Hip Extension Moment Research Articles

Gait and Stair Function in Total and Resurfacing Hip Arthroplasty: A Pilot Study

Standard total hip arthroplasty (THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis but survivorship curves wane in patients younger than 50. Resurfacing hip arthroplasty (RHA) is an alternative for younger, active patients reportedly providing superior range of motion. Quantitative investigation of functional recovery following arthroplasty may elucidate limitations that aid in device selection. Although limited long-term kinematic data are available, the early rate of recovery and gait compensations are not well described. This information may aid in refining rehabilitation protocols based on limitations specific to the implant. We presumed hip motion and forces for subjects receiving RHA are more similar to age-matched controls during physically demanding tasks, such as stair negotiation, at early time points than those for THA. In a pilot study, we quantified walking and stair negotiation preoperatively and 3 months postoperatively for seven patients with RHA (mean age, 49 years), seven patients with standard THA (mean age, 52 years), and seven age-matched control subjects (mean age, 56 years). Although both treatment groups demonstrated trends toward functional recovery, the RHA group had greater improvements in hip extension and abduction moment indicating typical loading of the hip. Further investigation is needed to determine if differences persist long term or are clinically meaningful.

Temporal characteristics of lower extremity moment generation in children with cerebral palsy

Lower extremity weakness has been documented in children with cerebral palsy (CP). However, the temporal characteristics of moment generation have not been characterized, and they may be important to function. This study tested ankle, knee, and hip flexion and extension moment generation capabilities in children with CP and in able-bodied children. Maximum voluntary isometric contractions (MVIC), the maximum rates of moment development and relaxation, and the time to produce and reduce the moments were quantified. Relationships between the temporal measures, Gross Motor Function Measure-66 (GMFM-66), and MVICs were also examined. Children with CP had significantly reduced MVICs, maximum development, and relaxation rates, and increased times to produce and reduce moments. The maximum rates of moment development and relaxation at some joints were correlated with the GMFM-66 and MVICs. These results suggest that both the magnitude and temporal characteristics of moment generation need to be targeted during therapeutic interventions for children with CP.

Ankle Load Modulates Hip Kinetics and EMG During Human Locomotion

The purpose of this research was to examine the role of isolated ankle-foot load in regulating locomotor patterns in humans with and without spinal cord injury (SCI). We used a powered ankle-foot orthosis to unilaterally load the ankle and foot during robotically assisted airstepping. The load perturbation consisted of an applied dorsiflexion torque designed to stimulate physiological load sensors originating from the ankle plantar flexor muscles and pressure receptors on the sole of the foot. We hypothesized that 1) the response to load would be phase specific with enhanced ipsilateral extensor muscle activity and joint torque occurring when unilateral ankle-foot load was provided during the stance phase of walking and 2) that the phasing of subject produced hip moments would be modulated by varying the timing of the applied ankle-foot load within the gait cycle. As expected, both SCI and nondisabled subjects demonstrated a significant increase (P < 0.05) in peak hip extension moments (142 and 43% increase, respectively) when given ankle-foot load during the stance phase compared with no ankle-foot load. In SCI subjects, this enhanced hip extension response was accompanied by significant increases (P < 0.05) in stance phase gluteus maximus activity (27% increase). In addition, when ankle-foot load was applied either 200 ms earlier or later within the gait cycle, SCI subjects demonstrated significant phase shifts ( approximately 100 ms) in hip moment profile (P < 0.05; i.e., the onset of hip extension moments occurred earlier when ankle-foot load was applied earlier). This study provides new insights into how individuals with spinal cord injury use sensory feedback from ankle-foot load afferents to regulate hip joint moments and muscle activity during gait.

