Quadriceps Exercise Research Articles

PELATIHAN LANSIA BEBAS NYERI LUTUT DI PATUKAN AMBARKETAWANG KECAMATAN GAMPING KABUPATEN SLEMAN

The increasing of Indonesian life expectancy needs to be balanced with the ability of independence in the health aspect of the elderly community. Patukan Ambarketawang Yogyakarta has high in a number of elderly people. Knee pain experienced by the elderly, which have an impact on reducing their activity and productivity. Isoquadrisep exercises are one of the non-pharmacological efforts that are recommended to prevent knee pain. Elderly Posyandu in Patukan Ambarketawang Gamping Sleman village conducts routine activities to control the health of the elderly in general such as to measure blood pressure. Posyandu cadres and elderly participants are not familiar with isoquadrisep exercises on the knee to reduce knee pain in the elderly. Community partnership service is carried out to form cadres and isoquadrisep exercise training to prevent elderly with knee pain. The method for this activity is Training Of Trainer on quadriceps exercise for cadres and some communities. The results of this activity are cadres have an isoquadricep exercise agenda at each elderly meeting alternating with other exercises that already existed in Patukan Ambarketawang Gamping.

Vascular function is related to blood flow during high-intensity, but not low-intensity, knee extension exercise.

While vascular function, assessed as the ability of the vasculature to dilate in response to a stimulus, is related to cardiovascular health, its relationship to exercise hyperemia is unclear. This study sought to determine if blood flow during submaximal and maximal exercise is related to vascular function. Nineteen healthy adults completed multiple assessments of vascular function specific to the leg, including passive leg movement (PLM), rapid onset vasodilation (ROV), reactive hyperemia (RH), and flow-mediated dilation (FMD). On a separate day, exercise blood flow (Doppler ultrasound) was assessed in the same leg during various intensities of single-leg, knee-extension (KE) exercise. Vascular function, determined by PLM, ROV, and RH, was related to exercise blood flow at high intensities, including maximum work rate (WRmax) (r = 0.58-0.77, P < 0.001), but not low intensities, like ~21% WRmax (r = 0.12-0.34, P = 0.12-0.62). Relationships between multiple indices of vascular function and peak exercise blood flow persisted when controlling for quadriceps mass and exercise work rate (P < 0.05), indicating vascular function is independently related to the blood flow response to intense exercise. When divided into two groups based upon the magnitude of the PLM response, subjects with a lower PLM response exhibited lower exercise flow at several absolute work rates, as well as lower peak flow (P < 0.05). In conclusion, leg flow during dynamic exercise is independently correlated with multiple different indices of microvascular function. Thus microvascular function appears to modulate the hyperemic response to high-intensity, but not low-intensity, exercise.NEW & NOTEWORTHY While substantial evidence indicates that individuals with lower vascular function are at greater risk for cardiovascular disease, with many redundant vasodilator pathways present during exercise, it has been unclear if low vascular function actually impacts blood flow during exercise. This study provides evidence that vascular function, assessed by multiple noninvasive methods, is related to the blood flow response to high-intensity leg exercise in healthy young adults. Importantly, healthy young adults with lower levels of vascular function, particularly microvascular function, exhibit lower blood flow during high-intensity, and maximal knee extension exercise. Thus it appears that in addition to increasing one's risk of cardiovascular disease, lower vascular function is also related to a blunted blood flow response during high-intensity exercise.

Comparison of effectiveness of hold-relax technique and maitlandfs mobilization in improving range of motion in posttraumatic stiffness of knee joint

Aims: This study aims to compare the effectiveness of Hold-Relax technique and Maitland's Mobilization in improving range of motion (ROM) in posttraumatic stiffness of knee joint. Materials and Methods: This was a randomized interventional comparative study with 30 subjects with posttraumatic stiffness of knee joint with restricted range of knee flexion were randomly allotted into two groups: Group A was given Hold-Relax technique and Group B was given Maitland's Mobilization consisted of Grade 3 posterior glide along with paraffin wax bath and isometric exercises of quadriceps and hamstring as a common baseline treatment for 5 days per week for 4 weeks. The baseline outcome measure was active knee flexion ROM measured by universal Goniometer before and after 4 weeks interventions. Results: Statistical analysis of data was done using paired t-test and unpaired t-test. Paired t-test showed that statistically significant increase in active knee flexion ROM in both the groups. On comparing by unpaired t-test it was found that both the techniques are equally effective in improving ROM. Conclusion: Both the Hold-Relax technique and Maitland's Mobilization are equally effective, in improving the knee flexion ROM.

