PhD DEGREE IN PHYSIOLOGY PhD DISSERTATION INFLUENCE OF AN INSOLE INTERVENTION ON BIOMECHANICAL PARAMETERS DURING RUNNING WITH AND WITHOUT FATIGUE A PhD Dissertation presented by: Mr. ÁNGEL GABRIEL LUCAS CUEVAS Codirected by: Mr. SALVADOR LLANA BELLOCH, Ph. D. Mr. PEDRO PÉREZ SORIANO, Ph. D. Valencia, 2016 PhD DEGREE IN PHYSIOLOGY INFLUENCE OF AN INSOLE INTERVENTION ON BIOMECHANICAL PARAMETERS DURING RUNNING WITH AND WITHOUT FATIGUE A PhD Dissertation presented by: Mr. ÁNGEL GABRIEL LUCAS CUEVAS Codirected by: Mr. SALVADOR LLANA BELLOCH, Ph. D. Mr. PEDRO PÉREZ SORIANO, Ph. D. Tutored by: Ms. Mª CARMEN GÓMEZ CABRERA, Ph. D. Submitted to the University of Valencia in Partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY IN PHYSIOLOGY Departament of Physiology University of Valencia Valencia, 2016 Dr. Salvador Llana Belloch, phD in the University of Valencia and professor in the Deparment of Physical Activity and Sports of the University of Valencia; Dr. Pedro Pérez Soriano, phD in the University of Valencia and professor in the Deparment of Physical Activity and Sports of the University of Valencia; and Dr. Mª Carmen Gómez Cabrera, phD in the University of Valencia and professor in the Department of Physiology of the University of Valencia Hereby state that the dissertation: “Influence of an insole intervention on biomechanical parameters during running with and without fatigue” authored by Mr. Ángel Gabriel Lucas Cuevas approves as to style and content and fulfills the requirements for the Degree of Doctor of Philosophy in the University of Valencia. Valencia, Dr. Salvador Llana Belloch Dr. Pedro Pérez Soriano Dr. Mª Carmen Gómez Cabrera ACKNOWLEDGEMENTS To everyone who has helped me in some way all these years throughout the development of this Dissertation. ANGEL GABRIEL LUCAS CUEVAS. PHD DISSERTATION i ACKNOWLEDGEMENTS Acknowledgements To Dr. Salvador Llana Belloch, for his constant advise throughout the whole dissertation. He has been an important support and his experience and knowledge have been very important for the development of this work. I am very grateful to have him near me. To Dr. Pedro Pérez Soriano, for his support during this whole work. He has devoted plenty of his time in making me progress and grow within this scientific adventure not only as a student, but also as a person. I really appreciate his constant support. To Dr. Mª Carmen Gómez Cabrera, for her rigour and advice provided throughout the dissertation. Her suggestions have been extremely useful in the creation of this document. I thank her for being there. To the podiatrists Dr. Cecili Macian and Dr. Maria Benimeli, who worked very hard to make this study happen. For all those hours analysing the participants and personalising the insoles. For their advice and suggestions in their field of study. To Dr. Marco Romagnoli and his research team, for their assistance not only during the fatigue protocol but also during the whole study. To José Priego, José Vicente, Inma, and, in general to all the members of GIBD “Grupo de Investigación en Biomecánica aplicada al Deporte” of the Department of Physical Education and Sports of the University of Valencia, because without their support and help, this study would not have been possible. ANGEL GABRIEL LUCAS CUEVAS. PHD DISSERTATION iii ACKNOWLEDGEMENTS To Andrés, Raúl and Daniel, for their assistance throughout the methodology and every time I needed them. They have helped me understand a little bit better their field of expertise and improve the quality of this work with their aid. To the “Facultad de Ciencias de la Actividad Física y del Deporte” and the “Facultad of Medicina y Odontología” of the University of Valencia for the educational, material and human support received throughout my educational years. To all the athletes who voluntarily participated in this study. For their energy, involvement and interest in taking part in the project. Without their effort and enthusiasm this study would not have been possible. To my friends, for all the energy and optimism provided during the whole study and my life, in general. To Michela, for her patience, unconditional support, and constant understanding. For being there. She has helped me overcome the challenges appearing throughout the whole process. With special affection, to my family: grandparents, aunts and uncles, cousins and, specially to my parents and brother, Mª Ángeles, Gabriel and Álvaro. They have raised me in the best family and social environment possible, teaching me the most important values in life. I am who I am because of them. ANGEL GABRIEL LUCAS CUEVAS. PHD DISSERTATION iv PUBLICATIONS Grants and Funding This thesis has been supported by the Spanish Ministry of Education and Culture under the Grant FPU12/00574. This