Jigayasa Thesis Final Completed

MPT (Musculoskeletal)
1. INTRODUCTION
CHAPTER OVERVIEW
Osteoarthritis (OA) is a common disease associated with significant morbidity.This is
particularly apparent at the knee joint, one of the commonest sites to be affected. As
prevalence of OA increases with age and aging is associated with decreasing
physiological function, the combination has major health implications. Symptoms
cannot, however, be predicted merely by the degree of structural damage.The
quadriceps weakness commonly associated with osteoarthritis of the knee is widely
believed to result from disuse atrophy secondary to pain in the involved joint. [1]
Osteoarthritis is degenerative joint disease. Commonly it is thought to be wear and tear
of joints as one ages.Two types of OA are recognized-primary and secondary.
1.Primary OA: It occurs in old age mainly in the weight bearing joints.
2.Secondary OA: In this type ,there is an underlying primary disease of the joint which
leads to degeneration of the joint. [2]
A high Quadriceps angle increases the chance of developing the various knee problems.
One of the most common problems associated with increased Quadriceps angle is
patellofemoral tracking syndrome. A high Quadriceps angle interferes with the smooth
gliding movement between the patella & the knee. Overtime, especially with repetitive
activities, this type of microtrauma causes non specific pain to the front of the knee. As
this abnormal tracking continues, various knee muscles like hamstrings, quadriceps &
calf muscle become imbalanced, and the cartilage on the underside of the patella begins
to wear &thin, Eventually knee becomes degenerative & develops osteoarthritis. [3]
Isometric quadriceps exercise program showed beneficial effects on quadriceps muscle

strength, pain, and functional disability in patients with osteoarthritis of the knee.[4]
TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

EXERCISE VERSUS VMO STRENGTHENING WITH GLUTEUS MEDIUS STRENGTHENING EXERCISE TO
NORMALIZE Q ANGLE IN PATIENTS WITH KNEE OSTEOARTHRITIS
1
1. INTRODUCTION
The Q angle have shown to be increased in the OA knee, possibly as the degeneration
progresses and more pain and immobility could be aggravating factor. The Q angle of
knee is measurement of the angle between quadriceps muscle and Patella tendon and it
provides useful information about the alignment of knee joint. It is likely to be
influenced by the muscle strength of varying group of muscles that alter the mechanics
of knee other that Quadriceps alone. Gluteus Medius weakness is very common among
people above age 50 and more evident with obesity indicating the mechanics change in
the knee joint too. [5]
Both Quadriceps isometric and VMO strengthening are effective in decreasing

qangle.[6]

2
1. INTRODUCTION
Figure-1.1 knee With Osteoarthritis

3
1. INTRODUCTION
1.1 Background of study

Knee osteoarthritis (OA), also known as degenerative joint disease of the knee, is
typically the result of wear and tear and progressive loss of articular cartilage. It is most
common in elderly women and men. Knee osteoarthritis can be divided into two types,
primary and secondary. Primary osteoarthritis is articular degeneration without any
apparent underlying reason. Secondary osteoarthritis is the consequence of either an
abnormal concentration of force across the joint as with post-traumatic causes or
abnormal articular cartilage, such as rheumatoid arthritis (RA). Osteoarthritis is
typically a progressive disease that may eventually lead to disability. The intensity of
the clinical symptoms may vary from each individual. However, they typically become
more severe, more frequent, and more debilitating over time. The rate of progression
also varies for each individual. Common clinical symptoms include knee pain that is
gradual in onset and worse with activity, knee stiffness and swelling, pain after
prolonged sitting or resting, and pain that worsens over time. Treatment for knee
osteoarthritis begins with conservative methods and progresses to surgical treatment
options when conservative treatment fails.[7]
Q- angle-The Q angle of knee is measurement of the angle between quadriceps muscle

and Patella tendon and it provides useful information about the alignment of knee
joint.[8]
Q angle is likely influenced by muscle strength of varying group of muscles that alter
the mechanics of kneeother that quadriceps muscle alone.Strengthening exercise is
widely recommended for the condition.[9]
1.2 Epidemiology
Osteoarthritis is the second most common rheumatological problem and it is the most
frequent joint disease with a prevalence of 22 to 39% in India.

4
1. INTRODUCTION
Knee osteoarthritis is the most common type of arthritis diagnosed, and its prevalence will
continue to increase as life expectancy and obesity rises. Depending on the source, roughly
13% of women and 10% of men 60 years and older have symptomatic knee osteoarthritis.
Among those older than 70 years of age, the prevalence rises to as high as 40%. The prevalence
of knee osteoarthritis in males is also lower than in females.[10]
1.3 Etiology
Knee osteoarthritis is classified as either primary or secondary, depending on its cause. Primary
knee osteoarthritis is the result of articular cartilage degeneration without any known reason.
This is typically thought of as degeneration due to age as well as wear and tear. Secondary
knee osteoarthritis is the result of articular cartilage degeneration due to a known reason. [11]
Possible Causes of Secondary Knee OA

Posttraumatic
Postsurgical
Congenital or malformation of the limb
Malposition (varus/valgus)
Scoliosis
Rickets
Hemochromatosis
Chondrocalcinosis
Ochronosis
Wilson disease
Gout
Pseudogout
Acromegaly
Avascular necrosis
Rheumatoid arthritis

5
1. INTRODUCTION
Infectious arthritis
Psoriatic arthritis
Hemophilia
Paget disease
Sickle cell disease
Risk Factors for Knee OA
Modifiable
Articular trauma
Occupation – prolonged standing and repetitive knee bending
Muscle weakness or imbalance
Weight
Health – metabolic syndrome
Non-modifiable
Gender - females more common than males
Age
Genetics
Race
1.4 Management
a)Drugs:Analgesics are mainly used to suppress the pain
b) Chondroprotective agents : Agents such as Glucosamine Chondroitin sulphate have

been introduced claiming to be the agents which results in repair of damaged cartilage.
c)Surgical Treatment : In selected cases surgery can provide significant relief.

Following are some of the surgical procedure performed for OA
(i)Osteotomy
(ii)Joint Replacement

6
1. INTRODUCTION
( iii) Joint Debridement

(iv) Arthroscopic Procedure
(i)Osteotomy- Osteotomy around a joint has been known to bring about relief in
symptom sespecially in arthritic joint with deformity. Osteotomy literally means cutting
of bone.In knee osteotomy, either the tibia or femur is cut and then reshape to relieve
pressure on knee joint. Knee osteotomy is used when a patient has early stage
osteoarthritis that has damaged just one side of knee joint.
(ii)Jointreplacement-
Forcasescripledwithadvanceddamagetothejointtotaljointreplacementoperationhasprovi
dedremarkablerehabilitation.Joint replacement is a surgical procedure to resurface a
knee damaged by arthritis. Metal and plastics are used to cap the ends of the bones that
form the knee joint, along with kneecap
(iii)Joint debridement- This method is not popular now. In this affected
cartilageisopened degenerated cartilage smoothened.
(iv) Arthroscopic Procedure-knee arthroscopy is a surgical procedure that allows

doctors to view the knee joint without making a large incision(cut) through the skin and
other soft tissue. knee arthroscopy may relieve painful symptoms of many problems
that damage the cartilage surfaces and other soft tissues surrounding the joint. Common
arthroscopic procedures for knee include repair of torn meniscus ,trimming of damaged
articular cartilage, removal of loose fragments of bone or cartilage, treatment of patella
problems.[12]
d)Physiotherapy
Physiotherapy plays an important role in the management of knee Osteoarthritis.
Strengthen exercise is very important in Knee Osteoarthritis.
Strengthening exercise helps in strengthening the muscles around the knee joint and
normalizes Q angle in knee Osteoarthritis. [13]

