Metabolic adaptation and related biomechanics in an ankle-based exoskeleton system during six sessions of steady state walking.

Ankle-based exoskeletons have demonstrated metabolic benefits during steady-state walking; however, variability exists in individual adaptation timelines necessary to achieve those benefits. This study assessed timelines for metabolic and gait-related adaptation while wearing an ankle-based exoskeleton while powered (EXOP) compared to unpowered (EXNP) and no device worn (NOEX). Metabolic (VO2) and biomechanics data were collected while 14 participants walked on a treadmill at 1.3 m/s for six sessions. To better understand variability in responses to wearing exoskeletons, the cohort was divided based on the slope of the VO2 response of the first two sessions in the EXOP condition, and gait parameters were compared between subgroups. Repeated measures analyses of variance revealed a significant (p ≤ 0.001) 10% VO2 reduction for EXOP compared to EXNP and a non-significant 2.5% reduction for EXOP v NOEX. Lack of significant session-based comparisons indicated no additional VO2 adaptation; however, significant session-related results for peak knee flexion (interaction, p = 0.042) and step width (session main effect, p = 0.003) suggest gait-related adaptation continued during the sessions. Subgroup results indicated different response profiles to wearing exoskeletons; and implications of classifying initial responses based on metabolic response are discussed as an approach to understand what drives variation in responses to these devices.

After initial training, VO₂ reductions were observed with an ankle-based exoskeleton during the initial session and those reductions were maintained for the remaining sessions. Some gait-related variables continued to change over the remaining sessions. Exploratory work based on differences between early metabolic responses revealed potential adaptation strategy subgroups.

Gait instability and estimated core temperature predict exertional heat stroke.

OBJECTIVE: Exertional heat stroke (EHS), characterised by a high core body temperature (Tcr) and central nervous system (CNS) dysfunction, is a concern for athletes, workers and military personnel who must train and perform in hot environments. The objective of this study was to determine whether algorithms that estimate Tcr from heart rate and gait instability from a trunk-worn sensor system can forward predict EHS onset. METHODS: Heart rate and three-axis accelerometry data were collected from chest-worn sensors from 1806 US military personnel participating in timed 4/5-mile runs, and loaded marches of 7 and 12 miles; in total, 3422 high EHS-risk training datasets were available for analysis. Six soldiers were diagnosed with heat stroke and all had rectal temperatures of >41°C when first measured and were exhibiting CNS dysfunction. Estimated core temperature (ECTemp) was computed from sequential measures of heart rate. Gait instability was computed from three-axis accelerometry using features of pattern dispersion and autocorrelation. RESULTS: The six soldiers who experienced heat stroke were among the hottest compared with the other soldiers in the respective training events with ECTemps ranging from 39.2°C to 40.8°C. Combining ECTemp and gait instability measures successfully identified all six EHS casualties at least 3.5 min in advance of collapse while falsely identifying 6.1% (209 total false positives) examples where exertional heat illness symptoms were neither observed nor reported. No false-negative cases were noted. CONCLUSION: The combination of two algorithms that estimate Tcr and ataxic gate appears promising for real-time alerting of impending EHS.

Severity of Overuse Injury Impacts Self-Efficacy and Quality of Life in Runners: A 2-Year Prospective Cohort Study.

CONTEXT: While 55 million Americans incorporate running into their exercise routines, up to 65% of runners sustain an overuse injury annually. It has been consistently shown that regular physical activity positively impacts quality of life (QOL), an essential public health indicator; however, the impact of running-related injuries on QOL is unknown. This study seeks to determine whether overuse injury severity impacts QOL in recreational runners, and if self-efficacy mediates this relationship. DESIGN: Community-based prospective cohort study of 300 runners who had been running injury free for at least 5 miles/wk in the past 6 months. METHODS: Self-efficacy for running and QOL measures (Short Form-12 Physical Component and Mental Component, Satisfaction with Life, Positive Affect and Negative Affect) were assessed at baseline, time of injury, and follow-up visits. Over 2 years of observation, overuse injuries were diagnosed by an orthopedic surgeon and injured runners were referred to a physical therapist. RESULTS: Injury severity was significantly (P < .01) related with 2 indices of QOL, such that the effect of injury severity was -2.28 units on the Short Form-12 physical component and -0.73 units on positive affect. Self-efficacy accounted for 19% and 48% of the indirect effects on Short Form-12 physical component and positive affect, respectively. CONCLUSIONS: Since self-efficacy is a modifiable factor related to decreased QOL, these findings have important clinical implications for rehabilitation interventions.

