The effect of trunk flexion angle on lower limb mechanics during running

Trunk flexion is an understudied biomechanical variable that potentially influences running performance and susceptibility to injury. We present and test a theoretical model relating trunk flexion angle to stride parameters, joint moments and ground reaction forces that have been implicated in repetitive stress injuries. Twenty-three participants (12 male, 11 female) ran at preferred trunk flexion and three more flexed trunk positions (moderate, intermediate and high) on a custom built Bertec™ instrumented treadmill while kinematic and kinetic data were simultaneously captured. Markers adhered to bony landmarks tracked the movement of the trunk and lower limb. Stride parameters, moments of force and ground reaction force were calculated using Visual 3D (C-Motion ©) software. From preferred to high trunk flexion, stride length decreased 6% (P < 0.001) and stride frequency increased 7% (P < 0.001). Extensor moments at the hip increased 70% (P < 0.001), but knee extensor (P < 0.001) and ankle plantarflexor moments (P < 0.001) decreased 22% and 14%, respectively. Greater trunk flexion increased rate of loading by 29% (P < 0.01) and vertical ground reaction force impact transients by 20% (P < 0.01). Trunk flexion angle during running has significant effects on stride kinematics, lower extremity joint moments and ground reaction force and should be further investigated in relation to running performance and repetitive stress injuries.     

GPS analysis of human locomotion: further evidence for long-range correlations in stride-to-stride fluctuations of gait parameters

During free walking, gait is automatically adjusted to provide optimal mechanical output and minimal energy expenditure; gait parameters, such as cadence, fluctuate from one stride to the next around average values. It was described that this fluctuation exhibited long-range correlations and fractal-like patterns. In addition, it was suggested that these long-range correlations disappeared if the participant followed the beep of metronome to regulate his or her pace. Until now, these fractal fluctuations were only observed for stride interval, because no technique existed to adequately analyze an extended time of free walking. The aim of the present study was to measure walking speed (WS), step frequency (SF) and step length (SL) with high accuracy (<1 cm) satellite positioning method (global positioning system or GPS) in order to detect long-range correlations in the stride-to-stride fluctuations. Eight participants walked 30 min under free and constrained (metronome) conditions. Under free walking conditions, DFA (detrended fluctuation analysis) and surrogate data tests showed that the fluctuation of WS, SL and SF exhibited a fractal pattern (i.e., scaling exponent alpha: 0.5 < alpha < 1) in a large majority of participants (7/8). Under constrained conditions (metronome), SF fluctuations became significantly anti-correlated (alpha < 0.5) in all participants. However, the scaling exponent of SL and WS was not modified. We conclude that, when the walking pace is controlled by an auditory signal, the feedback loop between the planned movement (at supraspinal level) and the sensory inputs induces a continual shifting of SF around the mean (persistent anti-correlation), but with no effect on the fluctuation dynamics of the other parameters (SL, WS).     

Effect of localized muscle fatigue on vertical ground reaction forces and ankle joint motion during running

The purpose of this study was to examine the changes in the vertical ground reaction force (VGRF) and ankle joint motion during the first 50% of the stance phase of running following fatiguing exercise of either the dorsiflexors or the invertors of the foot. VGRFs, sagittal and rearfoot kinematic data were collected from 11 female recreational runners running at 2.9 m/second on a treadmill prior to and following localized muscle fatigue of either the invertors or dorsiflexors of the right foot. Loading rate of the impact peak force significantly increased following fatiguing exercise of the dorsiflexors, while the peak magnitudes of the impact and push-off forces remained unchanged. There were significant decreases in dorsiflexion at heel contact, but no significant difference in any rearfoot motion parameters tested following dorsiflexor fatigue. Following fatiguing exercise of the invertors, impact peak magnitude, push-off peak magnitude and the rate of decline of the impact peak force significantly decreased; there was no change in the loading rate of the impact peak force. Invertor fatigue also resulted in a less inverted foot position at heel contact, but there were no significant differences in any other kinematic parameters tested. The results demonstrate that localized muscle fatigue of either the invertors or dorsiflexors can have a significant effect on the loading rates, peak magnitudes and ankle joint motion seen during running. These changes, due to localized muscle fatigue, may play a role in many common lower extremity running injuries.     

