Peak Ankle Plantarflexion Research Articles

Effects of unweighting on gait kinematics during walking on a lower-body positive-pressure treadmill in patients with hip osteoarthritis

BackgroundHip osteoarthritis (OA) is a musculoskeletal condition that makes walking difficult due to pain induced by weight-bearing activities. Treadmills that support the body weight (BW) reduce the load on the lower limbs, and those equipped with a lower-body positive-pressure (LBPP) device, developed as a new method for unweighting, significantly reduce pain in patients with knee OA. However, the effects of unweighting on gait kinematics remain unclear in patients with hip OA. Therefore, we investigated the effects of unweighting on kinematics in patients with hip OA during walking on a treadmill equipped with an LBPP device.MethodsA total of 15 women with hip OA and 15 age-matched female controls wore a three-dimensional (3-D) motion analysis system and walked at a self-selected speed on the LBPP treadmill. Data regarding self-reported hip pain using a numeric rating scale (NRS) in which the scores 0 and 10 represented no pain and the worst pain, respectively, under three different BW conditions (100, 75, and 50%) were collected. Moreover, 3-D peak joint angles during gait under each condition were calculated and compared.ResultsIn the hip OA group, the NRS pain scores at 50 and 75% BW conditions significantly decreased compared with that at 100% BW condition (50%, P = 0.002; 75%, P = 0.026), and the peak hip extension angle decreased compared with that in the healthy controls (P = 0.044). In both groups, unweighting significantly decreased the peak hip (P < 0.001) and knee (P < 0.001) flexion angles and increased the peak ankle plantar flexion angle (P < 0.001) during walking.ConclusionsUnweighting by the LBPP treadmill decreased pain in the hip OA group but did not drastically alter the gait kinematics compared with that in the control group. Therefore, regarding the use of the LBPP treadmill for patients with hip OA, clinicians should consider the benefits of pain reduction rather than the kinematic changes.

Does running speed affect the response of joint level mechanics in non-rearfoot strike runners to footwear of varying longitudinal bending stiffness?

BackgroundModifying the longitudinal bending stiffness (LBS) of footwear has become a popular method to improve sport performance. It has been demonstrated to influence running economy by altering lower extremity joint level mechanics. Previous studies have only examined within-participant effects at one running speed. Research questionDo joint level mechanics differ in response to varying footwear LBS at a range of running speeds? MethodsThis study utilized a cross-sectional repeated measure study design using a convenience sample. Ten well trained non-rearfoot strike male distance runners ran at 3.89, 4.70, and 5.56 m/s (14, 17, 20 km/hr) in footwear of three different LBS levels. Mechanics and energetics of the metatarsophalangeal joint (MTPJ), ankle, knee, and hip joints during stance phase were assessed using an 8-camera optical motion capture system (fs = 200 Hz), a force instrumented treadmill (fs = 1000 Hz) and standard inverse dynamics theory. ResultsRange of motion and negative work decreased and angular stiffness increased for the MTPJ with increasing LBS at all speeds (p < .001). Peak MTPJ moment did not change at any speed in response to increased LBS. Negative work at the ankle decreased in the stiff shoe at 17 km/hr (p = .036). Peak ankle plantar flexion velocity decreased with increasing LBS at all speeds (p < .05). SignificanceWhile changes in MTPJ mechanics were consistent across speeds, decreased negative ankle work was only observed at 17 km/hr in the stiff shoe, suggesting that perhaps tuned footwear LBS may need to focus primarily on metabolically beneficial changes in ankle plantar flexor mechanical behavior to improve performance in distance runners. Tuning footwear stiffness may also be beneficial to clinical populations, as clinicians seek to optimize their patients’ locomotion economy.

Knee joint biomechanics of patients with unilateral total knee arthroplasty during stationary cycling