Biomechanics of Load Carriage--Historical Perspectives and Recent Insights.

Loads carried by the warfighter have increased substantially throughout recorded history, with the typical U.S. ground soldier carrying external loads averaging 45 kg during operations in Afghanistan. Incidence of disability in the U.S. Army has also increased sixfold since the 1980s, predominantly driven by increases in musculoskeletal injuries, with load carriage implicated as a possible mechanism. This article will provide a brief overview of the biomechanics of load carriage and will provide some recent insights into how the stress of the loads carried by military personnel can affect the musculoskeletal system. Studies into the biomechanics of load carriage have documented motion-related differences such as increased step rate, decreased stride length, and more trunk lean with increases in pack-borne loads. However, there is a paucity of literature on the relationship between load carriage and biomechanical mechanisms of overuse injury. Findings of recent studies will be presented, which add mechanistic information to increased stresses on the lower extremity. This was particularly true at the knee, where in one study, peak knee extension moment increased 115% when carrying a 55 kg load (0.87 ± 0.16 Nm·kg⁻¹) vs. no external load (0.40 ± 0.13 Nm·kg⁻¹). Efforts to model injury mechanisms require continued biomechanical measurements in humans while carrying occupationally relevant loads to be validated. Specifically, imaging technologies (e.g., bone geometry scans) should be incorporated to produce higher fidelity model of the stresses and strains experienced by the load carrier. In addition to laboratory-based biomechanics, data are needed to further explore the mechanistic relationship between load magnitude and injury; to this end, wearable sensors should continue to be exploited to accurately quantify biomechanical stresses related to load carriage in the field.

Lower extremity mechanics during marching at three different cadences for 60 minutes.

During group marches, soldiers must walk in step with one another at the same imposed cadence. The literature suggests that shorter trainees may be more susceptible to injury due to overstriding that can occur when taller recruits dictate marching cadence. This study assessed the effects of fixed cadence simulated marching at cadences above and below preferred step rate (PSR) on lower extremity joint mechanics in individuals who were unaccustomed to marching. During three separate visits, 13 volunteers walked with a 20 kg load on a force-sensing treadmill at self-selected PSR, PSR+15% (shorter strides), and PSR-15% (longer strides) at 1.3 m/s for 60 min. Two-way RM ANOVAs (cadence by time) were performed during the stance phase. Ranges of motion and anteroposterior ground reaction force increased significantly as cadence decreased (P < .03). Knee extension moment increased slightly when step rate decreased from PSR+15% (shortest strides, 0.85 ± 0.2 N m/kg) to PSR (0.87 ± 0.3 N m/kg, 3% increase); however, this increase was substantially greater (20% increase) when cadence was decreased from PSR to PSR-15% (longest strides, 1.09 ± 0.3 N m/kg). Our results indicate that overstriding during fixed-cadence marching is a factor that can substantially increase mechanical stress on lower extremity joints.

A history of low back pain affects pelvis and trunk mechanics during a sustained lift/lower task.

This study compared three-dimensional trunk and pelvis range of motion (ROM) during a sustained asymmetric box lift/lower task between a group with a history of low back pain (HBP, n = 9) and a group with no history of low back pain (NBP, n = 9). Participants lifted an 11-kg box for 10 min at 12 cycles/min from ankle height in front to shelves 45 deg off-centre at waist height. Kinematic data were collected at the beginning (min1), middle (min5) and end of the bout (min9). Two-way analyses of variance were performed for all variables. Pelvis and trunk transverse ROM were similar at min1. By min9, HBP group did not change (31.9 ± 9 deg); however, ROM decreased in NBP group (21.6 ± 6 deg, p < 0.05). Therefore, despite no current pain, the HBP group demonstrated protective lifting mechanics compared to controls. Also discussed are implications for studying lifting paradigms at sub-maximal effort over longer periods of time. PRACTITIONER SUMMARY: Differences between groups over time demonstrate residual consequences of low back pain (LBP) in a manual materials handling scenario. Individuals with a history of LBP (pain free for 6 months) demonstrated more conservative lifting mechanics towards the end of the bout compared to controls with no history of LBP.

