Influence of closed Kinematic chain exercise versus open Kinematic Chain Exercise on Q-Angle in subjects with Osteoarthritis Knee

 

Sowmya. M.V1, Shaik Chandbee2, Rahul Dev3

1Assistant Professor, Department of Orthopedics, Saveetha College of Physiotherapy, SIMATS, Chennai, India.

2BPT, Saveetha College of Physiotherapy, SIMATS, Chennai, India

3BPT Final Year, Saveetha College of Physiotherapy, SIMATS, Chennai, India

*Corresponding Author E-mail: Sowmyamv83@gmail.com

 

ABSTRACT:

BACKGROUND: Osteoarthritis knee (OA) has been the most common complaint among men and women. The primary goal for Osteoarthritis (OA) therapy are pain relief and maintenance of joint integrity. OBJECTIVES: To determine the influence of closed kinematic chain exercise versus open kinematic chain exercise on Q-angle in subjects with knee osteoarthritis. METHODOLOGY: 20 subjects were selected from Saveetha College of Physiotherapy by inclusion and exclusion criteria. All these subjects understood the purpose of the study and inform constant was obtained prior to participation. Initially these 20 subjects have been given self assessment osteoarthritis knee. Each subjects have been taken Q-angle measurement by using goniometryand inch-tape. Followed by initial assessment subject with straight leg raises exercise and mini-squat exercise for 20 times twice daily. Post test was done after four week. RESULT From the statistical analysis it shows that the group-A is significantly higher than the group-B, in comparison to both group-A and group-B. CONCLUSION: From the result, the open kinematic chain exercise versus closed kinematic chain exercise on Q-angle in osteoarthritis knee, group-A straight leg raises exercise is more effective than group-B mini-squat exercise.

 

KEYWORDS: Osteoarthritis, knee, Q-angle, closed kinetic.

 

 

 

INTRODUCTION:

Osteoarthritis knee (OA) has been the most common complaint among men and women. Osteoarthritis is a disease that causes degeneration of articular cartilage and bony changes at the joints and is the most common cause of disability. (1) The prevalence of the osteoarthritis knee increases with advancing age. People with knee Osteoarthritis are usually symptoms with knee pain, joint stiffness, decrease of muscle strength, and deficit of proprioception. Subsequently they often have poor neuromuscular control reduced walking speed, decreased functional ability, and an increased susceptibility to fall. Osteoarthritis of the knee typically affects women than men and has a prevalence between 10-15% at age 40 and 35-45% at age 65.(2)

 

 

The primary goal for Osteoarthritis (OA) therapy is pain relief and maintenance of joint integrity, improvement in functional status, and a decrease in deformity and instability. Active modalities such as muscle strengthening exercises have been found to be effective in reducing pain and disability as well as in improving the quality of life and performance of functional tasks in patients with knee osteoarthritis (OA). Exercises to improve muscle strength and joint mobility often require a considerable commitment by patients over long periods of time. However, their efficacy has been proven as previous studies have found that exercise had a small-to-moderate effect on pain, quadriceps strength, and physical function.(3)

 

Muscle weakness, particularly of the quadriceps is one of the earliest clinical signs of knee osteoarthritis and has long been recognized as a hallmark of the disease. In fact, muscle weakness may precede disease onset and play a role in knee osteoarthritis. Since muscle strengthening improves pain and function in knee osteoarthritis strengthening exercise is widely recommended for the condition.(4,5) Closed kinetic chain exercises or closed chain exercises are physical exercise performed where the hand or foot is fixed in space and cannot move. The extremity remains in constant contact with the immobile surface, usually the ground or the base of a machine (6,7,8)

 

Open kinetic chain exercises are exercises that are performed where the hand or foot is free to move. The opposite of open kinetic chain are closed kinetic chain exercises. Both are effective for strengthening and rehabilitation objectives. (9, 10, 11) The Q-angle of the knee is a measurement of the angle between the quadriceps muscles and the patella tendon and provides useful information about the alignment of the knee joint.(12)

 

Straight leg raises and mini-squats are very commonly prescribed exercises to increase the strength and control of the knee muscles.[13] Straight leg raises are a movement with a free distal extremity that improves the strength of the knee muscles and protects the knee joints. Mini-squats target only the knee joint and are performed under weight-bearing or simulated weight-bearing conditions with a fixed distal extremity.

 

MATERIALS AND METHODS:

A total of 200 subjects with Osteoarthritis between the age of 40-65 years, were participated in the study. Subjects were selected from Saveetha Medical College and Hospital. All the subjects were signed an informed consent form approved by the scientific review board and Institutional human Ethical committee at the Saveetha University before participating in the study.

 

Selection criteria for subjects with osteoarthritis

Subjects with age between 40–65years, both male and female will be included, bilateral knee osteoarthritis. chronic osteoporosis, age above 65 years, old fractures, the presence of any causes of secondary osteoarthritis, previous joint surgery, intra articular medications, recent trauma were excluded.

 

PROCEDURE:

After clearing the ISRB by the approval of ISRB committee, the written consent is obtained from subjects. Base line data including age, gender, admission diagnosis, will be assessed one after another receiving the medical request and reference by physician for physical therapy, where required consultant according to first come first preference they are allocated into groups, Whoever fulfills the inclusion criteria’s outcome measures will be taken before and after treatment. Detailed procedure will be explained in subject’s words.

