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To evaluate whether the knee adduction moment (KAM) could be reduced by a short instruction in the Draw-in (DI) maneuver in healthy adults, and whether knee joint function would improve with a longer DI gait intervention in patients with knee osteoarthritis (OA). In Study 1, healthy adults received 10 minutes supervised instruction in DI gait in and then practiced the gait independently for 10 minutes. Three-dimensional motion analysis measurement was performed in each phase. In Study 2, patients with OA performed a 20-minute DI gait intervention daily for 6 weeks. At baseline and after 6 weeks, knee pain, the Knee injury and Osteoarthritis Outcome Score, the MOS 8 item Short-Form Health Survey, thoracic kyphosis angle, knee joint range of motion, knee extension muscle strength, hip abduction muscle strength, and activity level were evaluated. In Study 1, the DI gait to decrease KAM could be learning following only 10 minutes of instruction and 10 minutes of self-practice in healthy adults. In Study 2, knee pain was reduced by 19 % and the thoracic kyphosis angle was reduced by 2.6° after 6 weeks. No significant changes in other parameters were detected, and the implementation rate was 86 ± 14 %. In healthy adults, DI gait instruction for 10 minutes of instruction and 10 minutes of self-practice reduced the KAM. In patients with knee OA, 20 minutes of DI gait per day for 6 weeks may reduce knee pain and thoracic kyphosis. • Using the draw-in maneuver while walking is an effective intervention for knee OA. • Gait retraining significantly improved knee pain and thoracic kyphosis. • Gait retraining had a high implementation rate. • Gate retraining using the draw-in maneuver can be mastered even by older adults. [ABSTRACT FROM AUTHOR]

Decreasing an external hip adduction moment (HAM) impulse during stance is important to prevent the progression of hip osteoarthritis. A hip adduction angle (HAA) during walking influences the HAM impulse. Although a wider step-width (WS) gait is a gait modification to decrease a peak HAM, no study has reported the HAM impulse and HAA. We investigated whether the HAA influences the peak HAM and HAM impulse during WS gait. Twenty-six healthy young adults walked with normal step-width (NS) and WS comfortably. They were not instructed about hip adduction motion during gait, and the peak HAM, HAM impulse, HAA, and other gait parameters were evaluated using a 3D motion capture system. The participants were divided into two groups according to the HAA size during WS gait. The percentage reduction of HAM variables (the WS condition relative to the NS condition) and other gait parameters were compared between the groups. No difference in gait parameters was found between the groups. The percentage reduction of the HAM impulse in participants with smaller HAA was significantly higher than that in participants with larger HAA (14.5 % vs. 1.6 %, p < 0.01). Also, during normal step-width gait, the large HAA group showed a significantly larger HAA compared to the small HAA group (about 3°). Participants with smaller HAA could decrease the HAM impulse more effectively during WS gait compared with those with larger HAA. Thus, the HAA would influence the HAM impulse reduction effect on the WS gait. We recommend paying attention to the HAA to decrease the HAM with the WS gait. • A relationship between hip adduction moment (HAM) and angle (HAA) was investigated. • Subjects with smaller HAA during wider step-width gait could reduce HAM effectively. • Subjects with larger HAA showed large HAA during normal step-width gait similarly. • We need to focus on HAA in gait modification with wider step-width to reduce HAM. [ABSTRACT FROM AUTHOR]

The gait modification strategies Trunk Lean and Medial Thrust have been shown to reduce the external knee adduction moment (EKAM) in patients with knee osteoarthritis which could contribute to reduced progression of the disease. Which strategy is most optimal differs between individuals, but the underlying mechanism that causes this remains unknown. Which gait parameters determine the optimal gait modification strategy for individual patients with knee osteoarthritis? Forty-seven participants with symptomatic medial knee osteoarthritis underwent 3-dimensional motion analysis during comfortable gait and with two gait modification strategies: Medial Thrust and Trunk Lean. Kinematic and kinetic variables were calculated. Participants were then categorized into one of the two subgroups, based on the modification strategy that reduced the EKAM the most for them. Multiple logistic regression analysis with backward elimination was used to investigate the predictive nature of dynamic parameters obtained during comfortable walking on the optimal modification gait strategy. For 68.1 % of the participants, Trunk Lean was the optimal strategy in reducing the EKAM. Baseline characteristics, kinematics and kinetics did not differ significantly between subgroups during comfortable walking. Changes to frontal trunk and tibia angles correlated significantly with EKAM reduction during the Trunk Lean and Medial Thrust strategies, respectively. Regression analysis showed that MT is likely optimal when the frontal tibia angle range of motion and peak knee flexion angle in early stance during comfortable walking are high (R2 Nagelkerke = 0.12). Our regression model based solely on kinematic parameters from comfortable walking contained characteristics of the frontal tibia angle and knee flexion angle. As the model explains only 12.3 % of variance, clinical application does not seem feasible. Direct assessment of kinetics seems to be the most optimal strategy for selecting the most optimal gait modification strategy for individual patients with knee osteoarthritis. • Self-selected Trunk Lean modification reduces the EKAM more than Medial Thrust. • The degree of frontal tibia angle modifications may determine the optimal strategy. • Parameters during comfortable walking only moderately predict the optimal strategy. [ABSTRACT FROM AUTHOR]

