Heelstrike and the pathomechanics of osteoarthrosis: a pilot gait study

Involvement of mechanical factors in osteoarthrosis (OA) has been well documented. For OA of the human lower limb, the impulse imparted at heelstrike has been suggested as a pathogenic factor. It has also been reported that there is a large amount of variation in the level of impulse experienced by different individuals, and it is suggested that those who experience large impulses are at a greater risk of developing OA. The current study investigated gait patterns of 12 normal subjects to establish the gait determinants responsible for producing large impulses at heelstrike. The results suggest that subtle variations in the early part of the swing phase pattern are responsible for large differences in the impulse experienced at heelstrike; the usually reported gait variables mask these variations.     

Human body proportions explained on the basis of biomechanical principles

On the basis of theoretical biomechanics and of experiments, we investigated the mechanical requirements to which the body of a bipedally walking primate is subject, and the possibilities to meet these requirements with a minimum amount of energy. The least energy-consuming adaptation is clearly a body shape favourable for the preferred locomotion. Some characteristics of human body shape, in particular its proportions, could be identified as advantageous for fulfilling obvious biological roles or mechanical necessities. The characteristic length and the extended position of human hindlimbs make walking faster without additional input of energy. Mass distribution on the hindlimbs reduces the energy necessary for accelerating the swing limb after liftoff and for decelerating the swing limb before the heelstrike. Length and mass distribution in the forelimb gives it a pendulum length comparable to that of the hindlimb, so that both extremities swing at the same frequency. This swinging of the forelimbs counters in part the movements exerted by the moved hindlimbs on the trunk. The elongate and slim shape of the trunk provides great mass moments of inertia and that means stability against being flexed ventrally and dorsally by the forward and rearward movements of the heavy and long hindlimbs. Shoulder breadth in combination with the shallow shape of the thorax yield higher mass moments of inertia against the rotation of the trunk about a vertical axis than a cylindrical trunk shape. Further elongation of the hindlimbs is limited by the energy necessary for acceleration and deceleration, as well as for lifting them during the swing phase. In addition, the reaction forces exerted by the hindlimbs would expose the trunk to undue excursions if the proportions trunk length/limb length or trunk mass/limb mass would decrease. The above-noted kinetic requirements are partly in line, partly in conflict with the requirements of statics.     

Algorithms to determine event timing during normal walking using kinematic data

Algorithms to predict heelstrike and toeoff times during normal walking using only kinematic data are presented. The accuracy of these methods was compared with the results obtained using synchronized force platform recordings of two subjects walking at a variety of speeds for a total of 12 trials. Using a 60Hz data collection system, the absolute value errors (AVE) in predicting heelstrike averaged 4.7ms, while the AVE in predicting toeoff times averaged 5.6ms. True average errors (negative for an early prediction) were +1.2ms for both heelstrike and toeoff, indicating that no systematic errors occurred. It was concluded that the proposed algorithms provide an easy and reliable method of determining event times during walking when kinematic data are collected, with a considerable improvement in resolution over visual inspection of video records, and could be utilized in conjunction with any 2-D or 3-D kinematic data collection system.     

Energetics of actively powered locomotion using the simplest walking model

We modified an irreducibly simple model of passive dynamic walking to walk on level ground, and used it to study the energetics of walking and the preferred relationship between speed and step length in humans. Powered walking was explored using an impulse applied at toe-off immediately before heel strike, and a torque applied on the stance leg. Although both methods can supply energy through mechanical work on the center of mass, the toe-off impulse is four times less costly because it decreases the collision loss at heel strike. We also studied the use of a hip torque on the swing leg that tunes its frequency but adds no propulsive energy to gait. This spring-like actuation can further reduce the collision loss at heel strike, improving walking energetics. An idealized model yields a set of simple power laws relating the toe-off impulses and effective spring constant to the speed and step length of the corresponding gait. Simulations incorporating nonlinear equations of motion and more realistic inertial parameters show that these power laws apply to more complex models as well.     

Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes

In this study we describe an ambulatory system for estimation of spatio-temporal parameters during long periods of walking. This original method based on wavelet analysis is proposed to compute the values of temporal gait parameters from the angular velocity of lower limbs. Based on a mechanical model, the medio-lateral rotation of the lower limbs during stance and swing, the stride length and velocity are estimated by integration of the angular velocity. Measurement's accuracy was assessed using as a criterion standard the information provided by foot pressure sensors. To assess the accuracy of the method on a broad range of performance for each gait parameter, we gathered data from young and elderly subjects. No significant error was observed for toe-off detection, while a slight systematic delay (10 ms on average) existed between heelstrike obtained from gyroscopes and footswitch. There was no significant difference between actual spatial parameters (stride length and velocity) and their estimated values. Errors for velocity and stride length estimations were 0.06 m/s and 0.07 m, respectively. This system is light, portable, inexpensive and does not provoke any discomfort to subjects. It can be carried for long periods of time, thus providing new longitudinal information such as stride-to-stride variability of gait. Several clinical applications can be proposed such as outcome evaluation after total knee or hip replacement, external prosthesis adjustment for amputees, monitoring of rehabilitation progress, gait analysis in neurological diseases, and fall risk estimation in elderly.     

