A new method for evaluating motor control in gait under real-life environmental conditions. Part 1: The instrument.

A new method for evaluating motor control in gait under real-life environmental conditions. Part 2: Gait analysis.

Postural adaptation to walking on inclined surfaces: I. Normal strategies

Objective

To determine whether the adduction moment at the knee during locomotor activity contributes to the development of future chronic knee pain.



Methods

We studied 132 community-dwelling elders who had undergone a full kinetic and kinematic motion analysis while performing 4 different activities: standing, walking, rising from a chair, and descending stairs. We contacted the participants 3–4 years after their baseline locomotion analysis and identified those who reported no knee pain at the time of motion analysis but who subsequently developed new chronic knee pain at followup. We examined whether the development of new chronic knee pain was associated with higher peak adduction moment at the knee during activities, measured at baseline.



Results

Of the 132 elders evaluated in 1995–1996, 118 (89%) were contacted in 1999. Of the 118 contacted, 80 (mean age 75 years; 78% women) had no lower extremity prosthetic joints at baseline, no known underlying inflammatory arthritis at baseline nor followup, and no baseline knee pain. At followup, 7 had developed new chronic knee pain defined as pain or stiffness on most days of the month and with walking 2 blocks or using stairs. Compared with those who did not develop knee pain, those who did develop new chronic knee pain had higher baseline adduction moments for all activities (P = 0.01), ranging from 8% higher during chair rise to 39% higher during stair descent.



Conclusion

We found that greater adduction moment at the knee during activities contributes to the development of future chronic knee pain. Our results suggest that biomechanical factors may play an important role in the pathogenesis of knee pain and should be studied further.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.20396

Knee adduction moment and development of chronic knee pain in elders

Patterns of spinal motion during walking

We investigated upper-body (ie, trunk) angular kinematics (motions) during gait, stair climbing and descending, and rising from a chair in two reference frames--relative to the pelvis and to room coordinates. Bilateral kinematic data were collected from 11 healthy subjects (6 female, 5 male), who were 27 to 88 years of age (mean = 58.9, SD = 17.9). During stair climbing, maximum trunk flexion relative to the room was at least double that during stair descending and gait. Arising from a chair required the most trunk flexion/extension range of motion (ROM) but the least abduction/adduction and medial/lateral (internal/external) rotation. Trunk ROM during gait was small (mean less than or equal to 12 degrees) and consistent with previous literature. Trunk range of motion relative to the room during stair climbing and descending was greater than trunk ROM during gait in all planes. The pelvis and trunk rotate in the transverse plane in greater synchrony during stair descending (mean = 8.1 degrees, SD = 5.6 degrees) than during gait (mean = 12.0 degrees, SD = 4.2 degrees). For all activities, trunk frontal and sagittal ROM relative to the pelvis was greater than that relative to the room coordinates. This finding suggests that trunk/pelvis coordination may be used to reduce potentially destabilizing anti-gravity trunk motions during daily activities. We conclude that upper-body kinematics relative to both pelvis and gravity during daily activities are important to locomotor control and should be considered in future studies of patients with locomotor disabilities.

D Jevsevar

Papers

Trunk kinematics during locomotor activities.