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--- visual3d:references [2024/11/15 19:17] – [Kinematics, kinetics, methods] wikisysop
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 **Richards J, Thewlis D, Selfe J, Cunningham A, Hayes C.**   "A biomechanical investigation of a single-limb squat: implications for lower extremity rehabilitation exercise."
 - //J Athl Train. 2008 Sep-Oct;43(5):477-82.//
-:Abstract\\ \\ CONTEXT: Single-limb squats on a decline angle have been suggested as a rehabilitative intervention to target the knee extensors. Investigators, however, have presented very little empirical research in which they have documented the biomechanics of these exercises or have determined the optimum angle of decline used. OBJECTIVE: To determine the involvement of the gastrocnemius and rectus femoris muscles and the external ankle and knee joint moments at 60 degrees of knee flexion while performing a single-limb squat at different decline angles.DESIGN: Participants acted as their own controls in a repeated-measures design.PATIENTS OR OTHER PARTICIPANTS: We recruited 10 participants who had no pain, injury, or neurologic disorder.INTERVENTION(S): Participants performed single-limb squats at different decline angles. MAIN OUTCOME MEASURE(S): Angle-specific knee and ankle moments were calculated at 60 degrees of knee flexion. Angle-specific electromyography (EMG) activity was calculated at 60 degrees of knee flexion. Integrated EMG also was calculated to determine the level of muscle activity over the entire squat. RESULTS: An increase was seen in the knee moments (P < .05) and integrated EMG in the rectus femoris (P < .001) as the decline angle increased. A decrease was seen in the ankle moments as the decline angle increased (P = .001), but EMG activity in the gastrocnemius increased between 16 degrees and 24 degrees (P = .018). CONCLUSIONS: As the decline angle increased, the knee extensor moment and EMG activity increased. As the decline angle increased, the ankle plantar-flexor moments decreased; however, an increase in the EMG activity was seen with the 24 degrees decline angle compared with the 16 degrees decline angle. This indicates that decline squats at an angle greater than 16 degrees may not reduce passive calf tension, as was suggested previously, and may provide no mechanical advantage for the knee.
+:Abstract CONTEXT: Single-limb squats on a decline angle have been suggested as a rehabilitative intervention to target the knee extensors. Investigators, however, have presented very little empirical research in which they have documented the biomechanics of these exercises or have determined the optimum angle of decline used. OBJECTIVE: To determine the involvement of the gastrocnemius and rectus femoris muscles and the external ankle and knee joint moments at 60 degrees of knee flexion while performing a single-limb squat at different decline angles.DESIGN: Participants acted as their own controls in a repeated-measures design.PATIENTS OR OTHER PARTICIPANTS: We recruited 10 participants who had no pain, injury, or neurologic disorder.INTERVENTION(S): Participants performed single-limb squats at different decline angles. MAIN OUTCOME MEASURE(S): Angle-specific knee and ankle moments were calculated at 60 degrees of knee flexion. Angle-specific electromyography (EMG) activity was calculated at 60 degrees of knee flexion. Integrated EMG also was calculated to determine the level of muscle activity over the entire squat. RESULTS: An increase was seen in the knee moments (P < .05) and integrated EMG in the rectus femoris (P < .001) as the decline angle increased. A decrease was seen in the ankle moments as the decline angle increased (P = .001), but EMG activity in the gastrocnemius increased between 16 degrees and 24 degrees (P = .018). CONCLUSIONS: As the decline angle increased, the knee extensor moment and EMG activity increased. As the decline angle increased, the ankle plantar-flexor moments decreased; however, an increase in the EMG activity was seen with the 24 degrees decline angle compared with the 16 degrees decline angle. This indicates that decline squats at an angle greater than 16 degrees may not reduce passive calf tension, as was suggested previously, and may provide no mechanical advantage for the knee.
 [PMID: 18833310 Reference]
@@ Line 534: / Line 534: @@
 **Bruening DA, Crewe AN, Buczek FL**   "A simple, anatomically based correction to the conventional ankle joint center"
 - //Clinical Biomechanics 23(10):1299-1302//
-Background. Conventional motion analysis studies define the ankle joint center as the midpoint between the most medial and lateral aspects of the malleoli, yet research points toward a more distal joint center location. The purpose of this study was to develop and evaluate an anatomically based correction that would move the conventional ankle joint center to a more accurate location.\\ \\ Methods. Lower extremity radiographs from 30 pediatric patients were analyzed retrospectively. An offset between the conventional and more accurate ankle joint centers was measured and correlated to other common anatomical measures based on conventional skin mounted marker positions. The best correlated measure was used to define a simple correction factor, which was subsequently evaluated by its effect on six degree-of-freedom ankle joint translations during normal gait (n = 8). Findings. Shank length was found to have the highest bivariate linear correlation (r = 0.89) with the offset. Adjusting the ankle joint center using a percentage of shank length (2.7%) was also as accurate as the regression equation in predicting offset (mean error 0.6 mm, or 6% offset). Adjusting the ankle joint center using this simple percentage resulted in a 25% reduction in mean ankle joint translations during normal gait.\\ \\ Interpretation. The accuracy of the ankle joint center can be increased through a simple, anatomically based correction. This correction may prove beneficial in some kinematic and kinetic applications requiring increased anatomical fidelity.
+Background. Conventional motion analysis studies define the ankle joint center as the midpoint between the most medial and lateral aspects of the malleoli, yet research points toward a more distal joint center location. The purpose of this study was to develop and evaluate an anatomically based correction that would move the conventional ankle joint center to a more accurate location. Methods. Lower extremity radiographs from 30 pediatric patients were analyzed retrospectively. An offset between the conventional and more accurate ankle joint centers was measured and correlated to other common anatomical measures based on conventional skin mounted marker positions. The best correlated measure was used to define a simple correction factor, which was subsequently evaluated by its effect on six degree-of-freedom ankle joint translations during normal gait (n = 8). Findings. Shank length was found to have the highest bivariate linear correlation (r = 0.89) with the offset. Adjusting the ankle joint center using a percentage of shank length (2.7%) was also as accurate as the regression equation in predicting offset (mean error 0.6 mm, or 6% offset). Adjusting the ankle joint center using this simple percentage resulted in a 25% reduction in mean ankle joint translations during normal gait. Interpretation. The accuracy of the ankle joint center can be increased through a simple, anatomically based correction. This correction may prove beneficial in some kinematic and kinetic applications requiring increased anatomical fidelity.
 [PMID: 18848739 Reference]
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 **Robinson MA, Barton GJ, Lees A, Sett P. (2010)**   "Analysis of tetraplegic reaching in their 3D workspace following posterior deltoid-triceps tendon transfer."
 //[[http://www.ncbi.nlm.nih.gov/pubmed/20065989|Spinal Cord. 2010 Aug;48(8):619-27]]//
-STUDY DESIGN: Cross-sectional study.\\ \\ OBJECTIVES: To quantify three-dimensional (3D) reachable workspace in different groups of tetraplegic participants and to assess their reaching performance within this workspace.\\ \\ SETTING: Northwest Regional Spinal Injuries Centre, UK.\\ \\ METHODS: The 3D reachable workspace of three groups of tetraplegics (NON-OP, operated group (OP) and tetraplegic control group (CON(Tetraplegic)) with varying levels of triceps function together with a healthy control group (CON(Healthy))) was defined by reaching to five target positions (anterior, medial, lateral, superior and inferior) located on the periphery of their workspace. Joint angles and inter-joint co-ordination were analysed after a 3D reconstruction of the thorax, humerus and forearm. The performance related variables of movement time, peak velocity, time-to-peak velocity and curvature index were also examined.\\ \\ RESULTS: The reachable volumes covered were consistent with the level of triceps function as CON(Healthy) covered a significantly greater volume than the tetraplegic groups and in turn the OP covered a larger workspace volume than NON-OP. The reduced workspace of tetraplegics was identified as being due to restrictions in workspace above shoulder height and across the body. Co-ordination data identified some differences in movement patterns but when reaching to targets on the workspace there were no significant differences between the OP and NON-OP groups.\\ \\ CONCLUSION: This study provided a detailed assessment of reachable workspace and target reaching. Tetraplegic participants found the superior and medial parts of the workspace were the most challenging directions. Standardised biomechanical analysis of tetraplegic upper-limb function is required for objective assessment..
+STUDY DESIGN: Cross-sectional study. OBJECTIVES: To quantify three-dimensional (3D) reachable workspace in different groups of tetraplegic participants and to assess their reaching performance within this workspace. SETTING: Northwest Regional Spinal Injuries Centre, UK. METHODS: The 3D reachable workspace of three groups of tetraplegics (NON-OP, operated group (OP) and tetraplegic control group (CON(Tetraplegic)) with varying levels of triceps function together with a healthy control group (CON(Healthy))) was defined by reaching to five target positions (anterior, medial, lateral, superior and inferior) located on the periphery of their workspace. Joint angles and inter-joint co-ordination were analysed after a 3D reconstruction of the thorax, humerus and forearm. The performance related variables of movement time, peak velocity, time-to-peak velocity and curvature index were also examined. RESULTS: The reachable volumes covered were consistent with the level of triceps function as CON(Healthy) covered a significantly greater volume than the tetraplegic groups and in turn the OP covered a larger workspace volume than NON-OP. The reduced workspace of tetraplegics was identified as being due to restrictions in workspace above shoulder height and across the body. Co-ordination data identified some differences in movement patterns but when reaching to targets on the workspace there were no significant differences between the OP and NON-OP groups. CONCLUSION: This study provided a detailed assessment of reachable workspace and target reaching. Tetraplegic participants found the superior and medial parts of the workspace were the most challenging directions. Standardised biomechanical analysis of tetraplegic upper-limb function is required for objective assessment..
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 **Chan ZYSm Zhang JHW, Au IPH, An WW, Shum GLK, Ng GYF, Cheung RTH.** (2017).   "Gait retraining lowers injury risk in novice distance runners: a randomized controlled trial."
