Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study

Hunt, Michael A.; Takacs, Judit

doi:10.1016/j.joca.2014.04.007

Cited by 87 publications

(124 citation statements)

References 40 publications

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“…However, the differences in the first peak knee adduction moment were not significant. A reduction in the second peak knee adduction moment has been associated with a reduced risk of OA progression, and there have been studies on gait retraining interventions to reduce the second peak knee adduction moment [7,27]. We also did not observe significant differences in medial cartilage or meniscus T 1q in any of the groups.…”

Section: Discussionmentioning

confidence: 43%

Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations?

Kumar

Souza

MacLeod

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Women are at a greater risk for knee osteoarthritis (OA), but reasons for this greater risk in women are not well understood. It may be possible that differences in cartilage composition and walking mechanics are related to greater OA risk in women.Questions/purposes (1) Do women have higher knee cartilage and meniscus T 1q than men in young healthy, middle-aged non-OA and OA populations? (2) Do women exhibit greater static and dynamic (during walking) knee loading than men in young healthy, middle-aged non-OA and OA populations? Methods Data were collected from three cohorts: (1) young active (\ 35 years) (20 men, 13 women); (2) middleaged (C 35 years) without OA (Kellgren-Lawrence [KL] grade \ 2) (43 men, 65 women); and (3) middle-aged with OA (KL [ 1) (18 men, 25 women). T 1q and T 2 relaxation times for cartilage in the medial knee, lateral knee, and patellofemoral compartments and medial and lateral menisci were quantified with 3.0-T MRI. A subset of the participants underwent three-dimensional motion capture during walking for calculation of peak knee flexion and adduction moments, flexion and adduction impulses, and peak adduction angle. Differences in MR, radiograph, and gait parameters between men and women were compared in the three groups separately using multivariate analysis of variance. Conclusions These data demonstrate differences in cartilage composition and gait mechanics between men and women in young healthy, middle-aged healthy, and OA cohorts. Considering the cross-sectional nature of the study, longitudinal research is needed to investigate if these differences in cartilage composition and walking mechanics are associated with a greater risk of lateral tibiofemoral or patellofemoral OA in women. Future studies should also investigate the relative risk of lateral versus medial patellofemoral cartilage degeneration risk in women compared with men. Level of Evidence Level III, retrospective study.

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Section: Discussionmentioning

confidence: 43%

Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations?

Kumar

Souza

MacLeod

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…reduction (e.g. 25-98% in [35] 0-45% in [25]). Future studies on gait modification may benefit by considering the motion of the whole body, even if a specific kinematic change is of primary interest.…”

Section: Discussionmentioning

confidence: 99%

“…To use a sports analogy, Usain Bolt is faster than the authors, and has a longer stride length, but taking longer steps would not necessarily increase our sprinting speeds. An impressive recent pilot study showed that a modified gait (toe-out) reduced the late-stance KAM and knee pain in a 10-week training study of individuals with medial knee OA [25]. Other similar studies on the long-term efficacy and mechanical consequences of gait modification are needed before it can be used confidently as an intervention.…”

Section: Stride (%) Grf Z (Bw)mentioning

confidence: 99%

Joint contact forces when minimizing the external knee adduction moment by gait modification: A computer simulation study

2015

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“…Hunt et al [31] reported that participants with a 10-week toe-out gait modification intervention have minimal to moderate difficulty, and 33% of participants feel joint discomfort within the first 2 weeks. The authors reported no data regarding the negative side effects over the long-term.…”

Section: Discussionmentioning

confidence: 99%

“…For the knee flexion moment, the moment is associated with the medial knee compression force [33], few longitudinal and interventional studies have examined the influence on medial knee OA. The knee flexion moment during the toe-out gait is significantly higher than that during normal walking [6], and the toe-out gait is reported to have beneficial effects for patients with knee OA after a 10-week intervention [31]. Although the peak knee flexion moment has no clear influence on medial knee OA [31], a potentially negative effect of the Nanba gait is that the moment could be increased during the stance phase.…”

Section: Discussionmentioning

confidence: 99%

Beneficial effects of a gait used while wearing a kimono to decrease the knee adduction moment in healthy adults

et al. 2017

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The knee adduction moment (KAM) relates to medial knee osteoarthritis (OA). Several gait modifications to reduce the KAM for the prevention of knee OA have been studied. Most of the modifications, however, involve voluntary changes in leg alignment. Here we investigated the biomechanical effects for reducing the KAM of a walking style with a small trunk rotation and arm swing gait, which is a natural walking style used while wearing a kimono (Nanba walk) that shifts the ground reaction force toward the stance leg (reduced lever arm). Twenty-nine healthy adults (21.5 ± 0.6 years) participated in the present study. A three-dimensional analysis system with 10 cameras and 1 force plate was used to obtain the KAM and other biomechanical data. Surface electromyography (EMG) of the hip and trunk muscles (internal obliquus abdominal muscle: IO, external obliquus abdominal muscle: EO, multifidus muscle: MF, and gluteus medius muscle: Gmed) was also assessed, and integrated EMG (iEMG) of the four muscles was assessed in the first and second halves of the stance phase. The 1st and 2nd peak KAMs were significantly decreased during Nanba walking (0.40±0.09 and 0.37±0.13 Nm/kg) compared with normal walking (0.45±0.09 and 0.45±0.13 Nm/kg; P = 0.002, P<0.001, respectively). The lever arm lengths at the 1st and 2nd peak KAMs were also significantly decreased during Nanba walking compared with normal walking (p = 0.023 and p<0.001, respectively). The iEMGs of IO, EO and Gmed muscles during the first half, and the iEMGs of EO and GM during the second half of the stance phase were significantly increased during Nanba walking compared with normal walking. The Nanba gait modification could be a useful strategy for reducing the KAM with high activation of the trunk and hip joint muscles for the prevention and/or treatment of medial knee OA.

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Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study

Cited by 87 publications

References 40 publications

Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations?

Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations?

Joint contact forces when minimizing the external knee adduction moment by gait modification: A computer simulation study

Beneficial effects of a gait used while wearing a kimono to decrease the knee adduction moment in healthy adults

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