Patient case (clinical description): A 47-year-old woman comes to the office complaining of pain in the calf and knee when she bends down. The pain limits her activity. Her medical history is significant for osteoarthritis, for which she uses nonsteroidal anti-inflammatory drugs (NSAIDs) for the past two years. She is living with her husband and has 3 children. She doesn't smoke but drinks alcohol occasionally. Her vital signs are normal. On physical examination, there is a small effusion in the right knee. The effusion grew a little larger and she developed a tender swelling in the popliteal fossa and calf. Both the pain and swelling worsened as she bent and straightened her knee.

Patient's own account: I'm a 47-year-old woman, married with 3 kids. I don't smoke and I drink occasionally. I went to the doctor because of pain in my calf and knee when I was bending down. This has been limiting my daily activities. I have been diagnosed with osteoarthritis for which I have taken anti-inflammatory drugs for the past 2 years. The doctor saw a small fluid buildup in my right knee. This buildup became a bit bigger and I have a swollen calf. The pain is worse when I bend and straighten my knee.

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