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Arthritis Research & Therapy
Published in: Arthritis Research & Therapy 5/2011

Open Access 01-10-2011 | Research article

Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects

Authors: David A Rice, Peter J McNair, Gwyn N Lewis

Published in: Arthritis Research & Therapy | Issue 5/2011

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Abstract

Introduction

A consequence of knee joint osteoarthritis (OA) is an inability to fully activate the quadriceps muscles, a problem termed arthrogenic muscle inhibition (AMI). AMI leads to marked quadriceps weakness that impairs physical function and may hasten disease progression. The purpose of the present study was to determine whether γ-loop dysfunction contributes to AMI in people with knee joint OA.

Methods

Fifteen subjects with knee joint OA and 15 controls with no history of knee joint pathology participated in this study. Quadriceps and hamstrings peak isometric torque (Nm) and electromyography (EMG) amplitude were collected before and after 20 minutes of 50 Hz vibration applied to the infrapatellar tendon. Between-group differences in pre-vibration torque were analysed using a one-way analysis of covariance, with age, gender and body mass (kg) as the covariates. If the γ-loop is intact, vibration should decrease torque and EMG levels in the target muscle; if dysfunctional, then torque and EMG levels should not change following vibration. One-sample t tests were thus undertaken to analyse whether percentage changes in torque and EMG differed from zero after vibration in each group. In addition, analyses of covariance were utilised to analyse between-group differences in the percentage changes in torque and EMG following vibration.

Results

Pre-vibration quadriceps torque was significantly lower in the OA group compared with the control group (P = 0.005). Following tendon vibration, quadriceps torque (P < 0.001) and EMG amplitude (P ≤0.001) decreased significantly in the control group but did not change in the OA group (all P > 0.299). Hamstrings torque and EMG amplitude were unchanged in both groups (all P > 0.204). The vibration-induced changes in quadriceps torque and EMG were significantly different between the OA and control groups (all P < 0.011). No between-group differences were observed for the change in hamstrings torque or EMG (all P > 0.554).

