1
|
Marriott KA, Birmingham TB. Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions. Osteoarthritis Cartilage 2023; 31:1312-1326. [PMID: 37423596 DOI: 10.1016/j.joca.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
Collapse
Affiliation(s)
- Kendal A Marriott
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
2
|
Pathak P, Kim HS, Kim H, Park J, Lee G, Ahn J. Feasibility of mitigating out-toeing gait using compression tights with inward-directing taping lines. PLoS One 2023; 18:e0291914. [PMID: 37733749 PMCID: PMC10513335 DOI: 10.1371/journal.pone.0291914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
Out-toeing gait may cause alterations in lower limb biomechanics that could lead to an increased risk of overuse injuries. Surgery and physical therapy are conventional methods for mitigating such gait, but they are costly and time-consuming. Wearable devices like braces and orthoses are used as affordable alternatives, but they apply non-negligible stress on the skin. Haptic feedback-delivering shoes were also recently developed, but they require actuators and power sources. The purpose of our study is to develop compression tights with inward directing taping lines that apply compression to lower limb muscles and segments to facilitate inward rotation of the foot, overcoming the drawbacks of previous methods. These compression tights were manufactured to fit the average height, leg length, hip girth, and waist girth of South Korean females in their twenties. The efficacy of these compression tights was evaluated by comparing walking kinematics and user satisfaction of 12 female dancers with an out-toeing gait under three conditions: wearing tights with taping lines, tights without taping lines, and basic bicycle shorts. The foot rotation angles and joint kinematics were recorded using a pressure-pad treadmill and motion capture system, respectively. Multiple pairwise comparisons revealed that the compression tights with inward-directing lines significantly reduced foot rotation angles (up to an average of 20.1%) compared with the bicycle shorts (p = 0.002 and 0.001 for dominant and non-dominant foot, respectively) or the compression tights without taping lines (p = 0.005 and p = 0.001 for dominant and non-dominant foot, respectively). Statistical parametric mapping revealed significant main effects of the tight type on joint kinematics. Also, t-tests revealed that the participants reported significantly higher ratings of perceived functionality and usability on the compression tights with inward-directing taping lines. In conclusion, we developed a comfortable and practical apparel-type wearable and demonstrated its short-term efficacy in mitigating out-toeing gait.
Collapse
Affiliation(s)
- Prabhat Pathak
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States of America
| | - Hye Suk Kim
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Hyunji Kim
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
| | - Juyeon Park
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
- Department of Fashion and Textiles, Seoul National University, Seoul, Republic of Korea
| | - Giuk Lee
- Department of Mechanical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Jooeun Ahn
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
- Institute of Sport Science, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
3
|
Sabashi K, Chiba T, Yamanaka M, Tohyama H. Effect of toe-out gait modification on patellofemoral joint loading. Gait Posture 2023; 104:135-139. [PMID: 37419054 DOI: 10.1016/j.gaitpost.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Toe-out gait has been proposed as a conservative treatment to reduce medial tibiofemoral joint loading. However, patellofemoral joint loading during toe-out gait is not yet understood. RESEARCH QUESTION Does the toe-out gait modification affect patellofemoral joint loading? METHODS Sixteen healthy adults were enrolled in this study. The natural gait and toe-out gait were measured using a three-dimensional motion analysis and a force plate. The knee flexion angle and external knee flexion moment during the stance phase were calculated. Thus, dynamic knee joint stiffness, a proxy of patellofemoral joint loading, was defined as a linear regression of the knee flexion moment and knee flexion angle during the early stance. Additionally, the peak patellofemoral compressive force during the early stance was calculated using a musculoskeletal simulation. A paired t-test was used to compare these biomechanical parameters during the natural gait and toe-out gait. RESULTS The toe-out gait significantly increased the peak patellofemoral compressive force (mean difference = 0.37 BW, P = 0.017) and dynamic knee joint stiffness (mean difference = 0.07%BW*Ht/°, P = 0.001). The 1st peak of the knee flexion moment also significantly increased in the toe-out gait (mean difference = 1.01%BW*Ht, P = 0.003); however, the knee flexion angle did not change significantly (initial contact: mean difference = 1.7°, P = 0.078; peak: mean difference = 1.3°, P = 0.224). SIGNIFICANCE Toe-out gait increased the patellofemoral compressive force and dynamic knee joint stiffness because of increasing knee flexion moment, but not the knee flexion angle. When the toe-out gait is adapted, clinicians should pay attention to an increase in the patellofemoral joint loading.
Collapse
Affiliation(s)
- Kento Sabashi
- Department of Rehabilitation, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan; Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-Ku, Sapporo, Hokkaido 060-0812, Japan.
| | - Takeshi Chiba
- Department of Rehabilitation, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan; Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-Ku, Sapporo, Hokkaido 060-0812, Japan
| | - Masanori Yamanaka
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Satomi 2-10, Chitose, Hokkaido 066-0055, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-Ku, Sapporo, Hokkaido 060-0812, Japan
| |
Collapse
|
4
|
Hashizume T, Ishii Y, Ishikawa M, Nakashima Y, Kamei G, Iwamoto Y, Okamoto S, Okada K, Takagi K, Takahashi M, Adachi N. Toe-out gait inhibits medial meniscus extrusion associated with the second peak of knee adduction moment during gait in patients with knee osteoarthritis. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 33:13-19. [PMID: 37663062 PMCID: PMC10474330 DOI: 10.1016/j.asmart.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/26/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023] Open
Abstract
Background A medial meniscus extrusion (MME) gradually expands during activities of daily living according to the mechanical stress on the medial compartment of the knee. Increase in MME occurs during the stance phase of the gait cycle, which is key for its expand. The knee adduction moment (KAM) represents the mechanical stress on the medial compartment; however, the relationship between the increase in MME and KAM is still unknown. Therefore, the present study aimed to investigate the relationship between MME during gait and KAM. Methods Twenty-one patients with medial knee osteoarthritis and 11 healthy middle-aged adults were recruited. Three-dimensional motion analysis system and ultrasonography were used to measure the KAM and MME in the stance phase. The increase in MME was identified as the difference in MME between the maximum and minimum (ΔMME). Patients with knee osteoarthritis performed two conditions as normal and toe-out gait. The difference in KAM and ΔMME between conditions were evaluated. Results ΔMME was correlated with the KAM second peak in normal gait of knee osteoarthritis patients (r = 0.51, p < 0.05). Toe-out gait reduced the KAM second peak and the ΔMME, and these reductions were correlated (r = 0.50, p < 0.05). Conclusions Toe-out gait immediately inhibited the expansion of MME associated with the KAM second peak.
Collapse
Affiliation(s)
- Takato Hashizume
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Ishii
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuko Nakashima
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Goki Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Iwamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Saeko Okamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Okada
- Ultrasound Business Operations, Healthcare Business Headquarters, Konica Minolta, Inc, Tokyo, Japan
| | - Kazuya Takagi
- Ultrasound Business Operations, Healthcare Business Headquarters, Konica Minolta, Inc, Tokyo, Japan
| | - Makoto Takahashi
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
5
|
Sacco ICN, Trombini-Souza F, Suda EY. Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective. J Biomech 2023; 154:111604. [PMID: 37159980 DOI: 10.1016/j.jbiomech.2023.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.
Collapse
Affiliation(s)
- Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Francis Trombini-Souza
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil; Master's and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Eneida Yuri Suda
- Postgraduate Program in Physiotherapy, Universidade Ibirapuera, São Paulo, Brazil
| |
Collapse
|
6
|
Kurihara Y, Ohsugi H, Tosaka T, Matsuda T, Tsuneizumi Y, Tsukeoka T. Verification of biomechanical factors of gait related to medial knee loading in patients 6 Months after total knee arthroplasty. J Clin Orthop Trauma 2023; 39:102150. [PMID: 37101901 PMCID: PMC10123370 DOI: 10.1016/j.jcot.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/31/2023] [Indexed: 04/28/2023] Open
Abstract
Background The knee adduction moment (KAM) is considered an index for estimating the knee mechanical load, and increased KAM peak and KAM impulse are related to increased medial knee load and progression of knee joint degeneration. We aimed to verify the biomechanical factors of gait related to medial knee loading in patients 6 months after TKA. Methods Thirty-nine women who underwent TKA were enrolled. A three-dimensional gait analysis was performed 6 months postoperatively to generate data on the lower limb joint angle, moment, and power at the backward component (braking phase) and forward component (propulsion phase) peaks of the ground reaction force. Medial knee loading was evaluated using the time-integrated value of KAM during the stance period (KAM impulse). The higher the value of the KAM impulse, the higher the medial knee joint load. The relationships between the KAM impulse and the data for biomechanical factors were evaluated using partial correlation analysis with gait speed as a control factor. Results In the braking phase, the KAM impulse positively correlated with the knee adduction angle (r = 0.377) and negatively correlated with the toe-out angle (r = -0.355). The KAM impulse positively correlated with the knee adduction angle (r = 0.402), the hip flexion moment (r = 0.335), and the hip adduction moment (r = 0.565) and negatively correlated with the toe-out angle (r = -0.357) in the propulsive phase. Conclusion The KAM impulse 6 months after TKA was related to the knee adduction angle, hip flexion moment, hip adduction moment, and toe-out angle. These findings may provide fundamental data for controlling variable medial knee joint load after TKA and implementing patient management strategies to ensure implant durability.
