Gait Analysis Can Ease Knee Pain

May 28, 2024

Ease knee pain with gait analysis. Understand its importance, technology, and how it targets knee dysfunctions.

Understanding Gait Abnormalities

To understand the role of gait analysis in knee pain, it's important first to comprehend what gait abnormalities are and how they are diagnosed and evaluated.

Impact of Gait Abnormalities

Gait abnormalities, or irregularities in the way a person walks or runs, become more common with age. As reported by the Cleveland Clinic, around 15% of people experience a gait abnormality by age 60, and over 80% of people over age 85 have a gait abnormality. These abnormalities can lead to an increased risk of injuries and falls, making it essential for individuals to take steps to protect themselves and consult a healthcare provider for guidance. While prevention of gait abnormalities caused by underlying medical conditions may not be possible, the risk of injury due to gait abnormalities can be reduced by taking steps to prevent falls.

Age	Percentage with Gait Abnormality
60 years	15%
Over 85 years	Over 80%

Diagnosis and Evaluation

The diagnosis of gait abnormalities is conducted through a physical exam, a complete medical history, and various tests, including imaging tests like X-ray and laboratory tests. In some cases, gait analysis may also be employed.

Gait analysis involves the assessment of the body's movement, particularly during walking or running, to detect abnormalities in locomotion. It encompasses complex functions utilizing the body's visual, somatosensory, and vestibular systems, along with issues related to the joints, which can result in postural and gait irregularities [2].

Understanding gait abnormalities and their diagnosis is the first step towards understanding how gait analysis can be used to alleviate knee pain, which will be the subject of the subsequent sections.

Importance of Gait Analysis

Gait analysis plays a crucial role in identifying gait abnormalities, which are common as individuals age. According to the Cleveland Clinic, around 15% of people experience a gait abnormality by age 60, and this increases to over 80% in people over age 85. Such abnormalities can lead to an increased risk of injuries and falls, making gait analysis an essential tool in preventive healthcare.

Procedure and Duration

Conducted through a combination of a physical exam, complete medical history, and various tests including imaging tests like X-ray and laboratory tests, the diagnosis of gait abnormalities is a comprehensive process. Advanced technology further aids in evaluating the patient's gait by analyzing data related to step length, stride length, cadence, cycle time, and joint angles.

In the context of running, gait analysis is a service provided at stores like Runners Need to help determine the best shoe for individuals. Here, the analysis involves recording the running style on a treadmill for about 20-30 seconds, taking into account factors such as the runner's future goals, events, and past injuries.

Gait Analysis for Pain Identification

Gait analysis can be particularly beneficial for identifying the cause of knee pain. By observing the way a person walks or runs, healthcare providers can detect abnormalities that may be contributing to discomfort or injury. For instance, pronation types, identified as Overpronation, Underpronation (supination), and Neutral pronation, are common factors analyzed in runners. Overpronation is common among runners with low arches, while underpronation is common in runners with high arches.

Choosing the right type of running shoe based on the type of pronation can significantly impact knee health and comfort. For example, stability shoes are recommended for overpronation, neutral shoes for underpronation, and neutral shoes for neutral pronation.

To ensure accuracy and adapt to changes in running style, gait analysis is recommended annually. Moreover, replacing running shoes every 300-500 miles is advised, and signs of wear such as compression of the midsole or excessive wear in one area should prompt the purchase of new shoes.

In summary, gait analysis for knee pain is a critical tool in both the diagnosis and the management of gait abnormalities. By understanding the individual nuances of each person's gait, healthcare providers can make personalized recommendations to help alleviate knee pain and improve overall mobility.

Advanced Technology in Gait Analysis

The use of advanced technology in gait analysis has revolutionized the way knee pain is evaluated and treated. These technologies allow for a detailed assessment of an individual's gait, helping to identify abnormalities that could be contributing to knee pain.

Data Analysis in Gait Assessment

Gait analysis involves evaluating a patient's stride by analyzing data related to step length, stride length, cadence, cycle time, and joint angles. This comprehensive analysis can be beneficial in recording gait abnormalities, broadening the scope of physical examination, and assisting in treatment decisions Orthopedic Medical Center.

Data analysis in gait assessment, using advanced technologies, can provide spatial gait information and measure the knee adduction moment, a crucial factor in understanding knee pain. For instance, the peak knee adduction moment during gait is highly correlated with medial contact force, disease progression, disease severity, and pain in individuals with medial compartment knee osteoarthritis (OA). Gait modification targeting the reduction of this moment has become a quantitative target for clinical treatment of medial compartment knee OA National Center for Biotechnology Information.

Clinical Methods and Technology

Clinical gait analysis uses various methods to investigate gait abnormalities, expanding the understanding of the patient's movement patterns. Patient history and current medical conditions remain crucial in the overall assessment process Orthopedic Medical Center.

Technologies are available to measure the knee adduction moment and provide spatial gait information. Actuators for active knee braces need to be compact, lightweight, and capable of generating significant torque. Electric, hydraulic, and pneumatic actuators are commonly used for this purpose ScienceDirect.

Control mechanisms such as position control techniques and force/torque control approaches are crucial for knee exoskeleton research and development. These methods have the potential to enhance the safety and effectiveness of knee joint rehabilitation and assistive technology ScienceDirect.

Real-time feedback methods, such as visual or vibratory feedback of the peak knee adduction moment, can lead to reductions ranging from 7% to 48% in the peak knee adduction moment during gait retraining for knee OA. These methods may provide a promising approach to gait modification for knee OA patients National Center for Biotechnology Information.

Moreover, wearable sensors have become a complementary means for evaluation of body function and gait in lower limb osteoarthritis. These sensors can provide accurate measurement of joint torque and related load estimation, leading to improved gait training and surgical planning PMC.

