Richard Willy

University of Montana | UMT · Physical Therapy and Rehabilitation Science

Patellofemoral pain (PFP) has historically been a complex and enigmatic issue. Many of the factors thought to relate to PFP remain after patients' symptoms have resolved making their clinical importance difficult to determine. The tissue homeostasis model proposed by Dye in 2005 can assist with understanding and implementing biomechanical intervent...

We sought to determine if an in-field gait retraining program can reduce excessive impact forces and peak hip adduction without adverse changes in knee joint work during running. Thirty healthy at-risk runners who exhibited high-impact forces were randomized to retraining [21.1 (±1.9) years, 22.1 (±10.8) km/week] or control groups [21.0 (±1.3) year...

Study Design Level 4: Controlled laboratory study. Background Little is known regarding potential differences between treadmill and overground running in regards to patellofemoral joint and Achilles tendon loading characteristics. Objectives We sought to compare measures of loading to the patellofemoral joint and Achilles tendon across treadmill...

Purpose While partial meniscectomy results in a compromised tibiofemoral joint, little is known regarding tibiofemoral joint loading during running in individuals who are post-partial meniscectomy. It was hypothesized that individuals post-partial meniscectomy would run with a greater hip support moment, yielding reduced peak knee extension moments...

Background Running retraining is commonly used in the management of medial tibial stress syndrome (MTSS) but evidence for its effectiveness is lacking. The primary aim of this study is to determine if the addition of running retraining to best standard care is beneficial in the management of runners with MTSS. Methods This study is an assessor‐bli...

Objective To explore clinical practice patterns of physical therapists (PTs) who treat people with Achilles tendinopathy (AT), and identify perceived barriers and facilitators for prescribing and engaging with therapeutic exercise among PTs and people with AT. Methods Two cross-sectional surveys were electronically distributed between November 202...

The study aims to investigate the effects of different loads and speed during running on inter- and intra-individual muscle force amplitudes, variabilities and coordination patterns. Nine healthy participants ran on an instrumentalized treadmill with an empty weight vest at two velocities (2.6 m/s and 3.3 m/s) or while carrying three different load...

Objectives: To estimate Achilles tendon forces and their relationship with self-reported pain in runners with Achilles tendinopathy (AT) during common rehabilitation exercises. Design: Cross-sectional. Setting: Laboratory. Participants: 24 recreational male runners (45.92 (8.24) years old; 78.20 (8.01) kg; 177.17 (6.69) cm) with symptomatic...

Objectives: Knee underloading patterns have been reported mid- and long-term after return to running post-ACLR, but changes in these patterns during the reintroduction to running are unknown. We evaluated knee biomechanics in individuals within 6 months of ACL-R at the start and completion of a reintroduction to running program. Design: Longitud...

Introduction Primary cam morphology is highly prevalent in many athlete populations, causing debilitating hip osteoarthritis in some. Existing research is mired in confusion partly because stakeholders have not agreed on key primary cam morphology elements or a prioritised research agenda. We aimed to inform a more rigorous, inclusive and evidence-...

Introduction Primary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers...

Background Running is a popular sport with widely recognized health benefits. Given the high rates of knee injury in runners and the growing prevalence of knee osteoarthritis (KOA), it may be useful to assess perceptions about running and knee joint health. Purpose The objectives of this study were to (1) explore and compare the perceptions of the...

Context: To determine (1) whether physical function and fear of movement are prospectively associated with the risk of females developing patellofemoral pain (PFP) and (2) whether they change following development of PFP. Design: Prospective observational study. Methods: A total of 114 asymptomatic females (18-22 y old) completed assessment of...

We aimed to 1) compare pain, tendon structure, lower limb function, and Achilles tendon loads while running between limbs in runners with Achilles tendinopathy, and 2) explore the relations of pain, tendon structure, and lower limb function to Achilles tendon loads while running. Twenty runners with Achilles tendinopathy participated in this pilot...

Objectives To compare beliefs of physical therapists (PTs) who read the clinical practice guideline (CPG) for the management of individuals with patellofemoral pain (PFP) to those who have not read the CPG. Design Cross-sectional study. Setting Online survey. Participants 494 currently licensed/registered PTs or physiotherapists. Main outcome m...

Objectives To confirm what impairments are present in runners with Achilles tendinopathy (AT) and explore the variance of AT severity in an adequately powered study. Design Case-control study. Setting Two private physiotherapy clinics in Australia and Spain. Participants Forty-four recreational male runners with AT and 44 healthy controls matche...