Inter-joint coordination of kinematics and kinetics before and after total hip arthroplasty compared to asymptomatic subjects

While differences in joint kinematics and kinetics between control subjects and patients before and after total hip arthroplasty (THA) has often been studied, inter-joint coordination has not been fully characterized. We hypothesized that in patients undergoing THA, inter-joint coordination (i) is different from control subjects before surgery, (ii) changes from pre-operative to post-operative, and (iii) remains different from control subjects after surgery. Seventy-eight subjects underwent gait analysis before and ∼1 year after primary unilateral THA. 109 control subjects were age, sex, and BMI matched to the THA group. We selected a representative trial at each subjects’ self-selected walking speed from a motion analysis data repository. To assess kinematic coordination, we constructed sagittal plane hip-knee angle cyclograms, and calculated total, stance, and swing phase plot area (deg²). To assess kinetic coordination, we calculated the support moment (M_S, %wt 1 ht), the time-integral of support moment (M_S impulse, %wt 1 ht 1 t), and the relative contribution of each joint to M_S impulse (%_Hip, %_Knee, %_Ankle). We used t-tests to compare groups. Total and swing-phase cyclogram area was smaller preoperatively, but improved to control values after THA. Swing-phase area was smaller than control values after THA. M_S impulse was larger in THA subjects than controls both before and after surgery. While, the relative contribution of the hip to M_S impulse was not different from control values, the contributions of the knee and ankle were smaller. Inter-joint coordination, as measured by hip-knee angle cyclograms and M_S impulse, may be used to distinguish differences in gait mechanics between osteoarthritis and THA. Future work focusing on coordination among joints may be needed to fully restore gait function.     

Characterizing and correcting for the dynamic response of a bag-in-box system

A bag-in-box system (BBS) whose volume is monitored by a mechanical spirometer tends to have a slow response if the volume of the box is large, and this may significantly affect its measurement of gas flow. We describe a device for creating reproducible gas flows with which the impulse response of a BBS may be conveniently determined. Two computational techniques for correcting a BBS flow measurement for the effects of the impulse response were investigated: 1) an exponential model method that assumes a second-order model of the BBS dynamics and 2) a Fourier transform-based method of deconvolution known as Wiener filtering. Both correction methods produced a significant increase in the accuracy of BBS flow estimations, with the Wiener filter giving superior results.     

The effects of step width and arm swing on energetic cost and lateral balance during running

In walking, humans prefer a moderate step width that minimizes energetic cost and vary step width from step-to-step to maintain lateral balance. Arm swing also reduces energetic cost and improves lateral balance. In running, humans prefer a narrow step width that may present a challenge for maintaining lateral balance. However, arm swing in running may improve lateral balance and help reduce energetic cost. To understand the roles of step width and arm swing, we hypothesized that net metabolic power would be greater at step widths greater or less than preferred and when running without arm swing. We further hypothesized that step width variability (indicator of lateral balance) would be greater at step widths greater or less than preferred and when running without arm swing. Ten subjects ran (3m/s) at four target step widths (0%, 15%, 20%, and 25% leg length (LL)) with arm swing, at their preferred step width with arm swing, and at their preferred step width without arm swing. We measured metabolic power, step width, and step width variability. When subjects ran at target step widths less (0% LL) or greater (15%, 20%, and 25% LL) than preferred, both net metabolic power demand (by 3%, 9%, 12%, and 15%) and step width variability (by 7%, 33%, 46%, and 69%) increased. When running without arm swing, both net metabolic power demand (by 8%) and step width variability (by 9%) increased compared to running with arm swing. It appears that humans prefer to run with a narrow step width and swing their arms so as to minimize energetic cost and improve lateral balance.     

Energy cost and muscular activity required for leg swing during walking.

