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Journal of Back and Musculoskeletal Rehabilitation 28 (2015) 327–334 DOI 10.3233/BMR-140523 IOS Press
Three-dimensional lower extremity kinematics of Chinese during activities of daily living Shuyang Hana,b , Gang Chenga,∗ and Peng Xua a
College of Mechanical and Electrical Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China b Julius Wolff Institute, Charite Universitätmedizin Berlin, Berlin, Germany
Abstract. OBJECTIVE: There were gender differences regarding lower extremity kinematics. The purpose of this study was to investigate three-dimensional kinematics of lower extremity for young Chinese during daily activities and to identify gender differences in lower extremity kinematics. METHODS: Lower extremity motions of 40 healthy volunteers (20 males and 20 females) were recorded while each subject performing each of three daily activities (walking, jogging, and deep squatting). The spatiotemporal parameters (speed, cadence and step length) and 3D joint kinematics (peak angles and mean range of motions) were compared with previous results and within gender group. Independent t-tests were used to test statistical significance (p < 0.05). RESULTS: Statistical analysis suggested that there was no gender difference in sagittal plane motions at the hip, knee and ankle joints, while females displayed greater non-sagittal plane joint motions compared to their male counterparts. CONCLUSIONS: The outcomes of this study added basic understanding of joint biomechanics during daily activities of Chinese and provided a basis for comparison to patients with various joint diseases. Keywords: Daily activities, kinematics, gender difference, deep squatting
1. Introduction The kinematics characteristics of lower extremity are essential not only for providing detailed mechanical properties and a quantitative description of human movements, but for analyzing the abnormal gait characteristics of injured individuals and evaluating the factors associated with pathological gait, rehabilitation and treatment interventions as well [1,2]. Meanwhile, the kinematics characteristics at the hip, knee and ankle joints can be used for experiment or finite element ∗ Corresponding author: Gang Cheng, College of Mechanical and Electrical Engineering, China University of Mining and Technology, Xuzhou 221116, Jiangsu, China. Tel.: +86 0516 83591916; Fax: +86 0516 83591916, E-mail: [email protected].
analysis of the implant components or preclinical fatigue and joint simulator testing, thereby improving the design of joint arthroplasty [2–4]. Discrepancies in lower extremity joint kinematics have been reported between genders. Females were reported having more non-sagittal plane joint motions during daily activities. For example, a significantly greater hip adduction, hip internal rotation and knee valgus angle were observed in females during walking [5]. Through entire movement cycle during jogging and cutting maneuvers, females revealed 8◦ less flexion, but 11◦ more valgus position in knee joint than males [6]. Moreover, during single-legged squatting posture, females demonstrated 6.7◦ more ankle dorsiflexion, 9.1◦ more hip flexion, 3.2◦ more hip adduction and 6.6◦ more external rotation than their male counterparts [7]. The differences have been speculated to be
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S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living Table 1 Demographic data (Mean ± SD) of the recruited subjects Item Age(years) Height(cm)∗ Mass(kg)∗ Leg length (cm)∗ BMI (kg/m2 )
∗P
Male (n = 20) 21.9 ± 1.5 174.2 ± 4.4 69.6 ± 7.7 78.9 ± 3.8 22.9 ± 2.3
Female (n = 20) 21.2 ± 1.4 158.8 ± 4.2 56.4 ± 5.6 73.2 ± 3.3 21.4 ± 2.7
< 0.05, significant difference between males and females.
a contributing factor to the higher injury rate in females (e.g. anterior cruciate ligament (ACL) injury) [8–10]. Although there is one-fifth of the world population living in China, few population-based studies have focused on the lower extremity kinematics of Chinese. Thus, normal Western kinematics parameters are frequently used in clinical application in China due to the lack of a standardized database. Meanwhile, the majority of the joint implants designed at present are geared predominantly towards a Western lifestyle [11]. However, postures that require a much higher range of motion (ROM) at the joints are frequently involved in Asian activities of daily living. It is a fact that the hip and knee joint implants currently used in Western countries do not adequately meet the needs of them [4, 11,12]. In addition, although lower extremity kinematics during walking and jogging activities have been studied extensively, little attention has been paid on the kinematics during high ROM tasks, such as deep squatting and kneeling, especially taking gender factor into account [3]. Therefore, the objective of this study was to investigate three-dimensional (3D) kinematic data of young Chinese during activities of daily living, especially during high ROM activities. A secondary objective was to compare gender differences in these kinematic parameters. It was hypothesized that there would be gender differences in lower extremity kinematics, not only during walking and jogging, but during deep squatting as well. It was expected that females would demonstrate more joint motions in non-sagittal planes compared to their male counterparts.
