Open Kinetic Chain Exercises Research Articles

Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction.

[Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction.

Influence of exercises on patellar height in women with patellofemoral pain syndrome.

OBJECTIVE: To evaluate the patellar height of volunteers with and without patellofemoral pain syndrome (PPS) during maximal voluntary isometric contraction (MVIC) in open kinetic chain (OKC) and closed kinetic chain (CKC) exercises. METHODS: Twenty healthy women, and nineteen women with patellofemoral pain syndrome were evaluated and subjected to nuclear magnetic resonance imaging during rest and MVIC in OKC and CKC at 15°, 30°, and 45° knee flexion. The patellar height was assessed by the K-Pacs program,using the Insall-Salvati index. For each exercise and knee position, patellar height was measured three times and the procedure was repeated after seven days. RESULTS: These data did not confirm our hypothesis that OKC exercises promote increased patellar height. CONCLUSION: Patellar height is not associated with PPS and suggests that CKC exercises lead an increased patellar height during knee position at 15º and 45º flexion for the PPS group. Level of Evidence II, Comparative Prospective.

To Determine effectiveness of Closed-Kinetic Chain Exercise on Motor Control and Function as Compared to Open-Kinetic Chain Exercise in Children with Spastic Diplegic CP

Background and purpose : Traditionally, rehabilitation program emphasize strengthening training under close loop exercises. This study is designed to compare the effectiveness of closed-kinetic chain exercise v/s open-kinetic chain on motor function in children with spastic diplegic CP. Method : 30 subjects with mild spastic diplegia (GMFCS level I-II) were selected on the basis of inclusion criteria and randomly assigned in two groups. Group A performed the loaded STS exercises 3 days a week, and 3 sets per day for 6 weeks. Group B performed progressive exercise training for 6 weeks, with three sessions per week, and at least one day's rest between sessions. 10-RM was calculated for the muscle selected. Result : Student's t test while discrete data (Sex and GMFCS level) were analyzed with Fisher's exact est. The pre-test and post-test outcome measures (SCALE score, GMFM dimension D and GMFM dimension E) of two independent groups were compared by repeated measures analysis of variance (RM ANOVA) using general linear models (GLM) and the significance of mean difference within and between the groups was done by Newman-Keuls post hoc test. Conclusion : study revealed that Progressive resisted lower limb strength training was found to be slightly (insignificant) more effective than Loaded sit-to-stand exercise. The SCALE score, GMFM Dimension D and GMFM Dimension E scores improved 1.08, 1.10 and 1.05 times more respectively in children those who received Progressive resisted lower limb strength training than those who received Loaded STS training.

The effects of closed and open kinetic chain exercises on lower limb muscle activity and balance in stroke survivors

The major contributors to physical disability after stroke are the negative impairments related to loss of functional ability and muscle strength. The aim of this study was to examine the effects of close kinetic chain (CKC) exercise and open kinetic chain (OKC) exercise on muscle activation of the paretic lower limb and balance in chronic stroke subjects. Thirty-three patients with chronic stroke of over 6 months were enrolled. They were randomly allocated to three groups: CKC exercise group (n = 11), OKC exercise group (n = 11), and control group (n = 11). CKC and OKC exercise groups were trained 5 times per week for 6 weeks. The control group maintained routine activities and did not participate in any regular exercise program. All subjects were measured on muscle activation of the paretic lower limb and balance. Muscle activation of rectus femoris (RF) and biceps femoris (BF) was significantly increased in both CKC exercise and OKC exercise groups, compared to the control group. However, muscle activation of gastrocnemius (GC) and tibialis anterior (TA) was significantly increased in only the CKC exercise group. Antero-posterior (A-P) andmedio-lateral (M-L) sway velocities (both with EO and EC) were decreased with the application of CKC exercise. These findings indicate that the CKC exercise can improve lower limb muscle strength, and balance in chronic stroke, and it may carry over into an improvement in functional performance.

