What is the typical progression sequence when integrating modalities with therapeutic exercise for knee osteoarthritis?

• A. Begin with pain and swelling control (ice, compression) → ROM and flexibility → isotonic strengthening → functional training
• B. Begin with high-intensity plyometrics
• C. Skip ROM and go straight to heavy strengthening
• D. Focus only on modalities

Answer: (A)

Starting with pain and swelling control using modalities like ice and compression creates a window where movement is tolerable. When symptoms are moderated, restore range of motion and flexibility to prevent stiffness and improve joint mechanics. Next, introduce isotonic strengthening to build the knee-supporting muscles, especially the quadriceps and hip stabilizers, which helps reduce knee load during activities. Finally, progress to functional training that mirrors daily tasks so gains transfer to real-life performance like walking, stairs, and sit-to-stand. This sequence supports safe loading, improves mobility, builds necessary strength, and ends with task-specific practice for real-world function. Using high-intensity plyometrics early would place excessive joint stress; skipping ROM and jumping straight to heavy strengthening bypasses mobility gains; and focusing only on modalities neglects the active work needed for lasting improvement.