The Degrees of Freedom Problem in Human Standing Posture: Collective and Component Dynamics

The experiment was setup to investigate the coordination and control of the degrees of freedom (DFs) of human standing posture with particular reference to the identification of the collective and component variables. Subjects stood in 3 postural tasks: feet side by side, single left foot quiet stance and single left foot stance with body rocking at the ankle joint in the sagittal plane. All three postural tasks showed very high coherence (∼1) of center of pressure (COP) - center of mass (COM) in the low frequency range. The ankle and hip coherence was mid range (∼.5) with the tasks having different ankle/hip compensatory cophase patterns. The findings support the view that the in-phase relation of the low frequency components of the COP-COM dynamic is the collective variable in the postural tasks investigated. The motions of the individual joints (ankle, knee, hip, neck) and couplings of pair wise joint synergies (e.g., ankle-hip) provide a supporting cooperative role to the preservation of the collective variable in maintaining the COM within the stability region of the base of support (BOS) and minimizing the amount of body motion consistent with the task constraint.     

Effect of severity of knee osteoarthritis on the variability of gait parameters

Gait analysis has provided important information concerning gait patterns and variability of gait in patients with knee osteoarthritis (OA) of varying severity. The objective of this study was to clarify how the variability of gait parameters is influenced by the severity of knee OA. Gait analysis was performed at three different controlled walking speeds in three groups of subjects with varying degrees of knee OA (20 healthy subjects with no OA and 90 patients with moderate or severe OA). The variability of gait parameters was characterized by the coefficient of variance (CV) of spatial-temporal parameters, as well as by the mean coefficient variance (MeanCV) of angular parameters. Based on our results, we conclude that the complexity of gait decreases if the walking speed differs from the self-selected speed. In patients with knee OA, the decreased variability of angular parameters on the affected side represents decreased joint flexibility. This leads to decreased consistency in movements of the lower limbs from stride-to-stride, as shown by increased variability of spatial-temporal parameters. Decreased joint flexibility and consistency of movement can be associated with decreased complexity of movement. Other joints of the kinetic chain, such as joints of the non-affected side and the pelvis, play an important role in compensation and adaptation of step-by step motion and in the ability of secure gait. Results suggest that the variability of gait associated with knee osteoarthritis is gender-dependent. During rehabilitation, particular attention must be paid to improving gait stability and proprioception and gender differences should be taken into account.     

Reconstruction of equilibrium trajectories during whole-body movements

The framework of the equilibrium-point hypothesis was used to reconstruct equilibrium trajectories (ETs) of the ankle, hip and body center of mass during quick voluntary hip flexions (`Japanese courtesy bow') by standing subjects. Different spring loads applied to the subject's back were used to introduce smooth perturbations that are necessary to reconstruct ETs based on a series of trials at the same task. Time patterns of muscle torques were calculated using inverse dynamics techniques. A second-order linear model was employed to calculate the instantaneous position of the spring-like joint or center of mass characteristic at different times during the movement. ETs of the joints and of the center of mass had significantly different shapes from the actual trajectories. Integral measures of electromyographic bursts of activity in postural muscles demonstrated a relation to muscle length corresponding to the equilibrium-point hypothesis. Received: 3 March 1997 / Accepted in revised form: 2 November 1998     

Biomechanical mechanism of lateral trunk lean gait for knee osteoarthritis patients