Stationary cycling is typically recommended following total knee arthroplasty (TKA) operations. However, knee joint biomechanics during cycling remains mostly unknown for TKA patients. Biomechanical differences between the replaced and non-replaced limb may inform applications of cycling in TKA rehabilitation. The purpose of this study was to examine the knee joint biomechanics of TKA patients during stationary cycling. Fifteen TKA participants cycled at 80 revolutions per minute and workrates of 80 W and 100 W while kinematics (240 Hz) and pedal reaction forces using a pair of instrumented pedals (1200 Hz) were collected. A 2x2 (limb × workrate) repeated measures ANOVA was run with an alpha of 0.05. Peak knee extension moment (KEM, p = 0.034) and vertical pedal reaction force (p = 0.038) were significantly reduced in the replaced limbs compared to non-replaced limbs by 21.3% and 5.3%, respectively. Peak KEM did not change for TKA patients with the increased workrate (p = 0.750). However, both peak hip extension moment (p = 0.009) and ankle plantarflexion moment (p = 0.017) increased due to increased workrate. Patients following TKA showed similar decreases in peak KEM and vertical pedal reaction force in their replaced compared to non-replaced limbs, as previously seen in gait. Patients of TKA may rely on their hip and ankle extensors to increases in workrate. Increasing intensity by 20 W did not exacerbate any inter-limb differences for peak KEM and vertical PRF.

Racial differences in gait mechanics

The effect of race has rarely been investigated in biomechanics studies despite racial health disparities in the incidence of musculoskeletal injuries and disease, hindering both treatment and assessment of rehabilitation. The purpose of this study was to test the hypothesis that racial differences in gait mechanics exist between African Americans (AA) and white Americans (WA). Ninety-two participants (18–30 years old) were recruited with equal numbers in each racial group and sex. Self-selected walking speed was measured for each participant. 3D motion capture and force plate data were recorded during 7 walking trials at regular and fast set speeds. Step length, step width, peak vertical ground reaction force, peak hip extension, peak knee flexion, and peak ankle plantarflexion were computed for all trials at both set speeds. Multivariate and post-hoc univariate ANOVA models were fit to determine main and interaction effects of sex and race (SPSS V26, α = 0.05). Self-selected walking speed was slower in AA (p = 0.004, ƞp2 = 0.088). No significant interactions between race and sex were identified. Males took longer steps (regular: p < 0.001, ƞp2 = 0.288, fast: p < 0.001, ƞp2 = 0.193) and had larger peak knee flexion (regular: p = 0.007, ƞp2 = 0.081, fast: p < 0.001, ƞp2 = 0.188) and ankle plantarflexion angles (regular: p = 0.050, ƞp2 = 0.044, fast: p = 0.049, ƞp2 = 0.044). Peak ankle plantarflexion angle (regular: p = 0.012, ƞp2 = 0.071, fast: p < 0.001, ƞp2 = 0.137) and peak hip extension angle during fast walking (p = 0.007, ƞp2 = 0.083) were smaller in AA. Equivalency in gait measures between racial groups should not be assumed. Racially diverse study samples should be prioritized in the development of future research and individualized treatment protocols.

Changes in the Plantar Flexion Torque of the Ankle and in the Morphological Characteristics and Mechanical Properties of the Achilles Tendon after 12-Week Gait Retraining.

Purpose: Although the Achilles tendon (AT) is the largest and strongest tendon, it remains one of the most vulnerable tendons among elite and recreational runners. The present study aims to explore the effects of 12-week gait retraining (GR) on the plantar flexion torque of the ankle and the morphological and mechanical properties of the AT. Methods: Thirty-four healthy male recreational runners (habitual rearfoot strikers) who never tried to run in minimal shoes were recruited, and the intervention was completed (20 in the GR group vs. 14 in the control (CON) group). The participants in the GR group were asked to run in minimal shoes (INOV-8 BARE-XF 210) provided by the investigators with forefoot strike patterns during the progressive 12-week GR. Meanwhile, the participants in the CON group were instructed to run in their own running shoes, which they were familiar with, with original foot strike patterns and intensities. The morphological properties of the AT, namely, length and cross-sectional area (CSA), were obtained by using an ultrasound device. A dynamometer was utilized simultaneously to measure and calculate the plantar flexion torque of the ankle, the rate of torque development, the peak force of the AT, and the stress and strain of the AT. Results: After 12-week GR, the following results were obtained: (1) A significant time effect in the peak ankle plantarflexion torque was observed (p = 0.005), showing a 27.5% increase in the GR group; (2) A significant group effect in the CSA was observed (p = 0.027), specifically, the increase in CSA was significantly larger in the GR group than the CON group; (3) A significant time effect in the peak AT force was observed (p = 0.005), showing a 27.5% increase in the GR group. Conclusion: The effect of 12 weeks of GR is an increase in AT CSA, plantar flexor muscle strength of the ankle, and peak AT force during a maximal voluntary isometric contraction test. These changes in AT morphology and function could be positive for tendon health and could prevent future AT injury.

Achilles Tendon Morphology Is Related to Triceps Surae Muscle Size and Peak Plantarflexion Torques During Walking in Young but Not Older Adults.

