Knee OA-Mid Range Strength Training

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The Effects of 16 Months of Angle-SpecificIsometric Strengthening Exercises in Midrangeon Torque of the nee-~xtensor MusclesOsteoarthritis of the Knee: A Case StudyRay Mark s, MScPT, BScPT, BSc'

ecause walking and stair-climbing deficiencies inpainful osteoarthri t is ofthe knee a r e a t tr i bu t-able, in part , t o stat icweakness of the surrou nding quadri -ceps muscles (1 l ,2 3) , open kineticchain (t ibia free) isometric quad ri-ceps s t rengthe ning exercises ar eoften advocated as eff icacious for thet reatme nt o f th is condi t ion (22 ,24).However, based on s tudies onhealthy populations ( 9,21), i t couldbe argued that i f perfo rmed a s iso f t en recommended a t t he ang le o fmaximal weakness (3) o r in th e leastpainful position ( 1 5). improvementsin quadricep s efficiency might b elimited solely to those occ urr ing atthat angle . T h e fact that functionssuch as walking an d staircl imbing re-qui re considerable q uadriceps forcegenerat ion ove r a large range of mo-tion (1 7) suggests that without at ransfer of t ra in ing to angles o therthan the t ra in ing angle , funct ional

improvemen ts sought most by pa-t ients with knee osteoarthri t is,namely walking and staircl imbing(2) , might no t occur.T h e ob j ec ti ves o f t h i s s t udy wereto examine t he t ransfe r o f t ra in ingeffect associated with isometrics t reng th t ra in ing o f t he ex t enso rmuscles surrou nding an o steoarthri -t ic knee a t 60" knee f lexion on kne e

Although often advocated for arthritis rehabilitation, several studies conducted on healthysubjects have demonstrated conflic ting results as t o whether isometric strengthening exercises per-formed at one joint angle can result in strength gains at other angles. The object ive of this study wasto determine whether midrange strength training of the quadriceps surrounding an osteoarthriticknee would increase strength in this part of the range of motion as well at other knee angles. Themidrange position was chosen because the subject, a 57-year-old female wit h a 2-year history ofmoderately severe osteoarthritis of the left knee, had greatest weakness in this position. The trainingoccurred three times per week for 16 months using a resistance training program of three sets of twomaximal isometric contractions at a knee angle of 60". The dependent variable of maximal isometricknee extensor torque was recorded on an isokinetic dynamometer at knee angles of 9@, 60, and 30"at 6 weeks, I year, and 16 months. These data demonstrated a progressive torque increase at al langles over the 16-month period, w ith a steeper slope at the training angle. Contrary to thespecificity of training concept, angle-specific strengthening in midrange may be sufficient tostrengthen the extensors surrounding an osteoarthritic knee through a w ide range of motion. Mid-range isometric strengthening exercises might thus prove useful in the rehabilitation of patients withknee osteoarthritis wh o are unable t o exercise their weakened quadriceps at o ther angles due topain or swelling.Key Words: osteoarthritis, knee, isometric exercise' Direc tor, Clinica l Research, Osteoarthritis Research Centre , P.O. Box 1153, Adelaide Postal Station, Toron to,Ontario, Canada M5 C 2K5; Student Mentor, Division of Physical Therapy, University of Toronto, Toronto,Ontar io, Can ada. This work was conducted as part o f a doctora l dissertation in the D epartm ent of PhysicalTherapy, University of Alberta, in cooperation with the Faculty of Health Administration.This study was supported by The Arthritis Society, Toronto, Ontario, Canada.

ex tenso r t o r que a t ang les o f 3 0 , 60 ,and 90" knee f l ex ion ; t o examinewhether the t ra in ing would resul t inimpr ovem ents in walking an d stair-c l imbing; and t o moni tor th e t imecourse o f t he adap tat i on t o t he p res -en t s t ren gthenin g s timulus.Th i s s t udy was conduc ted a s pa r tof a larger pro ject designed to es tab-l ish th e m ost effective ways of pro-viding physical therap y t o impro ve

the s t rength an d funct ion of the pa-t ient with kne e osteoarthri t is.METHODSSubject

