Document Type : Original Articles
Authors
- Sara Abolahrari Shirazi 1
- Farahnaz Ghafari Nezhad 1
- Maryam Ebrahimian 1
- Elham Nouraddini 2
- Azadeh Mansoorian 2
- Farahnaz Emami 3
1 PhD candidate ,Center for Human Motion Science Research, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
2 B.Sc , Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
3 PhD candidate, Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Abstract
Background: Osteoarthritis is one of the most common diseases in synovial joints. Dueto high loading forces during weight-bearing activities, the knee joint is prone to degenerative processes. This study aimed to compare the flexibility of muscles around the knee joint in patients with knee osteoarthritis with those of healthy individuals.Methods: Twenty-three women with bilateral knee osteoarthritis and 23 healthy women matched with the patient group for age, height and weight participated in this study. Flexibility of the quadriceps, hamstring, iliotibial band, adductor and gastrocnemius muscles was evaluated with a goniometric device. Pain intensity was assessed with a visual analogue scale. The data were analyzed with independent t-tests to compare the two groups, and Pearson correlation coefficient was calculated to correlate muscle flexibility and pain intensity.Results: significant lower flexibility of the bilateral quadriceps muscles was found in patients compared to healthy women (P<0.05). No significant differences were detected between groups regarding other muscles. Quadriceps flexibility correlated significantly with pain intensity in patients (P<0.001).Conclusion: In patients with osteoarthritis, quadriceps flexibility may be decreased although other muscles may remain unaffected. Quadriceps stretching is thus a potentially important component of treatment, which may influence pain reduction in these patients.
Keywords
- Pollard H, Ward G, Hoskins W, Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. The Journal of the Canadian Chiropractic Association. 2008;52(4):229.
- Bruyère O, Ethgen O, Neuprez A, Zegels B, Gillet P, Huskin J-P, et al. Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study. Archives of orthopaedic and trauma surgery. 2012;132(11):1583-7.
- McCarthy C, Dieppe P. Taping the patella medially: a new treatment for osteoarthritis of the knee joint? Bmj. 1994;308(6931):753-5.
- Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Annals of internal medicine. 2000;132(3):173-81.
- Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clinics in geriatric medicine. 2010;26(3):355-69.
- Kaur M, Paul R, Kumar S, Arora R, Arora L. A Randomized Controlled Trial to Compare the Effectiveness of Static Stretching Versus PNF Stretching of Hamstring Muscles Following Superficial Heat in Athletes.2014;7(4);1-4.
- Smith AD, Stroud L, McQueen C. Flexibility and anterior knee pain in adolescent elite figure skaters. Journal of Pediatric Orthopaedics. 1991;11(1):77-82.
- Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach: Human Kinetics; 2010:43-44.
- Hollinger H. The Effect of Stretching and Strengthening on Patellofemoral Pain Syndrome. 2014. [Thesis]
- Bennell KL, Hunt MA, Wrigley TV, Lim B-W, Hinman RS. Role of muscle in the genesis and management of knee osteoarthritis. Rheumatic Disease Clinics of North America. 2008;34(3):731-54.
- Gardner JK, Zhang S, Liu H, Klipple G, Stewart C, Milner CE, et al. Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis. Clinical Biomechanics. 2015;30(3):276-82.
- Conroy MB, Kwoh CK, Krishnan E, Nevitt MC, Boudreau R, Carbone LD, et al. Muscle strength, mass, and quality in older men and women with knee osteoarthritis. Arthritis care & research. 2012;64(1):15-21.
- Childs JD, Sparto PJ, Fitzgerald GK, Bizzini M, Irrgang JJ. Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis. Clinical biomechanics. 2004;19(1):44-9.
- Goldblatt JP, Richmond JC. Anatomy and biomechanics of the knee. Operative Techniques in Sports Medicine. 2003;11(3):172-86.
- Pappas E, Wong-Tom WM. Prospective Predictors of Patellofemoral Pain Syndrome A Systematic Review With Meta-analysis. Sports Health: A Multidisciplinary Approach. 2012;4(2):115-20.
- Barrios JA, Crenshaw JR, Royer TD, Davis IS. Walking shoes and laterally wedged orthoses in the clinical management of medial tibiofemoral osteoarthritis: a one-year prospective controlled trial. The Knee. 2009;16(2):136-42.
- Pons M, Pasarin A, Garcia J, Viladot B. Therole of quadricepstightness inpatientswith patellar symptoms. Journal of Bone & Joint Surgery, British Volume. 2006;88(SUPP I):104
- Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. Journal of orthopaedic & sports physical therapy. 2005;35(12):793-801.
- Kwon O, Yun M, Lee W. Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. Journal of physical therapy science. 2014;26(7):961.
- Muyor JM, Lopez-Miñarro PA, Casimiro AJ. Effect of stretching program in an industrial workplace on hamstring flexibility and sagittal spinal posture of adult women workers: a randomized controlled trial. Journal of back and musculoskeletal rehabilitation. 2012;25(3):161.
