The Effect of Manual Joint Mobilization on Pain, ROM, Body Function and Balance in Patients with Knee Osteoarthritis

슬관절 골관절염환자에서 도수 관절가동술이 통증, 관절가동범위, 신체기능과 균형능력에 미치는 효과

Lee, Nam-Young;Kwon, Chun-Suk;Song, Hyun-Seung

  • Received : 2015.09.01
  • Accepted : 2015.10.16
  • Published : 2015.11.30


PURPOSE: The purpose of this study was to investigate effect of the manual joint mobilization to the patients with knee osteoarthritis and to determine the effect of pain, range of motion, body function and balance after applying it. METHODS: The thirty participants who complained the knee pain were randomly assigned to control (Con) group (n=15) that received the general physical therapy and experimental (Exp) group (n=15) that received the applied the manual joint mobilization and the general physical therapy three times per week, 30 minutes per day for four weeks. It measured the visual analogue scale (VAS), the range of motion (ROM), body function (WOMAC) and balance (TUG). RESULTS: It showed the significantly different between the control group and experiment group in VAS, ROM and WOMAC. After 4 weeks, the experiment group was significantly different from other group in VAS, ROM and WOMAC. But the measurement of balance did not show the significantly difference within group and between groups. CONCLUSION: This results suggest that Manual joint mobilization was effective in pain, ROM, function in patient with knee osteoarthritis.


