Clinical Validation of Pain Management Manipulative Therapy for Knee Osteoarthritis With the Squeeze-Hold Technique: A Case Series

Abstract

Objective: The purpose of this case series was to describe the short-term and long-term clinical effects of a manual technique for treating osteoarthritis (OA) knee pain. Methods: This study measured of the immediate effect and long-term effect by using a case series of different groups of subjects. Knee OA and activity restriction in patients were evaluated by using the Kellgren-Lawrence (K/L) Grading Scale and the Japanese Knee Osteoarthritis Measure (JKOM) index. In the intervention, lower limb muscles were squeezed by hand for 20 seconds. Each squeeze was performed for both lower limbs. Passive range-of-motion (ROM) exercise was performed on the knee joint. In one set of cases, immediate effects were measured after a one-time treatment with pretreatment and posttreatment outcome measures. Eleven people with knee OA participated in the study. On a visual analogue scale (VAS) for pain, muscle stiffness, and muscular hemodynamics for estimation of muscle blood flow were recorded before and after the squeeze-hold treatment. In another set of cases, the treatment was given to all patients once a week for 6 months, and long-term effects were measured. Data on 5 subjects with knee OA were collected for 6 months after initial treatment. The VAS for pain and JKOM were recorded every month for 6 months. Results: For immediate effects, the VAS was 69 ± 21 mm before treatment and 26 ± 22 mm after treatment. Muscle stiffness was 8.8 ± 3.6 (absolute number) before treatment and 3.5 ± 2.1 after treatment. Tissue (muscle) oxygen saturation was 60.1 ± 5.7% before treatment and 65.3 ± 4.8% after treatment. Total hemoglobin was 24.3 ± 3.3 (absolute number) before treatment and 25 ± 2.3 after treatment. A tendency for reduction in OA knee pain and muscle stiffness was observed, and a tendency for increase was observed in the blood flow in the muscle. For long-term effects in all 5 participants (any K/L grade, any JKOM score), OA knee pain and JKOM score improved gradually through 6 months. Conclusions: The participants in this case series showed improvement in pain and function. These findings indicate the feasibility of a larger study on the squeeze-hold intervention for OA knee pain. (J Chiropr Med 2017;16:122-130)

Understanding tightened muscle in knee osteoarthritis and the impacts of Fu’s subcutaneous needling: A pilot trial with shear-wave elastography and near-infrared spectroscopy

“…In line with our hypothesis, Chiu et al [10] validated FSN effectiveness in reducing skeletal muscle hardness around the knee and alleviating knee pain, Nakajima [11,12] demonstrated that increasing blood flow and reducing stiffness in lower limb muscles could relieve knee pain. Building on this, considering the physiological heterogeneity in individual muscles, a self-controlled before-and-after study design with unilateral knee osteoarthritis (KOA) patients was deemed most suitable for our small-sample exploratory pilot trial.…”

Sustained Compression with a Pneumatic Cuff on Skeletal Muscles Promotes Muscle Blood Flow and Relieves Muscle Stiffness

“…Even after 10 min of opening, StO 2 remained higher than at rest at 74.3 ± 5.5%. In Nakajima's manual compression therapy, StO 2 at rest was 60.1 ± 5.7%, and after the intervention, StO 2 was 65.3 ± 4.8%-an increase of about 10% [6]. Intervention with the pneumatic cuff is thought to have the same level of effect on promoting muscle blood flow as manual compression therapy by Nakajima.…”

“…This method involves manually applying pressure to the muscle and holding it there for a period of time. Nakajima reported that when this new method was applied to patients with OA of the knee, it promoted muscle blood flow and provided excellent pain relief [6]. On the other hand, Knee OA affects a large number of people [7].…”

Association Between Pain in Knee Osteoarthritis and Mechanical Properties of Soft Tissue Around Knee Joint

“…Specifically, Young's modulus of the QT in the AS pain group was significantly increased; Young's modulus of the PT in the AI pain group was significantly increased; Young's modulus of the MCL in the ME pain group was significantly increased; and Young's modulus of the LPR in the LA pain group were significantly increased in patients. In addition, Nakajima used a manipulative therapy to treat knee OA by squeezing the lower limb muscles by hand, and found that the pain can be effectively alleviated by changing the mechanical properties of muscles [39]. The results obtained in this study will provide better guidance and help for follow-up knee pain relief and more targeted rehabilitation treatment.…”