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Hussain I, Kim SE, Kwon C, Hoon SK, Kim HC, Ku Y, Ro DH. Estimation of patient-reported outcome measures based on features of knee joint muscle co-activation in advanced knee osteoarthritis. Sci Rep 2024; 14:12428. [PMID: 38816528 PMCID: PMC11139965 DOI: 10.1038/s41598-024-63266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
Electromyography (EMG) is considered a potential predictive tool for the severity of knee osteoarthritis (OA) symptoms and functional outcomes. Patient-reported outcome measures (PROMs), such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), are used to determine the severity of knee OA. We aim to investigate muscle activation and co-contraction patterns through EMG from the lower extremity muscles of patients with advanced knee OA patients and evaluate the effectiveness of an interpretable machine-learning model to estimate the severity of knee OA according to the WOMAC (pain, stiffness, and physical function) and VAS using EMG gait features. To explore neuromuscular gait patterns with knee OA severity, EMG from rectus femoris, medial hamstring, tibialis anterior, and gastrocnemius muscles were recorded from 84 patients diagnosed with advanced knee OA during ground walking. Muscle activation patterns and co-activation indices were calculated over the gait cycle for pairs of medial and lateral muscles. We utilized machine-learning regression models to estimate the severity of knee OA symptoms according to the PROMs using muscle activity and co-contraction features. Additionally, we utilized the Shapley Additive Explanations (SHAP) to interpret the contribution of the EMG features to the regression model for estimation of knee OA severity according to WOMAC and VAS. Muscle activity and co-contraction patterns varied according to the functional limitations associated with knee OA severity according to VAS and WOMAC. The coefficient of determination of the cross-validated regression model is 0.85 for estimating WOMAC, 0.82 for pain, 0.85 for stiffness, and 0.85 for physical function, as well as VAS scores, utilizing the gait features. SHAP explanation revealed that greater co-contraction of lower extremity muscles during the weight acceptance and swing phases indicated more severe knee OA. The identified muscle co-activation patterns may be utilized as objective candidate outcomes to better understand the severity of knee OA.
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Affiliation(s)
- Iqram Hussain
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Department of Anesthesiology, Weill Cornell Medicine, Cornell University, New York, NY, 10065, USA
| | - Sung Eun Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Chiheon Kwon
- Medical Device Research Center, Department of Biomedical Research Institute, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Seo Kyung Hoon
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Hee Chan Kim
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Republic of Korea
| | - Yunseo Ku
- Medical Device Research Center, Department of Biomedical Research Institute, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea.
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- CONNECTEVE Co., Ltd, Seoul, 06224, Republic of Korea.
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
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Remedios S, Rutherford D. Lower extremity muscle patterns and frontal plane biomechanics are altered in the contralateral knee of adults with osteoarthritis compared to asymptomatic adults. J Electromyogr Kinesiol 2024; 75:102865. [PMID: 38316102 DOI: 10.1016/j.jelekin.2024.102865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
PURPOSE To compare knee joint muscle activity during gait between the contralateral limb of individuals with knee osteoarthritis (OA) and an asymptomatic older adult group. A secondary objective was to compare frontal and sagittal plane moment and sagittal plane motion features between groups. SCOPE 84 individuals with moderate knee OA (61 ± 6 years, 43 % female, BMI 29.2 ± 5.7 kg/m2), and 45 asymptomatic older adults (61 ± 7 years, 49 % female, BMI 25.0 ± 3.4 kg/m2) participated. Participants walked at a self-selected pace on a dual belt treadmill. Surface electromyograms of the quadriceps, hamstrings, and gastrocnemius, segment motions and ground reaction forces were recorded. Principal component analyses identified amplitude and temporal electromyogram features. Sagittal plane motion and net external sagittal and frontal plane moments were calculated. Analysis of Variance models using Bonferroni corrections determined between and within group differences in these gait features. CONCLUSIONS The contralateral knee showed prolonged lateral hamstring activation and altered temporal features of the gastrocnemius and greater knee adduction moments compared to asymptomatic adults. Group, muscle, or interaction effects were not found for the quadriceps. These findings highlight the importance of exploring the implications of contralateral knee function of individuals with moderate knee OA, particularly considering the altered antagonist muscle activations, and heightened frontal plane moments.
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Affiliation(s)
- Sarah Remedios
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - Derek Rutherford
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
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Taniguchi M, Umehara J, Yamagata M, Yagi M, Motomura Y, Okada S, Okada S, Nakazato K, Fukumoto Y, Kobayashi M, Kanemitsu K, Ichihashi N. Understanding muscle coordination during gait based on muscle synergy and its association with symptoms in patients with knee osteoarthritis. Clin Rheumatol 2024; 43:743-752. [PMID: 38133793 DOI: 10.1007/s10067-023-06852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/03/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE We aimed to investigate the muscle coordination differences between a control group and patients with mild and severe knee osteoarthritis (KOA) using muscle synergy analysis and determine whether muscle coordination was associated with symptoms of KOA. METHOD Fifty-three women with medial KOA and 19 control patients participated in the study. The gait analyses and muscle activity measurements of seven lower limb muscles were assessed using a motion capture system and electromyography. Gait speed and knee adduction moment impulse were calculated. The spatiotemporal components of muscle synergy were extracted using non-negative matrix factorization, and the dynamic motor control index during walking (walk-DMC) was computed. The number of muscle synergy and their spatiotemporal components were compared among the mild KOA, severe KOA, and control groups. Moreover, the association between KOA symptoms with walk-DMC and other gait parameters was evaluated using multi-linear regression analysis. RESULTS The number of muscle synergies was lower in mild and severe KOA compared with those in the control group. In synergy 1, the weightings of biceps femoris and gluteus medius in severe KOA were higher than that in the control group. In synergy 3, the weightings of higher tibial anterior and lower gastrocnemius lateralis were confirmed in the mild KOA group. Regression analysis showed that the walk-DMC was independently associated with knee-related symptoms of KOA after adjusting for the covariates. CONCLUSIONS Muscle coordination was altered in patients with KOA. The correlation between muscle coordination and KOA may be attributed to the knee-related symptoms. Key points • Patients with knee osteoarthritis (OA) experienced a deterioration in muscle coordination when walking. • Loss of muscle coordination was associated with severe knee-related symptoms in knee OA. • Considering muscle coordination as a knee OA symptom-related factor may provide improved treatment.
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Affiliation(s)
- Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiki Motomura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Kobayashi Orthopaedic Clinic, Kyoto, Japan
| | - Sayaka Okada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shogo Okada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kaede Nakazato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshihiro Fukumoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | | | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Lee S, Neogi T, Costello KE, Senderling B, Stefanik JJ, Frey-Law L, Kumar D. Association of mechanical temporal summation of pain with muscle co-contraction during walking in people with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2023; 110:106105. [PMID: 37778085 PMCID: PMC10841902 DOI: 10.1016/j.clinbiomech.2023.106105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND People with knee osteoarthritis walk with excessive muscle co-contraction that can accelerate disease progression. Central pain sensitization is common in people with knee osteoarthritis and may be related to walking patterns. The objective of this study was to examine the relation of central pain sensitization with muscle co-contraction during walking in people with knee osteoarthritis. METHODS This study reports secondary analysis from baseline data of two clinical trials (n = 90 participants with knee osteoarthritis). The presence of central pain sensitization was measured by mechanical temporal summation at the patella and the wrist. Quadriceps and hamstrings activation was assessed using surface electromyography during walking at self-selected and fast paces. Muscle co-contraction indices for vastus medialis-medial hamstrings and vastus lateralis-lateral hamstrings muscle pairs were calculated during stance phases. Co-contraction outcomes were compared between people with and without mechanical temporal summation at each site, adjusting for age, sex, and body mass index. FINDINGS People with mechanical temporal summation at the knee had greater vastus lateralis-lateral hamstrings co-contraction while walking at a fast pace (P = 0.04). None of the other differences was statistically significant, but the overall trends and effect sizes indicated greater co-contraction in people with temporal summation at the knee irrespective of gait phase, walking speed, or muscle pairs. INTERPRETATION Central pain sensitization, assessed as mechanical temporal summation at the knee, is related to greater knee muscle co-contraction during fast walking in people with knee osteoarthritis. Thus, mitigating central sensitization may be an interventional target to reduce muscle co-contraction for people with knee osteoarthritis.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kerry E Costello
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | | | - Joshua J Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Laura Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Deepak Kumar
- Department of Physical Therapy, Boston University, Boston, MA, USA; Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Matsumura U, Tsurusaki T, Ogusu R, Yamamoto S, Lee Y, Sunagawa S, Reid WD, Koseki H. The interrelationship between lower limb movement, muscle activity, and joint moment during half squat and gait. Heliyon 2023; 9:e21762. [PMID: 38028012 PMCID: PMC10651501 DOI: 10.1016/j.heliyon.2023.e21762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Joint moment is the resultant force of limb movements. However, estimation methods for joint moments using surface electromyography frequently use joint angles instead of limb angles. The limb angle in joint moment estimation using electromyography could clarify the effects of muscle activity on the limbs: acceleration, deceleration, or stabilization. No study has quantified the comprehensive relationship between limb movement, muscle activity, and joint moment. This study aimed to determine the influencing factors for ankle-joint moment and knee-joint moment in the sagittal plane among muscle activities and parameters related to limb movements during half squat and gait. This study included 29 healthy adults (16 female participants, 21.1 ± 2.09 years). Using inertial measurement units, thigh, shank, and foot inclination angles and angular accelerations were calculated as the parameters of limb movements. Muscle activations of the biceps femoris long head, rectus femoris, gastrocnemius, and tibialis anterior were measured. Ankle joint moment and knee-joint moment were measured using a three-dimensional motion capture system and two force plates. Regression models showed high accuracy in measuring ankle-joint moment during a half squat and gait (R2f = 0.92, 0.97, respectively) and knee-joint moment during a half squat (R2f = 0.98), but not knee-joint moment during gait (R2f = 0.63). However, only a maximum of five parameters were selected from muscle activities and limb angular information. Tibialis anterior and gastrocnemius activity were the largest contributors to ankle-joint moment during a half squat and gait, respectively, while muscle activities were not directly reflected in the knee-joint moment during either movement. Consideration of the interrelationships among limb movement, muscle activity, and joint moment is required when adjusting joint movements according to the target and aim of the therapeutic interventions.
