title: Potential interaction of experimental knee pain and laterally wedged insoles for knee off-loading during walking.
abstract: BACKGROUND
  Laterally wedged insoles are one of the gait modifications potentially slowing down progression of medial knee osteoarthritis. Clinical studies have, however, found large individual differences in the biomechanical effect and an insufficient pain reduction. To clarify if and how pain mediates mechanical changes during gait the current study investigated how acute experimental knee pain changes the mechanical effect of laterally wedged insoles in healthy subjects during walking.
  
  
  METHODS
  3D gait analysis was carried out for twelve healthy individuals. The study followed a cross-over design and data were collected with both a neutral and a 10-degree laterally wedged insole with experimental pain induced by hypertonic and isotonic saline injections into the infrapatellar fat pad. Peak knee adduction moment was the primary outcome. A repeated ANOVA (analysis of variance) was used to evaluate the relationship between the factors wedge, condition and test number.
  
  
  RESULTS
  Wedges significantly reduced peak knee adduction moment but experimental knee pain did only marginally affect its magnitude in either condition. While frontal plane mechanics were relatively unaffected by pain, the sagittal plane knee extension moment increased with laterally wedging (P=0.008), whereas late knee flexion moment was reduced by experimental knee pain (P=0.04).
  
  
  CONCLUSIONS
  The effect of laterally wedged insoles in attenuating knee adduction moment during walking is independent of experimental knee pain. The present study provides evidence that subjects with experimental knee pain reduce knee loading by reducing extension moment, whereas lateral wedges have the opposite effect and increase the extension moment.
authors.affiliation: Department of Occupational and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Carsten M
authors.initials: CM
authors.lastname: Mølgaard
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Graven-Nielsen
authors.affiliation: Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Simonsen
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. Electronic address: uwek@hst.aau.dk.
authors.forename: Uwe G
authors.initials: UG
authors.lastname: Kersting
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D018592:Cross-Over Studies; D018450:Disease Progression; D004867:Equipment Design; D005260:Female; D061826:Foot Orthoses; D005684:Gait; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000534:rehabilitation*; D010146:Pain / Q000503:physiopathology*; D010808:Physical Examination; D012775:Shoes; D016138:Walking; D055815:Young Adult
keywords: Experimental pain; Gait analysis; Knee; Knee adduction moment; Lateral wedges; OA