Research Paper
E-ISSN No : 2455-295X | Volume : 2 | Issue : 7 | July 2016
EFFECT OF RETRO WALKING ON DYNAMIC BALANCE AND MOBILITY IN PATIENTS WITH KNEE OSTEOARTHRITIS *Jagga Vinay Prof., Prem Physiotherapy & Rehabilitation College, Panipat, [Haryana]. (*Corresponding Author) ABSTRACT Objective: This study aimed to investigate the effect of retro walking on dynamic balance and mobility in patients with knee osteoarthritis. Methods: Total 50 subjects were taken and then they were randomly divided into 2 experimental groups: Group A (25 Females) and Group B (25 Males). The subjects were assessed and demographic data such as height, weight, were assessed and noted. Then the subjects in both the groups were assessed for STEP UP and TUG (time up & go test). . After 2 weeks training, again balance & mobility was tested again by step up & timed up & go test. Results: The results of the study reveal that Retro Walking is effective in improving dynamic balance and mobility. Conclusion: Retro Walking is effective in improving dynamic balance and mobility. KEY WORDS: Step up test, timed up and go test, retrowalking, osteoarthritis.
INTRODUCTION Osteoarthritis is a non-inflammatory degenerative disorder of joints characterized by progressive deterioration of the articular cartilage and formation of new bone (osteophytes). Pain is the main presenting symptom. The joint become swollen due to synovitis. Stiffness gradually sets in following severe pain in late stages of the disease, the joint becomes deformed.1 Individuals with knee OA suffer progressive loss of function, displaying. Understanding the impact of knee OA on balance may allow possible mechanisms of disability in this patient population to be elucidated, and may permit more effective management of patients with the disease.2 Balance is the complex function involving numerous neuromuscular processes. Control of balance is dependent upon sensory input from vestibular, visual and somatosensory system. Central processing of this information results in coordinated neuromuscular responses that ensure the centre of mass remains within the base of support in situations when balance is disturbed. Effective control of balance thus relies not only on accurate sensory input but also on a timely response of strong muscles. Balance impairments are associated with an increased risk of falls and poorer mobility measures in the elderly population.3 Falls and loss of balance most commonly occur during dynamic activities (walking) than in static activities. Backward walking and other “retro” movements are becoming increasingly popular rehabilitation methods to enhance ankle and knee joint range of motion and selectively activate muscle groups such as ankle dorsiflexors and knee extensors.4 So backward locomotion is also commonly used in rehabilitation treatment as a modality for injuries such as patellofemoral pain syndrome. This study emphasizes on the effect of Retro Walking on dynamic balance and mobility in patients with knee osteoarthritis. This study will provide a new protocol for the beneficence of patients with knee osteoarthritis and also perform the role of an important rehabilitation modality during the treatment METHODS 1. 50 Subjects were randomly assigned to each experimental Group A (Females) and Group B (males) using Convenience Random Sampling method. Consents of subjects who were able to read and write simple English were collected with prior permission. Inclusion criteria included age of 40 to 60 years and both gender fulfilling ACR criteria and Grade 2 Kellgren and Lawrence classification. The subjects were excluded on the basis of any History of lower limb surgery , Lower limb joint replacement, Intra articular steroid injection, Fixed flexion deformity, Subjects with cardiac problems, Hearing loss, Deformity. The subjects were assessed and demographic data such as height, weight, were assessed and noted. Then the subjects in both the groups were assessed for STEP UP and TUG. Then during the training session, the subjects were instructed to walk backward for 120 meters for 6 sessions per week for 2 weeks. The commands were given in the starting and ending of the session only. After 2 weeks training, again balance & mobility was tested again by step up & timed up & go test.
