Injuries and rehabilitation

This research area focuses on the prevention of falls on stairs and during locomotion in general. One of the greatest daily challenges for frail populations such as older people and people with musculoskeletal, neuromuscular and cognitive deficits is to negotiate steps and stairs, and this is where falls and accidents occur most frequently, resulting in serious injuries with substantial consequences for the fallers, their carers and the NHS.

Important questions that this research aims to address include:

• Can we predict a fall on stairs?
• Is the ability to recover a safe stance after a perturbation while standing indicative of a reduced risk for a fall due to a trip or slip?
• Which preventative measures are more effective and pragmatic for making stair negotiation safer?
• Which environmental changes can most effectively reduce stair fall risk?
• Which functional capabilities and behaviours of the user on stairs can best improve safety?  

A unique custom-made staircase with adjustable dimensions in each step, instrumented with force sensors in the steps and the handrails, is available at the RISES for studying the biomechanics of stair and step negotiation. Collaborations with the Brain & Behaviour group within the RISES, with the LJMU School of Nursing and Allied Health, and with the Built Environment and Sustainable Technologies (BEST) Research Institute at LJMU, have recently been developed, leading to a new multidisciplinary cross-faculty group, the Research to Improve Stair Climbing Safety (RISCS) group.

The focus of RISCS is to investigate and document the nature of the factors compromising stair safety and develop effective tools/interventions to detect stair fall risk and prevent stair falls.  We have recently documented various aspects impacting stair fall prevention in older people, including:

• the role of muscle strength (functional capability)
• the role of eye-gaze, dual-tasking and stepping technique during stair walking (behaviour and technique)
• the role of lighting, physical characteristics of stairs and inconsistency in step dimensions (environment)

We have also developed for the first time a stepping profiling tool for the assessment of stair fall risk in older people. The RISCS group is supported by PhD students and research interns, by internal and external funding,  and importantly also by various external partners and end-users pivotal for impact translation, policy-making and implementation of our research, including the Building Research Establishment, the formal UK body that issues building regulations, the Liverpool Housing Trust, AgeUK. Cheshire, the Liverpool Community Health NHS Trust, and the Aintree University Hospital NHS Foundation Trust and Promedica24. The scientific and socio-economical impact potential of RISCS is exemplified by inclusion of this research area in two reports recently published by the Physiological Society, one on Sport and Exercise Education: Impact on the UK Economy,  and the second on Growing Older, Better: Physiology’s role in meeting the UK government’s healthy ageing mission.

Staff: Prof. Costis Maganaris, Prof. Bill Baltzopoulos, Dr Tom O’Brien, Dr Richard Foster

Primary contact: Prof Costis Maganaris

Selected publications

Ackermans T, Francksen N, Lees C, Papatzika F, Arampatzis A, Baltzopoulos V, Lisboa P, Hollands M, O'Brien T, Maganaris CN. (2020). Prediction of balance perturbations and falls on stairs in older people using a biomechanical profiling approach: A 12-month longitudinal study. J Gerontol A Biol Sci Med Sci. doi: 10.1093/gerona/glaa130. Online ahead of print.PMID: 32453832

Francksen NC, Ackermans TMA, Holzer D, Ebner SA, Maganaris CN, Hollands MA, Karamanidis K, Roys M, O'Brien TD. (2020). Negotiating stairs with an inconsistent riser: Implications for stepping safety. Appl Ergon. doi: 10.1016/j.apergo.2020.103131. Epub 2020 May 7.PMID: 32501252

Thomas NM, Skervin T, Foster RJ, O'Brien TD, Carpenter MG, Maganaris CN, Baltzopoulos V, Lees C, Hollands MA. (2020). Optimal lighting levels for stair safety: Influence of lightbulb type and brightness on confidence, dynamic balance and stepping characteristics. Exp Gerontol.  doi: 10.1016/j.exger.2020.110839. Epub 2020 Jan 17.PMID: 31958491

Charette C, Blanchet S, Maganaris CN, Baltzopoulos V, McFadyen BJ. (2020). Community-dwelling older adults with mild cognitive impairments show subtle visual attention costs when descending stairs. Hum Mov Sci. doi: 10.1016/j.humov.2019.102561. Epub 2019 Dec 19.PMID: 31989954

Di Giulio I, McFadyen BJ, Blanchet S, Reeves ND, Baltzopoulos V, Maganaris CN. (2020). Mobile phone use impairs stair gait: A pilot study on young adults. Appl Ergon. doi: 10.1016/j.apergo.2019.103009. Epub 2019 Dec 3.PMID: 31987506

Di Giulio I, Reeves ND, Roys M, Buckley JG, Jones DA Baltzopoulos V, Maganaris CN. (2020). Stair gait in older adults worsens with smaller step treads and when transitioning between level and stair walking Frontiers Sports Act. Living. doi>

Debelle H, Harkness-Armstrong C, Hadwin K, Maganaris CN, O'Brien TD (2020). Recovery from a forward falling slip: measurement of dynamic stability and strength requirements using a split-belt instrumented treadmill. Frontiers Sports Act. Living. In Press.

