RESEARCH PAPER

Correlation of Pain Improvement and Quadriceps Strength with Knee

Functional Disability Index after Elastic Taping Application in Obese Patiens
with Knee Osteoarthritis
Tirza Z Tamin1, Andi Dala Intan2, Regio Santoso3, Mirawaty4, Nia Zanatunnisa5
Department of Physical Medicine and Rehabilitation, Cipto Mangunkusumo Hospital; Faculty of Medicine,
University of Indonesia, Jakarta, Indonesia

ABSTRACT

Objective : To find the correlation between improved pain and quadriceps muscle strength with
functional disability status in obese patients with knee OA.

Methods : This is a single-blind randomized controlled trial. Outcomes measured included pain
(VAS), quadriceps strength and knee functional disability index assessed using hand held
dynamometer, and Lequesne Index was evaluated before and after treatment. Data was analyzed
using SPSS 20.0 with Pearson’s and Spearman correlation.

Case description : Twenty three patients with knee osteoarthritis (age range between 43-79
years old) at Obesity Clinic Department of Medical Rehabilitation Cipto Mangunkusumo
Hospital, divided into two groups: elastic taping group (ETG) and control group (CG). We used
the Leukotape® BSN Kinesio Tape Strip which was reapplied after 3 days. Before treatment on
ETG, right quadriceps Visual Analog Scale (R-VAS) = 4, left quadriceps VAS (L-VAS) = 4,
right quadriceps strength = 11, left quadriceps strength = 10, and knee functional disability index
= 8. Before treatment on CG, right quadriceps VAS (R-VAS) = 5, left quadriceps VAS (L-VAS)
= 4, right quadriceps strength = 10, left quadriceps strength = 9, and knee functional disability
index = 10. After treatment on ETG, right quadriceps VAS (R-VAS) = 0, left quadriceps VAS
(L-VAS) = 0, right quadriceps strength = 16, left quadriceps strength = 15, and knee functional
disability index = 5. After treatment on CG, right quadriceps Visual Analog Scale (R-VAS) = 5,
left quadriceps VAS (L-VAS) = 4, right quadriceps strength = 10, left quadriceps strength = 9,
and knee functional disability index = 10.

Results : In between groups analysis, pain intensity in taping group has significantly correlated
with functional disability index (p < 0.001, r = 0.718 on right knee, p = 0.001, r = 0.665 on left
knee) and has an inverse correlation between muscle strength and functional disability index (p =
0.004, r = 0.581 on right knee, and p = 0.023 r = 0.473 on left knee).

Conclusion : This study suggests that correlation with functional activities was greater in pain
than quadriceps strength because elastic taping can acutely stimulate cutaneous
mechanoreceptor, proprioceptor, and correct joint alignment. Meanwhile, quadriceps strength
improvement requires long period of exercise.

Keywords : pain, quadriceps, strength, knee functional disability index, elastic taping, knee
osteoarthritis.
INTRODUCTION
Obesity associated with an elevated risk of an array of chronic diseases. Obesity has many
negative impacts on weight-bearing joints especially the knee. On the musculoskeletal system,
the most significant impact of obesity is osteoarthritis (OA). Osteoarthritis is degenerative joint
disorder characterized by pain, decreased mobility, and affects more people than any other joint
disease.1 OA can affects all aspects of life especially through pain and limitation of mobility.2

Patients has knee OA and people has risk of developing knee OA have demonstrated decreased
physical activity.3 Patients with chronic diseases has physical inactivity decreased is associated
with quadriceps weakness. Associations between quadriceps muscle strength, quadriceps
activation, and disability have been evaluated in patients with knee OA.4,5,6 Improving lower
extremity strength is a goal of non‐surgical knee OA management.7

Association between quadriceps muscle strength and the amount of exercise on knee OA patients
participate is very important for understanding the effects of physical inactivity on the
quadriceps. Additionally, increasing quadriceps muscles strength in patients with knee OA may
positively affect exercise.3 Much of the disability in patients with knee OA is attributed to
quadriceps weakness and pain, rather than radiographic change.8

