Lower extremity walking mechanics of young individuals with asymptomatic varus knee alignment

Barrios, Joaquin Alberto; Davis, Irene S.; Higginson, Jill S.; Royer, Todd D.

doi:10.1002/jor.20904

Cited by 21 publications

(17 citation statements)

References 27 publications

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“…These biomechanical differences should not be attributed to walking speed, as speed did not differ across time for any of the experimental conditions ( Table 2). The present data are comparable to similar previously collected data, 12,[27][28][29][30] indicating that our data-collection and -analysis methods were appropriate.…”

Section: Discussionsupporting

confidence: 90%

A Novel Experimental Knee-Pain Model Affects Perceived Pain and Movement Biomechanics

Seeley

Park

King

et al. 2013

Journal of Athletic Training

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Context: Knee injuries are prevalent, and the associated knee pain is linked to disability. The influence of knee pain on movement biomechanics, independent of other factors related to knee injuries, is difficult to study and unclear.Objective: (1) To evaluate a novel experimental knee-pain model and (2) better understand the independent effects of knee pain on walking and running biomechanics.Design: Crossover study. Setting: Biomechanics laboratory.Patients or Other Participants: Twelve able-bodied volunteers (age ¼ 23 6 3 years, height ¼ 1.73 6 0.09 m, mass ¼ 75 6 14 kg).Intervention(s): Participants walked and ran at 3 time intervals (preinfusion, infusion, and postinfusion) for 3 experimental conditions (control, sham, and pain). During the infusion time interval for the pain and sham conditions, hypertonic or isotonic saline, respectively, was continuously infused into the right infrapatellar fat pad for 22 minutes.Main Outcome Measure(s): We used repeated-measures analyses of variance to evaluate the effects of time and condition on (1) perceived knee pain and (2) key biomechanical characteristics (ground reaction forces, and joint kinematics and kinetics) of walking and running (P , .05).Results: The hypertonic saline infusion (1) increased perceived knee pain throughout the infusion and (2) reduced discrete characteristics of each component of the walking ground reaction force, walking peak plantar-flexion angle (range ¼ 628-678), walking peak plantar-flexion moment (range ¼ 95-104 NÁm), walking peak knee-extension moment (range ¼ 36-49 NÁm), walking peak hip-abduction moment (range ¼ 62-73 NÁm), walking peak support moment (range ¼ 178-207 NÁm), running peak plantar-flexion angle (range ¼ 388-778), and running peak hip-adduction angle (range ¼ 5-218).Conclusions: This novel experimental knee pain model consistently increased perceived pain during various human movements and produced altered running and walking biomechanics that may cause abnormal knee joint-loading patterns.

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Section: Discussionsupporting

confidence: 90%

A Novel Experimental Knee-Pain Model Affects Perceived Pain and Movement Biomechanics

Seeley

Park

King

et al. 2013

Journal of Athletic Training

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“…Knee adduction moments can be modified by orthoses (32)(33)(34), variable-stiffness shoes (35), leg braces (36), and reduced walking velocity (37). Knee malalignment may be associated with alterations in foot angle in early adult life (38). Because it is easier to alter foot angulation, we assume that this occurred secondary to constitutional knee malalignment.…”

Section: Discussionmentioning

confidence: 99%

“…This may be because knee adduction moment does not influence thigh rotation (20) or hip adduction moment (38). Alternatively, Figure 1.…”

