Chapter 4 Biomechanics of standing He that stands upon a slippery place makes nice of no vile hold to stay him up. Shakespeare CHAPTER CONTENTS The ground reaction force 73 Tendon and muscle forces 76 Ankle moment 75 Control of standing 79 OBJECTIVES, ‘© Understand how the ground reaction force arises Know how the external joint moment is calculated from the ground reaction force Understand how the external moment is balanced by an internal muscle moment Know how to infer muscle action from the location of the ground reaction force Understand normal ankle and knee action during quiet standing It is helpful to analyse standing before looking further at walking, since standing illustrates many of biomechanics fundamentals that are needed to understand gait, THE GROUND REACTION FORCE When a person is standing completely still (so-called quiet standing — Fig. 4.1), the ground produces a reaction force equal and opposite to their body weight ~ a consequence of Newton’s Third Law. This ground reaction force (GRF) is really an average of all the forces ‘or pressure under the feet. Pressure is not borne evenly by all parts of the sole, but is concentrated in two main regions: the heel and the ball74_Part | THEORY Figure 4.1 During quiet standing, body weight acting downwards gives rise to an ‘equal and opposite reaction, called the ground reaction Figure 42 force (GRP, Body weight RF (metatarsophalangeal joints). The location of the centre of pressure (CoP) marks the line of action of the GREF, and in normal quiet standing is about 5 cm anterior to the ankle joint (under the navicular bone). Note that there is very little actual pressure in this region (the instep) - the CoP is a purely mathematical concept. It is, however, an extremely useful one. ‘Standing up is what makes us human, So when did it evolve and why? This turns out to be a surprisingly difficult question to answer. In 1978, Mary Leakey made the sensational discovery of ancient footprints extending more than 20 m, fossilized in cement-like volcanic ash on the arid Laetoli plain in Tanzania, The footprints were remarkable evidence of an adult couple strolling with their child across Africa around 3.7 million years ago. They probably ‘belonged to the human ancestor (oratohominid) Australopithecus aforensis, whase famous skeleton, Lucy, had been discovered four years previously. Lucy lived in the Pliocene, when climate change in the Rift valley caused tropical forests to be replaced by patches of savannah (open grassland). The pattern of indentation in the footsteps is a rough guide to the amount of pressure transmitted by each region of the sole. A Laetoli footprint is shown here (Fig, 42, left) compared to a modern human print (Fg. 42, right), with darker areas reflecting greater weight bearing. Although the toes were longer than ours, the big toe was in alignment with the athers, showing that the ‘mechanism of weight transfer through the foot during walking was remark ably similar to ours. It is thought that bipedal stance and locomotion aided these Australopithecines in moving from one clump of trees to another because they could see aver the long grass and so spot any predators, Later, other advantages were evident: freeing the hands allowed them to be used forChapter 4 Biomechanics of standing 75 ‘making and using tools, and for carrying food and babies, Another theory holds that the brain became overheated as it enlarged in size, and stand~ ing helped keep it cool. We'll probably never know for certain, but those ancient evocative footprints at Laetoli will forever keep us wondering! ‘itl M M1995 Speculation on posture, locomotion, energy consumption, and blood fw in carly hominis. Gait & Posture 31)28-37 ANKLE MOMENT Whenever a force is applied some distance away from a joint or fulerum, it “will tend to rotate the joint in the direction of the force, This effect is called he moment of force, or simply the joint moment. In normal standing, with the CoP 5 em anterior tothe ankle joint, the foot will tend to dorsiflex (Fig. 43) Figure 4.3 The ground reaction force typically acts Exernal about 5 em anterior to the dercilner ankle joint, which causes an arnt ‘external dorsiflexor moment. Moment am The GRF is caused by gravity = so what happens in the zerosg conditions of space flight? Astronauts have long reported problems with increased sway while standing when they return fram space flight. Inflight experiments aboard the space shuttle and Mir space station, in which bungee cords were used to simulate gravity, have revealed disordered responses to perturba- tions. Interestingly, these abnormalities improved when foot pressure was artificially applied to the feet, and special boots