Introduction: The frontal plane knee moment (KAM1 and KAM2) derived from non-invasive three-dimensional gait analysis is a surrogate measure for knee joint load and of great interest in clinical and research settings. Many aspects can influence this measure either unintentionally or purposely in order to reduce the knee joint load to relieve symptoms and pain. All these aspects must be known when conducting a study or interpreting gait data for clinical decision-making.Methods: This systematic review was registered with PROSPERO (CRD42020187038). Pubmed and Web of Science were searched for peer-reviewed, original research articles in which unshod three-dimensional gait analysis was undertaken and KAM1 and KAM2 were included as an outcome variable. Two reviewers independently screened articles for inclusion, extracted data and performed a methodological quality assessment using Downs and Black checklist.Results: In total, 42 studies were included. Based on the independent variable investigated, these studies were divided into three groups: 1) gait modifications, 2) individual characteristics and 3) idiopathic orthopedic deformities. Among others, fast walking speeds (1) were found to increase KAM1; There were no sex-related differences (2) and genu valgum (3) reduces KAM1 and KAM2.Conclusion: While consistent use of terminology and reporting of KAM is required for meta-analysis, this review indicates that gait modifications (speed, trunk lean, step width), individual characteristics (body weight, age) and idiopathic orthopedic deformities (femoral or tibial torsion, genu valgum/varum) influence KAM magnitudes during walking. These factors should be considered by researchers when designing studies (especially of longitudinal design) or by clinicians when interpreting data for surgical and therapeutic decision-making. [ABSTRACT FROM AUTHOR]

Objective: To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics.Design: Thirty patients with symptomatic medial knee osteoarthritis underwent 3-dimensional gait analysis. Participants received verbal instructions on two gait strategies (Trunk Lean and Medial Thrust) in randomized order after comfortable walking was recorded. The peaks and impulse of the EKAM and strategy-specific kinematic and kinetic variables were calculated for all conditions.Results: Early stance EKAM peak was significantly reduced during Medial Thrust (-29%). During Trunk Lean, early and late stance EKAM peak and EKAM impulse reduced significantly (38%, 21% and -25%, respectively). In 79% of the subjects, the Trunk Lean condition was significantly more effective in reducing EKAM peak than Medial Thrust. Peak ankle dorsi and plantar flexion, knee flexion and hip extension and adduction moments were not significantly increased.Conclusions: Medial Thrust and Trunk Lean reduced the EKAM during gait in patients with knee osteoarthritis. Individual selection of the most effective gait modification strategy seems vital to optimally reduce dynamic knee loading during gait. No detrimental effects on external ankle and hip moments or knee flexion moments were found for these conditions. [ABSTRACT FROM AUTHOR]

Background: Gait modification is a treatment approach often used for a variety of neuromuscular and musculoskeletal pathologies. Gait modification is commonly applied to a single limb, as is done with foot rotation (FR) in people with knee osteoarthritis (KOA). However, the extent to which gait changes observed in the trained limb are also exhibited in the untrained, contralateral limb during a training session is unknown.Research Question: The purpose of this study was to examine the within-limb FR differences across four unilateral FR modifications compared to natural walking.Methods: Sixteen individuals with KOA walked on a treadmill while performing four different FR conditions: 10° toe-in, 0°, 10° toe-out and 20° toe-out. Motion capture was conducted to track FR magnitude after five minutes of practice.Results: The change in contralateral FR angle compared to natural walking significantly increased during toe-in 10° walking (3.1°) compared to toe-out -10° and -20° walking (-1.2° and -1.5°, respectively). As expected, the ipsilateral FR angle was significantly different between all conditions.Significance: These results suggest that small, but statistically significant changes in the untrained contralateral limb FR are observed during FR training of the ipsilateral limb. This may indicate a desire for symmetry, or a compensation when modifying the ipsilateral limb. Therefore, clinicians may need to maintain baseline FR magnitudes in the untrained limb when a patient exhibits unilateral KOA characteristics or lateral compartment KOA. [ABSTRACT FROM AUTHOR]

The goal of this study was to examine the transition of walking from a level surface onto different inclined surfaces. Kinematic data of limb and trunk segments were recorded from individuals as they approached and stepped onto four different ramped surfaces (slopes=3°, 6°, 9°, 12°). This transition introduced significant adaptations to the swing limb trajectory that were evident in even the lowest ramp condition and appear to be scaled to the ramp inclination although the nature of this scaling seemed to change between the 6° and 9° conditions. An increased forward pitch of the trunk orientation during all ramp conditions was initiated early on during the preceding stance phase on level ground. The swing limb modification essentially consisted of a two-stage response. The initial response of the limb trajectory changes was not specific to the degree of inclination but later changes were dependent on the ramp condition. The initial response is to ensure a safe toe clearance as the foot approaches the edge of the ramp and then later modifications provide the appropriate positioning of the limb to prepare for an elevated foot contact. Early changes were actively produced through an increased pull-off by the hip flexors and an elevation of the swing limb by the active muscle control of the stance limb. Ankle dorsiflexion also appears to have a supporting role increasing toe clearance. Absorption at the hip and knee during later swing contribute to control and position the limb in preparation for foot contact. These strategies were similar to those adopted for step changes in the level of the walking surface where there are similar demands of the quickly moving the limb forward and upward, however, the positioning of the limb for new angled landing surface requires further adaptations. [Copyright &y& Elsevier]