Tibialis posterior muscle pain effects on hip,knee and ankle gait mechanics

BackgroundTibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects.MethodsTwelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale.FindingsDecreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation.InterpretationThe study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.     

Effects of gait pattern and arm swing on intergirdle coordination

Mature locomotion in humans is characterized by an anti-phase coordination (moving in opposite directions) between the pelvic and the scapular girdles. This pattern involves a specific relationship between the arm and leg motion is deemed to be most flexible and dynamically efficient. Still, when the arms are involved in another task, like a field player running with a ball in the hands, locomotion is still possible. In order to probe the flexibility of the locomotor synergy, the present study aimed to determine the persistence and the strength of the coordination patterns between the pelvic and scapular girdles when no arm swing was allowed during walking and running. Relative phase, the time difference between the girdle rotations, measured the ongoing inter-girdle coordination of eight healthy participants asked to walk and run with or without arm swing. Results showed that an absence of arm swing led to a change from an anti-phase to in-phase pattern (girdles moving in the same direction) and that an increase in velocity strengthened the adopted pattern. Moreover, the frequency distribution of relative phase for all gait patterns with arm swing proved to be bimodal, indicating that the prevailing anti-phase pattern was always mixed with a noticeable proportion of in-phase coordination. The presence of the in-phase pattern in the easy, natural locomotion with arm swing manifests its persistence and its stability, perhaps pertaining to its prevalence in earlier times in ontogeny or evolution.     

Contralateral pelvic drop during gait increases knee adduction moments of asymptomatic individuals

PurposeThe current study purpose was to investigate the effects of contralateral pelvic drop gait on the magnitude of the knee adduction moment (KAM) within asymptomatic individuals.Methods15 participants walked on a dual belt instrumented treadmill while segment motions and ground reaction forces were recorded. Participants completed typical gait trials and pelvic drop gait trials. The net external KAM was calculated using inverse dynamics. Peak and impulse were identified. Frontal plane hip abduction/adduction and pelvic drop were determined. Correlations and paired t-tests were used for statistical hypothesis testing (alpha = 0.05).ResultsPeak hip adduction angle reached 4° (±6°) during pelvic drop trials compared to 0° (±6°) in the typical gait trials (p < 0.05) equating to 4° of pelvic drop. KAM impulse was higher in the pelvic drop trial (0.16 Nm s/kg ± 0.04) compared to the typical gait trial (0.13 Nm s/kg ± 0.05) (p < 0.001). Peak KAM was higher in the pelvic drop trial (0.55 Nm/kg ± 0.15) compared to the typical gait trial (0.40 Nm/kg ± 0.109) (p < 0.001). Correlations between change in KAM and change in hip adduction moment and pelvic drop were r > 0.80 (p < 0.001).ConclusionPelvic drop gait increased KAM peak and impulse. Results have implications for understanding relationships between frontal plane hip movement and the knee adduction moment during gait.     

Self-reported walking difficulty and knee osteoarthritis influences limb dynamics and muscle co-contraction during gait

Knee osteoarthritis (OA) gait is characterized by simultaneous flexor and extensor use, or co-contraction. Co-contraction can stabilize and redirect joint forces. However, co-contraction can push and pull on the femur and tibia that exacerbate OA symptoms and make walking difficult. Such movements are quantifiable by limb dynamics (i.e., linear acceleration and jerk); thus, this study examines limb dynamics and its relationship with co-contraction and OA related walking difficulty.Three groups of age-and-sex-matched subjects with and without OA and walking difficulty (N = 13 per group) walked with electromyography (EMG) on the knee extensors and flexors and inertial measurement units (IMUs) at the femur and tibia. We calculated co-contraction from antagonistic EMG signals and linear acceleration and its derivative jerk from IMUs. We determined group differences using one-way ANOVAs, nonparametric equivalence, and effect sizes, and main and interaction effects of walking difficulty with regression modeling.Medium effect sizes and differences for femoral acceleration (d = 0.64; P = .02) and jerk (d = 0.51; P = .01) were observed between with and without knee OA. Medium to large effect sizes (r = 0.33 to 0.51 and d = 0.81 to 0.97) and differences (P = .01 to 0.05) for tibial acceleration and jerk were obsevered between with and without walking difficulty. Walking difficulty moderated the relationship between tibial jerk and co-contraction (p < .05).Tibial jerk differences were observed based on walking difficulty. The significant interaction effect suggested that walking difficulty explained the relationship between limb dynamics and co-contraction. Perhaps co-contraction levels used by those with knee OA and no walking difficulty are optimal as compared to those with walking difficulty.     

