Therapeutic Utility of Mulligan Traction Straight Leg Raise Stretch and Proprioceptive Exercises in Osteoarthritis Treatment

Abstract

Background Given the increasing incidence and severity of knee osteoarthritis (OA), it is crucial to investigate and refine therapeutic approaches. Aim The objective of this study is to evaluate the effectiveness and potential synergistic effects of proprioceptive exercises combined with Mulligan traction straight leg raise (MT-SLR) in treating OA. This includes improving symptoms such as functional mobility, pain reduction, and relevant serological markers, highlighting the potential of this approach to enhance overall patient outcomes. Methods A pragmatic, community-based, parallel-group, double-blinded, randomized clinical trial was conducted from August 2023 to March 2024. A probability convenience sampling technique was used to calculate the sample size. A total of 130 pre-diagnosed OA patients were randomly assigned to three groups via the lottery method. Group A received proprioceptive exercises, group B received the MT-SLR, and group C received both proprioceptive exercises and MT-SLR. The Pain Catastrophizing Scale (PCS), Numerical Pain Rating Scale, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), erythrocyte sedimentation rate (ESR), flexion, CRP, bone electrolytes in blood (calcium, magnesium, and phosphorus), and X-rays were used to quantify pain, stiffness, functional activities, biochemical parameters, and radiographic findings at baseline and after the 24th session. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, NY, USA), with a p-value of <0.05 considered statistically significant. Results Out of the 130 participants, 126 were analyzed at the 24th session, comprising 50 males and 76 females. After 24 sessions, Group C (combined therapy) exhibited the most significant improvements across all parameters (p = 0.000), including flexion range of motion, WOMAC Pain, activities of daily living, stiffness, and PCS, outperforming both Group A (p = 0.011) and Group B (p = 0.005). Group C also demonstrated the greatest reductions in ESR (p < 0.001), CRP (p < 0.001), and IL-6 (p < 0.001), along with the highest improvements in calcium, magnesium, and phosphorus levels (p < 0.005). X-ray assessments revealed that Group C had the most notable joint space recovery, while Group B showed no changes. Conclusions In the treatment of knee OA, proprioceptive exercises have been found to be more effective than the MT-SLR stretch. Given the rising prevalence and severity of knee OA, this study emphasizes the need to explore and refine treatment strategies. The findings indicate that combining MT-SLR with proprioceptive exercises yields superior results compared to either intervention alone. The group receiving the combined therapy showed the most significant improvements across several key measures, including functional mobility, pain reduction, and relevant serological markers, highlighting the potential of this approach to enhance overall patient outcomes. The notable differences in performance between the treatment groups suggest that a more comprehensive, integrative approach to knee OA could lead to better management outcomes.

Keywords: functional activities; mulligan traction; osteoarthritis; physical therapy; proprioceptive exercises.

Figure 1. CONSORT diagram illustrating the flow of participants through each stage of the randomized trial

Figure 2. Pictorial representation of X-ray images of osteoarthritic knee joints before and after treatment in the three groups

The pre-treatment X-ray of Group A shows joint space narrowing and the presence of osteophytes, indicating joint deterioration. Post-treatment, the joint space appears normalized, and osteophytes are no longer visible, suggesting improvement. Group B’s pre-treatment X-ray also reveals osteophytes and joint space narrowing. However, the post-treatment X-ray shows persistent osteophytes and joint narrowing, indicating minimal or no effect from the treatment. Group C’s pre-treatment X-ray similarly displays osteophytes and joint space narrowing, but the post-treatment X-ray shows a significant improvement, with no visible osteophytes and normalized joint space, indicating a highly significant treatment effect.