Effects of Mulligan’s Rotation Mobilization with Movement and Taping on Knee Pain, Foot Posture and Functional Status in Medial Compartment Knee Osteoarthritis.
Corresponding Author(s) : Dr Priyanka Mehendale
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 9 No. 2 (2021): 2021 Volume - 9 Issue - 2
Abstract
Background: Mulligan’s Mobilization With Movement (MWM) and taping techniques are known to be effective in reducing pain, increasing Knee range of motion and improving function in patients with Knee osteoarthritis (OA). This study specifically focussed on determining the effect of Mulligan’s Rotation MWM and taping not only on local parameters at the site of application of the glide at the knee, but also distally at the foot.
Methods: This Quasi experimental study was performed on a purposive sample of 54 individuals responding to Mulligan’s Internal or External Rotation glide, in the age group of 50 to 70 years having Grade 2/3 medial compartment Knee OA on Kellgren and Lawrence classification for Knee OA.Outcome measures included the Visual Analogue Scale (VAS) for Knee pain, Navicular Height (NH), Foot Posture Index (FPI), Aggregated Locomotor Function (ALF) Score, Knee Range of motion (ROM) using goniometer, Tibial Torsion Angle and Quadriceps Angle (Q angle) using goniometer. Outcomes were assessed at baseline and 24 hours after application of the last treatment session. All participants underwent treatment sessions of therapist-applied MWM and taping daily for 4 consecutive days after the baseline assessment. Tape was removed prior to the post-intervention assessment.
Results: 65% of patients responded to an Internal Rotation Mulligan glide in this study. Statistically significant improvements from baseline were seen in all outcome measures except the Q angle. Knee pain intensity reduced at rest, during lunging and during performance of most-offending movement post-treatment compared to the baseline (p <0.001). Time required for performance of functional activities including locomotion, sit-to-stand and staircase ascending-descending was statistically significantly reduced post-treatment as demonstrated by a lowered ALF score (p <0.001). Foot posture changes seen post-treatment included a statistically significant increase in the NH (p<0.001) and a reduction in the FPI score (p=0.021). A statistically significant reduction in the Tibial torsion angle was seen post-treatment compared to the baseline (p< 0.031).
Conclusion: In this study conducted in patients with medial compartment Knee OA; Mulligan’s Rotation MWM and taping were associated not only with reduced Knee pain, increased Knee range of motion and improved locomotor function; but also changes in foot posture.
Background: Mulligan’s Mobilization With Movement (MWM) and taping techniques are known to be effective in reducing pain, increasing Knee range of motion and improving function in patients with Knee osteoarthritis (OA). This study specifically focussed on determining the effect of Mulligan’s Rotation MWM and taping not only on local parameters at the site of application of the glide at the knee, but also distally at the foot.
Methods: This Quasi experimental study was performed on a purposive sample of 54 individuals responding to Mulligan’s Internal or External Rotation glide, in the age group of 50 to 70 years having Grade 2/3 medial compartment Knee OA on Kellgren and Lawrence classification for Knee OA.Outcome measures included the Visual Analogue Scale (VAS) for Knee pain, Navicular Height (NH), Foot Posture Index (FPI), Aggregated Locomotor Function (ALF) Score, Knee Range of motion (ROM) using goniometer, Tibial Torsion Angle and Quadriceps Angle (Q angle) using goniometer. Outcomes were assessed at baseline and 24 hours after application of the last treatment session. All participants underwent treatment sessions of therapist-applied MWM and taping daily for 4 consecutive days after the baseline assessment. Tape was removed prior to the post-intervention assessment.
Results: 65% of patients responded to an Internal Rotation Mulligan glide in this study. Statistically significant improvements from baseline were seen in all outcome measures except the Q angle. Knee pain intensity reduced at rest, during lunging and during performance of most-offending movement post-treatment compared to the baseline (p <0.001). Time required for performance of functional activities including locomotion, sit-to-stand and staircase ascending-descending was statistically significantly reduced post-treatment as demonstrated by a lowered ALF score (p <0.001). Foot posture changes seen post-treatment included a statistically significant increase in the NH (p<0.001) and a reduction in the FPI score (p=0.021). A statistically significant reduction in the Tibial torsion angle was seen post-treatment compared to the baseline (p< 0.031).
Conclusion: In this study conducted in patients with medial compartment Knee OA; Mulligan’s Rotation MWM and taping were associated not only with reduced Knee pain, increased Knee range of motion and improved locomotor function; but also changes in foot posture.
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1- O'Neill, T. and Felson, D., 2018. Mechanisms of Osteoarthritis (OA) Pain. Current Osteoporosis Reports, 16, 611-616.
