Volume 7, Issue 1, January – 2022 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

The Effectiveness of Ultrasound (US) Intervention

and Static Bicycle Exercise to Improve Functional
Ability in Genu Osteoarthritis
Siti Muawanah, Yose Rizal
Vocational Program of Physiotherapy
Faculty of Pharmacy and Health Sciences, Abdurrab University
Pekanbaru, Indonesia

Abstract:- Genu Osteoarthritis is a degenerative disease Osteoarthritis attacks mainly the hand joints or the joints
of the knee joint due to the abrasion of joint cartilage that support weight or lower limbs, including the knee joints
and the formation of new bone on the joint surface [2].
which can cause muscle and tendon weakness so that
movement is limited and causes pain. Degenerative According to the World Health Organization (WHO)
diseases of the genu can cause the erosion of the articular in 2019, Osteoarthritis is one of ten the most disabling
surface, this will cause pain and swelling in the genu. diseases in developed countries. Worldwide, it is estimated
This research method is pure experimental with that 9.6% of men and 18.0% of women over the age of 60
randomized pre-test and post-test group design. Samples have symptomatic Osteoarthritis. 80% of those with
of this study is 13 patients were given Ultrasound (US) Osteoarthritis will have limitations in movement, and 25%
and Static Bicycle Exercise 6 times for 2 weeks. will be unable to perform their main daily functional
Physiotherapy examinations and measurements were activities. In Indonesia alone, the prevalence of
carried out using the WOMAC Index (Western Ontario Osteoarthritis is 11.9% of the total population of Indonesia
and McMaster Universities Osteoarthritis Index). The with the highest occupational prevalence at the age of over
results showed an increase in knee functional activity 75 years, which is 33%. For knee osteoarthritis, the
before and after treatments with the normality test using prevalence is about 15.5% in women and 12.7% in men [3].
the Shapiro-Wilk test with value P value before = 0.034
(P>0.05) with a mean value of 78.00± 4.46 and the P Pain is the main complaint in patients with
value after = 0.276 (P>0.05) with a mean of 19.77±5.85 Osteoarthritis Genu. Usually the pain will increase when
then the normality value of the data is normally moving and slightly less when resting. These changes can be
distributed so the research hypothesis test used Paired found even though osteoarthritis is still relatively early
Samples Test with significant results P = 0.000 (P<0, 05) (radiologically). The pain will get worse until the joint can
with a mean value = 58.23±5.49. The conclusion of this only be shaken and become contractures, the disruptions of
study is Ultrasound (US) and Static Bicycle Exercise can the motion can be concentric (all directions of movement) or
improve functional ability in patients with Genu eccentric (one direction of movement only). Based on the
Osteoarthritis. results of Magnetic Resonance Imaging (MRI), it is
suspected that the source of the pain that arises comes from
Keywords:- Genu Osteoarthritis, Ultasound, Static Bicycle joint inflammation (synovitis), joint effusion, and bone
Exercise. marrow oedema. Osteophytes are one of the causes of pain.
I. INTRODUCTION As the osteophyte grows, the neurovascular innervation
penetrates the base of the bone to the cartilage and into the
Age is a major factor in the occurrence of developing osteophyte, this is what will cause pain [4].
osteoarthritis. According to the theory, more than 80% of Therefore, proper treatment by physiotherapy is needed to
individuals over the age of 65 develop knee osteoarthritis. reduce the pain. The pain appears when the knee is moved,
This is due to a decrease in muscle strength that occurs due causing the patient to be reluctant/fearful to move the knee
to a decrease in muscle morphology. There is a progressive joint, resulting in decreased muscle strength, where the
loss of body mass or active body tissue that begins at the age muscle is also the main stabilizer of the knee joint and also
of 40 years with a 2% decrease in basal metabolism as a protector of the knee joint structure itself. Then the joint
accompanied by body systems, so that when age begins to Range of Motion (ROM) will also decrease with this pain
increase, the incidence of knee osteoarthritis increases [1]. because the joints are infrequently moved. The presence of
muscle weakness and decreased balance of posture,
Degenerative joint disease or Osteoarthritis, generally increases the risk of falling in patients with Osteoarthritis
affects one or more joints, localized destruction of joint Genu. The high risk of falls and motion pain, this causes
cartilage and is characterized by progressive degeneration of functional activities to be hampered, such as sitting and
cartilage, muscle atrophy, remodeling of the subchondral standing for a long time, going up and down stairs, praying,
bone, and secondary inflammation of the synovial walking with heavy lifting, working, and even losing
membrane. This disease is localized without any systemic independence because they always need external help [5].
effects, slowly progressive, and generally occurs in the
elderly although age is not the only risk factor.

