Michael Hunt


Research Classification

Research Interests

Arthritis / Osteo-Arthritis
Joints (Articulations)
Musculoskeletal Deformation
Neuromuscular Diseases
Orthoses and Prostheses
Physical Activity

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Affiliations to Research Centres, Institutes & Clusters


Research Methodology

clinical trials
Randomized Controlled Trials


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Graduate Student Supervision

Doctoral Student Supervision

Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.

Arch-supported lateral wedge insoles for biomechanical management of knee osteoarthritis (2022)

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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Technology-enabled gait monitoring and modification in real-world settings for the management of knee osteoarthritis (2022)

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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Gait retraining for reducing biomechanical injury risk factors in novice recreational runners (2018)

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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The experience, contributors, and etiology of pain in people with chronic obstructive pulmonary disease (2018)

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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The assessment and treatment of dynamic balance in individuals with knee osteoarthritis (2016)

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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Motor Control of Response to External Perturbations in People Post-Stroke (2015)

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.

Biomechanics during cross-body lunging in individuals with and without symptomatic femoroacetabular impingement (2019)

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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Examining lower leg biomechanics during toe-in and toe-out walking in people with medial compartment knee osteoarthritis (2017)

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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Magnetic resonance imaged tibiofemoral contact in standing during toe-in and toe-out positions (2016)

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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Trunk and lower limb biomechanics during stair climbing in those with symptomatic femoroacetabular impingement compared to asymptomatic healthy controls (2016)

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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Clinical and biomechanical changes following a pre-operative muscle strenghtening intervention for people with femoroacetabular impingement (2015)

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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The relationship between dynamic knee joint load and matrix metalloproteinases in people with and without knee osteoarthritis (2013)

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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