Improving Engagement With Biomechanics: Student Perspectives and a Professional Development Initiative.

Student engagement is an essential aspect of educational environments, and this is especially true for Science, Technology, Engineering, and Mathematics (STEM) disciplines, where student engagement declines in middle and high school years. Techniques for bolstering student engagement, such as hands-on learning, may be especially effective in the field of biomechanics since this discipline is rooted in STEM and has fundamental applications to everyday movement. To this end, this paper describes (1) the perceptions of student teachers in their first year of tertiary (undergraduate) education regarding the biomechanics content from their secondary (high school) education, and (2) a professional development initiative, in the form of a discipline-specific teacher training workshop, to enhance biomechanics resources for teachers via peer networking. The perception of student teachers in their first year of tertiary education in teaching indicated a positive relationship between perception of secondary school teaching quality and self-confidence with specific biomechanical concepts. Open responses focused on the need to cover concepts thoroughly, using practical activities where possible, and taking time to ensure understanding before progressing to more advanced concepts. The teacher training workshop provided secondary school Physical Education teachers with an opportunity to network nationally with other teachers across New Zealand, and internationally with university-based biomechanics researchers. Peer focus groups helped to design and refine sets of experiential learning activities that could be easily implemented in the classroom.

The Proportion of Lower Limb Running Injuries by Gender, Anatomical Location and Specific Pathology: A Systematic Review.

Running is associated with a higher risk of overuse injury than other forms of aerobic exercise such as walking, swimming and cycling. An accurate description of the proportion of running injuries per anatomical location and where possible, per specific pathology, for both genders is required. The aim of this review was to determine the proportion of lower limb running injuries by anatomical location and by specific pathology in male and female runners (≥800m - ≤ marathon). The preferred reporting items for systematic reviews and meta-analyses guidelines were followed for this review. A literature search was performed with no restriction on publication year in Web of Science, Scopus, Sport-Discus, PubMed, and CINAHL up to July 2017. Retrospective, cross-sectional, prospective and randomised-controlled studies which surveyed injury data in runners were included. 36 studies were included to report the overall proportion of injury per anatomical location. The overall proportion of injury by specific pathology was reported from 11 studies. The knee (28%), ankle-foot (26%) and shank (16%) accounted for the highest proportion of injury in male and female runners, although the proportion of knee injury was greater in women (40% vs. 31%). Relative to women, men had a greater proportion of ankle-foot (26% vs. 19%) and shank (21% vs. 16%) injuries. Patellofemoral pain syndrome (PFPS; 17%), Achilles tendinopathy (AT; 10%) and medial tibial stress syndrome (MTS; 8%) accounted for the highest proportion of specific pathologies recorded overall. There was insufficient data to sub-divide specific pathology between genders. The predominate injury in female runners is to the knee. Male runners have a more even distribution of injury between the knee, shank and ankle-foot complex. There are several methodological issues, which limit the interpretation of epidemiological data in running injury.

Criteria and Guidelines for Returning to Running Following a Tibial Bone Stress Injury: A Scoping Review.

Tibial bone stress injuries (BSIs) are common among long-distance runners. They have a high recurrence rate, and complexity emerges in the wider management and successful return to running. Following a tibial BSI, a critical component of complete rehabilitation is the successful return to running, and there is a lack of consistency or strong evidence to guide this process. The objectives of this review were to outline the criteria used in clinical decision-making prior to resuming running, and to establish evidence-based guidelines for the return to running process following a tibial BSI. Electronic databases including MEDLINE, CINAHL, Scopus, SPORTDiscus and AMED were searched for studies that stated criteria or provided guidelines on the objectives above. Fifty studies met the inclusion criteria and were included. Thirty-nine were reviews or clinical commentaries, three were retrospective cohort studies, two were randomised controlled trials, two were pilot studies, one was a prospective observational study, and three were case studies. Therefore, the recommendations that have been surmised are based on level IV evidence. Decisions on when an athlete should return to running should be shared between clinicians, coaches and the athlete. There are five important components to address prior to introducing running, which are: the resolution of bony tenderness, pain-free walking, evidence of radiological healing in high-risk BSIs, strength, functional and loading tests, and the identification of contributing factors. Effective return to running planning should address the athlete's risk profile and manage the risk by balancing the athlete's interests and reinjury prevention. An individualised graduated return to running programme should be initiated, often starting with walk-run intervals, progressing running distance ahead of speed and intensity, with symptom provocation a key consideration. Contributing factors to the initial injury should be addressed throughout the return to run process.

