Changes In Joint Stiffness Research Articles

Therapeutic Effects of Low Level Laser Therapy (LLLT) in Knee Osteoarthritis, Compared to Therapeutic Ultrasound

INTRODUCTION: Low-level laser therapy (LLLT) is thought to have analgesic and biomodulatory effects. Our objective was to assess the pain-relieving effect of LLLT and possible changes in joint stiffness and disability of patients with knee osteoarthritis (KOA) and compare it to the more commonly used modality; therapeutic ultrasound(US). METHODS: 37 patients with mild or moderate KOA were randomized to receive either LLLT, placebo LLLT or US. All patients received a common treatment including acetaminophen (up to 2gr/d) and medical advices for lifestyle modification and exercise. Treatments were delivered 5 times a week over a period of 2 weeks. Active laser group was treated with a diode laser (wavelength 880 nm, continuous wave, power 50 mW) at a dose of 6 J/point (24 J/knee). The placebo control group was treated with an ineffective probe (power 0 mW) of the same appearance. The third group received pulsed ultrasound with an intensity of 1.5-2 w/cm2, and for 5 minutes per knee. Visual Analogue Scale (VAS) and Western Ontario MacMaster (WOMAC) questionnaires were used for data gathering before,1 and 3 months after completing the therapy. RESULTS: Pain reduced in all 3 groups but laser was superior in comparison. Stiffness improved 1 mo after therapy in the laser group but not in the others. Disability decreased in both laser and US groups (more significantly in the laser group) but not in the placebo group. CONCLUSION: Our results show that LLLT reduces pain, joint stiffness and disability in KOA and is superior to placebo and US.

Muscle co-contraction modulates damping and joint stability in a three-link biomechanical limb.

Computational models of neuromotor control require forward models of limb movement that can replicate the natural relationships between muscle activation and joint dynamics without the burdens of excessive anatomical detail. We present a model of a three-link biomechanical limb that emphasizes the dynamics of limb movement within a simplified two-dimensional framework. Muscle co-contraction effects were incorporated into the model by flanking each joint with a pair of antagonist muscles that may be activated independently. Muscle co-contraction is known to alter the damping and stiffness of limb joints without altering net joint torque. Idealized muscle actuators were implemented using the Voigt muscle model which incorporates the parallel elasticity of muscle and tendon but omits series elasticity. The natural force-length-velocity relationships of contractile muscle tissue were incorporated into the actuators using ideal mathematical forms. Numerical stability analysis confirmed that co-contraction of these simplified actuators increased damping in the biomechanical limb consistent with observations of human motor control. Dynamic changes in joint stiffness were excluded by the omission of series elasticity. The analysis also revealed the unexpected finding that distinct stable (bistable) equilibrium positions can co-exist under identical levels of muscle co-contraction. We map the conditions under which bistability arises and prove analytically that monostability (equifinality) is guaranteed when the antagonist muscles are identical. Lastly we verify these analytic findings in the full biomechanical limb model.

Identification of Time-Varying Intrinsic and Reflex Joint Stiffness

Dynamic joint stiffness defines the dynamic relationship between the position of a joint and the torque acting about it and can be separated into intrinsic and reflex components. Under stationary conditions, these can be identified using a nonlinear parallel-cascade algorithm that models intrinsic stiffness-a linear dynamic response to position-and reflex stiffness-a nonlinear dynamic response to velocity-as parallel pathways. Experiments using this method show that both intrinsic and reflex stiffness depend strongly on the operating point, defined by position and torque, likely because of some underlying nonlinear behavior not modeled by the parallel-cascade structure. Consequently, both intrinsic and reflex stiffness will appear to be time-varying whenever the operating point changes rapidly, as during movement. This paper describes and validates an extension of the parallel-cascade algorithm to time-varying conditions. It describes the ensemble method used to estimate time-varying intrinsic and reflex stiffness. Simulation results demonstrate that the algorithm can track rapid changes in joint stiffness accurately. Finally, the performance of the algorithm in the presence of noise is tested. We conclude that the new algorithm is a powerful new tool for the study of joint stiffness during functional tasks.

