Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of p... more Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability and psychological dysfunction. To evaluate whether adding an internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater improvements in pain and function. Assessor-, therapist- and participant-blinded randomized controlled trial SETTING: Community PARTICIPANTS: 142 people over 50 years of age with self-reported hip pain consistent with hip OA INTERVENTION: Participants will be randomly allocated to: i) control - a 24 week standardized intervention comprising an 8-week internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or ii) PCST - adding an 8-week internet-based PCST protocol to the control intervention. Outcomes will be measured at baseline, 8, 24 and 52 weeks with the primary ...
Objectives. To evaluate the effects of two knee taping techniques, therapeutic tape and neutral t... more Objectives. To evaluate the effects of two knee taping techniques, therapeutic tape and neutral tape, on pain and observed disability in symptomatic generalized knee osteoarthritis (OA). Methods. Using a within-subjects study design, 18 participants were tested under three conditions in random order: untaped, wearing therapeutic knee tape and wearing neutral knee tape. Outcome measures included assessment of pain during each
Alterations in hip abductor strength and hip and knee adduction moments during gait are associate... more Alterations in hip abductor strength and hip and knee adduction moments during gait are associated with knee osteoarthritis. This study examines the relationship between hip abductor strength and hip and knee adduction moments during gait in individuals with symptomatic medial knee osteoarthritis. Ninety-nine participants underwent maximal isometric hip abductor strength testing and 3D gait analysis. Pearson correlations examined relationships between non-normalized maximal hip abductor strength (Nm), peak external hip and knee adduction moments (Nm) and knee adduction moment impulse (Nm∙s). Linear regressions examined these relationships while controlling for body size (height and mass) and walking speed. Positive relationships existed between non-normalized hip abductor strength and hip and knee adduction moments (r=0.28 and 0.37, respectively, p<0.01) as well as the knee adduction moment impulse (r=0.47, p<0.01). However, after controlling for body size and walking speed, h...
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2015
ABSTRACT Drs White and Cummings state1 that we negatively reported findings of our ‘positive stud... more ABSTRACT Drs White and Cummings state1 that we negatively reported findings of our ‘positive study’—namely, our trial evaluating acupuncture for chronic knee osteoarthritis (OA).2 Our study was not a ‘positive study’ as they suggest. Rather, our study showed no benefit of needle or laser acupuncture compared with sham laser acupuncture on either of our two primary outcomes (pain and function), and small clinically irrelevant benefits compared with no acupuncture for both laser and needle acupuncture. In accordance with best practice in the conduct and interpretation of clinical trials, we (1) a priori specified our primary outcome measures, including the minimum clinically important difference (MCID) on the scale of measurement for each outcome measure; (2) determined and recruited the sample size needed to show meaningful between-group differences in primary outcomes based on our chosen MCIDs and estimated SDs with adequate power; and (3) interpreted our findings based on both of these primary outcomes, their MCIDs and considering both control conditions included in our study design (ie, sham laser acupuncture and no acupuncture). Accordingly, the conclusion stating that our findings do not support acupuncture for these patients is appropriate and is the only conclusion that can (and should) be drawn from our study. We powered our study to detect the absolute MCID between groups in pain (1.8 units) and function (6 units), which have been recommended specifically for our chosen primary …
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, 2002
Knee osteoarthritis has a major impact on quadriceps function, yet its effect on the specific tem... more Knee osteoarthritis has a major impact on quadriceps function, yet its effect on the specific temporal recruitment of vastus medialis obliquus and vastus lateralis is unknown. The aim of this study was to determine the electromyographic onset of vastus medialis obliquus activity relative to that of vastus lateralis in individuals with symptomatic knee osteoarthritis and in an asymptomatic control group during the functional task of stair climbing. Cross-sectional, comprising 41 participants with symptomatic knee osteoarthritis and 33 controls matched for age, sex, and body mass. No significant differences were detected in the timing of onset of vastus medialis obliquus relative to that of vastus lateralis between the osteoarthritis and control groups. Radiographic osteoarthritis severity, presence of patellofemoral joint disease, and pain intensity did not seem to influence the temporal relationship of the vastii in the osteoarthritis group. The presence of symptomatic, radiographic...
Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip and/or gro... more Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip and/or groin pain in younger active adults. Understanding the nature of physical impairments and activity limitations associated with symptomatic FAI is important to evaluate outcomes and guide development of rehabilitation strategies. The purpose of this systematic review was to establish: (1) whether people with symptomatic FAI demonstrate physical impairments and/or activity limitations compared with people without FAI; and (2) whether treatment affects these parameters. Four databases (Pubmed, CINAHL, SportDISCUS and Cochrane Library) were searched until the 21 June 2013. Studies evaluated measures of physical impairment and/or activity limitations in people with symptomatic FAI and included either: (1) a comparison control group; or (2) a pretreatment and post-treatment comparison. Methodological quality was assessed using the Newcastle-Ottawa Scale. 16 studies were included. The most commonl...
Purpose: Meta-analysis of randomized controlled trials (RCTs) -of a hip powder of Rosa canina (ro... more Purpose: Meta-analysis of randomized controlled trials (RCTs) -of a hip powder of Rosa canina (rosehip) preparation for symptomatic treatment of osteoarthritis (OA), in order to estimate the empirical efficacy as a pain-reducing compound. Methods: RCTs from systematic searches were included if they explicitly stated that OA patients were randomized to either rosehip or placebo. The primary outcome was reduction in pain calculated as effect size (ES), defined as the standardized mean difference (SMD). As secondary analysis the number of responders to therapy was analyzed as Odds Ratios (OR), and expressed as the Number Needed to Treat (NNT). Restricted Maximum Likelihood (REML) methods were applied for the meta-analyses using mixed effects models. Results: The three studies (287 patients and a median trial-duration of 3 months) -all supported by the manufacturer (Hyben-Vital International) -showed a reduction in pain scores by rosehip powder (145 patients) compared to placebo (142 patients): ES of 0.37 [95% confidence interval (CI): 0.13−0.60], P = 0.002. Test for homogeneity seemed to support that the efficacy was consistent across trials (I-square = 0%). Thus it seems reasonable to assume that the three studies were measuring the same overall effect. It seemed twice as likely that a patient allocated to rosehip powder would respond to therapy, compared to placebo (OR = 2.19; P = 0.0009); corresponding to a NNT of six (95% CI: 4−13) patients (figure).
Background: Expert opinion recommends cushioned and supportive footwear for people with knee oste... more Background: Expert opinion recommends cushioned and supportive footwear for people with knee osteoarthritis (OA). However, little is known about the footwear advice people receive from healthcare professionals, or the beliefs and footwear habits of people with knee OA. This study aimed to determine i) what types of shoes people are advised to wear for their knee OA and by whom; ii) establish which types of shoes people with knee OA believe are best for managing their knee OA symptoms and (iii) which shoes they wear most often.
To evaluate the relationship between dynamic mechanical loading, as indicated by external knee ad... more To evaluate the relationship between dynamic mechanical loading, as indicated by external knee adduction moment (KAM) measures during walking, and measures of articular cartilage morphology and subchondral bone size in people with medial knee osteoarthritis (OA). 180 individuals with radiographic medial tibiofemoral OA participated. Peak KAM and KAM angular impulse were measured by walking gait analysis. Tibial cartilage volume and plateau bone area, and tibiofemoral cartilage defects were determined from magnetic resonance imaging using validated methods. Both peak KAM (coefficient=0.42, 95% confidence interval (CI) 0.04-0.79, P=0.03) and KAM impulse (coefficient=1.79, 95% CI 0.80-2.78, P&lt;0.001) were positively associated with the severity of medial tibiofemoral cartilage defects. KAM impulse was also associated with the prevalence of medial tibiofemoral cartilage defects (odds ratio 4.78, 95% CI 1.10-20.76, P=0.04). Peak KAM (B=0.05, 95% CI 0.01-0.09, P=0.02) and KAM impulse (B=0.16, 95% CI 0.06-0.25, P=0.002) were positively associated with medial:lateral tibial plateau bone area, and KAM impulse was also associated with medial tibial plateau bone area (B=133.7, 95% CI 4.0-263.3, P=0.04). There was no significant association between KAM measures and tibial cartilage volume. Peak KAM and KAM impulse are associated with cartilage defects and subchondral bone area in patients with medial knee OA, suggesting that increased mechanical loading may play a role in the pathological changes in articular cartilage and subchondral bone that occur with medial knee OA.
