{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:53:22Z","timestamp":1790790802784,"version":"4.1.0"},"reference-count":76,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Musculoskeletal injuries pose a health threat to U.S. Service members. In particular, the physical demands of walking and running with load carriage contribute to a high incidence of musculoskeletal injuries of the lower back. Active ankle exoskeleton devices are promising technologies that may help mitigate the impact of load carriage on the incidence of these injuries. However, the safe extended use of these devices requires an understanding of their beneficial or detrimental effects on the lumbar spine. In this pilot study, we investigated the impact of walking with an ankle exoskeleton device on lumbar biomechanical responses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected motion-capture data and computed tomography images for five young, healthy men walking with a 22.7\u00a0kg (50-lb) load for 5\u00a0km at a speed of 1.3\u00a0m\/s, with and without an active ankle exoskeleton (ExoBoot EB60). We developed individualized musculoskeletal and finite-element models to characterize the effects of walking distance and ExoBoot use on the trunk flexion angle, joint reaction force at the L4-L5 joint, and stress on the L4-L5 intervertebral disc annulus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>While not statistically significant, we found that the peak trunk flexion angle and the peak annulus stress increased by 16% and 12%, respectively, after walking 5\u00a0km with the ExoBoot, and by 34% and 25%, respectively, without it. Similarly, the peak L4-L5 joint reaction force minimally increased by 4% with the ExoBoot, while it increased by 22% without the device.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ExoBoot use likely attenuates the effect of fatigue on the lumbar spine induced by walking with load carriage.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fbioe.2025.1654585","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T05:30:34Z","timestamp":1758778234000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Effect of walking with an active ankle exoskeleton on the biomechanical responses of the lumbar spine"],"prefix":"10.3389","volume":"13","author":[{"given":"Jose E.","family":"Rubio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfei","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aravind","family":"Sundaramurthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anup","family":"Pant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sridevi","family":"Nagaraja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith K.","family":"Owen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Samaan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Noehren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaques","family":"Reifman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/0268-0033(94)90052-3","article-title":"The clinical biomechanics award paper 1993 posture and the compressive strength of the lumbar spine","volume":"9","author":"Adams","year":"1994","journal-title":"Clin. Biomech."},{"key":"B2","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1302\/0301-620x.78b6.0780965","article-title":"\u201cStress\u201d distributions inside intervertebral discs. The effects of age and degeneration","volume":"78","author":"Adams","year":"1996","journal-title":"J. Bone Jt. Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e0190135","DOI":"10.1371\/journal.pone.0190135","article-title":"Posture alteration as a measure to accommodate uneven ground in able-bodied gait","volume":"12","author":"Aminiaghdam","year":"2017","journal-title":"PLoS One"},{"key":"B4","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/B978-0-12-819531-4.00004-3","article-title":"Introduction to musculoskeletal modelling","volume-title":"Computational modelling of biomechanics and biotribology in the musculoskeletal system","author":"Andersen","year":"2021"},{"key":"B5","doi-asserted-by":"publisher","first-page":"jeb243104","DOI":"10.1242\/jeb.243104","article-title":"Energy expenditure does not solely explain step length-width choices during walking","volume":"225","author":"Antos","year":"2022","journal-title":"J. Exp. Biol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"646042","DOI":"10.3389\/fphys.2021.646042","article-title":"Biomechanical response of the lower extremity to running-induced acute fatigue: a systematic review","volume":"12","author":"Apte","year":"2021","journal-title":"Front. Physiology"},{"key":"B7","first-page":"6","article-title":"Degenerative disc disease, active component, U.S. armed forces, 2001-2011","volume":"19","year":"2012","journal-title":"Med. Surveill. Mon. Rep."},{"key":"B8","first-page":"2","article-title":"Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. armed forces, 2021","volume":"29","year":"2022","journal-title":"Med. Surveill. Mon. Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1080\/00140130600757237","article-title":"Influence of carrying heavy loads on soldiers' posture, movements and gait","volume":"49","author":"Attwells","year":"2006","journal-title":"Ergonomics"},{"key":"B10","doi-asserted-by":"publisher","first-page":"4572","DOI":"10.1007\/s00586-024-08449-6","article-title":"Association between MRI measurements of lumbar spine alterations and self-reported outcomes of pain and disability in subjects with non-specific low back pain","volume":"33","author":"Bassani","year":"2024","journal-title":"Eur. Spine J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.1093\/milmed\/usad086","article-title":"Effect of fatigue on movement patterns during a loaded ruck march","volume":"189","author":"Bloch","year":"2024","journal-title":"Mil. Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1093\/milmed\/usaa435","article-title":"Spatiotemporal and kinematic comparisons between anthropometrically paired male and female soldiers while walking with heavy loads","volume":"186","author":"Bode","year":"2021","journal-title":"Mil. Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e83","DOI":"10.1093\/milmed\/usy218","article-title":"The physiology and biomechanics of load carriage performance","volume":"184","author":"Boffey","year":"2019","journal-title":"Mil. Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.gaitpost.2014.04.001","article-title":"Body borne loads impact walk-to-run and running biomechanics","volume":"40","author":"Brown","year":"2014","journal-title":"Gait Posture"},{"key":"B15","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1016\/j.jmpt.2005.08.005","article-title":"The biomechanical and clinical significance of the lumbar erector spinae flexion-relaxation phenomenon: a review of literature","volume":"28","author":"Colloca","year":"2005","journal-title":"J. Manip. Physiological Ther."},{"key":"B16","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/j.jbiomech.2007.10.012","article-title":"An accurate finite element model of the cervical spine under quasi-static loading","volume":"41","author":"del Palomar","year":"2008","journal-title":"J. Biomechanics"},{"key":"B17","unstructured":"2023 demographics: profile of the military community\n          \n          \n          2023"},{"key":"B18","volume-title":"Army techniques publication 3-21.18. Foot marches, 2022","year":"2022"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1016\/0021-9290(94)90224-0","article-title":"Passive tissues help the back muscles to generate extensor moments during lifting","volume":"27","author":"Dolan","year":"1994","journal-title":"J. Biomechanics"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e1026","DOI":"10.1002\/jsp2.1026","article-title":"Mechanotransduction and cell biomechanics of the intervertebral disc","volume":"1","author":"Fearing","year":"2018","journal-title":"JOR Spine"},{"key":"B21","doi-asserted-by":"publisher","first-page":"S26","DOI":"10.1016\/S0268-0033(97)00071-5","article-title":"Effects of varying backpack loads on peak forces in the lumbosacral spine during walking","volume":"13","author":"Goh","year":"1998","journal-title":"Clin. Biomech."},{"key":"B22","volume-title":"2012 Anthropometric survey of US army personnel: methods and summary statistics","author":"Gordon","year":"2014"},{"key":"B23","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1152\/jn.2000.83.1.288","article-title":"Interactions between posture and locomotion: motor patterns in humans walking with bent posture versus erect posture","volume":"83","author":"Grasso","year":"2000","journal-title":"J. Neurophysiology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1080\/00140139.2010.512982","article-title":"Effects of a lower-body exoskeleton device on metabolic cost and gait biomechanics during load carriage","volume":"53","author":"Gregorczyk","year":"2010","journal-title":"Ergonomics"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e814","DOI":"10.1093\/milmed\/usab217","article-title":"Prevalence and risk factors for musculoskeletal back injury among U.S. Army personnel","volume":"187","author":"Gun","year":"2021","journal-title":"Mil. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/s1050-6411(00)00027-4","article-title":"Development of recommendations for SEMG sensors and sensor placement procedures","volume":"10","author":"Hermens","year":"2000","journal-title":"J. Electromyogr. Kinesiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1109\/ojemb.2023.3288469","article-title":"Neuromechanical adaptation to walking with electromechanical ankle exoskeletons under proportional myoelectric control","volume":"4","author":"Hybart","year":"2023","journal-title":"IEEE Open J. Eng. Med. Biol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e15775","DOI":"10.7717\/peerj.15775","article-title":"Metabolic cost of walking with electromechanical ankle exoskeletons under proportional myoelectric control on a treadmill and outdoors","volume":"11","author":"Hybart","year":"2023","journal-title":"PeerJ"},{"key":"B29","doi-asserted-by":"publisher","first-page":"eabj3487","DOI":"10.1126\/scirobotics.abj3487","article-title":"The role of user preference in the customized control of robotic exoskeletons","volume":"7","author":"Ingraham","year":"2022","journal-title":"Sci. Robotics"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.4085\/1062-6050-0380.19","article-title":"Timing of stress fractures in soldiers during the first 6 career months: a retrospective cohort study","volume":"56","author":"Kardouni","year":"2021","journal-title":"J. Athl. Train."},{"key":"B31","doi-asserted-by":"publisher","first-page":"45","DOI":"10.7205\/milmed.169.1.45","article-title":"Soldier load carriage: historical, physiological, biomechanical, and medical aspects","volume":"169","author":"Knapik","year":"2004","journal-title":"Mil. Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.jsams.2013.05.013","article-title":"Kinematic changes during running-induced fatigue and relations with core endurance in novice runners","volume":"17","author":"Koblbauer","year":"2014","journal-title":"J. Sci. Med. Sport"},{"key":"B33","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/s0030-5898(20)31644-8","article-title":"The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia","volume":"22","author":"Kuslich","year":"1991","journal-title":"Orthop. Clin. N. Am."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e55256","DOI":"10.1371\/journal.pone.0055256","article-title":"Trunk's natural inclination influences stance limb kinetics, but not body kinematics, during gait initiation in able men","volume":"8","author":"Leteneur","year":"2013","journal-title":"PLoS One"},{"key":"B35","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.humov.2019.04.006","article-title":"Changes of lumbosacral joint compression force profile when walking caused by backpack loads","volume":"66","author":"Li","year":"2019","journal-title":"Hum. Mov. Sci."},{"key":"B36","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1123\/jab.2016-0185","article-title":"Physiological and biomechanical responses to prolonged heavy load carriage during level treadmill walking in females","volume":"33","author":"Lidstone","year":"2017","journal-title":"J. Appl. Biomechanics"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e56137","DOI":"10.1371\/journal.pone.0056137","article-title":"A simple exoskeleton that assists plantarflexion can reduce the metabolic cost of human walking","volume":"8","author":"Malcolm","year":"2013","journal-title":"PLoS One"},{"key":"B38","doi-asserted-by":"publisher","first-page":"675","DOI":"10.2106\/00004623-197456040-00003","article-title":"The structural components of the intervertebral disc. A study of their contributions to the ability of the disc to withstand compressive forces","volume":"56","author":"Markolf","year":"1974","journal-title":"J. Bone Jt. Surg."},{"key":"B39","doi-asserted-by":"publisher","first-page":"2190","DOI":"10.1097\/00007632-199410000-00013","article-title":"Transfer of loads between lumbar tissues during the flexion-relaxation phenomenon","volume":"19","author":"McGill","year":"1994","journal-title":"Spine"},{"key":"B40","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s12984-022-01002-w","article-title":"Can humans perceive the metabolic benefit provided by augmentative exoskeletons?","volume":"19","author":"Medrano","year":"2022","journal-title":"J. NeuroEngineering Rehabilitation"},{"key":"B41","doi-asserted-by":"publisher","first-page":"208","DOI":"10.3390\/ijms24010208","article-title":"Discogenic low back pain: anatomy, pathophysiology and treatments of intervertebral disc degeneration","volume":"24","author":"Mohd Isa","year":"2022","journal-title":"Int. J. Mol. Sci."},{"key":"B42","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1016\/S0021-9290(02)00433-5","article-title":"Normalization of joint moments during gait: a comparison of two techniques","volume":"36","author":"Moisio","year":"2003","journal-title":"J. Biomechanics"},{"key":"B43","doi-asserted-by":"publisher","first-page":"69","DOI":"10.3389\/fbioe.2015.00069","article-title":"On the use of biaxial properties in modeling annulus as a Holzapfel\u2013Gasser\u2013Ogden material","volume":"3","author":"Momeni Shahraki","year":"2015","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12984-016-0111-3","article-title":"Biomechanical walking mechanisms underlying the metabolic reduction caused by an autonomous exoskeleton","volume":"13","author":"Mooney","year":"2016","journal-title":"J. NeuroEngineering