Neuromuscular Training Compared to Progressive Resistance Training for Patients With Anterior Knee Pain

NCT ID: NCT06110455

Last Updated: 2023-10-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-02-02

Study Completion Date

2024-05-15

Brief Summary

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The primary aim of this randomized control trial is to investigate patients' with anterior knee pain if a neuromuscular training program (NMT) has better results in pain and functionality, than an ordinary progressive resistance training program (PRT). Pain will be measured via a visual analog scale for pain (VAS) and functionality via questionnaires such as Kujala and the Greek version of the Modified Baecke Questionnaire (mBQ) and functional tests such as the Anterior Lunge test, Step up/down, squat, balance and reach test. The secondary aims are to investigate the:

1. Hip and knee muscles strength, which will be measured with the Kinvent K-Push dynamometer. Strength will be measured before and after the rehabilitation programs (at baseline and after 8 weeks of intervention).
2. Balance, will also be measured to see the effects of the NMT program.
3. Kinesiophobia, which will be measured with the Tampa Scale
4. Dynamic Knee Valgus, via the Single Leg Landing and Single Leg Squat tests

Detailed Description

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Participants will be randomized into two groups: PRT or NMT. All sessions will be conducted in group sessions, with one physical therapist/researcher supervising the exercises. Patients will be taught on how to correctly do the exercises beforehand from trained physical therapists. Outcomes will be measured in person at baseline and after 8 weeks of treatment, the exercises will be supervised remotely. The duration of the intervention program will be 8 weeks, with 3 sessions per week with at least one day resting in between, totaling 24 training sessions.

The NMT intervention sessions consist of a 5 minute submaximal warm-up, followed by 25 minutes of NMT with exercises focused on functional and core stability, strength, agility, proprioception, balance, landing, plyometrics and coordination. The training sessions will consist of 5 different exercises. Each of them will be performed for 2 sets, and depending on the exercise either for 8 to 10 reps or for 30 seconds. In between the sets and the exercises there will be a 30 sec rest period. The exercises will be focused on the lower limb which has anterior knee pain and on the core. Four levels of difficulty will be given for each exercise to allow progression. Progression will be individualized for each patient. Every 2 weeks, there will be a progression that will be achieved by changing the exercise gradually, making it harder, or/and changing the support surface.

The PRT intervention will also consist of a 5 minute submaximal warm-up, followed by 25 minutes of the PRT exercises, targeting the hip and knee muscles. The program will consist of 5 different exercises, which each of them will focus on a different muscle group (hip abductors, knee extensors and knee flexors). Each exercise will be performed in sets of 3 of 10 repetitions and there will be a 30 sec rest period between sets and exercises.

Progression will be done by increasing the resistance and by increasing the range of motion. The exercise intensity will be monitored by the researcher, as determined by the patient's ability to complete 3 sets of 8-12 repetitions for a given exercise and a Borg Rating of Perceived Exertion (RPE) of 6-10. The progression will be done safely, based on VAS, patients tolerance and movement quality.

Adherence to the program for both groups will be assessed by the total number of training sessions performed in 8 weeks (total=24 training sessions).

Conditions

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Anterior Knee Pain Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Neuromuscular Exercise Training (NMT)

The 8-week exercise intervention program consists of group sessions of Neuromuscular training supervised by a physical therapist 3 times per week. Patients will be taught and familiarized with the proper way to do the exercises on a separate day prior to the start of their actual rehabilitation program.

Each session consists of a 5 minute submaximal warm-up followed by 25 minutes of NMT.

Every 2 weeks, there will be a progression that will be achieved by increasing the difficulty level of each exercise. We will take under consideration the individuality each patient has on how much progression is needed every two weeks and it will be done by maintaining a proper quality of performance, minimal exertion and control of the movement. Participants will be given special equipment including sliders and elastic tubing

Group Type EXPERIMENTAL

Neuromuscular Training exercises

Intervention Type OTHER

The 8 week exercise intervention consists of 25 minute group sessions of Neuromuscular training supervised by a physical therapist.