Ackermans TMA, Francksen NC, Casana-Eslava RV, Lees C, Baltzopoulos V, Lisboa PJG, Hollands MA, O'Brien TD, Maganaris CN. (2020). Stair negotiation behaviour of older individuals: Do step dimensions matter? J Biomech. doi: 10.1016/j.jbio(2019).mech.2020.109616. Epub 2020 Jan 9.PMID: 31980206

Gavin JP, Reeves ND, Jones DA, Roys M, Buckley JG, Baltzopoulos V, Maganaris CN. (2019). Combined Resistance and Stretching Exercise Training Benefits Stair Descent Biomechanics in Older Adults. Front Physiol. doi: 10.3389/fphys.2019.00873. eCollection 2019.PMID: 31379594 

Foster RJ, Maganaris CN, Reeves ND, Buckley JG.(2019). Centre of mass control is reduced in older people when descending stairs at an increased riser height. Gait Posture. doi: 10.1016/j.gaitpost.2019.08.004. Epub 2019 Aug 7.

Ackermans TMA, Francksen NC, Casana-Eslava RV, Lees C, Baltzopoulos V, Lisboa PJG, Hollands MA, O'Brien TD, Maganaris CN. (2019). A novel multivariate approach for biomechanical profiling of stair negotiation. Exp Gerontol. doi: 10.1016/j.exger.2019.110646. Epub 2019 Jun 30.PMID: 31269462

King SL, Underdown T, Reeves ND, Baltzopoulos V, Maganaris CN. (2018). Alternate stair descent strategies for reducing joint moment demands in older individuals. J Biomech. doi: 10.1016/j.jbiomech.2018.07.029. Epub 2018 Jul 29.

Brown SJ, Handsaker JC, Maganaris CN, Bowling FL, Boulton AJ, Reeves ND., (2016). Altered joint moment strategy during stair walking in diabetes patients with and without peripheral neuropathy. Gait Posture 46:188-93. doi>

Handsaker JC, Brown SJ, Bowling FL, Maganaris CN, Boulton AJ, Reeves ND., (2016). Resistance exercise training increases lower limb speed of strength generation during stair ascent and descent in people with diabetic peripheral neuropathy. Diabet Med 33(1):97-104. doi>

This research group is a collaboration between LJMU and the Gait Laboratory and Orthopaedics Department of Alder Hey Children’s Hospital; members of the clinical teams hold honorary research positions at the University.

Our aim is improve the treatment outcomes for ambulant children with physical disabilities. We do this by determining the biomechanical, anatomical and neurophysiological mechanisms that underpin the functional impairment, so that we can devise and test targeted treatments and diagnostic tools.

This approach is applied when working with children with a range of musculo-skeletal disorders, including cerebral palsy, idiopathic toe walking and developmental coordination disorder. Our studies quantify the structure, neural control and functional properties of the musculoskeletal system, the involvement and utilisation of the sensory systems to guide movement, clinical gait analysis, and advanced data analytics. We integrate these measurements in a mechanistic approach to understand the underlying causes of functional impairment and the specific treatment needs.

We additionally undertake studies of typical growth and development to elucidate the biological process by which strength and function improves with maturation. These also provide comparative data for our clinical studies.

Staff: Dr Tom O’Brien, Dr Richard Foster, Prof. Bill Baltzopoulos, Prof. Costis Maganaris,