The relationship between hip,knee and ankle muscle mechanical characteristics and gait transition speed

The purpose of the present study was to explore the relationship between mechanical characteristics of hip, knee and ankle extensor and flexor muscle groups and gait transition speed. The sample included 29 physically active male adults homogenized regarding their anthropometric dimensions. Isokinetic and isometric leg muscle mechanical characteristics were assessed by an isokinetic dynamometer, while individual walk-to-run (WRT) and run-to-walk transition speeds (RWT) were determined using the standard increment protocol. The relationship between transition speeds and mechanical variables scaled to body size was determined using Pearson correlation and stepwise linear regression. The highest correlations were found for isokinetic power of ankle dorsal flexors and WRT (r = .468, p < .01) and the power of hip extensors and RWT (r = .442, p < .05). These variables were also the best predictors of WRT and RWT revealing approximately 20% of explained variance. Under the isometric conditions, the maximal force and rate of force development of hip flexors and ankle plantar flexors were moderately related with WRT and RWT (ranged from r = .340 to .427). The only knee muscle mechanical variable that correlated with WRT was low velocity knee flexor torque (r = .366, p < .05). The results generally suggest that the muscle mechanical properties, such as the power of ankle dorsal flexors and hip extensors, influence values of WRT and RWT.     

Effects of boundary height and horizontal size within boundary on perceived enclosure

The permeability theory of environmental design predicts that perceived enclosure will be more strongly related to boundary properties such as height as opposed to the size of a horizontal area within a boundary. An experiment on perceived enclosure, provided by 24 participants on 12 spaces in a park, indicated that enclosure correlated at .85 with boundary height and -.60 with horizontal area. These results were as predicted by permeability theory.     

Effects of stimulus complexity on mental rotation rate of polygons

Both spatial and propositional theories of imagery predict that the rate at which mental images can be rotated is slower the more complex the stimulus. Four experiments (three published and one unpublished) testing that hypothesis found no effect of complexity on rotation rate. It is argued that despite continued methodological improvements, subjects in the conditions of greater complexity may have found it sufficient to rotate only partial images, thereby vitiating the prediction. The two experiments reported here are based on the idea of making the discriminative response sufficiently difficult so as to force the rotation of complete images. The first one scaled the similarity between standard polygons and certain systematically mutated versions. From the ratings so obtained, two levels of perceived similarity, high and low, were defined and served as separate conditions in a response-time, image rotation experiment. The second experiment tested the complexity hypothesis by examining the effect of similarity on rotation rates and its interaction with levels of complexity. The results support the complexity hypothesis, but only for the highly similar stimuli. Rotation times were also generally slower for high as compared with low similarity. It is argued that these results arise because subjects rotate incomplete images when the stimuli are not very similar.     

Influence of restricted vision and knee joint range of motion on gait properties during level walking and stair ascent and descent

Because elderly individuals experience marked declines in various physical functions (e.g., vision, joint function) simultaneously, it is difficult to clarify the individual effects of these functional declines on walking. However, by imposing vision and joint function restrictions on young men, the effects of these functional declines on walking can be clarified. The authors aimed to determine the effect of restricted vision and range of motion (ROM) of the knee joint on gait properties while walking and ascending or descending stairs. Fifteen healthy young adults performed level walking and stair ascent and descent during control, vision restriction, and knee joint ROM restriction conditions. During level walking, walking speed and step width decreased, and double support time increased significantly with vision and knee joint ROM restrictions. Stance time, step width, and walking angle increased only with knee joint ROM restriction. Stance time, swing time, and double support time were significantly longer in level walking, stair descent, and stair ascent, in that order. The effects of vision and knee joint ROM restrictions were significantly larger than the control conditions. In conclusion, vision and knee joint ROM restrictions affect gait during level walking and stair ascent and descent. This effect is marked in stair ascent with knee joint ROM restriction.     

