Effect of Spinal and Lower limb Re-alignment Protocol on Bilateral Medial Compartment Osteoarthritis of Knee in Postmenopausal Women

Year 2024, , 527 - 540, 25.05.2024

Khushboo Agarwal , Sumeeran Mishra , Sandeep Shinde

https://doi.org/10.33438/ijdshs.1399844

Cited By: 1

Abstract

The alignment of spine-pelvis-lower extremity axis is significantly influenced by knee osteoarthritis. Joint alignment is the main bio-mechanical risk factor for progression of knee osteoarthritis. The purpose of this study was to find out the effect of spinal and lower limb realignment protocol on bilateral medial compartment knee osteoarthritis in postmenopausal women and to compare it with the conventional method of treatment for osteoarthritis of knee. A study sample of 128 post-menopausal subjects within age group 50-70 and BMI between 25-35 kg/m2 having bilateral knee osteoarthritis with medial compartment involvement were selected and equally divided into two groups as the control group and the experimental group. Assessment of pain, knee range of motion, quadriceps and hip abductor strength, and posture for spinal and lower limb malalignment was taken before and after giving the treatment regime to both the groups. Comparison was carried out between the results of the two groups.The results showed how significantly the mal-aligned structures were re-aligned after giving 8 weeks of realignment protocol and how significantly this resulted in better reduction of pain intensity and improvement in knee range of motion and strength of quadriceps and hip abductor muscles in experimental group as compared to the control group. Re-aligning the spinal and lower limb malalignment present in postmenopausal women with bilateral medial compartment knee osteoarthritis results in pain reduction associated with knee joint and improved knee range of motion and strength of quadriceps and hip abductor muscles in these individuals as compared to the ones receiving conventional physiotherapy.

