Knee Osteoarthritis (OA) is the second most prevalent musculoskeletal disorder in society at almost 29%. As the world gets older and the baby boom population continues to age (along with the rest of us), knee OA becomes more prevalent in the general population. Thus, I wanted to highlight and expound on some important findings in the study “Long-term efficacy of mobilization with movement on pain and functional status in patients with knee osteoarthritis: a randomized clinical trial". (HERE)
This publication investigated pain and functional outcome differences between a control group receiving exercises (Exercises included pelvic bridging, resisted knee flexion and extension, mini squats, and heel raises) and hot packs. The experimental group received MWM’s for the knee as well as the same treatment as the control group.
As an accredited Mulligan Concept Teacher Association member since 2014 and a Certified Mulligan Practitioner since 2007, I view MWMs as the greatest accelerant to my functional and manual treatments in my clinical population. If my patient demonstrates a PILL response, I feel incredibly confident we are going to have a positive outcome much more quickly than waiting on standard care. It’s an accelerant. Getting to both my treatment goals and the patient’s goals much more quickly. Quicker than manipulation, any soft tissue technique, or solely exercise.
We can see that in the results of this publication. Subjects with symptomatic knee osteoarthritis receiving two weeks of mobilization with movement in addition to usual care had significantly greater improvements than those receiving usual care alone. Beneficial effects were seen in disability, pain, function, and patient satisfaction and were sustained for six months. subjects receiving mobilization with movement together with usual care showed significantly greater improvements in self-reported function, pain, and patient satisfaction than those receiving usual care alone. This effect was apparent immediately after the intervention and was maintained even six months later. However, there were no significant differences between groups for functional mobility as measured with the timed up-and-go test and the 12-step test immediately after the intervention.
I wanted to further discuss this final interesting finding. For the timed up-and-go test and 12-step test the difference between experimental and control groups was evident only after three months. Why? One explanation for this is that pain reduction achieved with mobilization with movement may not have been sufficient to achieve an immediate improvement in these functional activities. These more vigorous activities are not only impaired by pain but also by other factors such as muscle weakness. Muscle strength may have improved over time with repetition during the resumption of normal functional activities and could explain the improvement seen in the experimental group after three months.
Now we do know, from other published research, that exercise reduces pain, increases muscle strength, and improves control around the affected joint. Exercise also potentially has disease-modification effects by increasing the proteoglycan content of cartilage, increasing its thickness, and reducing the rate of joint space narrowing.
So why did the experimental group find MWM’s effective, at different times, in different ways? Both immediate and then also with some delay. Well, the real answer is, that we don’t know all the interplay of affects and contextual residue. But what I do see in clinical practice, is the reports of patients feeling more confident, less afraid, and more willing to MOVE. To engage in the daily trials with the mentality that I’m not broken by my arthritis. What if I can move with no pain, take those stairs, rise from that chair without excessive pushing with my arms, walk around the block, that more is less? More well-tolerated activity yields less pain. And MWM’s inform my patients of that immediately. They don’t have to just trust me, my education, my experience. They can experience the results instantaneously…in real-time.
So as a clinician, I encourage you to just try MWM’s with your knee OA patients. Just try to make that immediate difference. Don’t wait. Accelerate, with a manual therapy accelerant. Get ALL the benefits of exercise and movement without delay. Without struggle. Without just hoping they improve with time.
Eric