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"Medicina Sportiva" No.14 - 2008 The 15-th Sports Medicine Balkan Congress


Evgeniya Dimitrova
NSA, Department of Kinesitherapy, Sofia, Bulgaria

INTRODUCTION. Knee osteoarthritis is a disabling disease affecting approximately 1% of the population. This study aims to establish whether mobilizations with movement (MWM) included in physiotherapy program, is effective in reducing pain and improving function in individuals diagnosed with knee osteo­arthritis.
MATERIAL AND  METHODS.  42 patients diagnosed by a physician as having knee OA were treated in NSA physiotherapy department, DKC and private practice between January 1999 and December 2007. Mean age of patients was 61.9 years. A lot of patients were former professional athletes.  They had received an average of 16.9 treatments including ice/heat, relaxation techniques, and active exercises, strengthening program, education and dietary changes. The Mulligan method of applying a combination of manual therapy techniques while simultaneously performing an active or
passive movement was tried on 24 patients (Group A) as addition to conventional physiotherapy treatment. Eighteen others (Group B) were given conventional physiotherapy treatment.
RESULTS. The statistical analyses were carried out using an SPSS package. The results showed initial objective improvements in the patient¢s condition in 36 patients (85,71% of cases). Application of Mulligan¢s mobilizations with movement techniques in Group A produced immediate pain relief after first treatment procedures (between 1 and 5.5 cm on the visual analogue scale). The effects were sustained four weeks later. Pain relief was not evident in those treated conventionally. This study demonstrated that strengthening of knee musculature was more effective after the MWM and was associated with significant improvement (p<0.05) in quadriceps strength and function, when compared with controls. As a result of treatment, 21 (87,5%) of the patients in Group A displayed a considerable increase (on the average by 10-15°) in knee range of motion and the average quadriceps strength ratio was 85% compared to healthy leg. At the six-month follow-up 19 (87,5%) of the patients in Group A had maintained improvement in stair climbing, level walking and sit-to-stand activities.
CONCLUSIONS. MWM have been found to be feasible and efficacious in individuals with knee osteoarthritis. The comparative analysis of two groups showed the original physiotherapy method to be more efficient than the conventional physiotherapy treatment. A high proportion of patients with moderate to severe knee joint disease may experience continued functional benefits from physiotherapy program­me, despite the poor outlook often associated with the disease.
Key Words:  osteoarthritis, knee, mobilizations with movement, physiotherapy.

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