Biomechanical Analysis of a Sport-Specific Lower Limb

Strengthening Device

Evan Breedlove1, Jocelyn Dunn1, Eric A. Nauman,1,2,3*

Running Head: Biomechanics of Limb Strengthening Device

Key Words: Rehabilitation, knee injury

1Weldon School of Mechanical Engineering

2School of Mechanical Engineering
3Department of Basic Medical Sciences
Purdue University, West Lafayette, IN 47907

for submission to the International Journal of Rehabilitation and Health

* to whom all correspondence should be addressed

585 Purdue Mall
West Lafayette, IN 47907-2088
[email protected]
phone: (765) 494-8602, fax: (765) 494-0539
Introduction
Cartilage injuries are common in adults and present a significant challenge for clinicians.
Once the articular surface is damaged, mechanical loading leads to accelerated joint wear and
degeneration [1-3]. It is estimated that 80% of focal cartilage defects, if left untreated, will result
in osteoarthritis, a degenerative joint disease characterized by both local cartilage pitting and
global articular cartilage thinning [1, 4]. Osteoarthritis currently affects 21 million Americans and
has been estimated to cost the US economy $60 billion per year [1]. Interestingly, the majority of
osteoarthritic lesions occur on the medial femoral condyle, largely due to chronic varus rotations,
suggesting that correction of asymmetric loading in the knee joint may arrest damage
progression. Recently, a device was developed by a former NBA player, Jonathan Bender, that
can be used during specific athletic activities and incorporates a harness and two lengths of
rubber tubing bands to apply a tensile forces between points just behind the hips and the
posterior aspect of the ankles (Fig. 1). Executing normal motions while wearing this lower limb
strengthening device requires concentric and eccentric contractions in opposing muscle groups,
and may help strengthen the joints.
It has been reported that a population of children identified as athletically inactive
exhibited 22-25% less articular cartilage than their athletically active peers and that appropriate
training has can increase articular cartilage thickness and may promote healing of chondral
lesions in adolescents [5]. This effect is believed to be mediated through increased tissue strain
and fluid transport [6-8]. The lower limb strengthening device may also assist in recovery by
improving joint stability. This mechanism also has the potential to distribute load more evenly
between the medial and lateral condyles, potentially lowering the stress on the articular surfaces
despite increasing the total force across the joint.
 Figure 1 – Schematic of the sport-specific lower
limb strengthening device which consists of a
harness that makes it possible to connect tension
bands from the torso to the ankles.

Other athletic training exercises used to rehabilitate the knee joint post injury are
primarily targeted to ligament injuries. The locations of maximum stress in the knee depends on
the activity and for a given activity, vary significantly throughout the full range of motion and
depend upon the muscle contraction. For instance, eccentric muscle contraction can produce
significantly larger loads than isometric contraction, leading to greater forces in the knee [9, 10].

Various extension-flexion exercises also tend to localize the stress to a particular part of the knee.
Isometric extension can create loads in the ACL up to 55% of body weight, while isometric
flexion may generate loads in the PCL up to 400% of body weight with negligible loading of the
ACL [11]. Because the quadriceps muscles must work to overcome the moment generated by the
tension bands during extension and the device also elicits eccentric co-contraction of the
quadriceps during flexion in order to prevent rapid, uncontrolled movement, it is possible that the
Bender Bands combine the benefits of several knee rehabilitation exercises. In order to develop a
more precise understanding of the therapeutic value of the sport-specific lower limb
strengthening device, a biomechanical analysis of their use was undertaken.

Theory
Euler’s equations were used to describe motion of the lower leg,

where the vectors, and represent the forces and moments, respectively, acting on the lower

leg during walking, running, and jumping motions (Fig. 2), is the mass of the lower leg, is
the acceleration of the lower leg’s center of mass, is the moment of inertia about the center of
mass, and is the angular acceleration. Because the accelerations were small compared to the

muscle and joint contact forces, and were neglected.

