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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine whether weight-bearing or non-weight-bearing exercise programs better correct abnormal knee movement in individuals without knee pain. Participants will perform exercises such as squats and planks three times a week for six weeks, with knee movement analyzed before and after. The trial seeks individuals with noticeable knee motion issues during activities like stepping down, who are not currently experiencing knee pain or have had recent leg surgeries.

As an unphased trial, this study provides participants the chance to contribute to valuable research that may enhance exercise recommendations for knee health.

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 prior data suggests that these exercise programs are safe for individuals with abnormal knee motion?

Research has shown that both closed-chain and open-chain exercises are generally safe and well-tolerated for people with knee problems. Closed-chain exercises, where the foot stays on the ground or a surface, are safe and effective for knee recovery, often reducing pain and improving knee function.

Open-chain exercises, where the foot moves freely, are also considered safe. Studies suggest they can similarly enhance knee pain, flexibility, and function. Some research even recommends starting with open-chain exercises due to their safety and effectiveness.

Overall, both exercise types have a good safety record and benefit knee health, with no major side effects reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the exercise treatments for valgus knee deformity because they offer a non-surgical approach to managing this condition. Unlike traditional treatments that often involve bracing or surgery, these exercises focus on strengthening muscles through specific movements. The closed-chain exercises, like single leg squats and banded squats, engage multiple joints simultaneously, potentially leading to improved joint stability and muscle coordination. On the other hand, the open-chain exercises, such as clamshells and wall slides, target isolated muscle groups, which may help in refining muscle control and strength. This study aims to find out which method is more effective in reducing symptoms and improving knee function.

What evidence suggests that this trial's exercise programs could be effective for improving abnormal knee motion?

This trial will compare two types of exercise programs for individuals with valgus knee deformity. Participants in one arm will perform closed-chain exercises, such as squats, where the feet remain on the ground. Studies have shown that these exercises can stabilize knees and improve muscle coordination, reducing pain and proving safe for those with knee issues. Participants in the other arm will engage in open-chain exercises, where the feet move freely, like leg extensions. These exercises build muscle strength and flexibility, which are also crucial for healthy knees. Both exercise types have led to significant improvements with regular practice. Research indicates that different exercise programs offer various benefits, so selecting the right one depends on personal needs and goals. ^{1 2 6 7 8}

Who Is on the Research Team?

James M O'Donohue, DPT

Principal Investigator

Alvernia University

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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 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]

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]

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]

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]

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 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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12417218/

Effect of Closed Kinetic Chain Exercise With Customized ... Results: Both groups showed significant improvements post-intervention, but Group B demonstrated superior outcomes across all measures. Pain ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9306108/

The effectiveness of the comprehensive corrective exercise ... Conclusion. The CCEP proved effective for significant improvement in the selected variables of lower extremity kinematics and muscle strength in ...

3. cureus.com cureus.com/articles/393592-effect-of-closed-kinetic-chain-exercise-with-customized-knee-brace-on-pain-and-functional-performance-in-patients-with-bilateral-medial-compartment-knee-osteoarthritis.pdf?email=

Effect of Closed Kinetic Chain Exercise With Customized ... Conclusion: The combination of CKCE and a customized knee brace was more effective than conventional physiotherapy alone in reducing pain and ...

4. withpower.com withpower.com/trial/phase-dynamic-knee-valgus-2-2024-c72fc

Exercise 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 ...

5. researchgate.net researchgate.net/publication/394413850_Effect_of_Closed_Kinetic_Chain_Exercise_With_Customized_Knee_Brace_on_Pain_and_Functional_Performance_in_Patients_With_Bilateral_Medial_Compartment_Knee_Osteoarthritis

Effect of Closed Kinetic Chain Exercise With Customized ... Results: Both groups showed significant improvements post-intervention, but Group B demonstrated superior outcomes across all measures. Pain ...

6. trial.medpath.com trial.medpath.com/clinical-trial/abf35c6ee1d62a86/nct06348836-effects-open-chain-closed-chain-strengthening-dynamic-valgus

The Effects of Open Chain Versus Closed Chain ... - MedPath The goal of this clinical trial is to compare the effects of different exercises programs in individuals with abnormal knee motion.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12401799/

The Efficacy of Closed Versus Open Kinetic Chain Exercise ... Exercise is safe and beneficial for people with knee OA, with reports of reduced pain, improved knee function, increased activity and ...

8. centerwatch.com centerwatch.com/clinical-trials/listings/NCT06348836/the-effects-of-open-chain-versus-closed-chain-strengthening-on-dynamic-valgus-during-a-step-down-test

The Effects of Open Chain Versus Closed ... The goal of this clinical trial is to compare the effects of different exercises programs in individuals with abnormal knee motion.