Your inability to move pain-free, without frailty and instability, related to body mass index, is “Locomotion Syndrome.”

You have seen doctors, and there is hope that knee replacement can help you move better. There is a hope that weight loss can help you move better. There is always hope, but if the reality is that you are aging, overweight, and losing range of motion, your adult children may be talking to you about considering assisted living one day in the future. Why? Because you may be on the verge of “Locomotion Syndrome.”

“Locomotion Syndrome” is the loss of your own “locomotion” or ability to move. There are some obvious causes of “Locomotion Syndrome.” These include progressive degenerative disorders such as degenerative joint disease, rapidly developing hip osteoarthritis, knee osteoarthritis, degenerative diseases of the ankle and foot, and osteoporosis. Obviously, disorders that would make it very difficult for someone to walk. But what if you did not have a significantly degenerated spine and joint disease, and you have problems walking, maintaining your balance, or even standing? What else could it be?

Let’s look at a November 2019 study in the medical journal Geriatrics & Gerontology International (1) that looks at aging patients to see what is causing their locomotion problems. The researchers state: The objective of the present study was to identify the factors related to the onset and progression of Locomotion Syndrome in the absence of degenerative joint and spine disorders.

So they gathered and examined 1034 volunteers (444 men, 590 women, average age 63.5 years).

They divided the volunteers into two groups:

• Those who had degenerative joint and spine disease.
• Those who did not.

Then they grouped these people by age, sex, body mass index, muscle strength, gait ability, pain, body balance, spinal sagittal alignment, geriatric syndrome (locomotive syndrome, frailty, and sarcopenia or bone loss), and Quality of Life scores.

The somewhat obvious findings were in patients without degenerative disease.

• If you can keep body mass index (weight and obesity) low, the faster you can walk, the greater the grip and back muscle strength you will have.
• You will also have more stable body balance, better sagittal spinal alignment (straight spine); and lower rates of locomotor syndrome, frailty, and sarcopenia.

In a September 2020 follow-up on this research, doctors writing in the journal BioMed Research International (2) “With increasing Locomotion Syndrome risk stage, the prevalence of and VAS (0-10 pain score, 10 being worst) score for low back pain increased significantly, and back muscle strength and physical abilities decreased significantly.”

A look at Locomotive Syndrome – reduced mobility requiring nursing care

In January 2019, researchers at Nara Medical University in Japan published a study in the journal Modern Rheumatology (3). What they wanted to observe and assess was the impact of musculoskeletal diseases, depressive mental state, and hypertension on locomotive syndrome.

Learning points of this research:

• Aging, osteoporosis, and low back pain significantly increased the risk of locomotive syndrome, followed by knee osteoarthritis and lumbar spinal stenosis.
• Locomotive syndrome was significantly related to depressive mental state and hypertension and led to functional “inconvenience” in daily chores such as cleaning, shopping, and strolling.
• The risk of locomotive syndrome may be decreased by treating comorbid osteoporosis and instituting exercise and diet-related modifications.

In November 2018, another Japanese research team lead by Tokai University Oiso Hospital researchers looked at people with reduced muscle strength to measure the relationship with muscle frailty and metabolic syndrome leading to locomotive syndrome and required nursing care. This was published in the Journal of Orthopaedic Science. (4) They found a problem for women.

Locomotive Syndrome – A problem for women 

In women, body weight, body mass index, and abdominal circumference were significantly higher in the Locomotive Syndrome risk group.

Here are the learning points of this study:

• In women, body weight, body mass index, and abdominal circumference were significantly lower in the non-Locomotive Syndrome risk group than in the Locomotive Syndrome higher risk group.
• In women, the ratio of lower limb muscular strength to body weight was significantly lower in the double-risk group (Locomotive Syndrome and Metabolic Syndrome, higher risk groups). In simpler terms, the muscles of the women at risk had a difficult time supporting their weight.

An August 2022 paper in the Japanese medical journal Modern Rheumatology (5) investigated whether the locomotive syndrome severity affects future fragility fractures in osteoporosis patients. In this study,  315 women with osteoporosis (mean follow-up period, 2.8 years) were reviewed. Fragility fractures occurred in 37 of 315 participants (11.8%). This study revealed the locomotive syndrome severity to predicted fragility fractures.  The researchers suggested that the progression of locomotive syndrome associated with osteoporosis increases the fracture risk.

Another problem for women is cardiovascular disease. A December 2022 paper published in the BMJ Open (6) medical journal also found that central (belly) obesity is associated with pain severity, and further, in women with osteoarthritis, an increased risk of cardiovascular disease. The stress here is on belly fat or central fat. The researchers found that belly fat, not Body Mass Index (BMI), is more relevant to pain and cardiovascular disease in patients with osteoarthritis than BMI.

Abdominal obesity, hypertension, and diabetes accelerate knee pain and osteoarthritis, and Locomotion Syndrome

In October 2018, researchers in the journal Clinical Rheumatology (7) reinforced these findings.

The goal of the study was to take patients who had metabolic syndrome (abdominal obesity, hypertension, and diabetes), and knee osteoarthritis, and examine the patients’ clinical history, functional capabilities, and match that with scans and MRIs of their knees.

• This study examined 60 patients, 55 of whom were women
  • Every patient had been diagnosed with metabolic syndrome (abdominal obesity, hypertension, and diabetes).
  • All patients had knee osteoarthritis documented by MRIs and scans
  • All patients were tested for pain, stiffness, and disability assessments
• The findings:
  • If you have the components of metabolic syndrome, abdominal obesity, hypertension, and diabetes, your knee pain worsens, your degeneration worsens, and your functionality worsens.

The obvious conclusion? You will probably walk a lot better and feel a lot better if the issues of abdominal obesity, hypertension, and diabetes are confronted.

References

1 Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, Kanbara S, Ito S, Inoue T, Seki T, Ishizuka S. Multivariate analysis of factors related to the absence of musculoskeletal degenerative disease in middle‐aged and older people. Geriatrics & Gerontology International. 2019 Nov 1;19(11):1141-6. [Google Scholar]
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