The biomechanical mechanism of lateral trunk lean gait employed to reduce external knee adduction moment (KAM) for knee osteoarthritis (OA) patients is not well known. This mechanism may relate to the center of mass (COM) motion. Moreover, lateral trunk lean gait may affect motor control of the COM displacement. Uncontrolled manifold (UCM) analysis is an evaluation index used to understand motor control and variability of the motor task. Here we aimed to clarify the biomechanical mechanism to reduce KAM during lateral trunk lean gait and how motor variability controls the COM displacement. Twenty knee OA patients walked under two conditions: normal and lateral trunk lean gait conditions. UCM analysis was performed with respect to the COM displacement in the frontal plane. We also determined how the variability is structured with regards to the COM displacement as a performance variable. The peak KAM under lateral trunk lean gait was lower than that under normal gait. The reduced peak KAM observed was accompanied by medially shifted knee joint center, shortened distance of the center of pressure to knee joint center, and shortened distance of the knee–ground reaction force lever arm during the stance phase. Knee OA patients with lateral trunk lean gait could maintain kinematic synergy by utilizing greater segmental configuration variance to the performance variable. However, the COM displacement variability of lateral trunk lean gait was larger than that of normal gait. Our findings may provide clinical insights to effectively evaluate and prescribe gait modification training for knee OA patients.     

Proximal gait adaptations in individuals with knee osteoarthritis: A systematic review and meta-analysis

Clarifying proximal gait adaptations as a strategy to reduce knee joint loading and pain for individuals with knee osteoarthritis (OA) contributes to understanding the pathogenesis of multi-articular OA changes and musculoskeletal pain in other joints. We aimed to determine whether biomechanical alterations in knee OA patients during level walking is increased upper trunk lean in the frontal and sagittal planes, and subsequent alteration in external hip adduction moment (EHAM) and external hip flexion moment (EHFM). A literature search was conducted in PubMed, PEDro, CINAHL, and Cochrane CENTRAL through May 2018. Where possible, data were combined into a meta-analysis; pooled standardized mean differences (SMD) of between knee OA patients and healthy adults were calculated using a random-effect model. In total, 32 articles (2037 participants, mean age, 63.0 years) met inclusion criteria. Individuals with knee OA had significantly increased lateral trunk lean toward the ipsilateral limb (pooled SMD: 1.18; 95% CI: 0.59, 1.77) along with significantly decreased EHAM. These subjects also displayed a non-significantly increased trunk/pelvic flexion angle and EHFM. The GRADE approach judged all measures as “very low.” These results may indicate that biomechanical alterations accompanying knee OA are associated with increased lateral trunk lean and ensuing alterations in EHAM. Biomechanical alterations in the sagittal plane were not evident. Biomechanical adaptations might have negative sequelae, such as secondary hip abductor muscle weakness and low back pain. Thus, investigations of negative sequelae due to proximal gait adaptations are warranted.     

Biomechanical analysis of movement strategies in human forward trunk bending. II. Experimental study

 The large mass of the human upper trunk, its elevated position during erect stance, and the small area limited by the size of the feet, stress the importance of equilibrium control during trunk movements. The objective of the present study was to perform a biomechanical analysis of fast forward trunk movements in order to understand the coordination between movement and posture. The analysis is based on a comparison between experimentally observed bending and hypothetical “optimal bending” performed on an infinitely narrow support, as presented in a companion paper. The experimental data were obtained from 16 subjects who performed fast forward bending while standing on a wide platform or on a narrow beam. The analysis is performed by decomposition of the movement into three dynamically independent components, each representing a movement along one of the three eigenvectors of the motion equation. The eigenmovements are termed “hip”, “ankle”, and “knee” eigenmovements, according to the dominant joint. The experimentally observed movement is characterized mainly by the hip and ankle eigenmovements, whereas the knee eigenmovement is negligible. Similarly to the “optimal bending” the ankle eigenmovement starts earlier and lasts longer than the hip eigenmovement. An early forward acceleration of the center of gravity in the ankle eigenmovement is caused by anticipatory changes in the ankle joint torque. This clarifies the role of the early tibialis anterior burst and/or soleus inhibition usually observed in electromyographic recordings during forward bending. The results suggest that the hip and the ankle eigenmovements can be treated as independently controlled motion units aimed at functionally different behavioral goals: the bending per se and postural adjustment. It is proposed that the central nervous system has to control these motion units sequentially in order to perform the movement and maintain equilibrium. It is also suggested that the hip and ankle eigenmovements can be regarded as a biomechanical background for the hip and ankle strategies introduced by Horak and Nashner (1986) on the basis of electromyographic recordings and kinematic patterns in response to postural perturbations. Received: 1 July 1999 / Accepted in revised form: 23 October 2000     