Figure 2 – Expanded view of the force model for the case where we allow for multiple contact points on the surface
FC FM
of the knee. The contact force, , was replaced by a medial contact force, , and a lateral

FL
contact force, , each with components defined relative to the co-rotational basis. The forces
in the quadriceps and hamstrings are also included along with their relative orientations with
respect to the tibia. Adapted from an illustration originally created by Patrick J. Lynch.

The vector equations were then cast in a simplified form,

,
where is the ground reaction force on the foot, is the mass of the shank (tibia and foot),

and are the forces on the medial and lateral condyles, respectively, and and are the
forces in the quadriceps and hamstrings, respectively. In order to mathematically describe the

forces, it is necessary to express them on either a fixed Cartesian basis, , or a

coordinates system that moves with the tibia, , which are related at any given instant
by,

The quadriceps and hamstring forces are given by,

where the angles, , , and the respective moment arms are summarized in Table 1, was

assumed to be 0o, and was assumed to be 20o.

Table 1: Geometric parameters for anatomical structures around the knee.

Anatomical Feature Males Females Reference
Q angle (o) 11.2 ± 3.0 15.8 ± 4.5 Horton and Hall, 1989 [12]
angle (o) 2.6 – 135.7 (17.5 – Kellis and Baltzopoulos , 1999 [13]
22.8 at 31-50o
flexion)
PT moment arm (mm) 36.9 – 42.6 Kellis and Baltzopoulos, 1999 [13]
H moment arm (mm) 20.5 – 29.9 Kellis and Baltzopoulos, 1999 [13]
The forces on the medial and lateral condyles are easiest to describe on the co-rotational basis,

where the negative sign on the signifies that the joint is assumed to be in compression. To
simulate jumps, jump stops, and running motions, it was assumed that the forces on the medial

and lateral sides were proportional, i.e. , where is less than unity for most activities.
Provided there is little or no twisting of the knee joint, this assumption is expected to provide
more physiologically accurate results than typical approaches which combine the shear loads on
each side. In particular, the assumption of proportionality allows for a more realistic treatment of
the moments caused by forces on the medial and lateral condyles.

Methods
When combined into Euler’s first and second laws, one obtains a set of six nonlinear
algebraic equations that must be solved numerically. The only required inputs are the joint
angles, muscle angles, and ground reaction forces.

Table 2 – Estimate ground reaction forces (GRF) for various activities.

Activity Peak Loads (multiples of BW) Reference
Jump Stops 3.5 – 4.0 VGRF Kernozek et al., 2008 [14]
Jump Stops 4.27 VGRF Onate et al., 2005 [15]
0.79 Lateral GRF
Running 0.25 Lateral GRF (Braking effect and propulsion) Munro et al., 1987 [16]
1.7 Average VGRF
2.32 Peak VGRF

Results
As an example, we considered a jump-stop with a vertical ground reaction force (VGRF)
of 2.5 times body weight, a lateral ground reaction force of 0.8 times body weight and a
sideways ground reaction force of 1/10 body weight. When the tibia makes an angle of 30o with
the vertical, the presence of the tension bands causes an increase in the quadriceps force and a
doubling of the force in the hamstrings. There is a negligible increase in the forces on the medial
condyle of the knee, but a notable balancing of the forces on the medial and lateral sides.

Table 3 – Joint reactions in response to a jump stop.

Stiffness of Tension Bands
Variable k = 0 N/m k = 100 N/m k = 200 N/m
Fsm1 -600 N -600 N -600 N
Fsm2 1000 N 1000 N 1000 N
Fm3 8200 N 8400 N 8400 N
FQ 8800 N 10,000 N 10,000 N
FH 3000 N 4000 N 4000 N
λ 0.40 0.60 0.60

Discussion
Taken together, these data suggest that the sport-specific lower limb strengthening device
increases the necessary force in all the muscles surrounding the knee, while improving the load
balance between the medial and lateral sides. This is beneficial because smooth motion of the leg
requires concentric contraction of either the quadriceps or hamstring muscles and eccentric
contraction of the opposing set, an excellent combination for strength training. Balancing the
load across the knee joint should also be beneficial. More importantly, these changes occur
without appreciable changes in the joint contact forces on the cartilaginous surfaces of the knee.
While this analysis cannot address changes in form that occur after the bands are removed, it has
been hypothesized that working with the device has the potential to train the leg muscles to
balance the load on the knee joint.

