Frontal plane mechanics have been associated with running-related injuries such as patellofemoral pain. Strengthening and gait retraining programs aimed at reducing hip adduction during running have been shown to be effective at alleviating symptoms, however evidence of their effect on running kinematics is equivocal. It is possible that such programs exert their benefits through altering kinetics rather than kinematics in the frontal plane during running. Further, the contributions of the ankle to frontal plane mechanics have not been well studied. PURPOSE: To determine if hip and ankle strength are associated with frontal plane kinetics in female runners. METHODS: 64 healthy women running at least 16km per week participated in this study. Isometric hip abduction and ankle inversion strength were measured using a handheld dynamometer. 3D gait analysis was conducted as participants ran on an instrumented treadmill at 2.7 m/s. Participants were ranked in order of isometric strength of both the hip and ankle, and divided into tertiles of high, medium and low strength. 2-way MANOVA was used to determine the relationship between strength and peak moment, positive work and negative work in the frontal plane of the hip and the ankle. Tukey post-hoc tests were conducted where applicable (α=0.05). RESULTS: There was no significant interaction effect, or main effect of hip strength. There was a significant main effect of ankle strength on frontal plane kinetics (p=0.024). Specifically, the strong ankle group compared to the weak ankle group had significantly greater magnitude of peak ankle inversion moment (0.95(0.32) vs 0.68(0.22) Nm/kg, p=0.033), hip abduction moment (-2.78(1.02) vs -1.88(0.24) Nm/kg, p=0.002) and hip frontal plane positive work (0.27(0.19) vs. 0.13(0.03) W/kg, p=0.006). CONCLUSION: Isometric ankle but not hip strength is associated with kinetics in the frontal plane during running in females. Thus ankle strength should not be overlooked in clinical evaluation and treatment of runners.
Listed In: Biomechanics, Gait, Physical Therapy, Sports Science

Even prior to walking slower, older adults walk with a diminished push-off – decreased propulsive forces (FP) accompanied by reduced ankle moment and power generation. The purpose of this study was to identify age-related differences in the joint-level modifications used to modulate FP generation during walking. We posit that there are two possibilities for older adults to enhance FP generation. First, older adults may increase ankle power generation and thereby alleviate compensatory demands at the hip. Alternatively, older adults may opt to exacerbate their distal to proximal redistribution by relying even more on the hip musculature. 10 healthy young adults and 16 healthy older adults participated in this study. Subjects walked at their preferred speed while watching a video monitor displaying their instantaneous FP while instructed to modify their FP to match target values representing normal and ±10% and ±20% of normal. For all trials, we estimated lower extremity joint kinematics and kinetics. During normal walking, older adults exerted smaller FP and ankle power than young adults. Enhancing FP via biofeedback alleviated mechanical power demands at the hip, without changes in ankle power. Further, older adults walked with increased FP without increasing their total positive joint work. Thus, given the same total requisite power generation, older adults got ‘more bang for their ankle power buck’ using biofeedback.
Listed In: Biomechanical Engineering, Biomechanics, Gait

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

Old versus young adults exhibit increased hip and decreased ankle joint mechanical output during level and incline walking. This distal-to-proximal redistribution of joint torques and powers is now a well-established age-related gait adaptation and has been termed biomechanical plasticity. The effect of physical capacity, which varies greatly in old adults, on this gait adaptation remains unclear. For example, high capacity old adults (i.e. those with fast walking speeds) might either retain a more youthful gait strategy or adopt larger magnitudes of plasticity in order to walk well. The purpose of this study was to quantify the relationships between physical capacity and biomechanical plasticity in old adults during level and incline walking. We conducted 3D gait analyses on 32 old adults (>70 yrs) as they walked over level ground and up a 10° incline at self-selected speeds. We used motion capture (Qualisys AB) and force platforms (AMTI) to collect kinematic and ground reaction force data, respectively. To measure physical capacity, we used the SF-36 Physical Component score and to define biomechanical plasticity we created ratios of hip extensor to ankle plantarflexor peak torques, angular impulses, peak positive powers, and work. We conducted correlation analyses between SF-36 PC scores and the biomechanical plasticity ratios. Positive relationships existed between SF-36 PC scores and all biomechanical plasticity ratios during level walking. Similar results were observed during incline walking, however only three of these four relationships reached statistical significance. Our results suggest that old adults of higher physical capacities exhibit larger magnitudes of biomechanical plasticity.
Listed In: Biomechanics, Gait

