Effect of Lumbar Stabilization on Knee OA
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      This study will be conducted to investigate the role of lumbar core strengthening in reducing
      knee pain and disability, and improving knee proprioception and Quadriceps strength in
      patients with knee OA.
    

Detailed description: 
      Osteoarthritis (OA) is a highly prevalent degenerative joint disease that impacts quality of
      life and puts a burden on health care costs. Idiopathic knee OA is an age-related disease,
      with prevalence ranging from 19-28%. Aetiology of OA (whether systemic or mechanical) remains
      unclear.

      Lumbar spine has been reported to be associated with knee joint because of the biomechanical
      interrelationship. Decreased lumbar lordosis (that may indicate weak back extensors) and
      range of motion (that may indicate weak core stabilizers) had significant correlations with
      an increased spinal inclination angle, which was an independent factor related to knee OA (by
      increasing knee flexion angle). Knee OA may radiate pain to the back that together lead to
      more limited hip motion causing overloaded knees. Convergence presents between nerve roots
      supplying mid-lumbar muscles and joints, and that supply femoral nerve and quadriceps.
      Progression of knee OA is associated with progression of lumbar spine osteoarthritis. Altered
      trunk kinematics may cause altered tibiofemoral kinematics.

      Strengthening of trunk extensors may be very important for knee OA as fatiguing back
      extensors led to 1) increased quadriceps inhibition (QI) that may lead to poor attenuation of
      ground reaction forces and excessive forces on the knees, 2) altered standing postural
      control, 3) a forward-leaned posture that increases the external knee moments, 4) a reduction
      in trunk proprioception.

      Core stabilization exercises combined with knee-focused exercise or combined with hip
      strengthening resulted in less pain and better function. Interestingly, these studies
      included only patellofemoral pain and OA patients. This program may benefit knee OA patients
      as well. Strength, neuromuscular training and lumbopelvic stabilization reduced muscle
      weakness (of quadriceps and hip abductors), pain, and disability in men with mild knee OA.
      However, specific role of lumbar core muscles on knee OA, their effect on wider population
      (including females) and their effect on higher severity knee OA are lacking.

      Strengthening of trunk core muscles may help pelvic stability which found to be beneficial in
      improving the trunk and lower extremity movement control, hip muscles strength, gait speed
      and daily activities. However, this done in stroke patients, it is hypothesized to benefit
      knee OA patients as well. Assessment and treatment of the trunk musculature should be
      considered in the rehabilitation of patients who demonstrate abnormal lower-extremity
      kinematics as found in knee OA.
    

Intervention name(s): Lumbar focused exercises; Knee focused exercises
Intervention type(s): Other; Other
Intervention description(s): Transersus abdominis activation Multifidus activation Back extension exercise Curl up abdominal exercise; Strengthening of quadriceps Stretching of calf and Hamstring muscles
Other intervention name(s): Core training; Core stability; Traditional knee program
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two groups; group A will be treated with exercises directed to lumbar and knee, group B will receive exercises directed to knee only. 3 sessions/ week for 4 weeks
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Knee osteoarthritis; Lumbar core strengthening exercises; Dpinal stabilization training