ArticleLiterature Review
To read the full-text of this research, you can request a copy directly from the author.

Abstract

Running biomechanics play an important role in the development of injuries. Performing a running biomechanics analysis on injured runners can help to develop treatment strategies. This article provides a framework for a systematic video-based running biomechanics analysis plan based on the current evidence on running injuries, using 2-dimensional (2D) video and readily available tools. Fourteen measurements are proposed in this analysis plan from lateral and posterior video. Identifying simple 2D surrogates for 3D biomechanic variables of interest allows for widespread translation of best practices, and have the best opportunity to impact the highly prevalent problem of the injured runner.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... These angles will be evaluated during midstance. In the sagittal plane the angles assessed will be: foot inclination; tibia inclination; ankle dorsiflexion; knee flexion [33,37,38]. Foot and tibia inclination will be evaluated during initial contact while ankle dorsiflexion and knee flexion during midstance. ...
... Foot and tibia inclination will be evaluated during initial contact while ankle dorsiflexion and knee flexion during midstance. In the frontal plane, the deepest landing position (near midstance) will be determined visually by slowly advancing the video frame by frame [33,37,38]. Since the cameras are synchronized this position will also be used to determine the midstance in the sagittal plane. ...
... The primary outcome of the study will be: (I) pain during daily activities (usual)-assessed using the Visual Analog Pain Scale [29]; The secondary outcomes will be: (II) pain during running-assessed using the Visual Analog Pain Scale [29]; (III) function-assessed using the Patellofemoral Disorders Scale [31]; (IV) kinematics of the lower limbs in the frontal (contralateral pelvic drop; hip adduction) [33,35,36] and sagittal planes (foot inclination; tibia inclination; ankle dorsiflexion; knee flexion) [33,37,38]-assessed through digital videos using two webcams (MyoVideo 139 HD Color Webcam) sampling at 30 frames per second and two leds (LED Floodlight) [33]. The video recordings will be analyzed using the MyoResearch 3.14 -MyoVideo software (Noraxon U.S.A. Inc.). ...
Article
Full-text available
Patellofemoral pain (PFP) is one of the most prevalent injuries in runners. Unfortunately, a substantial part of injured athletes do not recover fully from PFP in the long-term. Although previous studies have shown positive effects of gait retraining in this condition, retraining protocols often lack clinical applicability because they are time-consuming, costly for patients and require a treadmill. The primary objective of this study will be to compare the effects of two different two-week partially supervised gait retraining programs, with a control intervention; on pain, function and lower limb kinematics of runners with PFP. It will be a single-blind randomized clinical trial with six-month follow-up. The study will be composed of three groups: a group focusing on impact (group A), a group focusing on cadence (group B), and a control group that will not perform any intervention (group C). The primary outcome measure will be pain assessed using the Visual Analog Pain scale during running. Secondary outcomes will include pain during daily activities (usual), symptoms assessed using the Patellofemoral Disorders Scale and lower limb running kinematics in the frontal (contralateral pelvic drop; hip adduction) and sagittal planes (foot inclination; tibia inclination; ankle dorsiflexion; knee flexion) assessed using the MyoResearch 3.14—MyoVideo (Noraxon U.S.A. Inc.). The study outcomes will be evaluated before (t0), immediately after (t2), and six months (t24) after starting the protocol. Our hypothesis is that both partially supervised gait retraining programs will be more effective in reducing pain, improving symptoms, and modifying lower limb kinematics during running compared with the control group, and that the positive effects from these programs will persist for six months. Also, we believe that one gait retraining group will not be superior to the other. Results from this study will help improve care in runners with PFP, while maximizing clinical applicability as well as time and cost-effectiveness.
... Other factors that are supposed to influence trunk stability during gait are gender and level of training, but studies exist only with regard to lower trunk level or walking gait [11,24]. However, to the best of the authors knowledge, no study directly investigated the relationship between acceleration of the UT and gender, level of training, and lower limb and pelvis run pattern, described through the footstrike pattern, presence of overstriding, crossover, excessive protonation (EPR), and pelvic drop (EPD), which have already been demonstrated to influence intensities and direction of the GRF, shock transmission, and runningrelated injuries [7,[18][19][20][25][26][27][28]. is study aims to fill this gap in the literature by characterizing UT kinematics by exploring differences in the UT kinematics according to gender and level of training and in relation to lower limb run pattern. e proposed analysis will be conducted by using an IMU placed on the UT. ...
... where i is the respective axis: AP or ML. is calculation resulted in a unitless ratio for each axis and was performed to account for influence of running speed on trunk acceleration [31]. Lower body variables chosen to describe running pattern were those that are frequently modified during gaitretraining with the goal of reducing injury risk [27] and that can be easily identified through a frame-by-frame video analysis, namely, the presence of rearfoot strike, overstriding, crossover, EPR, and EPD. Rearfoot strike, overstriding, and crossover were assessed to describe the running pattern at initial contact, EPR, and EPD at midstance. ...
... Running gait phases were identified by the use of the Optogait system, and the presence or not of the selected running patterns was detected by video analysis with manual digitation. Criteria used to assess the presence of rearfoot strike, overstriding, crossover, EPR, and EPD by 2D video analysis referred to those used in literature [7,18,27,28]. In particular, rearfoot refers to initial contact made by the heel in which the heel lands before the ball of the foot, a midfoot strike refers to an initial contact in which the heel and the ball of the foot land quasisimultaneously, while in a forefoot strike the ball of the foot lands before the heel [7]. ...
Article
Full-text available
Upper trunk (UT) kinematics in runners and its relationship with lower limbs has been poorly investigated, although it is acknowledged that dynamic stability of the upper body is a primary objective of human locomotion. This study aimed to explore UT kinematics according to gender and level of training and in relation to lower limb run patterns described through the presence of: overstriding, crossover, excessive protonation, and pelvic drop. Lower body variables chosen to describe running pattern were those that are frequently modified during gait-retraining with the goal of reducing injury risk. Eighty-seven recreational runners (28 females and 59 males, age 41 ± 10 years) performed a one minute run test on a treadmill at self-selected speed. UT kinematics was measured using an inertial measurement unit, while run features were assessed through an optoelectronic system and video analysis. Accelerations and root-mean-square on mediolateral and anteroposterior axes, normalized using the vertical component of the acceleration, were estimated to describe UT stability. Results showed no significant differences in the normalized UT acceleration root-mean-square according to gender and level of training as well as according to the presence of overstriding, crossover, and excessive protonation. The only running strategy studied in this work that showed a significant relationship with UT stability was the presence of excessive pelvic drop. The latter was significantly associated (p=0.020) to a decrease in the normalized acceleration root-mean-square along the mediolateral direction. Although the excessive pelvic drop seemed to have a positive effect in stabilizing the upper body, concerns remain on the effect of a poor control of the pelvis on the biomechanics of lower limbs. Results obtained confirm the hypothesis that the lower body is able to respond to varying impact load conditions to maintain UT stability.
... In settings where 3D motion capture systems are not available, it is common to assess human movement in two-dimensions (2D) using a single, consumer grade, video camera. 7,10,28,32,33,37 However, often only a few video frames are manually digitized to assess discrete kinematic outcomes in 2D. 7,10,28,32,33,37 The ability to automatically digitize markers could allow for outcome measures that require continuous data to be quickly, objectively, and accurately extracted from collected videos. ...
... 7,10,28,32,33,37 However, often only a few video frames are manually digitized to assess discrete kinematic outcomes in 2D. 7,10,28,32,33,37 The ability to automatically digitize markers could allow for outcome measures that require continuous data to be quickly, objectively, and accurately extracted from collected videos. ...
... knee flexion at initial contact) are commonly assessed during running using 2D video analysis in clinical settings. 7,10,28,37 However, outcomes that require continuous data (e.g. joint range of motion or variability) have not been assessed using 2D video analysis, likely because these outcomes are more challenging to compute using manual digitization. ...
Article
Two-dimensional video analysis is commonly used to assess kinematics when three-dimensional motion capture is unavailable. However, videos are often assessed using manual digitization, which limits the ability to extract outcomes that require continuous data. Here, we introduced a method to collect continuous kinematic data in 2D using an inexpensive camera and an open-source automated marker tracking program. We tested the validity of this method by comparing 2D video analysis to 3D motion capture for measuring sagittal-plane running kinematics. Twenty uninjured participants ran on a treadmill for 1-min while lower extremity kinematics were collected simultaneously in 3D using a motion capture system and in 2D using a single digital camera, both at 120 Hz. Knee, ankle, and foot angle at contact, peak knee flexion, knee flexion excursion, and knee-ankle flexion vector coding variability were computed using both the 3D and 2D kinematic data, and were compared using intraclass correlation coefficients and Bland-Altman plots. The agreement between collection methods was excellent for foot angle at contact and knee flexion excursion, good for ankle and knee angle at contact and knee-ankle vector coding variability, and moderate for peak knee flexion. However, Bland-Altman plots revealed significant differences between the 2D and 3D collection methods, which varied across study participants. These low-cost methods could be useful for collecting continuous sagittal plane running kinematics in non-laboratory settings.
... 2,3,5 Most researchers agree that the etiology of running injuries is multifactorial with contributing factors including age, sex, history of previous injury, lower extremity bony alignment, running terrain, and running kinematics. [6][7][8] While several intrinsic and extrinsic factors, including age, alignment, and history of previous injury cannot be altered, running kinematics can be modified based on a video analysis of running mechanics. Several running kinematic variables, including the foot inclination angle at initial contact, vertical displacement of the center of mass, and total knee flexion during stance phase have been related to higher peak vertical ground reaction forces, increased peak knee extensor moments, and reduced shock absorption, all of which can increase the stresses placed on the leg and knee during running. ...
... Several running kinematic variables, including the foot inclination angle at initial contact, vertical displacement of the center of mass, and total knee flexion during stance phase have been related to higher peak vertical ground reaction forces, increased peak knee extensor moments, and reduced shock absorption, all of which can increase the stresses placed on the leg and knee during running. 7 As previously noted, the leg and knee are common locations of running-related injuries in high school cross-country runners. ...
... The seven kinematic variables selected for analysis in this study have been previously identified as important sagittal plane variables that should be included in an analysis of running mechanics. 7 In addition, all seven kinematic variables have been shown to have high levels of within and between rater reliability for both inexperienced and experienced raters. 18 All angles were measured in degrees and all distance measurements were recorded in centimeters using a free-access video analysis software program (Kinovea, version 0.8.15, http://www.kinovea.org). ...
Article
Full-text available
Background: While previous research has assessed running kinematics for age-related differences that could increase the risk of a running-related injury, none of these studies have included high school aged runners or assessed running kinematics using 2-dimensional video analysis. Purpose: The purpose of this study was to compare sagittal plane kinematics during treadmill running in high school cross-country and young adult recreational runners using 2-dimensional motion analysis techniques. Methods: Twenty-five high school cross-country runners (13 women, 12 men) and 25 young adult recreational runners (12 women, 13 men) consented to participate in this study. Reflective markers were placed on each lower extremity over multiple anatomical landmarks. After a five-minute acclimation period in which the participants ran on a treadmill at their preferred running speed, video data were recorded at 240 frames per second for all participants while they continued to run on the treadmill. Results: There were no significant differences between left and right extremities. The young adult recreational runners exhibited significantly greater vertical excursion of the center of mass (t = 4.64, p = .0001) compared to the high school runners. There was no significant difference between the two age groups regarding the six other sagittal plane variables. Conclusions: The young adult recreational runners demonstrated an increased center-of-mass vertical excursion in comparison to high school cross-country runners. In addition, the results obtained in this study for kinematic variables using 2-dimensional motion analysis were similar to previously reported studies using 3-dimensional motion analysis, demonstrating that 2-dimensional motion analysis could be used for analyzing sagittal plane running kinematics in clinical settings. Level of evidence: 4, Controlled laboratory study.
... Alteration in these parameters, such as the presence of overstride (i.e., an excessive stride length associated with a decreased cadence) or an excessive cadence variability, contribute to increased risk of injuries and to decreased running economy. Moreover, the longitudinal monitoring of these parameters allows the follow-up of functional outcomes after rehabilitation treatments [11][12][13]. Qualitative gait analysis identifies specific running features (e.g., foot strike pattern, presence of cross-over, and low gait harmony) that are associated with increased risk of overuse injuries [13] or global movement scores (e.g., Volodalen Scale) indicative of running economy and inversely related to the risk of overuse injuries [14]. ...
... Moreover, the longitudinal monitoring of these parameters allows the follow-up of functional outcomes after rehabilitation treatments [11][12][13]. Qualitative gait analysis identifies specific running features (e.g., foot strike pattern, presence of cross-over, and low gait harmony) that are associated with increased risk of overuse injuries [13] or global movement scores (e.g., Volodalen Scale) indicative of running economy and inversely related to the risk of overuse injuries [14]. ...
... Limitations of the use of gold-standard methods are a not fully ecological walking or running style, due to the use of a treadmill, and the high costs and complexity in terms of experimental setup [15][16][17][18]. In recent years, more low-cost, easy-to-use, and marker-less alternatives to gold-standard methods have been developed for large-scale gait evaluation [6,8,13,14]. The most frequently used alternative technologies for quantitative gait analysis are optical timing systems and inertial sensors. ...
Article
Full-text available
Quantitative and qualitative running gait analysis allows the early identification and the longitudinal monitoring of gait abnormalities linked to running-related injuries. A promising calibration- and marker-less video sensor-based technology (i.e., Graal), recently validated for walking gait, may also offer a time- and cost-efficient alternative to the gold-standard methods for running. This study aim was to ascertain the validity of an improved version of Graal for quantitative and qualitative analysis of running. In 33 healthy recreational runners (mean age 41 years), treadmill running at self-selected submaximal speed was simultaneously evaluated by a validated photosensor system (i.e., Optogait-the reference methodology) and by the video analysis of a posterior 30-fps video of the runner through the optimized version of Graal. Graal is video analysis software that provides a spectral analysis of the brightness over time for each pixel of the video, in order to identify its frequency contents. The two main frequencies of variation of the pixel's brightness (i.e., F1 and F2) correspond to the two most important frequencies of gait (i.e., stride frequency and cadence). The Optogait system recorded step length, cadence, and its variability (vCAD, a traditional index of gait quality). Graal provided a direct measurement of F2 (reflecting cadence), an indirect measure of step length, and two indexes of global gait quality (harmony and synchrony index). The correspondence between quantitative indexes (Cadence vs. F2 and step length vs. Graal step length) was tested via paired t-test, correlations, and Bland-Altman plots. The relationship between qualitative indexes (vCAD vs. Harmony and Synchrony Index) was investigated by correlation analysis. Cadence and step length were, respectively, not significantly different from and highly correlated with F2 (1.41 Hz ± 0.09 Hz vs. 1.42 Hz ± 0.08 Hz, p = 0.25, r2 = 0.81) and Graal step length (104.70 cm ± 013.27 cm vs. 107.56 cm ± 13.67 cm, p = 0.55, r2 = 0.98). Bland-Altman tests confirmed a non-significant bias and small imprecision between methods for both parameters. The vCAD was 1.84% ± 0.66%, and it was significantly correlated with neither the Harmony nor the Synchrony Index (0.21 ± 0.03, p = 0.92, r2 = 0.00038; 0.21 ± 0.96, p = 0.87, r2 = 0.00122). These findings confirm the validity of the optimized version of Graal for the measurement of quantitative indexes of gait. Hence, Graal constitutes an extremely time- and cost-efficient tool suitable for quantitative analysis of running. However, its validity for qualitative running gait analysis remains inconclusive and will require further evaluation in a wider range of absolute and relative running intensities in different individuals.
