The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis

Du Jiong; Wang Jing

doi:doi:10.11648/j.sd.20251304.13

Research Article |

| Peer-Reviewed

The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis

Du Jiong, Wang Jing^*

Published in Science Discovery (Volume 13, Issue 4)

Received: 13 July 2025 Accepted: 4 August 2025 Published: 16 August 2025

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background：Knee osteoarthritis (KOA) is the most common degenerative joint disease in an aging world. In China, its prevalence exceeds 85 % among people aged 70 years and older. Although current guidelines recommend exercise as first-line management, they provide little detail on which forms of exercise suit specific patient phenotypes. Existing programmers often carry high costs, require professional supervision, or depend on specialized facilities, creating barriers to population-wide implementation. Traditional Chinese Medicine (TCM) proposes the “tendon–bone balance” theory, which maintains that coordinated muscle and bone function is essential for joint integrity; however, modern empirical evidence for this concept is lacking. Kneeling ambulation—an equipment-free, home-based manoeuvre rooted in traditional practice—has been proposed as a highly accessible intervention, yet its biomechanical mechanisms and clinical efficacy have never been rigorously examined. Objective：Guided by the TCM “tendon–bone balance” theory, we aimed to evaluate the biomechanical effects and clinical efficacy of kneeling ambulation in KOA patients and to explore its potential as a public-health strategy. Methods：Biomechanical study: Twenty healthy volunteers underwent three-dimensional gait analysis and surface electromyography while kneeling and while walking normally; thirteen additional volunteers completed repeat sessions to verify reliability. Clinical study: In a single-centre randomized controlled trial, 30 participants who met the 2015 OARSI/AAOS criteria for KOA were randomly assigned to a kneeling group (three 5-minute sessions daily for 12 weeks) or to a no-exercise control group. The primary endpoints were total and pain scores on the WOMAC; secondary endpoints included the isokinetic peak flexor/extensor torque ratio at 60 °/s, knee range of motion, and safety. Results：Biomechanics: Compared with walking, kneeling increased peak knee flexion range of motion (117° vs 48°, P < 0.05) and reduced the knee adduction moment toward zero, shifting the load axis from the medial to the lateral compartment. Clinical: After 12 weeks, the kneeling group showed significantly greater improvements than controls in total WOMAC score (P = 0.013) and pain score (P = 0.012), a flexor/extensor torque ratio closer to unity (P < 0.05), and a marked increase in maximum knee flexion angle (P < 0.01); no serious adverse events were reported. Conclusion：Kneeling ambulation redistributes joint load and restores balanced flexor–extensor strength, leading to clinically meaningful pain relief and functional improvement. Its low cost, lack of required equipment, and suitability for home use position it as an evidence-based, scalable adjunct for population-level KOA prevention and management.

Published in	Science Discovery (Volume 13, Issue 4)
DOI	10.11648/j.sd.20251304.13
Page(s)	73-77
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Knee Osteoarthritis (KOA), Public Health, Muscle-Bone Balance, Kneeling Exercise, Biomechanics, Traditional Chinese Medicine (TCM), Functional Exercise

1．引言

1.1．全球和中国膝骨关节炎（KOA）的公共卫生负担

膝骨关节炎（KOA）作为一种常见的慢性退行性骨关节疾病，其主要特征是关节疼痛和功能障碍。随着人口老龄化，KOA 患病率日益升高，已成为严重的公共卫生问题

[1]

。在中国，KOA 是最常见的骨关节疾病之一，70岁以上人群患病率超过85%。KOA 是导致膝关节置换手术的首要原因

[2]

，带来巨大的医疗经济负担，严重影响患者生活质量并给家庭和社会造成沉重负担。

1.2．当前KOA管理策略在公共卫生背景下的局限性

尽管国内外指南强烈建议将功能锻炼作为 KOA 干预的主要措施，但未明确不同锻炼方式的适用症，临床缺乏具体指导。常用治疗如非甾体抗炎药（NSAIDs）和关节腔注射等在公共卫生层面存在局限性（成本高、副作用、依从性差等）

[3]

。因此亟需一种高效、便捷、经济且易推广的功能锻炼方法，以促进患者自我管理，降低医疗成本并改善生活质量。

1.3．中医药（TCM）与“筋骨平衡”理论的介绍

中医将 KOA 归入“骨痹”“痿证”等范畴，认为肝肾亏虚是其发病的重要内因之一。例如《素问·痿论》提出肾虚导致骨枯髓减、筋脉失养的病机

[4]

。石印玉教授概括 KOA 病机为“本痿标痹，痹痿并存”

[5]

