Shoe drop has opposite influence on running pattern when running overground or on a treadmill

The Relationship Between Running Biomechanics and Running Economy: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

Running biomechanics is considered an important determinant of running economy (RE). However, studies examining associations between running biomechanics and RE report inconsistent findings.

OBJECTIVE

The aim of this systematic review was to determine associations between running biomechanics and RE and explore potential causes of inconsistency.

METHODS

Three databases were searched and monitored up to April 2023. Observational studies were included if they (i) examined associations between running biomechanics and RE, or (ii) compared running biomechanics between groups differing in RE, or (iii) compared RE between groups differing in running biomechanics during level, constant-speed, and submaximal running in healthy humans (18-65 years). Risk of bias was assessed using a modified tool for observational studies and considered in the results interpretation using GRADE. Meta-analyses were performed when two or more studies reported on the same outcome. Meta-regressions were used to explore heterogeneity with speed, coefficient of variation of height, mass, and age as continuous outcomes, and standardization of running shoes, oxygen versus energetic cost, and correction for resting oxygen or energy cost as categorical outcomes.

RESULTS

Fifty-one studies (n = 1115 participants) were included. Most spatiotemporal outcomes showed trivial and non-significant associations with RE: contact time r = - 0.02 (95% confidence interval [CI] - 0.15 to 0.12); flight time r = 0.11 (- 0.09 to 0.32); stride time r = 0.01 (- 0.8 to 0.50); duty factor r = - 0.06 (- 0.18 to 0.06); stride length r = 0.12 (- 0.15 to 0.38), and swing time r = 0.12 (- 0.13 to 0.36). A higher cadence showed a small significant association with a lower oxygen/energy cost (r = - 0.20 [- 0.35 to - 0.05]). A smaller vertical displacement and higher vertical and leg stiffness showed significant moderate associations with lower oxygen/energy cost (r = 0.35, - 0.31, - 0.28, respectively). Ankle, knee, and hip angles at initial contact, midstance or toe-off as well as their range of motion, peak vertical ground reaction force, mechanical work variables, and electromyographic activation were not significantly associated with RE, although potentially relevant trends were observed for some outcomes.

CONCLUSIONS

Running biomechanics can explain 4-12% of the between-individual variation in RE when considered in isolation, with this magnitude potentially increasing when combining different variables. Implications for athletes, coaches, wearable technology, and researchers are discussed in the review.

PROTOCOL REGISTRATION

https://doi.org/10.17605/OSF.IO/293 ND (OpenScience Framework).

An Investigation of Running Kinematics with Recovered Anterior Cruciate Ligament Reconstruction on a Treadmill and In-Field Using Inertial Measurement Units: A Preliminary Study

Anterior cruciate ligament reconstruction (ACLR) may affect movement even years after surgery. The purpose of this study was to determine possible interlimb asymmetries due to ACLR when running on a treadmill and in field conditions, with the aim of contributing to the establishment of objective movement assessment in real-world settings; moreover, we aimed to gain knowledge on recovered ACLR as a biomechanical risk factor. Eight subjects with a history of unilateral ACLR 5.4 ± 2.8 years after surgery and eight healthy subjects ran 1 km on a treadmill and 1 km on a concrete track. The ground contact time and triaxial peak tibial accelerations were recorded using inertial measurement units. Interlimb differences within subjects were tested and compared between conditions. There were no significant differences between limbs in the ACLR subjects or in healthy runners for any of the chosen parameters on both running surfaces. However, peak tibial accelerations were higher during field running (p-values < 0.01; Cohen's d effect sizes > 0.8), independent of health status. To minimize limb loading due to higher impacts during field running, this should be considered when choosing a running surface, especially in rehabilitation or when running with a minor injury or health issues.

A 0.05 m Change in Inertial Measurement Unit Placement Alters Time and Frequency Domain Metrics during Running

Inertial measurement units (IMUs) provide exciting opportunities to collect large volumes of running biomechanics data in the real world. IMU signals may, however, be affected by variation in the initial IMU placement or movement of the IMU during use. To quantify the effect that changing an IMU's location has on running data, a reference IMU was 'correctly' placed on the shank, pelvis, or sacrum of 74 participants. A second IMU was 'misplaced' 0.05 m away, simulating a 'worst-case' misplacement or movement. Participants ran over-ground while data were simultaneously recorded from the reference and misplaced IMUs. Differences were captured as root mean square errors (RMSEs) and differences in the absolute peak magnitudes and timings. RMSEs were ≤1 g and ~1 rad/s for all axes and misplacement conditions while mean differences in the peak magnitude and timing reached up to 2.45 g, 2.48 rad/s, and 9.68 ms (depending on the axis and direction of misplacement). To quantify the downstream effects of these differences, initial and terminal contact times and vertical ground reaction forces were derived from both the reference and misplaced IMU. Mean differences reached up to -10.08 ms for contact times and 95.06 N for forces. Finally, the behavior in the frequency domain revealed high coherence between the reference and misplaced IMUs (particularly at frequencies ≤~10 Hz). All differences tended to be exaggerated when data were analyzed using a wearable coordinate system instead of a segment coordinate system. Overall, these results highlight the potential errors that IMU placement and movement can introduce to running biomechanics data.

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.

Validity and reliability of the DANU sports system for walking and running gait assessment

Objective. Gait assessments have traditionally been analysed in laboratory settings, but this may not reflect natural gait. Wearable technology may offer an alternative due to its versatility. The purpose of the study was to establish the validity and reliability of temporal gait outcomes calculated by the DANU sports system, against a 3D motion capture reference system.Approach. Forty-one healthy adults (26 M, 15 F, age 36.4 ± 11.8 years) completed a series of overground walking and jogging trials and 60 s treadmill walking and running trials at various speeds (8-14 km hr-1), participants returned for a second testing session to repeat the same testing.Main results. For validity, 1406 steps and 613 trials during overground and across all treadmill trials were analysed respectively. Temporal outcomes generated by the DANU sports system included ground contact time, swing time and stride time all demonstrated excellent agreement compared to the laboratory reference (intraclass correlation coefficient (ICC) > 0.900), aside from ground contact time during overground jogging which had good agreement (ICC = 0.778). For reliability, 666 overground and 511 treadmill trials across all speeds were examined. Test re-test agreement was excellent for all outcomes across treadmill trials (ICC > 0.900), except for swing time during treadmill walking which had good agreement (ICC = 0.886). Overground trials demonstrated moderate to good test re-test agreement (ICC = 0.672-0.750), which may be due to inherent variability of self-selected (rather than treadmill set) pacing between sessions.Significance. Overall, this study showed that temporal gait outcomes from the DANU Sports System had good to excellent validity and moderate to excellent reliability in healthy adults compared to an established laboratory reference.

Wearables for running gait analysis: A study protocol

Quantitative running gait analysis is an important tool that provides beneficial outcomes to injury risk/recovery or performance assessment. Wearable devices have allowed running gait to be evaluated in any environment (i.e., laboratory or real-world settings), yet there are a plethora of different grades of devices (i.e., research-grade, commercial, or novel multi-modal) available with little information to make informed decisions on selection. This paper outlines a protocol that will examine different grades of wearables for running gait analysis in healthy individuals. Specifically, this pilot study will: 1) examine analytical validity and reliability of wearables (research-grade, commercial, high-end multimodal) within a controlled laboratory setting; 2) examine analytical validation of different grades of wearables in a real-world setting, and 3) explore clinical validation and usability of wearables for running gait analysis (e.g., injury history (previously injured, never injured), performance level (novice, elite) and relationship to meaningful outcomes). The different grades of wearable include: (1) A research-grade device, the Ax6 consists of a configurable tri-axial accelerometer and tri-axial gyroscope with variable sampling capabilities; (2) attainable (low-grade) commercial with proprietary software, the DorsaVi ViMove2 consisting of two, non-configurable IMUs modules, with a fixed sampling rate and (3) novel multimodal high-end system, the DANU Sports System that is a pair of textile socks, that contain silicone based capacitive pressure sensors, and configurable IMU modules with variable sampling rates. Clinical trial registration: Trial registration: NCT05277181.

Simulation of Lower Limb Muscle Activation Using Running Shoes with Different Heel-to-Toe Drops Using Opensim

BACKGROUND

Although numerous studies have been conducted to investigate the acute effects of shoe drops on running kinematics and kinetic variables, their effects on muscle forces remain unknown. Thus, the primary aim of this study was to compare the muscle force, kinematics, and kinetic variables of habitually rearfoot runners with heel-to-toe drops of negative 8 mm shoes (minimalist shoes) and positive 9 mm shoes (normal shoes) during the running stance phase by using musculoskeletal modeling and simulation techniques.

METHODS

Experimental data of lower limb kinematics, ground reaction force, and muscle activation from 16 healthy runners with rearfoot strike patterns were collected and analyzed in OpenSim. Using Matlab, the statistical parameter mapping paired t-test was used to compare the joint angle, moment, and muscle force waveform.

RESULTS

The results revealed differences in the sagittal ankle and hip angles and sagittal knee moments between the different heel-to-toe drops of running shoes. Specifically, it showed that the negative 8 mm running shoes led to significantly smaller values than the positive 9 mm running shoes in terms of the angle of ankle dorsiflexion, ankle eversion, knee flexion, hip flexion, and hip internal and hip external rotation. The peak ankle dorsiflexion moment, ankle plantarflexion moment, ankle eversion moment, knee flexion moment, knee abduction moment, and knee internal rotation also decreased obviously with the minimalist running shoes, while the lateral gastrocnemius, Achilleas tendon, and extensor hallucis longus muscles were obviously greater in the minimalist shoes compared to normal shoes. The vastus medialis, vastus lateralis and extensor digitorum longus muscles force were smaller in the minimalist shoes.

CONCLUSIONS

Runners may shift to a midfoot strike pattern when wearing negative running shoes. High muscle forces in the gastrocnemius lateral, Achilleas tendon, and flexor hallucis longus muscles may also indicate an increased risk of Achilleas tendonitis and ankle flexor injuries.

A novel characterisation protocol of mechanical interactions between the ground and a tibial prosthesis for long jump

The mechanical study of Running Specific Prostheses (RSPs) is often limited to the blade. The setup developed and presented herein is a simple experiment, based on a mechanical testing machine and a camera, that assesses two indicators relevant to coaches and athletes in the field of athletics: secant stiffness and energy dissipation. The influence of four parameters on global prosthesis behaviour is evaluated: the load line offset, the prosthesis-ground angle, the sole type and the flooring type. The load line offset and the flooring type have little to no influence on their behaviour. The prosthesis-ground angle impacts the stiffness: an increase in the angle brings a significant decrease in stiffness, which strongly impacts the performance. The type of sole modifies the kinematics of the blade tip's interaction with the ground. However, this effect is less likely to enhance the sports practice since athletics imposes the use of spikes. The camera images allow assessing the local behaviour of the sole, thus enabling to follow its strain through the compression process.

