The mechanical loading of the spine in physical activities.

PURPOSE: To summarize the mechanical loading of the spine in different activities of daily living and sports. METHODS: Since the direct measurement is not feasible in sports activities, a mathematical model was applied to quantify spinal loading of more than 600 physical tasks in more than 200 athletes from several sports disciplines. The outcome is compression and torque (normalized to body weight/mass) at L4/L5. RESULTS: The data demonstrate high compressive forces on the lumbar spine in sport-related activities, which are much higher than forces reported in normal daily activities and work tasks. Especially ballistic jumping and landing skills yield high estimated compression at L4/L5 of more than ten times body weight. Jumping, landing, heavy lifting and weight training in sports demonstrate compression forces significantly higher than guideline recommendations for working tasks. CONCLUSION: These results may help to identify acute and long-term risks of low back pain and, thus, may guide the development of preventive interventions for low back pain or injury in athletes.

Altered Gastrocnemius Contractile Behavior in Former Achilles Tendon Rupture Patients During Walking.

Achilles tendon rupture (ATR) remains associated with functional limitations years after injury. Architectural remodeling of the gastrocnemius medialis (GM) muscle is typically observed in the affected leg and may compensate force deficits caused by a longer tendon. Yet patients seem to retain functional limitations during-low-force-walking gait. To explore the potential limits imposed by the remodeled GM muscle-tendon unit (MTU) on walking gait, we examined the contractile behavior of muscle fascicles during the stance phase. In a cross-sectional design, we studied nine former patients (males; age: 45 ± 9 years; height: 180 ± 7 cm; weight: 83 ± 6 kg) with a history of complete unilateral ATR, approximately 4 years post-surgery. Using ultrasonography, GM tendon morphology, muscle architecture at rest, and fascicular behavior were assessed during walking at 1.5 m⋅s-1 on a treadmill. Walking patterns were recorded with a motion capture system. The unaffected leg served as control. Lower limbs kinematics were largely similar between legs during walking. Typical features of ATR-related MTU remodeling were observed during the stance sub-phases corresponding to series elastic element (SEE) lengthening (energy storage) and SEE shortening (energy release), with shorter GM fascicles (36 and 36%, respectively) and greater pennation angles (8° and 12°, respectively). However, relative to the optimal fascicle length for force production, fascicles operated at comparable length in both legs. Similarly, when expressed relative to optimal fascicle length, fascicle contraction velocity was not different between sides, except at the time-point of peak series elastic element (SEE) length, where it was 39 ± 49% lower in the affected leg. Concomitantly, fascicles rotation during contraction was greater in the affected leg during the whole stance-phase, and architectural gear ratios (AGR) was larger during SEE lengthening. Under the present testing conditions, former ATR patients had recovered a relatively symmetrical walking gait pattern. Differences in seen AGR seem to accommodate the profound changes in MTU architecture, limiting the required fascicle shortening velocity. Overall, the contractile behavior of the GM fascicles does not restrict length- or velocity-dependent force potentials during this locomotor task.

Surface Stiffness and Footwear Affect the Loading Stimulus for Lower Extremity Muscles When Running.

