Knee Strengthening Research Articles

Effects of metformin phonophoresis and exercise therapy on pain, range of motion, and physical function in chronic knee osteoarthritis: randomized clinical trial

BackgroundKnee osteoarthritis (KOA) is a common musculoskeletal disorder. Therapeutic ultrasound (US) is a safe and effective treatment for KOA. It relieves knee pain and enhances function. Metformin (MF) regulates chondrocytes, hence providing chondroprotection. Furthermore, it efficiently reduces knee articular cartilage degeneration and retards the progression of osteoarthritis. However, the localized administration of MF by phonophoresis for KOA has yet to be studied.PurposeTo assess the possible effects of metformin phonophoresis (MFPH) plus exercise therapy (EX) compared to MFPH alone or the US on knee pain, function, and range of motion (ROM) in chronic KOA patients.MethodsSeventy-eight patients with unilateral mild to moderate chronic KOA were included. Patients were randomly assigned to three groups: group A (MFPH + EX), group B (MFPH alone), and group C (US). The US group used an acoustic-neutral gel, while the MFPH group used a gel containing 1.2% MF. The exercises included hamstring stretches, calf stretches, and knee strengthening exercises. Treatment in the three groups continued for four weeks (three sessions per week). The Visual Analog Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the goniometer were used to assess knee pain, function disability, and ROM, respectively. All measures were recorded before, 2 weeks, and 4 weeks after the intervention in all groups. Multivariate Analysis of Variance (MNOVA) was performed to compare the effects within and between groups for knee ROM and function disability. The Kruskal-Wallis test and the Friedman test analyzed the pain intensity.ResultsWhen the baseline patient characteristics were compared, there were no significant differences in means of age, gender, body mass index (BMI), or lower limb dominance across the three groups (p > 0.05). After 4 weeks of intervention, clinical outcomes significantly improved in all three groups (p < 0.05). However, patients in the MFPH + EX group improved significantly in all outcomes compared to the MFPH and US groups (p < 0.05).ConclusionPost-treatment results showed a statistically and clinically significant improvement in pain intensity, knee ROM, and function in the MFPH group; however, combining MFPH with exercises is more beneficial in reducing KOA symptoms.Trial registrationClinical Trial Registry at (pactr.samrc.ac.za) database.NO: PACTR202311507335269. Date: November 9, 2023 (retrospectively registered).

Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial

BackgroundKnee osteoarthritis (KOA) progression is often influenced by biomechanical factors. Biomechanical interventions, such as Trunk stabilization exercise (TSE) and Mulligan joint mobilization (MWM), may offer relief from KOA symptoms and potentially slow disease progression. However, the comparative efficacy of these therapies remains uncertain. This study aimed to compare the efficacy of TSE, Mulligan joint mobilization, and isometric knee strengthening (KSE) on disability, pain severity, and aerobic exercise capacity in patients with KOA.MethodologyA randomized controlled trial (RCT) with three intervention groups was conducted between September 2020 to February 2021. The study enrolled adults aged between 40 and 60 years with a confirmed KOA diagnosis recruited from the physical therapy clinic of the Sindh Institute of Physical Medicine and Rehabilitation, Pakistan. Participants were randomly assigned to receive 24 sessions of either TSE, MWM, or KSE. The knee’s functionality was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), pain on a visual analogue scale (VAS), and two objective functional tests—the 6-minute walk test (6MWT) and the 11-stair climb test (SCT). These assessments were conducted at baseline, the third week, and the sixth week. Changes in outcome measures were analyzed using a mixed-design ANOVA with Bonferroni post-hoc analysis, with statistical significance set at a p-value < 0.05.ResultOf the 60 participants, 22 (36.7%) were females, and 38 (63.3%) were males. Within-group analysis revealed a significant improvement in all outcome measures at the third week (p < 0.05) and sixth week (p < 0.05). Notably, the TSE group exhibited a greater reduction in mean difference (M.D) in VAS scores than the MWM and KSE groups across various measures in the third week. At rest, during stair ascent, and descent, the TSE group showed significant improvements in VAS scores: MWM (-2.05; -1.94; -1.94), TSE (-2.38; -2.5; -2.5), KSE (-1.05; -0.63; -0.63). Additionally, during sub-maximal exercise capacity assessment, the TSE group showed greater improvement (MWM 12.89; TSE 22.68; KSE 7.89), as well as in Knee Injury and Osteoarthritis Outcome Score for activities of daily living (KOOS-ADL) (MWM 20.84; TSE 28.84; KSE 12.68), and KOOS-pain (MWM 24.84; TSE 27.77; KSE 5.77) at the third-week assessment (p < 0.05). The TSE group demonstrated significant improvements (p < 0.05) across various measures in the sixth week. Specifically, improvements were observed in VAS scores at rest (MWM − 4.15; TSE − 4.42; KSE − 3.78), during stair ascent (MWM − 3.89; TSE − 4.88; KSE − 3.56) and descent (MWM − 3.78; TSE − 4.05; KSE − 2.94). Furthermore, significant improvements were noted in the stair climb test (MWM − 7.05; TSE − 7.16; KSE − 4.21), 6-minute walk test (6MWT) (MWM 22.42; TSE 37.6; KSE 13.84), KOOS-pain (MWM 41.47; TSE 49.11; KSE 28.73), and KOOS-ADL (MWM 40.31; TSE 50.57; KSE 26.05).ConclusionIn this study in patients with KOA, TSE had greater efficacy compared to MWM and KSE in enhancing functional levels, reducing pain, improving sub-maximal exercise capacity, and performance on the stair climb test. Importantly, mean scores between the groups, particularly in the TSE group, reached the minimally important level, particularly in key areas such as pain, functional levels, sub-maximal exercise capacity, and stair climb performance. Clinicians should consider the significant pain reduction, improved functionality, and enhanced exercise capacity demonstrated by TSE, indicating its potential as a valuable therapeutic choice for individuals with KOA.Trial noClinicalTrials.gov = NCT04099017 23/9/2019.

