1
|
Liu T, Xie H, Yan S, Zeng J, Zhang K. Thigh muscle features in female patients with severe knee osteoarthritis: a cross-sectional study. BMC Musculoskelet Disord 2025; 26:206. [PMID: 40022077 PMCID: PMC11869621 DOI: 10.1186/s12891-025-08361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 01/28/2025] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND Muscle function deterioration in female patients with severe knee osteoarthritis (KOA) is linked to alterations in muscle morphology, composition, and mechanical properties. This study evaluates thigh muscle features in female patients with severe KOA and explores correlations with knee joint function. METHODS Ultrasound and shear wave elastography measured physiological cross-sectional area (PCSA), echo intensity (EI), and shear modulus (G) in the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris long head (BFL), and semitendinosus (ST) of 24 KOA patients and 24 controls. EI indicates intramuscular fat, while G reflects stiffness. Muscle characteristics were compared between groups, and correlations with knee function scores (WOMAC, KSS, HSS) were analyzed. RESULTS In patients, the symptomatic side displayed reduced PCSA for RF, VL, VM, BFL, and ST (15.85[Formula: see text], 28.18[Formula: see text], 21.53[Formula: see text], 11.67[Formula: see text], 6.59[Formula: see text] respectively) vs. controls (19[Formula: see text], 36.32[Formula: see text], 23.37[Formula: see text], 14.15[Formula: see text], 7.12[Formula: see text] respectively). EI was elevated (128.95, 121.12, 105.72, 90.52, 93.15) vs. controls (100.39, 93.97, 88.14, 77.69, 78.73), and G values (9.48 kPa, 7.88 kPa, 6.9 kPa, 7.2 kPa, 9.03 kPa) was higher than controls (8.85 kPa, 5.28 kPa, 5.98 kPa, 6.58 kPa, 6.73 kPa). BFL`s G, ST`s G, and VM`s EI, negatively correlated with knee function, whereas BFL`s PCSA positively correlated. The variable importance of BFL's PCSA and G ranked at the top in all scores. CONCLUSIONS Compared to controls, PCSAs in muscles on both sides of KOA patients were lowered by up to 22%, indicative of muscle loss and diminished strength. The G value is 20.65% higher, suggesting poor flexibility and elevated passive tension. EI in muscles on both sides of KOA patients was greater, reaching up to 23.88%, possibly reducing contractile components and muscle force. G, PCSA, and EI are closely correlated with function scores, and PCSA and G of BFL are the most significant predictors of knee function. These results may help explain muscle dysfunction in KOA patients. CLINICAL TRIAL NUMBER Not applicable.
Collapse
Affiliation(s)
- Tingting Liu
- School of Biomedical Engineering, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
| | - Hao Xie
- School of Biomedical Engineering, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
| | - Songhua Yan
- School of Biomedical Engineering, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
| | - Jizhou Zeng
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China.
| |
Collapse
|
2
|
Du X, Liu Z, Tao X, Mei Y, Zhou D, Cheng K, Gao S, Shi H, Song C, Zhang X. Research Progress on the Pathogenesis of Knee Osteoarthritis. Orthop Surg 2023; 15:2213-2224. [PMID: 37435789 PMCID: PMC10475681 DOI: 10.1111/os.13809] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 07/13/2023] Open
Abstract
Knee osteoarthritis (KOA) is a chronic joint bone disease characterized by inflammatory destruction and hyperplasia of bone. Its main clinical symptoms are joint mobility difficulties and pain, severe cases can lead to limb paralysis, which poses major pressure to the quality of life and mental health of patients, but also brings serious economic burden to society. The occurrence and development of KOA is influenced by many factors, including systemic factors and local factors. The joint biomechanical changes caused by aging, trauma and obesity, abnormal bone metabolism caused by metabolic syndrome, the effects of cytokines and related enzymes, genetic and biochemical abnormalities caused by plasma adiponectin, etc. all directly or indirectly lead to the occurrence of KOA. However, there is little literature that systematically and comprehensively integrates macro- and microscopic KOA pathogenesis. Therefore, it is necessary to comprehensively and systematically summarize the pathogenesis of KOA in order to provide a better theoretical basis for clinical treatment.