2- Ledingham, J., Regan, M., Jones, A. and Doherty, M., 1993. Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital. Annals of rheumatic diseases, Jul;52(7), 520-6.
3- Hunter, D. and Felson, D., 2006. Osteoarthritis. BMJ, 332, 639.
4- Creamer, P., Lethbridge-Cejku, M. and Hochberg, M., 2000. Factors associated with functional impairment in symptomatic knee osteoarthritis. Rheumatology (Oxford), May;39(5), 490-6.
5- Walankar, P., Panhale, V. and Koli, A., 2018. Pain, Functional Disability and Quality of Life in Knee Osteoarthritis. Int J Health Sci Res, 8(7), 177-181.
6- Page, C., Hinman, R. and Bennell, K., 2011. Physiotherapy management of knee osteoarthritis. International Journal of Rheumatic Diseases, 14(2), 145-151.
7- Hochberg, M., Altman, R., April, K. and Benkhalti, M et al., 2012. 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, 64(4), 465-74
8- Mulligan, B., 2010. Manual Therapy NAGS, SNAGS, MWMS etc.. 6th ed. New Zealand: Plane View Services Ltd
9- Vicenzino, B., Paungmali, A. and Teys, P., 2007. Mulligan's mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature. Man Ther, May;12(2), 98-108.
10- Baker, R., Nasypany, A., Seegmiller, J. and Baker, J., 2013. The Mulligan Concept: Mobilizations With Movement. International Journal of Athletic Therapy & Training, 18(1), 34-38.
11- Kumar, D. and Mulligan, B., 2014. Manual of Mulligan Concept. 1st ed. New Delhi: Capri Institute of Manual Therapy.
12- Brouwer, G., van Tol, A., Bergink, A. and Belo, J et al., 2007. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum, 56(4), 1204-11.
13- Sharma, L., 2007. The role of varus and valgus alignment in knee osteoarthritis. Arthritis Rheum, 56, 1044-1047
14- Riegger-Krugh, C. and Keysor, J., 1996. Skeletal malalignments of the lower quarter: correlated and compensatory motions and postures. J Orthop Sports Phys Ther, 23(2), 164-70
15- Levinger, P., Menz, H., Fotoohabadi, M. and Feller, J et al., 2010. Foot posture in people with medial compartment knee osteoarthritis. J Foot Ankle Res, 3, 29
16- Levinger, P., Menz, H., Morrow, A. and Feller, J et al., 2012. Foot kinematics in people with medial compartment knee osteoarthritis. Rheumatology (Oxford), 51(12), 2191-8
17- Duivenvoorden, T., Brouwer, R., van Raaij, T. and Verhagen, A et al., 2015. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database of Systematic Reviews, Issue 3, Art. No: CD004020.
18- Levinger, P., Menz, H., Morrow, A. and Feller, J et al., 2012. Changes in foot posture and function following total knee replacement surgery. J Foot Ankle Res, 5, P17
19- Lafortune, M., Cavanagh, P., Sommer, H. and Kalenak, A., 1994. Foot inversion-eversion and knee kinematics during walking. Journal of Orthopaedic Research, 12(3), 412-20
20- McCarthy, C. and Oldham, J., 2004. The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee. Rheumatology, Volume 43, Issue 4, 514–517.
21- Hawker, G., Mian, S., Kendzerska, T. and French, M., 2011. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), Nov;63 Suppl 11, S240-52.
22- Nilsson, M., Friis, R., Michaelsen, M. and Jakobsen, P., 2012. Classification of the height and flexibility of the medial longitudinal arch of the foot. J Foot Ankle Res, Feb 17;5:3
23- Redmond, A., Crosbie, J. and Ouvrier, R., 2006. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech, 21(1), 89-98.
24- Norkin, C. and White, D., 2009. Measurement of Joint Motion: A Guide to Goniometry. 4th ed. Philadelphia: F.A. Davis.
25- Livingston, L., 1998. The quadriceps angle: a review of the literature. J Orthop Sports Phys Ther, Aug;28(2), 105-9
26- Milner, C. and Soames, R., 1998. A comparison of four in vivo methods of measuring tibial torsion. J Anat, 193 ( Pt 1), 139-44
27- Neogi, T., 2013. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage, 21(9), 1145-53.
28- Fu, K., Robbins, S. and McDougall, J., 2018. Osteoarthritis: the genesis of pain. Rheumatology, Volume 57, Issue suppl_4, iv43–iv50
29- Bialosky, J., Bishop, M., Price, D. and Robinson, M., 2009. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther, 14(5), 531-538
30- Hamai, S., Moro-oka, T., Miura, H. and Shimoto, T et al., 2009. Knee kinematics in medial osteoarthritis during in vivo weight-bearing activities.. J Orthop Res, 27(12), 1555-61.
