Open Kinetic Chain Research Articles

Motor unit discharge rate and the estimated synaptic input to the vasti muscles is higher in open compared with closed kinetic chain exercise.

Conflicting results have been reported on whether closed kinetic chain exercises (such as a leg press) may induce more balanced activation of vastus medialis (VM) and lateralis (VL) muscles compared with open kinetic chain exercise (such as pure knee extension). This study aimed to 1) compare between-vasti motor unit activity and 2) analyze the combined motor unit behavior from both muscles between open and closed kinetic chain exercises. Thirteen participants (four women, mean ± SD age: 27 ± 5 yr) performed isometric knee extension and leg press at 10, 30, 50, 70% of the maximum voluntary torque. High density surface EMG signals were recorded from the VM and VL and motor unit firings were automatically identified by convolutive blind source separation. We estimated the total synaptic input received by the two muscles by analyzing the difference in discharge rate from recruitment to target torque for motor units matched by recruitment threshold. When controlling for recruitment threshold and discharge rate at recruitment, the motor unit discharge rates were higher for knee extension compared with the leg press exercise at 50% [estimate = 1.2 pulses per second (pps), standard error (SE) = 0.3 pps, P = 0.0138] and 70% (estimate = 2.0 pps, SE = 0.3 pps, P = 0.0001) of maximal torque. However, no difference between the vasti muscles were detected in both exercises. The estimates of synaptic input to the muscles confirmed these results. In conclusion, the estimated synaptic input received by VM and VL was similar within and across exercises. However, both muscles had higher firing rates and estimated synaptic input at the highest torque levels during knee extension. Taken together, the results show that knee-extension is more suitable than leg-press exercise at increasing the concurrent activation of the vasti muscles.NEW & NOTEWORTHY There is a significant debate on whether open kinetic chain, single-joint knee extension exercise can influence the individual and combined activity of the vasti muscles compared with closed kinetic chain, multijoint leg press exercise. Here we show that attempting to change the contribution of either the vastus medialis or vastus lateralis via different forms of exercise does not seem to be a viable strategy. However, the adoption of open kinetic chain knee extension induces greater discharge rate and estimated synaptic input to both vasti muscles compared with the leg press.

Kinesitherapeutic behaviour in conservative treatment of coxarthrosis – case report

Hip arthrosis is the main cause of disability of all degenerative joint diseases and therefore it is considered to be of social significance. The presented clinical case aims to confirm the efficacy of the applied kinesitherapeutic program in conservative treatment of 62-year-old patient with right-sided coxarthrosis. The kinesitherapeutic methods included right lower limb massage, suspension therapy, tractions and manual movements of the right hip joint, positional treatment, active exercisesinan openkinetic chain, postisometric relaxation and stretching for shortened muscles.The pain symptoms were reduced, the volume of movement in the right hip increased, the strength of the right hip joint stabilizer musclespartially improved.

The Detection of Knee Joint Sounds under Different Loading Conditions using Vibroarthrography

Crepitus of the knee may mirror structural changes of the joint during motion. Although the magnitude of these sounds increases with greater cartilage damage, it is unclear whether knee joint sounds also reflect joint loading. PURPOSE: To reveal whether the magnitude of knee joint sounds differs across defined dynamic loading conditions using vibroarthrography. METHODS: Twelve healthy volunteers (26 ± 3.59 years, 7 females) participated in the randomized-balanced crossover study. Knee joint sounds were recorded (linear sampling, 5512 Hz) by means of two acoustic sensors (microphones), one placed on the medial tibial plateau and one on the patella. Two activities of daily life (standing up from and sitting down on a bench; descending stairs) and three open kinetic chain (OKC) knee extension-flexion cycles (passive movement, 10 % and 40 % loading of the individual one repetition maximum) were performed. Each participant carried out three sets of five repetitions and three sets of 15 steps downwards (stairs), respectively. For data analysis, the mean noise volume for each loading condition was determined. The resulting values were expressed as relative difference to the individual OKC passive movement value. Friedman test and Bonferroni-Holm adjusted post-hoc test were performed to detect differences between conditions. RESULTS: The OKC passive movement sound ranged from .0001 to .003 a.u. (≙ 43.6 - 69.3 dB) at the medial tibia and from .001 to .03 a.u. (≙ 60.6 - 87.7 dB) at the patella. Significant differences between joint sound amplitudes for all movements, both measured at the medial tibial plateau (Chi2=20.7, p<0.001) and at the patella (Chi2=27.6, p<0.001) were obtained. The corresponding median differences for the tibia sensor were: stand/sit: 236 %, stairs: 675 %, OKC10: 291 %, OKC40: 384 %; and for the patella sensor: stand/sit: 158 %, stairs: 260 %, OKC10: 75 %, OKC40: 78 %. CONCLUSION: Overall, the larger the supposed knee joint loading was, the louder was the recorded knee crepitus. Consequently, vibroarthrographically assessed knee joint sounds can differ across knee joint loading conditions. Future studies should further support these findings using inverse dynamics as a measurement of knee joint loading.

