Journal of Isfahan Medical School

Journal of Isfahan Medical School

Effects of Treadmill Incline on Mean Knee Angle and Frontal-Plane Range of Motion During Walking and Running in Individuals With Genu Varum and Healthy Controls

Document Type : Original Article(s)

Authors
1 Assistant Professor, Department of Biomechanics, Faculty of Physical Education and Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
2 MSc in Sports Biomechanics, Department of Biomechanics, Faculty of Physical Education and Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
3 Associate Professor, Department of Biomechanics, Faculty of Physical Education and Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
10.48305/jims.v44.i873.1384
Abstract
Background: Genu varum may alter frontal-plane knee kinematics by changing lower-limb alignment; however, the knee response to treadmill incline in individuals with genu varum remains unclear. Therefore, this study aimed to investigate the effects of treadmill incline on mean knee angle and range of motion (ROM) during walking and running in individuals with genu varum and healthy controls.
Methods: In this quasi-experimental repeated-measures study, 36 young men (18 with genu varum and 18 healthy controls) performed walking at 1.3 m/s and running at 3 m/s on a treadmill at 0%, 5%, and 10% inclines. Knee kinematics were recorded using a three-dimensional motion analysis system, and mean knee angle and frontal-plane ROM were calculated. Data were analyzed using mixed analysis of variance.
Findings: Compared with healthy controls, individuals with genu varum showed a greater mean knee angle toward varus (p=0.005) and greater ROM (p<0.001). ROM was greater during running than walking (p=0.002) and decreased with increasing incline (p<0.001). In the genu varum group, ROM showed a significant linear decrease with increasing incline (p=0.003). The effect of incline on mean knee angle and the interactions among group, activity, and incline were not significant (p>0.05).
Conclusion: Increasing treadmill incline up to 10% was associated with reduced frontal-plane knee ROM without increasing mean knee angular deviation toward varus. The kinematic response to incline did not differ significantly between groups. As kinetic variables and joint loading were not assessed, no conclusions can be drawn regarding the mechanical safety or suitability of inclined treadmill exercise.

