Identifying yoga-based knee strengthening exercises using the knee adduction moment

      Highlights

      • Squats and lunges require large quadriceps activations with minimal knee adduction moments.
      • Single-leg balance exercises produce greater medial relative to lateral knee loading.
      • Squats and lunges require greater lateral/medial co-contraction than other yoga postures.

      Abstract

      Background

      This study aimed to compare muscle activations, co-contraction indices, and the knee adduction moment between static standing yoga postures to identify appropriate exercises for knee osteoarthritis.

      Methods

      Healthy young women (24.4 (5.4) years, 23.1 (3.7) kg/m 2) participated. Primary outcome variables were electromyographic activations of the vastus lateralis, rectus femoris, vastus medialis, biceps femoris, and semitendinosus; co-contraction between the biceps femoris and rectus femoris, and vastus lateralis and vastus medialis; and knee adduction moments of both legs during six static, standing yoga postures (two squatting postures, two lunging postures, a hamstring stretch, and a single-leg balance posture). A two-factor repeated measures analysis of variance was used to identify differences in muscle amplitudes, co-contractions, and knee adduction moment between postures and legs.

      Findings

      Quadriceps activations were highest during squat and lunge postures (p ≤ 0.001). Hamstring activations were highest during the hamstring stretch (p ≤ 0.003). Squat and lunge postures produced higher co-contraction indices than other postures (p ≤ 0.011). The wide legged squat (Goddess) and lunge with trunk upright (Warrior) produced the lowest knee adduction moments (p ≤ 0.006), while the single-leg balance posture elicited a higher knee adduction moment than all other postures (p < 0.05).

      Interpretation

      Squatting and lunging postures could improve leg strength while potentially minimizing exposure to high knee adduction moments. Future work should evaluate whether these exercises are useful in people with knee osteoarthritis.

