Towards functionally individualised designed footwear recommendation for overuse injury prevention: a scoping review.

Injury prevention is essential in running due to the risk of overuse injury development. Tailoring running shoes to individual needs may be a promising strategy to reduce this risk. Novel manufacturing processes allow the production of individualised running shoes that incorporate features that meet individual biomechanical and experiential needs. However, specific ways to individualise footwear to reduce injury risk are poorly understood. Therefore, this scoping review provides an overview of (1) footwear design features that have the potential for individualisation; and (2) the literature on the differential responses to footwear design features between selected groups of individuals. These purposes focus exclusively on reducing the risk of overuse injuries. We included studies in the English language on adults that analysed: (1) potential interaction effects between footwear design features and subgroups of runners or covariates (e.g., age, sex) for running-related biomechanical risk factors or injury incidences; (2) footwear comfort perception for a systematically modified footwear design feature. Most of the included articles (n = 107) analysed male runners. Female runners may be more susceptible to footwear-induced changes and overuse injury development; future research should target more heterogonous sampling. Several footwear design features (e.g., midsole characteristics, upper, outsole profile) show potential for individualisation. However, the literature addressing individualised footwear solutions and the potential to reduce biomechanical risk factors is limited. Future studies should leverage more extensive data collections considering relevant covariates and subgroups while systematically modifying isolated footwear design features to inform footwear individualisation.

Does lateral banking and radius affect well-trained sprinters and team-sports players during bend sprinting?

This study investigated the short-term responses of step characteristics in sprinters and team-sports players under different bend conditions. Eight participants from each group completed 80 m sprints in four conditions: banked and flat, in lanes two and four (L2B, L4B, L2F, L4F). Groups showed similar changes in step velocity (SV) across conditions and limbs. However, sprinters produced significantly shorter ground contact times (GCT) than team sports players in L2B and L4B for both left (0.123 s vs 0.145 s and 0.123 s vs 0.140 s) and right steps (0.115 s vs 0.136 s and 0.120 s vs 0.141 s) (p > 0.001-0.029; ES = 1.15-1.37). Across both groups, SV was generally lower in flat conditions compared to banked (Left: 7.21 m/s vs 6.82 m/s and Right: 7.31 m/s vs 7.09 m/s in lane two), occurring due to reduced step length (SL) rather than step frequency (SF), suggesting that banking improves SV via increased SL. Sprinters produced significantly shorter GCT in banked conditions that led to non-significant increases in SF and SV, highlighting the importance of bend sprinting specific conditioning and training environments representative of indoor competition for sprint athletes.

Modifications to head-trunk coordination dynamics during running and sidestepping.

The purpose of this study was to determine how the intrinsic head-trunk coordination dynamics that exist during forward running are modified during a dynamic sidestepping task. Fourteen athletes performed both forward running and sidestepping tasks. Head-trunk coordination and range of motion were assessed during the flight and stance phases in the transverse and sagittal planes. The sidestepping task resulted in greater in-phase head-trunk coordination during stance in the transverse plane (p < .001, ES = -1.71) and in reduced anti-phase coordination between head and trunk in the sagittal plane (p < .001, ES = 1.52). Statistical non-parametric mapping revealed that during sidestepping the sagittal plane coupling angle shifted away from anti-phase earlier during midstance. The sidestepping task resulted in greater transverse and sagittal plane head and trunk range of motion and greater vertical trunk centre of mass displacement. Sidestepping modified the intrinsic coordination dynamics that are present during forward running, with greater transverse plane head contributions and reductions in compensatory sagittal plane head motion, which may occur during the transition from weight acceptance to propulsion during the stance phase. These changes in the intrinsic coordination dynamics of the upper body during sidestepping tasks may impact visual perception and readiness compared to forward running during complex sports tasks.

Head control and head-trunk coordination as a function of anticipation in sidestepping.

