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. 2019 Mar 14;20(1):107.
doi: 10.1186/s12891-019-2493-4.

Gait mechanics contribute to exercise induced pain flares in knee osteoarthritis

Katherine A Boyer  1   2   3 , Jocelyn F Hafer  4   5
Affiliations

Gait mechanics contribute to exercise induced pain flares in knee osteoarthritis

Katherine A Boyer et al. BMC Musculoskelet Disord. .

Abstract

Background: Exercise-induced pain flares represent a significant barrier for individuals with knee osteoarthritis to meet physical activity recommendations. There is a need to understand factors that contribute to pain flares and the potential for the motor system to adapt and reduce joint loading should a flare occur. The study aim was to examine the impact of a bout of exercise on self-reported pain, walking mechanics and muscle co-contraction for participants with knee osteoarthritis.

Methods: Thirty-six adults (17 healthy older and 19 knee osteoarthritis) participated in this study. Self-reported pain, joint mechanics and muscle co-activation during gait at two self-selected speeds were collected before and after a 20-min preferred pace treadmill walk (20MTW).

Results: Eight of nineteen osteoarthritis participants had a clinically significant pain flare response to the 20MTW. At baseline the participants that did not experience a pain flare had smaller knee flexion and total reaction moments compared to both the participants with pain flares (p = 0.02; p = 0.05) and controls (p < 0.001; p < 0.001). In addition, the 2nd peak knee adduction (p = 0.01) and internal rotation (p = 0.001) moments were smaller in the no flares as compared to controls. The pain flare participants differed from controls with smaller knee internal rotation moments (p = 0.03), but greater relative hamstrings (vs. quadriceps) and medial (vs. lateral) muscle activation (p = 0.04, p = 0.04) compared to both controls and no flare participants (p = 0.04, p = 0.007). Following the 20MTW there were greater decreases in the 1st and 2nd peak knee adduction (p = 0.03; p = 0.02), and internal rotation (p = 0.002) moments for the pain flare as compared to the no flare group. In addition, for the pain flare as compared to controls, greater decreases in the knee flexion (p = 0.03) and internal rotation (p = 0.005) moments were found.

Conclusions: Individuals who adapt their gait to reduce knee joint loads may be less susceptible to exercise-induced pain flares. This highlights a potential role of gait biomechanics in short-term osteoarthritis pain fluctuations. The results also suggest that despite the chronic nature of osteoarthritis pain, the motor system's ability to respond to nociceptive stimuli remains intact.

Keywords: Exercise induced pain flare; muscle activation; Gait mechanics; Knee osteoarthritis.

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Conflict of interest statement

Ethics approval and consent to participate

Approval from the University of Massachusetts-Amherst Institutional Review Board, Federal Wide Assurance # 00003909, was obtained for the protocol as reported in this manuscript.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Mean changes (±SE) in hip, knee and ankle kinematics with the 20-min treadmill walk (20MTW). Black bars indicate significant post-hoc group differences α = 0.05
Fig. 2
Fig. 2
Mean changes (±SE) in knee joint moments with the 20-min treadmill walk (20MTW). Black bars indicate significant post-hoc group differences α = 0.05
See this image and copyright information in PMC

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