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Affiliation(s)
- Umi Matsumura
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiya Tsurusaki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Rena Ogusu
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shimpei Yamamoto
- Department of Rehabilitation, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yeonghee Lee
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinya Sunagawa
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Rehabilitation, Wajinkai Hospital, Nagasaki, Japan
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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van de Ven WAF, Bosga J, Hullegie W, Verra WC, Meulenbroek RGJ. More Predictable and Less Automatized Movements during Walking -not during Repetitive Punching- in Knee Osteoarthritis. J Mot Behav 2023; 55:499-512. [PMID: 36990461 DOI: 10.1080/00222895.2023.2194242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Abstract
Using the non-affected leg as stable frame of reference for the affected leg in gait assessment in knee osteoarthritis (KO) fails due to compensatory mechanisms. Assessing the cyclical movements of the upper extremities in a frequency-controlled repetitive punching task may provide an alternative frame of reference in gait assessment in patients with KO. Eleven participants with unilateral KO and eleven healthy controls were asked to perform treadmill walking and repetitive punching. The KO group showed more predictable (p = 0.020) and less automatized (p = 0.007) movement behavior than controls during treadmill walking. During repetitive punching, the KO group showed a similar degree of predictability (p = 0.784) but relative more automatized movement behavior (p = 0.013). Thus, the predictability of the movement behavior of the upper extremities during repetitive punching seems unaffected by KO and could provide an alternative frame of reference in gait assessment in patients with KO.
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Affiliation(s)
- Werner A F van de Ven
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
- FysioHolland Twente, Enschede, The Netherlands
| | - Jurjen Bosga
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Wim Hullegie
- Physiotherapy practice Hullegie and Richter MSC, Enschede, The Netherlands
| | - Wiebe C Verra
- Department of Orthopedic Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ruud G J Meulenbroek
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
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Bowen W, Frazer AK, Tallent J, Pearce AJ, Kidgell DJ. Unilateral Strength Training Imparts a Cross-Education Effect in Unilateral Knee Osteoarthritis Patients. J Funct Morphol Kinesiol 2022; 7:jfmk7040077. [PMID: 36278738 PMCID: PMC9589957 DOI: 10.3390/jfmk7040077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Worldwide, 86 million individuals over the age of 20 were diagnosed with knee osteoarthritis (KOA) in 2020. Hallmark features of KOA are the loss in knee extensor strength, increasing knee pain severity, and deficits in functional performance. There is a critical need for the investigation into potential cost-effective therapeutic interventions in the treatment of KOA. A potential therapeutic option is the cross-education phenomenon. Methods: This was a non-blinded randomized control trial, with a 4-week intervention, with a pre, post and follow-up assessment (3 months post intervention). Outcome measures of isometric knee extensor strength, rectus femoris muscle thickness and neuromuscular activation were assessed at all-time points. Results: Compared to age-matched KOA controls, 4 weeks of unilateral strength training in end-stage KOA patients increased strength of the untrained affected KOA limb by 20% (p < 0.05) and reduced bilateral hamstring co-activation in the KOA intervention group compared to the KOA control group (p < 0.05). Conclusions: A 4-week-long knee extensor strength training intervention of the contralateral limb in a cohort with diagnosed unilateral KOA resulted in significant improvements to knee extensor strength and improved neuromuscular function of the KOA limb. Importantly, these results were maintained for 3 months following the intervention.
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Affiliation(s)
- Warren Bowen
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne 3125, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia
| | - Ashlyn K. Frazer
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
| | - Jamie Tallent
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK
| | - Alan J. Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia
| | - Dawson J. Kidgell
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
- Correspondence: ; Tel.: +61-3-9904-4119
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Alfayyadh A, Neal K, Williams JR, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Limb and sex-related differences in knee muscle co-contraction exist 3 months after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2022; 66:102693. [PMID: 36041294 DOI: 10.1016/j.jelekin.2022.102693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/06/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
Interlimb and sex-based differences in gait mechanics and neuromuscular control are common after anterior cruciate ligament reconstruction (ACLR). Following ACLR, individuals typically exhibit elevated co-contraction of knee muscles, which may accelerate knee osteoarthritis (OA) onset. While directed (medial/lateral) co-contractions influence tibiofemoral loading in healthy people, it is unknown if directed co-contractions are present early after ACLR and if they differ across limbs and sexes. The purpose of this study was to compare directed co-contraction indices (CCIs) of knee muscles in both limbs between men and women after ACLR. Forty-five participants (27 men) completed overground walking at a self-selected speed 3 months after ACLR during which quadriceps, hamstrings, and gastrocnemii muscle activities were collected bilaterally using surface electromyography. CCIs of six muscle pairs were calculated during the weight acceptance interval. The CCIs of the vastus lateralis/biceps femoris muscle pair (lateral musculature) was greater in the involved limb (vs uninvolved; p = 0.02). Compared to men, women exhibited greater CCIs in the vastus medialis/lateral gastrocnemius and vastus lateralis/lateral gastrocnemius muscle pairs (p < 0.01 and p = 0.01, respectively). Limb- and sex-based differences in knee muscle co-contractions are detectable 3 months after ACLR and may be responsible for altered gait mechanics.
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Affiliation(s)
- Abdulmajeed Alfayyadh
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Physical Therapy and Rehabilitation Department, Jouf University, Jouf, Saudi Arabia.
| | - Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Jack R Williams
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA
| | - Ashutosh Khandha
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Kurt Manal
- Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Thomas S Buchanan
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
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Medial and Lateral Tibiofemoral Compressive Forces in Patients Following Unilateral Total Knee Arthroplasty During Stationary Cycling. J Appl Biomech 2022; 38:179-189. [PMID: 35588765 DOI: 10.1123/jab.2020-0324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022]
Abstract
Patients following unilateral total knee arthroplasty (TKA) display interlimb differences in knee joint kinetics during gait and more recently, stationary cycling. The purpose of this study was to use musculoskeletal modeling to estimate total, medial, and lateral tibiofemoral compressive forces for patients following TKA during stationary cycling. Fifteen patients of unilateral TKA, from the same surgeon, participated in cycling at 2 workrates (80 and 100 W). A knee model (OpenSim 3.2) was used to estimate total, medial, and lateral tibiofemoral compressive forces for replaced and nonreplaced limbs. A 2 × 2 (limb × workrate) and a 2 × 2 × 2 (compartment × limb × workrate) analysis of variance were run on the selected variables. Peak medial tibiofemoral compressive force was 23.5% lower for replaced compared to nonreplaced limbs (P = .004, G = 0.80). Peak medial tibiofemoral compressive force was 48.0% greater than peak lateral tibiofemoral compressive force in nonreplaced limbs (MD = 344.5 N, P < .001, G = 1.6) with no difference in replaced limbs (P = .274). Following TKA, patients have greater medial compartment loading on their nonreplaced compared to their replaced limbs and ipsilateral lateral compartment loading. This disproportionate loading may be cause for concern regarding exacerbating contralateral knee osteoarthritis.
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Mets M, Tootsi P, Sokk J, Ereline J, Haviko T, Pääsuke M, Gapeyeva H. Thigh Muscle Activation After a Home Exercise Program in Knee Osteoarthritis Patients. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2036295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Monika Mets
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Piret Tootsi
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Jelena Sokk
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Jaan Ereline
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Tiit Haviko
- Department of Traumatology and Orthopaedics, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Mati Pääsuke
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
| | - Helena Gapeyeva
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia
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Rutherford D, Baker M, Urquhart N, Stanish W. The effect of a frontal plane gait perturbation bout on knee biomechanics and muscle activation in older adults and individuals with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2022; 92:105574. [PMID: 35066441 DOI: 10.1016/j.clinbiomech.2022.105574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Walking can be a challenging task for individuals with knee osteoarthritis and many older adults. The purpose was to determine the immediate effect of a frontal plane perturbation bout during walking on knee biomechanics and muscle activation patterns in these groups. METHODS 44 asymptomatic older adults and 32 individuals with knee osteoarthritis were recruited. Sagittal and frontal plane knee biomechanics and muscle activation levels were calculated and recorded during treadmill walking. After a baseline collection at 6-min, a random series of unexpected medial/lateral walkway surface perturbations were delivered over approximately 24 min. Data was collected immediately after the perturbations. Discrete measures extracted from biomechanical waveforms, and principal component analysis to analyze muscle activation were utilized to determine time effects and interactions using analysis of variance models (alpha = 0.05). FINDINGS After the perturbation bout, sagittal plane range of motion was significantly increased in the osteoarthritis group (Effect Size = 0.24) and in both groups peak knee adduction moment (Effect Size = 0.10) and difference between peak flexion and extension moments (Effect Size = 0.16) were significantly increased. Muscle amplitudes in both groups were significantly reduced (PP1-scores) after perturbation bout, whereas significant time-based gait cycle activation pattern alterations identified by PP2- and PP3-scores were related to group and muscle assignment. INTERPRETATION Perturbations were tolerated by all participants, resulting in significant alterations to biomechanical outcomes and muscle activation levels and patterns. Demand on the knee joint was not increased after perturbations. Gait perturbation training in these groups may be feasible using a frontal plane perturbation bout.
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Affiliation(s)
- Derek Rutherford
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
| | - Matthew Baker
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - Nathan Urquhart
- Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
| | - William Stanish
- Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
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Ghazwan A, Wilson C, Holt CA, Whatling GM. Knee osteoarthritis alters peri-articular knee muscle strategies during gait. PLoS One 2022; 17:e0262798. [PMID: 35051232 PMCID: PMC8775536 DOI: 10.1371/journal.pone.0262798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
The primary role of muscles is to move, and control joints. It is therefore important to understand how degenerative joint disease changes this role with the resulting effect on mechanical joint loading. Muscular control strategies can vary depending on strength and coordination which in turn influences joint control and loading. The purpose of this study was to investigate the variation in neuromuscular control mechanisms and joint biomechanics for three subject groups including those with: uni-compartmental knee osteoarthritis (OA), listed for high tibial osteotomy surgery (pre-HTO, n = 10); multi-compartmental knee OA listed for total knee replacement (pre-TKR, n = 9), and non-pathological knees (NP, n = 11). Lower limb kinematics and electromyography (EMG) data for subjects walking at self-selected speed, were input to an EMG-driven musculoskeletal knee model which was scaled and calibrated to each individual to estimate muscle forces. Compared to NP, the peak gastrocnemius muscle force reduced by 30% and 18% for pre-HTO and pre-TKR respectively, and the peak force estimated for hamstring muscle increased by 25% for pre-HTO. Higher quadriceps and hamstring forces suggest that co-contraction with the gastrocnemius could lead to higher joint contact forces. Combined with the excessive loading due to a high external knee adduction moment this may exacerbate joint destruction. An increased lateral muscle co-contraction reflects the progression from NP to uni-compartmental OA (pre-HTO). Pre-TKR patients adopt a different gait pattern to pre-HTO patients. Increased medial muscle co-activation could potentially differentiate between uni- or multi-compartmental OA.
