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Journal ArticleDOI

Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers.

TL;DR: FFS exhibit both lower patellofemoral stress and knee frontal plane moment than RFS, which may reduce the risk of running-related knee injuries, and parallel increase in ankle plantarflexor and Achilles tendon loading may increase risk for ankle and foot injuries.
Abstract: AB Purpose: Knee pain and Achilles tendinopathies are the most common complaints among runners. The differences in the running mechanics may play an important role in the pathogenesis of lower limb overuse injuries. However, the effect of a runner's foot strike pattern on the ankle and especially on the knee loading is poorly understood. The purpose of this study was to examine whether runners using a forefoot strike pattern exhibit a different lower limb loading profile than runners who use rearfoot strike pattern. Methods: Nineteen female athletes with a natural forefoot strike (FFS) pattern and pair-matched women with rearfoot strike (RFS) pattern (n = 19) underwent 3-D running analysis at 4 m[middle dot]s-1. Joint angles and moments, patellofemoral contact force and stresses, and Achilles tendon forces were analyzed and compared between groups. Results: FFS demonstrated lower patellofemoral contact force and stress compared with heel strikers (4.3 +/- 1.2 vs 5.1 +/- 1.1 body weight, P = 0.029, and 11.1 +/- 2.9 vs 13.0 +/- 2.8 MPa, P = 0.04). In addition, knee frontal plane moment was lower in the FFS compared with heel strikers (1.49 +/- 0.51 vs 1.97 +/- 0.66 N[middle dot]m[middle dot]kg-1, P =0.015). At the ankle level, FFS showed higher plantarflexor moment (3.12 +/- 0.40 vs 2.54 +/- 0.37 N[middle dot]m[middle dot]kg-1; P = 0.001) and Achilles tendon force (6.3 +/- 0.8 vs 5.1 +/- 1.3 body weight; P = 0.002) compared with RFS. Conclusions: To our knowledge, this is the first study that shows differences in patellofemoral loading and knee frontal plane moment between FFS and RFS. FFS exhibit both lower patellofemoral stress and knee frontal plane moment than RFS, which may reduce the risk of running-related knee injuries. On the other hand, parallel increase in ankle plantarflexor and Achilles tendon loading may increase risk for ankle and foot injuries
Citations
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Journal ArticleDOI
TL;DR: The loading rate is higher in respondents with a history of stress fractures than in respondents without running injuries, and it is not possible to draw definite conclusions regarding their relation with loading rate.
Abstract: Background Vertical ground reaction force (VGRF) parameters have been implicated as a cause of several running-related injuries. However, no systematic review has examined this relationship. Aim We systematically reviewed evidence for a relation between VGRF parameters and specific running-related injuries. Methods MEDLINE, Web of Science and EMBASE databases were searched. Two independent assessors screened the articles and rated the methodological quality. The 3 key VGRF parameters we measured were vertical loading rate, impact/passive peak (Fz1) and propulsive/active peak (Fz2). Standardised mean differences of these parameters were calculated using a random-effects model. Meta-regression was performed using injury type, study type and methodological quality as factors. Results The search yielded 2016 citations and 18 met the inclusion criteria for the systematic review. The loading rate was higher in studies that included patients with a history of stress fractures and patients with all injury types, both compared with controls. Only studies that included patients with a history of symptoms at the time of kinetic data collection showed higher loading rates overall in cases than in controls. There were no differences between injured subjects and controls for the active and passive peaks of the VGRF. Summary The loading rate is higher in respondents with a history of stress fractures than in respondents without running injuries. Owing to the absence of prospective studies on other injury types, it is not possible to draw definite conclusions regarding their relation with loading rate.

187 citations

Journal ArticleDOI
TL;DR: There are differences in kinematic and kinetic characteristics between foot-strike patterns when running and Clinicians should be aware of these characteristics to help in the management of running injuries and advice on training.
Abstract: Study Design Systematic review with meta-analysis. Objectives To determine the biomechanical differences between foot-strike patterns used when running. Background Strike patterns during running have received attention in the recent literature due to their potential mechanical differences and associated injury risks. Methods Electronic databases (MEDLINE, Embase, LILACS, SciELO, and SPORTDiscus) were searched through July 2014. Studies (cross-sectional, case-control, prospective, and retrospective) comparing the biomechanical characteristics of foot-strike patterns during running in distance runners at least 18 years of age were included in this review. Two independent reviewers evaluated the risk of bias. A meta-analysis with a random-effects model was used to combine the data from the included studies. Results Sixteen studies were included in the final analysis. In the meta-analyses of kinematic variables, significant differences between forefoot and rearfoot strikers were found for foot and knee angle ...