Collapse
Affiliation(s)
- Yasushi Kurihara
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture, 283-8555, Japan
| | - Hironori Ohsugi
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture, 283-8555, Japan
| | - Tomonari Tosaka
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 2-1-1 Hongou Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoshikazu Tsuneizumi
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tadashi Tsukeoka
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| |
Collapse
|
7
|
Iwasaki K, Ohkoshi Y, Hosokawa Y, Chida S, Ukishiro K, Kawakami K, Suzuki S, Maeda T, Onodera T, Kondo E, Iwasaki N. Higher Association of Pelvis-Knee-Ankle Angle Compared With Hip-Knee-Ankle Angle With Knee Adduction Moment and Patient-Reported Outcomes After High Tibial Osteotomy. Am J Sports Med 2023; 51:977-984. [PMID: 36786244 DOI: 10.1177/03635465221150513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) reduces the load distribution of the medial compartment by modifying leg alignment. Knee adduction moment (KAM), a surrogate measure of dynamic loading in the knee joint, decreases after HTO. However, leg alignment does not fully account for KAM. PURPOSE To assess the association between the pelvis-knee-ankle angle (PKA), a novel radiographic parameter reflecting leg alignment and pelvic width, and KAM and patient-reported outcomes after HTO. STUDY DESIGN Cross sectional study; Level of evidence, 3. METHODS PKA is the angle between the line from the midpoint of the anterior superior iliac spine to the center of the knee joint and the mechanical axis of the tibia. In this study, 54 patients with medial compartment knee osteoarthritis and varus alignment who underwent 3-dimensional gait analysis preoperatively and 2 years after medial open-wedge HTO were evaluated. The primary outcomes were hip-knee-ankle angle (HKA), PKA, KAM peaks, and Knee Society Score (KSS). Single and multivariate regression analysis including PKA and KAM peaks as well as other demographic and radiologic factors was performed. RESULTS HKA was weakly correlated with the first peak KAM (r = -0.33; P < .01) and second peak KAM (r = -0.27; P = .01) before HTO, but not significantly correlated after HTO. PKA was moderately correlated with the first peak KAM (r = 0.45; P < .01) and second peak KAM (r = 0.45; P < .01) before HTO and with the first peak KAM (r = 0.51; P < .01) and second peak KAM (r = 0.56; P < .01) after HTO. Multivariate linear regression revealed that postoperative PKA was still associated with the KAM peaks after HTO. Only postoperative PKA was correlated with the KSS satisfaction subscale (r = -0.30; P = .03). CONCLUSION Although HKA was not correlated with KAM peaks after HTO, PKA was significantly correlated with KAM peaks in patients with varus knee osteoarthritis after HTO.
Collapse
Affiliation(s)
- Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Yoshiaki Hosokawa
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shuya Chida
- Department of Rehabilitation, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Kengo Ukishiro
- Department of Rehabilitation, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Kensaku Kawakami
- Department of Production Systems Engineering, National Institute of Technology, Hakodate College, Hakodate, Japan
| | - Sho'ji Suzuki
- Department of Complex and Intelligent Systems, Future University Hakodate, Hakodate, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
8
|
Holmes SC, Montgomery MM, Lynn SK, Pamukoff DN. Sex-Specific associations between hip muscle strength and foot progression angle. J Electromyogr Kinesiol 2023; 68:102723. [PMID: 36402073 DOI: 10.1016/j.jelekin.2022.102723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/14/2022] Open
Abstract
The foot progression angle (FPA) influences knee loading during gait, but its determinants are unclear. The purpose of this study was to compare FPA between males and females and also examine the association between lower extremity kinematics during gait, hip strength, and the FPA. 25 males and 25 females completed 5 gait trials while FPA and frontal and transverse plane hip and knee angles were calculated from the dominant limb during the foot flat portion of stance. Hip extensor/flexor, abductor/adductor, and internal/external rotator strength were evaluated using maximum voluntary isometric contractions. One-way MANOVAs compared gait and strength outcomes. Stepwise regression assessed the association between FPA, and MVIC and kinematics after accounting for speed in males and females. There was no difference in FPA between sexes (p > 0.05), but females had greater frontal and transverse plane hip angles compared with males (all p < 0.05). Greater hip abduction (p = 0.02) strength was associated with greater FPA, but only in males. In males, greater hip abductor strength may contribute to a more neutral position of the foot during gait, which could help maintain an equal knee loading distribution. Our results suggest that there are sex specific control strategies to achieve a similar FPA during gait.
Collapse
Affiliation(s)
- Skylar C Holmes
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Melissa M Montgomery
- Department of Kinesiology, California State University, Fullerton, Fullerton, CA, USA
| | - Scott K Lynn
- Department of Kinesiology, California State University, Fullerton, Fullerton, CA, USA
| | - Derek N Pamukoff
- School of Kinesiology, Western University, London, Ontario, Canada.
| |
Collapse
|
9
|
Althomali OW, Starbuck C, Alarifi S, Alsaqri KK, Mohammad WS, Elsais WM, Jones R. The effect of foot position during static calibration trials on knee kinematic and kinetics during walking. Gait Posture 2023; 99:133-138. [PMID: 36435067 DOI: 10.1016/j.gaitpost.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/14/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gait analysis has been used extensively for computing knee kinematics and kinetics, in particular, in healthy and impaired individuals. One variable assessed is the external knee adduction moment (EKAM). Variations in EKAM values between investigations may be caused by changes in static standing position, especially foot placement angles which may increase or reduce any differences seen. PURPOSE OF THE STUDY The current study aimed to explore the influence of static trial foot position on knee kinematic and kinetic variables during walking. METHODS Twelve healthy male participants completed three different static standing trials; 1) 20-degrees toe-in, 2) 0° and 3) 20-degrees toe-out before walking at their own pace during a lower limb kinematics and kinetics assessment. First and second peak EKAM was compared between static foot position trials, as well other knee kinematic and kinetic outcomes. Repeated measures ANOVA was used with post hoc pairwise comparison to determine the differences between static foot position trials. RESULTS The first peak of EKAM was significantly smaller in the 20o toe-out angle, than the 20o toe-in angle (p = 0.04-8.16% reduction). Furthermore, significant changes were found in peak knee kinematics and kinetics variables (adduction angle, external rotation angle, knee flexion moment external rotation moment, abduction angle and internal rotation angle) in the different positions. CONCLUSION Modification in static foot position between study visits may result in changes especially in the 1st peak EKAM and other kinematics and kinetics variables during walking. Therefore, standardisation of static foot position should be utilised in longitudinal studies to ensure changes in EKAM are not masked or accentuated between assessments.
Collapse
Affiliation(s)
- Omar W Althomali
- Department of Physiotherapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia.
| | - Chelsea Starbuck
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK; Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, UK
| | - Saud Alarifi
- Department of Physiotherapy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khalid K Alsaqri
- Department of Physiotherapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Walaa S Mohammad
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia; Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walaa M Elsais
- Physical Therapy Department, College of Allied Medical Sciences, Isra University, Amman, Jordan
| | - Richard Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK
| |
Collapse
|
10
|
Baniasad M, Martin R, Crevoisier X, Pichonnaz C, Becce F, Aminian K. Knee adduction moment decomposition: Toward better clinical decision-making. Front Bioeng Biotechnol 2022; 10:1017711. [PMID: 36466350 PMCID: PMC9715598 DOI: 10.3389/fbioe.2022.1017711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2023] Open
Abstract
Knee adduction moment (KAM) is correlated with the progression of medial knee osteoarthritis (OA). Although a generic gait modification can reduce the KAM in some patients, it may have a reverse effect on other patients. We proposed the "decomposed ground reaction vector" (dGRV) model to 1) distinguish between the components of the KAM and their contribution to the first and second peaks and KAM impulse and 2) examine how medial knee OA, gait speed, and a brace influence these components. Using inverse dynamics as the reference, we calculated the KAM of 12 healthy participants and 12 patients with varus deformity and medial knee OA walking with/without a brace and at three speeds. The dGRV model divided the KAM into four components defined by the ground reaction force (GRF) and associated lever arms described with biomechanical factors related to gait modifications. The dGRV model predicted the KAM profile with a coefficient of multiple correlations of 0.98 ± 0.01. The main cause of increased KAM in the medial knee OA group, the second component (generated by the vertical GRF and mediolateral distance between the knee and ankle joint centers), was decreased by the brace in the healthy group. The first peak increased, and KAM impulse decreased with increasing velocity in both groups, while no significant change was observed in the second peak. The four-component dGRV model successfully estimated the KAM in all tested conditions. It explains why similar gait modifications produce different KAM reductions in subjects. Thus, more personalized gait rehabilitation, targeting elevated components, can be considered.
Collapse
Affiliation(s)
- Mina Baniasad
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Robin Martin
- Department of Orthopaedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Xavier Crevoisier
- Department of Orthopaedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claude Pichonnaz
- Department of Orthopaedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Physiotherapy, School of Health Sciences HESAV, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| |
Collapse
|
11
|
Li B, Zhang X. The dynamic characteristics of the center of pressure for toe-out gait: implications for footwear design. JOURNAL OF LEATHER SCIENCE AND ENGINEERING 2022. [DOI: 10.1186/s42825-022-00088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Toe-out gait is often used as a conservative technique to reduce knee adduction moment, which has been targeted to modify knee osteoarthritis progression. The center of pressure (COP) can not only be used to evaluate gait stability, but is also more reliable and practical than local plantar pressures as it does not depend on accurate foot zone divisions. However, to the authors’ knowledge, few study has reported the influence of the foot progression angle on the dynamic characteristics of the COP.
Research question
The aim of the study was to investigate the effects of the deliberately toe-out gait on the COP trajectory and stability during walking in healthy individuals.
Methods
Thirty healthy young adults were asked to walk along an 8-m walkway. A Footscan 1 m pressure plate was used to measure the center of pressure during walking.
Results
Compared to the normal gait, the COP of the toe-out gait shifted laterally during the initial contact phase, and shifted laterally and anteriorly during the forefoot contact phase. The mean anterior–posterior velocity of COP reduced by 0.109 m/s during the foot flat phase and the duration of the foot flat phase and forefoot push off phase increased by 4.5% and reduced by 7.0%, respectively.
Significance
Compared to the normal gait, the findings of this study suggest that biomechanical alteration of foot under our experimental conditions may decrease gait stability and increase forefoot load during toe-out walking. The situation may be improved by well-designed footwear or custom-made insole and the biomechanics analysis method can be used to test the efficacy of therapeutic footwear or insole for individuals with deliberately toe-out walking.
Graphical Abstract
Collapse
|
12
|
Research on Knee Joint Load and Influencing Factors of Typical Tai Chi Movements. Appl Bionics Biomech 2022; 2022:6774980. [PMID: 35310685 PMCID: PMC8924602 DOI: 10.1155/2022/6774980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Tai chi is recognized worldwide for its rehabilitation abilities and healthcare benefits. However, in recent years, some movements associated with tai chi have been shown to damage the lower limb joints. The purpose of this study was to investigate and compare the effects of different movements, postures, center of mass (COM) movements, and range of knee movement of tai chi exercises on knee joint load. Methods Fourteen professional tai chi practitioners in two postures (high and low) were enrolled to perform the following four typical tai chi movements: wild horse's mane (WHM), repulse monkey (RM), wave-hand in cloud (WHIC), and grasp the bird's tail (GBT). Kinematic and kinetics data were synchronously collected using the Vicon infrared high-speed motion capture system and a three-dimensional (3D) force measurement platform. Variance analysis and partial correlation analysis were performed to investigate factors influencing peak knee joint moment and vertical ground reaction force (VGRF). Results The results showed that the peak knee extension and abduction moment were larger in WHM and RM than those in WHIC and GBT (p < 0.05). WHM was associated with greater rotation moment than the other typical movements (p < 0.05). VGRF and joint moment among different poses were significantly different. Low-pose tai chi typical movements were associated with greater VGRF, knee joint extension and abduction, and rotation moments than high-pose movements (p < 0.05). The anteroposterior and mediolateral COM displacements were strongly and positively associated with VGRF (p < 0.001), while the mediolateral COM displacement was negatively associated with knee extension moment (p < 0.001). The knee internal-external rotation ROM and anteroposterior and mediolateral COM displacements were positively associated with knee abduction moment (p < 0.01). Conclusion For long-term tai chi exercises, choosing a suitable posture based on an individual exercise level and reasonable control of knee ROM and COM displacement can reduce the risk of knee injury during exercise.
