Varus-valgus laxity correlates with pain in osteoarthritis of the knee.

Pain during osteoarthritis (OA) of the knee does not necessarily correlate with the severity of the radiographic grade, and the mechanism of pain has not been completely clarified. The purpose of this study was to evaluate risk factors for pain in the knee OA using epidemiologic analyses. We evaluated 518 out of 4183 people over the age of 40 (156 males and 362 females) from Shinyoshitomi village, Japan. Mean ages were 63.8 years for men and 60.7 years for women. Screening included a physical examination of the knee and a standing AP roentgenogram of the bilateral knee. Radiographic OA was defined as a Kellgren-Lawrence grade 2 or higher. All data were coded and pain risk factors were evaluated using a multiple logistic regression model. Radiographic OA was observed in 18.4% of men and 26% of women. Of these subjects with OA, 10.9% of men and 32.5% of women complained of knee pain. Seven factors-age, gender, BMI, radiographic grade, varus-valgus laxity, torque of quadriceps muscles, and varus-valgus alignment-were evaluated as potential risk factors for pain. A significant increase in the odds ratio was observed with varus-valgus laxity (p=0.005; odds ratio, 3.04). Our results suggest that varus-valgus laxity is a risk factor for pain during knee OA.

Two subtypes of radiographic osteoarthritis in the distal interphalangeal joint of the hand.

BACKGROUND: The etiology and pathogenesis of hand osteoarthritis (OA) are not completely clarified, and several factors may cooperate in a multifactorial fashion in its development. The purpose of this study was to clarify the effects of the dominant hand that contribute to the development of distal interphalangeal (DIP) joint OA using epidemiological analyses. METHODS: A total of 518 subjects (156 men, 362 women) in a rural community were analyzed. Their mean age was 63.8 years for men and 60.7 years for women. Anteroposterior (AP) standing radiographs of bilateral knees, lateral views of the lumbar spine, and AP views of bilateral hands were obtained. Furthermore, a survey of their life patterns was conducted using self-administered questionnaires. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade 2 or higher. Hand OA was limited to Heberden's nodes. Generalized OA (GOA) was defined as bilateral knee OA plus lumbar spine OA. RESULTS: GOA was observed in 13.0% of the subjects. The incidence of DIP joint OA was significantly higher in the GOA group than that in the non-GOA group. In the GOA group, the incidence of right-hand DIP joint OA in right-handed and left-handed subjects was 37.5% and 40.0%, respectively, without a significant difference. In the non-GOA group, however, the incidence of right-hand DIP joint OA in right-handed and left-handed subjects was 16.4% and 3.2%, respectively, with a significant difference. With a multiple logistic regression model, the P value of the handedness was marginal (0.060), but a clear tendency of increase in the odds ratio (7.129) was observed in the dominant hand for the non- GOA group. In contrast, there was no effect of the handedness on right-hand DIP joint OA in the GOA group. CONCLUSIONS: There are two subtypes of hand DIP joint OA in terms of the etiology. One is environmental, and the other is genetic.

[Prevention of falls].

Falls among the elderly mainly result from aging, lack of exercise, and physical and/or mental disorders. They cause fractures and other injuries. It is necessary that likelihood of falling should be evaluated from the view point of both decreased physical function and fear of falling. General exercise including balance training is considered to be most effective to reduce falls. We must take good care not to cause falling and resultant fracture due to exercise of falls prevention program. Many sided intervention, including a check and counseling on medication and environmental improvement, walking in the sunshine, which stimulates vitamin D biosynthesis and so on, are needed. Further studies on falls prevention among the elderly with dementia and males receiving hormonal therapy with prostatic cancer are necessary.

Factors associated with pain and functional limitation in Japanese male patients with knee osteoarthritis.

