Running Alterations Pre- and Postarthroscopy for Femoroacetabular Impingement Syndrome and Labral Tears

ABSTRACT

Freemyer, B, Beeler, D, Crawford, S, Durkin, R, and Stickley, C. Running alterations pre- and postarthroscopy for femoroacetabular impingement syndrome and labral tears. J Strength Cond Res 38(3): 501-509, 2024-Running is essential to sports participation and activity over the lifespan; however, running biomechanics are not fully described in patients with femoroacetabular impingement (FAIS). The purpose was to compare FAIS patient report outcome surveys (PRO) and running biomechanics preoperatively and 6 months postoperatively with controls. Nineteen subjects (FAIS, n = 10 and age-matched controls, n = 9) were included. The UCLA, Hip Outcome Score activity of daily living (HOS ADL ) and sports subscale (HOS SS ), and 3-D running biomechanics were evaluated. Statistical parametric mapping was conducted on biomechanics data. Statistical significance was set at p ≤ 0.05. Femoroacetabular impingement had similar UCLA activity scores compared with controls by 6 months (FAIS: 8.4 ± 1.7, CON: 8.6 ± 2.0, p = 0.80), despite lower HOS ADL (FAIS-Six: 89.3 ± 6.3, CON: 100 ± 0, p = 0.04) and HOS SS (FAIS-Six: 82.6 ± 18.5, CON: 100 ± 0, p = 0.05). The FAIS group had lower knee adduction moments (KAM) around 22-27% of stance ( p = 0.05) and lower sagittal plane ankle power generation during the final 5% of stance compared with the controls ( p = 0.04) preoperatively. The FAIS also had lower vertical ground reaction forces the first 2% of stance ( p = 0.05) and lower KAM from 20 to 30% stance ( p = 0.03) at the postoperative time vs. controls. Femoroacetabular impingement had higher hip external rotation angles the first 5% stance ( p = 0.05) and the last 20% of stance ( p = 0.01) vs. controls. This is the first study to describe FAIS running pre- and postoperatively. Despite higher activity and health 6 months postarthroscopy, the patients with FAIS had altered running biomechanics. Clinicians should consider these findings when creating rehabilitation protocols and during running progressions across the postoperative care of patients with FAIS.

Stance Time and Impact Loading Rates are Significant Predictors of Critical Speed During a 3-Minute All-Out Running Test

The addition of wearable technology during a 3-minute all-out overground running test (3MAOT) could provide additional insights to guide training and coaching strategies. The purpose of this study was to explore the relationships between critical speed (CS) and biomechanical parameters (cadence, stride length, vertical oscillation, stance time, form power, leg spring stiffness, and impact loading rate), and changes in biomechanical parameters throughout the 3MAOT. Sixty-three (male, n=37, female, n=26) recreationally active college-aged (23.4±3.9 years) subjects completed a 3MAOT while wearing a Stryd foot-pod. The correlations between CS and biomechanical parameters were evaluated using Pearson coefficients. Stepwise multiple linear regressions were used to test if biomechanical parameters could predict CS. Stance time and impact loading rate explained 69% and 63% of the variance in CS, respectively (R2=0.69, p<0.05; R2=0.63, p<0.05). Step-wise multiple linear regression analysis indicated that vertical oscillation, stance time, form power, leg spring stiffness, and impact loading rate explained 90% of the variance in CS (R2=0.90, p<0.05). Throughout the 3MAOT, changes in cadence (-29%), stride length (57%), vertical oscillation (-8%), stance time (82%), form power (-5%), leg spring stiffness (-24%), and impact loading rate (-48%) were observed. Interventions such as auditory cueing or training designed to improve CS should focus on maintaining large impact loading rates and short stance times, and efforts should be made to enhance an athlete's ability to maintain cadence, leg spring stiffness, vertical oscillation, and form power throughout the 3MAOT.