Prevalence and Risk Factors for Musculoskeletal Pain when Running During Pregnancy: A Survey of 3102 Women.

BACKGROUND: Musculoskeletal pain while running is a concern to women during pregnancy and can lead to running cessation. To support women who wish to run during pregnancy, it is essential to understand the sites, severities and personal risk factors associated with musculoskeletal pain. OBJECTIVE: The aim was to investigate prevalence and risk factors for musculoskeletal pain when running during pregnancy. METHODS: An online survey was completed by women who had a child in the past 5 years and ran prior to and during pregnancy. Pain frequency informed prevalence rates by body site, and logistic regression odds ratios (ORs) and 95% confidence intervals were calculated. RESULTS: A total of 3102 women of 23 ethnicities from 25 countries completed the survey. Women were 22-52 years old when they gave birth and ran 2-129 km/week during the 0.5-35 years before the birth of their youngest child. Women ran significantly less distance and less often during pregnancy than before pregnancy. Most women (86%) experienced pain while running during pregnancy (59% pelvis/sacroiliac joint, 52% lower back, 51% abdomen, 44% breast, 40% hip). The highest prevalence of severe-to-worst pain was at the pelvis/sacroiliac joint (9%). Women at greatest risk of pain while running during pregnancy had a previous injury (OR = 3.44) or were older (OR = 1.04). Women with a previous child were less likely to experience breast pain (OR = 0.76) than those running during their first pregnancy. CONCLUSION: Healthcare practices to reduce pain should focus on regions of greatest musculoskeletal change during pregnancy, specifically the pelvis, lower back and abdomen. Efforts to support women to run for longer throughout pregnancy should focus on pain at the pelvis and breasts.

Rugby World Cup 2011: International Rugby Board injury surveillance study.

OBJECTIVE: To determine the frequency and nature of injuries sustained during the IRB 2011 Rugby World Cup. DESIGN: A prospective, whole population survey. POPULATION: 615 international rugby players representing 20 teams competing at the IRB 2011 Rugby World Cup in New Zealand. METHOD: The study was implemented according to the international consensus statement for epidemiological studies in rugby union; the main measures included the players' age (years), stature (cm) and body mass (Kg) and the incidence (number of injuries/1000 player-hours), mean and median severity (days absence), location (%), type (%) and cause (%) of match and training injuries. RESULTS: The incidences of injuries were 89.1/1000 player-match-hours (forwards: 85.0; backs: 93.8) and 2.2/1000 player-training-hours (forwards: 2.7; backs: 1.7). The mean severity of injuries was 23.6 days (forwards: 21.2; backs: 26.2) during matches and 26.9 (forwards: 33.4; backs: 14.3) during training. During matches, lower-limb muscle/tendon (31.6%) and ligament (15.8%) and, during training, lower-limb muscle/tendon (51.4%) and trunk muscle/tendon (11.4%) injuries were the most common injuries. The most common cause of injury during matches was the tackle (forwards: 43.6%, backs: 45.2%), and during training was full and semicontact skills activities. CONCLUSION: The results confirm that rugby, like other full-contact sports, has a high incidence of injury: the results from IRB Rugby World Cup (RWC) 2011 were similar to those reported for RWC 2007.

Lateral Wedging of the Foot: A Scoping Review.