IJISRT22JAN354 www.ijisrt.com 461

Volume 7, Issue 1, January – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
The task of Physiotherapy is to help reduce the pain people (15.4%), the maximum number of respondents based
and increase functional activity and reduce problems caused on work as a housewife as many as 7 people (53.8%) and
by Osteoarthritis genu. One of them is by providing a the number of respondents based on work as a farmer as
combination intervention of Ultrasound (US) and Static many as 1 person (7, 7%).
Bicycle Exercises. Ultrasound (US) can reduce pain with the
right dose in combination with Static Bicycle Exercises Samples Shapiro Wilk Normality Test
which can make it easier to move with a wider range of joint (n = 13) Mean ± SD P
motion, helping increase strength and functional activities Before 78.00±4.64 0, 034
that are lighter and more flexible [6]. Evaluating the results
After 19.77±5.85 0,276
of the Ultrasound (US) method, and Static Bicycle Exercise
on knee osteoarthritis, the researchers used measurements Table 2
with several questionnaires in the form of the WOMAC Table 2 describes the normality test of the WOMAC
Index (Western Ontario and McMaster Universities Index (Western Ontario and McMaster Universities
Osteoarthritis Index) to see the value of pain, stiffness, and Osteoarthritis Index) data before and after Ultrasound
increased functional activity. treatment and Static Bicycles Exercises to improve
II. RESEARCH METHOD functional ability in Knee Osteoarthritis patients P value
before = 0.034 (P> 0.05) with the mean value was
This research method is a "Quasi-Experimental" to 78.00±4.64 and P value after = 0.276 (P>0.05) with a mean
determine the effectiveness of ultrasound intervention and of 19.77±5.85, the data were normally distributed to
Static Bicycle Exercise to improve the functional ability of determine the difference before and after treatment using the
the knee in the case of Osteoarthritis genu. This study used paired sample test.
one-group pre-test-post-test design, that is, the research is
taken from the comparison of values in the period before Samples Mean ± SD P
and after the intervention of Ultrasound and Static Bicycle (n=13)
Exercise. Physiotherapy examination and measuring Difference 58.23±5.49 0.000
instruments used to see and measure the increase in Table 3
functional ability of the knee by used WOMAC Index
(Western Ontario and McMaster Universities Osteoarthritis Based on the results of the paired t-test in table 3, the
Index). Samples of the treatment is 13 people, 3 times a mean difference between before and after treatment was
week for 2 weeks. Ethics in this study pays attention to 58.23 + 5.49 with a significant value of p = 0.000 (p < 0.05),
informed consent, respondent confidentiality, and it showed significant results that there was a significant
respondent security. effect before and after the intervention Ultrasound and Static
Bicycles Exercises to Improve Functional Ability in Knee
III. RESULTS AND DISCUSSION Osteoathritis.

The criteria for respondents can be seen based on the The research on Knee Pain in Osteoarthritis Patients
distribution of sample data given Ultrasound (US) and Static was obtained from all patients who went to the Mandau Duri
Bicyle Exercise tested based on Age, Weight, Height, Hospital on 17 May – 11 June 2021 as many as 13 patients
Occupation and Gender, before and after test WOMAC consisting of 2 men and 11 women aged between 45-62
scores. The results of the sample homogeneity test analysis years. Samples were obtained from doctor's referrals and
are presented in Table 1 below: Physiotherapy examinations. The sample was only 1 group,
according to the inclusion and exclusion criteria. From the
number of samples taken, Ultrasound Intervention (US) and
Variable Value Static Bicycles Exercise to Increase Knee Functional
Activities in Osteoarthritis Patients. Prior to physiotherapy
N=13 Minimum Maximum Mean Std. intervention, at the beginning of the program, pain values
Deviation were measured using the WOMAC Index (Western Ontario
Age 45 62 53.53 6.09 and McMaster Universities Osteoarthritis Index).
Weight 65 85 72.53 6.27 Furthermore, the sample was given intervention 6 times and
Gender Male Female 1.85 0.38 at the end of the program a re-measurement was carried out,
Occupation Farmer Housewife 1.95 1.32 this was done to determine the success rate of pain reduction
Table 1 from each treatment that had been given.