... Due to advancements in video technology, clinicians can analyze various 2D kinematic and spatiotemporal data during treadmill running. 13 Additionally, treadmills are a common platform for gait retraining, such as cadence training 9,11,14 and various motor learning strategies. [15][16][17] Researchers also utilize instrumented treadmills for running analysis. ...
... Thus, the insole design and shoe-fit compatibility may have impacted running technique, but the questionnaire responses suggest that the insoles created minimal discomfort or alteration of running technique ( Table 2). In order to reduce the bulk, however, the current Moticon sensor insole system is limited by the low number of pressure capacitors (13) and sampling frequency (50 Hz), which may affect data processing. 26 Future advancements in technology, allowing for a larger quantity of capacitors and higher sampling frequency, will permit more accurate measurements in order to better analyze running. ...
Article
Study design: Repeated measures. Background: Both clinicians and researchers often utilize treadmills to analyze spatiotemporal and biomechanical factors during running. However, there is question of whether or not treadmill running mimics overground running. The development of new wearable technology, such as pressure sensor insoles, presents an opportunity to compare the two running conditions. Purpose: To compare the spatiotemporal factors between overground and treadmill running in collegiate runners, using pressure sensor insoles. Methods: Twenty-one collegiate runners (age 20.1 ± 1.5 years, 81% female) were recruited from a Division I Cross Country team. Subjects participated in two 15-minute testing sessions. During the first session, subjects ran at their "easy run pace" for 200 meters, while wearing pressure sensor insoles. During the second session, subjects ran at a speed-matched pace on a treadmill for one minute at a level grade, and one minute at a 1% incline. Cadence, stance duration and swing duration were processed using Moticon Science Pro + software (Munich, DE). Data between overground and treadmill running was compared using repeated measures analysis of variance with α = 0.05. Results: Compared to overground running, level and incline treadmill running was associated with increased cadence (mean difference [MD] = 3.55-3.22 strides per minute; p < 0.01), decreased stance duration (MD = 14-16 ms; p < 0.01), and decreased swing duration (MD = 11-12 ms; p < 0.05). Conclusion: In collegiate runners, overground and treadmill running differ in spatiotemporal comparisons. Levels of evidence: 3.
... A nominal (visual) classification of footstrike patterns usually requires a lateral view on the runner's foot (12,46). Sometimes the attempt is made to identify the footstrike pattern of an athlete without a video recording. ...
... Sometimes the attempt is made to identify the footstrike pattern of an athlete without a video recording. However, not only for research purposes, a lateral video recording is recommended and often necessary to avoid misinterpretation (46). To analyze the footstrike accurately, a high-speed camera (preferably more than 120 frames per second, but there are no specific recommendations) with slow motion or frame-by-frame analysis should be used (16). ...
Article
Full-text available
The footstrike pattern of an athlete is understood as the way the foot touches the ground. Over the years, several definitions and techniques to classify and quantify footstrike patterns have been described. Therefore, this narrative review summarizes the existing classifications of footstrike patterns, gives suggestions for further use of these classifications, and provides a summary of the relationship between footstrike patterns and the occurrence of overuse injuries. Footstrike patterns are classified by using nominal (e.g. forefoot strike, midfoot strike, rearfoot strike) or continuous variables (e.g. footstrike angle). Possible assessments include visual, video-based, 3D-biomechanical, force plate-based or inertial measurement unit-based analysis. Scientists, coaches, and clinicians can choose between different methods to analyze footstrike patterns in runners. All approaches to classify footstrike patterns have advantages and limitations. In certain situations, it might be beneficial to combine these methods. Despite great efforts in analyzing footstrike patterns, relationships between footstrike patterns and running-related injuries are mostly unclear at present. Based on the current literature, causal links to overuse injuries, recommendations to change running technique, and other simplifications solely based on the footstrike pattern must be considered critically.
... Trunk, hip, knee, and ankle sagittal plane angles determined at the foot strike instant, step frequency, and step length were determined by 2D video analysis [19]. Measurements were taken at the 1st, 3rd, and 5th kilometers of the 5 km run on day 2 with a video camera placed aside the treadmill with the lens perpendicular to the plane of movement. ...
... Joint angles were defined in the sagittal at the foot strike as illustrated in Figure 3 (trunk angle defined according to the vertical axis, hip angle defined according to the horizontal axis, relative angles for knee and ankle, see Figure 3). Ten complete strides were analyzed for each kilometer considered [19]. All participants presented a rear strike landing pattern. ...
Article
Full-text available
Compression and temperature manipulation are discussed as strategies to improve performance markers and recovery in sports. Here, we investigate the effects of compression stockings made with fabric, either combined or not with heating and cooling substances, on variables related to running performance and recovery. Ten trained runners (mean ± standard deviation age 45 ± 9 years old, body mass 69 ± 7 kg, height 166 ± 4 cm) with no experience of using compression garments performed an intense running session of 10 km, then wore a stocking for 24 h (randomized; without compression, compression, compression with camphor, and compression with menthol), and were evaluated on the following day, after running 5 km. The different types of compression stockings used 24 h before exercise did not affect running kinematics (p > 0.14), skin temperature (p > 0.05), heart rate (p > 0.12; mean value of maximal heart rate 156 bpm), comfort perception (p = 0.13; mean value of 7/10 points), or perception of recovery (p = 0.13; mean value of 7/10 points). In general, there were no effects of 24 h pre-exercise lower leg compression, including those treated with menthol and camphor applications on running kinematics, skin temperature, heart rate, or recovery perception in athletes undertaking consecutive running exercises.
... Therefore, it has been suggested that TW may have greater ecological value for knee extension and flexion strength injury risk screening, as it is a more comprehensive measure that accounts difference in force produced in the entire range of motion of a task [18]. The common knee range of motion during endurance running is ~ 0-45° [19], which is different from those of mechanical advantage for the quadriceps muscles (~ 60°), for example, but matches the angles in which knee injuries are most susceptible to occur [20]. To the best of our knowledge, no previous study has compared knee joint muscle strength imbalance profile between traditional PT-based and alternative TW-based H:Q methods in endurance runners. ...
... Despite recent controversies regarding PT-based assessment [11,12], PT measurements are still considered as a tool for injury risk screening [8,9] as well as to investigate knee joint overload [25-27, 31, 32]. The nature of long-and middle-distance running, in which cyclic anterior-to-posterior displacement takes place, leads to possible specific changes in knee muscles strength, since the knee range of motion is usually limited to ~ 0-45° during distance running [19]. In this context, PT alone is unlikely to reflect the angle-specific torque produced during running. ...
Article
Full-text available
Background: Running is a very popular activity and muscle strength imbalance has been treated with caution to prevent injuries. Aims: The present study aimed to compare and correlate knee flexion and extension strength imbalance based on Peak Torque (PT) and total work (TW) in running athletes. Methods: Thirty-eight male amateur running athletes (38±6 years; 80.6±8.3 kg; 177±7 cm; 7.8±8.4 years of training; 3.5±0.9 training sessions a week; 33.5±13.4 kilometers of training per week) took part in the present study. Knee flexion eccentric and concentric PT and TW, as well as concentric knee extension PT and TW were assessed. PT- and TW-based hamstring-to-quadriceps ratios (H:Q), as well as PT and TW contralateral imbalance were quantified. Results: A significant correlation was observed between TW and PT concentric knee flexion contralateral deficits (r=0.52, p<0.001). No further correlations were found among TW- and PT-based muscle strength imbalance variables (p>0.05). All mean comparisons of H:Q and contralateral imbalances using TW or PT were significantly different (p<0.05). Conclusions: Our results showed that TW and PT muscle strength imbalance were unrelated, and the H:Q and contralateral imbalance profile of endurance runners may differ based on the isokinetic variable analyzed.
... First, the research team took footage of each runner on a treadmill (Supplementary Material: Videos S1 and S2). Second, the videos were analysed together with the participants, and the main researcher gave them verbal feedback in order to achieve a proper running technique which, following Souza et al.'s criterion [26], is defined by midfoot strike pattern, vertical tibia in the moment of contact, trunk lightly leaned forward, and short overstride. ...
... First, the research team took footage of each runner on a treadmill (Supplementary material: Videos S1 and S2). Second, the videos were analysed together with the participants, and the main researcher gave them verbal feedback in order to achieve a proper running technique which, following Souza et al.'s criterion [26], is defined by midfoot strike pattern, vertical tibia in the moment of contact, trunk lightly leaned forward, and short overstride. In the first part of the session, runners started with 30 min of warm up (15 min of slow running and 15 min of running drills). ...
Article
Full-text available
Foot-strike and the associated load rate are factors related to overuse injuries in runners. The purpose of this study was to analyse structural and functional changes in runners using floating heel running shoes, compared with runners using conventional footwear. A randomised control trial was conducted. Twenty runners with overuse injuries were followed over a 12-week gait retraining programme using floating heel running shoes or their conventional footwear. Pain was measured with pressure pain thresholds (PPTs), structural changes were measured with ultrasonography, and severity and impact of injury was scored on the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O). Statistical differences were found between groups after the intervention (p < 0.001), with a medium size effect SE = 0.8, and the floating heel running shoes group reached higher PPTs values. Participants using floating heel running shoes showed higher OSTRC-O scores than those using their conventional footwear (p < 0.05), with higher scores after the intervention (p < 0.05). A 12-week gait retraining programme using floating heel running shoes had positive effects on the injury recovery process when compared to the use of conventional footwear, with significant differences in terms of pain and impact on sports activity.
... Given the large volumes of trunk flexion and the interaction of playing position, coaches are recommended to incorporate position-specific training drills aimed to properly prepare the players for the perception-action demands (i.e., visual exploration and decision-making) of the match, as well as trunk strength exercises and other compensatory strategies before and after the match. trunk flexion is a natural movement given the increase in speed [6], which suggests that the analysis of the trunk inclination required for different speeds thresholds is necessary. ...
... Finally, the results showed that the trunk flexion increased with greater speeds in all playing positions, except for MF. Although the trunk inclination is a variable that has received little attention in the literature, it is to highlight that the increase in trunk flexion is a natural movement given the increase in speed [6]. The progression to faster running speeds is associated with increases in electromyographic activity, especially in the multifidus muscle, and kinematic changes [32]. ...
Article
Full-text available
The development of wearable sensors has allowed the analysis of trunk kinematics in match play, which is necessary for a better understanding of the postural demands of the players. The aims of this study were to analyze the postural demands of professional soccer players by playing position. A longitudinal study for 13 consecutive microcycles, which included one match per microcycle, was conducted. Wearable sensors with inertial measurement units were used to collect the percentage (%) of playing time spent and G-forces experienced in different trunk inclinations and the inclination required for different speeds thresholds. The inclination zone had a significant effect on the time percentage spent on each zone (p < 0.001, partial eta-squared (ηp 2 = 0.85) and the G-forces experienced by the players (p < 0.001, ηp 2 = 0.24). Additionally, a significant effect of the speed variable on the trunk inclination zones was found, since trunk flexion increased with greater speeds (p < 0.001; ηp 2 = 0.73), except for midfielders. The players spent most of the time in trunk flexion between 20 • and 40 • ; the greatest G-forces were observed in trunk extension zones between 0 • and 30 • , and a linear relationship between trunk inclination and speed was found. This study presents a new approach for the analysis of players' performance. Given the large volumes of trunk flexion and the interaction of playing position, coaches are recommended to incorporate position-specific training drills aimed to properly prepare the players for the perception-action demands (i.e., visual exploration and decision-making) of the match, as well as trunk strength exercises and other compensatory strategies before and after the match.
... In addition, the program made it possible to combine the marked anatomical points and determine the appropriate angles assessed in the study. The scoring criteria for the video-analysis of the run are presented in Tab. 2 [10,11,12,13]. were observed between the groups with or without a history of trauma (p>0.05). ...
... In this study, only the greatest extent of heel eversion was assessed during the transfer phase. An angle of 9° is assumed an excessive range of eversion [12,13]. A certain range of foot pronation is both normal and necessary in the shifting phase during running, but it has been suggested that the excessive range of foot pronation may be related to lower limb injuries. ...
Article
Full-text available
Objective: The main goal of this study was to determine the correlation between running pattern and the lower limb injuries in long-distance runners. Materials and methods: The study comprised 23 long-distance runners (7 women, 16 men). The research used a questionnaire and video-analysis of running technique on a treadmill. The running on the treadmill was recorded from 3 views. Recordings were assessed in slow-motion. The following features were assessed: a foot strike pattern, a tibia angle at loading response, the maximum knee flexion angle during the stance phase, the maximum hip extension during the late stance phase, the maximum heel eversion angle, the distance between the knees and the pelvic drop angle. The subjects were divided into two groups-without previous trauma and with a history of previous trauma of a particular part of the lower limb.
... As a previous study concluded that at least 7 steps need to be analyzed in order to obtain a stable mean for 2D kinematic measures (Dingenen, Barton, Janssen, Benoit, & Malliaras, 2018), we decided to analyze 10 consecutive running steps using Coach's Eye for each variable. For the 2D analysis, touchdown was determined based on visual identification of the first frame showing heel contact with the treadmill (Pipkin et al., 2016;Souza, 2016) and toe-off was determined based on visual identification of the last frame showing toe contact with the treadmill (Souza, 2016). Table 1 describes the definition of kinematics measured within Coach's Eye and 3D motion capture system. ...