Function;Knee osteoarthritis;Mobilization;Pain;ROM


  1. Bellamy N. Osteoarthritis clinical trials: candidate variables and clinimetric properties. J Rheumatol. 1997;24(4): 768-78.
  2. Berryman P, Lukes E, Aluoch MA, et al. Risk Factors for Occupational Osteoarthritis A Literature Review. AAOHN J. 2009;57(7):283-92.
  3. Andrianakos AA, Kontelis LK, Karamitsos DG, et al. Prevalence of symptomatic knee, hand, and hip osteoarthritis in Greece. The ESORDIG study. J Rheumatol. 2006; 33(12):2507-13.
  4. Astephen JL, Deluzio KJ, Caldwell GE, et al. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res. 2008;26(3):332-41.
  5. Bjordal JM, Johnson MI, Lopes-Martins RA, et al. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskelet Disord. 2007;8(1):51.
  6. Bohannon RW. Reference Values for the Timed Up and Go Test: A Descriptive Meta-Analysis. J Geriatr Phys Ther. 2006;29(2):64-8.
  7. Cetin N, Aytar A, Atalay A, et al. Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil. 2008;87(6): 443-51.
  8. Deyle GD, Allison SC, Matekel RL, 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. Phys Ther. 2005;85(12):1301-17.
  9. Fitzgerald G. Therapeutic exercise for knee osteoarthritis: considering factors that may influence outcome. Eura Medicophys. 2005;41(2):163.
  10. Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. J Rheumatol. 2001;28(1):156-64.
  11. Godges JJ, Mattson-Bell M, Thorpe D, et al. The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach. Journal of Orthopaedic & Sports Physical Therapy. 2003;33(12):713-18.
  12. Han TR, Bang MS. Rehabilitation medicine(3rd ed). Kunja. Seoul. 2008.
  13. Harrison AL. The influence of pathology, pain, balance, and self-efficacy on function in women with osteoarthritis of the knee. Phys Ther. 2004;84(9):822-31.
  14. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011;2(2):205.
  15. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis care & research. 2012;64(4):465-74.
  16. Jang WS, Bae SS, Ju MY, et al. Influence of lower extremity strengthening exercise on sway area of knee osteoarthritis. J Korean soc phys med. 2006;1(1): 13-21.
  17. Jansen M, Hendriks E, Oostendorp R, et al. Quality indicators indicate good adherence to the clinical practice guideline on "Osteoarthritis of the hip and knee" and few prognostic factors influence outcome indicators: a prospective cohort study. Eur J Phys Rehabil Med. 2010;46(3):337-45.
  18. Jansen MJ, Viechtbauer W, Lenssen AF, et al. Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. J Physiother. 2011;57(1):11-20.
  19. Jeong HS, Hae SS, Jung YW. Effect on muscle questionnaire of knee osteoarthritis with lower extremity patterns of the proprioceptive neuron-tIscular facilitation. J Korean soc phys med. 2007;2(1):21-30.
  20. Kaltenborn FM, Kaltenborg FM, Kaltenborn TB, et al. Manual Mobilization of the Joints: The Kaltenborn Method of Joint Examination and Treatment: Traction-Manipulation of the Extremities and Spine. Norli. 2008.
  21. Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. FA Davis. 2012.
  22. Kumar S. Effect of knee complex mobilization on pain and active range of motion arc in osteoarthritis knee joint. Physical Therapy in Sport. 2006;7(4):176.
  23. Kutlay S, Kucukdeveci AA, Elhan AH, et al. Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis. Rheumatol Int. 2011;31(3):339-46.
  24. Lee HJ, Jeon CB, Kim JH, et al. The Effects of 20-Weeks Tai-Chi Exercise Program on the Isokinetic Muscle Strength of Elderly Women. Official Journal of the Korean Society of Dance Science. 2012;26:145-60.
  25. LYN, KSU. Effects of passive joint mobilization on patients with knee osteoarthritis. Sains Malaysiana. 2011;40 (12):1461-65.
  26. Maher S, Creighton D, Kondratek M, et al. The effect of tibio-femoral traction mobilization on passive knee flexion motion impairment and pain: a case series. Journal of Manual & Manipulative Therapy. 2010;18 (1):29-36.
  27. Maitland GD, Hengeveld E, Banks K, et al. Maitland's vertebral manipulation. Butterworth-Heinemann. 2005.
  28. McMeeken J, Stillman B, Story I, et al. The effects of knee extensor and flexor muscle training on the timedup-and-go test in individuals with rheumatoid arthritis. Physiother Res Int. 1999;4(1):55.
  29. Miyazaki T, Wada M, Kawahara H, et al. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. 2002;61(7):617-22.
  30. Moss P, Sluka K, Wright A. The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Man Ther. 2007;12(2):109-18.
  31. Norkin CCWhite DJ. Measurement of joint motion: a guide to goniometry. FA Davis. 2009.
  32. Patrick D. Textbook of Pain II. Ronald Melzack. 2002;241-56.
  33. Peat G, McCarney RCroft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91-97.
  34. Perrot S, Poiraudeau S, Kabir-Ahmadi M, et al. Correlates of pain intensity in men and women with hip and knee osteoarthritis. Results of a national survey: The French ARTHRIX study. Clin J Pain. 2009;25(9): 767-72.
  35. Pollard H, Ward G, Hoskins W, et al. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. J Can Chiropr Assoc. 2008;52(4):229.
  36. Rutjes AW, Nuesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823.
  37. Sambajon VV, Cillo JE, Gassner RJ, et al. The effects of mechanical strain on synovial fibroblasts. Int J Oral Maxillofac Surg. 2003;61(6):707-12.
  38. Souvlis T, Vicenzino B. Neurophysiological effect of spinal manual therapy. Spine J. 2002;2(5):357-71.
  39. Vicenzino B, Paungmali A, Teys P. Mulligan's mobilizationwith-movement, positional faults and pain relief: current concepts from a critical review of literature. Man Ther. 2007;12(2):98-108.
  40. WHO. Global Burden of Disease Study 2004. World Health Organization. 2008.
  41. Won SJ, Chae YR. The Effects of Aromatherapy Massage on Pain, Sleep, and Stride Length in the Elderly with Knee Osteoarthritis. J Korean Biol Nurs Sci. 2011;13(2):142-48.

Cited by

  1. Effects of Joint Mobilization Intervention Combined with Exercise on Range of Motion, Pain Intensity, and Functional Performance in Adolescent Baseball Players with Internal Impingement of the Shoulder vol.13, pp.2, 2018,