Conclusions

γ-loop dysfunction may contribute to AMI in individuals with knee joint OA, partially explaining the marked quadriceps weakness and atrophy that is often observed in this population.
Appendix
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Literature
1.
Hall MC, Mockett SP, Doherty M: Relative impact of radiographic osteoarthritis and pain on quadriceps strength, proprioception, static postural sway and lower limb function. Ann Rheum Dis. 2006, 65: 865-870.PubMedCentralCrossRefPubMed
2.
Hassan BS, Mockett S, Doherty M: Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis. 2001, 60: 612-618. 10.1136/ard.60.6.612.PubMedCentralCrossRefPubMed
3.
Liikavainio T, Lyytinen T, Tyrvainen E, Sipila S, Arokoski JP: Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis. Arch Phys Med Rehabil. 2008, 89: 2185-2194. 10.1016/j.apmr.2008.04.012.CrossRefPubMed
4.
Felson DT, Niu J, McClennan C, Sack B, Aliabadi P, Hunter DJ, Guermazi A, Englund M: Knee buckling: prevalence, risk factors, and associated limitations in function. Ann Intern Med. 2007, 147: 534-540.CrossRefPubMed
5.
Hurley MV, Scott DL, Rees J, Newham DJ: Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis. 1997, 56: 641-648. 10.1136/ard.56.11.641.PubMedCentralCrossRefPubMed
6.
Brandt KD, Dieppe P, Radin EL: Etiopathogenesis of osteoarthritis. Rheum Dis Clin North Am. 2008, 34: 531-559. 10.1016/j.rdc.2008.05.011.CrossRefPubMed
7.
Jefferson RJ, Collins JJ, Whittle MW, Radin EL, O'Connor JJ: The role of the quadriceps in controlling impulsive forces around heel strike. Proc Inst Mech Eng H. 1990, 204: 21-28.CrossRefPubMed
8.
Mikesky AE, Meyer A, Thompson KL: Relationship between quadriceps strength and rate of loading during gait in women. J Orthop Res. 2000, 18: 171-175. 10.1002/jor.1100180202.CrossRefPubMed
9.
Amin S, Baker K, Niu J, Clancy M, Goggins J, Guermazi A, Grigoryan M, Hunter DJ, Felson DT: Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum. 2009, 60: 189-198. 10.1002/art.24182.PubMedCentralCrossRefPubMed
10.
Segal NA, Torner JC, Felson D, Niu J, Sharma L, Lewis CE, Nevitt M: Effect of thigh strength on incident radiographic and symptomatic knee osteoarthritis in a longitudinal cohort. Arthritis Rheum. 2009, 61: 1210-1217. 10.1002/art.24541.PubMedCentralCrossRefPubMed
11.
Segal NA, Glass NA, Torner J, Yang M, Felson DT, Sharma L, Nevitt M, Lewis CE: Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage. 2010, 18: 769-775. 10.1016/j.joca.2010.02.002.PubMedCentralCrossRefPubMed
12.
Hurley MV: The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am. 1999, 25: 283-298. 10.1016/S0889-857X(05)70068-5. viCrossRefPubMed
13.
Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L: Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc. 2008, 40: 422-427. 10.1249/MSS.0b013e31815ef285.PubMedCentralCrossRefPubMed
14.
Rice DA, McNair PJ: Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum. 2010, 40: 250-266. 10.1016/j.semarthrit.2009.10.001.CrossRefPubMed
15.
16.
Hurley MV, Jones DW, Newham DJ: Arthrogenic quadriceps inhibition and rehabilitation of patients with extensive traumatic knee injuries. Clin Sci (Lond). 1994, 86: 305-310.CrossRef
17.
Rossi MD, Brown LE, Whitehurst M: Early strength response of the knee extensors during eight weeks of resistive training after unilateral total knee arthroplasty. J Strength Cond Res. 2005, 19: 944-949.PubMed
18.
Stevens JE, Mizner RL, Snyder-Mackler L: Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res. 2003, 21: 775-779. 10.1016/S0736-0266(03)00052-4.CrossRefPubMed
19.
Hurley MV: The effects of joint damage on muscle function, proprioception and rehabilitation. Man Ther. 1997, 2: 11-17. 10.1054/math.1997.0281.CrossRefPubMed
