Objectives: Chronic fracture pain (CFP) is a significant issue in patients with osteoporotic fractures (OFs) in convalescent rehabilitation wards (CRWs). This study aimed to examine the association between CFP and the Japanese short-form Central Sensitization Inventory (CSI-9) and verify the predictive validity of CSI-9 in patients with OF admitted to a CRW. Methods: This single-center retrospective study included 71 patients with OF (median age: 85.3 years, 54 females). CFP was defined as pain of Numerical Rating Scale (NRS) score ≥4 persisting at discharge, despite >3 months post-fracture. Multiple logistic regression and receiver operating characteristic curve analyses were performed to assess the association and predictive validity of the CSI-9 for CFP. Results: The incidence of CFP was 38.0%. CSI-9 was independently associated with CFP at admission (odds ratio = 1.12, 95% confidence interval [CI]: 1.01–1.24) and discharge (odds ratio = 1.15, 95% CI: 1.03–1.29). The area under the curve for the CSI-9 was 0.727 (95% CI: 0.605–0.850) at admission and 0.752 (95% CI: 0.637–0.867) at discharge, indicating fair predictive accuracy. The optimal cutoff values for the CSI-9 were 8 points at admission and 6 points at discharge. Conclusions: CSI-9 was independently associated with CFP and demonstrated moderate predictive accuracy in patients with OF in CRWs. Assessing central sensitization-related symptoms using the CSI-9 may be useful for evaluating and preventing CFP in this population. Further validation using large-scale prospective studies is required.

Objectives: This study aimed to determine whether neuromuscular electrical stimulation (NMES) of the quadriceps muscle early after total knee arthroplasty (TKA) is effective in improving muscle strength. Methods: This was a single-center, non-blinded, randomized controlled trial involving 37 patients (60 knees) who underwent TKA. Patients were randomly assigned to either the intervention group (19 patients, 30 knees) or the control group (18 patients, 30 knees). Both groups received standard rehabilitation starting on postoperative day 1. Additionally, the intervention group received NMES therapy starting on postoperative day 2. NMES was administered at the highest tolerable intensity for 15 min per session (10-s stimulation and 10-s rest) twice daily for 4 weeks. Outcome measures included voluntary isometric quadriceps strength, knee joint range of motion (ROM), visual analog scale (VAS), and the Timed Up and Go (TUG) test, which were assessed preoperatively and at 4, 8, and 12 weeks postoperatively. The outcomes were compared between the two groups. Results: Both groups showed improvements in all outcomes over time. However, no significant differences were observed between the two groups (muscle strength: p = 0.412, flexion ROM: p = 0.668, extension ROM: p = 1.000, VAS score: p = 0.192, TUG test score: p = 0.296) (p-values are main effects of group factors in the split-plot analysis of variance). Conclusions: NMES in the early postoperative period after TKA did not provide significant additional functional recovery benefits compared with standard rehabilitation.

Objectives: The study provided a comprehensive analysis exploring the association between athletes’ injury characteristics and the choice of physiotherapy treatments applied at the Polyclinic Tokyo 2020. Methods: Data from all physiotherapy treatments offered in the Polyclinic Olympic Village in Tokyo between 13 July and 10 August were recorded electronically. The physiotherapy team consisted of approximately 150 Japanese physiotherapists. Physiotherapy modalities analyzed were cryotherapy, electrotherapy, exercise therapy, laser therapy, manual therapy, shockwave therapy, taping, and ultrasound therapy. Logistic regression assessed the association between athletes’ injury characteristics and the physiotherapy treatment the Polyclinic Physiotherapy Services offered at the Tokyo 2020 Olympic Games using odds ratio. Results: This study analyzed 808 athletes who received physiotherapy, of which 66.6% (n = 1023) were for lower limb chronic injuries affecting muscles and tendons (72.8%, n = 1209) and were the most prevalent ones treated. Chronic injuries accounted for 56.7% (n = 942). Manual therapy was associated with trunk injuries (odds ratio 1.8, 95% confidence interval 1.4–2.3) and chronic injuries (1.5, 1.2–1.9). Ultrasound therapy was associated with injuries of the upper limbs (3.6, 1.9–6.7) and lower limbs (3.0, 1.7–5.2). Taping was associated with bone/joint/ligament injuries (2.1, 1.4–3.0). Shockwave was associated with muscle/tendon injuries (2.0, 1.2–3.4). Cryotherapy was related to acute injuries (1.8, 1.1–3.0) and lower limbs (3.6, 1.4–9.4). Laser was associated with bone/joint/ligament injuries (14.4, 4.5–45.8). Conclusions: Chronic injuries affecting lower limb muscles and tendons were the most prevalent musculoskeletal injuries treated at the Tokyo 2020 Polyclinic. Overall, Japanese physiotherapists used manual therapy, taping, exercise, and ultrasound therapy to treat athlete injuries.