，即肝肾不足的“痿证”为本，关节痛风湿的“痹证”为标，两者贯穿病程始终。“筋骨平衡”理论是中医骨伤科的重要内容，强调筋（肌肉、韧带、软骨等软组织）与骨的协调对关节功能至关重要，两者应相互支撑、协调统一。这与《灵枢·经脉》所述“骨为干，筋为刚”思想一致。现代研究证实，膝关节周围肌肉力量不足或协调失衡是导致关节功能障碍的关键因素，这与中医“筋骨平衡”理论不谋而合。

1.4．跪行锻炼作为公共卫生干预的理论依据

跪姿是中华传统礼仪姿态，古代文献记载其医疗价值。例如古代导引法中有“双膝下跪行走可去膝冷痛”等记载

[6]

。现代中医骨科经验认为，“膝为肝之府”，跪膝锻炼有助于滋养肝肾之气，促进膝关节康复

[7]

。临床观察也发现，跪行功能锻炼配合中药熏洗可改善髌骨软化症患者的膝关节疼痛和上下楼困难等症状。此外，生物力学研究提供了跪行锻炼的现代科学依据：(1) Ditchen 等研究发现双膝90°跪姿时膝关节屈曲力矩最小

[8]

，(2) Hofer 等对尸体膝关节的测量表明，相比单膝跪，双膝90°跪姿可减少胫骨后移位，并显著改变胫骨外旋和内外侧室受力，这意味着跪姿可以减轻膝关节内侧间室负荷

[9]

。这些发现为跪行防治 KOA 提供了生物力学理论基础。综上，跪行锻炼易获取、成本低、可自主进行，符合公共卫生对于简便、经济、自我管理干预的要求。

1.5．研究目的与公共卫生相关性

本研究旨在通过肌肉力学测试、动态捕捉分析、临床量表等手段，观察跪行对KOA生物力学影响，并进一步通过动态捕捉系统对跪行对正常人跪行时不同肌动学参数、动力学参数、时间空间参数改变进行探索以期验证中医骨伤“筋骨平衡”理论生物力学机制并为跪行功能锻炼治疗膝骨关节炎安全性与有效性提供可靠研究依据。本研究的公共卫生意义在于，它旨在为KOA的预防和管理提供一种简单、有效且广泛适用的功能锻炼方法，尤其适用于日益老龄化的人群。

2．跪行锻炼的生物力学基础与“筋骨平衡”

2.1．KOA生物力学分析的原理

生物力学是理解关节功能和KOA病理生理机制的关键工具。运动学（如角度和位移）、动力学（如力矩和地面反作用力）和肌电图（测量肌肉电活动）能提供客观、量化的数据。本研究采用了英国VICON三维步态分析系统和NORAXON无线表面肌电信号采集系统，能够实现高精度的数据采集。

2.2．生物力学测量的重复性和可靠性

在正式试验前，我们对13名健康志愿者进行两次跪行步态生物力学测量（间隔一周），以评估方法的重测信度。结果各项参数的组内相关系数（ICC）均在0.85以上（运动学 ICC≈0.97，动力学 ICC≈0.85，地面反作用力 ICC≈0.95，肌电图 ICC≈0.91），显示测量具有良好的重复性和可靠性

[10]

。

2.3．跪行与正常步行生物力学机制的比较

在20名健康受试者中，我们比较了正常步行和跪行时膝关节的运动学和动力学差异，以探讨跪行对膝关节的生物力学影响机制。

运动学变化：

跪行时膝关节活动范围显著大于正常步行。支撑相膝关节屈曲最大角度：跪行约 117°，明显高于正常步行约48°（P<0.05）；跪行时膝关节在冠状面略有增加的屈曲/外翻角度（约15°对10°，P<0.05）。这表明跪行能使膝关节获得更大的屈曲幅度和灵活性，有助于改善关节柔韧性和活动度。

动力学变化：

与正常步行相比，跪行时膝关节力矩大幅减小。跪行时膝关节伸展力矩接近于0，远低于正常步行的背伸力矩（P<0.05）；膝关节内收力矩在跪行时也降至接近0，显著低于正常步行时的内收力矩（P<0.05）。更重要的是，跪行改变了膝关矩的传导轴向：正常步行时膝关节载荷主要作用于内侧间室，而跪行时载荷轴向转移至外侧间室。这意味着跪行锻炼重新分配了膝关节负荷，减轻了内侧间室的压力。该作用机制对于KOA尤为关键——有望减缓内侧关节的退变，延缓疾病进展，从而降低手术需求。

[10]

“筋骨平衡”的生物力学解读：

跪行引起的上述关节力学变化与中医“筋骨平衡”理论高度吻合。中医认为筋骨失衡是 KOA 发病的重要机制之一。当跪行锻炼增大膝关节活动度、降低伸展和内收力矩并优化受力分布后，可减轻病变区域的应力负荷，促进膝部筋骨关系的协调平衡。这从生物力学角度印证了“筋骨平衡”理论在KOA康复中的作用。

