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Running-Specific Prostheses: the History, Mechanics, and Controversy

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Running-Specific Prostheses: the History, Mechanics, and Controversy バイオメカニズム学会誌，Vol. 38，No.2（2014） 解 説 Running-specific prostheses: The history, mechanics, and controversy Hiroaki HOBARA1† 1Digital Human Research Center, National Institute of Advanced Industrial Science and Technology (AIST) Abstract : Recent developments in carbon fiber running-specific prostheses (RSPs) have allowed individuals with lower extremity amputation (ILEA) to regain the functional capability of running. There are many amputee sprinters who are now able to run faster and achieve longer jumps than able-bodied athletes. However, ironically, this phenomenon has raised a debate in the scientific community regarding the potential advantages or disadvantages of RSPs in athletic ILEA compared to able-bodied counterparts in running. This article describes the history, classification, and regulations of RSPs, and current world records in athletic ILEA. Finally, a debate regarding the advantages or disadvantages of RSPs is presented. Key Words : Prostheses, Amputees, Sprinting, Biomechanics, Paralympic games 1. INTRODUCTION running biomechanics in ILEA and the biomechanical function Recent technical developments in carbon fiber running-specific of prostheses during this activity. However, due to the lack of prostheses (RSPs) with energy storing capabilities have allowed studies on running in ILEA and the dearth of information on individuals with lower extremity amputation (ILEA) to compete RSPs, quantification of biomechanical parameters in ILEA during at levels achieved never before. Additionally, RSPs have attracted running using RSPs is scarce. more and more ILEA to running as a form of exercise and athletic This article describes the history, classification, and regulations competition. In Sainsbury’s Anniversary Games at the Olympic of RSPs, and current world records of athletic ILEA. After Stadium on July 28, 2013, Alan Fonteles Oliveira (Brazil) and discussing the advantages and disadvantages of RSPs, several Richard Browne (USA), who are the best amputee sprinters in the suggestions for future studies are presented. It is my hope that world, set new world-best times in the 100-m T43 and T44 classes, this paper will shed light on the role of RSPs in the area of respectively. Oliveira broke his own T43 record, achieving victory biomechanics. This paper presents some of the findings and ideas with a time of 10.57 [s], while Browne set a new T44 world record published in a previous publication1). of 10.75 [s] and finished second. Furthermore, the participation of a South African double-amputee sprinter (Oscar Pistorius) in an 2. HISTORY OF RUNNING-SPECIFIC PROSTHESES event with able-bodied sprinters (Men’s 400[m] race) at the 2012 After the invention of the Solid Ankle and Cushioned Heel London Olympics is still fresh in our minds. (SACH) foot (Ohio Willow Wood, Ohio, USA) in the late Not surprisingly, there are a lot of amputee sprinters who are 1950s, prosthetic foot designs and materials changed little for able to run faster and achieve longer jumps than able-bodied approximately 20-30 years2). According to the previous studies3), athletes. The phenomenon may exemplify how amputee sprinters the usefulness of lower-limb prostheses improved tremendously work hard with high motivation, and how current prostheses in the 1980s, when advances in composite materials flooded the have advanced. Therefore, developments of improved training/ prosthetics industry. Carbon composite materials, used extensively rehabilitation regimes and prosthetic designs to promote running in the aerospace industry, brought lightness, durability, and within this population requires a detailed understanding of strength to the design of prosthetic feet, pylons, and sockets2-4). In 1984, Van Phillips, an American inventor of prostheses, created the “Flex-Foot®” (Figure 1) made of carbon graphite. The innovative 2013 年 12 月 24 日受付 † artificial foot allowed users to store and then return elastic energy Waterfront 3F, DHRC, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, JAPAN Hiroaki HOBARA during the ground-contact phase of gait. E-mail: [email protected] The Flex-Foot was first seen in elite sports at the 1988 Phone: +81-3-3599-8201 Fax: +81-3-5530-2066 ー 105 ー バイオメカニズム学会誌，Vol. 38，No.2（2014） in 1989, his personal record in the 100[m] race was only 14.38 [s]. Later, when provided with the Flex-Foot prostheses, he won the gold medal at the Atlanta Paralympic Games in the men’s 100[m] race by setting a world record with a time of 11.36 [s]. Furthermore, he also won the gold medal in the 200[m] race with a time of 23.28 [s]. For the last 15 years, technical advances in prostheses have been a main factor in the increased performance of athletes with lower-limb amputations. The use of materials such as carbon fiber, titanium, and graphite has provided added strength and energy- Figure 1 Schematic representation of “Flex-Foot®” and prosthetic storage capabilities to prostheses while decreasing the weight of components (socket and liner) with representation of a residual prosthetic components6). Today, carbon fiber prostheses are most limb. The schema is based on transtibial (below-knee) amputees. popular in elite running and jumping events. These prostheses allow lower-limb amputees to actively participate in sporting activities including competitive sports4). 