Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility

Context: The Ober and Thomas tests are subjective and involve a "negative" or "positive" assessment, making them difficult to apply within the paradigm of evidence-based medicine. No authors have combined the subjective clinical assessment with an objective measurement for these special tests. Objective: To compare the subjective assessment of iliotibial band and iliopsoas flexibility with the objective measurement of a digital inclinometer, to establish normative values, and to provide an evidence-based critical criterion for determining tissue tightness. Design: Cross-sectional study. Setting: Clinical research laboratory. Patients or Other Participants: Three hundred recreational athletes (125 men, 175 women; 250 in injured group, 50 in control group). Main Outcome Measure(s): Iliotibial band and iliopsoas muscle flexibility were determined subjectively using the modified Ober and Thomas tests, respectively. Using a digital inclinometer, we objectively measured limb position. lnterrater reliability for the subjective assessment was compared between 2 clinicians for a random sample of 100 injured participants, who were classified subjectively as either negative or positive for iliotibial band and iliopsoas tightness. Percentage of agreement indicated interrater reliability for the subjective assessment. Results: For iliotibial band flexibility, the average inclinometer angle was -24.59 degrees +/- 7.27 degrees. A total of 432 limbs were subjectively assessed as negative (-27.13 degrees +/- 5.53 degrees) and 168 as positive (-16.29 degrees +/- 6.87 degrees). For iliopsoas flexibility, the average inclinometer angle was -10.60 degrees +/- 9.61 degrees. A total of 392 limbs were subjectively assessed as negative (-15.51 degrees +/- 5.82 degrees) and 208 as positive (0.34 degrees +/- 7.00 degrees). The critical criteria for iliotibial band and iliopsoas flexibility were determined to be -23.16 degrees and -9.69 degrees, respectively. Between-clinicians agreement was very good, ranging from 95.0% to 97.6% for the Thomas and Ober tests, respectively. Conclusions: Subjective assessments and instrumented measurements were combined to establish normative values and critical criterions for tissue flexibility for the modified Ober and Thomas tests

GAIT COORDINATION VARIABILITY BETWEEN TRAINED RUNNERS AND NON-RUNNERS

The objective of this study was to examine the differences in coordination variability in gait running between trained runners and non-runners. Kinematic data were collected from 20 participants divided into two groups (runners and non-runners) during treadmill running. Coordination variability was evaluated by calculating continuous relative phase (CRP) for four coupling pairs. The CRP variability averaged over the entire stance phase was equal between both groups of runners in the coupling joint analysed (t 0.192). The result suggest that the skill level did not influence on the CRP variability in running gait

HEAD ACCELERATION EVENTS USING INSTRUMENTED MOUTHGUARDS IN FEMALE RINGETTE PLAYERS

Ringette is a contact sport which prompts high rates of head contacts and concussion, some of the highest reported rates in youth sport. Biomechanical forces at the head can cause concussion injury, therefore examination of head acceleration events and head biomechanics during ringette is useful to understand injury risk and mechanism. The purpose of this study was to describe head acceleration events (HAEs) in female youth ringette players and examine head biomechanics during video-verified head acceleration events. Instrumented mouthguards were worn by 8 players and 36 video-verified HAEs were accumulated from in-game exposure. Results indicate athletes sustain HAEs from both direct and indirect head contacts. Mann Whitney U tests reveal no significant differences in biomechanics between direct and indirect HAEs. Most direct head impacts were related to mechanism of head-head contacts or head contact with the boards and typically involved impact high on the head. Indirect HAEs were usually due to whiplash or stabilization. Data also show most HAEs result from deliberate physical contacts initiated by non-ring carriers. Future work with greater data accumulation and verification of head acceleration events can inform coaches and players on the risks of head injury associated with specific mechanisms

Validity and reliability of a smartphone motion analysis app for lower limb kinematics during treadmill running

