Comparison of Effects of Mulligan Techniques and Muscle Energy Technique on Pain and Function in Knee Osteoarthritis
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Abstract
Introduction: Osteoarthritis (OA) is a chronic degenerative disabling worldwide disorder in which the knee osteoarthritis range of motion (ROM) is particularly reduced. Mobilization with Movement (MWM) has shown rapid improvements in pain and functions. The muscle energy technique (MET) is claimed to be effective in muscle lengthening, strengthening, and increasing joint ROM.
Materials and Methods: A clinical trial was conducted to compare knee Mulligan (lateral, medial, and rotational glides) techniques (n=15), and post-isometric relaxation muscle energy techniques (quadriceps, hamstring, and tensor fascia latae) (n=15) on pain and function in OA.
Results: Twenty-two subjects (73.3%) were grade-II of knee OA and 8 subjects (26.7%) with grade III. The visual analogue scale (VAS) showed significant changes in the reduction of pain. In the VAS, the main effect of time of treatment shows that the mean value of the VAS score was statistically significant between at least two assessment stages (before the first session, after the third session, and after a month) (P<0.001) in each group. In knee osteoarthritis outcome score (KOOS), the main effect of time of treatment shows that the mean value of KOOS score is statistically significant in increasing KOOS between at least two assessment stages (before the first session, after the third session, and after a month) (P<0.001) in each group. KOOS showed significant changes for increasing function. Timed up and go (TUG) score showed decremental significant changes in time. In the TUG score, the main effect of time of the treatment shows that the mean value of the TUG score was statistically significant between at least two assessment stages (before the first session, after the third session, and after a month ) (P<0.008). In ROM score, the main effect of time of the treatment shows that the mean value of ROM score was statistically significant in increasing ROM between at least two assessment stages (before the first session, after the third session, and after a month) (P<0.002, observed power= 0.927).
Conclusion: Applying MWM is more functionally effective than applying the post-isometric relaxation muscle energy technique, both interventions increase functional performance in the short term in patients with chronic knee osteoarthritis, but they are not functionally effective from a single session. Applying both techniques has effects on reducing pain immediately and in the short term.
Ashraf Ramadan Hafez, Ahmed H. AL-Johani, Abdul Rahim Zakaria, Abdulaziz AL-Ahaideb, SyamalaBuragadda, GaneswaraRaoMelam, John K. Shajj. Treatment of Knee Osteoarthritis in Relation to Hamstring and Quadriceps Strength. J. Phys. Ther. Sci. 2013; 25: 1401–1405.
Goldring SR, Goldring MB.Clinical aspects, pathology and pathophysiology of osteoarthritis. J Musculoskeletal Neuronal Interact 2006;6(4):376-8.
Lawrence RC FD, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum.;58(1):26–35. 2008.
Michael JW, Schlüter-Brust KU, Eysel P.The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee.DtschArzteblInt 2010;107(9):152-62.
Ledingham J, Regan M, Jones A, Doherty M: Radiographic patterns & association of OA knee in patients referred to hospital. Ann Rheum Dis 1993, 52(7):520526.
Mackinnon CD, Winter DA. Control of whole body balance in the frontal plane during human walking. J Biomech 1993; 26(6): 633-644.
Dieppe, P. Osteoarthritis: time to shift the paradigm. British Medical Journal, 1999; 318, 1299-1300.
K Satku.Clinical Practice Guidelines Osteoarthritis of the Knees. Singapore. Ministry of Health; 2007
Hortobágyi T, Westerkamp L, Beam S, Moody J, Garry J, Holbert D, DeVita P. Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis.ClinBiomech (Bristol, Avon). 2005 Jan;20(1):97-104.
Philadelphia Panel. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Shoulder Pain. Phys Ther.2001; 81(10):1719–1730.
Deyle GD, Henderson NE, Matekel RL, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med.2000; 132(3):173–181.
Gail D Deyle, Stephen C Allison et al., Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program, PHYS THER.2005; 85(12):1301-1317
Paul A Van Den Dolder, Roberts. Six sessions of Manual Therapy increase knee flexion & improve activity in people with anterior knee pain: a randomised controlled trial. Aust J Physiother. 2006;52(4):261-4.
M.A. Fitzcharles, “Is it time for rheumatologists to rethink the use of manual therapies?” The Journal of Rheumatology, vol. 29, no. 6, pp. 1117–1120, 2002.
P. A. van den Dolder and D. L. Roberts, “Six sessions of manual therapy increase knee flexion and improve activity in people with anterior knee pain: a randomized controlled trial,” Australian Journal of Physiotherapy, vol. 52, no. 4, pp. 261–264, 2006.
M. W. Romanowski, M. Majchrzak, A. Kostiukow, R. Malak et al., “Effect of manual therapy on pain sensation and hand dexterity and grip strength in a patient with RA. Didactic case study,” Orthopedic TraumatologiaRehabilitacja, vol. 20, no. 2, pp. 157–162, 2018 30.
Mulligan, B., Manual Therapy, - “NAGS”, “SNAGS”, MWMS” etc. 5th ed. 2004.
