#&\x07Theparallel with the medical literature recognizes the need to develop a morespine in neutral. benecial, long-term, non-pharmacologic approach for theFurthermore, rehabilitation of KOA with safe and effective exercises. Thethe anterior paradigm shift to non-pharmacologic treatment of chronicknee translation conditions is afoot and as chiropractic doctors, we are in ais controlled unique position to seize this opportunity. 5\x03\x063\x0f\x07\x0c7\x07\x08\x06\x07\x06\x1d\x07 by a posterior recent studies on therapeutic exercises for KOA to restoreshift of the hips ROM, muscular balance, and biomechanics in KOA. Figure 1 and pelvis. In exercise Knee exercises that favor an open chain approach, where\x14\x16'\x0f\x11\x0c\x12'\x07\x11\x0e\x0c\x03\x0f\x07\x06\x16\x11\x0f\x07\x11\x0f\x07\x06\x03\x0e\x0b\x03\x18\x07\x08\x04\x07\x03\x13\x05\x11\x03\x04\x06\x07\x16\x11\x14\x07\x18\x0e\x11\x19\x03&\x07\x1c\x16\x11\x0f\x07the foot is free to move and the leg is non-weight bearing,movement strengthens the posterior chain and allows eccentric are often prescribed to strengthen the quadriceps and vastiloading of the hamstring to balance anterior sheer forces on medialis oblique in an effort to strengthen the muscles andthe knee. Furthermore, it is also essential the tibia, femur, reduce compression on an already irritated arthritic knee.hip lines are all maintained.Similarly, seated hamstring and gluteal exercises are also\\\x16\x08\x07\x08\x0c\x0f\x07\x03*\x08\x0b\x11\x04\x03\x18\x07\x06\x16\x03\x07\x0f'\x04\x19\x11\x08\x0c\x07]\x11\x18\x07\x13\x0e\x07\x14\x0e\x11\x04]\x08\x0b\x0b\x08\x06\x0e'\x07prescribed with the same rationale: strengthen the leg withcytokines at baseline and at the end of the study. He found a minimal compression on the joint. While logical, research\x0e\x03\x18\x06\x11\x04\x07\x11\x04\x07\x11\x04\x06\x0e\x08\x08\x0e\x06\x11\x0c\x08\x0e\x07\x14\x0e\x11\x04]\x08\x0b\x0b\x08\x06\x0e'\x07\x0b\x03\x18\x11\x08\x06\x0e\x0f\x07\x1d\x11\x06\x16\x07\x06\x16\x03\x07points to another approach. 85#8&\x07Closed chain exercises, done in a weight bearing position \x1d\x11\x06\x16\x07\x08\x07\x05*\x03\x18\x07\x13\x06\x10\x07\x08\x0e\x03\x07\x03*\x06\x0e\x03\x0b\x03\x0c'\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x13\x0e\x07Z>#\x07\x13\x0e\x07\x0f\x03\x19\x03\x0e\x08\x0c\x07 Our data suggest that low-dose long-term exercise such \x02\x03\x0e\x03\x08\x0f\x04\x0f&\x07[\x11\x0e\x0f\x06\x10\x07\x06\x16\x03'\x07\x08\x0e\x03\x07\x13\x04\x06\x11\x04\x08\x0c\x07\x08\x04\x18\x07\x18\x14\x0c\x11\x08\x06\x03\x07#=5\x0f&\x078\x03\x04\x18\x10\x07 as SLAS can reduce the inammatory state of the OA knee they address the entire kinetic chain, allowing re-programing ofjoint, which may be achieved not only by strengthening the proper biomechanics as best as possible from the foot throughmuscles but also by soothing the microenvironment niche of the lumbo-pelvic junction. Third, they improve balance andinnate immunity in the joint space.joint proprioception. Finally, closed chain exercises can beThe second study looked at a different closed chain activity