Knee braces and foot orthoses multimodal 3-month treatment of medial knee osteoarthritis in a randomised crossover trial.

PURPOSE: Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer-term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment. METHODS: Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM. RESULTS: An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO. CONCLUSION: The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes. LEVEL OF EVIDENCE: Therapeutic study level I randomised crossover trial.

Machine learning applications in spine biomechanics.

Spine biomechanics is at a transformation with the advent and integration of machine learning and computer vision technologies. These novel techniques facilitate the estimation of 3D body shapes, anthropometrics, and kinematics from as simple as a single-camera image, making them more accessible and practical for a diverse range of applications. This study introduces a framework that merges these methodologies with traditional musculoskeletal modeling, enabling comprehensive analysis of spinal biomechanics during complex activities from a single camera. Additionally, we aim to evaluate their performance and limitations in spine biomechanics applications. The real-world applications explored in this study include assessment in workplace lifting, evaluation of whiplash injuries in car accidents, and biomechanical analysis in professional sports. Our results demonstrate potential and limitations of various algorithms in estimating body shape, kinematics, and conducting in-field biomechanical analyses. In industrial settings, the potential to utilize these new technologies for biomechanical risk assessments offers a pathway for preventive measures against back injuries. In sports activities, the proposed framework provides new opportunities for performance optimization, injury prevention, and rehabilitation. The application in forensic domain further underscores the wide-reaching implications of this technology. While certain limitations were identified, particularly in accuracy of predictions, complex interactions, and external load estimation, this study demonstrates their potential for advancement in spine biomechanics, heralding an optimistic future in both research and practical applications.

Biomechanical differences in experts' and novices' footstep patterns during a palletizing task.

Very few studies have examined differences between experts' and novices' foot positioning and movements during manual materials handling tasks. The impact of footstep patterns on low back loading needs to be better understood. The goals of this study were to characterize foot placement and movements in novices and experts and to assess their impact on back loading considering the height of grasp. The task consisted in transferring 24 15 kg boxes from a pallet to another. Foot placement and movements were classified with a recently developed taxonomy. Results show that experts' feet remained static more often than novices' feet during the lifting phase. Positioning the feet towards the deposit site during lifting increased asymmetrical moments, especially for novices. Positioning one foot forward increased asymmetrical moments for novices. Overall, footstep strategies are an effective indicator of low back exposure and should be considered in ergonomic studies.

Inertial Motion Capture-Based Estimation of L5/S1 Moments during Manual Materials Handling.

Inertial motion capture (IMC) has gained popularity in conducting ergonomic studies in the workplace. Because of the need to measure contact forces, most of these in situ studies are limited to a kinematic analysis, such as posture or working technique analysis. This paper aims to develop and evaluate an IMC-based approach to estimate back loading during manual material handling (MMH) tasks. During various representative workplace MMH tasks performed by nine participants, this approach was evaluated by comparing the results with the ones computed from optical motion capture and a large force platform. Root mean square errors of 21 Nm and 15 Nm were obtained for flexion and asymmetric L5/S1 moments, respectively. Excellent correlations were found between both computations on indicators based on L5/S1 peak and cumulative flexion moments, while lower correlations were found on indicators based on asymmetric moments. Since no force measurement or load kinematics measurement is needed, this study shows the potential of using only the handler's kinematics measured by IMC to estimate kinetics variables. The assessment of workplace physical exposure, including L5/S1 moments, will allow more complete ergonomics evaluation and will improve the ecological validity compared to laboratory studies, where the situations are often simplified and standardized.

Knee braces and foot orthoses multimodal treatment of medial knee osteoarthritis.

BACKGROUND: Knee braces and lateral wedge foot orthoses are two treatment options recommended for medial knee osteoarthritis, but the combination of both of them could further improve their effectiveness. RESEARCH QUESTION: The aim was to evaluate whether the combination of lateral wedge foot orthoses with two types of knee brace enhances the biomechanical effects and pain relief during the stance phase of gait while maintaining comfort. METHODS: Ten patients with medial knee osteoarthritis were fitted with a standard valgus brace, an unloader brace with valgus and external rotation functions, and 7° lateral wedge foot orthoses. The pain relief, comfort, kinematics and kinetics of the lower limb were measured during walking without orthotics, with the combined and with the isolated treatments. RESULTS: The valgus and external rotation brace significantly reduced the knee adduction moment and allowed more knee flexion both in isolation and in combination to foot orthoses compared to the valgus brace or without treatment. Pain relief was not significant with the different orthotic treatment modalities. The valgus brace and combined treatment with either brace significantly increased the discomfort level, whereas the valgus and external rotation brace or foot orthoses in isolation did not induce significant discomfort. SIGNIFICANCE: Amongst the tested orthotic treatment modalities, the valgus and external rotation brace obtained better biomechanical outcomes while maintaining comfort. The combined treatment with foot orthoses enhanced the effectiveness of the valgus brace, however foot orthoses may be unnecessary with the valgus and external rotation brace.