ABSTRACT: Willwacher, S, Fischer, KM, Rohr, E, Trudeau, MB, Hamill, J, and Brüggemann, G-P. Surface stiffness and footwear affect the loading stimulus for lower extremity muscles when running. J Strength Cond Res 36(1): 82-89, 2022-Running in minimal footwear or barefoot can improve foot muscle strength. Muscles spanning the foot and ankle joints have the potential to improve performance and to reduce overuse injury risk. Surface stiffness or footwear use could modify the intensity of training stimuli acting on lower extremity joints during running. The purpose of this study was to systematically investigate external ankle, knee, and hip joint moments during shod and barefoot running while considering the stiffness of the running surface. Two footwear conditions (barefoot and neutral running shoe) and 4 surface conditions (Tartan, Tartan + Ethylene Vinyl Acetate [EVA] foam, Tartan + artificial turf, Tartan + EVA foam + artificial turf) were tested at 3.5 m·s-1. Repeated measures analysis of variance revealed that barefoot running in general and running barefoot on harder surfaces increased and decreased ankle (between +5 and +26%) and knee (between 0 and -11%) joint moments, respectively. Averaged over all surfaces, running barefoot was characterized by a 6.8° more plantarflexed foot strike pattern compared with running shod. Foot strike patterns were more plantarflexed on harder surfaces; the effects, however, were less than 3°. Most surface effects were stronger in barefoot compared with shod running. Surface stiffness may be used to modulate the loading intensity of lower extremity muscles (in particular extrinsic and intrinsic foot muscles) during running. These results need to be considered when coaches advise barefoot running as a method to improve the strength of extrinsic and intrinsic foot muscles or when trying to reduce knee joint loading.

Insights into extrinsic foot muscle activation during a 75 min run using T2 mapping.

The extrinsic foot muscles are essentially for controlling the movement path but our knowledge of their behavior during prolonged running is still very limited. Therefore, this study analyzed the time-course of muscle activation using T2 mapping during 75 min of running. In this prospective study, 19 recreational active runners completed 75 min of treadmill running at a constant speed. Interleaved T2 mapping sequences were acquired and segmented at timepoints 0, 2.5, 5, 10, 15, 45, and 75 min. ANOVA for repeated measurements followed by a Tukey post hoc test and Pearson correlation between running speed and initial signal increase at 2.5 min were calculated. All muscles showed a significant signal increase between baseline and 2.5 min (e.g. medial gastrocnemius: + 15.48%; p < 0.01). This was followed by a plateau phase till 15 min for all but the extensor digitorum longus muscle and a significant decrease at 45 or 75 min for all muscles (all p < 0.05). Correlation between running speed and signal increase was negative for all muscles and significant for both gastrocnemii (e.g. medial: r = - 0.57, p = 0.0104) and soleus (r = - 0.47, p = 0.0412). The decrease of relaxation times times in the later running phases was less pronounced for faster runners (≥ 10 km/h). T2 relaxation times do not only decrease after cessation of exercise but already during prolonged running. The lesser initial increase and later decrease in faster runners may indicate training induced changes.

Recovery from Achilles Tendon Repair: A Combination of Postsurgery Outcomes and Insufficient Remodeling of Muscle and Tendon.

INTRODUCTION: Achilles tendon rupture (ATR) patients have persistent functional deficits in the triceps surae muscle-tendon unit (MTU). The complex remodeling of the MTU accompanying these deficits remains poorly understood. The purpose of the present study was to associate in vivo and in silico data to investigate the relations between changes in MTU properties and strength deficits in ATR patients. METHODS: Eleven male subjects who had undergone surgical repair of complete unilateral ATR were examined 4.6 ± 2.0 (mean ± SD) yr after rupture. Gastrocnemius medialis (GM) tendon stiffness, morphology, and muscle architecture were determined using ultrasonography. The force-length relation of the plantar flexor muscles was assessed at five ankle joint angles. In addition, simulations (OpenSim) of the GM MTU force-length properties were performed with various iterations of MTU properties found between the unaffected and the affected side. RESULTS: The affected side of the patients displayed a longer, larger, and stiffer GM tendon (13% ± 10%, 105% ± 28%, and 54% ± 24%, respectively) compared with the unaffected side. The GM muscle fascicles of the affected side were shorter (32% ± 12%) and with greater pennation angles (31% ± 26%). A mean deficit in plantarflexion moment of 31% ± 10% was measured. Simulations indicate that pairing an intact muscle with a longer tendon shifts the optimal angular range of peak force outside physiological angular ranges, whereas the shorter muscle fascicles and tendon stiffening seen in the affected side decrease this shift, albeit incompletely. CONCLUSIONS: These results suggest that the substantial changes in MTU properties found in ATR patients may partly result from compensatory remodeling, although this process appears insufficient to fully restore muscle function.

