Foot structure and knee joint kinetics during walking with and without wedged footwear insoles

The relationship between static foot structure characteristics and knee joint biomechanics during walking, or the biomechanical response to wedged insoles are currently unknown. In this study, 3D foot scanning, dual X-ray absorptiometry and gait analysis methods were used to determine structural parameters of the foot and assess their relation to knee joint loading and biomechanical response to wedged insoles in 30 patients with knee osteoarthritis. In multiple linear regression models, foot fat content, height of the medial longitudinal arch and static hind foot angle were not associated with the magnitude of the knee adduction moment (R² = 0.24, p = 0.060), knee adduction angular impulse (R² = 0.21, p = 0.099) or 3D resultant knee moment (R² = 0.23, p = 0.073) during gait. Furthermore, these foot structure parameters were not associated with the patients’ biomechanical response to medial or lateral wedge footwear insoles (all p < 0.01). These findings suggest that static foot structure is not associated with gait mechanics at the knee, and that static foot structure alone cannot be utilized to predict an individual’s biomechanical response to wedged footwear insoles in patients with knee osteoarthritis.     

Effect of footwear on intramuscular EMG activity of plantar flexor muscles in walking

One of the purposes of footwear is to assist locomotion, but some footwear types seem to restrict natural foot motion, which may affect the contribution of ankle plantar flexor muscles to propulsion. This study examined the effects of different footwear conditions on the activity of ankle plantar flexors during walking. Ten healthy habitually shod individuals walked overground in shoes, barefoot and in flip-flops while fine-wire electromyography (EMG) activity was recorded from flexor hallucis longus (FHL), soleus (SOL), and medial and lateral gastrocnemius (MG and LG) muscles. EMG signals were peak-normalised and analysed in the stance phase using Statistical Parametric Mapping (SPM). We found highly individual EMG patterns. Although walking with shoes required higher muscle activity for propulsion than walking barefoot or with flip-flops in most participants, this did not result in statistically significant differences in EMG amplitude between footwear conditions in any muscle (p > 0.05). Time to peak activity showed the lowest coefficient of variation in shod walking (3.5, 7.0, 8.0 and 3.4 for FHL, SOL, MG and LG, respectively). Future studies should clarify the sources and consequences of individual EMG responses to different footwear.     

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.     

Foot center of pressure manipulation and gait therapy influence lower limb muscle activation in patients with osteoarthritis of the knee

Background

Foot center of pressure (COP) manipulation has been associated with improved gait patterns. The purpose of this study was to determine lower limb muscle activation changes in knee osteoarthritis patients, both immediately after COP manipulation and when COP manipulation was combined with continuous gait therapy (AposTherapy).

Methods

Fourteen females with medial compartment knee osteoarthritis underwent EMG analyzes of key muscles of the leg. In the initial stage, trials were carried out at four COP positions. Following this, gait therapy was initiated for 3 months. The barefoot EMG was compared before and after therapy.

Results

The average EMG varied significantly with COP in at least one phase of stance in all examined muscles of the less symptomatic leg and in three muscles of the more symptomatic leg. After training, a significant increase in average EMG was observed in most muscles. Most muscles of the less symptomatic leg showed significantly increased peak EMG. Activity duration was shorter for all muscles of the less symptomatic leg (significant in the lateral gastrocnemius) and three muscles of the more symptomatic leg (significant in the biceps femoris). These results were associated with reduced pain, increased function and improved spatiotemporal parameters.

Conclusions

COP manipulation influences the muscle activation patterns of the leg in patients with knee osteoarthritis. When combined with a therapy program, muscle activity increases and activity duration decreases.     