20.
Geborek P, Moritz U, Wollheim FA: Joint capsular stiffness in knee arthritis. Relationship to intraarticular volume, hydrostatic pressures, and extensor muscle function. J Rheumatol. 1989, 16: 1351-1358.PubMed
21.
Henriksen M, Rosager S, Aaboe J, Graven-Nielsen T, Bliddal H: Experimental knee pain reduces muscle strength. J Pain. 2011, 12: 460-467. 10.1016/j.jpain.2010.10.004.CrossRefPubMed
22.
Rice D, McNair PJ, Dalbeth N: Effects of cryotherapy on arthrogenic muscle inhibition using an experimental model of knee swelling. Arthritis Rheum. 2009, 61: 78-83.CrossRefPubMed
23.
Hurley MV, Jones DW, Wilson D, Newham DJ: Rehabilitation of quadriceps inhibited due to isolated rupture of the anterior cruciate ligament. J Orthop Rheumatol. 1992, 5: 145-154.
24.
Newham DJ, Hurley MV, Jones DW: Ligamentous knee injuries and muscle inhibition. J Orthop Rheumatol. 1989, 2: 163-173.
25.
Baxendale RH, Ferrell WR, Wood L: The effect of mechanical stimulation of knee joint afferents on quadriceps motor unit activity in the decerebrate cat. Brain Res. 1987, 415: 353-356. 10.1016/0006-8993(87)90219-8.CrossRefPubMed
26.
Baxendale RH, Ferrell WR, Wood L: Responses of quadriceps motor units to mechanical stimulation of knee joint receptors in the decerebrate cat. Brain Res. 1988, 453: 150-156. 10.1016/0006-8993(88)90153-9.CrossRefPubMed
27.
Grigg P, Harrigan EP, Fogarty KE: Segmental reflexes mediated by joint afferent neurons in cat knee. J Neurophysiol. 1978, 41: 9-14.PubMed
28.
Hagbarth KE, Kunesch EJ, Nordin M, Schmidt R, Wallin EU: Gamma loop contributing to maximal voluntary contractions in man. J Physiol. 1986, 380: 575-591.PubMedCentralCrossRefPubMed
29.
Shinohara M: Effects of prolonged vibration on motor unit activity and motor performance. Med Sci Sports Exerc. 2005, 37: 2120-2125. 10.1249/01.mss.0000178106.68569.7e.CrossRefPubMed
30.
Bongiovanni LG, Hagbarth KE, Stjernberg L: Prolonged muscle vibration reducing motor output in maximal voluntary contractions in man. J Physiol. 1990, 423: 15-26.PubMedCentralCrossRefPubMed
31.
Jackson SW, Turner DL: Prolonged muscle vibration reduces maximal voluntary knee extension performance in both the ipsilateral and the contralateral limb in man. Eur J Appl Physiol. 2003, 88: 380-386. 10.1007/s00421-002-0701-6.CrossRefPubMed
32.
Konishi Y, Fukubayashi T, Takeshita D: Possible mechanism of quadriceps femoris weakness in patients with ruptured anterior cruciate ligament. Med Sci Sports Exerc. 2002, 34: 1414-1418. 10.1097/00005768-200209000-00003.CrossRefPubMed
33.
Kouzaki M, Shinohara M, Fukunaga T: Decrease in maximal voluntary contraction by tonic vibration applied to a single synergist muscle in humans. J Appl Physiol. 2000, 89: 1420-1424.PubMed
34.
Konishi Y, Aihara Y, Sakai M, Ogawa G, Fukubayashi T: Gamma loop dysfunction in the quadriceps femoris of patients who underwent anterior cruciate ligament reconstruction remains bilaterally. Scand J Med Sci Sports. 2007, 17: 393-399.CrossRefPubMed
35.
Konishi Y, Konishi H, Fukubayashi T: Gamma loop dysfunction in quadriceps on the contralateral side in patients with ruptured ACL. Med Sci Sports Exerc. 2003, 35: 897-900. 10.1249/01.MSS.0000069754.07541.D2.CrossRefPubMed
36.
Richardson MS, Cramer JT, Bemben DA, Shehab RL, Glover J, Bemben MG: Effects of age and ACL reconstruction on quadriceps gamma loop function. J Geriatr Phys Ther. 2006, 29: 28-34.PubMed
37.
Charles HC, Kraus VB, Ainslie M, Hellio Le Graverand-Gastineau MP: Optimization of the fixed-flexion knee radiograph. Osteoarthritis Cartilage. 2007, 15: 1221-1224. 10.1016/j.joca.2007.05.012.CrossRefPubMed