dosed with body weight, which is exactly the load needed to\x13\x0e\x07\x06\x16\x03\x077\x04\x03\x03\x10\x07\x1d\x08\x0c7\x11\x04\x12&\x07^\x03\x12\x0c\x08\x0e\x07\x1d\x08\x0c7\x11\x04\x12\x07\x03*\x03\x0e\x11\x0f\x03\x0f\x07\x08\x0e\x03\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x0e\x03\x0b\x08\x11\x04\x07\x13\x04\x06\x11\x04\x08\x0c\x07\x11\x04\x07#=5\x0f&\x07<\x04\x07\x13\x08\x06\x10\x07\x06\x16\x03\x07\x0f\x06\x18\x11\x03\x0f\x07\x02\x03\x0c\x1d\x07\x04\x0c'\x07\x0f\x03\x18\x07 and are recommended to reduce pain and disability in body weight to successfully treat KOA in the adult population. Z>#&\x07#\x07\x0b\x18\x03\x0e\x08\x06\x03\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x03\x13\x13\x03\x06\x07\x13\x07\x1d\x08\x0c7\x11\x04\x12\x07\x0b\x14\x08\x0e\x03\x18\x07\x06\x07Zhao and his team demonstrated in their 2-year studyhome-based quadriceps strengthening exercises on knee pain clinically signicant improvement against the control groupand function has been shown in a meta-analysis by Roddy with a single exercise done twice a day for 30 minutes: \x11\x04\x07\x1e\x1f&\x07#\x0c\x12\x16\x08\x18\x11\x0e\x10\x07\x1e+1!\x10\x07\x03\x0f\x06\x08\x02\x0c\x11\x0f\x16\x03\x18\x07\x06\x16\x08\x06\x07\x1d\x08\x0c7\x11\x04\x12\x07\x02\x087\x1d\x08\x0e\x18\x0f\x07the Static Low Angle Squat, SLAS.4\x0e\x03\x06\x0e\x07\x1d\x08\x0c7\x11\x04\x126\x07\x16\x08\x0f\x07\x0f\x11\x12\x04\x11\x05\x08\x04\x06\x07\x02\x03\x04\x03\x05\x06\x07\x11\x04\x07\x0e\x03\x0f\x06\x0e\x11\x04\x12\x07\x13\x04\x06\x11\x04\x07\x08\x04\x18\x07reducing pain in KOA.\x02SLAS: the patient stands with the legs apart; the distance \x03 Alghadirs study had three groups: control, retro and forward between the knees as well as the feet should be as widewalking. All received open and closed chain exercises as well as the shoulders, and then they try to squat down. When\x08\x0f\x07\x0c\x06\x0e\x08\x0f\x04\x18&\x07^\x03\x06\x0e\x07\x1d\x08\x0c7\x11\x04\x12\x07\x1d\x08\x0f\x07\x14\x03\x0e\x13\x0e\x0b\x03\x18\x07\x13\x0e\x071+\x07\x0b\x11\x04\x06\x03\x0f\x07bending the knees, patients should try to keep the backwith 5-minute warm-up and cool-down sessions three days a straight and adjust the angle of knees from straight downweek for six weeks at a comfortable walking speed along with as close to 90 degrees as possible but no less than 90a routine physiotherapy as mentioned above. The participants degrees. However, it should not reach the position thatwere instructed to gradually increase their walking time up patients feel pain so that any potential damage shouldbe avoided.to 30 minutes over the six-week period, if they consistently 14 I Winter 2020 www.anjc.info""/>