To investigate the metabolic cost and muscular actions required for the initiation and propagation of leg swing, we applied a novel combination of external forces to subjects walking on a treadmill. We applied a forward pulling force at each foot to assist leg swing, a constant forward pulling force at the waist to provide center of mass propulsion, and a combination of these foot and waist forces to evaluate leg swing. When the metabolic cost and muscle actions were at a minimum, the condition was considered optimal. We reasoned that the difference in energy consumption between the optimal combined waist and foot force trial and the optimal waist force-only trial would reflect the metabolic cost of initiating and propagating leg swing during normal walking. We also reasoned that a lower muscle activity with these assisting forces would indicate which muscles are normally responsible for initiating and propagating leg swing. With a propulsive force at the waist of 10% body weight (BW), the net metabolic cost of walking decreased to 58% of normal walking. With the optimal combination, a propulsive force at the waist of 10% BW plus a pulling force at the feet of 3% BW the net metabolic cost of walking further decreased to 48% of normal walking. With the same combination, the muscle activity of the iliopsoas and rectus femoris muscles during the swing phase was 27 and 60% lower, respectively, but the activity of the medial gastrocnemius and soleus before swing did not change. Thus our data indicate that approximately 10% of the net metabolic cost of walking is required to initiate and propagate leg swing. Additionally, the hip flexor muscles contribute to the initiation and propagation leg swing.     

Behavior of a single neuron in a recurrent excitatory loop

A recurrent excitation loop was constructed by enabling each impulse from the slowly adapting stretch receptor organ SAO (crayfish) to trigger through an electronic circuit a brief stretch, or “tug,” of the receptor. When applied independently, each tug influenced the discharge as would an EPSP. Recurrent excitation led to characteristic discharge timings; hence, even an isolated neuron can have intrinsic mechanisms that prevent positive feedback from freezing it in an extreme non-operational state. Such timings depended critically on the “phase”, i.e., on the time elapsed between an SAO impulse and the tug. When the control discharge was stationary (because the SAO length remained invariant), phases of a few ms simply changed the pattern to one of doublets, and affected little the average rate. As the phase increased, bursts appeared, bursts and interburst intervals became more prolonged, and average rates increased. With the largest phases examined (40 ms), the discharge consisted of a slow alternation of high rate bursts, separated by long intervals. When the discharge was modulated (by 0.2/s sinusoidal length variation) with recurrent excitation, the peak-to-peak rate swing, i.e., the sensitivity, and the proportion of the cycle without afferent discharges increased, and the rate vs. length display was distorted even though remaining “loop-plus-extension.” Changes were phase-dependent: for example, loops could have a sharp high peak at one phase and be flat-topped at another. When the interspike interval variability was exaggerated (by a length jitter superimposed upon either invariant or sinusoidally varying lengths), recurrent excitation exerted fewer, weaker and somewhat different effects: e.g., it reduced the overall intensity of the invariant cases and the peak-to-peak swing in the modulated one. The precise mechanisms of these results can only be conjectured at but are likely to involve an electrogenic pump, electromechanical interactions, topographical issues, as well as their interplays. The functional implications involve, for instance, the modulation of the intensity, duration and occurrence of the bursting patterns in oscillating functions (e.g., breathing, chewing, etc.).     

Influence of gait parameters on the loading of the lower limb

The ground reaction force which acts on the foot during normal walking consists of the sum of two components: the support of the weight of the body and the acceleration of the body. The relationships between the initial loading rate of the lower limb (ignoring the contribution of the heelstrike transient) and the general gait parameters — cadence, stride length, and velocity — have been examined. Plots of the resultant ground reaction force were used to calculate the loading rate of the limb. A sample of 13 normal male subjects, aged from 18 to 63 years, walked at five different self-selected speeds. Velocity showed the highest correlation with loading rate (r = 0.95) and stride length the lowest (r = 0.85). The relationship between cadence and loading rate was non-linear.     

Metabolic energy and muscular activity required for leg swing in running.

The metabolic cost of leg swing in running is highly controversial. We investigated the cost of initiating and propagating leg swing at a moderate running speed and some of the muscular actions involved. We constructed an external swing assist (ESA) device that applied small anterior pulling forces to each foot during the first part of the swing phase. Subjects ran on a treadmill at 3.0 m/s normally and with ESA forces up to 4% body weight. With the greatest ESA force, net metabolic rate was 20.5% less than during normal running. Thus we infer that the metabolic cost of initiating and propagating leg swing comprises approximately 20% of the net cost of normal running. Even with the greatest ESA, mean electromyograph (mEMG) of the medial gastrocnemius and soleus muscles during later portions of stance phase did not change significantly compared with normal running, indicating that these muscles are not responsible for the initiation of leg swing. However, with ESA, rectus femoris mEMG during the early portions of swing phase was as much as 74% less than during normal running, confirming that it is responsible for the propagation of leg swing.     

