Purpose: To validate an instrumented figure skating blade that is designed to measure impact forces while skating. Methods: Seven subjects (Age: 21.3±2.8 yrs, Ht: 166.9±2.5 cm, Mass: 64.7±7.9 kg) performed 20 landings each onto artificial ice while landing on the instrumented blade from heights of 17.5cm, 25cm, and 33cm. A custom instrumented blade calibrated to measure in forces in Newtons (N) was used to measure impact forces (1000Hz) during landings. These forces were compared to forces obtained while subjects landed on AMTI force plates located underneath the artificial ice surface. Boot angle (250Hz) and force plate data (1000Hz) were collected using Vicon Nexus. Custom LabVIEW programs were used to determine peak force, loading rate, impulse, and the correlation between the blade force data and the force plate data. Paired T-tests were used to compare peak force, loading rate, and impulse between the blade and force plate data. Alpha = 0.05. Results: Correlations between the blade force data and force plate data were good to excellent: mean r (±SD) = .86 ± 0.08. No significant differences were found for peak force and impulse between the blade and force plate data. Peak force means (±SD) were 1353.7 ± 352.2 N for the blade and 1361.2 ± 309.7 N for the force plate (p=.86). Conclusion: The custom instrumented blade is a valid tool for measuring peak forces and impulse during landings. Current research is focused on increasing the gain of the instrumented blade to improve loading rate accuracy.
Listed In: Biomechanics

Movement and Loading Symmetry Changes when Wearing a Functional Knee Brace Following ACL Reconstruction

Asymmetries in discrete measures following anterior cruciate ligament reconstruction (ACL-R) during landing have been reported to be risk factors for secondary ACL injuries. Our purpose was to examine the impact of functional brace wear on kinematic and kinetic inter-limb movement symmetry during landing in ACL-R patients. 20 adolescent athletes (15.8 ± 1.2 years) (7 male, 13 female) 6 months following ACL reconstruction performed 5 trials of a stop-jump task in both a braced (B) and non-braced (NB) condition, with the first landing being analyzed. A custom fit functional knee brace (DJO, Vista, CA) was worn on the ACL reconstructed limb (AL) during the B trials. Mean curves were created for each limb (AL and unaffected limb (UL)) for the vertical (vGRF) and anterior-posterior ground reaction forces (apGRF) and frontal and sagittal knee angles and moments. Coefficients of multiple determination (CMD) between the AL and UL curves were compared between B and NB conditions with students’ t-tests (p≤0.05). No significant differences existed for movement and loading symmetry between B and NB conditions among all subjects. Secondary analysis revealed significant differences in apGRF (p=0.014), vGRF (p=0.011) and sagittal knee angles (p=0.003) in subjects with improved sagittal knee angle symmetry in the B condition. The data show that brace wear improves loading symmetry in adolescent patients that also exhibit improved sagittal knee angle symmetry while braced 6 months following ACL-R. Identifying factors that affect inter-limb movement and loading response to brace wear could assist in determining each patient’s need for a brace.

Listed In: Biomechanics, Sports Science

Ground Reaction Force Symmetry during Sitting and Standing Tasks after a Dual Mobility or Conventional Cup Total Hip Arthroplasty

