INTRODUCTION Osteoarthritis is the most common form of chronic arthritis affecting the synovial joints and is the common cause for disability worldwide. The terminology osteoarthritis comprises of two different terms where “osteo†means bone and “arthritis†means joint inflammation. Osteoarthritis is defined as a chronic progressive disease of synovial joints that is characterized by articular cartilage erosion, osteophytes formation at subchondral bone margins, inflammation of synovial membrane and resulting in pain, reduced range of motion, muscle weakness and eventually difficulty in performing daily activities. Osteoarthritis is also known as degenerative joint disease, wear and tear arthritis and age related arthritis. Knee is the joint most commonly affected by osteoarthritis and its prevalence is more in people above 60 years of age. Knee osteoarthritis involves all three compartments of knee joint: medial tibiofemoral joint, lateral tibiofemoral joint and patellofemoral joint. Risk factors of knee osteoarthritis can be described as systemic risk factors, joint level risk factors, non-modifiable risk factors and modifiable risk factors. Systemic risk factors includes elderly age group (>60 years) and female population. Joint level risk factors include joint injury due to repitative trauma and abnormal loading on the joint. Apart from systemic and joint level risk factors modifiable risk factors also include any hereditary conditions and congenital abnormalities like genu valgum and genu varum. The most common modifiable risk factor include obesity (BMI >30). The epidemiology of knee osteoarthritis may vary depending on population studied, but some general patterns have been observed. According to a March 2024 study, worldwide prevalence of knee osteoarthritis above 40 years of age was 22.9% and for above 15 years of age it was 16.0%. According to a 2020 study, globally 10% - 20% of population have knee pain among which 80% experience reduced range of motion and 20% of population are unable to perform daily living activities. Assistance in basic daily activities is required by 11% of knee osteoarthritis patients. Knee osteoarthritis is commonly divided in two types. They are primary osteoarthritis and secondary osteoarthritis. 1. Primary osteoarthritis is the most common type seen in elderly people due to wear and tear degeneration. It is also termed as idiopathic osteoarthritis. 2. Secondary osteoarthritis occurs due to joint injury or any change in articular cartilage or subchondral bone due to any underlying causes like metabolic or endocrine disorders, hereditary conditions, neurological conditions, post traumatic cases or due to congenital malformations. Causes of secondary osteoarthritis includes obesity, knee fracture, trauma, infections, genu valgum or genu varum deformity, metabolic conditions like rickets, hemochromatosis, endocrine disorders like acromegaly, hyperparathyroidism, neurological conditions like diabetes, syringomyelia, excessive use of intraarticular steroid therapy. Clinical features includes severe intermittent pain seen after activity in early stages of osteoarthritis whereas constant pain is more pronounced in advance stages of osteoarthritis, swelling and knee crepitus, muscle weakness and instability of joint, decreased range of motion of the knee joint, stiffness of knee joint mainly after rest. Kellgren and Lawrence scale is used for grading/staging of osteoarthritis. Stage 0 is absence of any abnormality. Stage 1 is beginning of osteoarthritis and beginning of osteophyte formation at bone ends. Stage 2 is moderate narrowing of joint space and subchondral sclerosis. Stage 3 is more than 50% narrowing of joint space, more pronounced subchondral sclerosis and osteophyte formation. Stage 4 is chracterized by destruction of joint, loss of joint space and subluxed position. NEED OF THE STUDY Osteoarthritis is a chronic progressive degenerative disease of synovial joints of multifactorial etiology characterized by inflammation, cartilage erosion and osteophytes formation resulting in pain and decreased functional activity. It is one of the common cause of disability worldwide. Proprioceptive exercises are used to improve proprioceptive responses that are generally impaired in knee osteoarthritis patients. Strengthening exercises helps to maintain the strength of weakened muscles. All these exercises thereby helps in reducing pain, stiffness and improving functional ability in knee osteoarthritis patients. Ultrasound therapy is a form of high frequency current that helps in reducing pain and is easy to use. Different therapeutic approaches have been developed for treating knee osteoarthritis such as Maitland mobilization, Mulligan mobilization, muscle energy technique, proprioceptive exercises, strengthening exercises. Though various studies showed that proprioceptive exercises, strengthening exercises and ultrasound therapy are effective for reducing pain and stiffness and increasing functional ability in knee osteoarthritis patients, but there is