Rugby is intrinsically an impact sport which results in concussions being a frequent injury within the game. Repeated concussion is linked to early-onset dementia and depression, and the rules for limiting repeated concussion are an ongoing controversy. Therefore a greater understanding of the dynamics of head impacts in rugby and the mechanism of concussion is required. Accordingly, this study focuses on assessing the use of Model Based Image Matching (MBIM) and multi-camera view video for measuring six degree of freedom head kinematics during an impact event in rugby union. The matching is performed on video evidence using 3-D animation software Poser 4. The surroundings are built in the virtual environment based on the real dimensions of the sport field. A skeleton model is then used to fit the player’s anthropometry for each video frame thus allowing player kinematics to be measured. The results from this initial study suggest that the MBIM method can be applied to head impact cases in rugby union. The head kinematics results from this case are similar to those reported in literature. The MBIM method should be applied to a number of head impact cases to establish thresholds for concussion injuries in rugby. The data gained from the MBIM method can allow for more reliable kinematic data to be inputted into finite element analysis and rigid body simulations of concussion impacts. This can allow multi-axis force measurements to be measured within the brain and neck. This can ultimately lead to an improvement in concussion injury prevention and management.
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.
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.
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.
Stair negotiation is one of the more difficult daily activities reported by total knee replacement (TKR) patients. Dissatisfied TKR patients have reported increased difficulty with stair negotiation, however it is unknown what the underlying mechanical issues are for this population. Therefore, the purpose of this research was to examine the knee joint biomechanics of dissatisfied TKR patients during stair descent. Nine dissatisfied TKR patients (34.6±14.3 months from surgery), 15 satisfied TKR patients (29.3±12.8 months from surgery), and 15 healthy participants performed stair descent trials on a five-step instrumented staircase at a preferred gait speed. The dissatisfied group showed lower knee extension and abduction moments in their replaced limb. The 2nd peak vertical ground reaction force (VGRF) and 1st and 2nd peak knee internal rotation moments showed lower moments for replaced limbs compared to non-replaced limbs. First peak VGRF was reduced for dissatisfied group compared to satisfied and healthy groups. The dissatisfied TKR group had significantly increased pain levels on their replaced limb compared to all other groups and limbs. The dissatisfied group had reduced gait speed compared to the satisfied and healthy groups. Increased pain levels lead to reduced descent speed and peak loading-response and pushoff sagittal plane knee joint moments in dissatisfied total knee replacement patients during stair descent. This creates an asymmetry in the extension loading response moment for the dissatisfied group, with the non-replaced limb showing increased joint moments whereas the satisfied and healthy groups do not have that imbalance.
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.
Purpose: An increased likelihood of developing obesity-related knee osteoarthritis may be associated with increased peak internal knee abduction moments. Increases in step width may act to reduce this moment. The purpose of this study was to determine the effects of increased step width on knee biomechanics during stair ascent of healthy-weight and obese participants. Methods: Participants ascended stairs while walking at their preferred speed in two different step width conditions – preferred and wide. A 2 x 2 (group x condition) mixed model analysis of variance (ANOVA) was performed to analyze differences between groups and conditions (p<0.05). Results: Increased step width decreased the loading-response peak vertical ground reaction force (GRF), loading-response knee abduction moment, knee extension ROM, and knee abduction ROM in both groups. However, it also increased loading and push-off peak mediolateral GRF, and peak knee abduction angle in both groups. Obese participants experienced a disproportionate increase in loading and push-off peak mediolateral GRF, and peak knee abduction angle compared to healthy. Conclusion: Increased SW successfully decreased loading-response peak knee abduction moment. Implications of this finding are that increased SW may decrease likelihood of developing medial compartment knee osteoarthritis. This study shows that this gait modification affects obese and healthy-weight differently, and the influence of body mass on knee biomechanics.
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.
This study examined triceps surae muscle strength and tendon stiffness in young adult elite sprinters and jumpers over one season, in order to detect potential discordance between muscle and tendon adaptation due to training. Furthermore, we examined the effect of habitual training on triceps surae muscle-tendon unit (MTU) mechanical properties in young and older athletes, using a cross-sectional design.
Eleven healthy younger elite sprinters and jumpers, 12 master athletes, 12 recreationally active young controls and one young elite athlete, 10 months after unilateral Achilles tendon reconstruction participated. All young athletes underwent regular measurements over one season. Triceps surae muscle strength and tendon stiffness of both legs were analysed using dynamometry and ultrasonography synchronously.
Within one season, similar patterns of relative changes in muscle strength and tendon stiffness were seen in the young elite athletes. For the tendon reconstruction athlete, the affected leg showed no increases in muscle strength or tendon stiffness over one season, and remarkably lower muscle strength but similar tendon stiffness compared to the non-affected leg. Healthy young elite athletes showed higher muscle strength and tendon stiffness than both other subject groups, with no differences between young controls and master athletes.
Our results provide evidence for training-induced concordant adaptation of muscle and tendon over one season within healthy young elite athletes. Achilles tendon rupture and reconstruction may be a major risk factor for irreversible discordance within the triceps surae MTU. Finally, habitual athletics training over the lifespan may effectively counteract age-related decreases in muscle strength and tendon stiffness.
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.