... As a previous study concluded that at least 7 steps need to be analyzed in order to obtain a stable mean for 2D kinematic measures (Dingenen, Barton, Janssen, Benoit, & Malliaras, 2018), we decided to analyze 10 consecutive running steps using Coach's Eye for each variable. For the 2D analysis, touchdown was determined based on visual identification of the first frame showing heel contact with the treadmill (Pipkin et al., 2016;Souza, 2016) and toe-off was determined based on visual identification of the last frame showing toe contact with the treadmill (Souza, 2016). Table 1 describes the definition of kinematics measured within Coach's Eye and 3D motion capture system. ...
Article
Full-text available
Objective: To investigate the validity and reliability of a smartphone application for selected lower-limb kinematics during treadmill running. Design: Validity and reliability study. Setting: Biomechanics laboratory. Participants: Twenty healthy female runners. Main outcome measure(s): Sagittal-plane hip, knee, and ankle angle and rearfoot eversion were assessed using the Coach's Eye Smartphone application and a 3D motion capture system. Paired t-test and intraclass correlation coefficients (ICC) established criterion validity of Coach's Eye; ICC determined test-retest and intrarater/interrater reliability. Standard error of measurement (SEM) and minimal detectable change (MDC) were also reported. Results: Significant differences were found between Coach's Eye and 3D measurements for ankle angle at touchdown and knee angle at toe-off (p < 0.05). ICCs for validity of Coach's Eye were excellent for rearfoot eversion at touchdown (ICC = 0.79) and fair-to-good for the other kinematics (range 0.51-0.74), except for hip at touchdown, which was poor (ICC = 0.36). Test-retest (range 0.80-0.92), intrarater (range 0.95-0.99) and interrater (range 0.87-0.94) ICC results were excellent for all selected kinematics. Conclusion: Coach's Eye can be used as a surrogate for 3D measures of knee and rearfoot in/eversion at touchdown, and hip, ankle, and rearfoot in/eversion at toe-off, but not for hip and ankle at touchdown or knee at toe-off. Reliable running kinematics were obtained using Coach's Eye, making it suitable for repeated measures.
... If room or equipment is available, runners may be asked to run while the practitioner examines rearfoot eversion and pronation position at midstance. Typically, health care professionals use qualitative analysis (Nicola and Jewison, 2012), but recent advancements and access to video annotation software allow for quantification of rearfoot eversion angle using 2D video (Souza, 2016). ...
... However, these wearable devices do not provide sufficient data to calculate joint kinetics. Foot strike pattern, foot inclination angle (the angle between the foot and the horizontal in the sagittal plane), step rate, and stride length are considered kinematic correlates to ground reaction or joint forces (Heiderscheit et al., 2011;Lenhart et al., 2014a,b;Wille et al., 2014;Souza, 2016). Runners who rearfoot strike tend to have low step rates, use longer steps, and run with higher magnitudes of peak vertical ground reaction force, loading rates, peak braking forces, and potentially larger lower extremity joint forces than non-rearfoot strikers. ...
Article
Full-text available
Many runners seek health professional advice regarding footwear recommendations to reduce injury risk. Unfortunately, many clinicians, as well as runners, have ideas about how to select running footwear that are not scientifically supported. This is likely because much of the research on running footwear has not been highly accessible outside of the technical footwear research circle. Therefore, the purpose of this narrative review is to update clinical readers on the state of the science for assessing runners and recommending running footwear that facilitate the goals of the runner. We begin with a review of basic footwear construction and the features thought to influence biomechanics relevant to the running medicine practitioner. Subsequently, we review the four main paradigms that have driven footwear design and recommendation with respect to injury risk reduction: Pronation Control, Impact Force Modification, Habitual Joint (Motion) Path, and Comfort Filter. We find that evidence in support of any paradigm is generally limited. In the absence of a clearly supported paradigm, we propose that in general clinicians should recommend footwear that is lightweight, comfortable, and has minimal pronation control technology. We further encourage clinicians to arm themselves with the basic understanding of the known effects of specific footwear features on biomechanics in order to better recommend footwear on a patient-by-patient basis.
... In sports, these types of sensors have been used to quantify the external workload in different team and individual sports [2]. Although the external workload and gait biomechanics has traditionally analyzed under laboratory conditions using three-dimensional capture systems [3], this microsensors technology have been started to use for the analysis of external workload and biomechanical aspects for the improvement of optimal performance in laboratory conditions [4][5][6][7]. ...
... pending) developed for the research. The suit was made with pockets for each IMU's in six different spots (one IMU at T 2 -T 4 , one IMU at L 1 -L 3 Figure 2a). Suit incorporated dark elastic straps were used to avoid vibrations or non-wanted movements of the devices during running (see Figure 2b). ...
Article
Full-text available
Muscle and kidney injury in endurance athletes is worrying for health, and its relationship with physical external workload (eWL) needs to be explored. This study aimed to analyze which eWL indexes have more influence on muscle and kidney injury biomarkers. 20 well-trained trail runners (age = 38.95 ± 9.99 years) ran ~35.27 km (thermal-index = 23.2 ± 1.8 • C, cumulative-ascend = 1815 m) wearing inertial measurement units (IMU) in six different spots (malleolus peroneus [MP left /MP right ], vastus lateralis [VL left /VL right ], lumbar [L 1-L 3 ], thoracic [T 2-T 4 ]) for eWL measuring using a special suit. Muscle and kidney injury serum biomarkers (creatin-kinase [sCK], creatinine (sCr), ureic-nitrogen (sBUN), albumin [sALB]) were assessed pre- ,-post 0h and post 24h. A principal component (PC) analysis was performed in each IMU spot to extract the main variables that could explain eWL variance. After extraction, PC factors were inputted in multiple regression analysis to explain biomarkers delta change percentage (∆%). sCK, sCr, sBUN, sALB presented large differences (p < 0.05) between measurements (pre < post 24h < post 0h). PC's explained 77.5-86.5% of total eWL variance. sCK ∆% was predicted in 40 to 47% by L 1-L 3 and MP left ; sCr ∆% in 27% to 45% by L 1-L 3 and MP left ; and sBUN ∆% in 38%-40% by MP right and MP left. These findings could lead to a better comprehension of how eWL (impacts, player load and approximated entropy) could predict acute kidney and muscle injury. These findings support the new hypothesis of mechanical kidney injury during trail running based on L 1-L 3 external workload data.
... 9,10,14,[16][17][18] Among these intrinsic factors, running kinematics such as cadence and foot strike pattern affect forces applied on the lower limbs and could influence the occurrence or location of lower limb overuse injuries. [19][20][21][22][23] Hence, running gait analysis is now an inherent part of the clinical assessment for RRI. 19 Extrinsic factors such as running parameters 9,11,24 running surface, 10 or type of running shoes 23,25,26 can also affect the risk of developing lower limb RRI. ...
... [19][20][21][22][23] Hence, running gait analysis is now an inherent part of the clinical assessment for RRI. 19 Extrinsic factors such as running parameters 9,11,24 running surface, 10 or type of running shoes 23,25,26 can also affect the risk of developing lower limb RRI. Some authors have argued that over half of all RRI could be caused by training errors and would therefore be preventable. ...
Article
Introduction While running is a popular activity because of the health and fitness benefits it provides, the yearly incidence of running-related injuries (RRI) is high across all populations of runners, including military members. The etiology of RRI is multifactorial, and despite the numerous studies on risk factors for RRI, there is no clear consensus in the literature on the relative contribution of several intrinsic or extrinsic risk factors to the development of RRI. Furthermore, little is known on RRI profile and running parameters among Canadian military members. The objectives of this study were to (1) describe the clinical presentation of lower limb RRI and running profile among military members and (2) explore any association between recent changes in running parameters (volume or intensity) and specific RRI diagnoses. Materials and Methods This cross-sectional study was conducted in 107 military members from the Canadian Armed Forces (Valcartier Military Base) who presented with a restriction or interruption of running because of lower limb running-related pain. The following variables were collected during a physiotherapy evaluation: injury location and diagnosis, running kinematics (foot strike pattern and step rate), degree of minimalism of running shoes, running parameters in the last 3 months before consultation (volume, duration, frequency, and intensity), and recent changes in training before pain onset. Descriptive statistical analyses were conducted to describe the clinical presentation and running profile, while chi-square tests and multiple correspondence analysis were used to explore the association between recent changes in running parameters and diagnosis. This study was approved by the institutional ethics committee, and participants signed a detailed consent form. Results Among the 107 participants included in the study (mean age: 30.7 ± 8.9 years; 13 females), the most common diagnoses were patellofemoral pain (26.2%), medial tibial stress syndrome (11.2%), plantar fasciopathy (9.3%), and sciatica (9.3%). The average Minimalist Index of running shoes was 27.6 ± 18.5%. Step rate was 161.7 ± 10.3 steps per minute, and 73.3% of the participants used a rearfoot strike pattern. The majority of military runners reported previous RRI, gradual onset of symptoms, and recent changes in their training parameters (75.7%) before injury onset. No association was found between recent changes in running volume ((χ2(4) = 2.849; P = .606)) or intensity ((χ2(4) = 1.381; P = .855)) and diagnosis. Conclusion This is the first study to specifically investigate RRI and running profile among Canadian military members. The most common injuries were located at the knee, and the most frequent diagnosis was patellofemoral pain. The majority of military runners reported previous RRI as well as recent changes in their running parameters before injury onset, but unique types of recent changes were not associated with specific diagnoses. This study illustrates the need to further investigate the impact of training loads on the development of RRI.
... While running, the subject demonstrated over striding, defined by the foot being anterior to the center of mass and knee in full extension, in the sagittal plane, during initial contact. 13 In addition, increased hip adduction and dynamic knee valgus at midstance were noted. All of these gait characteristics were observed bilaterally. ...
Article
Background: Athletic pubalgia is a prevalent injury in athletes who kick, pivot, and cut, however it is poorly described in the literature. Many athletes with this diagnosis fail conservative management secondary to continued pain with activity and require surgical intervention for return to sport. Purpose: The purpose of this case report is to describe an intervention strategy focusing on gait retraining and hip and lumbopelvic stability for a female runner diagnosed with athletic pubalgia and a labral tear of the hip. Case description: This case report involved a 45-year-old female runner who was seen for 14 visits, from examination to return to sport, with a follow up at 12 months post discharge. Interventions included hip, pelvic, and lumbar stability exercises, and gait retraining. Outcomes measurements included: pain on the numeric pain rating scale, the Lower Extremity Functional Scale (LEFS), gait mechanics, strength, and participation in sport. Outcomes: At discharge the subject demonstrated improved strength of all muscle groups and changes in lower extremity running biomechanics. Changes in running mechanics included increased cadence, decreased pelvic drop, diminished over striding, and improved knee control with less valgus movement during the stance phase of gait. The subject reported no pain with running or recreational activities at discharge and follow up at 12 months post discharge. Discussion/conclusion: Most of the literature on conservative rehabilitation for athletic pubalgia focuses on athletes whose sports require pivoting and kicking. The literature provides little information on gait analysis and retraining for runners with a diagnosis of athletic pubalgia and/or hip labrum tears. The program used in this case report including gait retraining and hip, pelvic, and lumbar stability training allowed for full return to running in a 45-year-old female with a diagnosis of hip labrum tear and athletic pubalgia. Further research is needed to discern best conservative treatment for runners with athletic pubalgia and/or hip labral tears. Level of evidence: 4.
... Transverse plane video capture only requires a device capable of a capture rate of 60 fps and a mount secured over a treadmill. A capture rate of 120 fps has been recommended for video analysis of frontal and sagittal plane lower extremity measures, 16 but the slower speed of UTR makes it possible to use a lower capture rate. This study utilized the tablet's front camera (maximum capture rate 60 fps) Table 4. Interrater reliability and responsiveness of the 2D transverse plane upper trunk rotation. ...
Article
Background: Two-dimensional (2D) video analysis is a practical tool for assessing biomechanical factors that may contribute to running-related injury. Asymmetrical or altered coordination of transverse plane trunk movement has been associated with low back pain, increased vertical and horizontal ground reaction forces, and altered hip abduction torque and strength. However, the reliability and validity of 2D transverse plane upper trunk rotation (UTR) has not been assessed. Study design: Validity and reliability study. Purpose: To determine the validity and reliability of 2D video-based, transverse plane UTR measurement during running. Methods: Sixteen runners ran at self-selected speed on a treadmill while three-dimensional (3D) and 2D motion capture occurred synchronously. Two raters measured peak UTR for five consecutive strides on two occasions. Interrater and intrarater reliability and the minimum detectable change was calculated for right and left peak 2D UTR measurement. Concurrent validity and agreement between 2D and 3D measures were determined by calculating Pearson Product Correlation Coefficients (r) and Bland-Altman plots, respectively. Results: Using a single UTR measure per runner, intrarater and interrater reliability (ICC2,1) was excellent (intrarater ICC2,1 range: 0.989-0.999; interrater ICC2,1 range: 0.990-0.995) and the minimum detectable change was 0.39-1.4 degrees. Measurements in 2D and 3D were significantly correlated for peak UTR (all r ≥ 0.986; all p-values < 0.001) and showed good agreement in Bland-Altman plots. Conclusion: Two-dimensional video-based measurement of transverse plane peak UTR is valid and reliable. Clinical relevance: UTR measurement may provide clinical insight into gait deviations in the transverse plane that alter angular momentum and increase risk for running-related injury. Level of evidence: 2B.
... The increasing popularity of running has led to a larger and larger number of recreational runners participating in long-distance running events like marathons and ultra-marathons. This has motivated a comparable explosion of research to improve the understanding of the biomechanics of running and to make technical advances in measurement systems (Novacheck, 1998, Souza, 2016. A basic understanding of the kinematics of running is helpful to prevent injuries related to overuse phenomena and/or improper training techniques (Thordarson, 1997). ...
Article
Full-text available
Biomechanics and thermoregulation of human running are key aspects playing an important role in the training of professional athletes. In the case of a prolonged exercise, as occurs during the marathon race, the intensity and duration of the exercise (in concert with environmental conditions) can affect the thermoregulatory response and the running mechanics. The aim of this study is the design of a novel experiment able to simultaneously capture information concerning the biomechanics of lower limbs and the surface temperature map of the whole body during a prolonged running exercise on treadmill. Kinematics quantities, such as linear and angular displacement, velocity and acceleration of relevant body markers are recorded by a video system, while surface temperature evolution on time is detected by an infrared thermal camera. A group of five amateur athletes, with long experience in long-distance running competitions, was involved in this study. Results for the sample group, in terms of kinematic (displacements and angles) and thermal (local and total-body skin temperatures) quantities, revealed features related to individual response to the effort. Even though the relatively little number of athletes does not permit to infer general conclusions, the combined mechanical and thermal experiment is deemed to be a useful tool for the investigation of endurance running characteristics.
