Biomechanical Adaptations to Strength Training OA

描述（由申请人提供）：膝关节骨关节炎（OA）的治疗性运动计划在OA的保守治疗中发挥着重要作用。加强股四头肌和腘绳肌是这些运动计划的主要目标之一，但加强如何影响膝关节骨性关节炎的机制还没有很好的理解。据推测，加强膝关节肌肉组织对OA和其他膝关节问题的积极影响是由于加强的肌肉能够“稳定”或“减少应力”或以某种方式“保护”膝关节。这种普遍持有的信念尚未得到实验评估。本研究的目的是阐明如何加强初级膝关节肌肉组织可能会导致生物力学适应，直接影响膝关节的机械负荷的机制。具体目的是确定OA患者和年龄匹配的非OA患者在水平行走和爬楼梯过程中的膝关节生物力学力和力矩，对两组的股四头肌和腘绳肌组织进行力量训练，然后比较两组训练前后的膝关节接触力和力矩。PI假设股四头肌和腘绳肌的力量对患者的膝关节力学几乎没有影响，这些患者的力量足以完成行走和爬楼梯的功能任务。他们认为，只有与年龄匹配的对照组相比肌肉组织明显较弱的患者才会因力量训练而显示关节生物力学变化，并且增加的力量不一定“保护”关节。两组（OA患者和年龄匹配的对照组）将接受为期2个月的监督力量训练计划。将在培训前后收集人口统计学、心理社会学和生物力学指标。在水平行走和爬楼梯期间将使用三维步态分析。EMG将用于确定肌肉激活。肌肉力量和关节动力学将使用SIMM肌肉骨骼建模软件和逆动力学进行估计。重复测量ANOVA和ANCOVA将用于检验研究假设。本研究的结果将通过提供有关治疗干预是否以及如何直接影响与膝关节OA相关的机械功能障碍的答案，支持促进基于证据的关节炎干预的国家目标。

DESCRIPTION (Provided by Applicant): Therapeutic exercise programs for osteoarthdtis (OA) of the knee play a major role in conservative management of OA. Strengthening of the quadriceps and hamstrings is one of the primary objectives of these exercise programs, yet the mechanisms of how strengthening affects the Osteoarthritic knee are not well understood. It is speculated that the positive influence of strengthening the knee musculature for OA and other knee joint problems is due to the strengthened muscle's ability to "stabilize" or "reduce stress" or somehow "protect" the knee joint. This commonly held belief has not been assessed experimentally. The purpose of this study is to elucidate the mechanisms of how strengthening primary knee joint musculature may cause biomechanical adaptations that directly influence knee joint mechanical loading. The specific aims will be to determine knee joint biomechanical forces and moments during level walking and stair climbing in patients with OA and age matched persons without OA, to strength train quadriceps and hamstrings musculature for both groups, and then to compare knee joint contact forces and moments before and after training in both groups. The PIs hypothesize that strength of the quadriceps and hamstrings has little influence on knee joint mechanics in patients that have strength sufficient for the functional tasks of walking and stair climbing. They believe that only patients with significantly weaker musculature compared to age-matched controls will show joint biomechanical changes due to strength training and that increased strength does not necessarily "protect" the joint. Two groups (OA patients and age-matched controls) will undergo a 2-month supervised strength-training program. Demographic, psychosocial, and biomechanical measures will be collected pre and post training. Three-dimensional gait analysis will be used during level walking and stair climbing. EMG will be used to determine muscle activation. Muscle forces and joint kinetics will be estimated using SIMM musculoskeletal modeling software and inverse dynamics. Repeated measures ANOVA and ANCOVA will be used to test the study hypotheses. The results of this study will support national objectives to promote evidence based arthritis interventions by providing answers pertaining to whether and how a therapeutic intervention directly affects the mechanical dysfunction associated with OA of the knee.