Activity-Dependent Pain in Patients with Knee Osteoarthritis Is Associated with Balance Ability

Naoto Ikeda, Sho Toyoshima, Yui Sezaki, Yukiho Ichikawa, Yuka Yokoi, Katsuyuki Morishita
Purpose:

The purpose of this study was to determine the effect of combined HICUS and automatic knee exercise on IFP stiffness and gliding.

Methods:

This study was a randomized controlled crossover study of HICUS (automatic knee motion + HICUS) and placebo (automatic knee motion + sham irradiation) conditions in 20 healthy adults. A multi-point probe capable of automatic rotation irradiation was placed just above the patellar ligament, and inside and outside the patellar ligament. The evaluation indices were IFP stiffness and gliding, and the measurement positions were 10° and 120° knee joint flexion. Shear wave elastic modulus (stiffness) and B-mode (gliding) of shear wave elastography were measured using an ultrasound imaging system (SUPERSONIC™ MACH20, Hologic). Gliding was measured as the difference between the Patellar-tendon tibial angle at 10° and 120° knee joint flexion. Irradiation conditions were 1 MHz, 2.5 W/cm², and 5 minutes of continuous irradiation. Automatic knee joint flexion and extension exercises (2 seconds of quadriceps afferent contraction, 10 seconds of isometric contraction, 3 seconds of centrifugal contraction, and 5 seconds of rest) were performed in the sitting position for 5 minutes. Measurements were taken three times: before the intervention (T1), immediately after the intervention (T2), and 15 minutes after the intervention (T3). Statistical analysis was performed by two-way ANOVA with repeated measures and Bonferroni's method for post-tests (significance level 5%).

Results:

IFP stiffness showed an interaction effect at 10° knee flexion (p0.05) and a main effect at 120° knee flexion (p0.05). Knee flexion at 10° was significantly lower at T2 than at T1 under US conditions, and at 120° knee flexion, HICUS conditions were significantly lower at T2 and T3 than at T1 (p0.05). Glide was significantly increased in the HICUS condition at T2 and T3 compared to T1, and in the placebo condition at T2 compared to T1 (p0.05).

Conclusion(s):

Mechanical and thermal stimulation combined with HICUS and automatic exercise decreased IFP stiffness and improved gliding at 10° and 120° knee flexion.

Implications:

The results suggest that the combination of HICUS and automatic exercise is effective for patients with knee OA who have IFP-derived pain. Further studies are needed to better understand the mechanism of efficacy in this study.

Funding acknowledgements:
None
Keywords:
Osteoarthritis
Movement-evoked pain
Physical function
Primary topic:
Musculoskeletal: lower limb
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Institution: Josai International University Ethics committee: Josai International University Ethics Committee for Research Involving Human Subjects
Provide the ethics approval number:
25W230027
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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