Collapse
|
13
|
Trunk lean and toe out gait strategies impact on lower limb joints. J Biomech 2021; 129:110740. [PMID: 34627072 DOI: 10.1016/j.jbiomech.2021.110740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022]
Abstract
Gait retraining as a non-invasive prospective approach to restore mechanical loading at the knee joint and slowing down knee osteoarthritis (OA) progression shows great promise. However, the impact of gait modifications such as an increase in foot progression angle (FPA) or lateral trunk lean (LTL) on the ankle and hip is not yet well understood. Thus, the goal of this study is to provide insight on the impact of FPA and LTL on the sagittal and frontal external moments at the ankle and hip of healthy participants. We hypothesize that there is an optimum, for which an increase in FPA and/or LTL minimize the knee adduction moment (KAM) without increasing significantly the frontal and sagittal external moments at the ankle and hip during gait. To test this hypothesis, 23 participants performed walking trials with modified FPA and/or LTL angles following a real-time visual feedback. The hypothesis was not confirmed and while not all the gait modifications performed by the participants in this study reduced the KAM, they significantly increased the sagittal moment at the ankle and the frontal moment at the hip. This study highlights the importance to consider the biomechanical consequences of gait modifications on the ankle and hip before considering a clinical application of gait retraining approaches.
Collapse
|
14
|
Abstract
Infection with mosquito-borne arthritogenic alphaviruses, such as Ross River virus (RRV) and Barmah Forest virus (BFV), can lead to long-lasting rheumatic disease. Existing mouse models that recapitulate the disease signs and immunopathogenesis of acute RRV and BFV infection have consistently shown relevance to human disease. However, these mouse models, which chiefly model hindlimb dysfunction, may be prone to subjective interpretation when scoring disease. Assessment is therefore time-consuming and requires experienced users. The DigiGait system provides video-based measurements of movement, behavior, and gait dynamics in mice and small animals. Previous studies have shown DigiGait to be a reliable system to objectively quantify changes in gait in other models of pain and inflammation. Here, for the first time, we determine measurable differences in the gait of mice with infectious arthritis using the DigiGait system. Statistically significant differences in paw area and paw angle were detected during peak disease in RRV-infected mice. Significant differences in temporal gait parameters were also identified during the period of peak disease in RRV-infected mice. These trends were less obvious or absent in BFV-infected mice, which typically present with milder disease signs than RRV-infected mice. The DigiGait system therefore provides an objective model of variations in gait dynamics in mice acutely infected with RRV. DigiGait is likely to have further utility for murine models that develop severe forms of infectious arthritis resulting in hindlimb dysfunction like RRV. IMPORTANCE Mouse models that accurately replicate the immunopathogenesis and clinical disease of alphavirus infection are vital to the preclinical development of therapeutic strategies that target alphavirus infection and disease. Current models rely on subjective scoring made through experienced observation of infected mice. Here, we demonstrate how the DigiGait system, and interventions on mice to use this system, can make an efficient objective assessment of acute disease progression and changes in gait in alphavirus-infected mice. Our study highlights the importance of measuring gait parameters in the assessment of models of infectious arthritis.
Collapse
|
15
|
Sinclair J, Brooks D, Taylor PJ, Liles N. Effects of toe-in/ out toe-in gait and lateral wedge orthoses on lower extremity joint kinetics; an exploration using musculoskeletal simulation and Bayesian contrasts. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Song O, Seo KE, O’Sullivan DM, Park JJ. A Biomechanical Analysis of the Effect of Pilates Exercise on Female College Students with Knee Joint Deformity. THE ASIAN JOURNAL OF KINESIOLOGY 2021. [DOI: 10.15758/ajk.2021.23.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Current research on genu varum shows the favorable influence of exercise on the biomechanics of the knee joint by reducing the static malalignment and mechanical imbalances, however the transference to a more optimum gait has not been investigated.OBJECTIVES To investigate the effects of Pilates exercise on the changes of gait and lower limb malalignment in female students with genu varum.METHODS A total of 23 female college students with verified genu varum participated in this study. The participants were randomly assigned to two groups a Pilates exercise group (n=15) and a control group (n=8). The Pilates exercise group participated in 1 hour Pilates exercise 3 times per week for a total of 10 weeks. Each of the participants had an X-ray and performed gait 5 times before and after the exercise treatment. The participants kinetic and kinematic data were gathered using an eight Vicon Motion camera system and two force platforms.RESULTS For the Pilates group gait their maximum extension and internal rotation knee moment, and maximum adduction and internal rotation hip moment significantly increased, while the maximum knee moment flexion decreased. For the control group gait their maximum hip extension and hip adduction moment significantly decreased. For the Pilates group there was a significant reduction in the distance from the anatomical axis to the weight bearing line in the left leg, but there was no significant change for the control group.CONCLUSIONS The results suggest that Pilates exercise may be beneficial for females with genu varum by helping to improve both their static alignment and helping their gait to become more balanced.
Collapse
|
17
|
Biomechanical Changes in Gait Patterns of Patients with Grade II Medial Gonarthritis. Diagnostics (Basel) 2021; 11:diagnostics11071242. [PMID: 34359325 PMCID: PMC8305118 DOI: 10.3390/diagnostics11071242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Deforming osteoarthritis (OA) of the knee is a progressive disease associated with pain and compromised function of the joint. Typical biomechanical modifications in the gait of subjects with medial knee OA are characterized by decreased gait speed and overload on the affected limb. The borderline stage for conservative versus surgical management is Grade II OA. The aim of this research was to study preoperatively the specific features of gait, knee, and hip function in patients with Grade II medial OA. We examined 26 patients with Grade II unilateral gonarthritis with varus deformity and 20 healthy adults. Biomechanical parameters of gait were recorded using an inertial sensor system. The gait cycle (GC) slightly increased both for the affected and for the intact limb. The hip joint movements showed significant symmetrical reduction in the first flexion amplitude, as well as a symmetrical delay in full hip extension at the end of the stance phase. In the knee, the first flexion amplitude was significantly reduced on the affected side compared to healthy control. The extension amplitude in the single support phase was significantly increased in both the affected and the intact lower limbs. The swing amplitude was significantly reduced on the affected side. On the affected side, the changes were more pronounced, both in incidence and in severity. The affected knee showed a syndrome of three reduced amplitudes. In patients, walking is characterized by several groups of symptoms: those of unloading of the affected limb, those of limiting the load on the affected joint and the musculoskeletal system as a whole, and those of gait harmonization. The symptoms of unloading the affected side and those of harmonization are the common symptoms of adaptation, typical for several pathological conditions with a relatively preserved function. The intensity of the observed symptoms can help assess changes in the subject’s functional condition over time and during the treatment.
Collapse
|
18
|
Fujita R, Ota S, Ogawa Y, Ota H. Effects of walking with a "draw-in maneuver" on the knee adduction moment and hip muscle activity. J Phys Ther Sci 2021; 33:329-333. [PMID: 33935356 PMCID: PMC8079891 DOI: 10.1589/jpts.33.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effect of performing a draw-in maneuver (DI) on knee
adduction moment (KAM) and hip and trunk muscle activities while walking. [Participants
and Methods] We included 30 healthy young adults (21.5 ± 0.6 years, 16 males and 14
females) in this study. We measured the KAM and lever arm while participants walked with
either a normal gait or a DI gait. We also performed surface electromyography (EMG) of the
hip and trunk muscles (i.e., internal oblique abdominal muscle [IO], external oblique
abdominal muscle [EO], multifidus muscle [MF], and gluteus medius muscle [GM]). [Results]
The 1st peak of the KAM was significantly lower when walking with a DI gait compared to
when walking with a normal gait. The integrated EMG activity of the IO, EO, and GM during
the 1st half of the stance phase, and of the IO and EO during the 2nd half of the stance
phase was significantly higher during the DI than during normal gait. [Conclusion]
Compared with a normal gait, a DI gait leads to a decrease in the 1st peak of the KAM as a
result of the shorter lever arm, and an increase in the muscular activity of the GM, IO,
and EO.
Collapse
Affiliation(s)
- Remi Fujita
- Department of Rehabilitation and Care, Seijoh University: 2-172 Fukinodai, Tokai, Aichi 476-8588, Japan
| | - Susumu Ota
- Department of Rehabilitation and Care, Seijoh University: 2-172 Fukinodai, Tokai, Aichi 476-8588, Japan
| | - Yukari Ogawa
- Department of Physical Medicine and Rehabilitation, Nagoya Tokushukai General Hospital, Japan
| | - Hiroki Ota
- Department of Physical Medicine and Rehabilitation, Nagoya Tokushukai General Hospital, Japan
| |
Collapse
|
19
|
Lindsey BW, Xu J, Chiasson D, Shull P, Cortes N. Feasibility of Wearable Haptic Biofeedback Training for Reducing the Knee Abduction Moment During Overground Walking. J Biomech Eng 2021; 143:044501. [PMID: 32793949 DOI: 10.1115/1.4048082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 11/08/2022]
Abstract
Gait modifications are effective in reducing the first peak knee abduction moment (PKAM), a surrogate for knee loading. Reliance on 3D motion capture currently restricts these modifications to the laboratory. Therefore, our purpose was to test the feasibility of a novel wearable biofeedback system to train (1) toe-in and trunk lean modifications and (2) combined toe-in and trunk lean modifications to reduce PKAM during overground walking outside of the laboratory. Twelve healthy participants practiced modifications in a university hallway directly after performing five normal walking trials. The wearable feedback system provided real-time haptic biofeedback during training trials to inform participants if they were within the prescribed modification range (7-12 deg greater than baseline). Participants were instructed to move to the next modification only once they felt comfortable and could perform it with minimal errors. Following training, five trials of each modification were immediately performed in the gait laboratory without feedback. All participants successfully modified their foot progression and trunk angle using the wearable system. At post-test, PKAM decreased from baseline by 62%, 55%, and 28% during combined, trunk leanand toe-in gait, respectively. The wearable feedback system was effective to modify participants' foot and trunk angle by the prescribed amount, resulting in reduced PKAM during all modifications at post-test. Participants were also able to perform a combined modification, although it took longer to report feeling comfortable doing so. This study demonstrates that a wearable feedback system is feasible to modify kinematic parameters and train gait modifications outside the laboratory.
