Knee Arthritis, OsteoarthritistheNCT07733518
Eccentric vs Low-Load Blood Flow Restriction Training in Knee Osteoarthritis in Knee Osteoarthritis
A study testing Eccentric Gastrocnemius Strengthening Exercises and Low-Load Blood Flow Restriction Training in people with Knee Arthritis, Osteoarthritis, run by Riphah International University at 1 site in Pakistan.
Trial summary
The aim of this randomized controlled trial is to find the effects of eccentric and low-load blood flow restriction training on neuromuscular adaptations, muscle strength, functional performance, and disability in patients with knee osteoarthritis Read more about this study
- Who is it for?
- Ages 40 to 70 years
- Conditions the study is for
- Knee Arthritis, Osteoarthritis
- What is being tested?
- Eccentric Gastrocnemius Strengthening Exercises and Low-Load Blood Flow Restriction Training
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 48 participants
- Where
- 1 sitePakistan
- Study dates
- 21 Jul 2026to 28 Dec 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 40 to 70 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age group 40-70
- Both genders male and female
- Clinical diagnosis of knee OA (Kellgren-Lawrence grade 1-3) of the most symptomatic knee.
- Pain stable enough to permit exercise on Numeric Pain Rating Scale 3/10.
- Participants must demonstrate a gastrocnemius muscle strength of grade ≥3 on the Manual Muscle Testing (MMT) scale (0-5), assessed using the standard standing heel-rise position.
- Participants must be able to ambulate independently and participate in supervised exercise.
Who cannot join
- • Presence of a prosthetic knee in the affected limb.
- Inflammatory arthritis (e.g., rheumatoid arthritis) or active flare-up of OA.
- Cardiovascular disease contraindicating exercise (e.g., unstable angina, recent MI, uncontrolled hypertension ≥160/100 mmHg).
- Pulmonary disease that limits safe participation (e.g., severe COPD, recent exacerbation).
- History of deep vein thrombosis (DVT), peripheral vascular disease, or bleeding/clotting disorders.
- Current anticoagulant therapy that increases bleeding risk (unless cleared by physician).
- Any pathology causing significant muscle weakness (e.g., neuromuscular disorders, severe neuropathy).
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Railway General Hospital, Rawalpindi
Rawalpindi, Punjab Province, 46000
KINZA ANWAR, MS-OMPT, +92-3239735427, kinza.anwar@riphah.edu.pk
SEHRISH MALIK, MS-OMPT*
About this study
Official title: Comparison of Eccentric and Low-Load Blood Flow Restriction Training on Neuromuscular Adaptations in Knee Osteoarthritis
The aim of this randomized controlled trial is to find the effects of eccentric and low-load blood flow restriction training on neuromuscular adaptations, muscle strength, functional performance, and disability in patients with knee osteoarthritis
Read the detailed description
Osteoarthritis (OA) is a chronic disease affecting the joint and its tissues, primarily leading to progressive damage to articular cartilage and, subsequently, to the subchondral bone and surrounding synovial structures. This chronic degenerative disease affects approximately one-third of adults, and its prevalence increasing with advancing age. The knee is one of the most common joints affected by the OA. Systematic reviews indicate a global prevalence of knee osteoarthritis (KOA) is 22.9% among individuals aged 40 and older, affecting an estimated 654.1 million people worldwide, with variations across countries and increasing with age.
Knee osteoarthritis (KOA) is a multi etiological, chronic disabling disease that affects the entire knee joint, which is the most common site of involvement in OA. KOA patients mostly suffer from progressive stiffness and knee pain. Gradually, they have some difficulties in performing daily activities, such as walking, squatting, and climbing and doing housework, as the disease progresses. Ultimately, pain and disability associated with the disease lead to a loss of functional independence and a profound reduction in quality-of- life. Impairments that are caused by KOA include knee pain, limited ROM of the knee, muscle weakness and knee instability.
The gastrocnemius muscle plays a crucial role in knee joint stability and ankle-knee biomechanics through its biarticular function, contributing to both knee flexion and ankle plantarflexion. During the stance phase of gait, the gastrocnemius co-activates with the tibialis anterior and quadriceps muscles, providing dynamic stability, reducing medial knee laxity, and assisting in forward propulsion.
The impaired neuromuscular recruitment of the gastrocnemius may result in reduced push-off strength, prolonged ground contact time, and diminished functional performance, ultimately contributing to functional limitations in patients with knee osteoarthritis. However, surface electromyography (sEMG) enables the assessment of gastrocnemius motor unit recruitment and fatigue characteristics, providing objective insight into neuromuscular adaptations before and after targeted interventions.
OA of the knee is characterized by changes in gait kinematics. In patients with knee OA, deficits in gastrocnemius strength and endurance can exacerbate difficulties in activities such as stair climbing, walking, and balance maintenance. Eccentric and low-load blood flow restriction (LL-BFR) training protocols have been proposed to optimize gastrocnemius activation, enhance muscle strength, and improve functional performance, offering clinically relevant rehabilitation strategies for enhancing lower limb function and reducing disability in knee osteoarthritis.