Allometric Scaling Hip Joint Moments Optimally Reduces Anthropometric Differences in Males and Females

Running biomechanics are scaled to reduce the effects of anthropometric differences between participants. Ratio scaling has limitations, and allometric scaling has not been applied to hip joint moments. The aim was to compare raw, ratio and allometrically scaled hip joint moments. Sagittal and frontal plane moments of 84 males and 47 females were calculated while running at 4.0 m/s. Raw data were ratio scaled by body mass (BM), height (HT), leg length (LL) and BM multiplied by HT (BM*HT) and LL (BM*LL). Log-linear (for BM, HT and LL individually) or log-multilinear regression (BM*HT and BM*LL) exponents were calculated. Correlations and r² values assessed the effectiveness of each scaling method. Eighty-five per cent of raw moments were positively correlated to the anthropometrics with r² values of 10-19%. In ratio scaling, 26-43% were significantly correlated to the moments and a majority were negative, indicating overcorrections. The most effective scaling procedure was the allometric BM*HT, as the mean shared variance between the hip moment and anthropometrics was 0.1-0.2% across all sexes and moments and none had significant correlations. Allometric scaling of hip joint moments during running are advised if the goal is to remove the underlying effects of anthropometrics across male and female participants.

Pre- and Post-Operative Walking Gait in Females with Acetabular Labral Tears and Femoroacetabular Impingement Syndrome

CONTEXT

Symptomatic Femoroacetabular Impingement Syndrome (FAIS) is a painful condition that leads to decreased function. It is currently unknown how walking gait changes over time following surgery for FAIS earlier than one year, or how these changes present in females.

OBJECTIVE

The purpose was to determine biomechanical gait differences between females with FAIS/labral tears and controls pre-operatively, and three- and six-months post-operatively.

DESIGN

Case-Control Study.

SETTING

Gait laboratory.

PARTICIPANTS

The study included 18 female participants (n=9 FAIS patients, n=9 controls).

MAIN OUTCOME MEASURES

Between-group comparisons of the Hip Outcome Score activity of daily living subscale (HOSadl) and gait biomechanics were evaluated at pre-operative and three- and six-months post-operative sessions. Statistical parametric mapping was conducted on normalized time-series data.

RESULTS

Pre-operatively, the FAIS group had poor HOSadl scores [Pre-operative: 64.1 (15.4), Controls 100.0 (0), p<0.001;], walked 15% slower, and had several gait differences compared to controls. Three months post-operatively, the FAIS group had greater vGRF (p=0.013), ankle dorsiflexion angles (p=0.021), and external dorsiflexion moment (p=0.012) in midstance, as well as greater knee flexion through the second half of stance (p<0.001). The FAIS group also demonstrated less hip extension (p=0.024) and hip abduction (p=0.010) through the second half of stance, which transitioned into less hip extension (p=0.040) and hip abduction (p=0.025) during the subsequent swing phase. The FAIS improved their HOSadl to 87.6 (7.6) by 6-months post-operatively and had greater dorsiflexion moment (p=0.003) and ankle external rotation during stance (p=0.033). The FAIS patients also showed greater external hip ER moment in late stance (p<0.001).

CONCLUSIONS

The most biomechanical differences between groups occurred 3-months post-operatively, suggesting that female FAIS patients have more post-operative gait compensations in the short term after surgery. By six-month post-operatively, the patient reported outcomes greatly improved and there were few gait differences compared to the control group.

Weight-Bearing Versus Traditional Strength Assessments of the Hip Musculature

CONTEXT

Traditional nonweight-bearing (NWB) hip-strength assessments may not directly translate to functional strength during weight-bearing (WB) activity. How NWB assessments of hip muscle strength compare with WB assessments in various positions is currently unknown.

OBJECTIVE

To determine the magnitude of the differences and correlations between NWB hip strength and WB functional strength during the squatting and lunge (LNG) positions in female athletes.

DESIGN

Crossover design.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Female athletes (N = 51, age = 16.2 ± 3.5 years, height = 161.5 ± 8.3 cm, mass = 58.3 ± 11.6 kg).

INTERVENTION(S)

Isometric resistance (N/kg) was determined for the dominant and nondominant limbs via WB assessments (squat-bilateral [legs tested simultaneously], squat-unilateral, and lunge positions) and NWB assessments (hip abduction [HAB], hip extension HEXT], and hip external rotation [HER]).

MAIN OUTCOME MEASURE(S)

To compare differences between positions (P ≤ .05), we used effect sizes (d) and matched-pairs t tests, and we calculated Pearson r and R2 values.

