How Osteoarthritis Affects Gait


Table of Contents

1. Age Group and Gender Affected

2. Symptoms of Osteoarthritis

3. Treatment of Osteoarthritis

4. Effect of Osteoarthritis and Patient Gait

5. Contralateral Walking Canes Benefit Gait Most

6. Energy Expenditure Decreases

7. Exercise Recommendationsfor Patients

8. Knee Exercise for Osteoarthritis Patients

9. Expert Contributions

10. References

11. Patient Reference


Arthritis is defined as a disorder that causes the joints of the body to become inflamed. There are over 100 varieties of arthritis, with Osteoarthritis (OA) being the most common. OA is caused by wear and tear and the eventual breakdown of cartilage inside the joints. This degenerative condition can happen to almost any joint in the body and ultimately results in decreased regeneration of joint cartilage. Areas in the body that are commonly affected are the weight bearing joints of the spine, knees and hips. OA is also known to affect other areas of the body, such as thumbs, fingers, the neck and big toes. OA is typically not found in other joints unless those joints are stressed or the patient has a history of suffering a previous injury involving that particular joint.(1)

Age Group and Gender Affected

There are about 27 million people in the United States that are affected with osteoarthritis. The risk of developing OA increases with age and as such, the majority of people over the age of 60 have it, to some degree. Though the incidence of osteoarthritis in patients under the age of 40, without a specific injury, is low, the risk of OA occurring increases with advancing age. The disorder is encountered most frequently in women over 50 years of age.(2)

Symptoms of Osteoarthritis

Symptoms of arthritis vary considerably, with the progressive deterioration happening slowly. The pain of the involved joint is typically reduced upon awakening but often worsens as the day progresses. Patients often complain of swelling, pain and warmth of the joints. Stiffness is also frequently noted after prolonged periods of inactivity.

For patients that have advanced arthritis, there is often a severe loss of cartilage, leading to increased friction between the boney surfaces. This friction can produce significant discomfort, whether at rest or in motion. In addition, patients commonly have symptoms of pain after overusing the joint or after extended periods of inactivity. Some patients suffer a boney enlargement on the end and in the middle of the affected joint.(3)

Treatment of Osteoarthritis

The treatment protocol often depends on which joints are affected and the severity of the involvement. Treatment may involve medication, the proper supporting tools or exercise. Osteoarthritis symptoms and disease progression can often be managed by the use of proper footwear(4) or by the use of a walking cane. If a patient is overweight, losing weight will often improve the symptoms of OA.(5)

Effect of Osteoarthritis on Patient Gait

Osteoarthritis of the knees can play a significant role in advancing a patient’s gait abnormailities. The disorder adversely affects the knees and associated gait, leading to a decrease in gait speed. The adverse symptoms of the affected knees, such as joint pain and deformity, as well as weakness in the muscles and musculoskeletal instability can cause the patient to expend more energy during their gait. The patient will then compensate by shifting their weight almost entirely to the medial compartment of the knee. As such, reducing the load on the medial compartment of the knee should be one of the hallmark treatment options utilized for these patients. (6)

Contralateral Canes Benefit Gait Most

The most common joint affected by osteoarthritis is the knee. Studies have shown that the use of a cane, during walking, removes a significant amount of stress on the knees, thereby decreasing the risk of osteoarthritis progression in those particular joints. By decreasing the risk of the progression of the disorder, the likehood of disability may be significantly reduced or prevented entirely.
The cane works by reducing the biomechanical load on the patient’s lower extremity joints. The end result is to increase tolerance to exercise and independence, thus allowing an optimal gait and decrease in stress to the afflicted joints.
A recent study, using randomized controlled trials, studied patients with osteoarthritis of the knees and evaluated episodes of ipsilateral and contralateral cane use. The study demonstrated that the contralateral cane was better suited for use and effectiveness of managing the biomechanical load on the knee joints. A lower peak force on the affected area was required and as such reduced friction occured. The use of the contralateral cane reduced the overall load on the medial compartment. The use of this type of cane also allowed for the affected lower limb to advance together with the patient’s upper limb carrying the contralateral cane, resulting in normalcy in the gait pattern. The use of a cane significantly reduced medial knee loading and resulted in a 10% decrease in the knee adduction movement.(7)

Energy Expenditure Decreases

A cane can be used to take away some of the pain, improve function, and improve some aspects of the quality of life in patients that have osteoarthritis of the knees. Healthcare providers that prescribe the use of a contralateral cane should take into account that the associated expenditure of energy in the first month of use will be quite large, however the energy expenditure will be reduced going forward, as the patient adapts to its use.(8)

Exercise Recommendations for Patients

In the past, healthcare providers frequenty recommended immobilizing the affected joint and reducing the patient’s activity levels. Researchers have since learned that locking up the joints in this fashion contributes to the worsening of osteoarthritis. In the case of knees, it is important to keep them moving with the proper types of exercise, in order to protect the joints and prevent any further damage caused by arthritis. With this said, all exercise is not created equal for arthritis sufferers, and people with knee osteoarthritis may have certain limitations.(9)