Collapse
Affiliation(s)
- Xin Du
- Center for Phenomics of Traditional Chinese MedicineThe Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Zi‐yu Liu
- Center for Phenomics of Traditional Chinese MedicineThe Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Xing‐xing Tao
- Center for Phenomics of Traditional Chinese MedicineThe Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Yong‐liang Mei
- Department of Orthopaedics and Traumatology (Trauma and Bone‐setting)The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Da‐qian Zhou
- Department of Orthopaedics and Traumatology (Trauma and Bone‐setting)The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Kang Cheng
- Department of Orthopaedics and Traumatology (Trauma and Bone‐setting)The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Si‐long Gao
- Department of Orthopaedics and Traumatology (Trauma and Bone‐setting)The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Hou‐yin Shi
- Medical DepartmentThe Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Chao Song
- Department of Orthopaedics and Traumatology (Trauma and Bone‐setting)The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| | - Xiao‐min Zhang
- Department of Orthopaedics and Traumatology (Trauma and Bone‐setting)The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
| |
Collapse
|
3
|
Cha Y, Yoon H, Park C, You SJH. Untacted automated robotic upper-trunk- lower reciprocal locomotor training for knee osteoarthritis: A randomized controlled trial. J Back Musculoskelet Rehabil 2023; 36:1101-1110. [PMID: 37248877 DOI: 10.3233/bmr-220182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Although millions of people with osteoarthritis (OA) have altered biomechanical alignment, movement, and knee joint pain during gait, there are no effective and sustainable interventions. To mitigate such impairments, we developed an untacted self-automated robotic and electromyography (EMG)-augmented upper-trunk-lower reciprocal locomotor training (SRGT) intervention. OBJECTIVE To compare the effects of SRGT and conventional treadmill gait training (CTGT) on the medial knee joint space width (JSW), hip adduction moment (HAM), knee varus deformity, pain, and physical function in community-dwelling older adults with OA. METHODS Older adults diagnosed with medial compartment knee OA (5 men, 35 women; mean age = 78.50 ± 9.10 years) were recruited and underwent either SRGT or CTGT, 30 min a day, 3 times a week, over a 4-week period. Outcome measurements included the JSW, HAM, knee varus angle (VA), and Western Ontario McMaster Universities osteoarthritis index (WOMAC). RESULTS Analysis of covariance (ANCOVA) showed that SRGT ed to greater changes in medial knee JSW (p= 0.00001), HAM (p= 0.00001), VA (p= 0.00001), and WOMAC (p= 0.00001) scores. CONCLUSION This study provides the first evidence for the long-term clinical and biomechanical effects of SRGT on JSW, knee joint kinematics, kinetics, and WOMAC scores in older adults with OA. Most importantly, self-automatic robotic gait training may be an alternative, effective, and sustainable treatment for the upper-trunk-lower reciprocal locomotor training in older adults with OA.
Collapse
Affiliation(s)
- Youngjoo Cha
- Department of Physical Therapy, Cheju Halla University, Jeju, Korea
| | - Hyunsik Yoon
- Chungnam National University Hospital, Daejeon, Korea
| | - Chanhee Park
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea
- Department of Physical Therapy, Yonsei University, Wonju, Korea
| | - Sung Joshua H You
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea
- Department of Physical Therapy, Yonsei University, Wonju, Korea
| |
Collapse
|
4
|
Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular joint function in knee osteoarthritis: A systematic review and meta-analysis. Ann Phys Rehabil Med 2022; 66:101662. [PMID: 35364316 DOI: 10.1016/j.rehab.2022.101662] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Neuromuscular alterations are common in people with knee osteoarthritis (KOA). A comprehensive understanding of these alterations is important to enable targeted rehabilitation strategies. OBJECTIVES This systematic review and meta-analysis aimed to comprehensively understand the neuromuscular alterations around the knee joint in people with KOA. METHODS Moderate- and high-quality studies based on a modified version of the Downs and Black checklist, comparing neuromuscular function of peri‑articular muscles between people with KOA and controls were retrieved from five databases from inception to October 2020. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and torque-related outcomes. Data were pooled according to structural KOA severity with sensitivity analysis based on sex. Evidence levels are presented in evidence gap maps. RESULTS A total of 7 high-quality and 22 moderate-quality studies were retained (1146 people with KOA and 1353 age- and sex-matched controls). Studies demonstrated quadriceps and hamstring strength deficits and increased hamstring-to-quadriceps strength ratios across KOA severities. Women presented lower quadriceps strength at early KOA (very limited evidence) and lower voluntary activation at end stage KOA (very limited evidence) as compared with controls, whereas men did not (moderate evidence). People with KOA also demonstrated lower quadriceps force control ability with no change in rapid force production (very limited evidence). Voluntary activation deficits for quadriceps were evident (moderate evidence), with no change in quadriceps cortical excitability (very limited evidence) or soleus spinal reflexes (very limited evidence). No muscle size change was demonstrated except for the vastus medialis (limited evidence). Evidence gaps were found for neural and torque-related measures and differences in hamstring, gastrocnemius, soleus, and popliteus. CONCLUSIONS Neuromuscular deficits are evident across different structural KOA severities and are seen in muscle strength, voluntary activation, muscle size, and force control ability. Women may exhibit these alterations to a greater extent than men. PROSPERO REGISTRATION NUMBER CRD42019160845.
