Gluteus Maximus-Gastrocnemius Versus Quadriceps Biofeedback Neuromuscular Training During Gait in Knee Osteoarthritis: Development and Feasibility of a Novel Concept With a Pilot Study Publisher

Summary: Can gait biofeedback ease knee arthritis? A 10-person pilot trial suggests gluteal and calf muscle training may improve pain and function, but larger trials are essential. #Osteoarthritis #Rehab

Kalantari K K ; Ganjeh S ; Bijari K ; Roostayi M M ; Aslani H ; Baghban A A ; Rezaeian Z S
Source: Journal of Medical Signals and Sensors Published:2026

Abstract

Background: The neuromuscular training is a subgroup of functional exercises. The effectiveness of the neuromuscular training substantially improves in combination with electromyography (EMG) biofeedback. The present study aimed to investigate the effect of a new model of neuromuscular training in knee osteoarthritis (KOA). Methods: This pilot, parallel randomized-clinical-trial involved 10 participants with moderate KOA, who were randomly assigned into either neuromuscular training for the gluteus maximus and gastrocnemius (pro-group = 5) or the quadriceps (against-group = 5). Muscle activity in the feedback phase of gait (EMG), pain (Visual Analog Scale [VAS] and knee injury and osteoarthritis outcome score [KOOS]-pain score), and function (average walking speed and KOOS score) were assessed at baseline, immediately after the first treatment session (except KOOS), after 10 sessions of intervention, and after a 3-month of follow-up. Results: After the first treatment session, pain slightly (5.71%) increased in the against-group, whereas decreased by 6.45% in the Progroup; after the 10th session and 3 months, all variables in both groups improved, with a slight extra positive difference in the Pro-group. However, after 3 months, the percentage of changes in the Progroup was greater than that of the against-group. The pain intensity based on VAS (−96.8%), pain (+101.30%), and quality of life (+145.41%) scores of the KOOS questionnaire showed nearly 100% or even greater improvement in the pro-group. Conclusion: Retraining quadriceps and gastrocnemius and gluteus maximus using biofeedback during gait seems promising in KOA, although the Progroup apparently experienced considerably greater clinical improvement. The study provides preliminary evidence of the clinical feasibility of a novel neuromuscular training paradigm for KOA based on biofeedback during gait. Trial Registration: This study was registered under the International Randomized Controlled Trial Number registry on November 20, 2023. © 2026 Journal of Medical Signals & Sensors.