Primary contact: Dr Tom O’Brien

Selected publications

• Kalkman BM, Bar-On L, O'Brien TD, Maganaris CN. (2020). Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function, and How Can We Better Their Outcome? Front Physiol. doi: 10.3389/fphys.2020.00131. eCollection 2020.
• Harkness-Armstrong C, Debelle HA, Maganaris CN, Walton R, Wright DM, Bass A, Baltzopoulos V, O'Brien TD. (2020). Effective Mechanical Advantage About the Ankle Joint and the Effect of Achilles Tendon Curvature During Toe-Walking. Front Physiol. 2020 May 19;11:407. doi: 10.3389/fphys.2020.00407. eCollection 2020.
• Kalkman BM, Holmes G, Bar-On L, Maganaris CN, Barton GJ, Bass A, Wright DM, Walton R, O'Brien TD. (2019). Resistance Training Combined With Stretching Increases Tendon Stiffness and Is More Effective Than Stretching Alone in Children With Cerebral Palsy: A Randomized Controlled Trial. Front Pediatr. doi: 10.3389/fped.2019.00333. eCollection 2019.
• Kalkman BM, Maganaris CN, Bar-On L, O'Brien TD. (2019). Letter to the editor regarding: Effects of cerebral palsy on Achilles tendon moment arm length - Do children with CP have larger or smaller moment arms than typically developing children? Commentary on: Alexander et al. J Biomech. doi: 10.1016/j.jbiomech. 2019.03.039. Epub 2019 May 9.
• Bar-On L, Kalkman BM, Cenni F, Schless SH, Molenaers G, Maganaris CN, Bass A, Holmes G, Barton GJ, O'Brien TD, Desloovere K. (2018). The Relationship Between Medial Gastrocnemius Lengthening Properties and Stretch Reflexes in Cerebral Palsy. Front Pediatr. doi: 10.3389/fped.2018.00259. eCollection 2018.
• Kalkman BM, Bar-On L, Cenni F, Maganaris CN, Bass A, Holmes G, Desloovere K, Barton GJ, O'Brien TD. (2018). Muscle and tendon lengthening behaviour of the medial gastrocnemius during ankle joint rotation in children with cerebral palsy. Exp Physiol. doi: 10.1113/EP087053. Epub 2018 Sep 13.
• Kalkman BM, Bar-On L, Cenni F, Maganaris CN, Bass A, Holmes G, Desloovere K, Barton GJ, O'Brien TD. (2018). Medial gastrocnemius muscle stiffness cannot explain the increased ankle joint range of motion following passive stretching in children with cerebral palsy. Exp Physiol. doi: 10.1113/EP086738. Epub 2018 Jan 31.
• Kalkman BM, Bar-On L, Cenni F, Maganaris CN, Bass A, Holmes G, Desloovere K, Barton GJ, O'Brien TD. (2017). Achilles tendon moment arm length is smaller in children with cerebral palsy than in typically developing children. J Biomech. doi: 10.1016/j.jbiomech.2017.02.027. Epub 2017 Mar 3.
• O'Brien TD, Reeves ND, Baltzopoulos V, Jones DA and Maganaris CN, (2012) Invited commentary on Child-Adult Differences in Muscle Activation—A Review. Pediatr Exerc Sci. doi: 10.1123/pes.24.1.22.
• O'Brien TD, Reeves ND, Baltzopoulos V, Jones DA and Maganaris CN, (2010). Muscle-tendon structure and dimensions in adults and children. J Anat. doi
• O'Brien TD, Reeves ND, Baltzopoulos V, Jones DA and Maganaris CN, (2010). In vivo measurements of muscle specific tension in adults and children. Exp Physiol 95(1), 202-10; Winner of the 2010 Early Career Author’s Prize. doi
• O'Brien TD, Reeves ND, Baltzopoulos V, Jones DA and Maganaris CN, (2010). Mechanical properties of the patellar tendon in adults and children. J Biomech 43(6), 1190-5. doi
• Mohagheghi AA, Khan T, Meadows TH, Giannikas K, Baltzopoulos V, Maganaris CN., 2008. In vivo gastrocnemius muscle fascicle length in children with and without diplegic cerebral palsy. Dev Med Child Neurol 50(1):44-50. doi
• Mohagheghi AA, Khan T, Meadows TH, Giannikas K, Baltzopoulos V, Maganaris CN., 2007. Differences in gastrocnemius muscle architecture between the paretic and non-paretic legs in children with hemiplegic cerebral palsy. Clin Biomech 22(6):718-24. doi: 10.1016/j.clinbiomech.2007.03.004.

The main focus of this research area is the study how human muscles, tendons and joints, and the neural control of muscle contraction, are all altered in response to:

1. Exercise
2. Chronic disuse, eg, immobilization following a spinal cord injury and during a space flight or enforced confinement
3. Ageing

Muscles, tendons and joints are being studied in vivo, using non-invasive scanning techniques such as ultrasonography and magnetic resonance imaging (MRI) to establish structural adaptation and their functional consequences. These studies enhance our knowledge on the biomechanical factors involved in the transmission of contractile forces to the skeleton to produce movement and provide crucial information as to how we can best intervene to ameliorate deteriorations in musculoskeletal structure and function and improve athletic performance.

Ultrasound scanners dedicated for in vivo muscle and tendon research are available at the RISES and links with other institutes exist for accessing MRI and fluoroscopy scanning facilities and the study of joint structure and function.

Staff: Prof. Costis Maganaris, Prof. Bill Baltzoopoulos, Dr Tom O’Brien, Dr Scott Brennan

Primary contact: Prof Dr Costis Maganaris

Selected publications

Narici M, De Vito G, Franchi M, Paoli A, Moro T, Marcolin G, Grassi B, Baldassarre G, Zuccarelli L, Biolo G, di Girolamo FG, Fiotti N, Dela F, Greenhaff P, Maganaris CN. (2020). Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. Eur J Sport Sci. doi: 10.1080/17461391.2020.1761076.

Wilke J, Debelle H, Tenberg S, Dilley A, Maganaris CN. (2020). Ankle Motion Is Associated With Soft Tissue Displacement in the Dorsal Thigh: An in vivo Investigation Suggesting Myofascial Force Transmission Across the Knee Joint. Front Physiol. doi: 10.3389/fphys.2020.00180.

Monte A, Baltzopoulos V, Maganaris CN, Zamparo P. (2019) Gastrocnemius Medialis and Vastus Lateralis in vivo muscle-tendon behavior during running at increasing speeds. Scand J Med Sci Sports.  doi: 10.1111/sms.13662. 

Brennan SF, Cresswell AG, Farris DJ, Lichtwark GA. (2019). The Effect of Cadence on the Mechanics and Energetics of Constant Power Cycling. Med Sci Sports Exerc. doi: 10.1249/MSS.0000000000001863.

Zügel M, Maganaris CN, Wilke J, Jurkat-Rott K, Klingler W, Wearing SC, Findley T, Barbe MF, Steinacker JM, Vleeming A, Bloch W, Schleip R, Hodges PW. (2018). Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med. doi: 10.1136/bjsports-2018-099308.

