For individuals over the age of 50, osteoarthritis (OA) of the knee is the leading cause of chronic disability (Bruce-Brand). Neuromuscular electrical stimulation (NMES) is a commonly used modality in physical therapy practice for increasing the strength of muscles. There is no cure for OA, but quadriceps strength is highly correlated with functional performance of the knee and, therefore, increasing quadriceps strength may lead to improvements in knee performance and quality of life for those with OA. The purpose of this paper is to assess the effectiveness of NMES for quadriceps strengthening for individuals with advanced knee OA. The first of three research articles examined was conducted by Bruce-Brand et. al. In this randomized control …show more content…
Though the researchers found improved functional performance and quadriceps cross-sectional area (CSA) increased by 5.4%, there was no statically significant increase in quadriceps strength. Reasons why the NMES group demonstrated no significant improvement may have been due to the limited 18 mA max RMS output as well as the dynamic pulse width that likely was too short to attain a therapeutic dose when at its lower range. Furthermore, lack of supervision, the inability for specific pad placement, and not assessing the percentage of maximal voluntary isometric contraction (MVIC) attained during stimulation may have limited gains. Consistent with their results, the researchers concluded NMES did not produce meaningful strength gains but did increase CSA as well as improve functional performance 6 weeks after intervention for those with grades 3 to 4 …show more content…
While conducting the literature search for this paper, no studies examined the effects on only individuals with grade 4 OA. In fact, most studies excluded individuals that presented with grade 4 OA. Only one study included individuals just with grades 3-4 OA, but I believe their results were severely limited by the device used. Furthermore, no meta-analysis studies were applicable due to the vast inconsistencies in treatment protocols and outcome assessments. There is a need for larger scale RCTs specifically assessing the short and long term effectiveness for those with grade 3 to 4 OA using adequate parameters and dosage for strengthening. From the studies included in this paper as well as what I have learned in class, NMES for quadriceps strengthening may be a good option for those who exhibit deficient activation, excessive weakness, or in which exercise is contraindicated, given that the patient can tolerate a therapeutic dose. Besides the strength assessments, all three studies included used the Western Ontario McMaster Universities Ostearthritis index (WOMAC) as well as functional tests involving timed walks, sit-to-stands, and stair climbs as outcome measures. Even though strength gains were not consistent from study to study, all three demonstrated improvements in WOMAC scores and functional performance. It is my
Yu, J., park, D., & Gyuchang, L. (2013). Effect of eccentric strengthening on pain, muscle strength, endurance, and functional fitness factors in male patients with achilles tendinopathy. American journal of physical medicine and rehabilitation , 92, 68-76.
Pain was significantly increased with flexion and extension. Sensation is decreased in the bilateral upper extremities. Strength is decreased in the bilateral upper extremities.
This systematic review conducted by Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H, Underwood M, (2012) sourced twenty-five trials, and the overall number of people of the collective trials included was 5,942. Interventions were classified and assessed using the following headings.-
Graston instrument-assisted soft tissue mobilization (GITSM) is a tool used by therapist and chiropractors to help break up the scar tissue and replace it with fibroblast allowing for faster recoveries (Black 2010). A series of heat, GISTM, then strength and flexibility training are required (Black 2010). Numerous studies have been conducted, by certified therapist qualified in GISTM, to examine the styles and recovery periods after an injury. After going through the treatment, patients are measured by their range of motion (ROM) to see if the treatments were effective or not (Black 2010). ROM can vary depending on the region of the body that is being treated, but the overall goal of GISTM is to allow a person to get back to their regular routines they had before their injury. A study conducted by Logan College of Chiropractic shows that plantar fasciitis (foot) can be treated by GISTM on the first day of treatment (Daniels and Morrell 2012). Another study by Duke University shows that GISTM can be effective for patients after surgery that had an injury in the Patellar tendon (knee) (Black 2010). After several treatments, GISTM can, also, be used to treat a compression fracture in the lumbar (back) (Papa 2012). Each study shows the method of GISTM, the patient’s recovery period along with the methods of recovery.
Ytterberg, S.R., Mahowald, M.L. & Krug, H.E.(1994) “Exercise for arthritis”, BailliOre' s Clinical Rheumatology, 8(1), pp. 161-189. ScienceDirect [Online]. Available at: http://www.sciencedirect.com/science/article/pii/S0950357905802304 (Accessed: 13th May 2014).