Core training for pain management and functional improvement in patients with patellofemoral pain syndrome: a systematic review and meta-analysis.

To investigate the effects of core strengthening exercises on pain, mobility, and lower extremity muscle strength in patients with Patellofemoral Pain Syndrome (PFP). Six databases were searched from inception until August 11, 2023. Pain, function and muscle strength related outcomes were extracted and the quality of the studies was assessed using the PEDro scale and the level of evidence was assessed using the GRADE. Nineteen studies involving 1138 patients were included. Very low-grade evidence supported the short-term pain-relieving effect of core training (SMD = -0.60 95% CI [-0.95, -0.25]), high-grade evidence supported the short-term functional improvement effects of core training (WMD = 3.61 95% CI [1.44, 5.78]), which was similarly significant within 3-12 months of follow-up. The results of the subgroup analyses suggested that hip-knee training was most advantageous in relieving pain and enhancing motor function. Although training that includes trunk core is clearly superior to knee strengthening alone, the effectiveness of hip-knee training, which is also a core training program for pain and function, is more pronounced. The available evidence supports that hip-knee training is the most valuable treatment option for patients with PFP.

Combined Hip and Knee Strengthening Compared With Knee Strengthening for Individuals With Lateral Patellar Dislocation: A Single-blind, Superiority, Randomized Controlled Trial