Study of intraarticular proximal tibia fractures treated with plating

Background: Intra articular fractures of proximal tibia are difficult to treat. Age, skin conditions, osteoporosis further increase the obstacles in the healing process. Various modalities of treatment are available but no ideal treatment has yet evolved. The aim of this study is to study the result of tibia plating in intra articular tibia fracture in terms of union, knee movement, infection and functional ability of the patient. Materials and methods: This is a prospective cohort study of 30 cases of intraarticular proximal tibia fractures, aged >18 years during the period 2018-2019 in our hospital. Fractures classified according to Schatzker Classification All are treated by open reduction and internal fixation with proximal tibial plate and screws, Post-operatively Above knee slab or removable knee brace with leg elevation given to decrease the pain and edema. Static quadriceps exercises and ankle pump exercise started on second day. The patients with stable fixation were allowed intermittent knee mobilization once the wound pain subsided, depending upon type of fracture. The patient is followed up at regular intervals of 4, 8, 12 and 16 weeks. The functional outcome is assessed at the end of 16 weeks by KNEE SOCIETY SCORE. Results: We had 73.33% excellent results, 20% good results, 6.66% fair results. Conclusion: In our study type V is the most common type of fracture pattern. Lateral locking plate with rafting screws provides support for postromedial and posterolateral fragments. Locking plate provides better stability than conventional buttress plating.

Effect of Resistance Training of Quadriceps Muscle in Patients with Knee Osteoarthritis: A Randomized Control Trial

Objective: To determine the effects of resistance training in quadriceps muscle in patients with knee osteoarthritis attending tertiary care hospital, Karachi. Materials and methods: This was a single blinded randomized control trial study with probability simple random sampling technique. Sampling was done in physiotherapy department of Al-Khidmat Hospital Korangi, Karachi from May to December 2018. The required sample size was found to be 74 (37 in experimental group and 37 in control group). Inclusion criteria for patients was age >45 years, moderate degree pain, ability to walk 20 to 30 meters, subject without any walking aid and chronic osteoarthritis of knee diagnosed on radiograph. Variables were observed using the Numerical Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and a strength gauge device, respectively. All observations were taken at baseline and after a week. SPSS version 23.0 was used for data analysis. Results: A total of 74 patients were recruited in this study. There were two groups Experimental and Control 37 patients were taken in each group. Strengthening of quadriceps exercises was assessed at baseline 9.13 ± 1.39 and after a week 11.36 ± 1.22 with statistically significant P-value of 0.041 in experimental group. In control group there was no statistical (difference observed at baseline and after a week routine checkup. Conclusion: Quadriceps strengthening exercises have a positive impact found in patients with knee OA. Experimental group patients gradually showed improvement after exercises of one week with good physical health status.

Assessing thigh muscle balance of male athletes with special emphasis on eccentric hamstring strength

ABSTRACT Background: Hamstring strength is important to prevent thigh muscle and knee injuries. Different antagonist-agonist relationships of thigh muscle strength are applied to estimate the injury risk e.g. the intersection point of eccentric hamstring (Hecc) and concentric quadriceps (Qcon) moment-knee flexion angle curves (dynamic control ratio at the equilibrium point = DCRe) and the dynamic control ratio (DCR = Hecc:Qcon). Objective: The aim was to quantify the relationships between DCR, DCRe moments and angles as well as their correlations with peak moments and contractional work of eccentric hamstring and concentric quadriceps exercise. Methods: This cross-sectional study included data from 238 healthy male participants of different sports. They conducted unilateral isokinetic tests obtained at 30°/s and 150°/s for the hamstrings (prone) and the quadriceps (supine). Results: Correlations between DCR and DCRe moments were significant, but weak to moderate in strength (R2 30°/s = 20%, R2 150°/s = 26%). In contrast to DCR (25% ≤ R2 ≤ 46%), DCRe moments (80% ≤ R2 ≤ 86%) showed very strong relations with peak moments and contractional work of eccentric hamstring exercise. Discussion: DCR and DCRe assess thigh balance by using the same isokinetic raw data. However, weak relations became apparent. DCRe moments were stronger related to eccentric hamstring strength and work than DCR. Therefore, the DCRe moment may serve as meaningful measure of thigh muscle balance because increased eccentric hamstring strength promotes dynamic joint stability and minimizes injury risk