Dual-mobility (DM) bearing implants reduce the incidence of dislocation following total hip arthroplasty (THA) also it increases hip stability and range of motion (ROM). However, it is unclear whether the improved ROM will lead to better mechanical symmetry. Ground reaction forces (GRF) analysis would help to understand joint compensatory effects and symmetry in THA patients. The purpose was to compare GRF symmetry between the operated and non-operated limbs in THA patients, of either DM or conventional-cup (CC) implant, during standing and sitting tasks. Twenty-four patients and 10 control participants (5M/5F; 62±10 years; 26±4 kg/m2) were recruited and underwent motion analysis before and nine months after THA. Patients were randomly assigned to either a DM (8M/4F; 63±5 years; 28±3 kg/m2) or CC (9M/3F; 62±5 years; 28±5 kg/m2) cementless replacement. Participants performed five sit-to-stand and stand-to-sit trials, with a bench adjusted to their knee heights and each foot on an individual force plate, with motion capture and GRF data been collected. Control group demonstrated standing (0.4±1.6%) and sitting (1.2±1.6%) symmetry. During sit-to-stand, DM group reduced its SI from pre- (5.5±1.6%) to post-op (1.2±1.9%, p=0.09), while the CC group showed a significant improvement (from 8.7±2.1% to 1.5±1.4%, p=0.02). For stand-to-sit, DM group reduced its SI (from 3.3±2.2% to 0.5±1.7%) while the CC group again had a significant improvement (from 8.2±2.1% to 1.2±1.1%, p=0.02). Larger improvements in symmetry were noticed for both groups during trunk flexion when standing; and for CC group during trunk extension when sitting. After surgery, patients with either implant reached SI inside the margin of 1.5 standard deviation from the CTRL (p>0.05). Statistical significance on paired condition was only observed on CC group due to its high pre-op score; however, both surgical groups showed an improved symmetry after THA.
Listed In: Biomechanics, Orthopedic Research

Gait Mechanics Depend Upon Quadriceps Central Activation Ratio in an Anterior Knee Pain Cohort

Gait Mechanics Depend Upon Quadriceps Central Activation Ratio in an Anterior Knee Pain Cohort Son SJ*, Kim HS†, Wiseman B‡, Seeley MK*, Hopkins JT*: *Brigham Young University, Provo, UT, †West Chester University, West Chester, PA, ‡West Virginia University, Morgantown, WV. Context: Quadriceps deficits are often present in an anterior knee pain (AKP) population. However, common self-reported classification tools including Visual Analog Scale (VAS), Kujala Anterior Knee Pain (KAKP), Tampa Scale for Kinesiophobia (TSK), Tegner Activity Level (TAL) scores, and/or other subject inclusion criteria may not be sensitive enough to identify specific movement characteristics in patients with AKP. Quadriceps central activation ratio (CAR) may help to discriminate movement characteristics in patients with AKP. Objective: To examine gait mechanics between two subdivisions of AKP patients, separated by quadriceps function (CAR < 0.95 and CAR > 0.95). AKP patients were defined by VAS, KAKP, TSK, and TAL scores. Design: Cohort. Setting: Controlled laboratory. Patients or Other Participants: 30 (M=16, F=14; 22.3±3 yrs, 175±9 cm, 72.5±14 kg) AKP patients participated: 15 Quadriceps Deficit (QD: CAR = 0.91±0.04, VAS = 3.87±1.3, KAKP = 82.9±6.6, TSK = 37.9±4.7, TAL = 6.3±1.2) and 15 Quadriceps Functional (QF: CAR = 0.97±0.01, VAS = 3.93±0.7, KAKP = 79.3±7.9, TSK = 36.9±5.2, TAL = 6.8±1.4). Interventions: Subjects performed three quadriceps maximum voluntary contractions (MVC) for 3 sec on a Biodex dynamometer (100 Hz). When MVC torque plateaued 1.5-2 sec later, a superimposed burst was transmitted to two electrodes placed on their quadriceps to measure CAR. Two successful trials were averaged for data analysis. Subjects performed five gait trials at a self-selected walking speed. Gait data were collected using high-speed video (240 Hz) and a force plate (1200 Hz). A functional analysis was used to detect mean between-group differences in gait mechanics during the entire stance phase (0-17% = loading response, 18-50% = mid-stance, 51-83% = terminal stance, and 84-100% = pre-swing). This analysis allowed us to compare variables as polynomial functions rather than discrete values. If 95% confidence intervals did not overlap zero, significant differences existed between groups (p < 0.05). Main Outcome Measures: Sagittal-plane knee joint angle (˚), internal knee joint torque (N∙m), and vertical ground reaction force (VGRF; N/kg). Results: Relative to QF patients, QD patients demonstrated (i) decreased knee flexion angle at 4-90% of stance, (ii) reduced internal knee extension torque at 14-32% of stance, and (iii) reduced VGRF at 19-37% of stance and increased VGRF at 46-70% of stance (p < 0.05). Conclusions: The present data suggest that relative to QF patients, QD patients adopt quadriceps weakness gait mechanics that have been reported in individuals with knee osteoarthritis, ACL reconstruction, and effused knee joints. These alterations may create long-term compensatory gait patterns at the knee and adjacent ankle and hip joints, which may lead to mechanical and biological changes in knee articular cartilage. Future research is needed to examine a potential relationship between these gait alterations and articular cartilage health over the long-term.
Listed In: Biomechanics, Gait

