Effectiveness of Joint Distraction Versus Passive End Range Overpressure in Osteoarthritis:

Comparative Effectiveness of Joint Distraction Versus Passive End Range Overpressure in Managing Knee Osteoarthritis: A Randomized Clinical Trial

Knee osteoarthritis was a common degenerative joint condition that caused pain, stiffness, reduced range of motion, and functional limitations. This study compared two manual therapy techniques: Joint Distraction and Passive Joint End-Range Overpressure. The goal was to determine which technique was more effective at reducing pain, improving knee range of motion, enhancing function, and improving quality of life in patients with knee osteoarthritis. Participants were randomly assigned to receive either Joint Distraction or Passive Joint End-Range Overpressure for 4 weeks.

Study Overview

• Status: Completed
• Conditions: Osteoarthritis; Osteogenesis; Joint Distraction
• Intervention / Treatment: Other: Joint distraction GROUP A; Other: Passive Joint End-Range Overpressure TO GROUP B

Detailed Description

This study was a randomized clinical trial. A sample of 26 participants aged 40-60 with Grade 2 or Grade 3 Knee Osteoarthritis was recruited from DHQ Hospital and Madinah Teaching Hospital Faisalabad. Participants were randomly assigned to two groups (n=13 each). Group A received the Joint Distraction Technique involving sustained traction of the knee joint for 20 minutes at the patient's perceived threshold. Group B received Passive Joint End-Range Overpressure involving Maitland Grade IV mobilization for 3 minutes, twice, with a 30-second rest interval. Both groups received a 10-minute hot pack before their respective techniques. Interventions occurred 3 times per week for 4 weeks (12 sessions total). Outcome measures included the Visual Analogue Scale (VAS), Goniometer, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Scale (KOOS), measured at baseline and after 4 weeks.

• Study Type: Interventional
• Enrollment (Actual): 26
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Faisalābad, Punjab Province, Pakistan, 3800
      • The University of Faisalabad

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria

• Patients diagnosed with Grade 2 or Grade 3 Knee Osteoarthritis.
• A Kellgren-Lawrence Grade (KLG) of at least 2.
• Age between 40-60 years.
• Knee pain for at least 6 months.
• A minimum pain score of 3 on the Visual Analogue Scale (VAS).

Exclusion Criteria

• Acute inflammation.
• Total Knee Replacement (TKR) surgery.
• Any lumbar spine disease (disc herniation or lumbar stenosis).
• Intra-articular injection.
• Recent tibia or femur fracture.
• Any systemic inflammatory arthritic condition or neurological condition (e.g., rheumatoid arthritis or stroke).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: GROUP A; The joint distraction is the manual approach in knee osteoarthritis. This is very efficient in managing pain, to increase range of motion and reduce stiffness of joint due to osteoarthritis.	Other: Joint distraction GROUP A; The joint distraction is the manual approach in knee osteoarthritis. This is very efficient in managing pain, to increase range of motion and reduce stiffness of joint due to osteoarthritis. A specialized greave would be created to distract the knee joint. Using a platform beneath the lower leg to create counterpressure, the knee would be put in flexion while sustained traction will be performed for 20 minutes while the patient would be in a supine posture. In each session, the traction would be adjusted to the patients' perceived threshold. The least amount of work that caused patients to get distracted would be employed as a diversion
Experimental: GROUP B; The passive joint end-range overpressure is the technique of Maitland grade IV which is performed passively. End-range Individual Maitland mobilizations were carried out at the tibiofemoral joint.	Other: Passive Joint End-Range Overpressure TO GROUP B; The passive joint end-range overpressure is the technique of Maitland grade IV which is performed passively. End-range Individual Maitland mobilizations were carried out at the tibiofemoral joint. Depending on the patient's level of pain and tolerance, an oscillatory accessory approach using Grade III or IV was carried out. Patients positioned their knees in their true end range while lying supine on the plinth. The most limited or reproducible knee pain was caused by the accessory approach that was employed. By moving the therapist's body without making any additional movements, the physical contact accurately replicated the hand position of the mobilization. For three minutes, Maitland mobilization was carried out twice at a rate of one oscillation every one or two seconds, with a 30-second break in between

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity	Primary Outcome Measure Pain Tool Used: Visual Analogue Scale (VAS) The Visual Analogue Scale (VAS) was used to assess the patient's pain level. Participants were asked to rate their pain on a scale from 0 to 10. 0 = No pain 1-3 = Mild pain 4-6 = Moderate pain 7-10 = Severe pain This scale was used to categorize the intensity of pain experienced by patients with knee osteoarthritis.	4 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Life / Broader Function	Quality of Life / Broader Function Tool Used: KOOS Questionnaire (Knee Injury and Osteoarthritis Outcome Scale. The KOOS questionnaire was used to assess: Pain Symptoms Activities of Daily Living (ADLs) Sport and Recreation Function Knee-related Quality of Life It contains 42 items divided into five sections: Pain = 9 items Symptoms = 7 items Activities of Daily Living = 17 items Sport and Recreation Function = 5 items Quality of Life = 4 items Each item is scored from 0 to 4. Maximum score: 42 items × 4 = 168 Interpretation (Percentage Based): < 40% = Extreme disability 40-59% = Severe problems 60-79% = Moderate problems 80-99% = Mild disability This questionnaire evaluates the overall impact of knee osteoarthritis on function and quality of life.4 months	4 months
Disability	Secondary Outcome Measures 1) Osteoarthritis Symptoms and Functions Tool Used: WOMAC Questionnaire (Western Ontario McMaster Universities Osteoarthritis Index) The WOMAC questionnaire was used to assess: Pain Stiffness Physical function It contains 24 items divided into three sections: Pain = 5 items Stiffness = 2 items Physical Function = 17 items Each question has 5 response options ranging from None to Extreme. Scoring: Each item = 0-4 points Pain section total = 20 Stiffness section total = 8 Physical function section total = 68 Total WOMAC score = 96 Interpretation: 0-30 = Mild 31-60 = Moderate 61-96 = Severe The higher the score, the greater the symptoms and functional limitations.	4 months
Passive Range of Motion	Passive Range of Motion Tool Used: Goniometer A goniometer was used to assess joint range of motion. The instrument consists of three parts: Moving Arm - aligned with the body segment that moves. Stationary Arm - aligned with the body segment that remains stationary. Fulcrum - positioned over the joint being assessed. The goniometer was used to measure the knee joint's range of motion before and after treatment.	4 months

Collaborators and Investigators

• Sponsor: University of Faisalabad

Study record dates

Study Major Dates

• Study Start (Actual): December 25, 2025
• Primary Completion (Actual): May 12, 2026
• Study Completion (Actual): May 25, 2026

Study Registration Dates

• First Submitted: June 23, 2026
• First Submitted That Met QC Criteria: July 14, 2026
• First Posted (Actual): July 17, 2026

Study Record Updates

• Last Update Posted (Actual): July 17, 2026
• Last Update Submitted That Met QC Criteria: July 14, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: osteoarthritis; pain; range of motion; traction
• Additional Relevant MeSH Terms: Neurologic Manifestations; Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Osteoarthritis
• Other Study ID Numbers: TUF/EIRB/143/2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No