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Objectives: Balance disorder is an important risk factor in elderly people falling while walking. Knee pain and low back pain are the most common disorders related to aging that disturb the balance of the elderly. The aim of this study is to investigate the relationship between chronic low back pain and chronic knee pain with dynamic balance in the elderly. Methods & Materials: In this analytical cross-sectional study using the census method, 79 elderly people aged 65 years and older living in a nursing home in Mashhad were selected based on the inclusion and exclusion criteria of the study. In addition to measuring demographic information, fear of falling was assessed with the Persian version of Falls Efficacy Scale - International (FES-I) and pain was assessed with a visual Analog Scale (VAS). To assess dynamic balance, the Time Up and Go (TUG) test was taken from the participants. Data analysis was done with SPSS23 software. Results: There was a significant difference between the three groups of the elderly in the values of the balance test (p=0.050). With the increase in the fear of falling questionnaire score, the average values of the balance test increased significantly (p=0.01). With increasing age, the average values of the balance test increased significantly (p=0.006). Conclusions: Dynamic balance was poorer in the elderly with chronic knee pain than in the elderly with chronic low back pain. Therefore, focusing on the prevention and treatment of knee injuries at younger ages will play an important role in preventing balance disturbances in the elderly.

Background and Objective: : Employees of wastewater treatment plants are exposed to various harmful factors in the work environment that can threaten their health. In this research, the health status of the employees of Mashhad sewage treatment plants has been evaluated to help by implementing intervention programs to improve the health of employees. Materials and Methods: In this descriptive-analytical study, (bioaerosols, UV rays, heat stress, and hydrogen disulfide gas) were measured in 5 treatment plants in Mashhad. All study variables, including health status, clinical tests, and job stress, were analyzed analytically in two operational and administrative employee groups. The standard HSE occupational stress questionnaire was used to investigate the state of occupational stress. All data were transferred to the computer and data analysis was done with the help of software SPSS20. Results: The amount of pollutants except H2S gas was lower than the national occupational exposure limit. The number of smokers, diabetics, knee pain, and hearing loss was higher among operational than administrative employees, and hypertension, increased cholesterol, back pain, and skin disease were also more common in office workers than operational workers, but there were no statistically significant differences. Obesity and overweight (p<0.009) and increased triglycerides (p<0.05) were more common in administrative than operational workers, which had statistically significant differences. The state of job stress in operational employees was statistically significant compared to administrative employees regarding role (p<0.018) and communication (p<0.002). Conclusion: Appropriate occupational health interventions to reduce pollutants, implement ergonomic programs and improve nutrition and increase physical activity and stress management can play an effective role in improving the health of employees of these units. [ABSTRACT FROM AUTHOR]

Background & objectives: Knee osteoarthritis is an important cause of pain and disability in the community. The present study investigated the risk factors for primary osteoarthritis of the knee in patients with knee pain and their relationship with knee osteoarthritis. Methods: 87 patients were included in the study and were matched in terms of age. Cases consisted of female patients less than 50 years of age with knee pain and the control group was selected from patients under 50 years of age with knee pain and no radiographic findings of osteoarthritis. Results: This study showed that the rate of osteoarthritis of the knee was significantly related to body mass index (p=0.001). The relationship between knee osteoarthritis and ESR was not significant, but an increase in CRP with a p-value of 0.01 was associated with a risk of approximately a 3.5-fold increase in knee osteoarthritis. With increasing education, the rate of knee osteoarthritis decreased (p=0.022). The Increased circadian outpatient activity was significantly associated with increased knee osteoarthritis (p=0.032). In performed assessments on osteoarthritis of the knee, there was no statistically significant relationship between the type of bathroom used, the use of stairs, and residential houses. Conclusion: Knee osteoarthritis has a relationship with body mass index, Education level, CRP index, and circadian activity level. it is recommended to lose weight in people with abnormal body mass index, exercise, and improve their lifestyle to reduce the incidence of knee osteoarthritis and disability.

