The effect of valgus bracing on the knee adduction moment during gait and running in male subjects with varus alignment

Background

Increased mechanical load is one risk factor for osteoarthritis. One possible treatment for this disorder is the use of knee braces in order to redistribute joint loading, which may inhibit the progression of the disease. The hypothesis was: knee adduction moment can be reduced with the use of a dedicated knee orthosis, which applies an abduction moment at the knee.

Methods

Sixteen healthy male subjects with varus alignment were analysed during walking and running while using an adjustable valgus orthosis. Peak knee adduction moments and knee adduction angular impulses were evaluated through inverse dynamics. Additionally, the abduction moment produced by the orthosis was measured in three different adjustments of valgus angulations (neutral, 4° and 8° valgus) using a strain gauge device.

Findings

During walking, mean reductions of 25% and 36% in the knee adduction angular impulse were found between the conditions without orthosis and 4° and between without orthosis and 8°, respectively. For the running trials mean reductions of 18% and 23% were observed between these same conditions. The first and second peak knee adduction moments also decreased during walking with different orthosis adjustments (changes from 5% to 33%). During running, a significant reduction was observed only between the conditions without orthosis and 8° valgus adjustments (change of 11%).

Interpretation

The orthosis tested in this study was effective in reducing the knee adduction moments during walking and running. This reduction of knee adduction moments during locomotion should contribute to decelerate osteoarthritis progression.     

Peak knee adduction moment during gait in anterior cruciate ligament reconstructed females

Background

Recent work has shown that anterior cruciate ligament reconstructed patients exhibit an increased peak knee adduction moment during walking gait compared to healthy controls. An increased peak knee adduction moment has been suggested to be a potential mechanism of degeneration for knee osteoarthritis. The few studies in this area have not considered an exclusively female anterior cruciate ligament reconstructed group. This study tested the hypothesis that female anterior cruciate ligament-reconstructed patients would have higher peak knee adduction moments than controls.

Methods

Peak knee adduction moment during walking was compared between a group of anterior cruciate ligament reconstructed females and a group of female activity matched controls over ten 15 m walking trials in a laboratory at a self-selected pace.

Findings

Peak knee adduction moment was lower for the anterior cruciate ligament reconstructed group (N = 17, M = 0.31 Nm/kg·m, SD = 0.08) than for the control group (N = 17, M = 0.41 Nm/kg·m, SD = 0.12; t(32) = 2.483, p = 0.010, one-tailed, eta squared effect size = 0.16).

Interpretation

A group of female anterior cruciate ligament reconstructed subjects did not exhibit a gait characteristic which has been suggested to be associated with knee osteoarthritis development and has been shown to be present in male and mixed sex anterior cruciate ligament reconstructed populations previously.     

Comparison of peak knee adduction moment and knee adduction moment impulse in distinguishing between severities of knee osteoarthritis

Background

The peak knee adduction moment is a valid proxy for medial knee joint loading. However as it only measures load at one instance of stance, knee adduction moment impulse, a measure that takes into account both the magnitude and duration of the stance phase, may provide more comprehensive information. This study directly compared the abilities of peak knee adduction moment and knee adduction moment impulse to distinguish between knee osteoarthritis severities.

Methods

169 participants with medial knee osteoarthritis completed radiographic and magnetic resonance imaging, the Western Ontario and McMaster Universities Arthritis Index to assess pain and a three-dimensional gait analysis. Participants were classified using four dichotomous classifications: Kellgren–Lawrence grading, alignment, medial tibiofemoral bone marrow lesions, and pain.

Findings

When using Kellgren–Lawrence grade and alignment classifications, the area under the receiver operator curves were significantly greater for knee adduction moment impulse than for peak knee adduction moment. Based on analysis of covariance, knee adduction moment impulse was significantly different between Kellgren–Lawrence grade and alignment groups while peak knee adduction moment was not significantly different. Both peak knee adduction moment and knee adduction moment impulse distinguished between bone marrow lesion severities while neither measure was significantly different between pain severity groups.