less evidence to document the efficacy of proprioceptive exercises over strengthening exercises and vice-versa in long term management plan. Hence, the purpose of this study is to find the effectiveness of proprioceptive exercises versus strengthening exercises with common use of ultrasound therapy in patients with osteoarthritis of knee. OBJECTIVE OF THE STUDY To evaluate the effectiveness of proprioceptive exercises along with UST in patients with osteoarthritis of knee. To evaluate the effectiveness of strengthening exercises along with UST in patients with osteoarthritis of knee. To compare the effectiveness between proprioceptive exercises and strengthening exercises along with UST in patients with osteoarthritis of knee. HYPOTHESIS NULL HYPOTHESIS (H0) There will be no significant difference between the effectiveness of proprioceptive exercises and strengthening exercises with the common use of UST among patients with osteoarthritis of knee. ALTERNATIVE HYPOTHESIS (H1) There will be significant difference between the effectiveness of proprioceptive exercises and strengthening exercises with the common use of UST among patients with osteoarthritis of knee. METHODOLOGY 30 patients with osteoarthritis of knee will be selected based on selection criteria by convenient sampling. They will be allocated into two groups, Group A and Group B. Each group will have 15 patients. Group A will receive proprioceptive exercises along with UST and Group B will receive strengthening exercises along with UST. The initial values will be checked by Western Ontario and McMaster Universities Arthritis Index (WOMAC). After 4 weeks of intervention these parameters will be assessed again. Intra group (paired t test) and inter group (independent t test) analysis will be done to find out which of the interventions are more effective. Group A will perform following proprioceptive exercises. 1. One leg balance in which patient will stand on one affected leg maintaining relaxed upright posture and the other leg will be flexed at hip, knee and ankle. Patient will hold this position for 1 minute followed by 10-20 seconds of rest and after that two more repetitions will be carried out. Patient will perform 3 similar repetitions for another leg. 2. Blind advanced one leg balance in which patient will stand on one affected leg maintaining relaxed upright posture and the other leg will be flexed at hip, knee and ankle with his/her eyes completely closed. Patient will hold this position for 1 minute followed by 10-20 seconds of rest and after that two more repetitions will be carried out. Patient will perform 3 similar repetitions for another leg. 3. Toe walking in which patient will walk 20 meters on toes with toes pointing straight ahead, then will walk with toes pointing outwards and then with toes pointing inwards. Patient will perform this for 1 more repetition. 4. Heel walking in which patient will walk 20 meters on heels with toes pointing straight ahead, will walk on heels with toes pointing out and then with toes pointing in. Patient will perform this for 1 more repetition. 5. Cross leg body swing in which patient will lean slightly forward with hands on wall for support and weight on one affected leg while the other leg will swing in front of body with toes pointing upwards as foot reaches the farthest point of motion and then patient will swing back this leg as far as comfortably possible. Patient will perform this for 15 repetitions. After a few seconds of rest patient will perform similar 15 repetitions with another leg as the weight bearing limb. Group B will perform following strengthening exercises. 1. Static quadriceps in knee extension in which patient will be in supine position. Patient will contract the quadriceps femoris muscle while pushing the knee down and maintaining full dorsiflexion of foot. Each contraction will be hold for 6 secs with 10 secs of rest between the repetitions. 2. Standing terminal knee extension in which patient will be in standing position with holding a resistive band behind a slightly flexed knee. Patient will contract the gluteal muscle and quadriceps femoris muscle to fully extend the hip and knee. Each contraction will be hold for 3 seconds. Resistance will be increased according to patient’s tolerance. 3. Seated leg press in which patient will be seated holding a resistive band with both the hands. Patient will place his/her foot against the band, then will extend the knee by pushing the foot down and forward by contracting the gluteal and quadriceps femoris muscles. Patient will hold each contractions for 3 seconds with knee as straight as possible and then will slowly return to the starting position. Both group A and group B will receive ultrasound therapy continuous mode, 1 MHz frequency, 1.5W/cm2 intensity for 10 minutes. EXPECTED OUTCOME Both the groups are expected to show improvement with the intervention of 4 weeks. However whether they are statistically significant and if there will be any difference between the two interventions remains to be seen. |