Effects of proprioceptive neuromuscular facilitation stretching in relieving pain and balancing knee loading during stepping over obstacles among older adults with knee osteoarthritis: A randomized controlled trial

Comparison of instrument-assisted soft tissue mobilization and proprioceptive neuromuscular stretching on hamstring flexibility in patients with knee osteoarthritis

Background

The association between hamstring tightness and knee osteoarthritis (KOA) is significant because tight hamstrings can put more strain on the knee joint, reduce its range of motion, and cause compensatory movements that worsen the KOA.

Objective

To compare the effects of instrument-assisted soft tissue mobilization (IASTM) and proprioceptive neuromuscular (PNF) on hamstring flexibility in patients with KOA.

Methods

Data for the randomized controlled trial (NCT05110326) was collected from n = 60 participants randomly divided into group A received IASTM and group B received PNF stretching. In group A, the therapist made 30 strokes gentle strokes with the tool from the origin to the insertion while holding the plane at a 45-degree angle over the treatment area. In group B, PNF stretching was done with three repetitions and 10 seconds rest between each, after isometric contraction of the hamstring muscle using approximately 50% of their maximum strength, holding it for 8 seconds, and then releasing it. A 30-minute session was given to each patient three times per week and was given for 6 weeks. Outcome measures were the visual analog scale (VAS) for pain intensity, the active knee extension test (AKET) for hamstring flexibility, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) for the health status of KOA patients.

Results

The study found a significant interaction (p < 0.001) between interventions and time across several measurements. After 6 weeks, both interventions resulted in significant improvements (p < 0.001) across all dependent variables, with group A (IASTM) showing more significant improvement in hamstring flexibility, pain reduction, and health status (p < 0.001) compared to group B (PNF).

Conclusions

Both the IASTM technique and PNF stretching resulted in increased hamstring flexibility, decreased pain, and enhanced general health. The IASTM technique, however, showed potential benefits over PNF stretching in terms of flexibility, pain relief, and public health enhancement. Physical therapists and manual therapists may prioritize the usage of the IASTM technique for patients who want to make significant changes in these areas.

Multidisciplinary Rehabilitation after Hyaluronic Acid Injections for Elderly with Knee, Hip, Shoulder, and Temporomandibular Joint Osteoarthritis

Osteoarthritis (OA) is a prevalent degenerative joint condition characterized by cartilage deterioration, joint inflammation, and functional limitations, particularly impacting the elderly population. Rehabilitation and hyaluronic acid (HA) injections are common therapeutic approaches routinely used in clinical practice, but their synergistic potential is far from being fully characterized. Thus, the aim of this narrative review was to elucidate the multilevel benefits and synergies of integrating these two approaches in multidisciplinary OA rehabilitation. This narrative review follows the scale for the assessment of narrative review articles (SANRA) criteria and involves a comprehensive literature search from July to August 2023. Two independent reviewers screened studies, including those involving human subjects with OA, rehabilitation strategies, and outcomes following HA injection, published in English. Results: HA injections might improve joint biomechanics, reducing friction, absorbing shocks, and potentially regulating inflammation. Rehabilitation plays a pivotal role in strengthening muscles, increasing the range of motion, and enhancing overall function. Optimizing rehabilitation following HA injection might provide additional benefits in joint health. OA management requires a multidisciplinary approach integrating HA injections, rehabilitation, and personalized care. Challenges in patient adherence and healthcare resources currently exist, but emerging technologies offer opportunities to enhance patient engagement and monitoring optimizing sustainability and outcomes of patients with knee, hip, shoulder, and temporomandibular joint OA.