Effects of Different Walking Exercises on Pain, Physical Performance and Balance in Knee Osteoarthritis

The aim of this study is to investigate and compare the effects of forward and backward walking exercises on treadmill in addition to traditional physiotherapy interventions on pain, physical performance and balance in patients with knee osteoarthritis. Secondarily, it is aimed to investigate the effects of walking on spatio-temporal parameters, knee joint position sense, range of motion, quadriceps, hamstring and hip adductors muscle strength, Q angle, quality of life and kinesiophobia.

Knee osteoarthritis is a common degenerative joint disease in the world and causes varying degrees of loss of function in individuals in terms of pain, physical performance and balance ability due to the wear and tear in the joint cartilage. Exercise practices play a critical role in the management of knee osteoarthritis and various types of exercises are used to alleviate the symptoms of the disease. One of the exercises used in this context is walking. Today, various modified or designed walking training programs such as walking on land/water, weight-supported walking, positive pressure walking, walking on a treadmill, walking forward-backward, and walking uphill can be applied in the rehabilitation of individuals with osteoarthritis.

Exercises done on a treadmill offer individuals the opportunity to exercise safely in a controlled environment. In addition, forward and backward walking exercises done on a treadmill have the potential to improve balance and coordination by activating different muscle groups. Such dynamic exercises can facilitate the daily activities of osteoarthritis patients and increase their physical activity levels.

Some biomechanical research results on backward walking in recent years are quite interesting. It is stated that the quadriceps muscle works more concentrically and isometrically while the eccentric load decreases during backward walking and can be used to increase and strengthen the stability of the knee. In addition, according to studies conducted in recent years, walking backwards is a useful strategy to reduce knee load compared to forward walking. In light of these findings, it is a walking exercise type that is thought to be more effective for knee osteoarthritis rehabilitation. However, although there are many studies on the effects of walking exercise in knee osteoarthritis rehabilitation, there are very few studies on backward walking in knee osteoarthritis. At the same time, it is unclear whether walking backwards provides an additional clinical benefit compared to walking forward in patients with knee osteoarthritis. In addition, there is no study comparing the effects of walking backwards and walking forward on the treadmill on pain, physical performance and balance, and there is a serious gap in the literature on this subject.

In light of this information in the literature, the primary purpose of this study is to investigate and compare the effects of walking forwards and backwards on the treadmill in patients with knee osteoarthritis on pain, physical performance and balance. Secondarily, the effects of gait on spatio-temporal parameters, knee joint position sense, range of motion, quadriceps, hamstring and hip adductors muscle strength, Q angle, quality of life and kinesiophobia will also be investigated.

Eligibility Criteria:
Inclusion Criteria:

* Diagnosed with knee OA
* According to the Kellgren Lawrence scale, grade I-II-III knee OA
* VAS score above 3

Exclusion Criteria:

* Knee pain caused by other diseases (rheumatoid arthritis, gouty arthritis, etc.)
* History of lower extremity surgery
* Receiving physical therapy within the last 6 months
* A medical condition that prevents safe exercise
* Intra-articular injection (hyaluronic acid/steroid) application within the last 6 months
* Diabetic neuropathy
* Active and regular exercise,
* Not volunteering to participate in the study
* Patients with osteoporosis