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Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN for PRINT: 0896-2960

Institutional price:	$684.00
Issues per year:	4

Best Paper Award Selection - Editorial Board Site

2007, Volume19

82 pages

DOI: 10.1615/CritRevPhysRehabilMed.v19.i3

Issue price - $190.00

The Role of the Neuromuscular System in the Development, Progression, and Rehabilitation of Osteoarthritis of the Knee

Michael J. Berger
Schulich School of Medicine and Dentistry, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada

Timothy J. Doherty
Schulich School of Medicine and Dentistry, School of Kinesiology, and Departments of Clinical Neurological Sciences and Rehabilitation Medicine, The University of Western Ontario, London, Ontario, Canada

ABSTRACT

The purpose of this review is to examine current understanding of the relationship between the neuromuscular system and osteoarthritis of the knee joint. Although deficits in neuromuscular function are common in the normal aging population, they are also considerable and often of greater magnitude in patients with OA. The mechanisms responsible for the loss in muscle strength and proprioceptive acuity seen in knee OA may include those previously implicated in normal aging processes, such as changes to muscle and motor unit morphology. In addition, neural mechanisms contributing to strength loss, such as reduced central drive (voluntary activation of the quadriceps muscle) due to alterations in joint architecture, may occur independently of normal aging processes. Furthermore, evidence from a variety of study designs illustrates a possible role for sensorimotor dysfunction in the incidence and progression of the degenerative changes occurring in knee OA. Although the relevance of the neuromuscular system to the pathogenesis of disease is not fully understood, the effect of these deficits on pain and disability is well established and has widespread implications for the development and implementation of rehabilitation protocols. Clinicians should be aware of the limited use of generalized joint-specific strength exercise programs for rehabilitation because patients require individualized assessment for differences in systemic and local neuromuscular factors.