Progressive Resistance Training (PRT)

The 8-week exercise intervention program consists of group sessions of progressive resistance training supervised by a physical therapist 3 times per week. Patients will be taught and familiarized with the proper way to do the exercises on a separate day prior to the start of their actual rehabilitation program.

Each session consists of a 5 minute submaximal warm-up followed by 25 minutes of PRT, targeting hip and knee muscles, such as hip abductors, knee flexors and extensors. The exercise intensity will be monitored by the physical therapist, as determined by the patients' ability to complete 3 sets of 8-12 repetitions for a given exercise and a Borg Rating of Perceived Exertion (RPE) of 6-8.

Every 2 weeks, progression will be achieved by changing the resistance based on VAS and RPE, with an elastic tubing

Group Type EXPERIMENTAL

Hip and Knee Muscular Strength exercises

Intervention Type OTHER

The 8 week exercise intervention consists of 25 minute group sessions of progressive resistance training, supervised by a physical therapist.

Interventions

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Neuromuscular Training exercises

The 8 week exercise intervention consists of 25 minute group sessions of Neuromuscular training supervised by a physical therapist.

Intervention Type OTHER

Hip and Knee Muscular Strength exercises

The 8 week exercise intervention consists of 25 minute group sessions of progressive resistance training, supervised by a physical therapist.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Pain ≥ 3 months
* Pain VAS now ≥ 3
* 18-40 y/o
* No pain relief medicine 2 weeks prior to the program
* Kujala 50-80
* Pain during squat, knee bending, palpation, isometric contraction on 60°, long sitting, jumping, step up/down, running.
* Theatre sign
* Positive functional tests: grind test, 45 sec anterior knee provocation, McConnel

Exclusion Criteria

* Patellar dislocation
* Lower extremity surgery
* Ligament instability
* Rheumatoid Arthritis
* Osteoarthritis
* Tendinopathy
* Meniscus tear
* Ligamentous knee injury or laxity
* Bursitis
* Sinding Larsen Johansson Syndrome
* Previous pathology
* Low back surgery
* Metabolic diseases
* NSAIDs for extended period of time
* Cardiorespiratory diseases
* Sacroiliac joint pain
* Pregnancy
* Physical therapy 2 months ago
Minimum Eligible Age

18 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University of Thessaly

OTHER

Sponsor Role lead

Responsible Party

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Savvas Spanos

Official Title: Head of Human Performance and Rehabilitation Laboratory of the Physiotherapy Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University of Thessaly

Lamia, Central Greece, Greece

Site Status RECRUITING

Countries

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Greece

Central Contacts

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Nick Chatziavraam

Role: CONTACT

Phone: 6974653813

Email: [email protected]

References

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Hott A, Brox JI, Pripp AH, Juel NG, Paulsen G, Liavaag S. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. Am J Sports Med. 2019 May;47(6):1312-1322. doi: 10.1177/0363546519830644. Epub 2019 Apr 8.

Reference Type BACKGROUND
PMID: 30958707 (View on PubMed)

Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, Lynch AD, Snyder-Mackler L, McDonough CM. Patellofemoral Pain. J Orthop Sports Phys Ther. 2019 Sep;49(9):CPG1-CPG95. doi: 10.2519/jospt.2019.0302.

Reference Type BACKGROUND
PMID: 31475628 (View on PubMed)

Bennell KL, Egerton T, Wrigley TV, Hodges PW, Hunt M, Roos EM, Kyriakides M, Metcalf B, Forbes A, Ageberg E, Hinman RS. Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol. BMC Musculoskelet Disord. 2011 Dec 5;12:276. doi: 10.1186/1471-2474-12-276.

Reference Type RESULT
PMID: 22141334 (View on PubMed)

Other Identifiers

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NMT PRT Thess

Identifier Type: -

Identifier Source: org_study_id