Managing knee Osteoarthritis (KOA) effectively often requires a multifaceted approach that includes various manual therapy techniques to reduce pain and improve joint function in the elderly. The effectiveness of manipulation with movement (MWM) and muscle energy technique (MET) is still unclear.
Objective
To compare the efficacy of MWM and MET in the elderly with KOA over time.
Methods
A double-blind randomized control trial was conducted in the rehabilitation division of Surakarta Hospital, Indonesia, with 54 participants randomized into two groups. The effects of MWM and MET on pain (Numeric Rating Scale), knee range of motion, static and dynamic balance, lower limb muscle strength, and fear of falling (FoF) were observed after 4 weeks of treatment and 2 weeks of follow-up. Repeated-measures ANOVA compared mean outcomes over time between the groups, and a t-test compared mean differences between groups.
Results
There was no mean difference in baseline between groups. MET and MWM showed a significant effect of time on all outcome measures (p < 0.05). MWM revealed higher knee flexion (p < 0.001), TUG (p = 0.010) and FoF (p = 0.008) after 4 weeks (p < 0.05). The follow-up resulted in significant differences between groups, knee flexion, TUG and one leg stance (OLS) on the left side and open eyes were higher in the MWM group.
Conclusions
Both MWM and MET were effective treatment strategies in managing KOA. MWM had a greater effect on improving knee flexion movement, dynamic balance and FoF than MET. OLS with open eyes was observed stable in follow-up observation in the MWM group.
BlagojevicMJinksCJefferyA, et al.Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage2010; 18: 24–33.
3.
WahyuniZFauziR. The effect of strengthening exercises with elastic bands in improving the abilities of osteoarthritis knee patients at Condong Catur hospital, Sleman. FisioMu2021; 2: 89–94.
4.
BlalockDMillerATilleyM, et al.Joint instability and osteoarthritis. J Clinical Medicine Insights: Arthritis2015; 8: CMAMD. S22147.
5.
StastnyPLehnertMTufanoJ. Muscle imbalances: testing and training functional eccentric hamstring strength in athletic populations. J Vis Exp: JoVE2018; 1: 1–7.
6.
LiLHuHDiYH, et al.Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis: a systematic review and meta-analysis. World J Clin Cases2022; 10: 954–965.
7.
TsokanosALivieratouEBillisE, et al.The efficacy of manual therapy in patients with knee osteoarthritis: a systematic review. Medicina (Kaunas)2021; 57: 1–12.
8.
FaqihAIBedekarNShyamA, et al.Effects of muscle energy technique on pain, range of motion and function in patients with post-surgical elbow stiffness: a randomized controlled trial. Hong Kong Physiother J2019; 39: 25–33.
9.
TalleyJTGotoKK. Osteopathic manipulative treatment: muscle energy procedure with post-isometric relaxation – thoracic vertebrae. Treasure Island (FL): StatPearls Publishing, 2024.
10.
DavisAMKingLKStanaitisI, et al.Fundamentals of osteoarthritis: outcome evaluation with patient-reported measures and functional tests. J Osteoarthritis2022; 30: 775–785.
11.
HancockGHepworthTWembridgeK. Accuracy and reliability of knee goniometry methods. Journal of Experimental Orthopaedics2018; 15: 46.
12.
NorkinCCWhiteDJ. Measurement of joint motion: a guide to goniometry. Philadelphia: F. A. Davis Company, 2016, p.592.
13.
El-SobkeyS. Normative values for one-leg stance balance test in population-based sample of community-dwelling older people. Middle East Journal of Scientific Research2011; 7: 497–503.
14.
KomalasariDRAmaliaH. Reliability test of the functional reach test for measuring static balance in patient with knee osteoarthritis. Jurnal Sains dan Kesehatan2023; 5: 615–622.
15.
KomalasariDRMotikAFSudaryantoAW. Reliability of dynamic balance test with the timed up and go test in elderly with knee osteoarthritis. Jurnal Medika Udayana2023; 12: 86–93.
16.
KhunaLSoisonTPlukwongchuenT, et al.Reliability and concurrent validity of 30-s and 5-time sit-to-stand tests in older adults with knee osteoarthritis. Clin Rheumatol2024; 43: 1–11.
17.
AnggaraniAPDjoarRK. Development and validation of the modified falls efficacy scale Indonesian version. Jurnal Keperawatan Soedirman2020; 15: 1–6.
18.
TakasakiHHallTJullG. Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis : a prospective case series. Physiother Theory Pract2013; 29: 87–95.