Knee kinematics in medial arthrosis. Dynamic radiostereometry during active extension and weight-bearing

We studied the kinematics of the knee during weight-bearing active extension in 14 patients with medial osteoarthrosis (OA) and in 10 controls using dynamic radiostereometry. Between 50 degrees and 20 degrees of extension the OA knees showed decreased internal tibial rotation corresponding to less posterior displacement of the lateral femoral flexion facet center. The midpoint between the two tips of the tibial intercondylar eminence occupied a more posterior position within the range of motion analyzed. The observed changes were similar to those previously recorded in chronic tear of the anterior cruciate ligament. Patients with medial arthrosis of the knee joint show a specific and abnormal pattern of joint motion.     

Body mass indices in patients with disabling hip osteoarthritis

Hip osteoarthritis (OA) is a degenerative joint disease that results in substantial morbidity. The disease may be preventable in some instances by reducing risk factors associated with the disease. We undertook a study to determine whether being overweight or obese, a health risk that applies to younger and older age groups, is commonly associated with hip joint OA. The body mass indices (BMIs) of 1021 males and females ranging in age from 23 to 94 years and requiring surgery for end-stage hip joint OA were analyzed to find the prevalence of high body weights at the time of surgery. Being overweight was defined as having a BMI of 25-29.9 kg/m2 and being obese as having a BMI >30 kg/m2. BMIs indicative of overweight were recorded for 68% of the patients surveyed. Of 35 patients aged 30-39 years, 53.3% had BMIs >25, with a mean of 28.8, which nearly reaches the lower limit defined for obesity. On average, patients who had had previous surgery and complications warranting reimplantation of new surgical devices had BMIs in the obese range. Our findings suggest that a high percentage of patients with end-stage hip OA are overweight, including younger adults and those with symptoms of 3-6 months' duration. Moreover, patients whose BMIs are in the obese range may be at increased risk for removal and reimplantation of their prosthesis.     

Familial osteoarthritis of the hip joint associated with acetabular dysplasia maps to chromosome 13q

Genetic factors have been implicated in osteoarthritis (OA), particularly in OA of the hip joint (hip OA). Several instances of familial hip OA that show distinctive modes of inheritance but that differ from chondrodysplasia have been reported. Here, we report the characterization of a large Japanese family with an inherited disease of the hip that is indistinguishable from common hip OA, as evidenced by clinical symptoms and radiographs of the joint. This family contained eight patients in 4 generations. Affected individuals develop pain in the hip joint during adolescence, and the disease progresses to severe crippling before age 60 years. Patients generally are in good health, height is not reduced, and there is no extraskeletal involvement suggestive of chondrodysplasia. The skeletal change is bilateral acetabular dysplasia followed by OA, which occurs after age approximately 40 years and is indistinguishable from idiopathic nonfamilial dysplastic hip OA. This trait shows autosomal dominant inheritance, with a considerably consistent phenotype. Genomewide screening revealed linkage at chromosome 13q22, and haplotype analysis narrowed the locus to a 6.0-cM interval between markers D13S1296 and D13S162, with a maximal multipoint LOD score of 3.57. The family described here represents a novel genetic entity as a monogenic form of hip OA. Its further characterization can aid in elucidating the etiology and pathogenesis of a common idiopathic form of OA.     

Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels

Knee osteoarthritis (OA) is a multifactoral, progressive disease process of the musculoskeletal system. Mechanical factors have been implicated in the progression of knee OA, but the role of altered joint mechanics and neuromuscular control strategies in progressive mechanisms of the disease have not been fully explored. Previous biomechanical studies of knee OA have characterized changes in joint kinematics and kinetics with the disease, but it has been difficult to determine if these biomechanical changes are involved in the development of disease, are in response to degenerative changes in the joint, or are compensatory mechanisms in response to these degenerative changes or other related factors as joint pain. The goal of this study was to explore the association between biomechanical changes and knee OA severity in an effort to understand the changing role of biomechanical factors in the progression of knee OA. A three-group cross-sectional model was used that included asymptomatic subjects, subjects clinically diagnosed with moderate knee OA and severe knee OA subjects just prior to total joint replacement surgery. Principal component analysis and discriminant analysis were used to determine the combinations of electromyography, kinematic and kinetic waveform pattern changes at the knee, hip and ankle joints during gait that optimally separated the three levels of severity. Different biomechanical mechanisms were important in discriminating between severity levels. Changes in knee and hip kinetic patterns and rectus femoris activation were important in separating the asymptomatic and moderate OA gait patterns. In contrast, changes in knee kinematics, hip and ankle kinetics and medial gastrocnemius activity were important in discriminating between the moderate and severe OA gait patterns.     

Effects of hip joint centre mislocation on gait analysis results

Methods to determine the hip joint centre (HJC) location are necessary in gait analysis. It has been demonstrated that the methods proposed in the literature involve large mislocation errors. The choice should be made according to the extent by which HJC location errors distort the estimates of angles and resultant moments at the hip and knee joints. This study aimed at quantifying how mislocation errors propagate to these gait analysis results. Angles and moments at the hip and knee joint were calculated for five able-bodied subjects during level walking. The nominal position of the HJC was determined as the position of the pivot point of a 3D movement of the thigh relative to the pelvis. Angles and moments were then re-calculated after having added to HJC co-ordinates errors in the range of +/-30 mm. Angles and moments at both hip and knee joints were affected by HJC mislocation. The hip moments showed the largest propagation error: a 30 mm HJC anterior mislocation resulted in a propagated error into flexion/extension component of about -22%. The hip abduction/adduction moment was found the second largest affected quantity: a 30 mm lateral HJC mislocation produced a propagated error of about -15%. Finally, a 30 mm posterior HJC mislocation produced a delay of the flexion-to-extension timing in the order of 25% of the stride duration. HJC estimation methods with minimum antero-posterior error should therefore be preferred.     

Simulating mechanical consequences of voluntary movement upon whole-body equilibrium: the arm-raising paradigm revisited

Voluntary arm-raising movement performed during the upright human stance position imposes a perturbation to an already unstable bipedal posture characterised by a high body centre of mass (CoM). Inertial forces due to arm acceleration and displacement of the CoM of the arm which alters the CoM position of the whole body represent the two sources of disequilibrium. A current model of postural control explains equilibrium maintenance through the action of anticipatory postural adjustments (APAs) that would offset any destabilising effect of the voluntary movement. The purpose of this paper was to quantify, using computer simulation, the postural perturbation due to arm raising movement. The model incorporated four links, with shoulder, hip, knee and ankle joints constrained by linear viscoelastic elements. The input of the model was a torque applied at the shoulder joint. The simulation described mechanical consequences of the arm-raising movement for different initial conditions. The variables tested were arm inertia, the presence or not of gravity field, the initial standing position and arm movement direction. Simulations showed that the mechanical effect of arm-raising movement was mainly local, that is to say at the level of trunk and lower limbs and produced a slight forward displacement of the CoM (1.5 mm). Backward arm-raising movement had the same effect on the CoM displacement as the forward arm-raising movement. When the mass of the arm was increased, trunk rotation increased producing a CoM displacement in the opposite direction when compared to arm movement performed without load. Postural disturbance was minimised for an initial standing posture with the CoM vertical projection corresponding to the ankle joint axis of rotation. When the model was reduced to two degrees of freedom (ankle and shoulder joints only) the postural perturbation due to arm-raising movement increased compared to the four-joints model. On the basis of these results the classical assumption that APAs stabilise the CoM is challenged.     

