Lower Extremity Biomechanics Research Articles

The effect of marathon running on the lower extremity kinematics and muscle activities during walking and running tasks

ABSTRACT Patellofemoral pain syndrome (PFPS) is a common injury among runners, and it is thought that abnormal lower extremity biomechanics contribute to its development. However, the relationship between biomechanical changes after a marathon and PFPS injury remains limited. This study aims to investigate whether differences in knee and hip kinematics and lower extremity muscle activities exist in recreational runners before and after a marathon. Additionally, it aims to explore the relationship between these biomechanical changes and the development of PFPS injury. 12 recreational runners participated in the study. Kinematics and muscle activities of the lower extremity were recorded during walking (5 km/h) and running (10 km/h) tasks within 24 hours before and within 5 hours after a marathon. After the marathon, there was a significant decrease in peak knee flexion (walking: p = 0.006; running: p = 0.006) and an increase in peak hip internal rotation (walking: p = 0.026; running: p = 0.015) during the stance phase of both walking and running compared to before the marathon. The study demonstrates a decrease in knee flexion and an increase in hip internal rotation during the stance phase of gait tasks after completing a marathon, which may increase the risk of developing PFPS injury.

Effects of peak ankle dorsiflexion angle on lower extremity biomechanics and pelvic motion during walking and jogging.

Ankle dorsiflexion during walking causes the tibia to roll forward relative to the foot to achieve body forward. Individuals with ankle dorsiflexion restriction may present altered movement patterns and cause a series of dysfunction. Therefore, the aim of this research was to clearly determine the effects of peak ankle dorsiflexion angle on lower extremity biomechanics and pelvic motion during walking and jogging. This study involved 51 subjects tested for both walking and jogging. The motion capture system and force measuring platforms were used to synchronously collect kinematics and kinetics parameters during these activities. Based on the peak ankle dorsiflexion angle during walking, the 51 subjects were divided into a restricted group (RADF group, angle <10°) and an ankle dorsiflexion-unrestricted group (un-RADF group, angle >10°). Independent-Sample T-tests were performed to compare the pelvic and lower limb biomechanics parameters between the groups during walking and jogging test on this cross-sectional study. The parameters that were significantly smaller in the RADF group than in the un-RADF group at the moment of peak ankle dorsiflexion in the walking test were: ankle plantar flexion moment (p < 0.05), hip extension angle (p < 0.05), internal ground reaction force (p < 0.05), anterior ground reaction force (p < 0.01), pelvic ipsilateral tilt angle (p < 0.05). In contrast, the external knee rotation angle was significantly greater in the RADF group than in the un-RADF group (p < 0.05). The parameters that were significantly smaller in the RADF group than in the un-RADF group at the moment of peak ankle dorsiflexion in the jogging test were: peak ankle dorsiflexion angle (p < 0.01); the anterior ground reaction force (p < 0.01), the angle of pelvic ipsilateral rotation (p < 0.05). This study shows that individuals with limited ankle dorsiflexion experience varying degrees of altered kinematics and dynamics in the pelvis, hip, knee, and foot during walking and jogging. Limited ankle dorsiflexion alters the movement pattern of the lower extremity during walking and jogging, diminishing the body's ability to propel forward, which may lead to higher injury risks.

The Impact of Running Experience and Shoe Longitudinal Bending Stiffness on Lower Extremity Biomechanics

Purpose The impacts of shoe stiffness on running biomechanics are well-documented, while the specific effects on the performance of biomechanically distinct groups such as novice runners and experienced runners are still largely unexplored. The study aimed to evaluate the biomechanical effects of different shoe longitudinal bending stiffness (adjusted by inserting carbon plate) on the lower limb during running in novice runners and experienced runners. Methods Twelve experienced runners and ten novice runners ran at a speed of 4.47 m/s while randomly wearing shoes with either low stiffness (5.9 Nm/rad) or high stiffness (8.6 Nm/rad). An Opensim musculoskeletal model was adopted for estimating lower limb joint angles, joint angular velocities, joint moment, joint work, peak joint reaction forces during running stance phase. Results Results showed that novice runners displayed greater lower limb joint mobility and less joint moment, while experienced runners exhibited less joint mobility but greater joint moment, and higher peak joint reaction forces were observed at the knee and ankle joints. Furthermore, increased shoe longitudinal bending stiffness resulted in higher peak joint reaction forces at the metatarsophalangeal joint for novice runners while lower for experienced runners. Conclusions Novice runners may face an increased risk of metatarsal pain or stress fractures when dealing with higher shoe stiffness. This nuanced understanding of joint dynamics underscores the need for tailored training and footwear recommendations to mitigate injury risks specific to different levels of running experience.

