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Gait stability in postpartum runners: A pilot study to inform the development of evidence-based return-to-running guidelines following childbirth
Introduction & Purpose
Only 75% of female runners return to running following pregnancy and childbirth (Moore et al., 2021). Reported barriers for returning to running postpartum include pelvic floor dysfunction, musculoskeletal pain, and fear of movement (Moore et al., 2021), all of which may trigger or be the result of compensatory running gait adaptations. Provenzano and colleagues (2019) showed limited transverse plane trunk and pelvis rotations during running in the first weeks of the postpartum period and speculated that this adaptation may be an attempt to compensate for lower gait stability and higher perceived injury risk. It is unknown, however, whether reduced gait stability is still present greater than four months post-birth when current Austrian physical activity guidelines consider a return to high-impact sports possible (Ring-Dimitriou et al., 2020).
Next to musculoskeletal and psychological rehabilitation, one possible approach to improve gait stability in postpartum runners may be through footwear interventions. This is based on evidence for an improved local dynamic joint stability during running with shoes of reduced midsole thickness – possibly due to superior sensory feedback from the running surface (Frank et al., 2019).
The goal of this pilot study was to test the hypothesis that gait stability, quantified by trunk rotation excursion and local dynamic gait stability during running, is lower in postpartum (PP) runners more than four months post-birth compared to nulliparous controls (CTR). Further, to explore the association between measures of gait stability, fear of movement, and the choice of running footwear to help inform return-to-running guidelines.
Methods
Twenty-one female runners (n = 12 PP, n = 9 CTR) self-reported their demographics, running habits, birth and postpartum history (PP only) and fear of movement according to a German version of the 11-item Tampa Scale of Kinesiophobia (TSK; Woby et al., 2005). Running kinematics were quantified using a 17-sensor inertial motion capture suit (Xsens Link, Movella, Enschede, NL). All runners ran on a treadmill at a self-selected speed for five minutes and in four running shoe conditions (their own running shoes plus three models varying in midsole thickness and stiffness). Trunk rotation excursion was quantified from the average range of motion of the thorax segment in the transverse plane for the last three minutes. Local dynamic gait stability was assessed using the local divergence exponent of the medio-lateral trunk velocity (Bruijn et al., 2013). Higher exponents indicate lower stability. Linear mixed effects models clustered by runner were used to investigate the influence of “group” (PP vs CTR), and “shoe condition” on the two measures of gait stability (α = .05) with “running speed” as a covariate. In addition, we explored the association between “fear of movement” (TSK-score) and the two measures of gait stability with “group” as a potential effect modifier.
Results
On average, PP runners returned to running five months [range 1-10 months] post-birth and were measured at eight months (range 4-18 months] post-birth. The mean age was slightly higher in PP runners (35 years) compared to the CTR group (30 years) but height and body mass were similar (PP: 176 cm, 63 kg vs. CTR: 169 cm, 64 kg). On average, the training frequency per week and distance per run were higher in the CTR group (2.2/week, 7.7 km/run) compared to PP runners (1.5/week, 5.3 km/run). Average fear of movement TSK-scores were marginally elevated in PP runners (19.1 [range 14-25]) compared to the control (CTR) group (17.4 [range 13-22]).
PP runners showed significantly elevated local divergence exponents compared to nulliparous runners (mean difference 95% CI = .07 [.01, .14], F(1, 17.6) = 5.202, p = .035, Figure 1a) indicative of lower local dynamic gait stability in PP runners. This effect was not significantly influenced by the type of running shoe (F(3, 54.9) = 0.282, p = .838) nor confounded by running speed (p = .160). In contrast, there was no significant influence of “group” (F(1, 18) = 0.672, p = .423) nor “shoe condition” (F(3, 56) = 1.125, p = .347) on the transverse plane trunk rotation excursion (Figure 1b) with a trend of confounding by running speed (p = .066). There was no significant association between the fear of movement (TSK-score) and local dynamic gait stability (p = .137) nor trunk rotation excursion (p = .550).