Dynamic hip screw technique in the management of trochanteric fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Study was conducted to find the results of dynamic hip screw in the management of trochanteric fracture by analyzing the factors which influence post-operative mobility.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Study was conducted in the department of orthopedics, GSL Medical College. Individuals &amp;gt;18 years, both genders who were diagnosed having trochanteric type I and II Boyd and Griffin stable fractures were included in the study. All surgeries were performed under spinal anesthesia, internal fixation with dynamic hip screw and 135o angled blade plate. Injectable third generation cephalosporins were used 24 hours preoperatively, intra- operatively and 5 days post-operatively, and oral antibiotics till suture removal. Patients allowed to sit on bed on 2nd and 3rd day and static quadriceps exercises were started from 2nd day onwards, hip and knee flexion exercises from 6 or 7th day and weight bearing walking form 10th day.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average age was of the participants was 61.53 years, ranged between 41 to 80 years; 65% were female participants and 35% were male patients. In the study, 20 (50%) patients had right side fracture and left sided affection of trochanteric fracture to the remaining 50%. Most of the patients (67.5%) in this study were classified as type II Boyd and Griffin criteria, and 32.5% were type I. The clinical and functional outcome was calculated using the Kyle's criteria; 25% (10) showed excellent response, followed by good (50%), fair (15%) and poor (10%) results.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Dynamic hip screw is the operative treatment of choice for stable trochanteric fractures. However, studies on large sample for long time are recommended.&lt;/p&gt;

Efficacy of Proprioceptive Neuromuscular Facilitation and Closed Kinetic Chain Exercises on Quadriceps and Plantar Flexors Among Geriatrics

Elderly population's quality of life decline at a faster rate and hence there is an increase in mortality rates. Anti-aging process can be emphasised by scheduled exercise programs which enhances beneficiary adaptations in vascular physiology and neurovascular coupling. The mobility function is disturbed due to reduced muscle strength, inappropriate activation of motor units, insufficiency to maintain balance which leads to higher risk offall in the elderly people. Closed kinetic chain exercises control the musculoskeletal system against gravity at rest and in motion thereby protecting the postural stability. PNF has a positive effect on balance and functionality in older adults. Materials and Method: A Quasi experimental study was done for 50 community dwelling elderly people from “Vishranthi Charitable Trust” with mean age of 73±4 years who were selected based on the inclusion criteria. Closed kinetic chain exercises for quadriceps and plantar flexors along with PNF technique such as anterior elevation and posterior depression were given and followed up for 3 weeks. The pretest and post test values were obtained using 6-min walk test, the knee extensor strength measurement and fall risk questionnaire.

Effects of Paretic Single Limb Exercise on Vascular Characteristics Changing of Bilateral Femoral Arteries on Sub Acute Stroke Patients

After a stroke, individuals have weakness and decrease mobility of the hemiparetic side, which demands less muscle oxygen consumption; thus, blood flow decrease. It interferes the hemodynamic system include vascular characteristics.The single limb (quadriceps) exercise intervention was aerobic training that focused only on the hemiparetic limb. The aims of this study was to determine the effects of the single limb exercise on vascular characteristics of both side femoral arteries using pre and post-interventional study. Twelve participants in subacute phase of stroke, performed endurance exercise using N-K table on the hemiparetic leg three times a week for eightweeks. The diameter, peak systolic velocity (PSV), total average maximal velocity (TA Max) of both side femoral arteries were measured. We found that the changing of vascular characteristics outcomes on both side femoral arteries were not statistically significant increased. Others factors that may impede vascular characteristics in both femoral arteries were blood viscosity, aging process and periods of exercise.&#x0D; Keywords: femoral arteries, paretic, stroke, vascular characteristics

Avoid post operative bracing to reduce ACL rerupture rates.

It has been quoted that the graft is more prone to injury in the early stages of ligamentization between 3 and 6months when the muscles are weak and compliance with post-op protocol is waning. Purpose of this study was to evaluate the functional outcome of avoiding postoperative bracing following ACL reconstruction and early enhanced recovery protocol on the reinjuries of graft. Thirty-two consecutive patients who underwent arthroscopic ACL reconstruction by a single surgeon in the same specialist center between October 2015 and May 2017 were included in the study. All the patients were educated regarding rehabilitation before the index surgery and preoperative quadriceps exercises had been initiated. Rehabilitation was undertaken as per a standard protocol with emphasis on early mobilization. No brace was used. Patients were followed up between 3 months and 1year. Lysholm knee scores were evaluated at 6 and 12months postoperatively. No failures were noted (failure defined as instability, stiffness or persistent pain). The average Lysholm knee score at 6months was 88 and at 12months period was 91. No statistical significance (P > 0.00001) was noted in the scores between braced and unbraced at 1year. ACL rehabilitation without a knee brace can indirectly prevent rerupture and is a cheaper as well as a safer method with better outcomes.