Clinical effects of Garcinia kola in knee osteoarthritis

ObjectivesOver the past years, there has been a growing number of knee osteoarthritis (KOA) patients who are not willing to comply with long-term non-steroidal anti-inflammatory drugs (NSAID) treatment and wish to use herbal anti- rheumatic medicine. This study assessed the clinical effects of Garcinia kola (GK) in KOA patients.Patients and methodsProspective randomized, placebo controlled, double blind, clinical trial approved by the institutional medical ethics review board and written informed consent obtained from each patient. All KOA patients presenting at the Obafemi Awolowo University Teaching Hospital complex were recruited into the study. The patients were grouped into four (A = Placebo, B = Naproxen, C = Garcinia kola, D = Celebrex). The drugs and placebo were given twice a day per oral route. Each dose consisted of 200 mg of G. kola, Naproxen (500 mg), Celebrex (200 mg) and Ascorbic acid (100 mg). The primary outcome measure over six weeks study period was the change in mean WOMAC pain visual analogue scales (VAS). Secondary outcome measures included the mean change in joint stiffness and physical function (mobility/walking).Results143 patients were recruited, 84 (58.7%, males – 24, females – 60) satisfied the selection criteria and completed the study. The effect of knee osteoarthritis bilateralism among the subjects was not significant on their outcome (p > 0.05). The change in the mean WOMAC pain VAS after six weeks of G. kola was significantly reduced compared to the placebo (p < 0.001). Multiple comparisons of the mean VAS pain change of G. kola group was not lowered significantly against the naproxen and celebrex groups (p > 0.05). The onset of G. kola symptomatic pain relief was faster than the placebo (p < 0.001). However, it was slower than the active comparators (p > 0.05). The duration of therapeutic effect of Garcinia kola was longer than the placebo (p > 0.001). G. kola period of effect was less than naproxen and celebrex (p < 0.001). G. kola subjects had improved mean change mobility/walking after six weeks better than the control group(p < 0.001). The mean change in mobility of the G. kola group when compared to the active comparators was not significantly better (p < 0.05). The mean change of knee joint stiffness (p < 0.001) and the change of mean WOMAC score (p < 0.001) were improved on Garcinia kola as compared to the placebo. The mid term outcome of eleven Garcinia kola subjects after cessation of use had a mean pain relief period of 17.27 +/- 5.15 days (range: 9–26 days). There was no significant cardiovascular, renal or drug induced adverse reaction to Garcinia kola.ConclusionGarcinia kola appeared to have clinically significant analgesic/anti-inflammatory effects in knee osteoarthritis patients. Garcinia kola is a potential osteoarthritis disease activity modifier with good mid term outcome. Further studies are required for standardization of dosages and to determine long-term effects.

Identification of time-varying stiffness, damping, and equilibrium position in human forearm movements.

Knowledge of how stiffness, damping, and the equilibrium position of specific limbs change during voluntary motion is important for understanding basic strategies of neuromotor control. Presented here is an algorithm for identifying time-dependent changes in joint stiffness, damping, and equilibrium position of the human forearm. The procedure requires data from only a single trial. The method relies neither on an analysis of the resonant frequency of the arm nor on the presence of an external bias force. Its validity was tested with a simulated forward model of the human forearm. Using the parameter estimations as forward model input, the angular kinematics (model output) were reconstructed and compared to the empirically measured data. Identification of mechanical impedance is based on a least-squares solution of the model equation. As a regularization technique and to improve the temporal resolution of the identification process, a moving temporal window with a variable width was imposed. The method's performance was tested by (a) identifying a priori known hypothetical time-series of stiffness, damping, and equilibrium position, and (b) determining impedance parameters from recorded single-joint forearm movements during a hold and a goal-directed movement task. The method reliably reconstructed the original angular kinematics of the artificial and human data with an average positional error of less than 0.05 rad for movement amplitudes of up to 0.9 rad, and did not yield hypermetric trajectories like previous procedures not accounting for damping.

Task-Dependent Viscoelasticity of Human Multijoint Arm and Its Spatial Characteristics for Interaction with Environments

Human arm viscoelasticity is important in stabilizing posture, movement, and in interacting with objects. Viscoelastic spatial characteristics are usually indexed by the size, shape, and orientation of a hand stiffness ellipse. It is well known that arm posture is a dominant factor in determining the properties of the stiffness ellipse. However, it is still unclear how much joint stiffness can change under different conditions, and the effects of that change on the spatial characteristics of hand stiffness are poorly examined. To investigate the dexterous control mechanisms of the human arm, we studied the controllability and spatial characteristics of viscoelastic properties of human multijoint arm during different cocontractions and force interactions in various directions and amplitudes in a horizontal plane. We found that different cocontraction ratios between shoulder and elbow joints can produce changes in the shape and orientation of the stiffness ellipse, especially at proximal hand positions. During force regulation tasks we found that shoulder and elbow single-joint stiffness was each roughly proportional to the torque of its own joint, and cross-joint stiffness was correlated with elbow torque. Similar tendencies were also found in the viscosity-torque relationships. As a result of the joint stiffness changes, the orientation and shape of the stiffness ellipses varied during force regulation tasks as well. Based on these observations, we consider why we can change the ellipse characteristics especially in the proximal posture. The present results suggest that humans control directional characteristics of hand stiffness by changing joint stiffness to achieve various interactions with objects.

The Effect of Experimental Hemarthrosis on Joint Stiffness and Synovial Histology in a Rabbit Model

The effect of a single injection of unpreserved blood on joint stiffness and on synovial and cartilage histomorphology in the ankle joints of rabbits was determined at ten and 28 days after injection. The same volume of saline was placed in the contralateral ankle for comparison. After ten days, the hemarthrosis ankle was stiffer than the control ankle (p < 0.027), whereas at 28 days there was no statistical difference in stiffness between the hemarthrosis and control ankles, regardless of whether the limbs had been immobilized. Also after ten days, the hemarthrosis ankles had varying amounts of clotted blood, darkened articular cartilage, hypertrophic synovium with reactive blood vessels, and macrophages containing heme. The gross and histologic appearance of the saline ankles was normal. After 28 days, there were no differences in gross or microscopic appearance between the two ankles of the caged or immobilized rabbits. All ankles exhibited retreating inflammatory response in the synovium and mild synovial thickening. Acute hemarthrosis, unassociated with fracture or discernible joint injury, caused only transient changes in joint stiffness and synovial histology. These results indicate that the presence of blood in an otherwise grossly uninjured joint should not lead to ultimate compromise in cartilage integrity or joint function. Therapeutic arthrocentesis for acute posttraumatic hemarthrosis does not appear to be necessary for the prevention of permanent problems.

