Acuity of force appreciation in the osteoarthritic knee joint
Brereton, Helen P
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Osteoarthritis and ageing have been shown to induce changes in the number and health of peripheral mechanoreceptors. Whilst position and movement awareness in the osteoarthritic knee have been studied extensively, little work to date has been produced on muscle force awareness in this subject group. Poor force acuity may contribute to muscle and joint pain and dysfunction, and additionally hinder rehabilitation efforts in an osteoarthritic population. Overestimation of the muscles forces required for a given task, resulting in greater joint compression forces, may aggravate and inflame osteoarthritic symptoms. Underestimation of required muscle forces may amplify existing joint instability, increasing the risk of injury in an osteoarthritic population. Additionally, both under and overloading of muscles during the rehabilitation process can delay the return to full function after injury.When regarding the neurological process of force coding, current debate centres on the relative importance of centrally generated motor command mediated 'sense of effort' versus the peripheral mechanoreceptor signalled 'sense of tension' as the dominant coding process, with central mechanisms favoured in the majority of studies published to date. The purpose of this study was to investigate muscle force awareness in the knee extensors and flexors and hands of subjects with and without knee joint osteoarthritis. Twenty one subjects with knee joint osteoarthritis and 23 age and gender matched subjects with no known knee pathology were evaluated. All subjects performed ipsilateral isometric force estimation and force matching tasks, at levels scaled to individual maximum voluntary capacity (MVC). Errors in estimation and matching acuity were normalised to reference targets (comparison force/reference force) giving a relative score (RS) to allow comparison across submaximal force levels with RS less than 1.0 indicating that subjects produced insufficient force and vice versa.Maximal voluntary capacity tests revealed significantly lower (p<0.05) peak knee extension torque (111.2 Nm versus 145.3 Nm), but similar peak knee flexion torque (46.1 Nm versus 45.4 Nm for osteoarthritis and control subjects respectively). A pattern of overestimation at low reference levels and underestimation at high reference levels was demonstrated by all subjects. In the lower limb, force appreciation differed significantly between muscle groups regardless of knee condition, with knee extensors demonstrating greater overall accuracy than knee flexors. There was a significant difference (p<0.05) in force estimation ability and a trend to significance (p=0.066) for force matching acuity across groups at the 10% MVC test level. A significant (p<0.05) group difference in grip force estimation ability between the lowest and highest target levels was demonstrated.It can be concluded that there are small differences in force acuity in osteoarthritis subjects at lower submaximal force targets when compared to healthy age matched peers. The notion of information redundancy, whereby no new proprioceptive inputs, regardless of origin, are able to effect an improvement in force acuity in a given situation has been demonstrated in previous studies that reported relatively stable force matching acuity at forces between 30% and 60% of maximal capacity. The poor comparative force perception demonstrated in this study by the osteoarthritis group at the lower submaximal test levels supports the notion that centrally generated copies of motor commands do not provide sufficient data to adequately encode force magnitude at low levels of force generation, evoking a greater reliance data received from peripheral mechanoreceptors. This has significant implications for this subject group given that the majority of daily tasks require only low levels of force generation. Given that perceptive acuity in a variety of sensory modalities has been shown to improve with training there may be a role for force perception training in older adults with osteoarthritis.