Background & Aims: Patellofemoral pain syndrome (PFPS) is one of the common causes of anterior knee pain, which is related to the intrinsic and extrinsic risk factors that affect the patellofemoral (PF) joint interface. The common causes of PFPS are: PF joint overloading, a disorder of patellar and femoral articular surface, knee muscular imbalance and weakness, an increase of Q angle, excessive subtalar pronation. This pathological chain can produce excessive compressive stress on the patellofemoral joint surface that causes nagging pain that significantly affects patients’ quality of life (QOL) and disability. The main factor of the therapeutic approach in conservative treatment of PFPS is exercise therapy including restoration of power balance quadriceps, improvement of the range of motion, as well as prevention of unequal compressive stresses on the PF joint. Generally, two exercise-based plans: Open kinetic chain (OKC) and closed kinetic chain exercises (CKC), have been employed for managing PFPS. It has been claimed that CKCs may provide more sensory feedback that could be effective in controlling joint stresses compared to OKCs. Quadriceps muscle actuates separately leading to an increase in PF compression stress; whereas muscular co-contraction occurs in CKCs that enhance joint stability and mitigate joint pain. Despite the existence of some clinical evidence of the effectiveness of the two exercise programs in the treatment of PFPS, there is a scarcity of scientific reports showing which method is most effective. The present study aimed to compare the therapeutic effect of the OKC and CKC exercises on the pain and functional statement in patients with PFPS. Methods: This study was designed as a randomized clinical trial with ethical approval of the Research Ethics Committee of Iran University of Medical Sciences. It was conducted on 64 patients with PFPS who were referred to the Clinic of Sports Medicine in Rasoul-e-Akram hospital in Tehran, Iran. Inclusion criteria were: 1) age between 18-70 years, 2) pain in the anterior knee for at least two months with pain intensity equal to or higher than three based on the visual analog scale (VAS), 3) three or more positive clinical signs in the following tests: Clarke's sign, McConnell test, Nobel compression test, Waldron test, and patella in medial or lateral positions, 4) pain arose in at least two of the following situations: Resisted contraction of the quadriceps, squatting, prolonged sitting or kneeling, descending or ascending stairs, 5) normal mental state and 6) not participating in sports programs and physical therapy in the recent three months. On the other hand, exclusion criteria were: 1) history of previous surgery or injury in the knee, 2) history of acute traumatic injuries, 3) history of knee locking, 4) history of patellar dislocation or knee osteoarthritis, 5) history of knee intra-articular injection in the past six months, 6) Osgood-Schlatter disease, 7) unwillingness to participate in the study; 8) uncompleted evaluation programs; 9) any damage to the knee joint during the study and 10) using any therapeutic protocols. Therefore, outcome measurements were consisted of anthropometric parameters which were measured by the standard tools, pain intensity by VAS, 6-minute walking test (6MW test), timed up and go (TUG), sit-up test (numbers of sitting and getting up from a chair in 30 seconds), KUJALA anterior knee pain questionnaire and Functional Index Questionnaire (FIQ) for assessment of lower extremity function. The outcome measurements were carried out at three intervals: The baseline or pre-intervention, the 4th week, and the 8th week. Also, study intervention: A total of 117 patients with PFPS, 64 patients were included and randomly allocated to two groups, with 32 patients in each group. The participants began a 24-session program (three times per week) in each group after the pre-intervention assessment. All groups received the same warm-up exercises. OKC Protocol- the OKC group, received an exercise protocol that consisted of quadriceps setting, straight leg raise (SLR), and knee extension. CKC Protocol- the CKC group, received an exercise protocol that consisted of mini squat, Standing wall sit, and step up. Statistical analysis: The SPSS (version 16; SPSS Inc., Chicago, IL, USA) was reasonably applied to provide the analysis. The normality of data was analyzed using the Kolmogorov-Smirnov test. Independent t-test and repeated measurement were also fulfilled to compare the results over time within and between groups. Results: Comparing the mean VAS pain score at baseline showed no difference between the OKC and CKC groups. And no difference was revealed in the mean KUJALA anterior knee pain score