ObjectiveTo investigate whether a combined hip and knee muscle strengthening program is superior to a knee strengthening program for people after lateral patellar dislocation (LPD). DesignSingle-blind, superiority, randomized controlled trial with 48 weeks follow-up. SettingPhysiotherapy out-patient clinic. ParticipantsForty individuals aged 16 or older, with a history of non-traumatic LPD were randomized to a knee-based strengthening (KBSG) or quadriceps and hip strengthening exercise (HQSG) program (N=40). Inclusion criteria included a positive apprehension sign, pain on palpation along the medial retinaculum, and J sign. Exclusion criteria included restricted range of motion (<90° knee flexion), and traumatic or postsurgical LPD. InterventionsConcealed randomization was performed using random permuted blocks of size 4. Individuals received their corresponding exercise program according to randomization and group allocation: knee-based strengthening (n=20) or combined hip and quadriceps strengthening (n=20) twice weekly for 8 weeks over 16 appointments. Main Outcome MeasuresPrimary outcome was the Lysholm Knee Score. Secondary outcomes included Numerical Pain Ratings Scale (NPRS) at rest and during effort, Norwich Patellar Instability Score (NPIS), Kujala Anterior Knee Pain Scale (AKPS), Lower Extremity Functional Scale (LEFS), 4 domains of the WHOQOL-Bref, and recurrence rate. Patient-reported outcome measures were assessed from the baseline to 48 weeks. Assessments were performed by a physiotherapist who was blinded to the group allocation. Data were analyzed by using a repeated-measures ANOVA model with Tukey's post hoc test after an intention-to-treat principle. ResultsAt the primary time-point of 8 weeks, there were no substantial between-group differences in the Lysholm Knee Score: mean difference=-6.8 (95% CI -14.3 to 3.7); NPIS: mean difference=23.5 (95% CI 5.6 to 41.3); AKPS: mean difference=-1.54 (95% CI -8.6 to 5.6), NPRS at rest and during effort (mean difference=0.32 (95% CI -0.37 to 1); and mean difference=0.68 (95% CI -0.9 to 1.86); LEFS mean difference=-1.08 (95% CI -5.9 to 2.4), WHOQOL-Bref domains (physical health: mean difference=-0.12, (95% CI -1.26 to 1.02); psychological: mean difference=-0.32 (95% CI -2.04 to 1.4); social relations: mean difference=-0.7 (95% CI -2.2 to 0.82); environment: mean difference=0.44 (95% CI -1 to 1.9), and recurrence rate (P=.69). ConclusionThis study indicates that combined hip and knee muscle strengthening is not superior to knee-based strengthening for LPD treatment. The limitations stemming from the underpowered nature of the trial must be acknowledged, concerning the potential oversight of moderate intervention effects.

Global research trends and hotspots in patellofemoral pain syndrome from 2000 to 2023: a bibliometric and visualization study.

Patellofemoral pain syndrome (PFPS) is a prevalent condition in sports medicine, and as sports competitions become more popular, the incidence of sports injuries is on the rise. Despite the increasing research on PFPS, there remains a lack of bibliometric analyses on this topic. The aim of this study was to identify the research hotspots and trends in the field of PFPS by reviewing 23 years of literature in this field. By analyzing the literature on PFPS research from 2000 to 2023 in the core dataset of the Web of Science database and utilizing bibliometric tools like CiteSpace 6.1, VOSviewer 1.6.18, R-bibliometrix 4.6.1, Pajek 5.16, and Scimago Graphica 1.0.26, our aim was to gain insights into the current status and key areas of PFPS research. The study examined various aspects including the number of publications, countries, institutions, journals, authors, collaborative networks, keywords, and more. Through the visualization of relevant data, we also attempted to forecast future trends in the field. There were 2,444 publications were included in this visualization study, published in 322 journals by 1,247 authors from 818 institutions in 67 countries. The Journal of Orthopaedic and Sports Physical Therapy had the highest number of publications, with the USA leading in article count. La Trobe University contributed the most articles, while Rathleff MS and Barton CJ emerged as the most prolific authors. Hip and knee strength and core strength, lower extremity kinematics and biomechanics, females (runners), muscle activation, risk factors, gait retraining, clinical practice guidelines, and rehabilitation were research hotspot keywords. Current research suggests that there is still significant potential for the development of PFPS research. Key areas of focus include the clinical effectiveness of combined hip and knee strengthening to address PFPS, characterization of lower limb kinematics and biomechanics, gait retraining, risk factors, and clinical practice guidelines. Future research could explore the effectiveness of innovative exercise therapies such as blood flow restricting training, gait retraining, and neuromuscular control training for PFPS improvement. Further investigation into gait retraining for runners, particularly females, and clinical efficacy study of a novel PRP formulation for the treatment of PFPS.

The Effectiveness of Kinesio-Taping and Muscle Energy Technique Versus Knee Strengthening Exercises on Pain and Function in Subjects with Osteoarthritis of the Knee

Background: An approach known as Kinesio-taping will be used to support the knee joint and muscle. MET isa sort of manual therapy that uses moderate isometric contractions to relax the muscles and reduces discomfort,stress and strain. It also prevents knee instability by enhancing quadriceps and hamstring muscle strength andfunction in patients with OA knees.Objective: The purpose of the study was to investigate the effectiveness of Kinesio-taping and muscle energytechniques for pain and function in terms of NPRS and KOOS in subjects with OA knee.Methodology: Forty osteoarthritis patients were randomly assigned to one of two groups (A or B). Group A(n=20) will receive Kinesio-taping and (MET) post-isometric relaxation for the hamstring, quadriceps, andgastrocnemius muscles along with interferential therapy. Group B (n=20) will receive knee strengthening exercisesfor both hamstring and quadriceps and interferential therapy for a period of thrice a week for 6 weeks. The NPRS(numerical pain rating scale) and KOOS (knee injury and osteoarthritis outcome score) were used to assess painand functional improvement before and after the tests.Results: Group A showed a significant mean difference (P = &gt;0.001) between the NPRS and KOOS. Hence Group-AKinesio-taping and muscle energy technique along with IFT are significant in treating individuals with pain andfunction in Osteoarthritis of the knee.Conclusion: This study concluded that the Kinesio-taping and MET (post isometric relaxation) with IFT (GroupA) shows effectiveness in improving the pain and function in the OA knee.

