Knee OsteoarthritisNCT06954363
Effectiveness of Muscle Energy Techniques and Mulligan Mobilization Along With Conventional Physical Therapy in Knee Joint Osteoarthritis Patients
A study testing Mulligan Mobilization and Muscle Energy Technique (MET) in people with Knee Osteoarthritis, run by Khyber Medical University Peshawar at 3 sites in Pakistan.
Trial summary
This study aims to evaluate the effectiveness of integrating Muscle Energy Technique (MET) and Mulligan Mobilization with conventional physical therapy in the management of knee osteoarthritis (OA), with a specific focus on improving hamstring flexibility and reducing functional limitations. Read more about this study
- Who is it for?
- Ages 40 years and older
- Conditions the study is for
- Knee Osteoarthritis
- What is being tested?
- Mulligan Mobilization and Muscle Energy Technique (MET)
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 24 participants
- Where
- 3 sitesPakistan
- Study dates
- 1 Apr 2025to 28 Nov 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 40 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Diagnosed cases of osteoarthritis (Grade 1 to 3)
- X-ray showing Grades I to III on Kellgren Lawrence scale of Osteoarthritis.
- Residents of Peshawar verified via NADRA CNIC
- Both genders will be included with unilateral or bilateral knee involvement.
- Age group 40 and above.
- Duration of Knee pain for more than 3 months.
Who cannot join
- History of any previously known neurological conditions i.e. stroke, peripheral neuropathy
- Fractures in treatment limb.
- Suspicious of malignancy around the knee joint.
- Recent under gone surgery
- Recent Intra-articular injection.
- Significant comorbid diseases and disabilities are excluded from the study
Trial locations and contacts
3 sites in 1 country.
Pakistan3 sites
Hayatabad Medical Complex Peshawar
Peshawar, KPK, 25000
Alkhidmat Hospital Peshawar
Peshawar, KPK
Bibi Zahida Memorial Hospital, NCS University System
Peshawar, KPK
About this study
Official title: Effectiveness of Muscle Energy Techniques and Mulligan Mobilization Along With Conventional Physical Therapy in Knee Joint Osteoarthritis Patients: A Randomized Controlled Trial
This study aims to evaluate the effectiveness of integrating Muscle Energy Technique (MET) and Mulligan Mobilization with conventional physical therapy in the management of knee osteoarthritis (OA), with a specific focus on improving hamstring flexibility and reducing functional limitations. The findings will help inform clinical decision-making and enhance patient outcomes in OA rehabilitation.
Read the detailed description
Osteoarthritis (OA) is a progressive degenerative joint disease characterized by the destruction of articular cartilage and the formation of bone spurs, leading to pain, joint stiffness, and decreased functional mobility. While its exact cause remains unknown, factors such as age, sex, obesity, sedentary lifestyle, genetics, bone density, smoking, and joint location contribute significantly to its development. As patients experience pain and reduced joint mobility, they often limit movement, particularly of the knee, resulting in muscular tightness-most notably in the hamstring, a two-joint muscle.
Globally, OA is a major public health concern, with knee OA affecting approximately 250 million people in 2010, including 18% of women and 9.6% of men over 60. It has substantial economic impacts, such as costing the United States 1-2.5% of its GDP and Spain €4.7 billion in 2007. Regional data from South Asia show higher prevalence in rural populations, emphasizing the disease's widespread burden.
Physical therapy has been shown to be highly effective in managing knee OA symptoms. Several randomized controlled trials support the use of techniques like Muscle Energy Technique (MET) and Mulligan Mobilization. MET has demonstrated superior efficacy compared to static stretching and whole-body vibration in improving hamstring flexibility and reducing stiffness. Similarly, Mulligan Mobilization, particularly when combined with supervised exercises, has shown better outcomes than Maitland mobilization in improving flexibility and function in OA patients.
However, current literature presents conflicting evidence regarding the individual efficacy of MET and Mulligan Mobilization. This study seeks to address these inconsistencies by investigating the effectiveness of integrating both MET and Mulligan Mobilization with conventional physical therapy in treating knee OA. The goal is to provide evidence-based insights that can guide clinicians in optimizing therapeutic strategies for better functional outcomes and enhanced quality of life for patients with knee osteoarthritis.