Collapse
Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom.
| | - Chedsada Charuphongsa
- Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom; Physiotherapy Department, Barts Health NHS trust, London E1 4DG, United Kingdom
| | - Stuart Charles Miller
- Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
5
|
Tung EV, Marriott KA, Laing AC, Mourtzakis M, Maly MR. The relationship between muscle capacity utilization during gait and pain in people with symptomatic knee osteoarthritis. Gait Posture 2022; 94:58-66. [PMID: 35247826 DOI: 10.1016/j.gaitpost.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle capacity utilization reflects the percentage of maximal knee extensor strength required to complete physical activities. RESEARCH QUESTION Is pain associated with muscle capacity utilization during walking in older adults with knee osteoarthritis? Secondarily, is muscle capacity utilization in older adults with knee osteoarthritis sex-specific? METHODS Twenty-three participants (15 females) with symptomatic knee OA completed this study [age 67 ( ± 8) years, body mass index 29.7 ( ± 3.9) kg/m2, gait speed during the Six Minute Walk test 1.25 ( ± 0.25) m/s]. Pain was measured using the Knee injury and Osteoarthritis Outcome Score. Muscle capacity utilization was quantified as the peak external knee flexor moment during level walking normalized to knee extensor maximum voluntary isometric contraction. The knee flexor moment was calculated from kinematic and kinetic data during barefoot level walking at a self-selected speed and at 1.1 m/s. Knee extensor maximum voluntary isometric contraction was measured on a dynamometer. Multiple linear regressions were used to determine the relationship between pain and muscle capacity utilization after adjusting for age, sex, body mass index, and gait speed. Independent sample t-tests examined sex differences. RESULTS Pain was not associated with muscle capacity utilization during self-selected and standardized walking speeds (p = 0.38 and p = 0.36, respectively). Females did not require a greater muscle capacity utilization than males to complete gait at self-selected and standardized speeds (p = 0.28, and p = 0.40, respectively). SIGNIFICANCE Muscle capacity utilization was not associated with pain during walking in people with knee osteoarthritis. Future work should explore more challenging activities of daily living in knee OA.
