International Journal of Advanced Research and Publications

ISSN: 2456-9992

Comparative Effects Of Russian Current And

Isometric Resisted Exercise On Quadriceps Angle
And Joint Space Width Among Patients With
Primary Knee Osteoarthritis
John O. Omole, Michael O. Egwu, Adesola O. Ojoawo, Abiola O. Ogundele
Obafemi Awolowo University Teaching Hospitals Complex, Physiotherapy Department, OAUTHC, Ile-Ife, Osun State, Nigeria, PH-
+2347032545870
elidrwiz@yahoo.com

Obafemi Awolowo University, College of Health Sciences, Department of Medical Rehabilitation, Ile-Ife, Osun State, Nigeria, PH-
+2348033739499
megwu@oauife.edu.ng

Obafemi Awolowo University, College of Health Sciences, Department of Medical Rehabilitation, Ile-Ife, Osun State, Nigeria, PH-
+2348033567577
aoojoawo@yahoo.com

Obafemi Awolowo University Teaching Hospitals Complex, Physiotherapy Department, OAUTHC, Ile-Ife, Osun State, Nigeria, PH-
+2348162760502
abiolaogundele@yahoo.com

Abstract: Background: Beneficial effects of Isometric Resisted Exercise (IRE) in the rehabilitation of patients with primary Knee
Osteoarthritis (OA) are sometimes restricted due to associated co-morbidities. Objective: This study compared the effects of Russian
Current (RC) and IRE in the management of patients with primary knee OA. Methods: A hospital-based quasi-experimental study was
conducted in a tertiary hospital in Osun State. Forty-seven consenting patients with knee OA participated in this study. They were randomly
assigned to either IRE only (IREO) group or IRE plus RC (IRERC) group. Each participant received treatment twice a week for a total of
eight weeks. Effects of intervention were assessed in terms of quadriceps angle and joint space width at the 4 th and 8th week of intervention.
Data were analyzed using descriptive and inferential statistics with alpha set at p<0.05. Result: IRERC and IREO resulted in a significant
mean change in quadriceps angle (IRERC – p=0.005: IREO – p=0.001) score. However, there was no significant mean change in joint space
width of both groups (IRERC – p=0.334: IREO – p=0.433). Furthermore, there was no significant difference in the mean changes in
quadriceps angle and joint space width scores between IRE plus RC and IRE only groups (p>0.05). Conclusion: Isometric resisted exercise
alone had a significant effect on quadriceps angle in patients with primary knee OA. However, Russian current did not show additional
effects.

Keywords: Electrical stimulation, Isometric resisted exercise, Primary knee Osteoarthritis, Russian current

1. Introduction
Knee osteoarthritis (OA) is characterized by degeneration of
normal cartilage which is progressive and debilitating due to
irreversible changes in the matrix structure of the joint [1].
Pathological changes in cartilage structure with radiological
evidence of osteophytes and narrowing joint space resulting
in perceived pain and in extreme cases disability are all
classical signs of knee OA [2]. The rate of knee OA
increases with age with females more predisposed to knee
OA than their male counterparts [3]. Knee OA can be
classified as either primary or secondary. Identifiable risk
factors for primary knee OA include aging or heredity even
though the majority of cases are idiopathic [4]. Joint
degeneration triggers like infections, congenital deformity,
trauma including repetitive micro-trauma due to certain
occupations like football or farming are the risk factors seen
in secondary knee OA [2], [4]-[5]. Amongst the earliest
symptoms of knee OA is pain, which is mainly a dull aching
pain occurring intermittently and during periods of
inactivity. This later progresses to a cramp-like pain
occurring continuously usually after activity [6]. Pain, either
acute or chronic lead to a reduction in joint range of motion
and quadriceps weakness which in turn could result in
disability particularly the older age group [7]. The etiology
and progression of knee OA are mainly due to weak
quadriceps which leads to an undue stress across the knee
[3]. Abnormal quadriceps-angle (Q-angle) can result in a
weak quadriceps apart from knee pain. The Q-angle is the
angle between the quadriceps muscles (primarily the rectus
femoris) and the patellar tendon and represents the angle of
the quadriceps muscle force [8]. The normal Q-angle for
healthy men is 13 degrees while for women is 18 degrees
[9]. In Nigeria, a study was conducted to find out if these
angles were also seen in the general population. The result
showed that both the Nigerian and Caucasian men had the
same Q-angle while the Nigerian women had an average of
3 degrees more than that of Caucasian women [10]. An
increased Q-angle away from the normal values has been
linked to weak quadriceps especially the medial quadriceps
[11]. while a decreased Q-angle may result in an increased
pressure to the tibiofemoral joint medially thereby
increasing the varus orientation [12]. Joint space narrowing
(JSN) occurs due to the erosion of the cartilage as part of the
degenerative process associated with arthritis but the best
method of evaluating the progression of the cartilage
destruction is through measurement of joint space width

