EFFECTS OF TIBIOFEMORAL MOBILIZATION WITH AND WITHOUT MULLIGAN’S MEDIAL GAPPING TECHNIQUE ON PAIN AND FUNCTION IN PATIENTS WITH MEDIAL COMPARTMENT KNEE OSTEOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Knee osteoarthritis (KOA) is a leading cause of pain and physical disability, and the medial compartment of the knee is usually the first to deteriorate. Manual therapy has an established place in conservative care, but it remains unclear whether adding a compartment-specific technique to standard tibiofemoral mobilization improves outcomes.

Objective: To compare the effects of tibiofemoral mobilization, with and without Mulligan’s medial gapping technique, on pain and function in patients with medial compartment knee osteoarthritis.

Methods: A single-blind randomized controlled trial was conducted in the Outpatient Physiotherapy Department of Surraya Azeem Hospital, Lahore. Forty-four patients aged 40–65 years with Kellgren–Lawrence grade 2 or 3 medial compartment osteoarthritis were randomly allocated into two equal groups (n=22 each). Group A received tibiofemoral mobilization plus medial gapping, whereas Group B received tibiofemoral mobilization alone; both groups were treated three sessions per week for six weeks. Pain was measured with the Numeric Pain Rating Scale (NPRS) and function with the WOMAC index at baseline and six weeks. Paired- and independent-samples t-tests, their non-parametric counterparts, and analysis of covariance (ANCOVA) were used.

Results: All 44 participants completed the study. Both groups improved, but Group A improved significantly more on every outcome. The mean reduction in NPRS was 4.00±0.69 in Group A versus 2.41±0.50 in Group B (mean difference 1.59; 95% CI 1.23–1.95), and the mean reduction in WOMAC total was 32.68±5.87 versus 21.18±2.02 (mean difference 11.50; 95% CI 8.90–14.10). Effect sizes were large for every outcome (Cohen’s d 1.69–2.63), and group allocation remained a significant predictor of post-treatment scores after adjustment for baseline values (all p<0.001).

Conclusion: Adding Mulligan’s medial gapping technique to standard tibiofemoral mobilization produced greater short-term improvement in pain, stiffness, and physical function than mobilization alone in patients with medial compartment knee osteoarthritis.