Hande Guney

How can we strengthen the quadriceps femoris in patients with patellofemoral pain syndrome

PURPOSE the aim of this article was to review the clinical approach of quadriceps strengthening programmes. METHODS a literature search was carried out from 1980 up to September 2011. Eligible studies were those that: (1) evaluated the patients with patellofemoral pain syndrome (not healthy or asymptomatic subjects) (2) examined the effect of kinetic chain exercises (3) examined the effect of weight-bearing exercises (4) compared the effect of the combined exercises programme in the treatment of patients with patellofemoral pain syndrome. RESULTS AND CONCLUSION patients with patellofemoral pain syndrome may tolerate a closed kinetic chain exercises programme better than open kinetic chain. Weight-bearing and non-weight-bearing quadriceps exercises can significantly improve subjective and clinical outcomes in patients with patellofemoral pain syndrome. Combining treatments as an initial approach to treating patellofemoral pain but developing individualized more functional, global treatments are essential.

Correlation between quadriceps to hamstring ratio and functional outcomes in patellofemoral pain

BACKGROUND The aim of this study was to investigate the correlation between quadriceps to hamstring (Q:H) ratio and the functional outcomes in Patellofemoral Pain (PFP) patients. METHODS The study included forty-four women diagnosed with unilateral PFP. Eccentric and concentric quadriceps and hamstring strength were recorded. Conventional Q:H ratio was calculated as the concentric quadriceps to concentric hamstring peak torque (Ratio 1). Functional ratios were calculated as the eccentric quadriceps to concentric hamstring peak torque (Ratio 2) and as the concentric quadriceps to eccentric hamstring torque (Ratio 3). Functional levels of the patients were determined by using Kujala scores, hop test and step test. Pain levels during activities were recorded. The relationship among Ratio 1, Ratio 2 and Ratio 3 with functional outcomes and pain levels were evaluated using Spearmans correlation coefficient test. RESULTS Eccentric and concentric quadriceps and hamstring strength were lower on involved side than uninvolved side. Ratio 2 correlated stronger with Kujala score (r=0.69) than Ratio 1 (r=0.49) and Ratio 3 (r=0.30). Step test (r=0.35) and hop test (r=0.38) only correlated with Ratio 2. Pain levels correlated more with Ratio 2 (r values ranged between 0.38 and 0.48). CONCLUSION Eccentric quadriceps to concentric hamstring ratio was observed more related to the functional outcomes and painful activities in patients with PFP. LEVEL OF EVIDENCE III Cross-sectional study.

Oxford Knee Score: cross-cultural adaptation and validation of the Turkish version in patients with osteoarthritis of the knee

OBJECTIVE The Oxford Knee Score (OKS) is a valid, short, self-administered, and site- specific outcome measure specifically developed for patients with knee arthroplasty. This study aimed to cross-culturally adapt and validate the OKS to be used in Turkish-speaking patients with osteoarthritis of the knee. METHODS The OKS was translated and culturally adapted according to the guidelines in the literature. Ninety-one patients (mean age: 55.89±7.85 years) with knee osteoarthritis participated in the study. Patients completed the Turkish version of the Oxford Knee Score (OKS-TR), Short-Form 36 Health Survey (SF-36), and Western Ontario and McMaster Universities Index (WOMAC) questionnaires. Internal consistency was tested using Cronbachs α coefficient. Patients completed the OKS-TR questionnaire twice in 7 days to determine the reproducibility. Correlation between the total results of both tests was determined by Spearmans correlation coefficient and intraclass correlation coefficients (ICC). Validity was assessed by calculating Spearmans correlation coefficient between the OKS, WOMAC, and SF-36 scores. Floor and ceiling effects were analyzed. RESULTS Internal consistency was high (Cronbachs α: 0.90). The reproducibility tested by 2 different methods showed no significant difference (p>0.05). The construct validity analyses showed a significant correlation between the OKS and the other scores (p<0.05). There was no floor or ceiling effect in total OKS score. CONCLUSION The OKS-TR is a reliable and valid measure for the self-assessment of pain and function in Turkish-speaking patients with osteoarthritis of the knee.

Shoulder-Rotator Strength, Range of Motion, and Acromiohumeral Distance in Asymptomatic Adolescent Volleyball Attackers

