The Effects of Kinetic Chain Exercises on The Joint Cartilage

Umit Dincer127 et al (2016) studied to investigate the effects of kinetic chain exercises on the joint cartilage and to assess whether it is possible to repair cartilage in patients with grade 1-3 knee osteoarthritis (OA). In their study total of 35 patients with grade 1-3 OA were included. The patients were randomly assigned into two groups as group 1 (exercise group, n=19) and group 2 (control group, n=16). The patients in group 1 performed closed kinetic chain exercises, transcutaneous electrical nerve stimulation (TENS) and hot-pack supervised by physiotherapists for three weeks in the hospital setting, followed by nine weeks of home exercises.

The patients in group 2 were treated with TENS + hot-pack for three weeks. All patients were evaluated by magnetic resonance imaging at baseline and at week 12. The primary increase in the cartilage volume and thickness was analyzed. Both groups were also compared for pain and functionality. Results of their study shown that there was no significant differences in the pre- and post-treatment total cartilage volume (from 4594.73 mm3 to 4866.80 mm3) and medial and lateral tibial plateau cartilage thickness (from 2.06 mm to 2.10 mm, and from 2.30 mm to 2.35 mm, respectively) in group 1 (p=0.505, p=0.450, p=0.161, respectively). Similarly, no significant difference in the pre- and post-treatment cartilage volume and thickness between the groups was observed (p>0.05). In terms of functionality, there were significant differences between the exercise group and the control group (p<0.05). They concluded that there is no significant effect of closed kinetic chain exercise on the cartilage volume or morphology.

Nor Azlin M.N128 et al., (2011) in their controlled, single blinded experimental study was conducted to determine the effects of passive joint mobilization on pain and stairs ascending-descending time in subjects with knee osteoarthritis (OA knee). They had studied on total of 22 subjects aged 40 and above with mild and moderate OA knee were assigned to either passive knee mobilization plus conventional physiotherapy (experimental group) or conventional physiotherapy alone (control group). Both groups received 2 therapy sessions per week, for 4 weeks. A blinded assessor measured pain with Visual analogue scale and stairs ascending-descending time with Aggregated Locomotor Function test, at baseline and at week 4. There was a significant reduction in pain among subjects in the experimental group (18.07 mm, t = 3.48, p = 0.01) compared to the control group (6.66 mm, t = 0.44, p = 0.67). Non-significant clinical difference was found in stairs ascending-descending time between the two groups (i.e. 6.25s in the experimental group versus 6.78 s in the control group, F (1,10) = 0.70, p = 0.42). No significant correlation was found between pain score and stairs ascending-descending time, r = 0.34, p = 0.16. They concluded that addition of passive joint mobilization to conventional physiotherapy reduced pain but not stairs ascending-descending time among subjects with knee osteoarthritis.

Yvonne M. Golightly129 et al., (2012) in their study reviewed to discuss the effectiveness of different types of exercise programs for OA based on trials, systematic reviews, and meta-analyses in the literature. Publications from January 1997 to July 2012 were searched by them in 4 electronic databases using the terms osteoarthritis, exercise, exercise program, effectiveness, and treatment outcome. Strong evidence supports that aerobic and strengthening exercise programs, both land- and water-based, are beneficial for improving pain and physical function in adults with mild to moderate knee and hip OA. Areas that require further research include examination of the long-term effects of exercise programs for OA, balance training for OA, exercise programs for severe OA, the effect of exercise programs on progression of OA, the effectiveness of exercise for joint sites other than the knee or hip, and the effectiveness of exercise for OA by such factors as age, gender and obesity. Efforts to improve adherence to evidence-based exercise programs for OA and to promote the dissemination and implementation of these programs are crucial.

Kevin R. Vincent130 et al., (2012) The initiation, progression, and severity of knee osteoarthritis (OA) has been associated with decreased muscular strength and alterations in joint biomechanics. Chronic OA pain may lead to anxiety, depression, fear of movement, and poor psychological outlook. The fear of movement may prevent participation in exercise and social events which could lead to further physical and social isolation. Resistance exercise (RX) has been shown to be an effective intervention both for decreasing pain and for improving physical function and self-efficacy. RX may restore muscle strength and joint mechanics while improving physical function.

RX may also normalize muscle firing patterns and joint biomechanics leading to reductions in joint pain and cartilage degradation. These physical adaptations could lead to improved self-efficacy and decreased anxiety and depression. RX can be prescribed and performed by patients across the OA severity spectrum. When designing and implementing an RX program for a patient with knee OA, it is important to consider both the degree of OA severity as well as the level of pain. RX, either in the home or at a fitness facility, is an important component of a comprehensive regimen designed to offset the physical and psychological limitations associated with knee OA. Unique considerations for this population include: 1) monitoring pain during and after exercise, 2) providing days of rest when disease flares occur, and 3) infusing variety into the exercise regimen to encourage adherence.