Brennan SF, Cresswell AG, Farris DJ, Lichtwark GA. (2018). The effect of muscle-tendon unit vs. fascicle analyses on vastus lateralis force-generating capacity during constant power output cycling with variable cadence. J Appl Physiol. doi: 10.1152/japplphysiol.00356.2017. Epub 2018 Jan 4.

Holzer D, Epro G, McCrum C, Doerner J, Luetkens JA, Scheef L, Kukuk GM, Boecker H, Mierau A, Brüggemann GP, Maganaris CN, Karamanidis K. (2018). The role of muscle strength on tendon adaptability in old age. Eur J Appl Physiol.  doi: 10.1007/s00421-018-3947-3. 

Quinlan JI, Maganaris CN, Franchi MV, Smith K, Atherton PJ, Szewczyk NJ, Greenhaff PL, Phillips BE, Blackwell JI, Boereboom C, Williams JP, Lund J, Narici MV. (2018). Muscle and Tendon Contributions to Reduced Rate of Torque Development in Healthy Older Males. J Gerontol A Biol Sci Med Sci. doi: 10.1093/gerona/glx149.

Petrovic M, Maganaris CN, Deschamps K, Verschueren SM, Bowling FL, Boulton AJM, Reeves ND. (2018). Altered Achilles tendon function during walking in people with diabetic neuropathy: implications for metabolic energy saving. J Appl Physiol. doi: 10.1152/japplphysiol.00290.2017. Epub 2018 Feb 8.

Brennan SF, Cresswell AG, Farris DJ, Lichtwark GA.(2017). In vivo fascicle length measurements via B-mode ultrasound imaging with single vs dual transducer arrangements. J Biomech. doi: 10.1016/j.jbiomech.2017.09.019. 

Maganaris CN, Chatzistergos P, Reeves ND, Narici MV. (2017). Quantification of Internal Stress-Strain Fields in Human Tendon: Unraveling the Mechanisms that Underlie Regional Tendon Adaptations and Mal-Adaptations to Mechanical Loading and the Effectiveness of Therapeutic Eccentric Exercise. Front Physiol. 2017 Feb 28;8:91. doi: 10.3389/fphys.2017.00091.

Epro G, Mierau A, Doerner J, Luetkens JA, Scheef L, Kukuk GM, Boecker H, Maganaris CN, Brüggemann GP, Karamanidis K. (2017). The Achilles tendon is mechanosensitive in older adults: adaptations following 14 weeks versus 1.5 years of cyclic strain exercise. J Exp Biol. doi: 10.1242/jeb.146407.

Petrovic M, Deschamps K, Verschueren SM, Bowling FL, Maganaris CN, Boulton AJM, Reeves N. (2017). Altered leverage around the ankle in people with diabetes: A natural strategy to modify the muscular contribution during walking?. Gait Posture. doi: 10.1016/j.gaitpost.2017.05.016. Epub 2017 May 19.

Bampouras TM, Reeves ND, Baltzopoulos V, Maganaris CN (2017). Interplay between body stabilisation and quadriceps muscle activation capacity. J Electromyogr Kinesiol. doi: 10.1016/j.jelekin.2017.03.002.

Bampouras TM, Reeves ND, Baltzopoulos V, Maganaris CN. (2017). The role of agonist and antagonist muscles in explaining isometric knee extension torque variation with hip joint angle. Eur J Appl Physiol doi: 10.1007/s00421-017-3693-y. Epub 2017 Aug 12.

Narici M, Franchi M, Maganaris CN. (2016). Muscle structural assembly and functional consequences. J Exp Biol. doi: 10.1242/jeb.12801

Lovell R, Siegler JC, Knox M, Brennan S, (2016). Acute neuromuscular and performance responses to Nordic hamstring exercises completed before or after football training. Marshall PW. J Sports Sci. doi: 10.1080/02640414.2016.1191661

Marshall PW, Lovell R, Knox MF, Brennan SL, Siegler JC. (2015). Hamstring Fatigue and Muscle Activation Changes During Six Sets of Nordic Hamstring Exercise in Amateur Soccer Players. J Strength Cond Res. doi: 10.1519/JSC.0000000000000966.

Finn HT, Brennan SL, Gonano BM, Knox MF, Ryan RC, Siegler JC, Marshall PW. (2014). Muscle activation does not increase after a fatigue plateau is reached during 8 sets of resistance exercise in trained individuals. J Strength Cond Res. doi: 10.1097/JSC.0000000000000226.

This area of work focuses on the rehabilitation of movement function in clinical populations such as cerebral palsy. Examples of ongoing research are the training and testing of core control using virtual reality games and the development and application of Virtual Mirror Box methods.

Training and testing core control using virtual reality games:

Our multi-disciplinary research team has developed custom made computer games focusing on movement co-ordination of the trunk and pelvis, known as the core of the body. In a recent pilot study, a group of children with cerebral palsy were recruited through Alder Hey Children’s Hospital, and over six weeks they played variants of the Goblin Post Office game on the first CAREN virtual reality system in the UK. In order to understand how their movement skills changed in response to the games training their walking style was tested using clinical gait analysis, and a detailed analysis was made of movement performance recorded while playing the games.

The findings of our research have been presented at national and international scientific conferences, and disseminated to physiotherapists in research seminars and postgraduate training programmes. We continue to analyse and publish the results of our research in peer reviewed scientific journals. The novelty and potentially high impact of our research has been recognised by the WellChild Researcher Award 2010.

