Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.

Older adults can develop neuromuscular deficiencies. We tested the hypothesis that these deficiencies could be reflected in altered neuromuscular control during normal daily tasks. Hence, we compared the ability to modulate ground reaction force (GRF) during lateral stepping (LS) from different step heights between younger and older adults. Kinetic data was obtained from younger (23-33yrs, n=5) and older (57-65yrs, n=5) male and female subjects. They stood on top of two 4-inch/8-inch high platforms. Each platform was placed on separate force plates. The subjects were instructed to step down laterally using their non-dominant leg and then step up to the original position. GRF and joint-angle kinematics of both limbs were recorded for the two-step heights. The time (% total) to achieve maximum amount of force (as % body weight) exerted was calculated using data from the average of three LS trials per subject. It was significantly different between males (32.75±1.57) and females (35.75±1.28) (p=0.012) or between young (33.479±1.43) and old (35.021±1.43) (p=0.018) using a three way repeated measures ANOVA comparing step height (4inch, 8inch), gender (male, female), and age (young, old.) According to the data, neuromuscular control of the LS task is affected by age and gender.

Different muscle groups function in a synchronized and coordinated manner to perform a given task, wherein the activity of one muscle group affects that of another (1, 3). Osteoarthritis (OA) is a common, chronic joint disease characterized by pain, disability and progressive loss of function. It is the most common musculoskeletal complaint worldwide and is associated with significant health and welfare costs (2, 7). The knee is the most frequently affected joint of the lower limb and prevalence of knee OA increases with age (6). Several studies have shown that muscle recruitment patterns and neuromuscular efficiency are different for patients with OA compared to normal controls during simple closed chain activities (4). However, no studies have investigated frontal plane control or the modulation of control due to, for example, a change in time or distance in OA (5).

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Older adults may have trouble when performing activities of daily living due to decrease in physical strength and degradation of neuromotor and musculoskeletal function. Motor activation patterns during Lateral Step Down and Step Up from 4-inch and 8-inch step heights was assessed in younger (n=8, 24.4 years) and older adults (n=8, 58.9 years) using joint angle kinematics and electromyography of lower extremity muscles. Ground reaction forces were used to ascertain the loading, stabilization and unloading phases of the tasks. Older adults had an altered muscle activation sequence and significantly longer muscle bursts during loading for the tibialis anterior, gastrocnemius, vastus medialis, bicep femoris, gluteus medius and gluteus maximus muscles of the stationary leg. They also demonstrated a significantly larger swing time (579.1 ms vs. 444.8 ms) during the step down task for the moving leg. The novel data suggests presence of age-related differences in motor coordination during lateral stepping. vii