Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain?
S Arumugam, Tvisha Ketan Parikh
Citation Information :
Arumugam S, Parikh TK. Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain?. J Postgrad Med Edu Res 2017; 51 (1):1-6.
To evaluate the association between anterior knee pain (AKP) and traditional Indian habits of cross-legged sitting and squatting which involve deep knee flexion.
Materials and methods
A case control study was carried out in 225 patients and 225 age and sex matched controls at a tertiary care university hospital in South India over 3 years. Males and females between 18 and 55 years were evaluated using a clinical proforma of history and musculoskeletal examination. The details of deep knee flexion habits with quantification of duration were noted and participants were categorized into those who sat and did not sit cross legged, and squatters and nonsquatters. Odds ratios and chi-square tests were calculated for both these categorical variables. A subgroup analysis and stratified analysis were also performed.
Results
The Odds ratios for cross-legged sitting and squatting were not significant at 0.88 and 0.92 respectively. Sixty-nine point three percentage of the AKP cases and 72% of the controls sat cross legged (p = 0.534) and 67.6% of the AKP cases and 69.3% of controls habitually squatted (p = 0.685). Stratified analysis revealed a protective effect of cross legged sitting in AKP cases with quadriceps muscle tightness.
Conclusion
This study did not find an association between AKP and Indian habits of deep knee flexion. More than 65% of all the participants regularly engaged in these habits. Laboratory biomechanical analysis of these positions is suggested in future to understand their effect on knee joint.
Clinical significance
These positions are integral to daily habits of many Indians. The advice to AKP patients to avoid them due to their probable AKP association is not supported by the current study. Clinicians can consider the impact on the patient's quality of life before advising against these positions.
How to cite this article
Parikh TK, Arumugam S. Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain? J Postgrad Med Edu Res 2017;51(1):1-6.
Concentric hip muscle function and quadricps: Hamstring in athlets with and without Oatellofemoral pain syndrome. Ibnosina J Med Biomed Sci 2012;4(1):20-27.
Patellofemoral pain syndrome: proximal, distal, and local factors, aninternational retreat, April 30–May 2, 2009, Fells Point, Baltimore, MD. J Orthop Sports Phys Ther 2010 Mar;40(3):A1-16.
Anterior knee pain: A long-term follow-up. Rheumatology (Oxford) 2003 Feb;42(2):380-382.
Are there three main subgroups within the patellofemoral pain population? A detailed characterisation study of 127 patients to help develop targeted intervention (TIPPs). Br J Sports Med 2016 Jul;50(14):873-880.
Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis? Knee 2005 Oct;12(5):362-365.
Best tests/ clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review. Physiotherapy 2012 Jun;98(2):93-100.
Comparison of symptoms and clinical findings in subgroups of individuals with patellofemoral pain. Physiother Theory Pract 2006 Jun; 22(3):105-118.
Patellofemoral stress during walking in persons with and without patellofemoral pain. Med Sci Sports Exerc 2002 Oct;34(10):1582-1593.
Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study. Osteoarthritis Cartilage 2011 Mar;19(3):287-294.
Patellofemoral joint contact area is influenced by tibiofemoral rotation alignment in individuals who have patellofemoral pain. J Orthop Sports Phys Ther 2007 Sep;37(9):521-528.
Patellofemoral joint kinetics while squatting with and without an external load. J Orthop Sports Phys Ther 2002 Apr; 32(4):141-148.
Patellofemoral joint force and stress during the wall squat and one-leg squat. Med Sci Sports Exerc 2009 Apr;41(4):879-888.
Regulation of the patellofemoral contact area: An essential mechanism in patellofemoral joint mechanics? J Biomech 2010 Dec 1;43(16):3237-3239.
Morphometric analysis of vertical groove on anterior surface of tibial lateral condyle and its relation with squatting. J Evol Med Dent Sci 2015 May 14;4(39):6774-6777.
Morphometric study of some lower femoral anatomy in Eastern Indian population. Indian J Basic Appl Med Res 2014 Sep;3(4):182-190.
Morphological measurements of knee joints in indian population: comparison to current knee prostheses. Open J Rheumatol Autoimmune Dis 2014 May;4(2):75-85.
Clinical tibiofemoral angle in south Indian children. Bone Joint Res 2013 Aug;2(8):155-161.
Demystifying the complex patellar form via ratios and indices. Mymensingh Med J 2014 Oct;23(4):787-791.
Q angle -relevance for evaluation of anterior knee pain. J Evol Med Dent Sci 2013 Dec 23;2(51):10066-10070.
Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 2005 Dec;35(12):793-801.
Foot and ankle characteristics in patellofemoral pain syndrome: a case control and reliability study. J Orthop Sports Phys Ther 2010 May;40(5):286-296.
Patellofemoral joint contact area increases with knee flexion and weight-bearing. J Orthop Res. 2005 Mar;23(2):345-350.
Anterior Knee Pain and Patellar Instability. London: Springer; 2006.
Thighcalf contact: does it affect the loading of the knee in the highflexion range? J Biomech 2009 Mar 26;42(5):587-593.
Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop Scand 1972; 43(2):126-137.
Knee joint kinetics in relation to commonly prescribed squat loads and depths. J Strength Cond Res 2013 Jul;27(7):1765-1774.
Patellofemoral joint contact area increases with knee flexion and weight-bearing. J Orthop Res 2005 Mar;23(2):345-350.
A new in vivo technique for determination of 3D kinematics and contact areas of the patellofemoral and tibio-femoral joint. J Biomech 2004 Jun;37(6):927-934.
In vivo assessment of patellofemoral joint contact area in individuals who are pain free. Clin Orthop Relat Res 2003 Dec;(417):277-284.
MRI-based analysis of patellofemoral cartilage contact, thickness, and alignment in extension, and during moderate and deep flexion. Knee 2015 Oct;22(5):405-410.
In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J bone Joint Surg Am 2009 Mar 1;91(3):558-566.
Differences in patellofemoral contact mechanics associated with patellofemoral pain syndrome. J Biomech 2009 Dec 11;42(16):2802-2807.
Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports Med 2013 Oct;43(10):993-1008.
Comparison of three-dimensional patellofemoral joint reaction forces in persons with and without patellofemoral pain. J Appl Biomech 2014 Aug;30(4):493-500.
