Vol 16: 2020:142-150

Comparison of Maximum Angles of Knee Varus and Flexion in the Stance Phase of Walking on a Treadmill with Different Inclinations between Female Athletes with Genu Valgum and Healthy Knees

Katayoon Gilani, Fariborz Mohammadipour, Mohammadreza Amirseyfaddini

DOI: 10.22122/jrrs.v1i1.3579

Abstract


Introduction: The use of treadmills and sports equipment is on the rise due to long stay at home because of the progression of Coronavirus Disease (COVID-19), and hence, tendency of individuals to exercise at home. Common movement patterns in non-contact anterior cruciate ligament (ACL) injuries include decreased knee flexion accompanied by increased knee valgus angles. Therefore, the aim of this study is to investigate the maximum angles of knee varus and flexion when walking on positive, negative, and zero treadmill inclinations.

Materials and Methods: 29 subjects within the age range of 18-28 years were selected and divided into two groups of healthy (weight: 58.95 ± 8.58, height: 163.14 ± 3.95, intermalleolar distance: 0.46 ± 0.40) and genu valgum (weight: 61.60 ± 5.56, height: 161.80 ± 5.50, intermalleolar distance: 6.95 ± 2.51). The parameters of maximum angles of knee varus and flexion when walking on -10, zero, +10% treadmill inclinations were calculated using three-dimensional motion analysis system. The data were processed in Cortex and MATLAB softwares and analyzed using mixed repeated measure at the significant level of P < 0.050.

Results: The results of this study showed that the highest values of maximum angles of knee varus and flexion were observed at -10% inclination. In addition, the maximum varus angle did not differ significantly between the positive and zero inclinations, but the maximum flexion angle showed a significant difference between these two inclinations.

Conclusion: Since walking on negative inclinations inclines the knee angle in the frontal plane toward the varus and increases the flexion angle and decreases the load exerted on the ACL, this type of walking can be more effective in rehabilitating people with genu valgum.


Keywords


Gait; Inclined slope; Declined slope; Knee range of motion

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References


Greie S, Humpeler E, Gunga HC, Koralewski E, Klingler A, Mittermayr M, et al. Improvement of metabolic syndrome markers through altitude specific hiking vacations. J Endocrinol Invest 2006; 29(6): 497-504.

Blake RL, Ferguson HJ. Walking and hiking injuries. A one year follow-up study. J Am Podiatr Med Assoc 1993; 83(9): 499-503.

Schwameder H. Biomechanische Belastungsanalysen beim Berggehen. Aachen, Germany: Meyer + Meyer Fachverlag; 2004.

Davis RB, Ounpuu S, Tyburski D, Gage JR. A gait analysis data collection and reduction technique. Hum Movement Sci 1991; 10(5): 575-87.

Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res 1990; 8(3): 383-92.

Perry J, Slac T, Davids JR. Gait Analysis: Normal and pathological function. J Pediatr Orthop1992; 12(6): 815.

Winter DA. The biomechanics and motor control of human gait: Normal, elderly and pathological. Waterloo, ON, Canada: University of Waterloo Press; 1991.

McIntosh AS, Beatty KT, Dwan LN, Vickers DR. Gait dynamics on an inclined walkway. J Biomech 2006; 39(13): 2491-502.

Perry J, Burnfield J, Burnfield JM. Gait analysis: normal and pathological function. 2nd ed. Thorofare, NJ: Slack; 2010.

Whittle M. Gait analysis: An introduction. New York, NY: Butterworth-Heinemann; 2007.

Akhavirad SMB, Mahdi Barzi D, Jashan S, Radmanesh M. Prevalence of foot and knee deformities among high school female students in Tehran district no.5. Hakim Res J 2006; 9(2): 18-23. [In Persian].

Ghandi AR, Hadi HA, Behruzi AR, Holakooie AR. The prevalence of genu-varum in students aged 7-16 in Arak city. J Arak Uni Med Sci 2012; 15(4): 63-8. [In Persian].

Karimi-Mobarake M, Kashefipour A, Yousfnejad Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. J Med Sci 2005; 5(1): 52-54.

Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, et al. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 2007; 56(4): 1204-11.

Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am 1994; 25(3): 367-77.

Cerejo R, Dunlop DD, Cahue S, Channin D, Song J, Sharma L. The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. Arthritis Rheum 2002; 46(10): 2632-6.

Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286(2): 188-95.

Boden BP, Torg JS, Knowles SB, Hewett TE. Video analysis of anterior cruciate ligament injury: Abnormalities in hip and ankle kinematics. Am J Sports Med 2009; 37(2): 252-9.

Ireland ML. Anterior cruciate ligament injury in female athletes: Epidemiology. J Athl Train 1999; 34(2): 150-4.

Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, et al. Mechanisms of anterior cruciate ligament injury in basketball: Video analysis of 39 cases. Am J Sports Med 2007; 35(3): 359-67.

Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: A systematic video analysis. Am J Sports Med 2004; 32(4): 1002-12.

Morley AJ. Knock-knee in children. Br Med J 1957; 2(5051): 976-9.

Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med 2009; 19(3): 201-6.

Mokhtari G, Mahdavinejad R, Mokhtari Azar A, Ebadifara M. Determination of normal index of lower extremity alignment (Knee valgus and varus) in normal men and women. J Res Rehabil Sci 2013; 9(2): 243-52. [In Persian].

Moreno CC, Mendes LA, Lindquist AR. Effects of treadmill inclination on the gait of individuals with chronic hemiparesis. Arch Phys Med Rehabil 2011; 92(10): 1675-80.

