The effects of alignment of an articulated ankle-foot orthosis on lower limb joint kinematics and kinetics during gait in individuals post-stroke

Mechanical tuning of an ankle-foot orthosis (AFO) is important in improving gait in individuals post-stroke. Alignment and resistance are two factors that are tunable in articulated AFOs. The aim of this study was to investigate the effects of changing AFO ankle alignment on lower limb joint kinematics and kinetics with constant dorsiflexion and plantarflexion resistance in individuals post-stroke. Gait analysis was performed on 10 individuals post-stroke under four distinct alignment conditions using an articulated AFO with an ankle joint whose alignment is adjustable in the sagittal plane. Kinematic and kinetic data of lower limb joints were recorded using a Vicon 3-dimensional motion capture system and Bertec split-belt instrumented treadmill. The incremental changes in the alignment of the articulated AFO toward dorsiflexion angles significantly affected ankle and knee joint angles and knee joint moments while walking in individuals post-stroke. No significant differences were found in the hip joint parameters. The alignment of the articulated AFO was suggested to play an important role in improving knee joint kinematics and kinetics in stance through improvement of ankle joint kinematics while walking in individuals post-stroke. Future studies should investigate long-term effects of AFO alignment on gait in the community in individuals post-stroke.     

Fatigue effects on the coordinative pattern during cycling: Kinetics and kinematics evaluation

The aim of the present study was to analyze the net joint moment distribution, joint forces and kinematics during cycling to exhaustion. Right pedal forces and lower limb kinematics of ten cyclists were measured throughout a fatigue cycling test at 100% of PO_MAX. The absolute net joint moments, resultant force and kinematics were calculated for the hip, knee and ankle joint through inverse dynamics. The contribution of each joint to the total net joint moments was computed. Decreased pedaling cadence was observed followed by a decreased ankle moment contribution to the total joint moments in the end of the test. The total absolute joint moment, and the hip and knee moments has also increased with fatigue. Resultant force was increased, while kinematics has changed in the end of the test for hip, knee and ankle joints. Reduced ankle contribution to the total absolute joint moment combined with higher ankle force and changes in kinematics has indicated a different mechanical function for this joint. Kinetics and kinematics changes observed at hip and knee joint was expected due to their function as power sources. Kinematics changes would be explained as an attempt to overcome decreased contractile properties of muscles during fatigue.     

The effects of fatigue on the resultant joint moment, agonist and antagonist electromyographic activity at different angles during dynamic knee extension efforts.

Examination of the effects of fatigue on antagonist function can provide information on the role of antagonists in limiting the resultant joint moment and stabilizing the knee. Therefore, the purpose of this study was to examine the moment, agonist and antagonist electromyographic (EMG) activity levels at different angular positions during an isokinetic muscular endurance knee extension test. Fifteen healthy males (age 22.6+/-1.9 yr) performed 34 maximal isokinetic concentric efforts of the knee extensors at 120 degrees s(-1). The EMG activity of vastus medialis and biceps femoris was recorded using surface electrodes. The motion ranged from 90 degrees to 0 degrees of knee flexion. The average moment and average EMG (AEMG) at 10-35 degrees, 36-55 degrees and 56-80 degrees angular position intervals were calculated for each repetition. Twenty eight efforts were further analysed. The moment of force demonstrated a decline of 70% at the end of the test. Two-way repeated measures analysis of variance tests indicated that this decline was significant (p < 0.05). No significant effects of angular position on fatigue moment characteristics were found. The agonist (vastus medialis) AEMG during the first repetition demonstrated a significant increase of 40-60% towards the middle part of the test (p < 0.05). In the second part of the test, the VM AEMG at longer muscle lengths was significantly higher compared to the initial efforts whereas the AEMG at short muscle lengths returned to initial values. The antagonist AEMG at all angular positions did not change significantly during the test. The decline in the resultant joint moment could be attributed to the effects of fatigue on the agonist muscle function. The agonist AEMG fatigue-patterns are dependent on the length of the muscle and may be due to alterations in the motor unit recruitment and/or activation failure in the quadriceps muscle. The biceps femoris maintains constant submaximal (21-33% of the maximum) AEMG activity which may play an important role in the stability of the knee joint. The contribution of antagonist activity to the resultant joint moment increases during the last part of an isokinetic concentric muscle endurance test.     

