The Knee extensor strength deficit is a common finding in patients suffering from knee pain1,2, this
deficit is reduced through well accepted methods of knee rehabilitation exercises leading to Quadriceps
strengthening and Closed Kinetic Chain (CKC) exercises. The closed chain concept of quadriceps
exercise is incorporated by Backward walking, which is the ability to move backward, it allows the body
to be positioned to accommodate various tasks. The Backward locomotion (walking or running) leads to
decrease in patellofemoral joint compressive forces and protect Anterior Cruciate Ligament (ACL) from
overstretching, it also decreases the eccentric loading of the knee extensors, thus it has gained
popularity as a part of program to rehabilitate certain knee injuries 2
.
However, there has not been any clinical trial conducted to support or refute the positive effects of
backward treadmill walking in altering pain and quadriceps strength in subjects with knee pain. Thus,
this study aimed at examining the effects of backward treadmill plain walking on pain and quadriceps
muscle strength in subjects presenting with knee pain and quadriceps insufficiency.
The performed study explored the effectiveness of retro-treadmill (backward) walking and Quadriceps
strengthening as a rehabilitative tool for the subjects with complaint of knee pain. The study includes a
total of 30 subjects (both males and females belonging to the age group of 25 to 55), duly screened on
the basis of inclusion and exclusion criteria. The study involves the usage of Visual Analog Scale (VAS)
and handheld dynamometer for the evaluation of pain and muscle strength, respectively. Based on the
performed work it is found that a better level of treatment success is achieved in the experimental group
compared to that in the control group.
The Observed results of experimental group compared to that in the control group for VAS (66.7% and
33.3%, respectively, for p< 0.05), and for Quadriceps muscle strength (57.8% and 42.6%,
respectively, for p< 0.05).The analysis of the results recommends that the patients undergone through
knee rehabilitation should undergo retro-treadmill walking in their rehabilitation protocol.
Download PDF
References
- Werner S. An evaluation of knee extensor and knee flexor torques and EMGs in patients with patello-femoral pain syndrome in comparison with matched controls. Knee Surgery Sports Traumatology Arthroscopy; 3 (2): 89-94, 1995
- Fairbank JC, Pynsent PB, van Poortvliet JA, et al. Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surgery Br; 66 (5): 685-93,1984
- Michael D. Lewek, Katherine S. Rudolph, Lynn Snyder- Mackler Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis. J Orthop Res. January; 22(1): 110– 115.2004
- Shelton GL, Thigpen LK. Rehabilitation of patellofemoral dysfunction: a review of literature. J Orthopaedic Sports Phys Therapy; 14:243-9, 1991
- Bynum B, Barrack R, Alexander A. Open versus closed chain kinetic exercises after anterior cruciate ligament reconstruction. American J Sports Med; 23:401-61995.
- Powers CM. Rehabilitation of patellofemoral joint disorders: a critical review. JOrthop Sports PhysTher; 28:345-54,1998
- Chaloupka EC, Kang J, MA Mastrangelo and Donnelly MS. Cardiorespiratory andmetabolic responses during forward and backward walking. Journal of Orthopaedic Sports Physical Therapy; 25(5):302-306, 1997
- Gregory W. Lange Electromyographic and kinematic analysis of graded treadmill walkingand implication for knee rehabilitation. J Orthop Sports Phys Therapy 23(5) 294- 301;1996
- Boiling, Lori, Carl. Outcomes of weight bearing rehabilitation program for patientsdiagnosed with patellofemoral pain syndrome. Arch Phys Med Rehab Vol 87, Nov 2006
- Cipriani, Armstrong, Gaul Backward walking at three levels of treadmill inclination: n An Electromyographic and Kinematic analysis.J Orthop Sports Phys Therapy,22; 31995
- Crossley K, Bennell K, Green S, McConnell J. A systematic review ofphysical interventions for patellofemoral pain syndrome. Clinical J SportsMed; 11:103-10, 2001
- EDWIN Bunton, William Pitney, Alexander. The role of limb torque, muscle actionand proprioception during closed kinetic chain rehabilitation of the lower extremity. J Athletic Training. Volume 28, Number1, 1993
- Flynn TW, Souttas Little RW mechanical power and muscle action duringforward and backward running. Journal of Orthopedic and Sports Physical Therapy 17, 1993.
- Flynn TW, Souttas Little Patellofemoral joint reaction forces in forward andbackward running Journal of Orthopedic Sports Physical Therapy 1995;21;5;277-81
- Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlayen JWS. The fear- avoidance model of musculoskeletal pain: current state of scientific evidence. JBehav Med.; 3:77–94, 2007
- Scott F. Dye. The Pathophysiology of Patellofemoral Paina Tissue Homeostasis Perspective, clinical orthopaedics and related research. Number 436, pp. 100– 110
- Threkald, Horn, Wojtowicz, Rooney, Shapiro: Kinematics, ground reaction force, and muscle balance produced by backward running. Journal of Orthopedics & Sports PhysicalTherapy 11:56- 63, 1989
- Whitley, Chet R.; Dufek, Janet S. The Effect of Retro Locomotion on Flexibilityof The Low Back and Hamstrings. Medicine and Science in Sports and Exercise. May, Volume 41, issue 5. pp 358, 2009
- Witrouwx, Lysens, Bellmens. Open vs. closed kinetic chain exercises for patellofemoral pain syndrome. Am J Sports Med 2000, 28: 687- 694
Back