31- Matsui, Y., Kadoya, Y., Uehara, K. and Kobayashi, A et al., 2005. Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography.. Clin Orthop Relat Res, Apr;(433), 147-51
32- Lee, T., Morris, G. and Csintalan, R., 2003. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther, 33(11), 686-93.
33- Redmond, A., Crane, Y. and Menz, H., 2008. Normative values for the Foot Posture Index. J Foot Ankle Res, 1(1), 6
34- Mackay, G., Stearne, S., Wild, C. and Nugent, E et al., 2020. Mulligan Knee Taping Using Both Elastic and Rigid Tape Reduces Pain and Alters Lower Limb Biomechanics in Female Patients With Patellofemoral Pain. Orthop J Sports Med, 29;8(5), 2325967120921673.
35- Takasaki, H., Hall, T. and Jull, G., 2013. Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis--a prospective case series. Physiother Theory Pract, 29(2):, 87-95
36- Altm??, H., Oskay, D., Elbasan, B. and Düzgün, ? et al., 2018. Mobilization with movement and kinesio taping in knee arthritis-evaluation and outcomes. Int Orthop, 42(12), 2807-2815.
37- Schein, J., Kosinski, M., Benson, C. and Gajria, K., 2008. Functionality and health-status benefits associated with reduction of osteoarthritis pain. Current Medical Research and Opinion, 24(5), 1255-65.
38- Mullaji, A., Sharma, A., Marawar, S. and Kohli, A., 2008. Tibial torsion in non-arthritic Indian adults: a computer tomography study of 100 limbs. Indian J Orthop, Jul;42(3), 309-13.
39- Yagi, T. and Sasaki, T., 1986. Tibial torsion in patients with medial-type osteoarthritic knee. Clin Orthop Relat Res, Dec;(213), 177-82.
40- Raveendranath, V., Nachiket, S., Sujatha, N., Priya, R et al. 2009. The quadriceps angle (Q angle) in Indian men and women. Eur J Anat, 13(3), 105-109.
41- Nguyen, A., Boling, M., Levine, B and Shultz, S. 2009. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med, May; 19(3), 201-6.
References
2- Ledingham, J., Regan, M., Jones, A. and Doherty, M., 1993. Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital. Annals of rheumatic diseases, Jul;52(7), 520-6.
3- Hunter, D. and Felson, D., 2006. Osteoarthritis. BMJ, 332, 639.
4- Creamer, P., Lethbridge-Cejku, M. and Hochberg, M., 2000. Factors associated with functional impairment in symptomatic knee osteoarthritis. Rheumatology (Oxford), May;39(5), 490-6.
5- Walankar, P., Panhale, V. and Koli, A., 2018. Pain, Functional Disability and Quality of Life in Knee Osteoarthritis. Int J Health Sci Res, 8(7), 177-181.
6- Page, C., Hinman, R. and Bennell, K., 2011. Physiotherapy management of knee osteoarthritis. International Journal of Rheumatic Diseases, 14(2), 145-151.
7- Hochberg, M., Altman, R., April, K. and Benkhalti, M et al., 2012. 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, 64(4), 465-74
8- Mulligan, B., 2010. Manual Therapy NAGS, SNAGS, MWMS etc.. 6th ed. New Zealand: Plane View Services Ltd
9- Vicenzino, B., Paungmali, A. and Teys, P., 2007. Mulligan's mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature. Man Ther, May;12(2), 98-108.
10- Baker, R., Nasypany, A., Seegmiller, J. and Baker, J., 2013. The Mulligan Concept: Mobilizations With Movement. International Journal of Athletic Therapy & Training, 18(1), 34-38.
11- Kumar, D. and Mulligan, B., 2014. Manual of Mulligan Concept. 1st ed. New Delhi: Capri Institute of Manual Therapy.
12- Brouwer, G., van Tol, A., Bergink, A. and Belo, J et al., 2007. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum, 56(4), 1204-11.
13- Sharma, L., 2007. The role of varus and valgus alignment in knee osteoarthritis. Arthritis Rheum, 56, 1044-1047
14- Riegger-Krugh, C. and Keysor, J., 1996. Skeletal malalignments of the lower quarter: correlated and compensatory motions and postures. J Orthop Sports Phys Ther, 23(2), 164-70
15- Levinger, P., Menz, H., Fotoohabadi, M. and Feller, J et al., 2010. Foot posture in people with medial compartment knee osteoarthritis. J Foot Ankle Res, 3, 29
16- Levinger, P., Menz, H., Morrow, A. and Feller, J et al., 2012. Foot kinematics in people with medial compartment knee osteoarthritis. Rheumatology (Oxford), 51(12), 2191-8
17- Duivenvoorden, T., Brouwer, R., van Raaij, T. and Verhagen, A et al., 2015. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database of Systematic Reviews, Issue 3, Art. No: CD004020.