Running into Fatigue: The Effects of Footwear on Kinematics, Kinetics, and Energetics.

PURPOSE: Recent studies identified a redistribution of positive mechanical work from distal to proximal joints during prolonged runs, which might partly explain the reduced running economy observed with running-induced fatigue. Higher mechanical demand of plantar flexor muscle-tendon units, for example, through minimal footwear, can lead to an earlier onset of fatigue, which might affect the redistribution of lower extremity joint work during prolonged runs. Therefore, the purpose of this study was to examine the effects of a racing flat and cushioned running shoe on the joint-specific contributions to lower extremity joint work during a prolonged fatiguing run. METHODS: On different days, 18 runners performed two 10-km runs with near-maximal effort in a racing flat and a cushioned shoe on an instrumented treadmill synchronized with a motion capture system. Joint kinetics and kinematics were calculated at 13 predetermined distances throughout the run. The effects of shoes, distance, and their interaction were analyzed using a two-factor repeated-measures ANOVA. RESULTS: For both shoes, we found a redistribution of positive joint work from the ankle (-6%) to the knee (+3%) and the hip (+3%) throughout the entire run. Negative ankle joint work was higher (P < 0.01) with the racing flat compared with the cushioned shoe. Initial differences in foot strike patterns between shoes disappeared after 2 km of running distance. CONCLUSIONS: Irrespective of the shoe design, alterations in the running mechanics occurred in the first 2 km of the run, which might be attributed to the existence of a habituation rather than fatigue effect. Although we did not find a difference between shoes in the fatigue-related redistribution of joint work from distal to more proximal joints, more systematical studies are needed to explore the effects of specific footwear design features.

Swing Phase Mechanics of Maximal Velocity Sprints-Does Isokinetic Lower-Limb Muscle Strength Matter?

PURPOSE: Concentric hip and eccentric knee joint mechanics affect sprint performance. Although the biarticular hamstrings combine these capacities, empirical links between swing phase mechanics and corresponding isokinetic outcome parameters are deficient. This explorative study aimed (1) to explain the variance of sprint velocity, (2) to compare maximal sprints with isokinetic tests, (3) to associate swing phase mechanics with isokinetic parameters, and (4) to quantify the relation between knee and hip joint swing phase mechanics. METHODS: A total of 22 sprinters (age = 22 y, height = 1.81 m, weight = 77 kg) performed sprints and eccentric knee flexor and concentric knee extensor tests. All exercises were captured by 10 (sprints) and 4 (isokinetics) cameras. Lower-limb muscle balance was assessed by the dynamic control ratio at the equilibrium point. RESULTS: The sprint velocity (9.79 [0.49] m/s) was best predicted by the maximal knee extension velocity, hip mean power (both swing phase parameters), and isokinetic peak moment of concentric quadriceps exercise (R2 = 60%). The moment of the dynamic control ratio at the equilibrium point (R2 = 39%) was the isokinetic parameter with the highest predictive power itself. Knee and hip joint mechanics affected each other during sprinting. They were significantly associated with isokinetic parameters of eccentric hamstring tests, as well as moments and angles of the dynamic control ratio at the equilibrium point, but restrictedly with concentric quadriceps exercise. The maximal sprints imposed considerably higher loads than isokinetic tests (eg, 13-fold eccentric knee joint peak power). CONCLUSIONS: Fast sprinters demonstrated distinctive knee and hip mechanics in the late swing phase, as well as strong eccentric hamstrings, with a clear association to the musculoarticular requirements of the swing phase in sprinting. The transferability of isokinetic knee strength data to sprinting is limited inter alia due to different hip joint configurations. However, isokinetic tests quantify specific sprint-related muscular prerequisites and constitute a useful diagnostic tool due to their predicting value to sprint performance.

Spinal and Pelvic Kinematics During Prolonged Rowing on an Ergometer vs. Indoor Tank Rowing.

ABSTRACT: Trompeter, K, Weerts, J, Fett, D, Firouzabadi, A, Heinrich, K, Schmidt, H, Brüggemann, GP, and Platen, P. Spinal and pelvic kinematics during prolonged rowing on an ergometer vs. indoor tank rowing. J Strength Cond Res 35(9): 2622-2628, 2021-This investigation aimed to compare spinopelvic kinematics during rowing on an ergometer vs. in a rowing tank and to evaluate changes with progressing fatigue. Spinal and pelvic kinematics of 8 competitive scull rowers (19.0 ± 2.1 years, 179.9 ± 7.6 cm, and 74.8 ± 8.1 kg) were collected during 1 hour of rowing on an ergometer and in a rowing tank using a routine training protocol. Kinematics of the upper thoracic spine, lower thoracic spine, lumbar spine, and pelvis were determined using an infrared camera system (Vicon, Oxford, United Kingdom). There was a greater lumbar range of motion (ROM) and less posterior pelvic tilt at the catch during rowing on the ergometer compared with in the rowing tank (p = 0.001-0.048), but no differences in pelvic ROM. In the rowing tank, the pelvic ROM increased over time (p = 0.002) and the ROM of the lower thoracic spine decreased (p = 0.002). In addition, there was an extended drive phase (when the rower applies pressure to the oar levering the boat forward) and an abbreviated recovery phase (setting up the rower's body for the next stroke) in the rowing tank (p = 0.032). Different rowing training methods lead to differences in spinopelvic kinematics, which may lead to substantially different spinal loading situations. Greater pelvic rotation and lesser lumbar ROM are considered ideal; therefore, the present results indicate that rowing in the rowing tank might facilitate the maintenance of this targeted spinopelvic posture, which might help protect the lower back. Rowers, coaches, and researchers should consider the differences between rowing training methods, especially when giving training recommendations.

Dorsal muscle fatigue increases thoracic spine curvature in all-out recreational ergometer rowing.

The purpose of this study was to investigate fatigue-related changes in spinal kinematics, kinetics, and muscle activity of back muscles during a 2000 m all-out ergometer rowing performance. We analyzed ten male subjects with experience in both rowing and CrossFit exercises. We applied a novel kinematic method to describe spine curvature, determined bending moments at the spine using inverse dynamics and collected EMG data. We identified significant increases in spine curvature of the thoracic spine (i.e. vertebrae Th6 to Th11). Significant increases in peak moments were found only at the upper spine (i.e. Th2). We found no significant changes in EMG amplitudes, while the frequency analysis showed significant decreases in the mean frequencies (MNF) for the M. latissimus dorsi, the M. trapezius descendens and the M. deltoideus posterior. No significant changes on MNF were found for the Mm. erector spinae. We hypothesize that the significant increase in curvature for the thoracic spine is connected to the fatigued back muscles, especially the Mm. trapezius descendens, and might lead to an unbalanced loading of intervertebral discs and other structures. These findings are particularly important for athletes and coaches in CrossFit as strenuous rowing intervals are combined with technical exercises with high loads on the back and spine (e.g. power and Olympic lifting) leading to impaired muscular stabilization and potentially to an increased injury risk.

Nordic Hamstring Exercise training induces improved lower-limb swing phase mechanics and sustained strength preservation in sprinters.

Nordic Hamstring Exercise (NHE) training improves eccentric hamstring strength and sprint performance. However, detraining causes rapid reductions of achieved adaptations. Furthermore, the transfer of improved hamstring capacity to swing phase mechanics of sprints is unknown. This longitudinal study aimed (a) to quantify NHE-induced adaptations by camera-based isokinetic assessments and sprint analyses, (b) to relate the magnitude of adaptations to the participants' initial performance level, (c) to investigate the transferability to sprints, and (4) to determine strength preservations after 3 months. Twelve sprinters (21 years, 1.81 m, 74 kg) were analyzed throughout 22 weeks. They performed maximal sprints and eccentric knee flexor and concentric knee extensor tests before and after a 4-week NHE training. Sprints and isokinetic tests were captured by ten and four high-speed cameras. The dynamic control ratio at the equilibrium point (DCRe) evaluated thigh muscle balance. High-intensity NHE training elicited significant improvements of hamstring function (P range: <.001-.011, d range: 0.44-1.14), thigh muscle balance (P < 0.001, d range: 0.80-1.08) and hamstring-related parameters of swing phase mechanics (P range: <0.001-0.022, d range: 0.12-0.57). Sprint velocity demonstrated small increases (+1.4%, P < 0.001, d = 0.26). Adaptations of hamstring function and thigh muscle balance revealed moderate to strong transfers to improved sprint mechanics (P range: <0.001-0.048, R2 range: 34%-83%). The weakest participants demonstrated the highest adaptations of isokinetic parameters (P range: 0.003-0.023, R2 range: 42%-62%), whereas sprint mechanics showed no effect of initial performance level. Three months after the intervention, hamstring function (+6% to +14%) and thigh muscle balance (+8% to +10%) remained significantly enhanced (P < 0.001, ƞp 2 range: 0.529-0.621). High-intensity NHE training induced sustained improved hamstring function of sprinters, which can be transferred to swing phase mechanics of maximal sprints. The initial performance level, NHE training procedures and periodization should be considered to optimize adaptations.

The time course of calf muscle fluid volume during prolonged running.

Muscle fluid is essential for the biochemistry and the biomechanics of muscle contraction. Here, we provide evidence that muscle fluid volumes undergo significant changes during 75 min of moderate intensity (2.7 ± 0.4 m/s) running. Using MRI measurements at baseline and after 2.5, 5, 10, 15, 45 and 75 min, we found that the volumes of calf muscles (quantified through average cross-sectional area) in 18 young recreational runners increase (up to 9% in the gastrocnemii) at the beginning and decrease (below baseline levels) at later stages of running. However, the intensity of changes varied between analyzed muscles. We speculate that these changes are induced by muscle activity and dehydration-related changes in osmotic pressure gradients between intramuscular and extramuscular spaces. These findings highlight the complex nature of muscle fluid shifts during prolonged running exercise.

The habitual motion path theory: Evidence from cartilage volume reductions in the knee joint after 75 minutes of running.

The habitual motion path theory predicts that humans tend to maintain their habitual motion path (HMP) during locomotion. The HMP is the path of least resistance of the joints defined by an individual's musculoskeletal anatomy and passive tissue properties. Here we tested whether participants with higher HMP deviation and whether using footwear that increases HMP deviation during running show higher reductions of knee joint articular cartilage volume after 75 minutes of running. We quantified knee joint articular cartilage volumes before and after the run using a 3.0-Tesla MRI. We performed a 3D movement analysis of runners in order to quantify their HMP from a two-legged squat motion and the deviation from the HMP when running in different footwear conditions. We found significantly more cartilage volume reductions in the medial knee compartment and patella for participants with higher HMP deviation. We also found higher cartilage volume reductions on the medial tibia when runners wore a shoe that maximized their HMP deviation compared with the shoe that minmized their HMP deviation. Runners might benefit from reducing their HMP deviation and from selecting footwear by quantifying HMP deviation in order to minimize joint cartilage loading in sub-areas of the knee.

Impact of knee joint loading on fragmentation of serum cartilage oligomeric matrix protein.