... Running requires efficient conversion of power output into translocation [1], initiated by a greater joint range of motion [2,3]. During running, while the hip generates power to accelerate the leg so as to optimize the position of the foot and center of body mass [3][4][5][6], the ankle stabilizes and further accelerates the limb forwards [3,7,8], and the knee absorbs the loading by increasing the muscular power [3,9,10]. Biomechanics plays an important role in running performance and energy cost [7,11]. ...
Article
Full-text available
This present review includes a systematic search for peer-reviewed articles published between March 2009 and March 2020 that evaluated the effects of wearable devices with biofeedback on the biomechanics of running. The included articles did not focus on physiological and metabolic metrics. Articles with patients, animals, orthoses, exoskeletons and virtual reality were not included. Following the PRISMA guidelines, 417 articles were first identified, and nineteen were selected following the removal of duplicates and articles which did not meet the inclusion criteria. Most reviewed articles reported a significant reduction in positive peak acceleration, which was found to be related to tibial stress fractures in running. Some previous studies provided biofeedback aiming to increase stride frequencies. They produced some positive effects on running, as they reduced vertical load in knee and ankle joints and vertical displacement of the body and increased knee flexion. Some other parameters, including contact ground time and speed, were fed back by wearable devices for running. Such devices reduced running time and increased swing phase time. This article reviews challenges in this area and suggests future studies can evaluate the long-term effects in running biomechanics produced by wearable devices with biofeedback.
... Descriptive statistics were then calculated, and subsequently linear mixed models with fixed effects of: speed, inclination, and bodyweight, and random (subject) effects were then used to identify main differences and interaction effects. Additionally cadence was calculated for each subject, in each trial condition, as the average number of strides (right foot strikes) per minute [9]. These data were examined similarly -initially distributions and normality and then linear mixed models to identify main and interaction effects. ...
Article
Full-text available
Background Progressive loading of the lower limb muscles during running on a positive pressure or reduced gravity (Alter-G™) treadmill is suggested as a rehabilitation strategy after muscle and tendon injury but the influence of running up or downhill and at higher speeds is not known, nor are the interaction effects of speed, inclination, and indicated bodyweight. Research question What are the lower limb EMG activation levels and cadence when running up and downhill in normal and reduced gravity? Methods 10 recreationally active male athletes ran on a positive-pressure Alter-G™ treadmill at: 3 indicated bodyweights (60 %, 80 %, and 100 %); 5 speeds (12, 15, 18, 21, and 24 km/h); for incline, decline, and flat conditions (-15 %, -10 %, -5%, 0%, 5%, 10 %, and 15 %); while monitoring the surface EMG of 11 leg muscles as well as cadence (strides per minute). Results and significance Linear mixed models showed significant effect of running speed, inclination, and indicated bodyweight, with interaction effects observed. Increasing running speed was associated with the largest change in activity, with smaller effects for increasing bodyweight and inclination. Downhill running was associated with reduced activity in all muscle groups, and more tightly clustered activity patterns independent of speed. Substantial variation in sEMG activity occurred in the flat and uphill conditions. Subject responses were quite variable for sEMG, less so for cadence. For the conditions examined, increasing running speed induced the largest changes in EMG of all muscles examined with smaller changes seen for manipulations of inclination and bodyweight.
... The primary physical therapist can also consult with colleagues across the globe using such technology. Despite the emphasis on movement in the physical therapy profession, recent development of smartphones/tablets/apps for VBMA, and an accumulating body of literature regarding VBMA application in therapy, injury prevention, and sports performance, [9][10][11] research on VBMA use in clinical practice is currently limited. ...
Article
Objective: Motion analysis is performed by physical therapists (PTs) to assess and improve movement. Two-dimensional video-based motion analysis (VBMA) is available for smartphones/tablets and requires little to no equipment or cost. Research on VBMA use in clinical practice is limited. The purpose of this study was to examine the current use of VBMA in orthopedic physical therapist practice. Methods: Members of the Academy of Orthopaedic Physical Therapy (AOPT) completed an online survey. Questions examined frequency of VBMA use, reasons for use, facilitators/barriers, device/apps used, practice patterns, other certificates/degrees, and demographic information. Results: Among our final analysis sample of 477 respondents, 228 (47.8%) use VBMA. Of 228 VBMA users, 91.2% reported using it for ≤ 25% of their caseload, and 57.9% reported using their personal device to capture movement. Reasons for using VBMA included visual feedback for patient education (91.7%), analysis of movement (91.2%), and assessment of progress (51.8%). Barriers to use included lack of device/equipment (48.8%), lack of space (48.6%), and time restraint (32.1%). Those respondents with ≤ 20 years of clinical experience (odds ratio [OR] = 1.83, 95% CI = 1.21-2.76), residency training (OR = 2.49, 95% CI = 1.14-5.43), fellowship training (OR = 2.97, 95% CI = 1.32-6.66), and from the West region of the United States (OR = 1.66, 95% CI = 1.07-2.56) were more likely to use VBMA. Conclusions: More than half of surveyed orthopedic physical therapists do not use VBMA in clinical practice. Future research should be directed toward assessing reliability and validity of VBMA use by smartphones, tablets, and apps and examining whether VBMA use enhances treatment outcomes. Data security, patient confidentiality, and integration into the electronic medical record should be addressed. Impact: This study is the first to describe the use of VBMA in orthopedic physical therapist practice in the United States. It is first step in understanding how VBMA is used and might be used to enhance clinical assessment and treatment outcomes.
... As they overstride they land more on their heels, increase the braking forces, and spend more contact time on the ground. [26][27][28] All of these slow the runner down more, gives them less explosion, and may lead to more stress-related injuries. Look at the leaders in a race compared to those behind them. ...
... Guidelines for the measurement of these running kinematics with two-dimensional (2D) video in clinical practice are already in place (Souza, 2016). Two previous studies have reported concurrent validity and reliability of high frame rate 2D video in comparison to three-dimensional (3D) kinematic motion capture, for measuring peak HADD (Bart Dingenen et al., 2017;Maykut, Taylor-Haas, Paterno, DiCesare, & Ford, 2015). ...
Article
Objectives: Investigate the validity and reliability of markerless, smart phone collected, two-dimensional (2D) video, analysed using the 'Hudl technique' application, compared to three-dimensional (3D) kinematics during running, in participants with patellofemoral pain (PFP). Design: Validity/reliability study. Setting: Biomechanics laboratory. Participants: Males/females with PFP (n = 21, 10 males, 11 females, age 32.1 months [±12.9]). Main outcome measures: Manually synchronised 2D and 3D measurement of peak hip adduction (HADD) and peak knee flexion (KFLEX) during running. Results: 2D and 3D measures of peak KFLEX (p = 0.02, d = 1.13), but not peak HADD (p = 0.25, d = -0.27), differed significantly. Poor validity was identified for 2D measurement of peak HADD (ICC 0.06, 95% CI -0.35, 0.47) and peak KFLEX ICC 0.42, 95% CI (-0.10, 0.75). Moderate intra-rater reliability was identified for both variables (ICC 0.61-65), alongside moderate inter-rater reliability for peak KFLEX (ICC 0.71) and poor inter-rater reliability for peak HADD (ICC 0.31). Conclusions: Measurement of peak HADD and KFLEX in runners with PFP using markerless, smart phone collected 2D video, analysed using the Hudl technique Application is invalid, with poor to moderate reliability. Investigation of alternate 2D video approaches to increase precision is warranted. At present, 2D video analysis of running using Hudl Technique cannot be advocated.
... The 2017 United States national runners survey for instance found that 14% of the runners preferred to run on a MT [1] and MTs are also often used as a supplementary training mode among elite athletes [2]. In clinical settings, MT running is increasingly combined with video analysis to investigate running technique and inform footwear, orthotic, and gait retraining strategies for performance enhancement, injury prevention and rehabilitation [3][4][5]. MTs are also used during rehabilitation to commence running in a controlled environment [6,7]. Finally, instrumented MTs are frequently used in research settings to evaluate running biomechanics [8][9][10][11][12]. ...
Article
Full-text available
Background Treadmills are often used in research, clinical practice, and training. Biomechanical investigations comparing treadmill and overground running report inconsistent findings. Objective This study aimed at comparing biomechanical outcomes between motorized treadmill and overground running. Methods Four databases were searched until June 2019. Crossover design studies comparing lower limb biomechanics during non-inclined, non-cushioned, quasi-constant-velocity motorized treadmill running with overground running in healthy humans (18–65 years) and written in English were included. Meta-analyses and meta-regressions were performed where possible. Results 33 studies (n = 494 participants) were included. Most outcomes did not differ between running conditions. However, during treadmill running, sagittal foot–ground angle at footstrike (mean difference (MD) − 9.8° [95% confidence interval: − 13.1 to − 6.6]; low GRADE evidence), knee flexion range of motion from footstrike to peak during stance (MD 6.3° [4.5 to 8.2]; low), vertical displacement center of mass/pelvis (MD − 1.5 cm [− 2.7 to − 0.8]; low), and peak propulsive force (MD − 0.04 body weights [− 0.06 to − 0.02]; very low) were lower, while contact time (MD 5.0 ms [0.5 to 9.5]; low), knee flexion at footstrike (MD − 2.3° [− 3.6 to − 1.1]; low), and ankle sagittal plane internal joint moment (MD − 0.4 Nm/kg [− 0.7 to − 0.2]; low) were longer/higher, when pooled across overground surfaces. Conflicting findings were reported for amplitude of muscle activity. Conclusions Spatiotemporal, kinematic, kinetic, muscle activity, and muscle–tendon outcome measures are largely comparable between motorized treadmill and overground running. Considerations should, however, particularly be given to sagittal plane kinematic differences at footstrike when extrapolating treadmill running biomechanics to overground running. Protocol registration CRD42018083906 (PROSPERO International Prospective Register of Systematic Reviews).
... A three-dimensional approach was not possible, but it could contribute to reinforce our findings. To discuss the movement characteristics after determining the moment of the rupture it was considered the best comparable jump performed within the same training session, but we acknowledge that the visual inspection of the same movement at a second position, ideally in the sagittal plane, would permit a more detailed and precise discussion of this case (Souza, 2016). However, a detailed and consistent methodology (i.e. ...
Article
We used image-processing techniques to determine the moment (i.e., image frame) of the Achilles tendon (AT) rupture in an Olympic sprinter. This report may be unique due to the difficulty in conducting motion capture analyses during injury events. Our report includes one female Olympic sprinter, 29 years old (body mass: 56 kg, height: 1.68 m, and body mass index: 19.8 kg/m2) with a high-competitive profile history (2008 and 2012 Olympic Games participation; South American record holder in 100- and 200-m; Pan-American gold medalist in 200-m and 4 x 100-m relay) who suffered a complete AT rupture in the left leg while exercising in the final phase of rehabilitation following an Achilles tendinopathy in the contralateral limb. The greater dorsiflexion found at the moment of the injury and the delayed control of heel position indicated the presence of uncontrolled dorsiflexion, which potentially generated excessive eccentric stress over the tendon and, thus, the AT rupture. Here we discuss the relevance of lower leg alignment, the movements’ characteristics, and the history of Achilles tendinopathy in the contralateral leg on the occurrence of the AT rupture.
... Biomovie, video analysis software with the aim to link row Moxy's data with the video making during the test [14]. ...
Article
Full-text available
Graduated compression stockings are now widely used in many sports both for recovery and during the competition with the aim of improving the efficiency of athletes in these two aspects of their sporting life. It does not seem very clear whether the compression of the lower limbs can improve performance, but it does appear evident that it is very useful in the recovery phase. There is also a tendency for compression stocking manufacturers to only offer stockings that begin compression at the ankle continuing upwards, with the primary goal of compressing the calf versus beginning compression at the midfoot upwards. Knowledge of the anatomy and venous biomechanics of the lower limb suggest the presence of an important amount of venous stasis at the level of the foot in correspondence with the midfoot. The benefits of compressing, or “squeezing” this area of the foot using the compression stockings are important in both walking and running, with running reaching a 12% increase in oxygen supply levels at the femoral area. For this reason, 14 female runners were recruited for this study, all of them performing the same tests wearing the control stockings, compression stockings that begin compression at the ankle moving upwards, and the stockings with the innovative contribution of the special screen printing of fabrics that begin compression at the midfoot level continuing upwards. Three tests were carried out, the first where the seated runners kept the dominant limb raised to pelvis height, the second where they walked at a speed of 6km / h for 3 minutes with a treadmill inclined at 0.5%, and the third where they were running at 9Km/h for two minutes with treadmill inclined at 0.5%. The conclusion of this study from the data collected was that there was an increase in oxygen based on the physical exercise required. In running, the increase in oxygen supply was maximal due to the dynamics of the squeezing forces of the plantar foot using the innovative compression stockings with the special screen printing of fabrics designed to optimize compression. This study highlights the comparison between two types of compression stockings, one that compresses from the calf upwards, and one that compresses from the midfoot upwards. In summary, the combination of compression stockings with special screen printing of fabrics that compresses from the midfoot upwards improves the efficiency of the venous system during physical activity and is therefore optimal to all sports in both the open and closed kinetic chains.
... Motion capture systems are often impractical to use in non-laboratory settings as they require significant physical space, are expensive, require specialized training, and are time consuming to collect data. Alternatively, using only one or two consumer-grade video cameras to assess landing kinematics in two-dimensions (2D) could be feasible for use in most nonlaboratory settings (Souza, 2016). ...
Article
Objectives 1) Determine the concurrent validity of using automated 2D video analysis relative to 3D motion capture for assessing frontal and sagittal-plane knee kinematics during landing, 2) compare the accuracy of visually estimating joint center locations (2D Manual) with computing joint center locations using anatomical markers (2D Automatic), and 3) compare landing kinematics between a controlled laboratory setting and a non-laboratory setting. Design Validity/repeatability study. Settings Biomechanics research laboratory and non-laboratory athletic facility. Participants Thirty uninjured recreational athletes: Main Outcome Measures: Peak knee flexion, knee flexion range of motion, peak knee frontal plane projection angle, and knee frontal plane projection angle range of motion during bilateral and unilateral landing were measured simultaneously in 3D using motion capture and in 2D using two low-cost video cameras during the first study session (biomechanics research laboratory), and in 2D only during the second study session (non-laboratory athletic facility). Results There was good to excellent agreement between 3D motion capture and both 2D Manual (ICC=0.86–0.99) and 2D Automatic (ICC=0.89–0.99) video analysis methods. There was good to excellent agreement between data collected in a laboratory and non-laboratory setting (ICC=0.75–0.95). Conclusion The methods introduced in this study are inexpensive, reliable, and feasible for use in non-laboratory settings.