Objective: This study aimed to derive a clinical prediction rule (CPR) that can predict changes in health-related quality of life at 5 months for patients with knee osteoarthritis (KOA) undergoing conservative treatment. Methods: Patients with KOA receiving physical therapy and exercise therapy at an outpatient clinic were included in this study. The basic characteristics, medical information, and motor function test results were recorded at baseline. The primary outcome measure was the change in the Japan Knee Osteoarthritis Measure (JKOM) 5 months after the baseline measurement. A decision tree analysis was performed with the basic characteristics, medical information, and the motor function test results as the independent variables and the changes in the JKOM after 5 months (≥8 in the improved groups) as the dependent variable. Results: Analyzed data from 87 patients. The variables included the visual analog scale score, bilateral KOA, 5-m walk test, JKOM, and body mass index. Six CPRs were obtained from the terminal nodes. Accuracy validation of the model for the entire decision tree revealed an area under the receiver operating characteristic curve of 0.87 (validation data: 0.83), a positive likelihood ratio of 2.6, and a negative likelihood ratio of 0.1. Conclusion: This CPR is an inspection characteristic that can exclude the possibility of the occurrence of an event based on a negative result. However, since the results of this study represent the first process of utilizing the CPR in actual clinical practice, its application should be kept in mind.

Objective: The purpose of this study was to identify the risk factors for the development of chronic lower back pain in older workers. Methods: This was a prospective cohort study using an Internet survey of workers aged 60–75 years, with a baseline survey conducted in September 2022 and a follow-up survey in October 2023. A total of 2257 participants who did not have chronic lower back pain in the baseline survey were included in the analysis, and the risk factors for chronic lower back pain were examined by logistic regression analysis. Results: The median age of the analyzed participants was 63.0 years, and the incidence of chronic lower back pain was 9.0%. Logistic regression analysis revealed that poor sleep habits (adjusted odds ratio [aOR]: 1.66, 95% confidence interval [CI]: 1.21–2.26), poor eating habits (aOR: 1.44, 95% CI: 1.03–2.01), no physical activity (aOR: 1.45, 95% CI: 1.00–2.09), and high stress (aOR: 1.62, 95% CI: 1.13–2.32) were significantly associated with the occurrence of chronic lower back pain. Conclusion: A comprehensive multidisciplinary collaboration program incorporating the assessment and management of lifestyle habits and mental health issues should be developed and implemented to prevent chronic lower back pain in older workers.

Objective: To examine the effect of isometric quadriceps exercises with visual and auditory feedback after total knee arthroplasty (TKA). Methods: The sample included 41 patients from our previous study who could be followed up for 1 year after TKA. Patients in the intervention group performed isometric quadriceps exercises with visual and auditory feedback using the quadriceps training machine from the 2nd to the 14th day after TKA, whereas those in the control group underwent standard postoperative rehabilitation (without visual or auditory feedback during isometric quadriceps exercises) in the hospital. Patients were evaluated for pain intensity, timed up and go test (TUG) score, 10-m gait speed, 6-minute walking distance (6MWD), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score 1 year after TKA. Additionally, exercise habits and responses to the International Physical Activity Questionnaire (IPAQ) were investigated. Results: Pain intensity was significantly lower in the intervention group than in the control group. Greater improvements in the TUG test scores, 10-m gait speed, 6MWD, and WOMAC scores were observed in the intervention group. Walking activity, as recorded by the IPAQ, and the proportion of patients with exercise habits were significantly higher in the intervention group than in the control group. Conclusions: These results suggest that performing isometric quadriceps exercise with visual and auditory feedback using the quadriceps training machine has good effects, such as pain reduction, physical function improvement, exercise tolerance, and increased physical activity at 1 year after TKA.