Section: Discussionmentioning

confidence: 99%

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

McWilliams¹,

Doherty²,

Maciewicz³

et al. 2010

Arthritis Care & Research

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Objective. To determine whether self-reported early adult life malalignment of knees or feet are risk factors for knee or hip osteoarthritis (OA). Methods. Participants in the Genetics of Osteoarthritis and Lifestyle case-control database were sent a questionnaire (n ‫؍‬ 3,022) containing line-drawing instruments for self-reported knee and foot alignment at ages 20 -29 years. Respondents were categorized as having straight, valgus, or varus knee, and straight, toe-in, or toe-out feet. Radiographic criteria were used to define current isolated knee or hip OA, combined knee and hip OA, or non-OA controls. Odds ratios (ORs), adjusted ORs, and 95% confidence intervals (95% CIs) were calculated and logistic regression was performed. Results. The response rate was 72%; 87.5% of responders (n ‫؍‬ 1,901) completed the alignment questions. Increased risk of isolated knee OA occurred with early adult varus (adjusted OR 5.16, 95% CI 2.87-9.41) and valgus knees (adjusted OR 3.16, 95% CI 1.04 -9.64). The positive association between knee OA and toe-in foot was explained by varus knee. There was an increased risk of combined knee/hip OA from varus (adjusted OR 4.52, 95% CI 2.39 -8.53) and valgus knees (adjusted OR 3.07, 95% CI 0.99 -9.54). Varus knee was associated with risk of medial tibiofemoral OA, whereas valgus knee was associated with risk of lateral tibiofemoral and lateral patellofemoral OA. Toe-out foot was associated with reduced medial patellofemoral OA. For knee OA, a multiplicative interaction analysis between occupational risks and varus/valgus yielded an OR int of 3.20 (95% CI 1.08 -9.49). Conclusion. Constitutional alignment of the leg in terms of varus or valgus knee or foot rotation may be a significant factor in determining development and distribution of knee but not hip OA.

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“…There is increasing evidence that individuals can successfully alter their gait mechanics using real-time feedback 16–18 19. As an example, White et al studied a group of individuals with a unilateral hip replacement and associated reduced loading on their involved side 16.…”

Section: Introductionmentioning

confidence: 99%

“…Indications of learning include the retention of new motor skills, as well as their transfer to another unpractised activity 20. Addressing the issue of retention, both Crowell et al (2009) and Barrios et al (2008) reported that gait changes induced using real-time biomechanical feedback were retained at a 1-month follow-up 18 19. However, neither of these studies examined the transfer of the new motor skills to other activities.…”

Section: Introductionmentioning

confidence: 99%

The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome

Noehren

Scholz²,

Davis³

2010

Br J Sports Med

275

264

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Background Patellofemoral pain syndrome (PFPS) is the most common overuse injury in runners. Recent research suggests that hip mechanics play a role in the development of this syndrome. Currently, there are no treatments that directly address the atypical mechanics associated with this injury. Objective The purpose of this study was to determine whether gait retraining using real-time feedback improves hip mechanics and reduces pain in subjects with PFPS. Methods Ten runners with PFPS participated in this study. Real-time kinematic feedback of hip adduction (HADD) during stance was provided to the subjects as they ran on a treadmill. Subjects completed a total of eight training sessions. Feedback was gradually removed over the last four sessions. Variables of interest included peak HADD, hip internal rotation (HIR), contralateral pelvic drop, as well as pain on a verbal analogue scale and the lower-extremity function index. We also assessed HADD, HIR and contralateral pelvic drop during a single leg squat. Comparisons of variables of interest were made between the initial, fi nal and 1-month follow-up visit. Results Following the gait retraining, there was a signifi cant reduction in HADD and contralateral pelvic drop while running. Although not statistically signifi cant, HIR decreased by 23% following gait retraining. The 18% reduction in HADD during a single leg squat was very close to signifi cant. There were also signifi cant improvements in pain and function. Subjects were able to maintain their improvements in running mechanics, pain and function at a 1-month follow-up. An unexpected benefi t of the retraining was an 18% and 20% reduction in instantaneous and average vertical load rates, respectively. Conclusions Gait retraining in individuals with PFPS resulted in a signifi cant improvement of hip mechanics that was associated with a reduction in pain and improvements in function. These results suggest that interventions for PFPS should focus on addressing the underlying mechanics associated with this injury. The reduction in vertical load rates may be protective for the knee and reduce the risk for other running-related injuries.

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Lower extremity walking mechanics of young individuals with asymptomatic varus knee alignment

Cited by 21 publications

References 27 publications

A Novel Experimental Knee-Pain Model Affects Perceived Pain and Movement Biomechanics

A Novel Experimental Knee-Pain Model Affects Perceived Pain and Movement Biomechanics

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome

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