... A compreensão dos parâmetros mecânicos do movimento humano, contribui para a análise de diversas características do aparelho locomotor em sua mais ampla perspectiva de manifestação, contemplando tanto os movimentos do cotidiano, quanto os mais complexos relacionados ao gesto esportivo. Desta forma, a Biomecânica tornou-se um recurso extremamente importante na triagem de técnicas assertivas para a melhora do rendimento e desempenho em atividades esportivas (SOUZA, 2016). À vista disso, cresce o número de pesquisas científicas envolto da referida área do conhecimento e suas possibilidades de aplicação. ...
... The importance of the risk factors analysis of injuries in sport lies precisely in this: it allows us to have a starting point on which to set specific prevention policies [16]. Prevention facilitates the use of all the tools available, such as new technologies [17,18] and training techniques [19,20,21], for promoting athletes health and physical activity. ...
Article
Background: Surfing is an increasingly popular sport in the world, but it is not sufficiently investigated in terms of epidemiology of injuries and possible prevention strategies. Moreover, there are different surfing disciplines, with specific characteristics and therefore different potential risks of injury. The aim of this study was to look at the injuries of recreational surfers in an Italian cohort, distinguishing between trauma and overuse lesions and putting in evidence any difference between specific water board sports. Methods: The design is that of a retrospective observational study. An online survey was distributed to a group of Italian surfers that are members of a surfing association. The survey comprised: demographic data, surfing information such as number of sessions per year and years of experience, and surfing injuries story. The sample size consisted of 126 recreational surfers who practiced four different types of surfing: surf, kitesurf, windsurf and stand-up paddle. Results: The incidence of trauma was significantly higher than the incidence of overuse lesions in all four water board sports evaluated (e.g. in surf, 81% for trauma vs. 27% for overuse, with a difference of 55% , P<0.0001). There was a statistically significant effect of the number of surfing sessions per year both for trauma (W=6.36, P=0.0117) and for total injuries (trauma + overuse; W=4.30, P=0.0381), with a 12-times increased risk for the surfers who performed more than 80 sessions per year. The risk of overuse injuries was higher for those who practice surf for more than seven years (P=0.0193). Conclusions: Traumas are more frequent than overuse injuries for all the investigated surfing disciplines. The risk of injury increases as the number of annual sessions and the years of practice increase, demonstrating that experience is not a protective factor, whereas higher exposure is certainly a risk factor. New injury prevention strategies should be based on athletic training and preparation programs, traditionally lacking among recreational surfers.
... Several studies have described and reviewed VBMA applications in sports activities, such as running (Souza, 2016), pitching (DeFroda et al., 2016, and jumping (Parsons & Alexander, 2012). Real-time videos for providing visual and verbal feedback to athletes have been shown to be an effective mode of education/ coaching (Parsons & Alexander, 2012;Raiola, 2014). ...
Article
Objective Examine video-based motion analysis (VBMA) use among sports physical therapists. Design Cross-sectional observation; Setting Survey, online-platform. Participants American Academy of Sports Physical Therapy members (n = 261). Main Outcome. Measures VBMA use frequency, reasons for use, facilitators/barriers, tools used, factors associated with use. Results 194 (74.3%) used VBMA but 163 (84%) use it for ≤ 25% of their caseload. Most (57.7%) used their personal device to capture VBMA. Commonly cited reasons for use were movement analysis (93.8%) and patient education (87.6%). Barriers to use included time (30.7%), unfamiliarity with device/equipment (19.2%), and lack of device/equipment (18.4%). Younger age, advanced training, and greater time spent with return patients were each associated with use. For every 5-year increase of age, there was a 12% reduced likelihood of VBMA use (OR = 0.88; 95% CI = 0.77–1.00). Board-certified sports clinical specialists were more likely to use vs. those without additional certifications/degrees (OR = 3.27; 95% CI = 1.33–8.02). Spending 30–59 (vs. <30) minutes with return patients increased the odds of use (ORs range: 2.71 to 3.85). Conclusion Most respondents used VBMA, albeit infrequently. Those younger, with advanced training, and spending ≥30 min with return patients were more likely to use VBMA. Future research should investigate whether VBMA use enhances patient outcomes.
... Furthermore, all phases of running are performed alternately between the right and left limbs. This includes upper limbs movements [6]. ...
Article
Full-text available
Background: Participating in amateur sports seeks to improve overall well-being. However, it also carries a high risk of injuries and abnormalities of the musculoskeletal system. One of the factors that predisposes to an increase in injuries in both amateur and professional sports is the asymmetry of movement. Asymmetrical movements in sports can globally affect the athlete's body and precursor to various types of abnormalities. Aims: The purpose of this study is to compare an asymmetrical sport (tennis) with symmetrical sport (long-distance running) in terms of injury risk and basic movement patterns. Material and methods: The study group consisted of 30 tennis players and 30 runners of both genders, between 20 and 50 years old, practicing their sports at the amateur level. One of the research methods used was a questionnaire that included questions regarding elementary participant information, training, and health information. In addition, basic movement patterns were assessed using the Functional Movement Screen (FMS) test. Results: There were more asymmetries found in the FMS test in tennis players than in runners, and better results in terms of the number of points in runners. However, they did not demonstrate a higher occurrence of injuries in those practicing an asymmetric sport than those practicing a symmetric sport. Conclusion: Based on the results, it was concluded that practicing an asymmetrical sport may increase the risk of asymmetries in basic movement patterns to a greater extent than practicing a symmetrical sport. Practicing asymmetrical sports at the amateur level does not seem to increase the occurrence of injuries any more than practicing symmetrical sports.
... It mainly includes marker-trajectory, path, displacement, angle, velocity, acceleration, angular velocity, etc. The most commonly used method is still a video-based gait analysis (Souza 2016). When using photo-stereo photometry, skin deformation and displacement can cause the marker to move relative to the underlying bone. ...
Thesis
Introduction / Background Although customized insoles are widely used in patients with flat feet, their biomechanical effects on the human kinematic chain are still not completely understood. Therefore, this proof-of-concept study was performed to evalu-ate the impact of customized insoles on subjects' gait patterns during walk-ing. Material and Methods Initially, the accuracy of a 2D gait analysis system (Dartfish, Ver. 9, Friborg, Switzerland) was tested by experimental research. Subsequently, 28 sub-jects (mean ± SD age: 26.9 ± 6.3) were recruited, 13 males and 15 females, 15 subjects with flat foot and 13 subjects with standard feet. Among them, 14 subjects had flat feet on both feet, and 1 subject had flat feet on the right foot. For each subject, kinematics data were measured under three test con-ditions: barefoot, with shoes, and with shoes and insoles. Five-round trips were recorded in each state. Before the test, each subject walked for 10 min with shoes and insoles to get familiar with the insoles. After the tests, the 2D gait analysis system was utilized to record each subject's gait patterns. Results The results showed a significant difference (p < 0.05) between subjects with and without flat foot, concerning the parameters achilles-tendon-angle, an-kle-dorsiflexion, knee-extension, knee-flexion, step-length, step-time, and stride-length). Among them, the achilles-tendon-angle of subjects with flat foot decreased from 9.95° to 8.75°, the angle of ankle-dorsiflexion increased from 24.94° to 30.22°, the angle of knee-extension increased from 174.68° to 176.28°, the angle of knee-flexion decreased from 126.37° to 123.98°. In comparison, the angle of achilles-tendon-angle of subjects without flat foot increased from 9.42° to 9.67°, the angle of ankle-dorsiflexion increased from 23.07° increased to 28.98°, the knee-extension angle increased from 173.86° to 174.74°. The knee-flexion angle changed from 126.26° to 124.80°. The effect of customized insoles on the ankle and knee joint is the most obvious. Discussion / Conclusion The human movement exists in the form of a kinematic chain, and the ankle joint is the first joint of load dissipation when walking. Therefore, the influ-ence of the insoles on the ankle joint when walking is relatively apparent. The mechanically induced effects of the insoles on the foot have a direct biomechanical effect on the ankle joint, the tibia, and the knee joint, while the influence on the hip joint is minimal. The results of this feasibility study demonstrate the effect of insoles. Howev-er, there are objective limitations due to the lack of power analysis (the exact definition of patient cohort/study sample size), as well as the lack of the ad-aptation time of the subjects to the insoles and limitations of reliable meas-urement methods (the deviations of individual parameters between the study conditions are in the range of the measurement resolution) for insole effect assessment. These will have to be statistically verified in further stud-ies.
... Souza et al. describes 17 different variables that can be assessed for evidence-based videotaped running biomechanics analysis. 21 Two key areas of emphasis to evaluate are landing pattern at initial contract and hip drop/pelvic obliquity. This can be accomplished with a more expensive multiview synchronized system or a tablet-based application. ...
Article
Full-text available
The purpose of the article is to present an updated literature review, as well as describe our approach to rehabilitation and return to sports following hip arthroscopy for femoroacetabular impingement (FAI) with labral repair. A literature review was performed to identify articles published within the last 10 years that were focused on this topic. Relevant articles were reviewed, and reference lists were searched to identify additional articles. Findings were summarized for rehabilitation phases and return-to-sports assessment. Additionally, advanced rehabilitation topics are reviewed. Several systematic reviews and individual case series were identified. There is relative uniformity concerning the use of a four-phase approach for rehabilitation. However, there is inconsistency in terms of timing and criteria for ultimate return to sport. Advanced rehabilitation topics were reviewed, and description of their relevance at various rehabilitation phases was provided. A four-phase approach to rehabilitation following hip arthroscopy for FAI is widely used with general uniformity, although the timing and level of detail concerning assessment and readiness for return to sport are variable. Advanced rehabilitation techniques may be used in select patients returning to high-level activities.
... Tracking body kinematics is key to answering questions in many scientific disciplines. For example, neuroscientists quantify animal movement to relate it to brain dynamics Seethapathi et al., 2019), biomechanists quantify the movement of specific body structures to understand their mechanical properties (Alexander, 2017;Bender et al., 2010), social scientists quantify the motion of multiple individuals to understand their interactions (Schwager et al., 2008;Halberstadt et al., 2016), and rehabilitation scientists quantify body movement to diagnose and treat disorders (Souza, 2016;Chiba et al., 2005;Rinehart et al., 2006). In all of these disciplines, achieving rapid and accurate quantification of animal pose is a major bottleneck to scientific progress. ...
Article
Full-text available
Quantifying movement is critical for understanding animal behavior. Advances in computer vision now enable markerless tracking from 2D video, but most animals move in 3D. Here, we introduce Anipose, an open-source toolkit for robust markerless 3D pose estimation. Anipose is built on the 2D tracking method DeepLabCut, so users can expand their existing experimental setups to obtain accurate 3D tracking. It consists of four components: (1) a 3D calibration module, (2) filters to resolve 2D tracking errors, (3) a triangulation module that integrates temporal and spatial regularization, and (4) a pipeline to structure processing of large numbers of videos. We evaluate Anipose on a calibration board as well as mice, flies, and humans. By analyzing 3D leg kinematics tracked with Anipose, we identify a key role for joint rotation in motor control of fly walking. To help users get started with 3D tracking, we provide tutorials and documentation at http://anipose.org/.
Article
Background Traditional running gait analysis is limited to artificial environments, but whether treadmill running approximates overground running is debated. This study aimed to compare treadmill gait analysis using fixed video with outdoor gait analysis using drone video capture. Hypothesis Measured kinematics would be similar between natural outdoor running and traditional treadmill gait analysis. Study Design Crossover study. Level of Evidence Level 2. Methods The study population included cross-country, track and field, and recreational athletes with current running mileage of at least 15 km per week. Participants completed segments in indoor and outdoor environments. Indoor running was completed on a treadmill with static video capture, and outdoor segments were obtained via drone on an outdoor track. Three reviewers independently performed clinical gait analysis on footage for 32 runners using kinematic measurements with published acceptable intra- and interrater reliability. Results Of the 8 kinematic variables measured, 2 were found to have moderate agreement indoor versus outdoor, while 6 had fair to poor agreement. Foot strike at initial contact and rearfoot position at midstance had moderate agreement indoor versus outdoor, with a kappa of 0.54 and 0.49, respectively. The remaining variables: tibial inclination at initial contact, knee flexion angle initial contact, forward trunk lean full gait cycle, knee center position midstance, knee separation midstance, and lateral pelvic drop at midstance were found to have fair to poor agreement, ranging from 0.21 to 0.36. Conclusion This study suggests that kinematics may differ between natural outdoor running and traditional treadmill gait analysis. Clinical Relevance Providing recommendations for altering gait based on treadmill gait analysis may prove to be harmful if treadmill analysis does not approximate natural running environments. Drone technology could provide advancement in clinical running recommendations by capturing runners in natural environments.
Chapter
Return to running after an injury is a milestone in the rehabilitation process of an athlete. To guide the patient in the return to running process, a comprehensive understanding of the running demands and the patient’s injury and current condition is paramount. A correct and thorough running implementation can represent a useful training stimulus for the athlete but on the other hand, if introduced too early or with the wrong progression, it can pose a threat for the athlete’s recovery process. For this reason, it is necessary that the patient is properly prepared before return to running and adequately monitored during this process. In this chapter, the authors discuss the return to running process after anterior cruciate ligament reconstruction (ACLR) stating the running demands and the physical criteria to be achieved after this surgery before allowing an athlete to return to run. The same clinical reasoning process can be applied to any other injury considering the running biomechanical demands of that specific area and the relative injury features. Finally, the authors present a return to running progression after ACLR with detailed information about the suggested rehabilitation strategies and their implementation.
Article
Full-text available
Somatosensory feedback is used in walking retraining; however, its utility in running is less feasible due to the greater associated speeds. The purpose of this study was to examine the acute effects of wearing a novel running belt device on sagittal plane running kinematics. Ten healthy runners ran on a treadmill with and without the use of a running belt device within a repeated measures study design. Temporal-spatial characteristics and sagittal plane knee and ankle kinematics were recorded with three-dimensional motion analysis. Wilcoxon Signed-Rank Tests revealed significant decreases in centre of mass vertical displacement (z = −2.083, p = 0.003), tibial inclination at initial contact (z = −2.803, p = 0.003), and stance phase knee joint excursion (z = −2.701, p = 0.003), and greater knee flexion at initial contact (z = −2.803, p = 0.003) when the belt was donned. No differences were observed in step rate (z = −0.351, p = 0.363), foot inclination angle at initial contact (z = −2.090, p = 0.018), or peak knee flexion during stance (z = −1.172, p = 0.121). Findings suggest that donning a running belt can minimise specific high-risk biomechanical characteristics in runners with particular kinematic profiles.
