Counterpoint: Artificial legs do not make artificially fast running speeds possible

Sprinting with prosthetic versus biological legs: insight from experimental data

Running-prostheses have enabled exceptional athletes with bilateral leg amputations to surpass Olympic 400 m athletics qualifying standards. Due to the world-class performances and relatively fast race finishes of these athletes, many people assume that running-prostheses provide users an unfair advantage over biologically legged competitors during long sprint races. These assumptions have led athletics governing bodies to prohibit the use of running-prostheses in sanctioned non-amputee (NA) competitions, such as at the Olympics. However, here we show that no athlete with bilateral leg amputations using running-prostheses, including the fastest such athlete, exhibits a single 400 m running performance metric that is better than those achieved by NA athletes. Specifically, the best experimentally measured maximum running velocity and sprint endurance profile of athletes with prosthetic legs are similar to, but not better than those of NA athletes. Further, the best experimentally measured initial race acceleration (from 0 to 20 m), maximum velocity around curves, and velocity at aerobic capacity of athletes with prosthetic legs were 40%, 1-3% and 19% slower compared to NA athletes, respectively. Therefore, based on these 400 m performance metrics, use of prosthetic legs during 400 m running races is not unequivocally advantageous compared to the use of biological legs.

How Can Biomechanics Improve Physical Preparation and Performance in Paralympic Athletes? A Narrative Review

Recent research in Paralympic biomechanics has offered opportunities for coaches, athletes, and sports practitioners to optimize training and performance, and recent systematic reviews have served to summarize the state of the evidence connecting biomechanics to Paralympic performance. This narrative review serves to provide a comprehensive and critical evaluation of the evidence related to biomechanics and Paralympic performance published since 2016. The main themes within this review focus on sport-specific body posture: the standing, sitting, and horizontal positions of current summer Paralympic sports. For standing sports, sprint and jump mechanics were assessed in athletes with cerebral palsy and in lower-limb amputee athletes using running-specific prostheses. Our findings suggest that running and jumping-specific prostheses should be ‘tuned’ to each athlete depending on specific event demands to optimize performance. Standing sports were also inclusive to athletes with visual impairments. Sitting sports comprise of athletes performing on a bike, in a wheelchair (WC), or in a boat. WC configuration is deemed an important consideration for injury prevention, mobility, and performance. Other sitting sports like hand-cycling, rowing, and canoeing/kayaking should focus on specific sitting positions (e.g., arm-crank position, grip, or seat configuration) and ways to reduce aero/hydrodynamic drag. Para-swimming practitioners should consider athlete-specific impairments, including asymmetrical anthropometrics, on the swim-start and free-swim velocities, with special considerations for drag factors. Taken together, we provide practitioners working in Paralympic sport with specific considerations on disability and event-specific training modalities and equipment configurations to optimize performance from a biomechanical perspective.

Prosthetic shape, but not stiffness or height, affects the maximum speed of sprinters with bilateral transtibial amputations

Running-specific prostheses (RSPs) have facilitated an athlete with bilateral transtibial amputations to compete in the Olympic Games. However, the performance effects of using RSPs compared to biological legs remains controversial. Further, the use of different prosthetic configurations such as shape, stiffness, and height likely influence performance. We determined the effects of using 15 different RSP configurations on the maximum speed of five male athletes with bilateral transtibial amputations. These athletes performed sets of running trials up to maximum speed using three different RSP models (Freedom Innovations Catapult FX6, Össur Flex-Foot Cheetah Xtend and Ottobock 1E90 Sprinter) each with five combinations of stiffness category and height. We measured ground reaction forces during each maximum speed trial to determine the biomechanical parameters associated with different RSP configurations and maximum sprinting speeds. Use of the J-shaped Cheetah Xtend and 1E90 Sprinter RSPs resulted in 8.3% and 8.0% (p<0.001) faster maximum speeds compared to the use of the C-shaped Catapult FX6 RSPs, respectively. Neither RSP stiffness expressed as a category (p = 0.836) nor as kN·m-1 (p = 0.916) affected maximum speed. Further, prosthetic height had no effect on maximum speed (p = 0.762). Faster maximum speeds were associated with reduced ground contact time, aerial time, and overall leg stiffness, as well as with greater stance-average vertical ground reaction force, contact length, and vertical stiffness (p = 0.015 for aerial time, p<0.001 for all other variables). RSP shape, but not stiffness or height, influences the maximum speed of athletes with bilateral transtibial amputations.

