A Study to Assess the Effectiveness of Mulligan Mobilization Technique Versus Conventional Therapy on Functional Performance and Mobility in Subjects with Chronic Osteoarthritis Knee – A Comparative Study.

INTRODUCTION

Osteoarthritis is a chronic degenerative condition with multiple causes, it is characterized by the degradation of articular cartilage, bone enlargement around the edges, thickening of bone underneath the cartilage, and various biochemical and structural changes in the synovial membrane and joint capsule.1

Osteoarthritis, the second most prevalent rheumatologic condition, it is the predominant joint disorder in India, affecting between 22% to 39% of the population. Although it is more prevalent in women, its occurrence escalates notably with advancing age.1

 From a clinical perspective, osteoarthritis of the knee manifests through pain experienced during weight-bearing, tenderness, limited range of motion, crepitus, occasional swelling, and fluctuating levels of local inflammation.2Pain, being the predominant symptom, imposes substantial social, psychological, and financial burdens on patients, necessitating medical attention and rehabilitation, which can further strain their finances. 2

OA is classified into two groups according to its etiology: primary (idiopathic or non-traumatic) and secondary (usually due to trauma or mechanical misalignment). The severity of the disease can also be graded according to the radiographical findings by the Kellgren–Lawrence (KL) system described in 1957.3

An evidence-based management approach should involve educating patients about osteoarthritis (OA) and its management. This education should include information on pain management, methods to improve function, reduce disability, and strategies to slow down the progression of the disease.4Physiotherapy focuses on achieving proper posture and enhancing muscle strength through various techniques, including manual therapy such as mobilization, along with exercises to strengthen muscles and stretch soft tissues. In the case of knee osteoarthritis (OA), the objective of physical therapy is to alleviate pain, preserve joint function, and restore or maintain normal joint activity.5

Mobilization with Movement (MWM) is a manual therapy technique frequently employed in the treatment of musculoskeletal conditions. Developed by Brian Mulligan, it offers a novel approach to addressing a range of soft tissue issues in both upper and lower limb joints. This technique involves executing pain-free physiological movements while applying accessory glides in the direction opposite to the previously painful movement, with the aim of achieving maximum improvement.6Hence, Mobilization with Movement (MWM) involves the therapist administering a corrective technique by applying a passive accessory glide perpendicular to the joint plane to address positional issues. Simultaneously, the patient actively executes the problematic movement repeatedly. Throughout this process, the goal is for pain to consistently diminish or vanish, and for pain-free function to be reinstated.7

Osteoarthritis can significantly impact functional performance and mobility, presenting a considerable challenge to individuals affected by the condition. As the disease progresses, the degeneration of cartilage and changes in joint structure can lead to stiffness, pain, and reduced range of motion, all of which can profoundly affect day-to-day activities. Tasks that once seemed effortless, such as walking, climbing stairs, or even getting out of a chair, may become arduous and painful.Furthermore, osteoarthritis often causes muscle weakness and imbalance around the affected joint, further compromising mobility and stability. This can lead to a vicious cycle where reduced activity due to pain and limitations exacerbates muscle weakness, ultimately worsening functional performance. As mobility declines, individuals may experience decreased independence and quality of life, impacting not only physical health but also mental well-being.

However, proactive management strategies, including physical therapy, exercise, weight management, and joint protection techniques, can play a crucial role in mitigating the impact of osteoarthritis on functional performance and mobility. By improving muscle strength, flexibility, and joint stability, these interventions can help individuals maintain or regain independence in daily activities, enhancing their overall quality of life despite the challenges posed by osteoarthritis.