Lateral wedges are a common intervention used to alter biomechanical function of the lower limb. Although there is evidence investigating the use and impact of lateral wedges in individuals with medial knee osteoarthritis, knowledge of how these wedges affect foot function in healthy adults is limited. Therefore, this study intends to investigate how lateral wedging affects foot function in healthy adults and, furthermore, how wedge design influences the outcome. The framework outlined by Arksey and O'Malley was used for this scoping review. To ensure methodologic quality and transparent reporting, the study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews preferred reporting guidelines. A systematic search was conducted using MEDLINE by means of EBSCO; SPORT Discuss; CINAHL; AMED by means of OVID; and Scopus. The initial search yielded 252 articles in total; 21 studies were included in the final analysis. Significant incongruence exists in descriptions of wedge length among the 21 included studies. Thirteen studies (61%) reported using full-length wedges, five studies did not report wedge length, and only one study analyzed more than one wedge length. Ethylene vinyl acetate was the most common material, and reporting of hardness was inconsistent. A broad range of inclination angles were used, with limited explanation for why these values were selected. All but one study that analyzed ankle/subtalar joint frontal plane moments reported an increase in the external eversion moment. The review identified significant variation in the design of wedges used within this body of work and a lack of investigation into the influence of wedge design. Wedge design appears to be a secondary consideration, with very few studies examining multiple material types or wedge placements. All but one of the included studies reported a significant change in ankle/subtalar joint moments with lateral wedging. Unfortunately, further generalization was not possible because of the inconsistency and variation.

Measurement of the Developing Foot in Shod and Barefoot Paediatric Populations: A Narrative Review.

The theory that footwear may change foot shape dates back 100 years. Since this period, research has revealed the anatomical and functional consequences that footwear can cause to the foot. Children's feet remain malleable as they undergo developmental changes until adolescence, which is why childhood is arguably a crucial period to understand how footwear can affect natural foot development. This review explored the development of the foot in children and adolescents and the methods used to measure the different foot structures; it comments on the key issues with some of these methods and gives direction for future research. Various internal and external factors can affect foot development; the main factors are age, gender, ethnicity, body mass index (BMI) and footwear habits. Research on how footwear can affect foot development has increased over the years and the final section of this review aimed to unpick the findings. Studies investigating the influence of footwear habits on foot length and width have established inconsistent findings. Many of the studies in the review did not control for internal and external factors that can affect foot development. There was also a limited number of studies that investigated hallux valgus angle and muscle strength differences in those with different footwear habits. Moreover, multiple studies in the final section of this review did not successfully examine the footwear habits of the participants and instead used observations or self-assessments, which is a major limitation. Future research should examine footwear behaviors and other confounding factors when investigating the development of the foot in children and adolescents. Moreover, researchers should critically evaluate the methods used to quantify the different structures of the foot to ensure valid and reliable parameters are being used.

Prevalence of sport specialisation and association with injury history in youth football.

OBJECTIVES: The aims of this study were to determine the prevalence of sport specialisation in youth football, and to investigate the associations of sport specialisation and volume of sport participation with injury history. DESIGN: Cross-sectional questionnaire. SETTING: New Zealand youth football teams. PARTICIPANTS: 414 youth football players aged 10-15 years. MAIN OUTCOME MEASURES: The level of specialisation, average weekly sport participation and free-play volume were recorded. 12-month injury history was captured and grouped by injury type. Associations between level of specialisation and demographic variables were analysed using chi square tests. Logistic regression was used to investigate associations between injury history, level of specialisation, and volume of participation. RESULTS: Participants were classified as high (43%), moderate (38%), or low (19%) specialised (n = 399 complete). High specialisation was more likely in boys, older participants, and those from large schools. Highly specialised participants were more likely to report a history of gradual onset injury than those who were low specialised (n = 340 with complete injury data). Odds of reporting a gradual onset injury also increased with greater weekly and annual sport participation volume. CONCLUSIONS: There is a high prevalence of sport specialisation in youth football, and it is associated with increased incidence of gradual onset injury.

The influence of running velocity on resultant tibial acceleration in runners.