Synthesis of natural arm swing motion in human bipedal walking

It has historically been believed that the role of arm motion during walking is related to balancing. Arm motion during natural walking is distinguished in that each arm swing is with the motion of the opposing leg. Although this arm swing motion is generated naturally during bipedal walking, it is interesting to note that the arm swing motion is not necessary for stable walking. This paper attempts to explain the contribution of out-of-phase arm swing in human bipedal walking. Consequently, a human motion control methodology that generates this arm swing motion during walking is proposed. The relationship between arm swing and reaction moment about the vertical axis of the foot is explained in the context of the dynamics of a multi-body articulated system. From this understanding, it is reasoned that arm swing is the result of an effort to reduce the reaction moment about the vertical axis of the foot while the torso and legs are being controlled. This idea is applied to the generation of walking motion. The arm swing motion can be generated, not by designing and tracking joint trajectories of the arms, but by limiting the allowable reaction moment at the foot and minimizing whole-body motion while controlling the lower limbs and torso to follow the designed trajectory. Simulation results, first with the constraint on the foot vertical axis moment and then without, verify the relationship between arm swing and foot reaction moment. These results also demonstrate the use of the dynamic control method in generating arm swing motion.     

Importance of preswing rectus femoris activity in stiff-knee gait

Stiff-knee gait is characterized by diminished and delayed knee flexion during swing. Rectus femoris transfer surgery, a common treatment for stiff-knee gait, is often recommended when a patient exhibits prolonged activity of the rectus femoris muscle during swing. Treatment outcomes are inconsistent, in part, due to limited understanding of the biomechanical factors contributing to stiff-knee gait. This study used a combination of gait analysis and dynamic simulation to examine how activity of the rectus femoris during swing, and prior to swing, contribute to knee flexion. A group of muscle-actuated dynamic simulations was created that accurately reproduced the gait dynamics of ten subjects with stiff-knee gait. These simulations were used to examine the effects of rectus femoris activity on knee motion by eliminating rectus femoris activity during preswing and separately during early swing. The increase in peak knee flexion by eliminating rectus femoris activity during preswing (7.5+/-3.1 degrees ) was significantly greater on average (paired t-test, p=0.035) than during early swing (4.7+/-3.6 degrees ). These results suggest that preswing rectus femoris activity is at least as influential as early swing activity in limiting the knee flexion of persons with stiff-knee gait. In evaluating rectus femoris activity for treatment of stiff-knee gait, preswing as well as early swing activity should be examined.     

Understanding how an arm swing enhances performance in the vertical jump

This investigation was conducted to examine the various theories that have been proposed to explain the enhancement of jumping performance when using an arm swing compared to when no arm swing is used. Twenty adult males were asked to perform a series of maximal vertical jumps while using an arm swing and again while holding their arms by their sides. Force, motion and electromyographical data were recorded during each performance. Participants jumped higher (0.086 m) in the arm swing compared to the no-arm swing condition and was due to increased height (28%) and velocity (72%) of the center of mass at take-off. The increased height at take-off was due to the elevation of the arm segments. The increased velocity of take-off stemmed from a complex series of events which allowed the arms to build up energy early in the jump and transfer it to the rest of the body during the later stages of the jump. This energy came from the shoulder and elbow joints as well as from extra work done at the hip. This energy was used to (i) increase the kinetic and potential energy of the arms at take-off, (ii) store and release energy from the muscles and tendons around the ankle, knee and hip joint, and (iii) ‘pull’ on the body through an upward force acting on the trunk at the shoulder. It was concluded that none of the prevailing theories exclusively explains the enhanced performance in the arm swing jump, but rather the enhanced performance is based on several mechanisms operating together.     

Comparing predictive validity of four ballistic swing phase models of human walking

It is unclear to what extent ballistic walking models can be used to qualitatively predict the swing phase at comfortable walking speed. Different study findings regarding the accuracy of the predictions of the swing phase kinematics may have been caused by differences in (1) kinematic input, (2) model characteristics (e.g. the number of segments), and (3) evaluation criteria. In the present study, the predictive validity of four ballistic swing phase models was evaluated and compared, that is, (1) the ballistic walking model as originally introduced by Mochon and McMahon, (2) an extended version of this model in which heel-off of the stance leg is added, (3) a double pendulum model, consisting of a two-segment swing leg with a prescribed hip trajectory, and (4) a shank pendulum model consisting of a shank and rigidly attached foot with a prescribed knee trajectory. The predictive validity was evaluated by comparing the outcome of the model simulations with experimentally derived swing phase kinematics of six healthy subjects. In all models, statistically significant differences were found between model output and experimental data. All models underestimated swing time and step length. In addition, statistically significant differences were found between the output of the different models. The present study shows that although qualitative similarities exist between the ballistic models and normal gait at comfortable walking speed, these models cannot adequately predict swing phase kinematics.     

