Abstract
Background: Knee osteoarthritis (OA) impairs functional mobility, including sit-to-stand and stand-to-sit movements. Thigh muscles stabilize the knee during these transitions, and variations in seat height and foot positioning may affect muscle activation. Assessing thigh muscle activity during these tasks may provide strategies to enhance function and guide targeted rehabilitation for individuals with knee OA. Objective: The aim of this study was to examine the EMG activity of the vastus medialis oblique (VMO), rectus femoris (RF), and biceps femoris (BF) muscles of arthritic knees during sit-to-stand and stand-to-sit movements when using varying seat heights and feet positions. Methods: The EMG activity was recorded from the three thigh muscles in the arthritic side during sit-to-stand and stand-to-sit movements under six different seating conditions from eight patients (three females; mean age: 64.6 ± 11.0 years). A three-way ANOVA was used to examine the effects of seat height, foot positioning, and movement type on muscle activation. Results: The results demonstrated significant interactions between muscle activation, movement type, and seating conditions (p = 0.022). The EMG activity of VMO and RF increased significantly during sit-to-stand movements from lower seat heights compared to knee-height seats (p < 0.05). RF activation was also significantly elevated during stand-to-sit transitions at low seat heights (p = 0.023). Additionally, sit-to-stand transitions with symmetrical foot placement elicited significantly greater VMO activation compared to BF activation (p < 0.05). While BF activation remained relatively low across most conditions, it was highest when the arthritic knee was positioned behind the sound foot during both movements. Conclusions: Seat height and foot positioning significantly impact thigh muscle activation in individuals with knee OA during sit-to-stand and stand-to-sit transitions. Lower seat heights require greater VMO and RF activation, indicating increased mechanical demands. Additionally, placing the arthritic knee behind the sound foot enhances BF activation, suggesting a potential strategy for targeted hamstring engagement. These findings provide directions for quadriceps and hamstring strengthening, alongside strategic seating adjustments to optimize functional mobility and reduce joint stress in individuals with knee OA.