3．临床效果与安全性

3.1．研究设计与参与者特征

本研究采用随机对照试验（RCT）评估跪行锻炼的临床效果和安全性。共纳入30例符合 2015年国际骨关节炎研究学会（OARSI）及美国骨科医师学会（AAOS）KOA 诊断标准的患者。受试者随机分为跪行锻炼组（15例）和空白对照组（15例）。所有患者来自医院骨伤科门诊/病房，基线特征均衡。随机分组采用计算机随机序列，以确保分配隐匿。

3.2．干预方案：跪行锻炼和对照组活动

治疗组进行标准化的跪行功能锻炼：患者在硬质地面铺垫瑜伽垫（约180×60×1.5 cm），双膝屈曲90°跪立，躯干竖直，双手自然下垂辅助平衡，腰部放松。以膝关节髌骨下缘至胫骨平台前缘着地，保持跪姿向前或向后行走。每次持续5分钟，每日练习3次。该锻炼方法简单易行、设备需求极少，患者可在家自行完成，对于公共卫生推广具有现实意义。对照组不实施任何功能锻炼干预，维持常规日常活动，仅在夜间疼痛影响睡眠时酌情口服塞来昔布止痛。这样的对照设计有助于凸显跪行锻炼本身的疗效。。

3.3．观察指标和统计分析

临床疗效主要评价指标为 Western Ontario and McMaster Universities 骨关节炎指数（WOMAC，3.1版）

[11]

。WOMAC从疼痛、僵硬和日常活动能力三个维度对膝关节功能进行评分，每项0~10分，总分越高表示病情越重，其中疼痛评分对患者影响最大

[12]

。WOMAC 作为患者报告结局（PRO）指标，在评估公共卫生干预效果方面具有重要意义。客观指标包括膝关节伸肌群峰值肌力、膝关节活动度（屈曲角度）以及在60°/秒等速条件下膝关节屈肌/伸肌峰力矩比值等。我们使用BTE Primus RS 系统测定膝伸肌群峰值肌力，并进行等速肌力测试获取上述力矩指标

[13]

。统计分析采用 SPSS16.0 软件；WOMAC 等等级数据组间比较用 Mann-Whitney U 检验，组内配对用 Wilcoxon 符号秩检验；步行速度、肌力、力矩比等计量数据经正态检验后采用独立样本t检验。以P<0.05为差异有统计学意义。

3.4．主要研究结果

WOMAC评分：干预前两组WOMAC总积分和疼痛积分无显著差异。治疗后，跪行干预组WOMAC总积分（P=0.013）和疼痛积分（P=0.012）均较治疗前显著降低，且治疗组低于空白对照组，差异均有统计学意义（均P<0.05）。这一结果提示，跪行能较好地缓解疼痛，并显著提高KOA患者的膝关节功能和生活质量。对于公共卫生而言，疼痛缓解和功能改善是直接影响患者日常活动能力和生活品质的关键指标

[14]

。

伸肌群肌力：干预前后，两组伸肌群峰值肌力比较，差异均无统计学意义（P＞0.05）。这表明跪行锻炼在短期内可能不会显著增加膝关节伸肌群的绝对力量。这并非负面发现，而是可能提示跪行锻炼更侧重于改善肌肉的协调性和平衡性，而非单纯的力量增长，这与“筋骨平衡”理论所强调的协同作用相符。

屈伸力矩比：干预前两组在60°/秒等速状态下膝关节屈/伸峰值力矩比无显著差异。干预后，跪行组该力矩比显著降低（更接近于1，P<0.05），且优于对照组（P<0.05）。说明跪行锻炼使膝关节屈肌与伸肌力矩趋于平衡，直接支持了中医“筋骨平衡”理论中关于肌力平衡的重要性

[15]

。

膝关节活动度：干预后跪行组膝关节矢状面最大屈曲角度显著增加，较对照组有明显优势（P<0.01）。这表明跪行锻炼有效提高了膝关节活动度，优化了关节力学性能，对患者整体功能的恢复有积极作用。

膝关节内收力矩：干预后，空白组与跪行组膝关节内收力矩无显著差异（P=0.627）。虽然临床试验中内收力矩的绝对值未见显著变化，但结合第二部分健康人研究中发现跪行能够改变力矩的轴向，将负荷从内侧间室转移到外侧间室，这可能是一个更深层次的、长期对关节保护有益的机制。