Controlled increases in physical stress through progressive resistive exercise cause muscle fibers to hypertrophy and become capable of generating greater force.3 Early emphasis is on restoring joint range of motion and muscle flexibility, however, resistive exercises are not delayed. The initial emphasis of muscle loading should be on endurance, accomplished with lower loads and higher repetitions. Progressive resistive exercises are initiated at the available range and progressed to new positions as wrist range of motion returns in all planes. Both the overload principle and the SAID Principle (Specific Adaptation to Imposed Demands) are important considerations in therapeutic exercise dosing.1,3,11 Within pain tolerance, dosing progressive resistive exercises that maintain a therapeutic stress level will encourage muscle tissue hypertrophy. Finding activities that produce the correct force and repetition, without injury, is the goal of the remobilization period. Starting with low force, moderate to high repetitions, and encouraging therapeutic rest following induced stress is important to both the overload principle and the SAID Principle. Additionally, it is important to prevent dosing resistive exercises that exceed optimal stress, which may result in injury. The patient’s response to therapeutic exercise should be assessed during, immediately following,
In this regard I hypothesise that altered biomechanics combined with poor neuromuscular responses in obese adult may have an association with OA. To the best of my knowledge there are no other studies that compared the knee biomechanics along with respective neuromuscular responses within non obese, obese and OA effected adult groups.
It is a home exercise program that allows the patient to take an active part in their healing. Gently moving the soft tissue prepares it for the treatment it receives from the therapist. Time previously spent during the therapy session to initiate change in the tissues is used instead to advance further release and flexibility. The therapist is able to focus treatment time on stubborn areas of connective tissue restriction that have not changed in response to exercise. The positioning the patient uses to complete the exercises helps the therapist identify the source of the problem which is not usually in the same place as the patient’s primary complaint. This partnership between the therapist and the patient translates into quicker recovery and improved pain relief for the
Gabboth, Tim. "Journal of Strength & Conditioning Research (Lippincott Williams & Wilkins). Feb2012, Vol. 26 Issue 2, P487-491. 5p." N.p., n.d. Web.
In elderly individuals loss of muscle strength and mass and its associated outcomes is a common problem. With ageing the bone tends to shrink in size and the density of the bones reduces. Such osteoporotic bones are more susceptible to fracture. With all this underlying causes there is lack of coordination and trouble in balancing which leads to increase in fall risk in such elderly individuals. So it becomes crucial to address the issue of muscle growth in elderly individuals. Another common and degenerative disorder with aging is osteoarthritis of knee which is a leading cause of disabilities among older adults. Osteoarthritis occurs due to degeneration of knee joint cartilage and the underlying bone which occurs commonly in people of and above 50 years of age. The classic clinical symptoms associated with it are joint pain, stiffness and loss of muscular strength of knee musculature of which loss of quadriceps muscle mass and strength is the most common. The activities of daily living is also affected in older patients with knee osteoarthritis. Increasing strength of quadriceps muscle has a lot of benefits like protecting the joint and delaying the progression of disease.
O'Brien, D. (2009). Randomized controlled trials (RCTs). In R. Mullner (Ed.), Encyclopedia of health services research. (pp. 1017-1021). Thousand Oaks, CA: SAGE Publications, Inc. doi: http://dx.doi.org.proxy1.ncu.edu/10.4135/9781412971942
"Physical Therapy." Mayo School of Health Sciences. Mayo Clinic, 25 June 2013. Web. 7 Nov. 2013.
"Spine & Sports Rehabilitation." - Rehabilitation Institute of Chicago. Ric.org, 2014. Web. 08 May 2014.
This paper explores the various benefits and disadvantages of the use of Neuromuscular Electrical Stimulation (NMES). NMES has been used as a rehabilitation tool for many athletes who are recovering from various injuries and complications that arise in sports. NMES is a treatment that involves the use of a device called a muscle stimulator that transmits electrical impulses through electrodes that are applied to a specific muscle or muscle group. When this electrical impulse is applied to the muscle fibers, contractions occur and the muscle, shortens. NMES cause concentric contractions where the muscle shortens, but the individual receiving the treatment can go through exercises that also require eccentric muscle contractions where
The purpose of the squat is to train the muscles around the knees and hip joints, as well as to develop strength in the lower back, for execution of basic skills required in many sporting events and activities of daily living. Because a strong and stable knee is extremely important to an athlete or patient’s success, an understanding of knee biomechanics while performing the squat is helpful to therapists, trainers, and athletes alike (11). Because most activities of daily living require the coordinated contraction of several muscle groups at once, and squatting (a multi-joint movement) is one of the few strength training exercises that is able to effectively recruit multiple muscle groups in a single movement, squats are considered one of the most functional and efficient weight-bearing exercises whether an individual’s goals are sport specific or are for an increased quality of life