Knee flexor strength,rate of torque development and flexibility in women and men with patellofemoral pain: Relationship with pain and the performance in the single leg bridge test

ObjectivesTo investigate the relationship between: (1) knee flexor strength, rate of torque development (RTD), and flexibility with pain level; (2) knee flexor strength and RTD with the performance in the single leg bridge test (SLBT) in women and men with patellofemoral pain (PFP).DesignCross-sectional.SettingLaboratory-based study.Participants39 women and 36 men with PFP.Main outcome measuresKnee flexor strength, RTD, and flexibility; performance in the SLBT, current, and worst pain level.ResultsModerate to strong significant negative relationships were identified between the current pain level with knee flexor strength (r = −0.57 to −0.34) and flexibility (r = −0.44 to −0.35); and between knee flexor strength and RTD with the performance in the SLBT (r = 0.34 to 0.57) in women and men with PFP. Knee flexor RTD was not related to any pain level and no significant relationships were identified between the worst pain level with knee flexor strength and flexibility in women and men with PFP.ConclusionsOur results support the potential value of assessing knee flexor strength and flexibility in women and men with PFP. The SLBT may be a useful tool to assess knee flexor muscle capacity in individuals with PFP in a clinical setting.     

膝关节屈肌和伸肌等速向心、等速离心及等长测试的研究

本文通过运用Ｃｙｂｅｘ－６０００型等速测力系统对２５名健康男青年膝屈肌和伸肌进行等速向心、等速离心及等长测试，来比较膝肌肉向心收缩、离心收缩和等长收缩的功能，并探讨其相互间的关系。结果表明：等速测试时，膝屈肌和伸肌离心收缩的肌力明显大于向心收缩。在膝屈曲６０°时，离心收缩和等长收缩的肌力同样明显大于向心收缩，但离心收缩与等长收缩相比无显著性差异。随运动速度增加，屈肌和伸肌向心收缩的肌力明显下降，而离心收缩的肌力无明显变化。     

Kinesiophobia,but not strength is associated with altered movement in women with patellofemoral pain

BackgroundEvidence indicates the presence of both kinesiophobia and knee extension strength deficits in women with patellofemoral pain (PFP). Both impairments may contribute to apparent compensatory gait patterns including reduced cadence and peak knee flexion during stair negotiation.Research questionIs kinesiophobia or knee extension strength associated with movement pattern in women with patellofemoral pain?MethodsForty women with PFP were assessed with three-dimensional kinematic analyses during stair descent; isokinetic dynamometry of the knee extensors (isometric, concentric and eccentric); and the Tampa scale for kinesiophobia. Pearson coefficients were calculated to determine relationship among variables.ResultsKinesiophobia correlated significantly with cadence (r = −0.62, p < 0.001), and peak knee flexion (r = −0.76, p < 0.001). No significant correlations were found between any knee extensor strength variables and kinematics (cadence or peak knee flexion); or kinesiophobia (p > 0.05).SignificanceFindings of this study could suggest addressing strength impairments alone may not adequately address kinesiophobia and movement pattern impairments in women with PFP. However, high-quality randomised controlled trials are needed to test this assumption. Further value may be added if currently evidence-based knee strengthening exercise is combined with education and/or graded exposure to address kinesiophobia, and consideration to gait retraining to address altered movement patterns at the knee.     

Reproducibility of isokinetic knee eccentric and concentric strength indices in asymptomatic young adults

ObjectiveTo assess the reproducibility of isokinetic eccentric and concentric knee extension and flexion strength indices obtained at two different angular velocities.DesignCohort study.SettingUniversity human performance laboratory.Participants45 healthy physically active young adults (25 males).Main outcome measuresA non reciprocal protocol of concentric and eccentric contractions of the knee extensors and flexors was performed at 30 and 120°/s. Strength indices evaluated included peak moment; dynamic control ratios; and the difference between eccentric and concentric ratio at the two angular velocities.ResultsNo evidence for inter-test bias in any of the strength indices was noted. Measurement precision for peak moment, as quantified using ratio limits of agreement, suggest that scores may be expected to vary up to 15% for the knee extensors in both eccentric and concentric contraction modes. An error of up to 19% was calculated for the peak moment scores of the knee flexors. Intraclass correlation coefficients revealed fairly robust preservation of participants’ rank order for the majority of strength indices (>0.85).ConclusionIsokinetic-related indices of knee muscles performance enable an acceptable level of detection of expected changes in muscular strength parameters as a result of planned interventions.     