3.5．安全性与依从性

本研究未发生因干预导致的严重不良事件，跪行锻炼整体安全性良好。在开始锻炼的前1~2周，部分患者主诉膝关节局部疼痛较平时略有加重，但不适程度轻微且短暂，通常两周后症状自行减轻。我们嘱咐患者耐受初期的不适，坚持锻炼，不要轻易中止；如个别患者疼痛持续加重超过两周，则停止跪行锻炼并给予医疗处理（本试验对因此产生的医疗费用予以承担）。这一管理策略保证了患者安全和依从性。公共卫生视角下，跪行锻炼仅有轻微且可控的风险，其操作简便、无需特殊设备、可在居家完成，大大降低了参与门槛，有望提高患者的长期依从性。

4．公共卫生启示与展望

4.1．“低成本、易行、有效”的干预措施

本研究的发现为跪行锻炼在公共卫生领域的广泛推广提供了强有力的证据。其作为一种“低成本、易行、有效”的干预措施，具有以下显著优势：

低成本：所需设备极少，仅需一块瑜伽垫即可开展锻炼，几乎不产生额外经济负担，适用于医疗资源有限或经济困难的地区和人群。

易行性与可及性：跪行锻炼可在家中或任何平坦硬质地面进行，无需专门场所。居家锻炼消除了交通、时间等障碍，降低了患者参与的难度。

自我管理赋能：跪行锻炼强调患者自主参与，通过简单指导即可自行练习，增强患者自我效能感和对疾病的掌控感

[16]

。慢性病的自我管理是减轻医疗系统负担的重要策略

[17]

。

有效性与安全性：本研究证实跪行锻炼能明显缓解疼痛、改善膝关节功能，提高患者生活质量和步行能力；除初期可能出现轻度不适外，并无严重不良反应。总体而言安全有效。

综上，这些优势契合公共卫生核心目标：以最小成本实现最大的群体健康效益。推广跪行锻炼有助于减少对昂贵药物和手术的依赖，减轻国家和个人的医疗支出，并促进健康公平，使更多慢病患者受益

[18]

。

4.2．搭建中医“筋骨平衡”与现代公共卫生方法的桥梁

本研究成功地将中医“筋骨平衡”的传统理论与现代生物力学科学进行了融合验证。通过生物力学参数（如膝关节力矩轴向改变、屈伸力矩比值趋于平衡）的客观测量，为“筋骨平衡”理论提供了科学解释，并为其在现代医学中的应用提供了依据。

这种跨学科的融合为公共卫生领域提供了新的思路：即传统医学实践，在经过现代科学的严谨验证后，可以成为成本效益高、文化适宜性强且可持续的健康解决方案。公共卫生部门可以考虑与中医机构合作，共同开发和推广基于“筋骨平衡”理论的KOA干预项目

[19]

。例如，在社区卫生服务中心或养老机构中推广跪行锻炼，并结合中医健康宣教，提升公众对中医理论的认知和接受度。

4.3．研究局限与未来方向

本研究虽然取得了积极成果，但也存在一些局限性，需要在今后的研究中完善

随访周期短：本研究干预随访时间相对较短，尚无法评价跪行锻炼对KOA疼痛缓解和功能改善的长期持续效果。未来应开展更长期的随访研究或RCT，以观察跪行锻炼对疾病进展、关节结构改变及肌肉力量影响的长期作用。

样本量和证据等级义：本研究临床样本量根据生物力学效应估算，未基于临床显著性指标进行计算，统计效能可能不足。后续研究应采用临床重要结局指标进行样本量估算，并开展更大规模、多中心的随机对照试验，以获取更高等级证据支持。

机制的深入阐明：对于跪行功能锻炼对防治肌肉萎缩、促进神经修复、以及肌肉、筋膜、韧带协调平衡机制仍需深入探索。未来的研究可以采用更先进的影像学技术、分子生物学方法和组织学分析，以揭示跪行锻炼在细胞和分子层面的具体作用机制。

4.4．公共卫生实施的实践建议

基于本研究的积极结果和上述展望，我们提出以下公共卫生实践建议：

开发标准化教育计划：制作简单易懂、图文并茂的跪行锻炼指南（包括正确姿势、常见误区、注意事项和循序渐进的方案）。通过线上平台（如健康科普APP、微信公众号）和线下社区活动（如健康讲座、义诊、老年大学课程）进行广泛传播。

加强基层医护人员培训：将跪行锻炼的理论和实践纳入基层社区医生、全科医生、物理治疗师、康复治疗师和社区健康工作者的培训内容。使其能够向KOA患者提供专业的指导和支持

[20]

。

融入现有公共卫生项目：将跪行锻炼作为一项核心内容，整合到国家和地方现有的老年人健康管理、慢性病自我管理、跌倒预防等公共卫生项目中

[21]