Knee Exercises for Osteoarthritis Patients

High-impact activities should be avoided by a person with knee osteoarthritis. These activities include those where the patient has both feet off the ground at the same time. For this reason, jumping rope and high-impact aerobics are not recommended for arthritis sufferers. The act of running and even jogging are also not recommended.
Many low-impact activities are very beneficial for people with knee osteoarthritis. The three key activities that patients with OA should concentrate on are weight-bearing cardiovascular activity, activities that build muscles, flexibility and range of motion exercises.
Cardiovascular activities that are helpful for patients that are low-impact include cycling, walking and swimming. Swimming is not recommended as highly for weight bearing as the other activities, but it does provide cardiovascular benefits to the heart and improved motion. Swimming is an excellent alternative for patients that experience difficulty and pain when performing other recommended low-impact activities.
An additional benefit to regular exercise is that it helps the patient with OA maintain an ideal and healthy weight, thus decreasing the force sustained by the affected joints.

*Always check with your healthcare provider prior to initiating any exercise program.(10)

Expert Contributions

1. The mission of Yoga for Arthritis is to foster a new concept of the possibilities for people living with arthritis. The yoga for arthritis program was developed at a leading research university by an interdisciplinary team of medical and healing professionals. By combining ancient yoga practices with modern medical knowledge, this program offers modifications to address the unique abilities and limitations of persons living with rheumatoid and osteoarthritis. In a 7-year randomized clinical trial, program participation was associated with improved arthritis symptoms, disease biomarkers, physical fitness, psychological functioning and quality of life.

Yoga for Arthritis offers yoga teacher training programs to ensure teachers are providing top-quality and safe practices to individuals living with arthritis. Look on our website for a list of trained Yoga for Arthritis teachers in your area! We also offer resources and products (such as a DVD, props, guides and much more) to promote knowledge and awareness of safe and effective yoga practices. These resources will also educate individuals of the many ways yoga is helpful for arthritis and related conditions. Check out our website at yoga4arthritis.com to learn about the many possibilities to become involved in or learn more about the Yoga for Arthritis community

2. "In Sixteenth Century China, the understanding at the time was that disease and maladies that effected the physical world was caused by energy imbalance. Acupuncture, the process of correcting this imbalance, works by opening blocked 'energy channels' by piercing specific body zones with stainless steel needles. Through this process, patients report relief from pain, stiffness, and other unpleasant manifestations of energy imbalances." Eric Schmidt, L.Ac, Dipl. O.M. Santa Monica Acupuncture

 

References

1. WebMD. Reviewed by David T. Derrer, MD on December 29, 2013. Osteoarthritis Health Center/The Basics of Osteoarthritis. http://www.webmd.com/osteoarthritis/guide/osteoarthritis-basics.

2. WebMD. Reviewed by David T. Derrer, MD on December 29, 2013. Osteoarthritis Health Center/The Basics of Osteoarthritis. http://www.webmd.com/osteoarthritis/guide/osteoarthritis-basics.

3. WebMD. Reviewed by David T. Derrer, MD on December 29, 2013. Osteoarthritis Health Center/What are the Symptoms of Osteoarthritis? http://www.webmd.com/osteoarthritis/guide/osteoarthritis-symptoms.

4. Georgina Kemp, Crossley, Kay M., Wrigley, Tim V., Metcalf, Ben R., and Hinman, Rana S. Arthritis Care and Research. Reducing Joint Loading in Medial Knee Osteoarthritis: Shoes and Canes. Vol. 59, No. 5, May 15, 2008, 609.

5. WebMD. Reviewed by David T. Derrer, MD on December 29, 2013. Osteoarthritis Health Center/The Basics of Osteoarthritis. http://www.webmd.com/osteoarthritis/guide/osteoarthritis-basics.

6. A Jones, P G Silva, A C Silva, M Colucci, A Tuffanin, J R Jardim, J Natour. Impact of Cane Use on Pain, Function, General Health and Energy Expenditure During Gait in Patients With Knee Osteoarthritis. Ann Rheum Dis. 2012;71(2):172-179.
http://www.medscape.com/viewarticle/756653.

7. A Jones, P G Silva, A C Silva, M Colucci, A Tuffanin, J R Jardim, J Natour. Impact of Cane Use on Pain, Function, General Health and Energy Expenditure During Gait in Patients With Knee Osteoarthritis. Ann Rheum Dis. 2012;71(2):172-179.
http://www.medscape.com/viewarticle/756653.

8. A Jones, P G Silva, A C Silva, M Colucci, A Tuffanin, J R Jardim, J Natour. Impact of Cane Use on Pain, Function, General Health and Energy Expenditure During Gait in Patients With Knee Osteoarthritis. Ann Rheum Dis. 2012;71(2):172-179.
http://www.medscape.com/viewarticle/756653.

9. Shaw, Gina. Knee and Hip Exercises for Osteoarthritis. http://www.webmd.com/osteoarthritis/default.htm?names-dropdown=MO.

10. Shaw, Gina. Knee and Hip Exercises for Osteoarthritis. http://www.webmd.com/osteoarthritis/default.htm?names-dropdown=MO.

Patient Reference

http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/osteoarthritis.asp


How Osteoarthritis Affects Gait is Written by: Dr. Elizabeth Lewis

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