In the JournalsPerspective

Patellar mobilization therapy may alleviate pain tied to knee osteoarthritis

Patellar mobilization therapy — patellofemoral joint mobilization followed by supervised nonload vastus medialis oblique exercise — showed potential in reducing pain in patients with knee osteoarthritis, according to phase 2 findings recently published in Annals of Family Medicine.

“Presently, clinical guidelines recommend using nonpharmacological strategies as the first-line treatment for knee osteoarthritis and propose individualizing treatment based on the site of joint damage,” Regina Wing Shan Sit, MBBS, DCH, DPD, The School of Public Health and Primary Care at The Chinese University at Hong Kong, and colleagues wrote.

“Only a few clinical trials, however, have evaluated the role of manual therapy that targets patellofemoral joint osteoarthritis and they are limited by small sample size, lack of methodological rigor or heterogeneous interventions,” they added.

Researchers randomly assigned 208 patients with knee osteoarthritis in Hong Kong to either receive no therapy or three patella mobilization therapy treatment sessions from primary care physicians at 2-month intervals for 24 weeks and an accompanying prescription of a home-based vastus medialis oblique muscle exercise.

Sit and colleagues found there was greater improvement in the Western Ontario and McMaster Universities Osteoarthritis Index pain scores in the intervention group (between-group difference –15.6; 95% CI, –20.5 to –10.7) after 24 weeks. In addition, secondary outcomes — Western Ontario and McMaster Universities Osteoarthritis Index stiffness, function, and composite scores; objective physical function tests such as the 30-second chair stand, 40-meter walk test, timed up and go test, and EuroQol-5D; and visual analog scale score for pain — showed significant between-group differences.

Sit and colleagues provided other possible benefits to patellar mobilization therapy as they discussed the findings.

“Unlike conventional mobilization therapy, that involves multiple treatment sessions at intense frequency, our technique can easily be performed in primary care practices. The approximate time needed for primary care physicians to learn [patellar mobilization therapy] is about 1 hour, which includes an overview of the biomechanics of knee osteoarthritis and supervised practice on three to four patients,” they wrote.

“We observed a high patient compliance rate in our study, indicating that patellar mobilization therapy is an acceptable treatment option for our patients,” Sit and colleagues added. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.


Patellar mobilization therapy — patellofemoral joint mobilization followed by supervised nonload vastus medialis oblique exercise — showed potential in reducing pain in patients with knee osteoarthritis, according to phase 2 findings recently published in Annals of Family Medicine.

“Presently, clinical guidelines recommend using nonpharmacological strategies as the first-line treatment for knee osteoarthritis and propose individualizing treatment based on the site of joint damage,” Regina Wing Shan Sit, MBBS, DCH, DPD, The School of Public Health and Primary Care at The Chinese University at Hong Kong, and colleagues wrote.

“Only a few clinical trials, however, have evaluated the role of manual therapy that targets patellofemoral joint osteoarthritis and they are limited by small sample size, lack of methodological rigor or heterogeneous interventions,” they added.

Researchers randomly assigned 208 patients with knee osteoarthritis in Hong Kong to either receive no therapy or three patella mobilization therapy treatment sessions from primary care physicians at 2-month intervals for 24 weeks and an accompanying prescription of a home-based vastus medialis oblique muscle exercise.

Sit and colleagues found there was greater improvement in the Western Ontario and McMaster Universities Osteoarthritis Index pain scores in the intervention group (between-group difference –15.6; 95% CI, –20.5 to –10.7) after 24 weeks. In addition, secondary outcomes — Western Ontario and McMaster Universities Osteoarthritis Index stiffness, function, and composite scores; objective physical function tests such as the 30-second chair stand, 40-meter walk test, timed up and go test, and EuroQol-5D; and visual analog scale score for pain — showed significant between-group differences.

Sit and colleagues provided other possible benefits to patellar mobilization therapy as they discussed the findings.

“Unlike conventional mobilization therapy, that involves multiple treatment sessions at intense frequency, our technique can easily be performed in primary care practices. The approximate time needed for primary care physicians to learn [patellar mobilization therapy] is about 1 hour, which includes an overview of the biomechanics of knee osteoarthritis and supervised practice on three to four patients,” they wrote.

“We observed a high patient compliance rate in our study, indicating that patellar mobilization therapy is an acceptable treatment option for our patients,” Sit and colleagues added. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.


    Perspective
    John Nickless

    John Nickless

    This study by Sit et al, demonstrates promising results and suggests patella mobilization therapy could be a useful modality to improve pain and function. However, it is worth noting that physical therapy is readily available and affordable here in the United States.

    It would have been interesting and helpful to see if Sit and colleagues’ results would be identical in other populations and ethnicities, such as those patients with a BMI of 35 kg/m2 or higher, since so much of the U.S. population is severely or morbidly obese. Researchers also did not blind patients to the treatment they were receiving, which makes me wonder if there was some aspect of a placebo effect where patients noted improvement in symptoms because they were receiving a treatment that they anticipated to be beneficial. In addition, co-interventions including medications, physical therapy and acupuncture were allowed during treatment. It is possible that these outside interventions improved the pain and functional outcomes as opposed to the clinic-based patellar mobilizations and exercises. There was also no breakdown of the results based on severity of osteoarthritis, and no results after 24 weeks. This leaves the questions of the treatment’s effectiveness across the osteoarthritis spectrum and whether the treatment works in the long term unanswered.

    Overall, based on these findings, clinic-based patellar mobilization may be a useful treatment in a select patient population. Patellar mobilization is likely better implemented as part of a comprehensive physical therapy program including a variety of modalities, flexibility exercises and strengthening exercises as opposed to a primary treatment option.


    • John Nickless, MD
    • staff physician, Midwest Orthopaedics at Rush
      Munster, Ind.

    Disclosures: Nickless reports no relevant financial disclosures.