Effects of Pilates and Neuromuscular Exercises on Postural Control in Dynamic Knee Valgus

This prospective, single-blind randomized controlled trial was designed to evaluate the comparative effects of Pilates and neuromuscular exercise training on lower extremity alignment and postural control in young adults with dynamic knee valgus (DKV). Ethical approval was obtained from the Istanbul Atlas University Non-Interventional Scientific Research Ethics Committee (Approval No: E-22686390-050.99-41964, 03/05/2024).

A total of 45 participants aged 18-24 years, all right-leg dominant, were initially enrolled and randomized into three groups: Pilates, neuromuscular exercise, and control (15 in each group). Randomization was performed using computerized allocation. Due to dropouts, 36 participants (12 per group) completed the study between June and August 2024.

The interventions consisted of a 6-week supervised program (18 sessions, 3 times per week). Both Pilates and neuromuscular protocols were progressive in intensity, incorporating resistance bands, core stabilization, and functional balance exercises. The control group did not receive any intervention but underwent the same baseline and post-intervention assessments.

The primary outcome was the frontal plane projection angle (FPPA) during single-leg squat and single-leg drop jump tasks, measured using 2D video analysis.

The secondary outcomes included:

Isometric strength of the gluteus medius and rectus femoris measured with a handheld dynamometer,

Balance performance assessed separately by the Biodex Postural Stability Test (overall, anterior-posterior, and medial-lateral stability indices) and the Limits of Stability Test,

Functional performance assessed by the OptoJump system, including vertical jump height, vertical jump power, and reactive strength index.

All assessments were conducted at baseline and after 6 weeks by the same physiotherapist to ensure intra-rater reliability.

Inclusion criteria

• having asymptomatic dynamic knee valgus
• being between 18 and 24 years of age
• having no medical history, a body mass index (BMI) between 18 and 24
• no history of orthopedic, neurological, vascular, systemic, or rheumatic diseases
• no complaints of pain in any part of the body during physical activities
• the ability to communicate in Turkish (both written and verbal)

Exclusion criteria

• individuals with hip anteversion or retroversion or other postural disorders affecting knee kinematics, those unable to perform the exercises as demonstrated, those experiencing pain during exercises (VAS >5)
• individuals with a history of orthopedic surgery, those with strength deficits between extremities
• the presence of cognitive or psychological disorders that could hinder cooperation
• pregnancy or suspected pregnancy
• sleep disorders, regular medication use, intake of painkillers, sedatives, or psychiatric drugs within the last 24 hours
• history of chronic systemic, rheumatologic, neurological, or vascular diseases