Öz
Amaç
Bu çalışmanın amacı, denge egzersizleri ile kombine edilen açık kinetik zincir egzersizleri (AKZE) ve kapalı kinetik zincir egzersizlerinin (KKZE), evre II veya III diz osteoartriti (DOA) olan hastalarda denge, düşme riski, ultrasonografi ile ölçülen kas kalınlığı ve pennasyon açısı üzerindeki etkilerini değerlendirmek ve karşılaştırmaktır.
Gereç ve Yöntem
Toplam 40 hasta rastgele iki gruba ayrıldı (AKZE grubu, n=20; KKZE grubu, n=20) ve denge egzersizlerini de içeren ev tabanlı egzersiz programını altı hafta süreyle uyguladı. Klinik değerlendirmeler kapsamında görsel analog ölçeği (VAS), Berg denge ölçeği (BBS), postürografi (Tetrax®) kullanılarak hesaplanan Fall Index ve ultrasonografi ile rektus femoris (RF) kas kalınlığı ile vastus medialis (VM) ve vastus lateralis (VL) kaslarının pennasyon açıları başlangıçta ve tedavi sonrasında ölçüldü.
Bulgular
Her iki grupta da BBS ölçeğinde, düşme riskinde, istirahat ve hareketle ilişkili ağrıda (VAS), RF kas kalınlığında ve VM ile VL kaslarının pennasyon açılarında istatistiksel olarak anlamlı iyileşme saptandı (p<0,05). Ancak ölçülen hiçbir parametrede AKZE ve KKZE grupları arasında istatistiksel olarak anlamlı fark bulunmadı (p>0,05). Bonferroni düzeltmesinden sonra, OKCE grubunda düşme riski ile VL pennasyon açısı arasında ve CKCE grubunda düşme riski ile VM pennasyon açısı arasında anlamlı bir negatif korelasyon gözlemlendi (p<0,0125).
Sonuç
Sonuç olarak, denge egzersizleri ile birlikte uygulanan hem AKZE hem de KKZE’nin, DOA olan hastalarda ağrının azaltılması, dengenin iyileştirilmesi, düşme riskinin azaltılması, kas gücünün artırılması ile kas kalınlığı ve pennasyon açısının artırılmasında yararlı olabileceği düşünülmektedir.
Anahtar Kelimeler:
Egzersiz, diz osteoartriti, pennasyon açısı, ultrasonografi
Kaynaklar
1Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020;72:149-62.
2Safiri S, Kolahi A-A, Smith E, Hill C, Bettampadi D, Mansournia MA, et al. Global, regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017. Ann Rheum Dis. 2020;79:819-28.
3Tuncer T, Cay FH, Altan L, Gurer G, Kacar C, Ozcakir S, et al. 2017 update of the Turkish league against rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis. Rheumatol Int. 2018;38:1315-31.
4Fernandes L, Hagen KB, Bijlsma JWJ, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72:1125-35.
5Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64:465-74.
6Ng WH, Jamaludin NI, Sahabuddin FNA, Ab Rahman S, Ahmed Shokri A, Shaharudin S. Comparison of the open kinetic chain and closed kinetic chain strengthening exercises on pain perception and lower limb biomechanics of patients with mild knee osteoarthritis: a randomized controlled trial protocol. Trials. 2022;23:315.
7Karandikar N, Vargas OO. Kinetic chains: a review of the concept and its clinical applications. PM R. 2011;3:739-45.
8Escamilla RF, Fleisig GS, Zheng N, Barrentine SW, Wilk KE, Andrews JR. Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. Med Sci Sports Exerc. 1998;30:556-69.
9Palmitier RA, An KN, Scott SG, Chao EY. Kinetic chain exercise in knee rehabilitation. Sports Med. 1991;11:402-13.
10Möller I, Bong D, Naredo E, Filippucci E, Carrasco I, Moragues C, et al Ultrasound in the study and monitoring of osteoarthritis. Osteoarthritis Cartilage. 2008;16(Suppl 3):S4-7.
11Herbert RD, Gandevia SC. Changes in pennation with joint angle and muscle torque: in vivo measurements in human brachialis muscle. J Physiol. 1995;484:523-32.
