EFFECTIVENESS OF KNEE PROPRIOCEPTIVE

EXERCISES AMONG OBESE MIDDLECLASS

HOUSEWIVES WITH IMPAIRMENT IN KNEE
PROPRIOCEPTION

STUDENT : Mr. PRAKASH.V

REGISTER NUMBER: RA1921001010090
GUIDE : Mrs. K. JOTHI PRASANNA, MPT
ADVANCED PT IN ORTHOPAEDICS

In partial fulfillment of the requirement for the Degree of

BACHELOR OF PHYSIOTHERAPY
June -2023
A Project submitted to
SRM COLLEGE OF PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
SRM Nagar, Kattankulathur,
Chengalpattu District – 603203
Tamil Nadu, India.
EFFECTIVENESS OF KNEE PROPRIOCEPTIVE
EXERCISES AMONG OBESE MIDDLECLASS
HOUSEWIVES WITH IMPAIRMENT IN KNEE
PROPRIOCEPTION

INTERNAL EXAMINER:

Name _______________________

Signature with date _______________________

EXTERNAL EXAMINER:

Name _______________________

Signature with date ________________________

In partial fulfillment of the requirement for the Degree of

BACHELOR OF PHYSIOTHERAPY
June -2023
A Project submitted to
SRM COLLEGE OF PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
SRM Nagar, Kattankulathur,
Chengalpattu District – 603203
Tamil Nadu, India.
 SRM COLLEGE OF PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
SRM Nagar, Kattankulathur – 603203
Chengalpattu (Dt), Tamil Nadu, India.
044- 27456729/ www.srmist.edu.in

CERTIFICATE

This is to certify that Mr. PRAKASH.V, REGISTER NO. RA1921001010090 has

satisfactorily completed his project on the topic “EFFECTIVENESS OF KNEE

PROPRIOCEPTIVE EXERCISES AMONG OBESE MIDDLECLASS

HOUSEWIVES WITH IMPAIRMENT IN KNEE PROPRIOCEPTION”. This

project is submitted towards partial fulfillment of Degree of BACHELOR OF

PHYSIOTHERAPY Examination, JUNE – 2023.

OFFICIAL SEAL WITH DATE DEAN

 SRM COLLEGE OF PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
SRM Nagar, Kattankulathur – 603203
Chengalpattu (Dt), Tamil Nadu, India.
044- 27456729/ www.srmist.edu.in

DECLARATION BY THE STUDENT

I hereby declare that this project entitled “EFFECTIVENESS OF KNEE

PROPRIOCEPTIVE EXERCISES AMONG OBESE MIDDLECLASS
HOUSEWIVES WITH IMPAIRMENT IN KNEE PROPRIOCEPTION” is a
bonafide and genuine research work carried out by me under the guidance of Mrs. K.
JOTHI PRASANNA, MPT, ASSISTANT PROFESSOR.

SIGNATURE OF THE STUDENT

CERTIFICATE BY THE GUIDE

This is to certify that the project entitled “EFFECTIVENESS OF KNEE

PROPRIOCEPTIVE EXERCISES AMONG OBESE MIDDLECLASS
HOUSEWIVES WITH IMPAIRMENT IN KNEE PROPRIOCEPTION” is a
bonafide research work done by Mr. PRAKASH.V, RA1921001010090 towards
partial fulfillment of the requirement for the Degree of BACHELOR OF
PHYSIOTHERAPY.

DATE: SIGNATURE OF THE GUIDE

PLACE:
 ACKNOWLEDGEMENT

First and foremost, I would like to thank the almighty, who showed his blessings
in all walks of my life.

I submit my Heartful thanks to Prof. T.S. VEERAGOUDHAMAN, MPT.,

M.S.W., DEAN I/c for the valuable advice and guidance towards this work.

I would like to thank Mr. T.N. SURESH, M.P.T., VICE PRINCIPAL, for
helping me with my project work.

I am highly indebted to my guide Mrs. K. JOTHI PRASANNA, M.P.T.,

ASSISTANT PROFESSOR, who took her real personal interest in providing me
proper guidance, encouragement and support at all levels.

I thank my class Coordinator Mrs. G. YASMEEN IMTIAZ, M.P.T.,

ASSISTANT PROFESSOR, who with all patience gave me helping hands whenever
I needed.

My grateful thanks to all my subject Staff, who contributed their time and energy
in this project.

I also thank the subjects who have given their consent for participating in my
study and co-operating till the procedure has been completed.

My entire effort stands credited at this moment only because of my family who
whole heartedly stood beside me always in each step of my career.

Last but not least, I would like to thank all my Friends for their valuable
suggestions and support in the completion of my project.