Based on table 1, the characteristics of respondents are The distribution of data in the treatment group based
based on age, weight, occupation and gender. In the research on age, weight, height, occupation, gender can be seen in
group with the number of samples (n = 13) it was found that Table 5.1. It shows the sample characteristics related to age,
the average age was 53.53 + 6.09 with a minimum age of 45 weight, height, occupation and gender. In the research group
years and a maximum age of 63 years, an average body with the number of samples (n = 13) it was found that the
weight of 72.53 + 6.27 with a minimum weight of 65 kg and average age was 53 + 6.09 with a minimum age of 45 years
a maximum weight of 85 kg. The number of respondent and a maximum age of 63 years, an average height of 161 +
female gender is 11 people (84.6%) and male gender is 2 5.25 with a minimum height of 155 cm and a maximum
height of 172 cm. While the number of respondents aged 45-

IJISRT22JAN354 www.ijisrt.com 462

Volume 7, Issue 1, January – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
50 was 5 people (38.5%), while the number of respondents adipokines can be dysregulated which can secrete
based on the age of 51-55 was 3 people (23%) as well as the proinflammatory factors.
number of respondents based on the age of 56-65 as many as
5 people (38.5%) and the number of respondents based on Description of work activities shows that the research
male gender as many as 2 people (15.4%), and the number sample is the treatment group with the level of often doing
of respondents based on female gender was 11 people work. Table 1 above, the number of respondents based on
(84.6%). This is in line with research according to the World work as a teacher in the Ultrasound and Static Exercises
Health Organization (WHO) in 2019, Osteoarthritis is one of intervention was 3 people (23.1%), the maximum number of
the ten most disabling diseases in developed countries. respondents based on work as a housewife as many as 7
Worldwide, it is estimated that 9.6% of men and 18.0% of people (53.8%) and the number of respondents based on
women over the age of 60 have symptomatic Osteoarthritis. work as a farmer as many as 1 person (7, 7%). This is in line
80% of those with Osteoarthritis will have limitations in with secondary research by Ismaningsih and Selviani [8]
movement, and 25% will be unable to perform their main which explains that Osteoarthritis most often occurs in
daily functional activities. In Indonesia, the prevalence of trauma or occurs as a result of a job. and Wijaya's research
Osteoarthritis is 11.9% of the total population of Indonesia [7] which explains that activity and work are risk factors for
with the highest prevalence at the age above 75 years which osteoarthritis where repetitive joint movements can
is 33%. For knee osteoarthritis, the prevalence is quite high, predispose to osteoarthritis or are related to a history of
about 15.5% in women and 12.7% in men [3]. According to injury. An injury that increases the risk of knee osteoarthritis
theory, more than 80% of individuals over the age of 65 is a torn meniscus or anterior cruciate ligament injury.
develop knee osteoarthritis. This is due to a decrease in Pratama [6] also explains that activities and work will cause
muscle strength that occurs due to a decrease in muscle oxidative damage, thinning of cartilage, weakening of
morphology. There is a progressive loss of body mass or muscles resulting in mechanical stress in the secondary
active body tissue that begins at the age of 40 years with a joints so that there is a change in proprioception and a
2% decrease in basal metabolism accompanied by body changing gait that causes quadriceps muscle weakness and
systems, so that as age begins to increase, the incidence of the process of decreasing the joint that absorbs muscle
knee osteoarthritis increases. material.

