Joints—should you spare them or keep moving despite the pain?

Aim of the study: To determine whether land-based therapeutic exercise is beneficial for people with knee osteoarthritis (OA) in terms of reduced joint pain or improved physical function and quality of life.

Results: In total, 54 studies were identified. Overall, 19 (35%) studies reported adequate random sequence generation, allocation concealment and adequately accounted for incomplete outcome data. However, research results may be vulnerable to selection, attrition and detection bias. Pooled results from 44 trials indicated that exercise significantly reduced pain (12 points/100; 95% CI 10 to 15) and improved physical function (10 points/100; 95% CI 8 to 13) to a moderate degree immediately after treatment, while evidence from 13 studies revealed that exercise significantly improved quality of life immediately after treatment with small effect (4 points/100; 95% CI 2 to 5). In addition, 12 studies provided 2-month to 6-month post-treatment sustainability data which showed significantly reduced knee pain (6 points/100; 95% CI 3 to 9) and 10 studies which showed improved physical function (3 points/100; 95% CI 1 to 5).

Aim of the study: To estimate the effectiveness of exercise at end of treatment and long-term follow-up compared to a control condition or other conservative treatments in patients with Greater Trochanteric Pain Syndrome (GTPS).

Results: Six RCTs including a total of 733 patients with GTPS were included. Three trials compared exercise to sham exercise or wait-and-see control groups, two trials compared exercise to corticosteroid injection, two trials compared exercise to shockwave therapy, and one trial compared exercise to another type of exercise. Meta-analyses showed that in the long term, exercise slightly reduces hip pain and disease severity, while slightly improving patient-reported physical function and global rating of change compared to a control condition. No serious adverse events were reported. Compared to corticosteroid injection, exercise improves long-term global rating of change. The current evidence supports a strong recommendation for exercise as first line treatment in patients clinically diagnosed with GTPS. Compared to corticosteroid injection, exercise is superior in increasing the likelihood that a patient experiences a meaningful global improvement.

Aim of the study: The purpose of this study was to determine dose parameters for resistance exercise associated with improvements in pain and physical function in knee and hip osteoarthritis (OA) and whether these improvements were related to adherence.

Results: For both knee and hip, data from 280 studies showed moderate benefit for pain, physical function ADL, and physical function SPORT in favor of interventions 3 to 6 months. For the knee, there was also a moderate benefit for physical function ADL in favor of interventions >6 to <12 months. From 151 knee and hip studies that provided total exercise volume data (frequency, time, duration), there was no association between volume with the effect size for pain and physical function. A total of 74 studies (69 knee, 5 hip) reported usable adherence data. There was no association between adherence with the effect size for pain and physical function. In knee and hip OA, resistance exercise interventions 3 to 6 months (and for the knee >6 to <12 months) duration improve pain and physical function. Improvements do not depend on exercise volume or adherence, suggesting exercise does not require rigid adherence to a specific dose.

Aim of the study: To investigate the effects of scapular stabilization exercise training on pain and functional recovery in people with shoulder impingement syndrome. Design: A systematic review protocol was registered with PROSPERO. We systematically searched different databases. A random-effects model was used to determine the mean difference (MD) and 95% confidence interval (CI) for pain and functional recovery.

Results: Fourteen studies (666 participants) were included in the analysis. Addition of scapular stabilization-based exercise training to general exercises reduce pain MD - 0.8 cm (95% CI, -1.07 to -0.4; I² = 0%) and improve the functional recovery and shoulder abduction range of motion MD -13.27 (95% CI, -16.85 to -9.69; I² = 5%) and MD 2.74 degrees (95% CI, 0.3 to 5.2; I² = 0%), respectively. However, the certainty of the evidence is low to very low. No significant differences in pain or functional recovery were found between participants in the scapular stabilization-based exercise training with the feedback group and those in the scapular stabilization-based exercise training without the feedback group. Our findings are promising; however, higher quality RCT is needed to better establish the superiority of the rehabilitation programs that include scapular stabilization exercises.

Aim of the study: People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in meaningful occupational activities. The purpose of this systematic review was to evaluate the current evidence for interventions within the occupational therapy scope of practice that address pain reduction and increase participation in functional activities.

Results: Seventy-six studies were reviewed for this study-67 of Level I evidence, 7 of Level II evidence, and 2 of Level III evidence. Strong evidence was found that ROM, strengthening exercises, and joint mobilizations can improve function and decrease pain. The evidence to support physical modalities is moderate to mixed, depending on the shoulder disorder. Occupational therapy practitioners can use this evidence to guide daily clinical decision making.

Aim of the study: Total knee arthroplasty (TKA) successfully alleviates pain from knee osteoarthritis, but muscle strength and function are reduced for a long period postoperatively. Postoperative active resistance exercise may play a relevant role. To systematically evaluate effects of lower-limb active resistance exercise (ARE) on mobility, physical function, muscle strength and pain intensity in patients with TKA.

