The effect of age and knee osteoarthritis on muscle activation patterns and knee joint biomechanics during dual belt treadmill gait

https://doi.org/10.1016/j.jelekin.2017.04.001Get rights and content

Abstract

Purpose

To compare a group of individuals with moderate medial compartment knee osteoarthritis (OA) to both an age-matched asymptomatic group of older adults and younger adults to determine whether differences in knee joint muscle activation patterns and joint biomechanics exist during gait between these three groups.

Scope

20 young adults, 20 older adults, and 40 individuals with moderate knee OA were recruited. Using standardized procedures, surface electromyograms were recorded from the vastus lateralis and medialis, rectus femoris and the medial and lateral hamstrings. All individuals walked on a dual belt instrumented treadmill while segment motions and ground reaction forces were recorded. Sagittal plane motion and net external sagittal and frontal plane moments were calculated. Discrete measures and principal component analyses extracted amplitude and temporal waveform features. Analysis of Variance models using Bonferroni corrections determined between and within group differences in these gait features (α = 0.05).

Conclusions

Individuals with knee OA have distinct biomechanics and muscle activation patterns when compared to age-matched asymptomatic adults and younger adults whereas differences between the young and older adults were few and included only measures of muscle activation amplitude.

Introduction

Gait analyses, including both biomechanical assessments and electromyography to uncover abnormalities in knee joint mechanics are employed to understand implications of injury and disease on walking ability. Panjabi theorized a model for understanding the control systems engaged to preserve joint function, including three interacting subsystems; the passive osteoligamentous system, muscular system and the neurological system (Panjabi, 1992). For decades, altered osteoligamentous structures have been associated with knee OA (Kellgren and Lawrence, 1957) but some of these hallmark features can be associated with aging in a portion of the population (Laxafoss et al., 2010) despite an asymptomatic joint. The OA joint experiences an altered mechanical environment (Rudolph et al., 2007, Astephen et al., 2008), resulting in subsequent alterations in muscle activation (Rutherford et al., 2013, Zeni et al., 2010) compared to age-matched asymptomatic adults, suggesting greater demands on the deteriorating joint during walking.

Biomechanically, studies generally find individuals with knee OA walk with greater and less dynamic knee adduction moments (Astephen et al., 2008), less dynamic knee flexion/extension moments (Kaufman et al., 2001) and less range of motion (ROM) during the stance phase gait (Astephen et al., 2008, Childs et al., 2004) compared to an age-matched group. Recently, these features have been attributed to a “stiff knee” gait, thought to reflect a strategy employed by those with knee OA to maintain stability during walking (Hatfield et al., 2015). Electromyographic studies, using both discrete amplitude and pattern recognition analysis methodology, support this notion. Elevated and prolonged quadriceps and hamstrings activation, particularly during early to mid-stance are typically found; the period of gait where moving towards single leg stance may result in the greatest stability demands (Rutherford et al., 2013, Heiden et al., 2009).

To date many knee OA gait studies compare findings against age-matched asymptomatic individuals. There exists equivocal evidence to support that knee function, measured through biomechanics and electromyography may change with age, limiting our ability to distinguish OA mechanics and muscle activation patterns from differences expected in an aged adult without knee OA. Regarding sagittal plane knee motion changes with age, no differences have been reported (Rudolph et al., 2007, Schloemer et al., 2016), however Ostrosky et al. (1994) found knee extension range during stance reduced, which would be consistent with a change seen in knee OA (Astephen et al., 2008). Blazek et al. (2013) found no relationship with increasing age in the first peak adduction moment or flexion moments in healthy weight individuals, supporting the findings of distinct moment alterations in an OA group. In contrast, altered muscle activation, particularly heightened antagonist co-activation is often found in older individuals (Rudolph et al., 2007, Schloemer et al., 2016, Hortobágyi et al., 2011) compared to younger adults. Some of these alterations with age are consistent with changes found in individuals with knee OA. Given gait analyses are increasingly used to understand OA disease severity, progression and management outcomes, a clearer recognition of joint function distinctions between asymptomatic individuals and those with OA is warranted. To address this question, a young adult group with no history of knee OA signs or symptoms will act as a comparator for a group of individuals with knee OA and an age-matched group with no current or past symptoms of OA.

