Patellofemoral Joint Stress during Running with Alterations in Foot Strike Pattern

Vannatta, C. Nathan; Kernozek, Thomas W.

doi:10.1249/mss.0000000000000503

Cited by 71 publications

(65 citation statements)

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“…13 A static, neutral-standing calibration trial was collected before all dynamic trials. Kinematic data were recorded at 180 Hz with 15 motionanalysis cameras (models Osprey, Kestrel, and Eagle) surrounding the measurement space.…”

Section: Instrumentationmentioning

confidence: 99%

Achilles Tendon Loading During Heel-Raising and -Lowering Exercises

Revak

Diers

Kernozek

et al. 2017

Journal of Athletic Training

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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.

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Section: Instrumentationmentioning

confidence: 99%

Achilles Tendon Loading During Heel-Raising and -Lowering Exercises

Revak

Diers

Kernozek

et al. 2017

Journal of Athletic Training

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“…Sample size was based off previous repeated measure studies that focused on PF kinetics and kinematics. [12][13][14]19 All participants included were rearfoot strikers, as determined by center of pressure at initial contact occurring in the rear most third of the foot during testing. 18 Additional inclusion criteria included five years of recreational running experience, self-reported running routine of >10 miles per week, and a score of at least level five on the Tegner Activity Level Scale (a questionnaire of regular participation with recreational sports which require running).…”

Section: Subjectsmentioning

confidence: 99%

“…2,[8][9][10] Musculoskeletal modeling studies have investigated PFJS during various movements to characterize this loading. [11][12][13][14] Patellofemoral (PF) joint stress is determined by dividing the PF joint reaction force by the PF contact area. Knee flexion angle influences PF joint contact area 2,15 while the interaction of quadriceps force and knee flexion influence the magnitude of PF joint reaction force.…”

Section: Introductionmentioning

confidence: 99%

“…[19][20][21] Overall, mild-moderate repetitive stress injuries (ie patellofemoral pain syndrome [PFPS], medial tibial stress reaction, IT band syndrome) were 2.5 times higher in RFS runners 22 and multiple authors have reported that runners who adopt a FFS pattern experience significant reduction (13-27%) in peak PFJS. 12,14,19 One recent case series examined the efficacy of converting runners from a RFS to FFS pattern. 23 These patients were able to decrease their PFP and maintain changes in foot strike pattern during follow up session.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Heel Lifts on Patellofemoral Joint Stress During Running

Mestelle

Kernozek

Adkins

et al. 2017

Intl J Sports Phys Ther

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Background: Patellofemoral pain is a debilitating injury for many recreational runners. Excessive patellofemoral joint stress may be the underlying source of pain and interventions often focus on ways to reduce patellofemoral joint stress.Purpose: Heel lifts have been used as an intervention within Achilles tendon rehabilitation programs and to address leg length discrepancies. The purpose of this study was to examine the effect of running with heel lifts on patellofemoral joint stress, patellofemoral stress impulse, quadriceps force, step length, cadence, and other related kinematic and spatiotemporal variables. Study Design: A repeated-measures research designMethods: Sixteen healthy female runners completed five running trials in a controlled laboratory setting with and without 11mm heel lifts inserted in a standard running shoe. Kinetic and kinematic data were used in combination with a static optimization technique to estimate individual muscle forces. These data were inserted into a patellofemoral joint model which was used to estimate patellofemoral joint stress and other variables during running.Results: When running with heel lifts, peak patellofemoral joint stress and patellofemoral stress impulse were reduced by a 4.2% (p=0.049) and 9.3% (p=0.002). Initial center of pressure was shifted anteriorly 9.1% when running with heel lifts (p<0.001) despite all runners utilizing a heel strike pattern. Dorsiflexion at initial contact was reduced 28% (p=0.016) when heel lifts were donned. No differences in step length and cadence (p>0.05) were shown between conditions. Conclusions: Heel lift use resulted in decreased patellofemoral joint stress and impulse without associated changes in step length or frequency, or other variables shown to influence patellofemoral joint stress. The center of pressure at initial contact was also more anterior using heel lifts. The use of heel lifts may have therapeutic benefits for runners with patellofemoral pain if the primary goal is to reduce patellofemoral joint stress. Level of Evidence: 3b

