Biomechanical influences of gait patterns on knee joint: Kinematic & EMG analysis

Electromyographic Analysis of Thigh Muscle Activity in Arthritic Knees During Sit-to-Stand and Stand-to-Sit Movements: Effects of Seat Height and Foot Position

Background: Knee osteoarthritis (OA) impairs functional mobility, including sit-to-stand and stand-to-sit movements. Thigh muscles stabilize the knee during these transitions, and variations in seat height and foot positioning may affect muscle activation. Assessing thigh muscle activity during these tasks may provide strategies to enhance function and guide targeted rehabilitation for individuals with knee OA. Objective: The aim of this study was to examine the EMG activity of the vastus medialis oblique (VMO), rectus femoris (RF), and biceps femoris (BF) muscles of arthritic knees during sit-to-stand and stand-to-sit movements when using varying seat heights and feet positions. Methods: The EMG activity was recorded from the three thigh muscles in the arthritic side during sit-to-stand and stand-to-sit movements under six different seating conditions from eight patients (three females; mean age: 64.6 ± 11.0 years). A three-way ANOVA was used to examine the effects of seat height, foot positioning, and movement type on muscle activation. Results: The results demonstrated significant interactions between muscle activation, movement type, and seating conditions (p = 0.022). The EMG activity of VMO and RF increased significantly during sit-to-stand movements from lower seat heights compared to knee-height seats (p < 0.05). RF activation was also significantly elevated during stand-to-sit transitions at low seat heights (p = 0.023). Additionally, sit-to-stand transitions with symmetrical foot placement elicited significantly greater VMO activation compared to BF activation (p < 0.05). While BF activation remained relatively low across most conditions, it was highest when the arthritic knee was positioned behind the sound foot during both movements. Conclusions: Seat height and foot positioning significantly impact thigh muscle activation in individuals with knee OA during sit-to-stand and stand-to-sit transitions. Lower seat heights require greater VMO and RF activation, indicating increased mechanical demands. Additionally, placing the arthritic knee behind the sound foot enhances BF activation, suggesting a potential strategy for targeted hamstring engagement. These findings provide directions for quadriceps and hamstring strengthening, alongside strategic seating adjustments to optimize functional mobility and reduce joint stress in individuals with knee OA.

Gait analysis using digital biomarkers including smart shoes in lumbar spinal canal stenosis: a scoping review

Lumbar spinal canal stenosis (LSS) is characterized by gait abnormalities, and objective quantitative gait analysis is useful for diagnosis and treatment. This review aimed to provide a review of objective quantitative gait analysis in LSS and note the current status and potential of smart shoes in diagnosing and treating LSS. The characteristics of gait deterioration in LSS include decreased gait velocity and asymmetry due to neuropathy (muscle weakness and pain) in the lower extremities. Previous laboratory objective and quantitative gait analyses mainly comprised marker-based three-dimensional motion analysis and ground reaction force. However, workforce, time, and costs pose some challenges. Recent developments in wearable sensor technology and markerless motion analysis systems have made gait analysis faster, easier, and less expensive outside the laboratory. Smart shoes can provide more accurate gait information than other wearable sensors. As only a few reports exist on gait disorders in patients with LSS, future studies should focus on the accuracy and cost-effectiveness of gait analysis using smart shoes.

Biomechanical Analysis of the Unaffected Limb While Using a Hands-Free Crutch

Basic human ambulation relies on a bipedal gait, which has been reported to be directly related to quality of life. However, injuries to the lower limb can cause an inability to walk and require non-weightbearing periods to heal. Among the many ambulatory aids, standard axillary crutches are prescribed. However, due to the disadvantages of having to use both hands, a slow gait, pain, nerve damage, and gait patterns that differ from that of healthy subjects, currently, a new generation of ambulatory aids has emerged. Among such aids, hands-free crutches (HFCs) are of particular interest due to their form factor, which does not require the use of the hands and facilitates a bipedal gait. In this study, we present an assessment of whether any different gait patterns, compared to overground gait, appeared on the unaffected limb during walking with an HFC. The spatiotemporal parameters, plantar force, lower-limb joint angles, and EMG patterns were evaluated. In conclusion, the results from 10 healthy subjects suggest that wearing an HFC causes only slight changes in the biomechanical gait patterns examined in the unaffected limb compared with overground walking without an HFC.