Discussion
Postpartum runners showed a reduced local dynamic gait stability during running compared to nulliparous runners in a time frame of 4-18 months post-birth. This effect was observed independently of the selected running speed and despite relatively low levels of fear of movement in the postpartum runners compared to other cohorts with musculoskeletal pain conditions (Chimenti et al., 2021). Local dynamic stability quantifies the ability of the neuromuscular control system to respond to and recover from small perturbations (Bruijn et al., 2013). Given the lack of association with the fear of movement (TSK-scores), we speculate that the lower gait stability in postpartum runners may result from persistent deficits in lumbopelvic muscle function postpartum (Christopher et al., 2020) or fluctuations in breast mass. This is because of the crucial role of the lumbopelvic region for force transmission between the ground, legs, and upper body during running (Schache et al., 1999) and thus the capacity to respond to perturbations. Since lumbopelvic muscle function and movement is notoriously difficult to measure (Schache et al., 1999), local dynamic gait stability indices may be an interesting marker for monitoring and guiding the rehabilitation and return to running postpartum. To understand its association with clinical and biomechanical measures of lumbopelvic muscle function should be the goal of future studies in this field.
In contrast to the findings of Provenzano and colleagues (2019), we did not observe a significant restriction of upper body rotation in postpartum runners, which may be owed to the longer time post-birth and low levels of fear of movement in the current PP group. Furthermore, we could not demonstrate a systematic influence of the shoe type on either measure of gait stability, which suggests that the optimal footwear characteristics regarding gait stability are likely runner-specific (Nigg et al., 2017).
Given the small sample size, this study must be considered a pilot study and should inform a more comprehensive assessment of postpartum runners including clinical and biomechanical markers of lumbopelvic function. One specific limitation is the heterogeneity of the PP group, which combined runners in a wide time frame post-birth, with one and more children as well as different birth modes, which may have masked effects present in more homogenous subgroups.
Conclusion
This pilot study suggests a reduced local dynamic trunk stability in postpartum runners 4-18 months post-birth compared to nulliparous runners. Local dynamic stability indices should be investigated as potential biomarkers for monitoring the rehabilitation and guiding the return to running process postpartum.
References
Bruijn, S. M., Meijer, O. G., Beek, P. J., & van Dieën, J. H. (2013). Assessing the stability of human locomotion: A review of current measures. Journal of the Royal Society Interface, 10(83), Article 20120999. https://doi.org/10.1098/rsif.2012.0999
Chimenti, R. L., Post, A. A., Silbernagel, K. G., Hadlandsmyth, K., Sluka, K. A., Moseley, G. L., & Rio, E. (2021). Kinesiophobia severity categories and clinically meaningful symptom change in persons with achilles tendinopathy in a cross-sectional study: Implications for assessment and willingness to exercise. Frontiers in Pain Research, 2, Article 739051. https://doi.org/10.3389/fpain.2021.739051
Christopher, S. M., Garcia, A. N., Snodgrass, S. J., & Cook, C. (2020). Common musculoskeletal impairments in postpartum runners: An international Delphi study. Archives of Physiotherapy, 10(1), Article 19. https://doi.org/10.1186/s40945-020-00090-y
Frank, N. S., Prentice, S. D., & Callaghan, J. P. (2019). Local dynamic stability of the lower extremity in novice and trained runners while running intraditional and minimal footwear. Gait and Posture, 68, 50–54. https://doi.org/10.1016/j.gaitpost.2018.10.034
Moore, I. S., James, M. L., Brockwell, E., Perkins, J., Jones, A. L., & Donnelly, G. M. (2021). Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum women. British Journal of Sports Medicine, 55(22), 1286–1292. https://doi.org/10.1136/bjsports-2021-104168
Nigg, B. M., Mohr, M., & Nigg, S. R. (2017). Muscle tuning and preferred movement path - A paradigm shift. Current Issues in Sport Science, 2, Article 007. https://doi.org/0.15203/CISS_2017.007