The aim of the study was to examine the effect of mechanical knee joint loading on the fragmentation pattern of serum cartilage oligomeric matrix protein (COMP). Ten healthy men ran with knee orthoses that were passive or active (+30.9 N·m external flexion moments) on a treadmill (30 minute; v = 2.2 m/s). Lower-limb mechanics, serum COMP levels, and fragmentation patterns (baseline; 0, 0.5, 1, 2 hours postrunning) were analyzed. Running with active orthoses enhanced knee flexion moments, ankle dorsiflexion, and knee flexion angles (P < .05). There was an increase in serum COMP (+25%; pre: 8.9 ± 2.4 U/l; post: 10.7 ± 1.9 U/l, P = .001), COMP pentamer/tetramer (+88%; 1.88 ± 0.81, P = .007), trimer (+209%; 3.09 ± 2.65, P = .005), and monomer (+78%; 1.78 ± 0.85, P = .007) after running with passive orthoses and in serum COMP (+41%; pre: 8.5 ± 2.7 U/l; post: 11.3 ± 2.1 U/l, P < .001), COMP pentamer/tetramer (+57%; 1.57 ± 0.39, P = .007), trimer (+86%; 1.86 ± 0.47, P = .005), and monomer (+19%; 1.19 ± 0.34, P = .114) after running with active orthoses. Increased fragmentation might indicate COMP release from cartilage while running. Interestingly, 0.5 h up to 2 hours after running with passive orthoses, trimer (0.5 hour: 2.73 ± 3.40, P = .029; 2 hours: 2.33 ± 2.88, P = .037), and monomer (0.5 hour: 2.23 ± 2.33, P = .007; 1 hour: 2.55 ± 1.96, P = .012; 2 hours: 2.65 ± 2.50, P = .009) increased while after running with active orthoses, pentamer/tetramer (1 hour: 0.79 ± 0.28, P = .029), and trimer (1 hour: 0.63 ± 0.14, P = .005; 2 hours: 0.68 ± 0.34, P = .047) decreased. It seems that COMP degradation and clearance vary depending on joint loading characteristics.

Influence of neutral and stability athletic footwear on lower extremity coordination variability during a prolonged treadmill run in male rearfoot runners.

The purpose of this study was to investigate changes in coordination variability (CV) over the course of a prolonged treadmill run and the influence of stability and neutral footwear on CV. Fourteen male habitually rearfoot runners completed two 42 min prolonged running sessions while three-dimensional kinematics and kinetics were recorded. During the first 21 min, participants ran in a neutral shoe (baseline run), then changed into either another neutral shoe of the same construction but another colour or a stability shoe and ran a further 21 min (intervention run). A modified vector coding technique was used to compute thigh-leg, leg-rearfoot and rearfoot-forefoot segment CV. Following the baseline run, thigh flexion/extension-leg flexion/extension, rearfoot inversion/eversion-forefoot plantar flexion/dorsiflexion and rearfoot inversion/eversion-forefoot adduction/abduction CV increased (p < .05). During the intervention run, CV was higher in the neutral shoe compared with the stability shoe for thigh flexion/extension-leg flexion/extension and leg flexion/extension-rearfoot inversion/eversion couplings (p < .05). Lower extremity CV increased or was maintained during a prolonged treadmill run in healthy male rearfoot runners, likely to distribute stresses among the tissues as muscles begin to fatigue. CV increased to a greater extent in neutral compared with stability footwear which may be a result of: (1) the stability shoe acting as a perturbation to the runner and their response is to regulate CV, or; (2) stability footwear provides greater support and consequently, runners do not need to explore additional degrees of freedom to reduce stresses applied to the tissues throughout a prolonged run.

Does footwear affect articular cartilage volume change after a prolonged run?

The aim of this study was to investigate knee intra-articular cartilage volume changes after a prolonged running bout in three footwear conditions. Twelve participants performed 75-minute running bouts in the three footwear conditions. Before and after each running bout, magnetic resonance imaging (MRI) scans were obtained using a high-resolution 3.0 Tesla MRI. Three-dimensional reconstruction of the cartilage plates of the patella, the femur, and the tibia was created to quantify cartilage volume change due to the 75-minute running bout. Three-dimensional biomechanical data were also collected using an integrated motion capture and force treadmill system. There were no statistically significant differences among shoe conditions for all anatomical regions. However, significant cartilage volume reductions at all anatomical sites were observed after the 75-minute running bout in each footwear condition. These data suggest that the intra-articular knee cartilage undergoes a significant reduction in cartilage volume during a prolonged run that may indicate an increase in joint loading. There was a considerable variation in cartilage volume between participants across footwear conditions indicating an individual cartilage volume response to footwear. An individualistic approach to footwear recommendations may help in minimizing this change in cartilage.

