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Objective: To test the hypothesis that varus thrust visualized during gait is associated with a higher prevalence of low back pain (LBP) in individuals with knee osteoarthritis (OA)., Methods: Individuals with knee OA (Kellgren/Lawrence grade ≥1) underwent a gait observation to assess varus thrust. The participants identified LBP and its severity using questionnaires. Logistic regression analyses were performed to examine the association between varus thrust and LBP., Results: We included 205 participants (mean age 68.19 years; 72.20% women). A total of 45 participants (22.0%) showed varus thrust in their painful knee, in whom 31 (68.89%) and 18 (40.00%) were identified as having any LBP and moderate-to-severe LBP (numerical rating scale ≥4 points), respectively. Patients with varus thrust demonstrated a 3.6-fold higher risk of the presence of moderate-to-severe LBP (95% confidence interval [95% CI] 1.62-8.10). In patients with LBP, the presence of varus thrust was associated with more severe LBP intensity (proportional odds ratio 2.25 [95% CI 1.02-4.96])., Conclusion: This study highlights the novel relationship between varus thrust and LBP, which supports the idea of a biomechanical link, the so-called knee-spine syndrome. These findings provide new insight for clarifying the pathogenesis of LBP related to knee OA., (© 2019, American College of Rheumatology.)

Background: A waist-mounted sensor is an attractive option for detecting initial and end of foot contacts during gait in a clinical setting without disturbing the subject's natural gait., Research Question: To examine the current state of the field regarding waist-mounted sensor algorithms for gait event detection during locomotion in adults., Methods: A scoping review design was used to search peer-reviewed literature or conference proceedings published through October 2018 for algorithms for gait event detection. We analyzed data from the studies in a descriptive manner., Results: In total, 588 potentially relevant articles were selected, of which 14 (171 participants, mean age: 44.0 years) met the inclusion criteria. We identified 15 algorithms developed using biomechanical theories including the inverted pendulum model that represents gait during level walking. Most algorithms estimated gait events using triaxial acceleration data with an absolute error of approximately 50-100 ms in healthy adults. However, there was a large amount of inter-trial heterogeneity, and only a few algorithms were validated in patients with neurological diseases. Lower gait speed reduced the accuracy of gait event estimation., Significance: There was no algorithm that showed outstanding performance in the estimation of gait events during level walking using the waist-mounted sensor. More comparisons of all available algorithms with an established reference standard for one data-set are needed to identify the best algorithms. As patients with pathological conditions display altered trunk acceleration and slower gait speeds, the development of an algorithm that does not rely on particular signal characteristics and is robust for a wide range of gait speeds is needed before a specific algorithm can be recommended as a valid strategy for clinical practice., Competing Interests: Declaration of Competing Interest The authors did not receive financial support or other benefits from commercial sources for the work reported in this manuscript. Nor did they receive any other financial support that could create a potential conflict of interest or the appearance of a conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Case: A 77-year-old woman with knee osteoarthritis (OA) complained of right (ipsilateral) knee pain for more than 5 years with gait asymmetry. The OA and quadriceps muscle weakness were more severe in the left (contralateral) knee, but she had no pain. Bracing of the left knee led to decreased gait asymmetry, as determined with an inertial measurement unit, and reduced pain in the right knee., Conclusion: This case highlights the contralateral knee effect on ipsilateral chronic knee pain, possibly through gait asymmetry. These findings provide a mechanistic insight into knee OA-related pain in patients with gait asymmetry and suggest a new rehabilitative approach.

Clarifying proximal gait adaptations as a strategy to reduce knee joint loading and pain for individuals with knee osteoarthritis (OA) contributes to understanding the pathogenesis of multi-articular OA changes and musculoskeletal pain in other joints. We aimed to determine whether biomechanical alterations in knee OA patients during level walking is increased upper trunk lean in the frontal and sagittal planes, and subsequent alteration in external hip adduction moment (EHAM) and external hip flexion moment (EHFM). A literature search was conducted in PubMed, PEDro, CINAHL, and Cochrane CENTRAL through May 2018. Where possible, data were combined into a meta-analysis; pooled standardized mean differences (SMD) of between knee OA patients and healthy adults were calculated using a random-effect model. In total, 32 articles (2037 participants, mean age, 63.0 years) met inclusion criteria. Individuals with knee OA had significantly increased lateral trunk lean toward the ipsilateral limb (pooled SMD: 1.18; 95% CI: 0.59, 1.77) along with significantly decreased EHAM. These subjects also displayed a non-significantly increased trunk/pelvic flexion angle and EHFM. The GRADE approach judged all measures as "very low." These results may indicate that biomechanical alterations accompanying knee OA are associated with increased lateral trunk lean and ensuing alterations in EHAM. Biomechanical alterations in the sagittal plane were not evident. Biomechanical adaptations might have negative sequelae, such as secondary hip abductor muscle weakness and low back pain. Thus, investigations of negative sequelae due to proximal gait adaptations are warranted., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Rodent models of sciatic nerve lesion are regularly used to assess functional deficits in nerves. Impaired locomotor functions induced by sciatic nerve lesion are currently evaluated with scoring systems despite their limitations. To overcome these shortcomings, which includes low sensitivity, little significance, and the representation of only marginal components of motion profiles, some additional metrics have been introduced. However, a quantitative determination of motion deficits is yet to be established. We used a three-dimensional motion analysis to investigate gait deficits after sciatic nerve lesion in rats. This enabled us to depict the distorted gait motion using both traditional parameters and novel readouts that are specific for the three-dimensional analysis. Our results suggest that three-dimensional motion analysis facilitates a comprehensive understanding of the gait impairment specifically, but not limited to, a sciatic lesion rat model. A broad application of these methods will improve understanding and standardized motor assessment.

