Physiological, perceptual, and biomechanical differences between treadmill and overground walking in healthy adults: A systematic review and meta-analysis.

This systematic review and meta-analysis aims to compare physiological, perceptual and biomechanical outcomes between walking on a treadmill and overground surfaces. Five databases (CINAHL, EMBASE, MEDLINE, SPORTDiscus, Web of Science) were searched until September 2022. Included studies needed to be a crossover design comparing biomechanical, physiological, or perceptual measures between motorised-treadmill and overground walking in healthy adults (18-65 years) walking at the same speed (<5% difference). The quality of studies were assessed using a modified Downs and Black Quality Index. Meta-analyses were performed to determine standardised mean difference ± 95% confidence intervals for all main outcome measures. Fifty-five studies were included with 1,005 participants. Relative oxygen consumption (standardised mean difference [95% confidence interval] 0.38 [0.14,0.63]) and cadence (0.22 [0.06,0.38]) are higher during treadmill walking. Whereas stride length (-0.36 [-0.62,-0.11]) and step length (-0.52 [-0.98,-0.06]) are lower during treadmill walking. Most kinetic variables are different between surfaces. The oxygen consumption, spatiotemporal and kinetic differences on the treadmill may be an attempt to increase stability due to the lack of control, discomfort and familiarity on the treadmill. Treadmill construction including surface stiffness and motor power are likely additional constraints that need to be considered and require investigation. This research was supported by an Australian Government Research Training Program (RTP) scholarship. Protocol registration is CRD42020208002 (PROSPERO International Prospective Register of Systematic Reviews) in October 2020.

Relative oxygen consumption is greater on a treadmill when compared with overground when walking at similar speeds and needs to be considered when prescribing exercise.Walking on a treadmill results in several biomechanical changes compared to overground that may be related to changes in gait stability.It may be favourable for rehabilitation purposes for people to initially walk on a treadmill due to lower vertical ground reaction force at push-off and lower joint moments at the knee and ankle.

The Iliotibial Band: A Complex Structure with Versatile Functions.

The development of a pronounced iliotibial band (ITB) is an anatomically distinct evolution of humans. The mechanical behaviour of this "new" structure is still poorly understood and hotly debated in current literature. Iliotibial band syndrome (ITBS) is one of the leading causes of lateral knee pain injuries in runners. We currently lack a comprehensive understanding of the healthy behaviour of the ITB, and this is necessary prior to further investigating the aetiology of pathologies like ITBS. Therefore, the purpose of this narrative review was to collate the anatomical, biomechanical and clinical literature to understand how the mechanical function of the ITB is influenced by anatomical variation, posture and muscle activation. The complexity of understanding the mechanical function of the ITB is due, in part, to the presence of its two in-series muscles: gluteus maximus (GMAX) and tensor fascia latae (TFL). At present, we lack a fundamental understanding of how GMAX and TFL transmit force through the ITB and what mechanical role the ITB plays for movements like walking or running. While there is a range of proposed ITBS treatment strategies, robust evidence for effective treatments is still lacking. Interventions that directly target the running biomechanics suspected to increase either ITB strain or compression of lateral knee structures may have promise, but clinical randomised controlled trials are still required.

Primary and secondary effects of real-time feedback to reduce vertical loading rate during running.

Gait modifications are often proposed to reduce average loading rate (AVLR) during running. While many modifications may reduce AVLR, little work has investigated secondary gait changes. Thirty-two rearfoot runners [16M, 16F, 24.7 (3.3) years, 22.72 (3.01) kg/m2 , >16 km/week] ran at a self-selected speed (2.9 ± 0.3 m/s) on an instrumented treadmill, while 3D mechanics were calculated via real-time data acquisition. Real-time visual feedback was provided in a randomized order to cue a forefoot strike (FFS), a minimum 7.5% decrease in step length, or a minimum 15% reduction in AVLR. AVLR was reduced by FFS (mean difference = 26.4 BW/s; 95% CI = 20.1, 32.7; P < 0.001), shortened step length (8.4 BW/s; 95% CI = 2.9, 14.0; P = 0.004), and cues to reduce AVLR (14.9 BW/s; 95% CI = 10.2, 19.6; P < 0.001). FFS, shortened step length, and cues to reduce AVLR all reduced eccentric knee joint work per km [(-48.2 J/kg*m; 95% CI = -58.1, -38.3; P < 0.001), (-35.5 J/kg*m; 95% CI = -42.4, 28.6; P < 0.001), (-23.1 J/kg*m; 95% CI = -33.3, -12.9; P < 0.001)]. However, FFS and cues to reduce AVLR also increased eccentric ankle joint work per km [(54.49 J/kg*m; 95% CI = 45.3, 63.7; P < 0.001), (9.20 J/kg*m; 95% CI = 1.7, 16.7; P = 0.035)]. Potentially injurious secondary effects associated with FFS and cues to reduce AVLR may undermine their clinical utility. Alternatively, a shortened step length resulted in small reductions in AVLR, without any potentially injurious secondary effects.

Knee contact forces and lower extremity support moments during running in young individuals post-partial meniscectomy.

