Patients with knee osteoarthritis exhibit greater knee muscle co-contraction, and which in turn is a risk factor for disease progression.
Objective
The aims of this study were to assess the muscle co-contraction during walking and quadriceps exercises in patients with medial knee osteoarthritis, and to identify the factors most associated with the alterations in co-contraction.
Methods
The subjects were 12 women with medial knee osteoarthritis and 13 asymptomatic controls. Kinematic and kinetic parameters during walking, and co-contraction indices during walking, knee extension and straight leg raising exercises were measured. The factors associated with the alteration in co-contraction in the osteoarthritis group were determined by linear regression analyses.
Results
Compared with the control group, the osteoarthritis group showed significantly greater co-contraction of the vastus lateralis and biceps femoris (VLBF) in two quadriceps exercises as well as the VLBF, co-contraction of the vastus lateralis and lateral gastrocnemius (VLLG) in walking. In linear regression analyses, the VLBF and VLLG in walking were associated with knee extension moment and knee pain frequency in daily life. The VLBF in knee extension and straight leg raising exercise were associated with knee flexion angle in a quiet standing position and knee varus peak angle during the stance phase of walking.
Conclusions
Greater muscle co-contractions were observed in not only walking but quadriceps strengthening exercises in patients with knee OA. Besides, the factors of these patterns were different in different tasks. These findings may help the development of more effective rehabilitation strategies for patients with knee osteoarthritis.
SirinAVPatlaAE. Myoelectric changes in the triceps surae muscles under sustained contractions - evidence for synergism. Eur J Appl Physiol Occup Physiol1987; 56(2): 238–244.
2.
SmithAM. The coactivation of antagonist muscles. Can J Physiol Pharmacol1981; 59(7): 733–747.
3.
TsaiLCMcLeanSCollettiPM, et al.Greater muscle co‐contraction results in increased tibiofemoral compressive forces in females who have undergone anterior cruciate ligament reconstruction. J Orthop Res2012; 30(12): 2007–2014.
4.
AndriacchiTPKooSScanlanSF. Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. J Bone Joint Surg Am2009; 91: 95–101.
ChildsJDSpartoPJFitzgeraldGK, et al.Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis. Clin Biomech2004; 19(1): 44–49.
7.
Hubley-KozeyCDeluzioKDunbarM. Muscle co-activation patterns during walking in those with severe knee osteoarthritis. Clin Biomech2008; 23(1): 71–80.
8.
SchmittLCRudolphKS. Influences on knee movement strategies during walking in persons with medial knee osteoarthritis. Arthritis Rheum2007; 57(6): 1018–1026.
9.
BennellKLWrigleyTVHuntMA, et al.Update on the role of muscle in the genesis and management of knee osteoarthritis. Rheum Dis Clin North Am2013; 39(1): 145–176.
10.
LewekMDRudolphKSSnyder-MacklerL. Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis. Osteoarthr Cartil2004; 12(9): 745–751.
11.
SchmittLCRudolphKS. Muscle stabilization strategies in people with medial knee osteoarthritis: the effect of instability. J Orthop Res2008; 26(9): 1180–1185.
12.
BrandonSCEMillerRHThelenDG, et al.Selective lateral muscle activation in moderate medial knee osteoarthritis subjects does not unload medial knee condyle. J Biomech2014; 47(6): 1409–1415.
13.
DixonPCGomesSPreussRA, et al.Muscular co-contraction is related to varus thrust in patients with knee osteoarthritis. Clin Biomech2018; 60: 164–169.
14.
HeidenTLLloydDGAcklandTR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clin Biomech2009; 24(10): 833–841.
15.
HodgesPWvan den HoornWWrigleyTV, et al.Increased duration of co-contraction of medial knee muscles is associated with greater progression of knee osteoarthritis. Man Ther2016; 21(5): 151–158.
16.
Hubley-KozeyCLHillNARutherfordDJ, et al.Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking. Clin Biomech2009; 24(5): 407–414.
17.
RutherfordDJHubley-KozeyCLStanishWD. Changes in knee joint muscle activation patterns during walking associated with increased structural severity in knee osteoarthritis. J Electromyogr Kinesiol2013; 23(3): 704–711.
18.