 //[[http://collections.crest.ac.uk/16085/1/AJSM_author%20version.pdf|The American Journal of Sports Medicine.]]//
-**Background**: With distance running gaining popularity, there is a concurrent increase in running related injuries that up to 85% of novice runners incur an injury in a given year. Previous studies have utilized gait retraining program to successfully lower impact loading, which has been associated with many running ailments. However, softer footfalls may not necessarily prevent running injury.\\ \\ **Purpose**: To examine the vertical loading rates before and after the gait retraining as well as the effectiveness of the program on reducing the occurrence of running-related injury across a 12-month observation period.\\ \\ **Study Design**: Randomized controlled clinical trial\\ \\ **Methods**: A total of 320 novice runners from the local running club completed this study. All the participants underwent a baseline running biomechanics evaluation on an instrumented treadmill with their usual running shoes at 8 and 12 km/h. Participants were then randomly assigned into either the gait retraining or control group. In the gait retraining group (n=166), participants received a two-week real time visual feedback gait retraining. In the control group (n=154), participants received treadmill running exercise but without visual feedback on their performance. The training time was identical between the two groups. Participants’ running mechanics were reassessed after the training and their 12-35 month post-training injury profile was tracked using an online surveillance platform.\\ \\ **Results**: There was a significant reduction in the vertical loading rates at both testing speeds in the gait retraining group (p<0.001, Cohen’s d>0.99) whereas the loading rates were either similar or slightly increased in the control group after training (p=0.001 to 0.461, Cohen’s d=0.03 to -0.14). At 12-month follow-up, the occurrence of running-related musculoskeletal injury was 16% and 38% in the gait retraining and control group respectively. Hazard ratio between gait retraining and control groups was 0.383 (95%C.I.=0.25-0.59), indicating a 62% lower injury risk in gait retrained runners when compared with controls.\\ \\ **Conclusion**: A two-week gait retraining program is effective in lowering impact loading in novice runners. More importantly, the injury occurrence is 62% lower after two weeks of 46 running gait modification.\\ \\ **Clinical Relevance**: A two-week gait retraining program may lower impact loading, thus reducing the injury occurrence in novice runners.
+**Background**: With distance running gaining popularity, there is a concurrent increase in running related injuries that up to 85% of novice runners incur an injury in a given year. Previous studies have utilized gait retraining program to successfully lower impact loading, which has been associated with many running ailments. However, softer footfalls may not necessarily prevent running injury. **Purpose**: To examine the vertical loading rates before and after the gait retraining as well as the effectiveness of the program on reducing the occurrence of running-related injury across a 12-month observation period. **Study Design**: Randomized controlled clinical trial **Methods**: A total of 320 novice runners from the local running club completed this study. All the participants underwent a baseline running biomechanics evaluation on an instrumented treadmill with their usual running shoes at 8 and 12 km/h. Participants were then randomly assigned into either the gait retraining or control group. In the gait retraining group (n=166), participants received a two-week real time visual feedback gait retraining. In the control group (n=154), participants received treadmill running exercise but without visual feedback on their performance. The training time was identical between the two groups. Participants’ running mechanics were reassessed after the training and their 12-35 month post-training injury profile was tracked using an online surveillance platform. **Results**: There was a significant reduction in the vertical loading rates at both testing speeds in the gait retraining group (p<0.001, Cohen’s d>0.99) whereas the loading rates were either similar or slightly increased in the control group after training (p=0.001 to 0.461, Cohen’s d=0.03 to -0.14). At 12-month follow-up, the occurrence of running-related musculoskeletal injury was 16% and 38% in the gait retraining and control group respectively. Hazard ratio between gait retraining and control groups was 0.383 (95%C.I.=0.25-0.59), indicating a 62% lower injury risk in gait retrained runners when compared with controls. **Conclusion**: A two-week gait retraining program is effective in lowering impact loading in novice runners. More importantly, the injury occurrence is 62% lower after two weeks of 46 running gait modification. **Clinical Relevance**: A two-week gait retraining program may lower impact loading, thus reducing the injury occurrence in novice runners.
-\\
 **Taylor JB, Nguyen A, Paterno MV, Huang B and Ford KR.**   "Real-time optimized bifeedback utilizing sport techniques (ROBUST): a study protocol for a randomized controlled trial."
 //[[http://www.ncbi.nlm.nih.gov/pubmed/28173788|BMC Musculoskeletal Disorders (2017) 18:71.]]//
-**Background**: Anterior cruciate ligament (ACL) injuries in female athletes lead to a variety of short- and long-term physical, financial, and psychosocial ramifications. While dedicated injury prevention training programs have shown promise, ACL injury rates remain high as implementation has not become widespread. Conventional prevention programs use a combination of resistance, plyometric, balance and agility training to improve high-risk biomechanics and reduce the risk of injury. While many of these programs focus on reducing knee abduction load and posture during dynamic activity, targeting hip extensor strength and utilization may be more efficacious, as it is theorized to be an underlying mechanism of injury in adolescent female athletes. Biofeedback training may complement traditional preventive training, but has not been widely studied in connection with ACL injuries. We hypothesize that biofeedback may be needed to maximize the effectiveness of neuromuscular prophylactic interventions, and that hip-focused biofeedback will improve lower extremity biomechanics to a larger extent than knee-focused biofeedback during dynamic sport-specific tasks and long-term movement strategies.\\ \\ **Methods**: This is an assessor-blind, randomized control trial of 150 adolescent competitive female (9–19 years) soccer players. Each participant receives 3x/week neuromuscular preventive training and 1x/week biofeedback, the mode depending on their randomization to one of 3 biofeedback groups (hip-focused, knee-focused, sham). The primary aim is to assess the impact of biofeedback training on knee abduction moments (the primary biomechanical predictor of future ACL injury) during double-leg landings, single-leg landings, and unplanned cutting. Testing will occur immediately before the training intervention, immediately after the training intervention, and 6 months after the training intervention to assess the long-term retention of modified biomechanics. Secondary aims will assess performance changes, including hip and core strength, power, and agility, and the extent to which maturation effects biofeedback efficacy.\\ \\ **Discussion**: The results of the Real-time Optimized Biofeedback Utilizing Sport Techniques (ROBUST) trial will help complement current preventive training and may lead to clinician-friendly methods of biofeedback to incorporate into widespread training practices.\\ \\ **Trial registration**: Date of publication in ClinicalTrials.gov: 20/04/2016. ClinicalTrials.gov Identifier: NCT02754700..
+**Background**: Anterior cruciate ligament (ACL) injuries in female athletes lead to a variety of short- and long-term physical, financial, and psychosocial ramifications. While dedicated injury prevention training programs have shown promise, ACL injury rates remain high as implementation has not become widespread. Conventional prevention programs use a combination of resistance, plyometric, balance and agility training to improve high-risk biomechanics and reduce the risk of injury. While many of these programs focus on reducing knee abduction load and posture during dynamic activity, targeting hip extensor strength and utilization may be more efficacious, as it is theorized to be an underlying mechanism of injury in adolescent female athletes. Biofeedback training may complement traditional preventive training, but has not been widely studied in connection with ACL injuries. We hypothesize that biofeedback may be needed to maximize the effectiveness of neuromuscular prophylactic interventions, and that hip-focused biofeedback will improve lower extremity biomechanics to a larger extent than knee-focused biofeedback during dynamic sport-specific tasks and long-term movement strategies. **Methods**: This is an assessor-blind, randomized control trial of 150 adolescent competitive female (9–19 years) soccer players. Each participant receives 3x/week neuromuscular preventive training and 1x/week biofeedback, the mode depending on their randomization to one of 3 biofeedback groups (hip-focused, knee-focused, sham). The primary aim is to assess the impact of biofeedback training on knee abduction moments (the primary biomechanical predictor of future ACL injury) during double-leg landings, single-leg landings, and unplanned cutting. Testing will occur immediately before the training intervention, immediately after the training intervention, and 6 months after the training intervention to assess the long-term retention of modified biomechanics. Secondary aims will assess performance changes, including hip and core strength, power, and agility, and the extent to which maturation effects biofeedback efficacy. **Discussion**: The results of the Real-time Optimized Biofeedback Utilizing Sport Techniques (ROBUST) trial will help complement current preventive training and may lead to clinician-friendly methods of biofeedback to incorporate into widespread training practices. **Trial registration**: Date of publication in ClinicalTrials.gov: 20/04/2016. ClinicalTrials.gov Identifier: NCT02754700..
 **Hafer JF, Brown AM, deMille P, Hillstrom HJ, Garber CE.**   "The effect of a cadence retraining protocol on running biomechanics and efficiency: a pilot study."
@@ Line 650: / Line 649: @@
 **Teran-Yengle P, Birkhofer R, Weber MA, Patton K, Thatcher E, Yack HJ.**   "Efficacy of Gait Training With Real-Time Biofeedback in Correcting Knee Hyperextension Patterns in Young Women."
 - //J Orthop Sports Phys Ther.//
-OBJECTIVES: To investigate the efficacy of real-time biofeedback provided during treadmill gait training for correcting knee hyperextension in asymptomatic female while walking.\\ \\ BACKGROUND:Knee hyperextension is associated with increased stress to the posterior capsule of the knee joint, anterior cruciate ligament (ACL), and anterior compartment of the tibiofemoral joint. Previous methods aimed at correcting knee hyperextension have shown limited success. Studies support the use of biofeedback to improve learning of motor skills.\\ \\ METHODS:Ten women, ages 18 to 39 years, with asymptomatic knee hyperextension during ambulation were provided with 6 sessions of real-time feedback of kinematic data (Visual3D) during treadmill training. Gait evaluations were performed pretraining, posttraining, and 1 month after the last training session.\\ \\ RESULTS:Improved control of knee hyperextension during over ground walking at 1.3 m/s was shown at posttraining and at 1 month post-training.\\ \\ CONCLUSION:The present study shows that knee sagittal plane kinematics can be influenced by gait re-training using real-time biofeedback.
+OBJECTIVES: To investigate the efficacy of real-time biofeedback provided during treadmill gait training for correcting knee hyperextension in asymptomatic female while walking. BACKGROUND:Knee hyperextension is associated with increased stress to the posterior capsule of the knee joint, anterior cruciate ligament (ACL), and anterior compartment of the tibiofemoral joint. Previous methods aimed at correcting knee hyperextension have shown limited success. Studies support the use of biofeedback to improve learning of motor skills. METHODS:Ten women, ages 18 to 39 years, with asymptomatic knee hyperextension during ambulation were provided with 6 sessions of real-time feedback of kinematic data (Visual3D) during treadmill training. Gait evaluations were performed pretraining, posttraining, and 1 month after the last training session. RESULTS:Improved control of knee hyperextension during over ground walking at 1.3 m/s was shown at posttraining and at 1 month post-training. CONCLUSION:The present study shows that knee sagittal plane kinematics can be influenced by gait re-training using real-time biofeedback.
 [PMID: 22030469]
 **Zeni J, Abujaber S, Flowers, P, Possi F, Snyder-Mackler L**  "Biofeedback to Promote Movement Symmetry After Total Knee Arthroplasty: A Feasibility Study. "
 J Orthop Sports Phys Ther 2013;43(10):715-726.
-STUDY DESIGN: Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point.\\ \\ OBJECTIVES: To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA).\\ \\ BACKGROUND: TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes.\\ \\ METHODS: Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean  SD age, 61.4  5.8 years; body mass index, 33.1  5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean  SD age, 61.8  5 years; body mass index, 34.3  5.1 kg/m2), that did not receive specialized symmetry retraining.\\ \\ RESULTS: Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol.\\ \\ CONCLUSION: Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared to rehabilitation protocols that focus on range of motion, strength, and return to independence..\\
+STUDY DESIGN: Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point. OBJECTIVES: To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA). BACKGROUND: TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes. METHODS: Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean  SD age, 61.4  5.8 years; body mass index, 33.1  5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean  SD age, 61.8  5 years; body mass index, 34.3  5.1 kg/m2), that did not receive specialized symmetry retraining. RESULTS: Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol. CONCLUSION: Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared to rehabilitation protocols that focus on range of motion, strength, and return to independence..