This study is to find the effects of eccentric and low-load blood flow restriction training on neuromuscular adaptations, muscle strength, functional performance, and disability in individuals affected by the knee OA.
- Conditions
- Knee Arthritis, Osteoarthritis
- Being tested
- Eccentric Gastrocnemius Strengthening Exercises, Low-Load Blood Flow Restriction Training
- Keywords
- Eccentric training,, Low-load blood flow restriction training, Muscle weakness, knee Osteoarthritis
- Medical subject headings
- Osteoarthritis, Muscle Weakness, Osteoarthritis, Knee
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Eccentric Gastrocnemius Strengthening ExercisesOther
Eccentric Gastrocnemius Strengthening Exercises .1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 3 sets 10 reps in session 1-2). 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 5 sets 15 reps in session 3-4). Total duration is 3 sessions per week for 4 consecutive weeks.
Low-Load Blood Flow Restriction TrainingOther
Low-load blood flow restriction training including 1-Low-intensity gastrocnemius strengthening with BFR cuff 2-Controlled exercise with intermittent vascular occlusion (inflated 50-70% for 4 weeks, 3 rep. 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 3 sets 10 reps in session 1-2). 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 5 sets 12 reps in session 3-4).
Total duration is 3 sessions per week for 4 consecutive weeks.
| Study group | Role | What they receive |
|---|---|---|
| Eccentric Training | Experimental | Eccentric Gastrocnemius Strengthening Exercises Receives: Other: Eccentric Gastrocnemius Strengthening Exercises |
| Low-Load Blood Flow Restriction Training | Experimental | Low-Load Blood Flow Restriction Training Receives: Other: Low-Load Blood Flow Restriction Training |
What is being measured
The primary outcome is the main question the study is designed to answer.
Surface Electromyography
The Electromyography (EMG) is an objective assessment tool used to measure the electrical activity of muscles during contraction. Motor unit recruitment will be analyzed through the amplitude of EMG signals (root mean square, RMS), reflecting the number and synchronization of active motor units during contraction. Fatigue characteristics will be assessed using changes in EMG frequency parameters (mean or median frequency), indicating alterations in muscle fiber conduction velocity and fatigue onset that will be assessed pre and post sessions.
Measured: Baseline and 4th week
Secondary outcomes (3)
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
The WOMAC is a widely used, validated questionnaire assessing pain, stiffness, and physical function in patients with knee osteoarthritis. It consists of 24 items divided into three subscales: Pain (5 items), Stiffness (2 items), and Physical Function (17 items).
Measured: 4 weeks
Timed Up and Go (TUG)
The Timed Up and Go (TUG) test assesses mobility and fall risk by timing how quickly a person can stand up from a standard armchair, walk 3 meters (10 feet) at a normal pace, turn around, walk back, and sit down again. Individuals can use their routine walking aids, but receive no physical help during the test; completing the maneuver in under 10 seconds indicates normal independence, whereas taking 30 seconds or longer points to an elevated risk of falling.
Measured: 4 weeks
Heel Raise Endurance Test
The Heel Raise Endurance Test measures the number of consecutive heel raises a participant can perform (or the time sustained) while standing, usually at a controlled pace until fatigue. It assesses calf muscle endurance, ankle plantar-flexor strength, and functional lower-limb performance, relevant for gait and mobility assessment. The duration for which the position is maintained is recorded.
Measured: 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jul 2026
- Study start21 Jul 2026
- Primary completion21 Dec 2026 (estimated)
- Study completion28 Dec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Knee Arthritis, OsteoarthritisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 48 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- KINZA ANWAR, MS-OMPT, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07733518
- Sponsor's protocol ID
- SEHRISH MALIK
- Acronym
- the
- Status last verified
- Aug 2026
- First submitted
- 24 Jul 2026
- Last updated
- 7 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 7 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of Eccentric and Low-Load Blood Flow Restriction Training on Neuromuscular Adaptations in Knee Osteoarthritis
- ClinicalTrials.gov ID
- NCT07733518
- Acronym / sponsor ID
- the / SEHRISH MALIK
- Conditions
- Knee Arthritis, Osteoarthritis
- Keywords
- Eccentric training,, Low-load blood flow restriction training, Muscle weakness, knee Osteoarthritis
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 48 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 21 Jul 2026 (actual)
- Primary completion
- 21 Dec 2026 (estimated)
- Study completion
- 28 Dec 2026 (estimated)
- First posted
- 29 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The aim of this randomized controlled trial is to find the effects of eccentric and low-load blood flow restriction training on neuromuscular adaptations, muscle strength, functional performance, and disability in patients with knee osteoarthritis
Detailed description
Osteoarthritis (OA) is a chronic disease affecting the joint and its tissues, primarily leading to progressive damage to articular cartilage and, subsequently, to the subchondral bone and surrounding synovial structures. This chronic degenerative disease affects approximately one-third of adults, and its prevalence increasing with advancing age. The knee is one of the most common joints affected by the OA. Systematic reviews indicate a global prevalence of knee osteoarthritis (KOA) is 22.9% among individuals aged 40 and older, affecting an estimated 654.1 million people worldwide, with variations across countries and increasing with age.
