Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics

Morten Bilde Simonsen, Aysun Yurtsever, Ketill Næsborg-Andersen, Peter Derek Christian Leutscher, Kim Hørslev-Petersen, Michael Skipper Andersen, Rogerio Pessoto Hirata*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Tibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects. Methods: Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. Findings: Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. Interpretation: The study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.

Original languageEnglish
JournalHuman Movement Science
Volume66
Pages (from-to)98-108
ISSN0167-9457
DOIs
Publication statusPublished - Aug 2019

Fingerprint

Myalgia
Mechanics
Hip
Knee
Joints
Muscles
Hip Joint
Knee Joint
Causality
Cross-Over Studies

Keywords

  • Dysfunction
  • Experimental pain
  • Gait
  • Rheumatoid arthritis
  • Tibialis posterior

Cite this

Simonsen, M. B., Yurtsever, A., Næsborg-Andersen, K., Leutscher, P. D. C., Hørslev-Petersen, K., Andersen, M. S., & Hirata, R. P. (2019). Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics. Human Movement Science, 66, 98-108. https://doi.org/10.1016/j.humov.2019.04.002
Simonsen, Morten Bilde ; Yurtsever, Aysun ; Næsborg-Andersen, Ketill ; Leutscher, Peter Derek Christian ; Hørslev-Petersen, Kim ; Andersen, Michael Skipper ; Hirata, Rogerio Pessoto. / Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics. In: Human Movement Science. 2019 ; Vol. 66. pp. 98-108.
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abstract = "Background: Tibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects. Methods: Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. Findings: Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. Interpretation: The study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.",
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Simonsen, MB, Yurtsever, A, Næsborg-Andersen, K, Leutscher, PDC, Hørslev-Petersen, K, Andersen, MS & Hirata, RP 2019, 'Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics', Human Movement Science, vol. 66, pp. 98-108. https://doi.org/10.1016/j.humov.2019.04.002

Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics. / Simonsen, Morten Bilde; Yurtsever, Aysun; Næsborg-Andersen, Ketill; Leutscher, Peter Derek Christian; Hørslev-Petersen, Kim; Andersen, Michael Skipper; Hirata, Rogerio Pessoto.

In: Human Movement Science, Vol. 66, 08.2019, p. 98-108.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics

AU - Simonsen, Morten Bilde

AU - Yurtsever, Aysun

AU - Næsborg-Andersen, Ketill

AU - Leutscher, Peter Derek Christian

AU - Hørslev-Petersen, Kim

AU - Andersen, Michael Skipper

AU - Hirata, Rogerio Pessoto

PY - 2019/8

Y1 - 2019/8

N2 - Background: Tibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects. Methods: Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. Findings: Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. Interpretation: The study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.

AB - Background: Tibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects. Methods: Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. Findings: Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. Interpretation: The study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.

KW - Dysfunction

KW - Experimental pain

KW - Gait

KW - Rheumatoid arthritis

KW - Tibialis posterior

U2 - 10.1016/j.humov.2019.04.002

DO - 10.1016/j.humov.2019.04.002

M3 - Journal article

C2 - 30981150

AN - SCOPUS:85064079782

VL - 66

SP - 98

EP - 108

JO - Human Movement Science

JF - Human Movement Science

SN - 0167-9457

ER -

Simonsen MB, Yurtsever A, Næsborg-Andersen K, Leutscher PDC, Hørslev-Petersen K, Andersen MS et al. Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics. Human Movement Science. 2019 Aug;66:98-108. https://doi.org/10.1016/j.humov.2019.04.002