Chinese Tuina Therapy for Treatment of Knee Osteoarthritis
Condition: Osteoarthritis, Knee
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Knee osteoarthritis (KOA) is one of the most common musculoskeletal diseases in clinic. It
      usually occurs in middle-aged people, especially women. An estimated lifetime risk for KOA is
      approximately 40% in men and 47% in women. KOA is a chronic disease which can lead to obvious
      pain, joint stiffness, limitation of activity and even disability, with significant
      associated costs and effects on society, health systems, and individuals. Tuina therapy has
      been used and showed effectiveness and safety for pain relief and disability for the patients
      with musculoskeletal disorders for years in China. Though it is regarded that the Traditional
      Chinese medicine (TCM) Tuina therapy is similar to the modern manual therapies, the
      modalities of TCM tuina therapy are different and effect maybe equal to or more better than
      the modern manual therapy in clinic. However, little evidence exists that Tuina benefits the
      KOA. The investigators will do this in a randomized, parallel, active controlled study to
      observe whether TCM Tuina is more beneficial to KOA than the physical manual therapy, which
      has been considered an effective and standard care for KOA.
    

Detailed description: 
      Patients will be randomly allocated to one of two groups. In the Chinese Tuina group (group
      CTG), patients will receive the traditional Chinese Tuina therapy (including rolling,
      grasping, scratching, pressing, acupressure or pushing) on the basis of KOA health education
      and home-exercise. Patients in the Physical Manual group (group PMG) will receive the modern
      physical manual therapy (including joint mobilization/manipulation, manual traction, soft
      tissue manipulations, passive stretching, range of motion and strength training) on the basis
      of KOA health education and home-exercise. Assessments will be conducted at baseline and 4
      and 16 weeks after randomization.

      It is expected that the interventions will alleviate the sufferings of the patient. The risks
      of participation are minimal. Occasionally, tuina can make people feel nauseous or experience
      a temporary increase in pain either during or after treatment. Rare side effects happen
      during and after Tuina or manual treatment.
    

Intervention name(s): Chinese Tuina therapy; Physical Manual therapy
Intervention type(s): Other; Other
Intervention description(s): The doctor presses the affected lower limb from the anterior superior iliac spine to the ankle;
The doctor gives the pressure on the Biguan(ST31), Futu(ST32), Heding(EX-LE2), Neixiyan(EX-LE4), Waixiyan(Dubi, ST35), Zusanli(ST36) and Sanyinjiao(SP6) of the affected lower limb;
Massage the spleen and stomach meridians of the affected lower extremes;
Roll the soft tissues around the affected knee;
Relax the gastrocnalis muscle
The doctor gives the pressure on the Xuehai(SP10), Liangqiu(ST34), Neixifeng(medial patellofemoral ligament), Waixifeng(lateral patellofemoral ligament), Neixiyan(EX-LE4) and Waixiyan(Dubi, ST35) at the same time;
Push the patella and do the passive movement of the affected knee;
Strength training of the affected knee.
This group receives 8 treatments over a 3 week period with a one week follow-up on site and a 3 month follow-up by mail, phone or email.; Manual therapy: Stretching the knee joint, stretching the knee joint with valgus or abduction, stretching the knee joint with varus or adduction is suitable for patients with knee flexion and extension difficulty.Patellar manipulation by bending the knee 5-10 degrees downward is suitable for patients with patellar sliding difficulty.The lower end of the muscle length manipulation is suitable for patients with muscle tension and soft tissue tension.Soft tissue loosening is performed in the suprapatellar and peripatellar regions, medial and lateral capsule joints, and popliteal fossa.
Activity training: Mainly about the knee joint flexion and extension movement training.
Strength training: Mainly about quadriceps muscle resistance exercises
This group receives 8 treatments over a 3 week period with a one week follow-up on site and a 3 month follow-up by mail, phone or email.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two arms recruit and evaluate the participants at the same time, and the included participants have the equal opportunity to either the Chinese Tuina or physical manual therapy groups.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Arthritis; Massage; Tuina; Traditional Chinese medicine; Physical therapy; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; manual therapy