Res. J. Sport. Sci. Vol., 1 (2), 45-49, 2013

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1 Improvement of Pain, Postural Control and Mobility in Men Patients with Knee OA after a Period of Water Exercise program RJSS RESEARCH Vol 1 (2): ISSN: Copyright 2013 JOURNAL OF SPORT SCIENCES Gharehlar Mahdieh 1*, Ahmadi Yaser 2, Norollah-Najafabadi Mahnaz 3, Moin Farzaneh 4, Rahbari Somayeh 4 1 Department of Physical Education and Sport Science, Urmia Branch, Islamic Azad University, Urmia, Iran 2 Department of Physical Education and Sport Science, University of Tehran, Tehran, Iran 3 Department of Physical Education and Sport Science, Isfahan University of Technology, Isfahan, Iran 4 Department of Physical Education and Sport Science, Najafabad Branch, Islamic Azad University, Najafabad, Iran * Corresponding Author m_gharehlar57@yahoo.com ABSTRACT The aim of this study was to investigate the effects of 8 weeks water exercise on pain, postural control and mobility in patient with over 8 months knee OA. 27 men over 60 years old with knee OA on preferred foot voluntarily participated in present study. Based on the preliminary examination and pretest, the subjects were divided by random matching into 2 homogeneous groups: 1) deep-water exercise (N=14), and 2) control group (N=13). Mobility was evaluated by dynamometer. Using Romberg test and KOOS questionnaire the Static Balance and Pain were evaluated respectively. Data were analyzed using independent t test and paired samples t test at p<0.05 significance level. Pain, postural control and mobility improved significantly in deep water group more than control group (p=0.0001, p=0.02 and p=0.008 respectively). Water exercise is recommended to rehabilitate the patients suffering from knee OA. KEYWORDS Pain, Postural Control, Mobility, Deep Water, Knee OA INTRODUCTION Osteoarthritis is a widespread disease among patients over 60 years (Felson, Naimark, Anderson, Kszis, Castelli, Meena., 1987), which causes destruction of cartilages and reactive changes in borders of joints and in subchondal bone (Forghanizadeh, 1987). The clinical manifestations are ongoing arthralgia, joint stiffness, and limited movements and impaired balance (Forghanizadeh, 1987). Knee OA associated with pain and stiffness of the joint, disability (Bruce, Peck, 2005; Brosseau, Pelland, Wells, 2004; Foley, Halbert, Hewitt, Crotty, 2003), impairment of the proprioceptive system (Garsden, Bullock-Saxton,1999; Sharma, Pai, Holtkamp, Rymer,1997) difficulties of the knee motion and postural control and then decline ability to perform simple daily activities(kaufman, Hughes, Morrey, Morrey, An, 2001). Furthermore, lack of proprioceptive feedback due to knee injuries could lead to improper and/or overload to joints. In addition, a capsule injury not only cause distortion in transmission of afferent signal from joints, but also more importantly could lead to change in coding of afferent nerve signal to central nervous system (Prentice, 2001). Also, osteoarthritis can affect ligaments, the joint capsule, muscles and 45

