Michael Hunt
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Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.
The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.
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For several decades biomechanical features of gait have been investigated for their relevance to musculoskeletal disease, particularly knee osteoarthritis. This is largely due to their established link between excessive or abnormally distributed ambulatory knee joint load and faster disease progression. Modifying aspects of gait kinematics, specifically the foot progression angle (FPA; a measure of in-toeing or out-toeing), can lower these joint loads and may be a tool for managing knee osteoarthritis. However, all the research both quantifying natural FPA and the work investigating how it can be modified, have relied on laboratory-based gait analysis which does not represent the typical walking environments people navigate in their daily life. In this dissertation we aimed to leverage innovative and clinically feasible technologies to move gait analysis and modification out of the laboratory and into the real-world. In the first study we demonstrated that the FPA can be measured with wearable technology both reliably and with acceptable accuracy compared to optical motion capture. We then identified the amount of gait data that needs to be collected in real-world settings to observe stable outcomes. Building from these initial studies, we performed the first characterization of the FPA in unsupervised, real-world settings over a week of community walking in a population with and without knee osteoarthritis. This showed the similarity between laboratory and real-world FPA magnitude but highlighted that laboratory measurements may underestimate the variability inherent in real-world walking. Lastly, we deployed a shoe-embedded sensor in the context of a gait modification clinical trial to monitor participants’ performance over time. This study also incorporated innovative methods, including a telerehabilitation delivery model, individualized gait modification, pre-screening for responders, and a self-directed gait modification magnitude. We found that delivering the intervention without any in-person guided practice still resulted in significant changes to the FPA, knee joint moments, and symptoms, warranting further investigation in a larger clinical trial. This dissertation demonstrated that real-world gait biomechanics can be collected with a single inertial sensor with sufficient precision to observe clinically meaningful changes, and it can be implemented in a clinical trial to monitor performance in ecologically valid environments.
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Introduction: The etiology of running-related injuries is multifactorial, but it is accepted that biomechanical factors play a role. This thesis examined the influence of peak braking force on running-related injury risk and the effectiveness of a gait retraining program using real-time biofeedback to reduce this parameter in high-risk individuals.Methods: Healthy novice female recreational runners were recruited from the local running community. The studies in Chapters 2 and 3 were run in parallel, while the study described in Chapter 4 took place following their completion. Kinetic risk factors of running-related injury were examined using a prospective longitudinal cohort design and Cox proportional hazard models with competing risks were fit for each kinetic variable independently (Chapter 2). Baseline data were then analyzed to determine the kinematic correlates of kinetic risk factors using stepwise multiple linear regression to evaluate the amount of variance in each kinetic outcome explained by speed, foot strike angle, and kinematic variables associated with overstriding (Chapter 3). Finally, a similar but separate sample of female recreational runners considered to be at higher-risk of developing injury (peak braking force>0.27 BW) were enrolled in an eight-session gait retraining program using real-time biofeedback of the anterior-posterior (braking) ground reaction force (Chapter 4).Results: Peak braking force was associated with a five to eight-fold increased risk of running-related injury. Our findings suggest that the use of peak braking force may be a more effective target for gait retraining than vertical loading rate. Regression analysis of kinematic variables revealed that shortening step length and transitioning away from a rearfoot strike pattern are appropriate strategies to reduce peak braking force. An eight-session gait retraining program significantly reduced peak braking force, as well as vertical loading rates associated with running-related injury. This was achieved predominantly through a combination of increased step frequency and decreased step length.Conclusions: This dissertation provides new understanding of the role of kinetic risk factors—specifically peak braking force—in the development of running-related injury. Furthermore, it provides the structure for a larger randomized controlled trial to assess a gait retraining intervention to reduce peak braking force and running-related injury risk.
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Pain is a common symptom in patients with chronic obstructive pulmonary disease (COPD). This symptom can negatively affect physical activity levels, quality of life, and health outcomes. It has been shown that systemic inflammation, comorbidities, and symptoms (e.g., dyspnea or fatigue) may cause pain. Although previous research has determined the association between pain and the presence of comorbidities, the specific comorbidities that cause pain and other etiologic factors of pain are still unknown. Also, the interrelationships among pain, dyspnea, and fatigue and whether the presence of one symptom accentuates another remain to be examined.The overall purpose of this dissertation was to investigate the etiology of pain by exploring the pain experience, the contributors to pain, the interrelationships between pain and other symptoms, and the associations between pain and thoracic abnormalities in patients with COPD. Studies I and II established the reliability and validity of the Brief Pain Inventory (BPI), Dyspnea Inventory (DI), and Brief Fatigue Inventory (BFI) in patients with COPD. Study III determined comorbidities that caused pain as well as compared pain, fatigue, and dyspnea symptomology in patients with COPD. This study utilized a cross-sectional survey design that included the BPI, DI, BFI, General Self-efficacy Scale, Clinical COPD Questionnaire, and Comorbidities/Medication Questionnaire. Study IV investigated chest computed tomography images of patients with COPD and current/ex-smokers to examine the associations between trunk pain and thoracic vertebral deformity and arthropathy. The findings showed that the BPI, DI, and BFI were reliable and valid questionnaires to evaluate symptoms in COPD. Similar to dyspnea and fatigue, pain was also a significant symptom in patients with COPD and these three symptoms were correlated with each other. Further, the most common comorbidities that caused pain were musculoskeletal diseases. Trunk pain in patients with COPD was associated with thoracic vertebral deformities, arthropathy of thoracic joints, and hyperkyphosis.In summary, pain in COPD is associated with musculoskeletal comorbidities and there are interactions between pain and other symptoms. This dissertation provides insight into the causes of pain in patients with COPD, which can facilitate the development of pain management strategies in COPD.