#&\x07Theparallel with the medical literature recognizes the need to develop a morespine in neutral. benecial, long-term, non-pharmacologic approach for theFurthermore, rehabilitation of KOA with safe and effective exercises. Thethe anterior paradigm shift to non-pharmacologic treatment of chronicknee translation conditions is afoot and as chiropractic doctors, we are in ais controlled unique position to seize this opportunity. 5\x03\x063\x0f\x07\x0c7\x07\x08\x06\x07\x06\x1d\x07 by a posterior recent studies on therapeutic exercises for KOA to restoreshift of the hips ROM, muscular balance, and biomechanics in KOA. Figure 1 and pelvis. In exercise Knee exercises that favor an open chain approach, where\x14\x16'\x0f\x11\x0c\x12'\x07\x11\x0e\x0c\x03\x0f\x07\x06\x16\x11\x0f\x07\x11\x0f\x07\x06\x03\x0e\x0b\x03\x18\x07\x08\x04\x07\x03\x13\x05\x11\x03\x04\x06\x07\x16\x11\x14\x07\x18\x0e\x11\x19\x03&\x07\x1c\x16\x11\x0f\x07the foot is free to move and the leg is non-weight bearing,movement strengthens the posterior chain and allows eccentric are often prescribed to strengthen the quadriceps and vastiloading of the hamstring to balance anterior sheer forces on medialis oblique in an effort to strengthen the muscles andthe knee. Furthermore, it is also essential the tibia, femur, reduce compression on an already irritated arthritic knee.hip lines are all maintained.Similarly, seated hamstring and gluteal exercises are also\\\x16\x08\x07\x08\x0c\x0f\x07\x03*\x08\x0b\x11\x04\x03\x18\x07\x06\x16\x03\x07\x0f'\x04\x19\x11\x08\x0c\x07]\x11\x18\x07\x13\x0e\x07\x14\x0e\x11\x04]\x08\x0b\x0b\x08\x06\x0e'\x07prescribed with the same rationale: strengthen the leg withcytokines at baseline and at the end of the study. He found a minimal compression on the joint. While logical, research\x0e\x03\x18\x06\x11\x04\x07\x11\x04\x07\x11\x04\x06\x0e\x08\x08\x0e\x06\x11\x0c\x08\x0e\x07\x14\x0e\x11\x04]\x08\x0b\x0b\x08\x06\x0e'\x07\x0b\x03\x18\x11\x08\x06\x0e\x0f\x07\x1d\x11\x06\x16\x07\x06\x16\x03\x07points to another approach. 85#8&\x07Closed chain exercises, done in a weight bearing position \x1d\x11\x06\x16\x07\x08\x07\x05*\x03\x18\x07\x13\x06\x10\x07\x08\x0e\x03\x07\x03*\x06\x0e\x03\x0b\x03\x0c'\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x13\x0e\x07Z>#\x07\x13\x0e\x07\x0f\x03\x19\x03\x0e\x08\x0c\x07 Our data suggest that low-dose long-term exercise such \x02\x03\x0e\x03\x08\x0f\x04\x0f&\x07[\x11\x0e\x0f\x06\x10\x07\x06\x16\x03'\x07\x08\x0e\x03\x07\x13\x04\x06\x11\x04\x08\x0c\x07\x08\x04\x18\x07\x18\x14\x0c\x11\x08\x06\x03\x07#=5\x0f&\x078\x03\x04\x18\x10\x07 as SLAS can reduce the inammatory state of the OA knee they address the entire kinetic chain, allowing re-programing ofjoint, which may be achieved not only by strengthening the proper biomechanics as best as possible from the foot throughmuscles but also by soothing the microenvironment niche of the lumbo-pelvic junction. Third, they improve balance andinnate immunity in the joint space.joint proprioception. Finally, closed chain exercises can beThe second study looked at a different closed chain activity dosed with body weight, which is exactly the load needed to\x13\x0e\x07\x06\x16\x03\x077\x04\x03\x03\x10\x07\x1d\x08\x0c7\x11\x04\x12&\x07^\x03\x12\x0c\x08\x0e\x07\x1d\x08\x0c7\x11\x04\x12\x07\x03*\x03\x0e\x11\x0f\x03\x0f\x07\x08\x0e\x03\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x0e\x03\x0b\x08\x11\x04\x07\x13\x04\x06\x11\x04\x08\x0c\x07\x11\x04\x07#=5\x0f&\x07<\x04\x07\x13\x08\x06\x10\x07\x06\x16\x03\x07\x0f\x06\x18\x11\x03\x0f\x07\x02\x03\x0c\x1d\x07\x04\x0c'\x07\x0f\x03\x18\x07 