Exercise in Patients With Hypermobile Joints and Knee Pain (HIPEr-Knee)

University of Southern Denmark (SDU)

Status: Enrolling

Conditions: Hypermobility, Joint; Knee Discomfort; Hypermobility Syndrome

Treatments: Other: High-load strength training for the knee; Other: Neuromuscular training for the knee

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT06277401

RCT_hypermobile_knee

Details and patient eligibility

About

Pain associated with knee joint hypermobility is common in the adult population, but evidence on treatment is sparse. This study investigates if high-load resistance training is superior to usual care in improving activity-related pain in young patients (18-45 years) with hypermobile joints and knee pain.

Full description

Knee joint hypermobility is common in the adult population. Patients with knee joint hypermobility and knee pain are typically managed with low intensity resistance training and proprioceptive training to reduce knee pain and improve function, but many patients do not respond well to these treatment strategies. High-load resistance training offers additional benefits to low intensity resistance training, including marked increase in muscle cross-sectional area, neural drive, and increased tendon stiffness, all important components of acquiring active knee joint stability during movement tasks and daily life. Therefore, the primary aim of this randomised controlled trial (RCT) is to investigate if high-load resistance training is superior to usual care in reducing activity-related pain in young patients (18-45 years) with hypermobile joints and knee pain.

Enrollment: 90 estimated patients

Sex: All

Ages: 18 to 45 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria

• Persistent knee pain for ≥ 3 months (self-reported)
• Knee pain ≥ 30mm during the last week using a 0-100 mm visual analogue scale (VAS; 0=no pain and 100=worst imaginable pain) (self-reported)
• Generalised joint hypermobility assessed with the Five-Part Hypermobility Questionnaire (positive ≥ 2/5) (self-reported)
• Local knee joint hypermobility using the passive hyperextension of the knee in standing (positive > 10 degrees of hyperextension) and confirmed in supine lying (heel resting on 20 cm high block on the bench surface), with passive knee hyperextension (positive > 10 degrees) (objectively measured)

Exclusion criteria

• Diagnosed with patellar tendinopathy
• Pregnancy or childbirth within the past year (due to increased levels of relaxin that could affect joint stability)
• Knee surgery within the past year
• Participation in regular structured resistance training within the past six months
• Inability to speak and understand Danish.
• All types of Ehlers-Danlos syndrome
• Other heritable connective tissue disorders such as Marfan syndrome, osteogenesis imperfecta, Loeys-Dietz syndrome, Stickler syndrome, skeletal dysplasias
• Autoimmune rheumatic connective tissue disorders such as lupus, rheumatoid arthritis; Chromosomal conditions such as Fragile X syndrome, Kabuki syndrome, Down syndrome
• Neuromuscular disorders that can cause joints to become unstable, such as multiple sclerosis

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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90 participants in 2 patient groups

Intervention

Experimental group

Description:

Progressive high-load resistance training program performed twice weekly for 12 weeks

Treatment:

Other: High-load strength training for the knee

Standard care

Active Comparator group

Description:

The standard care group will receive instructions on a neuromuscular training program with focus on knee stability and function performed at low intensities to be conducted twice weekly for 12 weeks

Treatment:

Other: Neuromuscular training for the knee