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Introduction: Those with knee osteoarthritis report more falls than those without, and falls present serious economic, personal and public health consequences. Dynamic balance is an important factor associated with falls risk. Current clinical tests of balance in this population have limitations to their use. Further, interventions to improve dynamic balance have had mixed results in this population, possibly since more information on dynamic balancing ability is needed for better program design. This thesis examined the assessment and treatment of dynamic balancing ability in individuals with knee osteoarthritis.Methods: The Community Balance and Mobility Scale (CB&M), an advanced test of dynamic balance, was examined for use in individuals with knee osteoarthritis. The convergent validity, construct (known groups) validity, and test re-test reliability of the scale was assessed (Chapter 2). Convergent validity was assessed by comparing to tests measuring similar constructs, such as the Berg Balance Scale. Construct validity was assessed by comparing scoring of those with and without knee osteoarthritis. Test re-test reliability was assessed one week apart. Clinically modifiable factors associated with dynamic balancing ability were then investigated (Chapter 3). These included muscle strength, knee joint proprioception, knee joint range of motion and anticipatory postural control. Finally, a ten week dynamic balance training program, designed using findings from Chapter 2 and 3, was assessed in Chapter 4. This was a randomized controlled trial, with dynamic balancing ability and self-reported physical function measured at baseline and follow-up.Results: The CB&M was found to display moderate to strong convergent validity with other tests, strong construct validity and high test re-test reliability. Lower extremity strength, and to a lesser extent, knee range of motion were important factors associated with dynamic balancing ability. Ten weeks of training resulted in significant improvement in self-reported physical function but not in CB&M scores.Conclusion: This dissertation provides new understanding of dynamic balance assessment and treatment in those with knee osteoarthritis. These findings highlight a valid and reliable clinical outcome measure for dynamic balance, as well as provide insights into balance training program designed to improve outcomes and maintain high adherence in this population.
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Mechanisms underpinning motor control of standing balance post-stroke remain unclear. Following stroke, ankle plantarflexor muscles demonstrate impairment associated with asymmetrical postural control and decreased balance. Stroke also results in increased attentional demands during challenges to standing balance. This thesis examined motor control impairment post-stroke from medial gastrocnemius motor units to the tri-muscle plantarflexor complex. Investigation of motor, kinematic and kinetic parameters of postural control during external perturbations in standing and associated levels of physiological arousal have furthered understanding of balance impairment post-stroke. Methods: Medial gastrocnemius motor units were recorded in controls (Chapter 2) and people post-stroke (Chapter 3) in standing as perturbations were sequentially applied at the pelvis under conditions of increased anteriorly-directed challenge. In both studies, motor unit firing rate was calculated during dynamic response to perturbation, and maintenance of steady state between perturbations. Joint kinematics, surface electromyography and movements of the centre of pressure were assessed. In Chapter 4, this methodology was expanded to cross-correlation analysis of electromyography activity of the three plantarflexor muscles with anterior-posterior centre of pressure during steady state. In Chapter 5, attentional demands surrounding timing of external perturbation were manipulated to investigate effects of stroke on physiological arousal and postural reactions.Results: In healthy subjects, medial gastrocnemius utilized primarily motor unit recruitment to maintain standing with a modest increase in motor unit firing rate only during the dynamic response to external perturbations. The paretic medial gastrocnemius also primarily used motor unit recruitment; however, lacked firing rate modulation during the dynamic response, albeit firing rate was related to kinematic variables of postural control. In people post-stroke, the three plantarflexors demonstrated asymmetrical motor control of postural sway between-legs but symmetry was improved under conditions of increased challenge to standing balance. Finally, knowledge of timing of perturbations did not decrease the heightened anticipatory postural strategy and level of physiological arousal exhibited post-stroke. Conclusions: This dissertation provides new understanding of motor control of standing balance post-stroke and reveals anticipatory postural strategies adopted post-stroke under conditions challenging balance. These findings implicate the importance of introducing challenge to standing balance post-stroke in the assessment and rehabilitation of postural control post-stroke.
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Master's Student Supervision
Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.