Objectives: The coordination of glenohumeral (GH) and scapular movements is central to the injury prevention of baseball pitchers. However, there is no objective data establishing the direct relationship between pitching injuries and associated GH and scapular movements. Therefore, this study demonstrated the biomechanical differences in the scapular and GH movements during pitching between injury-prone pitchers and healthy college baseball pitchers. Methods: A total of 30 collegiate baseball pitchers were classified into two groups according to their injury status: injury-prone group (n = 15) and control group (n = 15). We obtained pitching motion data using three-dimensional motion analysis technique. Results: The horizontal abduction angles of the GH joint during cocking and acceleration phases were considerably greater in the injury-prone pitchers (19.0° at stride foot contact [SFC], −4.0° at maximum external rotation [MER], and −0.3° at ball release) than those in healthy controls (11.7° at SFC, −10.0° at MER, and −6.9° at ball release). Additionally, in the cocking phase, the amount of angular change in the scapular external rotation (ER) was significantly smaller in the injury-prone group than that in the control group (mean difference, −13.0). Conclusion: These results suggest that the injury-prone pitchers have less internal rotation of the scapula and a more horizontal abduction of the GH joint during the cocking and acceleration phases. Therefore, sports medicine practitioners may need to pay considerable attention to the coordination of scapular and GH horizontal movements during pitching for prevention of shoulder injuries.

Anterior cruciate ligament reconstruction (ACLR) is the standard surgical treatment for ACL injury, which typically uses a graft to replace the torn ligament in the knee that uses small incisions with minimally invasive surgery. The optimal knee functions following ACLR depend on rehabilitation processes before and after the surgery. Knee function is the ability of the knee to perform various types of functional movements like walking, squatting, running, jumping, and pivoting where patients expect to achieve maximum knee function or at least more than 80% of its initial condition before the injury to avoid being categorized as poor knee function after ACLR. Patients use patient-reported outcome measures to collect data on their health status and quality of life after ACLR. Post-traumatic osteoarthritis (PTOA) is a type of OA that manifests in local cartilage injury caused by chondrocyte death, and matrix dispersion occurs following a joint injury like ACL injury. Gender, time from injury to surgery, and graft type were considered as risk factors for poor knee function after ACLR, while overweight, meniscus tear, and cartilage defect as risk factors for PTOA. However, age is an internal risk factor for both poor knee function and PTOA following ACLR. This review suggests several strategies to prevent both conditions, including a pre-operative program, comprehensive rehabilitation, body weight control, and return to sport (RTS) consideration based on physical capacity, proper time, and psychological readiness.

Objective: To investigate the differences in self-efficacy (SE) for walking tasks between older patients with knee osteoarthritis (OA) and older adults without knee OA. Methods: A cross-sectional design was employed. Older patients with radiographic knee OA and community-dwelling older adults without knee OA as controls were enrolled in the study. SE for the walking task was assessed using the modified gait efficacy scale (mGES). A Wilcoxon rank-sum test was used to compare the mGES between the groups of participants. A Tobit regression model was used to estimate the difference in mGES. The presence of radiographic knee OA was used as an independent variable. Sex (women), age, and body mass index were used as potential confounding variables in the model. Results: After exclusion, 78 participants (n=40 with knee OA, n=38 controls) were included. The mGES was lower in patients with knee OA than in controls. In the Tobit regression model adjusted for confounding factors, mGES in patients with knee OA was estimated to be 26.8 (95% confidence interval [CI]: 15.8-37.8) points lower than in controls. Conclusion: This study demonstrated that mGES was lower in older patients with knee OA than in older adults without knee OA.

Objective: Previous studies have reported the relationship between nutritional status and gait independence in elderly fracture patients. However, the degree to which nutritional indicators are related to gait independence is unclear. The purpose of this study is to calculate a cutoff value for a nutritional indicator related to gait independence in patients with hip and vertebral compression fractures. Method: This study included 69 patients (33 hip fracture, 36 vertebral compression fracture) who underwent rehabilitation at a convalescent rehabilitation ward. The relationships between nutritional indexes (Mini-Nutritional Assessment-Short Form [MNA^®-SF] and skeletal muscle mass index [SMI] ) at admission and gait independence at discharge were analyzed using logistic regression. In addition, receiver operating characteristic analysis was performed to calculate a cutoff value that predicts gait independence. Results: Among the nutritional indicators used in this study, only MNA^®-SF was significantly able to predict gait independence at discharge, and this association was maintained, even after adjustment for confounders. The calculated MNA^®-SF cutoff values were 5.5 (sensitivity 100%, specificity 46.3%) and 7.5 points (sensitivity 67.9%, specificity 78.0%). Conclusion: This study suggests that MNA^®-SF may be an index for predicting gait independence in patients with hip or vertebral compression fractures in the convalescent rehabilitation ward. The cutoff values calculated in this study were simple and useful index for physical therapists to interpret the results of MNA^®-SF.

