This document summarizes a study that examined the effectiveness of retro walking (backward walking) in patients with chronic osteoarthritis of the knee. 30 patients with grade 3 knee osteoarthritis underwent 10 minutes of retro walking per day on an inclined treadmill for 10 days. Outcome measures assessed before and after the intervention included pain, stiffness, physical function via the WOMAC index, knee extension lag, dynamic balance, and parameters of forward walking. The results showed statistically significant improvements in all outcome measures following the retro walking intervention. The study concluded that retro walking is an effective approach for reducing symptoms and improving physical function in patients with osteoarthritis of the knee.
Discus throwing performances and medical classification of wheelchair athlete...Ciro Winckler
CHOW, J. W.; MINDOCK, L. A. Discus throwing performances and medical classification of wheelchair athletes. Medicine and Science in Sports and Exercise, v. 31, n. 9, p. 1272-1279, 1999.
Assessment of the Muscle Strength and Range of
Motion Ankle in Boys With and Without Flatfoot by Kasbparast Mehdi in Research & Investigations in Sports Medicine
Discus throwing performances and medical classification of wheelchair athlete...Ciro Winckler
CHOW, J. W.; MINDOCK, L. A. Discus throwing performances and medical classification of wheelchair athletes. Medicine and Science in Sports and Exercise, v. 31, n. 9, p. 1272-1279, 1999.
Assessment of the Muscle Strength and Range of
Motion Ankle in Boys With and Without Flatfoot by Kasbparast Mehdi in Research & Investigations in Sports Medicine
Correlation between conventional clinical tests and a new movement assessment...Stavros Litsos
Correlation between conventional clinical tests and a new movement assessment battery - Bachelor thesis
Despite the complexity of movements performed in sports, physical examination is today done by conventional tests that evaluate joints and muscles individually (e.g. Smith press test, Figure1). Our study used a new movement assessment battery of 20 reach tests, which incorporates the complexity and diversity of natural human movements, taking into consideration that joints are interdependent in a movement and that the planes and sequences of a movement change during its performance. The purpose of this study was to determine whether or not there is a correlation between conventional mobility tests and the new assessment battery.
Mark Sherry
Manager of Sports Rehabilitation at the University of Wisconsin Sports Medicine Center, Physical Therapist, Madison, Wisconsin, USA.
-
Return to Play Guidelines Following Acute Hamstring Strain
(6th MuscleTech Network Workshop)
14th October, Barcelona
My sections of lecture given to regional ATCs as part of Signature Healthcare's SportSmart program presented on March 31, 2016.
Complete lecture included presentations by orthopedic surgeon Marshal Armitage, MD, FRCSC and athletic trainer Evan Chandra, LAT, ATC. -their sections not included here.
A criteria based progression rehabilitation protocol for hamstring strain injuries presented at the Sports Medicine Australia conference 2015 during the Hamstring symposium
A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
Comparison of a strengthening programme to a proprioceptive training in impro...IOSR Journals
Abstract: Strength and proprioception are important to have a stable and functional ankle .Individuals with
ankle injuries are bound to develop a loss of either or both of these during and after the phase of
immobilization. Objectives: 1. To assess the effects of a 4 weeks strengthening programme on dynamic balance
in CAI. 2. To assess the effects of a 4 weeks proprioceptive training on dynamic balance in CAI.3. To compare
the effects of a 4 weeks strengthening programme to a proprioceptive training on dynamic balance in CAI.