19.
Kaya MutluEErcinERazak OzdınclerA, et al.A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: a randomized three arm clinical trial. Physiother Theory Pract2018; 34: 600–612.
20.
UsmanGTamjeedGWassiA. Comparative effects of muscle energy and mobilization with movement techniques on knee pain, range of motion and functional disability in patients with knee osteoarthritis. Xi'an Shiyou Daxue Xuebao (Ziran Kexue Ban)/J Xi'an Shiyou Univ2023; 19: 40–464.
21.
WitwitRTShadmehrAMirSM, et al.Comparison of non-thrust manipulation VS. muscle energy techniques in management of patients with knee osteoarthritis: a randomized clinical trial. NeuroQuantology2022; 20: 6843.
22.
JamaludinUAgusW. The effect of belt mobilization therapy on reducing pain in chronic knee osteoarthritis (OA) at RSU ‘Aisyiyah Ponorogo’. FisioMu2021; 2: 23–29.
23.
ManzoorAAnwarNKhalidK, et al.Comparison of effectiveness of muscle energy technique with Mulligan mobilization in patients with non-specific neck pain. JPMA2021; 71: 1532–1524.
24.
RazzaqANadeemRDAkhtarM, et al.Comparing the effects of muscle energy technique and mulligan mobilization with movements on pain, range of motion, and disability in adhesive capsulitis. JPMA2022; 72: 13–16.
25.
BagcaciSUnuvarBSGercekH, et al.A randomized controlled trial on pain, grip strength, and functionality in lateral elbow pain: mulligan vs muscle energy techniques. J Back Musculoskelet Rehabil 2023; 36: 419–427.
26.
VaidyaABabuVSMungikarS, et al.Comparison between muscle energy technique and Mulligan’s mobilization with movement in patients with anterior innominate iliosacral dysfunction. J Int J Health Sci2019; 1: 76–84.
27.
HariharasudhanRBalamuruganJ. Effectiveness of muscle energy technique and Mulligan′ s movement with mobilization in the management of lateral epicondylalgia. J Arch Med Health Sci2015; 3: 198–202.
28.
MossPSlukaKWrightA. The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Man Ther2007; 12: 109–118.
29.
SkybaDARadhakrishnanRRohlwingJJ, et al.Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord. Pain2003; 106: 159–168.
ChaitowLCrenshawK. Muscle energy techniques. Elsevier Health Sciences, 2006.
32.
KruseARivaresCWeideG, et al.Stimuli for adaptations in muscle length and the length range of active force exertion-A narrative review. Front Physiol2021; 12: 742034.
33.
WeleslassieGGTemesgenMHAlamerA, et al.Effectiveness of mobilization with movement on the management of knee osteoarthritis: a systematic review of randomized controlled trials. Pain Res Manag2021; 2021: 1–12.
34.
AlkhawajahHAAlshamiAM. The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial. J BMC Musculoskelet Disord2019; 20: 1–9.
35.
TaherAFBagheriHAshnagarZ, et al.Comparison of effects of Mulligan techniques and muscle energy technique on pain and function in knee osteoarthritis. J Mod Rehabil2022; 1: 103–113.
36.
AltmışHOskayDElbasanB, et al.Mobilization with movement and kinesio taping in knee arthritis-evaluation and outcomes. Int Orthop2018; 42: 2807–2815.
37.
ThiamwongLXieRConnerNE, et al.Body composition, fear of falling and balance performance in community-dwelling older adults. Transl Med Aging2023; 7: 80–86.
38.
KevinRVBryanPCBenjaminJF, et al.The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint. PM&R2012; 4(5 Suppl): S3–S9.
39.
39. SailorSMehtaYShahN, et al.A comparative study of muscle energy technique and positional release technique on hamstring flexibility in healthy individuals. J Integr Health Sci2018; 6: 64–68.
40.
KalidhasanSKotteeswaranKAnbarasonA, et al.Effectiveness of muscle energy technique and strengthening exercises by KOOS in knee osteoarthritis strengthening exercise in reducing pain to improve functional activity measured by KOOS in knee osteoarthritis. Indian J Physiother Occup Ther – Int J2024; 18: 574–580.
41.
GashMCKandlePFMurrayIV, et al.Physiology muscle contraction. Treasure Island (Finlandia): StatPearls, 2023.
42.
KristinVKatie CapistranMChristenL. Proprioception: an evidence-based review. J Hand Ther2024; 37: 269–272.