T h e s ingle subject s tudied was ahealthy 57-year-old woman. (height= 155 cm, weight = 4 5 kg) with cl in-ical an d radiologically established

JOSPT Volume 20 Number 2 August 1994

Journal of Orthopaedic & Sports Physical TherapOfficial Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Associa


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primary unilateral medial compart-men t osteoarthri t i s of the lef t kneewho was not cu rrent ly receiv ing anyform of in tervent ion for he r condi -t ion . At s tudy en t ry , she was com-plaining of intermittent knee painwhen walking on level ground forabou t 15 minu tes o r l onger (pa inscore of 5.4 o n a 10-point visual ana-log scale) an d ma rke d difficulty withsta irc l imbing and descending m orethan 8- 1 0 s ta irs du e to pain (painscore 5.9) an d subjective feelings offat igue. She was also experiencin gmo rnin g stiffness of he r kn ee of lessthan 30-minutes durat ion . Thesesymptoms had prevai led for approxi -mately 2 years and were get t ingworse despite tradit ional physiother-apy, ie., stra ight-leg raising exercisesand medicat ion for inflammat ion inthe init ial stages of h er disease.Sta nda rd clinical exam ination re-vealed crepi tus on knee mot ion ,mo der ate antero lateral instabili ty, a5" f lexion cont ractu re , and ham -strin g discomfort with passive k neeextension . H er knee f lexion ran gewas >100 , and quad r i ceps t o rque a t60" was diminished by approxi-mately 59 % on the affected s ide . Inaddi t ion , the quadriceps force curvewas abnorm al on the affected s ide(Tab le 1). Th e gravi ty-corrected i so-kinetic quadriceps-to-hamstring workra t io on t he a f fec t ed s ide was a pproximately 2. T h e disease severi tywas assessed as mode rate o r gra de 2by the investigator on a 4-pointscale devised by Stauff er et al (23),where 4 = n o s y m p to m s a n d 1 =very seve re disease.T h e s tudy was reviewed by a

Knee Flexion AnglesPeriod 90' 60' 30'Preexercise 44 41 44Postexercise

6 weeks 60 70 621 year 64 87 6416 months 78 93 68

TABLE 1. Peak torque values (in Nm ) recorded forthe quadriceps fernoris of one subject withosteoarthritis before and after exercise training.

University H ospital Ethics Comm it-tee. Prior to her part icipation in thestudy, the subject received a writ tenexplanat ion of the s tudy purpose an dprocedures and inform ed consentwas provid ed.Design

T h e research design chosen tomee t t he study objectives was a sin-gle-subject, modified, time-series ex-periment with three baseline meas-ures conducted biweekly before thestar t of t he exercises an d post in ter-vent ion measures conducted a t 6weeks, 1 year , and 16 months. T h eindependent variable for th is s tudy

The training wascarried out inmidrange to

eliminate discomfortexperienced when the

limb was placed inthe more extended

position.was a quadriceps s t ren gth t ra in ingprotocol carr ied o ut isometrically ata knee ang le o f 60" f lex ion . Th emain dependent variables weremeasurem ents of maximal i sometricquad r i ceps t o rque genera t ed a t kneeangles of 90 , 60 , and 30" . Also as-sessed were changes in level walking,s tai rwalking, and torque over t ime.Instruments

A Kin-Com robot ic dynamom e-ter system (Med-Ex Diagnostics, Co-quit lam, Brit ish Columbia, Canada)capable of gene ratin g a visual recordo f t o rque m easu remen ts gene ra t edisometrically at differe nt k nee angleswas used for the initial 6 weeks of

t ra in ing and fo r measu r ing t hechanges in maximal isometric qua d-riceps torque postexercise . T h e dy-namometer was calibrated electroni-cally before test ing a subject , an d th ereliability and validity of the instru-men t had been found to be sa t isfac-tory (4). As well, th e test-retest relia-b il ity of th e dyna mom eter for meas-u r ing t he ex t enso r t o rque o f womenwith knee osteo arthri t is has beenfound to be h ighe r t han 0 .80 fo rknee angles o f 90 , 60 , and 30" (26) .Testing Procedures