The development of a pronounced iliotibial band (ITB) is an anatomically distinct evolution of humans. The mechanical behaviour of this “new” structure is still poorly understood and hotly debated in current literature. Iliotibial band syndrome (ITBS) is one of the leading causes of lateral knee pain injuries in runners. We currently lack a compreh...

Background: Athletes, especially female athletes, experience high rates of tibial bone stress injuries (BSIs). Knowledge of tibial loads during walking and running is needed to understand injury mechanisms and design safe running progression programs. Purpose: To examine tibial loads as a function of gait speed in male and female runners. Study...

Bone stress injuries (BSIs) occur at inopportune times to invariably interrupt training. All BSIs in runners occur due to an “error” in workload wherein the interaction between the number and magnitude of bone tissue loading cycles exceeds the ability of the tissue to resist the repetitive loads. There is not a single optimal bone workload, rather...

Background: Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphysis account for >50% of BSIs in runners. They interrupt training and are managed using non-invasive approaches. The desire by all involved is for a speedy, but safe return to running. Clinical question: What is the optimal load to manage low-risk tibial and metata...

Introduction: Most running-related injuries are believed to be caused by abrupt changes in training load, compounded by biomechanical movement patterns. Wearable technology has made it possible for runners to quantify biomechanical loads (e.g., peak positive acceleration; PPA) using commercially available inertial measurement units (IMUs). However,...

Objectives: Investigate the association of fear of movement and (re)injury with clinical outcomes in women with patellofemoral pain (PFP). Methods: This cross-sectional study included 92 women with PFP who completed the TAMPA scale for kinesiophobia. The TAMPA score and its two subscales - activity avoidance and somatic focus were correlated wit...

Background: Quantifying total running distance is valuable, as it comprises some aspects of the mechanical/neuromuscular, cardiovascular, and perceptual/psychological loads that contribute to training stress and is partially predictive of distance running success. However, running distance is only one aspect contributing to training stress. Clini...

Background Altered patellofemoral joint (PFJ) loading and elevated kinesiophobia are commonly reported in people with patellofemoral pain (PFP). However, the relative relationship of these physical‐psychological variables with pain and disability in people with PFP is unknown. Aim To explore the relationship of PFJ loading during stair ascent and...

Background Treadmills are often used in research, clinical practice, and training. Biomechanical investigations comparing treadmill and overground running report inconsistent findings. Objective This study aimed at comparing biomechanical outcomes between motorized treadmill and overground running. Methods Four databases were searched until June...

Current frameworks on running-related injury (RRI) aetiology emphasise the relation between exposure to training load, internal tissue loads, and tissue capacity; with tissue load exceeding its capacity being the key biological mechanism in the development of RRI. Despite this, runners and clinicians commonly attribute improper prescription of runn...

Purpose of review: Movement retraining in rehabilitation is the process by which a motor program is changed with the overall goal of reducing pain or injury risk. Movement retraining is an important component of interventions to address patellofemoral pain. The purpose of this paper is to review the methods and results of current retraining studie...

Wearable devices are ubiquitous among runners, coaches, and clinicians with an ever-increasing number of devices coming on the market. In place of gold standard measures in the laboratory, these devices attempt to provide a surrogate means to track running biomechanics outdoors. This review provides an update on recent literature in the field of we...

Background A return to running after anterior cruciate ligament reconstruction (ACL-R) is critical to the clinical success of any cutting and pivoting athlete who wishes to return to sport. Knowledge of specific alterations during running after ACL-R is required to optimise rehabilitation for improving outcomes and long-term disability. Objective...

Patellofemoral pain (PFP) is a common musculoskeletal-related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. The onset of symptoms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatti...

Objectives: To examine the feasibility of recommended education and exercise supplemented by a hopping intervention implemented based on self-reported pain over 12 weeks for recreational runners with Achilles tendinopathy. Design: Single cohort feasibility study. Setting: One private physiotherapy clinic in Melbourne, Australia. Participants:...

High impact forces during running have been associated with tibial stress injuries. Previous research has demonstrated increasing step rate will decrease impact forces during running. However, no research has determined the cognitive demand of gait retraining. The primary purpose was to determine the cognitive demand and effectiveness of field-base...