Konstantinou K, Foster N, Rushton A, Baxter D 2002 The use and reported effects of mobilization with movement techniques in low back pain management; a cross-sectional descriptive survey of physiotherapists in Britain. Manual Therapy 7: 206–214
Mulligan BR 2004 Manual Therapy NAGS SNAGS MWMS etc. Wellington, Plane View Services
Linda Exelby. Peripheral Mobilisation with Movement. Manual therapy.1996;1(3):118-126.
Vicenzino, B. and A. Wright, Effects of a Novel Manipulative Physiotherapy Technique on Tennis Elbow: A Single Case Study. Manual Therapy. 1995;1(1):3035.
AbbottJH, PatlaCE, JensenRH2001Theinitialeffectsofanelbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia. Manual Therapy 6: 163–169
Vaseghnia A, Shadmehr A, Attarbashi Moghadam B, Olyaei G, et al. Effects of Muscle Energy Technique on Daily Activities and Lumbar Stiffness in Women with Sacroiliac Joint Dysfunction: A Randomized Controlled Clinical Trial Study. jmr. 13(1):23-30.
Grubb ER, Muscle energy, university of Kentucky, at 690,2010
Mohd.Waseem, ShibiliNuhmani. Efficacy of Muscle energy technique on hamstring muscle flexibility in normal Indian collegiate males, Calicut medical journal 2009; 7.
Anwer S, Alghadir A. Effect of isometric quadriceps exercise on muscle strength, pain, and function in patients with knee osteoarthritis: a randomized controlled study. J Phys Ther Sci. 2014;26(5):745-748. doi:10.1589/jpts.26.745.
Professional Education Council of the National Athletic Trainer’s Association. 2011. Athletic Training Competencies. 5th Edition.
Clinical Application of Neuromuscular Techniques, Volume 2, 2nd Edition, The Lower Body, Leon Chaitow Judith DeLany,5th July 2011. Pages 125 and 126.
30 .P. Ratan Khuman, et al. Immediate Effects of Single Session Post Isometric Relaxation Muscle Energy Technique Versus Mulligan’s Bent Leg Raise Technique on Pain and Hamstring Flexibility in Knee Osteoarthritis Participants: A Randomized Controlled Study. September 2014.
31. Komal Tariq, Filza Shoukat, Umair Ahmed, Effectiveness of Mulligan's Bent Leg Raise Technique Versus Muscle Energy Technique on pain intensity and Hamstring flexibility in patients with knee osteoarthritis. Rawal Medical Journal: Vol. 45. No. 2, April-June 2020
33 Jadhav, Vrushali&Anap, Deepak. (2015). Effectiveness of Mulligan Mobilization with conventional Physiotherapy in Knee Osteoarthritis - A Case Series.Int J Clin and Biomed Res. 1. 15-21.
33 Jadhav, Vrushali&Anap, Deepak. (2015). Effectiveness of Mulligan Mobilization with conventional Physiotherapy in Knee Osteoarthritis - A Case Series.Int J Clin and Biomed Res. 1. 15-21.
32. Khan AA, Rizvi J.The effects of muscle energy technique and static stretching of gastrocnemius on pain and disability in knee osteoarthritis.
33 Jadhav, Vrushali&Anap, Deepak. (2015). Effectiveness of Mulligan Mobilization with conventional Physiotherapy in Knee Osteoarthritis - A Case Series.Int J Clin and Biomed Res. 1. 15-21.
34 Vrushali S, et al. Effectiveness of mulligan mobilization with conventional physiotherapy in knee osteoarthritis: -a case series Int J Clin and Biomed Res. 2015;1(1): 15-21. (www.ijhsr.org) 258Vol.7; Issue: 4; April 2017
35J.E.Bialosky, M.D.Bishop, D.D.Price, M.E.Robinson, and S. Z. George, “The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model,” Manual Therapy, vol. 14, no. 5, pp. 531–538, 2009.
36 Neelapala, Y. V. R., Reddy, Y. R. S., &Danait, R. (2016). Effect of Mulligan's posterolateral glide on shoulder rotator strength, scapular upward rotation in shoulder pain subjects—A randomized controlled trial. Journal of Musculoskeletal Research, 19(03), 1650014.
37 Mulligan BR. Manual Therapy: NAGS, SNAGS, MWM etc, 6th ed. wellington, New Zealand: Plane View Services; 2010.
38 Bill Vicenzino, AatitPaungmali, Pamela Teys. Mulligan’s mobilization-withmovement, positional faults and pain relief: current concepts from a critical review of literature. Manual therapy 12(2007) 98-108.
39 W.A.Hing. Positional Fault: Fact or fiction? Musculoskeletal Diagnostic Imaging Unit.
40 Croft P. Diagnosing regional pain: The view from primary care. Baillieres Best Pract Res ClinRheumatol.1999; 13:231- 42.
| Files | ||
| Issue | Vol 17 No 1 (2023) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v17i1.11302 | |
| Keywords | ||
| Osteoarthritis Knee Muscle energy Mobilization with movement | ||
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