The interaction of the triceps surae muscles and the Achilles tendon is critical in producing the ankle plantarflexion torque required for human walking. Deficits in plantarflexor output are a hallmark of reduced mobility in older adults and are likely associated with changes in the triceps surae muscles that occur with age. Structural differences between young and older adults have been observed in the Achilles tendon and in the triceps surae muscles. However, less is known about how age-related differences in muscle and tendon morphology correspond with each other and, furthermore, how those morphology differences correlate with age-related deficits in function. The goal of this work was to investigate whether there is a correlation between age-related differences in triceps surae muscle size and Achilles tendon cross-sectional area (CSA) and whether either is predictive of ankle plantarflexion torque during walking. We used magnetic resonance imaging (MRI) to measure triceps surae muscle volumes and tendon CSAs in young (n = 14, age: 26 ± 4 years) and older (n = 7, age: 66 ± 5 years) adults, and we determined peak plantarflexion torques during treadmill walking. We found that individual muscle volumes as a percentage of the total triceps surae volume did not differ between young and older adults, though muscle volumes per body size (normalized by the product of height and mass) were smaller in older adults. Achilles tendon CSA was correlated with body size and muscle volumes in young adults but not in older adults. The ratio of tendon CSA to total triceps surae muscle volume was significantly greater in older adults. Peak ankle plantarflexion torque during walking correlated with body size and triceps surae volume in young and older adults but was correlated with tendon CSA only in the young adults. Structure–function relationships that seem to exist between the Achilles tendon and the triceps surae muscles in young adults are no longer evident in all older adults. Understanding mechanisms that determine altered Achilles tendon CSA in older adults may provide insight into age-related changes in function.

Sagittal And Frontal Plane Joint Moments Of The Sumo Deadlift During Shod And Barefoot Conditions

Sumo style deadlifting has recently become more prevalent. Barefoot-style lifting has also become increasingly popular with claims such as increased force production and improved “grounding” of the foot. However, the biomechanics of sumo deadlifting while barefoot have not been examined. PURPOSE: To examine the effects on the hip, knee, and ankle joint moments during a sumo deadlift when comparing shod and barefoot conditions. METHODS: Ten subjects (27.3±3.5 yrs, 1.74±0.13m, 77.97±17.34kg) with minimum six months of deadlift experience (7.6±4.6 yrs), who were free from lower extremity injury, performed 1 repetition maximum (1RM; 137.7±43.0 kg) testing on day 1. This testing was performed in self-selected footwear. On day 2, a minimum of 72 hours later, subjects lifted 70% of their 1RM during a 3-dimensional analysis. Subjects performed one set of five continuous repetitions of a sumo deadlift in shod and barefoot conditions in randomized order. Five minutes of rest was given between sets. Marker data were collected using Qualisys Track Manager, sampling at 240Hz. Force data were collected using Bertec force plates, sampling at 1200Hz. Raw marker and force data were imported into Visual3D. Marker and force data were filtered using a fourth-order lowpass Butterworth filter at 8Hz. Peak internal sagittal and frontal plane joint moments of the hip, knee, and ankle were calculated during the concentric phase of each repetition. Peak vertical ground reaction force was measured during the concentric phase. RESULTS: No significant differences were detected in peak hip extension moment (p=0.855), hip abduction (p=0.288), knee extension (p=0.607), knee abduction (p=0.926), ankle plantarflexion (p=0.376), ankle eversion (p=0.739), or peak vertical ground reaction force (p=0.558). CONCLUSIONS: There is no evidence to suggest that the barefoot lifting style increases performance capabilities when lifting the same weight as in the shod condition. Additionally, there is no evidence to suggest that there is any increased risk in excess frontal plane joint moments during barefoot lifting. Future research should examine the 1RM capabilities in both shod and barefoot conditions to determine if differences exist during maximal compared to submaximal efforts.

