Neuromuscular Mechanisms Explaining Functional Decline

  • Martin van der Esch
  • Joost DekkerEmail author
Part of the SpringerBriefs in Specialty Topics in Behavioral Medicine book series (BRIEFSSPETOBEME)


This chapter describes the neuromuscular model of activity limitations in knee osteoarthritis. The current scientific evidence for components of the model (i.e. muscle strength, joint proprioception, joint laxity and varus-valgus motion) is reviewed.


Muscle Strength Knee Joint Muscle Weakness Activity Limitation Knee Laxity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM et al (2000) Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 133(8):635–646PubMedCrossRefGoogle Scholar
  2. 2.
    Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW et al (1994) The effects of specific medical conditions on the functional limitations of elders in the Framingham study. Am J Public Health 84:351–358PubMedCrossRefGoogle Scholar
  3. 3.
    Van Dijk GM, Dekker J, Veenhof C, van den Ende CHM (2006) Course of functional status and pain in osteoarthritis of the hip and knee: a systematic review of the literature. Arthritis Rheum 55:779–785PubMedCrossRefGoogle Scholar
  4. 4.
    Dekker J, van Dijk GM, Veenhof C (2009) Risk factors for functional decline in osteoarthritis of the hip or knee. Curr Opin Rheumatol 21:520–524PubMedCrossRefGoogle Scholar
  5. 5.
    Sharma L, Cahue S, Song J, Hayes K, Pai Y, Dunlop D (2003) Physical functioning over three years in knee osteoarthritis. Arthritis Rheum 48:3359–3370PubMedCrossRefGoogle Scholar
  6. 6.
    Van der Esch M, Steultjens MPM, Knol D, Dinant H, Dekker J (2006) Joint laxity modifies the relationship between muscle strength and disability in patients with osteoarthritis of the knee. Arthritis Rheum 55:953–959PubMedCrossRefGoogle Scholar
  7. 7.
    Van der Esch M, Steultjens M, Harlaar J, Knol D, Lems W, Dekker J (2007) Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum 57:787–793PubMedCrossRefGoogle Scholar
  8. 8.
    Van der Esch M, Steultjens M, Harlaar J et al (2008) Varus-valgus motion and functional ability in patients with knee osteoarthritis. Ann Rheum Dis 67:471–477PubMedCrossRefGoogle Scholar
  9. 9.
    Knoop J, Steultjens MP, van der Leeden M, van der Esch M, Thorstensson CA, Roorda LD et al (2011) Proprioception in knee osteoarthritis: a narrative review. Osteoarthritis Cartilage 19:381–388PubMedCrossRefGoogle Scholar
  10. 10.
    World Health Organization (2002) Towards a common language for functioning, disability and health: ICF. WHO, GenevaGoogle Scholar
  11. 11.
    Botha-Scheepers S, Riyazi N, Kroon HM, Scharloo M, Houwing-Duistermaat JJ, Slagboom E, Rosendaal FR, Breedveld FC, Kloppenburg M (2006) Activity limitations in the lower extremities in patients with osteoarthritis: the modifying effects of illness perceptions and mental health. Osteoarthritis Cartilage 14(11):1104–1110PubMedCrossRefGoogle Scholar
  12. 12.
    Veenhof C, Bijlsma JW, van den Ende CH, van Dijk GM, Pisters MF, Dekker J (2006) Psychometric evaluation of osteoarthritis questionnaires: a systematic review of the literature. Arthritis Rheum 55:480–492PubMedCrossRefGoogle Scholar
  13. 13.
    Roorda L, Jones C, Waltz M, Lankhorst G, Bouter L, van der IJken J, Willems W, Heyligers I, Voaklander D, Kelly K, Suarez-Almazor M (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63:36–42PubMedCrossRefGoogle Scholar
  14. 14.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840PubMedGoogle Scholar
  15. 15.
    Ware JE Jr, Keller SD, Hatoum HT, Kong SX (1999) The SF-36 Arthritis-Specific Health Index (ASHI): I. Development and cross-validation of scoring algorithms. Med Care 37(5 Suppl):MS40–MS50PubMedCrossRefGoogle Scholar
  16. 16.
    Hurley MV, Scott DL, Rees J, Newham DJ (1997) Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis 56:641–648PubMedCrossRefGoogle Scholar
  17. 17.
    Piva SR, Fitzgerald GK, Irrgang JJ, Bouzubar F, Starz TW (2004) Get up and go test in patients with knee osteoarthritis. Arch Phys Med Rehabil 85:284–289PubMedCrossRefGoogle Scholar
  18. 18.
