This study is designed to investigate whether a hands-on therapy called Mobilization with Movement (MWM) can reduce pain and inflammation in individuals with knee osteoarthritis (OA). The investigators will compare MWM to a sham treatment that resembles mobilization but does not involve the specific therapeutic movements. Both groups will also receive standard care, including exercise and education about managing knee OA.

A total of 40 adults (aged 18 years and older) with moderate to severe knee OA will be enrolled. Participants will be randomly assigned to either the MWM group or the sham group. Each intervention will be delivered twice per week over a four-week period.

Outcomes will include measures of inflammation obtained from blood samples, self-reported pain levels, and assessments of knee function before and after the intervention period. It is hypothesized that individuals allocated to the MWM group will demonstrate reduced inflammation and pain compared with those in the sham group. The findings of this study may help clarify the potential role of MWM as a treatment option for knee OA.

Inclusion Criteria:

• Clinical diagnosis of unilateral or bilateral knee osteoarthritis (OA) according to the criteria of the American College of Rheumatology
• Age ≥ 18 years
• Kellgren-Lawrence grade 2 or 3 knee OA
• Pain intensity > 3 on a visual analogue scale (VAS)
• Body mass index (BMI) between 18.5 and 30 kg/m²

Exclusion Criteria:

• Knee or lower limb surgery within the last six months.
• Significant joint disorders (e.g., rheumatoid arthritis, gout, or other inflammatory arthritis).
• Recent significant acute infections.
• Contraindications to mobilization with movement.
• Current or recent use systemic glucocorticoids, intra-articular glucocorticoid injections or intra-articular hyaluronic acid injections.

While participants and outcome assessors are blinded to treatment allocation, therapists delivering the MWM and sham mobilization interventions are aware of the assigned treatment for each participant. However, therapists are blinded to all outcome measures, including pain scores, inflammatory marker results, and functional assessments.