Does Overhead Squat Performance Affect the Swing Kinematics and Lumbar Spine Loads during the Golf Downswing?

The performance of the overhead squat may affect the golf swing mechanics associated with golf-related low back pain. This study investigates the difference in lumbar kinematics and joint loads during the golf downswing between golfers with different overhead squat abilities. Based on the performance of the overhead squat test, 21 golfers aged 18 to 30 years were divided into the highest-scoring group (HS, N = 10, 1.61 ± 0.05 cm, and 68.06 ± 13.67 kg) and lowest-scoring group (LS, N = 11, 1.68 ± 0.10 cm, and 75.00 ± 14.37 kg). For data collection, a motion analysis system, two force plates, and TrackMan were used. OpenSim 4.3 software was used to simulate the joint loads for each lumbar joint. An independent t-test was used for statistical analysis. Compared to golfers demonstrating limitations in the overhead squat test, golfers with better performance in the overhead squat test demonstrated significantly greater angular extension displacement on the sagittal plane, smaller lumbar extension angular velocity, and smaller L4-S1 joint shear force. Consequently, the overhead squat test is a useful index to reflect lumbar kinematics and joint loading patterns during the downswing and provides a good training guide reference for reducing the risk of a golf-related lower back injury.

Impact of reverse shoulder arthroplasty design and patient shoulder size on moment arms and muscle fiber lengths in shoulder abductors.

BACKGROUND: Reverse shoulder arthroplasty (RSA) increases the moment arm of the deltoid; however, there is limited knowledge on the accompanying changes in muscle architecture that play a role in muscle force production. The purpose of this study was to use a geometric shoulder model to evaluate the anterior deltoid, middle deltoid, and supraspinatus regarding (1) the differences in moment arms and muscle-tendon lengths in small, medium, and large native shoulders and (2) the impact of 3 RSA designs on moment arms, muscle fiber lengths, and force-length (F-L) curves. METHODS: A geometric model of the native glenohumeral joint was developed, validated, and adjusted to represent small, medium, and large shoulders. Moment arms, muscle-tendon lengths, and normalized muscle fiber lengths were assessed for the supraspinatus, anterior deltoid, and middle deltoid from 0° to 90° of abduction. RSA designs were modeled and virtually implanted, including a lateralized glenosphere with an inlay 135° humeral component (lateral glenoid-medial humerus [LGMH]), a medialized glenosphere with an onlay 145° humeral component (medial glenoid-lateral humerus [MGLH]), and a medialized glenosphere with an inlay 155° humeral component (medial glenoid-medial humerus [MGMH]). Descriptive statistics were used to compare moment arms and normalized muscle fiber lengths. RESULTS: As shoulder size increased, the moment arms and muscle-tendon lengths for the anterior deltoid, middle deltoid, and supraspinatus increased. All RSA designs achieved greater moment arms for the anterior and middle deltoid, with the MGLH design achieving the largest increase. The resting normalized muscle fiber length of the anterior and middle deltoid was substantially increased in the MGLH (1.29) and MGMH (1.24) designs, shifting the operating ranges of these muscles to the descending portions of their F-L curves, whereas the LGMH design maintained a resting deltoid fiber length (1.14) and operating range similar to the native shoulder. All RSA designs demonstrated a decrease in the native supraspinatus moment arm in early abduction, with the largest decrease in the MGLH design (-59%) and minimal decrease in the LGMH design (-14%). The supraspinatus operated on the ascending limb of its F-L curve in the native shoulder and remained on this portion of the F-L curve for all RSA designs. CONCLUSION: Although the MGLH design maximizes the abduction moment arm for the anterior and middle deltoid, overlengthening of the muscle may compromise deltoid muscle force production by forcing the muscle to operate on the descending portion of its F-L curve. In contrast, the LGMH design increases the abduction moment arm for the anterior and middle deltoid more modestly while allowing the muscle to operate near the plateau of its F-L curve and maximizing its force-producing potential.

How muscles maximize performance in accelerated sprinting.

