Biomechanics

Quantifying varus and valgus thrust in individuals with severe knee osteoarthritis

Background: Gait abnormalities can influence surgical outcomes in people with severe knee osteoarthritis (OA) and thus a thorough understanding of gait abnormalities in these people prior to arthroplasty is important. Varus-valgus thrust is a characteristic linked to OA disease progression that has not yet been investigated in a cohort with severe knee OA awaiting knee arthroplasty. The aims of this study were to determine i) prevalence of varus and valgus thrust in a cohort with severe knee OA compared to an asymptomatic group, ii) whether the thrust magnitude differed between these groups iii) differences between varus and valgus thrusters within the OA cohort and iv) whether certain measures could predict thrust in the OA cohort. Methods: 40 patients with severe knee OA scheduled for primary TKR and 40 asymptomatic participants were recruited. Three-dimensional gait analysis was performed on all participants, with the primary biomechanical measures of interest being: varus and valgus thrust, knee adduction angle, peak KAM, and KAM impulse. Additionally, static knee alignment and quadriceps strength were assessed in the subgroup with knee OA. Findings: No difference was found in the prevalence of varus and valgus thrust between the severe OA and control groups (Pearson chi-square = 3.735, p value = 0.151). The OA varus thrust group had a significantly higher peak KAM (p=0.000), KAM impulse (p=0.001), static alignment (p=0.021), and lower quadriceps strength (p=0.041) than the valgus thrust group. Peak KAM and quadriceps strength were found to explain 34.9% of the variation in maximum thrust, such that an increase in KAM and a decrease in quadriceps strength were associated with an increase in maximum (varus) thrust. Interpretation: Few differences between the severe OA and control groups were seen, however dichotomizing the groups into varus and valgus cohorts revealed a number of biomechanical differences. Patients with severe OA are often treated as a homogenous cohort; however, by classifying which individuals have a varus or valgus thrust, we have identified a subset of patients with poorer biomechanics who could potentially be at a higher risk of a worse outcome after surgery.
Listed In: Biomechanics, Gait, Orthopedic Research


Postural Responses to Noisy Support Surface Translations in Stroke Survivors

Healthy standing posture is characterized by the ability to interact with a changing environment while maintaining upright stance. Being adaptable to changing environments affords flexibility and allows the system to encounter novel environments without losing control of posture. The purpose of this research was to determine if stroke survivors could adapt to support surface translations with differing temporal structures. Methods: Eight stroke survivors participated in this research. Participants stood on a force platform on the Neurocom Balance Manager (Neurocom Intl., Clackamas, OR, USA). The support surface was translated in the anteroposterior direction according to waveforms with different temporal structures, this included white noise, pink noise, brown noise, and a sine wave. They also performed a normal standing trial where the platform did not move. Root mean square and detrended fluctuation analysis of the center of pressure signal were calculated to determine amount and temporal structure of variability respectively. Results: During normal standing the stroke survivors’ posture exhibited lack of adaptability. The stroke survivors had increased amount of variability in all conditions compared to normal standing, regardless of the inherent structure of the support surface translations. The temporal structure of variability indicated weakened long-range correlations in all conditions compared to normal standing. This indicates that regardless of the temporal structure of the support surface movement the amount of movement increased while the structure of movement became more random. Previous work has demonstrated that healthy posture is able to adapt to the temporal structure of support surface translations, this adaptability was not seen in a population of stroke survivors. This lack of adaptability makes interactions with environmental perturbations difficult and impacts functionality. Focusing rehabilitation protocols towards regaining healthy temporal structures in postural control could improve functionality in chronic stroke survivors.
Listed In: Biomechanics, Posturography


The Effects of Knee Taping Techniques on Lower Extremity Kinematics During Running