Predictors of patellofemoral joint stress: an examination of patellofemoral joint morphology

INTRODUCTION: Patellofemoral pain (PFP) is a common condition seen in orthopedic practice, accounting for approximately 25-40% of all knee injuries [1]. A commonly cited hypothesis as to the cause of PFP is elevated patellofemoral joint (PFJ) stress [2] secondary to abnormal PFJ structure. Previous studies have shown that persons with PFP exhibit altered patella position [3], abnormal femoral morphology [4], and decreased patella cartilage thickness [5] when compared to healthy individuals. However, the influence of the abnormal morphology on PFJ stress is unknown. METHODS: Nineteen subjects (10 PFP and 9 pain-free controls) were recruited for this study. Each subject completed 2 phases of data collection: magnetic resonance imaging (MRI) assessment and biomechanical testing. The measurement of morphological variables (patella height (Insall-Salvati ratio or ISR), lateral trochlear inclination angle (LTI), and patella cartilage thickness). For the biomechanical testing, kinematic, kinetic, and electromyographic were obtained. RESULTS AND DISCUSSION: Pearson correlation coefficients revealed that only patella height (r=0.48, p=0.018) and patella cartilage thickness (r=-0.58, p=0.005) were significantly correlated with peak hydrostatic pressure (Table 1). Results of the stepwise regression analysis revealed that patella cartilage thickness was the single best predictor of peak hydrostatic pressure, followed by patella height. Together, these 2 variables explained 50% of the variance in peak PFJ stress. The results of the current study support the premise that PFJ stress is associated with PFJ morphology. Patella height was the best predictor of PFJ stress with greater degrees of patella height being correlated with greater stress. This is logical given that a higher positioned patella articulates with the more shallow portion of the trochlear groove, thus decreasing PFJ contact area [6]. The finding that patella cartilage thickness was negatively correlated with PFJ stress is in agreement with the results of Li et al. [7], who demonstrated that a reduction of cartilage thickness causes increase cartilage stress. Furthermore, our findings revealed that 50% of the variance in PFJ stress could be explained by morphological factors. CONCLUSIONS: Identifying the underlying factors that contribute to elevated PFJ stress is an important step in developing effective interventions for persons with PFP. Although abnormal structure may not be correctable through conservative measures, it is important to recognize abnormal structure may play a role in contributing to pain and pathology.
Listed In: Biomechanics, Sports Science

Knee Biomechanics of Selected Knee Unfriendly Movement Elements in 42-Form Tai Ji

