Neuromuscular alterations during walking in persons with moderate knee osteoarthritis.

This paper compared the neuromuscular responses during walking between those with early-stage knee osteoarthritis (OA) to asymptomatic controls. The rationale for studying those with mild to moderate knee OA was to determine the alterations in response to dynamic loading that might be expected before severe pain, joint space narrowing and joint surface changes occur. We used pattern recognition techniques to explore both amplitude and shape changes of the surface electromyograms recorded from seven muscles crossing the knee joint of 40 subjects with knee OA and 38 asymptomatic controls during a walking task. The principal patterns for each muscle grouping explained over 83% of the variance in the waveforms. This result supported the notion that the main neuromuscular patterns were similar between asymptomatic controls and those with OA, reflecting the specific roles of the major muscles during walking. ANOVA revealed significant (p<0.05) differences in the principal pattern scores reflecting both amplitude and shape alterations in the OA group and among muscles. These differences captured subtle changes in the neuromuscular responses of the subjects with OA throughout different phases of the gait cycle and most likely reflected changes in the mechanical environment (joint loading, instability) and pain. The subjects with OA attempted to increase activity of the lateral sites and reduce activity in the medial sites, having minimal but prolonged activity during late stance. Therefore, alterations in neuromuscular responses were found even in this high functioning group with moderate knee OA.     

Functional and EMG responses to a physical therapy treatment in patellofemoral syndrome patients.

There are several pathologies related to the patellofemoral joint, in which the patellofemoral syndrome is one of the most common and challenging to treat. The patellofemoral syndrome results from a malalignment of the knee extensor mechanism. The purpose of our study was to describe and compare EMG responses of the vastus medialis and vastus lateralis muscles while walking up and down stairs and other clinical and functional responses in PFS subjects before and after a physical therapy intervention. Eleven subjects were studied and divided in two groups: six subjects with clinically diagnosed patellofemoral syndrome and five healthy control subjects. Subjects were evaluated by a functional and biomechanical evaluation protocol: postural evaluation, pain and knee function evaluation, and electromyographic activity of vastus medialis and lateralis muscles while walking up and down a staircase. Results showed higher efficiency of the vastus medialis muscle in carrying out eccentric exercises and increased muscle activity in both the vastus medialis and vastus lateralis muscles while climbing stairs after physical therapy treatment. We were able to identify an improvement in postural alignment of lower limb muscles and knee functionality among patellofemoral syndrome group subjects after treatment.     

The effect of patella taping on vastus medialis oblique and vastus laterialis EMG activity and knee kinematic variables during stair descent

The purpose of this study was to evaluate the effect of patella taping in normal subjects. Previous work has established positive effects of patella taping on patellofemoral pain syndrome patients, but the mode of action remains unclear. It has been hypothesized that taping brings about subtle changes in the internal physiological environment of the joint. It could be expected that in normal joints taping would bring about a measurable change in function, as the joint is no longer operating in an optimal physiological environment. 10 normal female subject’s (21.4 ± 1.2 years) vastus medialis oblique (VMO) and vastus laterialis (VL) EMG activity and knee kinematics (peak stance flexion angle and angular velocity) were assessed during a step descent, with and without a taped patella. The effect of taping was to significantly decrease VMO and VL EMG activity. Taping also significantly reduced peak stance phase knee flexion and peak stance phase knee flexion angular velocity. In normal asymptomatic subjects patella taping created a situation in which their performance was changed to one similar to that of the pathological patellofemoral pain syndrome population. It would appear that taping caused the joint to function sub-optimally supporting the hypothesis that taping could change the functioning of the patellofemoral joint.     

