Patients with osteoarthritis of the knee may change their gait in an attempt to reduce loading of the affected knee, thereby reducing pain. Especially changes in lateral trunk motion may be potentially effective, since these will affect the position of the centre of mass relative to the knee, enabling minimization of the load on the knee and thereby knee pain. The aim of the study was to test the hypothesis that a higher level of knee pain is associated with higher lateral trunk motion in patients with knee OA.
Fifty-two patients with OA of the knee were tested. Lateral trunk motion was measured during the stance phase of walking with an optoelectronic motion analysis system and a force plate. Knee pain was measured with the VAS and the WOMAC pain questionnaire. Regression analyses were performed to assess the relationship between lateral trunk motion and knee pain.
It was shown that in bivariate analyses knee pain was not associated with lateral trunk motion. In regression analyses, pain was associated with more lateral trunk motion. In addition, more lateral trunk motion was associated with younger age, being female, higher self-reported knee stiffness and higher maximum walking speed.
Pain is associated with lateral trunk motion. This association is weak and is influenced by age, gender, self-reported stiffness and maximum walking speed.
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[Show abstract][Hide abstract] ABSTRACT: To evaluate whether increased lateral trunk lean toward the symptomatic lower extremity during gait in people with medial knee osteoarthritis (OA) immediately alters symptoms or medial knee load, as measured by the external knee adduction moment (KAM).
Participants with medial knee OA (n = 22) underwent 3-dimensional gait analysis to measure KAM peaks (early and late stance) and KAM impulse. Following the analysis of natural gait, participants were trained to lean their trunk toward the symptomatic leg during ipsilateral stance over 3 randomly ordered conditions (6°, 9°, and 12° lean). A projection screen displayed real-time trunk angles and target levels. Pain/discomfort in the knees, the hip, and the back were measured across conditions. Load-modifying effects of increasing lean magnitudes were investigated using linear mixed models. Mediating effects of peak lean timing and participant characteristics (pain and malalignment) were evaluated.
Increased trunk lean reduced all KAM measures (P < 0.001), with larger lean angles achieving greater reductions. Efficacy of load reduction improved with later peak lean timing for all measures of the KAM. Participant characteristics did not mediate the effect of trunk lean on the KAM, and symptoms did not change across conditions (P > 0.05).
Increased trunk lean reduced medial knee load in a dose-response manner. Slightly later achievement of peak trunk lean improved the load-modifying effect of this gait strategy. No immediate symptomatic changes were identified. Future research should determine if long-term implementation of this gait strategy is feasible and whether it can modify disease symptoms and OA progression.
Arthritis Care and Research 10/2012; 64(10):1545-53. DOI:10.1002/acr.21724 · 4.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This updated review outlines the influence of muscle activity on knee joint loading, describes the deficits in muscle function observed in people with knee osteoarthritis, and summarizes available evidence pertaining to the role of muscle in the development and progression of knee osteoarthritis. The review also focuses on whether muscle deficits can be modified in knee osteoarthritis and whether improvements in muscle function lead to improved symptoms and joint structure. The review concludes with a discussion of exercise prescription for muscle rehabilitation in knee osteoarthritis.
Rheumatic diseases clinics of North America 02/2013; 39(1):145-76. DOI:10.1016/j.rdc.2012.11.003 · 2.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate if altering the foot progression angle (FPA) by varying magnitudes during gait alters the external knee adduction moment (KAM), knee flexion moment (KFM), knee extension moment (KEM) and/or symptoms in people with medial knee osteoarthritis (OA). Potential influence of pain and knee malalignment on load-modifying effects of FPA was investigated.
Participants (n = 22) underwent 3-dimensional gait analysis to measure KAM peaks, KAM impulse, KFM and KEM peaks. Following natural gait, five altered FPA conditions were performed in random order (10° toe-in, 0° FPA, 10° toe-out, 20° toe-out and 30° toe-out). A projection screen displayed their real-time FPA. Pain/discomfort at knees and feet/ankles were evaluated for each condition. Linear mixed models were used for statistical analysis.
Toe-in reduced the early stance peak KAM and KEM but increased the KAM impulse, late stance peak and KFM. Toe-out reduced the KAM impulse, late stance peak and KFM (P < 0.001) but increased the early stance peak KAM and KEM. All effects were greater in participants with more varus knees. Pain significantly mediated the effect of altered FPA on the KAM impulse and late stance peak. In more painful individuals, toe-in was predicted to reduce the KAM impulse and late stance peak, and increase them for toe-out gait. There were no immediate symptomatic changes.
Effects of altered FPA vary across all medial knee load parameters and it is difficult to determine an optimal direction of FPA change. Future studies should consider Western Ontario McMaster Universities OA Index (WOMAC) pain to judge the likely effects of altered FPA.
Osteoarthritis and Cartilage 09/2013; 21(9):1272-80. DOI:10.1016/j.joca.2013.06.001 · 4.17 Impact Factor