title: Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee.
abstract: METHODS
  An experimental laboratory study with a repeated-measures crossover design.
  
  
  BACKGROUND
  Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways. Impaired conditioned pain modulation (CPM) has been found experimentally in persons with knee and hip osteoarthritis, indicating impaired inhibition of central nociceptive pathways. We hypothesized increased effectiveness of CPM following application of joint mobilization, determined via measures of deep tissue hyperalgesia.
  
  
  OBJECTIVE
  To examine the effect of joint mobilization on impaired CPM.
  
  
  METHODS
  An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 (73%) with impaired CPM. The subjects were randomized to receive 6 minutes of knee joint mobilization (intervention) or manual cutaneous input only, 1 week apart. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline, postintervention, and post-CPM testing. Further, vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing.
  
  
  RESULTS
  Joint mobilization, but not cutaneous input intervention, resulted in a global increase in pressure pain threshold, indicated by diminished hyperalgesic responses to pressure stimulus. Further, CPM was significantly enhanced following joint mobilization. Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention, but not at the contralateral knee. Resting pain was also significantly lower following the joint intervention.
  
  
  CONCLUSIONS
  Conditioned pain modulation was enhanced following joint mobilization, demonstrated by a global decrease in deep tissue pressure sensitivity. Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Courtney
authors.forename: Alana D
authors.initials: AD
authors.lastname: Steffen
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Chmell
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications*; D026741:Physical Therapy Modalities
keywords: arthralgia; diffuse noxious inhibitory control; manual therapy; physical therapy techniques