The purpose of this study was to compare a group of individuals with moderate medial compartment knee OA (MOA) to both an age-matched asymptomatic group of older adults and an asymptomatic group of young adults to determine whether differences in joint biomechanics and knee joint muscle activation patterns exist during gait between these three groups. It is hypothesized that individuals with knee OA will differ from both groups in ways of less dynamic sagittal and frontal plane joint moments, less sagittal plane ROM, and greater and more prolonged quadriceps and hamstrings activation. Minimal differences will exist between older and young adults suggesting greater demands for maintaining knee joint function in individuals with knee OA.

Section snippets

Methods and materials

Younger and older adults were considered a sample of convenience, recruited through local community advertisements. These individuals had no pain in their lower extremities and had not sustained lower extremity injuries within the past year. Participants with unilateral symptomatic MOA were recruited after consultation with an orthopaedic surgeon and excluded if they were candidates for total knee replacement. Standard anterior-posterior radiographs were obtained for the MOA group and scored

Results

Table 1 outline subject anthropometrics, radiographic grades, questionnaire outcomes, muscle strength and biomechanical walking outcomes. Older and young adults were similar on all variables except age (p < 0.001), muscle strength (p < 0.001) and walking velocity (p = 0.01). Individuals with MOA, were heavier (p < 0.001), with greater BMI (p < 0.001), and walked slower (p = 0.003) with less sagittal plane ROM (p < 0.01), less dynamic knee flexion/extension moment (p = 0.001) and greater KAM as indicated by the

Discussion

The purpose of this study was to understand whether a group of individuals with moderate medial compartment knee OA walk on a treadmill with different knee mechanics and muscle activation patterns compared to an aged-matched asymptomatic group and secondly, to determine whether these age-matched asymptomatic individuals walk differently than a group of asymptomatic young adults. These data help to elucidate the effects of knee OA on treadmill walking mechanics and muscle activation from the

Conclusion

These data help to elucidate effects of knee OA on treadmill walking mechanics and muscle activation from age. The study hypotheses were partially supported. Individuals with knee OA have distinct biomechanics and muscle activation patterns when compared to age-matched asymptomatic adults and younger adults whereas differences between the young and older adults were few and included only measures of muscle activation amplitude.

Competing interest statement

Authors have no competing interests pertaining to this manuscript.

Role of funding source

Support for this study was provided by the Nova Scotia Health Research Foundation Establishment and Development and Innovation Grant (MED-DI-2014-8668 and MED-EST-2014-9605) as well as the Faculty of Health Professions Research Development Grant. The sponsors had no role in the design and conduct of this study; collection analysis, and interpretation of data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Acknowledgements

We would like to acknowledge Dr. Janice Moreside, Michelle Jones, Caitlyn Dunphy, Adam Lomond and Sarah Casey for their assistance with data collections, Ms. Nicole Paquet for recruitment and our participants for taking time to help us with our research.

Derek Rutherford, PT PhD. Received an Honors Bachelor of Science from the University of Western Ontario in 2000, Bachelor of Science in Physiotherapy from the University of Toronto in 2003, Masters of Science in Rehabilitation Research from Dalhousie University in 2007 and his PhD from the School of Biomedical Engineering at Dalhousie University in 2012. His research interests concentrate on understanding how lower extremity injuries and joint disease (osteoarthritis) impact gait dynamics to

References (30)

Cited by (18)

  • The effect of a frontal plane gait perturbation bout on knee biomechanics and muscle activation in older adults and individuals with knee osteoarthritis

    2022, Clinical Biomechanics
    Citation Excerpt :

    For instance, VL PP2-scores, which were interpreted to indicate greater mid-stance activation did not change in the OA group but did in the asymptomatic group. The finding of greater LH compared to MH in the OA group previously found in gait studies (Hubley-Kozey et al., 2006; Rutherford et al., 2017) was not altered in response to the perturbation bout. Additionally, gastrocnemius PP3-scores, capturing greater activation during early stance compared to late stance, showed a group*time*muscle interaction where time had less of an effect on OA LG/MG PP3-scores than those in the ASYM group.

