Classification of multi muscle activation patterns of osteoarthritis patients during level walking

The study compares the timing and frequency changes of surface EMGs recorded from osteoarthritis patients with previous traumatic ankle injury and normal subjects during level walking. EMG intensity (power) was obtained by a wavelet analysis. There were intensity values for each frequency characterized by the wavelets for every time point. The intensities were compounded into Multi Muscle Patterns (MMP) simultaneously showing the time and spectral aspects of the lower leg muscle activity.The aim of the study was to test the hypothesis that the differences between the group of the MMPs from the affected leg (AFL) and the not affected leg (NAL) allow detecting whether a newly measured MMP results from an AFL or NAL. This hypothesis was tested by a spherical classification procedure yielding the correctly classified MMPs thus indicating the significance of the differences between the MMPs of the AFL and NAL. The hypothesis was supported (not falsified) by the results. Thus there were common features of muscle activity in the AFL of most osteoarthritis patients that allowed detecting whether the MMP of a new patient was of the kind seen in most other osteoarthritis patients. The spectral, timing and intensity factors in the MMP that allowed this classification were visualized in the mean MMPs of the patients and the control group. The comparison revealed where on average the relative timing and spectral differences of the muscle activation of osteoarthritis patients and control subjects occurred.     

Obesity is not associated with increased knee joint torque and power during level walking

While it is widely speculated that obesity causes increased loads on the knee leading to joint degeneration, this concept is untested. The purpose of the study was to identify the effects of obesity on lower extremity joint kinetics and energetics during walking. Twenty-one obese adults were tested at self-selected (1.29m/s) and standard speeds (1.50m/s) and 18 lean adults were tested at the standard speed. Motion analysis and force platform data were combined to calculate joint torques and powers during the stance phase of walking. Obese participants were more erect with 12% less knee flexion and 11% more ankle plantarflexion in self-selected compared to standard speeds (both p<0.02). Obese participants were still more erect than lean adults with approximately 6 degrees more extension at all joints (p<0.05, for each joint) at the standard speed. Knee and ankle torques were 17% and 11% higher (p<0.034 and p<0.041) and negative knee work and positive ankle work were 68% and 11% higher (p<0.000 and p<0.048) in obese participants at the standard speed compared to the slower speed. Joint torques and powers were statistically identical at the hip and knee but were 88% and 61% higher (both p<0.000) at the ankle in obese compared to lean participants at the standard speed. Obese participants used altered gait biomechanics and despite their greater weight, they had less knee torque and power at their self-selected walking speed and equal knee torque and power while walking at the same speed as lean individuals. We propose that the ability to reorganize neuromuscular function during gait may enable some obese individuals to maintain skeletal health of the knee joint and this ability may also be a more accurate risk indicator for knee osteoarthritis than body weight.     

Responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects

PurposeTo compare the responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects.ScopeNine healthy participants were subjected to perturbed walking on a split-belt treadmill. Four perturbation types were applied, each at five intensities. The activations of seven muscles surrounding the knee were measured using surface EMG. The responses in muscle activation were expressed by calculating mean, peak, co-contraction (CCI) and perturbation responses (PR) values. PR captures the responses relative to unperturbed gait. Statistical parametric mapping analysis was used to compare the muscle activation patterns between conditions.ResultsPerturbations evoked only small responses in muscle activation, though higher perturbation intensities yielded a higher mean activation in five muscles, as well as higher PR. Different types of perturbation led to different responses in the rectus femoris, medial gastrocnemius and lateral gastrocnemius. The participants had lower CCI just before perturbation compared to the same phase of unperturbed gait.ConclusionsHealthy participants respond to different perturbations during gait with small adaptations in their knee joint muscle activation patterns. This study provides insights in how the muscles are activated to stabilize the knee when challenged. Furthermore it could guide future studies in determining aberrant muscle activation in patients with knee disorders.     

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.     

Trunk muscle activation patterns during walking at different speeds.

Investigations of trunk muscle activation during gait are rare in the literature. As yet, the small body of literature on trunk muscle activation during gait does not include any systematic study on the influence of walking speed. Therefore, the aim of this study was to analyze trunk muscle activation patterns at different walking speeds. Fifteen healthy men were investigated during walking on a treadmill at speeds of 2, 3, 4, 5 and 6 km/h. Five trunk muscles were investigated using surface EMG (SEMG). Data were time normalized according to stride time and grand averaged SEMG curves were calculated. From these data stride characteristics were extracted: mean SEMG amplitude, minimum SEMG level and the variation coefficient (VC) over the stride period. With increasing walking speed, muscle activation patterns remained similar in terms of phase dependent activation during stride, but mean amplitudes increased generally. Phasic activation, indicated by VC, increased also, but remained almost unchanged for the back muscles (lumbar multifidus and erector spinae) between 4 and 6 km/h. During stride, minimum amplitude reached a minimum at 4 km/h for the back muscles, but for internal oblique muscle it decreased continuously from 2 to 6 km/h. Cumulative sidewise activation of all investigated muscles reached maximum amplitudes during the contralateral heel strike and propulsion phases. The observed changes argue for a speed dependent modulation of activation of trunk muscles within the investigated range of walking speeds prior to strictly maintaining certain activation characteristics for all walking speeds.     