I DEDICATE THIS PROJECT TO MY MOTHER

 ABSTRACT

BACKGROUND: The perception of one’s own motion and body location is known as
proprioception. Age, obesity, sedentary behavior, and other factors can all have an
impact on joint position sense. Many research have proved that obesity plays major role
in impairment of proprioception. The knee joint is the body’s most vulnerable to this
injury of all the joints. OBJECTIVE: To find out the effectiveness of knee
proprioceptive exercises among obese middle-class housewives with impairment in
knee proprioception. METHODS: It is a Quasi-experimental study of pre and post type
performed among 44 obese housewives with knee joint proprioceptive impairment
selected through convenient sampling of age group 20 – 35 years, socioeconomic status
– middleclass, BMI ≥ 25 Kg/m2 and participants with measurement angle error > 0.4 in
objective joint position sense test. The selected group is treated with an 8-week knee
joint proprioceptive exercises to see if there is any effect. OUTCOME MEASURE:
Objective joint position sense (OJPS) test. RESULTS: The result shows that there is a
significant improvement in joint position sense in the post test (5.29 ± 1.11) when
compared with the pre-test (3.27 ± 1.14), p value is 0.000, regarding the mean absolute
angle error for the experimental group. CONCLUSION: The study concluded that the
proprioceptive exercise is an effective treatment approach for improving the joint
position sense among obese middleclass housewives with impairment in knee
proprioception.

KEYWORDS: Knee proprioception, Obesity, Middleclass housewives,

Proprioceptive exercises, Objective joint position sense test.
 INDEX

S.NO CONTENTS PAGE NO.

1. INTRODUCTION 1

2. REVIEW OF LITERATURE 6

3. METHODS 8

4. DATA ANALYSIS 15

5. RESULTS 19

6. DISCUSSION 20

7. CONCLUSION 23

8. LIMITATIONS AND RECOMMENDATIONS 24

9. REFERENCES 25

10. ANNEXURES 27
 INTRODUCTION

One of the major health problems whose incidence is rising at an alarming rate
is obesity. People with obesity is most likely to develop major chronic diseases such as
diabetes mellitus, coronary heart diseases, chronic obstructive pulmonary disease, and
other musculoskeletal condition.1

Presently, there is a rapid increase in the incidence and co-morbidities of obesity

in India. Between 1980 and 2014, the prevalence of obesity, worldwide is more than
doubled. About 300 billion are clinically obese according to the report presented by
WHO on global epidemic.2

Since 1975, the prevalence of overweight and obesity has tripled globally. The
World Health Organization (WHO) reports that in 2016, among persons ages 18 and
older, 39% were overweight and 13% were obese.

In India, the incidence and co-morbidities of obesity are currently rapidly rising.
The prevalence of obesity more than doubled between 1980 and 2014. According to the
report on the worldwide epidemic that the WHO provided, around 300 billion people
are clinically obese. According to recent surveys, 650 million persons were obese and
1.9 billion adults are overweight. More women than men are impacted.

The World Health Organization defines obesity as having a body mass index
(BMI) greater than 30 kg/m2, and overweight as having a BMI between 25 and 30
kg/m2. These definitions are used in the "2013 AHA [American Heart
Association]/ACC [American College of Cardiology]/TOS [The Obesity Society]
Guideline for the Management of Overweight and Obesity in Adults.

Overall, obesity can be viewed as a chronic, relapsing, and progressive disease

as well as a major cause of mortality worldwide. 8

1.9 billion adults are overweight and 650 million were obese according to
recent studies. Women are affected higher than men.3

Both in stationery (static limb position sense) and in movement

(kinesthesia)humans are aware of the position of the limbs. The major role of the static
and dynamic stabilizers is to provide support in a normal healthy knee joint.

1
 Apart from that these static stabilizers, which includes ligaments, meniscus and
the joint capsule helps in determining the joint position and motion. The receptors
present in the capsuloligamentous structure sends sensory afferent feedback which
projects directly to the reflex and cortical pathway. 4

Proprioceptors is a type of mechanoreceptors which is in skin, muscle, tendon,

ligament, and joint capsule. Postural control is maintained by sensorimotor system,
proprioception is one of the important components of this system.2

Vision, vestibular and proprioception plays an important role in postural

stability and control. Conscious sensation (muscle sense), total posture (postural
equilibrium), and segmental posture (joint stability) is contributed by the sensory
feedback provided by the proprioception.5

In muscle, there are two proprioceptors, the muscle spindle, and the Golgi
tendon organs. In which, the muscle spindle is mainly concerned with sensing muscle
length, whereas the Golgi tendon organs is responsible for sensing muscle tension.
Whenever there is a movement, the proprioceptors send the degree, rate, and amount of
stretch and contractile force of muscle to the central nervous system (CNS). The CNS
integrates this sensory input with other inputs provided by the peripheral
mechanoreceptors, i.e., from visual and vestibular receptors, to generate a motor
response.6

Coordinated movements such as reaching, grasping, maintenance of static

balance and locomotion is generated by the help of proprioception. There may be a
defect in goal directed movements, prehension, accurate aiming tracking movement, if
proprioception is impaired.2

