Close Chain and Open Chain Exercises With Blood Flow Restriction in Knee Osteoarthritis

Comparison of Close Chain and Open Chain Exercises With Blood Flow Restriction in Knee Osteoarthritis

The aim of this research is to find and compare the effect of close chain and open chain exercises with blood flow restriction in knee osteoarthritis on pain, range of motion, strength and functional performance in patients with knee osteoarthritis. Randomized controlled trials done at Railway General Hospital and Medistic Medical and Dental Center, Rawalpindi. The sample size was 40. The subjects were divided in two groups, 20 subjects in close chain exercises with blood flow restriction group and 20 in open chain exercises with blood flow restriction group. Study duration was of 4 weeks. Sampling technique applied was purposive non probability sampling technique. Only 45-75 years individual with grade 1 or 2 knee osteoarthritis were included. Tools used in the study are Numeric pain rating scale (NPRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), goniometer, crane scale (dynamometer), 30 s chair stand test. Data was analyzed through SPSS 21.

Study Overview

• Status: Not yet recruiting
• Conditions: Knee Osteoarthristis
• Intervention / Treatment: Other: Closed kinetic chain exercises with blood flow restriction; Other: Open kinetic chain exercises with blood flow restriction

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Imran Amjad, Phd; Phone Number: 03324390125; Email: imran.amjad@riphah.edu.pk

Study Locations

• Pakistan
  • Rawalpindi, Pakistan
    • Medistic Medical and Dental Center
    • Contact: Neha Maqsood, DPT; Phone Number: 03091115301; Email: nehamaqsood08@gmail.com
    • Principal Investigator: Neha Maqsood, DPT
  • Rawalpindi, Pakistan
    • Pakistan Railway General Hospital
    • Contact: Muhammad Affan Iqbal, Phd*; Phone Number: 03336754837; Email: affan.iqbal@riphah.edu.pk
    • Sub-Investigator: Muhammad Affan Iqbal, PhD*
    • Principal Investigator: Neha Maqsood, DPT

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Radiologic confirmation of KOA demonstrating Kellgren-Lawrence grade 1 or 2.
• Exhibited symptoms of unilateral KOA.
• Not taking any medications for KOA or receiving other treatments (including physiotherapy).
• Willing to participate without any neurological symptoms were the main objects of study.

Exclusion Criteria:

• A history of knee surgery or scheduled surgery.
• Kellgren-Lawrence grade 3 or 4.
• Systolic blood pressure over 160 mm Hg or under 100 mm Hg.
• Use of nonsteroidal anti-inflammatory drugs in the past 3 months.
• Any known vascular disease or any diagnosed blood pathology.
• Concomitant symptomatic hip or ankle pathology that could influence knee pain or function.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Closed kinetic chain exercises with blood flow restriction; Closed kinetic chain exercises with blood flow restriction and conservative therapy	Other: Closed kinetic chain exercises with blood flow restriction; Closed kinetic chain exercises with blood flow restriction and conservative therapy. Participants in this group will receive conventional physiotherapy including hot pack application over the knee for 10 minutes and TENS applied medial and lateral to the knee for 10 minutes prior to exercises. Mulligan mobilization with movement will be performed using pain free sustained tibial glides during active knee flexion and extension. Closed kinetic chain quadriceps strengthening exercises will include seated heel press, mini squats, wall slides, step ups, and step downs performed under blood flow restriction. Exercises will be performed using a standardized blood flow restriction protocol of 4 sets with repetitions of 30, 15, 15, and 15 at low load. Sessions will be conducted 3 days per week for 4 weeks, with a total of 12 sessions, each session lasting approximately 40 minutes.
Active Comparator: Open kinetic chain exercises with blood flow restriction; Open kinetic chain exercises with blood flow restriction and conservative therapy.	Other: Open kinetic chain exercises with blood flow restriction; Open kinetic chain exercises with blood flow restriction and conservative therapy. Participants in this group will receive conventional physiotherapy including hot pack application over the knee for 10 minutes and TENS applied medial and lateral to the knee for 10 minutes prior to exercises. Mulligan mobilization with movement will be performed using pain free sustained tibial glides during active knee flexion and extension. Open kinetic chain quadriceps strengthening exercises will include straight leg raises and knee extension exercises performed under blood flow restriction. Exercises will be performed using a standardized blood flow restriction protocol of 4 sets with repetitions of 30, 15, 15, and 15 at low load. Sessions will be conducted 3 days per week for 4 weeks, with a total of 12 sessions, each session lasting approximately 40 minutes

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale (NPRS)	Changes from baseline pain intensity will be assessed using the Numeric Pain Rating Scale. The Numeric Pain Rating Scale is a subjective pain assessment tool ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Participants will be asked to rate their average knee pain intensity at rest and during activity. NPRS is widely used in clinical practice due to its simplicity, reliability, and responsiveness to change in musculoskeletal conditions.	[Time Frame: Pre intervention (Week 1) and Post intervention (Week 4)]

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)	Changes from baseline pain, stiffness, and physical function will be assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, a validated questionnaire for individuals with knee osteoarthritis.	[Time Frame: Pre intervention (Week 1) and Post intervention (Week 4)]
Knee Range of Motion (Flexion)	Changes from baseline knee flexion range of motion will be measured using a universal goniometer following standard procedures.	[Time Frame: Pre intervention (Week 1) and Post intervention (Week 4)]
Knee Range of Motion (Extension)	Changes from baseline knee extension range of motion will be measured using a universal goniometer in a standardized position.	[Time Frame: Pre intervention (Week 1) and Post intervention (Week 4)]
Knee Muscle Strength	Changes from baseline knee extensor muscle strength will be assessed using a crane scale (dynamometer) in a standardized testing position.	[Time Frame: Pre intervention (Week 1) and Post intervention (Week 4)]
30 Second Chair Stand Test	Changes from baseline functional lower limb strength will be assessed using the 30 second chair stand test, which measures the number of sit to stand repetitions completed in 30 seconds.	[Time Frame: Pre intervention (Week 1) and Post intervention (Week 4)]

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Muhammad Affan Iqbal, PhD*, Riphah International University

Study record dates

Study Major Dates

• Study Start (Estimated): February 28, 2026
• Primary Completion (Estimated): May 20, 2026
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: February 17, 2026
• First Submitted That Met QC Criteria: February 17, 2026
• First Posted (Actual): February 23, 2026

Study Record Updates

• Last Update Posted (Actual): February 23, 2026
• Last Update Submitted That Met QC Criteria: February 17, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Knee Osteoarthritis; Blood Flow Restriction; Knee Joint; Blood Flow Resriction Therapy
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: RCRAHS-ISB/REC/MS-PT/02420

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No