 

According to inclusion and exclusion criteria and based on the 20 subjects with osteoarthritis of knee are selected from Saveetha Medical College and Hospital Physiotherapy out-patient department and Q-angle measured the 20 subjects they are divided into two groups. Group A (n=10) and group B(n=10) by odd or even method. Pre-test measurements for Q-angle of the knee were taken prior to performing exercises. Group A will be trained with open kinematic chain exercise straight leg raises (SLR) exercise and group B will be trained with closed kinematic chain exercise mini-squat (MSE). Post-test measurements were taken to check for the increase or decrease in Q-angle after performing the exercises.

 

To perform these straight leg raises (SLR) exercises, the subjects were in a supine position with their hip and flexed in both extremities while the soles of their feet were on the treatment table. They were asked to extend one leg and hold it with an extended knee until 45 degrees hip flexion for three-four seconds. This exercise is performed 20 times twice daily. Rest period was given for 3-4 seconds for 4 weeks. To perform this mini-squat (MSE) exercise, the subjects were asked to stand on the lower extremity to be exercised and hold onto a stable surface using their hands. Meanwhile the other lower extremity was in 90 degrees hip and knee flexion. The subject was then asked to flex the extended knee 15-20 degrees and hold this position for three-four seconds. Then they brought it to full extension and remained in that position for a three-four seconds rest. This exercise is performed 20 times twice daily for 4 weeks. Q-angle was measured with an inch tape with Subjects supine lying with knee extended. The therapist stands next to subjects. When measuring, ensure that the lower extremity is at a right angle to the line joining each anterior superior iliac spine (ASIS). The foot should be placed in a neutral position relative to supination and pronation with the hip in neutral position relative to medial and lateral rotation. Draw a line from anterior superior iliac spine (ASIS) to the midpoint of patella and then from the midpoint of the patella to the tibial tubercle. The resultant angle formed by the crossing of these two lines is called the Q-angle. Group-A .SLRE- Supine laying position. Extended knee until 45degrees, hip flexion for 3-4seconds. Holding time 3-4 seconds. Rest period is 3-4 seconds. Performed 20 times twice daily. This exercise duration is 4 – weeks. Group-B MSE- Stand on the lower extremity to flex the extended knee. Flex the extended knee 15-20 degrees. Holding time for 3-4 seconds. Rest period is 3-4 seconds. Performed 20 times twice daily. This exercise duration is 4- weeks.

 

RESULTS:

The collected data was tabulated and analyzed using descriptive and inferential statistics. To all parameters mean and standard deviation (SD) was used. Paired t-test will be used to analyze significant changes between pre-test and post-test measurements. Unpaired t-test was used to analyze significant changes between two groups.

The pre-test mean value of MSE is 17.60 (SD 2.50) and pre-test mean value of MSE is 17.30(SD 2.67). This shows that p value (0.7984), not statistically significant.

The pre-test mean value of SLRE is 17.60 (SD 2.50) and post-test mean value of SLRE is 34.50 (SD 3.69). This shows that P value (>0.0001) in SLRE, Extremely statistically significant. The pre-test mean value of MSE is 17.30 (SD 2.67) and post-test mean value of MSE is 24.00 (SD 6.99). This shows that p value (0.0046) in MSE, very statistically significant. The post-test mean value of SLRE is 34.50(SD 3.69) and post-test mean value of MSE is 24.00 (SD 6.99). This shows that P value (0.0005), Extremely statistically significant.

 

 

DISCUSSION:

Various types of exercises have been commonly used and are effective non pharmacological treatment modalities for patients with OA. A more recent study accentuated the fact that exercise is the core component for the management of knee OA. In addition, isometric, isotonic, isokinetic, concentric, and eccentric exercises can be performed in an open or closed kinetic chain manner to increase muscle strength.

 

Our study evaluated the influence of straight leg raises and mini-squats in q-angle, when they were added to a traditional physical therapy program in patients with knee OA. Both type of exercises exhibited that they can be used to reduce pain and stiffness in knee OA. However, after completing an outpatient physical therapy program, continuation of these beneficial effects depends on the patients compliance with exercise at home. Our outcome were examined in relation to previous reports. For example, one study which compared the effects of straight leg raises and mini-squats included patients with patella femoral pain rather than OA patients. the exercise in and of itself might be responsible for all observed treatment effects between the MSE and SLRE groups. Despite the higher average age of our sample, their improvements in strength and pain perception after treatment and at the four-week follow-up were consistent.

 

REFERNCES:

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3.        Behzad Hedari et al (2004) knee OA, Prevalence risk factors, pathogenesis and features.

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12.      Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain: a 5-years prospective randomized study. Am j sports med 2004; 32:1122-30.

13.      Bakhtiary AH, Fatemi E. open versus closed kinetic chain exercises for patellar chondromalacia. Br J Sports Med 2008; 42:99-102.

 

 

 

 

Received on 27.03.2019         Modified on 15.04.2019

Accepted on 20.06.2019         © RJPT All right reserved

Research J. Pharm. and Tech. 2020; 13(4):1813-1816.

DOI: 10.5958/0974-360X.2020.00326.1