CONTEXT Sport-specific adaptations at the glenohumeral joint could occur in adolescent athletes because they start participating in high-performance sports in early childhood. OBJECTIVE To investigate shoulder-rotator strength, internal-rotation (IR) and external-rotation (ER) range of motion (ROM), and acromiohumeral distance (AHD) in asymptomatic adolescent volleyball attackers to determine if they have risk factors for injury. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Thirty-nine adolescent high school-aged volleyball attackers (22 boys, 17 girls; age = 16.0 ± 1.4 years, height = 179.2 ± 9.0 cm, mass = 67.1 ± 10.9 kg, body mass index = 20.7 ± 2.6 kg/m2). MAIN OUTCOME MEASURE(S) Shoulder IR and ER ROM, total-rotation ROM, glenohumeral IR deficit, AHD, and concentric and eccentric strength of the shoulder internal and external rotators were tested bilaterally. RESULTS External-rotation ROM was greater (t38 = 4.92, P < .001), but IR ROM (t38 = -8.61, P < .001) and total ROM (t38 = -3.55, P = .01) were less in the dominant shoulder, and 15 athletes had a glenohumeral IR deficit (IR ROM loss > 18°). We observed greater concentric internal-rotator (t38 = 2.89, P = .006) and eccentric external-rotator (t38 = 2.65, P = .01) strength in the dominant than in the nondominant shoulder. The AHD was less in the dominant shoulder (t38 = -3.60, P < .001). CONCLUSIONS Adolescent volleyball attackers demonstrated decreased IR ROM, total ROM, and AHD and increased ER ROM in their dominant shoulder. Therefore, routine screening of adolescent athletes and designing training programs for hazardous adaptive changes could be important in preventing shoulder injuries.

AB1242-HPR Fear of Movement Affects Functional Levels and Quality of Life After Total Hip Arthroplasty

Background Though total hip arthroplasty (THA) is a successful procedure for the late stage of hip osteoarthritis, high pain levels and functional impairment are considerable. In addition, THA patients suffer from psychological symptoms such as kinesiophobia/fear of movement. Objectives The purpose of this study was to determine the fear of movement impact on functional levels and quality of life. Methods Forty-two patients who underwent unilateral THA were included in the study. Tampa Scale for Kinesiophobia (TSK) was applied to detect fear of movement level. A high value on the TSK indicates a high degree of fear of movement and a score of 37 differentiates between high and low scores. Patients were divided into two groups either to have high scores (Group I; high kinesiophobia, n=22) or low scores (Group II; low kinesiophobia, n=20). Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain, stiffness and activity of daily living questionnaire and Hip Osteoarthritis Outcome Survey-Physical Function Survey (HOOS-PS) were used to determine the functional status. Physical component summary (PCS) and mental component summary (MCS) of Short Form-12 (SF-12) was used to define the quality of life level. Intensity of pain was measured with visual analog scale (VAS). Assessments were applied at least three months after surgery and time after surgery was recorded. Statistical analysis of the data was performed with Mann Whitney-U test. Results There were no differences in age (p=0.72), BMI (p=0.31), time from surgery (p=0.11), WOMAC pain (p=0.41), WOMAC stiffness (p=0.87), SF-12 MCS (p=0.57)scores between Group I and Group II (Table I).The pain levels (p=0.02), HOOS-PS (p<0.001) WOMAC-ADL and SF-12 PCS (0.02) scores were better in Group II (low kinesiophobia) when compared to Group I (high kinesiophobia). Conclusions Fear of movement has an adverse effect on pain, functional levels and activity of daily living in THA patients. References Cheatham SW, Mokha M, Lee M. Postoperative Rehabilitation After Hip Resurfacing: A Systematic Review.J Sport Rehabil. 2015 Jan 22. Peter WF, Dekker J, Tilbury C, Tordoir RL, Verdegaal SH, Onstenk R, Bénard MR, Vehmeijer SB, Fiocco M, Vermeulen HM, van der Linden-van der Zwaag HM, Nelissen RG, VlietVlieland TP. The association between comorbidities and pain, physical function and quality of life following hip and knee arthroplasty. Rheumatol Int. 2015 Jan 14. Disclosure of Interest None declared

Effects of Different Isokinetic Training Programs on Hamstring/Quadriceps Ratio and Proprioception in Patients with Patellofemoral Pain.

Objectives: To determine the effects of different isokinetic training programs; eccentric training, concentric training and combined (concentric-eccentric) training on quadriceps and hamstring muscle strength functional ratio (H/Qfunc ) and knee proprioception in Patellofemoral Pain Syndrome (PFPS) patients. Methods: Thirty patients with unilateral PFPS were randomly assigned to 3 groups: concentric (CON, n=10) (31.23±3.12 years), eccentric (ECC, n=10) (33.73±2.21 years) and combined (combined, n=10) (30.41±4.35 years). In accordance with the progression principle, the training program was divided into 3 mesoscycles, and the sets and angular speeds were increased in each mesocycle. All groups were treated for 8 weeks. To determine H/Qfunc, eccentric quadriceps and concentric hamstring peak torques were evaluated at 60°/sec with Biodex System 3 (Biodex® Corp., Shirley, NY, USA). 20° and 60° of knee flexion target angles were used to evaluate the knee proprioception. Peak torques and proprioception were evaluated before and 8-week after training. Repeated measure of ANOVA was used for the analysis. Results: There was a significant difference in H/Qfunc between groups at 60°/sec (F= 9.048, p<0.001). The mean improvement difference in ECC and CON-ECC groups were better than CON group. Proprioception improvement was found significant after 8-weeks training for both on 20° (F=150.879 p<0.001) and 60° (F=247.561, p<0.001) of knee flexion. The mean improvement was similar for 20° (F=1.964, p=0.132) and 60° (F=0.493, p=0.711) of knee flexion between the groups. Conclusion: Isokinetic training with the emphasis on eccentric training of quadriceps muscle had a significant effect in H/Qfunc in PFPS patients. This is mostly based on the improvement in quadriceps eccentric peak torque and the improvement in balance between hamstring and quadriceps muscles. Eccentric and combined (concentric-eccentric) training is more appropriate model for strengthening compared to only concentric training.