Materials and methods: This was an interventional study done amongst athlete students at Deccan Education
Society college campus, Pune during November 2013 to April 2014. Total 27 college students who were known
athletes with chronic ankle instability were selected by convenient sampling. These 27 subjects were randomly
allotted, 13 to the strengthening group and 14 to the proprioceptive group. Dynamic balance was assessed
using the Functional reach test (FRT) prior to the intervention. Maximum three readings were collected and
then an average of the best two was taken while the first was considered as the trial. This was considered as the
pre intervention reading. These subjects then underwent a 4 week programme depending upon the group they
were allotted. Post intervention readings were taken of the FRT scores in the two groups and statistical analysis
was done. Results & Conclusion: Paired andUnpaired t tests were done to compare the Functional reach test
(FRT) scores pre and post in both the strengthening and proprioceptive groups and also the post training FRT
scores between the two groups. The differences in the pre and post FRT scores were found to be extremely
significant in both the groups (p value < 0.0001). However there was no significant difference between the FRT
scores post training between the two groups (p value > 0.0001). The study proves that both the strength training
as well as proprioceptive training are equally effective in improving the dynamic balance in athletes with ankle
instability. They should thus both be given to improve dynamic balance.
Keywords: Strength, Proprioceptive training, chronic ankle instability.
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis.Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Correlation between conventional clinical tests and a new movement assessment...Stavros Litsos
Correlation between conventional clinical tests and a new movement assessment battery - Bachelor thesis
Despite the complexity of movements performed in sports, physical examination is today done by conventional tests that evaluate joints and muscles individually (e.g. Smith press test, Figure1). Our study used a new movement assessment battery of 20 reach tests, which incorporates the complexity and diversity of natural human movements, taking into consideration that joints are interdependent in a movement and that the planes and sequences of a movement change during its performance. The purpose of this study was to determine whether or not there is a correlation between conventional mobility tests and the new assessment battery.
Mark Sherry
Manager of Sports Rehabilitation at the University of Wisconsin Sports Medicine Center, Physical Therapist, Madison, Wisconsin, USA.
-
Return to Play Guidelines Following Acute Hamstring Strain
(6th MuscleTech Network Workshop)
14th October, Barcelona
My sections of lecture given to regional ATCs as part of Signature Healthcare's SportSmart program presented on March 31, 2016.
Complete lecture included presentations by orthopedic surgeon Marshal Armitage, MD, FRCSC and athletic trainer Evan Chandra, LAT, ATC. -their sections not included here.
A criteria based progression rehabilitation protocol for hamstring strain injuries presented at the Sports Medicine Australia conference 2015 during the Hamstring symposium
A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
Comparison of a strengthening programme to a proprioceptive training in impro...IOSR Journals
Abstract: Strength and proprioception are important to have a stable and functional ankle .Individuals with
ankle injuries are bound to develop a loss of either or both of these during and after the phase of
immobilization. Objectives: 1. To assess the effects of a 4 weeks strengthening programme on dynamic balance
in CAI. 2. To assess the effects of a 4 weeks proprioceptive training on dynamic balance in CAI.3. To compare
the effects of a 4 weeks strengthening programme to a proprioceptive training on dynamic balance in CAI.
Materials and methods: This was an interventional study done amongst athlete students at Deccan Education
Society college campus, Pune during November 2013 to April 2014. Total 27 college students who were known
athletes with chronic ankle instability were selected by convenient sampling. These 27 subjects were randomly
allotted, 13 to the strengthening group and 14 to the proprioceptive group. Dynamic balance was assessed
using the Functional reach test (FRT) prior to the intervention. Maximum three readings were collected and
then an average of the best two was taken while the first was considered as the trial. This was considered as the
pre intervention reading. These subjects then underwent a 4 week programme depending upon the group they
were allotted. Post intervention readings were taken of the FRT scores in the two groups and statistical analysis
was done. Results & Conclusion: Paired andUnpaired t tests were done to compare the Functional reach test
(FRT) scores pre and post in both the strengthening and proprioceptive groups and also the post training FRT
scores between the two groups. The differences in the pre and post FRT scores were found to be extremely
significant in both the groups (p value < 0.0001). However there was no significant difference between the FRT
scores post training between the two groups (p value > 0.0001). The study proves that both the strength training
as well as proprioceptive training are equally effective in improving the dynamic balance in athletes with ankle
instability. They should thus both be given to improve dynamic balance.