Al-KhlaifatLHerringtonLCHammondA, et al.The effectiveness of an exercise programme on knee loading, muscle co-contraction, and pain in patients with medial knee osteoarthritis: a pilot study. Knee2016; 23(1): 63–69.
19.
ZeniJARudolphKHigginsonJS. Alterations in quadriceps and hamstrings coordination in persons with medial compartment knee osteoarthritis. J Electromyogr Kinesiol2010; 20(1): 148–154.
20.
Astephen WilsonJLDeluzioKJDunbarMJ, et al.The association between knee joint biomechanics and neuromuscular control and moderate knee osteoarthritis radiographic and pain severity. Osteoarthr Cartil2011; 19(2): 186–193.
21.
Hubley-KozeyCLDeluzioKJLandrySC, et al.Neuromuscular alterations during walking in persons with moderate knee osteoarthritis. J Electromyogr Kinesiol2006; 16(4): 365–378.
22.
BennellKLHinmanRS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport2011; 14(1): 4–9.
23.
ForoughiNSmithRMLangeAK, et al.Progressive resistance training and dynamic alignment in osteoarthritis: a single-blind randomised controlled trial. Clin Biomech2011; 26(1): 71–77.
24.
FransenMMcConnellSHarmerAR, et al.Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev2015; 1: CD004376.
25.
McQuadeKJde OliveiraAS. Effects of progressive resistance strength training on knee biomechanics during single leg step-up in persons with mild knee osteoarthritis. Clin Biomech2011; 26(7): 741–748.
26.
EscamillaRFFleisigGSZhengN, et al.Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. Med Sci Sports Exerc1998; 30(4): 556–569.
27.
BegalleRLDiStefanoLJBlackburnT, et al.Quadriceps and hamstrings coactivation during common therapeutic exercises. J Athl Train2012; 47(4): 396–405.
28.
LutzGEPalmitierRAAnKN, et al.Comparison of tibiofemoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises. J Bone Joint Surg Am1993; 75(5): 732–739.
29.
FelsonDTLawrenceRCDieppePA, et al.Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med2000; 133(8): 635–646.
30.
GuccioneAAFelsonDTAndersonJJ, et al.The effects of specific medical conditions on the functional limitations of elders in the Framingham study. Am J Public Health1994; 84(3): 351–358.
31.
SlemendaCBrandtKDHeilmanDK, et al.Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med1997; 127(2): 97–104.
32.
AltmanRD. Classification of disease: osteoarthritis. Semin Arthritis Rheum1991; 20(6): 40–47.
33.
KellgrenJHLawrenceJS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis1957; 16(4): 494–502.
34.
AkaiMDoiTFujinoK, et al.An outcome measure for Japanese people with knee osteoarthritis. J Rheumatol2005; 32(8): 1524–1532.
35.
SchooAMMMorrisMEBuiQM. Influence of home exercise performance, concurrent physical activities and analgesics on pain in people with osteoarthritis. N Z J Physiother2004; 32(2): 67–74.
36.
KuroyanagiYNaguraTKiriyamaY, et al.A quantitative assessment of varus thrust in patients with medial knee osteoarthritis. Knee2012; 19(2): 130–134.
37.
O’ConnorCMThorpeSKO’MalleyMJ, et al.Automatic detection of gait events using kinematic data. Gait Posture2007; 25(3): 469–474.
38.
AndriacchiTPGalanteJOFermierRW. The influence of total knee-replacement design on walking and stair-climbing. J Bone Joint Surg Am1982; 64(9): 1328–1335.
39.
AnanMShinkodaKSuzukiK, et al.Do patients with knee osteoarthritis perform sit-to-stand motion efficiently?Gait Posture2015; 41(2): 488–492.
RudolphKSAxeMJSnyder-MacklerL. Dynamic stability after ACL injury: who can hop?Knee Surg Sports Traumatol Arthrosc2000; 8(5): 262–269.
42.
VosEJMullenderMGvan Ingen SchenauGJ. Electromechanical delay in the vastus lateralis muscle during dynamic isometric contractions. Eur J Appl Physiol Occup Physiol1990; 60(6): 467–471.
43.
AnanMShinkodaKSuzukiK, et al.Dynamic frequency analyses of lower extremity muscles during sit-to-stand motion for the patients with knee osteoarthritis. PLoS One2016; 11(1): e0147496.
