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Females with knee osteoarthritis use a detrimental knee loading strategy when squatting

      Highlights

      • Squats detected OA related impairments in movement patterns and muscle activity.
      • Males with OA implemented a hip-dominant strategy, decreasing knee joint loading.
      • Females with OA had the highest muscle activation throughout the squat.
      • Sex differences in hip and knee frontal plane kinematics and kinetics were present.
      • Hip joint power was lower in females during squat descent compared to males.

      Abstract

      Background

      The purpose of this study was to identify sex differences in lower limb kinematics, kinetics, and muscle activation patterns between individuals with osteoarthritis and healthy controls during a two-legged squat.

      Method

      Thirty OA (15 females) and 30 healthy (15 females) participants performed three 2-legged squats. Sagittal and frontal plane hip, knee, and ankle kinematics and kinetics were calculated. Two-way ANOVAs (Sex X OA Status) were used to characterize differences in squatting strategies between sexes and between those with and without knee OA.

      Results

      A greater decrease in sagittal hip, knee, and ankle range of motion and knee joint power was observed in the OA participants compared to the healthy controls. Females with OA had significantly reduced hip and knee adduction angles compared to the healthy females and males with OA. Females also had decreased hip power, hip flexion, and hip adduction moments and knee adduction moments compared to their male counterparts, with the greatest deficits observed in the females with OA. Females with OA also had the highest magnitude of muscle activation for the quadriceps, hamstrings, and gastrocnemius throughout the squat, while males with OA showed increased activation of the vastus lateralis and medial gastrocnemius compared to the healthy males.

      Conclusions

      OA significantly altered biomechanics and neuromuscular control during the squat, with males employing a hip-dominant strategy, allowing them to achieve a greater lower limb range of motion.

      Keywords

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      References

        • Badley E.
        The effect of osteoarthritis on disability and health care use in Canada.
        J Rheumatol Suppl. 1995; 43: 19-22
        • Buckwalter J.A.
        • Stanish W.D.
        • Rosier R.N.
        • Schenck R.C.
        • Dennis D.A.
        • Coutts R.D.
        The Increasing Need for Nonoperative Treatment of Patients With Osteoarthritis.
        Clin Orthop Relat Res. 2001; 385: 36-45https://doi.org/10.1097/00003086-200104000-00008
        • Bombardier C.
        • Hawker G.
        • Mosher D.
        The impact of arthritis in Canada: Today and over the next 30 years.
        Arthritis Alliance Canada. 2011; : 1-52
        • Guccione A.A.
        • Felson D.T.
        • Anderson J.J.
        • Anthony J.M.
        • Zhang Y.
        • Wilson P.W.
        • et al.
        The effects of specific medical conditions on the functional limitations of elders in the Framingham Study.
        Am J Public Health. 1994; 84: 351-358https://doi.org/10.2105/AJPH.84.3.351
        • Lewek M.D.
        • Rudolph K.S.
        • Snyder-Mackler L.
        Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis.
        J Orthop Res. 2004; 22: 110-115https://doi.org/10.1016/S0736-0266(03)00154-2
        • Hurley M.V.
        The effects of joint damage on muscle function, proprioception and rehabilitation.
        Manual Therapy. 1997; 2: 11-17
        • Petterson S.C.
        • Raisis L.
        • Bodenstab A.
        • Snyder-Mackler L.
        Disease-specific gender differences among total knee arthroplasty candidates.
        J Bone Joint Surgery Am Vol. 2007; 89: 2327-2333https://doi.org/10.2106/JBJS.F.01144
      1. Jones H, Reed B. Why should the water and sanitation sector consider disabled people. WELL—Resource Centre Network for Water, Sanitation and Environmental Health, 2005.