and are recommended to reduce pain and disability in body weight to successfully treat KOA in the adult population. Z>#&\x07#\x07\x0b\x18\x03\x0e\x08\x06\x03\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x03\x13\x13\x03\x06\x07\x13\x07\x1d\x08\x0c7\x11\x04\x12\x07\x0b\x14\x08\x0e\x03\x18\x07\x06\x07Zhao and his team demonstrated in their 2-year studyhome-based quadriceps strengthening exercises on knee pain clinically signicant improvement against the control groupand function has been shown in a meta-analysis by Roddy with a single exercise done twice a day for 30 minutes: \x11\x04\x07\x1e\x1f&\x07#\x0c\x12\x16\x08\x18\x11\x0e\x10\x07\x1e+1!\x10\x07\x03\x0f\x06\x08\x02\x0c\x11\x0f\x16\x03\x18\x07\x06\x16\x08\x06\x07\x1d\x08\x0c7\x11\x04\x12\x07\x02\x087\x1d\x08\x0e\x18\x0f\x07the Static Low Angle Squat, SLAS.4\x0e\x03\x06\x0e\x07\x1d\x08\x0c7\x11\x04\x126\x07\x16\x08\x0f\x07\x0f\x11\x12\x04\x11\x05\x08\x04\x06\x07\x02\x03\x04\x03\x05\x06\x07\x11\x04\x07\x0e\x03\x0f\x06\x0e\x11\x04\x12\x07\x13\x04\x06\x11\x04\x07\x08\x04\x18\x07reducing pain in KOA.\x02SLAS: the patient stands with the legs apart; the distance \x03 Alghadirs study had three groups: control, retro and forward between the knees as well as the feet should be as widewalking. All received open and closed chain exercises as well as the shoulders, and then they try to squat down. When\x08\x0f\x07\x0c\x06\x0e\x08\x0f\x04\x18&\x07^\x03\x06\x0e\x07\x1d\x08\x0c7\x11\x04\x12\x07\x1d\x08\x0f\x07\x14\x03\x0e\x13\x0e\x0b\x03\x18\x07\x13\x0e\x071+\x07\x0b\x11\x04\x06\x03\x0f\x07bending the knees, patients should try to keep the backwith 5-minute warm-up and cool-down sessions three days a straight and adjust the angle of knees from straight downweek for six weeks at a comfortable walking speed along with as close to 90 degrees as possible but no less than 90a routine physiotherapy as mentioned above. The participants degrees. However, it should not reach the position thatwere instructed to gradually increase their walking time up patients feel pain so that any potential damage shouldbe avoided.to 30 minutes over the six-week period, if they consistently 14 I Winter 2020 www.anjc.info"" />
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b"REHAB CouncilRehab Update: Knee OA, DoesBy Dr. Donald C. DeFabio Exercise Help?Chair, ANJC Physical Rehabilitation and Performance CouncilOsteoarthritis of the knee, KOA, is one of the top causesIn China this \x13\x07\x18\x11\x0f\x08\x02\x11\x0c\x11\x06'\x07\x08\x0b\x04\x12\x07\x08\x18\x0c\x06\x0f\x07\x1d\x11\x06\x16\x07\x08\x14\x14\x0e*\x11\x0b\x08\x06\x03\x0c'\x071\x1eX\x07\x13\x07\x08\x0c\x0c\x07 exercise is called Americans over 60 experiencing symptoms. The risk ofMa Bu (Horse OA-associated disability is equal to that of cardiac disordersStance) and is and more common than any other medical problem in oldera traditional populations. We have all seen KOA and its constellation ofChinese exercise symptoms: pain, stiffness, joint