Proprioception can be defined as the sense of position i.e., a person’s awareness

of the position of their own limb and the orientation of their body parts with respect to
one another. It can also be defined as the sense of movement i.e., the ability to perceive
both the direction and velocity of a movement. Proprioception also can sense the force
i.e., to determine the amount of force required to do the movement 7.One of the
modifiable risk factors for knee osteoarthritis (OA) is obesity. One of the major causes
of OA knee is overstressing the joint which may trigger the cartilage breakdown. The
proprioceptive impairment is seen more in OA knee patients than in normal peers.1

2
 Many studies had proved that proprioception is impaired in individuals with
obesity. Because in obesity, there an overloading in the knee joint, which affects the
proprioceptors which is present in the knee joint which may lead to postural stability
and displacement of center of pressure (COP). 8

Housewives within the age 30- 45 years, belonging to middleclass are mostly
obese. Less household, less physical activity and more sedentary lifestyle is the major
cause for their obesity.9

The proprioception can be improved by retrain the altered afferent pathway by

providing a therapeutic exercise protocol which facilitated the dynamic stabilizers by
incorporating the sensory input.10

Closed chain exercises are preferred more than open chain exercises to improve
proprioception. These closed chain exercise must be performed in various positions
because for different joint positions, there are different afferent responses. 11

The proprioceptive exercises are based on the principle that while doing a
balance-keeping exercises, proprioceptive respos4es occur. These responses adjust the
length and tension of the muscles as well as the position of the joints to facilitate joint
movements.12

Obese boys showed a deficit in proprioception in knee flexion, similarly obese

individual manifested poorer proprioception in knee extension movement and weight
bearing exercises are associated with a better proprioceptive acuity in obese
individual.13

Proprioceptive exercises cause decrease in pain and improvement of

proprioception and functional status in benign joint hypermobility syndrome 14. A
sensorimotor proprioceptive training exercise improved the patient’s proprioception in
knee joint and their self-reported function among osteoarthritis patient.15

Housewives within the age of 30 – 45 years has high prevalence of obese. 9

Therefore, this study checks whether the knee proprioceptive exercises have any effects
on obese middleclass housewives.

3
AIM OF THE STUDY

To find out the effectiveness of knee proprioceptive exercises among obese

middle-class housewives with impairment in knee proprioception.

NEED OF THE STUDY

Overweight is an initial stage of the obesity. Due to increase in weight, joint

proprioception gets affected. A study proves that there is a high prevalence of joint
proprioceptive impairment in knee joint among obese middleclass housewives (90%)
within 30-45 years.3 Several other studies found that knee proprioceptive exercises
improve proprioception among individuals with knee osteoarthritis, benign joint
hypermobility syndrome11,12. Hence the study has been formulated to find out effect of
the knee proprioceptive exercises on obese middleclass housewives with impaired joint
position sense. This study is linked with the third Sustainable Development Goal(SDG)
to transform the World ie, Good health and wellness of human beings.

4
HYPOTHESIS
NULL HYPOTHESIS
There is no significant effect of knee proprioceptive exercises on obese
middleclass housewives.

ALTERNATE HYPOTHESIS
There is a significant effect of knee proprioceptive exercises on obese
middleclass housewives.

5
 REVIEW OF LITERATURE
John Dick Fleming et al. (2021) stated that Compared to a healthy individual, knee
proprioception is continuously impaired 6–24 months after surgical treatment of ACL
tears.

Meredith Chaput et al. (2021) stated that after an ACL reconstruction, visual
cognition may serve as a compensatory technique to maintain knee proprioception and
dynamic stability by increased sensory integration neuronal activity.

Marco Bravi et al. (2021) revealed that patients with OA knees who undergone TKA
tend to benefit from improved knee proprioception regardless of whether the PCL is
retained or sacrificed.

Oday Al-Dadahet et al. (2020) concluded that despite having a healthy ACL and
menisci, patients with chondral injuries have a clearly visible proprioceptive deficit.

Jiajia ye et al. (2020) recommended that regular baduanji quigong practice assisted
older persons with knee osteoarthritis in reducing pain, stiffness, and functional
impairment as well as improving knee joint proprioception and postural stability.

Nabeela Nazish et al. (2020) concluded that working women and housewives both
have an increased risk of developing musculoskeletal discomfort, moreover housewives
are more prone to shoulder pain compared to working women.

Defne Kaya et al. (2019) recommended that a neuromuscular control training program
is effective in improving knee proprioception compared to a standard ACL-R program.

Marieke L.A. Landsmeer et al. (2019) stated that readily accessible variables
somewhat enhanced the ability to predict symptomatic knee osteoarthritis and frequent
knee discomfort beyond age and BMI.

Raana Alikhani et al. (2019) recommended that six weeks of plyometric training (PT)
improves dynamic balance and proprioception significantly among female badminton
players.