Characterizing Relationships Among the Cognitive, Physical, Social-emotional, and Health-related Traits of Military Personnel.

INTRODUCTION: Personnel engaged in high-stakes occupations, such as military personnel, law enforcement, and emergency first responders, must sustain performance through a range of environmental stressors. To maximize the effectiveness of military personnel, an a priori understanding of traits can help predict their physical and cognitive performance under stress and adversity. This work developed and assessed a suite of measures that have the potential to predict performance during operational scenarios. These measures were designed to characterize four specific trait-based domains: cognitive, health, physical, and social-emotional. MATERIALS AND METHODS: One hundred and ninety-one active duty U.S. Army soldiers completed interleaved questionnaire-based, seated task-based, and physical task-based measures over a period of 3-5 days. Redundancy analysis, dimensionality reduction, and network analyses revealed several patterns of interest. RESULTS: First, unique variable analysis revealed a minimally redundant battery of instruments. Second, principal component analysis showed that metrics tended to cluster together in three to five components within each domain. Finally, analyses of cross-domain associations using network analysis illustrated that cognitive, health, physical, and social-emotional domains showed strong construct solidarity. CONCLUSIONS: The present battery of metrics presents a fieldable toolkit that may be used to predict operational performance that can be clustered into separate components or used independently. It will aid predictive algorithm development aimed to identify critical predictors of individual military personnel and small-unit performance outcomes.

Carrying a rifle with both hands affects upper body transverse plane kinematics and pelvis-trunk coordination.

The purpose of this study was to assess how carrying a rifle in both hands affects upper body motion and coordination during locomotion. In total, 11 male soldiers walked (1.34 m/s) and ran (2.46 m/s) with a weapon (M4 condition) and without a weapon (NW condition) while kinematic pelvis and trunk data were collected. Two-way ANOVA was used to compare segmental ranges of motion (ROM), pelvis-trunk coordination (continuous relative phase) and coordination variability between gait mode and weapon combinations. Carrying a weapon decreased sagittal plane trunk ROM at both speeds and increased trunk rotation during running. Mean (±SD) transverse plane coordination was more in-phase while carrying a weapon (M4 = 83°±31, NW = 60°±36, p = 0.027) and transverse plane coordination variability decreased (M4 = 23°±3.6, NW = 15°±4.4, p = 0.043). Coordination differences between M4 and NW were similar to differences reported in the literature between individuals with and without back pain. Long-term injury implications due to decreased coordination variability are discussed. STATEMENT OF RELEVANCE: Knowledge of the effects of rifle carriage on pelvis-trunk coordination may provide insight into short-term protective strategies and long-term injury mechanisms. These should be considered in occupations requiring individuals to carry torso loads in combination with holding an object in both hands that restricts arm swing.

Spatiotemporal and Kinematic Comparisons Between Anthropometrically Paired Male and Female Soldiers While Walking With Heavy Loads.