Collapse
Affiliation(s)
- Bryndan W Lindsey
- School of Kinesiology, George Mason University, 10890 George Mason Circle, Katherine Johnson Hall 201E, MSN 4E5, Manassas, VA 20110; Sports Medicine Assessment, Research & Testing (SMART) Laboratory, 9438 Innovation Loop, Manassas, VA 20110
| | - Junkai Xu
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - David Chiasson
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Peter Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Nelson Cortes
- School of Kinesiology; Sports Medicine Assessment, Research & Testing (SMART) Laboratory; George Mason University, 10890 George Mason Circle, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110; Department of Bioengineering, George Mason University, 4400 University Dr, Fairfax, VA 22030; Institute for BioHealth Innovation, George Mason University, 10890 George Mason Circle, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110
| |
Collapse
|
20
|
Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta-analysis. J Foot Ankle Res 2021; 14:24. [PMID: 33771204 PMCID: PMC8004391 DOI: 10.1186/s13047-021-00462-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Foot characteristics and mechanics are hypothesized to affect aetiology of several lower extremity musculoskeletal conditions, including knee osteoarthritis (KOA). The purpose of this systematic review was to identify the foot characteristics and mechanics of individuals with KOA. Methods Five databases were searched to identify relevant studies on foot characteristics and mechanics in people with KOA. Meta-analyses were performed where common measures were found across included studies. Included studies were evaluated for data reporting quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist. Results Thirty-nine studies were included in this systematic review. Two studies reported participants with KOA had statistically significantly (P < 0.05) more pronated foot postures than those without. Meta-analyses for foot progression angle (FPA) and peak rearfoot eversion angle found no difference between those with and without KOA (FPA mean difference:-1.50 [95% confidence interval − 4.20-1.21]; peak rearfoot eversion mean difference: 0.71 [1.55–2.97]). Conclusion A more pronated foot posture was noticed in those with KOA. However, it was not possible to establish a relationship between other foot characteristics or mechanics in people with KOA due to heterogeneity between the included study and limited number of studies with similar measurements. There is need for identifying common measurement techniques and reporting metrics when studying the foot in those with KOA.
Collapse
|
21
|
Tibiofemoral Contact Measures During Standing in Toe-In and Toe-Out Postures. J Appl Biomech 2021; 37:233-239. [PMID: 33690165 DOI: 10.1123/jab.2020-0206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/17/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022]
Abstract
Knee osteoarthritis is thought to result, in part, from excessive and unbalanced joint loading. Toe-in and toe-out gait modifications produce alterations in external knee joint moments, and some improvements in pain over the short- and long-term. The aim of this study was to probe mechanisms of altered joint loading through the assessment of tibiofemoral contact in standing with toe-in and toe-out positions using an open magnetic resonance scanner. In this study, 15 young, healthy participants underwent standing magnetic resonance imaging of one of their knees in 3 foot positions. Images were analyzed to determine contact in the tibiofemoral joint, with primary outcomes including centroid of contact and contact area for each compartment and overall. The centroid of contact shifted laterally in the lateral compartment with both toe-in and toe-out postures, compared with the neutral position (P < .01), while contact area in the medial and lateral compartments showed no statistical differences. Findings from this study indicate that changes in the loading anatomy are present in the tibiofemoral joint with toe-in and toe-out and that a small amount of lateralization of contact, especially in the lateral compartment, does occur with these altered lower limb orientations.
Collapse
|
22
|
Bennett HJ, Valenzuela KA, Lynn SK, Weinhandl JT. Foot Rotation Gait Modifications Affect Hip and Ankle, But Not Knee, Stance Phase Joint Reaction Forces During Running. J Biomech Eng 2021; 143:021001. [PMID: 32734282 DOI: 10.1115/1.4047994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Indexed: 07/25/2024]
Abstract
Alterations of foot rotation angles have successfully reduced external knee adduction moments during walking and running. However, reductions in knee adduction moments may not result in reductions in knee joint reaction forces. The purpose of this study was to examine the effects of internal and external foot rotation on knee, hip, and ankle joint reaction forces during running. Motion capture and force data were recorded of 19 healthy adults running at 3.35 m/s during three conditions: (1) preferred (normal) and with (2) internal and (3) external foot rotation. Musculoskeletal simulations were performed using opensim and the Rajagopal 2015 model, modified to a two degree-of-freedom knee joint. Muscle excitations were derived using static optimization, including muscle physiology parameters. Joint reaction forces (i.e., the total force acting on the joints) were computed and compared between conditions using one-way analyses of variance (ANOVAs) via statistical parametric mapping (SPM). Internal foot rotation reduced resultant hip forces (from 18% to 23% stride), while external rotation reduced resultant ankle forces (peak force at 20% stride) during the stance phase. Three-dimensional and resultant knee joint reaction forces only differed at very early and very late stance phase. The results of this study indicate, similar to previous findings, that reductions in external knee adduction moments do not mirror reductions in knee joint reaction forces.
Collapse
Affiliation(s)
- Hunter J Bennett
- Department of Human Movement Sciences, 2016 Student Recreation Center, Old Dominion University, Norfolk, VA 23529
| | - Kevin A Valenzuela
- Department of Kinesiology, HHS2-203, California State University, Long Beach, CA 90840
| | - Scott K Lynn
- Department of Kinesiology, KHS 224, California State University, Fullerton, CA 92834
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, 322 HPER Building, Knoxville, TN 37996-2700
| |
Collapse
|
23
|
Sample DW, Thorsen TA, Weinhandl JT, Strohacker KA, Zhang S. Effects of Increased Step-Width on Knee Biomechanics During Inclined and Declined Walking. J Appl Biomech 2020; 36:292-297. [PMID: 32781436 DOI: 10.1123/jab.2019-0298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 05/18/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate effects of preferred step width and increased step width modification on knee biomechanics of obese and healthy-weight participants during incline and decline walking. Seven healthy-weight participants and 6 participants who are obese (body mass index ≥ 30) performed 5 walking trials on level ground and a 10° inclined and declined instrumented ramp system at both preferred and wide step-widths. A 2 × 2 (step-width × group) mixed-model analysis of variance was used to examine selected variables. There were significant increases in step-width between the preferred and wide step-width conditions for all 3 walking conditions (all P < .001). An interaction was found for peak knee extension moment (P = .048) and internal knee abduction moment (KAM) (P = .025) in uphill walking. During downhill walking, there were no interaction effects. As step-width increased, KAM was reduced (P = .007). In level walking, there were no interaction effects for peak medial ground reaction force and KAM (P = .007). There was a step-width main effect for KAM (P = .007). As step-width increased, peak medial ground reaction force and peak knee extension moment increased, while KAM decreased for both healthy weight and individuals who are obese. The results suggest that increasing step-width may be a useful strategy for reducing KAM in healthy and young populations.
Collapse
|
24
|
Qiu R, Xu R, Wang D, Ming D. The effect of modifying foot progression angle on the knee loading parameters in healthy participants with different static foot postures. Gait Posture 2020; 81:7-13. [PMID: 32650240 DOI: 10.1016/j.gaitpost.2020.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have found that toe-in gait reduced the peak knee adduction moment (KAM) during early stance, while toe-out gait reduced the peak KAM during late stance. However, some other studies found that toe-in or toe-out gait could reduce the KAM throughout stance phase. There is still a divergence of opinion on the use of toe-in or toe-out gait for reducing the KAM. RESEARCH QUESTION This study aimed to investigate whether static foot posture affected participants' biomechanical responses to three self-selected foot progression angles (FPA): neutral, toe-out and toe-in. METHODS Twenty-seven healthy participants were recruited for this FPA gait modification experiment and classified into three groups: neutral (n = 8), supination (n = 9) and pronation (n = 10), based on the Foot Posture Index (FPI). The kinematic and kinetic data were recorded with Vicon motion capture system and three force plates. The knee adduction moment and ankle eversion moment were calculated using an inverse dynamics model. The effect of the FPA modification on the knee loading parameters was analysed by the Friedman non-parametric test. RESULTS The KAM results in the neutral group showed that the toe-in gait modification reduced the first peak of the KAM (KAM1), while the KAM1 was increased in the supination group. The effect of the FPA modification on the KAM1 did not reach significance in the pronation group. The toe-out gait modification reduced the second peak (KAM2) regardless of the static posture. SIGNIFICANCE Different static foot postures were correlated with different peak KAM during the early stance phase due to FPA modification. These data suggest that the assessment of static foot posture provides a reference on how to offer adequate FPA modification for knee OA patients with different foot postures.
Collapse
Affiliation(s)
- Rongmei Qiu
- Lab of Neural Engineering & Rehabilitation, Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China; Department of Rehabilitation, Faculty of Rehabilitation, BinZhou Medical University, Yantai, Shandong, China.
| | - Rui Xu
- Lab of Neural Engineering & Rehabilitation, Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.
| | - Deqiang Wang
- Department of Rehabilitation, Faculty of Rehabilitation, BinZhou Medical University, Yantai, Shandong, China; Department of Pain, BinZhou Medical University Affiliated Hospital, BinZhou, Shandong, China.
| | - Dong Ming
- Lab of Neural Engineering & Rehabilitation, Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
| |
Collapse
|
25
|
Influence of the initial foot contact strategy on knee joint moments during stair and ramp descent. Sci Rep 2020; 10:13922. [PMID: 32811865 PMCID: PMC7435172 DOI: 10.1038/s41598-020-70933-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022] Open
Abstract
Gait modification strategies are effective in reducing knee joint loads, which are associated with the development and progression of knee osteoarthritis (OA). However, the effect of modification of the initial foot contact method in high-loading descending task was not investigated. Here, we show that the initial foot contact strategy significantly alters knee joint moments during descending tasks. We found that the second peak flexion moment was lower for the forefoot strike (FFS) than for the rearfoot strike (RFS) in both stair and ramp descent. As for the peak adduction moment, the second peak was lower for the FFS in stair descent, but two peaks were inconsistent in ramp descent. Our results demonstrate that the knee joint loads can be reduced by simple modification of the initial foot contact strategy. In both descending modalities, the FFS may benefit people with early OA in the patellofemoral joint, whose progression is associated with the peak flexion moment. Likewise, the FFS during stair descent may benefit people with early OA in the medial knee, whose progression is associated with the peak adduction moment. The results would be helpful for prevention and rehabilitation programmes of knee OA.
