Learning effects in over-ground running gait retraining: A six-month follow-up of a quasi-randomized controlled trial.

This study evaluated learning and recall effects following a feedback-based retraining program. A 6-month follow-up of a quasi-randomized controlled trial was performed with and without recall. Twenty runners were assigned to experimental or control groups and completed a 3-week running program. A body-worn system collected axial tibial acceleration and provided real-time feedback on peak tibial acceleration for six running sessions in an athletic training facility. The experimental group received music-based biofeedback in a faded feedback scheme. The controls received tempo-synchronized music as a placebo for blinding purposes. The peak tibial acceleration and vertical loading rate of the ground reaction force were determined in a lab at baseline and six months following the intervention to assess retention and recall. The impacts of the experimental group substantially decreased at follow-up following a simple verbal recall (i.e., run as at the end of the program): peak tibial acceleration:-32%, p = 0.018; vertical loading rate:-34%, p = 0.006. No statistically significant changes were found regarding the retention of the impact variables. The impact magnitudes did not change over time in the control group. The biofeedback-based intervention did not induce clear learning at follow-up, however, a substantial impact reduction was recallable through simple cueing in the absence of biofeedback.

Peak Muscle and Joint Contact Forces of Running with Increased Duty Factors.

PURPOSE: Running with increased duty factors (DF) has been shown to effectively reduce external forces during running. In this study, we investigated whether running with increased DF (INCR) also reduces internal musculoskeletal loading measures, defined as peak muscle forces, muscle force impulses, and peak joint contact forces compared with a runners' preferred running pattern (PREF). METHOD: Ten subjects were instructed to run with increased DF at 2.1 m·s -1 . Ground reaction forces and three-dimensional kinematics were simultaneously measured. A musculoskeletal model was used to estimate muscle forces based on a dynamic optimization approach, which in turn were used to calculate muscle force impulses and (resultant and three-dimensional) joint contact forces of the ankle, knee, and hip joint during stance. RESULTS: Runners successfully increased their DF from 40.6% to 49.2% on average. This reduced peak muscle forces of muscles that contribute to support during running, i.e., the ankle plantar flexors (-19%), knee extensors (-18%), and hip extensors (-15%). As a consequence, peak joint contact forces of the ankle, knee, and hip joint reduced in the INCR condition. However, several hip flexors generated higher peak muscle forces near the end of stance. CONCLUSIONS: Running with increased DF lowers internal loading measures related to support during stance. Although some swing-related muscles generated higher forces near the end of stance, running with increased DF can be considered as a preventive strategy to reduce the occurrence of running-related injuries, especially in running populations that are prone to overuse injuries.

Biomechanical adaptations following a music-based biofeedback gait retraining program to reduce peak tibial accelerations.

PURPOSE: The present study aimed to determine whether runners can reduce impact measures after a six-session in-the-field gait retraining program with real-time musical biofeedback on axial peak tibial acceleration (PTAa ) and identify the associated biomechanical adaptations. METHODS: Twenty trained high-impact runners were assigned to either the biofeedback or the music-only condition. The biofeedback group received real-time feedback on the PTAa during the gait retraining program, whereas the music-only condition received a sham treatment. Three-dimensional gait analysis was conducted in the laboratory before (PRE) and within one week after completing the gait retraining program (POST). Subjects were instructed to replicate the running style from the last gait retraining session without receiving feedback while running overground at a constant speed of 2.9 m∙s-1 . RESULTS: Only the biofeedback group showed significant reductions in both PTAa (∆x̅ = -26.9%, p = 0.006) and vertical instantaneous loading rate (∆x̅ = -29.2%, p = 0.003) from PRE to POST. In terms of biomechanical adaptations, two strategies were identified. Two subjects transitioned toward a more forefoot strike. The remaining eight subjects used a pronounced rearfoot strike and posteriorly inclined shank at initial contact combined with less knee extension at toe-off while reducing vertical excursion of the center of mass. CONCLUSIONS: After completing a music-based biofeedback gait retraining program, runners can reduce impact while running overground in a laboratory. We identified two distinct self-selected strategies used by the participants to achieve reductions in impact.

Relationship between duty factor and external forces in slow recreational runners.

