"Effectiveness of Mulligan Mobilization Technique and Proprioceptive Exercises Among Patients With Knee Osteoarthritis"

Summary

This research analyzes the effectiveness of Mulligan mobilization in comparison to proprioceptive exercises for treating patients with mild to moderate Knee osteoarthritis whose condition falls under Kellgren and Lawrence grading system Grades 2 and 3. The current study evaluates these therapeutic approaches as a combined method during a 10-week assessment period which incorporates pain intensity measures, movement analysis and functional activities and balance performance together with quality of life improvement. The study implements a preliminary test followed by standardized evaluation tests to establish robust data for Knee osteoarthritis physical therapy strategies.

The study population will include individuals diagnosed with knee OA, aged 40 years and above, clinically diagnosed mild to moderate primary OA in knee. Participants will be recruited from a physical therapy clinic, and will be screened for inclusion and exclusion criteria. Inclusion criteria will include diagnosed cases of knee OA with mild to moderate Grade of OA (According to Kellgren and Lawrence Scale) and the ability to walk without assistive devices for at least 50 feet.

A total of 60 subjects will be chosen equally for three groups (Experimental Group A=Proprioceptive Exercises group), (Experimental Group B=Mulligan Mobilization Technique Group), and (Control Group C= Traditional physical therapy). Double blinding randomized selection through simple random sampling will determine all participants. Study will continue for 10 weeks and a total number of 30 treatment sessions will be given to each patient with 3 sessions per week. Session lasting an average of 40 minutes to an hour each. Assessment of the patients will be done at the beginning of 1st Session day and at the end of treatment of 30th Session day. The research site for this investigation is Physiotherapy Out-Patient Department at National Healthcare Centre, Karachi-Pakistan.

Conditions

• Knee Osteoarthritis

Interventions

OTHER

Mulligan Mobilization technique

i. Mulligan Mobilization for Medial Glide: During the treatment, the patient will be positioned in a prone (face-down) posture. To execute a medial glide, the therapist will position themselves on the side opposite to the target knee. They will place a belt around the patient's waist and lower leg, aligning the upper edge of the belt with the margin of the tibial joint. Using one hand to stabilize the thigh above the knee and the other hand to support the lower leg, the therapist will apply a medial force to the knee using the belt. The therapist will then instruct the patient to flex their knee while maintaining the glide. ii. Mulligan Mobilization for Lateral Glide: To administer a lateral glide to the knee, the therapist will position themselves next to the affected knee. They will employ the belt to facilitate the glide by applying force from the opposite side.

OTHER

Proprioceptive Exercises

i. One leg balance- It requires flexing the opposite leg at the knee, hip, and ankle while standing on the affected foot. This position will be hold for one minute (60 seconds), followed by rest for 10 to 20 seconds, then continue this process twice more. Three repetitions of the same exercise will be performed with the unaffected leg after a brief break. ii. Blind advanced one leg balance- The task will resemble one-legged balance, but the participant will be required to close their eyes while executing the routine, and then repeat it two more times. iii. Toe walking- In this activity, the participant will be instructed to walk a 20-meter distance while balancing on their toes with their toes pointing straight ahead. They will then be asked to walk the same distance again, but this time with their toes pointing outward. After a brief rest, the entire procedure will be repeated once more.

OTHER

Traditional Physical therapy

• Stretching of the Gastrocnemius and Soleus Muscles * Frequency: 3-5 times per week. * Intensity: Stretch to the point of mild discomfort, not pain. * Time: Hold each stretch for 30 seconds and repeat 3 times on each leg. * Type: Static stretching. Gastrocnemius Stretch: Stand facing a wall with one foot forward (slightly bent) and the other foot back (straight). Press the back heel into the floor and lean forward to feel the stretch in the calf. Soleus Stretch: From the same position, slightly bend the back knee while keeping the heel on the ground to target the lower calf (soleus muscle). • Stretching of the Hamstrings * Frequency: 3-5 times per week. * Intensity: Stretch to a tolerable point of tension without causing pain. * Time: Hold each stretch for 30 seconds and repeat 3 times on each leg. * Type: Static stretching. Seated Hamstring Stretch: Sit on the floor with one leg straight and the other bent.

Sponsors & Collaborators

• National Healthcare Center

  lead OTHER

Principal Investigators

• Muhammad Atif Khan, PhD Scholar · National Healthcare Center

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

40 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-03-27

Primary Completion

2025-06-30

Completion

2025-08-31

Countries

• Pakistan

Study Locations