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Affiliation(s)
- Aseel Ghazwan
- Cardiff School of Engineering, College of Physical Sciences and Engineering, Cardiff University, Cardiff, United Kingdom
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
- Biomedical Engineering Department, College of Engineering, Al-Nahrain University, Baghdad, Iraq
- * E-mail:
| | - Chris Wilson
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
- University Hospital of Wales, Cardiff, United Kingdom
| | - Cathy A. Holt
- Cardiff School of Engineering, College of Physical Sciences and Engineering, Cardiff University, Cardiff, United Kingdom
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
| | - Gemma M. Whatling
- Cardiff School of Engineering, College of Physical Sciences and Engineering, Cardiff University, Cardiff, United Kingdom
- Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom
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Armitano-Lago C, Pietrosimone B, Evans-Pickett A, Davis-Wilson H, Franz JR, Blackburn T, Kiefer AW. Cueing Changes in Peak Vertical Ground Reaction Force to Improve Coordination Dynamics in Walking. J Mot Behav 2022; 54:125-134. [PMID: 34148523 PMCID: PMC8722397 DOI: 10.1080/00222895.2021.1929810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AbstractsBiofeedback has been effectively implemented to improve the mediation and distribution of joint loads during gait, however, the inability to effectively coordinate lower limb movement by altering loading patterns may increase pathological stress and risk of injury and deleterious joint changes. This study examined the influence cueing an increase or decrease in lower extremity loading has on inter- and intralimb joint coordination during gait, applied herein for 12 persons following anterior cruciate ligament reconstruction across three loading conditions (control, high, and low). Visual biofeedback was presented on a screen via a force-measuring treadmill with targeted changes prescribed based on stride-to-stride peak vertical ground reaction forces bilaterally. The pattern and stability of coordination dynamics among each of the ankle, hip and knee joint pairs were assessed via discrete relative phase and cross-recurrence quantification analyses for each condition. High and low loading altered the pattern and stability of intralimb coordination; low loading led to decreased coordination stability (20° greater than control condition) and high loading resulted in a more tightly coupled coordination pattern (higher %CDET). With thoughtful consideration for movement control, biofeedback can be used to target mechanisms leading to long-term deleterious joint adaptations.
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Affiliation(s)
- Cortney Armitano-Lago
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hope Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State University, Raleigh, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam W. Kiefer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Hatfield GL, Costello KE, Astephen Wilson JL, Stanish WD, Hubley-Kozey CL. Association Between Knee Joint Muscle Activation and Knee Joint Moment Patterns During Walking in Moderate Medial Compartment Knee Osteoarthritis: Implications for Secondary Prevention. Arch Phys Med Rehabil 2021; 102:1910-1917. [PMID: 33965394 DOI: 10.1016/j.apmr.2021.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine associations between knee moment features linked to osteoarthritis (OA) progression, gait muscle activation patterns, and strength. DESIGN Cross-sectional secondary analysis. SETTING Gait laboratory. PARTICIPANTS Convenience sample of 54 patients with moderate, medial knee OA (N=54). INTERVENTIONS None. MAIN OUTCOME MEASURES Knee moments and quadriceps and hamstrings activation were examined during walking. Knee extensor and flexor strength were measured. Waveform patterns were extracted using principal component analysis. Each measured waveform was scored against principal components (PCs) that captured overall magnitude (PC1) and early to midstance difference (PC2) features, with higher PC2 scores interpreted as greater moment differential and more prolonged muscle activity. Correlations were calculated between moment PC scores and muscle PC and strength scores. Regression analyses determined moment PC score variance explained by muscle PC scores and strength. RESULTS All correlations for knee adduction moment difference feature (KAMPC2) and prolonged muscle activity (PC2) were significant (r=-0.40 to -0.54). Knee flexion moment difference feature (KFMPC2) was significantly correlated with all quadriceps and medial hamstrings PC2 scores (r=-0.47 to -0.61) and medial hamstrings magnitude feature (PC1) (r=-0.52). KAMPC2 was significantly correlated with knee flexor strength (r=0.43), and KFMPC2 was significantly correlated with knee extensor (r=0.60) and flexor (r=0.55) strength. Regression models including muscle PC2 scores and knee flexor strength explained 46% of KAMPC2 variance, whereas muscle PC2 scores and knee extensor strength explained 59% of KFMPC2 variance. CONCLUSIONS Muscle activation patterns and strength explained significant variance in moment difference features, highest for the knee flexion moment. This supports that exercises such as neuromuscular training, focused on appropriate muscle activation patterns, and strengthening have the potential to alter dynamic loading gait patterns associated with knee OA clinical progression.
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Affiliation(s)
- Gillian L Hatfield
- School of Kinesiology, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Kerry E Costello
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA; Section of Rheumatology, Boston University School of Medicine, Boston, MA
| | - Janie L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - William D Stanish
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl L Hubley-Kozey
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Affiliated Scientist Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
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15
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Reza MK, Shaphe MA, Qasheesh M, Shah MN, Alghadir AH, Iqbal A. Efficacy of Specified Manual Therapies in Combination with a Supervised Exercise Protocol for Managing Pain Intensity and Functional Disability in Patients with Knee Osteoarthritis. J Pain Res 2021; 14:127-138. [PMID: 33531832 PMCID: PMC7847368 DOI: 10.2147/jpr.s285297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/24/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose The current study aimed to determine the efficacy of specified manual therapies in combination with a supervised exercise protocol for managing pain intensity and functional disability in patients with knee osteoarthritis. Methods The study was based on a two-arm parallel-group randomized controlled trial design, including a total of 32 participants with knee osteoarthritis randomly divided into groups A and B. Group A received a supervised exercise protocol; however, group B received specified manual therapies in combination with a supervised exercise protocol. Pain and functional disability were measured with the numeric pain rating scale (NPRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. Data were collected at baseline (pre-intervention), 2 weeks, and 4 weeks post-intervention. To evaluate the efficacy of specific manual therapies with supervised exercise compared to supervised exercise alone, an unpaired t-test and repeated measures ANOVA were used to analyze the data, keeping the level of significance at p<0.05. Results A significant (p<0.05) mean difference (∆MD) was found within group A and group B for both outcomes when we compared their baseline scores with 2-week (group A, NPRS: ∆MD=−1.56 and WOMAC: ∆MD=14.94; group B, NPRS: ∆MD=2.06 and WOMAC: ∆MD=22.19) and 4-week post-intervention scores (group A, NPRS: ∆MD=0.62 and WOMAC: ∆MD=6.75; group B, NPRS: ∆MD=0.75 and WOMAC: ∆MD=11.12). In addition, significant mean differences (p<0.05) reported for both outcomes when we compared their scores between groups A and B at 2 weeks (∆MD: NPRS=0.69; WOMAC=10.87) and 4 weeks post-intervention (∆MD: NPRS=0.31; WOMAC=8.00). Furthermore, a post hoc Scheffe analysis for the outcomes NPRS and WOMAC revealed the superiority of group B over group A. Conclusion The specified manual therapies, in combination with a supervised exercise protocol, were found to be more effective than a supervised exercise protocol alone for improving pain and functional disability in patients with knee osteoarthritis.
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Affiliation(s)
| | | | | | | | - Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Amir Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Kordi Yoosefinejad A, Samani M, Jabarifard F, Setooni M, Mirsalari R, Kaviani F, Jazayeri Shooshtari SM. Comparison of the prevalence of myofascial trigger points of muscles acting on knee between patients with moderate degree of knee osteoarthritis and healthy matched people. J Bodyw Mov Ther 2020; 25:113-118. [PMID: 33714481 DOI: 10.1016/j.jbmt.2020.10.012] [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: 05/21/2019] [Revised: 08/31/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Trigger points have been implicated in the development of several musculoskeletal disorders. Trigger points harbored in lower limb muscles might represent a ubiquitous source of pain in patients with knee osteoarthritis (OA). This study was carried out to evaluate the prevalence of Myofascial Trigger Points (MTrPs) in muscles acting on the knee in patients with OA. METHODS Thirty-seven patients aged at least 55 years old with a moderate degree of OA (grade III of Kellgren and Lawrence scale) were recruited. Thirty asymptomatic people, matched on age and body mass index, were considered as the control group. Ten muscles acting on the knee joint were selected. Taut bands were also identified using a skin rolling method. A pressure of 3 kg/cm2 was used to identify myofascial trigger points in all muscles except the popliteus (8 kg/cm2). RESULTS Chi-square was performed to compare the prevalence of trigger points between the groups. The McNemar test was administered to compare the prevalence of trigger points in the right and left sides of participants. Prevalence of the trigger points was significantly higher in patients with knee OA compared with asymptomatic people in all muscles except for right (p = 0.17) and left (p = 0.41) rectus femoris, right (p = 0.61) and left (p = 0.22) sartorius and left biceps femoris (p = 0.08). Comparison of the prevalence of MTrPs bilaterally revealed that only the right and left sartorius differed significantly (p = 0.008). CONCLUSIONS The prevalence of MTrPs in the muscles acting on the knee joint is higher in patients with a moderate degree of knee OA compared with asymptomatic subjects.
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Affiliation(s)
- Amin Kordi Yoosefinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahbobeh Samani
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fatemeh Jabarifard
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Setooni
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rezvan Mirsalari
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Kaviani
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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17
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Sex- and osteoarthritis-related differences in muscle co-activation during weight-bearing tasks. Gait Posture 2020; 79:117-125. [PMID: 32402893 DOI: 10.1016/j.gaitpost.2020.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with knee osteoarthritis (OA) demonstrate impairments in muscle function (i.e. muscle weakness, high muscle co-activation believed to have detrimental effects on joint integrity). Women with knee OA exhibit poorer health outcomes than men. Sex and muscle function are known risk factors for knee OA. It is unclear how these risk factors are associated with muscle function in knee OA and the implications for disease aetiology. RESEARCH QUESTION How does sex and knee osteoarthritis disease status relate to muscle function, specifically strength and muscle co-activation, during walking, stair negotiation and sit-to-walk activities. METHODS A cross-sectional study assessed muscle co-activation in 77 individuals with knee OA (mean[SD], 62.5[8.1] years; 48/29 women/men) and 18 age-matched controls (62.5[10.4] years; 9/9 women/men), during a series of walking, stair ascent and descent and sit-to-walk activities. Muscle strength of the knee extensors and flexors was assessed using maximal voluntary isometric contractions (MVIC). Electromyography was recorded from the vastus lateralis/medalis, rectus femoris, biceps femoris, semitendinosus, medial/lateral gastrocnemius normalised to MVIC. Multiple regression assessed the relationship between sex, disease status, and muscle strength on muscle co-activation. RESULTS Individuals with knee OA were weaker than controls, had higher hamstrings-quadriceps and medial-lateral co-activation for specific phases of gait. Women were weaker than men with higher muscle co-activation across all activities. Sex and muscle weakness, but not age or disease status predicted high muscle co-activation. SIGNIFICANCE High muscle co-activation was associated with female sex and muscle weakness regardless of disease status and age. High muscle co-activation is believed to be a compensatory mechanism for muscle weakness to maintain a certain level of function. High muscle co-activation is also thought to have detrimental effects on cartilage and joint integrity this may explain high muscle co-activation in women with muscle weakness and contribute to increased risk of incidence and progression of knee OA in women.