Kinematics and paraspinal muscle activation patterns during walking differ between patients with lumbar spinal stenosis and controls

BACKGROUND

The narrowing of the spinal canal due to degenerative processes may lead to symptomatic lumbar spinal stenosis (sLSS) and impairments in the patients' gait. Changes in lower extremity joint kinematics and trunk flexion angles have been reported, yet less is known about muscle activation patterns of paraspinal and gluteal muscles in patients with sLSS compared to healthy participants.

RESEARCH QUESTION

Do muscle activation patterns together with sagittal joint kinematics differ between patients with sLSS and healthy controls and do these differences-quantified using gait scores-correlate with clinical scores?

METHODS

In 20 patients with sLSS scheduled for surgery and 19 healthy participants, gait was assessed using seven inertial sensors and muscle activation of gluteus medius, erector spinae and multifidus using wireless surface electromyography (EMG). Differences in joint kinematics and EMG patterns were assessed using statistical parametric mapping with non-parametric independent sample t tests (P < 0.05). Gait scores that describe the overall deviation in joint angles (mGPS) and muscle activation patterns (EMG-Profile Score) were calculated as root mean square distances between patients and healthy participants and their associations with clinical scores (pain, Oswestry Disability Score (ODI)) were analyzed using Spearman's correlation coefficients rho (P < 0.05).

RESULTS

Patients had larger mGPS (+1.9°) and EMG-Profile Scores (+50%) and walked on average slower (-0.26 m/s) than controls. EMG patterns revealed higher activation of multifidus, erector spinae and gluteus medius during midstance in patients compared to controls. Clinical scores (pain, ODI) did not correlate with mGPS or EMG-Profile Scores within patients.

SIGNIFICANCE

Observed differences in gait and muscle activation patterns and in the summary scores of gait and EMG deviations between patients with sLSS and healthy controls may represent additional functional outcomes reflecting the functional status of patients that can be measured using wearable sensors and hence is suitable for application in clinical practice.

Does category of strength predict return-to-work after occupational injury?

Background

Occupational accidents may lead laborers to lose their working capacities, affecting their physical and mental health. Occupational rehabilitation helps improve the ability of patients with occupational accidents and suggests appropriate jobs to avoid second injuries. This study aimed to identify whether any of the functional capacity evaluation (FCE) strength subtests predicted successful return to work.

Methods

Data were collected of 84 patients receiving government-subsidized occupational rehabilitation between September 2016 and December 2018. A structured questionnaire was employed for pre- and post-training assessment, including basic information, information of the occupational accident, status of the laborer at the opening of the injury case, physical requirement for the job, and physical capacity. Eight subtests of strength were included in the physical capacity evaluation, i.e., carrying, lifting to several levels, power grip, and lateral pinch, to explore the association between the strength tests and return to work.

Results

The unadjusted model showed that for every additional kilogram in bilateral carrying strength before work hardening training, the odds of successful return to work increased (crude odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.01–1.24, p = 0.027). After adjustment for basic demographic information and pre-accident physical functional elements of work, the odds of successful return to work increased (adjusted OR = 1.27, 95% CI = 1.04–1.54, p = 0.02) for every additional kilogram in the pre-training bilateral carrying strength. There were no statistically significant differences observed in the other seven subtests.

Conclusion

Through thorough evaluation and work hardening training provided in the occupational rehabilitation, patients’ physical capacity can be understood and improved. However, a full evaluation of functional capacities is prolonged and time-consuming. This study provides evidence that pre-work-hardening bilateral carrying strength may be a promising predictor of return to work and we recommend to consider it as a prioritized test to assist in determining appropriate advice regarding return to work.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13817-2.

Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume

PURPOSE

Quadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross-sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2 years following ACLR and determine the influence of concomitant meniscal pathology.

METHODS

The involved limb of 51 ACLR participants (31 isolated ACLR; 20 combined meniscal pathology) aged 18-40 years were tested at 2.4 ± 0.4 years post-surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°-50°, 50°-40°, 40°-30°, 30°-20°, 20°-10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle-specific knee extension torque and MRI-derived cartilage volumes were evaluated using multiple linear regression.

RESULTS

In ACLR participants with and without meniscal pathology, higher knee extension torques at 60°-50° and 50°-40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle-specific knee extension torques and patellar cartilage volume.

CONCLUSION

Higher quadriceps strength at knee flexion angles of 60°-40° was associated with lower cartilage volume on the medial tibia ~ 2 years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes.

LEVEL OF EVIDENCE

III.

I. Cantacuzino Clinical Hospital, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Department of Physical and Rehabilitation Medicine, Elias Emergency University Hospital, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Department I, Faculty of Midwives and Nursing, University of Medicine and Pharmacy of Craiova, Romania, Department of Nursing Surgery, University of Medicine and Pharmacy of Craiova, Romania, Department of Physiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania. Osteoarthritis induces gender-related changes in the knee range of motion

In time, osteoarthritis (OA) generates the misalignment of the affected joint structures. However, due to the nature of bipedal gait, OA in the lower limb can also cause pathological gait patterns, which can generate instability and falls, with great consequence, especially in the aged population. With goniometry used to evaluate the range of motion (ROM) of joints, we wanted to evaluate how gender impacts gait dynamics in OA patients. For this study, we have compared 106 OA patients (74 females and 32 males) to age matched controls. All participants had their right leg as dominant. Video recording of normal gait was analyzed with a digital goniometry tool phone application, and the knee's ROM was measured in midstance and midswing moment of the gait. During midstance, significant extension and flexion of the knee excursion have been observed in both males and females. During midswing, knee OA presents more differences, whereas subjects with hip and knee OA present changes on the dominant knee. Midstance changes suggest that the knee's joint degenerative changes, such as synovitis, can be linked to hip OA secondary changes. Midswing changes in lower limb OA suggest a connection to the activities of daily life. Gender differences generated by OA must furthermore be studied in both lower limbs so that the best therapeutic approach can be chosen.

Quantitative Gait Analysis of Patients with Severe Symptomatic Spinal Stenosis Utilizing the Gait Profile Score: An Observational Clinical Study

Lumbar spine stenosis (LSS) typically manifests with neurogenic claudication, altering patients’ gait. The use of optoelectronic systems has allowed clinicians to perform 3D quantitative gait analysis to quantify and understand these alterations. Although several authors have presented analysis of spatiotemporal gait parameters, data concerning kinematic parameters is lacking. Fifteen patients with LSS were matched with 15 healthy controls. Quantitative gait analysis utilizing optoelectronic techniques was performed for each pair of subjects in a specialized laboratory. Statistical comparison of patients and controls was performed to determine differences in spatiotemporal parameters and the Gait Profile Score (GPS). Statistically significant differences were found between patient and control groups for all spatiotemporal parameters. Patients had significantly different overall GPS (p = 0.004) and had limited internal/external pelvic rotation (p < 0.001) and cranial/caudal movement (p = 0.034), limited hip extension (p = 0.012) and abduction/adduction (p = 0.012) and limited ankle plantar flexion (p < 0.001). In conclusion, patients with LSS have significantly altered gait patterns in three regions (pelvis, hip and ankle) compared to healthy controls. Analysis of kinematic graphs has given insight into gait pathophysiology of patients with LSS and the use of GPS will allow us to quantify surgical results in the future.