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 **Mitchell K, Porter M, Anderson L, Phillips C, Arceo G, Montz B, Levy S, and Gombatto SP**(2017)   "Differences in lumbar spine and lower extremity kinematics in people with and without low back pain during a step-up task: a cross-sectional study."
 //BMC Musculoskeletal Disorders (2017) 18:369//
-Abstract\\ \\ Background: Low back pain (LBP) affects more than one third of the population at any given time, and chronic LBP is responsible for increased medical costs, functional limitations and decreased quality of life. A clear etiology is often difficult to identify, but aberrant posture and movement are considered contributing factors to chronic LBP that are addressed during physiotherapy intervention. Information about aberrant movement during functional activities in people with LBP can help inform more effective interventions. The purpose of this study was to determine if there are differences in lumbar spine and lower extremity kinematics in people with and without LBP during a step-up task.\\ \\ Methods: A convenience sample of 37 participants included 19 with LBP and 18 without a history of LBP. All participants were between the ages of 18 and 65, and controls were matched to participants with LBP based on age, gender and BMI. A motion capture system was used to record spine and lower extremity kinematics during the step-up task. ANOVA tests were used to determine differences in three-dimensional kinematics between groups.\\ \\ Results: Participants with LBP displayed less lower lumbar motion in the sagittal plane (P = 0.001), more knee motion in the coronal plane (P = 0.001), and more lower extremity motion in the axial plane (P = 0.002) than controls.\\ \\ Conclusions: People with LBP display less lower lumbar spine motion in the sagittal plane and more out-of-plane lower extremity motion. Clinically, the step-up task can be used to identify these aberrant movements to develop more focused functional interventions for patients with LBP.
+Abstract Background: Low back pain (LBP) affects more than one third of the population at any given time, and chronic LBP is responsible for increased medical costs, functional limitations and decreased quality of life. A clear etiology is often difficult to identify, but aberrant posture and movement are considered contributing factors to chronic LBP that are addressed during physiotherapy intervention. Information about aberrant movement during functional activities in people with LBP can help inform more effective interventions. The purpose of this study was to determine if there are differences in lumbar spine and lower extremity kinematics in people with and without LBP during a step-up task. Methods: A convenience sample of 37 participants included 19 with LBP and 18 without a history of LBP. All participants were between the ages of 18 and 65, and controls were matched to participants with LBP based on age, gender and BMI. A motion capture system was used to record spine and lower extremity kinematics during the step-up task. ANOVA tests were used to determine differences in three-dimensional kinematics between groups. Results: Participants with LBP displayed less lower lumbar motion in the sagittal plane (P = 0.001), more knee motion in the coronal plane (P = 0.001), and more lower extremity motion in the axial plane (P = 0.002) than controls. Conclusions: People with LBP display less lower lumbar spine motion in the sagittal plane and more out-of-plane lower extremity motion. Clinically, the step-up task can be used to identify these aberrant movements to develop more focused functional interventions for patients with LBP.
 **D'Angelo K1, Triano JJ, Kawchuk GN, Howarth SJ**(2016)   "Patient-Induced Reaction Forces and Moments are Influenced by Variations in Spinal Manipulative Technique."
 - //Spine Jun 6// PMID:27270638
-STUDY DESIGN: An in vivo biomechanical study OBJECTIVE.: . The aim of the present study was to quantify and compare the reaction loads for two spinal manipulation therapy (SMT) procedures commonly used for low back pain using a biomechanical computer model.\\ \\ SUMMARY OF BACKGROUND DATA: Contemporary computer-driven rigid linked-segment models (LSMs) have made it feasible to analyze low back kinetics and kinematics during various activities including spinal manipulation therapy (SMT) procedures. Currently, a comprehensive biomechanical model analyzing actual differences in loading effects between different SMT procedures is lacking.\\ \\ METHODS: Twenty-four healthy/asymptomatic participants received a total of 6 SMT applications, representing all combinations of two similar SMT procedures within three patient hip flexion angles. All contact forces, patient torso kinematics, and inertial properties were entered into a dynamic three-dimensional LSM to calculate lumbar reaction forces and moments. Peak net applied force along with the maximums, minimums, and ranges for each component of the three-dimensional reaction force and moment vectors during each SMT procedure were analyzed.\\ \\ RESULTS: One specific SMT technique (lumbar spinous pull) produced greater maximum anterior-posterior reaction force and both lateral bending and axial twisting reaction moments when compared to the other technique (lumbar push procedure (all p ≤ 0.034)). SMT trials without hip flexion had lower maximum medial-lateral reaction force and range compared to those with 45 and 90 degrees of hip flexion (all p ≤ 0.041). There were no interactions between procedure and hip angle for any of the dependent measurements.\\ \\ CONCLUSION: The technique used to apply SMT and the participant's initial hip orientation induced significantly different actions on the low back. These findings and future research can improve patient outcomes and safety by informing clinicians on how to best utilize SMT given specific types of low back pain.
+STUDY DESIGN: An in vivo biomechanical study OBJECTIVE.: . The aim of the present study was to quantify and compare the reaction loads for two spinal manipulation therapy (SMT) procedures commonly used for low back pain using a biomechanical computer model. SUMMARY OF BACKGROUND DATA: Contemporary computer-driven rigid linked-segment models (LSMs) have made it feasible to analyze low back kinetics and kinematics during various activities including spinal manipulation therapy (SMT) procedures. Currently, a comprehensive biomechanical model analyzing actual differences in loading effects between different SMT procedures is lacking. METHODS: Twenty-four healthy/asymptomatic participants received a total of 6 SMT applications, representing all combinations of two similar SMT procedures within three patient hip flexion angles. All contact forces, patient torso kinematics, and inertial properties were entered into a dynamic three-dimensional LSM to calculate lumbar reaction forces and moments. Peak net applied force along with the maximums, minimums, and ranges for each component of the three-dimensional reaction force and moment vectors during each SMT procedure were analyzed. RESULTS: One specific SMT technique (lumbar spinous pull) produced greater maximum anterior-posterior reaction force and both lateral bending and axial twisting reaction moments when compared to the other technique (lumbar push procedure (all p ≤ 0.034)). SMT trials without hip flexion had lower maximum medial-lateral reaction force and range compared to those with 45 and 90 degrees of hip flexion (all p ≤ 0.041). There were no interactions between procedure and hip angle for any of the dependent measurements. CONCLUSION: The technique used to apply SMT and the participant's initial hip orientation induced significantly different actions on the low back. These findings and future research can improve patient outcomes and safety by informing clinicians on how to best utilize SMT given specific types of low back pain.
 **Howarth SJ, D'Angelo K, Triano JJ. (2016)**   "Development of a Linked Segment Model to Derive Patient Low Back Reaction Forces and Moments During High-Velocity Low-Amplitude Spinal Manipulation."
 - //J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):176-84. PMID: 27034108//
-OBJECTIVE: The purpose of this paper is to present the experimental setup, the development, and implementation of a new scalable model capable of efficiently handling data required to determine low back kinetics during high-velocity low-amplitude spinal manipulation (HVLA-SM).\\ \\ METHODS: The model was implemented in Visual3D software. All contact forces and moments between the patient and the external environment (2 clinician hand contact forces, 1 contact force between the patient and the treatment table), the patient upper body kinematics, and inertial properties were used as input. Spine kinetics and kinematics were determined from a single HVLA-SM applied to one healthy participant in a right side-lying posture to demonstrate the model's utility. The net applied force was used to separate the spine kinetic and kinematic time-series data from the HVLA-SM into preload as well as early and late impulse phases.\\ \\ RESULTS: Time-series data obtained from the HVLA-SM procedure showed that the participant's spine underwent left axial rotation, combined with extension, and a reduction in left lateral bending during the procedure. All components of the reaction force, as well as the axial twist and flexion/extension reaction moments demonstrated a sinusoidal pattern during the early and late impulse phases. During the early impulse phase, the participant's spine experienced a leftward axial twisting moment of 37.0 Nm followed by a rightward moment of -45.8 Nm. The lateral bend reaction moment exhibited a bimodal pattern during the early and late impulse phases.\\ \\ CONCLUSION: This model was the first attempt to directly measure all contact forces acting on the participant/patient's upper body, and integrate them with spine kinematic data to determine patient low back reaction forces and moments during HVLA-SM in a side-lying posture. Advantages of this model include the brevity of data collection (<1 hour), and adaptability for different patient anthropometries and clinician-patient contacts.
+OBJECTIVE: The purpose of this paper is to present the experimental setup, the development, and implementation of a new scalable model capable of efficiently handling data required to determine low back kinetics during high-velocity low-amplitude spinal manipulation (HVLA-SM). METHODS: The model was implemented in Visual3D software. All contact forces and moments between the patient and the external environment (2 clinician hand contact forces, 1 contact force between the patient and the treatment table), the patient upper body kinematics, and inertial properties were used as input. Spine kinetics and kinematics were determined from a single HVLA-SM applied to one healthy participant in a right side-lying posture to demonstrate the model's utility. The net applied force was used to separate the spine kinetic and kinematic time-series data from the HVLA-SM into preload as well as early and late impulse phases. RESULTS: Time-series data obtained from the HVLA-SM procedure showed that the participant's spine underwent left axial rotation, combined with extension, and a reduction in left lateral bending during the procedure. All components of the reaction force, as well as the axial twist and flexion/extension reaction moments demonstrated a sinusoidal pattern during the early and late impulse phases. During the early impulse phase, the participant's spine experienced a leftward axial twisting moment of 37.0 Nm followed by a rightward moment of -45.8 Nm. The lateral bend reaction moment exhibited a bimodal pattern during the early and late impulse phases. CONCLUSION: This model was the first attempt to directly measure all contact forces acting on the participant/patient's upper body, and integrate them with spine kinematic data to determine patient low back reaction forces and moments during HVLA-SM in a side-lying posture. Advantages of this model include the brevity of data collection (<1 hour), and adaptability for different patient anthropometries and clinician-patient contacts.
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 [[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18701198|Reference]]
-**Svehlika M, Slaby K, Soumar L, Smetanaa P, Kobesovac A, and Trca T**\\ \\   "Evolution of walking ability after soft tissue surgery in\\ \\ cerebral palsy patients: what can we expect? "
+**Svehlika M, Slaby K, Soumar L, Smetanaa P, Kobesovac A, and Trca T**  "Evolution of walking ability after soft tissue surgery in cerebral palsy patients: what can we expect? "
 - //Journal of Pediatric Orthopaedics B 2008, 17:107–113//
 Eleven patients with spastic cerebral palsy were evaluated preoperatively, and 3 and 9 months postoperatively after soft tissue surgery. Evaluation included clinical examination, the Functional Mobility Scale questionnaire, and instrumented gait and center of mass trajectory analysis. A decrease in time–distance parameters after 3 months was followed by progress in all parameters at 9 months postoperatively. Push-off range of ankle motion decreased after surgery and was not restored to preoperative level until 9 months later. The center of mass vertical displacement improved significantly. The Functional Mobility Scale showed gait improvement. Despite the normalization of range of motion after surgery, there is an obvious period of functional gait deterioration in the early postoperative period and the push-off range of motion at the ankle did not recover to preoperative level until 9 months later.
