The effect of anti-gravity treadmill training for knee osteoarthritis rehabilitation on joint pain, gait, and EMG

Abstract

Introduction: To date, the anti-gravity treadmill (AlterG), as a representative method of Lower body positive pressure (LBPP) treadmills, has been rarely reported for knee osteoarthritis (KOA) rehabilitation. The purpose of this case study was to setup the clinical protocol example for AlterG intervention on KOA and evaluate treatment effectiveness by 3D gait analysis combined with free EMG to explore the kinematic gait parameter changes. Patient concerns: A 65-year-old female patient (BMI = 26, mild obesity) undergoing “more than 7 years of KOA.” The activity of the right knee joint was obviously limited and she suffered from severe pain over the past month. Diagnosis: Due to the patient's symptoms and radiographic findings, she was diagnosed with acute attack of KOA. Interventions: The patient has performed clinical function evaluation and gait analysis combined at pretreatment, post-treatment, and 4 months follow-up assessment. AlterG training was performed 6 days/week for 2 weeks, with up to 30 min of training per session. The training protocol included two major parts, walking and squatting in AlterG. Outcomes: After 2 weeks of AlterG intervention, the 10-m walking test (10 MWT) and Timed-up-and-go (TUG) test improved significantly post-treatment, whereas the Visual Analog Scale (VAS) score decreased post-treatment. The Modified Barthel Index improved post-treatment and the patient restored basic community walk after treatment. The temporal parameter results showed that stride length (%height), mean velocity (%height), and cadence gradually increased before treatment, after treatment, and at 4-month follow-up. The right range of motion (ROM) of knee flexion-extension were gradually increased. Meanwhile, the synchronized EMG data showed that the RMS (root means square) values of the rectus femoris, semitendinosus, and biceps femoris at post-treatment were improved to different degrees than at pretreatment. Conclusion: We found that for this patient with KOA, AlterG relieved pain, and was also effective at improving spatio-temporal parameters, knee flexion/extension gait pattern, and corresponding muscle strength, thereby restoring certain community activities.

Effects of lower body positive pressure treadmill on functional improvement in knee osteoarthritis: A randomized clinical trial study

“…Meanwhile, the LBPP treadmill proved useful for reducing pressure across the entire foot in normal subjects while running[ 21 ]. Previous studies have also indicated that the effects of LBPP cause an increase in the reduction of the peak joint force on the knee joint[ 11 ]. Based on this finding, we have reason to infer that the knee pressure on the mechanical chain would be reduced accordingly, which might be crucial for knee OA patients undergoing rehabilitation.…”

“…The entire training session was supervised by a trained physiotherapist for guidance and safety. The patients in the LBPP group (experimental treatment group) performed an LBPP walking training program (provided using AlterG M320 Antigravity Treadmill, California, USA) for 30 min/session/day, 6 d/week for 2 wk, which was based on our previous study[ 11 ]. The LBPP walking protocol included 20 min walking stage (speed = 1.5–2.0 mph, BW = 65%, Incline = 0%) and 10 min warm-up and cooling down stage at the beginning and ending of the session (Figure 1B ).…”

“…All patients underwent clinical assessments and gait analysis at pre- and 2-wk post-treatment time points. The assessment method was based on our previous study[ 11 ]. Lower limb function and mobility for knee OA patients were measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) with five items for pain, two items for stiffness, and 17 functional items[ 16 ].…”

A Review of the Relationships Between Knee Pain and Movement Neuromechanics

“…In a case study, knee OA pain was reduced using reduced gravity treadmill walking for 2 weeks. 66 As the knee pain decreased, several biomechanical variables improved, including increased stride length, walking velocity, and flexion-extension excursion during stance. Rectus femoris, semitendinosus, and biceps femoris activation also increased.…”

Walking on the Moon: A randomized clinical trial on the role of lower body positive pressure treadmill training in post-stroke gait impairment

“…LBPPSS is increasingly used after knee surgery to reduce ground reaction forces during walking and running to facilitate postoperative rehabilitation [20], [21]. It has also been successfully employed in children with cerebral palsy [22].…”