- Mandeep Kaur RP, Sandeep Kumar,Reena Arora, Lalit Arora. A Randomized Controll Trial to Copmared the effectiveness of static stretching versus PNF streching of Hamstring Muscles Following superficial Heat in Athletes. International Journal of Scientific and Research Publications. 2014;4(7):1-4.
- Dixon SJ, Hinman RS, Creaby MW, Kemp G, Crossley KM. Knee joint stiffness during walking in knee osteoarthritis. Arthritis care & research. 2010;62(1):38-44.
- Oatis CA, Wolff EF, Lockard MA, Michener LA, Robbins SJ. Correlations among measures of knee stiffness, gait performance and complaints in individuals with knee osteoarthritis. Clinical Biomechanics. 2013;28(3):306-11.
- Petersson IF, BoegÃ¥rd T, Saxne T, Silman AJ, Svensson B. Radiographic osteoarthritis of the knee classified by the Ahlbäck and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35â54 years with chronic knee pain. Annals of the rheumatic diseases. 1997;56(8):493-6.
- Sacco I, Alibert S, Queiroz B, Pripas D, Kieling I, Kimura A, et al. Reliability of photogrammetry in relation to goniometry for postural lower limb assessment. Brazilian Journal of Physical Therapy. 2012;11(5):411-7.
- Colby LA, Kisner C. Therapeutic Exercise: Foundations and Techniques: 6 th ed . Phyladelphyia Lippincott. FA Davis Company; 2007.335-336
- White LC, Dolphin P, Dixon J. Hamstring length in patellofemoral pain syndrome. Physiotherapy. 2009;95(1):24-8.
- Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic Risk Factors for Hamstring Injuries Among Male Soccer Players A Prospective Cohort Study. The American Journal of Sports Medicine. 2010;38(6):1147-53.
- O'Hora J, Cartwright A, Wade CD, Hough AD, Shum GL. Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstrings length after a single session. The Journal of Strength & Conditioning Research. 2011;25(6):1586-91.
- Papadopoulos K, Noyes J, Jones JG, Thom JM, Stasinopoulos D. Clinical tests for differentiating between patients with and without patellofemoral pain syndrome. Hong Kong Physiotherapy Journal. 2014;32(1):35-43.
- Herrington L. The effect of pelvic position on popliteal angle achieved during 90: 90 hamstring length test. J Sport Rehab. 2013;22:254-6.
- Forman J, Geertsen L, Rogers ME. Effect of deep stripping massage alone or with eccentric resistance on hamstring length and strength. Journal of bodywork and movement therapies. 2014;18(1):139-44.
- Janda V. Muscle function testing: Elsevier; UK:Butterworths.Elsevie.r;2013.
- Nakase J, Aiba T, Goshima K, Takahashi R, Toratani T, Kosaka M, et al. Relationship between the skeletal maturation of the distal attachment of the patellar tendon and physical features in preadolescent male football players. Knee surgery, sports traumatology, arthroscopy. 2014;22(1):195-9.
- Reese NB, Bandy WD. Joint range of motion and muscle length testing: Elsevier Health Sciences; 2013.573-574.
- Reid D, Burnham R, Saboe L, Kushner S. Lower extremity flexibility patterns in classical ballet dancers and their correlation to lateral hip and knee injuries. The American journal of sports medicine. 1987;15(4):347-52.
- Halabchi F, Mazaheri R, Seif-Barghi T. Patellofemoral pain syndrome and modifiable intrinsic risk factors; how to assess and address? Asian journal of sports medicine. 2013;4(2):85.
- Arab AM, Nourbakhsh MR. The relationship between hip abductor muscle strength and iliotibial band tightness in individuals with low back pain. Chiropractic & osteopathy. 2010;18(1):1.
- Witvrouw E, Werner S, Mikkelsen C, Van Tiggelen D, Berghe LV, Cerulli G. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surgery, Sports Traumatology, Arthroscopy. 2005;13(2):122-30.
- Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic medicine. 2008;7(1):9.
- Hertling D, Kessler RM. Management of common musculoskeletal disorders: physical therapy principles and methods:4th ed.Philadelphia Lippincott .Williams & Wilkins; 2006.525-526.
- Balagopal P, Rooyackers OE, Adey DB, Ades PA, Nair KS. Effects of aging on in vivo synthesis of skeletal muscle myosin heavy-chain and sarcoplasmic protein in humans. American Journal of Physiology-Endocrinology And Metabolism. 1997;273(4):E790-E800.
- Lewek MD, Rudolph KS, SnyderâMackler L. Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis. Journal of Orthopaedic Research. 2004;22(1):110-5.
- Hudson Z, Darthuy E. Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Manual therapy. 2009;14(2):147-51.
- W.W.W Postural Restoration Institute.