ORIGINAL ARTICLE   Open access

European Journal of Physical and Rehabilitation Medicine 2022 October;58(5):774-83

DOI: 10.23736/S1973-9087.22.07506-2

Copyright © 2022 THE AUTHORS

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language: English

Effect of single end-range and not end-range Maitland mobilization on pressure pain threshold and functional measures in knee osteoarthritis: randomised, controlled clinical trial

Miklós POZSGAI ^{1, 2} ✉, Kyra UDVARÁCZ ³, Iván A. PÉTER ¹, Péter THAN ^{2, 4}, Nóra NUSSER ^{1, 2}

¹ Department of Balneology, Harkány Termal Rehabilitation Centre, Harkány, Hungary; ² Medical School, University of Pécs, Pécs, Hungary; ³ Faculty of Health Sciences, University of Pécs, Pécs, Hungary; ⁴ Department of Orthopedics, Medical School, University of Pécs, Pécs, Hungary

BACKGROUND: Hyperalgesia is attributed to peripheral and central sensitization in knee osteoarthritis (OA). Pressure pain threshold (PPT) is a relevant method for evaluating pain sensitivity in knee OA. The effect of end-range and not end-range Maitland mobilization for certain time-period on pain sensitivity has not been investigated in knee OA.
AIM: The aim of this study was to investigate the effect of end-range and not end-range Maitland mobilization compared to sham manual therapy technique on PPT and functional measures.
DESIGN: Randomised, controlled clinical trial.
SETTING: Outpatient setting.
POPULATION: Sixty-six patients with mild-to-severe knee OA.
METHODS: Twenty-one patients (N.=21) received end-range Maitland mobilization (EMGr), twenty patients (N.=20) received not end-range Maitland mobilization (nEMGr) and twenty-two patients (N.=22) received sham manual therapy technique (CG). All interventions were performed once. Evaluation was conducted pre-, postintervention and on the following consecutive second days within a 6-day period. Outcomes were local and distant PPT, Timed Up and Go Test (TUG) and strength of passive resistance of knee at onset of pain.
RESULTS: Local and distant PPT increased, TUG time and strength of passive resistance decreased immediately, local and distant PPT remained decreased in 6-day and 4-day period, TUG time remained decreased in 6-day period in EMGr (all changes P≤0.017). Local PPT increased immediately compared to baseline in nEMGr. In between group comparison, increase of local, distant PPT and strength of passive resistance endures on 2^nd day, 4^th day and postintervention, respectively, in EMGr compared to CG. EMGr compared to nEMGr presented significant difference on 6^th day and 4^th day in local and distant PPT, respectively (all changes P≤0.021). NEMGr presented no significant difference compared to CG on either follow-up.
CONCLUSIONS: Single end-range Maitland mobilization is effective immediately and in 4-day period on pain sensitization and immediately on physical function compared to not end-range Maitland mobilization and sham manual therapy technique in knee OA.
CLINICAL REHABILITATION IMPACT: Based on the present results, applying end-range Maitland mobilization is suggested on every second day to maintain alleviation of pain sensitization and increasing passive knee joint mobility effectively in knee OA.

KEY WORDS: Pain threshold; Musculoskeletal manipulations; Osteoarthritis, knee