In vivo patellofemoral contact mechanics during active extension using a novel dynamic MRI-based methodology

To establish an in vivo, normative patellofemoral (PF) cartilage contact mechanics database acquired during voluntary muscle control using a novel, dynamic, magnetic resonance (MR) imaging-based, computational methodology and validate the contact mechanics sensitivity to the known sub-millimeter methodological accuracies. Dynamic cine phase-contrast and multi-plane cine (MPC) images were acquired while female subjects (n = 20, sample of convenience) performed an open kinetic chain (knee flexion-extension) exercise inside a 3-T MR scanner. Static cartilage models were created from high resolution three-dimensional static MR data and accurately placed in their dynamic pose at each time frame based on the cine-PC (CPC) data. Cartilage contact parameters were calculated based on the surface overlap. Statistical analysis was performed using paired t-test and a one-sample repeated measures ANOVA. The sensitivity of the contact parameters to the known errors in the PF kinematics was determined. Peak mean PF contact area was 228.7 ± 173.6 mm(2) at 40° knee angle. During extension, contact centroid and peak strain locations tracked medially on the femoral and patellar cartilage and were not significantly different from each other. At 25°, 30°, 35°, and 40° of knee extension, contact area was significantly different. Contact area and centroid locations were insensitive to rotational and translational perturbations. This study is a first step towards unfolding the biomechanical pathways to anterior PF pain and osteoarthritis (OA) using dynamic, in vivo, and accurate methodologies. The database provides crucial data for future studies and for validation of, or as an input to, computational models.

열린사슬운동 및 닫힌사슬운동에서 위팔굽힘 각도에 따른 앞톱니근의 근활성도 비교

PURPOSE: The purpose of present study was to ascertain how the activity of the serratus anterior muscle, the upper trapezius muscle and the pectoral major muscle was affected while the upper arm was being flexed at 70, 90 and 110 degrees respectively in a closed kinetic chain exercise (wall push up plus) and an open kinetic chain exercise (static hug). METHODS: Sixteen healthy young men subjects participated in the study. Surface electromyography (EMG) data were collected from the dominant-side muscles during a closed kinetic chain exercise and an open kinetic chain exercise. The activity of each muscle was measured quantitatively, and by the use of the two-way repeated ANOVA, the data were compared with each other according to exercises and shoulder flexion angles. RESULTS: Results indicated that the closed kinetic chain exercise did not interact with the open kinetic chain exercise (p>.05). In both the closed kinetic chain exercise and the open kinetic chain exercise, the activity of the serratus anterior muscle became different significantly according to angles (p

닫힌사슬운동과 열린사슬운동이 요부안정화근의 두께에 미치는 영향

Abstract Purpose : This study was to investigate effects of closed kinetic chain and open kinetic chain exercise on the lumbar stabilizarion. Methods : A total of 30 healthy over 20 years old college students(men = 14, women = 16) who were participated in this. We selected randomly people of CKC, OKC, and control group. For the past four weeks, CKC and OKC group worked out 3 times per week and then we compared within group and between groups on muscle width. Results : 1. The width of internal oblique, transverse abdominis, and multifidus were all significantly increased after four weeks exercise in the CKC group(P<.05). 2. The width of internal oblique, transverse abdominis, and multifidus were all increased after four weeks exercise in the OKC group but transverse abdominis musule only showed significant difference. 3. Difference values between pre-exercise and post-exercise of transverse abdominis and multifidus in the CKC group was significantly high and difference among the groups were significant. Conclusion : Accordingly, lumbar stabilizing exercise was more effective to increase a width of abdominal deep muscles through CKC exercise. Key Words : CKC, OCK, stabilization, ultrasound

Subjective Assessment of Rehabilitation Protocol by Patients after ACL Reconstruction – Preliminary Report

