Efficacy of Proprioceptive and Strengthening Exercise on Functional Ability in Osteoarthritis (OA) Knee: Quasi Experimental Study

Mari Muthu¹, Premkumar M^2*, Shyam Sundar R³, Muthupandikumar R⁴, Kavitha S⁵

¹Associate Professor, Dr. N.Y. Tasganonkar College of Physiotherapy, Kharghar, Maharastra, India
²Associate Professor cum PhD Research Scholar, Institute of Physiotherapy, Srinivas University, City Campus, Pandeshwar, Mangaluru, Karnataka, India
³Principal, Thiravium College of Physiotherapy, Theni, Affiliated The Tamilnadu Dr.MGR Medical University, Chennai, India
⁴Clinical Director, Ayush Physiotherapy Clinic, Madurai, Tamilnadu, India
⁵PhD Research Scholar, Institute of Physiotherapy, Srinivas University, Mangaluru, India

*Correspondence author: Premkumar M, Associate Professor, Department of Cardiorespiratory Physiotherapy, Institute of Physiotherapy, Srinivas University, City Campus, Pandeshwar, Mangalore, Karnataka-575001, India;
Email: [email protected]

Citation: Muthu M, et al. Efficacy of Proprioceptive and Strengthening Exercise on Functional Ability in Osteoarthritis (OA) Knee: Quasi Experimental Study. J Ortho Sci Res. 2025;6(2):1-7.

Copyright^© 2025 by Muthu M, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Criteria of selection.

Data Analysis and Results

After intervention in both control and experimental group, baseline and post intervention values were documented. Normality of data was done with Shapiro Wilk test. Data was normally distributed. Thus parametric t test was used for analyzing the data.

Paired sample t test was used to analyze pre and post intervention mean values comparison within the control and experimental group (Table 2). There was statistically significant difference in post intervention mean values in both control and experimental groups with p ≤0.001*** (Fig. 1,2). Independent sample t-test was used to analyze the comparison between pre and post intervention mean values in control and experimental group (Table 4). The baseline values were homogenous (Table 3). There was statistically significant difference in post intervention mean values (Table 4) in experimental group when compared to control group with p ≤0.001*** (Fig. 1,2).

Table 2: Comparison of Pre and Post Mean, Standard Deviation, ‘t’ value and ‘p’ value of Pain in VAS and Pain Free Knee Extension Range ROM in Control Group (n=30) and Experimental Group (n=30).

Table 3: Comparison of Pre Mean, Standard Deviation, ‘t’ Value and ‘p’ value of Pain in VAS and Pain Free Knee Extension Range ROM between Control and Experimental Group to check homogeneity (n=60).

Table 4: Comparison of Post Mean, Standard Deviation, ‘t’ value and ‘p’ value of Pain in VAS and Pain Free Knee Extension Range ROM between Control and Experimental Group to check significance (n=60).

Figure 1: Comparison of pre and post mean value of pain in VAS and pain free knee extension range ROM in control group.

Figure 2: Comparison of pre and post mean value of pain in VAS and pain free knee extension range ROM in experimental group.

Figure 3: Comparison of pre mean values of pain in VAS and pain free knee extension range ROM between control and experimental group to check homogeneity.

Figure 4: Comparison of post mean value of pain in VAS and pain free knee extension range ROM between control and experimental group to check significance.

Discussion

This study results shows that there is statistically significant improvement in the variables of pain in VAS and pain free knee extension ROM between pre and post mean values in both control and experimental group (Table 1) with p<0.001***. There is homogenous of variables in pre values of variables of pain in VAS and pain free knee extension ROM between control and experimental groups (Table 3). The Post mean values of pain in VAS and pain free knee extension ROM shows significant improvement with P-values p<0.001*** in Experimental Group when compared to Control Group (Table 4). Thus null hypothesis has been rejected and alternate hypothesis has been accepted for this study. There is statistically significant improvement in the variable of pain in VAS and pain free knee extension ROM in both groups due to proprioceptive exercises and strengthening exercises which improves the joint flexibility and reduces muscle stiffness. This physiological change helps in improving the pain free knee extension joint ROM in experimental group where interventions of proprioceptive exercises were given. Pain reduction in VAS and pain free knee extension range ROM is the result of improved proprioceptive and kinaesthetic sensation.

This study results are strengthened the view of Hee Seong Jeong, et al., stated that among people with knee OA, proprioceptive training may relieve pain and improve physical function during activities of daily living. This training should include neuromuscular-control elements, with coordinated trunk and lower extremity strengthening, at an average frequency of 3 to 4 times per week for 30 to 40 minutes per session. Under these conditions, proprioceptive training may improve the physical function of patients with knee OA [19].

This study results reflected the concept of Kelley Fitzgerald, et al., studied on agility and perturbation training technique in exercise therapy for reducing pain and improving function in people with knee osteoarthritis. They concluded that both intervention groups exhibited some moderate improvements in self-reported outcome measures; there was no additive benefit from including agility and perturbation training techniques in a standard exercise program for their participants with knee Osteoarthritis [20].