INTRODUCTION: Limited work comparing the effect of heavier carried loads (greater than 30 kg) between men and women has attributed observed differences to sex with the possibility that anthropometric differences may have contributed to those discrepancies. With the recent decision permitting women to enter Combat Arms roles, knowledge of sex-based differences in gait response to load carriage is more operationally relevant, as military loads are absolute and not relative to body weight. The purpose of this study was to describe differences in gait parameters at light to heavy loads between anthropometrically similar male and female soldiers. MATERIALS AND METHODS: Eight female and 8 male soldiers, frequency-matched (1-to-1) on height (±0.54 cm) and mass (±0.52 kg), walked at 1.34 m∙s-1 for 10-min bouts on a level treadmill while unloaded (BM) and then carrying randomized vest-borne loads of 15, 35, and 55 kg. Spatiotemporal and kinematic data were collected for 30 s after 5 min. Two-way repeated measures analyses of variance were conducted to compare the gait parameter variables between sexes at each load. RESULTS: As load increased, overall, the percent double support increased, step frequency increased, stride length decreased, hip and ankle range of motion (ROM) increased, and vertical center of mass (COM) displacement increased. Sex-based significant differences were observed in knee ROM and mediolateral COM displacement. Among the male participants, knee ROM increased significantly for all loads greater than BM. For mediolateral COM displacement, male remained constant as load increased, whereas female values decreased between BM and 35 kg. CONCLUSIONS: Spatiotemporal and kinematic differences in gait parameters were primarily because of increases in load magnitude. The observed sex-related differences with increasing loads suggest that women may require a more stable gait to support the additional load carried.

Lower extremity joint stiffness in runners with low back pain.

The purpose of this retrospective study was to examine lower extremity joint stiffness between runners with and without low back pain. We compared data from three groups: current low back pain (LBP), resolved pain (RES), and a control (CTRL) group of runners. We hypothesized that the LBP group would exhibit increased ankle, knee, and hip joint stiffness when compared with the other groups. Subjects ran on a force treadmill at 3.8 m*s(-1) while data were collected. Joint stiffness was determined from the joint moment-angle profiles. Differences were observed in knee joint stiffness, with the LBP group exhibiting the greatest stiffness values. No differences in ankle or hip joint stiffness were observed. These data suggest that the LBP group of runners may not attenuate the foot-ground impact to the same level as the other groups. The decreased attenuation may increase the level of the shock to the low back region, thus potentially increasing the load on the low back.

In vivo lumbo-sacral forces and moments during constant speed running at different stride lengths.

The aim of this study was to introduce a Newton-Euler inverse dynamics model that included reaction force and moment estimation at the lumbo-sacral (L5-S1) and thoraco-lumbar (T12-L1) joints. Data were collected while participants ran over ground at 3.8 m x s(-1) at three different stride lengths: preferred stride length, 20% greater than preferred, and 20% less than preferred. Inputs to the model were ground reaction forces, bilateral lower extremity and pelvis kinematics and inertial parameters, kinematics of the lumbar spine and thorax and inertial parameters of the lumbar segment. Repeated measures ANOVA were performed on the lower extremity sagittal kinematics and kinetics, including L5-S1 and T12-L1 three-dimensional joint angles, reaction forces and moments at touchdown and peak values during impact phase across the three stride conditions. Results indicated that L5-S1 and T12-L1 vertical reaction forces at touchdown and during the impact portion of the support phase increased significantly as stride length increased (P < 0.001), as did peak sagittal L5-S1 moments during impact (P = 0.018). Additionally, the transverse T12-L1 joint moment increased as running speed increased (P = 0.006). We concluded from our findings that our model was sensitive to our perturbations in healthy runners, and may prove useful in future mechanistic studies of L5-S1 mechanics.

Lower-Extremity Injury Increases Risk of First-Time Low Back Pain in the US Army.

Low back pain (LBP) and lower-extremity injuries (LEI) are primary reasons for lost duty days and disability among military populations. PURPOSE: This study examined acute LEI as a risk factor for developing LBP and examined the time to incident LBP between individuals with and without a history of LEI. METHODS: This retrospective cohort study examined U.S. Army medical and personnel data from the Total Army Injury and Health Outcomes Database for the years 2007 to 2011. Andersen-Gill Cox regression methods were used to examine the change in LEI status over time and changes in demographic covariates. Adjusted hazard ratios (HR) for LBP after LEI were calculated from the Cox regression model for each calendar year. An accelerated failure time (AFT) model was used to describe time to LBP, and mean time to event and adjusted time ratios (TR) after LEI were calculated from the AFT model for each year. Overall HR and TR for LBP after LEI were calculated over the five calendar years using variance-based weighted averages. RESULTS: Each yearly analysis included an average of 213,307 soldiers; on average for each year 8.44% of soldiers developed LBP and 11.54% had previous LEI. The pooled TR showed soldiers with a LEI had a 10% decrease in mean survival times to LBP compared to those without a LEI (TR, 0.901; 95% confidence interval, 0.897-0.905). The weighted average HR showed that soldiers with a LEI had 1.7 times the hazard of LBP compared with those without LEI (HR, 1.70; 95% confidence interval, 1.66-1.74). CONCLUSIONS: These findings suggest that a potential second-order effect of LEI is an increased short-term risk for developing LBP, which should be considered during rehabilitation planning.