Effects of Isokinetic Strength Exercise of the Hemiparetic Knee Joint on Lower Extremity Sensorimotor and Gait Functions in Patients With Chronic Stroke: Open Kinetic Chain Versus Closed Kinetic Chain

Background: After stroke, in order to improve gait function, it is necessary to increase the muscle strength and to enhance the propriocetive function of the lower extremity. Objects: This study aimed to compare the effects of open kinetic chain (OKC) versus closed kinetic chain (CKC) isokinetic exercise of the hemiparetic knee using the isokinetic equipment on lower extremity sensorimotor function and gait ability in patients with chronic stroke. Methods: Thirty participants with chronic hemiplegia (> 6 months post-stroke) were randomly divided into 2 equal groups: CKC group and OKC group. Patients from both groups attended conventional physiotherapy sessions 3 times a week for 6 weeks. Additionally, subjects from the CKC group performed isokinetic exercise using the CKC attachment, while those from the OKC group performed isokinetic exercise using the OKC attachment. The isokinetic knee and ankle muscles strength, position sense of the knee joint, and spatiotemporal gait parameters were measured before and after interventions. Results: The knee muscles peak torque/body weight (PT/BW) and hamstring/quadriceps (H/Q) ratio significantly increased in both groups (p<.01). In particular, ankle plantarflexors PT/BW, position sense of the knee, gait velocity, and spatial gait symmetry significantly improved in the CKC group (p<.01, p<.05, p<.01, and p<.01, respectively). Conclusion: CKC isokinetic exercise can be an effective therapeutic intervention for the improvement of sensorimotor function of the lower extremity and gait functions, such as gait velocity and symmetry. CKC position in isokinetic strength training is effective to improve functional ability in patients with chronic stroke.

Validity and Reliability of a Digital Inclinometer to Assess Knee Joint Position Sense in an Open Kinetic Chain.

Context: New methods are being validated to easily evaluate the knee joint position sense (JPS) due to its role in the sports movement and the risk of injury. However, no studies to date have considered the open kinetic chain (OKC) technique, despite the biomechanical differences compared with closed kinetic chain movements. Objective: To analyze the validity and reliability of a digital inclinometer to measure the knee JPS in the OKC movement. Design: The validity and intertester and intratester reliability of a digital inclinometer for measuring knee JPS were evaluated. Setting: Sports research laboratory. Participants: A total of 18 athletes (11 males and 7 females; 28.4 [6.6]y; 71.9 [14.0]kg; 1.77 [0.09]m; 22.8 [3.2]kg/m2) voluntary participated in this study. Main Outcomes Measures: Absolute angular error (AAE), relative angular error (RAE), and variable angular error (VAE) of knee JPS in an OKC. Results: Intraclass correlation coefficient (ICC) and standard error of the mean(SEM) were calculated to determine the validity and reliability of the inclinometer. Data showed excellent validity of the inclinometer to obtain proprioceptive errors compared with the video analysis in JPS tasks (AAE: ICC = .981, SEM = 0.08; RAE: ICC = .974, SEM = 0.12; VAE: ICC = .973, SEM = 0.07). Intertester reliability was also excellent for all the proprioceptive errors (AAE: ICC = .967, SEM = 0.04; RAE: ICC = .974, SEM = 0.03; VAE: ICC = .939, SEM = 0.08). Similar results were obtained for intratester reliability (AAE: ICC = .861, SEM = 0.1; RAE: ICC = .894, SEM = 0.1; VAE: ICC = .700, SEM = 0.2). Conclusions: The digital inclinometer is a valid and reliable method to assess the knee JPS in OKC. Sport professionals may evaluate the knee JPS to monitor its deterioration during training or improvements throughout the rehabilitation process.