Subjective evaluation by patients has recently become an important adjunct to postoperative clinical assessment. Apart from standard physical examination, scales demonstrating patients’ subjective outcome measures are used for assessing the efficacy of the treatment and rehabilitation of knee ligamentous injuries. The present work presents patients’ subjective assessment of rehabilitation protocols after ACL reconstruction. Forty individuals who had undergone ACL reconstruction were randomised into two groups (G1, G2) and followed one of two rehabilitation protocols (A or B). The subjects assessed their knee function at baseline and after physical therapy using the Lysholm score and the IKDC form. The results were analysed with the Mann-Whitney U test. The subjects also completed a questionnaire at discharge. Analysis of Lysholm and IKDC scores revealed significant differences between the mean pre- and postrehabilitation results in the groups (p<0.05). The greatest improvement was seen in G2 patients rehabilitated with protocol B, with significant mean improvements of 56.3% and 46.7% for the Lysholm and IKDC scores, respectively. Group G1 registered only half of this magnitude of change. Protocol B was also highly rated in the questionnaires. According the patients opinion a rehabilitation protocol involving a larger number of open kinetic chain exercises may prove more effective in the rehabilitation of patients after ACL reconstruction compared to a programme basing mainly on closed kinetic chains.

Changes of plantar pressure distributions following open and closed kinetic chain exercise in patients with stroke

The aim of this study is to investigate whether progressive resistive training with closed-kinetic chain (CKC) and open-kinetic chain (OKC) exercises could change plantar pressure distribution during walking in patients with stroke. Thirty-nine stroke patients were recruited and randomly divided into a CKC exercise group (n = 13), an OKC exercise group (n = 13), and a control group (n = 13). Both CKC and OKC exercise groups performed their own respective training programs 5 times per week for 6 weeks, whereas no training was done in the control group. Barefoot plantar pressure distribution was measured during walking in terms of contact area (CA), peak contact force (PCF), and contact impulse (CI) on each of three foot regions (i.e. forefoot (FF), midfoot (MF), and hindfoot (HF)). In the CKC exercise group, there were significant changes in only the CA and PCF of HF. In the OKC exercise and control groups, no significant differences were found for all variables of plantar pressure distributions. We found that resistive training with closed kinetic chain exercises could be an effective treatment method for improving normal gait patterns in stroke patients. These findings may be attributed to the fact that CKC exercise induced use of the ankle and knee muscles and provided repetitive sensory input from the affected foot.

Open Kinetic Chain Exercises in a Restricted Range of Motion After Anterior Cruciate Ligament Reconstruction

Background: Recent studies have shown that an early start of open kinetic chain (OKC) exercises for quadriceps strengthening in a full range of motion (ROM) could increase anterior knee laxity after anterior cruciate ligament (ACL) reconstruction with flexor tendons. However, there are no clinical trials that evaluated outcomes of OKC exercises in a restricted ROM for pain, function, muscle strength, and anterior knee laxity at 1 year after surgery. Purpose: To determine if an early start of OKC exercises for quadriceps strength in a restricted ROM would promote a clinical improvement without causing increased anterior knee laxity in patients after ACL reconstruction. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: A total of 49 patients between 16 and 50 years of age who underwent ACL reconstruction with semitendinosus and gracilis autografts were randomly assigned to an early start OKC (EOKC) exercise group or a late start OKC (LOKC) exercise group. The EOKC group (n = 25; mean age, 26 years) received a rehabilitation protocol with an early start of OKC (fourth week postoperatively) within a restricted ROM between 45° and 90°. The LOKC group (n = 24; mean age, 24 years) performed the same protocol with a late start of OKC exercises between 0° and 90° (12th week postoperatively). Quadriceps and hamstring muscle strength, 11-point numerical pain rating scale (NPRS), Lysholm knee scoring scale, single-legged and crossover hop tests, and anterior knee laxity were measured to assess outcomes at the 12-week, 19-week, 25-week, and 17-month postoperative follow-up (range, 13-24 months). Results: No difference (P < .05) was noted between groups with respect to demographic data. Both groups (EOKC and LOKC) had a higher level of function and less pain at the 19-week, 25-week, and 17-month assessments when compared with 12 weeks postoperatively (P < .05). The EOKC group had improved quadriceps muscle strength at the 19-week, 25-week, and 17-month follow-up when compared with 12 weeks postoperatively (P < .05); the LOKC group showed improvement only at the 17-month postoperative assessment. However, the analysis between groups showed no difference for all pain and functional assessments, including anterior knee laxity (P > .05). Conclusion: An early start of OKC exercises for quadriceps strengthening in a restricted ROM did not differ from a late start in terms of anterior knee laxity. The EOKC group reached the same findings in relation to pain decrease and functional improvement when compared with the LOKC group but showed a faster recovery in quadriceps strength. The nonweightbearing exercises seem appropriate for patients who have undergone ACL reconstruction, when utilized in a specific ROM. The magnitude of difference in quadriceps strength between the 2 rehabilitation protocols was around 5%; however, this difference was not clinically significant, especially because both groups had equal function on the hop tests.