New taxonomy for assessing manual material handlers' footstep patterns.

Current taxonomies for assessing foot strategies in manual material handling lack exhaustive classification of foot movements and foot positioning. They also fail to consider different instants of the task as checkpoints to relate foot strategies. The goal of the study was first to develop a new taxonomy to assess foot positions and motions considering those limitations. The second goal was to assess reliability and reproducibility using raw agreement percentages, Cohen's kappa, prevalence-adjusted, bias-adjusted kappa and Gwet's AC1. A filmed task consisted of transferring boxes from one pallet to another. Intra- and inter-rater reliability were assessed reviewing 23% and 10%, respectively, of video data. Reproducibility and reliability results are substantial and almost perfect on average. In comparison to similar studies, reproducibility and reliability were considered acceptable.

Combined influence of transfer distance, pace, handled mass and box height on spine loading and posture.

Work-related low back disorders are commonly associated with handling tasks. The objective of this study was to determine the combined influence of distance, pace, handled mass and height, on back loading and posture during free box transfer. Kinematics and kinetics of 17 handlers were recorded during a box transfer task between two pallets. Four-way repeated measures ANOVA were conducted on four lift-deposit height conditions (from lift and deposit of 0.16 or 1.16 m), three distances between pallets (1.5, 1.0 and 0.5 m), two handled masses (10 and 20 kg) and two paces (free and faster). The interaction between distance and height on back loading and posture (P < 0.001) showed that increasing distance to more than 1 m is not recommended to avoid unnecessary cumulative loading. The shorter distance of 0.5 m, which generally reduced the most spine loading, may increase it for transfers varying in height. The effect of pace to reduce spine cumulative loading and increase the peak asymmetric loading (P < 0.05) was accentuated by mass, height and distance. The combined factors revealed the importance of tradeoff between peak, cumulative and asymmetric loading.

Three-month efficacy of three knee braces in the treatment of medial knee osteoarthritis in a randomized crossover trial.

Immediate biomechanical and functional effects of knee braces are often reported, however, the duration and type of knee brace treatment for knee osteoarthritis (KOA) remain unclear. The objective was to evaluate usage, comfort, pain, and knee adduction moment (KAM) of three knee braces each worn 3 months by patients. Twenty-four patients with KOA were assigned in a randomized crossover trial a valgus three-point bending system brace (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a stabilizing brace used after ligament injuries (ACL-brace). Functional questionnaires and gait assessment were carried out before and after each brace wear period of 3 months. A Friedman test was applied between brace wear diary recordings. Repeated measures analyses of variance contrasted the factors brace type (ACL, V3P, and VER), time (pre and post) and wear (without and with) on comfort, pain, function, and KAM. Brace usage was similar, but the V3P-brace was slightly less worn. Discomfort was significantly lowered with the VER-brace. All knee braces relieved pain and symptoms from 10% to 40%. KAM angular impulse was reduced with the three braces, but the VER-brace obtained the lowest relative reduction of 9%. The interaction between time and wear indicated that part of the KAM reduction with brace wear was maintained post treatment. All three knee braces have great benefits for pain and function among the medial KOA population. The VER-brace offers additional advantages on daily use, comfort and KAM, which could improve compliance to brace treatment.

Inertial motion capture validation of 3D knee kinematics at various gait speed on the treadmill with a double-pose calibration.

