Neil A Segal

Neil A Segal
University of Kansas | KU · Department of Rehabilitation Medicine

MD, MS

About

243
Publications
35,141
Reads
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6,069
Citations
Citations since 2016
102 Research Items
3847 Citations
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Introduction
As a clinical rehabilitation scientist, I hope to advance understanding of physical function, particularly for people with lower limb musculoskeletal disorders. Research that targets the mechanistic pathways for disease, impairments and functional limitations will enable clinicians to use rehabilitation strategies to reduce risk and severity of disease and disablement. My current research focusses on effects of pregnancy and joint contact stress that may lead to hip, knee or foot problems.
Additional affiliations
December 2014 - present
University of Kansas
Position
  • Professor
July 2004 - December 2014
University of Iowa
Position
  • Professor (Associate)
June 2000 - July 2001
Saint Joseph Hospital
Position
  • Intern
Education
June 2005 - May 2008
University of Iowa
Field of study
  • Clinical Investigation
June 2001 - July 2004
Mayo Foundation for Medical Education and Research
Field of study
  • Physical Medicine & Rehabilitation
August 1995 - May 2000
Vanderbilt University
Field of study
  • Medicine

Publications

Publications (243)
Article
Objective Although radiography has traditionally been the most common means of imaging knee and ankle osteoarthritis (OA), the technology is limited in its abilities to accurately detect features of OA and provide accurate, sensitive, and responsive imaging biomarkers. More advanced modalities such as non-weight-bearing CT and MRI reveal additional...
Preprint
Gait alterations in those with mild unilateral knee pain during walking may provide clues to modifiable alterations that affect progression of knee pain and osteoarthritis(OA). To examine this, we applied machine learning (ML) approaches to gait data from wearable sensors in a large observational knee OA cohort, the Multicenter Osteoarthritis (MOST...
Preprint
Objective To 1) develop and evaluate a machine learning model incorporating gait and physical activity to predict medial tibiofemoral cartilage worsening over two years in individuals without or with early knee osteoarthritis and 2) identify influential predictors in the model and quantify their effect on cartilage worsening. Design An ensemble ma...
Article
INTRODUCTION 3-D joint space width (JSW) measured from weight bearing CT (WBCT) has been suggested to be more sensitive than radiographic 2-D measurement in detecting joint space narrowing (JSN), but its diagnostic value in osteoarthritis is yet to be established. OBJECTIVE To determine the predictive validity of 3-D JSW measurement from baseline...
Article
INTRODUCTION An important development in osteoarthritis imaging has been the ability to assess joint space width (JSW) from weight bearing CT (WBCT). The value of combining JSW with subchondral bone parameters in disease assessment is less well understood, particularly with respect to disease phenotype. OBJECTIVE To investigate associations of wor...
Article
INTRODUCTION Weight bearing CT (WBCT) technology has been increasingly used in imaging of knee osteoarthritis in recent years because of its ability to assess the weight bearing joint space. However, relatively little is known regarding the extent to which this cone beam technology can provide useful information on peri-articular bone beyond the su...
Article
INTRODUCTION Radiography is the current standard for assessing osseous structural knee OA, but it is a 2D image of a 3D structure and superimposition of bone impairs ability to sensitively detect changes. Weight-bearing CT (WBCT) allows improved visualization of OA features, shows greater correlation with central medial cartilage damage on MRI and...
Article
Full-text available
Objective Computed tomography (CT) can deliver multiple parameters relevant to osteoarthritis. In this study we demonstrate that a 3-D multiparametric approach at the weight bearing knee with cone beam CT is feasible, can include multiple parameters from across the joint space, and can reveal stronger relationships with disease status in combinatio...
Article
Objective Cryoneurolysis, cold-induced reversible conduction block of peripheral nerves, is an effective treatment for reducing knee osteoarthritis (OA) symptoms and opioid use following knee arthroplasty. There are limited data concerning its use for ankle OA. Our aim was to assess clinically significant long-term symptomatic relief of ankle OA wi...