Introduction: Femoroacetabular impingement (FAI) is a patho-mechanical hip condition that involves abnormal contact between the femoral head/neck and the pelvis acetabulum. This abnormal contact can lead to impingement and restrictions in hip motion, particular in end-range hip flexion, adduction and/or internal rotation. Most of the biomechanical research to date has involved the symptomatic population (sFAI), where motion analysis was used to quantify differences in movement performance compared to healthy populations. However, the study of asymptomatic FAI (aFAI) is also important due to its high prevalence in the general population. The prevalence of FAI is also high in the athletic population; however there is a lack of studies that have analyzed a sport-specific movement. One such movement is the lunge, and because of the multidirectional nature of many sports, the 45˚ cross-body lunge was specifically chosen to be biomechanically analyzed. Purpose: The purpose of this thesis was to compare trunk and lower limb biomechanics during the 45˚ cross-body lunge between sFAI, aFAI and healthy control populations.Methods: 33 total participants were recruited: 9 sFAI, 13 aFAI and 11 healthy individuals. In a single session, these participants were asked to perform the 45˚ cross-body lunge. Trunk, pelvis, hip, knee and ankle kinematics, as well as hip, knee and ankle kinetics and vertical ground reaction forces were examined.Results: Overall, there were very few statistically significant between-group differences in 45˚ cross-body lunge performance. Prior to outlier removal, though, the sFAI group exhibited a larger pelvis sagittal plane excursion during the entire movement than the aFAI group (p=0.046). After outlier removal, this difference was no longer statistically significant. As for knee sagittal moment net impulse, the only statistically significant difference became evident after outlier removal, where the aFAI group exhibited a larger knee sagittal moment net impulse than the control group (p=0.016).Conclusions: The results of our study generally show that sFAI, aFAI and healthy control populations perform the 45˚ cross-body lunge similarly. However, future research should aim to better understand pelvis and knee biomechanics during sporting activities like the lunge, as these parameters may have important implications in rehabilitation and sport performance.
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Introduction:Knee osteoarthritis is a common and painful disease, and is one of the leading causes of disability in Canada. It is thought that one of the primary causes of disease progression is excessive knee joint loading. Thus, conservative treatments have aimed to reduce knee joint load, predominantly targeting the knee adduction moment – a valid proxy of tibial joint load distribution. Toe-in and toe-out walking are two such strategies which have proven effective in the short term at reducing the knee adduction moment, but still require longer-term assessment and a more thorough understanding of the ancillary effects at joints other than the knee prior to clinical implementation. The ankle joint in particular may be subjected to altered biomechanics during toe-in and toe-out walking.Purpose:The purpose of this thesis was to examine ankle biomechanics during toe-in and toe-out foot rotations in those with medial compartment knee osteoarthritis.Methods:Fifteen individuals with medial compartment knee osteoarthritis were recruited. In a single session, participants were instructed to walk in four conditions guided by real-time biofeedback of performance: 1) toe-in (+10°), 2) neutral (0°), 3) toe-out (-10°) and 4) toe-out (-20°). Ankle kinematics, kinetics and muscle activity were examined during over-ground walking.Results:Toe-out walking exhibited an increase (p=0.011) in peak ankle eversion compared to toe-in walking, while toe-in walking exhibited an increase in ankle inversion at heel strike (p
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Introduction: Knee osteoarthritis is a common, painful disease typically affecting the medial compartment of the tibiofemoral joint (TFJ). It is thought to result from excessive loading through the knee joint, and conservative treatments, like toe-in and toe-out gait modification, have been designed to alter the distribution of forces through the joint. Toe-in and toe-out have shown improvements in pain over the short-term, but it is not clear what changes actually occur within the TFJ. Since changes in orientation and contact between the tibia and femur would be indicative of altered loading in the TFJ, our goal was to examine the TFJ in standing with toe-in and toe-out positions using an open magnetic resonance scanner.Methods: This was a within-subjects study comparing tibiofemoral contact in standing in three foot positions (neutral, 0 degrees foot rotation; toe-in, 20 degrees internal rotation; and toe-out, 20 degrees external rotation). Fifteen young participants underwent magnetic resonance imaging of one of their knees. Images were analyzed to determine contact in the TFJ, with primary outcomes including centroid of contact and contact area for each compartment and overall.Results: The centroid of contact shifted laterally in the lateral compartment with the toe-in position compared to the neutral position (p = 0.05) while toe-out resulted in a lateral shift of the centroid of contact for the entire joint (p
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Introduction: Femoroacetabular impingement is a pathomechanical hip condition that leads to pain, impaired physical function and, if left untreated, potentially hip osteoarthritis. It has been shown that those with femoroacetabular impingement exhibit altered gait characteristics during level walking and stair climbing, and decreased muscle force production during isometric contractions. However, to-date no studies have looked at muscle activation during dynamic movements such as stair climbing in this patient population. Purpose: The purpose of this study was to compare three-dimensional gait kinematics of the trunk and lower limb joint kinetics, and activation of the hip, knee and ankle musculature during stair climbing in those with femoroacetabular impingement and pain free controls. Methods: Trunk, hip knee and ankle kinematics, as well as hip, knee and ankle kinetics and EMG activity of nine lower limb muscles were collected during stair climbing for 20 people with femoroacetabular impingement and compared to 20 pain-free individuals. Results: Those with femoroacetabular impingement had significantly increased peak trunk forward flexion angles (p=0.01) and external hip flexion moments (0.01), and decreased peak external knee flexion moments (0.01) and lateral gastrocnemius activation (p=0.04) compared to the control group. Conclusion: Findings from this study indicate that those with FAI may increase their trunk forward flexion to potentially compensate for reduced gastrocnemius activation, to decrease the demand on the quadriceps or as a response to pain. However, a trunk lean may also be a potential cause of FAI due to increased external hip flexion moments. This should all be taken into account by clinicians when rehabilitating those with FAI.