- Conditions
- Knee Osteoarthritis
- Being tested
- Mulligan Mobilization, Muscle Energy Technique (MET)
- Keywords
- Knee Osteoarthritis, Muscle Stretching Exercises, Range of Motion, Articular
- Medical subject headings
- Osteoarthritis, Knee
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mulligan MobilizationProcedure or surgery
Mulligan Mobilization involves manual tibial glides (medial and lateral) using a mobilization belt. The patient lies supine with the knee flexed between 30°-45°. The therapist applies a sustained glide while the patient actively moves the knee into flexion and extension. The treatment is delivered in 3 sets of 10 repetitions per session, 5 days per week for 3 weeks, along with a conventional physical therapy protocol.
Muscle Energy Technique (MET)Procedure or surgery
Muscle Energy Technique involves the application of post-isometric relaxation targeting hamstring muscles. The therapist applies a 10-second isometric contraction at the resistance barrier, followed by a 20-second passive stretch, progressing into a new range of motion. This technique is applied 3 times per session, 5 days per week for 3 weeks, in combination with a conventional physical therapy protocol.
| Study group | Role | What they receive |
|---|---|---|
| Intervention Group | Experimental | Participants in this group will receive Mulligan Mobilization combined with Conventional Physical Therapy. Mulligan Mobilization includes medial and lateral tibial glides using a Mulligan belt. Each session will consist of 3 sets of 10 repetitions, administered 5 days a week for 3 weeks. In addition, patients will undergo standard conventional physical therapy exercises such as quadriceps strengthening, straight leg raising, and stretching exercises. Each treatment session will last 30 minutes. Receives: Procedure: Mulligan Mobilization |
| Control Group | Active comparator | Participants in this group will receive Muscle Energy Technique (MET) targeting the hamstring muscles, in combination with Conventional Physical Therapy. The MET will follow a post-isometric relaxation approach, using both direct and indirect methods depending on patient condition. Each isometric contraction will be held for 10 seconds, followed by a 20-second stretch, repeated for 3 sets. Therapy will be conducted 5 days a week over a 3-week period. Each session will last 30 minutes. The same conventional physical therapy regimen as the intervention group will be applied. Receives: Procedure: Muscle Energy Technique (MET) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Hamstring Flexibility Measured by Goniometer
Hamstring range of motion (ROM) will be assessed using a goniometer before and after the intervention. The change in ROM will be used to evaluate effectiveness. Outcome improvement categories:
Mild Increase: 5-10 degrees
Moderate Increase: 10-15 degrees
Marked Increase: >15 degrees
Measured: Baseline (Day 1) and Post-treatment (End of Week 3)
Change in Pain Score Using Knee Osteoarthritis Outcome Score-12 questionnaire Questionnaire
The function in daily activities subscale of Knee Osteoarthritis Outcome Score-12 questionnaire will assess participants' ability to perform routine activities before and after the intervention.
Measured: Baseline (Day 1) and Post-treatment (End of Week 3)
Change in Knee-Related Quality of Life Using Knee Osteoarthritis Outcome Score-12 questionnaire
The quality of life (QOL) subscale of KOOS-12 will evaluate the impact of osteoarthritis on participants' knee-related wellbeing pre- and post-treatment.
Measured: Baseline (Day 1) and Post-treatment (End of Week 3)
Change in Activity of Daily Living Function Using KOOS-12
The function in daily activities subscale of KOOS-12 will assess participants' ability to perform routine activities before and after the intervention.
Measured: Baseline (Day 1) and Post-treatment (End of Week 3)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 May 2025
- Study start1 Apr 2025
- Primary completion30 Oct 2025
- Study completion28 Nov 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Knee OsteoarthritisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be randomly assigned to one of two parallel treatment groups that includes experimental Group (Mulligan Mobilization + Conventional Physical Therapy) and Control Group (Muscle Energy Technique + Conventional Physical Therapy).
