• The Journal of Korean Physical Therapy
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• v.36 no.1
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• pp.27-32
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• 2024

Purpose: This study was conducted to verify the effect of applying a pressure biofeedback unit on walking ability and knee joint function while performing knee joint extensor strengthening exercises using resistance exercise equipment in total knee replacement (TKR) patients. Methods: This study was conducted on twelve patients receiving rehabilitation treatment after being admitted to a rehabilitation hospital post-TKR. Of these, six were allocated to a feedback group with a pressure biofeedback unit, and the other 6 were allocated to a control group without a pressure biofeedback unit. The subjects performed an exercise program for 45 minutes per session, five times a week, for two weeks. Walking ability and knee joint function were evaluated and analyzed before and after exercise. Results: The feedback group showed significantly better improvements in walking speed, gait cycle, step length on the non-operation side, time on the foot on the operation side, K-WOMAC stiffness, and K-WOMAC function than the control group (p<0.05). Conclusion: When strengthening the knee joint extensor muscles using resistance exercise equipment in TKR patients, the provision of a pressure biofeedback unit was found to improve walking ability and knee joint function by inducing concentric-eccentric contraction of the knee joint extensor muscles. Therefore, the study shows that exercise based on the provision of a pressure biofeedback unit should be considered when strengthening knee joint extensor muscles to improve the walking ability and knee joint function of TKR patients in clinical practice.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.1
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• pp.101-108
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• 2021

Purpose : The purpose of this study is to verify the effect of selective muscle strengthening of the knee joint extensor muscles using a pressure biofeedback unit to improve knee extensor strength and the balance ability of total knee replacement patients. Through this, we tried to provide clinical information. Methods : In this study, 12 patients with total knee replacement were recruited from a rehabilitation hospital. They were divided into two groups: a feedback group (n=6) and a control group (n=6). All patients received 30 minutes of continuous passive motion and leg-strengthening exercises for 15 minutes five times a week for two weeks. Subjects performed knee extension exercises with or without biofeedback units in the sitting position. The knee extensor strength and balance ability were measured before and after exercise. Knee extensor strength was measured by Biodex system 3 and balance ability was measured by Balancia software. Results : Both the experimental group and the control group showed a significant difference in the muscle strength of the knee joint extensor muscles after intervention (p<.05). In comparison, the experimental group showed a significant difference than the control group (p<.05). Both the experimental group and the control group showed a significant difference in the velocity average, path length, area 95 % center of pressure (COP), weight distribution, five times sit to stand test (FTSST) after intervention. In comparison, the experimental group showed a significant difference in velocity average, area 95 % COP, and FTSST than the control group (p<.05). Conclusion : In order to strengthen the knee extensor muscle and improve the balance ability in total knee replacement patients, it is necessary to consider providing pressure biofeedback unit during leg strengthening exercises.

• The Journal of Korean Physical Therapy
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• v.33 no.1
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• pp.34-39
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• 2021

Purpose: The purpose of this study was to verify the effectiveness of repetitive sit to stand training to improve knee extensor strength and walking ability of total knee replacement patients. Methods: In this study, 12 patients with total knee replacement patients were recruited from a rehabilitation hospital. They were divided into two groups: a repetitive sit to stand group (n=6) and a control group (n=6). They all received 30 minutes of continuous passive motion (CPM). After that, the repetitive sit to stand group performed repetitive sit to stand training, and the control group performed resistance exercise for 15 minutes five times a week for 2 weeks. After 2 weeks of training, knee extensor strength and spatiotemporal gait parameters were measured. Knee extensor strength was measured by Biodex system 3, walking ability was measured by Biodex gait trainer 2. Paired t test was performed to verify the difference between before and after intervention within the group, and analysis of covariance was used to verify the differences between the two groups. Results: After the training periods, the repetitive sit to stand group showed a significant improvement in knee extensor muscle strength, walking speed, step length of the operated side, and step length of the non-operated side (p<0.05). Conclusion: The results of this study showed that repetitive sit to stand training was more effective in improving knee extensor muscle strength and walking ability. Therefore, to strengthen knee extensor muscles and improve the walking ability of total knee replacement patients, it is necessary to consider repetitive sit to stand training.

