Effects of changing speed on knee and ankle joint

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Effects of changing speed on knee and ankle joint load during walking and running a

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Ana Cristina de David , Felipe Pivetta Carpes & Darren Stefanyshyn a

Faculty of Physical Education, University of Brasília, Brasilia, Brazil

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Applied Neuromechanics Group, Center for Health Sciences, Federal University of Pampa, Uruguaiana, Brazil c

Human Performance Laboratory, Faculty of Kinesiology, The University of Calgary, Calgary, Canada Published online: 08 Aug 2014.

To cite this article: Ana Cristina de David, Felipe Pivetta Carpes & Darren Stefanyshyn (2014): Effects of changing speed on knee and ankle joint load during walking and running, Journal of Sports Sciences, DOI: 10.1080/02640414.2014.946074 To link to this article: http://dx.doi.org/10.1080/02640414.2014.946074

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Journal of Sports Sciences, 2014 http://dx.doi.org/10.1080/02640414.2014.946074

Effects of changing speed on knee and ankle joint load during walking and running

ANA CRISTINA DE DAVID1, FELIPE PIVETTA CARPES2 & DARREN STEFANYSHYN3 1

Faculty of Physical Education, University of Brasília, Brasilia, Brazil, 2Applied Neuromechanics Group, Center for Health Sciences, Federal University of Pampa, Uruguaiana, Brazil and 3Human Performance Laboratory, Faculty of Kinesiology, The University of Calgary, Calgary, Canada

Downloaded by [ANA DE DAVID] at 07:22 11 August 2014

(Accepted 15 July 2014)

Abstract Joint moments can be used as an indicator of joint loading and have potential application for sports performance and injury prevention. The effects of changing walking and running speeds on joint moments for the different planes of motion still are debatable. Here, we compared knee and ankle moments during walking and running at different speeds. Data were collected from 11 recreational male runners to determine knee and ankle joint moments during different conditions. Conditions include walking at a comfortable speed (self-selected pacing), fast walking (fastest speed possible), slow running (speed corresponding to 30% slower than running) and running (at 4 m · s−1 ± 10%). A different joint moment pattern was observed between walking and running. We observed a general increase in joint load for sagittal and frontal planes as speed increased, while the effects of speed were not clear in the transverse plane moments. Although differences tend to be more pronounced when gait changed from walking to running, the peak moments, in general, increased when speed increased from comfortable walking to fast walking and from slow running to running mainly in the sagittal and frontal planes. Knee flexion moment was higher in walking than in running due to larger knee extension. Results suggest caution when recommending walking over running in an attempt to reduce knee joint loading. The different effects of speed increments during walking and running should be considered with regard to the prevention of injuries and for rehabilitation purposes. Keywords: joint moment, kinetic, inverse dynamics, knee, ankle, injury

Introduction Running is one physical activity during which overuse injuries of the lower extremity may occur (Hoch, Pepper, & Akuthota, 2005; Hreljac, 2004, 2005; Van Mechelen, 1992). Approximately 42% of the injuries occur at the knee while foot, ankle and lower leg make up almost 40% of the remaining injuries (Hreljac, 2005; Van Mechelen, 1992). The aetiology of overuse running injuries is multifactorial and diverse, including training, anatomical and biomechanical factors (Hreljac, 2004). It has been postulated that walking imposes lower mechanical loads than running and thus walking is often recommended as a form of exercise for people who are beginning physical fitness programmes or recovering from musculoskeletal injuries. Indeed, faster speed walking is used to increase workout intensity and recommended as an alternative to running. Changes in speed and the associated changes in limb posture affect muscle forces by altering the

