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Dimitrios-Sokratis Komaris, Cheral Govind, Andrew Murphy, Alistair Ewen and Philip Riches

Patients with osteoarthritis of the knee commonly alter their movement to compensate for lower limb weakness and alleviate joint pain. Movement alterations may lead to weight-bearing asymmetries, and potentially to the progression of the disease. This study presents a novel numerical procedure for the identification of sit-to-walk strategies and differences in movement habits between control adults and persons with knee osteoarthritis. Ten control and 12 participants with osteoarthritis performed the sit-to-walk task in a motion capture laboratory. Participants sat on a stool with the height adjusted to 100% of their knee height, then stood and walked to pick up an object from a table in front of them. Different movement strategies were identified by means of hierarchical clustering. Trials were also classified as to whether the left and right extremities used a bilateral or an asymmetrical strategy. Participants with osteoarthritis used significantly more asymmetrical arm strategies (P = .03) while adopting the pushing through the chair strategy more often than the control subjects (P = .02). The results demonstrated that the 2 groups favor different sit-to-walk strategies. Asymmetrical arm behavior possibly indicates a compensation for the weakness of the affected leg. The proposed procedure may be useful to rapidly assess postoperative outcomes and developing rehabilitation strategies.

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Nick Caplan, Andrew Forbes, Sarkhell Radha, Su Stewart, Alistair Ewen, Alan St Clair Gibson and Deiary Kader

Context:

Ankle immobilization is often used after ankle injury.

Objective:

To determine the influence of 1 week’s unilateral ankle immobilization on plantar-flexor strength, balance, and walking gait in asymptomatic volunteers.

Design:

Repeated-measures laboratory study.

Setting:

University laboratory.

Participants:

6 physically active male participants with no recent history of lower-limb injury.

Interventions:

Participants completed a 1-wk period of ankle immobilization achieved through wearing a below-knee ankle cast. Before the cast was applied, as well as immediately, 24 h, and 48 h after cast removal, their plantar-flexor strength was assessed isokinetically, and they completed a single-leg balance task as a measure of proprioceptive function. An analysis of their walking gait was also completed

Main Outcome Measures:

Peak plantar-flexor torque and balance were used to determine any effect on muscle strength and proprioception after cast removal. Ranges of motion (3D) of the ankle, knee, and hip, as well as walking speed, were used to assess any influence on walking gait.

Results:

After cast removal, plantar-flexor strength was reduced for the majority of participants (P = .063, CI = −33.98 to 1.31) and balance performance was reduced in the immobilized limb (P < .05, CI = 0.84−5.16). Both strength and balance were not significantly different from baseline levels by 48 h. Walking speed was not significantly different immediately after cast removal but increased progressively above baseline walking speed over the following 48 h. Joint ranges of motion were not significantly different at any time point.

Conclusions:

The reduction in strength and balance after such a short period of immobilization suggested compromised central and peripheral neural mechanisms. This suggestion appeared consistent with the delayed increase in walking speed that could occur as a result of the excitability of the neural pathways increasing toward baseline levels.