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Selistre LFA, Gonçalves GH, Vasilceac FA, Serrão PRMDS, Nakagawa TH, Petrella M, Jones RK, Mattiello SM. The relationship between urinary C-Telopeptide fragments of type II collagen, knee joint load, pain, and physical function in individuals with medial knee osteoarthritis. Braz J Phys Ther 2020; 25:62-69. [PMID: 32151525 DOI: 10.1016/j.bjpt.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Considering the osteoarthritis (OA) model that integrates the biological, mechanical, and structural components of the disease, the present study aimed to investigate the association between urinary C-Telopeptide fragments of type II collagen (uCTX-II), knee joint moments, pain, and physical function in individuals with medial knee OA. METHODS Twenty-five subjects radiographically diagnosed with knee OA were recruited. Participants were evaluated through three-dimensional gait analysis, uCTX-II level, the WOMAC pain and physical function scores, and the 40m walk test. The association between these variables was investigated using Pearson's product-moment correlation, followed by a hierarchical linear regression, controlled by OA severity and body mass index (BMI). RESULTS No relationship was found between uCTX-II level and knee moments. A significant correlation between uCTX-II level and pain, physical function, and the 40m walk test was found. The hierarchical linear regression controlling for OA severity and BMI showed that uCTX-II level explained 9% of the WOMAC pain score, 27% of the WOMAC physical function score, and 7% of the 40m walk test. CONCLUSION Greater uCTX-II level is associated with higher pain and reduced physical function and 40m walk test performance in individuals with medial knee OA.
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Affiliation(s)
| | - Glaucia Helena Gonçalves
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | | | - Theresa Helissa Nakagawa
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Marina Petrella
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Stela Márcia Mattiello
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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Smith SL, Allan R, Marreiros SP, Woodburn J, Steultjens MPM. Muscle Co-Activation Across Activities of Daily Living in Individuals With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 71:651-660. [PMID: 29953745 DOI: 10.1002/acr.23688] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Muscle co-activation has been shown to be elevated in individuals with knee osteoarthritis (OA) during gait. Comparisons of muscle co-activation across different activities of daily living such as stair negotiation have yet to be explored. The aim of this study was to explore muscle co-activation across different activities of daily living in patients with knee OA. METHODS Muscle co-activation was assessed in 77 symptomatic knee OA patients (mean ± SD age 62.5 ± 8.1 years, body mass index 29.4 ± 6.0 kg/m2 , and sex 48:29 female:male) using electromyography (EMG), during a series of walking, stair negotiation (ascent, descent), and sit-to-walk activities. EMG was recorded from 7 sites, mediolateral gastrocnemius, biceps femoris, semitendinosus, vastus lateralis/medialis, and rectus femoris, and normalized to maximal voluntary isometric contraction. Correlation was used to assess the consistency of co-activation across activities. Repeated-measures analysis of variance assessed the muscle combination by activity differences. RESULTS Muscle co-activation was highest during stair ascent. When comparing muscle combinations within the same activity, we found that correlations ranged from r = 0.003 to r = 0.897, of which 80% of the combinations were significant. Between activities, muscle co-activation was significantly different (P < 0.05). Mediolateral muscle co-activation was higher than hamstrings/quadriceps across activities. CONCLUSION Two muscle co-activation strategies were observed during activities of daily living in patients with knee OA to maintain stability. Muscle co-activation was higher during more challenging activities, particularly when the joint was accepting load. Mediolateral muscle co-activation was higher than hamstrings/quadriceps, so that mediolateral co-activation was thought to be a stabilization mechanism, while hamstrings/quadriceps co-activation responds to knee flexion moments, suggesting that different muscle combinations may have different roles in responding to joint demand.
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Affiliation(s)
- Stephanie L Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Richard Allan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Sara P Marreiros
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Martijn P M Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
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Knee muscle co-contractions are greater in old compared to young adults during walking and stair use. Gait Posture 2019; 73:315-322. [PMID: 31419759 DOI: 10.1016/j.gaitpost.2019.07.501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/08/2019] [Accepted: 07/31/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle co-contraction is an accepted clinical measure to quantify the effects of aging on neuromuscular control and movement efficiency. However, evidence of increased muscle co-contraction in old compared to young adults remains inconclusive. RESEARCH QUESTION Are there differences in lower-limb agonist/antagonist muscle co-contractions in young and old adults, and males and females, during walking and stair use? METHODS In a retrospective study, we analyzed data from 20 healthy young and 19 healthy old adults during walking, stair ascent, and stair descent at self-selected speeds, including marker trajectories, ground reaction force, and electromyography activity. We calculated muscle co-contraction at the knee (vastus lateralis vs. biceps femoris) and ankle (tibialis anterior vs. medial gastrocnemius) using the ratio of the common area under a muscle pairs' filtered and normalized electromyography curves to the sum of the areas under each muscle in that pair. RESULTS Old compared to young adults displayed 18%-22% greater knee muscle co-contractions during the entire cycle of stair use activities. We found greater (17%-29%) knee muscle co-contractions in old compared to young adults during the swing phase of walking and stair use. We found no difference in ankle muscle co-contractions between the two age groups during all three activities. We found no difference in muscle co-contraction between males and females at the knee and ankle joints for all three activities. SIGNIFICANCE Based on our findings, we recommend clinical evaluation to quantify the effects of aging through muscle co-contraction to include the knee joint during dynamic activities like walking and stair use, and independent evaluation of the stance and swing phases.
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Selistre LFA, Gonçalves GH, Nakagawa TH, Petrella M, Jones RK, Mattiello SM. The role of hip abductor strength on the frontal plane of gait in subjects with medial knee osteoarthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1779. [PMID: 31012216 DOI: 10.1002/pri.1779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/13/2019] [Accepted: 03/17/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship of hip abductor strength with external hip and knee adduction moments, pain and physical function, and trunk, pelvis, and hip kinematics in the frontal plane during walking in subjects with medial knee osteoarthritis. METHODS Twenty-five subjects with medial knee osteoarthritis were evaluated through an isokinetic strength test for hip abductor, three-dimensional gait analysis (kinetics and kinematics), and pain and physical function scores. Regression models were used to control the influence of other parameters such as pain, age, gender, severity, walking speed, mass, and height. RESULTS No relationship was found of hip abductor strength with peak of external knee adduction moment and knee adduction angular impulse. Hip abductor strength explained 17% of contralateral pelvic drop and 21% of hip adduction angle. In addition, hip abductor strength explained 4% and 1% of the variance in the WOMAC physical function score and 40-m fast paced walk test, respectively. CONCLUSION Considering the relationship of hip abductor strength with contralateral pelvic drop and hip adduction angle, specific exercises might improve physical function and lower limb dynamic alignment during gait.