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 24 participants (actual)
Sponsor and investigators
- Lead sponsor
- Khyber Medical University Peshawar
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Babar Israr, MSPT, Principal investigator, Institute of Physical Medicine and Rehabilitation, Khyber Medical University PeshawarShakir Ullah, PhD, Study director, Institute of Physical Medicine and Rehabilitation, Khyber Medical University PeshawarSamra Farid, MSPT, Principal investigator, Alkhidmat Hospital Peshawar
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06954363
- Sponsor's protocol ID
- KMU/DIR/CTU/2024/015
- Status last verified
- Jan 2026
- First submitted
- 24 Apr 2025
- Last updated
- 8 Jan 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: The study will make individual participant data (IPD) available to other researchers after the conclusion of the study. The IPD shared will include anonymized data related to the primary and secondary outcome measures, including depression scores, biochemical markers (e.g., TNF-α, IL-6, BDNF), EEG data, and other relevant clinical and demographic data collected during the trial. The data will be de-identified to ensure participant confidentiality. The data will be shared through an approved data repository or by direct request to the study's primary investigators.
Publications
Farazdaghi M, Kordi Yoosefinejad A, Abdollahian N, Rahimi M, Motealleh A. Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. J Bodyw Mov Ther. 2021 Jul;27:597-604. doi: 10.1016/j.jbmt.2021.04.011. Epub 2021 Apr 30.
PubMed 34391293Ceballos-Laita L, Jimenez-Del-Barrio S, Marin-Zurdo J, Moreno-Calvo A, Marin-Bone J, Albarova-Corral MI, Estebanez-de-Miguel E. Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial. Complement Ther Med. 2020 Jun;51:102443. doi: 10.1016/j.ctim.2020.102443. Epub 2020 May 18.
PubMed 32507443Ashraf F, Anwar K, Arshad H. Effects of muscle energy technique along conventional physical therapy after mesenchymal stem cell transplantation in knee osteoarthritis patients. Pak J Med Sci. 2024 Dec;40(11):2558-2564. doi: 10.12669/pjms.40.11.9605.
PubMed 39634887Goksen A, Can F, Yilmaz S, Korkusuz F. Comparison of different neuromuscular facilitation techniques and conventional physiotherapy in knee osteoarthritis. Turk J Med Sci. 2021 Dec 13;51(6):3089-3097. doi: 10.3906/sag-2101-298.
PubMed 34565133Sanchez-Romero EA, Pecos-Martin D, Calvo-Lobo C, Ochoa-Saez V, Burgos-Caballero V, Fernandez-Carnero J. Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial. Medicine (Baltimore). 2018 Jun;97(26):e11255. doi: 10.1097/MD.0000000000011255.
PubMed 29952993
Study at a glance
From the registry record, last updated by the sponsor on 8 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effectiveness of Muscle Energy Techniques and Mulligan Mobilization Along With Conventional Physical Therapy in Knee Joint Osteoarthritis Patients: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT06954363
- Acronym / sponsor ID
- KMU/DIR/CTU/2024/015
- Conditions
- Knee Osteoarthritis
- Keywords
- Knee Osteoarthritis, Muscle Stretching Exercises, Range of Motion, Articular
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 24 participants (actual)
- Lead sponsor
- Khyber Medical University PeshawarUniversity, hospital or other
- Study start
- 1 Apr 2025 (actual)
- Primary completion
- 30 Oct 2025 (actual)
- Study completion
- 28 Nov 2025 (actual)
- First posted
- 1 May 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to evaluate the effectiveness of integrating Muscle Energy Technique (MET) and Mulligan Mobilization with conventional physical therapy in the management of knee osteoarthritis (OA), with a specific focus on improving hamstring flexibility and reducing functional limitations. The findings will help inform clinical decision-making and enhance patient outcomes in OA rehabilitation.
Detailed description
Osteoarthritis (OA) is a progressive degenerative joint disease characterized by the destruction of articular cartilage and the formation of bone spurs, leading to pain, joint stiffness, and decreased functional mobility. While its exact cause remains unknown, factors such as age, sex, obesity, sedentary lifestyle, genetics, bone density, smoking, and joint location contribute significantly to its development. As patients experience pain and reduced joint mobility, they often limit movement, particularly of the knee, resulting in muscular tightness-most notably in the hamstring, a two-joint muscle.
