Effectiveness of Closed and Open Kinematic Chain Exercises in Improving Muscle Strength, Range of Motion and Balance in Subjects with Meniscal Injuries

EFFECTIVENESS OF CLOSED AND OPEN KINEMATIC CHAIN EXERCISES IN IMPROVING MUSCLE STRENGTH, RANGE OF MOTION AND BALANCE IN SUBJECTS WITH MENISCAL INJURIES. By Dr Afreen Jahan Design: Experimental study design Study setting: Sri Venkateswara Ram Narayan RUIA Government General Hospital, Physiotherapy outpatient department. Number of subjects: Thirty subjects between the age group of 17-25 years were taken. Total number of subjects n=30 were divided based on simple random sampling and divided into two groups consisting of 15 subjects each and named as control group and experimental group 15 subjects were treated with open kinematic chain exercises and 15 subjects were treated with closed kinematic chain exercises. Selection criteria A) Inclusion criteria Subjects between age of 17-25 years. Patients of both male and female sex. Patients with meniscal injury of Grade-I and Grade-II with the duration of sub- acute stage. Patients who were conformed with Grade-I and Grade-II meniscle injuries by MC-MURRYS test. Patients who are willing to participate in the study. B) Exclusion criteria Patients who are less than 17 years and more than 25 years of age. Patients with Grade-III meniscal injuries. Patients with acute stage of meniscal injuries. Patients who are contraindicated with exercise protocol. Patients with chronic instability of the joint. Patients with neurological disorders. Patients who are unaware of the joint position sense. Patients with malignancy. Patients with chronic infections of the joint. OUTCOME MEASURES Universal Goniometer Spring balance test Standing stroke test Duration of study Two weeks RESULTS Open kinematic chain exercises and closed kinematic chain exercises are effective in the improvement of strength, Range of motion and balance but closed kinematic chain exercises are more effective in improving strength and range of motion than open kinematic chain exercises in patients with meniscal injuries. CONCLUSION Both Open kinematic chain exercises and closed kinematic chain exercises are effective in the improvement of strength, Range of motion and balance but closed kinematic chain exercises are more effective in improving strength, range of motion and balance than open kinematic chain exercises. GENERAL INTRODUCTION ABOUT MENISCI The articular disks of the knee joint are called menisci because they only partly divide the joint space (G. P. Mills). There are medial and lateral meniscus consists of connective tissue with extensive collagen fibres containing cartilage like cells. The menisci are flattered at the center of the knee joint, fused with the synovial membrane laterally and can move over the tibial surface. FUNCTIONS OF MENISCI The menisci serve to protect the joint ends from rubbing on each other and to effectively deepen the tibial socket into which the femur attaches. They act as a shock absorber (B. D. Chaurasia). MENISCUS TEAR AND ITS CAUSES The meniscus can be damage or torn during activities that put pressure and rotate the knee joint. Taking the hard tackle on the football field or a sudden pivot on the basketball court can result in a meniscal tear. SPECIAL TEST FOR MENISCAL TEAR MC-MURRYS TEST APLEYS GRINDING TEST INVESTIGATIONS Knee imaging, x-ray MRI Arthroscopy TIPS TO PREVENT MENISCAL TEAR Meniscal tear can be prevented by regular exercises that strengthen leg muscles which will stabilize the knee to protect it from injury. Knee can also be protected during sports or activities. Idea of warm-up and stretch before exercise use proper gear. CHARACTERISTICS OF OPEN KINEMATIC CHAIN EXERCISES These exercises are primarily concentric. Motion occurs distal to joint axis. Greater distraction and rotator forces are required. Stabilization of joint occurs via outside means. These movements activate mechanoreceptors in moving joint. These are characteristics with non-weight bearing activities. CHARACTERISTICS OF CLOSED KINEMATIC EXERCISES These movements are primary seen during eccentric contraction with dynamic stabilization via co-contraction. Motion occurs proximal to the joint axis. Greater compressive forces and less shearing. Enhanced proprioceptive feedback. AIM OF THE STUDY To compare the effectiveness of closed and open kinematic chain exercises in improving muscle strength, range of motion and balance in subjects with meniscal tear. REVIEW OF LITERATURE 1. Ricklin P, Ruttimann A, Delbuono MS. Meniscus Lesions: Practical problems of clinical diagnosis, arthrography and therapy.2nd ed. Thieme medical publishers: 2016: 16.2. Jackson JP. Degenerative changes in the knee after meniscectomy. BMJ 2016 ; 2: 525-7.3. Iobst CA, Stanitski CL. Acute knee injuries. Clin Sports Med.2016 ; 19 (4): 621-35.4. Goldstein J, Zuckerman JD. Selected orthopaedic problems in the elderly. Rheum Dis Clin North Am. Aug 2015; 26 (3): 593-616.5. Edelman