Isometric and isokinetic knee joint performance in Japanese alpine ski racers.

Isometric and isokinetic (concentric and eccentric, strength of alpine skiers with different performance levels were measured. Nine national (elite, EG) and 10 collegiate (trained, TG) female alpine skiers (16 to 23 years of age) performed maximal voluntary knee extension and flexion. Peak torque was measured at an angular velocity of 30 deg.s-1. The cross-sectional area (CSA) of thigh muscles (quadriceps and hamstring muscles) was determined by an ultrasonic method. No significant differences in anthropometric variables and CSA were observed between EG and TG. EG had significantly greater (p < 0.01 for extensors and p < 0.05 for flexors) eccentric knee extensor and flexor strength than that of TG whereas no significant differences were noted in isometric and concentric strength. Eccentric strength/CSA ratio was also higher for EG than for TG. It was suggested that knee extension and flexion strength during eccentric muscle action might be related to the performance level of alpine skiers.     

Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction

PURPOSE: The purpose of this study was to examine the strength of the knee flexors and knee extensors after two surgical techniques of ACL reconstruction and compare them to an age and activity level matched control group. METHODS: Twenty-four subjects who had undergone ACL reconstruction greater than 1 yr previously were placed into one of two groups according to autograft donor site: patellar tendon (BPB; N = 8) and hamstring (H; N = 16), and compared with an active, control group (N = 30). Knee flexor and extensor strength was evaluated using isovelocity dynamometry (5 speeds, eccentric and concentric, 5-95 degrees ROM). Strength maps were used to graphically analyze strength over a broad operational domain of the neuromuscular system. Average strength maps were determined for each autograft group and compared with controls. A difference map (control minus graft group) and confidence (t-test) maps were used to quantitatively identify strength deficits. RESULTS: The combined ACL group (N = 24) revealed a global 25.5% extensor strength deficit, with eccentric regional (angle and velocity matched) deficits up to 50% of control. Strength deficits covered over 86% of the sampled strength map area (P < 0.01). These knee extensor strength deficits are greater than previously reported. In addition, the BPB group demonstrated a concentric, low velocity, knee extensor strength deficit at 60-95 degrees that was not observed in the H group. Significant graft site dependent, regional knee flexor deficits of up to 50% of control were observed for the H group. CONCLUSIONS: Strength deficits localized to specific contraction types and ranges of motion were demonstrated between the ACL and control groups that were dependent upon autograft donor site. Postoperative rehabilitation protocols specific to these deficits should be devised.     

Reduced biceps femoris myoelectrical activity influences eccentric knee flexor weakness after repeat sprint running

The aim of this study was to determine whether declines in knee flexor strength following overground repeat sprints were related to changes in hamstrings myoelectrical activity. Seventeen recreationally active men completed maximal isokinetic concentric and eccentric knee flexor strength assessments at 180°/s before and after repeat sprint running. Myoelectrical activity of the biceps femoris (BF) and medial hamstrings (MHs) was measured during all isokinetic contractions. Repeated measures mixed model [fixed factors = time (pre‐ and post‐repeat sprint) and leg (dominant and nondominant), random factor = participants] design was fitted with the restricted maximal likelihood method. Repeat sprint running resulted in significant declines in eccentric, and concentric, knee flexor strength (eccentric = 26 ± 4 Nm, 15% P < 0.001; concentric 11 ± 2 Nm, 10% P < 0.001). Eccentric BF myoelectrical activity was significantly reduced (10%; P = 0.035). Concentric BF and all MH myoelectrical activity were not altered. The declines in maximal eccentric torque were associated with the change in eccentric BF myoelectrical activity (P = 0.013). Following repeat sprint running, there were preferential declines in the myoelectrical activity of the BF, which explained declines in eccentric knee flexor strength.     