Collapse
Affiliation(s)
- Emma V Tung
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Kendal A Marriott
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Andrew C Laing
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Marina Mourtzakis
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Monica R Maly
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| |
Collapse
|
6
|
Myers BJ. Isokinetic testing of muscle strength in older adults with knee osteoarthritis: An integrative review. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-201150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
7
|
Sex- and osteoarthritis-related differences in muscle co-activation during weight-bearing tasks. Gait Posture 2020; 79:117-125. [PMID: 32402893 DOI: 10.1016/j.gaitpost.2020.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with knee osteoarthritis (OA) demonstrate impairments in muscle function (i.e. muscle weakness, high muscle co-activation believed to have detrimental effects on joint integrity). Women with knee OA exhibit poorer health outcomes than men. Sex and muscle function are known risk factors for knee OA. It is unclear how these risk factors are associated with muscle function in knee OA and the implications for disease aetiology. RESEARCH QUESTION How does sex and knee osteoarthritis disease status relate to muscle function, specifically strength and muscle co-activation, during walking, stair negotiation and sit-to-walk activities. METHODS A cross-sectional study assessed muscle co-activation in 77 individuals with knee OA (mean[SD], 62.5[8.1] years; 48/29 women/men) and 18 age-matched controls (62.5[10.4] years; 9/9 women/men), during a series of walking, stair ascent and descent and sit-to-walk activities. Muscle strength of the knee extensors and flexors was assessed using maximal voluntary isometric contractions (MVIC). Electromyography was recorded from the vastus lateralis/medalis, rectus femoris, biceps femoris, semitendinosus, medial/lateral gastrocnemius normalised to MVIC. Multiple regression assessed the relationship between sex, disease status, and muscle strength on muscle co-activation. RESULTS Individuals with knee OA were weaker than controls, had higher hamstrings-quadriceps and medial-lateral co-activation for specific phases of gait. Women were weaker than men with higher muscle co-activation across all activities. Sex and muscle weakness, but not age or disease status predicted high muscle co-activation. SIGNIFICANCE High muscle co-activation was associated with female sex and muscle weakness regardless of disease status and age. High muscle co-activation is believed to be a compensatory mechanism for muscle weakness to maintain a certain level of function. High muscle co-activation is also thought to have detrimental effects on cartilage and joint integrity this may explain high muscle co-activation in women with muscle weakness and contribute to increased risk of incidence and progression of knee OA in women.
Collapse
|
8
|
Moura TGD, Nagata CDA, Garcia PA. The influence of isokinetic peak torque and muscular power on the functional performance of active and inactive community-dwelling elderly: a cross-sectional study. Braz J Phys Ther 2020; 24:256-263. [PMID: 31000175 PMCID: PMC7253910 DOI: 10.1016/j.bjpt.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To verify the importance of the isokinetic muscular torque and power of knee extensors and flexors on the functional performance of active and inactive elderly women. METHODS A cross-sectional observational study was conducted with 116 community-dwelling women (≥60 years old) without severe cognitive and/or motor dysfunction. Isokinetic muscle function was measured by peak torque and muscle power at 60°/s (5 repetitions) and 180°/s (15 repetitions), respectively. Mobility was evaluated by means of the Timed Up and Go test (TUG) and the Habitual Gait Speed (HGS) test. Balance was evaluated via the alternate step and semitandem tests. Lower limb strength was assessed using the Sit-to-stand test. Univariate and multivariate logistic regression analysis was used to determine association between independent and dependent variables (α=0.05). RESULT Active elderly women had better muscle function and functional performance than inactive elderly women for almost all variables. Peak torque and muscular power of knee extensor muscles explained the dynamic balance, mobility, and lower limb strength among inactive elderly women (OR: 0.89-0.95; p<0.05). Muscular power of knee flexors influenced tasks that required mobility and lower limb strength among active elderly (OR: 0.82-0.87; p<0.05). CONCLUSIONS The muscular power of knee flexors was shown to be more important for the functional performance of active elderly women. The muscular power of knee extensors had a stronger influence on the performance of the inactive elderly women.
Collapse
Affiliation(s)
- Tayla Gomes de Moura
- Graduation in Physical Therapy, Universidade de Brasília (UnB), Brasília, DF, Brazil
| | - Cristiane de Almeida Nagata
- Postgraduate Program in Rehabilitation Sciences, Universidade de Brasília (UnB) - Campus Ceilândia, Brasília, DF, Brazil
| | - Patrícia Azevedo Garcia
- Postgraduate Program in Rehabilitation Sciences, Universidade de Brasília (UnB) - Campus Ceilândia, Brasília, DF, Brazil.