The influence of step-down technique on lower extremity mechanics during curb descent

When stepping down from a curb, individuals typically make initial ground contact with either their rearfoot or forefoot. The purpose of this study was to compare vertical ground reaction forces, lower extremity mechanics, and intra-limb work distribution when individuals adopt a rearfoot technique vs. a forefoot technique, during simulated curb descent. Sixteen subjects stepped down from a platform with both a rearfoot and a forefoot technique. Vertical ground reaction forces and sagittal plane joint kinematics and kinetics were examined for the lead limb during the step-down task. Paired t-tests were used for comparison. Subjects demonstrated greater ankle joint power and negative work, and less hip joint power and negative work, with the forefoot technique vs. the rearfoot technique. Total lower extremity negative work was greater for the forefoot technique vs. the rearfoot technique. The percent contribution to the total negative work was greater for the ankle joint, and less for the hip and knee joints, with the forefoot technique vs. the rearfoot technique. The results of this study may provide insight into how curb descent technique can be modified to alter lower extremity loading.     

The Degrees of Freedom Problem in Human Standing Posture: Collective and Component Dynamics

The experiment was setup to investigate the coordination and control of the degrees of freedom (DFs) of human standing posture with particular reference to the identification of the collective and component variables. Subjects stood in 3 postural tasks: feet side by side, single left foot quiet stance and single left foot stance with body rocking at the ankle joint in the sagittal plane. All three postural tasks showed very high coherence (∼1) of center of pressure (COP) - center of mass (COM) in the low frequency range. The ankle and hip coherence was mid range (∼.5) with the tasks having different ankle/hip compensatory cophase patterns. The findings support the view that the in-phase relation of the low frequency components of the COP-COM dynamic is the collective variable in the postural tasks investigated. The motions of the individual joints (ankle, knee, hip, neck) and couplings of pair wise joint synergies (e.g., ankle-hip) provide a supporting cooperative role to the preservation of the collective variable in maintaining the COM within the stability region of the base of support (BOS) and minimizing the amount of body motion consistent with the task constraint.     

Biomechanics of overground vs. treadmill walking in healthy individuals.

The goal of this study was to compare treadmill walking with overground walking in healthy subjects with no known gait disorders. Nineteen subjects were tested, where each subject walked on a split-belt instrumented treadmill as well as over a smooth, flat surface. Comparisons between walking conditions were made for temporal gait parameters such as step length and cadence, leg kinematics, joint moments and powers, and muscle activity. Overall, very few differences were found in temporal gait parameters or leg kinematics between treadmill and overground walking. Conversely, sagittal plane joint moments were found to be quite different, where during treadmill walking trials, subjects demonstrated less dorsiflexor moments, less knee extensor moments, and greater hip extensor moments. Joint powers in the sagittal plane were found to be similar at the ankle but quite different at the knee and hip joints. Differences in muscle activity were observed between the two walking modalities, particularly in the tibialis anterior throughout stance, and in the hamstrings, vastus medialis and adductor longus during swing. While differences were observed in muscle activation patterns, joint moments and joint powers between the two walking modalities, the overall patterns in these behaviors were quite similar. From a therapeutic perspective, this suggests that training individuals with neurological injuries on a treadmill appears to be justified.     

Changes in knee function associated with treadmill ambulation

A comparison of level walking, on a walkway and on a treadmill, was performed using ten normal subjects. Motion about the knee was measured using a triaxial electrogoniometer, and foot-floor contact patterns were recorded by means of four foot switches attached to the sole of each shoe. On the walkway, the data were collected with the subject moving at a comfortable walking speed. The treadmill was then set at the average velocity obtained on the walkway. Knee joint rotation in the coronal and transverse planes did not change significantly between the walkway and the treadmill. In the sagittal plane, significant differences were found for total motion (p less than 0.01), swing phase motion (p less than 0.01), knee position at heel strike (p less than 0.05), and maximum swing phase extension (p less than 0.01). A comparison of the foot-floor contact patterns between walkway and treadmill ambulation revealed reduced heel contact time, with an increase in toe contact while on the treadmill. It was concluded that sagittal plane knee kinematics during level treadmill walking differ significantly from level overground walking.     