We sought to provide a more comprehensive understanding of how the individual leg muscles act synergistically to generate a ground force impulse and maximize the change in forward momentum of the body during accelerated sprinting. We combined musculoskeletal modelling with gait data to simulate the majority of the acceleration phase (19 foot contacts) of a maximal sprint over ground. Individual muscle contributions to the ground force impulse were found by evaluating each muscle's contribution to the vertical and fore-aft components of the ground force (termed "supporter" and "accelerator/brake," respectively). The ankle plantarflexors played a major role in achieving maximal-effort accelerated sprinting. Soleus acted primarily as a supporter by generating a large fraction of the upward impulse at each step whereas gastrocnemius contributed appreciably to the propulsive and upward impulses and functioned as both accelerator and supporter. The primary role of the vasti was to deliver an upward impulse to the body (supporter), but these muscles also acted as a brake by retarding forward momentum. The hamstrings and gluteus medius functioned primarily as accelerators. Gluteus maximus was neither an accelerator nor supporter as it functioned mainly to decelerate the swinging leg in preparation for foot contact at the next step. Fundamental knowledge of lower-limb muscle function during maximum acceleration sprinting is of interest to coaches endeavoring to optimize sprint performance in elite athletes as well as sports medicine clinicians aiming to improve injury prevention and rehabilitation practices.

Direct Validation of Human Knee-Joint Contact Mechanics Derived From Subject-Specific Finite-Element Models of the Tibiofemoral and Patellofemoral Joints.

The primary aim of this study was to validate predictions of human knee-joint contact mechanics (specifically, contact pressure, contact area, and contact force) derived from finite-element models of the tibiofemoral and patellofemoral joints against corresponding measurements obtained in vitro during simulated weight-bearing activity. A secondary aim was to perform sensitivity analyses of the model calculations to identify those parameters that most significantly affect model predictions of joint contact pressure, area, and force. Joint pressures in the medial and lateral compartments of the tibiofemoral and patellofemoral joints were measured in vitro during two simulated weight-bearing activities: stair descent and squatting. Model-predicted joint contact pressure distribution maps were consistent with those obtained from experiment. Normalized root-mean-square errors between the measured and calculated contact variables were on the order of 15%. Pearson correlations between the time histories of model-predicted and measured contact variables were generally above 0.8. Mean errors in the calculated center-of-pressure locations were 3.1 mm for the tibiofemoral joint and 2.1 mm for the patellofemoral joint. Model predictions of joint contact mechanics were most sensitive to changes in the material properties and geometry of the meniscus and cartilage, particularly estimates of peak contact pressure. The validated finite element modeling framework offers a useful tool for noninvasive determination of knee-joint contact mechanics during dynamic activity under physiological loading conditions.

Direct Validation of Model-Predicted Muscle Forces in the Cat Hindlimb During Locomotion.

Various methods are available for simulating the movement patterns of musculoskeletal systems and determining individual muscle forces, but the results obtained from these methods have not been rigorously validated against experiment. The aim of this study was to compare model predictions of muscle force derived for a cat hindlimb during locomotion against direct measurements of muscle force obtained in vivo. The cat hindlimb was represented as a 5-segment, 13-degrees-of-freedom (DOF), articulated linkage actuated by 25 Hill-type muscle-tendon units (MTUs). Individual muscle forces were determined by combining gait data with two widely used computational methods-static optimization and computed muscle control (CMC)-available in opensim, an open-source musculoskeletal modeling and simulation environment. The forces developed by the soleus, medial gastrocnemius (MG), and tibialis anterior muscles during free locomotion were measured using buckle transducers attached to the tendons. Muscle electromyographic activity and MTU length changes were also measured and compared against the corresponding data predicted by the model. Model-predicted muscle forces, activation levels, and MTU length changes were consistent with the corresponding quantities obtained from experiment. The calculated values of muscle force obtained from static optimization agreed more closely with experiment than those derived from CMC.

A Randomized Controlled Trial Comparing a Medial Stabilized Total Knee Prosthesis to a Cruciate Retaining and Posterior Stabilized Design: A Report of the Clinical and Functional Outcomes Following Total Knee Replacement.

