Exercise for Valgus Knee Deformity

Overseen By James M O'Donohue, DPT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Alvernia University

Disqualifiers: Lower extremity pain, recent surgery

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 15

Duration: 6 weeks

10 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this clinical trial is to compare the effects of different exercises programs in individuals with abnormal knee motion. The main question it aims to answer are: * In individuals with abnormal knee motion and without knee pain, does a weight-bearing exercise program reduce abnormal knee motion during a step-down test better than a non weight-bearing exercise program? Participants will * Perform a stepdown test while undergoing motion analysis and electromyograph (EMG) recording. * Participants will then be placed either into a weight-bearing or non weight-bearing exercise group. Exercises will be performed 3 times per week for 6 weeks. * Further motion analysis and EMG data will be collected to test for differences. Researchers will compare individual results before and after exercise, and between-group results before and after exercise to see if one exercise program helps improved abnormal knee motion more than the other.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Exercise for Valgus Knee Deformity is an effective treatment?

The available research does not provide specific data on the effectiveness of exercise for Valgus Knee Deformity. Instead, it focuses on exercise in the context of heart conditions and other medical issues. Therefore, no direct evidence from the provided information supports the effectiveness of exercise for Valgus Knee Deformity. ^{1 2 3 4 5}

What safety data exists for exercise treatments for valgus knee deformity?

The studies reviewed suggest that closed kinetic chain exercises are generally safe and effective for knee rehabilitation. They are associated with reduced patellofemoral pain, improved knee stability, and better functional outcomes compared to open kinetic chain exercises. Closed chain exercises are also preferred for their ability to simulate normal physiological functions and create less shear stress on joints, making them suitable for early rehabilitation. Both open and closed chain exercises can improve muscle strength, but closed chain exercises may offer some advantages in terms of patient satisfaction and quicker return to normal activities. ^{6 7 8 9 10}

Is Open Chain Versus Closed Chain Strengthening a promising treatment for Valgus Knee Deformity?

Yes, Open Chain Versus Closed Chain Strengthening is a promising treatment for Valgus Knee Deformity. Closed chain exercises, like squats, are shown to improve knee stability, reduce pain, and enhance muscle coordination. They are effective and safe, helping people return to normal activities faster. Open chain exercises, like leg extensions, are also beneficial, especially for those who feel unstable standing. Both types of exercises can strengthen muscles and improve knee function. ^{6 11 12 13 14}

Research Team

James M O'Donohue, DPT

Principal Investigator

Alvernia University

Eligibility Criteria

This trial is for individuals with abnormal knee motion but no knee pain. Participants will be tested and then do exercises three times a week for six weeks, either weight-bearing or non-weight-bearing, to see which improves knee motion.

Inclusion Criteria

My knee moves inward when I step down.

Exclusion Criteria

I am currently experiencing pain in my legs.

I had surgery on my leg or foot in the last year.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Baseline Assessment

Initial data collection including motion capture testing and EMG recording

1 week

1 visit (in-person)

Treatment

Participants perform either closed or open chain exercises 2-3 times per week

6 weeks

12-18 sessions (in-person)

Post-Treatment Assessment

Final data collection matching initial assessment to evaluate changes

1 week

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Open Chain Versus Closed Chain Strengthening

Trial Overview The study tests if a weight-bearing exercise program is more effective than a non weight-bearing one in reducing abnormal knee motion during a step-down test. Motion analysis and EMG recordings are used before and after the exercise period.

Participant Groups

Group I: Closed-Chain exercise Active Control 1 Intervention

4 exercises: 1)Single leg bridge, 2)side plank (with testing side down), 3) single leg squat, 4) banded squat Exercises to be performed with 3 sets of 10 repetitions each. Frequency will be 2 times per week for 6 weeks.

Group II: Open-Chain exercise Active Control 1 Intervention

4 exercises: 1) Side plank (with testing side up), 2) clamshells, 3) front plank with hip extension, 4)wall slide Exercises to be performed with 3 sets of 10 repetitions each. Frequency will be 2 times per week for 6 weeks.

Who Is Running the Clinical Trial?

Alvernia University

Lead Sponsor

Trials

5

Recruited

170+

Findings from Research

In a study of 85 patients who underwent valvular heart surgery, a significant number (58%) showed reduced exercise capacity post-surgery, indicating the need for rehabilitation to improve their physical fitness.