The relationship of behavioral and psychological traits with pain sensitivity in females with patellofemoral pain: A cross-sectional study

ObjectiveThe purpose of this study was to describe the relationship between behavioral and psychological traits with indicators of central sensitization in female runners with patellofemoral pain (PFP), and to determine if behavioral and psychological traits improve with strength training. DesignCross-sectional study. SettingUniversity laboratory. ParticipantsTwenty-eight active females (mean age 32 ± 8.1 years) with PFP completed testing at baseline, 8 weeks (post intervention), and 12 weeks. Main outcome measuresBehavioral and psychological questionnaires included the General Anxiety Disorder-7, Patient Health Questionairre-9, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia-11, and Central Sensitization Inventory. Quantitative sensory testing (QST) measures were also collected. After baseline testing, subjects were instructed in a hip and knee strengthening intervention to be completed twice daily over 8 weeks. ResultsA statistically significant improvement was found at 12 weeks for anxiety (p = .015; ηp (Boling et al., 2010) = 0.099) and kinesiophobia (p = .041; ηp (Boling et al., 2010) = 0.076). There was no significant improvement for depression, catastrophizing, or subjective central sensitization. No significant correlations were found between any of the behavioral and psychological questionnaires with baseline QST variables. ConclusionsNo relationship was found for behavioral and psychological characteristics with QST measures in female runners with persistent PFP.

Exploring the impact of integrated polyvagal exercises and knee reinforcement in females with grade II knee osteoarthritis: a randomized controlled trial

This study aimed to compare the effects of knee strengthening exercises to those of polyvagal theory–based exercises combined with knee strengthening exercises on selected outcomes in women with grade II knee osteoarthritis (OA). A randomized controlled trial was conducted, in which 60 female participants diagnosed with grade II knee OA, with a mean age of 57.27 ± 7.81 years and knee pain rated between 4 and 7 on the visual analog scale (VAS), were assigned to either the knee strengthening exercise group (Group 1, n = 30) or the polyvagal theory–based exercise plus knee strengthening exercise group (Group 2, n = 30). Pre- and posttreatment assessment of outcome variables, including WOMAC scores (joint pain, joint stiffness, functional limitations, and the overall index), WHOQOL scores (overall quality of life, general health, physical, psychological, social, and environmental domains), and heart rate variability (HRV, time and frequency domains), were analyzed. Group 2 demonstrated significantly greater reductions in joint pain, stiffness, and functional limitations than Group 1 after the intervention. Group 2 presented with significantly improved WOMAC scores, indicating better overall outcomes. Group 2 showed significant improvements in the psychological and social domains regarding quality of life. There were no significant differences in the physical domain or the environmental domain. Group 2 showed a significant increase in high-frequency power (HF) and a significant decrease in the LF/HF ratio, suggesting improved autonomic regulation. A combination of polyvagal exercise and knee strengthening training resulted in superior outcomes compared to knee strengthening exercises alone in women with grade II knee OA. These findings support the potential effectiveness of incorporating polyvagal exercises as an adjunctive intervention for osteoarthritis management.