Article
Background The literature on the reliability of qualitative and quantitative measures for running video analysis in the adolescent population is limited. Reliability of 2-dimensional (2D) video analysis has been reported in adult runners, but these findings may not apply to youth runners. Purpose We sought to determine the intra-rater and inter-rater reliability of sagittal and frontal plane kinematics using 2D video analysis in healthy adolescent runners. Methods High-definition (1080p) videos were recorded of 10 healthy runners between 14 and 18 years old running on a treadmill at self-selected speed with markers attached to the cervical spine, pelvis, and lower extremities. Kinematic variables in the sagittal and frontal planes were measured using Dartfish Motion Analysis Software by 3 raters (2 sports medicine physical therapists and a research assistant). Intra- and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs). Results Of the 10 runners, 4 (40%) were male and the mean age was 16 ± 1.5 years. The intra-rater ICC for all kinematic variables ranged from 0.574 to 0.999 for the experienced physical therapist, and 0.367 to 0.973 for the inexperienced research assistant. The inter-rater ICC for all raters ranged from −0.01 to 0.941. Eleven kinematic variables showed substantial agreement and 4 showed almost perfect agreement. Step width and foot progression showed fair and poor agreement, respectively. Conclusions Running analysis using 2D video can be performed reliably in adolescents on all kinematic variables except for step width and foot progression. Inexperienced raters can be properly trained in the video analysis of running kinematics to consistently assess the same runner.
Running after childbirth, specifically how or when to return, is a hot topic in the field of physical therapy and on social media; however, there are significant gaps in the literature supporting when and how to safely initiate running postpartum. During pregnancy and following childbirth (both vaginal and cesarean), the body undergoes changes that may impact strength, neuromuscular control, endurance, and the ability to withstand the high-impact forces and repetitive nature of running. Many mothers experience new or worsened symptoms of musculoskeletal or pelvic floor dysfunction following pregnancy and childbirth and require physical therapy to normalize function. After most major injuries, it is common to participate in formalized rehabilitation; however, this is not the norm for athletes returning to running postchildbirth. Because of lack of evidence, many runners and clinicians struggle to develop appropriate rehabilitation progressions for return to running after childbirth. Pelvic and sports physical therapists must understand biomechanical features of running gait and safely progress strength, endurance, and neuromuscular control of the kinetic chain when guiding a runner back to running. This clinical commentary builds on existing guidelines, research, and expert opinion to propose a 4-phase rehabilitation framework to help runners initiate and progress running after childbirth. The result is an in-depth exercise prescription (intensity, frequency, type), examples of exercises (hip, abdominal, pelvic floor, and foot), running progression, and progression goals to prepare runners for symptom-free running after childbirth (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JWHPT/A58, where authors provide more insight on this return to running framework).
Chapter
Bone stress injury is common in active populations and can be a significant barrier to a healthy lifestyle. Optimal training regimens that maximize osteogenic potential while minimizing fatigue damage remain ideal but remain elusive. Examining evidence related to the complex etiology of bone stress injury reveals key factors associated with injury. Biomechanical factors, specifically bone stress and strain, are introduced as proximate causes of injury. Key components of bone stress and strain are introduced and discussed. Targets for intervention are identified with emphasis on bone strength, load management, and running mechanics. Because each individual with bone stress injury has a unique presentation, clinicians need to fully examine the web of determinants that interact to influence bone-specific load and load capacity and direct personalized interventions accordingly.
Article
Full-text available
Introduction: The purpose of this research was to compare the coordination variability of lower extremity segments in men with genu varum and healthy men during treadmill running at different speeds . Materials and Methods: Among sports and physical education students, 15 healthy men and 15 men with genu varum voluntarily participated in this research. Each participant ran on treadmill for 60 seconds at preferred speed and 25% faster and 25% slower than preferred speed. The kinematics data of lower extremities were collected by MyoMotion motion analysis system at 200 Hz sampling frequency. Coordination calculations were done by continuous relative phase (CRP) method for three segments coupling and compared between two groups. Results: The results of repeated measures analysis of variance (ANOVA) between groups showed that coordination patterns of segments did not differ significantly between the groups during running at different speeds (P ˃ 0.05). However, the change in running speed caused significant differences in coordination and coordination variability of segments in some phases of running in two groups (P ≤ 0.05). Conclusion: Coordination pattern of segments during running seems the same between genu varum and healthy groups; however, significant differences in these patterns and different running speeds were evident in both groups. On the other hand, coordination variability of segments was not different between groups, but the increase in running speed reduced the coordination variability during early and late swing and mid-stance phase of running in both groups. This finding may imply higher risk of overuse injuries at these phases.
Article
Objectives To explore whether homogeneous subgroups could be discriminated within a population of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis. Design Cross-sectional. Setting Research laboratory. Participants Fifty-three recreational runners (15 males, 38 females) with a running-related injury. Main outcome measures Foot and tibia inclination at initial contact, and hip adduction and knee flexion at midstance were measured in the frontal and sagittal plane with marker-based two-dimensional video analysis during shod running on a treadmill at preferred speed. The four outcome measures were clustered using K-means cluster analysis (n = 2–10). Silhouette coefficients were used to detect optimal clustering. Results The cluster analysis led to the classification of two distinct subgroups (mean silhouette coefficient = 0.53). Subgroup 1 (n = 39) was characterized by significantly greater foot inclination and tibia inclination at initial contact compared to subgroup 2 (n = 14). Conclusion The existence of different subgroups demonstrate that the same running-related injury can be represented by different kinematic presentations. A subclassification based on the kinematic presentation may help clinicians in their clinical reasoning process when evaluating runners with a running-related injury and could inform targeted intervention strategy development.
Article
Background While there is substantial information available regarding expected biomechanical adaptations associated with adult running-related injuries, less is known about adolescent gait profiles that may influence injury development. Research Questions Which biomechanical profiles are associated with prevalent musculoskeletal lower extremity injuries among adolescent runners, and how do these profiles compare across injury types and body regions? Methods We conducted a cross-sectional study of 149 injured adolescents (110 F; 39 M) seen at a hospital-affiliated injured runner’s clinic between the years 2016-2021. Biomechanical data were obtained from 2-dimensional video analyses and an instrumented treadmill system. Multivariate analyses of variance covarying for gender and body mass index were used to compare continuous biomechanical measures, and Chi-square analyses were used to compare categorical biomechanical variables across injury types and body regions. Spearman’s rho correlation analyses were conducted to assess the relationship of significant outcomes. Results Patients with bony injuries had significantly higher maximum vertical ground reaction forces (bony: 1.87 body weight [BW] vs. soft tissue: 1.79BW, p=0.05), and a higher proportion of runners with contralateral pelvic drop at midstance (χ²=5.3, p=0.02). Maximum vertical ground reaction forces and pelvic drop were significantly yet weakly correlated (ρ=0.20, p=0.01). Foot strike patterns differed across injured body regions, with a higher proportion of hip and knee injury patients presenting with forefoot strike patterns (χ²=22.0, p=0.01). Significance These biomechanical factors may represent risk factors for injuries sustained by young runners. Clinicians may consider assessing these gait adaptations when treating injured adolescent patients.
Article
Full-text available
Running is an athletic activity that is increasingly gaining popularity. Despite its benefits, there are many suspected risk factors for running-related overuse injuries. The objective of this study is to describe injuries and clinical symptoms observed on the sole of the foot in runners, giving special attention to the weekly running volume. The literature presented in this narrative review is based on a non-systematic search of the Medline, Google Scholar, and ResearchGate databases and focuses on foot injuries (the full spectrum of the foot pathology from bones to tendons and plantar fascia, nerve, and joint disorders) in runners, which represents an important topic for both professional and recreational runners. The weekly running distance appeared to be one of the strongest predictors for future overuse injuries. Marathon training and average weekly running of over 20 km are possible predictive factors in the development of plantar foot injuries. The plantar medial aspect of the foot is the anatomic area of the foot that most frequently experiences pain, with numerous pathologic conditions. As a result, diagnosis is always a challenging task. The ability to obtain an accurate medical history and carefully perform a physical examination, together with good knowledge of the foot anatomy and kinesiology, are also proven to be key players in ensuring proper diagnosis.
Article
O objetivo deste estudo foi verificar a influência do nível de flexibilidade e da mobilização articular de membros inferiores nos parâmetros biomecânicos da corrida, sendo categorizado como um estudo experimental com delineamento transversal. Foram avaliados 12 corredores com idade de 33 ± 3 anos, sendo 6 mulheres e 6 homens; com o banco de Wells, goniômetro e o sistema de análise de biomecânica cinemática da corrida. Após a primeira coleta foi feita a aplicação da mobilização articular e registrado o resultado do banco de Wells e no sistema de análise 3D. Então foi verificada a relação entre flexibilidade e a mobilização articular com as variáveis biomecânicas da corrida, concluindo que houve correlação de ângulo articular a partir da cinemática nos voluntários com maior amplitude de rotação externa (0,4555) e flexão do quadril (0,454), sendo que no teste de sentar e alcançar houve aumento no escore em centímetros após a intervenção.
Article
Full-text available
Background: There is a scarcity of evidence describing how physical therapists use data from clinical examinations to inform the treatment of runners with knee pain. Objective: Our purpose was to examine the between physical therapist agreement on the selection of perceived impairments in runners with knee pain. Methods: Twelve physical therapists reviewed two cases of runners with knee pain. The cases included clinical subjective information, objective data, and review of videos of each participant running. Each rater selected up to three perceived impairments (from a list of eight) that each physical therapist would address at the next physical therapy session. Percent agreement was calculated to determine the between rater agreement on each individual perceived impairment selection and Fleiss Kappa was calculated for each unique combination of three perceived impair�ments per case. Results: Twelve raters with 51 (18–156) months of clinical experience participated. Percent agree�ment ranged from 8%-100% for both cases for individual impairments. When assessing the unique combination of three impairments selected, inter-rater agreement was less than what is expected due to chance alone (κ = −0.09, p = .92; κ = −0.09, p = .98) for both cases. Conclusion: The 12 physical therapists demonstrated poor to excellent levels of agreement when selecting an individual perceived impairment. Agreement was worse than chance when selecting a combination of three unique impairments.
Article
Physiotherapy has long followed a standard script. The patient is seen in-person at a clinic, a subjective history is taken and the physiotherapist completes a physical examination consisting of strength, range of motion, functional testing, etc to determine the cause of injury and prescribe an appropriate treatment plan. For running injuries, this assessment often includes an analysis—either on a treadmill or overground— of the patient’s running gait. When facilities and equipment are available, this may include three-dimensional (3D) motion capture and force plate analysis, which provides more detailed information about the biomechanics contributing to the presenting injury. Since most clinicians do not have access to this equipment, many use two-dimensional (2D) video analysis in the clinic. Recent circumstances have pushed many of us to explore remote options using online platforms, such as telehealth. This has forced us to be more creative with how we assess and treat patients and presents an opportunity to evolve our practice. With most runners having access to a high-quality video camera on their phone or tablet, 2D motion capture can be performed remotely. Recent advances and access to wearable technology—inertial measurement units (IMUs), in particular— now allow remote measurement of forces and spatiotemporal data. Remote biomechanical running gait analysis is now a reality
Article
Full-text available
This review article summarized the literature regarding running gait. It describes characteristics of running gait and running gait cycle, explains running anatomy in relation to lower and upper body mechanism; contribution of muscles, and joint running gait cycle. The concept of running kinematics and kinetics has described motion characteristics such as position, velocity, acceleration, and force applied during the running cycle. Running gait analysis techniques has discussed such as motion analysis, force plate analysis, and electromyography.
Chapter
This chapter introduces readers to the MEMS sensors technology, and also explores the background theory and applications of barometric altimetry.
Article
Full-text available
The purpose of this study was to identify biomechanical and anthropometric variables that contribute to overuse injuries in runner. The comparisons were made between a group of runners who had sustained at least one overuse running injury and a group of runners who had been injury free throughout their running careers. Groups were well matched in important training variables. Synchronized kinetic and rearfoot kinematic variables of both feet were collected by filming subjects running over a force platform at a speed of 4 m.s-1. The injury-free group demonstrated significantly greater posterior thigh (hamstring) flexibility, as measured by a standard sit and reach test. This was the only anthropometric variable in which the groups differed. Within each group, there were no significant differences between left and right foot landing for any biomechanical variable. Biomechanical variables that demonstrated significantly lower values for the injury free group were the vertical force impact peak and the maximal vertical loading rate, with the maximal rate of rearfoot pronation and the touchdown supination angle showing a trend toward being greater in the injury free group. These results suggest that runners who have developed stride patterns that incorporate relatively low levels of impact forces, and a moderately rapid rate of pronation are at a reduced risk of incurring overuse running injuries. (HERACLES) Identification des variables biomecaniques et anthropometriques intervenant dans l'etiologie des lesions de fatigue des membres inferieurs chez les coureurs de fond.
Article
Full-text available
Three-dimensional motion analysis is the "gold standard" for evaluating kinematic variables during treadmill running. However, its use is limited by temporal and financial restraints. Therefore, the purpose of this study was to assess the concurrent validity and reliability of 2D video analysis for frontal plane kinematic variables during treadmill running. Twenty-four healthy male and female collegiate cross-country runners completed a running protocol at a self-selected speed. Frontal plane kinematic data were collected using 3D and 2D motion analysis systems. Variables of interest included contralateral pelvic drop (CPD), peak hip adduction angle (HADD), and peak knee abduction angle (KABD). Pearson Product Correlation Coefficients were used to determine the relationship between the 3D and 2D systems for each variable. Intra-Class Correlation Coefficients (ICC) were used to assess intra-rater reliability of the user of the 2D software. The 2D testing method demonstrated excellent intra-rater reliability for peak HADD (ICCs: 0.951-0.963), peak CPD (0.958-0.966), and peak KABD (ICCs: 0.955-0.976). Moderate correlations between 2D and 3D measures of HADD on the left (0.539; p=0.007) and the right (0.623; p=0.001) and peak KABD on the left (0.541; p=.006) lower extremity were found. No statistically significant correlation of CPD was found between the 2D and 3D systems. The 2D measure of CPD had a strong correlation to the 2D assessment of HADD on both the left (0.801; p=0.0001) and the right (0.746; p=0.0001) extremity. These findings and the ease of data capture using 2D software provide support for the utility of 2D video analysis in the evaluation of frontal plane variables, specifically HADD. 2B.
