Manual Therapy: Knee: Difference between revisions

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== Description  ==
== Description  ==


The primary goals of manual therapy are<ref name="hax">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 )</ref><ref name="hun">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)</ref><ref name="car">Carolyn J. et al, ‘Physiotherapy management of knee osteoarthritis.’, International Journal of Rheumatic Disease 2011, 145-151 (Level of evidence: 1A)</ref><span style="font-size: 13.28px;">:</span>  
The primary goals of [[Manual Therapy|manual therapy]] are<ref name="hax">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 )</ref><ref name="hun">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)</ref><ref name="car">Carolyn J. et al, ‘Physiotherapy management of knee osteoarthritis.’, International Journal of Rheumatic Disease 2011, 145-151 (Level of evidence: 1A)</ref><span style="font-size: 13.28px;">:</span>  


*Modulate pain  
*Modulate pain  
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*Facilitate movement<br>
*Facilitate movement<br>


[[Manual Therapy|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<ref name="hax" /><span style="font-size: 13.28px;">.</span><span style="font-size: 13.28px;">&nbsp;It includes many techniques, the most common being joint mobilisations and manipulation. </span>[[Knee Mobilizations|Mobilisation]]<span style="font-size: 13.28px;"> is a manual technique with the aid of repeated passive motion at low speed and with varying amplitudes, while </span>[[Manual Therapy|manipulation]]<span style="font-size: 13.28px;"> is defined as fast with a small force, small amplitude and high speed of movement of a joint</span><ref name="car" /><span style="font-size: 13.28px;">. &nbsp;Mobilisations are most commonly employed in the knee.</span>
[[Manual Therapy|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<ref name="hax" /><span style="font-size: 13.28px;">.</span><span style="font-size: 13.28px;">&nbsp;It includes many techniques, the most common being joint mobilisations and manipulation. </span>'''Mobilisation'''<span style="font-size: 13.28px;"> is a manual technique that through repeated passive motion at low speed replicates normal joint glides at varying amplitudes, while </span>'''manipulation'''<span style="font-size: 13.28px;"> is defined as fast with a small force, small amplitude and high speed of movement of a joint</span><ref name="car" /><span style="font-size: 13.28px;">. &nbsp;</span>  


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" /><span style="font-size: 13.28px;">.</span>
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" /><span style="font-size: 13.28px;">.</span>  
 
[[Manual Therapy|Read more about manual therapy]]


== Indication  ==
== Indication  ==
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== Clinical&nbsp;application  ==
== Clinical&nbsp;application  ==
<span style="font-size: 13.28px;">A commonly used form of manual therapy applied to joints are oriented mobilisations called ‘joint glides’, these are performed in specific planes of movement and are intended to restore specific movements. Research demonstrates increased knee extension in standing following tibiofemoral&nbsp;</span>anterior glide mobilisation <span style="font-size: 13.28px;">but these positive effects are only for a short duration</span><ref name="hun" /><span style="font-size: 13.28px;">.</span>


Manual therapy is often used in clinical practice for [[Knee Osteoarthritis|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<ref name="car" /><span style="font-size: 13.28px;">.  
Manual therapy is often used in clinical practice for [[Knee Osteoarthritis|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<ref name="car" /><span style="font-size: 13.28px;">.  
</span>Two studies of the effect of manual therapy on pain in knee osteoarthritis showed a hypoalgesia effect from manual therap<span style="font-size: 13.28px;">y</span><ref name="dey">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)</ref><ref name="car" />. &nbsp;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.&nbsp; 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<ref name="yle">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)</ref>.


Manual therapy along with guided exercises reduces pain and stiffness and allows improved knee function. Two studies of the effect of manual therapy on pain in knee osteoarthritis showed a hypoalgesia effect with a potential analgesic benefit from manual therap<span style="font-size: 13.28px;">y</span><ref name="dey">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)</ref><ref name="car" />.
Manipulative therapy of the knee and/or full kinetic chain combined with multimodal or exercise therapy improves [[Patellofemoral Pain Syndrome|patellofemoral pain syndrome]]<ref name="jam" /><ref name="pau">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 )</ref> 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<ref name="est">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)</ref>  
 
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.&nbsp; 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<ref name="yle">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)</ref>.
 