Knee osteoarthritis (KOA) is a multi etiological, chronic disabling disease that affects the entire knee joint, which is the most common site of involvement in OA. KOA patients mostly suffer from progressive stiffness and knee pain. Gradually, they have some difficulties in performing daily activities, such as walking, squatting, and climbing and doing housework, as the disease progresses. Ultimately, pain and disability associated with the disease lead to a loss of functional independence and a profound reduction in quality-of- life. Impairments that are caused by KOA include knee pain, limited ROM of the knee, muscle weakness and knee instability.
The gastrocnemius muscle plays a crucial role in knee joint stability and ankle-knee biomechanics through its biarticular function, contributing to both knee flexion and ankle plantarflexion. During the stance phase of gait, the gastrocnemius co-activates with the tibialis anterior and quadriceps muscles, providing dynamic stability, reducing medial knee laxity, and assisting in forward propulsion.
The impaired neuromuscular recruitment of the gastrocnemius may result in reduced push-off strength, prolonged ground contact time, and diminished functional performance, ultimately contributing to functional limitations in patients with knee osteoarthritis. However, surface electromyography (sEMG) enables the assessment of gastrocnemius motor unit recruitment and fatigue characteristics, providing objective insight into neuromuscular adaptations before and after targeted interventions.
OA of the knee is characterized by changes in gait kinematics. In patients with knee OA, deficits in gastrocnemius strength and endurance can exacerbate difficulties in activities such as stair climbing, walking, and balance maintenance. Eccentric and low-load blood flow restriction (LL-BFR) training protocols have been proposed to optimize gastrocnemius activation, enhance muscle strength, and improve functional performance, offering clinically relevant rehabilitation strategies for enhancing lower limb function and reducing disability in knee osteoarthritis.
This study is to find the effects of eccentric and low-load blood flow restriction training on neuromuscular adaptations, muscle strength, functional performance, and disability in individuals affected by the knee OA.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Eccentric Training | Experimental | Other: Eccentric Gastrocnemius Strengthening ExercisesEccentric Gastrocnemius Strengthening Exercises |
| Low-Load Blood Flow Restriction Training | Experimental | Other: Low-Load Blood Flow Restriction TrainingLow-Load Blood Flow Restriction Training |
Who may qualify
- Ages
- 40 to 70 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- Age group 40-70
- Both genders male and female
- Clinical diagnosis of knee OA (Kellgren-Lawrence grade 1-3) of the most symptomatic knee.
- Pain stable enough to permit exercise on Numeric Pain Rating Scale 3/10.
- Participants must demonstrate a gastrocnemius muscle strength of grade ≥3 on the Manual Muscle Testing (MMT) scale (0-5), assessed using the standard standing heel-rise position.
Key exclusion criteria (7 listed)
- • Presence of a prosthetic knee in the affected limb.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Eccentric Gastrocnemius Strengthening ExercisesEccentric Gastrocnemius Strengthening Exercises .1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 3 sets 10 reps in session 1-2). 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 5 sets 15 reps in session 3-4). Total duration is 3 sessions per week for 4 consecutive weeks. | Other | Eccentric Training |
| Low-Load Blood Flow Restriction TrainingLow-load blood flow restriction training including 1-Low-intensity gastrocnemius strengthening with BFR cuff 2-Controlled exercise with intermittent vascular occlusion (inflated 50-70% for 4 weeks, 3 rep. 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 3 sets 10 reps in session 1-2). 1. Eccentric Heel Drop 2. leg press calf lowering 3. Eccentric Stair Descent (Frequency: 5 sets 12 reps in session 3-4). Total duration is 3 sessions per week for 4 consecutive weeks. | Other | Low-Load Blood Flow Restriction Training |
Primary outcome
Surface Electromyography
Time frame: Baseline and 4th week
The Electromyography (EMG) is an objective assessment tool used to measure the electrical activity of muscles during contraction. Motor unit recruitment will be analyzed through the amplitude of EMG signals (root mean square, RMS), reflecting the number and synchronization of active motor units during contraction. Fatigue characteristics will be assessed using changes in EMG frequency parameters (mean or median frequency), indicating alterations in muscle fiber conduction velocity and fatigue onset that will be assessed pre and post sessions.
3 secondary outcomes
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
Time frame: 4 weeks
Timed Up and Go (TUG)
Time frame: 4 weeks
Heel Raise Endurance Test
Time frame: 4 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Aug 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
KINZA ANWAR, MS-OMPT principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Eccentric Gastrocnemius Strengthening Exercises and Low-Load Blood Flow Restriction Training in people with Knee Arthritis, Osteoarthritis, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 7 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact KINZA ANWAR, MS-OMPT (+92-3239735427, kinza.anwar@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Surface Electromyography (time frame: Baseline and 4th week). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Aug 2026.