Concussion History Moderates Trunk Motion and Lower Extremity Biomechanical Relationships During Jump Landing and Cutting.

Concussion history, trunk motion, and lower extremity biomechanics associate with musculoskeletal injury risk. We aimed to examine the interaction between concussion history and trunk motion as possible modifiable factors for injury risk biomechanics during jump landing and cutting. Division I female athletes (24 with, 20 without concussion history) performed jump landings and jump-to-cuts at 45° in the opposite direction of the landing limb. We used multiple linear regressions with interaction terms to examine ankle dorsiflexion angle, knee flexion and abduction angle, and external knee flexion and abduction moment. We observed a group by trunk flexion interaction for nondominant external knee flexion moment (P = .042) during jump landing. Concussion history associated with increased external knee flexion moment as trunk flexion increased. We observed a group by trunk flexion interaction for the dominant limb dorsiflexion angle (P = .044), and group by trunk lateral bending interactions for the dominant (P = .039) and nondominant limb (P = .016) external knee flexion moment during cutting. During cutting, concussion history associated with decreased dominant dorsiflexion angles as trunk flexion increased, and decreased dominant and nondominant external knee flexion moment as lateral bending toward the planted limb increased. Concussion history associated with atypical biomechanics as trunk flexion and lateral bending increased.

The relationship between body mass index and lower extremity biomechanics in children aged 10-12 years: a comprehensive analysis

Childhood obesity has emerged as a global health concern leading to complications, such as bones and muscles misalignment of knees, flat feet and changes in walking patterns. Although some studies have individually linked these conditions to body mass index (BMI), the relationship between these variables needs to be explored. This study aimed to investigate the associations between BMI and knee position, foot position and plantar footprint in children aged 10 to 12 years. Data were collected from 59 children by measuring their BMI, knee alignment, foot position and plantar footprint. Spearman’s correlation coefficient was used to examine the relationship between BMI and inter-malleolar distance (DIM), foot position and plantar footprint. The Mann- Whitney U test was used to compare these variables between boys and girls (p-value &lt; 0.05). Higher BMI values were associated with higher DIM in both boys and girls. Furthermore, we observed that genu valgum was positively correlated with foot pronation and a flattened plantar footprint. No significant differences were found in relation to BMI, variations in foot position or footprint types. Our research provides evidence that there is a connection, between BMI and genu valgum in children between the ages of 10 and 12. We have also found a correlation between genu valgum and foot pronation among children in this age group. These findings highlight the significance of addressing childhood obesity to prevent any health issues.

The Effect of Different Degrees of Ankle Dorsiflexion Restriction on the Biomechanics of the Lower Extremity in Stop‐Jumping

Purpose. The functional status of the ankle joint is critical during dynamic movements in high‐intensity sports like basketball and volleyball, particularly when performing actions such as stopping jumps. Limited ankle dorsiflexion is associated with increased injury risk and biomechanical changes during stop‐jump tasks. Therefore, this study aims to investigate how restricting ankle dorsiflexion affects lower extremity biomechanics during the stop‐jump phase, with a focus on the adaptive changes that occur in response to this restriction. Initially, 18 participants during stop‐jumping with no wedge plate (NW), 10° wedge plate (10 W), and 20° wedge plate (20 W) using dominant leg data were collected to explore the relationship between limiting ankle mobility and lower extremity biomechanics. Following this, a musculoskeletal model was developed to simulate and calculate biomechanical data. Finally, one‐dimensional parametric statistical mapping (SPM1D) was utilized to evaluate between‐group variation in outcome variables using a one‐way repeated measures analysis of variance (ANOVA). Results. As the ankle restriction angle increased, knee external rotation angles, knee extension angular velocities, hip extension angle, and angular velocity increased and were significantly different at different ankle restriction angles (p &lt; 0.001 and p = 0.001), coactivation of the peripatellar muscles (BF/RF and BF/VM) increased progressively, and patellofemoral joint contact force (PTF) increased progressively during the 3%–8% phase (p = 0.015). These results highlight the influence of ankle joint restriction on lower limb kinematics and patellofemoral joint loading during the stop‐jump maneuver. Conclusion. As the angle of ankle restriction increased, there was an increase in coactivation of the peripatellar muscles and an increase in PTF, possibly because a person is unable to adequately adjust their body for balance when the ankle valgus angle is restricted. The increased coactivation of the peripatellar muscles and increased patellofemoral contact force may be a compensatory response to the body’s adaptation to balance adjustments.

