The Effectiveness of Eight Weeks Neuromuscular Exercises in the Water Environment on Knee Muscles Electrical Activity in Middle-age Female with Grade Two and Three Knee Osteoarthritis: A Randomized Clinical Trial

Document Type : Original Articles


1 PhD Candidate, Department of Sports Injuries and Corrective Exercises, School of Sports Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

2 Associate Professor, Department of Sports Injuries and Corrective Exercises, School of Sports Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

3 Professor, Department of Sports Injuries and Corrective Exercises, School of Sports Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

4 Assistant Professor, Department of Sport Medicine, School of Medical Sciences, Kerman University of Medical Sciences, Kerman, Iran





Main Subjects

  1. Zeng CY, Zhang ZR, Tang ZM, Hua FZ. Benefits and mechanisms of exercise training for knee osteoarthritis. Front Physiol 2021; 12: 794062.
  2. Abbassy AA, Trebinjac S, Kotb N. The use of cellular matrix in symptomatic knee osteoarthritis. Bosn J Basic Med Sci 2020; 20(2): 271-4.
  3. Landsmeer MLA, Runhaar J, van Middelkoop M, Oei EHG, Schiphof D, Bindels PJE, et al. Predicting knee pain and knee osteoarthritis among overweight women. J Am Board Fam Med 2019; 32(4): 575-84.
  4. Runhaar J, van Middelkoop M, Reijman M, Willemsen S, Oei EH, Vroegindeweij D, et al. Prevention of knee osteoarthritis in overweight females: the first preventive randomized controlled trial in osteoarthritis. Am J Med 2015; 128(8): 888-95.
  5. Etesami AS, Zolaktaf V, Esmaeili H. Comparison of the Effect of 8 Weeks of Land Exercise Therapy and Hydrotherapy on Functional Activities of Elderly Women with Knee Osteoarthritis. Salmand Iran J Ageing 2022; 17(2): 154-69. [In Persian].
  6. Palazzo C, Nguyen C, Lefevre-Colau MM, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Ann Phys Rehabil Med 2016; 59(3): 134-8.
  7. Martel-Pelletier J, Barr AJ, Cicuttini FM, Conaghan PG, Cooper C, Goldring MB, et al. Osteoarthritis. Nat Rev Dis Primers 2016; 2: 16072.
  8. Mesa-Castrillon CI, Simic M, Ferreira ML, Hatswell K, Luscombe G, de Gregorio AM, et al. EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol. BMC Musculoskelet Disord 2021; 22(1): 11.
  9. Mao HY, Hu MT, Yen YY, Lan SJ, Lee SD. Kinesio Taping Relieves Pain and Improves Isokinetic Not Isometric Muscle Strength in Patients with Knee Osteoarthritis-A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021; 18(19): 10440.
  10. Zhang X, Pan X, Deng L, Fu W. Relationship between Knee Muscle Strength and Fat/Muscle Mass in Elderly Women with Knee Osteoarthritis Based on Dual-Energy X-Ray Absorptiometry. Int J Environ Res Public Health 2020; 17(2): 573.
  11. Raposo F, Ramos M, Lucia CA. Effects of exercise on knee osteoarthritis: A systematic review. Musculoskeletal Care 2021; 19(4): 399-435.
  12. Varbakken K, Loras H, Nilsson KG, Engdal M, Stensdotter AK. Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive: an exploratory cross-sectional study. BMC Musculoskelet Disord 2019; 20(1): 593.
  13. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther 2010; 40(2): 42-51.
  14. Raghava Neelapala YV, Bhagat M, Shah P. Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature. J Geriatr Phys Ther 2020; 43(2): 89-98.
  15. Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother 2009; 55(1): 9-15.
  16. Huang CC, Wang HH, Chen KC, Yang KJ, Chang LY, Shiang TY, et al. Effects of a dynamic combined training on impulse response for middle-aged and elderly patients with osteoporosis and knee osteoarthritis: a randomized control trial. Aging Clin Exp Res 2021; 33(1): 115-23.
  17. Deasy M, Leahy E, Semciw AI. Hip Strength Deficits in People with Symptomatic Knee Osteoarthritis: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther 2016; 46(8): 629-39.