For each of th ree preexercisecontro l assessments of kne e streng thconducted a t 0 , 3 , and 5 weeks andfor th e postexercise strength tests,the test ing protocol of Wessel et al(26) was used. T h at is, the subject saon a Kin-Com chai r with back s u ppor t , h ips ang led a t 8 0 , and the pelvis and thigh stabilized with straps.T h e a xi s o f t h e d y n a m o m e t e r a r mwas al igned with th e lateral epicon-dyle of the test leg and secured by anankle s t rap just above th e m edialmalleolus (Figure 1).Immediately following 10 iso-tonic warm-up cont ract ions of th equadriceps thr ough the avai lablerange o f mot ion , the subject per-form ed two submaximal (


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FIGURE 1. Subject positioned for testrng andtrarning.

corded twice at baseline and afte rtraining according to Marks (1 6)over a 13-m indoor carpeted walk-way at a self-selected walking speedusing a stopwatch. T o control forthe effects of acceleration and decel-eration, the subject walked a dis-tance of 3 m before and after com-pletion of the walk. After a furtherI-minute rest, walking time up anddown four stairs without pause wasrecorded. The verbal commands,time, and o rder of testing remainedconstant throughout the study. Thetotal number of stairs that could benegotiated by the subject withoutpain was assessed subjectively atbaseline and af ter training.Training Protocol

The training was initially carriedout for 6 weeks on a Kin-Com undersupervision using a similar set-up asdescribed for the baseline testing.The protocol adopted was that ofMarks (1 5), which included 10 iso-tonic warm-up contractions of thequadriceps through full range withno resistance, three submaximal iso-metric contractions of increasing in-tensity at 60" knee flexion followedby three sets of two maximal, 5-sec-ond isometric contractions with aninterval of 30 seconds between con-

tractions and a 2-minute interval be-tween sets. After the three sets werecompleted, the subject rested for 5minutes and then repeated the exer-cises on the unaffected limb.

T o attempt to control for historyeffects associated with the strengthtraining regimen, the subjectstopped exercising for 6 weeks afterthe initial 6-week exercise trainingsession. After that time, she carriedout the same protocol for a further13 months at home using a belt forresistance. She reported t o the labo-

Regarding the transferof training effect, the

present results suggestthat high-intensityisometric knee

extension exercisesperformed in

midrange by anindividual with knee

osteoarthritis cancon tribu e toward

marked improvementsin relative peak

torque production.ratory once per month during thisperiod to ensure that the protocolwas being followed rigorously. Shewas requested to continue her nor-mal daily routine but not to partici-pate in any additional activities orforms of physical therapy for thestudy period. It was not possible,however, to control the duration ofher regular daily activities as hercondition improved, which may haveincreased accordingly as indicated bynonsolicited verbal feedback fromthe subject.

The training was carried out inmidrange (Figure 1) to eliminate discomfort experienced when the limbwas placed in the more extended po-sition and because the subjects' kneeextensor torque was lower at this angle than i t was at angles of 30 or90". Both knees were exercised be-cause muscle torque of an osteoar-thritic asymptomatic knee may notbe as strong as that of healthy sub-jects (23) and may attenuate morequickly with age in women with uni-lateral knee involvement (8), contributing to more stress on the affectedknee.

Data AnalysisT o describe the changes in peakisometric quadriceps torque re-

corded over the study period, thevalues recorded immediately beforethe start of the exercises (ie., at week5 of the study) as well as those gen-erated 6 weeks, 1 year, and 16months after the exercises had beenimplemented were tabulated. A per-centage change score in these valueswas then obtained by dividing thedifference between the preexerciseand postexercise scores for eachperiod and for each angular positionby the preexercise scores. T o permitvisual analysis, the data were plottedgraphically.