Globally, OA is a major public health concern, with knee OA affecting approximately 250 million people in 2010, including 18% of women and 9.6% of men over 60. It has substantial economic impacts, such as costing the United States 1-2.5% of its GDP and Spain €4.7 billion in 2007. Regional data from South Asia show higher prevalence in rural populations, emphasizing the disease's widespread burden.
Physical therapy has been shown to be highly effective in managing knee OA symptoms. Several randomized controlled trials support the use of techniques like Muscle Energy Technique (MET) and Mulligan Mobilization. MET has demonstrated superior efficacy compared to static stretching and whole-body vibration in improving hamstring flexibility and reducing stiffness. Similarly, Mulligan Mobilization, particularly when combined with supervised exercises, has shown better outcomes than Maitland mobilization in improving flexibility and function in OA patients.
However, current literature presents conflicting evidence regarding the individual efficacy of MET and Mulligan Mobilization. This study seeks to address these inconsistencies by investigating the effectiveness of integrating both MET and Mulligan Mobilization with conventional physical therapy in treating knee OA. The goal is to provide evidence-based insights that can guide clinicians in optimizing therapeutic strategies for better functional outcomes and enhanced quality of life for patients with knee osteoarthritis.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
- Model description
- Participants will be randomly assigned to one of two parallel treatment groups that includes experimental Group (Mulligan Mobilization + Conventional Physical Therapy) and Control Group (Muscle Energy Technique + Conventional Physical Therapy).
| Arm | Type | Receives |
|---|---|---|
| Intervention Group | Experimental | Procedure: Mulligan MobilizationParticipants in this group will receive Mulligan Mobilization combined with Conventional Physical Therapy. Mulligan Mobilization includes medial and lateral tibial glides using a Mulligan belt. Each session will consist of 3 sets of 10 repetitions, administered 5 days a week for 3 weeks. In addition, patients will undergo standard conventional physical therapy exercises such as quadriceps strengthening, straight leg raising, and stretching exercises. Each treatment session will last 30 minutes. |
| Control Group | Active comparator | Procedure: Muscle Energy Technique (MET)Participants in this group will receive Muscle Energy Technique (MET) targeting the hamstring muscles, in combination with Conventional Physical Therapy. The MET will follow a post-isometric relaxation approach, using both direct and indirect methods depending on patient condition. Each isometric contraction will be held for 10 seconds, followed by a 20-second stretch, repeated for 3 sets. Therapy will be conducted 5 days a week over a 3-week period. Each session will last 30 minutes. The same conventional physical therapy regimen as the intervention group will be applied. |
Who may qualify
- Ages
- 40 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- Diagnosed cases of osteoarthritis (Grade 1 to 3)
- X-ray showing Grades I to III on Kellgren Lawrence scale of Osteoarthritis.
- Residents of Peshawar verified via NADRA CNIC
- Both genders will be included with unilateral or bilateral knee involvement.
- Age group 40 and above.
Key exclusion criteria (6 listed)
- History of any previously known neurological conditions i.e. stroke, peripheral neuropathy
- Fractures in treatment limb.
- Suspicious of malignancy around the knee joint.
