With the high prevalence of pediatric obesity worldwide, there is a critical need for structured physical activity interventions during childhood. However, obese children exhibit altered walking mechanics that are associated with decreased gait stability, reduced walking performance and an increased prevalence of musculoskeletal pain and pathology. Left unaddressed, the increased pain and orthopedic conditions associated with pediatric obesity may lead to reduced physical activity and a cycle of perpetual weight gain for the child and future adult. To enhance the efficacy of health and weight loss interventions, clinicians could benefit from an improved understanding of how pediatric obesity affects the neuromuscular and musculoskeletal systems during walking, the most common form of daily activity.

The mechanisms for the altered gait and associated risks to the developing musculoskeletal system in obese children are not well understood, particularly as they relate to excess adiposity and exercise related fatigue. This void in the literature may be attributed in part to the lack of experimental and computational tools necessary to accurately quantify muscle function and joint loads during walking in obese and healthy-weight adults and children. Therefore, to improve our understanding of the musculoskeletal mechanisms for the altered gait mechanics and orthopedic disorders exhibited by obese children, this dissertation sought to first, establish the proper methods to adequately quantify the necessary biomechanical measures in iiibese and healthy-weight individuals, and second, determine the effects of obesity and duration on muscle function and tibiofemoral loading during walking in children.

The accuracy of muscle and joint contact forces estimated from dynamic musculoskeletal simulations is dependent upon the experimental kinematic data used as inputs. Subcutaneous adipose tissue makes the measurement of representative kinematics from motion analysis particularly challenging in overweight and obese individuals. We developed an obesity-specific kinematic marker set and methodology that accounted for subcutaneous adiposity. Next, we determined how this methodology affected muscle and joint contact forces predicted from musculoskeletal simulations of walking in obese individuals. The marker set methodology had a significant effect on model quantified lower-extremity kinematics, muscle forces, and hip and knee joint contact forces. We demonstrated the need for biomechanists to account for subcutaneous adiposity during kinematic data collection and proposed a feasible solution that likely improves the accuracy of musculoskeletal simulations in overweight and obese people.

Understanding orthopedic disorders of biological and prosthetic knee joints requires knowledge of the in-vivo loading environment during activities of daily living. Anthropometric and orthopedic differences between individuals make accurate predictions from generic musculoskeletal models a challenge. We developed a knee mechanism within a full-body OpenSim musculoskeletal model that incorporated subject-specific knee parameters to predict medial and lateral tibiofemoral contact forces. To assess the accuracy of our model, we compared measured to predicted medial and lateral compartment contact forces during walking in an individual with an instrumented knee replacement. We determined the importance of specifying subject-specific tibiofemoral alignment and contact locations and validated a simple approach to measure and specify these parameters on a subject-specific basis using radiography.

The biomechanical mechanisms responsible for the altered gait mechanics in obese children are not well understood. We investigated the relationship between adiposity and lower extremity kinematics, muscle force requirements, and individual muscle contributions to whole body dynamics by generating musculoskeletal simulations of walking in a group of children with a range of adiposity. Body fat percentage was correlated with average knee flexion angle during stance and pelvic obliquity range of motion, as well as with relative vasti, gluteus medius and soleus force production. The functional demands and relative force requirements of the hip abductors during walking in pediatric obesity likely contribute to the altered gait mechanics in obese children.

The combination of larger magnitude and altered application of tibiofemoral loads during physical activity in obese children is commonly theorized to contribute to their increased risk of orthopedic disorders of the knee, such as growth-plate suppression leading to conditions of malalignment. To evaluate this theory and determine how prolonged activity affects knee loading, we quantified the effects of pediatric obesity and walking duration on medial and lateral tibiofemoral contact forces. We found that obese children have elevated medial compartment magnitudes, loading rates, and load share, which further increased with walking duration. The altered tibiofemoral loading environment during walking in obese children likely contributes to their increased risk of knee pain and pathology. These risks may increase with activity duration.

This dissertation provides a foundation for improved understanding of the effects of pediatric obesity on the neuromuscular and musculoskeletal systems during walking. The main research outcomes from this dissertation aim to improve rehabilitation and activity guidelines that minimize the risk of musculoskeletal pain and pathology in obese children, address degenerative gait mechanics, and assist in breaking the cycle of weight gain.