Tibial acceleration is a surrogate measure for impact loading and might be useful for identifying lower limb fatigue injury in runners. The resultant tibial acceleration calculated from all three axes of a triaxial accelerometer provides a single metric that is independent of the sensor orientation. The purpose of this study was to investigate the relationship between resultant tibial acceleration and running velocity, and to establish a normative database of tibial acceleration profiles. Triaxial accelerometers were attached to the distal tibiae of 85 runners before they ran on a treadmill for 2 min each, at speeds of 2.7, 3.0, 3.3, and 3.7 m/s. Differences in resultant tibial acceleration were calculated using a one-way ANOVA, and the relationship between tibial acceleration and velocity was determined using a Pearson correlation coefficient and a multiple linear regression analysis. Tibial acceleration increased with higher velocities, with an average increase of 3.8 g (38%) between the slowest and fastest speeds. A moderate correlation was demonstrated between tibial acceleration and running velocity, and 19% of tibial acceleration was explained by velocity. While velocity influences tibial acceleration, individual variances to this relationship exist, highlighting the need for a personalised approach to understanding the response of each runner.

The effectiveness of real-time haptic feedback gait retraining for reducing resultant tibial acceleration with runners.

OBJECTIVES: To examine the effectiveness of real-time haptic feedback gait retraining for reducing resultant tibial acceleration (TA-R) with runners, the retention of changes over four weeks, and the transfer of learning to overground running. DESIGN: Case control. SETTING: Biomechanical laboratory treadmill, and track-based overground, running. PARTICIPANTS: 18 experienced uninjured high tibial acceleration runners. MAIN OUTCOME MEASURES: TA-R measured while treadmill and overground running assessed at pre-, post- and 4-weeks post-intervention. RESULTS: Across the group, a 50% reduction in TA-R was measured post-intervention (ES: 0.9, z = -18.2, p < .001), and 41% reduction at 4-weeks (ES: 0.8, z = -12.9, p < .001) with treadmill running. A 28% reduction (ES: 0.7, z = -13.2, p < .001), and a 17% reduction in TA-R were measured at these same time points when runners ran overground (ES: 0.7, z = -11.2, p < .001). All but two runners responded positively to the intervention at the post-intervention assessment. Eleven runners were categorised as positive responders to the intervention at the 4-week post-intervention. CONCLUSIONS: Haptic feedback based on TA-R appears to be as effective, but less invasive and expensive, compared to other more established modalities, such as visual feedback. This new approach to movement retraining has the potential to revolutionise the way runners engage in gait retraining.

The measurement of tibial acceleration in runners-A review of the factors that can affect tibial acceleration during running and evidence-based guidelines for its use.

BACKGROUND: Impact loading in runners, assessed by the measurement of tibial acceleration, has attracted substantial research attention. Due to potential injury links, particularly tibial fatigue fractures, tibial acceleration is also used as a clinical monitoring metric. There are contributing factors and potential limitations that must be considered before widespread implementation. AIM: The objective of this review is to update current knowledge of the measurement of tibial acceleration in runners and to provide recommendations for those intending on using this measurement device in research or clinical practice. METHODS: Literature relating to the measurement of tibial acceleration in steady-state running was searched. A narrative approach synthesised the information from papers written in English. A range of literature was identified documenting the selection and placement of accelerometers, the analysis of data, and the effects of intrinsic and extrinsic factors. RESULTS AND DISCUSSION: Tibial acceleration is a proxy measurement for the impact forces experienced at the tibia commonly used by clinicians and researchers. There is an assumption that this measure is related to bone stress and strain, however this is yet to be proven. Multi-axis devices should be secured firmly to the tibia to limit movement relative to the underlying bone and enable quantification of all components of acceleration. Additional frequency analyses could be useful to provide a more thorough characterisation of the signal. CONCLUSIONS: Tibial accelerations are clearly affected by running technique, running velocity, lower extremity stiffness, as well as surface and footwear compliance. The interrelationships between muscle pre-activation and fatigue, stiffness, effective mass and tibial acceleration still require further investigation, as well as how changes in these variables impact on injury risk.

The one-week and six-month reliability and variability of three-dimensional tibial acceleration in runners.

