Why are we neglecting the core muscles in patients with knee osteoarthritis? A narrative review of the literature

Abstract Background Knee osteoarthritis impairs patients’ ability to function normally, specifically impacting their ability to walk without limitation. Research in other populations at risk for knee injury, including young, active populations, has included core muscle considerations. Treatment regimens for those with knee osteoarthritis have traditionally been joint and extremity specific. Objectives The objectives of this narrative literature review were to determine whether: 1) core training has been beneficial for older adults without knee osteoarthritis, and 2) core activation and/or stabilization have been integrated into the treatment recommendations for patients with knee osteoarthritis to improve their gait and functional ability. Major Findings Although core training has been safe and beneficial in older adults to address balance, fall risk, and mobility, the standard of care approach for treating knee osteoarthritis continues to be either joint/extremity specific or generalized to include more whole-body activity (e.g. cardiovascular training). Some early evidence has shown a relationship between core strength and transversus abdominis muscle integrity; however, using core activation and/or stabilization as an intervention for persons with knee osteoarthritis has not yet been reported. Conclusions Despite findings that core training is beneficial for other populations at risk for or rehabilitating from various knee pathologies, investigations that show it is safe and effective in older adults has not been adapted to/incorporated into treatment recommendations for those with knee osteoarthritis. Early results indicate a relationship between core muscle dimensions, strength, and knee osteoarthritis; however, no interventional studies have yet been published. Future study in this area is indicated.