Focus of attention effects on lower extremity biomechanics during vertical jump landings

This study examined biomechanical differences between external and internal foci of attention during vertical jump landings in males and females. Twenty-four healthy adults performed eight vertical jump landings using both internal and external foci while three-dimensional kinematic and ground reaction force (GRF) data were obtained. Two (focus) by two (sex) analyses of variance (α = 0.05) and Cohen's d effect sizes (ES) were used to compare differences in vertical GRF, joint angular positions and displacements, and lower limb joint angular work between foci and between sexes. Significantly greater knee contributions to total angular work occurred during external versus internal focus landings regardless of sex (p = .013; ES = 0.30). Significantly smaller plantarflexion angles (p = .019; ES = 0.53) and significantly greater knee flexion angles were observed at ground contact (p < .001; ES = 1.11) in males during external focus landings. Females exhibited significantly smaller knee flexion angles at both ground contact during external versus internal focus landings (p = .031; ES = 0.20) and compared to males during external focus landings (p < .001; ES = 1.76). Both peak vertical GRF (p = .003; ES = 1.54) and the ankle contributions to total angular work during loading (p = .026; ES = 1.07) were greater in females versus males regardless of foci, whereas the knee contributions to total angular work during loading were smaller in women (p = .026; ES = 1.07). Males and females might consider adopting an external focus during vertical jump landings to increase knee joint contributions to lower limb energy absorption. Females, in particular, might consider external focus use to decrease peak vertical GRF and increase the knee joint's contribution to total energy absorption to magnitudes similar to those exhibited by males.     

Kinematic and ground reaction force accommodation during weighted walking

Weighted walking is a functional activity common in daily life and can influence risks for musculoskeletal loading, injury and falling. Much information exists about weighted walking during military, occupational and recreational tasks, but less is known about strategies used to accommodate to weight carriage typical in daily life. The purposes of the study were to examine the effects of weight carriage on kinematics and peak ground reaction force (GRF) during walking, and explore relationships between these variables. Twenty subjects walked on a treadmill while carrying 0, 44.5 and 89 N weights in front of the body. Peak GRF, sagittal plane joint/segment angular kinematics, stride length and center of mass (COM) vertical displacement were measured. Changes in peak GRF and displacement variables between weight conditions represented accommodation. Effects of weight carriage were tested using analysis of variance. Relationships between peak GRF and kinematic accommodation variables were examined using correlation and regression. Subjects were classified into sub-groups based on peak GRF responses and the correlation analysis was repeated. Weight carriage increased peak GRF by an amount greater than the weight carried, decreased stride length, increased vertical COM displacement, and resulted in a more extended and upright posture, with less hip and trunk displacement during weight acceptance. A GRF increase was associated with decreases in hip extension (|r| = .53, p = .020) and thigh anterior rotation (|r| = .57, p = .009) displacements, and an increase in foot anterior rotation displacement (|r| = .58, p = .008). Sub-group analysis revealed that greater GRF increases were associated with changes at multiple sites, while lesser GRF increases were associated with changes in foot and trunk displacement. Weight carriage affected walking kinematics and revealed different accommodation strategies that could have implications for loading and stability.     

Ankle kinetics and plantarflexor morphology in older runners with different lifetime running exposures

Running promotes better cardiovascular health and has positive effects on the musculoskeletal system in older adults. However, older adults have lower ankle plantarflexor torques and positive powers during running, and exhibit changes in plantarflexor morphology than young adults. Since older runners who run as much as younger runners exhibit youthful ankle mechanical outputs, running exposure may preserve the locomotor factors that mediate running speed. The purpose of this study was to compare ankle mechanical output during running and plantarflexor morphological characteristics between older runners who have low or high lifetime running exposure. Ten older runners with low lifetime running exposure and nine older runners with high lifetime running exposure performed over-ground running trials at 3.0 m/s (±5%) while kinematic and ground reaction force (GRF) data were collected and used to compute joint angular kinetics. Right medial gastrocnemius morphological characteristics were assessed using ultrasonography at rest and during isometric contractions. Ankle torques, powers, and plantarflexor morphology were compared between groups. Older runners with different lifetime running exposures ran with similar ankle mechanical output (i.e. no effect of running exposure) (p > .05) and exhibited similar medial gastrocnemius morphology during isometric testing. The findings from this study demonstrate that lifetime running exposure does not appear to influence ankle mechanical output or plantarflexor morphology in middle-aged runners.     

