Iranian Journal of Biomedical Engineering (IJBME)
نشریه علمی مهندسی پزشکی زیستی

Investigating the Effect of Muscle Co-Contraction in Providing Stability while Standing in Patients with Knee Osteoarthritis

Document Type : Full Research Paper

Authors

Zahra Yaghmaei 1
Iman Hosseini 2
Mohammed N. Ashtiani 3

1 M.Sc. Student, Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

2 M.Sc., Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

3 Assistant Professor, Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

https://doi.org/10.22041/ijbme.2024.2028321.1898
Abstract
Knee osteoarthritis is a prevalent chronic musculoskeletal disorder that has a significant impact on postural stability and increases the risk of falls. Individuals with knee osteoarthritis often experience pain and proprioceptive deficits, highlighting the importance of muscle contraction in maintaining stability. Visual feedback also plays a crucial role in balance maintenance, particularly on unstable surfaces. This study aims to explore the co-contraction index of knee and ankle muscles in patients with moderate knee osteoarthritis while standing on an unstable surface, with and without visual feedback. A cross-sectional study involving 28 participants (14 men with knee osteoarthritis and 14 healthy men) was conducted to assess postural control during standing on an unstable surface with eyes open and closed. Electromyography with surface electrodes was utilized to measure the activity of seven muscles during the standing tests. The findings revealed that knee osteoarthritis leads to distinct changes in the co-contraction patterns of the ankle and knee joints. Closing the eyes during the tests resulted in increased ankle co-contraction variability and decreased knee and ankle joint co-contraction patterns. The co-contraction differential zeros cross of knee muscles with eyes open exhibited a significant positive correlation with the WOMAC questionnaire score (p = 0.048, r = 0.52). The central nervous system compensates for reduced co-contraction in the knee joint of individuals with knee osteoarthritis by adjusting the co-contraction rate of ankle muscles to prevent falls. The study also demonstrated increased instability when visual feedback was removed, emphasizing the role of visual cues in balance maintenance. The significant correlation between disease severity and co-contraction changes suggests that the body utilizes ankle muscles as a compensatory mechanism in response to knee pain.