A Study to compare the effect of Open versus Closed kinetic chain exercises in Patello-femoral arthritis.

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 patello- femoral 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

The Effect of Open and Closed Kinetic Chain Exercises on Dynamic Balance Ability of Normal Healthy Adults

[Purpose] This study investigated the effect of open and closed kinetic chain exercise on the dynamic balance ability of healthy young adults. [Subjects] Thirty-three healthy adults participated in this study. [Methods] Subjects were randomly assigned to either an open kinetic chain exercise group (n=17) or a closed kinetic chain exercise group (n=16). Both the open kinetic chain and closed kinetic chain exercise groups performed 3 sets of exercises 3 times per week for 6 weeks. Dynamic balance was measured at the beginning and end of the 6-week training period, including anterior-posterior, medial-lateral, and total displacement of the center of pressure. [Results] Both exercise groups showed improvement in balance parameters but the improvement was only statistically significant in the closed kinetic chain group. [Conclusion] Closed kinetic chain exercise appears to be more effective at improving of dynamic balance ability than open kinetic chain exercise within a 6-week training period.

Kinetic Chain Exercise For Patello Femoral Pain Syndrome - A Randomised Control Study

Objective: The objective was to compare the effect of open kinetic chain exercise and closed kinetic chain exercise in quadriceps strength and pain in patients with patella femoral pain syndrome. Introduction: Patello femoral pain syndrome [PFPS] can be defined as retropatellar pain or peri patellar pain resulting from physical and biochemical change in patella femoral joint. The patients with patello femoral pain syndrome have anterior knee pain, which typically occurs during activity and often worsens with descending stairs and also triggered by prolonged sitting. Patello femoral pain syndrome is due to the degeneration in the articular cartilage of the knee cap. PFPS is the most prevalent disorder involving the knee and can be misdiagnosed sometime as bursitis, meniscus, and ligament instability. Osteoarthritis, chondromalacia patella produce more stress on the patella femoral mechanism. Materials & Methodology: After getting the ethical clearance for this study 30 patients with PFPS were selected and randomized into 2 groups after due consideration of the inclusive and exclusion criteria. The patients consent for this study was taken and documented. Procedure: Group A and Group B subjects were given with open kinetic chain [OKC] and closed kinetic chain [CKC] exercises respectively. The dosimetry of these exercises was 30 minutes duration every alternate day for 4 weeks. Data collected for statistical analysis included Maximal Isometric Voluntary Contraction [MVIC] using surface EMG on Vastus Medialis [quadriceps muscle] and Pain by visual analog scale [VAS] before and after exercise. Result: Data collected were statistically analyzed using the SPSS 11 version for t-test. The paired ttest value for both CKC and OKC shows that there is a significant improvement in the quadriceps strength and pain reduction in both the groups. The unpaired t-test between the groups for quadriceps interference [3.45] and pain score in VAS scale [2.89] with p value at 0.01 shows that closed kinetic chain [CKC] exercise is better than the open kinetic chain [OKC] exercise in improving the strength and reducing the pain among PFPS patients. Conclusion: To conclude, though both OKC and CKC exercises are beneficial in PFPS patients, CKC proved to be better than the OKC in improving the quadriceps muscle strength and reducing the pain. This study proves this statement statistically with significance.

