Full length ArticleLower extremity joint position sense in runners with and without a history 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.
References (27)
- et al.
What are causes and treatment strategies for patellar-tendinopathy in female runners?
Journal of Biomechanics
(2008) - et al.
ASB clinical biomechanics award winner 2006 prospective study of the biomechanical factors associated with iliotibial band syndrome
Clinical Biomechanics (Bristol, Avon)
(2007) - et al.
Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands
Clinical Biomechanics (Bristol, Avon)
(2008) - et al.
A prospective study of iliotibial band strain in runners
Clinical Biomechanics (Bristol, Avon)
(2008) - et al.
Abnormal knee joint position sense in individuals with patellofemoral pain syndrome
Journal of Orthopaedic Research
(2002) - et al.
Warming-up before sporting activity improves knee position sense
Physical Therapy Sport
(2010) - et al.
The role of weight bearing in the clinical assessment of knee joint position sense
Australian Journal of Physiotherapy
(2001) - et al.
Use of gait sandals for measuring rearfoot and shank motion during running
Gait and Posture
(2010) - et al.
Comparison of surface mounted markers and attachment methods in estimating tibial rotations during walking: an in vivo study
Gait and Posture
(2000) - et al.
Preferred placement of the feet during quiet stance: development of a standardized foot placement for balance testing
Clinical Biomechanics (Bristol, Avon)
(1997)
Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?
Gait and Posture
A retrospective case–control analysis of 2002 running injuries
British Journal of Sports Medicine
Relation between running injury and static lower limb alignment in recreational runners
British Journal of Sports Medicine
Cited by (3)
Impact of Patellar Tendinopathy on Knee Proprioception: A cross-sectional study
2017, Clinical Journal of Sport MedicineDifferences in joint-position sense and vibratory threshold in runners with and without a history of overuse injury
2015, Journal of Sport Rehabilitation