Neha.V.Jagtap et al. (2018) concluded that knee proprioception is compromised in

overweight middle-class housewives aged between 30 to 45 years of age.

6
Rajeev Ahirivar et al. (2018) stated that south India and the urban population both
have higher socioeconomic position and a higher prevalence of obesity. Obesity
prevalence has increased dramatically between 1998 and 2018 because of sedentary
lifestyles and a diet high in calories.

Marwa S.M Saleh et al. (2017) concluded obese prepubertal children shows impaired
proprioception in the knee joint, which may be an important cause of the impaired
postural control ability in obese children.

Rui Torres et al. (2017) concluded that athletes with patellar tendon syndrome have
reduced perception of force signals necessary for body weight discrimination.

Hajar Moravveji et al. (2016) concluded that Obese grasp showed deficits in
proprioceptive function during knee extension movement compared with athletes and
non-athlete non-obese groups.

Manjula et al. (2016) concluded that sitting for long periods of time affects knee joint
position sense in both men and women with sedentary jobs with the same job nature,
and knee proprioceptive quality may be significantly better in non-sedentary active
individuals.

Carlen Reyes et al. (2016) found that with a rising BMI, the risk of hand and knee
osteoarthritis rises for both overweight and obese people, notably for the latter.

Huihui Wang et al. (2016) concluded that at different knee angles, the correlation
differs among proprioception, force sense, quadriceps strength, the quadriceps /
hamstring ratio, and balance.

Sung-Bum Ju et al. (2015) recommended that 8-weeks of proprioceptive circuit

training is an effective way to strengthen knee joint muscle function and reduce pain in
patients with knee osteoarthritis.

Kanchan Bandopadhyay et al. (2015) proves that urban housewives have a more
comfortable life than rural housewives, and rural housewives also had less leisure time
due to household work.

Dilek B et al. (2015) recommended that proprioceptive exercises in patients with

subacromial impingement syndrome provide better proprioceptive acuity, but no other
additional positive effect on other clinical parameters have been observed.

7
 METHODS

STUDY DESIGN : Quasi-Experimental study

STUDY TYPE : Pre and post type

SAMPLING METHOD : Convenient sampling

SAMPLE SIZE : 44 subjects

STUDY SETTING : In and around Chennai

STUDY DURATION : 8 Weeks

INCLUSION CRITERIA

Age: 25 – 40 years.

Socioeconomic status - Middle class (according to kuppusamyscale – score

should be between 11 to 25).

Obese housewives - BMI ≥25 Kg/m2. (For Asian Indian population)14

Participants with measurement angle error > 0.4 in OJPS test in their dominant

leg.

EXCLUSION CRITERIA

Known case of Knee osteoarthritis

Known case of Diabetes mellites

Known case of Hypertension

Any other musculoskeletal injuries in lower limb.

8
MATERIALS USED IN THE STUDY

 Couch
 Chair
 Towels
 Long arm goniometer

FIGURE 1: COUCH FIGURE 2: CHAIR

FIGURE 3: TOWEL FIGURE 4: LONG ARM GONIOMETER

9
PROCEDURE:

Institutional ethical Committee (IEC) of SRM Medical College Hospital and

Research Centre approved the study with IEC clearance no: SRMIEC-ST0922-129.

A total of 44 participants was selected based on the inclusion and exclusion

criteria. Procedure was clearly explained, and the informed consent was obtained. The
participants with body mass index above 25 were included.

Objective joint position sense test is done to all the participants, among which
the participants with the affection of knee proprioception, i.e measurement angle error
> 0.4,13 is added in the intervention group.

This intervention group is treated with knee proprioceptive exercises for 8

weeks, 3 days per week.

TREATMENT PROTOCOL:

TABLE I: KNEE PROPRIOCEPTIVE EXERCISES

WEEKS EXERCISES DURATION PROCEDURE

1st week Walking 30 sec

backwards

10
 Heel walking 30 sec

Walking with 30 sec

eyes closed
1st week

Standing in one
extremity 30 sec

Bending forward
30 sec

11
1st week

Slowly sitting and 20 times

stand up

Half squat and 10 times each

straight lunge

Slow sitting and 10 times

standing up

Exercises
added in Slow walk – 5 times each
2nd week broad circle

Slow walk – 5 times each

narrow circle

12
 Straight leg raise 30 sec

Exercises
added in Short arc
3rd week extension 30 sec
exercises

Walking 30 mins

13
OUTCOME MEASURE

Objective joint position sense test (OJPS):

The individuals was asked to lie prone with feet out of the plinth. The subject
was asked to flex the knee of testing limb to the predetermined target angle/position
and let her feel that angle or position for 5sec.Then the knee to target angle passively.
The angle was measured using universal goniometer. The subject was asked to move
the limb to that target angle and the perceived angle was measured. The angular
difference was recorded.