may be used in future to help prevent the problems with postural control on return to earth, These ‘may also prove helpful for patients who need to undergo prolonged periods of bed rest. Layne CS, Mutavaa &P, MeDonald PV etal 2007 The effect af long duration spacetght on postral contol daring sel-generatedpecturatons Journal of Aoalie Physiology 90(3):997-100676 | Part | THEORY Figure 4.4 The external dorsiflexor moment is balanced by an internal plantarflexor moment generated by the plantarflexors (gastrocnemius + soleus) through the Achilles 2 Mca 4.1 tendon, Moment am en) Since there is no movement in quiet standing, there must be an equal and opposite opposing moment (Newton’s Third Law again), This, ‘moment is produced by tension (force) in the Achilles tendon (Fig. 44), which inserts onto the calcaneus bone on the opposite (posterior) aspect of the ankle joint. In effect, the two forces (ground reaction and Achilles tendon tension) act as an inverted see-saw (Fig. 45) The external moment at the ankle due to the GRV can be calculated quite simply: ‘Ankle Moment = GRF x Moment Arm of GRE iad where m = body mass, g = acceleration due to gravity (9.81 m/s? -let’s, round it off to 10 to keep things simple) and d is the moment arm of the GRE (6 cm in this case). Ifthe weight is borne symmetrically on the two feet, this total moment will need to be divided by two. So, we have: ‘Ankle Moment = (mgd)/2 So, if body mass = 80 kg, the moment at the ankle = 80x 10x 0.05/2=20Nm What would be the ankle moment if the GRE passes through the ankle joint? (@) 20 Nm (b) -20 Nm (ONm @I1Nm TENDON AND MUSCLE FORCES This external moment at the ankle must be exactly balanced by the internal moment produced by the Achilles tendon force (Fig. 4.6). From dissecting cadavers, it is known that the moment arm of the Achilles tendon (when the foot is plantigrade, ic. ankle at 0") is about 4.em, (you can estimate it yourself by measuring the distance between yourChapter 4 Biomechanics of standing 77 Figure 4.5. The external (ground reaction) and internal (Achilles tendon) forces act like ‘an inverted see-saw at the ankle joint and need to be balanced during standing, Figure 4.6 Balanced equillbrium between external ‘and internal moments at the ankle ama78 = Part | THEORY Figure 4.7 (Reproduced by permission fiom Maganaris CN, Baltzopouls V, Sargeant AJ 1988 Changes in Achiles tendon moment arm fom rest to maximum isometrie plantarfexion: In vivo ‘observations in man. Journal of Physiology 510377-285, Blackwell Publshingl. lateral malleolus and Achilles tendon). We can now estimate the force (tension) in the Achilles tendon: Since, Ankle Moment = Tendon Force x Tendon Moment Arm ‘Tendon Force = Ankle Moment/Tendon Moment Arm 20/0.04, or 500. N Although this force is transmitted via the Achilles tendon, it is, of course, mosily generated by muscle, since tendon is a passive structure. ‘The muscles that insert onto it are the soleus and gastrocnemius (often called collectively the plantarflexors, or triceps surae). So, we now know that these muscles (in each leg) are contracting during normal quiet standing to provide a total force of 1000 N. This is quite a lot of force ~ equivalent to a weight of 100 kg, ie. 20 kg more than body mass, so it’s, a surprising finding. What is the tension in each Achilles tendon in a person of mass 60 kg standing symmetrically? (@) 150N (b) 300 N (© 375N (@) 750N The tendon moment arm does not have a fixed value - it changes slightly according to the angle of the joint (Fig. 4.7; from Maganaris et al 1998). In Y Aehiles moment am em ° 15 Plantgrade Dotson g § ; i i Rest is o 6 Plnarlexon Planigade DosiesonChapter 4 Biomechanics of standing 79) standing, the foat is plantigrade (lat on the groune) so the ankle is in neutral (0"), and the Achilles tendon lies approximately 4 em posterior to the ankle joint ax’. At other angles, the calcaneus rotates and moves the tendon insertion closer to the ankle joint axis. The tibialis anterior tendon rmament arm is even more variable, because of the way it wraps under the retinaculum in front of the ankle. Its moment arm depends on the strength of the contraction as well as the ankle angle Maganas CN, SakzopoulasV, Sargeant AJ 1998 Changes in Aehiles tendon mame am om Testo maximum sone plantrexon: In vivo observations n man Jounal a Pyslogy s10977-865 Magenars CN 2000 I vivo measurement-based estimations ofthe manent am inthe huran ‘has anterior muscestedon unt. Joual of iomechanes22:2975-279 CONTROL OF STANDING ‘The GRF isn’t always 5 cm anterior to the ankle joint. If, for example, an external force (perturbation) ~ a gust of wind or a nudge from someone — pushes the person forwards, their body