7
1. INTRODUCTION
1.5 Operationaldefinition
Operational definition of OsteoarthritisOsteo meaning bone arthro meaning joint
and itis meaning inflammation Osteoarthritis is a degenerative joint disease.It is a
progressive disorder of the joints caused by gradual loss of cartilage and resulting in
the development of bony spurs and cysts at the margins of the joints. It results from
deterioration or loss of the cartilage that acts as protective cushion between bones. As
the cartilage is worn away, the bone form spurs, areas of abnormal hardening and fluid
filled pockets known as subchondral cysts. As the disorder progresses,pain results from
deformation of the bones and fluid accumulation in the joints. The pain is relieved by
rest and made worse by movement. In early OA, the pain is minor and may take the
form of mild stiffness in the morning. In the later stages of OA, inflammation develops,
the patient may experience pain even when the joint is not being used, and the patient
may suffer permanent loss of the normal range of motion in that joint. [14]
Operational definition of Q angleThe quadriceps angle, or Q-angle, is defined as the

angle formed by the intersection of two lines, one that starts at the anterior iliac spine
and goes to the center of the patella, and another that goes from the tibial tuberosity to
the center of the patella. Normal value of quadriceps angle is 12degree to 15 degree in
male and 15 degree to 18 degree in male. [15]
Operational definition of Strengthening ExerciseStrengthening exercises are

exercises which are designed to increase the strength of specific or groups of muscles.
Strengthening exercises overload the muscle until the point of muscle fatigue.[16]
1.6 Aim of study:

To Compare the effect of VMO strengthening with Quadriceps Isometric Exercise
Versus VMO strengthening With Gluteus Medius Strengthening Exercise To
Normalize Q Angle In Patients With Knee Osteoarthritis.

8
1. INTRODUCTION
1.7 Need ofstudy:
A high Q angle increase the chance of knee osteoarthritis.This affects the
biomechanics of knee joint.
The muscle strength affects Q angle variation of osteoarthritis of knee.
Some studies have shown that vastus medialis oblique strengthening exercise
combined with quadriceps isometric exercise is effective in normalizing Q angle
in in Patients with knee osteoarthritis.
The weakness of hip gluteus medius (hip abductor) can be attributed to gender
and obesity.
Gluteus Medius (hip abductor) strengthening exercise combined with vastus medialis
obique strengthening exercise helps in reducing pain and can normalize q angle
in knee osteo arthritis.
1.8 Purpose ofstudy

The purpose of present study is to normalize Q angle in patients with knee
osteoarthritis by strengthening the weak muscles.
The importance of muscle strengthening is to treat Q angle in patients with knee

osteoarthritis.This will help in correcting the alignment of the knee joint. This
will alter the mechanics of the knee joint.
Muscle strength of varying group of muscles alter the mechanics of the knee
joint.

9
1. INTRODUCTION
1.9 Hypothesis
Experimental Hypothesis-There may be significant difference betweeneffects of VMO
strengthening exercise combined with Quadriceps isometric exercise versus VMO
strengthening exercise combined with hip abductors to normalize Q angle in
patients with knee osteoarthritis.
Null Hypothesis
There may or may not be no significant difference between effects of VMO
strengthening exercise combined with quadriceps isometric exercise versus VMO
strengthening exercise combined with hip abductors to normalize Q angle in

10
2. WORK PLAN WITH FLOW CHART
PLAN OF WORK
The research will be done on VMO strengthening exercise combined with

quadriceps isometric exercise versus VMO strengthening exercise combined with
hip abductor strengthening exercise to normalize Q angle in patients with knee
osteoarthritis. A Comparative Study
Plan of work is as follows
Total 30 patients will be included in the study.Group A includes 15 patients and Group
B includes 15 patients
The study will be accorded from Shri Mahant Indiresh Hospita Patel Nagar Dehradun
Department Of Physiotherapy.
The subject will be undertaken according to inclusion and exclusion criteria and a
written informed consent will be contained (appendix 1)
A detailed briefing will be given to the family of patient about the purpose and method
of study

11
2. WORK PLAN WITH FLOW CHART
FLOW CHART OF PLAN OF WORK
Subjects included in the study (n=50) and after meeting up with the inclusion
criteria, subjects included in study (n=30)
Randomization n=30
VMO strengthening combined With VMO Strengthening combined With

Quadriceps isometrics n=15 Gluteus Medius Strengthtening n=15
Pretest score based on outcome

Pretest score based on outcome (WOMAC)
(WOMAC)
VMO strengthening combined with VMO Strengthening combined with

Quadriceps Isometrics for 8 weeks 6 days a Gluteus Medius Strengthening for 8
week weeks 6 days a week
Post test evaluation based on outcome measure

(WOMAC)
Figure 2.1 Flow Chart of plan of work

12
3. REVIEW OF LITERATURE
The name of study is “To compare the effect of VMO strengthening with
Quadriceps Isometric Exercise Versus VMO strengthening With Gluteus Medius
Strengthening Exercise To Normalize Q Angle In Patients With Knee
Osteoarthritis.”.and it was a 8 week study on 30 patients with . In this study the
dependent variables were used such as Pain, Incorrect Q angle, Muscle strength and the
scale to measure were VAS, and WOMAC scale to check the pre and post evaluation.
Searched were performed for studies published in English in electronic databases,

including Pub Med (publication year with in 30 years from 1989 to 2019, species:
human), google scholar (publication year with in 30 years from 1989 to 2019, species:
human) . (Table 3.1)
keyword used to search the literature are ,Osteoarthritis, Q-angle , quadriceps

isometrics, VMO strengthening, gluteus medius strengthening, WOMAC scale.
Search engine No of articles No of relevant No of selectedarticle

searched articles
Google scholar 45 15 9
PubMed Elsevier
Research gate 40 25 10
30 10 2
24 14 4
Table: 3.1: Search Strategy

13
3.2 ANATOMY OF KNEE JOINT

13
The knee joint is a largest, complex synnovial joint of a modified hinge variety. There
are three articulations in the knee joint i.e. two between the tibial ajjrh4fhnd femoral
condyles and the third with the patella and femur.
Knee is one of the most unprotected joint and it is subjected to all types of acute and
chronic injuries leading to pain and disability. [17]
Traumatic injuries of the knee joint can occur anytime during walking, or during sports
or road traffic accidents.
The principle intra-articular structures in knee are two cruciate ligaments, two menisci
and synovium lining the fat pad. The interaction of physical and biochemical structures
of cartilage is necessary to allow the normal function of providing nearly frictionless
motion, wear resistance, joint congruence, and transmission of load to subchondral
bone. Chondrocytes are responsible for synthesizing and maintaining the material
required for this purpose. Osteoarthritis occurs when there is disruption of normal
cartilage structure and homeostasis [18].
Osteoarthritis results from a complex interaction of biochemical and biomechanical

factors that occur concurrently to perpetuate degenerative changes. The progressive
pathologic change that occurs in osteoarthritis has been characterized, not only for
articular cartilagebut alsofor periarticular tissues.[19]
Anatomic organization and stabilizing factors of the knee Joint

The articulating surfaces of the knee joint are contributed by the lower end of femur,
superior surfaces of the tibia and patellar posterior surface.