Tai Ji is one of the recommended non-pharmacologic treatments for knee osteoarthritis (OA), but it is not clear if all Tai Ji movements would be suitable and beneficial for knee OA patients. PURPOSE: To examine knee biomechanical characteristics of the selected knee unfriendly Tai Ji movement elements performed in high-pose position compared to slow walking. METHODS: Seventeen healthy participants (age: 23.9 ± 2.7 years, height: 1.73 ± 0.08 m, body mass: 69.0 ± 13.0 kg) performed three trials in each of the following five test conditions: level walking at 0.8 m/s and four identified knee unfriendly Tai Ji movement elements: lunge, pushdown and kick performed in high-pose position (35 ± 5°) and pseudo-step. Simultaneous collection of 3D kinematics (120 Hz) and ground reaction forces (1200 Hz) was conducted. A one-way ANOVA was performed with post hoc paired samples t-tests to determine differences of the high-pose lunge, pushdown, and kick, and pseudo-step and walking. RESULTS: Knee flexion range of motion for high-pose lunge (29.5°), pushdown (24.3°) and kick (11.1°) was lower than pseudo-step (45.0°, p<0.001 for all comparisons) and walking (47.8°, p<0.001 for all comparisons). Peak knee extensor moment was lower in high-pose lunge (1.04 Nm/kg), pushdown (1.01 Nm/kg) and kick (0.48 Nm/kg) than pseudo-step (1.46 Nm/kg, p<0.001 for all comparisons), but higher than walking (0.38 Nm/kg, p<0.001 for all comparisons) except for kick. Peak knee abduction moment was higher in pseudo-step (-0.61 Nm/kg) than high-pose pushdown (-0.43 Nm/kg), kick (-0.44 Nm/kg), and walking (-0.45 Nm/kg, for all comparisons p<0.001). CONCLUSION: These findings demonstrate higher peak knee extensor moment in most of the Tai Ji knee unfriendly movement elements compared to slow walking. It is recommended that Tai Ji participants with knee OA and other knee pathological conditions modify knee unfriendly movement elements (e.g. lunge) and reduce the size of their movements to minimize knee joint loading. The Tai Ji movement elements including pushdown and pseudo-step should be avoided in the Tai Ji exercises designed for knee OA patients.

Listed In: Biomechanics


Introduction and Objectives: Traditional motion analysis provides limited insight into muscle and tendon forces during movement. This study used B-mode ultrasound, in combination with measured joint angles and scaled musculoskeletal models, to provide subject-specific estimates of in vivo Achilles tendon (AT) force. Previous studies have used ultrasound images, tracked in 3D space, to estimate AT strains during walking, running, and jumping [1,2]. Our approach extends this work in one novel way. Specifically, we characterized AT stiffness on a subject-specific basis by recording subjects’ ankle moments and AT strains during a series of isometric tests. We then used these data to estimate AT force during movement from in vivo measurements of tendon strain. To demonstrate this approach, we report AT forces measured during cycling. Cycling offers a unique paradigm for studying AT mechanics. First, because the crank trajectory is constrained, joint angles and muscle-tendon unit (MTU) lengths of the gastrocnemius (MG, LG) and soleus (SOL) are also constrained. By varying crank load, subjects’ ankle moments can be altered without imposing changes in MTU lengths. For this study, 10 competitive cyclists were tested at 4 different crank loads while pedaling at 80 rpm. Based on published EMG recordings (e.g., [3]) and on in vivo tendon force buckle data from one subject [4], we hypothesized that the cyclists’ AT forces would increase systematically with crank load. Methods: We coupled B-mode ultrasound with motion capture, EMG, and pedal forces to estimate in vivo AT forces non-invasively during cycling and during a series of isometric ankle plantarflexion tests. Marker trajectories were tracked using an optical motion capture system. Joint angles and MTU lengths were calculated based on scaled musculoskeletal models [5] using OpenSim [6]. A 50 mm linear-array B-mode ultrasound probe was secured over the distal muscle-tendon junction (MTJ) of the MG and was tracked using rigid-body clusters of LEDs. AT lengths were calculated as the distance from a calcaneus marker to the 3D coordinates of the MG MTJ. Subject-specific AT force-strain curves were obtained from isometric tests using ultrasound to track the MTJ, markers to track both the ultrasound probe and the AT insertion, and a strain gauge to measure the net ankle torques generated by each of the subjects at ankle angles of -10° dorsiflexion, 0°, +10° plantarflexion, and +20° plantarflexion. AT strain during cycling was converted to AT force using each subject’s force-strain relation. Subject-specific tendon slack lengths were calculated as the mean tendon length at 310° over all pedal cycles, based on examination of the AT length changes and on published data showing that this position in the pedal cycle precedes tendon loading across multiple pedalling conditions [4]. Results: Peak AT forces during cycling ranged from 1320 to 2160 N ± 400 N (mean± SD) and increased systematically with load (p<0.001; Fig. 1A/B). At the highest load, the peak AT forces represented, on average, 50 to 70 % of the combined MG, LG, and SOL muscles’ maximum isometric force-generating capacity, as estimated from the muscles’ scaled volumes [7], the muscles’ scaled optimal fiber lengths [5], and a specific tension of 20-30 N/cm2. Peak AT forces occurred midway through the pedaling downstroke, at about 80°, which is consistent with the AT forces directly measured from one subject [4] and with patterns of EMG during cycling [3]. Peak AT strains during cycling were uncoupled from the MG MTU strains and ranged from 3 to 5 % across the different loads examined, measured at the MG MTJ. Conclusion: Our results are consistent with published data from a single subject in which AT force was measured using an implanted tendon buckle [8]; however, our results were obtained non-invasively using ultrasound and motion capture. These methods substantially augment the experimental tools available to study muscle-tendon dynamics during movement. References: [1]Lichtwark and Wilson, 2005, J Exp Biol, 208(24), 4715-4725. [2]Lichtwark et al., 2007, J Biomech, 40(1), 157-164. [3]Wakeling and Horn, 2009, J Neurophysiol, 101(2), 843-854. [4]Gregor et al., 1987, Int J Sports Med, 8(S1), S9-S14. [5]Arnold et al., 2010, Ann Biomed Eng, 38(2), 269-279. [6]Delp et al., 2007, IEEE Trans Bio Med Eng, 54(11), 1940-50. [7]Handsfield et al., 2014, J Biomech, 47(3),631-638. [8]Gregor et al. 1991, J Biomech, 24(5), 287-297
Listed In: Biomechanics, Sports Science


