Manual Therapy: Knee: Difference between revisions
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It is hypothesised that manual therapy improves function of the kinetic chain (joints and sot tissue) by a combination of mechanical and neuromuscular mechanisms. In particular in the knee, techniques are aimed at increasing the extensibility of collagen, optimising joint lubrication and reduction of muscle tone which all result in improved joint function and joint mobility.<ref name="hun" /> | It is hypothesised that manual therapy improves function of the kinetic chain (joints and sot tissue) by a combination of mechanical and neuromuscular mechanisms. In particular in the knee, techniques are aimed at increasing the extensibility of collagen, optimising joint lubrication and reduction of muscle tone which all result in improved joint function and joint mobility.<ref name="hun" /> | ||
== Indication == | == Indication == | ||
Indications for the use of manual therapy | Indications for the use of manual therapy include<ref name="jam">James W. brantighal et al., Manipulative therapy for lower extremity conditions: Expansion of literature review, National University of Health sciences 2009, 53-71 (Level of evidence: 2A)</ref><span style="font-size: 13.28px;">:</span> | ||
#painful neuromusculoskeletal joint disorder | #painful neuromusculoskeletal joint disorder | ||
#pain in or from palpation of bony joint surfaces | #pain in or from palpation of bony joint surfaces | ||
#pain in of from palpation of joint soft tissues | #pain in of from palpation of joint soft tissues | ||
#decreased or altered range of quality of motion | #decreased or altered range of quality of motion | ||
#pain on | #pain on joint movement. | ||
When there is pain in combination with joint restriction, it is recommended to apply manual therapy together with exercise therapy. There is a consensus that manual therapy can be considered as a preparation for exercise therapy by having an effect on pain and joint limitations <ref name="pet">Peter WF et al.,’ Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.’ Acta Reumatol Port 2011, 268-281 (Level of evidence: 1A )</ref>.<br> | When there is pain in combination with joint restriction, it is recommended to apply manual therapy together with exercise therapy. There is a consensus that manual therapy can be considered as a preparation for exercise therapy by having an effect on pain and joint limitations <ref name="pet">Peter WF et al.,’ Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.’ Acta Reumatol Port 2011, 268-281 (Level of evidence: 1A )</ref>.<br> | ||
== Clinical application == | == Clinical application == | ||
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Description[edit | edit source]
The primary goals of manual therapy of the knee are:
- Modulate pain
- Increase range of motion
- Reduce soft-tissue inflammation
- Improve contractile & non-contractile tissue repair, extensibility, or stability
- Facilitate movement [1] [2] [3]
Manual therapy is defined as the application of manual forces of the therapist, to change/improve the quality and the range of motion of joints and soft tissues. [1] It includes many techniques. The most common are joint mobilization and manipulation. Mobilization is a manual technique with the aid of repeated passive motion at low speed and with varying amplitudes, while manipulation is defined as fast with a small force, small amplitude and high speed of movement of a joint. [3]
It is hypothesised that manual therapy improves function of the kinetic chain (joints and sot tissue) by a combination of mechanical and neuromuscular mechanisms. In particular in the knee, techniques are aimed at increasing the extensibility of collagen, optimising joint lubrication and reduction of muscle tone which all result in improved joint function and joint mobility.[2]
Indication[edit | edit source]
Indications for the use of manual therapy include[4]:
- painful neuromusculoskeletal joint disorder
- pain in or from palpation of bony joint surfaces
- pain in of from palpation of joint soft tissues
- decreased or altered range of quality of motion
- pain on joint movement.
When there is pain in combination with joint restriction, it is recommended to apply manual therapy together with exercise therapy. There is a consensus that manual therapy can be considered as a preparation for exercise therapy by having an effect on pain and joint limitations [5].