BACKGROUND: The purpose of this randomized controlled trial was to compare the performance of 3 total knee joint replacement (TKJR) designs 6 months after the surgery. METHODS: Patients were recruited between March 2015 and March 2018. Patients with osteoarthritis consented for TKJR were randomly allocated to a medial stabilized (MS), cruciate retaining (CR), or posterior stabilized (PS) design. Primary outcome measures were self-reported improvement in pain and function 6 months after TKJR, using the Oxford Knee Score. Secondary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index, Veterans RAND 12-item Health Survey, Knee Society Score 2011, Timed Up and Go test, and Six-Minute Walk Test. Twelve-month outcomes were also measured. RESULTS: Ninety participants enrolled, 83 were randomized: PS (n = 26), CR (n = 28), and MS (n = 29) designs. One case withdrew before surgery: planned use of non-study implant; 7 did not complete all outcome measures. No 6-month between-group difference was observed for the primary outcome. A 6-month difference was observed in Knee Society Score 2011 Satisfaction: MS favored over CR and PS. Clinically meaningful 12-month differences in Western Ontario and McMaster Universities Osteoarthritis Index Pain, Function, and Global Subscales were observed: MS favored over CR. Twelve-month differences occurred in Veterans RAND 12-item Health Survey mental well-being, favoring MS and PS over CR. CONCLUSION: MS prosthesis can be expected to yield similar clinical and functional outcomes to PS and CR designs 6 months after TKJR, and patients were more satisfied with their outcome. Compared with CR, patients with MS prosthesis also reported superior pain, function, and quality-of-life outcomes at 12 months.

Lower-limb joint mechanics during maximum acceleration sprinting.

We explored how humans adjust the stance phase mechanical function of their major lower-limb joints (hip, knee, ankle) during maximum acceleration sprinting. Experimental data [motion capture and ground reaction force (GRF)] were recorded from eight participants as they performed overground sprinting trials. Six alternative starting locations were used to obtain a dataset that incorporated the majority of the acceleration phase. Experimental data were combined with an inverse-dynamics-based analysis to calculate lower-limb joint mechanical variables. As forward acceleration magnitude decreased, the vertical GRF impulse remained nearly unchanged whereas the net horizontal GRF impulse became smaller as a result of less propulsion and more braking. Mechanical function was adjusted at all three joints, although more dramatic changes were observed at the hip and ankle. The impulse from the ankle plantar-flexor moment was almost always larger than those from the hip and knee extensor moments. Forward acceleration magnitude was linearly related to the impulses from the hip extensor moment (R2=0.45) and the ankle plantar-flexor moment (R2=0.47). Forward acceleration magnitude was also linearly related to the net work done at all three joints, with the ankle displaying the strongest relationship (R2=0.64). The ankle produced the largest amount of positive work (1.55±0.17 J kg-1) of all the joints, and provided a significantly greater proportion of the summed amount of lower-limb positive work as running speed increased and forward acceleration magnitude decreased. We conclude that the hip and especially the ankle represent key sources of positive work during the stance phase of maximum acceleration sprinting.

Athletes Rated as Poor Single-Leg Squat Performers Display Measurable Differences in Single-Leg Squat Biomechanics Compared With Good Performers.