Hip joint replacement surgery for idiopathic osteoarthritis aggregates in families

In order to determine whether there is a genetic component to hip or knee joint failure due to idiopathic osteoarthritis (OA), we invited patients (probands) undergoing hip or knee arthroplasty for management of idiopathic OA to provide detailed family histories regarding the prevalence of idiopathic OA requiring joint replacement in their siblings. We also invited their spouses to provide detailed family histories about their siblings to serve as a control group. In the probands, we confirmed the diagnosis of idiopathic OA using American College of Rheumatology criteria. The cohorts included the siblings of 635 probands undergoing total hip replacement, the siblings of 486 probands undergoing total knee replacement, and the siblings of 787 spouses. We compared the prevalence of arthroplasty for idiopathic OA among the siblings of the probands with that among the siblings of the spouses, and we used logistic regression to identify independent risk factors for hip and knee arthroplasty in the siblings. Familial aggregation for hip arthroplasty, but not for knee arthroplasty, was observed after controlling for age and sex, suggesting a genetic contribution to end-stage hip OA but not to end-stage knee OA. We conclude that attempts to identify genes that predispose to idiopathic OA resulting in joint failure are more likely to be successful in patients with hip OA than in those with knee OA.     

Body mass indices in patients with disabling hip osteoarthritis

Hip osteoarthritis (OA) is a degenerative joint disease that results in substantial morbidity. The disease may be preventable in some instances by reducing risk factors associated with the disease. We undertook a study to determine whether being overweight or obese, a health risk that applies to younger and older age groups, is commonly associated with hip joint OA. The body mass indices (BMIs) of 1021 males and females ranging in age from 23 to 94 years and requiring surgery for end-stage hip joint OA were analyzed to find the prevalence of high body weights at the time of surgery. Being overweight was defined as having a BMI of 25–29.9 kg/m² and being obese as having a BMI >30 kg/m². BMIs indicative of overweight were recorded for 68% of the patients surveyed. Of 35 patients aged 30–39 years, 53.3% had BMIs >25, with a mean of 28.8, which nearly reaches the lower limit defined for obesity. On average, patients who had had previous surgery and complications warranting reimplantation of new surgical devices had BMIs in the obese range. Our findings suggest that a high percentage of patients with end-stage hip OA are overweight, including younger adults and those with symptoms of 3–6 months' duration. Moreover, patients whose BMIs are in the obese range may be at increased risk for removal and reimplantation of their prosthesis.     

Hip joint replacement surgery for idiopathic osteoarthritis aggregates in families

In order to determine whether there is a genetic component to hip or knee joint failure due to idiopathic osteoarthritis (OA), we invited patients (probands) undergoing hip or knee arthroplasty for management of idiopathic OA to provide detailed family histories regarding the prevalence of idiopathic OA requiring joint replacement in their siblings. We also invited their spouses to provide detailed family histories about their siblings to serve as a control group. In the probands, we confirmed the diagnosis of idiopathic OA using American College of Rheumatology criteria. The cohorts included the siblings of 635 probands undergoing total hip replacement, the siblings of 486 probands undergoing total knee replacement, and the siblings of 787 spouses. We compared the prevalence of arthroplasty for idiopathic OA among the siblings of the probands with that among the siblings of the spouses, and we used logistic regression to identify independent risk factors for hip and knee arthroplasty in the siblings. Familial aggregation for hip arthroplasty, but not for knee arthroplasty, was observed after controlling for age and sex, suggesting a genetic contribution to end-stage hip OA but not to end-stage knee OA. We conclude that attempts to identify genes that predispose to idiopathic OA resulting in joint failure are more likely to be successful in patients with hip OA than in those with knee OA.     

Accuracy of the functional method of hip joint center location: effects of limited motion and varied implementation.

