1.    Introduction
Body posture is a significant quantitative variable affecting skeletal and muscular health. Misalignment due to physiological, psychological, and structural factors can result in repeated pressure distribution on the musculoskeletal joints, leading to joint cartilage degradation and severe postural abnormalities (1). The knee joint, being the body's largest joint, plays a crucial role in stability and weight-bearing capacity. In a normal standing position, the center of gravity or the lower limb's mechanical axis aligns with the knee joint's center, evenly distributing weight between its inner and outer aspects. However, in bracket knee deformity, the knees diverge while the inner ankles draw closer, causing a duck-like gait, with weight primarily borne on the outer edge of the foot. Knee brace movement disorder is common in early childhood (first 2-3 years) due to growth and mobility, usually resolving by ages 6-7, gradually returning to a normal state (2, 3).
2.    Methods
This study employed a semi-experimental design with pre- and post-test assessments. The statistical population included male primary school students aged 10 to 12, having a 4 cm distance between femoral condyles. Measurement instruments included tape measures, rulers, calipers, or vernier calipers. Before screening, the research adhered to Helsinki ethical principles, obtaining parental consent for participants. Sample criteria comprised healthy individuals without rheumatic diseases, surgery history, congenital deformities, or previous injuries/pain. Thirty-six male students exhibiting knee brace abnormalities were chosen and randomly allocated into three groups (two experimental—corrective exercises and games, and one control group). Sample size calculation utilized J. Power software, considering an effect size of 0.9. Experimental groups underwent four weeks of interventions (following American College of Sports Medicine principles for muscle inhibition, tension, activation, and coordination), including corrective games (ball games, tunnel pass-through, and a local game 'Gorg'). Weekly sessions were held at the Tavn Afza Rehabilitation Center and Tabriz University Laboratory. The control group maintained regular activities without specific interventions. Post-test evaluations were conducted at the study's conclusion. Analysis of covariance and Bonferroni's post hoc test assessed the research hypotheses at a significance level of 0.05.
3.    Results
Demographic characteristics and Q angle variations among the remedial exercises, remedial games, and control groups indicated significant differences. For corrective games, the pre-test Q angle was 10.10±26.11, improving to 6.66±0.97 in the post-test. The corrective exercises group displayed pre-test Q angle values of 10.26±1.28, improving to 8.03±1.15 in the post-test (Table 2). Statistical analysis revealed significant differences between common corrective exercises and corrective games groups (P=0.004), as well as between the corrective games group and the control group (P=0.000). However, no significant difference was found between the common corrective exercises group and the control group (P=0.073).

4.    Conclusion
Exercise therapy following the principles of the American College of Sports Medicine stands as a pivotal method in addressing musculoskeletal disorders. This approach encompasses muscle inhibition, stretching, activation, and coordination. Moreover, regular games commonly played by children can serve therapeutic purposes by enhancing movement performance and preventing movement abnormalities. Several factors contribute to skeletal-muscular abnormalities, especially in the lower limbs and knee joint, including muscle weakness, imbalance, muscular shortening, the use of bulky diapers, bone rickets, and various orthopedic conditions. Previous research has highlighted the effectiveness of combining corrective games and exercises in managing knee brace deformities (Genu varum) in children (6). While significant effects were observed in corrective games during this study, it's noteworthy that targeted corrective games could mitigate knee braces and enhance alignment, thereby potentially preventing children from abstaining from movement therapy programs due to their time-consuming nature.
Ethical Considerations
Compliance with ethical guidelines
Adhering to research ethics principles, this article complies with Helsinki principles, ensuring informed consent for participation in research and reaping the benefits of rehabilitation counseling.
Funding
This research received financial support from the Shams Tabriz Institute of Science and Technology.
Authors' contributions
All authors participated in designing corrective therapeutic exercise methods, implementing the study, and contributing to the writing of this research.
Conflicts of interest
The authors declared no conflict of interest.