  18. de Zwart AH, van der Esch M, Pijnappels MA, Hoozemans MJ, van der Leeden M, Roorda LD, et al. Falls Associated with Muscle Strength in Patients with Knee Osteoarthritis and Self-reported Knee Instability. J Rheumatol 2015; 42(7): 1218-23.
  19. Rahmann AE. Exercise for people with hip or knee osteoarthritis: a comparison of land-based and aquatic interventions. Open Access J Sports Med 2010; 1: 123-35.
  20. Hassani haghighi F, Hashemi Javaheri AA, Ariamanesh AS, khoshraftar yazdi N. Effect of Aquatic Exercise Therapy on the Quadriceps Muscle Electromyography and Pain in Women with Knee Osteoarthritis. Journal of Paramedical Sciences & Rehabilitation 2016; 5(2): 42-50.
  21. Spinoso DH, Bellei NC, Marques NR, Navega MT. Quadriceps muscle weakness influences the gait pattern in women with knee osteoarthritis. Adv Rheumatol 2018; 58(1): 26.
  22. Bouchouras G, Sofianidis G, Patsika G, Kellis E, Hatzitaki V. Women with knee osteoarthritis increase knee muscle co-contraction to perform stand to sit. Aging Clin Exp Res 2020; 32(4): 655-62.
  23. Kacmaz KS, Unver B, Karatosun V. The Reliability and Validity of the Lie-to-Sit-to-Stand-to-Walk Transfer (LSSWT) Test in Knee Osteoarthritis. Indian J Orthop 2023; 57(2): 290-6.
  24. Turcot K, Armand S, Fritschy D, Hoffmeyer P, Suva D. Sit-to-stand alterations in advanced knee osteoarthritis. Gait Posture 2012; 36(1): 68-72.
  25. Huang KH, Hsieh RL, Lee WC. Pain, Physical Function, and Health in Patients with Knee Osteoarthritis. Rehabil Nurs 2017; 42(4): 235-41.
  26. Bakirhan S, Bozan O, Unver B, Karatosun V. Evaluation of functional characteristics in patients with knee osteoarthritis. Acta Ortop Bras 2017; 25(6): 248-52.
  27. Lewek MD, Rudolph KS, Snyder-Mackler L. Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis. Osteoarthritis Cartilage 2004; 12(9): 745-51.
  28. Rutherford D, Baker M, Urquhart N, Stanish W. The effect of a frontal plane gait perturbation bout on knee biomechanics and muscle activation in older adults and individuals with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2022; 92: 105574.
  29. Assar S, Gandomi F, Mozafari M, Sohaili F. The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial. BMC Sports Sci Med Rehabil 2020; 12: 27.
  30. Rashid SA, Hussain ME, Bhati P, Veqar Z, Parveen A, Amin I, et al. Muscle activation patterns around knee following neuromuscular training in patients with knee osteoarthritis: secondary analysis of a randomized clinical trial. Arch Physiother 2022; 12(1): 19.
  31. Joshi S, Kolke S. Effects of progressive neuromuscular training on pain, function, and balance in patients with knee osteoarthritis: a randomised controlled trial. European Journal of Physiotherapy 2023; 25(4): 179-86.
  32. Joon M, Gupta A, Badhal S, Kumar P. Efficacy of Neuromuscular Training in Patients of Osteoarthritis Knee via Telerehabilitation. Archives of Physical Medicine and Rehabilitation 2023; 104(3): e26.
  33. Hewidy AM, Ghuiba K, Ewais WM, Abdelsalam MS. Neuromuscular versus Strengthening Program on Pain, and Function in Knee Osteoarthritis. Proceedings of the 21th International Scientific Conference Faculty of Physical Therapy; 2022 July 28-29; Cairo, Egypt.
  34. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16(4): 494-502.
  35. Bokaeian HR, Esfandiarpour F, Zahednejad S, Mohammadi HK, Farahmand F. Effects of an Exercise Therapy Targeting Knee Kinetics on Pain, Function, and Gait Kinetics in Patients with Knee Osteoarthritis: A Randomized Clinical Trial. Adapt Phys Activ Q 2021; 38(3): 377-95.
  36. Vinstrup J, Skals S, Calatayud J, Jakobsen MD, Sundstrup E, Pinto MD, et al. Electromyographic evaluation of high-intensity elastic resistance exercises for lower extremity muscles during bed rest. Eur J Appl Physiol 2017; 117(7): 1329-38.
  37. Dashti RK, Naderi A, Thomas A. Hip Abductor and Adductor Muscles Activity Patterns during Landing after Anterior Cruciate Ligament Injury. J Sport Rehabil 2019; 28(8): 871-6.