Joint moments and power in the acceleration phase of bend sprinting

Joint kinetics of the lower limb (hip, knee, ankle, midfoot and metatarsophalangeal joints) were investigated during the acceleration phase of bend sprinting and straight-line sprinting. Within the bend sprinting literature, it is generally accepted that sprint performance on the bend is restricted by moments in the non-sagittal plane preventing the production of force in the sagittal plane. However, there is limited evidence in conditions representative of elite athletics performance that supports this hypothesis. Three-dimensional kinematic and ground reaction force data were collected from seven participants during sprinting on the bend (36.5 m radius) and straight, allowing calculation of joint moment, power and energy. No changes in extensor moment were observed at the hip and knee joints. Large effect sizes (g = 1.07) suggest a trend towards an increase in left step peak ankle plantarflexion moment. This could be due to a greater need for stabilisation of the ankle joint as a consequence of non-sagittal plane adaptations of the lower limb. In addition, the observed increase in peak MTP joint plantar-flexor moment might have implications for injury risk of the fifth metatarsal. Energy generation, indicated by positive power, in the sagittal plane at the MTP and ankle joints was moderately lower on the bend than straight, whilst increases in non-sagittal plane energy absorption were observed at the ankle joint. Therefore, energy absorption at the foot and ankle may be a key consideration in improving bend sprinting performance.

Unloading Shoes for Intermittent Claudication: A Randomised Crossover Trial

Introduction - Intermittent claudication is a common condition often managed with high-risk invasive arterial revascularisation procedures. The primary first-line non-invasive intervention of supervised exercise training is rarely available for several reasons. As such non-invasive management is often sub-optimal. This study aims to assess the functional effects and acceptability of rocker-soled shoes that were designed to relatively “unload” the calf muscles during walking in people with calf claudication due to peripheral arterial disease. Methods - In this randomised AB/BA crossover trial, participants completed two assessment visits up to two weeks apart. At each visit, participants completed walking tests whilst wearing the unloading shoes or visually-similar control shoes. At the end of the second visit, participants were given either the unloading or control shoes to use in their home environment for 2 weeks, with the instruction to wear them at least 4 hours every day. The primary outcome was total distance walked during a forced-pace, 6-minute walking test. We also assessed pain-free walking distance and gait biomechanical variables during usual-pace walking, adverse events, and participants’ opinions about the shoes. Data for continuous outcomes are presented as mean difference between conditions with corresponding 95% confidence interval Results - Thirty-four participants (27 males, mean age 68 years, mean ankle-brachial index 0.54) completed both assessment visits. On average, the 6-minute walk distance was 11 m greater when participants wore the control shoes (95% CI -5 to 26), whereas mean pain-free walking distance was 7 m greater in the unloading shoes (95% CI -17 to 32). Neither of these differences were statistically significant (p=0.18 and p=0.55, respectively). This was despite the unloading shoes reducing peak ankle plantar flexion moment (mean difference 0.2 Nm/kg, 95% CI 0.0 to 0.3) and peak ankle power generation (mean difference 0.6 W/kg, 95% CI 0.2 to 1.0) during pain-free walking. The survey and interview data was mixed, with no clear differences between the unloading and control shoes. Conclusion - Shoes with modified soles to relatively unload the calf muscles during walking conferred no substantial acute functional benefit over control shoes.

The effects of intensive dietary weight loss and exercise on gait in overweight and obese adults with knee osteoarthritis. The Intensive Diet and Exercise for Arthritis (IDEA) trial

The Intensive Diet and Exercise for Arthritis (IDEA) trial was an 18-month randomized controlled trial that enrolled 454 overweight and obese older adults with symptomatic and radiographic knee osteoarthritis (OA). Participants were randomized to either exercise (E), intensive diet-induced weight loss (D), or intensive diet-induced weight loss plus exercise (D + E) interventions. We previously reported that the clinical benefits of D + E were significantly greater than with either intervention alone (e.g., greater pain reduction, and better function, mobility, and health-related quality of life). We now test the hypothesis that D + E has greater overall benefit on gait mechanics compared to either intervention alone. Knee joint loading was analyzed using inverse dynamics and musculoskeletal modeling. Analysis of covariance determined the interventions’ effects on gait. The D + E group walked significantly faster at 18-month follow-up (1.35 m s−1) than E (1.29 m s−1, p = 0.0004) and D (1.31 m s−1, p = 0.0007). Tibiofemoral compressive impulse was significantly lower (p = 0.0007) in D (1069 N s) and D + E (1054 N s) compared to E (1130 N s). D had significantly lower peak hip external rotation moment (p = 0.01), hip abduction moment (p = 0.0003), and peak hip power production (p = 0.016) compared with E. Peak ankle plantar flexion moment was significantly less (p < 0.0001) in the two diet groups compared with E. There also was a significant dose-response to weight loss; participants that lost >10% of baseline body weight had significantly (p = 0.0001) lower resultant knee forces and lower muscle (quadriceps, hamstring, and gastrocnemius) forces than participants that had less weight loss. Compared to E, D produces significant load reductions at the hip, knee, and ankle; combining D with E attenuates these reductions, but most remain significantly better than with E alone.