Head reorientation precedes body reorientation during direction change to facilitate gaze realignment, thus enhancing perceptual awareness. Whole body kinematics are dependent on the available planning time. The purpose of this study was to assess the role of anticipation on head control and head-trunk coordination during sidestepping tasks. Fourteen male collegiate athletes performed anticipated and unanticipated sidestepping tasks. Transverse plane head, trunk and heading direction, as well as head-trunk coordination were assessed. During change of direction tasks, we observed greater head orientation towards the new travel direction, followed by heading direction and then trunk direction during both anticipated and unanticipated tasks. With reduced planning time, heading in the preparatory phase and trunk rotation in the preparatory and stance phases were significantly less oriented towards the new travel direction, with no differences in head rotation. During anticipated sidestepping, significantly greater in-phase coordination was observed during the preparatory phase compared to unanticipated sidestepping. Head reorientation facilitates gaze realignment and may be prioritized irrespective of planning time during sidestepping tasks. During anticipated trials, the head and trunk move more synchronously compared to unanticipated sidestepping, highlighting the potential benefits of aligning the degrees of freedom earlier in the change of direction stride and optimizing perceptual awareness.

Is coordination variability using vector coding different in overground and treadmill walking and running?

BACKGROUND: Coordination variability has been linked to overuse running injuries and has been studied both on a treadmill and over-ground. It is not clear, however, if the coordination variability data from over-ground locomotion can be compared with treadmill locomotion data. RESEARCH QUESTION: Therefore, the purpose of this study was to compare coordination variability of selected lower extremity couplings at different locomotor speeds during over-ground and treadmill walking and running. METHODS: Nineteen (10 female, 9 male) healthy, recreational collegiate runners participated in this study. Each participant performed in two different conditions: over-ground and on a treadmill at three walking speeds (1.2, 1.6, and 2.0 m•s-1) and three running speeds (2.8, 3.2, and 3.6 m•s-1). A modified vector coding technique was used to calculate coordination variability for five selected coupled segment and joint angles. Each of the segmental couples was analyzed separately using a two-way repeated measures ANOVA (Condition Χ Speed) implemented with one-dimensional statistical parametric mapping. RESULTS: While no interaction effects were observed for condition X speed, we saw increased coordination variability in the sagittal couples during overground compared with treadmill locomotion, which predominantly occurred during the stance phase. There were mixed results for changes in coordination variability as a function of gait speed. However, for the sagital plane couplings, coordination variability decreased with speed, particularly during the stance phase. SIGNIFICANCE: These results suggest that the controlled belt speed of the treadmill affects the intrinsic dynamics of human movement and this should be considered when making comparisons between treadmill and over-ground studies and in future study designs.

Archery's signature: an electromyographic analysis of the upper limb.

Non-technical summary: Bow and arrow technology plays a significant role in the recent evolutionary history of modern humans, but limitations of preservation make it challenging to identify archaeological evidence of early archery. Since bone structure can change in response to muscle force, archers of the past can potentially be identified through analysis of upper arm bones. However, there is limited research on how archery impacts upper limb musculature. This study offers initial insights into how archery impacts humeral musculature and highlights the need for additional research focused on archery's direct impact on humeral morphology. Technical summary: Humeral morphology has been used to support behaviour reconstructions of archery in past populations. However, the lack of experimental research concerning the impacts that archery has on the upper limb weakens skeletal morphological approaches. The goal of this study was to determine how archery impacts the activation of upper limb musculature. More specifically, this study tested: (a) whether the relative muscle activations are similar between arms; and (b) what muscles were activated on the dominant (draw) arm compared with the non-dominant (bow) arm. Data on upper arm muscle activation were collected bilaterally for nine archers using surface electromyography (EMG). Results show similar levels of muscle activation bilaterally with different muscles being activated in each arm. There were significantly higher integrated EMG and peak muscle activations of the biceps brachii muscles in the draw arm compared with the bow arm. In contrast, the lateral deltoid and the triceps brachii muscles had significantly higher integrated EMG and peak muscle activations on the bow arm compared with the draw arm. This work offers initial insights into how archery impacts humeral musculature and highlights the need for additional research focused on archery's direct impact on humeral morphology.

Anterior cruciate ligament injury prevention in sport: biomechanically informed approaches.

