title: Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment.
abstract: Varus knee alignment is a risk factor for medial knee osteoarthritis and is associated with high knee adduction moments. Therefore, reducing the knee adduction moment in varus-aligned individuals with otherwise healthy knees may reduce their risk for developing osteoarthritis. A gait modification that improves dynamic knee alignment may reduce the adduction moment, and systematic training may lead to more natural-feeling and less effortful execution of this pattern. To test these hypotheses, eight healthy, varus-aligned individuals underwent a gait modification protocol. Real-time feedback of dynamic knee alignment was provided over eight training sessions, using a fading paradigm. Natural and modified gait were assessed post-training and after 1 month, and compared to pre-training natural gait. The knee adduction moment, as well as hip adduction, hip internal rotation and knee adduction angles were evaluated. At each training session, subjects rated how effortful and natural-feeling the modified pattern was to execute. Post-training, the modified pattern demonstrated an 8 degrees increase in hip internal rotation and 3 degrees increase in hip adduction. Knee adduction decreased 2 degrees , and the knee adduction moment decreased 19%. Natural gait did not differ between the three visits, nor did the modified gait pattern between the post-training and 1 month visits. The modified pattern felt more natural and required less effort after training. Based on these results, gait retraining to improve dynamic knee alignment resulted in significant reductions in the knee adduction moment, primarily through hip internal rotation. Further, systematic training led to more natural-feeling and less effortful execution of the gait pattern.
authors.affiliation: University of Dayton, Dayton, OH 45440-2925, USA. barrios@notes.udayton.edu
authors.forename: Joaquin A
authors.initials: JA
authors.lastname: Barrios
authors.forename: Kay M
authors.initials: KM
authors.lastname: Crossley
authors.forename: Irene S
authors.initials: IS
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D001676:Biofeedback, Psychology / Q000379:methods*; D003199:Computer Systems; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000473:pathology* / Q000534:rehabilitation*; D007719:Knee Joint / Q000002:abnormalities* / Q000473:pathology*; D008297:Male; D026741:Physical Therapy Modalities; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface; D014796:Visual Perception; D055815:Young Adult
references.citation: Orthop Clin North Am. 1994 Jul;25(3):395-403
references.pmid: 8028883
references.citation: Arthritis Rheum. 2004 Apr;50(4):1172-8
references.pmid: 15077299
references.citation: J Biomech. 2008;41(1):165-70
references.pmid: 17678933
references.citation: J Sci Med Sport. 2006 May;9(1-2):67-71
references.pmid: 16621703
references.citation: Gait Posture. 2005 Oct;22(2):138-45
references.pmid: 16139749
references.citation: Clin Neurophysiol. 2004 Sep;115(9):2134-43
references.pmid: 15294216
references.citation: Arthritis Rheum. 2008 Sep 15;59(9):1207-13
references.pmid: 18759314
references.citation: J Orthop Res. 1996 Mar;14(2):289-95
references.pmid: 8648508
references.citation: J Orthop Res. 2007 Sep;25(9):1121-7
references.pmid: 17469197
references.citation: J Biomech Eng. 1983 May;105(2):136-44
references.pmid: 6865355
references.citation: J Orthop Res. 2009 Aug;27(8):1016-21
references.pmid: 19148939
references.citation: Gait Posture. 2001 Oct;14(2):85-91
references.pmid: 11544058
references.citation: J Orthop Res. 2009 Nov;27(11):1414-9
references.pmid: 19402149
references.citation: IEEE Trans Biomed Eng. 2008 Aug;55(8):2104-6
references.pmid: 18632374
references.citation: J Orthop Sports Phys Ther. 1998 Aug;28(2):88-96
references.pmid: 9699158
references.citation: Arthritis Rheum. 2007 Apr;56(4):1204-11
references.pmid: 17393449
references.citation: Ann Rheum Dis. 2002 Jul;61(7):617-22
references.pmid: 12079903
references.citation: IEEE Trans Biomed Eng. 2007 Sep;54(9):1687-95
references.pmid: 17867361
references.citation: Osteoarthritis Cartilage. 2008 Aug;16(8):883-9
references.pmid: 18182310
references.citation: Clin Biomech (Bristol, Avon). 2009 Dec;24(10):850-4
references.pmid: 19703728
references.citation: Gait Posture. 2007 Sep;26(3):436-41
references.pmid: 17134902
references.citation: J Orthop Res. 2002 Jan;20(1):101-7
references.pmid: 11853076
references.citation: Gait Posture. 2008 May;27(4):710-4
references.pmid: 17723303
references.citation: Arthritis Rheum. 2006 Apr 15;55(2):306-13
references.pmid: 16583430
references.citation: Best Pract Res Clin Rheumatol. 2001 Oct;15(4):645-56
references.pmid: 11567545
references.citation: Am J Phys Anthropol. 1959 Dec;17(4):289-317
references.pmid: 13815872
references.citation: Phys Ther. 1991 Feb;71(2):140-9
references.pmid: 1989009
references.citation: J Exp Psychol Learn Mem Cogn. 2008 Jul;34(4):994-1000
references.pmid: 18605884