Evaluating footwear "in the wild": Examining wrap and lace trail shoe closures during trail running

Trail running participation has grown over the last two decades. As a result, there have been an increasing number of studies examining the sport. Despite these increases, there is a lack of understanding regarding the effects of footwear on trail running biomechanics in ecologically valid conditions. The purpose of our study was to evaluate how a Wrap vs. Lace closure (on the same shoe) impacts running biomechanics on a trail. Thirty subjects ran a trail loop in each shoe while wearing a global positioning system (GPS) watch, heart rate monitor, inertial measurement units (IMUs), and plantar pressure insoles. The Wrap closure reduced peak foot eversion velocity (measured via IMU), which has been associated with fit. The Wrap closure also increased heel contact area, which is also associated with fit. This increase may be associated with the subjective preference for the Wrap. Lastly, runners had a small but significant increase in running speed in the Wrap shoe with no differences in heart rate nor subjective exertion. In total, the Wrap closure fit better than the Lace closure on a variety of terrain. This study demonstrates the feasibility of detecting meaningful biomechanical differences between footwear features in the wild using statistical tools and study design. Evaluating footwear in ecologically valid environments often creates additional variance in the data. This variance should not be treated as noise; instead, it is critical to capture this additional variance and challenges of ecologically valid terrain if we hope to use biomechanics to impact the development of new products.

Wearables for Running Gait Analysis: A Systematic Review

BACKGROUND

Running gait assessment has traditionally been performed using subjective observation or expensive laboratory-based objective technologies, such as three-dimensional motion capture or force plates. However, recent developments in wearable devices allow for continuous monitoring and analysis of running mechanics in any environment. Objective measurement of running gait is an important (clinical) tool for injury assessment and provides measures that can be used to enhance performance.

OBJECTIVES

We aimed to systematically review the available literature investigating how wearable technology is being used for running gait analysis in adults.

METHODS

A systematic search of the literature was conducted in the following scientific databases: PubMed, Scopus, Web of Science and SPORTDiscus. Information was extracted from each included article regarding the type of study, participants, protocol, wearable device(s), main outcomes/measures, analysis and key findings.

RESULTS

A total of 131 articles were reviewed: 56 investigated the validity of wearable technology, 22 examined the reliability and 77 focused on applied use. Most studies used inertial measurement units (n = 62) [i.e. a combination of accelerometers, gyroscopes and magnetometers in a single unit] or solely accelerometers (n = 40), with one using gyroscopes alone and 31 using pressure sensors. On average, studies used one wearable device to examine running gait. Wearable locations were distributed among the shank, shoe and waist. The mean number of participants was 26 (± 27), with an average age of 28.3 (± 7.0) years. Most studies took place indoors (n = 93), using a treadmill (n = 62), with the main aims seeking to identify running gait outcomes or investigate the effects of injury, fatigue, intrinsic factors (e.g. age, sex, morphology) or footwear on running gait outcomes. Generally, wearables were found to be valid and reliable tools for assessing running gait compared to reference standards.

CONCLUSIONS

This comprehensive review highlighted that most studies that have examined running gait using wearable sensors have done so with young adult recreational runners, using one inertial measurement unit sensor, with participants running on a treadmill and reporting outcomes of ground contact time, stride length, stride frequency and tibial acceleration. Future studies are required to obtain consensus regarding terminology, protocols for testing validity and the reliability of devices and suitability of gait outcomes.

CLINICAL TRIAL REGISTRATION

CRD42021235527.

Effect of the Innovative Running Shoes With the Special Midsole Structure on the Female Runners’ Lower Limb Biomechanics

The study aimed to research the effects of innovative running shoes (a high heel-to-toe drop and special structure of midsole) on the biomechanics of the lower limbs and perceptual sensitivity in female runners. Fifteen healthy female runners were recruited to run through a 145-m runway with planted force plates at one peculiar speed (3.6 m/s ± 5%) with two kinds of shoe conditions (innovative running shoes vs. normal running shoes) while getting biomechanical data. The perception of shoe characteristics was assessed simultaneously through a 15-cm visual analog scale. The statistical parametric mapping technique calculated the time-series parameters. Regarding 0D parameters, the ankle dorsiflexion angle of innovative running shoes at touchdown was higher, and the peak dorsiflexion angle, range of motion, peak dorsiflexion velocity, and plantarflexion moment on the metatarsophalangeal joint of innovative running shoes during running were significantly smaller than those of normal running shoes (all p < 0.001). In addition, the braking phase and the time of peak vertical force 1 of innovative running shoes were found to be longer than those of normal running shoes (both p < 0.05). Meanwhile, the average vertical loading rate 1, peak vertical loading rate 1, peak braking force, and peak vertical force 1 in the innovative running shoes were lower than those of the normal running shoes during running (both p < 0.01). The statistical parametric mapping analysis exhibited a higher ankle dorsiflexion angle (0–4%, p < 0.05), a smaller knee internal rotation angle (0–6%, p < 0.05) (63–72%, p < 0.05), a decreased vertical ground reaction force (11–17%, p = 0.009), and braking anteroposterior ground reaction force (22–27%, p = 0.043) for innovative running shoes than normal running shoes. Runners were able to perceive the cushioning of innovative running shoes was better than that of normal running shoes. These findings suggested combining the high offset and structure of the midsole would benefit the industrial utilization of shoe producers in light of reducing the risk of running injuries for female runners.