Background Treadmills are routinely used to assess running performance and training parameters related to physiological or perceived effort. These measurements are presumed to replicate overground running but there has been no systematic review comparing performance, physiology and perceived effort between treadmill and overground running. Objecti...

Introduction Longer steps with load carriage is common in shorter Soldiers when matching pace with taller Soldiers whereas shorter steps are hypothesized to reduce risk of injury with load carriage. The effects of load carriage with and without step length manipulation on loading patterns of three commonly injured structures were determined: Achill...

The Master runner (age 35 y and above) represents a unique athletic patient. Lifelong participation in endurance running slows the inevitable age-related decline in aerobic function and muscular strength. Still, the Master runner does not escape the inevitable effects of aging. Master runners experience a steady decline in running performance, that...

Background: Needling has been shown to decrease pain in the short term; however, its effects on muscle force production are unclear. Objective: To evaluate the evidence regarding the comparative effects of needling on muscle force production. Methods: In this systematic review, an electronic search was performed using key words related to need...

Background: Wearable devices validly assess spatiotemporal running parameters (cadence, vertical oscillation and ground contact time), but the relationship between these parameters and lower limb loading parameters (loading rate, peak vertical ground reaction force [vGRF] and braking impulse) is unknown. Purpose: To characterize changes in lower...

Study Design Cross sectional, laboratory study. Background Asymmetrical knee loading has been reported in individuals post-Achilles tendon rupture during jogging and hopping. Yet, no studies have examined knee loads in individuals post-Achilles tendon rupture during high demand tasks, such as single limb landings. Objectives We sought to determine...

Background & Purpose: Dry needling (DN) involves the insertion of a monofilament needle into various soft tissue structures in the body with the goal of decreasing neuromusculoskeletal pain and improving function. DN has been shown to decrease pain in the short-term; however, its effects on muscle function are unclear. The purpose of this systemati...

Background: Our aims were to (1) Evaluate sex-specific contributions of peak knee flexion moment (pKFM) and peak knee adduction moment (pKAM) in medial tibiofemoral joint (TFJ) force during walking and running; (2) identify kinematic variables to estimate peak medial TFJ force. Methods: Eighty-seven runners participated (36 females, 51 males; ag...

Running-related injuries are common and are associated with a high rate of reoccurrence. Errors in applied training loads are often cited as a primary cause of running-related injuries. Clinicians and runners are beginning to utilize wearable technologies to quantify training loads with the hope of reducing the incidence of running-related injuries...

Background: It is unknown whether the height of a heel-rise performed in the single-leg standing heel-rise test 1 year after an Achilles tendon rupture (ATR) correlates with ankle biomechanics during walking, jogging, and jumping in the long-term. Purpose: To explore the differences in ankle biomechanics, tendon length, calf muscle recovery, and...

Background: Deficits in plantarflexor function are common after an Achilles tendon rupture. These deficits may result in an altered distribution of joint loads during lower extremity tasks. Hypothesis: We hypothesized that, regardless of treatment, the Achilles tendon-ruptured limb would exhibit deficits in ankle kinematics and joint power while...

Background: Anterior cruciate ligament reconstruction is associated with early onset knee osteoarthritis. Running is a typical activity following this surgery, but elevated knee joint contact forces are thought to contribute to osteoarthritis degenerative processes. It is therefore clinically relevant to identify interventions to reduce contact fo...

Frontal plane knee alignment can influence the development and management of various knee pathologies. Valid and reliable clinical methods for assessment are needed. The primary purposes of this study were to assess the validity and reliability of inclinometer-based frontal plane tibial orientation as a limb alignment measure, and secondarily to es...

The purpose of this study was to examine the effects of step length and foot strike pattern along with their interaction on tibiofemoral joint (TFJ) and medial compartment TFJ kinetics during running. Nineteen participants ran with a rear foot strike pattern at their preferred speed using a short (-10%), preferred, and long (+10%) step length. Thes...

Objectives It is still unknown how heel-rise height during the single leg heel-rise height one year after an Achilles tendon rupture (ATR) affects ankle biomechanics during jumping in the long-term. The aim of this study was to compare ankle biomechanics five years after an ATR injury in patients with > 30 % side differences (>30-group) in heel-ris...

Gait modifications are often proposed to reduce average loading rate (AVLR) during running. While many modifications may reduce AVLR, little work has investigated secondary gait changes. Thirty-two rearfoot runners [16M, 16F, 24.7 (3.3) years, 22.72 (3.01) kg/m(2) , >16 km/week] ran at a self-selected speed (2.9 ± 0.3 m/s) on an instrumented treadm...