2. Materials and methods 2.1. Participants Forty healthy Chinese adults (20 males and 20 females) were recruited for this study. The recruited participants were students and staffs of the university. All subjects had a common Chinese lifestyle. All of the
subjects had no history of injury or pain to the lower limbs, any type of lower extremity surgery, or balance problems that would affect their performance. Besides, they usually performed high ROM activities during their daily living. For instance, they preferred to sit cross-legged versus the traditional upright sitting position. Prior to data collection, the body parameters of each subject including age, height, leg length and weight were measured (Table 1). The study was approved by the ethics committee of the university, and all participants signed a consent form before participating. 2.2. Experimental protocol 3D motion analysis was performed with Optotrak CertusTM 3020 dynamic tracking system (Northern Digital Inc., Waterloo, Canada). The sample frequency was set to 95 Hz. The 3D accuracy of the system was 0.15 mm. Three Optotrak 3020 position sensors (9 cameras) were employed to obtain an effective detect range. In order to minimize soft tissue artifact, seven rigid parts with each consisting of four tracking markers and one shell were designed according to the body characters so as to track the 3D movements of all lower extremity segments. These rigid parts were attached to the lateral aspects of the feet (bilateral instep), shanks (bilateral surface of tibia), thighs (bilateral surface of the thigh, below hand swing), and pelvis (over the center point between both posterior superior iliac spines) using flexible cohesive elastic bandage. One specific experimenter was responsible for applying the markers to the subjects. All subjects wore shorts, and the rigid plates were secured by a common non-elastic medical bandage so as to avoid loosening and relative displacement between the markers and skin (Fig. 1). Local coordinate systems were defined for the foot, shank, thigh and pelvis segments through digitized palpated bony landmarks. The bony landmarks included left/right ilium anterior superior, left/right prominence of the greater trochanter external surface, left/right femur lateral/medial epicondyle, left/right fibula apex of lateral malleolus, left/right tibia apex of medial malleolus, left/right dorsal aspect of first metatarsal head, and left/right dorsal aspect of fifth metatarsal head. The local coordinate system for each segment was linked to the segment’s individual tracking plate and enabled the calculation of joint angles at the ankle, knee, and hip. The relative joint angles were defined by using a Cardan sequence (x-y-z rotation). The local x, y, and z axes corresponded respectively to flexion/extension, abduction/adduction, and internal/external rotation.
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Fig. 1. The overall arrangement of the measurement and the distribution of markers on human body.
Three different activities were measured for each subject, namely, walking, jogging, and deep squatting. Walking and jogging were performed on a treadmill. Prior to data collection, all subjects were required to familiarize to the treadmill for at least 6 minutes. During the measurement, all subjects performed walking and jogging at a self-selected speed. On the other hand, since performing the high ROM activities would make the infrared tracking markers too close to the ground, resulting in an inaccurate collection, a wooden test platform with a height of 50 cm was employed for the deep squatting measurement. The subjects were required to perform the activity from an initial upright position, with feet shoulder-width apart, to a fullflexion position. In order to acquire the maximum motion angle, the participants were asked to hold the final position motionless for approximately 5 s and then rose to the upright position at a natural pace. The start of each trial was triggered by movement at any of the three joints, while the end was defined as the termination of motions at all three joints. For each subject, six trials were recorded for each activity, and 10 min rest was given between each activity. 2.3. Data analysis The raw kinematic data were smoothed using an integrated digital filter with a cut-off frequency of 6 Hz in Visual 3D software (C-Motion Inc., USA). To generate ensemble graphs, data were normalized to 100%.
The flexion/dorsiflexion, adduction and internal rotation were positive. For each subject, the joint angles were averaged from six trials. These individual data were then averaged for each gender group. The interested variables were spatiotemporal parameters (speed, cadence and step length) and 3D joint kinematics (peak angles and mean ROMs). The spatiotemporal parameters were normalized to leg length [13]. The variables were divided into two groups based on gender. The variables for each group were statistically compared using independents t-test. Statistical analysis was performed using SPSS (SPSS Inc., USA). Statistical significance was set at p < 0.05.
3. Results Table 2 shows the spatiotemporal parameters for males and females during walking and jogging. No significant differences in the self-selected speed were found during walking and jogging, while significant gender difference could be found for the speed when normalized to leg length. Meanwhile, the normalized cadence and step length were not significantly different between genders at both conditions (Table 2). Mean curves of 3D lower extremity kinematics during walking, jogging and squatting were presented in the sagittal, frontal and transverse planes (Figs 2–4). Peak hip flexion angles were 34.7◦ ± 3.0◦ (walking), 36.7◦ ± 3.0◦ (jogging), and 121.3◦ ± 13.2◦ (squat-