38.
39.
McNair PJ, Depledge J, Brettkelly M, Stanley SN: Verbal encouragement: effects on maximum effort voluntary muscle action. Br J Sports Med. 1996, 30: 243-245. 10.1136/bjsm.30.3.243.PubMedCentralCrossRefPubMed
40.
Merletti R, Hermens H: Introduction to the special issue on the SENIAM European Concerted Action. J Electromyogr Kinesiol. 2000, 10: 283-286. 10.1016/S1050-6411(00)00019-5.CrossRefPubMed
41.
Heiden TL, Lloyd DG, Ackland TR: Knee extension and flexion weakness in people with knee osteoarthritis: is antagonist cocontraction a factor?. J Orthop Sports Phys Ther. 2009, 39: 807-815.CrossRefPubMed
42.
Konishi Y, Aihara Y, Sakai M, Ogawa G, Fukubayashi T: Gamma loop dysfunction in the quadriceps femoris of patients who underwent anterior cruciate ligament reconstruction remains bilaterally. Scand J Med Sci Sports. 2007, 17: 393-399.CrossRefPubMed
43.
Ellaway PH, Davey NJ, Ferrell WR, Baxendale RH: The action of knee joint afferents and the concomitant influence of cutaneous (sural) afferents on the discharge of triceps surae gamma-motoneurones in the cat. Exp Physiol. 1996, 81: 45-66.CrossRefPubMed
44.
Johansson H, Sjolander P, Sojka P: Actions on gamma-motoneurones elicited by electrical stimulation of joint afferent fibres in the hind limb of the cat. J Physiol. 1986, 375: 137-152.PubMedCentralCrossRefPubMed
45.
Scott DT, Ferrell WR, Baxendale RH: Excitation of soleus/gastrocnemius gamma-motoneurones by group II knee joint afferents is suppressed by group IV joint afferents in the decerebrate, spinalized cat. Exp Physiol. 1994, 79: 357-364.CrossRefPubMed
46.
Hurley MV, Newham DJ: The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheumatol. 1993, 32: 127-131. 10.1093/rheumatology/32.2.127.CrossRefPubMed
47.
Konishi Y, Suzuki Y, Hirose N, Fukubayashi T: Effects of lidocaine into knee on QF strength and EMG in patients with ACL lesion. Med Sci Sports Exerc. 2003, 35: 1805-1808. 10.1249/01.MSS.0000093753.55866.2F.CrossRefPubMed
48.
Mullaji AB, Marawar SV, Simha M, Jindal G: Cruciate ligaments in arthritic knees: a histologic study with radiologic correlation. J Arthroplasty. 2008, 23: 567-572. 10.1016/j.arth.2007.05.024.CrossRefPubMed
49.
Tahmasebi-Sarvestani A, Tedman R, Goss AN: The influence of experimentally induced osteoarthrosis on articular nerve fibers of the sheep temporomandibular joint. J Orofac Pain. 2001, 15: 206-217.PubMed
50.
Ferrell WR: The effect of acute joint distension on mechanoreceptor discharge in the knee of the cat. Q J Exp Physiol. 1987, 72: 493-499.CrossRefPubMed
51.
Palmieri RM, Weltman A, Edwards JE, Tom JA, Saliba EN, Mistry DJ, Ingersoll CD: Pre-synaptic modulation of quadriceps arthrogenic muscle inhibition. Knee Surg Sports Traumatol Arthrosc. 2005, 13: 370-376. 10.1007/s00167-004-0547-z.CrossRefPubMed
52.
Konishi Y, Kasukawa T, Tobita H, Nishino A, Konishi M: Gamma loop dysfunction of the quadriceps femoris of elderly patients hospitalized after fall injury. J Geriatr Phys Ther. 2007, 30: 54-59. 10.1519/00139143-200708000-00004.CrossRefPubMed
53.
Pap G, Machner A, Awiszus F: Strength and voluntary activation of the quadriceps femoris muscle at different severities of osteoarthritic knee joint damage. J Orthop Res. 2004, 22: 96-103. 10.1016/S0736-0266(03)00128-1.CrossRefPubMed
54.
Mizner RL, Stevens JE, Snyder-Mackler L: Voluntary activation and decreased force production of the quadriceps femoris muscle after total knee arthroplasty. Phys Ther. 2003, 83: 359-365.PubMed
55.
Ribot-Ciscar E, Rossi-Durand C, Roll JP: Muscle spindle activity following muscle tendon vibration in man. Neurosci Lett. 1998, 258: 147-150. 10.1016/S0304-3940(98)00732-0.CrossRefPubMed