weight, and hence GRF, will also move forwards. The plantarflexors must balance the GRF to prevent col- lapse, so when it moves further forwards they must contract more strongly to generate a larger ankle moment. For example, say the GRF moves to 7 cm anterior to the ankle (Fig. 4.8) ‘The external moment is now: Ankle Moment = GRF Moment Arm of GRF (mga) /2 80x 10x 0.07/2 =28Nm ‘The new tendon force can now be calculated: ‘Tendon Force = Ankle Moment/Tendon Moment Arm 28/0.04, or 700 N Figure 4.8 When the GRF acts further in front of the ankle, the external moment is increased, requiring a ‘complementary increase in internal moment generated by increased tension in the ‘Achilles tendon80 Part | THEORY PI Mca 4.3 Figure 4.9 When the GRF passes behind the ankle joint, the external moment becomes Plantarflexar, and must be resisted by an internal dorsiflexor moment, €. from Ubialis onterior tension. 2 mca 4.4 PROXIMAL JOINT MOMENTS What would be the new tendon force in the person of mass 60 kg? (a) 150 N (b) 350 N (9 375N (a) 525 N The opposite can happen, too, of course. If a gust of wind blows the person backwards, the GRF may even move posteriorly — until it is underneath the heel (Fig. 49). Now the GRF tends to plantarfex the ankle, and a restraining dorsiflexor moment is needed from muscles such as the tibialis anterior (TA). Assuming that the TA tendon inserts 5 cm anterior to the ankle, ifthe GRF is 3m posterior to the ankle joint, the tendon force in an 80 kg per- son must now be ‘Tendon Force = Ankle Moment/Tendon Moment Arm 80 x 10 x 0.03 /(2 x 0.05), or 240 N What would be the TA tendon force for an 80 kg person if the GRF were cm ‘oehind the ankle joint? (@)50N (b) 80N (9 150N (@) 500 N ‘The same principle applies to the knee and hip joints. The internal joint ‘moment at each joint must be equal and opposite to the moment exerted by the GRE. However, in quiet standing, the GRF usually passes pretty close to these joints, so the joint moments required are very small, and very little muscle action is needed.Chapter 4 Biomechanics of standing 81 Figure 4.10 During a squat, ‘the GRF passes behind the knee, The moment arm i the perpendicular distance from the joint to line of the force ~ in this case 10 em, In a squatting posture (Fig. 4.10), the GRF now passes behind (poste- rior to) the knee joint, so the moment is now given by: Knee Moment ‘orce x Moment Arm of GRF at knee (mgd) /2 For example, assuming symmetrical standing, with a body mass of 80 kg (800 N) and the GRE passing 10 cm posterior to the knee, then Joint Moment = 800 x 0.1/2 = 40 Nm Clearly, the knee will tend to collapse (flex) in this posture ~ in other words, this external moment is flexor. So, just as at the ankle, a muscle must generate an internal moment to maintain equilibrium. Since the external moment is flexor, the internal muscle moment must be extensor. In other words, the quadriceps muscle is contracting. Rule of thumb; the active muscle is always the one on the opposite side of the joint to the GRE Mca 4.5 Which statement is true when the GRF is anterior to the hip joint? (a) External moment is extensor (6) Internal moment is flexor (c) Active muscle is iliopsoas (q) Active muscle is gluteus maximus ‘What happens if the GRF passes in front of the knee joint? By the rule of thumb, the flexors of the knee (hamstrings) must be active. However, the knee isa little special, in that in most people it cannot extend beyond82__Part | THEORY Figure 4.11 The posterior ‘capsule ligaments prevent hyperextension, Posteri capsule Tgeenis 0°, The strong posterior capsule ligaments (Fig. 4.11) become taut at this, angle and so prevent any hyperextension. ‘Thus, in the standing position, whenever the GRF passes anteriorly, the knee is passively stable and no muscle action is necessary. In this way, the knee and ankle work together by maintaining the GRF forward of the ankle and slightly forward of the knee, the constant (tonic) contraction of the plantarflexors simplifies the control of standing considerably. Only ‘oceasional (phasic) contractions of the quadriceps muscle are needed when. the GRF passes posterior to the knee axis in order to bring it back to the stable position. fal KEY POINTS “In quiet standing the ground reaction force is equal and opposite to body weight 4 The centre of pressure falls about 5 cm anterior to the ankle joint % An external moment acts on the ankle equal to the force multiplied by the CoP 4 Abalancing internal moment is generated by muscle tension on the opposite side of the joint % The internal moment is equal to the muscle tension multiplied by its lever, arm at the joint oe At the knee, the posterior capsule ligaments prevent hyperextension