Neuromuscular and functional responses in professional soccer players during pre-season: implications for injury prevention

Objective

The purpose of this investigation was to assess the muscular strength of the knee extensors and flexors muscles, agility and functionality between dominant leg (DL) vs. non-dominant leg (NDL) of professional soccer players during pre-season.

Methods

Twenty-two healthy male professional soccer players (25.1?±?3.8 years; 182.1?±?5.9 cm; 79.3?±?5.4 kg; body fat 14.6?±?3.8%) from a club of the Brazilian second-division soccer league participated in this study. All soccer players underwent three tests to assess strength, power, and physical performance with an interval of 48 h inter-sessions. During the first assessment session, isokinetic tests were performed in which athletes performed maximal isokinetic concentric and eccentric contractions, as well as maximal isometric contractions. In the second and third assessment sessions, single leg step down and agility tests were performed, respectively.

Results

Maximum voluntary isometric contraction (MVIC) results showed a significant difference (p?<?0.04) between DL compared to the NDL for absolute and relative values. But, the isokinetic variables of knee extensors at 60°/s (total work and power) were significantly higher (p?<?0.03) in NDL. Pearson’s correlation was found to be significant between MVIC and single leg step down (SLSD) test for DL (r?=?0.70, p?=?0.0001) and NDL (r?=?0.58; p?=?0.002).

Conclusion

The results confirm that DL shows greater isometric strength than NDL. However, NDL revealed an increase in the total work and power output in professional soccer players. Furthermore, the SLSD test is recommended because it proved to be a good method for evaluating muscle strength by a positive correlation with MVIC.

     

Steadiness training with light loads in the knee extensors of elderly adults

PURPOSE: This study was conducted to determine the effect of steadiness training with light loads in the knee extensors of elderly adults. METHODS: Twenty-one elderly adults (72 +/- 4.6 yr) performed 16 wk of closely supervised knee extensor training that consisted of lifting and lowering 30% of the one-repetition maximum (1-RM) load as steadily as possible (10 reps per set, three sets per session, three sessions per week). Nine subjects served in a control group. Unilateral and bilateral maximal voluntary contraction (MVC) force; 1-RM load; force fluctuations during submaximal isometric, concentric, and eccentric contractions; timed functional performance (gait, chair rise, stair ascent and descent); muscle volume via magnetic resonance imaging (MRI); and the electromyogram (EMG) were measured. RESULTS: The training group exhibited modest average gains in MVC force and 1-RM load; muscle volume and EMG were unaltered. Although isometric steadiness was unchanged on average, training elicited the greatest improvements in the least steady subjects. Force fluctuations during concentric and eccentric contractions were significantly reduced. Of 21 subjects, 14 responded to training with gains in 1-RM load greater than the typical change (6%) in the control group. Before training, these responders exhibited greater force during bilateral compared with unilateral contractions. The small changes in physical functional performance were similar for the training and control groups. The training group could lift the pretraining 1-RM load 4.6 times after training (5.6 times for responders). CONCLUSIONS: Steadiness training with the knee extensors thus produced neural adaptations that increased strength in elderly adults who exhibited bilateral facilitation, improved isometric steadiness in unsteady subjects, improved steadiness during concentric and eccentric contractions, and enhanced the ability to lift heavy loads repeatedly.     

Knee isokinetic muscle strength and balance ratio in female soccer players of different age groups: a cross-sectional study

ABSTRACT

Background: As a consequence of years of soccer training and sexual maturation, there is an increase in lower body muscle mass and strength especially in the knee extensors and flexors muscles. In this context, the lack of knee joint stability, resulting from strength imbalance between knee extensor and flexors muscles, has been associated with knee injuries. The aim of this study was to compare the knee flexor and extensor muscle peak torque, average power, contralateral deficit, conventional and functional balance ratios of female soccer players from different age groups.

Methods: Sixty-six female soccer players were divided into four groups: under 13 (U13), under 15 (U15), under 17 (U17) years old and professional (PRO). Flexor and extensor knee muscle strength in concentric and eccentric actions of both limbs were assessed using isokinetic dynamometer.