Keywords

Knee Osteoarthritis
Muscle Co-Contraction
Stability
Articular Pain
Subjects
  1. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Annals of the rheumatic diseases. 2014; 73 (7): 1323-30.
  2. Bortoluzzi A, Furini F, Scirè CA. Osteoarthritis and its management-Epidemiology, nutritional aspects and environmental factors. Autoimmunity reviews. 2018; 17 (11): 1097-104.
  3. Zhang Y, Li X, Wang Y, Ge L, Pan F, Winzenberg T, et al. Association of knee and hip osteoarthritis with the risk of falls and fractures: a systematic review and meta-analysis. Arthritis Research & Therapy. 2023; 25 (1): 184.
  4. Darbandi M, Shadmani FK, Miryan M, Ghalandari M, Mohebi M, Jam SA, et al. The burden of osteoarthritis due to high Body Mass Index in Iran from 1990 to 2019. Scientific Reports. 2023; 13 (1): 11710.
  5. Dehghan A, Soleimani Salehabadi H, Jamshidi A, Kamali Z, Mali M, Faezi ST, et al. Epidemiology of musculoskeletal symptoms, rheumatologic disorders, and disability in the Zoroastrian population in Yazd, Iran: a WHO-ILAR COPCORD study (stage 1). BMC rheumatology. 2021; 5: 1-9.
  6. Huang L, Zhang Y, Li Q. Investigating the causal relationship between physical activity and incident knee osteoarthritis: a two-sample Mendelian randomization study. Scientific Reports. 2024; 14 (1): 1663.
  7. El-Adham NA, Abdelhady MS, Osman ZHH. Effect of Nursing Education program on Knowledge, Uncertainty, Mastery, Pain, and Quality of Life for Knee Osteoarthritis Patients. Int J Novel Res Healthc Nurs. 2019; 6 (3): 867-81.
  8. Hosseini I, Najafi Ashtiani MN, Bahrpeyma F. Correlation between the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and the stability metrics in patients with knee osteoarthritis. International Journal of Musculoskeletal Pain Prevention. 2022; 7 (3): 741-9.
  9. Peixoto JG, Dias JMD, Dias RC, da Fonseca ST, Teixeira-Salmela LF. Relationships between measures of muscular performance, proprioceptive acuity, and aging in elderly women with knee osteoarthritis. Archives of gerontology and geriatrics. 2011; 53 (2): e253-e7.
  10. Li G, Shourijeh MS, Ao D, Patten C, Fregly BJ. How well do commonly used co-contraction indices approximate lower limb joint stiffness trends during gait for individuals post-stroke? Frontiers in Bioengineering and Biotechnology. 2021; 8: 588908.
  11. Rashid SA, Hussain ME, Bhati P, Veqar Z, Parveen A, Amin I, et al. Muscle activation patterns around knee following neuromuscular training in patients with knee osteoarthritis: secondary analysis of a randomized clinical trial. Archives of physiotherapy. 2022; 12 (1): 19.
  12. Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clinical biomechanics. 2009; 24 (10): 833-41.
  13. Ivanenko YP, Levik YS, Talis V, Gurfinkel V. Human equilibrium on unstable support: the importance of feet-support interaction. Neuroscience letters. 1997; 235 (3): 109-12.
  14. Hosseini I, Ashtiani MN, Bahrpeyma F. Postural Stability in Patients with Moderate Knee Osteoarthritis: Roles of Visual Feedback and Dynamic Perturbations. Journal of Rehabilitation Sciences & Research. 2021; 8 (4): 189-97.
  15. Dixon PC, Gomes S, Preuss RA, Robbins SM. Muscular co-contraction is related to varus thrust in patients with knee osteoarthritis. Clinical Biomechanics. 2018; 60: 164-9.
  16. Schrijvers JC, van den Noort JC, van der Esch M, Harlaar J. Neuromechanical assessment of knee joint instability during perturbed gait in patients with knee osteoarthritis. Journal of Biomechanics. 2021; 118: 110325.
  17. Kiss RM. Effect of degree of knee osteoarthritis on balancing capacity after sudden perturbation. Journal of Electromyography and Kinesiology. 2012; 22 (4): 575-81.
  18. Hafezi M, Rahemi Z, Ajorpaz NM, Izadi FS. The effect of the Alexander Technique on pain intensity in patients with chronic low back pain: A randomized controlled trial. Journal of Bodywork and Movement Therapies. 2022; 29: 54-9.
  19. Schiphof D, Boers M, Bierma-Zeinstra SM. Differences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis. Annals of the rheumatic diseases. 2008; 67 (7): 1034-6.
  20. Kim J, Son J, Kim Y. Consistency of the optimized bandwidth in filter-based fatigue index. International journal of precision engineering and manufacturing. 2014; 15: 2473-7.
  21. Li Y, Song H, Shen L, Wang Y. The efficacy and safety of moderate aerobic exercise for patients with Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. Annals of Palliative Medicine. 2021; 10 (3): 2638649-2649.
  22. Shanbhag J, Wolf A, Wechsler I, Fleischmann S, Winkler J, Leyendecker S, et al. Methods for integrating postural control into biomechanical human simulations: a systematic review. Journal of NeuroEngineering and Rehabilitation. 2023; 20 (1): 111.
  23. Kaewmanee T, Aruin AS. The role of predictability of perturbation in control of posture: a scoping review. Motor control. 2021; 26 (1): 97-143.
  24. Pater ML, Rosenblatt NJ, Grabiner MD. Knee osteoarthritis negatively affects the recovery step following large forward-directed postural perturbations. Journal of Biomechanics. 2016; 49 (7): 1128-33.
  25. Sanders O, Hsiao HY, Savin DN, Creath RA, Rogers MW. Aging changes in protective balance and startle responses to sudden drop perturbations. Journal of neurophysiology. 2019; 122 (1): 39-50.
  26. Kal EC, Young WR, Ellmers TJ. Balance capacity influences the effects of conscious movement processing on postural control in older adults. Human movement science. 2022; 82: 102933.
  27. Preece SJ, Jones RK, Brown CA, Cacciatore TW, Jones AK. Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC musculoskeletal disorders. 2016; 17: 1-12.
