The effectiveness of eight weeks neuromuscular exercises in the water environment on knee proprioception and pain in women with second and third grade knee osteoarthritis

Background and Aims: Osteoarthritis (OA) is a degenerative and progressive disease that may become one of the main causes of lower limb deformity in older adults. Recent research provides evidence that the chronicity and recurrence of Knee OA (KOA) are very common, possibly attributed to the concept of central pain. On the other hand, people with KOA experience a loss of proprioception. In general, these things affect the posture and the risk of falling. On the other hand, people with KOA occurrence a loss of proprioception. In general, these things affect the posture and the risk of falling. In other words, these factors make a person feel unstable and then experience a decrease in status. Due to the reduction of health care costs, several past studies have introduced exercise therapy as a therapeutic method for osteoarthritis. Neuromuscular therapeutic exercises, as one of the therapeutic exercise methods, are based on biomechanical principles and target the sensory-motor system. However, past literature has reported that one of the best treatment protocols for people with knee osteoarthritis is water-based exercises. Therefore, according to the studies conducted on the effect of neuromuscular exercises in the water environment, the aim of this study is to investigate the effect of neuromuscular exercises in water on pain and proprioception in women with second- and third-grade KOA.

Material and Method: In the present study, the subjects entered the research confirming their participation. Based on the Kellgren-Lawrence classification and a diagnosis from a specialist doctor, they were divided into two groups of 12 individuals suffering from second- and third-grade osteoarthritis. After participating in the familiarization session, all the subjects completed the written consent form and the personal information form (general health and physical activity readiness questionnaires). At the beginning of the test, people's demographic measurements were recorded. After 10 minutes of general warm-up, the camera was used to record knee proprioceptive data. In this way, the camera was stabilized using a tripod at a height of 185 cm, and then AutoCAD 2014 software was used to determine the amount of error. The test method was such that the subject sits at the end of a chair with the ability to adjust the height and adjust the back. Their feet were far from the ground and hang. In this way, in the initial state, the knee was approximately 85 degrees of flexion, and the ankle was at rest, and the trunk was 30 degrees behind the vertical plane, and the thigh was almost horizontal. In the same situation, without changing the position of the ankle, the examiner takes the subject's knee to a 45-degree flexion angle and keeps it in the same position for 5 seconds, so that the subject remembers the target knee in his short-term memory. In this situation, the first picture is taken from the outside of the subject's knee, and then the knee is returned to the resting position, and after seven seconds, the subject is asked to actively move the leg and restore the desired angle and compare it with announce the word "I arrived". In this way, the amount of difference between the angle created by the examiner and the average of the three reconstructed target angles was statistically investigated as the error angle. The measurement of proprioception was repeated three times and the average of these three angles was recorded as the joint reconstruction angle. In addition, in order to evaluate the amount of pain from osteoarthritis, the set of questions in the pain section, the Knee injury and osteoarthritis outcome score (KOOS) questionnaire was used. After completing the pre-test, an eight-week protocol of neuromuscular exercises in water (three sessions per week), including 10 minutes of warm-up, 45 minutes of main exercises, and five minutes of cooling down, was carried out in the pool of Shahid Bahonar Physical Education Faculty, Kerman. It should also be mentioned that all the tests performed in the pre-test stage were repeated after the eight-week protocol of neuromuscular exercises in water as a post-test and under the same conditions.

Results: Despite the lack of significant differences between the two groups of second- and third-grade osteoarthritis in the factors of age, weight, height and body mass index, the results of the analysis of variance with repeated measures showed that after eight weeks of therapeutic intervention of neuromuscular exercises in water, the interaction of the group There is no significant difference in proprioception and pain variables in time (p>0.005). Also, the inter-group results did not show a significant difference between the two research groups (grade two and grade three) in the variety proprioception and pain (p>0.005). But the results within the group indicated that in the two studied groups (grade two: proprioception (p=0.001) and pain (p=0.044), grade three: proprioception (p=0.018) and Pain (p=0.001)) showed a significant difference from pre-test to post-test.

Conclusion: The results of the present study indicated that people with knee osteoarthritis in both grades showed a significant improvement in knee joint proprioceptive factors and pain after performing neuromuscular exercises in water. It is worth noting that the difference between groups was not significant in any of the proprioceptive and pain factors. Therefore, based on these results, it can be stated that people with second- and third-grade knee osteoarthritis can benefit from these exercises in approximately the same proportion. Also, according to the average age and body mass index in both groups and comparison with the world averages, it can be concluded that the prevalence of osteoarthritis in young Iranian women is increasing, and also that the average body mass index is high compared to the normal range, the necessity Paying attention to the weight of these patients shows the reduction of pressure on the knee. Therefore, considering the adverse effects of osteoarthritis on pain, proprioception, balance, function and quality of life, the importance of preventing and breaking the cycle of pain and injury in the elderly with osteoarthritis is felt more than ever. Therefore, elderly people with osteoarthritis can benefit the neuromuscular exercise protocol while maintaining immunity.