பிசியோதெரபி & உடல் மறுவாழ்வு இதழ்

Impact of Retro-Walking on Pain and Disability Parameters among Chronic Osteoarthritis Knee Patients

Abstract

Balraj AM, Krishnan R and Kamaraj B

Objective: Osteoarthritis is a degenerative joint disease involving the cartilage and surrounding tissues. It results in damage and loss of articular cartilage, remodeling of sub articular bone, osteophyte formation, ligamentous laxity, weakening of periarticular muscles and synovial inflammation. Retro-walking is walking backwards. Since there is propulsion in backward direction and reversal of leg movement in Retro-walking, different muscle activation patterns from those in forward walking are required. Back ward walking increases stride rate, decreases stride length and increases support time. Muscular structure supporting ankle and knee reversed their role during retro-walking.
Materials and methods: An Experimental study designs with random sampling methods was used. The total duration of study extended to 3 months and study was done at Co-operative Institute of Health Science, Physiotherapy Department, Tellicherry, Kerala, India. All the samples participants were informed about the study and a written consent was obtained from each. Approval of the local ethical committee was also obtained. The study population includes 30 patients with chronic OA knee with age group of 50-55years. For this study both male and female were included. Also inclusion criteria with knee pain more than 6 weeks, Bilateral and unilateral involvement, participant’s fulfilling three out of the six clinical criteria listed by The American College of Rheumatology were diagnosed as knee OA which was confirmed using radiological investigations. The criteria are Age >50 years, Morning stiffness lasting <30 min, Crepitus with active motion, Bony tenderness, Bony enlargement and No warmth to touch and diagnosed to have chronic OA Kellengren and Lawrence scale were included in the study. Participants with balance problem, history of any lower extremity injury or underlying pathology, Systemic inflammatory disease, Osteoporosis, Post traumatic stiffness of knee and acute post-surgical knee cases were not included in the study.
Results: When comparing the post-test values of ROM &WOMAC in both control and experimental group through analysis of inter group significance: WOMAC shows sig value 0.002 in independent t-test {p<0.05}, calculated t value 3.436 [>tabled t value 2.048 df=28], knee flexion ROM shows sig value 0.038 [p<0.05} calculated t-value 2.289 >tabled t value 2.048, df=28 at p=0.05 and Knee extension ROM sig value 0.025 {p<0.05}, calculated value 2.82 >tabled t value 2.048, df=28 at p=0.05. This shows that control group shows significant difference from experimental group in WOMAC and extension ROM and flexion ROM. There is significant difference for Retrowalking and conventional treatment over conventional treatment alone in reducing pain & disability and improving ROM for patients with OA knee.
Conclusion: The study was to evaluate the effectiveness of retro-walking for reducing pain and disability and improving range of motion in patients with chronic osteoarthritis. The subjects included were those who came to the outpatient clinic at CIHS. 30 subjects were randomly divided into Control Group and Experimental Group [15 pts in each group]. Control Group received conventional treatment alone and Experimental Group received conventional treatment and retro-walking. Both Group received treatment period of about 40-45 min in each session for a regular period of 6 days in a week. The outcome measures used were standard goniometer and WOMAC, The measurement were taken prior to the treatment on the first day (pre-test value) and on the last day of treatment (posttest value). Statistical analysis was done using paired t-test and Independent t-test. The result obtained revealed that both group showed significant difference between their pre- test and post-test values but statistically, Experimental Group shows more significant difference than Control Group. Statistically it is observed that, retro-walking leads to a significant improvement in reduction of pain and disability of the subjects under study. Based on the performed study was concluded that the patients who undergone OA knee rehabilitation should undergo retro-walking in their rehabilitation protocol.