14
M L
Figure - 3.1 Anatomic Stabilization of Knee Joint
Figure-3.2 Knee Joint

15
Bones involved in formation the knee. The intercondylar notch of femur and
intercondylar eminence of tibia provides bony stability to the joint much similar to
horse rider straddling on back of the horse .
The extensor compartment muscle, the quadriceps femoris provides a greater

mechanical advantage for the extension. The medial stabilizer is semimembranosus
muscle with its five extensions at insertion. During flexion, the semimembranosus and
its attachment to medial meniscus pulls the meniscus posteriorly so as to prevent the
crushing of meniscus between medial condyles of tibia and femur [20]
Posterior cruciate ligament (PCL) is part of medial tibiofemoral joint and acts like a
major stabilizer of knee joint. It is made up of two parts: antero-lateral and postero-
medial. The tension within each cruciate varies with the movements of the knee joint
.[21]
Iliotibial tract and biceps femoris is the main knee joint stabilizer from lateral side. The
insertion of biceps femoris reinforces the posterior 1/3rd of the lateral part of capsule.
The posterior third of lateral tibiofemoral joint is supported by “Arcuate complex”. This
complex is composed of 4 components: fibular collateral ligament, posterior 1/3rd of
lateral capsular ligament, popliteal tendon and arcuate ligament [22]. The anterior
cruciate ligament (ACL) is taut during extension and lax during flexion of the knee, this
ligament is also a chief stabilizer of the knee joint .
The menisci increase stability for femorotibial articulation, distribute axial load, absorb
shock and provide lubrication and nutrition to the knee joint.
The Injuries to the menisci are recognized as a cause of significant musculoskeletal

morbidity. The unique and complex structure of menisci makes treatment and repair
challenges or the patient, surgeon and physical therapist. Long-term damage may lead
to degenerative joint changes such as osteophyte formation, articular cartilage

16
degeneration, joint space narrowing, and symptomatic osteoarthritis (OA)

Preservation of the menisci depends on maintaining their distinctive composition and
organization. Early in embryonic life, the normal menisci develop within the limb bud
from mesoderm. They are well defined at 8th week of gestation and by 14th week they
gain appropriate anatomical shape [23]
The menisci serve as shock absorbers and load distributors and play a role in joint
stability as well as in synovial fluid distribution and cartilage nutrition.
The medial collateral ligament (MCL) is a major stabilizer of the knee joint. It is the
most common ligament injured in the knee

17
The lateral collateral ligament (LCL) or fibular collateral ligament, is one of the
major stabilizers of the knee joint with a primary purpose of preventing excess
varus and posterior-lateral rotation of the knee.[24]
Figure-3.3 Ligaments And Meniscus Of Knee Joint

18
Articulating Surfaces
The thigh bone (femur), the shin bone (tibia) and the kneecap (patella) articulate
through tibiofemoral and patellofemoral joints. These three bones are covered in
articular cartilage which is an extremely hard, smooth substance designed to decrease
the friction forces. The patella lies in an indentation of the femur
knownasintercondylargroove.
Figure - 3.4 Knee Joint Articulating Surface

19
The smaller fibula runs alongside the tibia and is attached via the superior tibiofibular
joint is not directly involved in the knee joint, but provides a surface for important
muscles and ligaments to attach to.
The distal aspect of the femur forms the proximal articulating surface for the knee,
which is composed of 2 large condyles. The medial and the lateral. These two condyles
are separated inferiorly by the intercondylar notch although they are connected
anteriorly by a small shallow groove which is known as either the femoral sulcus or the
patella groove or patella surface. This engages the patella in early flexion.
The tibia also has 2 asymmetrical condyles (medial and lateral) of which are relatively
flat, These are also known as the tibial plateau. The medial tibial plateau is much longer
than the lateral anteroposteriorly, and the diameter of the proximal tibia is much greater
than the shaft posteriorly which is sloped at approximately 7 to 10o to facilitate flexion
of the femoral condyles on the tibia.
The two tibial condyles are separated by the intercondylar tubercles, these are two bony
spines which are roughened and their role lies within knee extension. They become
lodged in the intercondylar notch of the femur, adding to the stability of the joint.
Overall the tibiofemoral joint is a relatively unstable joint as the plateaus are slightly
convex anteriorly and posteriorly. This emphasizes the importance of the other
structures of the knee such as the menisci.[25]

20
20
Figure - 3.5 Knee Joint Articulating Surface

21
Muscles
Peripheral Spinal
Muscles Function
nerve innervation
Quadriceps femoris Strong extensor of the knee Femoral L2, L3, L4
Semitendinosus* Flexor and internal rotator of the knee Tibial L5, S1, S2
Semimembranosus Flexor and internal rotator of the knee Tibial L5, S1, S2
Gracilis* Flexor and internal rotator of the knee Obturator L2, L3, L4
Sartorius* Flexor and internal rotator of the knee Femoral L2, L3
Flexor and internal rotator of the knee

Popliteus Prevents the femur from slipping Tibial L4, L5, S1
forwards on the tibia during squatting
Weak extensor when knee is extended

Superior
Tensor fasciae latae Weak flexor and external rotator of the gluteal L4, L5
knee in flexion greater than 30o
Weak flexor of the knee

Weak internal and external
Gastrocnemius rotator of the knee Tibial S1, S2
Strong plantiflexor and
inventor of the heel
Strong flexor and

Biceps femoris external rotator of the Sciatic L5, S1
knee
Table - 3.2 Muscles Of Knee Joint

22
Figure - 3.6 Muscles Of Knee Joint
Figure :3.7 Muscles Of Knee Joint

23
Figure - 3.8 Muscles Of Knee Joint
Figure -3.9 Muscles Of Knee Joint

24
3.3BIOMECHANICS OF KNEE JOINT
The ligaments and menisci provide static stability and the muscles and tendons dynamic
stability.
The main movement of the knee is flexion - extension. For that matter, knee act as a
hinge joint, whereby the articular surfaces of the femur roll and glide over the tibial
surface. During flexion and extension, tibia and patella act as one structure in relation
to the femur. The quadriceps muscle group is made up of four different individual
muscles.They join together forming one single tendon which inserts into the anterior
tibial tuberosity. embedded in the tendon is the patella, a triangular sesamoid bone and
its function is to increase the efficiency of the quadriceps contractions. Contraction of
the quadriceps pulls the patella upwards and extends the knee.Range of motion:
extension 0o. The hamstring muscle group consists of the biceps femoris,
semitendinosus and semimembranosus. They are situated at the back of the thigh and
their function is flexing or bending the knee as well as providing stability on either side
of the joint line. Range of motion: flexion 140o.
Secondary movement is internal - external rotation of the tibia in relation to the femur,
but it is possible only when the knee is flexed.[26]
Arthrokinematics
Viewed in the sagittal plane, the femur's articulating surface is convex while the tibia's
in concave. Knee arthrokinematics is based on the rules of concavity and convexityand
is described in terms of open and closed chain:
Open kinetic chain - During knee extension, tibia glides anteriorly on femur. More
precisely, from 20o knee flexion to full extension, tibia rotates externally. During

