The Influence of Arthrogenous Muscle Inhibition on Quadriceps Rehabilitation of Patients With Early, Unilateral Osteoarthritic Knees

Hurley, MV; Newham, Di J.

doi:10.1093/rheumatology/32.2.127

Cited by 223 publications

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“…These results also indicate that the lower the muscle strength, the greater the functional deficit. Although they evaluated subjects with various stages of knee OA, some studies also found a correlation between quadriceps muscle weakness and functional disability 19,32,33 , in agreement with our results.…”

Section: Discussionsupporting

confidence: 91%

Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function

Serrão

Gramani-Say

Lessi

et al. 2012

Rev. bras. fisioter.

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Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function Homens com graus iniciais de osteoartrite apresentam correlação entre torque extensor do joelho e dor, rigidez e função Paula R. M. S. Serrão, Karina Gramani-Say, Giovanna C. Lessi, Stela M. Mattiello AbstractBackground: Osteoarthritis (OA) is a chronic-degenerative disease. The knee is the most commonly affected joint and the symptoms are generally attributed to quadriceps muscle weakness. However, few studies have evaluated this relationship in a population with early stages of knee OA. Objective: To investigate whether a correlation among the knee extensor torque and the three subscales of the WOMAC questionnaire in men with early stages of knee OA exists. Method: Twenty-one men with knee OA grades I or II (according to Kellgren and Lawrence* criteria) participated in this study. The concentric and eccentric knee extensor torque were assessed using a Biodex System 3 Pro ® isokinetic dynamometer, at a speed of 90°/s. Self-reported symptoms and disability were assessed using the WOMAC questionnaire. Spearman's correlation coefficient was used to test the relationship between the dependent variables (three subscales of WOMAC questionnaire) and the independent variables (average knee extensor peak torque). Results: We found a strong negative correlation between the concentric extensor torque and pain (r=-0.7, p<0.001) and a moderate and negative correlation among the concentric extensor torque and stiffness (r=-0.62, p=0.002) and physical function (r=-0.54, p=0.011). Eccentric extensor torque presented a moderate and negative correlation with the three subscales of the WOMAC (r=-0.40 to 0.69, p<0.05). Conclusions: The concentric and eccentric knee extensor torque is significantly correlated with self-report symptoms of patients in initial stages of knee OA. Therefore, the strengthening of the quadriceps muscles, through concentric and eccentric exercise is indicated for these patients in order to minimize these symptoms.Trial registration: number RBR-8q4zfh.Keywords: physical therapy; knee osteoarthritis; WOMAC; muscle strength. ResumoContextualização: A osteoartrite (OA) é uma doença crônico-degenerativa. O joelho é a articulação mais afetada, e os sintomas geralmente são atribuídos à fraqueza do músculo quadríceps. Entretanto, poucos estudos têm avaliado essa relação em indivíduos com graus iniciais de OA. Objetivo: Verificar se existe correlação entre o torque extensor do joelho e as seções dor, rigidez e função física do questionário WOMAC de homens com OA de joelho nos graus iniciais. Método: Participaram deste estudo 21 homens com OA de joelho graus I ou II (segundo critérios de Kelgren e Lawrence*). Foi avaliado o torque extensor concêntrico e o excêntrico do joelho por meio do dinamômetro isocinético (Biodex System 3 Pro ® ), na velocidade de 90º/s. O autorrelato de sintomas e incapacidades foi avaliado por meio do questionário WOMAC. O Coeficiente de Correlação de Spearman foi utilizado para d...

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Section: Discussionsupporting

confidence: 91%

Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function

Serrão

Gramani-Say

Lessi

et al. 2012

Rev. bras. fisioter.

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“…Strengthening exercise seems to improve physical function and sensorimotor deficits in osteoarthritic or rheumatoid patients [8,27] but the results of our study cannot be used to support the theory that muscle strengthening may influence muscle function and progression of joint degeneration. However, in contrast, Sharma et al [43] showed that increased quadriceps strength may increase the risk of femorotibial osteoarthritis especially in malaligned and lax knees.…”