Collapse
|
26
|
Wang S, Mo S, Chung RCK, Shull PB, Ribeiro DC, Cheung RTH. How foot progression angle affects knee adduction moment and angular impulse in people with and without medial knee osteoarthritis: a meta-analysis. Arthritis Care Res (Hoboken) 2020; 73:1763-1776. [PMID: 33242375 DOI: 10.1002/acr.24420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate effects of foot progression angle (FPA) modification on the first and second peaks of external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) in individuals with and without medial knee osteoarthritis (OA) during level walking. METHODS PubMed, Embase, CINAHL, Web of Science and SPORTDiscus were searched from inception to February 2020 by two independent reviewers. Included studies compared FPA modification (toe-in or toe-out gait) interventions to lower EKAM and/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI. RESULTS Sixteen studies were included and more than 85% of included patients were graded with Kellgren-Lawrence II-IV knee OA. Toe-in gait reduced the first EKAM peak (standard mean difference (SMD): -0.75; 95%CI: -1.05~-0.45) and KAAI (SMD: -0.46; 95%CI: -0.86~-0.07), while toe-out gait reduced the second EKAM peak (SMD: -1.04; 95%CI: -1.34~-0.75) in healthy individuals. For patients with knee OA, toe-out gait reduced the second EKAM peak (SMD: -0.53; 95%CI: -0.75~-0.31) and KAAI (SMD: -0.26; 95%CI: -0.49~-0.03) while toe-in gait did not affect both EKAM peaks and KAAI. CONCLUSION Discrepancy in biomechanical effects of FPA modification was demonstrated between individuals with and without medial knee OA. Compared with natural walking, both toe-in and toe-out gait may be more effective in lowering EKAM and KAAI in healthy individuals. Toe-out gait may reduce EKAM and KAAI in patients with mild to severe knee OA. There is insufficient data from patients with early-stage knee OA, indicating future research is required.
Collapse
Affiliation(s)
- Sizhong Wang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Shiwei Mo
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Division of Sports Science and Physical Education, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Peter B Shull
- State Key Laboratory of Mechanical Systems and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Roy T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,School of Health Sciences, Western Sydney University, NSW, Australia, Penrith South
| |
Collapse
|
27
|
Edd SN, Bennour S, Ulrich B, Jolles BM, Favre J. Modifying Stride Length in Isolation and in Combination With Foot Progression Angle and Step Width Can Improve Knee Kinetics Related to Osteoarthritis; A Preliminary Study in Healthy Subjects. J Biomech Eng 2020; 142:074505. [PMID: 32203585 DOI: 10.1115/1.4046713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to determine the effects of modifying stride length (SL) on knee adduction and flexion moments, two markers of knee loading associated with medial-compartment knee osteoarthritis (OA) progression. This study also tested if SL modifications, in addition to foot progression angle (FP) and step width (SW) modifications, provide solutions in more subjects for reducing knee adduction moment (KAM) without increasing knee flexion moment (KFM), potentially protecting the joint. Fourteen healthy subjects (six female) were enrolled in this preliminary study. Walking trials were collected first without instructions, and then following foot placement instructions for 50 combinations of SL, FP, and SW modifications. Repeated measures analysis of variance was used to detect group-average effects of footprint modifications on maximum KAM and KFM and on KAM impulse. Subject-specific dose-responses between footprint modifications and kinetics changes were modeled with linear regressions, and the models were used to identify modification solutions, per subject, for various kinetics change conditions. Shorter SL significantly decreased the three kinetics measures (p < 0.01). Potential solutions for 10% reductions in maximum KAM and KAM impulse without increasing maximum KFM were identified for five subjects with FP and SW modifications. A significantly higher proportion of subjects had solutions when adding SL modifications (11 subjects, p = 0.04). In conclusion, SL is a valuable parameter to modify, especially in combination with FP and SW modifications, to reduce markers of medial knee loading. Future work is needed to extend these findings to osteoarthritic knees.
Collapse
Affiliation(s)
- Shannon N Edd
- Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
| | - Sami Bennour
- Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland; Mechanical Laboratory of Sousse, National Engineering School of Sousse, University of Sousse, Sousse 4054, Tunisia
| | - Baptiste Ulrich
- Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
| | - Brigitte M Jolles
- Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland; Ecole Polytechnique Fédérale de Lausanne, Institute of Microengineering, Lausanne CH-1015, Switzerland
| | - Julien Favre
- Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne CH-1011, Switzerland
| |
Collapse
|
28
|
Shi D, Zhang W, Ding X, Sun L. Parametric generation of three-dimensional gait for robot-assisted rehabilitation. Biol Open 2020; 9:bio047332. [PMID: 32001490 PMCID: PMC7063668 DOI: 10.1242/bio.047332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022] Open
Abstract
For robot-assisted rehabilitation and assessment of patients with motor dysfunction, the parametric generation of their normal gait as the input for the robot is essential to match with the features of the patient to a greater extent. In addition, the gait needs to be in three-dimensional space, which meets the physiological structure of the human better, rather than only on a sagittal plane. Thus, a method for the parametric generation of three-dimensional gait based on the influence of the motion parameters and structure parameters is presented. First, the three-dimensional gait kinematic of participants is collected, and trajectories of ankle joint angle and ankle center position are calculated. Second, for the trajectories, gait features are extracted including gait events indicating the physiological features of walking gait, in addition to extremes indicating the geometrical features of the trajectories. Third, regression models are derived after using leave-one-out cross-validation for model optimization. Finally, cubic splines are fitted between the predicted gait features to generate the trajectories for a full gait cycle. It is inferred that the generated curves match the measured curves well. The method presented herein gives an important reference for research into lower limb rehabilitation robots.
Collapse
Affiliation(s)
- Di Shi
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
| | - Wuxiang Zhang
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
| | - Xilun Ding
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
| | - Lei Sun
- Beijing Institute Traumatology & Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
| |
Collapse
|
29
|
Marriott KA, Birmingham TB, Leitch KM, Pinto R, Giffin JR. Strong independent associations between gait biomechanics and pain in patients with knee osteoarthritis. J Biomech 2019; 94:123-129. [DOI: 10.1016/j.jbiomech.2019.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
|
30
|
Influence of foot progression angle on knee adduction and flexion moment during stair climbing in healthy individuals. Gait Posture 2019; 71:163-169. [PMID: 31071539 DOI: 10.1016/j.gaitpost.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/31/2019] [Accepted: 03/15/2019] [Indexed: 02/02/2023]
|
31
|
Ankle Joint and Rearfoot Biomechanics During Toe-In and Toe-Out Walking in People With Medial Compartment Knee Osteoarthritis. PM R 2019; 11:503-511. [PMID: 30195708 DOI: 10.1016/j.pmrj.2018.08.388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/25/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Toe-in and toe-out walking are 2 strategies that have been shown to be effective in reducing the knee adduction moment in people with knee osteoarthritis. However, despite a positive biomechanical impact on the knee, altering foot rotation may impart unintended forces or joint positions on the ankle that could impact joint health. The kinematic and kinetic changes at the ankle during toe-in or toe-out walking have yet to be examined. OBJECTIVE To examine ankle/rearfoot biomechanics during toe-in and toe-out walking in those with knee osteoarthritis. DESIGN Single-session repeated measures design to compare ankle biomechanics during walking with 4 different foot rotations. SETTING University motion analysis laboratory. PARTICIPANTS A convenience sample (N = 15) of males and females with a diagnosis of medial knee osteoarthritis confirmed by radiographs. METHODS Participants walked in 4 conditions guided by real-time biofeedback: (1) toe-in (+10°), (2) zero rotation (0°), (3) toe-out (-10°), and (4) toe-out (-20°). Ankle and rearfoot kinematics and kinetics were examined during barefoot over-ground walking. MAIN OUTCOME MEASURES Ankle joint angles, moments, moment impulses, and foot rotation. RESULTS Overall, toe-in compared to toe-out walking decreased (P = .03) peak rearfoot eversion (toe-in = -1.6°; 10° toe-out = -3.7°; 20° toe-out = -4.1°). Toe-in compared to toe-out walking also increased rearfoot inversion at initial contact (7.4° vs 3.1° at 10° toe-out and 1.9° at 20° toe-out; P < .001) and frontal plane rearfoot angle excursion (9.0° vs 6.8° at 10° toe-out and 6.0° at 20° toe-out; P < .006). Toe-in compared to all other conditions increased peak external ankle inversion moments (0.04 Nm/kg vs 0.02 Nm/kg at 0°, 0.02 Nm/kg at 10° toe-out, and 0.01 Nm/kg at 20° toe-out; P < .003). CONCLUSIONS Toe-in and toe-out walking require different ankle/rearfoot biomechanics, though no differences in discomfort were observed. Longer-term studies are required to properly assess these relationships in knee osteoarthritis populations. LEVEL OF EVIDENCE IV.
Collapse
|
32
|
Wang S, Chan KHC, Lam RHM, Yuen DNS, Fan CKM, Chu TTC, Baur H, Cheung RTH. Effects of foot progression angle adjustment on external knee adduction moment and knee adduction angular impulse during stair ascent and descent. Hum Mov Sci 2019; 64:213-220. [PMID: 30784892 DOI: 10.1016/j.humov.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/19/2022]
Abstract
Foot progression angle adjustment was shown to reduce external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) during level ground walking. However, evidence on effects of foot progression angle adjustment on the above surrogate measures of medial knee loading during stair climbing is limited. Hence, this study examined the effects of toe-in and toe-out gait on EKAM and KAAI during stair ascent and descent. Kinematic and kinetic data were collected from thirty-two healthy adults during stair ascent and descent with toe-in, toe-out and natural gait. A repeated measures ANOVA indicated that toe-in gait significantly reduced the first EKAM peak (P < 0.001) and KAAI (P = 0.002), while toe-out gait significantly increased the first (P < 0.001) and second (P = 0.04) EKAM peaks and KAAI (P < 0.001) when compared with natural gait during stair ascent. During stair descent, toe-in gait significantly reduced the first (P < 0.001) and second (P = 0.032) EKAM peaks and KAAI (P < 0.001), whilst toe-out gait significantly increased the first EKAM peak (P = 0.022) and KAAI (P = 0.028) when compared with natural gait. In conclusion, toe-in gait was found to be a viable strategy in reducing medial knee loading during stair climbing.
