Research Summary
Neuromuscular Training Eased Knee Arthritis Symptoms and Daily Function, Review of 14 Trials Finds
Neuromuscular training—exercises that challenge balance, control, and how the muscles stabilize the knee—helped people with knee osteoarthritis feel better day to day, according to a new systematic review and meta-analysis. The paper was published online in October 2026 in Frontiers in Physiology.
What was studied
Standard exercise is a first-line treatment for knee osteoarthritis, but programs that specifically train coordination and joint control (sometimes called neuromuscular or proprioceptive training) are used less consistently. The authors searched major medical databases through August 30, 2025, and included randomized controlled trials of neuromuscular training in people with knee osteoarthritis. When several papers came from the same trial, they counted that trial once.
They analyzed 14 independent randomized trials from 17 reports, covering 1,029 participants (516 in neuromuscular training groups and 513 in control groups). Outcomes focused on the Knee injury and Osteoarthritis Outcome Score (KOOS) domains for symptoms, pain, daily activities, sport and recreation, and quality of life, plus reported adverse events. Certainty of evidence was graded with GRADE.
Key findings
- Compared with control care, neuromuscular training significantly improved KOOS Symptoms (mean difference 4.44 points), activities of daily living (3.94), and quality of life (5.59).
- Average differences for KOOS Pain and Sport/Recreation favored training but did not reach statistical significance.
- Reported adverse events were not significantly more common with neuromuscular training than with control care, though how studies defined and tracked side effects varied.
- Most subgroup interaction tests were not significant; one age-related interaction for quality of life needs cautious interpretation because few studies contributed.
What it means for people with knee pain
If you have knee osteoarthritis, asking a physical therapist about a program that includes balance, control, and functional movement—not only straight strength work—may be worthwhile. This review suggests those programs can ease overall symptoms and make daily tasks and knee-related quality of life better. Pain relief was less consistent across trials, so expectations should stay realistic, and any new exercise plan should fit your health history.
Limitations
Programs labeled “neuromuscular training” were not identical across trials, follow-up lengths differed, and the clinical size of the score changes may be modest for some people. Safety conclusions are limited by uneven adverse-event reporting. The authors call for larger trials with standardized protocols and longer follow-up.
Frequently asked questions
- What is neuromuscular training for the knee?
- It is exercise that emphasizes balance, joint control, and how muscles work together to stabilize the knee during movement, often going beyond simple strength machines or straight-ahead walking.
- Did neuromuscular training clearly reduce knee pain in this review?
- Average pain scores leaned toward improvement, but the difference versus control care was not statistically significant. Clearer benefits showed up for overall symptoms, daily activities, and quality of life.
- Is this kind of training safe?
- Across the included trials, adverse events were not significantly more common with neuromuscular training than with control care. Reporting of side effects varied, so talk with a clinician before starting a new program.
Sudden severe pain, swelling, or can't bear weight? Seek medical care promptly. In an emergency call 911.