The Effect of Severity on the Isokinetic Strength in Knee Osteoarthritis (OA)
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Purpose
To determine the relationship of torque measures of knee flexors to extensor muscles developed as a result of dysfunction and disease in knee Osteoarthritis (OA) and does the maximum peak torque measures change in patients with knee OA compared to healthy normal subjects.
Materials and Methods
30 patients with the symptomatic osteoarthritic knees (age 40 - 60 yrs) were divided into 3 groups. Group1 - 10 Subjects exhibiting symptomatology and radiologic findings of knee OA. Group2 - 10 Subjects having knee joint pain without any radiologic evidence of knee OA. Group3 - 10 Healthy subjects. Subjects in all the 3 groups performed concentric contractions of knee flexors and extensors that include 4 repetitions at 60 deg/sec, 10 reps at 120 deg/sec and 20 reps at 180 deg/sec. Values of maximum peak torque of flexors and extensors and maximum peak torque hamstring to quadriceps ratio were recorded after each session.
Results
Significant difference was found in maximum peak torque of flexors and extensors among 3 groups of subjects but no significant difference for ratio was observed among 3 groups. Values of maximum peak torque measures decreased with increasing speed of shortening and the hamstring to quadriceps values increased with increasing speed of shortening.
Conclusion
There is equal strength loss of both the muscles in patients with knee osteoarthritis, so hamstring strengthening exercises should be incorporated along with quadriceps strengthening exercise in rehabilitation plan of knee OA.
Keywords
- Sharma Leena, September Cahue, Jing Song, Karen Hayes(2003), Physical functioning over three years in knee osteoarthritis, Arthritis & Rheumatism, 48;3359- 3370
- Bullough G. Peter (1984), Osteoarthritis: Pathogenesis and Aetiogy, British Journal of Rheumatology, 23;166- 169
- Lawrence J.S., J.M. Bremner, F. Bier (1966), Prevalence in population and relationship between symptoms and X-ray changes, Ann Rheum Dis, 25;1-24
- Mahajan A., Verma S, V. Tandon(2005), Osteoarthritis, Journal of Association of Physicians in India, 53;634-41
- Malaviya AN, Singh RR, Kapoor SK, Sharmati(1994), Prevalence of rheumatic diseases in India; results of a population survey, Journal of Indian Rheumatism Association, 2; 7-13
- Spector T.D., Hart DJ, J Byrene, PA Harris(1993), Definition of Osteoarthritis of the knee for epidemiological studies, Ann RheumDis, 52;790 – 94
- Moskowitz RW (1992): Osteoarthritis – symptoms and signs, Osteoarthritis Diagnosis and 8. Medical/Surgical Management. 2nd Ed., Philadelphia, WB Saunders, 255 – 61
- Howell DS, Felletier JP:Etiopathogenesis of Osteoarthritis, McCarthy & Koopman, Arthritis & Allied Conditions, (13th Ed.), Philadelphia, Lea & FebigerVol. 2;1723 – 34
- Campbell DE, Glenn W (1982), Rehabilitation of Knee Flexor and knee extensor muscle strength in patients with menisectomies, ligamentous repairs and chondromalacia, Physical Therapy, 62;10-15
- Leader(1989), Osteoarthritis: definitions and criteria, Annals of rheumatic diseases, 48;531 – 32
- Carolyn Kisner, Lynn Allen Colby(2003), Therapeutic Exercise Foundations and Technique, 4th Edition, 86., Jaypee Publications
- Todd S. Ellenbecker (2000), Isokinetics in Rehabilitation, Knee Ligament Rehabilitation, 1st Edition, Churchill Livingstone, 52 – 65.
