The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
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Pelvic, Hip, and Knee Kinematics of Stair Climbing in People with Genu Varum

  • Chae, Yun Won (Department of Physical Therapy, Gwangju Health University) ;
  • Park, Seol (Division of Biokinesiology and Physical therapy, University of Southern California) ;
  • Park, Ji Won (Department of Physical Therapy, College of Bio and Medical Sciences, Daegu Catholic University of Daegu)
  • Received : 2018.01.09
  • Accepted : 2018.02.28
  • Published : 2018.02.28
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Abstract

Purpose: This study examined the effects of the lower limb alignment on the pelvis, hip, and knee kinematics in people with genu varum during stair walking. Methods: Forty subjects were enrolled in this study. People who had intercondylar distance ${\geq}4cm$ were classified in the genu varum group, and people who had intercondylar distance <4cm and intermalleolar distance <4cm were placed in the control group. 3D motion analysis was used to collect the pelvis, hip, and knee kinematic data while subjects were walking stairs with three steps. Results: During stair ascent, the genu varum group had decreased pelvic lateral tilt and hip adduction at the early stance phase and decreased pelvic lateral tilt at the swing phase compared to the control group. At the same time, they had decreased minimal hip adduction ROM at the early stance and decreased maximum pelvic lateral tilt ROM and minimum hip rotation ROM at the swing phase. During stair descent, the genu varum group had decreased pelvic lateral tilt at the early stance and decreased pelvic lateral tilt and pelvic rotation at the swing phase. In addition, they had decreased pelvic frontal ROM during single limb support and increased knee sagittal ROM during the whole gait cycle. Conclusion: This study suggests that a genu varum deformity could affect the pelvis, hip and knee kinematics. In addition, the biomechanical risk factors that could result in the articular impairments by the excessive loads from lower limb malalignment were identified.