Interpretations

Findings suggest knee adduction moment impulse is more sensitive at distinguishing between disease severities and may provide more comprehensive information on medial knee joint loading. Future studies investigating biomechanics of knee osteoarthritis should include knee adduction moment impulse in conjunction with peak knee adduction moment.     

Effects of foot orthoses and valgus bracing on the knee adduction moment and medial joint load during gait

BACKGROUND: Lateral shoe wedges and valgus knee braces are designed to decrease the force acting in the medial knee compartment by reducing the external adduction moment applied at the knee. The biomechanical changes introduced by these orthoses can be relatively small. Computer modeling and simulation offers an alternative approach for assessing the biomechanical performance of these devices. METHODS: A three-dimensional model of the lower-limb was used to calculate muscle, ligament, and joint loading at the knee during gait. A lateral shoe wedge was simulated by moving the center of pressure of the ground reaction force up to 5mm laterally. A valgus knee brace was simulated by applying abduction moments of up to 12 Nm at the knee. FINDINGS: Knee adduction moment and medial compartment load decreased linearly with lateral displacement of the center of pressure of the ground reaction force. A 1 mm displacement of the center of pressure decreased the peak knee adduction moment by 2%, while the peak medial compartment load was reduced by 1%. Knee adduction moment and medial compartment force also decreased linearly with valgus moments applied about the knee. A 1 Nm increase in brace moment decreased the peak knee adduction moment by 3%, while the peak medial compartment load was reduced by 1%. INTERPRETATION: Changes in knee joint loading due to lateral shoe wedges and valgus bracing are small and may be difficult to measure by conventional gait analysis methods. The relationships between lateral shift in the center of pressure of the ground force, valgus brace moment, knee adduction moment, and medial joint load can be quantified and explained using computer modeling and simulation. These relationships may serve as a useful guide for evaluating the biomechanical efficacy of a generic wedge insole or knee brace.     

The effect of orthotic devices on knee adduction moment,pain and function in medial compartment knee osteoarthritis: a literature review

Background Knee braces and foot orthoses are commonly used to improve knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). However, no literature review has been performed to compare the effects of foot orthoses and knee braces in this group of patients. Purpose The aim of this review was to evaluate the effects of foot orthoses and knee braces on knee adduction moment, pain and function in individuals with knee OA. Study design Literature review. Method The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar and ISI web of knowledge databases using the PRISMA method and based on selected keywords. Thirty-one related articles were selected for final evaluation. Results The results of the analysis of these studies demonstrated that orthotic devices reduce knee adduction moment and also improve pain and function in individuals with knee OA. Conclusion Foot orthoses may be more effective in improving pain and function in subjects with knee OA. Both knee braces and foot orthoses reduce the knee adduction moment in knee OA and consequently patients typically do not need to use knee braces for a long period of time. Also, foot orthoses and knee braces may be more effective for medial compartment knee OA patients due to the fact that this treatment helps improve pain and function.

• Implications for Rehabilitation

• Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA).

• Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA.

• The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.

     

Explaining the hip adduction moment variability during gait: Implications for hip abductor strengthening

Background

There is emerging interest in hip abductor function during gait and its potential relationship to knee joint pathology. During gait, the hip abductor muscles are primarily responsible for generating moments of force to control frontal plane movement. The current study investigated the relationship between hip abductor muscle function and frontal plane hip moments of force during gait.

Methods

Frontal plane hip moments of force and electromyographic features of gluteus medius were measured during walking in 22 healthy individuals. Hip abductor strength, subject anthropometrics and gait velocity were recorded. Multiple regression models were used to evaluate the relationship between the anthropometric, velocity, strength and electromyographic variables and the initial and mid-stance magnitude of the hip adduction moment.