。例如，在社区养老服务中心、老年活动中心定期组织跪行锻炼小组。

鼓励患者自我监测与反馈：借助智能手机计步器等便捷工具，鼓励患者记录日常活动量和锻炼情况，并通过简化的量表（如简版WOMAC）定期评估疼痛和功能，实现自我监测和及时反馈。

4.5．结论

综上所述，本研究在“筋骨平衡”理论的指导下，通过严谨的生物力学分析和临床随机对照试验，证实了跪行锻炼在改善KOA患者膝关节疼痛、功能活动和肌肉平衡方面的显著疗效和良好安全性

[22]

。这些结果从生物力学角度较好地解释了中医“筋骨平衡”理论。其低成本、易行和高依从性的特点，使其成为一种极具潜力的公共卫生干预措施。

References

[1]	陆艳红, 石晓兵. 膝骨关节炎国内外流行病学研究现状及进展 [J]. 中国中医骨伤科杂志, 2012(6):81-84.
[2]	吕苏梅, 张瑞丽. 中老年膝骨关节炎的流行病学研究进展 [J]. 中国老年学杂志, 2016, 36(16):4133-4135.
[3]	李元浩. 膝骨关节炎认知度调查及膝周软组织张力与膝骨关节炎的相关性研究 [D]. 北京: 中国中医科学院, 2019.
[4]	寇赵淅, 赵明宇, 张向东, 等. “以筋为先, 以衡为用”理念在膝骨关节炎中的应用探讨 [J]. 中医学报, 2020, 35(3): 520-523. https://doi.org/10.16368/j.issn.1674-8999.2020.03.012
[5]	庞坚, 罗明江, 曹月龙, 等. 刍论 KOA“本痿标痹, 痹痿并存” [J]. 上海中医药杂志, 2013, 47(3): 25-26. https://doi.org/10.16305/j.1007-1334.2013.03.012
[6]	刘峰, 刘天君. 《诸病源候论》中导引起始姿势探析 [J]. 中医文献杂志, 2010, 28(6): 13-15.
[7]	詹红生. 海派中医石氏伤科 [M]. 上海: 上海科技出版社, 2017: 35-27.
[8]	Ditchen D M, Ellegast R P, Gawliczek T, et al. Occupational kneeling and squatting: development and validation of an assessment method combining measurements and diaries [J]. International Archives of Occupational and Environmental Health, 2015, 88(2): 153-165. https://doi.org/10.1007/s00420-014-0946-0
[9]	Hofer J K, Gejo R, Mcgarry M H, et al. Effects on tibiofemoral biomechanics from kneeling [J]. Clinical Biomechanics, 2011, 26(6):0-611. https://doi.org/10.1016/j.clinbiomech.2011.03.004
[10]	王晶. 跪行训练治疗膝骨关节炎的临床疗效及其生物力学机制研究 [D]. 上海中医药大学, 2021.
[11]	Bellamy N, Buchanan W etal. Validation study of WOMAC:a health status instrument for measuring clinical important patient relevant outcomers to antirheumatic drug therapy in patients with OA of the hip or knee. J Rheumatol, 1988; 15: 1833-40. https://doi.org/10.1002/art.1780151206
[12]	庞坚. 膝骨关节炎疼痛强度评价方法 [J]. 中医正骨, 2018, 30(11): 36-38.
[13]	Torpel A, Becker T, Thiers A, et al. Intersession Relia bility of Isokinetic Strength Testing in Knee and Elbow Extension and Flexion Using the BTE PrimusRS [J]. J Sport Rehabil, 2017, 26(4). https://doi.org/10.1123/jsr.2016-0209
[14]	张喆安. 膝痛女性跑步爱好者跑步姿势及半足鞋垫干预效果研究 [D]. 北京: 北京体育大学, 2018.
[15]	谢光柏, 陶新民, 姚文均, 等. 膝关节损伤后期屈膝肌与伸膝肌力矩比值的远期评价研究 [J]. 中国运动医学杂志, 1999, 18(3): 223-225.
[16]	李帅妙, 杨支兰, 许娟. 养老机构膝骨关节炎患者的心理弹性状况及影响因素 [J]. 中国当代医药, 2019, 26(5): 191-195. https://doi.org/10.3969/j.issn.1674-4721.2019.05.062
[17]	王伟群, 汪晓凤. 授权和自我效能对老年慢性病患者自我管理行为的影响研究 [J]. 实用临床护理学电子杂志, 2020, 5(2): 156.
[18]	倪进东. 浅议我国基层公共卫生的特征与发展 [J]. 中华疾病控制杂志, 2024, 28(12): 1387-1390. https://doi.org/10.16462/j.cnki.zhjbkz.2024.12.002
[19]	Stanhope, M., & Lancaster, J. Foundations for Population Health in Community/Public Health Nursing [M]. 6th ed. St. Louis: Elsevier, 2018.
[20]	池方方, 蔡滨欣. 我国公共卫生人才队伍现状及发展研究 [J]. 中国公共卫生管理, 2021, 37(3): 317-320. https://doi.org/10.19568/j.cnki.23-1318.2021.03.003
[21]	韩雨廷, 吕筠, 余灿清, 等. 数字公共卫生的进展与应用 [J]. 中华流行病学杂志, 2022, 43(6): 791-797. https://doi.org/10.3760/cma.j.cn112338-20220221-00114
[22]	梁轶峰, 李雷. 筋骨平衡理论研究进展 [J]. 中医学, 2025, 15(2): 154-160. https://doi.org/10.12677/TCM.2025.152020