Non-linear changes of lower extremity kinetics prior to gait transition

IntroductionThe purpose of this study was to examine the changes of lower extremity kinetics during walk-to-run (WR) transition and if the changes would follow a non-linear trend within the five strides before WR transition using a constant acceleration protocol.MethodsFourteen participants performed gait transition on the instrumented treadmill at a constant acceleration. Peak, time to peak, and movement and power of hip, knee and ankle joints were recorded and analyzed in sagittal plane for five strides before gait transition. Three Two-way MANOVA were employed to examine the differences of kinetic measures among the five strides. Univariate analysis and Post-Hoc Tukey’s test would be applied if needed. Also, Post hoc polynomial trend analyses were used to examine the trend of the kinetic measures that significantly changed during the five strides.ResultsCompared to the first four strides, significant differences were observed for peaks moments, joint powers, and time to peaks in the last stride before running at ankle, knee, and hip joints respectively. In general, the changes of kinetic variables were following a quadratic trend during the five strides before running.ConclusionJoint kinetic measures actively change in non-linear patterns during the five strides before running to prepare for the gait transition, indicating that the gait transition is an active reorganization rather than a passive reaction.     

Effects of gender and foot-landing techniques on lower extremity kinematics during drop-jump landings

The purpose of this study was to assess kinematic lower extremity motion patterns (hip flexion, knee flexion, knee valgus, and ankle dorsiflexion) during various foot-landing techniques (self-preferred, forefoot, and rear foot) between genders. 3-D kinematics were collected on 50 (25 male and 25 female) college-age recreational athletes selected from a sample of convenience. Separate repeated-measures ANOVAs were used to analyze each variable at three time instants (initial contact, peak vertical ground reaction force, and maximum knee flexion angle). There were no significant differences found between genders at the three instants for each variable. At initial contact, the forefoot technique (35.79 degrees +/- 11.78 degrees ) resulted in significantly (p = .001) less hip flexion than did the self-preferred (41.25 degrees +/- 12.89 degrees ) and rear foot (43.15 degrees +/- 11.77 degrees ) techniques. At peak vertical ground reaction force, the rear foot technique (26.77 degrees +/- 9.49 degrees ) presented significantly lower (p = .001) knee flexion angles as compared with forefoot (58.77 degrees +/- 20.00 degrees ) and self-preferred (54.21 degrees +/- 23.78 degrees ) techniques. A significant difference for knee valgus angles (p = .001) was also found between landing techniques at peak vertical ground reaction force. The self-preferred (4.12 degrees +/- 7.51 degrees ) and forefoot (4.97 degrees +/- 7.90 degrees ) techniques presented greater knee varus angles as compared with the rear foot technique (0.08 degrees +/- 6.52 degrees ). The rear foot technique created more ankle dorsiflexion and less knee flexion than did the other techniques. The lack of gender differences can mean that lower extremity injuries (e.g., ACL tears) may not be related solely to gender but may instead be associated with the landing technique used and, consequently, the way each individual absorbs jump-landing energy.     

Ambulation in simulated fractional gravity using lower body positive pressure: cardiovascular safety and gait analyses.

The purpose of this study is to assess cardiovascular responses to lower body positive pressure (LBPP) and to examine the effects of LBPP unloading on gait mechanics during treadmill ambulation. We hypothesized that LBPP allows comfortable unloading of the body with minimal impact on the cardiovascular system and gait parameters. Fifteen healthy male and female subjects (22-55 yr) volunteered for the study. Nine underwent noninvasive cardiovascular studies while standing and ambulating upright in LBPP, and six completed a gait analysis protocol. During stance, heart rate decreased significantly from 83 +/- 3 beats/min in ambient pressure to 73 +/- 3 beats/min at 50 mmHg LBPP (P < 0.05). During ambulation in LBPP at 3 mph (1.34 m/s), heart rate decreased significantly from 99 +/- 4 beats/min in ambient pressure to 84 +/- 2 beats/min at 50 mmHg LBPP (P < 0.009). Blood pressure, brain oxygenation, blood flow velocity through the middle cerebral artery, and head skin microvascular blood flow did not change significantly with LBPP. As allowed by LBPP, ambulating at 60 and 20% body weight decreased ground reaction force (P < 0.05), whereas knee and ankle sagittal ranges of motion remained unaffected. In conclusion, ambulating in LBPP has no adverse impact on the systemic and head cardiovascular parameters while producing significant unweighting and minimal alterations in gait kinematics. Therefore, ambulating within LBPP is potentially a new and safe rehabilitation tool for patients to reduce loads on lower body musculoskeletal structures while preserving gait mechanics.     