The effects of compression stockings on the energetics and biomechanics during walking.

The purpose of this study was to explore how compression stockings affect the energetics and biomechanics during walking. Sixteen male adults participated in this study. Participants completed walking trials on the treadmill and force plates, wearing compression stockings (CS) or nothing as a control condition (CON). The data obtained included metabolic rate, muscle activation, step frequency and step length as well as their variability, joint kinematics and joint kinetics. The effect of compression stockings on metabolic rate was trivial (CS: 3.81 ± 0.44Wkg-1, CON: 3.83 ± 0.46Wkg-1, p = 0.84, d = 0.05). Activation of calf muscles, step frequency and step length as well as their variability, joint range of motion and joint powers did not show a significant difference between conditions (p = 0.09-0.90, d = 0.01-0.34). The peak knee extension moment during the early stance phase had a tendency to increase (CS: 0.57 ± 0.27Nmkg-1, CON: 0.51 ± 0.28Nmkg-1, p = 0.05, d = 0.19) while the peak knee flexion moment during the late swing phase had a tendency to decrease (CS: 0.16 ± 0.10Nmkg-1, CON: 0.19 ± 0.12Nmkg-1, p = 0.10, d = 0.21). The peak ankle dorsiflexion moment during the early stance phase significantly increased (CS: 0.11 ± 0.06Nmkg-1, CON: 0.08 ± 0.05Nmkg-1, p = 0.02, d = 0.58) while the peak ankle plantar flexion moment during the late swing phase significantly decreased (CS: 1.41 ± 0.12Nmkg-1, CON: 1.47 ± 0.14Nmkg-1, p = 0.02, d = 0.45). Compression stockings have a limited effect on improving energetics of walking, but they may play a role in improving biomechanics by altering the relative contribution of knee and ankle moments to propulsion.

Statistical Parametric Mapping as a Measure of Differences Between Limbs: Applications to Clinical Populations

In healthy individuals, symmetrical lower-extremity movement is often assumed and calculated using discrete points during various tasks. However, measuring overall movement patterns using methods such as statistical parametric mapping (SPM) may allow for better interpretation of human movement. This study demonstrated the ability of SPM to assess interlimb differences in lower-extremity movement during 2 example tasks: running and landing. Three-dimensional motion analysis was used to determine sagittal and frontal plane lower-extremity joint angles in (1)young and older individuals during running and (2)patients with anterior cruciate ligament reconstruction and uninjured control athletes during landing. Interlimb differences within each group were compared using SPM and paired t tests on peak discrete angles. No differences between limbs were found between young and older runners using SPM. Peak ankle eversion and plantar flexion angles differed between limbs in young and older runners. Sagittal plane hip angle varied between limbs in uninjured control athletes. Frontal plane ankle angle and sagittal plane knee and hip angles differed between limbs in patients with anterior cruciate ligament reconstruction using SPM and discrete analysis. These data suggest that SPM can be useful to determine clinically meaningful interlimb differences during running and landing in multiple populations.

Lower extremity characteristics in recurrent clubfoot: Clinical and gait analysis findings that may influence decisions for additional surgery

BackgroundPatients with recurrent clubfoot may seek intervention to address impairments that impact gait function. An understanding of these impairments and associated gait issues will provide valuable information about ongoing treatment requirements. Research QuestionThe purpose of this study was to describe the prevalence of impairments and associated gait deviations in children with recurrent clubfoot and to evaluate whether these findings differ depending on unilateral or bilateral presentation. MethodsEighty-four affected feet (42 unilateral, 21 bilateral) were retrospectively reviewed. History, clinical exam, and gait data were collected. Statistical analysis included evaluations of associations between clinical exam and gait parameters and differences among patients with unilateral versus bilateral clubfoot and a database of healthy controls. ResultsThe average age was 7.5 ± 3.3 years for unilateral and 7.0 ± 2.8 years for bilateral patients. Patients presented with limited passive ankle dorsiflexion (unilateral/bilateral:67%/57%), limited ankle plantar flexion strength (unilateral/bilateral:53%/55%), metatarsus adductus (unilateral/bilateral:86%/83%) and internal foot-thigh angles (unilateral/bilateral:83%/82%), while only a subset presented with internal bi-malleolar axis angles (unilateral/bilateral:36%/45%). The most common gait deviations were internal foot progression (unilateral/bilateral:76%/73%), external hip rotation (unilateral/bilateral:66%/69%), reduced peak ankle plantar flexion moments (unilateral/bilateral:84%/83%), and reduced peak ankle power generation (unilateral/bilateral:67%/74%). Passive dorsiflexion was significantly correlated with peak dorsiflexion during stance and swing in both groups. Patients with unilateral compared to bilateral clubfoot showed decreased peak dorsiflexion and an associated knee flexor moment. SignificancePatients with recurrent clubfoot show gait deviations at the ankle that can be explained by joint level impairment and compensations at the knee, hip and pelvis. Patients with unilateral clubfoot typically show decreased dorsiflexion range of motion and associated greater gait impacts and compensations than bilateral clubfoot. Understanding the relationships between impairments and gait function and the implications of unilateral versus bilateral clubfoot will help improve prognostic ability and optimize future treatment outcomes.