- Lawrence H. Bannister, Martin M. Berry, Mary Dyson (2000), (Lower LimbSkeletal System), Gray’s Anatomy, 38th Edition ,Churchill Livingstone, 697 - 704
- Chaurasia B.D.(1999), Human Anatomy : Lower Limb and abdomen, 3rd Edition, Vol. 2: 50; 74
- Norkin Cynthia, Pamela K. Levangie(1998), The knee Complex structure & function,Joint structure and function , 2nd Ed, Jaypee 337- 39
- Donald B. KettleKamp, Robert A. Colyer(1984); OA of knee, Osteoarthritis diagnosis and management, Ist Edition, , Philadelphia, 403 – 424
- Felson David T., Yuquing Zhang (1995). The incidence and natural history of OA in Elderly:Framingham Osteoarthritis study, Arthritis & Rheumatism, 38;1500 – 1505
- Koopman, Altman(1991), Osteoarthritis, Clinical Primer on Rheumatic Diseases, 1st Edition, 245 – 61
- Peyron Jacques G. (1982), The epidemiology of Osteoarthritis. Osteoarthritis diagnosis & Management, Ist Edition, Philadelphia 9 – 27
- Maradee A. Davis, walter HI Ettinger, John M. Neuhaus (1989), The association of knee injury and obesity with unilateral and bilateral osteoarthritis of the knee, American journal of Epidemiology, 130;278 – 288
- Cooper cyrus, Paul A. Dieppe (2000), Risk factors for the incidence and progression of radiographic knee osteoarthritis, Arthritis & Rheumatism, 43;995- 1000
- Marc. C. Hochberg, Jordan D. Tobin (1995), The association of body weight, body fatness and body fat distribution with osteoarthritis of the knee, J Rheumatol, 22;488 – 93
- Felson David, Jennifer J. Anderson, Allan Naimark (1988), Obesity and knee osteoarthritis, Annals of Internal Medicine, 1, 18 – 24
- Felson David Barbara Weissmann (1997), Risk factors for incident radiographis knee Osteoarthritis in the elderly, Arthritis & Rheumatism, 40; 728 – 33
- Sharma leena, September Cahue, Dorothy D. Dunlop (2000), The mechanism of the effect of obesity in knee OA, Arthritis & Rheumatism, 43;568 – 75
- Marco A. Cimmino, Massimiliano Parodi (2000), Risk factors for Osteoarthritis, Seminars in Arthritis and Rheumatism, 49;29 – 34
- Cooper Cyprus, David Coggon, Peter Egger (1994), Occupational activity and osteoarthritis of the knee, Ann of Rheumatic Diseases, 53;90 – 93
- Sharma leena, David T. Felson, Dorothy D. Dunlop (1999), Laxity in healthy and osteoarthritic knees, Arthritis and Rheum, 42; 861 – 70
- David T. Felson (1988), Epidemiology of Osteoarthritis, Osteoarthritis Management, 2nd Edition, W.B. Saunders 9 – 16.
- Howell DS, Felletier JP: Etiopathogenesis of osteoarthritis, McCarthy & Koopman, Arthritis & Allied Conditions, 13th Edition, Philadelphia, Vol. 2; 1723 – 34
- Sheila O’ Reilly and Michael Doherty, Signs, symptoms and laboratory tests, McCarthy & Koopman, Arthritis & allied Conditions, 13th Edition, Philadelphia Vol. 2;197 – 209
- Feliciantonio Di Domenica, Fabiola Atzeni Laura Volonte, Gerardo Mele (2004), Physical and rehabilitative approaches in osteoarthritis,seminars in Arthritis and Rheumatism, 62 – 69
- i) Gail D. Deyle, Nancy E. Henderson (2000), Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee, Annals of Internal Medicine, 132; 173 – 181 ii) R. Altman, E. Asch, D. Bloch (1986), Development of criteria for the classification and reporting of osteoarthritis, Arthritis and Rheumatism, 29; 1039 – 49. iii) Kellgren JH, Lawrence JS(1957),Radiological assessment Osteoarthrosis, Annals of Rheum. Dis16;494-501.
- Helen J. Hislop, james J Perrine (1967), The isokinetic concept of Ex., Physical Therapy, 47; 114 – 117
- Todd S. Ellenbecker (2002), Isokinetics in Rehabilitation, Knee Ligament Rehabilitation, 277 – 290
- V. Baltzopoulous, D.A. Broadie (1989), Isokinetic dynamometry; Applications and limitations, Sports Medicine, 8;101 – 116
- Mary Moffroid, Robert Whipple, Jack Hofkosh(1969), A study of Isokinetic Exercise, Physical Therapy, 49; 435 – 746
- Howard G. Thistle, Helen J. Hislop, Mary Moffroid(1967), Isokinetic Contraction: A new concept of resistive exercise, Arch Phys Med & Rehabil, 43; 279 – 282
- Zeevi D Vir(1994),Isokinetic testing in knee Isokinetics: Muscle Testing, Interpretation and clinical applications, Ist Edition, 2 – 20.
- i) R. A. Gaard, E. B. Simonsen, M. Trolle, J. Bangsbo(1995), Isokinetic hamstring/Quadriceps. Strength ratio: Influence from joint angular velocity, gravity correction and contraction mode, Acta Physial Scand, 154; 421 – 427 ii) Rosalind Coombs, Gerard Garbutt(2002) Development in the use of the hamstring/Quadriceps ratio for the assessment of muscle balance, Journal of sports science and Medicine 1; 56 – 62
- Jules M. Rothstein, Robert L . Lamd, Thomas P. Mayhew (1987), Clinical uses of Isokinetic measurements, Physical Therapy, 67;1840 – 44
- Davie G.,Kevin E. Wilk (1988), Isokinetic Testing and Exercise for the knee, Physical Therapy of the knee, 2nd Edition, Churchill Livingstone 262 – 288
- Joseph J. Knapik, Roberta H. Mawdsley (1982), Comparison of Isokinetic measurements with test repetitions, Physical Therapy, 62; 169 – 172.
- Johnson R, Wilk K (1988), Leverarm length relative to peak torque production of knee musculature, Physical Therapy, 68;779
- Michael Fillyaw, Thomas Bevins, Lisa Fernandez (1986), Importance of correcting Isokinetic peak torque for the effect of gravity when calculating knee flexor to extensor muscle ratios, Physical Therapy, 66; 23 – 31
- Hakan Giir, Nilgiin Cakin (2003), Muscle Mass, Isokinetic torque and functional capacity in women with Osteoarthritis of the knee, Arch Phys Med Rehabil, 84; 1534 – 41
- Negil A. S. Taylor, Ross H Sanders, E. Ian Howick, Stephen N. Stanley (1990), Static and dynamic assessment of the Biodex dynamometer, Eur J Appl Physiol, 62; 180 – 88
- Marjorie R. Wilhite, Ellen R. Cohen, Stephen C. Wilhite (1992), Reliability of concentric and eccentric measurements of quadriceps performance using the kincom dynamometer: The effect of testing order for 3 different speeds, J Orthop sports Phys Ther 15; 175 – 82
- Stephen P. Messier, Richard F. Loeser, Jacqueline L. Hoover, Christopher M. Wise (1992), Osteoarthritis of the knee: Effects Gait, Strength and flexibility, Arch Phys Med Rehabil, 73; 29 – 36
- Gustaf J. Lankherst, Rob J. Vandestadt (1985), the relationships of functional capacity, pain and Isometric and Isokinetic torque in osteoarthritis of the knee, Scand J Rehad Med, 17;167 – 72
- Mark F Reinking, Teddy Worrell, Jack Farr (1996), Assessment of quadriceps muscle performance by Hand held, Isometric and Isokinetic dynamometry in patients with knee dysfunction, J Orthop Sports Phys Therapy, 24,;154 – 159
- Kenneth D. Brandt, Charles Slemenda, Steven Mazzuca (2000). A comparison of lower extremity muscle strength, obesity and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis, The Journal of Rheumatology, 27;1937 – 46
- Charles Slemenda, Douglas K. Heilman, Barry P. Katz (1997), Quadriceps weakness and osteaoarthritis of the knee, Annals of Internal Medicina, 127;97 – 104
- Lars Olof Nordesjo, Bengt Nordgren (1983), Isometric Strength and endurance in patients with severe rheumatic arthritis or osteoarthritis in knee joints, Scand j Rheumatology, 12; 132 – 136
- Jale Tan, Nilufer Balci, Vesile Sepici (1995), Isokinetic and Isometric strength in osteoarthritis of the knee, Am J. Phys. Med. Rehabil, 74;364 – 369
- Moskowitz RW (1993) Clinical and laboratory findings is osteoarthritis, in: Mc Carthy DJ, Koopman WJ, Arthritis & allied conditions, Philadelphia, 1st Edition, 1735 – 59
- Pai Y – C, Chang HJ, Sinacore JM (1994), Alterations in multi joint dynamics in patients with bilateral knee osteoarthritis, J. Orthop Sports Phys Ther, 19;60 – 61
- David C. Feiring, Todd S. Ellenbecker (190), Test restest reliability of the Biodex Isokinetic Dynamometer J Orthop sports Phys Therapy, II, 298 -300
- Charles Slemenda, Douglas K. Heilman, Barry P. Katz, Donna Byrd (1998), Reduced Quadriceps strength relative to body weight, Arthritis & Rheumatism 41; 1951 –59.
