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P76: Bilateral and multi-joint strength in patients with painful knee osteoarthritis: a case-control study
Gait & Posture xxx (xxxx) xxx–xxx
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P76
Bilateral and multi-joint strength in patients with painful knee osteoarthritis: A case-control study ⁎
Kjartan Vårbakkena, , Kåre Birger Hagenc, Kjell Gunnar Nilssonb, Ann-Katrin Stensdottera,b a b c
NTNU, Trondheim, Norway Umeå University, Umeå, Sweden Diakonhjemmet Hospital, Oslo, Norway
1. Introduction Individuals with long-term, painful knee osteoarthritis (OA) are known to exhibit muscle weakness [1–4] and to respond well to strength exercise therapy [1]. Case-control studies have assessed mostly the quadriceps muscle for the affected knee [3], seldom the hip muscles [4] and barely the ankle muscles. No studies have yet assessed strength comprehensively across the entire kinetic chain of the lower extremity for both legs in individuals with knee OA and controls without knee complaints [3,4]. We argue that broad and objective data, including all major muscles groups of both lower limbs, offer potentially important information for understanding movement impairments, prerequisites for functional movements, and to design optimal therapeutic interventions for individuals with painful knee OA. 2. Research question What are the differences in comprehensive strength between patients with chronic knee OA and matched healthy controls? 3. Methods In this cross-sectional case-control study, patients 45–70 years old, scheduled for physiotherapy, with knee pain duration > 1 year, and radiographic verified OA, as well as matched healthy controls, are tested on strength for all major muscles of both lower limbs. A Biodex Dynamometer linked protocol 1–5 and a Hand Held Dynamometer protocol 6, are applied. The respective protocols include (1) Knee Extension/Flexion, (2) Ankle Eversion/Inversion, (3) Ankle Dorsal/ Plantar Flexion, (4) Hip Internal/External Rotation, (5) Hip Flexion/ Extension, and (6) Hip Ab-/Adduction. In particular the first protocol tests concentric and eccentric peak strength, as well as endurance strength; protocols 2–5 test isokinetic, concentric peak strength; and protocol 6 tests peak isometric strength. Torque data will be normalized
⁎
Corresponding author.
http://dx.doi.org/10.1016/j.gaitpost.2017.06.434
0966-6362/ © 2017 Published by Elsevier B.V.
to body weight and presented by descriptive statistics and differences with 95% confidence intervals. 4. Results Intermediate results on strength will be presented on the upcoming ESMAC-2017 Conference. Data collection is ongoing. 5. Discussion In knee OA, not only strength across the knee joint, but also strength across the adjacent joints, i.e. hip and ankle, are considered essential to enable proper alignment of the kinetic chain for functional movements as well as for optimal joint loading conditions. Eccentric strength of the quadriceps and hamstrings are seldom assessed (in patients), although being pivotal particularly to normal stair decent. Endurance strength might explain increased perceived exertion and decreased performance during climbing a floor of stairs. In view of knee OA as a long-term condition affecting the body as a system, our upcoming results, data on bilateral lower-limb-kinetic-chain strength, including different contraction modes, all in one sample, may improve basic understanding of movement impairments in individuals with chronic painful knee OA. Additional protocols assessing motor control issues in gait and posture will provide answers to how deficits in lower extremity strength influences motor strategies for functional tasks in gait and posture. References [1] [2] [3] [4]
Fransen, et al. Cochrane Database Syst. Rev. (2015) CD004376. Conroy, et al. Arthritis Care Res. (Hoboken) 64 (2012) 15–21. Øienstad, et al. Osteoarthr. Cartilage 23 (2015) 171–177. Deasy, et al. J. Orthop. Sports Phys. Ther. 46 (2016) 629–639.
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P76
Bilateral and multi-joint strength in patients with painful knee osteoarthritis: A case-control study ⁎
Kjartan Vårbakkena, , Kåre Birger Hagenc, Kjell Gunnar Nilssonb, Ann-Katrin Stensdottera,b a b c
NTNU, Trondheim, Norway Umeå University, Umeå, Sweden Diakonhjemmet Hospital, Oslo, Norway
1. Introduction Individuals with long-term, painful knee osteoarthritis (OA) are known to exhibit muscle weakness [1–4] and to respond well to strength exercise therapy [1]. Case-control studies have assessed mostly the quadriceps muscle for the affected knee [3], seldom the hip muscles [4] and barely the ankle muscles. No studies have yet assessed strength comprehensively across the entire kinetic chain of the lower extremity for both legs in individuals with knee OA and controls without knee complaints [3,4]. We argue that broad and objective data, including all major muscles groups of both lower limbs, offer potentially important information for understanding movement impairments, prerequisites for functional movements, and to design optimal therapeutic interventions for individuals with painful knee OA. 2. Research question What are the differences in comprehensive strength between patients with chronic knee OA and matched healthy controls? 3. Methods In this cross-sectional case-control study, patients 45–70 years old, scheduled for physiotherapy, with knee pain duration > 1 year, and radiographic verified OA, as well as matched healthy controls, are tested on strength for all major muscles of both lower limbs. A Biodex Dynamometer linked protocol 1–5 and a Hand Held Dynamometer protocol 6, are applied. The respective protocols include (1) Knee Extension/Flexion, (2) Ankle Eversion/Inversion, (3) Ankle Dorsal/ Plantar Flexion, (4) Hip Internal/External Rotation, (5) Hip Flexion/ Extension, and (6) Hip Ab-/Adduction. In particular the first protocol tests concentric and eccentric peak strength, as well as endurance strength; protocols 2–5 test isokinetic, concentric peak strength; and protocol 6 tests peak isometric strength. Torque data will be normalized
⁎
Corresponding author.
http://dx.doi.org/10.1016/j.gaitpost.2017.06.434
0966-6362/ © 2017 Published by Elsevier B.V.
to body weight and presented by descriptive statistics and differences with 95% confidence intervals. 4. Results Intermediate results on strength will be presented on the upcoming ESMAC-2017 Conference. Data collection is ongoing. 5. Discussion In knee OA, not only strength across the knee joint, but also strength across the adjacent joints, i.e. hip and ankle, are considered essential to enable proper alignment of the kinetic chain for functional movements as well as for optimal joint loading conditions. Eccentric strength of the quadriceps and hamstrings are seldom assessed (in patients), although being pivotal particularly to normal stair decent. Endurance strength might explain increased perceived exertion and decreased performance during climbing a floor of stairs. In view of knee OA as a long-term condition affecting the body as a system, our upcoming results, data on bilateral lower-limb-kinetic-chain strength, including different contraction modes, all in one sample, may improve basic understanding of movement impairments in individuals with chronic painful knee OA. Additional protocols assessing motor control issues in gait and posture will provide answers to how deficits in lower extremity strength influences motor strategies for functional tasks in gait and posture. References [1] [2] [3] [4]
Fransen, et al. Cochrane Database Syst. Rev. (2015) CD004376. Conroy, et al. Arthritis Care Res. (Hoboken) 64 (2012) 15–21. Øienstad, et al. Osteoarthr. Cartilage 23 (2015) 171–177. Deasy, et al. J. Orthop. Sports Phys. Ther. 46 (2016) 629–639.