Chronic ankle instability (CAI) patients often exhibit altered walking mechanics, due to strength and proprioceptive deficits associated with CAI. Reduced strength and proprioception function may alter walking energetic patterns, by reducing energy absorption and generation capability. It is unclear whether strength and proprioceptive training can affect walking energetics for CAI patients. PURPOSE: To examine the effect of a 6-week ankle and hip rehab program on ankle, knee, and hip joint energetic patterns during walking in CAI patients. METHODS: 15 CAI patients (23 ± 2 yrs, 178 ± 8 cm, 76 ± 9 kg, 83 ± 7% FAAM ADL, 56 ± 10% FAAM Sports, 3.6 ± 1.1 MAII, 4.7 ± 2.0 ankle sprains) performed ankle and hip strength and proprioceptive exercises (i.e., theraband, wobble board, etc.) 3 times per week, for 6 weeks (rehab group). 14 CAI patients (22 ± 2 yrs, 177 ± 9 cm, 75 ± 12 kg, 81 ± 9% FAAM ADL, 56 ± 12% FAAM Sports, 3.4 ± 1.2 MAII, 5.9 ± 3.3 sprains) performed no rehab exercises (control group). We measured ankle, knee, and hip joint power during walking for all patients before and after 6 week duration. Functional statistics (α = 0.05) were used to evaluate the influence of the rehab exercises on joint power for both groups across the entire stance phase of walking. RESULTS: The rehab intervention resulted in up to 0.07 W/kg more positive ankle power (concentric) between 19 and 26% of stance and up to 0.06 W/kg more positive knee power (concentric) between 40 and 48% of stance. No changes were detected in hip joint power during the stance phase of walking. CONCLUSION: Strength and proprioceptive training resulted in an improved gait energetic efficiency via increased ankle and knee power generation during mid-stance. As greater muscular strength can lead to an increase in power absorption and generation, the intervention focusing on strength could be beneficial in improving walking energetics in a CAI population.
Listed In: Biomechanics, Gait

Bilateral vestibular hypofunction (BVH) is a bilateral reduction or loss of vestibular function resulting in balance deficits and an increased falls risk. As part of a larger study, this experiment aimed to assess how spatiotemporal gait characteristics and their variability change across different walking speeds in patients with BVH. Nine patients (55±15y) with BVH have participated thus far. Experiments were conducted on the CAREN Extended system (Motekforce Link, Amsterdam, The Netherlands). Following multiple familiarisation trials, the participants completed five recorded two minute walking bouts at different speeds (0.6m/s, 0.8m/s, 1.0m/s, 1.2m/s and 1.4m/s). 60 strides per speed were analysed and the means, standard deviations and coefficients of variation (CV) of stride length and time, step length and width, double support time and swing phase toe clearance were calculated. Stride length, step length and toe clearance all increased with increases in walking speed (P<0.001). Stride and double support time decreased with increased walking speed (P<0.0001). No walking speed effect was found for step width (P=0.25). Significant reductions in variability with increases in walking speed were found for stride length, stride time, step length, toe clearance (P<0.01) and double support time (P<0.05). A significant increase in step width variability was observed with increases in walking speed (P=0.0033). These preliminary data suggest that while anteroposterior gait characteristics may improve in terms or variability with increases in walking speed in these patients, mediolateral motions may become more variable, which may have implications for mediolateral stability and falls risk in patients with BVH.
Listed In: Biomechanics, Gait, Neuroscience

Objectives: The conventional push-up is a popular exercise used by the American College of Sports Medicine to test participant muscular endurance. Push-ups require changes in the ground reaction forces generated at each point of contact with the ground (all four extremities) which are achieved through muscular contractions. Although this exercise is common, the motor control mechanisms used in this motion are relatively unknown. We investigated whether humans adjust individual limb forces (push-up synergies) as they reached volitional fatigue and evaluated the hypothesis that muscular fatigue influences synergistic actions between the forces produced at the hand contact points. Approach: Twenty-one volunteers participated in a single motion capture trial where they performed as many push-ups as possible, stopping at self-determined failure. Push-ups were completed to a controlled three-beat rhythm (down, up, hold plank) at a rate of 24 repetitions per minute. Participants were instructed to arrange themselves in a plank position with each extremity within the bounds of an embedded force platform and analog data was collected at a frequency of 1000Hz. An index of synergy, defined as correlations between vertical forces, was calculated for every downward and upward motion within the push-up trial. Findings: Between-arm vertical forces were positively correlated during upward and downward motion. Positive correlation indicates that limbs worked together to produce increases or decreases needed for center of mass movement. Upward limb synergy significantly (p ≤ 0.00) decreased as participants neared volitional fatigue while downward limb synergy did not significantly change (p = 0.77). Conclusions: We found that muscular fatigue affected the synergistic actions between limbs in upward motion but not in downward motion. After muscular fatigue, between arm synergy was reduced only during concentric muscle contractions. Public Health Significance: Better understanding the synergistic changes produced by fatigue could be used to evaluate or better understand control changes behind pathologic gait or movement adaptations.
Listed In: Biomechanical Engineering, Biomechanics, Neuroscience