A Re-examination of the Measurement of Foot Strike Mechanics During Running: The Immediate Effect of Footwear Midsole Thickness

Purpose

Midsole cushioning thickness (MT) is a key component of running footwear that may influence the stiffness setting of the joints, performance enhancement, and injury prevention. Most studies that have investigated the influence of manipulating shoe midsole characteristics on foot strike patterns and vertical force loading rates have not considered the dynamic conditions of initial landing and the associated initial lower limb joint stiffness. In this study, we examined the effect of running in shoes with large changes in MT on both the posture and dynamics associated with foot strike.

Methods

12 injury-free runners with habitual rearfoot strike patterns ran at 4.5 m/s along a 40-m runway in shoe conditions with MT of 30, 42, and 54 mm, respectively. Ground reaction force and the right leg kinematic data were collected. One-way repeated measures ANOVA was conducted to statistically analyze the effect of MT on key variables linked to foot strike.

Results

Increased midsole thickness resulted in a slightly flatter foot strike posture (p < 0.05), a decreased shank retraction velocity (p < 0.05), and an increase in forward horizontal foot velocity (p < 0.05), all at initial ground contact. Vertical force loading rates were reduced with increasing MT (p < 0.05), but this was associated with large increases in the initial ankle and knee joint stiffness (p < 0.05).

Conclusion

Adjustments in the initial conditions of contact with the ground during running were seen in both the posture and dynamics of the lower limbs. To help to mitigate the impact severity from foot-ground collision with the thinnest shoe condition, there was an increased shank retraction velocity and decreased forward velocity of the foot at landing. These active impact-moderating adaptations likely served to reduce the changes in impact severity expected due to midsole material properties alone and should be considered in relation to altering the risk of running-related injuries.

The effect of heel-to-toe drop of running shoes on patellofemoral joint stress during running

BACKGROUND

Traditional running shoes with heel-to-toe drops is thought to be a contributor to increased patellofemoral joint stress, which is proposed as a mechanism of patellofemoral pain.

RESEARCH QUESTION

Is there an increase in patellofemoral joint stress when running in shoes with drops compared to running in shoes without a drop?

METHODS

Lower limbs kinematics and ground reaction force were collected from eighteen healthy runners during over-ground running in shoes with 15 mm, 10 mm, 5 mm drops, and without a drop. Patellofemoral joint force and stress were calculated from the kinematic and kinetic data using a biomechanical model of the patellofemoral joint.

RESULTS

The peak patellofemoral joint stress was increased by more than 15% when running in shoes with 15 mm and 10 mm drops compared to running in shoes without a drop (p = 0.003, p = 0.001). The knee flexion angle was significantly increased when running in shoes with 15 mm, 10 mm and 5 mm drops (p = 0.014, p = 0.003, p = 0.002), the knee extension moment (p = 0.009, p = 0.002) and patellofemoral joint force (p = 0.003, p = 0.001) were increased when running in shoes with 15 mm and 10 mm drops, compared to running in shoes without a drop.

SIGNIFICANCE

Compared to running in shoes without a drop, running in shoes with drops > 5 mm increase the peak patellofemoral joint stress significantly, which is mainly due to the increased knee extension moment.

Is Motorized Treadmill Running Biomechanically Comparable to Overground Running? A Systematic Review and Meta-Analysis of Cross-Over Studies

BACKGROUND

Treadmills are often used in research, clinical practice, and training. Biomechanical investigations comparing treadmill and overground running report inconsistent findings.

OBJECTIVE

This study aimed at comparing biomechanical outcomes between motorized treadmill and overground running.

METHODS

Four databases were searched until June 2019. Crossover design studies comparing lower limb biomechanics during non-inclined, non-cushioned, quasi-constant-velocity motorized treadmill running with overground running in healthy humans (18-65 years) and written in English were included. Meta-analyses and meta-regressions were performed where possible.

RESULTS

33 studies (n = 494 participants) were included. Most outcomes did not differ between running conditions. However, during treadmill running, sagittal foot-ground angle at footstrike (mean difference (MD) - 9.8° [95% confidence interval: - 13.1 to - 6.6]; low GRADE evidence), knee flexion range of motion from footstrike to peak during stance (MD 6.3° [4.5 to 8.2]; low), vertical displacement center of mass/pelvis (MD - 1.5 cm [- 2.7 to - 0.8]; low), and peak propulsive force (MD - 0.04 body weights [- 0.06 to - 0.02]; very low) were lower, while contact time (MD 5.0 ms [0.5 to 9.5]; low), knee flexion at footstrike (MD - 2.3° [- 3.6 to - 1.1]; low), and ankle sagittal plane internal joint moment (MD - 0.4 Nm/kg [- 0.7 to - 0.2]; low) were longer/higher, when pooled across overground surfaces. Conflicting findings were reported for amplitude of muscle activity.

CONCLUSIONS

Spatiotemporal, kinematic, kinetic, muscle activity, and muscle-tendon outcome measures are largely comparable between motorized treadmill and overground running. Considerations should, however, particularly be given to sagittal plane kinematic differences at footstrike when extrapolating treadmill running biomechanics to overground running. Protocol registration CRD42018083906 (PROSPERO International Prospective Register of Systematic Reviews).

