• Journal of Korean Physical Therapy Science
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• v.9 no.3
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• pp.67-75
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• 2002

The purpose of this study was to evaluate the effects of quadriceps femoris flexibility exercise which would improve the degree of knee flexion range of motion, extension torque, and the activities of daily living (ADL) in elderly subjects with degenerative knee arthritis. Fourteen elderly patients (two men and twelve women) with degenerative knee arthritis participated and had a quadriceps femoris flexibility exercise intervention program in this study. The mean age of the patients was 70.00 years for men and 71.16 years for women. This study carried out the experimental study of one group pretest-posttest design, which evaluated the degree of knee flexion range of motion, extension torque, the ADL ability of the patients before and after applying the exercise intervention for five weeks. The results of this study are as follow: 1. The knee flexion ranges of motion of the patients were measured before and after the intervention and the ranges increased significantly both in the left and right knee flexion range of motion (p < 0.05). 2. The peak torque of the knee muscle, the peak torque/body weight, and average power of the patients showed significant increases in both in the left and right knee after applying the intervention (p < 0.05). 3. The intervention produced a significant reduction in pain of the patients (p < 0.05). Their functional activities of ADL improved significantly compared with before the intervention (p < 0.05). It has been shown that the quadriceps femoris flexibility exercise intervention program increased significantly the knee flexion range of motion, and extension torque, as well as an increase in performance of functional activities of ADL of the patients. Thus, the quadriceps femoris flexibility exercise should be considered as one of the therapeutic exercises for the elderly patients with degenerative knee arthritis applied.

• Physical Therapy Korea
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• v.26 no.3
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• pp.23-31
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• 2019

Background: Measurement of passive ankle dorsiflexion range of motion (ADROM) is often part of a physical therapy assessment. Objects: The objective of this study was to identify the effects of subtalar joint neutral position (SJNP) on passive ADROM according to knee position in young adults. Methods: We recruited 14 young adult participants for this study. Two examiners used a universal goniometer to measure passive ADROM with and without SJNP. Dorsiflexion force was applied to the forefoot until maximum resistance was reached in two knee positions (extension and $90^{\circ}$ flexion) in the prone position. Subtalar joint position was also recorded at maximum ADROM. Passive ADROM was measured three times at different knee and subtalar joint positions, in random order. Two-way repeated-measures analysis of variance was used to compare the effects of subtalar joint and knee position on passive ADROM. Results: Passive ADROM was significantly lower with than without SJNP during both knee extension (mean difference: $7.4^{\circ}$) and $90^{\circ}$ flexion (mean difference: $16.9^{\circ}$) (p<.01). Passive ADROM was significantly higher during $90^{\circ}$ knee flexion than during knee extension both with (mean difference: $5.8^{\circ}$) and without SJNP (mean difference: $15.2^{\circ}$) (p<.01). The valgus position of the subtalar joint was significantly lower with than without SJNP during both knee extension (mean difference: $3.3^{\circ}$) and $90^{\circ}$ flexion (mean difference: $4.3^{\circ}$) (p<.01). Conclusion: Our results indicate that the gastrocnemius may limit ankle dorsiflexion more than the soleus does. Greater dorsiflexion at the subtalar and midtarsal joints was observed during passive ADROM measurement without than that with SJNP; therefore, SJNP should be maintained for accurate measurement of ADROM.

• Journal of International Academy of Physical Therapy Research
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• v.9 no.1
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• pp.1426-1434
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• 2018

This study was conducted to observe the isokinetic strength (IS) of the hip, ankle, and knee joints in young age groups. Thirty eight men and thirty one women with mean age of $30.4{\pm}3.5$ and $32.8{\pm}4.4years$, respectively, were enrolled in this study. Measurements of hip flexion, extension, abduction, and adduction at $30^{\circ}/sec$, Knee flexion and extension at $60^{\circ}/sec$, ankle inversion, eversion, plantarflexion, and dorsiflexion $30^{\circ}/sec$ were conducted. Absolute IS (Nm), relative IS (Nm/kg), strength ratios, correlations between movements were observed. Significant differences in absolute and relative strength were observed between groups in all movement except in the relative ankle strength. Relative isokinetic strength ratios of hip flexion/extension were .45 and .55, knee flexion/extension were .84 and .89, ankle dorsi/plantarflexion were .30 and .29, and ankle eversion/inversion were .86 and .84 for men and women, respectively. In the hip extension, men had about three times the body weight, and women had about 2.5 times the strength. The abduction muscle had about 1.5 times the body weight of both men and women. Height and body weight showed the significantly strong correlating relationship with hip (r, .76-.86) and knee (r, .67-.84) strength. However, ankle strength showed the comparatively correlating relationship, especially in women (r, .03 - .36). Similar age and physique characteristics of female and male groups could provide useful isokinetic strength reference values for developing the exercise program for healthy and rehabilitation groups.

