scholarly journals A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Stephen J. Preece ◽  
Nathan Brookes ◽  
Anita E. Williams ◽  
Richard K. Jones ◽  
Chelsea Starbuck ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Large Scale ◽  
Muscle Activation ◽  
Biofeedback Training ◽  
Behavioural Intervention ◽  
Clinical Effects ◽  
Motivation To Change ◽  
Muscle Strengthening ◽  
Muscle Activation Patterns ◽  
Knee Muscle

Abstract Background Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist. Methods Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists. Results The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention. Conclusion We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes. Trial registration ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered).

scholarly journals Tension Release Therapy: The Development of a New Integrated Behavioural Intervention for Knee Osteoarthritis

2021 ◽  
Author(s):  
Stephen Preece ◽  
Nathan Brookes ◽  
Anita Williams ◽  
Richard Jones ◽  
Chelsea Starbuck ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Large Scale ◽  
Previous Attempt ◽  
Behavioural Intervention ◽  
Motivation To Change ◽  
Instructional Videos ◽  
Muscle Strengthening ◽  
Psychological Techniques ◽  
Making Sense ◽  
Knee Muscle

Abstract Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, the magnitude of clinical effect is considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While many exercise-based approaches incorporate an educational/coping component alongside muscle strengthening, there has been no previous attempt to integrate psychological techniques with muscle retraining. Building on these ideas, the aim of this study was to create a new integrated behavioural intervention for knee osteoarthritis, suitable for delivery by a physiotherapist.Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to knee muscle co-contraction. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with users.Results: The underlying framework incorporated ideas related to central sensitisation to pain, maladaptive motor responses to pain and also focused on the idea that increased knee muscle co-contraction could result from changes in postural tone. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to enable patients to visualise muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a full prototype version of the intervention. Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle patterns and beliefs associated with pain. Preliminary feedback and clinical indications are positive, and this motivates future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to a muscle strengthening programme. Trial Registration: ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered)

scholarly journals Inter-laboratory comparison of knee biomechanics and muscle activation patterns during gait in patients with knee osteoarthritis

The Knee ◽  
2021 ◽  
Vol 29 ◽  
pp. 500-509
Author(s):  
J.C. Schrijvers ◽  
D. Rutherford ◽  
R. Richards ◽  
J.C. van den Noort ◽  
M. van der Esch ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Muscle Activation ◽  
Knee Biomechanics ◽  
Activation Patterns ◽  
Muscle Activation Patterns

Kinetics, kinematics, and knee muscle activation during sit to stand transition in unilateral and bilateral knee osteoarthritis

2021 ◽  
Vol 86 ◽  
pp. 38-44
Author(s):  
Marina Petrella ◽  
Luiz Fernando A. Selistre ◽  
Paula R.M.S. Serrão ◽  
Giovanna C. Lessi ◽  
Glaucia H. Gonçalves ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Muscle Activation ◽  
Bilateral Knee ◽  
Sit To Stand ◽  
Knee Muscle

Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis

2004 ◽  
Vol 19 (1) ◽  
pp. 44-49 ◽  
Author(s):  
John D Childs ◽  
Patrick J Sparto ◽  
G.Kelley Fitzgerald ◽  
Mario Bizzini ◽  
James J Irrgang
Keyword(s):  
Lower Extremity ◽  
Knee Osteoarthritis ◽  
Muscle Activation ◽  
Activation Patterns ◽  
Muscle Activation Patterns

scholarly journals Vision affects gait speed but not patterns of muscle activation during inclined walking – a virtual reality study

2020 ◽  
Author(s):  
Amit Benady ◽  
Sean Zadik ◽  
Oran Ben-Gal ◽  
Desiderio Cano-Porras ◽  
Atalia Wenkert ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Gait Speed ◽  
Large Scale ◽  
Muscle Activation ◽  
Real Surface ◽  
Muscle Activation Patterns ◽  
Short Period ◽  
Intensity Changes ◽  
Surface Inclination ◽  
Downhill Walking

