Patellofemoral joint and Achilles tendon loads during Treadmill - PowerPoint PPT Presentation

Patellofemoral joint and Achilles tendon loads during Treadmill and Overground Running Willy et al., JOSPT , 2016 Richard Willy, PhD, PT Assistant Professor Motion Analysis Laboratory Physical Therapy University of Montana The presenter has no financial relationships or product endorsements to disclose Movement Science Laboratory

The presenter has no financial relationships or product endorsements to disclose Movement Science Laboratory

Where do runners get injured? Taunton 2002, Callahan 2000, Matheson 1987, Lopes 2012 Iliotibial band syndrome Patellofemoral pain 1.9-10% 48.8% of knee injuries Taunton 2002 Female: 62% Male: 38% Up to 58%: recurring symptoms Lankhorst 2016 Tibial stress injuries Achilles tendinopathy Bennell and Brukner, 2005 9.1-10.9% Female: 42% Male: 58% Up to 45% fail treatment Sayana 2007 Movement Science Laboratory

Cumulative loads Rate of Peak loads loading Willy and Meira, IJSP T, 2016 Movement Science Laboratory

Background Overground vs. treadmill running Reported differences with overground running: Temporospatial metrics 1-5% Shorter step length Elliott and Blanksby 1976, Riley 2007 Slightly flatter footstrike Nigg 1997 Knee flexion also less Riley 2007 Movement Science Laboratory

Purpose Assess Patellofemoral & Achilles tendon loading patterns during overground vs. treadmill running: Hypotheses Hypothesis 1: Peak & loading rate of Patellofemoral joint loading would be less during treadmill running Hypothesis 2: Peak & loading rate of Achilles tendon loading would be greater during treadmill running Hypothesis 3: Cumulative loads (Load per km) greater during treadmill running Movement Science Laboratory

Participants Demographics for Participants n=18 Characteristics Value Age (yrs) 23.6 ±3.5 BMI (kg/m²) 22.2 ±2.6 Self-paced running velocity (m/s) 2.9 ±0.3 Running volume (km/wk) 36.7 ±26.5 Tegner Score (0-10) 6.9 ±0.6 Treadmill comfort (0-10) 9.6 ±0.5 Movement Science Laboratory

Methods 55 retroreflective markers Self-paced-3D-running mechanics were sampled during TM and OG running (Qualisys, Gothenburg, SWE) : • Treadmill (Bertec, Worthington, OH) • Overground speed monitored via velocity of sacral marker Processed via MotionMonitor software (Innovative Sports, Chicago, Ill.) Movement Science Laboratory

Estimation of PFJ & Achilles tendon loads DeVita & Hortobagyi 2001, Willson 2015, Willy 2017 Muscle forces: Quadriceps, hamstring and PFJ and gastrocnemius Achilles DeVita & Hortobagyi 2001 tendon Ward 2009 Nemeth & Ohlsen 1985, loads Klein 1996, Devita & Herzog & Read 1993 Hortobagyi 2001 Van Eijden 1987, Kinematics Spoor & van Leeuwen and 1992, Van Eijden 1987 Werkhoven and Piazza 2017 kinetics Willson et al., 2015 Besier et al., 2005 Peak & impulse knee contact forces within 3%, 7% of in vivo forces Fregly 2012 Movement Science Laboratory

Data Reduction and Analysis Temporospatial data Distribution of total support moment: hip, knee, ankle PFJ and Achilles tendon Peak Variables of interest: Peak force Loading rate Impulse Loads per km • Impulse x steps per km Paired t- test α = 0.05, Effect sizes (Cohen’s d) Pearson’s r Movement Science Laboratory

Results: Temporospatial data Effect TM OG T-test Size Correlation 2.88 (0.26) 2.89 (0.27) p= 0.50 d= -0.04 r=0.97 Gait Speed (m/sec) Stance Length 273.1 (30.6) 277.3 (26.1) P= 0.23 d= -0.15 r=0.88 (msec) 1.04 (0.10) 1.10 (0.12) p<0.001 d= -0.62 r=0.86 Step Length (m) 23 additional loading cycles per 1 km of TM running Movement Science Laboratory

Results: Ground reaction forces (+) propulsive (-) braking Movement Science Laboratory

Results: Support moment Treadmill vs. Overground running Distribution of the respective proportions of the total support moment (x/100). Mean (sd). Movement Science Laboratory

Patellofemoral joint stress Peak PFJ stress Variable P-value Effect size Pearson’s r Peak PFJ loads 0.73 0.04 0.86 Loading rate of PFJ 0.11 -0.55 0.39 Cumulative PFJ loads per 1-km 0.21 0.21 0.88 Movement Science Laboratory

