Effect of Electrotherapy and Strength Training of Selected Lower Limb Muscles on Pain and Balance in Elderly Women with Knee Osteoarthritis with Emphasis on the Type of Focus of Attention

Document Type : Original article

Authors

1 PhD Candidate in Sports Biomechanics, Faculty of Physical Education and Sport Sciences, Central Branch of Azad University, Tehran, Iran

2 Full Professor, Department of Sport and Injury Biomechanics, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran, Full Professor, Department of Sport and Injury Biomechanics, Kinesiology Research Center,

3 Assistant Professor, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

4 Professor in Exercise Physiology, Department of Exercise Physiology, Tehran Central Branch, Islamic Azad University, Tehran, Iran

Abstract

Background and Aim: Given that knee osteoarthritis, as one of the most common joint diseases in the elderly, causes pain and imbalance, leading to disruption of daily activities and performance of this group of society, the objective of this study was to investigate the effect of electrotherapy and strength training of the knee extensor and thigh extensor muscles on pain and balance in elderly women with osteoarthritis of the knee with emphasis on the type of focus of attention.
Materials and Methods: In the current study 31 elderly women aged 60 to 80 years with osteoarthritis of the knee from the elderly center of Kerman after filling out the consent form, accidentally participated in two research groups as subjects in this study. The individuals in each group were randomly divided into two subgroups: the external focus and the internal focus. The exercises were performed three times a week for eight weeks. To assess pain, a VAS scale, and to assess a static, dynamic and total balance, Rumberg, TGUG, and TBT tests were used before and after the test, respectively. For statistical analysis of the data with SPSS software, version 20 and dependent ammonia test were used for intragroup comparison and independent test for intergroup comparison for normal data and for non-normal data, Mann-Whitney and Wilcoxon tests were used. For all tests, a significance level was p≤0/05.
Results: : The results showed a decrease in the amount of pain in both electrotherapy and strength training of the quadriceps muscles and hip abductors group, both of which showed external and internal focus. An improvement was seen in the equilibrium index, in the dynamic and total equilibrium (p≤0.05). The results of the independent t-test for comparing the groups did not show a significant difference in the pain variable based on the numerical measurement scale between the quadriceps training group and the hip abductor training group (p ˃ 0.05). While the difference between internal and external attention was significant (p ≤0.05). The results did not show a significant difference in the balance index in any of the balance indicators between the two groups of quadriceps and hip abductor (p˃0.05), but between the internal and external attention group in the dynamic balance index (TGUG), The difference between the two groups became significant (p ≤ 0.05).
Conclusion: According to the results of the research, strength training of the hip abductor muscles along with common electrotherapy treatments and attention-oriented guidelines can be recommended for pain management and improving the level of performance of the elderly with osteoarthritis of the knee.

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References

  1. sabeti Dehkordi A.Effect of a training course on water balance in older men and knee joint position sense in Ahwaz[M.A thesis]Islamic Azad University Central Tehran Branch: Spring  2012.[In Persian].##

2. Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Physical Therapy 2008; 88(1): 123-36. ##

3.  Song R, Lee E-o, Bae S-C .Effects of tai chi exercise on pain , balance, muscle strength , and perceived difficulties in physical functioning in older woman with osteoarthritis: A randomized clinical trial .Journal of  Rheumatology 2003;30)9):2039-44. ##

4. Jordan JM, Linder GF, Renner JB, Fryer JG. The impact of arthritis in rural population. Arthritis Care Research 1995;8(4):242-50##

5. Flugsrud GB, Nordsletten L, Reinholt FP, Risberg MA, Rydevic K, Uhlig T. Osteoarthritis. Tidsskr Nor Laegeforen 2010;130(21):2136-40##

6. Hertling D, Kessler RM. Management of common musculoskeletal disorders. 3 rd ed. NewYork, Lippincott, 1996,pp:363-365##

7. Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. Journal of Rheumatology 2001 Jan; 28(1): 156-64##

8. Pollard CD, Sigward SM, Powers CM. Gender differences in hip joint kinematics and kinetics during side-step cutting maneuver. Clinical Journal of Sport Medicine 2007;17(1):38-42##

9. Thorp LE, Wimmer MA, Foucher KC, Sumner DR, Shakoor N, Block JA. The biomechanical effects of focused muscle training on medial knee loads in OA of the knee: A pilot, proof of concept study. Journal of Musculoskeletal and Neuronal Interaction 2010;10(2):166–73##

10. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial.physical  therapy 2010;90(6):895-904##

11. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Annals of Rheumic Diseases. 2003 Dec; 62(12): 1145-55. ##

12. Hinman R S, Bennell K L, Metcalf B R,and Crossley K.M. Balance impairments in individuals with symptomatic knee osteoarthritis :A comparison with matched controls using clinical tests. Journal of Rheumatology 2002; 41:1388-139. ##

