title: Gait modification strategies for altering medial knee joint load: a systematic review.
abstract: OBJECTIVE
  To evaluate the effect of gait modification strategies on the external knee adduction moment (KAM), a marker of medial knee joint load; determine potentially adverse effects; assess the methodologic quality; and identify areas of future research.
  
  
  METHODS
  Five electronic databases were searched. Studies evaluating the effects of gait modifications on the KAM in either healthy individuals or those with knee osteoarthritis (OA) were included. Methodologic quality was evaluated by 2 reviewers using the Downs and Black checklist.
  
  
  RESULTS
  Twenty-four studies met the inclusion criteria, exploring 14 different gait modifications of varying sample sizes, age groups, and OA classifications. Contralateral cane use, increased step width, medial knee thrust, increased hip internal rotation, weight transfer to the medial foot, and increased lateral trunk lean demonstrated KAM reductions. Tai Chi gait, ipsilateral cane use, Nordic walking poles, and increased knee flexion exhibited increases in the KAM, demonstrating a potential detriment to their use. The effects of reduced stride length, as well as increases and reductions in either toe-out or gait speed, were inconsistent across the studies and gait cycle.
  
  
  CONCLUSIONS
  This review demonstrates that some gait modifications have the ability to alter knee load. Future research is required to determine the magnitude of modification required to maximize beneficial effects, the best method of training, long-term patient adherence, and if these biomechanical changes can translate into clinically relevant changes in symptoms or disease progression risk.
authors.affiliation: University of Melbourne, Victoria, Australia. simicm@unimelb.edu.au
authors.forename: Milena
authors.initials: M
authors.lastname: Simic
authors.forename: Rana S
authors.initials: RS
authors.lastname: Hinman
authors.forename: Tim V
authors.initials: TV
authors.lastname: Wrigley
authors.forename: Kim L
authors.initials: KL
authors.lastname: Bennell
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002183:Canes; D002648:Child; D005260:Female; D005684:Gait; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000628:therapy*; D026741:Physical Therapy Modalities / Q000009:adverse effects / Q000295:instrumentation; D020127:Recovery of Function; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult