Effect of Lumbar Stabilization on Knee OA
Effect of Lumbar Stabilization on Knee OA
This study will be conducted to investigate the role of lumbar core strengthening in reducing
 knee pain and disability, and improving knee proprioception and Quadriceps strength in
 patients with knee OA.
Osteoarthritis (OA) is a highly prevalent degenerative joint disease that impacts quality of
 life and puts a burden on health care costs. Idiopathic knee OA is an age-related disease,
 with prevalence ranging from 19-28%. Aetiology of OA (whether systemic or mechanical) remains
 unclear.

 Lumbar spine has been reported to be associated with knee joint because of the biomechanical
 interrelationship. Decreased lumbar lordosis (that may indicate weak back extensors) and
 range of motion (that may indicate weak core stabilizers) had significant correlations with
 an increased spinal inclination angle, which was an independent factor related to knee OA (by
 increasing knee flexion angle). Knee OA may radiate pain to the back that together lead to
 more limited hip motion causing overloaded knees. Convergence presents between nerve roots
 supplying mid-lumbar muscles and joints, and that supply femoral nerve and quadriceps.
 Progression of knee OA is associated with progression of lumbar spine osteoarthritis. Altered
 trunk kinematics may cause altered tibiofemoral kinematics.

 Strengthening of trunk extensors may be very important for knee OA as fatiguing back
 extensors led to 1) increased quadriceps inhibition (QI) that may lead to poor attenuation of
 ground reaction forces and excessive forces on the knees, 2) altered standing postural
 control, 3) a forward-leaned posture that increases the external knee moments, 4) a reduction
 in trunk proprioception.

 Core stabilization exercises combined with knee-focused exercise or combined with hip
 strengthening resulted in less pain and better function. Interestingly, these studies
 included only patellofemoral pain and OA patients. This program may benefit knee OA patients
 as well. Strength, neuromuscular training and lumbopelvic stabilization reduced muscle
 weakness (of quadriceps and hip abductors), pain, and disability in men with mild knee OA.
 However, specific role of lumbar core muscles on knee OA, their effect on wider population
 (including females) and their effect on higher severity knee OA are lacking.

 Strengthening of trunk core muscles may help pelvic stability which found to be beneficial in
 improving the trunk and lower extremity movement control, hip muscles strength, gait speed
 and daily activities. However, this done in stroke patients, it is hypothesized to benefit
 knee OA patients as well. Assessment and treatment of the trunk musculature should be
 considered in the rehabilitation of patients who demonstrate abnormal lower-extremity
 kinematics as found in knee OA.
Inclusion Criteria:

 1. Knee pain for most days of previous month

 2. Age 40- 65 years Knee OA grade 2-3 on kellgren- Lawrence grading scale. Unilateral or
 bilateral (provided that they radiologically have one knee ≤ grade 1 on KL score, and
 clinically pain ≤2 in VAS. The more severally affected knee will be included in
 evaluation and treatment) BMI= 25-32 kg/m2.

 Exclusion Criteria:

 -  Symptomatic hip OA Hip or pelvis trauma Knee or hip infection Congenital or
 developmental disorder of lower limbs Intra-articular corticosteroid or hyaluronic
 acid injection into the knee within the last 3 months.

 Previous surgery of the affected knee or spine. Significant injury to the knee within the
 past 6 months. Any disease or medication worsens physical function or hampers with knee
 evaluation (e.g. rheumatoid arthritis, canal stenosis..).