Rehabilitation"},{"key":"B45","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1186\/1743-0003-11-151","article-title":"Autonomous exoskeleton reduces metabolic cost of human walking","volume":"11","author":"Mooney","year":"","journal-title":"J. NeuroEngineering Rehabilitation"},{"key":"B46","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/1743-0003-11-80","article-title":"Autonomous exoskeleton reduces metabolic cost of human walking during load carriage","volume":"11","author":"Mooney","year":"","journal-title":"J. NeuroEngineering Rehabilitation"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1687814018779494","DOI":"10.1177\/1687814018779494","article-title":"A non-linear multiaxial fatigue damage model for the cervical intervertebral disc annulus","volume":"10","author":"Motiwale","year":"2018","journal-title":"Adv. Mech. Eng."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1533001","DOI":"10.3389\/fbioe.2025.1533001","article-title":"Effects of an active ankle exoskeleton on the walking biomechanics of healthy men","volume":"13","author":"Nagaraja","year":"2025","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B49","doi-asserted-by":"publisher","first-page":"111007","DOI":"10.1115\/1.3212104","article-title":"Theoretical and uniaxial experimental evaluation of human annulus fibrosus degeneration","volume":"131","author":"O'Connell","year":"2009","journal-title":"J. Biomechanical Eng."},{"key":"B50","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s10237-011-0328-9","article-title":"Human annulus fibrosus material properties from biaxial testing and constitutive modeling are altered with degeneration","volume":"11","author":"O'Connell","year":"2012","journal-title":"Biomechanics Model. Mechanobiol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1080\/17457300.2013.833944","article-title":"Soldier occupational load carriage: a narrative review of associated injuries","volume":"21","author":"Orr","year":"2014","journal-title":"Int. J. Inj. Control Saf. Promot."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/milmed\/usae357","article-title":"Burden of musculoskeletal injuries in U.S. Active duty service members: a 12-year study spanning fiscal years 2010\u20132021","volume":"189","author":"Pav","year":"2024","journal-title":"Mil. Med."},{"key":"B53","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1109\/tnsre.2022.3162213","article-title":"Actuation timing perception of a powered ankle exoskeleton and its associated ankle angle changes during walking","volume":"30","author":"Peng","year":"2022","journal-title":"IEEE Trans. Neural Syst. Rehabilitation Eng."},{"key":"B54","volume-title":"R: a Language and environment for statistical computing","year":"2023"},{"key":"B55","doi-asserted-by":"publisher","first-page":"245","DOI":"10.31616\/asj.2019.0046","article-title":"Significance of the association between disc degeneration changes on imaging and low back pain: a review article","volume":"14","author":"Rahyussalim","year":"2020","journal-title":"Asian Spine J."},{"key":"B56","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/0021-9290(93)90042-D","article-title":"Young's modulus of trabecular and cortical bone material: ultrasonic and microtensile measurements","volume":"26","author":"Rho","year":"1993","journal-title":"J. Biomechanics"},{"key":"B57","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1080\/00140139.2016.1252858","article-title":"The effect of training on lumbar spine posture and intervertebral disc degeneration in active-duty marines","volume":"60","author":"Rodriguez-Soto","year":"2017","journal-title":"Ergonomics"},{"key":"B58","doi-asserted-by":"publisher","first-page":"1250937","DOI":"10.3389\/fbioe.2023.1250937","article-title":"Differences in running biomechanics between young, healthy men and women carrying external loads","volume":"11","author":"Rubio","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B59","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jmbbm.2014.12.018","article-title":"The poro-viscoelastic properties of trabecular bone: a micro computed tomography-based finite element study","volume":"44","author":"Sandino","year":"2015","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"B60","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s12984-020-00663-9","article-title":"The exoskeleton expansion: improving walking and running economy","volume":"17","author":"Sawicki","year":"2020","journal-title":"J. NeuroEngineering Rehabilitation"},{"key":"B61","doi-asserted-by":"publisher","first-page":"2724","DOI":"10.1097\/01.brs.0000146049.52152.da","article-title":"Mechanical conditions that accelerate intervertebral disc degeneration: overload versus immobilization","volume":"29","author":"Stokes","year":"2004","journal-title":"Spine"},{"key":"B62","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1080\/10255842.2020.1764545","article-title":"Fatigue damage prediction in the annulus of cervical spine intervertebral discs using finite element analysis","volume":"23","author":"Subramani","year":"2020","journal-title":"Comput. Methods Biomechanics Biomed. Eng."