Clinical Pilates in Practice: Joint Impairment & Gait in Juvenile Idiopathic Arthritis (July 2020)

 

Researchers used a musculoskeletal model to predict joint contact forces and investigate the variations of joint contact forces due to joint impairment in 18 juvenile idiopathic arthritis patients.

 

Erica Montefiori et al. Linking Joint Impairment and Gait Biomechanics in Patients with Juvenile Idiopathic Arthritis. Annals of Biomedical Engineering 2019; 47(11): 2155-2167

 

KEY POINTS: JOINT IMPAIRMENT & GAIT BIOMECHANICS IN JUVENILE IDIOPATHIC ARTHRITIS

  • Juvenile idiopathic arthritis (JIA) is the commonest rheumatic condition in childhood, although the etiology remains unknown.
  • JIA encompasses several subgroups but most generally presents as peripheral arthritis.
    • Clinical presentation includes fever, joint swelling and pain, hepatomegaly, lymphadenopathy, cardiac involvement, splenomegaly, and skin rashes.
  • Medical imaging of JIA:
    • Ultrasound is used to assess joint synovial and tendon inflammation.
    • MRI helps with early diagnosis of JIA, identifying synovitis, bone erosions, and bone marrow edema.
  • Medical imaging only provides information about local impairment.
  • Gait analysis is also used as a tool to assess joint kinematics in JIA patients.
    • Hyper-flexion of the hip and knee joints are often observed.
    • Reduced plantarflexion of the ankle, and decreased ankle moment and power, are also commonly observed. 

 

There is a direct relationship between internal joint loading and loading of bone and cartilage.

 

  • A reduction in internal load is observed in inflamed joints, as a protective response to pain.
  • This compensatory strategy, however, overloads other joints in the limbs.
  • This study failed to observe patterns of hip and knee hyperflexion or decreased ankle plantarflexion, but the authors do note the extremely small study size. 
  • Overloading of the knee joint was observed, especially in those with a bilateral impairment.
    • Increased loading of the less affected knee was especially observed in push-off during gait.
  • Increased loading in the contralateral hip was also observed in the most impaired patients.
  • Overloading of both hips was observed in early stance phase of gait. 
  • From this study, only knee joint contact forces are recommended as a candidate for predicting JIA activity.
    • This may also act as an indicator of compensatory mechanisms in the other limb.
  • A dynamic gait assessment is proposed as part of any JIA assessment.

CLINICAL PILATES IN PRACTICE

  • Knee joint loading directly impacts loading and function of the contralateral hip.
  • Work to improve alignment and force transfer through the knee, by promoting balance around the knee: quads, adductors, hamstrings, popliteus, plantaris, and gastrocnemius need to be working in harmony.
  • Double and Single Leg Press on the Reformer to offload the knee from gravity if full weightbearing is painful.
  • Tibial rotations on the Rotator Discs if appropriate. 
  • Work to then balance loading and weightbearing into the hips.
    • Standing Leg Press at the Wunda Chair.
    • Standing Platform on the Reformer.
  • Integrating hip extension with knee flexion to support both the hip and knee with both ends of the hamstrings.
    • Supported hip extension at the Tower (use a box to avoid kneeling).
  • Bend/Stretch with feet in straps at Reformer or leg springs at the Tower, ensuring that the proximal hamstring is supported.

 

REFERENCES

  1. Barut K, Adrovic A, ┼×ahin S, Kasapçopur Ö. Juvenile Idiopathic Arthritis. Balkan Med J. 2017;34(2):90-101. doi:10.4274/balkanmedj.2017.0111
  2. Aslan M, Kasapcopur O, Yasar H, Polat E, Saribas S, Cakan H, et al. Do infections trigger juvenile idiopathic arthritis? Rheumatol Int.2011; 31:215–20.
  3. Gonzalez B, Larrañaga C, León O, Díaz P, Miranda M, Barría M, et al. Parvovirus B19 may have a role in the pathogenesis of juvenile idiopathic arthritis. J Rheumatol. 2007; 34:1336–40.

 

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The Calibrate Pilates team translates research into clinically relevant information so that you can build your core practice and improve client outcomes. 

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