@@ Line 837: / Line 836: @@
 ==== Other ====
-**Palmieri-Smith RM, Kreinbrink J, Ashton-Miller JA, and Wojtys EM**\\ \\   "Association of Quadriceps and Hamstrings\\ \\ Cocontraction Patterns With Knee Joint Loading"
+**Palmieri-Smith RM, Kreinbrink J, Ashton-Miller JA, and Wojtys EM**   "Association of Quadriceps and Hamstrings Cocontraction Patterns With Knee Joint Loading"
 - //Journal of Athletic Training 2009;44(3):256–263//
 CONTEXT: Sex differences in neuromuscular control of the lower extremity have been identified as a potential cause for the greater incidence of anterior cruciate ligament (ACL) injuries in female athletes compared with male athletes. Women tend to land in greater knee valgus with higher abduction loads than men. Because knee abduction loads increase ACL strain, the inability to minimize these loads may lead to ACL failure. OBJECTIVE: To investigate the activation patterns of the quadriceps and hamstrings muscles with respect to the peak knee abduction moment. DESIGN: Cross-sectional study. SETTING: Neuromuscular research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-one recreationally active adults (11 women, 10 men). MAIN OUTCOME MEASURE(S): Volunteers performed 3 trials of a 100-cm forward hop. During the hop task, we recorded surface electromyographic data from the medial and lateral hamstrings and quadriceps and recorded lower extremity kinematics and kinetics. Lateral and medial quadriceps-to-hamstrings (QratioH) cocontraction indices, the ratio of medial-to-lateral QratioH cocontraction, normalized root mean square electromyographic data for medial and lateral quadriceps and hamstrings, and peak knee abduction moment were calculated and used in data analyses. RESULTS: Overall cocontraction was lower in women than in men, whereas activation was lower in the medial than in the lateral musculature in both sexes (P < .05). The medial QratioH cocontraction index (R(2) = 0.792) accounted for a significant portion of the variance in the peak knee abduction moment in women (P = .001). Women demonstrated less activation in the vastus medialis than in the vastus lateralis (P = .49) and less activation in the medial hamstrings than in the lateral hamstrings (P = .01). CONCLUSIONS: Medial-to-lateral QratioH cocontraction appears to be unbalanced in women, which may limit their ability to resist abduction loads. Because higher abduction loads increase strain on the ACL, restoring medial-to-lateral QratioH cocontraction balance in women may help reduce ACL injury risk.
@@ Line 848: / Line 847: @@
 **O'Connor K, Bottum MC**   "Differences in Cutting Knee Mechanics Based on Principal Components Analysis"
 - //Medicine & Science in Sports & Exercise: April 2009 - Volume 41 - Issue 4 - pp 867-878//
-Purpose: The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Analysis of injury risk is limited to identification of discrete-dependent variables, but analysis of the entire waveform using principal components analysis (PCA) may provide greater insight. The purpose of this study was to examine gender differences in cutting knee mechanics using PCA and to compare these findings to those based on traditional discrete measures.\\ \\ Methods: Sixteen male and 17 female recreational athletes were recruited to perform unanticipated run and cutting tasks. Three-dimensional joint dynamics were recorded, and discrete variables were extracted. PCA analyses were also performed on the angle and moment waveforms in all three planes. The PCA used an eigenvalue analysis on the data covariance matrix. Gender differences in the principal component (PC) scores generated by the PCA were assessed using a MANOVA (P < 0.05).\\ \\ Results: On the basis of the discrete variables, flexion range of motion for females was less than for males. From the PCA analysis, females were less internally rotated during late stance and exhibited a relatively greater peak adduction moment that was not apparent in the original time series. This peak moment correlated with a greater abduction oscillation during early stance. There was also less variability for females in the sagittal and frontal plane moment PC.\\ \\ Conclusions: The PCA analysis did not significantly detect the decreased flexion, but PCA did reveal gender differences in movement patterns and variability that were not apparent in the discrete variables. The results of this study demonstrate the potential of PCA to provide deeper understand of movement dynamics that may help in detecting injury risk factors.
+Purpose: The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Analysis of injury risk is limited to identification of discrete-dependent variables, but analysis of the entire waveform using principal components analysis (PCA) may provide greater insight. The purpose of this study was to examine gender differences in cutting knee mechanics using PCA and to compare these findings to those based on traditional discrete measures. Methods: Sixteen male and 17 female recreational athletes were recruited to perform unanticipated run and cutting tasks. Three-dimensional joint dynamics were recorded, and discrete variables were extracted. PCA analyses were also performed on the angle and moment waveforms in all three planes. The PCA used an eigenvalue analysis on the data covariance matrix. Gender differences in the principal component (PC) scores generated by the PCA were assessed using a MANOVA (P < 0.05). Results: On the basis of the discrete variables, flexion range of motion for females was less than for males. From the PCA analysis, females were less internally rotated during late stance and exhibited a relatively greater peak adduction moment that was not apparent in the original time series. This peak moment correlated with a greater abduction oscillation during early stance. There was also less variability for females in the sagittal and frontal plane moment PC. Conclusions: The PCA analysis did not significantly detect the decreased flexion, but PCA did reveal gender differences in movement patterns and variability that were not apparent in the discrete variables. The results of this study demonstrate the potential of PCA to provide deeper understand of movement dynamics that may help in detecting injury risk factors.
 **Schmitt LC, Rudolph KS**   "Muscle stabilization strategies in people with medial knee osteoarthritis: The effect of instability"
@@ Line 856: / Line 855: @@
 **Goldberg EJ, Requejo PS, Fowler EG**   "The effect of direct measurement versus cadaver estimates of anthropometry in the calculation of joint moments during above-knee prosthetic gait in pediatrics"
 - //Journal of Biomechanics 41 (2008) 695-800//
-Joint reaction forces, moments and powers are important in interpreting gait mechanics and compensatory strategies used by patients\\ \\ walking with above-knee prostheses. Segmental anthropometrics, required to calculate joint moments, are often estimated using data from cadaver studies. However, these values may not be accurate for patients following amputation as prostheses are composed of nonbiologic material. The purpose of this study was to compare joint moments using anthropometrics calculated from cadaver studies versus direct measurements of the residual limb and prosthesis for children with an above-knee amputation. Gait data were collected for four subjects with above-knee prostheses walking at preferred and fast speeds. Joint moments were computed using anthropometrics from cadaver studies and direct measurements for each subject. The difference between these two methods primarily affected the inertia couple (Ia term) and the inertial effect due to gravity, which comprised a greater percentage of the total joint moment during swing as compared to stance. Peak hip and knee flexor and extensor moments during swing were significantly greater when calculated using cadaver data (po0.05). These differences were greater while walking fast as compared to slow speeds. A significant difference was not found between these two methods for peak hip and knee moments during stance. A significant difference was found for peak ankle joint moments during stance, but the magnitude was not clinically important. These results support the use of direct measurements of anthropometry when\\ \\ examining above-knee prosthetic gait, particularly during swing.
+Joint reaction forces, moments and powers are important in interpreting gait mechanics and compensatory strategies used by patients walking with above-knee prostheses. Segmental anthropometrics, required to calculate joint moments, are often estimated using data from cadaver studies. However, these values may not be accurate for patients following amputation as prostheses are composed of nonbiologic material. The purpose of this study was to compare joint moments using anthropometrics calculated from cadaver studies versus direct measurements of the residual limb and prosthesis for children with an above-knee amputation. Gait data were collected for four subjects with above-knee prostheses walking at preferred and fast speeds. Joint moments were computed using anthropometrics from cadaver studies and direct measurements for each subject. The difference between these two methods primarily affected the inertia couple (Ia term) and the inertial effect due to gravity, which comprised a greater percentage of the total joint moment during swing as compared to stance. Peak hip and knee flexor and extensor moments during swing were significantly greater when calculated using cadaver data (po0.05). These differences were greater while walking fast as compared to slow speeds. A significant difference was not found between these two methods for peak hip and knee moments during stance. A significant difference was found for peak ankle joint moments during stance, but the magnitude was not clinically important. These results support the use of direct measurements of anthropometry when examining above-knee prosthetic gait, particularly during swing.
 **Farrokhi S, Pollard CD, Souza RB, Chen YJ, Reischl S, Powers CM.**   "Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise."
@@ Line 867: / Line 866: @@
 **Rudolph KS, Schmitt LC, and Lewek MD**   "Age-Related Changes in Strength, Joint Laxity, and Walking Patterns: Are They Related to Knee Osteoarthritis?"
 - //PHYS THER, Vol. 87, No. 11, 1422-1432//
-Background and Purpose\\ \\ Aging is associated with musculoskeletal changes and altered walking patterns. These changes are common in people with knee osteoarthritis (OA) and may precipitate the development of OA. We examined age-related changes in musculoskeletal structures and walking patterns to better understand the relationship between aging and knee OA. Methods Forty-four individuals without OA (15 younger, 15 middle-aged, 14 older adults) and 15 individuals with medial knee OA participated. Knee laxity, quadriceps femoris muscle strength (force-generating capacity), and gait were assessed. Results Medial laxity was greater in the OA group, but there were no differences between the middle-aged and older control groups. Quadriceps femoris strength was less in the older control group and in the OA group. During the stance phase of walking, the OA group demonstrated less knee flexion and greater knee adduction, but there were no differences in knee motion among the control groups. During walking, the older control group exhibited greater quadriceps femoris muscle activity and the OA group used greater muscle co-contraction. Discussion and Conclusion\\ \\ Although weaker, the older control group did not use truncated motion or higher co-contraction. The maintenance of movement patterns that were similar to the subjects in the young control group may have helped to prevent development of knee OA. Further investigation is warranted regarding age-related musculoskeletal changes and their influence on the development of knee OA.
+Background and Purpose Aging is associated with musculoskeletal changes and altered walking patterns. These changes are common in people with knee osteoarthritis (OA) and may precipitate the development of OA. We examined age-related changes in musculoskeletal structures and walking patterns to better understand the relationship between aging and knee OA. Methods Forty-four individuals without OA (15 younger, 15 middle-aged, 14 older adults) and 15 individuals with medial knee OA participated. Knee laxity, quadriceps femoris muscle strength (force-generating capacity), and gait were assessed. Results Medial laxity was greater in the OA group, but there were no differences between the middle-aged and older control groups. Quadriceps femoris strength was less in the older control group and in the OA group. During the stance phase of walking, the OA group demonstrated less knee flexion and greater knee adduction, but there were no differences in knee motion among the control groups. During walking, the older control group exhibited greater quadriceps femoris muscle activity and the OA group used greater muscle co-contraction. Discussion and Conclusion Although weaker, the older control group did not use truncated motion or higher co-contraction. The maintenance of movement patterns that were similar to the subjects in the young control group may have helped to prevent development of knee OA. Further investigation is warranted regarding age-related musculoskeletal changes and their influence on the development of knee OA.