Comparison of Sprinting With and Without Running-Specific Prostheses Using Optimal Control Techniques

The purpose of our study was to get deeper insights into sprinting with and without running-specific prostheses and to perform a comparison of the two by combining analysis of known motion capture data with mathematical modeling and optimal control problem (OCP) findings. We established rigid multi-body system models with 14 bodies and 16 degrees of freedom in the sagittal plane for one unilateral transtibial amputee and three non-amputee sprinters. The internal joints are powered by torque actuators except for the passive prosthetic ankle joint which is equipped with a linear spring–damper system. For each model, the dynamics of one sprinting trial was reconstructed by solving a multiphase least squares OCP with discontinuities and constraints. We compared the motions of the amputee athlete and the non-amputee reference group by computing characteristic criteria such as the contribution of joint torques, the absolute mechanical work, step frequency and length, among others. By comparing the amputee athlete with the non-amputee athletes, we found reduced activity in the joints of the prosthetic limb, but increased torques and absolute mechanical work in the arms. We also compared the recorded motions to synthesized motions using different optimality criteria and found that the recorded motions are still far from the optimal solutions for both amputee and non-amputee sprinting.

Athletes With Versus Without Leg Amputations: Different Biomechanics, Similar Running Economy

Athletes with transtibial amputations use carbon-fiber prostheses to run. Compared with biological legs, these devices differ in structure and function, and consequently yield affected leg running biomechanics that are theoretically more economical than those of nonamputees. However, experimental data indicate that athletes with unilateral and bilateral transtibial amputations exhibit running economy values that are well within the range of nonamputee values.

The biomechanics of the fastest sprinter with a unilateral transtibial amputation

People have debated whether athletes with transtibial amputations should compete with nonamputees in track events despite insufficient information regarding how the use of running-specific prostheses (RSPs) affect athletic performance. Thus, we sought to quantify the spatiotemporal variables, ground reaction forces, and spring-mass mechanics of the fastest athlete with a unilateral transtibial amputation using an RSP to reveal how he adapts his biomechanics to achieve elite running speeds. Accordingly, we measured ground reaction forces during treadmill running trials spanning 2.87 to 11.55 m/s of the current male International Paralympic Committee T44 100- and 200-m world record holder. To achieve faster running speeds, the present study’s athlete increased his affected leg (AL) step lengths ( P < 0.001) through longer contact lengths ( P < 0.001) and his unaffected leg (UL) step lengths ( P < 0.001) through longer contact lengths ( P < 0.001) and greater stance average vertical ground reaction forces ( P < 0.001). At faster running speeds, step time decreased for both legs ( P < 0.001) through shorter ground contact and aerial times ( P < 0.001). Unlike athletes with unilateral transtibial amputations, this athlete maintained constant AL and UL stiffness across running speeds ( P ≥ 0.569). Across speeds, AL step lengths were 8% longer ( P < 0.001) despite 16% lower AL stance average vertical ground reaction forces compared with the UL ( P < 0.001). The present study’s athlete exhibited biomechanics that differed from those of athletes with bilateral and without transtibial amputations. Overall, we present the biomechanics of the fastest athlete with a unilateral transtibial amputation, providing insight into the functional abilities of athletes with transtibial amputations using running-specific prostheses.

NEW & NOTEWORTHY The present study’s athlete achieved the fastest treadmill running trial ever attained by an individual with a leg amputation (11.55 m/s). From 2.87 to 11.55 m/s, the present study’s athlete maintained constant affected and unaffected leg stiffness, which is atypical for athletes with unilateral transtibial amputations. Furthermore, the asymmetric vertical ground reaction forces of athletes with unilateral transtibial amputations during running may be the result of leg length discrepancies.

Maximum-speed curve-running biomechanics of sprinters with and without unilateral leg amputations

On curves, non-amputees' maximum running speed is slower on smaller radii and thought to be limited by the inside leg's mechanics. Similar speed decreases would be expected for non-amputees in both counterclockwise and clockwise directions because they have symmetric legs. However, sprinters with unilateral leg amputation have asymmetric legs, which may differentially affect curve-running performance and Paralympic competitions. To investigate this and understand the biomechanical basis of curve running, we compared maximum curve-running (radius 17.2 m) performance and stride kinematics of six non-amputee sprinters and 11 sprinters with a transtibial amputation. Subjects performed randomized, counterbalanced trials: two straight, two counterclockwise curves and two clockwise curves. Non-amputees and sprinters with an amputation all ran slower on curves compared with straight running, but with different kinematics. Non-amputees ran 1.9% slower clockwise compared with counterclockwise (P<0.05). Sprinters with an amputation ran 3.9% slower with their affected leg on the inside compared with the outside of the curve (P<0.05). Non-amputees reduced stride length and frequency in both curve directions compared with straight running. Sprinters with an amputation also reduced stride length in both curve-running directions, but reduced stride frequency only on curves with the affected leg on the inside. During curve running, non-amputees and athletes with an amputation had longer contact times with their inside compared with their outside leg, suggesting that the inside leg limits performance. For sprinters with an amputation, the prolonged contact times of the affected versus unaffected leg seem to limit maximum running speed during both straight running and running on curves with the affected leg on the inside.

Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations

Inspired by the springlike action of biological legs, running-specific prostheses are designed to enable athletes with lower-limb amputations to run. However, manufacturer’s recommendations for prosthetic stiffness and height may not optimize running performance. Therefore, we investigated the effects of using different prosthetic configurations on the metabolic cost and biomechanics of running. Five athletes with bilateral transtibial amputations each performed 15 trials on a force-measuring treadmill at 2.5 or 3.0 m/s. Athletes ran using each of 3 different prosthetic models (Freedom Innovations Catapult FX6, Össur Flex-Run, and Ottobock 1E90 Sprinter) with 5 combinations of stiffness categories (manufacturer’s recommended and ± 1) and heights (International Paralympic Committee’s maximum competition height and ± 2 cm) while we measured metabolic rates and ground reaction forces. Overall, prosthetic stiffness [fixed effect (β) = 0.036; P = 0.008] but not height ( P ≥ 0.089) affected the net metabolic cost of transport; less stiff prostheses reduced metabolic cost. While controlling for prosthetic stiffness (in kilonewtons per meter), using the Flex-Run (β = −0.139; P = 0.044) and 1E90 Sprinter prostheses (β = −0.176; P = 0.009) reduced net metabolic costs by 4.3–4.9% compared with using the Catapult prostheses. The metabolic cost of running improved when athletes used prosthetic configurations that decreased peak horizontal braking ground reaction forces (β = 2.786; P = 0.001), stride frequencies (β = 0.911; P < 0.001), and leg stiffness values (β = 0.053; P = 0.009). Remarkably, athletes did not maintain overall leg stiffness across prosthetic stiffness conditions. Rather, the in-series prosthetic stiffness governed overall leg stiffness. The metabolic cost of running in athletes with bilateral transtibial amputations is influenced by prosthetic model and stiffness but not height.

NEW & NOTEWORTHY We measured the metabolic rates and biomechanics of five athletes with bilateral transtibial amputations while running with different prosthetic configurations. The metabolic cost of running for these athletes is minimized by using an optimal prosthetic model and reducing prosthetic stiffness. The metabolic cost of running was independent of prosthetic height, suggesting that longer legs are not advantageous for distance running. Moreover, the in-series prosthetic stiffness governs the leg stiffness of athletes with bilateral leg amputations.

The influence of push-off timing in a robotic ankle-foot prosthesis on the energetics and mechanics of walking

BACKGROUND

Robotic ankle-foot prostheses that provide net positive push-off work can reduce the metabolic rate of walking for individuals with amputation, but benefits might be sensitive to push-off timing. Simple walking models suggest that preemptive push-off reduces center-of-mass work, possibly reducing metabolic rate. Studies with bilateral exoskeletons have found that push-off beginning before leading leg contact minimizes metabolic rate, but timing was not varied independently from push-off work, and the effects of push-off timing on biomechanics were not measured. Most lower-limb amputations are unilateral, which could also affect optimal timing. The goal of this study was to vary the timing of positive prosthesis push-off work in isolation and measure the effects on energetics, mechanics and muscle activity.

METHODS

We tested 10 able-bodied participants walking on a treadmill at 1.25 m · s(-1). Participants wore a tethered ankle-foot prosthesis emulator on one leg using a rigid boot adapter. We programmed the prosthesis to apply torque bursts that began between 46% and 56% of stride in different conditions. We iteratively adjusted torque magnitude to maintain constant net positive push-off work.

RESULTS

When push-off began at or after leading leg contact, metabolic rate was about 10% lower than in a condition with Spring-like prosthesis behavior. When push-off began before leading leg contact, metabolic rate was not different from the Spring-like condition. Early push-off led to increased prosthesis-side vastus medialis and biceps femoris activity during push-off and increased variability in step length and prosthesis loading during push-off. Prosthesis push-off timing had no influence on intact-side leg center-of-mass collision work.

CONCLUSIONS

Prosthesis push-off timing, isolated from push-off work, strongly affected metabolic rate, with optimal timing at or after intact-side heel contact. Increased thigh muscle activation and increased human variability appear to have caused the lack of reduction in metabolic rate when push-off was provided too early. Optimal timing with respect to opposite heel contact was not different from normal walking, but the trends in metabolic rate and center-of-mass mechanics were not consistent with simple model predictions. Optimal push-off timing should also be characterized for individuals with amputation, since meaningful benefits might be realized with improved timing.

