Type of Article:  Original Research

Volume 10; Issue 6 (December 2022)

Page No.: 4409-4416

DOI: https://dx.doi.org/10.16965/ijpr.2022.167

Efficacy of Aquatic Therapy and VMO Strengthening in Patellofemoral Arthritis

Supriya Nikam *1, Trupti Saurabh Yadav

*1 Intern, Department of physiotherapy, Krishna Institute of Medical Sciences “Deemed to be” University, Karad, Maharashtra, India.

*2 Assistant Professor, HOD Oncogenic Physiotherapy, Department of Physiotherapy, Krishna Institute of Medical Sciences “Deemed to be” University, Karad, Maharashtra, India.


Supriya Nikam –  0000 0002 9583 2293

Truprti Saurabh Yadav – 0000 0002 6113 274X

Address of correspondence: Supriya Dinkar Nikam, Department of Physiotherapy, Krishna Institute of Medical sciences deemed to be University, Karad, Maharashtra – 415539, India. Phone number – 7045270773 E-Mail: supriyanikam98@gmail.com


Background: Arthritis is inflammation of joints which leads to pain and stiffness that worsens with age. Patellofemoral arthritis affects the underside of the patella and the channel-like groove in the femur that the patella rests in. PFPS is an overuse injury in which anterior knee pain is present. The patient with patellofemoral arthritis has kneecap pain, stiffness and often swelling in the front part of the knee that typically worsens when walking on inclined terrain, climbing stairs, squatting. The patients with patellofemoral arthritis have reduced functional ability due to pain. It is important to increase the strength of Vastus Medialis Oblique Muscle which helps in stabilizing the patella during knee joint movements in order to reduce the pain. Aquatic physical therapy is considered as a safe and effective treatment program for managing knee OA as it contribute to the increase in the pain threshold and it also decreases the joint overload and pain symptoms and improves functionality and quality of life.

Objective: To compare the effect of aquatic therapy and Vastus Medialis Oblique strengthening on pain and functional ability in patellofemoral arthritis (PFA).

Materials and methods: An experimental study was conducted on total of 30 subjects on the basis of inclusion and exclusion criteria with 15 subjects in group A for VMO strengthening and 15 subjects in group B for aquatic therapy exercise. Outcome measures used were Visual Analogue Scale (VAS) and Anterior Knee Pain Scale (AKPS). The protocol was conducted for 5 weeks, 3 days a week.

Results: A total of 30 patients between the age of 40-65 years were included. Statistically it shows that there was extremely significant difference (p<0.0001) between pre intervention assessment and post intervention assessment. But the subjects treated with aquatic therapy shows more significant difference than the subjects treated with VMO strengthening program. 

Conclusion: The present study concludes that the aquatic therapy program is more effective than the VMO strengthening program which showed more reduction in pain and increase in functional ability in PFA.

Key words: Patellofemoral arthritis, Patellofemoral pain syndrome, knee pain, VMO strengthening, Aquatic therapy, Visual Analogue Scale, Anterior Knee Pain Scale.


