Lower Extremity Kinetics and Kinematics in Runners with Patellofemoral Pain: A Retrospective Case–Control Study Using Musculoskeletal Simulation

Patellofemoral pain (PFP) is a common atraumatic knee pathology in runners, with a complex multifactorial aetiology influenced by sex differences. This retrospective case–control study therefore aimed to evaluate lower limb kinetics and kinematics in symptomatic and control male and female runners using musculoskeletal simulation. Lower extremity biomechanics were assessed in 40 runners with PFP (15 females and 25 males) and 40 controls (15 females and 25 males), whilst running at a self-selected velocity. Lower extremity biomechanics were explored using a musculoskeletal simulation approach. Four intergroup comparisons—(1) overall PFP vs. control; (2) male PFP vs. male control; (3) female PFP vs. female control; and (4) male PFP vs. female PFP—were undertaken using linear mixed models. The overall (stress per mile: PFP = 1047.49 and control = 812.93) and female (peak stress: PFP = 13.07 KPa/BW and control = 10.82 KPa/BW) comparisons showed increased patellofemoral joint stress indices in PFP runners. A significantly lower strike index was also shown in PFP runners in the overall (PFP = 17.75% and control = 33.57%) and female analyses (PFP = 15.49% and control = 40.20%), revealing a midfoot strike in control, and a rearfoot pattern in PFP runners. Peak rearfoot eversion and contralateral pelvic drop range of motion (ROM) were shown to be greater in PFP runners in the overall (eversion: PFP = −8.15° and control = −15.09°/pelvic drop ROM: PFP = 3.64° and control = 1.88°), male (eversion: PFP = −8.05° and control = −14.69°/pelvic drop ROM: PFP = 3.16° and control = 1.77°) and female (eversion: PFP = 8.28° and control = −15.75°/pelvic drop ROM: PFP = 3.64° and control = 1.88°) PFP runners, whilst female PFP runners (11.30°) exhibited a significantly larger peak hip adduction compared to PFP males (7.62°). The findings from this investigation highlight biomechanical differences between control and PFP runners, as well as demonstrating distinctions in PFP presentation for many parameters between sexes, highlighting potential risk factors for PFP that may be addressed through focused intervention modalities, and also the need, where appropriate, for sex-specific targeted treatment approaches.

Within-Session Reliability and Minimum Detectable Differences for Discrete Lower-Extremity Angles and Moments During Walking

Differences in walking biomechanics between groups or conditions should be greater than the measurement error to be considered meaningful. Reliability and minimum detectable differences (MDDs) have not been determined for lower-extremity angles and moments during walking within a session, as needed for interpreting differences in cross-sectional studies. Thus, the purpose of this study was to determine within-session reliability and MDDs for peak ankle, knee, and hip angles and moments during walking. Three-dimensional gait analysis was used to record walking at 1.25 m/s (±5%) in 18 men, 18–50 years of age. Peak angles and moments were calculated for 2 sets of 3 trials. Intraclass correlation coefficients (3, 3) were used to determine within-session reliability. In addition, MDDs were calculated. Within-session reliability was good to excellent for all variables. The MDDs ranged from 0.9° to 3.6° for joint angles and 0.06 to 0.15 N·m/kg for joint moments. Within-session reliability for peak ankle, knee, and hip angles and moments was better than the between-session reliability reported previously. Overall, our MDDs were similar or smaller than those previously reported for between-session reliability. The authors recommend using these MDDs to aid in the interpretation of cross-sectional comparisons of lower-extremity biomechanics during walking in healthy men.

Lower Extremity Biomechanics Predicts Major League Baseball Player Performance

Background: Although lower extremity biomechanics has been correlated with traditional metrics among baseball players, its association with advanced statistical metrics has not been evaluated. Purpose: To establish normative biomechanical parameters during the countermovement jump (CMJ) among Major League Baseball (MLB) players and evaluate the relationship between CMJ-developed algorithms and advanced statistical metrics. Study Design: Cohort study; Level of evidence, 3. Methods: MLB players in 2 professional organizations performed the CMJ at the beginning of each baseball season from 2013 to 2017. We collected ground-reaction force data including the eccentric rate of force development (“load”), concentric vertical force (“explode”), and concentric vertical impulse (“drive”) as well as the Sparta Score. The advanced statistical metrics from each baseball season (eg, fielding independent pitching [FIP], weighted stolen base runs [wSB], and weighted on-base average) were also gathered for the study participants. The minimal detectable change (MDC) was calculated for each CMJ variable to establish normative parameters. Pearson coefficient analysis and regression trees were used to evaluate associations between CMJ data and advanced statistical metrics for the players. Results: A total of 151 pitchers and 138 batters were included in the final analysis. The MDC for “load,” “explode,” “drive,” and the Sparta Score was 10.3, 8.1, 8.7, and 4.6, respectively, and all demonstrated good reliability (intraclass correlation coefficient > 0.75). There was a weak but statistically significant correlation between the Sparta Score and wSB ( r = 0.23; P = .007); however, there were no significant correlations with any other advanced metrics. Regression trees demonstrated superior FIP with higher Sparta Scores in older pitchers compared with younger pitchers. Conclusion: There was a positive but weak correlation between the Sparta Score and base-stealing performance among professional baseball players. Additionally, older pitchers with a higher Sparta Score had statistically superior FIP compared with younger pitchers with a similar Sparta Score after adjusting for age.

Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing

Background: Restricted ankle dorsiflexion range of motion (DFROM) has been linked to lower extremity biomechanics that place an athlete at higher risk for injury. Whether reduced DFROM during dynamic movements is due to restrictions in joint motion or underutilization of available ankle DFROM motion is unclear. Hypothesis: We hypothesized that both lesser total ankle DFROM and underutilization of available motion would lead to high-risk biomechanics (ie, greater knee abduction, reduced knee flexion). Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Nineteen active female athletes (age, 20.0 ± 1.3 years; height, 1.61 ± 0.06 m; mass, 67.0 ± 10.7 kg) participated. Maximal ankle DFROM (clinical measure of ankle DFROM [DF-CLIN]) was measured in a weightbearing position with the knee flexed. Lower extremity biomechanics were measured during a drop vertical jump with 3-dimensional motion and force plate analysis. The percent of available DFROM used during landing (DF-%USED) was calculated as the peak DFROM observed during landing divided by DF-CLIN. Univariate linear regressions were performed to identify whether DF-CLIN or DF-%USED predicted knee and hip biomechanics commonly associated with injury risk. Results: For every 1.0° less of DF-CLIN, there was a 1.0° decrease in hip flexion excursion ( r2 = 0.21, P = 0.05), 1.2° decrease in peak knee flexion angles ( r2 = 0.37, P = 0.01), 0.9° decrease in knee flexion excursion ( r2 = 0.40, P = 0.004), 0.002 N·m·N−1·cm−1 decrease in hip extensor work ( r2 = 0.28, P = 0.02), and 0.001 N·m·N−1·cm−1 decrease in knee extensor work ( r2 = 0.21, P = 0.05). For every 10% less of DF-%USED, there was a 3.2° increase in peak knee abduction angles ( r2 = 0.26, P = 0.03) and 0.01 N·m·N−1·cm−1 lesser knee extensor work ( r2 = 0.25, P = 0.03). Conclusion: Lower levels of both ankle DFROM and DF-%USED are associated with biomechanics that are considered to be associated with a higher risk of sustaining injury. Clinical Relevance: While total ankle DFROM can predict some aberrant movement patterns, underutilization of available ankle DFROM can also lead to higher risk movement strategies. In addition to joint specific mobility training, clinicians should incorporate biomechanical interventions and technique feedback to promote the utilization of available motion.

Effects of External Load on Sagittal and Frontal Plane Lower Extremity Biomechanics During Back Squats

Previous literature suggests the sticking region, the transition period between an early peak concentric velocity to a local minimum, in barbell movements may be the reason for failing repeated submaximal and maximal squats. This study determined the effects of load on lower extremity biomechanics during back squats. Twenty participants performed the NSCA's one-repetition maximum (1RM) testing protocol, testing to supramaximum loads (failure). After completing the protocol and a 10-minute rest, 80% 1RM squats were performed. Statistical parametric mapping was used to determine vertical velocity, acceleration, ankle, knee, and hip sagittal and frontal plane biomechanics differences between 1RM, submaximum, and supramaximum squats (105% 1RM). Vertical acceleration was a better discriminative measure than velocity, exibiting differences across all conditions. Supramaximum squats emphasized knee moments, whereas 1RM emphasized hip moments during acceleration. Submaximum squats had reduced hip and knee moments compared to supramaximum squats, but similar knee moments to 1RM squats. Across all conditions, knee loads mirrored accelerations and a prominent knee (acceleration) to hip (sticking) transition existed. These results indicate that 1) submaximum squats performed at increased velocities can provide similar moments at the ankle and knee, but not hip, as maximal loads and 2) significant emphasis on hip strength is necessary for heavy back squats.

Measurement Properties of Clinically Accessible Movement Assessment Tools for Analyzing Single-Leg Squats and Step-Downs: A Systematic Review

Context: Poor lower-extremity biomechanics are predictive of increased risk of injury. Clinicians analyze the single-leg squat (SLS) and step-down (SD) with rubrics and 2D assessments to identify these poor lower-extremity biomechanics. However, evidence on measurement properties of movement assessment tools is not strongly outlined. Measurement properties must be established before movement assessment tools are recommended for clinical use. Objective: The purpose of this study was to systematically review the evidence on measurement properties of rubrics and 2D assessments used to analyze an SLS and SD. Evidence Acquisition: The search strategy was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search was performed in PubMed, SPORTDiscus, and Web of Science databases. The COnsensus-based Standards for the selection of health Measurement INstruments multiphase procedure was used to extract relevant data, evaluate methodological quality of each study, score the results of each movement assessment, and synthesize the evidence. Evidence Synthesis: A total of 44 studies were included after applying eligibility criteria. Reliability and construct validity of knee frontal plane projection angle was acceptable, but criterion validity was unacceptable. Reliability of the Chmielewski rubric was unacceptable. Content validity of the knee-medial-foot and pelvic drop rubrics was acceptable. The remaining rubrics and 2D measurements had inconclusive or conflicting results regarding reliability and validity. Conclusions: Knee frontal plane projection angle is reliable for analyzing the SLS and SD; however, it does not serve as a substitute for 3D motion analysis. The Chmielewski rubric is not recommended for assessing the SLS or SD as it may be unreliable. Most movement assessment tools yield indeterminate results. Within the literature, standardized names, procedures, and reporting of movement assessment tool reliability and validity are inconsistent.