Effects of bilateral medial knee osteoarthritis on intra- and inter-limb contributions to body support during gait

Patients with knee OA show altered gait patterns, affecting their quality of living. The current study aimed to quantify the effects of bilateral knee OA on the intra-limb and inter-limb sharing of the support of the body during gait. Fifteen patients with mild, 15 with severe bilateral knee OA, and 15 healthy controls walked along a walkway while the kinematic and kinetic data were measured. Compared with the controls, the patients significantly reduced their knee extensor moments and the corresponding contributions to the total support moment in the sagittal plane (p<0.05). For compensation, the mild OA group significantly increased the hip extensor moments (p<0.05) to maintain close-to-normal support and a more symmetrical inter-limb load-sharing during double-limb support. The severe OA group involved compensatory actions of both the ankle and hip, but did not succeed in maintaining a normal sagittal total support moment during late stance, nor a symmetrical inter-limb load-sharing during double-limb support. In the frontal plane, the knee abductor moments and the corresponding contributions to the total support moment were not affected by the changes in the other joints, regardless of the severity of the disease. The observed compensatory changes suggest that strengthening of weak hip muscles is essential for body support during gait in patients with knee OA, but that training of weak ankle muscles may also be needed for patients with severe knee OA.     

Influence of fatigue on upper limb muscle activity and performance in tennis

The study examined the fatigue effect on tennis performance and upper limb muscle activity. Ten players were tested before and after a strenuous tennis exercise. Velocity and accuracy of serve and forehand drives, as well as corresponding surface electromyographic (EMG) activity of eight upper limb muscles were measured. EMG and force were also evaluated during isometric maximal voluntary contractions (IMVC). Significant decreases were observed after exercise in serve accuracy (−11.7%) and velocity (−4.5%), forehand accuracy (−25.6%) and consistency (−15.6%), as well as pectoralis major (PM) and flexor carpi radialis (FCR) IMVC strength (−13.0% and −8.2%, respectively). EMG amplitude decreased for PM and FCR in serve, forehand and IMVC, and for extensor carpi radialis in forehand. No modification was observed in EMG activation timing during strokes or in EMG frequency content during IMVC. Several hypotheses can be put forward to explain these results. First, muscle fatigue may induce a reduction in activation level of PM and forearm muscles, which could decrease performance. Second, conscious or subconscious strategies could lead to a redistribution of muscle activity to non-fatigued muscles in order to protect the organism and/or limit performance losses. Otherwise, the modifications of EMG activity could also illustrate the strategies adopted to manage the speed-accuracy trade-off in such a complex task.     

Influence of patellar position on the knee extensor mechanism in normal and crouched walking

Patella alta is common in cerebral palsy, especially in patients with crouch gait. Correction of patella alta has been advocated in the treatment of crouch, however the appropriate degree of correction and the implications for knee extensor function remain unclear. Therefore, the goal of this study was to assess the impact of patellar position on quadriceps and patellar tendon forces during normal and crouch gait. To this end, a lower extremity musculoskeletal model with a novel 12 degree of freedom knee joint was used to simulate normal gait in a healthy child, as well as mild (23 deg min knee flexion in stance), moderate (41 deg), and severe (67 deg) crouch gait in three children with cerebral palsy. The simulations revealed that quadriceps and patellar tendon forces increase dramatically with crouch, and are modulated by patellar position. For example with a normal patellar tendon position, peak patellar tendon forces were 0.7 times body weight in normal walking, but reached 2.2, 3.2 and 5.4 times body weight in mild, moderate and severe crouch. Moderate patella alta acted to reduce quadriceps and patellar tendon loads in crouch gait, due to an enhancement of the patellar tendon moment arms with alta in a flexed knee. In contrast, patella baja reduced the patellar tendon moment arm in a flexed knee and thus induced an increase in the patellar tendon loads needed to walk in crouch. Functionally, these results suggest that patella baja could also compromise knee extensor function for other flexed knee activities such as chair rise and stair climbing. The findings are important to consider when using surgical approaches for correcting patella alta in children who exhibit crouch gait patterns.     