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Introduction: Femoroacetabular impingement (FAI) is a pathomechanical process of the hip joint that has been linked to the early development of hip osteoarthritis. FAI morphology usually progresses gradually and can limit the ability of individuals to engage in sports and causes pain during activities of daily living. These impairments can lead to loss of range of motion, muscle weakness and altered walking biomechanics. Currently, surgery is the common treatment, however little is known about the effects of muscle strengthening in this population. Based on the results of similar programs in other pathologies, muscle strengthening may alleviate this muscle weakness and hip pain. Our goal was to investigate the effects of a pre-surgical hip muscle strengthening intervention on hip strength, pain and function in those with FAI.Methods: This was a within subject, pre-test – post-test intervention study examining the effects of a 10-week hip muscle strengthening program in 20 individuals (18 males) with FAI before hip surgery. Clinical outcomes including maximum isometric hip strength, hip pain and physical function were collected before and after the strengthening intervention. During the intervention, participants progressed through three phases of increasing resistance and functionality as they received a bilateral hip strengthening program consisting of 4-6 exercises per phase.Results: Maximum isometric hip strength significantly increased in abduction (p=0.008), adduction (p=0.021) and internal rotation (p=0.006) at follow-up. Flexion, extension and external rotation strength changes did not reach significance. Self-reported HOOS pain subscale scores (p
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Introduction: Knee osteoarthritis (OA) is a destructive joint disease resulting from a number of factors including excessive and repetitive loading of the joints. Even though OA symptoms begin mostly in midlife, the degenerative changes of articular cartilage take place a long time before the onset, so it is important to track osteoarthritic changes at earlier phases. Radiology imaging is widely used for this purpose; however, radiology does not show minute changes that occur before onset of OA symptoms. Due to such limitations, the investigation of molecular changes is growing in today’s research. Matrix metalloproteinases (MMPs) are degenerative enzymes of connective tissue and their quantities are thought to be related to OA changes. Our goal was to investigate how MMP variance is explained by OA–related factors, mainly dynamic knee joint loading. Methods: A cross-sectional design was used to collect data on the intraarticular knee joint load, reflected by knee adduction moment (KAM), as well as serum samples in 28 participants of which half had mild to severe OA and the other half were OA-free. Laboratory-based motion analysis was used to compute the KAM, while MMP levels (MMPs- 1, 3, 13) were measured using ELISA. Multiple-regression analysis was used to investigate the explanatory role of KAM, and potential confounders like age, and OA severity in explaining MMP variance. Results: KAM impulse predicted significant variance in MMP-3 levels (R²=0.197, p=0.018). After controlling for the effect of age and severity, the explanatory role of KAM impulse was decreased (R²=0.157), still remaining statistically significant (p=0.036). The explained variance of MMP-1, 13 did not reveal statistical significance from explanatory variables. Conclusion: This research provides evidence of a positive relationship between MMP- 3 and intraarticular knee joint load, quantified by the KAM. The relationship remained significant after controlling for age and OA severity. Our findings support the notion that MMP-3 may be a candidate for OA investigations. Since MMP levels are influenced by a number of factors, it seems logical to consider the levels of other biomarkers along with them.
