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BACKGROUND Some recreational runners with obesity successfully train or compete without musculoskeletal injury. Insight into the key kinetic strategies of injury-free heavier runners is necessary to appropriately guide development of safe training programs for this population. OBJECTIVE To determine key biomechanical strategies of running in individuals with body mass index (BMI) values above and equal to and higher than 30 kg/m2 . DESIGN This was a case-control study. PARTICIPANTS Runners with obesity (n =18; 42.7 years, 38.9% women) who were matched by sex, age, footstrike type, footwear characteristics, and running speed with healthy runners (n = 36; 41.7 years, 32.5% women). SETTING Research laboratory affiliated with an academic medical center. METHODS A seven-camera optical motion analysis system was used to capture running kinematics and an instrumented treadmill captured kinetic data. MAIN OUTCOMES Main outcomes were temporal spatial parameters, joint excursions, peak ground reaction forces (GRFs), joint moments, vertical average loading rate (VALR), impulses, and vertical stiffness (Kvert ). RESULTS Runners with obesity demonstrated 15% less vertical excursion of the center of mass, 18% wider strides, and 3% longer stance times than nonobese runners (P

Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients. Level of Evidence V

Osteoarthritis (OA) is the most frequent cause of disability in the United States, with the medial compartment of the knee being most commonly affected. The initiation and progression of knee OA is influenced by many factors, including kinematics. In response to loading during weight-bearing activity, cartilage in healthy knees demonstrates spatial adaptations in morphology and mechanical properties. These adaptations allow certain regions of the cartilage to respond to loading; other regions are less well suited to accommodate loading. Alterations in normal knee kinematics shift loading from cartilage regions adapted for loading to regions less well suited for loading, which leads to the initiation and progression of degenerative processes consistent with knee OA. Kinematic variables that are associated with the development, progression, and severity of knee OA are the adduction moment and tibiofemoral rotation. Because of its strong correlation with disease progression and pain, the peak adduction moment during gait has been identified as a target for treatment design. Gait modification offers a noninvasive option for seeking significant reductions. Gait modification has the potential to reduce pain and slow the progression of medial compartment knee OA.

Obesity is associated with an increasing prevalence of musculoskeletal complaints and pain. Obesity is a major risk factor for osteoarthritis (OA), and pain can manifest in load-bearing and nonload-bearing joints. The lumbar spine and the knee are 2 primary sites for pain onset in the obese patient. Irrespective of the weight loss method, reduction of body fat can lower the mechanical and inflammatory stressors that contribute to OA. Single or combined methods of weight loss including exercise, dietary modification, medications, and bariatric surgery are associated with lower joint pain and increased physical function. Methods of weight loss or maintenance in early years may reduce the life exposure of joints to the obesity induced stressors on load bearing joints.

Objective To describe injury rates and patterns in the emerging sport of hardcourt bike polo (HBP). Design Descriptive survey. Setting HBP playing areas (urban flat concrete surfaces). Participants Twenty-two adult (≥18 years) HBP players who presented to a routine thrice-weekly playing site completed the survey. Main Outcome Measurements Participants completed a survey that was used to evaluate demographics; frequency of play; rate, localization, and severity of injuries sustained in the past 1 year; and use of medical care. Results The incidence of sustaining an injury in 1 year was 0.86. The main sites of injury involved the knee, elbow, wrist, and hand. Medical attention was sought by 15% of the injured players. Conclusion HBP is a rapidly evolving urban sport in which participants are at risk for trauma-related injury, some of which may be preventable by the addition of appropriate safety equipment.

To compare fear of movement in patients with different body mass index (BMI) values referred for rehabilitative care of the knee and to examine whether this fear contributed to self-reported knee-related function. We hypothesized that fear of movement would be elevated with increasing BMI and that fear would correspond with lower self-report knee-related function and lower quality of life (QOL).Retrospective cross-sectional study.Outpatient therapy clinic affiliated with a tertiary care hospital.Patients with knee pain diagnoses (n = 278) were stratified into 4 BMI groups (inor =25 kg/m(2) nonobese; 25-29.9 kg/m(2) overweight; 30-39.9 kg/m(2) obese;or =40 kg/m(2) morbidly obese).The Tampa Scale of Kinesiophobia (TSK; fear of movement), International Knee Documentation (IKDC; knee function), and Short-Form 8 (SF-8; QOL) scores were main outcomes. Pain and straight leg raise test scores also were collected.After review of the medical records, descriptive statistics and nonparametric tests were performed, and TSK, QOL, and SF-8 scores were compared. Hierarchical regression modeling determined the contribution of TSK scores to the variance of IKDC scores.Pain scores were greatest in the nonobese group and lowest in the morbidly obese group (7.5 +/- 2.6 points vs 4.8 +/- 3.1 points; P.05). TSK scores in morbidly obese patients were greater than in nonobese patients (27.1 +/- 7.7 points vs 22.0 +/- 6.6 points; P = .002). The SF-8 mental-physical subscores were 27% to 32% lower in the morbidly obese than nonobese patients (both P.0001). IKDC scores were lower in the morbidly obese than nonobese patients (32.1 +/- 19.2 points vs 50.9 +/- 23.8 points; P = .0001). Pain severity and TSK scores contributed 28.6% and 7.1% to the variance of the IKDC scores (overall R(2) = 68.6).Morbid obesity is associated with elevated fear of movement. Pain was the strongest predictor of IKDC scores, and fear of movement enhanced this predictive value of the regression model. Despite lower absolute pain severity in the morbidly obese group, this fear may influence IKDC scores in this population. Morbidly obese patients might benefit from rehabilitation activities that reduce fear of movement to optimize participation in rehabilitation activity.