Keywords

Isotonic quadriceps; Osteoarthrosis; Knee

Introduction

OA can be characterized as a condition portrayed by central regions of loss of articular ligament inside the synovial joints, related with hypertrophy of the bone (osteophytes and subchondral bone sclerosis) and thickening of the capsule. These changes may happen because of an irregularity in the balance between the breakdown and fix of joint tissue. Essential manifestations of OA incorporate joint torment, firmness and constraint of development. Infection movement was generally slow however can at last prompt joint disappointment with torment and handicap. An ongoing overview in India revealed that the pervasiveness of OA in more established grown-ups over 65 years old was 32.6% in the rustic populace and 60.3% in the metropolitan populace [1]. Three significant actual debilitations, for example, knee agony, solidness, and diminished quadriceps quality, are profoundly connected with knee OA and are accepted to add to actual incapacity and movement of the disease.

Review of Literature

People with osteoarthritis (OA) of the knee joint generally show stamped shortcoming of the quadriceps muscles, with quality deficiencies of 20 to 45% contrasted and age and sex coordinated controls. Tenacious quadriceps shortcoming was clinically significant in people with OA as it is connected with debilitated unique knee security and physical function and particularly on the off chance that you don't have a solid VMO, you may encounter knee torment and annoying injuries. Additionally, the quadriceps have a significant defensive capacity at the knee joint, working unconventionally during the early position period of stride to pad the knee joint and acting to decelerate the appendage before heel strike, along these lines lessening indiscreet loading [2,3]. More vulnerable quadriceps have been related with an expanded pace of stacking at the knee joint and late longitudinal information have demonstrated that more noteworthy benchmark quadriceps quality may ensure against episode knee pain.

There are two fundamental elements related with loss of quadriceps quality in patients with knee joint inflammations were decay and muscle restraint. The quadriceps has been appeared to show a 12% decrease in cross sectional region speaking to decay in patients with knee joint inflammation. This decay clearly adds to loss of solidarity, anyway hindrance of volitional control of the quadriceps has additionally been found. In this way, quadriceps quality should be considered in the investigation of knee OA [4].

Exploration is as yet progressing with respect to examination of the function of reinforcing in the treatment of OA of the knee. When all is said in had done, the greater part of the patients with OA knee going through isometric preparing as it permits low expansion in intra-articular weight and negligible joint development. In any case, everyday actual exercises may request more isotonic muscle work and anyway there is little proof that isometric quality will continue to isotonic strong capacity [5]. Accepting that the isotonic opposed preparing may have a bit of leeway as the quadriceps have a significant defensive capacity at the knee joint by working unusually during the early position period of stride to pad the knee joint and acting to decelerate the appendage before heel strike, in this way diminishing indiscreet stacking. Thus, it is fundamental to break down the impact of isotonic quadriceps fortifying improving practical action and lessening torment in tolerant with OA knee.

Methods

Selection criteria

• Both male and female

• Age between 40 to 70 years

• Tolerant with generally consistent action level.

• Tolerant with moderate pain intensity 4-6(NPRS)

• Patient who can tolerate resistance of least 1/2 kg were considered

• Secondary type of osteoarthritis knee were not thought of

• Patient without deformity of knee were only considered

Materials required

• Quadriceps chair

• Towel

• Weight plates

• Footstool

• Stopwatch

Wax therapy

The patient in the both groups were underwent wax therapy and it was applied over the affected knee, for a period of 20 minutes by using clothing method in a day.

Exercise therapy protocol for control group

Followed by wax therapy, the controlled group underwent 10 minutes of isometric quadriceps muscle setting exercise session.

Isometric quadriceps exercises

A role of towel was placed below the affected knee. The participant was asked to press the back of the knee downward through the towel, while dorsiflexing the ankle. Ask the patient to feel the quadriceps contraction and to maintain it for 10 seconds and then to relax for 5 seconds. One set comprises of 10 repetition and the patients were asked to do 3 sets with a brief rest between every set [6-8].

Exercise therapy protocol for experimental group

Followed by wax therapy, the experimental group underwent 10 minutes of pain tolerable isotonic quadriceps muscle resisted exercise by using Quadriceps chair.