Objective: Anterior cruciate ligament (ACL) injury is one of the most frequent sportsinjuries, and previous studies have shown that fatigue is a risk factor for sports injuries.This study aimed to inform prevention of ACL injury by investigating how exercise and desk tasks affect trunk and lower limb alignment and ground reaction force (GRF) during one-legged landing movements. Methods: The study subjects were 12 men who performed a one-legged landing movement from a 30-cm platform before and after fatigue tasks, including lower-limb muscle fatigue, cardiopulmonary fatigue, and brain fatigue tasks. For the measurement of joint angles and moments and GRF, a three-dimensional motion analysis device and a floor reaction-force meter were used. Statistics were performed using Wilcoxon's signed rank sum test as a multiple comparison test with Bonferroni adjustment to compare the difference in effects. Results: The maximum trunk flexion angle during landing on one leg was significantly lower in the brain fatigue group than in the control group. The time to peak vertical GRF (pGRF) was significantly shorter in the leg-muscle fatigue group than in the control group. Conclusion: Brain fatigue may have altered the postural strategy before and after landing, resulting in a decrease in trunk flexion angle. Time to pVGRF was shortened in the leg muscle fatigue group, suggesting that there may be an increased risk of ACL injury. Time to pVGRF during lower extremity muscle fatigue and trunk flexion angle during brain fatigue may be more pronounced during actual sports activities.

Objective: To clarify the effect of intervention with dynamic motor control exercise (DMCE) for the lumbar region on low back pain in sedentary office workers (SOWs). Methods: The participants comprised 32 SOWs with low back pain who were randomly categorized into two groups: the DMCE group and the normal trunk exercise (NTE) group. Both groups performed each exercise for three days per week for 8 weeks. The primary endpoints were evaluated for the lumbar and hip flexion angles during trunk forward bending, effect of low back pain on activities of daily living (using the Oswestry Disability Index), and intensity of low back pain (using the Visual Analog Scale) pre- and post-intervention. The extent of changes was calculated by subtracting the pre-intervention value from the post-intervention value and was compared between the two groups using an unpaired t-test. Results: The extent of changes in the lumbar flexion and hip flexion angles at 10° of trunk forward bending were significantly greater in the DMCE group than in the NTE group, and no significant differences were noted between the two groups at other angles of trunk forward bending. The extent of changes in the Oswestry Disability Index and the Visual Analog Scale scores were significantly greater in the DMCE group than in the NTE group. Conclusion: DMCE is effective in improving motor control in the lumbar region and hip joints, thereby ameliorating low back pain in SOWs.

Objective: Preoperative factors related to perceived leg length discrepancy (PLLD) after total hip arthroplasty (THA) are not well studied. This study aimed to examine the preoperative factors, including hip abductor modulus, related to PLLD one month after THA. Methods: The study included 73 patients diagnosed with osteoarthritis secondary to developmental dysplasia of the hip and a posterior approach to surgery. Multiple logistic regression analysis was performed using the presence or absence of PLLD as the dependent variable and preoperative hip abductor's modulus of elasticity, pain, hip abduction range of motion, hip abductor muscle strength and pelvic obliquity as the independent variable. Additionally, receiver operating characteristic curves were used for the extracted variables for calculating the cutoffs, sensitivity, specificity and area under the curve (AUC) to determine the presence or absence of PLLD. The significance level was set at p<0.05. Results: The hip abductor modulus (odds ratio=1.13; 95% confidence interval=1.06-1.21; p<0.001) was selected as a preoperative factor. The cutoff value to determine the presence or absence of a PLLD was 16.32 kPa. The sensitivity and specificity were 81.8% and 72.5%, respectively, and the AUC was 0.8137. Conclusion: The hip abductor muscle elastic modulus affected PLLD one month after THA. If the preoperative hip abductor elastic modulus is higher than the cutoff value, it may affect the appearance of PLLD at one month postoperatively.