Results: For the dominant limb, the knee concentric extensor muscles peak torques, assessed at 60 and at 240 deg/sec, and the average power of U15 group were significantly higher than U13 group. Extensor muscle average power of the PRO group was higher than U17. Dominant knee flexor average power of U15 was significantly higher than the U13 group. Peak torque at 60 deg/sec and 240 deg/sec and average power of the PRO group were higher than the U17 group. No differences were found regarding the eccentric action for flexor and extensor muscles. Conventional and functional balance ratios were similar among all age group, except for U13, which presented higher values than the U15 group for the dominant limb.

Conclusions: The greatest improvement in muscular performance occur when the athlete starts practicing soccer (after U13) and when they become professional (after U17) and the balance ratios, and muscle balance ratios remain stable in all age groups, although they are below the recommended level in the literature, which may increase the risk for lower limb injury.     

Persistent knee flexor strength deficits identified through the NordBord eccentric test not seen with “gold standard” isokinetic concentric testing during the first year after anterior cruciate ligament reconstruction with a hamstring tendon autograft

ObjectiveTo investigate the recovery of knee flexor muscle strength evaluated with a Nordic hamstring eccentric test (NordBord) compared with an isokinetic concentric test (Biodex) during the first year after anterior cruciate ligament (ACL) reconstruction using a hamstring tendon autograft.DesignProspective observational registry study; level of evidence, 3.SettingPrimary care.ParticipantsCross-sectional data of 127 patients (45% women, mean age 24.9 ± 8.1 years) were extracted from a rehabilitation outcome registry at 10 weeks and 4, 8 and 12 months after ACL reconstruction with hamstring tendon autograft.Main outcome measuresAll patients performed a concentric Biodex test, and an eccentric NordBord test on the same occasion or within seven days of the concentric test. The primary outcome was the limb symmetry index between the respective tests.ResultsA greater knee flexor symmetry deficit was observed with the eccentric test compared with the concentric test at all follow-ups with clinically relevant differences at 4 (11.8% ± 12.7% [CI 7.8–15.8%]) and 8 months (13.4 ± 11.9 [CI 9.7–17.2%].ConclusionThe eccentric NordBord test was able to identify clinically relevant deficits in knee flexor strength symmetry that were not identified by gold standard isokinetic concentric testing during the first year among patients treated with an ACL reconstruction using a hamstring tendon autograft.     

Association between polymorphisms of vitamin D receptor gene ApaI, BsmI and TaqI and muscular strength in young Chinese women

The association between the polymorphisms of vitamin D receptor gene ApaI, BsmI and TaqI and isokinetic muscular strength was examined in 109 healthy, young Chinese women. Methods: Genomic DNA was extracted from mouthwash samples and vitamin D receptor genotypes were determined with the established methods. The peak torque of the dominant limb in concentric and eccentric knee extensors and flexors and elbow extensors and flexors was measured using Cybex-Norm-770 isokinetic dynamometer at slow and fast velocities. The distribution frequency of vitamin D receptor gene alleles was analyzed by chi-square test. The difference in muscular strength between VDR genotype groups was analyzed using one-way ANOVA. The ApaI, BsmI and TaqI alleles and genotype frequencies appeared to be in a Hardy-Weinberg equilibrium. Subjects with the vitamin D receptor ApaI null (A allele) mutation (AA) exhibited significantly lower knee and elbow concentric or eccentric peak torque than those with aa homozygous or Aa heterozygous. The BB & Bb group showed significantly higher peak torque in concentric knee flexors than bb group. No association was found between vitamin D receptor gene TaqI and muscular strength. The data indicated that vitamin D receptor gene ApaI and BsmI polymorphisms rather than TaqI polymorphism might be associated with muscular strength.     

Low strength is related to diminished ground reaction forces and walking performance in older women

