TY - JOUR
T1 - Effect of walking with a modified gait on activation patterns of the knee spanning muscles in people with medial knee osteoarthritis
AU - Booij, M. J.
AU - Richards, R.
AU - Harlaar, J.
AU - van den Noort, J. C.
N1 - Copyright © 2019 Elsevier B.V. All rights reserved.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Objective: To evaluate muscle activation patterns and co-contraction around the knee in response to walking with modified gait patterns in patients with medial compartment knee-osteoarthritis (KOA). Design: 40 medial KOA patients walked on an instrumented treadmill. Surface EMG activity from seven knee-spanning muscles (gastrocnemius, hamstrings, quadriceps), kinematics, and ground reaction forces were recorded. Patients received real-time visual feedback on target kinematics to modify their gait pattern towards three different gait modifications: Toe-in, Wider steps, Medial Thrust. The individualized feedback aimed to reduce their first peak knee adduction moment (KAM) by ≥ 10%. Changes in muscle activations and medial/lateral co-contraction index during the loading response phase (10–35% of the gait cycle) were evaluated, for the steps in which ≥ 10% KAM reduction was achieved. Results: Data from 30 patients were included in the analyses; i.e. all who could successfully reduce their KAM in a sufficient number of steps by ≥ 10%. When walking with ≥ 10% KAM reduction, Medial Thrust gait (KAM − 31%) showed increased flexor activation (24%), co-contraction (17%) and knee flexion moment (35%). Isolated wider-step gait also reduced the KAM (− 26%), but to a smaller extent, but without increasing muscle activation amplitudes and co-contraction. Toe-in gait showed the greatest reduction in the KAM (− 35%), but was accompanied by an increased flexor activation of 42% and hence an increased co-contraction index. Conclusion: Gait modifications that are most effective in reducing the KAM also yield an increase in co-contraction, thereby compromising at least part of the effects on net knee load.
AB - Objective: To evaluate muscle activation patterns and co-contraction around the knee in response to walking with modified gait patterns in patients with medial compartment knee-osteoarthritis (KOA). Design: 40 medial KOA patients walked on an instrumented treadmill. Surface EMG activity from seven knee-spanning muscles (gastrocnemius, hamstrings, quadriceps), kinematics, and ground reaction forces were recorded. Patients received real-time visual feedback on target kinematics to modify their gait pattern towards three different gait modifications: Toe-in, Wider steps, Medial Thrust. The individualized feedback aimed to reduce their first peak knee adduction moment (KAM) by ≥ 10%. Changes in muscle activations and medial/lateral co-contraction index during the loading response phase (10–35% of the gait cycle) were evaluated, for the steps in which ≥ 10% KAM reduction was achieved. Results: Data from 30 patients were included in the analyses; i.e. all who could successfully reduce their KAM in a sufficient number of steps by ≥ 10%. When walking with ≥ 10% KAM reduction, Medial Thrust gait (KAM − 31%) showed increased flexor activation (24%), co-contraction (17%) and knee flexion moment (35%). Isolated wider-step gait also reduced the KAM (− 26%), but to a smaller extent, but without increasing muscle activation amplitudes and co-contraction. Toe-in gait showed the greatest reduction in the KAM (− 35%), but was accompanied by an increased flexor activation of 42% and hence an increased co-contraction index. Conclusion: Gait modifications that are most effective in reducing the KAM also yield an increase in co-contraction, thereby compromising at least part of the effects on net knee load.
KW - Co-contraction index
KW - Electromyography
KW - Foot progression angle
KW - Gait retraining
KW - Knee osteoarthritis
KW - Medial compartment loading
UR - http://www.scopus.com/inward/record.url?scp=85076850515&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.knee.2019.10.006
DO - https://doi.org/10.1016/j.knee.2019.10.006
M3 - Article
C2 - 31882386
SN - 0968-0160
VL - 27
SP - 198
EP - 206
JO - Knee
JF - Knee
IS - 1
ER -