The effect of shear-wave elastography on functional results and muscle stiffness in patients undergoing non-selective and selective open kinetic chain exercises.

This study aims to assess the effect of shear-wave elastography (SWE) on vastus medialis obliquus (VMO) and vastus lateralis (VL) muscle performances and functional outcomes of patients with patellofemoral pain syndrome (PFPS) undergoing non-selective open kinetic chain exercises (NSOKCE) and selective open kinetic chain exercises (SOKCE). This randomized-controlled clinical trial included a total of 40 patients with PFPS (20 males, 20 females; mean age 46.5±9.8 years, range, 27 to 65 years) and 40 healthy controls (20 males, 20 females; mean age 36.3±11.2 years, range, 23 to 71) between February 2013 and August 2014. The participants in each group were randomized into subgroups according to NSOKCE or SOKCE for six weeks. The VMO and VL muscles were assessed with the SWE, thigh circumferences were measured, and the Visual Analog Scale (VAS) and Lysholm Knee Scale (LKS) scores were obtained. The OKCE alleviated pain, improved LKS scores, and increased the thigh circumference in PFPS patients. While the healthy controls were able to increase the resting muscle tone of their VMO, the patients with PFPS failed in their both knees. Similarly, resting as well as contracted VMO and VL muscles' functions were improved significantly by both NSOKCE and SOKCE in the healthy controls. The NSOKCE improved the VAS scores in the PFPS group. The increase in the muscle mass of the affected sides of PFPS patients were more evident with NSOKCE. Our study results show that NSOKCE planning can be preferred over SOKCE, thanks to its contribution to pain improvement and increase in the thigh circumference in the conservative treatment of PFPS.

COMPARATIVE EFFICACY OF CLOSED AND OPEN KINETIC CHAIN EXERCISES ON DEVELOPMENT OF EXPLOSIVE STRENGTH IN LOWER EXTREMITY

The purpose of the study is to compare the efficacy of closed and open kinetic chain exercises on development of explosive strength in lower extremity and to determine which mode of training resulted in the greatest performance enhancement. The case study incorporated randomly a total of seventy five college level players of different games, each aged between 19 to 24 years. The total seventy five players were randomly divided into equal three groups. Among these groups, two different groups were gone through closed chain kinetic and open chain kinetic exercises respectively and one group kept as control group. Progressive weight training thrice a week for 7 weeks scheduled. Necessary data was collected by administering standing broad jump performance prior to training and at the completion of the training period. Statistical technique Analysis of covariance test was applied to compare the efficacy between closed chain and open chain kinetic exercise at 0.05 level of significance, while significant changes were seen in the open kinetic chain group and close chain kinetic group. The closed kinetic chain group improved in .16 meters which was significantly more than the .08 meters seen in the open kinetic chain group. The result reveals close chain kinetic exercise mode of training resulted in the greatest strength development in lower extremity. Article visualizations:

Comparisons of Accuracy of Knee Joint Motion During Closed verse Open Kinetic Chain Tasks in Subjects with Flexible Flatfeet

Purpose: This study examined the effects of flexible flatfeet on the accuracy of knee joint motions in closed and open kinetic chain tasks. Methods: Twenty-four healthy participants were recruited for this study. The subjects were divided into two groups using a navicular drop (ND) test: flexible flatfoot group (n=12, male: 6, aged 22.00±2.22 years) and age-matched control group (n=12, males: 6, aged 22.17±1.53 years). The accuracy of knee motion was measured quantitatively by tracing through the flexion and extension motion of the knee joints in the closed kinetic chain and the open kinetic chain. Results: There was a significant difference in the accuracy index between the groups in closed kinetic chain task, but there was no significant difference in the open kinetic chain task. In addition, there was a significant difference in the accuracy index between the closed kinetic chain and the open kinetic chain task in the flexible flatfoot group. In addition, a significant negative correlation was observed between the ND and accuracy index in the closed kinematic chain task, but there was no significant relationship between the ND and accuracy index in the open kinematic chain task. Conclusion: Flexible flatfeet can affect the accuracy of the adjacent joints, such as the knee joint in the closed kinematic chain.