Implications of sample size and acquired number of steps to investigate running biomechanics

Low reproducibility and non-optimal sample sizes are current concerns in scientific research, especially within human movement studies. Therefore, this study aimed to examine the implications of different sample sizes and number of steps on data variability and statistical outcomes from kinematic and kinetics running biomechanical variables. Forty-four participants ran overground using their preferred technique (normal) and minimizing the contact sound volume (silent). Running speed, peak vertical, braking forces, and vertical average loading rate were extracted from > 40 steps/runner. Data stability was computed using a sequential estimation technique. Statistical outcomes (p values and effect sizes) from the comparison normal vs silent running were extracted from 100,000 random samples, using various combinations of sample size (from 10 to 40 runners) and number of steps (from 5 to 40 steps). The results showed that only 35% of the study sample could reach average stability using up to 10 steps across all biomechanical variables. The loading rate was consistently significantly lower during silent running compared to normal running, with large effect sizes across all combinations. However, variables presenting small or medium effect sizes (running speed and peak braking force), required > 20 runners to reach significant differences. Therefore, varying sample sizes and number of steps are shown to influence the normal vs silent running statistical outcomes in a variable-dependent manner. Based on our results, we recommend that studies involving analysis of traditional running biomechanical variables use a minimum of 25 participants and 25 steps from each participant to provide appropriate data stability and statistical power.

Muscle Activity of the Triceps Surae With Novel Propulsion Heel-Lift Orthotics in Recreational Runners

Background:

The triceps surae muscle has been identified with propulsion during running gait, and typical heel-lift orthotics (THOs) have been used to treat some sports injuries of this structural-biomechanical unit. The effects of a novel propulsion heel-lift orthotic (PHO) on surface electromyography (EMG) activity of the gastrocnemius during a full cycle of running have yet to be tested.

Purpose/Hypothesis:

We aimed to assess EMG changes in gastrocnemius medialis and lateralis muscle activity when wearing THOs, PHOs, or neutral sports shoes only (SO) during running. We hypothesized that EMG activity of the triceps surae muscle would be lower for PHOs than THOs or SO during running.

Study Design:

Controlled laboratory study.

Methods:

A total of 26 healthy, regular recreational runners of both sexes (mean age, 33.58 ± 6.02 years) with a neutral Foot Posture Index and rearfoot strike pattern were recruited to run on a treadmill at 9 km/h using aleatory THOs of 6 and 9 mm, PHOs, and SO while EMG activity of the gastrocnemius medialis and lateralis muscles was recorded over a 30-second period. Intraclass correlation coefficients were calculated to assess reliability.

Results:

The intraclass correlation coefficient values indicated near perfect reliability, ranging from 0.801 for 6-mm THOs to 0.959 for SO in the gastrocnemius lateralis muscle. EMG activity of the gastrocnemius lateralis muscle was greater for PHOs (25.516 ± 4.780 mV) than for SO (23.140 ± 4.150 mV) (P < .05), but EMG activity of the gastrocnemius medialis muscle did not show any statistically significant difference between conditions (23.130 ± 2.980 mV vs 26.315 ± 2.930 mV, respectively) (P = .3).

Conclusion:

A novel PHO may increase muscle activity of the gastrocnemius lateralis during a full cycle of running gait; consequently, its prescription to treat triceps surae muscle injuries is cautioned.

Clinical Relevance:

The prescription of novel PHOs could increase EMG activity, which has not been previously described.

Effect of minimalist and maximalist shoes on impact loading and footstrike pattern in habitual rearfoot strike trail runners: An in-field study

Running-related injuries among trail runners are very common and footwear selection may modulate the injury risk. However, most previous studies were conducted in a laboratory environment. The objective of this study was to examine the effects of two contrasting footwear designs, minimalist (MIN) and maximalist shoes (MAX), on the running biomechanics of trail runners during running on a natural trail. Eighteen habitual rearfoot strike trail runners completed level, uphill and downhill running at their preferred speeds in both shod conditions. Peak tibial acceleration, strike index and footstrike pattern were compared between the two footwear and slopes. Interactions of footwear and slope were not detected for all the selected variables. There was no significant effect from footwear (F = 1.23, p = 0.27) and slope (F = 2.49, p = 0.09) on peak tibial acceleration and there was no footwear effect on strike index (F = 3.82, p = 0.056). A significant main effect of slope on strike index (F = 13.24, p < 0.001) was found. Strike index during uphill running was significantly greater (i.e. landing with a more anterior foot strike) when compared with level (p < 0.001, Cohen's d = 1.72) or downhill running (p < 0.001, Cohen's d = 1.44) in either MIN or MAX. The majority of habitual rearfoot strike runners switched to midfoot strike during uphill running while maintaining a rearfoot strike pattern during level or downhill running. In summary, wearing either one of the two contrasting footwear (MIN or MAX) demonstrated no effect on impact loading and footstrike pattern in habitual rearfoot strike trail runners running on a natural trail with different slopes.