2 tendons (Barrett, Cobb & Bentley, 1991; Hurley & Newham, 1993). This in turn causes swelling, joint deformity, limitation of motion, decrease in muscle strength, damage in proprioceptive system, and ultimately to increase the level of pain. Kind of exercises to help arthritis sufferers can manage their conditions and improve their daily function is training in the water. Studies showed that various kind of exercise are important for flexibility and balance improvement in knee OA patients (Messier, Royer, Craven, O Toole, Burns, Ettinger, 2000; Wang, Belza, Thompson, Whitney, Bennet, 2007). However, because of advantages of water, exercise in the water recommended for the rehabilitation of these patients (Cochrane, Davey, Matthes Edwards, 2005; Foley, Halbert, Hewitt, Crotty, 2003). Hence, the objective of present study was to examination the effects of water exercise on pain, mobility and static balance in male with chronic Osteoarthritis. MATERIALS AND METHODS Originally, 27 men patients who had knee OA on preferred foot participated in present study. They were selected from among patients who had been diagnosed with chronic knee OA that suffered over 8 months. Based on the preliminary examination and pretest, the subjects were divided by random matching into 2 homogeneous groups: 1) deepwater exercise program (N=13, age: 58.11±5.47 year; height: ±6.11 cm. weight: 72.2±10.18 kg; BMI: 26.37±4.09 kg/m2, BFP: 31.98±6.21), and 2) control group (N=14, age: 55.41±6.03 year; height: ±5.09 cm; weight: 70.12±11.61 kg ; BMI: 24.77±4.21 kg/m2, BFP: 31.77±6.93) without intervention. There was no statistical significant between groups on BMI and BFP (p=0.4, P=0.8). It means two groups are homogenous. The water exercise program include one hour of exercises was performed three session per week on experimental groups underwent a 8 weeks period. The protocol of water exercise described by Zamanian et al (2013) was used. Pain of knee with OA was evaluated using the KOOS questionnaire. The KOOS's five patientrelevant dimensions are scored separately: Pain (nine items); Symptoms (seven items); ADL Function (17 items); Sport and Recreation Function (five items); Quality of Life (four items). A Likert scale is used and all items have five possible answer options scored from 0 (No problems) to 4 (Extreme problems) and each of the five scores is calculated as the sum of the items included. Scores are transformed to a scale, with zero representing extreme knee problems and 100 representing no knee problems as common in orthopedics scales and generic measures. Scores between 0 and 100 represent the percentage of total possible score achieved. Scores near to zero refer to more painful status and lower quality of life (Roos et al., 1998). Postural control was evaluated using a One-Leg Balance with open eyes test (Romberg test). The participant stands on the preferred foot with knee OA while resting the hands at waist level and then raises the other foot approximately 10 cm off the floor. Balance is scored by the number of seconds for which the foot is kept raised or until balance is lost. Timing is terminated with touch the floor by the free foot, take hands away from the hips, move the support foot from the initial place, and hook the free foot behind the supporting foot (Rogers, Rogers, Takeshima, Isam, 2003). Mobility was measured by a goniometry. This testing procedure used in this study has been described by Luttgens and Hamilton (1997). Data were analyzed using independent t test for comparisons between groups and paired samples t test for comparison within groups at p<0.05 significance level. The data were analyzed using the statistical package SPSS, PC program, version 15.0 (SPSS Inc., USA). RESULTS Table 1 shows the data in pre test and post test of the knee pain in Deep-water exercise group and Control group. Independent t test showed that the pain rate in water exercise group improved more than control group (p<0.001). 46

3 Table1. Data in pre test and post test of the study for: Rate of Knee Pain (KOOS questionnaire (Section Pain). Groups Measurements P Experimental 33.56± ± Control 33.42± ± Table 2 shows the descriptive data of static balance in pretest and posttest of two groups. Table 2. The descriptive data of postural control (second) in pre-test and post-test. Groups Measurements Percentage of changes Experimental 28.13± ± % * Control ± ± % * Significant at p 0.05 Table 2 depicts that static balance in experimental group increased significantly about 38.49% after water exercise (p<0.05). Also, it improved significantly in water exercise group more than control group (p=0.02). Table 3 shows the descriptive data of mobility of the knee joint with OA in pretest and posttest of two groups. Table 3. The descriptive data of mobility in pre-test and post-test. Groups Measurements Percentage of changes Experimental 115± ± % * Control 116.6± ± % * Significant at p 0.05 Table 3 depicts that mobility in experimental group increased significantly about 11.03% after water exercise (p<0.05). Also, it improved significantly in water exercise group more than control group (p=0.008). DISCUSSION AND CONCLUSION This study showed that a program of aquatic exercise in deep water during a period of 8 weeks was effective in improving the static balance (open eyes position), range of motion of the knee and pain of knee in the men with knee OA. It seems that For old people and those who have pain because of osteoarthritis and cannot exercise on land, water prepares a good environment for movement and relaxation. It seems that painless movement in water allows the patient to achieve more success in comparison to exercise on land, and this increases the self-confidence of the person. The fear of fall and injury to damaged parts of body is lower in the water. Therefore it is thought that the patient takes more advantage in water, especially patient with the lower body injuries, to regain balance and proprioception. Because, extension in the reaction time (Winter, 1990) allows them (people unable to maintain balance) to get to understand their posture mistakes. In fact, sense of hydrostatic pressure of water all over the body creates a feeling of stability (Genuario & Vegaso, 1990; Thein & Brody, 1998) for the patient. 47

