Quadricep strength and speed of force affects knee osteoarthritis

Quadricep strength and speed of force production (SFP) both affect physical functioning in people with, or at risk for, knee osteoarthritis, according to research presented this week at the Association of Academic Physiatrists Annual Meeting in Las Vegas.

Thigh Circumference Measurement. Robert LaPrade MD PhD

Association of Academic Physiatrists, AAP, Newswise 6 February 2017

The lower limb muscles, especially the quadriceps, play an important role in the development of knee osteoarthritis (OA). Muscle weakness has already been identified as a potential risk factor for developing knee OA (due to increased knee loading), and researchers recently set out to see if SFP — how fast the quadricep muscle is able to generate force, pushing the leg out — would have an effect on physical function in people with, or at risk for, knee OA.

“As far as we know, there have not been studies on people with or at risk for knee OA that comprehensively investigated quadriceps SFP as a risk factor for worsening physical function – such as walking, rising from a chair or climbing stairs,” explains Neil Segal MD MS, director of clinical research and medical director of Musculoskeletal Rehabilitation in the Department of Rehabilitation Medicine at University of Kansas Medical Center. “Better understanding the relationship of speed of muscle force development and worsening physical function could inform design of rehabilitation interventions to protect people from suffering loss of physical function.”

Through the Osteoarthritis Initiative — a study of nearly 5,000 adults with or at risk for knee OA — Dr. Segal’s team followed 3,996 participants for 12 months, 3,820 for 24 months and 3,623 for 36 months (those with knee injuries or who developed rheumatoid arthritis, a type of inflammatory arthritis, did not continue through all 36 months of the study).

Participants’ SFP was measured using a special chair with a cable that measures muscle strength when pushing the leg out. Physical functioning was measured using timed 20- and 400- meter walks as well as chair stand tests, which measure the speed at which participants stand from a seated position in a chair. Finally, the researchers noted participants’ self-assessments of their functioning (e.g., walking, getting dressed, bathing, etc.) using the WOMAC-PF scale, which is the most common survey of self-reported physical function in people with knee OA.

Dr. Segal’s team looked for any worsening in the areas of physical function, including: an absolute decrease in 20-meter walk speed of .14 meters per second; an increased time in the 400-meter walk of at least 20 seconds; an increased time to stand from a chair of 4.18 seconds; and/or a reported nine-point or greater worsening on the WOMAC-PF scale.

SFP was categorized as low, medium and high. Participants with medium SFP were found to be at lower risk for worsening self-reported function at 24 months when compared to those with low SFP. Interestingly, participants with high SFP didn’t experience the same decreased risk as those with medium SFP. Additionally, at 36 months, those with medium and high SFP had a lower risk of worsening self-reported function than those with lower SFP.

Next, Dr. Segal’s team looked specifically at women, and the results were similar. In comparison to those with lower SFP, those with the highest SFP had lower risk for worsening 20-meter walk, and those with medium SFP showed lower risk for worsening self-reported physical function at 24 and 36 months.

“The results of this study indicated that interventions to maintain physical function in people with knee OA should focus both on quadriceps strength and the SFP of the muscle,” says Dr. Segal of the findings. “Compared to people who can push faster, we found people with slower muscle responses are more likely to suffer from worsening physical function in the future. We know that maintaining quadriceps strength is important for protection against painful knee OA. Now, we know the ability to move the muscle quickly is important for keeping people able to walk, stand from a chair and do other functional activities.”

As a next step, Dr. Segal notes the importance of understanding why women seem to show more positive effects of SFP over men. He also suggests interventional studies should be completed to confirm the results of this observational study.


To examine the relationship between speed of force production (SFP) and physical function in subjects with or at risk for knee osteoarthritis (OA) in order to determine whether quadriceps SFP at baseline was a potential determinant of worsening self-reported physical function and functional performance at 36-month follow-up.


All data were obtained from the Osteoarthritis Initiative, a longitudinal study of ~5,000 adults with or at risk for knee OA. Isometric quadriceps SFP (N/sec) was measured using the Good Strength chair.

Worsening physical function was defined as the Minimal Clinically Important Difference in WOMAC physical function (WOMAC-PF), 20-meter walk, 400-meter walk, and repeated chair stand performance over 36 months.

Logistic regression was used to evaluate the associations between SFP tertiles and worsening physical function, after adjusting for baseline age, sex, BMI, and knee pain.


3,996, 3,820 and 3,623 participants were included in 12-month, 24-month, and 36-month statistical analyses respectively.

Compared to the lowest tertile of SFP, the middle and highest tertiles had lower risk of worsening of WOMAC-PF at 36-month follow-up with adjusted odds ratios of 0.758 (0.583, 0.987) and 0.689 (0.497, 0.956).

In women, in comparison with the lowest tertile of SFP, the highest tertile had lower risk for worsening of 20-meter walk, and the middle tertile had lower risk for worsening of WOMAC-PF at 24-month follow-up, after adjustment for other factors, with odds ratios of 0.652 (0.448, 0.948) and 0.620 (0.426, 0.903) respectively.

In addition, in comparison with the lowest tertile of SFP, the middle tertile had lower risk of worsening of WOMAC-PF at 36-month follow-up, with an odds ratio of 0.669 (0.476, 0.941).


These findings indicate that lower quadriceps rate of force production predates worsening of self-reported physical function.

Source Newswise


Lower Quadriceps Speed of Force Production is associated with Worsening Physical Function in Adults with or at Risk for Knee Osteoarthritis: 36-month Follow-up Data from the Osteoarthritis Initiative, Bo Hu PHD; Søren T. Skou PT PHD; Michael Nevitt PHD MPH; Glenn Williams PT PHD, ATC; Barton L Wise MD; Neil Segal MD MS. 2017 AAP Annual Meeting, Las Vegas. February 10, 2017

  Further reading

Correlation between Quadriceps Endurance and Adduction Moment in Medial Knee Osteoarthritis,
Soon-Hyuck Lee, Jin-Hyuck Lee, Sung-Eun Ahn, Min-Ji Park and Dae-Hee Lee. PLoS One. 2015; 10(11): e0141972. Published online 2015 Nov 5. doi: 10.1371/journal.pone.0141972

Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation, Fisher NM, White SC, Yack HJ, Smolinski RJ, Pendergast DR. Disabil Rehabil. 1997 Feb;19(2):47-55.

Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis, Tibor Hortobágyi, Lenna Westerkamp, Stacey Beam, Jill Moody, Joseph Garry, Donald Holbert, Paul DeVita. Clinical Biomechanics, Volume 20, Issue 1, January 2005, Pages 97–104. DOI: 10.1016/j.clinbiomech.2004.08.004

Thigh muscle specific strength and the risk of incident knee osteoarthritis: The influence of sex and greater body mass index, Culvenor AG, Felson DT, Niu J, Wirth W, Sattler M, Dannhauer T. and Eckstein F. (2016) Arthritis Care & Research. Accepted Author Manuscript. doi:10.1002/acr.23182

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