Knee joint laxity affects muscle activation patterns in the healthy knee.

This study investigated the effects of anterior knee joint laxity on muscle activation patterns prior to and following a lower extremity perturbation. Participants were subjected to a forward and either internal (IR) or external (ER) rotation perturbation of the trunk and thigh on the weight-bearing shank. Pre-activity (%MVIC) before the perturbation, and reflex time (ms) and mean reflex amplitude (%MVIC) following the perturbation were recorded via surface electromyography (sEMG) in the medial and lateral gastrocnemius, hamstring and quadriceps muscles. Twenty-one NCAA DI intercollegiate female athletes with below average anterior knee laxity (3-5 mm) were compared to 21 with above average anterior knee laxity (7-14 mm) as measured by a standard knee arthrometer. Groups differed in reflex timing by muscle (P = 0.013), with females with above average knee laxity (KT((>7 mm))) demonstrating a 16 ms greater delay in biceps femoris reflex timing compared to females with below average knee laxity (KT((<5 mm))). Groups also differed in muscle activation amplitude by response, muscle and direction of rotation (i.e. a 4-way interaction; P = 0.027). The magnitude of change from pre to post perturbation was significantly less in KT((>7 mm)) vs. KT((<5 mm)) for the medial (MG) and lateral (LG) gastrocnemius muscles, primarily due to higher levels of muscle preactivity while awaiting the perturbation (MG = 20% vs. 12% MVIC, P = 0.05; LG = 33% vs. 21% MVIC, P = 0.11). Further, KT((>7 mm)) demonstrated higher activation levels in the biceps femoris than KT((<5 mm)) (47% vs. 27% MVIC; P = 0.025) regardless of response (pre vs. post perturbation) or direction of rotation. These findings suggest females with increased knee laxity may be less sensitive to joint displacement or loading (delayed reflex), and are more reliant on active control of the gastrocnemius and biceps femoris muscles to potentially compensate for reduced passive joint stability.     

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.     

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.     

Reliability of surface electromyographic recordings during walking in individuals with knee osteoarthritis

To determine test–retest reliability of a surface electromyographic protocol designed to measure knee joint muscle activation during walking in individuals with knee osteoarthritis (OA). Twenty-one individuals with moderate medial compartment knee OA completed two gait data collections separated by approximately 1 month. Using a standardized protocol, surface electromyograms from rectus femoris plus lateral and medial sites for the gastrocnemii, vastii and hamstring muscles were recorded during walking. After full-wave rectification and low pass filtering, time and amplitude normalized (percent of maximum) waveforms were calculated. Principal component analysis (PP-scores) and co-contraction indices (CCI) were calculated from the waveforms. Intraclass correlation coefficients (ICC_2,k) were calculated for PP-scores and CCI’s. No differences in walking speed, knee muscle strength and symptoms were found between visits (p > 0.05). The majority of PP-scores (17 of 21) and two of four CCIs demonstrated ICC_2,k values greater than 0.81. Remaining PP-scores and CCIs had ICC_2,k values between 0.61 and 0.80. The results support that reliable EMG characteristics can be captured from a moderate knee OA patient population using a standardized protocol.     

Sagittal plane hip motion reversals during walking are associated with disease severity and poorer function in subjects with hip osteoarthritis

A midstance reversal of sagittal plane hip motion during walking, or motion discontinuity (MD), has previously been observed in subjects with endstage hip osteoarthritis (OA) and in patients with femoroacetabular impingement. The goal of the present study was to evaluate whether this gait pattern is a marker of OA presence or radiographic severity by analyzing a large IRB approved motion analysis data repository. We also hypothesized that subjects with the MD would show more substantial gait impairments than those with normal hip motion. We identified 150 subjects with symptomatic unilateral hip OA and Kellgren-Lawrence OA severity data on file, and a control group of 159 asymptomatic subjects whose ages fell within 2 standard deviations of the mean OA group age. From the gait data, the MD was defined as a reversal in the slope of the hip flexion angle curve during midstance. Logistic regressions and general linear models were used to test the association between the MD and OA presence, OA severity and, other gait variables. 53% of OA subjects compared to 7.5% of controls had the MD (p<0.001); occurrence of the MD was associated with OA severity (p=0.009). Within the OA subject group, subjects with the MD had reduced dynamic range of motion, peak, extension, and internal rotation moments compared to those who did not (MANCOVA p ≤ 0.042) after controlling for walking speed. We concluded that sagittal plane motion reversals are indeed associated with OA presence and severity, and with more severe gait abnormalities in subjects with hip OA.     

