The aim of this randomized controlled trial is to find the effects of eccentric and low-load blood flow restriction training on neuromuscular adaptations, muscle strength, functional performance, and disability in patients with knee osteoarthritis
Age group 40-70
Both genders male and female
Clinical diagnosis of knee OA (Kellgren-Lawrence grade 1-3) of the most symptomatic knee.
Pain stable enough to permit exercise on Numeric Pain Rating Scale 3/10.
• Presence of a prosthetic knee in the affected limb.
Inflammatory arthritis (e.g., rheumatoid arthritis) or active flare-up of OA.
Cardiovascular disease contraindicating exercise (e.g., unstable angina, recent MI, uncontrolled hypertension ≥160/100 mmHg).
Pulmonary disease that limits safe participation (e.g., severe COPD, recent exacerbation).
Parallel
Eccentric Gastrocnemius Strengthening Exercises
Other interventionEccentric Gastrocnemius Strengthening Exercises .1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 3 sets 10 reps in session 1-2). 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 5 sets 15 reps in session 3-4). Total duration is 3 sessions per week for 4 consecutive weeks.
Low-Load Blood Flow Restriction Training
Other interventionLow-load blood flow restriction training including 1-Low-intensity gastrocnemius strengthening with BFR cuff 2-Controlled exercise with intermittent vascular occlusion (inflated 50-70% for 4 weeks, 3 rep. 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 3 sets 10 reps in session 1-2). 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 5 sets 12 reps in session 3-4). Total duration is 3 sessions per week for 4 consecutive weeks.
Surface Electromyography
The Electromyography (EMG) is an objective assessment tool used to measure the electrical activity of muscles during contraction. Motor unit recruitment will be analyzed through the amplitude of EMG signals (root mean square, RMS), reflecting the number and synchronization of active motor units during contraction. Fatigue characteristics will be assessed using changes in EMG frequency parameters (mean or median frequency), indicating alterations in muscle fiber conduction velocity and fatigue onset that will be assessed pre and post sessions.
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
The WOMAC is a widely used, validated questionnaire assessing pain, stiffness, and physical function in patients with knee osteoarthritis. It consists of 24 items divided into three subscales: Pain (5 items), Stiffness (2 items), and Physical Function (17 items).
Timed Up and Go (TUG)
The Timed Up and Go (TUG) test assesses mobility and fall risk by timing how quickly a person can stand up from a standard armchair, walk 3 meters (10 feet) at a normal pace, turn around, walk back, and sit down again. Individuals can use their routine walking aids, but receive no physical help during the test; completing the maneuver in under 10 seconds indicates normal independence, whereas taking 30 seconds or longer points to an elevated risk of falling.
Heel Raise Endurance Test
The Heel Raise Endurance Test measures the number of consecutive heel raises a participant can perform (or the time sustained) while standing, usually at a controlled pace until fatigue. It assesses calf muscle endurance, ankle plantar-flexor strength, and functional lower-limb performance, relevant for gait and mobility assessment. The duration for which the position is maintained is recorded.
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