Running with Prosthetics:

Unfair Advantage?

vs
 Purpose
• Compare running mechanics in bilateral
transtibial amputees using modern prosthetics to
intact runners to discover any significant
advantage.
– Interpret the findings of 3 studies:
• Point: “Artificial Limbs Do Make Artificially Fast Running
Speeds Possible.”
• Counterpoint: “Artificial Limbs Do Not Make Artificially Fast
Running Speeds Possible.”
• “The Fastest Runner on Artificial Legs: Different Limbs,
Similar Function?”
– Point/counterpoint argument features same authors
 Amputation Statistics
• 1.7 million amputees in America
– 1/200 people
– 3,000 people become amputees each week
• 82% due to vascular disease
– Of remaining 18% dysvascular, 97%= lower limb
• Approximately 50% of lower limb amputations
are transtibial
• Prosthetic leg market grows 4% each year
– Ossur and Otto Bock
 Prosthetics Terminology
• Residual limb- what’s left of limb after
amputation, “stump”
• Transfemoral/AK- above knee amputation
– 35-60% femur spared
• Knee disarticulation- amputation at the knee joint
with femur still intact
• Transtibial/BK- below knee amputation
– 20-50% of tibia spared
• Socket: connects prosthesis to residual limb,
transfers forces
 Running Terminology
• Swing time- measured time (s) between the push-
off and initial foot strike of the same leg
• Stride time- measured time (s) between initial
foot strike of the same leg
• Leg length- measured (m) from the axis of
rotation of hip joint to the ground at the outside
of the heel or prosthetic blade
• Run speed - depends on stride length and rate
• Distance body moves per toe-off
– Depends on takeoff angle - amt of forward lean of
body over takeoff foot)
 Case Study: Oscar Pistorius
• “Blade Runner”
– Born without fibulas
– J-shaped carbon fiber bilateral BK prosthetics
• “Cheetahs” by Ossur
– Paralympic Record: 100-11.17s, 200- 22:67s, 400- 47.49s
– 2nd in S. African Nationals able-bodied 400m
• IAAF International Track Organization banned from
Olympic competition Jan. 2008
– Prosthetics more spring than human legs
– Appeal was approved by Court of Arbitration for Sport in
May 2008
– Did not make qualifying time of 45.95s, PR is 46.25

http://www.youtube.com/watch?v=ON4B-fNCvSg
“The Fastest Runner on Artificial Legs:
Different Limbs, Similar Function?”
– Published in June 2009 in the Journal of Applied
Physiology
– Question: Is running with lower-limb prostheses
functionally similar to running with intact, biological
limbs?
• 3 hypotheses: metabolic cost, sprint endurance, mechanics
– Main subject: Oscar Pistorius
– Comparison group: past studies of elite and sub elite
runners, collected data from competitive runners with
similar speeds to Pistorius
 1) Metabolic Cost of Running
• Hypothesis: greater than 2 standard
deviations below the mean of intact groups
• Test: interval run on treadmill
– (Rate of Oxygen Uptake/speed of trial)
• Result: 17% lower than able-bodied sprinters
– 2.7 SD lower
• Discussion: inconclusive
– Found research of bilateral amputees having
higher metabolic costs
 2) Sprinting Endurance
• Hypothesis: longer duration due to lightweight
carbon-fiber material resisting fatigue
• Test: constant-speed, all-out treadmill trials
• Result: amputee sprint within same range as
intact
 3) Running Mechanics
• Hypothesis: Greater than 2 SD below for:
– Foot-ground contact times, aerial times, swing times,
stance-avg vertical rxn forces
• Test: video analysis of 2.5 m/s to 10 m/s, force
software used
• Result: Foot-ground contact 14.1% longer, aerial times
34.3% shorter, swing times 21% shorter, vertical rxn
forces 22.8% less
– All greater than 2 SD away from mean
• Discussion:
– vertical rxn forces less due to absence of several muscles
crossing foot, ankle, and knee joints
– Faster turnover due to weight of prosthetic and residual
limb below the knee being half that of a normal limb
 Running Mechanics Graph
A) video images at 10.5 m/s
•solid line shows longer contact,
shorter stride, aerial, and swing
duration
B) Vertical ground forces vs time
•Peaks lower than able-bodied
•Peaks arise faster
C) Horizontal ground forces vs time
•More steady peak than able-
bodied
•Peaks arise faster

Black: amputee
Gray: able-body
Solid: right limb
Dotted: left limb

Weyand et. al. The Fastest Runner on Artificial Legs: Different limbs, Similar Function? J Appl Physiol 107: 903-911,
2009; doi:10.1152/japplphysiol.00174.2009
Running Mechanics
Results
A. Contact time vs. Speed
• 3.5 SD higher at 10m/s
B. Aerial time vs. Speed
• 4.4 SD lower at 10m/s
C. Swing time vs. Speed
• 3.4 SD lower at 10m/s
D. Vertical Force vs. Speed
• 5.2 SD lower at 10m/s

