Diz ağrısı olan ve olmayan kadınlarda vücut yağ kütlesi, kas dayanaklılığı, koordinasyon ve propriosepsiyondaki farklılıklar: Kesitsel bir çalışma

Öz

Amaç: Çalışmamızda diz ağrısı olan ve olmayan sedanter yetişkin kadınların vücut yağ kütlesi, kas dayanaklılığı, çoklu eklem koordinasyonu ve propriosepsiyon farklılıklarının değerlendirilmesi amaçlandı. Çalışma planı: Bu kesitsel çalışmaya 149 kadın alındı. Özel fonksiyonlar sırasında diz ağrısının durumu tüm katılımcılar için Görsel Analog Skala ile değerlendirildi ve katılımcılar 2 gruba ayrıldı. Hafif ve orta şiddette diz ağrısı rapor eden bireyler diz ağrısı olanlar grubuna (n=52, ortalama yaş: 42.6±4.1 yıl, ortalama boy: 1.56±5.11 m, ortalama vücut ağırlığı: 75.2±14.1 kg), ağrısı olmadığını belirten bireyler ise diz ağrısı olmayan gruba (n=97, ortalama yaş: 41.7±4.2 yıl, ortalama boy: 1.58±5.06 m, ortalama vücut ağırlığı: 73.4±10.6 kg) alındı. Vücut kompozisyonu TANITA Vücut Kompozisyon Analizörü ile değerlendirildi. Diz fleksör ve ekstansör kaslarının maksimal konsantrik tork değerleri 180º/s’de Isomed 2000 izokinetik dinamometre kullanılarak kaydedildi. Koordinasyon ve propriosepsiyon ise Fonksiyonel Squat Sistemi ile ölçüldü. Bulgular: Grupların fiziksel özellikleri, vücut kompozisyonu parametreleri ve koordinasyon sonuçları arasında anlamlı farklılık gözlenmedi (p>0.05). Diz ağrısı grubunun etkilenmiş taraf fleksiyon (0.65±0.21 N/kg) ve ekstansiyon (0.88±0.23 N/kg) pik torku diz ağrısı olmayan grubun dominant tarafı ile karşılaştırıldığında fleksiyon (0.74±0.19 N/kg) ve ekstansiyon (0.98±0.19 N/kg) pik torkundan anlamlı derecede daha düşüktü (p<0.05). Diz ağrısı grubunda etkilenmiş taraf (0.88±0.23 N/kg) ile etkilenmemiş tarafın (0.93±0.21 N/kg) ekstansiyon kuvvetinde anlamlı farklılık gözlendi (p<0.05). Gruplar arasında her iki bacağın taraf tarafa karşılaştırmasında koordinatif konsantrik defisit ve eksantrik defisit sonuçlarında anlamlı bir fark bulunmadı (p>0.05). Diz ağrısı grubunda propriosepsiyon için görünür hareketteki deviasyon (3.23±1.01 cm) diz ağrısı olmayan gruptan (2.78±1.03 cm) anlamlı olarak yüksekti (p=0.012). Çıkarımlar: Sedanter kadınlarda diz ağrısı, diz fleksör ve ekstansörlerinin pik torkunu ve çoklu eklem proprioseptif duyusunu olumsuz etkilemektedir. Diz ağrısı olan ve olmayan grubun vücut kompozisyonu ve eklem koordinasyonu arasında farklılık gözlenmedi.

Anahtar Kelimeler

• Eklem pozisyon hissi; izokinetik test; sedanter yaşam stili.

Differences in body fat mass, muscular endurance, coordination and proprioception in woman with and without knee pain: a cross-sectional study

