Effects of Body Weight Support in Running on Achilles Tendon Loading

Abstract

Achilles tendon (AT) tendinopathy is common in runners. Repetitive AT loading may play a role in etiology. Interventions such as body weight support (BWS) may reduce loading on the AT in running. Examine how ground reaction force, AT loading, foot strike, and cadence variables change in running with BWS. Twenty-four healthy female runners free from injury were examined. Participants ran on an instrumented treadmill with and without BWS using a harness-based system at a standardized speed. The system has 4 elastic cords affixed to a harness that is attached to a frame-like structure. Kinematic data and kinetic data were used in a musculoskeletal model (18 segments and 16 degrees of freedom) to determine AT loading variables, foot strike angle, and cadence. Paired t-tests were used to compare each variable between conditions. Ground reaction force was 9.0% lower with BWS (p<.05). Peak AT stress, force, and impulse were 9.4, 11.7%, and 14.8% lower when using BWS in running compared to no support (p<.05). Foot strike angle was similar (p<.05) despite cadence being reduced (p<.05). BWS may reduce AT loading and impulse variables during running. This may be important in rehabilitation efforts.

Key words

ankle - modeling - kinetics - kinematics

• References

• 1 Francis P, Whatman C, Sheerin K. et al. The proportion of lower limb running injuries by gender, anatomical location and specific pathology: A systematic review. J Sports Sci Med 2019; 18: 21-31
• 2 Carcia CR, Martin RL, Houck J. et al. Achilles pain, stiffness, and muscle power deficits: achilles tendinitis. J Orthop Sports Phys Ther 2010; 40: A1-A26
• 3 Almonroeder T, Willson JD, Kernozek TW. The effect of foot strike pattern on Achilles tendon load during running. Ann Biomed Eng 2013; 41: 1758-1766
• 4 Apte S, Plooij M, Vallery H. Influence of body weight unloading on human gait characteristics: a systematic review. J Neuroeng Rehabil 2018; 15: 53
• 5 Lyght M, Nockerts M, Kernozek TW. et al. Effects of foot strike and step frequency on achilles tendon stress during running. J Appl Biomech 2016; 32: 365-372
• 6 Silbernagel KG, Thomeé R, Eriksson BI. et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: A randomized controlled study. Am J Sports Med 2007; 35: 897-906
• 7 Smoliga JM, Wirfel LA, Paul D. et al. Effects of unweighting and speed on in-shoe regional loading during running on a lower body positive pressure treadmill. J Biomech 2015; 48: 1950-1956
• 8 Fenuta AM, Hicks AL. Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI. Biomed Res Int 2014; 2014: 632765
• 9 Flynn TW, Canavan PK, Cavanagh PR. et al. Plantar pressure reduction in an incremental weight-bearing system. Phys Ther 1997; 77: 410-416
• 10 Ogston JB, Crowell RD, Konowalchuk BK. Graded group exercise and fear avoidance behavior modification in the treatment of chronic low back pain. J Back Musculoskelet Rehabil 2016; 29: 673-684
• 11 Barela AMF, de Freitas PB, Celestino ML. et al. Ground reaction forces during level ground walking with body weight unloading. Braz J Phys Ther 2014; 18: 572-579
• 12 Fischer AG, Wolf A. Assessment of the effects of body weight unloading on overground gait biomechanical parameters. Clin Biomech (Bristol, Avon) 2015; 30: 454-461
• 13 Ertman B, Dade R, Vannatta CN. et al. Offloading effects on impact forces and patellofemoral joint loading during running in females. Gait Posture 2022; 93: 212-217
• 14 Arampatzis A, Karamanidis K, Mademli L. et al. Plasticity of the human tendon to short- and long-term mechanical loading. Exerc Sport Sci Rev 2009; 37: 66-72
• 15 Kjaer M, Langberg H, Miller BF. et al. Metabolic activity and collagen turnover in human tendon in response to physical activity. J Musculoskelet Neuronal Interact 2005; 5: 41-52
• 16 Maganaris CN, Chatzistergos P, Reeves ND. et al. Quantification of internal stress-strain fields in human tendon: Unraveling the mechanisms that underlie regional tendon adaptations and mal-adaptations to mechanical loading and the effectiveness of therapeutic eccentric exercise. Front Physiol 2017; 8: 91
• 17 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
• 18 van den Bogert AJ, Geijtenbeek T, Even-Zohar O. et al. A real-time system for biomechanical analysis of human movement and muscle function. Med Biol Eng Comput 2013; 51: 1069-1077
• 19 Fellin RE, Rose WC, Royer TD. et al. Comparison of methods for kinematic identification of footstrike and toe-off during overground and treadmill running. J Sci Med Sport 2010; 13: 646-650
• 20 Koivunen-Niemelä T, Parkkola K. Anatomy of the Achilles tendon (tendo calcaneus) with respect to tendon thickness measurements. Surg Radiol Anat 1995; 17: 263-268
• 21 Bell AL, Pedersen DR, Brand RA. A comparison of the accuracy of several hip center location prediction methods. J Biomech 1990; 23: 617-621
• 22 de Leva P. Adjustments to Zatsiorsky-Seluyanov’s segment inertia parameters. J Biomech 1996; 29: 1223-1230
• 23 Delp SL, Loan JP, Hoy MG. et al. An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng 1990; 37: 757-767
• 24 Xia Y, Feng G. An improved neural network for convex quadratic optimization with application to real-time beamforming. Neurocomputing 2005; 64: 359-374
• 25 Falisse A, Van Rossom S, Gijsbers J. et al. OpenSim versus human body model: A comparison study for the lower limbs during gait. J Appl Biomech 2018; 1-7
• 26 Kernozek T, Gheidi N, Ragan R. Comparison of estimates of Achilles tendon loading from inverse dynamics and inverse dynamics-based static optimisation during running. J Sports Sci 2017; 35: 2073-2079
• 27 Altman AR, Davis IS. A kinematic method for footstrike pattern detection in barefoot and shod runners. Gait Posture 2012; 35: 298-300
• 28 Starbuck C, Bramah C, Herrington L. et al. The effect of speed on Achilles tendon forces and patellofemoral joint stresses in high-performing endurance runners. Scand J Med Sci Sports 2021; 31: 1657-1665
• 29 Riley PO, Dicharry J, Franz J. et al. A kinematics and kinetic comparison of overground and treadmill running. Med Sci Sports Exerc 2008; 40: 1093-1100
• 30 Masumoto K, Joerger J, Mercer JA. Influence of stride frequency manipulation on muscle activity during running with body weight support. Gait Posture 2018; 61: 473-478
• 31 Grabowski AM, Kram R. Effects of velocity and weight support on ground reaction forces and metabolic power during running. J Appl Biomech 2008; 24: 288-297
• 32 Lorimer AV, Hume PA. Achilles tendon injury risk factors associated with running. Sports Med 2014; 44: 1459-1472
• 33 Saxena A, Granot A. Use of an anti-gravity treadmill in the rehabilitation of the operated Achilles tendon: a pilot study. J Foot Ankle Surg 2011; 50: 558-561