Cite This Article

Plain Text BibTeX RIS

APA Style

Jiong, D., Jing, W. (2025). The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis. Science Discovery, 13(4), 73-77. https://doi.org/10.11648/j.sd.20251304.13

Copy | Download

ACS Style

Jiong, D.; Jing, W. The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis. Sci. Discov. 2025, 13(4), 73-77. doi: 10.11648/j.sd.20251304.13

Copy | Download

AMA Style

Jiong D, Jing W. The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis. Sci Discov. 2025;13(4):73-77. doi: 10.11648/j.sd.20251304.13

Copy | Download

@article{10.11648/j.sd.20251304.13,
  author = {Du Jiong and Wang Jing},
  title = {The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis
},
  journal = {Science Discovery},
  volume = {13},
  number = {4},
  pages = {73-77},
  doi = {10.11648/j.sd.20251304.13},
  url = {https://doi.org/10.11648/j.sd.20251304.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sd.20251304.13},
  abstract = {Background：Knee osteoarthritis (KOA) is the most common degenerative joint disease in an aging world. In China, its prevalence exceeds 85 % among people aged 70 years and older. Although current guidelines recommend exercise as first-line management, they provide little detail on which forms of exercise suit specific patient phenotypes. Existing programmers often carry high costs, require professional supervision, or depend on specialized facilities, creating barriers to population-wide implementation. Traditional Chinese Medicine (TCM) proposes the “tendon–bone balance” theory, which maintains that coordinated muscle and bone function is essential for joint integrity; however, modern empirical evidence for this concept is lacking. Kneeling ambulation—an equipment-free, home-based manoeuvre rooted in traditional practice—has been proposed as a highly accessible intervention, yet its biomechanical mechanisms and clinical efficacy have never been rigorously examined. Objective：Guided by the TCM “tendon–bone balance” theory, we aimed to evaluate the biomechanical effects and clinical efficacy of kneeling ambulation in KOA patients and to explore its potential as a public-health strategy. Methods：Biomechanical study: Twenty healthy volunteers underwent three-dimensional gait analysis and surface electromyography while kneeling and while walking normally; thirteen additional volunteers completed repeat sessions to verify reliability. Clinical study: In a single-centre randomized controlled trial, 30 participants who met the 2015 OARSI/AAOS criteria for KOA were randomly assigned to a kneeling group (three 5-minute sessions daily for 12 weeks) or to a no-exercise control group. The primary endpoints were total and pain scores on the WOMAC; secondary endpoints included the isokinetic peak flexor/extensor torque ratio at 60 °/s, knee range of motion, and safety. Results：Biomechanics: Compared with walking, kneeling increased peak knee flexion range of motion (117° vs 48°, P < 0.05) and reduced the knee adduction moment toward zero, shifting the load axis from the medial to the lateral compartment. Clinical: After 12 weeks, the kneeling group showed significantly greater improvements than controls in total WOMAC score (P = 0.013) and pain score (P = 0.012), a flexor/extensor torque ratio closer to unity (P < 0.05), and a marked increase in maximum knee flexion angle (P < 0.01); no serious adverse events were reported. Conclusion：Kneeling ambulation redistributes joint load and restores balanced flexor–extensor strength, leading to clinically meaningful pain relief and functional improvement. Its low cost, lack of required equipment, and suitability for home use position it as an evidence-based, scalable adjunct for population-level KOA prevention and management.},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis

AU  - Du Jiong
AU  - Wang Jing
Y1  - 2025/08/16
PY  - 2025
N1  - https://doi.org/10.11648/j.sd.20251304.13
DO  - 10.11648/j.sd.20251304.13
T2  - Science Discovery
JF  - Science Discovery
JO  - Science Discovery
SP  - 73
EP  - 77
PB  - Science Publishing Group
SN  - 2331-0650
UR  - https://doi.org/10.11648/j.sd.20251304.13
AB  - Background：Knee osteoarthritis (KOA) is the most common degenerative joint disease in an aging world. In China, its prevalence exceeds 85 % among people aged 70 years and older. Although current guidelines recommend exercise as first-line management, they provide little detail on which forms of exercise suit specific patient phenotypes. Existing programmers often carry high costs, require professional supervision, or depend on specialized facilities, creating barriers to population-wide implementation. Traditional Chinese Medicine (TCM) proposes the “tendon–bone balance” theory, which maintains that coordinated muscle and bone function is essential for joint integrity; however, modern empirical evidence for this concept is lacking. Kneeling ambulation—an equipment-free, home-based manoeuvre rooted in traditional practice—has been proposed as a highly accessible intervention, yet its biomechanical mechanisms and clinical efficacy have never been rigorously examined. Objective：Guided by the TCM “tendon–bone balance” theory, we aimed to evaluate the biomechanical effects and clinical efficacy of kneeling ambulation in KOA patients and to explore its potential as a public-health strategy. Methods：Biomechanical study: Twenty healthy volunteers underwent three-dimensional gait analysis and surface electromyography while kneeling and while walking normally; thirteen additional volunteers completed repeat sessions to verify reliability. Clinical study: In a single-centre randomized controlled trial, 30 participants who met the 2015 OARSI/AAOS criteria for KOA were randomly assigned to a kneeling group (three 5-minute sessions daily for 12 weeks) or to a no-exercise control group. The primary endpoints were total and pain scores on the WOMAC; secondary endpoints included the isokinetic peak flexor/extensor torque ratio at 60 °/s, knee range of motion, and safety. Results：Biomechanics: Compared with walking, kneeling increased peak knee flexion range of motion (117° vs 48°, P < 0.05) and reduced the knee adduction moment toward zero, shifting the load axis from the medial to the lateral compartment. Clinical: After 12 weeks, the kneeling group showed significantly greater improvements than controls in total WOMAC score (P = 0.013) and pain score (P = 0.012), a flexor/extensor torque ratio closer to unity (P < 0.05), and a marked increase in maximum knee flexion angle (P < 0.01); no serious adverse events were reported. Conclusion：Kneeling ambulation redistributes joint load and restores balanced flexor–extensor strength, leading to clinically meaningful pain relief and functional improvement. Its low cost, lack of required equipment, and suitability for home use position it as an evidence-based, scalable adjunct for population-level KOA prevention and management.
VL  - 13
IS  - 4
ER  -

Copy | Download

Author Information

Du Jiong

Department of Orthopaedics & Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China

Contact Email
Wang Jing

Department of Orthopaedics & Traumatology, Xishan Hospital of Traditional Chinese Medicine in Wuxi City, Wuxi, China

Contact Email

Download PDF

Submit an Article

Sections

Plain Text BibTeX RIS

APA Style

Jiong, D., Jing, W. (2025). The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis. Science Discovery, 13(4), 73-77. https://doi.org/10.11648/j.sd.20251304.13

Copy | Download

ACS Style

Jiong, D.; Jing, W. The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis. Sci. Discov. 2025, 13(4), 73-77. doi: 10.11648/j.sd.20251304.13

Copy | Download

AMA Style

Jiong D, Jing W. The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis. Sci Discov. 2025;13(4):73-77. doi: 10.11648/j.sd.20251304.13