magnitude and mechanical advantage of the ground reaction force (Biewener, Farley, Roberts, & Temaner, 2004; Zeni & Higginson, 2009). Kinetic data, in general, have a stronger relationship than kinematic parameters with speed (Landry, McKeana, Hubley-Kozeya, Stanishc, & Deluzio, 2007; Lelas, Merriman, Riley, & Kerrigan, 2003; Stoquart, Detrembleur, & Lejeune, 2008). When running speed increases, sagittal plane hip and knee loading increase (Edwards, Taylor, Rudolphi, Gillette, & Derrick, 2010; Schache et al., 2011). However, studies on the dependency of kinetic parameters on speed generally focus on slower walking speeds, which although useful for comparisons with pathologic gait (Lelas et al., 2003; Stoquart et al., 2008) do not necessarily represent more typical nonpathological speeds. Although increased knee joint moments in the frontal and transverse planes have been associated with an increased incidence of injuries (Ferber, Davis, & Williams, 2003; Landry et al., 2007) and

Correspondence: Ana Cristina de David, Faculty of Physical Education, University of Brasília, Via L4 Norte, Brasilia, DF, Brazil, Brasilia, 70919900 Brazil. E-mail: [email protected] © 2014 Taylor & Francis


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A.C. De David et al.

have been shown as important components to moderate stability, force attenuation and economy of gait (Woo, Abramowitch, Kilger, & Liang, 2006), many studies on gait considered loads only in the sagittal plane (Biewener et al., 2004; Lelas et al., 2003; Stoquart et al., 2008). Of note, no studies were found regarding knee and ankle moments in the sagittal, frontal and transverse planes for comfortable walking compared with self-selected fast walking or running at different speeds. Schache et al. (2011) computed the torques at the lower limb joints at four speeds towards maximal running speed and showed increased sagittal plane hip and knee torques and a plateau for moments at the ankle joint for higher speeds. However, the differences between walking and running were not addressed. Biomechanical information regarding lower extremity joint loads during walking and running at different speeds can provide insight into injury prevention, fitness and rehabilitation programme planning or sport footwear design. Therefore, the goal of our study was to compare knee and ankle moments during comfortable walking, self-selected fast walking, slow running and running in recreational males. Specifically, certain questions were posed: (1) Do the ankle and knee moments increase as gait changes from walking to running? (2) Are differences in the peak resultant joint moments observed between self-selected fast walking and slow running? (3) What are the effects on the joint moment peaks when speed increases by 30% from slow running to running? Methods Participants Eleven recreational male runners aged between 20 and 30 years (age 21.2 ± 1.8 years; height 1.77 ± 0.60 m; body mass 74.8 ± 5.6 kg) were participated in this study. They were all rearfoot strikers, which was determined by visual inspection of their gait kinematics, training regularly without history of lower extremity injuries, and signed an informed consent form approved by the local ethics committee before the start of testing. All participants had recreational experience with running (at least three times per week) in the last six months before the experiments. Experimental design Participants were evaluated while walking and running overground using control running shoes (Adizero Tempo 5 M, Adidas Int., Herzogenaurach, Germany), which means a standardised shoe across participants was used to minimise the influence of