Effects of visual focus and gait speed on walking balance in the frontal plane

We investigated how head position and gait speed influenced frontal plane balance responses to external perturbations during gait. Thirteen healthy participants walked on a treadmill at three different gait speeds. Visual conditions included either focus downward on lower extremities and walking surface only or focus forward on a stationary scene with horizontal and vertical lines. The treadmill was positioned on a platform that was stationary (non-perturbed) or moving in a pattern that appeared random to the subjects (perturbed). In non-perturbed walking, medial–lateral upper body motion was very similar between visual conditions. However, in perturbed walking, there was significantly less body motion when focus was on the stationary visual scene, suggesting visual feedback of stationary vertical and horizontal cues are particularly important when balance is challenged. Sensitivity of body motion to perturbations was significantly decreased by increasing gait speed, suggesting that faster walking was less sensitive to frontal plane perturbations. Finally, our use of external perturbations supported the idea that certain differences in balance control mechanisms can only be detected in more challenging situations, which is an important consideration for approaches to investigating sensory contribution to balance during gait.     

A note on modulation of gait in man: Effects of constraining stride length and frequency

In this study, our aim was to investigate the effect of an imposed stride-length on walking speed and stride-frequency, and the effect of an imposed stride-frequency on walking speed and stride-length. These variations were determined in relation to the values obtained by analysing the subject's preferred pace. In the first case, the subject had to step on transversal stripes on the floor; in the second case, he had to synchronize his stride with a regular auditory signal. The results obtained with 8 subjects show that speed was the most variable factor. Variations in speed were correlated with variations in the imposed parameter: whenever the subject lengthened his stride or increased his stride-frequency, his walking speed increased proportionally. These results point to a relative independence between stride-length and stride-frequency, and a strong correlation between each of these parameters and speed.     

Effects of the axis of rotation and primordially solicited limb of high level athletes in a mental rotation task

A recent set of studies has investigated the selective effects of particular physical activities that require full-body rotations, such as gymnastics and wrestling (Moreau, Clerc, Mansy-Dannay, & Guerrien, 2012; Steggemann, Engbert, & Weigelt, 2011), and demonstrated that practicing these activities imparts a clear advantage in in-plane body rotation performance. Other athletes, such as handball and soccer players, whose activities do require body rotations may have more experience with in-depth rotations. The present study examined the effect of two components that are differently solicited in sport practices on the mental rotation ability: the rotation axis (in-plane, in-depth) and the predominantly used limb (arms, legs). Handball players, soccer players, and gymnasts were asked to rotate handball and soccer strike images mentally, which were presented in different in-plane and in-depth orientations. The results revealed that handball and soccer players performed the in-depth rotations faster than in-plane rotations; however, the two rotation axes did not differ in gymnasts. In addition, soccer players performed the mental rotations of handball strike images slower. Our findings suggest that the development of mental rotation tasks that involve the major components of a physical activity allows and is necessary for specifying the links between this activity and the mental rotation performance.     

Contribution of ankle, knee, and hip joints to the perception threshold for support surface rotation

The purpose of the present experiment was to investigate the extent to which subjects can perceive, at very slow velocities, an angular rotation of the support surface about the medio-lateral axis of the ankle, knee, hip, or neck joint when visual cues are not available. Subjects were passively displaced on a slowly rotating platform at .01, .03, and .05 deg/sec. The subjects’ task was to detect movements of the platform in four different postural conditions allowing body oscillations about the ankle, knee, hip, or neck joint. In Experiment 1, subjects had to detect backward and forward rotation (pitching). In Experiment 2, they had to detect left and right rotations of the platform (rolling). In Experiment 3, subjects had to detect both backward/forward and left/right rotations of the platform, with the body fixed and the head either fixed or free to move. Overall, when the body was free to oscillate about the ankle, knee, or hip joints, a similar threshold for movement perception was observed. This threshold was lower for rolling than for pitching. Interestingly, in these postural conditions, an unconscious compensation in the direction opposite to the platform rotation was observed on most trials. The threshold for movement perception was much higher when the head was the only segment free to oscillate about the neck joint. These results suggest that, in static conditions, the otoliths are poor detectors of the direction of gravity forces. They also suggest that accurate perception of body orientation is improved when proprioceptive information can be dynamically integrated.     

