- Volume 11 Issue 1
DOI QR Code
The Effect of Corrective Exercise in a patient with knee joint valgus deformity: A single-subject A-B-A experimental design
외반슬 환자의 교정운동의 효과: 단일 피험자 A-B-A 실험 설계
Lee, Ho-Seong;Kim, Ah-Ram
- Received : 2015.12.04
- Accepted : 2015.12.29
- Published : 2016.02.29
PURPOSE: The purpose of this study was to determine the effect of corrective exercise on hip joint range of motion, lower limb alignment, radiographs of hip and knee joints, and quadriceps muscle activity in a patient with knee joint valgus deformity. METHODS: A single-subject A-B-A experimental design was used to determine the effects of therapeutic exercise. The single-subject was a 27-year-old male, who presented with knee joint valgus deformity. Corrective exercise program was performed for 40 min/day twice a week for 12-week. Range of motion (hip flexion, extension, abduction, adduction, internal rotation, and external rotation), lower limb alignment test (Q-angle, rear foot alignment, and leg length), standing anterior-posterior radiographs (neck shaft angle and knee joint space), and quadriceps muscle activity of both lower limbs were measured before (A 1), after 6 weeks (B 1) and after 12-weeks (B 2) of corrective exercise and after 6 weeks of exercise completion (A 2). RESULTS: Hip range of motion increased in all directions of both sides at B 2 and A 2 compared to at A 1. Q-angle of both side and leg length discrepancy decreased at B 2 and A 2 compared to at A 1. Neck shaft angle and knee joint space of both sides improve at B 2 and A 2 compared to at A 1. Quadriceps of both side muscle activities improved at B 2 and A 2 compared to at A 1. CONCLUSION: We demonstrated that corrective exercise increases range of motion, and improves lower limb alignment and muscle activity in a patient with knee joint valgus deformity.
Knee joint valgus deformity;Corrective exercise;Radiographs of hip and knee joint
- Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc. 2007;15(2):48-56. https://doi.org/10.1097/JSA.0b013e318053eb74
- Anderson JY, Trinkaus E. Patterns of sexual, bilateral and interpopulational variation in human femoral neck-shaft angles. J Anat. 1998;192(Pt 2):279-85. https://doi.org/10.1046/j.1469-7580.1998.19220279.x
- Bakhtiary AH, Fatemi E. Open versus closed kinetic chain exercises for patellar chondromalacia. Br J Sports Med. 2008;42(2):99-102.
- Barendrecht M, Lezeman HC, Duysens J. Neuromuscular training improves knee kinematics, in particular in valgus aligned adolescent team handball players of both sexes. J Strength Cond Res. 2011;25(3):575-84. https://doi.org/10.1519/JSC.0b013e3182023bc7
- Barrios JA, Heitkamp CA, Smith BP, Sturgeon MM, Suckow DW, Sutton CR. Three-dimensional hip and knee kinematics during walking, running, and single-limb drop landing in females with and without genu valgum. Clin Biomech (Bristol, Avon). 2015;pil:S0268-0033(15)00284-3.
- Buchanan KR, Davis I. The relationship between forefoot, midfoot, and rearfoot static alignment in pain-free individuals. J Orthop Sports Phys Ther. 2005;35(9):559-66. https://doi.org/10.2519/jospt.2005.35.9.559
- Chae JB, Cho HR, Hwa NJ, et al. The Change of Gait as Q-angle in Chronic Knee Osteoarthritis Disease. J Korean Soc Phys Med. 2010;5(1):71-9.
- Chappell JD, Creighton RA, Giuliani C, Yu B, Garrett WE. Kinematics and electromyography of landing preparation in vertical stop-jump: risks for noncontact anterior cruciate ligament injury. Am J Sports Med. 2007;35(2):235-41. https://doi.org/10.1177/0363546506294077
- Dacre JE, Scott DL, Da Silva JA, et al. Joint space in radiologically normal knees. Br J Rheumatol. 1991;30(6):426-8. https://doi.org/10.1093/rheumatology/30.6.426
- Donatelli R, Hurlbert C, Conaway D, et al. Biomechanical foot orthotics: A retrospective study. Orthop Sports Phys Ther. 1988;10:205-12. https://doi.org/10.2519/jospt.1918.104.22.168
- Duivenvoorden T, van Raaij TM, Horemans HL, et al. Do laterally wedged insoles or valgus braces unload the medial compartment of the knee in patients with osteoarthritis? Clin Orthop Relat Res. 2015;473(1):265-74. https://doi.org/10.1007/s11999-014-3947-5
- Felson DT, Niu J, Gross KD, et al. Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Rheum. 2013;65(2):355-62. https://doi.org/10.1002/art.37726
- Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. J Rheumatol. 2001;28(1):156-64.
