Test-retest reliability of isokinetic dynamometry for the assessment of spasticity of the knee flexors and knee extensors in children with cerebral palsy

OBJECTIVE: To assess test-retest reliability of the peak resistance torque and slope of work methods of spasticity measurement of the knee flexors and extensors in children with cerebral palsy (CP). DESIGN: Test-retest reliability study. SETTING: Pediatric orthopedic hospital. PARTICIPANTS: Fifteen children with CP. INTERVENTION: Knee extensor and flexor spasticity was assessed with an isokinetic dynamometer using passive movements at 15 degrees, 90 degrees, and 180 degrees/s taken 1 hour apart. MAIN OUTCOME MEASURES: Peak resistive torque and work were calculated. The relative and absolute test-retest reliability was calculated by using intraclass correlation coefficients (ICCs) and Bland-Altman plots, respectively. RESULTS: Relative reliability was good (ICC>.75) for slope-of-work and peak resistance torque measurements at a velocity of 180 degrees/s, whereas reliability of peak torque measurements was decreased (ICC<.51) at slower velocities for both muscle groups. The 95% limits of agreement of Bland-Altman plots contained most data points for both methods, but the width of the limits of agreement were wide. CONCLUSIONS: The measurement of spasticity of the knee extensors and flexors in children with CP using peak-resistance torque at 180 degrees/s and the slope of work method has acceptable relative test-retest reliability. However, the absolute reliability of spasticity data should be considered cautiously.     

Reliability of measurements of concentric and eccentric isokinetic loading

The purpose of this study was to assess the reliability of a method for testing peak torque and work output of the knee extensor muscle during concentric and eccentric loading at three velocities of exercise (60 degrees, 120 degrees, and 180 degrees/sec). Fourteen healthy men (23-32 years of age) performed exercises of the quadriceps femoris muscles during concentric and eccentric loading, with a five-second pause between each contraction. Three different tests were performed on different occasions. The first exercise session was a practice session, and the next two sessions were established to collect data in a test-retest format. Peak torque and work were measured for the two testing sessions. The results of this study demonstrated that with a very specific protocol, the reliability of concentric peak torque and work measurements was excellent at 60 degrees and 120 degrees/sec and good at 180 degrees/sec. In contrast, reliability of eccentric peak torque and work measurements was good at 120 degrees and 180 degrees/sec but low at 60 degrees/sec.     

Reliability of isokinetic measurements of hip muscle torque in young boys

The purpose of this study was to determine the reliability of measurements of hip muscle torque obtained with the Cybex II isokinetic dynamometer from healthy young boys. Twenty-nine healthy boys, aged 6 to 10 years, were tested two times at one- to two-week intervals. Torque of the hip flexors and extensors and the hip abductors and adductors was assessed at angular velocities of 30 degrees and 90 degrees/sec. The torque generated by each muscle group at 30 degrees/sec was similar to the torque generated at 90 degrees/sec. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability for measurements of each of the muscle groups at both angular velocities. The ICCs were higher for hip flexion and extension than they were for hip abduction and adduction. The highest ICC (ICC = .84) was found for hip extension at 90 degrees/sec. The ICCs for hip abduction and adduction at both angular velocities were less than .60. Factors that possibly contributed to the relatively low reliability in hip abduction and adduction are discussed.     

Reliability of knee extensor and flexor torques during continuous concentric-eccentric cycles

Peak and average torques of the knee extensors and flexors were determined on three occasions within ten days. On each occasion, 20 healthy women and 15 healthy men performed three continuous concentric-eccentric cycles with no pause between muscle actions or between cycles at 45 degrees and 90 degrees/sec angular velocities. Peak and average torques did not vary significantly or systematically over the three test occasions. Intraclass correlation coefficients (ICCs), based on one occasion, ranged from 0.79 to 0.91 for peak torques and from 0.75 to 0.88 for average torques. At 45 degrees/sec angular velocity, the ICCs for peak torque tended to be greater than those for average torque, whereas at 90 degrees/sec angular velocity the ICCs were similar whether calculated using peak or average torque. The ICCs during knee extension were greater than those during knee flexion. Eccentric muscle actions produced significantly higher torques than did concentric actions (p less than 0.01). A continuous concentric-eccentric cycle protocol which emphasizes teaching the subject to perform the test maneuvers and using at least three submaximal practice contractions and one maximal practice contraction can produce reliable isokinetic torques.     

