Immediate Effects of Simple Quadriceps Exercises in Osteoarthritis Knee Pain among Overweight Individuals M. Karthikeyan, R.Lavanya Ashitha 2, Prof. V. P. R Sivakumar 3 Assistant Professor, SRM College of Physiotherapy SRM Institute of Science and Technology, Kattankulathur-6322, Tamil Nadu, India 2 Student, SRM Institute of Science and Technology, Kattankulathur-6322, Tamil Nadu, India 3 Dean, SRM College of Physiotherapy, SRM Institute of Science and Technology, Kattankulathur-6322, Tamil Nadu, India Abstract:- BACKGROUND: OBJECTIVE: The aim of the study is to immediate effects of simple quadriceps exercises in osteoarthritis knee pain among overweight individuals. STUDY DESIGN: Quasi- experimental. METHODS: This experimental study was conducted on 3 male and female patients (aged above 6 years) s. 3 subjects were divided into 2 groups, the outcome measures, grip strength was measured using handheld dynamometer and hand function using Michigan hand outcome questionnaire. RESULTS: There is a statistical significance on comparison of pre and post mean values of functional task exercises group on grip strength measurements of both hands( Right p=., Left p=.) and 3 components of Michigan hand outcome questionnaire (OAHF: over all hand function(p=.2), ADL: activity of daily living (p=.) and work(p=.). The comparison of pre and post mean values of resistance exercises group also shows statistically significant effect on grip strength measurements of both hands ( Right p=., Left p=.) and 4 components of Michigan hand outcome measure questionnaire (OAHF: over all hand function(p=.), ADL: activity of daily living(p=.2),work(p=.5) and satisfaction (p=.5). But there is no statistical significance on comparing the post test mean values of hand grip strength and Michigan Hand Outcome measure Questionnaire between both the functional task exercises (Group A) and resistance exercises (Group B). CONCLUSION: There is no statistically significant difference between functional task exercises and resistance exercises in improving the grip strength and hand function in elderly population. Key words: Michigan hand outcome questionnaire, Functional tasks training, Resistance exercise O I. INTRODUCTION steoarthritis is a highly prevalent joint disorder estimated to affect more than 37% of adults over the age of 3-6 ; It is a leading cause of pain and disability. Osteoarthritis is associated with considerable loss in productivity and healthcare expenditures, accounting for 97% of the total knee replacements and 83% of the total hip replacements in 24 2.The frequency of knee osteoarthritis continues to accelerate, likely because of the aging of the population and the increasing proliferation of the primary risk factor, obesity. However, these are special cases, and for the majority of people who are overweight the excess weight is due to excess body fat. For adults, the following classification is used by the World Health Organization to indicate the overweight and obese: Weight status BMI (kg/m2) Underweight below 8.5 Normal range 8.5 24.9 Overweight 25 29.9 Obese Morbidly obese 3 and above 4 and above There is an increasingly greater proportion of the total population, worldwide 3, over age 3-6, the age range typically associated with having osteoarthritis. Although the prevalence of obesity is rising in this elderly segment of the population, it is the escalating prevalence of obesity in those men and women aged 3 6 years, who are simultaneously the major contributors to the osteoarthritis population.excessive loading of the joint is the most important means by which obesity causes osteoarthritis. It is in the weight-bearing joints - the knee and to a lesser extent the hips - that obese individuals are most at risk of developing osteoarthritis. Because of the way the knee joint works, the effect of excess weight can be four or five times greater in key parts of the joint so that even modest weight gain speeds up the breakdown of cartilage and increases susceptibility to osteoarthritis. At the same time, poor posture and unhealthy gait are more common in obese people, further predisposing the joints to osteoarthritis. Non-weight bearing joints such are also marginally affected by obesity. This suggests that excess weight causes additional damage through a separate pathway, probably by raising blood glucose and insulin levels, thereby increasing inflammation of the joint. Once entrenched, osteoarthritis is likely to have the effect of further reducing www.rsisinternational.org Page 54
