Inclusion Criteria:

• Age group 40-70
• Both genders male and female
• Clinical diagnosis of knee OA (Kellgren-Lawrence grade 1-3) of the most symptomatic knee.
• Pain stable enough to permit exercise on Numeric Pain Rating Scale 3/10.
• Participants must demonstrate a gastrocnemius muscle strength of grade ≥3 on the Manual Muscle Testing (MMT) scale (0-5), assessed using the standard standing heel-rise position.
• Participants must be able to ambulate independently and participate in supervised exercise.

Exclusion Criteria:

• • Presence of a prosthetic knee in the affected limb.

  • Inflammatory arthritis (e.g., rheumatoid arthritis) or active flare-up of OA.
  • Cardiovascular disease contraindicating exercise (e.g., unstable angina, recent MI, uncontrolled hypertension ≥160/100 mmHg).
  • Pulmonary disease that limits safe participation (e.g., severe COPD, recent exacerbation).
  • History of deep vein thrombosis (DVT), peripheral vascular disease, or bleeding/clotting disorders.
  • Current anticoagulant therapy that increases bleeding risk (unless cleared by physician).
  • Any pathology causing significant muscle weakness (e.g., neuromuscular disorders, severe neuropathy).