Effect of Combined Interventions on Pressure Pain Threshold

The positive effect of different manual mobilizations have been proven in the management of knee osteoarthritis (KOA). Pressure pain threshold, as a measure of somatosensory function, is a well-applied measurement technique for the pain perception in KOA. The effect of mobilizations on decrease of peripheral and central sensitivity has been proven in KOA. Furthermore, few studies has revealed the effect of conservative therapy as an effective intervention in the increase of pain threshold. However, no study has investigated the effect of these interventions combined till date in KOA, which could give a long-lasting effect in the decrease of sensitization in KOA.

Therefore, the aim of the present study is to investigate the short-term and long-term effect of end-range mobilization in addition to conservative therapy on decrease of pressure pain threshold in KOA.

Inclusion criteria

• clinical classification criteria of knee osteoarthritis according to the American College of Rheumatology
• categorization as End of Range Problem based on Maitland manual therapy
• unilateral/bilateral moderate-to-severe symptomatic tibiofemoral KOA with radiographic evidence of Kellgren-Lawrence scale 2 or 3
• pain during weight-bearing activities at least within 6 months
• at least 90° knee flexion
• sufficient mental status

Exclusion criteria

• acute inflammation of the knee
• total knee replacement in the opposite side
• class II. obesity (body mass index>35kg/m2)
• severe degenerative lumbar spine disease (e.g. spondylolisthesis)
• systemic inflammatory arthritic or neurological condition
• physiotherapy/balneotherapy attendance or manual therapy within 3 months
• intraarticular injections in the prior 12 months
• use of walking aid
• contraindication for manual therapy
• complex regional pain syndrome
• cognitive impairment