Effectiveness of Muscle Energy Techniques and Mulligan Mobilization Along With Conventional Physical Therapy in Knee Joint Osteoarthritis Patients

Khyber Medical University Peshawar

Status: Completed

Conditions: Knee Osteoarthritis

Treatments: Procedure: Mulligan Mobilization; Procedure: Muscle Energy Technique (MET)

Study type: Interventional

Funder types: Other

Identifiers

NCT06954363

KMU/DIR/CTU/2024/015

Details and patient eligibility

About

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.

Full 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.

Enrollment: 24 patients

Sex: All

Ages: 40+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

24 participants in 2 patient groups

Intervention Group

Experimental group

Description:

Participants in this group will receive Mulligan Mobilization combined with Conventional Physical Therapy. Mulligan Mobilization includes medial and lateral tibial glides using a Mulligan belt. Each session will consist of 3 sets of 10 repetitions, administered 5 days a week for 3 weeks. In addition, patients will undergo standard conventional physical therapy exercises such as quadriceps strengthening, straight leg raising, and stretching exercises. Each treatment session will last 30 minutes.

Treatment:

Procedure: Mulligan Mobilization

Control Group

Active Comparator group

Description:

Participants in this group will receive Muscle Energy Technique (MET) targeting the hamstring muscles, in combination with Conventional Physical Therapy. The MET will follow a post-isometric relaxation approach, using both direct and indirect methods depending on patient condition. Each isometric contraction will be held for 10 seconds, followed by a 20-second stretch, repeated for 3 sets. Therapy will be conducted 5 days a week over a 3-week period. Each session will last 30 minutes. The same conventional physical therapy regimen as the intervention group will be applied.

Treatment:

Procedure: Muscle Energy Technique (MET)