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(JSW) [13]. The JSW is assessed by measuring the inter-
bone distance at its narrowest point referred to as minimum
JSW. Two methods had been used as a radiographic
assessment method to measure the rate of progression of
knee OA. They are the anteroposterior (AP) view with the
knees extended and the Lyon schuss view which is a
posteroanterior (PA) radiographic view with the knees
flexed from 10° to 30° depending on the relative length of
the feet and tibiae. Both radiographic views are taken in a
standing position [13]. The treatment method employed in
the management of patients with knee OA is mainly divided
into two: non-invasive treatment including pharmacology
and physiotherapy and the invasive method such as surgery
[14]. Physiotherapy intervention has been proven to be
effective as a means of treating knee OA [15], [16] with the
sole aim of reducing pain, strengthening weak muscles,
increasing joint range of motion, joint function restoration
and deformities prevention [17]. Modalities used by the
physiotherapist includes exercise therapy, cryotherapy,
electrotherapy, manual therapy, foot orthosis, brace, tapping,
and education on self-care [7], [15]. Isometric Resisted
Exercises (IRE) to the quadriceps has been shown to be an
effective management in patients with knee OA with some
studies claiming that IRE delays degenerative changes and
enhances the activity of daily living [18], [19]. However,
most patients are unable to perform the isometric resisted
exercise type to a point of benefit due to co-morbidity like
cardiac disease and high blood pressure [20]. Consequently,
the introduction of other intervention as an adjunct to
isometric resisted exercises has been suggested [21].
Russian current was first used on Russian athletes to
improve muscle strength [22] but has also been reported to
reduce pain22 and improve physical function [23]. However,
a few studies had been conducted on Russian current in the
management of patients with primary knee OA. Therefore,
the objective of this study was to compare the effects of
Russian current and IRE on quadriceps angle and joint space
width amongst patients with primary knee OA with a view
of finding out if Russian current could be used to augment
exercise in patients with primary knee OA.
2. Methods
2.1. Participants
Participants in this hospital-based quasi-experimental study
design were forty-seven in number. They were diagnosed
with primary osteoarthritis of the knee joint and referred
from the outpatient orthopedic clinic of the Obafemi
Awolowo University Teaching Hospitals Complex
(OAUTHC), Ile-Ife and Ilesha Units. The participants were
then recruited from the outpatient physiotherapy clinics of
the Obafemi Awolowo University Teaching Hospitals
Complex (OAUTHC), Ile-Ife and Ilesha Units, Osun State.
Eligibility for inclusion were patients with knee OA whose
ages were 40 to 75 years of age; grade III OA according to
Kellgren and Lawrence classification; unilateral and/or
bilateral OA of the knee (However, the knee joint with the
greater symptoms was considered for patients with bilateral
knee OA). Exclusion criteria included patients with
secondary knee OA due to traumatic injury or infection; any
absolute or uncontrolled cardiovascular contraindications to
exercise; any current severe neuromuscular disorders; any
recent surgical interventions, metallic implants and Intra-
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articular steroid injections to knee within three months prior
to the study.
2.2 Procedure
Ethical approval was obtained from the Ethics and Research
Committee of the Obafemi Awolowo University Teaching
Hospitals Complex (OAUTHC) Ile-Ife, Nigeria. Approval
was also obtained from the head of the Physiotherapy
department. Participants gave written informed consent after
the purpose and protocol of the study had been explained to
them. Each participant who satisfied the eligibility criteria
was then given a study number in order to ensure
confidentiality. All information collected from participants
were encrypted in an electronic file and protected by a
password. Only the principal researcher had access to all
