THE ROLE OF MUSCLE WEAKNESS IN THE PATHOGENESIS OF OSTEOARTHRITIS
Section snippets
Movement
The purpose of a synovial joint is to enable an individual to move and interact with his or her environment. Force generation and movement are effected by contraction of the skeletal muscles that span the joint. Muscle contractions may be concentric (the muscle shortens and moves the joint), eccentric (the muscle lengthens but still maintains tension and controls the movements of the joint) or isometric (the muscle contracts but joint movement is prevented by an opposing force).
Functional Joint Stability
Another
CONTROL OF MUSCLE FUNCTION
Skeletal muscle activity is controlled and innervated by peripheral motor nerves that are comprised of α-motoneurones. Excitability of α-motoneurones is influenced by the supraspinal motor centers of the CNS, segmental spinal interneurons, rhythmic movement pattern generators, involuntary reflexes and sensory input from proprioceptors in muscle, articular structures, and skin.2, 6, 66, 83, 84, 93 Factors that decrease the excitability of α-motoneurones reduce muscle activation and decrease
THE ARTICULAR CONSEQUENCES OF MUSCLE DYSFUNCTION
It is usually assumed that articular damage elicits pain and effusion that can be improved by rest or decreased joint use, but this therapeutic approach exacerbates the weakness (Fig. 1).119 Weak muscles are fatigued more readily, and their voluntary and reflex motor control is slower than those of well-conditioned muscles. This motor dysfunction compromises the neuromuscular protective mechanisms of the muscle, leading to excessive joint movement and instability, which stresses innervated
Lack of Association Between Radiographic Evidence of Joint Damage, Muscle Weakness, Pain, and Disability
A poor association exists between radiographic signs of joint damage and the joint pain and disability experienced by a patient with OA; some patients with severe radiographic joint damage complain of little pain or may even be asymptomatic, whereas others with severe pain may exhibit only minor degenerative changes.21, 91 Conversely, quadriceps weakness is one of the commonest and earliest symptoms reported by patients41, 42, 43, 60, 79, 85 and is a better determinant of pain and disability
CAN QUADRICEPS SENSORIMOTOR DEFICITS BE REVERSED?
That changes in muscle sensorimotor dysfunction are involved in the pathogenesis and progression of OA may be good news. At present, little can be done to reverse damage to articular structures or subchondral bone. Surgical intervention and drug therapy can reduce pain and improve function, but their availability is limited, they are expensive, they can have serious side effects and risks, and they are initiated only after the symptoms and radiological damage are well established. Even when
A MODIFIED PARADIGM OF THE INTERRELATIONSHIP BETWEEN MUSCLE DYSFUNCTION, JOINT DAMAGE, AND DISABILITY
It is assumed joint damage initiates the proposed vicious circle of events that leads to decreased activity and muscle weakness (exacerbated by arthrogenic reduction in voluntary activation), which increases the risk of secondary joint damage (see Fig. 1).119 Based on the preceding arguments and evidence, the author contends that the initiation and progression of the pathological processes in OA are not so straightforward (Fig. 2). The pathologic processes may be initiated by sensorimotor
ACKNOWLEDGEMENT
The author would like to thank the Arthritis Research Campaign, which generously funded much of this work.
References (125)
- et al.
Measurement of shoulder kinaesthesia
Manual Therapy
(1996) - et al.
Osteoarthritis: A review of the cell biology involved and evidence for reversibility: Management rationally related to known genesis and pathophysiology
Semin Arthritis Rheum
(1984) A neurosensory hypothesis of ligament function
Med Hypotheses
(1989)- et al.
Negative affect, pain and disability in osteoarthritis patients: The mediating role of muscle weakness
Behav Res Ther
(1993) - et al.
How do physiological components of balance affect mobility in elderly men
Arch Phys Med Rehabil
(1993) - et al.
Thigh muscle activity and ACL insufficiency
Clin Biomech
(1989) - et al.
The influence of joint afferent discharge on locomotion, proprioception and activity in conscious cats
Brain Res
(1985) - et al.
Age-dependent changes in position sense in human proximal interphalangeal joints
Neuroreport
(1992) - et al.
Quantitative effects of physical therapy on muscular and functional performance in subjects with osteoarthritis of the knees
Arch Phys Med Rehabil
(1993) - et al.