Modeling the effect of a prosthetic limb on 4-km pursuit performance

The individual pursuit is a 4-km cycling time trial performed on a velodrome. Parathletes with transtibial amputation (TTA) have lost physiological systems, but this may be offset by the reduced aerodynamic drag of the prosthesis. This research was performed to understand the effect of a unilateral TTA on Olympic 4-km pursuit performance. A forward-integration model of pursuit performance explored the interplay between power loss and aerodynamic gains in parathletes with TTA. The model is calibrated to a 4-km pursuit time of 4:10.5 (baseline), then adjusted to account for a TTA. Conditions simulated were based on typical pedal asymmetry in TTA (AMP), if foot stiffness were decreased (FLEX), if pedaling asymmetries were minimized (ASYM), if the prosthesis were aerodynamically optimized (AERO), if the prosthesis had a cosmetic cover (CC), and if all variables were optimized (OPT). A random Monte Carlo analysis was performed to understand model precision. Four-kilometer pursuit performances predicted by the model were 4:10.5, 4:20.4, 4:27.7, 4:09.2, 4:19.4, 4:27.9, and 4:08.2 for the baseline, AMP, FLEX, ASYM, AERO, CC, and OPT models, respectively. Model precision was ±3.7 s. While the modeled time decreased for ASYM and OPT modeled conditions, the time reduction fell within model precision and therefore was not significant. Practical application of these results suggests that parathletes with a TTA could improve performance by minimizing pedaling asymmetry and/or optimizing aerodynamic design, but, at best, they will have performance similar to that of intact cyclists. In conclusion, parathletes with TTA do not have a net advantage in the individual pursuit.

Sport prostheses and prosthetic adaptations for the upper and lower limb amputees: an overview of peer reviewed literature

BACKGROUND

Sport prostheses are used by both upper- and lower-limb amputees while participating in sports and other physical activities. Although the number of these devices has increased over the past decade, no overview of the peer reviewed literature describing them has been published previously. Such an overview will allow specialists to choose appropriate prostheses based on available scientific evidence rather than on personal experience or preference.

OBJECTIVE

To provide an overview of the sport prostheses as they are described by the papers published in peer reviewed literature.

STUDY DESIGN

Literature review.

METHODS

Four electronic databases were searched using free text and Medical Subject Headings (MESH) terms. Papers were included if they concerned a prosthesis or a prosthetic adaptation used in sports. Papers were excluded if they did not originate from peer reviewed sources, if they concerned prostheses for body parts other than the upper or lower limbs, if they concerned amputations distal to the wrist or ankle, or if they were written in a language other than English.

RESULTS

Twenty-four papers were included in this study. The vast majority contained descriptive data and consisted of expert opinions and technical notes.

CONCLUSION

Data concerning the energy efficiency, technical characteristics and special mechanical properties of prostheses or prosthetic adaptations for sports, other than running, are scarce.

Recent trends in assistive technology for mobility

Loss of physical mobility makes maximal participation in desired activities more difficult and in the worst case fully prevents participation. This paper surveys recent work in assistive technology to improve mobility for persons with a disability, drawing on examples observed during a tour of academic and industrial research sites in Europe. The underlying theme of this recent work is a more seamless integration of the capabilities of the user and the assistive technology. This improved integration spans diverse technologies, including powered wheelchairs, prosthetic limbs, functional electrical stimulation, and wearable exoskeletons. Improved integration is being accomplished in three ways: 1) improving the assistive technology mechanics; 2) improving the user-technology physical interface; and 3) sharing of control between the user and the technology. We provide an overview of these improvements in user-technology integration and discuss whether such improvements have the potential to be transformative for people with mobility impairments.

Paralympic sport: an emerging area for research and consultancy in sports biomechanics

The Paralympic Games are the pinnacle of sport for many athletes with a disability. The overall purpose of this paper is to highlight the role that the field of sports biomechanics specifically (and sports science in general) may play in improving performance in various summer Paralympic sports through research and consultancy. To achieve this broad aim, this review provides some history and background on the Summer Paralympic Games, discusses the eligibility and classification rules, describes the potential for the constraints-led approach of dynamical systems theory to inform practice and research in this area, and reviews selected studies examining the biomechanics of the primary forms of Paralympic locomotion. Some recommendations on how sports biomechanics can help facilitate improvements in Paralympic athletic performance through applied research and consultancy are provided, along with commentary on what may be some of the most important issues addressing Paralympic sport.