Accurate location of the hip joint center is essential for computation of hip kinematics and kinetics as well as for determination of the moment arms of muscles crossing the hip. The functional method of hip joint center location involves fitting a pelvis-fixed sphere to the path traced by a thigh-fixed point while a subject performs hip motions; the center of this sphere is the hip joint center. The aim of the present study was to evaluate the potential accuracy of the functional method and the dependence of its accuracy on variations in its implementation and the amount of available hip motion. The motions of a mechanical linkage were studied to isolate the factors of interest, removing errors due to skin movement and the palpation of bony landmarks that are always present in human studies. It was found that reducing the range of hip motion from 30 degrees to 15 degrees did significantly increase hip joint center location errors, but that restricting motion to a single plane did not. The magnitudes of these errors, however, even in the least accurate cases, were smaller than those previously reported for either the functional method or other methods based on pelvis measurements of living subjects and cadaver specimens. Neither increasing the number of motion data observations nor analyzing the motion of a single thigh marker (rather than the centroid of multiple markers) was found to significantly increase error. The results of this study (1) imply that the limited range of motion that is often evident in subjects with hip pathology does not preclude accurate determination of the hip joint center when the functional method is used; and (2) provide guidelines for the use of the functional method in human subjects.     

Selected reaction monitoring assays in mesenchymal stem cells from osteoarthritis patients

Osteoarthritis (OA) is considered the most prevalent form of arthritis. The aim of this study was to verify potential protein OA biomarkers by applying Selected Reaction Monitoring (SRM) assays to protein extracts obtained from Bone Marrow-Mesenchymal Stem Cells (BM-MSCs) isolated from OA patients.BM aspirates were obtained from the femoral channel of OA patients at the time of surgery and from the femoral channel of hip fracture subjects without OA during hip joint replacement surgery for the treatment of subcapital fracture.SRM results verified the differential expression of several protein biomarkers in BM-MSCs from OA patients.     

Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance

In order to determine the type of somatosensory information for postural control that is most affected by neuropathy, we compared the relative effects of three methods of sway-referencing the surface in a group of subjects with profound loss of somatosensory function associated with sensory polyneuropathy from diabetes with age-matched control subjects. Sway-referencing disrupted somatosensory feedback for postural control by servo-controlling the dorsi- and plantar-flexion rotation of the support surface in proportion to anterior-posterior excursion of (1) ankle angle, (2) center of body mass (CoM) angle or (3) filtered center of pressure (CoP). Postural sway in subjects with somatosensory loss was significantly larger than normal on a firm surface but not on the sway-referenced surfaces, suggesting that sway-referencing disrupts somatosensory information for postural control already disrupted by neuropathy. Control subjects standing on any sway-referenced surface swayed significantly more than neuropathy subjects who stood on a firm surface, suggesting that sway-referencing disrupts more somatosensory information than disrupted by severe neuropathy. CoP sway-referencing was less sensitive than ankle or CoM sway-referencing for distinguishing postural sway in subjects with somatosensory loss from age-matched control subjects. Given that filtered CoP sway-referencing disrupts the ability to utilize somatosensory information related to surface reactive force to a greater extent than the other two methods of sway-referencing, then these results support the hypothesis that subjects with diabetic peripheral neuropathy have lost more CoP information, than ankle or CoM angle information, for controlling postural sway in stance.     

The effect of three-dimensional postural change on shear elastic modulus of the iliotibial band

To understand and treat iliotibial band (ITB) syndrome, caused by excessive compression between the ITB and lateral femoral condyle, it is important to identify factors contributing to an increase in ITB stiffness. The purpose of this study was to clarify the factors that contribute to an increase in ITB stiffness by examining the relationship between three-dimensional postural changes and ITB stiffness. Fourteen healthy individuals performed one-leg standing under 7 conditions (including normal one-leg standing as a control condition) in which the pelvic position was changed in three planes. The shear elastic modulus in the ITB was measured using shear-wave elastography, as a measure of ITB stiffness. The three-dimensional joint angles and external joint moments in the hip and knee joints were also measured to confirm the changes in joint angles and external load. Compared to the normal one-leg standing condition, ITB stiffness was significantly increased in the pelvic posterior tilted position (i.e. hip extension), contralateral pelvic dropped position (i.e. hip adduction), and contralateral pelvic posterior rotated position (i.e. hip external rotation). The findings suggest that interventions to reduce hip extension, adduction, and external rotation might be useful if these excessive positional changes are detected in patients with ITB syndrome.