The Effects of Knee Pain on the Quadriceps Strength, Proprioception and Balance in Patients with Knee Osteoarthritis

Jung Hyun Kim; Ji Hye Hwang; Moon Ju Ko; Kyoung Bin Min; Won Hah Park; Tae Kyu Kwon

doi:10.5763/kjsm.2013.31.1.1

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Kim, Hwang, Ko, Min, Park, and Kwon: The Effects of Knee Pain on the Quadriceps Strength, Proprioception and Balance in Patients with Knee Osteoarthritis

Clinical Article

Korean J Sports Med 2013;31(1):1-6.

Published online: 10 January 2013

DOI: https://doi.org/10.5763/kjsm.2013.31.1.1

The Effects of Knee Pain on the Quadriceps Strength, Proprioception and Balance in Patients with Knee Osteoarthritis

Jung Hyun Kim¹, Ji Hye Hwang^1,, Moon Ju Ko¹, Kyoung Bin Min¹, Won Hah Park¹, Tae Kyu Kwon²

¹ Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul

² Division of Biomedical Engineering, Chonbuk National University, Jeonju, Korea

Correspondence: Ji Hye Hwang Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea Tel: +82-2-3410-2818, Fax: +82-2-3410-0388, E-mail: hwanglee@skku.edu

Received 23 November 2012 Revised 13 May 2013 Accepted 27 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The purpose of this study was to assess the effects of knee pain on the quadriceps strength, proprioception and balance in subjects with bilateral knee osteoarthritis and the correlation between muscle strength, proprioception, and balance in knee osteoarthritis patients with knee pain. The inclusion criteria were symptomatic and radiographic bilateral knee osteoarthritis (Kellgren-Lawrence grade ≥2), visual analogue scale difference of the both knees ≥2. Thirty three participants (32 women, 1 men: mean age, 59.18 years) underwent assessment of maximal voluntary contraction of quadriceps and hamstring muscles, knee proprioceptive acuity (measure passive joint reposition sense) and balance index using Biodex System 3 isokinetic dynamometer and Biodex balance System. In this study, the more pain knee had weaker quadriceps strength than less pain knee (p＜0.05) but proprioceptive acuity and balance index did not show significant differences in both knees (p＞0.05). Poor proprioception was associated with low quadriceps strength and poor Mediolateral Stability Index (p＜0.05). Future studies needed to account the influence of pain on neuromuscular factors as well as attempt to further clarify the relationships between these factors.

Keywords: Balance, Knee osteoarthritis, Pain, Proprioception, Strength

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Table 1.

General characteristics of patients

Value	Patients (n=33)
Age (y)	59.5±4.9
Sex (male/female)	1/32
Body mass index (kg/m²)	23.9±2.7
Dominant leg (right/left)	29/4
More pain knee (right/left)	22/11
Visual analogue scale (cm)
More pain knee	5.86±1.64
Less pain knee	2.54±0.98

Values are presented as mean±standard deviation.

Table 2.

Quadriceps strength according to the extent of pain

Peak extensor torque	More pain site	Less pain site
Peak extensor torque (ft-lbs)
60 ^o/s	51.63±12.83^*	57.78±11.14
180 ^o/s	30.31±8.13^*	33.52±6.25
Peak flexor torque (ft-lbs)
60 ^o/s	26.15±9.22	27.63±8.66
180 ^o/s	18.47±6.64	20.63±6.36

Values are presented as mean±standard deviation.

^* Statistically significant.

Table 3.

Proprioceptive acuity according to the extent of pain

Proprioceptive acuity (degrees error)	More pain site	Less pain site
90 ^o to 15 ^o	3.36±1.42	2.92±1.53
90 ^o to 30 ^o	4.27±1.92	3.71±1.62
90 ^o to 45 ^o	4.48±2.49	4.26±2.19

Values are presented as mean±standard deviation.

Table 4.

Balance index according to the extent of pain

Stability index	More pain site	Less pain site
Overall	3.56±1.07	3.50±1.03
Anteroposterior	3.07±0.91	3.18±1.07
Mediolateral	1.84±0.71	1.77±0.51

Values are presented as mean±standard deviation.

Table 5.

Correlation between quadriceps strength, proprioceptive acuity and balance in knee osteoarthritis patients with knee pain

Proprioceptive acuity	90 ^o to 15 ^o		90 ^o to 30 ^o		90 ^o to 45 ^o
Proprioceptive acuity	CC	p-value	CC	p-value	CC	p-value
PET 60 ^o/s	0.347	0.048^*	0.081	0.654	0.102	0.572
PET 180 ^o/s	−0.052	0.774	−0.100	0.579	−0.233	0.191
Overall stability index	0.240	0.179	0.068	0.707	−0.250	0.160
Anteroposterior stability index	0.170	0.344	0.055	0.762	−0.106	0.555
Mediolateral stability index	0.098	0.586	0.000	0.999	−0.344	0.050^*

CC: correlation coefficient, PET: peak extensor torque.

^* Statistically significant.

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