The purpose of this study was to determine how lower-limb strength in older women affected gait speed, supportive forces, spatial, and temporal aspects of walking gait. Twenty-four women between 65 and 80 yr performed maximal voluntary isometric contractions for the knee extensors (KE), knee flexors (KF), ankle plantarflexors (PF) and ankle dorsiflexors (DF) and were separated into low strength and normal strength groups using a KE torque threshold of 1.5 Nm kg(-1). They walked at both a standard speed of 0.8 m s(-1) and at a self-selected maximal speed on an instrumented treadmill that recorded vertical ground reaction forces (vGRF) and spatiotemporal gait measures. Older women with low strength had 30% lower KE maximal torque, 36% lower PF maximal torque, 34% lower KE rate of torque development (RTD) and 30% lower KF RTD. Low strength women demonstrated slower maximal walking speeds (1.26±0.20 m s(-1) vs. 1.56±0.20 m s(-1)), lower vGRF during weight acceptance (1.15±0.10 BW vs. 1.27±0.13 BW), lower weight acceptance rates (11.3±0.5 BW s(-1) vs. 17.0±5.5 BW s(-1)), slower stride rates, shorter stride lengths, and longer foot-ground and double-limb support times (all P<0.05). Maximal gait speed was strongly correlated to peak vGRF and rate (r=0.60-0.85, P<0.01) and moderately related to lower-limb strength (r=0.42-0.60, P<0.05). In older women with low strength, diminished peak vGRFs were associated with slower walking speeds putting them at risk for mobility limitation, disability, poor health, and loss of independence.     

The functional significance of hamstrings composition: is it really a “fast” muscle group?

Hamstrings muscle fiber composition may be predominantly fast‐twitch and could explain the high incidence of hamstrings strain injuries. However, hamstrings muscle composition in vivo, and its influence on knee flexor muscle function, remains unknown. We investigated biceps femoris long head (BFlh) myosin heavy chain (MHC) composition from biopsy samples, and the association of hamstrings composition and hamstrings muscle volume (using MRI) with knee flexor maximal and explosive strength. Thirty‐one young men performed maximal (concentric, eccentric, isometric) and explosive (isometric) contractions. BFlh exhibited a balanced MHC distribution [mean ± SD (min‐max); 47.1 ± 9.1% (32.6–71.0%) MHC‐I, 35.5 ± 8.5% (21.5–60.0%) MHC‐IIA, 17.4 ± 9.1% (0.0–30.9%) MHC‐IIX]. Muscle volume was correlated with knee flexor maximal strength at all velocities and contraction modes (r = 0.62–0.76, P < 0.01), but only associated with late phase explosive strength (time to 90 Nm; r = −0.53, P < 0.05). In contrast, BFlh muscle composition was not related to any maximal or explosive strength measure. BFlh MHC composition was not found to be “fast”, and therefore composition does not appear to explain the high incidence of hamstrings strain injury. Hamstrings muscle volume explained 38–58% of the inter‐individual differences in knee flexor maximum strength at a range of velocities and contraction modes, while BFlh muscle composition was not associated with maximal or explosive strength.     

Is there a correlation between isometric muscle strength and the kinematics of the pelvis,hip and knee during functional tasks in women with patellofemoral pain?

ObjectivesTo evaluate the correlation between isometric muscle strength of the hip abductors (HABD) and lateral rotators (HLR) with the range of motion (ROM) of the pelvis/hip in the frontal/transverse planes, respectively, and between the strength of the knee extensors (KExt) with the ROM of the knee in the sagittal plane during seven tasks.DesignCross-sectional study.SettingLaboratory.ParticipantsThirty-five women with patellofemoral pain.Main outcome measuresMaximum isometric muscle strength of the HABD, HLR, and KExt was measured using a manual dynamometer, and pelvis and lower limbs kinematics were evaluated using 3D optical system during gait, ascending and descending stairs, the forward and lateral step down tests, and the propulsion and landing phases of the single leg hop test (SLHT).ResultsA weak correlation was found between KExt strength and knee ROM in the sagittal plane (p = 0.05; r = −0.33) during SLHT landing, and a moderate correlation between HABD strength and ROM of pelvic obliquity (p < 0.01; r = 0.50) during ascending stairs.ConclusionsThe lower strength of KExt has a weak correlation with higher knee flexion during the landing phase of the SLHT, and the lower strength of HABD has a moderate correlation with lower pelvis ROM in the frontal plane when ascending stairs.     