Werner C, Lindquist AR, Bardeleben A, Hesse S. The influence of treadmill inclination on the gait of ambulatory hemiparetic subjects. Neurorehabil Neural Repair 2007; 21(1): 76-80.

Rodenbusch TL, Ribeiro TS, Simao CR, Britto HM, Tudella E, Lindquist AR. Effects of treadmill inclination on the gait of children with Down syndrome. Res Dev Disabil 2013; 34(7): 2185-90.

Munro A, Herrington L, Comfort P. Comparison of landing knee valgus angle between female basketball and football athletes: Possible implications for anterior cruciate ligament and patellofemoral joint injury rates. Phys Ther Sport 2012; 13(4): 259-64.

Alexander N, Schwameder H. Lower limb joint forces during walking on the level and slopes at different inclinations. Gait Posture 2016; 45: 137-42.

Alexander N, Schwameder H. Effect of sloped walking on lower limb muscle forces. Gait Posture 2016; 47: 62-7.

Varma RK, Duffell LD, Nathwani D, McGregor AH. Knee moments of anterior cruciate ligament reconstructed and control participants during normal and inclined walking. BMJ Open 2014; 4(6): e004753.

Zeni JA, Richards JG, Higginson JS. Two simple methods for determining gait events during treadmill and overground walking using kinematic data. Gait Posture 2008; 27(4): 710-4.

Pallant J. SPSS Survival Manual: A Step-by-step Guide to Data Analysis Using SPSS for Windows (Version 10). London, UK: Open University Press; 2001.

Ma Y, Liang Y, Kang X, Shao M, Siemelink L, Zhang Y. Gait Characteristics of children with spastic cerebral palsy during inclined treadmill walking under a virtual reality environment. Appl Bionics Biomech 2019; 2019: 8049156.

Haggerty M, Dickin DC, Popp J, Wang H. The influence of incline walking on joint mechanics. Gait Posture 2014; 39(4): 1017-21.

Stevens PM, MacWilliams B, Mohr RA. Gait analysis of stapling for genu valgum. J Pediatr Orthop 2004; 24(1): 70-4.

Naderi S, Mohammadipour F, Amir Seyfaddini MR. The effects of different walking inclinations on knee angle in the frontal plane of patients with varus malalignment. Physical Treatments 2014; 4(3): 139-44. [In Persian].

Naderi S, Mohammadipour F, Amir Seyfaddini MR. Kinematics of lower extremity during forward and backward walking on different gradients. Physical Treatment 2017; 7(2): 71-8. [In Persian].

Yang Z, Qu F, Liu H, Jiang L, Cui C, Rietdyk S. The relative contributions of sagittal, frontal, and transverse joint works to self-paced incline and decline slope walking. Journal of Biomechanics 2019; 92: 35-44.

Lange GW, Hintermeister RA, Schlegel T, Dillman CJ, Steadman JR. Electromyographic and kinematic analysis of graded treadmill walking and the implications for knee rehabilitation. J Orthop Sports Phys Ther 1996; 23(5): 294-301.

Shultz SP, D'Hondt E, Fink PW, Lenoir M, Hills AP. The effects of pediatric obesity on dynamic joint malalignment during gait. Clin Biomech (Bristol, Avon) 2014; 29(7): 835-8.

Espandar R, Mortazavi SM, Baghdadi T. Angular deformities of the lower limb in children. Asian J Sports Med 2010; 1(1): 46-53.

Han J, Kwon YH, Park Jw, Koo H, Nam K. Three-Dimensional kinematic analysis during upslope walking with different inclinations by healthy adults. J Phys Ther Sci 2009; 21(4): 385-91.

Vogt L, Banzer W. Measurement of lumbar spine kinematics in incline treadmill walking. Gait Posture 1999; 9(1): 18-23.

Chung MJ, Wang MJ. The change of gait parameters during walking at different percentage of preferred walking speed for healthy adults aged 20-60 years. Gait Posture 2010; 31(1): 131-5.

McLean SG, Huang X, van den Bogert AJ. Association between lower extremity posture at contact and peak knee valgus moment during sidestepping: Implications for ACL injury. Clin Biomech (Bristol, Avon) 2005; 20(8): 863-70.

Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res 2008; 26(3): 332-41.

Fatahi F, Ghasemi GA, Karimi MT, Beyranvand R. Can eight weeks of stabilization exercise change the amount of knee flexion and anterior shear force? J Clin Anal Med 2018; 9(3): 203-8.

Lay AN, Hass CJ, Gregor RJ. The effects of sloped surfaces on locomotion: a kinematic and kinetic analysis. J Biomech 2006; 39(9): 1621-8.

Thelen E, Ulrich BD. Hidden skills: A dynamic systems analysis of treadmill stepping during the first year. Monogr Soc Res Child Dev 1991; 56(1): 1-98.

Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GA, Slauterbeck JL. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res 1995; 13(6): 930-5.

Nunley RM, Wright D, Renner JB, Yu B, Garrett WE. Gender comparison of patellar tendon tibial shaft angle with weight bearing. Res Sports Med 2003; 11(3): 173-85.

Cerulli G, Benoit DL, Lamontagne M, Caraffa A, Liti A. In vivo anterior cruciate ligament strain behaviour during a rapid deceleration movement: Case report. Knee Surg Sports Traumatol Arthrosc 2003; 11(5): 307-11.

Hewett TE, Myer GD, Ford KR, Heidt RS, Colosimo AJ, McLean SG, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: A prospective study. Am J Sports Med 2005; 33(4): 492-501.

Myer GD, Ford KR, Di Stasi SL, Foss KD, Micheli LJ, Hewett TE. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? Br J Sports Med 2015; 49(2): 118-22.


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