FIGURE 5 OBJECTIVE JOINT POSITION SENSE TEST

14
 DATA ANALYSIS

The collected data were analysed by using the Statistical Package for Social
Science (SPSS) version 26 where alpha level below 0.05 were considered statistically
significant. The mean, standard deviation and mean difference of the demographics and
the mean absolute angle error were calculated and presented in the following table.

15
 TABLE II
DEMOGRAPHICS OF THE STUDY PARTICIPANTS

N MINIMUM MAXIMUM MEAN S.D

AGE 44 26 35 31.04 2.72

HEIGHT(m) 44 1.44 1.70 1.55 0.06

WEIGHT(kg) 44 59 82 70.31 6.10

BMI(kg/m2) 44 25.80 33.70 29.16 2.10

A total of 44 female subjects were recruited in the study . The age of the subjects
ranged between 20 and 35 years and of BMI above 25 kg/m2. Demographic
characteristics and the BMI are shown in Table II.

The mean age of subjects were 31.04 ± 2.72. Mean height of the subjects were
1.55 ± 0.06 m. Mean weight of the subjects were 70.31 ± 6.10 Kg. Mean BMI of the
subjects were 29.16 ± 2.10 Kg/m2.

16
 TABLE III

PRE AND POST TEST MEAN VALUES OF MEAN AVERAGE

ANGLE ERROR OF THE EXPERIMENTAL GROUP

OUTCOME TEST N MEAN S.D MEAN t value p

DIFFERENCE value

MEAN PRE 44 5.29 1.11

AVERAGE TEST 2.01 12.13 0.000
ANGLE POST 44 3.27 1.14
ERROR TEST

p < 0.05 statistically significant

Table III shows that there is a significant difference between the mean values
of pre test (5.29 ± 1.11) and the post test ( 3.27 ± 1.14 ) of the experimental group.

17
 BAR DIAGRAM I

PRE AND POST TEST MEAN VALUES OF MEAN AVERAGE

ANGLE ERROR OF THE EXPERIMENTAL GROUP

MEAN AVERAGE ANGLE ERROR

4.5 4.3

3.5

3
2.5
2.5

1.5

0.5

0
PRE TEST POST TEST

MEAN AVERAGE ANGLE ERROR

18
 RESULTS
According to Table II, A total of 44 subjects were recruited in the study. The
age of the subject ranged between 31.04 ± 2.72. Mean height of the subjects were 1.55
± 0.06 m. Mean weight of the subjects were 70.31 ± 6.10 kg. Mean BMI of the subjects
were 29.16 ± 2.10 kg/m2.

According to Table III, there is a significant improvement in joint position

sense in the post test (5.29 ± 1.11) when compared with the pre test ( 3.27 ± 1.14 ), p
value is 0.000.

According to Bar diagram I, significant improvement of the Mean absolute

angle error is seen in the post test, when compared with pre test.

19
 DISCUSSION
The coordination of intricate movement systems is successfully aided by
proprioceptive mechanisms. Proprioception plays a protective role in injuries and is
crucial for avoiding undesirable joints like hyperextension. Inadequate proprioception
and aberrant motor control are brought on by a decline in muscle tone and tight tendons.
Therefore, ligament degeneration would result in a loss of proprioceptive feedback,
which would add to functional impairment. 14

Obesity is becoming more common all over the globe, and this is probably
related to rising rates of cardiovascular disease and diabetes mellitus. These changes
are probably the result of changes in lifestyle, particularly a decrease in physical
exercise and an increase in the consumption of foods with a high energy density.
Meanwhile, most cultures have been impacted by an increase in sedentary behaviour.
Due to this, middle-class housewives have a higher prevalence of obesity and
overweight than other categories.

Proprioception plays a critical part in maintaining joint stabilization and

postural stability in both dynamic and static postures. Detecting the postural sway
requires signals from proprioceptive receptors in the lower limbs, according to
Fitzpatrick R. et al. (1994). (Fitzpatrick et al., 1994) Joint sensors in the articular
structure include Pacinian corpuscles, Ruffini endings, and free nerve endings. Muscle
spindles are thought to be the most significant proprioceptive sensors in the knee. 10

These receptors are activated by the mechanical deformation caused by the

motions to provide information about joint angles, joint motion velocity, and limb
relative movements. Depending on the input, various mechanoreceptors exhibit
adaptive characteristics.2

Recent research have suggested that heavier subjects may have different
mechanoreceptor sensitivities. Mechanoreceptors in heavier people have more bodily
mass, which causes them to be more hyperactive and less sensitive. It is unclear whether
the change in postural stability seen in obese people is due to excessive joint loading
that effects the proprioceptors in their lower extremity joints, or whether the observed
instability in obese people is simply a result of their larger body mass.