25
knee flexion, tibia glides posteriorly on femur and from full knee extension to 20o
flexion, tibia rotates internally.
Closed kinetic chain - During knee extension, femur glides posteriorly on tibia. To be
more specific, from 20o knee flexion to full extension, femur rotates internally on stable
tibia. During knee flexion, femur glides anteriorly on tibia and from full knee extension
to 200 flexion, femur rotates externally on stable tibia.
The "screw home mechanism"
The "screw-home" mechanism, considered to be a key element to knee stability, is the

rotation between the tibia and femur. It occurs at the end of knee extension, between
full extension (0o) and 20o of knee flexion. The tibia rotates internally during the open
chain movements (swing phase) and externally during closed chain movements (stance
phase). External rotation occurs during the terminal degrees of knee extension and
results in tightening of both cruciate ligaments, which locks the knee. The tibia is then
in the position of maximal stability with respect to the femur.[27]
Knee Osteoarthritis is a multifactor degenerative disease, these factors range from

increased mechanical loading, breakdown of articular cartilage, bone development
and muscle impairments.
Varus alignment is associated with greater risk of developing tibiofemoral

osteoarthritis and increased medial OA progression.
Due to this varus direction, the knee joint is subject to higher mechanical stress on
the medial compartment. This also contributes to the degradation of the intra
articular cartilage.

26
The majority of the patients with knee osteoarthritis have joint laxity, this is the
loss of joint stabilization due to ligaments inability to counteract external
mechanical forces
Individuals with knee osteoarthritis have lower knee flexor/extensor muscle

strength.
This is shown in gait studies where individuals with osteoarthritic knees have lesser
knee flexion and higher knee adduction. [28]
Knee extensor muscles are vital for knee stabilization during joint loading and
consequent
movement.[29]
Abnormal joint mechanical stress causes the articular cartilage to degenerate

faster, and weak extensor muscles further increase the symptoms of knee
osteoarthritis.
The knee joint has motions such as sliding, rolling, gliding and rotation. The loss
of cartilage and reduction in the meniscus changes the joint alignments and
contributes to knee osteoarthritis.
In the process of knee osteoarthritis, the knee articular cartilage can go metabolic
disturbances where degenerative enzymes can be overexpressed.[30]
The chondrocytes release proteoglycans to balance the equilibrium and maintain

the surface of the articular cartilage. External trauma faced near the knee joint can
also cause intra articular fractures which may result in incongruent joint alignment.

27
This leads into an uneven load distribution and overall joint instability of the knee.
Individuals with weaker quadriceps lead to increased lower limb loading in normal
gait.
Individuals with occupations that lead to repetitive joint loading can lead to
degeneration of the articular cartilage and chondrocytes increasing the progression
of knee OA. .
Lastly, Individuals with damaged meniscus of the knee cartilage damage, and
change in alignment via exercise can cause cartilage degeneration.
Q Angle
The Quadriceps angle is formed between a line connecting the anterior superior iliac
spine (ASIS) to the midpoint of the patella & a line connecting the tibial tuberosity &
the midpoint of the patella. Normal value of Quadriceps angle is 12◦ -15◦ & 15◦ -18◦ in
male & female respectively. Quadriceps angle is more in female because of wider
pelvic, increased femoral anti-version & relative knee valgus.[31]
The Q- angle is widely used as an indicator of patellofemoral problems such as

patellofemoral pain syndrome.In patients with advanced OA of the knee, patellofemoral
degeneration at the joint frequently coexist with tibiofemoral OA. [32]
28
Measurement
The Q angle is formed between:
1. A line representing the resultant line of force of the quadriceps, made by

connecting a point near the ASIS to the mid-point of the Patella.
2. The Q angle can be measured in laying or standing. Standing is usually

more suitable, due to the normal weight-bearing forces being applied to the
knee joint as occurs during daily activity.
3. Traditionally, the Q angle has been measured with the knee at or near full
extension (but not hyperextension) with subjects in supine and the
quadriceps relaxed, as lateral forces on the patella may be more of a
problem in these circumstances.

29
Figure - 3.10 Q-angle
Figure- 3.11 Q-angle
Normative Values
A typical Q angle is 12 degrees for men and 17 degrees for women

30
3.4 Author’s studydescription

3.4.1Santhi Venkatapathy et did a study on the effect of Isometric Quadricep
Activation and Vastus Medialis Obliqus Strengthening in Decreasing Q-Angle among
Young Females and concluded that both isometrics quadriceps activation and VMO
strengthening reduced Q angle significantly and there was no difference between the
two procedures.[33]
3.4.2 Ayşe Aydemir EKİM et al 2017did a study on Relationship Between Q-Angle

and Articular Cartilage in Female Patients With Symptomatic Knee Osteoarthritis:
Ultrasonographic and Radiologic Evaluation and concluded thatHQ-angle was
associated with cartilage thickness measurements of the medial femoral condyle and
cartilage grading by ultrasonography and the Kellgren-Lawrence grading system in
patients with knee OA. [34]
3.4.3 Ved Prakash et al did a study on Correlation between Body Mass Index, Waist
Hip Ratio & Quadriceps Angle in Subjects with Primary Osteoarthritic Knee and
concluded that these 3 independent parameters as risk factors for primaryOA were also
a risk factors for the same interdependently.[35]
3.4.4 S.G. Sudhan 2018did a study on Relationship Of Muscle Strength And ‘Q’
Angle In Knee Osteoarthritis andConcluded that there is positive relationship between
muscle strength, Q angle and Osteoarthritis knee and negative relation between muscle
strength OA knees.[36]
3.4.5 .Shahnawaz Anwer et al 2014did a study onEffect of isometric quadriceps

exercise on muscle strength, pain and function in patients with knee osteoarthritis and
concluded that the 5 week of isometric quadriceps exercise program for patients with

31
knee OA showed beneficial effects on quadriceps muscle strength , pain and functional
disability. [37]
3.4.6 Laura H. Lathinghouse et al 2000 did a study on Effect of Isometric Quadriceps

Activation on q angle in Women Before and after Quadriceps Exercise and concluded
that Q angle decreases with IQA.[38]
3.4.7Varah Yuenyongviwat et al 2020 did a study on Effect of hip abductor

strengthening exercises in knee osteoarthritis: a randomized controlled trial and
concluded that either hip abductor exercises combined with quadriceps exercises or
quadriceps exercises alone could lessen patient pain and improve function. Adding
quadriceps exercises could expedite improvement of less pain, symptoms, activity in
daily living and quality of life faster than quadriceps exercises alone; however, this only
appeared to be over a 2–4 weeks period with small effect size, after which there was
there were no differences. Hence, considering to add hip abductor exercises in the
treatment protocol should be based on the patients and doctors perspective.[39]
3.4.8 Elizabeth A.Sled et aldid a study on Hip Abductor Muscle Strengthening In