Functional Strength Ratio in Athletes with and Without Glenohumeral Internal Rotation Deficit (GIRD).

Objectives: Eccentric external rotator (ER) and concentric internal rotator (IR) strength is expressed as a functional strength ratio (ER:IR) for shoulder. The difference in functional strength ratio has been well documented in athletes, but no one compared the functional ratio in athletes with glenohumeral internal rotation deficit (GIRD). The aim of this study was to investigate the effects of GIRD on functional ER:IR strength ratio of the adolescent athletes. Methods: Fifty-three adolescent athletes (12-18 years) from basketball and volleyball teams participated in the study. All the athletes were filled a questionnaire to obtain demographic information and information about their sporting activity. To determine the GIRD, the range of glenohumeral internal rotation motion was measured with the use of a digital inclinometer. An isokinetic dynamometer was used for the assessment of eccentric and concentric muscle strength of the dominant and non-dominant shoulders. Student-t test was used to assess the difference on ER:IR strength ratio between groups. Results: After the clinical examination of all shoulders the athletes were divided into 2 different groups, which were shoulders with glenohumeral internal rotation deficit (Group 1, n=34) and shoulders without GIRD (Group 2, n=22). There was a significant difference among groups on functional ER: IR strength ratio (t=-2.172, p=0.034). The ratio was lower in shoulders with GIRD. Conclusion: GIRD has an adverse effect on functional shoulder ratio, which is one of the causes of shoulder injuries in adolescent athletes. Therefore, GIRD should be treated to prevent future injuries.

FRI0572-HPR Kinesiophobia Affects Early Stage Functional Levels after Total Knee Arthroplasty

Background Though total knee arthroplasty (TKA) is a successful procedure for the late stage of knee osteoarthritis, high pain levels and functional impairment are considerable. In addition, TKA patients suffer from psychological symptoms such as kinesiophobia and fear of motion. Objectives The purpose of this study was to determine the fear of motion and kinesiophobia impact on early functional capacity and performance. Methods Forty-six patients who underwent unilateral TKA were included in the study. Tampa Scale for Kinesiophobia (TSK) was applied to detect kinesiophobia. A high value on the TSK indicates a high degree of kinesiophobia and a score of 37 differentiates between high and low scores. Patients were divided into two groups either to have high scores (Group I; high kinesiophobia, n=22) or low scores (Group II; low kinesiophobia, n=24). Timed up and go (TUG) and 2-minute walk tests (2-MWT) were used to determine the early stage of functional status. Intensity of pain was measured with visual analog scale (VAS). Knee flexion range of motion (ROM) and day of hospital stay were recorded. Assessments were applied on the post-operative day four. Statistical analysis of the data was performed with Mann-Whitney U test Results There were no differences in age (z= -0.320, p=0.749), BMI (z= -0.299, p=0.765) and hospital stay (z= -0.798, p=0.425) between Group I (mean age = 64.1±5.1 years) and Group II (years mean age = 63.5±5.3 years) (Table 1). The pain levels (z= -0.115, p=0.909) and knee flexion ROM (z= -0.088, p=0.930) were similar between groups. While there was no difference in TUG test (z= -0.416,p=0.676) there was significant difference in 2-MWT (z= -4.788, p<0.001). Group II (low kinesiophobia) had better 2-MWT results compared to Group I (high kinesiophobia) (Table 1). Table 1. Variables of the patients Variables Group I (n=22) Group II (n=24) p Median (IQR) Median (IQR) Age (year) 65.5 (59–68.2) 65.5 (59.2–68) 0.749 BMI (kg/cm2) 27 (26.5–30) 28 (26–30) 0.765 Pain (VAS) 5 (3–6) 5 (2–6) 0.909 TSK score 46.5 (43.9–53.5) 28.5 (23.1–33.5) <0.001 Hospital stay (day) 4 (3–4) 4 (3–4) 0.425 Knee flexion ROM (°) 88.1 (74.3–97.5) 89.9 (71.1–98.4) 0.930 TUG (sec) 49.8 (34.2–54.2) 47.3 (30.2–55.1) 0.676 2-MWT (m) 26.1 (22.2–19.7) 35.5 (22.7–41.2) <0.001 Conclusions Kinesiophobia and fear of motion have an adverse effect on early stage walking performance in TKA patients. References Monticone M, Ferrante S, Rocca B, Salvaderi S, Fiorentini R, Restelli M, Foti C. Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2013 Feb;94(2):231-9. Singh JA, Lewallen DG. Patient-level improvements in pain and activities of daily living after total knee arthroplasty.Rheumatology (Oxford). 2014 Feb;53(2):313-20. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4248