Variability of a “force signature” during windmill softball pitching and relationship between discrete force variables and pitch velocity

This study assessed reliability of discrete ground reaction force (GRF) variables over multiple pitching trials, investigated the relationships between discrete GRF variables and pitch velocity (PV) and assessed the variability of the “force signature” or continuous force-time curve during the pitching motion of windmill softball pitchers. Intraclass correlation coefficient (ICC) for all discrete variables was high (0.86–0.99) while the coefficient of variance (CV) was low (1.4–5.2%). Two discrete variables were significantly correlated to PV; second vertical peak force (r(5) = 0.81, p = 0.03) and time between peak forces (r(5) = −0.79; p = 0.03). High ICCs and low CVs support the reliability of discrete GRF and PV variables over multiple trials and significant correlations indicate there is a relationship between the ability to produce force and the timing of this force production with PV. The mean of all pitchers’ curve-average standard deviation of their continuous force-time curves demonstrated low variability (CV = 4.4%) indicating a repeatable and identifiable “force signature” pattern during this motion. As such, the continuous force-time curve in addition to discrete GRF variables should be examined in future research as a potential method to monitor or explain changes in pitching performance.     

Effect of Heel Heights on Female Postural Control During Standing on a Dynamic Support Surface With Sinusoidal Oscillations

The authors aimed to investigate female balance or stability control with comparative analysis of the center of pressure trajectory and plantar pressure distribution with different high-heeled shoes while standing on a dynamic surface with multidirectional perturbations. College females with at least 2 years' history of wearing high-heel shoes voluntarily participated in the test with a Novel Pedar insole (Novel, GmBH, Munich, Germany. With heels height increasing, the pressure time integral obviously transfer to the medial forefoot region, with center of pressure trajectory medially deviated significantly, either under anteroposterior or mediolateral perturbations. The passive plantarflexion position of ankle incurred by high heel increased the range of motion in the frontal plane but decreased ankle stability, thus increasing the challenge of body balance maintenance.     

Ground reaction force adaptations during cross-slope walking and running

Though transversely inclined (cross-sloped) surfaces are prevalent, our understanding of the biomechanical adaptations required for cross-slope locomotion is limited. The purpose of this study was to examine ground reaction forces (GRF) in cross-sloped and level walking and running. Nine young adult males walked and ran barefoot along an inclinable walkway in both level (0°) and cross-slope (10°) configurations. The magnitude and time of occurrence of selected features of the GRF were extracted from the force plate data. GRF data were collected in level walking and running (LW and LR), inclined walking and running up-slope (IWU and IRU), and down-slope (IWD and IRD), respectively. The GRF data were then analyzed using repeated measures MANOVA. In the anteroposterior direction, the timing of the peak force values differed across conditions during walking (p=.041), while the magnitude of forces were modified across conditions for running (p=.047). Most significant differences were observed in the mediolateral direction, where generally force values were up to 390% and 530% (p<.001) larger during the cross-slope conditions compared to level for walking and running, respectively. The maximum force peak during running occurred earlier at IRU compared to the other conditions (p≤.031). For the normal axis a significant difference was observed in the first maximum force peak during walking (p=.049). The findings of this study showed that compared to level surfaces, functional adaptations are required to maintain forward progression and dynamic stability in stance during cross-slope walking and running.     

Weighted vest effects on impact forces and joint work during vertical jump landings in men and women

