Effect of Dynamic Neuromuscular Stabilization Along With Aquatic Exercises on Pain, Functional Mobility, and Muscle Performance in Bilateral Medial Compartment Knee Osteoarthritis

Background: Bilateral medial compartment knee osteoarthritis (KOA) is characterized by the gradual breakdown of joint structures, which frequently leads to chronic pain, reduced flexibility, and compromised physical function. Although exercise serves as the foundation of non-pharmacological care, there is still a lack of consensus regarding the ideal integration of different therapeutic interventions. Dynamic Neuromuscular Stabilization (DNS) and aquatic therapy have independently demonstrated benefits in improving neuromuscular control and reducing joint loading. Objective: The objective of this research is to analyze the extent to which integrating aquatic exercises with DNS alters pain perception and functional mobility outcomes for patients suffering from bilateral medial compartment KOA. Methods: A total of 60 participants with clinically diagnosed bilateral medial compartment KOA were evaluated in a comparative study featuring a pre-test and post-test design. The sample was segmented into two treatment groups: Group A was administered standard physiotherapy, while Group B received a combined regimen of aquatic therapy and DNS. Following an eight-week intervention period of three sessions per week, treatment outcomes were quantified via the Visual Analog Scale (VAS), Timed Up and Go (TUG) test, and Manual Muscle Testing (MMT) of the quadriceps, hamstrings, and hip abductors. Statistical analysis included paired and independent t-tests, with significance set at p<0.05. Results: Both groups registered statistically significant improvements across all evaluations (p<0.01). However, the integrated approach in Group B resulted in mean improvements that not only demonstrated greater statistical significance but also exceeded the minimal clinically important difference (MCID) thresholds for the VAS and TUG test. Group B exhibited significantly larger decreases in VAS pain scores (p<0.001), greater functional mobility gains in TUG times (p<0.01), and more pronounced MMT grade improvements (p<0.001) compared to Group A, suggesting the potential clinical relevance of the combined intervention at the group level. Conclusion: A combined regimen of DNS and aquatic therapy may offer enhanced benefits in alleviating pain and enhancing physical function in bilateral medial compartment KOA patients than standard physiotherapeutic interventions. These preliminary findings suggest that integrating specialized neuromuscular stabilization with aquatic training is a promising area for further large-scale investigation.