Objective: To investigate the validity and reliability of a smartphone application for selected lower-limb kinematics during treadmill running. Design: Validity and reliability study. Setting: Biomechanics laboratory. Participants: Twenty healthy female runners. Main outcome measure(s): Sagittal-plane hip, knee, and ankle angle and rearfoot eversion were assessed using the Coach's Eye Smartphone application and a 3D motion capture system. Paired t-test and intraclass correlation coefficients (ICC) established criterion validity of Coach's Eye; ICC determined test-retest and intrarater/interrater reliability. Standard error of measurement (SEM) and minimal detectable change (MDC) were also reported. Results: Significant differences were found between Coach's Eye and 3D measurements for ankle angle at touchdown and knee angle at toe-off (p < 0.05). ICCs for validity of Coach's Eye were excellent for rearfoot eversion at touchdown (ICC = 0.79) and fair-to-good for the other kinematics (range 0.51–0.74), except for hip at touchdown, which was poor (ICC = 0.36). Test-retest (range 0.80–0.92), intrarater (range 0.95–0.99) and interrater (range 0.87–0.94) ICC results were excellent for all selected kinematics. Conclusion: Coach's Eye can be used as a surrogate for 3D measures of knee and rearfoot in/eversion at touchdown, and hip, ankle, and rearfoot in/eversion at toe-off, but not for hip and ankle at touchdown or knee at toe-off. Reliable running kinematics were obtained using Coach's Eye, making it suitable for repeated measures

The effect of running speed on joint coupling coordination and its variability in recreational runners

The purpose of this study was to examine the effect of speed on coordination and its variability in running gait using vector coding analysis. Lower extremity kinematic data were collected for thirteen recreational runners while running at three different speeds in random order: preferred speed, 15% faster and 15% lower than preferred speed. A dynamical systems approach, using vector coding and circular statistics, were used to quantify coordination and its variability for selected hip-knee and knee-ankle joint couplings. The influence of running speed was calculated from the continuous data sets of the running cycle, allowing for the identification of time percentages where differences existed. Results indicate that increases in running speed produced moderate alterations in the frequency of movement patterns which were not enough to alter classification of coordination. No effects of speed on coordination variability were observed. This study has demonstrated that coordination and coordination variability is generally stable in the range of ±15% around of preferred speed in recreational runners.Centro de Investigación en Rendimiento Físico y Deportivo. Universidad Pablo de Olavide de SevillaPostprin

Effects of running experience on coordination and its variability in runners

The purpose of this study was to examine the differences in coordination variability in running gait between trained runners and non-runners using continuous relative phase (CRP) analysis. Lower extremity kinematic data were collected for 22 participants during the stance phase. The participants were assigned to either a runner or non-runner group based on running volume training. Segment coordination and coordination variability were calculated for selected hip¿knee and knee¿ankle couplings. Independent t-tests and magnitude-based inferences were used to compare the 2 groups. There were limited differences in the CRP and its variability among runners and non-runner groups. The runners group achieved moderately lower coordination compared with non-runners group in the phase angle for hip abduction/adduction and knee flexion/extension. The runners tended to show moderately lower coordination variability in the phase angle for knee flexion/extension and subtalar inversion/eversion in comparison to non-runners group. These results suggested that levels of experience as estimated from weekly training volume had little influence on coordination and its variability.Universidad Pablo de Olavide de Sevilla. Departamento de Deporte e InformáticaPostprin

Walking with head-mounted virtual and augmented reality devices : effects on position control and gait biomechanics

What was once a science fiction fantasy, virtual reality (VR) technology has evolved and come a long way. Together with augmented reality (AR) technology, these simulations of an alternative environment have been incorporated into rehabilitation treatments. The introduction of head-mounted displays has made VR/AR devices more intuitive and compact, and no longer limited to upper-limb rehabilitation. However, there is still limited evidence supporting the use of VR and AR technology during locomotion, especially regarding the safety and efficacy relating to walking biomechanics. Therefore, the objective of this study is to explore the limitations of such technology through gait analysis. In this study, thirteen participants walked on a treadmill in normal, virtual and augmented versions of the laboratory environment. A series of spatiotemporal parameters and lower-limb joint angles were compared between conditions. The center of pressure (CoP) ellipse area (95% confidence ellipse) was significantly different between conditions (p = 0.002). Pairwise comparisons indicated a significantly greater CoP ellipse area for both the AR (p = 0.002) and VR (p = 0.005) conditions when compared to the normal laboratory condition. Furthermore, there was a significant difference in stride length (p0.082), except for maximum ankle plantarflexion (p = 0.001). These differences in CoP ellipse area indicate that users of head-mounted VR/AR devices had difficulty maintaining a stable position on the treadmill. Also, differences in the gait parameters suggest that users walked with an unusual gait pattern which could potentially affect the effectiveness of gait rehabilitation treatments. Based on these results, position guidance in the form of feedback and the use of specialized treadmills should be considered when using head-mounted VR/AR devices