Obtaining reliable measurements of knee extensor torque produced during maximal voluntary contractions: an experimental investigation.

The purpose of this study was to develop and test a protocol that could be used to obtain reliable measurements of knee extensor torque produced during maximal voluntary contractions. On each of 3 days, 10 subjects performed six consecutive maximal voluntary contractions, in the same randomized order, for each of the following 10 conditions: concentric isokinetic contractions at velocities of 30 degrees, 90 degrees, 120 degrees, and 180 degrees/s; eccentric isokinetic contractions at velocities of 30 degrees, 90 degrees, 120 degrees, and 180 degrees/s; and isometric contractions at 40 and 60 degrees of knee flexion. The peak torques produced were examined to determine on which day and during which contraction subjects produced the greatest torques for each condition. This information was used to develop a practice protocol. Fifteen different subjects were tested following this protocol. Subjects participated in two practice sessions, a test session, and a retest session. Intraclass correlation coefficients (ICCs) were calculated to determine the degree of agreement between torques for the test and retest sessions. The ICCs ranged from .87 to .98. The protocol developed appears to be useful for obtaining reliable measurements of knee extensor torque.     

Differences in elbow flexion torque measured concentrically, eccentrically, and isometrically

The purposes of this study were to describe torque-velocity relationships during concentric, eccentric, and isometric testing of elbow flexor muscles and to determine test-retest reliability of a specific isokinetic testing protocol. Thirty healthy women were tested using an isokinetic dynamometer at velocities of 0 degrees, 30 degrees, 120 degrees, and 210 degrees/sec. Reliability was assessed in 20 of the subjects by retesting concentric and eccentric torques at 30 degrees and 120 degrees/sec after a 30-minute rest interval. The highest torque from three maximal efforts was considered to be peak torque. Mean eccentric peak torque was greater than either isometric or concentric peak torque; as isokinetic test velocity increased, the differences between concentric and eccentric torques became larger. Intraclass correlation coefficients ranged from .72 to .83, indicating lack of consistency between test and retest torques. Consecutive concentric-eccentric testing and lack of mechanical stabilization might have contributed to test-retest variability and to the relatively small differences between concentric and eccentric torques. Continued study of reliability of isokinetic testing protocols and further investigation of concentric-eccentric torque-velocity relationships are advocated.     

Continuous versus separate isokinetic test protocol: the effect of estradiol on the reproducibility of concentric and eccentric isokinetic measurements in knee muscles.

OBJECTIVE: To investigate the effects of estradiol on the reliability of concentric and eccentric isokinetic measurements of knee muscles and to compare the reproducibility of measurements in a continuous test protocol and a separate test protocol. DESIGN: Repeated measurements. SETTING: A university exercise physiology laboratory. PARTICIPANTS: Twenty healthy sedentary women volunteers, aged 19 to 37 years, who had regular menstrual cycles (ranging from 27 to 35 days). Subjects were randomly divided into two groups: continuous test group (n = 10) and separate test group (n = 10) and tested at the menstrual phase (days 1 to 3) and preovulatory phase (days 12 to 14) in both legs. METHODS: Continuous reciprocal flexion-extension contractions were used in the continuous test group, and separated flexion and extension contractions were used in the separate test group. Four different test protocols were designed to determine the effects of test mode and number of contractions on the isokinetic measurements: Group A, 4 reciprocal flexion-extension repetitions at each angular velocity of 60 degrees/sec and 180 degrees/sec in one leg in the continuous test group; Group B, 4 and 20 reciprocal flexion-extension repetitions at 60 degrees/sec and 180 degrees/sec, respectively, in the contralateral leg in the same group; Group C, 4 repetitions in extensors and flexors at each angular velocity of 60 degrees/sec and 180 degrees/sec with a 5-minute rest between the two muscle groups in one leg in the separate test group; and Group D, 4 repetitions at 60 degrees/sec and 20 repetitions at 180 degrees/sec for extensors and flexors with a 5-minute rest between the two muscle groups in the contralateral leg in the same group. Blood samples were analyzed for sex hormones, creatine kinase, and lactate dehydrogenase before the tests at the menstrual phase and the preovulatory phase. In addition subjective assessment of muscle soreness was made at each blood sampling. RESULTS: Concentric and eccentric peak torque, average power, total work, and endurance ratio at both angular velocities were not significantly different in the two phases of the cycle by paired observation t test for each of the four groups. Except for concentric and eccentric endurance ratios of quadriceps and hamstrings, and concentric peak torque and average power of hamstrings at 180 degrees/sec in Group D, intraclass correlation coefficients of tested variables showed correlations that were moderate to excellent (p < .05) between two phases. In addition, there were no significant correlations between estradiol and the tested variables. Resting serum creatine kinase and lactate dehydrogenase activities and the score of muscle soreness were at the baseline and not significantly different prior to the tests performed at preovulatory and menstrual phases. CONCLUSIONS: The results suggest that: (1) reproducibility of isokinetic tests during the menstrual cycle is not influenced by sex hormone fluctuations, particularly estradiol; (2) when compared with the separate test protocol used in this study, the continuous test protocol is more appropriate to measure peak torque, average power, total work, and endurance ratio for both muscle groups of the knee even if the number of contractions is changed. However, these conclusions are specific to sedentary individuals; to make more valid conclusions, further studies with different subject groups are needed.     