Collegiate softball has become increasingly popular since the passage of Title IX. As with any sport, injuries are a common occurrence. Interestingly, the base runner is at the highest risk of injury, and rounding the base, specifically, has resulted in approximately 187 game-day injuries. Rounding the base involves planting the right foot on a raised surface and cutting to the left, a dynamic movement often associated with noncontact ACL injuries. Frontal plane loading and unbalanced quadriceps-to-hamstring co-contraction indices (Q:H CCI) have been associated with increasing the likelihood of noncontact ACL injuries occurring. Neuromuscular abnormalities pre- and post-contact have also been suggested to increase the risk of injury. To date, no study has analyzed the effect of rounding a base on noncontact ACL injury risk factors in softball players. Nine recreationally active females completed two base conditions. The first simulated rounding a base with no base on the force platform (NB), and the second simulated rounding a base with a base on the force platform (WB). Three-dimensional motion capture, one force platform, and electromyography were utilized. Results indicated the WB condition reduced the risk of noncontact ACL injury by decreasing frontal plane loading. Movement patterns at the ankle and abnormal foot strikes may provide a better explanation for why noncontact ACL injuries occur while rounding first base. Post-contact Q:H CCI was significantly greater than pre-contact, indicating significantly greater quadriceps activity post-contact. Neuromuscular training could potentially reduce the load applied to the ACL and decrease the risk of injury.
Listed In: Biomechanics, Sports Science

Purpose: Knee pain is a chief symptom of knee pathology. Both acute and chronic knee pain result in altered joint loads during walking, which potentially result in mechanical and biological changes in knee articular cartilage. Due to confounding factors in clinical knee pain (effusion, muscle weakness, inflammation, structural changes), it is difficult to examine the independent effect of knee pain on walking mechanics. The purpose of this study is to examine whether unilateral experimentally induced knee pain influences bilateral loading patterns during walking in healthy individuals. Methods: This study was a controlled laboratory, cross-over trial. Each of 30 able-bodied subjects (M = 20, F = 10; 23 ± 2.4 yrs, 71 ± 12.7 kg, 178 ± 8.2 cm) completed three experimental sessions: pain (5.0% NaCl infusion), sham (0.9% NaCl infusion), and control (no infusion) in a counterbalanced order, 2 days apart (a washout period). For the experimental sessions, hypertonic (5% NaCl) or isotonic (0.9% NaCl) saline was continuously infused into the right (involved limb) infrapatellar fat pad using a portable infusion pump, which produced a continuous saline flow of 0.154mL/min (total 2.16 mL) for 14 min for the pain or sham session, respectively. No infusion was administered to the control session. Subjects and investigators were blinded regarding the saline solution which was being infused. During each of three experimental sessions, subjects performed 30-sec gait trials at a self-selected speed at two time points (pre- and post-infusion). Ground reaction force (GRF) data were collected using an AMTI instrumented force-sensing tandem treadmill (1200 Hz). The first 4 successful gait cycles in each limb were used for data analysis. A functional data analysis approach (α = .05) was used to detect time (pre- and post-infusion) x limb (involved vs. uninvolved) interactions for the vertical, anterior-posterior, and medial-lateral GRF. Results: Significant time x limb interactions were observed during the pain session (hypertonic saline; 5.0% NaCl; p < .05). Experimental knee pain resulted in up to (i) 0.05 N/kg less vertical GRF and 0.02 N/kg more vertical GRF during various stance phases, (ii) 0.01 N/kg less breaking GRF during loading response, and (iii) 0.007 N/kg less lateral GRF and 0.007 N/kg more lateral GRF during various stance phases in the involved limb. Conclusions: Relative to the pre-infusion condition, subjects during the knee pain condition tended to walk with less vertical, posterior and lateral GRF in the involved limb (painful limb) across various portions of stance, which simultaneously increased loads in the uninvolved limb (non-painful limb). Our data suggest that compensatory loading patterns occur simultaneously for the involved and uninvolved limbs. This unloading pattern in the involved limb may be due to perception of knee pain, which can make subjects feel fear for damaging or provoking pain more during walking. Moreover, voluntary and/or involuntary quadriceps inhibition (e.g., neuromuscular activation and strength) due to experimentally induced knee pain may play a role in reducing the loads in the involved limb because the quadriceps support the center of body mass eccentrically from initial loading response to midstance to prevent collapse of the lower limbs. These asymmetrical loading patterns due to knee pain and associated with neural inhibition may be a risk factor for knee joint disease progression via changes in mechanical components.
Listed In: Biomechanics, Gait