T o substantiate whether quanti-tative as well as favorable changes inthe force curve occurred dur ing thestudy, given the unknown measure-ment properties of visually analyzeddata, the preexercise and postexer-cise torque values at 60" were ex-pressed as a ratio of those recordedat 30 and 90" for each respectivetime period. They were then com-pared with representative data re-corded in the identical manner by asample of older, healthy women.

Differences in level walking andstairwalking time before and after 6weeks of exercise, for which the in-tra rater reliability as determined byintraclass correlation coefficients wafound to be greater than 0.80 for



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both tests ( I 6), were expressed a s aperc entag e of basel ine values.RESULTS

T h e peak t o rque va lue s gene r -a t ed by t h e quadr i ceps of t he sub-jec t ' s a ffec ted knee recorded overt he t i me course of t he s t udy a t kneeflexion angles of 30, 60, a n d 90" a r egiven in Table 1 . As indicated, thesetorqu e va lues increased markedly a t60" as well as at k nee flexion an gleso f 30 a n d 90" a t 6 weeks when as-sessed against the ir stabi l ized base-line values of 44. 4 I . a n d 44 N m .Th ey cont i nued t o i mprove s t ead il va t th e t ra ining angle as well as a t th eo t h e r t wo angl e s fb r u p t o 16mont hs a f t e r t h e s t a r t o f t r a i n i ng .As depic ted in Tab le 2, t he i m-provem ents in maximal i somet r icquadr i ceps t o rque ranged f rom 36t o 70%a t 6 weeks, at taining a maxi-mal value of 126%a t t h e e n d o f 16mon ths wi th n o torque dec l ine re -cord ed a t th e t ra ining angle follow-in g 6 weeks of de t ra in i ng . T h emarked increase in torq ue a t thet ra ining angle of 60" coupled withsubstant ia l s t rength ga ins a t theoth er angles resul ted in a favorablechange of t he quadr i ceps force curve(F i gure 2). As depic ted in Tab le 3.a f t e r a yea r o f unde rg oi ng t he t r ai n-ing, re la t ive peak torqu e va lues gen-era ted by the quad riceps femoriso v e r a n a n g u l a r r a n g e o f 60" werewell within no rma l l imits rec ord edfor the hea l thy knee . After 1 year oft ra ining, the peak torq ue va lues gen-e ra t ed by t he quadr i ceps of t hesymptomat ic knee we re a lmost iden-

DegreesFIGURE 2. Graphic representation of peak isometric quadriceps femoris torque values recorded before, during,and alter training at knee angles of 30, 60, and 90' flexion.

Subject ControlsRatio heexercise Postexercise (N = 5 )5 Weeks 6 Weeks 1 Year 16 Months

TABLE 3. Ratio of isometric quadriceps femoris (QF) peak torque values (PT) (in Nm) enerated at 60' andthose generated at 30 and 90' by study subject and range of scores of five healthy, older control women, ages60-72.

t ical to, i f not sl ightly higher tha n,those of the asymptomat ic knee(Tabl e 4).As i l lustrated in Table 5, t h et orqu e i nc rement s a t 6 weeks wereaccompanied by a 7.5% mprove-

Postexercise Knee flexion AnglesPeriod 90' 60' 30'6 weeks 36 70 401 year 45 117 4516 months 77 126 54

change in QF PT relative to baseline'% improvement = X 100QF PT at baselineTABLE 2. Percentage (YO) mprovement' in isometric quadriceps femoris (QF) peak torque (PT) at angles of 90,60, and 30' knee flexion follow ing training.

me nt in level walking t ime and asimilar improvement in stairwalkingt ime. By th e end of 16 mont hs , t henum ber o f s t ai rs t ha t cou l d be nego-t ia ted by th e subjec t wi thout pa in o rfa t igue had increased by approx i -mately 200%. indica ting impro vedstairwalking capacity.DISCUSSION

Despite their widespread use inthe funct ional rehabil i ta t ion o f per-sons with k nee osteoarthri t is , knowl-edg e is l acking as to wheth er maxi-mal isometric quad ricep s exercisescarr ied ou t a t a s ingle joint angle a r eefficacious for increasing mu scularVolume 20 Number 2 August 1994 JOSPT