enlargement, crepitus, muscle4\x0f\x03\x03\x07\x05\x12\x0e\x03\x0716&\x07weakness, deformity, impaired proprioception and reducedNotice that the joint motion, all leading to loss of function and disability.tibia line and New evidence has emerged suggesting that moderate physicalthe spine are \x08\x06\x11\x19\x11\x06'\x07\x0b\x08'\x07\x02\x03\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x06\x07\x06\x16\x03\x07\x14\x03\x14\x0c\x03\x07\x1d\x11\x06\x16\x07Z>#&\x07Theparallel with the medical literature recognizes the need to develop a morespine in neutral. benecial, long-term, non-pharmacologic approach for theFurthermore, rehabilitation of KOA with safe and effective exercises. Thethe anterior paradigm shift to non-pharmacologic treatment of chronicknee translation conditions is afoot and as chiropractic doctors, we are in ais controlled unique position to seize this opportunity. 5\x03\x063\x0f\x07\x0c7\x07\x08\x06\x07\x06\x1d\x07 by a posterior recent studies on therapeutic exercises for KOA to restoreshift of the hips ROM, muscular balance, and biomechanics in KOA. Figure 1 and pelvis. In exercise Knee exercises that favor an open chain approach, where\x14\x16'\x0f\x11\x0c\x12'\x07\x11\x0e\x0c\x03\x0f\x07\x06\x16\x11\x0f\x07\x11\x0f\x07\x06\x03\x0e\x0b\x03\x18\x07\x08\x04\x07\x03\x13\x05\x11\x03\x04\x06\x07\x16\x11\x14\x07\x18\x0e\x11\x19\x03&\x07\x1c\x16\x11\x0f\x07the foot is free to move and the leg is non-weight bearing,movement strengthens the posterior chain and allows eccentric are often prescribed to strengthen the quadriceps and vastiloading of the hamstring to balance anterior sheer forces on medialis oblique in an effort to strengthen the muscles andthe knee. Furthermore, it is also essential the tibia, femur, reduce compression on an already irritated arthritic knee.hip lines are all maintained.Similarly, seated hamstring and gluteal exercises are also\\\x16\x08\x07\x08\x0c\x0f\x07\x03*\x08\x0b\x11\x04\x03\x18\x07\x06\x16\x03\x07\x0f'\x04\x19\x11\x08\x0c\x07]\x11\x18\x07\x13\x0e\x07\x14\x0e\x11\x04]\x08\x0b\x0b\x08\x06\x0e'\x07prescribed with the same rationale: strengthen the leg withcytokines at baseline and at the end of the study. He found a minimal compression on the joint. While logical, research\x0e\x03\x18\x06\x11\x04\x07\x11\x04\x07\x11\x04\x06\x0e\x08\x08\x0e\x06\x11\x0c\x08\x0e\x07\x14\x0e\x11\x04]\x08\x0b\x0b\x08\x06\x0e'\x07\x0b\x03\x18\x11\x08\x06\x0e\x0f\x07\x1d\x11\x06\x16\x07\x06\x16\x03\x07points to another approach. 85#8&\x07Closed chain exercises, done in a weight bearing position \x1d\x11\x06\x16\x07\x08\x07\x05*\x03\x18\x07\x13\x06\x10\x07\x08\x0e\x03\x07\x03*\x06\x0e\x03\x0b\x03\x0c'\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x13\x0e\x07Z>#\x07\x13\x0e\x07\x0f\x03\x19\x03\x0e\x08\x0c\x07 Our data suggest that low-dose long-term exercise such \x02\x03\x0e\x03\x08\x0f\x04\x0f&\x07[\x11\x0e\x0f\x06\x10\x07\x06\x16\x03'\x07\x08\x0e\x03\x07\x13\x04\x06\x11\x04\x08\x0c\x07\x08\x04\x18\x07\x18\x14\x0c\x11\x08\x06\x03\x07#=5\x0f&\x078\x03\x04\x18\x10\x07 as SLAS can reduce the inammatory state of the OA knee they address the entire