Effects of biofeedback on biomechanical factors associated with chronic ankle instability: a systematic review with meta-analysis

BackgroundBiofeedback may alter the biomechanics of lower extremities in patients with chronic ankle instability (CAI). We aimed to systematically review the literature on the effect of gait-training and biofeedback on biomechanical parameters in individuals with CAI and conduct a meta-analysis.MethodsWe searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 30th June 2022. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify those reporting the effect of biofeedback on biomechanical factors associated with CAI. Outcomes of interest were kinetics and kinematics. Two authors separately extracted data from included studies. Data of interest were study design, number of sessions, intervention, tools, outcomes, number, sex, age, height, and body mass of participants.ResultsThirteen studies with a total of 226 participants were included. Biofeedback was capable of shifting center of pressure (COP) and lateral plantar pressure medially and reducing foot inversion, adduction, propulsive vertical ground reaction force (vGRF), ankle joint contact force, peak pressure and pressure time integral in the lateral mid-foot and forefoot. Auditory biofeedback had agreater impact on modifying plantar pressure in individuals with CAI. The meta-analyses revealed that visual biofeedback reduces peak pressure in lateral mid-foot and pressure time integral at lateral and medial heel and pressure increases under the hallux.ConclusionBiofeedback can alter pressure, vGRF, and foot inversion associated with CAI. Auditory biofeedback had greater impact on modifying plantar pressure in individuals with CAI. Further studies are required to assess the prolonged effect and clinical consequences of biofeedback or a combination of feedback on CAI in different age groups. Moreover, developing a low-cost and user-friendly device that can be evaluated in high quality RCTs is important prior to implementing the intervention in the clinical setting to reduce symptoms of CAI.

The effects of joint hypermobility on pain and functional biomechanics in adolescents with juvenile fibromyalgia: secondary baseline analysis from a pilot randomized controlled trial

BackgroundJoint hypermobility is a common clinical finding amongst hereditary connective tissue disorders that is observed in pediatric rheumatological settings, and often associated with chronic pain. Joint hypermobility may also contribute to deficits in physical functioning and physical activity, but previous findings have been inconsistent. It is possible that physical activity impairment in joint hypermobility may be due to chronic aberrant movement patterns subsequent to increased joint laxity.MethodAs part of a larger randomized pilot trial of juvenile onset fibromyalgia (JFM), a secondary analysis was conducted to explore whether adolescents with JFM and joint hypermobility differed from non-joint hypermobility peers in terms of pain, daily functioning, and biomechanics (i.e., kinetics and kinematics) during a moderately vigorous functional task.ResultsFrom the larger sample of adolescents with JFM (N = 36), 13 adolescents (36.1%) met criteria for joint hypermobility and 23 did not have joint hypermobility. Those with joint hypermobility exhibited poorer overall functioning (Md = 20, Q1,Q3 [5.8, 7.6] vs. Md = 29, Q1,Q3 [5.1, 7.6]) but there were no differences in pain (Md = 6.9, Q1,Q3 [22, 33], vs. Md = 6.45, Q1,Q3 [15, 29.5]). Inspection of time-series plots suggests those with joint hypermobility exhibited decreased hip flexion and frontal plane hip moment (e.g., resistance to dynamic valgus) during the landing phase (early stance) and greater hip and knee transverse plane moments during the propulsion phase (late stance) of the drop vertical jump task (DVJ). No other differences in lower extremity biomechanics were observed between study groups.ConclusionsIn this exploratory study, there were small but notable differences in biomechanics between patients with JFM who also had joint hypermobility versus those without joint hypermobility during a landing and jumping task (e.g., DVJ). These differences may indicate decreased joint stiffness during landing, associated with increased joint laxity and decreased joint stability, which may put them at greater risk for injury. Further study with a larger sample size is warranted to examine whether these biomechanical differences in patients with JFM and joint hypermobility affect their response to typical physical therapy or exercise recommendations.

How Subtalar Kinematics Affects Knee Laxity in Soccer Players After Anterior Cruciate Ligament Injury?