Findings

A positive relationship was found between the initial peak moment (Nm), and both body mass and gait speed (R² = 90%). Body mass (positive) and hip abductor strength (negative) explained significant levels of mid-stance magnitude variability (R² = 62.5%). Gait speed (positive) explained significant levels of variability in the normalized initial peak moment (Nm/kg) (R² = 52%). No variables were included in the normalized mid-stance moment model (P > 0.05).

Interpretation

Body mass was the key factor associated with high hip adduction moments during initial and mid-stance of the gait cycle. Increased gait velocity was associated with higher initial peaks and higher muscle strength was associated with lower mid-stance magnitude of the external hip adductor moment during walking. These findings suggest that in a healthy adult population, hip abductor strength and activation were not directly related to the hip adduction moment magnitude during gait.     

Mechanisms underpinning longitudinal increases in the knee adduction moment following arthroscopic partial meniscectomy

Background

Knee osteoarthritis is common following arthroscopic partial meniscectomy and a higher external peak knee adduction moment is believed to be a contributor. The peak knee adduction moment has been shown to increase over 2 years (from 3-months post-arthroscopic partial meniscectomy). The aim of this study was to evaluate mechanisms underpinning the increase in peak knee adduction moment over 2 years observed in people 3-months following arthroscopic partial meniscectomy.

Methods

Sixty-six participants with medial arthroscopic partial meniscectomy were assessed at baseline and again 2 years later. Parameters were evaluated at time of peak knee adduction moment as participants walked barefoot at their self-selected normal and fast pace for both time points.

Findings

For normal pace walking, an increase in frontal plane ground reaction force-to-knee lever arm accounted for 30% of the increase in peak knee adduction moment (B = 0.806 [95% CI 0.501–1.110], P < 0.001). For fast pace walking, an increase in the frontal plane ground reaction force magnitude accounted for 21% of the increase in peak knee adduction moment (B = 2.343 [95% CI 1.219–3.468], P < 0.001); with an increase in tibia varus angle accounting for a further 15% (B = 0.310 [95% CI 0.145–0.474], P < 0.001).

Interpretation

Our data suggest that an increase in lever arm and increase in frontal plane ground reaction force magnitude are contributors to the increased knee adduction moment observed over time in people following arthroscopic partial meniscectomy.     

Contribution of knee adduction moment impulse to pain and disability in Japanese women with medial knee osteoarthritis

Background

An increase in the knee adduction moment is one of the risk factors of medial knee osteoarthritis. This study examined the relationship between knee adduction moment and self-reported pain and disability. We also investigated the influence of pain on the relationships between knee adduction moment and gait performance and disability.

Methods

Thirty-eight Japanese women with medial knee osteoarthritis participated in this study (66.37 years (41–79 years)). Gait analysis involved the measurement of the external knee adduction moment impulse in the stance duration and during 3 subdivisions of stance. The total, pain and stiffness, and physical function Japanese Knee Osteoarthritis Measure scores were determined.

Findings

The pain and stiffness, physical function, and total scores were positively correlated with the knee adduction moment impulses in the stance duration, and initial and second double support interval, and single limb support interval. The knee adduction moment impulse during the stance duration was related to the pain and stiffness subscale and gait velocity. The pain and stiffness subscale was related to the physical function subscale.

Interpretation

Our results suggest that increasing in the knee adduction moment impulse, a proxy for loading on the medial compartment of the knee, is related to increased pain during weight-bearing activities such as walking, thereby restricting walking performance and causing disability by reducing gait velocity. Thus, the reduction in the knee adduction moment impulse during gait may result in pain relief and may serve as a conservative treatment option with disease-modifying potential.     

Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis

Fantini Pagani CH, Böhle C, Potthast W, Brüggemann G-P. Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis.

Objective

To analyze knee joint loading, subjective pain relief, and improvements in function in patients with osteoarthritis (OA) with the use of 2 orthosis adjustments.

Design

Patients were tested under 3 different conditions (without orthosis, orthosis at 4° valgus, and a neutral very flexible adjustment) in a crossover trial.