Kinematics and muscle activity when running in partial minimalist, traditional, and maximalist shoes

While several studies have examined kinematic and kinetic differences between maximalist (MAX), traditional (TRAD), or partial minimalist (PMIN) shoes, to date it is unknown how MAX shoes influence muscle activity. This study compared lower extremity kinematics and muscle activity when running in PMIN, TRAD, and MAX shoes. Thirteen participants ran in each shoe while whole body kinematics were recorded using motion capture and electromyography was recorded from seven leg muscles. Differences in kinematics and root mean square amplitudes (RMS) were compared between shoe conditions. There were small differences in sagittal and frontal plane ankle kinematics between shoe conditions, with the MAX shoes resulting in less dorsiflexion at foot strike (p = .002) and less peak dorsiflexion (p < .001), and the PMIN shoes resulting in greater peak eversion (p = .012). Gluteus medius (p.006) and peroneus longus (p = .007) RMS amplitudes were greater in the MAX shoe then the TRAD or PMIN shoes while tibialis anterior RMS amplitudes were higher in the PMIN shoes (p = .005) than either the TRAD or MAX shoes. Consistent with previous findings, these results suggest there are small differences in kinematics when running in these three shoe types. This may partly be explained by the changes in muscle activity, which may be a response in order to maintain a preferred or habitual movement path. Implications for these difference in muscle activity in terms of fatigue or injury remain to be determined.

Running Propensities of Athletes with Hamstring Injuries

The current study aims to compare the mechanical propensities between healthy runners and runners with hamstring injuries. Retrospective case-control video analysis was used. A total of 35 (12 male and 23 female) videos of runners with hamstring injuries were compared with videos of sex-, age-, mass-, and height-matched healthy control runners. The main outcome variables were trunk posture angles, overstride angles, and foot strike patterns. An independent t-test and chi-squared tests were employed to analyze the main outcome variables between the runners with hamstring injuries and the healthy control runners. The statistical significance of less than 0.05 (p < 0.05) was used. The runners with hamstring injuries had a 1.6° less forward-trunk posture angles compared with the healthy control runners (p = 0.043). Also, the runners with hamstring injuries demonstrated a 4.9° greater overstride angles compared with the healthy control runners (p = 0.001). Finally, the runners with hamstring injuries had a tendency of rearfoot strike, while the healthy control runners showed a forefoot strike pattern (p = 0.004). In conclusion, the runners with hamstring injuries demonstrated different running mechanical propensities compared with the healthy runners.

Differences and mechanisms underpinning a change in the knee flexion moment while running in stability and neutral footwear among young females

Background

Higher peak external knee flexion moments (KFM) during running has been observed in healthy people wearing athletic footwear compared to barefoot, which may increase risk of knee pathologies such as patellofemoral pain. Currently, no studies have examined whether stability and neutral style athletic shoes influence the peak KFM differently, or explored the underlying biomechanical mechanisms by which footwear alters peak KFM in young females.

Methods

Lower limb biomechanics of sixty girls aged between 10 and 25 years old were collected while running in footwear (both stability and neutral) and barefoot. The external peak KFM, sagittal plane kinematics, sagittal plane knee ground reaction force (GRF) lever arm and sagittal plane resultant GRF magnitude were analysed by repeated measures Analysis of Variance. Linear mixed models were fit to identify predictors of a change in peak KFM, and to determine if the effects of these predictors differed between footwear conditions.

Results

The peak KFM was higher wearing both shoe styles compared to barefoot (p < 0.001), while no between-shoe differences were found (p > 0.05). Both shoes also increased kinematic variables at the hip, knee, and ankle (p < 0.05). When all these variables were entered into the mixed model, only a change in the knee-GRF lever arm was predictive of a change in peak KFM wearing shoes compared to barefoot (p < 0.001).

Conclusion

These findings provide evidence that stability and neutral shoes increase peak KFM compared to barefoot, which is associated with a change in the knee-GRF lever arm rather than a change in lower limb kinematics. Future studies may consider manipulating footwear characteristics to reduce the knee-GRF lever arm in an effort to reduce peak KFM and the potential risk of patellofemoral pain.

Electronic supplementary material

The online version of this article (10.1186/s13047-018-0307-9) contains supplementary material, which is available to authorized users.

Effects of footwear midsole thickness on running biomechanics

Shoe manufacturers launch running shoes with increased (e.g., maximalists) or decreased (e.g., minimalists) midsole thickness and claim that they may prevent running injury. Previous studies tested footwear models with different midsole thicknesses on the market but the shoe construct was not strictly comparable. Therefore, in the present study, we examined the effect of midsole thickness, from 1-mm to 29-mm, in a standard test shoe prototype on the vertical loading rates, footstrike angle and temporal spatial parameters in distance runners. Fifteen male habitual rearfoot strikers were recruited from local running clubs. They were asked to run on an instrumented treadmill in shoes with different midsole thicknesses. We found significant interactions between midsole thickness with vertical loading rates (p < 0.001), footstrike angle (p = 0.013), contact time (p < 0.001), cadence (p = 0.003), and stride length (p = 0.004). Specifically, shoes with thinner midsole (1- and 5-mm) significantly increased the vertical loading rates and shortened the contact time, when compared with thicker midsole shoes (25- and 29-mm). However, we did not observe any substantial differences in the footstrike angle, cadence and stride length between other shod conditions. The present study provides biomechanical data regarding the relationship between full spectrum midsole thicknesses and running biomechanics in a group of rearfoot strikers.