Shearwave elastography to quantify stiffness of selected upper and lower limb muscles: an intra and inter-rater reliability study

Purpose: Musculoskeletal conditions are a leading cause of disability in the UK accounting for 30.8 million work day absences. Besides pain, muscle stiffness is a commonly reported symptom. To date, approaches to quantify muscle stiffness have been limited. With advances in ultrasound technologies, shearwave elastography (SWE) provides a non-invasive quantification of muscle stiffness affording novel opportunities to evaluate muscle stiffness in research and clinical practice. Reliability data is initially required to support the use of SWE and enable clinical examination of muscle stiffness in practice. The aim of this study was therefore to investigate the intra- and inter-rater reliability of SWE quantification of muscle stiffness of the wrist extensors under open kinetic chain conditions (replicating seated upper limb computer work), and vastus medialis under closed kinetic chain conditions (replicating sit to stand).

The Effectiveness of Strengthening of Hip Extensors and Ankle Plantar Flexors in Early Post-Anterior Cruciate Ligament Reconstruction

AbstractBackground: Impaired hip strength may underlie abnormal movement patterns, suggesting that diminished hip strength may increase the risk of ACL injury and re injury after anterior cruciate ligament reconstruction.Aim of Study: To investigate the effect of strengthening of hip extensors and ankle plantar flexors in early Anterior Cruciate Ligament reconstruction on knee effusion, knee function, hip, knee and ankle muscles strength.Methods: The study was conducted on 30 male patients referred from the orthopedic surgeon with early post operative Anteior Cruciate Ligament reconstruction by hamstring graft or patellar tendon graft after acute injuries, their age range from 18-40 years and were randomly assigned into two groups. Group A: Consisted of fifteen patients who had received open kinetic chain strengthening exercises for hip extensors and ankle plantar flexors in addition to the traditional accelerated program. Group B: Consisted of fifteen patients who had received the traditional accelerated program for 6 weeks (three sessions per week), effusion grading scale for effusion to assess effusion, handheld dynamometer to assess muscle power, Westen Ontario and MACmaster universities score and Time Up and Go test for functional assessment.Results: There was no significant difference between both groups for, hip extensors force and (TUG at 3 weeks). There was no significant difference between both groups for knee extensors torque between base line and 3 weeks and the same for plantar flexors force and WOMAC at 3 weeks. There was significant difference between both groups for knee extensors torque between 3 and 6 weeks, WOMAC at 6 weeks, TUG at 6 weeks and plantar flexors force between 3 and 6 weeks.Conclusion: Adding strengthening exercises of hip exten-sors and plantar flexors to the traditional accelerated protocol added more beneficial outcomes in relation to function after 6 weeks.

Effects of Closed and Open Kinetic Chain Exercise Induced-Localized Fatigue on Static and Dynamic Balance in Trained Individuals

Background: As balance impairment induced by fatigue is implicated in injury occurrence, the aim of this study was to evaluate the effects of closed and open kinetic chain exercise-induced localized fatigue on static and dynamic balance in trained individuals. Methods: 30 healthy boys with mean age of 19.75 ± 1.20 years, participated in this research. Static and dynamic balance were measured before and after open and closed chain fatigue protocol. Static and dynamic balance were measured respectively using the Balance Error Scoring System (BESS) and the Star Excursion Balance test (SEBT) in eight directions. The data was analyzed by two-way repeated measures ANOVA at the significance level of P ≤ 0.05. Results: The results indicated that both static and dynamic balance changed significantly following the study intervention (P ≤ 0.05). In addition, a statistically significant difference was found after fatigue protocol in the static and dynamic balance between open (P = 0.003) and closed (P = 0.001) kinetic chains and respectively. Conclusions: Localized fatigue in both open and closed kinetic chain has affected the static and dynamic balance. Although, localized fatigue in the closed kinetic chain has a more devastating effect on static balance, in the open kinetic chain, the more deleterious effect influenced the dynamic balance.