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Affiliation(s)
| | | | | | - Marina Petrella
- Departamento de Fisioterapia, São Carlos, Universidade Federal de São Carlos, São Paulo, Brazil
| | - Richard Keith Jones
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - Stela Márcia Mattiello
- Departamento de Fisioterapia, São Carlos, Universidade Federal de São Carlos, São Paulo, Brazil
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22
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Self-reported walking difficulty and knee osteoarthritis influences limb dynamics and muscle co-contraction during gait. Hum Mov Sci 2019; 64:409-419. [DOI: 10.1016/j.humov.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022]
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Flaxman TE, Alkjaer T, Smale KB, Simonsen EB, Krogsgaard MR, Benoit DL. Differences in EMG-moment relationships between ACL-injured and uninjured adults during a weight-bearing multidirectional force control task. J Orthop Res 2019; 37:113-123. [PMID: 30259562 DOI: 10.1002/jor.24145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/27/2018] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament injury (ACLi) reduces mechanical knee joint stability. Differences in muscle activation patterns are commonly identified between ACLi individuals and uninjured controls (CON); however, how and which of these differences are adaptations to protect the knee or adversely increase risk of joint instability remain unclear. Since the neuromuscular system integrates activity of all muscles crossing the knee to create a moment-of-force that opposes an external load, this study sought to quantify differences in individual muscle electromyography (EMG)-moment relationships between ACLi and CON. Participants isometrically modulated ground reaction forces during a standing force matching protocol to elicit combinations of sagittal, frontal and transverse plane moments. Partial least squares regressions determined which internal joint moment(s) predicted activation of 10 leg muscles for each group. Compared to CON, ACLi demonstrated greater contribution of rectus femoris to knee extension, semitendinosus and gastrocnemii to knee flexion, and lateral gastrocnemii to knee external rotation moments. ACLi also showed lower contributions of biceps femoris to knee flexion, medial gastrocnemius to internal rotation, and varied hip muscle contributions to frontal plane hip moments. Between group differences in EMG-moment relationships during static conditions suggest neuromuscular contributions to sagittal plane stability increases after ACL injury, while knee stability during knee abduction and external rotation is reduced. Clinical Significance: Clinical assessments of ACLi should account for deficits in frontal and rotational plane stability by including tasks that elicit such loads. Improving hamstring muscle balance, hip abductor and gastrocnemius function may benefit ACLi rehabilitation interventions and should be studied further. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Teresa E Flaxman
- School of Rehabilitation Sciences, University of Ottawa, 200 Lees Ave, Rm E020, Ottawa, Ontario, Canada K1S 5L5.,Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Tine Alkjaer
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth B Smale
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Erik B Simonsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | - Daniel L Benoit
- School of Rehabilitation Sciences, University of Ottawa, 200 Lees Ave, Rm E020, Ottawa, Ontario, Canada K1S 5L5.,School of Human Kinetics, University of Ottawa, Ottawa, Canada
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A calibrated EMG-informed neuromusculoskeletal model can appropriately account for muscle co-contraction in the estimation of hip joint contact forces in people with hip osteoarthritis. J Biomech 2019; 83:134-142. [DOI: 10.1016/j.jbiomech.2018.11.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 11/20/2022]
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25
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Trepczynski A, Kutzner I, Schwachmeyer V, Heller MO, Pfitzner T, Duda GN. Impact of antagonistic muscle co-contraction on in vivo knee contact forces. J Neuroeng Rehabil 2018; 15:101. [PMID: 30409163 PMCID: PMC6225620 DOI: 10.1186/s12984-018-0434-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/12/2018] [Indexed: 11/17/2022] Open
Abstract
Background The onset and progression of osteoarthritis, but also the wear and loosening of the components of an artificial joint, are commonly associated with mechanical overloading of the structures. Knowledge of the mechanical forces acting at the joints, together with an understanding of the key factors that can alter them, are critical to develop effective treatments for restoring joint function. While static anatomy is usually the clinical focus, less is known about the impact of dynamic factors, such as individual muscle recruitment, on joint contact forces. Methods In this study, instrumented knee implants provided accurate in vivo tibio-femoral contact forces in a unique cohort of 9 patients, which were used as input for subject specific musculoskeletal models, to quantify the individual muscle forces during walking and stair negotiation. Results Even between patients with a very similar self-selected gait speed, the total tibio-femoral peak forces varied 1.7-fold, but had only weak correlation with static alignment (varus/valgus). In some patients, muscle co-contraction of quadriceps and gastrocnemii during walking added up to 1 bodyweight (~ 50%) to the peak tibio-femoral contact force during late stance. The greatest impact of co-contraction was observed in the late stance phase of stair ascent, with an increase of the peak tibio-femoral contact force by up to 1.7 bodyweight (66%). Conclusions Treatment of diseased and failed joints should therefore not only be restricted to anatomical reconstruction of static limb axes alignment. The dynamic activation of muscles, as a key modifier of lower limb biomechanics, should also be taken into account and thus also represents a promising target for restoring function, patient mobility, and preventing future joint failure. Trial registration German Clinical Trials Register: ID: DRKS00000606, date: 05.11.2010. Electronic supplementary material The online version of this article (10.1186/s12984-018-0434-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam Trepczynski
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ines Kutzner
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Verena Schwachmeyer
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Markus O Heller
- Bioengineering Sciences Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Tilman Pfitzner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Clinic for Adult Hip and Knee Reconstruction, Vivantes Spandau Hospital, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Jones M, Stanish W, Rutherford D. Co-activation is not altered in the contra-lateral limb of individuals with moderate knee osteoarthritis compared to healthy controls. Clin Biomech (Bristol, Avon) 2018; 59:71-77. [PMID: 30199822 DOI: 10.1016/j.clinbiomech.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/22/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Contra-lateral knee joint function in individuals with moderate knee osteoarthritis is not well understood, despite the functional burden of bilateral osteoarthritis on end stage clinical management. The purpose of this study was to determine whether co-activation and joint biomechanics are altered in the contra-lateral limb compared to age-matched controls. METHODS 20 Individuals with moderate knee osteoarthritis and 20 asymptomatic individuals walked on an instrumented dual belt treadmill at a self-selected speed. Surface electromyography of the knee joint musculature, including quadriceps, hamstrings and gastrocnemius muscles, normalized to maximum voluntary isometric contractions, as well as sagittal plane motion and sagittal and frontal plane moments were collected. Co-contraction indices were calculated and discrete variables from motion and moment data were extracted. Two-sample t-tests and 2-sample mixed model ANOVAs were performed with alpha <0.05. FINDINGS Contra-lateral knee muscle co-activation differences were not found between groups (p > 0.65). Peak knee adduction moment (0.41 Nm/kg vs. 0.32 Nm/kg) and knee adduction moment impulse (0.14 Nm s/kg vs. 0.10 Nm s/kg) were higher in the contra-lateral limb compared to the asymptomatic group respectively, whereas the sagittal motion (9.8° vs. 14.4°) and moment ranges (0.66 Nm/kg vs. 0.86 Nm/kg) during stance were less dynamic (p < 0.03). INTERPRETATION The contra-lateral limb was functioning differently biomechanically despite no changes present in muscle co-activation. Findings suggest biomechanical changes are occurring without greater demand on the neuromuscular system to preserve contra-lateral joint function in moderate knee osteoarthritis gait. A greater focus should be made to address biomechanical abnormalities in both knees of individuals with moderate unilateral symptomatic knee osteoarthritis.
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Affiliation(s)
- Michelle Jones
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - William Stanish
- Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
| | - Derek Rutherford
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
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Neelapala YVR. Self-reported Instability in Knee Osteoarthritis: A Scoping Review of Literature. Curr Rheumatol Rev 2018; 15:110-115. [PMID: 29952262 DOI: 10.2174/1573397114666180628111858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/07/2018] [Accepted: 06/22/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Knee Osteoarthritis (OA) is a disabling musculoskeletal condition among the elderly. Self-reported instability is one of the impairments associated with osteoarthritis. A complete understanding of the self-reported instability in knee OA is essential, to identify the best strategies for overcoming this impairment. The focus of this scoping review is to provide an overview of evidence supported information about the prevalence and other associated features of selfreported instability in Knee OA. A broad search of the database PubMed with keywords such as knee osteoarthritis and instability resulted in 1075 articles. After title abstract and full-text screening, 19 relevant articles are described in the review. Overall, there is less amount of published literature on this topic. Studies reported prevalence rates of more than 60% for self-reported instability in knee osteoarthritis, which causes functional deterioration and high fear of falls. The most probable causative factors for self-reported instability in knee OA were altered sensory mechanisms and decreased muscle strength. CONCLUSION To conclude, self-reported knee instability in knee OA requires thorough evaluation and directed treatment with further studies providing rationalistic evidence-based management strategies. The current literature regarding self-reported knee instability is summarized, highlighting the research gaps.
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Affiliation(s)
- Y V Raghava Neelapala
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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28
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Muscle contributions to knee extension in the early stance phase in patients with knee osteoarthritis. Gait Posture 2017; 58:88-93. [PMID: 28763714 DOI: 10.1016/j.gaitpost.2017.07.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 02/02/2023]
Abstract
The aim of this study was to analyze individual muscle contributions to knee angular acceleration using a musculoskeletal simulation analysis and evaluate knee extension mechanics in the early stance phase in patients with knee osteoarthritis (OA). The subjects comprised 15 patients with medial knee OA and 14 healthy elderly individuals. All participants underwent gait performance test using 8 infrared cameras and two force plates to measure the kinetic and kinematic data. The simulation was driven by 92 Hill-type muscle-tendon units of the lower extremities and a trunk with 23° of freedom. We analyzed each muscle contribution to knee angular acceleration in the 5%-15% and 15%-25% periods of the stance phase (% SP) using an induced acceleration analysis. We compared accelerations by individual muscles between the two groups using an analysis of covariance for controlling gait speed. Patients with knee OA had a significantly lesser knee extension acceleration by the vasti muscles and higher knee acceleration by hip adductors than those in controls in 5-15% SP. In addition, knee OA resulted in significantly lesser knee extension acceleration by the vasti muscles in 15-25% SP. These results indicate that patients with knee OA have decreased dependency on the vasti muscles to control knee movements during early stance phase. Hip adductor muscles, which mainly control mediolateral motion, partly compensate for the weak knee extension by the vasti muscles in patients with knee OA.
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29
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Rutherford D, Baker M, Wong I, Stanish W. The effect of age and knee osteoarthritis on muscle activation patterns and knee joint biomechanics during dual belt treadmill gait. J Electromyogr Kinesiol 2017; 34:58-64. [DOI: 10.1016/j.jelekin.2017.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/31/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022] Open
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30
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The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis. J Electromyogr Kinesiol 2017; 33:64-72. [DOI: 10.1016/j.jelekin.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/19/2022] Open
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31
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Sritharan P, Lin YC, Richardson SE, Crossley KM, Birmingham TB, Pandy MG. Musculoskeletal loading in the symptomatic and asymptomatic knees of middle-aged osteoarthritis patients. J Orthop Res 2017; 35:321-330. [PMID: 27088430 DOI: 10.1002/jor.23264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/08/2016] [Indexed: 02/04/2023]
Abstract
This study quantified the contributions by muscles, gravity, and inertia to the tibiofemoral compartment forces in the symptomatic (SYM) and asymptomatic (ASYM) limbs of varus mal-aligned medial knee osteoarthritis (OA) patients, and compared the results with healthy controls (CON). Muscle forces and tibiofemoral compartment loads were calculated using gait data from 39 OA patients and 15 controls aged 49 ± 7 years. Patients exhibited lower knee flexion angle, higher hip abduction, and knee adduction angles, lower internal knee flexion torque but higher external knee adduction moment. Muscle forces were highest in CON except hamstrings, which was highest in SYM. ASYM muscle forces were lowest for biceps femoris short head and gastrocnemius but otherwise intermediate between SYM and CON. In all subjects, vasti, hamstrings, gastrocnemius, soleus, gluteus medius, gluteus maximus, and gravity were the largest contributors to medial compartment force (MCF). Inertial contributions were negligible. Highest MCF was found in SYM throughout stance. Small increases in contributions from hamstrings, gluteus maximus, gastrocnemius, and gravity at the first peak; soleus and rectus femoris at the second peak; and soleus, gluteus maximus, gluteus medius, and gravity during mid-stance summed to produce significantly higher total MCF. Compared to CON, the ASYM limb exhibited similar peak MCF but higher mid-stance MCF. In patients, diminished non-knee-spanning muscle forces did not produce correspondingly diminished MCF contributions due to the influence of mal-alignment. Our findings emphasize consideration of muscle function, lower-limb alignment, and mid-stance loads in developing interventions for OA, and inclusion of the asymptomatic limb in clinical assessments. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:321-330, 2017.
