Neuromuscular exercise for degenerative knees: can we optimize the treatment effect?

The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris...

The movement of the legs is facilitated by numerous muscles located within the anterior, medial, and posterior compartments of the thigh.
Anterior Compartment
The quadriceps femoris, the most visible muscle of the anterior compartment, is integral for leg extension and thigh flexion. It is formed by merging four distinct muscles — the vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris. The quadriceps tendon, a shared tendon of the four quadriceps muscles, is affixed...

Degenerative disc disease is a chronic condition in which intervertebral discs gradually lose structure and function. It is not infectious or autoimmune; rather, it results from age-related biochemical and mechanical changes, influenced by genetic, metabolic, and environmental factors.Structure and Function of DiscsThe spine contains 23 intervertebral discs that absorb load, distribute forces, maintain spacing, and allow flexibility. Each disc consists of a nucleus pulposus, a gel-like core...

The symptoms of degenerative disc disease arise from a combination of mechanical compression, vascular compromise, and biochemical inflammation, which together disrupt nerve function and produce pain.Mechanical CompressionDisc degeneration reduces height and elasticity, predisposing to herniation of the nucleus pulposus, a major cause of radicular pain. Herniations may be protrusion (bulging with intact annulus), extrusion (nucleus extends beyond disc but remains connected), or sequestration...

Exercise induces a range of adaptations in muscle tissue, depending on the type and duration of activity. Such physical training can be broadly categorized into two types: endurance exercises and resistance exercises.
Endurance exercises
Endurance exercises involve running, swimming, or cycling, which require repetitive movements with low force output. When a person engages in endurance exercise, a few noticeable changes occur in their skeletal muscles. For instance, the number of capillaries...

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...