Keywords

Knee-hip-spine syndrome, Genu varum malalignment, Realignment exercises

References

• Anderson, M. K., Hall, S. J., & Martin, M. (2005). Foundation of Athletic Training: Prevention. Assessment and Management. Philadelphis. [CrossRef]
• Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., Arden, N. K., Bennell, K., Bierma-Zeinstra, S. M. A., ... & McAlindon, T. E. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage, 27(11), 1578-1589. [PubMed]
• Bennell, K. L., Hunt, M. A., Wrigley, T. V., Hunter, D. J., McManus, F. J., Hodges, P. W., ... & Hinman, R. S. (2010). Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis and cartilage, 18(5), 621-628. [PubMed]
• Berdishevsky, H., Lebel, V. A., Bettany-Saltikov, J., Rigo, M., Lebel, A., Hennes, A., ... & Durmala, J. (2016). Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools. Scoliosis and spinal disorders, 11(1), 1-52. [PubMed]
• Bhore, P., & Shinde, S. (2023). Effect of multi-component exercises program on pain-related gait adaptations among individuals with osteoarthritis of the knee joint. Journal of Education and Health Promotion, 12(1), 138. [PubMed]
• Brotzman, S. B., & Manske, R. C. (2011). Clinical orthopaedic rehabilitation e-book: An evidence-based approach-expert consult. Elsevier Health Sciences.
• Chidi-Ogbolu, N., & Baar, K. (2019). Effect of estrogen on musculoskeletal performance and injury risk. Frontiers in physiology, 9, 1834. [PubMed]
• Fenton, A., & Panay, N. (2016). Estrogen, menopause and joints. Climacteric, 19(2), 107-108. [CrossRef]
• Fernandes, L., Hagen, K. B., Bijlsma, J. W., Andreassen, O., Christensen, P., Conaghan, P. G., ... & Vlieland, T. P. V. (2013). EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Annals of the rheumatic diseases, 72(7), 1125-1135. [CrossRef]
• Gaudreault, N., Mezghani, N., Turcot, K., Hagemeister, N., Boivin, K., & De Guise, J. A. (2011). Effects of physiotherapy treatment on knee osteoarthritis gait data using principal component analysis. Clinical Biomechanics, 26(3), 284-291. [CrossRef]
• Han, S. M., Lee, K. K., Ha, S., & Sohn, J. H. (2011). The effects of correction exercise on hip joint angle, Q angle, and the distance between knees of genu varum patients. The Official Journal of the Korean Academy of Kinesiology, 13(1), 83-90.
• Hanada, K., Hara, M., Hirakawa, Y., Hoshi, K., Ito, K., & Gamada, K. (2018). Immediate effects of leg‐press exercises with tibial internal rotation on individuals with medial knee osteoarthritis. Physiotherapy Research International, 23(4), e1725. [CrossRef]
• Homan, K. J., Norcross, M. F., Goerger, B. M., Prentice, W. E., & Blackburn, J. T. (2013). The influence of hip strength on gluteal activity and lower extremity kinematics. Journal of Electromyography and Kinesiology, 23(2), 411-415. [CrossRef]
• Hubley-Kozey, C. L., Deluzio, K. J., Landry, S. C., McNutt, J. S., & Stanish, W. D. (2006). Neuromuscular alterations during walking in persons with moderate knee osteoarthritis. Journal of Electromyography and Kinesiology, 16(4), 365-378. [CrossRef]
• Javid, M., Najafabadi, E., Motlagh, K., & Fatemi, R. (2014). The effects of 8 weeks corrective training on lumbar angle and flexibility of lumbosacral muscles in females with hyperlordosis; William’s intervention. Int J Res Stud Biosci, 2(11), 116-125.
• Jin, X., Wang, B. H., Wang, X., Antony, B., Zhu, Z., Han, W., ... & Ding, C. (2017). Associations between endogenous sex hormones and MRI structural changes in patients with symptomatic knee osteoarthritis. Osteoarthritis and cartilage, 25(7), 1100-1106. [CrossRef]
• Kadav, N., Bhende, R., & Shinde, S. (2023). Proximal to distal posture correction protocol for IT band friction syndrome in female amateur runners. International Journal of Disabilities Sports and Health Sciences, 6(2), 139-149. [CrossRef]
• Kang, S. H., Lee, W. J., & Kim, T. Y. (2009). Possible effects of applying rehabilitation program upon bowlegged undergraduates COG (Center of Gravity) oscillation and its correction. Journal of Sport and Leisure Studies, 35(2), 1061-1072. [CrossRef]
• Kisner, C., Colby, L. A., & Borstad, J. (2017). Therapeutic exercise: foundations and techniques. Fa Davis.
• Kuszewski, M. T., Gnat, R., & Gogola, A. (2018). The impact of core muscles training on the range of anterior pelvic tilt in subjects with increased stiffness of the hamstrings. Human movement science, 57, 32-39. [CrossRef]
• Kwon, S. Y., Jung, J. H., & Yang, J. H. (2013). Effects of elastic band exercise for 8 weeks on interval of knee joint, foot pressure and pain for adult women with genu varum according to surface. Korean Journal of Sports Science, 22(3), 1109-1119.
• Lee, J., & Park, H. S. (2016). Effects of physical characteristics and residence style on alignment of lower extremity. Journal of exercise rehabilitation, 12(2), 109. [PubMed]
• Li, Y., McClure, P. W., & Pratt, N. (1996). The effect of hamstring muscle stretching on standing posture and on lumbar and hip motions during forward bending. Physical therapy, 76(8), 836-845. [CrossRef]
• McGill, S. (2015). Low back disorders: evidence-based prevention and rehabilitation. Human Kinetics. Martín-Millán, M., & Castañeda, S. (2013). Estrogens, osteoarthritis and inflammation. Joint Bone Spine, 80(4), 368-373. [CrossRef]
• McGrory, B. J., Weber, K. L., Jevsevar, D. S., & Sevarino, K. (2016). Surgical management of osteoarthritis of the knee: evidence-based guideline. Journal of the American Academy of Orthopaedic Surgeons, 24(8), e87-e93[PubMed]