Persons with Knee OA: Effect on Knee Joint Loading During Gait and concluded that
8 week home program of hip abductor muscle strengthening did not reduce knee joint
loading, but improved function , in a group of participants with medial knee OA.[40]
3.4.9 Kumar Mrityunjay et al 2014 did a study on Comparision between Effect of

Isometric Quadriceps Exercise and Vastus Medialis Oblique Strengthening on
Quadriceps Angle and Patellar Shift in Normal Individuals and concluded that VMO
strengthening is better than isometric quadriceps exercise in reducing the Q-angle and
lateral patellar shift in normal individuals. [41]

4. METHODOLOGY AND METHODS
4.1 Sample Size:

30 osteo arthritis patient between 50 to 65 years of age group participate in the
study.They will randomly divided into 2 groups. Group A (Experimental Group)
and Group B (Experimental Group) with each group having 15.
Subjects..The confidence level 95% and confidence interval 5% will be used to

calculate the sample size.Dehradun Census (Uttarakhand) population (6797970 in
2018) was included (census and sample survey,Dehradun 2018).This formula will be
used in this study.
4.2 Sampling Technique:

Simple random sampling technique will be used.
4.3 Sample Center:

Study will be conducted at Department of Physiotherapy, Shri Mahant Indiresh
Hospital Patel Nagar
4.4 Study duration:

Study will be completed in 8 weeks.
4.5 Study Groups:

Two groups will be included in the study.First group will be Group - A which include
VMO strengthening with Quadriceps Isometrics and other Group will be Group – B
which include VMO strengthening with Gluteus Medius Strengthening.
4.6 Sample selection:

Consist of inclusion and exclusion criteria:
4.6.1 Inclusion Criteria
1.Age Group 60-65 years
2.Both sex groups

33
3. Experienced symptoms for atleast 4 weeks or more

4.6.2 Exclusion Criteria
1.Recent Traumatic Injury
2.Recent Knee Fracture
3.Recent injury to hip
4.Past surgery
5.Lower Limb Deformity
6.Scoliosis
4.7 Variables of the study:

The independent variables are
Quadriceps Isometric
Vastus Medialis Oblique Strengthening
Gluteus Medius Strengthening
Quadriceps Isometric
Vastus Medialis Oblique Strengthening
Hip Abductor Gluteus Medius Strengthening
Dependent Variables are
Pain
Incorrect Q angle
Muscle Srength
4.8 OUTCOME MEASUREMENT
WOMAC
The Western Ontario and McMaster Universities Arthritis Index (WOMAC) is widely
used in the evaluation of Hip and Knee Osteoarthritis. It is a self-administered
questionnaire consisting of 24 items divided into 3 subscales:

34
1) Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing
upright
2) Stiffness (2 items): after first waking and later in the day
3)Physical Function (17 items): using stairs, rising from sitting, standing, bending,
walking, getting in / out of a car, shopping, putting on / taking off socks, rising from
bed, lying in bed, getting in / out of bath, sitting, getting on / off toilet, heavy domestic
duties, light domestic duties
4.9 Materials Used
Goniometer
Towel roll
Pen
Pillow
Socks
Data Collection sheet
Patient Consent Form

35
Figure - 4.1 Materials Used In The Study

36
Figure - 4.2 Materials Used In The Study

37
Figure - 4.3 Msterials Used In The Study

38
4.10 Procedure
30 patients between the age group of 50-65 years were included in the study after taking
a written consent from either the patient or their relative.Patient were made aware of
the research and the procedure to be followed.Patient were divided into two
groups.Each group consist of patients of both the gender.Group A received VMO
strengthening with Quadriceps Isometric Exercise and Group B received VMO
strengthening with Gluteus strengthening exercise.Both groups had received the
rehabilitative exercise program to normalize Q-angle in Knee Osteoarthritis.The study
was 8 weeks 6 days per week at department of Ortho in Shri Mahant ndresh Hospital,
physiottherapy OPD. Examination included assessment which was performed on first
and last day of treatment and data was recorded
Group A-VMO strengthening exercise with quadriceps isometric exercise
VMO strengthening Exercise.
Patients were instructed to lie in supine position with extended knee. Patients were
instructed to rotate their leg laterally.Maintain the position for 10 seconds and then
slowly lower the leg down. Relax and repeat the procedure for 10 times (Figure-A)
Quadriceps Isometric Exercise-Patient is in supine position with extended knee. A
rolled towel was placed under the knee. Next the patient was instructed to press the
towel hold iot for about 10 seconds and then relax. The procedure was repeated 10
times.(Figure-B)
Group B- VMO strengthening Exercise with Gluteus Medius Strengthening Exercise
VMO Strengthening Exercise
VMo strengthening exercise through squat with isometric hip adduction.(Figure- C)
Gluteus Medius Strengthening Exercise- Lie on one side with with bottom leg bent to
45 degree and the top leg straight.Stack the hips and shoulders directly on top of one
another.There is a strong tendency to roll the hips forwardor back here.engage the
gluteus medius to lift the upper leg towardsthe ceiling:squeeze and hold the top position
and then slowly lower the leg. (Figure- D)

39
Group A
Figure- 4.4 Patient Performing Quadriceps Isometric Exercise

40
Figure- 4.5 Patient Performing VMO strengthening Exercise
Group-B
Figure- 4.6 Patient Performing VMO Strengthening Exercise

41
4.METHODOLOGY AND METHODS
Figure – 4.7 Patient Performing Gluteus Medius Strengthening

42
5. DATA ANALYSIS
The chapter deals with statistical analysis of 1 outcome measure.that is WOMAC score
of individuals which was analyzed on day 1 , before the start of therapy and at the end
of 8 weeks.
Descriptive statistics is used for analysing data.In this we find mean and standard
deviation for comparing the data between two group
Paired T test is used to compare the pre and post treatment score of WOMAC scale
between group A and group B.
We also used paired T test for finding the significant difference between pre and post.

