Vibromyographic analysis of knee muscle imbalances in knee osteoarthritis

Kenneth McLeod, Sara Morley, Andrew Matsushima

Clinical Science and Engineering Research Center, Binghamton University, Binghamton, USA.

DOI: 10.4236/jbise.2012.54025                

Abstract

Muscle imbalances are a well accepted cause of musculo-skeletal pain, yet clinicians lack a simple, non-invasive, and reproducible means to assess muscle effort during activities of daily living. To address this issue, we have been developing vibromyography (VMG) as a means to quantitatively assess muscle mechanical effort such that accurate muscle effort ratios can be determined in the clinic. In this study, VMG was used to characterize muscle imbalances in older adults with low-level knee pain while they performed step-up and step-down activities. In addition to determining whether VMG can identify the imbalances previously reported in individuals with knee pain, we address the question of whether these knee muscle imbalances were a likely cause of knee pain, or whether the imbalances represented a coping response for pre-existing knee pain. A population (N = 30) of 35 - 85 year old men and women with a total of 42 painful knees were assessed. Robust multiple step-wise regression analysis identified weak hip abductor muscle effort relative to hamstring muscle effort as the best predictor of knee pain (p = 0.00006), with weak vastus lateralis effort in eccentric contraction, relative to concentric contraction, being the second best predictor (p = 0.0003). Muscle imbalances were able to account for 40% of the variation in reported pain, and the observed pattern of increasing knee pain with increasing quadriceps strength during concentric contraction leads us to infer that the observed muscle imbalances are not the result of a protective action by the individual, but rather are a principle cause of the knee pain.

