Exercise Therapy Targeting Neuromuscular Mechanisms

  • Jesper Knoop
  • Martijn P. M. Steultjens
  • Joost DekkerEmail author
Part of the SpringerBriefs in Specialty Topics in Behavioral Medicine book series (BRIEFSSPETOBEME)


This chapter presents the rationale of innovative exercise modalities that target neuromuscular mechanisms for patients with osteoarthritis. An overview of different modalities of exercise therapy targeting neuromuscular mechanisms and three examples of specific programs will be provided. Available evidence for the effectiveness of exercise therapy targeting neuromuscular mechanisms in patients with osteoarthritis is presented.


Exercise Therapy Neuromuscular Control Muscle Strengthen Knee Position Neuromuscular Training 
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  1. 1.
    Peter WF, Jansen MJ, Hurkmans EJ, Bloo H, Dekker J, Dilling RG et al (2011) Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation. Acta Reumatol Port 36(3):268–281PubMedGoogle Scholar
  2. 2.
    Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK et al (2010) OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 18(4):476–499PubMedCrossRefGoogle Scholar
  3. 3.
    Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J et al (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 64(4):455–474CrossRefGoogle Scholar
  4. 4.
    Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P et al (2003) EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 62(12):1145–1155PubMedCrossRefGoogle Scholar
  5. 5.
    Fransen M, McConnell S (2008) Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 4:CD004376PubMedGoogle Scholar
  6. 6.
    Fitzgerald GK, Piva SR, Irrgang JJ (2004) Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum 51(6):941–946PubMedCrossRefGoogle Scholar
  7. 7.
    Knoop J, van der Leeden M, van der Esch M, Thorstensson CA, Gerritsen M, Voorneman RE et al (2012) Association of lower muscle strength with self-reported knee instability in osteoarthritis of the knee: results from the Amsterdam Osteoarthritis Cohort. Arthritis Care Res (Hoboken) 64(1):38–45CrossRefGoogle Scholar
  8. 8.
    Schmitt LC, Fitzgerald GK, Reisman AS, Rudolph KS (2008) Instability, laxity, and physical function in patients with medial knee osteoarthritis. Phys Ther 88(12):1506–1516PubMedCrossRefGoogle Scholar
  9. 9.
    Felson DT, Niu J, McClennan C, Sack B, Aliabadi P, Hunter DJ et al (2007) Knee buckling: prevalence, risk factors, and associated limitations in function. Ann Intern Med 147(8):534–540PubMedCrossRefGoogle Scholar
  10. 10.
    van der Esch M, Steultjens M, Harlaar J, Knol D, Lems W, Dekker J (2007) Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum 57(5):787–793PubMedCrossRefGoogle Scholar
  11. 11.
    van der Esch M, Steultjens M, Knol DL, Dinant H, Dekker J (2006) Joint laxity and the relationship between muscle strength and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum 55(6):953–959PubMedCrossRefGoogle Scholar
  12. 12.
    van der Esch M, Steultjens M, Harlaar J, Wolterbeek N, Knol D, Dekker J (2008) Varus-valgus motion and functional ability in patients with knee osteoarthritis. Ann Rheum Dis 67(4):471–477PubMedCrossRefGoogle Scholar
  13. 13.
    Williams GN, Chmielewski T, Rudolph K, Buchanan TS, Snyder-Mackler L (2001) Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther 31(10):546–566PubMedCrossRefGoogle Scholar
  14. 14.
    Jan MH, Tang PF, Lin JJ, Tseng SC, Lin YF, Lin DH (2008) Efficacy of a target-matching foot-stepping exercise on proprioception and function in patients with knee osteoarthritis. J Orthop Sports Phys Ther 38(1):19–25PubMedCrossRefGoogle Scholar
  15. 15.
    Fitzgerald GK, Childs JD, Ridge TM, Irrgang JJ (2002) Agility and perturbation training for a physically active individual with knee osteoarthritis. Phys Ther 82(4):372–382PubMedGoogle Scholar
  16. 16.
    Ageberg E, Link A, Roos EM (2010) Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal-based NEMEX-TJR training program. BMC Musculoskelet Disord 11:126PubMedCrossRefGoogle Scholar
  17. 17.
    Thorstensson CA, Henriksson M, von Porat A, Sjodahl C, Roos EM (2007) The effect of eight weeks of exercise on knee adduction moment in early knee osteoarthritis–a pilot study. Osteoarthritis Cartilage 15(10):1163–1170PubMedCrossRefGoogle Scholar
  18. 18.
    Knoop J, Steultjens MP, van der Leeden M, van der Esch M, Thorstensson CA, Roorda LD et al (2011) Proprioception in knee osteoarthritis: a narrative review. Osteoarthritis Cartilage 19(4):381–388PubMedCrossRefGoogle Scholar
  19. 19.
    Butler AA, Lord SR, Rogers MW, Fitzpatrick RC (2008) Muscle weakness impairs the proprioceptive control of human standing. Brain Res 1242:244–251PubMedCrossRefGoogle Scholar
  20. 20.
    Wise AK, Gregory JE, Proske U (1998) Detection of movements of the human forearm during and after co-contractions of muscles acting at the elbow joint. J Physiol 508(Pt 1):325–330PubMedGoogle Scholar
  21. 21.
    Givoni NJ, Pham T, Allen TJ, Proske U (2007) The effect of quadriceps muscle fatigue on position matching at the knee. J Physiol 584(Pt 1):111–119PubMedCrossRefGoogle Scholar
  22. 22.
    Lin DH, Lin YF, Chai HM, Han YC, Jan MH (2007) Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis. Clin Rheumatol 26(4):520–528PubMedCrossRefGoogle Scholar
  23. 23.
    Lin DH, Lin CH, Lin YF, Jan MH (2009) Efficacy of 2 non-weight-bearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. J Orthop Sports Phys Ther 39(6):450–457PubMedCrossRefGoogle Scholar
  24. 24.
    Jan MH, Lin CH, Lin YF, Lin JJ, Lin DH (2009) Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil 90(6):897–904PubMedCrossRefGoogle Scholar
  25. 25.
    Diracoglu D, Aydin R, Baskent A, Celik A (2005) Effects of kinesthesia and balance exercises in knee osteoarthritis. J Clin Rheumatol 11(6):303–310PubMedCrossRefGoogle Scholar
  26. 26.
    Fitzgerald GK, Piva SR, Gil AB, Wisniewski SR, Oddis CV, Irrgang JJ (2011) Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial. Phys Ther 91(4):452–469PubMedCrossRefGoogle Scholar
  27. 27.
    Diracoglu D, Baskent A, Celik A, Issever H, Aydin R (2008) Long-term effects of kinesthesia/balance and strengthening exercises on patients with knee osteoarthritis: a one-year follow-up study. J Back Musculoskelet Rehabil 21(4):253–262Google Scholar
  28. 28.
    Knoop J, Dekker J, Leeden vd M, Esch vd M, Thorstensson CA, Gerritsen M et al (2013) Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized, controlled trial. Osteoarthritis Cartilage (accepted for publication)Google Scholar

Copyright information

© The Author(s) 2014

Authors and Affiliations

  • Jesper Knoop
    • 1
  • Martijn P. M. Steultjens
    • 2
  • Joost Dekker
    • 3
    • 4
    Email author
  1. 1.Amsterdam Rehabilitation Research Center ∣ ReadeAmsterdamThe Netherlands
  2. 2.School of Health and Life SciencesInstitute for Applied Health Research, Glasgow Caledonian UniversityGlasgowUK
  3. 3.Department of Rehabilitation MedicineVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands

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