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Publications
- Frontal plane knee alignment mediates the effect of frontal plane rearfoot motion on knee joint load distribution during walking in people with medial knee osteoarthritis (2021)
Osteoarthritis and Cartilage, - Infographic. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018 (2021)
British Journal of Sports Medicine, 55 (2), 115-117 - Knee-specific gait biomechanics are reliable when collected in multiple laboratories by independent raters (2021)
Journal of Biomechanics, 115 - Learning Gait Modifications for Musculoskeletal Rehabilitation: Applying Motor Learning Principles to Improve Research and Clinical Implementation (2021)
Physical Therapy, - Relationships Between Stepping-Reaction Movement Patterns and Clinical Measures of Balance, Motor Impairment, and Step Characteristics After Stroke (2021)
Physical Therapy, - Using the VERT wearable device to monitor jumping loads in elite volleyball athletes (2021)
PLOS ONE, - Biomechanics during cross-body lunging in individuals with and without painful cam and/or pincer morphology (2020)
Clinical Biomechanics, 76 - Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018 (2020)
British Journal of Sports Medicine, - Immediate effects of valgus bracing on knee joint moments during walking in knee-healthy individuals: Potential modifying effects of body height (2020)
Gait and Posture, 80, 383-390 - Influence of foot posture on immediate biomechanical responses during walking to variable-stiffness supported lateral wedge insole designs (2020)
Gait and Posture, 81, 21-26 - Osteoarthritis year in review 2019: mechanics (2020)
Osteoarthritis and Cartilage, 28 (3), 267-274 - Patient-reported outcome measures for hip-related pain: A review of the available evidence and a consensus statement from the International Hiprelated Pain Research Network, Zurich 2018 (2020)
British Journal of Sports Medicine, 54 (14), 848-857 - Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: Consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018 (2020)
British Journal of Sports Medicine, 54 (9), 504-511 - Portable, automated foot progression angle gait modification via a proof-of-concept haptic feedback-sensorized shoe (2020)
Journal of Biomechanics, 107 - Reliability of tibiofemoral contact area and centroid location in upright, open MRI (2020)
BMC Musculoskeletal Disorders, 21 (1) - Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: Recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018 (2020)
British Journal of Sports Medicine, 54 (12), 702-710 - The use of a single sacral marker method to approximate the centre of mass trajectory during treadmill running (2020)
Journal of Biomechanics, 108 - Validity and reliability of wearable inertial sensors in healthy adult walking: A systematic review and meta-analysis (2020)
Journal of NeuroEngineering and Rehabilitation, 17 (1) - What are the perceptions of runners and healthcare professionals on footwear and running injury risk? (2020)
BMJ Open Sport & Exercise Medicine, - Ankle Joint and Rearfoot Biomechanics During Toe-In and Toe-Out Walking in People With Medial Compartment Knee Osteoarthritis (2019)
PM and R, 11 (5), 503-511 - Cartilage recovery in runners with and without knee osteoarthritis: A pilot study (2019)
Knee, 26 (5), 1049-1057 - Challenging standing balance reduces the asymmetry of motor control of postural sway poststroke (2019)
Motor Control, 23 (3), 327-343 - Individuals with knee osteoarthritis present increased gait pattern deviations as measured by a knee-specific gait deviation index (2019)
Gait and Posture, 72, 82-88 - Kinematic correlates of kinetic outcomes associated with running-related injury (2019)
Journal of Applied Biomechanics, 35 (2), 123-130 - Real-time biofeedback of performance to reduce braking forces associated with running-related injury: An exploratory study (2019)
Journal of Orthopaedic and Sports Physical Therapy, 49 (3), 136-144 - Regional Vastus Medialis and Vastus Lateralis Activation in Females with Patellofemoral Pain (2019)
Medicine and Science in Sports and Exercise, 51 (3), 411-420 - Validity and reliability of a shoe-embedded sensor module for measuring foot progression angle during over-ground walking (2019)
Journal of Biomechanics, 89, 123--127 - A Comparison of Pain, Fatigue, Dyspnea and their Impact on Quality of Life in Pulmonary Rehabilitation Participants with Chronic Obstructive Pulmonary Disease (2018)
COPD: Journal of Chronic Obstructive Pulmonary Disease, 15 (1), 65-72 - Clinical and biomechanical changes following a 4-month toe-out gait modification program for people with medial knee osteoarthritis: a randomized controlled trial (2018)
Osteoarthritis and Cartilage, 26 (7), 903--911 - Contralateral limb foot rotation during unilateral toe-in or toe-out walking in people with knee osteoarthritis (2018)
Gait & Posture, 62, 132--134 - Gait patterns, symptoms, and function in patients with isolated tibiofemoral osteoarthritis and combined tibiofemoral and patellofemoral osteoarthritis (2018)
Journal of Orthopaedic Research, 36 (6), 1666-1672 - Kinetic risk factors of running-related injuries in female recreational runners (2018)
Scandinavian Journal of Medicine and Science in Sports, 28 (10), 2164-2172 - Long-term gait outcomes following conservative management of idiopathic toe walking (2018)
