Muscle Fatigue's Impact on Gait Mechanics and Neuromuscular Control in Individuals With Knee Osteoarthritis

Links

URL: https://hdl.handle.net/20.500.14394/55936

Abstract

Fatigue, defined here as a lack of physical and/or mental energy, is a commonly-reported symptom of osteoarthritis (OA) that may limit physical capacity and contribute to disability. In healthy older adults, muscle fatigue (acute decrement in muscle power) has been proposed as a key contributor to symptoms of fatigue. Knee extensor muscle dysfunction, including lower isometric and isokinetic torques and altered muscle activation patterns, are common with knee osteoarthritis (KOA). Together these changes in neuromuscular function may increase locomotor muscle fatigue in KOA compared to age-matched controls, as a greater percentage of the muscle’s capacity must be used for daily activities such as walking. To date, evidence to explain whether and how muscle fatigue may alter control and coordination of movement in KOA is limited. Our working hypothesis was that KOA-related neuromuscular changes may exacerbate locomotor muscle fatigue (Aim 1) and alter the neuro-mechanical response to muscle fatigue during gait (Aim 2), thereby contributing to mobility declines. To assess and compare the mechanisms for loss of force with a prolonged walk in individuals with KOA we used high density EMG (Aim 3). We collected data on 2 groups of 19 participants (9 male, 10 female): KOA (65-80 years) and older healthy controls (70-80 years). We implemented a 30-minute treadmill walk (30MTW) to induce knee extensor muscle fatigue and quantified the response with measures of gait mechanics, electromyography, physical performance, and motor unit behavior. We found that knee extensor peak power during dynamic contractions is lower in individuals with KOA compared to older healthy, however, muscle fatigue in response to a 30MTW is not different between groups, and intramuscular fat negatively is associated with poorer mobility. We also found that individuals with KOA do not experience greater performance fatigability (6m walk test) than age and sex matched controls, but they do alter gait mechanics and muscle activation in response to a 30MTW. Finally, individuals with KOA do not have impaired force steadiness as compared to older healthy controls and that only the recruitment threshold is impacted by a 30MTW in individuals with or without KOA. The results of this study suggest that individuals with and without KOA experience measurable knee extensor fatigue in response to 30MTW and individuals with KOA adapt to this fatigue with a gait strategy aimed at maintaining joint stability and attenuating load on the knee joint.

Cited Works (16)

Year	Entry
2006	Andriacchi TP, Mündermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rhuematol. September 2006;18(5):514-518.
1998	Andriacchi TP, Alexander EJ, Toney MK, Dyrby C, Sum J. A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J Biomech Eng. December 1998;120(6):743-749.
2002	Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D'Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion, I: ankle, hip, and spine. J Biomech. 2002;35(4):543-548.
2000	DeVita P, Hortobagyi T. Age causes a redistribution of joint torques and powers during gait. J Appl Physiol. May 2000;88(5):1804-1811.
1957	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. December 1957;16(4):494-502.
2002	Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. July 2002;61(6):617-622.
2002	Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, Andriacchi TP. Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis Cartilage. July 2002;10(7):573-579.
2008	Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res. March 2008;26(3):332-341.
2008	Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part II. Arthritis Rheum. January 2008;58(1):26-35.
1998	Sharma L, Hurwitz DE, Thonar EJ-MA, Sum JA, Lenz ME, Dunlop DD, Schnitzer TJ, Kirwan-Mellis G, Andriacchi TP. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis Rheum. July 1998;41(7):1233-1240.
2004	Andriacchi TP, Mündermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S. A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. March 2004;32(3):447-457.
2007	Deluzio KJ, Astephen JL. Biomechanical features of gait waveform data associated with knee osteoarthritis: an application of principal component analysis. Gait Post. January 2007;25(1):86-93.
2001	Kaufman KR, Hughes C, Morrey BF, Morrey M, An K-N. Gait characteristics of patients with knee osteoarthritis. J Biomech. July 2001;34(7):907-915.
2012	Burr DB, Gallant MA. Bone remodelling in osteoarthritis. Nat Rev Rheumatol. November 2012;8(11):665-673.
2007	Zhao D, Banks SA, Mitchell KH, D'Lima DD, Colwell CW Jr, Fregly BJ. Correlation between the knee adduction torque and medial contact force for a variety of gait patterns. J Orthop Res. June 2007;25(6):789-797.
1964	Hanavan EP Jr. A Mathematical Model of the Human Body. Wright-Patterson AFB, OH: Air Force Aerospace Medical Research Lab; October 1964. Technical Report AMRL-TR-64-100.