Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking

Background: Increased muscle co-activation during gait has been identified as a neuromuscular alteration associated with knee osteoarthritis, however levels of co-activation among different osteoarthritis severity have not been established. The purpose of this study was to determine if differences in co-activation could be detected among asymptomatic controls, those with moderate and those with severe osteoarthritis using a co-activation index and a pattern recognition technique. Methods: Surface electromyograms from vastus lateralis and medialis, lateral and medial hamstring and gastrocnemius pairs were recorded from 63 asymptomatic, 59 moderate and 48 severe osteoarthritic subjects during self-selected walking. A co-activation index was calculated over the initial stance for four medial and lateral muscle pairs. The four co-activation indices were tested among groups using a one factor ANOVA (α = 0.05). Gait waveform pattern recognition procedures were applied to yield a principal pattern, scored for each muscle site and subject. A mixed model ANOVA (group-muscle) tested for principal pattern score differences. Findings: A significant group effect was found (P < 0.05) for all four co-activation indices. Principal pattern one captured the amplitude and general shape of activity throughout the entire stance phase. ANOVA revealed a significant (P < 0.05) group by muscle interaction for the principal pattern scores. Significant differences were found among all three groups and between the two osteoarthritic groups for both measures. Interpretation: The co-activation indices and principal patterns identified that lateral site differences occurred among all three groups with medial site differences between the two osteoarthritic groups. These findings suggest that measures of muscle co-activity provide additional information related to knee osteoarthritis severity.