Gait and Posture, 62, 214-219 - The effects of shoe-worn insoles on gait biomechanics in people with knee osteoarthritis: A systematic review and meta-analysis (2018)
British Journal of Sports Medicine, 52 (4), 238-253 - Toe-in and toe-out walking require different lower limb neuromuscular patterns in people with knee osteoarthritis (2018)
Journal of Biomechanics, 76, 112-118 - Vastus Lateralis Motor Unit Firing Rate Is Higher in Women With Patellofemoral Pain (2018)
Archives of Physical Medicine and Rehabilitation, 99 (5), 907--913 - What are the perceptions about running and knee joint health among the public and healthcare practitioners in Canada? (2018)
PLOS ONE, - A pre-operative exercise intervention can be safely delivered to people with femoroacetabular impingement and improve clinical and biomechanical outcomes (2017)
Physiotherapy Canada, 69 (3), 204-211 - Ankle and knee biomechanics during normal walking following ankle plantarflexor fatigue (2017)
Journal of Electromyography and Kinesiology, - Comorbidities That Cause Pain and the Contributors to Pain in Individuals With Chronic Obstructive Pulmonary Disease (2017)
Archives of Physical Medicine and Rehabilitation, 98 (8), 1535-1543 - Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial (2017)
Archives of Physical Medicine and Rehabilitation, 98 (8), 1586-1593 - Factor Analysis of the Community Balance and Mobility Scale in Individuals with Knee Osteoarthritis (2017)
Physiotherapy Research International, - Gait retraining: Out of the lab and onto the streets with the benefit of wearables (2017)
British Journal of Sports Medicine, 51 (23), 1642-1643 - Lateral wedges with and without custom arch support for people with medial knee osteoarthritis and pronated feet: An exploratory randomized crossover study (2017)
Journal of Foot and Ankle Research, 10 (1) - Physiological arousal accompanying postural responses to external perturbations after stroke (2017)
Clinical Neurophysiology, 128 (6), 935-944 - Respiratory Mechanical and Cardiorespiratory Consequences of Cycling with Aerobars (2017)
Medicine and Science in Sports and Exercise, 49 (12), 2578-2584 - The biomechanical demands on the hip during progressive stepping tasks (2017)
Journal of Strength and Conditioning Research, 31 (12), 3444-3453 - The effects of a heel wedge on hip, pelvis and trunk biomechanics during squatting in resistance trained individuals (2017)
Journal of Strength and Conditioning Research, 31 (6), 1678-1687 - Trunk and lower limb biomechanics during stair climbing in people with and without symptomatic femoroacetabular impingement (2017)
Clinical Biomechanics, 42, 108--114 - Validation of a smart shoe for estimating foot progression angle during walking gait (2017)
Journal of Biomechanics, 61, 193-198 - Clinical tests of standing balance in the knee osteoarthritis population: Systematic review and meta-analysis (2016)
Physical Therapy, 96 (3), 324-337 - Immediate Effects of a Brace on Gait Biomechanics for Predominant Lateral Knee Osteoarthritis and Valgus Malalignment after Anterior Cruciate Ligament Reconstruction (2016)
American Journal of Sports Medicine, 44 (4), 865-873 - Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet (2016)
Journal of Orthopaedic Research, 34 (9), 1597-1605 - Motor Planning for Loading during Gait in Subacute Stroke (2016)
Archives of Physical Medicine and Rehabilitation, 97 (4), 528-535 - Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial (2016)
Arthritis Care and Research, 68 (5), 590-602 - The effect of Tai Chi on four chronic conditions - cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: A systematic review and meta-analyses (2016)
British Journal of Sports Medicine, 50 (7), 397-407 - Behavior of medial gastrocnemius motor units during postural reactions to external perturbations after stroke (2015)
Clinical Neurophysiology, 126 (10), 1951-1958 - Factors Associated with Dynamic Balance in People with Knee Osteoarthritis (2015)
Archives of Physical Medicine and Rehabilitation, 96 (10), 1873-1879 - Gait modifications to change lower extremity gait biomechanics in runners: A systematic review (2015)
British Journal of Sports Medicine, 49 (21), 1382-1388 - Influence of biomechanical characteristics on pain and function outcomes from exercise in medial knee osteoarthritis and varus malalignment: Exploratory analyses from a randomized controlled trial (2015)
Arthritis Care and Research, 67 (9), 1281-1288 - Laboratory-based measurement of standing balance in individuals with knee osteoarthritis: A systematic review (2015)
Clinical Biomechanics, 30 (4), 330-342 - Author response to the letter: On " Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance" : are the conclusions stated by the authors justified? (2014)
Gait & posture, 39 (4) - Biomechanical mechanisms of toe-out gait performance in people with and without knee osteoarthritis (2014)
Clinical Biomechanics, 29 (1), 83-86 - Comparison of Mirror, Raw Video, and Real-Time Visual Biofeedback for Training Toe-Out Gait in Individuals With Knee Osteoarthritis (2014)
Archives of Physical Medicine and Rehabilitation, - Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study (2014)