• Journal of Korean Medicine Rehabilitation
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• v.28 no.2
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• pp.105-111
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• 2018

Objectives The purpose of this study was to examine the effects muscle fatigue at the knee muscles on balance during standing in healthy adults. Methods Thirty healthy adults were recruited along with their written informed consent. Subjects were randomly assigned to knee extensor group (fatigue on knee extensor, KE), and knee flexor group (fatigue on knee flexor, KF). And subjects performed exercise with each muscle group until muscle fatigue was induced. They were assessed balance ability by functional reaching test (FRT), limit of stability (LOS), and postural sway (one leg standing, normal eye open (NO), normal eye close (NC), pillow with eye open (FO), and pillow with eye close (FC)) before and after fatigue. Results There were significant group differences balance performances in FRT, anterior of limit of stability, one leg standing, and the muscle fatigue of knee muscles were decreased balance performances. The balance performance was affected by visual sense and proprioception. Conclusions These results show that the muscle fatigue of knee muscles decreased balance performance. Therefore, balance exercise program should be trained without muscle fatigue.

• PNF and Movement
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• v.19 no.1
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• pp.9-17
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• 2021

Purpose: This study aims to verify the effectiveness of sit-to-stand training with visual feedback to improve balance ability and knee extensor strength of total knee replacement patients. Methods: In this study, 15 patients with total knee replacement participated in this study. Subjects were assigned to two groups: a feedback group (experimental group)(n = 8) and a control group (n = 7). They all received 30 min of continuous passive motion (CPM) and sit-to-stand training for 15 min five times per week for two weeks. Knee extensor and balance ability were measured. Knee extensor was measured by Biodex system 3; balance ability was measured by Balancia software. Results: After the intervention, there was a significant difference in the strengthening of the knee extensor muscles in the feedback group, area 95%, weight distribution of the affected side, and the sit-to-stand test repeated five times (p < 0.05). Conclusion: The results of this study showed that sit-to-stand training with visual feedback was more effective in increasing knee extensor muscle strength and balance ability than the sit-to-stand training without visual feedback. Therefore, in order to improve the knee extensor muscle and the balance of total knee replacement patients, it is necessary to consider providing visual feedback during sit-to-stand training.

• Journal of Advanced Technology Convergence
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• v.1 no.1
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• pp.33-42
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• 2022

The flexors and extensors of the knee joint are essential for maintaining body stability. The purpose of this study was to investigate the correlation between the isokinetic parameters of the knee flexor and extensor muscles and the function of the lower extremity muscles. Twenty-two healthy adults participated in this study. The time to peak torque (TTP), acceleration time (AT), and peak torque (PT) of the knee flexor and extensor muscles were measured. A 20m sprint, Sargent jump, one leg hop test, and side shuffle were measured to evaluate lower extremity function. The correlation between each variable was analyzed using Pearson correlation coefficient. PT of the knee flexor showed a significant correlation with single leg hops and 6M hops in a single leg. PT of knee extensors was found to be significantly correlated with Sargent jumps and triple hops. Based on the results of this study, we suggest that the strength of the knee flexor and extensor muscles has the potential to be used to predict lower extremity function.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.10 no.1
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• pp.30-36
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• 2003