collected data. Forty-seven participants were consecutively
recruited and randomly assigned into two different treatment
groups using a permuted block program [24]. This block
randomization online program used a block size of four. The
first group of participants received a combination of
Isometric Resisted Exercise and Russian Current (IRERC) to
the quadriceps of the affected knee joint while the second
group of participants received Isometric Resisted Exercises
only to their involved knee joint (IREO). Each participant
received treatment twice per week for eight weeks.
2.3 Instruments
A stadiometer manufactured by Leaidal Medical Ltd, the
United Kingdom with model number: RGZ-160 was used to
measure both the weight and height of each participant in
kilograms and meters respectively. An electrical stimulation
machine, Sonopuls 692 made by Enraf-Nonius Company,
The Netherlands with model number: 1600945 was used to
stimulate the quadriceps of participants with knee OA in the
second group.
2.4 Measurement
Height
Height measurement was done with a stadiometer in meters
to the nearest centimeter. Each participant stood on the
weight measure erect, with shoes off while their occiput
touched the metering rod. This measuring rod was carefully
placed on the highest point of each participants head which
is perpendicular to the height meter [25].
Weight
Each participant weight was measured in kilogram (Kg) to
the nearest 0.1kg. Each participant stood on the stadiometer
with shoes off while wearing a light apparel. Each
participant was asked to look forward while reading was
recorded [25].
Body Mass Index (BMI)
Participant’s BMI which is in kilogram per meter squared
(Kg/m2) was calculated using the participant's weight
measured in kilograms and diving it by the square of the
appropriate height in meters. Classification of the BMI was
done according to WHO (2000) recommendations [26]. The
BMI values are as follows:
i. Underweight - < 18.50 Kg/m2
ii. Normal - 18.50 – 24.99 Kg/m2
iii. Overweight - 25.00 – 29.99 Kg/m2
iv. Obese Class I - 30.00 – 34.99 Kg/m2
v. Obese Class II - 35.00 – 39.99 Kg/m2
vi. Obese Class III - 40 Kg/m2 and above
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 International Journal of Advanced Research and Publications
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Quadriceps angle
A Baseline trademark 30cm absolute + axis Goniometer was
used to assess the knee Q-angle of each participant. The
midpoint of the patella was determined by first using a tape
(Butterfly measuring tape made by Shanghai Kearing
Stationary Co. Ltd, China with model number HD1516 of
150cm / 60 inches) to measure the patella’s length in which
the midpoint was marked, then the height (the apex and
base) of the patella was measured with the same tape
measure and the midpoint marked. The intersection
represents its midpoint. The Q-angle was then obtained by
drawing an imaginary line from the Anterior Superior Iliac
Spine (ASIS) to the midpoint of the patella and from the
tibial tubercle to the midpoint of the same patella. The angle
formed by the intersection of both lines is the Q-angle and
was measured using a goniometer [27].
Joint space width
Each participant was required to take a radiographic imaging
of their involved osteoarthritic knee joint. As for participants
with both knees involved, radiographic imaging of both
knees was taken but the more affected knee was recorded.
The postero-anterior radiographic imaging was done with
the participants in standing position, with their knee joint
slightly flexed to 30º and patellae pressed against the
imaging plate. Once the radiographic images are taken and
the film released, the minimum joint space width was then
measured. The medial joint space width was assessed by
measuring the inter-bone distance (between the femur and
tibia bone) at its narrowest point using a 0.1-mm graduated
magnifying lens laid over the radiograph [28], [29].
Intervention using Isometric Resisted Exercise (IRE)
Three specific open chain IRE were completed by every
participant in both groups. The resistance used were free
weights to the osteoarthritic leg but if bilateral knee OA was