Purpose The goal of the current study was to ascertain whether there is an association between foot pronation and anterior cruciate ligament (ACL) injury in a group of elite professional soccer players. Methods Two groups of soccer players were studied, all of whom played in the Greek Super League. The ACL group included players who had suffered an ACL injury in the last 2 years. The non-ACL group was composed of players who had never suffered an ACL injury. We used a 3D baropodometric laser scanner to measure pronation or overpronation (navicular drop phenomenon) of the subtalar joint and how this affects the subtalar joint while standing. We assessed ACL laxity using the Genourob Rotab. Results ACL-injured patients, regardless of the mechanism of injury, exhibited greater navicular drop values than a randomly selected group of subjects with no history of ACL injury. Conclusion Greater knee joint laxity and subtalar pronation may be associated with an increased risk of ACL injury. Pronation of the foot appears to be a risk factor for ACL injury. These findings should be integrated into future studies to better define how neuromuscular control related to lower extremity biomechanics is associated with ACL injury.

Pedobarographic evaluations in physical medicine and rehabilitation practice.

The feet are complex structures that transmit loads transferred by other parts of the body to the ground and are involved in many static and dynamic activities, such as standing and walking. The contact area and pressure changes between the feet and the ground surface can be measured using pedobarographic devices. With pedobarographic examinations, it is possible to obtain a wide range of information needed to support clinical evaluation and diagnostic tests in physical medicine and rehabilitation practice. Foot structure and function, postural stability, lower extremity biomechanics, and gait analysis are among the areas that can be further investigated using pedobarography.

Current Concepts in Lower Extremity Amputation: A Primer for Plastic Surgeons.

After studying this article, the participant should be able to: 1. Understand the goals of lower extremity reconstruction and identify clinical scenarios favoring amputation. 2. Understand lower extremity amputation physiology and biomechanics. 3. Review soft-tissue considerations to achieve durable coverage. 4. Appreciate the evolving management of transected nerves. 5. Highlight emerging applications of osseointegration and strategies to improve myoelectric prosthetic control. Plastic surgeons are well versed in lower extremity reconstruction for traumatic, oncologic, and ischemic causes. Limb amputation is an increasingly sophisticated component of the reconstructive algorithm and is indicated when the residual limb is predicted to be more functional than a salvaged limb. Although plastic surgeons have traditionally focused on limb salvage, they play an increasingly vital role in optimizing outcomes from amputation. This warrants a review of core concepts and an update on emerging reconstructive techniques in amputee care.

Kadınlarda Dinamik Denge Üzerinde Kuadriseps Kas Aktivasyonu ile Q Açısı Arasındaki İlişki

Introduction: Lower extremity biomechanics affects the relationship between Q angle, quadriceps muscle activation and the balance.&#x0D; Objectiveː The aim was to examine the relationship between Q angle and quadriceps muscle activation on dynamic balance position in women. &#x0D; Materials and Methodsː Forty women were included in the study. The muscle activation of the quadriceps during dynamic balance in a single leg stance was recorded. A tape measure was used to measure Q angle, surface electromyography was used to assess muscle activation, the Flamingo Balance Test was used to assess static balance, the TechnoBody PK 200WL computerized balance device was used to assess dynamic balance, and the Short Form Musculoskeletal Assessment was used to assess functionality.&#x0D; Resultsː There was a statistically significant positive correlation between the Q angle standing and supine position and vastus medialis muscle activation respectively, (r=0.35, p=0,02; r=0.40, p=0.01). There was a statistically significant positive correlation between the perimeter length and Q angle in standing/supine position respectively, (r=0.33, p=0.04; r=0.32, p=0.04). Area gap percentage and Q angle standing (r=0.89, p=0.02), supine position Q angle values (r=0.63, p=0.03) were positively correlated.&#x0D; Conclusionː If vastus medialis is more strengthened, Q angle would be more normalized, so quadriceps muscle strengthening exercises are helpful for the normalization of the Q angle. Also, when the Q angle is normalized, a single leg balance would be revealed.

Modified Trunk And Lower Extremity Biomechanics During Running At Preferred Speed: A Case Study In Foot Landing Type And Footwear

Modified Trunk And Lower Extremity Biomechanics During Running At Preferred Speed: A Case Study In Foot Landing Type And Footwear

Concussion History Moderates Relationships Between Trunk And Lower Extremity Biomechanics During A Cut

Concussion History Moderates Relationships Between Trunk And Lower Extremity Biomechanics During A Cut

How does flexible pes planus affect jumping performance and lower extremity biomechanics during countermovement jump in volleyball players?

How does flexible pes planus affect jumping performance and lower extremity biomechanics during countermovement jump in volleyball players?