The Effects of Midfoot Strike Gait Retraining on Impact Loading and Joint Stiffness

Objective: To assess the biomechanical changes following a systematic gait retraining to modify footstrike patterns from rearfoot strike (RFS) to midfoot strike (MFS). Design: Pre-post interventional study. All participants underwent a gait retraining program designed to modify footstrike pattern to MFS. Setting: Research laboratory. Participants: Twenty habitual RFS male runners participated. Main Outcome Measures: Gait evaluations were conducted before and after the training. Footstrike pattern, loading rate (LR), ankle and knee joint stiffness were compared. Results: Participants’ footstrike angle was reduced (p<0.001, Cohen’s d=1.65) and knee joint stiffness was increased (p=0.003, Cohen’s d=0.69). No significant difference was found in the vertical loading rates (p>0.155). Further sub-group analyses were conducted on the respondents (n=8, 40% of participants) who exhibited MFS for over 80% of their footfalls during the post-training evaluation. Apart from the increased knee joint stiffness (p=0.005, Cohen’s d=1.14), respondents exhibited a significant reduction in the ankle joint stiffness (p=0.019, Cohen’s d=1.17) when running with MFS. Conclusions: Gait retraining to promote MFS was effective in reducing runners’ footstrike angle, but only 40% of participants responded to this training program. The inconsistent training effect on impact loading suggests a need to develop new training protocols in an effort to prevent running injuries

Effects of deceptive footwear condition on subjective comfort and running biomechanics

Comfort is a major criterion for footwear selection. Previous studies have suggested that physical properties were not enough to predict comfort and psychological factors could also affect the perception. To understand comfort, this study examined the effect of controlled shoe description and price cue on the perception of comfort. Furthermore, this study also examined the running biomechanics in response to footwear conditions of differing comfort. Fifteen runners completed treadmill running tests in two conditions: Shoe A and Shoe B. The same pair of neutral running shoes was used in both conditions, yet, Shoe B was described to be the “latest model designed to maximize comfort” and more expensive than Shoe A. Comfort assessment was conducted after the running trial of each condition. Participants reported significantly greater comfort in Shoe B than Shoe A (p=0.011, Cohen’s d=0.70). There were no significant differences found among the temporal-spatial parameters (p>0.916) and the vertical loading rates (p>0.161) when comparing the more and less comfortable conditions. In conclusion, runners exhibited a biased perception of footwear comfort when presented with different shoe description and price information. However, such a difference in perceived comfort alone is not likely to affect running biomechanics

Changes in joint coupling and variability during walking following tibialis posterior muscle fatigue

<p>Abstract</p> <p>Background</p> <p>The tibialis posterior muscle is believed to play a key role in controlling foot mechanics during the stance phase of gait. However, an experiment involving localised tibialis posterior muscle fatigue, and analysis of discrete rearfoot and forefoot kinematic variables, indicated that reduced force output of the tibialis posterior muscle did not alter rearfoot and forefoot motion during gait. Thus, to better understand how muscle fatigue affects foot kinematics and injury potential, the purpose of this study was to reanalyze the data and investigate shank, rearfoot and forefoot joint coupling and coupling variability during walking.</p> <p>Methods</p> <p>Twenty-nine participants underwent an exercise fatigue protocol aimed at reducing the force output of tibialis posterior. An eight camera motion analysis system was used to evaluate 3 D shank and foot joint coupling and coupling variability during treadmill walking both pre- and post-fatigue.</p> <p>Results</p> <p>The fatigue protocol was successful in reducing the maximal isometric force by over 30% and a concomitant increase in coupling motion of the shank in the transverse plane and forefoot in the sagittal and transverse planes relative to frontal plane motion of the rearfoot. In addition, an increase in joint coupling variability was measured between the shank and rearfoot and between the rearfoot and forefoot during the fatigue condition.</p> <p>Conclusions</p> <p>The reduced function of the tibialis posterior muscle following fatigue resulted in a disruption in typical shank and foot joint coupling patterns and an increased variability in joint coupling. These results could help explain tibialis posterior injury aetiology.</p