| |
Collapse
|
9
|
Zhang X, Pan X, Deng L, Fu W. Relationship between Knee Muscle Strength and Fat/Muscle Mass in Elderly Women with Knee Osteoarthritis Based on Dual-Energy X-Ray Absorptiometry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E573. [PMID: 31963156 PMCID: PMC7013934 DOI: 10.3390/ijerph17020573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 12/17/2022]
Abstract
Purpose: This study aimed to examine the characteristics and correlation of knee muscle strength and body composition (fat and muscle mass) among elderly women aged 60-70 years with knee osteoarthritis. The present study hypothesized that the muscle mass and the peak torques of the knee joints were considerably low in the knee osteoarthritis (KOA) group. Methods: A total of 47 elderly women aged 60-70 years were recruited from Yangpu District in Shanghai and assigned to the knee osteoarthritis (n = 25, KOA) or healthy control group (n = 22, CON). The knee extension/flexion isokinetic strength measurements were conducted on an isokinetic dynamometer at angular velocities of 90°/s. Dual-energy X-ray absorptiometry was used to measure the body composition (fat and muscle mass in the whole body and lower limbs). The independent sample t-test was employed to determine the effects of knee osteoarthritis on each variable, and the Pearson correlation analysis was used to investigate the correlation between the body composition and knee muscle strength. Results: Compared with the CON, the KOA exhibited the following: (1) Lower absolute peak knee extension torque (66.02 ± 10.57 vs. 56.61 ± 14.69 Nm), relative peak knee extension (1.11 ± 0.19 vs. 0.89 ± 0.26 Nm/kg), and flexion torque (0.62 ± 0.15 vs. 0.54 ± 0.16 Nm/kg, p < 0.05); (2) greater relative peak torque ratio of the knee extension and flexion (0.55 ± 0.08 vs. 0.62 ± 0.15, p < 0.05); and (3) lower total body muscle mass percentage (63.24% ± 4.50% vs. 59.36% ± 3.94%), particularly in the lower limbs (19.96% ± 1.51% vs. 18.47% ± 1.49%, p < 0.05). Furthermore, the total body fat mass percentage was negatively associated with the relative peak knee extension and flexion torque regardless of the group (p < 0.05). The total body muscle mass percentage was positively associated with the relative peak knee extension torque in the two groups and the relative peak knee flexion torque in the CON (p < 0.05). Conclusion: For elderly women with knee osteoarthritis, knee muscle strength decreases significantly, especially for the extensor strength. Moreover, compared with fat mass, the index of muscle mass is more sensitive in detecting the decrease in knee joint torque. Therefore, rather than weight loss alone, the quadriceps muscle and the rear-thigh muscles, which maintain the stability of knee joints during rehabilitation training, should be strengthened emphatically to improve muscle mass.
Collapse
Affiliation(s)
- Xini Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (X.P.); (L.D.)
| | - Xiaoyu Pan
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (X.P.); (L.D.)
| | - Liqin Deng
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (X.P.); (L.D.)
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (X.P.); (L.D.)
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
| |
Collapse
|
10
|
Smith SL, Allan R, Marreiros SP, Woodburn J, Steultjens MPM. Muscle Co-Activation Across Activities of Daily Living in Individuals With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 71:651-660. [PMID: 29953745 DOI: 10.1002/acr.23688] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Muscle co-activation has been shown to be elevated in individuals with knee osteoarthritis (OA) during gait. Comparisons of muscle co-activation across different activities of daily living such as stair negotiation have yet to be explored. The aim of this study was to explore muscle co-activation across different activities of daily living in patients with knee OA. METHODS Muscle co-activation was assessed in 77 symptomatic knee OA patients (mean ± SD age 62.5 ± 8.1 years, body mass index 29.4 ± 6.0 kg/m2 , and sex 48:29 female:male) using electromyography (EMG), during a series of walking, stair negotiation (ascent, descent), and sit-to-walk activities. EMG was recorded from 7 sites, mediolateral gastrocnemius, biceps femoris, semitendinosus, vastus lateralis/medialis, and rectus femoris, and normalized to maximal voluntary isometric contraction. Correlation was used to assess the consistency of co-activation across activities. Repeated-measures analysis of variance assessed the muscle combination by activity differences. RESULTS Muscle co-activation was highest during stair ascent. When comparing muscle combinations within the same activity, we found that correlations ranged from r = 0.003 to r = 0.897, of which 80% of the combinations were significant. Between activities, muscle co-activation was significantly different (P < 0.05). Mediolateral muscle co-activation was higher than hamstrings/quadriceps across activities. CONCLUSION Two muscle co-activation strategies were observed during activities of daily living in patients with knee OA to maintain stability. Muscle co-activation was higher during more challenging activities, particularly when the joint was accepting load. Mediolateral muscle co-activation was higher than hamstrings/quadriceps, so that mediolateral co-activation was thought to be a stabilization mechanism, while hamstrings/quadriceps co-activation responds to knee flexion moments, suggesting that different muscle combinations may have different roles in responding to joint demand.