Early Regain of Function and Proprioceptive Improvement Following Knee Arthroplasty.

Techniques that allow early muscle activation, such as closed kinetic chain (CKC) and open kinetic chain (OKC) exercises, may play a beneficial role in the early rehabilitation of the reconstructed knee. However, current rehabilitation regimens have not been shown to reverse post-operative quadriceps activation failure and weakness. To investigate whether patients who use a continuous active motion (CAM) device that follows closed kinetic chain principles have better early post-operative functional improvements than patients who use a continuous passive motion (CPM) device that follows the principles of open kinetic chain principles. A prospective randomized controlled trial with non-blinded study staff. A tertiary care clinic at a teaching hospital. A total of 110 patients signed the consent form and 83 patients participated in the study. Patients were randomly assigned to use either the CPM device for 4 hours daily for 3 weeks (control group), or a CAM device for 3 sessions of 20 minutes for 3 weeks (intervention group), starting 24 hours after knee replacement surgery.The primary outcome measure was to identify the superiority, inferiority, or equivalence of one device at week 4 after knee arthroplasty using various functional outcome measures such as kinesthesia, quadriceps strength, coordination, general orthopaedic outcome measures and narcotic consumption. At 4 weeks, all outcome measurements were comparable between the two groups, with the exception of sit-to-stand test: in the treatment group the time was significantly shorter compared to the control group (P=0.016). Balance was significantly better in both control (P=0.001) and treatment group (P=0.032) compared to prior surgery. Most clinical centers would like to expedite functional recovery of knee arthroplasty patients without increasing the risk of falls. We observed balance and kinesthesia improvements after surgery using either device which may be important to benefit fast recovery programs. Further research is warranted to see whether additional active closed kinetic chain exercised following knee replacement surgery could improve specific functional outcomes such the observed sit-to-stand test. I.

Low load resistance training with blood flow restriction decreases anterior knee pain more than resistance training alone. A pilot randomised controlled trial

ObjectivesTo evaluate if application of blood flow restriction (BFR) combined with low-load resistance training (LLRT) would induce significant anterior knee pain (AKP) reduction compared to LLRT alone. DesignRandomised Controlled Trial. SettingInstitutional physiotherapy clinic. ParticipantsForty males suffering from AKP were randomly allocated in the LLRT-BFR or LLRT group. BFR was applied at 80% of complete vascular occlusion. Four sets of open kinetic chain knee extensions were implemented in both groups using a pain monitoring model. Main outcome measuresPain (0–10) was assessed immediately after LLRT-BFR or LLRT application and after a physiotherapy session (45 min) during shallow and deep single-leg squat (SLSS, SLSD), and step-down test (SDT). ResultsSignificant immediate pain reduction was found in LLRT-BFR group in SLSS, SLSD and SDT (d = 1.32, d = 1.12, d = 0.88 respectively), but no difference was found in LLRT group. Following the physiotherapy session pain reduction was sustained in LLRT-BFR group in both SLSs and SDT (d = 1.32, d = 0.78, d = 0.89 respectively). For the control group significant pain reduction was only found in SLSS (d = 0.56). No significant between-group differences were observed. ConclusionsThe pain reduction induced by LLRT-BFR could indicate this intervention as a preconditioning process prior to the rehabilitation of AKP.

The Effect of Erector Spinae Muscle Fatigue on the Sensation of Trunk, Hip, and Knee Position among the Male Karate Athletes