AbstractWhile walking, our locomotion is affected by and adapts to the environment based on vision-based and body-based (vestibular and proprioception) cues, all contributing to an “Internal Model of Gravity”. During surface inclination transitions, we modulate gait to counteract gravitational forces by braking during downhill walking to avoid uncontrolled acceleration or by exerting effort to avoid deceleration while walking uphill. In this study, we investigated the role of vision in gait modulation during surface inclination transitions by using an immersive large-scale Virtual Reality (VR) system equipped with a self-paced treadmill and projected visual scenes that allowed us to modulate physical-visual inclinations congruence parametrically. Gait speed and leg muscle electromyography (EMG) were measured in 12 healthy young adults. In addition, the magnitude of subjective visual misperception of verticality was measured by the rod and frame test. During virtual (non-veridical) inclination transitions, vision modulated gait speed after transitions by (i) slowing down to counteract the excepted gravitational ‘boost’ in virtual downhill inclinations and by (ii) speeding up to counteract the expected gravity resistance in virtual uphill inclinations. These gait speed modulations were reflected in muscle activation intensity changes and associated with subjective visual verticality misperception. However, temporal patterns of muscle activation, which are significantly affected by real gravitational inclination transitions, were not affected by virtual (visual) inclination transitions. Our results delineate the contribution of vision to functional locomotion on uneven surfaces and may lead to enhanced rehabilitation strategies for neurological disorders affecting movement.Significance statementA crucial component of successful locomotion is maintaining balance and speed while walking on uneven surfaces. In order to reach successful locomotion, an individual must utilize multisensory integration of visual, gravitational, and proprioception cues. The contribution of vision to this process is still unclear, thus we used a fully immersive virtual reality treadmill setup allowing us to manipulate visual (virtual) and gravitational (real) surface inclinations independently during locomotion of healthy adults. While vision modulated gait speed for a short period after inclination transitions and this was predictive of individual’s visual dependency, muscle activation patterns were only affected by gravitational surface inclinations, not by vision. Understanding the vision’s contribution to successful locomotion may lead to improved rehabilitation for movement disorders.

scholarly journals Fatigue’s Lack of Effect on Thigh-Muscle Activity in Anterior Cruciate Ligament–Reconstructed Patients During a Dynamic-Landing Task

2013 ◽  
Vol 22 (2) ◽  
pp. 83-92 ◽  
Author(s):  
Lindsey K. Lepley ◽  
Abbey C. Thomas ◽  
Scott G. McLean ◽  
Riann M. Palmieri-Smith
Keyword(s):  
Anterior Cruciate Ligament ◽  
Outcome Measures ◽  
Muscle Activity ◽  
Muscle Activation ◽  
Cruciate Ligament ◽  
Activation Patterns ◽  
Female Age ◽  
Muscle Activation Patterns ◽  
Anterior Cruciate ◽  
Knee Muscle

Context:As individuals returning to activity after anterior cruciate ligament reconstruction (ACLr) likely experience fatigue, understanding how fatigue affects knee-muscle activation patterns during sport-like maneuvers is of clinical importance. Fatigue has been suggested to impair neuromuscular control strategies. As a result, fatigue may place ACLr patients at increased risk of developing posttraumatic osteoarthritis (OA).Objective:To determine the effects of fatigue on knee-muscle activity post-ACLr.Design:Case control.Setting:University laboratory.Participants:12 individuals 7–10 mo post-ACLr (7 male, 5 female; age 22.1 ± 4.7 y; 1.8 ± 0.1 m; mass 77.7 ± 11.9 kg) and 13 controls (4 male, 9 female; age 22.9 ± 4.3 y; 1.7 ± 0.1 m; mass 66.9 ± 9.8 kg).Interventions:Fatigue was induced via repetitive sets of double-leg squats (n = 8), which were interspersed with sets of single-leg landings (n = 3), until squats were no longer possible.Main Outcome Measures:2 × 2 repeated-measures ANOVA was used to detect the main effects of group (ACLr, control) and fatigue state (prefatigue, postfatigue) on quadriceps:hamstring cocontraction index (Q:H CCI).Results:All subjects demonstrated higher Q:H CCI at prefatigue compared with postfatigue (F1,23 = 66.949, P ≤ .001). Q:H CCI did not differ between groups (F1,23 = 0.599, P = .447).Conclusions:The results indicate that regardless of fatigue state, ACLr individuals are capable of restoring muscle-activation patterns similar to those in healthy subjects. As a result, excessive muscle cocontraction, which has been hypothesized as a potential mechanism of posttraumatic OA, may not contribute to joint degeneration after ACLr.

Aging Related Changes in the Kinematics of Walking: A Potential Pathway to Changes in Cartilage Morphology

2012 ◽  
Author(s):  
K. A. Boyer ◽  
T. P. Andriacchi
Keyword(s):  
Muscle Strength ◽  
Knee Osteoarthritis ◽  
Muscle Activation ◽  
Sagittal Plane ◽  
Activation Patterns ◽  
Muscle Activation Patterns ◽  
Age Related ◽  
Ligament Stiffness ◽  
Spatio Temporal ◽  
Age Related Changes

Age-related changes in spatio-temporal and sagittal plane walking mechanics are well documented [1, 2]. These changes along with age-related changes in muscle strength, muscle activation patterns and ligament stiffness [3] may also lead to changes in both rotational and translation motions at the knee. It has been suggested that alterations in the normal kinematics of the knee related to aging may be a contributing factor to the increased incidence of knee osteoarthritis (OA) with aging [4].

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