Implications of increased medio-lateral trunk sway for ambulatory mechanics

Mündermann, Annegret; Asay, Jessica L.; Mündermann, Lars; Andriacchi, Thomas P.

doi:10.1016/j.jbiomech.2007.07.001

Cited by 236 publications

(193 citation statements)

References 32 publications

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“…Increased trunk lean during gait did not immediately affect symptoms at the knees, hip, or back in this medial knee OA cohort. Increased lateral trunk lean significantly reduced the KAM in our sample of medial knee OA participants, which is consistent with previous research in healthy individuals (10,21). This is the first study to implement the trunk lean gait modification in a knee OA sample and evaluate loadmodifying effects with increasing magnitudes of lean.…”

Section: Discussionsupporting

confidence: 91%

“…The greater effects demonstrated by Mundermann et al (10) may be due to: 1) their implementation of trunk lean bilaterally (compared to ipsilaterally in the present study), 2) the self-selected magnitude of lean, resulting in an average peak trunk lean angle of 10°with large variability (5°SD), and 3) potentially different timing of trunk lean (not reported), which may have altered the gait modification effect size. Furthermore, the trunk motion evaluation method used by Mundermann et al (10) calculated frontal plane trunk angle as the projection of the angle between a line intersecting the midpoints between anterior superior iliac spines and the scapular acromion processes and the global vertical axis. This method of trunk lean motion cannot exclude the confounding motion of the shoulder and pelvis as readily in comparison to the method chosen for this study.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Of these, increasing lateral trunk lean (or lateral flexion) toward the symptomatic knee during stance appears to give the greatest reduction in the early stance peak KAM (10). This strategy has been evaluated in 2 studies of healthy young individuals, both demonstrating significant load reductions (10,21). Increasing trunk lean is postulated to modify knee load by changing the frontal plane center of mass location, subsequently reducing the ground reaction force lever arm at the knee and thus the KAM (22).…”

Section: Introductionmentioning

confidence: 99%

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Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles

Simić¹,

Hunt²,

Bennell³

et al. 2012

Arthritis Care & Research

105

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Objective. 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). Methods. 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. Results. Increased trunk lean reduced all KAM measures (P

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles

Simić¹,

Hunt²,

Bennell³

et al. 2012

Arthritis Care & Research

105

View full text Add to dashboard Cite

show abstract

“…Thus, specific recommendations for ''ideal'' gait and for rehabilitation strategies to attain this gait will require future research. Gait training is possible through biofeedback, 31 altering body position during walking, 32,33 or by altering muscle mechanics through targeted training 34 in various hip and knee pathologies. The increasingly younger joint replacement patient population may require further advances in implant longevity and postoperative function beyond what is currently achieved based on materials and surgical improvements.…”

mentioning

confidence: 99%

Relative importance of gait vs. joint positioning on hip contact forces after total hip replacement

Foucher

Hurwitz

Wimmer

2009

Journal Orthopaedic Research

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Implant loosening is a common indication for total hip replacement (THR) revision. High contact forces and implant twisting moments are thought to be associated with implant loosening. Relationships between joint positioning and hip forces, or outcomes, have been investigated through in vivo and in vitro modalities. Relationships between hip forces and gait are less understood, despite repeated findings that gait following a THR does not fully return to normal. We tested the hypothesis that gait parameters would be better predictors of implant force (peak contact forces and peak twisting moment during walking) than joint positioning parameters. Subjects underwent gait analysis, hip force modeling, and measurement of clinical radiographs 1 year after successful THR surgery. Gait parameters were consistently more influential in determining hip forces. Alone, gait explained as much as 67% of the variation in force, compared to a maximum of 33% by joint geometry. Combinations of gait and joint positioning parameters together explained up to 86% of the variation in hip force parameters. Results suggest that gait may provide a valuable postoperatively modifiable target to improve hip loads and potentially reduce the risk for implant loosening. ß

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Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

Henriksen¹,

Graven‐Nielsen²,

Aaboe³

et al. 2010

Arthritis Care & Research

Self Cite

151

112

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Objective. Medial knee osteoarthritis (OA) is characterized by pain and associated with abnormal knee moments during walking. The relationship between knee OA pain and gait changes remains to be clarified, and a better understanding of this link could advance the treatment and prevention of disease progression. This study investigated changes in knee moments during walking following experimental knee pain in healthy volunteers, and whether these changes replicated the joint moments observed in medial knee OA patients. Methods. In a crossover study, 34 healthy subjects were tested on 3 different days; gait analyses were conducted before, during, and after pain induced by hypertonic saline injections (0.75 ml) into the infrapatellar fat pad. Isotonic saline and sham injections were used as control conditions. Peak moments in frontal and sagittal planes were analyzed. The results were compared with data from 161 medial knee OA patients. The patients were divided into less severe OA and severe OA categories, which was based on radiographic disease severity of the medial compartment. Results. Experimental knee pain led to reduced peak moments in the frontal and sagittal planes in the healthy subjects, which were similar to the patterns observed in less severe OA patients while walking at the same speed. Conclusion. In healthy subjects, pain was associated with reductions in knee joint moments during walking in a manner similar to less severe knee OA patients. The experimental model may be used to study mechanically-driven knee OA progression and preventive measures against abnormal joint loading in knee OA.

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Implications of increased medio-lateral trunk sway for ambulatory mechanics

Cited by 236 publications

References 32 publications

Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles

Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles

Relative importance of gait vs. joint positioning on hip contact forces after total hip replacement

Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

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