Effects of arm swing on mechanical parameters of human gait

The aim of this study was to investigate the influence of the upper limb swing on human gait. Measurements were performed on 52 subjects by using the Elite system with two cameras and a Kistler force platform. The recording of trajectories of characteristic body points on the subjects and the measurement of ground reaction forces have been performed at normal walking and at walking with emphasised rhythmic upper limb swing. The trajectory of the whole body mass centre, central dynamic moments of inertia and ground reaction forces have been calculated for every subject and mean curves of the entire group have been determined for walking with the natural and the emphasised upper limb swing. The determined mean values of normalised mechanical parameters have been compared and differences between the gait with the natural and the emphasised upper limb swing have been described.     

A bipedal compliant walking model generates periodic gait cycles with realistic swing dynamics

A simple spring mechanics model can capture the dynamics of the center of mass (CoM) during human walking, which is coordinated by multiple joints. This simple spring model, however, only describes the CoM during the stance phase, and the mechanics involved in the bipedality of the human gait are limited. In this study, a bipedal spring walking model was proposed to demonstrate the dynamics of bipedal walking, including swing dynamics followed by the step-to-step transition. The model consists of two springs with different stiffnesses and rest lengths representing the stance leg and swing leg. One end of each spring has a foot mass, and the other end is attached to the body mass. To induce a forward swing that matches the gait phase, a torsional hip joint spring was introduced at each leg. To reflect the active knee flexion for foot clearance, the rest length of the swing leg was set shorter than that of the stance leg, generating a discrete elastic restoring force. The number of model parameters was reduced by introducing dependencies among stiffness parameters. The proposed model generates periodic gaits with dynamics-driven step-to-step transitions and realistic swing dynamics. While preserving the mimicry of the CoM and ground reaction force (GRF) data at various gait speeds, the proposed model emulated the kinematics of the swing leg. This result implies that the dynamics of human walking generated by the actuations of multiple body segments is describable by a simple spring mechanics.     

Effect of swing phase load on metal-on-metal hip lubrication, friction and wear

There is renewed interest in metal-on-metal (MOM) total hip replacements (THRs), however, variable wear rates have been observed clinically. It is hypothesised that changes in soft tissue tensioning during surgery may alter loading of THRs during the swing phase of gait leading to changes in fluid film lubrication, friction and wear. This study aimed to assess the effect of swing phase load on the lubrication, friction and wear of MOM hip replacements. Theoretical lubrication modelling was carried out using elastohydrodynamic theory. All the governing equations were solved numerically for the lubricant film thickness between the articulating surfaces under the transient dynamic conditions with low and high swing phase loads. Friction testing was completed using a single axis pendulum simulator, simplified loading cycles were applied with low and high swing phase loads. MOM hip replacements were tested in a hip simulator, modified to provide different swing phase loading regimes; a low (100 N) and a high load (as per ISO 14242-1; 280 N). Results demonstrated that the performance of MOM bearings is highly dependent on swing phase load. Hence, changes in the tension of the tissues at surgery and variations in muscle forces may increase swing phase load, reduce lubrication, increase friction and accelerate wear. This may explain some of the variations that have been observed with clinical wear rates.     

Effects of aging and arm swing on the metabolic cost of stability in human walking

To gain insight into the mechanical determinants of walking energetics, we investigated the effects of aging and arm swing on the metabolic cost of stabilization. We tested two hypotheses: (1) elderly adults consume more metabolic energy during walking than young adults because they consume more metabolic energy for lateral stabilization, and (2) arm swing reduces the metabolic cost of stabilization during walking in young and elderly adults. To test these hypotheses, we provided external lateral stabilization by applying bilateral forces (10% body weight) to a waist belt via elastic cords while young and elderly subjects walked at 1.3m/s on a motorized treadmill with arm swing and with no arm swing. We found that the external stabilizer reduced the net rate of metabolic energy consumption to a similar extent in elderly and young subjects. This reduction was greater (6-7%) when subjects walked with no arm swing than when they walked normally (3-4%). When young or elderly subjects eliminated arm swing while walking with no external stabilization, net metabolic power increased by 5-6%. We conclude that the greater metabolic cost of walking in elderly adults is not caused by a greater cost of lateral stabilization. Moreover, arm swing reduces the metabolic cost of walking in both young and elderly adults likely by contributing to stability.