Provenzano, S. G., Hafer, J. F., Peacock, J., Kempner, S., Zendler, J. D., & Agresta, C. E. (2019). Restriction in pelvis and trunk motion in postpartum runners compared with pre-pregnancy. Journal of Women’s Health Physical Therapy, 43(3), 119-126. https://doi.org/10.1097/JWH.0000000000000129
Ring-Dimitriou, S., Windsperger, K., Felder-Puig, R., Kayer, B., Zeuschner, V., & Lercher, P. (2020). Österreichische Bewegungsempfehlungen für Frauen während der Schwangerschaft und danach, für Kinder im Kindergartenalter und für Kinder und Jugendliche [Austrian physical activity recommendations for women during and after pregnancy, children of kindergarten age, children, and adolescents]. Gesundheitswesen, 82(S 03), S177–S183. https://doi.org/10.1055/a-1191-4060
Schache, A. G., Bennell, K. L., Blanch, P. D., & Wrigley, T. V. (1999). The coordinated movement of the lumbo-pelvic-hip complex during running: A literature review. Gait & Posture, 10(1), 30–47. https://doi.org/10.1016/s0966-6362(99)00025-9
Woby, S. R., Roach, N. K., Urmston, M., & Watson, P. J. (2005). Psychometric properties of the TSK-11: A shortened version of the Tampa Scale for Kinesiophobia. Pain, 117(1–2), 137–144. https://doi.org/10.1016/j.pain.2005.05.02
Amor y onomatogonía: Ideas de Miguel de Unamuno sobre los préstamos y la renovación léxica de las lenguas
In this article I review the ideas of Miguel de Unamuno (1864-1936) on neologisms, focusing on the mechanisms of lexical borrowing from foreign languages. After setting out his general position and the names he considers appropriate or inappropriate, I deal with some specific aspects of neology: consideration of the so-called “luxury neologisms”; issues of use, frequency and implementation of terms; neologisms in the press and in the dictionary, and specialised language. In addition to reviewing Don Miguel\u27s views on the lexical renewal of some European languages, we will see how he proposes that foreign words be adopted or assimilated into Spanish; how the learning of foreign languages can serve to enrich the Spanish language; the difficulties posed by the intersection between neology and translation; and, finally, how Unamuno deals with neological creation in his writings.En este artículo revisamos cuáles fueron las ideas de Miguel de Unamuno (1864-1936) sobre los neologismos, fijándonos principalmente en los mecanismos de adopción de términos a partir de lenguas extranjeras. Tras exponer su posicionamiento general y las denominaciones que considera adecuadas o impropias, abordamos algunos aspectos concretos de la neología: la consideración acerca de los denominados “neologismos de lujo”; cuestiones de uso, frecuencia e implantación de los términos; los neologismos en la prensa y en el diccionario, y el lenguaje especializado. Además de repasar qué opina don Miguel sobre la renovación léxica de algunas lenguas europeas, veremos cómo propone que se adopten o asimilen las voces extranjeras al español; cómo el aprendizaje de lenguas extranjeras puede servir para enriquecer el castellano; qué dificultades plantea la intersección entre neología y traducción, y, finalmente, cómo aborda Unamuno la creación neológica en sus escritos
Toponymy in Brazilian Sign language. : Formation and Motivational Aspects of Tocantins State’s Cities (Brazil)
This article presents the results of a research on toponyms of cities in the state of Tocantins, Brazil, in Brazilian Sign Language (Libras). Signs were collected from observation and interviews with deaf people. The state of Tocantins consists of 139 municipalities and, so far, we have surveyed 61 toponyms. Signs were categorized into (1) native, (2) initialized and (3) fingerspelled (exclusive categories). Regarding motivation, toponyms categorized as iconic motivation, covering (1) material and (2) cultural and Portuguese language motivation, covering (3) calque and (4) writing. The spelling motivation is the most prevalent in the toponyms of the cities of Tocantins, also combining with other types of motivation, such as (5) material and spelling, (6) cultural and writing, and (7) calque and spelling. We bring further considerations on these categories and suggest forearm as a productive point of articulation for toponymic signs in the context of Tocantins
Motivational differences for physical activity and gaming: Do the perceived motives of parents differ from those of their children?
