Knee osteoarthritis (OA) can benefit from exercise to improve proprioception. Proprioception is the awareness of joint position and motion. Loss of muscle strength and damage to the ligaments and joint capsule from OA can reduce proprioception.
In this study, physical therapists from Taiwan study the use of a foot stepping exercise program. The idea behind this approach was to improve knee proprioception and function in adults with OA. The exercises were done sitting down. This is important because proprioceptive training in the standing position can make symptoms worse for patients with knee OA.
A special device called an electrogoniometer was used to measure knee joint position. A special foot pedal was designed that was hooked up to a computer.
A computer game controlled by pressing the foot down on one of four pedals was used. The patients were required to step on the right, left, up down pedals with increasing speed over time. This feature increased the difficulty of the task. All testing was done in the sitting position.
Training sessions lasted 20 minutes per leg. There were three sessions per week for six weeks. An experienced physical therapist supervised each patient. There was a control group of similar patients with OA. The control group did not do the target-matching foot-stepping exercise (TMFSE). No other exercises were done by the control group.
Measures used to assess results included knee reposition error (KRE), walking speed, and function. KRE is a measure of the person’s ability to repeat the same motion at the same pace over several trials. This is a valid measure of joint proprioception.
After the training session, the exercise group could walk faster and go up and down stairs faster than before the program. They could also walk faster than the control group. Walking speed did not change for the control group.
Reposition error was less for the exercise group but unchanged for the control group. Pain and function were also improved in the exercise group but not for the control group.
The results of this study suggest that repeated stepping drills done in the sitting position can benefit patients with knee OA. Proprioceptors in muscles, tendons, and joints are activated with this activity.
Improved knee function is possible with changes in proprioception. When proprioception is improved there may be a decreased risk of falls for this patient population. This training program is a good option for patients who cannot exercise in the standing position.