Collapse
Affiliation(s)
- Sizhong Wang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Kitty H C Chan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Rachel H M Lam
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Daisy N S Yuen
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Carmen K M Fan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Thomas T C Chu
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Heiner Baur
- Movement Laboratory, Health Department, Bern University of Applied Sciences, Switzerland
| | - Roy T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| |
Collapse
|
33
|
Marriott K, Birmingham TB, Pinto R, Primeau C, Bryant D, Degen R, Giffin JR. Gait biomechanics after combined HTO-ACL reconstruction versus HTO alone: A matched cohort study. J Orthop Res 2019; 37:124-130. [PMID: 30303555 DOI: 10.1002/jor.24157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening-wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO-ACLR). Fifty-two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [-1.34 %BW × Ht (-1.71, -0.96) and -1.72 %BW × Ht (-1.99, -1.44) for HTO and HTO-ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [-0.88 %BW × Ht (-1.45, -0.31)] but not in the HTO-ACLR group [0.03 %BW × Ht (-0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening-wedge HTO and ACL reconstruction may not experience the same long-term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Collapse
Affiliation(s)
- Kendal Marriott
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Ryan Pinto
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Codie Primeau
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Ryan Degen
- The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
34
|
Mauricio E, Sliepen M, Rosenbaum D. Acute effects of different orthotic interventions on knee loading parameters in knee osteoarthritis patients with varus malalignment. Knee 2018; 25:825-833. [PMID: 30017510 DOI: 10.1016/j.knee.2018.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 06/05/2018] [Accepted: 06/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is the most common form of arthritis with an estimated lifetime prevalence of 45%. The use of orthotic devices is a generally accepted conservative therapy in KOA. A new conservative treatment is an ankle-foot orthosis (AFO); however, studies on the biomechanical effects are limited. The aim of this study was to examine the acute effects of different orthotic devices (AFO, knee brace and wedged shoes) on (un)loading parameters in subjects with KOA. METHODS Fifty-two medial KOA patients (mean age 59 (standard deviation (SD) 10) years and mean body mass index 27.5 (SD 4.9) kg/m2) were recruited. Three-dimensional gait analysis was undertaken with different interventions in a randomized order: control (own shoes), new AFO, conventional unloader brace and laterally wedged shoes (six degrees). RESULTS Significant decreases of 27% and nine percent in first peak knee adduction moment (KAM) were observed for the AFO and wedged shoes, respectively, in comparison with the control. Significant decreases of 21%, seven percent and 18% in the KAM impulse were observed for the AFO, brace and wedged shoes, respectively, compared to the control. The knee flexion moment (KFM) increased compared to the control for all conditions, but only significantly while using the AFO, showing an increase of 26% as compared to the control. CONCLUSIONS The AFO and wedged shoes were more effective in unloading the medial compartment of the knee compared to the unloader brace. However, the effect of an increased KFM on KOA remains unclear and requires further investigation.
Collapse
Affiliation(s)
- Elsa Mauricio
- Funktionsbereich Bewegungsanalytik, IEMM, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, Gebäude D3, 48129 Münster, Germany.
| | - Maik Sliepen
- Funktionsbereich Bewegungsanalytik, IEMM, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, Gebäude D3, 48129 Münster, Germany
| | - Dieter Rosenbaum
- Funktionsbereich Bewegungsanalytik, IEMM, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, Gebäude D3, 48129 Münster, Germany
| |
Collapse
|
35
|
Mahmoudian A, Van Assche D, Herzog W, Luyten FP. Towards secondary prevention of early knee osteoarthritis. RMD Open 2018; 4:e000468. [PMID: 30167325 PMCID: PMC6109947 DOI: 10.1136/rmdopen-2017-000468] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 01/09/2023] Open
Abstract
Osteoarthritis (OA) of the knee is the most common arthritic disease, yet a convincing drug treatment is not available. The current narrative review focuses on integration of scientific evidence and professional experience to illustrate which management approaches can be taken for prototypical individual patient profiles with early knee OA. Animal models suggest that: (1) OA can progress even in the presence of fully recovered movement kinetics, kinematics and muscle activation patterns; (2) muscle weakness is an independent risk factor for the onset and possibly the rate of progression of knee OA; (3) onset and progression of OA are not related to body weight but appear to depend on the percentage of body fat. From studies in the human model, one could postulate that risk factors associated with progression of knee OA include genetic traits, preceding traumatic events, obesity, intensity of pain at baseline, static and dynamic joint malalignment and reduced muscle strength. Taken this into account, an individual can be identified as early knee OA at high risk for disease progression. A holistic patient-tailored management including education, supportive medication, weight loss, exercise therapy (aerobic, strengthening and neuromuscular) and behavioural approaches to improve self-management of early knee OA is discussed in individual prototypic patients. Secondary prevention of early knee OA provides a window of opportunity to slow down or even reverse the disease process. Yet, as the sheer number of patients early in the OA disease process is probably large, a more structured approach is needed to provide appropriate care depending on the patient's individual risk profile.
Collapse
Affiliation(s)
- Armaghan Mahmoudian
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Dieter Van Assche
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Walter Herzog
- Human Performance Laboratory, The University of Calgary, Calgary, Alberta, Canada
| | - Frank P Luyten
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
36
|
Sliepen M, Mauricio E, Rosenbaum D. Acute and mid-term (six-week) effects of an ankle-foot-orthosis on biomechanical parameters, clinical outcomes and physical activity in knee osteoarthritis patients with varus malalignment. Gait Posture 2018; 62:297-302. [PMID: 29609157 DOI: 10.1016/j.gaitpost.2018.03.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/05/2018] [Accepted: 03/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a painful disease commonly caused by high loads on the articular cartilage. Orthotic interventions aim to reduce mechanical loading, thereby alleviating pain. Traditional orthotics appear effective, but high drop-out rates have been reported over prolonged periods. RESEARCH QUESTION The aim of this study was to examine the effect of a novel ankle-foot orthosis (AFO) on gait parameters, physical function and activity of KOA patients. METHODS 29 clinically diagnosed KOA patients with varus malalignment wore an AFO for 6 weeks. Prior to and after the intervention period, 3D gait analysis, physical function tests and the KOOS questionnaire were administered. Physical activity was objectively assessed with accelerometers. RESULTS The AFO immediately reduced the first peak of the knee adduction moment (KAM) and the KAM impulse by 41% and 19%. The knee flexion moment (KFM) was increased by 48%. After six weeks, the first KAM peak and KAM impulse were decreased by 27% and 19% while using the AFO. The KFM was increased by 71%. Furthermore, patients completed the functional tests faster (1.4-2.6%). The KOOS scores decreased significantly. No significant differences were found in physical activity parameters. SIGNIFICANCE The six-week AFO application significantly reduced the KAM. The patients' physical function appeared improved; yet these improvements were only minor and therefore arguably clinically irrelevant. The KFM appeared to be negatively affected after six weeks, as were the scores on the KOOS subscales. In summary, even though the AFO reduced the KAM and improved physical function, the clinical benefit for KOA patients with varus malalignment after the 6-week AFO application is debatable.
Collapse
Affiliation(s)
- Maik Sliepen
- Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Münster, Germany.
| | - Elsa Mauricio
- Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Münster, Germany.
| | - Dieter Rosenbaum
- Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Münster, Germany; Otto Bock Healthcare GmbH, Göttingen, Germany.
| |
Collapse
|
37
|
Fryzowicz A, Dworak LB, Koczewski P. Prophylaxis of medial compartment gonarthrosis in varus knee - current state of knowledge. Arch Med Sci 2018; 14:454-459. [PMID: 29593820 PMCID: PMC5868653 DOI: 10.5114/aoms.2016.57961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/08/2015] [Indexed: 12/27/2022] Open
Abstract
The progression of gonarthrosis results in reduction of physical activity. One of the factors that increase the risk of osteoarthrosis may be joint overload related to the malalignment of the mechanical axis of the lower extremity. The medial compartment (MC) of the knee is particularly susceptible to overload due to the external knee adduction moment (EKAM). Varus knee malalignment contributes to increased EKAM and thus results in increased MC loading. The purpose of this study is to present methods described in current literature aimed at reducing the disproportion in the distribution of loads on articular surfaces of medial and lateral knee compartments in people with varus knee malalignment. Methods have been divided into non-surgical (gait training, physiotherapy, and orthopedic supplies such as valgus braces, lateral wedge insoles, walking poles) and surgical ones (corrective osteotomy).
Collapse
Affiliation(s)
- Anna Fryzowicz
- Chair of Biomechanics, University School of Physical Education, Poznan, Poland
| | | | - Paweł Koczewski
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
38
|
Gait analysis in short-term follow-up of medial opening wedge high tibial osteotomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:939-946. [PMID: 29234863 DOI: 10.1007/s00590-017-2099-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Biomechanical gait changes are proposed as adaptations to medial knee osteoarthritis (OA), and little is known about which parameters can be modified early by high tibial osteotomy (HTO) surgery. The aim of this study was to identify early gait changes in a postoperative period of 6 months as compared to a control group, in three different spatial planes. METHODS Twenty-one patients with OA were submitted to three-dimensional gait analysis preoperatively and 6 months after HTO surgery. Sixteen healthy individuals were selected for the control group. RESULTS Compared to the control group, OA patients walked more slowly, with a shorter stride length, and with a higher knee varus and flexion angles. The gait changes detected in the postoperative of 6 months were a significant reduction in knee varus angle and adductor moment in coronal plane; an important reduction in knee extension and an increased extensor moment in sagittal plane; also an increased foot external rotation angle in axial plane was observed. Flexion angle peak in swing phase, adductor and flexor moments were the gait parameters with postoperatively results that were closer to those of the control group. CONCLUSIONS Even in a short follow-up of 6 months, HTO determines positive results in biomechanical gait, not only in the coronal plane but also in the sagittal and axial planes and should be taken into account during the rehabilitation process.
Collapse
|
39
|
Bennett HJ, Shen G, Cates HE, Zhang S. Effects of toe-in and toe-in with wider step width on level walking knee biomechanics in varus, valgus, and neutral knee alignments. Knee 2017; 24:1326-1334. [PMID: 28970124 DOI: 10.1016/j.knee.2017.08.058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased peak external knee adduction moments exist for individuals with knee osteoarthritis and varus knee alignments, compared to healthy and neutrally aligned counterparts. Walking with increased toe-in or increased step width have been individually utilized to successfully reduce 1st and 2nd peak knee adduction moments, respectfully, but have not previously been combined or tested among all alignment groups. The purpose of this study was to compare toe-in only and toe-in with wider step width gait modifications in individuals with neutral, valgus, and varus alignments. METHODS Thirty-eight healthy participants with confirmed varus, neutral, or valgus frontal-plane knee alignment through anteroposterior radiographs, performed level walking in normal, toe-in, and toe-in with wider step width gaits. A 3×3 (group×intervention) mixed model repeated measures ANOVA compared alignment groups and gait interventions (p<0.05). RESULTS The 1st peak knee adduction moment was reduced in both toe-in and toe-in with wider step width compared to normal gait. The 2nd peak adduction moment was increased in toe-in compared to normal and toe-in with wider step width. The adduction impulse was also reduced in toe-in and toe-in with wider step width compared to normal gait. Peak knee flexion and external rotation moments were increased in toe-in and toe-in with wider step width compared to normal gait. CONCLUSION Although the toe-in with wider step width gait seems to be a viable option to reduce peak adduction moments for varus alignments, sagittal, and transverse knee loadings should be monitored when implementing this gait modification strategy.