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Knee Angle QF PTLeft Knee Riaht Knee

TABLE 4. Comparison of isometric quadricepsfemoris (QF) peak torque values (PT) (in Nm)generated at 90,60, and 30' by the quadriceps ofthe affected (left) and unaffected (right) knees of thepatient aher I year of training.

s t rength a t knee ang les o the r t hanthe t ra in ing angle . Mo re s tudies area l so needed to de t e rmine whe the risometric resistance exercises can r e-sult in functional imp rovem ents inwalking an d staircl imbing in this pa-t ient grou p. It is also necessary tode t e rmine t he op t imum t ra in ing du -ra t ion that might be requi red tomaximize muscle function and func-t ional performance for osteoarthri t icpatients.Regarding the t ransfer of t ra in-ing effect , the pre sent results suggestthat high-intensity isometric kne e ex-tension exercises performed in mid-ran ge by an individual with knee os-teoarthri t is can cont r ib ute towardmark ed improv ements in re la t ivepeak torque product ion of the kneeex tenso rs a t t he t ra in ing ang le a swell as peak torq ue improv ementswithin 3 0" o f the training angle. AI-though exercising in the midart icu-lar position was not equally benefi-cial at angles distant fr om the train-ing angle , a f inding of Rasch an dPierson (19) and Thepau t -Math i eue t a l (25 ) . t he deg re e o f ca r ryoverwas inconsistent with t he specificityof trainin g principle which suggestst ra in ing effects are specif ic to themovem ent pat tern se lected for t ra in-ing (6 .1 2 ,13 ,21). M oreover, the

present findings wer e also inconsist-en t with t he conclusions of Kitai an dSale (9),who fou nd that when i so-metr ic t ra in ing occurre d in themidart icular posit ion, a significantincrease in maximal t or qu e was con-fined wi th in 10" of th e t ra in ing an-gle. While in agreement with thefindings of M arks (1 5) and Fisher eta l (5). who exercised th e knee exten-sors of m en wi th knee osteoarthri t i sisometrically at several angle s, in-c luding midrange, an d notedmarked improvemen ts in quadricepsstrength a nd diminished w alking dif-ficulties, the present results werecont rary to those of Luckhurst e t a l(1 4) , who not only foun d a decre-ment in extensor torq ue a t 3 weeksin patients with kn ee osteoa rthri t isbu t a l so reco rded no improvemen tsin walking and staircl imbing follow-ing 10 maximal i sometric quadricepscontra ctions carried o ut daily in fullextension fo r 4 weeks.It is possible, however, that thela t ter result s were a t t r ibutable t o re-flex inhibit ion o f the quadric eps,which could occur if an inflamed o rpainful osteoarthri t ic kn ee is exe r-cised with the leg in an e xten ded po-sition (15-27). Moreover, the in ten-sity and frequency of th e t ra in ing ap-plied by Luck hurst e t al (14) mayhave been excessive, given th e factthat the knee extensors of personswi th o steoarthri t is may under go ex-tensive pathological ch ange s (7),thereby undermining recovery andthe training response. It is also possi-ble that if stren gthe nin g is restrictedto a posi tion o the r than th e on e a twhich th e joints usually dev elopmaximal torq ue, results might be lessthan optimal. In addit ion, because

Test Preexercise Postexercise % ChangeLevel walking 7.9 7.3 7.5Stair walk in^ 5.2 4.8 7.6

preexerose-poctexercise test scores'% change = x 100preexerclse test scoreTABLE 5. Walking time (in seconds) before and after 6 weeks of training.