References
1. Buckwalter, J.A., C. Saltzman, and T.D. Brown, The impact of
osteoarthritis: implications for research. Clin Orthop Relat Res, 2004. 427
Suppl: p. S6-S15.
2. Fazzalari, N.L., R.B. Vernon, and J. Darracott, Osteoarthritis of the hip.
Possible protective and causative roles of trabecular microfractures in the
head of the femur. Clin Orthop, 1987.
3. Radin, E.L., et al., Mechanical determinants of osteoarthrosis. Semin
Arthritis Rheum, 1991: p. 12-21.
4. Buckwalter, J.A. and H.J. Mankin, Articular cartilage part II: Degeneration
and osteoarthrosis, repair, regeneration, and transplantation. J Bone Jt
Surg, 1997. 79-A(612-632).
5. Della Villa, S., et al., Does intensive rehabilitation permit early return to
sport without compromising the clinical outcome after arthroscopic
autologous chondrocyte implantation in highly competitive athletes? Am J
Sports Med. 38(1): p. 68-77.
6. Mayerhoefer, M.E., et al., The in vivo effects of unloading and
compression on T1-Gd (dGEMRIC) relaxation times in healthy articular
knee cartilage at 3.0 Tesla. Eur Radiol. 20(2): p. 443-9.
7. Mayerhoefer, M.E., et al., Feasibility of texture analysis for the
assessment of biochemical changes in meniscal tissue on T1 maps
calculated from delayed gadolinium-enhanced magnetic resonance
imaging of cartilage data: comparison with conventional relaxation time
measurements. Invest Radiol. 45(9): p. 543-7.
8. Tranquille, C.A., et al., Effect of exercise on thicknesses of mature hyaline
cartilage, calcified cartilage, and subchondral bone of equine tarsi. Am J
Vet Res, 2009. 70(12): p. 1477-83.
9. Higashihara, A., et al., Differences in the electromyographic activity of the
hamstring muscles during maximal eccentric knee flexion. Eur J Appl
Physiol. 108(2): p. 355-62.
10. Higashihara, A., et al., Functional differences in the activity of the
hamstring muscles with increasing running speed. J Sports Sci. 28(10): p.
1085-92.
11. Toutoungi, D.E., et al., Cruciate ligament forces in the human knee during
rehabilitation exercises. Clin Biomech (Bristol, Avon), 2000. 15(3): p.
176-87.
12. Horton, M.G. and T.L. Hall, Quadriceps femoris muscle angle: normal
values and relationships with gender and selected skeletal measures.
Phys Ther, 1989. 69(11): p. 897-901.
13. Kellis, E. and V. Baltzopoulos, In vivo determination of the patella tendon
and hamstrings moment arms in adult males using videofluoroscopy
during submaximal knee extension and flexion. Clin Biomech (Bristol,
Avon), 1999. 14(2): p. 118-24.
14. Kernozek, T.W., M.R. Torry, and M. Iwasaki, Gender differences in lower
extremity landing mechanics caused by neuromuscular fatigue. Am J
Sports Med, 2008. 36(3): p. 554-65.
15. Onate, J.A., et al., Instruction of jump-landing technique using videotape
feedback: altering lower extremity motion patterns. Am J Sports Med,
2005. 33(6): p. 831-42.
16. Munro, C.F., D.I. Miller, and A.J. Fuglevand, Ground reaction forces in
running: a reexamination. J Biomech, 1987. 20(2): p. 147-55.