Saúde Do Joelho

Treatment of Knee Osteoarthritis in Relation to

Hamstring and Quadriceps Strength

Ashraf Ramadan Hafez1), Ahmed H. Al-Johani2), Abdul Rahim Zakaria1),

Abdulaziz Al-Ahaideb3), Syamala Buragadda4)*, Ganeswara Rao Melam4), John K. Shajj i5)

1) College of Applied Medical Sciences, King Saud University, Saudi Arabia

2) Rehabilitation Medical Hospital in AL-Medina AL-Manwerah, Saudi Arabia

3) Department of Orthopedics, College of Medicine, King Saud University, Saudi Arabia

4) Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University:

P.O. box 10219, Saudi Arabia

5) Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi

Arabia

Abstract. [Purpose] To assess the effect of hamstring and quadriceps strengthening exercises on pain intensity,

gait velocity, maximum isometric strength, and activities of daily living of patients with knee osteoarthritis (OA).

[Subjects and Methods] A total of 20 patients with knee OA, 50 to 65 years of age (57.65 ± 4.78 years), received hot

packs, strengthening exercises for the quadriceps and the hamstring muscles and stretching exercises for hamstring

muscles. Outcome measures included: the Western Ontario and McMaster Universities OA index questionnaire

(WOMAC) scores for assessing health status and health outcomes of knee OA; self-reported pain intensity scores,

measured using a visual analogue scale; the 50 ft walk test (a measure of gait velocity and function); and handheld

dynamometry (a tool used to measure maximum isometric strength of knee extension and flexion). [Results] There

was a significant difference between pre- and post-intervention measures of pain intensity, 50 ft walk times, hamstring

strength, and quadriceps strength. Significant differences in WOMAC measures were also observed in the

subscales of pain, stiffness and physical function, as well as WOMAC total scores. [Conclusion] Strengthening the

hamstring muscles in addition to strengthening the quadriceps muscles proved to be beneficial for perceived knee

pain, range of motion, and decreasing the limitation of functional performance of patients with knee OA.

Key words: Hamstring/quadriceps ratio, Knee pain, Osteoarthritis

(This article was submitted Apr. 15, 2013, and was accepted Jun. 7, 2013)

INTRODUCTION

Osteoarthritis (OA) is regarded a major public health

problem, as reported by the World Health Organization. It

is one of the major causes of impaired function that reduces

quality of life (QOL) worldwide1). OA is a very common

disorder in patients presenting to primary care physicians

in the Kingdom of Saudi Arabia, and is a leading cause of

morbidity and reduced QOL2).

OA is a progressive degenerative disease that affects the

joint cartilage, subchondral bone, and the synovial joint

capsule. It has a multifactorial etiology and affects approximately

60% of individuals older than 50 years of age3–5).

The etiology of OA is related to repetitive mechanical

loads and aging. Recent studies have separated the etiological

factors into three main subgroups: sex, anatomy and

body mass. The clinical manifestations are joint pain, stiffness,

decreased range of joint movement, weakness of the

quadriceps muscle and alterations in proprioception6). Decreased

strength in the muscle groups involving the joints is

significant because it causes a progressive loss of function.

These symptoms significantly restrict an individual’s ability

to get up from a chair, walk or climb stairs7). Limping, poor

alignment of the limb and instabilities can also be observed

in individuals with OA. During movement, crepitation can

be heard due to irregular joint surfaces caused by arthritis.

The knee is the most common weight-bearing joint affected

by OA, with the disease predominantly affecting the

medial compartment of the tibiofemoral joint7, 8). Patients

with knee OA frequently report symptoms of knee pain and

stiffness as well as difficulty with activities of daily living

such as walking, stair-climbing and housekeeping3, 9).

Plain radiographs are commonly used to classify OA

subjects for the purposes of clinical studies, and joint space

narrowing is often used as a measure of disease progression.

Although plain radiography is currently the ‘gold standard’

for the evaluation of OA progression, it is associated

with problems related to the accurate reproduction of measurements

of joint space width, especially in subjects with

knee OA10).

There is evidence that muscle dysfunction is involved in

J.