the shorte r the muscle length a twhich training has been carried out,the m ore the gain i s res t ric ted to thet ra in ing angle (25). the d egr ee towhich a p atient is then ab le to usethe q uadric eps in daily l ife oncestreng th train ing is ini tiated may beunder mine d bv exercises conductedin extension.T h e p resen t f i nd ing tha t kneeextensor torque improved un der a lltest condi tions over the 16-monthstudy period , i rrespect ive of w hetherthey were carr ied out in the labora-tory o r a t home, was a lso cont rary tofindings of Kreindler et al (1 0).These investigators reported incon-sistent imp rovem ents in patients withosteoarthri t i s on a 6-week hom e pro-gram of e i the r " t radi t ional" progres-sive resistive exercises with o r with-out a progressive Kinetron programperformed wi th th e knee f lexed to30-40" wi th n o furthe r increase inst rength dur ing a 6-week h ometreatm ent phase.Th is was not th e f inding ofQuirk e t a l (18),however, whotaugh t patients with os teoarthr i t is astandardized exercise regimen in theinn er range , which patients per-for me d twice daily at hom e withsteadv im prove men ts in overall clini-cal condit ion u p to 6 m onths af tertreatment. Likewise. Anderson (1 )found progressive s t rength improve-men t s o f t he knee ex t ensors ove r a12-m onth period , which were ac-companied by im provements inwalking capacity.Thus , it may be a rgued tha t t hespecifici ty of training conc ept, oftenat t r ibuted t o neural mechanisms(9.13), may not apply in advancedtraining. which has th e potential toinduce muscle hypertrophy. In sup-port of this, Sale an d MacDougall(2 1 suggested that any muscular ad-aptation, such as hypertrophy, wouldtend to increase the force-generat ingcapacity at all muscle leng ths (jointangles). Although no est imate wasmad e in the present case to est imatehypert rophy. Anderson ( 1 repo r t edincreases in thigh girth f or two pa-

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t ients with a r thr i t ic oint damagewho exerc ised the ir extensors maxi-mally at a relatively shor t musclele ng th fo r a bou t on e yea r .In a dd i t ion to improve me ntsove r a wide ra nge o f a ng le s tha tmigh t the re fo re o c c ur wi th p ro -longe d t r a in ing , the p re se n t f ind ingsof marked improv ements in sta ir -c l imbing capaci ty a f te r 16 monthssuggest tha t when an uns table os-teoar thr i t ic k nee is exercised withthe leg pos i t ioned comfortably witht h e k n e e e x t e n s or s cl os e t o t h e i r o ptimal leng th (ie .. between 50-70").the a da p t ive r e sponse o f th e musc lemay be maximized.T h e a u t h o r r ec o g ni ze s , n o n et h e -less, tha t t he p resent s tud y used re -pea ted isometr ic tes ts a t mult iple an-g les a s a n ou tc om e me a sure a nd tha tthese may well have provided an ad-di t iona l t ra ining e ffec t over an dabove t he midar t icu la r resis tancetra ining regimen . Addit iona l ly , th eor de r of tes t ing was somewhat l im-ited by th e capabilities of th e Kin-C o m d y n a m o m e t e r a n d m a y h a v e af -fec ted the fo rce curve in some way.Likewise , impro ved s tren gth follow-ing th e ini t ia t ion o f t ra ining mayha ve be e n pa r ti a lly d ue t o imp rove duse of t he leg dur ing da i ly ac tivi ties ,which pro vided a t ra in ing e ffec t .Howe ve r , s inc e the s t r e ng th tes tswere con duc ted re la tive ly infre -quently and only two 3-second con-t r ac t ions w e re pe r fo rme d a t a ng le so t h e r t h a n t h e t r ai n i ng a n g l e a teach, the l ike lihood tha t a lea rn ingeffec t (20) inf luenced th e s tudy re -sul ts app ears remote . Since the shapeof the fo rc e c urve in the l as t a ng le o fme a sure me nt r e ma ine d unc ha nge d ,i t d id no t appea r tha t fa t igue e ffec tsd u e t o t h e o r d e r o f t e st in g h a d i nf lu -e n c ed t h e s tu d y ou t co m e . T o h e e x-te n t tha t kne e e x te nsor to rqu e im-prove d ma xima l ly a s e xpe c te d a t th emaximal point of mechanical tensionge ne ra t ion , the p re se n t to rq ue im-provement resul ts appeared s tronglyre la ted t o the spec if ic m ode of t ra in-ing used.Given th e present resul ts , i t is