Article
Objective While the effect of triamcinolone acetonide extended-release (TA-ER) on reducing knee osteoarthritis (OA) pain has been reported, the effects on physical performance are incompletely understood. This open label clinical trial systematically evaluated the effects of intra-articular TA-ER on physical performance, self-reported function, and...
Article
Background: Limb circumference predicts the pressure needed for complete occlusion. However, that relationship is inconsistent at moderate pressures typical of effective blood flow restriction (BFR) training. The purpose of this study was to investigate the influence of subject factors on BFR at low restriction pressures in the arm. Methods: Fif...
Article
Objective: To assess the extent to which pain sensitivity is altered in obese women with frequent knee symptoms who walk with either a hybrid training system (HTS) that provides antagonist muscle electrical stimulation vs. sensory transcutaneous electrical nerve stimulation (TENS). Design: Randomized, double-blinded, controlled trial. Setting:...
Article
Objective This study aimed to determine longitudinal associations, including sex-specific differences, between greater knee flexor antagonist coactivation and worsening cartilage morphology in knees with or at risk for OA. Design Baseline measurements were collected at the 60-month visit of a longitudinal osteoarthritis study following community-d...
Article
Objective: Determine whether tibiofemoral contact stress predicts risk for worsening knee pain over 84-months in adults aged 50-79 years with or at elevated risk for knee osteoarthritis. Design: Baseline tibiofemoral contact stress was estimated using discrete element analysis. Other baseline measures included weight, height, hip-knee-ankle (HKA...
Article
Full-text available
Background TPX-100, a promotor of osteoblast and chondroblast differentiation, is a potential osteoarthritis (OA) therapy. This retrospective study compared MRI 3D femoral bone shape changes ( B -scores) after intra-articular TPX-100 or placebo and analyzed the relationship between cartilage thickness and bone shape change over 12 months. Methods...
Article
Full-text available
Objectives To examine whether foot and/or ankle pain increases the risk of knee OA. Design We utilised longitudinal data from the Multicentre Osteoarthritis Study (MOST); a community-based cohort of risk factors for knee OA. Participants without frequent knee pain (clinic visit only) and radiographic knee OA (RKOA) at baseline and, with no evidenc...
Article
Objective The patellofemoral joint is frequently affected by osteoarthritis (PFOA) and is incompletely imaged on radiographs (XR). Weight-Bearing CT (WBCT) could offer advantages for visualization. This study determined the sensitivity, specificity, and accuracy of axial WBCT and lateral XR for detection of PFOA features in comparison with cartilag...
Article
Full-text available
Objectives: To determine how many persons with knee pain have subsequent pain resolution and what factors are associated with resolution, focusing especially on types of physical activity. Methods: Using data from MOST, an NIH funded longitudinal cohort study of persons with or at risk of knee osteoarthritis, we studied participants who at basel...
Article
Full-text available
Background: This study examined the association between baseline gait speed with incident diabetes mellitus (DM) among people with or at elevated risk for knee OA. Materials and methods: Participants from the Osteoarthritis Initiative, aged 45 to 79 years, where included. Participants with or at risk of knee OA from baseline to the 96-month visi...
Article
Background Imaging of structural disease in osteoarthritis has traditionally relied on MRI and radiography. Joint space mapping (JSM) can be used to quantitatively map joint space width (JSW) in three dimensions from CT images. Purpose To demonstrate the reproducibility, repeatability, and feasibility of JSM of the knee using weight-bearing CT imag...
Article
Objective To compare ground reaction force patterns (GRF) during walking among legs defined by presence or absence of knee pain and/or radiographic knee osteoarthritis (ROA). Method Principal component analysis extracted major modes of variation (PCs) in GRF data from the Multicenter Osteoarthritis Study during self-paced walking. Legs were catego...