SSC fatigue: Interaction between changes in joint stiffness and jumping performance

SSC fatigue: Interaction between changes in joint stiffness and jumping performance

Independent control of joint stiffness in the framework of the equilibrium-point hypothesis.

In the framework of the equilibrium-point hypothesis, virtual trajectories and joint stiffness patterns have been reconstructed during two motor tasks practiced against a constant bias torque. One task required a voluntary increase in joint stiffness while preserving the original joint position. The other task involved fast elbow flexions over 36 degrees. Joint stiffness gradually subsided after the termination of fast movements. In both tasks, the external torque could slowly and unexpectedly change. The subjects were required not to change their motor commands if the torque changed, i.e. "to do the same no matter what the motor did". In both tasks, changes in joint stiffness were accompanied by unchanged virtual trajectories that were also independent of the absolute value of the bias torque. By contrast, the intercept of the joint compliant characteristic with the angle axis, r(t)-function, has demonstrated a clear dependence upon both the level of coactivation and external load. We assume that a template virtual trajectory is generated at a certain level of the motor hierarchy and is later scaled taking into account some commonly changing dynamic factors of the movement execution, for example, external load. The scaling leads to the generation of commands to the segmental structures that can be expressed, according to the equilibrium-point hypothesis, as changes in the thresholds of the tonic stretch reflex for corresponding muscles.

Nonlinear Axial Stiffness Characteristics of Axisymmetric Bolted Joints

A critical assessment of the current design theory for bolted joints which is based on a linear, one-dimensional stiffness analysis is presented. A detailed nonlinear finite element analysis of a bolted joint conforming to ANSI standards was performed. The finite element results revealed that the joint stiffness is highly dependent on the magnitude of the applied load. The joint stiffness changes continuously from extremely high for small applied loads to the bolt stiffness during large applied loads, contrary to the constant joint stiffness of the linear theory. The linear theory is shown to be inadequate in characterizing the joint stiffness. The significance of the results in terms of the failure of bolted joints is discussed. A number of sensitivity studies were carried out to assess the effect of various parameters on the axial joint stiffness. The results revealed that bending and rotation of the joint members, interfacial friction, and the bolt/nut threading significantly influence the axial stiffness characteristics of the bolted joint. The two-dimensional, axisymmetric finite element model includes bilinear gap elements to model the interfaces. Special orthotropic elements were used to model the bolt/nut thread interaction. A free-body-diagram approach was taken by applying loads to the outer diameter of the joint model which correspond to internal, uniformly distributed line-shear and line-moment loads in the joint. A number of convergence studies were performed to validate the solution.

Compliance of single joints: elastic and plastic characteristics.

1. Step changes in torque were applied to the elbow or ankle joint of normal human subjects who exerted constant levels of effort. They were instructed to not react to the torque but to allow their limbs to move to a new equilibrium position. In this experimental paradigm, the joint may be characterized by a nonlinear compliant element. The aim of this study was to characterize the elastic properties of the compliant element. 2. Joint elasticity is described by an S-shaped relation between torque and angle (a "compliant characteristic curve"). The stiffness of a joint is greatest for small perturbations and decreases as the size of the perturbation is increased whether the limb is loaded or unloaded from its initial equilibrium. 3. The S shape of the compliant characteristic curve is relatively constant when measured at different initial joint angles from the same initial joint torque. 4. Higher levels of initial muscle torque increase the steepness of the compliant characteristic curve. 5. All changes in initial joint torque and angle preserve the S shape. The inflection point of the characteristic curve is always at the initial equilibrium angle and torque. This shifting of the inflection point of the torque-angle relation implies a fundamental plasticity in joint compliance. The elastic component is not invariant but changes with the joint's initial equilibrium state. 6. Changes in muscle tension and length that result from a perturbation are accompanied by changes in muscle activation. The relationship between perturbation torque and mean equilibrium EMG is similar to that found for voluntary isometric contraction. It is not possible to conclude what proportion of the late EMG response to perturbation is mediated by segmental reflex mechanisms. 7. At the levels of torque used here, changes in joint stiffness are highly correlated with changes in tonic contraction of the muscle opposing the load. This change in stiffness is not the result of antagonist coactivation, which was minimal. 8. The compliant characteristic curves of elbow and ankle are qualitatively similar. The principal difference is due to the greater passive stiffness of the ankle. 9. Our findings are inconsistent with aspects of the theory of invariant characteristics or with models of movement and load compensation that postulate a control scheme based only on the setting of muscle and reflex equilibrium points. The data are also incompatible with models that only control the elastic stiffness of the muscle.