Inclusion Criteria:

• Age ≥ 60
• Clinical and radiological diagnosis of knee OA grade I-IV
• Pain ≥ 3 on Numeric Analog Scale for >6 months
• Can walk (with/without aid)
• Cognitive ability to follow instructions
• Signed informed consent
• Availability for 9 treatment sessions and home exercise Exclusion Criteria
• Prior total knee arthroplasty (unilateral or bilateral)
• Neurological disorders affecting motor function or cognition (e.g., Parkinson's disease, stroke, moderate to severe dementia)
• Active inflammatory rheumatic diseases (e.g., rheumatoid arthritis, lupus)
• Presence of pacemakers, implantable defibrillators, or metallic implants near the treatment area
• Current use of other physical therapy modalities for pain (e.g., electrotherapy, ultrasound, TENS) outside the study protocol
• Participation in another clinical trial within the past 3 months
• Current use of NSAIDs or systemic/local corticosteroids (including intra-articular injections)
• Open wounds or active infections at the treatment site
• Decompensated cardiac conditions or medical contraindication to exercise
• Vestibular disorders that affect balance and interfere with functional assessments
• Uncorrected visual impairment interfering with gait or balance (visual acuity worse than 20/60 in the better eye, assessed by Snellen chart)

Withdrawal Criteria:

• Participants who complete fewer than 7 out of the 9 planned intervention sessions (i.e., less than 80% adherence)
• Occurrence of serious adverse events related to the intervention that contraindicate continuation
• Repeated non-compliance with the home exercise program, documented in at least two consecutive weekly follow-up reports
• Voluntary withdrawal of consent at any time during the study

History of severe allergic reactions to study medication Currently pregnant or breastfeeding Recent participation in another clinical trial within the last 30 days Presence of uncontrolled medical conditions that could affect safety