Collapse
Affiliation(s)
- Hunter J Bennett
- Department of Human Movement Sciences, Old Dominion University, Norfolk, VA, USA
| | - Guangping Shen
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | | | - Songning Zhang
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA.
| |
Collapse
|
40
|
Uhlrich SD, Silder A, Beaupre GS, Shull PB, Delp SL. Subject-specific toe-in or toe-out gait modifications reduce the larger knee adduction moment peak more than a non-personalized approach. J Biomech 2017; 66:103-110. [PMID: 29174534 DOI: 10.1016/j.jbiomech.2017.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022]
Abstract
The knee adduction moment (KAM) is a surrogate measure for medial compartment knee loading and is related to the progression of knee osteoarthritis. Toe-in and toe-out gait modifications typically reduce the first and second KAM peaks, respectively. We investigated whether assigning a subject-specific foot progression angle (FPA) modification reduces the peak KAM by more than assigning the same modification to everyone. To explore the effects of motor learning on muscle coordination and kinetics, we also evaluated the peak knee flexion moment and quadriceps-hamstring co-contraction during normal walking, when subjects first learned their subject-specific FPA, and following 20 min of training. Using vibrotactile feedback, we trained 20 healthy adults to toe-in and toe-out by 5° and 10° relative to their natural FPA, then identified the subject-specific FPA as the angle where each subject maximally reduced their larger KAM peak. When walking at their subject-specific FPA, 18 subjects significantly reduced their larger KAM peak; 8 by toeing-in and 10 by toeing-out. On average, subjects reduced their larger KAM peak by 18.6 ± 16.2% when walking at their subject-specific FPA, which was more than the reductions achieved when all subjects toed-in by 10° (10.0 ± 17.1%, p = .013) or toed-out by 10° (11.0 ± 18.3%, p = .002). Quadriceps-hamstring co-contraction and the peak knee flexion moment increased when subjects first learned their subject-specific FPA, but only co-contraction returned to baseline levels following training. These findings demonstrate that subject-specific gait modifications reduce the peak KAM more than uniformly assigned modifications and have the potential to slow the progression of medial compartment knee osteoarthritis.
Collapse
Affiliation(s)
- Scott D Uhlrich
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, United States; Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, CA 94304, United States.
| | - Amy Silder
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States; Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, CA 94304, United States
| | - Gary S Beaupre
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States; Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, CA 94304, United States
| | - Peter B Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Scott L Delp
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, United States; Department of Bioengineering, Stanford University, Stanford, CA 94305, United States; Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, United States
| |
Collapse
|
41
|
Ota S, Ogawa Y, Ota H, Fujiwara T, Sugiyama T, Ochi A. Beneficial effects of a gait used while wearing a kimono to decrease the knee adduction moment in healthy adults. PLoS One 2017. [PMID: 28640896 PMCID: PMC5480874 DOI: 10.1371/journal.pone.0179260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The knee adduction moment (KAM) relates to medial knee osteoarthritis (OA). Several gait modifications to reduce the KAM for the prevention of knee OA have been studied. Most of the modifications, however, involve voluntary changes in leg alignment. Here we investigated the biomechanical effects for reducing the KAM of a walking style with a small trunk rotation and arm swing gait, which is a natural walking style used while wearing a kimono (Nanba walk) that shifts the ground reaction force toward the stance leg (reduced lever arm). Twenty-nine healthy adults (21.5 ± 0.6 years) participated in the present study. A three-dimensional analysis system with 10 cameras and 1 force plate was used to obtain the KAM and other biomechanical data. Surface electromyography (EMG) of the hip and trunk muscles (internal obliquus abdominal muscle: IO, external obliquus abdominal muscle: EO, multifidus muscle: MF, and gluteus medius muscle: Gmed) was also assessed, and integrated EMG (iEMG) of the four muscles was assessed in the first and second halves of the stance phase. The 1st and 2nd peak KAMs were significantly decreased during Nanba walking (0.40±0.09 and 0.37±0.13 Nm/kg) compared with normal walking (0.45±0.09 and 0.45±0.13 Nm/kg; P = 0.002, P<0.001, respectively). The lever arm lengths at the 1st and 2nd peak KAMs were also significantly decreased during Nanba walking compared with normal walking (p = 0.023 and p<0.001, respectively). The iEMGs of IO, EO and Gmed muscles during the first half, and the iEMGs of EO and GM during the second half of the stance phase were significantly increased during Nanba walking compared with normal walking. The Nanba gait modification could be a useful strategy for reducing the KAM with high activation of the trunk and hip joint muscles for the prevention and/or treatment of medial knee OA.
Collapse
Affiliation(s)
- Susumu Ota
- Department of Rehabilitation and Care, Seijoh University, Tokai, Japan
- * E-mail:
| | - Yukari Ogawa
- Department of Physical Medicine and Rehabilitation, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Hiroki Ota
- Department of Physical Medicine and Rehabilitation, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | | | - Tadashi Sugiyama
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Akira Ochi
- Department of Rehabilitation and Care, Seijoh University, Tokai, Japan
| |
Collapse
|
42
|
Chen DKY, Haller M, Besier TF. Wearable lower limb haptic feedback device for retraining Foot Progression Angle and Step Width. Gait Posture 2017; 55:177-183. [PMID: 28460321 DOI: 10.1016/j.gaitpost.2017.04.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/10/2017] [Accepted: 04/21/2017] [Indexed: 02/02/2023]
Abstract
Technological developments in the last decade have enabled the integration of sensors and actuators into wearable devices for gait interventions to slow the progression of knee osteoarthritis. Wearable haptic gait retraining is one area which has seen promising results for informing modifications of gait parameters for reducing knee adduction moments (KAM) during walking. Two gait parameters which can be easily adjusted to influence KAM include foot progression angle (FPA) and step width (SW). The purpose of this study was to: (1) determine whether a custom haptic ankle bracelet using binary vibrotactile and tactile apparent movement feedback could retrain ten healthy subjects to walk with a modified FPA and SW within a short training session with 80% accuracy; and (2) whether there was a difference between the number of steps required to complete the retraining task based on the two feedback schemes being tested. Retraining multiple gait parameters using a single device was a novel aspect of this work and we found that nine out of ten subjects were able to retrain their gait using the ankle bracelet in both feedback schemes to within 2° and 39mm of target FPA and SW respectively. We also found no difference in the number steps required for completion between the two schemes (p>0.05). Future research will investigate the device performance with patients with knee osteoarthritis and the effective change in KAM by modifying a combination of FPA and SW.
Collapse
Affiliation(s)
- Daniel K Y Chen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
| | - Markus Haller
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Thor F Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Dept of Engineering Science, University of Auckland, Auckland, New Zealand
| |
Collapse
|
43
|
Moyer R, Birmingham T, Dombroski C, Walsh R, Giffin JR. Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis. Gait Posture 2017; 54:160-166. [PMID: 28301825 DOI: 10.1016/j.gaitpost.2017.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17-0.52, p<0.001) were observed during stair descent; and significant increases in the EKFM were observed during stair ascent (0.54, 95%CI: 0.30-0.78, p<0.001) and descent (1stpk: 0.48, 95%CI: 0.15-0.80, p=0.005; 2ndpk: 0.55, 95%CI: 0.34-0.76, p<0.001). Fewer gait compensations were observed between conditions during stair descent compared to ascent, except for toe out. Findings suggest greater effects on gait when both knee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes.
Collapse
Affiliation(s)
- Rebecca Moyer
- School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Trevor Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada.
| | - Colin Dombroski
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada
| | - Robert Walsh
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada; Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
44
|
Whelton C, Thomas A, Elson DW, Metcalfe A, Forrest S, Wilson C, Holt C, Whatling G. Combined effect of toe out gait and high tibial osteotomy on knee adduction moment in patients with varus knee deformity. Clin Biomech (Bristol, Avon) 2017; 43:109-114. [PMID: 28237873 DOI: 10.1016/j.clinbiomech.2017.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait adaptations, including toe out gait, have been proposed as treatments for knee osteoarthritis. The clinical application of toe out gait, however, is unclear. This study aims to identify the changes in Knee adduction moment in varus knee deformity assessing toe out gait as an alternative to high tibial osteotomy, and if any change in dynamic loading persists post operatively, when anatomical alignment is restored. METHODS Three-dimensional motion analysis was performed on 17 patients with medial compartment knee osteoarthritis and varus deformity prior to undergoing high tibial osteotomy, 13 patients were assessed post-operatively, and results compared to 13 healthy controls. FINDINGS Pre-operatively, there was no significant difference between natural and toe out gait for measures of knee adduction moment. Post high tibial osteotomy, first (2.70 to 1.51% BW·h) and second peak (2.28 to 1.21% BW·h) knee adduction moment were significantly reduced, as was knee adduction angular impulse (1.00 to 0.52% BW·h·s), to a healthy level. Adopting toe out gait post-operatively reduced the second peak further to a level below that of healthy controls. INTERPRETATION Increasing the foot progression angle from 20° (natural) to 30° in isolation did not significantly alter the knee adduction moment or angular impulse. This suggests that adopting a toe out gait, in isolation, in an already high natural foot progression angle, is not of benefit. Adopting toe out gait post-operatively, however, resulted in a further reduction in the second peak to below that of the healthy control cohort, however, this may increase lateral compartment load.