Men and women adopt similar walking mechanics and muscle activation patterns during load carriage

Although numerous studies have investigated the effects of load carriage on gait mechanics, most have been conducted on active military men. It remains unknown whether men and women adapt differently to carrying load. The purpose of this study was to compare the effects of load carriage on gait mechanics, muscle activation patterns, and metabolic cost between men and women walking at their preferred, unloaded walking speed. We measured whole body motion, ground reaction forces, muscle activity, and metabolic cost from 17 men and 12 women. Subjects completed four walking trials on an instrumented treadmill, each five minutes in duration, while carrying no load or an additional 10%, 20%, or 30% of body weight. Women were shorter (p<0.01), had lower body mass (p=0.01), and had lower fat-free mass (p=0.02) compared to men. No significant differences between men and women were observed for any measured gait parameter or muscle activation pattern. As load increased, so did net metabolic cost, the duration of stance phase, peak stance phase hip, knee, and ankle flexion angles, and all peak joint extension moments. The increase in the peak vertical ground reaction force was less than the carried load (e.g. ground force increased approximately 6% with each 10% increase in load). Integrated muscle activity of the soleus, medial gastrocnemius, lateral hamstrings, vastus medialis, vastus lateralis, and rectus femoris increased with load. We conclude that, despite differences in anthropometry, men and women adopt similar gait adaptations when carrying load, adjusted as a percentage of body weight.     

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.     

Three-dimensional knee joint contact forces during walking in unilateral transtibial amputees

Individuals with unilateral transtibial amputations have greater prevalence of osteoarthritis in the intact knee joint relative to the residual leg and non-amputees, but the cause of this greater prevalence is unclear. The purpose of this study was to compare knee joint contact forces and the muscles contributing to these forces between amputees and non-amputees during walking using forward dynamics simulations. We predicted that the intact knee contact forces would be higher than those of the residual leg and non-amputees. In the axial and mediolateral directions, the intact and non-amputee legs had greater peak tibio-femoral contact forces and impulses relative to the residual leg. The peak axial contact force was greater in the intact leg relative to the non-amputee leg, but the stance phase impulse was greater in the non-amputee leg. The vasti and hamstrings muscles in early stance and gastrocnemius in late stance were the largest contributors to the joint contact forces in the non-amputee and intact legs. Through dynamic coupling, the soleus and gluteus medius also had large contributions, even though they do not span the knee joint. In the residual leg, the prosthesis had large contributions to the joint forces, similar to the soleus in the intact and non-amputee legs. These results identify the muscles that contribute to knee joint contact forces during transtibial amputee walking and suggest that the peak knee contact forces may be more important than the knee contact impulses in explaining the high prevalence of intact leg osteoarthritis.     

Influence of a valgus knee brace on muscle activation and co-contraction in patients with medial knee osteoarthritis

The purpose of this study was to analyse the effect of a valgus knee orthosis designed for patients with knee osteoarthritis on the electromyographic activity (EMG) of seven muscles of the lower limb during gait. Twelve patients with medial knee osteoarthritis walked on a treadmill in three different conditions: without orthosis, with a knee orthosis in 4° valgus adjustment and with an orthosis in a neutral flexible adjustment. Root-mean-square (RMS) was analysed in each condition during a 150 ms pre-activation phase and during the stance phase of gait, which was divided in four sub-phases. In addition, co-contraction ratios (CCRs) were calculated between extensor/flexor, medial/lateral muscles and between agonist and antagonist muscle pairs. Significant decreases in muscle activity and CCRs were observed with the use of the knee orthosis in both adjustments compared to the condition without orthosis. Using the valgus brace, medial/lateral CCR decreased significantly during the late stance and the flexor/extensor CCR decreased significantly during the loading phase and late stance. Decreases of muscle pairs CCRs were observed with the neutral flexible adjustment. The results support the theory of a possible beneficial effect of knee braces in reducing knee loading by decreasing muscle activation and co-contraction levels, which could contribute to decelerate disease progression in patients with knee osteoarthritis.     

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.     