        • Hirvensalo M.
        • Rantanen T.
        • Heikkinen E.
        Mobility Difficulties and Physical Activity as Predictors of Mortality and Loss of Independence in the Community-Living Older Population.
        J Am Geriatr Soc. 2000; 48: 493-498https://doi.org/10.1111/j.1532-5415.2000.tb04994.x
        • Lynn S.K.
        • Noffal G.J.
        Lower Extremity Biomechanics During A Regular and Counterbalanced Squat.
        J Strength Condition Res. 2012; 26: 2417-2425
        • Dionisio V.C.
        • Almeida G.L.
        • Duarte M.
        • Hirata R.P.
        Kinematic, kinetic and EMG patterns during downward squatting.
        J Electromyogr Kinesiol. 2008; 18: 134-143https://doi.org/10.1016/j.jelekin.2006.07.010
        • Hase K.
        • Sako M.
        • Ushiba J.
        • Chino N.
        Motor strategies for initiating downward-oriented movements during standing in adults.
        Exp Brain Res. 2004; 158: 18-27https://doi.org/10.1007/s00221-004-1875-4
        • Almosnino S.
        • Kingston D.
        • Graham R.B.
        Three-Dimensional Knee Joint Moments During Performance of the Bodyweight Squat: Effects of Stance Width and Foot Rotation.
        J Appl Biomech. 2013; 29: 33-43
        • Flanagan S.
        • Salem G.J.
        • Wang M.-Y.
        • Sanker S.E.
        • Greendale G.A.
        Squatting Exercises in Older Adults: Kinematic and Kinetic Comparisons:.
        Med Sci Sports Exerc. 2003; 35: 635-643
        • Youdas J.W.
        • Hollman J.H.
        • Hitchcock J.R.
        • Hoyme G.J.
        • Johnsen J.J.
        Comparison of Hamstring and Quadriceps Femoris Electromyographic Activity Between Men and Women During a Single-Limb Squat on Both a Stable and Labile Surface.
        J Strength Condition Res. 2007; 21: 105-111https://doi.org/10.1519/00124278-200702000-00020
        • Zeller B.L.
        • McCrory J.L.
        • Ben Kibler W.
        • Uhl T.L.
        Differences in Kinematics and Electromyographic Activity Between Men and Women during the Single-Legged Squat.
        Am J Sports Med. 2003; 31: 449-456
        • Dwyer M.K.
        • Boudreau S.N.
        • Mattacola C.G.
        • Uhl T.L.
        • Lattermann C.
        Comparison of lower extremity kinematics and hip muscle activation during rehabilitation tasks between sexes.
        J Athletic Train. 2010; 45: 181-190https://doi.org/10.4085/1062-6050-45.2.181
        • Graci V.
        • Van Dillen L.R.
        • Salsich G.B.
        Gender differences in trunk, pelvis and lower limb kinematics during a single leg squat.
        Gait & Posture. 2012; 36: 461-466https://doi.org/10.1016/j.gaitpost.2012.04.006
        • Silva R.S.
        • Serrão F.V.
        Sex differences in trunk, pelvis, hip and knee kinematics and eccentric hip torque in adolescents.
        Clin Biomech. 2014; 29: 1063-1069https://doi.org/10.1016/j.clinbiomech.2014.08.004
        • Mauntel T.C.
        • Post E.G.
        • Padua D.A.
        • Bell D.R.
        Sex differences during an overhead squat assessment.
        J Appl Biomech. 2015; 31: 244-249
        • Turcot K.
        • Armand S.
        • Fritschy D.
        • Hoffmeyer P.
        • Suvà D.
        Sit-to-stand alterations in advanced knee osteoarthritis.
        Gait & Posture. 2012; 36: 68-72
        • Bouchouras G.
        • Patsika G.
        • Hatzitaki V.
        • Kellis E.
        Kinematics and knee muscle activation during sit-to-stand movement in women with knee osteoarthritis.
        Clin Biomech. 2015; 30: 599-607
        • Sharma L.
        • Pai Y.-C.
        Impaired proprioception and osteoarthritis.
        Curr Opin Rheumatol. 1997; 9: 253-258
        • Hinman R.S.
        • Bennell K.L.