footwear on pronation or supination movements of the ankle joint while walking or running at different speeds in a single session in the laboratory. The trials started after measurement of body mass and height. Kinematic and kinetic data were acquired at four different conditions as follows: (a) comfortable walking at self-selected pacing, (b) fast walking at the maximal possible walking speed, (c) slow running at a speed corresponding to 30% slower than running and (d) running at 4 m · s−1 ± 10%. Five successful trials were recorded at each condition. Biomechanical measurements The speed was measured using photoelectric cells 2 m far apart from each other (Banner Engineering Corp., Minneapolis, MN, USA) placed just before and after the force plate. Kinematic data were collected at 240 Hz using an 8-camera 3D motion capture system (Motion Analysis Corp., Santa Rosa, CA, USA). Ground reaction forces were acquired at 1200 Hz using a 3D force plate (Kistler AG, Winterthur, Switzerland) in a 30-m walkway with data being acquired in the middle of the trail. To record 3D motion, a neutral standing trial was performed where retro-reflective markers were attached to the right foot (shoe), shank and thigh. Additionally, anatomical markers were attached on the medial and lateral malleolus, lateral epicondyle and patella centre, and greater trochanter to determine ankle, knee and hip joint centres. Full details on the data acquisition and processing used here are available in a former publication (Park, Stefanyshyn, Ramage, Hart, & Ronsky, 2009). The anatomical markers were then removed, and dynamic trials were collected. Repeatability in 3D lower extremity kinetic variables using external marker sets, including resultant moments in the transversal and frontal planes, is discussed in the literature (Ferrari et al., 2008; Leardini, Chiari, Della Croce, & Cappozzo, 2005). Data reduction Commercial software (EVaRT, Motion Analysis Corp., Santa Rosa, CA, USA) was used to track the target markers from each camera and create 3D position data. Tracked files were imported into KinTrak (Motion Analysis Corp., Santa Rosa, CA, USA) to calculate knee kinematic and kinetic output variables. A joint coordinate system (JCS) was created at each joint centre during a neutral trial. The JCS was created following the methods described in Cole, Nigg, Ronsky, and Yeadon (1993). Briefly, the JCS consists of three axes, with the first axis being defined as the hinge axis (flexion–extension axis) of the proximal segment, the second axis being defined

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Joint moments during walking and running as the long axis of the distal segment and the third axis being defined as the cross product of the hinge and long axis. Internal knee and ankle joint moments were calculated during the stance phase using an inverse dynamics approach as described elsewhere (Park et al., 2009). A forth-order Butterworth filter was used to low-pass filter both the kinematic (10 Hz cut-off) and kinetic data (50 Hz cut-off). The joint moment profiles were averaged for all participants, and peak values were identified for each plane of movement and each condition. The resultant nonsagittal joint moments were also computed (vector addition of frontal and transverse moments) for further comparison between sagittal and non-sagittal loads. All walking and running waveforms were normalised to 100% stance phase.

Table I. Speed (m · s−1) measured at comfortable walking, fast walking, slow running and running. Data are presented as mean ± standard deviation (s) and coefficient of variation (CV) (n = 11).

Statistical analysis

Results

Data normality was verified using Shapiro–Wilk test. Coefficient of variation was defined as the ratio between the standard deviation and mean. Oneway ANOVA with Tukey’s post hoc test was used to examine the differences in the peak joint moments between the four different speeds tested. Similar procedure was conducted to compare the different speeds. The significance level was set at α = 0.05 with 95% confidence interval. Cohen’s effects sizes were used to show a magnitude of difference in the comparisons and provide the reader with a more comprehensive picture of our findings. Statistical analysis was performed using a commercial statistic

All speeds were significantly differed between the conditions (Table I). Curve patterns for joint moments in the sagittal plane at different speeds were similar between comfortable walking and fast walking (Figures 1 and 2 for knee and ankle joint, respectively). A similar pattern was observed for slow running and running, but running differed from walking. Sagittal knee moment presented an extension peak at early stance and a flexion peak at late stance when walking; running presented predominantly extension moment during stance. The peaks in the sagittal and frontal plane were observed at similar percentage of stance,

Condition

Speed (mean ± s; m · s−1)

Comfortable walking Fast walking Slow running Running

1.61 2.09 2.90 4.07

± ± ± ±

0.11* 0.14* 0.09* 0.12*

CV (%) 6.83 6.70 3.10 2.95

Note: *Statistical significant different (P < 0.01) from all other conditions.

package (SPSS IL, USA).

Inc.,

version

13.0,

Chicago,

Figure 1. Curve patterns for resultant knee joint moments across the sagittal, frontal and transverse planes at different speed conditions (comfortable walking, fast walking, slow running and running). Data are presented as mean (continuous line) and respective standard deviation (dashed line) for each speed. Timing of the peak moment in the sagittal plane is identified by the dashed vertical line.