Effects of auditory feedback on gait behavior,gaze patterns and outcome performance in long jumping

In the current study, we conducted two experiments to investigate the impact of concurrent, action-induced auditory feedback on gait patterns, gaze behavior and outcome performance in long jumping. In Experiment 1, we examined the effects of present vs. absent auditory feedback on gait, gaze and performance outcome measures. Results revealed a significant interaction effect between condition (present vs. absent auditory feedback) and phase (acceleration vs. zeroing-in phase) on participants' step lengths indicating that the absence (rather than the presence) of auditory feedback led to facilitatory effects in terms of a more prototypical gait pattern (i.e., shorter steps in the acceleration phase and longer steps in the zeroing-in phase). Similarly, the absent auditory feedback led to a higher gaze stability in terms of less switches between areas of interest (AOIs). However, there was no effect on jumped distance. In Experiment 2, we scrutinized the influence of concurrent vs. delayed auditory feedback on all three performance parameters. In contrast to concurrent feedback, delayed auditory feedback negatively affected all three measures: participants showed (i) dysfunctional deviations from their prototypical gait pattern (i.e., shorter steps across both phases of the run-up), (ii) less stable, maladaptive gaze patterns (i.e., more switches between AOIs) and (iii) poorer jumping performance (i.e., shorter jumped distances). Together, the two experiments provide clear evidence for the impact of concurrent, action-induced auditory feedback on the coordination of complex, rhythmical motor tasks such as the long jump.     

Effects of plane rotation,task, and complexity on recognition of familiar and chimeric objects

We examined the effects of plane rotation, task, and visual complexity on the recognition of familiar and chimeric objects. The effects of rotation, with response times increasing linearly and monotonically with rotation from the upright, were equivalent for tasks requiring different degrees of visual differentiation of the target from contrasting stimuli--namely, (1) deciding whether the stimulus was living or nonliving (semantic classification), (2) deciding whether the stimulus was an object or a nonobject (object decision), and (3) naming. The effects of complexity, with shorter response times to more complex stimuli, were most apparent in semantic classification and object decision and were additive with the effects of rotation. We discuss the implications of these results for theories of the relationship between the process of normalization and the determining of object identity.     

Effects of foot progression angle adjustment on external knee adduction moment and knee adduction angular impulse during stair ascent and descent

Foot progression angle adjustment was shown to reduce external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) during level ground walking. However, evidence on effects of foot progression angle adjustment on the above surrogate measures of medial knee loading during stair climbing is limited. Hence, this study examined the effects of toe-in and toe-out gait on EKAM and KAAI during stair ascent and descent. Kinematic and kinetic data were collected from thirty-two healthy adults during stair ascent and descent with toe-in, toe-out and natural gait. A repeated measures ANOVA indicated that toe-in gait significantly reduced the first EKAM peak (P < 0.001) and KAAI (P = 0.002), while toe-out gait significantly increased the first (P < 0.001) and second (P = 0.04) EKAM peaks and KAAI (P < 0.001) when compared with natural gait during stair ascent. During stair descent, toe-in gait significantly reduced the first (P < 0.001) and second (P = 0.032) EKAM peaks and KAAI (P < 0.001), whilst toe-out gait significantly increased the first EKAM peak (P = 0.022) and KAAI (P = 0.028) when compared with natural gait. In conclusion, toe-in gait was found to be a viable strategy in reducing medial knee loading during stair climbing.     

Effects of circular motion on judgment of rotation direction and depth order in visual motion

Abstract:  The rotation direction and depth order of a rotating sphere consisting of random dots often reverses while it is viewed under orthographic projection. However, if a short viewing distance is simulated under perspective projection, the correct rotation direction can be perceived. There are two motion cues for the rotation direction and depth order. One is the speed cue; points with higher velocities are closer to the observer. The other is the vertical motion cue; vertical motion is induced when the dots recede from or approach the observer. It was examined whether circular motion, which does not have any depth information but induces vertical velocities, masks the vertical motion cue. In Experiment 1, the effects of circular motion on the judgment of the rotation direction of a rotating sphere were examined. The magnitude of the two cues (the speed cue and the vertical velocity cue) as well as the angular speed of circular motion was varied. It was found that the performance improved as the vertical velocity increased and that the speed cue had slight effects on the judgment of the rotation direction. It was also found that the performance worsened as the angular speed of the circular motion was increased. In Experiment 2, the effects of circular motion on depth judgment of a rotating half sphere were investigated. The performance worsened as the angular speed of the circular motion increased, as in Experiment 1. These results suggest that the visual system cannot compensate perfectly for circular motion for the judgment of the rotation direction and depth order.     

