Differences and mechanisms
and neutral shoes would increase peak KFM
compared to barefoot, but that the increase in
peak KFM would be less with the neutral shoes. University of Melbourne Human Ethics Advisory
Group (HEAG) and Human Ethics Sub Committee
(HESC; application ID#: 1442604).
Methods Information regarding menarche informed the
appropriate time for biomechanical testing [13]
as fluctuating estradiol levels in girls during
and post-puberty may influence lower limb
biomechanics [25, 26] . Participants who indicated
that they had experienced menarche, but were
not using a monophasic OCP, were tested within
the first 7 days of their menstrual cycle (i.e.,
early follicular phase). In contrast, girls who
had not experienced menarche or were using
a monophasic OCP were tested anytime. To
confirm that eumenorrheic participants were
tested at the time of low estradiol levels (i.e.,
< 18 pmol/L according to the reference ranges
for the follicular phase), a 5 mL saliva sample
was provided immediately before biomechanical
testing. Samples were sent to the manufacturer
(Nutripath Integrative Pathology, Melbourne,
Australia) for analysis via enzyme immunoassay.
Participants: This was a nested cohort study
based on a previous related study in which
higher peak KFM was found during running in
both early/mid- and late/post-pubertal groups
compared to pre-pubertal girls; however, no
differences between early/mid- and late/post-
pubertal groups were observed [13] . Moreover,
no between group differences were reported
for the peak knee abduction moment or knee
internal rotation moment. Thus, the present
study included the 60 early/mid- and late/post-
pubertal girls, which is relevant in context of
PFP given that this population is generally at
higher risk of the condition compared to pre-
pubertal girls [3, 4] .
A detailed description of study participants
and pubertal classification can be found in our
previous study [13] . Briefly, girls were recruited
from local sporting clubs surrounding the
University of Melbourne Parkville campus. All
participants included were healthy, physically
active girls with a healthy weight (i.e., body
mass index < 30 kg/m2). Girls were excluded
if they: (i) had a history of lower limb injury,
knee pain or medical condition that currently
affected walking, running or jumping, (ii)
previous anterior cruciate ligament, meniscal
or PFJ injury, (iii) use of a bi- or tri-phasic oral
contraceptive pill (OCP), (iv) any medically
prescribed or over the counter orthotic worn in
the past 6 months and (v) unable to speak write
or read English. Written informed consent was
obtained from the participant or her parent/
guardian with prior ethics approval from the
Descriptive measures of height and weight were
recorded barefoot. Limb dominance was then
determined using the footedness subscale of the
Lateral Preference Inventory (LPI) [27] . Following
this, forty 13 mm retroreflective markers were
adhered to each participant’s trunk, thigh,
shank and foot according to a model previously
described by Schache and Baker (Fig. 1) [28] .
Running task
The running task was described to participants
using a standardized set of instructions that
emphasized the importance of completing
each trial using their natural running style
[13]
. No instructions/corrections were given
about running technique. All participants were
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