MODIFYING MIDSOLE STIFFNESS of BASKETBALL FOOTWEAR AFFECTS FOOT and ANKLE BIOMECHANICS.

There is a growing incidence of foot injuries in basketball, which may be from the sport's repetitive, forceful multi-directional demands. Modifying midsole stiffness of the basketball shoe has been reported to alter ankle motion and plantar forces to reduce the risk of injury; however, the effects on anatomical, in-shoe foot (metatarsal), motion is not well understood. The purpose of this study was to identify differences in foot and ankle biomechanics between basketball shoes with differing midsole stiffness values during single-leg jump landings. It was hypothesized that a stiffer midsole would elicit lower 1st metatarsophalangeal joint (MTPJ) dorsiflexion angles, higher ankle dorsiflexion angles, and higher plantar forces and relative loading in the distal foot. Experimental cross-sectional study. Twenty high school and collegiate-aged basketball players performed a single-leg side drop jump and a single-leg cross drop jump in a pair of standard basketball shoes and a pair of shoes modified with a fiberglass plate to increase midsole stiffness. Three-dimensional motion analysis and flexible insoles quantified foot and ankle kinematics and plantar force distribution, respectively. Separate 2 (footwear) × 2 (task) repeated measures ANOVA models were used to analyze differences in 1) ankle kinematics, 2) 1st metatarsophalangeal kinematics, 3) maximal regional plantar forces, and 4) relative load. The stiffer shoe elicited decreased peak ankle plantarflexion (mean difference = 5.8 °, p = 0.01) and eversion (mean difference = 6.6 °, p = 0.03) and increased peak ankle dorsiflexion angles (mean difference = 5.0 °, p = 0.008) but no differences were observed in 1st MTPJ motion (p > 0.05). The stiffer shoe also resulted in lower peak plantar forces (mean difference = 24.2N, p = 0.004) and relative load (mean difference = 1.9%, p = 0.001) under the lesser toes. Altering the midsole stiffness in basketball shoes did not reduce motion at the MTPJ, indicating that added stiffness may reduce shoe motion, but does not reduce in-shoe anatomical motion. Instead, a stiffer midsole elicits other changes, including additional ankle joint motion and a reduction in plantar forces under the lesser toes. Collectively, this indicates that clinicians need to account for unintended compensations that can occur throughout the kinetic chain when altering a shoe property to alleviate a musculoskeletal injury. 2b.

Amputee Locomotion: Joint Moment Adaptations to Running Speed Using Running-Specific Prostheses after Unilateral Transtibial Amputation.

The objective of this study was to investigate three-dimensional lower extremity joint moment differences between limbs and speed influences on these differences in individuals with lower extremity amputations using running-specific prostheses. Eight individuals with unilateral transtibial amputations and 8 control subjects with no amputations ran overground at three constant velocities (2.5, 3.0, and 3.5 m/sec). A 2 × 2 × 3 (group × leg × speed) repeated-measures analysis of variance with Bonferroni adjustments determined statistical significance. The prosthetic limb generated significantly greater peak ankle plantarflexion moments and smaller peak ankle varus, knee stance extension, knee swing flexion, knee internal rotation, hip stance flexion, hip swing flexion, hip swing extension, hip valgus, and hip external rotation moments than the intact limb did. The intact limb had greater peak hip external rotation moments than control limbs did, but all other peak moments were similar between these limbs. Increases in peak hip stance and knee swing flexion moments associated with speed were greater in the intact limb than in the prosthetic limb. Individuals with amputation relied on the intact limb more than the prosthetic limb to run at a particular speed when wearing running-specific prostheses, but the intact joints were not overloaded relative to the control limbs.