  28. Asai Y, Tateyama S, Nomura T. Learning an intermittent control strategy for postural balancing using an EMG-based human-computer interface. PLoS One. 2013; 8 (5): e62956.
  29. Asai Y, Tasaka Y, Nomura K, Nomura T, Casadio M, Morasso P. A model of postural control in quiet standing: robust compensation of delay-induced instability using intermittent activation of feedback control. PloS one. 2009; 4 (7): e6169.
  30. Suzuki Y, Nomura T, Casadio M, Morasso P. Intermittent control with ankle, hip, and mixed strategies during quiet standing: a theoretical proposal based on a double inverted pendulum model. Journal of theoretical biology. 2012; 310: 55-79.
  31. Yoshikawa N, Suzuki Y, Kiyono K, Nomura T. Intermittent feedback-control strategy for stabilizing inverted pendulum on manually controlled cart as analogy to human stick balancing. Frontiers in computational neuroscience. 2016; 10: 34.
  32. Vieira TM, Loram ID, Muceli S, Merletti R, Farina D. Recruitment of motor units in the medial gastrocnemius muscle during human quiet standing: is recruitment intermittent? What triggers recruitment? Journal of neurophysiology. 2012; 107 (2), 666-76.
  33. Héroux ME, Dakin CJ, Luu BL, Inglis JT, Blouin J-S. Absence of lateral gastrocnemius activity and differential motor unit behavior in soleus and medial gastrocnemius during standing balance. Journal of applied physiology. 2014; 116 (2): 140-8.
  34. Elias LA, Watanabe RN, Kohn AF. Spinal mechanisms may provide a combination of intermittent and continuous control of human posture: predictions from a biologically based neuromusculoskeletal model. PLoS computational biology. 2014; 10 (11): e1003944.
  35. Preece S, Brookes N, Walsh N, Williams A, Starbuck C, Griffiths B, et al. The development of a new EMG biofeedback intervention for people with knee osteoarthritis. Osteoarthritis and Cartilage. 2020; 28: S238.
  36. Zeni JA, Rudolph K, Higginson JS. Alterations in quadriceps and hamstrings coordination in persons with medial compartment knee osteoarthritis. Journal of Electromyography and Kinesiology. 2010; 20 (1): 148-54.
  37. Falk J, Strandkvist V, Pauelsen M, Vikman I, Nyberg L, Röijezon U. Increased co-contraction reaction during a surface perturbation is associated with unsuccessful postural control among older adults. BMC geriatrics. 2022; 22 (1): 438.
  38. Gaerlan MG, Alpert PT, Cross C, Louis M, Kowalski S. Postural balance in young adults: the role of visual, vestibular and somatosensory systems. Journal of the American Association of Nurse Practitioners. 2012; 24 (6): 375-81.
  39. Eikema DJ, Hatzitaki V, Tzovaras D, Papaxanthis C. Application of intermittent galvanic vestibular stimulation reveals age-related constraints in the multisensory reweighting of posture. Neuroscience letters. 2014; 561: 112-7.
  40. Peterka RJ. Sensorimotor integration in human postural control. Journal of neurophysiology. 2002; 88 (3): 1097-118.
  41. Diener H-C, Dichgans J. On the role of vestibular, visual and somatosensory information for dynamic postural control in humans. Progress in brain research. 1988; 76: 253-62.
  42. Daneshmandi H, Norasteh AA, Zarei H. Balance in the blind: A systematic review. Physical Treatments-Specific Physical Therapy Journal. 2021; 11 (1): 1-12.
  43. Wright WG, Ivanenko YP, Gurfinkel VS. Foot anatomy specialization for postural sensation and control. Journal of neurophysiology. 2012; 107 (5): 1513-21.
  44. Inglis JT, Kennedy PM, Wells C, Chua R. The role of cutaneous receptors in the foot. Sensorimotor control of movement and posture: Springer; 2002, 111-7.
  45. Applegate C, Gandevia S, Burke D. Changes in muscle and cutaneous cerebral potentials during standing. Experimental brain research. 1988; 71: 183-8.
  46. Eklund G. General features of vibration-induced effects on balance. Upsala journal of medical sciences. 1972; 77 (2): 112-24.
  47. Katz R, Meunier S, Pierrot-Deseilligny E. Changes in presynaptic inhibition of Ia fibres in man while standing. Brain. 1988; 111 (2): 417-37.
  48. Błaszczyk JW, Fredyk A, Błaszczyk PM, Ashtiani M. Step response of human motor system as a measure of postural stability in children. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2020; 28 (4): 895-903.
  49. Fernandes SG, Sales WB, Tavares DV, da Silva Pereira D, de Negreiros Nóbrega PV, de Almeida Holanda CM, et al. Relationship between pain, fear of falling and physical performance in older people residents in long-stay institutions: a cross-sectional study. International journal of environmental research and public health. 2022; 19 (19): 12014.
  50. Graven-Nielsen T, Arendt-Nielsen L. Impact of clinical and experimental pain on muscle strength and activity. Current rheumatology reports. 2008; 10 (6): 475-81.
  51. Henriksen M, Alkjær T, Lund H, Simonsen EB, Graven-Nielsen T, Danneskiold-Samsøe B, et al. Experimental quadriceps muscle pain impairs knee joint control during walking. Journal of Applied Physiology. 2007; 103 (1): 132-9.
  52. Hwang S, Agada P, Kiemel T, Jeka JJ. Identification of the unstable human postural control system. Frontiers in systems neuroscience. 2016; 10: 22.
  53. Schmitt LC, Rudolph KS. Muscle stabilization strategies in people with medial knee osteoarthritis: the effect of instability. Journal of Orthopaedic Research. 2008; 26 (9): 1180-5.
Iranian Journal of Biomedical Engineering (IJBME)
Volume 17, Issue 3
Autumn 2023
Pages 273-283

  • Receive Date 06 May 2024
  • Revise Date 03 July 2024
  • Accept Date 18 July 2024

Home

Contact Us