A comparative study on the effectiveness of PNF stretching versus static stretching on Pain and Hamstring flexibility in osteoarthritis knee patients

Osteoarthritis (OA) knee is a long-term chronic disease characterized by the destruction of articular cartilage and underlying bone. Pain, limitation of motion and functional impairment are common clinical features. Poor hamstring flexibility is a major problem for patients with OA knee. The stretching of the hamstring is a necessary intervention in the management of the OA knee. This study is therefore intended to compare the effectiveness of static stretching vs PNF stretching for pain, hamstring flexibility and functional mobility in OA Knee patients. 30 patients were randomly divided into two groups. Group A (N=15) received PNF stretching, wax therapy and isometric quadriceps exercises, and group B (N=15) received static stretching, wax therapy and isometric quadriceps exercises. The intensity of the pain was measured using the NPRS (Numerical Pain Rating Scale), hamstring flexibility by AKET (Active Knee Extension Test) and functional mobility by TUG (Timed up and Go) test. The results showed that significant differences in NPRS (Z=4.64, P=0.001), AKET (t=9.61, P=0.001) and TUG (t=8.19, P=0.001) were observed in group A patients when compared to group B. In conclusion, the PNF stretching treatment program is effective in reducing pain, improving hamstring flexibility and functional mobility in patients with OA knee compared to static stretching.

Beneficial role of Avocado oil orally used in Osteoarthritis: experience in a tertiary care hospital of Bihar, India

Background: Osteoarthritis is the most common type of joint disease. It represents a heterogeneous group of conditions resulting in common histopathologic and radiologic changes. It is a degenerative disorder arising from biochemical breakdown of articular (hyaline) cartilage in the synovial joints.Methods: Total of 90 patients were randomly selected from outdoor and indoor of Orthopaedics department (IGIMS Patna). Study was done in Department of Pharmacology &amp; Orthopaedics at IGIMS Patna. Three groups A, B and C were taken. Each group was consist of 30 patients of both sexes and age groups between 18 to 65 years. Group A was received Multivitamin with Exercise. Group B was received NSAIDS only. Group C was received Avocado oil orally along with Exercises as Muscle strengthening exercises of Quadriceps, Hamstrings, Abductor and Adductor muscles of thigh. We had compared pain thresholds among all these three groups with the help of Visual analogue scale and Oxford Knee score.Results: After 3 months of treatment the patients belonging to group C showed better response as compared to group A and B. When we compared pain threshold among group A, B and C on the basis of Oxford Knee score group C had occupied maximum score, which meant satisfactory joint functions and did not require any formal treatment. we also compared average visual analogue scale and average oxford knee score, Group C showed better response.Conclusions: Avocado oil is a food supplement and does not contain any side effects as compared to NSAIDS [Non-steroidal anti inflammatory drugs], glucosamine sulfate, chondroitin sulfate, sulfasalazine etc so avocado oil can be used for long duration in case of osteoarthritis.

Cardiorespiratory and Muscle Oxygenation Responses to Isokinetic Exercise in Chronic Obstructive Pulmonary Disease.