CONTEXT: It is important to validate single-leg squat visual rating criteria used in clinical practice and research. Foot orthoses may improve single-leg squat performance in those who demonstrate biomechanics associated with increased risk of lower limb injury. OBJECTIVE: Validate visual rating criteria proposed by Crossley et al, by determining whether athletes rated as poor single-leg squat performers display different single-leg squat biomechanics than good performers; and evaluate immediate effects of foot orthoses on single-leg squat biomechanics in poor performers. DESIGN: Comparative cross-sectional study. SETTING: University laboratory. PARTICIPANTS: 79 asymptomatic athletes underwent video classification of single-leg squat performance based on established visual rating criteria (overall impression, trunk posture, pelvis "in space," hip movement, and knee movement), and were rated as good (n = 23), fair (n = 41), or poor (n = 15) performers. INTERVENTION: A subset of good (n = 16) and poor (n = 12) performers underwent biomechanical assessment, completing 5 continuous single-leg squats on their dominant limb while 3-dimensional motion analysis and ground reaction force data were recorded. Poor performers repeated the task standing on prefabricated foot orthoses. MAIN OUTCOME MEASURES: Peak external knee adduction moment (KAM) and peak angles for the trunk, hip, knee, and ankle. RESULTS: Compared with good performers, poor performers had a significantly lower peak KAM (mean difference = 0.11 Nm/kg, 95% confidence interval = 0.02 to 0.2 Nm/kg), higher peak hip adduction angle (-4.3°, -7.6° to -0.9°), and higher peak trunk axial rotation toward their stance limb (3.8°, 0.4° to 7.2°). Foot orthoses significantly increased the peak KAM in poor performers (-0.06 Nm/kg, -0.1 to -0.01 Nm/kg), with values approximating those observed in good performers. CONCLUSIONS: Findings validate Crossley et al's visual rating criteria for single-leg squat performance in asymptomatic athletes, and suggest that "off-the-shelf" foot orthoses may be a simple intervention for poor performers to normalize the magnitude of the external KAM during single-leg squat.

Physical activity when young provides lifelong benefits to cortical bone size and strength in men.

The skeleton shows greatest plasticity to physical activity-related mechanical loads during youth but is more at risk for failure during aging. Do the skeletal benefits of physical activity during youth persist with aging? To address this question, we used a uniquely controlled cross-sectional study design in which we compared the throwing-to-nonthrowing arm differences in humeral diaphysis bone properties in professional baseball players at different stages of their careers (n = 103) with dominant-to-nondominant arm differences in controls (n = 94). Throwing-related physical activity introduced extreme loading to the humeral diaphysis and nearly doubled its strength. Once throwing activities ceased, the cortical bone mass, area, and thickness benefits of physical activity during youth were gradually lost because of greater medullary expansion and cortical trabecularization. However, half of the bone size (total cross-sectional area) and one-third of the bone strength (polar moment of inertia) benefits of throwing-related physical activity during youth were maintained lifelong. In players who continued throwing during aging, some cortical bone mass and more strength benefits of the physical activity during youth were maintained as a result of less medullary expansion and cortical trabecularization. These data indicate that the old adage of "use it or lose it" is not entirely applicable to the skeleton and that physical activity during youth should be encouraged for lifelong bone health, with the focus being optimization of bone size and strength rather than the current paradigm of increasing mass. The data also indicate that physical activity should be encouraged during aging to reduce skeletal structural decay.

Modulation of work and power by the human lower-limb joints with increasing steady-state locomotion speed.

We investigated how the human lower-limb joints modulate work and power during walking and running on level ground. Experimental data were recorded from seven participants for a broad range of steady-state locomotion speeds (walking at 1.59±0.09 m s(-1) to sprinting at 8.95±0.70 m s(-1)). We calculated hip, knee and ankle work and average power (i.e. over time), along with the relative contribution from each joint towards the total (sum of hip, knee and ankle) amount of work and average power produced by the lower limb. Irrespective of locomotion speed, ankle positive work was greatest during stance, whereas hip positive work was greatest during swing. Ankle positive work increased with faster locomotion until a running speed of 5.01±0.11 m s(-1), where it plateaued at ∼1.3 J kg(-1). In contrast, hip positive work during stance and swing, as well as knee negative work during swing, all increased when running speed progressed beyond 5.01±0.11 m s(-1). When switching from walking to running at the same speed (∼2.0 m s(-1)), the ankle's contribution to the average power generated (and positive work done) by the lower limb during stance significantly increased from 52.7±10.4% to 65.3±7.5% (P=0.001), whereas the hip's contribution significantly decreased from 23.0±9.7% to 5.5±4.6% (P=0.004). With faster running, the hip's contribution to the average power generated (and positive work done) by the lower limb significantly increased during stance (P<0.001) and swing (P=0.003). Our results suggest that changing locomotion mode and faster steady-state running speeds are not simply achieved via proportional increases in work and average power at the lower-limb joints.