Individual muscle contributions to the axial knee joint contact force during normal walking

Muscles are significant contributors to the high joint forces developed in the knee during human walking. Not only do muscles contribute to the knee joint forces by acting to compress the joint, but they also develop joint forces indirectly through their contributions to the ground reaction forces via dynamic coupling. Thus, muscles can have significant contributions to forces at joints they do not span. However, few studies have investigated how the major lower-limb muscles contribute to the knee joint contact forces during walking. The goal of this study was to use a muscle-actuated forward dynamics simulation of walking to identify how individual muscles contribute to the axial tibio-femoral joint force. The simulation results showed that the vastii muscles are the primary contributors to the axial joint force in early stance while the gastrocnemius is the primary contributor in late stance. The tibio-femoral joint force generated by these muscles was at times greater than the muscle forces themselves. Muscles that do not cross the knee joint (e.g., the gluteus maximus and soleus) also have significant contributions to the tibio-femoral joint force through their contributions to the ground reaction forces. Further, small changes in walking kinematics (e.g., knee flexion angle) can have a significant effect on the magnitude of the knee joint forces. Thus, altering walking mechanics and muscle coordination patterns to utilize muscle groups that perform the same biomechanical function, yet contribute less to the knee joint forces may be an effective way to reduce knee joint loading during walking.     

Experimental quadriceps muscle pain impairs knee joint control during walking.

Pain is a cardinal symptom in musculoskeletal diseases involving the knee joint, and aberrant movement patterns and motor control strategies are often present in these patients. However, the underlying neuromuscular mechanisms linking pain to movement and motor control are unclear. To investigate the functional significance of muscle pain on knee joint control during walking, three-dimensional gait analyses were performed before, during, and after experimentally induced muscle pain by means of intramuscular injections of hypertonic saline (5.8%) into vastus medialis (VM) muscle of 20 healthy subjects. Isotonic saline (0.9%) was used as control. Surface electromyography (EMG) recordings of VM, vastus lateralis (VL), biceps femoris, and semitendinosus muscles were synchronized with the gait analyses. During experimental muscle pain, the loading response phase peak knee extensor moments were attenuated, and EMG activity in the VM and VL muscles was reduced. Compressive forces, adduction moments, knee joint kinematics, and hamstring EMG activity were unaffected by pain. Interestingly, the observed changes persisted when the pain had vanished. The results demonstrate that muscle pain modulated the function of the quadriceps muscle, resulting in impaired knee joint control and joint instability during walking. The changes are similar to those observed in patients with knee pain. The loss of joint control during and after pain may leave the knee joint prone to injury and potentially participate in the chronicity of musculoskeletal problems, and it may have clinically important implications for rehabilitation and training of patients with knee pain of musculoskeletal origin.     

Activation of vastus medialis obliquus among individuals with patellofemoral pain syndrome

The purpose of this study was to determine whether various positions of the lower extremity affect the muscle activity of the vastus medialis obliquus (VMO) differently during both open and closed kinetic chain exercise conditions among patients with patellofemoral pain syndrome (PFPS). Patients who presented with symptoms consistent with PFPS completed a series of open kinetic chain and closed kinetic chain exercises in which VMO activity was measured and compared. Statistical analysis revealed that there is less than a 0.001% (open kinetic chain) or 0.005% (closed kinetic chain) chance that all positions activate the VMO equally. In open kinetic exercise, maximum VMO activity was achieved with terminal knee extension with medial tibial rotation. During closed kinetic exercises, squats with external rotation were preferred for maximum VMO activation. Therefore, our results highlight the importance of including both the open and closed kinetic chain exercises into rehabilitation programs for patients with PFPS.     

In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain

Patellofemoral pain is a common knee disorder with a multi-factorial etiology related to abnormal patellar tracking. Our hypothesis was that the pattern of three-dimensional rotation and translation of the patella induced by selective activation of individual quadriceps components would differ between subjects with patellofemoral pain and healthy subjects. Nine female subjects with patellofemoral pain and seven healthy female subjects underwent electrical stimulation to selectively activate individual quadriceps components (vastus medialis obliquus, VMO; vastus medialis lateralis, VML; vastus lateralis, VL) with the knee at 0° and 20° flexion, while three-dimensional patellar tracking was recorded. Normalized direction of rotation and direction of translation characterized the relative amplitudes of each component of patellar movement. VMO activation in patellofemoral pain caused greater medial patellar rotation (distal patellar pole rotates medially in frontal plane) at both knee positions (p<0.01), and both VMO and VML activation caused increased anterior patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects at 20° knee flexion. VL activation caused more lateral patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects. In healthy subjects the 3-D mechanical action of the VMO is actively modulated with knee flexion angle while such modulation was not observed in PFP subjects. This could be due to anatomical differences in the VMO insertion on the patella and medial quadriceps weakness. Quantitative evaluation of the influence of individual quadriceps components on patellar tracking will aid understanding of the knee extensor mechanism and provide insight into the etiology of patellofemoral pain.     

