Biomechanical and neuromuscular characteristics during gait in moderate knee osteoarthritis: A framework for developing and evaluating noninvasive interventions

Each year Canadians spend over 4.4 billion dollars on direct health care costs associated with arthritis. Knee osteoarthritis (OA) is a leading cause of chronic disability in older adults. Non-surgical/non-pharmacological management strategies such as bracing, exercise and heel wedges are advocated for persons with knee OA. Currently, there are few clinical studies that support these strategies based on pathomechanical frameworks that have been recognized in the development and progression of this disease. Unfortunately, this leads to the conclusion that these strategies are good, without considering that some may not be effective and worse some may be harmful to the knee joint. Our research team and others have been exploring the link between joint mechanics (loading) during walking and knee OA progression. In addition, a unique aspect of our work is the inclusion of knee muscle function evaluations noting their importance for joint loading and stability. These data provide a foundation to directly evaluate noninvasive therapies purported to influence the mechanical loading associated with this disease. We are proposing to evaluate the effect of management strategies based on exercise and mechanical supports such as bracing on the loading and neuromuscular function of the knee in those with moderate knee OA. The fundamental question is "can we modify factors related to disease progression?" Cost effective knee OA management practices are critical to the musculoskeletal health and thus general health of Canadians.