    van der Esch M, Knoop J, van der Leeden M, Voorneman R, Gerritsen M, Reiding D, Romviel S, Knol D, Lems W, Dekker J, Roorda L (2012) Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results from the AMS-OA cohort. Cin Rheumatol 31:1505–1510Google Scholar
  19. 19.
    Carpenter MR, Carpenter RL, Peel J, Zukley LM, Angelopoulou KM, Fischer I, Angelopoulos TJ, Rippe JM (2006) The reliability of isokinetic and isometric leg strength measures among individuals with symptoms of mild osteoarthritis. J Sports Med Phys Fitness 46:585–589PubMedGoogle Scholar
  20. 20.
    Hinman RS, Hunt MA, Creaby MW, Wrigley TV, McManus FJ, Bennell KL (2010) Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care Res 62(8):1190–1193CrossRefGoogle Scholar
  21. 21.
    Marks R (1994) An investigation of the influence of age, clinical status, pain and position sense on stair walking in women with osteoarthrosis. Int J Rehabil Res 17:151–158PubMedCrossRefGoogle Scholar
  22. 22.
    Sharma L (2003) Proprioception in osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS (eds) Osteoarthritis, 2nd edn. Oxford Univ Press, Oxford, pp 172–177Google Scholar
  23. 23.
    Sharma L, Pai Y, Holtkamp K, Zev Rymer W (1997) Is knee proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis? Arthritis Rheum 40:1518–1525PubMedCrossRefGoogle Scholar
  24. 24.
    Bennell KL, Hinman RS, Metcalf BR, Crossley KM, Buchbinder R, Smith M et al (2003) Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis. J Orthop Res 21:792–797PubMedCrossRefGoogle Scholar
  25. 25.
    Marks R (1994) Correlation between knee position sense measurements and disease severity in persons with osteoarthritis. Rev Rheum Engl 61:365–372Google Scholar
  26. 26.
    Sharma L, Pai Y (1997) Impaired proprioception and osteoarthritis. Curr Opin Rheumatol 9:253–258PubMedCrossRefGoogle Scholar
  27. 27.
    Sharma L (1999) Proprioceptive impairments in knee osteoarthritis. Rheu Dis Clin North Am 2:299–313CrossRefGoogle Scholar
  28. 28.
    Garsden LR, Bullock-Saxton JE (1999) Joint reposition sense in subjects with unilateral osteoarthritis of the knee. Clin Rehabil 13:148–155PubMedCrossRefGoogle Scholar
  29. 29.
    Sharma L (2004) The role of proprioceptive deficits, ligamentous laxity, and malalignment in development and progression of knee osteoarthritis. J Rheumatol 31(Suppl 70):87–92Google Scholar
  30. 30.
    Felson DT, Gross KD, Nevitt MC, Yang M, Lane NE, Torner JC, Lewis CE, Hurley MV (2009) The effects of impaired joint position sense on the development and progression of pain and structural damage in knee osteoarthritis. Arthritis Rheum 61(8):1070–1076PubMedCrossRefGoogle Scholar
  31. 31.
    Hurkmans EJ, van der Esch M, Ostelo RW, Knol D, Dekker J, Steultjens MP (2007) Reproducibility of the measurement of knee joint proprioception in patients with osteoarthritis of the knee. Arthritis Rheum 57(8):1398–1403PubMedCrossRefGoogle Scholar
  32. 32.
    Piriyaprasarth P, Morris ME, Winter A, Bialocerkowski AE (2008) The reliability of knee joint position testing using electrogoniometry. BMC Musculoskelet Disord 9:6PubMedCrossRefGoogle Scholar
  33. 33.
    Segal NA, Glass NA, Felson DT, Hurley M, Yang M, Nevitt M, Lewis CE, Torner JC (2010) Effect of quadriceps strength and proprioception on risk for knee osteoarthritis. Med Sci Sports Exerc 42(11):2081–2088PubMedCrossRefGoogle Scholar
  34. 34.
    Marks R, Quinney E, Wessel J (1993) Proprioceptive sensibility in women with normal and osteoarthritic knee joints. Clin Rheumatol 12:170–175PubMedCrossRefGoogle Scholar
  35. 35.
    Thorlund JB, Shakoor N, Ageberg E, Sandal LF, Block JA, Roos EM (2012) Vibratory perception threshold in young and middle-aged patients at high risk of knee osteoarthritis compared to controls. Arthritis Care Res 64:144–148CrossRefGoogle Scholar
  36. 36.
    Shakoor N, Lee KJ, Fogg LF, Wimmer MA, Foucher KC, Mikolaitis RA, Block JA (2012) The relationship of vibratory perception to dynamic joint loading, radiographic severity, and pain in knee osteoarthritis. Arthritis Rheum 64:181–186PubMedCrossRefGoogle Scholar
  37. 37.
    Sharma L, Congron L, Felson DT, Dunlop DD, Kirwan-Mellis G, Hayes KW, Weinrach D, Buchanan T (1999) Laxity in healthy and osteoarthritic knees. Arthritis Rheum 42:861–870PubMedCrossRefGoogle Scholar