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Affiliation(s)
- Prasanna Sritharan
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Yi-Chung Lin
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Sara E Richardson
- Faculty of Health Sciences, University of Western Ontario, Ontario, Canada
| | - Kay M Crossley
- School of Allied Health, La Trobe University, Victoria, Australia
| | | | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
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Pinto FG, Thaunat M, Daggett M, Kajetanek C, Marques T, Guimares T, Quelard B, Sonnery-Cottet B. Hamstring Contracture After ACL Reconstruction Is Associated With an Increased Risk of Cyclops Syndrome. Orthop J Sports Med 2017; 5:2325967116684121. [PMID: 28203602 PMCID: PMC5298440 DOI: 10.1177/2325967116684121] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cyclops syndrome is characterized by loss of terminal knee extension due to proliferative fibrous nodule formation in the intercondylar notch. This complication occurs in the early postoperative period after anterior cruciate ligament reconstruction (ACLR). The pathogenesis of Cyclops syndrome is not well understood. Hypothesis: Persistent hamstring contracture after ACLR is associated with an increased risk of subsequent Cyclops syndrome. Study Design: Case-control study; Level of evidence, 3. Methods: The files of 45 patients who underwent arthroscopic debridement of a Cyclops lesion after ACLR were analyzed. Recorded data included demographic information and technical details of surgery. Preoperative magnetic resonance images were also analyzed, and patients with femoral bone bruising were identified. Passive and active range of motion were recorded in all patients preoperatively and at 3 and 6 weeks after surgery to address the Cyclops lesion. Passive extension deficit was evaluated in comparison with the contralateral limb and classified as secondary to hamstring contracture when contracture was observed and palpated in the prone position and when the extension deficit was reversed after exercises performed to fatigue the hamstrings. A control group was selected using a random numbers table among our entire ACLR cohort. Statistical analysis was performed to analyze differences between the 2 groups. Results: There was no significant difference between the groups with regard to age at ACLR, sex distribution, time from injury to surgery (P > .05), proportion of professional athletes, presence of femoral bone bruise, or technical aspects of surgery. The overall extension deficit incidence was significantly higher in the Cyclops group at 3 weeks (Cyclops, 71%; control, 22%) (P < .001) and at 6 weeks (Cyclops, 60%; control, 7%) (P < .001). The extension deficit related to hamstring contracture was significantly higher in the Cyclops group at 3 weeks (Cyclops, 58%; control, 22%) (P < .001) and at 6 weeks (Cyclops, 29%; control, 2%) (P < .001). Conclusion: The Cyclops lesion is associated with a persistent hamstring contracture at 3 and 6 weeks after ACLR.
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Affiliation(s)
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Matt Daggett
- Kansas City University, Kansas City, Missouri, USA
| | - Charles Kajetanek
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Tiago Marques
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Tales Guimares
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bénédicte Quelard
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskelet Disord 2016; 17:372. [PMID: 27568007 PMCID: PMC5002319 DOI: 10.1186/s12891-016-1209-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022] Open
Abstract
Background Both increased knee muscle co-contraction and alterations in central pain processing have been suggested to play a role in knee osteoarthritis pain. However, current interventions do not target either of these mechanisms. The Alexander Technique provides neuromuscular re-education and may also influence anticipation of pain. This study therefore sought to investigate the potential clinical effectiveness of the AT intervention in the management of knee osteoarthritis and also to identify a possible mechanism of action. Methods A cohort of 21 participants with confirmed knee osteoarthritis were given 20 lessons of instruction in the Alexander Technique. In addition to clinical outcomes EMG data, quantifying knee muscle co-contraction and EEG data, characterising brain activity during anticipation of pain, were collected. All data were compared between baseline and post-intervention time points with a further 15-month clinical follow up. In addition, biomechanical data were collected from a healthy control group and compared with the data from the osteoarthritis subjects. Results Following AT instruction the mean WOMAC pain score reduced by 56 % from 9.6 to 4.2 (P < 0.01) and this reduction was maintained at 15 month follow up. There was a clear decrease in medial co-contraction at the end of the intervention, towards the levels observed in the healthy control group, both during a pre-contact phase of gait (p < 0.05) and during early stance (p < 0.01). However, no changes in pain-anticipatory brain activity were observed. Interestingly, decreases in WOMAC pain were associated with reductions in medial co-contraction during the pre-contact phase of gait. Conclusions This is the first study to investigate the potential effectiveness of an intervention aimed at increasing awareness of muscle behaviour in the clinical management of knee osteoarthritis. These data suggest a complex relationship between muscle contraction, joint loading and pain and support the idea that excessive muscle co-contraction may be a maladaptive response in this patient group. Furthermore, these data provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. This finding challenges clinical management models of knee osteoarthritis which focus primarily on muscle strengthening. Trial registration ISRCTN74086288, 4th January 2016, retrospectively registered.
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Muscle co-contraction during gait in individuals with articular cartilage defects in the knee. Gait Posture 2016; 48:68-73. [PMID: 27477711 DOI: 10.1016/j.gaitpost.2016.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/20/2016] [Indexed: 02/02/2023]
Abstract
Increased muscle co-contraction during gait is common in individuals with knee pathology, and worrisome as it is known to amplify tibiofemoral compressive forces. While knees with articular cartilage defects (ACD) are more vulnerable to compressive forces, muscle co-contraction has never been reported in this population. The purpose of this study was to evaluate the extent to which individuals with ACDs in the knee demonstrate elevated quadriceps to hamstrings muscle co-contraction on the involved limb during gait compared to the uninvolved limb and to healthy controls. We also explored the impact of participant characteristics and knee impairments on co-contraction. Twenty-nine individuals with full-thickness knee ACDs (ACD group) and 19 healthy adults (control group) participated in this study. Participants performed five gait trials at self-selected speed, during which activity of the quadriceps and hamstrings muscles were collected with surface electromyography. Three-dimensional motion capture was used to define phases of gait. Quadriceps strength and self-reported outcomes were also assessed in the same session. There were no differences in quadriceps: hamstrings co-contraction between the ACD and control groups, or between the involved and uninvolved limb for the ACD group. For both ACD and control groups, co-contraction was highest in early stance and lowest in late stance. Quadriceps strength was consistently the strongest predictor of muscle co-contraction in both the ACD and the control groups, with individuals with lower strength demonstrating greater co-contraction. Further study is needed to understand the effect of increased muscle co-contraction on joint compressive forces in the presence of varied quadriceps strength.
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Parker RS, Lewis GN, Rice DA, McNair PJ. Is Motor Cortical Excitability Altered in People with Chronic Pain? A Systematic Review and Meta-Analysis. Brain Stimul 2016; 9:488-500. [DOI: 10.1016/j.brs.2016.03.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/02/2016] [Accepted: 03/30/2016] [Indexed: 01/18/2023] Open
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Favre J, Erhart-Hledik JC, Chehab EF, Andriacchi TP. Baseline ambulatory knee kinematics are associated with changes in cartilage thickness in osteoarthritic patients over 5 years. J Biomech 2016; 49:1859-1864. [PMID: 27178021 DOI: 10.1016/j.jbiomech.2016.04.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/19/2016] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
Abstract
Although kinematic alterations during walking have been reported with knee osteoarthritis (OA), there is a paucity of longitudinal data, therefore limiting our understanding of the role of kinematics in OA development. This study tested the hypothesis that less knee extension angle and less posterior displacement of the femur relative to the tibia during the heel-strike portion of the gait cycle are associated with greater loss of medial cartilage thickness during a follow-up period of five years. This study also tested for associations between flexion-extension angle and anterior-posterior displacement during other periods of the gait cycle and 5-year cartilage thinning. 16 subjects with moderate medial knee OA were tested with gait analysis and MRI at baseline and had a follow-up MRI after 5 years. Linear regressions were used to assess the relationship between changes in cartilage thickness and baseline kinematics using Pearson correlation coefficients. Multivariate regressions were also performed to adjust for gender, baseline age, BMI, walking speed, Kellgren/Lawrence grade, and baseline knee pain score. As hypothesized, baseline knee flexion angle and femoral displacement during heel-strike and other gait cycle periods were significantly associated with medial femoral and tibial cartilage thinning at the 5 year follow-up; these associations were strengthened after adjustment for covariates. This study provided new insight into the pathogenesis of knee OA where baseline knee kinematics were associated with longitudinal disease progression. These results could serve as a basis for developing newer gait modification interventions to reduce the risk for developing knee OA.
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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, CA, United States.
| | - Jennifer C Erhart-Hledik
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States; Department of Orthopedic Surgery, Stanford University Medical Center, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Eric F Chehab
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States; Department of Bioengineering, Stanford Unviersity, Stanford, CA, United States
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States; Department of Orthopedic Surgery, Stanford University Medical Center, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
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Deyle GD, Gill NW, Rhon DI, Allen CS, Allison SC, Hando BR, Petersen EJ, Dusenberry DI, Bellamy N. A multicenter randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injection on pain and function related to knee osteoarthritis (PTA Trial). BMJ Open 2016; 6:e010528. [PMID: 27033961 PMCID: PMC4823390 DOI: 10.1136/bmjopen-2015-010528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Corticosteroid injections (CSIs) are commonly used as an initial or a primary intervention for knee osteoarthritis (OA). Consistent evidence indicates CSIs offer symptom relief with conflicting reports regarding long-term efficacy. Physical therapy (PT) offers a non-invasive alternative. There is moderate evidence suggesting short-term and long-term symptom relief and functional improvement with PT interventions. Patients with knee OA are more commonly prescribed CSI than PT prior to total joint replacement. UnitedHealthcare and Military Health System data show substantially more total knee replacement patients receive preoperative CSI than PT. There are no studies comparing CSI to a PT approach in individuals with knee OA. The primary objective of this study is to compare the effectiveness of CSI to PT in individuals with knee OA at 1, 2 and 12 months. METHODS AND ANALYSIS We plan to recruit 156 participants meeting established knee OA criteria. Following informed consent, participants will be randomised to receive either CSI or PT. All participants will receive instruction on recommended exercise and weight control strategies plus usual medical care. The CSI intervention consisting of 3 injections and the PT intervention consisting of 8-12 sessions will be spaced over 12 months. Measures of the dependent variables (DVs) will occur at baseline, 4 weeks, 8 weeks, 6 months and 12 months post enrolment. This pragmatic, randomised clinical trial will be a mixed-model 2×5 factorial design. The independent variables are treatment (CSI and PT) and time with five levels from baseline to 1 year. The primary DV is the Western Ontario & McMaster Universities Arthritis Index (WOMAC). We will also compare healthcare utilisation between the 2 groups. ETHICS AND DISSEMINATION The protocol was approved by the Madigan Army Medical Center Institutional Review Board. The authors intend to publish the results in a peer-reviewed source. TRIAL REGISTRATION NUMBER NCT01427153.
