Dr. Shirley Sahrmann's Movement System Impairment (MSI) approach for knee osteoarthritis operates on the kinesiopathologic model: it asserts that repetitive faulty movement patterns and sustained improper alignments-not just age or wear-are primary drivers of joint stress and cartilage breakdown

Comparator group patients will receive, Conventional treatment exercises.

• ROMs, SLR, VMO's and Quadriceps strengthening, Partial squatting, Terminal knee extension ROM, ITB, Hamstrings and gastrocnemius stretching

• with and without resistance band-SLR
• with and without resistance band-Hip extension
• with and without resistance band-clamshells
• IT Band stretch
• Squatting in front of mirror
• with resistance band-lateral walk
• Hip lateral rotation

The Numeric Pain Rating Scale (NPRS) is a unidimensional, patient-reported outcome measure used to assess pain intensity. Participants are asked to rate their current pain level, or average pain over a specified recall period (e.g., past 24 hours or past week), using an 11-point scale ranging from 0 to 10, where 0 indicates "no pain" and 10 indicates "worst imaginable pain."

The NPRS is widely used in musculoskeletal and orthopedic conditions due to its simplicity, high responsiveness, and strong psychometric properties. It demonstrates excellent reliability (test-retest reliability ICC > 0.80) and good construct validity in chronic pain populations including knee osteoarthritis.

The WOMAC Osteoarthritis Index is a disease-specific, self-administered questionnaire designed to evaluate symptoms and functional status in patients with hip and knee osteoarthritis.

It consists of 24 items divided into three subscales:

Pain (5 items) Stiffness (2 items) Physical Function (17 items)

Each item is typically scored using a 5-point Likert scale (0 = none to 4 = extreme), or alternatively via a visual analog format depending on study design. Total scores are summed, with higher scores indicating greater pain, stiffness, and functional disability.

The Universal Goniometer (UG) is a standard clinical instrument used to measure joint angles and assess alignment. In this study, it will be used to measure the knee valgus angle, which reflects medial-lateral alignment of the lower limb in the frontal plane.

The participant is typically assessed in a standing anatomical position, with landmarks aligned at:

Anterior superior iliac spine (ASIS) Center of patella Ankle/midline of tibia or second toe alignment (depending on protocol standardization)

The stationary arm of the goniometer is aligned with the femur, while the movable arm follows the tibial shaft. The angle between these segments represents the dynamic or static valgus alignment, depending on whether assessment is static posture or functional task-based measurement.

Changes in valgus angle will be used to assess biomechanical alignment improvements following the intervention.