This paper reviews a series of studies contributing to a framework for preventing anterior cruciate ligament (ACL) injuries in sport. As the majority of these injuries are non-contact in nature, theoretically, these injuries are preventable. The studies presented in this paper focus on understanding biomechanical countermeasures of ACL injury and how this knowledge can inform both screening and training intervention research and practice in sport. These countermeasures include: 1) modifying an athlete's technique to reduce externally applied loads to the knee; 2) increasing the muscle support around the knee and hip to counter elevated loads applied to the knee and; 3) improving an athlete's perception during dynamic sports tasks to increase planning time to coordinate desirable movement patterns. By furthering the empirical evidence of modifiable biomechanical countermeasures of ACL injury risk, we can better understand best practices for developing interventions on a mass scale to prevent ACL injuries in the sporting community.

Development and validation of FootNet; a new kinematic algorithm to improve foot-strike and toe-off detection in treadmill running.

The accurate detection of foot-strike and toe-off is often critical in the assessment of running biomechanics. The gold standard method for step event detection requires force data which are not always available. Although kinematics-based algorithms can also be used, their accuracy and generalisability are limited, often requiring corrections for speed or foot-strike pattern. The purpose of this study was to develop FootNet, a novel kinematics and deep learning-based algorithm for the detection of step events in treadmill running. Five treadmill running datasets were gathered and processed to obtain segment and joint kinematics, and to identify the contact phase within each gait cycle using force data. The proposed algorithm is based on a long short-term memory recurrent neural network and takes the distal tibia anteroposterior velocity, ankle dorsiflexion/plantar flexion angle and the anteroposterior and vertical velocities of the foot centre of mass as input features to predict the contact phase within a given gait cycle. The chosen model architecture underwent 5-fold cross-validation and the final model was tested in a subset of participants from each dataset (30%). Non-parametric Bland-Altman analyses (bias and [95% limits of agreement]) and root mean squared error (RMSE) were used to compare FootNet against the force data step event detection method. The association between detection errors and running speed, foot-strike angle and incline were also investigated. FootNet outperformed previously published algorithms (foot-strike bias = 0 [-10, 7] ms, RMSE = 5 ms; toe-off bias = 0 [-10, 10] ms, RMSE = 6 ms; and contact time bias = 0 [-15, 15] ms, RMSE = 8 ms) and proved robust to different running speeds, foot-strike angles and inclines. We have made FootNet's source code publicly available for step event detection in treadmill running when force data are not available.

Comparing Leg Quasi-Stiffness Methods Across Running Velocities.

This study investigated the differences between 5 commonly used methods to calculate leg stiffness over a range of running velocities. Thirteen male, habitually rearfoot, recreational runners ran on a force instrumented treadmill for a 5-minute running session. Each session consisted of 30-second intervals at 6 progressively faster speeds from 2.5 m·s-1 through 5.0 m·s-1 with each interval speed increasing by 0.5 m·s-1. Two-way within-factors repeated-measures analyses of variance were used to evaluate leg stiffness and length. A one-way repeated-measures analysis of variance was used to evaluate the slope of each trend line of each model across speeds. Pearson correlations were used to compare the relationship between the different computational methods. The results indicated that the direct stiffness methods increased with speed whereas the indirect stiffness methods did not. The direct methods were strongly correlated with each other as were the indirect methods. However, there were no strong correlations between the direct and indirect methods. These differences can be mostly attributed to how each individual stiffness method calculated leg length. It is important for researchers to understand these differences when conducting future studies and comparing past studies.

Stable Coordination Variability in Overground Walking and Running at Preferred and Fixed Speeds.

Coordination variability (CV) is commonly analyzed to understand dynamical qualities of human locomotion. The purpose of this study was to develop guidelines for the number of trials required to inform the calculation of a stable mean lower limb CV during overground locomotion. Three-dimensional lower limb kinematics were captured for 10 recreational runners performing 20 trials each of preferred and fixed speed walking and running. Stance phase CV was calculated for 9 segment and joint couplings using a modified vector coding technique. The number of trials required to achieve a CV mean within 10% of 20 strides average was determined for each coupling and individual. The statistical outputs of mode (walking vs running) and speed (preferred vs fixed) were compared when informed by differing numbers of trials. A minimum of 11 trials were required for stable mean stance phase CV. With fewer than 11 trials, CV was underestimated and led to an oversight of significant differences between mode and speed. Future overground locomotion CV research in healthy populations using a vector coding approach should use 11 trials as a standard minimum. Researchers should be aware of the notable consequences of an insufficient number of trials for overall study findings.