A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS).

BACKGROUND: The National Center for Injury Prevention and Control, noting flaws in previous running injury research, called for more rigorous prospective designs and comprehensive analyses to define the origin of running injuries. PURPOSE: To determine the risk factors that differentiate recreational runners who remain uninjured from those diagnosed with an overuse running injury during a 2-year observational period. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Inclusion criteria were running a minimum of 5 miles per week and being injury free for at least the past 6 months. Data were collected at baseline on training, medical and injury histories, demographics, anthropometrics, strength, gait biomechanics, and psychosocial variables. Injuries occurring over the 2-year observation period were diagnosed by an orthopaedic surgeon on the basis of predetermined definitions. RESULTS: Of the 300 runners who entered the study, 199 (66%) sustained at least 1 injury, including 73% of women and 62% of men. Of the injured runners, 111 (56%) sustained injuries more than once. In bivariate analyses, significant ( P ≤ .05) factors at baseline that predicted injury were as follows: Short Form Health Survey-12 mental component score (lower mental health-related quality of life), Positive and Negative Affect Scale negative affect score (more negative emotions), sex (higher percentage of women were injured), and knee stiffness (greater stiffness was associated with injury); subsequently, knee stiffness was the lone significant predictor of injury (odds ratio = 1.18) in a multivariable analysis. Flexibility, quadriceps angle, arch height, rearfoot motion, strength, footwear, and previous injury were not significant risk factors for injury. CONCLUSION: The results of this study indicate the following: (1) among recreational runners, women sustain injuries at a higher rate than men; (2) greater knee stiffness, more common in runners with higher body weights (≥80 kg), significantly increases the odds of sustaining an overuse running injury; and (3) contrary to several long-held beliefs, flexibility, arch height, quadriceps angle, rearfoot motion, lower extremity strength, weekly mileage, footwear, and previous injury are not significant etiologic factors across all overuse running injuries.

A history of low back pain affects pelvis and trunk coordination during a sustained manual materials handling task.

PURPOSE: The purpose of this study was to compare the coordination between the trunk and the pelvis during a sustained asymmetric repetitive lifting task between a group with a history of low back pain (LBP; HBP) and a group with no history of LBP (NBP). METHODS: Volunteers lifted a 11-kg box from ankle height in front to a shelf 45° off-center at waist height, and lowered it to the start position at 12 cycles/min for 10 min. Lifting side was alternated during the trial. Continuous relative phase was used to calculate coordination between the pelvis and trunk rotation at the beginning (Min 1), middle (Min 5), and end of the bout (Min 9). RESULTS: While there were no main effects for group, a significant interaction between time and group indicated that, in the frontal plane, the NBP group coordination was more anti-phase toward the end of the bout, with no such differences for the HBP group. Analysis of sagittal-axial (bend and twist) coordination revealed the HBP group coordination was more in-phase at the end of the bout over the entire cycle and for the lifting phase alone, with no such differences for the NBP group. CONCLUSION: Differences between groups demonstrate residual consequences of LBP in an occupational scenario, even though the HBP group was pain-free for >6 months prior to data collection. More in-phase coordination in the HBP group may represent a coordination pattern analogous to "guarded gait" which has been observed in other studies, and may lend insight as to why these individuals are at increased risk for re-injury.

Spatiotemporal Parameters are not Substantially Influenced by Load Carriage or Inclination During Treadmill and Overground Walking.