Knee tape usually used by physiotherapists to manage knee pain. There is evidence suggests
taping may benefit individuals with knee OA.8 Kinesio taping (KT) is a technique that is now
increasingly considered for the management of knee OA. Kinesio tape is an elastic therapeutic
tape can used to professional activities in healthcare, rehabilitation, prevention and sports.
Kinesio tape was also used for treating sports and orthopedic injuries, and various of
musculoskeletal disorders, like osteoarthritis (OA).9

Association between KT with isokinetic quadriceps torque in patients with knee OA, and was
concluded that therapeutic KT was effective in improving isokinetic quadriceps torque and
reducing pain.10 The authors conclude that KT might be a suitable intervention to reduce pain
and improve the active range of motion in patients with OA.11 KT can also enhance muscle
performance and activity.12 Compared with other therapeutic methods, this method is very safe
with few side effects, and it is relatively inexpensive.
MATERIAL AND METHODS

This is a single-blind randomized controlled trial. Outcomes measured included pain (VAS),
quadriceps strength and knee functional disability index assessed using hand held dynamometer,
and Lequesne Index was evaluated before and after treatment. Data was analyzed using SPSS
20.0 with Pearson’s and Spearman correlation.
Twenty three patients with knee osteoarthritis (age range between 43-79 years old) at Obesity
Clinic Department of Medical Rehabilitation Cipto Mangunkusumo Hospital, divided into two
groups: elastic taping group (ETG) and control group (CG). We used the Leukotape® BSN
Kinesio Tape Strip which was reapplied after 3 days.

RESULT
This study found significant improvement in pain, muscle strength and functional activity after
taping application (p<0.05). In between groups analysis, pain intensity in taping group has
significantly correlated with functional disability index (p < 0.001, r = 0.718 on right knee, p =
0.001, r = 0.665 on left knee) and has an inverse correlation between muscle strength and
functional disability index (p = 0.004, r = 0.581 on right knee, and p = 0.023 r = 0.473 on left
knee).

DISCUSSION

Obesity has negative impacts on weight-bearing joints especially the knee. Painful disorders and
debilitation of the quadriceps muscle group were common conditions present in obese patient
which leads to disability on a functional capacity. The purpose of the study was to find the
correlation between improved pain and quadriceps muscle strength with functional disability
status in obese patients with knee OA.

In this case, twenty three patients with knee osteoarthritis (age range between 43-79 years old) at
Obesity Clinic Department of Medical Rehabilitation Cipto Mangunkusumo Hospital, divided
into two groups: elastic taping group (ETG) and control group (CG). We used the Leukotape®
BSN Kinesio Tape Strip which was reapplied after 3 days. Before treatment on ETG, right
quadriceps Visual Analog Scale (R-VAS) = 4, left quadriceps VAS (L-VAS) = 4, right
quadriceps strength = 11, left quadriceps strength = 10, and knee functional disability index = 8.
Before treatment on CG, right quadriceps VAS (R-VAS) = 5, left quadriceps VAS (L-VAS) = 4,
right quadriceps strength = 10, left quadriceps strength = 9, and knee functional disability index
= 10. After treatment on ETG, right quadriceps VAS (R-VAS) = 0, left quadriceps VAS (L-
VAS) = 0, right quadriceps strength = 16, left quadriceps strength = 15, and knee functional
disability index = 5. After treatment on CG, right quadriceps Visual Analog Scale (R-VAS) = 5,
left quadriceps VAS (L-VAS) = 4, right quadriceps strength = 10, left quadriceps strength = 9,
and knee functional disability index = 10.

Decreased quadriceps strength and voluntary activation predict disability when measured both
physical performance and self-assessments in patients with knee OA.4 In fact, increased risk for
developing disability related decreased physical activity. Decreased voluntary quadriceps
activation has association between muscle strength and disability in patients with knee OA.