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References

  1. Sharma LJ, Song J, Felson DT et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001; 288(2):188-95.
  2. Bezerra MJCB, Barbosa IM, Sousa TG et al. Profile of patients receiving total knee arthroplasty: a cross-sectional study. Acta Ortop Bras. 2017; 25(5):202-5. https://doi.org/10.1590/1413-785220172505168806
  3. Scouten JSAG, van den Ouweland FA, Valkenburg HA. A 12 year follow up study in the general population on prognostic factors of cartilage loss in osteoarthritis of the knee. Ann Rheum Dis. 1992;51(8):932-7. https://doi.org/10.1136/ard.51.8.932
  4. Ramsey DK, Snyder-Mackler L, Lewek M et al. Effect of anatomic realignment on muscle function during gait in patients with medial compartment knee osteoarthritis. Arthritis Rheum. 2007;57(3):389-97. https://doi.org/10.1002/art.22608
  5. Roos EM. Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol. 2005;17(2):195-200. https://doi.org/10.1097/01.bor.0000151406.64393.00
  6. Cahue S, Dunlop D, Hayes K et al. Varus-valgus alignment in the progression of patellofemoral osteoarthritis. Arthritis Rheum. 2004;50(7): 2184-90. https://doi.org/10.1002/art.20348
  7. Stief F, Bohm H, Dussa CU et al. Effect of lower limb malalignment in the frontal plane on transverse plane mechanics during gait in young individuals with varus knee alignment. Knee. 2014;21(3):688-93. https://doi.org/10.1016/j.knee.2014.03.004
  8. Cicuttini F, Wluka A, Hankin J et al. Longitudinal study of the relationship between knee angle and tibiofemoral cartilage volume in subjects with knee osteoarthritis. Rheumatology. 2004;43(3):321-4. https://doi.org/10.1093/rheumatology/keh017
  9. Wu DD, Burr DB, Boyd RD et al. Bone and cartilage changes following experimental varus or valgus tibial angulation. J Orthop Res. 1990;8(4): 572-85. https://doi.org/10.1002/jor.1100080414
  10. Stief F, Bohm H, Schwirtz A et al. Dynamic loading of the knee and hip joint and compensatory strategies in children and adolescents with varus malalignment. Gait Posture. 2011;33(3):490-5. https://doi.org/10.1016/j.gaitpost.2011.01.001
  11. Colyn W, Agricola R, Arnout N et al. How does lower leg alignment differ between soccer players, other athletes, and non-athletic controls? Knee Surg Sports Traumatol Arthrosc. 2016;24(11):3619-26. https://doi.org/10.1007/s00167-016-4348-y
  12. Driban JB, Hootman JM, Sitler MR et al. Is participation in certain sports associated with knee osteoarthritis? A systematic review. J Athl Train. 2017;52(6):497-506. https://doi.org/10.4085/1062-6050-50.2.08
  13. Ackerman IN, Kemp JL, Crossley KM et al. Hip and knee osteoarthritis affects younger people, too. J Orthop Sports Phys Ther. 2017;47(2):67-79. https://doi.org/10.2519/jospt.2017.7286
  14. Chae YW, Park JW, Park S. Effects of knee malalignment on static and dynamic postural stability. J Kor Phys Ther. 2015;27(1):7-11.
  15. Boissonneault A, Lynch JA, Wise BL et al. Association of hip and pelvic geometry with tibiofemoral osteoarthritis: multicenter osteoarthritis study (MOST). Osteoarthritis Cartilage. 2014;22(8):1129-35. https://doi.org/10.1016/j.joca.2014.06.010
  16. Lahner M, Jahnke NL, Zirke S et al. The deviation of the mechanical leg axis correlates with an increased hip alpha angle and could be a predictor of femoroacetabular impingement. Int Orthop. 2014;38(1):19-25. https://doi.org/10.1007/s00264-013-2085-0
  17. Palmer JS, Palmer AJ, Jones LD et al. The failing medial compartment in the varus knee and its association with cam deformity of the hip. Knee. 2017;24(6):1388-91.
  18. Bagwell JJ, Snibbe J, Gerhardt M et al. Hip kinematics and kinetics in persons with and without cam femoroacetabular impingement during a deep squat task. Clin Biomech 2015;31:87-92.
  19. Moghtadaei M, Yeganeh A, Boddouhi B et al. Effect of high tibial osteotomy on hip biomechanics in patients with genu varum: a prospective cohort study. Interv Med Appl Sci. 2017;9(2):94-99.
  20. Sogabe A, Mukai N, Miyakawa S et al. Influence of knee alignment on quadriceps cross-sectional area. J Biomech. 2009;42(14):2313-7. https://doi.org/10.1016/j.jbiomech.2009.06.022
  21. McFadyen BJ, Winter DA. An integrated biomechanical analysis of normal stair ascent and descent. J Biomech. 1988;21(9):733-44. https://doi.org/10.1016/0021-9290(88)90282-5
  22. kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res. 1990;8(3):383-92. https://doi.org/10.1002/jor.1100080310
  23. Gao B, Cordova ML, Zheng N. Three-dimensional joint kinematics of ACL-deficient and ACL-reconstructed knees during stair ascent and descent. Hum Mov Sci. 2012;31(1):222-35. https://doi.org/10.1016/j.humov.2011.04.009
  24. Shin DY, Heo JY. The effects of kinesiotaping applied onto erector spinae and sacroiliac joint on lumbar flexibility. J Kor Phys Ther. 2017;29(6): 307-15.
  25. Kim CH, Han JT. Comparison of hip and lumbopelvic movement while hip lateral rotating in individual with chronic low back pain. J Kor Phys Ther. 2017;29(5):241-5. https://doi.org/10.18857/jkpt.2017.29.5.241
  26. Kim WG, Kim YS, Kim YB et al. Effects of fast treadmill training on spinal alignment and muscles thickness. J Kor Phys Ther. 2017;29(4):175-80. https://doi.org/10.18857/jkpt.2017.29.4.175
  27. Lee SY, Lee MH. Comparison of trunk strategy to maintain balance during the one-leg stance on a medio-lateral ramp and an anterior-posterior ramp. J Kor Phys Ther. 2017;29(4):223-6. https://doi.org/10.18857/jkpt.2017.29.4.223
  28. Chu JH, Kim YJ, Park JW. The influence of restricted arm swing on symmetry, movement of trunk and pelvis rotation according to using a mobile phone. J Kor Phys Ther. 2017;29(1):33-8. https://doi.org/10.18857/jkpt.2017.29.1.33
  29. Gu JS, Choi SJ, Choi HS et al. Effects of pelvic tilt training using inclinometer on joint position sense and postural alignment in patients with chronic stroke. J Kor Phys Ther. 2017;28(1):33-8.
  30. Kim YJ, Park JW. The influence of unstable shoes on kinematics and kinetics of the lower limb joints during sit-to-stand task. J Kor Phys Ther. 2016;28(1):14-21.
  31. Bennett HJ, Zhang S, Shen G et al. Effects of toe-in and wider step width in stair ascent with different knee alignments. Med Sci Sports Exerc. 2017;49(3):563-72.
  32. Barrios JA, Strotman DE. A sex comparison of ambulatory mechanics relevant to osteoarthritis in individuals with and without asymptomatic varus knee alignment. J Appl Biomech. 2014;30(5):632-6. https://doi.org/10.1123/jab.2014-0039
  33. Nadeau S, McFadyen BJ, Malouin F. Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking? Clin Biomech. 2003;18(10): 950-9. https://doi.org/10.1016/S0268-0033(03)00179-7
  34. Mian OS, Thom JM, Narici MV et al. Kinematics of stair descent in young and older adults and the impact of exercise training. Gait Posture. 2007;25(1):9-17. https://doi.org/10.1016/j.gaitpost.2005.12.014
  35. Hall M, Wrigley TV, Kean CO et al. Hip biomechanics during stair ascent and descent in people with and without hip osteoarthritis. J Orthop Res. 2017;35(7):1505-14. https://doi.org/10.1002/jor.23407
  36. Farr S, Kranzl A, Pablik E et al. Functional and radiographic consideration of lower limb malalignment in children and adolescents with idiopathic genu valgum. J Orthop Res. 2014;32(10):1362-70. https://doi.org/10.1002/jor.22684
  37. Bak JW, Cho MK, Chung YJ. The effects of performing a one-legged bridge with hip abduction and unstable surface on trunk and gluteal muscle activation in healthy adults. J Kor Phys Ther. 2016;28(3):206-11.

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