Objective: Exercise therapy to strengthen quadriceps muscle is recommended in rehabilitation program for people with patellofemoral pain syndrome (PFPS). This study aimed to investigate the electromyography (EMG) activity of vastus medialis obliquus (VMO), vastus lateralis (VL) and VMO/VL ratio during PNF in individuals with and without PFPS. Methods: 26 persons with PFPS and 26 healthy subjects participated to study. All subjects performed PNF patterns (Flexion-Adduction-External Rotation (D₁FL), Extension-Adduction-External Rotation (D₂EX), D₁FL+ load, D₂EX+ load) and straight leg raise (SLR). The normalized EMG activity of VMO, VL and VMO/VL ratio were measured and analyzed using repeated measure ANOVA. Results: There were significant main effects of group and exercises for the both VMO and VL (p<0.05). It was found that except SLR and D₂EX, in the other motions PFPS group had lower VMO activity compared to healthy group (p<0.05). For VL except SLR, in the other motions PFPS group had lower VL activity too (p<0.05). The PNF patterns activated VMO more than SLR, however it was not significant (p>0.05). Also; there weren't any significant difference between the two groups in VMO/VL activation ratios. Also, performing the PNF patterns with load increased VMO and VL muscles activity significantly (p<0.05). It also found that in PFPS group the VMO/VL ratio values in PNF patterns were significantly more than SLR and the highest VMO/VL ratio value (0.96) was found during D₂EX. Conclusion: The PNF patterns due to provide optimal VMO/VL ratio value than SLR and proper balance between these two muscles can be recommended in rehabilitation of individuals with PFPS.

Objective: Postoperative complications and non-periprosthetic fractures (NPPFs), which was defined as a fracture existing non- periprosthetic implant, after total hip arthroplasty (THA) have a negative effect on the patients' ability to perform activities of daily living. Thus, investigating these incidences of patients after THA will be valuable as it lead to a more strategic physical therapy interventions and advanced research to prevent these problems. The purpose of this study was to investigate the incidence of postoperative complications related to implants and NPPFs in patients after THA, a more than 10-year follow-up. Methods: This is a retrospective cohort study. A total 892 patients with hip osteoarthritis who underwent primary THA were analyzed (age at surgery was 45-79 years; 805 women; the average follow-up period was 12.4-year). The postoperative complications related to implants and NPPFs were calculated using data from their medical records. Results: The postoperative complications occurred in 37 patients, and NPPFs occurred in 72 patients, who were significantly older, and hip and knee OA diagnosis, compared to patients without NPPFs ( p <.05). The most common cause of NPPFs was minor trauma. In patients aged ≥ 65 years, significantly more NPPFs occurred during the first year after surgery ( p <.05). Conclusion: More than 10-year after THA, the incidence of NPPFs was higher than that of postoperative complications related to implants. Older patients who had hip and knee OA were a significantly higher risk of developing NPPFs due to falls within the first year after surgery.

Objective: Knee pain (KP) and low-back pain (LBP) are common sites of pain and major public health issues among older adults. We investigated the combined association of bilateral KP and LBP with objectively measured physical activity (PA) among adults with knee osteoarthritis (OA). Methods: We recruited 150 knee OA adults and measured steps and PA intensity, including sedentary behavior (SB), low PA (LPA), and moderate-to-vigorous PA, using an accelerometer. KP and LBP were measured using a numerical rating scale. They were classified into 4 groups based on the presence of KP and LBP: with the only unilateral KP (UKP), with the combined UKP and LBP (UKP and LBP), with the bilateral KP (BKP), and with the combined bilateral KP and LBP (BKP and LBP). One-way analysis of covariance was performed to compare physical activity variables (intensity or steps) between the four groups. Results: Overall, 126 patients were enrolled. The prevalence of UKP, BKP, UKP and LBP, and BKP and LBP were 29.4%, 23.8%, 18.3%, and 28.6%. The proportion of SB was higher in the BKP and LBP group than in the other groups (F = 6.51, p < 0.01). The proportion of LPA was lower in the BKP and LBP group than in the other groups (F = 6.21, p < 0.01). Conclusions: The proportions of SB and LPA were significantly worse in knee OA adults with BKP and LBP than in those with UKP. Our findings may be a basis for considering knee OA adults for improving PA.

