ORIGINAL RESEARCH article
Front. Sports Act. Living
Sec. Biomechanics and Control of Human Movement
Volume 7 - 2025 | doi: 10.3389/fspor.2025.1631357
This article is part of the Research TopicBiomechanical Performance and Relevant Mechanism of Physical Medicine and Rehabilitation for Neuromusculoskeletal Disorders, Volume IIView all 15 articles
Effects of tDCS combined with TENS in relieving pain and improving gait patterns during stepping over obstacles among older adults with knee osteoarthritis
Provisionally accepted
- 1Shandong Sport University, Jinan, China
- 2Beijing Sport University, Beijing, Beijing Municipality, China
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Purpose: Older adults with knee osteoarthritis (KOA) exhibit an elevated risk of falls during obstacle negotiation, primarily due to pain-induced gait deviations. While transcutaneous electrical nerve stimulation (TENS) offers modest pain relief and limited gait modulation, combining it with transcranial direct current stimulation (tDCS) may enhance the effects. This study evaluated the comparative efficacy of tDCS+TENS versus TENS alone in mitigating pain and optimizing gait patterns during obstacle crossing in older adults with KOA. Methods: Twenty-three participants with KOA (mean age: 67.6±5.0 years; BMI: 25.9±2.4 kg/m² ) were randomized to either tDCS+TENS (n=12; 7F/5M) or TENS-only (n=11; 7F/4M) groups. Both interventions involved 20-minute sessions, administered thrice weekly for six weeks. Outcome measures included pain intensity (visual analog scale, VAS) and gait variables (foot clearance height, crossing velocity) assessed pre-(week 0) and post-intervention (week 7). Data were analyzed using mixed-design two-way ANOVAs with Bonferroni corrections. Results: Statistically significant group-by-time interactions were observed for pain (p = 0.002, η²p = 0.378), foot clearance (p = 0.038, η²p = 0.190), and crossing velocity (p < 0.001, η²p = 0.588). Post hoc analyses revealed that the tDCS+TENS group (week0=4.72±1.01, week7=1.98±0.88, p<0.001) experienced significantly greater reductions in pain scores compared to the TENS-only group(week0=5.02±1.19, week7=3.56±1.18, p<0.001); tDCS+TENS group experienced significantly greater improvements in foot clearance (week0=0.19±0.04, week7=0.20±0.03, p<0.001) and crossing velocity (week0=0.53±0.11, week7=0.62±0.08, p<0.001), compared to the TENS-only group(week0=0.17±0.02, week7=0.17±0.02,p<0.001; week0=0.52±0.09, week7=0.54±0.09). Conclusion: The combination of tDCS and TENS significantly outperformed TENS-only in reducing pain and enhancing gait adaptability during obstacle negotiation in older adults with KOA. These findings support the integration of tDCS as an adjunctive neuromodulatory strategy to amplify the therapeutic benefits of TENS in this population.
Keywords: knee pain1, osteoarthritis2, Transcranial direct current stimulation3, transcutaneous electrical nerve stimulation4, obstacle crossing5
Received: 13 Jun 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Zhang, Wang, Song, Luo, Ge, Shen and Song. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qipeng Song, Shandong Sport University, Jinan, China
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