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Vertical impact increase in middle age may explain idiopathic weight-bearing joint osteoarthritis,☆☆

https://doi.org/10.1053/apmr.2001.26255Get rights and content

Abstract

Robbins S, Waked E, Krouglicof N. Vertical impact increase in middle age may explain idiopathic weight-bearing joint osteoarthritis. Arch Phys Med Rehabil 2001;82:1673-7. Objective: To test the hypothesis that ground reaction force increases when a standard stepping task is performed in late middle age. Design: Consecutive sample. Setting: Internal medicine practice. Participants: Thirty-six male patients (age range, 17–72yr) from an internal medicine practice. Intervention: Subjects performed 20 consecutive footfall impacts onto a force platform while barefoot and while wearing shoes. Main Outcome Measures: Ground reaction forces were recorded for each footfall. Results: Impact is positively related to age both when barefoot (r = .84, p < .001) and when wearing shoes (r = .71, p < .001). Impact remains constant until age 50, after which it increases by 13.3% for barefoot subjects. Barefoot impact was significantly lower and less variable than impact when shod (barefoot = 1.18 body weight [BW]; shod = 1.22 BW; F1,5 = 169.91, p < .001). Conclusion: An increase in impact force during locomotion was identified that occurs in late middle age, when stability declines and idiopathic weight-bearing joint osteoarthritis develops. Because impact is negatively related to stability, the impact rise is probably caused by postural adjustments to instability resulting from irreversible neurologic decline. This heightened impact may account for the accelerated rate of weight-bearing joint osteoarthritis that begins in late-middle age. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Subjects

Subjects consisted of 36 consecutive patients from an internal medicine practice who met admission criteria regarding age group and mobility. By a priori design, subjects were divided into 6 age groups, with 6 subjects per group. None had conditions affecting their balance and ability to walk, such as severe stability problems and advanced weight-bearing joint osteoarthritis. The mean age and body mass of each age group are listed in table 1.

Table 1: Mean age and body weight for each age group

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Testing procedure

Written consent was obtained according to guidelines of the Helsinki Declaration. The testing procedure called for subjects to perform 20 consecutive footfall impacts while barefoot and while wearing their own shoes. The details of shoe construction were not recorded—any inference about the effect of specific shoe types is impossible because of the variability of materials and construction methods in the shoes worn. Subjects were required to step forward from a perch, fall to a surface 4.5cm

Steady-state impact

Steady-state impact was achieved in both footwear and barefoot conditions by trial 10, with post hoc testing indicating no differences thereafter (F1,35 = .33, p = .56). Because the average of trials 11 to 20 was not significantly different from trial 20 for both footwear and barefoot conditions, the last trial was selected for statistical analysis (fig 2).

. Mean impact for each of the 20 trials as a function of age group, for barefoot and footwear conditions. Impact values were stabilized at

Discussion

Results indicate that impact when men step remains constant until age 50, at which time it rises 13.3% (p < .001) on average for barefoot individuals, and this increase remains relatively unchanged into later years. This is consistent with our hypothesis. The abruptness of the rise seems remarkable, considering that the age of 50 separated barefoot subjects into high and low impact groups without a single exceptional case. This impact upsurge coincides temporally with the development of

Conclusion

This report is the first to identify that a sharp increase in impact forces during locomotion occurs at approximately age 50. It is probably the result of postural adjustments from instability caused by a decline in plantar tactile sensibility that is inherent with aging. These results suggest that improving stability in older groups may have a moderating effect on impact forces. This may delay the beginning of, or slow the progression, of weight-bearing joint osteoarthritis. Low levels of

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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    Reprint requests to Steven Robbins, MD, 800 Rene Levesque W, Ste 1540, Montreal, Que H3B 1X9 Canada, e-mail: [email protected].

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