      Keywords

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      References

        • Ageberg E.
        • Nilsdotter A.
        • Kosek E.
        • Roos E.M.
        Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study.
        BMC Musculoskelet. Disord. 2013; 14: 232
        • Andriacchi T.P.
        Editorial: Valgus alignment and lateral compartment knee osteoarthritis: a biomechanical paradox or new insight into knee osteoarthritis?.
        Arthritis Rheum. 2013; 65: 310-313https://doi.org/10.1002/art.37724
        • Bennell K.L.
        • Hunt M.A.
        • Wrigley T.V.
        • et al.
        Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial.
        Osteoarthr. Cartil. 2010; 18: 621-628https://doi.org/10.1016/j.joca.2010.01.010
        • Bennell K.L.
        • Bowles K.-A.
        • Wang Y.
        • et al.
        Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis.
        Ann. Rheum. Dis. 2011; 70: 1770-1774https://doi.org/10.1136/ard.2010.147082
        • Bennell K.L.
        • Wrigley T.V.
        • Hunt M.A.
        • et al.
        Update on the role of muscle in the genesis and management of knee osteoarthritis.
        Rheum. Dis. Clin. N. Am. 2013; 39: 145-176https://doi.org/10.1016/j.rdc.2012.11.003
        • Birmingham T.B.
        • Hunt M.A.
        • Jones I.C.
        • et al.
        Test–retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis.
        Arthritis Rheum. 2007; 57: 1012-1017https://doi.org/10.1002/art.22899
        • Bukowski E.
        • Conway A.
        • Glentz L.
        • et al.
        The effect of Iyengar yoga and strengthening exercises for people living with osteoarthritis of the knee: a case series.
        Int. Q. Community Health Educ. 2006; 26: 287-305https://doi.org/10.2190/IQ.26.3.f
        • Cheung C.
        • Wyman J.
        • Resnick B.
        Is yoga effective for knee osteoarthritis in older women?.
        Osteoarthr. Cartil. 2012; 20: S280
        • Clark R.A.
        • Pua Y.-H.
        • Bryant A.L.
        • Hunt M.A.
        Validity of the Microsoft Kinect for providing lateral trunk lean feedback during gait retraining.
        Gait Posture. 2013; 38: 1064-1066
        • Creaby M.W.
        • Wang Y.
        • Bennell K.L.
        • et al.
        Dynamic knee loading is related to cartilage defects and tibial plateau bone area in medial knee osteoarthritis.
        Osteoarthr. Cartil. 2010; 18: 1380-1385https://doi.org/10.1016/j.joca.2010.08.013
        • Ebenbichler G.
        • Kollmitzer J.
        • Glöckler L.
        • et al.
        The role of the biarticular agonist and cocontracting antagonist pair in isometric muscle fatigue.
        Muscle Nerve. 1998; 21: 1706-1713
        • Ebnezar J.
        • Nagarathna R.
        • Yogitha B.
        • Nagendra H.R.
        Effects of an integrated approach of Hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study.
        J. Altern. Complement. Med. 2012; 18: 463-472https://doi.org/10.1089/acm.2010.0320
        • Felson D.T.
        • Lawrence R.C.
        • Dieppe P.A.
        • et al.
        Osteoarthritis: new insights. Part 1: the disease and its risk factors.
        Ann. Intern. Med. 2000; 133: 635-646
        • Foroughi N.
        • Smith R.
        • Vanwanseele B.
        The association of external knee adduction moment with biomechanical variables in osteoarthritis: a systematic review.
        Knee. 2009; 16: 303-309
        • Fransen M.
        • McConnell S.
        Exercise for osteoarthritis of the knee.
        Cochrane Database Syst. Rev. 2008; CD004376https://doi.org/10.1002/14651858.CD004376.pub2
        • Grood E.S.
        • Suntay W.J.
        A joint coordinate system for the clinical description of three-dimensional motions: application to the knee.
        J. Biomech. Eng. 1983; 105: 136-144
        • Hortobágyi T.
        • DeVita P.
        Muscle pre-and coactivity during downward stepping are associated with leg stiffness in aging.
        J. Electromyogr. Kinesiol. 2000; 10: 117-126
        • Hubley-Kozey C.L.
        • Deluzio K.J.
        • Landry S.C.
        • et al.
        Neuromuscular alterations during walking in persons with moderate knee osteoarthritis.
        J. Electromyogr. Kinesiol. 2006; 16: 365-378https://doi.org/10.1016/j.jelekin.2005.07.014
        • Hubley-Kozey C.L.
        • Hill N.A.
        • Rutherford D.J.
        • et al.
        Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking.
        Clin. Biomech. 2009; 24: 407-414https://doi.org/10.1016/j.clinbiomech.2009.02.005
        • Jenkinson C.M.
        • Doherty M.
        • Avery A.J.
        • et al.
        Effects of dietary intervention and quadriceps strengthening exercises on pain and function in overweight people with knee pain: randomised controlled trial.
        BMJ. 2009; 339 (b3170-b3170)https://doi.org/10.1136/bmj.b3170
        • Kamen G.
        • De Luca C.J.
        Unusual motor unit firing behavior in older adults.
        Brain Res. 1989; 482: 136-140
        • Katz P.
        • O'Grady M.
        • Davis G.
        • et al.
        Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations—a supplement to the AGS clinical practice guidelines on the management of chronic pain in older adults.
        J. Am. Geriatr. Soc. 2001; 49: 808-823
        • Kolasinski S.L.
        • Garfinkel M.
        • Tsai A.G.
        • et al.
        Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study.
        J. Altern. Complement. Med. 2005; 11: 689-693
        • Lange A.K.
        • Vanwanseele B.
        • Fiatarone Singh M.A.
        Strength training for treatment of osteoarthritis of the knee: a systematic review.
        Arthritis Rheum. 2008; 59: 1488-1494https://doi.org/10.1002/art.24118
        • Lewek M.D.
        • Rudolph K.S.
        • Snyder-Mackler L.
        Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis.
        J. Orthop. Res. 2004; 22: 110-115https://doi.org/10.1016/S0736-0266(03)00154-2