Keywords: Strength, Proprioceptive training, chronic ankle instability.
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis.Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Effect of aerobic exercise on walking capacity in subjects with parkinsonism-...Sports Journal
Background Parkinson disease is a neurological syndrome usually resulting from deficiency of
neurotransmitter dopamine as the consequence of degenerative, vascular or inflammatory changes in the
basal ganglia. Aerobic exercise is physical exercise of low to high intensity that depends primarily on the
aerobic energy-generating process. Objective of the study was to review the effect of aerobic exercise on
walking capacity in subject with Parkinson disease. Methods. Total of 7 articles reviewed, which
supports aerobic exercise and walking capacity and conclusion made on the basis of results reviewed.
Conclusion. Thus based on the various results achieved in the previous studies, this literature review
concluded that the aerobic exercises can be a great way to improve walking capacity in patients with
Parkinsonism.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
2. Shankar et.al/Effectiveness Of Retrowalking In Chronic Osteoarthritis Of Knee Joint
20
flexors shock absorber] . Direction of knee joint shear force
directed forward initially during backward walking [B.W]
where as backward in forward walking[FW] . According
Flynn et al.[1995] study show backward walking produces
significantly lower patellar compressive force than forward
walking. Flynn[1993] Retro walking helps to reduce
maximal vertical force and impulsive force on knee
compare to f.w because of Toe heel contact pattern.
Considering the advantageous effect of B.W. with
respect to F.W. in decreasing the compressive load on knee,
and improvising the muscular strength in functional range,
study was hypothesized to find effectiveness of Back ward
Walking or Retro Walking [R.W]training to overcome pain
and physical dysfunction in patients suffering from chronic
O.A knee.
The Objective of the study was to find 1] RetroWalking is
effective in alleviating pain of O.A. knee patients 2]
Retrowalking is effective in improving physical function of
chronic O.A. knee 3] Retrowalking is effective in improving
Balance in O.A. knee
MATERIAL AND METHOD;
30 Subjects both male and female of Mean age
group of 50.23 years who clinically diagnosed as O.A. by
Orthopedician and having grade 3 OA changes on
radiological evaluation using Kellgren and Lawrence
system and fulfilling inclusion criteria were selected in the
study. Details of the study were explained to each subject
and got signed in written informed consent form prior to
enrollment in the trial. The study was approved by J.S.S.
Research Ethics Committee. Subjects suffering from pain
in the peripheral joints, Lumbar disc lesion, Neurological
disorder [motor and sensory loss], cardio vascular disease
and suffering from grade 4 or 5 OA were excluded from
study.
INTERVENTION;
Prior to undergoing intervention each subjects base line
measurement of parameter of the study such as Visual
Anolog scale, Western Ontario and McMaster universities
(WOMAC) index, extension lag, dynamic balance through
Step Test were taken for each subject prior to their
intervention.
A motorized Tread Mill with 15 Degree inclination made
from floor were used in this study.
Subjects initially underwent forward[F.W.] walking with
minimal speed on a motorized treadmill with 15 degree
inclination for duration one minute as a warm up and to get
familiarized with equipment. Later speed was increased
to their maximum tolerance and went Forward walking
to extent of duration that stopped only when they report
pain or discomfort. Time and distance covered in F.W. were
recorded.
Same subject next day underwent retro walking [R.W]
training on motorized treadmill to learn or to be familiar
with R.W.. Patients were instructed to hold the Rails of
Tread mill for support while doing R.W. After taking rest
for 20 min and being familiarized with R.W. Subjects
underwent retro walking on 15 degree angle inclined
motorized treadmill with (self tolerated) minimal pace and
gradually increased depending on the patients comfort up
to 10 minutes.
Subjects underwent 10 minutes retro walking, one session
per day for 10 days. On 10th day parameter of VAS,
WOMAC, extension lag were taken. Dynamic balance
through step test was also recorded.