Additionally, patients has high physical activity (> 32.5 on the Godin leisure-time questionnaire)
had a stronger quadriceps muscle than the patients with low physical activity.3 This study
concuded the use of tape in managing painful in patient with knee OA can reduced pain by up to
50% compared with the untaped condition.8

Several theories may explain the pain‐relieving effect of therapeutic tape, which tape can
improve patellar alignment in healthy controls and those with PFPS.8 Therapeutic tape may thus
ease pain by improving patellar alignment. Source of pain in knee OA came from the
infrapatellar fat pad is pain‐sensitive, and often inflamed secondarily to other knee joint
pathology.13 By shortening the soft tissue of the fat pad, therapeutic tape may relieve pain which
that inflamed soft tissue does not respond well to stretching. Placebo effect of tape is an unlikely
mechanism given the superior effect of therapeutic tape over neutral tape.8

Fourteen patients with PFJ disease, the effect of tape was evaluated over 4 days. Medial patellar
taping can reduced overall daily pain (VAS) by 25% compared with neutral and lateral taping, a
significant difference was not observed until day 2, with pain unchanged 1 h following
application.8 Consumption analgesic also need to be measured to be sure that changes score VAS
pain were not caused by the analgesic consumption, and it should be analgesic consumption
decreased within every group from the beginning of the treatment to the end of it.14

CONCLUSION

This study suggests that correlation with functional activities was greater in pain than quadriceps
strength because elastic taping can acutely stimulate cutaneous mechanoreceptor, proprioceptor,
and correct joint alignment. Meanwhile, quadriceps strength improvement requires long period
of exercise.

REFERENCES

1. Brooks PM. Impact of osteoarthritis on individuals and society: how much disability? Social
consequences and health economic implications. Curr Opin Rheumatol 2002; 14 : 573-7.
2. King LK, March L, Obesity and osteoarthritis. Indian J Med Res. 2013; 138(2):185-93
3. Pietrosimone B, Thomas AC, Saliba SA, Ingersoll CD, Association between quadriceps
strength and self-reported physical activity in people with knee osteoarthritis. Int J Sports
Phys Ther. 2014; 9(3):320-8
4. Fitzgerald GK Piva SR Irrgang JJ Bouzubar F Starz TW Quadriceps activation failure as a
moderator of the relationship between quadriceps strength and physical function in
individuals with knee osteoarthritis. Arthritis Rheum. 2004;51(1):40‐48.
5. Hurley M Scott D Rees J Newham D Sensorimotor changes and functional performance in
patients with knee osteoarthritis. Ann Rheum Dis. 1997;56(11):641‐648.
6. Miller M Rejeski W Messier S Loeser R Modifiers of change in physical functioning in
older adults with knee pain: the Observational Arthritis Study in Seniors (OASIS). Arthritis
Rheum. 2001;45(4):331‐339.
7. Fransen M McConnell S Exercise for osteoarthritis of the knee. Cochrane Database Syst
Rev. 2008;8:CD004376.
8. Hinman R, Bennell K, Crossley K, et al. Immediate effects of adhesive tape on pain and
disability in individuals with knee osteoarthritis. Rheumatology. 2003; 42:865–9.
9. Huang CY, Hsieh TH, Lu SC, Su FC, Effect of the kinesio tape to muscle activity and
vertical jump performance in healthy inactive people. Biomed Eng Online. 2011; 10:70-81
10. Chang, W.D.; Chen, F.C.; Lee, C.L.; Lin, H.Y.; Lai, P.T. Effects of kinesio taping versus
mcconnell taping for patellofemoral pain syndrome. A systematic review and meta-analysis.
Evid. Based Complement. Altern. Med. 2015, 2015, 471208.
11. . Crossley, K.M.; Vicenzino, B.; Lentzos, J.; Schache, A.G.; Pandy, M.G.; Ozturk, H.;
Hinman, R.S. Exercise, education, manual-therapy and taping compared to education for
patellofemoral osteoarthritis: A blinded, randomised clinical trial. Osteoarthr. Cartil. 2015,
23, 1457–1464.
12. Bennell, K.L.; Hinman, R.S.; Metcalf, B.R.; Buchbinder, R.; McConnell, J.; McColl, G.;
Green, S.; Crossley, K.M. Efficacy of physiotherapy management of knee joint
osteoarthritis, a randomised, double blind, placebo controlled trial. Ann. Rheum. Dis. 2005,
64, 906–912.
13. Duri ZA, Aichroth PM, Dowd G. The fat pad. Clinical observations. Am J Knee Surg 1996;
9:55–66.
14. Castrogiovanni P, Giunta A, Guglielmino C, et al. The effects of exercise and kinesio tape on
physical limitations in patients with knee osteoarthritis. J. Funct. Morphol. Kinesiol.
2016;1:355–68.