The immediate effects of open kinetic chain knee extensor exercise at different loads on knee anterior laxity in the uninjured

BackgroundThere is evidence that anterior laxity may be affected by knee extensor open kinetic chain (OKC) exercise with responses being load-dependent. The aim of this study is to evaluate the immediate and short-term changes in passive knee anterior laxity following a single session of OKC knee extensor exercise. MethodsThirty two participants were randomly allocated to perform either high load (20 sets of 2 repetitions) or low load (2 sets of 20 repetitions) knee extensor OKC exercise with knee anterior laxity assessed before exercise, immediately after exercise and 45 and 90min after exercise with a KT-2000 arthrometer using a 133N force. ResultsA significant effect of time was observed on knee laxity (p<0.001). However, a significant interaction of time and group was not found (p=0.54) and so the results presented here are for the combined (low and high load) group mean±standard deviation knee anterior laxity (mm) in the exercised leg: 7.2±2.2 (baseline), 8.2±2.3 (immediate post exercise, 14% change from baseline), 8.1±2.3 (45min post exercise, 12% change from baseline), and 7.7±2.2/0.29 (6.9) (90min post exercise, 7% change from baseline). ConclusionOKC knee extensor exercise at high loads and low loads causes an immediate increase in knee laxity that begins to decrease within 90min.

Shear wave elastography properties of vastus lateralis and vastus medialis obliquus muscles in normal subjects and female patients with patellofemoral pain syndrome

The aim of our study was to define and compare the mechanical properties of the vastus lateralis (VL) and vastus medialis obliquus muscles (VMO) by the way of quantitative shear-wave elastography in male and female healthy control (HC) subjects, and in female patients with patellofemoral pain syndrome (PFPS). Twenty-two healthy volunteers (11 male and 11 female) and 11 female patients with anterior knee pain were included in the study. The SWE examinations for VL and VMO were performed while the subjects were performing open kinetic chain exercises in neutral and 30° hip abduction. The contraction capacity (CC) and contraction ratio (CR) values were determined in resting and contraction phases in both hip positions. The mean elasticity values in the CC for VL and VMO muscles were significantly higher in male HC subjects when compared to female HC subjects (p < 0.05). The CR of the VL muscle in female patients with PFPS was not significantly different than the female HC group. The CR for the VMO muscle was significantly lower in female patients with PFPS when compared to female HC subjects (p < 0.05). We found a significant VMO weakness, and this method may provide quantitative data that might influence the diagnosis of muscle weakness, in female patients with PFPS.

Comparison of Exercise Open Kinetic Chain and Closed Kinetic Chain in The Rehabilitation of Patellofemoral Dysfunction: an Updated Revision

Introduction: The patellofemoral syndrome (PDS) is a disease characterized by pain in the patellofemoral l and physical changes resulting from this joint biomechanics. The rate of incidence is high and its etiology remains unknown. Objective: This literature review aims to compare the effectiveness of open kinetic chain exercises with closed kinetic chain into the functional recovery of patients with the patella-femoral syndrome. Methods: We conducted a systematic review in the database LILACS, MEDLINE and PUB MED SCIELO as search term words patellofemoral syndrome, Open Kinetic Chain and Closed Kinetic Chain. Discussion: The imbalance of forces of patella dynamic stabilizers, Vastus medialis oblique (VMO) and vastus lateralis (VL), is still considered the primary factor for the onset of symptoms. Since this change causes an increase in reaction force and patellofemoral compression. In order to recover the balance of forces of the muscles acting as stabilizers of the knee and as a means of restoring stability to the joint, exercises in open kinetic chain (OKC) and closed kinetic chain (CKC) has been used in rehabilitation programs patellofemoral disorders. Conclusion: The benefits for implementing these protocols are not well documented; scientific evidences are insufficient to prove the real effectiveness of these exercises in improving the performance of quadriceps muscle or assist in muscle balance of patellofemoral stabilizers.