There is debate about benefits of acupuncture for knee pain. OBJECTIVE To determine the efficacy ... more There is debate about benefits of acupuncture for knee pain. OBJECTIVE To determine the efficacy of laser and needle acupuncture for chronic knee pain. DESIGN, SETTING, AND PARTICIPANTS Zelen-design clinical trial (randomization occurred before informed consent), in Victoria, Australia (February 2010-December 2012). Community volunteers (282 patients aged Ն50 years with chronic knee pain) were treated by family physician acupuncturists.
People following arthroscopic partial medial meniscectomy (APM) are at increased risk of developi... more People following arthroscopic partial medial meniscectomy (APM) are at increased risk of developing knee osteoarthritis. High impact loading and peak loading early in the stance phase of gait may play a role in the pathogenesis of knee osteoarthritis. This was a secondary analysis of longitudinal data to investigate loading-related indices at baseline in an APM group (3 months post-surgery) and a healthy control group, and again 2 years later (follow-up). At baseline, 82 participants with medial APM and 38 healthy controls were assessed, with 66 and 23 re-assessed at follow-up, respectively. Outcome measures included: (i) heel strike transient (HST) presence and magnitude, (ii) maximum loading rate, (iii) peak vertical force (Fz) during early stance. At baseline, maximum loading rate was lower in the operated leg (APM) and non-operated leg (non-APM leg) compared to controls (p ≤ 0.03) and peak Fz was lower in the APM leg compared to non-APM leg (p ≤ 0.01). Over 2 years, peak Fz incr...
Objective: Establish priority key messages for patients with osteoarthritis. Method: A Delphi sur... more Objective: Establish priority key messages for patients with osteoarthritis. Method: A Delphi survey and priority pairwise ranking activity was conducted. Participants included 51 osteoarthritis experts from 13 countries and 9 patients (consumers) living with hip and/or knee osteoarthritis. Over three Delphi rounds, the panel of experts and consumers rated recommendations extracted from clinical guidelines and provided additional statements they considered important. When 70% or more of panel members agreed a statement was 'essential' it was retained for the next Delphi round. The final list of essential statements was reviewed by a consumer focus group and statements were modified for clarity if required. Finally, a priority pairwise ranking activity determined the rank order of the list of essential messages. Results: 85 experts and 15 consumers were invited to participate; 51 experts and 9 consumers completed Round 1 of the Delphi survey, and 43 experts and 8 consumers co...
Knee osteoarthritis (OA) is a prevalent disease afflicting elderly people. As the knee joint is t... more Knee osteoarthritis (OA) is a prevalent disease afflicting elderly people. As the knee joint is tri-compartmental, numerous radiographic patterns of disease are possible. The patellofemoral joint (PFJ) is one of the most commonly affected compartments. Although PFJ OA is frequently observed, this particular disease sub-group has gone largely unrecognised. Recent research suggests that not only is the PFJ an important source of symptoms in knee OA, but also that afflicted individuals demonstrate disease features distinct from those observed in tibiofemoral joint OA. This has implications for the assessment and treatment of patients with PFJ OA. This review summarises the evidence suggesting why PFJ OA should be considered a distinct clinical entity and how it may best be managed using conservative, non-pharmacological treatment approaches that are targeted to the PFJ. Interventions such as patella taping, patella bracing and physiotherapy have the potential to alleviate joint stress and symptoms for people with this condition.
The muscles of the lower limb play an important role in the genesis and management of knee osteoa... more The muscles of the lower limb play an important role in the genesis and management of knee osteoarthritis (OA). This article outlines the influence of muscle activity on knee joint loading, the deficits in muscle function observed in people who have knee OA, and available evidence pertaining to the role of muscle in the development and progression of knee OA. It also discusses whether muscle deficits can be modified in knee OA and whether improvements in muscle function lead to improved symptoms and joint structure. It concludes with a discussion of exercise prescription for muscle rehabilitation in knee OA.
Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of p... more Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability and psychological dysfunction. To evaluate whether adding an internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater improvements in pain and function. Assessor-, therapist- and participant-blinded randomized controlled trial SETTING: Community PARTICIPANTS: 142 people over 50 years of age with self-reported hip pain consistent with hip OA INTERVENTION: Participants will be randomly allocated to: i) control - a 24 week standardized intervention comprising an 8-week internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or ii) PCST - adding an 8-week internet-based PCST protocol to the control intervention. Outcomes will be measured at baseline, 8, 24 and 52 weeks with the primary ...
Objectives. To evaluate the effects of two knee taping techniques, therapeutic tape and neutral t... more Objectives. To evaluate the effects of two knee taping techniques, therapeutic tape and neutral tape, on pain and observed disability in symptomatic generalized knee osteoarthritis (OA). Methods. Using a within-subjects study design, 18 participants were tested under three conditions in random order: untaped, wearing therapeutic knee tape and wearing neutral knee tape. Outcome measures included assessment of pain during each
Alterations in hip abductor strength and hip and knee adduction moments during gait are associate... more Alterations in hip abductor strength and hip and knee adduction moments during gait are associated with knee osteoarthritis. This study examines the relationship between hip abductor strength and hip and knee adduction moments during gait in individuals with symptomatic medial knee osteoarthritis. Ninety-nine participants underwent maximal isometric hip abductor strength testing and 3D gait analysis. Pearson correlations examined relationships between non-normalized maximal hip abductor strength (Nm), peak external hip and knee adduction moments (Nm) and knee adduction moment impulse (Nm∙s). Linear regressions examined these relationships while controlling for body size (height and mass) and walking speed. Positive relationships existed between non-normalized hip abductor strength and hip and knee adduction moments (r=0.28 and 0.37, respectively, p<0.01) as well as the knee adduction moment impulse (r=0.47, p<0.01). However, after controlling for body size and walking speed, h...
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2015
ABSTRACT Drs White and Cummings state1 that we negatively reported findings of our ‘positive stud... more ABSTRACT Drs White and Cummings state1 that we negatively reported findings of our ‘positive study’—namely, our trial evaluating acupuncture for chronic knee osteoarthritis (OA).2 Our study was not a ‘positive study’ as they suggest. Rather, our study showed no benefit of needle or laser acupuncture compared with sham laser acupuncture on either of our two primary outcomes (pain and function), and small clinically irrelevant benefits compared with no acupuncture for both laser and needle acupuncture. In accordance with best practice in the conduct and interpretation of clinical trials, we (1) a priori specified our primary outcome measures, including the minimum clinically important difference (MCID) on the scale of measurement for each outcome measure; (2) determined and recruited the sample size needed to show meaningful between-group differences in primary outcomes based on our chosen MCIDs and estimated SDs with adequate power; and (3) interpreted our findings based on both of these primary outcomes, their MCIDs and considering both control conditions included in our study design (ie, sham laser acupuncture and no acupuncture). Accordingly, the conclusion stating that our findings do not support acupuncture for these patients is appropriate and is the only conclusion that can (and should) be drawn from our study. We powered our study to detect the absolute MCID between groups in pain (1.8 units) and function (6 units), which have been recommended specifically for our chosen primary …
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, 2002
Knee osteoarthritis has a major impact on quadriceps function, yet its effect on the specific tem... more Knee osteoarthritis has a major impact on quadriceps function, yet its effect on the specific temporal recruitment of vastus medialis obliquus and vastus lateralis is unknown. The aim of this study was to determine the electromyographic onset of vastus medialis obliquus activity relative to that of vastus lateralis in individuals with symptomatic knee osteoarthritis and in an asymptomatic control group during the functional task of stair climbing. Cross-sectional, comprising 41 participants with symptomatic knee osteoarthritis and 33 controls matched for age, sex, and body mass. No significant differences were detected in the timing of onset of vastus medialis obliquus relative to that of vastus lateralis between the osteoarthritis and control groups. Radiographic osteoarthritis severity, presence of patellofemoral joint disease, and pain intensity did not seem to influence the temporal relationship of the vastii in the osteoarthritis group. The presence of symptomatic, radiographic...
Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip and/or gro... more Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip and/or groin pain in younger active adults. Understanding the nature of physical impairments and activity limitations associated with symptomatic FAI is important to evaluate outcomes and guide development of rehabilitation strategies. The purpose of this systematic review was to establish: (1) whether people with symptomatic FAI demonstrate physical impairments and/or activity limitations compared with people without FAI; and (2) whether treatment affects these parameters. Four databases (Pubmed, CINAHL, SportDISCUS and Cochrane Library) were searched until the 21 June 2013. Studies evaluated measures of physical impairment and/or activity limitations in people with symptomatic FAI and included either: (1) a comparison control group; or (2) a pretreatment and post-treatment comparison. Methodological quality was assessed using the Newcastle-Ottawa Scale. 16 studies were included. The most commonl...
Purpose: Meta-analysis of randomized controlled trials (RCTs) -of a hip powder of Rosa canina (ro... more Purpose: Meta-analysis of randomized controlled trials (RCTs) -of a hip powder of Rosa canina (rosehip) preparation for symptomatic treatment of osteoarthritis (OA), in order to estimate the empirical efficacy as a pain-reducing compound. Methods: RCTs from systematic searches were included if they explicitly stated that OA patients were randomized to either rosehip or placebo. The primary outcome was reduction in pain calculated as effect size (ES), defined as the standardized mean difference (SMD). As secondary analysis the number of responders to therapy was analyzed as Odds Ratios (OR), and expressed as the Number Needed to Treat (NNT). Restricted Maximum Likelihood (REML) methods were applied for the meta-analyses using mixed effects models. Results: The three studies (287 patients and a median trial-duration of 3 months) -all supported by the manufacturer (Hyben-Vital International) -showed a reduction in pain scores by rosehip powder (145 patients) compared to placebo (142 patients): ES of 0.37 [95% confidence interval (CI): 0.13−0.60], P = 0.002. Test for homogeneity seemed to support that the efficacy was consistent across trials (I-square = 0%). Thus it seems reasonable to assume that the three studies were measuring the same overall effect. It seemed twice as likely that a patient allocated to rosehip powder would respond to therapy, compared to placebo (OR = 2.19; P = 0.0009); corresponding to a NNT of six (95% CI: 4−13) patients (figure).
Background: Expert opinion recommends cushioned and supportive footwear for people with knee oste... more Background: Expert opinion recommends cushioned and supportive footwear for people with knee osteoarthritis (OA). However, little is known about the footwear advice people receive from healthcare professionals, or the beliefs and footwear habits of people with knee OA. This study aimed to determine i) what types of shoes people are advised to wear for their knee OA and by whom; ii) establish which types of shoes people with knee OA believe are best for managing their knee OA symptoms and (iii) which shoes they wear most often.
To evaluate the relationship between dynamic mechanical loading, as indicated by external knee ad... more To evaluate the relationship between dynamic mechanical loading, as indicated by external knee adduction moment (KAM) measures during walking, and measures of articular cartilage morphology and subchondral bone size in people with medial knee osteoarthritis (OA). 180 individuals with radiographic medial tibiofemoral OA participated. Peak KAM and KAM angular impulse were measured by walking gait analysis. Tibial cartilage volume and plateau bone area, and tibiofemoral cartilage defects were determined from magnetic resonance imaging using validated methods. Both peak KAM (coefficient=0.42, 95% confidence interval (CI) 0.04-0.79, P=0.03) and KAM impulse (coefficient=1.79, 95% CI 0.80-2.78, P&lt;0.001) were positively associated with the severity of medial tibiofemoral cartilage defects. KAM impulse was also associated with the prevalence of medial tibiofemoral cartilage defects (odds ratio 4.78, 95% CI 1.10-20.76, P=0.04). Peak KAM (B=0.05, 95% CI 0.01-0.09, P=0.02) and KAM impulse (B=0.16, 95% CI 0.06-0.25, P=0.002) were positively associated with medial:lateral tibial plateau bone area, and KAM impulse was also associated with medial tibial plateau bone area (B=133.7, 95% CI 4.0-263.3, P=0.04). There was no significant association between KAM measures and tibial cartilage volume. Peak KAM and KAM impulse are associated with cartilage defects and subchondral bone area in patients with medial knee OA, suggesting that increased mechanical loading may play a role in the pathological changes in articular cartilage and subchondral bone that occur with medial knee OA.
