Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment |
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| Authors: | Joaquin A Barrios Kay M Crossley Irene S Davis |
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| Institution: | 1. 300 College Park, University of Dayton, Dayton, OH 45440-2925, USA;2. Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, 3010, Australia;3. 305 McKinly Lab, University of Delaware, Newark, DE 19716, USA;1. Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands;2. Human Movement Biomechanics Research Group, Department of Kinesiology, KU Leuven, Belgium;3. Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands;4. Physical Therapy Research, Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands;5. Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium;1. Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA;2. Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Harvard Medical School, Cambridge, MA, USA;3. La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia;1. School of Exercise Science, Australian Catholic University, Melbourne, Australia;2. Department of Physiotherapy, The University of Melbourne, Melbourne, Australia;3. Department of Physiotherapy, Singapore General Hospital, Singapore;4. Department of Physical Therapy, University of British Columbia, Vancouver, Canada;1. College of Physical Sciences and Engineering, Cardiff University, Cardiff, United Kingdom;2. Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom;1. Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland;2. Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland |
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| Abstract: | Varus knee alignment is a risk factor for medial knee osteoarthritis and is associated with high knee adduction moments. Therefore, reducing the knee adduction moment in varus-aligned individuals with otherwise healthy knees may reduce their risk for developing osteoarthritis. A gait modification that improves dynamic knee alignment may reduce the adduction moment, and systematic training may lead to more natural-feeling and less effortful execution of this pattern. To test these hypotheses, eight healthy, varus-aligned individuals underwent a gait modification protocol. Real-time feedback of dynamic knee alignment was provided over eight training sessions, using a fading paradigm. Natural and modified gait were assessed post-training and after 1 month, and compared to pre-training natural gait. The knee adduction moment, as well as hip adduction, hip internal rotation and knee adduction angles were evaluated. At each training session, subjects rated how effortful and natural-feeling the modified pattern was to execute. Post-training, the modified pattern demonstrated an 8° increase in hip internal rotation and 3° increase in hip adduction. Knee adduction decreased 2°, and the knee adduction moment decreased 19%. Natural gait did not differ between the three visits, nor did the modified gait pattern between the post-training and 1 month visits. The modified pattern felt more natural and required less effort after training. Based on these results, gait retraining to improve dynamic knee alignment resulted in significant reductions in the knee adduction moment, primarily through hip internal rotation. Further, systematic training led to more natural-feeling and less effortful execution of the gait pattern. |
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