Effect of Combined Balance and Isotonic Resistive Exercises Versus Isotonic Resistive Exercise alone on Proprioception and Stabilizing Reactions of Quadriceps and Hamstrings and Functional Capacity of Knee Osteoarthritis Patients

Objectives: To compare the effect of combined balance and dynamic resistive exercise versus dynamic resistive exercise alone on proprioception and stabilizing actions of the quadriceps and hamstrings and functional capacities in patients with knee osteoarthritis. Design: Randomized clinical trial. Participants: Fifty nine patients with knee osteoarthritis randomized to group I (resistive exercise) (n=21) and group II (combined resistive +balance exercise) n=38. Intervention: All patients had electrotherapy, flexibility and resistive exercises for the legs, 3 times weekly for 8 weeks. Group II also added balance exercises. Main outcome measures: Knee examination, knee pain by visual analogue scale, Lequesne index, one repetition maximum for quadriceps, body mass index, recording of postural evoked surface EMG for quadriceps and hamstrings, and measurement of knee proprioception inaccuracy. Results: Knee effusion improved in both groups with significantly higher improvement in group II (P=0.017). Knee pain significantly decreased in both groups with higher mean percent change in group II (-50.9 ± 29.59) than in group I (-41.2± 10.89) with no significant difference in between groups (P=0.48). Lequesne score significantly decreased in both groups without difference in between groups (P value within groups =0.000). One repetition maximum for quadriceps significantly increased in both groups with higher mean percent change in group II (50.43 ± 16.6) than in group I (47.02 ± 41.97) (P value within group =0.000, P in-between groups=0.64). There were limited significant changes of quadriceps and hamstring reflex EMG in both groups. There were significant improvements of knee joint proprioception inaccuracy at the three measured angles 10, 30, 60 in both groups. However the mean percentage of changes was higher in group II than in group I at the measured angle 10 and 30. Group I had significantly higher improvement at angle 60. Conclusion: Balance exercises add to the benefits of resistive exercise to knee osteoarthritis patients.