Abstract ABSTRACT BODY: Purpose/Hypothesis : It is still unknown how the heel-rise height performed in the standing single leg heel- rise test 1- year after an Achilles tendon rupture (ATR) affects ankle biomechanics during jumping in the long- term. The aim of this study was to compare the ankle biomechanics 5 years after an ATR injury in patients...

Abstract ABSTRACT BODY: Purpose/Hypothesis : It is still unknown how the heel-rise height performed in the standing single leg heel- rise test 1- year after an Achilles tendon rupture (ATR) affects ankle biomechanics during jumping in the long- term. The aim of this study was to compare the ankle biomechanics 5 years after an ATR injury in patients...

Identification of the impact peak (IP) from the vertical ground reaction force (vGRF) is required to calculate indices of impact loading during running. The IP, however, is not always clearly discernible. Previous researchers have estimated the timing of the IP using surrogate methods, the most common of which is a set time point of 13% stance (TPS...

We evaluated the efficacy of an in-field gait retraining programme using mobile biofeedback to reduce cumulative and peak tibiofemoral loads during running. Thirty runners were randomised to either a retraining group or control group. Retrainers were asked to increase their step rate by 7.5% over preferred in response to real-time feedback provided...

Patellofemoral joint pain (PFP) is a common running-related injury that is more prevalent in females and thought to be associated with altered running mechanics. Changes in running mechanics have been observed following an exhaustive run but have not been analyzed relative to the sex bias for PFP. The purpose of this study was to test if females de...

PURPOSE/HYPOTHESIS: Individuals who are post–partial meniscectomy (IPM) for a traumatic meniscal tear are at high risk for knee osteoarthritis. Post procedure, IPM demonstrate quadriceps strength deficits and walk with high peak knee external adduction moments (KEAM), likely resulting in greater contact forces in the medial tibiofemoral compartment...

Elevated patellofemoral joint kinetics during running may contribute to patellofemoral joint symptoms. The purpose of this study was to test for independent effects of foot strike pattern and step length on patellofemoral joint kinetics while running. Effects were tested relative to individual steps and also taking into account the number of steps...

Study design: Case report. Background: The underlying mechanism of the changes in running mechanics after gait retraining is presently unknown. This case report assesses changes in muscle coordination and kinematics during treadmill running and step ascent in 2 female runners with patellofemoral pain after mirror gait retraining. Case descripti...

The purpose of this study was to determine if running in a minimalist shoe results in a reduction in ground reaction forces and alters kinematics over standard shoe running. The secondary purpose of this study was to determine if within-session accommodation to a novel minimalist shoe occurs. Subjects were 14 male, rearfoot striking runners who had...

Pathological mechanics are thought to play a role in many common running injuries. A review of the biomechanical literature reveals that a given running injury may be associated with multiple faulty running mechanics. Traditional rehabilitation programs have focused their efforts on addressing the injured anatomical structure. By focusing rehabilit...

Background: Abnormal hip mechanics are often implicated in female runners with patellofemoral pain. We sought to evaluate a simple gait retraining technique, using a full-length mirror, in female runners with patellofemoral pain and abnormal hip mechanics. Transfer of the new motor skill to the untrained tasks of single leg squat and step descent...

Patellofemoral pain (PFP) has often been attributed to abnormal hip and knee mechanics in females. To date, there have been few investigations of the hip and knee mechanics of males with PFP. The purpose of this study was to compare the lower extremity mechanics and alignment of male runners with PFP with healthy male runners and female runners wit...

Case report. The Achilles tendon is the most frequently ruptured tendon, and the incidence of Achilles tendon rupture has increased in the last decade. The rupture generally occurs without any preceding warning signs, and therefore preinjury data are seldom available. This case represents a unique opportunity to compare preinjury running mechanics...

Block randomized controlled trial. To investigate whether a strengthening and movement education program, targeting the hip abductors and hip external rotators, alters hip mechanics during running and during a single-leg squat. Abnormal movement patterns during running and single-leg squatting have been associated with a number of running-related i...

Single group repeated measures. To determine the effects of cessation and resumption of a hamstring muscle stretching protocol on knee range of motion (ROM). It is generally accepted that stretching exercises result in an increase in ROM. The ability to maintain ROM once stretching has ceased and the ability to regain ROM after resumption of the st...