Accuracy and precision of loadsol® insole force-sensors for the quantification of ground reaction force-based biomechanical running parameters

Force plates represent the "gold standard" in measuring running kinetics to predict performance or to identify the sources of running-related injuries. As these measurements are generally limited to laboratory analyses, wireless high-quality sensors for measuring in the field are needed. This work analysed the accuracy and precision of a new wireless insole forcesensor for quantifying running-related kinetic parameters. Vertical ground reaction force (GRF) was simultaneously measured with pit-mounted force plates (1 kHz) and loadsol^® sensors (100 Hz) under unshod forefoot and rearfoot running-step conditions. GRF data collections were repeated four times, each separated by 30 min treadmill running, to test influence of extended use. A repeated-measures ANOVA was used to identify differences between measurement devices. Additionally, mean bias and Bland-Altman limits of agreement (LoA) were calculated. We found a significant difference (p < .05) in ground contact time, peak force, and force rate, while there was no difference in parameters impulse, time to peak, and negative force rate. There was no influence of time point of measurement. The mean bias of ground contact time, impulse, peak force, and time to peak ranged between 0.6% and 3.4%, demonstrating high accuracy of loadsol^® devices for these parameters. For these same parameters, the LoA analysis showed that 95% of all measurement differences between insole and force plate measurements were less than 12%, demonstrating high precision of the sensors. However, highly dynamic behaviour of GRF, such as force rate, is not yet sufficiently resolved by the insole devices, which is likely explained by the low sampling rate.

Acute and chronic effects of aquatic treadmill training on land treadmill running kinematics: A cross-over and single-subject design approach

The aim of this study was to determine if selected kinematic measures (foot strike index [SI], knee contact angle and overstride angle) were different between aquatic treadmill (ATM) and land treadmill (LTM) running, and to determine if these measures were altered during LTM running as a result of 6 weeks of ATM training. Acute effects were tested using 15 competitive distance runners who completed 1 session of running on each treadmill type at 5 different running speeds. Subsequently, three recreational runners completed 6 weeks of ATM training following a single-subject baseline, intervention and withdrawal experiment. Kinematic measures were quantified from digitisation of video. Regardless of speed, SI values during ATM running (61.3 ± 17%) were significantly greater (P = 0.002) than LTM running (42.7 ± 23%). Training on the ATM did not change (pre/post) the SI (26 ± 3.2/27 ± 3.1), knee contact angle (165 ± 0.3/164 ± 0.8) or overstride angle (89 ± 0.4/89 ± 0.1) during LTM running. Although SI values were different between acute ATM and LTM running, 6 weeks of ATM training did not appear to alter LTM running kinematics as evidenced by no change in kinematic values from baseline to post intervention assessments.

Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners: A Randomized Controlled Trial With 6-Month Follow-up

BACKGROUND

Modern running shoes are available in a wide range of heel-to-toe drops (ie, the height difference between the forward and rear parts of the inside of the shoe). While shoe drop has been shown to influence strike pattern, its effect on injury risk has never been investigated. Therefore, the reasons for such variety in this parameter are unclear.

PURPOSE

The first aim of this study was to determine whether the drop of standard cushioned running shoes influences running injury risk. The secondary aim was to investigate whether recent running regularity modifies the relationship between shoe drop and injury risk.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

Leisure-time runners (N = 553) were observed for 6 months after having received a pair of shoes with a heel-to-toe drop of 10 mm (D10), 6 mm (D6), or 0 mm (D0). All participants reported their running activities and injuries (time-loss definition, at least 1 day) in an electronic system. Cox regression analyses were used to compare injury risk between the 3 groups based on hazard rate ratios (HRs) and their 95% CIs. A stratified analysis was conducted to evaluate the effect of shoe drop in occasional runners (<6 months of weekly practice over the previous 12 months) versus regular runners (≥6 months).

RESULTS

The overall injury risk was not different among the participants who had received the D6 (HR, 1.30; 95% CI, 0.86-1.98) or D0 (HR, 1.17; 95% CI, 0.76-1.80) versions compared with the D10 shoes. After stratification according to running regularity, low-drop shoes (D6 and D0) were found to be associated with a lower injury risk in occasional runners (HR, 0.48; 95% CI, 0.23-0.98), whereas these shoes were associated with a higher injury risk in regular runners (HR, 1.67; 95% CI, 1.07-2.62).

CONCLUSION

Overall, injury risk was not modified by the drop of standard cushioned running shoes. However, low-drop shoes could be more hazardous for regular runners, while these shoes seem to be preferable for occasional runners to limit injury risk.

Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running

Study Design Level 4, controlled laboratory study. Background Little is known regarding how the potential differences between treadmill and overground running may affect patellofemoral joint and Achilles tendon loading characteristics. Objectives To compare measures of loading of the patellofemoral joint and Achilles tendon across treadmill and overground running in healthy, uninjured runners. Methods Eighteen healthy runners ran at their self-selected speed on an instrumented treadmill and overground, while 3-D running mechanics were sampled. A musculoskeletal model derived peak load, rate of loading, and estimated cumulative load per 1 km of continuous running for the patellofemoral joint and Achilles tendon for each condition. Data were analyzed via paired t tests and Pearson correlations to detect differences and assess relationships, respectively, between the 2 running mediums. Results No differences (P>.05) were found between treadmill and overground running for peak load, rate of loading, or estimated cumulative patellofemoral joint stress per 1 km of continuous running. However, treadmill running resulted in 12.5% greater peak Achilles tendon force (P<.001), 15.6% greater loading rate of Achilles tendon force (P<.001), and 14.2% greater estimated cumulative Achilles tendon force per 1 km of continuous running (P<.001) compared with overground running. There were strong (r>0.70) and moderate agreements (r>0.50) for most patellofemoral joint and Achilles measures, respectively, between treadmill and overground running. Conclusion No differences were observed in loading characteristics to the patellofemoral joint between running mediums; however, treadmill running resulted in greater Achilles tendon loading compared with overground running. Future investigations should examine whether sudden bouts of treadmill running may increase the risk of mechanical overload of the Achilles tendon in runners who habitually train overground. J Orthop Sports Phys Ther 2016;46(8):664-672. Epub 12 May 2016. doi:10.2519/jospt.2016.6494.

