Kenji Hanada1,2, Michiya Hara3, Yoshiyuki Hirakawa1, Kenji Hoshi2, Kazuya Ito2, Kazuyoshi Gamada2. 1. Fukuoka Rehabilitation Hospital, Department of Rehabilitation, Fukuoka, Japan. 2. Hiroshima International University, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima, Japan. 3. Fukuoka Rehabilitation Hospital, Department of Orthopedic Surgery, Fukuoka, Japan.
Abstract
OBJECTIVE: Although patients with knee osteoarthritis (OA) demonstrate abnormal kinematics involving greater tibial external rotation during squatting, there have not been any previous studies investigating an exercise focused on correcting knee rotational kinematics. This study aimed to determine the immediate effects of exercise with tibial internal rotation (IR) on symptoms and functions in patients with knee osteoarthritis (KOA). METHODS: This study provides Level II evidence using a small randomized controlled trial. Sixty patients were allocated to either the tibial IR or neutral rotation (NR) group in this randomized controlled trial. The IR group performed a leg press activity with the tibia in maximal IR, whereas the NR group performed leg press activity with the tibia in NR. Outcome measures were (a) 10-m walk test; (b) Timed Up and Go test, (c) knee flexion angle while squatting, (d) knee pain during walking and squatting, and (e) difficulty during walking and squatting. RESULTS: Significant interaction was observed in all outcomes. The IR group exhibited significant improvement on all outcome measures, whereas the NR group exhibited significant improvements only in the 10-m walk. CONCLUSION: The IR group exhibited greater improvements than the NR group on all outcome measures. After a single session, leg press activity with the tibia in maximal IR improved the symptoms and functions measured in this study more effectively than leg press activity with the tibia in a neutral position. This suggests that correcting rotational malalignment is more important than strengthening the quadriceps for maintaining or even improving function of OA knees. (Clinical trials registration number: UMIN000021751).
RCT Entities:
OBJECTIVE: Although patients with knee osteoarthritis (OA) demonstrate abnormal kinematics involving greater tibial external rotation during squatting, there have not been any previous studies investigating an exercise focused on correcting knee rotational kinematics. This study aimed to determine the immediate effects of exercise with tibial internal rotation (IR) on symptoms and functions in patients with knee osteoarthritis (KOA). METHODS: This study provides Level II evidence using a small randomized controlled trial. Sixty patients were allocated to either the tibial IR or neutral rotation (NR) group in this randomized controlled trial. The IR group performed a leg press activity with the tibia in maximal IR, whereas the NR group performed leg press activity with the tibia in NR. Outcome measures were (a) 10-m walk test; (b) Timed Up and Go test, (c) knee flexion angle while squatting, (d) knee pain during walking and squatting, and (e) difficulty during walking and squatting. RESULTS: Significant interaction was observed in all outcomes. The IR group exhibited significant improvement on all outcome measures, whereas the NR group exhibited significant improvements only in the 10-m walk. CONCLUSION: The IR group exhibited greater improvements than the NR group on all outcome measures. After a single session, leg press activity with the tibia in maximal IR improved the symptoms and functions measured in this study more effectively than leg press activity with the tibia in a neutral position. This suggests that correcting rotational malalignment is more important than strengthening the quadriceps for maintaining or even improving function of OA knees. (Clinical trials registration number: UMIN000021751).
Authors: Devin Drummer; Jeremy McAdam; Regina Seay; Arny Ferrando; S Louis Bridges; Jasvinder A Singh; Marcas Bamman Journal: Front Rehabil Sci Date: 2021-08-23