End-range Mobilization on Pressure Pain Threshold

Knee osteoarthritis (OA) is the most common form of arthritis contributing to a major cause of disability worldwide. Although many mechanisms may contribute to knee pain severity, the patient-reported hyperalgesia can be attributed to peripheral and central sensitivity in knee OA. Pressure pain threshold (PPT) measurement is a simple and commonly applied method for measuring somatosensory function in musculoskeletal disorders, just as in knee OA. Many trials have shown a lower PPT value in knee OA underlining the presence of peripheral and central sensitivity compared to healthy controls.

Manual therapy techniques, as a preferred treatment option, may not only alleviate pain, but also increase pain tolerance to locally applied mechanical pressure. Positive results of different manual therapy techniques on increase of PPT has been reported in knee OA. End-range manual therapy is an option for the decrease of sensitivity in knee OA; however, the effect of end-range mobilization has not been evaluated so far in knee OA.

Inclusion criteria

• the clinical classification criteria of knee OA according to the American College of Rheumatology
• Categorization of patients as End Of Range Problem based on Maitland manual therapy
• female patients aged between 60 and 80 years
• uni/bilateral moderate-to-severe symptomatic tibiofemoral knee osteoarthritis 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
• 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 aids
• contraindication for manual therapy
• complex regional pain syndrome
• cognitive impairment