present, the most symptomatic leg was then selected for the
study. The exercises that each participant underwent
included:
1. Knee extension while in a high seated position –
The starting point was the arthritic knee in 90
degrees of flexion followed by verbal instruction
given by the therapist to the participant to extend
his / her affected leg against pre-determined ankle
weights.
2. Knee extension with an instruction to hold at 30
degrees of knee flexion while in a high seated
position – The starting point with the arthritic knee
in 90 degrees of flexion, each participant was
verbally instructed to extend / straighten their
affected leg against a pre-determined ankle weight
and told to hold this position once the knee flexion
was at 30 degrees.
3. Straight Leg Raise (SLR)while in a supine lying
position – Each participant while in a supine lying
position will raise the affected / arthritic leg (knee
joint) to 30 degrees hip flexion against pre-
determined ankle weights [30].
The free ankle weights used were pre-determined for each
consenting participant in this study by using the progressive
resistance exercise program which was on ten Repetition
Maximum (RM) as suggested by Thomas Delome [31]. By
definition, an RM is simply “the greatest amount of weight
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or load a muscle can move through the full, available range
of motion with control a specific number of times before
fatigue sets in” [32]. Each participant 10 RM was
determined, documented and then told to come back after a
week to commence the strength training. Each participant
after checking their blood pressure to be sure they are fit for
such an exercise program were instructed to perform a
warm-up exercise by riding on a bicycle ergometer without
resistance applied for five minutes. Once the warm-up
session was completed the resisted exercise sessions began
with the first set of 10 repetitions at 50% of 10RM, a second
set of 10 repetitions at 75% of 10RM and a third set of 10
repetitions at 100% of 10RM [31]. Therefore, each
participant performed a total of 30 repetitions for each of the
previously described knee/hip joint positions. A rest period
of 120 seconds in between each set was given. The exercises
were performed slowly but in a systematic manner and at
each given end range the position was sustained for first five
seconds but later increased to 10 seconds. Constant
instructions were given to each participating participant to
sustain breathing throughout the phase of the exercise to
avoid Valsalva maneuver [30], [33]. Once the participant is
observed to have adapted to the free ankle weights, a
progressive increase was made [32]. A cool down session
was also performed at the end of the IRE session using the
bicycle ergometer without resistance applied for five
minutes. All IRE was done with tolerable levels of pain [30].
Intervention using Russian Current (RC)
Participants who were randomly selected from the second
group also received RC stimulation (IRERC) to their
quadriceps after resting for a period of 10 minutes following
the RE intervention. Each participant in this group was
positioned in a supine lying position on a plinth with
reasonably sized pillows placed underneath the knee joint.
Carbon rubber electrodes (8 x 12 cm) of equal paired size
were placed first placed in a moist pad before placing them
on the rectus femoris and vastus medialis muscles of the
arthritic knee joint and held in place by a Velcro strap. A
carrier frequency of 2,500Hz alternating sinusoidal
waveform current with a burst frequency at 50Hz was used.
The intensity was then gradually increased until there was a
maximum but tolerable strong quadriceps contraction. Once
it was observed that neural accommodation has occurred, the
amplitude was further increased to produce the strong
contraction but at a comfortable sensory level for each
participant25. The electrical stimulation was given for a
duration of 10 minutes using the regimen 10/50/10 –
meaning 10 seconds “on”, 50 seconds “off” and this
sequence is repeated in 10 minutes [34]. Participant in this
group had their quadriceps stimulated twice a week for 8
weeks.
3 Data analysis
