Description

Osteoarthritis is a degenerative disease that occurs especially in weight-bearing joints, characterized by a decrease in joint space due to progressive cartilage loss, subchondral sclerosis and osteophyte formations (Martel et al., 2016). Although OA is also seen in the hip, spine and hand joints, it is most commonly seen in the knee joint (Neogi et al., 2012). Although the primary change in knee OA is in the articular cartilage of the knee, all tissues in and around the joint are affected by OA. The clinical features of the condition are pain, joint stiffness, edema, local tenderness in the joint, crepitation and swelling, muscle weaknesses, osteophytes, instability, subluxations, joint deformities, limitation of joint movement and functional limitations (Sharma 2021).

Pain in knee osteoarthritis is a multifactorial phenomenon in which structural, neurophysiological and psychosocial factors play a role (Emmert et al, 2018). Regarding neurophysiological factors, it has been shown that there are inflammatory mediators within the articular cartilage that alter afferent sensory inputs and cause plastic changes in the nervous system leading to central sensitization (Schaible et al, 2022). Although it is such a multifactorial symptom, the methods used in the evaluation of pain sensation for osteoarthritis are mostly subjective and include the patient's feedback, such as visual analog scale, numerical rating scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). ) is limited to tests, surveys or scales (Dainese et al, 2022). Although these scales are an important part of clinical practice and reflect the patient's capacity to express his or her own experience, they provide subjective information on issues such as the patient's pain intensity, the effects of pain, and its effects on quality of life (Dainese et al, 2022).

Quantitative sensory testing (QST) is a systematic psychophysical testing method used to measure sensory thresholds for pain, touch, vibration and temperature sensations (Mücke et al, 2021). It measures individual sensory perceptions using direct patient feedback. It tests sensory loss (hypoesthesia, hypoalgesia) and sensory gain (hyperesthesia, hyperalgesia, allodynia) and is used to test the nociceptive and non-nociceptive properties of different afferent nerve fibers and central pathways (Mücke et al, 2021). Quantitative sensory testing may offer a more objective approach to identifying underlying causes of pain. Physical measurements such as nerve damage, loss of sensation, and changes in touch sensitivity can provide more objective data in assessing pain (Arant et al, 2021).

It has been reported that pain, movement limitations and muscle weakness in individuals with osteoarthritis cause indirect effects on muscle activity and functions (Petterson et al, 2023). Changes in muscle activity usually occur in response to pain or as the patient tries to compensate for functional limitations in the joint (Petterson et al, 2023).

It has been shown that due to pain and movement limitations in the affected joint, it causes the individual to change body position and use other muscle groups more (Sharma 2021). Avoidance of using the affected joint has also been reported as a factor in the weakening of the relevant muscle groups. OA can affect joint stability, which can impair muscle coordination (Sharma 2021). Superficial Electromyography (EMG) appears as a method that helps us monitor changes in the activation patterns of certain muscle groups and understand the underlying causes of these functional limitations (Simonsen et al., 2014).

OA treatment generally focuses on relieving symptoms, controlling pain, improving joint function, and improving quality of life (Block et al, 2020). Treatment methods used in the rehabilitation of patients with OA include exercise, electrotherapy and manual therapy. Mulligan Movement Mobilization (MWM), which is among manual therapy practices, is a manual therapy concept developed by Brian Mulligan. This concept includes a set of techniques aimed at correcting pain and limitations in joint range of motion (Anwer et al, 2018). It has been supported by studies that in conditions such as osteoarthritis, these mobilization techniques can help increase joint mobility and relieve the patient's symptoms (Alkhawajah et al, 2019).

The basic principles of Mulligan Movement Mobilization include collaboration with the patient, pain-free mobilization, and a manual force applied during a specific joint movement. It is aimed to increase joint range of motion, pain control and functional recovery, and to contribute to the patient being more effective in daily activities by increasing joint function (Oskay et al., 2015), (Alkhawajah et al., 2019).