The relationship between trunk acceleration parameters and kinematic characteristics during walking in patients with stroke.

[Purpose] Limited literature has investigated the relationships between acceleration-based gait characteristics and kinematic information from motion analysis systems in gait analysis. The purpose of this study is to determine whether acceleration-based gait characteristics were associated with gait characteristics by motion analysis systems in patients with stroke. [Participants and Methods] Seventeen patients with stroke walked along a 10-m-long walkway at their comfortable speed. Trunk acceleration was measured with an accelerometer. Several reflective markers over bony landmarks on the lower extremities were used to capture movements. We evaluated the correlations of variables calculated between the trunk accelerometers and the motion analysis system. [Results] Walking speed was positively correlated with harmonic ratios along the anteroposterior axis and stride regularity along the vertical and anteroposterior axes. Harmonic ratios were associated with the stance phase percent on the unaffected side. Stride regularity was associated with the stance phase percent on both sides. Smaller interstride variability was associated with smaller peak ankle plantarflexion during both phases and greater peak ankle dorsiflexion during swing phase. Stride regularity is positively associated with maximal knee flexion during swing phase. [Conclusion] Relationships with spatiotemporal and joint kinematic parameters from the motion analysis system support the potential use of accelerometers.

Changes in Vertical and Joint Stiffness in Runners With Advancing Age.

Powell, DW and Williams, DSB. Changes in vertical and joint stiffness in runners with advancing age. J Strength Cond Res 32(12): 3425-3431, 2018-Age-related changes in the neuromuscular system underlie reduced performance and injury but may be mitigated through regular physical activity. It was hypothesized that older (OLD) compared with young (YOUNG) adults would exhibit greater vertical and joint stiffness when running at 3.35 m·s. Nine YOUNG and 10 OLD runners performed over ground running trials while three-dimensional biomechanics were recorded. Ankle and knee joint angles, moments and stiffness values were compared between YOUNG & OLD. YOUNG had smaller vertical stiffness (p = 0.01; YOUNG: 32.8 ± 3.6; OLD: 38.1 ± 5.7) and greater joint stiffness than OLD at the ankle (p = 0.04; YOUNG: 0.134 ± 0.021; OLD: 0.118 ± 0.017) and knee (p = 0.01; YOUNG: 0.119 ± 0.016; OLD: 0.098 ± 0.014). YOUNG exhibited greater peak knee flexion angles (p = 0.04; YOUNG: 43.4 ± 6.5°; OLD: 39.1 ± 2.6°), and peak ankle plantarflexion (p = 0.02; YOUNG: -2.8 ± 0.4 Nm·kg; OLD: -2.5 ± 0.1 Nm·kg) and knee extension moments (p < 0.01; 2.6 ± 0.3 Nm·kg; OLD: 2.1 ± 0.2 Nm·kg) than OLD whereas no differences were observed in peak ankle dorsiflexion angles (p = 0.44; YOUNG: 23.6 ± 4.2°; OLD: 23.4 ± 2.1°). The findings of this study suggest that OLD compared with YOUNG adults adopt altered lower extremity biomechanics. These altered running biomechanics by seek to minimize the metabolic cost of running or may be a function of reduced lower extremity strength and power.

Does clinically measured ankle plantar flexor muscle strength or weakness correlate with walking performance in healthy individuals?

Muscle strength is usually measured using isometric hand-held dynamometers (HHDs) in the clinic. However, during functional activities, the muscle acts more dynamically. The aim of this study was to investigate the relation between clinically measured plantar flexor (PF) muscle strength (PFMS) and laboratory measurements of peak ankle plantar flexion power generation (APFPG), peak ankle moment (PAM), peak plantar flexion velocity (PFV) and mean gait velocity in healthy participants. The maximum PFMS on non-dominant sides in 18 able-bodied persons 23.88 (SD 3.55 years) was measured before (Pre-S) and after a stretching (Post-S) procedure (135 sec. × 13 rep. with 5 sec. rest) by using a HHD. The stretching procedure was used to generate temporary PF muscle weakness. Gait analysis was carried out for Pre-S and Post-S conditions. Normalized (by weight and height) and non-normalized HHD scores and differences for both conditions were correlated by Pearson correlation coefficient calculations (p< 0.05). Reduced PFMS (%23, p< 0.001) in Post-S, according to the HHD scores, has only a weak correlation with APFPG (r> 0.3, p< 0.5). Gait velocity was found to be strongly correlated with APFPG only in the Post-S condition (r= 0.68, p< 0.002). HHD scores and PAM were moderately correlated with the non-normalized Post-S condition (r= 0.44, p= 0.70) and strongly correlated with the non-normalized Pre-S condition (r= 0.62, p< 0.01). HHD scores of plantar flexor muscles give very limited information about the PF performance during walking in healthy individuals. Simple normalization did not improve the relations. Clinically measured isometric muscle strength and muscle weakness have only moderate strengths for establishing a treatment protocol and for predicting performance during walking in neurologically intact individuals.