Test-retest reliability of isokinetic knee extension and flexion torque measurements in persons with spastic hemiparesis

The purpose of this study was to evaluate and compare the test-retest reliability of isokinetic torque measurements in the involved and uninvolved knee musculature of 20 subjects with spastic hemiparesis. An isokinetic dynamometer was used to measure maximal voluntary knee extension and flexion at 60 degrees and 120 degrees/s. Peak torque (PT) and average peak torque (APT) data were collected from five repetitions on two separate occasions. Average peak torque was defined as the mean of the PT values obtained during each of the five repetitions. Spasticity was measured in the involved knee musculature prior to isokinetic testing using the Ashworth Scale. Pearson Product-Moment Correlation Coefficients and intraclass correlation coefficients (ICCs) were high (greater than or equal to .90) for both knees for PT and APT at both angular velocities. No clinically meaningful differences were found between the Pearson correlation coefficients and the ICCs of the involved versus the uninvolved knee for any testing conditions. We concluded that isokinetic evaluation of torque, as measured by PT and APT in subjects with spastic hemiparesis, can yield reliable results in both extremities.     

Knee extensor and flexor torque characteristics before and after unilateral total knee arthroplasty

OBJECTIVE: The purpose of this study was to document torque characteristics and strength recovery of the knee extensors and flexors before and up to 1 yr after unilateral total knee arthroplasty. Our goal was to also document the responsiveness of isokinetic testing over repeated measures. DESIGN: Thirteen individuals voluntarily participated in this study. Torque production of the knee extensors and flexors was assessed isokinetically at 1.047 and 3.142 radians/sec. RESULTS: Regardless of time, the knee extensors and flexors on the involved side generated a range of 76 and 82% of the average peak torque produced by the uninvolved side at both 1.047 and 3.142 radians/sec, respectively. At 30 days after surgery, there was a "dip" in both knee extensor and flexor torque production. Responsiveness indices for the knee extensors and flexors ranged from 0.95 to 2.12 at 1.047 radians/sec. At 3.142 radians/sec, the responsiveness indices for the knee extensors and flexors ranged from 0.65 to 2.87. CONCLUSION: One year after surgery, there continues to be knee extensor and flexor strength asymmetry between limbs. Moreover, within the first month after surgery, the knee extensors and flexors are at the weakest point compared with before, 60 days, and 1 yr after surgery. Isokinetic testing is a useful tool to document torque production before and in the early time after unilateral total knee arthroplasty.     

Isometric and isokinetic measurement of hamstring and quadriceps strength.

This study evaluates quadriceps strength at varying movement velocities in a group of healthy subjects. Specific objectives included (1) investigating the effect of angular velocity on peak torque (PT) (2) investigating the effect of angular velocity on joint angle at peak torque (JAPT) and (3) evaluating whether the use of a relatively new isokinetic testing device yields new insights to previously accepted relationships between angular velocity and PT or JAPT. Twenty healthy subjects were tested for isometric and isokinetic knee extension and flexion strength on a LIDO Active Isokinetic Rehabilitation System at velocities of 0 degrees, 60 degrees, 120 degrees, and 180 degrees/sec. Isometric PT (0 degrees/sec) was found to be highly correlated with isokinetic PT for both extensors and flexors at all velocities (r = .88-.93, p less than .01). PT declined significantly as angular velocity increased for both extension (p less than .01) and flexion (p less than .05). A relationship between isometric and isokinetic JAPT was significant for extension only at 60 degrees and 180 degrees/sec (r = .48-.52, p less than .05). These results indicate that knee isometric and isokinetic PT as measured on the LIDO Active system are highly related for both extension and flexion. PT declined as isokinetic angular velocity increased. Isometric and isokinetic JAPT are significantly related only for extension.     