the a u thor ' s v iew th a t s t r e ng the n in gth e quadr icep s isometr ica l ly in mid-ra nge th r e e t ime s a we e k fo r 6 weeksunder supervision may substantiallye nha nc e t he phys ic al pe r fo rma n c e o fan o s teoar thr i t ic pa t ient with weakkne e e x te nsors who c a nno t pe r fo rmiso ton ic e xe rc i se s o r inn e r r a ngeknee extens ion exerc ises du e to pa in.Howe ve r , to ma ximiz e the t r e a tm e nteffec t , the exerc ises should probablybe c on t inue d fo r p ro longe d pe r iodsa t ho me. Since it is ant ic ipa ted tha tas the pa tient' s condit ion im proves ,the exerc ises could then be per-f o r m e d t h r o u g h o u t a g r e a t e rra nge o f mot ion , r e gu la r fo llow-upof pa t ients an d th e ir progress isr e c omme nde d .SUMMARY

This s tudy supp or te d th e v ie wtha t q ua dr ic e ps s t r e ng the n ing e xe r -c ises perfo rme d in mid rang e may beuseful for the t rea tme nt of pa t ientswi th kne e os te oa r th r i t is who c a n no texerc ise in full extens ion d ue to pa ino r os te oa r th r i ti c pa t ie n t s wh o ha vespec if ic weakness of t he ir quadr icep sin midra nge . T h e re sul t s a l so de m-onstra ted th a t these ope n kine t iccha in s t reng then ing exerc ises mayimprove lowe r l imb func t ion , a smeasu red by w alking and s tairc limb-ing tes ts . T h e resul ts a lso sugges ttha t isometr ic quadr icep s s t rengthen-ing seems e ff icac ious on a long- te rmbasis.It is recognized, however, thatthe in te rna l a nd the e x te rna l va lidi tyof a s ingle subjec t s tudy migh t becomp romised d u e to the poss ibil ityof se lec t ion bias an d th e fact tha t th et re a tme nt ou tc om e would no t nec es -sarily be typical of an unbiased sam-ple. The ref ore , the present resul tsmay no t be genera l izable to a l l per-sons with knee osteoarthritis . Addi-t ional ly , a l thoug h w ithdrawing th ee xe rc i se s a ppe a re d to ru le o u t a p la -c e bo a t t e n tion e f fe c t on the p re se n ts tudy 's ou tcom e, fur th er invest iga-t ion of oth er individua ls with kn eeos teoar thr i t is to rule o ut his tory e f-

fects an d t o va l idate th e present ob-serva t ions is s t rongly recom mend ed.JOSPT

ACKNOWLEDGMENTST h e a u t h o r t h a n k s t h e v o lu n -

te e r s f rom T h e Ar th r i t i s Soc ie ty o fEdm onton for th e ir ass is tance in thisresearch; Dr . J. Wessel, University ofAlbe r ta , fo r the use o f h e r l a bora -tory; and Dr. C.B. H az le t t , Univer-s ity of Alber ta , fo r his contr ibut iontowa rd th i s unde r tak ing .REFERENCES

7. Anderson TP: Management of degenerative joint d isease of th e knee . ArchPhys Med Reha bil3 6: 754- 159, 19552. Bellamy N, Buchanan WW: A preliminary evaluation of the dimensionalityand clinical importance of pain anddisability in o steoarth ritis of the hipand knee. Clin Rheumatol 5(2):23 7 -247, 19863. Bender /A, Kaplan HM: The effectiveness of isometric testing as a diagnosticaid: A hospital study. I Assoc PhyMent Rehabil 16:737-139, 79624. Farrell M, Richards IC: Analysis of thereliability an d the validity of the kineticcommunicator exercise device. MedSci Sports Exerc 18:44-49, 19865. Fisher NM, Pendergast CR, GreshamCE, Calkins E: Muscle rehabilitationIts effect on muscular and functionaperformance of patien ts with knee os-teoarthritis . Arch Phys Med Rehabi72:367-374, 19916. Cardner CW: Specificity of strengthchanges of the exercised and non-ex-ercised limb following isometric training. Res Q Exerc Sport 34:98-707,