Effect of trunk inclination on lower limb joint and lumbar moments in able men during the stance phase of gait

Background Though the effect of imposed trunk posture affects walking patterns little is known about the effect of natural orientation of the trunk on gait. The objectives of this study are to test if the lower limb joint and thoraco-lumbar moments are similar in subjects who maintain an average natural forward or backward trunk inclination during gait and verify if the lower limbs are equally affected. Methods Twenty-five young men were divided according to their natural backward or forward trunk inclination during level walking. Ankle, knee, hip and thoraco-lumbar moments were calculated by an inverse dynamic approach for the two limbs. A two-way ANOVA was performed on peak lower limb moments. A one-way ANOVA was performed on thoraco-lumbar peak moments. Findings There was a main effect for both trunk inclinations and lower limb sides but no interaction. For the forward leaners, the duration of hip extension moment was longer ( P < 0.001) while the hip flexion moment was 1.3 times smaller ( P < 0.001). Differences between the lower limb sides were noted in all joints but at push-off of the stance phase only. The two thoraco-lumbar extension moments were, respectively, 1.4 times higher for the forward leaners while the two flexion moments were approximately 1.4 times higher for the backward leaners. Interpretations The backward leaners propel themselves with a strong hip flexor activity at push-off while the forward leaners use their hip muscles throughout stance. These results support the idea that trunk inclinations and moment variations are associated with the type of walking patterns.

Gender differences exist in the hip joint moments of healthy older walkers

Gender differences in the incidence of symptomatic hip osteoarthritis (OA), changes in hip cartilage volume and hip joint space and rates hip arthroplasty of older people are reported in the literature. As the rate of progression of OA is in part mechanically modulated it is possible that this gender bias may be related to inherent differences (if they exist) in walking mechanics between older males and females. The purpose of this study was to examine potential mechanisms for gender differences in hip joint mechanics during walking by testing the hypotheses that females would exhibit higher hip flexion, adduction and internal rotation moments but not significantly greater normalized ground reaction forces (GRFs). Forty-two healthy subjects (21 male, 21 female), ages 50–79 yr were recruited for gait analysis. In support of the hypotheses, greater external hip adduction and internal rotation along with hip extension moments were found for females compared to males after normalizing for body size for all self-selected walking speeds. Differences in walking style (kinematics) were the main determinants in the joint kinetic differences as no differences in the normalized GRFs were found. As external joint moments are surrogate measures of the joint contact forces, the results of this study suggest the hip joint stress for the female population is higher compared to male population. This is in favor of a hypothesis that the increased joint contact stress in a female population could contribute to a greater joint degeneration at the hip in females as compared with males.

SHEAR LOAD SHARING IN THE HUMAN LUMBAR SPINE

In a simple bipedal walking model, an impulsive push along the trailing limb (similar to ankle plantar flexion) or a torque at the hip can power level walking. This suggests a tradeoff between ankle and hip muscle requirements during human gait. People with anterior hip pain may benefit from walking with increased ankle pushoff if it reduces hip muscle forces. The purpose of our study was to determine if simple instructions to alter ankle pushoff can modify gait dynamics and if resulting changes in ankle pushoff have an effect on hip muscle requirements during gait. We hypothesized that changes in ankle kinetics would be inversely related to hip muscle kinetics. Ten healthy subjects walked on a custom split-belt force-measuring treadmill at 1.25 m/s. We recorded ground reaction forces and lower extremity kinematic data to calculate joint angles and internal muscle moments, powers and angular impulses. Subjects walked under three conditions: natural pushoff, decreased pushoff and increased pushoff. For the decreased pushoff condition, subjects were instructed to push less with their feet as they walked. Conversely, for the increased pushoff condition, subjects were instructed to push more with their feet. As predicted, walking with increased ankle pushoff resulted in lower peak hip flexion moment, power and angular impulse as well as lower peak hip extension moment and angular impulse (p<0.05). Our results emphasize the interchange between hip and ankle kinetics in human walking and suggest that increased ankle pushoff during gait may help to compensate for hip muscle weakness or injury and reduce hip joint forces.

Walking with increased ankle pushoff decreases hip muscle moments

In a simple bipedal walking model, an impulsive push along the trailing limb (similar to ankle plantar flexion) or a torque at the hip can power level walking. This suggests a tradeoff between ankle and hip muscle requirements during human gait. People with anterior hip pain may benefit from walking with increased ankle pushoff if it reduces hip muscle forces. The purpose of our study was to determine if simple instructions to alter ankle pushoff can modify gait dynamics and if resulting changes in ankle pushoff have an effect on hip muscle requirements during gait. We hypothesized that changes in ankle kinetics would be inversely related to hip muscle kinetics. Ten healthy subjects walked on a custom split-belt force-measuring treadmill at 1.25 m/s. We recorded ground reaction forces and lower extremity kinematic data to calculate joint angles and internal muscle moments, powers and angular impulses. Subjects walked under three conditions: natural pushoff, decreased pushoff and increased pushoff. For the decreased pushoff condition, subjects were instructed to push less with their feet as they walked. Conversely, for the increased pushoff condition, subjects were instructed to push more with their feet. As predicted, walking with increased ankle pushoff resulted in lower peak hip flexion moment, power and angular impulse as well as lower peak hip extension moment and angular impulse ( p<0.05). Our results emphasize the interchange between hip and ankle kinetics in human walking and suggest that increased ankle pushoff during gait may help to compensate for hip muscle weakness or injury and reduce hip joint forces.