The inter-laboratory equivalence for lower limb kinematics and kinetics during unplanned sidestepping.

Much inter-intra-tester kinematic and kinetic repeatability research exists, with a paucity investigating inter-laboratory equivalence. The objective of this research was to evaluate the inter-laboratory equivalence between time varying unplanned kinematics and moments of unplanned sidestepping (UnSS). Eight elite female athletes completed an established UnSS procedure motion capture laboratories in the UK and Australia. Three dimensional time varying unplanned sidestepping joint kinematics and moments were compared. Discrete variables were change of direction angles and velocity. Waveform data were compared using mean differences, 1D 95%CI and RMSE. Discrete variables were compared using 0D 95% CI. The mean differences and 95%CI for UnSS kinematics broadly supported equivalence between laboratories (RMSE≤5.1°). Excluding hip flexion/extension moments (RMSE = 1.04 Nm/kg), equivalence was also supported for time varying joint moments between laboratories (RMSE≤0.40 Nm/kg). Dependent variables typically used to characterise UnSS were also equivalent. When consistent experimental and modelling procedures are employed, consistent time varying UnSS lower limb joint kinematic and moment estimates between laboratories can be obtained. We therefore interpret these results as a support of equivalence, yet highlight the challenges of establishing between-laboratory experiments or data sharing, as well as establishing appropriate ranges of acceptable uncertainty. These findings are important for data sharing and multi-centre trials.

Prescribing joint co-ordinates during model preparation in OpenSim improves lower limb unplanned sidestepping kinematics.

OBJECTIVES: Investigate how prescribing participant-specific joint co-ordinates during model preparation influences the measurement agreement of inverse kinematic (IK) derived unplanned sidestepping (UnSS) lower limb kinematics in OpenSim in comparison to an established direct kinematic (DK) model. DESIGN: Parallel forms repeatability. METHODS: The lower limb UnSS kinematics of 20 elite female athletes were calculated using: 1) an established DK model (criterion) and, 2) two IK models; one with (IKPC) and one without (IK0) participant-specific joint co-ordinates prescribed during the marker registration phase of model preparation in OpenSim. Time-varying kinematic analyses were performed using one dimensional (1D) statistical parametric mapping (α=0.05), where zero dimensional (0D) Root Mean Squared Error (RMSE) estimates were calculated and used as a surrogate effect size estimates. RESULTS: Statistical differences were observed between the IKPC and DK derived kinematics as well as the IK0 and DK derived kinematics. For the IKPC and DK models, mean kinematic differences over stance for the three dimensional (3D) hip joint, 3D knee joint and ankle flexion/extension (F/E) degrees of freedom (DoF) were 46±40% (RMSE=5±5°), 56±31% (RMSE=7±4°) and 3% (RMSE=2°) respectively. For the IK0 and DK models, mean kinematics differences over stance for the 3D hip joint, 3D knee joint and ankle F/E DoF were 70±53% (RMSE=14±11°), 46±48% (RMSE=8±7°) and 100% (RMSE=11°) respectively. CONCLUSIONS: Prescribing participant-specific joint co-ordinates during model preparation improves the agreement of IK derived lower limb UnSS kinematics in OpenSim with an established DK model, as well as previously published in-vivo knee kinematic estimates.

Field hockey sport-specific postures during unanticipated sidestepping: Implications for anterior cruciate ligament injury prevention.