Results: A total of 14 randomized controlled trials, involving 880 patients, were finally included. The lower-limb ARE exhibited significantly greater improvement in MWS (MD 0.13, 95%CI 0.08-0.18, P < 0.00001), TUG(MD -0.92, 95%CI -1.55- -0.28, P = 0.005), KEP (SMD 0.58, 95%CI 0.20-0.96, P = 0.003), KFP (SMD 0.38, 95%CI 0.13-0.63, P = 0.003), ROM-flexion (MD 2.74, 95%CI 1.82-3.67, P < 0.00001) and VAS (MD - 4.65, 95% CI - 7.86- -1.44, p = 0.005) compared to conventional exercise(CE) immediately post-intervention. However, there were no statistically significant differences between both groups in regard to 6MWT (MD 7.98, 95%CI -4.60-20.56, P = 0.21), SCT (MD -0.79, 95%CI -1.69-0.10, P = 0.08) and ROM-extension (MD -0.60, 95%CI -1.23-0.03, P = 0.06). According to the results of meta-analysis, patients undergoing TKA who receive the lower extremity ARE show better clinical effects in terms of pain relief, strength recovery and knee ROM.

Aim of the study: Knee osteoarthritis (KOA) is a leading cause of chronic pain and physical disability in the aging global population, placing an immense burden on healthcare systems. Despite its rising incidence, clinical practice and research remain disproportionately focused on late-stage joint replacement, neglecting early-stage preventive and conservative care for high-risk individuals.

Results: Literature analysis demonstrates that a structured, "lifelong, stepped" non-surgical paradigm yields significant clinical efficacy. Specifically, combining dietary weight loss with physical exercise optimally reduces mechanical joint loading and systemic inflammatory markers; targeted muscle strengthening, alongside mind-body exercises like Tai Chi or yoga, improves the joint microenvironment and neuromuscular control; biomechanical orthoses and physical therapies offer substantial short-term pain relief; and topical or systemic NSAIDs combined with intra-articular injections effectively manage refractory acute symptoms. Crucially, continuous clinical supervision and structured patient education are vital for enhancing long-term treatment adherence and delaying radiological disease progression.

Aim of the study: Physical activity is widely recommended for preserving musculoskeletal health and managing osteoarthritis-related pain, although its benefits are commonly framed in terms of muscle strengthening, weight control, and physical performance. This narrative review aimed to examine movement more broadly as a physiological regulator of synovial joint homeostasis, sensory calibration, and functional adaptation.

Results: The narrative synthesis indicates that the concept of the synovial joint as a dynamic mechano-fluidic organ in which cartilage, synovium, synovial fluid, capsule, subchondral bone, periarticular tissues, and sensory pathways interact continuously. Repeated physiological movement may promote synovial fluid exchange, lubrication, cartilage nutrition, hyaluronic acid and lubricin function, matrix turnover, anti-inflammatory signaling, proprioceptive control, and exercise-induced hypoalgesia. In contrast, inactivity and unloading may impair fluid dynamics, promote muscle inhibition, stiffness, inflammatory persistence, sensory deconditioning, and loss of function. Excessive or poorly distributed loading may also disrupt homeostasis through matrix injury, inflammation, fatigue, and nociceptive sensitization.

Aim of the study: This study examined the effects of a neuromuscular exercise program on knee joint alignment, pain, and static and dynamic balance in patients with genu varum. Forty female patients aged 40-60 years with radiographically confirmed genu varum and a Short-Form McGill Pain Questionnaire (SF-MPQ) score ≥18.0 were randomly assigned to either an exercise group (EG, n=20) or a control group (CG, n=20).

Results: Significant interactions were observed for KTKL, bilateral HIA, bilateral MPTA, and pain scores (all P<0.001). The EG demonstrated reductions in KTKL (-1.09 cm) and pain (-8.15), as well as increases in HIA (right: +1.56°, left: +1.39°) and MPTA (right: +1.11°, left: +0.89°), whereas the CG showed minimal changes. For balance outcomes, significant interactions were identified in selected static and dynamic balance measures (P<0.05), with post hoc analyses indicating improvements primarily in the EG. A 12-week neuromuscular exercise program may be beneficial for improving alignment-related measures, reducing pain, and enhancing selected balance outcomes in individuals with genu varum.

Aim of the study: To compare 4-week short-term outcomes associated with adding supervised joint mobilization to ultrasound-guided suprascapular nerve block (SSNB) plus home exercise in patients with frozen shoulder and to explore factors associated with poor treatment response.

Results: After adjustment for the corresponding baseline value and age, compared with the basic-treatment group, the combined-treatment group had a lower VAS score [adjusted mean difference (AMD), -0.78; 95% CI, -1.37 to -0.19; P = 0.010], greater forward flexion, abduction, and external rotation (AMD, 4.78°, 4.03°, and 3.38°, respectively; all P < 0.05), and a lower SPADI total score (AMD, -6.80; 95% CI, -11.08 to -2.53; P = 0.002). The adjusted between-group difference in CMS total score was not statistically significant (AMD, 3.42; 95% CI, -0.50 to 7.35; P = 0.087). The overall response rate was 89.39% in the combined-treatment group and 70.69% in the basic-treatment group; after adjustment for age and baseline VAS, combined treatment was associated with lower odds of poor response (adjusted OR, 0.319; 95% CI, 0.117-0.868; P = 0.025). Adverse-event rates did not differ significantly between groups (P = 0.147).