Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Dr. Trevor Birmingham

2nd Supervisor

Dr. Thomas Jenkyn

Joint Supervisor

Abstract

Excessive dynamic loading of the knee joint, quantified indirectly during three dimensional gait analysis, is a risk factor for the progression of knee osteoarthritis (OA). The overall objective of this thesis was to explore the effects of prolonged walking and the use of Nordic walking poles on selected gait characteristics indicative of knee joint load. The first study evaluated the time-varying behaviour, reliability, and validity of selected gait kinematics during 60 minutes of treadmill walking in 20 healthy adults. Maximum lateral trunk lean angle and maximum toe-out angle did not change over time, were consistent from day to day and were consistent with values assessed during over-ground gait analysis, suggesting that these measures are appropriate for use in studying potential adaptive gait mechanisms. The second study compared the time-varying behaviour of selected gait kinematics during 30 minutes of treadmill walking in 20 participants with, and 20 participants without, medial compartment knee OA, and explored correlations between these gait kinematics and pain intensity. Trunk lean, toe-out, and pelvic rise were different between those with and without knee OA, but did not systematically change over time in either group. Trunk lean and contralateral pelvic drop were significantly correlated to pain intensity. The third study was a technical report describing the use of three dimensional gait analysis and a Nordic walking pole instrumented with a compression load cell. This methodology was then used in the fourth study to evaluate the effect of walking poles used by 34 patients with medial compartment knee OA. Despite small reductions in the vertical ground reaction force, walking with poles increased the frontal plane lever arm, and therefore the knee adduction moment. The pole force in the vertical direction was inversely related to the increase in first peak knee adduction moment. Overall, this thesis suggests that, although biomechanically plausible, patients with knee OA do not naturally adopt gait characteristics or use walking poles in a way to decrease knee joint loads. These findings support the need for future efforts directed at explicitly teaching walking techniques, including the optimal use of assistive devices, to decrease knee joint loading.

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