Addressing Circadian Disruptions in Visually Impaired Paralympic Athletes.

PURPOSE: Transmeridian travel is common for elite athletes participating in competitions and training. However, this travel can lead to circadian misalignment wherein the internal biological clock becomes desynchronized with the light-dark cycle of the new environment, resulting in performance decrement and potential negative health consequences. Existing literature extensively discusses recommendations for managing jet lag, predominantly emphasizing light-based interventions to synchronize the internal clock with the anticipated time at the destination. Nevertheless, visually impaired (VI) athletes may lack photoreceptiveness, diminishing or nullifying the effectiveness of this therapy. Consequently, this invited commentary explores alternative strategies for addressing jet lag in VI athletes. CONCLUSIONS: VI athletes with light perception but reduced visual acuity or visual fields may still benefit from light interventions in managing jet lag. However, VI athletes lacking a conscious perception of light should rely on gradual shifts in behavioral factors, such as meal timing and exercise, to facilitate the entrainment of circadian rhythms to the destination time. Furthermore, interventions like melatonin supplementation may prove useful during and after travel. In addition, it is recommended that athlete guides adopt phase-forward or phase-back approaches to synchronize with the athlete, aiding in jet-lag management and optimizing performance.

Assessing spring-mass similarity in elite and recreational runners.

The dynamic complexity and individualization of running biomechanics has challenged the development of objective and comparative gait measures. Here, we present and explore several novel biomechanical metrics for running that are informed by a canonical inter-species gait template-the spring-mass model. The measures assess running mechanics systemically against the template via quantifying characteristics of a runner's kinetics relative to the energy-conserving elastic system-i.e., their "spring-mass similarity". Applying these metrics in a retrospective cohort investigation, we studied the overground kinetics of two heterogenous populations of runners in two footwear conditions: elite and recreational athletes in shod and barefoot conditions. Across all measures and within foot strike types, the elite runners exhibited mechanics that were more similar to those of the ideally elastic spring-mass template. The elite runners had more symmetric bounces, less discrepancy (i.e., greater coordination) between horizontal and vertical kinetic changes, and better fit to a spring-mass vertical ground reaction force time series. Barefoot running elicited greater kinetic coordination in the recreational runners. At a faster speed, the elites further improved their similarity to the template. Overall, the more economical elite group exhibited greater likeness to the linearly elastic, energy-conserving spring-mass system than their recreational counterparts. This study introduces novel biomechanical measures related to performance in distance running. More broadly, it provides new, approachable metrics for systemic quantification of gait biomechanics in runners across all demographics. These metrics may be applied to assess a runner's global biomechanical response to a variety of interventions, including training adaptations, rehabilitation programs, and footwear conditions.

Changes in running biomechanics during the 2017 IAAF world championships men's 1500 m final.

The aim of this study was to analyze key kinematic, spatiotemporal, and global mechanical characteristics in world-class middle-distance racing. Eight men were recorded halfway along the home straight on the second, third, and final laps in the 2017 IAAF World Championship 1500 m final. Video data (150 Hz) from three high-definition camcorders were digitized to calculate relevant variables, subsequently analyzed in relation to running speed and finishing position. Better-placed finishers had greater hip extension at initial contact and through late stance, greater knee excursion throughout stance, and longer overstriding distances. Step length did not change with faster speeds as runners relied on increasing step frequency, but the highest-finishing athletes had longer contact phases and greater fluctuations in speed through the step cycle, which were related to higher normalized peak horizontal forces. The best athletes also had lower leg stiffnesses and vertical stiffnesses. The extended contact phase and greater compression could allow for more sustained force production, enabling better acceleration and maintenance of sprinting speed, indicating a trade-off between aerobic energetic efficiency and anaerobic power capacity. Coaches should note that these factors, as well as the best athletes' greater overstriding distances, show that elite 1500 m runners might prioritize a technique that favors running speed over economy.

Effects of Highly Cushioned and Resilient Racing Shoes on Running Economy at Slower Running Speeds.