activity, bringing about increased weight gain. As well as worsening osteoarthritis symptoms, this further increase in weight will also raise the risk of developing other obesityrelated diseases. Obesity has long been recognized as a risk factor for prevalent osteoarthritis, especially knee osteoarthritis [4 9] although the obesity definition based on a BMI more than 3 kg/m 2 was not widely adopted until the 99s []. Similarly, a study of US African-American and Caucasian women identified higher risk of prevalent knee osteoarthritis with higher BMI levels [2]. Longitudinal studies show that increased weight precedes the presentation of Osteoarthritis Knee ; in a longitudinal study of men and women aged 4 64 years, Manninen et al. [8] reported that for every standard deviation increase in BMI (3.8 kg/m 2 ), there was a 4% increased risk [relative risk (RR) =.4; 95% confidence interval (CI).2.5] for developing Osteoarthritis Knee. Other clinical trials have shown that weight loss, particularly when combined with an appropriate exercise programme, greatly improves the symptoms of osteoarthritis, in some cases equaling the benefits of joint replacement surgery. Such drastic measures are not appropriate for everyone with an obesity problem. Yet anyone whose weight problem puts them at risk of developing or worsening the symptoms of osteoarthritis deserves appropriate help and support through counseling or another weight loss programme. Dysregulation of lipid homeostasis is one of the mechanisms leading to osteoarthritis Osteoarthritis is usually considered to be a joint disorder the central pathological feature of which is cartilage destruction. Osteoarthritis is generally regarded as a disease that may affect the whole joint (bone, muscles, ligaments and synovium). Although the etiology of osteoarthritis is not established, the main risk factors are well known and commonly include mechanical, biochemical and genetic factors. Of these risk factors, obesity is beyond doubt considered a prominent one. A series of studies show that even modest weight loss, when combined with exercise, reduces pain in obese patients with knee osteoarthritis, as well as improving mobility and physical functioning. For instance, gradually losing just five to ten per cent of initial body weight over several months is worthwhile; for each pound lost, there is a reduction in pain and disability caused by knee osteoarthritis. II. AIM OF THE STUDY Aim of the study is to find out the immediate effects of simple quadriceps exercises in Osteoarthritis knee pain among overweight individuals. III. NEED FOR THE STUDY To find the effectiveness of simple quadriceps exercises in over weight individuals with osteoarthritis knee pain for 2weeks duration. NULL HYPOTHESIS III. HYPOTHESIS There is no significant effect of Short Term simple Quadriceps exercise in osteoarthritis knee pain among over weight individuals ALTERNATE HYPOTHESIS There is significant effect of Short Term simple Quadriceps exercise in osteoarthritis knee pain among over weight individuals. IV. METHODOLOGY STUDY DESIGN : Quasi- Experimental STUDY TYPE : Pre - Post test SAMPLING METHOD : Convenient Sampling SAMPLE SIZE : 3 STUDY DURATION : 2 weeks STUDY SETTING : i ) SRM Medical College Hospital & Research Centre, Kattankulathur. ii )Venkateswara physiotherapy Clinic, Ashok nagar, Kancheepuram Inclusion criteria for the study are as follows Age : 35-6 Clinically diagnosed Osteoarthritis knee pain patients. Body mass index : 25 22.9 Both males and females Subjects those who are willing to participate in the study. VAS 3-6 Exclusion criteria for the study are as follows Procedure Any unhealed fracture at lower extremities. Ligament injury of lower extremities. Acute and inflammatory conditions of knee. Any recent surgery in and around knee. 45 subjects were screened out of which 3 subjects were selected from SRM College of Physiotherapy and Venkateswara physiotherapy clinic, Kancheepuram based on the inclusion an exclusion criteria. The detailed explanation about the procedure and the effectiveness of reducing pain in Osteoarthritis knee was explained to the subjects. Informed www.rsisinternational.org Page 55
consent was obtained from the subjects who were willing to participate in the study. The Subjects pre test score of WOMAC questionnaire and visual analogue scale was assessed prior to intervention. Womac questionnaire of pain, stiffness and disability assessment and visual analogue scale was taken as the outcome measure to find out the effectiveness of exercise on osteoarthritis knee in obese individuals. Subjects underwent a therapeutic exercise protocol of 25-3 minutes every day for a period of 2 weeks which included Active Straight leg Raise Exercise Sets Repetations Isometric exercises 3 sets reps Resisted exercises 3 sets reps Theraband exercises 3sets reps Straight leg raise 3 sets reps After the end of 2 weeks, the post test measurement of Womac questionnaire and Visual analogue scale was taken. Methods ISOMETRICS: Ask the Patient to lie in supine position, therapist places a towel roll under the patient s knee and command the patient to press the towel with the knee. Hold it for to 5 seconds. RESISTED EXERCISES: Ask the patient to lie in supine position and the patient is asked to raise the leg while the therapist gives resistance against the movement of the patient.hold it for -5seconds and relax. THERABAND EXERCISES: Ask the patient to sit with the back support and one end of theraband is tied on the leg of the chair and another end is tied the patient s leg. STRAIGHT LEG RAISE: Ask the patient to raise the leg actively and the therapists give the instructions to hold and relax. Hold it for -5 seconds. Isometric Exercises Outcome Measures Table : Variable name VAS WOMAC questionnair e WOMAC Questionnaire. Visual analogue scale. Mean V. DATA ANALYSIS Standard deviation Pre Post pre post 5.466 2.664.8 63.62 Pre Post pre post 58.6 7 4.8 4.7 34 5.8 2 Df 29 29 t value 37.6 8 4.93 sig p> (.57).. P<.5, this table shows that there is significant difference between pre test and post test of VAS and WOMAC questionnaire scores in the Experimental Group. GRAPH a : Comparison of the pre and post mean values of the visual analogue scale 6 5 4 3 2 PRE POST VAS www.rsisinternational.org Page 56
GRAPH b : Comparison of the pre and post values of mean of the WOMAC questionnaire scores for pain, stiffness and physical disability. 6 5 4 3 2 PRE WOMAC VI. RESULT Table : This table shows the pre and post values of the mean an standard deviation of the visual analogue scale and the womac questionnaire. The mean values of Visual analogue scale and the womac questionnaire for the baseline measurement (pre-test) was insignificant (p>.5). There was significant improvement in the VAS an WOMAC questionnaire post-test scores (p<.5). The statistical difference between pre and post treatment results was significant in favour of the group (p=.). The average improvement in the VAS and womac quesstionaire tend to being highly significant in the group. GRAPH a : This graph shows the comparison of the pre and post mean values of the Visual analogue scale. GRAPH b : This graph shows the comparison of the pre and post mean values of the WOMAC questionnaire scores of pain, stiffness and physical disability. VII. DISCUSSION POST Amongst adults without knee pain, those who were obese were nearly three times more likely than those of normal weight to develop severe knee pain in a subsequent three-year period. Including progression from non-severe pain, almost one-fifth of all new cases of severe knee pain in people aged 5 years and over in a three-year period could be avoided if excess weight was prevented. and effects of quadriceps exercises on osteoarthritis knee pain. 3 subjects more selected above the age of 35 both male and female 7 female and 3 male were selected and isometric exercise, resisted exercise with theraband,slr(straight leg raise) exercise were taught to the subjects. these were done by subjects under the superficient student therapist.which was done for 2 weeks. All 3 subjects completed 2weeks of Intervention and there were no dropouts. Ask the subjects to fill the WOMAC and VAS measured before intervention started. Again assest the WOMAC and VAS and data given for analysis. The data were analysed spss 7. version using paired t test. This table shows the pre and post values of the mean an standard deviation of the visual analogue scale and the womac questionnaire. The mean values of Visual analogue scale and the womac questionnaire for the baseline measurement (pre-test) was insignificant (p>.5). There was significant improvement in the VAS an WOMAC questionnaire post-test scores (p<.5). The statistical difference between pre and post treatment results was significant in favour of the group (p=.). The average improvement in the VAS and womac quesstionaire tend to be highly significant in the group. GRAPH a: This graph shows the comparison of the pre and post mean values of the Visual analogue scale. GRAPH 2b: This graph shows the comparison of the pre and post mean values of the WOMAC questionnaire scores of pain, stiffness and physical disability shows that there is significant P Value (p<..) before and after simple quadriceps exercise for overweight individuals with osteoarthritis knee pain. VIII. LIMITATIONS AND RECOMMENDATIONS LIMITATIONS: Study duration was less. There was no Control Group. Sample size was small. RECOMMENDATIONS: Comparative studies between right and left extremities. Comparative studies could be done between diabetes and non diabetes individuals. IX. CONCLUSION The Study concludes that there is reduction of pain and immediate effect of simple quadriceps in Osteoarthritis knee pain, among over weight individuals. REFERENCES []. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 998; 4:778 99. World Health Organization. WHO Technical Report Series (99): the burden of musculoskeletal conditions at the start of the new millenium. 23. Collerton J, Davies K, Jagger C, Kingston A, Bond J, Eccles MP, et al. Health and disease in 85 year olds: baseline findings from the Newcastle www.rsisinternational.org Page 57
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