Lower Extremity Joint Moments of Collegiate Soccer Players Differ between Genders during a Forward Jump

Lower extremity kinetics while performing a single-leg forward jump landing may help explain gender biased risk for noncontact anterior cruciate ligament injury. Gender comparison of lower extremity joint angles and moments. Static groups comparison. Motion analysis laboratory. 8 male and 8 female varsity, collegiate soccer athletes. 5 single-leg landings from a 100cm forward jump. Peak and initial contact external joint moments and joint angles of the ankle, knee, and hip. At initial heel contact, males exhibited a adduction moment whereas females exhibited a abduction moment at the hip. Females also had significantly less peak hip extension moment and significantly less peak hip internal rotation moment than males had. Females exhibited greater knee adduction and hip internal rotation angles than men did. When decelerating from a forward jump, gender differences exist in forces acting at the hip.

Biomechanical investigation of ambulatory training in patients with acetabular dysplasia

The purpose of this study was to investigate the effectiveness and safety of ambulatory training in patients with acetabular dysplasia. To achieve this, we studied the hip joint moment in subjects walking with laterally and horizontally elevated arms and changing speeds as a form of training to strengthen hip joint abductor muscles. We studied eight women with pre- or early stage hip disease (center–edge angle of Wieberg 18.5° to −3.0°) and six healthy women. In exercise task 1 the subjects walked at a rate of 90 steps/min, with abduction of 90° in the shoulder joint ipsilateral or contralateral to the affected hip joint, and either no load or a 1 kg weight in either hand. In exercise task 2, walking speed was changed in three stages from 60 steps/min (s-gait), 90 steps/min (n-gait), and 120 steps/min (f-gait), with both hands swinging freely. Using results from a three-dimensional motion analysis system, the hip joint moments were calculated. In both the healthy and the acetabular dysplasia groups, the abduction moment of the hip joint decreased significantly with ipsilateral elevation and increased significantly with contralateral elevation. There was no significant change in hip flexion moment in either group. The hip extension moment decreased significantly with contralateral elevation, but no significant changes were seen in ipsilateral elevation. In the walking rate variation, the extension hip moment in fast gait was higher than in slow gait. It was concluded that ambulatory training with contralateral horizontal arm elevation may be an effective way of increasing hip joint abductor muscle strength. Ipsilateral arm elevation decreases gluteus medius muscle tension and is an effective way of ambulatory training for people with compensated trendelenburg gait. Variable speed walking is an effective exercise method that can strengthen extensor muscles. Therefore, these ambulatory training methods are useful for acetabular dysplasia patients.

Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity

Mechanical factors have been implicated in the progression of knee osteoarthritis (OA). Understanding how these factors change as the condition progresses would elucidate their role and help in developing interventions that could delay the progress of knee OA. In this cross-sectional study, we identified kinematic and kinetic variables at the hip, knee, and ankle joints that change between three clinically distinct levels of knee OA disease severity: asymptomatic, moderate OA, and severe OA. The severity level was based on a combined radiographic/symptomatic clinical decision for treatment with (severe) or without (moderate) total knee replacement surgery. Gait variables that changed between groups were categorized as: those that differed between the asymptomatic group and both OA groups, those that differed between the asymptomatic group and the severe OA group only, or those that changed progressively, that is, the asymptomatic differed from the moderate OA, and the moderate OA differed from the severe OA group. Changes seen in both OA subject groups compared to asymptomatic included increased mid-stance knee adduction moments, decreased peak knee flexion moments, decreased peak hip adduction moments, and decreased peak hip extension moments. Changes found only in the severe knee OA group included multiple kinematic and kinetic differences at the hip, knee, and ankle joints. Gait differences that progressed with OA severity included decreased stance phase knee flexion angles, decreased early stance knee extension moments, decreased peak stance phase hip internal rotation moments, and decreased peak ankle dorsiflexion moments.