Effect of resisted knee flexion on knee extension torque

We tested the principle of "reversal of antagonists" by measuring the effect of resisted knee flexion on subsequent peak knee extension torque at velocities of 60 degrees/sec and 120 degrees/sec using an isokinetic dynamometer. We determined peak knee extension torques from torque curves produced during knee extension that was performed reciprocally with either passive or maximum voluntary resisted knee flexion. We used a crossover design so that all 18 healthy adult subjects performed knee extension reciprocally with both passive and resisted knee flexion. Paired means t tests revealed no statistically significant difference between the peak knee extension torques produced under the two knee flexion conditions either at 60 degrees/sec or 120 degrees/sec. We, therefore, concluded that resisted knee flexion does not augment peak knee extension torque under our conditions of testing. The concept of reversal of antagonists was not supported. Antagonistic muscle functioning, therefore, may be irrelevant to agonist isokinetic testing and training in neurologically healthy persons.     

The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee

Thirty-nine patients suffering from osteoarthrosis of the knee were repeatedly measured. The relationship was studied for two groups of variables. The first group consisted of subjective assessments of functional capacity and pain and a walking test. The second group consisted of isometric knee extension torque and isokinetic knee flexion and extension torque at 30 degrees/sec, 60 degrees/sec, 120 degrees/sec and 180 degrees/sec. High correlations between each of the static and dynamic torque values were found. Multiple regression analysis showed that isometric and isokinetic torque measures are unsatisfactory predictors of functional capacity, since only 23-35% of the variation of functional capacity, pain and walking test variables was explained by the variation of torque variables. Dynamic torque measurements had very little advantage over static torque tests. It is concluded that outcome measures in studies of osteoarthrosis should be problem-oriented and include direct assessments of functional capacity, pain and walking ability.     

Reliability of torque measurements during passive isokinetic knee movements in healthy subjects

In the literature, few data are available about the reliability of torque measured during passive isokinetic knee movements. This study investigated the consistency of torque measurements during passive knee movements at 60, 180 and 300 degrees/second in 30 healthy subjects. Intraclass correlation values ranged between 0.78 and 0.92 when the results of two consecutive tests were compared. When retests were performed after repositioning the subjects, intraclass correlation values ranged between 0.43 and 0.87. These findings indicate the necessity for meticulous standardization of the test situation. Series of 10 consecutive movements, specifically repetitions of knee flexion at 180 and 300 degrees/second, indicated that torque measurements during the first two movements were less stable than those following. A concurrent change in electromyographic activity in the rectus femoris muscle suggested that these torque variations resulted from habituation of the stretch reflex.     

Test-retest reliability of isokinetic muscle strength of the lower extremities in patients with stroke

OBJECTIVE: To i the test-retest reliability of isokinetic strength measurements of 3 muscle groups of the lower extremities in stroke patients. DESIGN: Isokineth tests of bilateral hip flexors, knee extensors, and ankle plantarflexors at 2 angular velocities, performed during 2 sessions scheduled 1 week apart for each subject. SETTING: Outpatilitation clinic of a local hospital in Taiwan. PARTICIPANTS: Nts with mild spastic hemiparesis secondary to stroke and with poststroke onset time of at least 6 months. All subjects could communicate and voluntarily move the affected lower extremity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The maximal peak torque, total work, and average power of the 3 muscle groups on the affected side examined during each test were quantified by using the normalization and the deficit methods. The normalization method divides the measured strength value by the patient's body weight, whereas the deficit method divides the difference between the strengths of the unaffected and affected extremities by the strength of the unaffected extremity. RESULTS: The normalized strength measures for muscles on the affected side showed good to excellent test-retest reliability (intraclass correlation coefficient [ICC] range,.62-.94; P<.05), whereas the deficit strength measures did not always show good reliability (ICC range,.13-.91). The knee extensors and ankle plantarflexors, but not the hip flexors, on the affected side showed better test-retest reliability of isokinetic strength generated at faster velocity (ICC range,.73-.94) than that generated at slower velocity (ICC range,.62-.88). The normalized peak torque (ICC range,.76-.94) and total work (ICC range,.83-.91) were more reliable than the normalized average power (ICC range,.62-.90) for all 3 muscle groups on the affected side. CONCLUSIONS: Quantitative assessment of muscle strength of the affected lower extremity in patients with mild spastic hemiparesis secondary to stroke is feasible using isokinetic testing. However, the test-retest reliability of isokinetic strength measures is affected by the quantifying method, testing velocity, and strength measures.     