        • Metcalf B.R.
        • Crossley K.M.
        Balance impairments in individuals with symptomatic knee osteoarthritis : a comparison with matched controls using clinical tests.
        Rheumatology. 2002; 41: 1388-1394
        • Padua D.A.
        • Bell D.R.
        • Clark M.A.
        Neuromuscular characteristics of individuals displaying excessive medial knee displacement.
        J Athl Train. 2012; 47: 525-536https://doi.org/10.4085/1062-6050-47.5.10
        • Bell D.R.
        • Padua D.A.
        • Clark M.A.
        Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.
        Arch Phys Med Rehabil. 2008; 89: 1323-1328
        • Hermens H.J.
        • Freriks B.
        • Disselhorst-Klug C.
        • Rau G.
        Development of recommendations for SEMG sensors and sensor placement procedures.
        J Electromyogr Kinesiol. 2000; 10: 361-374https://doi.org/10.1016/S1050-6411(00)00027-4
        • Roos E.M.
        • Toksvig-Larsen S.
        Knee injury and Osteoarthritis Outcome Score (KOOS) – validation and comparison to the WOMAC in total knee replacement.
        Health Quality Life Outcomes. 2003; 1: 17https://doi.org/10.1186/1477-7525-1-17
        • Beaulieu M.L.
        • Lamontagne M.
        • Beaulé P.E.
        Lower limb biomechanics during gait do not return to normal following total hip arthroplasty.
        Gait & Posture. 2010; 32: 269-273https://doi.org/10.1016/j.gaitpost.2010.05.007
        • Pataky T.C.
        • Robinson M.A.
        • Vanrenterghem J.
        Vector field statistical analysis of kinematic and force trajectories.
        J Biomech. 2013; 46: 2394-2401https://doi.org/10.1016/j.jbiomech.2013.07.031
        • Nene A.
        • Byrne C.
        • Hermens H.
        Is rectus femoris really a part of quadriceps?: Assessment of rectus femoris function during gait in able-bodied adults.
        Gait & Posture. 2004; 20: 1-13https://doi.org/10.1016/S0966-6362(03)00074-2
        • Piazza S.J.
        • Delp S.L.
        The influence of muscles on knee flexion during the swing phase of gait.
        J Biomech. 1996; 29: 723-733https://doi.org/10.1016/0021-9290(95)00144-1
        • Ito J.
        • Moriyama H.
        • Inokuchi S.
        • Goto N.
        Human Lower Limb Muscles: an Evaluation of Weight and Fiber Size.
        Okajimas Folia Anat Jpn. 2003; 80: 47-56https://doi.org/10.2535/ofaj.80.47
        • Gans C.
        • Gaunt A.S.
        Muscle Architecture in Relation to Function.
        J Biomech. 1991; 24: 53-65
        • Powers C.M.
        The influence of abnormal hip mechanics on knee injury: a biomechanical perspective.
        J Orthopaedic Sports Phys Therapy. 2010; 40: 42-51https://doi.org/10.2519/jospt.2010.3337
        • Hewett T.E.
        • Paterno M.V.
        • Myer G.D.
        Strategies for Enhancing Proprioception and Neuromuscular Control of the Knee.
        Clin Orthop Relat Res. 2002; 402: 76-94
        • Youssef A.R.
        • Longino D.
        • Seerattan R.
        • Leonard T.
        • Herzog W.
        Muscle Weakness Causes Joint Degeneration in Rabbits.
        Osteoarthritis Cartilage. 2009; 17: 1228-1235https://doi.org/10.1016/j.joca.2009.03.017
        • Herzog W.
        • Longino D.
        The Role of Muscles in Joint Degeneration and Osteoarthritis.
        J Biomech. 2007; 40: 54-63https://doi.org/10.1016/j.jbiomech.2007.03.001
        • Hortobágyi T.
        • Westerkamp L.
        • Beam S.
        • Moody J.
        • Garry J.
        • Holbert D.
        • et al.
        Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis.
        Clin Biomech. 2005; 20: 97-104
        • Piscoya J.L.
        • Fermor B.
        • Kraus V.B.
        • Stabler T.V.
        • Guilak F.