Much research has investigated whole-body postures and associated knee joint loading during unanticipated sidestepping (UnSS). However, no research has considered sport-specific postures in field hockey. The purpose of this study was to investigate differences in trunk and lower limb angle and lower extremity joint moment waveforms during UnSS while holding a hockey stick in a flexed posture (HS-UnSS) and traditional UnSS. Additionally, we aimed to determine if differences in posture during HS-UnSS were associated with changes in knee joint moments. Twelve elite female field hockey athletes underwent 3D motion analysis during UnSS and HS-UnSS. Athletes increased trunk (0-100% of stance phase, hip (0-15%), knee (12-29%; 39-59%; 78-100%) and ankle (41-57%) flexion angles, and increased hip flexion (19-24%; 42-45%; 75-84%) and external rotation moments (75-80%) during HS-UnSS compared with UnSS (p < 0.05). Flexed postures observed during HS-UnSS did not influence knee flexion and valgus moments when compared with UnSS (p > 0.05), however knee external rotation moments reduced. Changes in trunk flexion were positively associated with peak knee internal rotation moments from UnSS to HS-UnSS (r = 0.779, p = 0.005). These findings indicate that field hockey players sidestep with significantly different techniques when holding a hockey stick, which should be considered in injury prevention training protocols.

The Influence of Prolonged Running and Footwear on Lower Extremity Joint Stiffness.

INTRODUCTION: The purpose of this study was to compare leg, sagittal plane knee and ankle, and frontal plane ankle stiffness over the course of a prolonged treadmill run in neutral and stability footwear. METHODS: Thirteen male habitual rearfoot runners completed two biomechanical testing sessions in which they ran for 21 min at their preferred running speed in a neutral shoe, then changed either into the same neutral shoe or a stability shoe and ran a further 21 min on a force-instrumented treadmill. Three-dimensional kinematics and kinetics were recorded at the beginning and end of each 21-min interval. RESULTS: No differences were observed in leg stiffness between footwear conditions throughout the run (P > 0.05). Knee stiffness increased during the first 21 min (P = 0.009), whereas ankle stiffness reduced at minute 21 (P = 0.004) and minute 44 (P = 0.006). These changes were modulated by an increase in ankle joint compliance and knee joint moments. No differences were observed between footwear conditions for leg and sagittal plane lower extremity joint stiffness (P > 0.05). During the second half of the run, frontal plane ankle stiffness increased in the stability shoe but decreased in the neutral shoe (P = 0.019), attributed to reduced eversion range of motion caused by the added medial post. CONCLUSIONS: These results suggest that over the course of a prolonged treadmill run, shock attenuation strategies change, which may affect the knee joint.

The habitual motion path theory: Evidence from cartilage volume reductions in the knee joint after 75 minutes of running.

The habitual motion path theory predicts that humans tend to maintain their habitual motion path (HMP) during locomotion. The HMP is the path of least resistance of the joints defined by an individual's musculoskeletal anatomy and passive tissue properties. Here we tested whether participants with higher HMP deviation and whether using footwear that increases HMP deviation during running show higher reductions of knee joint articular cartilage volume after 75 minutes of running. We quantified knee joint articular cartilage volumes before and after the run using a 3.0-Tesla MRI. We performed a 3D movement analysis of runners in order to quantify their HMP from a two-legged squat motion and the deviation from the HMP when running in different footwear conditions. We found significantly more cartilage volume reductions in the medial knee compartment and patella for participants with higher HMP deviation. We also found higher cartilage volume reductions on the medial tibia when runners wore a shoe that maximized their HMP deviation compared with the shoe that minmized their HMP deviation. Runners might benefit from reducing their HMP deviation and from selecting footwear by quantifying HMP deviation in order to minimize joint cartilage loading in sub-areas of the knee.

Influence of neutral and stability athletic footwear on lower extremity coordination variability during a prolonged treadmill run in male rearfoot runners.

The purpose of this study was to investigate changes in coordination variability (CV) over the course of a prolonged treadmill run and the influence of stability and neutral footwear on CV. Fourteen male habitually rearfoot runners completed two 42 min prolonged running sessions while three-dimensional kinematics and kinetics were recorded. During the first 21 min, participants ran in a neutral shoe (baseline run), then changed into either another neutral shoe of the same construction but another colour or a stability shoe and ran a further 21 min (intervention run). A modified vector coding technique was used to compute thigh-leg, leg-rearfoot and rearfoot-forefoot segment CV. Following the baseline run, thigh flexion/extension-leg flexion/extension, rearfoot inversion/eversion-forefoot plantar flexion/dorsiflexion and rearfoot inversion/eversion-forefoot adduction/abduction CV increased (p < .05). During the intervention run, CV was higher in the neutral shoe compared with the stability shoe for thigh flexion/extension-leg flexion/extension and leg flexion/extension-rearfoot inversion/eversion couplings (p < .05). Lower extremity CV increased or was maintained during a prolonged treadmill run in healthy male rearfoot runners, likely to distribute stresses among the tissues as muscles begin to fatigue. CV increased to a greater extent in neutral compared with stability footwear which may be a result of: (1) the stability shoe acting as a perturbation to the runner and their response is to regulate CV, or; (2) stability footwear provides greater support and consequently, runners do not need to explore additional degrees of freedom to reduce stresses applied to the tissues throughout a prolonged run.

