Effects of an acute hamstring stretch in people with and without osteoarthritis of the knee

Objective

To compare the effects of an acute stretching intervention on knee extension range of motion, passive resistive torque and stiffness in subjects with osteoarthritis of the knee, and to compare these variables with subjects without osteoarthritis.

Design

Cross-sectional experimental study.

Setting

Human performance laboratory.

Participants

A total of 55 participants were recruited: 28 subjects (males and females) with osteoarthritis of the knee joint and 27 subjects of a similar age without osteoarthritis of the knee joint.

Intervention

Using the Kincom dynamometer, three 60-second stretches with 60 seconds of rest between stretches were applied to the hamstring muscle group.

Main outcome measures

Peak knee extension range of motion, peak passive torque and stiffness in the final 10% of knee extension range of motion.

Results

A significant (P < 0.05) increase in knee extension range of motion, peak passive torque and stiffness was observed in both groups. For knee extension range of motion, the mean difference for the osteoarthritis group and non-osteoarthritis group was 4.9 degrees [95% confidence interval (CI) 0.9 to 8.5] and 4.4 degrees (95% CI 1.8 to 6.8), respectively. For peak passive torque, the mean difference in the osteoarthritis group and the non-osteoarthritis group was 4.4 N m (95% CI 0.8 to 6.9) and 1.0 N m (95% CI −1.4 to 3.5), respectively. For stiffness in the final 10% of knee extension range of motion, the mean difference for the osteoarthritis group and the non-osteoarthritis group was 0.19 N m/degree (95% CI 0.08 to 0.3) and 0.04 N m/degree (95% CI −0.05 to 0.1), respectively. Stiffness in the final 10% of knee extension range of motion was significantly higher in the osteoarthritis group compared with the non-osteoarthritis group after stretching.

Conclusions

Elderly individuals with and without osteoarthritis of the knee are able to demonstrate immediate beneficial adaptations to a stretching intervention. This is important as stretching is often used in preparation for exercise programmes.     

The effect of neuromuscular electrical stimulation on arthritis knee pain in older adults with osteoarthritis of the knee.

The objective of this study was to examine the short- and long-term effects of a home-based, 12-week neuromuscular electrical stimulation (NMES) of the quadriceps femoris to decrease arthritis knee pain in older adults with osteoarthritis of the knee. The study sample (N = 38) was randomly assigned to the NMES treatment plus education group or the arthritis education-only group. Pain was measured in both groups with the McGill Pain Questionnaire (MPQ) at baseline, during the intervention at weeks 4, 8, 12, and at follow-up and with the Arthritis Impact Measurement Scale 2-Pain Subscale (AIMS2-PS) at baseline and week 12. The NMES Pain Diary (PD) was completed 15 minutes before and after each stimulation session. There was a significant 22% decline in pain 15 minutes after as compared with immediately before each NMES treatment (p <.001), as measured by the PD. No significant group differences were found between the 2 groups over the course of the intervention and follow-up. These findings indicate that a home-based NMES intervention reduced arthritis knee pain 15 minutes after a NMES treatment.     

Physical functions associated with health-related quality of life in older adults diagnosed with knee osteoarthritis

[Purpose] The present study aimed to identify the physical functions associated with health-related quality of life in older adults with knee osteoarthritis. [Participants and Methods] A total of 132 participants were included in this study in two groups: the knee osteoarthritis group (n=66) and the control group (n=66). We compared the results of the Medical Outcomes Study 36-Item Short-Form Health Survey with the physical function measures related to health-related quality of life. In the knee osteoarthritis group, we examined the relationship between the degree of knee pain and health-related quality of life. [Results] The knee osteoarthritis group showed a significantly shorter one-leg standing time, lower maximum walking speed, and significantly longer time to complete the Sit-to-Stand-5 and Timed Up and Go tests than the control group. The knee osteoarthritis group had significantly lower 36-Item Short-Form Health Survey scores than the control group on seven subscales and significantly lower scores for physical component summary and role or social component summary. In the knee osteoarthritis group, physical component summary and role or social component summary were correlated with Sit-to-Stand-5, Timed Up and Go, and maximum walking speed. We observed a correlation between physical component summary and knee pain on joint loading. [Conclusion] In older adults with knee osteoarthritis, rehabilitation approaches aimed at achieving a smooth transition from sitting to standing may increase social participation and improve health-related quality of life.     

