Barefoot vs Shod and patellofemoral joint stresses

NewsBot · Jul 13, 2013

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Take your shoes off to reduce patellofemoral joint stress during running
Jason Bonacci, Bill Vicenzino, Wayne Spratford, Paul Collins
Br J Sports Med doi:10.1136/bjsports-2013-092160

Aim Elevated patellofemoral joint stress is thought to contribute to the development and progression of patellofemoral pain syndrome. The purpose of this study was to determine if running barefoot decreases patellofemoral joint stress in comparison to shod running.

Methods Lower extremity kinematics and ground reaction force data were collected from 22 trained runners during overground running while barefoot and in a neutral running shoe. The kinematic and kinetic data were used as input variables into a previously described mathematical model to determine patellofemoral joint stress. Knee flexion angle, net knee extension moment and the model outputs of contact area, patellofemoral joint reaction force and patellofemoral joint stress were plotted over the stance phase of the gait cycle and peak values compared using paired t tests and standardised mean differences calculated.

Results Running barefoot decreased peak patellofemoral joint stress by 12% (p=0.000) in comparison to shod running. The reduction in patellofemoral joint stress was a result of reduced patellofemoral joint reaction forces (12%, p=0.000) while running barefoot.

Conclusions Elevated patellofemoral joint stress during shod running might contribute to patellofemoral pain. Running barefoot decreases patellofemoral joint stress.
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NewsBot · Aug 6, 2013

Increasing Running Step Rate Reduces Patellofemoral Joint Forces
Lenhart, Rachel L.; Thelen, Darryl G.; Wille, Christa M.; Chumanov, Elizabeth S.; Heiderscheit, Bryan C.
Medicine & Science in Sports & Exercise: 2 August 2013

Purpose: Increasing step rate has been shown to elicit changes in joint kinematics and kinetics during running, and has been suggested as a possible rehabilitation strategy for runners with patellofemoral pain. The purpose of this study was to determine how altering step rate affects internal muscle forces and patellofemoral joint loads, and then to determine what kinematic and kinetic factors best predict changes in joint loading.
Methods: We recorded whole body kinematics of 30 healthy adults running on an instrumented treadmill at three step rate conditions (90%, 100%, and 110% of preferred step rate). We then used a 3D lower extremity musculoskeletal model to estimate muscle, patellar tendon, and patellofemoral joint forces throughout the running gait cycles. Additionally, linear regression analysis allowed us to ascertain the relative influence of limb posture and external loads on patellofemoral joint force.

Results: Increasing step rate to 110% of preferred reduced peak patellofemoral joint force by 14%. Peak muscle forces were also altered as a result of the increased step rate with hip, knee and ankle extensor forces, and hip abductor forces all reduced in mid-stance. Compared to the 90% step rate condition, there was a concomitant increase in peak rectus femoris and hamstring loads during early and late swing, respectively, at higher step rates. Peak stance phase knee flexion decreased with increasing step rate, and was found to be the most important predictor of the reduction in patellofemoral joint loading.

Conclusion: Increasing step rate is an effective strategy to reduce patellofemoral joint forces and could be effective in modulating biomechanical factors that can contribute to patellofemoral pain.
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NewsBot · Sep 11, 2014

Patellofemoral Joint Stress during Running with Alterations in Foot Strike Pattern.
Nathan Vannatta, C.; Kernozek, Thomas W.
Medicine & Science in Sports & Exercise; September 8, 2014

Purpose: This study aimed to quantify differences in patellofemoral joint stress which may occur when healthy runners alter their foot strike pattern from their habitual rearfoot strike to a forefoot strike in order to gain insight on the potential etiology and treatment methods of patellofemoral pain.
Methods: Sixteen healthy female runners completed twenty running trials in a controlled laboratory setting under rearfoot strike and forefoot strike conditions. Kinetic and kinematic data were used to drive a static optimization technique to estimate individual muscle forces to input into a model of the patellofemoral joint to estimate joint stress during running.
Results: Peak patellofemoral joint stress and the stress-time integral over stance phase decreased 27% and 12%, respectively, in the forefoot strike condition (p<0.001). Peak vertical ground reaction force increased slightly in the forefoot strike condition (p<0.001). Peak quadriceps force and average hamstring force decreased while gastrocnemius and soleus muscle forces increased when running with a forefoot strike (p<0.05). Knee flexion angle at initial contact increased (p<0.001), total knee excursion decreased (p<0.001), and no change occurred in peak knee flexion angle (p=0.238). Step length did not change between conditions (p=0.375), but the leading leg landed with the foot positioned with a horizontal distance closer to the hip at initial contact in the forefoot strike condition (p<0.001).
Conclusion: Altering one’s strike pattern to a forefoot strike results in consistent reductions in patellofemoral joint stress independent of changes in step length. Thus, implementation of forefoot strike training programs may be warranted in the treatment of runners with patellofemoral pain. However, it is suggested that the transition to a forefoot strike pattern be completed in a graduated manner.
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