Limitations:

• Study was done with less number of patients
• Study was done in short duration and follow up was done
• Study not analyzing the inter rater or Intra rater reliability
• Biasness in the exercises programme couldn’t be controlled
• Measurement of knee joint proprioception was not considered in the study
• Certain factors like Medications, Life style, sleeping pattern are not modified by the patient

Future Recommendations

• Future study should focus on other forms of exercise which improves proprioception and balance
• Similar type of study can be advised for the OA Hip joint
• Future study should include other different techniques like MET’s or Maitland
• Long term follow-up should be made to find out the effect of the treatment
• Randomized control trail can be done

Conclusion

There was a significant improvement pain in VAS and pain free knee extension ROM in both the groups. When compared with Experimental Group, Control Group shows statistically less significant improvement in functional ability. So, this study concluded that proprioceptive exercises along with strengthening exercises shows a significant improvement on pain in VAS and pain free knee extension ROM when compared to strengthening exercise alone in patient’s osteoarthritis of knee.

Conflict of Interests

The author declares no conflict of interest.

Funding/Sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Acknowledgments

None.

References

1. Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman B, Aliabadi P, Levy D. Risk factors for incident radiographic knee osteoarthritis in the elderly. Arthritis Rheum. 1998;40(4):728-33.
2. Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, Moskowitz RW, Schnitzer TJ. Guidelines for the medical management of osteoarthritis. Part I. Osteoarthritis of the hip. Arthritis Rheum. 1995;38(11):1535-40.
3. Alnahdi AH, Zeni JA, Snyder-Mackler L. Muscle impairments in patients with knee osteoarthritis. Sports Health. 2012;4(4):284-92.
4. Stillman BC. Making sense of proprioception: the meaning of proprioception, kinaesthesia and related terms. Physiotherapy. 2002;88(11):667-76.
5. Olsson L, Lund H, Henriksen M, Rogind H, Bliddal H, Danneskiold-Samsoe B. Test-retest reliability of a knee joint position sense measurement method in sitting and prone position. Adv Physiother. 2004;6(1):37-47.
6. Kinzey SJ, Armstrong CW. The reliability of the star excursion test in assessing dynamic balance. J Orthop Sports Phys Ther. 1998;27(5):356-60.
7. Horak FB, Macpherson JM. Postural orientation and equilibrium. In: Shepard J, Rowell JL, editors. Handbook of Physiology. New York: Oxford University Press. 1995:252-92.
8. Knobloch K, Martin-Schmitt S, Crosling T. Proprioceptive and coordinative training for injury reduction in elite female soccer. Sportverletz Sportschaden. 2005;19(3):123-9.
9. Gordon NF, Kohi HW, Villages JA. Effect of rest interval duration on cardiorespiratory responses to hydraulic resistance circuit training. J Cardiopulm Rehabil. 1989;9(7):325-30.
10. Jerosch J, Prymka M. Knee joint proprioception in patients with post-traumatic recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc. 1996;4(1):14-8.
11. Jerosch J, Prymka M. Proprioception and joint stability. Knee Surg Sports Traumatol Arthrosc. 1996;4(3):171-9.
12. Baker V, Bennell K, Stillman B, Cowan S, Crossley K. Abnormal knee joint position sense in individuals with patellofemoral pain syndrome. J Orthop Res. 2002;20(2):208-14.
13. Hassan BS, Doherty SA, Mockett S, Doherty M. Effect of pain reduction on postural sway, proprioception and quadriceps strength in subjects with knee osteoarthritis. Ann Rheum Dis. 2002;61(5):422-8.
14. Hinman RS, Bennell KL, Metcalf BR, Crossley KM. Balance impairments in individuals with symptomatic knee osteoarthritis: A comparison with matched controls using clinical tests. Rheumatology (Oxford). 2002;41(12):1388-94.
15. van der Esch M, Steultjens M, Harlaar J, Knol D, Lems W, Dekker J. Joint proprioception, muscle strength and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum. 2007;57(5):787-93.
16. Zech A, Hubscher M, Vogt L, Banzer W, Hansel F, Pfeifer K. Balance training for neuromuscular control and performance enhancement: A systematic review. J Athl Train. 2010;45(4):392-403.
17. Tsauo JY, Cheng PF, Yang RS. The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: A preliminary report. Clin Rehabil. 2008;22(5):448-57.
18. Lephart SM, Pincivero DM, Giraldo JL. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med. 1997;25(1):130-7.
19. Jeong HS, Lee SC, Jee H, Song JB, Chang HS, Lee SY. Proprioceptive training and outcomes of patients with knee osteoarthritis: A meta-analysis of randomized controlled trials. J Athl Train. 2019;54(4):418-28.
20. Fitzgerald GK, Piva SR, Gil AB, Wisniewski SR, Oddis CV. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: A randomized clinical trial. Phys Ther. 2011;91(4):452-69.
21. Rahnama N, Mazloum V. Effects of strengthening and aerobic exercises on pain severity and function in patients with knee rheumatoid arthritis. Int J Prev Med. 2012;3(7):493-8.
22. Brakke R, Singh J, Sullivan WJ. Physical therapy in persons with osteoarthritis. PM R. 2012;4(5 Suppl):S53-8.