Joint-specific power production and fatigue during maximal cycling

Cycling power decreases substantially during a maximal cycling trial of just 30 s. It is not known whether movement patterns and joint powers produced at each joint decrease to a similar extent or if each joint exhibits an individual fatigue profile. Changes in movement patterns and/or joint powers associated with overall task fatigue could arise from several different mechanisms or from a complex interplay of these mechanisms. The purpose of this investigation was to determine the changes in movement and power at each joint during a fatiguing cycling trial. Thirteen trained cyclists performed a 30 s maximal cycling trial on an isokinetic cycle ergometer at 120 rpm. Pedal forces and limb kinematics were recorded. Joint powers were calculated using a sagittal plane inverse dynamics model and averaged for the initial, middle, and final three second intervals of the trial, and normalized to initial values. Relative ankle plantar flexion power was significantly less than all other joint actions at the middle interval (51±5% of initial power; p=0.013). Relative ankle plantar flexion power for the final interval (37±3%) was significantly less than the relative knee flexion and hip extension power (p=0.010). Relative knee extension power (41±5%) was significantly less than relative hip extension power (55±4%) during the final three second interval (p=0.045). Knee flexion power (47±5%) did not differ from relative hip extension power (p=0.06). These changes in power were accompanied by a decrease in time spent extending by each joint with fatigue (i.e., decreased duty cycle, p<0.03). While central mechanisms may have played a role across all joints, because the ankle fatigued more than the hip and knee joints, either peripheral muscle fatigue or changes in motor control strategies were identified as the potential mechanisms for joint-specific fatigue during a maximal 30 s cycling trial.     

High day-to-day repeatability of lower extremity muscle activation patterns and joint biomechanics of dual-belt treadmill gait: A reliability study in healthy young adults

PurposeThe reliability of lower extremity muscle activation patterns has not been clearly studied in a dual-belt instrumented treadmill environment. The primary study objective was to quantify the day-to-day reliability of quadriceps, hamstrings, gastrocnemius and gluteus medius activation patterns in healthy young adult gait. Secondarily, the reliability of spatiotemporal, and knee/hip motion and moment-based gait outcomes was assessed.Scope: 20 young adults were recruited and tested on two separate days. Using standardized procedures, participants were prepared for surface electromyography and lower extremity motion capture. All individuals walked on a dual-belt instrumented treadmill while muscle activation, segment motions and ground reaction forces were recorded. Sagittal plane motion and net external sagittal and frontal plane moments were calculated. Discrete biomechanical and muscle activation measures were calculated, and non-negative matrix factorization extracted amplitude and temporal muscle activation features. Intraclass Correlation Coefficients, Standard Error of Measurement and Minimum Detectable Change were calculated.ConclusionsHigh to excellent Intraclass correlation coefficients were found between visits for most primary and secondary outcomes. The absolute and relative reliability, including Minimum Detectable Change values, provided in this study support the use of dual-belt instrumented treadmill walking as an acceptable medium to collect biomechanical and lower extremity EMG outcomes for future studies.     

A laboratory captured ‘giving way’ episode during a single-leg landing task in an individual with unilateral chronic ankle instability

An episode of ‘giving way’ at the ankle is described as excessive inversion of the rearfoot that does not result in an acute ankle sprain and is a unique feature associated with chronic ankle instability (CAI). Limited data currently exists describing the preparatory movement patterns and those that occur during an episode of ‘giving way. Therefore, this case report describes the movement patterns and the forces generated during an unintentional ‘giving way’ captured while an individual with unilateral CAI was performing a single-leg landing task in a research laboratory. The participant completed five single-leg landing trials for both limbs. 3D lower extremity kinematics and kinetics for the sagittal and frontal plane were extracted from 200 ms before and after initial contact (IC). Relative to the affected and un-affected single-leg landing trials, the ‘giving way’ episode was characterized by an increase in plantarflexion and hip extension moments before and after IC. The plantarflexion deviation dissipated (50 ms post-IC) and was followed by excessive ankle inversion. The ankle began to plantarflex again (150 ms post-IC) and the knee extended (50 ms post-IC) and adducted (100 ms post-IC). As a result, the ankle inversion angle plateaued at 150 ms post-IC. Furthermore, large sagittal plane internal joint moments were observed. In the frontal plane, the ‘giving way’ trial generated a large inversion joint moment which was counteracted by a large internal eversion joint moment. The observed plantarflexion and knee extension and adduction after initial contact likely contributed to preventing the ankle from continuing to invert and avoid an ankle sprain.     

