Table Of ContentPatellofemoral joint and Achilles tendon loads during overground and treadmill
running
Richard W. Willy, PhD, PT, OCS1, Lisa Halsey, DPT1, Andrew Hayek, DPT 1, Holly
n. Johnson, BS1, John D. Willson, PhD, PT1
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out 1Department of Physical Therapy, East Carolina University, Greenville, NC, USA.
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h Key words: running, patellofemoral joint, Achilles tendon, biomechanics
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use Compliance with Ethical Standards:
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pers The authors have no declared conflicts of interest and there are no disclosures of
or
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Melbourne - Faculties on June 15, 2016. Physical Therapy®. All rights reserved. ptprheraeosre ftreicaesirspscuaiholnt nspt saroo lp ftr ortehicolaiosrt l it poowrn eaesssnhe riaopnplstl pm swrteouitnvdhety cdi.no W bmthyrp iisttaht einenni veE aesans osdtitrg vCmaeatairorbnonauli.lfn aPcacor itUnousrnr eeitvornse ti rnwwsiithatiyaos t Hiomoubnamt ayo/aifnw nteih ldSli s buf resbotnjumeedcf yitats ,lf l rthoem
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East Carolina University
Greenville, NC 27834
Overground
and
treadmill
comparison
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tendon
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Patellofemoral joint and Achilles tendon loads during overground and treadmill
running
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ut The authors have no declared conflicts of interest and there are no disclosures of
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uses professional relationships with companies or manufacturers who may/will benefit from
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No the results of this present study. Written and verbal consent was obtained from all
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us participants prior to enrollment in this investigation. Prior to initiation of this study, the
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Overground
and
treadmill
comparison
of
patellofemoral
joint
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Achilles
tendon
loads,
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Abstract
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Study design: Level 4: Controlled laboratory study.
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Background: Little is known regarding potential differences between treadmill and
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overground running in regards to patellofemoral joint and Achilles tendon loading
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characteristics.
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Objectives: We sought to compare measures of loading to the patellofemoral joint and
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Achilles tendon across treadmill and overground running in healthy, uninjured runners.
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Methods: Eighteen healthy runners ran at their self-selected speed on an instrumented
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treadmill and overground while three-dimensional running mechanics were sampled. A
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detect differences and assess relationships, respectively, between the two running
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force (p<0.001) and 14.2% greater estimated cumulative Achilles tendon force per 1
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kilometer of continuous running (p<0.001) compared with overground running. There
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were strong (r>0.70) and moderate agreements (r>0.50) for most patellofemoral joint
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and Achilles measures, respectively, between treadmill and overground running.
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Conclusions: No differences were observed in loading characteristics to the
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patellofemoral joint between running mediums, yet treadmill running resulted in greater
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Achilles tendon loading compared with overground running, Future investigations
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should determine if sudden bouts of treadmill running places the Achilles tendon at risk
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for mechanical overload in runners who habitually train overground.
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Key words: Knee, ankle, biomechanics, musculoskeletal model
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Overground
and
treadmill
comparison
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patellofemoral
joint
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Achilles
tendon
loads,
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Introduction
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The patellofemoral joint and Achilles tendon are among the most common sites of
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injuries sustained by runners. More specifically, patellofemoral pain and Achilles
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tendinopathy represents up to 25% and 9.5% of all running injuries, respectively. 31, 46
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As a result of the high prevalence associated with these injuries, it is not surprising that
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individuals with these injuries make up a large portion of patients in sports medicine
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clinics.15, 35
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Factors previously related to patellofemoral pain and Achilles tendinopathy in runners
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include injury history, age, strength deficits, training errors, structural issues, biological
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Melbourne - Faculties on June 15, 2016. Physical Therapy®. All rights reserved. 33448901
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Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at The University of Copyright © ${year} Journal of Orthopaedic & Sports 4444423456
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are restricted. Treadmills are also routinely used in clinical gait analysis and gait
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retraining programs due to the ability to evaluate and retrain running mechanics in a
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controlled environment.4, 13, 43 Further, treadmills are often a fixture in training programs
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and return to running programs after injury to the patellofemoral joint or Achilles tendon.
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Instrumented treadmills are now commonly used in biomechanical studies of ankle and
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knee mechanics during running.8, 29, 30, 40, 52 In particular, instrumented treadmills enable
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the study of repetitive gait cycles and facilitate more in-depth analyses, such as exertion
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and gait modification studies.23, 51 Despite their common use in either of these
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applications, little is known regarding the potential differences of loading to the
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patellofemoral joint and the Achilles tendon during overground and treadmill running.
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Seminal biomechanical comparisons between treadmill and overground running
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suggest that these running mediums have largely similar knee and ankle kinematics,
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particularly in the sagittal plane.20, 40 However, potential differences in joint kinetics exist,
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moment likely closely relates to peak quadriceps force 2 which in turn greatly influences
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moment and eccentric ankle joint power may be as much as 14% and 16% higher,
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respectively, during treadmill running 40 suggesting greater Achilles tendon demands.