7 9637. Glasberg MR, Clasberg lR, /ones RE:Muscle pathology in total knee re-placements for severe osteoarthritis: Ahistochemical and morphometricstudy. Henry Ford Hosp Med34(1):37-40, 19868. Ian M, Lai 1, Tsauo 1, Lien I: lsokinetistudy of muscle strength in osteoarthritic knees of females. TaiwanHsueh Hui Tsa Chih 89:873-879, 19909. Kitai TA, Sale DC: Specificity of jointangle in isometric training. Eur 1 ApplPhysiol58:744-748, 798910. Kreindler H, Lewis CB, Rush 5, Schaefer K: Effects of thre e exercise protocolson strength of persons with osteoar-thritis of th e knee. Top Ceriatr Rehabi4(3):32-39, 1989

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C A S E S T U D Y

1 1 . Lankhorst GI, V an de Stadt RI, Van derKorst IK: The relationship of functionalcapacity, pain, isometric and isokinetictorque in osteoarthritis of the knee.Scand I Rehabil Med 17:167-172,198512. Lindh M: Increase of muscle strengthfrom isometric quadriceps exercises atdifferent knee angles. Scand I RehabilM ed 1 1 (1):33-36, 197913. Logan CA: Differential applications ofresistance and resulting strength meas-ured at varying degrees of knee exten-sion. Diss Abs Int 20:4027 -403 1, 196014. Luckhurst B, Peppiat I, Reynolds Wl:The response of th e quadriceps m uscleto an isometric strength training pro-gram in rheumatoid arthritis. In: Pro-ceedings of the World Confederationfor Physical Therapy, Seventh Interna-tional Congress, Montreal, Canada,lune 1974, pp 244-249. London:World Confederation for PhysicalTherapy, 197415. Marks R: The effect of isometric quad -riceps strength training in mid-range

for osteoarthritis of the knee. ArthritisCare Res 6(1):5 2-56 , 199316. Marks R: Reproducibility of measuresof walking performance variables inpersons w ith osteoarthritis o f the knee.Physiother Can, 1994 (in press)17. Perry I, Anto nneli D, Ford W : Analysisof knee-joint forces during flexed kneestance. I Bone loint Surg 57A(7):961-967, 197518. Quirk AS, Newman Rl, Newman K/:An evaluation of interferential therapy,shortwave diathermy and exercise inthe treatment of osteoarthritis of theknee. Physiother 71 2):55-57, 198519. Rasch PI, Pierson WR : O n e positionversus multiple positions in isometricexercise. Am I Phys Med Rehabil43:lO-12, 196420. Rutherford O M , lones DA: The role oflearning and coordination in strengthtraining. Eur I Appl Physiol 55:100-105, 198 6

2 1 . Sale D, MacDougall D: Specificity instrength training: A review for thecoach and athlete. Can / Appl Sport

Sci 6:87 -92, 198 122. Semble EL , Loeser RF, W ise C M : Ther-apeutic exercise for rheumatoid andosteoarthritis. Semin Arthritis Rheuml8(1):5 1-56, 198923. Stauffer RN, Cha o EYS, Cyory AN : Bio-mechanical gait analysis of the dis-eased joint. C lin Ort ho p 126:246-255,197724. Swedberg /A, Steinbauer IR: Osteoar-thritis. Am Fam P hysician 45:557-568,199225. Thepaut-M athieu C, Van Hoeke I, Ma-ton B: Myoelectric and mechanicalchanges linked to length specificityduring isometric tra ining. 1 Ap pl Phys-i01 64(4):1500- 1505, 198826. Wessel I, Baron D, Baergen I: Test re-test reliability of measu rements ofknee extensor torque of womenwith osteoarthritis. Physiother Can43(Supp l): 10, 199 1 (abstract)27. Young A, Stokes M, lles IF: Effects ofjoint pathology on muscle. Cl in Or-tho p 219:21-27, 1987


Knee OA-Mid Range Strength Training

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