Effect of plantarflexion resistance of an ankle-foot orthosis on ankle and knee joint power during gait in individuals post-stroke

Plantarflexion resistance of an ankle-foot orthosis (AFO) plays an important role to prevent foot-drop, but its impact on push-off has not been well investigated in individuals post-stroke. The aim of this study was to investigate the effect of plantarflexion resistance of an articulated AFO on ankle and knee joint power of the limb wearing the AFO in individuals post-stroke. Gait analysis was performed on 10 individuals with chronic stroke using a Vicon 3-dimensional motion capture system and a Bertec split-belt instrumented treadmill. They walked on the treadmill under 4 plantarflexion resistance levels (S1 < S2<S3 < S4) set on the AFO with resistance adjustable ankle joints. The ankle and knee joint power calculations were performed using Visual3D, and mean values were plotted across a gait cycle. Statistical analyses revealed significant differences in the peak ankle joint power generation according to the plantarflexion resistance of the AFO (P = 0.008). No significant differences were found in the knee joint power. Peak ankle joint power generation [Median (IQR: Interquartile range)] were S1: 0.0517 (0.0238–0.1071) W/kg, S2: 0.0342 (0.0132–0.0862) W/kg, S3: 0.0353 (0.0127–0.0821) W/kg, and S4: 0.0234 (0.0087–0.06764) W/kg. Reduction of the peak ankle joint power generation appeared to be related to reduction in the peak plantarflexion angular velocity at late stance due to increases in the plantarflexion resistance of the AFO. This study showed that peak ankle joint power generation was significantly, and somewhat systematically, affected by plantarflexion resistance of the AFO in individuals post-stroke.     

Lower-limb joint work and power are modulated during load carriage based on load configuration and walking speed

Soldiers regularly transport loads weighing >20 kg at slow speeds for long durations. These tasks elicit high energetic costs through increased positive work generated by knee and ankle muscles, which may increase risk of muscular fatigue and decrease combat readiness. This study aimed to determine how modifying where load is borne changes lower-limb joint mechanical work production, and if load magnitude and/or walking speed also affect work production. Twenty Australian soldiers participated, donning a total of 12 body armor variations: six different body armor systems (one standard-issue, two commercially available [cARM1-2], and three prototypes [pARM1-3]), each worn with two different load magnitudes (15 and 30 kg). For each armor variation, participants completed treadmill walking at two speeds (1.51 and 1.83 m/s). Three-dimensional motion capture and force plate data were acquired and used to estimate joint angles and moments from inverse kinematics and dynamics, respectively. Subsequently, hip, knee, and ankle joint work and power were computed and compared between armor types and walking speeds. Positive joint work over the stance phase significantly increased with walking speed and carried load, accompanied by 2.3–2.6% shifts in total positive work production from the ankle to the hip (p < 0.05). Compared to using cARM1 with 15 kg carried load, carrying 30 kg resulted in significantly greater hip contribution to total lower-limb positive work, while knee and ankle work decreased. Substantial increases in hip joint contributions to total lower-limb positive work that occur with increases in walking speed and load magnitude highlight the importance of hip musculature to load carriage walking.     

Repeatability of 3D gait kinematics obtained from an electromagnetic tracking system during treadmill locomotion

The purpose of this paper was to describe a technique that enables three-dimensional (3D) gait kinematics to be obtained using an electromagnetic tracking system, and to report the intra-trial, intra-day/inter-tester and inter-day/intra-tester repeatability of kinematic gait data obtained using this technique. Ten able-bodied adults underwent four gait assessments; the same two testers tested each subject independently on two different days. Gait assessments were conducted on a custom-built long-bed treadmill with no metal components between the rollers. Each gait assessment involved familiarisation to treadmill walking, subject anatomical and functional calibration, and a period of steady-state treadmill walking at a self-selected speed. Following data collection, 3D joint kinematics were calculated using the joint coordinate system approach. 3D joint angle waveforms for 10 left and right strides were extracted and temporally normalised for each trial. Intra-trial, intra-day/inter-tester and inter-day/intra-tester repeatability of the temporally normalised kinematic waveforms were quantified using the coefficient of multiple determination (CMD). CMDs for joint kinematics averaged 0.942 intra-trial, 0.849 intra-day/inter-tester and 0.773 inter-day/intra-tester. In general, sagittal plane kinematics were more repeatable than frontal or transverse plane kinematics, and kinematics at the hip were more repeatable than at the knee or ankle. The level of repeatability of kinematic gait data obtained during treadmill walking using this protocol was equal or superior to that reported previously for overground walking using image-based protocols.     