열린사슬운동과 닫힌사슬운동이 정상성인의 하지근활성도에 미치는 영향

Purpose : This study was investigated the effect of lower extremity muscle activity during open kinetic chain exercise (OKC) and closed kinetic exercise (CKC) in normal young adults. Methods : The participants were consisted of forty-one. All subjects were randomly assigned to two groups of open kinetic chain exercise group (n=21) and closed kinetic chain exercise group(n=20). It was perform 3 sets, 3 times per week for 6 weeks both open kinetic chain exercise group and closed kinetic chain exercise group. Subjects were assessed for each subject took pre-test, post-test in 2 weeks, post-test in 4 weeks, post-test in 6 weeks measurement the surface EMG data for vastus medialis and lateralis, lateral and medial hamstring, lateral and medial gastrocnemius, tibialis anterior. Results : The vastus medialis and lateralis muscle activity was significantly increased within the intervention period both group(p<.05). The lateral and medial part of hamstring muscle activity was significantly increased with in the intervention period(p<.05). The tibialis anterior muscle activity of open kinetic chain exercise group and closed kinetic chain exercise group was significantly increased in the intervention period(p<.05). The lateral and medial part of gastrocnemius muscle activity of open kinetic chain exercise group and closed kinetic chain exercise group was significantly increased with in the intervention period(p<.05). Conclusion : It was found that both open kinetic chain exercise and closed kinetic chain exercise was significantly increased muscle activity. Further studies are needed to analyzed long term effects and subjects resulting from these changed. these exercises can be selectively adapted not only as treatment exercise for patients but also as preventive exercise for normal person to improve balancing ability by conducting proper amount of exercise for each individual's condition and stage.

Clinical trial of step-up exercise therapy using DVD for patients with hip osteoarthritis

Purpose: Efficacy of exercise treatment for osteoarthritis (OA) has been reported controversially. We developed a new exercise program designed as several step-up stages in accordance with patient disease activity, using a digital video disc (DVD). In this study, we analyzed the efficacy of this step-up exercise therapy program using DVD for the hip OA patients. Methods: We prospectively recruited 45 patients (male1, female44) with symptomatic hip OA were included. All participants provided informed consent to the study which was approved by the Institutional Review Board. They were assigned into 2 groups; (1) DVD group in which the patient was instructed to perform exercise by watching specially-developed DVD program, (2) control group in which the patient was instructed to perform exercise by referring to the home exercise instruction documents. The original DVD was developed among the community of the orthopaedic surgeons, physical therapists and the orthopaedic research nurse. On the DVD, the step-up program had 6 stages consisting of 3 OKC (Open kinetic chain) exercise programs and 3 CKC (Closed kinetic chain) exercise programs. Patients were instructed to perform exercise daily for 30-40 minutes by watching DVD, with completing each stage for 2 weeks. All patients received the following assessments at the entry to the study and 3 months later; (1) muscle volume in the lower limb estimated by impedance of living body instrument, (2) muscle strength by dynamometer, (3) gait speed by time up and go test, (4) stability of lower limb by one-legged standing time (up to 120 seconds), and (5) the objective evaluations by Oxford hip score, Health related Quality of life by SF-8 and Self-efficacy (Self-efficacy is defined as people's beliefs about their capabilities to produce designated levels of performance) by General Selfefficacy scale. If the patient had OA in both hips, only one hip with more painful side was included. Results: There were 12 patients (mean age 54.0 years) in the DVD group and 33 patients (51.7) in the control group. At 3 months, time up and go test was significantly improved from 7.4 seconds to 6.9 seconds (p1⁄40.015) in the DVD group and from 7.6 seconds to 7.2 seconds in the control group (p1⁄40.024). The effect size of this improvement was superior in the DVD group. The stability of lower limb by one-legged standing time was significantly improved only in the DVD group from 81.6 seconds to 103.8 seconds (p1⁄40.02). The muscle volume of the lower limbwas not changed significantly in both groups. The muscle strength of hip abduction was significantly improved from 114.2 to 133.2 newton (p1⁄40.031) only in the control group. SF-8(physical), General Self-efficacy, and Oxford hip score showed tendency of improvement in both groups. However, statistically significant improvement was only seen for pain score of Oxford hip score from 11.9 to 9.6 (p1⁄40.002) in the control group. In hearing of impression regarding DVD program, patients had feeling of better understating of program content by movie, or of accelerating effect by synchronization with the instructor's action in the DVD. Conclusions: Physical function and pain of the patients were significantly improved in both DVD and control groups. Although muscle volume and muscle strength were not improved apparently, physical function including the time up and go test and one-legged standing time was improved better in DVD group than control group. The body balance might be improved more by visual education of DVD movie. The patients’ comments were also related with encouragement of correct understanding of exercise using DVD.