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Figure 2. Curve patterns for ankle joint moments across the sagittal, frontal and transverse planes at different speed conditions (comfortable walking, fast walking, slow running and running). Data are presented as mean (continuous line) and respective standard deviation (dashed line) for each speed. Timing of the peak moment in the sagittal plane is identified by the dashed vertical line.

except for the knee abduction moment, which had two peaks in fast walking. Peak knee external rotation moment occurred later in comfortable walking and fast walking than for running and slow running. The peak plantar flexion moment occurred later for walking than for running. While for running only one peak was observed for ankle inversion and knee abduction, comfortable and fast walking had two peaks. In the transverse plane, the ankle presented an adductor moment at early stance that changed to an abductor pattern after 40% of stance. For both running conditions, a predominant ankle adduction moment was observed with peaks occurring close to 40% of stance phase. Ankle plantar flexion moment had the highest magnitudes followed by knee

extension. During running, the peak plantar flexion and knee abduction moments increased by almost a factor of two when compared with comfortable walking, while peak knee extensor moment increased for running almost three times that of comfortable walking. Figure 3 illustrates the joint moment pattern in the sagittal plane compared to data obtained by vector addition of the frontal and transverse moments (non-sagittal plane moment). The knee joint during walking presented peak moments in the sagittal and non-sagittal planes at similar timing during stance. As speed increased, peaks occurred at different percentages of stance and were higher for the sagittal plane. For the ankle joint, moments in the sagittal

Figure 3. Curve patterns for joint moments across sagittal and non-sagittal planes (vector addiction of moments in the frontal and transverse planes) at different speed conditions (comfortable walking, fast walking, slow running and running). Joint moments are presented in the upper row for the knee and lower row for the ankle. The black line represents the data from the sagittal plane, and the grey line represents data from the non-sagittal plane. Data are presented as mean (continuous line) and respective standard deviation (dashed line).

Joint moments during walking and running

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Figure 4. Peak values for joint moments at the knee (flexion, extension, abduction and external rotation) and ankle (plantar flexion, inversion and abduction) in the four examined conditions (comfortable walking, fast walking, slow running and running). Data are presented as mean (bars) and standard deviation (vertical lines) for the group (n = 11). a – significantly different from comfortable walking (P < 0.05); b – significantly different from fast walking (P < 0.05); c – significantly different from slow running (P < 0.05); d – significantly different from running (P < 0.05).

plane were much higher for the entire stance phase with peak non-sagittal plane moments occurring at midstance. The joint moment peak values are depicted in Figure 4. Peak plantar flexion and knee abduction moments were significantly influenced by speed (P < 0.001 and P < 0.020, respectively). Peak knee extension and flexion moment significantly differed between walking and running as well as within walking speeds, but not within running speeds. Between running and slow running, only a statistical trend was observed for knee flexion moment (P = 0.060; d = 0.48; IC = −[−0.43;17.10]). Knee external rotation moment significantly differed between running and slow running (P = 0.001; d = 0.44; IC = [2.08;5.72]) and between fast and comfortable walking (P = 0.002; d = 0.44; IC = −[0.73;2.40]). Peak ankle inversion moment significantly differed between conditions, except between slow running and fast walking (P = 0.059; d = 0.71; IC = −[−0.28;12.93]). In the transverse plane, no significant differences at the ankle were observed when the speed increased from comfortable walking to fast walking (P = 0.058; d = 0.46; IC = [−0.64;3.12]) or from slow running to running (P > 0.05; d = −0.20; IC = [−1.61;6.12).

Discussion Running towards maximal speeds increases lower limb joint moments (Schache et al., 2011). An increase in peak knee joint moment during locomotion is related to injury risk (Woo et al., 2006). However, there is a lack of information concerning 3D joint moments during common exercise conditions, such as fast walking and slow running, which may provide insight into injury risk, fitness and rehabilitation programme planning or footwear design. Here, we quantified knee and ankle joint moments during walking and running at different speeds.