Influences of load carriage and inclination on spatiotemporal parameters were examined during treadmill and overground walking. Ten soldiers walked on a treadmill and overground with three load conditions (00 kg, 20 kg, 40 kg) during level, uphill (6% grade) and downhill (-6% grade) inclinations at self-selected speed, which was constant across conditions. Mean values and standard deviations for double support percentage, stride length and a step rate were compared across conditions. Double support percentage increased with load and inclination change from uphill to level walking, with a 0.4% stance greater increase at the 20 kg condition compared to 00 kg. As inclination changed from uphill to downhill, the step rate increased more overground (4.3 ± 3.5 steps/min) than during treadmill walking (1.7 ± 2.3 steps/min). For the 40 kg condition, the standard deviations were larger than the 00 kg condition for both the step rate and double support percentage. There was no change between modes for step rate standard deviation. For overground compared to treadmill walking, standard deviation for stride length and double support percentage increased and decreased, respectively. Changes in the load of up to 40 kg, inclination of 6% grade away from the level (i.e., uphill or downhill) and mode (treadmill and overground) produced small, yet statistically significant changes in spatiotemporal parameters. Variability, as assessed by standard deviation, was not systematically lower during treadmill walking compared to overground walking. Due to the small magnitude of changes, treadmill walking appears to replicate the spatiotemporal parameters of overground walking.

An integrative modeling approach for the efficient estimation of cross sectional tibial stresses during locomotion.

The purpose of this research was to utilize a series of models to estimate the stress in a cross section of the tibia, located 62% from the proximal end, during walking. Twenty-eight male, active duty soldiers walked on an instrumented treadmill while external force data and kinematics were recorded. A rigid body model was used to estimate joint moments and reaction forces. A musculoskeletal model was used to gather muscle length, muscle velocity, moment arm and orientation information. Optimization procedures were used to estimate muscle forces and finally internal bone forces and moments were applied to an inhomogeneous, subject specific bone model obtained from CT scans to estimate stress in the bone cross section. Validity was assessed by comparison to stresses calculated from strain gage data in the literature and sensitivity was investigated using two simplified versions of the bone model-a homogeneous model and an ellipse approximation. Peak compressive stress occurred on the posterior aspect of the cross section (-47.5 ± 14.9 MPa). Peak tensile stress occurred on the anterior aspect (27.0 ± 11.7 MPa) while the location of peak shear was variable between subjects (7.2 ± 2.4 MPa). Peak compressive, tensile and shear stresses were within 0.52 MPa, 0.36 MPa and 3.02 MPa respectively of those calculated from the converted strain gage data. Peak values from a inhomogeneous model of the bone correlated well with homogeneous model (normal: 0.99; shear: 0.94) as did the normal ellipse model (r=0.89-0.96). However, the relationship between shear stress in the inhomogeneous model and ellipse model was less accurate (r=0.64). The procedures detailed in this paper provide a non-invasive and relatively quick method of estimating cross sectional stress that holds promise for assessing injury and osteogenic stimulus in bone during normal physical activity.

The Relationships between Age and Running Biomechanics.

UNLABELLED: Running has high injury rates, especially among older runners. Most aging literature compares young with old runners without accounting for the progression of biomechanics throughout the lifespan. We used age as a continuous variable to investigate the continuum of age-related gait adaptations in running along with determining the chronology and rate of these adaptations. PURPOSE: This study aimed to identify the relations among age and selected running biomechanics throughout the range of 18-60 yr. METHODS: Experienced (n = 110) healthy runners (male, 54%) provided informed consent and ran at their training pace while motion and force data were captured. Kinematics, ground reaction forces (GRF), and lower limb joint torques and powers were correlated with age using Pearson product-moment correlations and linear regression. RESULTS: Running velocity was inversely related to age (r = -0.27, P = 0.005) because of decreased stride length (r = -0.25, P = 0.008) but not rate. Peak vertical GRF (r = -0.23, P = 0.016) and peak horizontal propulsive GRF decreased with age (r = -0.38, P < 0.0001). Peak ankle torque (r = -0.32, P = 0.0007) and peak negative (r = 0.34, P = 0.0003) and positive (r = -0.37, P < 0.0001) ankle power decreased with age. Age-based regression equations and per-year reductions in all variables significantly related to age are reported. CONCLUSIONS: Data support previous work showing lower GRF, stride length, and velocity in old runners. Results are novel in showing the rate of decline in running biomechanics on a per-year basis and that mechanical reductions at the ankle but not at the hip or knee were correlated with age, confirming a previous observation of biomechanical plasticity with age showing reduced ankle but not hip function in gait.

