Knee Osteoarthritis
Conditions
Keywords
Knee Osteoarthritis, Muscle Stretching Exercises, Range of Motion, Articular
Brief summary
This study aims to evaluate the effectiveness of integrating Muscle Energy Technique (MET) and Mulligan Mobilization with conventional physical therapy in the management of knee osteoarthritis (OA), with a specific focus on improving hamstring flexibility and reducing functional limitations. The findings will help inform clinical decision-making and enhance patient outcomes in OA rehabilitation.
Detailed description
Osteoarthritis (OA) is a progressive degenerative joint disease characterized by the destruction of articular cartilage and the formation of bone spurs, leading to pain, joint stiffness, and decreased functional mobility. While its exact cause remains unknown, factors such as age, sex, obesity, sedentary lifestyle, genetics, bone density, smoking, and joint location contribute significantly to its development. As patients experience pain and reduced joint mobility, they often limit movement, particularly of the knee, resulting in muscular tightness-most notably in the hamstring, a two-joint muscle. Globally, OA is a major public health concern, with knee OA affecting approximately 250 million people in 2010, including 18% of women and 9.6% of men over 60. It has substantial economic impacts, such as costing the United States 1-2.5% of its GDP and Spain €4.7 billion in 2007. Regional data from South Asia show higher prevalence in rural populations, emphasizing the disease's widespread burden. Physical therapy has been shown to be highly effective in managing knee OA symptoms. Several randomized controlled trials support the use of techniques like Muscle Energy Technique (MET) and Mulligan Mobilization. MET has demonstrated superior efficacy compared to static stretching and whole-body vibration in improving hamstring flexibility and reducing stiffness. Similarly, Mulligan Mobilization, particularly when combined with supervised exercises, has shown better outcomes than Maitland mobilization in improving flexibility and function in OA patients. However, current literature presents conflicting evidence regarding the individual efficacy of MET and Mulligan Mobilization. This study seeks to address these inconsistencies by investigating the effectiveness of integrating both MET and Mulligan Mobilization with conventional physical therapy in treating knee OA. The goal is to provide evidence-based insights that can guide clinicians in optimizing therapeutic strategies for better functional outcomes and enhanced quality of life for patients with knee osteoarthritis.
Interventions
PROCEDUREMulligan Mobilization
Mulligan Mobilization involves manual tibial glides (medial and lateral) using a mobilization belt. The patient lies supine with the knee flexed between 30°-45°. The therapist applies a sustained glide while the patient actively moves the knee into flexion and extension. The treatment is delivered in 3 sets of 10 repetitions per session, 5 days per week for 3 weeks, along with a conventional physical therapy protocol.
PROCEDUREMuscle Energy Technique (MET)
Muscle Energy Technique involves the application of post-isometric relaxation targeting hamstring muscles. The therapist applies a 10-second isometric contraction at the resistance barrier, followed by a 20-second passive stretch, progressing into a new range of motion. This technique is applied 3 times per session, 5 days per week for 3 weeks, in combination with a conventional physical therapy protocol.
Sponsors
Khyber Medical University Peshawar
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
The study will utilize a single-blinded design, where the patients will be blinded to group allocation.
Intervention model description
Participants will be randomly assigned to one of two parallel treatment groups that includes experimental Group (Mulligan Mobilization + Conventional Physical Therapy) and Control Group (Muscle Energy Technique + Conventional Physical Therapy).
Eligibility
Sex/Gender
ALL
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosed cases of osteoarthritis (Grade 1 to 3) * X-ray showing Grades I to III on Kellgren Lawrence scale of Osteoarthritis. * Residents of Peshawar verified via NADRA CNIC * Both genders will be included with unilateral or bilateral knee involvement. * Age group 40 and above. * Duration of Knee pain for more than 3 months.
Exclusion criteria
* History of any previously known neurological conditions i.e. stroke, peripheral neuropathy * Fractures in treatment limb. * Suspicious of malignancy around the knee joint. * Recent under gone surgery * Recent Intra-articular injection. * Significant comorbid diseases and disabilities are excluded from the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hamstring Flexibility Measured by Goniometer | Baseline (Day 1) and Post-treatment (End of Week 3) | Hamstring range of motion (ROM) will be assessed using a goniometer before and after the intervention. The change in ROM will be used to evaluate effectiveness. Outcome improvement categories: Mild Increase: 5-10 degrees Moderate Increase: 10-15 degrees Marked Increase: \>15 degrees |
| Change in Pain Score Using Knee Osteoarthritis Outcome Score-12 questionnaire Questionnaire | Baseline (Day 1) and Post-treatment (End of Week 3) | The function in daily activities subscale of Knee Osteoarthritis Outcome Score-12 questionnaire will assess participants' ability to perform routine activities before and after the intervention. |
| Change in Knee-Related Quality of Life Using Knee Osteoarthritis Outcome Score-12 questionnaire | Baseline (Day 1) and Post-treatment (End of Week 3) | The quality of life (QOL) subscale of KOOS-12 will evaluate the impact of osteoarthritis on participants' knee-related wellbeing pre- and post-treatment. |
| Change in Activity of Daily Living Function Using KOOS-12 | Baseline (Day 1) and Post-treatment (End of Week 3) | The function in daily activities subscale of KOOS-12 will assess participants' ability to perform routine activities before and after the intervention. |
Countries
Pakistan
Outcome results
None listed