- Genova JM, Gross MT. Effect of foot orthotics on calcaneal eversion during standing and treadmill walking for subjects with abnormal pronation. J Orthop Sports Phys Ther. 2000;30(11):664-75. https://doi.org/10.2519/jospt.2000.30.11.664
- Gong WT, Bae SS, Jung YW. Influence of therapeutic exercise on functional leg length inequality. J Korean Soc Phys Med. 2007;2(2):183-94.
- Gurney B. Leg length discrepancy. Gait Posture. 2002;15(2):195-206. https://doi.org/10.1016/S0966-6362(01)00148-5
- Guzman H, Yaszay B, Scott VP, et al. Early experience with medial femoral tension band plating in idiopathic genu valgum. J Child Orthop. 2011;5(1):11-7. https://doi.org/10.1007/s11832-010-0310-6
- Häkkinen K, Alen M, Kallinen M. Neuromuscular adaptation during prolonged strength training, detraining and re-strength-training in middle-aged and elderly people. Eur J Appl Physiol. 2000;83(1):51-62. https://doi.org/10.1007/s004210000248
- Heiderscheit BC, Hamill J, Caldwell GE. Influence of Q-angle on Lower-Extremity Running kinematic. J Orthop Sports Phys Ther. 2000;30(5):271-8. https://doi.org/10.2519/jospt.2000.30.5.271
- Herring SA. Predictors of low back injuries in varsity athletes. Clin J Sport Med. 2002;12(4):261. https://doi.org/10.1097/00042752-200207000-00012
- Hurley ST, Hatfield Murdock GL, Stanish WD, et al. Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength? Arch Phys Med Rehabil. 2012;93(3):496-502. https://doi.org/10.1016/j.apmr.2011.09.002
- Ilahi OA, Kohl HW. Lower extremity morphology and alignment and risk of overuse injury. Clin J Sport Med, 1998;8:38-42 https://doi.org/10.1097/00042752-199801000-00009
- James SL, Bates BT, Osternig LR. Injuries to runners. Am Sports Med. 1978;6:40-50. https://doi.org/10.1177/036354657800600202
- Jung YW, Kim YJ, Lee JG, et al. Correlations Between Quadriceps Angle, Functional Leg Length Discrepancy and Lower Extremity Muscle Strength of Women University Students in Their Twenties. Korean Academy of Orthopedic Manual Ther. 2014;20(2):9-14.
- Kader M. The Correction of genu valgum by a reversed dome osteotomy in the supracondylar area of the femur. Pan Arab J Orth Trauma. 2002;6(2):199-202.
- Kang JS, Lee WH, Lee DJ, et al. Effect of a modified maneuver for quadriceps muscle setting with co-contraction of the hamstrings on patients with knee joint osteoarthritis. J Korean Soc Phys Med. 2010;5(3):375-83.
- Kim Y, Kim S, Jang H. Correlation of Hip Joint Range of Motion and Femur Head Anterior Glide Mobility with Gait Ability in Stroke Patients. J Korean Soc Phys Med, 2014;9(1):35-44. https://doi.org/10.13066/kspm.2014.9.1.35
- Kraus VB, Vail TP, Worrell T, et al. A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arthritis Rheum. 2005;52(6):1730-5. https://doi.org/10.1002/art.21100
- Kulkarni GS. Angular deformities in lower limb in children. In: Kulkarni GS, editor. Text Book of Orthopedics and Trauma. 2nd ed. Jaypee Publishers. New Delhi. 2008.
- Kulkarni RM, Ilyas Rushnaiwala FM, Kulkarni GS, et al. Correction of coronal plane deformities around the knee using a tension band plate in children younger than 10 years. Indian J Orthop. 2015;49(2):208-18. https://doi.org/10.4103/0019-5413.152484
- Lathinghouse LH, Trimble MH. Effects of isometric quadriceps activation on the Q-angle in women before and after quadriceps exercise. J Orthop Sports Phys Ther. 2000;30(4):211-6. https://doi.org/10.2519/jospt.2000.30.4.211
- Lee J, Lee H, Lee W. Effect of Weight-bearing Therapeutic Exercise on the Q-angle and Muscle Activity Onset Times of Elite Athletes with Patellofemoral Pain Syndrome: A Randomized Controlled Trial. J Phys Ther Sci. 2014;26(7):989-92. https://doi.org/10.1589/jpts.26.989
- Mikesky AE, Mazzuca SA, Brandt KD, Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Rheum. 2006;55(5):690-9. https://doi.org/10.1002/art.22245
- Monk AP, Choji K, O'Connor JJ, et al. The shape of the distal femur: a geometrical study using MRI. Bone Joint J. 2014;96-B(12):1623-30. https://doi.org/10.1302/0301-620X.96B12.33964
- Muscolino, J. Flashcards for Bone s, Joints, and Actions of the Human Body. Mosby. United States. 2010.