Changes in relative work of the lower extremity joints and distal foot with walking speed

The modulation of walking speed results in adaptations to the lower limbs which can be quantified using mechanical work. A 6 degree-of-freedom (DOF) power analysis, which includes additional translations as compared to the 3 DOF (all rotational) approach, is a comprehensive approach for quantifying lower limb work during gait. The purpose of this study was to quantify the speed-related 6 DOF joint and distal foot work adaptations of all the lower extremity limb constituents (hip, knee, ankle, and distal foot) in healthy individuals. Relative constituent 6 DOF work, the amount of constituent work relative to absolute limb work, was calculated during the stance and swing phases of gait. Eight unimpaired adults walked on an instrumented split-belt treadmill at slow, moderate, and typical walking speeds (0.4, 0.6, and 0.8 statures/s, respectively). Using motion capture and force data, 6 DOF powers were calculated for each constituent. Contrary to previously published results, 6 DOF positive relative ankle work and negative relative distal foot work increased significantly with increased speed during stance phase (p < 0.05). Similar to previous rotational DOF results in the sagittal plane, negative relative ankle work decreased significantly with increased speed during stance phase (p < 0.05). Scientifically, these findings provide new insight into how healthy individuals adapt to increased walking speed and suggest limitations of the rotational DOF approach for quantifying limb work. Clinically, the data presented here for unimpaired limbs can be used to compare with speed-matched data from limbs with impairments.     

Analysis on the activation of the VMO and VLL muscles during semisquat exercises with and without hip adduction in individuals with patellofemoral pain syndrome

Objective: The purpose of this study was to investigate the effect of hip adduction on the activity of the Vastus Medialis Obliquus (VMO) and Vastus Lateralis Longus (VLL) muscles during semisquat exercises.

Methods: Twenty female subjects, divided into two groups comprising healthy and patellofemoral pain syndrome (PFPS) subjects (ten volunteers for each group), performed three double-leg semisquat exercise trials with maximum hip adduction isometric contraction (DLSS-HA) and three double-leg semisquat exercise trials without hip adduction (DLSS). The normalized electromyographic muscle data were analysed using Repeated Measure ANOVA (p  0.05).

Results: The electrical activity of both VMO and VLL muscles was significantly greater during DLSS-HA exercise than during DLSS (p = 0.0002) for both groups. Additionally, an independent Repeated Measure ANOVA revealed that the electric activity of the VLL muscle was significantly greater (p = 0.0149) than that of the VMO muscle during DLSS exercises only for the PFPS group. However, no differences were found during DLSS-HA exercises.

Conclusions: Although there was no preferential VMO muscle activation, the association of hip adduction with squat exercise promoted a greater balance between the medial and lateral portions of the quadriceps femoris muscle and could be indicated for the conservatory treatment of PFPS patients. The association of isometric hip adduction with isometric semisquat exercises produced a more overall quadriceps activity and could be indicated for clinical rehabilitation or muscle strengthening programs.     

温针联合骨疏康胶囊治疗膝关节骨性关节炎的疗效及对炎症因子的影响

目的:分析温针联合骨疏康胶囊治疗膝关节骨性关节炎的疗效及对患者白细胞介素-1(IL-1)、肿瘤坏死因子(TNF-α)、基质金属蛋白(MMP-3)水平的影响。方法:以2013年1月至2016年1月新疆巴音郭楞蒙古自治州人民医院中医科收治的90例膝关节骨性关节炎患者为研究对象,并根据就诊顺序分为观察组、对照组A和对照组B,每组30例。观察组采用温针联合骨疏康胶囊治疗,对照组A仅给予温针治疗,对照组B仅给予骨疏康胶囊治疗。观察和比较三组的临床疗效、视觉模拟评分法(VAS)评分、Lysholm膝关节康复量表(LKSS)评分和症状评分及膝关节液中IL-1、TNF-α、MMP-3水平。结果:观察组的总有效显著高于对照组A和对照组B(P0.05),而对照组A和对照组B之间比较差异无统计学意义(P0.05)。治疗后,三组的VAS、症状评分、膝关节液中IL-1、TNF-α、MMP-3水平均较治疗前显著降低,LKSS评分较治疗前显著升高(P0.05)。观察组的VAS、症状评分、膝关节液中IL-1、TNF-α、MMP-3水平低于对照组A和对照组B,LKSS评分高于对照组A和对照组B(P0.05),对照组A和对照组B之间比较差异均无统计学意义(P0.05)。结论:温针联合骨疏康胶囊治疗膝关节骨性关节炎的疗效较单用温针或骨疏康胶囊更显著,可有效改善患者的临床症状,可能与降低膝关节液中IL-1、TNF-α、MMP-3水平有关。     

