The Efficacy of Manual Therapy in Patients with Knee Osteoarthritis: A Systematic Review

Alexios Tsokanos, Elpiniki Livieratou, Evdokia Billis, Maria Tsekoura, Petros Tatsios, Elias Tsepis, Konstantinos Fousekis, Alexios Tsokanos, Elpiniki Livieratou, Evdokia Billis, Maria Tsekoura, Petros Tatsios, Elias Tsepis, Konstantinos Fousekis

Abstract

Background and objectives: Osteoarthritis (OA) is among the most common degenerative diseases that induce pain, stiffness and reduced functionality. Various physiotherapy techniques and methods have been used for the treatment of OA, including soft tissue techniques, therapeutic exercises, and manual techniques. The primary aim of this systemic review was to evaluate the short-and long-term efficacy of manual therapy (MT) in patients with knee OA in terms of decreasing pain and improving knee range of motion (ROM) and functionality. Materials and Methods: A computerised search on the PubMed, PEDro and CENTRAL databases was performed to identify controlled randomised clinical trials (RCTs) that focused on MT applications in patients with knee OA. The keywords used were 'knee OA', 'knee arthritis', 'MT', 'mobilisation', 'ROM' and 'WOMAC'. Results: Six RCTs and randomised crossover studies met the inclusion criteria and were included in the final analysis. The available studies indicated that MT can induce a short-term reduction in pain and an increase in knee ROM and functionality in patients with knee OA. Conclusions: MT techniques can contribute positively to the treatment of patients with knee OA by reducing pain and increasing functionality. Further research is needed to strengthen these findings by comparing the efficacy of MT with those of other therapeutic techniques and methods, both in the short and long terms.

Keywords: Mulligan technique; knee osteoarthritis; manual therapy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart.

