NEUROMECHANICAL AND PHYSIOLOGICAL ADAPTATIONS TO RESISTANCE EXERCISE IN JOINT INJURY REHABILITATION: IMPLICATIONS FOR CLINICAL PRESCRIPTION

Abstract

Objective: to synthesize and quantify neuromechanical, morphological, and functional adaptations to resistance exercise during joint injury rehabilitation and translate the findings into clinical prescription Methods: a PRISMA 2020 systematic review searched PubMed/MEDLINE and PEDro through July 30, 2026. Controlled trials were eligible when they included participants aged 14 years or older with a traumatic joint injury or postoperative condition and delivered progressive resistance exercise for at least four weeks. Risk of bias was assessed with RoB 2. Standardized between-group changes were pooled using random effects, REML, and Hartung-Knapp inference Results: fifteen trials comprising 890 randomized participants were included. Strength favored additional, higher-load, or more specific resistance strategies (Hedges g=0.63; 95%CI 0.18–1.08; I²=71.9%; eight studies), although the prediction interval included no benefit. Functional outcomes were imprecise (g=0.83; 95%CI −0.15–1.82; I²=91.4%; six studies). Morphological gains were promising but sparsely measured Conclusion: progressive resistance exercise improves strength, whereas transfer to function and tissue structure remains heterogeneous. Load should be individualized according to the joint, healing phase, symptoms, and 24-hour response