Weighted vest (WV) use during vertical jump landings (VJL) does not appear to alter peak vertical ground reaction forces (GRF) or peak joint torques. However, WV effects on joint work and sex differences during VJL are not well understood. This study assessed WV effects on vertical GRF and sagittal joint work during VJL in men and women. Twelve men and 12 women performed VJL wearing a WV with zero added mass (unloaded) and with 10% body mass (loaded) while GRF and kinematic data were obtained. Mixed-model analyses of variance (α = 0.05) and effect sizes (ES) were used to assess differences between sexes and/or load conditions. Regardless of sex, greater landing height (p < 0.001; ES = 0.37) and peak vertical GRF (p = 0.001; ES 0.51) occurred when unloaded, while greater landing time (p = 0.001; ES = 0.46) and negative lower extremity work (p < 0.001; ES = 0.41) occurred when loaded through greater negative work about the hip (p = 0.001; ES = 0.27) and ankle (p = 0.020; ES = 0.27). No differences in hip (p = 0.753; ES = 0.03), knee (p = 0.588; ES = 0.07), or ankle (p = 0.580; ES = 0.09) joint displacement were detected between loaded and unloaded conditions. Men exhibited greater landing heights (p < 0.001; ES = 2.49) and greater peak vertical GRF than women (p = 0.007; ES = 1.18), though women exhibited greater negative lower extremity work (p < 0.001; ES = 1.98) than men through greater negative knee (p < 0.001; ES = 1.98) and ankle (p = 0.032; ES = 0.94) work. No sex differences were detected for joint angular displacement about the hip (p = 0.475; ES = 0.30), knee (p = 0.666; ES = 0.18), or ankle (p = 0.084; ES = 0.71). These data revealed a unique load accommodation strategy during VJL with a WV characterized by greater lower extremity joint work performed via increased joint torque despite lesser landing height and peak vertical GRF. Women appear to perform greater lower extremity joint work than men during VJL despite lesser landing height and peak vertical GRF. Current and prospective WV users should be aware of their load accommodation strategy during VJL with an external load. Women may consider developing more refined load accommodation strategies for VJL regardless of whether external loading is applied to avoid performing excessive amounts of lower extremity work.     

The effect of shoe and floor characteristics on walking kinematics

It is common sense that walking on sand poses challenges to postural control. However, there are no studies quantifying the kinematics of sand walking compared to other types of postural perturbations such as unstable shoes. The aim of the study was to investigate differences in walking kinematics during walking on solid ground, in unstable shoes and on unstable surfaces. Nineteen healthy young adults (23.5 ± 1.5 years) performed three different walking tasks: 1) walking at preferred speed while wearing regular shoes; 2) Walking at preferred speed wearing Masai Barefoot Technology shoes and 3) barefoot walking at preferred speed on a large sand grave. Full-body kinematics were recorded during all conditions using an inertial motion capture system. Basic gait parameters (walking speed, stride length and duration), relative vertical center-of-mass position (rvCOM), and ankle, knee and hip joint angles in the sagittal plane were compared across the tasks through statistical parametric mapping over the course of full walking cycles. Participants presented similar walking speed, as well as stride length and duration across different conditions (p > 0.05). However, walking on sand reduced the rvCOM (p < 0.05), while also requiring greater ankle plantarflexion during stance phase (p < 0.05), as well as greater knee and hip flexion during leg swing and initial contact when compared to the other conditions (p < 0.05). It was concluded that walking on sand substantially changes walking kinematics, and may cause greater postural instability than unstable shoes. Therefore, walking on sand can be an alternative to improve postural control in patients undergoing walking rehabilitation.     

Bilateral asymmetry of running gait in competitive,recreational and novice runners at different speeds

The mechanisms and underlying causes of bilateral asymmetry among healthy runners of different levels remain unclear. This cross-sectional laboratory study aimed to investigate the effects of running speed and running experience or competitive level on bilateral symmetry during running. Eleven competitive runners, 9 recreational runners and 11 novice runners were recruited in this study. They ran on an instrumented treadmill for 3 min at each of 5 fixed speeds (8, 9, 10, 11 and 12 km/h) in a randomized order. Bilateral asymmetry was evaluated and quantified using symmetry index (SI) of temporal and kinetic parameters. Overall, SI ranged between 0.8% for stride time and 21.4% for vertical average loading rate. Significant speed effects were observed on SI of flight time (p = .012), which was significantly higher at 8 km/h than that of the other 4 speeds (p = .023, 0.005, 0.023 and 0.028, respectively). Group-by-speed interactions were detected on SI in time to peak vertical ground reaction force (p = .032) and vertical average loading rate (p = .002). The competitive runners presented linear reduction in the SI with increasing speed from 8 to 12 km/h (R² > 0.94); for the recreational runners, SI changed nonlinearly and presented a roughly U-shaped trend across speeds (R² > 0.88); and for the novice runners, changes of SI across speed were inconsistent and dependent on parameters of interest (R² > 0.64). Bilateral asymmetry was affected by both running speed and runners' running experience or competitive level. The competitive runners were found to run with a more symmetrical manner with a greater running speed, the recreational runners demonstrated the most symmetrical pattern at the critical speed, whereas the novice runners showed inconsistent trends.     