kinetic chain, allowing re-programing ofjoint, which may be achieved not only by strengthening the proper biomechanics as best as possible from the foot throughmuscles but also by soothing the microenvironment niche of the lumbo-pelvic junction. Third, they improve balance andinnate immunity in the joint space.joint proprioception. Finally, closed chain exercises can beThe second study looked at a different closed chain activity dosed with body weight, which is exactly the load needed to\x13\x0e\x07\x06\x16\x03\x077\x04\x03\x03\x10\x07\x1d\x08\x0c7\x11\x04\x12&\x07^\x03\x12\x0c\x08\x0e\x07\x1d\x08\x0c7\x11\x04\x12\x07\x03*\x03\x0e\x11\x0f\x03\x0f\x07\x08\x0e\x03\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x0e\x03\x0b\x08\x11\x04\x07\x13\x04\x06\x11\x04\x08\x0c\x07\x11\x04\x07#=5\x0f&\x07<\x04\x07\x13\x08\x06\x10\x07\x06\x16\x03\x07\x0f\x06\x18\x11\x03\x0f\x07\x02\x03\x0c\x1d\x07\x04\x0c'\x07\x0f\x03\x18\x07 and are recommended to reduce pain and disability in body weight to successfully treat KOA in the adult population. Z>#&\x07#\x07\x0b\x18\x03\x0e\x08\x06\x03\x07\x02\x03\x04\x03\x05\x11\x08\x0c\x07\x03\x13\x13\x03\x06\x07\x13\x07\x1d\x08\x0c7\x11\x04\x12\x07\x0b\x14\x08\x0e\x03\x18\x07\x06\x07Zhao and his team demonstrated in their 2-year studyhome-based quadriceps strengthening exercises on knee pain clinically signicant improvement against the control groupand function has been shown in a meta-analysis by Roddy with a single exercise done twice a day for 30 minutes: \x11\x04\x07\x1e\x1f&\x07#\x0c\x12\x16\x08\x18\x11\x0e\x10\x07\x1e+1!\x10\x07\x03\x0f\x06\x08\x02\x0c\x11\x0f\x16\x03\x18\x07\x06\x16\x08\x06\x07\x1d\x08\x0c7\x11\x04\x12\x07\x02\x087\x1d\x08\x0e\x18\x0f\x07the Static Low Angle Squat, SLAS.4\x0e\x03\x06\x0e\x07\x1d\x08\x0c7\x11\x04\x126\x07\x16\x08\x0f\x07\x0f\x11\x12\x04\x11\x05\x08\x04\x06\x07\x02\x03\x04\x03\x05\x06\x07\x11\x04\x07\x0e\x03\x0f\x06\x0e\x11\x04\x12\x07\x13\x04\x06\x11\x04\x07\x08\x04\x18\x07reducing pain in KOA.\x02SLAS: the patient stands with the legs apart; the distance \x03 Alghadirs study had three groups: control, retro and forward between the knees as well as the feet should be as widewalking. All received open and closed chain exercises as well as the shoulders, and then they try to squat down. When\x08\x0f\x07\x0c\x06\x0e\x08\x0f\x04\x18&\x07^\x03\x06\x0e\x07\x1d\x08\x0c7\x11\x04\x12\x07\x1d\x08\x0f\x07\x14\x03\x0e\x13\x0e\x0b\x03\x18\x07\x13\x0e\x071+\x07\x0b\x11\x04\x06\x03\x0f\x07bending the knees, patients should try to keep the backwith 5-minute warm-up and cool-down sessions three days a straight and adjust the angle of knees from straight downweek for six weeks at a comfortable walking speed along with as close to 90 degrees as possible but no less than 90a routine physiotherapy as mentioned above. The participants degrees. However, it should not reach the position thatwere instructed to gradually increase their walking time up patients feel pain so that any potential damage shouldbe avoided.to 30 minutes over the six-week period, if they consistently 14 I Winter 2020 www.anjc.info"