OBJECTIVES: Recreational runners show a large interindividual variation in spatiotemporal characteristics. This research focused on slow runners and intended: (1) to document the variance in duty factor (DF) between runners in a real-life running setting and (2) examine whether the interindividual variation in DF and stride frequency (SF) relates to differences in external loading parameters between runners. METHODS: Spatiotemporal characteristics of 23 slow runners (ie, <2.6 m/s) were determined during a 5.2 km running event. To relate the interindividual variation in DF and SF to differences in external forces between runners (maximal vertical ground reaction force (FzMax), peak braking force (PBF) and vertical instantaneous loading rate (VILR)), 14 of them were invited to the lab. They ran at 1.9 m/s on a treadmill while ground reaction forces were recorded. A multiple linear regression analysis was conducted to investigate the effect of DF and SF on external force measures. RESULTS: DF between slow runners varied from 42.50% to 56.49% in a recreational running event. DF was found to be a significant predictor of FzMax (R²=0.755) and PBF (R²=0.430). SF only improved the model for PBF, but to a smaller extent than DF (R² change=0.191). For VILR, neither DF nor SF were significant predictors. CONCLUSION: External forces are lower in recreational runners that run with higher DFs and slightly lower SFs. These findings may be important for injury prevention purposes, especially directed to recreational runners that are more prone to overuse injuries.

Improving the energy economy of human running with powered and unpowered ankle exoskeleton assistance.

Exoskeletons that reduce energetic cost could make recreational running more enjoyable and improve running performance. Although there are many ways to assist runners, the best approaches remain unclear. In our study, we used a tethered ankle exoskeleton emulator to optimize both powered and spring-like exoskeleton characteristics while participants ran on a treadmill. We expected powered conditions to provide large improvements in energy economy and for spring-like patterns to provide smaller benefits achievable with simpler devices. We used human-in-the-loop optimization to attempt to identify the best exoskeleton characteristics for each device type and individual user, allowing for a well-controlled comparison. We found that optimized powered assistance improved energy economy by 24.7 ± 6.9% compared with zero torque and 14.6 ± 7.7% compared with running in normal shoes. Optimized powered torque patterns for individuals varied substantially, but all resulted in relatively high mechanical work input (0.36 ± 0.09 joule kilogram-1 per step) and late timing of peak torque (75.7 ± 5.0% stance). Unexpectedly, spring-like assistance was ineffective, improving energy economy by only 2.1 ± 2.4% compared with zero torque and increasing metabolic rate by 11.1 ± 2.8% compared with control shoes. The energy savings we observed imply that running velocity could be increased by as much as 10% with no added effort for the user and could influence the design of future products.

Running speed-induced changes in foot contact pattern influence impact loading rate.

Purpose. We aimed to determine the effect of speed-induced changes in foot contact patterns on the vertical instantaneous loading rate (VILR). We hypothesized that transition runners, i.e. runners that shift towards a mid- (MF) or forefoot contact pattern (FF) when running speed increases, show smaller increases in VILR than non-transition runners, i.e. runners that remain with a rearfoot contact pattern (RF). Methods. Fifty-two male and female runners ran overground at 3.2, 4.1, 5.1 and 6.2 m s-1. Ground reaction forces, lower limb sagittal plane knee and ankle kinematics and plantar pressures were recorded. Multi-level linear regression models were used to assess differences between transition and non-transition runners. Results. Non-transition runners experienced larger speed-induced increases in VILR (48.6 ± 2.6 BW s-1 per m s-1) than transition runners (-1.4 ± 7.6 BW s-1 per m s-1). Transition runners showed higher VILRs and a more flat foot touch down at the same pre-transition speed than non-transition runners. Conclusion. When running speed increases, some runners transition towards more anterior foot contact patterns. This reduces or even eliminates the speed-induced increase in VILR. This result is especially the case for those RF runners who already have relatively high VILRs and flat foot positioning at slower running speeds.

Grounded Running Reduces Musculoskeletal Loading.

