Osteoarthritis of the knee: Why does exercise work? A qualitative study of the literature

The Influence of Joint Loading on Bone Marrow Lesions in the Knee

“…26,51 In our previously published systematic literature review, we found that one of the proposed hypotheses for the explanation of the beneficial effect of exercise in knee OA is an exercise-induced reduction of the focal peak load in the tibiofemoral joint, but this hypothesis needs to be confirmed in clinical trials. 5 However, the results of the present review suggest that BMLs may be associated with such focal loads. Interestingly, Wiegant et al 70 found beneficial effects of unloading the knee by means of joint distraction on OA-related structural changes; however, they did not report on BMLs.…”

Knee extensor strength gains mediate symptom improvement in knee osteoarthritis: secondary analysis of a randomised controlled trial

“…This is also evidenced by the unaccounted proportion of improvement in pain (68%) and physical function (40%). The proportion of symptom improvement unaccounted for could be attributed to several other hypothesised mediators including exercise-related improvements in proprioception 7,11 , inflammation 10e12 , depression and self-efficacy 11 , none of which were assessed in our study.…”

“…Although selfreported physical function also improved in the strengthening group, no between-group statistical difference was observed 9 . Several mechanisms could potentially explain the relief in symptoms such as improvements in knee muscle strength 10e12 , proprioception 7,11 , inflammation 10e12 , depression and self-efficacy 11 . Despite the plethora of possible mechanisms 7,10e12 , knee extensor strength is particularly relevant to investigate 7 .…”

The effects of progressive neuromuscular training on postural balance and functionality in elderly patients with knee osteoarthritis: a pilot study

“…In its early stages, this training includes proprioceptive and strength exercises on stable surfaces without weight support, and it progresses to exercises of proprioception and balance on unstable and weight-bearing surfaces10, 12 ) . According to previous studies, patients with knee OA who receive physical therapy focused on improving neuromuscular control obtain favorable results9, 10 ) . Nevertheless, specific reports about the effectiveness of short-, medium-, and long-term progressive neuromuscular training do not exist3, 10 ) .…”

“…Studies indicate that these limitations are due to a neuromuscular deficit, characterized by poor proprioceptive capacity and a decrease of muscle strength and balance8 ) . Muscle strength training (strengthening), balance, and proprioception have been recommended as standard treatment for knee OA9 ) . Progressive and coordinated inclusion of these motor qualities helps restore neuromuscular control and balance, significantly increasing the functionality of patients10 ) .…”