149 citations

Journal ArticleDOI
TL;DR: Barefoot and barefoot inspired footwear may serve to reduce the incidence of knee injuries in runners although corresponding increases in Achilles tendon loading may induce an injury risk at this tendon.

130 citations


Cites background or methods or result from "Forefoot strikers exhibit lower run..."

  • ...Similarly in examinations of rear and mid/forefoot strike patterns, mid/forefoot runners have also been shown to exhibit increases in Achilles tendon force (ATF) and reductions in patellofemoral contact force (PTF) and pressure (PP) in comparison to those exhibiting a rearfoot strike pattern (Kulmala et al., 2013). Similarly, Bonacci et al. (2013b) showed that running without shoes was linked to significant reductions in PTF and PP compared to running footwear....

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  • ...As would be expected increased stride/step frequency is associated with reductions in joint energy absorption during the impact phase of running (Kulmala et al., 2013)....

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  • ...This algorithm has been utilized previously to resolve differences in PTF and PP when wearing different footwear (Bonacci et al., 2013b; Ho et al., 2012; Kulmala et al., 2013) and between those with and without patellofemoral pain (Heino and Powers, 2002)....

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  • ...This observation may have clinical relevance for the pathogenesis of Achilles tendinopathy, a further pathology that is commonplace amongst recreational runners (Kulmala et al., 2013)....

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  • ...Similarly in examinations of rear and mid/forefoot strike patterns, mid/forefoot runners have also been shown to exhibit increases in Achilles tendon force (ATF) and reductions in patellofemoral contact force (PTF) and pressure (PP) in comparison to those exhibiting a rearfoot strike pattern (Kulmala et al., 2013)....

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Journal ArticleDOI
TL;DR: Sagittal plane trunk posture has a significant influence on PFJ kinetics during running and incorporation of a forward trunk lean may be an effective strategy to reduce PFJ stress during running.
Abstract: Study Design Cross-sectional, repeated-measures. Objectives To examine the association between sagittal plane trunk posture and patellofemoral joint (PFJ) stress, and to determine whether modifying sagittal plane trunk posture influences PFJ stress during running. Background Patellofemoral pain is the most common injury among runners and is thought to be the result of elevated PFJ stress. While sagittal plane trunk posture has been shown to influence tibiofemoral joint mechanics, no study has examined the influence of trunk posture on PFJ kinetics. Methods Twenty-four asymptomatic recreational runners (12 women, 12 men) ran overground at a speed of 3.4 m/s under 3 trunk-posture conditions: self-selected, flexed, and extended. Trunk and knee kinematics, ground reaction forces, and electromyographic signals from selected lower extremity muscles were obtained. A previously described PFJ biomechanical model was used to quantify PFJ stress. Results The mean ± SD trunk flexion angles under the self-selected, fl...

104 citations

Journal ArticleDOI
TL;DR: In this paper, a study was conducted to determine whether gait retraining by modifying foot strike patterns from rearfoot strike to forefoot strike reduces patellofemoral pain and improves associated biomechanical measures, and whether the modification influences risk of ankle injuries.

104 citations

References
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Journal ArticleDOI
T Miyazaki, M Wada, H Kawahara, M Sato, H Baba, S Shimada 
TL;DR: The results suggest that the baseline adduction moment of the knee, which reflects the dynamic load on the medial compartment, can predict radiographic OA progression at the six year follow up in patients with medial compartment knee OA.
Abstract: Objective: To test the hypothesis that dynamic load at baseline can predict radiographic disease progression in patients with medial compartment knee osteoarthritis (OA). Methods: During 1991–93 baseline data were collected by assessment of pain, radiography, and gait analysis in 106 patients referred to hospital with medial compartment knee OA. At the six year follow up, 74 patients were again examined to assess radiographic changes. Radiographic disease progression was defined as more than one grade narrowing of minimum joint space of the medial compartment. Results: In the 32 patients showing disease progression, pain was more severe and adduction moment was higher at baseline than in those without disease progression (n=42). Joint space narrowing of the medial compartment during the six year period correlated significantly with the adduction moment at entry. Adduction moment correlated significantly with mechanical axis (varus alignment) and negatively with joint space width and pain score. Logistic regression analysis showed that the risk of progression of knee OA increased 6.46 times with a 1% increase in adduction moment. Conclusions: The results suggest that the baseline adduction moment of the knee, which reflects the dynamic load on the medial compartment, can predict radiographic OA progression at the six year follow up in patients with medial compartment knee OA.

1,292 citations


"Forefoot strikers exhibit lower run..." refers background in this paper

  • ...Previous studies have also shown a link between high gait-induced knee frontal plane moment and the presence and progression of knee disorders like osteoarthritis (3,20)....