Tendon elastic strain energy in the human ankle plantar-flexors and its role with increased running speed.

The human ankle plantar-flexors, the soleus and gastrocnemius, utilize tendon elastic strain energy to reduce muscle fiber work and optimize contractile conditions during running. However, studies to date have considered only slow to moderate running speeds up to 5 m s(-1). Little is known about how the human ankle plantar-flexors utilize tendon elastic strain energy as running speed is advanced towards maximum sprinting. We used data obtained from gait experiments in conjunction with musculoskeletal modeling and optimization techniques to calculate muscle-tendon unit (MTU) work, tendon elastic strain energy and muscle fiber work for the ankle plantar-flexors as participants ran at five discrete steady-state speeds ranging from jogging (~2 m s(-1)) to sprinting (≥8 m s(-1)). As running speed progressed from jogging to sprinting, the contribution of tendon elastic strain energy to the positive work generated by the MTU increased from 53% to 74% for the soleus and from 62% to 75% for the gastrocnemius. This increase was facilitated by greater muscle activation and the relatively isometric behavior of the soleus and gastrocnemius muscle fibers. Both of these characteristics enhanced tendon stretch and recoil, which contributed to the bulk of the change in MTU length. Our results suggest that as steady-state running speed is advanced towards maximum sprinting, the human ankle plantar-flexors continue to prioritize the storage and recovery of tendon elastic strain energy over muscle fiber work.

Patellofemoral joint loading during stair ambulation in people with patellofemoral osteoarthritis.

OBJECTIVE: To determine whether people with patellofemoral (PF) joint osteoarthritis (OA) ascend and descend stairs with different PF joint loading, knee joint moments, lower limb kinematics, and muscle forces compared to healthy people. METHODS: We recruited 17 participants with isolated PF joint OA, 13 participants with concurrent PF joint OA and tibiofemoral (TF) joint OA, and 21 age-matched controls. Joint kinematics and ground reaction forces were measured while participants ascended and descended stairs at a self-selected speed. Musculoskeletal computer modeling was used to determine lower limb muscle forces and the PF joint reaction force, and these parameters were compared between groups by analysis of variance. RESULTS: Compared to their healthy counterparts, participants with isolated PF joint OA and participants with concurrent PF and TF joint OA ascended and descended stairs with lower knee extension moments, lower quadriceps muscle forces, lower PF joint reaction forces, and increased anterior pelvic tilt. Participants with OA also ascended stairs with increased hip flexion angles and descended stairs with smaller knee flexion angles and smaller hip abductor muscle forces. No differences were evident between the two groups with OA. CONCLUSION: Compared to their healthy counterparts, people with PF joint OA (with or without concurrent TF joint OA) exhibit lower PF joint reaction forces during stair ascent and descent, in conjunction with lower knee extension moments and lower quadriceps muscle forces.

Tibiofemoral Slip Velocity in Total Knee Arthroplasty is Design-Invariant but Activity-Dependent.

Tibiofemoral slip velocity is a key contributor to total knee arthroplasty (TKA) component wear, yet few studies have evaluated this quantity in vivo. The aim of the present study was to measure and compare tibiofemoral slip velocities in 3 TKA designs for a range of daily activities. Mobile biplane X-ray imaging was used to measure 6-degree-of-freedom tibiofemoral kinematics and the locations of articular contact in 75 patients implanted with a posterior-stabilized, cruciate-retaining, or medial-stabilized design while each patient performed level walking, step up, step down, sit-to-stand, and stand-to-sit. Using these data, tibiofemoral slip velocity was calculated for the duration of each activity for each TKA design. The pattern of tibiofemoral slip velocity was similar for all 3 TKA designs within each activity but markedly different across the 5 activities tested, with the magnitude of peak slip velocity being significantly higher in level walking (range: 158-211 mm/s) than in all other activities (range: 43-75 mm/s). The pattern of tibiofemoral slip velocity in both the medial and lateral compartments closely resembled the pattern of tibiofemoral (knee) flexion angular velocity, with a strong linear relationship observed between slip velocity and flexion angular velocity (r = 0.81-0.97). Tibiofemoral slip velocity was invariant to TKA design but was significantly affected by activity type. Our measurements of slip velocity and articular contact locations for a wide range of daily activities may be used as inputs in joint simulator testing protocols and computational models developed to estimate TKA component wear.

