Lower-limb joint reaction forces and moments during modified cycling in healthy controls and individuals with knee osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is a clinical problem affecting an estimated 27 million adults in the United States, with the only clear treatment options being pain management. Cycling is an integral component of exercise for individuals with knee osteoarthritis, while the joint reaction forces during cycling remain unknown. METHODS: Thirteen subjects with medial compartment knee osteoarthritis and eleven healthy subjects performed a cycling protocol with a neutral pedal and four pedal modifications. Six hundred muscle-actuated inverse-dynamic simulations (24 subjects, 5 trials in each of 5 conditions) were performed to estimate joint reaction force differences between conditions. FINDINGS: Subjects with knee osteoarthritis had many significant changes among them was a reduction in knee adduction-abduction moment by 45% (5° lateral wedge), 77% (10° lateral wedge), 54% (5° toe-in) and 58% (10° toe-in). Conversely the healthy subjects had no significant changes in the knee adduction-abduction moment for the lateral wedge conditions and the 5° toe-in but did decrease by 18% for the 10° toe-in condition. When comparing the cohorts across the different pedal conditions, the data showed many significant differences among the groups. INTERPRETATION: This study showed that while cycling in different pedal modifications, the knee osteoarthritis subjects had more beneficial changes in their knee adduction-abduction moment compared to the healthy subjects with the lateral-wedge modification resulting in the greatest impact on the subjects with knee osteoarthritis. Both groups had greater contact forces at the hip and ankle across pedal modifications compared to neutral. For the knee, subjects with osteoarthritis mostly decreased their knee contact forces but the healthy subjects mostly increased these forces with all pedal modifications.

Acute effects of lateral shoe wedges on joint biomechanics of patients with medial compartment knee osteoarthritis during stationary cycling.

Cycling is commonly prescribed for individuals with knee osteoarthritis (OA) but very little biomechanical research exists on the topic. Individuals with OA may be at greater risk of OA progression or other knee injuries because of their altered knee kinematics. This study investigated the effects of lateral wedges on knee joint biomechanics and pain in patients with medial compartment knee OA during stationary cycling. Thirteen participants with OA and 11 paired healthy participants volunteered for this study. A motion analysis system and a customized instrumented pedal were used to collect 5 pedal cycles of kinematics and kinetics, respectively, during 2 minutes of cycling in 1 neutral and 2 lateral wedge (5° and 10°) conditions. Participants pedaled at 60 RPM and an 80W workrate and rated their knee pain on a visual analog scale during each minute of each condition. There was a 22% decrease in the internal knee abduction moment with the 10° wedge. However, this finding was not accompanied by a decrease in knee adduction angle or subjective pain. Additionally, there was an increase in vertical and horizontal pedal reaction force which may negate the advantages of the decreased internal knee abduction moment. For people with medial knee OA, cycling with 10° lateral wedges may not be sufficient to slow the progression of OA beyond the neutral riding condition.

Effects of Workloads and Cadences on Frontal Plane Knee Biomechanics in Cycling.

UNLABELLED: Although effects of workload and cadence on sagittal plane knee biomechanics in cycling have been widely studied, few studies have examined their impact on the frontal plane. PURPOSE: The purpose of this study was to investigate the effects of different workloads and cadences on knee sagittal and frontal plane biomechanics. METHODS: Eighteen healthy participants (age, 55.7 ± 11.0 yr) volunteered for this study. A motion analysis system and a custom instrumented pedal were used to collect five cycles of three-dimensional kinematics (240 Hz) and pedal reaction force (PRF, 1200 Hz) during 2 min of cycling in each of eight testing conditions, including five workload conditions of 0.5, 1, 1.5, 2, and 2.5 kg at 60 rpm, and three cadence conditions of 70, 80, and 90 rpm with 1-kg workload. Two one-way repeated measures analyses of variance were used to examine the influence of cadence and workload on selected variables (P < 0.05). RESULTS: Increased workloads with constant rpm caused an increased peak knee abduction moment from 5.82 to 14.36 N · m and peak knee extension moment from 11.61 to 37.16 N · m. Increased workloads also significantly increased peak medial and vertical PRF. Increased cadences at the constant workload had no effects on peak knee abduction moment but caused increased peak anterior and vertical PRF and peak knee flexion moment. CONCLUSIONS: The findings of this study indicate that increasing workload at constant cadence significantly increased peak knee abduction moment. Further study may be needed to demonstrate the efficacy of appropriate levels of workload and cadence in knee osteoarthritis and other populations with knee problems.

Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis.