4 Numerous studies revealed that physical exercise in water could lead to a improvement in static balance (e.g. Zamanian et al., 2012; Roth et al., 2006; Yennan et al., 2010; Sadeghi & Alirezaei, 2007). Results on mobility showed that water exercise improved ROM. buoyancy in water environment keep up the body against gravity and help to feel weight loss (Genuario, Vegaso, 1990; Thein & Brody, 1998). Consequently, it decreases the feel of pain of the knee joint with OA. Therefore, patients are able to do exercise in aquatic environment with further range of motion. Therefore, buoyancy help patient to do exercise with maximum their exertion in the water. These advantages of water and better training in the water lead to improve postural control, mobility of the knee joint and then decrease the pain. In general, the results of this study showed that exercise in deep water of 8 weeks has significant impact on improving static balance and mobility and pain in elderly male with knee OA. Hence, Deep water exercise appears to be a safe and an effective treatment modality for elderly men with knee OA to diminish the knee pain and improve postural control and range of motion of knee. REFERENCES Barrett DS, Cobb AG, Bentley G, Joint proprioception in normal, osteoarthritis and replaced knees. Journal of Bone & Joint Surgery. 73(B): Brosseau L, Pelland L, Wells G, et al, Efficacy of aerobic exercises for osteoarthritis (part II): a meta-analysis. Physical Therapy Reviews. 9: Bruce ML, Peck B, New rheumatoid arthritis treatments. Holistic Nursing Practice. 19(5): Cochrane T, Davey RC, Matthes Edwards SM, Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis. Health Technol Assess. 9: Felson DT, Naimark A, Anderson J, Kszis L, Castelli W, Meenan EF, The Prevalence of knee osteoarthritis in the elderly. Arthritis & Rheumatology. 30: Foley A, Halbert J, Hewitt T, Does hydrotherapy improve strength and physical function in patients with osteoarthritis: a randomized controlled trial comparing a gym based and a hydrotherapy base strengthening programme. Annals of Rheumatic Diseases. 62(12): Forghanizadeh J, The basic principle of Rheumatic diseases. Publication: Jahade daneshgahi. Garsden LR, Bullock-Saxton JE, Joint reposition sense in subjects with unilateral osteoarthritis of the knee. Clinical Rehabilitation. 13: Genuario SE, Vegaso JJ, The use of a swimming pool in the rehabilitation and reconditioning of athletic injuries. Clin Orthop. 20(4): Hurley MV, Newham DJ, The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritis knees. British Journal of Rheumatology. 32(2): Kaufman KR, Hughes C, Morrey BF, Morrey M, An K, Gait characteristics of patients with knee osteoarthritis. Journal of Biomechanics. 34: Luttgens K, Hamilton N, Kinesiology: Scientific Basis of Human Motion. 9th Edn. Brown and Benchmark, Madison, W.I. Messier SP, Royer TD, Craven TE, O Toole ML, Burns R, Ettinger WH Jr, Long-term exercise and its effect on balance in older, osteoarthritic adults: results from the fitness, arthritis, and seniors trial (FAST). Journal of American Geriatrics Society. 48: Prentice WE, Rehabilitation Techniques in Sport Medicine. 5 th Edn. New York: McGraw-Hill Rogers ME, Rogers NL, Takeshima N, Isam MM, Methods to assess and improve the physical parameters associated with fall risk in older adults. Preventive Medicine. 36:

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