Use of Ultrasound to Increase Effectiveness of Isokinetic Exercise for Knee Osteoarthritis

doi:10.1016/j.apmr.2005.02.007

Archives of Physical Medicine and Rehabilitation

Volume 86, Issue 8, August 2005, Pages 1545-1551

https://doi.org/10.1016/j.apmr.2005.02.007 Get rights and content

Abstract

Huang M-H, Lin Y-S, Lee C-L, Yang R-C. Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis.

Objective

To investigate the effects of ultrasound (US) in isokinetic muscle strengthening exercises on functional status of patients with knee osteoarthritis (OA).

Design

Effectiveness of isokinetic muscle strengthening exercises for treatment of periarticular soft tissue disorders was compared with and without pulsed and continuous US.

Setting

Outpatient exercise program in a Taiwan medical university hospital.

Participants

One hundred twenty subjects with bilateral knee OA (Altman grade II).

Intervention

Subjects were randomized sequentially into 1 of 4 groups. Group I received isokinetic muscular strengthening exercises, group II received isokinetic exercise and continuous US, group III received isokinetic exercise and pulsed US treatment, and group IV was the control group.

Main Outcome Measures

Therapeutic effects of isokinetic exercise were evaluated by changes in ambulation speed and the Lequesne index. In addition, changes in knee range of motion (ROM), visual analog scale for pain, and muscle peak torques during knee flexion and extension were compared. Compliance in each group was recorded.

Results

Each treated group had increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-up. However, only patients in groups II and III had significant improvement in ROM and ambulation speed after treatment. Fewer participants in group III discontinued treatment due to knee pain during exercise. Patients in group III also showed the greatest increase in walking speed and decrease in disability after treatment and at follow-up. Gains in muscular strength in 60°/s angular velocity peak torques were also noted in groups II and III. However, group III showed the greatest muscular strength gains with 180°/s angular velocity peak torques after treatment and follow-up.

Conclusions

US treatment could increase the effectiveness of isokinetic exercise for functional improvement of knee OA, and pulsed ultrasound has a greater effect than continuous US.

Section snippets

Participants

One hundred twenty patients with bilateral moderate knee OA (Altman grade II) with periarticular soft tissue pain, as identified by painful sensations during palpation or passive stretching of the arthritic knee under orthopedic examination. The locations of soft tissue pain were confirmed by the findings of musculoskeletal US images (as shown in US treatment) were selected. After radiographs were taken and patients clinically evaluated by the criteria of stages of knee OA,²⁴ they were randomly

Participants

The 120 patients ranged in age from 42 to 72 years (mean age, 62.0±8.4y), with a female to male ratio of 4.2:1. The duration of knee pain ranged from 6 months to 11 years.

Changes in ROM

The changes in average ROM of the arthritic knees for each group are shown in table 1. Ten subjects stopped the therapeutic exercises because of intolerable pain during exercise (5 subjects in group I, 3 in group II, 2 in group IV). Contact with 13 subjects was lost during the follow-up period (4 subjects in group I, 3 in

Discussion

Physical disability is frequently reported in patients with knee OA. However, the disability of these patients can only partly be explained by degeneration of the knee joints. Several other factors have been proposed as possible explanations for their disability, including physical factors such as reduced ROM of the knee joints. In a study of elderly Swedish subjects, Odding et al²⁹ found correlations between knee and hip joint ROM and disability. They also found that restricted flexion of the

Conclusions

US treatment, especially pulsed US, can enhance the therapeutic effects of isokinetic strengthening exercise for treating periarticular soft tissue pain in patients with knee OA.

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Osteoarthritis (OA), degeneration of cartilage associated with aging, lifestyle, and trauma, is one of the most common diseases that leads to lower quality of life and socioeconomic burden in the United States. Clinically, OA is initially managed by non-steroidal anti-inflammatory drugs, but eventually requires surgical intervention to reduce pain and increase function. Cartilage is a mechanotransductive tissue and requires a mechanical stimulus to sustain its mechanical and physiologic properties. Low-intensity pulsed ultrasound (LIPUS) is a cyclic acoustic wave that can provide essential mechanical stimuli to activate molecular and cellular pathways leading to chondrocyte proliferation, differentiation and activity, as well as to inhibit inflammatory pathways associated with OA. The activation of chondrocyte proliferation and inhibition of anti-inflammatory cytokines make LIPUS a potential therapy for mild to moderate OA. Although a few review articles have described the effects of ultrasound on chondrocytes and cartilage, there remains a need for a comprehensive analysis of our current understanding of the basic science and clinical status of the effects of low-intensity ultrasound on chondrocytes and cartilage and the implications of these studies on LIPUS as a therapeutic option for OA. This review analyzes recent literature describing the results of LIPUS using in vitro and in vivo pre-clinical models and clinical studies, as well as future directions for research.
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The inadequate description of recommended interventions for knee OA is a serious problem that precludes replication of effective interventions in clinical practice. By consequence, the relevance and usability of clinical guideline documents and original study reports are diminished.
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The 45 eligible trials with 4699 participants and 56 comparisons (22 ACSM interventions) were included in this analysis. A statistically significant difference favoring the ACSM interventions with respect to knee extensor strength was found [SMD difference: 0.448 (95% CI: 0.091–0.805)]. No differences were observed regarding effects on pain and disability. The meta-regressions indicated that increases in knee extensor strength of 30–40% would be necessary for a likely concomitant beneficial effect on pain and disability, respectively.
Exercise interventions following the ACSM criteria for strength training provide superior outcomes in knee extensor strength but not in pain or disability. An increase of less than 30% in knee extensor strength is not likely to be clinically beneficial in terms of changes in pain and disability (PROSPERO: CRD42014015344).
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Supported by National Science Council of Taiwan (grant no. NSC-92-2314-B-037-067).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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Original articleUse of Ultrasound to Increase Effectiveness of Isokinetic Exercise for Knee Osteoarthritis

Abstract

Objective

Design

Setting

Participants

Intervention

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Participants

Changes in ROM

Discussion

Conclusions

Semin Arthritis Rheum

Arch Phys Med Rehabil

Semin Arthritis Rheum

Microvasc Res

Ultrasound Med Biol

Ultrasound Med Biol

Impact of disablement due to rheumatic disorders in a British populationestimates of severity and prevalence from the Calderdale Rheumatic Disablement Survey

Ann Rheum Dis

Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States

Arthritis Rheum

Knee pain and disability in the community

Br J Rheumatol

Quadriceps weakness in knee osteoarthritisthe effect of pain and disability

Ann Rheum Dis

Determinants of disability in osteoarthritis of the knee

Ann Rheum Dis

Proteoglycan-collagen interactions and subfibrillar structure in collagen fibrils. Implications in the development and aging of connective tissue

J Anat

Aggrecan degradation in osteoarthritis and rheumatoid arthritis

Acta Orthop Scand Suppl

Immunolocalisation of type VI collagen, decorin, and fibromodulin in articular cartilage and isolated chondrons

Trans Orthop Res Soc

Experimental verification of the roles of intrinsic matrix viscoelasticity and tension-compression nonlinearity in the biphasic response of cartilage

J Biomech Eng

Cartilage tissue remodeling in response to mechanical force

Ann Rev Biomed Eng

Osteoarthritic changes after acute transarticular loadan animal model

J Bone Joint Surg Am

Original article
Use of Ultrasound to Increase Effectiveness of Isokinetic Exercise for Knee Osteoarthritis