The integration of advanced technology in gait analysis has significantly improved the understanding and treatment of knee pain. With continuous advancements in this field, the future of gait analysis for knee pain looks promising.

Gait Analysis for Knee Dysfunctions

When it comes to knee pain, one of the most effective ways to understand, diagnose, and treat the condition is through gait analysis. This method is particularly beneficial in understanding the dynamics of knee dysfunctions and the subsequent adaptations in gait.

Knee Mechanics and Dysfunctions

Knee mechanics play a key role in our ability to move and walk. When these mechanics are disrupted due to conditions such as osteoarthritis (OA), it can lead to significant changes in gait. Gait adaptations in people with early knee osteoarthritis (OA) have been well documented, with increased knee adduction moments (KAM) the most commonly reported parameter. People with early OA have altered gait parameters and neuromuscular adaptations, including postural deficits during one-leg standing and altered hip adduction moments compared with controls.

Interestingly, those with early OA showed no differences in the gait parameters measured, however, they demonstrated postural deficits during one-leg standing on both their affected and unaffected sides and altered hip adduction moments compared with controls. In addition, increased activity of the gluteus medius of both sides, and quadriceps and hamstrings of the affected side, was noted during one-leg standing compared with controls [4].

Treatment Options and Technology

Gait modifications are a common treatment strategy for managing knee pain associated with OA. The peak knee adduction moment during gait is highly correlated with medial contact force, disease progression, disease severity, and pain in individuals with medial compartment knee osteoarthritis (OA). Consequently, gait modification targeting the reduction of this moment has become a quantitative target for clinical treatment of medial compartment knee OA [5].

These modifications can be learned or assisted. Learned modifications that reduce the peak knee adduction moment include walking with decreased speed, increased stance width, toes pointed outward, knees medialized, and increased medial–lateral trunk sway. Assisted gait modifications that reduce this moment include the use of lateral wedge insoles, lateral wedge insoles with subtalar strapping, variable stiffness shoes, high mobility shoes, valgus knee braces, canes, and bilateral hiking poles [5].

It's important to note that while these modifications can be significant, there are several challenges that exist in gait modification for knee OA. This includes how to get patients to achieve and retain learned gait modifications, especially for older patients with knee OA. Additionally, ensuring the effectiveness and consistent use of assisted gait modifications poses challenges, as small reductions in the peak knee adduction moment or peak medial contact force may not always be clinically meaningful.

Gait Adaptations in Knee Osteoarthritis

Research shows that osteoarthritis (OA) can affect the way individuals walk, leading to gait adaptations. These changes can be different during the early and advanced stages of OA.

Gait Alterations in Early OA

In the early stages of knee osteoarthritis (OA), gait alterations are not as evident compared to the advanced stages. However, individuals with early OA show signs of neuromuscular adaptations, including postural deficits during one-leg standing and altered hip adduction moments in comparison to controls.

Gait Parameters	Early OA	Controls
One-leg standing	Altered	Normal
Hip adduction moments	Altered	Normal

These findings indicate that while gait parameters remain unchanged in the early stages of OA, neuromuscular adaptations are already present. This information is vital for early interventions aimed at delaying or preventing the progression of OA.

Neuromuscular Adaptations

Neuromuscular adaptations are among the first changes observed in individuals with early OA. These include increased activity of the gluteus medius of both sides, and quadriceps and hamstrings of the affected side during one-leg standing as compared to controls [4].

Muscle Group	Early OA	Controls
Gluteus medius (both sides)	Increased Activity	Normal
Quadriceps (affected side)	Increased Activity	Normal
Hamstrings (affected side)	Increased Activity	Normal

These neuromuscular adaptations, along with gait alterations, are significant factors in gait analysis for knee pain. Understanding these changes can help in formulating effective treatment plans and implementing early interventions for individuals with knee OA.

Gait Modification Techniques

To manage and alleviate knee pain, especially for individuals with knee osteoarthritis or post-knee replacement therapy, gait modification techniques can be a beneficial approach. These techniques typically fall into two categories: learned modifications and assisted modifications.

Learned Modifications

Learned modifications involve consciously altering one's walking pattern to reduce the peak knee adduction moment, a key factor associated with knee load and pain. Examples of learned modifications that can significantly reduce the peak knee adduction moment include walking with decreased speed, increased stance width, toes pointed outward, knees medialized, and increased medial–lateral trunk sway.

Real-time feedback methods, such as visual or vibratory feedback of the peak knee adduction moment, can be beneficial in gait retraining for knee osteoarthritis. These methods have led to reductions ranging from 7% to 48% in the peak knee adduction moment, offering a promising approach to gait modification for knee OA patients.

Assisted Gait Modifications

Assisted gait modifications involve the use of external aids to alter the gait pattern and reduce knee load. These include the use of lateral wedge insoles, lateral wedge insoles with subtalar strapping, variable stiffness shoes, high mobility shoes, valgus knee braces, canes, and bilateral hiking poles. Such methods have shown to be effective in reducing the peak knee adduction moment, similar to the reductions achieved by learned modifications.

Advancements in wearable sensor technology have also shown promise in assisting gait modifications. The sensors can provide accurate measurements of joint torque and related load estimation, leading to improved gait training and surgical planning. Furthermore, they offer the potential to remotely monitor the gait function post-knee surgery in both controlled environments and patients' daily life, covering more aspects than traditional patient-reported outcome measures [6].

In conclusion, both learned and assisted gait modifications can be effective strategies in managing knee pain, particularly in individuals with knee osteoarthritis or those recovering from knee replacement surgery. By understanding and implementing these modifications, individuals can take proactive steps towards improving their gait, reducing knee load, and ultimately alleviating knee pain.