Impact of subject’s physical properties on joint biomechanics: Hypermobility alters lower extremity biomechanics during knee-bearing activity

Impact of subject’s physical properties on joint biomechanics: Hypermobility alters lower extremity biomechanics during knee-bearing activity

Walking speed differentially affects lower extremity biomechanics in individuals with anterior cruciate ligament reconstruction compared to uninjured controls

BackgroundWalking biomechanics are commonly affected after anterior cruciate ligament reconstruction and differ compared to uninjured controls. Manipulating task difficulty has been shown to affect the magnitude of walking impairments in those early after knee surgery but it is unclear if patients in later phases post-op are similarly affected by differing task demands. Here, we evaluated the effects of manipulating walking speed on between-limb differences in ground reaction force and knee biomechanics in those with and without anterior cruciate ligament reconstruction. MethodsWe recruited 28 individuals with anterior cruciate ligament reconstruction and 20 uninjured control participants to undergo walking assessments at three speeds (self-selected, 120%, and 80% self-selected speed). Main outcomes included sagittal plane knee moments, angles, excursions, and ground reaction forces (vertical and anterior-posterior). FindingsWe observed walking speed differentially impacted force and knee-outcomes in those with anterior cruciate ligament reconstruction. Between-limb differences increased at fast and decreased at slow speeds in those with anterior cruciate ligament reconstruction while uninjured participants maintained between-limb differences regardless of speed (partial η2 = 0.13–0.33, p < 0.05). Anterior cruciate ligament reconstruction patients underloaded the surgical limb relative to both the contralateral, and uninjured controls in GRFs and sagittal plane knee moments (partial η2 range = 0.13–0.25, p < 0.05). InterpretationOverall, our findings highlight the persistence of walking impairments in those with anterior cruciate ligament reconstruction despite completing formal rehabilitation. Further research should consider determining if those displaying larger changes in gait asymmetries in response to fast walking also exhibit poorer strength and/or joint health outcomes.

Challenges and advances in the use of wearable sensors for lower extremity biomechanics

The use of wearable sensors for the collection of lower extremity biomechanical data is increasing in popularity, in part due to the ease of collecting data and the ability to capture movement outside of traditional biomechanics laboratories. Consequently, an increasing number of researchers are facing the challenges that come with utilizing the data captured by wearable sensors. These challenges include identifying/calculating meaningful measures from unfamiliar data types (measures of acceleration and angular velocity instead of positions and joint angles), defining sensor-to-segment alignments for calculating traditional biomechanics metrics, using reduced sensor sets and machine learning to predict unmeasured signals, making decisions about when and how to make algorithms freely available, and developing or replicating methods to perform basic processing tasks such as recognizing activities of interest or identifying gait events. In this perspective article, we present our own approaches to common challenges in lower extremity biomechanics research using wearable sensors and share our perspectives on approaching several of these challenges. We present these perspectives with examples that come mostly from gait research, but many of the concepts also apply to other contexts where researchers may use wearable sensors. Our goal is to introduce common challenges to new users of wearable sensors, and to promote dialogue amongst experienced users towards best practices.

Real-time ground reaction force and knee extension moment estimation during drop landings via modular LSTM modeling and wearable IMUs.

This work investigates real-time estimation of vertical ground reaction force (vGRF) and external knee extension moment (KEM) during single- and double-leg drop landings via wearable inertial measurement units (IMUs) and machine learning. A real-time, modular LSTM-based model with four sub-deep neural networks was developed to estimate the vGRF and KEM from wearable IMUs. Sixteen subjects wore eight IMUs on the chest, waist, right and left thighs, shanks, and feet and performed drop landing trials. Ground embedded force plates and an optical motion capture system were used to capture lower extremity biomechanics for model training and evaluation. During single-leg drop landings, accuracy for the vGRF and KEM estimation was R2=0.88 ±0.12 and R2=0.84 ±0.14, respectively, and during double-leg drop landings, accuracy for the vGRF and KEM estimation was R2=0.85 ±0.11 and R2=0.84 ±0.12, respectively. The best vGRF and KEM estimations of the model with the optimal LSTM unit number (130) require eight IMUs placed on the eight selected locations during single-leg drop landings. During double-leg drop landings, the best estimation on a leg only needs five IMUs placed on the chest, waist, and the leg's shank, thigh, and foot. The proposed modular LSTM-based model with optimally-configurable wearable IMUs can accurately estimate vGRF and KEM in real-time with relatively low computational cost during single- and double-leg drop landing tasks. This investigation could potentially enable in-field, non-contact anterior cruciate ligament injury risk screening and intervention training programs.

Republication of "Uses of Braces and Orthotics for Conservative Management of Foot and Ankle Disorders".

Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will summarize the orthoses used for treatment of the most commonly encountered foot and ankle pathologies, with the exclusion of treatment for the diabetic foot because of the unique requirements of that disease process.