The time children spend playing digital games has seen a notable increase. The suggested motives for children to engage in gaming are predominantly competition, social interaction, and achievement (Martucci et al., 2023). Concurrently, there has been a concerning decline in physical activity (PA) among children. This shift suggests a potential conflict in leisure-time activities for children (Salmensalo et al., 2024). The motivations driving children towards PA include well-being, enjoyment, social interaction, and seeking social support (Pedersen et al., 2021). Interestingly, studies have identified a positive relationship between parent and child PA levels. Similarly, parental involvement in gaming seems to have a beneficial impact on children’s gaming habits. However, to date, no study has directly compared the actual motives for gaming and PA of children. Moreover, the perceived motives of their parents are under-researched. The aim of the study was to compare the motives for gaming and PA of children. Additionally, the parents’ perceptions of what motivates their children to engage in both activities were considered.
Children (N = 73; 15.5 ± 5.9 y; 26% female) and parents (N = 50; 45.1 ± 7.1 y; 56% female) were asked to answer a questionnaire during the Frühjahrsmesse in Innsbruck. Questions were based on the “Videogaming Motives Questionnaire” (López-Fernández et al., 2020) and were adapted in terms of PA and the perceived motives of the parents. Motives recreation, social interaction, coping, competition and skill were considered. Order of the questions as well as of the sub-items was randomized. Item reliability was tested using Cronbach’s alpha and scales were calculated using the mean of the sub-items based on a 5-point Likert Scale. Since the data were not normally distributed, the Kruskal-Wallis H test was used to compare the motives of the children with the perceived motives of the parents. Differences within the groups between gaming and PA were tested using Friedman.
Motive comparison between groups showed significant differences regarding recreation in Gaming H = 6,443, p = 0.011, r = 0.61, with children (4.28 ± 0.69) identifying this motive more strongly than parents (4.03 ± 0.67). Skill H = 4.704, p = 0.030, r = 0.44, presented significant differences, showing children (3.51 ± 0.99) to find this motive more relevant than parents (3.17 ± 0.78). A trend was observed in social interaction in PA H = 3.673, p = 0.055, r = 0.34. Parents (3.72 ± 0.92) perceived this motive to be more relevant than children (3.39 ± 0.97). When analysing differences between the motives within the groups, no significant results were observed.
Children perceive gaming as more recreational and skill-educating than their parents, potentially due to changing everyday life. This shift towards educational gaming might have positive cognitive benefits. Additionally, gaming skills may better align with today’s digital requirements (Nordlund et al., 2019). However, no significant motive variances between gaming and PA exist. This disparity underscores potential conflicts in children’s leisure activities.
References
López-Fernández, F. J., Mezquita, L., Griffiths, M. D., Ortet, G., & Ibáñez, M. I. (2020). The development and validation of the Videogaming Motives Questionnaire (VMQ). PLoS ONE, 15(10), Article e0240726. https://doi.org/10.1371/journal.pone.0240726
Martucci, A., Gursesli, M. C., Duradoni, M., & Guazzini, A. (2023). Overviewing gaming motivation and its associated psychological and sociodemographic variables: A PRISMA systematic review. Human Behavior and Emerging Technologies, 2023, Article 5640258. https://doi.org/10.1155/2023/5640258
Nordlund, A., Sekki, S., Korvela, P., & Silvonen, J. (2019). The changing everyday life of families and young people. In M. Toivonen & E. Saari (Eds.), Human-centered digitalization and services (pp. 79–100). Springer Nature. https://doi.org/10.1007/978-981-13-7725-9_5
Pedersen, M. R. L., Hansen, A. F., & Elmose-Østerlund, K. (2021). Motives and barriers related to physical activity and sport across social backgrounds: Implications for health promotion. International Journal of Environmental Research and Public Health, 18(11), Article 5810. https://doi.org/10.3390/ijerph18115810
Salmensalo, M., Ruotsalainen, H., Hylkilä, K., Kääriäinen, M., Konttila, J., Männistö, M., & Männikkö, N. (2024). Associations between digital gaming behavior and physical activity among Finnish vocational students. Journal of Public Health, 32, 53–63. https://doi.org/10.1007/s10389-022-01788-
Flexible und individualisierte Entwicklung digitaler Kompetenzen von Lehrpersonen am Beispiel der Weiterbildungsplattform «aprendo – digitale Kompetenz»
Um Bildung in einer digitalen Welt zu gestalten, benötigen Lehrpersonen und Schulleitende digitale Kompetenzen. Studien zeigen Defizite in der Schweiz und betonen den Bedarf an gezielten Weiterbildungen. Da Lehrpersonen zeitlich stark belastet sind, müssen diese Angebote in den beruflichen Alltag integrierbar sein. Daher wurde basierend auf den Kompetenzmodellen «digi.kompP» und «DigCompEdu» die Plattform «aprendo – digitale Kompetenz» entwickelt. Sie bietet flexible Module auf verschiedenen Kompetenzstufen. Erste Nutzungszahlen zeigen eine Beteiligung von über 9900 Lehrpersonen. Die Wirksamkeit und die Effizienz der Plattform müssen jedoch in zukünftigen Studien noch untersucht werden
Intelligent evaluation method for design education and comparison research between visualizing heat-maps of class activation and eye-movement
The evaluation of design results plays a crucial role in the development of design. This study presents a design work evaluation system for design education that assists design instructors in conducting objective evaluations.