Introduction and Objectives: It has previously been reported that deterioration in contractile strength and tendon stiffness in the elderly is associated with altered motor task execution and reduced performance while walking [1,2], and that resistance training improves muscle function, resulting in more effective and safer gait characteristics in the older population [3]. In particular, triceps surae (TS) muscle-tendon unit (MTU) properties seem to be an important determinant for walk-to-run transition speed [4], emphasizing the relevant role intrinsic MTU properties play in gait performance. The objective of this empirical study was to examine the hypothesis that maximal walking velocity is related to TS MTU mechanical and morphological properties and their enhanced capacities would improve gait velocity in the elderly. Methods: Thirty four older female adults (66±7 yrs.) took part in the study. Nineteen of them were recruited for the experimental group, who underwent a 14-week TS MTU physical exercise intervention which has been previously established to increase muscle strength and tendon stiffness [5]. The remaining 15 subjects formed the control group (no physical exercise intervention). The experimental group performed three times per week five sets of four repetitive (3·s loading, 3·s relaxation) isometric plantar flexion contractions in order to induce high cyclic strain magnitudes on the TS tendon and aponeurosis. Maximal walking velocity, defined as walking with a double support phase, was determined by using two force plates (60 x 40 cm, 1080 Hz; Kistler, Winterthur, CH) and a motion capture system (Vicon Motion Systems, Oxford, UK) with 12 infrared cameras operating at a frequency of 120 Hz. TS MTU properties were assessed using simultaneous dynamometry and ultrasonography (Esaote MyLab Five; Esaote Biomedica, Genoa, IT). Results: A significant correlation was found between the TS MTU mechanical and morphological properties and maximal gait velocity (0.40 < r < 0.64; P < 0.05; n = 34). The experimental group showed higher TS contractile strength, tendon stiffness, and higher gastrocnemius medialis muscle thickness post- compared to pre-intervention (P < 0.05). However, calculated maximal gait velocity did not differ between pre and post-intervention measurements (2.39 ± 0.41 vs. 2.44 ± 0.45 m·s-1). Control subjects showed no statistically significant differences in maximal gait velocity or TS MTU mechanical and morphological properties. Conclusion: This empirical study confirms previous forward simulation models [4] proposing that intrinsic TS MTU properties are significant determinants of gait performance. However, older adults may not be capable of fully utilizing improvements of the MTU capacities while walking at maximal velocities following a 14 week physical exercise intervention. Therefore, the benefits of a long term physical exercise intervention (1.5 years) will be discussed.
Listed In: Biomechanics, Gait, Other

