Groucho running reveals disparate results between ground reaction force and tibia-fibula bone strain in runners

The relationship between external forces and bone strain in running is often complex and nonintuitive. We used Groucho running (i.e., running with exaggerated knee flexion) as a model to dramatically reduce the vertical ground reaction force (VGRF) and examined the relationship between peak VGRF and finite element (FE)-predicted tibia-fibula bone strain. Nine physically active males ran on an instrumented treadmill at 2.8 m/s with their preferred running technique, increased knee flexion (Groucho), and exaggerated knee flexion (Ex Groucho) in a randomized order. Strains at the tibia-fibula midshaft were calculated using computed-tomography-based FE modeling with loads and boundary conditions calculated from an inverse-dynamics based musculoskeletal model. Pressure-modified von Mises strain was used to quantify the peak strain (90th percentile strain) and strained volume (volume of bone experiencing strains above 3000 micro strains). We further explored the relationship between peak VGRF, lower leg angle, and FE-predicted strain variables. The results showed that a 15.8% and 22.9% reduction in VGRF during Groucho and Ex Groucho, respectively, had no significant effect on FE-predicted peak strain (p > 0.304) and strained volume (p>0.053). Changes in peak VGRF did not correlate with FE-predicted strain variables (p>0.54) while changes in lower leg angle in the sagittal plane were moderately correlated (r>0.65; p<0.047). Our findings suggest that reductions in peak external forces do not always coincide with reductions in bone strain, especially in cases where running kinematics are dramatically altered. This work has important implications for designing gait retraining interventions based on reductions in external force measures.