PURPOSE: The Nike Vaporfly line of running shoes improves running economy by ∼2.7% to 4.2% at running speeds of 13 to 18 km·h-1. It is unclear whether similar benefits are conferred at slower speeds. Our purpose was to determine the effects of the Nike ZoomX Vaporfly Next% 2 (VFN2) on running economy at 10 and 12 km·h-1 compared with a mass-matched control (CTRL) shoe. METHODS: Sixteen runners completed 4 × 5-minute trials at both 10 and 12 km·h-1 on the same day. Each shoe was tested twice at each speed in a counterbalanced, mirrored sequence. Data are displayed as mean (SD). RESULTS: A 2-way repeated-measures analysis of variance showed a significant shoe × speed interaction for oxygen consumption (P = .021). At 12 km·h-1, oxygen consumption (in mL·kg-1·min-1) was lower (-1.4% [1.1%]; P < .001) for VFN2 (35.8 [1.7]) relative to CTRL (36.4 [1.7]). That was greater in magnitude than the differences observed at 10 km·h-1 (-0.9% [1.8%]; P = .065) between VFN2 (29.4 [1.9]) and CTRL (29.6 [1.9]). CONCLUSIONS: From these data, it appears that the VFN2 still enhances running economy at 10 and 12 km·h-1; however, these benefits are smaller in magnitude compared with previous research at faster speeds.

Position-Specific Physical Workload Intensities in American Collegiate Football Training.

ABSTRACT: MamonJr, MA, Olthof, SBH, Burns, GT, Lepley, AS, Kozloff, KM, and Zernicke, RF. Position-specific physical workload intensities in American collegiate football training. J Strength Cond Res 36(2): 420-426, 2022-Quantifying player training loads allows football coaching staff to make informed adjustments to the volume and intensity of training. Physical workload intensity in American football practices have not been extensively quantified. The current study examined physical workload intensities across positions in American collegiate football during training. Data from player tracking technology (Catapult Vector) were collected from 72 American football players (National Collegiate Athletic Association Division I) during in-season practices. Players were involved in individualized skill (indy), team playbook (team), and special team (ST) drills during practice and analyzed for their specialist offensive or defensive role (e.g., linebacker or wide receiver). Player running (i.e., high-speed running and sprint) and accelerations (i.e., high-intensity PlayerLoad and high-intensity inertial movement analysis) per minute were of interest. Drill type and practice day had significant effects on all workload intensity metrics (p < 0.01), but not position. Greater running intensities were seen in ST drills compared with other drill types. Tuesday practice sessions had greater overall intensities compared with other days. Interaction effect of position and drill type was significant (p < 0.001) for all intensity metrics, indicating that position groups exhibited unique workload responses to the drill types. Drill type and practice day interaction effect was significant for all intensity metrics (p < 0.01). The findings may be informative for coaches to tailor physical workloads of practice drills for positional roles in preparation for games and practices. Player tracking technology can add value for strength and conditioning coaches to adjust training programs based on position-specific on-field demands of players.

A simple computational method to estimate stance velocity in running.

Running dynamical analyses typically approximate a runner's stance velocity as the average stride cycle velocity (the average running speed). That approximation necessarily overestimates stance velocity and biases subsequent results. Stance velocity is crucial in kinetic spring-mass analyses of running, where approximation of a runner's impact angle and calculation of leg stiffness require that input. Here, a new method is presented to approximate a runner's stance velocity via measurement of contact and flight times with the runner's average speed, leg length or height, and mass. This method accurately estimated the stance velocity of simulated spring-mass systems across typical running speeds of 3.5-5.5 m s-1 (r>0.99) and more accurately estimated the impact angle and leg stiffness. The method also accurately estimated the peak horizontal ground reaction force across speeds (r=0.82), but the bias magnitude increased with speed. Robustness of the new method was further tested for runners at 2.5, 3.5 and 4.5 m s-1, and the new method provided steeper impact angles than those from traditional estimates and correspondingly higher leg stiffnesses, analogous to the observations in the simulation models. Horizontal ground reaction force estimates were weakly correlated in braking and propulsion. They were improved by a corrective algorithm, but the intra- and inter-individual variation persisted. The directionality and magnitude of angle and stiffness estimates in the human runners were similar to simulations, suggesting the new method more accurately modeled runners' spring-mass characteristics by using an accurate approximation of stance velocity. The new method can improve traditional kinetic analyses of running where stance velocity recordings are not captured with kinematic recordings and extend opportunities for accurate field-based analyses with limited measurement sources.