Acute Effects of Lateral Ankle Sprains on Range of Motion, Single Limb Balance, and Self-Reported Function

One in three individuals who suffer a lateral ankle sprain (LAS) subsequently develop chronic ankle instability. However, our inability to properly treat acute LAS is not surprising given our limited understanding of post-LAS consequences. 12 patients (21.6±2.9yrs; 172.9±13.1cm; 79.1±21.4kg) with an acute LAS participated. All participants were evaluated for dorsiflexion range of motion (DFROM), time-to-boundary (TTB) in single limb balance (SLB), and self-reported function (SRF) at 1-week, 2-weeks, 4-weeks, 6-weeks, and 8-weeks post injury. Both the involved and uninvolved limbs were measured during the patients first test session. DFROM was assessed using the weight-bearing lunge test and all participants performed 3, 10s of single limb stance with eyes open on a force plate to measure their single limb balance. SRF was measured using the Foot and Ankle Ability Measure (FAAM) and FAAM-Sport (FAAM-S). Post injury time points were compared to a control condition using multivariate ANOVAs (α=0.05). Relative to the control condition, FAAM and FAAM-S were significantly lower at 1-week and 2-weeks post injury. The FAAM-S was also significantly lower score compare to control condition at 4-weeks post-injury. Both FAAM and FAAM-S were not significant different at 6-weeks post-injury. Post-injury TTB measures and DFROM were not significantly different from the control condition. Non-significant declines in DFROM and TTB were observed as in this sample of acute LAS and appear to present with unique recovery patterns. Different recovery patterns among the tested outcomes indicate the need for further research with a larger cohort and for a longer post-injury duration.

Listed In: Biomechanics, Physical Therapy, Posturography, Sports Science

A preliminary study on quality of knee strength measurements by means of Hand Held Dynamometer and Optoelectronic System

Strength measurements are popular in the clinical practice to evaluate the health status of patients and quantify the outcome of training programs. Currently a common method to measure strength is based on Hand Held Dynamometers (HHD) which is operator-dependent. Some studies were conducted on repeatability of strength measurements but they were limited to the statistical analysis of repeated measurements of force. In this work, the authors developed a methodology to study the quality of knee flexion/extension strength measurements by measuring the effective HHD position and orientation with respect to the patient. HHD positioning attitude was measured by means of an Optoelectronic System for which a marker protocol was defined ad-hoc. The approach allowed to assess quality of measurements and operator’s ability by means of quantitative indices. The protocol permitted the evaluation of: angles of HHD application, angular range of motion of the knee and range of motion of the HHD. RMSE parameters allowed to quantify the inaccuracy associated to the selected indices. Results showed that the operator was not able to keep the subject’s limb completely still. The force exerted by the subject was higher in knee extension and the knee range of motion was higher than expected, however the operator had more difficulties in holding the HHD in knee flexion trials. This work showed that HHD positioning should be as accurate as possible, as it plays an important role for the strength evaluation. Moreover, the operator should be properly trained and should be strong enough to counteract the force of the subject.
Listed In: Biomechanical Engineering, Biomechanics, Physical Therapy, Sports Science