Contralateral pelvic drop during gait increases knee adduction moments of asymptomatic individuals
Dunphy
C, Casey S, Lomond A, & Rutherford D. Human Movement Science. 2016; 49:27-35.
DOI: 10.1016/j.humov.2016.05.008
C, Casey S, Lomond A, & Rutherford D. Human Movement Science. 2016; 49:27-35.
DOI: 10.1016/j.humov.2016.05.008
Take Home Message: Increased hip adduction during stance
phase of Trendelenburg
gait contributes to
excessive knee
joint loading.
phase of Trendelenburg
gait contributes to
excessive knee
joint loading.
Weakness
of the hip abductors is implicated in increased knee joint loads, which can be quantified
biomechanically using the knee adduction moment (KAM) and has been
observed in patients with knee osteoarthritis. This weakness has been
associated with contralateral pelvic drop during gait, and is theorized to
result in increased KAM. Therefore, the authors’
purpose was to examine the effects of a contralateral pelvic drop gait on the
magnitude of KAM, as measured by peak KAM and KAM impulse, within a healthy
cohort. Fifteen healthy adults with no recent history of musculoskeletal injury were recruited
to participate in the study. Participants were instructed on how to complete a contralateral pelvic drop gait pattern and encouraged to
practice until motion was mastered. The principal investigators and two
physical therapists verified successful adoption of pelvic drop gait based on
visual observation and clinical standards. Participants were instructed to
avoid leaning the trunk over the stance leg or altering sagittal plane
kinematics during pelvic drop gait trials. Average self selected-speed was measured using
the GaitRITE walkway for reference during
the experimental trials. Participants completed a five-minute warm-up
per condition while walking barefoot on an instrumented treadmill, which was adjusted
to their average self-selected speed. Three gait trials lasting 20 seconds each were
collected for both the typical gait pattern and contralateral pelvic drop gait pattern.
Contralateral pelvic drop trials that were deemed unsatisfactory by the principal investigators and the physical therapists were excluded from
analysis. Lower extremity kinematics was captured
concurrently using three-dimensional motion capturing system. Peak KAM and KAM
impulse were significantly higher during contralateral pelvic drop gait
compared to typical gait. A strong and significant relationship existed between
changes in KAM and changes in frontal plane hip kinematics. A greater change in
pelvic drop or hip adduction was related to a greater change in peak KAM and KAM
impulse.
of the hip abductors is implicated in increased knee joint loads, which can be quantified
biomechanically using the knee adduction moment (KAM) and has been
observed in patients with knee osteoarthritis. This weakness has been
associated with contralateral pelvic drop during gait, and is theorized to
result in increased KAM. Therefore, the authors’
purpose was to examine the effects of a contralateral pelvic drop gait on the
magnitude of KAM, as measured by peak KAM and KAM impulse, within a healthy
cohort. Fifteen healthy adults with no recent history of musculoskeletal injury were recruited
to participate in the study. Participants were instructed on how to complete a contralateral pelvic drop gait pattern and encouraged to
practice until motion was mastered. The principal investigators and two
physical therapists verified successful adoption of pelvic drop gait based on
visual observation and clinical standards. Participants were instructed to
avoid leaning the trunk over the stance leg or altering sagittal plane
kinematics during pelvic drop gait trials. Average self selected-speed was measured using
the GaitRITE walkway for reference during
the experimental trials. Participants completed a five-minute warm-up
per condition while walking barefoot on an instrumented treadmill, which was adjusted
to their average self-selected speed. Three gait trials lasting 20 seconds each were
collected for both the typical gait pattern and contralateral pelvic drop gait pattern.
Contralateral pelvic drop trials that were deemed unsatisfactory by the principal investigators and the physical therapists were excluded from
analysis. Lower extremity kinematics was captured
concurrently using three-dimensional motion capturing system. Peak KAM and KAM
impulse were significantly higher during contralateral pelvic drop gait
compared to typical gait. A strong and significant relationship existed between
changes in KAM and changes in frontal plane hip kinematics. A greater change in
pelvic drop or hip adduction was related to a greater change in peak KAM and KAM
impulse.
Authors
observed increased knee joint loads as a result of the decreased hip abduction (contralateral
pelvic drop gait). By investigating within a healthy population, the authors effectively
isolated the effect of frontal plane hip mechanics on knee joint loads while controlling
for potential confounders common to pathological populations. The authors further
controlled for medial-lateral trunk sway, and sagittal plane lower extremity
mechanics, which could also affect the magnitude of medial compartment loads
experienced during stance. Study results implicate weak hip abductor muscles in
the abnormal knee joint loading observed during pelvic drop gait. Although the study
was conducted using a healthy sample, evidence implies that the use of hip
strengthening might be an effective method for gait modification. Clinicians
should however still evaluate patients individually to determine appropriate
intervention strategy. The results from this study suggest that a threshold exist
regarding frontal plane hip function and knee joint loading. Further
investigation within symptomatic osteoarthritis population is needed before widespread
adoption in clinical practice can be recommended.
observed increased knee joint loads as a result of the decreased hip abduction (contralateral
pelvic drop gait). By investigating within a healthy population, the authors effectively
isolated the effect of frontal plane hip mechanics on knee joint loads while controlling
for potential confounders common to pathological populations. The authors further
controlled for medial-lateral trunk sway, and sagittal plane lower extremity
mechanics, which could also affect the magnitude of medial compartment loads
experienced during stance. Study results implicate weak hip abductor muscles in
the abnormal knee joint loading observed during pelvic drop gait. Although the study
was conducted using a healthy sample, evidence implies that the use of hip
strengthening might be an effective method for gait modification. Clinicians
should however still evaluate patients individually to determine appropriate
intervention strategy. The results from this study suggest that a threshold exist
regarding frontal plane hip function and knee joint loading. Further
investigation within symptomatic osteoarthritis population is needed before widespread
adoption in clinical practice can be recommended.
Questions for
Discussion: As
clinicians, does your initial assessment include a gait screening to aid in
identifying the appropriate intervention? How often do you observe a Trendelenburg
gait?
Discussion: As
clinicians, does your initial assessment include a gait screening to aid in
identifying the appropriate intervention? How often do you observe a Trendelenburg
gait?
Written
by: Oladipo Eddo
by: Oladipo Eddo
Reviewed
by: Stephen Thomas
by: Stephen Thomas
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Posts:
Posts:
Dunphy, C., Casey, S., Lomond, A., & Rutherford, D. (2016). Contralateral pelvic drop during gait increases knee adduction moments of asymptomatic individuals Human Movement Science, 49, 27-35 DOI: 10.1016/j.humov.2016.05.008