Effect of prolonged walking with backpack loads on trunk muscle activity and fatigue in children

This study investigated the effect of prolonged walking with load carriage on muscle activity and fatigue in children. Fifteen Chinese male children (age = 6 years, height = 120.0 ± 5.4 cm, mass = 22.9 ± 2.6 kg) performed 20-min walking trials on treadmill (speed = 1.1 m s⁻¹) with different backpack loads (0%, 10%, 15% and 20% body weight). Electromyography (EMG) signals from upper trapezius (UT), lower trapezius (LT) and rectus abdominis (RA) were recorded at several time intervals (0, 5, 10, 15 and 20 min), and were normalized to the signals collected during maximum voluntary contraction. Integrated EMG signal (IEMG) was calculated to evaluate the muscle activity. Power spectral frequency analysis was applied to evaluate muscle fatigue by the shift of median power frequency (MPF). Results showed that a 15% body weight (BW) load significantly increased muscle activity at lower trapezius when the walking time reached 15 min. When a 20% BW load was being carried, increase in muscle activity was found from 5 min, and muscle fatigue was found from 15 min. In upper trapezius, increase of muscle activity was not found within the 20-min period, however, muscle fatigue was found from 10 min. No increased muscle activity or muscle fatigue was found in rectus abdominis. It is suggested that backpack loads for children should be restricted to no more than 15% body weight for walks of up to 20 min duration to avoid muscle fatigue.     

放散式体外冲击波穴位治疗联合中药熏洗治疗老年膝骨关节炎的疗效分析

摘要 目的：评价放散式体外冲击波（rESW）穴位治疗联合中药熏洗在老年膝骨关节炎（KOA）中的应用效果。方法：选入2021年2月~2022年8月我院收治的老年KOA患者76例,根据治疗方法不同分为对照组和观察组,各38例,两组均予以中药熏洗,观察组加用rESW穴位治疗。评价两组的治疗效果、膝关节功能、疼痛程度等指标,并进行统计比较。结果：与治疗前相比,两组治疗2周、治疗4周时的VAS评分明显下降（P＜0.05）,而观察组下降幅度更大,与对照组差异显著（P＜0.05）;两组治疗前Lysholm评分无明显差异（P＞0.05）,而观察组治疗2周、治疗4周时的Lysholm评分显著高于对照组（P＜0.05）;观察组治疗显效率和有效率均显著高于对照组（P＜0.05）;观察组治疗2周、4周时的血清IL-1β、TNF-α和MMP-13水平较对照组低（P＜0.05）。结论：rESW穴位联合中药熏洗治疗老年KOA患者疗效显著,可缓解疼痛症状,改善膝关节功能,控制炎症反应,且操作简单,值得推荐。     

盐酸氨基葡萄糖胶囊对膝骨关节炎患者血清IL-1β和TNF-α水平的影响及临床疗效

目的:观察盐酸氨基葡萄糖对膝骨关节炎(Knee osteoarthritis,KOA)患者血清IL-1β和TNF-α水平的影响及临床治疗效果。方法:将128例KOA患者随机分为治疗组与对照组,治疗组口服盐酸氨基葡萄糖胶囊,对照组口服双氯芬酸钠缓释胶囊,各组均以8周为一个疗程。用流式细胞仪微球阵列法检测两组患者治疗前后血清IL-1β和TNF-α水平,比较两组治疗前后膝关节功能WOMAC评分、疼痛VAS评分的变化及疼痛缓解时间。结果:治疗后,两组患者血清IL-1β和TNF-α的水平均较治疗前明显降低(P0.05),WOMAC评分较治疗前显著升高(P0.05),且治疗组血清IL-1β和TNF-α的水平均显著低于对照组(P0.05),而WOMAC评分明显高于对照组(P0.05)。两组患者疼痛VAS评分和疼痛缓解时间比较差异无统计学意义(P0.05)。结论:盐酸氨基葡萄糖胶囊能明显改善KOA患者膝关节功能,缓解膝关节局部的疼痛,可能与其显著降低患者血清IL-1β和TNF-α的水平有关。     

