Effect of open kinetic and close kinetic exercise on vastus medialis oblique and gluteus medius on EMG evaluation for chondromalacia patella in young adults

Thejazenuo Sachu; T. G. Tilak Francis

doi:10.15391/prrht.2025-10(6).06

Authors

Thejazenuo Sachu Krupanidhi college of Physiotherapy, RGUHS, Bangalore, Karnataka, India https://orcid.org/0009-0008-7309-1659
T. G. Tilak Francis Musculoskeletal sciences department, Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India https://orcid.org/0009-0009-3582-6906

DOI:

https://doi.org/10.15391/prrht.2025-10(6).06

Keywords:

Chondromalacia patella, closed kinetic chain exercises, open kinetic chain exercises, surface electromyography (sEMG), vastus medialis oblique activation, gluteus medius strengthening, anterior knee pain rehabilitation

Abstract

Purpose. Young individuals frequently experience anterior knee pain due to chondromalacia patella (CMP), which is frequently caused by muscle imbalances and improper patellar tracking. Enhancing patellofemoral stability requires targeted strengthening of the gluteus medius (GMed) and the vastus medialis oblique (VMO). Rehabilitation programs frequently include both open kinetic chain (OKC) and closed kinetic chain (CKC) exercises; however, there is limited data comparing their effectiveness in improving neuromuscular activation and functional outcomes. This study's objective was to evaluate and contrast the impacts of CKC as well as OKC exercises on the functional performance, pressure pain threshold, and EMG-based activation of VMO and GMed in young individuals with CMP.

Material & Methods. 52 participants with a clinically diagnosed case of CMP, aged 20-30, where randomization was not followed, but the participants were equally assigned to two clusters. c cluster CKC (n=26) received a six-week CKC exercise protocol, and cluster OKC (n=26) received an OKC protocol. The interventions lasted 45-50 minutes each session, five days a week, for six weeks. Assessments were conducted before and after the intervention and included surface electromyography (sEMG) of the VMO and GMed, pressure pain threshold via algometry, and functional evaluation using the Kujala Anterior Knee Pain Scale. The data's normality was verified using the Shapiro-Wilk test. Within-group and between-group differences used independent samples t-tests and paired t-tests for evaluation, respectively, with p<0.05 deemed statistically.

Results. Both groups demonstrated significant improvements across all outcome measures (p<0.001). Cluster CKC outperformed cluster OKC. VMO activation rose from 49.27% to 87.85% in cluster CKC and 50.88% to 77.73% in cluster OKC. GMed activation increased from 110.62% to 144.65% in cluster CKC and 111.04% to 128.00% in cluster OKC. An increase in pressure pain threshold was noted, from 2.84 kg up to 5.84 kg, measured under CLUSTER CKC, and from 2.91 kg up to 5.76 kg in CLUSTER OKC. Kujala functional scores increased from 63.73 to 88.65 in cluster CKC, while cluster OKC recorded from 63.72 to 82.84. Between-group comparisons revealed statistically significant differences favouring CKC for VMO activation (p=0.006), GMed activation (p=0.001), and Kujala ratings (p=0.001). cluster CKC also had better clinical outcomes, according to effect size analysis, especially in terms of VMO activation (5.76 vs. 3.11) and pain threshold (6.99 vs. 5.56).

Conclusions. In young individuals with CMP, neuromuscular activation, pain tolerance, and functional capacity were all successfully enhanced by CKC and OKC exercises. But the effects of CKC exercises were considerably larger, particularly when it came to improving function and activating important stabilising muscles. These findings indicate that CKC exercises should be prioritised in conservative physiotherapy for CMP to optimise clinical outcomes.

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