Different Effects of Progressive Resistance Exercise and Knee Strengthening Exercise on Increasing Functional Capabilities in Case Knee Osteoarthritis in Paccerakkang Health Center Area

Knee osteoarthritis is a degenerative disease that occurs due to the aging process that attacks the knee joint. Knee OA is characterized by the erosion of joint cartilage and the formation of new bone on the joint surface. Symptoms that occur are Morning Sickness, Start Pain, Stiffness, and pain when supporting or walking, causing functional impairment of the knee. This study aims to determine the difference in the effect of Progressive Resistance Exercise and Knee Strengthening Exercise on functional ability in patients with knee osteoarthritis. The research is Quasi Experiment while the approach used is Two Group Pre Test-Post Test Design. The study population was taken from all patients with knee OA in the Paccerakg Health Center Makassar, South Sulawesi. Samples were taken by means of Accidental Sampling, totaling 16 people and divided into two groups, namely treatment group 1 with 8 people and treatment group 2 with 8 people. The data obtained were first tested using Shapiro-Wil and the results of the pre-test value of treatment group 1 were 0.922 &gt;α 0.05 and post-test value was 0.336 &gt;α 0.05, treatment group 2 pre-test was 0.781 &gt;α 0 .05 and post test 0.845 &gt;α 0.05. The data is said to be normal if p&gt; 0.05. Then tested with Paired Simple T-test. The results of the study in treatment group 1 were 0.007 (p&lt;0.05) and treatment group 2 was 0.001 (p&lt;0.05), which means that there is a difference in the effect of Progressive Resistance Exercise and Knee Strengthening Exercise interventions on functional ability in patients with knee osteoarthritis.

Het patellofemoraal pijnsyndroom: een literatuuroverzicht

Patellofemoral pain syndrome: a literature review Patellofemoral pain (PFP) is one of the most common diagnoses of anterior knee pain, particularly among the physically active population. Symptoms mainly occur during load on the patellofemoral joint or in prolonged sitting. The etiology of PFP is complex, with multiple factors, such as overload and structural malalignment contributing to the development of the complaints, creating an imbalance of forces that stabilize the patella. The heterogeneity in the literature and the lack of evidence-based clinical guidelines reflect the challenge in the management of PFP. International consensus proposes multimodal intervention including exercise therapy targeting knee and hip strengthening. The aim of this article is to present the current literature in a comprehensive and unambiguous way and to provide both primary and secondary care providers with sufficient tools to work with this pathology in a more targeted way.

The Effect of Strengthing Core Stabilization Training and the Knee Strengthening Training on Improving Pain in Older Women Athletes with Patellofemoral Pain Syndrome

Background and Aim: Patellofemoral Pain Syndrome is one of the most common musculoskeletal problems in the elderly that Can affect their daily activity. This study aims to compare the effectiveness of a period strengthening core stabilization exercise with the Knee strengthening exercises on improving pain in female athletes with Patellofemoral Pain Syndrome. Methods &amp; Materials: In this study, 20 female athletes with Patellofemoral Pain Syndrome participated. They were accidentally divided into two groups: strengthening core stabilization exercise (10 people( and strengthening knee exercise (10 people). A visual analog scale measured patients’ pain before and after eight weeks of practice interventions. Paired t-test and independent t-test were used at the significant level of (P&lt;0.05) to analyze the results. Ethical Considerations: This study was approved by the Research Ethics Committee of Bu Ali Sina University Hamedan (Code: IR.BASU.REC.1398.032). Results: The results showed that the pain level in both groups decreased significantly after strengthening core stabilization exercises (P=0.006) and the Knee strengthening exercises (P=0.000). Although intergroup comparison did not show a significant difference in the results (P̀=0.064), the calculation of the effect showed a more significant effect of strengthening knee exercise [ES=1.8) on the improvement of pain compared to the strengthening core stabilization group (ES=0.7). Conclusion: The results showed that knee strengthening and core stabilization exercises reduced the pain. But due to the higher effectiveness of knee strengthening exercises in improving pain, it is recommended to use this protocol to reduce the pain of these patients.

Is Isolated Hip Strengthening or Traditional Knee-Based Strengthening More Effective in Patients With Patellofemoral Pain Syndrome? A Systematic Review With Meta-analysis.