Objectives: This study aimed to assess physical function such as lower limb function and Activities of Daily Living after surgery for proximal femoral fractures ( unstable medial femoral neck fracture and trochanteric fracture). Methods: This study enrolled 68 patients with proximal femoral fractures. Isometric knee extension strength (IKES), the Japanese Orthopedic Association (JOA) hip score, and the number of days required to develop straight leg raising, transfer, and T-caneassisted gait abilities to become independent were assessed. Patients were classified based on the types of proximal femoral fractures, namely unstable medial femoral neck fracture (bipolar hip arthroplasty [BHA] group), stable trochanteric fracture (S group), and unstable trochanteric fracture (US group). Results: IKES and the JOA hip score were significantly better in the BHA group than in the S and US groups. IKES and the JOA hip score were significantly worse in the US group than in the BHA and S groups. Both transfer and T-cane-assisted gait abilities of patients in the BHA and S groups were indifferent. However, all physical functions were significantly worse in the US group. Conclusions: Our study results suggested that physical therapists plan the different rehabilitation program for the patients with proximal femoral fractures who were classified into three types, namely unstable medial femoral neck fracture, stable trochanteric fracture, and unstable trochanteric fracture, instead of two types.

Objective: To derive a clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty. Methods: This prospective cohort study evaluated the data of 273 individuals undergoing primary total knee arthroplasty. The individual factors, the physical and motor function data were assessed preoperatively upon admission as a baseline survey. The knee joint extension angle and knee joint flexion angle were re-evaluated on postoperative day 14 as a follow-up. The recovery group comprised individuals with a knee joint extension angle of more than -5 degrees and knee joint flexion angle of more than 110 degrees on postoperative day 14. The other patients constituted the non-recovery group. Multivariate logistic regression analysis was used for deriving a clinical prediction rule. Results: The results indicated that the use of a cane, knee joint extension and flexion angles, and Timed Up and Go test time were significant factors for predicting early recovery of knee range of motion after total knee arthroplasty. Furthermore, a clinical prediction rule was derived and included the use of a cane, knee joint extension angle ≥ -15 degrees, knee joint flexion angle ≥ 125 degrees, and a Timed Up and Go test time < 11.2 s. A total clinical prediction rule score ≥ 8 indicated a positive likelihood ratio of more than 10 for a successful outcome and the post-test probability was approximately 95%. Conclusions: The derived clinical prediction rule might be a useful screening tool for proper postoperative goal setting and the establishment of individualized physical therapy programs.

Background: We investigate the association with knee flexion range of motion (ROM) during the acute phases and that at 12 months after total knee arthroplasty (TKA). We also clarified the cut-off ROM during the acute phases in predicting the goal of knee flexion ROM at 12 months. Methods: In this retrospective study, 193 patients with knee osteoarthritis (female:144 patients, age:73.2 ± 7.7 years) who underwent unilateral TKA at an orthopedic clinic were recruited. They underwent assessments of knee flexion ROM at 5 days, 1 month, and 12 months after TKA. The goal of knee flexion ROM at 12 months after TKA was set at 120°. Single and logistic-regression analyses were performed with the dependent variables including the outcome of the goal of knee flexion ROM at 12 months, and the independent variables included knee flexion ROM at 5 days and 1 month, separately. We calculated the cut-off ROM at 5 days and 1 month for predicting the goal of knee flexion ROM at 12 months with receiver operating curve analysis. Results: Knee flexion ROM at 5 days and 1 month were significantly associated with the goal of that at 12 months (p < 0.01). The cut-off ROM were 85° at 5 days and 105° at 1 month separately. Conclusions: Our results suggest the importance of early improvement in knee flexion ROM after TKA, and that at 1 month postoperatively indicates the likelihood of achievement of the goal of knee flexion ROM at 12 months after TKA.

Objective: Deep vein thrombosis (DVT) is a severe complication after total knee arthroplasty (TKA). Performing self-calf massage may decrease the incidence of DVT. The purpose of this study was to investigate whether self-calf massage is effective for preventing DVT after TKA. Method: In all, 165 patients participated in the present study. Patients were randomized to one of two groups: the self-calf massage group or the control group. In the control group, patients started regular physical therapy. In the self-calf massage group, in addition to regular physical therapy, patients were instructed to massage their calf muscles 30 times from the distal to proximal side. This procedure was repeated three times and was completed in 2 mins during the 2 days following TKA. All patients were evaluated for DVT on postoperative day 3 using lower limb vein ultrasonography. Results: The incidence of DVT was significantly lower in the self-calf massage group than in the control group. Self-calf massage was associated with a lower incidence of DVT, whereas age and female sex were risk factors for DVT. Conclusion: This study showed that the self-calf massage may be beneficial for the prevention of DVT after TKA.