Effectiveness of Movement Representation Strategies in Knee Pain: A Systematic Review and Meta-Analyses on Knee Pain and Function

Abstract

Introduction: A highly prevalent condition, knee pain often results in significant functional limitations and a reduced quality of life. Due to its multifactorial causes and diverse pathologies, numerous therapeutic approaches have been proposed, each with varying degrees of success. Among these, movement representation strategies have emerged as promising interventions. These techniques engage the central nervous system by using mental simulation of motor actions—such as motor imagery and action observation—without the need for actual physical movement, often focusing on imagining or observing pain-free, unrestricted motion. Methods: Because the effectiveness of movement representation strategies in knee pain remains uncertain and no prior synthesis of randomised evidence exists, a systematic review of the literature was conducted for randomised controlled trials indexed from three databases inception to March 2025. Two reviewers performed independent data extraction and methodologic quality assessment of the studies. Results: Eleven studies were included in this review. The results of pain and function outcomes showed significant improvements after interventions based on movement representation techniques. The meta-analyses showed that these techniques have a significant effect on pain and function. Discussion and Conclusion: The results of our review demonstrated notable results from the implementation of movement representation techniques to standard physical therapy aimed at decreasing pain and increasing function in patients with knee pain. The meta-analyses revealed a significant positive effect of these interventions. Significance Statement: Movement representation strategies combined with physical therapy have a significant effect on function and pain in patients with knee pain. The most commonly used strategies were motor imagery training and action observation training. The meta-analyses revealed a significant positive effect of these interventions, showing improvements in both pain and function in patient with knee pain.