Causes of Hand on Knee Gait
The primary causes of hand on knee gait are knee osteoarthritis with joint instability, pain, and weakness, which lead patients to place their hands on their knees for additional support during ambulation. 1
Knee Osteoarthritis-Related Causes
Joint Instability: Self-reported knee instability in osteoarthritis patients is associated with increased knee motion variability during gait, causing patients to seek additional support by placing hands on knees 2
Pain and Discomfort: Significant knee pain during weight-bearing activities forces patients to modify their gait pattern, often using hands on knees to redistribute weight and reduce pain 1
Quadriceps Weakness: Early and established knee osteoarthritis patients experience significant quadriceps weakness, compromising knee stability during weight-bearing activities 3
Altered Biomechanics: Patients with knee osteoarthritis demonstrate reduced knee flexion and altered rotation patterns during gait, contributing to instability that may necessitate hand support 4
Biomechanical Factors
Medial Compartment Issues: Longer medial compartment contact point excursions and higher velocities in unstable knees represent objective signs of mechanical instability that may require compensatory hand support 5
Abnormal Loading Patterns: Altered knee adduction moment, flexion moment, and flexion angle during walking in patients with medial knee OA contribute to instability and compensatory gait patterns 6
Coupled Movement Abnormalities: Unstable knee OA patients demonstrate a coupled movement pattern of knee extension and external rotation after heel contact, different from the normal coupled motion of knee flexion and internal rotation 5
Management Considerations
Assistive Devices: Canes are strongly recommended for patients with knee OA causing significant impact on ambulation, joint stability, or pain, which may reduce the need for hand-on-knee support 1
Knee Bracing: Tibiofemoral knee braces are strongly recommended for patients with knee OA affecting ambulation, joint stability, or pain who can tolerate the associated inconvenience 1
Exercise Therapy: Progressive strengthening of hip girdle muscles, particularly the gluteus medius, and quadriceps can improve stability and potentially reduce hand-on-knee gait patterns 7
Coordination of Care: Optimal management with knee bracing and assistive devices requires coordination between primary care providers, specialists, and device providers 1
Pitfalls and Caveats
Misdiagnosis Risk: Hand-on-knee gait may be mistakenly attributed solely to pain when underlying instability is the primary cause 2
Overlooking Secondary Effects: Using hands on knees can alter overall biomechanics and potentially lead to secondary issues in the spine and other joints 8
Inadequate Assessment: Failure to distinguish between patients with and without self-reported instability may lead to inappropriate treatment approaches, as these groups demonstrate different gait variability patterns 2
Delayed Intervention: Early osteoarthritis patients already exhibit quadriceps weakness comparable to established OA patients, suggesting early intervention is warranted before gait changes become established 3