43
6. RESULT
The chapter deals with result of data analysis of data ofone outcome measure that is
WOMAC within group A and Group B.The score were analyzed and interpreted and
interpreted to determine which intervention is more effective in normalizing Q-angle in
patiernts with knee osteoarthritis.
The data were analyzed using statistical software SPSS 15 version. To analyze the
difference in the Womac scale between Group-A and Group-B, paired t- test was
used. The p values <0.0001 in both the groups showing extremely significant but the
Womac score in Group- A is more effective as compared to Group B
Table-1: Mean Difference in Womac Score between Group A &

Group B
Difference in Womac Group A Group B
Score
Mean 27.66 16.73
SD 2.79 5.81
t value 37.86 11.15
P value <o.ooo1 <0.0001
Table 6.1

44
6. RESULT
Figure- 6.1 Comparing mean pre and post of Group A

45
6. RESULT
Figure – 6.2 Comparing mean pre and post of

46
6. RESULT
MEAN DIFFERENCE
GROUP B
GROUP A
GROUP B
GROUP A
0 5 10 15 20 25 30
Fig. 6.3
Comparing mean difference of Group A and Group B

47
7. DISCUSSION
Osteoarthritis (OA) is a common disease associated with significant morbidity.This is

particularly apparent at the knee joint, one of the commonest sites to be affected. As
prevalence of OA increases with age and aging is associated with decreasing
physiological function, the combination has major health implications. Symptoms
cannot, however, be predicted merely by the degree of structural damage.The
quadriceps weakness commonly associated with osteoarthritis of the knee is widely
believed to result from disuse atrophy secondary to pain in the involved joint.
Osteoarthritis is degenerative joint disease. Commonly it is thought to be wear and tear
of joints as one ages.Two types of OA are recognized-primary and secondary.
1.Primary OA: It occurs in old age mainly in the weight bearing joints. 2.Secondary
OA: In this type ,there is an underlying primary disease of the joint which leads to
degeneration of the joint
The Q angle have shown to be increased in the OA knee,possibly as the degeneration

progresses and more pain and immobility could be aggravating factor.The Q angle of
knee is measurement of the angle between quadriceps muscle and Patella tendon and it
provides useful information about the alignment of knee joint. It is likely to be
influenced by the muscle strength of varying group of muscles that alter the mechanics
of knee other that Quadriceps alone. Gluteus Medius weakness is very common among
people above age 50 and more evident with obesity indicating the mechanics change in
the knee joint too.
The Western Ontario and McMaster Universities Arthritis Index (WOMAC) is widely
used in the evaluation of Hip and Knee Osteoarthritis. It is a self-administered
questionnaire consisting of 24 items divided into 3 subscales.
1) Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing
upright
2) Stiffness (2 items): after first waking and later in the day

48
7. DISCUSSION
3) Physical Function (17 items): using stairs, rising from sitting, standing, bending,
walking, getting in / out of a car, shopping, putting on / taking off socks, rising
from bed, lying in bed, getting in / out of bath, sitting, getting on / off toilet,
heavy domestic duties, light domestic duties WOMAC Index was developed in
1982 at Western Ontario and McMaster Universities.
Area of assessment of WOMAC are activities of daily living, functional mobility , gait
general health , quality of life.
The WOMAC takes approximately 12 minutes to complete.

The test questions are scored on a scale of 0-4 , which correspond to : None (0) , Mild
(1), Moderate (2) , Severe (3), and Extreme (4)
The scores for each subscale are summed up , with a possible score range of 0-20 for
Pain , 0-8 for Stiffness , and 0-68 for physical function
High scores on the WOMAC indicate worse pain , stiffness , and functional limitations.
The WOMAC Index has been used extensively in clinical trials.
WOMAC Index can be a useful screening tool for people at risk for Osteoarthritis and
will help in identifying the disease early.
Isometrics quadriceps exercise strengthen the quads by contracting the muscle.

Vastus Medialis Oblique Strengthening is important in knee rehabilitation as it helps
control the position of patella

49
7. DISCUSSION
Gluteus Medius weakness cause knee pain. Gluteus Medius is weak in patients with
knee osteoarthritis. Gluteus Medius weakness is very common among people above age
50 and more evident with obesity indicating the mechanics change in the knee joint too.
Strengthening gluteus medius helps in reducing knee pain in patients with knee
osteoarthritis.
VMO strengthening with quadriceps isometrics along with stretching is more effective
according to WOMAC.
Supported by Santhi Venkatapathy et al there is significant change in post intervention

in group a p value is less than less than 0.05 which approved that VMO strengthening
with quadriceps isometrics along with stretching is more effective according to
WOMAC.
The improvement was seen after 8 weeks but continued improvement was not
found.The group B show non significant result of P > 0.05.In this group VMO with
gluteus medius strengthening was given to the patient and shows non significant result
after 8 weeks when compared to preintervention score this states that VMO
strengthening with gluteus medius strengthening are not sufficient outcome clinically
this study demonstrated that VMO strengthening with Quadriceps isometrics with
stretching as treatment tool improvement was seen in normalizing Q-angle in
Ostearthritis.

50
8. LIMITATION OF STUDY
The duration of study was only 8 weeks so further progressive long term benefit could
not be recorded whom exercise was prescribed to the patient.
Proper follow up would not be done due to Covid-19

51
9. FUTURE OF STUDY
Study can be done on larger population. Further study can be done to check to compare
the effect of VMO strengthening with quadriceps isometric exercise versus VMO
strengthening with Gluteus Medius strengthening exercise to normalize Q- angle in
The exact mechanism of incorrect Q- angle in knee osteoarthritis and the muscle
weakness affecting Q-angle in knee osteoarthritis can be studied in more detail
The duration of the study can be increased further studies are recommended to minimize
these limitation in search way that larger sample size that included various age group
of people are studied..Various outcome measure can be used to record the pain.

52
10. CONCLUSION
The study provided evidence to support the use of VMO strengthening exercise with
quadriceps isometric and VMO strengthening with gluteus medius strengthening
exercise to normalize Q-angle in patients with knee osteoarthritis.
In conclusionVMO strengthening exercise with quadriceps isometrics was found to be

effective in normalizing Q- angle in patients with knee osteoarthritis.
When VMO strengthening exercise and quadriceps isometrics exercise is administered

to patients suffering from knee osteoarthritis with affected Q-angle over a period of
8weeks it result in normalizing Q-angle in patients with knee Osteoarthritis

53
11. BIBLIOGRAPHY
1. Kelgren JH, Lawrence JS, Osteoarthrosis and disk degeneration in an urban

population. Ann Rheum Dis 1958 ; 388-96
2. Anna Latwice et al Epidemiology and Burden of Osteoarthritis.
3. Dr.Dany Tong, October 23 2010 Higher Q-angle in women increases chances of
having knee pain.
4. Shahnaz Anwar Ahmed 2014 26:745-748 A study on the effect of Isometric
Quadriceps exercise on muscle strength pain and functions in patients with Knee
Osteoarthritis : A randomized control study
5. Presswood Laura et al vol 30 2008 Gluteus Medius Applied banatomy,
dysfunction,assessment and progressive strengthening.
6. Santhi Venkatapathy et al A study on the effect of Isometric Quadriceps Activation
and Vastus Medialis Oblique Strengthening in Decreasing Q-angle among Young
Females.
7. Hunter Hsu et al June 29, 2020. Knee Osteoarthritis and its background
8. Doug Caylor et al June 13 2021 The Relationship between Quadriceps Angle and
Anterior Knee Pain syndrome
9. Zhang W , Moskowitz et al 2008:16:137-62 Recommendations for the management
of hip and knee Osteoarthritis.
10. David Spitaels et al 2020 Epidemiology of knee osteoarthritis in general practice: a
registry-based study
11. Behzad Heidari ; 2011; 2(2) : 205-212 Knee Osteoarthritis Prevalence , risk factors
pathogenesis and features : Part I
12. Jean Pierre et al 2013 4 (3) : 219-226 Total Knee Replacement as Knee
Osteoarthritis Outcome
13. David J Hunter et al 2006 693-642 Osteoarthritis and its Management
14. Lendghar Priti G et al 2278-0505 Correlation of Quadriceps Angle With Foot
Position in knee osteoarthritis.
15. Heiderscheit BC et al 1999;31;1313-9 Q-angle influences on the the variability of
lower extremity coordination during runing