Bouncing behavior of sub-four minute milers.

Elite middle distance runners present as a unique population in which to explore biomechanical phenomena in relation to running speed, as their training and racing spans a broad spectrum of paces. However, there have been no comprehensive investigations of running mechanics across speeds within this population. Here, we used the spring-mass model of running to explore global mechanical behavior across speeds in these runners. Ten elite-level 1500 m and mile runners (mean 1500 m best: 3:37.3 ± 3.6 s; mile: 3:54.6 ± 3.9 s) and ten highly trained 1500 m and mile runners (mean 1500 m best: 4:07.6 ± 3.7 s; mile: 4:27.4 ± 4.1 s) ran on a treadmill at 10 speeds where temporal measures were recorded. Spatiotemporal and spring-mass characteristics and their corresponding variation were calculated within and across speeds. All spatiotemporal measures changed with speed in both groups, but the changes were less substantial in the elites. The elite runners ran with greater approximated vertical forces (+ 0.16 BW) and steeper impact angles (+ 3.1°) across speeds. Moreover, the elites ran with greater leg and vertical stiffnesses (+ 2.1 kN/m and + 3.6 kN/m) across speeds. Neither group changed leg stiffness with increasing speeds, but both groups increased vertical stiffness (1.6 kN/m per km/h), and the elite runners more so (further + 0.4 kN/m per km/h). The elite runners also demonstrated lower variability in their spatiotemporal behavior across speeds. Together, these findings suggested that elite middle distance runners may have distinct global mechanical patterns across running speeds, where they behave as stiffer, less variable spring-mass systems compared to highly trained, but sub-elite counterparts.

Improving spring-mass parameter estimation in running using nonlinear regression methods.

Runners are commonly modeled as spring-mass systems, but the traditional calculations of these models rely on discrete observations during the gait cycle (e.g. maximal vertical force) and simplifying assumptions (e.g. leg length), challenging the predicative capacity and generalizability of observations. We present a method to model runners as spring-mass systems using nonlinear regression (NLR) and the full vertical ground reaction force (vGRF) time series without additional inputs and fewer traditional parameter assumptions. We derived and validated a time-dependent vGRF function characterized by four spring-mass parameters - stiffness, touchdown angle, leg length and contact time - using a sinusoidal approximation. Next, we compared the NLR-estimated spring-mass parameters with traditional calculations in runners. The mixed-effect NLR method (ME NLR) modeled the observed vGRF best (RMSE:155 N) compared with a conventional sinusoid approximation (RMSE: 230 N). Against the conventional methods, its estimations provided similar stiffness approximations (-0.2±0.6 kN m-1) with moderately steeper angles (1.2±0.7 deg), longer legs (+4.2±2.3 cm) and shorter effective contact times (-12±4 ms). Together, these vGRF-driven system parameters more closely approximated the observed vertical impulses (observed: 214.8 N s; ME NLR: 209.0 N s; traditional: 223.6 N s). Finally, we generated spring-mass simulations from traditional and ME NLR parameter estimates to assess the predicative capacity of each method to model stable running systems. In 6/7 subjects, ME NLR parameters generated models that ran with equal or greater stability than traditional estimates. ME NLR modeling of the vGRF in running is therefore a useful tool to assess runners holistically as spring-mass systems with fewer measurement sources or anthropometric assumptions. Furthermore, its utility as statistical framework lends itself to more complex mixed-effects modeling to explore research questions in running.

Biomechanical Evaluation of the Depth of Resection During Femoral Neck Osteoplasty for Anterior Impingement Following Slipped Capital Femoral Epiphysis.