Setting

University gait analysis laboratory with 3-dimensional motion analysis and force platforms.

Participants

Patients (N=11) with a clinical and radiographic diagnosis of unilateral OA in the medial knee compartment.

Interventions

Patients wore a knee orthosis designed to unload the medial knee compartment for 4 weeks in 2 different adjustments (2 weeks in each adjustment).

Main Outcome Measures

Net knee adduction moment and net knee adduction angular impulse during the stance phase were analyzed by using inverse dynamics. Subjective pain relief, stiffness, and function improvement were evaluated using a questionnaire (Western Ontario and McMaster Universities Osteoarthritis Index). A 6-minute walk test and stair-climbing test also were performed.

Results

Both orthosis adjustments induced subjective pain relief and improvement in function compared with the condition without orthosis. Knee adduction moment was significantly decreased with both adjustments, whereas the decrease observed with the 4° valgus adjustment was significantly greater than the flexible adjustment (25% vs 12.5%). Compared with the condition without orthosis, changes in knee adduction angular impulse of 29% and 15% were found with 4° valgus and the neutral flexible orthosis, respectively. Time required for the stair-climbing activity was significantly decreased using the orthosis in 4° valgus adjustment compared with the condition without orthosis. No significant differences were observed among conditions during the 6-minute walk test.

Conclusions

Both orthosis adjustments were effective in decreasing symptoms; however, a decrease in knee loading was more effective using the 4° valgus adjustment, which could contribute to avoidance of disease progression.     

Static and dynamic correlates of the knee adduction moment in healthy knees ranging from normal to varus-aligned

Background

Individuals with medial knee osteoarthritis often present with varus knee alignment and ambulate with increased knee adduction moments. Understanding the factors that relate to the knee adduction moment in healthy individuals may provide insight into the development of this disease. Thus, this study aimed to examine the relationships of both static and dynamic lower extremity measures with the knee adduction moment. We hypothesized that the dynamic measures would be more closely related to this moment.

Methods

Arch height index, hip abduction strength and two static measures of knee alignment were recorded for 37 young asymptomatic knees that varied from normal to varus-aligned. Overground gait analyses were also performed. Correlation coefficients were used to assess the relationships between the static and dynamic variables to the knee adduction moment. Hierarchical regression analyses were then conducted using the static measures, the dynamic measures, and the static and dynamic measures together.

Results

Among the static measures, the tibial mechanical axis and the distance between the medial knee joint lines were correlated with the knee adduction moment. The best predictive static model (R² = 0.53) included only the tibial mechanical axis. Among the dynamic variables, knee adduction and rearfoot eversion angles were correlated with the knee adduction moment. Knee adduction and rearfoot eversion, together, were the best dynamic model (R² = 0.53). The static and dynamic measures together created the strongest of the three models (R² = 0.59).

Conclusions

These results suggest that dynamic measures slightly enhance the predictive strength of static measures when explaining variation in the knee adduction moment.     

The effect of total knee replacement on the knee varus angle and moment during walking and stair ascent

BACKGROUND: This study examined the effect of total knee replacement surgery on the frontal plane knee varus angle and moment. Secondarily, the relationships between knee varus angle and moment to a clinical outcome measure were assessed. METHODS: Twenty-one patients with total knee replacement and 21 controls performed level walking and stair ascent at two testing periods, pre- and 6-months post-surgery. The dependent variables included frontal plane knee angle and moment, and Western Ontario and McMaster Universities Osteoarthritis Index scores. FINDINGS: During level walking the mean knee varus moment of the patient group was significantly greater than controls at pre-surgery but was restored to control level post-operatively. During stair ascent the patient group produced a significantly smaller knee varus moment post-surgically. The mean frontal knee valgus angle of total knee replacement patients increased significantly from pre- to post-surgery during level walking. The Western Ontario and McMaster Universities Osteoarthritis Index score was not significantly correlated to the knee variables. However, the knee angle and moment were significantly correlated during level walking pre- and post-operatively and stair ascent post-operatively. INTERPRETATION: The decreased frontal plane knee moment in total knee replacement patients during level walking appeared to be affected by surgical realignment of the tibio-femoral joint, as the frontal knee angle and varus moment were strongly correlated. The subjective Western Ontario and McMaster Universities Osteoarthritis Index and the objective gait measures appeared to capture different dimensions of knee osteoarthritis.     