Introduction: Proprioception (PP) and balance play a significant role in improving performance and preventing acute and chronic sport injuries. Muscle fatigue can be one of the factors that may interfere with signaling sensory input to the brain, and disturb the balance. The effect of muscle fatigue on this sensation has hardly been studied. The aim of this study was to investigate the effect of erector spinae muscle fatigue on the sensation (PP) of trunk, hip and knee among the male Karate athletes. Materials and Methods: 10 male karate athletes participating in Iranian national league matches were recruited in this study. Absolute error of active angles reconstruction (the trunk in 45 degrees of flexion, the hip in 30 degrees of abduction and flexion in open kinetic chain, and the knee in 30 and 60 degrees of flexion in closed kinetic chain) was measured by filming and analyzed, using AutoCAD software in pretest and posttest. Sorensen test was used as fatigue protocol. Results : The t test showed that erector spinea muscle fatigue had a significant effect on trunk flexion in 45 degrees (P = 0.046), and dominant (P = 0.001), and non-dominant (P = 0.001) hip joint in 30 degrees of abduction; but did not have any significant effect on positioning sensation of dominant (P = 0.434) and non-dominant (P = 0.703) hip flexion in 30 degrees, dominant (P = 0.148) and non-dominant (P = 0.204) knee flexion in 30 degrees, and dominant (P = 0.417) and non-dominant (P = 0.439) knee flexion in 60 degrees. Conclusion : According to the obtained results, erector spinae muscle fatigue in Karate athletes is likely to cause disruption in their trunk and hip position sensations, which can be the probable cause of lower-limbs injury and instability, particularly in the hips. Erector spinae muscle fatigue, however, may have no significant effect on knee position sensation or the injury potential of this joint.

The relationship between core endurance and upper extremity performance in sedentary collegiate males

Core muscles contribute to general spine stabilization when the trunk is exposed to flexion and extension moments. It is thought that movements begin from the center of the body (called the “powerhouse” or “core”) and flow outward to the extremities, and a strong core strengthens the whole body. Few studies have examined the relationship between core endurance and upper extremity performance and most of the studies have been done in athletes. Thus, the purpose of this study was to investigate relationships between core endurance, and upper extremity performance in sedentary collegiate males. Sedentary collegiate males who had not suffered any orthopedic injury in the past year were enrolled the study. Core endurance (CE) was evaluated using Trunk Extensor Test, Bilateral Side Bridge Tests, and The Core Muscle Strength and Stability test. The results of the core endurance tests were compared with several upper extremity performance measurements: The Upper Quarter Y Balance Test (bilaterally in medial, inferolateral, and superolateral directions-UQYBT), Close Kinetic Chain Upper Extremity Stability Test (CKCUES test), medicine ball throws test (forward, reverse, right, and left in static and dynamic positions), hand grip strength, and Nelson hand reaction test. Eighty-three males were assessed during the study. Their mean age was 22.07 ± 1.89 year (range: 18–25) and mean body mass index was 23.77 ± 3.26 kg/m 2 (range: 17.67–36.11). We observed low correlations between the CE tests and UQYBT ( r range = 0.220 − 0.393, P < 0.05) but no correlations between the CE and hand grip strength and Nelson hand reaction test. CKCUES and medicine ball throws test (nondominant side in dynamic position) correlated with side bridge test, r = 0.279 and r = 0.240, respectively ( P < 0.05). The results of this study imply that the core endurance is related to the upper extremity performance in closed kinetic chain but not with open kinetic chain functions, where only distal extremity performance is present.

열린사슬운동과 닫힌사슬운동이 큰가슴근과 위팔세갈래근의 근활성도에 미치는 영향

열린사슬운동과 닫힌사슬운동이 큰가슴근과 위팔세갈래근의 근활성도에 미치는 영향

Blood Flow Restriction induces hypoalgesia in recreationally active adult male anterior knee pain patients allowing therapeutic exercise loading

ObjectiveTo evaluate if a single blood flow restriction (BFR)-exercise bout would induce hypoalgaesia in patients with anterior knee pain (AKP) and allow painless application of therapeutic exercise. DesignCross-sectional repeated measures design. SettingInstitutional out-patients physiotherapy clinic. PatientsConvenience sample of 30 AKP patients. InterventionBFR was applied at 80% of complete vascular occlusion. Four sets of low-load open kinetic chain knee extensions were implemented using a pain monitoring model. Main outcome measurementsPain (0–10) was assessed immediately after BFR application and after a physiotherapy session (45 min) during shallow and deep single-leg squat (SSLS, DSLS), and step-down test (SDT). To estimate the patient rating of clinical effectiveness, previously described thresholds for pain change (≥40%) were used, with appropriate adjustments for baseline pain levels. ResultsSignificant effects were found with greater pain relief immediate after BFR in SSLS (d = 0.61, p < 0.001), DSLS (d = 0.61, p < 0.001), and SDT (d = 0.60, p < 0.001). Time analysis revealed that pain reduction was sustained after the physiotherapy session for all tests (d(SSLS) = 0.60, d(DSLS) = 0.60, d(SDT) = 0.58, all p < 0.001). The reduction in pain effect size was found to be clinically significant in both post-BFR assessments. ConclusionA single BFR-exercise bout immediately reduced AKP with the effect sustained for at least 45 min.