The next stage of the research took place in schools across Merseyside. In order to make the method available to a larger number of children, a portable prototype of the game has been developed. It was used within a PhD study in schools to train and test children with cerebral palsy, focusing on the core of the body, as well as the ankle, knee, and hip joints. The portable Goblin Post Office is installed at The Movement Centre and BASIC where we are working towards integration of the game in the daily physiotherapy of patients with neuromuscular problems e.g. cerebral palsy.

We aim to improve hand function in scleroderma with our custom developed virtual rehabilitation game, FlappyBird-CAREN, which builds on the addictive power of Flappy Bird, the most downloaded smartphone game in 2013. Initially as a Masters student project and now as an LJMU PhD Scholarship programme we collaborate with Aintree Hospital NHS Foundation Trust. 

We can now stream 3D hand movement data from the Leap Motion sensor into the D-Flow software (Motek) and this opens up the possibility of further smart games aiming at hand function rehabilitation.

Primary contact: Prof. Gabor Barton

Research assistant and then PhD student:

Richard Foster, 2009-2012. Funded by Alder Hey Children’s NHS Trust and LJMU’s Institute for Health Research.

Elena Eusterwiemann, 2016-2019. Funded by LJMU PhD Scholarship scheme.

Selected publications

Barton GJ, Hawken MB, Foster RJ, Holmes G, Butler PB, 2013. The effects of virtual reality game training on trunk to pelvis coupling in a child with cerebral palsy. Journal of Neuroengineering and Rehabilitation. 10:15. doi>

Barton GJ, Hawken MB, Holmes G, Schwartz MH, 2013. A gait index may underestimate changes of gait: a comparison of the Movement Deviation Profile and the Gait Deviation Index. Computer Methods in Biomechanics and Biomedical Engineering.

Virtual Mirror Box

A physical mirror positioned in the mid-sagittal plane can reduce phantom limb pain in amputees and improve movement function in stroke and upper limb control in children with cerebral palsy. A mirror illusion of unimpaired limb movement during gait might enhance the effect, but a physical mirror is only capable of showing parallel movement of limbs in real time while sitting, standing or lying. In this project, funded by LJMU’s Institute of Health Research, we aimed to overcome the limitations of physical mirrors by developing and evaluating a Virtual Mirror Box which delays the mirrored image of limbs during gait.

Most recently the Walton Centre NHS Foundation Trust has shown a lot of interest in the Virtual Mirror Box as one of many novel approaches relevant in neurology and neurosurgery. Collaboration efforts are underway to translate innovative research to clinical practice.

Primary contact: Prof. Gabor Barton

Selected publications

Barton JG, De Asha AR, van Loon ECP, Geijtenbeek T, Robinson MA, 2014. Manipulation of visual bio-feedback during gait with a time delayed adaptive Virtual Mirror Box. Journal of Neuroengineering and Rehabilitation. 11:101. doi>

We perform clinical gait analysis for all patients in the UK (and eventually the world) who were born with alkaptonuria and so develop early osteoarthritis.

Alkaptonuria is a rare metabolic disease leading to accumulation of homogentisic acid which damages cartilage, heart valves, kidneys, etc. The National Alkaptonuria Centre (NAC), based at the Royal Liverpool Hospital, is monitoring, treating and researching this medical condition. As part of the long term service provided to patients with alkaptonuria in collaboration with the Alkaptonuria Society, clinical gait analysis is performed for patients at LJMU funded by the NAC. We examine the natural progression of the disease with a focus on changes in movement function due to the special form of osteoarthritis which develops in patients with alkaptonuria. A clinical drug trial of nitisinone is currently under way and an advanced form of gait analysis is used to identify the optimal timing of treatment.

We have recently developed real-time gait training protocols using the M-Gait system and D-Flow software (Motek) to reduce joint loading and related pain. Patients modify their gait under continuous feedback about their knee joint moments, aiming to reduce loading by 10%.

Staff: Prof. Gabor Barton, Dr Mark Robinson

Research assistant: Kimberley Lewin, 2013-2014. Funded by the National Alkaptonuria Centre.

PhD student: Hannah Shepherd, 2017-2020. Match funded by the National Alkaptonuria Centre and LJMU. 

Selected publications

Shepherd HR, Robinson MA, Ranganath LR, Barton GJ (2022) Identifying joint-specific gait mechanisms causing impaired gait in alkaptonuria patients. Gait and Posture. 91:312-317.

Cox TF, Psarelli EE, Taylor S, Barton GJ, Robinson MA, Shepherd H, Mistry A, Genovese F, Braconi D, Giustarini D, Rossi R, Santucci A, Khedr M, Hughes A, Milan AM, Dillon J, Gallagher JA, Ranganath LR. (2019) Subclinical Ochronosis Features In Alkaptonuria: A Cross-Sectional Study. BMJ Innovations.

Anderson J, King S, Przybyla A, Ranganath LR, Barton GJ (2018) Reduction of frontal plane knee load caused by lateral trunk lean depends on step width. Gait and Posture. 61:483-487. 