A functional modulation for timing a movement: a coordinative structure in baseball hitting

In baseball hitting, a powerful bat-swing needs to be produced by utilizing ground reaction force (GRF) and it should also be temporally coordinated relative to the flight of the pitch. The temporal organization of hitting movements associated with these task requirements was investigated by analyzing GRF during hitting slow and fast pitches. The timing of stepping with a front foot and shifting weight forward was modulated relative to the pitch's speed. The temporal relation between successive motion phases was compensatory and timing variability progressively reduced up to ball-bat contact. These results demonstrated the coordinative structure of the hitting movement for timing the bat-swing relative to the pitch's flight.     

Characterization of statistical persistence in joint angle variation during walking

The objective of this study was to characterize joint angle variation across strides. Specifically, the statistical persistence of variations were quantified using the Hurst exponent. If a time series exhibits statistical persistence, then a parameter which is smaller (or larger) than average will tend to be followed by additional values that are also smaller (or larger) than average. Human walking has statistical persistence between stride durations. Variation in stride duration must arise from variation in the motion of the leg segments during walking. It is unclear, however, if the joint angle variation also exhibits statistical persistence. This study examined kinematic data collected from nine healthy adults walking for 10 min at a self-selected comfortable speed on a treadmill. The joint angle variation in the lower limbs was parameterized using first-order Fourier series which in turn were described by frequency and magnitude coefficients for each stride. To determine if the joint angle variation exhibited statistical persistence, the Hurst exponent was found for each coefficient at each joint. The mean Hurst exponents were 0.54 for the frequency coefficients and 0.61 for the magnitude coefficients. Neither the frequency or magnitude coefficients exhibited statistically significant persistence, although some of the magnitude coefficients were close to reaching statistical significance. This suggests that joint angle variability in healthy adults does not directly produce the statistical persistence observed in stride duration fluctuations.     

Leg and vertical stiffness (a)symmetry between dominant and non-dominant legs in young male runners

Biomechanical findings show that running is asymmetric in many kinetic properties. Running stiffness is a vital kinetic property of yet unknown pattern of lateralization. The aim of this study was to examine the degree and variability of lower limb dominance specific asymmetry of running in terms of leg stiffness, vertical stiffness, contact time, flight time, maximal ground reaction force during contact, vertical displacement of the center of mass, and change in leg length. Leg and vertical stiffness was estimated by the sine-wave method in 22 young males during treadmill running at 4.44 m/s. Lower limb dominance was determined by the triple-jump test. Asymmetry was expressed as dominant – non-dominant, and indexed by the absolute asymmetry index. Significant asymmetry was found only in flight time (3.98%) and in maximal ground reaction force (1.75%). The absolute asymmetry index ranged from 1.8% to 6.4%, showed high variation between subjects (0–31.6%), and differentiated among the 7 analyzed variables. Leg and vertical stiffness in treadmill running of moderate pace (4.44 m/s) should be considered symmetric.     

Evaluation of key points in the sit-to-stand movement using two force platforms

Three key points of the sit-to-stand (STS) movement were confirmed as aspects of the ground reaction force (GRF): the onset, maximum GRF, and seat-off. 46 healthy subjects (M age = 22.2 yr., SD = 4.4) participated. During the STS movement, two vertical force platforms were used to measure the resultant GRF, defined as the whole-body force, and its two components, the buttock and leg GRFs. The onsets of the component GRFs identified the sequence of the important time points in the STS movement more precisely than the onset of the resultant GRF. Data showed that the maximum whole-body GRF, the maximum GRF of both legs, and seat-off appeared in sequence and not simultaneously.     