Electromyographic analysis of rectus femoris activity during seated to standing position and walking in water and on dry land in healthy children and children with cerebral palsy

Purpose: To analyze rectus femoris activity during seated to standing position and walking in water and on dry land comparing a group of children with the spastic diparesis type of cerebral palsy (CP) and a group of children without neurological disorders. Methods: This study included a group of nine children with CP and a control group of 11 children. The study compared the electromyographic activity of the rectus femoris during seated to standing position and walking, in water and on land. Results: A greater activation of the rectus femoris was observed in the group of children with CP compared with the control group when moving from a seated position to a standing position in water (p = 0.0039) and while walking on land (p = 0.0014) or in the pool (p = 0.007). Conclusion: This study demonstrated the activation of the rectus femoris while walking or standing up from a seated position in water was greater in the group of children with CP. Further studies should be performed to better understand the extent of muscular activation during body immersion in individuals with neurological disorders.     

神经肌肉电刺激联合吞咽康复训练对脑卒中后吞咽障碍患者吞咽功能、表面肌电图及舌骨喉复合体动度的影响

摘要 目的：观察吞咽康复训练、神经肌肉电刺激（NMES）联合治疗对脑卒中后吞咽障碍患者吞咽功能、表面肌电图及舌骨喉复合体动度的影响。方法：选取2018 年9月~2020年10 月期间在我院治疗的70例脑卒中后吞咽障碍患者,根据住院号尾数的奇偶将患者分为对照组和实验组,各35例。对照组仅进行吞咽康复训练,实验组在此基础上接受NMES治疗,两组均治疗2个疗程,观察治疗前后两组患者吞咽功能、表面肌电图、舌骨喉复合体动度及生活质量变化。结果：治疗2个疗程后,实验组患者的吞咽功能改善总有效率高于对照组,组间比较有显著性差异（P<0.05）。治疗2个疗程后,两组吞咽时程缩短、最大波幅值升高,且实验组的吞咽时程短于对照组,最大波幅值高于对照组（P<0.05）。治疗2个疗程后,两组舌骨上移距离、舌骨前移距离、甲状软骨上移距离、甲状软骨前移距离增大,且实验组的舌骨上移距离、舌骨前移距离、甲状软骨上移距离、甲状软骨前移距离大于对照组（P<0.05）。治疗2个疗程后,两组SWAL-QOL总分均升高,且实验组的SWAL-QOL总分高于对照组（P<0.05）。结论：NMES联合吞咽康复训练应用于脑卒中后吞咽障碍患者,可有效促进其吞咽功能改善,提高舌骨肌肌群肌力及生活质量。     

The impact of diabetic neuropathy on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 diabetes mellitus: a cross-sectional study

Objectives:This study aimed to determine the impact of diabetic neuropathy (dNP) on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 Diabetes Mellitus (T2DM).Methods:19 healthy male controls without neuropathy (HC) and 35 male T2DM patients, without dNP (n=8), with sensory dNP (n=13) or with sensorimotor dNP (dNPsm; n=14), were enrolled in this study. Maximal isometric (IM) and isokinetic (IK) muscle strength and IK muscle endurance of the dominant knee, ankle and elbow, and maximal IM handgrip strength were measured by means of dynamometry.Results:Ankle muscle endurance was lower compared to the knee, independently of dNP (p<0.001). Maximal IK ankle muscle strength was also lower compared to the knee, albeit only in dNPsm (p=0.003). No differences were found between maximal IM handgrip and elbow strength.Conclusions:Our results suggest an impact of T2DM -with or without dNP- on lower limb muscle strength more distally than proximally, while this was not observed in the upper limb. The gradient of dNP seemed to be a determining factor for the maximal muscle strength, and not for muscle endurance, in the lower limb.