BACKGROUND: Cycling is commonly prescribed for knee osteoarthritis, but previous literature on biomechanics during cycling and the effects of acute intervention on osteoarthritis patients does not exist. Due to their altered knee kinematics, osteoarthritis patients may be at greater risk of osteoarthritis progression or other knee injuries during cycling. This study investigated the effects of reduced foot progression (toe-in) angles on knee joint biomechanics in subjects with medial compartment knee osteoarthritis. METHODS: Thirteen osteoarthritis and 11 healthy subjects participated in this study. A motion analysis system and custom instrumented pedal was used to collect 5 pedal cycles of kinematic and kinetic data in 1 neutral and 2 toe-in conditions (5° and 10°) at 60 RPM and 80W. FINDINGS: For peak knee adduction angle, there was a 61% (2.7°) and a 73% (3.2°) decrease in the 5° and 10° toe-in conditions compared to neutral in the osteoarthritis group and a 77% (1.7°) and 109% (2.4°) decrease in the healthy group for the 5° and 10° conditions, respectively. This finding was not accompanied by a decrease in pain or peak knee abduction moment. A simple linear regression showed a positive correlation between Kelgren-Lawrence score and both peak knee adduction angle and abduction moment. INTERPRETATION: For individuals who cycle with increased knee adduction angles, decreasing the foot progression angle may be beneficial for reducing the risk of overuse knee injuries during cycling by resulting in a frontal plane knee alignment closer to a neutral position.

Gait biomechanics of a second generation unstable shoe.

The recent popularity of unstable shoes has sparked much interest in the efficacy of the shoe design. Anecdotal evidence suggests that earlier designs appear bulky and less aesthetically appealing for everyday use. The purpose of this study was to examine effects of a second generation unstable shoe on center of pressure (COP), ground reaction force (GRF), kinematics, and kinetics of the ankle joint during level walking at normal and fast speeds. In addition, findings were compared with results from the first generation shoe. Fourteen healthy males performed five successful level walking trials in four testing conditions: walking in unstable and control shoes at normal (1.3 m/s) and fast (1.8 m/s) speeds. The unstable shoe resulted in an increase in mediolateral COP displacement, first peak vertical GRF loading rate, braking GRF, ankle eversion range of motion (ROM), and inversion moment; as well as a decrease in anteroposterior COP displacement, second peak vertical GRF, ankle plantarflexion ROM, and dorsiflexion moment. Only minor differences were found between the shoe generations. Results of the generational comparisons suggest that the lower-profile second generation shoe may be as effective at achieving the desired unstable effects while promoting a smoother transition from heel contact through toe off compared with the first generation shoe.

Filtering ground reaction force data affects the calculation and interpretation of joint kinetics and energetics during drop landings.

An inverse dynamic analysis and subsequent calculation of joint kinetic and energetic measures is widely used to study the mechanics of the lower extremity. Filtering the kinematic and kinetic data input to the inverse dynamics equations affects the calculated joint moment of force (JMF). Our purpose was to compare selected integral values of sagittal plane ankle, knee, and hip joint kinetics and energetics when filtered and unfiltered GRF data are input to inverse dynamics calculations. Six healthy, active, injury-free university student (5 female, 1 male) volunteers performed 10 two-legged landings. JMFs were calculated after two methods of data filtering. Unfiltered: marker data were filtered at 10 Hz, GRF data unfiltered. Filtered: both GRF and marker data filtered at 10 Hz. The filtering of the GRF data affected the shape of the knee and hip joint moment-time curves, and the ankle, knee and hip joint mechanical power-time curves. We concluded that although the contributions of individual joints to the support moment and to total energy absorption were not affected, the attenuation of high-frequency oscillations in both JMF and JMP time curves will influence interpretation of CNS strategies during landing.

Effect of ankle braces on lower extremity joint energetics in single-leg landings.

PURPOSE: Ankle sprains are one of the most common injuries in competitive and recreational athletics. Studies have shown that the use of prophylactic ankle braces effectively reduces the frequency of ankle sprains in athletes. However, although it is generally accepted that the ankle braces are effective at reducing frontal plane motion, some researchers report that the design of the brace may also reduce ankle sagittal plane motion. The purpose of this study was to quantify lower extremity joint contributions to energy absorption during single-legged drop landings in three ankle brace conditions (no brace, boot brace, and hinged brace). METHODS: Eleven physically active females experienced in landing and free of lower extremity injury (age = 22.3 ± 1.7 yr, height = 1.66 ± 0.04 m, mass = 58.43 ± 5.83 kg) performed 10 single-leg drop landings in three conditions (one unbraced, two braced) from a 0.33-m height. Measurements taken were hip, knee, and ankle joint impulse; hip, knee, ankle, and total work; and hip, knee, and ankle joint relative work. RESULTS: Total energy absorption remained consistent across the braced conditions (P = 0.057). Wearing the boot brace reduced relative ankle work (P = 0.04, Cohen d = 0.43) but did not change relative knee (P = 0.08, Cohen d = 0.32) or hip (P = 0.14, Cohen d = 0.20) work compared with the no-brace condition. CONCLUSIONS: In an ankle-braced condition, ankle, knee, and hip energetics may be altered depending on the design of the brace.