Differences In ACL Laxity Between Breaststroke And Freestyle Swimmers Compared With Non-swimmers

Originally based on a case study of the lead author who, as a competitive breaststroker, ruptured his left ACL during a basketball game we wanted to know if swimming breaststroke tends to increase ACL laxity and hence make breaststrokers at risk for injuring their ACLs in other sports. PURPOSE: The purpose was to compare differences in ACL laxity between breaststroke and freestyle swimmers compared to non-swimmers. METHODS: 20 competitive swimmers (11 breaststrokers, 9 freestylers) and 20 non-swimmers were selected as subjects. A KT-1000 knee arthrometer was used to assess ACL laxity. Additional measurements were taken to determine generalized joint laxity (GJL; Beighton test) and ankle ROM. RESULTS: Breaststrokers were found to have significantly greater ACL laxity than freestyle swimmers (8.7 mm vs. 6.7 mm, p=.03). Neither group was significantly different than non-swimmers (7.9 mm, p>.05). Also, breaststrokers were found to have significantly greater GJL (p=.02) and ankle ROM (p=.03) than non-swimmers. CONCLUSIONS: Breaststroke and freestyle appear to have opposite effects on ACL laxity with breaststroke tending to increase it and freestyle tending to decrease it compared with non-swimmers. However we cannot eliminate the possibility that persons with greater ACL laxity seem to do better at breaststroke and those with less tend to do better at freestyle. If developing less laxity in a stronger ACL is a goal, then we'd like to propose freestyle kicking as a means of rehabilitation even though it is an open kinetic chain exercise. Open kinetic chain exercises are generally discouraged for ACL patients because of the anterior pull of the quadriceps on the tibia. But given the small range of knee motion and relatively small forces involved in freestyle kicking this might prove to be an exception to the rule.

Exercise Therapy For Patellofemoral Pain Syndrome, A Systematic Review

PURPOSE: To evaluate the short (3 months or less) and longer term effects of exercise therapy on reducing pain intensity and improving function and/or recovery in patients suffering from patellofemoral pain syndrome through a systematic literature review. METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (December 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009-4), MEDLINE, EMBASE, and other databases to December 2009. The primary comparison was between any exercise program mainly aiming at (quadriceps) muscle strengthening versus no intervention/usual care, an exercise program versus other type of intervention or an exercise program versus any other type of exercise intervention. Primary outcomes were pain, knee function and recovery. Data collection and analysis were done by two pairs of two authors who independently selected trials based on pre-defined inclusion criteria, extracted data and assessed the risk of bias. When appropriate data were pooled using the random-effect model. Mean differences (continuous data) and risk ratios (dichotomous data) with 95% confidence intervals were calculated. RESULTS: 23 trials were included in the review involving 1503 participants with age ranging from 14 to 40 years. At short term (-1.52, 95%CI -2.29;-0.76) and long term (-1.30, 95%CI -2.15; -0.46) exercise therapy shows to be effective on pain reduction compared to no intervention. At short term exercise therapy is effective on improving knee function (5.69, 95%CI 0.70; 10.67). At long term these effects are not significant. The effects of exercise therapy are not clearly reflected on the outcome measures for recovery. At short term exercise therapy is more effective on pain reduction than other conservative strategies such as brace, tape or insoles (-9.26; 95%CI -17.47, -1.05). No significant differences in effect were found when comparing exercise strategies for quadriceps muscle strengthening with other exercise strategies such as closed vs. open kinetic chain, hip abductor or abdominal muscle exercise. CONCLUSION: Data from this review show that exercise therapy is effective on reducing pain at short and long term and improving function at short term compared to no treatment/usual care for patients with patellofemoral pain syndrome.