PURPOSE: While partial meniscectomy results in a compromised tibiofemoral joint, little is known regarding tibiofemoral joint loading during running in individuals who are post-partial meniscectomy. It was hypothesized that individuals post-partial meniscectomy would run with a greater hip support moment, yielding reduced peak knee extension moments and reduced tibiofemoral joint contact forces. METHODS: 3-D Treadmill running mechanics were evaluated in 23 athletic individuals post-partial meniscectomy (37.5 ± 19.0 months post-partial meniscectomy) and 23 matched controls. Bilateral hip, knee and ankle contributions to the total support moment and the peak knee extension moment were calculated. A musculoskeletal model estimated peak and impulse tibiofemoral joint contact forces. Knee function was quantified with the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: During running, the partial meniscectomy group had a greater hip support moment (p = 0.002) and a reduced knee support moment (p < 0.001) relative to the total support moment. This movement pattern was associated with a 14.5 % reduction (p = 0.019) in the peak knee extension moment. Despite these differences, there were no significant group differences in peak or impulse tibiofemoral joint contact forces. Lower KOOS Quality of Life scores were associated with greater hip support moment (p = 0.004, r = -0.58), reduced knee support moment (p = 0.006, r = 0.55) and reduced peak knee extension moment (p = 0.01, r = 0.52). CONCLUSIONS: Disordered running mechanics are present long term post-partial meniscectomy. A coordination strategy that shifts a proportion of the total support moment away from the knee to the hip reduces the peak knee extension moment, but does not equate to reduced tibiofemoral joint contact forces during running in individuals post-partial meniscectomy. LEVEL OF EVIDENCE: III.

In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture.

We sought to determine if an in-field gait retraining program can reduce excessive impact forces and peak hip adduction without adverse changes in knee joint work during running. Thirty healthy at-risk runners who exhibited high-impact forces were randomized to retraining [21.1 (± 1.9) years, 22.1 (± 10.8) km/week] or control groups [21.0 (± 1.3) years, 23.2 (± 8.7) km/week]. Retrainers were cued, via a wireless accelerometer, to increase preferred step rate by 7.5% during eight training sessions performed in-field. Adherence with the prescribed step rate was assessed via mobile monitoring. Three-dimensional gait analysis was performed at baseline, after retraining, and at 1-month post-retraining. Retrainers increased step rate by 8.6% (P < 0.0001), reducing instantaneous vertical load rate (-17.9%, P = 0.003), average vertical load rate (-18.9%, P < 0.0001), peak hip adduction (2.9° ± 4.2 reduction, P = 0.005), eccentric knee joint work per stance phase (-26.9%, P < 0.0001), and per kilometer of running (-21.1%, P < 0.0001). Alterations in gait were maintained at 30 days. In the absence of any feedback, controls maintained their baseline gait parameters. The majority of retrainers were adherent with the prescribed step rate during in-field runs. Thus, in-field gait retraining, cueing a modest increase in step rate, was effective at reducing impact forces, peak hip adduction and eccentric knee joint work.

Influence of step length and landing pattern on patellofemoral joint kinetics during running.

Elevated patellofemoral joint kinetics during running may contribute to patellofemoral joint symptoms. The purpose of this study was to test for independent effects of foot strike pattern and step length on patellofemoral joint kinetics while running. Effects were tested relative to individual steps and also taking into account the number of steps required to run a kilometer with each step length. Patellofemoral joint reaction force and stress were estimated in 20 participants running at their preferred speed. Participants ran using a forefoot strike and rearfoot strike pattern during three different step length conditions: preferred step length, long (+10%) step length, and short (-10%) step length. Patellofemoral kinetics was estimated using a biomechanical model of the patellofemoral joint that accounted for cocontraction of the knee flexors and extensors. We observed independent effects of foot strike pattern and step length. Patellofemoral joint kinetics per step was 10-13% less during forefoot strike conditions and 15-20% less with a shortened step length. Patellofemoral joint kinetics per kilometer decreased 12-13% using a forefoot strike pattern and 9-12% with a shortened step length. To the extent that patellofemoral joint kinetics contribute to symptoms among runners, these running modifications may be advisable for runners with patellofemoral pain.

Effect of cessation and resumption of static hamstring muscle stretching on joint range of motion.

STUDY DESIGN: Single group repeated measures. OBJECTIVES: To determine the effects of cessation and resumption of a hamstring muscle stretching protocol on knee range of motion (ROM). BACKGROUND: It is generally accepted that stretching exercises result in an increase in ROM. The ability to maintain ROM once stretching has ceased and the ability to regain ROM after resumption of the stretching exercise is not well-known. METHODS AND MEASURES: Evaluated the effect of 6 weeks of static hamstring stretching, 4 weeks with cessation from stretching, and 6 weeks with resumption of stretching on knee ROM in 18 inactive college students (12 men, 6 women, mean age 21.0 years). The hamstring stretching consisted of 2 30-second stretches per day, 5 days per week. Knee ROM was measured before and after each of the above phases with an active knee extension test. RESULTS: Mean knee ROM increased after the initial stretching period (143+/-11 to 152+/-9 degrees), decreased to baseline following the cessation period (145+/-8 degrees) and again increased following the resumption of stretching but was not different from the initial gains (154+/-10 degrees). Unlike the stretch limb, the control limb ROM did not change over the 4 measurement times. CONCLUSIONS: There was no retention of knee ROM 4 weeks following a 6-week stretching protocol and a subsequent stretching period did not enhance the gain of knee ROM over the initial stretching period.