Tendon stress may be one of the important risk factors for running-related tendon injury. Several methods have been used to estimate Achilles tendon (AT) loading during a human performance such as inverse dynamics (ID) and inverse dynamics-based static optimisation (IDSO). Our purpose was to examine differences between ID and IDSO estimates of AT loading during running. Kinematic data were captured simultaneously with kinetic data. Imaging of the AT cross-sectional area was performed with ultrasound for 17 healthy runners (height: 170.2 ± 6.2 cm, mass: 63.9 ± 11.0 kg, age: 21.8 ± 1.4 years). AT stress, strain, and force were estimated from both ID and IDSO approaches. The two methods resulted in minimal differences (3.6-4.7%) in estimated peak AT stress, strain, and force (P = 0.051-0.054); however, IDSO estimates were greater (32.7-36.8%) during early-stance phase of running (P = 0.000-0.008). This difference in AT load during early-stance may be due to the inability of the ID to account muscle coactivation. The similarity between the peak AT loading for ID and IDSO methods revealed that the advantage of IDSO used to estimate muscle forces had little effect on the ankle plantar flexor peak forces during running. Therefore, the use of IDSO with a higher computational cost compared with ID may not be necessary for estimating AT stress during running.

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Context: Achilles tendinopathies are common injuries during sport participation, although men are more prone to Achilles tendon injuries than women. Heel-raising and -lowering exercises are typically suggested for Achilles tendon rehabilitation.Objective: To compare the estimated Achilles tendon loading variables and the ankle range of motion (ROM) using a musculoskeletal model during commonly performed heelraising and -lowering exercises.Design: Controlled laboratory study. Setting: University biomechanics laboratory.Patients or Other Participants: Twenty-one healthy men (age ¼ 21.59 6 1.92 years, height ¼ 178.22 6 8.02 cm, mass ¼ 75.81 6 11.24 kg).Intervention(s): Each participant completed 4 exercises: seated heel raising and lowering, bilateral standing heel raising and lowering, bilateral heel raising and unilateral lowering, and unilateral heel raising and lowering.Main Outcome Measure(s): A repeated-measures multivariate analysis of variance (a ¼ .05) was used to compare Achilles tendon stress, force, and strain and ankle ROM for each exercise. Kinematic data were recorded at 180 Hz with 15 motion-analysis cameras synchronized with kinetic data collected from a force platform sampled at 1800 Hz. These data were then entered in a musculoskeletal model to estimate force in the triceps surae. For each participant, we determined Achilles tendon stress by measuring cross-sectional images using ultrasound.Results: Peak Achilles tendon loading was lowest when performing the seated heel-raising and -lowering exercise and highest when performing the unilateral heel-raising and -lowering exercise. Loading was greater for the unilateral exercise or portions of the exercise that were performed unilaterally.Conclusions: Bilateral and seated exercises with less weight-bearing force resulted in less Achilles tendon loading. These exercises may serve as progressions during the rehabilitation process before full-body weight-bearing, unilateral exercises are allowed. Ankle ROM did not follow the same order as loading and may need additional monitoring or instruction during rehabilitation.Key Words: kinematics, kinetics, strain, therapeutic exercise, rehabilitation Key PointsBilateral and seated heel-raising and -lowering exercises resulted in less Achilles tendon loading. Unilateral exercises and the unilateral phase of the bilateral heel-raising and unilateral heel-lowering exercise resulted in more Achilles tendon loading.

Findings provide some general support for minimizing forward knee translation during squats for patients that may have patellofemoral pain syndrome.

Background Patellar tendinopathy (PT) or “jumper's knee” is generally found in active populations that perform jumping activities. Graded exposure of patellar tendon stress through functional exercise has been demonstrated to be effective for the treatment of PT. However, no studies have compared how anterior knee displacement variations during the commonly performed forward step lunge (FSL) affect patellar tendon stress. Methods Twenty-five subjects (age: 22.69 ± 0.74 years; height: 169.39 ± 6.44 cm; mass: 61.55 ± 9.74 kg) performed 2 variations of an FSL with the anterior knee motion going in front of the toes (FSL-FT) and the knee remaining behind the toes (FSL-BT). Kinematic and kinetic data were used with an inverse-dynamics based static optimization technique to estimate individual muscle forces to determine patellar tendon stress during both lunge techniques. A repeated measures multivariate analysis was used to analyze these data. Results The peak patellar tendon stress, stress impulse, quadriceps force, knee moment, knee flexion, and ankle dorsiflexion angle were significantly greater ( p < 0.001) during the FSL-FT as compared to the FSL-BT. The peak patellar tendon stress rate did not differ between the FSL-FT and FSL-BT. Conclusion The use of an FSL-FT as compared to an FSL-BT increased the load and stress on the patellar tendon. Because a graded exposure of patellar tendon loading with other closed kinetic chain exercises has proven to be effective in treating PT, consideration for the prescription of variations of the FSL and further clinical evaluation of this exercise is warranted in individuals with PT.