long time delay indicated a proximal-to-distal strategy, whereas no time delay represented a simultaneous strategy. Longer relative time delay was correlated with higher jump height in jumps with (r = 0.82, p < 0.001) and without arm swing (r = 0.58, p = 0.02). Longer relative time delay and higher jump height were associated with greater hip extensor and ankle plantar flexor net joint moments (NJM), and greater ratio of concentric to eccentric knee extensor NJM (p ≤ 0.05). Longer relative time delay and higher jump height were correlated with greater thigh and leg angular accelerations (p ≤ 0.05). These kinetic and kinematic variables, along with relative time delay and jump height were greater in jumps with arm swing than without (p ≤ 0.05), indicating arm swing promotes use of a proximal-to-distal strategy. Use of a proximal-to-distal strategy is associated with greater NJM and segment accelerations, which may contribute to better vertical jump performance.

The effect of trunk flexion on lower-limb kinetics of able-bodied gait

Able-bodied individuals spontaneously adopt crouch gait when walking with induced anterior trunk flexion, but the effect of this adaptation on lower-limb kinetics is unknown. Sustained forward trunk displacement during walking can greatly alter body center-of-mass location and necessitate a motor control response to maintain upright balance. Understanding this response may provide insight into the biomechanical demands on the lower-limb joints of spinal pathology that alter trunk alignment (e.g., flatback). The purpose of this study was to determine the effect of sustained trunk flexion on lower-limb kinetics in able-bodied gait, facilitating understanding of the effects of spinal pathologies. Subjects walked with three postures: 0° (normal upright), 25±7°, and 50±7° trunk flexion. With increased trunk flexion, decreased peak ankle plantar flexor moments were observed with increased energy absorption during stance. Sustained knee flexion during mid- and terminal stance decreased knee flexor moments, but energy absorption/generation remained unchanged across postures. Increased trunk flexion placed significant demand on the hip extensors, thus increasing peak hip extensor moments and energy generation. The direct relationship between trunk flexion and energy absorption/generation at the ankle and hip, respectively, suggest increased muscular demand during gait. These findings on able-bodied subjects might shed light on muscular demands associated with individuals having pathology-induced positive sagittal spine balance.

Gait pattern in 9-11-year-old children with generalized joint hypermobility compared with controls; a cross-sectional study

BackgroundTo study differences in gait patterns in 10-year-old children with Generalized Joint Hypermobility (GJH) and with no GJH (NGJH).MethodsA total of 37 children participated (19 GJH, 18 NGJH, mean age 10.2 (SD 0.5) years). Inclusion criteria for GJH were a Beighton score of ≥5, with at least one hypermobile knee joint; for NGJH a Beighton score of ≤4, and no hypermobile knees and for both groups no knee pain during the previous week. All children were recorded by five video cameras, while they walked across three force platforms. Net joint moments were calculated in 3D by inverse dynamics and peak values provided input to statistical analyses.ResultsIn the frontal plane, children with GJH had a significantly lower peak knee abductor moment and peak hip abductor moment. In the sagittal plane, the peak knee flexor moment and the peak hip extensor moment were significantly lower in the GJH group although the absolute difference was small.ConclusionsThe walking pattern was the same for children with GJH and for healthy children, as there were no differences in kinematics, but it was, however, performed with different kinetics. Children with GJH walked with lower ankle, knee and hip joint moments compared to children with NGJH. However, the clinical importance of these differences during normal gait is unknown. To obtain this knowledge, children with GJH must be followed longitudinally.Trial registrationThe study was approved by the Committee on Biomedical Research Ethics for Copenhagen and Frederiksberg, Denmark (jnr. KF01-2006-178).

Effects of bilateral medial knee osteoarthritis on intra- and inter-limb contributions to body support during gait

Patients with knee OA show altered gait patterns, affecting their quality of living. The current study aimed to quantify the effects of bilateral knee OA on the intra-limb and inter-limb sharing of the support of the body during gait. Fifteen patients with mild, 15 with severe bilateral knee OA, and 15 healthy controls walked along a walkway while the kinematic and kinetic data were measured. Compared with the controls, the patients significantly reduced their knee extensor moments and the corresponding contributions to the total support moment in the sagittal plane (p<0.05). For compensation, the mild OA group significantly increased the hip extensor moments (p<0.05) to maintain close-to-normal support and a more symmetrical inter-limb load-sharing during double-limb support. The severe OA group involved compensatory actions of both the ankle and hip, but did not succeed in maintaining a normal sagittal total support moment during late stance, nor a symmetrical inter-limb load-sharing during double-limb support. In the frontal plane, the knee abductor moments and the corresponding contributions to the total support moment were not affected by the changes in the other joints, regardless of the severity of the disease. The observed compensatory changes suggest that strengthening of weak hip muscles is essential for body support during gait in patients with knee OA, but that training of weak ankle muscles may also be needed for patients with severe knee OA.

Biomechanical demands differentiate transitioning vs. continuous stair ascent gait in older women

BackgroundStair ascent mechanics change with age, but little is known about the differing functional demands of transitioning and continuous ascent. Work investigating the risky transition from gait to ascent is sparse, and the strategies that older adults adopt to achieve these demanding tasks have not been investigated. MethodsThis study compared the biomechanics of a 2-step transitional (floor-to-step2) and continuous ascent cycle (step1-to-step3) and investigated the role of limb preference in relation to dynamometer-derived knee strength during this transition. A biomechanical analysis of 36 women (60–83 years) ascending a 3-step staircase was conducted. FindingsThe 2-step transitioning cycle was completed quicker, with a larger range of motion, increased forces, larger knee flexor and dorsiflexor moments and ankle powers (P≤0.05), but reduced hip and knee flexion, smaller hip extensor moments and hip and knee powers compared to continuous ascent. During the transition, 44% of the participants demonstrated a consistent limb preference. In these cases large between-limb extensor strength differences existed (13.8%) and 71% of these participants utilised the stronger limb to execute the 2-step transitional cycle. InterpretationThe preferential stronger-limb 2-step transitioning strategy conflicts with previous recommendations of a stronger lead limb for frail/asymmetric populations. Our findings suggest that most healthy older women with large between-limb differences utilise the stronger limb to achieve the considerable propulsion required to redirect momentum during the 2-step transition. The biomechanical demands of ascent, relative to limb strength, can inform exercise programmes by targeting specific muscle groups to help older adults maintain/improve general functioning.