Ranganath L, Khedr M, Milan AN, Davison A, Hughes A, Usher JL, Taylor S, Loftus N, Daroszewska A, West L, Jones A, Briggs M, Fisher M, McCormick M, Judd S, Vinjamuri S, Griffin R, Psarelli EE, Cox TF, Sireau N, Dillon JP, Devine JM, Hughes G, Harrold J, Barton GJ, Jarvis, JC, Gallagher JA (2018) Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre. Molecular Genetics and Metabolism. IF: 3.774

Griffin R, Psarelli EE, Cox TF, Khedr M, Milan AM, Davison AS, Hughes AT, Usher JL, Taylor S, Loftus N, Daroszewska A, West E, Jones A, Briggs M, Fisher M, McCormick M, Judd S, Vinjamuri S, Sireau N, Dillon JP, Devine JM, Hughes G, Harrold J, Barton GJ, Jarvis JC, Gallagher JA, Ranganath LR. (2018) Data on items of AKUSSI in Alkaptonuria collected over three years from the United Kingdom National Alkaptonuria Centre and the impact of nitisinone. Data in Brief. 20:1620-1628.

King SL, Barton GJ, Ranganath LR, 2017. Interpreting sources of variation in clinical gait analysis: a case study. Gait and Posture, 52: 1-4. doi>

Barton GJ, King SL, Robinson MA, Hawken MB, Ranganath LR, 2015. Age related deviation of gait from normality in alkaptonuria. Invited paper in Special Issue on Alkaptonuria, Journal of Inherited Metabolic Disease Reports. 24: 39-44. doi>

A set of unique methods to quantify deviation of movement from normality to support clinical decision-making using artificial intelligence. Software tools developed in our project are available as free downloads.

Free download

Characteristics of abnormal gait can be captured by quantifying the three dimensional joint angles, moments and powers of the lower limbs but the complexity of the resultant high dimensional data space makes data interpretation prone to bias. Self-organising neural networks can be used to map complex gait data onto a two dimensional topographic map, thereby improving the efficiency of decision-making in clinical gait analysis.

We have developed the Movement Deviation Profile which shows the deviation of an individual’s movement from normality in a single curve and a single number.

Staff: Prof. Gabor Barton, Dr Malcolm Hawken, Dr Mark Robinson

Selected publications

Fidalgo-Herrera AJ, Martínez-Beltrán MJ, de la Torre-Montero JC, Moreno-Ruiz JA, Barton GJ (2020) Artificial intelligence prediction of the effect of rehabilitation in whiplash associated disorder. PLoS ONE 15(12): e0243816.

Ferreira CL, Barton GJ, Borges LD, Rabelo N, Politti F, Lucareli P. (2019) Step down tests are the tasks that most differentiate the kinematics of women with patellofemoral pain compared to asymptomatic controls. Gait and Posture. 72:129-134.

Barton GJ, Hawken MB, Scott M, Schwartz MH (2019) Leaving hip rotation out of a conventional 3D gait model improves discrimination of pathological gait in cerebral palsy: a novel neural network analysis. Gait and Posture. 70:48-52.

Barton GJ, Hawken MB, Holmes G, Schwartz MH, 2013. A gait index may underestimate changes of gait: a comparison of the Movement Deviation Profile and the Gait Deviation Index. Computer Methods in Biomechanics and Biomedical Engineering. doi>

Barton GJ, Hawken MB, Scott M, Schwartz MH, 2010. Movement Deviation Profile: a measure of distance from normality using a self-organizing neural network. Invited paper in Special Issue on Network Approaches in Complex Environments, Human Movement Science. 31: 284-294. doi>

Barton GJ, Lees A, Lisboa P, Attfield S, 2007. Gait quality assessment using self-organising artificial neural networks. Gait and Posture. 25/3: 374-379. doi>

Barton JG, Lees A, Lisboa P, Attfield S, 2006. Visualisation of gait data with Kohonen self organising neural maps. Gait and Posture. 24/1: 46-53. doi>

PhD opportunity: The Magic Mirror - showing patients how their normal movements would look like

One area of research has explored lower limb loading during human locomotion with reference both to sporting and clinical applications. Protective and therapeutic aspects of footwear have been a particular research focus and various commercial projects have been undertaken with footwear and sports surface manufacturers. Techniques have been developed to examine transient, high frequency aspects of lower limb loading and the possible links to specific overuse injury mechanisms. Recently, internal foot and lower leg loading has been estimated using finite element methods.

Primary contact: Dr Mark Lake

Selected publications

Müller, C., Sterzing, T., Milani, T. L., Lake, M. J., 2010. Different Stud Configurations Cause Movement Adaptations during a Soccer Turning. Footwear Science, 2: 1, 21-28.

Morio, C., Lake, M. J., Guequen, N., Rao, G., Baly, L., 2009. The influence of footwear on foot motion during walking and running. J. Biomechanics, 42, 2081-2088. doi>

Gu Y.D., Li J.S., Ren X.J. and Lake M., 2008. The mechanical response of Achilles tendon during different kinds of sports. Commun. Numer. Meth. Eng, 24: 2077–2085. doi>

Gu Y.D., Li J.S., Lake M., Ren X.J., 2008. Three dimensional finite element analysis of hind foot bones in jumping movements. Journal of Medical Biomechanics, 23(2): 127-130. doi>

Digby, C. J., Lake, M.J. and Lees, A., 2005. High-speed non-invasive measurement of tibial rotation during the impact phase of running. Ergonomics, 48,1623-1637.

