Manual Therapy and Exercise for Total Knee Arthroplasty

#025 – Manual Therapy and Exercise for Total Knee Arthroplasty

Estimated reading time: 1 minute, 39 seconds. *

Manual therapy added to exercise program can improve pain, function and patient satisfaction post total knee replacement

?What was the aim?

  • This randomized controlled trial, tested the effectiveness of adding manual therapy to exercise versus exercise alone post total knee replacement.


  • Exercise alone group (21 Participant):
    • Supine active-assisted knee flexion, straight-leg raises, seated active-assisted knee flexion-extension, standing hip and knee flexion, stretching exercises for hamstrings and calf muscles, gait training, and functional exercises for transfers and stair climbing.
    • Each exercise was done for 3 sets/10 repetition.
  • Manual therapy+Exercise (21 Participant):
  • Home exercise for both groups after discharge:
    • The home exercise program consisted of the knee flexion from supine and setting, straight-leg raises, standing hip and knee flexion, and flexibility exercises.
    • Daily 2 sets/ 10 repetitions, participants were given exercise diary.


  • The intention to treat analysis showed no significant difference between groups in all outcome measure after 2 months.
  • Significant differences:
    • Numeric pain rating scale significantly decreased in the experimental group compared to control group, 1.3 change in score with large effect size.
    • Function measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, but did not reach the minimal clinically important differences (MCID)
    • Function measured by 10MWT
    • Quality of life using Short Form-12 mental component (SF-12MCS)
    • Patient satisfaction
  • No Significant differences:
    • Knee flexion ROM, measured by electro-goniometer.
    • Knee extension ROM had no significant difference between groups, participants in both groups achieved full extension at 2 months mark, measured by electro-goniometer.
    • Function: 5 times sit to stand test (5SST).
    • Quality of life using SF-12PCS (physical component of short form-12).

↘️Which means?

  • Adding patellofemoral and tibiofemoral joint glides, friction massages and soft tissue mobilization to a structured exercise program can improve pain, function and patient satisfaction.

??‍♀️Should I use these results?

  • Well, the sample size was small and follow-up time was short, nonetheless, the results make sense, exercise was shown to be effective post TKA and the manual techniques used in the study were also shown to be effective for knee stiffness and soft tissue extensibility.

?️ Recommend Read:

? Reference

*Calculation is based on the average reading speed that around 200 words per minute (wpm).

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