The load/capacity ratio affects the sit-to-stand movement strategy

In this study the effect of a changed load/capacity ratio on sit-to-stand performance and on the underlying net joint moments was investigated. In subjects with muscle weakness the load/capacity ratio is increased due to reduced muscle capacity. In the current study this ratio was manipulated by changing the load. This approach allowed studying the isolated effect of an increased load/capacity ratio on sit-to-stand strategy. Ten healthy women performed sit-to-stand movements under four load conditions. The load/capacity ratio was manipulated by adding 0%, 15%, 30% and 45% of the body mass to a weight vest. To determine changes in sit-to-stand strategy flexion of the trunk and temporal characteristics were assessed. Joint moments at ankle, knee and hip joints and activation patterns of major leg muscles were determined from the kinematics and kinetics. Increasing the extra load from 30% to 45% changed the sit-to-stand performance. In the 45% condition maximal trunk flexion was increased and movement time significantly elongated. The strategy change was associated with a disproportionate increase of the net hip extension moment and a delayed peak of the net knee extension moment. This study shows that experimentally observed changes in sit-to-stand strategy can be attributed to an increase in the load/capacity ratio. For treatment purposes this implies that increasing muscle strength, reducing body mass or a combination of these could be a suitable approach to improve sit-to-stand performance. The experimental model applied will be useful to study the isolated effect of the load/capacity ratio.

A Comparison of Gait Analysis after Total Knee Arthroplasty and Unicompartmental Knee Arthroplasty in the Same Patient

Purpose: To compare the gait characteristics of unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) performed on the same patient. Materials and Methods: Twelve female patients with advanced degenerative arthritis of both knee joints were enrolled for the study group. The mean age was 70.3 (64-74) years old. One side of the knee joint had been replaced with UKA and the other side with TKA. The mean follow-up period was 11.8 months for the UKA side and 14.8 months for TKA side. The clinical and radiographic evaluations were performed. The gait features of the study group were assessed using computerized gait analysis. Seven age-matched healthy female volunteers (14 knees) were included as the normal control group. Results: The clinical and radiographic results improved after joint replacement in both groups. The postoperative gait was almost normalized regardless of the type of surgery performed, with the exception of some parameters including the walking speed, mean pelvic tilt, knee flexion at initial contact, peak knee flexion, knee flexion between initial contact and loading response, knee flexion between initial swing phase and mid-stance phase and ankle 3rd rocker. Knee flexion at the initial contact of UKA and TKA groups was similar, and was different from that of the normal control group. At the loading response, the amount of knee flexion was similar between the three groups. Kinetic data of the first peak vertical ground reaction force and hip extension moment at loading response were better in the UKA group. Conclusion: The gait features were normalized in both groups. The UKA group was better normalized than the TKA group in terms of the aspect of the gait features, whereas TKA group showed better correction of deformities.

Gait Analysis of Patients with Resurfacing Hip Arthroplasty Compared with Hip Osteoarthritis and Standard Total Hip Arthroplasty

Patients with standard total hip arthroplasties may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips. In comparison, patients after resurfacing total hip arthroplasty appear to have a near-normal gait. The authors evaluated temporal-spatial parameters, hip kinematics, and kinetics in hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral standard total hip arthroplasties. Patients with resurfacing walked faster (average 1.26 m/s) and were comparable with normals. There were no significant differences in hip abductor and extensor moments of patients with resurfacing compared with patients in the standard hip arthroplasty group. This study showed more normal hip kinematics and functionality in resurfacing hip arthroplasty, which may be due to the large femoral head.

