Evaluation of an Unloading Concept for Knee Osteoarthritis: A Pilot Study in a Small Patient Group.

Joint compressive forces have been identified as a risk factor for osteoarthritis disease progression. Therefore, unloader braces are a common treatment with the aim of relieving pain, but their effects are not clearly documented in the literature. A knee brace concept was tested with the aim of reducing joint loads and pain in knee osteoarthritis patients by applying an extension moment exclusively during the stance phase. The ideal effects were evaluated during gait based on musculoskeletal modeling of six patients, and experimental tests with a prototype brace were conducted on one patient. The effects were evaluated using electromyography measurements and musculoskeletal models to evaluate the muscle activation and knee compressive forces, respectively. The ideal brace simulations revealed a varying reduction of the first peak knee force between 3.5% and 33.8% across six patients whereas the second peak was unaffected. The prototype reduced the peak vasti muscle activation with 7.9% and musculoskeletal models showed a reduction of the first peak knee compressive force of up to 26.3%. However, the prototype brace increased the knee joint force impulse of up to 17.1% and no immediate pain reduction was observed. The reduction of the first peak knee compressive force, using a prototype on a single patient, indicates a promising effect from an applied knee extension moment for reducing knee joint loads during normal gait. However, further clinical experiments with this brace method are required to evaluate the long-term effects on both pain and disease progression in knee osteoarthritis patients.

Development and Functional Testing of an Unloading Concept for Knee Osteoarthritis Patients: A Pilot Study.

This paper presents a knee brace design that applies an extension moment to unload the muscles in stance phase during gait, and thereby the knee, as alternative to conventional valgus braces for knee osteoarthritis patients. The concept was tested on one healthy subject during normal gait with a prototype, which was designed to activate and deactivate in order to apply the extension moment in the stance phase only and hereby avoid any interference during the swing phase. Electromyography measurements and musculoskeletal models were used to evaluate the brace effects on muscle activation and knee compressive forces, respectively. Simulations predicted an ideal reduction of up to 36%, whereas experimental tests revealed a reduction of up to 24% with the current prototype. The prototype brace also reduced the knee joint force impulse up to 9% and electromyography (EMG) peak signal of the vasti muscles with up to 19%. Due to these reductions on a healthy subject, this bracing approach seems promising for reducing knee loads during normal gait. However, further clinical experiments on knee osteoarthritis patients are required to evaluate the effect on both pain and disease progression.

Resistance training for explosive and maximal strength: effects on early and late rate of force development.

The aim of the present study was to verify whether strength training designed to improve explosive and maximal strength would influence rate of force development (RFD). Nine men participated in a 6-week knee extensors resistance training program and 9 matched subjects participated as controls. Throughout the training sessions, subjects were instructed to perform isometric knee extension as fast and forcefully as possible, achieving at least 90% maximal voluntary contraction as quickly as possible, hold it for 5 s, and relax. Fifteen seconds separated each repetition (6-10), and 2 min separated each set (3). Pre- and post-training measurements were maximal isometric knee extensor (MVC), RFD, and RFD relative to MVC (i.e., %MVC·s(-1)) in different time-epochs varying from 10 to 250 ms from the contraction onset. The MVC (Nm) increased by 19% (275.8 ± 64.9 vs. 329.8 ± 60.4, p < 0.001) after training. In addition, RFD (Nm·s(-1)) increased by 22-28% at time epochs up to 20 ms from the contraction onset (0-10 ms = 1679. 1 ± 597.1 vs. 2159.2 ± 475.2, p < 0.001; 0-20 ms = 1958.79 ± 640.3 vs. 2398.4 ± 479.6, p < 0. 01), with no changes verified in later time epochs. However, no training effects on RFD were found for the training group when RFD was normalized to MVC. No changes were found in the control group. In conclusion, very early and late RFD responded differently to a short period of resistance training for explosive and maximal strength. This time-specific RFD adaptation highlight that resistance training programs should consider the specific neuromuscular demands of each sport. Key PointsThe time-specific RFD adaptation evoked by resistance training highlight that the method of analyzing RFD is essential for the interpretation of results.Confirming previous data, maximal contractile RFD and maximal force can be differently influenced by resistance training. Thus, the resistance training programs should consider the specific neuromuscular demands of each sport.In active non-strength trained individuals, a short-term resistance training program designed to increase both explosive and maximal strength seems to reduce the adaptive response (i.e. increased RFDMAX) evoked by training with an intended ballistic effort (i.e. high-RFD contraction).