• Journal of Korean Physical Therapy Science
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• v.24 no.1
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• pp.69-78
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• 2017

Background: The purpose of the present study is to report the effect of muscle performance on knee flexion and extension by chin in exercise. Methods: This study was Participated in 10 healthy subjects. For conducting the chin-in exercise, subjects are lay down with supine position. Using the rounded towel, subjects was performed contraction of longus colli and longus capatis muscle by push the towel. Chin-in exercise was conducted 3 times a day, 4 times a week for 4 weeks. By using the Biodex system4, We measured absolute muscle strength, relative muscle strength, total exercise quantity and average rate of production in knee flexion and extension. The data was analyzed by the repeated-measure ANOVA for comparing before, after exercise 2 weeks, after exercise 4 weeks changes of factors. Results: After chin-in exercise, there was significant difference of before, after 2 weeks and 4weeks results in absolute muscle strength, relative muscle strength, total exercise quantity, average rate of production, agonist/antagonist ratio(p<.05). Conclusion: As a results of this study, chin-in exercise may help to improve muscle ability of knee joint activation and knee joint action performance.

• PNF and Movement
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• v.15 no.2
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• pp.177-183
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• 2017

Purpose: This study compared and analyzed the effect of the proprioceptive neuromuscular facilitation (PNF) arm extension pattern and leg flexion pattern on the contralateral lower extremity muscles when the patterns were applied to the same subject. Methods: In the study, 35 healthy men and women who understood the PNF patterns were selected as participants. The participants completed the PNF arm extension-abduction-internal rotation pattern and leg flexion-adduction-external rotation with knee flexion pattern in the supine position. While the patients' completed each pattern, the contralateral leg muscle activity was measured to examine the irradiation effect. The maximum isometric contraction time of the muscles to be measured was kept for 5 seconds, and the mean value was obtained by repeating the pattern three times. Results: When the leg flexion-adduction-external rotation with knee flexion pattern was completed, the muscle activity in the vastus lateralis, vastus medialis, biceps femoris, tibialis anterior, and gastrocnemius of the contralateral lower extremity was significantly greater than that found in the PNF arm extension-abduction-internal rotation pattern. Conclusion: The PNF leg flexion pattern showed greater muscle activity on the contralateral lower extremity than the arm extension pattern. Thus, the PNF leg extension pattern is more effective in the activation of the muscles associated with weight-bearing activity.

• Korean Journal of Applied Biomechanics
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• v.16 no.3
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• pp.105-115
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• 2006

The purpose of this study is to elucidate the mechanical characteristics of lower extremity joint movements at different walking speeds in obese people and suggest the very suitable exercise for obese person's own body weight and basic data for clinical application leading to medical treatment of obesity. This experimental subjects are all males between the ages of 20 and 30, who are classified into two groups according to Body Mass Index(BMI): one group is 15 people with normal body weight and the other 15 obese people. Walking speed is analysed at 3 different speeds ($1.5^m/s$, $1.8^m/s$, $2.1^m/s$) which is increased by $0.3^m/s$ from the standard speed of $1.5^m/s$. We calculated joint moments of lower extremity during stance phase through video recording and platform force measurement.Two-way ANOVA(Analysis of Variance, Mix) is applied to get the difference of moments according to walking speeds between normal and obese groups. Pearson's Correlation Analysis is applied to look into correlation between walking speeds and joint moments in both groups. Significance level of each experiment is set as ${\alpha}=.05$. As walking speed increases maximum ankle plantar flexion moment in the stance phase is smaller in obese group than in normal group, which is suggestive of weak toe push-off during terminal stance in obese group, and the highest maximum ankle plantar flexion moment in obese group during the middle speed walking($1.8^m/s.$). Maximum ankle dorsal flexion moment in obese group is relatively higher than in normal group and this is regarded as a kind of compensatory mechanism to decrease the impact on ankle when heel contacts the floor. Maximum knee flexion and extension moments are both higher in normal group with an increase tendency proportional to walking speed and maximum hip flexion and extension moments higher in obese group. In summary, maximum ankle plantar flexion moment between groups(p<.025), maximum knee moment not in flexion but in extension(p<.001) within each group according to increasing walking speed, and maximum hip flexion and extension moment(p<.001 and p<.004, respectively according to increasing walking speed are statistically significant but knee and hip moments between groups are not. Pearson correlation are different: high correlation coefficients in maximum knee flexion and extension moments, in maximum hip extension moment but not hip flexion, and in maximum ankle dorsal flexion moment but not ankle plantar flexion, in each group. We suspect that equilibrium imbalance develops when the subject increases walking speed and the time is around which he takes his foot off the floor.