Background:Focus on the importance of hip muscle strength in patients with patellofemoral pain syndrome (PFPS) has recently increased. It is unknown whether patients with PFPS will benefit more from hip strengthening compared with traditional knee-based strengthening.Purpose:To compare the efficiency of isolated hip strengthening versus traditional knee-based strengthening for patients with PFPS.Study Design:Systematic review; Level of evidence, 2.Methods:We conducted a search for studies comparing isolated hip strengthening and knee-based strengthening by using the MEDLINE, Embase, and Cochrane Library electronic databases. The methodological quality of included studies was assessed using the PEDro scale. Predetermined variables from each study were extracted and analyzed.Results:A total of 5 comparative studies were included in this review; all studies were of moderate to high quality and reflected good internal and external validity. Pain (visual analog scale [VAS]) and function (Anterior Knee Pain Scale) scores improved in both the hip and knee groups after strengthening intervention, although no statistically significant differences were seen between groups in the pooled analysis. In 2 studies, VAS pain scores were reduced earlier for patients in the hip group than for those in the knee group (P < .05). In 1 study, improvement in Western Ontario and McMaster Universities Osteoarthritis Index function scores in the hip group was statistically superior compared with those in the knee group after intervention and at 6-month follow-up (P < .05). In 2 studies, patients in the hip group exhibited statistically greater hip abductor and extensor strength than did those in the knee group after intervention (P < .05).Conclusion:The best-available evidence suggests that overall, isolated hip strengthening and knee strengthening were equivalent for treatment of PFPS.

Aquatic Exercise and Land Exercise Treatments after Total Knee Replacement Arthroplasty in Elderly Women: A Comparative Study.

Background and Objectives: Early intensive exercise after total knee replacement arthroplasty (TKRA) has become increasingly popular due to its ability to enhance knee physical function and reduce pain. When implemented exclusively, aquatic exercise (AE) appears to be more advantageous than land exercise (LE), particularly in the early phase after TKRA. Our study aimed to compare the clinical efficacy of AE and LE with respect to their effects on pain and physical function after TKRA. Materials and Methods: Between February 2008 and January 2020, 100 female patients who underwent TKRA were enrolled in this retrospective study. We measured the range of motion (ROM) of the knee, the isokinetic strength of the knee joint (function), and pain both initially and one month after TKRA. Two weeks after TKRA, the participants were enrolled in either the AE or the LE program for a total of two weeks. Two 30 min sessions of intensive ROM and knee strengthening exercises and balance training were provided to the AE and LE groups for 10 days. The home exercise group (HE) only received information on ROM and strengthening exercises. There were 33, 21, and 46 patients allocated to the AE, LE, and HE groups, respectively. Results: The ROM of the side on which surgery was performed improved significantly in all groups, as did the pain scores. In the AE group, the knee flexor strength showed a tendency toward improvement. Contrastingly, there was no significant improvement in the knee extensor strength in the AE group. Conclusions: Overall, the AE and LE groups showed superior outcomes compared with HE. In addition, the AE group demonstrated some improvement in knee muscle strength even with a short hospital stay. Further study with long-term follow-up should be performed to better define the outcomes.

Effect of Additional Hip Strengthening on Anterior Knee Pain, Strength, and Health Status in Patients with Total Knee Replacement: A Pilot Randomized Clinical Trial

Background: Total knee replacement (TKR) is a standard surgical option for advanced-stage knee osteoarthritis. The primary indication of TKR is incapacitating knee pain. 75% to 89% of patients undergoing TKR reports a satisfactory reduction in pain. However, some patients develop anterior knee pain post-TKR. Therefore, different treatment strategies are used for the management of pain post TKR. In the present study, we aimed to evaluate the additional effects of hip strengthening on pain, muscle strength, and health status in TKR patients.Methods: We randomized patients into two groups: knee group and knee hip group. The knee group (n=6) did knee flexors and extensors strengthening. The knee hip group (n=6) performed knee strengthening with additional hip abductors, lateral rotators, and extensors strengthening exercises. Both groups received four-session/week for six weeks. The pain was measured on NPRS, muscle strength on a hand-held dynamometer, and health status using the WOMAC scale. The data was collected at the baseline and post intervention (six weeks).Results: The knee hip group shows more marked improvements in pain than the knee group, t value =3.3 (p=0.012). The data did not suggest any difference in knee muscle strength between the groups. Hip muscle strength showed a significant difference. Health status significantly improved in the knee hip group compared to the knee group, t value = 4.68 (p=0.005).Conclusion: We can conclude that a six-week hip muscle strengthening exercise program effectively improves pain, muscle strength, and health status than a conventional knee strengthening program.