Knee muscle forces during walking and running in patellofemoral pain patients and pain-free controls

One proposed mechanism of patellofemoral pain, increased stress in the joint, is dependent on forces generated by the quadriceps muscles. Describing causal relationships between muscle forces, tissue stresses, and pain is difficult due to the inability to directly measure these variables in vivo. The purpose of this study was to estimate quadriceps forces during walking and running in a group of male and female patients with patellofemoral pain (n=27, 16 female; 11 male) and compare these to pain-free controls (n=16, 8 female; 8 male). Subjects walked and ran at self-selected speeds in a gait laboratory. Lower limb kinematics and electromyography (EMG) data were input to an EMG-driven musculoskeletal model of the knee, which was scaled and calibrated to each individual to estimate forces in 10 muscles surrounding the joint. Compared to controls, the patellofemoral pain group had greater co-contraction of quadriceps and hamstrings (p=0.025) and greater normalized muscle forces during walking, even though the net knee moment was similar between groups. Muscle forces during running were similar between groups, but the net knee extension moment was less in the patellofemoral pain group compared to controls. Females displayed 30–50% greater normalized hamstring and gastrocnemius muscle forces during both walking and running compared to males (p<0.05). These results suggest that some patellofemoral pain patients might experience greater joint contact forces and joint stresses than pain-free subjects. The muscle force data are available as supplementary material.     

How changing the inversion/eversion foot angle affects the nondriving intersegmental knee moments and the relative activation of the vastii muscles in cycling

Nondriving intersegmental knee moment components (i.e., varus/valgus and internal/external axial moments) are thought to be primarily responsible for the etiology of overuse knee injuries such as patellofermoral pain syndrome in cycling because of their relationship to muscular imbalances. However the relationship between these moments and muscle activity has not been studied. Thus the four primary objectives of this study were to test whether manipulating the inversion/eversion foot angle alters the varus/valgus knee moment (Objective 1) and axial knee moment (Objective 2) and to determine whether activation patterns of the vastus medialis oblique (VMO), vastus lateralis (VL), and tensor fascia latae (TFL) were affected by changes in the varus/valgus (Objective 3) and axial knee moments (Objective 4). To fulfill these objectives, pedal loads and lower limb kinematic data were collected from 15 subjects who pedaled with five randomly assigned inversion/eversion angles: 10 deg and 5 deg everted and inverted and 0 deg (neutral). A previously described mathematical model was used to compute the nondriving intersegmental knee moments throughout the crank cycle. The excitations of the VMO, VL, and TFL muscles were measured with surface electromyography and the muscle activations were computed. On average, the 10-deg everted position decreased the peak varus moment by 55% and decreased the peak internal axial moment by 53% during the power stroke (crank cycle region where the knee moment is extensor). A correlation analysis revealed that the VMO/VL activation ratio increased significantly and the TFL activation decreased significantly as the varus moment decreased. For both the VMO/VL activation ratio and the TFL activation, a path analysis indicated that the varus/valgus moment was highly correlated to the axial moment but that the correlation between muscle activation and the varus moment was due primarily to the varus/valgus knee moment rather than the axial knee moment. The conclusion from these results is that everting the foot may be beneficial towards either preventing or ameliorating patellofemoral pain syndrome in cycling.     

Lower extremity corrective reactions to slip events.

A significant number of injuries in the workplace is attributed to slips and falls. Biomechanical responses to actual slip events determine whether the outcome of a slip will be recovery or a fall. The goal of this study was to examine lower extremity joint moments and postural adjustments for experimental evidence of corrective strategies evoked during slipping in an attempt to prevent falling. Sixteen subjects walked onto a possibly oily vinyl tile floor, while ground reaction forces and body motion were recorded at 350 Hz. The onset of corrective reactions by the body in an attempt to recover from slips became evident at about 25% of stance and continued until about 45% into stance, i.e. on average between 190 and 350 ms after heel contact. These reactions included increased flexion moment at the knee and extensor activity at the hip. The ankle, on the other hand, acted as a passive joint (no net moment) during fall trials. Joint kinematics showed increased knee flexion and forward rotation of the shank in an attempt to bring the foot back towards the body. Once again, the ankle kinematics appeared to play a less dominant role (compared to the knee) in recovery attempts. This study indicates that humans generate corrective reactions to slips that are different than previously reported responses to standing perturbations translating the supporting surface.     