Tibial acceleration is a surrogate measure for impact loading and lower limb fatigue injury in runners. Triaxial accelerometers may offer reliable and practical measurement of resultant peak tibial acceleration (PTA). With such potential in mind, this study examined variability and measurement reliability of tibial acceleration in 14 runners at baseline at one week, and eight of the runners again at six months. Triaxial accelerometers were attached to the distal tibiae of runners before they ran on a treadmill for two minutes each, at speeds of 2.7, 3.0, 3.3 and 3.7 m/s in standardised shoes. Resultant PTAs were calculated for each speed and session. Reliability outcomes were presented as percentage change and effect sizes. Variability outcomes included intraclass correlation coefficients and the typical error of the measurement. Smallest worthwhile change and performance/noise ratio were also calculated. While runners demonstrated marginally lower reliability and higher variability over six months, compared to one week, in all cases the measures of reliability and variability were of 'good' to 'moderate' reliability, and 'small' to 'moderate' variability using magnitude-based inferences. We can be confident that resultant PTA can be used with runners to assess and monitor their impacts throughout a six-month intervention.

Effects of a lower limb functional exercise programme aimed at minimising knee valgus angle on running kinematics in youth athletes.

OBJECTIVES: To investigate the effectiveness of 8-weeks of lower limb functional exercises on frontal plane hip and knee angles during running in youth athletes. DESIGN: Pre- and post-intervention quantitative experimental. METHODS: Nineteen athletes (11 male, 8 female, 11.54 ± 1.34 years) from a long-term athletic development programme had 3-dimensional running gait measured pre and post an 8-week exercise intervention. Youth athletes randomised to control (upper limb strengthening exercises) or experimental (lower limb functional exercises aimed at minimising knee valgus angle) interventions completed the exercises during the first 10 min of training, three mornings a week. Pre- and post-parallel groups' analysis provided estimates of intervention effects for control and experimental groups. RESULTS: Differences in pre- to post-intervention changes in mean frontal plane angles between control and experimental groups were trivial for the left hip (0.1°) and right knee (-0.3°). There was a small beneficial decrease in right hip joint angle (0.4°) but a very large (ES = 0.77, CI 0.1-3.7) detrimental increase in left knee valgus angle (1.9°) between groups. CONCLUSION: The 8-week lower limb functional exercises had little beneficial effects on lower limb hip and knee mechanics in youth athletes aged 9-14 years.

Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness.

Kinesio tape (KT) is an elastic therapeutic tape used for treating sports injuries and a variety of other disorders. Chiropractor, Dr Kenso Kase, developed KT taping techniques in the 1970s. It is claimed that KT supports injured muscles and joints and helps relieve pain by lifting the skin and allowing improved blood and lymph flow. The profile of KT rose after the tape was donated to 58 countries for use during the 2008 Olympic Games, and was seen on high-profile athletes. Practitioners are asking whether they should use KT over other elastic adhesive tapes. The aim of this review was to evaluate, using meta-analysis, the effectiveness of KT in the treatment and prevention of sports injuries. Electronic databases including SPORTDiscus, Scopus, MEDLINE, ScienceDirect and sports medicine websites were searched using keywords 'kinesio taping/tape'. From 97 articles, ten met the inclusion criteria (article reported data for effect of KT on a musculoskeletal outcome and had a control group) and were retained for meta-analyses. Magnitude-based inferences were used to assess clinical worth of positive outcomes reported in studies. Only two studies investigated sports-related injuries (shoulder impingement), and just one of these involved injured athletes. Studies attending to musculoskeletal outcomes in healthy participants were included on the basis that these outcomes may have implications for the prevention of sporting injuries. The efficacy of KT in pain relief was trivial given there were no clinically important results. There were inconsistent range-of-motion outcome results, with at least small beneficial results seen in two studies, but trivial results in two other studies across numerous joint measurements. There was a likely beneficial effect for proprioception regarding grip force sense error, but no positive outcome for ankle proprioception. Seven outcomes relating to strength were beneficial, although there were numerous trivial findings for quadriceps and hamstrings peak torque, and grip strength measures. KT had some substantial effects on muscle activity, but it was unclear whether these changes were beneficial or harmful. In conclusion, there was little quality evidence to support the use of KT over other types of elastic taping in the management or prevention of sports injuries. KT may have a small beneficial role in improving strength, range of motion in certain injured cohorts and force sense error compared with other tapes, but further studies are needed to confirm these findings. The amount of case study and anecdotal support for KT warrants well designed experimental research, particularly pertaining to sporting injuries, so that practitioners can be confident that KT is beneficial for their athletes.