Fatigue matters: An intense 10 km run alters frontal and transverse plane joint kinematics in competitive and recreational adult runners.

BACKGROUND: Fatigue is an essential component of distance running. Still, little is known about the effects of running induced fatigue on three-dimensional lower extremity joint movement, in particular in the frontal and transverse planes of motion. RESEARCH QUESTION: How are non-sagittal plane lower extremity joint kinematics of runners altered during a 10 km treadmill run with near-maximum effort? METHODS: In a cross-sectional study design, we captured three-dimensional kinematics and kinetics at regular intervals throughout a 10 km treadmill run in 24 male participants (subdivided into a competitive and recreational runner group) at a speed corresponding to 105 % of their season-best time. We calculated average and peak joint angles at the hip, knee and ankle during the stance phase. RESULTS: We observed peak deviations of 3.5°, 3° and 5° for the hip (more adduction), knee (more abduction) and ankle (more eversion) in the frontal plane when comparing the final (10 km) with the first (0 km) measurement. At the end of the run peak knee internal rotation angles increased significantly (up to 3° difference). Running with a more abducted knee joint and with a higher demand for hip abductor muscles in the unfatigued state was related to greater fatigue-induced changes of joint kinematics at the knee and hip. SIGNIFICANCE: The fatigue related change of non-sagittal joint kinematics needs to be considered when addressing risk factors for running-related injuries, when designing shoe interventions as well as strengthening and gait retraining protocols for runners. We speculate that strengthening ankle invertors and hip abductors and monitoring the dynamic leg axis during running appear to be promising in preventing fatigue induced alterations of non-sagittal joint kinematics.

Leg amputation side determines performance in curve sprinting: a case study on a Paralympic medalist.

The lower limb kinetics of curve sprinting in amputees are not well described in the literature, particularly with respect to the effect of the side of amputation. This is an issue due to the importance of the knowledge for prosthetic design and classification of athletes. Thus, the aim of this study was to investigate the influence of side of amputation on curve sprinting performance in athletes with a unilateral leg amputation. A three-dimensional motion analysis system (Vicon), four force plates (Kistler) and a modified mathematical human model (ALASKA) were used to compare clockwise and counter clockwise curve sprinting lower limb kinematics and kinetics of a Paralympic medalist with a left-sided knee exarticular amputation. Results reveal that vertical ground reaction force application and total vertical impulse were lower when the affected limb was at the inside of the curve. The unaffected limb showed joint mechanics different to those established for non-amputee athletes and might contribute better to propulsion when being the inside limb. Curve sprinting biomechanics and the ability to attain high radial velocities are directly dependent on the side of amputation relative to the curve direction in a unilateral amputee athlete of highest performance level.

Evaluation of foot position and orientation as manipulated variables to control external knee adduction moments in leg extension training.

