Thoracic Mobility Exercises Impact in Tibio Femoral Arthritis Patients

Riphah International University

Status: Completed

Conditions: Knee Osteoarthritis (Knee OA)

Treatments: Other: Self myofascial release with foam roller, T6- T7 Maitland mobilization + Conventional therapy; Other: Thoracic mobility exercises + Conventional therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT06737783

REC/02007 Sameen Fatima

Details and patient eligibility

About

The aim of this randomized clinical trial is to find the effect of thoracic mobility exercises on thoracic hyper kyphosis and hamstring flexibility with tibiofemoral arthritis patients on reducing hyper kyphotic posture, knee pain and improving flexibility of hamstring muscles.

Full description

Tibio Femoral Arthritis is a painful heterogeneous musculoskeletal condition that comprises of articular cartilage degradation, distortion of joint tissues, depletion in synovial fluid and progression over time. Decline in joint ROM usually began in fourth decade, more common in women in the age of menopause mostly the age of 45 years or elder. In Pakistan prevalence of Tibio femoral arthritis is 28.0% in urban population and 25.0% in the rural population, estimated o outstretch 35% by 2030. Hamstring muscle are part of superficial posterior anatomical chain in body that form meridians or myofascial chains connected to thoracolumbar fascia via sacro tuberous ligament.

Knee joint movements are primarily facilitated by the quadriceps and hamstrings, which play a crucial role in ensuring smooth and accurate ambulation. Tightness in hamstring put stress on Tibio-femoral joint which further reduce its range of motion especially knee extension, joint loading problems, induce compensatory movements, gait limitations, disturbs overall spinal postural alignment, increase thoracic kyphosis, decrease lumbar lordosis, and inducing posterior pelvic tilt. Until now most existing studies focus on the impact of thoracic mobility on thoracic spine issues or general posture, with limited research on its secondary effects on lower limb flexibility in 45 to 65 years old Tibio femoral arthritic patients. There is still research gap present to identify comprehensive effects of thoracic mobility exercises, on hyper kyphotic postures with tightened hamstrings, complementing Tibio femoral arthritis with aging.

Enrollment: 32 patients

Sex: All

Ages: 45 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Thoracic Kyphotic angle > 40
• Asymptomatic (no pain symptoms in) thoracic spine
• Able to stand independently
• Less than 70 degree Hip Flexion Angle on active SLR, with limited knee extension range more than 20 degree restriction on AKE test
• Bilateral Hamstring tightness
• Visual Analogue Scale in targeted Joint Tibiofemoral arthritis >3 cm
• Having Osteoarthritis in Tibio femoral Joint, according to KL (Grade 2 and 3)
• X-rays showing evidence of reduced knee spaced/osteoarthritis symptoms B/L( >2 year)

Exclusion criteria

• Muscle/tendon injuries of hamstring
• Spinal Injuries, scoliosis, tumors and malignancies
• Any surgery, infection, skin sensitivity, trauma, fracture and fall
• Involvement in regular flexibility yoga program
• Patient with intra articular steroidal therapy with in last 6 months
• Patient unwilling to comply follow up schedule
• Patient involvement in another interventional study

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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32 participants in 2 patient groups

Thoracic mobility exercises + Conventional therapy

Experimental group

Description:

mobility exercises comprises of Cat and camel stretch (On hands and knees (supported with knee braces), alternating between arching the back up and dropping it down to stretch thoracic spine), Thoracic rotations in side lying (side lying on the side with knees bent, rotating the upper body to increase thoracic mobility alternatively), Thoracic extension at wall using body weight (Standing with back to wall, gently pushing the upper back into extension while keeping the lower back stable), half kneeling chop thrust (Kneeling on one knee (supported with knee braces), rotating the torso while keeping the pelvis stable to mobilize the thoracic spine) ,Thoracic extension with a foam roller (Lying on the back with foam roller along thoracic spine, rolling gently to extend the thoracic spine in supine position). Adopt these positions with 5 secs hold and 15-20 reps will be performed for 2 sets and 10 reps per set. hold and 15-20 reps will be performed for 2 sets and 10 reps per set.

Treatment:

Other: Thoracic mobility exercises + Conventional therapy

Self myofascial release with foam roller, T6- T7 Maitland mobilization and conventional therapy

Active Comparator group

Description:

Hamstring Self myofascial release with foam roller (Sitting with one leg extended, roll the foam roller along the hamstring while applying pressure to tender spots) 3 sets with 30 to 120 secs rolling duration per second for 5 mins T6-T7 grade 3 Maitland mobilization (Lying on the back, the therapist applies a sustained, posterior-to-anterior force on T6-T7 in prone position) 30 repetitions, with 1 min rest between 4 sets for 15 mins. Conventional therapy includes Hot pack/Cold pack + tens = 15 mins, Frequency 80 Hz, Pulse duration: 100 microseconds, Static quads (10 reps, 10 second hold, 2 sets), Active knee flexion and extension ROMs (10 reps, 5 secs hold, 2 sets), Long Axis Knee traction (5 reps, 30 secs hold, 10sec rest in b/w 2 sets), Kaltenborn Knee Glides Ant and Post direction ( 5 reps, 30 secs hold,10 sec rest interval in b/w 2 sets), Calf stretches (10 reps, 5 secs hold , 2 sets).

Treatment:

Other: Self myofascial release with foam roller, T6- T7 Maitland mobilization + Conventional therapy