Copy | Download

@article{10.11648/j.sd.20251304.13,
  author = {Du Jiong and Wang Jing},
  title = {The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis
},
  journal = {Science Discovery},
  volume = {13},
  number = {4},
  pages = {73-77},
  doi = {10.11648/j.sd.20251304.13},
  url = {https://doi.org/10.11648/j.sd.20251304.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sd.20251304.13},
  abstract = {Background：Knee osteoarthritis (KOA) is the most common degenerative joint disease in an aging world. In China, its prevalence exceeds 85 % among people aged 70 years and older. Although current guidelines recommend exercise as first-line management, they provide little detail on which forms of exercise suit specific patient phenotypes. Existing programmers often carry high costs, require professional supervision, or depend on specialized facilities, creating barriers to population-wide implementation. Traditional Chinese Medicine (TCM) proposes the “tendon–bone balance” theory, which maintains that coordinated muscle and bone function is essential for joint integrity; however, modern empirical evidence for this concept is lacking. Kneeling ambulation—an equipment-free, home-based manoeuvre rooted in traditional practice—has been proposed as a highly accessible intervention, yet its biomechanical mechanisms and clinical efficacy have never been rigorously examined. Objective：Guided by the TCM “tendon–bone balance” theory, we aimed to evaluate the biomechanical effects and clinical efficacy of kneeling ambulation in KOA patients and to explore its potential as a public-health strategy. Methods：Biomechanical study: Twenty healthy volunteers underwent three-dimensional gait analysis and surface electromyography while kneeling and while walking normally; thirteen additional volunteers completed repeat sessions to verify reliability. Clinical study: In a single-centre randomized controlled trial, 30 participants who met the 2015 OARSI/AAOS criteria for KOA were randomly assigned to a kneeling group (three 5-minute sessions daily for 12 weeks) or to a no-exercise control group. The primary endpoints were total and pain scores on the WOMAC; secondary endpoints included the isokinetic peak flexor/extensor torque ratio at 60 °/s, knee range of motion, and safety. Results：Biomechanics: Compared with walking, kneeling increased peak knee flexion range of motion (117° vs 48°, P < 0.05) and reduced the knee adduction moment toward zero, shifting the load axis from the medial to the lateral compartment. Clinical: After 12 weeks, the kneeling group showed significantly greater improvements than controls in total WOMAC score (P = 0.013) and pain score (P = 0.012), a flexor/extensor torque ratio closer to unity (P < 0.05), and a marked increase in maximum knee flexion angle (P < 0.01); no serious adverse events were reported. Conclusion：Kneeling ambulation redistributes joint load and restores balanced flexor–extensor strength, leading to clinically meaningful pain relief and functional improvement. Its low cost, lack of required equipment, and suitability for home use position it as an evidence-based, scalable adjunct for population-level KOA prevention and management.},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - The Application of Kneeling Exercise, Guided by the Tendon-Bone Balance Theory, as a Public Health Strategy in the Management of Knee Osteoarthritis

AU  - Du Jiong
AU  - Wang Jing
Y1  - 2025/08/16
PY  - 2025
N1  - https://doi.org/10.11648/j.sd.20251304.13
DO  - 10.11648/j.sd.20251304.13
T2  - Science Discovery
JF  - Science Discovery
JO  - Science Discovery
SP  - 73
EP  - 77
PB  - Science Publishing Group
SN  - 2331-0650
UR  - https://doi.org/10.11648/j.sd.20251304.13
AB  - Background：Knee osteoarthritis (KOA) is the most common degenerative joint disease in an aging world. In China, its prevalence exceeds 85 % among people aged 70 years and older. Although current guidelines recommend exercise as first-line management, they provide little detail on which forms of exercise suit specific patient phenotypes. Existing programmers often carry high costs, require professional supervision, or depend on specialized facilities, creating barriers to population-wide implementation. Traditional Chinese Medicine (TCM) proposes the “tendon–bone balance” theory, which maintains that coordinated muscle and bone function is essential for joint integrity; however, modern empirical evidence for this concept is lacking. Kneeling ambulation—an equipment-free, home-based manoeuvre rooted in traditional practice—has been proposed as a highly accessible intervention, yet its biomechanical mechanisms and clinical efficacy have never been rigorously examined. Objective：Guided by the TCM “tendon–bone balance” theory, we aimed to evaluate the biomechanical effects and clinical efficacy of kneeling ambulation in KOA patients and to explore its potential as a public-health strategy. Methods：Biomechanical study: Twenty healthy volunteers underwent three-dimensional gait analysis and surface electromyography while kneeling and while walking normally; thirteen additional volunteers completed repeat sessions to verify reliability. Clinical study: In a single-centre randomized controlled trial, 30 participants who met the 2015 OARSI/AAOS criteria for KOA were randomly assigned to a kneeling group (three 5-minute sessions daily for 12 weeks) or to a no-exercise control group. The primary endpoints were total and pain scores on the WOMAC; secondary endpoints included the isokinetic peak flexor/extensor torque ratio at 60 °/s, knee range of motion, and safety. Results：Biomechanics: Compared with walking, kneeling increased peak knee flexion range of motion (117° vs 48°, P < 0.05) and reduced the knee adduction moment toward zero, shifting the load axis from the medial to the lateral compartment. Clinical: After 12 weeks, the kneeling group showed significantly greater improvements than controls in total WOMAC score (P = 0.013) and pain score (P = 0.012), a flexor/extensor torque ratio closer to unity (P < 0.05), and a marked increase in maximum knee flexion angle (P < 0.01); no serious adverse events were reported. Conclusion：Kneeling ambulation redistributes joint load and restores balanced flexor–extensor strength, leading to clinically meaningful pain relief and functional improvement. Its low cost, lack of required equipment, and suitability for home use position it as an evidence-based, scalable adjunct for population-level KOA prevention and management.
VL  - 13
IS  - 4
ER  -

Copy | Download