Characterization of Foot-Strike Patterns: Lack of an Association With Injuries or Performance in Soldiers.

OBJECTIVES: Characterize the distribution of foot-strike (FS) patterns in U.S. Army Soldiers and determine if FS patterns are related to self-reported running injuries and performance. METHODS: 341 male Soldiers from a U.S. Army Combined Arms Battalion ran at their training pace for 100 meters, and FSs were recorded in the sagittal plane. Participants also completed a survey related to training habits, injury history, and run times. Two researchers classified FS patterns as heel strike (HS) or nonheel strike (NHS, combination of midfoot strike and forefoot strike patterns). Two clinicians classified the musculoskeletal injuries as acute or overuse. The relationship of FS type with two-mile run time and running-related injury was analyzed (p ≤ 0.05). RESULTS: The Soldiers predominately landed with an HS (87%) and only 13% were characterized as NHS. Running-related injury was similar between HS (50.3%) and NHS (55.6%) patterns (p = 0.51). There was no difference (p = 0.14) between overuse injury rates between an HS pattern (31.8%) and an NHS pattern (31.0%). Two-mile run times were also similar, with both groups averaging 14:48 minutes. CONCLUSION: Soldiers were mostly heel strikers (87%) in this U.S. Army Combined Arms Battalion. Neither FS pattern was advantageous for increased performance or decreased incidence of running-related injury.

Trunk bend and twist coordination is affected by low back pain status during running.

Recent literature has related differences in pelvis-trunk coordination to low back pain (LBP) status. In addition, repetitive motions involving bending and twisting have been linked to high incidence of LBP. The purpose of this study was to examine trunk sagittal motion - axial rotation ('bend and twist') coordination during locomotion in three groups of runners classified by LBP status (LBP: current low back pain; RES: resolved low back pain and CTR: control group with no history of LBP). Trunk kinematic data were collected as running speed was systematically increased on a treadmill. Within-segment coordination between trunk sagittal and transverse planes of motion (trunk lean and axial rotation, respectively) was calculated using continuous relative phase (CRP), and coordination variability was defined as the between stride cycle standard deviation of CRP (CRPvar). Bend-twist coordination was more in-phase for the LBP group than CTR (p = 0.010) regardless of running speed. No differences in CRPvar were found between the groups. The results from our coordination (CRP) analysis were sensitive to LBP status and suggest that multi-plane interactions of the trunk should be considered in the assessment of LBP. This analysis also has potential for athletically oriented tasks that involve multi-plane interactions of the trunk, particularly ones that contain asymmetric action, such as sweep rowing or a shot on goal in field hockey or ice hockey.

Lower extremity biomechanical changes associated with symmetrical torso loading during simulated marching.

The dose-response relationship between biomechanical variables and the magnitude of external loads is unclear. The use of different load distributions (e.g., pack types) may confound results because of changes in torso center of mass. Therefore, we examined the relationship between load magnitude and sagittal plane lower extremity mechanics of Soldiers walking with two symmetrically distributed loads. Fourteen Soldiers marched on a force-sensing treadmill at 1.34 m/s for 10 minutes with no load (BW_00) and while wearing vest-borne loads of 15 kg (BW_15) and 55 kg (BW_55). The effects of the loads on sagittal plane joint angles and moments were compared using 1-way repeated measures analyses of variance. Compared with BW_00, knee extension moment increased with the 15- and the 55-kg loads (both p < 0.003), confirming previously reported load-related biomechanical responses. Knee moment increases during early stance appeared to be the primary means by which the lower extremity counteracted BW_15 during early stance; in contrast, hip extensors and ankle dorsiflexors appeared to be the primary muscular efforts responsible for propulsion during late stance. Findings elucidated the effects of load magnitude on lower extremity mechanics without postural changes that result from pack-related shifts in torso center of mass.