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A biomechanical approach to musculoskeletal disease

https://doi.org/10.1016/j.berh.2004.02.005Get rights and content

Abstract

The importance of biomechanical factors in musculoskeletal disease may be appreciated in the clinical characteristics and pathophysiology of joint degeneration in osteoarthritis. The biomechanical characteristics of the neuromuscular system are integral in determining the function and stability of the synovial joint and in mediating the biochemical structure of articular cartilage. Alterations in the neuromuscular system including abnormal gait and dynamic joint loading patterns as well as muscle strength and proprioception deficits have been independently studied and associated with osteoarthritis. These factors have close functional and physiological interactions. Nevertheless, specific relations between muscle strength and proprioception and their independent contributions to dynamic joint loading are not yet clear. Targeted interventions to moderate these factors may, in the future, be a therapeutic option for the management of osteoarthritis.

Section snippets

Biomechanical factors, occupation and epidemiology of degenerative disease

There are several reported clinical associations between the degree of daily joint ‘loads’ and the prevalence of degenerative arthritis.1., 2., 3., 4., 5. An increased prevalence of hip and knee OA in agricultural workers is a commonly referenced association.2., 3. Some studies suggest a dose dependent relation between the degree of occupational lifting and hip OA.4., 5. Similarly, occupations requiring repeated knee bending or kneeling have been associated with knee OA.3 In addition to

Effects of biomechanical factors on articular cartilage

The important role of mechanical stimulation in regulating the biochemical architecture of chondrocytes and cartilage matrix is well recognized,11., 12. however, the complex nature of the biomechanical-chemical interactions at the joint is not completely clear. Studies suggest that although some degree of mechanical stimulation is necessary to maintain cartilage integrity13., 14., ‘pathologic’ loading of cartilage can have deleterious effects.11., 12., 14. Furthermore, the affect of loading on

Gait analysis

OA has traditionally been recognized as a ‘wear and tear’, degenerative arthritis. The prior discussion suggests that there may be inherent characteristics of articular cartilage that alter its susceptibility to loads. Nevertheless, the data also suggest that one of the primary mediators of cartilage metabolism is biomechanical loading. In the biomechanical paradigm of degenerative arthritis, a ‘normal’ joint if subjected to ‘abnormal loading’ could presumably develop manifestations of OA.23.,

Muscle strength and OA

Muscles are obviously an integral part of the musculoskeletal system. Muscles function to coordinate limb movement and are important for joint stability. They serve as the body's shock absorbers in that they dissipate load and evenly distribute load across the joint.45 An extreme example of the importance of muscle for normal gait biomechanics and joint protection is the myectomy-induced experimental animal model for OA.46 Unilateral resection of a segment of gluteal muscles of a guinea pig was

Proprioception and OA

In musculoskeletal biomechanics, proprioception refers to a measure of joint position sense. Specifically, most biomechanical studies measure proprioceptive acuity as the ability to detect angular joint motion or to accurately replicate the position of the knee in space.55., 56., 57., 58., 59. Proprioception acuity is felt to be important in neuromuscular control of gait. Proprioception sense allows for anticipation of joint load and thus, facilitates appropriate load dissipation across the

The relation between muscle strength, proprioception and dynamic joint loading in OA

Muscle weakness, proprioception deficits and alterations in dynamic joint loading are important in function and coordination of limb movement, and therefore, in maintaining the integrity of the synovial joint.45., 60. These factors have independently been associated with the presence of OA.34., 35., 36., 44., 47., 48., 49., 56., 57., 58. However, the extent to which these factors are inherent risk factors for OA vs the extent to which they may be consequences of the OA-induced pain, atrophy and

Physical therapy and exercise

Patients with OA are commonly forced to limit their activity level due to pain and stiffness at the affected joint. This decrease in activity level leads to further reductions in muscle strength, loss of flexibility, and diminished aerobic capacity. Many studies have assessed the efficacy of muscle strengthening69., 70., or aerobic conditioning programs in subjects with OA and reported significant improvements in muscle strength, functional mobility, and pain with such interventions.69., 71.

Knee bracing and wedge insoles

Physical therapy is aimed to improve muscle strength and function. Interventions to improve proprioception and dynamic joint loading have also been evaluated. A few small studies suggest that knee sleeve-type bracing may improve proprioceptive acuity.73., 74. Initially, knee bracing was particularly of interest for subjects with anterior cruciate ligament injuries.73., 75., 76. In these studies, bracing did not appear to directly ‘stabilize’ the joint, however, proprioceptive input appeared to

Summary

The neuromuscular system is essential in maintaining integrity of the synovial joint. Biomechanical alterations of the neuromuscular system are major factors in the pathophysiology of joint degeneration in osteoarthritis. Biomechanical factors have been associated with the pattern and prevalence of osteoarthritis in specific occupations and have also been shown to mediate the gross and chemical structure of articular cartilage. Abnormal dynamic joint loading, muscle weakness and proprioception

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