Highlights

Sasan Naderi: Google Scholar, PubMed

Fariborz Mohammadipour: Google Scholar, PubMed

Keywords
Subjects

1.     Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286(2): 188-95.
2.     Andriacchi TP, Mündermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rheumatol 2006; 18(5): 514-8.
3.     Hurwitz DE, Sumner DR, Andriacchi TP, Sugar DA. Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech 1998; 31(5): 423-30.
4.     Byrnes SK, Holder J, Stief F, Wearing S, Böhm H, Dussa CU, et al. Frontal plane knee moment in clinical gait analysis: A systematic review on the effect of kinematic gait changes. Gait Posture 2022; 98: 39-48.
5.     Kim J, Lee H-J, Lee S-H, Lee J, Chang WH, Ryu G-H, et al. Correlation between cardiopulmonary metabolic energy cost and lower-limb muscle activity during inclined treadmill gait in older adults. BMC Geriatr 2021; 21(1): 469.
6.     Haight DJ, Lerner ZF, Board WJ, Browning RC. A comparison of slow, uphill and fast, level walking on lower extremity biomechanics and tibiofemoral joint loading in obese and nonobese adults. J Orthop Res 2014; 32(2): 324-30.
7.     Franz JR, Kram R. The effects of grade and speed on leg muscle activations during walking. Gait Posture 2012; 35(1): 143-7.
8.     Haggerty M, Dickin DC, Popp J, Wang H. The influence of incline walking on joint mechanics. Gait Posture 2014; 39(4): 1017-21.
9.     Zeng X, Xie Z, Zhong G, Chen Y, Wen B, Li Y, et al. The 6DOF knee kinematics of healthy subjects during sloped walking compared to level walking. Gait Posture 2022; 95: 198-203.
10.  Naderi S, Mohammadipour F, Amir Seyfaddini M. The effects of different walking inclinations on knee angle in the frontal plane of patients with varus malalignment. Physical Treatments-Specific Physical Therapy Journal 2014; 4(3): 139-44.
11.  Davis RB, Õunpuu S, Tyburski D, Gage JR. A gait analysis data collection and reduction technique. Human Movement Science 1991; 10(5): 575-87.
12.  Dewolf AH, Ivanenko Y, Zelik KE, Lacquaniti F, Willems PA. Kinematic patterns while walking on a slope at different speeds. J Appl Physiol (1985) 2018; 125(2): 642-53.
13.  Xie H, Chien JH. Walking on different inclines affects gait symmetry differently in the anterior-posterior and vertical directions: implication for future sensorimotor training. PeerJ 2024; 12: e18096.
14.  Madadi-Shad M, Jafarnezhadgero A, Zago M, Granacher U. Effects of varus knee alignment on gait biomechanics and lower limb muscle activity in boys: A cross sectional study. Gait Posture 2019; 72: 69-75.
15.  Keller TS, Weisberger AM, Ray JL, Hasan SS, Shiavi RG, Spengler DM. Relationship between vertical ground reaction force and speed during walking, slow jogging, and running. Clin Biomech (Bristol) 1996; 11(5): 253-9.
16.  Fain A, McCarthy A, Nindl BC, Fuller JT, Wills JA, Doyle TL. IMUs can estimate hip and knee range of motion during walking tasks but are not sensitive to changes in load or grade. Sensors 2024; 24(5): 1675.
17.  Kent JA, Sommerfeld JH, Stergiou N. Changes in human walking dynamics induced by uneven terrain are reduced with ongoing exposure, but a higher variability persists. Sci Rep 2019; 9(1): 17664.
18.  Naderi S, Mohammadipour F, Amir Seyfaddini MR. Kinematics of Lower Extremity During Forward and Backward Walking on Different Gradients. J Appl Physiol (1985) 2017; 7(2): 71-8.
19.  Zeni Jr J, Richards JG, Higginson J. Two simple methods for determining gait events during treadmill and overground walking using kinematic data. Gait Posture 2008; 27(4): 710-4.
20.  Gidley AD, Bailey JP. Walking kinematic coordination becomes more in-phase at extreme inclines. J Appl Biomech 2023; 39(6): 361-9.
21.  Lu C, Al-Juaid R, Al-Amri M. Gait stability characteristics in able-bodied individuals during self-paced inclined treadmill walking: within-subject repeated-measures study. JMIR Form Res 2023; 7(1): e42769.
22.  Higgins S, Dickin DC, Hankemeier D, Wells MD, Wang H. The effect of incline walking on lower extremity and trunk mechanics in older adults. Sports Med Health Sci 2025; 7(1): 56-60.
23.  Yoon J-y, Moon SW. Impacts of asymmetric hip rotation angle on gait biomechanics in patients with knee osteoarthritis. Knee Surg Relat Res 2024; 36(1): 23.
24.  Zhang L, Liu G, Yan Y, Han B, Li H, Ma J, et al. A subject-specific musculoskeletal model to predict the tibiofemoral contact forces during daily living activities. Comput Methods Biomech Biomed Engin 2023; 26(8): 972-85.
25.  Bowd J, Van Rossom S, Williams D, Elson D, Wilson C, Whatling G, et al. Using musculoskeletal modelling to estimate knee joint loading pre and post high tibial osteotomy. Clin Biomech (Bristol) 2023; 101: 105855.
26.  Wang W, Tsai T-Y, Zhang C, Lin J, Dai W, Zhang M, et al. Comparison of instantaneous knee kinematics during walking and running. Gait Posture 2022; 97: 8-12.
27.  Willwacher S, Kurz M, Robbin J, Thelen M, Hamill J, Kelly L, et al. Running-related biomechanical risk factors for overuse injuries in distance runners: a systematic review considering injury specificity and the potentials for future research. Sports Med 2022; 52(8): 1863-77.
Volume 44, Issue 873
Sports Medicine, Especial Issue
September and October 2026
Pages 1383-1393

  • Receive Date 24 August 2026
  • Accept Date 26 September 2026