Article
Full-text available
Running-related injuries remain problematic among recreational runners. We evaluated the association between having sustained a recent running-related injury and speed, and the strike index (a measure of footstrike pattern, SI) and spatiotemporal parameters of running. Forty-four previously injured and 46 previously uninjured runners underwent treadmill running at 80%, 90%, 100%, 110%, and 120% of their preferred running speed. Participants wore a pressure insole device to measure SI, temporal parameters, and stride length (Slength) and stride frequency (Sfrequency) over 2-min intervals. Coefficient of variation and detrended fluctuation analysis provided information on stride-to-stride variability and correlative patterns. Linear mixed models were used to compare differences between groups and changes with speed. Previously injured runners displayed significantly higher stride-to-stride correlations of SI than controls (P = 0.046). As speed increased, SI, contact time (Tcontact), stride time (Tstride), and duty factor (DF) decreased (P < 0.001), whereas flight time (Tflight), Slength, and Sfrequency increased (P < 0.001). Stride-to-stride variability decreased significantly for SI, Tcontact, Tflight, and DF (P ≤ 0.005), as did correlative patterns for Tcontact, Tstride, DF, Slength, and Sfrequency (P ≤ 0.044). Previous running-related injury was associated with less stride-to-stride randomness of footstrike pattern. Overall, runners became more pronounced rearfoot strikers as running speed increased.
Article
Full-text available
Study design: Cross-sectional, repeated-measures. Objectives To examine the association between sagittal plane trunk posture and patellofemoral joint (PFJ) stress, and to determine whether modifying sagittal plane trunk posture influences PFJ stress during running. Background: Patellofemoral pain is the most common injury among runners and is thought to be the result of elevated PFJ stress. While sagittal plane trunk posture has been shown to influence tibiofemoral joint mechanics, no study has examined the influence of trunk posture on PFJ kinetics. Methods: Twenty-four asymptomatic recreational runners (12 women, 12 men) ran overground at a speed of 3.4 m/s under 3 trunk-posture conditions: self-selected, flexed, and extended. Trunk and knee kinematics, ground reaction forces, and electromyographic signals from selected lower extremity muscles were obtained. A previously described PFJ biomechanical model was used to quantify PFJ stress. Results: The mean ± SD trunk flexion angles under the self-selected, flexed, and extended running conditions were 7.3° ± 3.6°, 14.1° ± 4.8°, and 4.0° ± 3.9°, respectively. A significant inverse relationship was observed between mean trunk flexion angle and peak PFJ stress during the self-selected condition (r = -0.60, P = .002). Peak PFJ stress was significantly lower in the flexed condition (mean ± SD, 20.2 ± 3.4 MPa; P<.001) and significantly higher in the extended condition (23.1 ± 3.4 MPa; P<.001) compared to the self-selected condition (21.5 ± 3.2 MPa). Conclusion: Sagittal plane trunk posture has a significant influence on PFJ kinetics during running. Incorporation of a forward trunk lean may be an effective strategy to reduce PFJ stress during running.
Article
Full-text available
Study design: Controlled laboratory study, cross-sectional design. Objective: To determine if sagittal kinematic variables can be used to estimate select running kinetics. Background: Excessive loading during running has been implicated in a variety of injuries, yet this information is typically not assessed during a standard clinical examination. Developing a clinically feasible strategy to estimate ground reaction forces and joint kinetics may improve the ability to identify those at an increased risk of injury. Methods: Three-dimensional kinematics and ground reaction forces of 45 participants were recorded during treadmill running at self-selected speed. Kinematic variables used to estimate specific kinetic metrics included vertical excursion of the center of mass, foot inclination angle at initial contact, horizontal distance between the center of mass and heel at initial contact, knee flexion angle at initial contact, and peak knee flexion angle during stance. Linear mixed-effects models were fitted to explore the association between the kinetic and kinematic measures, including step rate and sex, with final models created using backward variable selection. Results: Models were developed to estimate peak knee extensor moment (R(2) = 0.43), energy absorbed at the knee during loading response (R(2) = 0.58), peak patellofemoral joint reaction force (R(2) = 0.55), peak vertical ground reaction force (R(2) = 0.48), braking impulse (R(2) = 0.50), and average vertical loading rate (R(2) = 0.04). Conclusion: Our findings suggest that insights into important running kinetics can be obtained from a subset of sagittal plane kinematics common to a clinical running analysis. Of note, the limb posture at initial contact influenced subsequent loading patterns in stance.
Article
Full-text available
Study design: Controlled laboratory study, cross-sectional. Objectives To characterize hip muscle forces and powers during running, and to determine how these quantities change when altering step rate for a given running speed. Background: Hip musculature has been implicated in a variety of running-related injuries and, as such, is often the target of rehabilitation interventions, including resistance exercises and gait retraining. The differential contributions of the hip muscles to the task of running are not well understood, and may be important for recognizing the biomechanical mechanisms of running-related injuries and refining current treatment and prevention strategies. Methods: Thirty healthy participants ran at their preferred speed at 3 different step rates: 90%, 100%, and 110% of their preferred step rate. Whole-body kinematics and ground reaction forces were recorded. A 3-D musculoskeletal model was used to estimate muscle forces needed to produce the measured joint accelerations. Forces and powers of each muscle were compared across step-rate conditions. Results: Peak force produced by the gluteus medius during running was substantially greater than that of any other hip muscle, with the majority of muscles displaying a period of negative work immediately preceding positive work. The higher running step rate led to an increase in hip flexor, hamstring, and hip extensor loading during swing, but, conversely, substantially diminished peak force and work during loading response for several hip muscles, including the gluteal muscles and piriformis. Conclusion: Increasing running step rate for a given running speed heightened hamstring and gluteal muscle loading in late swing, while decreasing stance-phase loading in the gluteal muscles and piriformis. These results may enable clinicians to support and refine current treatment strategies, including exercise prescription and gait retraining for running-related injuries.
Article
Full-text available
Study design: Cross-sectional laboratory study. Objectives: To assess differences in hip strength, iliotibial band length, and hip and knee mechanics during running between male runners with iliotibial band syndrome (ITBS) and healthy controls. Background: Flexibility, strength, and running mechanics are commonly assessed in patients with ITBS. However, these variables have not been evaluated concurrently in this population. Methods: Thirty-four men participated (17 healthy, 17 ITBS). Hip strength was measured with a handheld dynamometer, and iliotibial band length was assessed using an inclinometer while performing the Ober test. Kinetic and 3-D kinematic data were obtained during running. Kinematic variables of interest included frontal and transverse plane hip and knee joint angles during early stance. Independent-samples t tests, as well as effect sizes, were used to assess group differences. Results: Compared to the control group, persons with ITBS had a significantly lower Ober measurement (1.2°), weaker hip external rotators (1.2 Nm/kg), greater hip internal rotation (3.7°), and greater knee adduction (3.6°). However, only hip internal rotation and knee adduction exceeded the minimal detectable difference value. Conclusion: Our results suggest that intervention strategies that target neuromuscular control of the hip and knee may be indicated for males with ITBS.
Article
Full-text available
Proximal factors such as excessive frontal plane pelvis and trunk motion have been postulated to be biomechanical risk factors associated with iliotibial band syndrome. Additionally, lateral core endurance deficiencies may be related to increased pelvis and trunk motion during running. The purpose of this cross-sectional investigation was to determine if differences in biomechanics during running, as well as lateral core endurance exist between female runners with previous iliotibial band syndrome and controls. Gait and lateral core endurance were assessed in 34 female runners (17 with previous iliotibial band syndrome). Multivariate analysis of variance was performed to assess between group difference in pelvis, trunk, hip, and knee variables of interest. Runners with previous iliotibial band syndrome exhibited similar peak: trunk lateral flexion, contralateral pelvic drop, hip adduction, and external knee adduction moment compared to controls. Additionally, trunk - pelvis \ coordination was similar between groups. Contrary to our hypotheses, both groups exhibited trunk ipsilateral flexion. Lateral core endurance was not different between groups. These findings provide the first frontal plane pelvis and trunk kinematic data set in female runners with previous iliotibial band syndrome. Frontal plane pelvis and trunk motion may not be associated with iliotibial band syndrome.
Article
Full-text available
Studies investigating the mechanics of human movement are often conducted using the treadmill. The treadmill is an attractive device for the analysis of human locomotion. Studies comparing overground and treadmill running have analyzed discrete variables, however differences in excursion from footstrike to peak angle and range of motion during stance have yet to be examined. This study aimed to examine the 3-D kinematics of the lower extremities during overground and treadmill locomotion to determine the extent to which the two modalities differ. Twelve participants ran at 4.0m/s in both treadmill and overground conditions. 3-D angular kinematic parameters during the stance phase were collected using an eight camera motion analysis system. Hip, knee and ankle joint kinematics were quantified in the sagittal, coronal and transverse planes, then compared using paired t-tests. Of the parameters analyzed hip flexion at footstrike 12° hip range of motion 17°, peak hip flexion 12.7°, hip transverse plane range of motion 8° peak knee flexion 5° and peak ankle excursion range 6.6°, coronal plane ankle angle at toe-off 6.5° and peak ankle eversion 6.3° were found to be significantly different. These results lead to the conclusion that the mechanics of treadmill locomotion cannot be generalized to overground.
Article
Full-text available
Abstract This study investigated the effects of knee localised muscle damage on running kinematics at varying speeds. Nineteen young women (23.2 ± 2.8 years; 164 ± 8 cm; 53.6 ± 5.4 kg), performed a maximal eccentric muscle damage protocol (5 × 15) of the knee extensors and flexors of both legs at 60 rad · s(-1). Lower body kinematics was assessed during level running on a treadmill at three speeds pre- and 48 h after. Evaluated muscle damage indices included isometric torque, muscle soreness and serum creatine kinase activity. The results revealed that all indices changed significantly after exercise, indicating muscle injury. Step length decreased and stride frequency significantly increased 48 h post-exercise only at the fastest running speed (3 m · s(-1)). Support time and knee flexion at toe-off increased only at the preferred transition speed and 2.5 m · s(-1). Knee flexion at foot contact, pelvic tilt and obliquity significantly increased, whereas hip extension during stance-phase, knee flexion during swing-phase, as well as knee and ankle joints range of motion significantly decreased 48 h post-exercise at all speeds. In conclusion, the effects of eccentric exercise of both knee extensors and flexors on particular tempo-spatial parameters and knee kinematics of running are speed-dependent. However, several pelvic and lower joint kinematics present similar behaviour at the three running speeds examined. These findings provide new insights into how running kinematics at different speeds are adapted to compensate for the impaired function of the knee musculature following muscle damage.
Article
Full-text available
Background: Abnormal hip mechanics are often implicated in female runners with patellofemoral pain. We sought to evaluate a simple gait retraining technique, using a full-length mirror, in female runners with patellofemoral pain and abnormal hip mechanics. Transfer of the new motor skill to the untrained tasks of single leg squat and step descent was also evaluated. Methods: Ten female runners with patellofemoral pain completed 8 sessions of mirror and verbal feedback on their lower extremity alignment during treadmill running. During the last 4 sessions, mirror and verbal feedback were progressively removed. Hip mechanics were assessed during running gait, a single leg squat and a step descent, both pre- and post-retraining. Subjects returned to their normal running routines and analyses were repeated at 1-month and 3-month post-retraining. Data were analyzed via repeated measures analysis of variance. Findings: Subjects reduced peaks of hip adduction, contralateral pelvic drop, and hip abduction moment during running (P<0.05, effect size=0.69-2.91). Skill transfer to single leg squatting and step descent was noted (P<0.05, effect size=0.91-1.35). At 1 and 3 months post retraining, most mechanics were maintained in the absence of continued feedback. Subjects reported improvements in pain and function (P<0.05, effect size=3.81-7.61) and maintained through 3 months post retraining. Interpretation: Mirror gait retraining was effective in improving mechanics and measures of pain and function. Skill transfer to the untrained tasks of squatting and step descent indicated that a higher level of motor learning had occurred. Extended follow-up is needed to determine the long term efficacy of this treatment.
Article
Full-text available
Various epidemiological studies have estimated that up to 70% of runners sustain an overuse running injury each year. Although few overuse running injuries have an established cause, more than 80% of running-related injuries occur at or below the knee, which suggests that some common mechanisms may be at work. The question then becomes, are there common mechanisms related to overuse running injuries? RESEARCH STUDIES WERE IDENTIFIED VIA THE FOLLOWING ELECTRONIC DATABASES: MEDLINE, EMBASE PsycInfo, and CINAHL (1980-July 2008). Inclusion was based on evaluation of risk factors for overuse running injuries. A majority of the risk factors that have been researched over the past few years can be generally categorized into 2 groups: atypical foot pronation mechanics and inadequate hip muscle stabilization. Based on the review of literature, there is no definitive link between atypical foot mechanics and running injury mechanisms. The lack of normative data and a definition of typical foot structure has hampered progress. In contrast, a large and growing body of literature suggests that weakness of hip-stabilizing muscles leads to atypical lower extremity mechanics and increased forces within the lower extremity while running.
Article
Full-text available
The purpose of the present study was to ascertain whether increase in step frequency at a given velocity during running reduces the lower extremity loading variables, which is associated with tibial stress fracture in runner. We hypothesized that the lower extremity loading variables at a given speed would be minimized at around +15% f step. 10 male subjects were asked to run at 2.5 m/s on a treadmill-mounted force platform. 5 step frequencies were controlled using a metronome: the preferred, below preferred (-15 and -30%) and above preferred (+15 and +30%). From the vertical ground reaction force, we measured following lower extremity loading variables; vertical impact peak (VIP), vertical instantaneous loading rate (VILR) and vertical average loading rate (VALR). We found that there were significant differences in lower extremity loading variables among 5 step frequency conditions. Furthermore, quadratic regression analyses revealed that the minimum loading variable frequencies were 17.25, 17.55, and 18.07% of preferred step frequency for VIP, VILR and VIAR, respectively. Thus, adopting a step frequency greater than one's preferred may be practical in reducing the risk of developing a tibial stress fracture by decreasing lower extremity loading variables.
Article
Full-text available
Case report. The Achilles tendon is the most frequently ruptured tendon, and the incidence of Achilles tendon rupture has increased in the last decade. The rupture generally occurs without any preceding warning signs, and therefore preinjury data are seldom available. This case represents a unique opportunity to compare preinjury running mechanics with postinjury evaluation in a patient with an Achilles tendon rupture. A 23-year-old female sustained a right complete Achilles tendon rupture while playing soccer. Running mechanics data were collected preinjury, as she was a healthy participant in a study on running analysis. In addition, patient-reported symptoms, physical activity level, strength, ankle range of motion, heel-rise ability, Achilles tendon length, and running kinetics were evaluated 1 year after surgical repair. During running, greater ankle dorsiflexion and eversion and rearfoot abduction were noted on the involved side postinjury when compared to preinjury data. In addition, postinjury, the magnitude of all kinetics data was lower on the involved limb when compared to the uninvolved limb. The involved side displayed differences in strength, ankle range of motion, heel rise, and tendon length when compared to the uninvolved side 1 year after injury. Despite a return to normal running routine and reports of only minor limitations with running, considerable changes were noted in running biomechanics 1 year after injury. Calf muscle weakness and Achilles tendon elongation were also found when comparing the involved and uninvolved sides.