44.
KitoNShinkodaKYamasakiT, et al.Contribution of knee adduction moment impulse to pain and disability in Japanese women with medial knee osteoarthritis. Clin Biomech2010; 25(9): 914–919.
45.
CohenJ. A power primer. Psychol Bull1992; 112: 155–159.
46.
AstephenJLDeluzioKJCaldwellGE, et al.Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res2008; 26(3): 332–341.
47.
GökHErginSYavuzerG. Kinetic and kinematic characteristics of gait in patients with medial knee arthrosis. Acta Orthop Scand2002; 73(6): 647–652.
48.
HurwitzDERyalsABCaseJP, et al.The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res2002; 20(1): 101–107.
49.
KaufmanKRHughesCMorreyBF, et al.Gait characteristics of patients with knee osteoarthritis. J Biomech2001; 34(7): 907–915.
50.
RobonMJPerellKLFangM, et al.The relationship between ankle plantar flexor muscle moments and knee compressive forces in subjects with and without pain. Clin Biomech2000; 15(7): 522–527.
51.
RudolphKSSchmittLCLewekMD. Age-related changes in strength, joint laxity, and walking patterns: are they related to knee osteoarthritis?Phys Ther2007; 87(11): 1422–1432.
52.
Graven-NielsenTSvenssonPArendt-NielsenL. Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Electroencephalogr Clin Neurophysiol1997; 105(2): 156–164.
53.
LundJPDongaRWidmerCG, et al.The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol1991; 69(5): 683–694.
54.
VlaeyenJWLintonSJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain2000; 85(3): 317–332.
55.
SchippleinODAndriacchiTP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res1991; 9(1): 113–119.
56.
ShalhoubSFitzwaterFGCyrAJ, et al.Variations in medial-lateral hamstring force and force ratio influence tibiofemoral kinematics. J Orthop Res2016; 34(10): 1707–1715.
57.
VictorJLabeyLWongP, et al.The influence of muscle load on tibiofemoral knee kinematics. J Orthop Res2010; 28(4): 419–428.
58.
MengarelliAGentiliAStrazzaA, et al.Co-activation patterns of gastrocnemius and quadriceps femoris in controlling the knee joint during walking. J Electromyogr Kinesiol2018; 42(December 2017): 117–122.
59.
MesfarWShirazi-AdlA. Biomechanics of the knee joint in flexion under various quadriceps forces. Knee2005; 12(6): 424–434.
60.
ShelburneKBTorryMRPandyMG. Contributions of muscles, ligaments, and the ground-reaction force to tibiofemoral joint loading during normal gait. J Orthop Res2006; 24(10): 1983–1990.
61.
MaquetPGVan de BergAJSimonetJC. Femorotibial weight-bearing areas. Experimental determination. J Bone Joint Surg Am1975; 57(6): 766–771.
62.
Bullock-SaxtonJEMurphyDNorrisC, et al.The muscle designation debate: the experts respond. J Bodyw Mov Ther2000; 4(4): 225–241.
63.
CzaprowskiDStolińskiŁTyrakowskiM, et al.Non-structural misalignments of body posture in the sagittal plane. Scoliosis Spinal Disord2018; 13(1): 6.
64.
BlalockDMillerATilleyM, et al.Joint instability and osteoarthritis. Clin Med Insights Arthritis Musculoskelet Disord2015; 8: 15–23.
65.
MacConaillMA. The movements of bones and joints; the synovial fluid and its assistants. J Bone Joint Surg Br1950; 32-B(2): 244–252.
66.
NaguraTDyrbyCOAlexanderEJ, et al.Mechanical loads at the knee joint during deep flexion. J Orthop Res2002; 20(4): 881–886.
67.
RoebroeckMEDoorenboschCAHarlaarJ, et al.Biomechanics and muscular activity during sit-to-stand transfer. Clin Biomech1994; 9(4): 235–244.
68.
HoffmanJGabelP. Expanding Panjabi’s stability model to express movement: a theoretical model. Med Hypotheses2013; 80(6): 692–697.
69.
SharmaLDunlopDDCahueS, et al.Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Ann Intern Med2003; 138(8): 613–620.
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