Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: Comparing Manipulation, Rehabilitation and Combination of the Two in the Treatment of Knee Osteoarthritis

Eligibility criteria:
Inclusion Criteria:

          1. Knee pain and crepitus with active motion and morning stiffness ≤ 30 min ages ≥ 38 and
             ≤ 80

          2. Knee pain and crepitus with active motion and morning stiffness >30 minutes and boney
             enlargement ages ≥ 38 and ≤ 80

          3. Knee pain and no crepitus and boney enlargement ages ≥ 38 and ≤ 80 Note: knee x-rays
             taken in each case to determine grades (0-4) Kellgren Lawrence x-ray scale - but not
             required for diagnosis - (and if needed lumbosacral/pelvic, hip, ankle or foot x-rays
             obtained) see exclusions below)

          4. Knee pain (mild to moderate) of 1 year duration and age ≥ 38 and ≤ 80 years of age and
             able to stand and walk (see informed consent)

          5. Diagnosis of concurrent subluxation/joint dysfunction (S/JD) complex a) Diagnosis of
             S/JD will be supported throughout using the PART(S) system 6).A patient must have a
             score of ≥720 mm on the WOMAC to be included (≥30%) 7).Additionally, KOA patients, who
             are + for the Berg Balance Scale (BBS) will be monitored as a subgroup (with OLST and
             BBS) at all clinic assessments.

        Exclusion Criteria:

        Rule out: General and internal medical disorders such as significant visual disorders,
        severe vestibular disorders (i.e., Meniere's), neurological (including Alzheimer's and
        other degenerative brain and mental disorders, disease and dysfunction) peripheral sensory
        disorders (severe insulin dependent diabetes), knee and hip joint replacement on side of
        knee that is treated (case by case otherwise), RA, instability, fracture/ and severe
        osteoporosis, frank avascular necrosis with or without moderate or severe deformity, lumbar
        herniated disc and injury, severe balance and proprioception problems (i.e., inability to
        stand with and/or without marked spinal, knee or hip deformity) etc. Symptoms (moderate to
        severe) in both knees or hips (case by case), etc. Recent history of meniscal or other knee
        surgery (not less than 6 months). Severe/constant self reported knee crepitus. Severe loss
        of knee or hip ROM and or severe deformity (in valgus, varus etc) particularly with
        instability. Severe depression per Beck Depression Index. Marked or severe fear of
        chiropractic adjustments/manipulative and or exercise procedures. Breaks for treatment
        longer than 3-4 weeks depending on each circumstance or merit may be construed as
        non-compliance and may be excluded.

        -
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 38 Years old.
Subject must be at most 80 Years

Eligibility (NLI label): Entailment