Isotonic quadriceps muscle resisted exercise

The patient was positioned in quadriceps chair and a suitable pain tolerable weight resistance was selected. Instruction was given to the patients to perform the movement in a smooth controlled manner. They were asked to extend the knee against this resistance from 90° to 0° (concentric) and then to lower it down (eccentric work). One set comprises of 10 repetition and the patients were asked to do 3 sets with a brief rest in between every set [9].

Statistical Analysis

The collected data were statistically analyzed to find out the effect of isotonic resisted exercise.

Table 1 shows the mean pretest value of 61.32 ± 3.53 and posttest mean value of 52.04 ± 6.91, with a t value of 5.086 and a significant of p value 0.001.This shows the conventionally used isometric training and wax bath were significantly improved the functional activity in patient with OA Knee [10].

Table 1: Paired sample test for Control Group (Pre and Post test WOMAC score).

Experimental group shows the mean pre test value of 64.25± 4.46 and post mean value of 45.35 ± 6.39 with a’t’ value of 9.075 and a significant of 'p' value of 0.001. Table 2 shows the experimentally used isotonic resistance training and wax bath were highly significant in improving functional activity in patient with OA knee.

Table 2: Paired sample test for Experimental Group (Pre and Post test WOMAC score).

Results and Discussion

This study was aimed to evaluate the effect of isotonic quadriceps resisted training in improving functional activity and reducing pain in patient with OA knee. Based on the selection criteria thirty patients with primary OA knee were randomly recruited for this study and they randomly assigned in control (n=15) and experimental (n=15) groups. All the subjects were informed about the possible risk and discomfort during therapy and an oral informed consent was obtained. None of the subjects in the groups complained pain during treatment session and no one stopped the training during 3 weeks of training and they completed the whole training schedule.

Before starting the treatment programme, the initial level of functional capacity and knee pain of the patient were assessed by using WOMAC scale and NPRS. The study didn't attempt to assess the objective muscle strength by repetition maximum (RM) as this procedure may induce pain. All the patient were attended a 4 treatment session in a week for 3 weeks. Initially, both the groups underwent wax therapy and it was applied over the affected knee, for a period of 20 minutes by using clothing method in a day. Followed by wax therapy, the controlled groups will undergo isometric quadriceps muscle setting exercise (15 Repetition) and the experimental group will undergo 10 min of pain tolerable isotonic quadriceps muscle resisted exercise in a range of 90° to 0° knee extension by using quadriceps chair. We didn’t attempt strenuous strength exercise programme presuming that they might be harmful to knee, another consent might be the pain could limit to the outcome. At the same time this protocol appeared to have a positive physiological adaptation to isotonic resisted training without an exacerbation of his knee OA symptoms.

Conclusion

Both the training groups showed a marked decrease of pain and increase in functional capacity. On comparing between the groups, the isotonic training group has a better influence on improving functional capacity and pain reduction. So, the study concluded by delivering the isotonic resisted exercise of quadriceps without over stressing the joints was a heavy element for successful program.

References

1. Lawrence RC, Helmick CG (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 41: 778e99.
2. Zhang Y, Xu L, Nevitt MC (2001) Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The beijing osteoarthritis study. Arthritis Rheum 44: 2065e71.
3. Slemenda C, Brandt KD, Heilman DK (1997) Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 127: 97-104.
4. Hurley MV, Scott DL, Rees J (1997) Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis 56: 641-648.
5. McAlindon TE, Cooper C, Kirwan JR (1993) Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 52: 258- 262.
6. Sheehan F, Borotikar (2013) Alterations in in vivo knee joint kinematics following a femoral nerve branch block of the vastus medialis: Implications for patellofemoral pain syndrome. Clinic Biomechan.
7. Brandt KD, Dieppe P, Radin EL (2008) Etiopathogenesis of osteoarthritis. RheumDis Clin North Am 34: 531-559.
8. Farr NJ, Scott B (2010) Progressive resistance training improves overall physical activity levels in patient with early osteoarthritis of the knee: A Randomized controlled trial. Phys Ther 90: 356-366.
9. Angela K (2008) Strength training for treatment of osteoarthritis of the knee: A systematic review patient. Arthr Rheumat 59: 1488- 94.
10. Alan E, Steven A, Mazzuca, Kenneth D (2006) Effects of strength training on the incidence and progression of knee osteoarthritis. Arthr Rheumat 55: 690-699.