Factors related to the indecision of older adults with knee osteoarthritis about receiving physician-recommended total knee arthroplasty

Purpose: To explore factors related to the indecision of older adults with knee osteoarthritis (OA) about receiving physician-recommended total knee arthroplasty (TKA) and their needs during the decision-making process.

Method: Older outpatients with knee OA and undecided about physician-recommended TKA (N?=?26) were recruited by convenience from two medical centers and one regional hospital in northern Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by thematic analysis.

Results: Participants’ indecision about receiving physician-recommended TKA was due to four major concerns: treatment-related concerns, physical condition-related concerns, surgery-related concerns, and postsurgical care concerns. The few participants (n?=?6) who expressed needs during the decision-making process wanted more information about preparing for surgery, postsurgical care, rehabilitation, and medicines.

Conclusions: Healthcare providers are challenged to respect the decision-making process of older adults with OA regarding recommended TKA while maintaining their quality of life. These adults need appropriate information not only about the relationship between OA suffering and quality of life, but also TKA. While these patients are deciding whether to undergo physician-recommended TKA, they also need information about preparations for surgery, postsurgical care, rehabilitation, and medicines.

• Implications for Rehabilitation

• Total knee arthroplasty (TKA) can significantly relieve pain and improve function for older adults with knee osteoarthritis (OA), but many are unwilling to receive the surgery.

• Our older adult participants with knee OA ascribed their indecision about receiving physician-recommended TKA to treatment-related, physical condition-related, surgery-related, and postsurgical care-related concerns.

• Healthcare providers need to provide appropriate information to older adults with knee OA not only about the relationship between OA suffering and quality of life, but also about TKA.

• Healthcare providers should also provide these patients information about preparing for surgery, postsurgical care, rehabilitation, and medicines while they are deciding whether to undergo TKA.

     

Transversus abdominis activation does not alter gait impairments in patients with and without knee osteoarthritis

BackgroundKnee osteoarthritis accounts for more years of disability than all other forms of osteoarthritis combined. Gait kinetic and kinematic changes, in addition to reduced gait speed, are commonly observed. This study investigates whether core activation, which modifies lower extremity movement in young, active populations, can alter the gait and baseline core activation of those with knee osteoarthritis as compared to controls, and alter osteoarthritic knee pain.MethodsForty-four participants (22 controls and 22 with knee osteoarthritis) underwent biomechanical gait assessment, examining kinetic and kinematic variables, in addition to gait speed, with and without volitional transversus abdominis activation. Surface electromyography was used to measure baseline transversus abdominis activation under both conditions. Knee pain ratings were examined for those with knee osteoarthritis.FindingsNo significant biomechanical differences were observed within groups, or in the time/group interaction. Between-groups kinetic (time to first peak ground reaction force and amplitude of second peak ground reaction force) and gait speed differences were observed under both conditions. There were no differences in baseline electromyography activation between or within-groups, or within-group for self-reported pain for the osteoarthritic group.InterpretationAlthough previous studies have shown the benefit of core activation in correcting lower extremity movement patterns and kinetic loading in young, athletic populations, this study is the first to show this is not the case for persons with knee osteoarthritis. Future studies should examine the value of a progressive core stabilization program, of sufficient dose and mode, in correcting the observed gait differences in those with knee osteoarthritis.Clinical Trial Registration Number: NCT03776981     

Atrophy of individual thigh muscles measured by MRI in older adults with knee osteoarthritis: A cross-sectional study

