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Exercise has been shown to alleviate symptoms of Osteoarthritis (OA) by increasing synovial fluid circulation and creating a reparative effect for inflamed joints. Previous studies have shown differences in treatment outcomes depending on the type and mode of exercises used to treat OA. Open kinetic chain (OKC) exercises are movements where the distal part of a joint moves freely in space. Closed kinetic chain (CKC) exercises are where the distal point is fixed or stabilized during the movement. OKC exercises have been noted to have a higher proportion of shear forces while CKC to have a greater proportion of compressive forces. Previous research has favored the use of CKC exercises for OA rehabilitation due to greater antagonist stabilizing functions. The purpose of this study was to determine if OKC and CKC exercises produce equal results in improving function and reducing pain in tibiofemoral OA patients.

For this study thirty participants between the ages of 45-75 who met the criteria for tibiofemoral OA were selected to complete either OKC exercise or CKC exercises along with physical therapy. Both groups completed exercises and other conventional physical therapy treatments including short wave diathermy 6 days a week for 8 weeks. The OKC group did exercises including leg extensions, hip abductions, supine flexion/extension/adduction and static quadriceps exercises. The CKC group performed squatting exercises, step-ups, lunges and static quadriceps exercises. Outcomes of the exercise protocols were measured using the Western Ontario and MC Master Universities Index of Osteoarthritis (WOMAC) and a visual analog scale before and after the 8-week intervention. Both groups showed significant improvement in both WOMAC and visual analog scale scores.

In conclusion, this study showed that there were no significant differences in the effectiveness between OKC and CKC in patients with tibiofemoral OA. The OKC and CKC groups both showed a decrease in pain and an increase in muscle strength and functional ability. One notable difference that was observed was that participants in the CKC group initially experienced greater discomfort with their exercise protocol than the OKC group but that overtime the benefit from the exercises outweighed any discomfort. Overall, this study suggested that programs that include both OKC and CKC rehabilitation for tibiofemoral OA can be effective treatments.

The findings from this study would apply to my field of interest, which is physical therapy for older adults, because it will help determine how to design the best therapy program for OA patients. Based on this study’s conclusions, starting a program with a greater dosage of OKC exercises may produce better results regarding patient compliance as there seemed to be less pain associated with these exercises at the start of the exercise program. Since there appears to be such a high success rate from the CKC exercises it is therefore important to also have those movements in a patient’s program. With this in mind, it may be best to wait to implement large doses of CKC exercises until the patient has grown more accustomed to exercise routines so that any initial pain is not overly discouraging in the initiation of the rehabilitation program.

References

Shah, C. (2014). A Study to Compare effectiveness of Closed Kinetic Chain Exercises Versus Open Kinetic Chain Exercises in Patients with Osteoarthritic Knee Joints. Indian Journal Of Physiotherapy & Occupational Therapy, 8(3), 195-201. doi:10.5958/0973- 5674.2014.00381.5