},{"key":"B63","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1186\/s12891-023-06733-y","article-title":"Effect of stride length on the running biomechanics of healthy women of different statures","volume":"24","author":"Sundaramurthy","year":"2023","journal-title":"BMC Musculoskelet. Disord."},{"key":"B64","doi-asserted-by":"publisher","first-page":"2445","DOI":"10.1109\/TBME.2023.3248504","article-title":"Effects of stature and load carriage on the running biomechanics of healthy men","volume":"70","author":"Tong","year":"2023","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"B65","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s12891-021-04076-0","article-title":"Effects of body size and load carriage on lower-extremity biomechanical responses in healthy women","volume":"22","author":"Unnikrishnan","year":"2021","journal-title":"BMC Musculoskelet. Disord."},{"key":"B66","doi-asserted-by":"publisher","first-page":"1830","DOI":"10.1007\/s00586-023-07602-x","article-title":"MRI image features with an evident relation to low back pain: a narrative review","volume":"32","author":"van der Graaf","year":"2023","journal-title":"Eur. Spine J."},{"key":"B67","doi-asserted-by":"publisher","first-page":"73","DOI":"10.5114\/jhk\/159460","article-title":"The effect of fatigue on trunk and pelvic jump-landing biomechanics in view of lower extremity loading: a systematic review","volume":"86","author":"Vermeulen","year":"2023","journal-title":"J. Hum. Kinet."},{"key":"B68","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1007\/s40279-019-01235-1","article-title":"Does acute fatigue negatively affect intrinsic risk factors of the lower extremity injury risk profile? A systematic and critical review","volume":"50","author":"Verschueren","year":"2020","journal-title":"Sports Med."},{"key":"B69","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1123\/jab.28.6.665","article-title":"Normalization of ground reaction forces, joint moments, and free moments in human locomotion","volume":"28","author":"Wannop","year":"2012","journal-title":"J. Appl. Biomechanics"},{"key":"B70","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1123\/jab.27.2.108","article-title":"The effects of repetitive drop jumps on impact phase joint kinematics and kinetics","volume":"27","author":"Weinhandl","year":"2011","journal-title":"J. Appl. Biomechanics"},{"key":"B71","doi-asserted-by":"publisher","first-page":"887","DOI":"10.23736\/s0022-4707.16.06339-8","article-title":"Effects of fatigue on kinematics and kinetics during overground running: a systematic review","volume":"57","author":"Winter","year":"2017","journal-title":"J. Sports Med. Phys. Fit."},{"key":"B72","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1177\/00187208221113625","article-title":"Impact of haptic cues and an active ankle exoskeleton on gait characteristics","volume":"66","author":"Wu","year":"2024","journal-title":"Hum. Factors"},{"key":"B73","doi-asserted-by":"publisher","first-page":"101001","DOI":"10.1115\/1.4034216","article-title":"An integrated musculoskeletal-finite-element model to evaluate effects of load carriage on the tibia during walking","volume":"138","author":"Xu","year":"2016","journal-title":"J. Biomechanical Eng."},{"key":"B74","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1109\/tbme.2019.2917415","article-title":"Individual differences in women during walking affect tibial response to load carriage: the importance of individualized musculoskeletal finite-element models","volume":"67","author":"Xu","year":"2020","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"B75","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1007\/s10237-022-01617-x","article-title":"Effect of degenerative factors on cervical spinal cord during flexion and extension: a dynamic finite element analysis","volume":"21","author":"Xu","year":"2022","journal-title":"Biomechanics Model. Mechanobiol."},{"key":"B76","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1126\/science.aal5054","article-title":"Human-in-the-loop optimization of exoskeleton assistance during walking","volume":"356","author":"Zhang","year":"2017","journal-title":"Science"}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1654585\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T05:30:37Z","timestamp":1758778237000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1654585\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":76,"alternative-id":["10.3389\/fbioe.2025.1654585"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2025.1654585","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,25]]},"article-number":"1654585"}}