End-range Mobilization on Time Curve of Pressure Pain Threshold

The Effect of End-range Mobilization on Time Curve of Pressure Pain Threshold in Knee Osteoarthritis

Pain in knee osteoarthritis (OA) represents increased pain intensity due to peripheral and central sensitivity. Pressure pain threshold (PPT) is a widely applied technique for measuring the magnitude of peripheral and central sensitivity in knee OA. Despite several manual therapy techniques has been proven to increase PPT in knee OA, the effect of end-range mobilization on the time curve of PPT has not been evaluated so far in knee OA. The aim of this study was to investigate the effect of end-range mobilization on the time curve of PPT and some function-related measures in knee OA.

Knee osteoarthritis (OA) is the most common form of arthritis leading to a major 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. Amongst quantitative sensory testing methods, 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 presented lower PPT in knee OA compared to healthy controls underlining the presence of peripheral and central sensitivity.

The different joint-based mobilization techniques may not only alleviate pain, but also increase pain tolerance to the locally applied mechanical pressure. Positive results of these techniques on increase of PPT has been reported in knee OA; however, the time curve of PPT has not evaluated so far in knee OA. Therefore, the aim of this study was to investigate the effect of end-range mobilization on the time curve of PPT and some function-related measures 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 manual therapy
• unilateral/bilateral symptomatic tibiofemoral knee osteoarthritis with radiographic evidence of Kellgren-Lawrence scale between 1 and 3
• pain during weight-bearing activities at least within 6 months
• sufficient mental status

Exclusion Criteria:

• acute inflammation of the knee
• class II. obesity (body mass index, BMI>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 aids
• contraindication for manual therapy
• complex regional pain syndrome
• cognitive impairment