Purpose: Anterior cruciate ligament (ACL) tear greatly increases the risk of knee osteoarthritis (OA), even when patients undergo ACL reconstruction surgery (ACLR). Changes to walking kinematics following ACLR have been suggested to play a role in this degenerative path to post-traumatic OA by shifting the location of repetitive joint contact loads that occur during walking to regions of cartilage not conditioned for altered loads. Recent work has shown that changes to the average knee center of rotation during walking (KCOR) between 2 and 4 years after ACLR are associated with long term changes in patient reported outcomes at 8 years. Changes to KCOR result in changes to contact patterns between the femur and the tibial plateau. However, it is unknown if changes to this kinematic measure are reflected by changes to cartilage as early as 2 years after surgery. Ultrashort TE-enhanced T2* (UTE-T2*) mapping has been shown to be sensitive to subsurface changes occurring in deep articular cartilage early after ACL injury and over 2 years after ACLR that were not detectable by standard morphological MRI. Thus, the purpose of this study was to test the hypothesis that side to side differences in KCOR correlate with side to side differences in UTE-T2* quantitative MRI (qMRI) in the central weight bearing regions of the medial and lateral tibial plateaus at 2 years following ACLR. Methods: Thirty-five human participants (18F, Age: 33.8±10.5 yrs, BMI: 24.1±3.3) with a history of unilateral ACL reconstruction (2.19±0.22 yrs post-surgery) and no other history of serious lower limb injury received bilateral examinations on a 3T MRI scanner. UTE-T2* maps were calculated via mono-exponential fitting on a series of T2*-weighted MR images acquired at eight TEs (32μs -16 ms, non-uniform echo spacing) using a radial out 3D cones acquisition. All subjects completed bilateral gait analysis. Medial-lateral (ML) and anterior-posterior (AP) coordinates of average KCOR during stance of walking were calculated for both knees. Side to side differences in KCOR were tested for correlations with side to side differences in mean full thickness UTE-T2* quantitative values in the central weight bearing regions of the medial and lateral tibial plateau using Pearson correlation coefficients. Results: There was a distribution in UTE-T2* values, with some subjects having higher UTE-T2* and some lower in the ACLR knee relative to the contralateral knee. A significant correlation (R=0.407, p=0.015, Figure 1A) was observed between UTE-T2* and the ML KCOR with a more lateral KCOR corresponding to higher values of UTE-T2* for the medial tibia. Similarly, for the lateral tibia, a lower UTE-T2* was correlated with a more posterior KCOR (R=0.363, p=0.032, Figure 1B). Significant correlations were not observed for UTE-T2* in the lateral tibia with the ML position of KCOR or for UTE-T2* in the medial tibia with the AP position of KCOR. Conclusions: The results of this study support the hypothesis that side to side differences in mean full thickness UTE-T2* qMRI correlate with side to side differences in knee kinematics at 2 years after ACLR. The finding that a more lateral KCOR in the ACLR knee correlates with UTE T2* values in the medial tibia that were higher than the contralateral side suggests that this kinematic change, which has been previously shown to result in more relative motion between the femur and tibia in the medial compartment, could be affecting subsurface matrix integrity, inducing changes detectable by UTE-T2* mapping. Additionally, the finding that a more posterior KCOR in the ACLR knee correlated with UTE-T2* values in the lateral tibia that were lower than the contralateral knee further suggests that the UTE-T2* metric may reflect early changes in cartilage health. When interpreted within the context of prior work showing that a posterior shift in KCOR from 2 to 4 years post-surgery correlated with improved clinical outcomes at 8 years, the observed lower UTE-T2* with a more posterior KCOR, which is reflective of improved quadriceps recruitment, suggests positive cartilage matrix properties. In spite of the limitations of this cross-sectional and exploratory study, and the difficulty accounting for changes in the contralateral knee, these results support future studies of the relationship between UTE-T2* and KCOR to provide new insight into predicting the risk for OA after ACLR.
Listed In: Biomechanical Engineering, Biomechanics, Gait, Mechanical Engineering, Orthopedic Research, Sports Science