13.Masui T, Hasegawa Y,Yamaguchi J. Increasing postural sway in rural- community dwelling elderly persons with knee osteoarthritis .Journal of Orthopaedic Science 2006;11:353-358. ##

14. Harringe ML, Halvorsen K, Renstrom P, Werner S. Postural control measured as the center of pressure excursion in young female gymnasts with low back pain or lower extremity injury. J Gait & Posture. 2008;28:38-45. ##

15. Wulf G. Attention and motor skill learning[Farrokhi A, Mahzoon M,trans].Tehran:Nersi press; 2009.[In Persian] ##

16. Wulf G. Attentional focus and motor learning: a review of 10 years of research. Journal Beweyung and Training 2007;1:4-14. ##

17. Laufer Y, Shtraker H, Gabyzon ME. The effects of exercise and neuromuscular electrical stimulation in subjects with knee osteoarthritis: a 3-month follow-up study. Clinical Interv Aging. 2014 Jul 17;9:1153-61. ##

 18.  Bennell K, Hunt M, Wrigley T, Hunter D, McManus F, Hodges P, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis and Cartilage 2010;18(5):621-8. ##

19. Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, Hinman RS. The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: a protocol for a randomized, single-blind controlled trial. BMC Musculoskeletal Disorders 2007;8(1):121. ##

20.  Pisters MF, Veenhof C, Schellevis FG, Bakker DH De, Dekker J. Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized controlled trial comparing two different physical therapy interventions. Osteoarthr Cartil. Elsevier Ltd; 2010;18(8):1019–26. ##

21. Sadeghi H, Mousavi Kh, Nabavinick H. Sport biomechanics laboratory manual.Tehran:Hatmi press;2015.[In Persian].##

22. Yalfani A, Naderi E, Shayesterudi Y. Comparing the effectiveness of hydrotherapy and physiotherapy in the management of knee osteoarthritis. Journal of Research in Rehabilitation Sciences 2011; 8(2): 328-336.[In Persian] ##

 23. Bennell KL, Kyriakides M, Metcalf B, Egerton T, Wrigley TV, Hodges PW, et al. Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial. Artheritis & Rhoumatology 2014;66(4):950-9. ##

24. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial. Physical Therapy 2010;90(6):895-904. ##

25. Braghin RMB, Libardi EC, Junqueira C, Nogueira-Barbosa MH,deAbreu DCC. Exercise on balance and function for knee osteoarthritis:A randomized controlled trial.Journal of Bodywork &Movement Therapies 2018;22:76-82##

26. .Verma S, Agarwal S. The effect of hip abductors strengthening exercise on knee pain and function in people with knee osteoarthritis. Journal of Romanian Sports Medicine Society 2013;9(2):2123-9. ##

27. Ashok C. Effects of Hip Abductor Muscle Strengthening Exercises in Patients with Osteoarthritic Knee Joints. Indian Journal of Physiotherapy & Occupational Therapy 2012;6(4):32-7. ##

28. Zarei P, Rahnama N. Comparison of the effect of the two strengthening and balanced, strengthening, balanced and core-stability exercise protocols on the balance and fear of falling in women with knee osteoarthritis. The Journal of Paramedical Science and Rehabilitation 2017;7(2): 43-54.[In Persian] ##

29. Hinman RS, Hunt MA, Creaby MW, Wrigley TV, McManus FJ, Bennell KL, et al. Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care & Research 2010;62(8):1190-3. ##

30. Sturmberg C, Marquez J, Heneghan N, Snodgrass S, van Vliet P. Attentional focus of feedback and instructions in the treatment of musculoskeletal dysfunction: a systematic review. Manual Therapy 2013;18(6):458-67. ##

31. Maxwell J.P, Masters R.S.External versus internal focus instruction: is the learner paying attention?. International of applied sport sciences 2002;14:70-88##

32. Wulf G. Attentional focus and motor learning: A review of 10 years of research. Gabriele Wulf on attentional focus and motor learning [Target article] E-Journal Bewegung and Training 2007;1: 4-14. ##

33. Olivier I, Palluel E, Nougier V. Effects of attentional focus on postural sway in children and adults. Experimental Brain Research. 2008;185(2):341-5. ##

34. Beilock SL, Bertenthal BI, McCoy AM, Carr TH. Haste does not always make waste: Expertise, direction of attention, and speed versus accuracy in performing sensorimotor skills. Psychonomic Bulletin & Review. 2004;11(2):373-9. ##

35. Perkins-Ceccato N, Passamore SR, Lee TD. Effects of focus of attention depend on golfers’ skill. Journal of Sports Sciences 2003; 21:593–600. ##

The Scientific Journal of Rehabilitation Medicine
Volume 9, Issue 4
January 2021
Pages 289-297

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History

  • Receive Date: 14 May 2020
  • Revise Date: 22 May 2020
  • Accept Date: 23 May 2020
  • First Publish Date: 21 December 2020

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