In the joint loading group it is our aim to advance the understanding of lower limb joint loading in all types of locomotion through rigorous biomechanical investigation. Our research helps innovate and validate advanced biomechanical techniques, develop and disseminate good research practice in biomechanical investigation, and to ultimately support mechanistic study of lower limb injuries, disorders or diseases, such as ACL injury in sports or osteoarthritis in frail populations.

Our muscles and joints undergo stresses during the activities we do, whether that is walking to the shop, jogging around the park, or rapidly changing direction to avoid the defender during a game of football. These stresses can lead to slow adaptations of the structures around the bones or pose a threat of acute muscle or ligament injury. The research undertaken at LJMU focuses on both, specialising in accurate assessment of those stresses in all types of activity.

A particular area of interest is the application of advanced techniques to measuring joint loading and (in)stability around hip, knee and ankle. We have developed a cluster-based biomechanical model that allows us to investigate lower limb kinematics and kinetics and we continue to undertake extensive validations of this and other models. The use of functional joint axis definitions has been evaluated as well as the use of inverse kinematics solutions.

The in-depth knowledge gained with those advanced techniques is then used to interpret data acquired during standard clinical tests (e.g. single leg hop test) or field-based technologies (e.g. trunk mounted GPS systems). It has also allowed us to build advanced screening tests, which can help assess progress during rehabilitation process or provide a pre-season screening.

Primary contacts: Dr Jos Vanrenterghem and Dr Mark Robinson

Current PhD projects

Biomechanical and neuromuscular evaluation of knee muscle and ligament injury risk due to mechanical loading during dynamic sports (funded by Malaysian Government) - Raja Mohammed Firhad Bin Raja Azidin

Prevention of hamstring re-injury in professional football (funded by Liverpool FC) - Paulo Barreira

Pitch hardness: The relationship to perceived injury risk, injury prevalence and movement in elite football (funded by Leicester FC) - Dave Rennie

Identification of biomechanical risk factors for knee injury during dynamic activities (funded by Malaysian Government) - Raihana Binti Sharir

Neuromuscular screening for prediction of knee injury during dynamic tasks (funded by Malaysian Government) - Radin Rafeeuddin Bin Radin Dzulfakar

Player load monitoring in dynamic sports (funded by Football Exchange) - Niels Jensby Nedergaard

Selected publications

Selfe J, Janssen J, Callaghan M, Witvrouw E, Sutton C, Richards J, Stokes M, Martin D, Dixon J, Hogarth R, Baltzopoulos V, Ritchie E, Arden N, Dey P. 2016. Are there three main subgroups within the patellofemoral pain population? A detailed characterisation study of 127 patients to help develop targeted intervention (TIPPs). Br J Sports Med 50(14):873-80. doi>

Callaghan MJ, Guney H, Reeves ND, Bailey D, Doslikova K, Maganaris CN, Hodgson R, Felson DT. 2016. A knee brace alters patella position in patellofemoral osteoarthritis: a study using weight bearing magnetic resonance imaging. Osteoarthritis Cartilage 24(12):2055-2060. doi>

Meireles S, De Groote F, Reeves ND, Verschueren S, Maganaris C, Luyten F, Jonkers I. 2016. Knee contact forces are not altered in early knee osteoarthritis. Gait Posture 45:115-20. doi>

Robinson, M., Tsao, J., Donnely, C.J., Vanrenterghem, J. (In Press) The effect of choosing a direct kinematic or inverse kinematic model on ACL injury risk during side-cutting. Medicine and Science in Sport and Exercise.

Malfait, B, Sankey, S, Azidin, R, Deschamps, K, Vanrenterghem, J, Robinson, MA, Staes, FF, Verschueren, SMP, 2013. How reliable are lower limb kinematics and kinetics during drop vertical jump tasks? Medicine and Science in Sports and Exercise Science, epub. doi>

Verrelst, R, De Clercq, D, Vanrenterghem, J, Willems, T, Palmans, T, Witvrouw, E, 2013. A prospective study on full-body kinematic related risk factors in the development of exertional medial tibial pain. British Journal of Sports

Dingenen, B, Malfait, B, Verschueren, SMP, Staes, FF, Vanrenterghem, J., 2013. The reliability and validity of the measurement of lateral trunk motion in two-dimensional video analysis during unipodal functional screening tests in female athletes. Physical Therapy in Sport, epub. doi>

De Ridder, R, Willems, T, Vanrenterghem, J, Robinson, MA, Pataky, T, Roosen, P., 2013. Gait kinematics of subjects with chronic ankle instability using a multi-segmented foot model. Medicine and Science in Sports and Exercise, 2129-2136. http://doi>

Vanrenterghem, J., Venables, E., Pataky, T., Robinson, M. 2012. The effect of running speed on knee mechanical loading in females during side cutting. Journal of Biomechanics, 45, 2444-2449.