A short-duration, frequent exercise program (Program A) effectively increased maximal oxygen uptake (max.VO2) from 18.2 to 20.7 ml/min/kg after 4 weeks, demonstrating its efficacy and safety, while a control group showed no improvement, highlighting the importance of physical training in recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical training in patients with valvular heart disease after surgery. Toyomasu, K., Nishiyama, Y., Yoshida, N., et al.[2019]

Exercise after open heart surgery is not only feasible but beneficial, as it enhances exercise efficiency and reduces the heart's workload during activities.

Most patients can safely improve their fitness levels by adhering to simple exercise guidelines, and upper-body exercises should be more prominently included in rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Athletic participation after myocardial revascularization. Possibilities and benefits. Kay, GL.[2007]

In a study of 145 patients who underwent aortic or mitral valve surgery, those with higher preoperative risk had significantly lower postoperative exercise capacity, indicating that pre-surgery health status impacts recovery outcomes.

Regardless of preoperative risk or type of surgery, all patients showed similar improvements in exercise capacity after participating in cardiac rehabilitation, highlighting the effectiveness of exercise training post-surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of the preoperative risk and the type of surgery on exercise capacity and training after valvular surgery. Pardaens, S., Moerman, V., Willems, AM., et al.[2014]

In a study of 114 patients, those who received online health education and engaged in functional resistance and pressure exercises showed a significantly lower failure rate of arteriovenous fistula (AVF) maturation compared to those who received conventional care.

The experimental group not only had a lower failure rate but also experienced a shorter clinical maturation time for the AVF, indicating that combining education with exercise is beneficial for improving AVF outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of health education and exercise style changes on the maturation of autologous arteriovenous fistula in hemodialysis patients: A randomized controlled trial. Cao, MC., Jia, RF., Wang, YF., et al.[2023]

The HF-ACTION trial aims to determine if exercise training can reduce all-cause mortality and hospitalization in patients with heart failure, involving 36 supervised sessions followed by home-based exercise over a 4-year period.

Exercise training is a low-cost and accessible intervention that may improve health outcomes for heart failure patients, with various physiological and quality-of-life measures being assessed throughout the study.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. Whellan, DJ., O'Connor, CM., Lee, KL., et al.[2007]

In a study involving patients recovering from anterior cruciate ligament reconstruction, closed kinetic chain exercises were found to be safe and effective, leading to better knee stability and less patellofemoral pain compared to open kinetic chain exercises.

Patients in the closed kinetic chain group reported higher satisfaction and a quicker return to normal activities and sports, prompting the researchers to adopt this method exclusively in their rehabilitation protocol.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Open versus closed chain kinetic exercises after anterior cruciate ligament reconstruction. A prospective randomized study. Bynum, EB., Barrack, RL., Alexander, AH.[2022]

Closed-chain exercise (CCE) resulted in less thigh circumference decrease and better functional outcomes, as measured by the Lysholm score, compared to open-chain exercise (OCE) in patients after medial patellofemoral ligament (MPFL) reconstruction.

At 3 months post-surgery, patients in the CCE group reported less pain on the visual analog scale compared to those in the OCE group, indicating that CCE may provide better pain management during recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of the clinical effects of open and closed chain exercises after medial patellofemoral ligament reconstruction. Zhang, F., Wang, J., Wang, F.[2021]

Closed-chain exercise protocols are beneficial for rehabilitating knee and shoulder injuries as they mimic normal joint functions and reduce shear stress on healing joints.

These exercises can be introduced early in rehabilitation programs, making them essential for 'accelerated' recovery, and the authors provide specific examples of exercises used in these protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Closed-chain rehabilitation for upper and lower extremities. Kibler, WB., Livingston, B.[2019]

Both open and closed kinetic-chain exercises significantly improved muscle strength in the ankle joint among 20 women in their 20s after 4 weeks of training, indicating their effectiveness for strength enhancement.

However, there were no significant changes in muscle activity for the targeted muscles (tibialis anterior, gastrocnemius, tibialis posterior, and peroneus longus) between the two exercise types, suggesting that while strength improved, the way muscles were activated did not differ significantly.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of open and closed kinetic-chain exercises on the muscle strength and muscle activity of the ankle joint in young healthy women. Kim, MK., Kong, BS., Yoo, KT.[2020]

In a study involving 60 patients with patellofemoral pain, both open and closed kinetic chain exercises significantly reduced pain and improved functional performance over a 5-week program.