RESULTS

During the squat-bilateral on the dominant limb, females produced the most hip torque (6.13 ± 1.12 N/kg). The magnitudes of differences were very large compared with HER (3.96 ± 0.83, d = 2.2), HEXT (3.22 ± 0.69, d = 3.2), and HAB (3.80 ± 1.01, d = 2.2; all P values ≤ .01), and positions were moderately correlated (r = 0.347-0.419, R2 = 0.12-0.18). The lunge position produced the least amount of torque in the dominant limb (2.44 ± 0.48 N/kg) compared with HER (d = -2.3), HEXT (d = -1.3), and HAB (d = -1.7; all P values ≤ .001), and correlations were small to moderate (r = 0.236-0.310, R2 = 0.06-0.10).

CONCLUSIONS

Strength in WB positions was different than strength evaluated using traditional NWB assessments in female athletes. Weight-bearing tests may provide clinicians with additional information regarding strength and function.

Differences in Spatiotemporal Parameters Between Trained Runners and Untrained Participants

Gómez-Molina, J, Ogueta-Alday, A, Stickley, C, Tobalina, JC, Cabrejas-Ugartondo, J, and García-López, J. Differences in spatiotemporal parameters between trained runners and untrained participants. J Strength Cond Res 31(8): 2169-2175, 2017-The aim of this study was to compare the spatiotemporal parameters of trained runners and untrained participants with the same foot strike pattern (rearfoot) during running at controlled speeds. Twenty-one participants were classified in 2 groups according to their training experience: Trained (n = 10, amateur runners with long distance training experience) and Untrained (n = 11, healthy untrained participants). Anthropometric variables were recorded, and the participants performed both a submaximal (between 9 and 15 km·h) and a graded exercise running test (from 6 km·h until exhaustion) on a treadmill. Physiological (V[Combining Dot Above]O2max, heart rate, running economy [RE], peak speed …) and biomechanical variables (contact and flight times, step rate, and length) were simultaneously registered. Trained runners showed higher step rate and shorter step length than the Untrained group at the same running speeds (between 4 and 7%, p ≤ 0.05) and at the same physiological intensities (between 7 and 11%, p ≤ 0.05). However, there were no differences in contact and flight times between groups. Significant differences (p ≤ 0.05) and large effect sizes (Cohen's d) between groups were found for body mass, sum of 6 skinfolds, V[Combining Dot Above]O2max, peak speed, and ventilatory threshold and respiratory compensation threshold speeds. The Trained group also showed a ∼7% better RE (ml·kg·km) than the Untrained group. In conclusion, adopting higher step rate and shorter step length may be an adaptive mechanism of the Trained group to reduce injury risk and possibly improve RE. However, contact and flight times were consistent regardless of training level.

Piezoelectric and electromagnetic respiratory effort energy harvesters

The movements of the torso due to normal breathing could be harvested as an alternative, and renewable power source for an ultra-low power electronic device. The same output signal could also be recorded as a physiological signal containing information about breathing, thus enabling self-powered wearable biosensors/harvesters. In this paper, the selection criteria for such a biosensor, optimization procedure, trade-offs, and challenges as a sensor and harvester are presented. The empirical data obtained from testing different modules on a mechanical torso and a human subject demonstrated that an electromagnetic generator could be used as an unobtrusive self-powered medical sensor by harvesting more power, offering reasonable amount of output voltage for rectification purposes, and detecting respiratory effort.

Electromagnetic respiratory effort harvester: human testing and metabolic cost analysis

Remote health monitoring is increasingly recognized as a valuable tool in chronic disease management. Continuous respiratory monitoring could be a powerful tool in managing chronic diseases, however it is infrequently performed because of obtrusiveness and inconvenience of the existing methods. The movements of the chest wall and abdominal area during normal breathing can be monitored and harvested to enable self-powered wearable biosensors for continuous remote monitoring. This paper presents human testing results of a light-weight (30 g), wearable respiratory effort energy harvesting sensor. The harvester output voltage, power, and its metabolic burden, are measured on twenty subjects in two resting and exercise conditions each lasting 5 min. The system includes two off-the-shelf miniature electromagnetic generators harvesting and sensing thoracic and abdominal movements. Modules can be placed in series to increase the output voltage for rectification purposes. Electromagnetic respiratory effort harvester/sensor system can produce up to 1.4 V, 6.44 mW, and harvests 30.4 mJ during a 5-min exercise stage. A statistical paired t-test analysis of the calculated EE confirmed there is no significant change ( P > 0.05 ) in the metabolic rate of subjects wearing the electromagnetic harvester and biosensor.

