Participants in this group will receive a structured therapeutic exercise program designed to improve physical function and reduce pain in patients with knee osteoarthritis.

The session includes:

Warm-Up (10 min): Light walking or stationary cycling

Range of Motion (ROM) Exercises: Heel slides, seated knee flexion/extension

Strengthening Exercises:

Quadriceps sets

Straight leg raises

Mini squats (within pain-free range)

Seated knee extensions using resistance bands

Stretching Exercises:

Hamstring stretch

Calf stretch

Quadriceps stretch

Cool Down (5-10 min): Breathing and relaxation techniques

Modalities:

Hot Pack: 15 minutes (applied pre- and post-exercise)

TENS: 10 minutes (applied pre- and post-exercise using dual-channel portable TENS unit - [Brand/Model, if available])

Participants in the control group will follow the same structured therapeutic exercise program as the experimental group. However, TENS will be replaced with a sham procedure that mimics device placement without electrical stimulation.

Warm-Up (10 min): Light walking or stationary cycling

Range of Motion (ROM) Exercises: Heel slides, seated knee flexion/extension

Strengthening Exercises:

Quadriceps sets

Straight leg raises

Mini squats (within pain-free range)

Seated knee extensions using resistance bands

Stretching Exercises:

Hamstring stretch

Calf stretch

Quadriceps stretch

Cool Down (5-10 min): Breathing and relaxation techniques

Modalities:

Hot Pack: 15 minutes (if applicable)

Sham TENS: Electrodes applied without current

Therapeutic Exercises with Hot Pack and TENS This intervention focuses on improving physical function and reducing pain through structured therapeutic exercises for knee OA patients. The program includes Warm-Up (10 min): Light walking or stationary cycling. 2. Range of Motion (ROM) Exercises: Heel slides, seated knee flexion/extension. 3. Strengthening Exercises:

Quadriceps sets Straight leg raises Mini squats (pain-free range)

Seated knee extensions with resistance band 4. Stretching Exercises:

Hamstring stretch Calf stretch Quadriceps stretch 5. Cool Down (5-10 min): Breathing and relaxation. 6. Hot Pack (15 min) + TENS (10 min): Applied pre and post exercises for pain relief and muscle relaxation.

Pain intensity will be assessed using the Visual Analog Scale (VAS), which ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent worse outcomes.

Physical disability will be measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The WOMAC consists of 24 items scored from 0 (none) to 4 (extreme), yielding a total score range from 0 to 96, where higher scores indicate worse disability