Purpose: The strength of hand grip, low back muscles and knee joint muscles were measured and then compared to the bone mineral density (BMD) of each forearm bones (including ulna and radius), lumbar spine, and femur in young women in order to identify the relationship between muscle strength and bone mineral density. Method: The BMD was measured with a Dual Energy X-ray Absorptiometry and muscle strength was measured with a handgrip dynamometer and a Cybex Norm. Data were analyzed with frequencies, percentages, means, and Pearson correlation coefficients. Result: 1) Higher grip strength correlated positively with higher BMD in the forearm (r=.246, p=.007), higher low back extensor strength with higher BMD in the femur (neck, trochanter and Ward's triangle)($r=.323{\sim}.226$, $p=.003{\sim}.043$) and higher strength in the knee joint extensor with higher BMD in the lumbar spine (r=.227, p=.041), femur neck, and femur trochanter significantly ($r=.295{\sim}.226$, $p=.007{\sim}.043$). There was no significant correlation between the strength of low back extensors and BMD in the lumbar spine, now with strength of knee joint flexor and the BMD in the femur. 2) The muscle strength of each part of the body had significant positive correlations to each other part ($r=.255{\sim}.728$ $p=.021{\sim}.000$) Conclusion: The results of this study showed that with the development of a muscle there was an increased BMD of the corresponding part, and the BMD of each part was influenced by adjacent muscles. To promote the health of bones, it is important to strengthen the muscles of related bones, based on balanced development of all muscles.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.2
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• pp.37-43
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• 2021

Background: The purpose of this study is to compare and analysis the changes in strength and endurance of the knee extensor muscles after Anterior cruciate ligament reconstruction. Methods: Twelve male subjects with ligament injury were seated on Biodex and the hip joint was flexed at 110°, and torso, lower extremities, and legs were fixed using Velcro. The resistance device was placed at a point 3cm above the ankle, and measurements were taken before and a surgery at 60°/sec and 180°/sec when the knee was maximally extended. The postures ingeniously combine forward-bending poses countered with backward-bending ones. Results: There was no significant difference in the comparison of muscle strength of 60°/sec and 180°/sec before surgery. But there was a significant difference after surgery. There was significant difference in muscle endurance both before and after surgery. There was a significant difference in the pre- and post- operative comparison values of muscle strength and endurance in isokinetic movements at 60°/sec and 180°/sec during knee extension on the injured side. Conclusion: For cruciate ligament tears, Orthopedic reconstruction is recommended. Correct alignment of the knee ligament after surgery can enhance the strength and endurance of the quadriceps femoris during knee extension rejuvenated.

• Journal of Korean Physical Therapy Science
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• v.7 no.2
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• pp.711-725
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• 2000

The purpose of this study was to determine the effects of knee flexor isokinetic training on the mean peak torque of knee muscles and hamstrings-to-quadriceps ratio(H/Q ratio) in hemiplegia able to walk independently for more than 10 meters, to analyze the effect of torque increasing on functional aspects; fatigability and ambulation times, also. Forty-one adult subjects with hemiplegia secondary to a stroke partipated in this study. All participants were in/out patients at the College of Medicine, Pocheon CHA University, Pundang CHA General Hospital. The patients were allocated to two groups: one group exclusively for isokinetic maximal voluntary knee flexor training at $150^{\circ}$/sec(n=20) and the other exclusively for isokinetic maximal voluntary knee flexor training from $30^{\circ}$/sec to $150^{\circ}$/sec (n=21) gradually. The allocation was performed according to patient age, sex, affected side to minimize imbalance between the two training groups. Training was carried out from February 14th, 2000 to April 15th, 2000. Analysis of the data was done by means of t-test, x2-test, paired t-test, ANOVA, and multiple regression analysis. The results of this study were as follows: 1. There were no significant differences between the two groups in mean peak torque of knee muscles and relative decreases in knee extensor mean peak torque with increased knee flexor velocities before training (P<.05). 2.There was no significant differences between the two groups in the H/Q ratio, and no relative increases with increased knee flexor velocities before training. 3. there were significant changes in mean peak torque in group A after training(P<.05), but no significant differences as the velocity increased 4.there were significant changes in mean peak torque in group B after training(P<.05), but no significant differences as the velocity increased 5.there were no significant differences between the two groups, and no significant differences in mean peak torque increase rate between the groups with increased knee flexor velocities after training 6.H/Q ratio increased with increased knee flexor velocities between the two groups, but not statistically And there was no significant differences between the groups with increased knee flexor velocities 7.After training, Ambulation time and its decreasing rate decreased significantly in group B (P<.05) 8Before and after training, there was no significant differences between the groups in the fatiguability 9. In the multiple regression analysis, mean peak torque increase rate of the knee extensor and flexor were higher in group B than A(P<.05), and significantly higher with increased knee flexor velocities (P<.05) Also, training method influenced on Ambulation times decreases significantly(P<.05). Results indicated that knee flexor isokinetic training was effective to knee extensor and flexor mean peak torque increase in the hemiplegia able to walk independently for more than 10 meters. Therefore, we were able to conclude that gradual training from low to high velocity was more effective in the increase of mean peak torque of knee joint and decrease of Ambulation times than training only at high velocity.