Effects of hip abduction and adduction accuracy on post-stroke gait

BackgroundGait instability often limits post-stroke function, although the mechanisms underlying this instability are not entirely clear. Our recent work has suggested that one possible factor contributing to post-stroke gait instability is a reduced ability to accurately control foot placement. The purpose of the present experiments was to investigate whether post-stroke gait function is related to the ability to accurately abduct and adduct the hip, as required for accurate foot placement.Methods35 chronic stroke survivors and 12 age-matched controls participated in this experiment. Participants performed hip oscillation trials designed to quantify hip abduction/adduction accuracy, in which they lay supine and moved their leg through a prescribed range of motion in time with a metronome. Stroke survivors also performed overground walking trials at their self-selected speed.Findings28 of the 35 stroke survivors had sufficient active range of motion to perform the prescribed hip oscillation task. In comparison to controls, these 28 stroke survivors were significantly less accurate at matching the abduction target, matching the adduction target, and moving in time with the metronome. Across these stroke survivors, a multiple regression revealed that only paretic hip abduction accuracy made a unique contribution to predicting paretic step width and paretic step period, metrics of gait performance.InterpretationThe present results demonstrate that the ability to accurately abduct the hip is related to post-stroke gait performance, as predicted from a model-based gait stabilization strategy. Therefore, interventions designed to improve lower limb movement accuracy may hold promise for restoring post-stroke gait stability.     

The pronociceptive effect of proteinase-activated receptor-4 stimulation in rat knee joints is dependent on mast cell activation

Proteinase-activated receptor-4 (PAR₄) is a G-protein-coupled receptor activated by serine proteinases released during tissue repair and inflammation. We have previously shown that PAR₄ activation sensitises articular primary afferents leading to joint pain. This study examined whether mast cells contribute to this PAR₄-induced sensitisation and consequent heightened pain behaviour. The expression of PAR₄ on synovial mast cells was confirmed with immunofluorescent staining of rat knee joint sections. Electrophysiological recordings were made from joint primary afferents in male Wistar rats during both nonnoxious and noxious rotations of the knee. Afferent firing rate was recorded for 15 minutes after close intra-arterial injection of 10⁻⁹ to 10⁻⁵ mol of the PAR₄ activating peptide, AYPGKF-NH₂, or the inactive peptide, YAPGKF-NH₂ (100-μl bolus). Rats were either naive or pretreated with the mast cell stabilise, cromolyn (20 mg/kg). Mechanical withdrawal thresholds were determined using a dynamic planter aesthesiometer and weight bearing determined using an incapacitance tester. These behavioural measurements were taken before and after intra-articular AYPGKF-NH₂, or the inactive peptide, YAPGKF-NH₂ (100 μg). Local administration of AYPGKF-NH₂ caused a significant increase in joint primary afferent firing rate and pain behaviour compared with the control peptide YAPGKF-NH₂. These effects were blocked by pretreatment with cromolyn. These data reveal that PAR₄ is expressed on synovial mast cells and the activation of PAR₄ has a pronociceptive effect that is dependent on mast cell activation.     