Classification of gait muscle activation patterns according to knee injury history using a support vector machine approach

Abnormal muscle activation patterns during gait following knee injury that persist past the acute injury and rehabilitation phase (>three years) are not well characterized but may be related to post-traumatic knee osteoarthritis. The aim was to characterize the abnormal muscle activity from electromyograms of five leg muscles that were recorded during treadmill walking for young adults with and without a previous knee injury 3–12 years prior. The wavelet transformed and amplitude normalized electromyograms yielded intensity patterns that reflect the muscle activity of these muscles resolved in time and frequency. Patterns belonging to the affected or unaffected leg in previously injured participants and patterns belonging to a previously injured vs. uninjured participant were grouped and then classified using a principal component analysis followed by a support vector machine. A leave-one-out cross-validation was used to test the model significance and generalization. The results showed that trained classifiers could successfully recognize whether muscle activation patterns belonged to the affected or unaffected leg of previously injured individuals. Classification rates of 83% were obtained for all subjects, 100% for females only, indicating sex-specific knee injury effects. In contrast, it was not possible to discriminate between patterns belonging to the previously injured legs or dominant legs of control subjects. For females, the injured leg showed a stronger muscle activity for hamstring muscles and a lower activity for the vastus lateralis. In conclusion, systematic knee injury effects on the neuromuscular control of the knee during gait were present 3–12 years later.     

Contribution of ankle, knee, and hip joints to the perception threshold for support surface rotation.

The purpose of the present experiment was to investigate the extent to which subjects can perceive, at very slow velocities, an angular rotation of the support surface about the medio-lateral axis of the ankle, knee, hip, or neck joint when visual cues are not available. Subjects were passively displaced on a slowly rotating platform at .01, .03, and .05 deg/sec. The subjects' task was to detect movements of the platform in four different postural conditions allowing body oscillations about the ankle, knee, hip, or neck joint. In Experiment 1, subjects had to detect backward and forward rotation (pitching). In Experiment 2, they had to detect left and right rotations of the platform (rolling). In Experiment 3, subjects had to detect both backward/forward and left/right rotations of the platform, with the body fixed and the head either fixed or free to move. Overall, when the body was free to oscillate about the ankle, knee, or hip joints, a similar threshold for movement perception was observed. This threshold was lower for rolling than for pitching. Interestingly, in these postural conditions, an unconscious compensation in the direction opposite to the platform rotation was observed on most trials. The threshold for movement perception was much higher when the head was the only segment free to oscillate about the neck joint. These results suggest that, in static conditions, the otoliths are poor detectors of the direction of gravity forces. They also suggest that accurate perception of body orientation is improved when proprioceptive information can be dynamically integrated.     

Effects of electromyostimulation on knee extensors and flexors strength and steadiness in older adults

It is known that electromyostimulation (EMS) alone or superimposed over voluntary contraction (EV) can effectively improve muscle strength. However, the effect of this type of training on the ability to control force production at submaximal levels is unknown. The authors examined the effects of EV training on steadiness in force production of knee extensors and flexors in older adults. Forty participants, including 20 men and 20 women, 60-77 years of age, were randomly allocated into a control group (CG) and an electromyostimulation superimposed over voluntary contraction (EVG) group. The EVG performed 30 bilateral isometric knee extension and flexion contractions per session, 3 training sessions per week, for 6 weeks. The variations in force production, expressed in absolute (standard deviation [SD]) and relative (coefficient of variation [CV]) terms, were assessed in isometric contractions at 5%, 15% and 25% maximal voluntary contraction (MVC) levels. Results indicated that MVC increased in knee extension and flexion in EVG (p < .05) after the training; steadiness CV also improved at 15% MVC in knee flexion (p < .05) but no significant changes were found in knee extension and steadiness SD. The training-induced changes in MVC were not correlated to steadiness CV that might indicate different mechanisms underlying these adaptations.