The present study investigated factors associated with knee pain and functional limitation in knee OA patients. Subjects were 109 Japanese males who were newly diagnosed with knee OA at three university hospitals over a 1-year period. Knee pain and functional limitation in walking and climbing and/or descending stairs were selected as outcome measures. To assess factors associated with outcomes, we calculated odds ratios (OR) using logistic regression analysis. Taller height (> or =163 vs. <163 cm) showed a negative association with knee pain, "Pain on walking": OR = 0.08, 95% confidence interval = 0.01-0.79; "Pain on stairs": 0.25, 0.08-0.82. A significant characteristic related to a lesser degree of functional disability was alcohol consumption ("Waking distance": 0.34, 0.14-0.84; "Help on stairs": 0.21, 0.09-0.51). In the present study, knee pain was associated with shorter height in male Japanese patients with knee OA. Functional limitation was associated with no consumption of alcohol.

Age-related differences in muscle activity, stride frequency and heart rate response during walking in water.

This study aimed to examine whether walking in water produces age-related differences in muscle activity, stride frequency (SF), and heart rate (HR) response. Surface electromyography (EMG) was used to evaluate muscle activities in six older and six young subjects while they walked in water immersed to the level of the xiphoid process. The trials in water utilized the Flowmill which consists of a treadmill at the base of a water flume. The measurement of maximal voluntary contraction (MVC) of each muscle was made prior to the gait analysis. The %MVCs, which refer to the surface EMG measures, from the gastrocnemius of the older subjects were significantly lower than those of the young subjects, in every experimental condition (P<0.05). In contrast, the %MVCs from the rectus femoris (P<0.05) and the biceps femoris (P<0.001) of older subjects were significantly greater than those of young subjects in every experimental condition. Moreover, the SFs of older subjects were also significantly greater than those of young subjects (P<0.05), while the HR responses of older and young subjects were similar. In conclusion, the older subjects had increased hip musculature activity and decreased ankle plantar flexor activity while walking in water, compared with the young subjects.

A comparison of muscle activity and heart rate response during backward and forward walking on an underwater treadmill.

This investigation compared muscle activities and heart rate (HR) responses while subjects walked backward or forward in water, with and without a water current. Ten healthy males (23.5+/-1.4 years) volunteered for the study. Surface electromyography (EMG) was used to evaluate muscle activities while the subjects walked in water, immersed to the level of the xiphoid process. HR responses were monitored continuously by a telemetry method. A "Flowmill" was used for this study, which involves a treadmill at the base of a water flume. Measurement of maximal voluntary contraction (MVC) of each tested muscle was undertaken prior to gait analysis. The %MVCs obtained from the paraspinal muscles, vastus medialis and tibialis anterior were all significantly greater when walking backward than when walking forward, for every experimental condition (P<0.05). HR responses tended to be greater while walking backward than when walking forward, with a statistical significance at fast speed (P<0.05). In conclusion, walking backward in water resulted in significantly greater muscle activation of the paraspinal muscles, vastus medialis and tibialis anterior compared with walking forward in water. These findings may be helpful in developing water-based exercise programs.

Short-term intensive treatment for donors with hepatic steatosis in living-donor liver transplantation.

BACKGROUND: The use of steatotic livers is associated with increased primary nonfunction in liver transplantation. To reduce the risk of liver injury, we applied a short-term combination therapy of diet, exercise and drugs for 11 living-donor liver transplantation (LDLT) candidates with steatosis. METHODS: Subjects were treated with a protein-rich (1000 kcal/day) diet, exercise (600 kcal/day), and bezafibrate (400 mg/day) for 2-8 weeks. RESULTS: The treatment significantly improved macrovesicular steatosis (30+/-4% vs. 12+/-2% [mean +/- SEM], P = 0.0028). Body weight and BMI were significantly reduced (73.7 +/- 3.2 kg vs. 66.9 +/- 2.9 kg, P = 0.0033, 26.4 +/- 0.7 kg/m vs. 24.1 +/- 0.8 kg/m, P = 0.0033). The treatment completely normalized liver function tests and lipid metabolism. Seven treated liver grafts (left lobe) were transplanted to the recipients. We compared transplanted graft function and resected liver function of donors using parameters such as peak total bilirubin, prothrombin time at postoperative day 3, and peak alanine aminotransferase between treated liver (n = 7) and donor liver without hepatic steotosis (n = 37). The transplanted grafts showed good liver functions, and there was no difference between them with respect to functional parameters. The treated donors also showed good liver functions, and no significant differences in functional parameters. CONCLUSIONS: The results of this study indicate that our short-term treatment effectively reduced steatosis and contributed to safer LDLT. Our findings also suggest that even severely steatotic livers can be used for LDLT grafting subsequent to our short-term treatment regimen.

