Knee Angular Impulse as a Predictor of Patellofemoral Pain in Runners

Stefanyshyn, Darren J.; Stergiou, Pro; Lun, Victor; Meeuwisse, Willem; Worobets, Jay T.

doi:10.1177/0363546506288753

Cited by 187 publications

(151 citation statements)

References 36 publications

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“…In fact, increased knee abduction moment with use of a medially wedged orthoses may be an undesirable effect based on previous research which identified knee abduction moment impulse as a potential risk factor for PFPS development among runners. 50 Therefore, although the effect to knee abduction moment in this study was small, a repeated exposure to these increased moments during a prolonged run may actually represent a mechanism for exacerbation of PFPS symptoms due to the use of medially wedged foot orthoses.…”

Section: Discussionmentioning

confidence: 75%

Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females With and Without Patellofemoral Pain Syndrome

Boldt

Willson²,

Barrios³

et al. 2013

Journal of Applied Biomechanics

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We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

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Section: Discussionmentioning

confidence: 75%

Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females With and Without Patellofemoral Pain Syndrome

Boldt

Willson²,

Barrios³

et al. 2013

Journal of Applied Biomechanics

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“…This is not unprecedented: external knee-adduction moments have been previously reported in females during single-leg activities. 15,65 Although a prospective study 14 suggested that external knee-abduction moments best predict ACL injury risk, cadaveric data 13 indicated that ACL loads increase when either a 10-Nm external knee-abduction or -adduction moment is applied to the knee in the presence of an anterior tibial force. In the context of our findings, these cadaveric data suggest that kinetic changes at the knee as a consequence of an isolated hip-abductor fatigue protocol may actually reduce ACL loads during single-leg landings.…”

Section: Kinematic and Kinetic Datamentioning

confidence: 99%

Hip-Abductor Fatigue and Single-Leg Landing Mechanics in Women Athletes

Patrek

Kernozek

Willson

et al. 2011

Journal of Athletic Training

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Context: Reduced hip-abductor strength and muscle activation may be associated with altered lower extremity mechanics, which are thought to increase the risk for anterior cruciate ligament injury. However, experimental evidence supporting this relationship is limited. Objective: To examine the changes in single-leg landing mechanics and gluteus medius recruitment that occur after a hip-abductor fatigue protocol. Design: Descriptive laboratory study. Patients or Other Participants: Twenty physically active women (age = 21.0 ± 1.3 years). Intervention(s): Participants were tested before (prefatigue) and after (postfatigue) a hip-abductor fatigue protocol consisting of repetitive side-lying hip abduction. Main Outcome Measure(s): Outcome measures included sagittal-plane and frontal-plane hip and knee kinematics at initial contact and at 60 milliseconds after initial contact during 5 single-leg landings from a height of 40 cm. Peak hip and knee sagittal-plane and frontal-plane joint moments during this time interval were also analyzed. Measures of gluteus medius activation, including latency, peak amplitude, and integrated signal, were recorded. Results: A small (<1°) increase in hip-abduction angle at initial contact and a small (<1°) decrease in knee-abduction (valgus) angle at 60 milliseconds after contact were observed in the postfatigue landing condition. No other kinematic changes were noted for the knee or hip at initial contact or at 60 milliseconds after initial contact. Peak external knee-adduction moment decreased 27% and peak hip adduction moment decreased 24% during the postfatigue landing condition. Gluteus medius activation was delayed after the protocol, but no difference in peak or integrated signal was seen during the landing trials. Conclusions: Changes observed during single-leg landings after hip-abductor fatigue were not generally considered unfavorable to the integrity of the anterior cruciate ligament. Further work may be justified to study the role of hip-abductor activation in protecting the knee during landing.

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“…9 studying the effects of sloped running on GRFs, noted that neither decline nor incline running affected normal active force peaks but that the impact peak of the vertical GRF increased during decline running. No authors have found a direct correlation between sloped running and injury risk, but it is worthwhile to recognize that changes in force demands on level surfaces have been suggested [11][12][13][14][15][16][17][18][19][20] to play a role in the development or progression (or both) of joint injury.…”

mentioning

confidence: 99%

Lower Limb Joint Kinetics During Moderately Sloped Running

Telhan

Franz

Dicharry

et al. 2010

Journal of Athletic Training

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, VA. Mr Franz is now at the University of Colorado at Boulder, Boulder, CO.Context: Knowledge of the kinetic changes that occur during sloped running is important in understanding the adaptive gaitcontrol mechanisms at work and can provide additional information about the poorly understood relationship between injury and changes in kinetic forces in the lower extremity. A study of these potential kinetic changes merits consideration, because training and return-to-activity programs are potentially modifiable factors for tissue stress and injury risk.Objective: To contribute further to the understanding of hill running by quantifying the 3-dimensional alterations in joint kinetics during moderately sloped decline, level, and incline running in a group of healthy runners.Design: Crossover study. Setting: Three-dimensional motion analysis laboratory.Patients or Other Participants: Nineteen healthy young runners/joggers (age 5 25.3 6 2.5 years).Intervention(s): Participants ran at 3.13 m/s on a treadmill under the following 3 different running-surface slope conditions: 46 decline, level, and 46 incline.Main Outcome Measure(s): Lower extremity joint moments and powers and the 3 components of the ground reaction force.Results: Moderate changes in running-surface slope had a minimal effect on ankle, knee, and hip joint kinetics when velocity was held constant. Only changes in knee power absorption (increased with decline-slope running) and hip power (increased generation on incline-slope running and increased absorption on decline-slope running in early stance) were noted. We observed an increase only in the impact peak of the vertical ground reaction force component during decline-slope running, whereas the nonvertical components displayed no differences.Conclusions: Running style modifications associated with running on moderate slopes did not manifest as changes in 3-dimensional joint moments or in the active peaks of the ground reaction force. Our data indicate that running on level and moderately inclined slopes appears to be a safe component of training regimens and return-to-run protocols after injury.Key Words: biomechanics, decline running, incline running, joint moments, joint power Key Points N Running style modifications on moderate slopes did not manifest as changes in 3-dimensional joint moments or active peaks of the ground reaction force. N However, changes in knee power absorption (increased on the decline slope) and hip power (increased generation on the incline slope and increased absorption on the decline slope in early stance) were seen. The impact peak of the vertical ground reaction force increased only during running on the decline slope.N Running on level and moderately inclined slopes appears to be a safe component of training regimens and return-to-run protocols after injury.

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Knee Angular Impulse as a Predictor of Patellofemoral Pain in Runners

Abstract: Footwear and running style can influence knee angular impulse, and the appropriate manipulation of these variables may play a preventive role for patients who are predisposed to patellofemoral pain.

Cited by 187 publications

References 36 publications

Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females With and Without Patellofemoral Pain Syndrome

Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females With and Without Patellofemoral Pain Syndrome

Hip-Abductor Fatigue and Single-Leg Landing Mechanics in Women Athletes

Lower Limb Joint Kinetics During Moderately Sloped Running

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