        • Lewek M.D.
        • Ramsey D.K.
        • Snyder-Mackler L.
        • Rudolph K.S.
        Knee stabilization in patients with medial compartment knee osteoarthritis.
        Arthritis Rheum. 2005; 52: 2845-2853https://doi.org/10.1002/art.21237
        • Messier S.P.
        • Loeser R.F.
        • Miller G.D.
        • et al.
        Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the arthritis, diet, and activity promotion trial.
        Arthritis Rheum. 2004; 50: 1501-1510https://doi.org/10.1002/art.20256
        • Miyazaki T.
        • Wada M.
        • Kawahara H.
        • et al.
        Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis.
        Ann. Rheum. Dis. 2002; 61: 617-622
        • Moisio K.C.
        • Sumner D.R.
        • Shott S.
        • Hurwitz D.E.
        Normalization of joint moments during gait: a comparison of two techniques.
        J. Biomech. 2003; 36: 599-603https://doi.org/10.1016/S0021-9290(02)00433-5
        • Mündermann A.
        • Dyrby C.O.
        • Hurwitz D.E.
        • et al.
        Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed.
        Arthritis Rheum. 2004; 50: 1172-1178https://doi.org/10.1002/art.20132
        • O'Reilly S.C.
        • Jones A.
        • Muir K.R.
        • Doherty M.
        Quadriceps weakness in knee osteoarthritis: the effect on pain and disability.
        Ann. Rheum. Dis. 1998; 57: 588-594
        • Pelland L.
        • Brosseau L.
        • Wells G.
        • et al.
        Efficacy of strengthening exercises for osteoarthritis (part I): a meta-analysis.
        Phys. Ther. Rev. 2004; 9: 77-108
        • Ratamess N.
        • Alvar B.
        • Evetoch T.
        • et al.
        Progression models in resistance training for healthy adults [ACSM position stand].
        Med. Sci. Sports Exerc. 2009; 41: 687-708
        • Rice D.A.
        • McNair P.J.
        • Lewis G.N.
        Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects.
        Arthritis Res. Ther. 2011; 13: R151
        • Roddy E.
        Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review.
        Ann. Rheum. Dis. 2005; 64: 544-548https://doi.org/10.1136/ard.2004.028746
        • Ross A.
        • Thomas S.
        The health benefits of yoga and exercise: a review of comparison studies.
        J. Altern. Complement. Med. 2010; 16: 3-12
        • Rutherford D.J.
        • Hubley-Kozey C.L.
        • Deluzio K.J.
        • et al.
        Foot progression angle and the knee adduction moment: a cross-sectional investigation in knee osteoarthritis.
        Osteoarthr. Cartil. 2008; 16: 883-889https://doi.org/10.1016/j.joca.2007.11.012
        • Rutherford D.J.
        • Hubley-Kozey C.L.
        • Stanish W.D.
        Maximal voluntary isometric contraction exercises: a methodological investigation in moderate knee osteoarthritis.
        J. Electromyogr. Kinesiol. 2011; 21: 154-160
        • Schmitt L.C.
        • Rudolph K.S.
        Influences on knee movement strategies during walking in persons with medial knee osteoarthritis.
        Arthritis Rheum. 2007; 57: 1018-1026https://doi.org/10.1002/art.22889
        • Segal N.A.
        • Torner J.C.
        • Felson D.
        • et al.
        Effect of thigh strength on incident radiographic and symptomatic knee osteoarthritis in a longitudinal cohort.
        Arthritis Rheum. 2009; 61: 1210-1217https://doi.org/10.1002/art.24541
        • Segal N.A.
        • Findlay C.
        • Wang K.
        • et al.
        The longitudinal relationship between thigh muscle mass and the development of knee osteoarthritis.
        Osteoarthr. Cartil. 2012; 20: 1534-1540https://doi.org/10.1016/j.joca.2012.08.019
        • Shakoor N.
        • Block J.A.
        Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis.
        Arthritis Rheum. 2006; 54: 2923-2927https://doi.org/10.1002/art.22123
        • Slemenda C.
        • Brandt K.D.
        • Heilman D.K.
        • et al.
        Quadriceps weakness and osteoarthritis of the knee.
        Ann. Intern. Med. 1997; 127: 97-104
        • Slemenda C.
        • Heilman D.K.
        • Brandt K.D.
        • et al.
        Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women?.
        Arthritis Rheum. 1998; 41: 1951-1959
        • Thomas S.
        • Reading J.
        • Shephard R.J.
        Revision of the physical activity readiness questionnaire (PAR-Q).
        Can. J. Sport Sci. 1992; 17: 338-345
        • Topp R.
        • Woolley S.
        • Hornyak J.
        • et al.
        The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee.
        Arch. Phys. Med. Rehabil. 2002; 83: 1187-1195
        • Van den Noort J.C.
        • Steenbrink F.
        • Roeles S.
        • Harlaar J.
        Real-time visual feedback for gait retraining: toward application in knee osteoarthritis.
        Med. Biol. Eng. Comput. 2014; : 1-12
        • Wahl M.J.
        • Behm D.G.
        Not all instability training devices enhance muscle activation in highly resistance-trained individuals.
        J. Strength Cond. Res. 2008; 22: 1360-1370
        • Wang M.-Y.
        • Sean S.Y.
        • Hashish R.
        • et al.
        The biomechanical demands of standing yoga poses in seniors: the yoga empowers seniors study (YESS).
        BMC Complement. Altern. Med. 2013; 13: 8
        • Williams S.B.
        • Brand C.A.
        • Hill K.D.
        • et al.
        Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.
        Arch. Phys. Med. Rehabil. 2010; 91: 106-114https://doi.org/10.1016/j.apmr.2009.08.150
        • Winter D.
        Biomechanics of human movement with applications to the study of human locomotion.
        Crit. Rev. Biomed. Eng. 1983; 9: 287-314
        • Zeni J.A.
        • Rudolph K.
        • Higginson J.S.
        Alterations in quadriceps and hamstrings coordination in persons with medial compartment knee osteoarthritis.
        J. Electromyogr. Kinesiol. 2010; 20: 148-154https://doi.org/10.1016/j.jelekin.2008.12.003