BACKGROUND AND OBJECTIVE: Effective leg extension training at a leg press requires high forces, which need to be controlled to avoid training-induced damage. In order to avoid high external knee adduction moments, which are one reason for unphysiological loadings on knee joint structures, both training movements and the whole reaction force vector need to be observed. In this study, the applicability of lateral and medial changes in foot orientation and position as possible manipulated variables to control external knee adduction moments is investigated. As secondary parameters both the medio-lateral position of the center of pressure and the frontal-plane orientation of the reaction force vector are analyzed. METHODS: Knee adduction moments are estimated using a dynamic model of the musculoskeletal system together with the measured reaction force vector and the motion of the subject by solving the inverse kinematic and dynamic problem. Six different foot conditions with varying positions and orientations of the foot in a static leg press are evaluated and compared to a neutral foot position. RESULTS: Both lateral and medial wedges under the foot and medial and lateral shifts of the foot can influence external knee adduction moments in the presented study with six healthy subjects. Different effects are observed with the varying conditions: the pose of the leg is changed and the direction and center of pressure of the reaction force vector is influenced. Each effect results in a different direction or center of pressure of the reaction force vector. CONCLUSIONS: The results allow the conclusion that foot position and orientation can be used as manipulated variables in a control loop to actively control knee adduction moments in leg extension training.

Positive Work Contribution Shifts from Distal to Proximal Joints during a Prolonged Run.

PURPOSE: To investigate the joint-specific contributions to the total lower-extremity joint work during a prolonged fatiguing run. METHODS: Recreational long-distance runners (n = 13) and competitive long-distance runners (n = 12) performed a 10-km treadmill run with near-maximal effort. A three-dimensional motion capture system synchronized with a force-instrumented treadmill was used to calculate joint kinetics and kinematics of the lower extremity in the sagittal plane during the stance phase at 13 distance points over the 10-km run. RESULTS: A significant (P < 0.05) decrease of positive ankle joint work as well as an increase of positive knee and hip joint work was found. These findings were associated with a redistribution of the individual contributions to total lower-extremity work away from the ankle toward the knee and hip joint which was more distinctive in the recreational runner group than in the competitive runner group. This redistribution was accomplished by significant (P < 0.05) reductions of the external ground-reaction force lever arm and joint torque at the ankle and by the significant (P < 0.05) increase of the external ground-reaction force lever arm and joint torque at the knee and hip. CONCLUSIONS: The redistribution of joint work from the ankle to more proximal joints might be a biomechanical mechanism that could partly explain the decreased running economy in a prolonged fatiguing run. This might be because muscle-tendon units crossing proximal joints are less equipped for energy storage and return compared with ankle plantar flexors and require greater muscle volume activation for a given force. To improve running performance, long-distance runners may benefit from an exercise-induced enhancement of ankle plantar flexor muscle-tendon unit capacities.

Glass -polyalkenoate cement: An alternative material for kyphoplasty in osteoporotic vertebral compression fractures - An ex vivo study.

Adjacent vertebral body fracture is described as a risk after vertebroplasty and kyphoplasty. It may be true that this phenomenon is caused precisely because of the frequently used polymethylmethacrylate cement (PMMA), which shows a higher level of stiffness than bone material and may ultimately lead to shifting stress levels within the entire spine. The goal of the present study was to evaluate and compare the pressure distribution in the endplate of human vertebrae after kyphoplasty with PMMA and aluminum-free glass-polyalkenoate cement (gpc). For the present study, 8 fresh frozen human cadaveric vertebral bodies from the thoracolumbar junction were used. All vertebrae were augmented transpedicularly on one side with gpc and on the other side with PMMA. A loading of 600 N, 800 N and 1000 N was applied. In the data processing an individual region of interest (roi) was generated for each vertebra. The following parameters were determined for each roi: maximum force [N], maximum pressure [kPa], mean pressure [kPa], roi area [cm2]. We found significantly higher mean pressure values in the areas of the vertebrae augmented with PMMA, compared to the ones after augmentation with gpc (p = 0.012) when applying 1000 N. In the groups with lower forces there were no statistical relevant differences. The pressure distribution shows an advantage for gpc. A material, which does not create load concentration onto the cranial and caudal vertebral surface, could have major advantages concerning the risk of adjacent vertebral fractures. Thus the results of the 1000 N loading protocol suggest gpc being a possible alternative to ordinary PMMA cement, regarding its influence on stiffness in kyphoplasty. These and other general aspects like incorporation should be addressed and elaborated more detailed in further studies.