• Moon, D. C., Kim, K., & Lee, S. K. (2014). Immediate effect of short-foot exercise on dynamic balance of subjects with excessively pronated feet. Journal of physical therapy science, 26(1), 117-119.[PubMed]
• Moon, H. H., Seo, Y. G., Kim, W. M., Yu, J. H., Lee, H. L., & Park, Y. J. (2022, December). Effect of Combined Exercise Program on Lower Extremity Alignment and Knee Pain in Patients with Genu Varum. In Healthcare (Vol. 11, No. 1, p. 122). MDPI. [PubMed]
• Murray, K. J., & Azari, M. F. (2015). Leg length discrepancy and osteoarthritis in the knee, hip and lumbar spine. The Journal of the Canadian Chiropractic Association, 59(3), 226. [PubMed]
• Norkin, C. C., & White, D. J. (2016). Measurement of joint motion: a guide to goniometry. FA Davis.
• Oshima, Y., Watanabe, N., Iizawa, N., Majima, T., Kawata, M., & Takai, S. (2019). Knee–hip–spine syndrome: improvement in preoperative abnormal posture following total knee arthroplasty. Advances in Orthopedics, 2019. [PubMed]
• Pabón-Carrasco, M., Castro-Méndez, A., Vilar-Palomo, S., Jiménez-Cebrián, A. M., García-Paya, I., & Palomo-Toucedo, I. C. (2020). Randomized clinical trial: The effect *of exercise of the intrinsic muscle on foot pronation. International journal of environmental research and public health, 17(13), 4882. [PubMed]
• Page, C. J., Hinman, R. S., & Bennell, K. L. (2011). Physiotherapy management of knee osteoarthritis. International journal of rheumatic diseases, 14(2), 145-151. [CrossRef]
• Riegger-Krugh, C., & Keysor, J. J. (1996). Skeletal malalignments of the lower quarter: correlated and compensatory motions and postures. Journal of Orthopaedic & Sports Physical Therapy, 23(2), 164-170. [CrossRef]
• Romano, M., & Negrini, S. (2008). Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review. Scoliosis, 3(1), 1-5. [PubMed]
• Sahrmann, S., Azevedo, D. C., & Dillen, L. V. (2017). Diagnosis and treatment of movement system impairment syndromes. Brazilian journal of physical therapy, 21(6), 391–399. [PubMed]
• Sawant Janhavi, M., & Shinde, S. (2021). Effect of lower limb proximal to distal muscle imbalance correction on functional pes planus deformity in young adults”. Journal of medical pharmaceutical and allied sciences, 10(4), 3469-3473. [CrossRef]
• Schroth, C. (2007). Three-dimensional treatment for scoliosis: Physiotherapeutic method for deformities of the spine. Christa Lehnert Schroth.− California: The Martindale Press Palo Alto.
• Seidi, F., Rajabi, R., Ebrahimi, I., Alizadeh, M. H., & Minoonejad, H. (2014). The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle. Journal of back and musculoskeletal rehabilitation, 27(1), 7-16. [CrossRef]
• Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. journal of orthopaedic & sports physical therapy, 43(2), 54-64. [CrossRef]
• Shelbourne, K. D., Biggs, A., & Gray, T. (2007). Deconditioned knee: the effectiveness of a rehabilitation program that restores normal knee motion to improve symptoms and function. North American Journal of Sports Physical Therapy: NAJSPT, 2(2), 81. [PubMed]
• Shultz, S. J., Sander, T. C., Kirk, S. E., & Perrin, D. H. (2005). Sex differences in knee joint laxity change across the female menstrual cycle. The Journal of sports medicine and physical fitness, 45(4), 594. [PubMed]
• Tauchi, R., Imagama, S., Muramoto, A., Tsuboi, M., Ishiguro, N., & Hasegawa, Y. (2015). Influence of spinal imbalance on knee osteoarthritis in community-living elderly adults. Nagoya Journal of Medical Science, 77(3), 329. [PubMed]
• Walker, M. L., Rothstein, J. M., Finucane, S. D., & Lamb, R. L. (1987). Relationships between lumbar lordosis, pelvic tilt, and abdominal muscle performance. Physical therapy, 67(4), 512-516. [CrossRef]
• Wang, W. J., Sun, M. H., Palmer, J., Liu, F., Bottomley, N., Jackson, W., ... & Price, A. (2018). Patterns of compartment involvement in end‐stage knee osteoarthritis in a Chinese orthopedic center: implications for implant choice. Orthopaedic Surgery, 10(3), 227-234. [PubMed]
• Wang, W. J., Liu, F., Zhu, Y. W., Sun, M. H., Qiu, Y., & Weng, W. J. (2016). Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: a radiographic study. Bone & joint research, 5(5), 198-205. [PubMed]
• Weng, W. J., Wang, W. J., Wu, M. D., Xu, Z. H., Xu, L. L., & Qiu, Y. (2015). Characteristics of sagittal spine–pelvis–leg alignment in patients with severe hip osteoarthritis. European Spine Journal, 24, 1228-1236. [CrossRef]
• Yasuda, T., Togawa, D., Hasegawa, T., Yamato, Y., Kobayashi, S., Yoshida, G., ... & Matsuyama, Y. (2020). Relationship between knee osteoarthritis and spinopelvic sagittal alignment in volunteers over 50 years of age. Asian Spine Journal, 14(4), 495. Yuenyongviwat, V., Duangmanee, S., Iamthanaporn, K., Tuntarattanapong, P., & Hongnaparak, T. (2020). Effect of hip abductor strengthening exercises in knee osteoarthritis: A randomized controlled trial. BMC Musculoskeletal Disorders, 21(1), 1-7. [CrossRef]
• Yilmaz, H., Polat, H. A. D., Erkin, G., Akkurt, E., & Küçükşen, S. (2013). Effectiveness of home exercise program in patients with knee osteoarthritis. European Journal of General Medicine, 10(2), 102-107. [CrossRef]
• Yoo, W. G. (2013). Effect of individual strengthening exercises for anterior pelvic tilt muscles on back pain, pelvic angle, and lumbar ROMs of a LBP patient with flat back. Journal of Physical Therapy Science, 25(10), 1357-1358. [PubMed]
• Yuenyongviwat, V., Duangmanee, S., Iamthanaporn, K., Tuntarattanapong, P., & Hongnaparak, T. (2020). Effect of hip abductor strengthening exercises in knee osteoarthritis: a randomized controlled trial. BMC musculoskeletal disorders, 21, 1-7. [PubMed]