- David A. Klopffer, Steven D. Greij (1988), Examining Quadriceps / Hamstring performance at high velocity Isokinetics in untrained subjects, J Orthop Sports Phys Ther, 10;18 –21
- Richard W. Bohannon, Richard L. Gajdosik, barney F. Leveau (1986), Isokinetic knee flexion and extension torque in the upright sitting and semireclined sitting positions, Physical Therapy, 66; 1083 – 86
- I) Todd John Tredinnick, Pamela W. Duncan (1988), Reliability of measurements of concentric and eccentric isokinetic leading, Physical Therapy, 68;656 – 659 II) Magnusson P, Geisman R, Nicholas J (1992). The effect of Trunk Stabilization on knee extension / flexion Torque Production, J Orthop Sports Phys Therapy, 15;51 – 52.
- Vasilios Baltzopoulos, John G. Williams, David A Broadie (1991), Sources of error in Isokinetic dynamometry: Effects of visual feedback on maximum torque measurements, J Orthop sports Phys Ther, 13; 138 – 142
- Janet P. Lord, Susan G. Aitkens (1992), Isometris and Isokinetic measurement of Hamstring and Quadriceps Strength, Arch Phys Med Rehabil, 73; 324 – 330
- Thorsten Ingemann, hansen and Jens Halkjaer (1979), Force velocity relationships in the human quadriceps muscles, Scand J Rehab med 11; 85 – 89
- David R. Ghena, Amy L. Kurth, Martha Thomas (1991), Torque characteristics of the quadriceps and hamstring muscles during concentric and eccentric loading; J Orthop Sports Phys Therapy, 14;149 – 167
- Teddy W. Worrell, David H. Perrin (1989), The influence of hip position on quads & names peak torque and reciprocal muscle group ratio values, J Orthop sports phys Therapy, 11; 104 – 107
- Joseph J. Knapik, James E Wright. Joanne Braun (1983), Isometric, Isotonic and Isokinetic torque variations in 4 muscle groups through a range of joint motion, Physical Therapy, 63; 938 – 47
- Alf Thorstensson, Gunnar Grimby (1976), Force Velocity Relations & fiber composition in human knee extensor muscles, J Applied Physiology, 40 (1);12 – 16
- Hill LD, Gillaspie DM (1988), Examining Quadriceps / Hamstrings performance at high velocity Isokinetics in untrained subjects; J Orthop sports Phys Therapy, 10; 18 –22
- Thorstenson A, Larsson L, Tesch P (1977), Muscle strength and fiber composition in athletes and sedentary men, Med Sci Sports Exerc, 9;26 – 30
- Kannus P (1988), Ratio of hamstring to quadriceps femoris muscles strength in the anterior cruciate ligament insufficient knee Phys Therapy, 68; 961 – 965 74. D.A.Winter, R.P.Wells,G.W.Orr (1981), Errors in use of Isokinetic Dynamometers,Eur J Appl Phsiol, 46; 397- 408
- T.Brock Symons, Anthony A.Vandervoort(2005), Reliability of single session isokinetic and Isometric Strength measurement protocol in older men, Journal of Gerontology, 60A; 114-119.
- Altman RD, Meenan RF, Hochberg MG (1983), An approach to developing criteria for the clinical diagnosis and classification of Osteoarthritis, Journal of Rheumatology, 10;180-83
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