Collapse
Affiliation(s)
- Stephanie L Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Richard Allan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Sara P Marreiros
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Martijn P M Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| |
Collapse
|
11
|
Takacs J, Krowchuk NM, Garland SJ, Carpenter MG, Hunt MA. Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:1586-1593. [PMID: 28279661 DOI: 10.1016/j.apmr.2017.01.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine the effect of a targeted balance training program on dynamic balance and self-reported physical function in people with medial tibiofemoral osteoarthritis (OA). DESIGN Single-blind randomized controlled trial. SETTING Exercise gymnasium and community dwellings. PARTICIPANTS Individuals with medial compartment knee OA (N=40). INTERVENTIONS Ten weeks of partially supervised exercises targeting dynamic balance and strength performed 4 times per week or no intervention (nonintervention group). MAIN OUTCOME MEASURES Dynamic balance was measured using the Community Balance and Mobility Scale (CB&M), and self-reported physical function was measured using the Western Ontario and McMaster Universities Arthritis Index physical function subscale. Secondary outcomes included knee pain, fear of movement, knee joint proprioception, and muscle strength. RESULTS Forty individuals underwent baseline testing, with 36 participants completing follow-up testing. Adherence to exercise in the training group was high, with 82.2% of all home-based exercise sessions completed. No significant changes were observed in any outcome in the nonintervention group at follow-up. Significant improvements in self-reported pain, physical function, and fear of movement were observed in the training group when compared with the nonintervention group. No other within- or between-group differences were observed. CONCLUSIONS A 10-week dynamic balance training program for people with knee OA significantly improved self-reported knee pain, physical function, and fear of movement; however, there was no change in dynamic balance as quantified by the CB&M. Further research is needed to investigate how exercise may result in improvement on objective measures of dynamic balance.
Collapse
Affiliation(s)
- Judit Takacs
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Natasha M Krowchuk
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - S Jayne Garland
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Mark G Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
12
|
Davison MJ, Maly MR, Keir PJ, Hapuhennedige SM, Kron AT, Adachi JD, Beattie KA. Lean muscle volume of the thigh has a stronger relationship with muscle power than muscle strength in women with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2017; 41:92-97. [PMID: 28038376 DOI: 10.1016/j.clinbiomech.2016.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/25/2016] [Accepted: 11/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thigh lean muscle and intramuscular fat have been implicated in the impairment of physical function observed in people with knee osteoarthritis. We investigated the relationships of quadriceps and hamstrings intramuscular fat fraction and lean muscle volume with muscle power and strength, controlling for neuromuscular activation, and physical performance in women with knee OA. METHODS Women (n=20) 55years or older with symptomatic, radiographic knee osteoarthritis underwent a 3.0T magnetic resonance imaging scan of the thigh of their most symptomatic knee. Axial fat-separated images were analyzed using software to quantify intramuscular fat and lean muscle volumes of the quadriceps and hamstrings. To quantify strength and power of the knee extensors and flexors, participants performed maximum voluntary isometric contraction and isotonic knee extensions and flexions, respectively. Electromyography of the quadriceps and hamstrings was measured. Participants also completed five physical performance tests. FINDINGS Quadriceps and hamstrings lean muscle volumes were related to isotonic knee extensor (B=0.624; p=0.017) and flexor (B=1.518; p=0.032) power, but not knee extensor (B=0.001; p=0.615) or flexor (B=0.001; p=0.564) isometric strength. Intramuscular fat fractions were not related to isotonic knee extensor or flexor power, nor isometric strength. No relationships were found between intramuscular fat or lean muscle volume and physical performance. INTERPRETATION Muscle power may be more sensitive than strength to lean muscle mass in women with knee osteoarthritis. Thigh lean muscle mass, but neither intramuscular nor intermuscular fat, is related to knee extensor and flexor power in women with knee osteoarthritis.