Does footwear affect articular cartilage volume change after a prolonged run?

The aim of this study was to investigate knee intra-articular cartilage volume changes after a prolonged running bout in three footwear conditions. Twelve participants performed 75-minute running bouts in the three footwear conditions. Before and after each running bout, magnetic resonance imaging (MRI) scans were obtained using a high-resolution 3.0 Tesla MRI. Three-dimensional reconstruction of the cartilage plates of the patella, the femur, and the tibia was created to quantify cartilage volume change due to the 75-minute running bout. Three-dimensional biomechanical data were also collected using an integrated motion capture and force treadmill system. There were no statistically significant differences among shoe conditions for all anatomical regions. However, significant cartilage volume reductions at all anatomical sites were observed after the 75-minute running bout in each footwear condition. These data suggest that the intra-articular knee cartilage undergoes a significant reduction in cartilage volume during a prolonged run that may indicate an increase in joint loading. There was a considerable variation in cartilage volume between participants across footwear conditions indicating an individual cartilage volume response to footwear. An individualistic approach to footwear recommendations may help in minimizing this change in cartilage.

Estimating Tibial Stress throughout the Duration of a Treadmill Run.

INTRODUCTION: Stress fractures of the tibia are a problematic injury among runners of all levels. Quantifying tibial stress using a modeling approach provides an alternative to invasive assessments that may be used to detect changes in tibial stress during running. This study aimed to assess the repeatability of a tibial stress model and to use this model to quantify changes in tibial stress that occur throughout the course of a 40-min prolonged treadmill run. METHODS: Synchronized force and kinematic data were collected during prolonged treadmill running from 14 recreational male rearfoot runners on two separate occasions. During each session, participants ran at their preferred speed for two consecutive 20-min runs, separated by a 2-min pause. The tibia was modeled as a hollow ellipse and bending moments and stresses at the distal third of the tibia were estimated using beam theory combined with inverse dynamics and musculoskeletal modeling. RESULTS: Intraclass correlation coefficients indicated good-to-excellent repeatability for peak stress values between sessions. Peak anterior and posterior stresses increased after 20 min of prolonged treadmill running and were 15% and 12% greater, respectively, after 40 min of running compared with the start of the run. CONCLUSION: The hollow elliptical tibial model presented is a repeatable tool that can be utilized to assess within-participant changes in peak tibial stress during running. The increased stresses observed during a prolonged treadmill run may have implications for the development of tibial stress fracture.

Whole-body control of anticipated and unanticipated sidestep manoeuvres in female and male team sport athletes.

The purpose of this study was to investigate the influence of sex and planning time on spatial and temporal aspects of the whole-body centre of mass (CoM) mechanics during sidestepping performance. Seventeen female and 17 male collegiate team sport athletes completed seven anticipated and seven unanticipated sidestep trials during which three-dimensional CoM data were recorded. Female athletes had a reduced ability to reorient their CoM towards the desired direction of travel (lower medio-lateral and anterior-posterior CoM velocity) than their male counterparts, with reduced medial (closer to stance foot) and increased posterior positioning of CoM relative to the stance foot (p < 0.05). When planning time was limited, female and male athletes performed sidestepping with CoM further from the stance foot (more medial) and more anterior than in the anticipated condition (p < 0.05) at reduced medio-lateral velocities. Sex and condition control strategy differences were evident both in the preparatory phase and the stance phase. The current research draws attention to the foreseen benefits of training athletes, with particular emphasis on females, to direct CoM towards the desired direction of travel in the preparatory and stance phases within temporally constrained situations for improved performance.