20
 The shift in postural control or an adaptation to lower extremity biomechanics
in obesity may be significantly influenced by the decrease in proprioception. Because
proprioception is a factor in postural control capacity, it is possible that obese
housewives decreased postural control capacity is linked to changes in their
proprioception as well as changes in their excess body size and weight. 8

According to Neha V. Jagtap's (2018) analysis, obese middle-class women

between the ages of 30-45 years had a high prevalence of knee joint proprioception
affection. In females, obesity overloads the knee joint, changing the sensitivity of the
mechanoreceptors near the joint and affecting proprioception. 2

It was established by Nilay Sahin (2008) that the increase in average absolute
angle error values in both knees in the BJHS exercise group was statistically extremely
significant when the proprioception measurements were evaluated (P < 0.001).
However, in BJHS control group no statistically significant difference was observed
between two knees with respect to average absolute angle error value measurements
done in the first and eighth weeks (P > 0.05). 15

A total of 44 obese middleclass housewives were selected for the study

out of 56 screened subjects collected through convenient sampling. Due to insufficiency
of proprioception, proprioceptive exercises were added to the treatment program for the
obese housewives that aim at restoring motor control of lower extremity and assist in
maintaining good balance and enough function.

All the 44 subjects were provided with an 8-week proprioceptive exercise

protocol. The treatment protocol successfully improved the knee joint position sense
among the obese housewives. In our study, a significant improvement in the knee joint
position sense was detected among the subjects.

With the exercise program, it is observed that there is a tendency of

improvement in proprioceptive accuracy among our subjects, which is statistically
significant(p<0.05). which could be the result of attention, a neuropsychological
process whereby the central nervous system responds to proprioceptive information that
is considered to be pertinent. Put simply, it is possible that proprioceptive exercises
increase the attention given to proprioceptive cues by the brain, first at the conscious
level early in training, then later, after perhaps more training, at the autonomous level.

21
 "The unity of conscious experience is also evidenced by our inability to perform
multiple tasks, unless some tasks are highly automated and impinge less on
consciousness," Tononi and Edelman16 stated in their review. The psychological
refractory period, which lasts for a few hundreds of milliseconds, prevents us from
making more than one conscious choice at once.

Proprioception is thought to be most important in the closed-loop control of

slow movements of a limb, as in tracking something with a finger 16 , detecting the
absolute or change in position of something in space, coordinating limb movements,
and in balancing tasks. Proprioception contributes to the maintenance of body posture
during these latter tasks at a subconscious level through spinal or longer loop reflexes
working in less than 100 ms.

There is evidence to suggest that humans can and do use proprioception to

automatically adjust their posture in reaction to slight alterations in limb position. For
instance, Cordo and Nashner17 discovered that muscle activation during postural
responses has such brief latencies that there is only enough time for neural conduction
to the cerebellum, brainstem, and spinal cord but not enough time for higher cortical
centers to be responsible for conscious regulation of the postural responses.

In obese individuals, the amount of mechanoreceptors in tendons and menisci

decreases.2 It is possible to speculate that mechanoreceptor concentration decreases
with increasing BMI. We believe that a substantial improvement in proprioception
could stop the further loss of musculotendinous mechanoreceptors.

Proprioceptive perception in patients with anterior cruciate ligament (ACL)

lesions was found to improve with exercise therapy. 12 Since the number of receptors
was not anticipated to decline, the ACL lesions in younger patients may have responded
to the exercises more favourable.

On the other hand, the tendency toward improvement in proprioception we

observed might be resulted from the biomechanical improvements due to the beneficial
effects of the increased muscle strength and ROM of the knee. In our opinion, this
tendency toward improvement might show that exercises have some useful effects for
the patients at some degree and the patients benefited from exercises, so we suggest
exercises targeting the impaired proprioception should be recommended for subjects
with obesity.

22
 CONCLUSION

The study concluded that the proprioceptive exercise is an effective treatment

approach for improving the joint position sense among obese middleclass housewives
with impairment in knee proprioception.

23
 LIMITATIONS AND RECOMMENDATIONS

LIMITATIONS

 Does not compare the knee joint position sense between the dominant and
non – dominant leg.
 Non consideration of joint velocity on position sense error.

RECOMMENDATIONS

 Large sample size can be included.

 Male participants can also be included.
 Future studies can be done with different proprioceptive exercise protocol.