 **Tokuno CD, Carpenter MG, Thorstensson A, Garland SJ, and Cresswell AG**   "Control of the triceps surae during the postural sway of quiet standing."
@@ Line 884: / Line 883: @@
 **Domingo A, Sawicki GS, Ferris DP.**   "Kinematics and muscle activity of individuals with incomplete spinal cord injury during treadmill stepping with and without manual assistance."
 - //Journal of Neuroengineering and Rehabilitation 4:32//
-Background\\ \\ Treadmill training with bodyweight support and manual assistance improves walking ability of patients with neurological injury. The purpose of this study was to determine how manual assistance changes muscle activation and kinematic patterns during treadmill training in individuals with incomplete spinal cord injury. Methods\\ \\ We tested six volunteers with incomplete spinal cord injury and six volunteers with intact nervous systems. Subjects with spinal cord injury walked on a treadmill at six speeds (0.18–1.07 m/s) with body weight support with and without manual assistance. Healthy subjects walked at the same speeds only with body weight support. We measured electromyographic (EMG) and kinematics in the lower extremities and calculated EMG root mean square (RMS) amplitudes and joint excursions. We performed cross-correlation analyses to compare EMG and kinematic profiles. Results\\ \\ Normalized muscle activation amplitudes and profiles in subjects with spinal cord injury were similar for stepping with and without manual assistance (ANOVA, p > 0.05). Muscle activation amplitudes increased with increasing speed (ANOVA, p < 0.05). When comparing spinal cord injury subject EMG data to control subject EMG data, neither the condition with manual assistance nor the condition without manual assistance showed a greater similarity to the control subject data, except for vastus lateralis. The shape and timing of EMG patterns in subjects with spinal cord injury became less similar to controls at faster speeds, especially when walking without manual assistance (ANOVA, p < 0.05). There were no consistent changes in kinematic profiles across spinal cord injury subjects when they were given manual assistance. Knee joint excursion was ~5 degrees greater with manual assistance during swing (ANOVA, p < 0.05). Hip and ankle joint excursions were both ~3 degrees lower with manual assistance during stance (ANOVA, p < 0.05). Conclusion\\ \\ Providing manual assistance does not lower EMG amplitudes or alter muscle activation profiles in relatively higher functioning spinal cord injury subjects. One advantage of manual assistance is that it allows spinal cord injury subjects to walk at faster speeds than they could without assistance. Concerns that manual assistance will promote passivity in subjects are unsupported by our findings.
+Background Treadmill training with bodyweight support and manual assistance improves walking ability of patients with neurological injury. The purpose of this study was to determine how manual assistance changes muscle activation and kinematic patterns during treadmill training in individuals with incomplete spinal cord injury. Methods We tested six volunteers with incomplete spinal cord injury and six volunteers with intact nervous systems. Subjects with spinal cord injury walked on a treadmill at six speeds (0.18–1.07 m/s) with body weight support with and without manual assistance. Healthy subjects walked at the same speeds only with body weight support. We measured electromyographic (EMG) and kinematics in the lower extremities and calculated EMG root mean square (RMS) amplitudes and joint excursions. We performed cross-correlation analyses to compare EMG and kinematic profiles. Results Normalized muscle activation amplitudes and profiles in subjects with spinal cord injury were similar for stepping with and without manual assistance (ANOVA, p > 0.05). Muscle activation amplitudes increased with increasing speed (ANOVA, p < 0.05). When comparing spinal cord injury subject EMG data to control subject EMG data, neither the condition with manual assistance nor the condition without manual assistance showed a greater similarity to the control subject data, except for vastus lateralis. The shape and timing of EMG patterns in subjects with spinal cord injury became less similar to controls at faster speeds, especially when walking without manual assistance (ANOVA, p < 0.05). There were no consistent changes in kinematic profiles across spinal cord injury subjects when they were given manual assistance. Knee joint excursion was ~5 degrees greater with manual assistance during swing (ANOVA, p < 0.05). Hip and ankle joint excursions were both ~3 degrees lower with manual assistance during stance (ANOVA, p < 0.05). Conclusion Providing manual assistance does not lower EMG amplitudes or alter muscle activation profiles in relatively higher functioning spinal cord injury subjects. One advantage of manual assistance is that it allows spinal cord injury subjects to walk at faster speeds than they could without assistance. Concerns that manual assistance will promote passivity in subjects are unsupported by our findings.
 [[http://www.jneuroengrehab.com/content/4/1/32/abstract|Reference]]
@@ Line 893: / Line 892: @@
 **Palmieri-Smith RM, Kreinbrink J, Ashton-Miller JA, and Wojtys EM**   "Quadriceps Inhibition Induced by an Experimental Knee Joint Effusion Affects Knee Joint Mechanics During a Single-Legged Drop Landing."
 - //Am J Sports Med. 35: 1269-1275//
-Background: Arthrogenic quadriceps muscle inhibition accompanies knee joint effusion and impedes rehabilitation after knee joint injury.\\ \\ Hypothesis: We hypothesized that an experimentally induced knee joint effusion would cause arthrogenic quadriceps muscle inhibition and lead to increased ground reaction forces, as well as sagittal plane knee angles and moments, during a single-legged drop landing.\\ \\ Study Design: Controlled laboratory study.\\ \\ Methods: Nine subjects (4 women and 5 men) underwent 4 conditions (no effusion, lidocaine injection, “low” effusion [30 mL], and “high” effusion [60 mL]) and then performed a single-legged drop landing. Lower extremity muscle activity, peak sagittal plane knee flexion angles, net sagittal plane knee moments, and peak ground reaction forces were measured.\\ \\ Results: Vastus medialis and lateralis activity were decreased during the low and high effusion conditions (P < .05). However, increases in peak ground reaction forces and decreases in peak knee flexion angle and net knee extension moments occurred only during the high effusion condition (P < .05).\\ \\ Conclusions: Knee joint effusion induced quadriceps inhibition and altered knee joint mechanics during a landing task. Subjects landed with larger ground reaction forces and in greater knee extension, thereby suggesting that more force will be transferred to the knee joint and its passive restraints when quadriceps inhibition is present.\\ \\ Clinical Relevance: Knee joint effusion results in arthrogenic quadriceps muscle inhibition, increasing loading about the knee that may potentially increase the risk of future knee joint trauma or degeneration.
+Background: Arthrogenic quadriceps muscle inhibition accompanies knee joint effusion and impedes rehabilitation after knee joint injury. Hypothesis: We hypothesized that an experimentally induced knee joint effusion would cause arthrogenic quadriceps muscle inhibition and lead to increased ground reaction forces, as well as sagittal plane knee angles and moments, during a single-legged drop landing. Study Design: Controlled laboratory study. Methods: Nine subjects (4 women and 5 men) underwent 4 conditions (no effusion, lidocaine injection, “low” effusion [30 mL], and “high” effusion [60 mL]) and then performed a single-legged drop landing. Lower extremity muscle activity, peak sagittal plane knee flexion angles, net sagittal plane knee moments, and peak ground reaction forces were measured. Results: Vastus medialis and lateralis activity were decreased during the low and high effusion conditions (P < .05). However, increases in peak ground reaction forces and decreases in peak knee flexion angle and net knee extension moments occurred only during the high effusion condition (P < .05).Conclusions: Knee joint effusion induced quadriceps inhibition and altered knee joint mechanics during a landing task. Subjects landed with larger ground reaction forces and in greater knee extension, thereby suggesting that more force will be transferred to the knee joint and its passive restraints when quadriceps inhibition is present. Clinical Relevance: Knee joint effusion results in arthrogenic quadriceps muscle inhibition, increasing loading about the knee that may potentially increase the risk of future knee joint trauma or degeneration.
 **Myer GD, Ford F, Khoury J, Hewett TE**   "Clinical correlates to laboratory measures for use in non-contact anterior cruciate ligament injury risk prediction algorithm."
 - //Clinical Biomechanics 25 (2010) 693–699//
-Background: Prospective measures of high knee abduction moment during landing identify female athletes at\\ \\ high risk for non-contact anterior cruciate ligament injury. Biomechanical laboratory measurements predict high knee abduction moment landing mechanics with high sensitivity (85%) and specificity (93%). The purpose of this study was to identify correlates to laboratory-based predictors of high knee abduction moment for use in a clinic-based anterior cruciate ligament injury risk prediction algorithm. The hypothesis was that clinically obtainable correlates derived from the highly predictive laboratory-based models would demonstrate high accuracy to determine high knee abduction moment status. Methods: Female basketball and soccer players (N=744) were tested for anthropometrics, strength and landing biomechanics. Pearson correlation was used to identify clinically feasible correlates and logistic regression to obtain optimal models for high knee abduction moment prediction. Findings: Clinical correlates to laboratory-based measures were identified and predicted high knee abduction moment status with 73% sensitivity and 70% specificity. The clinic-based prediction algorithm, including(Odds Ratio: 95% confidence interval) knee valgus motion (1.43:1.30–1.59 cm), knee flexion range of motion (0.98:0.96–1.01°), body mass (1.04:1.02–1.06 kg), tibia length (1.38:1.25–1.52 cm) and quadriceps to hamstring ratio (1.70:1.06–2.70) predicted high knee abduction moment status with C statistic 0.81. Interpretation: The combined correlates of increased knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio predict high knee abduction moment status in female athletes with high sensitivity and specificity. Clinical Relevance:\\ \\ Utilization of clinically obtainable correlates with the prediction algorithm facilitates high non-contact anterior cruciate ligament injury risk athletes' entry into appropriate interventions with the greatest potential to prevent injury.