There is debate about benefits of acupuncture for knee pain. OBJECTIVE To determine the efficacy ... more There is debate about benefits of acupuncture for knee pain. OBJECTIVE To determine the efficacy of laser and needle acupuncture for chronic knee pain. DESIGN, SETTING, AND PARTICIPANTS Zelen-design clinical trial (randomization occurred before informed consent), in Victoria, Australia (February 2010-December 2012). Community volunteers (282 patients aged Ն50 years with chronic knee pain) were treated by family physician acupuncturists.
People following arthroscopic partial medial meniscectomy (APM) are at increased risk of developi... more People following arthroscopic partial medial meniscectomy (APM) are at increased risk of developing knee osteoarthritis. High impact loading and peak loading early in the stance phase of gait may play a role in the pathogenesis of knee osteoarthritis. This was a secondary analysis of longitudinal data to investigate loading-related indices at baseline in an APM group (3 months post-surgery) and a healthy control group, and again 2 years later (follow-up). At baseline, 82 participants with medial APM and 38 healthy controls were assessed, with 66 and 23 re-assessed at follow-up, respectively. Outcome measures included: (i) heel strike transient (HST) presence and magnitude, (ii) maximum loading rate, (iii) peak vertical force (Fz) during early stance. At baseline, maximum loading rate was lower in the operated leg (APM) and non-operated leg (non-APM leg) compared to controls (p ≤ 0.03) and peak Fz was lower in the APM leg compared to non-APM leg (p ≤ 0.01). Over 2 years, peak Fz incr...
Objective: Establish priority key messages for patients with osteoarthritis. Method: A Delphi sur... more Objective: Establish priority key messages for patients with osteoarthritis. Method: A Delphi survey and priority pairwise ranking activity was conducted. Participants included 51 osteoarthritis experts from 13 countries and 9 patients (consumers) living with hip and/or knee osteoarthritis. Over three Delphi rounds, the panel of experts and consumers rated recommendations extracted from clinical guidelines and provided additional statements they considered important. When 70% or more of panel members agreed a statement was 'essential' it was retained for the next Delphi round. The final list of essential statements was reviewed by a consumer focus group and statements were modified for clarity if required. Finally, a priority pairwise ranking activity determined the rank order of the list of essential messages. Results: 85 experts and 15 consumers were invited to participate; 51 experts and 9 consumers completed Round 1 of the Delphi survey, and 43 experts and 8 consumers co...
Knee osteoarthritis (OA) is a prevalent disease afflicting elderly people. As the knee joint is t... more Knee osteoarthritis (OA) is a prevalent disease afflicting elderly people. As the knee joint is tri-compartmental, numerous radiographic patterns of disease are possible. The patellofemoral joint (PFJ) is one of the most commonly affected compartments. Although PFJ OA is frequently observed, this particular disease sub-group has gone largely unrecognised. Recent research suggests that not only is the PFJ an important source of symptoms in knee OA, but also that afflicted individuals demonstrate disease features distinct from those observed in tibiofemoral joint OA. This has implications for the assessment and treatment of patients with PFJ OA. This review summarises the evidence suggesting why PFJ OA should be considered a distinct clinical entity and how it may best be managed using conservative, non-pharmacological treatment approaches that are targeted to the PFJ. Interventions such as patella taping, patella bracing and physiotherapy have the potential to alleviate joint stress and symptoms for people with this condition.
The muscles of the lower limb play an important role in the genesis and management of knee osteoa... more The muscles of the lower limb play an important role in the genesis and management of knee osteoarthritis (OA). This article outlines the influence of muscle activity on knee joint loading, the deficits in muscle function observed in people who have knee OA, and available evidence pertaining to the role of muscle in the development and progression of knee OA. It also discusses whether muscle deficits can be modified in knee OA and whether improvements in muscle function lead to improved symptoms and joint structure. It concludes with a discussion of exercise prescription for muscle rehabilitation in knee OA.
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Papers by Rana Hinman