• Korean Journal of Applied Biomechanics
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• v.25 no.3
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• pp.275-281
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• 2015

Objective : In order for Taekwondo athletes to perform destructive kicking performance, they are expected to have Taekwondo-specific muscle properties such as high muscle strength and power. The purpose of this study was to investigate the joint angle-dependent force-producing property of Taekwondo athletes' knee extensor muscles, which is one of the primary muscle groups involved in kicking performance. Method : Ten Taekwondo male athletes (age: $19.9{\pm}0.7yrs$, height: $180.6{\pm}6.2cm$, body mass: $75.9{\pm}8.9kg$, career: $9.2{\pm}2.9yrs$.) and 10 healthy male non-athletes (age: $26.3{\pm}2.6yrs$, height: $174.2{\pm}4.8cm$, body mass: $72.8{\pm}7.7kg$) participated in this study. Subjects performed maximum isometric knee extension at knee joint angles of $40^{\circ}$, $60^{\circ}$, $80^{\circ}$, and $100^{\circ}$ (the full knee extension was set to $0^{\circ}$) with the hip joint angles of $0^{\circ}$ and $80^{\circ}$ (the full extension was set to $0^{\circ}$). During the contractions, knee extension torque using an isokinetic dynamometer simultaneously with muscle activities of the rectus femoris (RF), and the vastus lateralis (VL) and vastus medialis (VM) using surface electromyography were recorded. Based on the torque values at systematically different knee-hip joint angles, the joint torque-angle relationships were established and then the optimal joint angle for the knee extensor was estimated. Results : The results of this study showed that the isometric knee extension torque values were greater for the Taekwondo athletes compared with the non-athlete group at all hip-knee joint angle combinations (p<.05). When the hip joint was set at $80^{\circ}$, the peak isometric torque was greater for the Taekwondo athletes compared with the non-athlete group ($313.61{\pm}36.79Nm$ and $221.43{\pm}35.92Nm$, respectively; p<.05) but the estimated optimum knee joint angles were similar ($62.33{\pm}5.71^{\circ}$ and $62.30{\pm}4.67^{\circ}$ for the Taekwondo athletes and non-athlete group, respectively). When the hip joint was set at $0^{\circ}$, the peak isometric torque was greater for the Taekwondo athletes compared with the non-athlete group ($296.29{\pm}45.13Nm$ and $199.58{\pm}25.23Nm$, respectively; p<.05) and the estimated optimum knee joint angle was larger for the Taekwondo athletes compared with the non-athlete group ($78.47{\pm}5.14^{\circ}$ and $67.54{\pm}5.77^{\circ}$, respectively; p<.05). Conclusion : The results of this study suggests that, compared with non-athletes, Taekwondo athletes have stronger knee extensor strength at all hip-knee joint angle combinations as well as longer optimum muscle length, which might be optimized for the event-specific required performance through prolonged training period.