+Background: Prospective measures of high knee abduction moment during landing identify female athletes at high risk for non-contact anterior cruciate ligament injury. Biomechanical laboratory measurements predict high knee abduction moment landing mechanics with high sensitivity (85%) and specificity (93%). The purpose of this study was to identify correlates to laboratory-based predictors of high knee abduction moment for use in a clinic-based anterior cruciate ligament injury risk prediction algorithm. The hypothesis was that clinically obtainable correlates derived from the highly predictive laboratory-based models would demonstrate high accuracy to determine high knee abduction moment status. Methods: Female basketball and soccer players (N=744) were tested for anthropometrics, strength and landing biomechanics. Pearson correlation was used to identify clinically feasible correlates and logistic regression to obtain optimal models for high knee abduction moment prediction. Findings: Clinical correlates to laboratory-based measures were identified and predicted high knee abduction moment status with 73% sensitivity and 70% specificity. The clinic-based prediction algorithm, including(Odds Ratio: 95% confidence interval) knee valgus motion (1.43:1.30–1.59 cm), knee flexion range of motion (0.98:0.96–1.01°), body mass (1.04:1.02–1.06 kg), tibia length (1.38:1.25–1.52 cm) and quadriceps to hamstring ratio (1.70:1.06–2.70) predicted high knee abduction moment status with C statistic 0.81. Interpretation: The combined correlates of increased knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio predict high knee abduction moment status in female athletes with high sensitivity and specificity. Clinical Relevance: Utilization of clinically obtainable correlates with the prediction algorithm facilitates high non-contact anterior cruciate ligament injury risk athletes' entry into appropriate interventions with the greatest potential to prevent injury.
 **Wheat JS, Vernon T, Milner CE**   "The measurement of upper body alignment during the golf drive."
@@ Line 914: / Line 913: @@
 **Milner CE, Ferber R, Pollard CD, Hamill J, Davis IS**   "Biomechanical Factors Associated with Tibial Stress Fracture in Female Runners"
 - //Med. Sci. Sports Exerc., Vol. 38, No. 2, pp. 323–328, 2006//
-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 kmIwkj1, 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 mIsj1 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 increases in dynamic loading-related variables. Key Words: GROUND REACTION FORCES, KINEMATICS, TIBIAL SHOCK,\\ \\ AREA MOMENT OF INERTIA
+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 kmIwkj1, 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 mIsj1 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 increases in dynamic loading-related variables. Key Words: GROUND REACTION FORCES, KINEMATICS, TIBIAL SHOCK, AREA MOMENT OF INERTIA
 **MacLean C, McClay Davis I, and Hamill J**   "Influence of a custom foot orthotic intervention on lower extremity dynamics in healthy runners."
@@ Line 971: / Line 970: @@
 **Gatev P, Thomas S, Kepple TM, & Hallett M**   "Feedforward ankle strategy of balance during quiet stance in adults"
 - //Journal of Physiology,514.3, 915-928//
-. We studied quiet stance investigating strategies for maintaining balance. Normal subjects stood with natural stance and with feet together, with eyes open or closed. Kinematic, kinetic and EMG data were evaluated and cross-correlated.\\ \\ 2. Cross-correlation analysis revealed a high, positive, zero-phased correlation between anteroposterior motions of the centre of gravity (COG) and centre of pressure (COP), head and COG, and between linear motions of the shoulder and knee in both sagittal and frontal planes. There was a moderate, negative, zero-phased correlation between the anteroposterior motion of COP and ankle angular motion. 3. Narrow stance width increased ankle angular motion, hip angular motion, mediolateral sway of the COG, and the correlation between linear motions of the shoulder and knee in the frontal plane. Correlations between COG and COP and linear motions of the shoulder and knee in the sagittal plane were decreased. The correlation between the hip angular sway in the sagittal and frontal planes was dependent on interaction between support and vision. 4. Low, significant positive correlations with time lags of the maximum of cross-correlation of 250-300 ms were found between the EMG activity of the lateral gastrocnemius muscle and anteroposterior motions of the COG and COP during normal stance. Narrow stance width decreased both correlations whereas absence of vision increased the correlation with COP. 5. Ankle mechanisms dominate during normal stance especially in the sagittal plane. Narrow stance width decreased the role of the ankle and increased the role of hip mechanisms in the sagittal plane, while in the frontal plane both increased.\\ \\ 6. The modulation pattern of the lateral gastrocnemius muscle suggests a central program of control of the ankle joint stiffness working to predict the loading pattern.
+. We studied quiet stance investigating strategies for maintaining balance. Normal subjects stood with natural stance and with feet together, with eyes open or closed. Kinematic, kinetic and EMG data were evaluated and cross-correlated. 2. Cross-correlation analysis revealed a high, positive, zero-phased correlation between anteroposterior motions of the centre of gravity (COG) and centre of pressure (COP), head and COG, and between linear motions of the shoulder and knee in both sagittal and frontal planes. There was a moderate, negative, zero-phased correlation between the anteroposterior motion of COP and ankle angular motion. 3. Narrow stance width increased ankle angular motion, hip angular motion, mediolateral sway of the COG, and the correlation between linear motions of the shoulder and knee in the frontal plane. Correlations between COG and COP and linear motions of the shoulder and knee in the sagittal plane were decreased. The correlation between the hip angular sway in the sagittal and frontal planes was dependent on interaction between support and vision. 4. Low, significant positive correlations with time lags of the maximum of cross-correlation of 250-300 ms were found between the EMG activity of the lateral gastrocnemius muscle and anteroposterior motions of the COG and COP during normal stance. Narrow stance width decreased both correlations whereas absence of vision increased the correlation with COP. 5. Ankle mechanisms dominate during normal stance especially in the sagittal plane. Narrow stance width decreased the role of the ankle and increased the role of hip mechanisms in the sagittal plane, while in the frontal plane both increased. 6. The modulation pattern of the lateral gastrocnemius muscle suggests a central program of control of the ankle joint stiffness working to predict the loading pattern.
 **Holden JP, Stanhope SJ.**   "The Effect of Variation in Knee Center Location Estimates on Net Knee Joint Moments."
@@ Line 999: / Line 998: @@
 **Farana R, Irwin G, Jandacka D, Uchytil J, Mullineaux DR(2015)**   "Elbow joint variability for different hand positions of the round off in gymnastics"
 //[[http://www.sciencedirect.com/science/article/pii/S0167945714001882|Human Movement Science 39 (2015) 88–100]]//
-The aim of the present study was to conduct within-gymnast analyses\\ \\ of biological movement variability in impact forces, elbow joint kinematics and kinetics of expert gymnasts in the execution of the round-off with different hand positions. Six international level female gymnasts performed 10 trials of the round-off from a hurdle step to a back-handspring using two hand potions: parallel and Tshape. Two force plates were used to determine ground reaction forces. Eight infrared cameras were employed to collect the kinematic data automatically.Within gymnast variability was calculated using biological coefficient of variation (BCV) discretely for ground reaction force, kinematic and kinetic measures. Variability of the continuous data was quantified using coefficient of multiple correlations (CMC). Group BCV and CMC were calculated and T-test with effect size statistics determined differences between the variability of the two techniques examined in this study. Themajor observation\\ \\ was a higher level of biological variability in the elbow joint abduction angle and adduction moment of force in the T-shaped hand position. This finding may lead to a reduced repetitive abduction stress and thus protect the elbow joint from overload. Knowledge of the differences in biological variability can inform clinicians and practitioners with effective skill selection.
+The aim of the present study was to conduct within-gymnast analyses of biological movement variability in impact forces, elbow joint kinematics and kinetics of expert gymnasts in the execution of the round-off with different hand positions. Six international level female gymnasts performed 10 trials of the round-off from a hurdle step to a back-handspring using two hand potions: parallel and Tshape. Two force plates were used to determine ground reaction forces. Eight infrared cameras were employed to collect the kinematic data automatically.Within gymnast variability was calculated using biological coefficient of variation (BCV) discretely for ground reaction force, kinematic and kinetic measures. Variability of the continuous data was quantified using coefficient of multiple correlations (CMC). Group BCV and CMC were calculated and T-test with effect size statistics determined differences between the variability of the two techniques examined in this study. Themajor observation was a higher level of biological variability in the elbow joint abduction angle and adduction moment of force in the T-shaped hand position. This finding may lead to a reduced repetitive abduction stress and thus protect the elbow joint from overload. Knowledge of the differences in biological variability can inform clinicians and practitioners with effective skill selection.
 Farana, R., Jandacka, D., & Irwin, G. (2013). Influence of different hand positions on impact forces and elbow loading during the round off in gymnastics: A case study. Science of Gymnastics Journal, 5, 5–14.
@@ Line 1007: / Line 1006: @@
 The round-off is a fundamental gymnastics skill and a key movement in the development of elite female gymnasts. The aim of this study was to determine whether differences in hand position during the round-off may influence the ground reaction forces and elbow joint moments in female artistic gymnastics. One international level active female gymnast from the Czech Republic participated in this study. Two force plates were used to determine ground reaction forces. A motion-capture system consisting of eight infrared cameras were employed to collect the kinematic data. The gymnast performed 10 trials of a round-off from a hurdle step to back handspring with a “parallel” hand position and 10 trials with a “T” shape hand position. Effect size statistics were used to establish differences in means. In conclusion “T” position of the second hand reduces vertical and anterior-posterior ground reaction forces. Differences in joint elbow moments and elbow kinematics indicated that the “T” position may prevent elbow joint complex and reduces potential of elbow injuries.
-**Farana, R., Jandacka, D., Uchytil, J., Zahradnik, D., & Irwin, G. (2014)**\\ \\   "Musculoskeletal loading during the round-off in female\\ \\ gymnastics: The effect of hand position."
+**Farana, R., Jandacka, D., Uchytil, J., Zahradnik, D., & Irwin, G. (2014)**   "Musculoskeletal loading during the round-off in female gymnastics: The effect of hand position."
 //[[http://www.ncbi.nlm.nih.gov/pubmed/25122997|Sports Biomechanics, 13, 123–134.]]//
 Chronic elbow injuries from tumbling in female gymnastics present a serious problem for performers. This research examined how the biomechanical characteristics of impact loading and elbow kinematics and kinetics change as a function of technique selection. Seven international-level female gymnasts performed 10 trials of the round-off from a hurdle step to flic-flac with 'parallel' and 'T-shape' hand positions. Synchronized kinematic (3D-automated motion analysis system; 247 Hz) and kinetic (two force plates; 1,235 Hz) data were collected for each trial. Wilcoxon non-parametric test and effect-size statistics determined differences between the hand positions examined in this study. Significant differences (p < 0.05) and large effect sizes (ES > 0.8) were observed for peak vertical ground reaction force (GRF), anterior-posterior GRF, resultant GRF, loading rates of these forces and elbow joint angles, and internal moments of force in sagittal, transverse, and frontal planes. In conclusion, the T-shape hand position reduces vertical, anterior-posterior, and resultant contact forces and has a decreased loading rate indicating a safer technique for the round-off. Significant differences observed in joint elbow moments highlighted that the T-shape position may prevent overloading of the joint complex and consequently reduce the potential for elbow injury.
@@ Line 1031: / Line 1030: @@
 ==== Golf ====
 \\
-**Susan J. Brown, Alan M. Nevill, Stuart A. Monk, Steve R. Otto, W. Scott Selbie & Eric S. Wallace**\\ \\ ****\\ \\   "Determination of the swing technique characteristics and performance outcome relationship in golf driving for low handicap female golfers."
+**Susan J. Brown, Alan M. Nevill, Stuart A. Monk, Steve R. Otto, W. Scott Selbie & Eric S. Wallace**   "Determination of the swing technique characteristics and performance outcome relationship in golf driving for low handicap female golfers."