Robinson, M., Vanrenterghem, J. 2012. An evaluation of anatomical and functional knee axis definition in the context of side cutting. Journal of Biomechanics, 45, 1941-1946. doi>

Vanrenterghem, J., Gormley, D., Robinson, M., Lees, A. 2010. Solutions for representing the whole-body centre of mass in side cutting manoeuvres based on data that is typically available for lower limb kinematics. Gait and Posture, 31, 517-521. doi>

Maintaining postural stability and overall balance during everyday activities requires a complex control of intersegmental motion based on knowing the musculoskeletal capacity and interpreting various sources of sensory information. The main focus of our work is around the mechanistic aspects of how we are limited in balancing over the available contact points with the floor and the environment. This applies to the understanding of how and when someone is likely to fall, as well as to the understanding of how good balancing abilities can reduce the loading in the knee joint during dynamic sporting tasks.

The focus of our work is on the biomechanical constraints to which balance is tied. These constraints are universal and can be explored across the typical fields of interest. We have investigated this in the context of identifying the risk of falling through observing whether and how individuals can withstand perturbations to the body, and how this might be age dependent. We have looked at the role of whole-body balance during a catching task. We have identified how the musculoskeletal system is able to generate those internal forces that ultimately lead to the corrective movements.

Staff: Dr Jos Vanrenterghem

Current PhD projects

The role of dynamic stability in the movement execution of highly dynamic tasks (funded by Bolton University) - Sean Sankey

Selected publications

Sturnieks, D.L., Menant, J., Vanrenterghem, J., Fitzpatrick, R., Rogers, M. Lord, S.R., 2013. Predicting falls in older people from force-controlled balance perturbations. PLOS ONE, in press.

Tijtgat, P., Vanrenterghem, J., Bennett, S., De Clercq D., Savelsbergh, GJP, Lenoir, M., 2013. Postural adjustments in catching : on the interplay between segment stabilization and equilibrium control. Motor Control, Epub ahead of print.

Di Giulio I, Baltzopoulos V, Maganaris CN, Loram ID., 2013. Human standing: does the control strategy preprogram a rigid knee? J Appl Physiol 114,1717-29. doi>

Sturnieks, D.L., Menant, J., Vanrenterghem, J., Delbaere, K., Fitzpatrick, R., Lord, S. 2012. Sensorimotor and neurophysiological correlates of force thresholds for stepping in older adults. Gait and Posture, 36, 356-360. doi>

Tijtgat, P., Vanrenterghem, J., Bennett, S., De Clercq D., Savelsbergh, GJP, Lenoir, M., 2012. Implicit advance knowledge effects on the interplay between arm movements and postural adjustments in catching. Neuroscience Letters, 518, 117-121. doi>

Loram ID, Lakie M, Di Giulio I, Maganaris CN., 2009. The consequences of short-range stiffness and fluctuating muscle activity for proprioception of postural joint rotations: the relevance to human standing. J Neurophysiol 102(1):460-74. doi>

Di Giulio I, Maganaris CN, Baltzopoulos V, Loram ID., 2009. The proprioceptive and agonist roles of gastrocnemius, soleus and tibialis anterior muscles in maintaining human upright posture. J Physiol 587, 2399-416. doi>

Loram ID, Maganaris CN, Lakie M. 2009. Paradoxical muscle movement during postural control. Med Sci Sports Exerc 41,198-204. doi>

The development and dissemination of analysis tools ranging from basic data processing for undergraduate students to advanced vector field analysis based on statistical parametric mapping techniques.

Vector continuum schematic, depicting a mean two-muscle EMG waveform in blue along with inter-muscle dependence (EMG1-EMG2 covariance) and time-dependence (TIME-EMG smoothness).

Biomechanical data range from discrete 0D scalars to complex 3D vectors (and beyond). Traditional analyses of biomechanical data typically reduces the complexity of the dataset by extracting “key scalars” to analyse with standard statistical analysis techniques. The problem with this approach is that the selection of the “key scalars” is inherently biased unless a hypothesis directly pertained to that key scalar at that instance in time. Our research involves the analysis of n-D biomechanical data using statistical parametric mapping. We use traditional general linear models e.g. t-test, ANOVA, regression to analyse biomechanical data but with the maintenance of time within the analysis fundamentally differentiating it from traditional analyses.

Primary contact: Dr Mark Robinson

Selected publications

Pataky, T., Robinson M., Vanrenterghem, J., Savage, R., Bates, K., Crompton, R., 2014. Vector field statistics for objective center-of-pressure trajectory analysis, with evidence of scalar sensitivity to small coordinate system rotations. Gait and Posture 40(1):255-8. doi>

Pataky, T., Robinson, M., Vanrenterghem, J., 2013. Vector field statistical analysis of kinematic and force trajectories. Journal of Biomechanics, 46, 2394-2401. doi>

Pataky, T., Vanrenterghem, J. Robinson, M., Parametric and non-parametric confidence intervals and hypothesis tests regarding scalar trajectories. Submitted to Journal of Biomechanics.

De Ridder, R., Willems, T., Vanrenterghem, J., Robinson, M., Pataky, T., Roosen, P., 2013. Gait kinematics of subjects with chronic ankle instability using a multi-segmented foot model. Medicine and Science in Sports and Exercise, 45, 2129-2136. doi>

Vanrenterghem, J., Venables, E., Pataky, T., Robinson, M., 2012. The effect of running speed on knee mechanical loading in females during side cutting. Journal of Biomechanics, 45, 2444-2449. doi>