Relative decreases in knee extension torque with increased knee extension velocities in stroke patients with hemiparesis

I examined the isokinetic knee extension torque (KET) produced by the paretic and nonparetic lower limbs of 27 stroke patients, with hemiparesis, at knee extension velocities (KEVs) of 30 degrees, 60 degrees, 120 degrees, and 180 degrees/sec. The purpose of this study was to determine whether the relative decreases in KET at velocities greater than 30 degrees/sec were different on the two sides. To further investigate this relative decrease, the relationship between the torque at 30 degrees/sec and those at higher speeds also was examined on each side. Relative decreases in KET differed between speeds, but not between sides. Torques at speeds greater than 30 degrees/sec were correlated significantly with the torque at 30 degrees/sec. These findings suggest that patients with hemiparesis and minimal muscle spasticity may have difficulty moving forcefully at higher speeds because they are weak. Therapeutic interventions, therefore, might be most beneficial when they are directed toward helping patients with hemiparesis activate their weak muscles.     

Test-retest reliability of isokinetic knee extension and flexion

OBJECTIVE: To assess reliability of isokinetic peak torque and work for knee flexion and extension. DESIGN: Single-group test-retest. SETTING: University laboratory. PARTICIPANTS: Eleven men and 7 women (mean age, 21 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Peak torque and work for concentric and eccentric knee extension and flexion were recorded at 60 degrees/s for 3 trials on 2 occasions. Intraclass correlation coefficient model 3,1 (ICC(3,1)), standard error (SE) of measurements, and smallest real differences were calculated for the maximum and for the mean peak torque and work of the 3 repetitions. RESULTS: Relative reliability was "very high" for peak torque and work (ICC range, >.90). The SE measurements ranged between 5% and 10% of the initial values for both peak torque and work. The smallest change that indicates a real improvement for a single subject (smallest real differences) ranged from 12% to 25% for peak torque and work variables and from 25% to 30% for the peak torque ratios. CONCLUSIONS: Isokinetic concentric and eccentric knee extensor and flexor strength variables are reliable when measured by the same examiner in asymptomatic subjects.     

Determining the number of repetitions to establish isokinetic knee evaluation protocols specific to angular velocities of 60°/second and 180°/second

IntroductionThis study aims to develop a standard number of repetition at angular velocities of 60°/sec and 180°/sec and define the difference of number of repetitions between genders.MethodOne hundred ninety-six athletes (judo, volleyball, Greco-Roman wrestling, runners, and gymnastics) were involved. Concentric-concentric isokinetic muscle strength of the knee flexor-extensor muscles of the athletes were performed with an ISOMED 2000 isokinetic dynamometer. The evaluation test protocol consisted of 10 repetition of knee flexion-extension at 60°/sec and 30 repetitions at 180°/sec.ResultsAthletes performed with maximal knee flexion strength at their second and third trial at 60°/sec and third-forth trial at 180°/sec. It was found that 2 repetitions and 2–3 repetitions were needed for knee extension peak torque at 60°/sec and 180°/sec respectively. The difference between the genders was significant at 60°/sec for knee flexion and extension on the dominant side; at 180°/sec for knee extension on the dominant and non-dominant side. It was determined that 3 repetitions for 60°/sec, 4 repetitions for 180°/sec were enough to determine peak torque values.DiscussionOptimal number of repetitions is crucial so that athletes could have the opportunity to reach maximal strength without unnecessary workload or waste of time.ConclusionsProtocols involving 3 repetitions for 60°/sec, 4 repetitions for 180°/sec were enough to determine peak torque values. Gender of athletes should be considered when establishing isokinetic knee evaluation protocols.     