Collapse
Affiliation(s)
- Michael J Davison
- Department of Medicine, McMaster University, 501-25 Charlton Ave. East, Hamilton, ON L8N 1Y9, Canada.
| | - Monica R Maly
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Room 403, 1400 Main St. W. Hamilton, ON L8S 1C7, Canada; Department of Kinesiology, B.C. Matthews Hall, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 3G1, Canada.
| | - Peter J Keir
- Department of Kinesiology, McMaster University, Ivor Wynne Centre, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Sandani M Hapuhennedige
- Department of Medicine, McMaster University, 501-25 Charlton Ave. East, Hamilton, ON L8N 1Y9, Canada.
| | - Amie T Kron
- Faculty of Science, McMaster University, Burke Science Building (BSB), Room 102, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, 501-25 Charlton Ave. East, Hamilton, ON L8N 1Y9, Canada.
| | - Karen A Beattie
- Department of Medicine, McMaster University, 501-25 Charlton Ave. East, Hamilton, ON L8N 1Y9, Canada.
| |
Collapse
|
13
|
Takacs J, Carpenter MG, Garland SJ, Hunt MA. Factors Associated With Dynamic Balance in People With Knee Osteoarthritis. Arch Phys Med Rehabil 2015; 96:1873-9. [DOI: 10.1016/j.apmr.2015.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/09/2015] [Accepted: 06/24/2015] [Indexed: 11/24/2022]
|
14
|
Superficial shoulder muscle co-activations during lifting tasks: Influence of lifting height, weight and phase. J Electromyogr Kinesiol 2015; 25:355-62. [DOI: 10.1016/j.jelekin.2014.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/22/2014] [Accepted: 11/12/2014] [Indexed: 11/21/2022] Open
|
15
|
Kellis E, Mademli L, Patikas D, Kofotolis N. Neuromuscular interactions around the knee in children, adults and elderly. World J Orthop 2014; 5:469-485. [PMID: 25232523 PMCID: PMC4133453 DOI: 10.5312/wjo.v5.i4.469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/12/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
Although injury and neuromuscular activation patterns may be common for all individuals, there are certain factors which differentiate neuromuscular activity responses between children, adults and elderly. The purpose of this study is to review recent evidence on age differences in neural activation and muscle balances around the knee when performing single joint movements. Particularly, current evidence indicates that there are some interesting similarities in the neuromuscular mechanisms by which children or the elderly differ compared with adults. Both children and elderly display a lower absolute muscle strength capacity than adults which cannot fully be explained by differences in muscle mass. Quadriceps activation failure is a common symptom of all knee injuries, irrespective of age but it is likely that its effect is more evident in children or adults. While one might expect that antagonist co-activation would differ between age categories, it appears that this is not the case. Although hamstring: quadriceps ratio levels are altered after knee injury, it is not clear whether this is an age specific response. Finally, evidence suggests that both children and the elderly display less stiffness of the quadriceps muscle-tendon unit than adults which affects their knee joint function.
Collapse
|
16
|
Effect of Submaximal Repetitive Exercise on Knee Coactivation in Young and Middle-Aged Women. J Appl Biomech 2014; 30:269-75. [DOI: 10.1123/jab.2013-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coactivation of the knee extensors and flexors increases knee joint contact forces, which may lead to degradation of the articular surfaces. This study investigated the effect of neuromuscular fatigue induced by submaximal, repetitive, dynamic contractions on coactivation of knee musculature in young and middle-aged women. Data from 10 young women (24.6 ± 1.8 years) and 8 middle-aged women (55.4 ± 4.2 years) were analyzed. Measures included peak knee extension and flexion torques and the average amplitude of surface electromyography of rectus femoris and biceps femoris. Coactivation ratios were calculated from these activations. To induce fatigue, participants completed up to ten sets of 50 concentric knee extension and flexion contractions at 60°/s. A two-factor analysis of variance was used to determine the effect of age and fatigue. The young group showed higher peak torque compared with the middle-aged group (P< .001). During flexion, biceps femoris activity increased after fatigue when both groups were considered together (P= .018). During extension, biceps femoris activity was higher in the middle-aged than young group (P= .043). Middle-aged women exhibited a trend for greater coactivation during knee extension compared with young women (P= .066). This coactivation likely contributed to extension torque decrements in middle-aged women.
Collapse
|