Contribution of ankle-foot orthosis moment in regulating ankle and knee motions during gait in individuals post-stroke

BackgroundAnkle-foot orthosis moment resisting plantarflexion has systematic effects on ankle and knee joint motion in individuals post-stroke. However, it is not known how much ankle-foot orthosis moment is generated to regulate their motion. The aim of this study was to quantify the contribution of an articulated ankle-foot orthosis moment to regulate ankle and knee joint motion during gait in individuals post-stroke.MethodsGait data were collected from 10 individuals post-stroke using a Bertec split-belt instrumented treadmill and a Vicon 3-dimensional motion analysis system. Each participant wore an articulated ankle-foot orthosis whose moment resisting plantarflexion was adjustable at four levels. Ankle-foot orthosis moment while walking was calculated under the four levels based on angle-moment relationship of the ankle-foot orthosis around the ankle joint measured by bench testing. The ankle-foot orthosis moment and the joint angular position (ankle and knee) relationship in a gait cycle was plotted to quantify the ankle-foot orthosis moment needed to regulate the joint motion.FindingsAnkle and knee joint motion were regulated according to the amount of ankle-foot orthosis moment during gait. The ankle-foot orthosis maintained the ankle angular position in dorsiflexion and knee angular position in flexion throughout a gait cycle when it generated moment from − 0.029 (0.011) to − 0.062 (0.019) Nm/kg (moment resisting plantarflexion was defined as negative).InterpretationsQuantifying the contribution of ankle-foot orthosis moment needed to regulate lower limb joints within a specific range of motion could provide valuable criteria to design an ankle-foot orthosis for individuals post-stroke.     

Individual selection of gait retraining strategies is essential to optimally reduce medial knee load during gait

Background

The progression of medial knee osteoarthritis seems closely related to a high external knee adduction moment, which could be reduced through gait retraining. We aimed to determine the retraining strategy that reduces this knee moment most effective during gait, and to determine if the same strategy is the most effective for everyone.

Methods

Thirty-seven healthy participants underwent 3D gait analysis. After normal walking was recorded, participants received verbal instructions on four gait strategies (Trunk Lean, Medial Thrust, Reduced Vertical Acceleration, Toe Out). Knee adduction moment and strategy-specific kinematics were calculated for all conditions.

Findings

The overall knee adduction moment peak was reduced by Medial Thrust (− 0.08 Nm/Bw·Ht) and Trunk Lean (− 0.07 Nm/Bw·Ht), while impulse was reduced by 0.03 Nms/Bw·Ht in both conditions. Toeing out reduced late stance peak and impulse significantly but overall peak was not affected. Reducing vertical acceleration at initial contact did not reduce the overall peak. Strategy-specific kinematics (trunk lean angle, knee adduction angle, first peak of the vertical ground reaction force, foot progression angle) showed that multiple parameters were affected by all conditions. Medial Thrust was the most effective strategy in 43% of the participants, while Trunk Lean reduced external knee adduction moment most in 49%. With similar kinematics, the reduction of the knee adduction moment peak and impulse was significantly different between these groups.

Interpretation

Although Trunk Lean and Medial Thrust reduced the external knee adduction moment overall, individual selection of gait retraining strategy seems vital to optimally reduce dynamic knee load during gait.     

Effects of walking with a “draw-in maneuver” on the knee adduction moment and hip muscle activity

[Purpose] To investigate the effect of performing a draw-in maneuver (DI) on knee adduction moment (KAM) and hip and trunk muscle activities while walking. [Participants and Methods] We included 30 healthy young adults (21.5 ± 0.6 years, 16 males and 14 females) in this study. We measured the KAM and lever arm while participants walked with either a normal gait or a DI gait. We also performed surface electromyography (EMG) of the hip and trunk muscles (i.e., internal oblique abdominal muscle [IO], external oblique abdominal muscle [EO], multifidus muscle [MF], and gluteus medius muscle [GM]). [Results] The 1st peak of the KAM was significantly lower when walking with a DI gait compared to when walking with a normal gait. The integrated EMG activity of the IO, EO, and GM during the 1st half of the stance phase, and of the IO and EO during the 2nd half of the stance phase was significantly higher during the DI than during normal gait. [Conclusion] Compared with a normal gait, a DI gait leads to a decrease in the 1st peak of the KAM as a result of the shorter lever arm, and an increase in the muscular activity of the GM, IO, and EO.Key words: Draw-in maneuver, Knee adduction moment, Hip abduction muscle activity     

Robust features of knee osteoarthritis in joint moments are independent of reference frame selection

Background

Changes in lower-limb joint moments are important outcome measures for treatment and prevention of knee osteoarthritis. However, it is known that both the magnitude and amplitude of joint moments are affected by the choice of anatomical reference frame. The purpose of this study was to identify features of joint moment waveforms that, regardless of the choice of reference frame, are different for subjects with knee osteoarthritis as compared to asymptomatic control subjects.