Profil isocinétique des muscles fléchisseurs et extenseurs du genou dans une population d'athlètes sauteurs

Introduction. – This study explored concentric and eccentric profile of knee musculature in a jumpers population. Relationships between isokinetic assessment and field tests performances have also been explored.Materials. – Jumpers population presented higher knee flexors performances in concentric and eccentric mode and superior knee extensors strength in eccentric. Significant correlations between isokinetics and field tests results were exclusively observed with athletes quadriceps performances. A very high correlation (r = 0.93) was found between the second bound relative performance of the ten multijumps test and eccentric quadriceps relative peak torque.Conclusion. – Jumpers training may favour a specific muscular development. The knee extensors eccentric strength may be a major factor in the athletic performance.     

Facilitation of quadriceps activation is impaired following eccentric exercise

Contracting the knee flexor muscles immediately before a maximum voluntary contraction (MVC) of knee extension increases the maximal force that the extensor muscles can exert. It is hypothesized that this phenomenon can be impaired by muscle fiber damage following eccentric exercise [delayed onset muscle soreness (DOMS)]. This study investigates the effect of eccentric exercise and DOMS on knee extension MVC immediately following a reciprocal‐resisted knee flexion contraction. Electromyography (EMG) was recorded from the knee extensors and flexors of 12 healthy men during knee extension MVCs performed in a reciprocal (maximal knee extension preceded by resisted knee flexion), and nonreciprocal condition (preceded by relaxation of the knee flexors). At baseline, knee extension MVC force was greater during the reciprocal condition (P < 0.001), whereas immediately after, 24 and 48 h after eccentric exercise, the MVC force was not different between conditions. Similarly, at baseline, the EMG amplitude of the quadriceps during the MVC was larger for the reciprocal condition (P < 0.001). However, immediately after, 24 and 48 h postexercise the EMG amplitude was similar between conditions. In conclusion, eccentric exercise abolished the facilitation of force production for the knee extensors, which normally occurs when maximum knee extension is preceded by activation of the knee flexors.     

Characteristics of isometric and dynamic strength loss following eccentric exercise-induced muscle damage

Angle-specific isometric strength and angular velocity-specific concentric strength of the knee extensors were studied in eight subjects (5 males and 3 females) following a bout of muscular damaging exercise. One hundred maximal voluntary eccentric contractions of the knee extensors were performed in the prone position through a range of motion from 40 degrees to 140 degrees (0 degrees = full extension) at 1.57 rads(-1). Isometric peak torque was measured whilst seated at 10 degrees and 80 degrees knee flexion, corresponding to short and optimal muscle length, respectively. Isokinetic concentric peak torque was measured at 0.52 and 3.14 rad x s(-1). Plasma creatine kinase (CK) activity was also measured from a fingertip blood sample. These measures were taken before, immediately after and on days 1, 2, 4, and 7 following the eccentric exercise. The eccentric exercise protocol resuited in a greater relative loss of strength (P< 0.05) at short muscle length (76.3 +/- 2.5% of pre-exercise values) compared to optimal length (82.1 +/- 2.7%). There were no differences in the relative strength loss between isometric strength at optimal length and isokinetic concentric strength at 0.52 and 3.14 rad x s(-1). CK activity was significantly elevated above baseline at days 4 (P < 0.01) and 7 (P < 0.01). The greater relative strength loss at short muscle length appeared to persist throughout the seven-day testing period and provides indirect evidence of a shift in the angle-torque relationship towards longer muscle lengths. The results lend partial support to the popping sarcomere hypothesis of muscle damage, but could also be explained by an impairment of activation at short muscle lengths.     

Effect of leg extension training on concentric and eccentric strength of quadriceps femoris muscles

Ten healthy male subjects carried out bilateral concentric leg extension training twice a week for 8 weeks. Before and after the training, maximal voluntary isometric and isokinetic strength and cross-sectional areas of the quadriceps femoris were measured. Maximal bilateral leg extension power increased significantly after the training. Isometric and concentric unilateral strength did not change significantly before and after the training, while eccentric strength at 0.52 and 1.05 rad·s⁻¹ increased after the training with no changes in cross-sectional area. The correlations between strength and cross-sectional area increased significantly after the training. It was speculated that the increase in eccentric strength of knee extensors was due to modification of the neural inhibition during eccentric muscle actions.     

Sex- and osteoarthritis-related differences in muscle co-activation during weight-bearing tasks

BackgroundIndividuals 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 questionHow 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.MethodsA 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.ResultsIndividuals 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.SignificanceHigh 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.