[1]. Lee TK, Park SM, Yun SB, Lee AR, Lee YS, Yong MS. Analysis of vastus lateralis and vastus medialis oblique muscle activation during squat exercise with and without a variety of tools in normal adults. Journal of physical therapy science. 2016;28(3):1071-3.
[2]. Coqueiro KR, Bevilaqua-Grossi D, Bérzin F, Soares AB, Candolo C, Monteiro-Pedro V. Analysis on the activation of the VMO and VLL muscles during semisquat exercises with and without hip adduction in individuals with patellofemoral pain syndrome. Journal of Electromyography and Kinesiology. 2005 Dec 1;15(6):596-603.
[3]. Villafañe JH, Bissolotti L, La Touche R, Pedersini P, Negrini S. Effect of muscle strengthening on perceived pain and static knee angles in young subjects with patellofemoral pain syndrome. Journal of exercise rehabilitation. 2019 Jun;15(3):454.
[4]. Li Z, Liu Q, Zhao C, Gao X, Han W, Stefanik JJ, Jin Q, Lin J, Zhang Y. High prevalence of patellofemoral osteoarthritis in China: a multi-center population-based osteoarthritis study. Clinical Rheumatology. 2020 Dec;39(12):3615-23.
[5]. Coburn SL, Barton CJ, Filbay SR, Hart HF, Rathleff MS, Crossley KM. Quality of life in individuals with patellofemoral pain: a systematic review including meta-analysis. Physical Therapy in Sport. 2018 Sep 1;33:96-108.
[6]. Song CY, Lin YF, Wei TC, Lin DH, Yen TY, Jan MH. Surplus value of hip adduction in leg-press exercise in patients with patellofemoral pain syndrome: a randomized controlled trial. Physical therapy. 2009 May 1;89(5):409-18.
[7]. Yalfani A. The effect of eight weeks of Aquatic therapy with patella taping on pain, motor function and unstable balance in women with the patellofemoral pain syndrome. KAUMS Journal (FEYZ). 2018 Jun 10;22(3):309-17.
[8]. Hart HF, Stefanik JJ, Wyndow N, Machotka Z, Crossley KM. The prevalence of radiographic and MRI-defined patellofemoral osteoarthritis and structural pathology: a systematic review and meta-analysis. British journal of sports medicine. 2017 Aug 1;51(16):1195-208.
[9]. Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. journal of orthopaedic & sports physical therapy. 2012 Feb;42(2):81-94.
[10]. Hame SL, Alexander RA. Knee osteoarthritis in women. Current reviews in musculoskeletal medicine. 2013 Jun;6(2):182-7.
[11]. Alcalde GE, Fonseca AC, Bôscoa TF, Gonçalves MR, Bernardo GC, Pianna B, Carnavale BF, Gimenes C, Barrile SR, Arca EA. Effect of aquatic physical therapy on pain perception, functional capacity and quality of life in older people with knee osteoarthritis: study protocol for a randomized controlled trial. Trials. 2017 Dec;18(1):1-6.
[12]. King MR, Haussler KK, Kawcak CE, McIlwraith CW, Reiser RF. Mechanisms of aquatic therapy and its potential use in managing equine osteoarthritis. Equine veterinary education. 2013 Apr;25(4):204-9.
[13]. Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. Journal of Strength and Conditioning Research. 2001 Aug 1;15(3):337-40.
[14]. McIlwraith CW, VACHON A. Review of pathogenesis and treatment of degenerative joint disease. Equine Veterinary Journal. 1988 Sep;20:3-11.
[15]. Fibra T, Sá TS, Fontes SV, Driusso P, Prado GF. Quality of life evaluation in elderly people submitted to Aquatic Physical Therapy. Rev Neurocienc. 2006;14(4):182-4.
[16]. Guerrero Y, Soomro N, Wilson G, Dam Y, Meiklejohn J, Simpson K, Smith R, Brand-Miller J, Simic M, O’Connor H, Mavros Y. Train High Eat Low for Osteoarthritis study (THE LO study): protocol for a randomized controlled trial. Journal of physiotherapy. 2015 Oct 1;61(4):217.
[17]. Kim IS, Chung SH, Park YJ, Kang HY. The effectiveness of an aquarobic exercise program for patients with osteoarthritis. Applied Nursing Research. 2012 Aug 1;25(3):181-9.
[18]. Hale LA, Waters D, Herbison P. A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis. Archives of physical medicine and rehabilitation. 2012 Jan 1;93(1):27-34.
[19]. Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ, Hubley-Kozey CL. Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels. Journal of biomechanics. 2008 Jan 1;41(4):868-76.
[20]. Hurley MV. The effects of joint damage on muscle function, proprioception and rehabilitation. Manual therapy. 1997 Feb 1;2(1):11-7.
[21]. Barker AL, Talevski J, Morello RT, Brand CA, Rahmann AE, Urquhart DM. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Archives of physical medicine and rehabilitation. 2014 Sep 1;95(9):1776-86.
[22]. Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold‐Samsøe B, Dagfinrud H, Lund H. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews. 2016;3.
[23]. K.Mrityunjay et.al.Comparision between effect of isometric quadriceps exercise and vastus medialis oblique strengthening on quadriceps angle and patellar shift in normal individuals. European Academic Research. July. 2004;II.(4).
[24]. GREEN, J.R, G. MCKENNA, E.J. REDFERN, AND M.A. CHAMBERLAIN. Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip. Br. Soc. Rheumatol. 1993;32:213-216.

Cite this article: Supriya Nikam, Trupti Saurabh Yadav.  Efficacy of Aquatic Therapy and VMO Strengthening in Patellofemoral Arthritis. Int J Physiother Res 2022;10(6):4409-4416. DOI: 10.16965/ijpr.2022.167