BACKGROUND: Femoroacetabular impingement as a result of slipped capital femoral epiphysis (SCFE) has been treated traditionally with a proximal femoral osteotomy, but open and arthroscopic femoral osteoplasty is becoming increasingly popular. Cam lesions result from excess bone primarily at the anterolateral femoral head-neck junction. SCFEs result from posterior and inferior slippage of the femoral epiphysis, causing the metaphysis to move anteriorly. This study's purpose was to compare fourth-generation sawbones standard femurs with SCFE femurs to determine whether bone resection from the anterior metaphysis results in similar biomechanical properties. METHODS: A custom fourth-generation composite SCFE sawbone was created with a 30-degree slip angle. Control group consisted of fourth-generation composite standard nondeformed medium femurs. The femoral neck at the head-neck junction was divided into 4 quadrants. All resections were done in the anterolateral quadrant. Twenty SCFE sawbones and 20 standard sawbones were divided into 4 subgroups based on resection depths of 0%, 10%, 30%, and 50% of the metaphysis at the head-neck junction. After resection, all proximal femurs were loaded to failure in an Instron testing machine to determine the ultimate load to failure, stiffness, and energy to failure. RESULTS: The standard femurs were significantly stronger than the SCFE femurs (P<0.001) and the strength of the femurs decreased significantly as the resection amount increased (P<0.001). Similarly, the standard femurs withstood significantly more energy before failing than the SCFE femurs (P<0.001) and the energy to failure decreased significantly with varying resection amounts (P<0.001). CONCLUSIONS: SCFE femurs demonstrate a significant reduction in strength and energy to failure after osteoplasty compared with nondeformed femurs in a sawbone model. Strength and energy to failure are inversely proportional to the depth of bone resection. CLINICAL RELEVANCE: Aggressive femoral neck osteoplasty for treatment of a SCFE deformity may lead to increased risk of fracture. Further studies are necessary to determine the safe depth of resection in a clinical setting.

Step frequency patterns of elite ultramarathon runners during a 100-km road race.

Step frequency (SF) in running has received substantial interest from researchers, coaches, therapists, and runners. It has been widely studied in controlled settings, but no published study has measured it continuously in elite-level competition. The present study used wrist-based accelerometers in consumer-grade watches to monitor SF and SF variability of competitors in the 2016 100-km World Championship road race. Using linear mixed-model regression, SF and SF variability were assessed across the race. The average SF (steps-per-minute) of competitors ( n = 20) was 182.0 spm (range: 155.4-203.1 spm). Race fluctuations in SF were influenced only by the speed the competitors were running, with faster speeds being associated with greater SF (5.6 spm/m·s-1, P < 0.001). Independently of this speed relation, SF did not significantly change over the course of the race. SF was further linked to the runner's stature (-123.1 spm/m, P = 0.01) but not significantly related to sex, weight, age, or years of experience. The SF coefficient-of-variation was inversely associated with running speed and distance covered, with runners demonstrating decreasing variability both at faster speeds and as the race progressed. Together, these results add ecological evidence to observations of a speed dependency of SF in a highly trained, elite population of runners and suggest that in road race conditions, SF changes only with speed and not fatigue. Furthermore, it presents evidence that the variability of an elite runner's SF is linked to both speed and fatigue but not to any other characteristics of the runner. The current findings are important for runners, clinicians, and coaches as they seek to monitor or manipulate SF. NEW & NOTEWORTHY Stride frequency (SF; or the synonymous "cadence") has become a popular point of monitoring and manipulation in runners. Advances in wearable technology have enabled continuous monitoring of SF. This study is the first to examine SF and SF variability patterns throughout an entire road race in elite ultramarathon runners. This adds ecological, normative data to the field's understanding of SF and demonstrates how it relates to running speed, fatigue, and individual characteristics.

Validation of a wireless shoe insole for ground reaction force measurement.

