Effect of walking with a modified gait on activation patterns of the knee spanning muscles in people with medial knee osteoarthritis

Booij, M.J.; Richards, R.; Harlaar, Jaap; Noort, Josien C. van den

doi:10.1016/j.knee.2019.10.006

Cited by 29 publications

(36 citation statements)

References 53 publications

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“…Other emerging treatment paradigms for knee OA focus on gait retraining through the use of simple instruction to change foot progression angle, alter step width or medialise the knee position [ 89 ]. However, while these approaches have been shown to reduce the load on the medial compartment [ 89 ], they are associated with muscle overactivity [ 90 ]. In contrast, Cognitive Muscular Therapy was specifically designed to reduce elevated muscle activity.…”

Section: Discussionmentioning

confidence: 99%

A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

Preece

Brookes

Williams

et al. 2021

BMC Musculoskelet Disord

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Background Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist. Methods Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists. Results The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention. Conclusion We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes. Trial registration ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered).

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Section: Discussionmentioning

confidence: 99%

A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

Preece

Brookes

Williams

et al. 2021

BMC Musculoskelet Disord

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“…It has been previously shown that there was a significant correlation between AT thickness and KOA severity ( Elbaz et al, 2017 ), and a diminished phase shift was detected between medial and lateral gastrocnemius activation in severe KOA patients during walking ( Rutherford et al, 2011 ). GM is one of the knees’ spanning flexor muscles, of which activation could affect knee adduction moment ( Booij et al, 2020 ), which was a reliable and accurate measurement of load exerted on the medial compartment of the knee joint, and had been proven to be highly related to the KOA severity ( Khan et al, 2018 ). Meanwhile, it was suggested that foot posture was related to the foot center of pressure and could affect the knee adduction moment by the mediolateral center of pressure shift ( Solomonow-Avnon et al, 2019 ), subsequently exerting an impact on KOA.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Asymmetries in Foot Posture and Properties of Gastrocnemius Muscle and Achilles Tendon Between Patients With Unilateral and Bilateral Knee Osteoarthritis

Chen

Shen

et al. 2021

Front. Bioeng. Biotechnol.

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Background: Asymmetrical foot posture and properties alterations of the gastrocnemius muscle (GM) and Achilles tendon (AT) were observed in knee osteoarthritis (KOA). We aimed to investigate the inter-limbs asymmetries in foot posture and the properties of GM and AT and explore the association between them.Methods: A total of 62 subjects with unilateral or bilateral KOA were included in this study: 30 patients with unilateral pain and 32 patients with bilateral pain were assigned to the bilateral group (BG) and unilateral group (UG), respectively. The relatively serious leg (RSL) and relatively moderate leg (RML) were judged according to the severity of symptoms assessed by using visual analogue scale (VAS) motion. Foot posture and asymmetrical foot posture scores were assessed based on Foot Posture index (FPI-6). Subsequently, all the participants received an assessment for properties of GM and AT, including tone/tension (Hz), stiffness (N/m), and elasticity. We calculated the asymmetry index of AT (Asy-AT) in both legs and the difference of muscle properties between medial and lateral gastrocnemius (D-MLG) in the ipsilateral limb.Results: Asymmetry of foot posture was categorized into three types including normal, asymmetry, and severe asymmetry. The percentage of subjects classified as normal was higher in the BG (62.5%) than in the UG (36.67%), p < 0.05. Tension of AT and tone of lateral gastrocnemius (LG) in RSL were higher than those in RML (15.71 ± 0.91 vs. 15.23 ± 1.01; 25.31 ± 2.09 vs. 23.96 ± 2.08, p < 0.01 and p < 0.01, respectively), and stiffness of AT in the RSL was higher than that in RML (676.58 ± 111.45 vs. 625.66 ± 111.19, p < 0.01). Meanwhile, a positive relationship was found between ipsilateral FPI and tone of MG and LG in the left leg (0.246 per degree, 95% CI: −0.001, 0.129; p = 0.054 and 0.293 per degree, 95% CI: −0.014, 0.157; p = 0.021, respectively) and right leg (0.363 per degree, 95% CI: 0.033, 0.146; p = 0.004 and 0.272 per degree, 95% CI: 0.007, −0.144; p = 0.032, respectively). Moreover, a positive link was observed between asymmetrical FPI scores and K/L grade (0.291 per degree, 95% CI: 0.018, 0.216; p = 0.022). Furthermore, a significantly greater Asy-AT(tension) was detected in the UG than that in the BG (UG vs. UG: 8.20 ± 5.09% vs. 5.11 ± 4.72%, p < 0.01). Additionally, an increased asymmetrical FPI score (i.e., more severe asymmetry) was significantly associated with increases in Asy-AT(tension) and Asy-AT(stiffness) (0.42 per degree, 95% CI: 0.533, 1.881; p = 0.001 and 0.369 per degree, 95% CI: 0.596, 2.82; p = 0.003, respectively).Conclusions: The stiffness and tension of AT and the tone of LG in RSL were higher than those in RML in KOA patients, and inter-limbs foot posture and tension of AT were more asymmetrical in unilateral KOA patients compared to patients with bilateral KOA. Notably, foot posture, as an important biomechanical factor, was significantly associated with properties of GM, AT, and K/L grade in KOA patients.

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“…Studies found that reducing KAM with gait modi cations does not necessarily also change medKCF because other joint loading parameters as KFM or muscle co-contraction might be affected 11,30,31 . A possible successful gait modi cation for reducing medKCF could be in-toeing that potentially reduces KAM but not substantially affecting KFM [32][33][34] .…”

Section: Discussionmentioning

confidence: 99%

Knee Joint Moments Can Accurately Predict Medial and Lateral Knee Contact Forces in Patients With Valgus Malalignment

Holder

Drongelen

Uhlrich

et al. 2022

Preprint

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Compressive knee joint contact force during walking is thought to be related to initiation and progression of knee osteoarthritis. However, joint loading is often evaluated with surrogate measures, like the external knee adduction moment, due to the complexity of computing joint contact forces. Statistical models have shown promise for predicting joint contact force from easily measured joint moments in individuals with osteoarthritis or joint replacements. This approach may also be effective in young patients with valgus deformities. The purpose of this study was to evaluate how accurately medial and lateral knee joint contact forces could be estimated by linear mixed-effects models during walking for children with and without valgus malalignment. Knee joint moments were strongly correlated (R2 > 0.85, p < 0.001) with both medial and lateral knee joint contact forces. The knee flexion and adduction moments were significant covariates in most of the models, strengthening the understanding of the contribution of both moments to medial and lateral knee joint contact force. In the future, these models could be used to predict knee joint contact forces using joint moments from motion capture software, obviating the need for time-consuming musculoskeletal simulations.

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Effect of walking with a modified gait on activation patterns of the knee spanning muscles in people with medial knee osteoarthritis

Cited by 29 publications

References 53 publications

A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

Comparison of the Asymmetries in Foot Posture and Properties of Gastrocnemius Muscle and Achilles Tendon Between Patients With Unilateral and Bilateral Knee Osteoarthritis

Knee Joint Moments Can Accurately Predict Medial and Lateral Knee Contact Forces in Patients With Valgus Malalignment

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