Elsevier

Gait & Posture

Volume 36, Issue 3, July 2012, Pages 557-560
Gait & Posture

Full length Article
Lower extremity joint position sense in runners with and without a history of knee overuse injury

https://doi.org/10.1016/j.gaitpost.2012.05.011Get rights and content

Abstract

Kinematic and kinetic analyses are routinely implemented to determine if gait differences exist between runners with and without a history of knee injury. Hip and knee kinematic differences have been reported between knee injured and non-injured runners. Yet, there is no consensus on whether these differences are the primary variables contributing to knee injury. Furthermore, there may be additional underlying factors that contribute to the development of injury that cannot be determined by gait analysis. The purpose of this investigation was to determine if joint position sense differences exist in runners with and without a history of knee overuse injury. Sagittal plane knee and hip joint position sense was measured in 13 runners with a history of knee overuse injury and 13 runners with no history of knee overuse injury. Absolute joint position replication error was measured during both a weight bearing and a non-weight bearing condition. Joint position replication errors at each joint were compared among groups and task using a two-way ANOVA with joint task as the repeated measure. Knee and hip joint replication errors were similar between both groups. The weight bearing and non-weight bearing tasks resulted in similar joint position replication errors. There were no interaction effects. In conclusion, knee flexion and hip adduction joint position sense is similar in runners with and without a history of knee overuse injury. Therefore, joint position sense measured via weight bearing and non-weight bearing joint position replication tasks may not play an important role in the development of knee overuse injury.

Highlights

► Joint position sense was measured in runners with and without a history of knee overuse injury. Hip and knee joint position sense was measured during weight bearing and non-weight bearing tasks. Absolute joint position replication error at the hip and knee was not different between groups. Joint position sense acuity may not be associated with the development of knee overuse injury.

Introduction

Running is a popular activity that is performed for enjoyment, as well as having physical health benefits. However, repetitive loads experienced by the body during running can lead to overuse injury. A running injury is accompanied by pain and leads to a reduction in weekly running mileage or temporary cessation of running [1]. It has been estimated that 47% of runners sustain a running related injury annually [2]. Three of the top seven most common injuries affect the knee: patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinopathy [1].

Hip and knee joint biomechanics are often the focus of running injury studies. It has been shown in several investigations that runners who have sustained knee overuse injury demonstrate different frontal plane hip [3], [4], [5], [6], [7] and sagittal plane [8] knee kinematics compared to uninjured runners. Injured runners diagnosed with any of the aforementioned knee injuries exhibited a greater peak hip adduction angle during stance than uninjured runners [3], [4], [5], [6], [7]. Excessive hip adduction may increase knee valgus [9]. Consequently, greater knee valgus may contribute to patellofemoral pain [9]. For runners with iliotibial band syndrome, it has been suggested greater hip adduction increases iliotibial band strain during stance due to the lateral insertion of the iliotibial band on the proximal shank [3], [5], [7]. An increased strain magnitude experienced by the iliotibial band over many runs may have a cumulative damaging effect [10]. A large effect for greater hip adduction in runners with patellar tendinopathy compared to controls has also been reported [4]. These authors suggest that since symptoms such as pain at the patellofemoral joint are present in patellar tendinopathy and patellofemoral pain syndrome, etiological frontal plane hip factors may be the same between injuries [4]. In the sagittal plane, runners with patellofemoral pain syndrome have decreased knee flexion during stance compared to controls [8]. Although ankle kinematics have been reported in previous knee overuse investigations, no ankle angle differences have been found [4], [5], [8]. While kinematic differences exist between runners with knee overuse injury and uninjured runners, whether these differences are due to proprioception has not been investigated.

Proprioception provides information about body segment orientation during activity. A component of proprioception includes joint position sense. Joint position sense characterizes one's ability to actively or passively reproduce a joint angle [11]. Differences in hip and knee joint position sense may exist between runners with and without a history of knee overuse injury. Researchers have implemented a variety of tasks to assess hip and knee joint position sense. Non-weight bearing and weight bearing sagittal plane knee joint position sense tasks have been assessed [12], [13], [14], [15]. Sagittal plane knee joint position sense has been previously evaluated between 40° and 60° in young healthy participants [12], [13], [14], [15]. Frontal plane hip joint position sense tasks within a 10° range from a neutral (0°) supine position have also been utilized [16]. However, non-weight bearing proprioception tasks test the ability to replicate joint position in isolation, without regard to the complexity of movement tasks. Thus, non-weight bearing joint position sense may not be indicative of the body position awareness needed during dynamic weight bearing activity like running. Therefore, a weight bearing proprioception task may be more appropriate to determine joint position sense of runners than a non-weight bearing proprioception task.

The purpose of this cross-sectional study was to determine if joint position sense is related to a history of knee overuse injury. Specifically, we investigated whether differences exist in joint position sense between runners with and without a history of knee overuse injury. We hypothesized that runners with previous knee overuse injury would demonstrate greater absolute error in joint position replication for knee flexion and hip adduction than runners with no history of knee injury. Secondly, we compared peak hip adduction and knee flexion angles in the injured group to those without a history of knee overuse injury.

Section snippets

Subject details

Approval for all procedures was obtained from the Institution's Human Subjects Review Board prior to the commencement of this study. All subjects gave their written informed consent prior to participating. Participants were recruited from the local running community, but were excluded from participating if they were currently injured, had previously sustained a major lower extremity injury such as a ligament rupture, or if they were not healthy enough to participate as determined by answering

Results

Knee joint position sense was similar between groups. There was no main effect for group (p = 0.239) or knee joint replication task (p = 0.534) (Table 1). Additionally, there was no significant interaction between knee joint replication tasks and runners with a history of knee overuse injury and controls (p = 0.412). At the hip, there was no main effect for group (p = 0.271) or hip joint replication tasks (p = 0.666) (Table 1). There was no significant interaction (p = 0.636) between group and hip joint

Discussion

The purpose of this retrospective cross-sectional study was to determine if knee and hip joint position sense differences exist between runners with and without a history of knee overuse injury. A variety of different overuse injuries can afflict the knee. Differences in knee [4], [8] and hip kinematics [3], [5], [7], [8], [9], [13], [25], [26] and hip musculature imbalances [25], [27] have been shown in runners with a history of knee overuse injury compared to controls. We proposed that

Conclusion

Knee flexion and hip adduction joint position sense is similar in runners with and without a history of knee overuse injury. Thus, joint position sense measured via weight bearing and non-weight bearing joint position replication tasks may not play an important role in the development of knee overuse injury.

Conflict of interest

None declared.

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