Kinaesthetic signals and muscle contraction
Trends Neurosci
(1992)
Interneurones in the spinal cord
Trends Neurosci
Economics of osteoarthritis: a global perspective
Baillieres Clin Rheumatol
Actions on α-motoneurons elicited by electrical stimulation of group I, II and III muscle afferent fibers in the hind limb of the cat
J Physiol
Reduction of pain inhibition on voluntary muscle activation by epidural analgesia
Orthopaedics
Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: Findings from the 1990 Ontario Health Survey
J Rheumatol
Impact of disablement due to rheumatic disorders in a British population: Estimates of severity and prevalence from the Calderdale Rheumatic Disablement Survey
Ann Rheum Dis
Integration in spinal neuron systems
Proprioception on the ACL deficient knee
Am J Sports Med
Proprioception and function after anterior cruciate reconstruction
J Bone Joint Surg Br
The effect of joint afferent discharge on transmission in flexion reflex pathways in decerebrate cats
J Physiol
Proprioception enhancement for anterior cruciate ligament deficiency: A prospective randomised trial of two physiotherapy regimes
J Bone Joint Surg Br
Proprioception after rupture of the anterior cruciate ligament
An objective indication of the need for surgery? J Bone Joint Surg Br
Manual muscle tapping decreases soleus H-reflex amplitude in control subjects
Physiotherapy Canada
Gait adaptations by patients who have a deficient anterior cruciate ligament
J Bone Joint Surg Am
Tonic vibration reflexes elicited during fatigue from maximal voluntary contractions in man
J Physiol
Putting some muscle into osteoarthritis
Ann Intern Med
Sensory changes associated with severe ankle sprain
Scand J Rehabil Med
Tonic descending inhibition of spinal cord neurons driven by joint afferents in normal cats and cats with inflamed knee joints
Exp Brain Res
Do clinical findings associate with radiographic osteoarthritis of the knee?
Ann Rheum Dis
Acute tears of the ACL, surgical versus conservative treatment
J Bone Joint Surg Am
Ageing and balance: The measurement of spontaneous sway by posturography
Gerontology
Joint distension and reflex muscle inhibition in the knee
J Bone Joint Surg Am
Pain and disability in osteoarthritis: A review of biobehavioral mechanisms
J Behav Med
Sympathetic or reflex footpad swelling due to crystal-induced inflammation in the opposite foot
Inflammation
Joint exercises in elderly persons with symptomatic osteoarthritis of the hip or knee: Performance patterns, medical support, and the relationship between exercising and medical care
Arth Care Res
Strength recovery and muscle activation of the knee extensor and flexor muscles after arthroscopic meniscectomy: A pilot study
Clin Orthop
Myofibrillar fatigue versus failure of activation during repetitive stimulation of frog muscle fibres
J Physiol
Autogenic reflex action on to gamma motorneurons by stretch of triceps surae in the decerebrated cat
J Physiol
Does a torn ACL lead to change in the central nervous drive to the knee extensors
Eur J Appl Physiol
A randomized control trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis
JAMA
Knee effusion and reflex inhibition of the quadriceps
J Bone Joint Surg Br
Position sense at the proximal interphalangeal joint is distorted in patients with rheumatoid arthritis of finger joints
Exp Physiol
High intensity strength training in nonagenarians: Effects on skeletal muscle
JAMA
Muscle rehabilitation: Its effect on muscular and functional performance of patients with knee osteoarthritis
Arch Phys Med Rehabil
Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation
Disabil Rehabil
The etiology and prevention of functional instability of the foot
J Bone Joint Surg Br
Articular reflexes at the ankle joint: An electromyographic study of normal and abnormal influences of ankle-joint mechanoreceptors upon reflex activity in the leg muscles
J Bone Joint Surg Br
Indirect and non-medical costs among people with rheumatoid arthritis and osteoarthritis compared with non-arthritic controls
J Rheumatol
Supraspinal factors in human muscle fatigue: Evidence for suboptimal output from the motor cortex
J Physiol
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Address reprint requests to Michael V. Hurley, PhD, MCSP, Rehabilitation Research Unit, Physiotherapy Division, King's College London, King's Healthcare (Dulwich), East Dulwich Grove, Dulwich, London, SE22 8PT, UK, [email protected]
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Rehabilitation Research Unit, Physiotherapy Division, King's College London, King's Healthcare, Dulwich, London, United Kingdom