Biomechanics Differ for Individuals With Similar Self-Reported Characteristics of Patellofemoral Pain During a High-Demand Multiplanar Movement Task.

CONTEXT: Patellofemoral pain (PFP) is often categorized by researchers and clinicians using subjective self-reported PFP characteristics; however, this practice might mask important differences in movement biomechanics between PFP patients. OBJECTIVE: To determine whether biomechanical differences exist during a high-demand multiplanar movement task for PFP patients with similar self-reported PFP characteristics but different quadriceps activation levels. DESIGN: Cross-sectional design. SETTING: Biomechanics laboratory. PARTICIPANTS: A total of 15 quadriceps deficient and 15 quadriceps functional (QF) PFP patients with similar self-reported PFP characteristics. INTERVENTION: In total, 5 trials of a high-demand multiplanar land, cut, and jump movement task were performed. MAIN OUTCOME MEASURES: Biomechanics were compared at each percentile of the ground contact phase of the movement task (α = .05) between the quadriceps deficient and QF groups. Biomechanical variables included (1) whole-body center of mass, trunk, hip, knee, and ankle kinematics; (2) hip, knee, and ankle kinetics; and (3) ground reaction forces. RESULTS: The QF patients exhibited increased ground reaction force, joint torque, and movement, relative to the quadriceps deficient patients. The QF patients exhibited: (1) up to 90, 60, and 35 N more vertical, posterior, and medial ground reaction force at various times of the ground contact phase; (2) up to 4° more knee flexion during ground contact and up to 4° more plantarflexion and hip extension during the latter parts of ground contact; and (3) up to 26, 21, and 48 N·m more plantarflexion, knee extension, and hip extension torque, respectively, at various times of ground contact. CONCLUSIONS: PFP patients with similar self-reported PFP characteristics exhibit different movement biomechanics, and these differences depend upon quadriceps activation levels. These differences are important because movement biomechanics affect injury risk and athletic performance. In addition, these biomechanical differences indicate that different therapeutic interventions may be needed for PFP patients with similar self-reported PFP characteristics.

Immediate effects of acupuncture and cryotherapy on quadriceps motoneuron pool excitability: randomised trial using anterior knee infusion model.

OBJECTIVE: The authors asked the following research questions: will an anterior knee infusion model induce constant pain? will perceived pain alter motoneuron pool (MNP) excitability? and will treatments alter perceived pain and/or MNP excitability? METHODS: Thirty-six neurologically healthy volunteers participated in this randomised controlled laboratory study. To induce anterior knee pain (AKP), 5% hypertonic saline (0.12 ml/min with a total volume of 8.5 ml over 70 min) was injected into the infrapatellar fat pad of the dominant leg. One of four 30-min treatments was randomly assigned to each subject after pain was induced (acupuncture, cryotherapy, sham cryotherapy and no treatment). Five acupuncture needles (SP9, SP10, ST36, GB34 and an ah shi point) were inserted to a depth of 1 cm. Vastus medialis (VM) maximum Hoffmann reflexes normalised by maximum motor response were recorded from each subject at baseline, 20 min post-injection, 50 min post-injection and 70 min post-injection. To record pain perception, a visual analogue scale was used every 5 min after injection. RESULTS: An anterior knee infusion pain model increased perceived pain (p<0.0001). No change was found in VM MNP excitability among the four treatments (p<0.19) or at any of the time intervals (p<0.52). Cryotherapy reduced perceived pain compared with acupuncture (p=0.0003) and sham treatment (p=0.0002). CONCLUSIONS: A pain model may be used in other neurophysiological intervention studies related to AKP. AKP alone may not directly alter quadriceps activation. None of the treatments altered VM MNP excitability. Cryotherapy reduced pain while a single session of acupuncture and sham treatments did not.

Ground reaction force differences between running shoes, racing flats, and distance spikes in runners.

Various shoes are worn by distance runners throughout a training season. This study measured the differences in ground reaction forces between running shoes, racing flats, and distance spikes in order to provide information about the potential effects of footwear on injury risk in highly competitive runners. Ten male and ten female intercollegiate distance runners ran across a force plate at 6.7 m·s(-1) (for males) and 5.7 m·s(-1) (for females) in each of the three types of shoes. To control for differences in foot strike, only subjects who exhibited a heel strike were included in the data analysis. Two repeated-measures ANOVAs with Tukey's post-hoc tests (p < 0.05) were used to detect differences in shoe types among males and females. For the males, loading rate, peak vertical impact force and peak braking forces were significantly greater in flats and spikes compared to running shoes. Vertical stiffness in spikes was also significantly greater than in running shoes. Females had significantly shorter stance times and greater maximum propulsion forces in racing flats compared to running shoes. Changing footwear between the shoes used in this study alters the loads placed on the body. Care should be taken as athletes enter different phases of training where different footwear is required. Injury risk may be increased since the body may not be accustomed to the differences in force, stance time, and vertical stiffness. Key pointsTo determine the differences in ground reaction forces between regular running shoes and competitive footwear, force plate data was obtained from 10 males (6.7 m·s(-1)) and 10 females (5.7 m·s(-1)) for each of three shoe types.Data from men and women were analyzed in two separate groups, and significant differences were found for various GRF components between the three types of shoes.The significant increases in GRF components in competitive footwear suggest that the body must deal with greater impact forces in these shoes than in running shoes at the same running speed.The results from this study warrant the recommendation that runners transition gradually from periods when most or all of their training is done in running shoes to more competitive seasons when more of their training is done in racing flats and spikes.

Muscle activation following sudden ankle inversion during standing and walking.

Dynamic response characteristics of ankle musculature following sudden ankle inversion have traditionally been tested in a static, standing position. However, this model does not take into consideration muscle activity and loading characteristics associated with active gait. This study compared muscle reaction times and amplitudes from sudden ankle inversion during standing (standing group) and walking (walking group) using one of two similar devices for each of these conditions. Surface EMG was collected from the peroneus longus (PL), brevis (PB), and tibialis anterior (TA) of the dominant leg from 25 subjects (age 20 +/- 1 years, height 174.0 +/- 10.2 cm, mass 74.3 +/- 12.9 kg) for each condition (walking and standing). Time to total inversion ROM (28 degrees ) was greater in the walking group (114.9 +/- 15.0 ms) than the standing group (65.6 +/- 17.8 ms, P < 0.05), whereas reaction time was less in the peroneals in the walking group (PL 56.9 +/- 8.4 ms, PB 60.1 +/- 10.6 ms, TA 65.0 +/- 14.9 ms) compared to the standing group (PL 74.3 +/- 8.5 ms, PB 73.5 +/- 8.2 ms, TA 73.3 +/- 8.3, P < 0.05). Additionally, Peak normalized EMG (% MVIC) for the walking condition (PL 367 +/- 254, PB 405 +/- 359, TA 84 +/- 39) exceeded that of the standing condition (PL 310 +/- 239, PB 328 +/- 215, TA 76 +/- 39, P < 0.05), and average normalized EMG (% MVIC) was greater in the peroneals for the walking condition (PL 233 +/- 171, PB 280 +/- 255) than the standing condition (PL 164 +/- 131, PB 193 +/- 137, P < 0.05). The differences noted between the conditions provide evidence that a dynamic response to ankle injury mechanisms is much different in a walking model compared to a traditional standing model. A walking model may be a more functional approach for evaluating dynamic response characteristics of ankle musculature due to sudden ankle inversion.