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Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis

Nature Reviews Rheumatology volume 7, pages 57–63 (2011)Cite this article

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Abstract

Lower-extremity muscle strength and afferent sensory dysfunction, such as reduced proprioceptive acuity, are potentially modifiable putative risk factors for knee osteoarthritis (OA). Findings from current studies suggest that muscle weakness is a predictor of knee OA onset, while there is conflicting evidence regarding the role of muscle weakness in OA progression. In contrast, the literature suggests a role for afferent sensory dysfunction in OA progression but not necessarily in OA onset. The few pilot exercise studies performed in patients who are at risk of incident OA indicate a possibility for achieving preventive structure or load modifications. In contrast, large randomized controlled trials of patients with established OA have failed to demonstrate beneficial effects of strengthening exercises. Subgroups of individuals who are at increased risk of knee OA (such as those with previous knee injuries) are easily identified, and may benefit from exercise interventions to prevent or delay OA onset.

Key Points

  • Muscle weakness is a predictor of knee osteoarthritis onset

  • Afferent sensory dysfunction is a predictor of osteoarthritis progression

  • Exercise training interventions should address both muscle weakness and afferent sensory dysfunction

  • Exercise regimens that aim to achieve modification of joint loading or cartilage structure seem to be more promising in at-risk individuals or those with early disease

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Figure 1: Joint injury, obesity, age and sex are associated with muscle weakness and afferent sensory dysfunction.
Figure 2: The effects of knee malalignment on knee loading.
Figure 3: The afferent somatosensory system comprises the receptors, afferent neurons and central processing centers that permit the detection of a diverse range of environmental sensory inputs, including the tactile sense (touch), proprioception, temperature and nociception (pain).

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Acknowledgements

L. Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense, DK-5230, Denmark

    Ewa M. Roos

  2. Human Performance Laboratory, Faculties of Kinesiology, Engineering, Medicine and Veterinary Medicine, University of Calgary, 2500 University Drive NW, Calgary, T2N 1N4, AB, Canada

    Walter Herzog

  3. Section of Rheumatology, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, 60612, IL, USA

    Joel A. Block

  4. Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, 200 Berkeley Street, Melbourne, 3010, Vic, Australia

    Kim L. Bennell

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Roos, E., Herzog, W., Block, J. et al. Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis. Nat Rev Rheumatol 7, 57–63 (2011). https://doi.org/10.1038/nrrheum.2010.195

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