 - //J Sports Sci. 2011 Oct 11.//
 Previous studies on the kinematics of the golf swing have mainly focused on group analysis of male golfers of a wide ability range. In the present study, we investigated gross body kinematics using a novel method of analysis for golf research for a group of low handicap female golfers to provide an understanding of their swing mechanics in relation to performance. Data were collected for the drive swings of 16 golfers using a 12-camera three-dimensional motion capture system and a stereoscopic launch monitor. Analysis of covariance identified three covariates (increased pelvis–thorax differential at the top of the backswing, increased pelvis translation during the backswing, and a decrease in absolute backswing time) as determinants of the variance in clubhead speed (adjusted r 2 = 0.965, P < 0.05). A significant correlation was found between left-hand grip strength and clubhead speed (r = 0.54, P < 0.05) and between handicap and clubhead speed (r = −0.612, P < 0.05). Flexibility measures showed some correlation with clubhead speed; both sitting flexibility tests gave positive correlations (clockwise: r = 0.522, P < 0.05; counterclockwise: r = 0.711, P < 0.01). The results suggest that there is no common driver swing technique for optimal performance in low handicap female golfers, and therefore consideration should be given to individual swing characteristics in future studies.
 \\
-**Susan J. Brown, W. Scott Selbie & Eric S. Wallace**\\ \\ ****\\ \\   "The X-Factor: An evaluation of common methods used to analyse major inter-segment kinematics during the golf swing". Journal of Sports Sciences."
+**Susan J. Brown, W. Scott Selbie & Eric S. Wallace**   "The X-Factor: An evaluation of common methods used to analyse major inter-segment kinematics during the golf swing". Journal of Sports Sciences."
 - //J Sports Sci. (in press).//
 A common biomechanical feature of a golf swing, described in various ways in the literature, is the interaction between the thorax and pelvis, often termed the X-Factor. There is no consistent method used within golf biomechanics literature however to calculate these segment interactions. The purpose of this study was to examine data calculated using three reported methods of the X-Factor in order to determine the similarity or otherwise of the data calculated using each method. A twelve camera three-dimensional motion capture system was used to capture the driver swings of 19 participants and a subject specific three-dimensional biomechanical model was created with the position and orientation of each model estimated using a global optimization algorithm. Comparison of the X-Factor methods showed significant differences for events during the swing (p<0.05). Data for each kinematic measure were derived as a times series for all three methods and regression analysis of these data showed that whilst one method could be successfully mapped to another, the mappings between methods are subject dependent (p<0.05). Findings suggest that a consistent methodology considering the X-Factor from a joint angle approach is most insightful in describing a golf swing.
@@ Line 1074: / Line 1073: @@
 **Willy RW, Manal KT, Witvrouw EE, Davis IS..**   "Are mechanics different between male and female runners with patellofemoral pain?."
 - //Br J Sports Med. Apr;48(7):560-1//
-INTRODUCTION: Patellofemoral pain (PFP) has often been attributed to abnormal hip and knee mechanics in females. To date, there have been few investigations of the hip and knee mechanics of males with PFP. The purpose of this study was to compare the lower extremity mechanics and alignment of male runners with PFP with healthy male runners and female runners with PFP. We hypothesized that males with PFP would move with greater varus knee mechanics compared with male controls and compared with females with PFP. Furthermore, it was hypothesized that males with PFP would demonstrate greater varus alignment.\\ \\ METHODS: A gait and single-leg squat analysis was conducted on each group (18 runners per group). Measurement of each runner's tibial mechanical axis was also recorded. Motion data were processed using Visual 3D (C-Motion, Bethesda, MD). ANOVAs were used to analyze the data.\\ \\ RESULTS: Males with PFP ran and squatted in greater peak knee adduction and demonstrated greater peak knee external adduction moment compared with healthy male controls. In addition, males with PFP ran and squatted with less peak hip adduction and greater peak knee adduction compared with females with PFP. The static measure of mechanical axis of the tibial was not different between groups. However, a post hoc analysis revealed that males with PFP ran with greater peak tibial segmental adduction.\\ \\ CONCLUSION: Males with PFP demonstrated different mechanics during running and during a single-leg squat compared with females with PFP and with healthy males. Based upon the results of this study, therapies for PFP may need to be sex specific.
+INTRODUCTION: Patellofemoral pain (PFP) has often been attributed to abnormal hip and knee mechanics in females. To date, there have been few investigations of the hip and knee mechanics of males with PFP. The purpose of this study was to compare the lower extremity mechanics and alignment of male runners with PFP with healthy male runners and female runners with PFP. We hypothesized that males with PFP would move with greater varus knee mechanics compared with male controls and compared with females with PFP. Furthermore, it was hypothesized that males with PFP would demonstrate greater varus alignment. METHODS: A gait and single-leg squat analysis was conducted on each group (18 runners per group). Measurement of each runner's tibial mechanical axis was also recorded. Motion data were processed using Visual 3D (C-Motion, Bethesda, MD). ANOVAs were used to analyze the data. RESULTS: Males with PFP ran and squatted in greater peak knee adduction and demonstrated greater peak knee external adduction moment compared with healthy male controls. In addition, males with PFP ran and squatted with less peak hip adduction and greater peak knee adduction compared with females with PFP. The static measure of mechanical axis of the tibial was not different between groups. However, a post hoc analysis revealed that males with PFP ran with greater peak tibial segmental adduction. CONCLUSION: Males with PFP demonstrated different mechanics during running and during a single-leg squat compared with females with PFP and with healthy males. Based upon the results of this study, therapies for PFP may need to be sex specific.
 **Alenezi F, Herrington L, Jones P, Jones R.**   "Relationships between lower limb biomechanics during single leg squat with running and cutting tasks: a preliminary investigation."
 - //Br J Sports Med. Apr;48(7):560-1//
-BACKGROUND:\\ \\ The need to develop screening tests to find athletes who maybe predisposed to knee injuries is of prime importance in order to design individualised intervention programmes. Previous research has found 3D joint kinematics of the hip and knee during a single leg squat (SLS) to be related to those during jogging (Whatman et al., 2011). Thus, further investigation as a potential screening test is warranted. OBJECTIVE:\\ \\ To investigate the relationship between peak 3D kinematic variables during SLS with those occurring during running (RUN) and 90° cutting (CUT) tasks.\\ \\ DESIGN: A correlational study.\\ \\ SETTING: Undertaken in the human performance laboratory at the University of Salford.\\ \\ PARTICIPANTS: 15 recreational athletes, 7 males and 8 females, (age 25.2±5.1 years; height 1.6±7.38 m; and mass 67.6 ±10.93 kg) were recruited.\\ \\ INTERVENTIONS: A ten-camera motion analysis system (Qualisys) and a force platform (AMTI) were used to collect kinematic variables during SLS, RUN, & CUT tasks. Visual 3D (C-Motion, USA) was used to process all data. Pearson correlation coefficients were used to evaluate the association between 3D variables among the three tasks.\\ \\ MAIN OUTCOME MEASUREMENTS: Hip and knee joint angles.\\ \\ RESULT: SLS was strongly correlated to run in knee valgus and hip internal rotation (r=0.70 and 0.76, respectively), and showed moderate correlation with knee external rotation (0.42). SLS and CUT were moderate to strongly correlate to each other in knee valgus, knee flexion, and hip internal rotation (r=0.54, 0.69, and 0.54, respectively), and moderately in hip flexion (r=0.38).\\ \\ DISCUSSION: The findings of this study provide evidence that performance of SLS relates to performance of other tasks (running and cutting). In those individuals displaying poor motion (excessive angles) during SLS this is likely to be predictive of poor motion during running and cutting, so could negate the need for assessing individuals during these tasks.
+BACKGROUND: The need to develop screening tests to find athletes who maybe predisposed to knee injuries is of prime importance in order to design individualised intervention programmes. Previous research has found 3D joint kinematics of the hip and knee during a single leg squat (SLS) to be related to those during jogging (Whatman et al., 2011). Thus, further investigation as a potential screening test is warranted. OBJECTIVE: To investigate the relationship between peak 3D kinematic variables during SLS with those occurring during running (RUN) and 90° cutting (CUT) tasks. DESIGN: A correlational study. SETTING: Undertaken in the human performance laboratory at the University of Salford. PARTICIPANTS: 15 recreational athletes, 7 males and 8 females, (age 25.2±5.1 years; height 1.6±7.38 m; and mass 67.6 ±10.93 kg) were recruited. INTERVENTIONS: A ten-camera motion analysis system (Qualisys) and a force platform (AMTI) were used to collect kinematic variables during SLS, RUN, & CUT tasks. Visual 3D (C-Motion, USA) was used to process all data. Pearson correlation coefficients were used to evaluate the association between 3D variables among the three tasks. MAIN OUTCOME MEASUREMENTS: Hip and knee joint angles. RESULT: SLS was strongly correlated to run in knee valgus and hip internal rotation (r=0.70 and 0.76, respectively), and showed moderate correlation with knee external rotation (0.42). SLS and CUT were moderate to strongly correlate to each other in knee valgus, knee flexion, and hip internal rotation (r=0.54, 0.69, and 0.54, respectively), and moderately in hip flexion (r=0.38). DISCUSSION: The findings of this study provide evidence that performance of SLS relates to performance of other tasks (running and cutting). In those individuals displaying poor motion (excessive angles) during SLS this is likely to be predictive of poor motion during running and cutting, so could negate the need for assessing individuals during these tasks.
 **McClay I, Manal K**   "Three-dimensional kinetic analysis of running: significance of secondary planes of motion."
@@ Line 1100: / Line 1099: @@
 **Altman AR, Reisman DS, Higginson JS, and Davis IS (2012)**   "A Kinematic Comparison of Split-belt and Single-belt Treadmill Walking and the Effects of Accommodation"
 - //Gait & Posture. 2012 February; 35(2): 287–291//
-INTRODUCTION: Instrumented treadmills are becoming increasingly more common in gait laboratories. Instrumented side-split treadmills allow the collection of forces under each foot during walking. However, there may be a tendency to increase the base of support when walking on these treadmills, influencing other frontal plane mechanics as well. Therefore, the purpose of this study was to examine the effect of walking on a side-split instrumented treadmill on base of gait and frontal plane kinematics of the lower extremity.\\ \\ METHODS: Twenty subjects walked on both a split and a single-belt treadmill. Base of gait and frontal plane kinematic angles and variability data were recorded. A one-way ANOVA was used to determine differences between the single and split-belt conditions at baseline and following a 10 minute accommodation on the split-belt. The relationships between the change in base of gait and change in each kinematic variable were also determined. RESULTS:On average, the base of gait was 3.7 cm wider on the split-belt treadmill with a 4 mm gap between belts. No significant differences were observed in the mean values of lower extremity kinematics or kinematic variability at baseline or following the 10 minute accommodation. However, the increase in base of gait was significantly related to a decrease in peak knee and hip adduction angles.\\ \\ CONCLUSION:The 4 mm gap between the treadmill belts significantly increased the mean base of gait in all subjects. This did not alter mean frontal plane kinematics. However, as base of gait increased, the tendency towards hip and knee abduction also increased.
