Manual Therapy Versus Exercise Therapy in Patients with Osteoarthritis of Knee -A Comparative Study
Authors: - YADA ALEKHYA , - P HARISH KUMAR , - K MADHAVI , - A S BEENA 
Published: June 2024

AIM OF THE STUDY:
The aim of the study to compare the effectiveness of manual therapy versus exercise therapy in patients with knee osteoarthritis in terms of decreasing pain
HYPOTHESIS
•	Null Hypothesis: There may be no significant difference in the effectiveness of manual therapy and exercise therapy in patients with knee osteoarthritis
•	Alternate Hypothesis: There may be significant difference in the effectiveness of manual therapy and exercise therapy in patients with knee osteoarthritis
INTERVENTION
Group A: MANUAL THERAPY
Manual physiotherapy protocol consisted of
Treatment is done for two sessions per week for four weeks. Knee
Mandatory interventions:

1.	Knee flexion, non-thrust Antero-posterior directed force to the tibia,
2.	Tibio-femoral joint ,non-thrust
3.	Knee extension, non-thrust Postero-anterior directed force to the tibia
4.	Tibio-femoral joint, non-thrust
5.	Patellar gliding force, non-thrust
6.	Manual stretch to quadriceps, hamstring, triceps surae muscle groups

7.	Soft tissue manipulation ,quadriceps and Peripatellar connective tissue, hamstring, hip adductor and triceps surae muscles groups
Treatment is done for two sessions per week for four weeks.
Group B: EXERCISE THERAPY
This group performed a closely supervised standardized knee exercise program at twice a week for four weeks at eight treatment sessions. This program consists of active range of motion exercise for knee, muscle strengthening exercise for hip and knee, muscle stretching for lower limbs and riding a stationary bike.
Aerobic exercises
•	Up to 10 minutes stationary bicycle or walk.
Stretching exercises:
•	Standing calf stretch – 3 repetitions with 30 sec hold
•	Supine hamstring stretch -3 repetitions with 30 sec hold
•	Prone quadriceps stretch –3 repetitions with 30 sec hold Range of motion exercises:
•	In long sitting position,
•	Knee mid flexion to end range extension – two 30 sec bouts with 3 sec hold at end range
•	In long sitting position, knee mid flexion to end range flexion – two sec bouts with 3 sec hold at end range
Strengthening exercises:
•	Static quad sets in knee extension –one set of 10 repetitions with 6 sec hold,10 sec rest between repetitions.
•	Short arc terminal extension exercises for the knee joint.
•	Quadriceps non-weight bearing progressive resistance exercises with weighted cuffs.
•	Supine Straight Leg Rise (SLR)

Neuro muscular control exercises:

Closed chain progression:
•	Seated leg press – one 30 sec bout
•	Standing weight –shifting exercises
•	Side- stepping
•	Step ups
•	Forward-backward and shuttle – walking drills
RESULTS:
Knee function of all patients increased significantly after the 4-week intervention program in both the groups of MANUAL THERAPY and EXERCISE THERAPY but Group A Manual therapy improved more significantly when compared to Group B Exercise therapy.
CONCLUSION:
Treatment effect was more in the patients received Manual therapy when compared to Exercise therapy. This finding suggest that Manual therapy can be useful intervention supplement in patients with osteoarthritis of knee.