Muscle Activation in Knee Osteoarthritis

Gender Difference of Muscle Activation Amongst Patients With Knee Osteoarthritis

Muscle activity, as a possible fundamental cause of functional limitation, has been extensively investigated in knee osteoarthritis (KOA). Many trials investigated muscle activity during dynamic movements and functional tasks in KOA. In addition, gender-related differences has been also investigated during functional movements in KOA. However, no trial investigated gender-related differences in muscle activation during static movement in KOA.

Study Overview

• Status: Completed
• Conditions: Knee Osteoarthritis
• Intervention / Treatment: Device: Electromyography (EMG) measurement

Detailed Description

Muscle activity, as a possible fundamental cause of functional limitation, has been extensively investigated in knee osteoarthritis (KOA). Interestingly, studies concentrated mainly on investigation of muscle activity during dynamic movements and different functional tests. Moznuzzaman et al displayed greater muscle activation during sitting to standing test (STS) and standing to sitting test in KOA patients compared to healthy participants. Interestingly, some studies investigated muscle activation standing up from a knee-height seat during STS and illustrated a greater muscle activation amongst KOA patients compared to healthy controls. Moreover, Amer et al found greater muscle activation while performing STS from a lower height seat compared to a knee-height seat amongst women and men patients with uni/bilateral KOA. These findings might be of interest due to compensatory mechanisms observed by female patients during STS transition increases loading on the joint surfaces and consequently leading to progression of KOA. Furthermore, different studies also presented gender-differences of muscle activation during different weight-bearing tasks (gait, STS, stair ascend/descend, and squat) amongst patients with KOA and healthy control. Interestingly, both studies showed women with KOA representing higher muscle activation compared to men. Therefore, an analytical comparative study might be useful for identification of gender-differences in muscle activation amongst patients with KOA.

Investigation of static muscle activity during functional movements is very rare in KOA. Zhang et al investigated muscle activation after single whole body vibration trial in standing position at 0°, 30° and 60° static knee flexion angles amongst women with KOA. Authors found that muscle activation in 60° was greater compared to 30°, and it was also greater in 30° compared to 0°. Based on our literature search, no further study examined muscle activity in static knee flexion in KOA. However, investigating static knee flexion might be useful as it could be related to different knee moments in KOA.

• Study Type: Observational
• Enrollment (Actual): 70

Contacts and Locations

Study Locations

• Hungary
  • Baranya
    • Pécs, Baranya, Hungary, 7621
      • University of Pecs

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients with radiologically diagnosed KOA

Description

Inclusion Criteria:

• radiologically diagnosed KOA based on the Kellgren-Lawrence grading system 1-3,
• age above 60 years
• at least 60° active knee flexion
• sufficient mental status

Exclusion Criteria:

• acute inflammation of the knee
• intraarticular injections within the last 3 months
• total knee replacement in the opposite side
• class II obesity (body mass index, BMI>35kg/m2)
• severe degenerative lumbar spine disease (e.g., spondylolisthesis)
• systemic inflammatory arthritic or neurological condition
• conservative intervention attendance within 6 months
• contraindication to conservative therapy and manual therapy
• unstable heart condition
• complex regional pain syndrome

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Men group; Muscle activity amongst men with KOA	Device: Electromyography (EMG) measurement; Electromyography (EMG) measurement of m. quadriceps femoris and semitendinosus muscle during static functional tasks
Women group; Muscle activity amongst women with KOA	Device: Electromyography (EMG) measurement; Electromyography (EMG) measurement of m. quadriceps femoris and semitendinosus muscle during static functional tasks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patients' baseline state	Measurement of patients' pain, stiffness and functional state based on WOMAC	within 1 day
Patients' baseline pain	Measurement of patients' pain based on Numeric Pain Rating Scale	within 1 day
Patients' baseline knee flexion	Measurement of patients' active knee flexion in supine	within 1 day
Patients' baseline knee flexion in standing position	Measurement of patients' active knee flexion during weight-bearing	within 1 day
Muscle strength of m. quadriceps femoris	Measurement of muscle strength of m. quadriceps femoris in 0, 35 and 60 degree	within 1 day
Muscle strength of hamstring muscles	Measurement of muscle strength of m. semitendinosus, semimembranosus and biceps femoris in 0, 35 and 60 degree	within 1 day
Muscle activation in 30 degree static knee flexion	EMG measurement of muscle activation during 2-leg 30 degree static knee flexion	within 1 day
Muscle activation in 60 degree static knee flexion	EMG measurement of muscle activation during 2-leg 60 degree static knee flexion	within 1 day
Muscle activation during stepping up a stair	EMG measurement of muscle activation during stepping up on a stair	within 1 day
Muscle activation during stepping down a stair	EMG measurement of muscle activation during stepping down from a stair	within 1 day
Muscle activation during stepping down side-ways a stair with affected leg	EMG measurement of muscle activation during stepping down side-ways a stair with affected leg	within 1 day
Muscle activation during stepping down side-ways a stair with opposite leg	EMG measurement of muscle activation during stepping down side-ways a stair with opposite leg	within 1 day
Muscle activation in one-leg standing position	EMG measurement of muscle activation in one-leg standing position	within 1 day

Collaborators and Investigators

• Sponsor: University of Pecs
• Investigators: Study Director: Csaba Melczer, Physiother., University of Pecs

Publications and helpful links

General Publications

• Al Amer HS, Sabbahi MA, Alrowayeh HN, Bryan WJ, Olson SL. Electromyographic activity of quadriceps muscle during sit-to-stand in patients with unilateral knee osteoarthritis. BMC Res Notes. 2018 Jun 5;11(1):356. doi: 10.1186/s13104-018-3464-9.
• Bouchouras G, Sofianidis G, Patsika G, Kellis E, Hatzitaki V. Women with knee osteoarthritis increase knee muscle co-contraction to perform stand to sit. Aging Clin Exp Res. 2020 Apr;32(4):655-662. doi: 10.1007/s40520-019-01245-z. Epub 2019 Jun 15.
• Smith SL, Woodburn J, Steultjens MPM. Sex- and osteoarthritis-related differences in muscle co-activation during weight-bearing tasks. Gait Posture. 2020 Jun;79:117-125. doi: 10.1016/j.gaitpost.2020.04.019. Epub 2020 Apr 27.

Study record dates

Study Major Dates

• Study Start (Actual): April 30, 2023
• Primary Completion (Actual): November 1, 2023
• Study Completion (Actual): November 30, 2023

Study Registration Dates

• First Submitted: May 2, 2023
• First Submitted That Met QC Criteria: May 19, 2023
• First Posted (Actual): May 23, 2023

Study Record Updates

• Last Update Posted (Estimated): December 1, 2023
• Last Update Submitted That Met QC Criteria: November 30, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: Muscle Activation

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No