BackgroundThe characteristics of thigh-muscle cross-sectional area (CSA) in older adults with knee osteoarthritis (KOA) remain controversial.ObjectivesThis study aimed to evaluate atrophy of individual thigh muscles in older adults with KOA and to determine which muscle CSA should be measured to detect KOA-related muscle atrophy of the thigh.MethodsIn older adults, individual thigh-muscle CSA measured by 1.5 Tesla MRI was analyzed at 5% intervals of the femoral length (FL) around the mid-thigh between the proximal 25% of the FL and the distal 25%. Participants with KOA grade ≤ 1 and grade ≥ 2 were compared for ratios of quadriceps muscle (QM) CSA to total thigh, individual QM CSA to QM, and individual hamstring (HAM) CSA to HAM at 5% intervals.ResultsWe included 40 older adults [20 males; mean (SD) age 73.3 (4.7) years; 20 with KOA grade ≤ 1 and 20 with KOA grade ≥ 2]. The ratio of vastus medialis (VM) CSA to QM from the proximal 25% to distal 15% and the ratio of semi-membranosus (SM) CSA to HAM at the distal 10% to 25% were significantly lower with KOA grade ≥ 2 than grade ≤ 1; the effect sizes were 0.34 to 0.67 for VM and 0.40 to 0.60 for SM. The effect sizes were greatest for the ratios of VM CSA to QM at the mid-thigh with 5% intervals and the ratio of SM CSA to HAM at the distal 25%.ConclusionsThe ratio of VM CSA to QM and/or that of SM CSA to HAM were low and were the best indicators to detect KOA-related muscle atrophy of the thigh. However, to detect KOA-related muscle atrophy, the VM CSA ratio should be analyzed in the thigh region around the mid-thigh, whereas the SM CSA ratio should be analyzed in the thigh region at the muscle belly.     

膝关节骨性关节炎患者股四头肌动员能力和肌力储备改变的研究

目的:观察膝关节骨性关节炎(KOA)患者股四头肌肌力,肌肉动员能力及肌力储备并探讨其改变原因,为KOA功能评定和康复治疗提供新的途径和依据。方法:本次研究对象20例KOA患者为实验组和10例健康人为对照组,利用肌肉随意收缩电刺激叠加法测定股四头肌最大随意收缩力量、肌力储备和动员能力。结果:KOA组左、右腿股四头肌相对肌力分别为0.22和0.21,两腿没有显著差异(P>0.05);对照组左腿和右腿相对肌力分别为0.34和0.32,KOA患者相对肌力显著低于对照组(P<0.05)。KOA组左、右腿肌力储备分别为31.09%和29.90%;对照组左、右腿肌力储备分别为18.56%和20.75%,KOA组双侧股四头肌肌力储备显著高于对照组(P<0.01);KOA组左、右腿动员能力分别为68.95%和70.05%;对照组左、右腿的股四头肌动员能力分别为81.40%和79.20%,KOA组双侧肌肉动员能力显著低于对照组(P<0.05)。结论:KOA患者存在着股四头肌肌力低下、股四头肌动员能力不足的情况,其肌力下降主要是由于神经肌肉控制能力较差所致,肌肉随意收缩电刺激叠加法可以敏感地反映这一变化。康复治疗可以训练股四头肌神经肌肉控制能力,增加KOA患者股四头肌肌力和关节稳定性。     

Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis

OBJECTIVE: Gait biomechanics (knee adduction moment, center of pressure) and static alignment were investigated to determine the mechanical effect of foot orthoses in people with medial compartment knee osteoarthritis. DESIGN: Repeated measures design in which subjects were exposed to three conditions (normal footwear, heel wedge and orthosis) in random order. BACKGROUND: The knee adduction moment is an indirect measure of medial compartment loading. It was hypothesized that the use of a 5 degrees valgus wedge and 5 degrees valgus modified orthosis would shift the center of pressure laterally during walking, thereby decreasing the adduction moment arm and the adduction moment. METHODS: Peak knee adduction moment and center of pressure excursion were obtained in nine subjects with medial compartment knee OA during level walking using an optoelectric system and force plate. Static radiographs were taken in 12 subjects using precision radiographs. RESULTS: There was no difference between conditions in static alignment, the peak adduction moment or excursion of the center of pressure in the medial-lateral direction. No relationship was found between the adduction moment and center of pressure excursion in the medial-lateral plane. The displacement of the center of pressure in the anterior-posterior direction, measured relative to the laboratory coordinate system, was decreased with the orthosis compared to the control condition (P=0.036) and this measure was correlated with the adduction moment (r=0.45, P=0.019). CONCLUSIONS: The proposed mechanism was not supported by the findings. The reduction in the center of pressure excursion in the anterior-posterior direction suggests that foot positioning was altered, possibly to a toe-out position, while subjects wore the orthoses. Based on the current findings, we hypothesize that toe-out positioning may reduce medial joint load. RELEVANCE: Knee Osteoarthritis is the most common cause of chronic disability amongst seniors. Developing inexpensive, non-invasive treatment strategies for this large population has potential to impact health care costs, quality of life and clinical outcomes.     

