Investigation of the immediate effects of Mobilisation with Movement on patients with osteoarthritis of the knee

The treatment condition has three levels: manual therapy, a placebo and a control condition. Participants will experience each treatment condition in a random order over three separate sessions. Participants will attend at approximately the same time of day on three occasions, each separated by at least 24 hours in order to control for carry-over effects. 'Mobilisation with Movement' manual therapy technique: This will consist of a passive glide (MWM) to the affected knee with a superimposed active movement in partial weight-bearing. The participant will be positioned in standing with the foot of the affected side resting on a 10 cm block. The therapist will stand beside the participant on the affected side. The therapist’s hands will hold around the distal femur and proximal lower leg region (fibula and tibia and surrounding soft tissues). The therapist will apply a sustained, passive mobilisation glide to the tibia relative to the femur, whilst the participant is asked to actively move the affected knee into flexion until the point of stiffness or onset of pain, with care by the therapist to avoid any skin areas that are hyperalgesic to touch. The direction of the glide (medial/lateral, anterior/posterior or rotary) will be decided pragmatically by the treating therapist as the one giving greatest pain relief and/or improvement in range of motion. Three sets of 10 repetitions will be applied with a rest interval of one minute between each set. The participant will be instructed that the MWM procedure, including knee flexion, is to be pain free, and must be ceased immediately if any pain is experienced during the application. If a pain-free technique cannot be achieved in weight-bearing, then the same technique will be applied with the participant lying supine (non-weight-bearing) on the treatment bed.