between the two groups before, one month, and two months after exercises. However, the results for the FIQ test were slightly different. Comparing the mean functional index between the subjects programmed for OKC and CKC exercises, it was presented that the CKC was slightly higher after two months of intervention. Again for the mean 6MW test, TUG test, and sit-up test, the difference was negligible between the two groups. Conclusion: Findings in the present study showed that by planning both OKC and CKC training programs for eight weeks, a significant improvement in pain intensity and functional expression was achieved. Still, no priorities were determined between the two programs. As indicated by Witvirouw et al., an increase in the torque peak of the functional capacity of knee-related muscles and also pain reduction were found in both exercise groups. In a similar study, excellent results were revealed related to the pain and functionality. Contrary to our observation, Stiene et al., concluded that after an eight-week treatment, the CKC exercises were more effective than the OKC exercises. The above exposed statement suggests that both the OKC and the CKC exercises have been employed to treat the PFPS, but the OKC program seemed more effective in pain relief. Moreover, some studies could not demonstrate a discrepancy between the two exercise types. As indicated in a systematic review no significant differences in improvement of function or reduction of pain were apparent between the two types of exercise in any of the studies. There are significant differences between OKC and CKC protocols regarding action mechanisms and muscular effects. In OKC, a combination in which the terminal joint is free, while in CKC, one in which the terminal joint meets with some considerable external resistance that prohibits or restrains free movement. Also, in OKC, the distal end is opened, whereas, in CKC, the motion of one segment at one joint will produce motion at all other joints in the system in a predictable manner. In CKC exercise, the main basis is an exercise with greater proprioceptive input leading to an increase in proprioceptive ability, increasing joint compressive forces and knee stability, and thus increasing muscular performance. Totally, CKC exercise seemed to be safe because of decreasing shear force and increased muscle co-contraction. Unlikely, some advantages have also been pointed out for OKC versus CKC exercise, including improving strength and increasing ROM at specific joints, correcting strength deficits of specific muscles or joints, and beginning rehabilitation when athletes are not able to perform CKC exercises. It has been demonstrated that OKC and CKC exercises are equally effective in pain reduction and functional improvement. They are strongly recommended as rehabilitation protocols in patients with PFPS. However, why one protocol is superior to another remains controversial and needs further assessment. [ABSTRACT FROM AUTHOR]

Background and Aim: Proximal femoral fracture is one of the most common fractures, especially among elderly people. Skin and skeletal traction are usually used to reduce the pain in the patients before surgery. In this study we investigated the effects of skin traction and use of pillow under knee before surgery on pain relief in the patients with proximal femoral fracture. Material and Methods: This study included patients with proximal femoral fractures referring to Ayatollah Kashani Hospital in Shahrekord in 2016. Patients were randomly assigned to skin traction and under knee pillow groups. Demographic data including gender, age, body mass index and other information such as type of fracture, time interval between the accident and referring to the hospital, the amount of sedatives taken, the time interval between admission and surgery, type of device used for surgical fixation and pain assessment by VAS were obtained after interview with the participants and recorded in a questionnaire. Results: The traction group included 19 men and 19 women with a mean age of 74.81 ± 13.10 years and the under knee pillow group consisted of 15 male and 20 female participants with a mean age of 73.08 ± 13.11 years. The mean pain scores did not show any significant differences at the first visit (traction group 7.31±2.08; pillow group 6.94±2.54) and also on every separate day of the study up to the fifth day of hospitalization in the traction (2.40±2.07) and pillow groups (2±0) (P>0.05). Conclusion: Considering the complications of skin transaction such as skin ulcers and its subsequent cost of treatment, in this study we found that use of pillow under knee was associated with a reduction in pain similar to the traction method and had fewer complications.