• Physical Therapy Korea
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• v.11 no.4
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• pp.1-6
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• 2004

The kinematics involved in different landing strategies may be related to the occurrence of trauma. Several sources suggest that the angle of knee extension on touchdown and impact with the ground determines the magnitude of the impact force and, indirectly, knee loading. This study compared the initial knee angle and maximum knee flexion angle at the instant of impact on drop-landings between healthy men and women. In this study, 60 participants (30 males, 30 females) dropped from a height of 43 cm. A digital camera and video motion analysis software were used to analyze the kinematic data. When landing, there was significant difference between the two groups ($15.67{\pm}6.05^{\circ}$ in male, $24.10{\pm}6.34^{\circ}$ in female) in the mean knee flexion angle. The range of knee flexion on landing ($44.06{\pm}10.97^{\circ}$ in male, $36.96{\pm}9.99^{\circ}$ in female) also differed significantly (p<.05). The greater knee flexion that was observed in the male subjects would be expected to decrease their risk of injury. Women land with smaller range of knee flexion than men and this might increase the likelihood of a knee injury.

• Transactions of the Korean Society of Mechanical Engineers A
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• v.30 no.4 s.247
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• pp.457-464
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• 2006

The anterior cruciate ligament (ACL) is liable to a major injury that often results in a functional impairment requiring surgical reconstruction. The success of reconstruction depends on such factors as attachment positions, initial tension of ligament and surgical methods of fixation. The purpose of this study is to find isometric positions of the substitute during flexion/extension. The distance between selected attachments on the femur and tibia was computed from a set of measurements using a 6 degree-of-freedom magnetic sensor system. A three-dimensional knee model was constructed from CT images and was used to simulate length change during knee flexion/extension. This model was scaled for each subject. Twenty seven points on the tibia model and forty two points on the femur model were selected to calculate length change. This study determined the maximum and minimum distances to the tibial attachment during flexion/extension. The results showed that minimum length changes were $1.9{\sim}5.8mm$ (average $3.6{\pm}1.4mm$). The most isometric region was both the posterosuperior and anterior-diagonal areas from the over-the-top. The proposed method can be utilized and applied to an optimal reconstruction of ACL deficient knees.

• Journal of the Korean Orthopaedic Association
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• v.54 no.3
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• pp.254-260
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• 2019

Purpose: To evaluate the relationship between the knee function at 1 year postoperation and the gap difference (90° flexion gap-extension gap) in total knee replacement. Materials and Methods: Eighty-two consecutive osteoarthritis knees that underwent primary total knee replacement using navigation from March 2017 June 2017 were evaluated prospectively. The gap was measured using navigation after reducing the patella with towel clips. After checking the average values of the medial and lateral gaps at extension and 90° flexion knee, the gap difference (90° flexion gap-extension gap) was calculated. The knees were divided into three groups according to the gap difference (gap difference<0 mm, 0 mm≤gap difference<2 mm, 2 mm≤gap difference). The Knee Society score (KSS) and maximal knee flexion were compared at 1 year postoperation among three groups. Results: The numbers of knees according to groups were 37, 29, and 16 knees in regular order. The average of the KSS knee, KSS function, and maximal knee flexion at the 1-year follow-up were 81.21±8.31, 71.34±9.84, and 126.48°±7.28°, respectively. No statistically significant difference in KSS was observed among the 3 groups. The third group (2 mm≤gap difference) showed a larger maximal knee flexion than the other groups in the Mann-Whitney test. Conclusion: The group of total knee replacement (2 mm≤90° flexion gap-extension gap) showed larger maximal knee flexion than the other groups at the 1-year follow-up in statistics.

• The Journal of Korean Physical Therapy
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• v.30 no.5
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• pp.159-165
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• 2018

Purpose: The aims of this study were to determine if game-based training with constraint-induced movement therapy (CIMT) is effective in improving the balance ability in female patients with a total knee replacement, and to provide clinical knowledge of CIMT game-based training that allows the application of total knee replacement. Methods: Thirty-six patients who had undergone a total knee replacement were assigned randomly to CIMT game training (n=12), general game training (n=12), and self-exercise (n=12) groups. All interventions were conducted 3 times a week for 4 weeks. All patients used a continuous passive motion machine 5 times a week and 2 times a day for 4 weeks. The visual analog scale (VAS), muscle strength of knee flexion and extension, and range of motion (ROM) of knee flexion and extension were assessed, and the functional reach test (FRT), and timed up and go (TUG) test were performed to evaluate the balance ability. Results: All 3 groups showed significant improvement in the VAS, knee flexion and extension muscle strength, FRT, and TUG test after the intervention (p<0.05). Post hoc analysis revealed significant differences in FRT, and TUG of the CIMT game training group compared to the other group (p<0.05). Conclusion: Although the general game training and CIMT game training improved both the knee extension muscle strength and dynamic balance ability, CIMT game training had a larger effect on dynamic balance control.