  38. Asri N, Farahpour N, Ghazaleh L. Assessment of Muscle Activity and Co-contraction in Knee and Ankle Joints during Forward and Backward Walking in Healthy Individuals. J Res Behav Sci 2018; 13(6): 309-17. [In Persian].
  39. Murley GS, Bird AR. The effect of three levels of foot orthotic wedging on the surface electromyographic activity of selected lower limb muscles during gait. Clin Biomech (Bristol, Avon) 2006; 21(10): 1074-80.
  40. Clausen B, Holsgaard-Larsen A, Roos EM. An 8-Week Neuromuscular Exercise Program for Patients with Mild to Moderate Knee Osteoarthritis: A Case Series Drawn From a Registered Clinical Trial. J Athl Train 2017; 52(6): 592-605.
  41. Pallant J. Spss Survival Manual: A step by step guide to data analysis using IBM SPSS. New York, NY: McGraw Hill; 2020.
  42. Glaviano NR, Marshall AN, Mangum LC, Hart JM, Hertel J, Russell S, et al. Improvements in lower-extremity function following a rehabilitation program with patterned electrical neuromuscular stimulation in females with patellofemoral pain: A randomized controlled trial. J Sport Rehabil 2020; 29(8): 1075-85.
  43. Alkatan M, Baker JR, Machin DR, Park W, Akkari AS, Pasha EP, et al. Improved function and reduced pain after swimming and cycling training in patients with osteoarthritis. J Rheumatol 2016; 43(3): 666-72.
  44. Hislop AC, Collins NJ, Tucker K, Deasy M, Semciw AI. Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2020; 54(5): 263-71.
  45. Loeser RF. Age-related changes in the musculoskeletal system and the development of osteoarthritis. Clin Geriatr Med 2010; 26(3): 371-86.
  46. Tieland M, Trouwborst I, Clark BC. Skeletal muscle performance and ageing. J Cachexia Sarcopenia Muscle 2018; 9(1): 3-19.
  47. Grassel S, Muschter D. Peripheral nerve fibers and their neurotransmitters in osteoarthritis pathology. Int J Mol Sci 2017; 18(5): 931.
  48. Mansfield CJ, Culiver A, Briggs M, Schmitt LC, Grooms DR, Onate J. The effects of knee osteoarthritis on neural activity during a motor task: A scoping systematic review. Gait Posture 2022; 96: 221-35.
  49. Orssatto LBR, Borg DN, Pendrith L, Blazevich AJ, Shield AJ, Trajano GS. Do motoneuron discharge rates slow with aging? A systematic review and meta-analysis. Mech Ageing Dev 2022; 203: 111647.
  50. Khalaj N, Abu Osman NA, Mokhtar AH, Mehdikhani M, Wan Abas WA. Effect of exercise and gait retraining on knee adduction moment in people with knee osteoarthritis. Proc Inst Mech Eng H 2014; 228(2): 190-9.
  51. Ganguly A. Management of muscular dystrophy during osteoarthritis disorder: A topical phytotherapeutic treatment protocol. Caspian J Intern Med 2019; 10(2): 183-96.
  52. Thomas DT, R S, Prabhakar AJ, Dineshbhai PV, Eapen C. Hip abductor strengthening in patients diagnosed with knee osteoarthritis - a systematic review and meta-analysis. BMC Musculoskelet Disord 2022; 23(1): 622.
  53. Rostron ZPJ, Green RA, Kingsley M, Zacharias A. Efficacy of exercise-based rehabilitation programs for improving muscle function and size in people with hip osteoarthritis: A systematic review with meta-analysis. Biology (Basel) 2021; 10(12): 1251.
  54. Ebert JR, Edwards PK, Fick DP, Janes GC. A systematic review of rehabilitation exercises to progressively load the gluteus medius. J Sport Rehabil 2017; 26(5): 418-36.
  55. Munukka M, Waller B, Hakkinen A, Nieminen MT, Lammentausta E, Kujala UM, et al. Effects of progressive aquatic resistance training on symptoms and quality of life in women with knee osteoarthritis: A secondary analysis. Scand J Med Sci Sports 2020; 30(6): 1064-72.
  56. Mattos F, Leite N, Pitta A, Bento PC. Effects of aquatic exercise on muscle strength and functional performance of individuals with osteoarthritis: A systematic review. Rev Bras Reumatol Engl Ed 2016; 56(6): 530-42.