Research Papers

Amplitude and Phasing of Trunk Motion is Critical for the Efficacy of Gait Training Aimed at Reducing Ambulatory Loads at the Knee

[+] Author and Article Information
Annegret Mündermann1

Division of Sport Science, Universität Konstanz, 78457 Konstanz, Germany; Department of Mechanical Engineering,  Stanford University, Stanford, CA 94305annegret.muendermann@uni-konstanz.de

Lars Mündermann

Department of Mechanical Engineering,  Stanford University, Stanford, CA 94305

Thomas P. Andriacchi

Department of Mechanical Engineering, Stanford University, Stanford, CA 94304; Bone and Joint Center, Palo Alto VA, Palo Alto, CA 94301; Department of Orthopedic Surgery,  Stanford University Medical Center, 300 Pasteur Dr., Stanford, CA 94305


Corresponding author.

J Biomech Eng 134(1), 011010 (Feb 09, 2012) (6 pages) doi:10.1115/1.4005540 History: Received May 24, 2011; Revised November 30, 2011; Posted January 19, 2012; Published February 08, 2012; Online February 09, 2012

The purpose of this study was to determine the contribution of changes in amplitude and phasing of medio-lateral trunk sway to a change in the knee adduction moment when walking with increased medio-lateral trunk sway. Kinematic and kinetic data of walking trials with normal and with increased trunk sway were collected for 19 healthy volunteers using a standard motion analysis system. The relationship between the change in first peak knee adduction moment (ΔKAM) and change in trunk sway amplitude (ΔSA; difference between maximum contralateral trunk lean and maximum ipsilateral trunk lean) and phasing (SP; time of heel-strike relative to time of maximum contralateral and time of maximum ipsilateral trunk lean) was determined using nonlinear regression analysis. On average, subjects increased their SA by 9.7 ± 3.6 deg (P < 0.001) with an average SP of 98.8 ± 88.8 ms resulting in an average reduction in the first peak knee adduction moment of −55.2 ± 30.3% (P < 0.001). 64.3% of variability in change in peak knee adduction moment with the increased trunk sway condition was explained by both differences in SA and SP, and the relationship among these parameters was described by the regression equation ΔKAM = 27.220−4.128 · ΔSA-64.785 · cos(SP). Hence, not only the amplitude but also the phasing of trunk motion is critical. Not only lower limb movement but also lumbar and thoracic lateral flexion should be considered in the decision making process for an optimal intervention aimed at reducing the load on the medial compartment of the knee during walking. However, these promising findings originated from studies on healthy subjects and their relevance for gait training interventions in patients with presumably painful knee osteoarthritis remains to be determined.

Copyright © 2012 by American Society of Mechanical Engineers
Topics: Motion , Stress , Knee
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Figure 1

Details of the trunk sway phasing (SP) definition and coordination between trunk sway and knee adduction moment for one exemplary subject (subject 6) where SP = ta /tb . Note that this subject had close to optimal phasing where the maximum ipsilateral trunk lean (top graph) coincided with the time of the first peak knee adduction moment (bottom graph) resulting in a large reduction in the first peak knee adduction moment.

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Figure 2

Trunk sway pattern for the normal trunk sway condition for the same exemplary subject as shown in Fig. 1 (subject 6). Note that trunk sway does not show a clear wave pattern.

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Figure 3

(a) Top graph: relationship between change in first peak knee adduction moment and increase in trunk sway amplitude. (b) Bottom graph: relationship between deviation from linear regression line and trunk sway phasing.

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Figure 4

Illustration of optimal trunk sway phasing. From left to right: Maximum contralateral trunk lean during early stance of contralateral foot contact; trunk is starting to move to the ipsilateral side during midstance of the contralateral foot contact; trunk reaches vertical (indicated by the dashed line) during late stance of the contralateral foot contact; heel-strike of the ipsilateral foot occurs 32 ms after the trunk passes the vertical; maximum ipsilateral trunk lean during early stance of ipsilateral foot contact.



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