Clinical / Research

Stressed out: A new paradigm for understanding joint function while walking

You are driving your car down the road at a reasonable speed of 80 km/hr and when you decide to go a little faster, you notice a little wobble some where in the front end of your vehicle that you had not really noticed before.  When you slow back down the wobble goes away. This keeps up for a while and before long, you can’t drive down the road without the 4-way flashers on…the wobble is getting worse!

Our most natural instinct would tell us to seek out a mechanic, sooner rather than later, but because you are still able to drive with some compensations, this takes you a little longer than it should. Also, good mechanics are hard to find and there is usually a wait to see them. Eventually you get to see your mechanic; they happily greet you, ask a few questions and get you to fill out a questionnaire to assess your perceptions of your cars function while driving, how disruptive the wobble is, a few characteristics of what makes it better, what makes it worse and how you have been managing.  In the mean time, your mechanic pushes and pulls on the tires a little, gets out their 35mm camera and takes a picture of the tires, to get a sense of the tread wear. The mechanic notices that the inside of the tire is wearing a little more than the outside on the front right and proceeds to ask whether you have injured your tire… I mean hit a pothole at some point in the past. The mechanic then recommends sending your car tires for more sophisticated imaging, but the wait can be months for those higher resolution images.  While this situation is a bit contrived, does it at all sound familiar?

All you want your mechanic to do is take your car for a spin or run some diagnostics, so they can test how it functions when you feel the symptoms…Sorry, I mean, when you feel the “wobble”.

When you visit your Dr. with symptoms of chest pain, your Dr. has the option to send you for a cardiac stress test and some form of cardiac imaging technique to assess the function of your heart. If you show up with difficulty breathing, a pulmonary function test may be ordered in conjunction with a chest x-ray.  These tests help provide the clinician with information on what the tissue looks like and how it functions.  Unfortunately you cannot insert “difficulty with joint function” into this paradigm.  Understanding, through measurement, how your joints work during tasks that are often difficult for you is currently not part of the assessment package for the evaluation of lower extremity joint injury and disease.  Like the heart, brain and lungs, images of the joint are taken, but using our knowledge and measurement techniques to understand how that joint functions is lacking.

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We are trying to understand whether we can develop such a stress test for knee and hip joint function in the context of osteoarthritis using our detailed understanding of joint biomechanics and muscle activation patterns associated with walking in these populations.  This work is currently underway at the Joint Action Research laboratory in the School of Physiotherapy, Dalhousie University supported, in part, by the Nova Scotia Health Research Foundation. We are also teaming up with a group of researchers in the VU Medical Center, MOVE Research Institute, Amsterdam, the Netherlands to help move this research forward.  Recently, Derek was talking with Ms. Heidi Petracek, of CTV Morning Live Atlantic about these recent initiatives.

A link to the interview can be found here (Interview Link)

We believe that patients and their health care providers should have the opportunity, like they do in other areas of health care, to understand how joints function in states of injury and disease through measurement andtesting. An image of the joint is only part of the picture, and in no way provides insight into how that joint may feel, work and support capacity for continued active living.  We would not tolerate this in the auto repair shop, why is it any different when our “joints” are in the picture.

If any thoughts on knee and hip joint stress testing while walking, be sure to reply to this blog.

Best wishes,

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