Treatment of osteoarthritic knee pain
Various studies have shown that osteoarthritic joint degeneration and osteoarthritic knee pain are not related.
In individuals with osteoarthritic knee pain, hyperexcitability of central nociceptive pathways has been demonstrated. It has also been shown that central sensitization produces an enhanced pain response, which could possibly lead to chronic pain.This study shows that joint mobilization enhances controlled pain modulation in patients with painful knee OA.
The imbalance in supraspinal mechanisms may be caused by the input from the periphery or central processes, such as hypervigilance or catastrophizing. Conditioned pain modulation (CPM) is a way to examine pain inhibitory mechanisms; in short, the application of a noxious stimulus at a remote site causes inhibition of pain at the initial site.
The aim of this study was to determine if CPM is effective in individuals with painful OA together with joint mobilization of the knee. Subjects were randomized to receive 6 minutes of knee joint mobilization or manual cutaneous input only. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline.
Previous studies have shown that joint mobilization is effective in individuals with OA knee pain; it has been speculated that manual therapy may alter the imbalance in the supraspinal mechanisms. This study shows that joint mobilization enhances CPM in patients with painful knee OA. There was a decrease in deep tissue sensitivity to pressure and an enhanced somatosensory acuity.
> From: Courtney et al., J Orthop Sports Phys Ther 46 (2016) 168-176. All rights reserved to Journal of Orthopaedic & Sports Physical Therapy.Click here for the Pubmed summary.