Article
Full-text available
Running with a step rate 5-10% greater than one's preferred can substantially reduce lower extremity joint moments and powers, and has been suggested as a possible strategy to aid in running injury management. The purpose of this study was to examine how neuromuscular activity changes with an increase in step rate during running. Forty-five injury-free, recreational runners participated in this study. Three-dimensional motion, ground reaction forces, and electromyography (EMG) of 8 muscles (rectus femoris, vastus lateralis, medial gastrocnemius, tibialis anterior, medial and lateral hamstrings, and gluteus medius and maximus) were recorded as each subject ran at their preferred speed for three different step rate conditions: preferred, +5% and +10% of preferred. Outcome measures included mean normalized EMG activity for each muscle at specific periods during the gait cycle. Muscle activities were found to predominantly increase during late swing, with no significant change in activities during the loading response. This increased muscle activity in anticipation of foot-ground contact likely alters the landing posture of the limb and the subsequent negative work performed by the joints during stance phase. Further, the increased activity observed in the gluteus maximus and medius suggests running with a greater step rate may have therapeutic benefits to those with anterior knee pain.
Article
Full-text available
Female runners have a high incidence of developing patellofemoral pain. Abnormal mechanics are thought to be an important contributing factor to patellofemoral pain. However, the contribution of abnormal trunk, hip, and foot mechanics to the development of patellofemoral pain within this cohort remains elusive. Therefore the aim of this study was to determine if significant differences during running exist in hip, trunk and foot kinematics between females with and without patellofemoral pain. 32 female runners (16 patellofemoral pain, 16 healthy control) participated in this study. All individuals underwent an instrumented gait analysis. Between-group comparisons were made for hip adduction, hip internal rotation, contra-lateral pelvic drop, contra-lateral trunk lean, rearfoot eversion, tibial internal rotation, as well as forefoot dorsiflexion and abduction The patellofemoral pain group had significantly greater peak hip adduction and hip internal rotation. No differences in contra-lateral pelvic drop were found. A trend towards reduced contra-lateral trunk lean was found in the patellofemoral pain group. No significant differences were found in any of the rearfoot or forefoot variables but significantly greater shank internal rotation was found in the patellofemoral pain group. We found greater hip adduction, hip internal rotation and shank internal rotation in female runners with patellofemoral pain. We also found less contra-lateral trunk lean in the patellofemoral pain group. This may be a potential compensatory mechanism for the poor hip control seen. Rehabilitation programs that correct abnormal hip and shank kinematics are warranted in this population.
Article
Full-text available
Block randomized controlled trial. To investigate whether a strengthening and movement education program, targeting the hip abductors and hip external rotators, alters hip mechanics during running and during a single-leg squat. Abnormal movement patterns during running and single-leg squatting have been associated with a number of running-related injuries in females. Therapeutic interventions for these aberrant movement patterns typically include hip strengthening. While these strengthening programs have been shown to improve symptoms, it is unknown if the underlying mechanics during functional movements is altered. Twenty healthy females with excessive hip adduction during running, as determined by instrumented gait analysis, were recruited. The runners were matched by age and running distance, and randomized to either a training group or a control group. The training group completed a hip strengthening and movement education program 3 times per week for 6 weeks in addition to single-leg squat training with neuromuscular reeducation consisting of mirror and verbal feedback on proper mechanics. The control group did not receive an intervention but maintained the current running distance. Using a handheld dynamometer and standard motion capture procedures, hip strength and running and single-leg squat mechanics were compared before and after the strengthening and movement education program. While hip abductor and external rotation strength increased significantly (P<.005) in the training group, there were no significant changes in hip or knee mechanics during running. However, during the single-leg squat, hip adduction, hip internal rotation, and contralateral pelvic drop all decreased significantly (P = .006, P = .006, and P = .02, respectively). The control group exhibited no changes in hip strength, nor in the single-leg squat or running mechanics at the conclusion of the 6-week study. A training program that included hip strengthening and movement training specific to single-leg squatting did not alter running mechanics but did improve single-leg squat mechanics. These results suggest that hip strengthening and movement training, when not specific to running, do not alter abnormal running mechanics. Therapy, level 2b.
Article
Full-text available
Researchers conduct gait analyses utilizing both overground and treadmill modes of running. Previous studies comparing these modes analyzed discrete variables. Recently, techniques involving quantitative pattern analysis have assessed kinematic curve similarity in gait. Therefore, the purpose of this study was to compare hip, knee and rearfoot 3-D kinematics between overground and treadmill running using quantitative kinematic curve analysis. Twenty runners ran at 3.35 m/s ± 5% during treadmill and overground conditions while right lower extremity kinematics were recorded. Kinematics of the hip, knee and rearfoot at footstrike and peak were compared using intraclass correlation coefficients. Kinematic curves during stance phase were compared using the trend symmetry method within each subject. The overall average trend symmetry was high, 0.94 (1.0 is perfect symmetry) between running modes. The transverse plane and knee frontal plane exhibited lower similarity (0.86-0.90). Other than a 4.5 degree reduction in rearfoot dorsiflexion at footstrike during treadmill running, all differences were ≤1.5 degrees. 17/18 discrete variables exhibited modest correlations (>0.6) and 8/18 exhibited strong correlations (>0.8). In conclusion, overground and treadmill running kinematic curves were generally similar when averaged across subjects. Although some subjects exhibited differences in transverse plane curves, overall, treadmill running was representative of overground running for most subjects.
Article
Full-text available
Patellofemoral pain syndrome (PFPS) is the most common overuse injury in runners. Recent research suggests that hip mechanics play a role in the development of this syndrome. Currently, there are no treatments that directly address the atypical mechanics associated with this injury. The purpose of this study was to determine whether gait retraining using real-time feedback improves hip mechanics and reduces pain in subjects with PFPS. Ten runners with PFPS participated in this study. Real-time kinematic feedback of hip adduction (HADD) during stance was provided to the subjects as they ran on a treadmill. Subjects completed a total of eight training sessions. Feedback was gradually removed over the last four sessions. Variables of interest included peak HADD, hip internal rotation (HIR), contralateral pelvic drop, as well as pain on a verbal analogue scale and the lower-extremity function index. We also assessed HADD, HIR and contralateral pelvic drop during a single leg squat. Comparisons of variables of interest were made between the initial, final and 1-month follow-up visit. Following the gait retraining, there was a significant reduction in HADD and contralateral pelvic drop while running. Although not statistically significant, HIR decreased by 23% following gait retraining. The 18% reduction in HADD during a single leg squat was very close to significant. There were also significant improvements in pain and function. Subjects were able to maintain their improvements in running mechanics, pain and function at a 1-month follow-up. An unexpected benefit of the retraining was an 18% and 20% reduction in instantaneous and average vertical load rates, respectively. Gait retraining in individuals with PFPS resulted in a significant improvement of hip mechanics that was associated with a reduction in pain and improvements in function. These results suggest that interventions for PFPS should focus on addressing the underlying mechanics associated with this injury. The reduction in vertical load rates may be protective for the knee and reduce the risk for other running-related injuries.
Article
Full-text available
Varus knee alignment is a risk factor for medial knee osteoarthritis and is associated with high knee adduction moments. Therefore, reducing the knee adduction moment in varus-aligned individuals with otherwise healthy knees may reduce their risk for developing osteoarthritis. A gait modification that improves dynamic knee alignment may reduce the adduction moment, and systematic training may lead to more natural-feeling and less effortful execution of this pattern. To test these hypotheses, eight healthy, varus-aligned individuals underwent a gait modification protocol. Real-time feedback of dynamic knee alignment was provided over eight training sessions, using a fading paradigm. Natural and modified gait were assessed post-training and after 1 month, and compared to pre-training natural gait. The knee adduction moment, as well as hip adduction, hip internal rotation and knee adduction angles were evaluated. At each training session, subjects rated how effortful and natural-feeling the modified pattern was to execute. Post-training, the modified pattern demonstrated an 8 degrees increase in hip internal rotation and 3 degrees increase in hip adduction. Knee adduction decreased 2 degrees , and the knee adduction moment decreased 19%. Natural gait did not differ between the three visits, nor did the modified gait pattern between the post-training and 1 month visits. The modified pattern felt more natural and required less effort after training. Based on these results, gait retraining to improve dynamic knee alignment resulted in significant reductions in the knee adduction moment, primarily through hip internal rotation. Further, systematic training led to more natural-feeling and less effortful execution of the gait pattern.
Article
Full-text available
Case-control and reliability study. To compare foot and ankle characteristics between individuals with and without patellofemoral pain syndrome (PFPS) and to identify reliable weight-bearing foot and ankle measurements for use in future research on PFPS. PFPS is a common presentation to sports medicine and orthopaedic clinics. Characteristics of the foot and ankle are often linked with PFPS development, although evidence to support this link is equivocal and there is a lack of consensus on how best to evaluate these characteristics. A variety of weight-bearing foot and ankle measurements were evaluated by 3 raters of varying experience in 20 individuals with PFPS and 20 controls matched by age, sex, height, and body mass. Between-group comparisons were made for each measurement using data from an experienced podiatrist blinded to group assignment of the participants. Intrarater and interrater reliability was compared between all measurements using the first 15 participants from each group. Between-group comparisons showed that the individuals in the PFPS group had a more pronated foot posture when assessed by the foot posture index and longitudinal arch angle, and for all measurements relative to subtalar joint neutral. Foot posture index, normalized navicular drop, and calcaneal angle relative to subtalar joint neutral measurements also possessed high reliability in both groups when used by experienced raters. Reliability was not influenced by rater experience or the presence of PFPS for relaxed-stance foot posture measurements. Both tester inexperience and the presence of PFPS reduced reliability for all measurements of foot posture relative to subtalar joint neutral and measurement of weight-bearing ankle dorsiflexion. The foot posture index, normalized navicular drop, and calcaneal angle relative to subtalar joint neutral are all reliable and sensitive to group differences when used in a population with PFPS. Individuals with PFPS possess a more pronated foot posture and increased foot mobility compared to controls. Prospective evaluation of these measurements is now required to determine whether they contribute to the development of PFPS. J Orthop Sports Phys Ther 2010;40(5):286-296, Epub 12 April 2010. doi:10.2519/jospt.2010.3227.
Article
Full-text available
Patellofemoral pain syndrome is one of the most common chronic knee injuries; however, little research has been done to determine the risk factors for this injury. Altered lower extremity kinematics and kinetics, decreased strength, and altered postural measurements will be risk factors. Cohort study (prognosis); Level of evidence, 2. A total of 1597 participants were enrolled in this investigation and prospectively followed from the date of their enrollment (July 2005, July 2006, or July 2007) through January 2008, a maximum of 2.5 years of follow-up. Each participant underwent baseline data collection during their pre-freshman summer at the United States Naval Academy. Baseline data collection included 3-dimensional motion analysis during a jump-landing task, 6 lower extremity isometric strength tests, and postural alignment measurements (navicular drop and Q angle). Risk factors for the development of patellofemoral pain syndrome included decreased knee flexion angle, decreased vertical ground-reaction force, and increased hip internal rotation angle during the jump-landing task. Additionally, decreased quadriceps and hamstring strength, increased hip external rotator strength, and increased navicular drop were risk factors for the development of patellofemoral pain syndrome. Multiple modifiable risk factors for patellofemoral pain syndrome pain have been identified in this investigation. To decrease the incidence of this chronic injury, the risk factors for patellofemoral pain syndrome need to be targeted in injury prevention programs. Prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements to decrease the incidence of patellofemoral pain syndrome.
Article
Full-text available
Controlled laboratory study using a cross-sectional design. To determine whether females with patellofemoral pain (PFP) demonstrate differences in hip kinematics, hip muscle strength, and hip muscle activation patterns when compared to pain-free controls. It has been proposed that abnormal hip kinematics may contribute to the development of PFP. However, research linking hip function to PFP remains limited. Twenty-one females with PFP and 20 pain-free controls participated in this study. Hip kinematics and activity level of hip musculature were obtained during running, a drop jump, and a step-down maneuver. Isometric hip muscle torque production was quantified using a multimodal dynamometer. Group differences were assessed across tasks using mixed-design 2-way analyses of variance and independent t tests. When averaged across all 3 activities, females with PFP demonstrated greater peak hip internal rotation compared to the control group (mean +/- SD, 7.6 degrees +/- 7.0 degrees versus 1.2 degrees +/- 3.8 degrees; P<.05). The individuals in the PFP group also exhibited diminished hip torque production compared to the control group (14% less hip abductor strength and 17% less hip extensor strength). Significantly greater gluteus maximus recruitment was observed for individuals in the PFP group during running and the step-down task. The increased peak hip internal rotation motion observed for females in the PFP group was accompanied by decreased hip muscle strength. The increased activation of the gluteus maximus in individuals with PFP suggests that these subjects were attempting to recruit a weakened muscle, perhaps in an effort to stabilize the hip joint. Our results support the proposed link between abnormal hip function and PFP.
Article
Full-text available
To provide an extensive and up to date database for specific running related injuries, across the sexes, as seen at a primary care sports medicine facility, and to assess the relative risk for individual injuries based on investigation of selected risk factors. Patient data were recorded by doctors at the Allan McGavin Sports Medicine Centre over a two year period. They included assessment of anthropometric, training, and biomechanical information. A model was constructed (with odds ratios and their 95% confidence intervals) of possible contributing factors using a dependent variable of runners with a specific injury and comparing them with a control group of runners who experienced a different injury. Variables included in the model were: height, weight, body mass index, age, activity history, weekly activity, history of injury, and calibre of runner. Most of the study group were women (54%). Some injuries occurred with a significantly higher frequency in one sex. Being less than 34 years old was reported as a risk factor across the sexes for patellofemoral pain syndrome, and in men for iliotibial band friction syndrome, patellar tendinopathy, and tibial stress syndrome. Being active for less than 8.5 years was positively associated with injury in both sexes for tibial stress syndrome; and women with a body mass index less than 21 kg/m(2) were at a significantly higher risk for tibial stress fractures and spinal injuries. Patellofemoral pain syndrome was the most common injury, followed by iliotibial band friction syndrome, plantar fasciitis, meniscal injuries of the knee, and tibial stress syndrome. Although various risk factors were shown to be positively associated with a risk for, or protection from, specific injuries, future research should include a non-injured control group and a more precise measure of weekly running distance and running experience to validate these results.