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“…Furthermore, the Achilles tendon moment arm also affects the relationships among the GRF, the Achilles tendon force and the joint reaction force. However, there are only limited studies examining the influence of foot strike patterns on these kinetic parameters by using an inverse dynamics approach [21,29,40,43], and the influence of three foot strike patterns on the Achilles tendon and joint reaction forces and the associated moment arm remains unclear.Clarifying the influences of three foot strike pattern on the forces applied to foot may help to reduce the potential risks of injuries occurring to the Achilles tendon and the tibia. We therefore hypothesized that the Achilles tendon and joint reaction forces are greater for FFS than for MFS, that forces for MFS would be greater than for RFS, and that these differences may originate from differences in the GRF moment arm associated with foot strike pattern.…”

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2017

Sports Med Int Open

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IntroductionDistance running is known to reduce the risks of some health problems in runners [7,27,31,41]; however, distance running also has negative effects that result in musculoskeletal overuse injuries in the lower extremities. The incidence of running-related musculoskeletal overuse injuries in previous studies ranged from 20 to 79 % [39]. The lower leg, foot, and ankle, especially the Achilles tendon and tibia, are commonly affected in running-related injuries [19,24,26,38]. On the basis of material fatigue, large forces applied to injured regions will decrease the number of cycles to failure [3]. Therefore, a decrease in the force applied to the lower leg, foot, and ankle during running may be able to reduce the potential risk of running-related injuries at the Achilles tendon and the tibia for a given running distance and frequency.Foot strike pattern is generally classified into 3 types according to the ground reaction force (GRF) application point, relative to foot length, at the instance of foot contact [5]. Foot strike pattern has been thought to influence the potential risk of running-related injuries [8,21,23,36]. Previous studies reported that 69-75 % runners use the rearfoot strike (RFS) and 25-31 % runners use the midfoot strike (MFS) or rearfoot strike (RFS) [8,15]. It was reported that the vertical component of GRF during the early stance phase, and the loading rate of that force, were smaller for FFS and MFS than for RFS [5,22,23,28]. In these studies, it was suggested that FFS might reduce the potential risk of injury as compared with RFS. However, the GRF does not necessarily coincide with the forces applied to the Achilles tendon and the tibia, and the magnitude of forces applied to the Achilles tendon and the tibia may be much greater than the GRF [9,20,32,34]. Although previous studies suggested that measurements of GRF may not be sufficient to evaluate the potential risk of running-related injuries, it is difficult to directly measure the forces applied to the Achilles tendon and the tibia.An inverse dynamics approach might resolve this problem. The forces applied to the Achilles tendon and the tibia can be calculated as the Achilles tendon force and joint reaction force, respectively. At the instance of foot contact, the application point of the GRF is positioned at the ball of the foot for FFS, the middle of the foot for MFS, and the heel for RFS, respectively [5]. When the orientation of the GRF line of action is similar among the three foot strike patterns, the GRF moment arm, defined as the shortest distance between the ankle joint axis and the GRF line of action, is greater for FFS than the other two foot strike patterns. A difference in the GRF moment arm induces a difference in the moment of the GRF, Abstr Ac tGround reaction force is often used to predict the potential risk of injuries but may not coincide with the forces applied to commonly injured regions of the foot. This study examined the forces applied to the foot, and the associated moment arms made by three foot strik...

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Patellofemoral Joint Stress during Running with Alterations in Foot Strike Pattern

Cited by 71 publications

References 39 publications

Achilles Tendon Loading During Heel-Raising and -Lowering Exercises

Achilles Tendon Loading During Heel-Raising and -Lowering Exercises

Effect of Heel Lifts on Patellofemoral Joint Stress During Running

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