Achilles tendon loads Peak Achilles load ** Loading rate ** Variable P-value Effect size Pearson’s r Peak Achilles tendon load <0.001 1.01 0.52 Loading rate of Achilles tendon <0.001 0.61 0.62 Cumulative Achilles loads per 1-km <0.001 1.04 0.39 Movement Science Laboratory

Discussion: Summary of Findings Peak Loads Loading Rate Cumulative Load PFJ No difference No difference No difference Achilles 12% greater 15.8% greater 14.2% greater Peak loads vs. loading rate vs. cumulative loads: unknown which is most important in injury process Chen 1999 Patellofemoral joint stress Uninjured runners Return to running: Use preference and safety as guide Strong relationships (r>0.80): support treadmill investigations Movement Science Laboratory

Discussion: Achilles tendon loads Return to sport programs include running Silbernagel and Crossley 2015 Overground running may be desirable due to lower Achilles tendon loads Masters runners: most at-risk for Achilles tendinopathy McKean et al. 2007 Some caution applying AT data from instrumented treadmills to overground www.simplepayday.co.uk running Movement Science Laboratory

In-field gait assessment: wearables Willy, IJSPT 2018 Enables testing of training pace, training habits, running surfaces Movement Science Laboratory

Limitations and future directions Only examined healthy, young population Used research grade treadmill Overground runway distance short (25m) Future study: does treadmill running increase injury risk in masters athletes? Compare hip contact forces between running modes Conclusion Slightly lower hip extensor support moment: Treadmill Slightly higher Achilles tendon loads: Treadmill No differences found at patellofemoral joint Movement Science Laboratory

References 1. Besier TF, Draper CE, Gold GE, Beaupre GS, Delp SL. Patellofemoral joint contact area increases with knee flexion and weight-bearing. Journal of Orthopaedic Research. 2005;23:345-350. 2. Chen CT, Burton-Wurster N, Lust G, Bank RA, Tekoppele JM. Compositional and metabolic changes in damaged cartilage are peak-stress, stress-rate, and loading-duration dependent. J Orthop Res. 1999;17:870-879. 3. DeVita P, Hortobagyi T. Functional knee brace alters predicted knee muscle and joint forces in people with ACL reconstruction during walking. Journal of applied biomechanics. 2001;17:297-311. 4. Elliott BC, Blanksby BA. A cinematographic analysis of overground and treadmill running by males and females. Med Sci Sports. 1976;8:84-87. 5. Fregly BJ, Besier TF, Lloyd DG, et al. Grand challenge competition to predict in vivo knee loads. J Orthop Res. 2012;30:503- 513. 6. Herzog W, Read LJ. Lines of action and moment arms of the major force-carrying structures crossing the human knee joint. J Anat. 1993;182 ( Pt 2):213-230. 7. Klein P, Mattys S, Rooze M. Moment arm length variations of selected muscles acting on talocrural and subtalar joints during movement: an in vitro study. J Biomech. 1996;29:21-30. 8. Nemeth G, Ohlsen H. In vivo moment arm lengths for hip extensor muscles at different angles of hip flexion. J Biomech. 1985;18:129-140. 9. Nigg BM, De Boer RW, Fisher V. A kinematic comparison of overground and treadmill running. Med Sci Sports Exerc. 1995;27:98-105. 10. Riley PO, Dicharry J, Franz J, Della Croce U, Wilder RP, Kerrigan DC. A kinematics and kinetic comparison of overground and treadmill running. Med Sci Sports Exerc. 2008;40:1093-1100. 11. Spoor CW, van Leeuwen JL. Knee muscle moment arms from MRI and from tendon travel. J Biomech. 1992;25:201-206. 12. Spoor CW, van Leeuwen JL, Meskers CG, Titulaer AF, Huson A. Estimation of instantaneous moment arms of lower-leg muscles. J Biomech. 1990;23:1247-1259. 13. Ward SR, Eng CM, Smallwood LH, Lieber RL. Are current measurements of lower extremity muscle architecture accurate? Clin Orthop Relat Res. 2009;467:1074-1082. 14. Willson JD, Loss JR, Willy RW, Meardon SA. Sex differences in running mechanics and patellofemoral joint kinetics following an exhaustive run. J Biomech. 2015;48:4155-4159. 15. Willy RW, Meira EP. Current Concepts in Biomechanical Interventions for Patellofemoral Pain. Int J Sports Phys Ther. 2016;11:877-890. Movement Science Laboratory

Acknowledgements OSET Organizing Committee Collaborators: John Willson, PT, PHD; Stacey Meardon, PT, PhD; Paul DeVita, PhD, Ryan Mizner, PT, PhD, Christian Barton, PT, PhD Rich.willy@umontana.edu @rwilly2003 Movement Science Laboratory