Normality testing for dependent variables was done using
Shapiro-Wilk test. Continuous variables such as age and
height were summarized using mean (standard deviation).
Inferential statistics of repeated measure of Analysis of
Variance (ANOVA) was used to compare quadriceps angle
and joint space width of each of the two groups across
baseline, 4th and 8th week. Post hoc analysis of Fisher’s
Least Significant Difference (LSD) was used to identify
which pair of means of quadriceps angle were statistically
different in each of the two groups at baseline, 4th and 8th
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week. Student t-test was also used to compare the mean pair of cell means that is significant has different
changes in quadriceps angle and joint space width between superscript.
the IRE only group and the IRERC group. Data were
analyzed using the Statistical Program for Social Sciences Table 3: Repeated measure ANOVA comparison of the
for Windows version 22 (SPSS Inc., Chicago, Illinois, effects of IRERC on quadriceps angle and joint space width
United States) and cut-off statistical level of significance across the three time periods.
was set at P < 0.05. ______________________________________________
Variable Baseline 4th Week 8th Week F-Ratio p-value
4. Results x± D x ±SD x±SD
________________________________________________
The mean (standard deviation) age, height, weight, and body Q–Angle (º) 20.04 19.54 19.04 9.41 0.005*
mass index of participants who took part in this study were ±3.06a ±2.64b ±2.48b
61.30(10.58) years, 1.59(0.07) m, 82.00(10.77) Kg and JSW (mm) 2.92 3.04 3.17 1.10 0.334
32.81(4.90) kg/m2 respectively. There were 36 (76.6%) ±0.93 ±0.95 ±1.01
females with a female to male ratio of 1.33:1. The ________________________________________________
independent t-test comparison of the general characteristics Key: IRERC = Isometric Resisted Exercise plus Russian
of participants by the group is shown in Table 1. There was Current; Q-Angle = Quadriceps Angle; JSW = Joint Space
no significant difference in both the age distribution and Width; º = Degree; mm = Millimeter; * Significance level =
anthropometric parameters of the two groups of study p < 0.05.
participants.
Superscripts (a, b, c).
Table 1: Comparison of the general characteristics of the For a particular variable, mode means with different
participants in the Isometric Resisted Exercise (IRE) only superscript are significantly (p < 0.05) different. Mode
group and the IRE plus Russian Current group means with the same superscript are not significantly (p >
0.05) different. In each column, a maximum of three
Variable IRE IRERC contrasts is possible, when only one contrast is significant,
Group (n=23) Group (n=24) one of the three cell means has no superscript attached. The
x .D x ± S.D pair of cell t-test
means that is p-value
significant has different
Age (years) 63.43 ± 10.23 59.33 ± 10.73 superscript. The1.337
results showed that
0.189the IRE only group had
Height (m) 1.58 ± 0.08 1.61 ± 0.07 a significant difference
1.317 in quadriceps
0.194 angle (F=10.82;
Weight (Kg) 83.43 ± 11.63 80.63 ± 10.54 p=0.001) while 0.870 0.389was seen in JSW. The
no significant change
BMI (Kg/m2) 34.38 ± 4.54 31.18 ± 4.90 result of the 1.550
IRERC group0.126 also showed a significant
Key: BMI = Body Mass Index; IRE = Isometric Resisted difference in quadriceps angle (F= 9.41; p=0.005) but no
Exercise; IRERC = Isometric Resisted Exercise plus Russian significant difference in the JSW. Table 4 shows the
Current; * Significance level = p < 0.05. independent t-test comparison of the effects of IRE only and
IRERC on quadriceps angle and JSW at the 4th week and
Repeated measure of Analysis of Variance (ANOVA) was 8th week. There was no significant difference in the
used to compare the effects of IRE only and IRERC on quadriceps angle scores (p>0.05) and JSW scores (p>0.05)
quadriceps angle and joint space width across the three time in both IRE and IRERC. Fisher’s least significant difference
periods (at baseline, 4th and 8th week) as presented in (LSD) post-hoc analysis was used to clarify where the
Tables 2 and 3. significance values in the F-ratio lie.