Closed kinetic chain exercises showed slightly better functional outcomes compared to open kinetic chain exercises, suggesting they may be a more effective option for nonoperative management of anterior knee pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Open versus closed kinetic chain exercises for patellofemoral pain. A prospective, randomized study. Witvrouw, E., Lysens, R., Bellemans, J., et al.[2019]

Closed kinetic chain rehabilitation exercises are more effective for lower extremity rehabilitation as they reduce shear forces on joints and enhance proprioception, which is crucial for joint stability.

This type of rehabilitation improves muscle coordination and is considered an economical and efficient approach to recovery, making it a valuable method in physical therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of limb torque, muscle action and proprioception during closed kinetic chain rehabilitation of the lower extremity. Bunton, EE., Pitney, WA., Cappaert, TA., et al.[2022]

In a study involving 16 subjects with lateral patellar compression syndrome, both relaxed and closed chain exercises significantly improved patellar tracking compared to open chain exercises at knee angles of 0, 10, and 20 degrees.

Open chain strengthening exercises are recommended to be used primarily after 30 degrees of knee flexion, as patellar tracking improved progressively from 0 to 40 degrees of knee flexion across different muscle conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome. Doucette, SA., Child, DD.[2016]

Computer simulations of five cadaveric knees showed that open kinetic chain leg extension exercises do not place supraphysiologic stresses on the patellofemoral cartilage, making them a safe option for rehabilitation.

Open kinetic chain exercises, especially at low flexion angles, can be beneficial for patients recovering from surgery or those with proximal patellar lesions, as they provide an alternative to closed kinetic chain exercises that may feel unstable.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patellofemoral stresses during open and closed kinetic chain exercises. An analysis using computer simulation. Cohen, ZA., Roglic, H., Grelsamer, RP., et al.[2017]

Both closed kinetic chain exercises and open kinetic chain exercises significantly improved pain, muscle strength, and quality of life in 60 patients with knee osteoarthritis over 12 weeks, compared to a control group.

There was no significant difference in effectiveness between the two types of exercises, suggesting that closed kinetic chain exercises can be safely included in treatment programs for patients with low-grade knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of closed and open kinetic chain exercises on pain, muscle strength, function, and quality of life in patients with knee osteoarthritis. Özüdoğru, A., Gelecek, N.[2023]

References

1. Japan pubmed.ncbi.nlm.nih.gov

Physical training in patients with valvular heart disease after surgery. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Athletic participation after myocardial revascularization. Possibilities and benefits. [2007]

3. United States pubmed.ncbi.nlm.nih.gov

Impact of the preoperative risk and the type of surgery on exercise capacity and training after valvular surgery. [2014]

4. United States pubmed.ncbi.nlm.nih.gov

The effects of health education and exercise style changes on the maturation of autologous arteriovenous fistula in hemodialysis patients: A randomized controlled trial. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. [2007]

6. United States pubmed.ncbi.nlm.nih.gov

Open versus closed chain kinetic exercises after anterior cruciate ligament reconstruction. A prospective randomized study. [2022]

7. Japan pubmed.ncbi.nlm.nih.gov

Comparison of the clinical effects of open and closed chain exercises after medial patellofemoral ligament reconstruction. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Closed-chain rehabilitation for upper and lower extremities. [2019]

9. Japan pubmed.ncbi.nlm.nih.gov

Effects of open and closed kinetic-chain exercises on the muscle strength and muscle activity of the ankle joint in young healthy women. [2020]

10. United States pubmed.ncbi.nlm.nih.gov

Open versus closed kinetic chain exercises for patellofemoral pain. A prospective, randomized study. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

The role of limb torque, muscle action and proprioception during closed kinetic chain rehabilitation of the lower extremity. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

The effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome. [2016]

13. United States pubmed.ncbi.nlm.nih.gov

Patellofemoral stresses during open and closed kinetic chain exercises. An analysis using computer simulation. [2017]

14. Brazil pubmed.ncbi.nlm.nih.gov

Effects of closed and open kinetic chain exercises on pain, muscle strength, function, and quality of life in patients with knee osteoarthritis. [2023]