High-power Pain Threshold Ultrasound and Vibration Massage in Treatment Knee Osteoarthritis Patients

Effect of Adding High-power Pain Threshold Ultrasound to Vibration Massage on Calf Muscle Tightness in Knee Osteoarthritis Patients

Calf muscle have tendency of development of trigger points that can increase pain in patients with osteoarthritis. Purpose:To investigate the effect of adding high-power pain threshold ultrasound to vibration massage on calf muscle tightness, pain intensity, pain threshold, and knee function in knee osteoarthritis patients. Subject and methods: Sixty male and female patients diagnosed clinically by physician as having knee osteoarthritis grades II-III participated in the study. Their age ranged from 40 to 60 years. They were assigned randomly into three groups (A, B, C) equal in number. Group (A) received conventional treatment. Group (B) received conventional treatment plus vibration. Group (C) received conventional treatment, vibration and the high-power pain threshold ultrasound. Outcome measurements were taken before and after intervention, so patients received intervention for 12 sessions (three sessions per week). Tape measurement was used to measure the calf muscle flexibility, VAS to measure pain intensity, pressure algometer to measure pain threshold and WOMAC questionnaire to measure the knee functions.

The current study was conducted to investigate the therapeutic effect of adding high-power pain threshold ultrasound to vibration massage on calf muscle tightness,pain intensity, pain threshold and knee function in patients with knee osteoarthritis.The study was conducted on 60 volunteer patients (age 40-60 years) suffering from unilateral knee OA grade II-III.Group (A): consisted of 20 patientsreceived the conventional physical therapy program only (Control group). Group (B): consisted of 20 patientsReceived conventional physical therapy program in addition to vibration massage. Group (C): consisted of 20 patientsreceived high-power pain threshold ultrasound in addition to conventional physical therapy program and the vibration massage. Tape measurement was used to measure the calf muscle flexibility, VAS to measure pain intensity, pressure algometer to measure pain threshold and WOMAC questionnaire to measure the knee functions. SPSS software version 22 was used to conduct all statistical analyses.

Inclusion Criteria:

1. Age from 40 to 60 years' patients of chronic knee OA
2. Patient with unilateral knee OA grade II-III Kellgren and Lawrence (K/L)
3. Patients with BMI < 30 kg/m² (not being classified as obese).
4. Patients who are able to walk with painful knee OAwithoutassistive devices.
5. Patients with knee pain intensity level at least >3 cm on a 10 cm. VAS scale in activities such as going up-and downstairs, sitting and squatting.

Exclusion Criteria:

• Radiated pain from low back pain.
• No radiographic evidence of knee OA or with mild OA (grade I according to K/L classification) or with severe OA (grade IV according to K/L classification).
• Bilateral knee OA.
• Loss of joint play in tibiofemoral and patellofemoral articulations.
• Lower extremity fracture and surgery or trauma to the knee joint.
• Neurological deficit or movement disorder related to lower limb.
• Athletes or who had been treated with physiotherapy or medications during the previous 6 weeks.
• Those who could not apply vibration and percussion stimuli.
• Those who had varicose veins.