Osteoarthritis and Cartilage, - Lateral trunk lean gait modification increases the energy cost of treadmill walking in those with knee osteoarthritis (2014)
Osteoarthritis and Cartilage, 22 (2), 203-209 - Motor unit recruitment and firing rate in medial gastrocnemius muscles during external perturbations in standing in humans (2014)
Journal of Neurophysiology, 112 (7), 1678-1684 - Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: A randomized controlled trial (2014)
Arthritis and Rheumatology, 66 (4), 950-959 - Protocol for a randomized controlled clinical trial investigating the effectiveness of Fast muscle Activation and Stepping Training (FAST) for improving balance and mobility in sub-acute stroke (2014)
BMC Neurology, 14 (1) - Quantified self and human movement: A review on the clinical impact of wearable sensing and feedback for gait analysis and intervention (2014)
Gait & Posture, 40 (1), 11--19 - Test re-test reliability of centre of pressure measures during standing balance in individuals with knee osteoarthritis (2014)
Gait and Posture, 40 (1), 270-273 - Use of the challenge point framework to guide motor learning of stepping reactions for improved balance control in people with stroke: A case series (2014)
Physical Therapy, 94 (4), 562-570 - Validation of the Fitbit One activity monitor device during treadmill walking (2014)
Journal of Science and Medicine in Sport, - Validity and reliability of the community balance and mobility scale in individuals with knee osteoarthritis (2014)
Physical Therapy, 94 (6), 866-874 - A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: A pilot study (2013)
Knee, 20 (2), 106-112 - A physiotherapy triage service for orthopaedic surgery: An effective strategy for reducing wait times (2013)
Physiotherapy Canada, 65 (4), 358-363 - A systematic review and meta-analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking (2013)
Clinical Biomechanics, 28 (7), 713-724 - Altering foot progression angle in people with medial knee osteoarthritis: The effects of varying toe-in and toe-out angles aremediated by pain and malalignment (2013)
Osteoarthritis and Cartilage, 21 (9), 1272-1280 - Biomechanical deviations during level walking associated with knee osteoarthritis: A systematic review and meta-analysis (2013)
Arthritis Care and Research, 65 (10), 1643-1665 - Erratum: Kinematic and kinetic differences during walking in patients with and without symptomatic femoroacetabular impingement (Clinical Biomechanics (2013) 28:5 (519-523)) (2013)
Clinical Biomechanics, 28 (8), 948 - Exercise, Gait Retraining, Footwear and Insoles for Knee Osteoarthritis (2013)
Current Physical Medicine and Rehabilitation Reports, 1 (1), 21-28 - Kinematic and kinetic differences during walking in patients with and without symptomatic femoroacetabular impingement (2013)
Clinical Biomechanics, 28 (5), 519-523 - Movement retraining using real-time feedback of performance. (2013)
Journal of visualized experiments : JoVE, (71) - Non-iterative partial view 3D ultrasound to CT registration in ultrasound-guided computer-assisted orthopedic surgery (2013)
International Journal of Computer Assisted Radiology and Surgery, 8 (2), 157-168 - Relationships amongst osteoarthritis biomarkers, dynamic knee joint load, and exercise: Results from a randomized controlled pilot study (2013)
BMC Musculoskeletal Disorders, 14 - Reliability and validity of the Performance Recorder 1 for measuring isometric knee flexor and extensor strength (2013)
Physiotherapy Theory and Practice, 29 (8), 639-647 - Sagittal plane joint loading is related to knee flexion in osteoarthritic gait (2013)
Clinical Biomechanics, 28 (8), 916-920 - The role of neuromuscular changes in aging and knee osteoarthritis on dynamic postural control (2013)
Aging and Disease, 4 (2), 84-99 - Update on the Role of Muscle in the Genesis and Management of Knee Osteoarthritis (2013)
Rheumatic Disease Clinics of North America, 39 (1), 145-176 - Validity of the Microsoft Kinect for providing lateral trunk lean feedback during gait retraining (2013)
Gait and Posture, 38 (4), 1064-1066 - Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson's disease (2013)
Clinical Rehabilitation, 27 (4), 361-366 - A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: A randomised controlled trial protocol (2012)
BMC Musculoskeletal Disorders, 13 - Biomechanical and clinical outcomes with shock-absorbing insoles in patients with knee osteoarthritis: Immediate effects and changes after 1 month of wear (2012)
Archives of Physical Medicine and Rehabilitation, 93 (3), 503-508 - Exercise prescription for hospitalized people with chronic obstructive pulmonary disease and comorbidities: a synthesis of systematic reviews. (2012)
International journal of chronic obstructive pulmonary disease, 7, 297-320 - Gait differs between unilateral and bilateral knee osteoarthritis (2012)
Archives of Physical Medicine and Rehabilitation, 93 (5), 822-827 - Non-iterative multi-modal partial view to full view image registration using local phase-based image projections (2012)
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 7330 , 64-73 - Reliability of measurement of maximal isometric lateral trunk-flexion strength in athletes using handheld dynamometry (2012)
Journal of sport rehabilitation, Techn (6) - The effect of contralateral pelvic drop and trunk lean on frontal plane knee biomechanics during single limb standing (2012)