Kaatsu training to enhance physical function of older adults with knee osteoarthritis: Design of a randomized controlled trial

As the U.S. population ages, efficacious interventions are needed to manage pain and maintain physical function among older adults with osteoarthritis (OA). Skeletal muscle weakness is a primary contributory factor to pain and functional decline among persons with OA, thus interventions are needed that improve muscle strength. High-load resistance exercise is the best-known method of improving muscle strength; however high-compressive loads commonly induce significant joint pain among persons with OA. Thus interventions with low-compressive loads are needed which improve muscle strength while limiting joint stress. This study is investigating the potential of an innovative training paradigm, known as Kaatsu, for this purpose. Kaatsu involves performing low-load exercise while externally-applied compression partially restricts blood flow to the active skeletal muscle. The objective of this randomized, single-masked pilot trial is to evaluate the efficacy and feasibility of chronic Kaatsu training for improving skeletal muscle strength and physical function among older adults. Participants aged ≥ 60 years with physical limitations and symptomatic knee OA will be randomly assigned to engage in a 3-month intervention of either (1) center-based, moderate-load resistance training, or (2) Kaatsu training matched for overall workload. Study dependent outcomes include the change in 1) knee extensor strength, 2) objective measures of physical function, and 3) subjective measures of physical function and pain. This study will provide novel information regarding the therapeutic potential of Kaatsu training while also informing about the long-term clinical viability of the paradigm by evaluating participant safety, discomfort, and willingness to continually engage in the intervention.     

治疗型关节炎护膝对实验性骨关节炎组织形态学的影响

背景:治疗型关节炎护膝具有通经活络、疏导瘀滞、行气活血的作用,已证实是防治膝骨性关节炎行之有效的医疗仪器.目的:通过观察兔膝骨性关节炎关节软骨组织的病理变化,探讨治疗型关节炎护膝的治疗作用.设计、时间及地点:随机对照动物观察,于2006-01/10在解放军南京军区福州总医院动物实验中心及病理中心完成.材料:健康6月龄日本大耳白兔54只,由无锡市惠山江南动物实验中心提供.治疗型关节炎护膝由福建中医学院和福州大学生物医学研究所共同研制,包括疏密波、热软膜程序,两种程序联合为温热动态干扰变频疏密波.微波仪产地日本.方法:取10只兔作为正常对照组,剩余44只采用改良Hulth法建立膝骨性关节炎模型,造模后随机分为模犁对照组9只、微波对照组9只、疏密波组9只、热软膜组8只、疏密波+热软膜组9只.造模后7d开始每日强迫兔活动30min,之后正常对照组、模型对照组不进行任何干预,其余组兔固定后分别对应给予微波仪治疗、疏密波治疗、热软膜治疗、疏密波+热软膜联合治疗,30 min/次,1次/d,连续16周.主要观察指标:通过CR片、光镜和电镜观察膝关节组织形态学变化.结果:干预16周后,CR片显示正常对照组关节间隙正常,关节面平整光滑,无骨赘;模型对照组内侧间隙明显变窄,有明显骨赘.光镜下正常对照组关节软骨四层结构清晰可辨,软骨细胞排列整齐呈柱状,染色质分布均匀,细胞核清晰;模型对照组关节软骨层变薄,部分区域软骨细胞核固缩、坏死,软骨细胞排列紊乱,四层结构不易分辨.电镜下正常对照组软骨细胞呈椭圆形,细胞及胞膜完整,包质内可见丰富的粗面内质网、高尔基体、线粒体,细胞核完整,染色质分布均匀;模型对照组软骨细胞明显固缩且外形不规则,细胞周晕消失,胞浆内细胞器凝成高电子密度的片状物不易分辨,细胞核不规则,染色质浓聚,散裂于核中.疏密波+热软膜组存病理程度上的改变明显轻于模型对照组,软骨表面裂纹少,胶原纤维结构基本完整,固缩的软骨细胞少,虽可见部分退变的软骨细胞,但部分软骨细胞具有较多的细胞器,某些区域形成软骨细胞簇.微波对照组、单纯疏密波组、单纯热软膜组膝关节组织形态学变化介于模型对照组和疏密波+热软膜组之间.结论:治疗型关节炎护膝的疏密波+热软膜程序能延缓膝关节软骨宏观形态、软骨细胞及软骨基质的退变,效果优于微波仪治疗或单纯的疏密波、热软膜治疗.     

Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis

Chen C-Y, Chen C-L, Hsu SC-C, Chou S-W, Wang K-C. Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis.

Objective

To determine the effects of magnetic knee wrap on isokinetic quadriceps strength in patients with painful knee osteoarthritis (OA).

Design

Randomized, double-blinded, placebo-controlled and before-after trial.

Setting

Rehabilitation clinic in a tertiary hospital.

Participants

Eligible patients (N=50) (mean age ± SD, 66.0±8.6y) with mild to moderate knee OA were recruited from the outpatient department and 37 (74%) completed the trial. Only 3 (6%) withdrew due to study-related adverse effects.

Interventions

Wearing the active (n=24) or sham (n=26) magnetic knee wrap for 12 weeks.

Main Outcome Measures

The primary outcome measure was isokinetic quadriceps strength. Secondary outcome measures included the Health Assessment Questionnaire Disability Index (HAQ-DI) and the Health Assessment Questionnaire (HAQ) Pain Scale.

Results

Using intention-to-treat analyses, the peak isokinetic quadriceps strength increased significantly in the treated leg at 30°/s (P=.007) and 60°/s (P=.022) after wearing the magnetic knee wrap. Compared with baseline, the median strength increase for the treated leg in the study group significantly exceeded that in the control group at week 4 (.05Nm/kg vs −.09Nm/kg at 60°/s, P=.038) and week 12 (30°/s, .09Nm/kg vs .04Nm/kg, P=.044; 60°/s, .17Nm/kg vs .02Nm/kg, P=.031). The HAQ-DI and HAQ Pain Scales improved significantly in both groups. Compared with baseline, the improvement at week 12 in terms of the HAQ-DI in the study group significantly exceeded that in the control group.

Conclusions

Magnetic knee wrap may significantly facilitate isokinetic quadriceps strength in patients with mild to moderate knee OA.     

Living experiences of middle-aged adults with early knee osteoarthritis in prediagnostic phase

Purpose: The aim of this study was to understand the living experiences of middle-aged Taiwanese adults with early knee osteoarthritis (OA). Methods: A qualitative research design was used in this study. Participants (n?=?17) were recruited by purposive sampling from orthopedic clinics at two medical centers in northern Taiwan. Data were collected through in-depth interviews from July to December 2010. The data were transcribed verbatim and summarized by content analysis. Results: The results indicated that the lived experiences could be grouped into 4 main themes: awareness; surmise of causes; acquisition of strategies; and the search for confirmative diagnosis. Conclusions: This study found that patients’ knowledge is insufficient for recognition of the presence of early OA. There is a need for clinicians to integrate knowledge of OA into the health education system and to develop interventions for early knee osteoarthritic patients. Patients’ disease cognition must be promoted so that their ability to process early symptoms of this disease will improve.

Implications for Rehabilitation

• Awareness, surmise of causes, and acquisition of strategies are repetitive circles. Patients pursue the true cause for their knee joint disease and seek confirmative diagnosis when the symptoms do not improve or when they became worse.

• The information patients have is insufficient to know the presence of degenerative osteoarthritis disease.

• There is a need for clinical practitioners to integrate knowledge of osteoarthritis into the health education system to increase awareness and to develop appropriate interventions for patients with early knee OA.