Table 2: Repeated measure ANOVA comparison of the Table 4: Independent t-test comparison of quadriceps angle
effects of IRE only on quadriceps angle and joint space and joint space width between IRE only group and IRERC
width across the three time periods. group in the 4th week and 8th week
________________________________________________ ________________________________________________
Variable Baseline 4th Week 8th Week Variable IRE IRERC t – cal p-value
x D x ±SD x SD F-ratio p-value (n = 23) (n = 24)
_____________________________________________ x ±SD x ±SD
Q–Angle (º) 19.04 18.74 18.09 10.82 0.001* ________________________________________________
±3.20a ±2.75a ±2.56b
JSW (mm) 3.04 3.09 2.96 0.691 0.433 4th Week
± 0.98 ± 1.00 ± 1.19 Q-angle (º) -0.50 -0.30 0.721 0.474
________________________________________________ ±0.93 ±0.93
Key: IRE = Isometric Resisted Exercise; Q-Angle = JSW (mm) 0.04 0.13 -1.000 0.324
Quadriceps Angle; JSW = Joint Space Width; º = Degree; ±0.21 ±0.34
mm = Millimeter; * Significance level = p < 0.05. 8th Week
Q–angle (º) -1.00 -0.96 0.115 0.909
±1.35 ±1.22
Superscripts (a, b, c). JSW (mm) -0.09 0.25 -1.917 0.062
For a particular variable, mode means with different ±0.67 ±0.53
superscript are significantly (p < 0.05) different. Mode ________________________________________________
means with the same superscript are not significantly (p > Key: IRE = Isometric Resisted Exercise; IRERC = Isometric
0.05) different. In each column, a maximum of three Resisted Exercise plus Russian Current; Q-Angle =
contrasts is possible, when only one contrast is significant, Quadriceps Angle; JSW = Joint Space Width; º = Degree;
one of the three cell means has no superscript attached. The mm = Millimeter.