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3D analysis of the gait of children with Duchenne muscular dystrophy (DMD) was the topic of only a few studies and none of these considered the effect of gait velocity on the gait parameters of children with DMD. Gait parameters of 11 children with DMD were compared to those of 14 control children while considering the effect of gait velocity using 3D biomechanical analysis. Kinematic and kinetic gait parameters were measured using an Optotrak motion analysis system and AMTI force plates embedded in the floor. The data profiles of children with DMD walking at natural gait velocity were compared to those of the control children who walked at both natural and slow gait velocities. When both groups walked at similar velocity, children with DMD had higher cadence and shorter step length. They demonstrated a lower hip extension moment as well as a minimal or absent knee extension moment. At the ankle, a dorsiflexion moment was absent at heel strike due to the anterior location of the center of pressure. The magnitude of the medio-lateral ground reaction force was higher in children with DMD. Despite this increase, the hip abductor moment was lower. Hip power generation was also observed at the mid-stance in DMD children. These results suggest that most of the modifications observed are strategies used by children with DMD to cope with possible muscle weakness in order to provide support, propulsion and balance of the body during gait.

Three-Dimensional Representation of Complex Muscle Architectures and Geometries

Almost all computer models of the musculoskeletal system represent muscle geometry using a series of line segments. This simplification (i) limits the ability of models to accurately represent the paths of muscles with complex geometry and (ii) assumes that moment arms are equivalent for all fibers within a muscle (or muscle compartment). The goal of this work was to develop and evaluate a new method for creating three-dimensional (3D) finite-element models that represent complex muscle geometry and the variation in moment arms across fibers within a muscle. We created 3D models of the psoas, iliacus, gluteus maximus, and gluteus medius muscles from magnetic resonance (MR) images. Peak fiber moment arms varied substantially among fibers within each muscle (e.g., for the psoas the peak fiber hip flexion moment arms varied from 2 to 3 cm, and for the gluteus maximus the peak fiber hip extension moment arms varied from 1 to 7 cm). Moment arms from the literature were generally within the range of fiber moment arms predicted by the 3D models. The models accurately predicted changes in muscle surface geometry over a 55 degrees range of hip flexion, as compared to changes in shape predicted from MR images (average errors between the model and measured surfaces were between 1.7 and 5.2 mm). This new framework for representing muscle will enhance the accuracy of computer models of the musculoskeletal system.

Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty

Purpose: Total knee arthroplasty (TKA) successfully reduces pain, but has not achieved comparable improvements in function. We hypothesized that quadriceps strength affects performance by altering loading and movement patterns during functional tasks. Methods: Fourteen subjects with isolated, unilateral TKA were tested three months after surgery. Quadriceps strength was assessed isometrically and kinematics, kinetics, and EMG were collected during level walking and sit-to-stand (STS). Function was assessed using the timed up and go test (TUG), stair climbing test (SCT), and the 6 min walk test (6MW). Results: Functional performance was significantly related to the quadriceps strength of both legs, but was more strongly related to the uninvolved strength (involved rho = −0.43 with TUG; −0.65 with SCT; 0.64 with 6MW) (uninvolved rho = −0.63 with TUG; −0.68 with SCT; 0.77 with 6MW). During STS, subjects shifted weight away from the operated limb ( p < 0.01). Quadriceps muscle activity and the extension moments at the knee and hip were smaller in the involved compared to the uninvolved ( p < 0.05). The amount of asymmetry in knee excursion during weight acceptance in gait, the asymmetry in weight bearing from sit-to-stand, and the uninvolved hip extension moment during STS were related to the amount of asymmetry in quadriceps strength (rho > 0.56, p < 0.05). Conclusions: Quadriceps weakness in patients with TKA has a substantial impact on the movement patterns and performance of the knee during functionally important tasks.

Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design

Introduction Previous radiostereometric studies have revealed abnormal anterior-posterior translation of the femur in patients operated with AMK (DePuy, Johnson and Johnson, Leeds, UK) total knee arthroplasty (TKA). Based on these observations, we hypothesized that patients with TKA have an abnormal gait pattern, and that there are differences in kinematics depending on the design of the tibial joint area.Method We used a gait analysis system to evaluate the influence of joint area design on the kinematics of the hip and knee during level walking. 39 TKA patients (42 knees) and 18 healthy age-matched controls were studied. Patients with 5° varus/valgus alignment or less were randomized to receive either a relatively flat or a concave tibial insert with retention of the posterior cruciate ligament. Patients who had more than 5° varus-valgus alignment and/or extension defect of 10° or more were randomized to receive the concave or a posterior-stabilized tibial component with resection of the posterior cruciate ligament.Results Patients with TKA tended to have less hip and knee extension and decreased knee and hip extension moment than controls. They also tended to walk more slowly. TKA altered the gait pattern, but choice of implant design had little influence.Interpretation In patients with a similar degree of degenerative joint disease and within the limits of the constraints offered by the prostheses under study, the choice of joint area constraint has little influence on the gait pattern.

Hamstring Muscle Kinematics during Treadmill Sprinting

The objective of this study was to characterize hamstring muscle kinematics during sprinting, so as to provide scientific data to better understand injury mechanisms and differences in injury rates between muscles. We conducted three-dimensional motion analyses of 14 athletes performing treadmill sprinting at speeds ranging from 80 to 100% of maximum. Scaled musculoskeletal models were used to estimate hamstring muscle-tendon lengths throughout the sprinting gait cycle for each speed. We tested the hypothesis that the biceps femoris (BF) long head would be stretched a greater amount, relative to its length in an upright posture, than the semitendinosus (ST) and semimembranosus (SM). We also tested the hypothesis that increasing from submaximal to maximal sprinting speed would both increase the magnitude and delay the occurrence of peak muscle-tendon length in the gait cycle. Maximum hamstring lengths occurred during the late swing phase of sprinting and were an average of 7.4% (SM), 8.1% (ST), and 9.5% (BF) greater than the respective muscle-tendon lengths in an upright configuration. Peak lengths were significantly larger in the BF than the ST and SM (P < 0.01), occurred significantly later in the gait cycle at the maximal speed (P < 0.01), but did not increase significantly with speed. Differences in the hip extension and knee flexion moment arms between the biarticular hamstrings account for the intermuscle variations in the peak lengths that were estimated. We conclude that intermuscle differences in hamstring moment arms about the hip and knee may be a factor contributing to the greater propensity for hamstring strain injuries to occur in the BF muscle.

Functional roles of lower-limb joint moments while walking in water

Objective. To clarify the functional roles of lower-limb joint moments and their contribution to support and propulsion tasks while walking in water compared with that on land. Design. Sixteen healthy, young subjects walked on land and in water at several different speeds with and without additional loads. Background. Walking in water is a major rehabilitation therapy for patients with orthopedic disorders. However, the functional role of lower-limb joint moments while walking in water is still unclear. Methods. Kinematics, electromyographic activities in biceps femoris and gluteus maximums, and ground reaction forces were measured under the following conditions: walking on land and in water at a self-determined pace, slow walking on land, and fast walking in water with or without additional loads (8 kg). The hip, knee, and ankle joint moments were calculated by inverse dynamics. Results. The contribution of the walking speed increased the hip extension moment, and the additional weight increased the ankle plantar flexion and knee extension moment. Conclusions. The major functional role was different in each lower-limb joint muscle. That of the muscle group in the ankle is to support the body against gravity, and that of the muscle group involved in hip extension is to contribute to propulsion. In addition, walking in water not only reduced the joint moments but also completely changed the inter-joint coordination. Relevance It is of value for clinicians to be aware that the greater viscosity of water produces a greater load on the hip joint when fast walking in water.

Effect of joint injections in children with juvenile idiopathic arthritis: evaluation by 3D‐gait analysis

To investigate how gait patterns change after intra-articular corticosteroid injections (ICIs) in the lower extremities. Eighteen children, aged 5-16 y, with juvenile idiopathic arthritis (JIA) and lower extremity involvement participated in the study. Sixty-four joints in the lower extremities were treated with ICIs. The Visual Analogue Scale (VAS, 0-100 mm) was used to assess pain. A 3D motion analysis system and two force plates were used to measure gait parameters, kinematics and kinetics. The first gait analysis was performed before treatment with ICIs, and a second one was done 8-17 d after treatment. The participants' average rating of pain decreased from 26 mm on the VAS before ICI to 11 mm (p = 0.001) after treatment. The self-chosen walking velocity was significantly faster (p = 0.02) after treatment. The range of knee and ankle joint angles during gait increased significantly (p = 0.03 and 0.04) after treatment. At loading response, the hip extension moment increased (p = 0.01) as did knee flexion moment, and plantar flexion moment at pre-swing increased significantly (p = 0.02 and 0.002) after treatment. The ankle also generated more power (p = 0.005) after treatment. The study shows positive effects of treatment with ICIs in the lower extremities--especially regarding pain, walking velocity and joint moments. The data indicate that ICI treatment influences the gait pattern also in joints that have not been injected.