Methods

External joint moments during the stance phase of gait were calculated for 44 subjects with moderate knee osteoarthritis and 44 asymptomatic subjects. Moments were then expressed using four anatomical reference frames: Joint Coordinate System, Plane of Progression, Proximal, and Distal. Principal component analysis was used to extract features of the moment waveforms that differed between control and osteoarthritis groups across all reference frames.

Findings

Principal component analysis revealed that, regardless of the choice of reference frame, subjects with knee osteoarthritis exhibited significantly decreased overall hip adduction moment magnitudes, increased overall knee adduction moment magnitudes, decreased knee internal rotation moment amplitudes, and increased early-stance ankle adduction magnitudes.

Interpretation

The four robust features identified in this study are sensitive to the effect of knee osteoarthritis, but independent of changes in the anatomical reference frame. These features can be solely attributed to the pathogenesis of the disease, and not to the artifact of reference frame selection.     

The effect of knee joint Mulligan taping on balance and gait in subacute stroke patients

[Purpose] This study aimed to determine the effects of Mulligan taping on balance and gait in subacute stroke patients. [Subjects] Thirty patients with subacute stroke were randomly divided into two groups: the experimental group (n = 15) and the control group (n = 15). Mulligan taping was applied to the knee joints of participants in the experimental group while placebo taping was applied to knee joints of subjects in the control group. Biodex was used to assess their balance ability and the GAITRite System was used to test gait. All measurements were performed before and after the intervention. [Results] Dynamic standing balance of the experimental group significantly improved after taping. Gait, gait cadence, velocity, step length, and stride length also improved significantly. However, no significant differences in standing balance or gait were observed for the control group. Furthermore, significant differences in dynamic standing balance, cadence, and velocity were found between the two groups after the intervention. [Conclusion] Our results demonstrate that Mulligan taping is effective for improving balance and gait in subacute stroke patients. Thus, this technique is a potential method for actively facilitating rehabilitation programs for hemiplegia patients.Key words: Stroke, Mulligan taping, Balance     

The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis

BackgroundThe association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis.MethodsSixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n = 18), mild pain (n = 27), or moderate/severe pain (n = 22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified.FindingsThe moderate/severe pain group demonstrated worse global pain (P < 0.01) and physical function scores (P < 0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P = 0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P = 0.009), which was associated with higher weight acceptance peak knee adduction moments (P = 0.003) and worse global pain (P = 0.003) and physical function scores (P = 0.006).InterpretationGreater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait.     

膝关节骨性关节炎患者步态运动学参数的研究

目的：定量分析膝关节骨性关节炎（knee osteoarthritis,KOA）患者步态运动学参数的变化特点。方法：利用三维动作分析系统对轻病组、重病组膝关节骨性关节炎患者和对照组各30名进行运动学参数测试。结果：两组患者与对照组的时空参数相比,支撑期百分比参数较大（P〈0.05）。关节角度方面,轻病组、重病组分别和对照组相比,最大伸髋角度明显减小（P〈0.05）;足跟着地期伸膝角度、支撑期最大屈膝角度和支撑期最大伸膝角度等参数均明显减小（P〈0.05）;踝关节支撑期最大跖屈角度和最大背屈角度较小（P〈0.05）,重病组与其他两组的差异较大（P〈0.001）。结论：KOA患病组与对照组步态的运动学参数存在明显差异,说明患者为减少患病部位的负荷采取了相应的代偿策略。