An automatic design evaluation model based on convolutional neural networks has been established, which enables intelligent evaluation of student design works. During the evaluation process, the CAM is obtained. Simultaneously, an eye-tracking experiment was designed to collect gaze data and generate eye-tracking heat maps. By comparing the heat maps with CAM, an attempt was made to explore the correlation between the focus of the evaluation’s attention on human design evaluation and the CNN intelligent evaluation. The experimental results indicate that there is some certain correlation between humans and CNN in terms of the key points they focus on when conducting an evaluation. However, there are significant differences in background observation.
The research results demonstrate that the intelligent evaluation model of CNN can automatically evaluate product design works and effectively classify and predict design product images. The comparison shows a correlation between artificial intelligence and the subjective evaluation of human eyes in evaluation strategy. Introducing artificial intelligence into the field of design evaluation for education has a strong potential to promote the development of design education
La fraseografia del catalano di Alghero
As already shown in a newly published article (Autelli/Caria 2022b), the phraseological studies on the Catalan of Alghero are still in their infancy, and there is an urgent need for documenting more phrasemes in this diatopic variety. One can already find some of them in dictionaries and amatorial collections. The aim of this paper is to give a brief overview of the written sources and dictionaries of Algherese, then to analyse the terminology used in the latter in reference to phrasemes and, most importantly, to find out what kind of phrasemes are provided, trying to pinpoint their main morphosyntactic, semantic and cultural features
Costruzioni a schema fisso in alcune varietà diatopiche d’Italia.: Prospettive teoriche e lessicografiche
The paper is devoted to the analysis of partially lexically specified constructions in different diatopic varieties of Italian. These word combinations can be defined as constructions since they are pairings of form and meaning characterized by the presence of fixed and empty positions. The investigation examines examples of partially lexically specified (phrasal and sentence) constructions in Sardinian and in the regional Italian of Rome. The analysis shows that this combinatorial type is widespread within the national language as well as in local varieties. The phenomena which have been considered mainly concern: i) the presence of indigenous constructions in the local variety; ii) the presence of constructions modelled on the roof language; iii) the lexicalisation of forms in the local variety from roof language constructions, which radiate back as fixed sequences into the national language. The analysis also considers the lexicographic perspective and shows that these constructions are generally underrepresented in lexicographic tools, even though their single instantiations are often recorded in the corresponding entries
La fraseografia degli italiani regionali: da ieri a domani
The phraseography of regional varieties of Italian is under-represented in lexicographic sources. This article aims to briefly review the main obstacles faced by the phraseological lexicography of regional Italian and to offer a working proposal based on the latest edition of the Dizionario di Fraseologia dell’Italiano Regionale (DFIR). The intention is to overcome the stereotypes that affect regional phraseography and to prepare the foundations for future work, which will involve, indispensably, improving the research methodology, consolidating the theoretical proposals on phraseology developed in recent years and, finally, taking advantage of technological advances to make the phraseological repertoires more accessible and more easily updatable