Effectiveness of Muscle Energy Techniques and Mulligan Mobilization Along With Conventional Physical Therapy in Knee Joint Osteoarthritis Patients

NCT06954363 | Completed DMC

• 1 other identifier: KMU/DIR/CTU/2024/015
• Study Type: interventional
• Target: 24
• Locations: 1 country
• Sites: 3

Brief Summary

This study aims to evaluate the effectiveness of integrating Muscle Energy Technique (MET) and Mulligan Mobilization with conventional physical therapy in the management of knee osteoarthritis (OA), with a specific focus on improving hamstring flexibility and reducing functional limitations. The findings will help inform clinical decision-making and enhance patient outcomes in OA rehabilitation.

Conditions

Knee Osteoarthritis

Keywords

Knee Osteoarthritis; Muscle Stretching Exercises; Range of Motion, Articular

Outcome Measures

Primary Outcomes (4)

• Hamstring Flexibility Measured by Goniometer

  Hamstring range of motion (ROM) will be assessed using a goniometer before and after the intervention. The change in ROM will be used to evaluate effectiveness. Outcome improvement categories: Mild Increase: 5-10 degrees Moderate Increase: 10-15 degrees Marked Increase: \>15 degrees

  Baseline (Day 1) and Post-treatment (End of Week 3)

• Change in Pain Score Using Knee Osteoarthritis Outcome Score-12 questionnaire Questionnaire

  The function in daily activities subscale of Knee Osteoarthritis Outcome Score-12 questionnaire will assess participants' ability to perform routine activities before and after the intervention.

  Baseline (Day 1) and Post-treatment (End of Week 3)

• Change in Knee-Related Quality of Life Using Knee Osteoarthritis Outcome Score-12 questionnaire

  The quality of life (QOL) subscale of KOOS-12 will evaluate the impact of osteoarthritis on participants' knee-related wellbeing pre- and post-treatment.

  Baseline (Day 1) and Post-treatment (End of Week 3)

• Change in Activity of Daily Living Function Using KOOS-12

  The function in daily activities subscale of KOOS-12 will assess participants' ability to perform routine activities before and after the intervention.

  Baseline (Day 1) and Post-treatment (End of Week 3)

Study Arms (2)

Intervention Group

EXPERIMENTAL

Participants in this group will receive Mulligan Mobilization combined with Conventional Physical Therapy. Mulligan Mobilization includes medial and lateral tibial glides using a Mulligan belt. Each session will consist of 3 sets of 10 repetitions, administered 5 days a week for 3 weeks. In addition, patients will undergo standard conventional physical therapy exercises such as quadriceps strengthening, straight leg raising, and stretching exercises. Each treatment session will last 30 minutes.

Procedure: Mulligan Mobilization

Control Group

ACTIVE COMPARATOR

Participants in this group will receive Muscle Energy Technique (MET) targeting the hamstring muscles, in combination with Conventional Physical Therapy. The MET will follow a post-isometric relaxation approach, using both direct and indirect methods depending on patient condition. Each isometric contraction will be held for 10 seconds, followed by a 20-second stretch, repeated for 3 sets. Therapy will be conducted 5 days a week over a 3-week period. Each session will last 30 minutes. The same conventional physical therapy regimen as the intervention group will be applied.

Procedure: Muscle Energy Technique (MET)

Interventions

Mulligan Mobilization PROCEDURE

Mulligan Mobilization involves manual tibial glides (medial and lateral) using a mobilization belt. The patient lies supine with the knee flexed between 30°-45°. The therapist applies a sustained glide while the patient actively moves the knee into flexion and extension. The treatment is delivered in 3 sets of 10 repetitions per session, 5 days per week for 3 weeks, along with a conventional physical therapy protocol.

Intervention Group

Muscle Energy Technique (MET) PROCEDURE

Muscle Energy Technique involves the application of post-isometric relaxation targeting hamstring muscles. The therapist applies a 10-second isometric contraction at the resistance barrier, followed by a 20-second passive stretch, progressing into a new range of motion. This technique is applied 3 times per session, 5 days per week for 3 weeks, in combination with a conventional physical therapy protocol.