Clinical application[edit | edit source]
Manual therapy is often used in clinical practice for osteoarthritis. Although it is often used, there is little research on the effects of the treatment of knee osteoarthritis independently of other interventions, such as exercise therapy. [3]
Manual therapy along with guided exercises reduces pain and stiffness and ensures that the knee function can improve. Also the walking distance in 6 minutes increases after a period from 4 to 6 weeks to 2-3 times a week of manual therapy and guided exercises. Osteoartritis is accompanied by one or more of these symptoms. [6] Two studies of the effect of manual therapy on pain in knee osteoarthritis showed a hypoalgesia effect with a potential analgesic benefit from manual therapy. [3]
A combination of manual therapy and guided exercises has functional benefits for patients with knee osteoarthritis and the need for surgery can be postponed or avoided. Manual therapy and a guided exercise program can reduce the burden of complaint and reduce the suspected higher cost of surgery and rehabilitation after a surgery. [7] Patients with positive scores on the variables of patellofemoral pain, anterior cruciate ligament laxity have no advantages to manual therapy with a supervised exercise program. For such persons, other appropriate measures in their therapy should be taken. [8]
A commonly used form of manual therapy applied to joints are oriented mobilizations called ‘joint glides’, these are performed in specific planes of movement and are intended to restore specific movements. After a session of tibiofemoral anterior glide mobilization occurs a remarkable improvement in the knee extension in the stand phase. These positive effects are only for a short duration. [2]
Manipulative therapy of the knee and/or full kinetic chain combined with multimodal or exercise therapy improves patellofemoral pain syndrome. [4]
There is little or no evidence of the use of manual therapy at acute knee injury, like ligaments or meniscus injury. [9]
Manual therapy is effective for improving knee flexion and it is also effective for climbing stairs in patients with anterior knee pain and there is a trend towards a small improvement in pain. [10] Manual therapy combined with an appropriate exercise therapy seems to be more effective for improving the muscle strength, proprioception and functional performance than just a randomized exercise therapy. Anterior knee pain is associated with the loss of strength and decreased activity of the knee extensors, which refers to a muscle inhibition. After sacroiliac joint manipulation, there was a significant loss in muscle inhibition of the knee extensors. What muscle function benefited, so spinal manipulation may be regarded as an effective treatment of muscle inhibition in the lower limb musculature.[11]
Grading scales [edit | edit source]
The intensity of the mobilization and traction is determined by the grading scale.
Key evidence [edit | edit source]
Here can you find the most important resources:
- Deyle GD et al.,’ Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program’ Physical therapy Dec 2005, 1301-1317
- Carolyn J. et al, ‘Physiotherapy management of knee osteoarthritis.’ International Journal of Rheumatic Diseases 2011, 145-151
- James W. brantighal et al., Manipulative therapy for lower extremity conditions: Expansion of literature review, National University of Health sciences 2009, 53-71
References[edit | edit source]
- ↑ 1.0 1.1 J Haxby Abbott et Al., ’Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomized controlled trial protocol’, trial journal, February 2009 (Level of evidence: 1B )
- ↑ 2.0 2.1 2.2 Michael A. Hunt et al., ‘Effect of Anterior Tibiofemoral Glides on Knee Extension during Gait in Patients with Decreased Range of Motion after Anterior Cruciate Ligament Reconstruction’, Physiother Can. 2012, 235-241 (Level of evidence: 1B)
- ↑ 3.0 3.1 3.2 3.3 Carolyn J. et al, ‘Physiotherapy management of knee osteoarthritis.’, International Journal of Rheumatic Disease 2011, 145-151 (Level of evidence: 1A)
- ↑ 4.0 4.1 James W. brantighal et al., Manipulative therapy for lower extremity conditions: Expansion of literature review, National University of Health sciences 2009, 53-71 (Level of evidence: 2A)
- ↑ Peter WF et al.,’ Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.’ Acta Reumatol Port 2011, 268-281 (Level of evidence: 1A )
- ↑ Deyle GD, Henderson NE, Matekel RL, et al. ‘Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: A randomized, controlled trial.’ Ann Intern Med 2000 Feb, fckLR173–81. (Level of evidence: 1B)
- ↑ Deyle GD et al.,’ Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program’ Physical therapy, December 2005, 1301-1317 (Level of evidence: 1B)
- ↑ Deyle G. et al.,’ A Preliminary clinical prediction rule: knee osteoarthritis patients who are unlikely to benefit from manual physical therapy and exercise’, The journal of manual and manipulative therapy 2009 (Level of evidence: 2B)
- ↑ Carol A Courtney et al, ‘Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions.’, Journal of Manual and Manipulative Therapy 2011, 212-222 (level of evidence: 2A)
- ↑ Paul A. Van den Dolder et al., ‘Six sessions of manual therapy increase knee flexion and improve activity in people with anterior knee pain: a randomized controlled trial’, Australian journal of physiotherapy 2006 vol.52 (Level of evidence: 1B )
- ↑ Esther Sutel; PhD et al., ‘Conservative Lower Back Treatment Reduces Inhibition in Knee-Extensor Muscles: A Randomized Controlled Trial’, Journal of manipulative and physiological therapeutics, February 2000 (Level of evidence: 2B)
