THE EFFECTIVENESS OF EARLY MOBILIZATION (COMPRESSION AND DECOMPRESSION WITH GLIDE) IN OSTEOARTHRITIS OF KNEE JOINT. DR.

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1 Abstract THE EFFECTIVENESS OF EARLY MOBILIZATION (COMPRESSION AND DECOMPRESSION WITH GLIDE) IN OSTEOARTHRITIS OF KNEE JOINT. DR. IMRAN RAFIQ BSPT, PP-DPT, ISRA UNIVERSITY, ISLAMABAD, DR. MUHAMMAD NAVEED BABUR PT. DPT, ISRA UNIVERSITY, ISLAMABAD Objective: Purpose of this study was to identify the effectiveness of mobilization (compression and decompression with glide) in patients of osteoarthritis of knee. Design: Case series Methods: A total of five patient s age between years and pain from mild to moderate in severity were treated using compression and decompression technique with glide for 9 minutes. All the patients were given 3-4 sessions per week and evaluated before and after treatment using visual analogue scale (VAS), 6 minute walk test and 8-feet up and go Results: After application of mobilization techniques there was decrease in knee joint pain, decrease in stiffness and improvement in functional capability of patients. Patients were pain free, with comfortable ROM and independent in performing activities of daily life. Conclusion: Study showed that compression and decompression technique with glide leads to significant improvement in symptoms in patients with mild pain but patients with moderate pain give satisfactory response. Functional capabilities of patients were also improved Key words: Mobilization, Osteoarthritis (OA), VAS (visual analogue scale), Anteroposterior (AP), Range of Motion (ROM) Introduction Osteoarthritis is a condition of synovial joints characterized by cartilage loss with an accompanying peri- articular response. Pathologically, there is an alteration in cartilage structure, radiologically there are osteophytes and joint space narrowing and clinically patient complains of pain and disability. [1] Osteoarthritis (OA) is the most common joint disorder, a prevalence that increases with age. Mobilization is a passive procedure performed to improve pain, increase range of motion and increase the functional capability of patient because optimal stimulus for the regeneration of joint cartilage is intermittent compressiondecompression with gliding. Mobilization of knee joint includes mobilization of tibiofemoral joint. Mobilization of tibiofemoral joint includes anterior and posterior glides with compression and decompression. [2] Objective of this study was to identify the effectiveness of early mobilization (compression and decompression with glide) in relieving pain, increase ROM of knee joint and functional capability in patients of osteoarthritis Study design was 252

2 case series. Patients were treated in Department of physical therapy Al- Raee hospital Gujranwala, Pakistan. Duration of study was two month. Five patients with inclusion criteria, age between years and pain from mild to moderate in severity were included and patients, age below 30 years or above 60 years and sever pain were excluded from study. Visual analogue scale was used to measure the severity of pain and functional capabilities were assessed with 6- minute walk test and 8- feet up and go Results Before treatment Case Pain ROM Functional capability Case 1 Case 2 Case 3 Case 4 Case5 Mild pain during walking at VAS Moderate at VAS during rising from chair. Mild pain in NWB. No pain in NWB. and rising from chair Difficult AROM& in non weight bearing. perform &AROM, NWB with mild difficulty. with mild difficulty. perform &AROM, NWB Unable to walk more than 10 meter in 6 minute walk Moderate pain in sitting and rising distance with mild pain in 6 pain in sitting and rising from chair in 8- feet up and go 253

3 After treatment Case no Pain ROM Functional capability Case 1 Mild pain at VAS Easy AROM& in NWB Distance increased in 6 minute walk Mild pain in sitting and rising from chair in 8- feet Case 2 Case 3 Case 4 Case5 Discussion No pain during walking at VAS No pain at VAS during rising from chair. No pain in NWB. Mild on off pain at VAS No pain at VAS during rising from chair without pain.. perform &AROM, up and go pain in rising from chair after prolong sitting pain in sitting and rising from chair in 8- feet up and go distance with mild pain on off in 6 minute walk test, sitting and rising from chair in 8- feet up and go minute walk test without pain in sitting and rising from chair in 8- feet up and go Study revealed that early mobilization (compression and decompression with glide ) in patients of osteoarthritis of knee, result in significant improvement of the symptoms of the patient which, support the results of study, The initial effects of knee joint mobilization on osteoarthritic hyperalgesia.by Mossa, P., Slukab, k., & Wrighta, A. (2007) [3]. The purpose of study was to investigate the initial effects of accessory knee joint mobilization on measures of pain and function in individuals with knee osteoarthritis. The effects of a 9-min, nonnoxious, AP mobilization of the tibio-femoral joint were compared with manual contact and no-contact interventions. The effectiveness of early mobilization (compression and decompression with glide) in osteoarthritis of knee to see the effects of mobilization to reduce pain and functional capability of the patient. There was decrease or no pain in patients and improved functional capability of patients. This shows the reliability and validity of this study. Results provide new evidences that mobilization of an osteoarthritic knee joint immediately could be an effective means of reducing pain and improving functional capability in this population. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee by Deyle, G, D., Henderson, N, E., & Matekel, R. L. et al (2000).[4] Clinically and statistically significant improvements in 6-minute walk distance. A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of 254

4 the knee and may delay or prevent the need for surgical intervention. Effectiveness of early mobilization (compression and decompression with glide) in osteoarthritis of knee also increase in distance walked by patient in 6- minute walk test and decrease in pain and improved functional capability. These techniques also delay or prevent the need for surgical procedures. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Therapeutic Exercises and Manual Therapy in the Management of Osteoarthritis (2005) [5].The purpose was to create guidelines for the use of therapeutic exercises and manual therapy in the management of adult. The Ottawa Panel recommended the use of therapeutic exercises alone, or combined with manual therapy, for managing patients with OA. This study also suggested the use of mobilization techniques in management of the patients suffering from OA. This suggests to investigate effects of a 9-min, non-noxious, AP mobilization of the tibio-femoral joint were compared with manual contact and no-contact interventions, which provides new experimental evidence that accessory mobilization of an osteoarthritic knee joint immediately produces both local and widespread hypoalgesic effects. It may therefore be an effective means of reducing pain in this population. Conclusion A large elderly population is suffering from osteoarthritis of knee resulting in psychological, social and functional limitations of this population. This prevents them from their participation as an active member of the society. Mobilization is an effective mean of reducing their disability and keeps them pain free and functional. This also helps delaying or preventing need for surgical procedures. But further research and evidences are necessary for efficacy of mobilization techniques in osteoarthritis of knee. In last, mobilization helps a lot to manage pain, increase ROM and improve the functional capability of the patient. 255

5 References Parveen, K & Michael, C (Eds.). (1999). Clinical Medicine. China : W.B.Saunders Kisner, C& Colby, L (1996) Therapeutic Exercises Foundation and Techniques.New Jaypee Brothers Dehli. Mossa, P., Slukab, k., & Wrighta, A. (2007). The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Manual therapy, 12(2), Deyle, G, D., Henderson, N, E., & Matekel, R. L. et al (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Annals of Internal Medicine, 132(3), Ottawa Panel Evidence-Based Clinical Practice Guidelines for Therapeutic Exercises and Manual Therapy in the Management of Osteoarthritis. Physical Therapy (2005). 85(9),