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  • ...High knee frontal plane moment is known to correspond with the increased medial compartment knee loading (29,41) and is commonly linked with the presence and progression of degenerative knee disorders such as medial tibiofemoral osteoarthritis (3,20)....

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  • ...931 Cadence (stepsImin) 175 (17) 186 (20) 11 (j2 to 23) 0....

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Journal ArticleDOI
28 Jan 2010-Nature
TL;DR: Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers, and this difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground.
Abstract: Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes. We wondered how runners coped with the impact caused by the foot colliding with the ground before the invention of the modern shoe. Here we show that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners.

1,261 citations


"Forefoot strikers exhibit lower run..." refers background or methods or result in this paper

  • ...Therefore, it has been proposed that FFS could potentially decrease running-related injuries (15,16,38)....

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  • ...0282 s, and this time point was used to determine the magnitude of the vertical impact force for FFS (16)....

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  • ...energy absorption during the first half of stance (16)....

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  • ...In addition, selected variables including subject, spatiotemporal, and secondary kinematic and kinetic parameters were chosen for comparison on the basis of the previous studies to ensure that the general running mechanics of the FFS and RFS in the current study is in line with those reported earlier (5,16,25,38)....

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  • ...The results of the current study are in line with the previous findings (5,16,25,38),...

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Journal ArticleDOI
TL;DR: Ground reaction forces and center of pressure (C of P) patterns were studied in 17 subjects running at 4.5 ms −1 and the implications in the areas of running mechanics, shoe design and sports injury are discussed.

1,179 citations


"Forefoot strikers exhibit lower run..." refers background or methods or result in this paper

  • ...In addition, selected variables including subject, spatiotemporal, and secondary kinematic and kinetic parameters were chosen for comparison on the basis of the previous studies to ensure that the general running mechanics of the FFS and RFS in the current study is in line with those reported earlier (5,16,25,38)....

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  • ...lower vertical GRF impact peak and reduced vertical GRF loading rate (5)....

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  • ...The results of the current study are in line with the previous findings (5,16,25,38),...

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Journal ArticleDOI
TL;DR: The patient group tended to compensate for a high midstance‐phase adducting moment by walking with a style of gait that demanded more muscle force (greater flexion‐extension moments), which can be speculated that would help to maintain equilibrium at the knee.

992 citations


"Forefoot strikers exhibit lower run..." refers background in this paper

  • ...High knee frontal plane moment is known to correspond with the increased medial compartment knee loading (29,41) and is commonly linked with the presence and progression of degenerative knee disorders such as medial tibiofemoral osteoarthritis (3,20)....

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Journal ArticleDOI
TL;DR: Data indicate that a history of TSF in runners is associated with increases in dynamic loading-related variables and the magnitude of tibial shock predicted group membership successfully in 70% of cases.
Abstract: MILNER, C. E., R. FERBER, C. D. POLLARD, J. HAMILL, and I. S. DAVIS. Biomechanical Factors Associated with Tibial Stress Fracture in Female Runners. Med. Sci. Sports Exerc., Vol. 38, No. 2, pp. 323–328, 2006. Purpose: Tibial stress fractures (TSF) are among the most serious running injuries, typically requiring 6–8 wk for recovery. This cross-sectional study was conducted to determine whether differences in structure and running mechanics exist between trained distance runners with a history of prior TSF and those who have never sustained a fracture. Methods: Female runners with a rearfoot strike pattern, aged between 18 and 45 yr and running at least 32 kmIwk j1 , were recruited for this study. Participants in the study were 20 subjects with a history of TSF and 20 ageand mileage-matched control subjects with no previous lower extremity bony injuries. Kinematic and kinetic data were collected during overground running at 3.7 mIs j1 using a six-camera motion capture system, force platform, and accelerometer. Variables of interest were vertical impact peak, instantaneous and average vertical loading rates, instantaneous and average loading rates during braking, knee flexion excursion, ankle and knee stiffness, and peak tibial shock. Tibial varum was measured in standing. Tibial area moment of inertia was calculated from tibial x-ray studies for a subset of runners. Results: The TSF group had significantly greater instantaneous and average vertical loading rates and tibial shock than the control group. The magnitude of tibial shock predicted group membership successfully in 70% of cases. Conclusion: These data indicate that a history of TSF in runners is associated with

724 citations


"Forefoot strikers exhibit lower run..." refers methods or result in this paper

  • ...Average vertical loading rate was calculated as the total change in force divided by the total change in time between 20% and 80% of the period between ground contact and vertical impact peak (19)....

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  • ...Findings of previous studies suggest that high vertical GRF impact peak and/or loading rate may increase the risk of running-related injuries (19,40)....

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