Effect of fatigue on single-leg hop landing biomechanics

The objective of this study was to measure adaptations in landing strategy during single-leg hops following thigh muscle fatigue. Kinetic, kinematic, and electromyographic data were recorded as thirteen healthy male subjects performed a single-leg hop in both the unfatigued and fatigued states. To sufficiently fatigue the thigh muscles, subjects performed at least two sets of 50 step-ups. Fatigue was assessed by measuring horizontal hopping ability following the protocol. Joint motion and loading, as well as muscle activation patterns, were compared between fatigued and unfatigued conditions. Fatigue significantly increased knee motion (p = 0.012) and shifted the ankle into a more dorsiflexed position (p = 0.029). Hip flexion was also reduced following fatigue (p = 0.042). Peak extension moment tended to decrease at the knee and increase at the ankle and hip (p = 0.014). Ankle plantar flexion moment at the time of peak total support moment increased from 0.8 (N x m)/kg (SD, 0.6 [N x m]/kg) to 1.5 (N x m)/kg (SD, 0.8 [N x m]/kg) (p = 0.006). Decreased knee moment and increased knee flexion during landings following fatigue indicated that the control of knee motion was compromised despite increased activation of the vastus medialis, vastus lateralis, and rectus femoris (p = 0.014, p = 0.014, and p = 0.017, respectively). Performance at the ankle increased to compensate for weakness in the knee musculature and to maintain lower extremity stability during landing. Investigating the biomechanical adaptations that occur in healthy subjects as a result of muscle fatigue may give insight into the compensatory mechanisms and loading patterns occurring in patients with knee pathology. Changes in single-leg hop landing performance could be used to demonstrate functional improvement in patients due to training or physical therapy.     

A comparison of dorsal and heel plate foot tracking methods on lower extremity dynamics

The primary method to model ankle motion during inverse dynamic calculations of the lower limb is through the use of skin-mounted markers, with the foot modeled as a rigid segment. Motion of the foot is often tracked via the use of a marker cluster triad on either the dorsum, or heel, of the foot/shoe. The purpose of this investigation was to evaluate differences in calculated lower extremity dynamics during the stance phase of gait between these two tracking techniques. In an analysis of 7 subjects, it was found that sagittal ankle angles and sagittal ankle, hip and knee moments were strongly correlated between the two conditions, however, there was a significant difference in peak ankle plantar flexion and dorsiflexion angles. Frontal ankle angles were only moderately correlated and there was a significant difference in peak ankle eversion and inversion, resulting in moderate correlations in frontal plane moments and a significant difference in peak hip adductor moments. We demonstrate that the technique used to track the foot is an important consideration in interpreting lower extremity dynamics for clinical and research purposes.     

Non-driving intersegmental knee moments in cycling computed using a model that includes three-dimensional kinematics of the shank/foot and the effect of simplifying assumptions

Assessing the importance of non-driving intersegmental knee moments (i.e. varus/valgus and internal/external axial moments) on over-use knee injuries in cycling requires the use of a three-dimensional (3-D) model to compute these loads. The objectives of this study were: (1) to develop a complete, 3-D model of the lower limb to calculate the 3-D knee loads during pedaling for a sample of the competitive cycling population, and (2) to examine the effects of simplifying assumptions on the calculations of the non-driving knee moments. The non-driving knee moments were computed using a complete 3-D model that allowed three rotational degrees of freedom at the knee joint, included the 3-D inertial loads of the shank/foot, and computed knee loads in a shank-fixed coordinate system. All input data, which included the 3-D segment kinematics and the six pedal load components, were collected from the right limb of 15 competitive cyclists while pedaling at 225 W and 90 rpm. On average, the peak varus and internal axial moments of 7.8 and 1.5 N m respectively occurred during the power stroke whereas the peak valgus and external axial moments of 8.1 and 2.5 N m respectively occurred during the recovery stroke. However, the non-driving knee moments were highly variable between subjects; the coefficients of variability in the peak values ranged from 38.7% to 72.6%. When it was assumed that the inertial loads of the shank/foot for motion out of the sagittal plane were zero, the root-mean-squared difference (RMSD) in the non-driving knee moments relative to those for the complete model was 12% of the peak varus/valgus moment and 25% of the peak axial moment. When it was also assumed that the knee joint was revolute with the flexion/extension axis perpendicular to the sagittal plane, the RMSD increased to 24% of the peak varus/valgus moment and 204% of the peak axial moment. Thus, the 3-D orientation of the shank segment has a major affect on the computation of the non-driving knee moments, while the inertial contributions to these loads for motions out of the sagittal plane are less important.