Keywords

Vibromyography; Knee Pain; Muscle Balance; Osteoarthritis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	National Center for Health Statistics. Health (2011) United States, 2010: With special feature on death and dying. Hyattsville, MS.
[2]	Jinks, C., Jordan, K. and Croft, P. (2002) Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain, 100, 55-64. doi:10.1016/S0304-3959(02)00239-7
[3]	Nguyen, U.D.T., Zhang, Y., Zhu, Y., Niu, J., Zhang, B. and Felson, D.T. (2011) Increasing prevalence of knee pain and symptomatic knee osteoarthritis: Survey and cohort data. Annals of Internal Medicine, 155, 725-732.
[4]	Muraki, S., Dennison, E., Jameson, K., Boucher, B.J., Akune, T., Yoshimura, N., Judge, A., Arden, N.K., Javaid, K. and Cooper, C. (2011) Association of vitamin D status with knee pain and radiographic knee osteoarthritis. Osteoarthritis and Cartilage, 19, 1301-1306. doi:10.1016/j.joca.2011.07.017
[5]	Hurley, M.V. (1999) The role of muscle weakness in the pathogenesis of osteoarthritis. Rheumatic Disease Clinics of North America, 25, 283-298. doi:10.1016/S0889-857X(05)70068-5
[6]	Becker, R., Berth, A., Mehring, M. and Awlszus. F. (2004) Neuromuscular quadriceps dysfunction prior to osteoarthritis of the knee. Journal of Orthopaedic Research, 22, 768-773. doi:10.1016/j.orthres.2003.11.004
[7]	Bennell, K.L. and Hinman, R.S. (2011) A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. Journal of Science and Medicine in Sport, 14, 4-9. doi:10.1016/j.jsams.2010.08.002
[8]	Hochberg, M.C., Altman, R.D., April, K.T., Benkhalti, M., Guyatt, G., McGowan, J., Towheed, T., Welch, V., Wells, G. and Tugwell, P. (2012) American college of rheumatology 2012 recommendations for the use of non-pharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip and knee. Arthritis Care & Research, 9 January 2012 (epub ahead of print).
[9]	Cerny, K. (1995) Vastus medialis oblique/vastus lateralis muscle activity ratios for selected exercises in persons with and without patellofemoral pain syndrome. Physical Therapy, 75, 672-682.
[10]	Cowan, S.M., Binnell, K.L., Hodges, P.W., Crossley, K.M. and McConnel, J.M. (2001) Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Archives of Physical Medicine and Rehabilitation, 82, 183-189. doi:10.1053/apmr.2001.19022
[11]	Hurley, M.V. (2003) Muscle dysfunction and effective rehabilitation of knee osteoarthritis: What we know and what we need to find out. Arthritis & Rheumatism, 49, 444-452. doi:10.1002/art.11053
[12]	Hortobagyi, T., Westerkamp, L., Beam, S., Moody, J., Garry, J., Holbert, D. and De Vita, P. (2004) Altered ham-string-quadriceps muscle balance in patients with knee osteoarthritis. Clinical Biomechanics, 20, 97-104. doi:10.1016/j.clinbiomech.2004.08.004
[13]	Chang, A., Hayes, K., Dunlop, D., Song, J., Hurwitz, D., Cahue, S. and Sharma, L. (2005) Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression. Arthritis & Rheumatism, 52, 3515-3519. doi:10.1002/art.21406
[14]	Sledm, E.A., Khoja, L., Deluzio, K.J., Olney, S.J. and Culham, E.G. (2010) Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: A clinical trial. Physical Therapy, 90, 895-904. doi:10.2522/ptj.20090294
[15]	Matheson, G.O., Maffey-Ward, L., Mooney, M., Ladly, K., Fung, T. and Zhang. Y-T. (1997) Vibromyography as a quantitative measure of muscle force production. Scandinavian Journal of Rehabilitation Medicine, 29, 29-35.
[16]	Madeleine, P., Bajaj, P., Sogaard, K. and Arendt-Nielsen, L. (2001) Mechanomyography and electromyography force relationships during concentric, isometric and eccentric contractions. Journal of Electromyography and Kinesiology, 11, 113-121. doi:10.1016/S1050-6411(00)00044-4
[17]	Orizio, C., Gobbo, M., Diemont, B., Esposito, F. and Veicsteinas, A. (2003) The surface mechanomyogram as a tool to describe the influence of fatigue on biceps brachii motor unit activation strategy. Historical basis and novel evidence. European Journal of Applied Physiology, 90, 326-336. doi:10.1007/s00421-003-0924-1v
[18]	Tian, S-L., Liu, Y., Li, L., Fu, W-J. and Peng, C.-H. (2010) Mechanomyography is more sensitive than EMG in detecting age-related sarcopenia. Journal of Biomechanics, 43, 551-556. doi:10.1016/j.jbiomech.2009.09.034
[19]	Archer, A.A., Atangcho. P., Sabra, K.G. and Shinohara, M. (2011) Propagation direction of natural mechanical oscillations in the biceps brachii muscle during voluntary contraction. Journal of Electromyography Kinesiology, 22, 51-59. doi:10.1016/j.jelekin.2011.09.011
[20]	Cole, J., Madhavan, G. and McLeod, K.J. (2006) Vibromyographic quantification of voluntary isometric contractile force in the brachioradialis. IEEE Engineering in Medicine and Biology Society, 1, 1708-1710.
[21]	Beck, T.W., Housh, T.J., Fry, A.C., Cramer, J.T., Weir, J.P., Schilling, B.K., Falvo, M.J. and Moore, C.A. (2009) Wavelet-based analysis of surface mechanomyographic signals from subjects with differences in myosin heavy chain isoform content. Electromyography and Clinical Neurophysiology, 49, 167-175.
[22]	McLeod, K.J. and Cole, J. (2011) Realtime assessment of muscle effort during open and closed chain activities. USPTO Pub. No. 2011/0196262A1.
[23]	Grood, E.S., Suntay, W.J., Noyes, F.R. and Butler, D.L. (1984) Biomechanics of the knee extension exercise. Journal of Bone Joint Surgery, 66A, 725-734.
[24]	Jonssonm P. and Alfredson, H. (2005) Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: A prospective randomized study. Journal of Sports Medicine, 9, 847-850.