Treatment of Knee Osteoarthritis in Relation to Hamstring and Quadriceps Strength

Abstract

[Purpose] To assess the effect of hamstring and quadriceps strengthening exercises on pain intensity, gait velocity, maximum isometric strength, and activities of daily living of patients with knee osteoarthritis (OA). [Subjects and Methods] A total of 20 patients with knee OA, 50 to 65 years of age (57.65 ± 4.78 years), received hot packs, strengthening exercises for the quadriceps and the hamstring muscles and stretching exercises for hamstring muscles. Outcome measures included: the Western Ontario and McMaster Universities OA index questionnaire (WOMAC) scores for assessing health status and health outcomes of knee OA; self-reported pain intensity scores, measured using a visual analogue scale; the 50 ft walk test (a measure of gait velocity and function); and handheld dynamometry (a tool used to measure maximum isometric strength of knee extension and flexion). [Results] There was a significant difference between pre- and post-intervention measures of pain intensity, 50 ft walk times, hamstring strength, and quadriceps strength. Significant differences in WOMAC measures were also observed in the subscales of pain, stiffness and physical function, as well as WOMAC total scores. [Conclusion] Strengthening the hamstring muscles in addition to strengthening the quadriceps muscles proved to be beneficial for perceived knee pain, range of motion, and decreasing the limitation of functional performance of patients with knee OA.

Association of knee pain with a reduction in thigh muscle strength – a cross-sectional analysis including 4553 osteoarthritis initiative participants

“…Thus, the observed 2–3% lower flexor strength and torque/body weight per increase of one WOMAC knee pain unit supports previous findings on the importance of flexor strength in context of knee pain in either sex 13,16 .…”

“…Knee flexor strength was also included in the current analysis, as hamstring strengthening has proven to have additional beneficial effects on the WOMAC knee pain score compared to quadriceps strengthening alone 13,16 . Thus, the observed 2–3% lower flexor strength and torque/body weight per increase of one WOMAC knee pain unit supports previous findings on the importance of flexor strength in context of knee pain in either sex 13,16 .…”

Role of thigh muscle cross-sectional area and strength in progression of knee cartilage degeneration over 48 months – data from the Osteoarthritis Initiative

“…However, a recent study by Ruhdorfer et al failed to demonstrate a significant relationship between thigh muscle CSA between knees with and without radiographic OA 12 . Some studies have suggested that both knee flexion and extension strength weakness can themselves be associated with knee OA 31, 32 . A recent study by Mikesky et al in which patients without radiographic knee OA underwent strength training of both hamstrings and quadriceps, demonstrated a greater incident joint space narrowing in the strength training group, suggesting an opposite effect of global muscle strength about the knee joint 33 .…”

Immediate effect of self-myofascial release on hamstring flexibility

“…Interaction with hamstring provides correct knee movement and stability. Also in the dynamic movement of sagittal plane abduction and adduction, hamstring muscle provides stability [18] to affect postural balance [19]. The muscular strength ratio to quadriceps and hamstring plays an important role in hip and knee joint stability as well.…”