We found a general increase in joint load for sagittal and frontal planes as speed increased. In the transverse plane, the effects of speed were not clear. When comparing walking and running, our data indicated an increase for plantar flexion and ankle inversion, knee extension and knee abduction, while knee flexion and external rotation moments decrease. Schache et al. (2011) showed that running close to maximal speed increases joint moments mainly in the sagittal plane when compared to walking. When walking speed increases from comfortable walking to fast walking, all knee moments and plantar flexion moments increase. Landry et al. (2007) found greater knee moments in the sagittal, frontal and transverse planes when walking speed increased, whereas significant differences for knee abduction moment peaks were reported previously (Robbins & Maly, 2009). On the other hand, when speed increases about 30% from slow running to running, the knee abduction and external rotation moments increase as well as ankle plantar flexion and inversion moments. Running and walking mainly involve movements in the sagittal plane, and loads in other planes, frontal and transverse, are often related to injury risk (Stefanyshyn, Stergiou, Lun, Meeuwisse, & Worobets, 2006). For example, it is believed that greater external knee adduction moments correspond to increased loads on the medial compartment of the proximal tibia, consequently playing an important role for stress injuries (Hoch et al., 2005). Our data suggest that knee external rotation moments in fast walking were similar to running and slow running, suggesting that fast walking may elicit similar loading to that experienced when running. These findings could possibly be explained by the larger knee internal angle at push-off during fast walking and running. Additionally, Stief et al. (2008) also observed similar peak knee external rotation moments for comfortable walking compared with running.


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Timing is another important factor for mechanical loading. High knee moments were observed between 0% and 20% of the stance phase during walking. For running, joint moments were high throughout the stance phase, with peaks occurring at approximately 40% of stance. Running is distinguished from walking by the presence of a flight phase. During a running gait cycle, there are two periods of flight when neither foot is in contact with the ground. This results in decreased time in stance and an increased swing phase. In running, toe-off occurs close to 40% of the gait cycle (Novacheck, 1998), while for walking it happens around 60% of the gait cycle. The first half of the stance phase in running is mainly concerned with force absorption, whereas the second half is responsible for propulsion. During running, the knee is more flexed throughout the stance phase, thus requiring more internal muscular support to maintain stability through midstance. The higher ground reaction forces and greater amplitude of motion and shorter stance phase time result in higher joint moments for running than for walking with different timings. These timing differences could be relevant given that injury risk may rely on altered muscle length and poor impact absorption at touchdown and early stance (Kong, 2009). According to Robbins and Maly (2009), some researchers have suggested that decreasing gait speed will benefit patients with less-severe knee osteoarthritis by decreasing the knee abduction moment peak; however, these patients would be exposed to longer duration loads in the medial knee compartment. The results of this study clearly showed that speed changes affected joint loading in different ways considering different planes of motion, and we should be careful when prescribing walking as a strategy to reduce joint loads compared to running, especially when repeated loading is considered. Among the limitations of our study are the possible influences of variability of the self-selected speeds on the joint moment values. Data were not normalised to emphasise the absolute load experienced in the joint tissues. Even though we considered a sample size similar to those observed in former similar studies, considering a larger sample with runners with different levels of experience may provide additional information. Conclusion Although the differences tend to be more pronounced when gait changes from walking to running, the peak moments, in general, also increase significantly when speed increases from comfortable walking to fast walking and from slow running to running, mainly in the sagittal and frontal planes.

However, knee flexion moment was higher in walking than in running, and peak knee external rotation moment in fast walking was similar to running and higher than slow running. This result suggests that we have to be careful when recommending walking over running in an attempt to reduce knee joint loading depending on the characteristics of the participant or patient. Indeed, the different effects of speed increments during walking and running should be considered with regard to the prevention of injuries and for rehabilitation purposes.

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