Progressive Resistance Exercise with Eccentric Loading for the Management of Knee Osteoarthritis

Abstract

IntroductionThe patient was a 58-year-old African-American male with radiographic evidence of bilateral knee osteoarthritis (OA). He participated in a standardized 12-week eccentric strengthening program within a Veterans Affairs (VA) medical center.BackgroundThe use of an eccentric training paradigm may prove to be beneficial for older adults with knee OA since eccentric muscle actions are involved in the energy absorption at the knee joint during gait and controlled movement during stair descent. Furthermore, in comparison to standard muscle actions, eccentric muscle actions result in higher torque generation and a lower rate of oxygen consumption at a given level of perceived exertion. Therefore, this mode of progressive resistance exercise may be ideal for older adults.DiscussionThe patient completed an eccentric strengthening regimen for the knee flexors and extensors twice per week without an exacerbation of knee pain. Muscle morphology measures of the rectus femoris were measured using diagnostic ultrasound. Isokinetic measures of muscle peak torque were obtained at 60°/s and 180°/s. Functional performance was assessed using a physical performance battery and stair-step performance was assessed from the linear displacement of the center of gravity trajectories obtained with a force plate. Visual analog scale pain ratings and self-reported global disease status were also documented. Post-exercise assessments revealed improvements in sonographic muscle size and tissue composition estimates, peak knee extensor torque (ranging from 60 to 253%), functional performance, and global disease status.Concluding remarksThe patient exhibited improvements in muscle morphology, muscle strength, functional performance, pain, and global disease status after 12 weeks of an eccentric strengthening regimen. The intervention and outcomes featured in this case were feasible to implement within a VA medical center and merit further investigation.

Ultrasound estimates of muscle quality in older adults: reliability and comparison of Photoshop and ImageJ for the grayscale analysis of muscle echogenicity

“…This study was also limited by the investigation of quantitative ultrasound in only the rectus femoris. Although the rectus femoris is an important muscle group in the sonographic assessment of sarcopenia and other chronic disorders ( Watanabe et al, 2013 ; Ismail et al, 2015 ; Hernandez et al, 2015 ), selected upper extremity muscle groups may merit further study as ultrasound-assisted sarcopenia screening and staging is further developed to accommodate non-ambulatory populations ( Harris-Love et al, 2014b ). This report addresses sources of error related to the post-image acquisition analysis by the examiners, the image analysis software used, and the inherent variation of the scanned images from the sample of older adult participants.…”

“…1 ). This approach facilitated the consistent image capture of the rectus femoris within the field of view and has been used in previous studies ( Ismail et al, 2015 ; Hernandez et al, 2015 ). Longitudinal view image capture was completed with the participant lying supine on a plinth and positioning the ultrasound transducer to be oriented 90° to the muscle bundles.…”

Eccentric Exercise Program Design: A Periodization Model for Rehabilitation Applications

“…The eccentric strength training and peak torque assessments were completed using an isokinetic dynamometer (Biodex System 4, Biodex Medical Systems, Shirley, NY) as previously described (Hernandez et al, 2015 ). Isokinetic data for peak torque, total work, and mean power were obtained at a sample rate of 100 Hz using the Biodex System 4 Advantage software.…”

“…The eccentric PRE program for the knee extensors and flexors was 12 weeks in duration with two scheduled training bouts per week, for a total of 24 training sessions as previously reported (Harris-Love, 2005 ; Hernandez et al, 2015 ). At least 1 day of rest was required between training sessions.…”

“…This mode of isokinetic exercise requires the participant to exert at least 10% of the assigned torque limit (~22.5–44.5 N m above the targeted workload in this study) in order to engage the mechanized motion of the dynamometer powerhead shaft. The concentric peak torque values were used to calculate the estimated isokinetic eccentric peak torque for the initial workload assignment (Hernandez et al, 2015 ). This approach was taken as a precaution given the arthritic conditions within the older men featured in our sample who were untrained and naïve to the eccentric muscle action exercise stimulus:…”