BACKGROUND: Inertial motion capture (IMC) is rapidly gaining in popularity to evaluate gait in clinical settings. Previous examinations of IMC knee kinematics were often limited to the sagittal plane and IMC calibration has not been thoroughly investigated. RESEARCH QUESTION: The objective was to validate IMC 3D knee kinematics calibrated with a double-pose during gait with reference to optical motion capture (OMC). The hypotheses are that IMC can estimate adequately knee kinematics and that both systems will detect similarly the changes with gait speed. METHODS: Twenty-four healthy participants walked on the treadmill at gait speed of 0.6, 0.8, 1.0 and 1.2 m/s. Knee kinematics were obtained simultaneously with two magnetic and inertial measurement units and passive markers fixed on the KneeKG system. OMC was calibrated with a functional anatomical approach and the IMC with a double-pose. RESULTS: Root mean square differences of the two systems yielded 3-6° for knee flexion, adduction and external rotation. Knee kinematics were more similar during the stance phase than the swing phase. Gait speed showed a significant progressive effect on the three knee angles that was similarly detected by the two systems. SIGNIFICANCE: IMC 3D knee kinematics can be obtained independently with a simple calibration and only two magnetic and inertial measurement units at an acceptable level of error especially during stance.

Feasibility of quantifying the physical exposure of materials handlers in the workplace with magnetic and inertial measurement units.

Handling tasks can expose workers to risk factors. The objective was to describe the feasibility of using magnetic and inertial measurement units (MIMUs) to quantify the physical exposure of materials handlers in the workplace. Full-body kinematics were obtained with MIMUs on 10 handlers gathering products ordered by retailers with a pallet truck. An observer classified the visual difference (VD) of segment orientation between a MIMUs avatar and video recordings in three categories (none, minor and major) for each product transfer. The feet, arms, shoulders and head were considered similar for ≥97% of observations. The trunk segment obtained the most differences with 9% of minor VD and 5% of major VD, which were related to the duration of the magnetic disturbances of the MIMUs. Estimating parameters of the physical exposure of handlers in the workplace is feasible with kinematics and an order list, but visual verification remains important for scientific rigour.Practitioner Summary: The feasibility of measuring physical exposure with magnetic and inertial measurement units was evaluated on materials handlers in the workplace. Visual observation of the postures indicated that most of the data is considered acceptable. Magnetic disturbances can increase the measurement error, so data must be verified to ensure validity.

Effect of local magnetic field disturbances on inertial measurement units accuracy.

Inertial measurement units (IMUs), a practical motion analysis technology for field acquisition, have magnetometers to improve segment orientation estimation. However, sensitivity to magnetic disturbances can affect their accuracy. The objective of this study was to determine the joint angles accuracy of IMUs under different timing of magnetic disturbances of various durations and to evaluate a few correction methods. Kinematics from 12 individuals were obtained simultaneously with an Xsens system where an Optotrak cluster acting as the reference system was affixed to each IMU. A handling task was executed under normal laboratory conditions and imposed magnetic disturbances. Joint angle RMSE was used to conduct a three-way repeated measures analysis of variance in order to contrast the following disturbance factors: duration (0, 30, 60, 120 and 240 s), timing (during the disturbance, directly after it and a 30-second delay after it) and axis (X, Y and Z). The highest joint angle RMSE was observed on rotations about the Y longitudinal axis and during the longer disturbances. It stayed high directly after a disturbance, but returned close to baseline after a 30-second delay. When magnetic disturbances are experienced, waiting 30 s in a normal condition is recommended as a way to restore the IMUs' initial accuracy. The correction methods performed modestly or poorly in the reduction of joint angle RMSE.

Accuracy and repeatability of single-pose calibration of inertial measurement units for whole-body motion analysis.

Portable inertial measurement units (IMUs) are suitable for motion analysis outside the laboratory. However, IMUs depend on the calibration of each body segment to measure human movement. Different calibration approaches have been developed for simplicity of use or similarity to laboratory motion analysis, but they have not been extensively examined. The main objective of the study was to determine the accuracy and repeatability of two common single-pose calibrations (N-pose and T-pose) under different conditions of placement (self-placement and passive placement), as well as their similarity to laboratory analysis based on anatomical landmarks. A further aim of the study was to develop two additional single-pose calibrations (chair-pose and stool-pose) and determine their accuracy and repeatability. Postures and movements of 12 healthy participants were recorded simultaneously with a full-body IMU suit and an optoelectronic system as the criterion measure. Three repetitions of the T-pose and the N-pose were executed by self-placement and passive placement, and three repetitions of the chair-pose and stool-pose were also performed. Repeatability for each single-pose calibration showed an average intraclass correlation coefficient for all axes and joints between 0.90 and 0.94 and a standard error of measurement between 1.5° and 2.1°. The T-pose with passive placement is recommended to reduce longitudinal axis offset error and to increase similarity to laboratory motion analysis. Finally, the chair-pose obtained the least longitudinal axis offset error amongst the tested poses, which shows potential for IMU calibration.

