Effect of single end-range and not end-range Maitland mobilization on pressure pain threshold and functional measures in knee osteoarthritis: randomised, controlled clinical trial

Miklós Pozsgai; Kyra Udvarácz; Iván A Péter; Péter Than; Nóra Nusser

doi:10.23736/S1973-9087.22.07506-2

Effect of single end-range and not end-range Maitland mobilization on pressure pain threshold and functional measures in knee osteoarthritis: randomised, controlled clinical trial

Eur J Phys Rehabil Med. 2022 Oct;58(5):774-783. doi: 10.23736/S1973-9087.22.07506-2. Epub 2022 Sep 12.

Authors

Miklós Pozsgai^{1

2}, Kyra Udvarácz³, Iván A Péter⁴, Péter Than^{5

6}, Nóra Nusser^{4

5}

Affiliations

¹ Department of Balneology, Harkány Termal Rehabilitation Centre, Harkány, Hungary - miklos.pozsgay@gmail.com.
² Medical School, University of Pécs, Pécs, Hungary - miklos.pozsgay@gmail.com.
³ Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
⁴ Department of Balneology, Harkány Termal Rehabilitation Centre, Harkány, Hungary.
⁵ Medical School, University of Pécs, Pécs, Hungary.
⁶ Department of Orthopedics, Medical School, University of Pécs, Pécs, Hungary.

Abstract

Background: Hyperalgesia is attributed to peripheral and central sensitization in knee osteoarthritis (OA). Pressure pain threshold (PPT) is a relevant method for evaluating pain sensitivity in knee OA. The effect of end-range and not end-range Maitland mobilization for certain time-period on pain sensitivity has not been investigated in knee OA.

Aim: The aim of this study was to investigate the effect of end-range and not end-range Maitland mobilization compared to sham manual therapy technique on PPT and functional measures.

Design: Randomised, controlled clinical trial.

Setting: Outpatient setting.

Population: Sixty-six patients with mild-to-severe knee OA.

Methods: Twenty-one patients (N.=21) received end-range Maitland mobilization (EMGr), twenty patients (N.=20) received not end-range Maitland mobilization (nEMGr) and twenty-two patients (N.=22) received sham manual therapy technique (CG). All interventions were performed once. Evaluation was conducted pre-, postintervention and on the following consecutive second days within a 6-day period. Outcomes were local and distant PPT, Timed Up and Go Test (TUG) and strength of passive resistance of knee at onset of pain.

Results: Local and distant PPT increased, TUG time and strength of passive resistance decreased immediately, local and distant PPT remained decreased in 6-day and 4-day period, TUG time remained decreased in 6-day period in EMGr (all changes P≤0.017). Local PPT increased immediately compared to baseline in nEMGr. In between group comparison, increase of local, distant PPT and strength of passive resistance endures on 2^nd day, 4^th day and postintervention, respectively, in EMGr compared to CG. EMGr compared to nEMGr presented significant difference on 6^th day and 4^th day in local and distant PPT, respectively (all changes P≤0.021). NEMGr presented no significant difference compared to CG on either follow-up.

Conclusions: Single end-range Maitland mobilization is effective immediately and in 4-day period on pain sensitization and immediately on physical function compared to not end-range Maitland mobilization and sham manual therapy technique in knee OA.

Clinical rehabilitation impact: Based on the present results, applying end-range Maitland mobilization is suggested on every second day to maintain alleviation of pain sensitization and increasing passive knee joint mobility effectively in knee OA.

Publication types

Randomized Controlled Trial

MeSH terms

Humans
Musculoskeletal Manipulations* / methods
Osteoarthritis, Knee* / therapy
Pain
Pain Measurement
Pain Threshold
Postural Balance
Range of Motion, Articular
Time and Motion Studies
Treatment Outcome