        The influence of mechanical compression on the induction of osteoarthritis-related biomarkers in articular cartilage explants.
        Osteoarthritis cartilage/OARS, Osteoarthritis Res Soc. 2005; 13: 1092-1099https://doi.org/10.1016/j.joca.2005.07.003
        • Al-Zahrani K.S.
        • Bakheit A.M.O.
        A study of the gait characteristics of patients with chronic osteoarthritis of the knee.
        Disabil Rehabil. 2002; 24: 275-280https://doi.org/10.1080/09638280110087098
        • Hicks-little C.A.
        • Peindl R.D.
        • Hubbard T.J.
        • Scannell B.P.
        • Springer B.D.
        • Odum S.M.
        • et al.
        Lower extremity joint kinematics during stair climbing in knee osteoarthritis.
        Med Sci Sports Exerc. 2011; 43: 516-524https://doi.org/10.1249/MSS.0b013e3181f257be
        • Takacs J.
        • Carpenter M.G.
        • Garland S.J.
        • Hunt M.A.
        The Role of Neuromuscular Changes in Aging and Knee Osteoarthritis on Dynamic Postural Control.
        Aging Disease. 2013; 4: 84-99
        • Gehlesen G.M.
        • Whaley M.H.
        Falls in the elderly: part II balance, strength, and flexibility.
        Arch Phys Med Rehabil. 1990; 71: 739-741
        • Hess J.A.
        • Woollacott M.
        Effect of High-Intensity Strength-Training on Functional Measures of Balance Ability in Balance-Impaired Older Adults.
        J Manipulative Physiol Ther. 2005; 28: 582-590https://doi.org/10.1016/j.jmpt.2005.08.013
        • Escamilla R.F.
        Knee biomechanics of the dynamic squat exercise.
        Med Sci Sports Exerc. 2001; 33: 127-141
        • Sritharan P.
        • Lin Y.-C.
        • Pandy M.G.
        Muscles that do not cross the knee contribute to the knee adduction moment and tibiofemoral compartment loading during gait.
        J Orthop Res. 2012; 30: 1586-1595
        • Neelapala Y.V.R.
        • Bhagat M.
        • Shah P.
        Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature.
        J Geriatr Phys Ther. 2020; 43: 89-98
        • Bennell K.L.
        • Hunt M.A.
        • Wrigley T.V.
        • Hunter D.J.
        • McManus F.J.
        • Hodges P.W.
        • et al.
        Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial.
        Osteoarthritis Cartilage. 2010; 18: 621-628
        • Resende R.A.
        • Fonseca S.T.
        • Silva P.L.
        • Magalhães C.M.B.
        • Kirkwood R.N.
        Power at hip, knee and ankle joints are compromised in women with mild and moderate knee osteoarthritis.
        Clin Biomech. 2012; 27: 1038-1044https://doi.org/10.1016/j.clinbiomech.2012.08.001
        • Skelton D.
        • Greig C.
        • Davies J.M.
        • Young A.
        Strength, Power and Related Functional Ability of Healthy People Aged 65–89 Years.
        Age Ageing. 1994; 23: 371-377https://doi.org/10.1093/ageing/23.5.371
        • Sattin R.W.
        Falls among older persons: a public health perspective.
        Annu Rev Public Health. 1992; 13: 489-508https://doi.org/10.1146/annurev.pu.13.050192.002421
        • Niino N.
        • Tsuzuku S.
        • Ando F.
        • Shimokata H.
        Frequencies and circumstances of falls in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA).
        J Epidemiol/Japan Epidemiol Assoc. 2000; 10: S90-S94https://doi.org/10.2188/jea.10.1sup_90
        • Smeesters C.
        • Hayes W.C.
        • McMahon T.A.
        Disturbance type and gait speed affect fall direction and impact location.
        J Biomech. 2001; 34: 309-317https://doi.org/10.1016/S0021-9290(00)00200-1
        • Hurley M.V.
        • Newham D.J.
        The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees.
        Rheumatology. 1993; 32: 127-131