Background and Aim: Knee pain causes the inability to perform daily activities, reduced productivity and combat readiness of the troops, and increased health care costs. The aim of this study was to investigate the risk factors related to knee pain in male military personnel. Methods: This study was a case-control study in which 150 military personnel with chronic knee pain and 150 healthy men were assessed through simple nonprobability sampling. A three-part questionnaire (Demographic, occupational, and Clinical Information) was used with closed questions, Knee Injury and Osteoarthritis Outcome Score (KOOS), WOMAC Osteoarthritis Index, JRPD (Job-Related Physical Demands questionnaire), and HRA (Health Risk Appraisals questionnaire) and meters and scales as tools. For the people of both groups, the four mentioned questionnaires were taken in one session and the contents of both groups were analyzed and reviewed. Results: There was no statistically significant difference between the baseline demographic results (age, height, weight, work experience) in the two groups. Among the factors studied, there was a positive significant relationship between knee pain and hard job category variables (P = 0.010), prolonged work experience (P = 0.001), heavy and continuous physical activity (P = 0.025), weakness in quadriceps (P = 0.001), variables of exercise level (P = 0.002), previous history of knee pain (P = 0.003), and the existence of bad knee posture during activity (P = 0.003) (working in the position of bending the knees for a long time (P = 0.001), working in the position of two knees for a long time (P = 0.003), working in long-term quadruple position (P = 0.003), and working in a long-term squatting position (P = 0.002). Also, BMI (P = 0.015), level of education (P = 0.001), smoking (P = 0.015), deformity in the lower limbs and knees (P = 0.003), swelling in the knee (P = 0.003), cryptation in knee (P = 0.002), dryness and limited mobility in the knee (P = 0.005), and shortening of the hamstrings muscles (P = 0.003) showed significant negative correlation with knee pain. Conclusion: It seems possible to reduce the amount of these factors by preventing knee pain or expanding them, and improving the level of military personnel efficiency. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) is one of the prevalent diseases in joints that the Knee joint is the most frequently involved than other joint. Its been shown that these patients get quadriceps muscles weakness deficits in knee. The aim of this study is evaluation of the effect of isokinetic exercise on knee pain, stifiness and the function of joint knee in patients with knee osteoarthritis. Methods: In this clinical traits studytrial 30 women ranging from 45-65 with average knee osteoarthritis were studied in two groups of control and introversion according to America Society of Rheumatology criteria. The control group received the routine protocol treatment of knee osteoarthritis physiotherapy. The case group (as isokinetic training group) in addition to routine protocol received isokinetic training. The rate of the patients’ pain was measured by McGill pain questionnaire and their function by WOMAC questionnaire before and after implementation workouts. Results: All parameters in both isokinetic exercises and physiotherapy groups, improved after treatment process.(P<0.05). While comparsion of variation in intergroups/ between groups showed which isokinetic exercises along with physiotherapy treatment have good function in improvment and intensity of pain reduction compare of physiotherapy treatmentand (P < 0.001, P<0.001 and P=0.008). Conclusion: The increase of isokinetic exercises to physiotherapy treatment significantly enhanced functional and reduced patient’s knee pain compared to patients that are treated with physiotherapy. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Mechanical shoulder, lumbar and knee pain is common on musculoskeletal system. Anti-inflammatory agents and physiotherapy are used for treatment of these conditions and unfortunately are unsuccessful. The purpose of this study was to assess the efficacy of aerobic exercise in the treatment of mechanical shoulder, lumbar and knee pain.METHODS: This semi- experimental study was conducted on 450 patients suffering from mechanical shoulder pain (150 patients), mechanical lumbar pain (150 patients) and mechanical knee pain (150 patients) referred to the clinic of orthopedics, Babol medical University from 2004 to 2006. All of these cases were educated to pain reduction or painless conditioning. Subjects were advised to do aerobic exercises such as swimming, running, walking and bicycling for one hour per day. They were followed at 2 month interval for 18 months. Cure rate in these three groups were compared.FINDINGS: The mean age of cases with shoulder, lumbar and knee pain was 36±22, 41±28 and 48±25 years, respectively. Duration of pain was 83±45, 93±80 and 48±30 days, respectively. Complete resolution of pain was seen in 80% of patients in shoulder group and in 88% of lumbar group and in 73.3% of knee group. Cure rate was significantly higher in patients suffered from spinal pain than to the other groups (p=0.03).CONCLUSION: The results showed that aerobic exercise is effective for treatment of mechanical pain. So establishing exercise program especially aerobic exercise should be considered as a way to prevent common musculoskeletal pains in community.

