An interventional study of Mulligan Mobilization and Muscle Energy Technique (MET) in Knee Osteoarthritis, sponsored by Khyber Medical University Peshawar. Completed at 3 sites in Pakistan. Open to participants aged 40 Years and older. Per ClinicalTrials.gov, last updated 2026-01-08.
Sponsored by Khyber Medical University Peshawar · Not applicable, Interventional, and Treatment
This study aims to evaluate the effectiveness of integrating Muscle Energy Technique (MET) and Mulligan Mobilization with conventional physical therapy in the management of knee osteoarthritis (OA), with a specific focus on improving hamstring flexibility and reducing functional limitations. The findings will help inform clinical decision-making and enhance patient outcomes in OA rehabilitation.
Osteoarthritis (OA) is a progressive degenerative joint disease characterized by the destruction of articular cartilage and the formation of bone spurs, leading to pain, joint stiffness, and decreased functional mobility. While its exact cause remains unknown, factors such as age, sex, obesity, sedentary lifestyle, genetics, bone density, smoking, and joint location contribute significantly to its development. As patients experience pain and reduced joint mobility, they often limit movement, particularly of the knee, resulting in muscular tightness-most notably in the hamstring, a two-joint muscle.
Globally, OA is a major public health concern, with knee OA affecting approximately 250 million people in 2010, including 18% of women and 9.6% of men over 60. It has substantial economic impacts, such as costing the United States 1-2.5% of its GDP and Spain €4.7 billion in 2007. Regional data from South Asia show higher prevalence in rural populations, emphasizing the disease's widespread burden.
Physical therapy has been shown to be highly effective in managing knee OA symptoms. Several randomized controlled trials support the use of techniques like Muscle Energy Technique (MET) and Mulligan Mobilization. MET has demonstrated superior efficacy compared to static stretching and whole-body vibration in improving hamstring flexibility and reducing stiffness. Similarly, Mulligan Mobilization, particularly when combined with supervised exercises, has shown better outcomes than Maitland mobilization in improving flexibility and function in OA patients.
However, current literature presents conflicting evidence regarding the individual efficacy of MET and Mulligan Mobilization. This study seeks to address these inconsistencies by investigating the effectiveness of integrating both MET and Mulligan Mobilization with conventional physical therapy in treating knee OA. The goal is to provide evidence-based insights that can guide clinicians in optimizing therapeutic strategies for better functional outcomes and enhanced quality of life for patients with knee osteoarthritis.
3,302 studies on the registry are indexed under Osteoarthritis, Knee; 608 are open to participants now.
This study's enrollment of 24 is below the median of 70 across 2,731 interventional studies indexed under Osteoarthritis, Knee.
Browse Osteoarthritis, Knee studies →Khyber Medical University Peshawar is the lead sponsor of 53 studies on the registry; 12 are open to participants now.
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Exclusion Criteria:
Participants in this group will receive Mulligan Mobilization combined with Conventional Physical Therapy. Mulligan Mobilization includes medial and lateral tibial glides using a Mulligan belt. Each session will consist of 3 sets of 10 repetitions, administered 5 days a week for 3 weeks. In addition, patients will undergo standard conventional physical therapy exercises such as quadriceps strengthening, straight leg raising, and stretching exercises. Each treatment session will last 30 minutes.
Procedure: Mulligan Mobilization
Participants in this group will receive Muscle Energy Technique (MET) targeting the hamstring muscles, in combination with Conventional Physical Therapy. The MET will follow a post-isometric relaxation approach, using both direct and indirect methods depending on patient condition. Each isometric contraction will be held for 10 seconds, followed by a 20-second stretch, repeated for 3 sets. Therapy will be conducted 5 days a week over a 3-week period. Each session will last 30 minutes. The same conventional physical therapy regimen as the intervention group will be applied.
Procedure: Muscle Energy Technique (MET)
Mulligan Mobilization involves manual tibial glides (medial and lateral) using a mobilization belt. The patient lies supine with the knee flexed between 30°-45°. The therapist applies a sustained glide while the patient actively moves the knee into flexion and extension. The treatment is delivered in 3 sets of 10 repetitions per session, 5 days per week for 3 weeks, along with a conventional physical therapy protocol.
Muscle Energy Technique involves the application of post-isometric relaxation targeting hamstring muscles. The therapist applies a 10-second isometric contraction at the resistance barrier, followed by a 20-second passive stretch, progressing into a new range of motion. This technique is applied 3 times per session, 5 days per week for 3 weeks, in combination with a conventional physical therapy protocol.
Hamstring Flexibility Measured by Goniometer
Hamstring range of motion (ROM) will be assessed using a goniometer before and after the intervention. The change in ROM will be used to evaluate effectiveness. Outcome improvement categories: Mild Increase: 5-10 degrees Moderate Increase: 10-15 degrees Marked Increase: \>15 degrees
Time frame: Baseline (Day 1) and Post-treatment (End of Week 3)
Change in Pain Score Using Knee Osteoarthritis Outcome Score-12 questionnaire Questionnaire
The function in daily activities subscale of Knee Osteoarthritis Outcome Score-12 questionnaire will assess participants' ability to perform routine activities before and after the intervention.
Time frame: Baseline (Day 1) and Post-treatment (End of Week 3)
Change in Knee-Related Quality of Life Using Knee Osteoarthritis Outcome Score-12 questionnaire
The quality of life (QOL) subscale of KOOS-12 will evaluate the impact of osteoarthritis on participants' knee-related wellbeing pre- and post-treatment.
Time frame: Baseline (Day 1) and Post-treatment (End of Week 3)
Change in Activity of Daily Living Function Using KOOS-12
The function in daily activities subscale of KOOS-12 will assess participants' ability to perform routine activities before and after the intervention.
Time frame: Baseline (Day 1) and Post-treatment (End of Week 3)
Plan to share: Yes — The study will make individual participant data (IPD) available to other researchers after the conclusion of the study. The IPD shared will include anonymized data related to the primary and secondary outcome measures, including depression scores, biochemical markers (e.g., TNF-α, IL-6, BDNF), EEG data, and other relevant clinical and demographic data collected during the trial. The data will be de-identified to ensure participant confidentiality. The data will be shared through an approved data repository or by direct request to the study's primary investigators.
Supporting information: Study protocol, Sap, Icf
This study is completed, as verified in Jan 2026. You cannot join it, but the record below documents what was studied.
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Khyber Medical University Peshawar