Preprint
Full-text available
Background: TPX-100, a promotor of osteoblast and chondroblast differentiation, is a potential osteoarthritis (OA) therapy. This retrospective study compared MRI 3D femoral bone shape changes (B-scores) after intra-articular TPX-100 or placebo and analyzed the relationship between cartilage thickness and bone shape change over 12 months. Methods: 1...
Article
Objective To determine whether amount of physical activity (PA) is a determinant of joint space narrowing (JSN) worsening over 48‐months in participants with knee osteoarthritis (OA). Methods Data were obtained from the Osteoarthritis Initiative. PA, measured using the Physical Activity Scale for the Elderly (PASE), was defined as the mean value o...
Article
Full-text available
As the population ages, there is a growing burden due to musculoskeletal diseases, such as knee osteoarthritis, and subsequent functional decline. In the absence of a cure, there is a need to identify factors amenable to intervention to prevent or slow this process. The Multicenter Osteoarthritis (MOST) Study cohort was developed for this purpose....
Article
Introduction: The coexistence of Knee osteoarthritis (OA) and diabetes mellitus (DM) can be explained by shared risk factors such as age and obesity. Both conditions adversely affect gait speed, however, longitudinal studies investigating the relationship between gait speed and DM incidence in people with or at elevated risk for knee OA are lacking...
Article
Objective To examine the relation of pain sensitization to altered motor activity in knee OA as assessed by hamstrings muscle co-contraction during maximal effort knee extension. Design Medial, lateral, and overall hamstring co-contraction was assessed in the Multicenter Osteoarthritis (MOST) Study cohort using electromyography during isokinetic k...
Article
Full-text available
Background Postpartum women are at increased risk for lower limb musculoskeletal disorders. Foot arch collapse following pregnancy has been reported as a mechanism for this increased risk. However, dynamic changes during gait in postpartum women have not been reported. Therefore, we assessed the association between parity and dynamic foot pronation...
Article
Full-text available
Limited research has examined the association between diabetes mellitus (DM) and knee pain in people with osteoarthritis (OA). Therefore, this study aimed at examining the association between DM and knee pain severity, and to explore the association between DM and knee pain distribution (unilateral or bilateral versus no pain) in subjects with knee...
Article
Objectives: Osteoarthritis (OA) and pain are both made more severe by low-grade inflammation. We examined whether visceral fat, a major source of inflammatory cytokines and adipokines, was associated with an increased risk of knee OA or of musculoskeletal pain. Methods: Member of the Multicenter Osteoarthritis Study cohort, age 50-79 with or at...
Article
Full-text available
Limitations of plain radiographs may contribute to poor sensitivity in the detection of knee osteoarthritis and poor correlation with pain and physical function. 3D joint space width, measured from weight bearing CT images, may yield a more accurate correlation with patients' symptoms. We assessed the cross‐sectional association between 3D joint sp...
Article
Introduction: We have a limited understanding of how antagonist muscle coactivation relates to measurement of strength in both individuals with and without knee osteoarthritis (KOA). Objective: We sought to determine if hamstring coactivation during a maximal quadriceps activation task attenuates net quadriceps strength. Design: Cross-sectiona...
Article
Objective: To assess the effectiveness of a hybrid training system with walking (HTSW) that simultaneously applies electrical stimulation to the knee extensors/flexors during walking in obese women with knee pain. Design: Randomized, single-blind (assessor), controlled trial. 28 obese women with knee pain randomized to 12 weeks of biweekly walki...
Article
Meralgia paresthetica (MP) is a sensory mononeuropathy characterized by pain, tingling, numbness, and paresthesias localized to the anterolateral thigh. Although most cases of MP are idiopathic, common causes include compression, surgical injury, and metabolic derangements [1]. The majority of MP cases either spontaneously resolve, or patients atta...
Article
Full-text available
Purpose Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of bre...