thesis has also been supported by the Spanish Government: Ministerio de Economía y Competitividad, Subdirección General de Proyectos de Investigación, Convocatoria Proyectos I+D “Excelencia”, Subprograma de Generación de Conocimiento (2013), Ref.proyecto: DEP2013-48420-P. Publications ARTICLES Lucas-Cuevas, A.G., Pérez-Soriano, P., Llana-Belloch, S., Macián-Romero, C., & Sánchez-Zuriaga, D. (2014). Effect of custom-made and prefabricated insoles on plantar loading parameters during running with and without fatigue. Journal of Sports Sciences, 32:1712-1721. Lucas-Cuevas; A.G., Pérez-Soriano, P., Priego-Quesada, J.I., & Llana-Belloch, S. (2014). Influence of foot orthosis customisation on perceived comfort during running. Ergonomics, 57: 1590-1596. CONGRESSES Lucas-Cuevas, A.G., Camacho, A., Llinares, R, Priego-Quesada, J., García-Pérez, J.A., & Pérez-Soriano, P. Do foot orthoses and fatigue modify impact acceleration during running? 25th Congress of the International Society of Biomechanics, Glasgow, 2015. Lucas-Cuevas, A.G. Proyecto Soportes Plantares durante la carrera. II Congreso GIBD. Biomecánica Aplicada al Deporte, Universidad de Valencia, Valencia, 2014. Pérez-Soriano, P., Lucas-Cuevas, A.G., Priego-Quesada, J., & Macián, C. Presión Plantar influenciada por diferentes tipos de ortesis durante la carrera. 45 ÁNGEL GABRIEL LUCAS CUEVAS. PHD DISSERTATION v PUBLICATIONS National Congress of Podiatry. II International Meeting of Clinical Podiatry, Sevilla, 2014. Lucas-Cuevas, A.G., Priego, J.I., Aparicio, I., Giménez, J.V., Llana-Belloch, S., & Pérez-Soriano, P. Perceived comfort assessment of custom-made and prefabricated orthoses during running. IV NSCA International Conference, Murcia, 2014. Lucas-Cuevas, A.G., Pérez-Soriano, P., Llana-Belloch, S., Macián-Romero, C., & García-Pérez, J.A. Effect of custom-made and prefabricated insoles on plantar pressure and kinematic parameters during running. 18th Annual Congress of the European College of Sport Science, Barcelona, 2013. Lucas-Cuevas, A.G. Modificaciones del mapa de presiones plantares en el corredor tras un esfuerzo extenuante. I Jornadas Podológicas de la Universidad de Valencia, Valencia, 2012. Lucas-Cuevas, A.G., Pérez-Soriano, P., Llana-Belloch, S., Aparicio-Aparicio, I., & Giménez-Gil, J.V. ¿Puede el uso de soportes plantares suponer un mecanismo protector en carreras de larga distancia? VII Congreso Internacional de la Asociación Española de Ciencias del Deporte, Granada, 2012. ÁNGEL GABRIEL LUCAS CUEVAS. PHD DISSERTATION vi ABSTRACT ABSTRACT ÁNGEL GABRIEL LUCAS CUEVAS. PHD DISSERTATION vii ABSTRACT ABSTRACT (SPANISH) El uso de soportes plantares está aumentando dentro de la población de corredores por sus demostrados beneficios sobre la redistribución de presiones plantares, la reducción del dolor, y la mejora de la función mecánica de las extremidades inferiores. Sin embargo, en contraposición a los soportes personalizados diseñados por un podólogo, la aparición de soportes prefabricados comercializados sin indicación médica ha provocado una gran controversia. El objetivo de este estudio fue analizar el efecto de soportes plantares (prefabricados, personalizados, control) y el estado de fatiga sobre parámetros espacio- temporales, presiones plantares, impactos de aceleración, y percepción de confort y esfuerzo durante la carrera. Para ello, en tres ocasiones diferentes (para cada uno de los soportes plantares de estudio), 40 participantes (20 hombres y 20 mujeres) fueron analizados antes y después de una carrera fatigante con un sistema de plantillas instrumentadas (Biofoot®) y acelerómetros colocados en tibia y cabeza (Sportmetrics). Además, también se midió la percepción de confort de cada soporte plantar, así como la fatiga percibida durante la carrera. Los soportes personalizados redujeron la presión plantar en el primer dedo (45%), arco interno (36%) y externo (40%) respecto a los soportes control; y en el talón interno (31%) y externo (53%) respecto a los soportes prefabricados. Además, los soportes prefabricados redujeron la presión en los dedos menores (35%), el arco interno (31%) y externo (31%) en comparación a los soportes control. De igual manera, se observó que los soportes personalizados redujeron la ratio de aceleración en cabeza respecto a los soportes prefabricados (11%) y de control (2%), mientras que los soportes prefabricados condujeron a una mayor ratio de aceleración en tibia (20%). Además, tanto los soportes personalizados como los prefabricados fueron percibidos como más confortables que la condición control. En conclusión, el uso de soportes plantares personalizados reduce significativamente la carga plantar en zonas de gran importancia para corredores respecto a no llevar soporte y respecto a soportes