Anteromedial versus posterolateral hip musculature strengthening with dose-controlled in women with patellofemoral pain: A randomized controlled trial

ObjectiveTo compare the effectiveness of adding anteromedial versus posterolateral hip musculature strengthening to knee strengthening in women with patellofemoral pain (PFP). DesignRandomized controlled trial. SettingUniversity physiotherapy clinic. ParticipantsFifty-two women with PFP were randomized to receive either anteromedial (AMHG) or posterolateral (PLHG) hip musculature strengthening. Main outcome measuresThe primary outcomes were pain intensity by the numeric pain rating scale and function by the Anterior Knee Pain Scale in six weeks. Secondary outcomes were pain and function at six months, global perceived effect at six weeks and six months, pain in step down, isometric torque of abductors, adductors and hip rotators measured with hand-held dynamometer, and dynamic knee valgus by step down in six weeks. ResultsBoth groups showed improvement in primary outcomes; however, no differences were found between groups in pain intensity and function in six weeks and the secondary outcomes. Group x time interaction found superior gains in abductor strength in the PLHG and increase in the strength of the adductors and internal rotators in AMHG. ConclusionThere was no difference between the addition of anteromedial or posterolateral hip musculature strengthening to knee strengthening in improving pain and function in women with PFP.

Hip and knee muscle torque and its relationship with dynamic balance in chronic ankle instability, copers and controls

ObjectivesWe compared hip and knee isometric muscle torque between individuals with chronic ankle instability (CAI), those who have sustained one ankle sprain with no ongoing problems (copers) and healthy controls. Our secondary objective was to compare balance between groups and investigate the relationship between muscle torque and balance. DesignCross-sectional study. Methods22 CAI, 20 copers and 22 uninjured participants were tested. Isometric torque (normalised to body mass (Nm/kg)) was measured using a rigidly-fixated hand-held dynamometer. Balance was assessed with the Y-balance test. ResultsKnee and hip flexor and extensor, and hip adductor and abductor muscle torque was less in individuals with CAI compared to controls (standardised mean difference (SMD) >1.2). Hip and knee flexor and extensor muscle torque was less in CAI participants than copers (SMD: 0.69–1.1). Hip external and internal rotator torque did not differ between groups. There was no difference in hip or knee muscle torque between controls and copers (SMD: 0.01–0. 54). Balance was impaired in CAI participants compared to copers and controls in all directions. There was a strong positive correlation between posterolateral Y-balance test performance and torque of the hip adductors (r=0.53), flexors (r=0.52) and extensors (r=0.50). ConclusionsIndividuals with CAI have weak knee and hip muscles compared to copers and controls. Hip strength was shown to be related to posterolateral balance performance. Future studies may investigate the effect of hip and knee strengthening exercise on ongoing ankle problems, such as episodic giving way in individuals with CAI.

Short foot exercises have additional effects on knee pain, foot biomechanics, and lower extremity muscle strength in patients with patellofemoral pain.

Patellofemoral pain (PFP) is a common knee problem. The foot posture in a relaxed stance is reported as a distal factor of PFP. However, the effects of short foot exercise (SFE) on the knee and functional factors have not yet been investigated in patients with PFP. This study aimed to investigate the additional effects of SFE on knee pain, foot biomechanics, and lower extremity muscle strength in patients with PFP following a standard exercise program. Thirty patients with a 'weak and pronated' foot subgroup of PFP were randomized into a control group (ConG, n= 15) and a short foot exercise group (SFEG, n= 15) with concealed allocation and blinded to the group assignment. The program of ConG consisted of hip and knee strengthening and stretching exercises. SFEG program consisted of additional SFE. Both groups performed the supervised training protocol two times per week for 6 weeks. Assessment measures were pain visual analog scale (pVAS), Kujala Patellofemoral Score (KPS), navicular drop test (NDT), rearfoot angle (RA), foot posture index (FPI), and strength tests of the lower extremity muscles. Both groups displayed decreases in pVAS scores, but it was only significant in favor of SFEG. NDT, RA, and FPI scores decreased in SFEG whereas they increased in ConG. There was a significant group-by-time interaction effect in hip extensor strength and between-group difference was found to be significantly in favor of SFEG. An intervention program consisting of additional SFE had positive effects on knee pain, navicular position, and rearfoot posture. An increase in the strength of the hip extensors may also be associated with improved stabilization by SFE.