Ground reaction force measurements are a fundamental element of kinetic analyses of locomotion, yet they are traditionally constrained to laboratory settings or stationary frames. This study assessed the validity and reliability of a new wireless in-shoe system (Novel Loadsol/Pedoped) for field-based ground reaction force measurement in hopping, walking, and running. Twenty participants bilaterally hopped on a force plate and walked (5 km/hr) and ran (10 km/hr) on an instrumented treadmill on two separate days while wearing the insoles. GRFs were recorded simultaneously on each respective system. Peak GRF in hopping and peak GRF, contact time (CT), and impulse (IMP) in walking and running were compared on a per-hop and step-by-step basis. In hopping, the insoles demonstrated excellent agreement with the force plate (ICC: 0.96). In walking and running, the insoles demonstrated good-to-excellent agreement with the treadmill across all measures (ICCs: 0.88-0.96) and were reliable across sessions (ICCs within 0.00-0.03). A separate verification study with ten participants was conducted to assess a correction algorithm for further agreement improvement but demonstrated little meaningful change in systemic agreements. These results indicated that the Novel Loadsol system is a valid and reliable tool for wireless ground reaction force measurement in hopping, walking, and running.

Effects of Volar Tilt, Wrist Extension, and Plate Position on Contact Between Flexor Pollicis Longus Tendon and Volar Plate.

PURPOSE: Volar plates positioned at, or distal to, the watershed line have been shown to have a higher incidence of attritional rupture of the flexor pollicis longus (FPL). In this study, we aimed to evaluate the effect of wrist extension and volar tilt on the contact between the plate and the FPL tendon in a cadaver model. We hypothesized that, following volar plate application, loss of native volar tilt increases the contact between the FPL and the plate at lower degrees of wrist extension. METHODS: A volar locking plate was applied on 6 fresh-frozen cadavers. To determine the contact between the plate and the FPL tendon, both structures were wrapped with copper wire and circuit conductivity was monitored throughout wrist motion. A lateral wrist radiograph was obtained at each circuit closure, indicating tendon-plate contact. Baseline measurements were obtained with plate positioned at Soong grades 0, 1, and 2. An extra-articular osteotomy was made and contact was recorded at various volar tilt angles (+5°, 0°, -5°, -10°, -15°, and -20°) in 3 different plate positions. A blinded observer measured the degree of wrist extension on all lateral radiographs. Data were analyzed using linear mixed-effects regression model. RESULTS: Plates placed distal to the watershed line had the most contact throughout wrist range of motion. Significantly, less wrist extension was required for contact in wrists with neutral or dorsal tilt and in distally placed volar plates. Volar tilt, wrist extension, and plate position were 3 independent risk factors determining contact between plate and tendon. CONCLUSIONS: Loss of volar tilt, increased wrist extension, and higher Soong grade plate position result in greater contact between wire-wrapped FPL tendon and plate. CLINICAL RELEVANCE: The FPL/plate contact chart generated in this study may be used to assess the risk of rupture in the clinical setting.

Comparison of 2-Dimensional and 3-Dimensional Metacarpal Fracture Plating Constructs Under Cyclic Loading.

