Manual therapy improves pain and walking function in geriatric knee osteoarthritis via proprioceptive mediation

Front Pain Res (Lausanne). 2026 Feb 26;7:1749582. doi: 10.3389/fpain.2026.1749582. eCollection 2026.

ABSTRACT

OBJECTIVE: To evaluate the therapeutic effects of manual therapy (MT) on pain, walking function, proprioception, and lower-limb muscle strength in geriatric patients with knee osteoarthritis (KOA), and to explore potential biomechanical mechanisms.

METHODS: In this prospective non-randomized controlled trial, 25 geriatric participants with unilateral mild-to-moderate KOA (intervention group) and 25 matched healthy controls were enrolled. The intervention group underwent a 4-week MT, while the control group received no intervention. The primary outcome was change in Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain subscale score. Secondary outcomes included 6-minute walk test (6-MWT) distance, proprioceptive force sense (PFS), and maximal isometric lower-limb strength. Causal mediation analysis was employed to investigate mechanistic pathways linking pain modulation to functional recovery.

RESULTS: Following MT intervention, the intervention group demonstrated significant reductions in WOMAC pain scores (13.04 ± 4.39 vs. 5.36 ± 2.40; P < 0.001), increased 6-MWT distance [320.44 m [95% CI: 283.68-357.20] vs. 612.28 m [95% CI: 594.42-630.14]; P < 0.001], and diminished inter limb asymmetry in PFS (54.52 ± 19.35 N vs. 15.92 ± 11.00 N; P < 0.05). Mediation analysis revealed that restoration of proprioceptive sensitivity accounted for 69.59% of the total effect through which pain reduction enhanced ambulatory capacity. Muscle strength profiling further indicated that functional improvement was potentially mediated by neuromuscular rebalancing of bilateral agonist-antagonist coordination.

CONCLUSION: MT delivers significant short-term clinical benefits for elderly patients with unilateral mild-to-moderate KOA (Kellgren-Lawrence grades 0-2), including effective pain relief and improved walking ability, potentially through restoring proprioceptive sensitivity and modulating intermuscular balance.

PMID:41835222 | PMC:PMC12979429 | DOI:10.3389/fpain.2026.1749582