Effects of exercise combined with whole body vibration in patients with patellofemoral pain syndrome: a randomised-controlled clinical trial

BackgroundPatellofemoral pain is a prevalent condition in the general population, especially in women, and produces functional impairment in patients. Therapeutic exercise is considered an essential part of the conservative management. The use of vibration platforms may help improve strength and function and reduce pain in patients with knee disorders. The aim of this investigation was to determine the effects of adding whole body vibration (vertical, vibration frequency of 40 Hz, with an amplitude from 2 to 4 mm) to an exercise protocol for pain and disability in adults with patellofemoral pain.MethodsA randomised clinical trial was designed, where 50 subjects were randomly distributed into either an exercise group plus whole body vibration or a control group. Pain, knee function (self-reported questionnaire) and range of motion and lower limb functionality were assessed at baseline and at 4 weeks. The experimental group performed 12 supervised sessions of hip, knee and core strengthening exercises on a vibration platform 3 times per week during 4 weeks. The control group followed the same protocol but without vibration stimuli. Differences in outcome measures were explored using an analysis of the variance of 2 repeated measures. Effect sizes were estimated using Square Eta (η2). Significant level was set al P < 0.05.ResultsStatistically significant differences were found after intervention in favour of the experimental group in the between-groups comparison and in the interaction of the experimental group before and after treatment in terms of pain perception (P = 0.000; η2 = 0.63) and function outcomes scores (P = 0.000; η2 0.39 and 0.51 for lower limb functional scale and Kujala scores respectively).ConclusionA 4-week whole body vibration exercise programme reduces pain level intensity and improves lower limb functionality in patellofemoral pain patients and is more effective than exercise alone in improving pain and function in the short-term.Trial registrationClinicalTrials.gov (NCT04031248). This study was prospectively registered on the 24th July, 2019.

Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study.

Background:Osgood-Schlatter disease (OSD) affects 1 in 10 adolescents. There is a lack of evidence-based interventions, and passive approaches (eg, rest and avoidance of painful activities) are often prescribed.Purpose:To investigate an intervention consisting of education on activity modification and knee-strengthening exercises designed for adolescents with OSD.Study Design:Case series; Level of evidence, 4.Methods:This study included 51 adolescents (51% female; age range, 10-14 years) with OSD. The 12-week intervention consisted of an activity ladder designed to manage patellar tendon loading and pain, knee-strengthening exercises, and a gradual return to sport. The primary outcome was the global reporting of change at 12 weeks, evaluated with a 7-point Likert scale (successful outcome was considered “much improved” or “improved”). Additional endpoints were at 4, 8, 26, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), objective strength, and jump performance.Results:Adolescents reported a mean pain duration of 21 months at enrollment. After 12 weeks, 80% reported a successful outcome, which increased to 90% at 12 months. At 12 weeks, 16% returned to playing sport, which increased to 69% at 12 months. The KOOS subscores of Pain, Activities of Daily Living, Sport and Recreation, and Quality of Life improved significantly (7-20 points), and there were improvements in knee extension strength (32%; P < .001), hip abduction strength (24%; P < .001), and jumping for distance (14%; P < .001) and height (19%; P < .001) at 12 weeks.Conclusion:An intervention consisting of activity modification, pain monitoring, progressive strengthening, and a return-to-sport paradigm was associated with improved self-reported outcomes, hip and knee muscle strength, and jumping performance. This approach may offer an alternative to passive approaches such as rest or wait-and-see, often prescribed for adolescents with OSD.Registration:NCT02799394 (ClinicalTrials.gov identifier)

EFFECT OF WHOLE BODY VIBRATION ON LOWER BODY STRENGTH AND BALANCE IN OSTEOARTHRITIS KNEE

Background: Knee osteoarthritis causes pain, functional limitation, and disability in the elderly. Whole-body vibration has gained a lot of attention in recent years. It is currently used in alleviating pain and improve physical function along with strength and balance.Methods: 34 individuals aged between 50-70 years fulfilling the inclusion criteria were selected and randomized into two groups. Baseline assessment was done using the VAS scale, WOMAC scale, Berg Balance Scale, and 30seconds chair stand test. Group A received whole-body vibration, and knee strengthening exercises, and group B received only strengthening exercises. The treatment was given thrice in a week for four weeks. The assessment was done by the end of the 2nd and 4th weeks.Results: Whole body vibration had shown greater improvement of VAS on rest (p&lt;0.05) compared to VAS on activity. Also, the WOMAC score was statistically improved between and within the group with p&lt;0.05.Conclusion: Whole body vibration, along with strengthening exercises, showed superior effects in reducing pain, stiffness, physical function, balance, and lower limb strength in osteoarthritis knee patients.