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S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living Table 2 Mean and standard deviation of the spatiotemporal parameters for males and females during walking and jogging
Spatiotemporal parameters Speed (m/s) Cadence (steps/min) Step length (m) Normalized Speed Normalized cadence Normalized step length ∗ Significant
Walking Females (SD) 1.26 (0.19) 119.2 (7.5) 0.62 (0.06) 0.51 (0.06) 34.1 (2.03) 0.87 (0.08)
Males (SD) 1.23 (0.15) 113.5 (6.2) 0.67 (0.06) 0.47 (0.05) 33.9 (1.78) 0.86 (0.07)
p-value 0.42 0.01∗ 0.01∗ 0.01∗ 0.19 0.24
Jogging Females (SD) 3.32 (0.28) 168.7 (7.3) 1.15 (0.07) 1.24 (0.07) 46.0 (2.03) 1.58 (0.04)
Males (SD) 3.31 (0.25) 160.7 (9.4) 1.23 (0.06) 1.19 (0.09) 45.6 (2.69) 1.56 (0.05)
p-value 0.72 0.01∗ 0.00∗ 0.00∗ 0.27 0.17
difference between males and females. Table 3 Comparisons of hip, knee and ankle peak (SD) joint angles for males and females
Peak angle
Walking Female
p-value
Male
Jogging Female
p-value
Male
35.2 (2.7) 64.9 (5.1) −14.3 (3.9)
0.12 0.14 0.25
36.7 (3.0) 62.0 (4.8) 14.6 (4.7)
34.9 (3.0) 60.3 (3.9) 12.9 (4.9)
0.21 0.29 0.43
121.3 (13.2) 147.6 (11.1) 33.6 (3.7)
117.8 (14.9) 154.1 (10.3) 36.2 (4.8)
0.19 0.18 0.35
9.9 (1.9) 4.8 (2.9) 6.6 (2.2)
0.02∗ 0.00∗ 0.29
9.2 (1.9) 6.7 (4.0) 4.9 (3.1)
10.6 (2.1) 4.4 (3.6) 8.2 (2.4)
0.02∗ 0.01∗ 0.00∗
12.8 (5.8) 9.7 (3.6) 11.4 (4.9)
19.1 (4.2) 13.8 (3.5) 13.7 (4.3)
0.02∗ 0.01∗ 0.23
6.3 (3.1) 4.1 (5.6) 3.2 (4.0)
0.01∗ 0.47 0.60
7.3 (3.6) 3.2 (2.6) 6.0 (4.4)
11.3 (3.3) 5.3 (3.0) 5.1 (3.7)
0.00∗ 0.53 0.42
12.8 (8.1) 19.2 (4.1) 6.0 (5.9)
18.7 (6.8) 25.9 (5.0) 7.7 (5.5)
0.00∗ 0.00∗ 0.08
Male Sagittal plane Hip 34.7 (3.0) Knee 66.2 (4.8) Ankle 13.7 (4.3) Frontal plane Hip 8.1 (2.1) Knee 6.9 (3.3) Ankle 6.3 (1.5) Transverse plane Hip 3.6 (1.6) Knee 3.8 (4.9) Ankle 3.6 (3.6)
difference between males and females.
30
Frontal
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∗ Significant
Squatting Female
-10
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Fig. 2. Mean curves of 3D joint angles for Chinese males (solid) and females (dashed) during walking.
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p-value
S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living Sagittal
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% Cycle
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Fig. 3. Mean curves of 3D joint angles for Chinese males (solid) and females (dashed) during jogging.
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Fig. 4. Mean curves of 3D joint angles for Chinese males (solid) and females (dashed) during deep squatting.
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S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living Table 4 Comparisons of spatiotemporal parameters published in previous studies during walking
Subjects Italy19 Velocity (m/s) Male 1.33 (0.03) Female 1.34 (0.02) p-value 0.826 Cadence (steps/min) Male 114.0 (2.4) Female 106.8 (2.4) p-value 0.06 ∗ Significant
France1
Canada16
USA20
Korea27
Korea22
Holland21
China
1.59 (0.13) 1.54 (0.12) −
1.60 (0.2) 1.40 (0.2) 0.62
1.54 (0.16) 1.63 (0.13) 0.229
1.19 (0.11) 1.12 (0.11) 0.001∗
1.17 (0.11) 1.08 (0.14) < 0.05∗
1.55 (0.18) 1.50 (0.15) −
1.26 (0.15) 1.23 (0.19) 0.42
116.4 (7.2) 123.6 (7.2) −
128.0 (8.5) 120.0 (8.6) < 0.01∗
− − −
111.8 (6.4) 112.5 (6.5) 0.552
107.2 (7.8) 109.3 (10.7) > 0.05
112.3 (5.8) 120.2 (7.0) −
113.5 (6.2) 119.2 (7.5) 0.01∗
difference between males and females. Table 5 Comparisons of angle ranges of hip, knee and ankle joints during walking
Subjects Hip Sagittal Frontal Transverse Knee Sagittal Frontal Transverse Ankle Sagittal Frontal Transverse
UK28
Australia24
Italy25
Korea27
Korea21
China
−6.3∼40.1 −6.4∼5.7 −16.7∼-1.2
−13.7∼32 1.5∼13.6 −13.3∼1.4
−10∼29.8 −5.5∼5.4 −3.4∼8.5
−4.2∼39 −4.3∼7.3 −5.0∼8.0
−18.3∼27.4 −14.1∼-0.2 0.4∼9.8
−5.5∼35.0 −2.3∼9.0 −3.2∼5.0
−8.3∼61.3 −4.5∼1.7 −2.4∼11.2
5.8∼73.7 −6.3∼2.5 −11.3∼4.5
0.4∼65.7 −6.5∼4.1 −5.3∼8.4
2.3∼59.0 −1.0∼7.5 −6.0∼5.0
1.4∼59.4 6.6∼13 −8.2∼3.3
3.9∼65.6 −2.2∼5.5 −7.6∼4.0
−10∼16.6 3.1∼14.2 −13.4∼-3.2
−22.7∼12.4 −9.4∼6.2 −4.4∼17.2
−22.6∼10.9 −3.2∼9.2 −
−14∼11.5 − −19.0∼-5.0
−17.5∼10.8 −1.9∼3.3 −17.3∼-3.5
−16.5∼31.6 −6.5∼6.0 −6.8∼4.5
ting) for males, while peak knee flexion were 66.2◦ ± 4.8◦ (walking), 62.0◦ ± 4.8◦ (jogging), and 147.6◦ ± 11.1◦ (squatting), respectively. Gender differences were not significant for the kinematics in sagittal plane at the hip, knee and ankle joints for all three activities (p > 0.05). In the remained planes, female subjects exhibited more non-sagittal plane motions compared to males (Table 3). Specifically, compared to males, females demonstrated significantly more peak hip adduction (p = 0.02), peak internal rotation (p = 0.01), and peak knee adduction (p = 0.00) during walking, while more peak hip adduction (p = 0.02), peak internal rotation (p = 0.00), peak knee adduction (p = 0.01) and peak ankle adduction (p = 0.00) were demonstrated by females during jogging, moreover, more peak hip adduction (p = 0.02), peak internal rotation (p = 0.00), and peak knee adduction (p = 0.01), peak internal rotation (p = 0.00) were found with respect to squatting.
4. Discussion Although lower extremity kinematics during walking and jogging activities have been studied extensively [5,14–17], there was no standardized data that characterizes lower extremity kinematics for Chinese,
especially during high ROM activities, which were practiced on a daily basis in some non-Western cultures. Comparison of spatiotemporal parameters was made with respect to previously reported results [1,5, 16–19] (Table 4), it shows that the walking velocity of Koreans was much slower than the Westerners, in this study the same result was found for Chinese, demonstrating the significance of studying subjects with fully considering their ethnic background. Meanwhile, the gait kinematics obtained in this study were quantitatively compared with previous studies [5,18,20–22] (Table 5). During deep squatting, the average joint motions of this study agreed well with those obtained from other Asian population, who had a similar lifestyle [2, 3], but differed from the Westerners [4,23]. Specifically, the mean ROM in sagittal plane for Chinese during squatting was 146◦. The results demonstrated a much larger range required for squatting than that of 101◦ for a group of Western subjects [23]. Besides, for Western populations, knee joint kinematics in sagittal plane was significantly different between genders during walking [14,24]. However, it was not found for Asians [5,18]. Therefore, the comparison demonstrated that it is very essential to establish a kinematic database for Chinese. Previous investigations have demonstrated the differences between males and females concerning med-
S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living
ical, physical, and psychological issues. The differences have been speculated to be a contributing factor to the higher injury rate in females [8,9]. Our hypothesis was that gender difference would appear during these three activities, especially in the frontal and transverse planes. The results were in support of our hypotheses. During walking and jogging, females showed greater hip adduction and knee valgus angles in the frontal plane. It was plausible that the wider pelvis and narrower step width of females were responsible for this [5,15]. In transverse plane, greater hip internal rotation was observed for females during walking and jogging, which could also be a result of the anatomical characteristics of the female femur [5]. Gender differences in joint angles were also observed during deep squatting. Females demonstrated more adduction and internal rotation at the hip and knee joint. The observed differences might be due to different periarticular connective tissue properties. As we all know, females turns to have higher joint laxity and altered musculoskeletal functional mechanism. The joint laxity of females could diminish joint proprioception, resulting in lower joint sensitivity to potentially injurious loads. For example, ACL laxity would allow for a longer time for females to detect the joint motion. Because of its contributing role in controlling knee axial rotation, females may demonstrate higher knee rotations. Moreover, it has been reported that female appeared to rely more on their quadriceps muscles in response to anterior translation, whereas male athletes relied more on their hamstring muscles [26]. These differences may all lead to a much higher risk of female to sustain an injury than their male counterparts [6,7]. One potential limitation of the current study was that the quantity of recruited subjects was relatively small compared with the whole population in China. Moreover, only young subjects were included. In this study, we do recognize this fact, and thus, we tried our best to recruit as much of subject from various regions of China. Totally, we selected 40 subjects from over 20 provinces. Secondly, this study only focused on the kinematics and spatiotemporal parameters, while the response of the neuromuscular system was not studied, which is also essential for better understanding the underlying mechanisms. Thus, in the future a comprehensive study on kinematic, kinetic, spatiotemporal, and EMG data should be performed. In summary, the lower extremity kinematics of a group of young Chinese was investigated during walking, jogging and deep squatting in this study. A brief comparison of the interested parameters was made
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with previous studies. The results indicated gender differences in joint kinematics during daily activities in the frontal and transverse planes. Compared to males, females demonstrated significantly higher joint adduction and internal rotation. The outcomes of this study not only improve our understanding of joint biomechanics during daily activities of Chinese, but it can also provide a basis for comparison to patients with various joint diseases.
Acknowledgement This work was funded by the National Natural Science Foundation of China (No. 51275512).
Conflict of interest We have no conflicts of interest with respect to the authorship and/or publication of this article.
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Data management in gait analysis for clinical applications. Clin Biomech. 1998; 13(3): 204-15. [21] Bennett D, Ogonda L, Elliott D, Humphreys L, Beverland DE. Comparison of gait kinematics in patients receiving minimally invasive and traditional hip replacement surgery: A prospective blinded study. Gait & Posture. 2006; 23(3): 37482. [22] Mills PM, Morrison S, Lloyd DG, Barrett RS. Repeatability of 3D gait kinematics obtained from an electromagnetic tracking system during treadmill locomotion. J Biomech. 2007; 40(7): 1504-11. [23] Flanagan S, Salem GJ, Wang MY, Sanker SE, Greendale GA. Squatting exercises in older adults: kinematic and kinetic comparisons. Med Sci Sport Exer. 2003; 35(4): 635-43. [24] Roislien J, Skare O, Gustavsen M, Broch NL, Rennie L, Opheim A. Simultaneous estimation of effects of gender, age and walking speed on kinematic gait data. Gait & Posture. 2009; 30(4): 441-5. [25] Bridger RS. Some fundamental aspects of posture related to ergonomics. Int J Ind Ergon. 1991; 8(1): 3-15. [26] Huston LJ, Wojtys EM. Neuromuscular performance characteristics in elite female athletes. Am J Sports Med. 1996; 24(4): 427-36. [27] Fehring TK, Odum SM, Hughes J, Springer BD, Beaver WB, Jr. Differences between the sexes in the anatomy of the anterior condyle of the knee. J Bone Joint Surg (Am). 2009; 91(10): 2335-41. [28] Kathiresan G, Jali N, Afiqah NR, Aznie NA, Fidieyana N, Osop N. The relationship between ankle joint flexibility and squatting knee flexion posture in young Malaysian men. World J Sport Sci. 2010; 3(3): 226-30.
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Journal of Back and Musculoskeletal Rehabilitation 28 (2015) 327–334 DOI 10.3233/BMR-140523 IOS Press
Three-dimensional lower extremity kinematics of Chinese during activities of daily living Shuyang Hana,b , Gang Chenga,∗ and Peng Xua a
College of Mechanical and Electrical Engineering, China University of Mining and Technology, Xuzhou, Jiangsu, China b Julius Wolff Institute, Charite Universitätmedizin Berlin, Berlin, Germany
Abstract. OBJECTIVE: There were gender differences regarding lower extremity kinematics. The purpose of this study was to investigate three-dimensional kinematics of lower extremity for young Chinese during daily activities and to identify gender differences in lower extremity kinematics. METHODS: Lower extremity motions of 40 healthy volunteers (20 males and 20 females) were recorded while each subject performing each of three daily activities (walking, jogging, and deep squatting). The spatiotemporal parameters (speed, cadence and step length) and 3D joint kinematics (peak angles and mean range of motions) were compared with previous results and within gender group. Independent t-tests were used to test statistical significance (p < 0.05). RESULTS: Statistical analysis suggested that there was no gender difference in sagittal plane motions at the hip, knee and ankle joints, while females displayed greater non-sagittal plane joint motions compared to their male counterparts. CONCLUSIONS: The outcomes of this study added basic understanding of joint biomechanics during daily activities of Chinese and provided a basis for comparison to patients with various joint diseases. Keywords: Daily activities, kinematics, gender difference, deep squatting
1. Introduction The kinematics characteristics of lower extremity are essential not only for providing detailed mechanical properties and a quantitative description of human movements, but for analyzing the abnormal gait characteristics of injured individuals and evaluating the factors associated with pathological gait, rehabilitation and treatment interventions as well [1,2]. Meanwhile, the kinematics characteristics at the hip, knee and ankle joints can be used for experiment or finite element ∗ Corresponding author: Gang Cheng, College of Mechanical and Electrical Engineering, China University of Mining and Technology, Xuzhou 221116, Jiangsu, China. Tel.: +86 0516 83591916; Fax: +86 0516 83591916, E-mail: [email protected].
analysis of the implant components or preclinical fatigue and joint simulator testing, thereby improving the design of joint arthroplasty [2–4]. Discrepancies in lower extremity joint kinematics have been reported between genders. Females were reported having more non-sagittal plane joint motions during daily activities. For example, a significantly greater hip adduction, hip internal rotation and knee valgus angle were observed in females during walking [5]. Through entire movement cycle during jogging and cutting maneuvers, females revealed 8◦ less flexion, but 11◦ more valgus position in knee joint than males [6]. Moreover, during single-legged squatting posture, females demonstrated 6.7◦ more ankle dorsiflexion, 9.1◦ more hip flexion, 3.2◦ more hip adduction and 6.6◦ more external rotation than their male counterparts [7]. The differences have been speculated to be
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S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living Table 1 Demographic data (Mean ± SD) of the recruited subjects Item Age(years) Height(cm)∗ Mass(kg)∗ Leg length (cm)∗ BMI (kg/m2 )
∗P
Male (n = 20) 21.9 ± 1.5 174.2 ± 4.4 69.6 ± 7.7 78.9 ± 3.8 22.9 ± 2.3
Female (n = 20) 21.2 ± 1.4 158.8 ± 4.2 56.4 ± 5.6 73.2 ± 3.3 21.4 ± 2.7
< 0.05, significant difference between males and females.
a contributing factor to the higher injury rate in females (e.g. anterior cruciate ligament (ACL) injury) [8–10]. Although there is one-fifth of the world population living in China, few population-based studies have focused on the lower extremity kinematics of Chinese. Thus, normal Western kinematics parameters are frequently used in clinical application in China due to the lack of a standardized database. Meanwhile, the majority of the joint implants designed at present are geared predominantly towards a Western lifestyle [11]. However, postures that require a much higher range of motion (ROM) at the joints are frequently involved in Asian activities of daily living. It is a fact that the hip and knee joint implants currently used in Western countries do not adequately meet the needs of them [4, 11,12]. In addition, although lower extremity kinematics during walking and jogging activities have been studied extensively, little attention has been paid on the kinematics during high ROM tasks, such as deep squatting and kneeling, especially taking gender factor into account [3]. Therefore, the objective of this study was to investigate three-dimensional (3D) kinematic data of young Chinese during activities of daily living, especially during high ROM activities. A secondary objective was to compare gender differences in these kinematic parameters. It was hypothesized that there would be gender differences in lower extremity kinematics, not only during walking and jogging, but during deep squatting as well. It was expected that females would demonstrate more joint motions in non-sagittal planes compared to their male counterparts.
2. Materials and methods 2.1. Participants Forty healthy Chinese adults (20 males and 20 females) were recruited for this study. The recruited participants were students and staffs of the university. All subjects had a common Chinese lifestyle. All of the
subjects had no history of injury or pain to the lower limbs, any type of lower extremity surgery, or balance problems that would affect their performance. Besides, they usually performed high ROM activities during their daily living. For instance, they preferred to sit cross-legged versus the traditional upright sitting position. Prior to data collection, the body parameters of each subject including age, height, leg length and weight were measured (Table 1). The study was approved by the ethics committee of the university, and all participants signed a consent form before participating. 2.2. Experimental protocol 3D motion analysis was performed with Optotrak CertusTM 3020 dynamic tracking system (Northern Digital Inc., Waterloo, Canada). The sample frequency was set to 95 Hz. The 3D accuracy of the system was 0.15 mm. Three Optotrak 3020 position sensors (9 cameras) were employed to obtain an effective detect range. In order to minimize soft tissue artifact, seven rigid parts with each consisting of four tracking markers and one shell were designed according to the body characters so as to track the 3D movements of all lower extremity segments. These rigid parts were attached to the lateral aspects of the feet (bilateral instep), shanks (bilateral surface of tibia), thighs (bilateral surface of the thigh, below hand swing), and pelvis (over the center point between both posterior superior iliac spines) using flexible cohesive elastic bandage. One specific experimenter was responsible for applying the markers to the subjects. All subjects wore shorts, and the rigid plates were secured by a common non-elastic medical bandage so as to avoid loosening and relative displacement between the markers and skin (Fig. 1). Local coordinate systems were defined for the foot, shank, thigh and pelvis segments through digitized palpated bony landmarks. The bony landmarks included left/right ilium anterior superior, left/right prominence of the greater trochanter external surface, left/right femur lateral/medial epicondyle, left/right fibula apex of lateral malleolus, left/right tibia apex of medial malleolus, left/right dorsal aspect of first metatarsal head, and left/right dorsal aspect of fifth metatarsal head. The local coordinate system for each segment was linked to the segment’s individual tracking plate and enabled the calculation of joint angles at the ankle, knee, and hip. The relative joint angles were defined by using a Cardan sequence (x-y-z rotation). The local x, y, and z axes corresponded respectively to flexion/extension, abduction/adduction, and internal/external rotation.
S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living
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Fig. 1. The overall arrangement of the measurement and the distribution of markers on human body.
Three different activities were measured for each subject, namely, walking, jogging, and deep squatting. Walking and jogging were performed on a treadmill. Prior to data collection, all subjects were required to familiarize to the treadmill for at least 6 minutes. During the measurement, all subjects performed walking and jogging at a self-selected speed. On the other hand, since performing the high ROM activities would make the infrared tracking markers too close to the ground, resulting in an inaccurate collection, a wooden test platform with a height of 50 cm was employed for the deep squatting measurement. The subjects were required to perform the activity from an initial upright position, with feet shoulder-width apart, to a fullflexion position. In order to acquire the maximum motion angle, the participants were asked to hold the final position motionless for approximately 5 s and then rose to the upright position at a natural pace. The start of each trial was triggered by movement at any of the three joints, while the end was defined as the termination of motions at all three joints. For each subject, six trials were recorded for each activity, and 10 min rest was given between each activity. 2.3. Data analysis The raw kinematic data were smoothed using an integrated digital filter with a cut-off frequency of 6 Hz in Visual 3D software (C-Motion Inc., USA). To generate ensemble graphs, data were normalized to 100%.
The flexion/dorsiflexion, adduction and internal rotation were positive. For each subject, the joint angles were averaged from six trials. These individual data were then averaged for each gender group. The interested variables were spatiotemporal parameters (speed, cadence and step length) and 3D joint kinematics (peak angles and mean ROMs). The spatiotemporal parameters were normalized to leg length [13]. The variables were divided into two groups based on gender. The variables for each group were statistically compared using independents t-test. Statistical analysis was performed using SPSS (SPSS Inc., USA). Statistical significance was set at p < 0.05.
3. Results Table 2 shows the spatiotemporal parameters for males and females during walking and jogging. No significant differences in the self-selected speed were found during walking and jogging, while significant gender difference could be found for the speed when normalized to leg length. Meanwhile, the normalized cadence and step length were not significantly different between genders at both conditions (Table 2). Mean curves of 3D lower extremity kinematics during walking, jogging and squatting were presented in the sagittal, frontal and transverse planes (Figs 2–4). Peak hip flexion angles were 34.7◦ ± 3.0◦ (walking), 36.7◦ ± 3.0◦ (jogging), and 121.3◦ ± 13.2◦ (squat-
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S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living Table 2 Mean and standard deviation of the spatiotemporal parameters for males and females during walking and jogging
Spatiotemporal parameters Speed (m/s) Cadence (steps/min) Step length (m) Normalized Speed Normalized cadence Normalized step length ∗ Significant
Walking Females (SD) 1.26 (0.19) 119.2 (7.5) 0.62 (0.06) 0.51 (0.06) 34.1 (2.03) 0.87 (0.08)
Males (SD) 1.23 (0.15) 113.5 (6.2) 0.67 (0.06) 0.47 (0.05) 33.9 (1.78) 0.86 (0.07)
p-value 0.42 0.01∗ 0.01∗ 0.01∗ 0.19 0.24
Jogging Females (SD) 3.32 (0.28) 168.7 (7.3) 1.15 (0.07) 1.24 (0.07) 46.0 (2.03) 1.58 (0.04)
Males (SD) 3.31 (0.25) 160.7 (9.4) 1.23 (0.06) 1.19 (0.09) 45.6 (2.69) 1.56 (0.05)
p-value 0.72 0.01∗ 0.00∗ 0.00∗ 0.27 0.17
difference between males and females. Table 3 Comparisons of hip, knee and ankle peak (SD) joint angles for males and females
Peak angle
Walking Female
p-value
Male
Jogging Female
p-value
Male
35.2 (2.7) 64.9 (5.1) −14.3 (3.9)
0.12 0.14 0.25
36.7 (3.0) 62.0 (4.8) 14.6 (4.7)
34.9 (3.0) 60.3 (3.9) 12.9 (4.9)
0.21 0.29 0.43
121.3 (13.2) 147.6 (11.1) 33.6 (3.7)
117.8 (14.9) 154.1 (10.3) 36.2 (4.8)
0.19 0.18 0.35
9.9 (1.9) 4.8 (2.9) 6.6 (2.2)
0.02∗ 0.00∗ 0.29
9.2 (1.9) 6.7 (4.0) 4.9 (3.1)
10.6 (2.1) 4.4 (3.6) 8.2 (2.4)
0.02∗ 0.01∗ 0.00∗
12.8 (5.8) 9.7 (3.6) 11.4 (4.9)
19.1 (4.2) 13.8 (3.5) 13.7 (4.3)
0.02∗ 0.01∗ 0.23
6.3 (3.1) 4.1 (5.6) 3.2 (4.0)
0.01∗ 0.47 0.60
7.3 (3.6) 3.2 (2.6) 6.0 (4.4)
11.3 (3.3) 5.3 (3.0) 5.1 (3.7)
0.00∗ 0.53 0.42
12.8 (8.1) 19.2 (4.1) 6.0 (5.9)
18.7 (6.8) 25.9 (5.0) 7.7 (5.5)
0.00∗ 0.00∗ 0.08
Male Sagittal plane Hip 34.7 (3.0) Knee 66.2 (4.8) Ankle 13.7 (4.3) Frontal plane Hip 8.1 (2.1) Knee 6.9 (3.3) Ankle 6.3 (1.5) Transverse plane Hip 3.6 (1.6) Knee 3.8 (4.9) Ankle 3.6 (3.6)
difference between males and females.
30
Frontal
20
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0 -10 -20
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∗ Significant
Squatting Female
-10
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Fig. 2. Mean curves of 3D joint angles for Chinese males (solid) and females (dashed) during walking.
100
p-value
S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living Sagittal
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Fig. 3. Mean curves of 3D joint angles for Chinese males (solid) and females (dashed) during jogging.
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Fig. 4. Mean curves of 3D joint angles for Chinese males (solid) and females (dashed) during deep squatting.
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S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living Table 4 Comparisons of spatiotemporal parameters published in previous studies during walking
Subjects Italy19 Velocity (m/s) Male 1.33 (0.03) Female 1.34 (0.02) p-value 0.826 Cadence (steps/min) Male 114.0 (2.4) Female 106.8 (2.4) p-value 0.06 ∗ Significant
France1
Canada16
USA20
Korea27
Korea22
Holland21
China
1.59 (0.13) 1.54 (0.12) −
1.60 (0.2) 1.40 (0.2) 0.62
1.54 (0.16) 1.63 (0.13) 0.229
1.19 (0.11) 1.12 (0.11) 0.001∗
1.17 (0.11) 1.08 (0.14) < 0.05∗
1.55 (0.18) 1.50 (0.15) −
1.26 (0.15) 1.23 (0.19) 0.42
116.4 (7.2) 123.6 (7.2) −
128.0 (8.5) 120.0 (8.6) < 0.01∗
− − −
111.8 (6.4) 112.5 (6.5) 0.552
107.2 (7.8) 109.3 (10.7) > 0.05
112.3 (5.8) 120.2 (7.0) −
113.5 (6.2) 119.2 (7.5) 0.01∗
difference between males and females. Table 5 Comparisons of angle ranges of hip, knee and ankle joints during walking
Subjects Hip Sagittal Frontal Transverse Knee Sagittal Frontal Transverse Ankle Sagittal Frontal Transverse
UK28
Australia24
Italy25
Korea27
Korea21
China
−6.3∼40.1 −6.4∼5.7 −16.7∼-1.2
−13.7∼32 1.5∼13.6 −13.3∼1.4
−10∼29.8 −5.5∼5.4 −3.4∼8.5
−4.2∼39 −4.3∼7.3 −5.0∼8.0
−18.3∼27.4 −14.1∼-0.2 0.4∼9.8
−5.5∼35.0 −2.3∼9.0 −3.2∼5.0
−8.3∼61.3 −4.5∼1.7 −2.4∼11.2
5.8∼73.7 −6.3∼2.5 −11.3∼4.5
0.4∼65.7 −6.5∼4.1 −5.3∼8.4
2.3∼59.0 −1.0∼7.5 −6.0∼5.0
1.4∼59.4 6.6∼13 −8.2∼3.3
3.9∼65.6 −2.2∼5.5 −7.6∼4.0
−10∼16.6 3.1∼14.2 −13.4∼-3.2
−22.7∼12.4 −9.4∼6.2 −4.4∼17.2
−22.6∼10.9 −3.2∼9.2 −
−14∼11.5 − −19.0∼-5.0
−17.5∼10.8 −1.9∼3.3 −17.3∼-3.5
−16.5∼31.6 −6.5∼6.0 −6.8∼4.5
ting) for males, while peak knee flexion were 66.2◦ ± 4.8◦ (walking), 62.0◦ ± 4.8◦ (jogging), and 147.6◦ ± 11.1◦ (squatting), respectively. Gender differences were not significant for the kinematics in sagittal plane at the hip, knee and ankle joints for all three activities (p > 0.05). In the remained planes, female subjects exhibited more non-sagittal plane motions compared to males (Table 3). Specifically, compared to males, females demonstrated significantly more peak hip adduction (p = 0.02), peak internal rotation (p = 0.01), and peak knee adduction (p = 0.00) during walking, while more peak hip adduction (p = 0.02), peak internal rotation (p = 0.00), peak knee adduction (p = 0.01) and peak ankle adduction (p = 0.00) were demonstrated by females during jogging, moreover, more peak hip adduction (p = 0.02), peak internal rotation (p = 0.00), and peak knee adduction (p = 0.01), peak internal rotation (p = 0.00) were found with respect to squatting.
4. Discussion Although lower extremity kinematics during walking and jogging activities have been studied extensively [5,14–17], there was no standardized data that characterizes lower extremity kinematics for Chinese,
especially during high ROM activities, which were practiced on a daily basis in some non-Western cultures. Comparison of spatiotemporal parameters was made with respect to previously reported results [1,5, 16–19] (Table 4), it shows that the walking velocity of Koreans was much slower than the Westerners, in this study the same result was found for Chinese, demonstrating the significance of studying subjects with fully considering their ethnic background. Meanwhile, the gait kinematics obtained in this study were quantitatively compared with previous studies [5,18,20–22] (Table 5). During deep squatting, the average joint motions of this study agreed well with those obtained from other Asian population, who had a similar lifestyle [2, 3], but differed from the Westerners [4,23]. Specifically, the mean ROM in sagittal plane for Chinese during squatting was 146◦. The results demonstrated a much larger range required for squatting than that of 101◦ for a group of Western subjects [23]. Besides, for Western populations, knee joint kinematics in sagittal plane was significantly different between genders during walking [14,24]. However, it was not found for Asians [5,18]. Therefore, the comparison demonstrated that it is very essential to establish a kinematic database for Chinese. Previous investigations have demonstrated the differences between males and females concerning med-
S. Han et al. / Three-dimensional lower extremity kinematics of Chinese during activities of daily living
ical, physical, and psychological issues. The differences have been speculated to be a contributing factor to the higher injury rate in females [8,9]. Our hypothesis was that gender difference would appear during these three activities, especially in the frontal and transverse planes. The results were in support of our hypotheses. During walking and jogging, females showed greater hip adduction and knee valgus angles in the frontal plane. It was plausible that the wider pelvis and narrower step width of females were responsible for this [5,15]. In transverse plane, greater hip internal rotation was observed for females during walking and jogging, which could also be a result of the anatomical characteristics of the female femur [5]. Gender differences in joint angles were also observed during deep squatting. Females demonstrated more adduction and internal rotation at the hip and knee joint. The observed differences might be due to different periarticular connective tissue properties. As we all know, females turns to have higher joint laxity and altered musculoskeletal functional mechanism. The joint laxity of females could diminish joint proprioception, resulting in lower joint sensitivity to potentially injurious loads. For example, ACL laxity would allow for a longer time for females to detect the joint motion. Because of its contributing role in controlling knee axial rotation, females may demonstrate higher knee rotations. Moreover, it has been reported that female appeared to rely more on their quadriceps muscles in response to anterior translation, whereas male athletes relied more on their hamstring muscles [26]. These differences may all lead to a much higher risk of female to sustain an injury than their male counterparts [6,7]. One potential limitation of the current study was that the quantity of recruited subjects was relatively small compared with the whole population in China. Moreover, only young subjects were included. In this study, we do recognize this fact, and thus, we tried our best to recruit as much of subject from various regions of China. Totally, we selected 40 subjects from over 20 provinces. Secondly, this study only focused on the kinematics and spatiotemporal parameters, while the response of the neuromuscular system was not studied, which is also essential for better understanding the underlying mechanisms. Thus, in the future a comprehensive study on kinematic, kinetic, spatiotemporal, and EMG data should be performed. In summary, the lower extremity kinematics of a group of young Chinese was investigated during walking, jogging and deep squatting in this study. A brief comparison of the interested parameters was made
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with previous studies. The results indicated gender differences in joint kinematics during daily activities in the frontal and transverse planes. Compared to males, females demonstrated significantly higher joint adduction and internal rotation. The outcomes of this study not only improve our understanding of joint biomechanics during daily activities of Chinese, but it can also provide a basis for comparison to patients with various joint diseases.
Acknowledgement This work was funded by the National Natural Science Foundation of China (No. 51275512).
Conflict of interest We have no conflicts of interest with respect to the authorship and/or publication of this article.
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