  • Inter-laboratory comparison of knee biomechanics and muscle activation patterns during gait in patients with knee osteoarthritis

    2021, Knee
    Citation Excerpt :

    Patients had KOA classified as moderate severity based on functional status [20], no previous or planned hip or knee replacement and were able to walk unaided. In addition, anthropometrics, quadriceps and hamstrings strength (isometric) and questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC [21]), Numeric Pain Rating Scale (NPRS [22])) were collected [20]. Patient characteristics from DAL are presented in Table 1.

  • Walking challenges in moderate knee osteoarthritis: A biomechanical and neuromuscular response to medial walkway surface translations

    2019, Human Movement Science
    Citation Excerpt :

    Commonly, knee muscle activation is elevated, either specifically (i.e. increased medial co-contraction) (Schmitt & Rudolph, 2008) or generally (elevated gastrocnemius, hamstrings and quadriceps) (Kumar et al., 2014; Rutherford et al., 2016) in response to a perturbation, with knee biomechanical differences, such as knee motion and moments, less consistent (Baker et al., 2016; Kumar et al., 2014; Schmitt & Rudolph, 2008). Elevated muscle activation in individuals with knee OA has been found in addition to altered knee biomechanics, specifically a less dynamic sagittal plane moment in those with osteoarthritis (Rutherford, Baker, Wong, & Stanish, 2017b). This biomechanical feature has been interpreted as a knee stiffening strategy (Hatfield, Stanish, & Hubley-Kozey, 2015) thought to aid in stabilizing the knee joint.

View all citing articles on Scopus

Derek Rutherford, PT PhD. Received an Honors Bachelor of Science from the University of Western Ontario in 2000, Bachelor of Science in Physiotherapy from the University of Toronto in 2003, Masters of Science in Rehabilitation Research from Dalhousie University in 2007 and his PhD from the School of Biomedical Engineering at Dalhousie University in 2012. His research interests concentrate on understanding how lower extremity injuries and joint disease (osteoarthritis) impact gait dynamics to develop and evaluate conservative intervention strategies. He has a particular interest in understanding alterations in biomechanical and neuromuscular gait patterns associated with knee and hip orthopedic conditions in response to walking challenges.

Matthew Baker, MSc received a Bachelors of Kinesiology from Acadia University in 2011, a Masters of Science in Rehabilitation Research from Dalhousie University in 2016 and is currently a PhD student in the Faculty of Health Professions. His main research interests are focussed on osteoarthritis of the knee and hip, specifically investigating how novel gait perturbations impact or alter biomechanical and neuromuscular control of joint level sensations of instability.

Dr. Ivan Wong is an Orthopaedic Surgeon at the QEII Health Sciences Center in Halifax, NS, specializing in Sports Medicine of the shoulder, hip, and knee. He has completed a Masters in Academic Medicine focusing on surgical skill translation from model to operating room. Dr. Wong has developed innovative surgical techniques available, including minimal invasive arthroscopic for irreparable massive rotator cuff tears, and recurrent dislocations of the shoulder with bone loss. Dr. Wong acts as the principle investigator several prospective clinical trials; including topics such as Osteoarthritis, rotator cuff tears, biologic reconstructions of rotator cuff tears, arthroscopic Latarjet, and cartilage reconstruction of the hip.

William D. Stanish, MD, FRCS(C), FACS, Diplomat of the American Academy of Orthopaedic Surgeons; Professor of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. He is also Director of the Orthopaedic and Sport Medicine Clinic of Nova Scotia. Dr. Stanish trained in Orthopaedic Surgery in Stoke Mandeville Hospital, in the Oxford University group of hospitals, Aylesbury, England; Dalhousie University, Halifax, Nova Scotia; and Harvard University, Boston, MA, USA. Dr. Stanish, as a clinical scientist, has fostered research in the area of physiology and biomechanics of ligaments and tendons. His research publications and book chapters by 2009 number 198. He has co-authored the highly regarded textbooks the “Oxford Textbook of Sports Medicine” and “Tendinitis: Its Etiology and Treatment”, both published by Oxford University Press and both in their Second Edition. He is past Deputy Editor of The Journal of Bone and Joint Surgery. He has been on the Editorial Board of several publications, including the American Journal of Sports Medicine.

View full text