RESULTS Results were analyzed by using t-test and paired t-test by using SPSS version 15. The between group analysis of the TUG showed that there was significant difference between the pre and post readings in both Groups. Group A (Females) that is of <.001 and there was an increase in TUG Scores with a percentage of 23.72% and in Group B (Males) there is significant difference that is p <.001 but with a increase in TUG Scores by 24.35% The between group analysis of the STEP UP showed that there was significant difference between the pre and post readings in both Groups. Group A (Females) that is of <.001 and there was an increase in STEP UP Scores with a percentage of 64.67% and in Group B (Males) there is significant difference that is p <.001 but with a increase in STEP UP Scores by 84.55% DISCUSSION The purpose of the study was to find out the effect of Retro Walking on dynamic balance and mobility in patients with knee osteoarthritis. The subjects in this study had similar baselines values of all dependent variables suggesting that all groups had homogeneous group of patients. The results of the study reveal that Retro Walking is effective in improving dynamic balance and mobility. In this study, improvement was shown more by males as compared to females and there was increase in TUG scores by 24.35% and there was increase in STEP UP scores by 84.55%. A study done by Chetr Whitley and Janet Dufek ,reported in the International Journal of Exercise Science examined the effects of backward walking on hamstring flexibility and low back range of motion and found that Retro Walking increased hamstring flexibility for those who took part in the four week program.6 A study done by R.L. Gajdosik PT, PHD, C.A. Giuliani PT,PHD AND R.W. Bohannon PT examined the passive compliance and length of hamstring muscles and found that the absolute hamstring muscle lengths differed between genders.7 So we conclude that the effect of backward walking is better in males than females due to more hamstring flexibility and as the backward walking phenomenon require hamstring pre stretch. So males were more effective for backward walking due to gender differences in hamstring flexibility. So the above two studies supported these results that backward walking is effective in improving dynamic balance and mobility in patients with knee osteoarthritis. The results of this study differ from the results of the study done by Terblanche et al. (2004) who reported no improvement in isokinetic strength of the knee extensors and flexors in healthy women after a six week training program.8 In this study there is significant difference in B.M.I. of male and female. These results are supported by a study done by Steven B. Halls, MD who found that
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International Educational Scientific Research Journal [IESRJ]
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Research Paper
E-ISSN No : 2455-295X | Volume : 2 | Issue : 7 | July 2016
there is difference between body mass index of male and female.9 In this study more improvement was shown in Step Up test as compared to Timed Up and Go test. The results of this study reveals that there was more improvement in balance of the patients. These results are supported by a study done by Wei Ya Hao and Yan Chen who found that backward walking training improves balance in school aged boys.10 The results of the cited study are also in accordance with a study done by Patrick. A. Costiga, Kevin. J. Deluzio who studied the knee and hip kinetics during normal stair climbing and found that knee flexion moment was higher during stair climbing and also a study done by Barry Bates and Janet Dufek who found that backward walking reduces shear forces on the knee joint.11 So we can justify these results as that backward walking ease the stair climbing because of two reasons-backward walking reduce the shear forces on the knee joint and backward walking also increase more flexion during stance phase and limited flexion during swing phase. So the above two studies supported these are that backward walking is effective in improving dynamic balance. So we conclude that Retro Walking is effective in improving dynamic balance and mobility. In this study improvement was shown in both groups but more improvement was shown by males as compared to females and improvement was shown in both the test scores but more improvement was shown in Step Up scores as compared to TUG scores. The result of the study reveals that Retro Walking is effective in improving balance and mobility. REFERENCES 1.
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R.L. Gajdosik PT, PHD, C.A. Giuliani PT, PHD, R.W. Bohannon. (1990) Passive compliance and length of the hamstring muscles of healthy men and women. Clin Biomech (Bristol, Avon). Feb;5(1):23-9.
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TERBLANCHE, E., PAGE, C., KROFF, J. & VENTER, R. (2004). The effect of backward locomotion training on the body composition and cardio-respiratory fitness of young women. International Journal of Sports Medicine 25: 1-6.
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Steven B. Halls, MD. The BMI gap between Men and Women
https://scholar.sun.ac.za/bitstream/handle/10019.1/5392/brink_effects_2010.pdf
10. Wei Ya Hao and Yan Chen.( 2011) Backward Walking training improves balance in school aged boys. Sports Med Arthrosc Rehabil Ther Technol. Oct 22;3:24. 11.
Patrick. A. Costiga, Kevin. J. Deluzio. (2002)The Knee and Hip Kinetics during normal stair climbing. Gait Posture. Aug;16(1):31-7.
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