The distribution of the data based on body weight on Normality Test Data on increasing functional activity
the Ultrasound and Static Bicycle Exercise intervention is in before and after treatment on hypothesis testing in the group
Table 1 the average body weight is 72 + 6.27 with a with the provision of Ultrasound Intervention (US) and
minimum weight of 65 kg and a maximum weight of 85 kg Static Bicycle Exercise to increase functional activity in
and in table 4.2 the number of respondents weighing 65 - 69 Osteoarthritis Genu patients using parametric test with
as many as 5 people (38, 5%), while the number of paired sample test. Because the Shapiro Wilk Test
respondents based on body weight 70-75 as many as 4 Normality Test data is normally distributed, it can be seen
people (30.8%) as well as the number of respondents based with the value before, P = 0.034 the average result before
on body weight 76-81 as many as 3 people (23%) and the treatment 78.00 + 0.034 then P> 0.05 and the value after P =
number of respondents based on body weight 82-87 as many 0.276 then P> 0.05 the average after treatment 19.77 +
as 1 people (7.7%). This shows that body weight is one of 0.276.
the factors that cause osteoarthritis, this study is in line with
research Pratama [6] which explains that the primary cause Based on the parametric test with the paired sample
of Genu Osteoarthritis is still not known for certain, but test in the hypothesis test, it was reported that the mean
there are several risk factors: age, gender, genetics, weight, difference before and after the data obtained was 58.23 +
occupation, trauma, skeletal malformations, and metabolic 5.49 in the Treatment Group with a P value = 0.000 then P <
disease and other factors. Weight gain is usually associated 0.05, meaning Ho was rejected and Ha was accepted. The
with triggers for Knee Osteoarthritis. Obesity increases the conclusion of this study is that there is an effect of
joint load so that the resultant force will shift to the medial Ultrasound (US) Intervention and Static Exercises Bicycles
or varus. Then, Wijaya's research [7] explains that someone to Improve Functional Ability in Genu Osteoarthritis
with obesity has a 2.96 times higher risk of developing Patients. There was a decrease in knee pain and an increase
osteoarthritis than people who have a normal body index. in functional activity as a result of an exercise program
While overweight 2 times higher risk of developing carried out progressively from week 1 to week 2, with a
osteoarthritis. Obesity increases the risk of osteoarthritis by frequency of 3 times per week with measurements using
several mechanisms, such as increasing joint load, especially WOMAC. This research is supported by Pratama [6], this
on weight-bearing joints, changing behavioral factors such study explains that to reduce knee pain in Osteoarthritis
as decreased physical activity which ultimately reduces the patients, physiotherapy intervention is given for 2 weeks at a
ability and protective strength of the muscles around the dose of 3 times per week. Ultrasound (US) can reduce pain
joints. In knee osteoarthritis, obesity causes weakness of the and the right quadriceps spasm disappears.
muscles around the knee joint and increases the incidence of Pramita and Wahyudi's research [9] explained that
arthroplasty. In obese patients, fatty tissue can also be found Osteoarthritis causes pain and movement disorders in a
behind the patella in the knee joint area, commonly called person. Not only that, Osteoarthritis also causes joint
the infra patellar fat pad, the fat tissue can produce stiffness and lack of proprioception as well as a decrease in
adipokines, which are cytokines produced by fat cells, such quadriceps muscle strength. This will lead to impaired
as leptin, adiponectin, resistin, and visfatin. These