Validation of inertial measurement units with an optoelectronic system for whole-body motion analysis.

The potential of inertial measurement units (IMUs) for ergonomics applications appears promising. However, previous IMUs validation studies have been incomplete regarding aspects of joints analysed, complexity of movements and duration of trials. The objective was to determine the technological error and biomechanical model differences between IMUs and an optoelectronic system and evaluate the effect of task complexity and duration. Whole-body kinematics from 12 participants was recorded simultaneously with a full-body Xsens system where an Optotrak cluster was fixed on every IMU. Short functional movements and long manual material handling tasks were performed and joint angles were compared between the two systems. The differences attributed to the biomechanical model showed significantly greater (P ≤ .001) RMSE than the technological error. RMSE was systematically higher (P ≤ .001) for the long complex task with a mean on all joints of 2.8° compared to 1.2° during short functional movements. Definition of local coordinate systems based on anatomical landmarks or single posture was the most influent difference between the two systems. Additionally, IMUs accuracy was affected by the complexity and duration of the tasks. Nevertheless, technological error remained under 5° RMSE during handling tasks, which shows potential to track workers during their daily labour.

Evaluation of Eight Methods for Aligning Orientation of Two Coordinate Systems.

The aim of this study was to evaluate eight methods for aligning the orientation of two different local coordinate systems. Alignment is very important when combining two different systems of motion analysis. Two of the methods were developed specifically for biomechanical studies, and because there have been at least three decades of algorithm development in robotics, it was decided to include six methods from this field. To compare these methods, an Xsens sensor and two Optotrak clusters were attached to a Plexiglas plate. The first optical marker cluster was fixed on the sensor and 20 trials were recorded. The error of alignment was calculated for each trial, and the mean, the standard deviation, and the maximum values of this error over all trials were reported. One-way repeated measures analysis of variance revealed that the alignment error differed significantly across the eight methods. Post-hoc tests showed that the alignment error from the methods based on angular velocities was significantly lower than for the other methods. The method using angular velocities performed the best, with an average error of 0.17 ± 0.08 deg. We therefore recommend this method, which is easy to perform and provides accurate alignment.

Scapulohumeral rhythm relative to active range of motion in patients with symptomatic rotator cuff tears.

BACKGROUND: Some patients with rotator cuff tears feel pain without functional limitation, whereas others show a decrease in range of motion. To investigate this distinction, the scapulohumeral rhythm was used to conduct a functional evaluation of shoulder joints' coordination. The objective was to characterize patients according to their active range of motion without pain and their scapulohumeral rhythm compared with healthy individuals. MATERIALS AND METHODS: Fourteen patients with rotator cuff tears and 14 healthy individuals were set up with 35 reflective markers on the trunk and upper limb tracked by an optoelectronic system to measure the scapulohumeral rhythm. Five scapular plane maximal arm elevations were executed without pain. Patients were separated by maximal arm elevation of 85° (category A) and 40° (category B). Three-way mixed-design analysis of variance with factors of group (patients and healthy), arm elevation, and motion direction was applied to the scapulohumeral rhythm. RESULTS: A main effect of group (P = .032) was observed in patients in category A, who showed inferior scapulohumeral rhythm. An interaction between group and arm elevation (P = .044) was observed for patients in category B, where their scapulohumeral rhythm increased more during arm elevation than in the healthy individuals. CONCLUSIONS: Patients who reached at least 85° compensated for the loss of glenohumeral motion by increased scapulothoracic contribution, suggesting that structural damage interferes with motion mechanics. In contrast, patients who reached less range of motion underused the scapulothoracic joint, which is likely to create subacromial impingement at low arm elevation. A patient's maximal range of motion without pain may indicate a pattern of scapulohumeral rhythm alteration.

Shoulder Coordination During Full-Can and Empty-Can Rehabilitation Exercises.