+INTRODUCTION: Instrumented treadmills are becoming increasingly more common in gait laboratories. Instrumented side-split treadmills allow the collection of forces under each foot during walking. However, there may be a tendency to increase the base of support when walking on these treadmills, influencing other frontal plane mechanics as well. Therefore, the purpose of this study was to examine the effect of walking on a side-split instrumented treadmill on base of gait and frontal plane kinematics of the lower extremity. METHODS: Twenty subjects walked on both a split and a single-belt treadmill. Base of gait and frontal plane kinematic angles and variability data were recorded. A one-way ANOVA was used to determine differences between the single and split-belt conditions at baseline and following a 10 minute accommodation on the split-belt. The relationships between the change in base of gait and change in each kinematic variable were also determined. RESULTS:On average, the base of gait was 3.7 cm wider on the split-belt treadmill with a 4 mm gap between belts. No significant differences were observed in the mean values of lower extremity kinematics or kinematic variability at baseline or following the 10 minute accommodation. However, the increase in base of gait was significantly related to a decrease in peak knee and hip adduction angles. CONCLUSION:The 4 mm gap between the treadmill belts significantly increased the mean base of gait in all subjects. This did not alter mean frontal plane kinematics. However, as base of gait increased, the tendency towards hip and knee abduction also increased.
 **Lee SJ, and Hidler J**   "Biomechanics of Overground Versus Treadmill Walking In Healthy Individuals."
@@ Line 1110: / Line 1109: @@
 Literature shows that running on an acceleratedmotorized treadmill is mechanically different from accelerated running overground. Overground, the subject has to enlarge the net anterior–posterior force impulse proportional to acceleration in order to overcome linearwhole body inertia,whereas on a treadmill, this force impulse remains zero, regardless of belt acceleration. Therefore, it can be expected that changes in kinematics and joint kinetics of the human body also are proportional to acceleration overground, whereas no changes according to belt acceleration are expected on a treadmill. This study documents kinematics and joint kinetics of accelerated running overground and running on an accelerated motorized treadmill belt for 10 young healthy subjects. When accelerating overground, groundreaction forces are characterized by less braking and more propulsion, generating a more forward-oriented ground reaction force vectorandamore forwardly inclined body comparedwith steady-state running. This change in body orientation as such is partly responsible for the changed force direction. Besides this,more pronounced hip andknee flexion at initial contact, a larger hip extension velocity, smaller knee flexion velocity and smaller initial plantarflexion velocity are associated with less braking. A larger knee extension and plantarflexion velocity result in larger propulsion. Altogether, during stance, joint moments are not significantly influenced by acceleration overground. Therefore, we suggest that the overall behaviour of the musculoskeletal system (in terms of kinematics and joint moments) during acceleration at a certain speed remains essentially identical to steady-state running at the same speed, yet acting in a different orientation. However, because acceleration implies extra mechanical work to increase the running speed, muscular effort done (in terms of power output) must be larger. This is confirmed by larger joint power generation at the level of the hip and lower power absorption at the knee as the result of subtle differences in joint velocity. On a treadmill, ground reaction forces are not influenced by acceleration and, compared with overground, virtually no kinesiological adaptations to an accelerating belt are observed. Consequently, adaptations to acceleration during running differ from treadmill to overground and should be studied in the condition of interest.
-**Ine Van Caekenberghe, Veerle Segers, Patrick Willems, Thierry Gosseye, Peter Aerts, and Dirk De Clercq**\\ \\   "Mechanics of overground accelerated running vs. running on an accelerated\\ \\ treadmill."
+**Ine Van Caekenberghe, Veerle Segers, Patrick Willems, Thierry Gosseye, Peter Aerts, and Dirk De Clercq**   "Mechanics of overground accelerated running vs. running on an accelerated treadmill."
 - //Gait & Posture 38 (2013) 125–131//
-Unsteady state gait involving net accelerations has been studied overground and on a treadmill. Yet it has never been tested if and to what extent both set-ups are mechanically equal.\\ \\ This study documents the differences in ground reaction forces for accelerated running on an instrumented runway and running on an accelerating treadmill by building a theoretical framework which is experimentally put to the test.\\ \\ It is demonstrated that, in contrast to overground, no mean fore-after force impulse should be generated to follow an accelerating treadmill due to the absence of linear whole body acceleration. Accordingly, the adaptations in the braking phase (less braking) and propulsive phase (more propulsion) to accelerate overground are not present to follow an accelerating treadmill.\\ \\ It can be concluded that running on an accelerating treadmill is mechanically different from accelerated running overground.
+Unsteady state gait involving net accelerations has been studied overground and on a treadmill. Yet it has never been tested if and to what extent both set-ups are mechanically equal. This study documents the differences in ground reaction forces for accelerated running on an instrumented runway and running on an accelerating treadmill by building a theoretical framework which is experimentally put to the test. It is demonstrated that, in contrast to overground, no mean fore-after force impulse should be generated to follow an accelerating treadmill due to the absence of linear whole body acceleration. Accordingly, the adaptations in the braking phase (less braking) and propulsive phase (more propulsion) to accelerate overground are not present to follow an accelerating treadmill. It can be concluded that running on an accelerating treadmill is mechanically different from accelerated running overground.
 **Whatman C, Hing W, Hume P.**   "Are mechanics different between male and female runners with patellofemoral pain?."
 //Phys Ther Sport. 2011 Feb;12(1):22-9//
-PURPOSE: To investigate the within-day and between-day reliability of 3D lower extremity kinematics during five lower extremity functional screening tests and to assess the association between these kinematics and those recorded during jogging.\\ \\ METHODS: Peak three-dimensional lower extremity kinematics were quantified in 25 uninjured participants during five lower extremity functional tests and jogging. A nine camera motion analysis system (Qualysis Medical AB, Sweden) was used to capture three trials of all tests. All functional tests were repeated by 10 participants one to two days later. Visual 3D (C-Motion Inc, USA) and Labview were used to process all data. Intraclass correlation coefficients (ICC) and typical errors (TE) were used to assess within- and between-day reliability of all variables. Pearson correlation coefficients were used to evaluate the association between peak joint kinematics during the functional tests and jogging.\\ \\ RESULTS: For the majority of kinematic variables the within-day reliability was excellent (ICC ≥ 0.92) and the between-day reliability was excellent to good (ICC ≥ 0.80). The correlation between kinematics of the functional tests and jogging was generally large to very large (r = 0.53 to 0.93).\\ \\ CONCLUSIONS: These results suggest these lower extremity functional screening tests should prove a useful clinical tool when assessing dynamic lower extremity alignment.
+PURPOSE: To investigate the within-day and between-day reliability of 3D lower extremity kinematics during five lower extremity functional screening tests and to assess the association between these kinematics and those recorded during jogging. METHODS: Peak three-dimensional lower extremity kinematics were quantified in 25 uninjured participants during five lower extremity functional tests and jogging. A nine camera motion analysis system (Qualysis Medical AB, Sweden) was used to capture three trials of all tests. All functional tests were repeated by 10 participants one to two days later. Visual 3D (C-Motion Inc, USA) and Labview were used to process all data. Intraclass correlation coefficients (ICC) and typical errors (TE) were used to assess within- and between-day reliability of all variables. Pearson correlation coefficients were used to evaluate the association between peak joint kinematics during the functional tests and jogging. RESULTS: For the majority of kinematic variables the within-day reliability was excellent (ICC ≥ 0.92) and the between-day reliability was excellent to good (ICC ≥ 0.80). The correlation between kinematics of the functional tests and jogging was generally large to very large (r = 0.53 to 0.93). CONCLUSIONS: These results suggest these lower extremity functional screening tests should prove a useful clinical tool when assessing dynamic lower extremity alignment.
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@@ Line 1124: / Line 1123: @@
 **Brown AM, Zifchock RA, Hillstrom HJ.(2014)**   "The effects of limb dominance and fatigue on running biomechanics."
 //[[http://www.ncbi.nlm.nih.gov/pubmed/24405748|Gait & Posture. 2014 Mar;39(3):915-9.]]//
-PURPOSE: To establish whether lower extremity limb dominance has an effect on overground running mechanics.\\ \\ BACKGROUND: In attempts to resolve unilateral pathology, physical therapists often use the restoration of symmetry as a clinical milestone. While lower limb dominance has been shown to affect lower extremity mechanics during dynamic tasks such as jump landing, its effect on running gait is poorly understood. Further, despite the role of fatigue in running mechanics and injury, the interaction between fatigue and limb dominance has yet to be examined.\\ \\ METHODS: Three-dimensional kinematic and kinetic data were collected on 20 females during overground running. Data were collected prior-to and following a treadmill run to exertion. Dominant and non-dominant limb data were compared in the fresh-state using a paired t-test. A 2-way repeated-measures ANOVA was used to test for an interaction between fatigue and limb dominance.\\ \\ RESULTS: There were no significant differences between the kinematic or kinetic patterns of the dominant and non-dominant lower extremities during fresh-state overground running. Fatigue was not shown to interact with limb dominance.\\ \\ CONCLUSION: Limb dominance did not affect kinematic or kinetic side-to-side differences. Therefore, physical therapists can continue to use resolution of lower extremity symmetry as a goal of therapy without having to account for limb dominance. The lack of an interaction between fatigue and limb dominance indicates that the dominant and non-dominant limbs fatigue at a similar rate.
+PURPOSE: To establish whether lower extremity limb dominance has an effect on overground running mechanics. BACKGROUND: In attempts to resolve unilateral pathology, physical therapists often use the restoration of symmetry as a clinical milestone. While lower limb dominance has been shown to affect lower extremity mechanics during dynamic tasks such as jump landing, its effect on running gait is poorly understood. Further, despite the role of fatigue in running mechanics and injury, the interaction between fatigue and limb dominance has yet to be examined.METHODS: Three-dimensional kinematic and kinetic data were collected on 20 females during overground running. Data were collected prior-to and following a treadmill run to exertion. Dominant and non-dominant limb data were compared in the fresh-state using a paired t-test. A 2-way repeated-measures ANOVA was used to test for an interaction between fatigue and limb dominance. RESULTS: There were no significant differences between the kinematic or kinetic patterns of the dominant and non-dominant lower extremities during fresh-state overground running. Fatigue was not shown to interact with limb dominance. CONCLUSION: Limb dominance did not affect kinematic or kinetic side-to-side differences. Therefore, physical therapists can continue to use resolution of lower extremity symmetry as a goal of therapy without having to account for limb dominance. The lack of an interaction between fatigue and limb dominance indicates that the dominant and non-dominant limbs fatigue at a similar rate.
 \\