56.
Ushiyama J, Masani K, Kouzaki M, Kanehisa H, Fukunaga T: Difference in after effects following prolonged Achilles tendon vibration on muscle activity during maximal voluntary contraction among plantar flexor synergists. J Appl Physiol. 2005, 98: 1427-1433. 10.1152/japplphysiol.00613.2004.CrossRefPubMed
57.
Pierrot-Deseilligny E, Mazevet D: The monosynaptic reflex: a tool to investigate motor control in humans. Interest and limits. Neurophysiol Clin. 2000, 30: 67-80. 10.1016/S0987-7053(00)00062-9.CrossRefPubMed
58.
Steffens H, Schomburg ED: Convergence in segmental reflex pathways from nociceptive and non-nociceptive afferents to alpha-motoneurones in the cat. J Physiol. 1993, 466: 191-211.PubMedCentralPubMed
59.
Pietrosimone BG, Hertel J, Ingersoll CD, Hart JM, Saliba SA: Voluntary quadriceps activation deficits in patients with tibiofemoral osteoarthritis: a meta-analysis. PM R. 2011, 3: 153-162. 10.1016/j.pmrj.2010.07.485.CrossRefPubMed
60.
Fitzgerald GK, Piva SR, Irrgang JJ, Bouzubar F, Starz TW: Quadriceps activation failure as a moderator of the relationship between quadriceps strength and physical function in individuals with knee osteoarthritis. Arthritis Rheum. 2004, 51: 40-48. 10.1002/art.20084.CrossRefPubMed
61.
Gapeyeva H, Buht N, Peterson K, Ereline J, Haviko T, Paasuke M: Quadriceps femoris muscle voluntary isometric force production and relaxation characteristics before and 6 months after unilateral total knee arthroplasty in women. Knee Surg Sports Traumatol Arthrosc. 2007, 15: 202-211. 10.1007/s00167-006-0166-y.CrossRefPubMed
62.
Lewek MD, Rudolph KS, Snyder-Mackler L: Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis. J Orthop Res. 2004, 22: 110-115. 10.1016/S0736-0266(03)00154-2.PubMedCentralCrossRefPubMed
63.
Scopaz KA, Piva SR, Gil AB, Woollard JD, Oddis CV, Fitzgerald GK: Effect of baseline quadriceps activation on changes in quadriceps strength after exercise therapy in subjects with knee osteoarthritis. Arthritis Rheum. 2009, 61: 951-957. 10.1002/art.24650.PubMedCentralCrossRefPubMed
64.
Courtney CA, Lewek MD, Witte PO, Chmell SJ, Hornby TG: Heightened flexor withdrawal responses in subjects with knee osteoarthritis. J Pain. 2009, 10: 1242-1249. 10.1016/j.jpain.2009.05.004.CrossRefPubMed
65.
Bampouras TM, Reeves ND, Baltzopoulos V, Maganaris CN: Muscle activation assessment: effects of method, stimulus number, and joint angle. Muscle Nerve. 2006, 34: 740-746. 10.1002/mus.20610.CrossRefPubMed
66.
Behm D, Power K, Drinkwater E: Comparison of interpolation and central activation ratios as measures of muscle inactivation. Muscle Nerve. 2001, 24: 925-934. 10.1002/mus.1090.CrossRefPubMed
67.
Krishnan C, Williams GN: Quantification method affects estimates of voluntary quadriceps activation. Muscle Nerve. 41: 868-874.
68.
O'Brien TD, Reeves ND, Baltzopoulos V, Jones DA, Maganaris CN: Assessment of voluntary muscle activation using magnetic stimulation. Eur J Appl Physiol. 2008, 104: 49-55. 10.1007/s00421-008-0782-y.CrossRefPubMed
69.
Kooistra RD, de Ruiter CJ, de Haan A: Conventionally assessed voluntary activation does not represent relative voluntary torque production. Eur J Appl Physiol. 2007, 100: 309-320. 10.1007/s00421-007-0425-8.PubMedCentralCrossRefPubMed
Metadata
Title
Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects
Authors
David A Rice
Peter J McNair
Gwyn N Lewis
Publication date
01-10-2011
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 5/2011
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/ar3467

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