CONTEXT: Supraspinatus tear is a common rotator cuff injury. During rehabilitation, debate persists regarding the most appropriate exercises. Whereas shoulder coordination is part of normal arm function, it has been infrequently considered in the context of exercise selection. OBJECTIVE: To assess shoulder-motion coordination during 2 common supraspinatus rehabilitation exercises and to characterize load and motion-direction influences on shoulder coordination. DESIGN: Descriptive laboratory study. SETTING: Motion-analysis laboratory. Patient or Other Participants : Fifteen asymptomatic right-hand-dominant men (age = 26 ± 4 years, height = 1.77 ± 0.06 m, mass = 74.3 ± 7.7 kg). INTERVENTION(S): Full-can and empty-can exercises with and without a 2.27-kg load. MAIN OUTCOME MEASURE(S): We recorded motion with an optoelectronic system. Scapulohumeral rhythm and complete shoulder joint kinematics were calculated to quantify shoulder coordination. The effects of exercise type, load, motion direction, and humerothoracic-elevation angle on the scapulohumeral rhythm and shoulder-joint angles were assessed. RESULTS: We observed multivariate interactions between exercise type and humerothoracic elevation and between load and humerothoracic elevation. Scapulohumeral rhythm increased by a mean ratio of 0.44 ± 0.22 during the full-can exercise, whereas the addition of load increased mean glenohumeral elevation by 4° ± 1°. CONCLUSIONS: The full-can exercise increased the glenohumeral contribution, as hypothesized, and showed normal shoulder coordination. During the empty-can exercise, the increased scapulothoracic contribution was associated with a compensatory pattern that limits the glenohumeral contribution. Using loads during shoulder rehabilitation seems justified because the scapulohumeral rhythm is similar to that of unloaded arm elevation. Finally, motion direction showed a limited effect during the exercises in healthy individuals.

3D shoulder kinematics for static vs dynamic and passive vs active testing conditions.

Shoulder motion analysis provides clinicians with references of normal joint rotations. Shoulder joints orientations assessment is often based on series of static positions, while clinicians perform either passive or active tests and exercises mostly in dynamic. These conditions of motion could modify joint coordination and lead to discrepancies with the established references. Hence, the objective was to evaluate the influence of static vs dynamic and passive vs active testing conditions on shoulder joints orientations. Twenty asymptomatic subjects setup with 45 markers on the upper limb and trunk were tracked by an optoelectronic system. Static positions (30°, 60°, 90° and 120° of thoracohumeral elevation) and dynamic motion both in active condition and passively mobilised by an examiner were executed. Three-dimensional sternoclavicular, acromioclavicular, scapulothoracic and glenohumeral joint angles (12 in total) representing the distal segment orientation relative to the proximal segment orientation were estimated using a shoulder kinematical chain model. Separate four-way repeated measures ANOVA were applied on the 12 joint angles with factors of static vs dynamic, passive vs active, thoracohumeral elevation angle (30°, 60°, 90° and 120°) and plane of elevation (frontal and sagittal). Scapulothoracic lateral rotation progressed more during arm elevation in static than in dynamic gaining 4.2° more, and also in passive than in active by 6.6°. Glenohumeral elevation increased more during arm elevation in active than in passive by 4.4°. Shoulder joints orientations are affected by the testing conditions, which should be taken into consideration for data acquisition, inter-study comparison or clinical applications.

Elucidating the scapulo-humeral rhythm calculation: 3D joint contribution method.

The scapulo-humeral rhythm quantifies shoulder joint coordination during arm elevation. The common method calculates a ratio of gleno-humeral (GH) elevation to scapulo-thoracic upward rotation angles. However the other rotations also contribute to arm elevation. The objective is to propose a 3D dynamic scapulo-humeral rhythm calculation method including all rotations of the shoulder joints and compare with the common method. Twenty-nine skin markers were placed on the trunk and dominant arm of 14 healthy males to measure shoulder kinematics. Two-way repeated measures ANOVAs were applied to compare the two methods of calculation of joint contributions and scapulo-humeral rhythm during arm elevation. Significant main effects (p < 0.05) were observed between methods in joint contribution angles and scapulo-humeral rhythms. A systematic overestimation of the GH contribution was observed when only using the GH elevation angle because the scapula is moved outside a vertical plane. Hence, the proposed 3D method to calculate the scapulo-humeral rhythm allows an improved functional shoulder evaluation.