Tennant ND, Ferrell WR, Creed G, Brydson G, Sturrock RD: Centre for Rheumatic Diseases and Physiotherapy department, Glasgow Royal Infrimary,Glasgow G31 2ER and Department of Physiotherapy Caledonian University, Glasgow G4 0BA, Scotland, UK. Nicola.tennant@northglasgow.scot.nhs.uk.

PURPOSE: The Hypermobility Syndrome also known as Benign Joint Hypermobility Syndrome (BJHS) is a connective tissue disorder characterised by joint hypermobility and musculo-skeletal symptomatology in the absence of systemic rheumatological disease. It has been postulated that such increased mobility of joints may lead to early degeneration of these joints. Several of the above authors have previously demonstrated that such patients have impaired proprioception at the knee joint compared to age and sex matched control subjects. The purpose of this investigation was to establish whether a home programme of Closed Kinetic Chain exercises could enhance proprioceptive acuity at the knee joint and influence symptomatology in such patients. SUBJECTS: Eighteen subjects diagnosed as having BJHS, based on the Brighton criteria, which required a Beighton score of ³ 4 and knee joint pain for three months or longer, were included. METHODS: Knee joint proprioception was measured using a detection threshold paradigm, balance was assessed using an instrumented balance board, muscle strength by isokinetic dynamometer, knee joint pain using a visual analogue scale (VAS) and quality of life assessment using SF-36. Measurements were taken before and after an eight-week progressive programme of closed kinetic chain strengthening exercises for hamstrings and quadriceps muscle groups. The exercise regime was prescribed using a home exercise diary and a balance board was provided for use at home. ANALYSIS: Analysis was performed using the Statistical Package for the Social Sciences (SPSS-PC) version 8. Comparisons were made using the paired 2-tailed T-tests and the Wilcoxon ranks test. Differences were accepted as being statistically significant at p £ 0.05. RESULTS: The mean threshold detection angle was 1.07˚ ± 0.07˚ prior to the exercise intervention, which significantly decreased (P = 0.00009) to 0.79˚ ± 0.04˚ after the exercise programme, demonstrating increased proprioceptive acuity. Performance on the balance board also improved with the percentage time spent out of balance (beyond 8˚ in sagittal and coronal planes) reducing significantly (P < 0.0002) from 8.4 ± 1.4% to 4 ± 0.6%. Hamstring and quadriceps power (120˚/second) increased after exercise, being significant for both peak (P < 0.05) and average power (P < 0.01). Pain, measured by VAS significantly reduced (P < 0.005) from 4.18 ± 1.05 to 2.32 ± 1.14. Quality of life assessment also showed significant improvement after exercise for both physical functioning (P < 0.05) and mental health (P < 0.01). CONCLUSIONS: Proprioception, muscle strength and balance can be enhanced by an eight-week, closed kinetic chain exercise programme and this may be responsible for the improvement in symptomatology in patients with BJHS. FUNDING SOURCE: Arthritis Research Council.

Copyright 2004 by the American Physical Therapy Association

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