PURPOSE: Recent observations demonstrate that a sizeable proportion of the recreational running population runs at rather slow speeds and does not always show a clear flight phase. This study determined the key biomechanical and physiological characteristics of this running pattern, i.e., grounded running (GR), and compared these characteristics with slow aerial running (SAR) and reference data on walking at the same slow running speed. METHODS: Thirty male subjects performed instructed GR and SAR at 2.10 m·s on a treadmill. Ground reaction forces, tibial accelerations, and metabolic rate were measured to estimate general musculoskeletal loading (external power and maximal vertical ground reaction force), impact intensity (vertical instantaneous loading rate and tibial acceleration), and energy expenditure. More explicit measures of muscular loading (muscle stresses and peak eccentric power) were calculated based on a representative subsample, in which detailed kinematics and kinetics were recorded. We hypothesized that all measures would be lower for the GR condition. RESULTS: Subjects successfully altered their running pattern upon a simple instruction toward a GR pattern by increasing their duty factor from 41.5% to 51.2%. As hypothesized, impact intensity, general measures for musculoskeletal, and the more explicit measures for muscular loading decreased by up to 35.0%, 20.3%, and 34.0%, respectively, compared with SAR. Contrary to our hypothesis, metabolic rate showed an increase of 4.8%. CONCLUSIONS: Changing running style from SAR to GR reduces musculoskeletal loading without lowering the metabolic energy requirements. As such, GR might be beneficial for most runners as it has the potential to reduce the risk of running-related injuries while remaining a moderate to vigorous form of physical activity, contributing to fulfillment of the recommendations concerning physical activity and public health.

Human-in-the-loop optimization of exoskeleton assistance during walking.

Exoskeletons and active prostheses promise to enhance human mobility, but few have succeeded. Optimizing device characteristics on the basis of measured human performance could lead to improved designs. We have developed a method for identifying the exoskeleton assistance that minimizes human energy cost during walking. Optimized torque patterns from an exoskeleton worn on one ankle reduced metabolic energy consumption by 24.2 ± 7.4% compared to no torque. The approach was effective with exoskeletons worn on one or both ankles, during a variety of walking conditions, during running, and when optimizing muscle activity. Finding a good generic assistance pattern, customizing it to individual needs, and helping users learn to take advantage of the device all contributed to improved economy. Optimization methods with these features can substantially improve performance.

Initial foot contact and related kinematics affect impact loading rate in running.

This study assessed kinematic differences between different foot strike patterns and their relationship with peak vertical instantaneous loading rate (VILR) of the ground reaction force (GRF). Fifty-two runners ran at 3.2 m · s-1 while we recorded GRF and lower limb kinematics and determined foot strike pattern: Typical or Atypical rearfoot strike (RFS), midfoot strike (MFS) of forefoot strike (FFS). Typical RFS had longer contact times and a lower leg stiffness than Atypical RFS and MFS. Typical RFS showed a dorsiflexed ankle (7.2 ± 3.5°) and positive foot angle (20.4 ± 4.8°) at initial contact while MFS showed a plantar flexed ankle (-10.4 ± 6.3°) and more horizontal foot (1.6 ± 3.1°). Atypical RFS showed a plantar flexed ankle (-3.1 ± 4.4°) and a small foot angle (7.0 ± 5.1°) at initial contact and had the highest VILR. For the RFS (Typical and Atypical RFS), foot angle at initial contact showed the highest correlation with VILR (r = -0.68). The observed higher VILR in Atypical RFS could be related to both ankle and foot kinematics and global running style that indicate a limited use of known kinematic impact absorbing "strategies" such as initial ankle dorsiflexion in MFS or initial ankle plantar flexion in Typical RFS.

Biomechanics of human bipedal gallop: asymmetry dictates leg function.

Unilateral skipping or bipedal galloping is one of the gait types that humans are able to perform. In contrast to many animals, where gallop is the preferred gait at higher speeds, human bipedal gallop only occurs spontaneously in very specific conditions (e.g. fast downhill locomotion). This study examines the lower limb mechanics and explores the possible reasons why humans do not spontaneously opt for gallop for steady-state locomotion on level ground. In 12 subjects, who were required to run and gallop overground at their preferred speed, kinematic and kinetic data were collected and mechanical work at the main lower limb joints (hip, knee, ankle) was calculated. In a separate treadmill experiment, metabolic costs were measured. Analysis revealed that the principal differences between running and galloping are located at the hip. The asymmetrical configuration of gallop involves distinct hip actions and foot placing, giving galloping legs different functions compared with running legs: the trailing leg decelerates the body in the vertical direction but propels it forward while the leading leg acts in the opposite way. Although both legs conserve mechanical energy by interchanging external mechanical energy with potential elastic energy, the specific orientation of the legs causes more energy dissipation and generation compared with running. This makes gallop metabolically more expensive and involves high muscular stress at the hips, which may be why humans do not use gallop for steady-state locomotion.