Optimizing Muscle-Tendon Lengths in Reverse Total Shoulder Arthroplasty: Evaluation of Surgical and Implant-Design-Related Parameters.

BACKGROUND: Optimizing the function of muscles that cross the glenohumeral articulation in reverse total shoulder arthroplasty (RTSA) is controversial. The current study used a geometric model of the shoulder to systematically examine surgical placement and implant-design parameters to determine which RTSA configuration most closely reproduces native muscle-tendon lengths of the deltoid and rotator cuff. METHODS: A geometric model of the glenohumeral joint was developed and adjusted to represent small, medium, and large shoulders. Muscle-tendon lengths were assessed for the anterior deltoid, middle deltoid, posterior deltoid, and supraspinatus from 0 to 90° of scaption; for the subscapularis from 0° to 60° of internal rotation (IR) and 0° to 60° of scaption; for the infraspinatus from 0° to 60° of external rotation (ER) and 0° to 60° of scaption; and for the teres minor from 0° to 60° of ER at 90° of scaption. RTSA designs were virtually implanted using the following parameters: (1) surgical placement with a centered or inferior glenosphere position and a humeral offset of 0, 5, or 10 mm relative to the anatomic neck plane, (2) implant design involving a glenosphere size of 30, 36, or 42 mm, glenosphere lateralization of 0, 5, or 10 mm, and humeral neck-shaft angle of 135°, 145°, or 155°. Thus, 486 RTSA-shoulder size combinations were analyzed. Linear regression assessed the strength of association between parameters and the change in each muscle-tendon length from the native length. RESULTS: The configuration that most closely restored anatomic muscle-tendon lengths in a small shoulder was a 30-mm glenosphere with a centered position, 5 mm of glenoid lateralization, 0 mm of humeral offset, and a 135° neck-shaft angle. For a medium shoulder, the corresponding combination was 36 mm, centered, 5 mm, 0 mm, and 135°. For a large shoulder, it was 30 mm, centered, 10 mm, 0 mm, and 135°. The most important implant-design parameter associated with restoration of native muscle-tendon lengths was the neck-shaft angle, with a 135° neck-shaft angle being favored (ß = 0.568 to 0.657, p < 0.001). The most important surgical parameter associated with restoration of native muscle-tendon lengths was humeral offset, with a humeral socket placed at the anatomic neck plane being favored (ß = 0.441 to 0.535, p < 0.001). CONCLUSIONS: A combination of a smaller, lateralized glenosphere, a humeral socket placed at the anatomic neck plane, and an anatomic 135° neck-shaft angle best restored native deltoid and rotator cuff muscle-tendon lengths in RTSA. CLINICAL RELEVANCE: This study of surgical and implant factors in RTSA highlighted optimal configurations for restoration of native muscle-tendon lengths of the deltoid and rotator cuff, which has direct implications for surgical technique and implant selection. Additionally, it demonstrated the most influential surgical and implant factors with respect to muscle-tendon lengths, which can be used to aid intraoperative decision-making.

Stretch and activation of the human biarticular hamstrings across a range of running speeds.