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Affiliation(s)
- Gail D Deyle
- Brooke Army Medical Center, San Antonio, Texas, USA
| | | | - Daniel I Rhon
- Madigan Army Medical Center, Tacoma, Washington, USA
| | | | | | - Ben R Hando
- National Defense University, Washington, DC, USA
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Pamukoff DN, Lewek MD, Blackburn JT. Greater vertical loading rate in obese compared to normal weight young adults. Clin Biomech (Bristol, Avon) 2016; 33:61-65. [PMID: 26952204 DOI: 10.1016/j.clinbiomech.2016.02.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/07/2016] [Accepted: 02/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is a risk factor for knee osteoarthritis. Altered gait biomechanics are common in obese individuals, and may contribute to the development of knee osteoarthritis. Research has focused on older obese adults with knee osteoarthritis, and it is unclear if young obese individuals display similar aberrant biomechanics. The purpose of this study was to compare gait biomechanics between normal-weight and obese young adults. METHODS 15 normal-weight (body mass index=21.5 (1.1)) and 15 obese (body mass index=33.5 (3.7)) young adults were recruited and categorized by body mass index. Lower extremity kinematics and kinetics were collected while participants walked at standardized (1m/s) and self-selected speeds. Analysis of variance (group by condition) was used to compare peak vertical ground reaction force, vertical loading rate, peak internal knee extension moment, peak internal knee abduction moment, peak knee flexion angle, and knee flexion excursion between groups. FINDINGS Gait biomechanics did not differ between groups during walking at a self-selected speed. When walking at a standardized speed, obese subjects displayed greater instantaneous vertical loading rates (46.2 vs. 35.0 N/s, P<0.001), and lesser knee flexion excursion (5.5° vs. 7.7°, P=0.04). Instantaneous vertical loading rate was greater during walking at a self-selected speed compared to a standardized speed in the obese (P=0.007) and normal weight groups (P=0.001). INTERPRETATION As greater loading rates are related to cartilage degeneration, these results suggest that obesity may contribute to knee osteoarthritis. Prospective studies are needed to identify the influence of higher loading rates on knee osteoarthritis.
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Affiliation(s)
- Derek N Pamukoff
- Department of Kinesiology, California State University, Fullerton, 800 N State College, Fullerton, CA 92831, USA; Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 209 Fetzer Hall, Chapel Hill, NC 27599-8700, USA; Curriculum in Human Movement Science, The University of North Carolina at Chapel Hill, Bondurant Hall, Suite 3000, Chapel Hill, NC 27599-7135, USA.
| | - Michael D Lewek
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 209 Fetzer Hall, Chapel Hill, NC 27599-8700, USA; Curriculum in Human Movement Science, The University of North Carolina at Chapel Hill, Bondurant Hall, Suite 3000, Chapel Hill, NC 27599-7135, USA; Division of Physical Therapy, The University of North Carolina at Chapel Hill, Bondurant Hall, Suite 3000, Chapel Hill, NC 27599-7135, USA.
| | - J Troy Blackburn
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 209 Fetzer Hall, Chapel Hill, NC 27599-8700, USA; Curriculum in Human Movement Science, The University of North Carolina at Chapel Hill, Bondurant Hall, Suite 3000, Chapel Hill, NC 27599-7135, USA; Department of Orthopedics, The University of North Carolina at Chapel Hill, 209 Fetzer Hall, Chapel Hill, NC 27599-8700, USA.
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Lyytinen T, Bragge T, Hakkarainen M, Liikavainio T, Karjalainen P, Arokoski J. Repeatability of knee impulsive loading measurements with skin-mounted accelerometers and lower limb surface electromyographic recordings during gait in knee osteoarthritic and asymptomatic individuals. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2016; 16:63-74. [PMID: 26944825 PMCID: PMC5089457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine the repeatability of knee joint impulsive loading measurements with skin-mounted accelerometers (SMAs) and lower limb surface electromyography (EMG) recordings during gait. METHODS Triaxial SMA and EMG from 4 muscles during level and stair walking in nine healthy and nine knee osteoarthritis (OA) subjects were used. The initial peak acceleration (IPA), root mean square (RMS), maximal acceleration transient rate (ATRmax) and mean EMG activity (EMGact) were calculated. The coefficient of variation (CV) and the intraclass correlation coefficient (ICC) were calculated to measure repeatability. RESULTS The CV and ICC of RMS accelerations ranged from 4.9% to 10.9% and from 0.69 to 0.96 in both study groups during level walking. The CV and ICC of IPA and ATRmax varied from 7.7% to 14.2% and from 0.85 to 0.99 during level and stairs up walking in healthy subjects. The CV and ICC of EMGact ranged from 8.3% to 31.7% and from 0.16 to 0.97 in both study groups. CONCLUSIONS RMS accelerations exhibited good repeatability during walking in healthy and knee OA subjects. The repeatability of EMG measurements was acceptable in healthy subjects depending on the measured muscles.
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Affiliation(s)
- T. Lyytinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland,Palokka Health Center, Jyväskylä, Finland,Corresponding author: Tarja Lyytinen, MD, Department of Physical and Rehabilitation Medicine, Kuopio University Hospital P.O.B. 100, FI-70029 Kuopio, Finland E-mail:
| | - T. Bragge
- Department of Applied Physics, University of Eastern Finland
| | - M. Hakkarainen
- Department of Applied Physics, University of Eastern Finland
| | | | | | - J.P. Arokoski
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Longpré HS, Brenneman EC, Johnson ALM, Maly MR. Identifying yoga-based knee strengthening exercises using the knee adduction moment. Clin Biomech (Bristol, Avon) 2015; 30:820-6. [PMID: 26094136 DOI: 10.1016/j.clinbiomech.2015.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to compare muscle activations, co-contraction indices, and the knee adduction moment between static standing yoga postures to identify appropriate exercises for knee osteoarthritis. METHODS Healthy young women (24.4 (5.4) years, 23.1 (3.7) kg/m(2)) participated. Primary outcome variables were electromyographic activations of the vastus lateralis, rectus femoris, vastus medialis, biceps femoris, and semitendinosus; co-contraction between the biceps femoris and rectus femoris, and vastus lateralis and vastus medialis; and knee adduction moments of both legs during six static, standing yoga postures (two squatting postures, two lunging postures, a hamstring stretch, and a single-leg balance posture). A two-factor repeated measures analysis of variance was used to identify differences in muscle amplitudes, co-contractions, and knee adduction moment between postures and legs. FINDINGS Quadriceps activations were highest during squat and lunge postures (p≤0.001). Hamstring activations were highest during the hamstring stretch (p≤0.003). Squat and lunge postures produced higher co-contraction indices than other postures (p≤0.011). The wide legged squat (Goddess) and lunge with trunk upright (Warrior) produced the lowest knee adduction moments (p≤0.006), while the single-leg balance posture elicited a higher knee adduction moment than all other postures (p<0.05). INTERPRETATION Squatting and lunging postures could improve leg strength while potentially minimizing exposure to high knee adduction moments. Future work should evaluate whether these exercises are useful in people with knee osteoarthritis.
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Affiliation(s)
- Heather S Longpré
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON Canada
| | - Elora C Brenneman
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON Canada
| | - Ayesha L M Johnson
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON Canada
| | - Monica R Maly
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON Canada.
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Hall M, Stevermer CA, Gillette JC. Muscle activity amplitudes and co-contraction during stair ambulation following anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2015; 25:298-304. [DOI: 10.1016/j.jelekin.2015.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/17/2015] [Accepted: 01/22/2015] [Indexed: 10/24/2022] Open
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Driban JB, Eaton CB, Lo GH, Ward RJ, Lu B, McAlindon TE. Association of knee injuries with accelerated knee osteoarthritis progression: data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2014; 66:1673-9. [PMID: 24782446 DOI: 10.1002/acr.22359] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 04/22/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to evaluate whether a recent knee injury was associated with accelerated knee osteoarthritis (OA) progression. METHODS In the Osteoarthritis Initiative, we studied participants free of knee OA on their baseline radiographs (Kellgren/Lawrence [K/L] <2). We compared 3 groups as follows: 1) individuals with accelerated progression of knee OA: defined as having at least 1 knee that progressed to end-stage knee OA (K/L grade 3 or 4) within 48 months, 2) common knee OA progression: at least 1 knee increased in radiographic scoring within 48 months (excluding those defined as accelerated knee OA), and 3) no knee OA: no change in K/L grade in either knee. At baseline, participants were asked if their knees had ever been injured, and at each annual visit they were asked about injuries during the prior 12 months. We used multinomial logistic regressions to determine whether a new knee injury was associated with the outcome of accelerated knee OA or common knee OA progression, after adjusting for age, sex, body mass index, static knee malalignment, and systolic blood pressure. RESULTS A knee injury during the total observation period was associated with accelerated knee OA progression (n = 54; odds ratio [OR] 3.14) but not common knee OA progression (n = 187; OR 1.08). Furthermore, a more recent knee injury (within a year of the outcome) was associated with accelerated (OR 8.46) and common knee OA progression (OR 3.12). CONCLUSION Recent knee injuries are associated with accelerated knee OA. Most concerning is that certain injuries may be associated with a rapid cascade toward joint failure in less than 1 year.
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Dessery Y, Belzile ÉL, Turmel S, Doré J, Diallo B, Corbeil P. Modulation of physical activity to optimize pain sensation following an intra-articular corticosteroid injection in patients with knee osteoarthritis. ScientificWorldJournal 2014; 2014:209165. [PMID: 25478585 PMCID: PMC4249605 DOI: 10.1155/2014/209165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/25/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intra-articular corticosteroid injection is often used to relieve pain caused by knee osteoarthritis. This study aims to assess the impact after an intra-articular corticosteroid injection treatment on objective and subjective measurement of physical function in knee osteoarthritis patients. METHODS Fourteen patients with unilateral knee osteoarthritis participated in this open-label uncontrolled trial. The intra-articular corticosteroid injection was given at the end of the second week. Physical activity was objectively measured by an accelerometer worn by the participants for eight weeks. Symptoms, quality of life and spatiotemporal parameters of gait were assessed every two weeks. RESULTS From the injection until six weeks later, pain and stiffness were reduced by approximately 60%. Patients' daily physical activity time was significantly improved after injection: participation in light and moderate physical activities increased during four and two weeks, respectively. CONCLUSIONS The beneficial effects after the intra-articular corticosteroid injection are visible in the duration and intensity of the knee osteoarthritis patients' daily physical activity. However, these effects declined gradually two weeks after injection. Modulating the intensity and duration of physical activity would allow patients to optimize pain sensation over a longer period following an intra-articular corticosteroid injection. Trial Registration. This trial was registered with ClinicalTrials: NCT02049879.
