National Journal of Multidisciplinary Research and Development 87 National Journal of Multidisciplinary Research and Development ISSN: 2455-9040 Impact Factor: RJIF 5.22 www.nationaljournals.com Volume 3; Issue 1; January 2018; Page No. 87-93 The effect of manual physical therapy and perturbation exercises on balance in knee osteoarthritis 1 Rajiv Sighamoney, 2 Riya Jain, 3 Ujwal L Yeole, 4 Siddhi Tendulkar 1, 4 Assistant Professor, MPT, Dept. of Physiotherapy, Tilak Maharashtra Vidyapeeth, Pune, Maharashtra, India 2 Intern, BPT, Dept. of Physiotherapy, Tilak Maharashtra Vidyapeeth, Pune, Maharashtra, India 3 MPT, Principal & Associate Professor, Dept. of Physiotherapy, Tilak Maharashtra Vidyapeeth, Pune, Maharashtra, India Abstract Background: Osteoarthritis has long been considered a “wear and tear” disease leading to loss of cartilage. Osteoarthritis of the knee is the most common form of arthritis and leads to more activity limitations than any other disease, especially in the elderly. Recently, impaired proprioceptive accuracy of the knee has been proposed as a local factor in the onset and progression of radiographic knee OA. Subjects: 30 subjects with diagnosed cases of OA Knee above 38 years. Both males and females were included. Method: Out of 30 participants 15 were in group A which received Manual physical therapy and 15 in group B which received Manual physical therapy along with perturbation exercises. The intervention protocol was carried for 3 weeks – 3 days per week. Initially step up test was recorded for balance evaluation. KOOS was taken as outcome measure. After the intervention again step up test was evaluated for Balance evaluation. Result: When manual physical therapy and manual physical therapy along with perturbation exercises were compared, manual physical therapy along with perturbation exercises showed greater improvement on all the outcome measures. For manual physical therapy along with perturbation exercises improved from–Pain 29.38+-9.03 to 33.45+-8.98, Symptoms 34.35+-9.06 to 38.34+- 9.11, ADLs 28.25+-8.79 to 32.17+-8.74, Sports and recreation function 12.09+-7.57 to 17.20+-6.76,Knee related QOL 27.48+- 8.90 to 31.82+-8.88. Perturbation exercises also showed significant improvement in balance on step up test which improved from 6.67+-3.81 to 10.27+-3.28. Conclusion: Addition of Perturbation exercises to Manual Physical Therapy shows greater improvement in OA Knee patients. Perturbation Exercises do improve balance in patients with OA Knee. Keywords: manual physical therapy, perturbation exercises, KOOS, step up test, range of motion Introduction Osteoarthritis (OA) has long been considered a “wear and tear” disease leading to loss of cartilage. Osteoarthritis (OA) of the knee is the most common form of arthritis and leads to more activity limitations (e.g., disability in walking and stair climbing) than any other disease, especially in the elderly [1] . At the knee-a key weight bearing joint required for walking, stair climbing, and sitting, and a joint commonly affected by osteoarthritis either on one side or both [10] . Recently, impaired proprioceptive accuracy of the knee has been proposed as a local factor in the onset and progression of radiographic knee OA (ROA). Additionally, proprioceptive impairments could be a cause of knee pain or activity limitations in knee OA patients [1] . It is a common cause of pain and disability, especially in the elderly [10] . Common signs and symptoms of knee OA include knee pain, tenderness, joint stiffness and decreased muscle strength. In addition, individual with knee OA often exhibit poor neuromuscular control, slower walking speed, decreased functional ability and increased susceptibility to fall [7] . Knee Proprioception There is no single accepted definition of proprioception. It is mostly defined as a conscious and/or unconscious perception of position and movement of an extremity or a joint in space. Knee proprioception derives from the integration of afferent signals from proprioceptive receptors in different structures of the knee and is also influenced by signals from outside the knee (e.g., from the vestibular organs, visual system, and cutaneous and proprioceptive receptors from other body parts). Muscle spindles are thought to be the most important proprioceptive receptors of the knee [1] . Proprioception encompasses the senses of joint position and joint motion. These senses originate from the stimulation of specialized nerve-endings or mechanoreceptors in the joint capsule and ligaments. Three presumed functions of knee proprioception have been described in the literature. Firstly, it is hypothesized that proprioceptive information is used to protect the knee against excessive and possible injurious movements via reflex responses. Secondly, proprioceptive accuracy of the knee is supposed to be needed to stabilize the knee during static posture. Thirdly, it is hypothesized that knee proprioception is important in coordinating complex movement systems and precise knee joint motions [1] . Perturbation training may be valuable, it can increase pain and inflammation when performed in the standing position. Perturbation exercise prescription in a seated position.