Exercise Therapy Interventions in Patients With Hip Osteoarthritis: Comparison of the Effects of DVD and Website-Based Interventions.

BackgroundPrevalence of developmental hip dysplasia is high in Japan. Exercise therapy has been proven effective to treat certain aspects of hip osteoarthritis. Moreover, therapy provided via digital video discs (DVDs) and websites allows patients to exercise in the comfort of their own homes. However, no studies have evaluated the effectiveness of visual instructions in patients with hip disorders.ObjectiveThis study aimed to compare the effectiveness of exercise therapy administered via DVD and that administered via a website.MethodsWe developed a six-step progressive exercise therapy program for patients with hip osteoarthritis, which included three kinds each of open kinetic chain and closed kinetic chain exercises. Once the program was developed, exercise DVDs were produced. In addition to the six-step exercise program, our website was enabled to count the number of exercises performed by each patient and was accessible via the Internet at any time. Patients with hip osteoarthritis for whom surgery was not advised were enrolled by one university hospital in the Kansai area in Japan. Clinical symptoms and hip function were quantified using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) and the Oxford Hip Score (OHS). Quality of life was measured using the SF-8 Health Survey, and self-efficacy for continued exercise was measured using the General Self-Efficacy Scale (GSES). Questionnaires were completed preintervention and after 6 months.ResultsAt 6-month follow-up, 10 DVD users (1 male, 9 female; mean age 51.3, SD 16.1 years) and 18 website users (2 male, 16 female; mean age 52.4, SD 10.4 years) were reachable. The change in each parameter could not be confirmed a significant improvement. However, most items tended to reflect overall improvement during the 6 months of intervention (P=.05-.94; paired t test). Regarding effect size, we considered a small effect to be greater than 0.2. Little effect was observed for JHEQ pain, SF-8 physical component summary (PCS), and SF-8 mental component summary in the DVD group, as well as OHS, SF-8 (PCS), and GSES in the website group.ConclusionsWhen comparing the effectiveness of exercise therapy between our DVD and website, we found that although both groups tended to improve in physical function, only the website group showed tendency of enhanced self-efficacy.

The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Background There is controversy surrounding the early use of open-kinetic-chain (OKC) quadriceps-strengthening exercises following anterior cruciate ligament reconstruction (ACLR) due to the belief that increased strain on the graft could cause damage. Objectives To determine whether OKC quadriceps exercises result in differences in anterior tibial laxity, strength, function, quality of life, or adverse events in the ACLR population, when compared to closed-kinetic-chain (CKC) quadriceps exercises. Methods Seven electronic databases (MEDLINE, Embase, AMED, CINAHL, SPORTDiscus, PEDro, and the Cochrane Central Register of Controlled Trials) were searched through April 2017. A systematic review with meta-analysis was conducted on randomized controlled trials comparing OKC versus CKC exercises following ACLR. Outcomes of interest were tibial laxity, strength, and function. A methodological quality assessment of the included studies was completed, and the results were synthesized using meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Ten studies were included in the review. The meta-analysis demonstrated low- to moderate-quality evidence of no between-group differences in anterior tibial laxity, strength, or patient-reported function at any time point. Meta-analysis was unable to be performed for functional outcomes. Conclusion There was limited to moderate-quality evidence of no difference in anterior tibial laxity, strength, patient-reported function, or physical function with early or late introduction of OKC exercises in the ACLR population, when compared to CKC exercises, at all follow-up time points. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(7):552-566. Epub 23 Apr 2018. doi:10.2519/jospt.2018.7656.

열린사슬운동과 닫힌사슬운동이 큰가슴근과 위팔세갈래근의 근활성도에 미치는 영향

열린사슬운동과 닫힌사슬운동이 큰가슴근과 위팔세갈래근의 근활성도에 미치는 영향