Trunk response to sudden forward perturbations – Effects of preload and sudden load magnitudes,posture and abdominal antagonistic activation

Unexpected loading of the spine is a risk factor for low back pain. The trunk neuromuscular and kinematics responses are likely influenced by the perturbation itself as well as initial trunk conditions. The effect of four parameters (preload, sudden load, initial trunk flexed posture, initial abdominal antagonistic activity) on trunk kinematics and back muscles reflex response were evaluated. Twelve asymptomatic subjects participated in sudden forward perturbation tests under six distinct conditions. Preload did not change the reflexive response of back muscles and the trunk displacement; while peak trunk velocity and acceleration as well as the relative load peak decreased. Sudden load increased reflex response of muscles, trunk kinematics and loading variables. When the trunk was initially flexed, back muscles latency was delayed, trunk velocity and acceleration increased; however, reflex amplitude and relative trunk displacement remained unchanged. Abdominal antagonistic preactivation increased reflexive response of muscles but kinematics variables were not affected. Preload, initial flexed posture and abdominal muscles preactivation increased back muscles preactivity. Both velocity and acceleration peaks of the trunk movement decreased with preload despite greater total load. In contrast, they increased in the initial flexed posture and to some extent when abdominal muscles were preactivated demonstrating the distinct effects of pre-perturbation variables on trunk kinematics and risk of injury.     

Experimentally reduced hip abductor function during walking: Implications for knee joint loads

Hip and knee functions are intimately connected and reduced hip abductor function might play a role in development of knee osteoarthritis (OA) by increasing the external knee adduction moment during walking. The purpose of this study was to test the hypothesis that reduced function of the gluteus medius (GM) muscle would lead to increased external knee adduction moment during level walking in healthy subjects. Reduced GM muscle function was induced experimentally, by means of intramuscular injections of hypertonic saline that produced an intense short-term muscle pain and reduced muscle function. Isotonic saline injections were used as non-painful control. Fifteen healthy subjects performed walking trials at their self-selected walking speed before and immediately after injections, and again after 20 min of rest, to ensure pain recovery. Standard gait analyses were used to calculate three-dimensional trunk and lower extremity joint kinematics and kinetics. Surface electromyography (EMG) of the glutei, quadriceps, and hamstring muscles were also measured. The peak GM EMG activity had temporal concurrence with peaks in frontal plane moments at both hip and knee joints. The EMG activity in the GM muscle was significantly reduced by pain (?39.6%). All other muscles were unaffected. Peaks in the frontal plane hip and knee joint moments were significantly reduced during pain (?6.4% and ?4.2%, respectively). Lateral trunk lean angles and midstance hip joint adduction and knee joint extension angles were reduced by ?1°. Thus, the gait changes were primarily caused by reduced GM function. Walking with impaired GM muscle function due to pain significantly reduced the external knee adduction moment. This study challenge the notion that reduced GM function due to pain would lead to increased loads at the knee joint during level walking.     

Musculature and biomechanics of the trunk in the maintenance of upright posture

Surface perturbation has been used for decades to study balance and postural control; however the behavior of the trunk in these postural responses has been largely overlooked. Thirteen healthy males (18–23 yrs) were exposed to horizontal support surface translations delivered randomly in one of eight different horizontal directions in both sitting and standing. A 4-segment model of the trunk was used to estimate the kinematics and kinetics associated with the postural response, while surface EMG was acquired, bilaterally, from seven trunk muscles and one hip muscle. Multi-segmental movement was observed in the trunk in both test postures. Both the biomechanical and neuromuscular aspects of the trunk response were significantly affected by translation direction and test posture, with an interaction effect between these variables. The response in sitting was closely tied to the movement of the support surface, while the response in standing occurred in two phases: the first related to the dynamic response in the lower limbs, and the second tied to the movement of the support surface. As such, the observed postural responses could be largely explained by the biomechanical constraints of the system, such that the neural control of trunk equilibrium is simplified.     