This study aimed to describe cardiorespiratory, quadriceps oxygenation, and muscle fatigue responses during a one-legged quadriceps isokinetic endurance exercise in chronic obstructive pulmonary disease (COPD) and control subjects. Fourteen patients with COPD and 14 control subjects performed a cardiopulmonary cycling exercise test to exhaustion to assess peak oxygen consumption (V˙O2peak), minute ventilation (V˙Epeak), and heart rate (HRpeak). They also performed a quadriceps isokinetic endurance exercise consisting in 30 maximal knee extensions at 90°·s with continuous monitoring of expired gases, cardiac output, and oxygenation of the quadriceps by near-infrared spectroscopy. Total muscle work and fatigue index were also quantified. The total muscle work developed during the quadriceps isokinetic endurance exercise was 2.25 ± 0.57 kJ in COPD and 3.12 ± 0.60 kJ in controls, P < 0.001. In absolute terms, there were no between-group differences in V˙O2, V˙E, cardiac output, and HR at the end of quadriceps isokinetic endurance exercise. However, V˙E and HR reported that a fraction of their respective peak values during cardiopulmonary cycling exercise test were higher in COPD (V˙E/V˙Epeak, 69% ± 3%; HR/HRpeak, 82% ± 15%) compared with controls (V˙E/V˙Epeak, 45% ± 2%; HR/HRpeak, 71% ± 13%), all P < 0.05. During quadriceps isokinetic endurance exercise, quadriceps deoxyhemoglobin increased by 47% ± 31% in patients versus 33% ± 41% in controls (P < 0.05 from rest values) with a significant between-group differences (P = 0.025). The fatigue index during the quadriceps exercise was higher in COPD compared with controls. Although one-legged quadriceps isokinetic endurance exercise resulted in substantial central cardiorespiratory demands in COPD, this exercise was nevertheless associated with muscle overload as evidenced by muscle deoxygenation and higher muscle fatigue index in COPD compared with controls. These findings may have implications of the design of exercise training programs in COPD.

Muscular Preconditioning Using Phototherapy Improves the Physical Work Capacity of the Quadriceps when Applied between Repeated Bouts of Resistance Exercise

Preconditioning skeletal muscle with phototherapy is an experimental technique for producing resistance against muscular fatigue during and after strenuous exercise. This study examined the ergogenic effects of phototherapy when applied intermittently during passive recovery between repeated bouts of isokinetic quadriceps exercise. A triple-blind, repeated measures, placebocontrolled, cross-over design was used in this study to compare the effects of phototherapy on torque/work and power output of the knee extensors in 20 healthy individuals (10 men, 10 women). The exercise protocol consisted of four repeated bouts of isokinetic exercise. Each bout consisted of 30 continuous knee extension concentric contractions at an angular velocity of 75°/s with a 4min recovery interval between bouts. Subjects received active and sham phototherapy in random order during passive recovery between exercise bouts. Phototherapy was administered using a near-infrared laser to the quadriceps femoris muscle group at 10 J/cm2 (total dose of 1600-2400 J). Performance measures included normalized peak torque [Nm/ kg], average peak torque [Nm], total work [Nm], and average power [W]. During the second, third and fourth exercise bouts, subjects produced significantly more torque (normalized and average) and total work/average power output during the active phototherapy condition compared to the sham phototherapy condition. Phototherapy applied as a preconditioning treatment during passive recovery intervals between bouts high of intensity and high volume resistance exercise significantly attenuated fatigue and maintained muscular performance of the quadriceps femoris muscle group. Preconditioning skeletal muscle with phototherapy intermittently during recovery intervals with fatiguing exercise may be a beneficial, non-invasive and safe ergogenic aid for athletes that require high levels of muscular endurance.

Effects of Muscle Activity and Muscle Strength According to Verbal Command Volume in Isokinetic and Isometric Exercise of Quadriceps

Purpose: The purpose of this study was to investigate the effects of muscle activity and muscle strength according to verbal command volume during isokinetic and isometric quadricep exercises. Methods: To measure muscle activity and muscle strength, surface electrodes were attached to the participants, as they sat on a Biodex chair. The isometric exercise was performed three times, with maximum exercise at 30° bending angle, based on a maximum extension state of the knee at 0°. The average holding time was unified to three seconds. In addition, the isokinetic exercise was performed three times, at 60°/sec. The verbal command ranged between 0∽60 dB and 0∽75 dB. Muscle activity was measured using surface electromyography (4D-MT, Relive, Gimhae, Korea). The Biodex System 4 was used to measure the isometric and isokinetic strength of the nodal line, and 4D-MT was used to measure muscle activity. Results: There were significant improvements in the maximal and relative muscle strengths, when the 0∽ 60 dB and 0∽75 dB verbal commands were applied with isokinetic extension/flexion (p<.05). The isokinetic exercise (0∽75 dB) group showed a significant difference in the vastus medialis oblique muscle activity change (p<.05), while the isometric exercise (0∽75 dB) group showed a significant difference in the rectus femoris muscle activity change (p<.05). Conclusions: Our results reveal that verbal commands effectively improve muscle activity and muscle strength during isokinetic and isometric quadricep exercises.