PURPOSE: The human biarticular hamstrings [semimembranosus (SM), semitendinosus (ST) and biceps femoris long head (BF(LH))] have an important role in running. This study determined how hamstrings neuro-mechanical behaviour changed with faster running, and whether differences existed between SM, ST and BF(LH). METHODS: Whole-body kinematics and hamstrings electromyographic (EMG) activity were measured from seven participants running at four discrete speeds (range: 3.4 ± 0.1 to 9.0 ± 0.7 m/s). Kinematic data were combined with a three-dimensional musculoskeletal model to calculate muscle-tendon unit (MTU) stretch and velocity. Activation duration and magnitude were determined from EMG data. RESULTS: With faster running, MTU stretch and velocity patterns remained similar, but maxima and minima significantly increased. The hamstrings were activated from foot-strike until terminal stance or early swing, and then again from mid-swing until foot-strike. Activation duration was similar with faster running, whereas activation magnitude significantly increased. Hamstrings activation almost always ended before minimum MTU stretch, and it always started before maximum MTU stretch. Comparing the hamstrings, maximum MTU stretch was largest for BF(LH) and smallest for ST irrespective of running speed, while the opposite was true for peak-to-peak MTU stretch. Furthermore, peak MTU shortening velocity was largest for ST and smallest for BF(LH) at all running speeds. Finally, for the two fastest running speeds, the amount of MTU stretch that occurred during terminal swing after activation had started was less for BF(LH) compared to SM and ST. CONCLUSION: Differences were evident in biarticular hamstrings neuro-mechanical behaviour during running. Such findings have implications for hamstrings function and injury.

A Two-Degree-of-Freedom Knee Model Predicts Full Three-Dimensional Tibiofemoral and Patellofemoral Joint Motion During Functional Activity.

Six kinematic parameters are needed to fully describe three-dimensional (3D) bone motion at a joint. At the knee, the relative movements of the femur and tibia are often represented by a 1-degree-of-freedom (1-DOF) model with a single flexion-extension axis or a 2-DOF model comprising a flexion-extension axis and an internal-external rotation axis. The primary aim of this study was to determine the accuracy with which 1-DOF and 2-DOF models predict the 3D movements of the femur, tibia and patella during daily activities. Each model was created by fitting polynomial functions to 3D tibiofemoral (TF) and patellofemoral (PF) kinematic data recorded from 10 healthy individuals performing 6 functional activities. Model cross-validation analyses showed that the 2-DOF model predicted 3D knee kinematics more accurately than the 1-DOF model. At the TF joint, mean root-mean-square (RMS) errors across all activities and all participants were 3.4°|mm (deg or mm) for the 1-DOF model and 2.4°|mm for the 2-DOF model. At the PF joint, mean RMS errors were 4.0°|mm and 3.9°|mm for the 1-DOF and 2-DOF models, respectively. These results indicate that a 2-DOF model with two rotations as inputs may be used with confidence to predict the full 3D motion of the knee-joint complex.

Muscle Contributions to Take-Off Velocity in the Long Jump.

PURPOSE: A key determinant of long jump performance is the ability to increase the vertical velocity of the center of mass (COM) while minimizing the loss in forward velocity (running speed) during the take-off phase, but exactly how this occurs is not fully understood. We combined a three-dimensional musculoskeletal model of the body with dynamic optimization theory to simulate the biomechanics of the long jump take-off and determine the contributions of the individual leg muscles to jump performance. METHODS: The body was modeled as a 29-degree-of-freedom skeleton actuated by a combination of muscles and net joint torques. A dynamic optimization problem was solved to reproduce full-body motion and ground-force data recorded from experienced subelite jumpers. The optimization solution then was analyzed to determine each muscle's contribution to the ground-force impulse and hence the change in velocity of the COM during the take-off phase. RESULTS: The hip, knee, and ankle extensors dominated the change in velocity of the COM during take-off. Vasti (VAS) generated the highest support impulse and contributed one-third (33%) of the increase in vertical COM velocity generated by all the muscles. Soleus (SOL) and gluteus maximus (GMAX) also developed substantial support impulses and contributed 24% and 16% of the increase in vertical COM velocity, respectively. VAS also generated the highest braking impulse and contributed approximately one-half (55%) of the loss in forward COM velocity generated by all the muscles, whereas SOL and GMAX made much smaller contributions (12% and 7%, respectively). CONCLUSIONS: VAS, SOL, and GMAX contributed nearly three-quarters (73%) of the increase in vertical COM velocity at take-off, suggesting that these muscles ought to be prioritized in strength training programs aimed at improving long jump performance.

Influence of muscle loading on early-stage bone fracture healing.