Kinematic and kinetic benefits of implantable peroneal nerve stimulation in people with post-stroke drop foot using an ankle-foot orthosis.

Contralesional 'drop foot' after stroke is usually treated with an ankle-foot orthosis (AFO). However, AFOs may hamper ankle motion during stance. Peroneal functional electrical stimulation (FES) is an alternative treatment that provides active dorsiflexion and allows normal ankle motion. Despite this theoretical advantage of FES, the kinematic and kinetic differences between AFO and FES have been scarcely investigated. To test whether walking with implanted FES leads to improvements in stance stability, propulsion, and swing initiation compared to AFO. A 4-channel peroneal nerve stimulator (ActiGait®) was implanted in 22 chronic patients after stroke. Instrumented gait analyses were performed during comfortable walking up to 26 weeks (n = 10) or 52 weeks (n = 12) after FES-system activation. Kinematics of knee and ankle (stance and swing phase) and kinetics (stance phase) of gait were determined, besides spatiotemporal parameters. Finally, we determined whether differences between devices regarding late stance kine(ma)tics correlated with those regarding the swing phase. In mid-stance, knee stability improved as the peak knee extension velocity was lower with FES (β = 18.1°/s, p = 0.007), while peak ankle plantarflexion velocity (β = -29.2°/s, p = 0.006) and peak ankle plantarflexion power (β = -0.2 W/kg, p = 0.018) were higher with FES compared to AFO. With FES, the ground reaction force (GRF) vector at peak ankle power (i.e., 'propulsion') was oriented more anteriorly (β = -1.1°, p = 0.001). Similarly, the horizontal GRF (β = -0.8% body mass, p = 0.003) and gait speed (β = 0.03 m/s, p = 0.015) were higher. An increase in peak ankle plantarflexion velocity and a more forward oriented GRF angle during late stance were moderately associated with an increase in hip flexion velocity during initial swing (rs = 0.502, p = 0.029 and rs = 0.504, p = 0.028, respectively). This study substantiates the evidence that implantable peroneal FES as a treatment for post-stroke drop foot may be superior over AFO in terms of knee stability, ankle plantarflexion power, and propulsion.

Effects of Two Plyometric Protocols at Different Surfaces on Mechanical Properties of Achilles Tendon in Children

Objectives: The purpose of this study was to compare the changes in muscle strength and Achilles tendon strain after two plyometric training programs performed on different surfaces in children. Methods: Thirty six children (21 girls, 15 boys) aged 9.30 ± 0.55 years were assigned into a mini-trampoline plyometric group (TPLG), a ground-plyometric group (GPLG) and a control group (CG). The training groups completed a 4-week plyometric intervention (PL) (three-times a week), consisting of hopping exercises performed either on a mini-trampoline (TPLG) or ground (GPLG). Achilles tendon strain, peak ankle plantar flexion torque (PAT), and rate of torque development (RTD) at 3 different angular positions of the ankle (15°, 0° and -15°) were measured before and after training. Results: The main finding of this study was that Achilles tendon strain decreased significantly after plyometric training performed on a mini-trampoline or ground surface ( 25% and 15%, for the TPLG and GPLG, respectively (P < 0.05)). This was accompanied by an increase in maximum ankle MVC torque and an increase in RTD (at 15°, 0° positions) for both experimental groups. Especially, statistically significant increases in PAT (30%) and RTD (14%) (P < 0.05) were found for the TPLG while for the GPLG group the increase was 19 % and 8% for PAT and RTD, respectively (P < 0.05). Conclusions: Both protocols show similar adaptations regardless of the surface of training. Training on elastic surface should be incorporated into exercise programs aiming either to enhance strength performance safely, or to achieve the target goal which is not only the safe performance but also the muscle-tendon system efficiency.