18- Levinger, P., Menz, H., Morrow, A. and Feller, J et al., 2012. Changes in foot posture and function following total knee replacement surgery. J Foot Ankle Res, 5, P17
19- Lafortune, M., Cavanagh, P., Sommer, H. and Kalenak, A., 1994. Foot inversion-eversion and knee kinematics during walking. Journal of Orthopaedic Research, 12(3), 412-20
20- McCarthy, C. and Oldham, J., 2004. The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee. Rheumatology, Volume 43, Issue 4, 514–517.
21- Hawker, G., Mian, S., Kendzerska, T. and French, M., 2011. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), Nov;63 Suppl 11, S240-52.
22- Nilsson, M., Friis, R., Michaelsen, M. and Jakobsen, P., 2012. Classification of the height and flexibility of the medial longitudinal arch of the foot. J Foot Ankle Res, Feb 17;5:3
23- Redmond, A., Crosbie, J. and Ouvrier, R., 2006. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech, 21(1), 89-98.
24- Norkin, C. and White, D., 2009. Measurement of Joint Motion: A Guide to Goniometry. 4th ed. Philadelphia: F.A. Davis.
25- Livingston, L., 1998. The quadriceps angle: a review of the literature. J Orthop Sports Phys Ther, Aug;28(2), 105-9
26- Milner, C. and Soames, R., 1998. A comparison of four in vivo methods of measuring tibial torsion. J Anat, 193 ( Pt 1), 139-44
27- Neogi, T., 2013. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage, 21(9), 1145-53.
28- Fu, K., Robbins, S. and McDougall, J., 2018. Osteoarthritis: the genesis of pain. Rheumatology, Volume 57, Issue suppl_4, iv43–iv50
29- Bialosky, J., Bishop, M., Price, D. and Robinson, M., 2009. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther, 14(5), 531-538
30- Hamai, S., Moro-oka, T., Miura, H. and Shimoto, T et al., 2009. Knee kinematics in medial osteoarthritis during in vivo weight-bearing activities.. J Orthop Res, 27(12), 1555-61.
31- Matsui, Y., Kadoya, Y., Uehara, K. and Kobayashi, A et al., 2005. Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography.. Clin Orthop Relat Res, Apr;(433), 147-51
32- Lee, T., Morris, G. and Csintalan, R., 2003. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther, 33(11), 686-93.
33- Redmond, A., Crane, Y. and Menz, H., 2008. Normative values for the Foot Posture Index. J Foot Ankle Res, 1(1), 6
34- Mackay, G., Stearne, S., Wild, C. and Nugent, E et al., 2020. Mulligan Knee Taping Using Both Elastic and Rigid Tape Reduces Pain and Alters Lower Limb Biomechanics in Female Patients With Patellofemoral Pain. Orthop J Sports Med, 29;8(5), 2325967120921673.
35- Takasaki, H., Hall, T. and Jull, G., 2013. Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis--a prospective case series. Physiother Theory Pract, 29(2):, 87-95
36- Altm??, H., Oskay, D., Elbasan, B. and Düzgün, ? et al., 2018. Mobilization with movement and kinesio taping in knee arthritis-evaluation and outcomes. Int Orthop, 42(12), 2807-2815.
37- Schein, J., Kosinski, M., Benson, C. and Gajria, K., 2008. Functionality and health-status benefits associated with reduction of osteoarthritis pain. Current Medical Research and Opinion, 24(5), 1255-65.
38- Mullaji, A., Sharma, A., Marawar, S. and Kohli, A., 2008. Tibial torsion in non-arthritic Indian adults: a computer tomography study of 100 limbs. Indian J Orthop, Jul;42(3), 309-13.
39- Yagi, T. and Sasaki, T., 1986. Tibial torsion in patients with medial-type osteoarthritic knee. Clin Orthop Relat Res, Dec;(213), 177-82.
40- Raveendranath, V., Nachiket, S., Sujatha, N., Priya, R et al. 2009. The quadriceps angle (Q angle) in Indian men and women. Eur J Anat, 13(3), 105-109.
41- Nguyen, A., Boling, M., Levine, B and Shultz, S. 2009. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med, May; 19(3), 201-6.