Physiotherapy - Theses
Permanent URI for this collection
Search Results
1 - 1 of 1
-
ItemGait modification strategies for people with medial knee osteoarthritis( 2012)Knee osteoarthritis, most commonly occurring in the medial compartment, is a leading cause of pain and disability among the elderly. During gait, greater compressive load in the medial compartment is a major risk factor for osteoarthritis. As there is currently no cure, interventions which can reduce compressive loads are needed, because of their potential to slow disease progression. Evaluated during gait, the knee adduction moment is a commonly used surrogate measure of medial knee load and a marker for medial knee osteoarthritis progression. One of the conservative biomechanical approaches which may reduce the knee adduction moment is gait modification, or gait retraining. However, little is known about the strategies and their effects on medial knee load. Firstly, a systematic literature review was conducted to identify gait modifications. Of the 14 gait modifications identified in 24 studies, four strategies demonstrated greatest ability to reduce the knee adduction moment. Several limitations of previous studies were identified, such as poor reporting of methods, inclusion of participants without osteoarthritis, no evaluation of symptoms and limited information regarding the amount of modification required. Because of demonstrated ability to reduce a parameter of the knee adduction moment in cohorts, the following modifications were investigated in separate studies involving participants with symptomatic medial knee osteoarthritis: use of a cane on the contralateral side, increased lateral trunk lean and altered foot progression angle. The effects of contralateral cane use on knee load and pain were investigated in 23 individuals. Participants placed pre-determined magnitudes of support through the cane. Findings showed reductions in all knee load parameters, with a dose-response relationship. Likely due to biomechanical advantages, the technique of cane use influenced the load-reducing efficacy, such as cane positioning and timing of support. Whilst there were no changes in pain with cane use, individuals with greater severity of pain and varus malalignment reduced load more effectively. The effects of ipsilateral trunk lean gait on the knee adduction moment and pain were investigated in 22 individuals. Participants walked with varying magnitudes of trunk lean. Results demonstrated dose-response reductions in all knee load parameters, whilst pain remained unchanged. Timing of the gait modification mediated the efficacy of load reduction. Lastly, effects of altered foot progression angle on pain, the knee adduction and knee flexion moments were investigated in 22 individuals. Participants walked with varying degrees of toe-in and toe-out gait. Whilst pain remained unchanged, toe-in gait reduced the knee adduction moment during early stance but increased the knee flexion moment, knee adduction impulse and late stance adduction moment. Toe-out gait demonstrated opposite effects to toe-in gait. Furthermore, pain and malalignment demonstrated significant mediating effects for some outcomes. This thesis reports new and clinically relevant information on gait modifications for people with medial knee osteoarthritis. It was discovered that participant characteristics, the magnitude of modification and technique of performance altered the efficacy of load reduction achieved by gait modification strategies. Although future longitudinal evaluations are required, gait modifications investigated in this thesis may have potential to slow osteoarthritis progression via load reduction.