24
 REFERENCES

1. Hajar Morauvij, Ali Ghanbari and Fahimch Kamali(2016) proprioception of

knee joint in athelets and non athelet obese Jan 1;1(1):20.
2. Neha V. Jagtag., Suchit Shitty and Ajay kumar (2017) Prevalence of knee joint
position sense affection in obese middleclass housewives. Jul 27;9(2);286.
3. Rajeiv Ahirvar et al. (2019) Prevalence of obesity in India. A systematic review
Diatietic metab syndr. Jan – Feb.
4. Barr ML and Kirnan JA.(1983) The human nervous system, An anatomical
viewpoint 4th edition. Philadelphia : Harper and Row .
5. Lephart SM, Pinavire DM, Giralsu JL, FH (1997) : The role of proprioceptive
in the management and rehabilitation of atheletes injuries, Am J sports med,
1997; 25(1): 130-137.
6. Marieb EN : Human anatomy and physiology (5th edition) New York, Addison
Wesley longman, (2001).
7. Schmidt RF, Altner H. Fundamentals of sensory hysiology, Robert 3rd edition
Springer- Verlag 1986 : 47.
8. Wang L, Li JX, Xu DQ, Hong YL. Proprioception of ankle and knee joints in
obese boys and nonobese boys. Medical Science Monitor. 2008 Feb
27;14(3):CR129- 35.
9. Saboo B, Talaviye P, Chandarana H, Shah S, Vyas C, Nayak H. Prevalence of
obesity and overweight in housewives and its relation with household activities
and socio- economic status. Journalof obesity and metabolic research, 2014 Jan
1; 1(1) : 20.
10. Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in
the management and rehabilitation of athletic injuries. Am J Sports Med 1997;
25: 130–37.
11. Fitzgerald GK. Open versus closed kinetic chain exercise: issues in
rehabilitation after anterior cruciate ligament reconstructive surgery. Phys Ther
1997; 77: 1747–54.
12. Kim KJ, Kim YE, Jun HJ, et al.: Which treatment is more effective for
functional ankle instability: strengthening or combined muscle strengthening
and proprioceptive exercises? J Phys Ther Sci, 2014, 26: 385–388. [Medline]
[CrossRef].

25
13. Lin Wang, Jing Xian LI, Dong Qing Xu , You tian. Proprioception of ankle and
knee joints in obese boys and non- obese boys. 2008Mar 01; 14(3) CR129-135.
14. Nilay sahin, Akin baskent, Aysegul cakmak, Ali salli, Hatice Ugurlu, Ender
Berber. evaluvation of knee propriocetion and effects of proprioceptio exercises
in patients with benign joint hypermobility syndrome 2008 Aug; 28(10) : 995-
1000.
15. Jau-Yih, Pai-fu Cheng and Rong-sen Yang. The effects of sensrimotor training
on knee proprioception and function for patients with knee osteoarthritis: a
preliminary report. Clin Rehebli 2008;22;448.
16. Schmidt RA (1988) Motor control and learning. A behavioral emphasis, 2nd
edn. Human Kinetics, Champaign.
17. Cordo PJ, Nashner LM (1982) Properties of postural adjustments associated
with rapid arm movements. J Neurophysiol 47:287–302.

26
 ANNEXURE-I

INSTITUTIONAL ETHICAL CLEARANCE CERTIFICATE

27
 ANNEXURE-I

INFORMED CONSENT FORM

I Ms/Mrs ________________________age________ freely and voluntarily

agree to participate in the study conducted on “EFFECTIVENESS OF KNEE
PROPRIOCEPTIVE EXERCISES AMONG OBESE MIDDLECLASS
HOUSEWIVES WITH IMPAIRMENT IN KNEE PROPRIOCEPTION” done by
Mr. PRAKASH.V, BPT VIII SEMESTER, SRM COLLEGE OF
PHYSIOTHERAPY, SRM INSTITUTE OF SCIENCE AND TECHNOLOGY,
KATTANKPULATHUR, CHENGALPATTU. 603 203.

I was explained in detail about the procedure of the study and understood the
requirements and benefits of this study.

I surely solely give consent to participate in this study.

DATE: SIGNATURE:

PLACE:

28
 ANNEXURE-III
ASSESSMENT FORM

NAME :

AGE :

GENDER :

DATE OF ASSESSMENT :

ADDRESS :

PHONE NUMBER :

MEDICAL HISTORY :

PAST HISTORY :

SOCIOECONOMIC STATUS :

BMI CALCULATION :

Height in m2 Weight in kgs BMI = Weight(kgs)/

Height(m2)

OBESITY ≥ 25 kg/m2

29
OBJECTIVE JOINT POSITION SENSE TEST (OJPS) :

OJPS TEST PRE TEST POST TEST

TRAIL 1

TRAIL 2

TRAIL 3

AVERAGE

PHYSIOTHERAPIST’S SIGNATURE:

30
 ANNEXURE-IV
MASTER CHART

AAE AAE
HEIGHT WEIGHT PRE POST
S.no AGE GENDER in m in kg BMI TEST TEST
1 35 FEMALE 1.59 76 30.1 3.66 3.33
2 32 FEMALE 1.5 60 26.7 4.33 2.33
3 29 FEMALE 1.52 65 28.1 4.66 3.33
4 32 FEMALE 1.52 65 27.4 3.66 2
5 34 FEMALE 1.59 72 28.5 5.6 3.33
6 27 FEMALE 1.44 65 31.3 4.66 2.66
7 34 FEMALE 1.44 67 32.3 3.66 1.66
8 30 FEMALE 1.49 65 29.3 4.33 2.66
9 29 FEMALE 1.58 66 26.4 5.33 2.66
10 28 FEMALE 1.45 65 30.9 6.33 3.66
11 31 FEMALE 1.49 67 30.2 4.66 3
12 32 FEMALE 1.44 60 28.9 7.66 6.33
13 32 FEMALE 1.54 64 27 5.66 2.33
14 32 FEMALE 1.59 66 26.1 6.33 3.66
15 27 FEMALE 1.46 62 29.1 3.33 3.66
16 35 FEMALE 1.56 63 25.9 5.33 6.33
17 33 FEMALE 1.48 62 28.3 6.33 3.33
18 33 FEMALE 1.66 73 26.5 3 2.66
19 32 FEMALE 1.48 65 29.7 4.33 2.66
20 29 FEMALE 1.52 64 27.7 5.33 3.66
21 34 FEMALE 1.56 66 27.1 6.33 3.66
22 28 FEMALE 1.53 75 32 3.33 3.66
23 35 FEMALE 1.56 68 27.9 5.66 3.33
24 32 FEMALE 1.6 66 25.8 5.33 2.66
25 28 FEMALE 1.62 75 28.6 6.33 4
26 27 FEMALE 1.68 82 29.1 2.66 2

31
27 28 FEMALE 1.56 82 33.7 4.66 2.66
28 32 FEMALE 1.59 77 30.5 4.66 3
29 26 FEMALE 1.62 78 29.7 6.33 4
30 30 FEMALE 1.61 80 30.9 4.33 2.33
31 29 FEMALE 1.54 76 32 4.66 3.33
32 29 FEMALE 1.6 70 27.3 3.66 2.33
33 30 FEMALE 1.63 78 29.4 5.6 3.33
34 35 FEMALE 1.7 78 27 4.66 2.66
35 27 FEMALE 1.45 70 33.3 3.66 1.66
36 33 FEMALE 1.53 73 31.2 4.33 2.66
37 34 FEMALE 1.55 75 31.2 5.33 2.66
38 34 FEMALE 1.6 70 27.3 6.33 3.66
39 35 FEMALE 1.56 78 32.1 4.66 3
40 30 FEMALE 1.62 73 27.8 7.66 6.33
41 28 FEMALE 1.53 74 31.6 5.66 2.33
42 33 FEMALE 1.56 70 28.8 6.33 3.66
43 29 FEMALE 1.62 73 27.8 3.33 3.66
44 34 FEMALE 1.56 75 30.8 5.33 6.33

32
 ANNEXURE-V
PLAGIARISM FORMAT
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
Office of Controller of Examinations

REPORT FOR PLAGIARISM CHECK ON THE PROJECT REPORTS FOR UG

PROGRAMMES
1. Name of the Candidate PRAKASH.V

2. Address of the Candidate 31, Sowjanya villas, Dilli Babu Nagar

Mobile 1st Street, Pallikaranai Chennai 100.
( Near Ambal nagar 8th cross street,
Sabthagiri garden apartments )

Mobile Number: 8248496737

3. Registration Number RA1921001010090

4. Date of Birth 13-11-2001

5. Department SRM College of Physiotherapy
6. Faculty Health Sciences

7. Title of the Project EFFECTIVENESS OF KNEE

PROPRIOCEPTIVE EXERCISES
AMONG OBESE MIDDLECLASS
HOUSEWIVES WITH IMPAIRMENT
IN KNEE PROPRIOCEPTION
8. Whether the above project is Individual or group: INDIVIDUAL
done by
9. Name and address of the Mrs. K. JOTHI PRASANNA, M.P.T.,
Guide ASSISTANT PROFESSOR.
SRM COLLEGE OF
PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND
TECHNOLOGY

Mail ID: jothiprk@srmist.edu.in

Mobile Number: 9894475735
10. Name and address of the Co- NA
Supervisor / Co-Guide (if
any)
11. Software Used TURNITIN
12. Date of Verification 30-03-2023

13. Plagiarism Details: (to attach the final report from the software)
Enclosed

33
 Title of the study Percentage Percentage % of
EFFECTIVENESS OF KNEE of similarity of Plagiarism
PROPRIOCEPTIVE EXERCISES index similarity after
AMONG OBESE MIDDLECLASS (Including index excluding
HOUSEWIVES WITH self citation) (Excluding Quotes,
IMPAIRMENT IN KNEE self Bibliography,
PROPRIOCEPTION citation) etc.,

-------- 7% 7%

I declare that the above information have been verified and found true to the best
of my / our knowledge.

Signature of the Candidate Name & Signature of the Staff

(who uses the Plagiarism check
software)

Name & Signature of the Guide Name & Signature of the Co-
Supervisor/ Co-Guide

Name & Signature of the HOD

34
 ANNEXURE-V
PLAGIARISM REPORT

35
36