Section: Discussionmentioning

confidence: 74%

Neuromuscular quadriceps dysfunction prior to osteoarthritis of the knee

Becker

Berth

Nehring

et al. 2004

Journal Orthopaedic Research

107

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Decreased maximal quadriceps strength and voluntary activation has been observed in patients with osteoarthritis in previous studies, but those results d o not allow any conclusions to be drawn as to whether quadriceps dysfunction precedes or follows osteoarthritis. Thirty-two patients (group a) who underwent partial ineniscectomy 48 k 9 month prior to the study were matched according to their weight and body mass index with a control group (group b). The twitch interpolation technique was used to determine maximal voluntary contraction (MVC) and voluntary activation (VA) of the quadriceps muscle of both legs. Subjective assessment of the knee was performed using the Lysholni-Score. AP and lateral X-rays of the operated knee were obtained. None of the participants showed any evidence of characteristic radiological or clinical signs for osteoarthritis. A significantly lower MVC was noticed in both the affected and the contralateral knee of group a in comparison to group b (p < 0.01). The VA in group a yielded 80.9i 15.4% for the injured side and 83.1 f 11.5% for the contralateral side, with no statistical difference (p = 0.18). The VA in group b was 89.4 i 5.8% for the right side and 88 ? 6.8% for the left side both being significantly higher in comparison to group a.This study has shown, that patients following meniscus resection present with bilateral quadriceps weakness as already described in patients with manifest osteoarthritis. The authors hypothesise that muscle dysfunction may be an etiologic factor underlying the pathologic changes of osteoarthritis. Whether muscle dysfunction occurs also at other sites, e.g. in the upper extremity, remains unclear but would be of interest in order to detect a generalized neuromuscular dysfunction.

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“…Strength on the nonarthritic side was significantly better than that on the arthritic side (45,46), and was comparable to that found in healthy control knees, even when all patients had advanced OA, a subset in whom contralateral effects might be most pronounced (45). In another study (44), patients with mild OA were 40% stronger on the nondiseased side. The magnitude of arthrogenous muscle inhibition was significantly greater in the diseased limb.…”

Section: How Proprioceptive Accuracy Expressed As Thementioning

confidence: 88%

“…Therefore, to maximize the likelihood of obtaining subjects free of disease in one knee, we required patients to have no symptoms and to meet examination criteria on the unaffected side. In published studies that include between-limb comparisons of other parameters in unilateral knee OA patients, specific radiographic criteria used to define disease have not been provided (44)(45)(46). In any case, the possible presence of subclinical and subradiographic OA in the "unaffected" knee does not alter our conclusion.…”

Section: How Proprioceptive Accuracy Expressed As Thementioning

confidence: 99%

Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis?

Sharma

Pai

Holtkamp

et al. 1997

Arthritis & Rheumatism

215

120

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Objective. Neuromuscular joint protection requires proprioceptive input and motor output. Impairment of proprioception in knee osteoarthritis (OA) may contribute to, and/or result from, the disease. If this impairment was exclusively a local result of OA, a between-knee difference would be expected in patients with unilateral OA (UOA). To explore causal directions, 2 hypotheses were tested 1) proprioception is worse in UOA patients versus elderly controls; 2) proprioception is worse in the arthritic knee versus the unaffected knee in UOA patients.Methods. Twenty-eight UOA patients (KellgrenLawrence grade 2 2 in 1 knee and <2 in the other knee) and 29 elderly controls were enrolled. The unaffected knee of each UOA patient and both knees of the elderly controls were required to meet symptom, examination, and radiographic criteria. Proprioception (detection threshold of joint displacement after slow, passive, automated knee motion), body mass index, pain, functional status, range of motion, and laxity were measured.Results. UOA patients had worse proprioception than did elderly controls, in either knee. A between-knee difference was not found in UOA patients.Conclusion. Impaired proprioception is not exclusively a local result of disease in knee OA. importance of impaired proprioception in the development and progression of knee OA will require longitudinal study.Functional impairment from osteoarthritis (OA) is primarily due to lower extremity involvement. The knee is the most frequently involved joint site associated with disability in OA (1,2). Population-based studies (3-5) have revealed that the prevalence of radiographic tibiofemoral knee OA, defined as grades 2-4 in the Kellgren-Lawrence grading system (6), increases with age. Findings from the Framingham study have indicated that radiographic tibiofemoral OA is present in 27% of subjects ages 60-69 years and in 44% of those over the age of 80 years (3). Among all subjects between the ages of 63 and 94 years, the prevalence was 34% in women and 31% in men (3). In the HANES study, the prevalence of radiographic tibiofemoral OA was found to rise, from 2% in men and 3.5% in women who were between the ages of 45 and 54 years, to 9% and 17.4%, respectively, in those who were ages 65-74 years (4). In older women (mean age 71 years) in the Framingham study, the incidence rate for radiographic tibiofemoral OA was found to be 2% per year (7). Prevalence of symptomatic radiographic tibiofemoral OA increases from 7% under the age of 70 years to 11.2% over the age of 80 years (3). Among those ages 60-90 years, symptoms increase with radiographic stage: 9.2% of subjects with Kellgren-Lawrence grades 0-1, 19% with grade 2, and 40% with grades 3-4 were symptomatic (3).

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The Influence of Arthrogenous Muscle Inhibition on Quadriceps Rehabilitation of Patients With Early, Unilateral Osteoarthritic Knees

Cited by 223 publications

References 0 publications

Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function

Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function

Neuromuscular quadriceps dysfunction prior to osteoarthritis of the knee

Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis?

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