The foot is speculated to play a role in knee joint kinematics. This exploratory cross-sectional study examined the association between static foot posture and the presence of varus thrust visualized during gait in patients with medial knee osteoarthritis (OA). Patients (n = 88 patients and 134 knees; age, 61-91 years; 68.2% female) with Kellgren/Lawrence (K/L) grade ≥1 in the medial compartment were included in this study and underwent gait observation for varus thrust. These patients' three-dimensional static foot posture while standing was evaluated and their tibiofemoral joint K/L grades and anatomical axis angles were also assessed as covariates. Knees with varus thrust (22 knees, 16.4%) on average had a 4° more inverted calcaneus relative to the floor than those without varus thrust (P < 0.001). A logistic regression analysis showed that an increased calcaneus inversion angle was significantly associated with higher odds of the presence of varus thrust with adjustments for age, sex, body mass index, K/L grade, and anatomical axis angle. The other predictors, such as navicular height, navicular height/foot length, and rearfoot angle relative to the lower leg, were not significantly associated with varus thrust. These results suggest that patients with varus thrust had a different static rearfoot posture as compared with those without varus thrust, a finding that may indicate an important role of static rearfoot posture in the pathogenesis of varus thrust. Furthermore, investigating the potential influence of foot posture on the efficacy of biomechanical interventions, such as lateral wedge insole use, on varus thrust would be of particular interest in the further studies., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This cross-sectional study investigated (i) the association of varus thrust during gait with the presence of patellofemoral osteoarthritis (PFOA) in patients with medial knee osteoarthritis (OA) and (ii) patellar alignment in the knees with varus thrust. Participants from orthopedic clinics (n=171; mean age, 73.4 years; 71.9% female) diagnosed with radiographic medial knee OA (Kellgren/Lawrence [K/L] grade ≥1) were included in this study, and underwent gait observation for varus thrust assessment using 2D video analysis. A radiographic skyline view was used to assess the presence of medial PFOA using the grading system from the Osteoarthritis Research Society International Atlas. The tibiofemoral joint K/L grade, patellar alignment (i.e., lateral shift and tilting angle), and knee pain intensity were also evaluated as covariates. Thirty-two (18.7%) of 171 patients exhibited varus thrust and they presented significantly higher knee pain (46.0±3.04mm vs. 32.4±2.73mm; P=0.024), a lower patellar tilting angle (P=0.024), and a higher prevalence of PFOA compared with those without varus thrust. A logistic regression analysis with adjustment of covariates showed that varus thrust was significantly associated with higher odds of the presence of mixed and medial PFOA, and trended to significantly associate with any PFOA, including lateral PFOA. This indicates that varus thrust was associated with PFOA in a compartment-nonspecific manner in patients with medial knee OA. Varus thrust may represent a clinical disease feature of more advanced and multicompartmental disease., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To investigate the association between knee pain during gait and 4 clinical phenotypes based on static varus alignment and varus thrust in patients with medial knee osteoarthritis (OA)., Methods: Patients in an orthopedic clinic (n = 266) diagnosed as having knee OA (Kellgren/Lawrence [K/L] grade ≥1) were divided into 4 phenotype groups according to the presence or absence of static varus alignment and varus thrust (dynamic varus): no varus (n = 173), dynamic varus (n = 17), static varus (n = 50), and static varus + dynamic varus (n = 26). The knee range of motion, spatiotemporal gait parameters, visual analog scale scores for knee pain, and scores on the Japanese Knee Osteoarthritis Measure were used to assess clinical outcomes. Multiple logistic regression analyses identified the relationship between knee pain during gait and the 4 phenotypes, adjusted for possible risk factors, including age, sex, body mass index, K/L grade, and gait velocity., Results: Multiple logistic regression analysis showed that varus thrust without varus alignment was associated with knee pain during gait (odds ratio [OR] 3.30, 95% confidence interval [95% CI] 1.08-12.4), and that varus thrust combined with varus alignment was strongly associated with knee pain during gait (OR 17.1, 95% CI 3.19-320.0). Sensitivity analyses applying alternative cutoff values for defining static varus alignment showed comparable results., Conclusion: Varus thrust with or without static varus alignment was associated with the occurrence of knee pain during gait. Tailored interventions based on individual malalignment phenotypes may improve clinical outcomes in patients with knee OA., (© 2015 The Authors. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.)

The effects of intermittent hypergravity on gait alterations and hindlimb muscle atrophy in rats induced by 2 weeks of simulated microgravity were investigated. Rats were submitted to hindlimb unloading for 2 weeks (unloading period), followed by 2 weeks of reloading (recovery period). During the unloading period, animals were subjected to the following treatments: (1) free in cages (Control); (2) continuous unloading (UL); (3) released from unloading for 1 hour per day (UL+1G); (4) hypergravity for 1h per day using a centrifuge for small animals (UL+2G). The relative weights of muscles to the whole body weight and kinematics properties of hindlimbs during gait were evaluated. UL rats walked with their hindlimbs overextended, and the oscillation of their limb motion had become narrowed and forward-shifted after the unloading period, and this persisted for at least 2 weeks after the termination of unloading. However, these locomotor alterations were attenuated in rats subjected to UL+2G centrifugation despite minor systematic changes in muscle recovery. These findings indicate hypergravity application could counteract the adverse effects of simulated or actual microgravity environments., (Copyright © 2015 Elsevier B.V. All rights reserved.)