Muscle activity and heart rate response during backward walking in water and on dry land.

The primary purpose of this study was to examine whether walking backward in water and walking backward on dry land elicit different electromyographic (EMG) activities in lower-extremity and trunk muscles. Surface EMG was used to evaluate muscle activities while six healthy subjects walked backward in water (with and without a water current, Water + Cur and Water - Cur, respectively) immersed to the level of the xiphoid process, and while they walked backward on dry land (DL). The trials in water utilized the Flowmill which consists of a treadmill at the base of a water flume. Integrated EMG analysis allowed the quantification of muscle activities. The measurement of maximal voluntary contraction (MVC) of each muscle was made prior to the gait analysis, and all data were expressed as the mean (SD). The %MVCs from the muscles tested while walking backward in water (both with and without a current) were all significantly lower than those obtained while walking backward on dry land (P < 0.05), with the exception of the paraspinal muscles. In the case of the paraspinal muscles, the %MVC while walking backward with a water current was significantly greater than when walking backward on dry land [Water + Cur 19.4 (6.8)%MVC vs. DL 13.1 (1.4)%MVC; P < 0.05], or walking backward without a water current [vs. Water - Cur 13.3 (1.8)%MVC; P < 0.05]. Furthermore, when walking backward in water, the %MVCs from the muscles investigated were significantly greater in the presence of a water current than without (P < 0.05). In conclusion, walking backward in water with a current elicits the greatest muscle activation of the paraspinal muscles. These data may help in the development of water-based exercise programs.

Electromyographic analysis of walking in water in healthy humans.

This study was designed to describe and clarify muscle activities which occur while walking in water. Surface electromyography (EMG) was used to evaluate muscle activities in six healthy subjects (mean age, 23.3 +/- 1.4 years) while they walked on a treadmill in water (with or without a water current) immersed to the level of the xiphoid process, and while they walked on a treadmill on dry land. The trials in water utilized the Flowmill which has a treadmill at the base of a water flume. Integrated EMG analysis was conducted for the quantification of muscle activities. In order to calculate the %MVC, the measurement of maximal voluntary contraction (MVC) of each muscle was made before the gait analysis, thus facilitating a comparison of muscle activities while walking in water with those on dry land. The %MVCs obtained from each of the tested muscles while walking in water, both with and without a water current, were all found to be lower than those obtained while walking on dry land at a level of heart rate response similar to that used when walking on dry land. Furthermore, the %MVCs while walking in water with a water current tended to be greater when compared to those while walking in water without a water current. In conclusion, the present study demonstrated that muscle activities while walking in water were significantly decreased when compared to muscle activities while walking on dry land, that muscle activities while walking in water tended to be greater with a water current than without, and that the magnitude of the muscle activity in water was relatively small in healthy humans. This information is important to design water-based exercise programs that can be safely applied for rehabilitative and recreational purposes.

Positive relationship between bone mineral density and low back pain in middle-aged women.

There have been a large number of epidemiological studies demonstrating various primary factors that cause musculoskeletal disorders in middle-aged and older women. However, the relationship between low back pain and bone mineral density is not well documented, and no evidence for any direct relationship between the two has been found. To investigate the relationship, we conducted a cross-sectional study, on a population of 2,244 Japanese women aged 25-85 years who were participating in a regional health screening program. Information on lifestyle, reproductive characteristics and the presence of current low back pain was collected by self-administered questionnaires, and bone mineral density at the distal radius was measured. We found increasing bone mineral density to be significantly associated with low back pain in middle-aged women using a logistic regression analysis. Exercise and smoking were also significantly associated with low back pain. This association remained even after entering other lifestyle and reproductive factors into the final model. Accordingly, high bone mineral density would seem to be as important a public health problem as low bone mineral density and osteoporosis when considering the musculoskeletal symptoms and disabilities that appear in middle-aged women.