Control Group

Eligibility Criteria

• Age: 40 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosed cases of osteoarthritis (Grade 1 to 3)
• X-ray showing Grades I to III on Kellgren Lawrence scale of Osteoarthritis.
• Residents of Peshawar verified via NADRA CNIC
• Both genders will be included with unilateral or bilateral knee involvement.
• Age group 40 and above.
• Duration of Knee pain for more than 3 months.

You may not qualify if:

• History of any previously known neurological conditions i.e. stroke, peripheral neuropathy
• Fractures in treatment limb.
• Suspicious of malignancy around the knee joint.
• Recent under gone surgery
• Recent Intra-articular injection.
• Significant comorbid diseases and disabilities are excluded from the study

Sponsors & Collaborators

• Khyber Medical University Peshawar: lead

Study Sites (3)

Hayatabad Medical Complex Peshawar

Peshawar, KPK, 25000, Pakistan

Location

Alkhidmat Hospital Peshawar

Peshawar, KPK, Pakistan

Location

Bibi Zahida Memorial Hospital, NCS University System

Peshawar, KPK, Pakistan

Location

Related Publications (5)

• Farazdaghi M, Kordi Yoosefinejad A, Abdollahian N, Rahimi M, Motealleh A. Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. J Bodyw Mov Ther. 2021 Jul;27:597-604. doi: 10.1016/j.jbmt.2021.04.011. Epub 2021 Apr 30.

  PMID: 34391293 BACKGROUND

• Ceballos-Laita L, Jimenez-Del-Barrio S, Marin-Zurdo J, Moreno-Calvo A, Marin-Bone J, Albarova-Corral MI, Estebanez-de-Miguel E. Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial. Complement Ther Med. 2020 Jun;51:102443. doi: 10.1016/j.ctim.2020.102443. Epub 2020 May 18.

  PMID: 32507443 BACKGROUND

• Ashraf F, Anwar K, Arshad H. Effects of muscle energy technique along conventional physical therapy after mesenchymal stem cell transplantation in knee osteoarthritis patients. Pak J Med Sci. 2024 Dec;40(11):2558-2564. doi: 10.12669/pjms.40.11.9605.

  PMID: 39634887 BACKGROUND

• Goksen A, Can F, Yilmaz S, Korkusuz F. Comparison of different neuromuscular facilitation techniques and conventional physiotherapy in knee osteoarthritis. Turk J Med Sci. 2021 Dec 13;51(6):3089-3097. doi: 10.3906/sag-2101-298.

  PMID: 34565133 BACKGROUND

• Sanchez-Romero EA, Pecos-Martin D, Calvo-Lobo C, Ochoa-Saez V, Burgos-Caballero V, Fernandez-Carnero J. Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial. Medicine (Baltimore). 2018 Jun;97(26):e11255. doi: 10.1097/MD.0000000000011255.

  PMID: 29952993 BACKGROUND

MeSH Terms

Conditions

Osteoarthritis, Knee

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Study Officials

• Babar Israr, MSPT

  Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar

  PRINCIPAL INVESTIGATOR

• Shakir Ullah, PhD

  Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar

  STUDY DIRECTOR

• Samra Farid, MSPT

  Alkhidmat Hospital Peshawar

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: The study will utilize a single-blinded design, where the patients will be blinded to group allocation.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants will be randomly assigned to one of two parallel treatment groups that includes experimental Group (Mulligan Mobilization + Conventional Physical Therapy) and Control Group (Muscle Energy Technique + Conventional Physical Therapy).

Study Record Dates

• First Submitted: April 24, 2025
• First Posted: May 1, 2025
• Study Start: April 1, 2025
• Primary Completion: October 30, 2025
• Study Completion: November 28, 2025
• Last Updated: January 8, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF
• Time Frame: The data will be made available 6 months after the study's completion and will remain accessible for a period of 5 years to facilitate further research.
• Access Criteria: Access to the data will be granted to qualified researchers upon submission of a formal request that includes a research proposal outlining the intended use of the data. Requests will be reviewed by the study investigators and ethical review committee to ensure compliance with data privacy regulations.

Locations

PA (3)