References

    1. Bijlsma J.W., Berenbaum F., Lafeber F.P. Osteoarthritis: An update with relevance for clinical practice. Lancet. 2011;377:2115–2126. doi: 10.1016/S0140-6736(11)60243-2.
    1. Chan W.P., Lang P., Stevens M.P., Sack K., Majumdar S., Stoller D.W., Basch C., Genant H.K. Osteoarthritis of the knee: Comparison of radiography, CT, and MR imaging to assess extent and severity. AJR Am. J. Roentgenol. 1991;157:799–806. doi: 10.2214/ajr.157.4.1892040.
    1. Muehleman C., Bareither D., Huch K., Cole A.A., Kuettner K.E. Prevalence of degenerative morphological changes in the joints of the lower extremity. Osteoarthr. Cartil. 1997;5:23–37. doi: 10.1016/S1063-4584(97)80029-5.
    1. Gamble R., Wyeth-Ayerst J., Johnson E.L., Searle W.A., Beecham S. Recommendations for the medical management of osteoarthritis of the hip and knee. ArthritisRheum. 2000;43:1905–1915.
    1. Bennell K.L., Hinman R.S. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J. Sci. Med. Sport. 2011;14:4–9. doi: 10.1016/j.jsams.2010.08.002.
    1. Jackson B.D., Wluka A.E., Teichtahl A.J., Morris M.E., Cicuttini F.M. Reviewing knee osteoarthritis—A biomechanical perspective. J. Sci. Med. Sport. 2004;7:347–357. doi: 10.1016/S1440-2440(04)80030-6.
    1. Cook C. Orthopedic Manual Therapy: An Evidence-Based Approach. Pearson Education; Upper Saddle River, NJ, USA: 2012.
    1. Cookson J.C., Kent B.E. Orthopedic Manual Therapy—An Overview: Part I: The Extremities. Phys. Ther. 1979;59:136–146. doi: 10.1093/ptj/59.2.136.
    1. Evans D.W., Lucas N. What is ‘manipulation’? A reappraisal. Man. Ther. 2010;15:286–291. doi: 10.1016/j.math.2009.12.009.
    1. Bialosky J.E., Bishop M.D., Price D.D., Robinson M.E., George S.Z. The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Man. Ther. 2009;14:531–538. doi: 10.1016/j.math.2008.09.001.
    1. Cookson J.C. Orthopedic Manual Therapy—An Overview: Part II: The Spine. Phys. Ther. 1979;59:259–267. doi: 10.1093/ptj/59.3.259.
    1. Bishop M.D., Torres-Cueco R., Gay C.W., Lluch-Girbés E., Beneciuk J.M., Bialosky J.E. What effect can manual therapy have on a patient’s pain experience? Pain Manag. 2015;5:455–464. doi: 10.2217/pmt.15.39.
    1. French H.P., Brennan A., White B., Cusack T. Manual therapy for osteoarthritis of the hip or knee—A systematic review. Man. Ther. 2011;16:109–117. doi: 10.1016/j.math.2010.10.011.
    1. Jansen M.J., Viechtbauer W., Lenssen A.F., Hendriks E.J., de Bie R.A. Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: A systematic review. J. Physiother. 2011;57:11–20. doi: 10.1016/S1836-9553(11)70002-9.
    1. Salamh P., Cook C., Reiman M.P., Sheets C. Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review andmeta-analysis. Musculoskelet. Care. 2017;15:238–248. doi: 10.1002/msc.1166.
    1. Xu Q., Pang J., Zheng Y., Zhan H., Cao Y., Ding C. The effectiveness of manual therapy for relieving pain, stiffness and dysfunction in knee osteoarthritis: A systematic review and meta-analysis. Osteoarthr. Cartil. 2015;23:A387. doi: 10.1016/j.joca.2015.02.715.
    1. Moher D., Shamseer L., Clarke M., Ghersi D., Liberati A., Petticrew M., Shekelle P., Stewart L.A. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst. Rev. 2015;4:1. doi: 10.1186/2046-4053-4-1.
    1. Higgins J.P., Green S., editors. Cochrane Handbook for Systematic Reviews of Interventions. Volume 4 John Wiley & Sons; Hoboken, NJ, USA: 2011.
    1. Dickersin K., Manheimer E., Wieland S., Robinson K.A., Lefebvre C., McDonald S., Central Development Group Development of the Cochrane Collaboration’s CENTRAL Register of controlled clinical trials. Eval. Health Prof. 2002;25:38–64.
    1. Michaleff Z.A., Costa L.O., Moseley A.M., Maher C.G., Elkins M.R., Herbert R.D., Sherrington C. CENTRAL, PEDro, PubMed, and EMBASE are the most comprehensive databases indexing randomized controlled trials of physical therapy interventions. Phys. Ther. 2011;91:190–197. doi: 10.2522/ptj.20100116.
    1. Abbott J.H., Chapple C.M., Fitzgerald G.K., Fritz J.M., Childs J.D., Harcombe H., Stout K. The incremental effects of manual therapy or booster sessions in addition to exercise therapy for knee osteoarthritis: A randomized clinical trial. J. Orthop. Sports Phys. Ther. 2015;45:975–983. doi: 10.2519/jospt.2015.6015.
    1. Asser A.L., Subramanian L. Effectiveness of manual traction of tibio-femoral joint on the functional outcome in knee joint osteoarthritis. Indian J. Phys. Ther. 2014;2:56–61.
    1. Fitzgerald G.K., Fritz J.M., Childs J.D., Brennan G.P., Talisa V., Gil A.B., Neilson B.D., Abbott J.H. Exercise, manual therapy, and use of booster sessions in physical therapy for knee osteoarthritis: A multi-center, factorial randomized clinical trial. Osteoarthr. Cartil. 2016;24:1340–1349. doi: 10.1016/j.joca.2016.03.001.
    1. Kaya Mutlu E., Ercin E., RazakOzdıncler A., Ones N. A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: A randomized three arm clinical trial. Physiother. Theory Pract. 2018;34:600–612. doi: 10.1080/09593985.2018.1423591.
    1. Pollard H., Ward G., Hoskins W., Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: A randomised controlled trial. J. Can. Chiropr. Assoc. 2008;52:229.
    1. Sit R.W.S., Chan K.K.W., Zou D., Chan D.C.C., Yip B.H.K., Zhang D.D., Chan Y.H., Chung V.C.H., Reeves K.D., Wong S.Y.S. Clinic-based patellar mobilization therapy for knee osteoarthritis: A randomized clinical trial. Ann. Fam. Med. 2018;16:521–529. doi: 10.1370/afm.2320.
    1. Bialosky J.E., Beneciuk J.M., Bishop M.D., Coronado R.A., Penza C.W., Simon C.B., George S.Z. Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. JOSPT. 2018;48:8–18. doi: 10.2519/jospt.2018.7476.
    1. Voogt L., de Vries J., Meeus M., Struyf F., Meuffels D., Nijs J. Analgesic effects of manual therapy in patients with musculoskeletal pain: A systematic review. Man. Ther. 2015;20:250–256. doi: 10.1016/j.math.2014.09.001.
    1. McPartland J.M., Giuffrida A., King J., Skinner E., Scotter J., Musty R.E. Cannabimimetic effects of osteopathic manipulative treatment. J. Am. Osteopath. Assoc. 2005;105:283–291.
    1. Lima C.R., Martins D.F., Reed W.R. Physiological Responses Induced by Manual Therapy in Animal Models: A Scoping Review. Front. Neurosci. 2020;14:430. doi: 10.3389/fnins.2020.00430.
    1. Teodorczyk-Injeyan J.A., Triano J.J., Gringmuth R., DeGraauw C., Chow A., Injeyan H.S. Effects of spinal manipulative therapy on inflammatory mediators in patients with non-specific low back pain: A non-randomized controlled clinical trial. Chiropr. Man. Therap. 2021;29:3. doi: 10.1186/s12998-020-00357-y.
    1. Savva C., Giakas G., Efstathiou M. The role of the descending inhibitory pain mechanism in musculoskeletal pain following high-velocity, low amplitude thrust manipulation: A review of the literature. J. Back Musculoskelet. Rehabil. 2014;27:377–382. doi: 10.3233/BMR-140472.
    1. Courtney C.A., Steffen A.D., Fernández-de-las-Pñas C., Kim J., Chmell S.J. Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee. JOSPT. 2016;46:168–176. doi: 10.2519/jospt.2016.6259.
    1. Brantingham J.W., Bonnefin D., Perle S.M., Cassa T.K., Globe G., Pribicevic M., Hicks M., Korporaal C. Manipulative therapy for lower extremity conditions: Update of a literature review. J. Manip. Physiol. Ther. 2012;35:127–166. doi: 10.1016/j.jmpt.2012.01.001.
    1. Knapik D.M., Harris J.D., Pangrazzi G., Griesser M.J., Siston R.A., Agarwal S., Flanigan D.C. The Basic Science of Continuous Passive Motion in Knee Health: A Systematic Review of Studies in a Rabbit Model. Arthroscopy. 2013;29:1722–1731. doi: 10.1016/j.arthro.2013.05.028.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe