During landing, lower-body bones experience large mechanical loads and are deformed. It is essential to measure bone deformation to better understand the mechanisms of bone stress injuries associated with impacts. A novel approach integrating subject-specific musculoskeletal modeling and finite element analysis is used to measure tibial strain during dynamic movements.
Bone stress injuries are common in sports and military trainings. Repetitive large ground impact forces during training could be the cause. It is essential to determine the effect of high ground impact forces on lower-body bone deformation to better understand the mechanisms of bone stress injuries. Conventional strain gauge measurement has been used to study in vivo tibia deformation. This method is associated with limitations including invasiveness of the procedure, involvement of few human subjects, and limited strain data from small bone surface areas. The current study intends to introduce a novel approach to study tibia bone strain under high impact loading conditions. A subject-specific musculoskeletal model was created to represent a healthy male (19 years, 80 kg, 1,800 mm). A flexible finite element tibia model was created based on a computed tomography (CT) scan of the subject's right tibia. Laboratory motion capture was performed to obtain kinematics and ground reaction forces of drop-landings from different heights (26, 39, 52 cm). Multibody dynamic computer simulations combined with a modal analysis of the flexible tibia were performed to quantify tibia strain during drop-landings. Calculated tibia strain data were in good agreement with previous in vivo studies. It is evident that this non-invasive approach can be applied to study tibia bone strain during high impact activities for a large cohort, which will lead to a better understanding of injury mechanism of tibia stress fractures.
Bone stress injuries, such as stress fractures, are severe overuse injuries requiring long periods of recovery and incurring significant medical cost1,2. Stress fractures are common both in athletic and military populations. Among all sports related injuries, stress fractures account for 10% of the total3. In particular, track athletes face a higher injury rate at 20%4. Soldiers also experience a high rate of stress fractures. For instance, a 6% injury rate was reported for the US Army1 and a 31% injury rate was reported in the Israeli Army5. Among all reported stress fractures, tibia stress fracture is the most common one6,7,8.
Sports and physical trainings with a higher risk of tibia stress fracture are normally associated with high ground impacts (e.g., jumping, landing, and cutting). During locomotion, a ground impact force is applied to the body when the foot contacts the ground. This impact force is dissipated by the musculoskeletal system and footwear. The skeletal system serves as a series of levers allowing muscles to apply forces to absorb the ground impact9. When the leg muscles cannot adequately reduce the ground impact, lower-body bones must absorb the residual force. Bone structure will experience deformation during this process. Repetitive absorption of residual impact force may result in microdamages in the bone, which will accumulate and become stress fractures. To date, information related to bone reaction to external ground impact forces is limited. It is important to study how the tibia bone responds to the mechanical load introduced by high impact forces during dynamic motions. Examining tibia bone deformation during high impact activities could lead to a better understanding of the mechanism of tibia stress fracture.
Conventional techniques used to measure bone deformation in vivo rely on instrumented strain gauges10,11,12,13,14,15. Surgical procedures are needed to implant strain gauges on bone surface. Due to the invasive nature, in vivo studies are limited by a small sample of volunteers. In addition, the strain gauge can only monitor a small region of the bone surface. Recently, a non-invasive method utilizing computer simulation to analyze bone strain was introduced16,17. This methodology allows for the ability to combine musculoskeletal modeling and computational simulations to study bone strain during human movement.
A musculoskeletal model is represented by a skeleton and skeletal muscles. The skeleton consists of bone segments, which are rigid or non-deformable bodies. Skeletal muscles are modeled as controllers using the progressive-integral-derivative (PID) algorithm. The three-term PID control uses errors in estimation to improve the output accuracy18. In essence, PID controllers representing muscles try to duplicate body movements by developing necessary forces to produce length changes of the muscles over time. The PID controller uses the error in the length/time curve to modify the force for reproducing the movement. This simulation process creates a feasible solution to coordinate all muscles to work together to move the skeleton and produce the body movement.
One or more segments in the skeleton of the musculoskeletal model can be modeled as flexible bodies to allow measurement of deformation. For instance, the tibia bone can be broken down into a finite number of elements, which consists of thousands of elements and nodes. The effect of mechanical loading on the flexible tibia can be examined through finite element (FE) analysis. The FE analysis calculates the loading response of individual elements over time. As the number of bone elements and nodes increase, the computation time of the FE analysis will significantly increase.
To reduce computational cost with accurate evaluation of flexible bodies' deformation, modal FE analysis has been developed and used within the automotive and aerospace industry19,20. Instead of analyzing individual FE elements' responses to mechanical load in the time domain, this procedure assesses an object's mechanical responses based on different vibrational frequencies in the frequency domain. This method results in a significant reduction in computation time while providing accurate measurement of deformation20. Although modal FE analysis has been widely used to study mechanical fatigue in automotive and aerospace areas, the application of this method has been very limited in human movement science. Al Nazer et al., used a modal FE analysis to examine tibial deformation during human gait and reported encouraging results16,17. However, their method was greatly affected by only using limited kinematic data from an experiment to drive the computer simulations; There were no real ground impact forces used to assist the simulations. This approach may be reasonable for studying low impact slow motions such as walking, but it is not a feasible solution to study high ground impact movements. Thus, in order to examine lower-body bone reactions during dynamic high impact activities, it is essential to develop an innovative approach to address the limitations associated with the previously reported method. Specifically, a method utilizing accurate experimental kinematic data and real ground impact forces must be developed. Therefore, the goal of this study was to develop a subject-specific musculoskeletal model to perform multibody dynamic simulations with modal FE analysis to examine tibial strain during high impact activities. A dynamic high impact movement represented by drop-landings from different heights was selected to test the method.
The purpose of this study was to develop a non-invasive method to determine tibia deformation during high impact activities. Quantifying tibia strain due to impact loading will lead to a better understanding of tibia stress fracture. In this study, a subject-specific musculoskeletal model was developed, and computer simulations were run to duplicate the drop-landing movements performed in a laboratory setting. The effect of drop-landing height on tibial strain was examined. In this study, we observed that as the drop-lan…
The authors have nothing to disclose.
Department of the Army #W81XWH-08-1-0587, #W81XWH-15-1-0006; Ball State University 2010 ASPiRE grant.
CT Scanner | GE Medical System | N/A | Light Speed VCT. For performing tibia CT scan. |
Motion Capture System | Vicon Inc | N/A | Vicon FX40 high speed cameras. For performing 3D motion capture. |
Force plates | AMTI Inc | N/A | Collecting 3D ground reaction forces |
Vicon Nexus | Vicon Inc | N/A | Motion capture software program. For processing visual marker trajectory data. |
Visual 3D | C-Motion Inc | N/A | Biomechanics analysis software. For computing 3D kinematics and kinetics of human movements. |
MATLAB | Mathworks Inc | N/A | Computer programming software. For performing raw data filtering, data conversion, and data processing. |
ADAMS 2012 | MSC Software Inc | N/A | Multibody dynamic computer simulation program. |
LifeMOD | Lifemodeler Inc | N/A | A software Plug-in in ADAMS. For building human body musculo-skeletal models. |
MIMICS 13 | Materialise Inc | N/A | Image processing program. A 3D modeling tool to process imaging data. For creating 3D tibia model from CT scans. |
MARC 2012 | MSC Software Inc | N/A | Finite element analysis software. For performing volumn meshing, generating tibia FE model, and running modal FE analysis. |
SPSS 19 | IBM Inc | N/A | Statistical analysis software. |