Preliminary study of modifications of gait and ADL to reduce knee pain and improve knee joint function

Purpose: The aim of this study was to investigate the effects of modifying gait and activities of daily living (ADL) to reduce knee pain and to improve function compared to straight leg raising (SLR) exercise in a randomized control study.

Methods: hirty-nine middle-age and older individuals with knee pain (12 men, 27 women; 72.0 ± 7.7 years old) participated in the study. The participants were randomly allocated to the control group (n = 18) or intervention group (n = 21). The control group performed SLR exercise at home (1 set: 10-s hold, 10 times, 3 sets/day) and the intervention group performed gait modifications and ADL with high activity of the hip joint muscles. Two gait modifications were used: gait with a draw-in maneuver (2 cm shortening of the abdominal circumference) and Nanba style walking, the walking style used in Japan when wearing a kimono, in which the leg steps and the arm on the same side as the leg that is stepping simultaneously swings with only small trunk rotation. These gait modifications (30 min/day) were previously reported to reduce the knee adduction moment. ADL with hip muscle dominance require large hip joint flexion similar to a chair squat (10 min/day) to reduce the knee flexion moment. All participants performed these programs for 3 months. The Japan knee osteoarthritis measure (JKOM), visual analogue scale (VAS) for knee pain, knee and hip muscle strength, range of motion at knee joint, 5-m walking time, and SF-8 were assessed at baseline and after 3 months. The study was registered in the UMIN Clinical Trials Registry (000023029). All participants were informed as to the nature of the study, and provided informed consent as approved by the Ethics Committee of an University.

Results: Two participants in the control group could not continue the exercise regimen. Three participants (1 control and 2 intervention) were excluded because of new treatment or other diseases. Finally, 15 and 19 participants in the control and intervention group, respectively, completed the 3 months of each program. In the control group, VAS of knee pain and JKOM were significantly improved after 3 months compared to the baseline. In the intervention group, the JKOM was significantly improved after 3 months compared to baseline values.

Conclusions: Gait modification with a reduced knee adduction moment and ADL modification with reduced knee flexion moment effectively improved the JKOM score of knee joint function. The effects of gait and ADL modifications on knee joint function with JKOM were similar to those of SLR exercises, which are already in use for knee osteoarthritis. Although knee pain was improved only in the SLR exercise group (control group), all participants in the intervention group were able to continue the program. The gait and ADL modification program might promote program adherence because the participants do not required additional exercise time.