On 10th day Subject under went forward walking on
motorized treadmill with their tolerated speed , they were
stopped immediately once they report pain or discomfort
Time and distance covered on 10th day was noted.
Retro walking Retro walking step test
Findings ;Pre and post intervention Data were statistically analyzed using “paired T-test”
Table 1. Woman index pre and post retrowalking intervention
MEAN S.D. S.E. MEAN S.D. S.E. MEAN DIFFERENCE T- VALUE P VALUE
Total score 91.16 164.5 30 8.9 5.6 1.03 82.2 2.7 0.001
pain 15.2 2.5 0.46 2.1 1.8 0.33 13.1 22.9 0.001
stiffness 4.3 2.29 0.41 0.53 0.73 0.13 3.8 9.51 0.001
Physical function 41.3 7.0 1.27 6.26 3.8 1.27 35.1 35.7 0.001
3. Shankar et.al/Effectiveness Of Retrowalking In Chronic Osteoarthritis Of Knee Joint
21
Table.2 Other parameter between pre and post Retro walking intervention
PRE MEAN S.D S.E POST MEAN S.D S.E MEAN DIFFERENCE T-VALUE P-VALUE
Extension lag 13.6 9.5 1.7 2.23 2.7 0.50 11.3 6.44 0.001
vas 8.0 0.80 0.14 1.8 1.2 0.23 6.23 27.9 0.001
Step test 4.91 1.08 0.197 12.7 1.68 0.197 -7.8 31.0 0.001
Table 3 comparison of forwalking 1st vs 10th day.
MEAN OF 1ST DAY S.D S.E MEAN OF 10TH DAY S.D S.E MEAN DIFFERENCE T-VALUE P-VALUE
time 4.6 2.1 0.39 11.4 1.50 0.27 -6.7 16.5 0.001
speed 1.14 0.26 0.04 1.4 0.15 0.18 -2.7 5.4 0.001
distance 84.2 68 12.5 236.3 40.46 7.38 -152 16.8 0.001
The result of the study had shown highly
significant improvement in all parameters of WOMAC
index, and also on other parameter Extension lag, VAS and
Dynamic Balance. Result also showed significant
improvement on time, speed, and distance of forward
walking following 10 days of B.W. Intervention.
DISCUSSION
Knee O.A. is a prevalent condition contributing
significantly to functional limitation and disability.
Numerous studies show secondary gait change pattern of
O.A. is due to pain, decreased muscle strength, instability
and stiffness. Numerous studies revealed pain in O.A. KNEE
is due to increased abnormal ground reaction force loading
on joint and decreased extensor moment. According to
Mundermann et al [2005] decreased knee extension
momentum is due to compensatory strategy to unload knee
joint. Kinetic and kinematic variable in knee joint of O.A.
include, decreased knee flexion angle, decreased knee
extension moment, increased hip extension moment at the
beginning of single leg stance and decreased flexion
momentum at the end of single leg stance. There will be
increased in leg stiffness adaption at the end of single leg
stance to gain stability while accepting body weight. This
adaptation gradually increases stiffness of knee joint,
increases extension lag and reduces their balance. The
results showed significant improvement in all parameter
following Retro walking intervention, shows normalizing
kinetic and kinematic variable.
According to Arata[1999], Batta[1980] from
research work stated numerous performance differences
between B.W. against F.W, they are as follows.
Increased stride rate and support time with
decreased stride length is the hall mark of B.W. In B.W. Toe
heel contact pattern is seen. In B.W. knee act as primary
power producer and an ankle shock absorber. According
Grano etal; Shear force is directed forward during
backward walking [b.w.], where as backward in forward
walking [fw] during the initial support phase there by
decreases external compression load. His study also shown
significant increase in hamstring stretch during each stride,
E.M.G. activity shown greater in lower limb muscles in
backward compared to forward walk. This study correlate
the result where Extension Lag, VAS, could have improved
because of retro walking effect in improving extensor
muscle activation , gaining flexibility with reduce reaction
and shear force directing on joint.