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Affiliation(s)
- Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Quebec City, QC, Canada G1V 0A6
- Unité de Recherche sur le Vieillissement, Centre de Recherche FRSQ du CHA Universitaire de Québec, 1050 Chemin Sainte-Foy, Quebec City, QC, Canada G1S 4L8
| | - Étienne L. Belzile
- Division de Chirurgie Orthopédique, CHUQ, 11 Côte du Palais, Quebec City, QC, Canada G1R 2J6
- Département de Chirurgie, Faculté de Médecine, Université Laval, 1050 avenue de la Médecine, Quebec City, QC, Canada G1V 0A6
| | - Sylvie Turmel
- Division de Chirurgie Orthopédique, CHUQ, 11 Côte du Palais, Quebec City, QC, Canada G1R 2J6
| | - Jean Doré
- Département de Kinésiologie, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Quebec City, QC, Canada G1V 0A6
| | - Binta Diallo
- Département de Kinésiologie, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Quebec City, QC, Canada G1V 0A6
- Unité de Recherche sur le Vieillissement, Centre de Recherche FRSQ du CHA Universitaire de Québec, 1050 Chemin Sainte-Foy, Quebec City, QC, Canada G1S 4L8
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Quebec City, QC, Canada G1V 0A6
- Unité de Recherche sur le Vieillissement, Centre de Recherche FRSQ du CHA Universitaire de Québec, 1050 Chemin Sainte-Foy, Quebec City, QC, Canada G1S 4L8
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Al-Johani AH, Kachanathu SJ, Ramadan Hafez A, Al-Ahaideb A, Algarni AD, Meshari Alroumi A, Alanezi AM. Comparative study of hamstring and quadriceps strengthening treatments in the management of knee osteoarthritis. J Phys Ther Sci 2014; 26:817-20. [PMID: 25013274 PMCID: PMC4085199 DOI: 10.1589/jpts.26.817] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/07/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Osteoarthritis (OA) of the knee is the most common form of joint disease. It
is one of the major causes of impaired function that reduces quality of life (QOL)
worldwide. The purpose of this study was to compare exercise treatments for hamstring and
quadriceps strength in the management of knee osteoarthritis. [Subjects and Methods] Forty
patients with OA knee, aged 50–65 years were divided into 2 groups. The first group
(57.65±4.78 years) received hot packs and performed strengthening exercises for the
quadriceps and hamstring, and stretching exercises for the hamstring. The second group
(58.15±5.11 years) received hot packs and performed strengthening exercises for only the
quadriceps, and stretching exercise for the hamstring. Outcome measures were the WOMAC
(Western Ontario and McMaster Universities OA index questionnaire), Visual Analogue Scale
(VAS) assessment of pain, the Fifty-Foot Walk Test (FWS), and Handheld dynamometry.
[Results] There was a significant difference between the groups. The first group showed a
more significant result than the second group. [Conclusion] Strengthening of the
hamstrings in addition to strengthening of the quadriceps was shown to be beneficial for
improving subjective knee pain, range of motion and decreasing the limitation of
functional performance of patients with knee osteoarthritis.
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Correlation between EMG-based co-activation measures and medial and lateral compartment loads of the knee during gait. Clin Biomech (Bristol, Avon) 2014; 28:1014-9. [PMID: 24135198 DOI: 10.1016/j.clinbiomech.2013.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inappropriate tibiofemoral joint contact loading during gait is thought to contribute to the development of osteoarthritis. Increased co-activation of agonist/antagonist pair of muscles during gait has commonly been observed in pathological populations and it is thought that this results in increased articular loading and subsequent risk of disease development. However, these hypotheses assume that there is a close relationship between muscle electromyography and force production, which is not necessarily the case. METHODS This study investigated the relationship between different electromyography-based co-activation measures and articular loading during gait using an electromyography-driven model to estimate joint contact loads. FINDINGS The results indicated that significant correlations do exist between selected electromyography-based activity measures and articular loading, but these are inconsistent and relatively low. However despite this, it was found that it may still be possible to use carefully selected measures of muscle activation in conjunction with external adduction moment measures to account for up to 50% of the variance in medial and lateral compartment loads. INTERPRETATION The inconsistency in correlations between many electromyography-based co-activation measures and articular loading still highlights the danger of inferring joint contact loads during gait using these measures. These results suggest that some form of electromyography-driven modelling is required to estimate joint contact loads in the tibiofemoral joint.
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Collins AT, Richardson RT, Higginson JS. Interlimb symmetry of dynamic knee joint stiffness and co-contraction is maintained in early stage knee osteoarthritis. J Electromyogr Kinesiol 2014; 24:497-501. [PMID: 24768278 DOI: 10.1016/j.jelekin.2014.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 02/21/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022] Open
Abstract
Individuals with knee OA often exhibit greater co-contraction of antagonistic muscle groups surrounding the affected joint which may lead to increases in dynamic joint stiffness. These detrimental changes in the symptomatic limb may also exist in the contralateral limb, thus contributing to its risk of developing knee osteoarthritis. The purpose of this study is to investigate the interlimb symmetry of dynamic knee joint stiffness and muscular co-contraction in knee osteoarthritis. Muscular co-contraction and dynamic knee joint stiffness were assessed in 17 subjects with mild to moderate unilateral medial compartment knee osteoarthritis and 17 healthy control subjects while walking at a controlled speed (1.0m/s). Paired and independent t-tests determined whether significant differences exist between groups (p<0.05). There were no significant differences in dynamic joint stiffness or co-contraction between the OA symptomatic and OA contralateral group (p=0.247, p=0.874, respectively) or between the OA contralateral and healthy group (p=0.635, p=0.078, respectively). There was no significant difference in stiffness between the OA symptomatic and healthy group (p=0.600); however, there was a slight trend toward enhanced co-contraction in the symptomatic knees compared to the healthy group (p=0.051). Subjects with mild to moderate knee osteoarthritis maintain symmetric control strategies during gait.
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Affiliation(s)
- A T Collins
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.
| | - R T Richardson
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - J S Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
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Selective lateral muscle activation in moderate medial knee osteoarthritis subjects does not unload medial knee condyle. J Biomech 2014; 47:1409-15. [PMID: 24581816 DOI: 10.1016/j.jbiomech.2014.01.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 12/11/2013] [Accepted: 01/20/2014] [Indexed: 11/23/2022]
Abstract
There is some debate in the literature regarding the role of quadriceps-hamstrings co-contraction in the onset and progression of knee osteoarthritis. Does co-contraction during walking increase knee contact loads, thereby causing knee osteoarthritis, or might it be a compensatory mechanism to unload the medial tibial condyle? We used a detailed musculoskeletal model of the lower limb to test the hypothesis that selective activation of lateral hamstrings and quadriceps, in conjunction with inhibited medial gastrocnemius, can actually reduce the joint contact force on the medial compartment of the knee, independent of changes in kinematics or external forces. "Baseline" joint loads were computed for eight subjects with moderate medial knee osteoarthritis (OA) during level walking, using static optimization to resolve the system of muscle forces for each subject's scaled model. Holding all external loads and kinematics constant, each subject's model was then perturbed to represent non-optimal "OA-type" activation based on mean differences detected between electromyograms (EMG) of control and osteoarthritis subjects. Knee joint contact forces were greater for the "OA-type" than the "Baseline" distribution of muscle forces, particularly during early stance. The early-stance increase in medial contact load due to the "OA-type" perturbation could implicate this selective activation strategy as a cause of knee osteoarthritis. However, the largest increase in the contact load was found at the lateral condyle, and the "OA-type" lateral activation strategy did not increase the overall (greater of the first or second) medial peak contact load. While "OA-type" selective activation of lateral muscles does not appear to reduce the medial knee contact load, it could allow subjects to increase knee joint stiffness without any further increase to the peak medial contact load.
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Hafez AR, Al-Johani AH, Zakaria AR, Al-Ahaideb A, Buragadda S, Melam GR, Kachanathu SJ. Treatment of knee osteoarthritis in relation to hamstring and quadriceps strength. J Phys Ther Sci 2013; 25:1401-5. [PMID: 24396198 PMCID: PMC3881465 DOI: 10.1589/jpts.25.1401] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/07/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To assess the effect of hamstring and quadriceps strengthening exercises on pain intensity, gait velocity, maximum isometric strength, and activities of daily living of patients with knee osteoarthritis (OA). [Subjects and Methods] A total of 20 patients with knee OA, 50 to 65 years of age (57.65 ± 4.78 years), received hot packs, strengthening exercises for the quadriceps and the hamstring muscles and stretching exercises for hamstring muscles. Outcome measures included: the Western Ontario and McMaster Universities OA index questionnaire (WOMAC) scores for assessing health status and health outcomes of knee OA; self-reported pain intensity scores, measured using a visual analogue scale; the 50 ft walk test (a measure of gait velocity and function); and handheld dynamometry (a tool used to measure maximum isometric strength of knee extension and flexion). [Results] There was a significant difference between pre- and post-intervention measures of pain intensity, 50 ft walk times, hamstring strength, and quadriceps strength. Significant differences in WOMAC measures were also observed in the subscales of pain, stiffness and physical function, as well as WOMAC total scores. [Conclusion] Strengthening the hamstring muscles in addition to strengthening the quadriceps muscles proved to be beneficial for perceived knee pain, range of motion, and decreasing the limitation of functional performance of patients with knee OA.
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Affiliation(s)
| | - Ahmed H Al-Johani
- Rehabilitation Medical Hospital in AL-Medina AL-Manwerah, Saudi Arabia
| | | | - Abdulaziz Al-Ahaideb
- Department of Orthopedics, College of Medicine, King Saud University, Saudi Arabia
| | - Syamala Buragadda
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Ganeswara Rao Melam
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Shaji J Kachanathu
- Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
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Davidson BS, Judd DL, Thomas AC, Mizner RL, Eckhoff DG, Stevens-Lapsley JE. Muscle activation and coactivation during five-time-sit-to-stand movement in patients undergoing total knee arthroplasty. J Electromyogr Kinesiol 2013; 23:1485-93. [DOI: 10.1016/j.jelekin.2013.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/24/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022] Open
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50
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Application of computational lower extremity model to investigate different muscle activities and joint force patterns in knee osteoarthritis patients during walking. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:314280. [PMID: 24302973 PMCID: PMC3834607 DOI: 10.1155/2013/314280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022]
Abstract
Many experimental and computational studies have reported that osteoarthritis in the knee joint affects knee biomechanics, including joint kinematics, joint contact forces, and muscle activities, due to functional restriction and disability. In this study, differences in muscle activities and joint force patterns between knee osteoarthritis (OA) patients and normal subjects during walking were investigated using the inverse dynamic analysis with a lower extremity musculoskeletal model. Extensor/flexor muscle activations and torque ratios and the joint contact forces were compared between the OA and normal groups. The OA patients had higher extensor muscle forces and lateral component of the knee joint force than normal subjects as well as force and torque ratios of extensor and flexor muscles, while the other parameters had little differences. The results explained that OA patients increased the level of antagonistic cocontraction and the adduction moment on the knee joint. The presented findings and technologies provide insight into biomechanical changes in OA patients and can also be used to evaluate the postoperative functional outcomes of the OA treatments.
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