3. CLASSIFICATION AND REGULATIONS IN ATHLETICS According to the International Paralympic Committee (IPC) regulations, transtibial amputee runners were classified into two classes: T43 class (double below-knee amputees and other Figure 2 Typical examples of running-specific prostheses (A to F were athletes with impairments that are comparable to a double-below adapted from from Lechlar and Lilja, [29]). A: Flex-Foot® (Modular III; Össur), B: Flex-Sprint II (Össur), C: Flex-Sprint I knee amputation) and T44 class (any athlete with a lower limb (Össur), D: Flex-Sprint III® (Cheetah; Össur), E: Flex-RunTM impairment/s that meets minimum disability criteria for lower limb (Össur), F: Symes-Sprint (Össur), G: Cheetah Xtreme® (Össur, deficiency, impaired lower limb passive range of motion, impaired https://www.ossur.com), H: Cheetah Xtend® (Össur, https://www. lower limb muscle power, or leg length difference). Although ossur.com), I: 1E90 (Sprinter, OttoBock, http://www.ottobockus. com), J: 1C2 (C-Sprint®, http://www.ottobockus.com), K: Nitro official records in the two classes were separately recognized, (Freedom Innovation, http://www.freedom-innovations.com), T43 and 44 classes were integrated into the same race in 2012. L: CatapultTM (Freedom Innovation, http://www.freedom- However, in the 6th IPC Athletics World Championships, in Lyon, innovations.com), M: SP1100 (KATANA, IMASEN Engineering Corporation, http://www.imasengiken.co.jp/), N: Rabbit France, in 2013, the two classes competed separately in a race. (IMASEN Engineering Corporation). Note that transfemoral amputees were classified in the T42 class (single above-knee amputees and athletes with other impairments that are comparable to a single above-knee amputation) regardless Paralympic Games5). Four years later, the prosthetic heel was of unilateral or bilateral amputations. absent in some athletes5) creating the first sprint prosthesis2). In According to Rule 3.3.2 of the IPC official guidelines, a fact, the first specialized running foot, the Flex-Sprint I (Figure competitor’s artificial limb “must not create the unrealistic 2-C; Össur, Reykjavik, Iceland), was developed by eliminating the enhancement of stride length.” Furthermore, in the IPC regulations, heel portion and altering the stiffness configuration with the lay- there are also statements such as: “equipment and/or prosthetic up sequence of carbon while still maintaining the J-shaped outline components are commercially available to all athletes (i.e., of the carbon forefoot. There are now several different sprint foot prototypes that are purposely built by manufacturers exclusively designs available, all with a similar basic shape (Figure 2-A to N), for the use of a specific athlete should not be permitted).” which has changed little since 19922). Similarly, “equipment used contains materials or devices that store, The advent of carbon-fiber prostheses and RSPs shortened generate, or deliver energy and/or are designed to provide function approximately 1.5 [s] off the world record of 100[m] races in the to enhance performance beyond the natural physical capacity of T44 class (transtibial amputees) within 10 years (from 1988 to the athlete” shall not be permitted. Furthermore, athletes using a 1998). One of the best examples of this context is the Paralympic prosthesis cannot use different lengths of prosthesis for different Games in Atlanta, Georgia, in 1996. Tony Volpentest, an American disciplines at the same competition (e.g. for the 100[m] and Paralympian athlete, was born with short malformed legs and the 400[m] race). However, it is possible for athletic ILEA to arms. When he initiated running using the walking prostheses ー 106 ー バイオメカニズム学会誌，Vol. 38，No.2（2014） use different prostheses for track events and field events if the Table 1 Current world records in the 100-, 200-, and 400-meter sprints prosthetic length is the same. In addition, the IPC has strict rules in able-bodied athletes (AB) and T43 and T44 classes (as of December 24, 2013). Data were adapted from the International for length of RSPs in runners with lower extremity amputation. Association of Athletics Federations (IAAF) website and the International Paralympic Committee (IPC) website. 4. WORLD RECORDS IN ATHLETICS The recent carbon-fiber prostheses along with hard training now enable athletes with amputations to run 100 m in just under 11[s]. The current world records in the 100, 200, and 400[m] sprints in T43 and T44 classes compared with the able-bodied world records, according to the IPC, are summarized in Table 1. Interestingly, many world records in track and field competitions were established in the last three years (2011 to 2013). In both, men and women, the T43 class has faster world records than the T44 class for 100, 200 and 400[m] sprints (Table 1).
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