PURPOSE: Metacarpal fractures are commonly treated by a variety of means including casting or open reduction internal fixation when unacceptable alignment is present following attempted closed reduction. Dorsal plating with either single-row 2-dimensional or double-row 3-dimensional plates has been proposed. This study's purpose was to determine if there are any differences in fixation construct stability under cyclic loading and subsequent load to failure between the lower profile 3-dimensional and the larger 2-dimensional plates in a metacarpal fracture gap sawbone model. METHODS: Thirty metacarpal cortico-cancellous synthetic bones were cut with a 1.75-mm gap between the 2 fragments simulating mid-diaphyseal fracture comminution. Half of the metacarpals were plated with 2.0-mm locking 2-dimensional plates and half with 1.5-mm locking 3-dimensional plates. The plated metacarpals were mounted into a materials testing apparatus and cyclically loaded under cantilever bending for 2,000 cycles at 70 N, then 2,000 cycles at 120 N, and finally monotonically loaded to failure. Throughout testing, fracture gap sizes were measured, failure modes were recorded, and construct strength and stiffness values were calculated. RESULTS: All 3-dimensional constructs survived both cyclic loading conditions. Ten (67%) 2-dimensional constructs survived both loading conditions, whereas 5 (33%) failed the 120-N loading at 1377 ± 363 cycles. When loaded to failure, the 3-dimensional constructs failed at 265 N ± 21 N, whereas the 2-dimensional constructs surviving cyclic loading failed at 190 N ± 17 N. CONCLUSIONS: The shorter, thinner 3-dimensional metacarpal plates demonstrated increased resistance to failure in a cyclic loading model and increased load to failure compared with the relatively longer, thicker 2-dimensional metacarpal plates. CLINICAL RELEVANCE: The lower-profile 3-dimensional metacarpal plate fixation demonstrated greater stability for early postoperative resistance than the thicker 2-dimensional fixation, whereas the smaller size and lower profile of the 3-dimensional plates potentially reduces soft tissue stripping, implant prominence, and risk of extensor tendon irritation.

Evaluating Internal Fixation Skills Using Surgical Simulation.

BACKGROUND: Open reduction and internal fixation (ORIF) is an essential skill for an orthopaedic surgeon, yet teaching its components to surgical residents poses challenges in both complexity and cost. Surgical simulation has demonstrated efficacy and is now a mandated component of residency programs, but the techniques and resources required for effective simulation vary greatly. We hypothesized that simulation of ORIF skills could be accomplished in a cost-effective, quantifiable, and reproducible manner and that this experience coupled with didactic learning would increase skill proficiency and enhance ORIF performance. METHODS: Sixteen postgraduate-year-1 orthopaedic surgery interns were assessed on performance of ORIF simulation tasks before and after attending a module designed to introduce and practice internal fixation techniques. Simulation tasks addressed drilling accuracy via oblique drilling through polyvinyl chloride (PVC) cylinders and bisecting wooden dowels and plunge control via drilling through layered boards of varying densities. Fracture fixation simulation involved fixing oblique fractures on synthetic ulnae. Task performance was assessed at 3 time points: immediately before the module, 1 week after the module, and 3 months after the module. Fracture fixation was assessed before and after the module via load-to-failure testing. Success rates for the tasks were analyzed using a repeated-measures analysis of variance, and mechanical properties of the fixed ulnar constructs were compared using paired t tests. RESULTS: In all ORIF simulation tasks, pre-module to post-module improvement in success rates was significant (p < 0.001) and improvements were maintained between the post-module assessment and the 3-month follow-up. The interns also achieved significantly greater strengths in their ulnar fixation constructs, with a mean improvement of 256 N (p = 0.01) after the module. CONCLUSIONS: These results indicate that the technical and sensorimotor skills relevant to internal fixation (with emphasis on the specific skill of using a drill) can be significantly augmented and retained in the short term in surgical residents after exposure to faculty-led lecture and hands-on skills practice using low-cost materials. CLINICAL RELEVANCE: This study provides evidence for an effective, accessible method of enhancing and assessing surgical skills in training.

Biomechanical Analysis of Intervertebral Cement Extravasation in Vertebral Motion Segments.

Kyphoplasty is a therapeutic option for pain relief in the setting of compression fractures. Cement extravasation into adjacent disks is a common occurrence. The biomechanical and clinical consequences of cement in the disks currently are unknown. This study investigated the biomechanical effects of cement extravasation into the intervertebral disk in a human cadaveric model. Seven thoracolumbar and lumbar embalmed human cadaveric motion segments were evaluated in axial rotation, right and left lateral bending, and flexion and extension. Stiffness was calculated at baseline and following injection of 1 mL of cement into the intervertebral disk. There was a 13.4% (P=.041) increase in stiffness in axial rotation compared with preinjection motion segments. No significant difference was observed in lateral bending or flexion and extension. In this model, cement extravasation into the disk space increased stiffness in axial rotation. [Orthopedics. 2017; 40(2):e300-e304.].