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Previous work has also investigated temporospatial differences between treadmill and
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overground running that can have an important effect on cumulative loading for the
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patellofemoral joint and Achilles tendon. Compared with overground, runners tend to
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adopt 1-5% shorter step length during treadmill running.18, 40 This potentially important
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temporospatial difference may have consequences for patellofemoral joint and Achilles
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tendon loading. Firstly, a shorter step length during treadmill running may indicate a
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shorter stance phase which may, in turn, result in a greater loading rate of the
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patellofemoral joint and Achilles tendon if peak loads are of the same or greater
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magnitude as overground running. Secondly, the shorter step length associated with
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treadmill running may result in a greater number of steps i.e., loading cycles, to cover a
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given distance which may in turn increase cumulative loading on the patellofemoral joint
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and Achilles tendon during a sustained run.
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treadmill running would result in reduced peak patellofemoral joint stress and
Journal of Orthopaedic & Sports Physical Therapy Downloaded from www.jospt.org at The Universit Copyright © ${year} Journal of Orthopaedic & Sp 8899989012
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Prior to study initiation, the research protocol was approved by the East Carolina
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University Institutional Human Subjects Research Board. An a priori sample size
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estimate was conducted to determine the number of participants necessary to detect
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differences between conditions. Using α = 0.05, β = 0.2, and means and variability of
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the peak knee extensor and plantarflexor moments between running overground and on
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a treadmill from Riley and colleagues40, 18 participants were conservatively determined
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to be necessary to adequately power this study. For this investigation, we recruited 18
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recreational runners (9 males, 9 females) from a large university and area running
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clubs.
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All participants provided written and verbal consent prior to enrollment. In order to
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qualify, all participants were required to be habitual runners (defined as at least 10
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km/week for at least the previous 6 months), free of any lower extremity surgeries and
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defined as a score of at least “8” on a visual analog scale (“0” and “10” corresponding to
Journal of Orthopaedic & Sports Physical Therapy Downloaded from www.jospt.org at The Universit Copyright © ${year} Journal of Orthopaedic & Sp 111111111101234
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trunk of each participant. Static calibration and dynamic hip trials28 were collected. The
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pelvis coordinate system was defined by markers placed on the midline of the iliac
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crests and the greater trochanters. The thigh coordinate system was defined proximally
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by the calculated hip joint center from the dynamic hip trial and distally by the femoral
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condyles. The shank coordinate system was defined proximally by the tibial condyles
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and distally by the malleoli. Finally, the foot was defined proximally by the malleoli and
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distally by the 1st and 5th metatarsal heads and the distal aspect of the shoe. Tracking
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markers consisted of markers placed on the anterior superior iliac spines and shell-
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mounted clusters on the sacrum, posterolateral aspect of the thigh and shank, and a
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cluster of three markers on the rearfoot. This is a common marker set configuration and
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was similar to the marker set used by Fellin et al. (2010), a study of comparison for the
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present investigation.20
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After a 6-minute treadmill accommodation period,34 3-dimensional running mechanics
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treadmill accommodation period. Ground reaction forces and marker trajectories were
Journal of Orthopaedic & Sports Physical Therapy Downloaded from www.jospt.org at The Universit Copyright © ${year} Journal of Orthopaedic & Sp 111113333334567
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minutes of sustained running and an approximately 10-minute rest period was provided
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to each runner between the end of treadmill testing and initiation of overground testing
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to minimize fatigue.
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Next, 3-D overground running mechanics were sampled as runners traversed a 25-
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meter runway at their same self-selected running speed (±3%) used during the treadmill
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running. Each runner practiced execution of the overground trials for several minutes to
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accommodate to the overground collection procedures, including establishment of
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running speed and runway starting position. Displacement of a single marker attached
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to the sacrum has previously been demonstrated to correspond to the displacement of a
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runner’s estimated center of mass.21, 22 Therefore, we tracked the anterior velocity of a
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sacral marker in real-time to measure running speed as the runner traversed force
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plates flush with the runway floor (AMTI, Watertown, Mass, USA). In post-processing,
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this method for tracking overground running velocity was highly correlated to the
F
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in which the participant was visibly changing velocity in the capture volume or when the
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Journal of Orthopaedic & Sports Physical Therapy Downloaded from www.jospt.org at The Universit Copyright © ${year} Journal of Orthopaedic & Sp 111111555556567890
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The order of testing (treadmill first followed by overground testing) was chosen to
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determine each participant’s safe self-selected running speed for the treadmill trials. In
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testing during protocol development, pilot subjects tended to self-select a running speed
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patellofemoral
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Description:running. Richard W. Willy, PhD, PT, OCS1, Lisa Halsey, DPT1, Andrew Hayek, Achilles tendon across treadmill and overground running in healthy,