Journal of Biomechanics, 45 (16), 2791-2796 - Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles (2012)
Arthritis Care and Research, 64 (10), 1545-1553 - Clinically assessed mediolateral knee motion: Impact on gait (2011)
Clinical Journal of Sport Medicine, 21 (6), 515-520 - Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: A randomised controlled trial protocol (2011)
BMC Musculoskeletal Disorders, 12 - Contralateral cane use and knee joint load in people with medial knee osteoarthritis: The effect of varying body weight support (2011)
Osteoarthritis and Cartilage, 19 (11), 1330-1337 - Feasibility of a gait retraining strategy for reducing knee joint loading: Increased trunk lean guided by real-time biofeedback (2011)
Journal of Biomechanics, 44 (5), 943-947 - Gait modification strategies for altering medial knee joint load: A systematic review (2011)
Arthritis Care and Research, 63 (3), 405-426 - Predicting dynamic knee joint load with clinical measures in people with medial knee osteoarthritis (2011)
Knee, 18 (4), 231-234 - Reduced Quadriceps Motor-Evoked Potentials in an Individual with Unilateral Knee Osteoarthritis: A Case Report (2011)
Case Reports in Rheumatology, 2011, 1--5 - Varus thrust in medial knee osteoarthritis: Quantification and effects of different gait-related interventions using a single case study (2011)
Arthritis Care and Research, 63 (2), 293-297 - Effect of anterior tibiofemoral glides on knee extension during gait in patients with decreased range of motion after anterior cruciate ligament reconstruction (2010)
Physiotherapy Canada, 62 (3), 235-241 - Hip muscle weakness in individuals with medial knee osteoarthritis (2010)
Arthritis Care and Research, 62 (8), 1190-1193 - Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: A randomised controlled trial (2010)
Osteoarthritis and Cartilage, 18 (5), 621-628 - Individuals with severe knee osteoarthritis (OA) exhibit altered proximal walking mechanics compared with individuals with less severe OA and those without knee pain (2010)
Arthritis Care and Research, 62 (10), 1426-1432 - Predictors of single-leg standing balance in individuals with medial knee osteoarthritis (2010)
Arthritis Care and Research, 62 (4), 496-500 - Quadriceps strength is not related to gait impact loading in knee osteoarthritis (2010)
Knee, 17 (4), 296-302 - Validity and inter-rater reliability of medio-lateral knee motion observed during a single-limb mini squat (2010)
BMC Musculoskeletal Disorders, 11 - Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance (2010)
Gait and Posture, 31 (3), 307-310 - Effect of tibial re-alignment surgery on single leg standing balance in patients with knee osteoarthritis (2009)
Clinical Biomechanics, 24 (8), 693-696 - Muscle and Exercise in the Prevention and Management of Knee Osteoarthritis: an Internal Medicine Specialist's Guide (2009)
Medical Clinics of North America, 93 (1), 161-177 - Real-time movement biofeedback for walking gait modification in knee osteoarthritis (2009)
2009 Virtual Rehabilitation International Conference, VR 2009, , 132-135 - Investigating attraction compatibility in an east Texas city (2008)
International Journal of Tourism Research, 10 (3), 237-246 - Lateral trunk lean explains variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis (2008)
Osteoarthritis and Cartilage, 16 (5), 591-599 - Measures of frontal plane lower limb alignment obtained from static radiographs and dynamic gait analysis (2008)
Gait and Posture, 27 (4), 635-640 - Role of Muscle in the Genesis and Management of Knee Osteoarthritis (2008)
Rheumatic Disease Clinics of North America, 34 (3), 731-754 - Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: A tri-planar kinetic mechanism (2008)
Journal of Biomechanics, 41 (2), 276-283 - Towards a biopsychosocial framework of osteoarthritis of the knee (2008)
Disability and Rehabilitation, 30 (1), 54-61 - Radiographic measures of knee alignment in patients with varus gonarthrosis: Effect of weightbearing status and associations with dynamic joint load (2007)
American Journal of Sports Medicine, 35 (1), 65-70 - Test-retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis (2007)
Arthritis Care and Research, 57 (6), 1012-1017 - The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: A protocol for a randomised, single-blind controlled trial (2007)
BMC Musculoskeletal Disorders, 8 - Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis (2006)
Journal of Biomechanics, 39 (12), 2213-2220 - Foot rotational effects on radiographic measures of lower limb alignment (2006)
Canadian Journal of Surgery, 49 (6), 401-406 - Interlimb asymmetry in persons with and without an anterior cruciate ligament deficiency during stationary cycling (2004)
Archives of Physical Medicine and Rehabilitation, 85 (9), 1475-1478 - Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. (2004)
The journal of knee surgery, 17 (4), 203-210 - Altered triggering of a prepared movement by a startling stimulus (2003)
Journal of Neurophysiology, 89 (4), 1857-1863 - Biomechanical changes elicited by an anterior cruciate ligament deficiency during steady rate cycling (2003)
Clinical Biomechanics, 18 (5), 393-400
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