12Degens H, Erskine RM, Morse CI. Disproportionate changes in skeletal muscle strength and size with resistance training and ageing. J Musculoskelet Neuronal Interact. 2009;9:123-9.
13Gschwind YJ, Kressig RW, Lacroix A, Muehlbauer T, Pfenninger B, Granacher U. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatr. 2013;13:105.
14Girgin N, Atıcı A, Akpınar P, Aktaş İ, Yüksek F. Effects of open versus closed kinetic chain exercises in patients with knee osteoarthritis. J Phys Med Rehabil Sci. 2020;23:167-73.
15Sahin F, Yilmaz F, Ozmaden A, Kotevoglu N, Sahin T, Kuran B. Reliability and validity of the Turkish version of the Berg balance scale. J Geriatr Phys Ther. 2008;31:32-7.
16Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992;73:1073-80.
17Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form mcgill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 2011;65(Suppl 11):S240-52.
18Rutherford OM, Jones DA. Measurement of fibre pennation using ultrasound in the human quadriceps in vivo. Eur J Appl Physiol Occup Physiol. 1992;65:433-7.
19Gellhorn AC, Stumph JM, Zikry HE, Creelman CA, Welbel R. Ultrasound measures of muscle thickness may be superior to strength testing in adults with knee osteoarthritis: a cross-sectional study. BMC Musculoskelet Disord. 2018;19:350.
20Daşkapan A. Comparison of mini-squats and straight leg raises in patients with knee osteoarthritis: a randomized controlled clinical trial. Turkish J Rheumatol. 2013;28:16-26.
21Olagbegi OM, Adegoke BOA, Odole AC. Effectiveness of combined chain exercises on pain and function in patients with knee osteoarthritis. Bangladesh J Med Sci. 2016;15:178-88.
22Kawakami Y. The effects of strength training on muscle architecture in humans. Int J Sport Health Sci. 2005;3(Special Issue 2):208-217.
23Mahmoud WS, Elnaggar RK, Ahmed AS. Influence of isometric exercise training on quadriceps muscle architecture and strength in obese subjects with knee osteoarthritis. Int J Med Res Heal Sci. 2017;6:1-9.
24Vieira A, Blazevich A, Souza N, Celes R, Alex S, Tufano JJ, et al. Acute changes in muscle thickness and pennation angle in response to work-matched concentric and eccentric isokinetic exercise. Appl Physiol Nutr Metab. 2018;43:1069-74.
25Malas FÜ, Ozçakar L, Kaymak B, Ulaşlı A, Güner S, Kara M, et al. Effects of different strength training on muscle architecture: clinical and ultrasonographic evaluation in knee osteoarthritis. PM R. 2013;5:655-62.
26Santos R, Valamatos MJ, Mil-Homens P, Armada-da-Silva PAS. Muscle thickness and echo-intensity changes of the quadriceps femoris muscle during a strength training program. Radiography. 2018;24:e75-84.
27Cheon S, Lee J-H, Jun H-P, An YW, Chang E. Acute effects of open kinetic Chain exercise versus those of closed kinetic Chain exercise on quadriceps muscle thickness in healthy adults. Int J Environ Res Public Health. 2020;17:4669.
28Tagesson S, Öberg B, Good L, Kvist J. A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic Chain exercise in patients with anterior cruciate ligament deficiency. Am J Sports Med. 2008;36:298-307.
29Manlapaz DG, Sole G, Jayakaran P, Chapple CM. Risk Factors for falls in adults with knee osteoarthritis: a systematic review. PM R. 2019;11:745-57.
30Sturnieks DL, Tiedemann A, Chapman K, Munro B, Murray SM, Lord SR. Physiological risk factors for falls in older people with lower limb arthritis. J Rheumatol. 2004;31:2272-9.
31Hoops ML, Rosenblatt NJ, Hurt CP, Crenshaw J, Grabiner MD. Does lower extremity osteoarthritis exacerbate risk factors for falls in older adults? Womens Health (Lond Engl). 2012;8:685-96; quiz 697-8.
