Combined Kinetic Chain Exercises on Knee Osteoarthritis

the study will be conducted at faculty of physical therapy cairo university to investigate the effect of combined kinetic chain exercises on static and dynamic hamstring and quadriceps strength ,knee pain ,function ,H/Q ratio in knee osteoarthritis patients .using lafayette hand held dynamometer to measuring static strength of hamstring and quadriceps ,and free weight by Brzycki formula for measuring dynamic hamstring and quadriceps strength by determining 1 repetition maximum ,and pain measured by visual analogue scale (VAS) rating from (0 = no pain ) to (10= worst pain ) ,and function by Western Ontario and McMaster Universities Osteoarthritis Index questionnaire lower score indicate patient get better ,number of patients will be 34 divided into 2 groups ,each group will include 17 patient ,with 2 drop out according to sample size calculation ,each group will receive conventional tens for 20 min. and hot back for 15 min. and stretching exercises for hamstring,quadriceps,calf muscles ,while the experimental group will be increased by combined kinetic chain exercises

• combined kinetic chain exercises (Other), also known as experimental: combined kinetic chain exercises in form of wall slide ,terminal knee extension ,forward step up and down ,side step up and down ,straight leg raise ,seated knee extension ,stretching exercises , hot back and trans cutaneous electrical stimulation,
• conventional (Other), also known as control: stretching exercises and hot back and trans cutaneous electrical stimulation,with out combined kinetic chain exercises

Primary outcomes

• static quadriceps strength [Evaluation will be performed prior to the first treatment session ;as a baseline measure,and at last treatment session (after 4 weeks) as a post -treatment measure]: measuring static quadriceps from sitting position at angle 60 and 90
• static hamstring strength [Evaluation will be performed prior to the first treatment session ;as a baseline measure,and at last treatment session (after 4 weeks) as a post -treatment measure]: measuring static hamstring strength from sitting position at angle 60 and 90
• dynamic quadriceps strength [Evaluation will be performed prior to the first treatment session ;as a baseline measure,and at last treatment session (after 4 weeks) as a post -treatment measure]: measuring dynamic quadriceps strength from sitting position by randomised free weight and Brzycki formula
• dynamic hamstring strength [Evaluation will be performed prior to the first treatment session ;as a baseline measure,and at last treatment session (after 4 weeks) as a post -treatment measure]: measuring dynamic hamstring strength from prone position by randomised free weight and Brzycki formula
• Hamstring /Quadriceps ((H/Q) ratio [Evaluation will be performed prior to the first treatment session ;as a baseline measure,and at last treatment session (after 4 weeks) as a post -treatment measure]: dividing static hamstring on static quadriceps strength and dynamic hamstring on dynamic quadriceps strength

Secondary outcomes

• change in neck pain [Evaluation will be performed prior to the first treatment session ;as a baseline measure,and at last treatment session (after 4 weeks) as a post -treatment measure]: by Visual Analog Scale (VAS) , (0=no pain ) and (10=worst pain)
• function [Evaluation will be performed prior to the first treatment session ;as a baseline measure,and at last treatment session (after 4 weeks) as a post -treatment measure]: BYWestern Ontario and McMaster Universities Osteoarthritis Index questionnaire ,Lower score indicate patient gets better

Sex: All, ages: 38 Years to 65 Years

Inclusion Criteria:

* the patients age from38 to 65
* recent radiographs confirming grade 2 and 3 (mild to moderate ) osteoarthritis
* primary and secondary Osteoarthritis
* both gender
* unilateral knee osteoarthritis
* pain in the knee for most days of prior month
* morning stiffness less than 30 min. in duration
* patient body mass index (BMI) between 18.5 and 29.9 kg/m2

Exclusion Criteria:

* neurological disorders
* wheelchair bound
* significant cognitive impairment
* present systemic inflammatory arthritis
* history of hip and knee arthroplasty

  * history of trauma or surgical arthroscopy of either knee in the last 6 months
* received knee intra-articular injection within the last 3 months
* under anticoagulant therapy ,recent or imminent surgery (within 3 months)