Metabolic equivalent determination in the cultural dance of hula

Ethnic minorities share an unequal burden of cardiometabolic syndrome. Physical activity (PA) has been shown to be an important factor for improving the outcomes of these diseases. While metabolic equivalents (METs) have been calculated for diverse activities, most cultural activities have not been evaluated. Hula, the traditional dance of Native Hawaiians, is practiced by men and women of all ages but its MET value is unknown. To our knowledge, this is the first scientific evaluation of energy expenditure of hula. 19 competitive hula dancers performed 2 dance sets of low- and high-intensity hula. METs were measured with a portable indirect calorimetry device. Mean and standard deviations were calculated for all the variables. A 2-way ANOVA was conducted to identify differences for gender and intensity. The mean MET were 5.7 (range 3.17-9.77) and 7.55 (range 4.43-12.0) for low-intensity and high-intensity, respectively. There was a significant difference between intensities and no significant difference between genders. This study demonstrates that the energy expenditure of both low- and high-intensity hula met the recommended guidelines for moderate and vigorous intensity exercise, respectively, and that hula can be utilized as a prescribed PA.

Hydration behaviors before and after an educational and prescribed hydration intervention in adolescent athletes

CONTEXT

The effectiveness of education in modifying hydration behaviors in adolescent athletes is unclear.

OBJECTIVE

To assess the hydration status and behaviors of female athletes before and after a 1-time educational intervention and prescribed hydration intervention in a warm, humid, tropical environment.

DESIGN

Cohort study.

SETTING

Non-air-conditioned gymnasium in a tropical environment (indoor wet bulb globe temperature = 24.0 ± 0.2°C). Patient or Other Participants: Thirty-six female adolescent elite volleyball players (age = 14.8 ± 0.8 years, height = 168.2 ± 8.2 cm, mass = 60.8 ± 9.0 kg, body mass index = 21.7 ± 2.7, body surface area = 1.65 ± 0.14 m(2), body surface area to mass ratio = 2.71 ± 0.18 m(2)·kg(-1)·10(-2)) participated.

INTERVENTION(S)

Four observational periods consisting of 3 practices per observational period separated by 48 hours. The 4 periods included a control period, educational intervention, prescribed hydration intervention (PHI), and observational follow-up (OF-U). After the control period, an educational intervention consisting of a slide presentation was provided to the participants, followed by a week of observation. In the PHI, a precalculated volume of water based on individual sweat rate was consumed every 20 minutes during each 2-hour practice. During all other periods, participants consumed their fluid of choice ad libitum. The order of the treatment periods was not randomized and was the same for all participants.

MAIN OUTCOME MEASURE(S)

Prepractice to postpractice changes in body mass (ΔBM), percentage of body mass lost (%BML), urine specific gravity, urine color, urine osmolality, sweat rate, and volume of fluid consumed (F(vol)).

RESULTS

The PHI was the only period during which participants maintained body mass (ΔBM = 0.05 ± 1.3%); F(vol) consumed was greatest during this time (F(vol) = 1.3 ± 0.4 L; F(1,3) = 34.869, P ≤ .001). TheΔBM was less for the PHI (ΔBM = 0.05 ± 0.9 kg, %BML = 0.04 ± 1.3%) than the OF-U period (ΔBM = -0.7 ± 1.1 kg, %BML = -1.2 ± 1.9%; F(1,3) = 6.220, P = .01). The F(vol) (1.3 ± 0.4 L) and percentage of fluid consumed (143.7 ± 110.8%) to restore sweat loss for the PHI period were higher than for any other period (F(1,3) = 34.869, P ≤ .001). None of the participants experienced serious dehydration in any of the conditions.

CONCLUSIONS

A 1-time education session alone was not successful in changing hydration behaviors. However, prescribing individualized hydration protocols improved hydration for adolescents exercising in a warm, humid environment.