- Recent under gone surgery
- Recent Intra-articular injection.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mulligan MobilizationMulligan Mobilization involves manual tibial glides (medial and lateral) using a mobilization belt. The patient lies supine with the knee flexed between 30°-45°. The therapist applies a sustained glide while the patient actively moves the knee into flexion and extension. The treatment is delivered in 3 sets of 10 repetitions per session, 5 days per week for 3 weeks, along with a conventional physical therapy protocol. | Procedure or surgery | Intervention Group |
| Muscle Energy Technique (MET)Muscle Energy Technique involves the application of post-isometric relaxation targeting hamstring muscles. The therapist applies a 10-second isometric contraction at the resistance barrier, followed by a 20-second passive stretch, progressing into a new range of motion. This technique is applied 3 times per session, 5 days per week for 3 weeks, in combination with a conventional physical therapy protocol. | Procedure or surgery | Control Group |
Primary outcome
Hamstring Flexibility Measured by Goniometer
Time frame: Baseline (Day 1) and Post-treatment (End of Week 3)
Hamstring range of motion (ROM) will be assessed using a goniometer before and after the intervention. The change in ROM will be used to evaluate effectiveness. Outcome improvement categories: Mild Increase: 5-10 degrees Moderate Increase: 10-15 degrees Marked Increase: >15 degrees
Change in Pain Score Using Knee Osteoarthritis Outcome Score-12 questionnaire Questionnaire
Time frame: Baseline (Day 1) and Post-treatment (End of Week 3)
The function in daily activities subscale of Knee Osteoarthritis Outcome Score-12 questionnaire will assess participants' ability to perform routine activities before and after the intervention.
Change in Knee-Related Quality of Life Using Knee Osteoarthritis Outcome Score-12 questionnaire
Time frame: Baseline (Day 1) and Post-treatment (End of Week 3)
The quality of life (QOL) subscale of KOOS-12 will evaluate the impact of osteoarthritis on participants' knee-related wellbeing pre- and post-treatment.
Change in Activity of Daily Living Function Using KOOS-12
Time frame: Baseline (Day 1) and Post-treatment (End of Week 3)
The function in daily activities subscale of KOOS-12 will assess participants' ability to perform routine activities before and after the intervention.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Jan 2026.
- Background: PubMed 34391293Farazdaghi M, Kordi Yoosefinejad A, Abdollahian N, Rahimi M, Motealleh A. Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. J Bodyw Mov Ther. 2021 Jul;27:597-604. doi: 10.1016/j.jbmt.2021.04.011. Epub 2021 Apr 30.
- Background: PubMed 32507443Ceballos-Laita L, Jimenez-Del-Barrio S, Marin-Zurdo J, Moreno-Calvo A, Marin-Bone J, Albarova-Corral MI, Estebanez-de-Miguel E. Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial. Complement Ther Med. 2020 Jun;51:102443. doi: 10.1016/j.ctim.2020.102443. Epub 2020 May 18.
- Background: PubMed 39634887Ashraf F, Anwar K, Arshad H. Effects of muscle energy technique along conventional physical therapy after mesenchymal stem cell transplantation in knee osteoarthritis patients. Pak J Med Sci. 2024 Dec;40(11):2558-2564. doi: 10.12669/pjms.40.11.9605.
- Background: PubMed 34565133Goksen A, Can F, Yilmaz S, Korkusuz F. Comparison of different neuromuscular facilitation techniques and conventional physiotherapy in knee osteoarthritis. Turk J Med Sci. 2021 Dec 13;51(6):3089-3097. doi: 10.3906/sag-2101-298.
- Background: PubMed 29952993Sanchez-Romero EA, Pecos-Martin D, Calvo-Lobo C, Ochoa-Saez V, Burgos-Caballero V, Fernandez-Carnero J. Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial. Medicine (Baltimore). 2018 Jun;97(26):e11255. doi: 10.1097/MD.0000000000011255.
- Individual participant dataSharing planned: Yes. The study will make individual participant data (IPD) available to other researchers after the conclusion of the study. The IPD shared will include anonymized data related to the primary and secondary outcome measures, including depression scores, biochemical markers (e.g., TNF-α, IL-6, BDNF), EEG data, and other relevant clinical and demographic data collected during the trial. The data will be de-identified to ensure participant confidentiality. The data will be shared through an approved data repository or by direct request to the study's primary investigators.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Babar Israr, MSPT principal investigator
Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar
Shakir Ullah, PhD study director
Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar
Samra Farid, MSPT principal investigator
Alkhidmat Hospital Peshawar
3 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mulligan Mobilization and Muscle Energy Technique (MET) in people with Knee Osteoarthritis, run by Khyber Medical University Peshawar at 3 sites in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 8 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 3 sites in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Hamstring Flexibility Measured by Goniometer (time frame: Baseline (Day 1) and Post-treatment (End of Week 3)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06954363, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Jan 2026.