Differences in running biomechanics between young, healthy men and women carrying external loads.

During U.S. Army basic combat training (BCT), women are more prone to lower-extremity musculoskeletal injuries, including stress fracture (SF) of the tibia, with injury rates two to four times higher than those in men. There is evidence to suggest that the different injury rates are, in part, due to sex-specific differences in running biomechanics, including lower-extremity joint kinematics and kinetics, which are not fully understood, particularly when running with external load. To address this knowledge gap, we collected computed tomography images and motion-capture data from 41 young, healthy adults (20 women and 21 men) running on an instrumented treadmill at 3.0 m/s with loads of 0.0 kg, 11.3 kg, or 22.7 kg. Using individualized computational models, we quantified the running biomechanics and estimated tibial SF risk over 10 weeks of BCT, for each load condition. Across all load conditions, compared to men, women had a significantly smaller flexion angle at the trunk (16.9%-24.6%) but larger flexion angles at the ankle (14.0%-14.7%). Under load-carriage conditions, women had a larger flexion angle at the hip (17.7%-23.5%). In addition, women had a significantly smaller hip extension moment (11.8%-20.0%) and ankle plantarflexion moment (10.2%-14.3%), but larger joint reaction forces (JRFs) at the hip (16.1%-22.0%), knee (9.1%-14.2%), and ankle (8.2%-12.9%). Consequently, we found that women had a greater increase in tibial strain and SF risk than men as load increases, indicating higher susceptibility to injuries. When load carriage increased from 0.0 kg to 22.7 kg, SF risk increased by about 250% in women but only 133% in men. These results provide quantitative evidence to support the Army's new training and testing doctrine, as it shifts to a more personalized approach that shall account for sex and individual differences.

Effect of stride length on the running biomechanics of healthy women of different statures.

BACKGROUND: Tibial stress fracture is a debilitating musculoskeletal injury that diminishes the physical performance of individuals who engage in high-volume running, including Service members during basic combat training (BCT) and recreational athletes. While several studies have shown that reducing stride length decreases musculoskeletal loads and the potential risk of tibial injury, we do not know whether stride-length reduction affects individuals of varying stature differently. METHODS: We investigated the effects of reducing the running stride length on the biomechanics of the lower extremity of young, healthy women of different statures. Using individualized musculoskeletal and finite-element models of women of short (N = 6), medium (N = 7), and tall (N = 7) statures, we computed the joint kinematics and kinetics at the lower extremity and tibial strain for each participant as they ran on a treadmill at 3.0 m/s with their preferred stride length and with a stride length reduced by 10%. Using a probabilistic model, we estimated the stress-fracture risk for running regimens representative of U.S. Army Soldiers during BCT and recreational athletes training for a marathon. RESULTS: When study participants reduced their stride length by 10%, the joint kinetics, kinematics, tibial strain, and stress-fracture risk were not significantly different among the three stature groups. Compared to the preferred stride length, a 10% reduction in stride length significantly decreased peak hip (p = 0.002) and knee (p < 0.001) flexion angles during the stance phase. In addition, it significantly decreased the peak hip adduction (p = 0.013), hip internal rotation (p = 0.004), knee extension (p = 0.012), and ankle plantar flexion (p = 0.026) moments, as well as the hip, knee, and ankle joint reaction forces (p < 0.001) and tibial strain (p < 0.001). Finally, for the simulated regimens, reducing the stride length decreased the relative risk of stress fracture by as much as 96%. CONCLUSIONS: Our results show that reducing stride length by 10% decreases musculoskeletal loads, tibial strain, and stress-fracture risk, regardless of stature. We also observed large between-subject variability, which supports the development of individualized training strategies to decrease the incidence of stress fracture.

Effects of Stature and Load Carriage on the Running Biomechanics of Healthy Men.

OBJECTIVE: Overuse musculoskeletal injuries, often precipitated by walking or running with heavy loads, are the leading cause of lost-duty days or discharge during basic combat training (BCT) in the U.S. military. The present study investigates the impact of stature and load carriage on the running biomechanics of men during BCT. METHODS: We collected computed tomography images and motion-capture data for 21 young, healthy men of short, medium, and tall stature (n = 7 in each group) running with no load, an 11.3-kg load, and a 22.7-kg load. We then developed individualized musculoskeletal finite-element models to determine the running biomechanics for each participant under each condition, and used a probabilistic model to estimate the risk of tibial stress fracture during a 10-week BCT regimen. RESULTS: Under all load conditions, we found that the running biomechanics were not significantly different among the three stature groups. However, compared to no load, a 22.7-kg load significantly decreased the stride length, while significantly increasing the joint forces and moments at the lower extremities, as well as the tibial strain and stress-fracture risk. CONCLUSION: Load carriage but not stature significantly affected the running biomechanics of healthy men. SIGNIFICANCE: We expect that the quantitative analysis reported here may help guide training regimens and reduce the risk of stress fracture.

Fatigue damage prediction in the annulus of cervical spine intervertebral discs using finite element analysis.

Neck pain is a major inhibitor affecting the performance of U.S. military personnel. Repetitive exposure to cyclic loading due to military activities over several years can lead to accumulation of fatigue damage in the cervical intervertebral disc annuli, leading to neck pain. We have developed a computational damage model based on continuum damage mechanics, to predict fatigue damage to cervical disc annuli over several years of exposure to military loading scenarios. By integrating this fatigue damage model with a finite element model of the cervical spine, we have overcome the underlying assumption of a uniform stress distribution in the annulus. The resulting element-wise damage prediction gives us insight into the location of damage initiation and pattern of fatigue damage progression in the cervical disc annulus.