Designing weight-bearing exercises for patients with lower-limb bone fractures is challenging and requires a systematic approach that accounts for patient-specific loading conditions. However, 'trial-and-error' approaches are commonplace in clinical settings due to the lack of a fundamental understanding of the effect of weight-bearing exercises on the bone healing process. Whilst computational modelling has the potential to assist clinicians in designing effective patient-specific weight-bearing exercises, current models do not explicitly account for the effects of muscle loading, which could play an important role in mediating the mechanical microenvironment of a fracture site. We combined a fracture healing model involving a tibial fracture stabilised with a locking compression plate (LCP) with a detailed musculoskeletal model of the lower limb to determine interfragmentary strains in the vicinity of the fracture site during both full weight-bearing (100% body weight) and partial weight-bearing (50% body weight) standing. We found that muscle loading significantly altered model predictions of interfragmentary strains. For a fractured bone with a standard LCP configuration (bone-plate distance = 2 mm, working length = 30 mm) subject to full weight-bearing, the predicted strains at the near and far cortices were 23% and 11% higher when muscle loading was included compared to the case when muscle loading was omitted. The knee and ankle muscles accounted for 38% of the contact force exerted at the knee joint during quiet standing and contributed significantly to the strains calculated at the fracture site. Thus, models of bone fracture healing ought to account explicitly for the effects of muscle loading. Furthermore, the study indicated that LCP configuration parameters play a crucial role in influencing the fracture site microenvironment. The results highlighted the dominance of working length over bone-plate distance in controlling the flexibility of fracture sites stabilised with LCP devices.

Kinematic function of knee implant designs across a range of daily activities.

The aim of this randomized controlled trial was to measure and compare six-degree-of-freedom (6-DOF) knee joint motion of three total knee arthroplasty (TKA) implant designs across a range of daily activities. Seventy-five TKA patients were recruited to this study and randomly assigned a posterior-stabilized (PS), cruciate-retaining (CR), or medial-stabilized (MS) implant. Six months after surgery, patients performed five activities of daily living: level walking, step-up, step-down, sit-to-stand, and stand-to-sit. Mobile biplane X-ray imaging was used to measure 6-DOF knee kinematics and the center of rotation of the knee in the transverse plane for each activity. Mean 6-DOF knee kinematics were consistently similar for PS and CR, whereas MS was more externally rotated and abducted, and lateral shift was lower across all activities. Peak-to-peak anterior drawer for MS was also significantly lower during walking, step-up, and step-down (p < 0.017). The center of rotation of the knee in the transverse plane was located on the medial side for MS, whereas PS and CR rotated about the lateral compartment or close to the tibial origin. The kinematic function of MS was more similar to that of the healthy knee than PS and CR based on reduced paradoxical anterior translation at low flexion angles and a transverse center of rotation located in the medial compartment. Overall, 6-DOF knee joint motion for PS and CR were similar across all daily activities, whereas that measured for MS was appreciably different. The kinematic patterns observed for MS reflects a highly conforming medial articulation in the MS design.

Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance.

Humans run faster by increasing a combination of stride length and stride frequency. In slow and medium-paced running, stride length is increased by exerting larger support forces during ground contact, whereas in fast running and sprinting, stride frequency is increased by swinging the legs more rapidly through the air. Many studies have investigated the mechanics of human running, yet little is known about how the individual leg muscles accelerate the joints and centre of mass during this task. The aim of this study was to describe and explain the synergistic actions of the individual leg muscles over a wide range of running speeds, from slow running to maximal sprinting. Experimental gait data from nine subjects were combined with a detailed computer model of the musculoskeletal system to determine the forces developed by the leg muscles at different running speeds. For speeds up to 7 m s(-1), the ankle plantarflexors, soleus and gastrocnemius, contributed most significantly to vertical support forces and hence increases in stride length. At speeds greater than 7 m s(-1), these muscles shortened at relatively high velocities and had less time to generate the forces needed for support. Thus, above 7 m s(-1), the strategy used to increase running speed shifted to the goal of increasing stride frequency. The hip muscles, primarily the iliopsoas, gluteus maximus and hamstrings, achieved this goal by accelerating the hip and knee joints more vigorously during swing. These findings provide insight into the strategies used by the leg muscles to maximise running performance and have implications for the design of athletic training programs.