Selective lateral muscle activation in moderate medial knee osteoarthritis subjects does not unload medial knee condyle

There is some debate in the literature regarding the role of quadriceps-hamstrings co-contraction in the onset and progression of knee osteoarthritis. Does co-contraction during walking increase knee contact loads, thereby causing knee osteoarthritis, or might it be a compensatory mechanism to unload the medial tibial condyle? We used a detailed musculoskeletal model of the lower limb to test the hypothesis that selective activation of lateral hamstrings and quadriceps, in conjunction with inhibited medial gastrocnemius, can actually reduce the joint contact force on the medial compartment of the knee, independent of changes in kinematics or external forces. “Baseline” joint loads were computed for eight subjects with moderate medial knee osteoarthritis (OA) during level walking, using static optimization to resolve the system of muscle forces for each subject?s scaled model. Holding all external loads and kinematics constant, each subject?s model was then perturbed to represent non-optimal “OA-type” activation based on mean differences detected between electromyograms (EMG) of control and osteoarthritis subjects. Knee joint contact forces were greater for the “OA-type” than the “Baseline” distribution of muscle forces, particularly during early stance. The early-stance increase in medial contact load due to the “OA-type” perturbation could implicate this selective activation strategy as a cause of knee osteoarthritis. However, the largest increase in the contact load was found at the lateral condyle, and the “OA-type” lateral activation strategy did not increase the overall (greater of the first or second) medial peak contact load. While “OA-type” selective activation of lateral muscles does not appear to reduce the medial knee contact load, it could allow subjects to increase knee joint stiffness without any further increase to the peak medial contact load.     

Analysis of muscle activation patterns during transitions into and out of high knee flexion postures

Increased risk of medial tibiofemoral osteoarthritis (OA) is linked to occupations that require frequent transitions into and out of postures which require high knee flexion (>90°). Muscle forces are major contributors to joint loading, and an association between compressive forces due to muscle activations and the degeneration of joint cartilage has been suggested. The purpose of this study was to evaluate muscle activation patterns of muscles crossing the knee during transitions into and out of full-flexion kneeling and squatting, sitting in a low chair, and gait. Both net and co-activation were greater when transitioning out of high flexion postures, with maximum activation occurring at knee angles greater than 100°. Compared to gait, co-activation levels during high flexion transitions were up to approximately 3 times greater. Co-activation was significantly greater in the lateral muscle group compared to the medial group during transitions into and out of high flexion postures. These results suggest that compression due to activation of the medial musculature of the knee may not be the link between high knee flexion postures and increased medial knee OA observed in occupational settings. Further research on a larger subject group and workers with varying degrees of knee OA is necessary.     

Dynamic joint and muscle forces during knee isokinetic exercise

Isokinetic exercise has been commonly used in knee rehabilitation, conditioning and research in the past two decades. Although many investigators have used various experimental and theoretical approaches to study the muscle and joint force involved in isokinetic knee extension and flexion exercises, only a few of these studies have actually distinguished between the tibiofemoral joint forces and muscle forces. Therefore, the objective of this study was to specify, via an eletromyography(EMG)-driven muscle force model of the knee, the magnitude of the tibiofemoral joint and muscle forces acting during isokinetic knee extension and flexion exercises. Fifteen subjects ranging from 21 to 36 years of age volunteered to participate in this study. A Kin Com exercise machine (Chattecx Corporation, Chattanooga, TN, U.S.A.) was used as the loading device. An EMG-driven muscle force model was used to predict muscle forces, and a biomechanical model was used to analyze two knee joint constraint forces; compression and shear force. The methods used in this study were shown to be valid and reliable (r > 0.84 andp < 0.05). The effects on the tibiofemoral joint force during knee isokinetic exercises were compared with several functional activities that were investigated by earlier researchers. The muscle forces generated during knee isokinetic exercise were also obtained. Based on the findings obtained in this study, several therapeutic justifications for knee rehabilitation are proposed.     

Changes in actin structural transitions associated with oxidative inhibition of muscle contraction

We have used transient phosphorescence anisotropy (TPA) to detect changes in actin structural dynamics associated with oxidative inhibition of muscle contraction. Contractility of skinned rabbit psoas muscle fibers was inhibited by treatment with 50 mM H 2O 2, which induced oxidative modifications in the myosin head and in actin, as previously reported. Using proteins purified from oxidized and unoxidized muscle, we used TPA to measure the effects of weakly (+ATP) and strongly (no ATP) bound myosin heads (S1) on the microsecond dynamics of actin labeled at Cys374 with erythrosine iodoacetamide. Oxidative modification of S1 had no effect on actin dynamics in the absence of ATP (strong binding complex), but restricted the dynamics in the presence of ATP (weakly bound complex). In contrast, oxidative modification of actin did not have a significant effect on the weak-to-strong transitions. Thus, we concluded that (1) the effects of oxidation on the dynamics of actin in the actomyosin complex are predominantly determined by oxidation-induced changes in S1, and (2) changes in weak-to-strong structural transitions in actin and myosin are coupled to each other and are associated with oxidative inhibition of muscle contractility.