• Comparison of Differences
• minimal at 2.5-3m/s
• Modest 4-5m/s
• Pronounced 6-10m/s
 Conclusion
• Bilateral transtibial amputee running is
physiologically similar to intact runners but
mechanically not.
– Physiological relation may be due to heavy use of
extensor muscles crossing hip and knee in both groups
– Weight of prosthetic and residual limb below knee:
2.5 kg, approximately half weight of normal limb
– More research needed
• Study was not in race setting: fast closing times may be due
to slow acceleration b/c no ankle muscles
 “Point: Artificial Limbs Do Make
Artificially Fast Running Speeds Possible”
• Published in Journal of Applied Physiology
Nov. 19, 2009 by Peter Weyand and Matthew
Bundle
• Subjects: compare double amputee sprint
runner to four track athletes and two elite
male sprinters
 Overview
• Mechanical variables determine run speed
– Quickness of reposition of limbs, forward distance
while foot touching ground, force applied to ground
– Speed=step freq*forward distance during contact*avg
vertical force
• Primary requirement to run: apply ground forces
large enough to get the aerial time needed for
next step
• Average Vertical Force= total step time/contact
time
 Artificial Limbs and Performance
• Amputee stride frequencies
– 15.8% greater than athletes in lab
– 9.3% greater than elite sprinters overground
• Short swing times=reposition limbs faster
– 21% shorter than athletes in lab
– 17.4% shorter than top two finishers in 1987
World Track Championships 100 m - (0.344s)
• Contact length to leg length
– 9.6% higher than athletes in lab
– Due to high compliancy of artificial limb
 Artificial Limbs and Performance
• Stanced average vertical force
– Lower by 0.46Wb than track athletes
– Fall within range of 1.65-2.52 Wb
• Adjusted swing times and contact lengths
similar to able-body athletes
– Speed=step freq*forward distance during
contact*avg vertical force
– speed decreased from 10.8 to 8.3m/s
 10m/s

• Leg compression insert: midstance, maximum

limb compression
– External moment arm at knee 40% less
– External moment arm at hip 65% less
 Conclusion
• Two modifications that would increase
bilateral transtibial amputee sprint speed:
– Reduction in mass-> reduce swing time
– Increase length-> increase contact time
• Finding: Artificial limbs out perform biological
 Counterpoint: “Artificial Limbs Do Not Make
Artificially Fast Running Speeds Possible.”

• Published in June 2009 in the Journal of Applied

Physiology by Kram, Grabowski, McGowan, Brown,
and Herr
• Question: Do modern running prostheses provide a
significant advantage over biological legs
• Overview: only one amputee tested, Oscar Pistorius-
no advantage or disadvantage, give experiments
needed for future
 Artificial Limbs vs Able-bodied
• Amputee Running Economy Higher: False
– Worse for amputees, but did not meet p<0.05 significance
– Only two reported bilateral transtibial: Pistorius and another
runner
• Pistorius 1.15 SD below mean, other runner 1.92 SD above mean
• Short leg swing due to prosthetic weight: False
– Highly neurologically trained
– Compensates for force limitations from prosthetics
• Amputees have lower ground reaction forces: False
– No published GRF data for unilateral at top speed
– Only one bilateral subject published: Pistorius
– Pistorius was found to exert lower vertical force
• Due to prosthetic or weak legs
• Prosthetics must have some give and Pistorius is highly trained
 Suggestion: Compare Unilateral
Amputees
• Vertical force of affected to unaffected?
– If greater vertical force with unaffected, than
prosthetics are disadvantageous b/c force limitation
• Unilateral amputees have same leg speed times
between legs?
– If true: Leg speed advantage NOT due to lightweight
prosthetics
• Adding mass will not increase leg swing or
decrease time?
– If true: weight of prosthetic is not a factor
 Who is correct?

Only time can tell…

 Resources
• “Amputation Statistics by Cause: Limb Loss in the United States.” National Limb
Loss Information Center. Revised 2008. http://www.amputee-
coalition.org/fact_sheets/amp_stats_cause.pdf.
• Epstein, D. “New Study, For Better or Worse, Puts Pistorius’ Trial in Limelight.”
Inside Olympic Sports: Sports Illustrated.
http://sportsillustrated.cnn.com/2009/writers/david_epstein/11/19/oscar.pistoriu
s/1.html
• Hamilton, N. et al. “Kinesiology: Scientific Basis of Human Motion.” 11 ed. 2008.
McGrawHill Companies. New York, NY.
• O’Sullivan, S. and Sielgman, R. “National Physical Therapy Exam Review and Study
Guide.” 2009. International Education Resources. Concord, MA.
• Weyand, P. et al. “The Fastest Runner on Artificial Legs: Different Limbs, Similar
Function?” J Applied Physiology. 2009 Sep;107(3):903-11. Epub 2009 Jun 18.
• Weyand, P. and Bundle, Kram, R. et al. “Point: Counterpoint ‘Artificial limbs do / do
not make artificial running speeds possible.’” J Applied Physiology. 2009 Nov 19.