Effects of methods of descending stairs forwards versus backwards on knee joint force in patients with osteoarthritis of the knee: a clinical controlled study

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to investigate the kinetic characteristics of compensatory backward descending movement performed by patients with osteoarthritis of the knee.</p> <p>Methods</p> <p>Using a three-dimensional motion analysis system, we investigated lower extremity joint angles, joint moments, joint force of the support leg in forward and backward descending movements on stairs, and joint force of the leading leg at landing in 7 female patients with osteoarthritis of the knee.</p> <p>Results</p> <p>Compared with the forward descending movement, knee joint angle, joint moment and joint force of the support leg all decreased in the backward descending movement. Joint force of the leading leg at landing was also reduced in the backward descending movement. In addition, we confirmed that the center of body mass was mainly controlled by the knee and ankle joints in the forward descending movement, and by the hip joint in the backward descending movement.</p> <p>Conclusions</p> <p>Since it has been reported that knee flexion angle and extensor muscle strength are decreased in patients with osteoarthritis of the knee, we believe that backward descending movement is an effective method to use the hip joint to compensate forthese functional defects. In addition, due to the decreased knee joint force both in the leading and support legs in backward descending movement, the effectiveness of compensatory motion for pain control and knee joint protection was also suggested.</p

Kinematic differences exist between transtibial amputee fallers and non-fallers during downwards step transitioning.

Stair negotiation is biomechanically more challenging than level gait. There are few biomechanical assessments of transtibial amputees descending stairs and none specifically related to falls. Stair descent may elicit more differences than level gait in amputees with and without a previous falls history

Lower Limb Kinematic and Kinetic Differences between Transtibial Amputee Fallers and Non-Fallers

Stair walking relies on concentric contraction of the ankle plantarflexor and knee extensor muscles, which are either absent or weakened in transtibial amputees. As a result the risk of falling is increased in this population. The aim of this study was to compare the gait patterns of transtibial amputee fallers and non-fallers during stair ascent. Eleven participants (fallers = 6; non-fallers = 5) walked along a 3-m walkway and ascended a three-step staircase with handrails, at their self-selected pace, while three-dimensional kinematic data were collected from the lower limbs. A force plate was embedded into the first step and kinetic data were measured for the intact lead limb only. The fallers walked significantly faster (p = 0.00) and exhibited less hip flexion (p = 0.05) and less anterior pelvic tilt (p = 0.04) compared to the non-fallers. The fallers had significantly greater first and second peak vertical ground reaction force (GRF) on the intact limb than the non-fallers (p = 0.05 and p = 0.01, respectively) contributing to the significantly larger ankle (p = 0.02) and hip moments (p = 0.04). These findings suggested the amputee non-fallers performed mechanically demanding tasks more cautiously. Two of the participants self-selected a ‘step to’ gait pattem, ascending one step at a time. This may be considered a compensatory mechanism for the lack of ankle mobility and functional muscle performance in these two transtibial amputees