Do patients with knee osteoarthritis perform sit-to-stand motion 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.
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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.
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