Intertrial reliability of work measurements recorded during concentric isokinetic knee extension and flexion in subjects with and without meniscal tears

Intertrial reliability of work measurements was studied in 19 men with a partial medial meniscal tear (ME group) and in 10 men with no history of knee injury (control group). Three maximal voluntary concentric contractions of the muscles involved in knee extension (KE) and knee flexion (KF) were performed on a dynamometer at 30 degrees and 180 degrees/s using a preloading protocol. The subjects moved their legs through an arc of 90 degrees, and the work produced in the constant-velocity phase between 70 and 20 degrees of KE was computed for each trial. In ME group subjects able to perform three consecutive contractions (n = 12-14), high intertrial intraclass correlation coefficients (ICCs) were found (ICCs = .86-.92), except for KE work measurements at 180 degrees/s (ICC = .67). In the control group subjects, high ICCs were obtained for KE work measurements (ICCs = .87 and .95), whereas the low ICCs obtained for KF work measurements (ICCs = .64 and .79) increased to .86 and .93 when the first trial was removed. In both groups, a significant increase was found over the trials for KF measurements at 180 degrees/s and KE measurements at 30 degrees/s, but work measurements were shown to peak at the second trial. The results of this study suggest that the work produced on the second trial reflects a subject's maximal capacity. [Durand A, Malouin F, Richards CL, Bravo G. Intertrial reliability of work measurements recorded during concentric isokinetic knee extension and flexion in subjects with and without meniscal tears.     

Reliability of the passive knee flexion and extension tests in healthy subjects

ObjectiveInformation on the reliability of the passive knee extension (PKE) and passive knee flexion (PKF) tests is still incomplete. Moreover, standardization of the 2 test procedures could be enhanced. The present study investigates interrater and test-retest reliability of the modified versions of the PKE and PKF tests to establish whether the level of reliability is sufficiently high to justify their use in scientific studies and clinical practice.MethodsA total of 14 healthy subjects met the selection criteria. The 2 tests were carried out successively by each of the 3 clinicians/raters involved in the study, and each test was repeated 3 times. Two series of such measurements were performed. To evaluate interrater and test-retest reliability of the 2 tests, we calculated the intraclass correlation coefficients (ICCs), the standard errors of measurement, and the smallest detectable differences.ResultsThe PKE and PKF tests showed excellent and good reliability, respectively. Mean ICCs for the PKE were greater than those for the PKF. Mean ICCs for the interrater reliability (0.88-0.93) were higher than those for test-retest reliability (0.84-0.93). No mean ICCs lower than 0.84 were found (test-retest for PKF). The lowest ICCs of 0.73 and 0.75 were registered for the test-retest reliability of PKF in the case of rater 1.ConclusionThese results show excellent and good interrater and test-retest reliability of the PKE and PKF, respectively. The PKE test seems to be slightly more reliable. These findings may help clinicians when using these tests. For research purposes, investigators must critically evaluate whether the presented amount of error is acceptable for a specific setting.     

Efficacy of isokinetic exercise on joint position sense and muscle strength in patellofemoral pain syndrome

OBJECTIVE: The objective of this study was to demonstrate the impairment of knee joint position sense in individuals with patellofemoral pain syndrome and investigate the effects of isokinetic exercise on knee joint position sense and muscle strength. DESIGN: A total of 24 male patients complaining of anterior knee pain caused by overexertion and 24 male healthy individuals without symptoms were included for this investigation. Isokinetic exercise protocol was carried out at angular velocities of 60 degrees/sec and 180 degrees/sec. These sessions were repeated three times per week and lasted for 6 wks. At the beginning and after 6 wks of knee passive joint position sense, quadriceps and hamstring muscle strength and pain assessments were performed. RESULTS: After the isokinetic exercise, flexion peak torque (P < 0.05), extension peak torque (P < 0.01), flexion total work (P < 0.001), extension total work (P < 0.001), passive reproduction of knee joint position sense for 40 degrees of flexion (P < 0.05) and 50 degrees of extension (P < 0.01), and pain score (P < 0.001) improved significantly in the patellofemoral pain syndrome group. CONCLUSION: Isokinetic exercises have positive effects on passive position sense of knee joints, increasing the muscular strength and work capacity. These findings show that using the present isokinetic exercise in rehabilitation protocols of patients with patellofemoral pain syndrome not only improves the knee joint stabilization but also the proprioceptive acuity.