Effect of boot shaft stiffness on stability joint energy and muscular co-contraction during walking on uneven surface

Increased boot shaft stiffness may have a noticeable impact on the range of motion of the ankle joint. Therefore, the ability of the ankle joint to generate power for propulsion might be impaired. This might result in compensatory changes at the knee and hip joint. Besides, adaptability of the subtalar joint to uneven surface might be reduced, which could in turn affect stability. The aim of the study was therefore to investigate the influence of boot shaft stiffness on biomechanical gait parameters.Fifteen healthy young adults walked over coarse gravel wearing two different hiking boots that differed by 50% in passive shaft stiffness. Leg kinematics, kinetics and electromyography were measured. Gait velocity and indicators for stability were not different when walking with the hard and soft boot shaft over the gravel surface. However, the hard boot shaft decreased the ankle range of motion as well as the eccentric energy absorbed at the ankle joint. As a consequence, compensatory changes at the knee joint were observed. Co-contraction was increased, and greater eccentric energy was absorbed. Therefore, the efficiency of gait with hard boots might be decreased and joint loading at the knee might be increased, which might cause early fatigue of knee muscles during walking or hiking. The results of this study suggest that stiffness and blocking of joint motion at the ankle should not be equated with safety. A trade-off between lateral stiffness and free natural motion of the ankle joint complex might be preferable.     

A novel method for determining articular cartilage chondrocyte mechanics in vivo

Work relating the mechanical states of articular cartilage chondrocytes to their biosynthetic responses is based on measurements in isolated cells or cells in explant samples removed from their natural in situ environment. Neither the mechanics nor the associated biological responses of chondrocytes have ever been studied in cartilage within a joint of a live animal, and no such measurements have ever been performed using physiologically relevant joint loading through muscular contractions. The purpose of this study was to design and apply a method to study the mechanics of chondrocytes in the exposed but fully intact knee of live animals, which was loaded near-physiologically through muscular contraction. In order to achieve this purpose, we developed an accurate and reliable method based on two-photon laser excitation microscopy. Near-physiological knee joint loading was achieved through controlled electrical activation of the knee extensor muscles that compress the articulating surfaces of the femur, tibia and patella. Accuracy of the system was assessed by inserting micro-beads of known dimensions into the articular cartilage of the mouse knee and comparing the measured volumes and diameters in the principal directions with known values of the beads. Accuracy was best in the plane perpendicular to the optical axis (average error = 1%) while it was slightly worse, but still excellent, along the optical axis (average error = 3%). Reliability of cell volume and shape measurements was 0.5% on average, and 2.9% in the worst-case-scenario. Pilot measurements of chondrocyte deformations upon sub-maximal muscular loading causing a mean articular contact pressure of 1.9 ± 0.2 MPa showed an "instantaneous" decrease in cell height (17 ± 4.5%) and loss of cell volume (22.3 ± 2.4%) that took minutes to recover upon deactivation of the knee extensor muscles.     

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.     

Individuals with non-specific low back pain use a trunk stiffening strategy to maintain upright posture

There is increasing evidence that individuals with non-specific low back pain (LBP) have altered movement coordination. However, the relationship of this neuromotor impairment to recurrent pain episodes is unknown. To assess coordination while minimizing the confounding influences of pain we characterized automatic postural responses to multi-directional support surface translations in individuals with a history of LBP who were not in an active episode of their pain. Twenty subjects with and 21 subjects without non-specific LBP stood on a platform that was translated unexpectedly in 12 directions. Net joint torques of the ankles, knees, hips, and trunk in the frontal and sagittal planes as well as surface electromyographs of 12 lower leg and trunk muscles were compared across perturbation directions to determine if individuals with LBP responded using a trunk stiffening strategy. Individuals with LBP demonstrated reduced peak trunk torques, and enhanced activation of the trunk and ankle muscle responses following perturbations. These results suggest that individuals with LBP use a strategy of trunk stiffening achieved through co-activation of trunk musculature, aided by enhanced distal responses, to respond to unexpected support surface perturbations. Notably, these neuromotor alterations persisted between active pain periods and could represent either movement patterns that have developed in response to pain or could reflect underlying impairments that may contribute to recurrent episodes of LBP.     

Comparison of lower limb kinetics,kinematics and muscle activation during drop jumping under shod and barefoot conditions

This study was to investigate the acute effects of wearing shoes on lower limb kinetics, kinematics and muscle activation during a drop jump. Eighteen healthy men performed a drop jump under barefoot and shod conditions. Vertical ground reaction force (GRF) was measured on a force plate during the contact phase of a drop jump, and GRF valuables were calculated for each condition. The angles of the knee and ankle joints, and the foot strike angle (the angle between the plantar surface of the foot and the ground during ground contact) as well as the electromyography of 7 muscles were measured. The shod condition showed a significant larger first peak GRF, longer time to first peak GRF from the initial ground contact and lower initial loading rate than the barefoot condition. The shod condition showed a significant larger ankle joint angle at initial ground contact, smaller knee joint angle between the second peak GRF and take-off as well as smaller foot strike angle at both initial ground contact and take-off than the barefoot condition. There were significant correlations between relative differences in ankle joint at the initial ground contact and relative differences in the initial loading rate. The muscle activity of all muscles during foot ground contact did not differ between two conditions; however, in the shod condition, muscle activation of 150 ms before foot ground contact was significantly higher in the rectus femoris, whereas it was lower in the biceps femoris and tibialis anterior muscles than the barefoot condition. These results indicate that wearing shoes alternates the GRF variables at initial ground contact, joint kinematics at the ground contact and muscle activation before foot ground contact during a drop jump, suggesting that the effects of wearing shoes on drop jump training differ from being barefoot.     

Electromyographic and kinematic analysis of females with excessive medial knee displacement in the overhead squat

Dynamic knee valgus is a multi-planar motion that has been associated with anterior cruciate ligament injuries and patellofemoral pain syndrome. Clinical assessment of dynamic knee valgus is usually performed through visual appearance of medial knee displacement (MKD) during the overhead squat. The aim of this study is to identify the kinematic and neuromuscular parameters associated with MKD. Twenty-two females performed an overhead squat and were assigned to the control group (n = 14) or the MKD group (n = 8). Electromyography and kinematic data of the lower extremity were collected. We observed MKD to exhibit greater muscle activity in the following muscles: adductor magnus, biceps femoris, vastus lateralis and vastus medialis muscles during the eccentric phase of the overhead squat. No group differences were observed during the concentric phase. Regarding the kinematics, the MKD group showed higher knee internal rotation and, knee abduction and ankle abduction, compared to controls. The combined information from the muscle activity results and kinematics of squat helps to explain the occurrence of excessive medial knee displacement and, hence, providing relevant information for health professionals to address this injury risk factor.     

Role of knee ligaments in proprioception and regulation of muscle stiffness

Physiologic evidence for the sensory role of the knee joint ligaments are reviewed. The cruciate and collateral ligaments accomodate morphologically different sensory nerve endings with different capabilities of providing the central nervous system (CNS) with information not only about noxious and chemical stimuli but also about mechanical events, e.g., movement- and position-related stretches of the ligaments. Available data show that low-threshold joint/ligament receptor (i.e., mechanoreceptor) afferents evoke only weak and rare effects in skeletomotor neurons (α-motoneurons), whereas they frequently and powerfully influence fusimotor neurons (γ-motoneurons). The effects on the γ-muscle-spindle system in the muscles around the knee are so potent that even stretches of the cruciate ligaments at relatively moderate loads (not noxious) may induce major changes in responses of the muscle spindle afferents. As the activity in the primary muscle spindle afferents modifies stiffness in the muscles, the cruciate ligament receptors may, through the γ-muscle-spindle system, participate in regulation and preparatory adjustment of the stiffness of the muscles around the knee joint and thereby of knee joint stiffness. Thus, the sensory system of the cruciate ligaments is able to contribute significantly to the functional stability of the knee joint. The possible role of (ligamentous) joint receptors in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes is also discussed.