Loading and gait symmetry during level and stair walking in asymptomatic subjects with knee osteoarthritis: importance of quadriceps femoris in reducing impact force during heel strike?

Repetitive impulsive forces during walking are claimed to result in joint osteoarthritis (OA). The aim of this study was to investigate impact loading and gait symmetry during level and stair walking in asymptomatic elderly subjects with knee OA. It was hypothesised that pre-activity of the quadriceps femoris muscle (QF) would be an important factor reducing impulsive loading when walking on level ground. Subjects [21 female, six men, 66.2 (7.6) years] were studied. The subjects had no knee pain or diminished functional capacity, but showed radiographically light or moderate bilateral knee OA changes. Ground reaction forces (GRFs), plantar pressure distribution, muscle activation pattern [vastus medialis (VM), vastus lateralis, biceps femoris and gastrocnemius medialis] and asymmetry during level walking and stair walking were evaluated. Almost 20% of subjects had a distinct heel-strike transient at maximal speed with lower pre-activity of VM (P<0.05). The most forceful maximum vertical GRF in the braking phase occurred in stair descent [1.52 (0.21) BW]. This was 32.5% (P<0.001) higher than seen when walking on the level at normal speed. The loading rate of stair descent [10.87 (2.96) BW/s] was significantly stronger (P<0.05) than in level walking at normal speed [8.55 (1.93) BW/s]. There was no asymmetry in kinematic or kinetic variables in level walking. However, asymmetry increased during stair walking. The control of quadriceps femoris prior to heel-strike is possibly an important factor that reduces impulsive loading during walking in asymptomatic OA subjects. Stair walking is a demanding motor task and the musculoskeletal system is loaded more during stair descent than level walking at normal speed.