Is four-week underwater treadmill exercise regimen compared to home exercise efficacious for pain relief and functional improvement in obese patients with knee osteoarthritis? A randomized controlled trial

Objective: To investigate the efficacy of a four-week underwater treadmill exercise regimen compared to a home exercise regimen relative to pain relief and functional improvement in obese patients with knee osteoarthritis. Design: Single-blind randomized controlled trial. Setting: Outpatient. Participants: Eighty primary knee osteoarthritis with pain ⩾5/10 and body mass index ⩾25 kg/m2. Interventions: Daily quadriceps exercise at home for 30 minutes (control group) or underwater treadmill exercise (study group) for 30 minutes/day, three times/week for four weeks. Main outcomes: Pain score, six-minute walking distance, quadriceps strength, and body weight were evaluated at baseline and after four weeks. Adverse events, global assessment, and satisfaction index were assessed at the end of study. Results: All outcomes in both groups were significantly improved at the end of the study, except for body weight. The mean difference (95% confidence interval (CI)) in outcomes between groups were −0.53 (−1.31, 0.26) for pain; 10.81 (−11.9, 33.53) meters for 6-minute walking distance; 0.67 (−0.10, 1.44) kilograms for quadriceps strength; and 0.01 (−0.66, 0.68) kilograms for body weight. No significant differences were observed between groups, for the per protocol analysis or the intention-to-treat analysis. Participants in the study group evaluated significantly better global improvement and higher patient satisfaction than those in control group (13 (39.4%) vs. 4 (10.8%); P = 0.014 and 23 (69.7%) vs. 16 (43.2%); P = 0.021, respectively). Conclusion: Exercise using an underwater treadmill was found to be as efficacious as home exercise for relieving pain and improving function in obese people with mild to moderate knee osteoarthritis.

Efficacy of resisted quadriceps exercise on ageing skeletal muscles (Sarcopenia)

Efficacy of resisted quadriceps exercise on ageing skeletal muscles (Sarcopenia)

Clinical Outcomes After the Nonoperative Management of Lateral Patellar Dislocations: A Systematic Review.

Background:The first-line treatment for patellar dislocations is often nonoperative and consists of physical therapy and immobilization techniques, with various adjuncts employed. However, the outcomes of nonoperative therapy are poorly described, and there is a lack of quality evidence to define the optimal intervention.Purpose:To perform a comprehensive review of the literature and assess the quality of studies presenting patient outcomes from nonoperative interventions for patellar dislocations.Study Design:Systematic review; Level of evidence, 4.Methods:The MEDLINE, AMED, Embase, CINAHL, Cochrane Library, PEDro, and SPORTDiscus electronic databases were searched through July 2017 by 3 independent reviewers. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Study quality was assessed using the CONSORT (Consolidated Standards for Reporting Trials) criteria for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies and case series.Results:A total of 25 studies met our inclusion criteria, including 12 randomized controlled trials, 7 cohort studies, and 6 case series, consisting of 1066 patients. Studies were grouped according to 4 broad categories of nonoperative interventions based on immobilization, weightbearing status, quadriceps exercise type, and alternative therapies. The most commonly used outcome measure was the Kujala score, and the pooled redislocation rate was 31%.Conclusion:This systematic review found that patient-reported outcomes consistently improved after all methods of treatment but did not return to normal. Redislocation rates were high and close to the redislocation rates reported in natural history studies. There is a lack of quality evidence to advocate the use of any particular nonoperative technique for the treatment of patellar dislocations.

THE BALANCE STRATEGY EXERCISE INTERVENTION IS BETTER FOR INCREASING DYNAMIC BALANCE THAN ISOTONIC QUADRICEPS EXERCISE WITH 1 KILOGRAM LOAD AMONG ELDERLY

Balance is an ability to maintain the center of gravity when stationary and when moving. An experimental study conducted with Pre and Post Test Two Group Design to compare Balance Strategy Exercise and Isotonic Quadriceps Exercise with a 1 kilogram load in improving dynamic balance for elderly aged over 60 years. A sample of 26 peoples divided into two groups. Independent Samples T-test found the average difference in improvement of dynamic balance in Balance Strategy group was 6,00 and the Isotonic Quadriceps group was 2,69 with p=0,000 (p&lt;0,05). BalanceStrategy Exercise can be summed better in improving dynamic balance rather than Isotonic Quadriceps with a load of 1 kilogram in elderly aged over 60 years at Pitra Village, Penebel District, Tabanan.&#x0D; Keywords: Dynamic Balance, Balance Strategy Exercise, isotonic Quadriceps Exercise, Functional Gait Assessment

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.