According Yoshimot et al [ ] backward walking on treadmill
of 15 degree slope increases higher firing rate of hamstring
and quadriceps, where vast us medialis of quadriceps
shown higher activation. According Finland etal B.W.
increases vo2max . these above changes correlate with
result of present study where there was improvement in
WOMAC INDEX, Extension lag, Dynamic balance occurred
due to its greater impact in increasing extension moment,
improvising strength in functional range with decline
compression force assist in improving physical function. In
our study most of subjects were around 50 year age group.
Future study required to know its effect on higher age
group and above grade 3 osteoarthritis.
CONCLUSION
The study concludes retro walking is effective in reducing
symptom and overcoming physical dysfunction in Osteo
Arthritis of knee.
ACKNOWLEDGEMENTS
I Acknowledge to His Holiness Sri Shivarathri Deshikendra
Swamiji his valuable support to conduct this experiment. I
Acknowledge my Principal A.V. Sunish, all Staff , P.G
students and Interns of J.S.S. College of Physiotherapy.
Mysore. Interest of conflict; Study was conducted on
Grade 3 Osteoarthritis where Degenerative changes and
deformities were minimal might have resulted in
significant improvement. Long term effect and kinematic
changes of retro walking in osteoarthritis yet to know.
Further study required on these limitation. Acknowledge to
all of my subjects, students of J.S.S. College of
physiotherapy. Mysore
REFERENCES
1. Felson D.T. and Zhang.Y., An Update on the
Epidemiology of Hip and Knee Osteoarthritis with a
view to Prevention Arthritis Rheum (1998) 41; 1343-
1345
2. Van den Berg. Pathophysiology of Osteoarthritis Joint
Bone Spine (2000) Revue du Rhumatisme, 67; 555-556
3. Mundermann, A., Dyrby, C.O. and Andriacchi, T.P.,
Secondary Gait Changes in Patients with Medial
Compartment Knee Osteoarthritis; Increased Load on
Ankle, Knee, Hip During Walking Arthritis Rheum
(2005) 52; 2835-2844
4. Arata A.W., KINEMATIC AND KINETIC EVALUATION
OF HIGH SPEED BACKWARD RUNNING UNIVERSITY
OF OREGON MICROFORM PUBLICATION(1999 ]
5. Bates B.T., A Comparison between Forward and
Backward locomotion. Human locomotion 4
proceedings of Biennial Conference of Canadian society
for Biomechanics Montreal Quebec Canada 307-308
(1986) http://www.toprunningtips.com/wp-
content/uploads/2011/03/Forward%20And%20Back
ward%20Locomotion%20Understanding
6. Grasso,R,, Bianchi,L, & Lacquaniti, F., Motor Patterns of
human Gait; Backward versus Forward locomotion;
journal of human physiology, (1998) 80; 1868- 1885
7. Huang Effects of Severity of Degeneration of Gait
Pattern in Patients with Knee Osteoarthritis of Knee In
Press[2008]
8. Kaufman KR, Hughes.C, Morrey.B.F,et al Gait
Characteristic of Patients with Knee Osteoarthritis
journal of biomechanics, (2001) 34 ;907-915
4. Shankar et.al/Effectiveness Of Retrowalking In Chronic Osteoarthritis Of Knee Joint
22
9. Flyns T.W., Connery. S.M., Smutok,M.A, Zeballos,R.J. &
Weisman I.M. comparison of cardiopulmonary
responses to forward and backward walking and
running , 1994; Medicine and science in sports and
exercise,1994 26; 89-94,
10. Bates B.T., Morrisons, E. Difference between Forward
and Backward Running. Proceedings of 1984 Olympic
scientific conference; university of Oregon Microform
Publication; 127-135, 1986
11. Terdanche.E., Dage The effects of Back ward
locomotion training on the body composition and
cardio respiratory fitness of young women.
international journal of sports medicine, 25; 1-6, 2004.