Faster Pain Relief, but Not Greater Overall Recovery: Adding Trunk Neuromuscular Training to Knee-Focused Rehabilitation in Patients with Knee Osteoarthritis

Background/Objectives: This study examined whether adding trunk neuromuscular training to knee-focused rehabilitation offers additional pain reduction in adults with knee osteoarthritis (OA) and sway-back posture. The study also assessed effects on muscle strength, knee range of motion, and postural alignment. Methods: Thirty adults with symptomatic knee OA and sway-back posture were randomized to knee-focused rehabilitation (KNEE; n = 15) or the same intervention with added trunk neuromuscular exercises (KNEE-CORE; n = 15). Twenty-four participants completed the study and were included in the analysis (12 per group). Both groups completed 12 supervised sessions, twice weekly. Outcomes included pain, muscle strength, knee range of motion, and postural alignment. Results: Both interventions resulted in substantial pain reduction. By session 6, pain decreased from 7.67 ± 1.07 to 3.75 ± 1.06 in KNEE and from 7.42 ± 1.68 to 1.58 ± 0.67 in KNEE-CORE, with a significant group-by-time interaction favouring KNEE-CORE (β = −1.92, 95% CI −2.80 to −1.04; p < 0.001). By session 12, pain was low in both groups (0.92 ± 0.67 and 0.17 ± 0.39), and the difference in change from baseline was no longer significant (p = 0.378). No consistent additional benefits were observed for knee range of motion or muscle strength. Some postural outcomes favoured KNEE-CORE, but these findings were exploratory. Conclusions: Trunk neuromuscular training accelerated early pain reduction but did not produce a clearly greater overall reduction by the end of treatment. Proximal neuromuscular training may influence the timing of symptomatic response rather than the final level of improvement.