Introduction: Running is a popular form of physical activity linked to various lower extremity injuries. A commonly used technique for injury prevention and rehabilitation is taping. There is considerable research investigating running biomechanics, however, there has been limited to no research examining the effects of gender, speed, and the type of tape used on two-dimensional lower extremity kinematics. Therefore, the purpose of this pilot study was to investigate the effects of gender, speed, and tape on two-dimensional lower extremity kinematics and stride characteristics during running. Method: Eight healthy runners participated (4 males, 4 females). Taping interventions (Leukotape, Kinesio Tape, no tape) and speeds (2.35 m/s, 3.35 m/s) were randomized and lower extremity stride kinematics were obtained using the Peak Motus System at initial contact, midstance, and toe off of running. Comparisons were made using descriptive statistics. Results: Females exhibited greater hip (FIC= 164.04+1.99°; MIC= 167.54+2.12°) and knee flexion (FIC= 167.73+0.93°; MIC= 170.42+1.65°; FPK= 142.83+1.28°; MPK= 146.35+1.21°), while males had greater ankle dorsiflexion (FIC= 88.60+1.00°; MIC= 84.14+1.08°) and plantarflexion (FTO= 51.90+1.01°; MTO= 55.99+0.825°). Females spent more time in support (FCT= 0.28+0.03s; MCT= 0.26+0.02s) while males spent more time in the air (FFT= 0.45+0.02s; MFT= 0.48+0.01s). Faster speed was associated with greater hip flexion and extension (SIC= 167.57+1.95°; FIC= 164.01+2.11°; STO= 197.14+1.23°; FTO= 201.28+0.74°), peak knee flexion (SPK= 145.39+1.82°; FPK= 143.79+2.39°), and less time during contact (SIC = 0.30+0.01s; FIC= 0.25+0.00s). Conclusion: Gender and speed seem to have effects on lower extremity stride kinematics, whereas type of tape does not.
Listed In: Biomechanics, Gait, Other


Effect of Transcutaneous Electrical Nerve Stimulation on Gait Kinematics in Subjects with Anterior Knee Pain

Knee pain is 1 of 5 leading causes of disability by altering lower-extremity muscle function and gait mechanics. While transcutaneous electrical nerve stimulation (TENS) mitigates deficits of muscle function due to pain, it is unclear whether TENS improves gait mechanics. Each of 15 participant (24±3yrs, 71±12kg, 178±7cm) was assigned to the TENS or matched placebo group (23±2yrs, 72±14kg, 177±9cm). Participants underwent 3 different experimental saline infusion sessions (hypertonic, isotonic, control) in a counterbalanced order, separated by 48-h. Hypertonic (5% NaCl) or isotonic (0.9% NaCl) saline was infused into the infrapatellar fat pad for 50-min. No infusion was administered to the control session. Participants and investigators were blinded to the saline solution. A 20-min TENS or placebo treatment was administered, which was blinded to participants. Gait kinematic data were collected using the high-speed video (240 Hz) and force-sending tandem treadmill (1200 Hz) at each time interval (baseline, infusion, treatment, post-treatment). Functional ANOVA (α=0.05) were used to evaluate difference between 2 groups (TENS, placebo) over time. Pairwise comparison functions with 95% confidence interval were plotted to determine specific difference. Hypertonic saline infusion (pain) resulted in increased (1) ankle dorsiflexion (38-75% of stance), (2) knee valgus (20-40%), (3) knee flexion (40-90%), (4) hip adduction (72-100%), (5) hip flexion (50-90%). However, there was no group x time interaction for all kinematics. Altered gait strategies due to pain may play a role in long-term compensation that could have consequences for the joint. TENS treatment, however, did not acutely reduce the deficits in aforementioned kinematic variables.


Listed In: Biomechanics, Gait, Neuroscience, Physical Therapy


Effects of Adiposity on Walking Muscle Function in Children: Implications for Bio-Feedback and Assistive Devices

Altered gait biomechanics associated with pediatric obesity may increase the risk of musculoskeletal injury/pathology during physical activity and/or diminish a child’s ability to engage in sufficient physical activity. The biomechanical mechanisms responsible for the altered gait in obese children are not well understood, particularly as they relate to increases in adipose tissue. The purpose of this study was to investigate the role of adiposity (i.e. body fat percentage, BF%) on lower extremity kinematics, muscle force requirements and their individual contributions to the acceleration of the center of mass (COM) during walking. We scaled a musculoskeletal model to the anthropometrics of each participant (n=14, 8-12 years old, BF%: 16-41%) and generated dynamic simulations of walking to predict muscle forces and their contributions to the acceleration of the COM. Muscle force output was normalized to muscle mass. BF% was correlated with average knee flexion angle during stance (r=−0.54) and pelvic obliquity range of motion (r=0.78), as well as with relative vasti (r=−0.60), gluteus medius (r=0.65) and soleus (r=0.59) force production. Contributions to COM acceleration from the vasti were negatively correlated to BF% (vertical: r=−0.75, posterior: r=−0.68, respectively), but there was no correlation between BF% and COM accelerations produced by the gluteus medius. The functional demands and relative force requirements of the hip abductors during walking in pediatric obesity may contribute to altered gait kinematics. Our results provide insight into the muscle force requirements during walking in pediatric obesity that may be used to improve the quality/quantity of locomotor activity in this population.
Listed In: Biomechanical Engineering, Biomechanics, Gait


