Exercise for knee osteoarthritis pain: Association or causation?

Henriksen, Marius; Runhaar, Jos; Turkiewicz, Aleksandra; Englund, Martin

doi:10.1016/j.joca.2024.03.001

Cited by 4 publications

(2 citation statements)

References 37 publications

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“…However, our study focused on less investigated variables that could aid functionality and performance in pain contexts ( 21 ). It is made clear that this study does not focus on strength improvement as a means to enhance patients’ self-perceived pain relief per se, given the existing controversy regarding the causal relationship between pain improvement by strength enhancement ( 64 , 65 ). Yet, the inverse relationship seems to be more evident, where we observe that pain can lead to strength loss, reduce the speed and range of movement, and alter the motoneuron discharge rate ( 66–69 ), even at a distance from the affected area ( 70 ).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial

Sartori,

Fagnani,

Monne-Guasch

et al. 2024

Front. Med.

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IntroductionVarious pathophysiological contexts can be accompanied by weakness, arthrogenic muscle inhibition, and even disability. In this scenario, peripheral nerve stimulation has been studied not only for pain management but also for the improvement of neuromuscular parameters. For this purpose, the use of Transcutaneous Electrical Nerve Stimulation (TENS) has typically been investigated, but recently, the use of ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) has gained popularity. In this regard, electrical stimulation has a predisposition to activate Type II muscle fibers and has been shown to be capable of generating short-term potentiation by increasing calcium sensitivity. However, the evidence of pPNS applied in humans investigating such variables is rather limited.ObjectivesThis pilot study aimed to assess the feasibility of the methodology and explore the potential of pPNS in enhancing hip extension performance in individuals suffering from knee pain, comparing it with TENS.MethodsTwelve participants were divided into pPNS and TENS groups, undergoing pre- and post-intervention assessments of peak concentric power (W), strength (N), execution speed (m/s), and one-repetition maximum (1RM) (kg) estimation. For pPNS, two needles were positioned adjacent to the superior and inferior gluteal nerves under ultrasound guidance. For TENS, electrodes were positioned between the posterosuperior iliac spine and the ischial tuberosity, and halfway between the posterosuperior iliac spine and the greater trochanter. The interventions consisted of 10 stimulations of 10 s at a frequency of 10 Hz with a pulse width of 240 μs, with rest intervals of 10 s between stimulations.ResultsPeripheral nerve stimulation significantly improved concentric power at 30% (p = 0.03) and 50% (p = 0.03) of 1RM, surpassing TENS, which showed minimal changes. No significant strength differences were observed post-intervention in either group.ConclusionThis work presents evidence where pPNS applied to the gluteal nerves results in an enhanced performance of hip extension at submaximal loads. However, this improvement does not seem to be reflected in short-term changes in the estimation of the 1RM by the force-velocity profile.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial

Sartori,

Fagnani,

Monne-Guasch

et al. 2024

Front. Med.

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“…Despite physiotherapists broadly embracing exercise therapy, in both historical and modern contexts, the pre-eminent position of exercise for RCRSP (Dube et al, 2023;Littlewood et al, 2023;Page et al, 2016), and other musculoskeletal conditions such as hip and knee osteoarthritis (Henriksen et al, 2024;Holden et al, 2023;Hunter & Hall, 2023), has come under increasing scrutiny. Critics appropriately assert that exercise does not appear to be held to the same standards as other treatments, such as manual therapy, surgery, and acupuncture, when considering its modest effects and low certainty of evidence (Naunton et al, 2020;Steuri et al, 2017), lack of demonstrated efficacy (Bennell et al, 2010), and importantly uncertainty regarding the causal pathways through which it may confer a therapeutic benefit (Powell et al, 2022b).…”

Section: Introductionmentioning

confidence: 99%

Is exercise therapy therighttreatment for rotator cuff‐related shoulder pain? Uncertainties, theory, and practice

Powell,

Lewis,

Schram

et al. 2024

Musculoskeletal Care

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BackgroundExercise therapy is a popular non‐surgical treatment to help manage individuals with rotator cuff‐related shoulder pain (RCRSP) and is recommended in all clinical practice guidelines. Due to modest effect sizes, low quality evidence, uncertainty relating to efficacy, and mechanism(s) of benefit, exercise as a therapeutic intervention has been the subject of increasing scrutiny.AimsThe aim of this critical review is to lay out where the purported uncertainties of exercise for RCRSP exist by exploring the relevant quantitative and qualitative literature. We conclude by offering theoretical and practical considerations to help reduce the uncertainty of delivering exercise therapy in a clinical environment.Results and DiscussionUncertainty underpins much of the theory and practice of delivering exercise therapy for individuals with RCRSP. Nonetheless, exercise is an often‐valued treatment by individuals with RCRSP, when provided within an appropriate clinical context. We encourage clinicians to use a shared decision‐making paradigm and embrace a pluralistic model when prescribing therapeutic exercise. This may take the form of using exercise experiments to trial different exercise approaches, adjusting, and adapting the exercise type, load, and context based on the individual's symptom irritability, preferences, and goals.ConclusionWe contend that providing exercise therapy should remain a principal treatment option for helping individuals with RCRSP. Limitations notwithstanding, exercise therapy is relatively low cost, accessible, and often valued by individuals with RCRSP. The uncertainty surrounding exercise therapy requires ongoing research and emphasis could be directed towards investigating causal mechanisms to better understand how exercise may benefit an individual with RCRSP.

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Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta‐Analysis

Lawford,

Hinman,

Spiers

et al. 2024

Arthritis Care & Research

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ObjectiveDetermine if higher compliance with American College of Sports Medicine (ACSM) exercise prescription guidelines influences exercise outcomes in knee osteoarthritis.MethodsSystematic review. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase up to 4th January 2024 for randomised controlled trials evaluating resistance and/or aerobic exercise for knee OA. Interventions were classified as higher compliance (meeting ≥60% of ACSM guideline recommendations for frequency, intensity, duration) or lower compliance (meeting <60% of recommendations). Effects on pain and function were evaluated via meta‐analysis, stratified by compliance.Results25 trials (3,290 participants) evaluated combined resistance and aerobic programs, with no differences in outcomes between those with higher and lower compliance (standardised mean difference [SMD] pain: ‐0.38 [95% confidence interval: ‐0.59 to ‐0.17] vs ‐0.31 [‐0.45 to ‐0.16], respectively; function: ‐0.43 [‐0.64 to ‐0.21] vs ‐0.36 [‐0.58 to ‐0.14]). 66 trials (5,231 participants) evaluated resistance exercise, with no differences between interventions with higher and lower compliance (pain: ‐0.60 [‐0.81 to ‐0.39] vs ‐0.93 [‐1.27 to ‐0.59]); function: ‐0.64 [‐0.83 to ‐0.44] vs ‐0.85 [‐1.20 to ‐0.49]). 12 trials (958 participants) evaluated aerobic exercise, with no differences between interventions with higher and lower compliance (pain: ‐0.83 [‐1.27 to ‐0.38] vs ‐0.76 [‐2.02 to 0.50]; function: ‐0.79 [‐1.20 to ‐0.38] vs ‐1.00 [‐2.52 to 0.53]).ConclusionHigher or lower compliance with ACSM exercise prescription guidelines did not influence exercise outcomes. Given there was substantial heterogeneity and many publications were at risk of bias, our results should be interpreted with caution.

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Exercise for knee osteoarthritis pain: Association or causation?

Cited by 4 publications

References 37 publications

Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial

Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial

Is exercise therapy therighttreatment for rotator cuff‐related shoulder pain? Uncertainties, theory, and practice

Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta‐Analysis

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