Plantar pressure measurements and running-related injury: A systematic review of methods and possible associations

Pressure-sensitive measuring devices have been identified as appropriate tools for measuring an array of parameters during running. It is unclear which biomechanical characteristics relate to running-related injury (RRI) and which data-processing techniques are most promising to detect this relationship. This systematic review aims to identify pertinent methodologies and characteristics measured using plantar pressure devices, and to summarise their associations with RRI. PubMed, Embase, CINAHL, ScienceDirect and Scopus were searched up until March 2015. Retrospective and prospective, biomechanical studies on running using any kind of pressure-sensitive device with RRI as an outcome were included. All studies involving regular or recreational runners were considered. The study quality was assessed and the measured parameters were summarised. One low quality, two moderate quality and five high quality studies were included. Five different subdivisions of plantar area were identified, as well as five instants and four phases of measurement during foot-ground contact. Overall many parameters were collated and subdivided as plantar pressure and force, plantar pressure and force location, contact area, timing and stride parameters. Differences between the injured and control group were found for mediolateral and anteroposterior displacement of force, contact area, velocity of force displacement, relative force-time integral, mediolateral force ratio, time to peak force and inter-stride correlative patterns. However, no consistent results were found between studies and no biomechanical risk patterns were apparent. Additionally, conflicting findings were reported for peak force in three studies. Based on these observations, we provide suggestions for improved methodology measurement of pertinent parameters for future studies.

The influence of shoe drop on the kinematics and kinetics of children tennis players

This study investigated the immediate effects of reducing the shoe drop (i.e. the difference between the heel and the forefoot height) on the kinematics and kinetics of the lower extremities of children tennis players performing a tennis-specific movement. Thirteen children tennis players performed a series of simulated open stance forehands wearing 3 pairs of shoes differing only in the drop: 0 (D0), 6 (D6) and the control condition of 12 mm (D12). Two embedded forceplates and a motion capture system were used to analyse the ground reaction forces and ankle and knee joint angles and moments of the leading lower limb. In D6 compared with D12, the peak impact force was reduced by 24% (p = .004) and the ankle was less dorsiflexed at foot strike (p = .037). In D0 compared with D12, the peak impact force was reduced by 17% (p = .049), the ankle was less dorsiflexed at foot strike (p = .045) and the knee was more flexed at foot strike (p = .007). In addition, 4 out of 13 participants (31%) presented a forefoot strike pattern for some of the trials in D0. No difference was observed across shoe conditions for the peak knee extensor moment (p = .658) or the peak ankle plantarflexor moment (p = .071). The results provide preliminary data supporting the hypothesis that for children tennis players, using a 6-mm lower shoe drop might reduce heel impact forces and thus limit potentially impact-related injuries.

Loading rate increases during barefoot running in habitually shod runners: Individual responses to an unfamiliar condition

The purpose of this study was to examine the effect of barefoot running on initial loading rate (LR), lower extremity joint kinematics and kinetics, and neuromuscular control in habitually shod runners with an emphasis on the individual response to this unfamiliar condition. Kinematics and ground reaction force data were collected from 51 habitually shod runners during overground running in a barefoot and shod condition. Joint kinetics and stiffness were calculated with inverse dynamics. Inter-individual initial LR variability was explored by separating individuals by a barefoot/shod ratio to determine acute responders/non-responders. Mean initial LR was 54.1% greater in the barefoot when compared to the shod condition. Differences between acute responders/non-responders were found at peak and initial contact sagittal ankle angle and at initial ground contact. Correlations were found between barefoot sagittal ankle angle at initial ground contact and barefoot initial LR. A large variability in biomechanical responses to an acute exposure to barefoot running was found. A large intra-individual variability was found in initial LR but not ankle plantar-dorsiflexion between footwear conditions. A majority of habitually shod runners do not exhibit previously reported benefits in terms of reduced initial LRs when barefoot. Lastly, runners who increased LR when barefoot reduced LRs when wearing shoes to levels similar seen in habitually barefoot runners who do adopt a forefoot-landing pattern, despite increased dorsiflexion.

Neuro-mechanical adjustments to shod versus barefoot treadmill runs in the acute and delayed stretch-shortening cycle recovery phases

In habitually shod recreational runners, we studied the combined influence of footwear and stretch-shortening cycle (SSC) fatigue on treadmill running pattern, paying special attention to neuro-mechanical adjustments in the acute and 2-day delayed recovery periods. The SSC exercise consisted of a series of 25 sub-maximal rebounds on a sledge apparatus repeated until exhaustion. The acute and delayed functional fatigue effects were quantified in a maximal drop jump test. The neuro-mechanical adjustments to fatigue were examined during two submaximal treadmill run tests of 3 min performed either barefoot or with shoes on. Surface electromyographic (EMG) activities, tibial accelerations and kinematics of the right lower limb were recorded during the first and last 15 s of each run. The main result was that neuro-mechanical differences between the shod and barefoot running patterns, classically reported in the absence of fatigue, persisted in the fatigued state. However, in the delayed recovery phase, rearfoot eversion was found to significantly increase in the shod condition. This specific footwear effect is considered as a potential risk factor of overuse injuries in longer runs. Therefore, specific care should be addressed in the delayed recovery phase of SSC fatigue and the use of motion control shoes could be of interest.