Thoracic Mobility Exercises Impact in Tibio Femoral Arthritis Patients

Effects of Thoracic Mobility Exercises on Thoracic Hyper Kyphosis and Impact on Hamstring Flexibility in Patients With Tibio Femoral Arthritis

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.

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.

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