Conference Paper
Full-text available
Background In new draft guidance for OA drugs, the U.S. FDA notes the “well-recognized discordance” in clinical trials between structural imaging and patient benefit. In a randomized, double-blind, placebo-controlled trial, IA TPX-100 was associated with statistically significant and clinically meaningful improvement in knee functions among subject...
Poster
Purpose: The association between higher body mass index (BMI) and the presence of multi-joint pain has been well documented in the literature. Both higher BMI and multi-joint pain are common in people with knee osteoarthritis (OA) and both are associated with greater pain severity. Despite the ongoing opioid epidemic, opioid prescription is often p...
Article
Full-text available
Objective To determine the association of self‐selected walking step rate with worsening of cartilage damage in the patellofemoral joint (PF) and tibiofemoral joint (TF) compartments two years later. Methods The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self‐selected st...
Article
Objective Whether diabetes mellitus (DM) is associated with increased risk of knee osteoarthritis is uncertain. We evaluated associations of DM and biomarkers of abnormal glucose metabolism with incident radiographic knee osteoarthritis (RKOA), controlling for body mass index (BMI). Methods Participants (mean age 60.6±7.8 years; mean BMI 29.1±4.9...
Article
Objectives Why some individuals develop pain with knee osteoarthritis (OA) is not clear. We sought to identify pain susceptibility phenotypes (PSPs) and their relation to incident persistent knee pain (PKP) 2 years later. Methods We identified individuals free of PKP from the Multicenter Osteoarthritis Study, a longitudinal cohort of older adults...
Article
Full-text available
Objective Reports on quadriceps weakness as a risk factor for incident and progressive knee osteoarthritis are conflicting, potentially due to differing effects of muscle strength on patellofemoral and tibiofemoral compartments. This study aimed to examine the sex‐specific relation of quadriceps strength to worsening patellofemoral and tibiofemoral...
Article
Objective Quadriceps weakness, associated with functional limitations, is a target of treatment of knee osteoarthritis (OA). Limited data exist on modest strength increases and improvements in function. We evaluated concurrent change in strength and physical function over 5 years. Methods Using subjects from the Multicenter Osteoarthritis (MOST) s...
Article
Contralateral knee pain has been suggested to be associated with muscle weakness in a pain-free knee, potentially through a mechanism of central nervous inhibition. Whether contralateral knee pain also affects muscle strength in a painful knee, however, is unknown. Here we study the extent to which isometric muscle strength differs between matched...
Article
Objective To investigate thresholds of strength below which people with knee osteoarthritis (OA) may have more difficulty carrying out physical functions of daily life. Persons below such thresholds might benefit more from strengthening interventions than those with greater strength. Methods We studied persons with symptomatic OA at baseline in th...
Article
Full-text available
PurposeTo analyse the stress distribution through longitudinal and radial meniscal tears in three tear locations in weight-bearing conditions and use it to ascertain the impact of tear location and type on the potential for healing of meniscal tears. Methods Subject-specific finite-element models of a healthy knee under static loading at 0°, 20°, a...
Article
Introduction Anthropometric changes to the feet with pregnancy may increase risk for musculoskeletal disease. Customized arch-supportive orthoses to prevent anthropometric changes could potentially provide an inexpensive means to prevent musculoskeletal impairments and improve quality of life for women during their post-reproductive years. The obje...
Article
Background: Altered joint laxity may contribute to joint dysfunction. Knee joint laxity has been shown to increase during pregnancy, but its long-term persistence is unknown. Objective: To determine whether pregnancy leads to lasting increases in knee joint compliance and laxity that persist greater than 4 months postpartum. Design: Prospectiv...
Article
Background: Knee osteoarthritis (OA) is a leading cause of disability that is associated with quadriceps weakness. However, strengthening in people with or with risk factors for knee OA can be poorly tolerated. Objective: To assess the efficacy of a twelve-week low-load exercise program, using a hybrid training system (HTS) that utilizes the com...