Collapse
Affiliation(s)
- C Whelton
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - A Thomas
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - D W Elson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - A Metcalfe
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - S Forrest
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - C Wilson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - C Holt
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - G Whatling
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK.
| |
Collapse
|
45
|
Favre J, Erhart-Hledik JC, Chehab EF, Andriacchi TP. General scheme to reduce the knee adduction moment by modifying a combination of gait variables. J Orthop Res 2016; 34:1547-56. [PMID: 26744298 DOI: 10.1002/jor.23151] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/21/2015] [Indexed: 02/04/2023]
Abstract
Reducing the knee adduction moment (KAM) is a promising treatment for medial compartment knee osteoarthritis (OA). Although several gait modifications to lower the KAM have been identified, the potential to combine modifications and individual dose-responses remain unknown. This study hypothesized that: (i) there is a general scheme consisting of modifications in trunk sway, step width, walking speed, and foot progression angle that reduces the KAM; (ii) gait modifications can be combined; and (iii) dose-responses differ among individuals. Walking trials with simultaneous modifications in step width, walking speed, progression angle, and trunk sway were analyzed for 10 healthy subjects. Wider step width, slower speed, toeing-in, and increased trunk sway resulted in reduced first KAM peak, whereas wider step width, faster speed, and increased trunk sway reduced the KAM angular impulse. Individual regressions accurately modeled the amplitude of the KAM variables relative to the amplitude of the gait modification variables, while the dose-responses varied strongly among participants. In conclusion, increasing trunk sway, increasing step width, and toeing-in are three gait modifications that could be combined to reduce KAM variables related to knee OA. Results also indicated that some gait modifications reducing the KAM induced changes in the knee flexion moment possibly indicative of an increase in knee loading. Taken together with the different dose-responses among subjects, this study suggested that gait retraining programs should consider this general scheme of modifications with individualization of the modification amplitudes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1547-1556, 2016.
Collapse
Affiliation(s)
- Julien Favre
- Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.,Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Jennifer C Erhart-Hledik
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Eric F Chehab
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Bioengineering, Stanford University, Stanford, California
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| |
Collapse
|
46
|
Liu W, Kovaleski JE, Kepple TM, Wolfe J, Decoux B, McCarthy JP, Singh J, Lewis CE. Does T'ai Chi Gait Reduce External Knee Adduction Moment? J Altern Complement Med 2016; 22:818-823. [PMID: 27347603 DOI: 10.1089/acm.2014.0174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION T'ai chi chuan is a beneficial exercise of improving health and function. Biomechanical insights of t'ai chi chuan are less understood. OBJECTIVES To study t'ai chi gait (TCG), a common form of t'ai chi chuan in order to quantify external knee adduction moment (EKAM) as a key indicator of mechanical loading of the medial compartment of the knee compared with normal walking (NW). DESIGN A quantitative biomechanics approach to determine peak EKAM for NW and TCG. RESULTS There were a tri-modal pattern of EKAM during TCG and a bimodal pattern of EKAM during normal walking. In addition, subsequent analysis showed a 25%-47% reduction in peak EKAM during double support phases of TCG compared with NW; the peak EKAM of TCG during single-limb support phase showed significantly higher magnitude than the other two double-support phases. CONCLUSION These results indicate that t'ai chi chuan might be a beneficial intervention for reducing the medial mechanical load at the knee joint, particularly during the first double-support phases of TCG, but the special consideration of higher peak EKAM of single-limb support phase is needed during regular t'ai chi chuan practice.
Collapse
Affiliation(s)
- Wei Liu
- 1 Division of Osteopathic Rehabilitation and Biomechaincs, Edward Via College of Osteopathic Medicine , Auburn, AL
| | - John E Kovaleski
- 2 Department of Health, Kinesiology and Sport, University of South Alabama , Mobile, AL
| | | | - Jonathan Wolfe
- 2 Department of Health, Kinesiology and Sport, University of South Alabama , Mobile, AL
| | - Brandi Decoux
- 4 School of Kinesiology, Auburn University , Auburn, AL
| | - John P McCarthy
- 5 Department of Human Movement Sciences. Carroll University , Waukesha, WI
| | - Jasvinder Singh
- 6 Division of Rheumatology, University of Alabama Birmingham , Birmingham, AL
| | - Cora E Lewis
- 7 Division of Preventive Medicine, University of Alabama Birmingham , Birmingham, AL
| |
Collapse
|
47
|
MacLean KF, Callaghan JP, Maly MR. Effect of obesity on knee joint biomechanics during gait in young adults. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1173778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kathleen F.E. MacLean
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Canada
| | - Jack P. Callaghan
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Canada
| | - Monica R. Maly
- Department of Rehabilitation Sciences, McMaster University, Room 435 Institutes of Applied Health Sciences, 1400 Main Street West, Hamilton, Ontario, Canada L8S 1C7
| |
Collapse
|
48
|
Tanikawa H, Ohtsuka K, Mukaino M, Inagaki K, Matsuda F, Teranishi T, Kanada Y, Kagaya H, Saitoh E. Quantitative assessment of retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegia using three-dimensional treadmill gait analysis. Top Stroke Rehabil 2016; 23:311-7. [PMID: 27077992 DOI: 10.1080/10749357.2016.1156361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gait assessment is important to determine the most effective strategy to regain gait function during stroke rehabilitation. To understand the mechanisms that cause abnormal gait patterns, it is useful to objectively identify and quantify the abnormal gait patterns. Objective assessment also helps evaluate the efficacy of treatments and can be used to provide suggestions for treatment. OBJECTIVE To evaluate the validity of quantitative indices for retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegic patients. METHODS Forty-six healthy control subjects and 112 hemiplegic patients participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the three abnormal gait patterns was calculated from the three-dimensional coordinate data. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment by three physical therapists with expertise in gait analysis. RESULTS Strong correlation was observed between the index value and the median observational rating for all three abnormal gait patterns (-0.56 to -0.74). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. CONCLUSIONS The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.
Collapse
Affiliation(s)
- Hiroki Tanikawa
- a Faculty of Rehabilitation , School of Health Sciences, Fujita Health University , Toyoake , Aichi , Japan
| | - Kei Ohtsuka
- a Faculty of Rehabilitation , School of Health Sciences, Fujita Health University , Toyoake , Aichi , Japan
| | - Masahiko Mukaino
- b Department of Rehabilitation Medicine I , School of Medicine, Fujita Health University , Toyoake , Aichi , Japan
| | - Keisuke Inagaki
- c Department of Rehabilitation , Fujita Health University Hospital , Toyoake , Aichi , Japan
| | - Fumihiro Matsuda
- a Faculty of Rehabilitation , School of Health Sciences, Fujita Health University , Toyoake , Aichi , Japan
| | - Toshio Teranishi
- a Faculty of Rehabilitation , School of Health Sciences, Fujita Health University , Toyoake , Aichi , Japan
| | - Yoshikiyo Kanada
- a Faculty of Rehabilitation , School of Health Sciences, Fujita Health University , Toyoake , Aichi , Japan
| | - Hitoshi Kagaya
- b Department of Rehabilitation Medicine I , School of Medicine, Fujita Health University , Toyoake , Aichi , Japan
| | - Eiichi Saitoh
- b Department of Rehabilitation Medicine I , School of Medicine, Fujita Health University , Toyoake , Aichi , Japan
| |
Collapse
|
49
|
Sawada T, Kito N, Yukimune M, Tokuda K, Tanimoto K, Anan M, Takahashi M, Shinkoda K. Biomechanical effects of lateral and medial wedge insoles on unilateral weight bearing. J Phys Ther Sci 2016; 28:280-5. [PMID: 26957775 PMCID: PMC4756021 DOI: 10.1589/jpts.28.280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022] Open
Abstract
[Purpose] Lateral wedge insoles reduce the peak external knee adduction moment and are
advocated for patients with knee osteoarthritis. However, some patients demonstrate
adverse biomechanical effects with treatment. In this study, we examined the immediate
effects of lateral and medial wedge insoles under unilateral weight bearing. [Subjects and
Methods] Thirty healthy young adults participated in this study. The subjects were
assessed by using the foot posture index, and were divided into three groups: normal foot,
pronated foot, and supinated foot groups. The knee adduction moment and knee-ground
reaction force lever arm under the studied conditions were measured by using a
three-dimensional motion capture system and force plates. [Results] In the normal and
pronated groups, the change in knee adduction moment significantly decreased under the
lateral wedge insole condition compared with the medial wedge insole condition. In the
normal group, the change in the knee-ground reaction force lever arm also significantly
decreased under the lateral wedge insole condition than under the medial wedge insole
condition. [Conclusion] Lateral wedge insoles significantly reduced the knee adduction
moment and knee-ground reaction force lever arm during unilateral weight bearing in
subjects with normal feet, and the biomechanical effects varied according to individual
foot alignment.
Collapse
Affiliation(s)
- Tomonori Sawada
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Hiroshima International University, Japan
| | | | - Kazuki Tokuda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kenji Tanimoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Masaya Anan
- Institute of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Makoto Takahashi
- Institute of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Koichi Shinkoda
- Institute of Biomedical and Health Sciences, Hiroshima University, Japan
| |
Collapse
|
50
|
Wahid F, Begg R, McClelland JA, Webster KE, Halgamuge S, Ackland DC. A multiple regression normalization approach to evaluation of gait in total knee arthroplasty patients. Clin Biomech (Bristol, Avon) 2016; 32:92-101. [PMID: 26874198 DOI: 10.1016/j.clinbiomech.2015.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 12/09/2015] [Accepted: 12/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait features characteristic of a cohort may be difficult to evaluate due to differences in subjects' demographic factors and walking speed. The aim of this study was to employ a multiple regression normalization method that accounts for subject age, height, body mass, gender, and self-selected walking speed in the evaluation of gait in unilateral total knee arthroplasty patients. METHODS Three-dimensional gait analysis was performed on 45 total knee arthroplasty patients and 31 aged-matched controls walking at their self-selected speed. Gait data peaks including joint angles, ground reaction forces, net joint moments, and net joint powers were normalized using subject body mass, standard dimensionless equations, and a multiple regression approach that modeled subject age, height, body mass, gender, and self-selected walking speed. FINDINGS Normalizing gait data using subject body mass, dimensionless equations, and multiple regression approach resulted in a significantly lower knee adduction moment and knee extensor power in total knee arthroplasty patients compared to controls (p<0.05). In contrast to normalization using body mass and dimensionless equations, multiple regression normalization greatly reduced variance in gait data by minimizing correlations with subject demographic factors and walking speed, resulting in significantly higher peak hip extension angles and peak hip flexion powers in total knee arthroplasty patients (p<0.05). INTERPRETATION Total knee arthroplasty patients generate greater hip extension angles and hip flexor power and have a lower knee adduction moment than healthy controls. This gait pattern may be a strategy to reduce muscle and joint loading at the knee.
Collapse
Affiliation(s)
- Ferdous Wahid
- Department of Mechanical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Rezaul Begg
- College of Sport and Exercise Science, VIC University, Melbourne, VIC, Australia
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Saman Halgamuge
- Department of Mechanical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - David C Ackland
- Department of Mechanical Engineering, University of Melbourne, Melbourne, VIC, Australia.
| |
Collapse
|