The Influence of Trunk Posture on Hip and Knee Moments during Over-ground Running

A high incidence of lower extremity injuries has been reported in runners, with half of the injuries occurring at the knee joint. Sagittal plane trunk posture was shown to influence hip and knee kinetics during landing. This suggests trunk posture may be a risk factor of running injuries. The purpose of this study was aimed to examine the influence of sagittal plane trunk posture on hip and knee kinetics during running. Forty runners were recruited. Three-dimensional kinematics (250Hz, Qualisys) and ground reaction force data (1500Hz, AMTI) were collected while subjects ran with a self-selected trunk posture (speed: 3.4m/s). Mean trunk flexion angle and peak hip and knee extensor moments during the stance phase were calculated. Subjects were dichotomized into High-Flex and Low-Flex groups based on trunk flexion angles. On average, the two groups demonstrate 7.4°difference in trunk flexion. Independent t-tests showed that the Low-Flex group demonstrated significantly higher knee extensor moments and lower hip extensor moments compared to the High-Flex group. Pearson correlations showed that trunk flexion angle was positively correlated with peak hip extensor moment (r=0.44) and inversely correlated with peak knee extensor moment (r=-0.51). The results suggested a small difference in trunk flexion angle has significant influences on hip and knee kinetics. Individuals who run with a more upright trunk posture may be predisposed to a higher risk of patellar tendinopathy and patellofemoral pain. Incorporating a forward lean trunk may be utilized as an intervention strategy to reduce knee loading and risk of knee injuries in runners.


Listed In: Biomechanics, Physical Therapy, Sports Science


Impacts of Stifle Joint Remodeling on Vertical Ground Reaction Forces Following MCL Transection and Medial Meniscectomy

Functional demands placed on the human knee’s anterior cruciate ligament (ACL) vary with activity but remain impossible to measure directly in-vivo. Our lab is characterizing these demands in the sheep model by recording in vivo knee kinematics and ACL transducer voltages during activities of daily living (ADLs), reproducing these motions using the instrumented limb, and measuring the 3D forces in the ligament. However, up to 13% of patients sustaining ACL injuries will also sustain dual medial meniscus (MM) injuries and up to 10% will sustain dual medial collateral ligament (MCL) injuries. These structures are frequently left unrepaired, which may alter the ACL’s functional demands, resulting in inadequate ACL reconstruction outcomes for patients with dual injuries. Although these structures have been shown to alter ACL loading in cadaveric studies, the extent to which they impact ACL functionality during in vivo ADLs remains unknown. Moreover, changes in ACL functionality over time due to joint healing and remodeling have yet to be investigated. In this study, we aimed to track stifle joint remodeling in response to surgically imposed MCL transections and medial meniscectomies through monitoring vertical ground reaction forces (VGRFs) for three ADLs over 12 weeks. Results of this study may then be used in conjunction with future robotic studies as a tool to estimate in vivo load requirements for ACL reconstructions in patients with dual injuries.


Listed In: Biomechanical Engineering, Biomechanics, Gait, Orthopedic Research


Accelerometry for outdoor effort quantification

Assessing the lower limb properties in-situ is of a major interest for analyzing the athletic performance. From a physical point of view, the lower limb could be modeled as single linear spring which supports the whole body mass. The main mechanical parameter studied when using this spring-mass-model is the leg-spring stiffness (k). In laboratory conditions, the movements are assessed using a force plate (Meth1) which measures the ground reaction force (GRF), and a motion capture system which could estimate the displacement of the centre of mass (CoM). In this way, k is calculated as shown in equation (2).More recent methods allow to calculate k in field conditions by using either foot switches (Meth2) or accelerometry-based instruments (Meth3) which are both wireless devices. The associated calculated methods assume that force-time signal is a sine wave, described by the equation (3) with equation (4) (CT: contact time; FT: flight time). In these cases, the kinematic measurement (CoM) could be calculated either by a mathematical approach (Eq.(5)) (meth2), or by double integrating the acceleration (meth3) in order to calculate k.Thanks to their transportability, the methods 2 and 3 offer not only the possibility to assess the lower limb movements, but also, to objectively follow up the athletic abilities (performance, reactivity, force and power, stiffness) in-situ.


Listed In: Biomechanical Engineering, Biomechanics, Sports Science