IJISRT22JAN354 www.ijisrt.com 463

Volume 7, Issue 1, January – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
immobilization and decreased functional activity. in patients with knee Osteoarthritis, because there is no
Osteoarthritis genu is often accompanied by several types of weight bearing so that there is no excessive loading on the
pain such as pain at rest, when moving and when walking. knee joint when exercising. The provision of static bicycle
The intensity of pain will increase when a person performs training aims to strengthen the quadriceps muscle.
daily functional activities, thereby reducing the ability of Osteoarthritis patients usually have a lower quality of life
functional activities. Symptoms that occur in knee due to knee pain, causing their extremity muscles to become
osteoarthritis are knee pain. The presence of knee pain weaker, thus static bicycle exercise can reduce pain and can
causes sufferers to be afraid to do activities or movements improve daily functional activities thereby improving the
so that it reduces their quality of life. Suggested non- quality of life in patients with knee Osteoarthritis. Static
pharmacological therapy such as exercise / knee exercises. cycling for 5 – 30 minutes as often as possible 3 times per
Other types of exercise that can be done are home exercise, week in Genu OA Patients by maintaining exercise
Range of Motion (ROM), strengthening exercise including intensity, can increase muscle strength, increase muscle
quadriceps and hamstring exercises as well as aerobics such flexibility, maintain joint propioceptive, increase ligament
as walking, cycling, swimming. The purpose of this exercise strength so as to reduce pain can be overcome by triggering
is to improve joint function, increase joint strength, protect the release of endorphins. as well as hormones that enter the
joints from damage by reducing stress on joints, prevent circulation of the bloodstream so that it provides a two-fold
disability and improve physical health. This exercise will of sedative effect on the joints.
course be adjusted to the patient's condition and ability [10]
Static Bicycle Exercises are active motion exercises
Khatri's research [11] explains that ultrasoud that involve external assistance, both human and machine.
intervention 3 MHz continuous ultrasound intensity heats This movement will force the muscles to contract and the
three times faster than 1 MHz. However, the intensity of 1 joints also move to the maximum extent. an active
MHz penetrates deeper than 3 MHz. Generally, the movement exercise that trains several muscle groups and
frequencies used in therapy are 1 and 3 MHz. For cases in joints at once. Exercise also exerts a large proprioceptive
subacute conditions, the time is 3 minutes, repetition 1x1 and kinesthetic stimulus effect through the resulting joint
day, 10x a day. For cases in chronic conditions, the time is approximation. Contraction of more than one muscle,
5-10 minutes, refining 1x1 day or 1x2 days. The therapeutic without weight bearing during the exercise process
effects of ultrasound, among others, relieve acute, subacute, stimulates mechano receptors in muscles and receptors
and chronic musculoskeletal pain. The pain relief is not yet around the joints to increase sensory input in the control of
known. However, some may be due to restoration of movement. This exercise can produce co-contraction
inflammation, elimination of waste products or changes in (contraction of agonist-antagonist muscles at the same time),
the permeability of cell membranes to sodium, which can approximation and activation of multiple muscles which are
alter electrical activity or pain thresholds. therapeutic effect all related and have a very large role in creating functional
overcomes inflammation by increasing blood supply, white movements. So that the muscles are able to stabilize the
blood cells, and removing waste products or substances that joints better so that it affects the quality of the resulting
are not useful in body tissues and preventing soft tissue movement. Multiple muscle contractions will greatly help
adhesions then the next therapeutic effect is to speed up produce synergistic movements in accordance with the
recovery or repair by regenerating or replacing damaged stages of normal movement, so as to reduce pain and
cells with the same cells, which have the same structure and increase functional ability in the knee joint and provide
function. The thermal effect of ultrasound therapy was exercise with a wider range of joint [13].
found to be very beneficial in the treatment of
musculoskeletal disorders, destroying scar tissue and IV. CONCLUSION
helping to stretch tendons. The use of ultrasound in heat
therapy can be combined with electrical stimulation of Based on the research carried out on the handling and
muscles. This combination can increase the ability to clear discussion above, it can be concluded that there is an effect
metabolic wastes, reduce muscle spasm and tissue of Ultrasound Intervention and Static Bicycle Exercises to
adhesions. Therapeutic ultrasound can reduce joint pain and reduce knee pain in patients with knee osteoarthritis, which
stiffness. This therapy can be used to improve nerve root can be seen from the hypothesis analysis of the data in the
impingement. and several types of neuritis (inflammation of treatment group with a mean value of 58.23 + 5.49 with a
nerves) and is also useful for post-injury healing. In addition significant value of p = 0.000 (p < 0.05).
to thermal effects, ultrasound therapy also produces non- Physiotherapists need to establish the correct
thermal effects in the form of cavitation and diagnoses, it is expected that the physiotherapist will carry
microstreaming. Cavitation is a process in which there are out specific physiotherapy examinations. For patients with
air bubbles that can enlarge in the tissue so that it can genu osteoarthritis who experience increasing activity and
increase the flow of plasma in the tissue. Microstreaming is functional abilities, it is hoped that they can continue static
the insistence of sound waves on cell membranes that can exercises at home.
increase the work of the cell's sodium pump which can
speed up the healing process. REFERENCES
The results of this study are supported by research by [1.] Dewi, Trisna Narta, Pramana, Yudi., Utama, Eka
Salacinski [12] who explains that physical fitness and Septian & Adhitya, Surya. (2019). Pengaruh
aerobic exercise capacity using a static bicycle are effective Pemberian Ultrasound Therapy Dan Neuromuscular