Background and Objective: Muscle weaknesse particularly in association with quadriceps muscle is known as a risk factor in the development and progression of knee osteoarthritis (KOA). The objective of this study was to compare quadriceps muscle strength (QMS) between asymptomatic controls and KOA patients and to elucidate its relationship with knee pain and radiographic changes. Materials and Methods: 77 patients with mean age of 53.6 ± 9.8 years and 75 asymptomatic controls with mean age of 55.8 ±2.8 (p=0.06) and respective BMI of 28.3±4.7 and 25.8 ±2.7 kg/m2 comprised the study. Diagnosis of KOA was confirmed by the criteria of American College of Rheumatology. QMS was determined by dynamometry method radiographic changes were assessed through Kellgren-Lawrence method, and Knee pain was measured using WOMAC index.ْ Statistical analysis was performed to compare QMS between two groups and to evaluate the relationship of QMS to knee pain and radiographic changes. Results: QMS in both limbs of the experimental group was significantly lower than the control group. The magnitude of reduction in both limbs was significantly lower in men (30.1%) than in women (31.6%) (p=0.002 and p=0.001, for both limbs). There was no relationship between QMS and knee pain or radiographic changes. Conclusion: In knee osteoarthritis, quadriceps muscle strength is lower compared with healthy controls regardless of pain or radiographic changes. [ABSTRACT FROM AUTHOR]

Background and Aim: This study was performed to compare the stiffness of hamstring and rectus femoris muscles in subjects with anterior knee pain and normal subjects. Materials and Methods: In this non experimental and case-control study, 20 persons with anterior knee pain were selected simply from convenient sample and 20 healthy persons were selected by matching method. proximal and distal stiffness of hamstring and rectus femoris muscles were measured using an isokinetic device in the passive mode. Also, maximal concentric peak torque during flexion and extension movements of hip and knee, in two groups were compared by independent T-test and correlation analysis. Results: There was no significant difference between anterior knee pain and proximal compartment of rectus femoris(P=0.320) and hamstring(P=0.125) stiffness, but there was significant difference between anterior knee pain and distal compartment of rectus femoris and hamstring stiffness (P<0.001). Significant relationship was found between anterior knee pain and muscles strength (P<0.001). No correlation was found between strength and stiffness of rectus femoris (P=0.356) and hamstring muscles (P=0.643) in patients group, but in healthy subjects this relationship was found (P<0.001). Conclusion: In patients with anterior knee pain, hamstring and rectus femoris muscles stiffness increased and muscle strength decreased. Increasing of muscle strength was effective on stiffness in healthy subjects, but there was no relation between them in patients group. Also rectus femoris and hamstring muscles possibly have different proximal and distal neuromuscular compartments. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis is the most common form of joint disease and a leading cause of disability in the elderly. The symptoms of osteoarthritis are pain, morning stiffness, and limited motion of the joint. Different treatments have been proposed for management of osteoarthritis but the results are not clear. We compared the effects of acupuncture and physical modalities on symptoms of knee osteoarthritis. Methods: In this study, 40 patients with knee osteoarthritis according to American College of Rheumatology (ACR) criteria were recruited using strict inclusion and exclusion criteria. The patients were randomly divided into two groups (A and B). The acupuncture group (A) only received acupuncture at selected acupoints for knee pain. On the other hand, the physical modality group (B) received transcutaneous electrical nerve stimulation (TENS), ultrasound (US), and hot pack at pain areas for 4 weeks. Treatment was performed 3 times