54
16. Physio,co.uk definition of strengthening exercise

17. Prathap Kumar et al Healthy Gait : Healthy Gait Review of Anatomy and
Physiology of Knee Joint
18. Hughston JC (2003). Acute injuries in athelets. Clinorthop. 114: 2962-67
19. Johnston SA (1997). Osteoarthritis. Joint anatomy, physiology, and pathobiology.
Vet Clin North Am Small Anim Pract. 27(4):699–723.
20. Hughston JC et al (1976). Classification of knee ligament instabilities: The medial
compartment and cruciate ligaments. J Bone Joint Surg. 58:159-72
21. Hughston JC et al (1980). Acute tears of the posterior cruciate ligament. J Bone
Joint Surg. 62: 438-50
22. Hughston JC et al (1976). Classification of knee ligament instabilities: The lateral
compartment. J Bone Joint Surg. 58: 173-79
23. Andrish J (1996). Meniscal injuries in children and adolescents: diagnosis and
management. J Am AcadOrthopSurg. 4: 231–37.
24. Kakarlapudi TK , Bickerstaff DR (2001)174 (4):266-72.Knee instability. West J
Med.
25. Moore KL et al 2013 P634 Clinically oriented anatomy
26. Ombregt L 2013 P 262-269 A system of orthopaedic medicine
27. Ha Yong Kim et al 2015 7 (3):303-309 Screw Home Movement of Tibiofemoral
Joint during normal Gait : Three Dimensional Analysis
28. Guilak F 2011; 25 (6) : 815-23 Biomechanical Factors in Osteoarthritis
29. Juhl C.B. et al 2015 ; 1; 23 (2) : 171-7 Knee extensor muscle weakness is a risk
factor for development of Knee Osteoarthritis. A systemic review and meta analysis
30. Wilson J A et al 2011;1;19(2) : 186-93 The association between Knee joint
biomechanics and neuromuscular control and Moderate knee Osteoarthtritis
radiographic and pain severity
31. Raveendranath Veeramani 2015 The Quadriceps Angle in Indian Men And Women
32. Mohammad Jafar Emami et al 2007 Q-angle an invaluable parameter for evaluation
of anterior knee pain.

55
33. Santhi Venkatapathy , Rajesh Bhargavan A Study on the Effect of Isometric

Quadriceps Activation and Vastus Medialis Obliqus Strengthening in Decreasing
Q- Angle among Young Females.
34. Aysye Aydemir EKIM et al 2017 32;347-352 Relationship Between Q-Angle and
Articular Cartilage in Female Patients With Symptomatic Knee Arthritis
:Ultrasonographic and Radiologic Evaluation
35. Ved Prakash et al 2017 Vol.7 Correlation between Body mass index, Waist Hip
Ratio and Quadriceps Angle in Subjects with Primary Osteoarthritis of Knee
36. S.G. Sudhan 2018 volume1 Relationship of muscle strength and Q angle in Knee
Osteoarthritis.
37. Shahnaz Anwar Ahmed 2014 26:745-748 A study on the effect of Isometric
Quadriceps exercise on muscle strength pain and functions in patients with Knee
Osteoarthritis : A randomized control study
38. Laura H. Lathinghouse , Mark H. trimble 2000;30 (4) : 211-216 Effects of
Isometricv Quadriceps Activation on the Q-Angle in Women Before and After
Quadriceps Exercise
39. Varah Yuenyongviwat et al 2020 21:284 Effect of Hip Abductor Strengthening
Exercise in Knee Osteoarthritis : A randomized controlled trial
40. Elizabeth A. Sled et al 2018 volume 93 HIP abductor Muscle strengthening in
Persons with Knee Osteoarthritis : Effect on Knee Joint Loading During Gait
41. Kumar Mrityunjay , Deepak Chhabra 2014 Comparision Between Effect of
Isometric Quadriceps Exercise And Vastus Medialis Oblique Strengthening on
Quadriceps Angle and Patellar Shift in Normal Individuals.
42. Murray CJ, Lopez AD: 1997 The global burden of disease. Geneva: World Health
Organization.
43. Kenton R. Kaufmana, et al; 34 (2001); page- 907 Gait characteristics of patients
with knee osteoarthritis; Journal of Biomechanics.

56
44. Pelland L et al , 2004;9: 77–108.Efficacy of strengthening exercises for

osteoarthritis (Part I): a meta-analysis.
45. Qi Li et al Case-control study on the relationship between body mass index and
lower limb alignment of patients with knee osteoarthritis.
46. Roy Davis Altman, MD Early Management of Osteoarthritis
47. Henning Bliddal Robin Christensen 2009 1793-1804 The treatment and prevention
of knee osteoarthritis: a tool for clinical decision-making.
48. Sunil Singh Thapa et al 2018 Relationship of Quadriceps angle and anterior knee
pain
49. Rana S.Hinman et al 2010 volume 62 1190-1193 Hip Muscle Weakness in
Individuals With Medial Knee Osteoarthritis
50. Knee Joint Biomechanics in Physiological Conditions and How Pathologies Can
Affect It: A Systematic Review
.
51. E.Jayakanthan et al 2018 volume 2- A correlation between leg heel alignment Tibial
torsion and Q-angle among ideal Overweight and obese individual.
52. Simisola Ajeyalemi et al Biomechanical considerstion in long term management of
knee Osteoarthritis.
53. Simeon Grazio 2009;131(1-2):22-6.Obesity: risk factor and predictor of
osteoarthritis
54. Ajedirani I Bello et al 2015 The influence of body mass index Q-angle and
Tibiofemoral Alignment on clinical deficits of osteoarthritis of knee
55. Eun-Kyung Kim The effect of Gluteus Medius Strengthening on Knee Joint
Function score and pain in meniscal surgery patients
56. JefreyA.Danso et al 2015 The Influence of body msass index , Q-angle and
Tibiofemoral Alignment On the clinical deficits of Knee Osteoathritis.

