The pros and cons of muscle co‐contraction in osteoarthritis of the knee: Comment on the article by Lewek et al

Steultjens, Martijn; Dekker, Joost

doi:10.1002/art.21781

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…It is has been suggested that co-contraction may be a coping response to counteract perceived knee joint instability [41], and our data may indicate that this increase in muscle activation occurs immediately before contact is made with the ground. However, there is currently debate as to whether this response should be counteracted [52]. The findings that larger reductions in clinical pain were associated with more reduction in co-contraction (Fig.…”

Section: Discussionmentioning

confidence: 99%

Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

Preece

Jones

Brown

et al. 2016

BMC Musculoskelet Disord

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BackgroundBoth increased knee muscle co-contraction and alterations in central pain processing have been suggested to play a role in knee osteoarthritis pain. However, current interventions do not target either of these mechanisms. The Alexander Technique provides neuromuscular re-education and may also influence anticipation of pain. This study therefore sought to investigate the potential clinical effectiveness of the AT intervention in the management of knee osteoarthritis and also to identify a possible mechanism of action.MethodsA cohort of 21 participants with confirmed knee osteoarthritis were given 20 lessons of instruction in the Alexander Technique. In addition to clinical outcomes EMG data, quantifying knee muscle co-contraction and EEG data, characterising brain activity during anticipation of pain, were collected. All data were compared between baseline and post-intervention time points with a further 15-month clinical follow up. In addition, biomechanical data were collected from a healthy control group and compared with the data from the osteoarthritis subjects.ResultsFollowing AT instruction the mean WOMAC pain score reduced by 56 % from 9.6 to 4.2 (P < 0.01) and this reduction was maintained at 15 month follow up. There was a clear decrease in medial co-contraction at the end of the intervention, towards the levels observed in the healthy control group, both during a pre-contact phase of gait (p < 0.05) and during early stance (p < 0.01). However, no changes in pain-anticipatory brain activity were observed. Interestingly, decreases in WOMAC pain were associated with reductions in medial co-contraction during the pre-contact phase of gait.ConclusionsThis is the first study to investigate the potential effectiveness of an intervention aimed at increasing awareness of muscle behaviour in the clinical management of knee osteoarthritis. These data suggest a complex relationship between muscle contraction, joint loading and pain and support the idea that excessive muscle co-contraction may be a maladaptive response in this patient group. Furthermore, these data provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. This finding challenges clinical management models of knee osteoarthritis which focus primarily on muscle strengthening.Trial registrationISRCTN74086288, 4th January 2016, retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

Preece

Jones

Brown

et al. 2016

BMC Musculoskelet Disord

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show abstract

“…That same study suggested that the coactivation, though stabilizing, should be altered because it could amplify joint destruction by increasing joint compression. Other investigators have proposed that altering coactivation could destabilize the knee, limiting walking 27 . Furthermore, coactivation could have a negative impact in those with knee joint buckling and shifting.…”

Section: Discussionmentioning

confidence: 99%

The association between antagonist hamstring coactivation and episodes of knee joint shifting and buckling

Segal

Nevitt

Welborn

et al. 2015

Osteoarthritis and Cartilage

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SUMMARY Objective Hamstring coactivation during quadriceps activation is necessary to counteract the quadriceps pull on the tibia, but coactivation can be elevated with symptomatic knee osteoarthritis (OA). To guide rehabilitation to attenuate risk for mobility limitations and falls, this study evaluated whether higher antagonistic open kinetic chain hamstring coactivation is associated with knee joint buckling (sudden loss of support) and shifting (a sensation that the knee might give way). Design At baseline, median hamstring coactivation was assessed during maximal isokinetic knee extensor strength testing and at baseline and 24-month follow-up, knee buckling and shifting was self-reported. Associations between tertiles of co-activation and knee (1) buckling, (2) shifting and (3) either buckling or shifting were assessed using logistic regression, adjusted for age, sex, knee OA and pain. Results 1826 participants (1089 women) were included. Mean ± SD age was 61.7 ± 7.7 years, BMI was 30.3 ± 5.5 kg/m2 and 38.2% of knees had OA. There were no consistent statistically significant associations between hamstring coactivation and ipsilateral prevalent or incident buckling or the combination of buckling and shifting. The odds ratios for incident shifting in the highest in comparison with the lowest tertile of coactivation had similar magnitudes in the combined and medial hamstrings, but only reached statistical significance for lateral hamstring coactivation, OR(95%CI) 1.53 (0.99, 2.36). Conclusions Hamstring coactivation during an open kinetic chain quadriceps exercise was not consistently associated with prevalent or incident self-reported knee buckling or shifting in older adults with or at risk for knee OA.

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The pros and cons of muscle co‐contraction in osteoarthritis of the knee: Comment on the article by Lewek et al

Cited by 2 publications

References 4 publications

Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis

The association between antagonist hamstring coactivation and episodes of knee joint shifting and buckling

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