weekly for 4 weeks (12 sessions) in both groups. Pain intensity was measured based on a visual analogue scale (VAS) while function was evaluated using knee injury and osteoarthritis outcome score with (KOOS). T-test was used to analyze the data in SPSS11. Findings: After treatment, acupuncture and physical modality groups reported significant improvements in symptoms. Compared to group A, group B reported a significantly higher level of improvement in subscale of everyday activity (P < 0.05). Based on VAS, pain intensity scores decreased in both groups but significantly more in group A (P < 0.05). Conclusion: According to the results of the present study, both acupuncture and physical modalities could efficiently reduce pain intensity and enhance daily activities and quality of life in patients with knee osteoarthritis. While acupuncture was more effective on pain reduction, physical modalities could better improve daily activity. [ABSTRACT FROM AUTHOR]

Background: Anterior knee pain is one of the most common complaints of patients in orthopedic clinics. The first step in the treatment of this problem is conservative treatment which includes administration of anti-inflammatory drugs, exercise and changes in life style. Many patients respond well to these measures in about six months, but a small number of patients may not respond to the conservative treatment; therefore, surgical procedures such as Maquet osteotomy or lateral retinacular release may be needed in these cases. The aim of this study was to determine the efficacy of intraosseous drilling and decompression of patella in the treatment of chronic anterior knee pain. Methods: This study was performed as a case series on ten patients with chronic anterior knee pain attending the Orthopedic Clinic of Imam Khomeini Hospital, in Tehran, Iran in 2009-2010. Eight of the patients were male and the rest were female. The patients met the inclusion criteria and were followed up for at least 12 months after the surgery. Results: The mean age of the patients was 27.8±4.66 yr and their mean BMI was 22.5±1.71 kg/m². The mean pain severity before the interventions was 8.2±0.78 based on VAS but it decreased to 2.5±1.26 post-surgically. An average reduction of 5.7 scores were noticed in pain severity depicting a significant reduction of pain (P<0.0001). Conclusion: It may be concluded that intraosseous drilling and decompression of patella is a safe and effective method in the treatment of chronic anterior knee pain not responding to conservative treatment. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain syndrome (PFPS) is the most prevalent knee disorder. In fact, one in every four knee patients suffers from this syndrom. The purpose of the present study was to compare the effects of kinesiotape and strength training on knee pain and quadriceps strength in people with patellofemoral pain syndrome. Methods: Thirty one male patients with patellofemoral pain syndrome, with a mean age of 25 ± 1 year, a mean height of 173.6 ± 6.15 cm, and a mean weight of 71.25 ± 7.1 kg, were randomly assigned into three groups of kinesiotape, exercise, and combined kinesiotape-exercise. All groups underwent six weeks of intervention. Pre- and post-tests were administered. A visual analogue scale and the Biodex isokinetic dynamometer were used to measure pain and strength of the knee muscles, respectively. Repeated measures analysis of variance (ANOVA) was used to analyze the data. The significance level was considered as α = 0.05. Findings: After six weeks of intervention, significant pain reductions were observed in the kinesiotape, and combined kinesiotape-exercise groups (P ? 0.05). However, mean of maximum quadriceps muscle torque improved significantly only in the combined kinesiotape-exercise group (P ? 0.05). Conclusion: The results of the present study showed that taping significantly reduced pain. It could be concluded that using kinesiotape increased the contact surface between patella and intercondylar groove and decreased pressure which in turn improved pain. [ABSTRACT FROM AUTHOR]