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5. Discussion
This study was carried out to determine the comparative
effects of Isometric Resisted Exercise (IRE) and Russian
Current (RC) on Quadriceps angle (Q-angle) and Joint
Space Width (JSW) among patients with primary knee
osteoarthritis (OA). The mean age of the study participants
was 61.30 ± 10.58 years. This age category of participants in
this study fell within the age bracket of 40 – 75 years within
which knee OA is prevalent [35]. Comparison of the mean
ages and anthropometric parameters of the two groups also
showed no significant difference. This study showed that
participants in the Isometric Resisted Exercise Group
(IREG) had a significant reduction in their quadriceps angle.
This finding is in agreement with previous studies by
Lathinghouse and Trimble [36], and Sarkar et al [37]. They
both showed that the use of isometric resisted exercises
resulted in a decreased Q-angle. Patients with knee OA
usually have a weak quadriceps which may be due to reflex
inhibition in response to joint effusion and pain, disuse or
limited use, loss of mechanical integrity around the knee
joint or impaired proprioception [20]. Due to this weak
muscle group – especially the medial part of the quadriceps,
the knee’s Q-angle begins to gradually increase resulting in
knee joint instability. Isometric resisted exercises, on the
other hand, strengthens the quadriceps including the vastus
medialis which in turns begins to correct the Q-angle. The
within-group comparison of participants in IREG across the
three time periods of the study revealed that resisted exercise
had a significant effect on quadriceps angle. These findings
are consistent with previous reports that demonstrated
evidence for the use of resisted exercise protocol [38], [39].
This study also showed that Isometric Resisted Exercise plus
Russian Current Group (IRERCG) had a significant
reduction in their quadriceps angle of participants with knee
OA post-treatment. Talbot et al [40], in their study, observed
an increase in quadriceps muscle strength following
treatment of adults with knee OA with RC which had a
positive effect on the quadriceps angle. The within-group
comparison of participants in IRERCG across the three
times periods of the study revealed a significant difference
in quadriceps angle. These findings are similar to findings
from similar studies [40], [41]. Russian current stimulation
of the peripheral muscle causes an increase in the
excitability of spinal routes, changes in the cortical
activation pattern and improves the recruitment of fast
twitch (fatigable) muscle fibers which are responsible for
strength [42]. Also, there seem to be some neural
adaptations that increase the capacity of voluntary muscle
contraction that was impaired in patients with knee OA [43].
However, there was no significant difference in the Joint
Space Width (JSW) of participants with primary knee
osteoarthritis in both the RE only group and IRERC group
post-treatment. This is in agreement with a similar study
conducted by Mikesky et al [38]. They concluded that
resisted exercise over a period of 30 months did not result in
an increment in JSW, rather a progressive joint narrowing
continued to occur. Segal et al [44], stated that quadriceps
weakness was associated with an increased risk of JSW
reduction in women but could not prove if an increase in
quadriceps strength, resulted in an improved JSW. Messier
et al [28], from their study, stated that the medial JSW
narrowed more than the lateral JSW probably due to greater
weight-bearing load on this compartment and that both parts
of the knee joint still underwent progressive JSW narrowing
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despite aerobic and resisted exercises. Joint space narrowing
often results in pseudo-laxity of the medial collateral
ligament, stretching of the lateral collateral ligament, and a
genu varus deformity [20]. Reasons for non-increase in JSW
following resisted exercises might probably be due to the
fact that the degenerative process once initiated cannot be
reversed [32]. The between-group comparison of
participants in the IREG and IRERCG across the three time
periods of the study also revealed no significant difference
in the quadriceps angle and joint space width. Reasons for
Russian Current not having an additional effect on
quadriceps angle may probably be due to high levels of
discomfort some participants experienced as attempts were
made to increase the current intensity because they
(participants) had reached neural accommodation. Russian
current has been shown to generate a greater discomfort
level than other therapeutic electric currents like Low-
Frequency Pulse Current (LFPC). A contractive force of 50-
60% maximum voluntary contraction (MCV) is needed to
bring about an effective change physiologically. However, a
study done by Laufer and Elboim [45], suggested that
participants could only tolerate a maximum electrically
induced contractive force of 30% -38% not enough for the
needed physiological changes. Another reason may be due
to the quick rate at which muscles fatigue during the
application of electrical stimulation. Russian current causes
the recruitment of fast glycolytic muscle fibers first before
that of the slow oxidative muscle fibers [46]. The
implication of this is that muscles tend to fatigue faster than
compared to aerobic or endurance exercises. But, resisted
exercise also has the same order of muscle recruitment as
that of Russian current. However, the difference may be in
the time allowed motor units to recover and replace used up
Adenosine triphosphate (ATP). Two minutes rest period was
allocated in-between resisted exercises while a fifty seconds
rest interval was observed during the use of Russian current.
The Russian current usually follows a protocol to prevent
continuous stimulation of the muscles by using the on: off
ratio protocol which is usually 1:5 which means 10 seconds
contraction with a 50 seconds rest interval [34]. However,
fifty seconds may still be insufficient for the motor units to
recover before another round of selective recruitment of
muscle fibers via synchronous stimulation [47].
6. Conclusion
The use of isometric resisted exercise (using the Delorme
resisted exercise protocol) alone had significant effects on
quadriceps angle in patients with primary knee
osteoarthritis. However, Russian Current did not show
additional effects.
Conflict of Interest: None declared
Funding: None
Acknowledgments
The authors gratefully acknowledge the assistance of Prof.
R.A. Adedoyin and Dr. O.B. Oyelese. Special appreciation
to Mrs O.A Arilewola and Mr. O.O. Afolabi for their input.
Finally, we thank all the participants that took part in this
study.
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Author Profile
Omole John Oluwatosin received a Bachelor’s degree in
Physiotherapy from the University of Ibadan, Nigeria in
2005. He also has a Master’s degree in physiotherapy from
the Obafemi Awolowo University, Ile-Ife, Nigeria. He
currently works as a chief physiotherapist at the Obafemi
Awolowo University Teaching Hospitals Complex,
Physiotherapy Department, OAUTHC, Ile-Ife, Osun State,
Nigeria.

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