Elsevier

Gait & Posture

Volume 41, Issue 2, February 2015, Pages 488-492
Gait & Posture

Do patients with knee osteoarthritis perform sit-to-stand motion efficiently?

https://doi.org/10.1016/j.gaitpost.2014.11.015Get rights and content

Highlights

  • We examined power of patients with knee osteoarthritis during sit-to-stand motion.

  • Patients with knee osteoarthritis showed decreased energy absorption in the knee extensors.

  • Patients with knee osteoarthritis cannot perform sit-to-stand motion efficiently.

Abstract

The sit-to-stand motion (STS) is a frequently executed activity that is affected by weakness in the quadriceps femoris muscle and knee joint pain in patients with knee osteoarthritis (OA). We investigated whether patients with knee OA can efficiently perform STS through mechanical energy transfer assessments. Participants were 20 women with knee OA and 17 age-matched asymptomatic controls. The center of mass (COM), segment angles, joint moments, and powers during STS were measured. The negative mechanical work in the proximal portion of the shank, negative mean powers in the distal portion of the pelvis and proximal portion of the shank, and the positive mean power in the proximal and distal portions of the thigh were significantly lower in the knee OA group than in the control group. Patients with knee OA primarily performed thoracic forward lean movement, shifting their COM closer to the base of support provided by the feet alone, in an attempt to achieve stability at and after buttocks-off. However, control ability, which generates and absorbs kinetic energy quickly, was not enhanced in these patients, and their motion was unable to increase absorption of the mechanical energy in hip extensors and reduce the load on knee extensors. Furthermore, STS in patients with knee OA had reduced energy absorption in the knee extensors from the shank forward lean movement after buttocks-off, had reduced knee extensor efficiency, and made greater use of physiological energy. These findings suggest that, from the standpoint of mechanical energy transfer, patients with knee OA do not perform STS efficiently.

Introduction

Knee osteoarthritis (knee OA) is a degenerative joint disease characterized by the accumulation of mechanical stress, leading to pathological changes, such as degeneration and failure of the articular cartilage and formation of osteophytes [1]. Knee OA is characterized by weakness in the quadriceps femoris muscle and knee joint pain [2], and affects the ability to perform various movements in daily life.

Sit-to-stand motion (STS) is a complicated motion routinely repeated and requires the coordination of multiple body segments. From the perspective of mechanical energy, total mechanical energy increases at motion termination compared to motion initiation. This underscores the importance of efficiency, in which work is done with joint moment, because the energy generated by this work is used to move body segments. Williams and Cavanagh [3] reported that mechanical energy transferred between segments increased the efficiency of utilized physiological energy, and that the increased mechanical energy transfer suppresses the generation of physiological energy by muscles, thereby enhancing their efficiency. In a previous study [4], we reported that trunk and shank forward lean movements in STS not only moved the center of mass (COM) forward, but also transferred energy to the thigh via muscle by rotating the trunk and shank in the same direction as the thigh. This decreased the generation of physiological energy by muscle in the buttocks-off task.

Patients with knee OA have increased co-contraction of lateral knee muscles [5] and increased stiffness of the knee joint during walking [6]. Thus, STS in patients with knee OA might be an inefficient motion. In a previous study of STS for patients with knee OA, Patsika et al. [7] reported that the slower performance of STS is due to the less efficient use of knee extensor muscles. Turcot et al. [8] demonstrated that patients with knee OA lean their trunk forward to reduce pain and decrease the solicitation of weaker muscles. Although studies have shown that STS is a more energy-demanding and less efficient task for patients with low back pain [9], none of these published STS studies have addressed the actual mechanical energy transfer in patients with knee OA. The purpose of this study was to investigate whether patients with knee OA can perform efficient STS through mechanical energy transfer assessments.

Section snippets

Subjects

Subjects were 20 women who were diagnosed with knee OA (knee OA group) and 17 women who did not fulfill the knee OA clinical diagnostic criteria of the American College of Rheumatology [10] and were free from pain in the other lower extremity joints (control group) (Table 1). Anteroposterior X-ray images of the knee joint taken when subjects were standing on both legs were used to determine the severity of knee OA with the Kellgren-Lawrence grading scale [11]. Severity of knee pain was measured

Results

The STS time and Phase II time in the knee OA group were significantly longer than those in the control group (p < 0.05), whereas the Phase I time did not differ between the two groups. DCH at buttocks-off in the knee OA group was significantly shorter than that in the control group (p < 0.01). The variation in thorax forward lean angle in the knee OA group was significantly larger than that in the control group (p < 0.01). Variations in the pelvis and shank forward lean angles did not differ

Discussion

This study aimed to investigate whether patients with knee OA performed efficient STS from the standpoint of mechanical energy transfer.

STS requires the transition from a wide BOS provided by the buttocks, thighs, and feet to a narrow BOS provided by feet alone. The positional relationship between COM and BOS during STS is used as an index for postural stability [17]. With respect to buttocks-off, i.e., the transitional phase of BOS, DCH at buttocks-off in the knee OA group was significantly

Conclusion

In this study, patients with knee OA primarily performed the thoracic forward lean movement, bringing their COM closer to the BOS provided by feet alone in an attempt to achieve stability after buttocks-off. However, these patients did not exhibit enhanced control ability and their motions did not increase hip extension moment impulses or reduce knee extension moment impulses. Moreover, STS in patients with knee OA had reduced negative mechanical work in the proximal portion of the shank after

Conflict of interest

The authors have no conflict of interest associated with this study.

Acknowledgments

This study was supported by a Grant-in-Aid 21700532 from the Japan Society for the Promotion of Science (JSPS). We hereby express our sincere appreciation to Dr. Yoshihiro Ehara at Niigata University of Health and Welfare for his advice and guidance throughout this study.

References (21)

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    The descriptive synthesized data indicated that individuals with knee-OA could not utilize the force generated from joints other than the knee joint based on following results and interpretation. Power analysis during STS motion showed that individuals with knee-OA could not increase the absorption of mechanical energy in the hip extensor with trunk flexion movement, whereas they decreased the absorption of mechanical energy in the knee extensor with the shank forward-lean movement following the buttocks-off movement (Anan et al., 2015). Furthermore, the extended time for STS motion interfered with the occurrence of inter-segment passive force (Bouchouras et al., 2015).

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