Comparison of kinematic and kinetic methods for computing the vertical motion of the body center of mass during walking

The vertical excursion of the body center of mass (BCOM) was calculated using three different techniques commonly used by motion analysis laboratories. The sacral marker method involved estimating vertical BCOM motion by tracking the position of a reflective marker that was placed on the sacrum of subjects as they walked. The body segmental analysis technique determined the vertical motion of the BCOM from a weighted average of the vertical positions of the centers of mass of individual body segments for each frame of kinematic data acquired during the data trial. Anthropomorphic data from standard tables were used to determine the mass fractions and the locations of the centers of mass of each body segment. The third technique involved calculating BCOM vertical motion through double integration of force platform data. Data was acquired from 10 able-bodied, adult research subjects--5 males and 5 females--walking at speeds of 0.8, 1.2, 1.6, and 2.0 m/s. A repeated measures ANOVA indicated that at the slowest walking speed the vertical excursions calculated by all three techniques were similar, but at faster speeds the sacral marker significantly (p < 0.001) overestimated the vertical excursion of the BCOM compared with the other two methods. The body segmental analysis and force platform techniques were in agreement at all walking speeds. Discrepancies between the sacral marker method and the other two techniques were explained using a simple model; the reciprocal configuration of the legs during double support phase significantly raises the position of the BCOM within the trunk at longer step lengths, corresponding to faster walking speeds. The sacral marker method may provide a reasonable approximation of vertical BCOM motion at slow and freely selected speeds of able-bodied walking. However, the body segmental analysis or force platform techniques will probably yield better estimates at faster walking speeds or in persons with gait pathologies.     

Growth rates in running speed and vertical jumping by boys and girls ages 11-13

This study examined growth rates in running speed and vertical jump among middle school children. 45 boys and 31 girls ages 11-13 years were tested on running speed and vertical jump three times (September, February, and May) during the school year. Hierarchical linear modeling was used to estimate initial status and growth rates for the entire sample (base model) and the association of running and vertical jump with height, weight, and sex (conditional model). Positive overall growth rates were found for both running speed and vertical jump. Increased heightand weight at the time of measurement were not significantly associated with growth rate for running. The growth rate for vertical jump was positively associated with height but unrelated to increased weight. Boys showed steeper growth rates than girls in jumping. No sex differences were found in running speed for either initial status or in growth rate. Furthermore, these results suggest highly variable rates of physical maturation but no general period of 'adolescent awkwardness'.     

Kinematic assessment of treadmill running using different body-weight support harnesses

10 male collegiate runners (M age = 21.4, SD = 1.5 yr.) ran on a treadmill with no body-weight support (BWS), 20% BWS, and 40% BWS conditions. In addition, they wore three different commercially available harnesses at the 20% and 40% BWS conditions. The aim was to run on the treadmill at a fast speed while maintaining an adequate step length. The purpose was to investigate how each harness changed running gait, and the differences in running gait between the harnesses with various body-weight support. Analysis of variance indicated significant restriction of upper body torso rotation between the harnesses at the 40% BWS conditions. Body-weight support resulted in a longer stride, decreased cadence, less vertical displacement of the center of mass, and diminished hip and ankle joint excursions. These changes indicated that increased body-weight support results in longer steps with the foot contacting the belt for a shorter period of time with less leg angular changes throughout the running cycling.     

Lower limb tri-joint synchrony during running gait: A longitudinal age-based study

Biomechanical research exploring the age-based mechanics of running gait can provide valuable insight into the reported decline in master endurance running performance. However, few studies have shown consistent biomechanical differences in the gait of trained distance runners compared to their younger counterparts. It might be that differences occur in the interaction between joints. The aim was to explore the differences in tri-joint synchrony of the lower limb, quantified through cluster phase analysis, of runners at 50 years of age compared to seven years later. Cluster phase analysis was used to examine changes in synchrony between 3 joints of the lower limb during the stance phase of running. Ten male, endurance-trained athletes M50 (age = 53.54 ± 2.56 years, mass = 71.05 ± 7.92 kg) participated in the study and returned after seven years M57 (age = 60.49 ± 2.56 years, mass = 69.08 ± 8.23 kg). Lower limb kinematics (Vicon, 120 Hz) and ground reaction forces (Kistler, 1080 Hz) were collected as participants performed multiple trials at a horizontal running velocity = 3.83 ± 0.40 m·s⁻¹ over the force plate. Significant increase (31%) in rate of force development in the absorption phase, and significantly reduced sagittal plane knee joint range of motion (30.50 v 23.68°) were found following the seven years of ageing. No further discrete single joint measures were significantly different between M50 and M57. Joint synchrony between the hip, knee and ankle was significantly higher at M57 compared to M50 during the absorption phase of stance. The force attenuation strategy is compromised after seven years of ageing, which is associated with more synchronous movements in the lower limb joints. Increased joint synchrony as a function of age could be a mechanism associated with this key injury provoking phase of running gait.