  38. 38.
    Sharma L, Hayes KW, Felson DT, Buchanan TS, Kirwan-Mellis G, Lou C et al (1999) Does laxity alter the relationship between strength and physical function in knee osteoarthritis? Arthritis Rheum 42:25–32PubMedCrossRefGoogle Scholar
  39. 39.
    Van der Esch M, Steultjens M, Ostelo RW, Harlaar J, Dekker J (2006) Reproducibility of instrumented knee joint laxity measurement in healthy subjects. Rheumatology (Oxford) 45:595–599CrossRefGoogle Scholar
  40. 40.
    Van der Esch M, Steultjens M, Wieringa H, Dinant H, Dekker J (2005) Structural joint changes, malalignment, and laxity in osteoarthritis of the knee. Scand J Rheumatol 34:298–301PubMedCrossRefGoogle Scholar
  41. 41.
    Yakhdani HR, Bafghi HA, Meijer OG, Bruijn SM, van den Dikkenberg N, Stibbe AB, van Royen BJ, van Dieen JH (2010) Stability and variability of knee kinematics during gait in knee osteoarthritis before and after replacement surgery. Clin Biomech 25:230–236CrossRefGoogle Scholar
  42. 42.
    Bruijn SM, van Dieen JH, Meijer OG, Beek PJ (2009) Statistical precision and sensitivity of measures of dynamic gait stability. J Neurosci Methods 178:327–333PubMedCrossRefGoogle Scholar
  43. 43.
    Felson DT, Niu J, McClennan C et al (2007) Knee buckling: prevalence, risk factors, and associated limitations in function. Ann Intern Med 147:534–540PubMedCrossRefGoogle Scholar
  44. 44.
    Fitzgerald GK, Piva SR, Irrgang JJ (2004) Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum 51:941–946PubMedCrossRefGoogle Scholar
  45. 45.
    Knoop J, van der Leeden M, van der Esch M, Thorstensson C, Gerritsen M, Voorneman R, Lems WF, Roorda LD, Dekker J, Steultjens MPM (2012) Lower muscle strength is associated with self-reported knee instability in osteoarthritis of the knee: results from the AM-OA cohort. Arthritis Care Res 64:38–45CrossRefGoogle Scholar
  46. 46.
    Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S (2009) Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev 3:CD007912PubMedGoogle Scholar
  47. 47.
    Van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Lemmens JAM, Bijlsma JW (1998) The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial. Rheumatology 25:2432–2439Google Scholar
  48. 48.
    Steultjens MP, Dekker J, van Baar ME, Oostendorp RA, Bijlsma JW (2001) Muscle strength, pain and disability in patients with osteoarthritis. Clin Rehabil 15:331–341PubMedCrossRefGoogle Scholar
  49. 49.
    Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP et al (1997) Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 127:97–104PubMedCrossRefGoogle Scholar
  50. 50.
    Thorstensson CA, Petersson IF, Jacobsson LT, Boegard TL, Roos EM (2004) Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later. Ann Rheum Dis 63:402–407PubMedCrossRefGoogle Scholar
  51. 51.
    Maly MR, Costigan PA, Olney SJ (2005) Contribution of psychosocial and mechanical variables to physical performance measures in knee osteoarthritis. Phys Ther 85:1318–1328PubMedGoogle Scholar
  52. 52.
    Holla JF, Steultjens MP, Roorda LD, Heymans MW, Ten Wolde S, Dekker J (2010) Prognostic factors for the two-year course of activity limitations in early osteoarthritis of the hip and/or knee. Arthritis Care Res (Hoboken) 62(10):1415–1425CrossRefGoogle Scholar
  53. 53.
    van der Esch M, Steultjens M, Harlaar J, Wolterbeek N, Knol DL, Dekker J (2008) Knee varus-valgus motion during gait: a measure of joint stability in patients with osteoarthritis? Osteoarthritis Cartilage 16(4):522–525PubMedCrossRefGoogle Scholar
  54. 54.
    Veenhof C, Huisman PA, Barten JA, Takken T, Pisters MF (2012) Factors associated with physical activity in patients with osteoarthritis of the hip or knee: a systematic review. Osteoarthritis Cartilage 20:6–12PubMedCrossRefGoogle Scholar

Copyright information

© The Author(s) 2014

Authors and Affiliations

  1. 1.Amsterdam Rehabilitation Research Center ∣ ReadeAmsterdamThe Netherlands
  2. 2.Department of Rehabilitation MedicineVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands

Personalised recommendations