57

ANNEXURE 1
CONSENT FORM
I Jigyasa Juyal pursuing Master of Physiotherapy at SMIH, Dehradun, Uttarakhand
would like to invite you to participate in my study entitle “To Compare the effect of
VMO strengthening With Quadriceps Isometric Exercise Versus VMO
strengthening with Gluteus medius strengthening Exercise To Normalize Q -angle
in Patients with Knee Osteoarthritis”
The purpose of the study is to normalize Q- angle in patients with knee
Osteorhritis.Every possible step should be taken to minimize any risk. There is no risk
involved in the study as the inclusion criteria of the study selects only if you are eligible
according to inclusion criteria. Your blindfolded photograph will be taken for the
research purpose. You have the right to withdraw from the research at any stage if you
are uncomfortable with the procedure. All the information about you will be kept
confidential and limited to my research guide Dr. Anirban Patra and co-guide Dr.
Shama it will not be shared with any other persons.
I ............................................................................. voluntarily agree to participate in the
study andtotally
aware of outcomes of study. I understood the procedure in my mother language and
therefore give consent to use data in form of photograph and personal data for research
purpose. My entire questions have been satisfactorily answered at any point of time
without assigning any reason.
The researcher is compelled to answer the question that I might have about the study
and about my rights as a participant of the study if any further communication is
required.
I have read the above instructions and I understood it and signing in front of my
physiotherapist and her guide.
Signature of the participant/relatives Signature (Researcher)

Name Jigyasa Juyal
Address MPT 2ndyear
Date (Musculoskeletal)

58
ANNEXURE II
PHYSIOTHERAPY ASSESSMENT CHART SUBJECTIVE EXAMINATION
*PERSONAL DATA
1)NAME:
2)AGE:
3)GENDER:
4)ADDRESS:
5)OCCUPATION:
6)DOMAIN:
7)BMI:
8 )CHIEF COMPLAINT-i)SYMPTOMS
ii)LOCATION
iii)DURATION
*HISTORY
1)PRESRENT HISTORY:
2)PAIN HISTORY:
3)DRUG HISTORY:
4)SURGICAL HISTORY:
5)PERSONAL HISTORY:
6)FAMILY HISTORY:
7)PSYCHOLOGICAL HISTORY:
8)ENVIRONMENTAL HISTORY:
ASSOCIATED HISTORY:

59
PAIN HISTORY
SITE:
SIDE:
ONSET:
DURATION:
TYPE:
NATURE:
FREQUENCY:
AGGRAATING FACTOR:
RELIEVING FACTOR:
I INTENSITY (VISUAL ANALOGUE SCALE)
0 -10
VITAL SIGN
TEMPERATURE
BLOOD PRESSURE
OBJECTIVE EXAMINATION ON OBSERVATION
POSTURE
ATTITUDE OF LIMB
SWELLING
BONY CONTOURS
DEFORMITIES

60
ON PALLPATION
WARMTH
TENDERNESS
EDEMA
PULSE
TRIGGER POINTS
ON EXAMINATION
MMT:
RANGE OF MOTION
END FEEL
MUSCLE GIRTH
POSTURE
GAIT
FUNCTIONAL ASSESSMENT

61
ANNEXURE III
DATA ASSESSMENT FORM
NAME - AGE-
SEX- D.O.A
GROUP-
PARAMETERS PRE -TREATMENT POST TREATMENT

SCORE SCORE(AFTER 8 WEEKS
OF INTERVENTION)

62
ANNEXURE IV (i)
MASTER CHART
GROUP-A
SNO. AGE SEX WOMACSCALE

PRE POST
1 61 F 43 15
2 50 F 27 6
3 54 F 33 3
4 57 F 33 7
5 56 M 30 5
6 52 F 28 2
7 59 F 46 17
8 62 F 49 18
9 60 F 40 16
10 61 F 51 23
11 59 M 35 5
12 63 F 42 15
13 60 F 28 3
14 64 F 46 16
15 65 F 48 19

63
ANNEXURE IV (II)
MASTER CHART GROUP B
SNO. AGE SEX WOMAC SCALE

PRE POST
1 60 F 46 31
2 59 F 47 28
3 55 F 42 24
4 51 F 49 33
5 54 M 46 22
6 59 F 56 34
7 60 F 43 28
8 61 F 49 33
9 65 F 51 36
10 65 F 56 41
11 60 M 53 37
12 65 F 49 34
13 63 F 42 24
14 60 F 45 32
15 65 F 47 33

64
ANNEXURE V
WOMAC SCALE
Scores of WOMAC Scale are

0-none,
1-slight,
2-Moderate
3-Very
4-Extremely
Pain
1.walking 0 1 2 3 4
2.Stair Climbing0 1 2 3 4
3.Nocturnal0 1 2 3 4
4.Rest0 1 2 3 4
5 Weight Bearing0 1 2 3 4

65
Stiffness
1.Morning Stiffnes 0 1 2 3 4
2.Stiffness occur later in the day 0 1 2 3 4
Physical function
1.Descending Stairs 0 1 2 3 4
2.Ascending Stairs 0 1 2 3 4
3.Rising From Sitting standing 0 1 2 3 4
4.Standing 0 1 2 3 4
5.Bending to floor 0 1 2 3 4
6.Walking on flat surface 0 1 2 3 4
7.Putting on socks 0 1 2 3 4
8.Sitting 0 1 2 3 4

66

Jigayasa Thesis Final Completed

Uploaded by

Copyright:

Available Formats

You might also like

Jigayasa Thesis Final Completed

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Jigayasa Thesis Final Completed

Uploaded by

Copyright:

Available Formats

MPT (Musculoskeletal)

Isometric quadriceps exercise program showed beneficial effects on quadriceps muscle

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

Both Quadriceps isometric and VMO strengthening are effective in decreasing

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

Figure-1.1 knee With Osteoarthritis

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

1.1 Background of study

Q- angle-The Q angle of knee is measurement of the angle between quadriceps muscle

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

Possible Causes of Secondary Knee OA

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

b) Chondroprotective agents : Agents such as Glucosamine Chondroitin sulphate have

c)Surgical Treatment : In selected cases surgery can provide significant relief.

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

( iii) Joint Debridement

(iv) Arthroscopic Procedure-knee arthroscopy is a surgical procedure that allows

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

Operational definition of Q angleThe quadriceps angle, or Q-angle, is defined as the

Operational definition of Strengthening ExerciseStrengthening exercises are

1.6 Aim of study:

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

The muscle strength affects Q angle variation of osteoarthritis of knee.

1.8 Purpose ofstudy

The importance of muscle strengthening is to treat Q angle in patients with knee

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

The research will be done on VMO strengthening exercise combined with

Plan of work is as follows

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

FLOW CHART OF PLAN OF WORK

VMO strengthening combined With VMO Strengthening combined With

Pretest score based on outcome

VMO strengthening combined with VMO Strengthening combined with

Post test evaluation based on outcome measure

Figure 2.1 Flow Chart of plan of work

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

Searched were performed for studies published in English in electronic databases,

keyword used to search the literature are ,Osteoarthritis, Q-angle , quadriceps

Search engine No of articles No of relevant No of selectedarticle

Table: 3.1: Search Strategy

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

3.2 ANATOMY OF KNEE JOINT

Osteoarthritis results from a complex interaction of biochemical and biomechanical

Anatomic organization and stabilizing factors of the knee Joint

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

Figure - 3.1 Anatomic Stabilization of Knee Joint

Figure-3.2 Knee Joint

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

The extensor compartment muscle, the quadriceps femoris provides a greater

The Injuries to the menisci are recognized as a cause of significant musculoskeletal

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

degeneration, joint space narrowing, and symptomatic osteoarthritis (OA)

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

Figure-3.3 Ligaments And Meniscus Of Knee Joint

TO COMPARE THE EFFECTS OF VMO STRENGTHENING EXERCISE WITH QUADRICEPS ISOMETRIC

Figure - 3.4 Knee Joint Articulating Surface