IJISRT22JAN354 www.ijisrt.com 464

Volume 7, Issue 1, January – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Taping Dalam Meningkatan Aktivitas Fungsional Pada
Kasus Osteoarthritis Lutut. Sport and Fitness Journal, 7
(2): 64-71
[2.] Dessy Hermawan, Andoko Andoko, Dewi
Kusumaningsih, Eka Yudha Chrisanto.(2019).
Pendidikan Kesehatan Terhadap Pengetahuan Pasien
Tentang Osteoarthritis di Puskesmas Kemiling, Bandar
Lampung. Jurnal Kreativitas Pengabdian kepada
Masyarakat, 2(1):10
[3.] Djawas.F.A.&Isna.W.R.2020.Closed Kinetic Chain
Exercise efektif dalam Meningkatkan Kemampuan
Fungsional pada Osteoartritis Lutut. Jurnal Ilmiah
Fisioterapi (JIF),3(2):2,4.
[4.] Winangun. (2019). Diagnosis Dan Tatalaksana
Komprehensif Osteoartritis. Jurnal Kedokteran, 5 (1):
125.
[5.] Khairuruizal et al. 2019.Perbandingan Pengaruh
Kombinasi Latihan Hold Relax danOpen Kinetic Chain
dengan Latihan Hold Relaxdan Close Kinetic Chain
Terhadap Peningkatan Kemampuan Fungsional Pasien
Osteoartritis Knee. Nusantara Medical
ScienceJournal,4(2):55,56,59
[6.] Pratama, Cafin Surya Putra, Pristianto, Arif &
Herawati, Isnaini (eds). (2020). Efektivitas Program
Aquatic Exercise Terhadap Penurunan Nyeri Pasien
Chronic Low Back Pain. Fisiomu, 1 (02): 49-53.
[7.] Wijaya, Sandy. (2018). Osteoartritis Lutut. Cdk, 45
(6): 424–429.
[8.] Ismaningsih & Selviani, Iit. (2018). Penatalaksanaan
Fisioterapi Pada Kasus Osteoarthritis Genue Bilateral
Dengan Intervensi Neuromuskuler Taping Dan
Strengthening Exercise Untuk Meningkatkan Kapasitas
Fungsional. Jurnal Ilmiah Fisioterapi, 1(2), 38–46.
[9.] Pramita, Indah & Wahyudi, Antonius Tri. (2020).
Ultrasoun, TENS dan Kineostaping Meningkatkan
Aktifitas Fungsional Pada Osteoarthritis Lutut. Jurnal
Fisioterapi dan Rehabilitasi, 4 (01): 41-48
[10.] Marlina, Theresia Titin. (2015). Efektivitas Latihan
Lutut Terhadap Penurunan Intensitas Nyeri Pasien
Osteoarthritis Lutut di Yogyakarta. Junal Keperawatan
Sriwijaya, 2 (01): 44-56
[11.] Khatri.S.M. 2015. Elektroterapi, Penerbit Buku
Kedokteran, Jakarta : 109-110 hlm.
[12.] Salacinski, (2021). The Effects Of High-Intensity And
Low-Intensity Cycle
[13.] Kisner C dan Colby L Alen.2012.Therapeutic Exercise
Foundations and Techniques. Sixth Edition. F.A Davis
Company.America. hal 850-859.

IJISRT22JAN354 www.ijisrt.com 465