 
A commonly used form of manual therapy applied to joints are oriented mobilisations called ‘joint glides’, these are performed in specific planes of movement and are intended to restore specific movements. Research demonstrates increased knee extension in stnading following tibiofemoral [[Knee Mobilizations|anterior glide mobilization occurs]] but these positive effects are only for a short duration<ref name="hun" />.
Manipulative therapy of the knee and/or full kinetic chain combined with multimodal or exercise therapy improves [[Patellofemoral Pain Syndrome|patellofemoral pain syndrome]]<ref name="jam" />


There is little or no evidence of the use of manual therapy at acute knee injury, like ligaments or meniscus injury. For such persons, other appropriate measures in their therapy should be taken such as a supervised exercise programme<ref name="eta">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</ref><ref name="rol">Carol A Courtney et al, ‘Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions.’, Journal of Manual and Manipulative Therapy 2011, 212-222</ref>.
There is little or no evidence of the use of manual therapy at acute knee injury, like ligaments or meniscus injury. For such persons, other appropriate measures in their therapy should be taken such as a supervised exercise programme<ref name="eta">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</ref><ref name="rol">Carol A Courtney et al, ‘Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions.’, Journal of Manual and Manipulative Therapy 2011, 212-222</ref>.  


Manual therapy is effective for improving knee flexion and it is also effective for climbing stairs in patients with [[Anterior knee pain|anterior knee pain]] and there is a trend towards a small improvement in pain.&nbsp;<ref name="pau">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 )</ref>&nbsp; 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.<ref name="est">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)</ref> <br>
Manual therapy combined with an appropriate exercise therapy seems to be more effective for improving the muscle strength, proprioception and functional performance than exercise therapy alone.  


== &nbsp;Grading scales&nbsp; ==
== Techniques ==


The intensity of the mobilization and traction is determined by the [[Manual Therapy|grading scale]].
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== &nbsp;Key evidence&nbsp;  ==


Here can you find the most important resources:
== Grading scales  ==


*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
The intensity of the mobilisation is determined by the [[Manual Therapy|grading scale]].<br>  
*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 <br>


== References  ==
== References  ==

Revision as of 09:10, 28 November 2016

Original Editor ­ - Berdien De Koster

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Description[edit | edit source]

The primary goals of manual therapy are[1][2][3]:

  • Modulate pain
  • Increase range of motion
  • Reduce soft-tissue inflammation
  • Improve contractile & non-contractile tissue repair, extensibility, or stability
  • Facilitate movement

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 being joint mobilisations and manipulation. Mobilisation is a manual technique that through repeated passive motion at low speed replicates normal joint glides at 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].

Read more about manual therapy

Indication[edit | edit source]

Indications for the use of manual therapy include[4]:

  1. painful neuromusculoskeletal joint disorder
  2. pain in or from palpation of bony joint surfaces
  3. pain in of from palpation of joint soft tissues
  4. decreased or altered range of quality of motion
  5. 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]

A commonly used form of manual therapy applied to joints are oriented mobilisations called ‘joint glides’, these are performed in specific planes of movement and are intended to restore specific movements. Research demonstrates increased knee extension in standing following tibiofemoral anterior glide mobilisation but these positive effects are only for a short duration[2].

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]. Two studies of the effect of manual therapy on pain in knee osteoarthritis showed a hypoalgesia effect from manual therapy[6][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].

Manipulative therapy of the knee and/or full kinetic chain combined with multimodal or exercise therapy improves patellofemoral pain syndrome[4][8] 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[9]

There is little or no evidence of the use of manual therapy at acute knee injury, like ligaments or meniscus injury. For such persons, other appropriate measures in their therapy should be taken such as a supervised exercise programme[10][11].

Manual therapy combined with an appropriate exercise therapy seems to be more effective for improving the muscle strength, proprioception and functional performance than exercise therapy alone.

Techniques[edit | edit source]


Grading scales[edit | edit source]

The intensity of the mobilisation is determined by the grading scale.

References[edit | edit source]

  1. ↑ 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. ↑ 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. ↑ 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. ↑ 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)
  5. ↑ 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 )
  6. ↑ 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)
  7. ↑ 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)
  8. ↑ 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 )
  9. ↑ 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)
  10. ↑ 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
  11. ↑ Carol A Courtney et al, ‘Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions.’, Journal of Manual and Manipulative Therapy 2011, 212-222


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