Abstract

Objective: The aim of this study was to compare body fat mass, muscular endurance, multi-joint coordination and proprioception between sedentary adult woman with and without knee pain.
Methods: This cross-sectional study included 149 women. All participants were evaluated using the Visual Analog Scale to determine knee pain during specific functions and divided into 2 groups accordingly. The knee pain group (n= 52; mean age: 42.6±4.1 years; mean height: 1.56±5.11 m; mean weight: 75.2±14.1 kg) included patients with mild to moderate knee pain scores. The without knee pain group (n=97; mean age: 41.7±4.2 years; mean height: 1.58±5.06 m; mean weight: 73.4±10.6 kg) included cases who reported no pain. Body composition was assessed using the TANITA Body Composition Analyzer. Concentric maximal torque of the knee flexor and extensor muscles was recorded using an Isomed 2000 isokinetic dynamometer at 180 deg/s. Coordination and proprioception were assessed using the Functional Squat System.
Results: There was no significant difference in terms of physical characteristics, body composition parameters and coordination results between groups (p>0.05). Peak torque of flexion (0.65±0.21 N/kg) and extension (0.88±0.23 N/kg) of the affected side in the knee pain group were significantly lower than the without knee pain group dominant side flexion (0.74±0.19 N/kg) and extension (0.98±0.19 N/kg) (p<0.05). A significant difference in knee extension was observed between the affected (0.88±0.23 N/kg) and non-affected sides (0.93±0.21 N/kg) of the knee pain group (p<0.05). There were no significant differences for both legs between groups in terms of coordinative concentric side-to-side deficits and eccentric deficits (p>0.05). The deviation on visible movement for proprioception was significantly higher in the knee pain group (3.23±1.01 cm) than in the without knee pain group (2.78±1.03 cm) (p=0.012).
Conclusion: Knee pain impairs flexor and extensor peak torques of knee endurance and multi-joint proprioceptive accuracy in sedentary woman. No differences were observed in terms of body composition and joint coordination of the groups with or without knee pain.

Keywords

• Isokinetic testing
• joint position sense
• sedentary lifestyle

Kaynakça

1. Cho HJ, Chang CB, Kim KW, Park JH, Yoo JH, Koh IJ, et al. Gender and prevalence of knee osteoarthritis types in elderly Koreans. J Arthroplasty 2011;26:994-9. CrossRef
2. Otterness IG, Eckstein F. Women have thinner cartilage and smaller joint surfaces than men after adjustment for body height and weight. Osteoarthritis Cartilage 2007;15:666-72. CrossRef
3. Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hos- mer D, Jones G. A meta-analysis of sex differences preva- lence, incidence and severity of osteoarthritis. Osteoar- thritis Cartilage 2005;13:769-81. CrossRef
4. McKnight PE, Kasle S, Going S, Villanueva I, Cornett M, Farr J, et al. A comparison of strength training, self-man- agement, and the combination for early osteoarthritis of the knee. Arthritis Care Res (Hoboken) 2010;62:45-53.
5. Felson DT, Radin EL. What causes knee osteoarthrosis: are different compartments susceptible to different risk factors? J Rheumatol 1994;21:181-3.
6. Tunay VB, Baltacı G, Atay AO. Hospital-based versus home-based proprioceptive and strengthening exercise programs in knee osteoarthritis. Acta Orthop Traumatol Turc 2010;44:270-7. CrossRef
7. Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998;57:649-55.
8. Jinks C, Jordan K, Ong BN, Croft P. A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over. Rheu- matology (Oxford) 2004;43:55-61. CrossRef

9. Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthri- tis: the Arthritis, Diet, and Activity Promotion Trial. Ar- thritis Rheum 2004;50:1501-10. CrossRef
10. Hall MC, Mockett SP, Doherty M. Relative impact of ra- diographic osteoarthritis and pain on quadriceps strength, proprioception, static postural sway and lower limb func- tion. Ann Rheum Dis 2006;65:865-70. CrossRef
11. Hortobágyi T, Garry J, Holbert D, Devita P. Aberrations in the control of quadriceps muscle force in patients with knee osteoarthritis. Arthritis Rheum 2004;51:562-9. CrossRef
12. Madsen OR, Bliddal H, Egsmose C, Sylvest J. Isometric and isokinetic quadriceps strength in gonarthrosis; inter- relations between quadriceps strength, walking ability, radiology, subchondral bone density and pain. Clin Rheu- matol 1995;14:308-14. CrossRef
13. Steultjens MP, Dekker J, van Baar ME, Oostendorp RA, Bijlsma JW. Muscle strength, pain and disability in pa- tients with osteoarthritis. Clin Rehabil 2001;15:331-41.
14. Baker K, McAlindon T. Exercise for knee osteoarthritis. Curr Opin Rheumatol 2000;12:456-63. CrossRef
15. Thomas KS, Muir KR, Doherty M, Jones AC, O’Reilly SC, Bassey EJ. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ 2002;325:752. CrossRef
16. Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a sys- tematic review. J Orthop Sports Phys Ther 2012;42:81- 94. CrossRef
17. Brandt KD, Heilman DK, Slemenda C, Katz BP, Maz- zuca SA, Braunstein EM, et al. Quadriceps strength in women with radiographically progressive osteoarthritis of the knee and those with stable radiographic changes. J Rheumatol 1999;26:2431-7.
18. Segal NA, Torner JC, Felson DT, Niu J, Sharma L, Lewis CE, et al. Knee extensor strength does not protect against incident knee symptoms at 30 months in the multicenter knee osteoarthritis (MOST) cohort. PM R 2009;1:459- 65. CrossRef
19. Segal NA, Glass NA, Felson DT, Hurley M, Yang M, Nevitt M, et al. Effect of quadriceps strength and proprio- ception on risk for knee osteoarthritis. Med Sci Sports Exerc 2010;42:2081-8. CrossRef
20. Callaghan MJ, Selfe J, McHenry A, Oldham JA. Ef- fects of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome. Man Ther 2008;13:192-9. CrossRef
21. Baker V, Bennell K, Stillman B, Cowan S, Crossley K. Ab- normal knee joint position sense in individuals with patel- lofemoral pain syndrome. J Orthop Res 2002;20:208-14.
22. Naseri N, Pourkazemi F. Difference in knee joint posi- tion sense in athletes with and without patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc 2012;20:2071-76. CrossRef
23. Knoop J, Steultjens MP, van der Leeden M, van der Esch M, Thorstensson CA, Roorda LD, et al. Proprioception in knee osteoarthritis: a narrative review. Osteoarthritis Car- tilage 2011;19:381-8. CrossRef
24. Clark P, Lavielle P, Martínez H. Learning from pain scales: patient perspective. J Rheumatol 2003;30:1584-8.
25. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997;72:95-7. CrossRef
26. Decoster L, Labore LL, Boquiren ML, Russell PJ. Moni- tored rehab functional squat coordination test: reliability, learning curve and eccentric-concentric performance com- parisons [Internet]. 2008 [cited 2011 Aug 06] Available from: http://www.nhmi.net/monitored_rehab_function- al_squat_coordination_test.php.
27. Maffiuletti NA, Bizzini M, Schatt S, Munzinger U. A multi-joint lower-limb tracking-trajectory test for the assessment of motor coordination. Neurosci Lett 2005;384:106-11. CrossRef
28. Van Tiggelen D, Witvrouw E, Coorevits P, Croisier JL, Roget P. Analysis of isokinetic parameters in the develop- ment of anterior knee pain syndrome: a prospective study in a military setting. Isokinetics Exerc Sci 2004;12:223-8.
29. Ozer D, Senbursa G, Baltaci G, Hayran M. The effect on neuromuscular stability, performance, multi-joint coordi- nation and proprioception of barefoot, taping or preventa- tive bracing. Foot (Edinb) 2009;19:205-10. CrossRef
30. Witvrouw E, Lysens R, Bellemans J, Cambier D, Vander- straeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 2000;28:480-9.
31. Macfarlane GJ, de Silva V, Jones GT. The relationship be- tween body mass index across the life course and knee pain in adulthood: results from the 1958 birth cohort study. Rheumatology (Oxford) 2011;50:2251-6. CrossRef
32. Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: a sys- tematic review and meta-analysis. Osteoarthritis Cartilage 2010;18:24-33. CrossRef
33. Lee R, Kean WF. Obesity and knee osteoarthritis. Inflam- mopharmacology 2012;20:53-8. CrossRef
34. Wearing SC, Hennig EM, Byrne NM, Steele JR, Hills AP. Musculoskeletal disorders associated with obesity: a bio- mechanical perspective. Obes Rev 2006;7:239-50. CrossRef
35. Diraçoglu D, Baskent A, Yagci I, Ozçakar L, Aydin R. Iso- kinetic strength measurements in early knee osteoarthri- tis. Acta Reumatol Port 2009;34:72-7.
36. Duvigneaud N, Bernard E, Stevens V, Witvrouw E, Van Tiggelen D. Isokinetic assessment of patellofemoral pain syndrome: a prospective study in female recruits. Isokinet- ics Exerc Sci 2008;16:213-9.
37. Hruda KV, Hicks AL, McCartney N. Training for muscle power in older adults: effects on functional abilities. Can J Appl Physiol 2003;28:178-89. CrossRef
38. Hassan BS, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps con- traction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis 2001;60:612-8. CrossRef
39. Mohammadi F, Taghizadeh S, Ghaffarinejad F, Khor- rami M, Sobhani S. Proprioception, dynamic balance and maximal quadriceps strength in females with knee osteo- arthritis and normal control subjects. Int J Rheum Dis 2008;11:39-44. CrossRef
40. Sharma L, Pai YC, Holtkamp K, Rymer WZ. Is knee joint proprioception worse in the arthritic knee versus the un- affected knee in unilateral knee osteoarthritis? Arthritis Rheum 1997;40:1518-25. CrossRef
41. Peat G, Thomas E. When knee pain becomes severe: a nested case-control analysis in community-dwelling older adults. J Pain 2009;10:798-808. CrossRef