- Nguyen AD, Shultz SJ, Schmitz RJ, et al. A preliminary multifactorial approach describing the relationships among lower extremity alignment, hip muscle activation, and lower extremity joint excursion. J Athl Train. 2011;46(3):246-56. https://doi.org/10.4085/1062-6050-46.3.246
- Nissen CW, Cullen MC, Hewett TE, et al. Physical and arthroscopic examination techniques of the patellofemoral joint. J Orthop Sports Phys Ther. 1998;28:277-85. https://doi.org/10.2519/jospt.1922.214.171.1247
- Omololu BB, Ogunlade OS, Gopaldasani VK. Normal Q-angle in an adult Nigerian population. Clin Orthop Relat Res. 2009;467(8):2073-6. https://doi.org/10.1007/s11999-008-0637-1
- Park SW, Kim MS, Bae HS, et al., The Reliability and Validity of Hip Range of Motion Measurement using a phone Operative Patient. J Korean Soc Phys Med. 2015;10(2):1-7.
- Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33(11):639-46. https://doi.org/10.2519/jospt.2003.33.11.639
- Puddu G, Cipolla M, Guglielmo C, et al. Which osteotomy for a valgus knee? Int Orthop. 2010;34:239-47. https://doi.org/10.1007/s00264-009-0820-3
- Raja K, Dewan N. Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis:a systematic review. Am J Phys Med Rehabil. 2011;90(3):247-62. https://doi.org/10.1097/PHM.0b013e318206386b
- Sacco Ide C, Konno GK, Rojas GB. Functional and EMG responses to a physical therapy treatment in patellofemoral syndrome patients. J Electromyogr Kinesiol. 2006;16(2):167-74. https://doi.org/10.1016/j.jelekin.2004.06.010
- Salenius P, Vankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg Am. 1975;57(2):259-61. https://doi.org/10.2106/00004623-197557020-00021
- Sanhudo JA, Gomes JL. Association between leg length discrepancy and posterior tibial tendon dysfunction. Foot Ankle Spec. 2014;7(2):119-26. https://doi.org/10.1177/1938640014522096
- Schulthies SS, Francis RS, Fisher AG. Does the Q angle reflect the force on the patella in the frontal plane? Phys Ther. 1995;75(1):24-30. https://doi.org/10.1093/ptj/75.1.24
- SENIAM. European Recommendations for Surface ElectroMyoGraphy, results of the SENIAM project. SENIAM project. Roessingh Research and Development. 1999.
- Shelbourne KD, Dickens JF. Digital radiographic evaluation of medial joint space narrowing after partial meniscectomy of bucket-handle medial meniscus tears in anterior cruciate ligament-intact knees. Am J Sports Med. 2006;34(10):1648-55. https://doi.org/10.1177/0363546506288019
- Stensdotter AK, Hodges PW, Mellor R, et al. Quadriceps activation in closed andopen kinetic chain exercise. Med Sci Sports Exerc. 2003;35(12):L2043-7. https://doi.org/10.1249/01.MSS.0000099107.03704.AE
- Urquhart DM, Tobing JF, Hanna FS, et al. What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc. 2011;43(3):432-42.
- van der Kraan P, van den Berg W. Osteophytes: relevance and biology. Osteoarthritis Cartilage. 2007;15:237-44. https://doi.org/10.1016/j.joca.2006.11.006
- Voight ML, Wieder DL. Comparative reflex response times of vastus medialis obliquus and vastus lateralis in normal subjects and subjects with extensor mechanism dysfunction. An electromyographic study. Am J Sports Med. 1991;19(2):131-7. https://doi.org/10.1177/036354659101900207
- Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dyn Med. 2008;7:9. https://doi.org/10.1186/1476-5918-7-9
- Woodland LH, Francis RS. Parameters and comparisons of the quadriceps angle of college-aged men and women in the supine and standing positions. Am J Sports Med. 1999;20(2):208-11.
- Zhang AL, Exner GU, Wenger DR. Progressive genu valgum resulting from idiopathic lateral distal femoral physeal growth suppression in adolescents. J Pediatr Orthop. 2008;28(7):752-6. https://doi.org/10.1097/BPO.0b013e3181875b46
- Zhang X, Chen C, Duan H, et al. Radiographic classification and treatment of fibrous dysplasia of the proximal femur: 227 femurs with a mean follow-up of 6 years. J Orthop Surg Res. 2015;16;10(1):171. https://doi.org/10.1186/s13018-015-0313-6
- Clinical efficacy and safety of thread-embedding acupuncture for treatment of the sequelae of Bellʼs palsy vol.98, pp.7, 2019, https://doi.org/10.1097/MD.0000000000014508
Grant : BK21플러스
Supported by : 단국대학교(천안캠퍼스)