Effects of Creatine and Glucoseamine/ Chondritin Sulfate Co-Supplementation in Addition to Exercise and Physical Therapy in Patients With Knee Osteoarthritis

• Lower Extremity Resistance Exercise Training (Other), also known as Lower Extremity Strength Training: 3 times supervised exercise for 4 weeks Warm up (Self Paced walking for 10 minutes) leg press (8-12 RM) leg extension (8-12 RM) Sit to stand squat (with weight) Stationary Cycling (Maximum Resistance as per patient tolerance till failure)
• Home Exercise Plan (Other): 2 sets of 10 repetitions/day of 1. AROM isolated knee extension and knee flexion 2. Isometric isolated knee extension and knee flexion 3. Isometric terminal knee extension 4. Sit to stand squat terminal extension as Home Exercise Program (HEP). (Iwamoto J et al, 2007)
• Electrotherapy + Heating (Device): Iinterferential Current therapy (2P), in combination with heating pad for 20 minutes
• Joint Mobilization (Procedure), also known as Manual Therapy: 1. Tibio-femoral Anterior Glide 2. Tibio-femoral Posterior Glide 3. Patellofemoral Joint Mobilization
• Creatine Supplementation (Dietary supplement), also known as Creatine Monohydrate: Creatine Supplementation 20g/day for 1 week followed by 5 g/day for 3 weeks
• Glucoseamine/ Chondritin Sulfate Supplementation (Dietary supplement): Glucoseamine/ Chondritin Sulfate Supplementation (500mg+400mg/day)

Primary outcomes

• Knee Pain: Numeric Pain Rating Scale [4 weeks]: Knee Pain will be quantified by using Numeric Pain Rating Scale
• Knee Range of Motion [4 weeks]: Knee Range of Motion will be quantified by using Gonimeter
• Knee Isometric Muscle Strength [4 weeks]: Knee Isometric Muscle Strength will be quantified by using Modified Sphygmomanometer Dynamometer
• Six Minute Walk Test [4 weeks]: Six Minute Walk Test will be used to quantify walking related performance fatigability, walkind distance and walking speed.

Secondary outcomes

• Knee Injury and Osteoarthritis Outcome Score (KOOS) [4 weeks]: The KOOS is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life.
• Body Composition [4 weeks]: Body Composition will be quantified by using Bioelectrical Impedance
• Fall Risk [4 weeks]: Fall risk will be quantified by using Biodex balance System
• Postural Stability [4 weeks]: Postural Stability will be quantified by using Biodex balance System

Sex: All, ages: 40 Years to 70 Years

Inclusion Criteria:

* Age 40-70 years
* Knee OA with history not less than three months.
* Radiological evidences of grade III or less on Kellgren classification.
* Knee pain on VNRS no more than 8/10

Exclusion Criteria:

* Neuromuscular conditions that may lead to fatigue such as multiple Sclerosis
* Signs of serious pathology (e.g., malignancy, inflammatory disorder, infection).
* History of trauma or fractures in lower extremity.
* Signs of lumbar radiculopathy or myelopathy.
* History of knee surgery or replacement.
* Patients on intra-articular steroid therapy within two months before the commencement of the study.
* Impaired skin sensation.
* Impaired renal function

• Muhammad Osama, PhD*, Principal investigator, Foundation University Institute of Rehabilitation Sciences